Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

Development of a fuzzy knowledge-based system for local traffic control for incident management

The primary objectives of this research include the development of a multi-stage fuzzy logic controller (MS-FLC) for local traffic control during incidents on expressways, and the development of a simulation model for the evaluation of the MS-FLC.Doctor of Philosophy (CEE

Land Transport Policy and Public Transport in Singapore

This paper reviews Singapore\u27s land transportation policy, with special emphasis on its public transportation systems. Singapore has a sophisticated and efficient system of land transport to serve a growing demand for transportation. Constrained by limited space, a comprehensive set of land transport policies has been in place to balance the growth in transport demand and the effectiveness and efficiency of the land transport system. A multi-pronged approach has been used to achieve the objective of a world-class transportation system. These include integration of urban and transport planning, expansion of the road network and improvement of the transport infrastructure, harnessing the latest technology in network and traffic management, managing vehicle ownership and usage, and improvement and regulation of public transport. Singapore was the first country in the world to introduce various new techniques, notably the area license scheme (ALS) in 1975 and the vehicle quota system in 1990. An electronic road pricing system replaced the ALS in 1998 to take the role of congestion management. In 2003, the world’s first and only fully automatic heavy rail mass rapid transit system was opened to the public. The positive effects of this comprehensive set of policies are evidenced in the level of performance achieved on Singapore road and public transportation systems

Travel demand management policies: a case study of Singapore and transferability potentials for Hanoi

This research study investigates the travel demand management (TDM) strategies and solutions and associated policies through a case study of Singapore to gain knowledge and experiences, and to evaluate the potentials for policy transfer in TDM from Singapore to Hanoi, the Capital of Vietnam. The research follows a qualitative approach that critically analyzes policies from international perspectives for lesson-drawing. The ideas generated in the literature review are reinforced by the case study of Singapore that examines relevant issues to acquire insights into policy transfer initiatives in TDM. The research identifies considerable differences between Singapore and Hanoi with respect to the development objectives, social and political settings and the governance structure of the city in general, and in transport sector in particular. The results show that there are critical political, institutional, physical and social constraints on policy transfer from Singapore to Hanoi. Given the stated critical constraints, it could be premature to conduct transfer of TDM policies from Singapore to Hanoi for the time being, but the findings from the case study have significant policy implications to Hanoi, and lesson-drawing is highly valuable and attainable. An initial screening was conducted to evaluate the applicability of policies used in Singapore as a starting point to develop a comprehensive TDM framework for Hanoi. The findings of the case study in critical contextual constraints for policy transfer should be useful in developing a roadmap for the transfer of TDM policies to a growing city like Hanoi