Data-driven surgical duration prediction model for surgery scheduling: A case-study for a practice-feasible model in a public hospital

Healthcare Automation Award Finalist</p

Implementing and evaluating Care and Support Planning : a qualitative study of health professionals’ experiences in public polyclinics in Singapore

Funding. The PACE-D programme is funded by Singapore’s Ministry of Health. This study was funded by the Centre for Chronic Disease Prevention and Management of the National University Health System, Singapore. SM was supported by a Wellcome Trust Institutional Strategic Support Fund flexible returners award (University of Aberdeen, RG13795-18). VAE’s contribution was also supported by a Wellcome Trust Collaborative Award: This research was funded in whole, or in part, by the Wellcome Trust [209811/Z/17/Z]. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. Acknowledgements We are extremely grateful to the health professionals who took part in interviews for this study and allowed observation of their team huddles. We also thank LIM Mui Eng and ANG Shu Lin for supporting the recruitment of health professionals and arrangement of interviews, Monica ASHWINI for arranging transcription and discussion of patients’ experiences of PACE-D, Matthavi SENGUTTUVAN for contributions to early analytic discussions, Marlie FERENCZI and LOY En Yun for support with grant administration, data sharing agreements and helpful suggestions, and the Year of Care Partnerships team, especially Lindsay OLIVER and Nick LEWIS-BARNED for training health professionals and trainers in Singapore and for ongoing advice and support, including helpful comments on a draft of this manuscript.Peer reviewedPublisher PD

Airborne dispersion of droplets during coughing: a physical model of viral transmission

The Covid-19 pandemic has focused attention on airborne transmission of viruses. Using realistic air flow simulation, we model droplet dispersion from coughing and study the transmission risk related to SARS-CoV-2. Although most airborne droplets are 8-16 $\mu$m in diameter, the droplets with the highest transmission potential are, in fact, 32-40 $\mu$m. Use of face masks is therefore recommended for both personal and social protection. We found social distancing effective at reducing transmission potential across all droplet sizes. However, the presence of a human body 1 m away modifies the aerodynamics so that downstream droplet dispersion is enhanced, which has implications on safe distancing in queues. Based on median viral load, we found that an average of 0.55 viral copies is inhaled at 1 m distance per cough. Droplet evaporation results in significant reduction in droplet counts, but airborne transmission remains possible even under low humidity conditions

A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond

© 2022 Leow, Tan, Tan, Tan, Chan, Tikkinen, Kamat, Sengupta, Meng, Shariat, Roupret, Decaestecker, Vasdev, Chong, Enikeev, Giannarini, Ficarra and Teoh. This is an openaccess article distributed under the terms of the Creative Commons Attribution License (CC BY). https://creativecommons.org/licenses/by/4.0/Purpose: The COVID-19 pandemic has led to competing strains on hospital resources and healthcare personnel. Patients with newly diagnosed invasive urothelial carcinomas of bladder (UCB) upper tract (UTUC) may experience delays to definitive radical cystectomy (RC) or radical nephro-ureterectomy (RNU) respectively. We evaluate the impact of delaying definitive surgery on survival outcomes for invasive UCB and UTUC. Methods: We searched for all studies investigating delayed urologic cancer surgery in Medline and Embase up to June 2020. A systematic review and meta-analysis was performed. Results: We identified a total of 30 studies with 32,591 patients. Across 13 studies (n = 12,201), a delay from diagnosis of bladder cancer/TURBT to RC was associated with poorer overall survival (HR 1.25, 95% CI: 1.09–1.45, p = 0.002). For patients who underwent neoadjuvant chemotherapy before RC, across the 5 studies (n = 4,316 patients), a delay between neoadjuvant chemotherapy and radical cystectomy was not found to be significantly associated with overall survival (pooled HR 1.37, 95% CI: 0.96–1.94, p = 0.08). For UTUC, 6 studies (n = 4,629) found that delay between diagnosis of UTUC to RNU was associated with poorer overall survival (pooled HR 1.55, 95% CI: 1.19–2.02, p = 0.001) and cancer-specific survival (pooled HR of 2.56, 95% CI: 1.50–4.37, p = 0.001). Limitations included between-study heterogeneity, particularly in the definitions of delay cut-off periods between diagnosis to surgery. Conclusions: A delay from diagnosis of UCB or UTUC to definitive RC or RNU was associated with poorer survival outcomes. This was not the case for patients who received neoadjuvant chemotherapy.Peer reviewe

Potential medicinal herb for cardiovascular health : a comprehensive review on Salviae miltiorrhizae

Cardiovascular disease (CVD) and its associated risk factors have been ranked the number 1 cause of mortality in noncommunicable diseases worldwide and Malaysia. The high statistic in CVD mortality indicates gaps and limitations in current treatment strategies using long-term drug prescription therapies. Hence, an immediate quest for alternative and effective treatments is needed. Medicinal herbs, which are ethnopharmacologically used to treat a wide range of conditions, have been used as an alternative or supplementary treatment for CVDs and their associated risk factors. The roots of Salviae miltiorrhizae have been traditionally used for centuries to treat various diseases including neurological disorders, cancer, and even coronary heart disease. Increasing evidence demonstrated a pharmacological basis for the action of S. miltiorrhizae and its active compounds, suggesting its potential in treating CVD. The objectives of this review were first to summarize published literature and synthesize the new body of knowledge on the use of S. miltiorrhizae as the potential medicinal herb that will positively impact the cardiovascular system, and secondly to elucidate the underlying mechanisms involved in promoting cardiovascular health. It is hoped that identification of key regulatory pathways by lipophilic and hydrophilic active compounds from S. miltiorrhizae will aid further investigation of its safety and efficacy to promote the use of evidence-based traditional medicinal herbs in alleviating symptoms and improve the prognosis of CVDs and their associated risk factors

The impact of using recycled culture medium to grow Chlorella vulgaris in a sequential flow system: Evaluation on growth, carbon removal, and biochemical compositions

Excessive of carbon dioxide (CO2) emission and water pollution have been identified as the two primary challenges to humans and environment. Hence, biological carbon sequestration by microalgae is recommended as an environmentally friendly approach to capture and convert this CO2 into value-added products. However, research related to the development of efficient system to concurrently overcome low CO2 solubility in water and reduction of water footprint in microalgae cultivation is still limited in the literature. In this study, the CO2 capture by Chlorella vulgaris in a recycled cultivation medium was exploited using a sequential flow photobioreactor system. The study revealed that nutrient replenished recycled medium did not significantly affect the growth performance and lipid content of C. vulgaris. It was also observed that the CO2 capture efficiency and protein content were gradually increased from the first (SFB-RWN1) to the third (SFB-RWN3) cycle of cultivation due to the increment of carbon and nitrogen content in the microalgae cell. Besides, the lipid profile of C. vulgaris cultivated in the recycled medium comprised of high concentration of saturated (up to 32.41%) and polyunsaturated (up to 43.21%) fatty acid methyl ester (FAME). The present study suggested that growing C. vulgaris in a recycled medium is a feasible solution to fix CO2 from the atmosphere and help to reduce water footprint in the microalgae cultivation system

Inhibition of Hypoxia-Inducible Factor-1α (HIF-1α) Protein Synthesis by DNA damage inducing agents

10.1371/journal.pone.0010522PLoS ONE55

European polygenic risk score for prediction of breast cancer shows similar performance in Asian women

Abstract: Polygenic risk scores (PRS) have been shown to predict breast cancer risk in European women, but their utility in Asian women is unclear. Here we evaluate the best performing PRSs for European-ancestry women using data from 17,262 breast cancer cases and 17,695 controls of Asian ancestry from 13 case-control studies, and 10,255 Chinese women from a prospective cohort (413 incident breast cancers). Compared to women in the middle quintile of the risk distribution, women in the highest 1% of PRS distribution have a ~2.7-fold risk and women in the lowest 1% of PRS distribution has ~0.4-fold risk of developing breast cancer. There is no evidence of heterogeneity in PRS performance in Chinese, Malay and Indian women. A PRS developed for European-ancestry women is also predictive of breast cancer risk in Asian women and can help in developing risk-stratified screening programmes in Asia

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely