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Look CSJ, Teixayavong S, Djärv T, Ho AFW, Tan KBK, Ong MEH. Improved interpretable machine learning emergency department triage tool addressing class imbalance. Digit Health 2024; 10:20552076241240910. [PMID: 38708185 PMCID: PMC11067679 DOI: 10.1177/20552076241240910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/05/2024] [Indexed: 05/07/2024] Open
Abstract
Objective The Score for Emergency Risk Prediction (SERP) is a novel mortality risk prediction score which leverages machine learning in supporting triage decisions. In its derivation study, SERP-2d, SERP-7d and SERP-30d demonstrated good predictive performance for 2-day, 7-day and 30-day mortality. However, the dataset used had significant class imbalance. This study aimed to determine if addressing class imbalance can improve SERP's performance, ultimately improving triage accuracy. Methods The Singapore General Hospital (SGH) emergency department (ED) dataset was used, which contains 1,833,908 ED records between 2008 and 2020. Records between 2008 and 2017 were randomly split into a training set (80%) and validation set (20%). The 2019 and 2020 records were used as test sets. To address class imbalance, we used random oversampling and random undersampling in the AutoScore-Imbalance framework to develop SERP+-2d, SERP+-7d, and SERP+-30d scores. The performance of SERP+, SERP, and the commonly used triage risk scores was compared. Results The developed SERP+ scores had five to six variables. The AUC of SERP+ scores (0.874 to 0.905) was higher than that of the corresponding SERP scores (0.859 to 0.894) on both test sets. This superior performance was statistically significant for SERP+-7d (2019: Z = -5.843, p < 0.001, 2020: Z = -4.548, p < 0.001) and SERP+-30d (2019: Z = -3.063, p = 0.002, 2020: Z = -3.256, p = 0.001). SERP+ outperformed SERP marginally on sensitivity, specificity, balanced accuracy, and positive predictive value measures. Negative predictive value was the same for SERP+ and SERP. Additionally, SERP+ showed better performance compared to the commonly used triage risk scores. Conclusions Accounting for class imbalance during training improved score performance for SERP+. Better stratification of even a small number of patients can be meaningful in the context of the ED triage. Our findings reiterate the potential of machine learning-based scores like SERP+ in supporting accurate, data-driven triage decisions at the ED.
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Affiliation(s)
- Clarisse SJ Look
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | | | - Therese Djärv
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Andrew FW Ho
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Kenneth BK Tan
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Marcus EH Ong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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2
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Knapp J, Levitin LV, Nyéki J, Ho AF, Cowan B, Saunders J, Brando M, Geibel C, Kliemt K, Krellner C. Electronuclear Transition into a Spatially Modulated Magnetic State in YbRh_{2}Si_{2}. Phys Rev Lett 2023; 130:126802. [PMID: 37027856 DOI: 10.1103/physrevlett.130.126802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/03/2023] [Indexed: 06/19/2023]
Abstract
The nature of the antiferromagnetic order in the heavy fermion metal YbRh_{2}Si_{2}, its quantum criticality, and superconductivity, which appears at low mK temperatures, remain open questions. We report measurements of the heat capacity over the wide temperature range 180 μK-80 mK, using current sensing noise thermometry. In zero magnetic field we observe a remarkably sharp heat capacity anomaly at 1.5 mK, which we identify as an electronuclear transition into a state with spatially modulated electronic magnetic order of maximum amplitude 0.1 μ_{B}. We also report results of measurements in magnetic fields in the range 0 to 70 mT, applied perpendicular to the c axis, which show eventual suppression of this order. These results demonstrate a coexistence of a large moment antiferromagnet with putative superconductivity.
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Affiliation(s)
- J Knapp
- Department of Physics, Royal Holloway University of London, TW20 0EX, Egham, United Kingdom
| | - L V Levitin
- Department of Physics, Royal Holloway University of London, TW20 0EX, Egham, United Kingdom
| | - J Nyéki
- Department of Physics, Royal Holloway University of London, TW20 0EX, Egham, United Kingdom
| | - A F Ho
- Department of Physics, Royal Holloway University of London, TW20 0EX, Egham, United Kingdom
| | - B Cowan
- Department of Physics, Royal Holloway University of London, TW20 0EX, Egham, United Kingdom
| | - J Saunders
- Department of Physics, Royal Holloway University of London, TW20 0EX, Egham, United Kingdom
| | - M Brando
- Max Planck Institute for Chemical Physics of Solids, Nöthnitzer Straße 40, 01187 Dresden, Germany
| | - C Geibel
- Max Planck Institute for Chemical Physics of Solids, Nöthnitzer Straße 40, 01187 Dresden, Germany
| | - K Kliemt
- Physikalisches Institut, Max-von-Laue-Straße 1, 60438 Frankfurt am Main, Germany
| | - C Krellner
- Physikalisches Institut, Max-von-Laue-Straße 1, 60438 Frankfurt am Main, Germany
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3
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Lim SL, Toh C, Fook-Chong S, Yazid M, Shahidah N, Ng QX, Ho AFW, Arulanandam S, Leong BSH, White AE, Ong MEH. Impact of COVID-19 on barriers to dispatcher-assisted cardiopulmonary resuscitation in adult out-of-hospital cardiac arrests in Singapore. Resuscitation 2022; 181:40-47. [PMID: 36280214 PMCID: PMC9596179 DOI: 10.1016/j.resuscitation.2022.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/06/2022] [Accepted: 10/15/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Fewer out-of-hospital cardiac arrest (OHCA) patients received bystander cardiopulmonary resuscitation during the COVID-19 pandemic in Singapore. We investigated the impact of COVID-19 on barriers to dispatcher-assisted cardiopulmonary resuscitation (DA-CPR). METHODS We reviewed audio recordings of all calls to our national ambulance service call centre during the pandemic (January-June 2020) and pre-pandemic (January-June 2019) periods. Our primary outcome was the presence of barriers to DA-CPR. Multivariable logistic regression was used to assess the effect of COVID-19 on the likelihood of barriers to and performance of DA-CPR, adjusting for patient and event characteristics. RESULTS There were 1241 and 1118 OHCA who were eligible for DA-CPR during the pandemic (median age 74 years, 61.6 % males) and pre-pandemic (median age 73 years, 61.1 % males) periods, respectively. Compared to pre-pandemic, there were more residential and witnessed OHCA during the pandemic (87 % vs 84.9 % and 54 % vs 38.1 %, respectively); rates of DA-CPR were unchanged (57.3 % vs 61.1 %). COVID-19 increased the likelihood of barriers to DA-CPR (aOR 1.47, 95 % CI: 1.25-1.74) but not performance of DA-CPR (aOR 0.86, 95 % CI: 0.73 - 1.02). Barriers such as 'patient status changed' and 'caller not with patient' increased during COVID-19 pandemic. 'Afraid to do CPR' markedly decreased during the pandemic; fear of COVID-19 transmission made up 0.5 % of the barriers. CONCLUSION Barriers to DA-CPR were encountered more frequently during the COVID-19 pandemic but did not affect callers' willingness to perform DA-CPR. Distancing measures led to more residential arrests with increases in certain barriers, highlighting opportunities for public education and intervention.
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Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Centre Singapore, Singapore,Department of Medicine, National University of Singapore, Singapore,Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore,Corresponding author at: Department of Cardiology, National University Heart Centre 1E, Kent Ridge Road, NUHS Tower Block, Singapore 119228, Singapore
| | - Cherylyn Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Muhammad Yazid
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Qin Xiang Ng
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Andrew FW Ho
- Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore,Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Benjamin SH Leong
- Emergency Medicine Department, National University Hospital, Singapore
| | - Alexander E White
- Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marcus EH Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore,Health Services and Systems Research, Duke-NUS Medical School, Singapore
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White AE, Ho AFW, Shahidah N, Asyikin N, Liew LX, Pek PP, Kua JPH, Chia MYC, Ng YY, Arulanandam S, Leong SHB, Ong MEH. An essential review of Singapore's response to out-of-hospital cardiac arrests: improvements over a ten-year period. Singapore Med J 2021; 62:438-443. [PMID: 35001113 PMCID: PMC8804483 DOI: 10.11622/smedj.2021114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Care for patients who experience out-of-hospital cardiac arrest (OHCA) has rapidly evolved in the past decade. Increased sophistication of care in the community, emergency medical services (EMS) and hospital setting is associated with improved patient-centred outcomes. Notably, Utstein survival doubled from 11.6% to 23.1% between 2011 and 2016. These achievements involved collaboration between policymakers, clinicians and researchers, and were made possible by a strategic interplay of policy, research and implementation. We review the development and current state of OHCA in Singapore using primary population-based data from the Pan-Asian Resuscitation Outcomes Study and an unstructured search of research databases. We discuss the roles of important milestones in policy, community, dispatch, EMS and hospital interventions. Finally, we relate these interventions to relevant processes and outcomes, such as the relationship between the strategic implementation of bystander cardiopulmonary resuscitation and placement of automated external defibrillator with return of spontaneous circulation, survival to discharge and survival with favourable neurological outcomes.
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Affiliation(s)
- Alexander E White
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Andrew FW Ho
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nurul Asyikin
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
| | - Le Xuan Liew
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
| | - Pin Pin Pek
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Jade PH Kua
- Emergency Department, Woodlands Health Campus, Singapore
| | | | - Yih Yng Ng
- Emergency Department, Tan Tock Seng Hospital, Singapore
- Home Team Medical Services Division, Ministry of Home Affairs, Singapore
| | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | | | - Marcus EH Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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5
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Abstract
BACKGROUND The global coronavirus disease 2019 pandemic has highlighted the importance of understanding the cardiovascular implications of coronavirus infections, with more severe disease in those with cardiovascular co-morbidities, and resulting cardiac manifestations such as myocardial injury, arrhythmias, and heart failure. DESIGN A systematic review of the current knowledge on the effects of coronavirus infection on the cardiovascular system in humans was performed and results were summarized. METHODS Databases such as MEDLINE, EMBASE, CENTRAL, Scopus, Web of Science, ClinicalTrials.gov, Chinese Knowledge Resource Integrated Database and Chinese Clinical Trial Registry were searched on 20 March 2020. RESULTS In total, 135 studies were included, involving severe acute respiratory syndrome, Middle East respiratory syndrome, coronavirus disease 2019 and other coronaviruses. Most were case reports, case series and cohort studies of poor to fair quality. In post-mortem examinations of subjects who died from infection, around half had virus identified in heart tissues in severe acute respiratory syndrome, but none in Middle East respiratory syndrome and coronavirus disease 2019. Cardiac manifestations reported include tachycardia, bradycardia, arrhythmias, and myocardial injury, secondary to both systemic infection and treatment. Cardiac injury and arrhythmias are more prevalent in coronavirus disease 2019, and elevated cardiac markers are associated with intensive care unit admission and death. In severe acute respiratory syndrome, Middle East respiratory syndrome, and coronavirus disease 2019, comorbidities such as hypertension, diabetes mellitus, and heart disease are associated with intensive care unit admission, mechanical ventilation, and mortality. There were cases of misdiagnosis due to overlapping presentations of cardiovascular diseases and coronavirus infections, leading to hospital spread and delayed management of life-threatening conditions. CONCLUSION This review highlighted the ways in which coronaviruses affect cardiovascular function and interacts with pre-existing cardiovascular diseases.
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Affiliation(s)
- Jamie SY Ho
- />School of Clinical Medicine, University of Cambridge, UK
| | - Paul A Tambyah
- />Division of Infectious Diseases, National University Hospital, Singapore
- />Department of Medicine, National University of Singapore, Singapore
| | - Andrew FW Ho
- />SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore
- />Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore
- />National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Mark YY Chan
- />Department of Medicine, National University of Singapore, Singapore
- />Department of Cardiology, National University Heart Centre, Singapore
| | - Ching-Hui Sia
- />Department of Medicine, National University of Singapore, Singapore
- />Department of Cardiology, National University Heart Centre, Singapore
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6
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Yeo LLL, Lye PPS, Yee KW, Cunli Y, Ming TT, Ho AFW, Sharma VK, Chan BPL, Tan BYQ, Gopinathan A. Deep Cerebral Venous Thrombosis Treatment. Clin Neuroradiol 2020; 30:661-670. [DOI: 10.1007/s00062-020-00920-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/23/2020] [Indexed: 11/29/2022]
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7
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Ho AFW, Lee KY, Lin X, Hao Y, Shahidah N, Ng YY, Leong BSH, Sia CH, Tan BYQ, Tay AM, Ng MXR, Gan HN, Mao DR, Chia MYC, Cheah SO, Ong MEH. Nation-Wide Observational Study of Cardiac Arrests Occurring in Nursing Homes and Nursing Facilities in Singapore. Ann Acad Med Singap 2020. [DOI: 10.47102/annals-acadmed.sg.2019244] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Nursing home (NH) residents with out-of-hospital cardiac arrests (OHCA) have unique resuscitation priorities. This study aimed to describe OHCA characteristics in NH residents and identify independent predictors of survival. Materials and Methods: OHCA cases between 2010–16 in the Pan-Asian Resuscitation Outcomes Study were retrospectively analysed. Patients aged <18 years old and non-emergency cases were excluded. Primary outcome was survival at discharge or 30 days. Good neurological outcome was defined as a cerebral performance score between 1–2. Results: A total of 12,112 cases were included. Of these, 449 (3.7%) were NH residents who were older (median age 79 years, range 69–87 years) and more likely to have a history of stroke, heart and respiratory diseases. Fewer NH OHCA had presumed cardiac aetiology (62% vs 70%, P <0.01) and initial shockable rhythm (8.9% vs 18%, P <0.01), but had higher incidence of bystander cardiopulmonary resuscitation (74% vs 43%, P <0.01) and defibrillator use (8.5% vs 2.8%, P <0.01). Non-NH (2.8%) residents had better neurological outcomes than NH (0.9%) residents (P <0.05). Factors associated with survival for cardiac aetiology included age <65 years old, witnessed arrest, bystander defibrillator use and initial shockable rhythm; for non-cardiac aetiology, these included witnessed arrest (adjusted odds ratio [AOR] 3.8, P <0.001) and initial shockable rhythm (AOR 5.7, P <0.001). Conclusion: Neurological outcomes were poorer in NH survivors of OHCA. These findings should inform health policies on termination of resuscitation, advance care directives and do-not-resuscitate orders in this population.
Ann Acad Med Singapore 2020;49:285–93
Key words: Advance care directives, Do-not-resuscitate orders, Geriatrics, Out-of- hospital, Palliative care
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Affiliation(s)
| | - Kai Yi Lee
- National University of Singapore, Singapore
| | | | - Ying Hao
- Division of Medicine, Singapore General Hospital, Singapore
| | | | | | | | - Ching-Hui Sia
- National University Heart Centre Singapore, Singapore
| | - Benjamin YQ Tan
- Department of Medicine, National University Health System, Singapore
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8
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Chan SL, Ho AFW, Ding H, Liu N, Earnest A, Koh MS, Chuah JST, Lau ZY, Tan KB, Zheng H, Morgan GG, Ong MEH. Impact of Air Pollution and Trans-Boundary Haze on Nation-Wide Emergency
Department Visits and Hospital Admissions in Singapore. Ann Acad Med Singap 2020. [DOI: 10.47102/annals-acadmedsg.2019209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Introduction: Air pollution is associated with adverse health outcomes. However,
its impact on emergency health services is less well understood. We investigated the
impact of air pollution on nation-wide emergency department (ED) visits and hospital
admissions to public hospitals in Singapore. Materials and Methods: Anonymised
administrative and clinical data of all ED visits to public hospitals in Singapore from
January 2010 to December 2015 were retrieved and analysed. Primary and secondary
outcomes were defined as ED visits and hospital admissions, respectively. Conditional
Poisson regression was used to model the effect of Pollutant Standards Index (PSI)
on each outcome. Both outcomes were stratified according to subgroups defined a
priori based on age, diagnosis, gender, patient acuity and time of day. Results: There
were 5,791,945 ED visits, of which 1,552,187 resulted in hospital admissions. No
significant association between PSI and total ED visits (Relative risk [RR], 1.002; 99.2%
confidence interval [CI], 0.995–1.008; P = 0.509) or hospital admissions (RR, 1.005;
99.2% CI, 0.996–1.014; P = 0.112) was found. However, for every 30-unit increase in
PSI, significant increases in ED visits (RR, 1.023; 99.2% CI, 1.011–1.036; P = 1.24 ×
10˗6) and hospital admissions (RR, 1.027; 99.2% CI, 1.010–1.043; P = 2.02 × 10˗5) for
respiratory conditions were found. Conclusion: Increased PSI was not associated with
increase in total ED visits and hospital admissions, but was associated with increased
ED visits and hospital admissions for respiratory conditions in Singapore.
Key words: Epidemiology, Healthcare utilisation, PSI, Public health, Time series
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Affiliation(s)
| | - Andrew FW Ho
- NUS Medical School, Singapore.Singapore General Hospital, Singapore
| | | | - Nan Liu
- Singapore Health Services, Singapore. NUS Medical School, Singapore
| | - Arul Earnest
- Monash University School of Public Health and Preventive Medicine, Australia
| | - Mariko S Koh
- Singapore General Hospital, Singapore. NUS Medical School, Singapore
| | | | | | - Kelvin Bryan Tan
- Ministry of Health, Singapore. National University of Singapore, Singapor
| | | | | | - Marcus EH Ong
- Singapore Health Services, Singapore. NUS Medical School, Singapore. Singapore General Hospital, Singapore
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Tan BY, Tan JTC, Cheah D, Pek PP, Zheng H, De Silva DA, Ahmad A, Chan BPL, Chang HM, Kong KH, Young SH, Tang KF, Yeo LLL, Venketasubramanian N, Ho AFW, Ong MEH. Abstract TP211: Long-Term Trends in Ischemic Stroke Risk Factors and Outcomes in a Multiethnic Population. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Stroke medicine has evolved over time, with changing demographics and improving outcomes. We aimed to evaluate trends in incidence, risk factors, treatment and case fatality of acute ischemic stroke (AIS) in a multiethnic population.
Methods:
Data was obtained from the Singapore Stroke Registry. 60,325 AIS cases that presented to Singapore’s public hospitals from 2005-16 were studied. Trends were analyzed with Poisson regression, logistic regression and Cox regression.
Results:
The AIS age-standardized incidence rate has decreased by 11.6% (126.5 to 111.8 per 100,000 person-years from 2005-07 to 2014-16, p < 0.001). This was observed in all gender and ethnic groups except in those younger than 65, which saw a 2.5% increase (51.0 to 52.4 per 100,000 person-years, p = 0.017). In terms of risk factors, hypertension, hyperlipidemia, and atrial fibrillation have increased in prevalence, while history of stroke, ischemic heart disease, diabetes, and smoking have decreased (Figure A). Treatment-wise, thrombolysis utilization rates have increased significantly from 0.8% in 2005-2007 to 6.7% in 2014-2016 (p < 0.001). While atrial fibrillation (AF) has become more prevalent (15.8% to 25.2%, p < 0.001), anticoagulant prescription has not increased by the same magnitude (13.2% to 14.4%, p = 0.014). Case fatality has reduced by 25.6% (8.2% to 6.1%, p < 0.001).
Conclusion:
In a multi-ethnic population, whilst we found that AIS age-standardized incidence rate has been declining, we demonstrate a temporal trend of changing risk factors. Further research is needed to investigate the causes and implications of these trends, so as to better strategize prevention efforts.
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Affiliation(s)
- Benjamin Y Tan
- Div of Neurology, Dept of Medicine, National Univ Health System, Singapore, Singapore, Singapore
| | - Joshua TC Tan
- Div of Neurology, Dept of Medicine, National Univ Health System, Singapore, Singapore, Singapore
| | - Dawn Cheah
- Yong Loo Lin Sch of Medicine, National Univ of Singapore, Singapore, Singapore
| | - Pin Pin Pek
- Dept of Emergency Medicine, Singapore General Hosp, Singapore, Singapore, Singapore
| | - Huili Zheng
- National Registry of Diseases Office, Health Promotion Board, Singapore, Singapore, Singapore
| | | | - Aftab Ahmad
- Ng Teng Fong General Hosp, National Univ Health System, Singapore, Singapore, Singapore
| | - Bernard PL Chan
- Div of Neurology, Dept of Medicine, National Univ Health System, Singapore, Singapore, Singapore
| | - Hui Meng Chang
- National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Keng He Kong
- Dept of Rehabilitation Medicine, Tan Tock Seng Hosp, Singapore, Singapore, Singapore
| | - Sherry H Young
- Dept of Rehabilitation Medicine, Changi General Hosp, Singapore, Singapore, Singapore
| | - Kok Foo Tang
- Mount Elizabeth Hosp, Singapore, Singapore, Singapore
| | - Leonard LL Yeo
- Div of Neurology, Dept of Medicine, National Univ Health System, Singapore, Singapore, Singapore
| | | | - Andrew FW Ho
- Dept of Emergency Medicine, Singapore General Hosp, Singapore, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Dept of Emergency Medicine, Singapore General Hosp, Singapore, Singapore, Singapore
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10
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Chong J, Bulluck H, FW Ho A, Boisvert WA, Hausenloy DJ. Chronic remote ischemic conditioning for cardiovascular protection. Cond Med 2019; 2:164-169. [PMID: 32313876 PMCID: PMC7169952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
New treatments are needed to prevent adverse left ventricular remodelling following acute myocardial infarction (AMI), in order to prevent heart failure and improve clinical outcomes following AMI. Remote ischemic conditioning (RIC) using transient limb ischemia and reperfusion has been reported to reduce myocardial infarct (MI) size in AMI patients treated by primary percutaneous coronary intervention, and whether it can improve clinical outcomes is currently being investigated. Interestingly, repeated daily episode of limb RIC (termed 'chronic remote ischemic conditioning', or CRIC) has been shown in experimental and clinical studies to confer beneficial effects on post-AMI cardiac remodelling and chronic heart failure. In addition, the beneficial effects of CRIC extend to vascular function, peripheral arterial disease and stroke. In this review article, we focus on the therapeutic potential of CRIC as a strategy for cardiovascular protection and for improving clinical outcomes in patients with cardiovascular disease.
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Affiliation(s)
- Jun Chong
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- National Heart Centre Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore
| | - Heerajnarain Bulluck
- National Heart Centre Singapore, Singapore
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Andrew FW Ho
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital
| | - William A. Boisvert
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii, USA
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Derek J Hausenloy
- National Heart Centre Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
- The Hatter Cardiovascular Institute, University College London, London, UK
- Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico
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11
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Chong J, Bulluck H, Yap EP, Ho AFW, Boisvert WA, Hausenloy DJ. Remote ischemic conditioning in ST-segment elevation myocardial infarction - an update. Cond Med 2018; 1:13-22. [PMID: 30338313 PMCID: PMC6191186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Acute myocardial infarction (AMI) and the heart failure (HF) that often results are among the leading causes of death and disability in the world. As such, novel strategies are required to protect the heart against the detrimental effects of acute ischemia/reperfusion injury (IRI), in order to reduce myocardial infarct (MI) size and prevent the onset of HF. The endogenous cardioprotective strategy of remote ischemic conditioning (RIC), in which cycles of brief ischemia and reperfusion are applied to a tissue or organ away from the heart, has been reported in experimental studies to reduce MI size in animal models of acute IRI. In the clinical setting, RIC can be induced by simply inflating and deflating a cuff placed on the upper arm or thigh to induce brief cycles of ischemia and reperfusion, a strategy which has been shown to reduce MI size in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). The results of the ongoing CONDI2/ERIC-PPCI trial are eagerly awaited, and will provide definitive answers with regards to the cardioprotective effect and clinical outcome benefits of RIC in STEMI.
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Affiliation(s)
- Jun Chong
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Heerajnarain Bulluck
- Hatter Cardiovascular Institute, London, United Kingdom
- Norfolk and Norwich University Hospital, Norwich, UK
| | - En Ping Yap
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Andrew FW Ho
- Department of Emergency Medicine, Singapore General Hospital
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore
| | - William A. Boisvert
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii, USA
| | - Derek J Hausenloy
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Hatter Cardiovascular Institute, London, United Kingdom
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
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Abstract
We study the decoherence and thermalization dynamics of a nanoscale system coupled nonperturbatively to a fully quantum-mechanical bath. The system is prepared out of equilibrium in a pure state of the complete system. We propose a random matrix model and show analytically that there are two robust temporal regimes in the approach of the system to equilibrium-an initial Gaussian decay followed by an exponential tail, consistent with numerical results on small interacting lattices [S. Genway, A. F. Ho, and D. K. K. Lee, Phys. Rev. Lett. 105, 260402 (2010)]. Furthermore, the system decays towards a Gibbs ensemble in accordance with the eigenstate thermalization hypothesis.
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Affiliation(s)
- S Genway
- School of Physics and Astronomy, The University of Nottingham, Nottingham NG7 2RD, United Kingdom
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13
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Genway S, Ho AF, Lee DKK. Dynamics of thermalization in small Hubbard-model systems. Phys Rev Lett 2010; 105:260402. [PMID: 21231633 DOI: 10.1103/physrevlett.105.260402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 11/17/2010] [Indexed: 05/16/2023]
Abstract
We study numerically the thermalization and temporal evolution of a two-site subsystem of a fermionic Hubbard model prepared far from equilibrium at a definite energy. Even for very small systems near quantum degeneracy, the subsystem can reach a steady state resembling equilibrium. This occurs for a nonperturbative coupling between the subsystem and the rest of the lattice where relaxation to equilibrium is Gaussian in time, in sharp contrast to perturbative results. We find similar results for random couplings, suggesting such behavior is generic for small systems.
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Affiliation(s)
- S Genway
- Blackett Laboratory, Imperial College London, London, United Kingdom
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14
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Cazalilla MA, Ho AF, Giamarchi T. Two-component Fermi gas on internal-state-dependent optical lattices. Phys Rev Lett 2005; 95:226402. [PMID: 16384247 DOI: 10.1103/physrevlett.95.226402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Indexed: 05/05/2023]
Abstract
We study the phase diagram of a one-dimensional, two-component (i.e., pseudo-"spin"-(1/2)) ultracold atomic Fermi gas. The two atom species can have different hopping or mass. A very rich phase diagram for equal densities of the species is found, containing Mott insulators and superfluids. We also discuss coupling such 1D systems and the experimental signatures of the phases. In particular, we compute the spin-structure factor at small momentum, which should reveal a spin gap.
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Affiliation(s)
- M A Cazalilla
- Donostia Int'l Physics Center, Manuel de Lardizabal, 4. 20018-Donostia, Spain
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15
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Abstract
We show that a two-dimensional (2D) array of 1D interacting boson tubes has a deconfinement transition between a 1D Mott insulator and a 3D superfluid for commensurate fillings and a dimensional crossover for the incommensurate case. We determine the phase diagram and excitations of this system and discuss the consequences for Bose condensates loaded in 2D optical lattices.
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Affiliation(s)
- A F Ho
- School of Physics and Astronomy, The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
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16
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Abstract
We show that one-dimensional binary mixtures of bosons or of a boson and a spin-polarized fermion are Luttinger liquids with the following instabilities: (i) For different particle densities, strong attraction between the mixture components leads to collapse, while strong repulsion leads to demixing, and (ii) For a low-density mixture of two gases of impenetrable bosons (or a spin-polarized fermion and an impenetrable boson) of equal densities, the system develops a gap and exhibits enhanced pairing fluctuations when there is attraction between the components. In the boson-fermion mixture, the pairing fluctuations occur at finite momentum. Our conclusions apply to mixtures both on the continuum and on optical lattices away from integer or fractional commensurability.
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Affiliation(s)
- M A Cazalilla
- Donostia International Physics Center, Manuel de Lardizabal 4, 20018-Donostia, Spain
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