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Voice banking involves recording an inventory of sentences produced via natural speech. The recordings are used to create a synthetic text-to-speech voice that can be installed on speech-generating devices. This study highlights a minimally researched, clinically relevant issue surrounding the development and evaluation of Singaporean-accented English synthetic voices that were created using readily available voice banking software and hardware. Processes used to create seven unique synthetic voices that produce Singaporean-accented English, and the development of a custom Singaporean Colloquial English (SCE) recording inventory, are reviewed. The perspectives of adults who spoke SCE and banked their voices for this project are summarized and were generally positive. Finally, 100 adults familiar with SCE participated in an experiment that evaluated the intelligibility and naturalness of the Singaporean-accented synthetic voices, as well as the effect of the SCE custom inventory on listener preferences. The addition of the custom SCE inventory did not affect intelligibility or naturalness of the synthetic speech, and listeners tended to prefer the voice created with the SCE inventory when the stimulus was an SCE passage. The procedures used in this project may be helpful for interventionists who wish to create synthetic voices with accents that are not commercially available.

Using expert reviews and item response theory (IRT), this study evaluated the language- and culture-related construct-irrelevant variance and reliability of the 2019 TIMSS sense of school belonging scale (SSBS) for grades 4 and 8. The five items of the SSBS, which were identical for both grades, were reviewed for the language- and culture-related construct-irrelevant variance evidence by 10 assessment experts who have expertise in Chinese and English languages and cultures. Further, the existing TIMSS 2019 SSBS data associated with the countries of China (Hong Kong), Singapore, Australia, and America were analyzed within the framework of IRT for estimating the item and scale information function values (i.e., reliability) of the SSBS. The experts did find language- and culture-related evidence in each of the five items that might lead to the construct variance of the SSBS across these four countries. The IRT results further indicated that the SSBS item and scale information function values varied considerably across these four countries. Suggestions for revising the SSBS are proposed for TIMSS program developers.

The purpose of this study is to evaluate students' perception of growth in the area of work-related skills through their participation in an integrated work study program (IWSP). In Singapore Institute of Technology (SIT), 368 students across a range of six programs took part in an IWSP lasting six to twelve months. Students reported self-perceived improvements after IWSP in their work-related skills, encompassed by six domains -- learning & work integration; professionalism; communication; problem solving and decision-making; teamwork; and adaptability. Their mindset was additionally analyzed against ratings by their work supervisors to determine if having a fixed or growth mindset would have any implications on how their work-related skills were perceived. This paper thus investigates the impact of the IWSP on students' self-perceived growth in comparison to their work supervisors' perception of them, and whether mindset contributes to this.

The lifelong and complex nature of autism necessitates an array of services and supports spanning across different sectors and providers at different life stages of an autistic individual. However, research has shown that autistic individuals and their families often experience barriers accessing the autism-related services and supports that they need. This is the first qualitative study to explore the provision and coordination of autism services and supports in Singapore from the perspectives of service providers, autistic adults and caregivers. Semi-structured interviews with 21 participants revealed three main themes: (1) improving access to autism-specific services, (2) creating flexible supports in an inclusive environment and (3) addressing stigma and changing societal attitudes. Our findings suggest that Singapore may have achieved rapid growth in autism services, but broader social structures may be slower to change. To better support autistic individuals in society, autistic voices need to be amplified and a collective effort is needed to achieve a paradigm shift from impairment to capability.

Background: Narrative medicine demonstrated positive impact on empathy in medicine and nursing students. However, this pedagogical approach had not been evaluated in pharmacy education. This study sought to apply and evaluate the narrative medicine approach in extending empathy in Asian undergraduate pharmacy students. Methods: Narrative medicine was applied through workshops which used narratives of people with different experiences and perspectives. First-year undergraduate pharmacy students who volunteered and attended these workshops formed the intervention group (N = 31) and the remaining first-year cohort formed the control group (N = 112). A sequential explanatory mixed methods approach was adopted in which quantitative methods were first used to measure impact on pharmacy students' empathy using the Jefferson Scale of Empathy– Health Professions Student (JSE-HPS), and qualitative methods (i.e. group interviews) were then used to assess pharmacy students' emotional responses to narratives, and the perspectives of pharmacy students and faculty of this pedagogical approach. Results: There was no difference in JSE-HPS scores between intervention and control groups across baseline (i.e. upon matriculation), pre-intervention, and post-intervention timepoints. Pharmacy students in the intervention group had lower scores in Factor 3 ("Standing in People's Shoes") following the intervention. Five themes, guided by internal and external factors in cognition, emerged from the Group Interviews: (1) incongruence between students' motivation and faculty's perception, (2) learning context, (3) academic context, (4) cognitive system, and (5) affective system. Themes 1, 4 and 5 referred to internal factors such as students' motivation, perceived learnings, and feelings. Themes 2 and 3 referred to external factors including workshop materials, activities, content, and facilitation. Conclusion: This study is the first to demonstrate that pharmacy students engaged with the narrative medicine approach as narratives elicited emotional responses, exposed them to diverse perspectives, and deepened their appreciation of the importance of empathy and complexities of understanding patients' perspectives. Scaffolded educational interventions using narratives and real-life patient encounters, alongside longitudinal measurements of empathy, are necessary to bring about meaningful and sustained improvements in empathy. [ABSTRACT FROM AUTHOR]

Background: Emerging diagnostic modalities suggest that miRNA profiles within extracellular vesicles (EVs) isolated from peripheral blood specimens may provide a non-invasive diagnostic alternative for dementia and neurodegenerative disorders. Given that EVs confer a protective environment against miRNA enzymatic degradation, the miRNAs enriched in the EV fraction of blood samples could serve as more stable and clinically relevant biomarkers compared to those obtained from serum. Objective: To compare miRNAs isolated from EVs versus serum in blood taken from Alzheimer's disease (AD) dementia patients and control cohorts. Methods: We compared 25 AD patients to 34 individuals who exhibited no cognitive impairments (NCI). Subjects were Singapore residents with Chinese heritage. miRNAs purified from serum versus blood-derived EVs were analyzed for associations with AD dementia and medial temporal atrophy detected by magnetic resonance imaging. Results: Compared to serum-miRNAs, we identified almost twice as many EV-miRNAs associated with AD dementia, and they also correlated more significantly with medial temporal atrophy, a neuroimaging marker of AD-brain pathology. We further developed combination panels of serum-miRNAs and EV-miRNAs with improved performance in identifying AD dementia. Dominant in both panels was miRNA-1290. Conclusions: This data indicates that miRNA profiling from EVs offers diagnostic superiority. This underscores the role of EVs as vectors harboring prognostic biomarkers for neurodegenerative disorders and suggests their potential in yielding novel biomarkers for AD diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to present key findings from the 2019 national adult oral health survey in Singapore (NAOHS). Methods: A multi‐stage stratified sampling method was used to recruit participants for a representative national adult oral health survey. A total of 12 212 households were randomly selected from the National Database on Dwellings in Singapore. Within each household eligible persons aged ≥65 years were automatically invited to participate while a Kish selection method was used to invite those between 21 and 64 years old. The survey comprised a face‐to‐face interview questionnaire and a clinical examination which recorded details of tooth loss, DMFT, DMFS and prevalence of periodontal disease according to the CPITN and the US CDC‐AAP classifications. Weighted analysis was performed to adjust for oversampling, non‐response and post‐stratification. Multivariate regression with backward stepwise selection was carried out to identify predictors of chronic periodontal disease and untreated dental caries. Results: Six hundred and sixty‐three participants completed both the questionnaires and the clinical examination. The prevalence of edentulousness was 2.7%. Of participants, 34.8% presented with untreated dental caries with a higher proportion found in those who were aged ≥60 years, of Malay ethnicity, living in 1–2‐room public housing and who only visited the dentist when there was a problem. Mean DMFS and DMFT indices were 24.7 and 7.9 respectively. Based on the CDC‐AAP classification, the prevalence of moderate–severe chronic periodontitis was 56.9% and increased with age, with a higher proportion in males. Participants with untreated dental caries were more likely to have moderate or severe periodontal disease. Conclusions: Survey findings showed high prevalence of dental caries and periodontal disease, at 34.8% and 77.6% respectively. A clear socio‐economic gradient in the distribution of tooth loss, untreated dental caries and moderate‐to‐severe periodontitis was observed. [ABSTRACT FROM AUTHOR]

Objectives: Prevention complements the curative management of oral diseases. Effective preventive interventions involve the adoption of oral health promoting behaviours. Little is known about the awareness of oral disease and its prevention among Singaporean adults as well as their prevailing oral health attitudes and behaviours. The aim of the study was to describe the oral health knowledge, attitudes and behaviours of adults in Singapore. Methods: A random sample of adults (≥21 years old) in Singapore was selected to complete an interviewer‐administered questionnaire. The questionnaire gathered information about their knowledge of the aetiology, signs and symptoms as well as prevention of dental caries and periodontal disease; attitudes about the value of teeth, locus of control in maintaining oral health and oral health behaviours including toothbrushing, flossing and dental attendance. Results: A total of 1196 adults of weighted mean age 48 years old with almost equal proportions of males and females responded to the questionnaire. Participants were more unaware about the causes of periodontal disease (25.7%) than dental caries (4%). While more than 90% of participants felt that healthy teeth were important and could affect their overall health, many (67.0%) felt it was natural to lose their teeth with old age. Among the participants, 83.5% brushed their teeth twice a day; 41.9% flossed their teeth and 53.9% visited the dentist at least once a year. Conclusions: The study findings showed good knowledge around dental caries but some gaps around periodontal disease. It also found that participants perceived having limited control over preventing tooth loss. Irregular dental attendance and poor denture wearing habits were also noted. The findings shed light on key areas to focus on through oral health promotion to improve overall oral health. [ABSTRACT FROM AUTHOR]

This paper explores the motives and mechanisms behind data localization implemented by states to protect data, which is essential to emerging technologies such as Artificial Intelligence. Despite the significant negative aspects of data localization for states, the practice has become increasingly prevalent, leading to the unexplored question of why states choose to implement it. This suggests that data localization is a form of economic means derived from digital technologies and employed by states to serve political objectives. Focusing on the data in platforms, the theoretical mechanism of data localization is captured in light of two factors: network perception and security externality. Network perception pertains to a state's perception of the positive network effect generated by platforms, while security externality refers to a state's consideration of the security implications in relation to the economic benefits derived from the positive network effect, serving the national interest in domestic and/or international contexts. To substantiate these theoretical propositions, the paper employs a comparative case study approach where Vietnam, Singapore, and Indonesia have been chosen as empirical cases based on the selection strategy. The paper bridges the concept of economic statecraft with digital technologies, fosters interdisciplinary discussions, and offers policy implications. [ABSTRACT FROM AUTHOR]

Existing methods that use propensity scores for heterogeneous treatment effect estimation on non-experimental data do not readily extend to the case of more than two treatment options. In this work, we develop a new propensity score-based method for heterogeneous treatment effect estimation when there are three or more treatment options, and prove that it generates unbiased estimates. We demonstrate our method on a real patient registry of patients in Singapore with diabetic dyslipidemia. On this dataset, our method generates heterogeneous treatment recommendations for patients among three options: Statins, fibrates, and non-pharmacological treatment to control patients' lipid ratios (total cholesterol divided by high-density lipoprotein level). In our numerical study, our proposed method generated more stable estimates compared to a benchmark method based on a multi-dimensional propensity score. [ABSTRACT FROM AUTHOR]

Aim: Myo‐inositol supplementation from ~13 weeks' gestation reportedly improves glycaemia regulation in metabolically at‐risk women, with speculation that earlier supplementation might bring further improvement. However, the NiPPeR trial of a myo‐inositol‐containing supplement starting preconception did not lower gestational glycaemia in generally healthy women. We postulated that the earlier timing of supplementation influences the maternal metabolic adaptation for gestational glycaemia regulation. Methods: In total, 585 women were recruited from Singapore, UK and New Zealand for the NiPPeR study. We examined associations of plasma myo‐inositol concentrations at 7 and 28 weeks' gestation with 28 weeks plasma glucose (PG; fasting, and 1 h and 2 h in 75 g oral glucose tolerance test) and insulin indices using linear regression adjusting for covariates. Results: Higher 7‐week myo‐inositol, but not 28‐week myo‐inositol, associated with higher 1 h PG [βadj (95% confidence intervals) 0.05 (0.01, 0.09) loge mmol/L per loge μmol/L, p =.022] and 2 h PG [0.08 (0.03, 0.12), p =.001]; equivalent to 0.39 mmol/L increase in 2 h PG for an average 7‐week myo‐inositol increase of 23.4 μmol/L with myo‐inositol supplementation. Higher 7‐week myo‐inositol associated with a lower 28‐week Stumvoll index (first phase), an approximation of insulin secretion [−0.08 (−0.15, −0.01), p =.020] but not with 28‐week Matsuda insulin sensitivity index. However, the clinical significance of a 7‐week myo‐inositol‐related increase in glycaemia was limited as there was no association with gestational diabetes risk, birthweight and cord C‐peptide levels. In‐silico modelling found higher 28‐week myo‐inositol was associated with lower gestational glycaemia in White, but not Asian, women after controlling for 7‐week myo‐inositol effects. Conclusion: To our knowledge, our study provides the first evidence that increasing first trimester plasma myo‐inositol may slightly exacerbate later pregnancy post‐challenge glycaemia, indicating that the optimal timing for starting prenatal myo‐inositol supplementation needs further investigation. [ABSTRACT FROM AUTHOR]

The Omicron variant has been reported to present with milder disease compared with Delta, although this may be due to immunity from vaccination and prior exposure. Predictors of severity with recent strains have not been well characterized. We retrospectively examined consecutive cases of moderate‐to‐severe COVID‐19 (defined as requiring supplemental oxygenation, intensive care or mortality) admitted to seven tertiary hospitals across Singapore in April 2023. Whole genome sequencing was performed on each isolate to determine the sublineage, while baseline clinical, laboratory data and outcomes were tabulated. We reviewed 182 patients with moderate‐to‐severe illness and 466 controls hospitalized at the same time. Advanced age and presence of chronic kidney disease predicted adverse outcome. Previously reported markers such as radiographic evidence of pneumonia, elevated C‐reactive protein and serum creatinine levels at presentation also correlated with adverse outcomes. There were no observable differences in outcomes with any specific Omicron XBB sublineage. We did not find any specific Omicron XBB sublineage that was associated with worse outcomes. Larger multinational studies would be important to track the clinical evolution of the virus in its current endemic state. [ABSTRACT FROM AUTHOR]

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]

Introduction: Low-income families are exposed to adverse childhood experiences and psychosocial risks that impact child development. At the KK Women's and Children's Hospital in Singapore, Kids Integrated Development Service (KIDS0-3) is a home visitation programme that aims to optimise the development of children from low-income families. Method: Data comprising family demographics, maternal psychosocial risks and outcomes of child development were collated through a chart review of 469 mother-child dyads enrolled from June 2014 to October 2022. Results: Based on the Family and Adult Support Tool, 312 families (67%) were identified as moderate or high-risk. Children from moderate and high-risk families had poorer Bayley cognitive (mean 95.88 [SD 8.25] versus [vs] 98.44 [SD 8.72], P=0.014) and language scores (mean 87.38 [SD 10.35] vs 90.43 [SD 9.61], P=0.016] at 24 months of age, compared to the low-risk group. Children of teenage mothers had lower Bayley cognitive scores (mean 95.16 [SD 8.42] vs 97.76 [SD 8.55], P=0.037), and children of mothers who experienced sexual abuse had lower Bayley cognitive scores (mean 93.1 [SD 5.68] vs 99.7 [SD 8.17], P=0.013) and language scores (mean 82.3 [SD 12.87] vs 91.3 [SD 10.86], P=0.021]. Antenatal enrolment yielded better child language (mean 90.1 [SD 9.37] vs 87.13 [SD 10.79], P=0.04) and motor outcomes (mean 99.62 [SD 9.45] vs 94.72 [SD 9.51], P=0 .001) than postnatal enrolment. Conclusion: Psychosocial risks impact the development of children from low-income families in Singapore. Findings underscore the importance of early, integrated intervention for vulnerable families. [ABSTRACT FROM AUTHOR]

Mobile health applications (mHealth apps) are increasingly being used in weight loss interventions. However, evidence on the effects of such interventions on diet quality and their correlation with weight loss is lacking. The objective of this study was to examine whether changes in the diet quality of adults with prediabetes followed the use of an mHealth-enabled lifestyle intervention, compared with those who did not, and whether these changes correlated with weight loss. A secondary analysis of a 6-month randomized controlled trial Diabetes Lifestyle Intervention using Technology Empowerment (D'LITE) was conducted, with participants recruited from October 2017 to September 2019. Community-dwelling adults (n = 148) in Singapore diagnosed with prediabetes and body mass index (BMI) ≥23 were included in this study. Participants were randomized to receive either a 6-month mHealth-enabled lifestyle intervention program (diet and physical activity) or standard care dietary advice. Dietary data were collected in the form of 2-day food records at baseline, 3, and 6 months. Changes in Alternate Healthy Eating Index-2010 (AHEI-2010) scores and food groups (servings/day), calculated from the dietary data, and correlation between changes in AHEI-2010 and weight loss at 3 and 6 months, were examined. Between-group comparisons of continuous variables and within-participants variation were performed using longitudinal mixed-effect models, intention-to-treat principles. The models included treatment groups, time (baseline, 3 months, and 6 months), and covariates (age, sex, and BMI), as well as the group × time interactions, as fixed variables and within-participant variation in outcome values as random variable. The random intercept for participants accounted for the dependence of repeated measures. A likelihood ratio test was also conducted to test random effect variance. Spearman correlation test was used to examine correlation between changes in AHEI-2010 scores and weight loss. There was a significant improvement in overall diet quality as ascertained by the AHEI-2010, by 6.2 points (95% confidence interval [CI], 3.8–8.7; P < 0.001) in the intervention group as compared with the control. The participants in the intervention group had a significantly greater reduction in intake of sugar-sweetened beverages (SSB) by 0.5 servings/day (95% CI, −0.8, −0.2; P < 0.001) and sodium by 726 mg/day (95% CI, −983, −468; P <.001), compared with those receiving standard care. At 3 and 6 months, a significant decrease in SSB (0.8 servings/day; 0.7 servings/day, respectively) and sodium (297 mg/day; 296 mg/day, respectively) intakes were reported compared with baseline intakes. Small positive correlations (r = 0.2; P < 0.05) were observed between changes in AHEI-2010 scores from baseline and percentage weight loss at 3 and 6 months. For adults with prediabetes in Singapore, diet quality can be improved with an mHealth-enabled lifestyle intervention program. A small positive correlation exists between AHEI-2010 scores and weight loss. [ABSTRACT FROM AUTHOR]

More contemporary personal recovery conceptualisation of mental health recovery emphasize the need to consider the perspectives of people who experience mental ill-health. Most lived experience research has been done in Western cultures with relatively few studies in Asian ones, creating a gap that needs to be addressed due to differences in cultural worldviews. This study explores the notion of recovery from the lens of people experiencing mental health challenges in Singapore. We adopted a constructivist grounded theory perspective to evaluate qualitative data from 21 participants. The core category which best represented what recovery meant was "reconciling and living with experiences of mental ill-health". Our findings suggest that a variety of societal aspects greatly influence perceptions of mental health recovery in Singapore, as participants often shared their desire to live a meaningful life within society but could only do so if they found a way to manage their symptoms more effectively. [ABSTRACT FROM AUTHOR]

Wildlife trade is one of the major contributors to biodiversity loss in Southeast Asia, especially in songbirds. Wildlife forensics using genomic data can be instrumental in informing conservation action by identifying trade routes and animals' provenance to help law enforcement. We obtained ~ 10,000 genome-wide markers spanning a panel of 87 wild, captive, and confiscated individuals of one of the most widely traded songbirds in Southeast Asia, Swinhoe's white-eye (Zosterops simplex), to examine shifts in trade routes. Our population-genomic analyses reveal that a well-studied population of this white-eye on Singapore Island exhibits a major genomic contribution from the geographically distant subspecies simplex, reflecting historic trade into Singapore from China. In contrast, modern confiscated samples as well as a minority of wild Singapore samples carry the genomic signature of the Southeast Asian subspecies erwini, suggesting that modern trade sources in Singapore have shifted from China towards adjacent Malaysia. Our study highlights how accurate identification of trade routes can help conservationists' efforts in tackling the growing songbird crisis in the region. [ABSTRACT FROM AUTHOR]

Neurological complications with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant have been reported in adults; however, there are little data in the pediatric population. We aimed to report on the prevalence and clinical characteristics of children with neurological symptoms during the SARS-CoV-2 omicron wave. This was a single-center, retrospective cohort review of children (<18 years old) hospitalized for SARS-CoV-2 infection from December 2, 2021, to June 30, 2022. During the study period, 455 children (mean age 4.8 years, range 0.67 to 18, male 58.9%) were hospitalized with SARS-CoV-2 infection. A total of 108 (23.7%) children experienced neurological symptoms; most common were seizures (62.0%), headaches (32.4%) and giddiness (14.8%). Seizures included febrile seizures (64.1%), acute symptomatic seizures (17.9%), and breakthrough seizures in known epileptics (17.9%). Children with neurological manifestations were older (7.3 vs 4.0 years, P < 0.00001), more likely to have underlying epilepsy (9.3% vs 1.2%, P = 0.0002) or neurodevelopmental disorders (17.6% vs 1.7%, P < 0.00001), and presented earlier in their illness (2.1 vs 2.8 days, P < 0.00001), compared with those without neurological manifestations. Neurological symptoms fully resolved in all but one patient at discharge. There were no mortalities and no difference in duration of hospitalization (3.1 vs 3.7 days, P = 0.5) between the groups. One in four hospitalized children with SARS-CoV-2 infection when omicron variant was dominant experienced mild neurological symptoms. Overall risk factors for neurological symptoms associated with SARS-CoV-2 included older age, pre-existing febrile seizures/epilepsy and neurodevelopmental disorders. [ABSTRACT FROM AUTHOR]

It is well‐known that Outer Circle English has undergone extensive contact‐induced lexical and grammatical restructuring. Is it possible to use common NLP tools developed for Inner Circle English to process Outer Circle English texts? Here, we report our experience of using the Stanford PoS tagger to tag the Singaporean component of the International Corpus of English (ICE‐SIN). We isolate two major contact‐related causes of tagging errors: (1) lexical and grammatical loans directly borrowed from the local languages; and (2) English‐origin words with new grammatical meanings acquired from the local languages. While the first type may be easy to overcome, the latter type is intractable, creating an extra layer of morphosyntactic complexity. We achieved comparable accuracy rates in the more formal registers, and a lower but still decent 88% in the informal register of private conversations. A tagged ICE‐SIN allows us to investigate lexical and grammatical restructuring at unprecedented levels of detail. [ABSTRACT FROM AUTHOR]

Surgical resection is the mainstay treatment for resectable gastrointestinal stromal tumors (GISTs). However, resection in anatomically challenging locations, such as near the gastroesophageal junction, lesser curve and fundus, remain technically challenging. We herein report the outcomes of the largest series of patients who underwent single-incision transgastric resection of an intraluminal gastric GIST. Our reduced-port resection technique for intraluminal GISTs in these anatomically challenging locations involves a single incision in the left hypochondrium, deepened to access the gastric lumen, with the surgery completed in a transgastric manner. A total of 22 patients received surgery with this technique at the National University Hospital in Singapore from November 2012 to September 2020. The median operative time was 101 (range 50–253) min, with no conversions to open surgery, median lesion size 3.6 (range 1.8–8.2) cm and median postoperative length of stay 5 (range 1–13) days. There was no 30-day mortality and no recurrence during the follow-up period. Our laparoscopic approach for reduced-port transgastric excision of intraluminal GISTs allows for adequate surgical clearance, convenient extraction and secure gastrostomy closure with low morbidity. [ABSTRACT FROM AUTHOR]

Using expert reviews and item response theory (IRT), this study evaluated the language- and culture-related construct-irrelevant variance and reliability of the 2019 TIMSS sense of school belonging scale (SSBS) for grades 4 and 8. The five items of the SSBS, which were identical for both grades, were reviewed for the language- and culture-related construct-irrelevant variance evidence by 10 assessment experts who have expertise in Chinese and English languages and cultures. Further, the existing TIMSS 2019 SSBS data associated with the countries of China (Hong Kong), Singapore, Australia, and America were analyzed within the framework of IRT for estimating the item and scale information function values (i.e., reliability) of the SSBS. The experts did find language- and culture-related evidence in each of the five items that might lead to the construct variance of the SSBS across these four countries. The IRT results further indicated that the SSBS item and scale information function values varied considerably across these four countries. Suggestions for revising the SSBS are proposed for TIMSS program developers. [ABSTRACT FROM AUTHOR]

Voice banking involves recording an inventory of sentences produced via natural speech. The recordings are used to create a synthetic text-to-speech voice that can be installed on speech-generating devices. This study highlights a minimally researched, clinically relevant issue surrounding the development and evaluation of Singaporean-accented English synthetic voices that were created using readily available voice banking software and hardware. Processes used to create seven unique synthetic voices that produce Singaporean-accented English, and the development of a custom Singaporean Colloquial English (SCE) recording inventory, are reviewed. The perspectives of adults who spoke SCE and banked their voices for this project are summarized and were generally positive. Finally, 100 adults familiar with SCE participated in an experiment that evaluated the intelligibility and naturalness of the Singaporean-accented synthetic voices, as well as the effect of the SCE custom inventory on listener preferences. The addition of the custom SCE inventory did not affect intelligibility or naturalness of the synthetic speech, and listeners tended to prefer the voice created with the SCE inventory when the stimulus was an SCE passage. The procedures used in this project may be helpful for interventionists who wish to create synthetic voices with accents that are not commercially available. [ABSTRACT FROM AUTHOR]

Singapore grouper iridovirus (SGIV) is a virus with high fatality rate in the grouper culture industry. The outbreak of SGIV is often accompanied by a large number of grouper deaths, which has a great impact on the economy. Therefore, it is of great significance to find effective drugs against SGIV. It has been reported that edaravone is a broad-spectrum antiviral drug, most widely used clinically in recent years, but no report has been found exploring the effect of edaravone on SGIV infections. In this study, we evaluated the antiviral effect of edaravone against SGIV, and the anti-SGIV mechanism of edaravone was also explored. It was found that the safe concentration of edaravone on grouper spleen (GS) cells was 50 µg/mL, and it possessed antiviral activity against SGIV infection in a dose-dependent manner. Furthermore, edaravone could significantly disrupt SGIV particles and interference with SGIV binding to host cells, as well as SGIV replication in host cells. However, edaravone was not effective during the SGIV invasion into host cells. This study was the first time that it was determined that edaravone could exert antiviral effects in response to SGIV infection by directly interfering with the processes of SGIV infecting cells, aiming to provide a theoretical basis for the control of grouper virus disease. [ABSTRACT FROM AUTHOR]

This paper examines how the concept of participation in planning has been constructed by state and nonstate actors in the politico-institutional context of Singapore. Our objective is to gain a deeper understanding of the political dynamics shaping ideas about participation, and the impact of these contested constructions on the perpetuation of the ruling party's political control. Drawing on strategic-relational institutionalist planning and cultural political economy theories, we analyze 312 documents including government and civil society periodicals, parliamentary debates, and academic publications, focusing on the planning and participatory practices of Singapore's national planning agency from the mid-1980s to 2020. The findings reveal that state-led coalitions continuously reframed participation as an instrument of economic growth, nation-building, and activism-management, while nonstate-led coalitions emerged to transform state-civil society relations through promoting and materializing alternative meanings of participation. These dynamics demonstrate the potentialities and limitations of democratizing urban planning and governance in Singapore's hybrid regime. [ABSTRACT FROM AUTHOR]

Objective: At the beginning of the coronavirus disease (COVID-19) pandemic in Singapore, the strategy initially involved aggressive ring-fencing of infections, before pivoting towards managing recurrent local interspersed outbreaks of COVID-19. A key feature of Singapore's efforts to preserve health-care capacity was the implementation of the nationwide Home Recovery Programme (HRP), whereby patients were allowed to recover at home as long as they met certain criteria. The programme was centrally coordinated by Singapore's Ministry of Health and was supported by telemedicine providers, primary care physicians and government agencies. This report aims to highlight Singapore's experience in coordinating and implementing the HRP, the challenges faced and the outcomes. Methods: Published and internal data from the Ministry of Health in Singapore, along with policy documents, were reviewed together with a brief literature review of similar programmes conducted globally. Results: Implementation of the HRP led to the majority of patients (98%) recovering from COVID-19 in the outpatient setting, with similar mortality rates to inpatient settings. Hospitalization rates for COVID-19 cases were reduced as compared to previously, alleviating strain on the health-care system. Discussion: The HRP was largely successful at preventing health-care capacities from being overwhelmed, while keeping fatalities to a minimum. Nonetheless, the risks of emergent variants of concern remain present, and heightened vigilance and potential modification of existing protocols based on fluctuations in virulence and infectivity are still needed. [ABSTRACT FROM AUTHOR]

Background: Low awareness about palliative care among the global public and healthcare communities has been frequently cited as a persistent barrier to palliative care acceptance. Given that knowledge shapes attitudes and encourages receptiveness, it is critical to examine factors that influence the motivation to increase knowledge. Health information-seeking from individuals and media has been identified as a key factor, as the process of accessing and interpreting information to enhance knowledge has been shown to positively impact health behaviours. Objective: Our study aimed to uncover public sentiments toward palliative care in Singapore. A conceptual framework was additionally developed to investigate the relationship between information-seeking preferences and knowledge, attitudes, receptiveness of palliative care, and comfort in death discussion. Design and Methods: A nationwide survey was conducted in Singapore with 1226 respondents aged 21 years and above. The data were analysed through a series of hierarchical multiple regression to examine the hypothesised role of information-seeking sources as predictors. Results: Our findings revealed that 53% of our participants were aware of palliative care and about 48% were receptive to receiving the care for themselves. It further showed that while information-seeking from individuals and media increases knowledge, attitudes and receptiveness to palliative care, the comfort level in death conversations was found to be positively associated only with individuals, especially healthcare professionals. Conclusion: Our findings highlight the need for public health authorities to recognize people's deep-seated beliefs and superstitions surrounding the concept of mortality. As Asians view death as a taboo topic that is to be avoided at all costs, it is necessary to adopt multipronged communication programs to address those fears. It is only when the larger communicative environment is driven by the media to encourage public discourse, and concurrently supported by timely interventions to trigger crucial conversations on end-of-life issues between individuals, their loved ones, and the healthcare team, can we advance awareness and benefits of palliative care among the public in Singapore. Plain language summary: A nationwide survey to understand public sentiments and the extent that information-seeking preferences can increase knowledge, attitudes, receptiveness of palliative care, and comfort level in death discussion in Singapore Low awareness of palliative care is a barrier that persistently hinders palliative care acceptance among populations in developing and developed countries. As knowledge shapes attitudes and encourages receptiveness, it is vital that researchers uncover factors that influence the motivation to increase knowledge. Health information-seeking is a factor that deserves greater attention in palliative care research because the process of seeking out information on health concerns from other people or the media can greatly increase individuals' knowledge. As such, this nationwide survey involving 1226 participants was carried out in Singapore to understand the public sentiments toward palliative care. It further statistically analyzed if information-seeking (from individuals and the media) will increase knowledge, attitudes, receptiveness toward palliative care, and comfort level in death discussion. Our findings indicated that 53% of our participants were aware of palliative care and about 48% were receptive to receiving the care for themselves. Furthermore, while information-seeking from individuals and media increases knowledge, attitudes, and receptiveness to palliative care, people are only comfortable to engage in death discussion with individuals, especially healthcare professionals. Exposure to media alone is not enough to encourage individuals to want to talk about end-of-life issues including palliative care. As Asians view death as a taboo topic, it is important for public health authorities to recognize people's deep-seated beliefs and superstitions surrounding the concept of mortality. A multipronged communication program is therefore needed to address these fears. It is only when the larger communicative environment driven by the media to encourage public discourse, and concurrently supported by timely interventions to trigger crucial conversations on end-of-life issues between individuals, their loved ones, and the healthcare team, can we advance awareness and benefits of palliative care among the public in Singapore. [ABSTRACT FROM AUTHOR]

Introduction: The National Institutes of Health Stroke Scale (NIHSS), originally designed in the United States of America, contains items on dysphasia and dysarthria that are deemed culturally unsuitable for the Singapore context. We compared the error rates of dysphasia objects, dysphasia phrases and dysarthria words between the original and alternative items in a cohort of Singaporean subjects without dysphasia or dysarthria. Methods: In this prospective study, 140 English-speaking Singaporean subjects without impairments of dysphasia or dysarthria had an assessment of NIHSS items 9 and 10 using the original and alternative items. Paired analyses were conducted for comparison of error rates. Results: The error rates were high for four original dysphasia objects (Hammock: 62.9%, Cactus: 38.6%, Feather: 23.6%, Glove: 20.7%) and significantly lower for alternative items (Snail: 5%, Horse: 1.4%, Hanger: 1.4%, Car: 0%) (P < 0.001). For dysphasia phrases and dysarthria words, the error rates were low and there were no differences in error rates between the original and alternative items. Conclusion: There are cultural issues with several dysphasia objects in the original NIHSS as evidenced by the high error rates, which were lowered with more culturally suitable alternatives. This study formed a basis to derive a more suitable version of the NIHSS for English-speaking subjects in Singapore. [ABSTRACT FROM AUTHOR]

OBJECTIVES Vancomycin 24-hour area under the curve over minimum inhibitory concentration (AUC/MIC) monitoring has been recommended over trough-based monitoring in pediatric patients. This study compared the proportion of target attainment between vancomycin AUC/MIC and trough-based methods, and identified risk factors for subtherapeutic initial extrapolated targets. METHODS This was a retrospective, observational study conducted at KK Women's and Children's Hospital (KKH), Singapore. Patients aged 1 month to 18 years with stable renal function who received intravenous vancomycin between January 2014 and October 2017, with at least 2 vancomycin serum concentrations obtained after the first dose of vancomycin, were included. Using a pharmacokinetic software, namely Adult and Pediatric Kinetics (APK), initial extrapolated steady-state troughs and 24-hour AUC were determined by using a one-compartmental model. Statistical tests included Wilcoxon rank sum test, McNemar test, logistic regression, and classification and regression tree (CART) analysis. RESULTS Of the 82 pediatric patients included, a significantly larger proportion of patients achieved therapeutic targets when the AUC/MIC-based method (24, 29.3%) was used than with the trough-based method (9, 11.0%; p < 0.01). Patients with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m² or with age <13 years had an increased risk of obtaining subtherapeutic targets. However, empiric vancomycin doses of 60 mg/kg/day would be sufficient to achieve serum therapeutic targets, using the AUC/MIC-based method. CONCLUSION The AUC/MIC-based vancomycin monitoring may be preferred because a larger proportion of patients could achieve initial therapeutic targets. Future prospective studies with larger sample size will be required to determine the optimal vancomycin strategy for pediatric patients. [ABSTRACT FROM AUTHOR]

Mental health recovery has shifted from clinical conceptualizations to more personal ones. However, much of the lived experience literature has focused on people living with mental health conditions, and less attention has been placed on various mental health professionals, especially in Asian countries, where the personal recovery literature base is in its nascent stage. We sought to contribute to a growing body of work by exploring recovery from the lens of different mental health professionals in Singapore. Mental health professionals in Singapore were invited to participate in an online interview through social media. The recordings were transcribed verbatim and analyzed using a constructive grounded theory approach. Nineteen participants were interviewed. A single core category, "living in society once more", and three categories, "An ongoing process", "Regaining ability to function in society", and "A normality report card" were identified from our data. Recovery within the Singapore mental health professional perspective focuses on helping individuals return to society and function productively while considering existing societal norms such as the highly competitive and pragmatic culture in Singapore. Future research can explore in greater depth the impact of these factors on the recovery process. [ABSTRACT FROM AUTHOR]

Introduction: In occupational therapy, emphasis is placed on the complex interplay between the client, the occupation and the environment, providing an opportunity for its practitioners to adopt recovery-oriented outcomes in interventions for people with mental health conditions. In this study, we seek to understand occupational therapy undergraduates' perceptions of recovery for people with mental health conditions. Method: A qualitative descriptive study was conducted at a university in Singapore, which provides a pre-registration occupational therapy programme. Seventeen undergraduates were recruited (year 1, n = 5; year 2, n = 7 and year 3, n = 5). A semi-structured interview guide was used during the interview. Data collection took place from June to August 2022. Results: Using thematic analysis, two macro themes were discerned: the understanding of mental health conditions and the meanings of recovery. Sub-themes were created under each grouping to describe the data. Conclusions: This study explored the perceptions of mental health recovery among occupational therapy undergraduates. Occupational therapy students appeared to be well-aligned with personal and functional recovery perspectives when providing support for people with mental health conditions. However, there seems to be a need to emphasise the more nuanced aspects of delivering care within the culturally diverse setting of Singapore. [ABSTRACT FROM AUTHOR]

This study compares two distinct approaches, pooling forecasts from single indicator MIDAS models versus pooling information from indicators into factor MIDAS models, for short-term Singapore GDP growth forecasting with a large ragged-edge mixed frequency dataset. We consider various popular weighting schemes in the literature when conducting forecast pooling. As for factor extraction, both the conventional dynamic factor model and the three-pass regression filter approach are considered. We investigate the relative predictive performance of all methods in a pseudo-out-of-sample forecasting exercise from 2007Q4 to 2020Q3. In the stable growth non-crisis period, no substantial difference in predictive performance is found across forecast models. In comparison, we find information pooling tends to dominate both the quarterly autoregressive benchmark model and the forecast pooling strategy particularly during the Global Financial Crisis. [ABSTRACT FROM AUTHOR]

From 2009 to 2011, a team from the Centre for Learning and Life Chances in Knowledge Economies and Societies carried out a mixed-methods study of young people in England and Singapore. With regard to civic attitudes, the study showed that there was a greater sense of political self-efficacy and collective (school) efficacy in Singapore than in England. In addition, the group in Singapore scored higher on future voting relative to the group in England. Further, while both political self-efficacy and collective (school) efficacy were correlated with future voting in England, only the latter was correlated in the case of Singapore. For some, the results may seem counter-intuitive. The article reflects on these results, particularly those relating to democratic outcomes.