Publications by authors named "Soh C"

262 Publications

Common and unique inhibitory control signatures of action-stopping and attentional capture suggest that actions are stopped in two stages.

J Neurosci 2021 Sep 7. Epub 2021 Sep 7.

Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52245

The ability to stop an already initiated action is paramount to adaptive behavior. Much scientific debate in the field of human action-stopping currently focuses on two interrelated questions. First: Which cognitive and neural processes uniquely underpin the implementation of inhibitory control when actions are stopped after explicit stop-signals, and which processes are instead commonly evoked by all salient signals, even those that do not require stopping? Second: Why do purported (neuro)physiological signatures of inhibition occur at two different latencies after stop-signals? Here, we address both questions via two pre-registered experiments that combined measurements of cortico-spinal excitability (CSE), electromyography (EMG), and whole-scalp electroencephalography (EEG). Adult human subjects performed a stop-signal task that also contained 'ignore' signals - equally salient signals that did not require stopping but rather completion of the Go response. We found that both stop- and ignore-signals produced equal amounts of early-latency inhibition of CSE and EMG, which took place ∼150ms following both signals. Multi-variate pattern analysis of the whole-scalp EEG data further corroborated that this early processing stage was shared between stop- and ignore-signals, as neural activity following the two signals could not be decoded from each other until a later time period. In this later period, unique activity related to stop-signals emerged at fronto-central scalp sites, reflecting an increased stop-signal P3. These findings suggest a two-step model of action-stopping, according to which an initial, universal inhibitory response to the saliency of the stop-signal is followed by a slower process that is unique to outright stopping.Humans often have to stop their ongoing actions when indicated by environmental stimuli (stop-signals). Successful action-stopping requires both the ability to detect these salient stop-signals and to subsequently inhibit ongoing motor programs. Because of this tight entanglement of attentional control and motor inhibition, identifying unique neurophysiological signatures of action-stopping is difficult. Indeed, we report that recently proposed early-latency signatures of motor inhibition during action-stopping are also found after salient signals that do not require stopping. However, using multi-variate pattern analysis of scalp-recorded neural data, we also identified subsequent neural activity that uniquely distinguished action-stopping from saliency detection. These results suggest that actions are stopped in two stages; the first common to all salient events, and the second unique to action-stopping.
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http://dx.doi.org/10.1523/JNEUROSCI.1105-21.2021DOI Listing
September 2021

Adjustments to Proactive Motor Inhibition without Effector-Specific Foreknowledge Are Reflected in a Bilateral Upregulation of Sensorimotor β-Burst Rates.

J Cogn Neurosci 2021 Apr;33(5):784-798

University of Iowa.

Classic work using the stop-signal task has shown that humans can use inhibitory control to cancel already initiated movements. Subsequent work revealed that inhibitory control can be proactively recruited in anticipation of a potential stop-signal, thereby increasing the likelihood of successful movement cancellation. However, the exact neurophysiological effects of proactive inhibitory control on the motor system are still unclear. On the basis of classic views of sensorimotor β-band activity, as well as recent findings demonstrating the burst-like nature of this signal, we recently proposed that proactive inhibitory control is implemented by influencing the rate of sensorimotor β-bursts during movement initiation. Here, we directly tested this hypothesis using scalp EEG recordings of β-band activity in 41 healthy human adults during a bimanual RT task. By comparing motor responses made in two different contexts-during blocks with or without stop-signals-we found that premovement β-burst rates over both contralateral and ipsilateral sensorimotor areas were increased in stop-signal blocks compared to pure-go blocks. Moreover, the degree of this burst rate difference indexed the behavioral implementation of proactive inhibition (i.e., the degree of anticipatory response slowing in the stop-signal blocks). Finally, exploratory analyses showed that these condition differences were explained by a significant increase in β bursting that was already present during baseline period before the movement initiation signal. Together, this suggests that the strategic deployment of proactive inhibitory motor control is implemented by upregulating the tonic inhibition of the motor system, signified by increased sensorimotor β-bursting both before and after signals to initiate a movement.
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http://dx.doi.org/10.1162/jocn_a_01682DOI Listing
April 2021

Associations between inappropriate medication use and (instrumental) activities of daily living in geriatric rehabilitation inpatients: RESORT study.

Aging Clin Exp Res 2021 Aug 9. Epub 2021 Aug 9.

Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, 300 Grattan Street, Parkville, VIC, 3050, Australia.

Background: Inappropriate medication use can affect functional independence in older adults.

Aims: The aim of the study is to examine associations between potentially inappropriate medication use and Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in geriatric rehabilitation inpatients.

Methods: A longitudinal, prospective, observational study was undertaken at a teaching hospital. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were measured at acute admission, and at admission and discharge from geriatric rehabilitation. Associations between PIM and PPO use and ADL and IADL scores were examined at admission to geriatric rehabilitation, discharge and 3-month post-discharge.

Results: A total of 693 inpatients were included. At the 3-month post-discharge, PPOs were associated with lower IADL scores (incident rate ratio = 0.868, 95% CI 0.776-0.972). There were no significant associations between PIMs and PPOs use at admission to geriatric rehabilitation with longitudinal changes of ADLs and IADLs from geriatric rehabilitation admission to 3-month post-discharge Renal PIMs were associated with higher IADL scores at 3-month post-discharge (incidence rate ratio = 1.750, 95% CI 1.238-2.474). At 3-month post-discharge, PPOs involving vaccinations were associated with a lower IADL score (incident risk ratio = 0.844, 95% CI 0.754-0.944).

Conclusions: Inappropriate medication use involving PPOs was associated with lower IADL scores at 3-month post-discharge from geriatric rehabilitation but not with ADL scores. Greater attention is needed in reducing PPOs in geriatric rehabilitation inpatients that can potentially impact IADLs. In the community, health professionals need to be vigilant about assessing how older patients' physical functioning may be affected by inappropriate medication prescribing.
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http://dx.doi.org/10.1007/s40520-021-01946-4DOI Listing
August 2021

Numerical modeling of pulsatile blood flow through a mini-oxygenator in artificial lungs.

Comput Methods Programs Biomed 2021 Sep 18;208:106241. Epub 2021 Jun 18.

International Intercollegiate Ph.D. Program, National Tsing Hua University, Hsinchu 30013, Taiwan; Department of Engineering and System Science, National Tsing Hua University, Hsinchu 30013, Taiwan; Institute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu 30013, Taiwan. Electronic address:

While previous in vitro studies showed divergent results concerning the influence of pulsatile blood flow on oxygen advection in oxygenators, no study was done to investigate the uncertainty affected by blood flow dynamics. The aim of this study is to utilize a computational fluid dynamics model to clarify the debate concerning the influence of pulsatile blood flow on the oxygen transport. The computer model is based on a validated 2D finite volume approach that predicts oxygen transfer in pulsatile blood flow passing through a 300-micron hollow-fiber membrane bundle with a length of 254 mm, a building block for an artificial lung device. In this study, the flow parameters include the steady Reynolds number (Re = 2, 5, 10 and 20), Womersley parameter (Wo = 0.29, 0.38 and 0.53) and sinusoidal amplitude (A = 0.25, 0.5 and 0.75). Specifically, the computer model is extended to verify, for the first time, the previously measured O transport that was observed to be hindered by pulsating flow in the Biolung, developed by Michigan Critical Care Consultants. A comprehensive analysis is carried out on computed profiles and fields of oxygen partial pressure (P) and oxygen saturation (S) as a function of Re, Wo and A. Based on the present results, we observe the positive and negative effects of pulsatile flow on P at different blood flow rates. Besides, the S variation is not much influenced by the pulsatile flow conditions investigated. While being consistent with a recent experimental study, the computed O volume flow rate is found to be increased at high blood flow rates operated with low frequency and high amplitude. Furthermore, the present study qualitatively explains that divergent outcomes reported in previous in vitro experimental studies could be owing to the different blood flow rates adopted. Finally, the contour analysis reveals how the spatial distributions of P and S vary over time.
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http://dx.doi.org/10.1016/j.cmpb.2021.106241DOI Listing
September 2021

Trajectories of functional performance recovery after inpatient geriatric rehabilitation: an observational study.

Med J Aust 2021 08 16;215(4):173-179. Epub 2021 Jun 16.

The University of Melbourne, Melbourne, VIC.

Objective: To identify functional performance trajectories and the characteristics of people who receive inpatient geriatric rehabilitation after hospital admissions.

Design, Setting, Participants: REStORing health of acutely unwell adulTs (RESORT) is an observational, prospective, longitudinal inception cohort study of consecutive patients admitted to geriatric rehabilitation wards at the Royal Melbourne Hospital. Recruitment commenced on 15 October 2017.

Main Outcome Measures: Functional performance, assessed with the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales two weeks before acute hospitalisation, on admission to and discharge from geriatric rehabilitation, and three months after discharge from geriatric rehabilitation.

Results: A total of 618 rehabilitation patients were included in our analysis. For each of the two scales, three distinct functional performance trajectories were identified by latent class growth modelling: poor at baseline and 3-month follow-up (remained poor: ADL, 6.6% of patients; IADL, 42%), good at baseline but poor recovery (deteriorated: ADL, 33%; IADL, 20%), and good at baseline and good recovery (recovered: ADL, 60%; IADL, 35%). Higher Clinical Frailty Scale (CFS) score (v recovered, per point: odds ratio [OR], 2.51; 95% CI, 1.64-3.84) and cognitive impairment (OR, 6.33; 95% CI, 2.09-19.1) were associated with greater likelihood of remaining poor in ADL, and also with deterioration (CFS score: OR, 1.76; 95% CI, 1.45-2.13; cognitive impairment: OR, 1.87; 95% CI, 1.24-2.82). Higher CFS score (OR, 1.64; 95% CI, 1.37-1.97) and cognitive impairment (OR, 3.60; 95% CI, 2.31-5.61) were associated with remaining poor in IADL, and higher CFS score was also associated with deterioration (OR, 1.63; 95% CI, 1.33-1.99).

Conclusions: Based on ADL assessments, most people who underwent inpatient geriatric rehabilitation regained their baseline functional performance. As higher CFS score and cognitive impairment were associated with poorer functional recovery, assessing frailty and cognition at hospital admission could assist intervention and discharge planning.
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http://dx.doi.org/10.5694/mja2.51138DOI Listing
August 2021

The importance of air quality for underground spaces: An international survey of public attitudes.

Indoor Air 2021 Jun 7. Epub 2021 Jun 7.

Culture Science Innovations, Nanyang Business School, Nanyang Technological University, Singapore, Singapore.

Space is a resource that is constantly being depleted, especially in mega-cities. Underground workspaces (UGS) are increasingly being included in urban plans and have emerged as an essential component of vertical cities. While progress had been made on the engineering aspects associated with the development of high-quality UGS, public attitudes toward UGS as work environments (ie, the public's design concerns with UGS) are relatively unknown. Here, we present the first large-scale study examining preferences and attitudes toward UGS, surveying close to 2000 participants from four cities in three continents (Singapore, Shanghai, London, and Montreal). Contrary to previous beliefs, air quality (and not lack of windows) is the major concern of prospective occupants. Windows, temperature, and lighting emerged as additional important building performance aspects for UGS. Early adopters (ie, individuals more willing to accept UGS and thus more likely to be the first occupants) across all cities prioritized air quality. Present results suggest that (perceived) air quality is a key building performance aspect for UGS that needs to be communicated to prospective occupants as this will improve their attitudes and views toward UGS. This study highlights the importance of indoor air quality for the public.
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http://dx.doi.org/10.1111/ina.12863DOI Listing
June 2021

Sebaceous carcinoma of the chest wall: A case report.

Radiol Case Rep 2021 Jul 25;16(7):1870-1873. Epub 2021 May 25.

Consultant Breast Surgeon Cambridge University Hospital NHS Trust, Cambridge and Anglia Ruskin School of Medicine, Cambridge, UK.

Sebaceous carcinoma is a rare, malignant tumor of the sebaceous glands. This is a case report of a 75-year-old man who presented with a right lower axillary mass which initially was considered to be a benign sebaceous cyst from sonography. The lesion rapidly changed in clinical and sonographic appearances and on histology was a sebaceous carcinoma. This unusual tumor accounts for less than 1% of all cutaneous malignant tumors, and the chest wall is a rare extraocular site with only nine cases described in the literature. Immunohistochemistry was negative for MSH2 and MSH6, and positive for MLH1 and PMS2, raising the possibility of Lynch or Muir-Torre Syndrome which is a known association with this rare tumor.
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http://dx.doi.org/10.1016/j.radcr.2021.04.060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166907PMC
July 2021

Malnutrition is associated with poor trajectories of activities of daily living in geriatric rehabilitation inpatients: RESORT.

Mech Ageing Dev 2021 07 16;197:111500. Epub 2021 May 16.

Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Healthy Longevity Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore. Electronic address:

Malnutrition is associated with poor functional performance in geriatric rehabilitation inpatients. However, it is unclear if malnourished patients have poor functional trajectories over time. This study aimed to determine the association between (the risk of) malnutrition at admission and trajectories of Activities of Daily Living (ADL) and Instrumental ADL (IADL) from pre-admission to post-discharge in geriatric rehabilitation inpatients. An observational, longitudinal study was conducted in the REStORing health of acutely unwell adulTs (RESORT) cohort of geriatric rehabilitation inpatients. A total of 618 patients (mean age 82.1 ± 7.8 years, 57.4 % females) were included. The prevalence of the risk of malnutrition, by Malnutrition Screening Tool (MST) was 41.3 % (n = 255) and malnutrition by the Global Leadership Initiative on Malnutrition (GLIM) and European Society for Clinical Nutrition and Metabolism (ESPEN) criteria were 53.5 % (n = 331) and 13.1 % (n = 81) respectively. Malnutrition by the GLIM criteria but not the ESPEN criteria nor the risk of malnutrition, was associated with ADL trajectories of 'remained poor' (OR: 3.33, 95 %CI: 1.21-9.19) and 'deteriorated' (OR: 1.68, 95 %CI: 1.13-2.52) compared to the 'recovered' trajectory. The risk of malnutrition and malnutrition were not associated with IADL trajectories. Malnutrition at admission was associated with poor ADL trajectories but not IADL trajectories in geriatric rehabilitation inpatients.
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http://dx.doi.org/10.1016/j.mad.2021.111500DOI Listing
July 2021

Spinal cord compression from hypertrophic nerve roots in chronic inflammatory demyelinating polyradiculoneuropathy - A case report.

Surg Neurol Int 2021 24;12:114. Epub 2021 Mar 24.

Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester, United Kingdom.

Background: Spinal cord compression secondary to nerve root hypertrophy is often attributed to hereditary neuropathies. However, to avoid misdiagnosis, rare immune-mediated neuropathy such as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) should not be overlooked. This report presents a case of multilevel nerve root hypertrophy leading to significant cord compression from CIDP.

Case Description: We report a 56-year-old gentleman with type two diabetes mellitus who presented with subacute cervical cord syndrome following a fall. Mixed upper and lower motor neuron features were noted on examination. Magnetic resonance imaging showed significant pan-spinal proximal nerve root hypertrophy, compressing the cervical spinal cord. Initial radiological opinion raised the possibility of neurofibromatosis type 1 (NF-1), but neurophysiology revealed both axonal and demyelinating changes that were etiologically non-specific. C6 root and sural nerve biopsies taken at cervical decompression displayed striking features suggestive for CIDP. Although NF-1 is the most observed condition associated with root hypertrophy, other important and potentially treatable differentials need to be entertained.

Conclusion: While rare, CIDP can cause significant spinal cord compression. Furthermore, clinical manifestations of CIDP can mimic those of inherited peripheral neuropathies. Neurologists and neurosurgeons should be aware of this condition to optimize subsequent therapeutic decision-making.
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http://dx.doi.org/10.25259/SNI_35_2021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053436PMC
March 2021

A Comparative Study of International and Asian Criteria for Overweight or Obesity at Workplaces in Singapore.

Asia Pac J Public Health 2021 05 14;33(4):404-410. Epub 2021 Mar 14.

Nanyang Technological University, Singapore.

To compare the prevalence of and risk factors associated with overweight or obesity between the international (body mass index [BMI] ≥25 kg/m) and Asian (BMI ≥23 kg/m) criteria in a working population in Singapore. This was a cross-sectional analysis of a cohort study of 464 employees (aged ≥21 years) conducted at 4 workplaces in Singapore. The prevalence of overweight or obesity was 47.4% and 67.0% with the international and Asian criteria, respectively. With both the criteria, higher age, male sex, Malay ethnicity (vs Chinese), lower white rice intake, and consumption of sugar-sweetened beverages were positively associated with overweight or obesity. Participants with poorer mental health and higher levels of thermal comfort in the workplace were positively associated with overweight or obesity only with the Asian criteria. The use of international criteria alone in this population could have overlooked these risk factors that are highly relevant to the Singapore context.
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http://dx.doi.org/10.1177/1010539521998855DOI Listing
May 2021

Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study.

BMC Nephrol 2021 02 22;22(1):63. Epub 2021 Feb 22.

Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore.

Background: Acute kidney injury is common in the surgical intensive care unit (ICU). It is associated with poor patient outcomes and high healthcare resource usage. This study's primary objective is to help identify which ICU patients are at high risk for acute kidney injury. Its secondary objective is to examine the effect of acute kidney injury on a patient's prognosis during and after the ICU admission.

Methods: A retrospective cohort of patients admitted to a Singaporean surgical ICU between 2015 to 2017 was collated. Patients undergoing chronic dialysis were excluded. The outcomes were occurrence of ICU acute kidney injury, hospital mortality and one-year mortality. Predictors were identified using decision tree algorithms. Confirmatory analysis was performed using a generalized structural equation model.

Results: A total of 201/940 (21.4%) patients suffered acute kidney injury in the ICU. Low ICU haemoglobin levels, low ICU bicarbonate levels, ICU sepsis, low pre-ICU estimated glomerular filtration rate (eGFR) and congestive heart failure was associated with the occurrence of ICU acute kidney injury. Acute kidney injury, together with old age (> 70 years), and low pre-ICU eGFR, was associated with hospital mortality, and one-year mortality. ICU haemoglobin level was discretized into 3 risk categories for acute kidney injury: high risk (haemoglobin ≤9.7 g/dL), moderate risk (haemoglobin between 9.8-12 g/dL), and low risk (haemoglobin > 12 g/dL).

Conclusion: The occurrence of acute kidney injury is common in the surgical ICU. It is associated with a higher risk for hospital and one-year mortality. These results, in particular the identified haemoglobin thresholds, are relevant for stratifying a patient's acute kidney injury risk.
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http://dx.doi.org/10.1186/s12882-021-02238-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898752PMC
February 2021

Adjustments to Proactive Motor Inhibition without Effector-Specific Foreknowledge Are Reflected in a Bilateral Upregulation of Sensorimotor β-Burst Rates.

J Cogn Neurosci 2021 Feb 5:1-16. Epub 2021 Feb 5.

University of Iowa.

Classic work using the stop-signal task has shown that humans can use inhibitory control to cancel already initiated movements. Subsequent work revealed that inhibitory control can be proactively recruited in anticipation of a potential stop-signal, thereby increasing the likelihood of successful movement cancellation. However, the exact neurophysiological effects of proactive inhibitory control on the motor system are still unclear. On the basis of classic views of sensorimotor β-band activity, as well as recent findings demonstrating the burst-like nature of this signal, we recently proposed that proactive inhibitory control is implemented by influencing the rate of sensorimotor β-bursts during movement initiation. Here, we directly tested this hypothesis using scalp EEG recordings of β-band activity in 41 healthy human adults during a bimanual RT task. By comparing motor responses made in two different contexts-during blocks with or without stop-signals-we found that premovement β-burst rates over both contralateral and ipsilateral sensorimotor areas were increased in stop-signal blocks compared to pure-go blocks. Moreover, the degree of this burst rate difference indexed the behavioral implementation of proactive inhibition (i.e., the degree of anticipatory response slowing in the stop-signal blocks). Finally, exploratory analyses showed that these condition differences were explained by a significant increase in β bursting that was already present during the premovement baseline period in stop blocks. Together, this suggests that the strategic deployment of proactive inhibitory motor control is implemented by upregulating the tonic inhibition of the motor system, signified by increased sensorimotor β-bursting both before and after signals to initiate a movement.
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http://dx.doi.org/10.1162/jocn_a_01682DOI Listing
February 2021

Comparison of Reusable Models in Pericardiocentesis Simulation Training.

Ann Acad Med Singap 2020 12;49(12):971-977

Emergency Medicine Department, National University Hospital, National University Health System, Singapore.

Introduction: Pericardiocentesis is a potentially life-saving procedure. We compared two low-cost models-an agar-based model and a novel model, Centesys-in terms of ultrasound image quality and realism, effectiveness of the model, and learners' confidence and satisfaction after training.

Methods: In this pilot randomised 2x2 crossover trial stratified by physician seniority, participants were assigned to undergo pericardiocentesis training either with the agar-based or Centesys model first, followed by the other model. Participants were asked to rate their confidence in performing ultrasound-guided pericardiocentesis, clarity and realism of cardiac structures on ultrasound imaging, and satisfaction on a 7-point Likert scale before and after training with each model.

Results: Twenty participants with median postgraduate year of 4 (interquartile range [IQR] 3.75-6) years were recruited. Pre-training, participants rated themselves a median score of 2.5 (IQR 2-4) for level of confidence in performing pericardiocentesis, which improved to 5 (IQR 4-6) post-training with Centesys (=0.007). Centesys was recognised to be more realistic in simulating cardiac anatomy on ultrasound (median 5 [IQR 4-5] versus 3.5 [IQR 3-4], =0.002) than the agar-based model. There was greater satisfaction with Centesys (median 5 [IQR 5-6] versus 4 [IQR 3.75-4], <0.001). All 20 participants achieved successful insertion of a pericardial drain into the simulated pericardial sac with Centesys.

Conclusion: Centesys achieved greater learner satisfaction as compared to the agar-based model, and was an effective tool for teaching ultrasound-guided pericardiocentesis and drain insertion.
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December 2020

Paired-pulse TMS and scalp EEG reveal systematic relationship between inhibitory GABA signaling in M1 and fronto-central cortical activity during action stopping.

J Neurophysiol 2021 02 13;125(2):648-660. Epub 2021 Jan 13.

Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa.

By stopping actions even after their initiation, humans can flexibly adapt ongoing behavior to changing circumstances. The neural processes underlying the inhibition of movement during action stopping are still controversial. In the 90s, a fronto-central event-related potential (ERP) was discovered in the human EEG response to stop signals in the classic stop-signal task, alongside a proposal that this "stop-signal P3" reflects an inhibitory process. Indeed, both amplitude and onset of the stop-signal P3 relate to overt behavior and movement-related EEG activity in ways predicted by the dominant models of action-stopping. However, neither EEG nor behavior allow direct inferences about the presence or absence of neurophysiological inhibition of the motor cortex, making it impossible to definitively relate the stop-signal P3 to inhibition. Here, we therefore present a multimethod investigation of the relationship between the stop-signal P3 and GABAergic signaling in primary motor cortex, as indexed by paired-pulse transcranial magnetic stimulation (TMS). In detail, we measured short-interval intracortical inhibition (SICI), a marker of inhibitory GABA activity in M1, in a group of 41 human participants who also performed the stop-signal task while undergoing EEG recordings. In line with the P3-inhibition hypothesis, we found that subjects with stronger inhibitory GABA activity in M1 also showed both faster onsets and larger amplitudes of the stop-signal P3. This provides direct evidence linking the properties of this ERP to a true physiological index of motor system inhibition. We discuss these findings in the context of recent theoretical developments and empirical findings regarding the neural implementation of motor inhibition. The neural mechanisms underlying rapid action stopping in humans are subject to intense debate, in part because recordings of neural signals purportedly reflecting inhibitory motor control are hard to directly relate to the true, physiological inhibition of motor cortex. For the first time, the current study combines EEG and transcranial magnetic stimulation (TMS) methods to demonstrate a direct correspondence between fronto-central control-related EEG activity following signals to cancel an action and the physiological inhibition of primary motor cortex.
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http://dx.doi.org/10.1152/jn.00571.2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948136PMC
February 2021

A Prospective Audit of Airway Code Activations and Adverse Events in Two Tertiary Hospitals.

Ann Acad Med Singap 2020 11;49(11):876-884

Department of Anaesthesiology, Division of Anaesthesiology and Perioperative Sciences, Singapore General Hospital, Singapore.

Introduction: Airway management outside the operating room can be challenging, with an increased risk of difficult intubation, failed intubation and complications. We aim to examine airway practices, incidence of difficult airway and complications associated with airway code (AC) activation.

Methods: We conducted a prospective audit of AC activations and adverse events in two tertiary hospitals in Singapore. We included all adult patients outside the operating room who underwent emergency intubation by the AC team after AC activation. Adult patients who underwent emergency intubation without AC activation or before the arrival of the AC team were excluded. Data were collected and documented by the attending anaesthetists in a standardised survey form shortly after their responsibilities were completed.

Results: The audit was conducted over a 20-month period from July 2016 to March 2018, during which a total of 224 airway activations occurred. Intubation was successful in 218 of 224 AC activations, giving a success rate of 97.3%. Overall, 48 patients (21.4%) suffered an adverse event. Thirteen patients (5.8%) had complications when intubation was carried out by the AC team compared with 35 (21.5%) by the non-AC team.

Conclusion: Dedicated AC team offers better success rate for emergency tracheal intubation. Non-AC team attempted intubation in the majority of the cases before the arrival of the AC team. Increased intubation attempts are associated with increased incidence of adverse events. Equipment and patient factors also contributed to the adverse events. A multidisciplinary programme including the use of supraglottic devices may be helpful to improve the rate of success and minimise complications.
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November 2020

Do morbidity measures predict the decline of activities of daily living and instrumental activities of daily living amongst older inpatients? A systematic review.

Int J Clin Pract 2021 Apr 14;75(4):e13838. Epub 2020 Dec 14.

Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.

Objectives: Older adults often suffer from multimorbidity, which results in hospitalisations. These are often associated with poor health outcomes such as functional dependence and mortality. The aim of this review was to summarise the current literature on the capacities of morbidity measures in predicting activities of daily living (ADL) and instrumental activities of daily living (IADL) amongst inpatients.

Methods: A systematic literature search was performed using four databases: Medline, Cochrane, Embase, and Cinahl Central from inception to 6th March 2019. Keywords included comorbidity, multimorbidity, ADL, and iADL, along with specific morbidity measures. Articles reporting on morbidity measures predicting ADL and IADL decline amongst inpatients aged 65 years or above were included.

Results: Out of 7334 unique articles, 12 articles were included reporting on 7826 inpatients (mean age 77.6 years, 52.7% females). Out of five morbidity measures, the Charlson Comorbidity Index was most often reported. Overall, morbidity measures were poorly associated with ADL and IADL decline amongst older inpatients.

Conclusion: Morbidity measures are poor predictors for ADL or IADL decline amongst older inpatients and follow-up duration does not alter the performance of morbidity measures.
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http://dx.doi.org/10.1111/ijcp.13838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047900PMC
April 2021

Unexpected Sounds Nonselectively Inhibit Active Visual Stimulus Representations.

Cereb Cortex 2021 02;31(3):1632-1646

Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52245, USA.

The brain's capacity to process unexpected events is key to cognitive flexibility. The most well-known effect of unexpected events is the interruption of attentional engagement (distraction). We tested whether unexpected events interrupt attentional representations by activating a neural mechanism for inhibitory control. This mechanism is most well characterized within the motor system. However, recent work showed that it is automatically activated by unexpected events and can explain some of their nonmotor effects (e.g., on working memory representations). Here, human participants attended to lateralized flickering visual stimuli, producing steady-state visual evoked potentials (SSVEPs) in the scalp electroencephalogram. After unexpected sounds, the SSVEP was rapidly suppressed. Using a functional localizer (stop-signal) task and independent component analysis, we then identified a fronto-central EEG source whose activity indexes inhibitory motor control. Unexpected sounds in the SSVEP task also activated this source. Using single-trial analyses, we found that subcomponents of this source differentially relate to sound-induced SSVEP changes: While its N2 component predicted the subsequent suppression of the attended-stimulus SSVEP, the P3 component predicted the suppression of the SSVEP to the unattended stimulus. These results shed new light on the processes underlying fronto-central control signals and have implications for phenomena such as distraction and the attentional blink.
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http://dx.doi.org/10.1093/cercor/bhaa315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869093PMC
February 2021

Leukoencephalopathy with calcifications and cysts: Genetic and phenotypic spectrum.

Am J Med Genet A 2021 01 7;185(1):15-25. Epub 2020 Oct 7.

Department of Paediatric Neurology, University Hospital of Wales, Cardiff, UK.

Biallelic mutations in SNORD118, encoding the small nucleolar RNA U8, cause leukoencephalopathy with calcifications and cysts (LCC). Given the difficulty in interpreting the functional consequences of variants in nonprotein encoding genes, and the high allelic polymorphism across SNORD118 in controls, we set out to provide a description of the molecular pathology and clinical spectrum observed in a cohort of patients with LCC. We identified 64 affected individuals from 56 families. Age at presentation varied from 3 weeks to 67 years, with disease onset after age 40 years in eight patients. Ten patients had died. We recorded 44 distinct, likely pathogenic, variants in SNORD118. Fifty two of 56 probands were compound heterozygotes, with parental consanguinity reported in only three families. Forty nine of 56 probands were either heterozygous (46) or homozygous (three) for a mutation involving one of seven nucleotides that facilitate a novel intramolecular interaction between the 5' end and 3' extension of precursor-U8. There was no obvious genotype-phenotype correlation to explain the marked variability in age at onset. Complementing recently published functional analyses in a zebrafish model, these data suggest that LCC most often occurs due to combinatorial severe and milder mutations, with the latter mostly affecting 3' end processing of precursor-U8.
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http://dx.doi.org/10.1002/ajmg.a.61907DOI Listing
January 2021

Caregiver- and Child-Reported Anxiety Using an Autism-Specific Measure: Measurement Properties and Correlates of the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD) in Verbal Young People with ASD.

J Autism Dev Disord 2021 Aug;51(8):2646-2662

General Psychiatry, Institute of Mental Health, Singapore, Singapore.

Identifying and measuring anxiety in young people on the autism spectrum can be challenging. The present study investigated the use of the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD), a self- and caregiver-rated screening tool in a Singaporean sample of ninety-one verbal autistic youths and their caregivers. Internal consistency ranged from satisfactory to desirable (α = .74-.92). Convergent validity with medium-large effect size was established using a structured diagnostic interview, the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). ASC-ASD scores were positively associated with autistic symptoms and response patterns indicated strong endorsement of autism-specific items. The findings are discussed in relation to existing literature on assessment of anxiety in ASD and in light of the study's strengths and limitations.
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http://dx.doi.org/10.1007/s10803-020-04739-2DOI Listing
August 2021

Factors associated with health-related quality of life in a working population in Singapore.

Epidemiol Health 2020 30;42:e2020048. Epub 2020 Jun 30.

Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.

Objectives: This study aimed to evaluate the determinants of health-related quality of life (HRQoL) among workers in Singapore.

Methods: We analysed data from a cross-sectional study of 464 participants from 4 companies in Singapore. Physical and mental components of HRQoL were assessed using the Short-Form 36 version 2.0 survey. A generalized linear model was used to determine factors associated with the physical component summary (PCS) and mental component summary (MCS) scores of HRQoL.

Results: The overall mean PCS and MCS scores were mean±standard deviation 51.6±6.7 and 50.2±7.7, respectively. The scores for subscales ranged from 62.7±14.7 for vitality to 83.5±20.0 for role limitation due to emotional problems. Ethnicity, overweight/obesity, and years working at the company were significantly associated with physical HRQoL, and age and stress at work were significantly associated with mental HRQoL. Moreover, sleep quality was significantly associated with both physical and mental HRQoL.

Conclusions: These findings could help workplaces in planning strategies and initiatives for employees to maintain a worklife balance that encompasses their physical, emotional, and social well-being.
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http://dx.doi.org/10.4178/epih.e2020048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871151PMC
September 2020

Anaesthesia and intensive care medicine in a COVID-19 pandemic.

Singapore Med J 2020 Jun 26. Epub 2020 Jun 26.

Division of Anaesthesiology, Singapore General Hospital, Singapore.

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http://dx.doi.org/10.11622/smedj.2020094DOI Listing
June 2020

Employee experiences in underground workplaces: a qualitative investigation.

Ergonomics 2020 Nov 18;63(11):1337-1349. Epub 2020 Jun 18.

Civil and Environmental Engineering, Nanyang Technological University, Singapore, Singapore.

Underground workplaces (UWS) are increasingly being recognised as a sustainable solution to concerns regarding lack of space facing megacities. UWS can multiply available space by reducing urban sprawl thereby improving quality of life in cities. However, developing workplaces that respond to the needs and preferences of occupants will be a crucial factor in determining the success of this concept. We examine the experiences of existing full-time employees of a large underground facility in North America and analyse how these are related to company policies and other organisational factors. From in-depth interviews of 73 participants, three predominant themes emerged from the analyses: environmental effects (e.g. lack of sunlight), design (e.g. the unique working environment), and organisational factors and social dynamics (e.g. policies regarding breaks). We discuss these themes in relation with interventions that may improve employee comfort and retention and suggest that many factors are within organisational control. Underground workplaces are a sustainable solution to lack of urban space. However, developing effective workplaces is crucial to their success. We examine the experiences of existing employees of an underground facility in North America. We suggest that most negative attitudes towards underground spaces can be mitigated through simple organisational interventions. UWS: underground workplaces; IRB: institutional review board.
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http://dx.doi.org/10.1080/00140139.2020.1780306DOI Listing
November 2020

Associations of perceived indoor environmental quality with stress in the workplace.

Indoor Air 2020 11 22;30(6):1166-1177. Epub 2020 Jun 22.

Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.

Indoor environmental quality (IEQ) is a general indicator of the quality of conditions inside a building. We investigated associations of perceived IEQ including air quality, thermal comfort, noise, and light quality with stress at work and the extent to which workplace location modifies these associations. We recruited 464 full-time workers from four companies in Singapore. Data on socio-demographic characteristics, lifestyle/health-related factors, and workplace factors were collected through self-administered questionnaires. Perceived IEQ satisfaction scores of all four factors were collected using the validated OFFICAIR questionnaire. We fitted a logistic regression model to assess associations between each perceived IEQ score and stress at work, adjusting for potential confounders. The odds ratio for stress at work associated with a 1-unit increase in perceived air quality score was 0.88 (0.82-0.94), 0.89 (0.82-0.97) for thermal comfort, 0.93 (0.87-0.98) for noise, and 0.88 (0.82-0.94) for light quality. Significant associations were found in office and control rooms for all four perceived IEQ, except for thermal comfort in office rooms. Higher satisfaction levels of perceived air quality, thermal comfort, noise, and lighting, were significantly associated with a reduction in stress at work. Our findings could potentially provide a useful tool for environmental health impact assessment for buildings.
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http://dx.doi.org/10.1111/ina.12696DOI Listing
November 2020

Clinical and neuroradiological characterisation of spinal lesions in adults with Neurofibromatosis type 1.

J Clin Neurosci 2020 Jul 13;77:98-105. Epub 2020 May 13.

Neurosurgery, Salford Royal Foundation Trust, Manchester, United Kingdom. Electronic address:

Neurofibromatosis type 1 (NF1) manifests itself in many ways in the spine. This study aims to report the types of spinal lesions, clinical and demographic data in a large cohort from a complex NF1 centre. The characteristics of those with spinal neurofibromatosis, where neurofibromas are present on every spinal nerve root, were sought for comparison with the wider group of NF1 patients. This is a retrospective review of MDT minutes of 303 patients from a UK NF1 centre and the largest reported series of NF1 patients based on radiological data. Prevalence of each symptom and lesion was calculated and statistically significant associations were established. The most reported findings were cutaneous lesions (44.9%) and neurological deficit (27.4%). 28.4% had dural ectasia, 52.5% had some form of spinal deformity. 57.8% had spinal nerve root tumours, the most common of which were at C2. The most progressive lesions were spinal nerve root tumours (29.1%). The only statistically significant association found was between dural ectasia and spinal deformity (P < 0.003), where dural ectasia is associated with a 32.6% increase in spinal deformity incidence. This is the largest descriptive study of spinal lesions in NF1. Spinal tumours and spinal deformity are prevalent in NF1. The predilection of spinal tumours for flexible spinal regions suggests that repetitive movement might be an important factor in pathogenesis. Physicians and patients should be alert to the observation that although many spinal neurofibromatosis patients display no neurological deficit, they often have significant lesions which require monitoring and sometimes surgery.
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http://dx.doi.org/10.1016/j.jocn.2020.05.014DOI Listing
July 2020

Synthesis and biological evaluation of 6-phenylpurine linked hydroxamates as novel histone deacetylase inhibitors.

Bioorg Chem 2020 05 4;98:103724. Epub 2020 Mar 4.

Drug Development Unit, Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, 61 Biopolis Drive, Proteos, Singapore 138673, Republic of Singapore; Probit Pharmaceuticals Pte. Ltd., 10 Anson Road #27-15, Singapore 079903, Republic of Singapore. Electronic address:

A series of 6-phenylpurine based hydroxamates have been designed, synthesized and evaluated. Compound 3b and its analogs are potent histone deacetylase (HDAC) but weak PI3K/mTOR inhibitors. These compounds demonstrated broad anti-cancer activities against 38 cancer cell lines with leukemia, lymphoma, and the majority of liver cancer cell lines exhibiting the most sensitivity towards these compounds. Compound 3b demonstrated modulation of HDAC targets in vitro in a dose-dependent manner. It has good in vitro ADME profile that translated into a greatly improved pharmacokinetic profile. 3b also demonstrated modulation of HDACs in tumors in a PC-3 xenograft model. It was further evaluated in combination therapies in vitro. It exhibited additive or synergistic growth inhibition effect in HepG2 cells when combined with a number of approved drugs such as sorafenib, sunitinib, and erlotinib. Hence, 3b has the potential to be combined with the above to treat advanced liver cancer. As such, current data warrant further evaluation, optimization, and subsequent in vivo validation of the potential combination therapies.
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http://dx.doi.org/10.1016/j.bioorg.2020.103724DOI Listing
May 2020

Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore.

Can J Anaesth 2020 06 11;67(6):732-745. Epub 2020 Mar 11.

Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.

The coronavirus disease 2019 (COVID-19) outbreak has been designated a public health emergency of international concern. To prepare for a pandemic, hospitals need a strategy to manage their space, staff, and supplies so that optimum care is provided to patients. In addition, infection prevention measures need to be implemented to reduce in-hospital transmission. In the operating room, these preparations involve multiple stakeholders and can present a significant challenge. Here, we describe the outbreak response measures of the anesthetic department staffing the largest (1,700-bed) academic tertiary level acute care hospital in Singapore (Singapore General Hospital) and a smaller regional hospital (Sengkang General Hospital). These include engineering controls such as identification and preparation of an isolation operating room, administrative measures such as modification of workflow and processes, introduction of personal protective equipment for staff, and formulation of clinical guidelines for anesthetic management. Simulation was valuable in evaluating the feasibility of new operating room set-ups or workflow. We also discuss how the hierarchy of controls can be used as a framework to plan the necessary measures during each phase of a pandemic, and review the evidence for the measures taken. These containment measures are necessary to optimize the quality of care provided to COVID-19 patients and to reduce the risk of viral transmission to other patients or healthcare workers.
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http://dx.doi.org/10.1007/s12630-020-01620-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090449PMC
June 2020

Association between shift work and poor sleep quality in an Asian multi-ethnic working population: A cross-sectional study.

PLoS One 2020 4;15(3):e0229693. Epub 2020 Mar 4.

Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.

Background: We aimed to examine the association between shift work and sleep quality in a diverse occupational type.

Methods: This was a cross-sectional study of self-reported sleep quality in 424 workers aged ≥21 using the Pittsburgh Sleep Quality Index (PSQI). We divided workers into two categories based on their PSQI score: (a) ≤5 (good sleep quality) and (b) >5 (poor sleep quality). We used multiple logistic regressions to assess the association between shift work and sleep quality adjusted for potential confounders.

Results: The mean age was 39.2 (SD = 11.3) years, with shift workers being older than their counterparts. Most workers were of Chinese ethnicity (63.9%). Males were significantly more likely to undertake shift work than females (89% v 11%, p-value<0.001), but it should be noted that the majority of workers was male (78.8%) in this sample of workers. Shift workers had a 198% increased odds of poor sleep quality compared to non-shift workers (OR = 2.98; 95% CI:1.53-5.81).

Conclusion: Shift work was significantly and independently associated with increased odds of poor sleep quality in this sample of workers. The present findings may inform employment guidelines and help develop workplace health promotion interventions aimed at improving sleep quality among workers and ultimately lead to a healthier workforce.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229693PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055880PMC
June 2020

Activity Tracker-Based Metrics as Digital Markers of Cardiometabolic Health in Working Adults: Cross-Sectional Study.

JMIR Mhealth Uhealth 2020 01 31;8(1):e16409. Epub 2020 Jan 31.

Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.

Background: Greater adoption of wearable devices with multiple sensors may enhance personalized health monitoring, facilitate early detection of some diseases, and further scale up population health screening. However, few studies have explored the utility of data from wearable fitness trackers in cardiovascular and metabolic disease risk prediction.

Objective: This study aimed to investigate the associations between a range of activity metrics derived from a wearable consumer-grade fitness tracker and major modifiable biomarkers of cardiometabolic disease in a working-age population.

Methods: This was a cross-sectional study of 83 working adults. Participants wore Fitbit Charge 2 for 21 consecutive days and went through a health assessment, including fasting blood tests. The following clinical biomarkers were collected: BMI, waist circumference, waist-to-hip ratio, blood pressure, triglycerides (TGs), high-density lipoprotein (HDL) and low-density lipoprotein cholesterol, and blood glucose. We used a range of wearable-derived metrics based on steps, heart rate (HR), and energy expenditure, including measures of stability of circadian activity rhythms, sedentary time, and time spent at various intensities of physical activity. Spearman rank correlation was used for preliminary analysis. Multiple linear regression adjusted for potential confounders was used to determine the extent to which each metric of activity was associated with continuous clinical biomarkers. In addition, pairwise multiple regression was used to investigate the significance and mutual dependence of activity metrics when two or more of them had significant association with the same outcome from the previous step of the analysis.

Results: The participants were predominantly middle aged (mean age 44.3 years, SD 12), Chinese (62/83, 75%), and male (64/83, 77%). Blood biomarkers of cardiometabolic disease (HDL cholesterol and TGs) were significantly associated with steps-based activity metrics independent of age, gender, ethnicity, education, and shift work, whereas body composition biomarkers (BMI, waist circumference, and waist-to-hip ratio) were significantly associated with energy expenditure-based and HR-based metrics when adjusted for the same confounders. Steps-based interdaily stability of circadian activity rhythm was strongly associated with HDL (beta=5.4 per 10% change; 95% CI 1.8 to 9.0; P=.005) and TG (beta=-27.7 per 10% change; 95% CI -48.4 to -7.0; P=.01). Average daily steps were negatively associated with TG (beta=-6.8 per 1000 steps; 95% CI -13.0 to -0.6; P=.04). The difference between average HR and resting HR was significantly associated with BMI (beta=-.5; 95% CI -1.0 to -0.1; P=.01) and waist circumference (beta=-1.3; 95% CI -2.4 to -0.2; P=.03).

Conclusions: Wearable consumer-grade fitness trackers can provide acceptably accurate and meaningful information, which might be used in the risk prediction of cardiometabolic disease. Our results showed the beneficial effects of stable daily patterns of locomotor activity for cardiometabolic health. Study findings should be further replicated with larger population studies.
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http://dx.doi.org/10.2196/16409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055791PMC
January 2020

Morbidity Measures Predicting Mortality in Inpatients: A Systematic Review.

J Am Med Dir Assoc 2020 04 14;21(4):462-468.e7. Epub 2020 Jan 14.

Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands. Electronic address:

Objectives: Morbidity is an important risk factor for mortality and a variety of morbidity measures have been developed to predict patients' health outcomes. The objective of this systematic review was to compare the capacity of morbidity measures in predicting mortality among inpatients admitted to internal medicine, geriatric, or all hospital wards.

Design: A systematic literature search was conducted from inception to March 6, 2019 using 4 databases: Medline, Embase, Cochrane, and CINAHL. Articles were included if morbidity measures were used to predict mortality (registration CRD42019126674).

Setting And Participants: Inpatients with a mean or median age ≥65 years.

Measurements: Morbidity measures predicting mortality.

Results: Of the 12,800 articles retrieved from the databases, a total of 34 articles were included reporting on inpatients admitted to internal medicine, geriatric, or all hospital wards. The Charlson Comorbidity Index (CCI) was reported most frequently and a higher CCI score was associated with greater mortality risk, primarily at longer follow-up periods. Articles comparing morbidity measures revealed that the Geriatric Index of Comorbidity was better predicting mortality risk than the CCI, Cumulative Illness Rating Scale, Index of Coexistent Disease, and disease count.

Conclusions And Implications: Higher morbidity measure scores are better in predicting mortality at longer follow-up period. The Geriatric Index of Comorbidity was best in predicting mortality and should be used more often in clinical practice to assist clinical decision making.
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http://dx.doi.org/10.1016/j.jamda.2019.12.001DOI Listing
April 2020

Prevalence of Vitamin D Deficiency and Its Associated Work-Related Factors among Indoor Workers in a Multi-Ethnic Southeast Asian Country.

Int J Environ Res Public Health 2019 12 25;17(1). Epub 2019 Dec 25.

Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore.

Little is known about the effect of working conditions on vitamin D status in Southeast Asia, where vitamin D deficiency is common despite the presence of sunlight all year round in most places. We examined the prevalence of vitamin D deficiency and its associated work-related factors among indoor workers using the data of 213 participants (aged ≥21 years) from a workplace cohort study in Singapore. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25(OH)D) concentration <50 nmol/L. Data on work-related factors, socio-demographic characteristics, and lifestyle habits were collected using standardized questionnaires. Clinical and biochemical measurements were performed using standard tools and protocols. Multivariate Poisson regression was used to examine the independent association of work-related factors with vitamin D deficiency. Mean serum 25(OH)D concentration was 59.6 nmol/L. The prevalence of vitamin D deficiency was 32.9% (95% confidence interval (CI): 26.6-39.6%). In the multivariate analysis, office workers (prevalence ratio (PR): 2.16, 95% CI: 1.12-4.16 versus control room workers), workshop workers (PR: 2.25, 95% CI: 1.05-4.81 versus control room workers), and night shift workers (PR: 1.31, 95% CI: 1.03-1.67) were at a greater risk for vitamin D deficiency. Workplace policies and wellness programs should encourage workers to take regular breaks to go outdoors for sunlight exposure and to consume adequate amounts of vitamin D-rich foods to maintain optimal vitamin D levels.
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http://dx.doi.org/10.3390/ijerph17010164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6981433PMC
December 2019
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