Coordinated budget allocation in multi-district highway agencies

Ph.DDOCTOR OF PHILOSOPH

A fast pruned‐extreme learning machine for classification problem

Agency for Science, Technology and Research (A*STAR) Science and Engineering Research Counci

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

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 < 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

Bus Ride Index – a refined approach to evaluating road surface irregularities

The road surface quality can be assessed with ride comfort indices because of their strong correlation. Many studies on ride comfort have focused on cars and trucks, but their results are not applicable to buses, which are characterised by inherently different vehicle dynamics. In this study, a quarter-vehicle simulation concept was used to develop a Bus Ride Index (BRI) for evaluating the effect of road irregularities on bus ride comfort. A BRI model was developed to optimise ride comfort depending on seat configuration and air suspension and validated according to technical data. The results show a good regression relationship between BRI and the International Roughness Index (IRI). New IRI thresholds with regard to ride comfort and bus operating speeds were established to serve as a benchmark to develop better pavement maintenance strategies for bus lanes and to estimate road quality based on acceleration data.National Research Foundation (NRF)Accepted versionThis work is a part of PhD study of the first author and financially supported by the National Research Foundation Singapore under its Campus for Research Excellence And Technological Enterprise (CREATE) programme

Case Report: Hypercalcemia as a manifestation of acute adrenal crisis precipitated by fluconazole use, and a review of the literature

Acute adrenal crisis classically presents with vomiting, altered sensorium, and hypotension. We describe a unique case manifesting with severe hypercalcemia. Addisonian crisis was unusually precipitated by fluconazole use. We reviewed other reported cases and discuss the possible mechanisms of hypercalcemia in adrenal insufficiency. This 67-year-old man presented with fever, cough, and vomiting for 1 week and with anorexia and confusion for 3 weeks. He was hypotensive and clinically dehydrated. Investigations revealed left-sided lung consolidation, acute renal failure, and severe non–parathyroid hormone (PTH)–mediated hypercalcemia (calcium, 3.55mol/L; PTH, 0.81pmol/L). Initial impression was pneumonia complicated by septic shock and hypercalcemia secondary to possible malignancy. He received mechanical ventilation; treatment with intravenous fluids, inotropes, and hydrocortisone for septic shock; and continuous renal replacement therapy with low-calcium dialysate. Although hypercalcemia resolved and he was weaned off inotropes, dialysis, and hydrocortisone, his confusion persisted. When hypercalcemia recurred on day 19 of admission, early morning cortisol was <8 nmol/L, with low ACTH level (3.2 ng/L). Other pituitary hormones were normal. Hypercalcemia resolved 3 days after reinstating stress doses of hydrocortisone, and his mentation normalized. On further questioning, he recently received fluconazole for a forearm abscess. He previously consumed traditional medications but stopped several years ago, which may have contained glucocorticoids. He was discharged on oral hydrocortisone. Cortisol levels improved gradually, and glucocorticoid replacement was ceased after 8 years, without any recurrence of hypercalcemia or Addisonian crisis. Both hypercalcemia and adrenal insufficiency may present with similar non-specific symptoms. It is important to consider adrenal insufficiency in hypercalcemia of unclear etiology

Social Frailty Is Independently Associated with Mood, Nutrition, Physical Performance, and Physical Activity: Insights from a Theory-Guided Approach

Notwithstanding the increasing body of evidence that links social determinants to health outcomes, social frailty is arguably the least explored among the various dimensions of frailty. Using available items from previous studies to derive a social frailty scale as guided by the Bunt social frailty theoretical framework, we aimed to examine the association of social frailty, independently of physical frailty, with salient outcomes of mood, nutrition, physical performance, physical activity, and life–space mobility. We studied 229 community-dwelling older adults (mean age 67.22 years; 72.6% females) who were non-frail (defined by the FRAIL criteria). Using exploratory factor analysis, the resultant 8-item Social Frailty Scale (SFS-8) yielded a three-factor structure comprising social resources, social activities and financial resource, and social need fulfilment (score range: 0–8 points). Social non-frailty (SNF), social pre-frailty (SPF), and social frailty (SF) were defined based on optimal cutoffs, with corresponding prevalence of 63.8%, 28.8%, and 7.4%, respectively. In logistic regression adjusted for significant covariates and physical frailty (Modified Fried criteria), there is an association of SPF with poor physical performance and low physical activity (odds ratio, OR range: 3.10 to 6.22), and SF with depressive symptoms, malnutrition risk, poor physical performance, and low physical activity (OR range: 3.58 to 13.97) compared to SNF. There was no significant association of SPF or SF with life–space mobility. In summary, through a theory-guided approach, our study demonstrates the independent association of social frailty with a comprehensive range of intermediary health outcomes in more robust older adults. A holistic preventative approach to frailty should include upstream interventions that target social frailty to address social gradient and inequalities