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Quantitative trait loci (QTL) affecting growth traits have previously been mapped in linkage groups (LG) 2, 3 and 23 of Barramundi ( Lates carcalifer), but these QTL have not been verified in different genetic backgrounds and environments. Here, we report the identification and verification of QTL for growth traits on LG2, 3, 10 and 23 in F1 families constructed using brooders from the Singapore Marine Aquaculture Center (MAC) and from wild stocks collected in Thailand (THAI). The previously detected QTL for body weight and length linked to marker Lca371 on LG2 were confirmed in both the MAC and THAI families, whereas other QTL previously mapped to LG3 and 23 were only detected in one of the two families. QTL for body weight and length were identified in the MAC family, but not in the THAI family, in a region where the insulin-like growth factor 2 ( IGF2) and tyrosine hydroxylase 1 ( TH1) genes are located on LG10. Significant epistatic interactions were identified between markers Lca287 on LG2 and IGF2 on LG10 for growth trait QTL in the MAC family, but not in the THAI family. Effects of the IGF2, TH1 and parvalbumin 1 candidate genes were family-specific. Our results indicate that some but not all QTL are family-specific in Barramundi. [ABSTRACT FROM AUTHOR]

This study evaluated whether the type of anesthesia independently related to risk of blood transfusion events in patients undergoing total knee arthroplasty (TKA) after adjusting for other covariates. This was a secondary analysis of a retrospective cohort study of patients undergoing primary unilateral TKA in Singapore. The independent variable was the type of anesthesia and the dependent variable was blood transfusion events. A multivariable logistic regression analysis was performed adjusting for variables that might affect the choice of anesthesia or blood transfusion events. Additional analyses examined this association by the subgroup analysis by using stratified multivariate logistic regression models. Of all 2,366 patients undergoing primary unilateral TKA, 120 (5.1%) developed blood transfusion events. Sixty-four (4.1%) of 1,560 patients with regional anesthesia (RA) developed blood transfusion events, compared with 56 (6.9%) of 806 patients with general anesthesia (GA; ( p  = 0.003). After adjusting for age, sex, preoperative hemoglobin, and other variables, patients who received RA had a decreased risk of blood transfusion events compared with those receiving GA (odds ratio [OR]: 0.53, 95% confidence interval [CI]: 0.35-0.81). This risk further decreased in male (OR: 0.20, 95% CI: 0.07-0.59) and participants whose operation time ≥ 90 minutes (OR: 0.39, 95% CI: 0.19-0.78). Our results indicated that patients receiving primary unilateral TKA who were managed with RA had a significantly decreased risk of blood transfusion events compared with those with GA, especially in male and participants whose operation time ≥ 90 minutes., Competing Interests: None declared., (Thieme. All rights reserved.)

Based on the theory of social construction and self-consistency, this study aims to investigate the mechanism of relational leadership's role in employees' unethical pro-organizational behavior (UPB) from the perspective of moral identity and ethical climate. We found that relational leadership negatively correlates with the instrumental ethical climate, positively correlates with caring ethical climate, and exerts no significant impact on the rule ethical climate. Instrumental ethical climate and caring ethical climate mediate the relationship between relational leadership and employees' unethical pro-organizational behavior. In addition, moral identity negatively moderates the relationship between instrumental ethical climate and employees' unethical pro-organizational behavior, and between caring ethical climate and employees' unethical pro-organizational behavior. Furthermore, moral identity positively moderates the relationship between a rule ethical climate and employees' unethical, pro-organizational behavior., Competing Interests: The authors have declared that no competing interests exist.

The unbalanced economic development, the lifestyle changes of the residents, the aging before getting rich and the burden of non-communicable chronic diseases in China have brought great pressure on China's health system. However, the prevention and control mechanism of chronic diseases in China is far from mature, which restricts the development of the prevention and control of chronic diseases in China. Singapore's new concept on chronic disease management and the the 3-level theoretical framework are good experience in the world and deserve to be learned by China. This article introduced the Healthy Living Master Plan in health promotion practice in Singapore, and made suggestions on construction of health management system to cope with the disease burden in China.

Background: The incidence of cancer was determined by genetic and environmental factors and varied across the world. The discrepancies in cancer profile among Chinese people living in different regions remained obscure., Methods: Chinese people living in urban Shanghai, Hong Kong, Taiwan, Macau, Singapore, and Los Angeles were included in this study. The cancer case data and population data were collected from either the Cancer Incidence in Five Continents Plus database or the regional cancer registry. A rate model was applied to examine the regional differences in cancer risk with Shanghai set as the reference., Results: From 1983 to 2013, the cancer profiles in most regions were changed. Significant differences in cancer incidence, by sex, period, and age, were detected across regions. The most pronounced disparities were found between Shanghai people and American Chinese in Los Angeles. For cancer site, the most significant differences were detected in prostate, gastrointestinal, gynecologic, oral cavity and pharynx, and brain and central nervous system (CNS) cancers. Specifically, Shanghai was significantly higher in stomach, liver, esophageal, pancreatic, and brain and CNS cancers, while lower in colon, prostate, breast, cervical, and oral cavity and pharynx cancers compared with the other five populations., Conclusions: Cancer profile was distinct across Chinese populations, which shared a similar genetic background but lived in different regions. The disparities indicate that cancer development was majorly determined by environmental factors, and suggests that region-tailored cancer prevention strategies were warranted., Impact: The cancer patterns in populations sharing the same genetic background were significantly influenced by different living conditions., (©2019 American Association for Cancer Research.)

Introduction: Comorbidity is common in elderly patients and it imposes heavy burden on both individual and the whole healthcare system. This study aims to gain insights of comorbidity development by simulating the lifetime trajectory of disease progression from single chronic disease to comorbidity., Methods: Eight health states spanning from no chronic condition to comorbidity are considered in this study. Disease progression network is constructed based on the seven-year retrospective data of around 700,000 residents living in Singapore central region. Microsimulation is applied to simulate the process of aging and disease progression of a synthetic new-born cohort for the entire lifetime., Results: Among the 40 unique trajectories observed from the simulation, the top 10 trajectories covers 60% of the cohort. Timespan of most trajectories from birth to death is 80 years. Most people progress to at risk at late 30 s, develop the first chronic condition at 50 s or 60 s, and then progress to complications at 70 s. It is also observed that the earlier one person develops chronic conditions, the more life-year-lost is incurred., Discussion: The lifetime disease progression trajectory constructed for each person in the cohort describes how a person starts healthy, becomes at risk, then progresses to one or more chronic conditions, and finally deteriorates to various complications over the years. This study may help us have a better understanding of chronic disease progression and comorbidity development, hence add values to chronic disease prevention and management., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Colorectal Cancer (CRC) is rapidly rising in Asia, but screening uptake remains poor. Although studies have reported gender differences in screening rates, there have been few studies assessing gender specific perceptions and barriers towards CRC screening, based on behavioral frameworks. We applied the Health Belief Model to identify gender-specific predictors of CRC screening in an Asian population., Methods: A nationwide representative household survey was conducted on 2000 subjects aged 50 years and above in Singapore from 2007 to 2008. Screening behaviour, knowledge and beliefs on CRC screening were assessed by face-to-face structured interviews. The response rate was 88.2%., Results: 26.7 percent had undergone current CRC screening with no gender difference in rates. Almost all agreed that CRC would lead to suffering (89.8%), death (84.6%) and would pose significant treatment cost and expense (83.1%). The majority (88.5%) agreed that screening aids early detection and cure but only 35.4% felt susceptible to CRC. Nearly three-quarters (74.3%) of the respondents recalled reading or hearing information on CRC in the print or broadcast media. However, only 22.6% were advised by their physicians to undergo screening. Significantly more women than men had feared a positive diagnosis, held embarrassment, pain and risk concerns about colonoscopy and had friends and family members who encouraged screening. On multivariate analysis, screening uptake showed a positive association with worry about contracting CRC and a physician's recommendation and a negative association with perceived pain about colonoscopy for both genders. For women only, screening was positively associated with having attended a public talk on CRC and having a family member with CRC, and was negatively associated with Malay race and perceived danger of colonoscopy., Conclusions: CRC screening remains poor despite high levels of awareness of its benefits in this Asian population. Race, worry about contracting cancer, psychological barriers, and cues from the doctor and a public talk on CRC were associated with screening with gender specific differences. Strategies to increase CRC screening uptake should consider gender specific approaches to address psychological barriers and increase disease susceptibility through public health education and active promotion by physicians.

This paper is focused on the factors causing long patient waiting time/clinic overtime in outpatient clinics and how to mitigate them using discrete event simulation. A two-week period of data collection is conducted in an outpatient clinic of a Singapore government hospital. Detailed time study from patient arrival to patient departure is conducted, and the possible factors causing long patient waiting time/clinic overtime are discussed. A discrete simulation model is constructed to illustrate how to improve the clinic performance by mitigating the detected factors. Simulation and implementation results show that significant improvement is achieved if the factors are well addressed.

Beds are one of the most important resources in a healthcare system. How to manage beds efficiently is an important indicator of the efficiency of the healthcare system. Bed management is challenging to many healthcare service providers in many aspects. In recent years, population growth and aging society impose extra pressure on bed requirement. There are usually two key performance indicators of a bed management system: bed occupancy rate and bed waiting time. In this paper, different discharge patterns and their impacts on the bed occupancy rate and bed waiting time are studied. A discrete event simulation model is constructed to evaluate the existing discharge pattern in a Singapore regional hospital using actual hospital admission and discharge transaction data. Then different discharge patterns are tested in the same context. Simulation results show that a proper discharge pattern significantly smoothes the fluctuation of bed occupancy rate and reduce the bed waiting time.

Background: Metastatic spinal cord compression is a dreaded complication of cancer affecting 5-10% of patients requiring urgent treatment. A clinical practice improvement project was carried out to review and fine tune the clinical pathway for the acute management of patients with metastatic spinal cord compression., Objective: To improve the quality of care for metastatic spinal cord compression over 6 months by ensuring that >90% of patients receive definitive treatment within 24 h of radiological diagnosis., Method: Using clinical practice improvement project methodology, the clinical pathway of 17 patients treated with radiotherapy for metastatic spinal cord compression within the last 6 months were reviewed to identify gaps and delays in the system. Interventions to form a multidisciplinary acute spinal cord crisis team, fine tune clinical referral processes and formulate a standardized treatment protocol were then implemented. Post-intervention of 22 subsequent patients were monitored for time to start steroids and radiation therapy, length of stay and hospitalization bill., Results: With the interventions implemented, the mean response time to start steroidal therapy was reduced from 8.4 to 2.6 days and radiotherapy from 9.9 to 3.9 days. These translated into shorter mean length of stay from 23.8 to 14.7 days and smaller hospitalization bill size from 13,723 to 8,808 Singapore dollars., Conclusion: A clinical practice improvement project, to improve the quality of care for patients with metastatic spinal cord compression, can shorten response time to start steroidal therapy and definitive radiotherapy resulting in shorter length of stay and smaller hospitalization bill.