Future requirements for and supply of ophthalmologists for an aging population in Singapore

#### Background Singapore’s population, as that of many other countries, is aging; this is likely to lead to an increase in eye diseases and the demand for eye care. Since ophthalmologist training is long and expensive, early planning is essential. This paper forecasts workforce and training requirements for Singapore up to the year 2040 under several plausible future scenarios. #### Methods The Singapore Eye Care Workforce Model was created as a continuous time compartment model with explicit workforce stocks using system dynamics. The model has three modules: prevalence of eye disease, demand, and workforce requirements. The model is used to simulate the prevalence of eye diseases, patient visits, and workforce requirements for the public sector under different scenarios in order to determine training requirements. #### Results Four scenarios were constructed. Under the baseline business-as-usual scenario, the required number of ophthalmologists is projected to increase by 117% from 2015 to 2040. Under the current policy scenario (assuming an increase of service uptake due to increased awareness, availability, and accessibility of eye care services), the increase will be 175%, while under the new model of care scenario (considering the additional effect of providing some services by non-ophthalmologists) the increase will only be 150%. The moderated workload scenario (assuming in addition a reduction of the clinical workload) projects an increase in the required number of ophthalmologists of 192% by 2040. Considering the uncertainties in the projected demand for eye care services, under the business-as-usual scenario, a residency intake of 8–22 residents per year is required, 17–21 under the current policy scenario, 14–18 under the new model of care scenario, and, under the moderated workload scenario, an intake of 18–23 residents per year is required. #### Conclusions The results show that under all scenarios considered, Singapore’s aging and growing population will result in an almost doubling of the number of Singaporeans with eye conditions, a significant increase in public sector eye care demand and, consequently, a greater requirement for ophthalmologists

Improving Risk Predictions by Preprocessing Imbalanced Credit Data

Imbalanced credit data sets refer to databases in which the class of defaulters is heavily under-represented in comparison to the class of non-defaulters. This is a very common situation in real-life credit scoring applications, but it has still received little attention. This paper investigates whether data resampling can be used to improve the performance of learners built from imbalanced credit data sets, and whether the effectiveness of resampling is related to the type of classifier. Experimental results demonstrate that learning with the resampled sets consistently outperforms the use of the original imbalanced credit data, independently of the classifier used

Assessing intraspecific wood density variations of Syzgium sp. in tropical forest of Southwest Sabah

Wood density (WD) is a critical determinant of estimating forest above-ground biomass (AGB) and carbon stock. Thus, heterogeneity in WD on individuals within species trees needs to be scrutinized, and acquisition of fixed WD value is essential to estimate carbon stock with confidence. This study investigated intraspecific variation in WD of Syzgium sp., also known as “Jambu” or “Kelat”. It is the most occurring species in study areas, and is regarded as an economically important species. Firstly, one half-diameter drilling from bark-to-pith measurement was taken per tree using Rinntech Resistograph R650-ED at breast height. Meanwhile, 5.15 mm-diameter core was sampled at 1.30 m above-ground, with DeWalt DCF899HP2 20V impact wrench 950 Nm and Haglöf increment borer. WD was estimated for each core sample using a dimensional method. Drilling resistance (DR) profiles were processed using DECOM 2.38m1 Scientific (c), and several independent variables were extracted from the resistogram. All resistogram-derived variables were positively correlated with field WD (R: 0.2 – 0.70). In addition, variability on WD in Syzgium sp. population is predominantly explained by the Resistograph amplitude, expressed as mean raw scale of adjusted DR (DRadj.RawSC) in a regression model. Given that intraspecific variation in WD is a crucial conjecture in forest AGB estimation, it is recommended to analyze with larger samples, and in-depth exploration on Resistograph-based variables is deemed to improve the accuracy of WD prediction models

First detection of a Vssc allele V1016G conferring a high level of insecticide resistance in Aedes albopictus collected from Europe (Italy) and Asia (Vietnam), 2016. A new emerging threat to controlling arboviral diseases

Introduction Aedes albopictus (Skuse) is an important vector of arboviral diseases, including dengue, chikungunya and Zika virus disease. Monitoring insecticide resistance and mechanisms by which the mosquito develops resistance is crucial to minimise disease transmission. Aim To determine insecticide resistance status and mechanisms in Ae. albopictus from different geographical regions. Methods We sampled 33 populations of Ae. albopictus from Asia, Europe and South America, and tested these for susceptibility to permethrin, a pyrethroid insecticide. In resistant populations, the target site for pyrethroids, a voltage-sensitive sodium channel (Vssc) was genotyped. Three resistant sub-strains, each harbouring a resistance allele homozygously, were established and susceptibilities to three different pyrethroids (with and without a cytochrome P450 inhibitor) were assayed. Results Most populations of Ae. albopictus tested were highly susceptible to permethrin but a few from Italy and Vietnam (4/33), exhibited high-level resistance. Genotyping studies detected a knockdown resistance (kdr) allele V1016G in Vssc for the first time in Ae. albopictus. Two previously reported kdr alleles, F1534C and F1534S, were also detected. The bioassays indicated that the strain homozygous for the V1016G allele showed much greater levels of pyrethroid resistance than other strains harbouring F1534C or F1534S. Conclusion The V1016G allele was detected in bothAsian and Italian Ae. albopictus populations, thus a spread of this allele beyond Italy in Europe cannot be ruled out. This study emphasises the necessity to frequently and regularly monitor the V1016G allele in Ae. albopictus, particularly where this mosquito species is the main vector of arboviruses

Vertical accuracy comparison of multi-source Digital Elevation Model (DEM) with Airborne Light Detection and Ranging (LiDAR)

Digital Elevation Model (DEM) is a digital representation of ground surface topography or terrain. There are many freely available DEM data with a spatial resolution of 30 m to 90 m. Nevertheless, their vertical accuracy may vary, depending on the vegetation cover and terrain characteristics. This study examined the vertical accuracy of open-access global DEMs (ALOS PALSAR, ASTER GDEM3, SRTM, TanDEM-X) and fused DEM (EarthEnvDEM90, MERIT DEM). Their performances were assessed using a Digital Terrain Model (DTM) generated using airborne LiDAR data that had an outstanding absolute vertical accuracy (mean error (ME) = 0.24 m; root mean square error (RMSEz) = 1.20 m). Height differences between the global DEMs and the LiDAR DTM were calculated and examined their performances by forested vs. non-forested, slope, and elevation classes. The results showed the MERIT DEM was superior to other DEMs in most of the testing methods. It outperformed other DEMs with an RMSEz value of 3.02 m in the forested areas, followed by ALOS PALSAR (9.29 m), EarthEnv-DEM90 (9.40 m), SRTM (9.80 m), TanDEM-X (10.41 m), and ASTER GDEM3 (12.57 m). The MERIT DEM also had the best accuracy in the higher elevation areas. Overall, the ASTER GDEM3 had the worst accuracies, with relatively large over-estimations compared to other DEMs. Despite its low spatial resolution, the MERIT DEM was the best for representing terrain elevation for applications over a large area

Mortality in Western Australian seniors with chronic respiratory diseases: a cohort study

<p>Abstract</p> <p>Background</p> <p>Relatively few studies have examined survival by pharmacotherapy level and the effects of patient characteristics on mortality by pharmacotherapy level in older chronic respiratory disease (CRD) patients. This study aimed to investigate these issues in older (≥ 65) CRD patients in Western Australia.</p> <p>Methods</p> <p>We identified 108,312 patients ≥ 65 years with CRD during 1992-2006 using linked medical, pharmaceutical, hospital and mortality databases held by the Commonwealth and State governments. Pharmacotherapy classification levels were designed by a clinical consensus panel. Cox regression was used to investigate the study aim.</p> <p>Results</p> <p>Patients using only short acting bronchodilators experienced similar, but slightly worse survival than patients in the highest pharmacotherapy level group using high dose inhaled corticosteroids (ICS) ± long acting bronchodilators (LABs) ± oral steroids. Patients using low to medium dose ICS ± LABs experienced relatively better survival. Also, male gender was associated with all-cause mortality in all patients (HR = 1.72, 95% CI 1.65-1.80) and especially in those in the highest pharmacotherapy level group (HR = 1.97, 95%CI = 1.84-2.10). The P-value of interaction between gender and pharmacotherapy level for the effect on all-cause death was significant (0.0003).</p> <p>Conclusions</p> <p>Older patients with CRD not using ICS experienced the worst survival in this study and may benefit from an escalation in therapeutic regime. Males had a higher risk of death than females, which was more pronounced in the highest pharmacotherapy level group. Hence, primary health care should more actively direct disease management to mild-to-moderate disease patients.</p

Diagnostic and prognostic value of procalcitonin among febrile critically ill patients with prolonged ICU stay

<p>Abstract</p> <p>Background</p> <p>Procalcitonin (PCT) has been proposed as a diagnostic and prognostic sepsis marker, but has never been validated in febrile patients with prolonged ICU stay.</p> <p>Methods</p> <p>Patients were included in the study provided they were hospitalised in the ICU for > 10 days, were free of infection and presented a new episode of SIRS, with fever >38°C being obligatory. Fifty patients fulfilled the above criteria. PCT was measured daily during the ICU stay. The primary outcome was proven infection.</p> <p>Results</p> <p>Twenty-seven out of 50 patients were diagnosed with infection. Median PCT on the day of fever was 1.18 and 0.17 ng/ml for patients with and without proven infections (p < 0.001). The area under the curve for PCT was 0.85 (95% CI; 0.71-0.93), for CRP 0.65 (0.46-0.78) and for WBC 0.68 (0.49-0.81). A PCT level of 1 ng/mL yielded a negative predictive value of 72% for the presence of infection, while a PCT of 1.16 had a specificity of 100%. A two-fold increase of PCT between fever onset and the previous day was associated with proven infection (p 0.001) (OR = 8.55; 2.4-31.1), whereas a four-fold increase of PCT of any of the 6 preceding days was associated with a positive predictive value exceeding 69.65%. A PCT value less than 0.5 ng/ml on the third day after the advent of fever was associated with favorable survival (p 0.01).</p> <p>Conclusion</p> <p>The reported data support that serial serum PCT may be a valuable diagnostic and prognostic marker in febrile chronic critically ill patients.</p

Home Range and Ranging Behaviour of Bornean Elephant (Elephas maximus borneensis) Females

BACKGROUND: Home range is defined as the extent and location of the area covered annually by a wild animal in its natural habitat. Studies of African and Indian elephants in landscapes of largely open habitats have indicated that the sizes of the home range are determined not only by the food supplies and seasonal changes, but also by numerous other factors including availability of water sources, habitat loss and the existence of man-made barriers. The home range size for the Bornean elephant had never been investigated before. METHODOLOGY/PRINCIPAL FINDINGS: The first satellite tracking program to investigate the movement of wild Bornean elephants in Sabah was initiated in 2005. Five adult female elephants were immobilized and neck collars were fitted with tracking devices. The sizes of their home range and movement patterns were determined using location data gathered from a satellite tracking system and analyzed by using the Minimum Convex Polygon and Harmonic Mean methods. Home range size was estimated to be 250 to 400 km(2) in a non-fragmented forest and 600 km(2) in a fragmented forest. The ranging behavior was influenced by the size of the natural forest habitat and the availability of permanent water sources. The movement pattern was influenced by human disturbance and the need to move from one feeding site to another. CONCLUSIONS/SIGNIFICANCE: Home range and movement rate were influenced by the degree of habitat fragmentation. Once habitat was cleared or converted, the availability of food plants and water sources were reduced, forcing the elephants to travel to adjacent forest areas. Therefore movement rate in fragmented forest was higher than in the non-fragmented forest. Finally, in fragmented habitat human and elephant conflict occurrences were likely to be higher, due to increased movement bringing elephants into contact more often with humans

Facilitating motor imagery-based brain–computer interface for stroke patients using passive movement

Motor imagery-based brain–computer interface (MI-BCI) has been proposed as a rehabilitation tool to facilitate motor recovery in stroke. However, the calibration of a BCI system is a time-consuming and fatiguing process for stroke patients, which leaves reduced time for actual therapeutic interaction. Studies have shown that passive movement (PM) (i.e., the execution of a movement by an external agency without any voluntary motions) and motor imagery (MI) (i.e., the mental rehearsal of a movement without any activation of the muscles) induce similar EEG patterns over the motor cortex. Since performing PM is less fatiguing for the patients, this paper investigates the effectiveness of calibrating MI-BCIs from PM for stroke subjects in terms of classification accuracy. For this purpose, a new adaptive algorithm called filter bank data space adaptation (FB-DSA) is proposed. The FB-DSA algorithm linearly transforms the band-pass-filtered MI data such that the distribution difference between the MI and PM data is minimized. The effectiveness of the proposed algorithm is evaluated by an offline study on data collected from 16 healthy subjects and 6 stroke patients. The results show that the proposed FB-DSA algorithm significantly improved the classification accuracies of the PM and MI calibrated models (p < 0.05). According to the obtained classification accuracies, the PM calibrated models that were adapted using the proposed FB-DSA algorithm outperformed the MI calibrated models by an average of 2.3 and 4.5 % for the healthy and stroke subjects respectively. In addition, our results suggest that the disparity between MI and PM could be stronger in the stroke patients compared to the healthy subjects, and there would be thus an increased need to use the proposed FB-DSA algorithm in BCI-based stroke rehabilitation calibrated from PM