The issue of age difference in hospital admission should be given special attention since it affects the structure of hospital care and treatments. Patients of different age groups should be given different priority in service provision. Due to crucial time and limited resources, healthcare managers need to make wise decisions in identifying priorities in age of admission. This paper aimed to propose a construction of a daily composite hospital admission index (CHAI) as an indicator that captures relevant information about the overall performance of hospital admission over time. It involves five different age groups of total patients admitted to seven major public hospitals in the Klang Valley, Malaysia for respiratory and cardiovascular diseases for a period of three years, 2008 - 2010. The criteria weights were predetermined by aggregating the subjective weight based on rank ordered centroid (ROC) method and objective weight based on entropy - kernel method. The highest and lowest scores of CHAI were marked, while the groups of patients were prioritized according to the criteria weight ranking orders.
This paper presents a comparison on the effects of blending chitin and/or starch with poly(lactic acid) (PLA). Three sets of composites (PLA-chitin, PLA-starch and PLA-chitin-starch) with 92%, 94%, 96% and 98% PLA by weight were prepared. The percentage weight (wt.%) amount of the chitin and starch incorporated ranges from 2% to 8%. The mechanical, dynamic mechanical, thermal and microstructural properties were analyzed. The results from the tensile strength, yield strength, Young's modulus, and impact showed that the PLA-chitin-starch blend has the best mechanical properties compared to PLA-chitin and PLA-starch blends. The dynamic mechanical analysis result shows a better damping property for PLA-chitin than PLA-chitin-starch and PLA-starch. On the other hand, the thermal property analysis from thermogravimetry analysis (TGA) shows no significant improvement in a specific order, but the glass transition temperature of the composite increased compared to that of neat PLA. However, the degradation process was found to start with PLA-chitin for all composites, which suggests an improvement in PLA degradation. Significantly, the morphological analysis revealed a uniform mix with an obvious blend network in the three composites. Interestingly, the network was more significant in the PLA-chitin-starch blend, which may be responsible for its significantly enhanced mechanical properties compared with PLA-chitin and PLA-starch samples.
A cross-sectional study was carried out to determine the current prevalence of protein-energy malnutrition (PEM) among Orang Asli schoolchildren and to investigate the potential predictors of malnutrition. A total of 241 (120 males and 121 females) Orang Asli schoolchildren age 7-12 years living in remote areas of Pos Betau, Pahang participated voluntarily in this study. Anthropometric and socioeconomic data were collected and the children were screened for intestinal parasitic infections. The overall prevalences of mild and significant underweight conditions were 52.3% and 37.3%, respectively, and the prevalences of mild stunting and wasting were 43.6% and 43.1%, respectively, while the prevalences of significant stunting and wasting were 43.6% and 5.6%, respectively. There was a significant association between gender (male) and malnutrition (p = 0.029). The results also showed a higher prevalence of stunting among children age < or = 10 years than in older children (p = 0.001). Other independent variables, including socioeconomic status and intestinal parasitic infections, had no significant associations with malnutrition indices. PEM is prevalent among schoolchildren in rural Malaysia and therefore of public health concern since PEM diminishes immune function and impairs cognitive function and educational performance. School-based programs of prevention through health education and interventions should be considered as an essential part of measures to improve the quality of life of schoolchildren in rural Malaysia.
Matched MeSH terms: Body Weights and Measures/statistics & numerical data
BACKGROUND: Osteoporotic fracture is a major health burden. Early diagnosis and management would improve the quality of life and reduce costs to the society.
OBJECTIVE: We aimed to identify risk factors associated with osteoporosis followed by development and validation of a screening tool in the hope of providing an appropriate regime to detect low bone density (BMD) in Malaysia.
METHODOLOGY: Between November 1999 and November 2002, 514 healthy women aged ≥ 45 with intact uterus, non-HRT users were recruited. Following BMD testing, a screening tool was developed. For validation, 72 women were recruited from June 2003 to December 2003.
RESULTS: Age and a longer duration postmenopause were negatively linked to BMD. Higher family income, BMI, waist and hip circumference were positively correlated. A score of ≥ 4, the screening tool had a sensitivity of 73.2%, a specificity of 61.6% for identifying women with low BMD (T score ≤ -2) plus a sensitivity of 80.2% in selecting women with osteoporosis. The tool enabled a 45.9% reduction in unnecessary DEXA testing. Validation of the screening tool showed a negative predictive value of 97.8%, sensitivity and specificity of 87.5% and 70.3%, respectively.
CONCLUSION: The Malaysian Osteoporosis Screening Tool (MOST) is relatively simple. Its usage may reduce unnecessary DEXA test.
Five specimens of Epinephelusepistictus (Temminck & Schlegel, 1843) were collected from a major landing site located on the west coast of Peninsula Malaysia during a fish faunal survey on 23 August 2017. The present study extends the distribution range of E.epistictus southwards from Andaman Sea to the Strait of Malacca. Species identification was confirmed by colour pattern and DNA barcoding (567 bp of cytochrome C oxidase I) of all E.epistictus specimens and nine closely related Epinephelus species. The interspecies genetic distance ranged from 0.002-0.245. This study also presents, for the first time for Malaysia, data on length-weight relationships and otolith measurements. It contributes to a better understanding of taxonomy, and phylogenetic and genetic diversity of E.epistictus.
The aim of this study was to investigate the effects of a two week reduction in training load on selected physiological and performance among junior cyclist. Twenty seven male junior cyclists (age= 16.6±0.7 years, height=165.6±6.1 cm, weight= 54.1±8.1 kg) were matched into either the control group (n=13) or the experimental group (n=14) using their initial VO2max values. Both groups followed a 12-week progressive endurance training program and subsequently, the experimental group (EXP) engaged in a two week tapering (recovery via a reduction in training loads) phase. The control group continued with their normal training routine. A simulated 20 km time trials performance and a graded exercise test on cycle ergometer were performed before and after endurance training and after the two week tapering protocol. Following the conclusion of the two week intervention or no intervention program both groups undertook a TT20km. Results showed no significant difference in the TT20km performance. Compared to the CON group, the EXP group showed significant changes in all the selected physiological variables tested, p
Body Mass Index (BMI) is the most established anthropometric indicator used for assessment of nutritional status. Other anthropometric indicators which are related closely to BMI are waist hip ratio (WHR) and waist circumference. In this paper, receiver operating characteristics (ROC) curves were constructed to assess the value of waist circumference and waist hip ratio as a screening measure for the need of weight management using BMI as the reference test. Sensitivity and specificity were calculated at several cut-offs. The areas under the ROC curve calculated by comparing waist circumference with BMI were high (0.70 - 0.86) while the areas calculated for WHR were low (0.46 - 0.67). Sensitivities of 0.745 and 0.800 were observed at cut-off points of waist circumference at 90cm and 80cm for males and females respectively, while the false positive rates were 0.233 for males and 0.250 for females. These cut-off points could be considered as a fair trade-off. Therefore it is concluded that waist circumference performed better than WHR as a screening test. It is indicative that waist circumference could be used as a tool in raising awareness of weight management in this population.
General obesity, as reflected by BMI, is an established risk factor for esophageal adenocarcinoma (EAC), a suspected risk factor for gastric cardia adenocarcinoma (GCC) and appears unrelated to gastric non-cardia adenocarcinoma (GNCC). How abdominal obesity, as commonly measured by waist circumference (WC), relates to these cancers remains largely unexplored. Using measured anthropometric data from 391,456 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) study and 11 years of follow-up, we comprehensively assessed the association of anthropometric measures with risk of EAC, GCC and GNCC using multivariable proportional hazards regression. One hundred twenty-four incident EAC, 193 GCC and 224 GNCC were accrued. After mutual adjustment, BMI was unrelated to EAC, while WC showed a strong positive association (highest vs. lowest quintile HR = 1.19; 95% CI, 0.63-2.22 and HR = 3.76; 1.72-8.22, respectively). Hip circumference (HC) was inversely related to EAC after controlling for WC, while WC remained positively associated (HR = 0.35; 0.18-0.68, and HR=4.10; 1.94-8.63, respectively). BMI was not associated with GCC or GNCC. WC was related to higher risks of GCC after adjustment for BMI and more strongly after adjustment for HC (highest vs. lowest quintile HR = 1.91; 1.09-3.37, and HR = 2.23; 1.28-3.90, respectively). Our study demonstrates that abdominal, rather than general, obesity is an indisputable risk factor for EAC and also provides evidence for a protective effect of gluteofemoral (subcutaneous) adipose tissue in EAC. Our study further shows that general obesity is not a risk factor for GCC and GNCC, while the role of abdominal obesity in GCC needs further investigation.
A study to determine average knee laxity in the Malaysian population and how it affects daily living was conducted at the University Malaya Medical Centre between January and April 2004. Fifty two male and 76 female subjects were recruited for this study, all of whom were healthy volunteers with no ambulatory problems. Side to side knee laxity testing was performed using a KT-1000 arthrometer. Significant differences in knee laxity were noted among different races and between sexes. For instance, overall, Chinese and female study participants had higher knee laxity: (left knee, 2.17 mm (SD=1.30) and right knee was 2.88 mm (SD= 1.51)). On average, the difference between knees was 0.70 ± 1.26 mm (less than 1 mm) which is a smaller variation than reported in previous studies which suggested 3 mm. Despite finding knee laxity ranging from 0 to 8mm, no correlations were found between Lysholm, IKDC and Tegner knee outcome scores and the degree of knee laxity. No other predictors such as height, weight and age correlated with levels of knee laxity. We therefore conclude that knee laxity is a common occurrence in the normal population and is therefore not suitable as a sole predictor of knee function and should not be used as the only criteria for surgical intervention.
Study site: Orthopedic clinic, Universiti Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Monitoring clinical activity at the bedside in the intensive care unit (ICU) can provide useful information to evaluate nursing care and patient recovery. However, it is labour intensive to quantify these activities and there is a need for an automated method to record and quantify these activities. This paper presents an automated system, Clinical Activity Tracking System (CATS), to monitor and evaluate clinical activity at the patient's bedside. The CATS uses four Microsoft Kinect infrared sensors to track bedside nursing interventions. The system was tested in a simulated environment where test candidates performed different motion paths in the detection area. Two metrics, 'Distance' and 'Dwell time', were developed to evaluate interventions or workload in the detection area. Results showed that the system can accurately track the intervention performed by individual or multiple subjects. The results of a 30-day, 24-hour preliminary study in an ICU bed space matched clinical expectations. It was found that the average 24-hour intervention is 22.0minutes/hour. The average intervention during the day time (7am-11pm) is 23.6minutes/hour, 1.4 times higher than 11pm-7am, 16.8minutes/hour. This system provides a unique approach to automatically collect and evaluate nursing interventions that can be used to evaluate patient acuity and workload demand.
Matched MeSH terms: Weights and Measures/instrumentation*; Weights and Measures/standards
The functions of dams are for water supply, flood control and hydroelectric power generation. A concrete faced rockfill dam (CFRD) is preferred by dam consultants due to its many advantages. It is designed to withstand all applied loads, namely gravity load due to its massive weight and hydrostatic load due to water thrust from the reservoir. The structural response of the Bakun CFRD which is the second highest dam in the world after the Shuibuya Dam, was analyzed using finite element method. A two-dimensional plane strain finite element analysis of the non-linear Duncan-Chang hyperbolic model was used in the study of the dam in respect to the deformation and stresses of the main dam of Bakun CFRD project. The Dead-Birth-Ghost element technique was used to simulate sequences of the construction of the dam. The comparison of rigid and flexible foundation on the behaviour of the dam is discussed in this study. In the finite element modeling, the concrete slab on the upstream was represented through a six-noded element, while the interface characteristic between the dam body and the concrete slab was modeled using an interface element. The maximum settlement and stresses of the cross-section were found and their distribution was discussed and tabulated in the form of contours. The effect of reservoir filling loading had a gradual effect on the dam response behaviour. Comparisons with no water impoundment in the dam were also discussed.
To assist in the broadcasting of time-critical traffic information in an Internet of Vehicles (IoV) and vehicular sensor networks (VSN), fast network connectivity is needed. Accurate traffic information prediction can improve traffic congestion and operation efficiency, which helps to reduce commute times, noise and carbon emissions. In this study, we present a novel approach for predicting the traffic flow volume by using traffic data in self-organizing vehicular networks. The proposed method is based on using a probabilistic generative neural network techniques called deep belief network (DBN) that includes multiple layers of restricted Boltzmann machine (RBM) auto-encoders. Time series data generated from the roadside units (RSUs) for five highway links are used by a three layer DBN to extract and learn key input features for constructing a model to predict traffic flow. Back-propagation is utilized as a general learning algorithm for fine-tuning the weight parameters among the visible and hidden layers of RBMs. During the training process the firefly algorithm (FFA) is applied for optimizing the DBN topology and learning rate parameter. Monte Carlo simulations are used to assess the accuracy of the prediction model. The results show that the proposed model achieves superior performance accuracy for predicting traffic flow in comparison with other approaches applied in the literature. The proposed approach can help to solve the problem of traffic congestion, and provide guidance and advice for road users and traffic regulators.
Individualising a drug dosage regimen is more appropriate if it is based on pharmacokinetics data derived from local populations. In this study, we estimated valproic acid (VPA) and carbamazepine (CBZ) clearances in the Malaysian population from routinely collected therapeutic drug monitoring (TDM) data. We also evaluated the effects of gender, age, weight and concurrent antiepileptic drug (AED) therapy on VPA and CBZ clearance. Data was collected retrospectively from TDM forms of adult patients. Apparent drug clearance was estimated based on the standard steady state clearance equation. Mann-Whitney and KruskalWallis tests were used to evaluate gender and therapy differences, while Spearman’s Rank correlation was used to determine the associations of age and weight with clearance. One hundred thirty-two samples for VPA and 67 for CBZ were included in the analysis. Patients’ ages ranged from 15 to 72 years old. Mean VPA and CBZ clearances were found to be 0.36 l/kg/d and 1.60 l/kg/d, respectively. VPA clearance correlated positively but poorly with weight. Our results showed significant differences in (i) VPA clearance among male and female patients and (ii) VPA clearance between monotherapy and combination therapy. These findings provide a guide to initiate maintenance doses of VPA and CBZ in our local patients. Awareness of factors influencing drug clearance should help to optimise patients’ dosing regimens.
Traditionally it was thought that fitness-related traits such as male mating frequency, with a history of strong directional selection, should have little additive genetic variance and thus respond asymmetrically to bidirectional artificial selection. However, recent findings and theory suggest that a balance between selection for increased male mating frequency and opposing selection pressures on physiologically linked traits will cause male mating frequency to have high additive genetic variation and hence respond symmetrically to selection. We tested these hypotheses in the stalk-eyed fly, Cyrtodiopsis dalmanni, in which males hold harems comprising many females and so have the opportunity to mate at extremely high frequencies. We subjected male stalk-eyed flies to artificial selection for increased ('high') and decreased ('low') mating frequency in the presence of ecologically realistic, high numbers of females. High line males mated significantly more often than control or low line males. The direct response to selection was approximately symmetric in the high and low lines, revealing high additive genetic variation for, and no significant genetic constraints on, increased male mating frequency in C. dalmanni. In order to investigate trade-offs that might constrain male mating frequency under natural conditions we examined correlated responses to artificial selection. We measured accessory gland length, testis length and eyespan after 7 and 14 generations of selection. High line males had significantly larger accessory glands than low line males. No consistent correlated responses to selection were found in testis length or eyespan. Our results suggest that costs associated with the production and maintenance of large accessory glands, although yet to be identified, are likely to be a major constraint on mating frequency in natural populations of C. dalmanni.
The family Poritidae formerly included 6 genera: Alveopora, Goniopora, Machadoporites, Porites, Poritipora, and Stylaraea. Morphologically, the genera can be differentiated based on the number of tentacles, the number of septa and their arrangement, the length of the polyp column, and the diameter of the corallites. However, the phylogenetic relationships within and between the genera are unknown or contentious. On the one hand, Alveopora has been transferred to the Acroporidae recently because it was shown to be more closely related to this family than to the Poritidae by previous molecular studies. On the other hand, Goniopora is morphologically similar to 2 recently described genera, Machadoporites and Poritipora, particularly with regard to the number of septa (approximately 24), but they have not yet been investigated at the molecular level. In this study, we analyzed 93 samples from all 5 poritid genera and Alveopora using 2 genetic markers (the barcoding region of the mitochondrial COI and the ITS region of the nuclear rDNA) to investigate their phylogenetic relationships and to revise their taxonomy. The reconstructed molecular trees confirmed that Alveopora is genetically distant from all poritid genera but closely related to the family Acroporidae, whereas the other genera are genetically closely related. The molecular trees also revealed that Machadoporites and Poritipora were indistinguishable from Goniopora. However, Goniopora stutchburyi was genetically isolated from the other congeneric species and formed a sister group to Goniopora together with Porites and Stylaraea, thus suggesting that 24 septa could be an ancestral feature in the Poritidae. Based on these data, we move G. stutchburyi into a new genus, Bernardpora gen. nov., whereas Machadoporites and Poritipora are merged with Goniopora.
Enhanced muscle strength is seen when resistance exercise is combined with the consumption of nutritional supplements. Although there is a limited number of studies available about the efficacy of gamma oryzanol supplementation with resistance exercise in humans, but its usage as a nutritional supplement for strength is common in athletes. The aim of this study was to determine the effects of gamma oryzanol supplementation during 9-week resistance training on muscular strength and anthropometric measurements of young healthy males.
Handgrip strength is useful for screening the nutritional status of adult population as it is strongly associated with physical disabilities and mortality. Therefore, we aimed to determine the predictors of handgrip strength among adults of a rural community in Malaysia using a cross-sectional study design with multistage sampling. All adults aged 30 years and older from 1250 households were invited to our study. Structured questionnaire on sociodemographic characteristics, medical history, occupation history, lifestyle practices, and measurements, including anthropometry and handgrip strength were taken. There were 2199 respondents with 55.2% females and majority were of Malay ethnicity. Their mean (standard deviation) age was 53.4 (13.2) years. The response rate for handgrip strength was 94.2%. Females had significantly lower handgrip strength than males (P < .05). In the multiple linear regression models, significant predictors of handgrip strength for males were age, height, job groups, and diabetes, while for females, the significant predictors were age, weight, height, and diabetes.
Skulls of the red-cheeked squirrel (Dremomys rufigenis) from various geographical locations: Malaysia (peninsular area), Vietnam (south district)-Laos, and Thailand (north district) were osteometrically examined. The skull size of the squirrels in the southern (Malaysia) population was fundamentally larger than that in the northern (Vietnam, Laos and Thailand) populations. The proportion indices indicated that the splanchnocranium was relatively longer in the Malaysia population, and that the interorbital space was narrower in Vietnam-Laos, and Thailand populations. We suggest that the long nose and laterally-oriented orbits in the skull may be better adapted for terrestrial-insectivorous life in the Malaysia population and the binocular sense facilitated by rostrally-oriented eyes contributes to the arboreal-fruit eating behavior in the two northern populations. The Malaysia population was clearly distinguished from the other populations by the principal component analysis. We suggest that the geographical barrier of the Isthmus of Kra influences the morphological variation of the skull among the squirrel populations.