Displaying publications 1 - 20 of 130 in total

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  1. Removal and speciation of heavy metals along the treatment path of wastewater in subsurface-flow constructed wetlands
    Lim PE, Mak KY, Mohamed N, Noor AM
    Water Sci Technol, 2003;48(5):307-13.
    PMID: 14621178
    This study was conducted to: (1) evaluate the performance of constructed wetlands in removing Zn, Pb and Cd, respectively, and Zn, Pb, Cd and Cu in combination and (2) investigate the speciation patterns of the dissolved metals differentiated according to their detectability by anodic stripping voltammetry (ASV) and their lability towards Chelex resin along the treatment path of metal-containing wastewater in horizontal subsurface-flow constructed wetlands. Four laboratory scale wetland units planted with cattails (Typha latifolia) were operated outdoors for six months. Three of the units were, respectively, fed with primary-treated domestic wastewater spiked with Zn(II), Pb(II) and Cd(II) whilst the fourth was spiked with a combination of Zn(II), Pb(II), Cd(II) and Cu(II). The results demonstrate that a metal removal efficiency of over 99% was achievable for wetland units treating the metals singly or in combination provided the sorption capacity of the media was not exceeded. When treating the metals in combination, an antagonistic effect, more significantly for Pb and Cd, on the sorptive metal uptake by media was observed. Based on the metal speciation patterns, the wetland system seemed to be capable of maintaining the ASV-labile metal species at relatively low level (< 10%) before media exhaustion.
  2. Could antiseptic gargling prevent COVID-19?
    Mohamed NA, Ahmad Zainol Hady A, Abdul Aziz AH, Isahak I
    Trop Biomed, 2020 Dec 01;37(4):1141-1145.
    PMID: 33612766 DOI: 10.47665/tb.37.4.1141
    Coronavirus Disease 2019 (COVID-19) has infected more than 8 million people globally since its discovery in December 2019. For COVID-19 prevention, the World Health Organization recommended regular handwashing with soap, cough etiquette, mask wearing and social distancing. However, COVID-19 is rather difficult to contain because of its high transmissibility property. Gargling is effective for reducing infection in the respiratory tract. Most antiseptic gargles have antimicrobial properties against common respiratory pathogens. No published study on the effectiveness of antiseptic gargling among COVID-19 patients has been available to date. This article reviewed available literature on methods and solutions available for gargling and their effect on respiratory tract infections.
  3. Knowledge, attitude and health seeking practice on bats-borne diseases among residents of Tioman Island, Malaysia
    Mohamed NA, Said MH, Mohd Rani MD, Ramli S, Isahak I
    Trop Biomed, 2019 Sep 01;36(3):709-717.
    PMID: 33597493
    Bats are slowly gaining recognition as a potential reservoir for viruses harmful to human (Smith and Wang, 2013). Bats are reservoir to viruses causing Ebola virus diseases (EBV) (Leroy et al., 2005), Nipah Encephalitis (NiV) (Chua et al., 2002), SARS(Li et al., 2005) and MERS-CoV (Yang et al., 2015) being the latest one making headlines. About 18 years ago, a major outbreak of Nipah virus encephalitis occurred in Peninsular Malaysia resulted in the deaths of 105 persons and the slaughter of approximately 1.1 million pigs. In 2006, a novel bat orthoreovirus was found to be associated with acute respiratory syndrome in Malaysia. Following that incidents, many studies have been done on bats, particularly to determine their species, behaviour, and antibody level and there were also studies in human on antibody prevalence to batsrelated viruses e.g. Nipah and Hendra and PRV. Humans may become infected with viruses from bats through intermediate host (swine, horse) or through aerosol or direct contact with bats. Communities living adjacent to bat roosts should aware of possible risk of infection transmission from bats. An earlier study in Guatemala demonstrated that risk of exposure to bats in communities near bats roosts was common, but recognition of the potential for disease transmission from bats was low (Moran et al., 2015). Surprisingly, there is no local published data on public awareness towards bats-related infection despite potential risk of getting the infection. This study aimed to determine knowledge and awareness on bat-related infections, attitudes towards bats and practices related to health-seeking behaviours following exposure to bats.
  4. Salmonella enteritidis abdominal aorta mycotic aneurysm presented with acute cholestatic jaundice: A case report and literature review
    Wahab AA, Mohamed N, Ding CH, Muttaqillah NAS, Rosli N, Mohammed F
    Trop Biomed, 2023 Mar 01;40(1):23-28.
    PMID: 37356000 DOI: 10.47665/tb.40.1.008
    Mycotic aneurysm is one of the extra-intestinal manifestations of Salmonella Enteritidis infection. The diagnosis of this condition is challenging owed to its variation in clinical presentations. We presented a case of a 54-year-old man with underlying diabetes mellitus and chronic smokers presented with acute right flank pain and fever associated with mild jaundice. The initial laboratory investigations suggested features of obstructive jaundice and urinary tract infection. The contrast enhancing computed tomography of the abdomen revealed the presence of saccular mycotic aneurysm located at the infrarenal abdominal aorta. The blood culture grew Salmonella Enteritidis which was susceptible to ceftriaxone, trimethoprim-sulfamethoxazole, ciprofloxacin, ampicillin, and amoxicillin-clavulanic acid. Intravenous ceftriaxone was initiated, and he underwent open surgery and artery repair at day 8 of admission. He responded well to the treatment given and subsequently discharged home after completed three weeks of intravenous ceftriaxone.
  5. Obstructive sleep apnea among express bus drivers in Malaysia: important indicators for screening
    Yusoff MF, Baki MM, Mohamed N, Mohamed AS, Yunus MR, Ami M, et al.
    Traffic Inj Prev, 2010 Dec;11(6):594-9.
    PMID: 21128189 DOI: 10.1080/15389588.2010.505255
    Obstructive sleep apnea (OSA) has been identified as one of the significant risk factors for motor vehicle crashes (MVCs). In the interest of public safety, this study was conducted to determine the prevalence of OSA and its associated factors among express bus drivers in Malaysia. Identifying factors or conditions related with OSA is very important because they can be used as indicators to subject a person to a confirmatory diagnosis using polysomnography testing.
  6. Fulltext Physical function assessment of older adults with lower body fractures at 3 months post-discharge from hospital
    Ibrahim N', Sharkawi Ahmad M, Zulfarina MS, Zaris SNASM, Nor Azlin ZA, Naina Mohamed I, et al.
    Ther Clin Risk Manag, 2019;15:201-210.
    PMID: 30774356 DOI: 10.2147/TCRM.S189748
    Background and purpose: Physical function assessment can be performed to assess functional mobility among older adults, especially after a traumatic incident such as lower body fracture (LBF). The objective of this study was to evaluate physical function of older patients with LBF after 3 months of discharge from the hospital.

    Patients and methods: A total of 89 patients were followed up at the discharge phase. Four independent variables were tested: age, sex, type of fracture, and use of a walking aid before fracture. Mobility and strength were assessed with the Timed Up and Go (TUG) test and hand-grip strength (HGS) test, respectively.

    Results: The majority of the patients were ≥65 years old (64%), female (61.8%), of Chinese ethnicity (50.6%), and had a hip fracture (51.7%). The mean time for TUG test was 26.11 seconds, while mean HGS was 19.02 kg. We found significant differences in TUG test scores with respect to all independent variables tested: age (P=0.026), sex (P=0.011), fracture type (P<0.001), and use of a walking aid before fracture (P=0.004). Significant differences were also detected in HGS test scores with respect to all independent variables tested: age (P<0.001), sex (P<0.001), fracture type (P<0.001), and use of a walking aid before fracture (P=0.035).

    Conclusion: Increasing age, female sex, having a hip fracture, and use of a walking aid before fracture predicted reduction in the physical function and strength among older adults with LBF.

  7. Fulltext Optimization of culture conditions (sucrose, pH, and photoperiod) for in vitro regeneration and early detection of somaclonal variation in ginger lime (Citrus assamensis)
    Yaacob JS, Mahmad N, Mat Taha R, Mohamed N, Mad Yussof AI, Saleh A
    ScientificWorldJournal, 2014;2014:262710.
    PMID: 24977187 DOI: 10.1155/2014/262710
    Various explants (stem, leaf, and root) of Citrus assamensis were cultured on MS media supplemented with various combinations and concentrations (0.5-2.0 mg L(-1)) of NAA and BAP. Optimum shoot and root regeneration were obtained from stem cultures supplemented with 1.5 mg L(-1) NAA and 2.0 mg L(-1) BAP, respectively. Explant type affects the success of tissue culture of this species, whereby stem explants were observed to be the most responsive. Addition of 30 gL(-1) sucrose and pH of 5.8 was most optimum for in vitro regeneration of this species. Photoperiod of 16 hours of light and 8 hours of darkness was most optimum for shoot regeneration, but photoperiod of 24 hours of darkness was beneficial for production of callus. The morphology (macro and micro) and anatomy of in vivo and in vitro/ex vitro Citrus assamensis were also observed to elucidate any irregularities (or somaclonal variation) that may arise due to tissue culture protocols. Several minor micromorphological and anatomical differences were observed, possibly due to stress of tissue culture, but in vitro plantlets are expected to revert back to normal phenotype following full adaptation to the natural environment.
  8. Fulltext Quantification of the dental morphology of orangutans
    Nambiar P, John J, Al-Amery SM, Purmal K, Chai WL, Ngeow WC, et al.
    ScientificWorldJournal, 2013;2013:213757.
    PMID: 24348143 DOI: 10.1155/2013/213757
    Orangutans are believed to have close biological affinities to humans. Teeth being the hardest tissue provide useful information on primate evolution. Furthermore, knowledge of the pulp chamber and root canal morphology is important for dental treatment. A female Bornean orangutan and a Sumatran male orangutan skull were available for this study. Both of their dentitions, comprising 50 teeth, were scanned employing the cone-beam computed tomography for both metrical and nonmetrical analyses. Measurements included tooth and crown length, root length, enamel covered crown height, root canal length (posterior teeth), length of pulpal space (anterior teeth), and root canal width. Nonmetrical parameters included number of canals per root, number of foramina in each root, and root canal morphology according to Vertucci's classification. It was found that the enamel covered crown height was the longest in the upper central incisors although the canine was the longest amongst the anterior teeth. Both the upper premolars were three-rooted while the lower second premolar of the Sumatran orangutan was two-rooted, with two foramina. The mandibular lateral incisors of the Bornean orangutan were longer than the central incisors, a feature similar to humans. In addition, secondary dentine deposition was noticed, a feature consistent with aged humans.
  9. The anti-osteoporotic effect of Eurycoma Longifolia in aged orchidectomised rat model
    Shuid AN, Abu Bakar MF, Abdul Shukor TA, Muhammad N, Mohamed N, Soelaiman IN
    Aging Male, 2011 Sep;14(3):150-4.
    PMID: 20874437 DOI: 10.3109/13685538.2010.511327
    Osteoporosis in elderly men is becoming an important health issue with the aging society. Elderly men with androgen deficiency are exposed to osteoporosis and can be treated with testosterone replacement. In this study, Eurycoma longifolia (EL), a plant with androgenic effects, was supplemented to an androgen-deficient osteoporotic aged rat as alternative to testosterone. Aged 12 months old Sprague-Dawley rats were divided into groups of normal control (NC), sham-operated (SO), orchidectomised-control (OrxC), orchidectomised and supplemented with EL (Orx + El) and orchidectomised and given testosterone (Orx + T). After 6 weeks of treatment, serum osteocalcin, serum terminal C-telopeptide Type 1 collagen (CTX) and the fourth lumbar bone calcium were measured. There were no significant differences in the osteocalcin levels before and after treatment in all the groups. The CTX levels were also similar for all the groups before treatment. However, after treatment, orchidectomy had caused significant elevation of CTX compared to normal control rats. Testosterone replacements in orchidectomised rats were able to prevent the rise of CTX. Orchidectomy had also reduced the bone calcium level compared to normal control rats. Both testosterone replacement and EL supplementation to orchidectomised rats were able to maintain the bone calcium level, with the former showing better effects. As a conclusion, EL prevented bone calcium loss in orchidectomised rats and therefore has the potential to be used as an alternative treatment for androgen deficient osteoporosis.
  10. The effect of heavy metals on nitrogen and oxygen demand removal in constructed wetlands
    Lim PE, Tay MG, Mak KY, Mohamed N
    Sci Total Environ, 2003 Jan 01;301(1-3):13-21.
    PMID: 12493181
    The objective of this study is to investigate the respective effects of Zn, Pb and Cd as well as the combined effect of Zn, Pb, Cd and Cu on the removal of nitrogen and oxygen demand in constructed wetlands. Four laboratory-scale gravel-filled subsurface-flow constructed wetland units planted with cattails (Typha latifolia) were operated outdoors and fed with primary-treated domestic wastewater at a constant flow rate of 25 ml/min. After 6 months, three of the wetland units were fed with the same type of wastewater spiked with Zn(II), Pb(II) and Cd(II), respectively, at 20, 5 and 1 mg/l for a further 9 months. The remaining unit was fed with the same type of wastewater spiked with a combination of Zn(II), Pb(II), Cd(II) and Cu(II) at concentrations of 10, 2.5, 0.5 and 5 mg/l, respectively, over the same period. The chemical oxygen demand (COD) and ammoniacal nitrogen (AN) concentrations were monitored at the inlet, outlet and three additional locations along the length of the wetland units to assess the performance of the wetland units at various metal loadings. At the end of the study, all cattail plants were harvested for the determination of total Kjeldahl nitrogen and metal concentrations. The results showed that the COD removal efficiency was practically independent of increasing metal loading or a combination of metal loadings during the duration of the study. In contrast, the AN removal efficiency deteriorated progressively with increasing metal loading. The relative effect of the heavy metals was found to increase in the order: Zn
  11. Fulltext Staphylococcus aureus carriage in selected kindergartens in Klang Valley
    Mohamed NA, Ramli S, Amin NN, Sulaiman WS, Isahak I, Jamaluddin TZ, et al.
    Med J Malaysia, 2016 04;71(2):62-5.
    PMID: 27326943 MyJurnal
    INTRODUCTION: Nasal colonisation of S. aureus in healthy children was 18% to 30%. One to three percent of them were colonised by Methicillin-resistant Staphlycoccus aureus (MRSA). Although MRSA infection has become increasingly reported, population-based S. aureus and MRSA colonisation estimates are lacking. The main objective of this study was to determine the prevalence of S. aureus carriage among children.

    METHODS: Nasal samples for S. aureus culture were obtained from 250 children from three kindergartens in the Klang Valley, after consent was obtained from the children and their parents. Swabs were transported in Stuart medium, and inoculated on mannitol-salt agar within four hours of collection. Identification and disk diffusion test were done according to guidelines. Polymerase chain reaction was done on MRSA isolates for the presence of mecA and lukS/FPV genes.

    RESULTS: Overall prevalence of S. aureus and MRSA carriage were 19.2% (48/250) and 1.6% (4/250) respectively. mecA gene was present in all isolates, 50% isolates carried Panton-Valentine leucocidin (PVL) gene. Sccmec type I was found in 2 isolates and the remaining isolates has Sccmec type V.

    CONCLUSION: The prevalence of S. aureus and MRSA carriage were similar to other studies. However, risk of contracting severe infection might be higher due to presence of PVL gene in half of the MRSA isolates.
  12. Imported Falciparum Malaria: A case series in a tertiary hospital
    Mohamed NA, Mansur FAF, Abdul Rahman N
    Malays J Pathol, 2020 Apr;42(1):107-110.
    PMID: 32342938
    INTRODUCTION: Malaysia declared its intent to eliminate malaria by 2020, with a phased goal of achieving zero local transmission. Nonetheless, Malaysia is highl susceptible to malaria importation due to geographical proximity to high-burden countries e.g. Thailand, Myanmar and high influx of foreign workers and students from Asia and Africa.

    CASE SERIES: We accumulated all malaria cases diagnosed in a tertiary hospital within a period of two years. Three cases were reported, where all of the patients were foreigners with recent travel history to African countries. All of them were infected by P. falciparum, responded to treatment and discharged well.

    DISCUSSION: This case series highlighted the importance of acquiring recent travel history during history taking and having a high index of suspicions on malaria when dealing with feverish patients originated particularly from African countries.

  13. Effects of very low blood lead levels on neurobehavioral performances of male policemen in kota bharu, kelantan
    Mohamed N, Nordin R
    Malays J Med Sci, 2004 Jul;11(2):12-8.
    PMID: 22973122
    Many published studies that examined the effect of lead exposure on neurobehavioral performances were conducted in confined manufacturing environment with low to moderate blood lead levels as a marker of exposure. This study was conducted in a general environmental setting with very low exposure intensity and blood lead levels. The objective of the study was to determine the effect of very low blood lead levels (below 10 μg/dl) on the neurobehavioral performances of policemen in Kota Bharu, Kelantan. The study, conducted between August 25(th) and October 20(th) 2001, was cross-sectional in design and comprised of 89 policemen working in Kota Bharu district. The lead concentration of venous blood was determined using graphite furnace absorption spectrometer. We assessed neurobehavioral performances using the WHO Neurobehavioral Core Test Battery (NCTB). The mean blood lead concentration was 2.5 + 1.0 mg/dl. Among the seven tests performed, the positive effect of blood lead on Benton visual retention was not significant after controlling for the confounding effect of smoke-dose. This study suggested that very low blood lead levels have no significant effects on the neurobehavioral performances. Therefore, more studies with blood lead levels below the recommended environmental limit of 10 mg/dl, as recommended by Centers for Disease Control (CDC), be conducted in order to justify that limit.
  14. Fulltext Potential Health Impacts of Bauxite Mining in Kuantan
    Abdullah NH, Mohamed N, Sulaiman LH, Zakaria TA, Rahim DA
    Malays J Med Sci, 2016 May;23(3):1-8.
    PMID: 27418864
    Bauxite mining is not known to most Malaysian except recently due to environmental pollution issues in Kuantan, Pahang. Potential impacts are expected to go beyond physical environment and physical illness if the situation is not controlled. Loss of economic potentials, and the presence of unpleasant red dust causing mental distress, anger and community outrage. More studies are needed to associate it with chronic physical illness. While evidences are vital for action, merely waiting for a disease to occur is a sign of failure in prevention. All responsible agencies should focus on a wider aspect of health determinants rather than merely on the occurrence of diseases to act and the need to emphasize on sustainable mining to ensure health of people is not compromised.
  15. Fulltext The risk of recurrence in breast cancer patients treated with tamoxifen: polymorphisms of CYP2D6 and ABCB1
    Teh LK, Mohamed NI, Salleh MZ, Rohaizak M, Shahrun NS, Saladina JJ, et al.
    AAPS J, 2012 Mar;14(1):52-9.
    PMID: 22183189 DOI: 10.1208/s12248-011-9313-6
    CYP2D6 plays a major role in the metabolism of tamoxifen, and polymorphism of P-glycoprotein has been associated with resistance of many drug therapies. This study investigates the clinical impact of genetic variants of CYP2D6 and ABCB1 in breast cancer patients treated with tamoxifen. Blood samples from 95 breast cancer patients treated with tamoxifen were collected and genotyped for CYP2D6 and ABCB1 variants using allele-specific PCR method. Recurrence risks were calculated using Kaplan-Meier analysis and compared using the log-rank test. Patients carrying CYP2D6*10/*10 and heterozygous null allele (IM) showed higher risks of developing recurrence and metastasis (OR 13.14; 95% CI 1.57-109.94; P = 0.004) than patients with CYP2D6*1/*1 and *1/*10 genotypes. Patients with homozygous CC genotypes of ABCB1 C3435T showed a shorter time to recurrence. Patients who were CYP2D6 IM and homozygous CC genotype of C3435T have statistically significant higher risks of recurrence (P = 0.002). Similarly, median time to recurrence in these patients was only 12 months (95% CI = 0.79-23.2) compared to those without this combination which was 48 months (95% CI = 14.7-81.2). Patients with CYP2D6 IM and homozygous CC genotype of ABCB1 C3435T have shorter times to recurrence. The results confirmed the findings of previous studies and support FDA recommendation to perform pre-genotyping in patients before the choice of therapy is determined in breast cancer patients.
  16. Fulltext Intrahepatic Portal Vein Aneurysm with Concurrent Hepatocellular Carcinoma
    Hanafiah M, Johari B, Koshy M, Misni MN
    Sultan Qaboos Univ Med J, 2016 Feb;16(1):e115-6.
    PMID: 26909202 DOI: 10.18295/squmj.2016.16.01.023
  17. An ecological study of the relationship between urban built environment and cardiovascular hospital admissions (2004-2016) in an Asian developing country
    Kwan SC, Ismail R, Ismail NH, Mohamed N
    Soc Sci Med, 2021 05;276:113868.
    PMID: 33799201 DOI: 10.1016/j.socscimed.2021.113868
    This study aims to evaluate the relationship between urban built environment and hospital admissions from cardiovascular diseases in Kuala Lumpur, Malaysia. Hospital admission data from 2004 to 2016 for cardiovascular diseases were used with patient residential postcodes as the unit of analysis. Data was split into 2004-2009 (12,551 cases) and 2010-2016 (17,154 cases) periods corresponding to land use data. We used generalized linear mixed model to analyse population density, property value, entropy index, and the kernel density (800 m) of specific land use, bus and rail stations, and road junctions, with time period and postcodes as the random effects to generate incidence rate ratios (IRRs). Results indicated that entropy index and recreational area density were associated with fewer hypertensive disease and ischemic heart disease hospital admissions (IRR range: 0.49-0.68, 95%CI: 0.27, 0.97). Population density and property value were associated with fewer cerebrovascular disease hospital admissions (IRR range: 0.29-0.34, 95%CI: 0.11, 0.75). Contrarily, density of road junctions was associated with 2.5-6.3 times more hospital admissions for cardiovascular disease hospital admissions (IRR range: 2.53-6.34, 95%CI: 1.07,17.91). There were no significant association between hospital admission and density of residential area, undeveloped land, rail and bus stations. The shapes of relationships for all attributes were non-linear, and changed markedly at the third quartile except for recreational area density. The findings suggest that land use attributes have some protective effects on the cardiovascular disease admission cases as compared to the transport attributes. These findings have important merits for integrating health into urban planning.
  18. Fulltext Potential New H1N1 Neuraminidase Inhibitors from Ferulic Acid and Vanillin: Molecular Modelling, Synthesis and in Vitro Assay
    Hariono M, Abdullah N, Damodaran KV, Kamarulzaman EE, Mohamed N, Hassan SS, et al.
    Sci Rep, 2016 12 20;6:38692.
    PMID: 27995961 DOI: 10.1038/srep38692
    We report the computational and experimental efforts in the design and synthesis of novel neuraminidase (NA) inhibitors from ferulic acid and vanillin. Two proposed ferulic acid analogues, MY7 and MY8 were predicted to inhibit H1N1 NA using molecular docking. From these two analogues, we designed, synthesised and evaluated the biological activities of a series of ferulic acid and vanillin derivatives. The enzymatic H1N1 NA inhibition assay showed MY21 (a vanillin derivative) has the lowest IC50 of 50 μM. In contrast, the virus inhibition assay showed MY15, a ferulic acid derivative has the best activity with the EC50 of ~0.95 μM. Modelling studies further suggest that these predicted activities might be due to the interactions with conserved and essential residues of NA with ΔGbind values comparable to those of oseltamivir and zanamivir, the two commercial NA inhibitors.
  19. A priority list of environmental health issues for Malaysia
    Hashim JH, Hashim Z, Hod R, Jalaludin J, Mohamed N, Karuppannan S, et al.
    Rev Environ Health, 2023 Jun 27;38(2):349-359.
    PMID: 35468665 DOI: 10.1515/reveh-2022-0030
    OBJECTIVES: Environmental risk factors contribute to 24% of the global burden of disease from all causes in disability-adjusted life years (DALYs), and to 23% of all global deaths. Malaysia being an advanced developing country, there is a need to prioritise environmental health issues to enable environmental health practitioners to focus on the most significant and urgent environmental health concerns.

    CONTENT: This project was undertaken by a Thematic Working Group on Environmental Health Experts (TWG 10) under the Malaysian National Environmental Health Action Plan. Sixteen pre-selected environmental health issues were presented to a two focus group discussions among 20 environmental health and related professionals who then scored each issue on its magnitude and severity scale.

    SUMMARY: The total of these scores generated a list of priority environmental health issues for Malaysia. Children environmental health came out as the environmental health issue of the highest priority.

    OUTLOOK: We hope that this list of priority environmental health issues will be used for prioritising academic and professional manpower training, research funding allocation and planning for intervention programmes by various stakeholders.

  20. A speech pronunciation practice system for speech-impaired children: A study to measure its success
    Salim SS, Mustafa MB, Asemi A, Ahmad A, Mohamed N, Ghazali KB
    Res Dev Disabil, 2016 Sep;56:41-59.
    PMID: 27262125 DOI: 10.1016/j.ridd.2016.05.013
    BACKGROUND: The speech pronunciation practice (SPP) system enables children with speech impairments to practise and improve their speech pronunciation. However, little is known about the surrogate measures of the SPP system.

    AIMS: This research aims to measure the success and effectiveness of the SPP system using three surrogate measures: usage (frequency of use), performance (recognition accuracy) and satisfaction (children's subjective reactions), and how these measures are aligned with the success of the SPP system, as well as to each other.

    METHODS AND PROCEDURES: We have measured the absolute change in the word error rate (WER) between the pre- and post-training, using the ANOVA test. Correlation co-efficiency (CC) analysis was conducted to test the relation between the surrogate measures, while a Structural Equation Model (SEM) was used to investigate the causal relations between the measures.

    OUTCOMES AND RESULTS: The CC test results indicate a positive correlation between the surrogate measures. The SEM supports all the proposed gtheses. The ANOVA results indicate that SPP is effective in reducing the WER of impaired speech.

    CONCLUSIONS AND IMPLICATIONS: The SPP system is an effective assistive tool, especially for high levels of severity. We found that performance is a mediator of the relation between "usage" and "satisfaction".

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