Singapore Experience Research Articles

Trading Through a Pandemic: The Singaporean Experience

Being a small country with one of the highest trade-to-GDP ratios in the world, Singapore faced seemingly insurmountable challenges at the onset of the Coronavirus disease 2019 (COVID-19) pandemic. As countries around the world scrambled to fight the pandemic, they imposed restrictions on exports and imports, suspended international transportation of both goods and people, and invoked emergency power and exceptions to justify their actions. All these presented unprecedented challenges to Singapore, a country which relies on international trade not only for its prosperity but also for survival. This article discusses how Singapore tries to meet these challenges through various initiatives to diversify its sources of supply, ensure trade of essential goods, and minimize the interruptions to business travel. The Singapore experience provides an invaluable case study on how trade agreements can be used not just to regulate trade, but also to facilitate trade, a lesson that will be useful for all countries as the world embark on the road to recovery. export restrictions, essential goods, general exception, stockpiling, movement of people, COVID-19, pandemic, GATT, GATS, WTO

A modern history textbook as a means of developing student reading literacy (based on Singapore experience)

A modern history textbook as a means of developing student reading literacy (based on Singapore experience)

Living with Quality: Strategies for Transferring Social Housing Development to After-war Syria

Obtaining a home in Syria has been an equivalent to a strategic goal around which the life of the Syrian citizen revolves. Housing was one of the problematic crises before the war, which accelerated due to the war. Moreover, this turned into a humanitarian disaster, and the situation has become more urgent and requires immediate treatment. The solution of this demolition is not limited to an easy rebuilding and needs a more sustainable and qualified policy in order to prevent to turn back to the existing crisis before the war. This paper focuses on finding an appropriate strategy to respond to the housing crisis in Syria in the light of successful implementations of social housing. In order to achieve that, after a literature review of the general context of social housing, the Singapore social housing experience has been analyzed. Considering the housing problems and implementations in Syria (before and after the war) in a comparative evaluation with the Singapore experience, some strategies have been suggested, along with discussing the transfer of this experience to the Syrian context. A list of recommendations for developing a social housing strategy based on a clear legal framework also provides a base for social housing.

Planning Practice of Coordinated Development of Urban Traffic and Land Use

While China’s economy is developing rapidly and sustainably, urban issues appears continuously, for instance traffic congestion, insufficient funds, environmental pollution, and housing shortages. It is necessary to learn from advanced international countries’ experiences and process urban planning in accordance with the domestic situation. This article analyses the relationship between transportation and land use, and proposes the basic idea of applying the concept of coordinated development of transportation and land use, by introducing the advanced experience of Singapore, Copenhagen and Hong Kong in the coordinated development of urban transportation and land use, which is conducive to improving transportation efficiency and has a realistic significance.

Successful territorial brand formation (on the example of Singapore)

This article is devoted to the issue of forming a successful brand of territories (on the example of Singapore). The key aspects of territorial branding are considered and the factors influencing this process are analyzed. The authors analyze the successful experience of Singapore as the country with the most influential brand in the world, and describe the key decisions, led to this. Aspects of the formed image of Singapore in the international arena, based on the international rankings of leading organizations, are highlighted. Attention must be paid to close term relationship between the national and tourism brand of countries and territories. The results of the article can be used to establish the vector of successful socio-economic development of countries and territories and in the process of further research on the issues of effective branding of territories.

Monitoring and Risk Assessment of the National Project “Ecology”

In the conditions of the modern economic development, its focus on sustainable development and environmental problems are of paramount importance. The directions of achieving environmental sustainability in Russia are supposed to be solved through the implementation of a set of measures outlined in the national project “Ecology”, which sets a number of targets and additional indicators that contribute to solving environmental problems. The article is devoted to the factors influencing the implementation of national projects and programs in the field of ecology in the Russian Federation. An analysis of the implementation of the “Ecology” project and the state program of the Russian Federation “Environmental Protection” as well as the study of Russian and foreign practices (experience of Singapore, Great Britain, Germany and other countries) regarding the monitoring the implementation of strategic documents, have helped to identify the relevant risks and to conduct their assessment, with the aim of increasing the effectiveness of financial control over the implementation of the national project. On the basis of the identified risks, the targets of the “Ecology” project were identified, which, in the opinion of the authors, requires its revision in order to be more effective. The results of the study may be interesting as relevant state bodies responsible for the implementation of the national project “Ecology”, in particular, the Ministry of Natural Resources and Ecology of the Russian Federation, as well as bodies which are monitoring its implementation, for example, the Accounts Chamber of the Russian Federation.

Singapore in Efforts to Increase the Air Pollution Index

<em><span lang="EN-US">According to the theory of environmentalism, human civilization has a negative impact on the environment because of industrialization. It means that it cannot be separated from the perspective of the green movement that underlies environmentalism. Environmental issues are an implicative issue because it creates a chain reaction for many parties. In general, cities in the Southeast Asia region are facing the same issue, such as air pollution obtained from factories and motorized vehicles. Within the regional scope, ASEAN has taken the initiative to create regional cooperation that specifically addresses cross-border haze and other environmental issues within the framework of ASEAN cooperation. One of the ASEAN member countries, Singapore was able to hold down the Air Pollution Standard Index and become the 5th ranked country in Asia Pacific with the best air quality. Thus, Singapore experience better air quality than most other countries in Southeast Asia. The achievement of Singapore also involves government policies that pay great attention to environmental issues. The results of this paper provide views and alternatives that can be applied by other countries' governments, related to environmental issues</span></em>

Long-Term Care Financing for an Aging Population: The Experience of Singapore

Singapore has a rapidly aging population. Long-term care (LTC) is one of the largest financial risks facing elderly in Singapore. Singapore implemented Eldershield, a long-term care insurance scheme which provided defined cash benefit payouts in the event of severe disability; but capped at a maximum of six years. Eldershield enrolled people at age 40, but offered an opt-out option. As of 2015, 65% of those aged 40 to 83 opted to be covered by Eldershield, making Singapore as having the highest voluntary LTC insurance rate in the world. This paper uses an actuarial multi-state disability model and calibrates the transition probabilities and duration-of-stay at various health (disability) states to assess the adequacy and comprehensiveness of Eldershield. The time-limited cash benefit design in Eldershield helped defray about 13% of LTC costs. Removing the time cap will help defray 23% and 26% of the LTC costs for elderly male and female respectively. Furthermore, the simulation results demonstrate that relaxing the trigger benefit and having staggered payouts will improve the adequacy of long-term care insurance. The experience of Singapore’s LTC insurance offers insights into the challenges of designing an insurance that tends to occur at higher age and insuring against a cost that could range from zero to a significantly large sum over a long period. Even with the enhanced Careshield Life, which provides cash payouts for life, other policy designs, for example caregiver grants, may be needed to ensure more adequate financing of long-term care.

Validation of the cycling anger scale in Singapore

Objectives Emotions can be dangerous companions in road traffic for vehicle drivers and cyclists in particular. It is therefore important to reliably assess emotions like anger in road traffic. The first objective of the present paper is to examine whether the cycling anger scale (CAS) can be used to assess Singaporean Cyclists’ anger experiences in traffic. In addition, it relates the cycling anger measure to similar constructs like driving anger (DAS), and the cyclists’ experiences of trait anger in general in order to further examine the validity of the CAS scale. Methods In an online survey, we distributed the English versions of the Cycling Anger Scale (CAS), the Driving Anger Scale (DAS), and the Trait Anger Scale (TAS) to a sample of 116 cyclists from Singapore. We then analyzed the psychometric properties of the CAS. In addition, we correlated cyclists’ CAS ratings with their DAS ratings, TAS ratings, and demographic variables. Finally, we compared cycling anger ratings across cultures. Results With respect to the first objective, we found that the Cycling Anger Scale can be applied to cyclists from Singapore given very minor modifications. Regarding our second objective, we obtained substantial correlations between cycling anger experience, driving anger experience, and general anger experience. In addition, cyclists’ CAS ratings were related to their demographic variables but not to their self-reported aggressive cycling behavior. The cross-cultural comparison revealed that cyclists from Singapore experience less anger than cyclists from other cultures. Conclusions We conclude that we could show the validity of the CAS for cyclists from Singapore. Researchers and practitioners who are interested in safer cycling can apply the CAS in Singapore. In line with other studies, we also conclude that cycling anger experience is related to driving anger experience and general trait anger. However, cycling anger does not seem to be related to self-reported aggressive cycling.

Comparison of Outcomes of Intra-operative Neuromonitoring of Recurrent Laryngeal Nerve Versus Visualisation Alone during Thyroidectomies: A Singapore Experience

Although intra-operative neuromonitoring (IONM) has become commonly used to identify the recurrent laryngeal nerve (RLN) during thyroid surgeries, its value is still debatable. This study aimed to evaluate the outcomes of thyroid surgery using IONM versus visualisation alone (VA). We conducted a retrospective analysis of all the open thyroidectomies performed by the otolaryngology department in a tertiary institution in Singapore (Khoo Teck Puat Hospital) from 1 January 2014 to 31 December 2018. There were 301 nerves-at-risk (NAR), 139 in the IONM group and 162 in the VA group. The primary outcome measure was the incidence of RLN injury and the secondary outcome measure was operative duration. There were 33 NAR with immediate post-operative RLN injury, of which 7 had permanent (>6 months) injury. There were minor improvements in the respective rates of immediate and permanent injury in the IONM group (7.9%, 0.7%) compared to the VA group (13.6%, 3.8%), but these were not statistically significant (P=0.14, 0.13). The average operative duration of total thyroidectomies in the IONM group was 37 minutes shorter than in the VA group, but the difference was not statistically significant (P=0.40). The current study shows that the use of intra-operative neuromonitoring shows a tendency towards better RLN outcome and operative duration for total thyroidectomies, but the study may be too small to demonstrate a statistical difference.

Revascularisation surgery for paediatric moyamoya disease: The Singapore experience

Moyamoya disease (MMD) is characterized by the spontaneous occlusion of the distal internal carotid arteries and resultant neo-angiogenesis of fragile collateral blood vessels. Direct and indirect revascularization surgeries have shown to effectively reduce stroke risks in paediatric MMD, whereby the latter is a more utilised technique in children. This study was undertaken to determine the outcomes of revascularization in Singapore’s multi-ethnic, Southeast Asian paediatric population. This is an ethics-approved study conducted in Singapore’s 2 tertiary children hospital units: KK Women’s and Children’s Hospital and National University Hospital. Sixteen patients with a diagnosis of ischaemic-type MMD are recruited between 01 January 2002 to 31 January 2019; and a total of 24 surgeries are undertaken (24 cerebral hemispheres). There are 2 cases of stroke within 30 days post-surgery. However, no stroke recurrence is observed beyond 30 days after surgery in all patients. Four patients reported recurrent transient ischaemic attack symptoms in the follow-up period ranging from 3 months to 12 years. Data analyses show a statistically significant improvement in modified Rankin’s Scale (mMRS) in post-operative patients from baseline to discharge, and at 3 months after surgery. Our study also observes that predictors of recurrent ischaemic events include higher pre-operative MRS, Suzuki stage and perioperative infarction. To the authors’ knowledge, this is the first study to date reporting the outcomes of revascularisation in a paediatric Southeast Asian cohort.

Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months

As of 27 October 2020, there have been 57,980 confirmed cases of COVID-19 in Singapore, with 28 fatalities. To summarise the Singapore experience in managing and containing COVID-19 based on available published data and from relevant sources, a review of literature using research databases such as PubMed and OVID Medline, along with non-peer-reviewed articles and other sources, was conducted with the search terms 'COVID-19' and 'Singapore'. Research conducted in Singapore has provided insight into the clinical manifestations and period of infectivity of COVID-19, demonstrated evidence of pre-symptomatic transmission, linked infection clusters using serological tools, and highlighted aspects of hospital-based environmental contamination. It has also provided guidance for diagnostic testing and has described immune and virologic correlates with disease severity. Evidence of effectiveness of containment measures such as early border control, rigorous contact training, and calibrated social distancing measures have also been demonstrated. Singapore's multipronged strategy has been largely successful at containing COVID-19 and minimising fatalities, but the risk of re-emergence is high.

Abstract 335: The Impact of Early Coronary Angiography on Outcomes in Out-of-hospital Cardiac Arrest: The Singapore Experience

Background and Aim: The benefit of early coronary angiography (CAG) and revascularization in resuscitated out-of-hospital cardiac arrest (OHCA) is unclear. We evaluated the association between early CAG and clinical outcomes in these patients. Methods: Data on all resuscitated adult OHCA cases of cardiac etiology between 2011-2015 were extracted from the prospective Singapore Pan-Asian Resuscitation Outcomes Study and linked with data from the national database of cardiac procedures. The 30-day survival and neurological outcomes (good outcome defined as Cerebral Performance Category [CPC] 1 or 2) were compared between patients undergoing early CAG (within 1-calender day) and patients not undergoing early CAG. Inverse probability weighted estimator was used to adjust for propensity to perform early CAG and PCI. Results: Of 976 consecutive patients who survived to admission (mean age 64±13, 73.7% males), 401 (41.1%) patients underwent CAG and obstructive coronary artery disease (CAD) was present in 352 (87.8%), of whom 284 (70.8%) underwent revascularization. Patients who underwent early CAG (n=337[34.5%]) were significantly different compared to those who underwent delayed or no CAG (n=639[65.5%]) (Table 1). Early CAG and PCI patients had improved survival and better neurological outcomes (adjusted odds ratio [AOR] 3.806 [95% CI 1.675 - 8.648] and AOR 3.075 [95% CI 1.119 - 8.451]), compared to those without. The odds of survival decreased with epinephrine administration (AOR 0.357 [95% CI 0.199 - 0.640]), but increased with an initial shockable rhythm (AOR 6.587 [95% CI 3.659 - 11.861]). The rates of bleeding (2% vs 0%, p=0.300) and stroke (1.6% vs 1.9%, p=0.880) were not increased with early intervention. Conclusion: Early CAG and PCI after OHCA were associated with improved clinical outcomes after OHCA without increasing complications. Further studies are required to identify the characteristics of patients who would benefit most from this invasive strategy.

Модель педагогічної освіти для ХХІ століття: досвід Сінгапуру

Модель педагогічної освіти для ХХІ століття: досвід Сінгапуру

372P Treatment patterns and outcomes in stage III non-small cell lung cancer (NSCLC): Real-world experience in Singapore from the KINDLE study

372P Treatment patterns and outcomes in stage III non-small cell lung cancer (NSCLC): Real-world experience in Singapore from the KINDLE study

Private tutoring and the subjective rationalities of parents: the experiences in South Korea and Singapore

PurposeThis article proposes a model of subjective rationalities to shed light on the global phenomenon of parental reliance on private tutoring for their children. The model is illustrated using the examples of the rational decision-making process and outcome of parents with regards to enrolling their children in private tutoring in South Korea and Singapore.Design/methodology/approachThis is a theoretical paper that relies on a critical review of official documents, academic publications and newspaper reports.FindingsThis article proposes an original model to shed light on the global phenomenon of parental reliance on private tutoring for their children. The model highlights the following: the dynamic interactions between parents, education policy and private tutoring; the active role of private tutoring providers; and the socio-culturally embedded and complex nature of educational decisions.Research limitations/implicationsThis is a conceptual paper that proposes a theoretical model, so there is no empirical data.Originality/valueThis article fills an existing research gap on the dynamic interactions between the parents, education policy and private tutoring. It offers an original model that illuminates the rational decision-making process and outcome of parents that pertains to private tutoring for their children.

Atypia of undetermined significance/follicular lesion of undetermined significance: Asian vs. non-Asian practice, and the Singapore experience.

The Bethesda System for Reporting Thyroid Cytopathology has paved the way for comparisons of the practice of thyroid cytology in many different regions. However, there have been comparatively few studies documenting differences between Asian and non-Asian practice. Here, we aim to compare a few key parameters between the two regions, focusing on the indeterminate category of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS). We compared its incidence, resection rates (RRs), risk of malignancy (ROM), rate of repeat fine needle aspiration (rFNA), ROMs of cytomorphologic subcategories of nuclear atypia (AUS-N) vs. architectural atypia (AUS-A), and, finally, the incidence of papillary thyroid carcinoma (PTC) vs. follicular neoplasms (FNs) in resected AUS/FLUS cases in Asian and non-Asian regions. Where possible, these metrics were compared with the Singapore experience from a tertiary referral institution. While the incidence of AUS/FLUS was similar in both regions, we found geographical differences in the RRs and ROMs, which may reflect a higher collective threshold for surgery in Asian countries. However, both cohorts showed higher ROMs in the AUS-N subcategory as compared to the AUS-A subcategory, supporting the subclassification of the AUS/FLUS based on the presence of nuclear atypia. We also observed a higher incidence of AUS-N coupled with a higher incidence of PTC in resected AUS/FLUS nodules in Asian cohorts, while AUS-A and follicular-patterned neoplasms featured more prominently in the non-Asian cohorts. These incidences may account for the starkly different molecular approaches that we noted-in Asian (chiefly Korean and Chinese) centers, BRAF mutational analysis was favored, while gene panels and gene expression classifiers were more frequently applied in non-Asian centers (chiefly in the United States of America). Overall, the data from Singapore appears more closely aligned to non-Asian trends, despite its geographical location in Southeast Asia and its predominantly Asian population. We conclude that there is significant heterogeneity in the outcomes of the AUS/FLUS categories between and within regions, which is only partially explained by regional variations, and may also reflect different regional diagnostic and management practices. This highlights the importance of understanding the local context in the interpretation of indeterminate Bethesda categories, rather than adopting a "one-size fits all" approach.

Health system resilience in managing the COVID-19 pandemic: lessons from Singapore

Singapore, one of the first countries affected by COVID-19, adopted a national strategy for the pandemic which emphasised preparedness through a whole-of-nation approach. The pandemic was well contained initially until...

The impact of COVID-19 on and recommendations for breast cancer care: the Singapore experience.

The ensuing COVID-19 pandemic poses unprecedented and daunting challenges to the routine delivery of oncological and supportive care to patients with breast cancer. Considerations include the infective risk of patients who are inherently immunosuppressed from their malignancy and therapies, long-term oncological outcomes from the treatment decisions undertaken during this extraordinary period, and diverted healthcare resources to support a coordinated whole-of-society outbreak response. In this review, we chronicle the repercussions of the COVID-19 outbreak on breast cancer management in Singapore and describe our approach to triaging and prioritising care of breast tumours. We further propose adaptations to established clinical processes and practices across the different specialties involved in breast oncology, with references to the relevant evidence base or expert consensus guidelines. These recommendations have been developed within the unique context of Singapore's public healthcare sector. They can serve as a resource to guide breast cancer management for future contingencies in this city-state, while certain elements therein may be extrapolatable to other medical systems during this global public health emergency.

Casino development and regulation in Asia: the experience of Macau and Singapore for Japan and other destinations

PurposeThe purpose of this paper is to examine the casino development and regulation in Macau and Singapore. The paper also seeks to assess the potential for casino development in Asia, with a particular focus on the prospects of Japan's casino resorts.Design/methodology/approachThe paper reviews the gaming history, gaming/tourism policies and casino regulations of Macau and Singapore. The key aspects concerned with the casino development in Asia are also examined.FindingsThe paper identifies the fundamentals that have contributed to the prosperity of casino resorts in Macau and Singapore, as well as highlights the potential and challenges for the casino developments in Japan and other Asian destinations.Research limitations/implicationsA number of legal and tourism-related factors are identified to be the determinants of casino development. However, more research is needed to examine the political, economic and socio-cultural factors associated with casino gaming.Practical implicationsThe paper, discussing the casino development and regulation in Macau and Singapore, provides practical implications for the design of gaming/tourism policy and casino control in Japan and other prospective gaming jurisdictions.Originality/valueThe paper contributes to the growing body of literature on the gaming law and casino development in Asia and provides insights for policymakers contemplating the adoption of casinos as a strategic policy for tourism development and economic growth.