Singapore's health-care system:key features, challenges, and shifts

Since Singapore became an independent nation in 1965, the development of its health-care system has been underpinned by an emphasis on personal responsibility for health, and active government intervention to ensure access and affordability through targeted subsidies and to reduce unnecessary costs. Singapore is achieving good health outcomes, with a total health expenditure of 4·47% of gross domestic product in 2016. However, the health-care system is contending with increased stress, as reflected in so-called pain points that have led to public concern, including shortages in acute hospital beds and intermediate and long-term care (ILTC) services, and high out-of-pocket payments. The main drivers of these challenges are the rising prevalence of non-communicable diseases and rapid population ageing, limitations in the delivery and organisation of primary care and ILTC, and financial incentives that might inadvertently impede care integration. To address these challenges, Singapore's Ministry of Health implemented a comprehensive set of reforms in 2012 under its Healthcare 2020 Masterplan. These reforms substantially increased the capacity of public hospital beds and ILTC services in the community, expanded subsidies for primary care and long-term care, and introduced a series of financing health-care reforms to strengthen financial protection and coverage. However, it became clear that these measures alone would not address the underlying drivers of system stress in the long term. Instead, the system requires, and is making, much more fundamental changes to its approach. In 2016, the Ministry of Health encapsulated the required shifts in terms of the so-called Three Beyonds—namely, beyond health care to health, beyond hospital to community, and beyond quality to value

A comparison of covered vs bare expandable stents for the treatment of aortoiliac occlusive disease

ObjectiveThis trial was conducted to determine if covered stents offer a patency advantage over bare-metal stents in the treatment of aortoiliac arterial occlusive disease.MethodsThe Covered Versus Balloon Expandable Stent Trial (COBEST), a prospective, multicenter, randomized controlled trial, was performed involving 168 iliac arteries in 125 patients with severe aortoiliac occlusive disease who were randomly assigned to receive a covered balloon-expandable stent or bare-metal stent. Patient demographic data, clinical signs and symptoms, TransAtlantic Inter-Society Consensus (TASC) classification, and preprocedure and postprocedure ankle-brachial index measurements were recorded. The primary end points included freedom from binary restenosis and stent occlusion of the treated area, as determined by ultrasound imaging or quantitative visual angiography, or both. Postprocedural follow-up was at 1, 6, 12, and 18 months.ResultsAortoiliac lesions treated with a covered stent were significantly more likely to remain free from binary restenosis than those that were treated with a bare-metal stent (hazard ratio [HR], 0.35; 95% confidence interval (CI), 0.15-0.82; P = .02). Freedom from occlusion was also higher in lesions treated with covered stents than in those treated with a bare-metal stent (HR, 0.28; 95% CI, 0.07-1.09); however, this did not reach statistical significance (P = .07). Subgroup analyses demonstrated a significant difference in freedom from binary restenosis for covered stents in TASC C and D lesions compared with a bare stent (HR, 0.136; 95% CI, 0.042-0.442). This difference was not demonstrated for TASC B lesions (HR, 0.748; 95% CI, 0.235-2.386).ConclusionsCOBEST demonstrates covered and bare-metal stents produce similar and acceptable results for TASC B lesions. However, covered stents perform better for TASC C and D lesions than bare stents in longer-term patency and clinical outcome

Charmonium dynamics in nucleus-nucleus collisions at SPS and FAIR energies

Charmonium production and suppression in In+In and Pb+Pb reactions at SPS energies is investigated with the HSD transport approach within the 'hadronic comover model' as well as the 'QGP threshold scenario'. The results of the transport calculations for J/Psi suppression and the Psi prime to J/Psi ratio are compared with the recent data of the NA50 and NA60 Collaborations. We find that the comover absorption model - with a single parameter |M_0|^2 for the matrix element squared for charmonium-meson dissociation - performs best with respect to all data sets. The 'threshold scenario' - within different assumptions for the melting energy densities - yields a reasonable suppression for J/Psi but fails in reproducing the Psi prime to J/Psi ratio for Pb+Pb at 158 A GeV. Predictions for Au+Au reactions are presented for a bombarding energy of 25 A GeV in the different scenarios which will allow for a clear distinction between the models from the experimental side at the future FAIR facility.Comment: 22 pages, 10 figures. v2: comments added according to referee suggestions; references updated; Nucl. Phys. A, in pres

Scoping review : intergenerational resource transfer and possible enabling factors

We explore the intergenerational pattern of resource transfer and possible associated factors. A scoping review was conducted of quantitative, peer-reviewed, English-language studies related to intergenerational transfer or interaction. We searched AgeLine, PsycINFO, Social Work Abstracts, and Sociological Abstracts for articles published between Jane 2008 and December 2018. Seventy-five studies from 25 countries met the inclusion criteria. The scoping review categorised resource transfers into three types: financial, instrumental, and emotional support. Using an intergenerational solidarity framework, factors associated with intergenerational transfer were placed in four categories: (1) demographic factors (e.g., age, gender, marital status, education, and ethno-cultural background); (2) needs and opportunities factors, including health, financial resources, and employment status; (3) family structures, namely, family composition, family relationship, and earlier family events; and (4) cultural-contextual structures, including state policies and social norms. Those factors were connected to the direction of resource transfer between generations. Downward transfers from senior to junior generations occur more frequently than upward transfers in many developed countries. Women dominate instrumental transfers, perhaps influenced by traditional gender roles. Overall, the pattern of resource transfer between generations is shown, and the impact of social norms and social policy on intergenerational transfers is highlighted. Policymakers should recognise the complicated interplay of each factor with different cultural contexts. The findings could inform policies that strengthen intergenerational solidarity and support.</jats:p

Out-of-equilibrium electromagnetic radiation

We derive general formulas for photon and dilepton production rates from an arbitrary non-equilibrated medium from first principles in quantum field theory. At lowest order in the electromagnetic coupling constant, these relate the rates to the unequal-time in-medium photon polarization tensor and generalize the corresponding expressions for a system in thermodynamic equilibrium. We formulate the question of electromagnetic radiation in real time as an initial value problem and consistently describe the virtual electromagnetic dressing of the initial state. In the limit of slowly evolving systems, we recover known expressions for the emission rates and work out the first correction to the static formulas in a systematic gradient expansion. Finally, we discuss the possible application of recently developed techniques in non-equilibrium quantum field theory to the problem of electromagnetic radiation. We argue, in particular, that the two-particle-irreducible (2PI) effective action formalism provides a powerful resummation scheme for the description of multiple scattering effects, such as the Landau-Pomeranchuk-Migdal suppression recently discussed in the context of equilibrium QCD.Comment: 34 pages, 9 figures, uses JHEP3.cl

Evidence for non-hadronic interactions of charm degrees of freedom in heavy-ion collisions at relativistic energies

Within the Hadron-String Dynamics (HSD) transport approach we study the suppression pattern of charmonia at RHIC with respect to centrality and rapidity employing various model concepts such as variants of the 'comover absorption' model or the 'charmonium melting' scenario. We find that especially the ratio of the forward to mid-rapidity nuclear modification factors of J/Psi (R_AA (forward) / R_AA (mid)) cannot be explained by the interactions with 'formed' comoving mesons or by the 'color screening mechanism' alone. Only when incorporating interactions of the c or c-bar quark with a pre-hadronic medium satisfactory results are obtained. A detailed comparison to the PHENIX data demonstrates that non-hadronic interactions are mandatory to describe the narrowing of the J/Psi rapidity distribution from p+p to central Au+Au collisions. The Psi' to J/Psi ratio is found to be crucial in disentangling the different charmonium absorption scenarios especially in the RHIC energy range. Furthermore, a comparison of the transport calculations to the statistical model of Gorenstein and Gazdzicki as well as the statistical hadronization model of Andronic et al. shows differences in the energy dependence as well as centrality dependence of the J/Psi to pion ratio which may be exploited experimentally to disentangle different concepts. We find additionally that the collective flow of charm in the HSD transport appears compatible with the data at SPS energies but substantially underestimates the data at top RHIC energies such that the large elliptic flow v_2 of charm seen experimentally has to be attributed to early interactions of non-hadronic degrees of freedom.Comment: 35 pages, 16 Figs, v2: additional figure and corresponding changes to the tex

Are direct photons a clean signal of a thermalized quark gluon plasma?

Direct photon production from a quark gluon plasma (QGP) in thermal equilibrium is studied directly in real time. In contrast to the usual S-matrix calculations, the real time approach is valid for a QGP that formed and reached LTE a short time after a collision and of finite lifetime ($\sim 10-20 \mathrm{fm}/c$ as expected at RHIC or LHC). We point out that during such finite QGP lifetime the spectrum of emitted photons carries information on the initial state. There is an inherent ambiguity in separating the virtual from the observable photons during the transient evolution of the QGP. We propose a real time formulation to extract the photon yield which includes the initial stage of formation of the QGP parametrized by an effective time scale of formation $\Gamma^{-1}$. This formulation coincides with the S-matrix approach in the infinite lifetime limit. It allows to separate the virtual cloud as well as the observable photons emitted during the pre- equilibrium stage from the yield during the QGP lifetime. We find that the lowest order contribution $\mathcal{O}(\alpha_{em})$ which does \emph{not} contribute to the S-matrix approach, is of the same order of or larger than the S-matrix contribution during the lifetime of the QGP for a typical formation time $\sim 1 \mathrm{fm}/c$. The yield for momenta $\gtrsim 3 \mathrm{Gev}/c$ features a power law fall-off $\sim T^3 \Gamma^2/k^{5}$ and is larger than that obtained with the S-matrix for momenta $\geq 4 \mathrm{Gev}/c$. We provide a comprehensive numerical comparison between the real time and S-matrix yields and study the dynamics of the build-up of the photon cloud and the different contributions to the radiative energy loss. The reliability of the current estimates on photon emission is discussed.Comment: 31 pages, 12 eps figures, version to appear in PR

J/Psi suppression in colliding nuclei: statistical model analysis

We consider the $J/\Psi$ suppression at a high energy heavy ion collision. An ideal gas of massive hadrons in thermal and chemical equilibrium is formed in the central region. The finite-size gas expands longitudinally in accordance with Bjorken law. The transverse expansion in a form of the rarefaction wave is taken into account. We show that $J/\Psi$ suppression in such an environment, when combined with the disintegration in nuclear matter, gives correct evaluation of NA38 and NA50 data in a broad range of initial energy densities.Comment: 14 pages, 13 figures. Accepted for publication in Phys. Rev.

Electromagnetic Probes

A review is presented of dilepton and real photon measurements in relativistic heavy ion collisions over a very broad energy range from the low energies of the BEVALAC up to the highest energies available at RHIC. The dileptons cover the invariant mass range \mll = 0 - 2.5 GeV/c$^2$, i.e. the continuum at low and intermediate masses and the light vector mesons, $\rho, \omega, \phi$. The review includes also measurements of the light vector mesons in elementary reactions.Comment: To be published in Landolt-Boernstein Volume 1-23A; 40 pages, 24 figures. Final version updated with small changes to the text, updated references and updated figure