Travel has been identified as a significant contributor to psychological well-being. The recent COVID-19 global pandemic disrupted travel patterns and behaviours, thereby negatively affecting the ...psychological health and well-being of those involved. With accelerating technology use, multiple forms of virtual tourism have emerged as alternatives to physical travel, including travel via webcam. Webcam travel has received limited scholarly attention, despite the unique capacity of global place-based webcams to offer cost-free, real-time viewing of places and destinations. Similarly, there has been limited research on how participation in webcam travel influences psychological well-being. This research note examines how the digital experience accelerates the hedonic and eudaimonic psychological well-being of webcam viewers by proposing a new model – Webcam Travel DREAMA (detachment-recovery, engagement, affiliation, meaning and achievement) model. The findings provide a better understanding of webcam travel and psychological well-being, establishing potential directions for future researchers.
Objectives
To evaluate the impact of intralesional heterogeneity on the performance of multiparametric magnetic resonance imaging (mpMRI) in determining cancer extent and treatment margins for focal ...therapy (FT) of prostate cancer.
Patients and Methods
We identified men who underwent primary radical prostatectomy for organ‐ confined prostate cancer over a 3‐year period. Cancer foci on whole‐mount histology were marked out, coding low‐grade (LG; Gleason 3) and high‐grade (HG; Gleason 4–5) components separately. Measurements of entire tumours were grouped according to intralesional proportion of HG cancer: 0%, <50% and ≥50%; the readings were corrected for specimen shrinkage and correlated with matching lesions on mpMRI. Separate measurements were also taken of HG cancer components only, and correlated against entire lesions on mpMRI. Size discrepancies were used to derive the optimal tumour size and treatment margins for FT.
Results
There were 122 MRI‐detected cancer lesions in 70 men. The mean linear specimen shrinkage was 8.4%. The overall correlation between histology and MRI dimensions was r = 0.79 (P < 0.001). Size correlation was superior for tumours with high burden (≥50%) compared to low burden (<50%) of HG cancer (r = 0.84 vs r = 0.63; P = 0.007). Size underestimation by mpMRI was more likely for larger tumours (51% for >12 mm vs 26% for ≤12 mm) and those containing HG cancer (44%, vs 20% for LG only). Size discrepancy analysis suggests an optimal tumour size of ≤12 mm and treatment margins of 5–6 mm for FT. For tumours ≤12 mm in diameter, applying 5‐ and 6‐mm treatment margins would achieve 98.6% and 100% complete tumour ablation, respectively. For tumours of all sizes, using the same margins would ablate >95% of the HG cancer components.
Conclusions
Multiparametric MRI performance in estimating prostate cancer size, and consequently the treatment margin for FT, is impacted by tumour size and the intralesional heterogeneity of cancer grades.
Background:
Evidence shows that early initiation of a continuous chain of rehabilitation is associated with better functional outcomes in traumatic brain injured patients. The Department of ...Rehabilitation Medicine initiated early screening and review of patients with all traumatic brain injury (TBI) severity within 72 hours of acute admission, followed by direct transfer of suitable patients to acute inpatient rehabilitation (AIR).
Objectives:
This study aim to document the demographics and clinical characteristics of all TBI patients admitted to the local acute hospital; determine the characteristics of patients with TBI who are directly transferred to AIR following early screening and review; and determine clinical predictors affecting functional outcomes of patients of all TBI severity.
Methods:
A total of 491 patients were screened and reviewed; 116 patients were directly transferred to AIR.
Results:
The median age of the screened cohort was 67.0 years (interquartile range 50.0–77.0 years). Falls were the leading mechanism of TBI. Infection (odds ratio (OR)=2.95, 95% confidence interval (CI) 1.59–5.49) and neurosurgical intervention (OR=2.18, 95% CI 1.24–3.81) increased the odds of transfer to AIR. The Functional Independence Measure (FIM) gain after receiving AIR was significant (p<0.001). Increased age, complications, high motor admission FIM (AFIM) and long rehabilitation length of stay (RLOS) were negatively associated with FIM gain and FIM efficiency.
Conclusions:
Our study demonstrated that falls were the leading mechanism of TBI, with the majority of patients being older. Infection and neurosurgical intervention increased the likelihood of transfer to AIR. There was functional improvement after AIR. Age, complications, motor AFIM and RLOS were negatively associated with FIM gain and FIM efficiency. Further local research is warranted to confirm these findings.
The aim of this study was to compare the body temperature measurements at tympanic, forehead and temporal sites using infrared thermometers. A total of 1576 consecutive visitors to Singapore General ...Hospital at two entry locations were included in this study. Pearson correlation and Bland–Altman mean difference between sites (95% confidence interval for limits of agreement) were calculated for the relationship between the three different sites of temperatures recorded (i.e. temporal, forehead and tympanic). Of all the visitors, 27 (1.7%) had fever. Moderate positive correlation was found between temporal and forehead temperature readings (r=0.602, mean difference (temporal – forehead), (95% limits of agreement) = 0.1 (−0.8, 0.7)), and there was very weak positive correlation between tympanic and temporal temperature readings (r=0.177, mean difference (temporal – tympanic), (95% limits of agreement) = −0.3 (−1.7, 1.1)). Sensitivity for temporal temperature readings (⩾37.5°C) to detect febrile visitors was 3.7%, specificity was 99.6%, positive predictive value was 14.3% and negative predictive value was 98.3%. Our results demonstrate that tympanic temperature readings should be used for fever screening instead of temporal or forehead readings.
Background:
Although growing evidence suggests that fructose intake contributes to the development of non-alcoholic fatty liver disease (NAFLD), fructose intake in NAFLD patients has not been ...documented locally.
Objectives:
The objectives of this study were to compare fructose intake between NAFLD patients and controls with chronic hepatitis B, and to ascertain whether fructose intake was associated with the presence of NAFLD.
Methods:
This was a cross-sectional, case–control study. Thirty-four patients diagnosed with NAFLD and 34 controls with chronic hepatitis B participated in this study between 2012 and 2014 in the Singapore General Hospital outpatient setting. Fructose, energy and nutrient intake were assessed by using food frequency questionnaires.
Results:
NAFLD patients had higher body mass index (28.6±4.0 vs. 22.5±3.9 kg/m2, p<0.001) and waist circumference (100.0±7.9 vs. 80.2±11.7 cm, p<0.001) than controls. Cases reported higher intakes of energy (2378±708 vs. 1796±398 kcal, p<0.001), protein (109±37 vs. 84±25 g, p<0.01), fat (87±33 vs. 62±19 g, p<0.001), total carbohydrate (294±83 vs. 232±63 g, p<0.001) and fructose (42±17 vs. 31±15 g, p<0.05). Logistic regression analysis showed waist circumference (odds ratio: 1.25; 95% confidence interval: 1.11–1.41; p<0.001) and energy intake (odds ratio: 1.002; 95% confidence interval: 1.001–1.004; p<0.05) were significant risk factors for NAFLD.
Conclusions:
Total calorie, macronutrient and fructose intake in NAFLD patients were significantly higher than in controls. Waist circumference and energy intake were significantly associated with NAFLD. Reducing total calorie intake and adopting healthy eating habits should be emphasized to NAFLD patients to manage their clinical conditions.
Objectives:
Copeptin, myeloperoxidase and pro-adrenomedullin have emerged as potential biomarkers for diagnosis and prognosis of acute coronary syndrome (ACS). However, their applicability in ...patients with chronic kidney disease (CKD) remains unknown as these patients were excluded from previous studies. Our objective was to determine the superior novel cardiac marker to predict 30-day and six-month adverse cardiac events (ACEs) defined as cardiac-related death, myocardial infarction and ventricular fibrillation.
Methods:
A prospective observational study was carried out. Patients were included if they presented to the emergency department with symptoms suggestive of ACS and had CKD as defined as a serum creatinine of more than 130 µmol/l. Copeptin, myeloperoxidase and pro-adrenomedulin assays were performed. Occurrence of ACE was traced from review of the patients’ case records and the registry of deaths.
Results:
A total of 724 patients were recruited: 60.6% were male and 68.6% were Chinese. The median age was 67 years. Among those recruited, 88.3% had CKD stages 4 and 5, with 33.5% on dialysis. The rates of ACE at 30 days and six months were 15.1% and 21.7%, respectively. All readings of the three biomarkers were not significantly different in patients with ACE compared with those without both at 30 days and six months. The areas under the curve for copeptin, myeloperoxidase and pro-adrenomedullin were 0.53, 0.50 and 0.45, respectively (p > 0.05).
Conclusions:
The poor performance of the biomarkers may be attributable to lack of specificity for ACS, as elevated levels could be from other causes in CKD patients. Routine testing cannot be recommended.
Background
Recent literature shows that multidisciplinary case management (MDCM) is the most cost‐effective intervention in reducing emergency department (ED) overutilization by frequent attenders ...(FAs). It is unclear whether we can extrapolate this finding to a Singapore‐based practice in light of the differences between healthcare systems and social structures.
Objectives
Our objectives were understand from the FA's perspective the reasons behind frequent ED visits and determine the clinical effectiveness of MDCM intervention in reducing ED visits by FAs at a tertiary hospital in Singapore.
Methods
We conducted a two‐stage pilot study that involved prospective recruitment of eligible patients for a qualitative study via face‐to‐face in‐depth interviews and subsequent random assignment of these patients into a dual‐arm randomized control trial with MDCM intervention.
Results
We recruited 40 patients (67.5% male, mean age = 58.25 years) between June 2014 and March 2015. Six main themes on why FAs chose to visit ED emerged: free/subsidized consultation, convenience, perceived better quality of care, perceived emergencies, third party's advice, and health services issues. Interim data analysis was conducted after 6 months’ follow‐up. The median percentage reduction of ED visits between control arm (50%, IQR = –80.00 to –5.00) and MDCM intervention arm (50%, IQR = –76.70 to 30.00) showed no significant difference (95% CI, p = 0.461).
Conclusion
While we discovered six major themes on patient's perspective of reasons behind frequent ED visits, the ability of MDCM intervention to reduce ED visits by FAs was not seen in the initial 6‐month interim analysis. Further research in FA subgroups is needed to develop more targeted interventions.
To assess the effects of hypoxia on human orbital fibroblasts (OF) on adipogenesis and adipocytokine production.
Human OF were derived from tissues obtained from patients with Graves' ophthalmopathy ...(GO) and from patients without known thyroid diseases undergoing blepharoplasty. The OF were cultured separately under normoxic and hypoxic conditions. Comparisons of adipocytokine concentrations using multiplex ELISA and lipid accumulation in the cells using Oil Red O staining were subsequently performed.
There was increased adipogenesis in OF from GO subject when exposed to hypoxic culture conditions. This was not observed in OF from normal controls. Hypoxia led to an increase in leptin and a decrease in MCP-1 secretion in OF cultures.
Hypoxia induces adipogenesis in OF and may represent a mechanism by which smoking contributes to deterioration of GO. We also found novel changes to leptin and MCP-1 production in OF cultures exposed to hypoxia suggesting important roles of these cytokines in the disease process.
In 2018, a Shiga toxin-producing
O121 outbreak that affected seven individuals was associated with raw milk Gouda-like cheese produced in British Columbia, Canada.
To describe the
.
O121 outbreak ...investigation and recommend greater control measures for raw milk Gouda-like cheese.
Cases of
.
O121 were identified through laboratory testing results and epidemiologic surveillance data. The cases were interviewed on exposures of interest, which were analyzed against
values for British Columbia. Environmental inspection of the dairy plant and the cheese products was conducted to ascertain a source of contamination. Whole genome multi-locus sequence typing (wgMLST) was performed on all positive
.
O121 clinical and food isolates at the provincial laboratory.
Four out of the seven cases consumed the same raw milk Gouda-like cheese between August and October 2018. The implicated cheese was aged longer than the required minimum of 60 days, and no production deficiencies were noted. One sample of the implicated cheese tested positive for
.
O121. The seven clinical isolates and one cheese isolate matched by wgMLST within 6.5 alleles.
Raw milk Gouda and Gouda-like cheese has been implicated in three previous Shiga toxin-producing
outbreaks in North America. It was recommended product labelling to increase consumer awareness and thermization of milk to decrease the risk of illness associated with raw milk Gouda and Gouda-like cheese.
Background
Conversations about sexuality with healthcare providers (HCPs) are critical to youth's positive development, including youth with disabilities or chronic conditions. Yet, little is known ...about the characteristics of sexuality conversations with youth in healthcare settings. This scoping review examined the nature and extent of sexuality conversations between HCPs and youth (with and without a disability or chronic condition) and aimed to identify barriers to these conversations.
Methods
Scoping review methodology using rapid review principles was employed. Inclusion criteria: studies published between 2009 and 2019; examined conversations between HCPs and youth aged 21 and below; addressed sexuality; and took place in a healthcare setting. Study characteristics were described and clustered into thematic groups.
Results
Of the 5543 identified, 32 articles were included. Articles addressed (i) the content of sexuality conversations, (ii) prevalence of sexuality conversations and (iii) barriers to discussing sexuality. The content of sexuality discussions was largely biologically focused. The prevalence of sexuality discussions varied, with some discrepancy between youth‐reported and HCP‐reported rates. Seven barriers (three personal and four systemic) were identified. Youth with disabilities or chronic conditions were vastly under‐represented in the published literature.
Conclusions
This study highlighted that sexuality is an underexplored topic between HCPs and young people, especially young people with disabilities and/or chronic conditions. Given the importance of sexuality to young people's mental and physical health, research addressing barriers to these discussions and development of evidence‐informed resources to support HCPs and youth to engage in conversations about sexuality should be a priority.
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