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Background: We aimed to explore the three-way interaction among age, gender, and kidney function on the risk of all-cause mortality and cardiovascular mortality among patients with type 2 diabetes (T2D). Methods: In a retrospective cohort study, patients aged > 40 years with T2D with serum creatinine and urine albumin measured from 2013 to 2019 were included from a multi-institutional diabetes registry. The exposure was estimated glomerular filtration rate (eGFR), outcomes were all-cause mortality (primary outcome) and cardiovascular disease (CVD) mortality (secondary outcome). We applied multivariable cox proportional hazards regression analysis to compute the association between eGFR and mortality. Results: A total of 36,556 patients were followed for up to 6 years during which 2492 (6.82%) died from all causes, and 690 (1.9%) died from CVD. We observed a significant three-way interaction (p = 0.021) among age (younger, < 65; older, ≥65 years), gender and eGFR for the risk of all-cause mortality. Using age- and gender-specific eGFR of 90 ml/min/1.73m2 as the reference point, the adjusted hazard rate (HR) (95% CI) for all-cause mortality at eGFR of 40 ml/min/1.73m2 was 3.70 (2.29 to 5.99) in younger women and 1.86 (1.08 to 3.19) in younger men. The corresponding adjusted HRs in older women and older men were 2.38 (2.02 to 2.82) and 2.18 (1.85 to 2.57), respectively. Similar results were observed for CVD deaths, although the three-way interaction was not statistically significant. Sensitivity analysis yielded similar results. Conclusions: In this T2D population, younger women with reduced kidney function might be more susceptible to higher risks of all-cause mortality and CVD mortality than younger men. [ABSTRACT FROM AUTHOR]

This article presents factors that place girls at risk of delinquency and offending as well as the patterns in juvenile delinquency trends for females in Singapore. The authors also describe Singapore's overall structure of services for young offenders and the current status of alternative education programmes for young women engaged in delinquent behaviours and at-risk teenage girls. The unique features of a Singapore girls' home are then highlighted. Finally, implications for juvenile educational programming are considered.

Dengue, a mosquito-transmitted viral disease, has posed a public health challenge to Singaporean residents over the years. In 2020, Singapore experienced an unprecedented dengue outbreak. We collected a dataset of geographical dengue clusters reported by the National Environment Agency (NEA) from 15 February to 9 July in 2020, covering the nationwide lockdown associated with Covid-19 during the period from 7 April to 1 June. NEA regularly updates the dengue clusters during which an infected person may be tagged to one cluster based on the most probable infection location (residential apartment or workplace address), which is further matched to fine-grained spatial units with an average coverage of about 1.35 km2. Such dengue cluster dataset helps not only reveal the dengue transmission patterns, but also reflect the effects of lockdown on dengue spreading dynamics. The resulting data records are released in simple formats for easy access to facilitate studies on dengue epidemics. Measurement(s) dengue infection locations Technology Type(s) NEA's disclosured report Factor Type(s) Singapore's dengue in in 2020 [ABSTRACT FROM AUTHOR]

Background: There is limited evidence to clarify the specific relationship between preoperative estimated glomerular filtration rate (preop-eGFR) and postoperative 30-day mortality in Asian patients undergoing non-cardiac and non-neuron surgery. We aimed to investigate details of this relationship.Methods: We reanalyzed a retrospective analysis of the clinical records of 90,785 surgical patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. The main outcome was postoperative 30-day mortality.Results: The average age of these recruited patients was 53.96 ± 16.88 years, of which approximately 51.64% were female. The mean of preop-eGFR distribution was 84.45 ± 38.56 mL/min/1.73 m2. Multivariate logistic regression analysis indicated that preop-eGFR was independently associated with 30-day mortality (adjusted odds ratio: 0.992; 95% confidence interval [CI] 0.990-0.995; P < 0.001). A U-shaped relationship was detected between preop-eGFR and 30-day mortality with an inflection point of 98.688 (P for log likelihood ratio test < 0.001). The effect sizes and confidence intervals on the right and left sides of the inflection point were 1.013 (1.007 to 1.019) [P < 0.0001] and 0.984 (0.981 to 0.987) [P < 0.0001], respectively. Preoperative comorbidities such as congestive heart failure (CHF), type 1 diabetes, ischemic heart disease (IHD), and anemia were associated with the odds ratio of preop-eGFR to 30-day mortality (interaction P < 0.05).Discussion: The relationship between preop-eGFR and 30-day mortality is U-shaped. The recommended preop-eGFR at which the rate of the 30-day mortality was lowest was 98.688 mL/min/1.73 m2. [ABSTRACT FROM AUTHOR]

Background: Evidence regarding the relationship between anemia and perioperative prognosis is controversial. The study was conducted to highlight the specific relationship between anemia and perioperative mortality in non-cardiac surgery patients over 18 years of age. Methods: This study was a retrospective analysis of the electronic medical records of 90,784 patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. Multivariate regression, propensity score analysis, doubly robust estimation, and an inverse probability-weighting model was used to ensure the robustness of our findings. Results: We identified 85,989 patients, of whom75, 163 had none or mild anemia (Hemoglobin>90g/L) and 10,826 had moderate or severe anemia (Hemoglobin≤90g/L). 8,857 patients in each study exposure group had similar propensity scores and were included in the analyses. In the doubly robust model, postoperative 30-day mortality rate was increased by 0.51% (n = 219) in moderate or severe anemia group (Odds Ratio, 1.510; 95% Confidence Interval (CI), 1.049 to 2.174) compared with none or mild anemia group (2.47% vs.1.22%, P<0.001). Moderate or severe anemia was also associated with increased postoperative blood transfusion rates (OR, 5.608; 95% CI, 4.026 to 7.811, P < 0.001). There was no statistical difference in Intensive Care Unit (ICU) admission rate among different anemia groups within 30 days after surgery (P=0.104). Discussion: In patients undergoing non-cardiac surgery over 18 years old, moderate or severe preoperative anemia would increase the occurrence of postoperative blood transfusion and the risk of death, rather than ICU admission within 30 days after surgery. [ABSTRACT FROM AUTHOR]

Abstract: The impacts of various ventilation strategies and facade designs on indoor thermal environment for naturally ventilated residential buildings in Singapore are investigated in this study based on thermal comfort index. Four ventilation strategies, nighttime-only ventilation, daytime-only ventilation, full-day ventilation and no ventilation were evaluated for hot-humid climate according to the number of thermal discomfort hours in the whole typical year on the basis of a series of TAS simulations. Parametric studies of facade designs on orientations, window to wall ratios and shading devices were performed for two typical weeks by coupled simulations between building simulation ESP-r and CFD (FLUENT). The results indicate that full-day ventilation for indoor thermal comfort is better than the other three ventilation strategies. With various facade design studies, it was found that north- and south-facing facades can provide much comfortable indoor environment than east- and west-facing facades in Singapore. It is recommended that optimum window to wall ratio 0.24 can improve indoor thermal comfort for full-day ventilation and 600mm horizontal shading devices are needed for each orientation in order to improve thermal comfort in further. [Copyright &y& Elsevier]

Abstract: Fully glazed facade that has been increasingly used in Singapore causes higher energy consumption and thermal discomfort due to higher solar gain. The use of double glazed facade system with ventilation system is one way to solve these problems. The objective of this paper is to investigate the effects of double glazed facade with ventilation system on the energy consumption, thermal comfort and condensation and compare to single glazed facade system. TAS and CFD software were utilized to calculate energy consumption, thermal comfort and condensation for single glazed facade building as well as double glazed facade building. The simulation results showed double glazed facade with natural ventilation were able to minimize energy consumption as well as to enhance the thermal comfort. Turning the mechanical fans on could also solve the condensation problem due to high humidity. [Copyright &y& Elsevier]

• A clapboard-type internally circulating fluidized-bed solar reactor was introduced. • The gas flow rate had a significant effect on the particle circulating rate. • Solar-to-thermal conversion efficiencies of SiC, alumina, and sand were reported. • The bed mass had an apparent effect on the solar-to-thermal conversion efficiency. • SiC presented the highest solar-to-thermal conversion efficiency of 10.7 ± 0.4%. Fluidized-bed based solar reactors for the gasification of biomass have been widely recognized as a promising approach to produce high-quality syngas due to the merits, e.g. continuous operation and superior heat and mass transport. In this work, a novel high-temperature solar reactor with a clapboard-type internally circulating configuration that can efficiently mitigate the overheating of the bed wall affected by non-uniform solar radiation, is designed, constructed, and experimentally investigated under Singapore's first 28 kW e high-flux solar simulator. To investigate the flow dynamics in the high-temperature solar reactor, a transient 3D computational fluid dynamics multi-phase model is developed accordingly and validated by the experimental data. The simulated results can well clarify the flow and thermal behaviours in experiments. The effects of the gas flow rate and bed mass on the thermal performances of different Group-B particle materials are studied through experiments and simulation. The results indicate that increasing the bed mass in the solar reactor is capable of mitigating the overheating of the absorber surface caused by hot spots. The gas flow rate is dependent on the particle thermo-physical properties and shape as well as the clapboard geometric parameters. The highest solar-to-thermal conversion efficiency (defined as the ratio of the accumulated sensible heat of the particles to the solar power input) of 10.7 ± 0.4% is achieved by SiC due to its superior thermal conductivity. [ABSTRACT FROM AUTHOR]

Introduction Warfarin is widely used for patients with non-valvular atrial fibrillation (NVAF). Variations in warfarin control, as measured by time in therapeutic range (TTR), have been reported across different regions and ethnicities, particularly between Western and Asian countries. However, there is limited data on comparative factors influencing warfarin control in Caucasian and Asian patients. Therefore, the aim of this study was to determine warfarin control and potential factors influencing this in patients with NVAF in Australia and Singapore. Methods Retrospective data was collected for patients receiving warfarin for January to June 2014 in Australia and Singapore. TTR was calculated for individuals with mean patient TTR used for analysis. Possible influential factors on TTR were analysed including age, gender, concurrent co-morbidities, and concurrent medication. Results The mean TTR was significantly higher in Australia (82%) than Singapore (58%). At both sites, chronic kidney disease significantly lowered this TTR. Further factors influencing control were anaemia and age < 60 years in Australia, and vascular disease, CHA 2 DS 2 -VASc score of 6, and concurrent platelet inhibitor therapy in Singapore. Discussion Warfarin control was significantly higher in Australia compared to Singapore, however chronic kidney disease reduced control at both sites. The different levels of control in these two countries, together with patient factors further reducing control may impact on anticoagulant choice in these countries with better outcomes from warfarin in Australia compared to Singapore. [ABSTRACT FROM AUTHOR]