Safran (Singapore)

Therapeutic vaccines may be promising treatments for chronic hepatitis B (CHB), but their clinical efficacy and safety are unclear. We conducted a systematic review of the evidence for the efficacy and safety of therapeutic vaccines in CHB patients. We searched PubMed, EMBASE and Google Scholar from 1990 until present and abstracts from EASL, APASL and AASLD from 2012 to 2017 and selected randomized controlled trials of CHB patients, comparing therapeutic vaccines with no treatment or standard of care. The Cochrane Risk of Bias tool v2.0 and GRADE method were used. Analyses were stratified by hepatitis B e antigen (HBeAg) status and the comparator (therapeutic vaccines vs no treatment, or therapeutic vaccines + standard of care vs standard of care). Efficacy outcomes were HBeAg seroconversion, hepatitis B virus DNA reduction and hepatitis B virus surface antigen (HBsAg) loss, measured at the end of treatment or end of follow-up. Effects were reported as risk differences with 95% confidence intervals using a random effects model. Fifteen studies were included. A wide variety of therapeutic vaccines were tested. For HBeAg clearance at the end of follow-up, when comparing therapeutic vaccines vs no therapy, RD = 0.01, 95% CI -0.05 to 0.07, and when comparing therapeutic vaccines + standard of care vs standard of care, RD = 0.03, 95% CI -0.03 to 0.09. For HBVDNA reduction at the end of follow-up, when comparing therapeutic vaccines vs no therapy, RD = -0.03, 95% CI -0.08 to 0.02, and when comparing therapeutic vaccines + standard of care, RD = 0.15, 95% CI 0.02-0.28. There were only a few studies on HBsAg loss, and hence, the findings were inconclusive. The only efficacy finding was HBVDNA reduction at the end of follow-up for therapeutic vaccines + standard of care vs standard of care; otherwise, therapeutic vaccines do not appear to be efficacious for the treatment of CHB, but were limited by few RCTs, suboptimal therapeutic vaccines and patient selection.

BACKGROUND: Aerosol-mediated delivery of nano-based therapeutics to the lung has emerged as a promising alternative for treatment and prevention of lung diseases. Superparamagnetic iron oxide nanoparticles (SPIONs) have attracted significant attention for such applications due to their biocompatibility and magnetic properties. However, information is lacking about the characteristics of nebulized SPIONs for use as a therapeutic aerosol. To address this need, we conducted a physicochemical characterization of nebulized Rienso, a SPION-based formulation for intravenous treatment of anemia. METHODS: Four different concentrations of SPION suspensions were nebulized with a one-jet nebulizer. Particle size was measured in suspension by transmission electron microscopy (TEM), photon correlation spectroscopy (PCS), and nanoparticle tracking analysis (NTA), and in the aerosol by a scanning mobility particle sizer (SMPS). RESULTS: The average particle size in suspension as measured by TEM, PCS, and NTA was 9±2 nm, 27±7 nm, and 56±10 nm, respectively. The particle size in suspension remained the same before and after the nebulization process. However, after aerosol collection in an impinger, the suspended particle size increased to 159±46 nm as measured by NTA. The aerosol particle concentration increased linearly with increasing suspension concentration, and the aerodynamic diameter remained relatively stable at around 75 nm as measured by SMPS. CONCLUSIONS: We demonstrated that the total number and particle size in the aerosol were modulated as a function of the initial concentration in the nebulizer. The data obtained mark the first known independent characterization of nebulized Rienso and, as such, provide critical information on the behavior of Rienso nanoparticles in an aerosol. The data obtained in this study add new knowledge to the existing body of literature on potential applications of SPION suspensions as inhaled aerosol therapeutics.

A comprehensive selection examination in the Republic of Singapore Air Force (RSAF) aims to minimise medical wastage of military pilots who have to function safely in the unnatural environment. Of the 8642 applicants examined, 657 (7.6%) were rejected for non-medical reasons before completion of medical examination. Of the remaining 7778, 58.7% passed the selection examination while 41.3% failed. Ophthalmological (34.3%), anthropometry (23.7%), and ENT (13.7%) conditions were the three major causes for failure (71.7%). Myopia and astigmatism accounted for 57.6% while squints accounted for 22.1% of the ophthalmological conditions. Amongst ENT conditions, 70.8% were for marked vasomotor rhinitis, sinusitis and nasal septum deviation with marked narrowing of one or both nasal passages, while 22.4% were for permanent abnormal hearing threshold shifts above the minimum standards.

AIM: To describe nutritional practices among preterm extremely low-birthweight (ELBW) infants and their impact on growth and to compare differences in nutritional intervention and comorbidities between those with limited growth velocity (GV < 25th percentile) and those with GV > 25th percentile. METHODS: A prospective cohort study was conducted to assess total protein and energy intake for week 1, days 14, 21 and 28 of life. Post-natal growth was calculated by measuring GV using an exponential model. Univariable analysis was applied to identify the potential risk factors associated with poor GV at day 28 and at discharge from hospital. RESULTS: The median GV from birth to day 28 was 9.84 g/kg/day and 11.87 g/kg/day for GV from birth to discharge. Increased protein and energy intake was associated with higher GV at discharge. Hypotension needing inotropes, necrotising enterocolitis (NEC), patent ductus arteriosus and chronic lung disease were significantly associated with reduced GV at discharge. Infants with NEC, hypotension needing inotropes and sepsis took a significantly longer time to achieve full enteral nutrition. A longer time to attain full enteral feeds was associated with slower GV at discharge. Small-for-gestational-age babies increased from 22% at birth to 66.6% at discharge. CONCLUSIONS: GV at discharge was positively correlated with increasing protein and energy intake in the first 28 days and adversely affected by the presence of neonatal morbidities. There was strong evidence of extra-uterine growth restriction, with the majority of preterm ELBW infants having lower z scores at discharge compared to at birth.

The Singapore Armed Forces has, since 1986, established a comprehensive smoking control programme which combines health education, counselling and administrative measures aimed at discouraging non-smokers from smoking, and encouraging smokers to quit the habit. The prevalence of regular smoking decreased from 28.6% in 1987 to 20.7% in 1993. The latest, 1993 survey as in past surveys covered 3,545 respondents, made up of regulars (32.0%), NSF (62.2%) and NUSAF (5.6%). The 1993 survey revealed that the majority of smokers (88.9%) in the SAF who consist primarily of 18 to 20-year-olds, had started smoking before enlistment. Most acquired the habit on their own (49.8%) or through influences outside the SAF (40.3%). Very few smokers became smokers through the influence of fellow soldiers (4.9%). The majority (87.7%) of smokers readily agreed that smoking is harmful, but this is not translated into practice. Health education efforts need to focus more on bringing about positive attitudinal and behavioural changes, rather than merely give information and advice. The young age of smoking onset (mean age of 14.3 years) In the SAF population surveyed points to the need to focus preventive efforts further upstream than hitherto emphasised.

Hardware and software of secured embedded systems are prone to physical attacks. In particular, fault injection attacks revealed vulnerabilities on the data and the control flow allowing an attacker to break cryptographic or secured algorithms implementations. While many research studies concentrated on successful attacks on the data flow, only a few targets the instruction flow. In this paper, we focus on electromagnetic fault injection (EMFI) on the control flow, especially on the instruction cache. We target the very widespread (smartphones, tablets, settop-boxes, health-industry monitors and sensors, etc.) ARMv7-M architecture. We describe a practical EMFI platform and present a methodology providing high control level and high reproducibility over fault injections. Indeed, we observe that a precise fault model occurs in up to 96% of the cases. We then characterize and exhibit this practical fault model on the cache that is not yet considered in the literature. We comprehensively describe its effects and show how it can be used to reproduce well known fault attacks. Finally, we describe how it can benefits attackers to mount new powerful attacks or simplify existing ones.

OBJECTIVES: Many nanomaterials (materials with structures smaller than 100 nm) have chemical, physical and bioactive characteristics of interest for novel applications. Considerable research efforts have been launched in this field. This study aimed to study exposure scenarios commonly encountered in research settings. METHODS: We studied one of the leading Swiss universities and first identified all research units dealing with nanomaterials. After a preliminary evaluation of quantities and process types used, a detailed analysis was conducted in units where more than a few micrograms were used per week. RESULTS: In the investigated laboratories, background levels were usually low and in the range of a few thousand particles per cubic centimeter. Powder applications resulted in concentrations of 10,000 to 100,000 particles/cm(3) when measured inside fume hoods, but there were no or mostly minimal increases in the breathing zone of researchers. Mostly low exposures were observed for activities involving liquid applications. However, centrifugation and lyophilization of nanoparticle-containing solutions resulted in high particle number levels (up to 300,000 particles/cm(3)) in work spaces where researchers did not always wear respiratory protection. No significant increases were found for processes involving nanoparticles bound to surfaces, nor were they found in laboratories that were visualizing properties and structure of small amounts of nanomaterials. CONCLUSIONS: Research activities in modern laboratories equipped with control techniques were associated with minimal releases of nanomaterials into the working space. However, the focus should not only be on processes involving nanopowders but should also be on processes involving nanoparticle-containing liquids, especially if the work involves physical agitation, aerosolization or drying of the liquids.

With the deployment of cameras for security control or identity verification, video streams become a common input for people tracking, behavior analysis or face recognition. Various methods have been proposed for these purposes, but their evaluation remains a core topic today. Indeed, due to the among of data in video streams, manual annotations limit the ground truth information that can be generated in reasonable time. Moreover, to validate an algorithm, various video streams should be used for the evaluation, to cover the variety of existing scenarios. The manual labeling of such a mass of data represents a considerable task.

BACKGROUND: Patients with persistent gastroesophageal reflux disease symptoms despite proton pump inhibitors are increasingly encountered. It remains controversial if proton pump inhibitors should be stopped before functional oesophageal tests. AIM: This meta-analysis compares the positive yield of oesophageal studies performed off versus on proton pump inhibitors. METHODS: Pubmed, Embase and the Cochrane Library were searched for eligible studies. Outcomes assessed were the number of subjects with: elevated oesophageal acid exposure time when studied off versus on proton pump inhibitors; positive symptom index (≥50%) and/or positive symptom association probability (≥95%) for acid reflux; and/or non-acid reflux events off versus on proton pump inhibitors. The random effects model was applied. RESULTS: = 5033 individuals; 33% on proton pump inhibitors; 32% men; mean age 52.1 years) were analysed. Pooled risk ratio for the comparison of high oesophageal acid exposure time off versus on proton pump inhibitors was 2.16 (95% confidence interval (CI) 1.42-3.28). The risk ratio of a positive symptom index (acid reflux) was 2.64 (95% CI 1.52-4.57) and the risk ratio of a positive symptom association probability (acid reflux) was 2.94 (95% CI 2.31-3.74). Conversely, the risk ratio of a positive symptom index (non-acid reflux) was 0.96 (95% CI 0.49-1.88) and risk ratio of a positive symptom association probability (non-acid reflux) was 0.54 (95% CI 0.30-0.99). CONCLUSIONS: Oesophageal studies after proton pump inhibitor cessation improve the positive yield for acid reflux-related events but reduce the detection of symptomatic non-acid reflux events.

BACKGROUND: Hospital-at-home (HaH) is increasingly adopted to expand hospital capacity, however, data from Asian healthcare remain limited. The study compares cost, utilisation, and clinical outcomes of HaH program compared to traditional hospital care in Singapore. METHODS: This prospective quasi-experimental study compared patients enrolled in the HaH programme with a comparator group of clinically eligible patients who received ward-based care because they lived outside the programme's catchment area or when HaH capacity was full. Adults admitted to two hospitals within an academic health system between January 2021 and May 2023 screened for eligibility based on clinical, social and functional criteria. The primary outcome was cost per bed day, with secondary outcomes including total episode cost, clinical outcomes, and patient-reported measures. Inverse probability treatment weighting was applied to balance baseline confounders, and regression analyses were used to evaluate outcomes. RESULTS: Among 302 patients (151 HaH, 151 ward), HaH patients were older (mean [SD] age, 58 [21] vs 51 [21] years) with higher Charlson Comorbidity Index (3 [3] vs 2 [3]). The top three diagnoses were cellulitis (43.0% HaH, 36.4% ward), urinary tract infection (17.9% HaH, 15.9% ward) and rhabdomyolysis (15.9% HaH, 23.8% ward). HaH had lower median cost per day S$676 (95% CI S$610 to S$742) and median cost per episode S$1,665 (95% CI S$765 to S$2,566) than ward group. No significant difference in weighted 30-day readmission risk (RR 1.2 [95% CI 0.56 to 2.58]; p-value = 0.65), 2 weeks post-discharge mean improvement in EQ-5D utility value (0.03 [95% CI -0.06 to 0.11; p-value = 0.54]) and EQ-VAS (1.0 [95% CI -3.7 to 5.6]; p-value = 0.69). There were two expected deaths in HaH and none in ward group. Weighted median lengths of stay in HaH and ward group were 5 and 4 days respectively (difference 1.0 [95% CI 0.2 to 1.8]; p-value = 0.02); HaH overall saved 682 hospital bed-days. CONCLUSION: For suitable patients, HaH care costs less than ward-based care, with no significant difference in clinical outcomes. TRIAL REGISTRATION: This study is registered at ClincialTrials.gov (NCT04330378, registration date 31 May 2020). It is funded by the National Medical Research Council (NMRC) Health Services Research Grant (HSRG) (MOH-000738).

Inco/Falconbridge: A nickel mine of applications in efficiencies and remedies* 1. Introduction Following an in-depth investigation, on 4 July 2006, the Commission approved the acquisition by…

A combination of gas release programmes and ownership unbundling as remedy to a problematic energy merger: E.ON / MOL* 1. Introduction Following an in-depth investigation, on 21 December…