Knowledge, Attitudes, and Practices of COVID-19 Vaccination among Adults in Singapore: A Cross-Sectional Study

Public health measures promoting compliance of COVID-19 vaccination requires understanding of knowledge, attitudes, and practices (KAP). This study explored the KAP and risk factors influencing COVID-19 vaccination, including changes in preventive practices before and after vaccination in a high-income country, Singapore. An online cross-sectional study among Singaporeans and permanent residents aged 21 years and older was conducted from July to August 2021. Univariate and multivariable logistic regressions using RStudio version 1.4.1106 was performed to assess associations between demographic factors, KAP, and vaccination status. P values < 0.05 were considered statistically significant. A total of 869 respondents completed the survey. Individuals with higher knowledge (adjusted odds ratio [aOR] = 2.00, P = 0.024), perceived efficacy (aOR = 1.19, P = 0.004), perceived safety (aOR = 1.20, P = 0.005), and willingness to uptake (aOR = 1.55, P < 0.001) scores were more likely to be vaccinated. There was a significant increase in the use of proper handwashing techniques among the vaccinated group before and after vaccinations. The governmental risk communication approaches have been useful in instilling high levels of vaccine knowledge. High levels of good attitudes about and knowledge of COVID-19 vaccination were associated with a high level of vaccination practices. Good perceived vaccine efficacy and confidence in government were also associated with positive vaccine uptake. This study paves the way for more targeted government measures to be implemented to improve vaccination rates of COVID-19 booster vaccines in a high-income country like Singapore.

POSSUM--a model for surgical outcome audit in quality care

Comparative surgical audit to monitor quality of care should be performed with a risk-adjusted scoring system rather than using crude morbidity and mortality rates. A validated and widely applied risk adjusted scoring system, P-POSSUM (Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality) methodology, was applied to a prospective series of predominantly general surgical patients at the Sarawak General Hospital, Kuching over a six months period. The patients were grouped into four risk groups. The observed mortality rates were not significantly different from predicted rates, showing that the quality of surgical care was at par with typical western series. The simplicity and advantages of this scoring system over other auditing tools are discussed. The P-POSSUM methodology could form the basis of local comparative surgical audit for assessment and maintenance of quality care.

Risk-adjusted surgical audit with the POSSUM scoring system in a developing country. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity

BACKGROUND

The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is an objective and appropriate scoring system for risk-adjusted comparative general surgical audit. This score was devised in the UK and has been used widely, but application of POSSUM to centres outside the UK has been limited, especially in developing countries. This prospective study validated its application in a surgical practice with a different population and level of resources.

METHODS

All general surgical patients who were operated on under regional or general anaesthesia as inpatients over a 4-month period at Sarawak General Hospital in 1999 were entered into the study. All data (12 physiological and six operative factors) were analysed for mortality only with the POSSUM equation and the modified Portsmouth POSSUM (P-POSSUM) equation. Comparisons were made between predicted and observed mortality rates according to four groups of risk: 0-4, 5-14, 15-49 and 50 per cent or more using the 'linear' method of analysis.

RESULTS

There were 605 patients who satisfied the criteria for the study. Some 56.7 per cent of patients were in the lowest risk group. The POSSUM predictor equation significantly overestimated the mortality in this group, by a factor of 9.3. The overall observed mortality rate was 6.1 per cent and, again, the POSSUM predictor equation overestimated it at 10.5 per cent (P < 0.01). In contrast, the observed and predicted mortality rates for all risk groups, including the predicted overall mortality rate of 4.8 per cent, were comparable when the P-POSSUM predictor equation was used.

CONCLUSION

The POSSUM scoring system with the modified P-POSSUM predictor equation for mortality was applicable in Malaysia, a developing country, for risk-adjusted surgical audit. This scoring system may serve as a useful comparative audit tool for surgical practice in many geographical locations.

Cassette-accelerated rapid rat screen: a systematic procedure for the dosing and liquid chromatography/atmospheric pressure ionization tandem mass spectrometric analysis of new chemical entities as part of new drug discovery

This report addresses the continuing need for increased throughput in the evaluation of new chemical entities (NCEs) in terms of their pharmacokinetic (PK) parameters by describing an alternative procedure for increasing the throughput of the in vivo screening of NCEs in the oral rat PK model. The new approach is called "cassette-accelerated rapid rat screen" (CARRS). In this assay, NCEs are dosed individually (n = 2 rats/compound) in batches of six compounds per set. The assay makes use of a semi-automated protein precipitation procedure for sample preparation in a 96-well plate format. The liquid chromatography/atmospheric pressure ionization tandem mass spectrometry (LC/API-MS/MS) assay is also streamlined by analyzing the samples as "cassettes of six". Using this new approach, a threefold increase in throughput was achieved over the previously reported "rapid rat screen".

Three-dimensional imaging of the prostatic urethra--an exciting new tool

OBJECTIVE

To evaluate the technique of three-dimensional (3-D) ultrasound imaging of the urethra and its application in both research and clinical practice.

PATIENTS AND TECHNIQUE

The study involved 23 patients: 10 with benign prostatic hyperplasia, four with urethral strictures, three post-insertion of prostatic stents, one with bladder neck dyssynergia, three post-transurethral resection of the prostate, and two with non-urological conditions. A transrectal ultrasound scan was initially performed to acquire a series of images of the urethra. These images were then reconstructed into a 3-D format.

RESULTS

The 3-D image of the urethra could be rotated on screen and viewed from any angle. The image could also be sliced at any plane to reveal the sectional view.

CONCLUSION

This new tool represents a major advance in imaging techniques and promises to provide new knowledge in understanding the hydrodynamics of the lower urinary tract. The precise geometry of the 3-D urethra will also help in the design of new stents.

Intralobar bronchopulmonary sequestration: antenatal diagnosis

A child with the antenatal diagnosis of pulmonary cystic adenomatoid malformation underwent thoracotomy and an intralobar bronchopulmonary sequestration was found. Histological examination of the resected specimen showed cystic adenomatoid malformation within the sequestered segment.

Endoscopic transanal resection of large villous tumours of the rectum

Endoscopic transanal resection (ETAR) is an innovative approach in the management of low lying tumours of the rectum. We report our experience of this technique in six elderly patients (mean age 74 years) with large villous adenomas, situated between 2 and 12 cm from the anal verge. There were no complications. One patient with a circumferential tumour has been spared the more conventional operation of abdominoperineal excision. Follow-up ranged from 6 to 30 months (mean 16 months) during which two recurrences were detected. These were adequately treated by further ETARs. It is concluded that ETAR is a simple and well-tolerated procedure and is a useful addition to the surgeon's armamentarium.

Experience with the APACHE II severity of disease scoring system in predicting outcome in a surgical intensive therapy unit

The APACHE II system, a severity of disease scoring system, has been used to identify intensive therapy unit patients in whom prolonged treatment is unlikely to be beneficial. Fifty-nine surgical patients admitted to the intensive care unit over a 6-month period underwent a single APACHE II scoring in the first 24 h. The overall 30-day mortality rate was 34%. The range of APACHE II scores was 3-29. The survivors had significantly lower scores (mean 11) than those who died (mean 19). Most patients (53%) had a score greater than or equal to 11 to less than or equal to 22 and had an equal chance of living or dying. No patient with a score greater than 22 survived and at this level the APACHE II score was highly specific (100%) but with a very low sensitivity (30%). APACHE II scores greater than 22 may be useful as an adjunct to a clinical decision to withhold treatment, but scores below that level lack the specificity and sensitivity to be of any value.

Modulation of the 5-lipoxygenase activity of MC-9 mast cells: activation by hydroperoxides

In order to identify regulatory steps in leukotriene synthesis, the biochemical characteristics of a 5-lipoxygenase activity in the 100,000 xg supernatant from sonicates of cells of an IL-3 dependent murine mast cell clone, MC-9 were determined. Principal products from exogenous 14C-arachidonic acid were identified as leukotriene B4, diastereomeric 5,12-dihydroxy-eicosatetraenoic acids (5,12 diHETEs) 5-hydroperoxy and hydroxyeicosatetraenoic acids (5-HPETE and 5-HETE) as well as a novel metabolite 5-oxo-6,8,11,14-eicosatetraenoic acid (5-oxo-ETE). The crude lipoxygenase activity had a pH optimum of 6.9 and was highly dependent upon added Ca++. The effective Ca++ concentration for 50 per cent activation (EC50) was 3 microM. Activity was also stimulated by ATP (EC50 = 160 microM). The cytosolic 5-lipoxygenase activity exhibited a biphasic concentration dependence for arachidonic acid with maximum product formation occurring at 35 microM (ca. 20 nmole/mg/4 min). The lipoxygenase activity exhibited apparent lag phase kinetics which were more pronounced at low protein concentrations (0.3 mg/ml). In addition, the lag phase was greatly accentuated by the addition of a hydroperoxide scavenging system consisting of glutathione (1 mM) plus glutathione peroxidase (0.4 unit/ml). In contrast, addition of any of several hydroperoxides, i.e. 5-,8-,9- or 15-HPETE (EC50 ca. 1 microM), but not the corresponding alcohols (5-HETE and 15-HETE), shortened the lag phase. These results show that the 5-lipoxygenase requires hydroperoxide for activation and that cellular level of hydroperoxides may be an important factor regulating leukotriene synthesis.

Identification of long chain dicarboxylic acids in the serum of two patients with Reye's syndrome

Sera from two patients with Reye's Syndrome were analysed by computerized capillary gas chromatography--mass spectrometry profiling techniques. The most striking abnormalities were the accumulation of long chain dicarboxylic acids. Four saturated dicarboxylic acids (dodecanedioic, tetradecanedioic, hexadecanedioic, and octadecanedioic), and six unsaturated long chain dicarboxylic acids (dodecenedioic, tetradecenedioic, tetradecadienedioic, hexadecenedioic, octadecadienedioic, and octadecenedioic) were identified. The C16 and C13 dicarboxylic acids have never been reported for Reye's Syndrome or any other dicarboxylic acidemias. The data might reflect marked increase of extramitochondrial omega-oxidation of long chain fatty acids or impaired metabolism of omega-dicarboxylic acids formed in Reye's patients.

Capillary gas chromatographic-mass spectrometric profiles of trimethylsilyl derivatives of organic acids from amniotic fluids of different gestational age

Amniotic fluid from different gestational age patients was partitioned into neutral, acidic and basic fractions. The organic acids were trimethylsilylated and analyzed by glass capillary gas chromatography-mass spectrometry. A marked difference in the level of hippuric acid was observed between samples from early (15-22 weeks) and late (30-38.5 weeks) pregnancy. This difference probably reflects the degree of maturity in the fetal liver and kidney. The procedures establish amniotic fluid profiles of substances of varying gestational age and should be useful in determining alterations caused by diseases.

Longevity, stability and DNA repair

The functional capacity of a cell, tissue, organ, or organism is dependent upon its ability to maintain the stability of its unit components. The higher the differentiated state of the system, the greater the amount of stability required to maintain that state as a function of time. Stability can be achieved via either redundancy or repair. Redundancy while easily achievable in biological systems is both costly and limited by thermodynamic considerations. Repair, in its general sense, has no such limitations. Repair at the cellular and macromolecular level is multiple in its forms and varies as a function of species, tissue, and stage of the cell cycle. The repair of DNA damage is a dynamic process with many components and subcomponents, each interacting with one another in order to achieve a balance between individual stability and evolutionary diversity. Thus, between internal and external factors which damage DNA and the subsequent expression of alterations in the functional stability of DNA lie the multi-functional pathways which attempt to maintain DNA fidelity. A strong correlation between ulta-violet light induced excision or pre-replication repair, as measured by autoradiogrphy and maximum species lifespan has been reported within different strains of the same species, between related species (e.g. Mus musculus and Peromyscus leucopus), between five orders of mammals, and most recently within members of the primate family. As has been demonstrated by the authors and others, differences in excision repair between species and tissues may relate to the turning off of portions of the repair processes during embryogenesis. Regardless of why such correlations exist or the nature of their mechanisms, it is naive to either assert or deny a causal role for DNA repair in longevity assurance systems. For example, while species-related differences in DNA repair may reflect the turning off of such repair processes during fetal development this does not mean that rates of accumulation of DNA damage are not altered by such changes. Indeed, such a phenomena might well explain the rapid evolution of lifespan within the primates without a concurrent input of new genes.