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Introduction: Open access to digital research output is increasing, but academic library policies can place restrictions on public access to libraries. This paper reports on a preliminary study to investigate the correlation between academic library access policies and institutional positions of openness to knowledge. Method: This primarily qualitative study used document and data analysis to examine the content of library access or use policies of twelve academic institutions in eight countries. The outcomes were statistically correlated with institutional open access publication policies and practices. Analysis: We used an automated search tool together with manual searching to retrieve Web-based library access policies, then categorised and counted the levels and conditions of public access. We compared scores for institutional library access feature with open access features and percentages of open access publications. Results: Academic library policies may suggest open public access but multi-layered user categories, privileges and fees charged can inhibit such access, with disparities in openness emerging between library policies and institutional open access policies. Conclusion: As open access publishing options and mandates expand, physical entry and access to print and electronic resources in academic libraries is contracting. This conflicts with global library and information commitments to open access to knowledge.

Lifelong learning is regarded as an important channel in promoting active engagement in later life for aging societies. While most studies depict older learners as a group resilient to engaging in lifelong learning, few have addressed the impacts of their social networks on their participation. Drawing on the nationwide lifelong learning program in Singapore, the study explores the extent older Singaporean adults' social networks influence their involvement in learning courses and illustrates how those networks matter to their motivations. A mixed methods approach consisting of two network instruments (Name Generator and Position Generator) and in-depth interviews based on 30 older Singaporeans (between 50 and 79 years old) were employed. The findings demonstrated that primary family members (spouse and children) were key discussants for older learners, but the narratives showed only children were key supporters. For female learners, husbands' support could be limited. Such a gender difference was revealed in overlap networks among couples, with male learners receiving greater positive support from their wives. Furthermore, the results showed that single or widowed learners had more non-kin members and diverse network resources, which reflect in their discourses of being highly motivated and active in spreading news of courses. To conclude, the study delivered deeper understandings of how diverse social contexts influence older learners' motivations. Future research shall continue to focus on variations of network characteristics and network resources to improve the understanding of how significant others and accessible network resources provide social support or opportunities for older learners.

Vector-borne infectious disease such as dengue fever (DF) has spread rapidly due to more suitable living environments. Considering the limited studies investigating the disease spread under climate change in South and Southeast Asia, this study aimed to project the DF transmission potential in 30 locations across four South and Southeast Asian countries. In this study, weekly DF incidence data, daily mean temperature, and rainfall data in 30 locations in Singapore, Sri Lanka, Malaysia, and Thailand from 2012 to 2020 were collected. The effects of temperature and rainfall on the time-varying reproduction number (Rt) of DF transmission were examined using generalized additive models. Projections of location-specific Rt from 2030s to 2090s were determined using projected temperature and rainfall under three Shared Socioeconomic Pathways (SSP126, SSP245, and SSP585), and the peak DF transmissibility and epidemic duration in the future were estimated. According to the results, the projected changes in the peak Rt and epidemic duration varied across locations, and the most significant change was observed under middle-to-high greenhouse gas emission scenarios. Under SSP585, the country-specific peak Rt was projected to decrease from 1.63 (95% confidence interval: 1.39–1.91), 2.60 (1.89–3.57), and 1.41 (1.22–1.64) in 2030s to 1.22 (0.98–1.51), 2.09 (1.26–3.47), and 1.37 (0.83–2.27) in 2090s in Singapore, Thailand, and Malaysia, respectively. Yet, the peak Rt in Sri Lanka changed slightly from 2030s to 2090s under SSP585. The epidemic duration in Singapore and Malaysia was projected to decline under SSP585. In conclusion, the change of peak DF transmission potential and disease outbreak duration would vary across locations, particularly under middle-to-high greenhouse gas emission scenarios. Interventions should be considered to slow down global warming as well as the potential increase in DF transmissibility in some locations of South and Southeast Asia. Author summary: Climate change has a significant impact worldwide, including the proliferation of infectious diseases in tropical areas. While the warmer and more humid living conditions in these regions are generally considered favorable for the transmission of vector-borne diseases, we argue that the effects of climate change on DF infection may vary across different locations. Unlike previous studies focusing primarily on the disease incidence, this study aims to estimate changes in peak DF transmissibility and the duration of disease epidemics in the future. By analyzing data from 30 locations in four tropical countries, we have found that changes in DF transmissibility and epidemic duration exhibit variations both within and between countries, particularly under the scenarios of moderate to high greenhouse gas emissions. In light of these findings, we recommend conducting location-specific evaluations of DF transmissibility under the influence of climate change, as well as implementing targeted interventions to mitigate the potential increase in DF transmission rates in specific tropical locations. [ABSTRACT FROM AUTHOR]

Background: Hong Kong, Macau and Singapore are the top five cities/countries with the cheapest fixed line broadband as proportion of monthly income. It is interesting to know that several decades ago, they were still among the list of developing nations, struggling for survival and relief. However, they are climbing to the top in ICT development now. Aims: This paper reviews the ICT development in school education of Hong Kong, Macau and Singapore with respect to their social, geographical, and economic backgrounds. Johannessen's three orders of benchmarks are proposed for the comparison. Method: Literature reviews on recent reports, research articles, books and internet data were used to understand the current situation of the ICT development in education for Hong Kong, Macau and Singapore. Conclusion: It is clear that these three cities' determination and relative amount that had invested in the development of ICT in education were enormous when compared with the US investment. Among these three cities, the investment of Singapore has been much larger than the other two. Singapore's apparent leading in the development of ICT in education is not an accident, especially for the first benchmarks. For the second and third benchmarks, Macau lags behind Hong Kong and Singapore, this is partially due to Macau education system is comparatively much liberal than the other two. (Contains 5 tables.)

Shadow education has been studied in areas such as comparative education, educational policy, sociology of education, education and economics, and lifelong education, but mainstream Anglophone curriculum studies have largely ignored this phenomenon. We argue that shadow education should be considered as an emerging (and significant) focus of curriculum studies worldwide and advance five approaches to studying shadow education as an object of transnational curriculum inquiry, including shadow education as historical/political text, auto/biographical text, critical text, ethnic text, and decolonising text. We argue that, because shadow education seems likely to expand, curriculum scholars should seek new understandings that might complicate and complexify both shadow education and mainstream curriculum discourses.

Background: During a nine-week teaching practice, 20 student teachers spent about 1.5 hours each week videoconferencing with one university faculty member and five student teachers from five different schools, while the other 22 student teachers did not have any videoconferences. Both groups were encouraged to make conscious effort in talking to school personnel and other student teachers about teaching practice related issues. Aims: The study examined the impact of student teachers' talk on their reported experience of student teaching and self-perceived teaching competencies. Sample: The participants were 44 student teachers who underwent a nine-week teaching practice in different primary schools. Method: The questionnaire was administered to the 44 student teachers two days before they reported to their respective teaching practice schools and two days after they completed their nine-week teaching practice. The return rate was about 80 percent. Out of 44 sets of questionnaires, a total of 35 pre and post questionnaires were valid and used for the analysis. Results: The findings suggested that the student teachers who had weekly videoconference reported more positive experience of their teaching practice. Self-reported teaching competencies were higher in the post teaching practice questionnaire for both groups and no significant differences were found between the two groups. Conclusion: The value-added potential of videoconferencing as a technology lies in its possibility of providing new and alternative experiences for student teachers to engage in conversations and collaborative reflection. As videoconferencing removes the barriers of time and space that prevented student teachers from interacting with peers outside their teaching practice schools. (Contains 1 figure and 3 tables.)

Background: This study aimed to investigate the rates and causality of patient-reported adverse events (AEs) associated with concomitant Chinese Herbal Medicine (CHM) and Western Medicine prescription drug (WMPD) consumption through active surveillance in Singapore's Traditional Chinese Medicine (TCM) clinics. Methods: A cross-sectional study was conducted at five TCM clinics across Singapore from 8th May till 8th July 2023. Patients were screened to determine rates of CHM and WMPD consumption, and then interviewed if an AE was reported. An expert committee assessed the AE reports to determine causality. Along with descriptive statistics, odds ratios were calculated to determine AE occurrence likelihoods for patients who consumed both CHM and WMPD compared to CHM consumption alone. Results: 1028 patients were screened and 62.65% of them reported concurrent CHM-WMPD consumption. Patients who consumed CHM and WMPD were 3.65 times more likely to experience an AE as compared to CHM consumption alone. 18 AE reports were adjudicated, with most AEs deemed unlikely due to CHM consumption. Conclusions: A large proportion of patients consumed CHM and WMPD concurrently, thus increasing their risk of experiencing AEs compared to those consuming CHM only. Active surveillance is applicable for detecting AEs, collecting data for causality assessment, and analysis. [ABSTRACT FROM AUTHOR]

The comparability of endovascular coiling over neurosurgical clipping has not been firmly established in elderly patients with aneurysmal subarachnoid haemorrhage (aSAH). Data were obtained from all patients with aSAH aged ≥60 across three tertiary hospitals in Singapore from 2014 to 2019. Outcome measures included modified Rankin Scale (mRS) score at 3 and at 6 months, and in-hospital mortality. Of the 134 patients analyzed, 84 (62.7%) underwent coiling and 50 (37.3%) underwent clipping. The endovascular group showed a higher incidence of good mRS score 0–2 at 3 months (OR = 2.45 [95%CI:1.16–5.20];p = 0.018), and a lower incidence of in-hospital mortality (OR = 0.31 [95%CI:0.10–0.91];p = 0.026). There were no significant difference between the two treatment groups in terms of good mRS score at 6 months (OR = 1.98 [95%CI:0.97–4.04];p = 0.060). There were no significant differences in the incidence of complications, such as aneurysm rebleed, delayed hydrocephalus, delayed ischemic neurological deficit and venous thromboembolism between the two treatment groups. However, fewer patients in the coiling group developed large infarcts requiring decompressive craniectomy (OR = 0.32 [95%CI:0.12–0.90];p = 0.025). Age, admission WFNS score I–III, and coiling were independent predictors of good functional outcomes at 3 months. Only age and admission WFNS score I–III remained significant predictors of good functional outcomes at 6 months. Endovascular coiling, compared with neurosurgical clipping, is associated with significantly better short term outcomes in carefully selected elderly patients with aSAH. Maximal intervention is recommended for aSAH in the young elderly age group and those with favorable WFNS scores. [ABSTRACT FROM AUTHOR]

Introduction: In 2022, the Minister for Health of Singapore launched Healthier SG, a national strategy in championing the shift towards a population health approach. Method: The Singapore Heart Foundation conducted a series of roundtable discussions, also attended by representatives of the Singapore Cardiac Society and the Chapter of Cardiologists of the Academy of Medicine Singapore. During the meetings, the authors formulated interventions supportive of Healthier SG that specifically aimed to uplift the state of cardiovascular (CV) preventive care in Singapore. Results: In line with Healthier SG, the authors propose a 3-pronged approach ("Healthier Heart SG") to augment the success of Healthier SG in achieving good CV outcomes. This proposal includes the following components: (1) a call to update the standards of care in addressing the 5 main modifiable risk factors of cardiovascular disease (CVD); (2) patient education through cooperation between healthcare professionals and community partners for a whole-of-system approach; and (3) support for integrated care, including access to cardiac rehabilitation in the community, improved referral processes and access to nutrition/dietetics counselling and tobacco cessation, optimal use of information technology, and continued CV research. Conclusion: Healthier Heart SG would bring the standards of care and CV care delivery in Singapore closer to achieving the vision of proactive prevention of CVD and CV morbidity and mortality. This can only be achieved through the concerted efforts of healthcare professionals, policymakers and community partners, coupled with the cooperation of community members. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between gifted students' academic self-concept (ASC) and academic achievement (AC) in earth science with internationally representative high-school students from the third International Earth Science Olympiad (IESO) held in Taiwan in 2009. The results of regression analysis indicated that IESO students' ASC was significantly correlated with their AC (R[superscript 2] = 0.53, p<0.01) with large effect size, even when compared to other Asian countries such as Korea and Japan. It was found that Taiwan's students had the lowest ASC and exhibited poor interaction with other IESO students. The unique pattern of Taiwanese students exhibited through the 3rd IESO leads to the conclusion that: For the top notch gifted students, their social and psychological character such as their popularity and interaction skills, have much strongly effect on their ASC than cultural factors.

Background: The COVID-19 pandemic increased the use of telemedicine in primary care services. Understanding patients' perspectives on telemedicine is pivotal for its wider adoption in managing non-communicable diseases (NCDs) in the community. Aim: To explore the views and concerns of patients who have yet to use video consultation (VC) for NCD management in Singapore. Design & setting: This qualitative study was conducted in a primary care clinic in Singapore. Method: In total, 16 patients participated in individual in-depth interviews. The participants had type 2 diabetes mellitus and/or hypertension and/or hyperlipidaemia without prior VC experience. They were purposively enrolled in the polyclinic. Audited transcripts were independently coded by two investigators. Thematic analysis was performed to identify perspectives on telemedicine based on the health, information, and technology zones of the Health Information Technology Acceptance Model. Results: The following three themes emerged: perceived benefits of VC utility; perceived barriers of VC adoption; and potential challenges of VC. Participants viewed VC as safe and convenient if they had stable NCD. They voiced concerns on possible suboptimal care owing to the absence of physical examination, network connectivity, and personal medical data security. Participants highlighted challenges of VC uptake such as digital health familiarity, availability of their own mobile and telemonitoring devices, and healthcare costs consideration. Conclusion: Addressing the concerns and challenges highlighted by non-VC users can help physicians and policymakers explore ways to scale up telemedicine in Singapore. A hybrid clinical care model comprising in-person visits and VC may be the way forward for NCD management. [ABSTRACT FROM AUTHOR]

Key Points: Question: Will an immune checkpoint blocker in combination with the first-line chemotherapy improve progression-free survival and overall survival in patients with recurrent or metastatic nasopharyngeal carcinoma? Findings: At the final progression-free survival analysis, toripalimab treatment had a significantly longer progression-free survival than placebo. The prespecified final overall survival analysis revealed that the addition of toripalimab to gemcitabine-cisplatin led to statistically significant and clinically meaningful improvement in survival compared with chemotherapy alone, with a manageable safety profile. Meaning: The demonstrated progression-free survival and overall survival benefits support the use of toripalimab in combination with gemcitabine-cisplatin as the new standard first-line treatment for patients with recurrent or metastatic nasopharyngeal carcinoma. Importance: There are currently no therapies approved by the US Food and Drug Administration for nasopharyngeal carcinoma (NPC). Gemcitabine-cisplatin is the current standard of care for the first-line treatment of recurrent or metastatic NPC (RM-NPC). Objective: To determine whether toripalimab in combination with gemcitabine-cisplatin will significantly improve progression-free survival and overall survival as first-line treatment for RM-NPC, compared with gemcitabine-cisplatin alone. Design, Setting, and Participants: JUPITER-02 is an international, multicenter, randomized, double-blind phase 3 study conducted in NPC-endemic regions, including mainland China, Taiwan, and Singapore. From November 10, 2018, to October 20, 2019, 289 patients with RM-NPC with no prior systemic chemotherapy in the RM setting were enrolled from 35 participating centers. Interventions: Patients were randomized (1:1) to receive toripalimab (240 mg [n = 146]) or placebo (n = 143) in combination with gemcitabine-cisplatin for up to 6 cycles, followed by maintenance with toripalimab or placebo until disease progression, intolerable toxicity, or completion of 2 years of treatment. Main Outcome: Progression-free survival as assessed by a blinded independent central review. Secondary end points included objective response rate, overall survival, progression-free survival assessed by investigator, duration of response, and safety. Results: Among the 289 patients enrolled (median age, 46 [IQR, 38-53 years; 17% female), at the final progression-free survival analysis, toripalimab treatment had a significantly longer progression-free survival than placebo (median, 21.4 vs 8.2 months; HR, 0.52 [95% CI, 0.37-0.73]). With a median survival follow-up of 36.0 months, a significant improvement in overall survival was identified with toripalimab over placebo (hazard ratio [HR], 0.63 [95% CI, 0.45-0.89]; 2-sided P =.008). The median overall survival was not reached in the toripalimab group, while it was 33.7 months in the placebo group. A consistent effect on overall survival, favoring toripalimab, was found in subgroups with high and low PD-L1 (programmed death–ligand 1) expression. The incidence of all adverse events, grade 3 or greater adverse events, and fatal adverse events were similar between the 2 groups. However, adverse events leading to discontinuation of toripalimab or placebo (11.6% vs 4.9%), immune-related adverse events (54.1% vs 21.7%), and grade 3 or greater immune-related adverse events (9.6% vs 1.4%) were more frequent in the toripalimab group. Conclusions and Relevance: The addition of toripalimab to chemotherapy as first-line treatment for RM-NPC provided statistically significant and clinically meaningful progression-free survival and overall survival benefits compared with chemotherapy alone, with a manageable safety profile. These findings support the use of toripalimab plus gemcitabine-cisplatin as the new standard of care for this patient population. Trial Registration: ClinicalTrials.gov Identifier: NCT03581786 This multicenter, double-blind, randomized trial conducted in nasopharyngeal cancer (NPC)–endemic regions assesses whether toripalimab in combination with gemcitabine-cisplatin as first-line treatment for recurrent or metastatic NPC, compared with gemcitabine-cisplatin alone, will significantly improve progression-free survival and overall survival among chemotherapy-naive patients with recurrent or metastatic NPC. [ABSTRACT FROM AUTHOR]

Case studies of adult d/Deaf or Hard of Hearing Multilingual Learners (DMLs) are few, especially studies of DMLs who learn more than one sign language and read logographic and alphabetic scripts. To reduce this paucity, two descriptive case studies are presented. Written questionnaires, face-to-face interviews, and self-appraisals of language-use rubrics were used to explore (a) the language and literacy histories of two adult Asian DMLs who had learned multiple languages: Chinese (spoken/written), English (written), Chinese Sign Language, and American Sign Language; and (b) how each language was used in different cultural communities with diverse conversational partners. Home literacy environment, family support, visual access to languages, peer and sibling support, role models, encouragement, perseverance, and Deaf identity all played vital roles in the participants' academic success. The findings provide insights into the acquisition of multiple languages and bi-literacy through social communication and academic content.

The solving of structured multi-step word problems has been a dominant practice in schools and is seen as a way to develop students' mathematical reasoning abilities. Unfortunately, it is limited in scope and does not provide opportunities for eliciting deeper reasoning as they are neither rich enough nor anchored in authentic data that resemble real-world scenarios. Mathematical modelling activities, on the other hand, feature meaningful real-world situations and data that lead to openness to student solution and student interaction in small group learning. Coupled with the teacher's scaffolding, students are expected to expand and extend their reasoning even more towards solving the modelling task. This paper describes a case study on fostering a group of Primary 5 students' mathematical reasoning during mathematical modelling. The findings reveal that the students displayed a rich repertoire of different forms of mathematical reasoning as they generated their models. The models are sophisticated systems that helped them make decisions.

Purpose: This paper aims to explore the holistic picture of sustainability curricula in Asian higher education. Design/methodology/approach: Content analysis was conducted based on Asian management education for sustainability in higher education. Online courses arrangement, teaching methods, instructors' educational background and cross-referencing data between triple bottom line and sustainability courses have been investigated. Findings: The paper provides empirical insights about the current state of sustainability education in Asia. The results show that there is an opportunity for interdisciplinary integration, as there are imbalanced sustainability courses offered by business, science and engineering schools. It also suggests that Asian universities should add an international connection and active promotion of sustainability education on their Web sites. Research limitations/implications: Findings are based on web-based sustainability-related courses. Future research could apply method of case study to do a deeper study. Practical implications: The paper provides an overview of Asian management education for sustainability and curricula analysis through our research, and that this will further assist in the development of interdisciplinary integration in Asian management education for sustainability. Originality/value: This paper is the first attempt to gain better understanding of sustainability-related courses offered in leading business/management colleges in Asia.

Background: Medication non-adherence has become a striking problem among patients with chronic diseases worldwide. However, literature on prevalence, reasons and factors associated with medication non-adherence in Singapore general population is still lacking. This study aimed to (1) estimate the prevalence of intentional and unintentional medication non-adherence in young (aged 21–64 years) and older adults (aged ≥ 65 years), respectively; (2) identify and compare the main reasons for non-adherence; and (3) examine the association between potential factors and non-adherence in each group. Methods: This study sampled 1,528 community-dwelling adults on medications (young adults:766, older adults: 762) from a cross-sectional population health survey conducted in the northern and central regions of Singapore in 2018/2019. Self-reported medication non-adherence and its reasons were collected using a modified questionnaire and compared between the two groups. Multiple logistic regressions were conducted to examine the association between potential factors (e.g., social-demographic factors, smoking and drinking status, presence of diabetes, hypertension, or dyslipidaemia, and presence of depressive symptoms) and medication non-adherence in each group. Results: The prevalence of non-adherence was 38.4% and 22.3% in young and older adults, respectively, with young adults reporting higher unintentional and intentional non-adherence rates than older adults. "Afraid of developing drug dependence" was the most common reason in both groups (young:74.8% vs. old:73.5%). Compared to young adults (3.7%), "Not understanding medication labels" was more prevalent in older adults (8.8%). Presence of depressive symptoms was associated with non-adherence in both young (odds ratio [95% confidence interval]: 3.00 [1.79, 5.05]) and older adults (4.16 [2.31, 7.51]). Being employed (2.92 [1.76, 4.84]) and taking ≥ 2 medications (1.42 [1.04, 1.95]) had positive association while personal income of SGD1,000–4,000 (0.53 [0.36, 0.77]) and current smoking (0.61 [0.39, 0.95]) had inverse association with non-compliance in young adults. Diagnosis of diabetes, hypertension, or dyslipidaemia (2.63 [1.25, 5.53]) was associated with higher odds of non-compliance in older adults. Conclusions: Young adults had higher prevalence of medication non-adherence than older adults. The main reasons for non-adherence reported by young and older adults were generally comparable. Presence of depressive symptoms was a risk factor of medication non-adherence in both groups. [ABSTRACT FROM AUTHOR]

Understanding the variation of geological interfaces plays a crucial role in the analysis and design of infrastructure systems. Generally, there are two classes of techniques for predicting geological interfaces, for example, interpolation/regression-based techniques and machine-learning-based techniques. In this paper, a Multi-scale Meta-learning Model (M3) methodology is proposed. The new methodology improves the current state-of-the-art techniques by fusing two levels of information: (i) generic characteristics of the sampling locations, for example, coordinates, and (ii) location-specific characteristics, for example, local-scale predictions. The implementation starts from using an array of classic interpolation/regression-based techniques as base learners to provide first-level predictions at a local scale. These predictions are then combined with generic characteristics to train a meta-learner following the stacking ensemble learning framework. In this manner, the location-specific information from the base learners can be simultaneously considered with the generic information in the training process. The variation of rockhead elevation is predicted using the M3 methodology and a comprehensive borehole dataset in Singapore. A detailed comparative study involving several existing methods is also carried out to rigorously validate the M3 methodology. The results show that the M3 methodology achieves 20% improvement in the model performance compared to existing methods, indicating its promising potential in geotechnical site characterization. [ABSTRACT FROM AUTHOR]

In this project report, the authors describe the five transformations that a primary school in Singapore underwent as it adopted an inquiry pedagogy and curriculum along with a 1:1 deployment of smartphones. Based on the students' end-of-year test scores, not only did the students learn the prescribed content, but also they developed key 21st century skills. Taken together, the transformations have engendered a cultural change at Nan Chiau Primary School. (Contains 6 figures and 1 footnote.)

Design/methodology/approach: A primary quantitative study was conducted using a structured questionnaire. To test our hypotheses across different cultures and increase the generalizability of our findings, we surveyed potential users of freemium mobile games in the UK and Singapore. Our final sample consisted of 295 users. Purpose: While a lot of research focus has been placed on mobile games, studies on the factors influencing the adoption of this form of entertainment do not distinguish between pay-to-play and freemium games. We argue that the freemium model, where the user downloads a stripped-down version of a game for free and pays for updates, requires distinct focus. Our research aims are to: a) explore the factors determining the adoption of freemium mobile gaming as a form of entertainment and b) identify the conditions under which the gap between intending to play freemium mobile games and making in-game purchases is created. Findings: Our study's contribution to current research is twofold. Firstly, its findings reveal the factors determining the adoption of freemium mobile games using TAM. Secondly, our findings indicate the additional factors that bridge the gap between intention to play and intention to pay, namely loyalty with playing mobile games and perceived economic value. Originality/value: To our knowledge this is the first study exploring the factors determining the adoption of freemium mobile gaming as a form of entertainment and identify the conditions under which the gap between intending to play freemium mobile games and making in-game purchases is created. [ABSTRACT FROM AUTHOR]

Background: Approximately 30–70% of patients who have undergone allogeneic (allo) hematopoietic stem cell transplantation (HSCT) eventually experience chronic graft-versus-host disease (cGVHD). Patients who develop steroid-refractory (SR)-cGVHD are the most severely impacted due to significant disease and financial burden. There remains an unmet need for safe, efficacious, and accessible treatments for these patients. The objective of this study was to determine the cost effectiveness of ruxolitinib for treatment of SR-cGvHD from the Singapore healthcare system perspective. Methods: Based on data from the REACH3 randomized open-label trial, a semi-Markov model was developed to evaluate cost-effectiveness of ruxolitinib compared with investigators' choice of best alternative therapy (BAT) for treatment of patients > 12 years of age with SR-cGVHD in Singapore over a 40-year time horizon. The model only considered direct medical-care costs related to the treatment of SR-cGVHD and reported them in Singapore Dollars (SGD). Half-cycle correction was applied to all costs and outcomes, which were discounted at 3%. Probabilistic sensitivity analysis (PSA), one-way sensitivity analysis (OWSA), and scenario analysis were conducted to explore the drivers of uncertainty in the model. Results: In the deterministic base case, more life years (LY; 10.28 vs. 9.42) and quality-adjusted life years (QALYs; 7.31 vs. 6.51) were gained with ruxolitinib than BAT at higher costs (SGD 303,214 vs. SGD 302,673) leading to an incremental cost-effectiveness ratio (ICER) of SGD 677/QALY. At a willingness-to-pay threshold of SGD 75,000/QALY gained, PSA found that ruxolitinib had a 78.52% probability of being cost-effective. Findings were sensitive to variations in non-responder utilities in the BAT arm and duration of BAT treatment in the OWSA, or comparison to either methotrexate (MTX) or mycophenolic acid as a single comparator in the scenario analysis. ICERs remained lower than SGD 75,000/QALY in all other tested variations and scenarios. Conclusion: Ruxolitinib is likely to be cost-effective from Singapore healthcare system's perspective for patients with SR-cGVHD, which is promising in the management of patients with unmet clinical needs. [ABSTRACT FROM AUTHOR]

Aim: This study aims to compare the efficacy and safety of combined phacoemulsification with iStent inject (Phaco-iStent) and Hydrus microstent (Phaco-Hydrus). Methods: This was a retrospective comparative study of patients who underwent Phaco-iStent from April 2019 to August 2020 and Phaco-Hydrus from August 2019 to December 2020 at a tertiary eye centre in Singapore. Sixty-nine Phaco-iStent eyes and 49 Phaco-Hydrus eyes were included in this study. Complete surgical success was defined as freedom from second glaucoma surgery, Intraocular pressure (IOP) of 18 mmHg or less, and discontinuation of all antiglaucoma medications. Results: At 12 months, both Phaco-iStent and Phaco-Hydrus groups had comparable surgical success rate (68.1% vs 51%, p=0.061), reduction in antiglaucoma medication use (− 1.3 ± 0.1 vs − 1.4 ± 0.10, p=0.880) and intraocular pressure reduction (− 1.1 ± 0.5 mmHg vs – 1.6 ± 0.9 mmHg, p=0.323). Overall intraoperative and postoperative complications rate were similar in both groups, though hyphema was more commonly seen in early postoperative period in the Phaco-Hydrus compared to the Phaco-iStent group (8% vs 0%, p=0.028), with majority of cases resolving without any need for surgical intervention. Device obstruction was also more common in the Phaco-Hydrus group compared to the Phaco-iStent group (14% vs 4.3%, p=0.04). Conclusion: Phaco-iStent and Phaco-Hydrus have similar surgical efficacy and safety profiles at 12 months. [ABSTRACT FROM AUTHOR]

Introduction In the National University Cancer Institute, Singapore (NCIS), 2 pilot programs providing (i) surgical prehabilitation before cancer surgery and (ii) geriatric oncology support for older adults planned for chemotherapy and/or radiotherapy were merged to form the Geriatric Oncology Longitudinal End to eNd (GOLDEN) program in 2019 to support patients from the time of their cancer diagnosis, through their treatment process, to cancer survivorship. Methods and Materials Older adults aged ≥65 years were enrolled in either surgical prehabilitation, the geriatric medical oncology (GO) arm, or both. All patients undergo a geriatric assessment. We assessed if patients had a change in treatment plans based on GOLDEN recommendations, and the impact on patient related outcomes. Results There were 777 patients enrolled in the GOLDEN program over 2 years; 569 (73%) were enrolled in surgical prehabilitation, 308 (40%) were enrolled in the GO arm, with 100 (12.8%) enrolled in both. 56.9% were females. Median age was 73. Lower gastrointestinal (51.2%) and hepatobiliary cancers (24.1%) were the most common cancer types. 43.4% were pre-frail and 11.7% were frail. Of the 308 patients in the GO arm, 86.0% had geriatric syndromes, while 60.7% had a change in their treatment plans based on GOLDEN recommendations. 31.5% reported an improved global health status, while 38.3% maintained their global health status. 226 (73%) responded that they had benefited from the GOLDEN. Conclusion More than half of the population was either pre-frail or frail. Amongst those in the GO arm, the majority had geriatric syndromes and had a change in their treatment plans based on GOLDEN recommendations. Majority reported either improvement or maintenance in global health status, with most feeling they have benefited from the program. Further evaluation of the longitudinal geriatric hematology-oncology program for cancer-related outcomes and sustainability should be carried out. [ABSTRACT FROM AUTHOR]

Mathematical modelling is increasingly becoming part of an instructional approach deemed to develop students with competencies to function as 21st century learners and problem solvers. As mathematical modelling is a relatively new domain in the Singapore primary school mathematics curriculum, many teachers may not be aware of the learning outcomes and competencies needed to develop in their students during mathematical modelling. This paper reports on the assessment of two groups of Primary 5 students' (aged 11) mathematical modelling competencies in their first attempt in completing a modelling task. The students' competencies are assessed to be at levels 1 and 2 of a researcher-designed rubric. Findings appear to suggest that students faced particular challenges in formulating a mathematical problem from the real-world problem through making assumptions. Implications on teacher education on the facilitation of problem formulation and mathematisation during mathematical modelling at the primary level are drawn. (Contains 2 tables and 7 figures.)

This paper attempts to identify the patterns of email use by schoolteachers. The findings are based on a survey of 2998 Singapore teachers whose teaching experiences ranged from 24 to 48 months. The result shows that teachers use email mainly to communicate with colleagues, and the degree of email use varies according to the school level that the teachers are working in. While the teachers teaching at higher school levels (Grades 11-12) email their colleagues more frequently than their counterparts teaching at lower school levels especially primary school teachers, the latter tend to email parents more frequently than other teachers. Implications of the findings are discussed in relevance to pre-service teacher education, teacher professional development and ICT adoption in organisations. (Contains 6 tables.)

The newly revised mathematics curriculum in Singapore has recently factored Applications and Modelling to be part of the teaching and learning of mathematics. Its implication is that even children should now be involved in works of mathematical modelling. However, to be able to implement modelling activities in the primary mathematics classroom, it is at the outset needful for teachers to have an understanding of what it is, how it is different from conventional pedagogies, and what the learning outcomes look like. Since the goal of the Singapore mathematics curriculum is problem solving, I discuss mathematical modelling as problem solving and examine the mathematical reasoning of two groups of high-ability Primary 6 students in their engagement of a model-eliciting task based on a classroom research. Comparisons of the two groups within the modelling stages show that primary school students were able to reason mathematically towards constructing models. (Contains 3 figures.)

Since the publication of 2 important articles, by E. Tan (2002) on career counseling and by W. H. Chong (2005) on group counseling in schools, changes have taken place in the school counseling field in Singapore. In this article, the authors review these articles and describe the development of the school counseling profession in Singapore based on the American model of counseling.

Introduction: Few studies have examined the changes in the prevalence of comorbidity of mental and physical disorders in recent years. The present study sought to examine whether the prevalence of comorbidity of mental and physical disorders in Singapore showed any changes between 2010 and 2016.Methods: We extracted data from two repeated nationally representative cross-sectional surveys conducted among resident adults aged ≥ 18 years in Singapore. Significant changes were tested using pooled multinomial logistic regression analyses.Results: The prevalence of comorbid mental and physical disorders increased significantly from 5.8% in 2010 to 6.7% in 2016. Among those with physical disorders, there were significant increases over time in the prevalence of comorbid generalised anxiety disorder (GAD) (0.1% vs. 0.4%) and obsessive-compulsive disorder (OCD) (1.4% vs. 3.9%) in diabetes mellitus, and alcohol dependence in cardiovascular disorders (0.1% vs. 1.3%). Among those with mental disorders, there were significant increases over time in the prevalence of comorbid diabetes mellitus in OCD (4.1% vs. 10.9%), cancer in major depressive disorder (0.4% vs. 2.4%), and cardiovascular disorders in GAD (0.4% vs. 6.7%) and alcohol dependence (0.9% vs. 11.8%). Significant changes in the overall prevalence of comorbid mental and physical disorders were also observed across age group, education and employment status.Conclusion: The prevalence of comorbid mental and physical disorders increased significantly over time. This finding supports the need for more appropriate clinical management with better integration between mental health and general medical care professionals across all aspects of the healthcare system to treat this comorbidity in Singapore. [ABSTRACT FROM AUTHOR]

This study aims to investigate how Singapore primary schools use their web sites, what kind of information is contained in the web sites, and how the information is presented. Based on an analysis of 176 primary school web sites, which represent all but one of the country's primary schools, findings indicate that most of Singapore's primary school web sites contain basic information about the schools only. Although school web sites use images and animations to augment their interface design, few school web sites function as a two-way communication tool with stakeholders by taking full advantage of the interactive features provided by the Internet. Fewer than half of the school web sites publish the date of their last update, making visitors wonder about the accuracy of the posted information. Recommendations are made for schools to improve the design of their web sites. (Contains 3 tables.)

A hybrid three-dimensional ensemble-variational (En3D-Var) data assimilation system has been developed to explore incorporating information from an 11-member regional ensemble prediction system, which is dynamically downscaled from a global ensemble system, into a 3-hourly cycling convective-scale data assimilation system over the western Maritime Continent. From the ensemble, there exists small-scale ensemble perturbation structures associated with positional differences of tropical convection, but these structures are well represented only after the downscaled ensemble forecast has evolved for at least 6 h due to spinup. There was also a robust moderate negative correlation between total specific humidity and potential temperature background errors, presumably because of incorrect vertical motion in the presence of clouds. Time shifting of the ensemble perturbations, by using those available from adjacent cycles, helped to ameliorate the sampling error prevalent in their raw autocovariances. Monthlong hybrid En3D-Var trials were conducted using different weights assigned to the ensemble-derived and climatological background error covariances. The forecast fits to radiosonde relative humidity and wind observations were generally improved with hybrid En3D-Var, but in all experiments, the fits to surface observations were degraded compared to the baseline 3D-Var configuration. Over the Singapore radar domain, there was a general improvement in the precipitation forecasts, especially when the weighting toward the climatological background error covariance was larger, and with the additional application of timeshifted ensemble perturbations. Future work involves consolidating the ensemble prediction and deterministic system, by centering the ensemble prediction system on the hybrid analysis, to better represent the analysis and forecast uncertainties. [ABSTRACT FROM AUTHOR]

Background: Despite making the influenza vaccine accessible and affordable, vaccination rates remained low among community-dwelling older adults. Therefore, this study aimed to explore the factors influencing vaccine uptake and the impact of COVID-19 on vaccine uptake among community-dwelling older adults in Singapore. Methods: A mixed methods study involving a survey and semi-structured interviews were conducted between September 2020 and July 2021. Community-dwelling older adults aged ≥ 65 years were recruited from 27 Community Nurse Posts. Data on participants' demographics, health condition(s), vaccination status, attitudes towards influenza infections and vaccinations, willingness to pay, intention for future vaccination and source of information were collected via the survey. Semi-structured interviews were conducted to understand vaccination experiences, key enablers and barriers, and the impact of COVID-19 on vaccine uptake. All interviews were analysed using Braun and Clarke's thematic analysis. Quantitative data were analysed using descriptive statistics, chi-square tests and multinomial logistic regressions. Results: A total of 235 participants completed the survey. Living arrangement was a statistically significant contributing factor for influenza vaccine uptake (ꭓ2= −0.139; p = 0.03). Participants who lived alone were 2.5 times more likely to be vaccinated than those living with others (OR = 2.504, 95% CI: 1.294–4.842, p = 0.006). Avoidance of getting infected (82.5%), avoidance of transmission to others (84.7%), and advice from healthcare professionals to receive vaccination (83.4%) were key enablers, while concerns about possible side effects (41.2%), the effectiveness of the vaccine (42.6%), and not having enough information (48.1%) were barriers. Twenty participants were interviewed. The findings were congruent with the survey results. Five themes were identified as follows: (1) Perceived importance of influenza vaccination, (2) Sphere of influence, (3) Healthcare schemes and medical subsidies, (4) Psychological impediments, and (5) Inconsistent emphases at various touch points. Conclusions: Greater public health efforts are needed to reach out to the larger population of older adults of different living arrangements and those concerned about the possible side effects and effectiveness of the influenza vaccine. Healthcare professionals need to provide more information to address these concerns, especially during COVID-19, to encourage vaccine uptake. [ABSTRACT FROM AUTHOR]

Kombucha is a fermented tea known for its health-enhancing properties owing to the bioactive compounds generated by acetic acid bacteria (AAB) and lactic acid bacteria (LAB). We compared the distribution of AAB and LAB across nine kombucha products in Singapore (Product A to I) using shotgun metagenomics. High prevalence of Komagataeibacter species including Komagataeibacter saccharivorans (82.93% in B), Komagataeibacter xylinus (93.38% in D), and Komagataeibacter rhaeticus (92.20% and 30.62% in G and I) was detected in AAB-dominant kombucha. LAB-dominant kombucha was represented mainly by Bacillus coagulans (~99% in E and F) and Lactobacillus nagelii (~60% in H). Despite differences in bacterial composition, all kombucha harbour pathways involved in the biosynthesis of short-chain fatty acids (SCFAs), amino acids and vitamin B12. Interestingly, "fatty acid and beta-oxidation II (peroxisome)" and "fatty acid and beta-oxidation I" were only present in LAB-dominant kombucha. Further study is required to elucidate the significance of the discrepancies. [ABSTRACT FROM AUTHOR]

In this paper, we suggest that case-based resources, which are used for assisting cognition during problem solving, can be structured around the work of narratives in social cultural psychology. Theories and other research methods have proposed structures within narratives and stories which may be useful to the design of case-based resources. Moreover, embedded within cases are stories which are contextually rich, supporting the epistemological groundings of situated cognition. Therefore the purposes of this paper are to discuss possible frameworks of case-stories; derive design principles as to "what" constitutes a good case story or narrative; and suggest how technology can support story-based learning. We adopt video-based Computer-Supported Collaborative Learning (CSCL) technology to support problem solving with case-stories learning scenarios. Our hypothesis in this paper is that well-designed case-based resources are able to aid in the cognitive processes undergirding problem solving and meaning making. We also suggest the use of an emerging video-based collaborative learning technology to support such an instructional strategy. (Contains 2 figures.)

Singapore is a tiny city-state located in maritime Southeast Asia. Weather systems such as localized thunderstorms, squalls, and monsoon surges bring extreme rainfall to Singapore, influencing the day-to-day conduct of stakeholders in many sectors. Numerical weather prediction models can provide forecast guidance, but existing global models struggle to capture the development and evolution of the small-scale and transient weather systems impacting the region. To address this, Singapore has collaborated with international partners and developed regional numerical weather prediction systems. Steady progress has been made, bringing added value to stakeholders. In recent years, complex earth system and ultra high-resolution urban models have also been developed to meet increasingly diverse stakeholder needs. However, further advancement of weather prediction for Singapore is often hindered by existing challenges, such as the lack of data, limited understanding of underlying processes, and geographical complexities. These may be viewed as opportunities, but are not trivial to address. There are also other opportunities that have remained relatively unexplored over Singapore and the region, such as the integration of earth system models, uncertainty estimation and machine learning methods. These are perhaps key research directions that Singapore should embark on to continue ensuring value for stakeholders. [ABSTRACT FROM AUTHOR]

Sarcopenia is a precursor for physical frailty and is associated with adverse outcomes. Low handgrip strength (HGS) is one of the diagnostic criteria for sarcopenia. Multiple factors can influence muscle quality, including muscle composition, architecture, fat infiltration, fibrosis, excessive iron deposition, and neural activation. There is limited evidence on the association of iron and HGS in community-dwelling older adults. We aim to examine the association of HGS with iron indices and inflammation. The Healthy Older People Everyday study is a subset of the Singapore Population Health Studies cohort. Complete cross-sectional data and iron indices were available for 477 participants. Sociodemographics, comorbidities, and final scores of the FRAIL scale, Barthel Index, Lawton Scale, HGS, and timed-up-and-go were collected and analyzed. Laboratory parameters including hemoglobin, hsCRP and iron indices were measured. The mean age of the participants was 70.9 ± 5.0 years, 258(54.1%) were females, and most were of Chinese(85.3%) ethnicity. Amongst the participants, 6.9% were frail, 39.4% were pre-frailt, and 53.7% were robust. Mean HGS was 22.2 ± 7.0 kg. Low HGS was prevalent in 47.8%, the highest amongst Indians. Prevalence of diabetes, chronic kidney disease, and ischaemic heart disease were significantly higher in those with low HGS. In multivariate regression adjusting for age, sex, comorbidities and Hb, ferritin (β = 0.004 95%CI 0.0002–0.007, p = 0.04), transferrin saturation (β = 0.06 95%CI 0.01–0.10, p = 0.02) and hsCRP (β = − 0.15 95%CI − 0.26 to − 0.04, p < 0.01) were significantly associated with HGS. CRP was negatively associated with HGS, whereas ferritin and transferrin saturation were positively associated with HGS. Older people with iron deficiency should be assessed for sarcopenia, and vice versa, as both can occur in multisystemic disorder, and need to be managed concurrently. Prospective longitudinal studies and clinical trials may be required to establish the causal effect of iron deficiency on muscle strength and sarcopenia and the benefits of iron therapy to improve function and quality of life. [ABSTRACT FROM AUTHOR]

Burrhole craniostomy is commonly performed for subdural hematoma (SDH) evacuation, but residual scalp depressions are often cosmetically suboptimal for patients. OsteoplugTM, a bioresorbable polycaprolactone burrhole cover, was introduced by the National University Hospital, Singapore, in 2006 to cover these defects, allowing osseous integration and vascular ingrowth. However, the cosmetic and safety outcomes of OsteoplugTM-C—the latest (2017) iteration, with a chamfered hole for subdural drains—remain unexplored. Data were collected from a single institution from April 2017 to March 2021. Patient-reported aesthetic outcomes (Aesthetic Numeric Analog (ANA)) and quality of life (EQ-5D-3L including Visual Analog Scale (VAS)) were assessed via telephone interviews. Clinical outcomes included SDH recurrence, postoperative infections, and drain complications. OsteoplugTM-C patients had significantly higher satisfaction and quality of life compared to those without a burrhole cover (ANA: 9 [7, 9] vs. 7 [5, 8], p = 0.019; VAS: 85 [75, 90] vs. 70 [50, 80], p = 0.021), and the absence of a burrhole cover was associated with poorer aesthetic outcomes after multivariable adjustment (adjusted OR: 4.55, 95% CI: 1.09–22.68, p = 0.047). No significant differences in other clinical outcomes were observed between OsteoplugTM-C, OsteoplugTM, or no burrhole cover. Our pilot study supports OsteoplugTM-C and its material polycaprolactone as suitable adjuncts to burrhole craniostomy, improving cosmetic outcomes while achieving comparable safety outcomes. [ABSTRACT FROM AUTHOR]

Urban greenspace has been widely recognized for its beneficial role in mitigating the urban heat island (UHI) effect and enhancing human thermal comfort. However, understanding on the thermal effects of greenspace still remains limited, particularly in the areas of regional differences, scale issues, and modeling approaches. This study employs a multiscale approach to evaluate the cooling effect of greenspace in Hong Kong and Singapore by combining remote sensing techniques at the territory level, a hybrid modeling approach at the urban district level, and field measurements at the micro level. Results demonstrate that the approach generally performed well in evaluating the relationship between cooling effect and various explanatory variables. At the city scale, the average reduction in LST by greenspace (△ LST G − UF ) was found to be 3.08 ℃ in Hong Kong and 2.84 ℃ in Singapore, respectively. However, the cooling effect of greenspace is much reduced at the urban district level. Of the evaluated urban districts, greenspace was found to have a LST reduction effect ranging from 0.27 to 1.56 ℃ in Hong Kong and from −0.02–2.69 ℃ in Singapore, respectively. At the micro level, the study reveals that building height and greenspace volume have the most significant influence on ambient temperature variations during the hottest time of the summer season. These findings not only highlight the importance of considering scale and time variations when evaluating the thermal effects of greenspace but also help identify effective greenspace deployment strategies to combat excessive urban heat. • The thermal effect of greenspaces is evaluated at regional, district, and micro levels. • Greenspaces in Hong Kong and Singapore lead to an average LST reduction of 3.08 ℃ and 2.84 ℃, respectively. • The cooling effect of greenspaces is much reduced at the urban district level. • A hybrid approach coupling GWR and DNN well depicts the relationships between cooling effect and influencing factors at the district level. • Building height and greenspace volumes have the greatest influence on ambient temperature at the micro level. [ABSTRACT FROM AUTHOR]

BACKGROUND: There has been a rapidly growing global burden of mental health disorders, and the COVID-19 pandemic has acutely highlighted its importance not only at workplaces but also across societies and varied populations. Aviation professionals around the world are not spared and may have occupation related stressors including high workload, inconsistent work schedule, time zone shifts, fatigue and sleep disturbances. The impact of aviation professionals' mental health on aviation safety is wide-ranging; from lapses and errors to intentional pilot actions. There is a need to address mental health related risks toward aviation safety. OVERVIEW: To effectively mitigate the associated aviation safety risks, a salutogenic approach and comprehensive framework for mental health were assessed to be critical. In Singapore, a unique tripartite framework on mental health and wellness for pilots and air traffic controllers was jointly developed by the Civil Aviation Authority Singapore, the airlines and unions. Also known as the EPIC framework, several initiatives along the four pillars of Education, Peer Support, Intervention and Collaborative Programs were pursued collaboratively to strengthen mental health and wellness for our aviation professionals. DISCUSSION: In this presentation, the philosophy and conceptualization of the EPIC framework will be expounded. The various efforts to strengthen the mental health support structures and networks, in alignment to the EPIC framework, will also be shared. Upcoming initiatives to anchor sustainable and long term outcomes will be briefly covered. Learning Objectives 1. Understand the complex nature of mental health and wellness issues and the importance of safeguarding it for Pilots and Air Traffic Controllers, to better manage aeromedical risks and aviation safety. 2. Learn about a novel tripartite approach for mental health and wellness under the EPIC Framework that has been designed to change culture, reduce stigma and grow peer support networks in encouraging aviation professionals to actively seek help and support. [ABSTRACT FROM AUTHOR]

Lophiotrema is a genus of ascomycetous fungi within the family Lophiotremataceae. Members of this genus have been isolated as endophytes from a wide range of host plants and also from plant debris within terrestrial and marine habitats, where they are thought to function as saprobes. Lophiotrema sp. F6932 was isolated from white mangrove (Avicennia officinalis) in Pulau Ubin Island, Singapore. Crude extracts from the fungus exhibited strong antibacterial activity, and bioassay-guided isolation and structure elucidation of bioactive constituents led to the isolation of palmarumycin C8 and a new analog palmarumycin CP30. Whole-genome sequencing analysis resulted in the identification of a putative type 1 iterative PKS (iPKS) predicated to be involved in the biosynthesis of palmarumycins. To verify the involvement of palmarumycin (PAL) gene cluster in the biosynthesis of these compounds, we employed ribonucleoprotein (RNP)-mediated CRISPR-Cas9 to induce targeted deletion of the ketosynthase (KS) domain in PAL. Double-strand breaks (DSBs) upstream and downstream of the KS domain was followed by homology-directed repair (HDR) with a hygromycin resistance cassette flanked by a 50 bp of homology on both sides of the DSBs. The resultant deletion mutants displayed completely different phenotypes compared to the wild-type strain, as they had different colony morphology and were no longer able to produce palmarumycins or melanin. This study, therefore, confirms the involvement of PAL in the biosynthesis of palmarumycins, and paves the way for implementing a similar approach in the characterization of other gene clusters of interest in this largely understudied fungal strain. [ABSTRACT FROM AUTHOR]