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Stories are widely used around the world to try to teach children moral lessons. However, it is often difficult for children to figure out how lessons from stories can be applied to real-life settings. In the present research, we tested whether encouraging children to be like the protagonists helps explain the success of positive moral stories (i.e., emphasizing positive consequence of truth-telling) in promoting honesty. Participants were 3- to 6-year-old children (N = 383), and honesty was operationalized in terms of truthful admission to cheating in the Temptation Resistance Paradigm (TRP). The results showed that stories were only effective at promoting honesty among young children when they were encouraged to try being like the protagonist in positive moral stories. Theoretical implications for moral development and practical implications for moral education are discussed.

Lying is a prevalent and normative behavior in young children. Conceptually, it is strongly linked with children's theory-of-mind development. However, empirical studies show that the link between children's lying and theory-of-mind is heterogeneous. This study examined whether parental control and parental warmth moderate the link between children's lying and theory-of-mind understanding. Three- to six-year-old Singaporean children (N = 116, M[subscript age] = 59 months, 59 male, 81.0% Chinese) participated in the temptation resistance paradigm, in which they were asked to guess the identity of a toy but instructed not to peek at it when left alone. Parental control and parental warmth were assessed via a parent-child interactive game. Results showed that the relation between children's maintenance of their initial lie and general theory-of-mind understanding was moderated by parental warmth. Specifically, there was a negative relation between children's lying and theory-of-mind for dyads with high parental warmth, but a positive relation between children's lying and theory-of-mind for dyads with low parental warmth. Overall, the findings suggest that children's lying behavior is the outcome of a complex interaction between cognitive and social factors.

Learning from others allows young children to acquire vast amounts of information quickly, but doing so effectively also requires epistemic vigilance. Although preschool-age children have some capacity to engage in such processes, they often have trouble resisting information from misleading informants. The present research takes a "novel strategic deception" training approach to addressing this limitation. The approach is grounded in theoretical work on children's recognition of self-other equivalences (Meltzoff, 2007) and in the default tendency to view communication as helpful (Mascaro et al., 2017). Eighty 3-year-old Singaporean children (M[subscript age] = 39.36 months, 37 girls, 90.0% Chinese) were randomly assigned to either an experimental condition, in which they were trained on strategic deception, or to a conservation training control condition. Findings showed that the strategic deception training was effective in promoting epistemic vigilance on a semantic task that involved object naming and no pointing, although the effect did not extend to performance on an episodic task that involved pointing to object locations. These findings provide the first evidence of a causal link between young children's reasoning about how to deceive others and their resistance to being misled by others. In doing so, they shed light on the mechanisms that come into play when children learn epistemic vigilance.

Purpose: Although it is clear that there are many benefits of academic-industry partnership through project-based learning (PBL) courses offered by universities, however, there are challenges in establishing such partnerships that if not addressed, may result in either failure of such collaboration or an unpleasant experience for parties involved. Accordingly, this study aims to address this knowledge gap in the PBL literature by identifying the essence of partnership management and offering insights to managing such partnerships effectively. Design/methodology/approach: This study aims to develop a framework that highlights the essence of partnership management in a PBL setting and validate the framework by conducting a focus group study on a university in Singapore (UNIS)'s PBL programmes called UNIS-X and UNIS-XO. Findings: The results suggest that the key features of partnership management include a value proposition, depth of collaboration, knowledge creation and exchange and continuous feedback. In addition, the findings offer useful insights to managing effective partnerships when engaging industry partners in a PBL programme. Originality/value: For researchers, this paper contributes to the PBL literature by identifying and validating the key features of effective partnerships in PBL. This serves as one of the first exploratory and validation studies in examining key features of partnership in the PBL literature. For educators, this study offers useful insights to understanding effective partnership management when engaging industry partners in a PBL course. With the knowledge, educators can devise useful actions to ensure these features of a partnership are established and maintained throughout the project.

Purpose: One of the main obstacles facing project-based learning (PBL) adoption relates to a lack of understanding by teachers and students in the roles they are required to play in the learning process. This study aims to address this obstacle, so as to better promote regular adoption of PBL pedagogy in educational institutions. Design/methodology/approach: The strategy was to undertake an in-depth case study of PBL courses taught in UNI-X's undergraduate curriculum. The case study approach is particularly appropriate for this exploratory study because it allows to capture the organizational dynamics of the phenomenon better and also its ability to explain the phenomenon based on interpretation of data. Findings: This paper presents an empirical study on the role perspective of PBL in a collaborative project environment. By drawing upon a case study of UNI-X, the authors argue that a teacher plays the roles of a designer, champion, facilitator and manager in a PBL course. To ensure that learning is effective, students should play the roles of a self-directed learner and a warrior when completing their projects. It is clear that role ambiguity and role conflict could occur in PBL courses and might even impact the effectiveness of student learning. Originality/value: For researchers, this paper contributes to the PBL literature by introducing a role perspective of PBL. This study identifies a list of roles a teacher and a student could potentially play in a PBL setting. Such understanding could serve as a reminder for a teacher and a student for the roles they need to play in achieving learning outcomes of a PBL course.

The influence of socio‐economic status (SES) on child temperament and psychological symptoms was examined using a nationally representative sample in Singapore. Data were available for 2169 children from 1987 families. Caregivers' reports were obtained on children aged 4–6. SES was operationalized as an aggregation of household income per capita, parental education level and housing type. Compared to their counterparts from higher SES families, children from low‐SES families tended to exhibit (a) higher negative affectivity but lower effortful control, and (b) higher internalizing and externalizing symptoms. In addition, children with a 'resilient' temperamental profile (i.e. low negative affectivity and high effortful control) were more likely to come from families with much higher SES, relative to children with other profiles. Children with high internalizing symptoms tended to come from low‐SES backgrounds, regardless of their externalizing symptoms. Among children with low internalizing symptoms, those with high externalizing symptoms came from lower SES backgrounds compared to those with low externalizing symptoms. Parental warmth and distress mediated the association between SES and child temperament and symptom profiles, with the exception of distress in the SES–temperament link. These findings supported the family stress model and highlighted the novel perspective of SES's influence on configurations of child temperament and symptom characteristics. [ABSTRACT FROM AUTHOR]

• Study links childcare hours with behavior problems and academic achievements. • In Singapore, 58 % of children spend over 40 hours per week in childcare. • Child outcomes show an inverted U-shaped relation with childcare hours. • The inflection points are at approximately 35–40 hours per week. This study examined how the number of hours of early childhood education (ECE) is associated with young children's behavior problems and early academic achievement in Singapore, a non-WEIRD ("Western, educated, industrialized, rich, democratic") country with families using long ECE hours. We drew data from the Singapore Longitudinal Early Development Study. Participants were 3- to 6-year-old children (N = 2,452). General linear models and spline regressions were utilized to analyze how ECE hours were associated with children's behavior problems and early academic achievement while controlling for child and family characteristics. On average, Singaporean children stayed 41.07 hours per week in ECE centers, with 38 % of the sampled children spending more than 50 hours per week in ECE centers. Notably, we found an inverted-U-shaped relation between ECE hours and child outcomes with a turning point of approximately 35–40 hours per week. Before the turning point, a greater number of hours in ECE was associated with more externalizing problems and higher academic achievement. However, after this point, a greater number of hours was associated with fewer behavior problems, both externalizing and internalizing, as well as poorer academic achievement. These findings demonstrate a complex nonlinear association between ECE hours and child outcomes in a context of children spending prolonged hours in centers. [ABSTRACT FROM AUTHOR]

Preclinical and limited epidemiological studies suggest that oxidative stress may be implicated in geriatric depression. Our study investigated the association between midlife dietary total antioxidant capacity (TAC) and depressive symptoms in late life among 13,712 participants in a population-based cohort of Chinese in Singapore. At baseline (1993–1998), intake of antioxidants from diet and supplements at a mean age of 52.4 years was estimated using a validated food frequency questionnaire to derive two dietary TAC indices from vitamins C and E, carotenoids and flavonoids: the Comprehensive Dietary Antioxidant Index (CDAI) and Vitamin C Equivalent Antioxidant Capacity (VCEAC). At follow-up 3 (2014–2016), when participants were at a mean age of 72.5 years, depressive symptoms were assessed using the Geriatric Depression Scale, and depression, defined as having ≥5 symptoms, was presented in 3173 (23.1%) participants. Both CDAI and VCEAC indices were inversely associated with odds of depressive symptoms in a stepwise manner: the OR (95% CI) comparing the extreme quartiles was 0.73 (0.64–0.83; Ptrend < 0.01) for the CDAI and 0.77 (0.68–0.87; Ptrend < 0.01) for the VCEAC. Specifically, higher intakes of vitamin C, carotenoids, and flavonoids were associated with a lower likelihood of depressive symptoms. Our findings support the recommendation of an antioxidant-rich diet for the prevention of depression. [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]

Background: Past research shows that young adults have poor knowledge of age-related fertility decline and that the provision of information can improve fertility knowledge. We provide university students with information on age-related fertility and fertility-related policies and investigate whether the provision of such information affects their family formation and career expectations. Methods: A three-armed randomized controlled trial was conducted online in Singapore between September and October 2021. A total of 1000 undergraduate students were recruited through campus advertisements to complete a 30- to 45-minute online survey, which randomly exposed participants to one of three informational brochures on age-related fertility decline, fertility policies, or diabetes (control group). Participants answered questions on family formation and career expectations both before and after the information intervention. Analysis of covariance was used to assess the effects of the information intervention. Results: Exposure to age-related fertility information resulted in significant reductions in the ideal age at first childbirth, significant increases in the expected probability of marriage before age 30, and (among female participants) significant increases in the expected likelihood of undergoing social egg-freezing. No difference existed in child-number ideals, educational aspirations, and income expectations between groups after exposure. No difference existed between the fertility policy information group and the control group after exposure in any of the outcomes of interest. Conclusions: Information on age-related fertility decline brought forward university students' expected timing of childbearing and marriage without reducing their educational and career expectations. The provision of fertility information at early ages, such as during university, can help correct widespread inaccurate beliefs about fertility and promote realistic family formation planning without adversely affecting educational and career goals. Trial registration: ClinicalTrials.gov. [ABSTRACT FROM AUTHOR]

Research has explored age-related and cultural differences in moral evaluations of dishonesty; however, this has not yet been examined in an aging context. The present study provided a novel account of how younger and older adults (in Canada, Singapore, and China; N = 401) morally evaluate adults' truths and lies in antisocial, modesty, and politeness settings. Participants completed a questionnaire assessing how acceptable it is for adults to tell the truth or a lie in given social scenarios, and they reported on their levels of collectivism and individualism. In all countries, older adults provided more favorable evaluations to blunt and immodest truths than younger adults did. Compared with younger adults, older adults provided harsher evaluations to Polite Lies (in Canada and China) and Modesty Lies (in Canada and Singapore). Thus, there may be an age-related increase in the acceptability of direct honesty over good-intentioned lies, and this age effect is somewhat stable across cultures. Older adults were also more lenient in evaluations of an antisocial lie to conceal an affair compared to younger adults. Overall, adults in China tended to rate lies less negatively, and their greater levels of collectivism mediated their greater approval of polite lies. The present results demonstrate that evaluations of (dis)honesty differ as a function of age and culture and these results can assist in developing a more complete lifespan model of the morality of dishonesty. [ABSTRACT FROM AUTHOR]

No one really knows what the first story ever told in human history was, but storytelling is an art that spans many civilizations and cultures, and continues to be a major part of our modern lives. More recently, storytelling has gone digital with advances in technology and connectivity. Educators have also rediscovered how storytelling can be an effective teaching pedagogy for engaged student learning. A digital story can engage students' visual and auditory senses in a way that the written word alone cannot. This article describes such an effort. The Movie-Door-2-Door.com (MD2D) is a digital story spanning 12 episodes. The story revolves around three young business graduates who started their own business and discovered the role of financial information in managing a business along the way. An independent survey by the University's teaching unit showed that the use of such digital stories can be an appropriate pedagogy to help student contextualize accounting and its role in helping management make decisions. The first four episodes of the MD2D digital story are available for viewing at www.research.smu.edu.sg/faculty/MD2D/.

There is limited evidence on fruit and vegetable intake in relation to cognitive function. This study aimed to evaluate the associations of quantity and variety in fruit and vegetable intake in midlife with cognitive impairment in late life. We used data from 16 737 participants of the Singapore Chinese Health Study, a population-based cohort study. The participants provided dietary data at recruitment at median age of 52·5 (range: 45–74) years and also participated in the third follow-up interview 20 years later at median age of 72·2 (range: 61–96) years. Quantity and variety of fruits and vegetables consumed at baseline were measured using a validated FFQ. Cognitive impairment at the third follow-up was defined using a Singapore-modified version of Mini-Mental State Examination. About 14·3 % participants had cognitive impairment. In multivariable logistic regression models, comparing extreme quartiles for intake of fruits and vegetables combined, the OR (95 % CI) associated with cognitive impairment was 0·83 (95 % CI: 0·73, 0·95; P -trend = 0·006) for quantity and 0·76 (95 % CI: 0·67, 0·87; P -trend< 0·001) for variety scores. Independently, those with increased variety of fruit intake or higher quantity of vegetable intake also had significantly 22 % and 15 % reduced odds of cognitive impairment, respectively. Finally, compared with those with low intake for both quantity and variety, those with both high quantity and variety for fruits and vegetables had 23 % reduction in odds of cognitive impairment. In conclusion, increase in quantity and variety of fruits and vegetables in midlife may reduce the risk of cognitive impairment in late life. [ABSTRACT FROM AUTHOR]

Objective: Balint groups provide a safe space for clinicians to discuss difficult cases, with the aim of deepening the clinician-patient relationship and providing space for self-introspection and personal development. During this COVID-19 period, mental health clinicians need a platform to undergo professional supervision and peer learning sessions, which can be provided for by Tele-Balint sessions. This study aims to understand the workings of Balint groups in a multi-disciplinary team, through exploring the experience and perceptions of mental health clinicians in a tertiary obstetrics- and paediatrics-focused hospital in Singapore towards Tele-Balint groups, and examining if these groups can address their professional needs. Method: A mixed-methods study was conducted. 26 mental health clinicians who had participated in Tele-Balint groups since March 2020 completed a semi-structured questionnaire, and 12 of them were interviewed. Qualitative analysis of interview transcripts was performed. Results: Qualitative analysis revealed 5 themes. The first 4: professional and personal growth of clinicians, providing emotional support to clinicians, burnout in clinicians: what contributes and what helps, and psychological safety, address whether Tele-Balint groups meet clinicians' needs. The last theme, evolution of nature of Balint groups, addresses whether Tele-Balint groups meet clinicians' needs during the time of a pandemic. Conclusions: Tele-Balint group participation was found to be beneficial in facilitating personal and professional growth, providing emotional support and preventing burnout, despite some limitations. Members should maintain flexibility towards the Balint process, in order to accommodate others who have differing needs, especially in a multi-disciplinary group. [ABSTRACT FROM AUTHOR]

Background: An ageing population has caused rising trauma cases amongst older patients. Multiple comorbidities, polypharmacy and limited reserves predispose them to poorer outcomes following a traumatic event. The Comorbidity Polypharmacy Score (CPS) has been found to predict outcomes and mortality in older trauma patients, but has not been studied in Asians.Aim: We aim to describe the epidemiological characteristics of older trauma patients and explore the association of CPS on clinical outcomes.Methods: We conducted a retrospective observational study using data from the trauma registries of 2 tertiary trauma centres. Patients aged 45 years and above attending the emergency departments (EDs) from January 2011 to December 2015 with traumatic injuries (Injury Severity Score [ISS] of 9 and above) were included. Demographics, clinical data including number of comorbidities and medications used were collected to calculate the CPS. Outcomes of mortality, ED disposition and hospital discharge venue were examined.Results: There were 4,522 patients (median age 70 years; males 53.8%), with majority sustaining Tier 2 injuries (ISS 9 to 15; 68.9%). Falls were the predominant mechanism for those aged above 60 years and above (76%). Median CPS was 6 (interquartile range [IQR] 1 to 11). Amongst patients 75 years and older, 56% comprised the moderate to morbid CPS groups (CPS ≥ 8). Overall mortality was 8.4%; patients above 75 years had longer median length of stay (10 versus 7.1-8.9 days in other ages). Male gender (adjusted odds ratio [aOR] 1.51; 95% confidence interval [CI] 1.12-2.02), increasing age (aOR 1.04; 95% CI 1.03-1.05), injury to abdomen (aOR 3.24; 95% CI 1.93-5.45) and severe CPS category (aOR 1.88; 95% CI 1.23-2.89) were associated with increased odds of death. Increasing age and moderate CPS category increased odds of discharge to a rehabilitation (aOR for age 1.03, 95% CI 1.02-1.04; aOR for moderate CPS 1.72, 95% CI 1.43-2.07) or long-term care facility (aOR for age 1.05, 95% CI 1.03-1.06; aOR for CPS 1.60, 95% CI 1.10-2.32).Conclusion: CPS predicted mortality and discharge to a rehabilitation or care facility in this urban, ageing Asian population. Its use may aid future trauma research and needs assessments in such patients. [ABSTRACT FROM AUTHOR]

The detection and recognition of ship mobile behavior patterns based on automatic identification system (AIS) data are crucial for ship navigation and maritime supervision. However, present methods, such as rule-based constraints and density clustering extraction, still suffer from restrictions imposed by artificial settings of parameters and thresholds. The lack of neighborhood context information in unstructured and serialized ship trajectory vector data makes it challenging to incorporate advanced methods such as deep learning for pattern learning. This study builds multiple semi-supervised deep learning graph neural network (GNN) models based on the message passing paradigm for recognizing ship mobile behavior patterns by constructing an AIS trajectory network and computing multi-order node features through Delaunay triangulation. It can get rid of the dependence on parameters of traditional rule-based and unsupervised learning methods. It also reduces the dependence on auxiliary information in trajectory qualitative by introducing multi-order node features. We conducted the experiments on cargo ship data from New York and Singapore to test our method. The model's classification accuracy is more than 99% for the New York dataset and more than 95% for the Singapore dataset. This method can be extended to other types of ships and traffic trajectory vector data with the excellent application potential of GNN in pattern recognition of vector mobile data. The code and experimental data are available at: https://github.com/destiny1103/DT-GNN. • A novel approach for recognizing ship behavior patterns from a network perspective is presented combining graph deep learning. • Pattern recognition can be achieved by utilizing solely trajectory points without the need for any external auxiliary information. • The efficient and accurate detection of ship behavioral patterns is achieved by utilizing a limited number of labeled samples. [ABSTRACT FROM AUTHOR]

While having social support can contribute to better health, those in poor health may be limited in their capacity to receive social support. We studied the health factors associated with social support among community-dwelling older adults in Singapore. We used data from the third follow-up interviews (2014–2016) of 16,943 participants of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese. Participants were interviewed at a mean age of 73 years (range 61–96 years) using the Duke Social Support Scale (DUSOCS). We first applied ordinary least squares regression to DUSOCS scores and found that those with instrumental limitations, poor self-rated health, cognitive impairment and depression had lower social support scores. We then applied latent class analysis to DUSOCS answer patterns and revealed four groups of older adults based on the source and amount of social support. Among them, compared to the 'overall supported' group (17%) with the highest social support scores and broad support from family members and non-family individuals, the 'family restricted' (50%) group had the lowest social support scores and only received support from children. Health factors associated with being 'family restricted' were instrumental limitations (odds ratio (OR) = 1.33, 95% confidence interval (CI) = 1.19–1.49), poor self-rated health (OR = 1.40, 95% CI = 1.28–1.53), cognitive impairment (OR = 1.19, 95% CI = 1.04–1.37) and depression (OR = 2.50, 95% CI = 2.22–2.82). We found that while older adults in poor health have lower social support scores, they were more likely to receive a lot of support from children. Our results showed that lower social support scores among Singaporean older adults in poor health may not indicate lack of social support, but rather that social support is restricted in scope and intensified around children. These results may apply to other Asian societies where family plays a central role in elder-care. [ABSTRACT FROM AUTHOR]

Background Understanding the genetic predisposition to cardiovascular disease (CVD) may help to improve clinical intervention strategies. Lifestyle factors, such as diet, may differ among ethnic groups and may, in turn, modify individuals' risks to diseases. Objectives We examined the genetic predisposition to ever smoking in relation to CVD mortality and assessed whether such an association could be modified by dietary intake. Methods A total of 23,760 Chinese adults from the Singapore Chinese Heath Study who were free of cancer and CVD at recruitment (1993–1998) were included in the study. A weighted genetic risk score (wGRS) was calculated to define the genetically determined regular smoking behavior (never or ever). Multivariable-adjusted Cox regression models were used to assess the association between the wGRS and CVD mortality. We also conducted a 1-sample Mendelian randomization analysis for ever smoking and CVD mortality. Results Over a mean of 22.6 years of follow-up, 2301 CVD deaths were identified. A genetic predisposition to ever smoking was significantly associated with CVD mortality; the multivariable-adjusted HR of CVD mortality was 1.07 (95% CI: 1.03–1.12), with a per-SD increment in the wGRS. However, the Mendelian randomization analysis did not support a causal relationship between ever smoking and CVD mortality (OR, 1.13; 95% CI: 0.87–1.45). Additionally, the Dietary Approaches to Stop Hypertension (DASH) score significantly modified the association between the smoking wGRS and CVD mortality; the association between a genetic predisposition to smoking and CVD mortality was only observed among individuals with a low DASH score (P- interaction = 0.004). Conclusions A genetic predisposition to smoking was associated with CVD mortality in the Chinese population. In addition, we detected a significant interaction showing higher CVD mortality related to genetically determined smoking among those with lower DASH scores. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the relations of dietary total antioxidant capacity (DTAC) with mortality outcomes in a Chinese population. Methods: The study included 62,063 participants from the Singapore Chinese Health Study. The participants were 45–74 years at baseline (1993–1998) when dietary data were collected with a validated 165-item food frequency questionnaire. The DTAC was derived using two widely adopted scores of integrated dietary consumption of antioxidant nutrients, i.e., the Comprehensive Dietary Antioxidant Index (CDAI) and Vitamin C Equivalent Antioxidant Capacity (VCEAC). We used Cox proportional hazard model to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations with adjustment for potential confounders. Results: During 1,212,318 person-years of follow-up, 23,397 deaths [cardiovascular diseases (CVD): 7523; respiratory diseases: 4696; and cancer: 7713] occurred. In multivariable models, the HR (95% CI) comparing participants in the highest vs. lowest quartile of CDAI was 0.85 (0.82, 0.88) for all-cause mortality, 0.82 (0.76, 0.88) for CVD mortality, 0.76 (0.70, 0.83) for respiratory disease mortality (all P-trend < 0.001), and 0.94 (0.88, 1.00) for cancer mortality (P-trend = 0.16). Similar associations were found with the VCEAC index. Higher intakes of the DTAC components, i.e., vitamin C, vitamin E, carotenoids, and flavonoids, were all associated with lower mortality risk. Conclusion: Diet with a higher antioxidant capacity in midlife was associated with a lower risk of all-cause, cardiovascular and respiratory disease mortality in the Singapore Chinese population, supporting the public health recommendation of consuming more plant-based foods that are rich in antioxidant nutrients. [ABSTRACT FROM AUTHOR]

Background Little is known about the joint associations of multiple lifestyle risk factors including smoking, low body mass index, physical inactivity, alcohol consumption, and low diet quality with risk of active tuberculosis. Methods We analyzed data from the Singapore Chinese Health Study, a prospective cohort study of 63 257 Chinese adults aged 45–74 years enrolled between 1993 and 1998. Incident cases of active tuberculosis were identified via linkage with the National TB Registry through 31 December 2016. Cox proportional hazards regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) of tuberculosis risk in relation to the combined scores of lifestyle risk factors. Results Compared with participants with none of the risk factors, the adjusted HRs (95% CI) of active tuberculosis for participants with 1, 2, 3, 4, and 5 risk factors were 1.24 (1.02–1.51), 1.84 (1.51–2.23), 2.52 (2.03–3.14), 4.07 (3.07–5.41), and 9.04 (5.44–15.02), respectively (P trend < .0001). The HR for those with 5 factors was ~1.5 times the product of individual risk estimates from the 5 factors on a multiplicative scale. The stepwise increase in risk of active tuberculosis with increasing number of lifestyle risk factors was significantly stronger in participants with diabetes than their counterparts without diabetes at recruitment (P interaction = .01). Conclusions Multiple lifestyle risk factors were associated with risk of active tuberculosis in a synergistic manner. Our findings highlight the importance of public health programs and interventions targeting these factors simultaneously to reduce the tuberculosis burden among the general population. [ABSTRACT FROM AUTHOR]

Learning from others allows young children to acquire vast amounts of information quickly, but doing so effectively also requires epistemic vigilance. Although preschool-age children have some capacity to engage in such processes, they often have trouble resisting information from misleading informants. The present research takes a novel strategic deception training approach to addressing this limitation. The approach is grounded in theoretical work on children's recognition of self-other equivalences (Meltzoff, 2007) and in the default tendency to view communication as helpful (Mascaro et al., 2017). Eighty 3-year-old Singaporean children (Mage = 39.36 months, 37 girls, 90.0% Chinese) were randomly assigned to either an experimental condition, in which they were trained on strategic deception, or to a conservation training control condition. Findings showed that the strategic deception training was effective in promoting epistemic vigilance on a semantic task that involved object naming and no pointing, although the effect did not extend to performance on an episodic task that involved pointing to object locations. These findings provide the first evidence of a causal link between young children's reasoning about how to deceive others and their resistance to being misled by others. In doing so, they shed light on the mechanisms that come into play when children learn epistemic vigilance. [ABSTRACT FROM AUTHOR]

Singapore grouper iridovirus (SGIV), a member of the Iridoviridae family, is an important marine cultured fish pathogen worldwide. Our previous studies have demonstrated that lipid metabolism was essential for SGIV entry and replication, but the roles of glucose metabolism during SGIV infection still remains largely unknown. In this study, we found that the transcription levels of key enzymes involved in glycolysis were regulated in varying degrees during SGIV infection based on the transcriptomic analysis. Quantitative PCR and western blot analysis also indicated that the expression of both glucose transporters (GLUT1 and GLUT2) and the enzymes of glucose metabolism (hexokinase 2, HK2 and pyruvate dehydrogenase complex, PDHX) were upregulated during SGIV infection in vivo or in vitro , suggesting that glycolysis might be involved in SGIV infection. Exogenous glucose supplementation promoted the expression of viral genes and infectious virion production, while glutamine had no effect on SGIV infection, indicating that glucose was required for SGIV replication. Consistently, pharmacological inhibition of glycolysis dramatically reduced the protein synthesis of SGIV major capsid protein (MCP) and infectious virion production, and promotion of glycolysis significantly increased SGIV infection. Furthermore, knockdown of HK2, PDHX, or GLUT1 by siRNA decreased the transcription and protein synthesis of SGIV MCP and suppressed viral replication, indicating that those enzymes exerted essential roles in SGIV replication. In addition, inhibition of mTOR activity in SGIV-infected cells effectively reduced the expression of glycolysis key enzymes, including HK2, PDHX, GLUT1, and GLUT2, and finally inhibited SGIV replication, suggesting that mTOR was involved in SGIV-induced glycolysis. Thus, our results not only provided new insights into the mechanism of how SGIV infection affects host cell glycolysis, but also contributed to further understanding of the iridovirus pathogenesis. [ABSTRACT FROM AUTHOR]

English and Mandarin Chinese differ in the voice onset times (VOTs) of /b/ and /p/. Hence the way bilinguals perceive these sounds may show 'tuning' to the language-specific acoustic structure of a bilingual's languages (a discrete model), or a shared representation across languages (a unitary model). We investigated whether an individual's early childhood exposure influences their model of phoneme perception across languages, in a large sample of early English-Mandarin bilingual adults in Singapore (N = 66). As preregistered, we mapped identification functions on a /b/-/p/ VOT continuum in each language. Bilingual balance was estimated using principal components analysis and entered into GLMMs of phoneme boundary and slope. VOT boundaries were earlier for English than Mandarin, and bilingual balance predicted the slope of the transition between categories across both languages: Those who heard more English from an earlier age showed steeper category boundaries than those who heard more Mandarin, suggesting early bilinguals may transfer their model for how phonemes differ from their earlier/stronger languages to later/weaker languages. We describe the transfer model of discrete phoneme representations and its implications for use of the phoneme identification task in diverse populations. [ABSTRACT FROM AUTHOR]

Background: With the dramatically rapid rate of aging worldwide, the maintenance of cognitive function in old age is a major public health priority. The association between total antioxidant capacity (TAC) of midlife diet and cognitive function in late life is still unclear.Method: The study included 16 703 participants from a prospective cohort study in Singapore. Dietary intakes and selected supplementary use were assessed with a validated 165-item food frequency questionnaire at baseline (1993-1998). Two dietary TACs were calculated from the intake of antioxidant nutrients: the Comprehensive Dietary Antioxidant Index (CDAI) and the Vitamin C Equivalent Antioxidant Capacity (VCEAC). Cognitive function was assessed 20.2 years later using a Singapore-modified version of the Mini-Mental State Examination when subjects were 61-96 years old. Cognitive impairment was defined using education-specific cutoffs. Multivariable logistic regression models were utilized to estimate the associations between dietary TACs, component nutrients, and cognitive impairment.Results: A total of 2 392 participants (14.3%) were defined to have cognitive impairment. Both CDAI and VCEAC scores were inversely associated with odds of cognitive impairment in a dose-dependent manner. The odds ratio (95% confidence interval; p-trend) comparing the highest with the lowest quartile was 0.84 (0.73, 0.96; p-trend = .003) for the CDAI and 0.75 (0.66, 0.86; p-trend < .001) for the VCEAC. Higher intakes of vitamin C, vitamin E, carotenoids, and flavonoids were all inversely associated with cognitive impairment.Conclusions: Higher dietary TAC was associated with lower odds of cognitive impairment in later life in a Chinese population in Singapore. [ABSTRACT FROM AUTHOR]

Purpose: Epidemiological studies directly investigating the association between different types of meat intake and cognitive impairment are limited. We, therefore, examined this association in the Singapore Chinese Health Study. Methods: In total, 16,948 participants were included in analysis. Diet was measured by a 165-item semiquantitative food-frequency questionnaire at baseline (1993–1998) when participants were 45–74 years. Cognitive impairment was defined using a Singapore modified version of Mini-Mental State Examination during follow-up three visits (2014–2016) when participants were 61–96 years. Multivariable logistic regression models were used to estimate odds ratio (OR) and 95% confidence interval (CI). Results: Cognitive impairment was present in 2443 (14.4%) participants. Compared to the lowest quartile, the highest quartile of red meat intake was associated with increased risk of cognitive impairment (OR 1.16, 95% CI 1.01–1.32, P for trend = 0.009), while the corresponding value for poultry intake was 0.89 (95% CI 0.78–1.02, P for trend = 0.10). Higher fresh fish/shellfish was associated with a lower risk of cognitive impairment (OR 0.88, 95% CI 0.77–1.00, P for trend = 0.03), while preserved fish/shellfish intake was associated with a higher risk (OR 1.19, 95% CI 1.04–1.36, P for trend = 0.01). Conclusion: This study found that a higher intake of red meat in midlife was associated with increased likelihood of cognitive impairment in later life, while substitution of red meat intake with poultry or fresh fish/shellfish was associated with reduced risk. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown inconsistent results for the relation between dietary fat intake and cognitive function in the elderly. Furthermore, prospective studies on this topic among the Chinese population are scarce.Objectives: We aimed to examine the association between midlife dietary fat intake and risk of cognitive impairment in the elderly.Methods: Prospective cohort analysis was conducted among 16,736 participants from the Singapore Chinese Health Study. Dietary information was assessed by a validated FFQ at baseline (1993-1998) when participants aged 45-74 y (mean: 53.5; SD: 6.22). Cognitive impairment was identified using the Singapore modified Mini-Mental State Examination at the third follow-up visit (2014-2016) when participants aged 61-96 y (mean: 73.2; SD: 6.41). Multivariable logistic regression models were used to calculate ORs and 95% CIs.Results: Cognitive impairment was presented in 2397 participants. When substituted for total carbohydrate, dietary fat intake was inversely related to cognitive impairment (OR comparing extreme quartiles: 0.80; 95% CI: 0.67, 0.94; P-trend = 0.003). The OR (95% CI) comparing extreme quartiles of specific dietary fats was 1.08 (0.89, 1.31; P-trend = 0.51) for SFAs, 0.80 (0.64, 0.99; P-trend = 0.02) for MUFAs, 0.84 (0.72, 0.99; P-trend = 0.02) for PUFAs, 0.92 (0.77, 1.09; P-trend = 0.49) for n-3 PUFAs, and 0.83 (0.70, 0.98; P-trend = 0.01) for n-6 PUFAs. An inverse association was found for plant-based fat (OR: 0.84; 95% CI: 0.72, 0.98; P-trend = 0.02), but not for animal-based fat (OR: 0.96; 95% CI: 0.81, 1.15; P-trend = 0.76). When substituted for SFAs, the OR (95% CI) was 0.77 (0.61, 0.97; P-trend = 0.02) for MUFAs and 0.82 (0.70, 0.95; P-trend = 0.003) for PUFAs.Conclusions: We found that substitution of total carbohydrate or SFAs with MUFAs and PUFAs, particularly n-6 PUFAs, was related to a lower risk of cognitive impairment in elderly Chinese participants. In addition, an inverse association with cognitive impairment was found for plant-based fat. [ABSTRACT FROM AUTHOR]

Aim: The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are important to consider as the novel coronavirus disease (COVID-19) pandemic stresses healthcare systems globally. The primary objective was to examine the changes in the proportion of HCWs reporting stress, anxiety, and job burnout over six months during the peak of the pandemic in Singapore. The secondary objective was to examine the extent that objective job characteristics, HCW-perceived job factors, and HCW personal resources were associated with stress, anxiety, and job burnout. Method: A sample of HCWs (doctors, nurses, allied health professionals, administrative and operations staff; N = 2744) was recruited via invitation to participate in an online survey from four tertiary hospitals. Data were gathered between March-August 2020, which included a 2-month lockdown period. HCWs completed monthly web-based self-reported assessments of stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7), and job burnout (Physician Work Life Scale). Results: The majority of the sample consisted of female HCWs (81%) and nurses (60%). Using random-intercept logistic regression models, elevated perceived stress, anxiety and job burnout were reported by 33%, 13%, and 24% of the overall sample at baseline respectively. The proportion of HCWs reporting stress and job burnout increased by approximately 1·0% and 1·2% respectively per month. Anxiety did not significantly increase. Working long hours was associated with higher odds, while teamwork and feeling appreciated at work were associated with lower odds, of stress, anxiety, and job burnout. Conclusions: Perceived stress and job burnout showed a mild increase over six months, even after exiting the lockdown. Teamwork and feeling appreciated at work were protective and are targets for developing organizational interventions to mitigate expected poor outcomes among frontline HCWs. [ABSTRACT FROM AUTHOR]

Background: Although higher diet quality at mid-life has been associated with better cognitive function in late adulthood, it is unclear whether dietary improvement after mid-life may reduce the risk of cognitive impairment.Objectives: We examined associations between changes in diet quality and risk of cognitive impairment in the Singapore Chinese Health Study cohort.Methods: We used data from 14,683 Chinese men and women who were recruited at ages 45 to 74 y from 1993 to 1998 and re-interviewed after 20 y at ages 61 to 96 y during follow-up 3 (2014-2016). Diet quality was measured using the Dietary Approaches to Stop Hypertension (DASH) scores at baseline and follow-up 3 interviews. Cognitive impairment was defined using scores from the Singapore-modified Mini-Mental State Examination at the follow-up 3 interview. Multivariable logistic regression models were used to estimate ORs and 95% CIs for the associations between change in DASH scores and cognitive impairment.Results: Higher quintiles in DASH scores at baseline and follow-up 3 interviews were associated with lower odds of cognitive impairment in a dose-dependent manner (both: P-trend < 0.001). Compared with participants with consistently low DASH scores, the OR (95% CI) of cognitive impairment was lowest, at 0.64 (0.51, 0.79), in those with consistently high DASH scores. Those with small (OR: 0.80, 95% CI: 0.65, 0.98) or moderate-large (OR: 0.72, 95% CI: 0.59, 0.86) increases in DASH scores were associated with significantly lower odds of cognitive impairment than those with consistently low DASH scores. Associations were consistent across subgroups by sex, BMI (kg/m2; <23 or ≥23), and age (<60 y, ≥60 y) at baseline.Conclusions: Although maintaining high diet quality confers the lowest risk, improving diet quality from mid- to late life was still associated with a lower risk of cognitive impairment in late adulthood. [ABSTRACT FROM AUTHOR]

This paper demonstrates the development of a moving point source (MPS) model for simulating the atmospheric dispersion of pollutants emitted from ships under movement. The new model is integrated into the chemistry transport model EPISODE–CityChem v1.3. In the new model, ship parameters, especially speed and direction, are included to simulate the instantaneous ship positions and then the emission dispersion at different simulation time. The model was first applied to shipping emission dispersion modeling under simplified conditions, and the instantaneous and hourly averaged emission concentrations predicted by the MPS model and the commonly used line source (LS) and fixed point source (FPS) models were compared. The instantaneous calculations were quite different due to the different ways to treat the moving emission sources by different models. However, for the hourly averaged concentrations, the differences became smaller, especially for a large number of ships. The new model was applied to a real configuration from the seas around Singapore that included hundreds of ships, and their dispersion was simulated over a period of a few hours. The simulated results were compared to measured values at different locations, and it was found that reasonable emission concentrations were predicted by the moving point source model. [ABSTRACT FROM AUTHOR]

Introduction: The Coronavirus-19 pandemic has had profound effects on health professions education (HPE) posing serious challenges to the continued provision and implementation of undergraduate, postgraduate and continuing medical education (CME). Across these HPE domains, the major disruptions included the exclusion of undergraduate learners from clinical learning environments, restricted intra-, inter-institutional and overseas movement of medical professionals, termination of face-to-face learner-educator interactions, deployment of postgraduate learners into non-scope service settings, and CME postponement. Methods: In this review we report on how in Singapore various adaptive measures were instituted across the 3 HPE domains at institutional and national level to maintain adequate resources at the frontline to meet service exigencies, promote healthcare professionals' wellbeing and safety as well as mitigate the spread of the pandemic. Results: We identified several strategies and contingencies developed to address these challenges. These involved the use of online learning platforms, distributed and asynchronous learning, an undergraduate Pathway Programme, and use of innovative hands-on technology like simulation. Robust, well pre-planned pandemic preparedness, effective communication, as well as provision of psychological support resources ensured maintenance of service and academic continuity, trust and resilience within HPE. However, several challenges remain, namely the timing and manner of conducting formative and summative assessments, cybersecurity, and the indispensable hands-on, in-person experiential learning for surgical training. Conclusion: Strong leadership with vision and planning, good communication, prioritising learners' and educators' wellbeing and safety, and harnessing existing and emerging online learning technologies are crucial elements for effective contingencies for HPE disruption during pandemics. [ABSTRACT FROM AUTHOR]

Purpose: Although it is clear that there are many benefits of academic–industry partnership through project-based learning (PBL) courses offered by universities, however, there are challenges in establishing such partnerships that if not addressed, may result in either failure of such collaboration or an unpleasant experience for parties involved. Accordingly, this study aims to address this knowledge gap in the PBL literature by identifying the essence of partnership management and offering insights to managing such partnerships effectively. Design/methodology/approach: This study aims to develop a framework that highlights the essence of partnership management in a PBL setting and validate the framework by conducting a focus group study on a university in Singapore (UNIS)'s PBL programmes called UNIS-X and UNIS-XO. Findings: The results suggest that the key features of partnership management include a value proposition, depth of collaboration, knowledge creation and exchange and continuous feedback. In addition, the findings offer useful insights to managing effective partnerships when engaging industry partners in a PBL programme. Originality/value: For researchers, this paper contributes to the PBL literature by identifying and validating the key features of effective partnerships in PBL. This serves as one of the first exploratory and validation studies in examining key features of partnership in the PBL literature. For educators, this study offers useful insights to understanding effective partnership management when engaging industry partners in a PBL course. With the knowledge, educators can devise useful actions to ensure these features of a partnership are established and maintained throughout the project. [ABSTRACT FROM AUTHOR]

Background: Studies suggest that nutritional interventions using the whole diet approach such as the Mediterranean diet may delay cognitive decline and dementia onset. However, substantial numbers of older adults are non-adherent to any ideally healthy dietary pattern and are at risk of malnutrition. Objective: The present study investigated the relationship between global malnutrition risk and onsets of cognitive decline and neurocognitive disorders (NCD), including mild cognitive impairment (MCI) or dementia in community-dwelling older adults. Methods: Participants aged ≥55 years in the Singapore Longitudinal Ageing Studies (SLAS) were assessed at baseline using the Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA) and followed up 3–5 years subsequently on cognitive decline (MMSE drop ≥ 2) among 3128 dementia-free individuals, and incident neurocognitive disorders (NCD) among 2640 cognitive normal individuals. Results: Individuals at high nutritional risk score (≥3) were more likely to develop cognitive decline (OR=1.42, 95%CI=1.01–1.99) and incident MCI-or-dementia (OR=1.64, 95%CI=1.03–2.59), controlling for age, sex, ethnicity, low education, APOE-e4, hearing loss, physical, social, and mental activities, depressive symptoms, smoking, alcohol, central obesity, hypertension, diabetes, low HDL, high triglyceride, cardiac disease, and stroke. Among ENIGMA component indicators, low albumin at baseline was associated with cognitive decline and incident NCD, and 5 or more drugs used, few fruits/vegetables/milk products daily, and low total cholesterol were associated with incident NCD. Conclusion: The ENIGMA measure of global malnutrition risk predicts cognitive decline and incident neurocognitive disorders, suggesting the feasibility of identifying vulnerable subpopulations of older adults for correction of malnutrition risk to prevent neurocognitive disorders. [ABSTRACT FROM AUTHOR]

This research proposes a novel deep learning approach named causal-temporal graphic convolutional network (CT-GCN) which aims to provide accurate predictions on tunnel boring machine's (TBM) load parameters. The causal associations among the key TBM operational parameters are detected and quantified with causal effects through the Peter and Clark momentary conditional independence plus (PCMCI+) method. The discovered causality can be further integrated with a deep learning model that consists of graph convolutional network (GCN) and long short-term memory (LSTM) layers for accurate prediction of TBM's torque and thrust. Data collected from a realistic tunnel project in Singapore is utilized to demonstrate the effectiveness of the proposed approach. The load parameters are predicted with their historical values and another 7 key operational parameters. The results indicate that (1) The proposed CT-GCN approach can achieve a low mean absolute error (MAE) and root mean squared error (RMSE) of 40.90 k N ∙ m and 64.53 k N ∙ m for thrust force (y 1) and that of 635.76 k N and 1168.59 k N for cutterhead torque (y 2), respectively. (2) The proposed CT-GCN method achieves 12.86 % and 24.38 % average improvements in the coefficient of determination ( R 2) for y 1 and y 2 , respectively when compared with the long-short term memory (LSTM) method and that of 5.62 % and 8.60 % improvements when compared with the GCN-LSTM method. (3) Compared with correlation-based GCN models, the proposed approach exerts an average improvement of 43.10 %, 41.97 %, and 22.72 % in terms of MAE, RMSE, and R 2 for torque and much better performance for thrust estimation. This study contributes to improving the understanding of TBM operation by quantifying the causality among the key operational parameters. It also contributes to developing a novel deep-learning method that estimates TBM's load parameters with high accuracy. [ABSTRACT FROM AUTHOR]

Background the relations of cigarette smoking and alcohol drinking with risk of cognitive impairment remain inconsistent. Methods to examine the independent and joint relations of smoking and alcohol drinking with cognitive impairment, we used data from 16,948 men and women, who had been followed-up for 16–23 (mean of 20) years as participants of the Singapore Chinese Health Study, a population-based prospective cohort. Data on smoking and alcohol drinking were collected at baseline (1993–98), when participants were aged 45–74 (mean 53) years. Cognition was assessed using a 30-item Mini-Mental State Examination during follow-up three visits (2014–16), when participants were aged 61–96 (mean 73) years. Multivariable logistic regression models were used to estimate the odd ratios (ORs) and 95% confidence intervals (CIs). Results cognitive impairment was present in 2,443 (14.4%) participants. Compared with non-current smokers, current smokers had 20% increased risk (OR = 1.20, 95% CI = 1.04–1.39). Compared with those who drank less than weekly, regular alcohol drinking (at least weekly) had 17% increased risk (OR = 1.17, 95% CI = 1.01–1.36). Compared with those who were neither smokers nor drinkers, those who were either current smokers or regular drinkers alone had no significantly increased risk, while the risk was highest in those who were both current smokers and regular drinkers (OR = 1.77, 95% CI = 1.39–2.26, P interaction = 0.003). Conclusions co-existence of smoking and regular alcohol drinking at midlife had a much stronger impact than the individual factors on risk of cognitive impairment in late life. [ABSTRACT FROM AUTHOR]

Coastal cities like Singapore and Jakarta have undergone rapid economic development in the past decades. There is an increasing demand for infrastructure upgrading. With climate changes and population increase, geotechnical design and construction are getting more and more challenging for coastal cities. We need to develop new technologies and new solutions to tackle the challenges and enhance our ability to fight disasters such as earthquake and flood. In this paper, four different solutions pertinent to geotechnical engineering for coastal cities are presented. The first is the establishment of a web-based 3D geological map to make better use of geological and geotechnical data and information for more reliable geotechnical design. The second is a new method for using dredged slurry or soft materials for land reclamation, as there is a shortage of granular fill materials in many cities. The third is the technology for construction of seawalls using suction caissons. The last solution is the biogas desaturation method for mitigation of soil liquefaction which is becoming the most cost-effective solution for prevention of liquefaction for a large area. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has been impacting on the whole world critically and constantly since late December 2019. Rapidly increasing infections has raised intense worldwide attention. How to model the evolution of COVID-19 effectively and efficiently is of great significance for prevention and control. Methods: We propose the multi-chain Fudan-CCDC model based on the original single-chain model in [Shao et al. 2020] to describe the evolution of COVID-19 in Singapore. Multi-chains can be considered as the superposition of several single chains with different characteristics. We identify the parameters of models by minimizing the penalty function. Results: The numerical simulation results exhibit the multi-chain model performs well on data fitting. Though unsteady the increments are, they could still fall within the range of _30% fluctuation from simulation results. Conclusion: The multi-chain Fudan-CCDC model provides an effective way to early detect the appearance of imported infectors and super spreaders and forecast a second outbreak. It can also explain the data from those countries where the single-chain model shows deviation from the data. [ABSTRACT FROM AUTHOR]

Seismic hazard assessment of metropolitan areas is an important topic in catastrophe risk management and disaster prevention. In this study, a probabilistic seismic hazard analysis (PSHA) is performed to estimate the seismic hazard for Singapore. The PSHA approach has been conducted based on the OpenQuake engine. An updated earthquake catalog for the neighboring region has been compiled from various sources, and three major source zones are identified using the updated earthquake catalog: Sumatra subduction zone, Sumatran strike–slip fault, and deformation–background zone. Also, 10 published ground motion prediction equations are incorporated in the logic-tree framework, which properly accounts for the epistemic uncertainty of ground motion intensity measures. The peak ground acceleration (PGA) values in the mean hazard maps at bedrock sites of Singapore for 10% and 2% exceedance probability in 50 years range from 0.04 to 0.05 g and from 0.14 to 0.15 g, respectively. The uniform hazard spectrum consisting of PGA and seven spectral accelerations is generated for rock sites in Singapore. Disaggregation analysis shows that the deformation zone identified contributes dominantly to the PGA hazard of Singapore, whereas the Sumatran strike–slip fault contributes dominantly to the long-period (spectral acceleration at 1.0 s) hazard. Besides, the seismic hazard maps for representative site conditions of Singapore are briefly presented. [ABSTRACT FROM AUTHOR]

Purpose: It is unclear if midlife consumption of dairy and soy food intake, and their components of calcium and isoflavones (in soy), is related to cognitive impairment in elderly. Methods: We used baseline data on lifestyle and habitual diet of 16,948 participants collected during their recruitment into the Singapore Chinese Health Study from 1993 to 1998, and data on their cognitive function, measured using a 30-item Singapore modified Mini-Mental State Examination, during follow-up interviews from 2014 to 2016. We used multivariable logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for developing cognitive impairment. Results: Higher dairy intake was associated with a lower risk of cognitive impairment in a dose-dependent manner (P for trend = 0.009). Compared to the lowest quartile of dairy intake, ORs (95% CIs) were 0.93 (0.81–1.07) for the second, 0.88 (0.76–1.01) for the third, and 0.82 (0.72–0.94) for the fourth quartiles of intake. Similar results were found for dairy calcium intake (P for trend = 0.008). However, there was no statistically significant association for intake of soy (OR comparing extreme quartiles 0.99, 95% CI 0.87–1.14, P for trend = 0.92), isoflavones (OR 1.01, 95% CI 0.88–1.15, P for trend = 0.90) or non-dairy calcium (OR 1.06, 95% CI 0.86–1.30, P for trend = 0.81) with risk of cognitive impairment. Conclusions: Dairy intake at midlife could have a protective association against cognitive impairment that may not be attributed to its calcium content alone, while soy or isoflavone intake was not associated with the cognition of elderly in our study. [ABSTRACT FROM AUTHOR]

Germline polymorphisms are linked with differential survival outcomes in cancers but are not well studied in nasopharyngeal carcinoma (NPC). Here, a two‐phase association study is conducted to discover germline polymorphisms that are associated with the prognosis of NPC. The discovery phase includes two consecutive hospital cohorts of patients with NPC from Southern China. Exome‐wide genotypes at 246 173 single nucleotide polymorphisms (SNPs) are determined, followed by survival analysis for each SNP under Cox proportional hazard regression model. Candidate SNP is replicated in another two independent cohorts from Southern China and Singapore. Meta‐analysis of all samples (n = 5553) confirms that the presence of rs1131636‐T, located in the 3′‐UTR of RPA1, confers an inferior overall survival (HR = 1.33, 95% CI = 1.20–1.47, P = 6.31 × 10−8). Bioinformatics and biological assays show that rs1131636 has regulatory effects on upstream RPA1. Functional studies further demonstrate that RPA1 promotes the growth, invasion, migration, and radioresistance of NPC cells. Additionally, miR‐1253 is identified as a suppressor for RPA1 expression, likely through regulation of its binding affinity to rs1131636 locus. Collectively, these findings provide a promising biomarker aiding in stratifying patients with poor survival, as well as a potential drug target for NPC. [ABSTRACT FROM AUTHOR]

Background: Multiple biomarkers have performed well in predicting type 2 diabetes mellitus (T2DM) risk in Western populations. However, evidence is scarce among Asian populations. Methods: Plasma triglyceride-to-high density lipoprotein (TG-to-HDL) ratio, alanine transaminase (ALT), high-sensitivity Creactive protein (hs-CRP), ferritin, adiponectin, fetuin-A, and retinol-binding protein 4 were measured in 485 T2DM cases and 485 age-and-sex matched controls nested within the prospective Singapore Chinese Health Study cohort. Participants were free of T2DM at blood collection (1999 to 2004), and T2DM cases were identified at the subsequent follow-up interviews (2006 to 2010). A weighted biomarker score was created based on the strengths of associations between these biomarkers and T2DM risks. The predictive utility of the biomarker score was assessed by the area under receiver operating characteristics curve (AUC). Results: The biomarker score that comprised of four biomarkers (TG-to-HDL ratio, ALT, ferritin, and adiponectin) was positively associated with T2DM risk (P trend <0.001). Compared to the lowest quartile of the score, the odds ratio was 12.0 (95% confidence interval [CI], 5.43 to 26.6) for those in the highest quartile. Adding the biomarker score to a base model that included smoking, history of hypertension, body mass index, and levels of random glucose and insulin improved AUC significantly from 0.81 (95% CI, 0.78 to 0.83) to 0.83 (95% CI, 0.81 to 0.86; P=0.002). When substituting the random glucose levels with glycosylated hemoglobin in the base model, adding the biomarker score improved AUC from 0.85 (95% CI, 0.83 to 0.88) to 0.86 (95% CI, 0.84 to 0.89; P=0.032). Conclusion: A composite score of blood biomarkers improved T2DM risk prediction among Chinese. [ABSTRACT FROM AUTHOR]

Background: Few prospective studies with long duration of follow-up have assessed the relations of body mass index (BMI) and weight change with cognitive function, especially in Asian populations.Objective: To investigate whether BMI and weight change in midlife are associated with cognitive impairment in old age.Methods: We used data from 14,691 participants in the Singapore Chinese Health Study and computed weight change as the difference between weight reported at baseline (1993-1998) at mean age of 53.0 years and follow-up 1 (1999-2004) at mean age of 58.6 years. Cognitive impairment was determined using education-specific cut-offs of the Singapore Modified Mini-Mental State Examination at follow-up 3 (2014-2016) at mean age of 72.9 years. We used multivariable logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations.Results: Obesity (as defined BMI ≥27.5 kg/m2) was associated with a higher risk of cognitive impairment at baseline (OR 1.33, 95% CI 1.12-1.58) and follow-up 1 (OR 1.30, 95% CI 1.10-1.54) compared to BMI of 18.5-22.9 kg/m2. Underweight (BMI <18.5 kg/m2) was not associated with a significant risk either at baseline (OR 0.91, 95% CI 0.73-1.13) or follow-up 1 (OR 1.05, 95% CI 0.85-1.28). Compared to participants with <5% weight change, the ORs (95% CIs) of cognitive impairment were 1.20 (1.03-1.41) for those with 5-9.9% weight loss, 1.53 (1.29-1.81) for ≥10% weight loss, 1.00 (0.85-1.17) for 5-9.9% weight gain, and 1.50 (1.28-1.75) for ≥10% weight gain.Conclusion: Obesity, weight loss, and excessive weight gain at midlife were associated with an increased risk of cognitive impairment at old age. [ABSTRACT FROM AUTHOR]

This paper exploits an administrative regulation in Singapore that allows individuals to withdraw between 10% and 30% of their pension savings at age 55. We find a large and highly significant increase in individuals' bank account balances within the first month of turning 55, which declines by about a third by the end of 12 months. Consumers use the increase in disposable income to pay down credit card debt. Liquidity constrained individuals are significantly more likely to increase their spending upon turning 55 than unconstrained individuals—nonetheless, the spending response of constrained individuals is concentrated on nondurable and nonvisible goods rather than visible goods. We also provide evidence that withdrawal behavior is responsive to the prices of durable goods such as cars. Consumers appear willing to forego much higher interest rates in their retirement accounts by leaving a sizeable portion of their withdrawn savings in a low-interest accruing bank account for at least a year after withdrawal. We show that, for some consumers, part of this behavior may be due to the desire to invest in the property market when housing returns are high. This paper was accepted by Gustavo Manso, finance. [ABSTRACT FROM AUTHOR]

Background Prospective studies linking dietary pattern and cognitive function in the elderly are limited in Asian populations. Objective We examined the associations between various healthful dietary patterns and risk of cognitive impairment in Chinese adults. Methods We used data from the Singapore Chinese Health Study of 16,948 men and women who were aged 45–74 y at baseline (1993–1998) and reinterviewed at the third follow-up visit (2014–2016), ∼20 y later. Diet quality at baseline was assessed according to the alternate Mediterranean diet (aMED), the Dietary Approaches to Stop Hypertension (DASH) diet, the alternative Healthy Eating Index (AHEI)-2010, overall plant-based diet index (PDI), and healthful plant-based diet index (hPDI). Cognitive function was evaluated using a Singapore-modified Mini-Mental State Examination during the third follow-up visit when subjects were aged 61–96 y. Multivariable logistic regression models were used to compute ORs and 95% CIs associated with the risk of cognitive impairment defined using education-specific cut-offs. Results Cognitive impairment was present in 2443 (14.4%) participants. The OR (95% CI) for cognitive impairment comparing the highest with the lowest quartile of diet quality scores was 0.67 (0.59, 0.77) for aMED, 0.71 (0.62, 0.81) for DASH, 0.75 (0.66, 0.85) for AHEI-2010, 0.82 (0.71, 0.94) for PDI, and 0.78 (0.68, 0.90) for hPDI (all P values for trend <0.001). Each SD increment in different diet quality scores was associated with 7–16% lower risk of cognitive impairment. Conclusions These results provide evidence that adherence to healthy dietary patterns in midlife is associated with a lower risk of cognitive impairment in late life in Chinese adults. [ABSTRACT FROM AUTHOR]

The wholesale electricity market is composed of real-time market and procurement. Since the fully liberalization of the energy market in Singapore in 2018, competition among the market participants has become intensive. Therefore, the forecast of the electricity price, including both Uniform Singapore Energy Price (USEP) and regulation price (REG), is essential for market participants to trade at the best possible price. This study proposes an event-driven forecast model to provide a real-time automatical price forecast of the wholesale electricity price using the cutting-edge regression tree ensembled algorithm, XGBoost. The model is triggered every half of an hour by the dispatch of the latest electricity price, which will be also used as the input together with other necessary training data from the historical price database. The training is finished within 1–2 min and the model makes the predictions on prices of the next 6 h. A better prediction has been demonstrated benchmarked to the forecast provided commercially by Energy Market Company. The forecast model only takes commercially available data as the input and is embedded with messaging broker, enabling online collaboration of different modules. The model is readily implemented, and thus can serve as an effective supplementary tool in virtual power plant operation with a higher renewable energy penetration in the future. • A wholesale electricity price forecast model is proposed based on XGBoost. • A real-time 6-h electricity price prediction is realized with an interval of 0.5 h. • Better prediction has been achieved benchmarked to the commercial forecast. • The model is operated automatically and readily implemented in virtual power plant operation. [ABSTRACT FROM AUTHOR]

How to scientifically measure corruption has become a key issue for both the anti-corruption research and practice. By introducing the search popularity of corruption-related topics in Google Trends, this paper proposes a comprehensive corruption index called Corruption Search Index (CSI). A novel search strategy is designed, aiming to adjust the search popularity data for the comparison among different countries. The empirical analysis of 63 countries along the Belt and Road shows that Singapore remains the cleanest status among these countries while Afghanistan is facing a serious corruption situation. [ABSTRACT FROM AUTHOR]

Background: Fetuin-A is a hepatokine that involved in the pathogenesis of insulin resistance. Previous epidemiological studies have found a positive association between blood fetuin-A and type 2 diabetes mellitus (T2DM) risk among Caucasians and African Americans. We aimed to investigate the prospective relationship between fetuin-A and T2DM in an Asian population for the first time. Methods: A nested case-control study was established within a prospective cohort of Chinese living in Singapore. At blood collection (1999 to 2004), all participants were free of diagnosed T2DM and aged 50 to 79 years. At subsequent follow-up (2006 to 2010), 558 people reported to have T2DM and were classified as incident cases, and 558 controls were randomly chosen from the participants who did not develop T2DM to match with cases on age, sex, dialect group, and date of blood collection. Plasma fetuin- A levels were measured retrospectively in cases and controls using samples collected at baseline. Conditional logistic regression models were used to compute the odds ratio (OR) and 95% confidence interval (CI). Restricted cubic spline analysis was used to examine a potential non-linear association between fetuin-A levels and T2DM risk. Results: Compared with those in the lowest fetuin-A quintile, participants in the highest quintile had a two-fold increased risk of developing T2DM (OR, 2.06; 95% CI, 1.21 to 3.51). A non-linear association was observed (P nonlinearity=0.005), where the association between fetuin-A levels and T2DM risk plateaued at plasma concentrations around 830 µg/mL. Conclusion: There is a positive association between plasma fetuin-A levels and risk of developing T2DM in this Chinese population. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether epigenetic mechanisms affecting gene expression may be involved in the pathogenesis of early-onset myopia, we performed genome-wide DNA methylation analyses of umbilical cord tissues, and assessed any associations between CpG site-specific methylation and the development of the disorder when the children were 3 years old. Methods: Genome-wide DNA methylation profiling of umbilical cord samples from 519 Singaporean infants involved in a prospective birth cohort ‘Growing Up in Singapore Towards healthy Outcomes’ (GUSTO) was performed using the Illumina Infinium HumanMethylation450K chip microarray. Multivariable logistic regression models were used to assess any associations between site-specific CpG methylation of umbilical cord tissue at birth and myopia risk in 3 year old children, adjusting for potential confounders. Gene expression of genes located near CpG sites that demonstrated statistically significant associations were measured in relevant ocular tissues using human and mouse fetal and adult eye samples. Results: We identified statistically significant associations between DNA methylation levels at five CpG sites and early-onset myopia risk after correcting for multiple comparisons using a false discovery rate of 5%. Two statistically significant CpG sites were identified in intergenic regions: 8p23(p = 1.70×10−7) and 12q23.2(p = 2.53×10−7). The remaining 3 statistically significant CpG sites were identified within the following genes: FGB (4q28, p = 3.60×10−7), PQLC1 (18q23, p = 8.9×10−7) and KRT12 (17q21.2, p = 1.2×10−6). Both PQLC1 and KRT12 were found to be significantly expressed in fetal and adult cornea and sclera tissues in both human and mouse. Conclusions: We identified five CpG methylation sites that demonstrate a statistically significant association with increased risk of developing early-onset myopia. These findings suggest that variability in the neonatal cord epigenome may influence early-onset myopia risk in children. Further studies of the epigenetic influences on myopia risk in larger study populations, and the associations with adulthood myopia risk are warranted. [ABSTRACT FROM AUTHOR]