The outbreak of SARS at Tan Tock Seng Hospital--relating epidemiology to control.

INTRODUCTION: The outbreak of severe acute respiratory syndrome (SARS) began after the index case was admitted on 1 March 2003. We profile the cases suspected to have acquired the infection in Tan Tock Seng Hospital (TTSH), focussing on major transmission foci, and also describe and discuss the impact of our outbreak control measures. MATERIALS AND METHODS: Using the World Health Organization (WHO) case definitions for probable SARS adapted to the local context, we studied all cases documented to have passed through TTSH less than 10 days prior to the onset of fever. Key data were collected in liaison with clinicians and through a team of onsite epidemiologists. RESULTS: There were 105 secondary cases in TTSH. Healthcare staff (57.1%) formed the majority, followed by visitors (30.5%) and inpatients (12.4%). The earliest case had onset of fever on 4 March 2003, and the last case, on 5 April 2003. Eighty-nine per cent had exposures to 7 wards which had cases of SARS that were not isolated on admission. In 3 of these wards, major outbreaks resulted, each with more than 20 secondary cases. Attack rates amongst ward-based staff ranged from 0% to 32.5%. Of 13 inpatients infected, only 4 (30.8%) had been in the same room or cubicle as the index case for the ward. CONCLUSIONS: The outbreak of SARS at TTSH showed the challenges of dealing with an emerging infectious disease with efficient nosocomial spread. Super-spreading events and initial delays in outbreak response led to widespread dissemination of the outbreak to multiple wards

Designing and implementing an exit communication test to gauge oral proficiency in a university

Innovation in education is an encouraged enterprise that could help to solve problems relevant to education. In Malaysia, the lack of English language ability has been constantly identified as a factor that contributes to graduate unemployment. To address this concern, measures are exponentially explored to articulate some solid answers as a basis for educational change. In Universiti Putra Malaysia, an innovative and proactive step was taken to introduce an exit oral communication test (Universiti Putra Malaysia Test of Communication Skills in English). The in-house test enables a system-wide assessment and reporting of students' English oral language ability as the students exit university to the work world. This paper examines issues in the designing and implementation of an exit test with due attention given to its credibility and usability. The step-by-step procedural moves are described and some salient educational outcomes pertaining to the improving of English language competence are discussed

Health System for Dengue Control in Singapore

Dengue fever/dengue haemorrhagic fever (DF/DHF) first appeared in Singapore in an outbreak in 1960. In 1966, the Ministry of Health established the Vector Control Unit which was charged with the responsibility of controlling the dengue vector mosquitoes, Aedes aegypti and Aedes albopictus. The Unit immediately launched an Aedes control programme based on source reduction and public health education. To obtain reliable statistics on disease incidence, DF/DHF was made administratively notifiable in 1966, and finally, legally notifiable in 1977. It was also recognized early in the control programme that long-term and active participation by the community was essential for its implementation. A new legislation called the Destruction of Disease-Bearing Insects Act was thus enacted in 1968. The Act empowers vector control officers to enter and examine houses for mosquito breeding, to take appropriate control measures, and to serve offenders with orders and summonses which carry a fine or imprisonment by the court. With the new legislation in force, the Aedes control programme adopted an integrated approach of source reduction, public health education and law enforcement. When the new Ministry of the Environment was formed in 1972 to take over the responsibility of environmental health, its Vector Control and Research Department and the Quarantine & Epidemiology Department became responsible for the surveillance and control of DF/DHF in the country. Surveillance of disease incidence and Aedes vectors is important in the prevention and control of DF/DHF outbreaks. Disease surveillance is conducted by officers of the Quarantine & Epidemiology Department based on notifications on clinically diagnosed cases as well as on the number of blood specimens submitted by hospitals, clinics, and private practitioners to the Virology Division of the Department of Pathology in the Ministry of Health and the Department of Microbiology of the National University of Singapore for laboratory confirmation of dengue infection. Aedes surveillance depends on regular surveys of mosquito larvae and adults in designated DF/DHF-sensitive areas. In addition to destruction of breeding habitats, fogging is carried out when the Aedes house index is 2% and above, or when a potential outbreak situation arises such as the occurrence of a focus of two or more DF/DHF cases in an area

Epidemiology of Dengue in Singapore-Current Situation

There has been a resurgence of dengue fever/dengue haemorrhagic fever (DF/DHF) cases in Singapore in recent years. Following the large outreak in 1973 with 1,187 cases and 27 deaths, the incidence of DF/DHF declined with minor bi-annual outbreaks occurring in 1978, 1980 and 1982. Beginning from 1986, however, the DF/DHF situation changed for the worse when outbreaks of increasing size occurred almost annually. In the past 3 years, there were 1,733 cases in 1990, 2,179 cases in 1991 and 2,878 cases in 1992. In the 1991 and 1992 outbreaks, 93-95% of the notified cases required hospitalization and 92-95% of them were serologically confirmed by the IgM capture ELISA and/or the commercial Dengue Blot assay. The number of fatal cases, however, remained low with 3-6 reported deaths in the three outbreaks. All age groups were affected with the highest morbidity rate in children and young adults between 15 and 24 years of age. In contrast, in the earlier 1973 and 1978 outbreaks, more patients below the age of 15 years were observed. There was a slight predominance among males and Chinese had the highest morbidity rate compared with Malays and Indians. The recent outbreaks occurred mainly in highly populated urban and suburban areas in the eastern, northeastern and southeastern parts of the island. Patients living in landed property such as compound houses had a 9X higher morbidity rate than those living in high-rise flats. Cases were reported throughout the year and the number increased during May and June. The increased DF/DHF incidence was preceded by an increase in the Aedes mosquito population. In the 1991 and 1992 outbreaks, although the overall Aedes house index was<1 for both Ae aegypti and Ae albopictus higher indices were detected in localized areas with high dengue transmission. The proportion of compound houses found breeding Ae aegypti was 3-4 times and Ae albopictus 7-10 times higher than that of flats. The major breeding habitats were ornamental and domestic containers and discarded receptacles

Secondary Household Transmission of SARS, Singapore

Secondary household transmission of severe acute respiratory syndrome (SARS) was studied in 114 households involving 417 contacts. The attack rate was low (6.2%). Occupation of the index case was the factor that most influenced household transmission (adjusted hazard ratio for healthcare workers 0.157; 95% confidence interval 0.042 to 0.588)

Forecasting daily attendances at an emergency department to aid resource planning

<p>Abstract</p> <p>Background</p> <p>Accurate forecasting of emergency department (ED) attendances can be a valuable tool for micro and macro level planning.</p> <p>Methods</p> <p>Data for analysis was the counts of daily patient attendances at the ED of an acute care regional general hospital from July 2005 to Mar 2008. Patients were stratified into three acuity categories; i.e. P1, P2 and P3, with P1 being the most acute and P3 being the least acute. The autoregressive integrated moving average (ARIMA) method was separately applied to each of the three acuity categories and total patient attendances. Independent variables included in the model were public holiday (yes or no), ambient air quality measured by pollution standard index (PSI), daily ambient average temperature and daily relative humidity. The seasonal components of weekly and yearly periodicities in the time series of daily attendances were also studied. Univariate analysis by t-tests and multivariate time series analysis were carried out in SPSS version 15.</p> <p>Results</p> <p>By time series analyses, P1 attendances did not show any weekly or yearly periodicity and was only predicted by ambient air quality of PSI > 50. P2 and total attendances showed weekly periodicities, and were also significantly predicted by public holiday. P3 attendances were significantly correlated with day of the week, month of the year, public holiday, and ambient air quality of PSI > 50.</p> <p>After applying the developed models to validate the forecast, the MAPE of prediction by the models were 16.8%, 6.7%, 8.6% and 4.8% for P1, P2, P3 and total attendances, respectively. The models were able to account for most of the significant autocorrelations present in the data.</p> <p>Conclusion</p> <p>Time series analysis has been shown to provide a useful, readily available tool for predicting emergency department workload that can be used to plan staff roster and resource planning.</p

Offline eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction

Background: The world is short of 7.2 million health–care workers and this figure is growing. The shortage of teachers is even greater, which limits traditional education modes. eLearning may help overcome this training need. Offline eLearning is useful in remote and resource–limited settings with poor internet access. To inform investments in offline eLearning, we need to establish its effectiveness in terms of gaining knowledge and skills, students’ satisfaction and attitudes towards eLearning. Methods: We conducted a systematic review of offline eLearning for students enrolled in undergraduate, health–related university degrees. We included randomised controlled trials that compared offline eLearning to traditional learning or an alternative eLearning method. We searched the major bibliographic databases in August 2013 to identify articles that focused primarily on students’ knowledge, skills, satisfaction and attitudes toward eLearning, and health economic information and adverse effects as secondary outcomes. We also searched reference lists of relevant studies. Two reviewers independently extracted data from the included studies. We synthesized the findings using a thematic summary approach. Findings: Forty–nine studies, including 4955 students enrolled in undergraduate medical, dentistry, nursing, psychology, or physical therapy studies, met the inclusion criteria. Eleven of the 33 studies testing knowledge gains found significantly higher gains in the eLearning intervention groups compared to traditional learning, whereas 21 did not detect significant differences or found mixed results. One study did not test for differences. Eight studies detected significantly higher skill gains in the eLearning intervention groups, whilst the other 5 testing skill gains did not detect differences between groups. No study found offline eLearning as inferior. Generally no differences in attitudes or preference of eLearning over traditional learning were observed. No clear trends were found in the comparison of different modes of eLearning. Most of the studies were small and subject to several biases. Conclusions: Our results suggest that offline eLearning is equivalent and possibly superior to traditional learning regarding knowledge, skills, attitudes and satisfaction. Although a robust conclusion cannot be drawn due to variable quality of the evidence, these results justify further investment into offline eLearning to address the global health care workforce shortage

Cross-disciplinary and cross-linguistic manifestation of theme in academic writing

There is considerable agreement among linguists that theme acts as a cohesive device in texts. It plays a major role in message organization and in enabling it to be communicated and understood clearly. Although one issue in writing is how writers apply this cohesive device in their writing, the question of how theme manifestation is affected by the writers’ disciplinary or linguistic background has received little attention. Therefore, this paper aims to review the issue of theme in cross-disciplinary and cross-linguistic studies. The reviewed studies supported the earlier claim that theme application is packed differently across different disciplines and linguistics

Interactional metadiscourse in academic research article abstracts as marker of discipline

Research article abstracts as a communicative genre let readers know the significant features of the research. In this regard, they are considered powerful to inform the scientific community of new findings. This study explores the status of interactional metadiscourse markers in research article abstracts across disciplines. The purpose is to investigate how these cohesive devices are manifested and tackled by research article writers in their abstracts in the effort to reach the audience so as to create interpersonality in discourse. Hyland’s (2005) taxonomy of metadiscourse was adopted to analyze sixty research article abstracts written in two disciplines (Applied Linguistics and Economics) selected from related journals. Results indicated that variations were present across two disciplines regarding interactional metadiscourse markers, especially attitude markers and self-mentions. Results of the present research may have some implications for novice researchers of the identified fields in meeting the needs of expertise and in getting an entry into their own disciplinary community

Review Article: Cross-disciplinary and cross-linguistic perspectives on metadiscourse in academic writing

The present review article examines a selection of recent academic discourse concerning metadiscourse. Metadiscourse relates to aspects of a text which organise the discourse in an explicit way, engage the addressee, and indicate the writer’s attitude. It is integral to the contexts in which it happens and is intimately dealt with according to the norms and expectations of specific cultural and professional communities. This review aims to explore the effect of disciplinary conventions and norms as well as language context on the manifestation of metadiscourse markers in academic writing. Since most scholars commonly believe that the application of metadiscourse differs from discipline to discipline and language to language, the accuracy of this belief is investigated. Therefore, results of some earlier studies are reviewed so as to investigate the accuracy of the above assertion. Limitations of existing empirical studies are discussed and some directions for future research regarding the use of metadiscourse in academic settings are suggested as well.Southern African Linguistics and Applied Language Studies 2013, 31(1): 129–13