Displaying publications 41 - 60 of 67 in total

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  1. Kurniawan A, Alias A, Yusof MYPM, Marya A
    Imaging Sci Dent, 2024 Mar;54(1):63-69.
    PMID: 38571779 DOI: 10.5624/isd.20230218
    PURPOSE: The objective of this study was to determine the minimum number of teeth in the anterior dental arch that would yield accurate results for individual identification in forensic contexts.

    MATERIALS AND METHODS: The study involved the analysis of 28 sets of 3-dimensional (3D) point cloud data, focused on the labial surface of the anterior teeth. These datasets were superimposed within each group in both genuine and imposter pairs. Group A incorporated data from the right to the left central incisor, group B from the right to the left lateral incisor, and group C from the right to the left canine. A comprehensive analysis was conducted, including the evaluation of root mean square error (RMSE) values and the distances resulting from the superimposition of dental arch segments. All analyses were conducted using CloudCompare version 2.12.4 (Telecom ParisTech and R&D, Kyiv, Ukraine).

    RESULTS: The distances between genuine pairs in groups A, B, and C displayed an average range of 0.153 to 0.184 mm. In contrast, distances for imposter pairs ranged from 0.338 to 0.522 mm. RMSE values for genuine pairs showed an average range of 0.166 to 0.177, whereas those for imposter pairs ranged from 0.424 to 0.638. A statistically significant difference was observed between the distances of genuine and imposter pairs (P<0.05).

    CONCLUSION: The exceptional performance observed for the labial surfaces of anterior teeth underscores their potential as a dependable criterion for accurate 3D dental identification. This was achieved by assessing a minimum of 4 teeth.

  2. Othman M, Latif MT, Yee CZ, Norshariffudin LK, Azhari A, Halim NDA, et al.
    Ecotoxicol Environ Saf, 2020 May;194:110432.
    PMID: 32169727 DOI: 10.1016/j.ecoenv.2020.110432
    It is important to have good indoor air quality, especially in indoor office environments, in order to enhance productivity and maintain good work performance. This study investigated the effects of indoor office activities on particulate matter of less than 2.5 μm (PM2.5) and ozone (O3) concentrations, assessing their potential impact on human health. Measurements of indoor PM2.5 and O3 concentrations were taken every 24 h during the working days in five office environments located in a semi-urban area. As a comparison, the outdoor concentrations were derived from the nearest Continuous Air Quality Monitoring Station. The results showed that the average 24 h of indoor and outdoor PM2.5 concentrations were 3.24 ± 0.82 μg m-3 and 17.4 ± 3.58 μg m-3 respectively, while for O3 they were 4.75 ± 4.52 ppb and 21.5 ± 5.22 ppb respectively. During working hours, the range of PM2.5 concentrations were 1.00 μg m-3 to 6.10 μg m-3 while for O3 they were 0.10 ppb to 38.0 ppb. The indoor to outdoor ratio (I/O) for PM2.5 and O3 was <1, thus indicating a low infiltration of outdoor sources. The value of the hazard quotient (HQ) for all sampling buildings was <1 for both chronic and acute exposures, indicating that the non-carcinogenic risks are negligible. Higher total cancer risk (CR) value for outdoors (2.67E-03) was observed compared to indoors (4.95E-04) under chronic exposure while the CR value for acute exposure exceeded 1.0E-04, thus suggesting a carcinogenic PM2.5 risk for both the indoor and outdoor environments. The results of this study suggest that office activities, such as printing and photocopying, affect indoor O3 concentrations while PM2.5 concentrations are impacted by indoor-related contributions.
  3. Saravanan C, Alias A, Mohamad M
    J Affect Disord, 2017 10 01;220:108-116.
    PMID: 28618312 DOI: 10.1016/j.jad.2017.05.037
    BACKGROUND: Students who go to other countries for higher education face various psychological problems, particularly homesickness and depression. The objectives of this study were to: (a) identify differences between students who did and did not receive brief individual cognitive behavioural therapy (CBT) for depression to reduce homesickness; (b) identify whether brief individual CBT for depression reduces the level of homesickness in students between pre-, post- and follow-up assessment; and (c) compare the scores of students experiencing only homesickness and those experiencing both homesickness and depression.

    METHOD: The sample consisted of 520 first-year undergraduate international students. The experimental group contained students who were diagnosed with depression and homesickness and received seven sessions of brief individual CBT for depression to reduce homesickness. The control group contained students who were diagnosed with depression and homesickness and received one session of advice and suggestions. The comparison group contained students who experienced only homesickness and did not receive any interventions. The study used the comparison group to determine if an interaction effect existed between students experiencing only homesickness and students experiencing both homesickness and depression.

    RESULTS: Students who received brief individual CBT displayed a significant reduction in their homesickness and depression scores compared to the scores of students in the control group. Students who experienced only homesickness exhibited a significant reduction in the scores on homesickness in the post-assessment compared to the control group's post-assessment homesickness scores.

    LIMITATION: The results of this study cannot be generalized as data were collected from three universities in Malaysia. The follow-up assessment was conducted six months after the post-assessment, which also limits generalizability beyond six months.

    CONCLUSION: Overall, homesickness is considered a normal reaction. Brief individual CBT for depression is effective in reducing homesickness and depression among international students.

  4. Alias A, Ibrahim A, Abu Bakar SN, Swarhib Shafie M, Das S, Abdullah N, et al.
    Clin Ter, 2018 11 6;169(5):e217-e223.
    PMID: 30393808 DOI: 10.7417/CT.2018.2082
    INTRODUCTION: The first step in the forensic identification is sex determination followed by age and stature estimation, as both are sex-dependent. The mandible is the largest, strongest and most durable bone in the face. Mandible is important for sex confirmation in absence of a complete pelvis and skull.

    AIM: The aim of the present study was to determine sex of human mandible from morphology, morphometric measurements as well as discriminant function analysis from the CT scan.

    MATERIALS AND METHODS: The present retrospective study comprised 79 subjects (48 males, 31 females), with age group between 18 and 74 years, and were obtained from the post mortem computed tomography data in the Hospital Kuala Lumpur. The parameters were divided into three morphologic and nine morphometric parameters, which were measured by using Osirix MD Software 3D Volume Rendering.

    RESULTS: The Chi-square test showed that men were significantly association with square-shaped chin (92%), prominent muscle marking (85%) and everted gonial glare, whereas women had pointed chin (84%), less prominent muscle marking (90%) and inverted gonial glare (80%). All parameter measurements showed significantly greater values in males than in females by independent t-test (p< 0.01). By discriminant analysis, the classification accuracy was 78.5%, the sensitivity was 79.2% and the specificity was 77.4%. The discriminant function equation was formulated based on bigonial breath and condylar height, which were the best predictors.

    CONCLUSION: In conclusion, the mandible could be distinguished according to the sex. The results of the study can be used for identification of damaged and/or unknown mandible in the Malaysian population.

  5. Md Naziri S.Z., Abu Bakar S.N., Alias A., Ibrahim A., Mohamed Swarhib D.M.J., Mohd Nor F.
    MyJurnal
    Introduction: Hanging is one of the most common methods of suicide in Malaysia, and to date, there is a rise in the number of deaths by hanging among adults. The purpose of this study was to determine the pattern of hanging in Malaysia from the year 2000 till 2009. Methods: The sample comprised 108 cases received at the Universiti Kebangsaan Malaysia Medical Centre, and five parameters, namely, age, sex, racial affiliation, marital status, and medical history were studied. Results: Of the 108 cases, 56% was reported to be Chinese. Suicide by hanging was more predominant in males (81%), and a high number of cases were seen in age groups of 21 to 30, 31 to 40 and 41 to 50 years. Of the cases studied, half of them were married, and previous history of physical and mental illness and alcohol intoxication were reported. Conclusions: In brief, this data would help the higher authorities in detecting the causes of suicide by hanging, as well as detecting the high risk groups with suicidal tendencies. In this way, suicide can be prevented and thus, the rate of suicide by hanging could be reduced in Malaysian.
  6. Choy KW, Murugan D, Leong XF, Abas R, Alias A, Mustafa MR
    Front Pharmacol, 2019;10:1295.
    PMID: 31749703 DOI: 10.3389/fphar.2019.01295
    Cardiovascular diseases (CVDs) such as angina, hypertension, myocardial ischemia, and heart failure are the leading causes of morbidity and mortality worldwide. One of the major transcription factors widely associated with CVDs is nuclear factor-kappa B (NFκB). NFκB activation initiates the canonical and non-conical pathways that promotes activation of transcription factors leading to inflammation, such as leukocyte adhesion molecules, cytokines, and chemokines. Flavonoids are bioactive polyphenolic compounds found abundantly in various fruits, vegetables, beverages (tea, coffee), nuts, and cereal products with cardiovascular protective properties. Flavonoids can be classified into six subgroups based on their chemical structures: flavanones, flavones, flavonols, flavan-3-ols, isoflavones, and anthocyanidins. As NFκB inhibitors, these flavonoids may modulate the expression of pro-inflammatory genes leading to the attenuation of the inflammatory responses underlying various cardiovascular pathology. This review presents an update on the anti-inflammatory actions of flavonoids via inhibition of NFκB mechanism supporting the therapeutic potential of these natural compounds in various CVDs.
  7. Hussein Z, Bidin ML, Alias A, Thiagarajan M, Latif KA, Ratnasingam J, et al.
    J ASEAN Fed Endocr Soc, 2019;34(1):8-14.
    PMID: 33442131 DOI: 10.15605/jafes.034.01.03
    In Malaysia, acromegaly is under-recognised with only 10-15% of the expected number of cases from prevalence estimates, having been diagnosed and managed in established endocrine centres with access to multidisciplinary care. This is mainly due to lack of awareness and standardised approach in diagnosing this disease resulting in delay in diagnosis and management with suboptimal treatment outcomes. This first Malaysian consensus statement on the diagnosis and management of acromegaly addresses these issues and is based on current best practices and latest available evidence so as to reduce the disease burden on acromegaly patients managed in the Malaysian healthcare system.
  8. Hong CX, Razuan NA, Alias A, Hassan FH, Nasseri Z
    Auris Nasus Larynx, 2021 Aug;48(4):788-792.
    PMID: 32513602 DOI: 10.1016/j.anl.2020.05.007
    Zygomatic root abscess is a rare extracranial extratemporal complication of otitis media. To the best of our knowledge, there are only a few scattered cases of zygomatic root abscesses reported in the literature. We present an unusual case of a zygomatic root abscess in a 24 years old adult. He presented with one month duration of right zygomatic swelling. Otoscopic examination revealed superior and posterior external auditory canal wall sagging with an intact tympanic membrane. High Resolution Computed Tomography (HRCT) temporal bone revealed a rim enhancing lesion lateral to the zygomatic process with fluid filled mastoid air cells. He was managed with antibiotics and staged surgical interventions. He recovered well. Our case serves to shed light on the pathways of infection, clinical manifestations and timely staged surgical intervention in this rare pathology.
  9. Tan EK, Alias A, Yeak R, Jaafar MS, Nizlan NM
    Cureus, 2022 Oct;14(10):e30606.
    PMID: 36426341 DOI: 10.7759/cureus.30606
    The sural nerve is a commonly encountered anatomical structure in foot and ankle surgeries. Knowledge of its location and course is imperative in performing surgeries within its vicinity to avoid neurological deficits. We herein report a rare anatomical variation of the sural nerve where it trifurcates above the level of the lateral malleolus that was discovered in a patient who underwent internal fixation for a trimalleolar ankle fracture with ipsilateral navicular fracture. This study aimed to raise awareness on a unique anatomical variation of the sural nerve in order to reduce the risk of iatrogenic injury.
  10. Mpofu E, Alias A, Tomita K, Suzuki-Minakuchi C, Tomita K, Chakraborty J, et al.
    Chemosphere, 2021 Jun;273:129663.
    PMID: 33515965 DOI: 10.1016/j.chemosphere.2021.129663
    Azoxystrobin (AZ) is a broad-spectrum synthetic fungicide widely used in agriculture globally. However, there are concerns about its fate and effects in the environment. It is reportedly transformed into azoxystrobin acid as a major metabolite by environmental microorganisms. Bacillus licheniformis strain TAB7 is used as a compost deodorant in commercial compost and has been found to degrade some phenolic and agrochemicals compounds. In this article, we report its ability to degrade azoxystrobin by novel degradation pathway. Biotransformation analysis followed by identification by electrospray ionization-mass spectrometry (MS), high-resolution MS, and nuclear magnetic resonance spectroscopy identified methyl (E)-3-amino-2-(2-((6-(2-cyanophenoxy)pyrimidin-4-yl)oxy)phenyl)acrylate, or (E)-azoxystrobin amine in short, and (Z) isomers of AZ and azoxystrobin amine as the metabolites of (E)-AZ by TAB7. Bioassay testing using Magnaporthe oryzae showed that although 40 μg/mL of (E)-AZ inhibited 59.5 ± 3.5% of the electron transfer activity between mitochondrial Complexes I and III in M. oryzae, the same concentration of (E)-azoxystrobin amine inhibited only 36.7 ± 15.1% of the activity, and a concentration of 80 μg/mL was needed for an inhibition rate of 56.8 ± 7.4%, suggesting that (E)-azoxystrobin amine is less toxic than the parent compound. To our knowledge, this is the first study identifying azoxystrobin amine as a less-toxic metabolite from bacterial AZ degradation and reporting on the enzymatic isomerization of (E)-AZ to (Z)-AZ, to some extent, by TAB7. Although the fate of AZ in the soil microcosm supplemented with TAB7 will be needed, our findings broaden our knowledge of possible AZ biotransformation products.
  11. Ibrahim A, Alias A, Nor FM, Swarhib M, Abu Bakar SN, Das S, et al.
    Anat Cell Biol, 2019 Jun;52(2):219.
    PMID: 31338243 DOI: 10.5115/acb.2019.52.2.219
    [This corrects the article on p. 86 in vol. 50, PMID: 28713610.].
  12. Fazilah A, Azemi MN, Karim AA, Norakma MN
    J Agric Food Chem, 2009 Feb 25;57(4):1527-31.
    PMID: 19166335 DOI: 10.1021/jf8028013
    Hemicelluloses from oil palm frond (OPF) were extracted using 3 M potassium hydroxide (KOH) for 4 h at 40 degrees C with stirring at 400 rpm to obtain hemicelluloses A and B. The total yield of the hemicellulose isolated from OPF was 33% (dry weight). Both hemicelluloses A and B were then subjected to hydrothermal treatment at 121 degrees C and 1.03 x 10(5) Pa for 10, 30, and 50 min. Physicochemical characterizations of hydrothermally treated hemicelluloses, such as Klason lignin content and reducing sugar content, were performed to study the effect of autohydrolysis processing on OPF-derived hemicelluloses. It was shown that Klason lignin content in hemicellulose A was higher than that in hemicellulose B and decreased after hydrothermal treatment. Hydrothermal treatment enhanced the solubility of hemicelluloses, which reflects their higher reducing sugar content. Monosaccharide analysis using HPLC showed that xylose was the predominant monosaccharide for both hemicelluloses A and B.
  13. Abd Wahab F, Abdullah S, Abdullah JM, Jaafar H, Md Noor SS, Wan Mohammad WMZ, et al.
    Malays J Med Sci, 2016 Nov;23(6):25-34.
    PMID: 28090176 MyJurnal DOI: 10.21315/mjms2016.23.6.3
    Ranking as the most communicable disease killer worldwide, tuberculosis, has accounted with a total of 9.6 million new tuberculosis cases with 1.5 million tuberculosis-related deaths reported globally in 2014. Tuberculosis has remain as an occupational hazard for healthcare workers since 1920s and due to several tuberculosis outbreaks in healthcare settings in the early 1990s, the concern about the transmission to both patients and healthcare workers has been raised. Healthcare workers have two to three folds greater the risk of active tuberculosis than the general population. Several studies on knowledge, attitude and practices on tuberculosis among healthcare workers worldwide have revealed that majority of the participated healthcare workers had good knowledge on tuberculosis. Most of the healthcare workers from South India and South Africa also reported to have positive attitude whereas a study in Thailand reported that most of the healthcare providers have negative attitude towards tuberculosis patients. Nevertheless, majority of the healthcare workers have low level of practice on tuberculosis prevention. An improved communication between healthcare workers and the patients as well as their families is the key to better therapeutic outcomes with good knowledge, attitude and preventive practice towards tuberculosis.
  14. Zulkifli NAF, Mohd Saaid NAS, Alias A, Mohamed Ibrahim N, Woon CK, Kurniawan A, et al.
    J Taibah Univ Med Sci, 2023 Dec;18(6):1435-1445.
    PMID: 38162871 DOI: 10.1016/j.jtumed.2023.05.020
    OBJECTIVES: In this study, the sizes and forms of mandibles in various age groups of the Malay population were measured and compared.

    METHODS: Geometric morphometric (GM) analysis of mandibles from 400 dental panoramic tomography (DPT) specimens was conducted. The MorphoJ program was used to perform generalized Procrustes analysis (GPA), Procrustes ANOVA, principal component analysis (PCA), discriminant function analysis (DFA), and canonical variate analysis (CVA). In the tpsDig2 program, the 27 landmarks were applied to the DPT radiographs. Variations in mandibular size and form were categorized into four age groups: group 1 (15-24 years), group 2 (25-34 years), group 3 (35-44 years), and group 4 (45-54 years).

    RESULTS: The diversity in mandibular shape among the first eight principal components was 81%. Procrustes ANOVA revealed significant shape differences (P 

  15. Siew-Wai L, Zi-Ni T, Karim AA, Hani NM, Rosma A
    J Agric Food Chem, 2010 Feb 24;58(4):2274-8.
    PMID: 20121195 DOI: 10.1021/jf903820s
    The in vitro fermentability of sago (Metroxylon sagu) resistant starch type III (RS(3)) by selected probiotic bacteria was investigated. Sago RS(3) with 12% RS content was prepared by enzymatic debranching of native sago starch with pullulanase enzyme, followed by autoclaving, cooling, and annealing. The fermentation of sago RS(3) by L. acidophilus FTCC 0291, L. bulgaricus FTCC 0411, L. casei FTCC 0442, and B. bifidum BB12 was investigated by observing the bacterial growth, carbohydrate consumption profiles, pH changes, and total short chain fatty acids (SCFA) produced in the fermentation media. Comparisons were made with commercial fructo-oligosaccharide (FOS), Hi-maize 1043, and Hi-maize 240. Submerged fermentations were conducted in 30 mL glass vials for 24 h at 37 degrees C in an oven without shaking. The results indicated that fermentation of sago RS(3) significantly (P < 0.05) yielded the highest count of Lactobacillus sp. accompanied by the largest reduction in pH of the medium. Sago RS(3) was significantly the most consumed substrate compared to FOS and Hi-maizes.
  16. Abedin MZ, Karim AA, Latiff AA, Gan CY, Ghazali FC, Barzideh Z, et al.
    Nat Prod Res, 2014;28(16):1302-5.
    PMID: 24670209 DOI: 10.1080/14786419.2014.900617
    The molecular mass distribution, amino acid composition and radical-scavenging activity of collagen hydrolysates prepared from collagen isolated from the sea cucumber Stichopus vastus were investigated. β and α1 chains of the collagen were successfully hydrolysed by trypsin. The molecular mass distribution of the hydrolysates ranged from 5 to 25 kDa, and they were rich in glycine, alanine, glutamate, proline and hydroxyproline residues. The hydrolysates exhibited excellent radical-scavenging activity. These results indicate that collagen hydrolysates from S. vastus can be used as a functional ingredient in food and nutraceutical products.
  17. Abd Elgadir M, Akanda MJ, Ferdosh S, Mehrnoush A, Karim AA, Noda T, et al.
    Molecules, 2012 Jan 09;17(1):584-97.
    PMID: 22231495 DOI: 10.3390/molecules17010584
    A binary mixture of starch-starch or starch with other biopolymers such as protein and non-starch polysaccharides could provide a new approach in producing starch-based food products. In the context of food processing, a specific adjustment in the rheological properties plays an important role in regulating production processing and optimizing the applicability, stability, and sensory of the final food products. This review examines various biopolymer mixtures based on starch and the influence of their interaction on physicochemical and rheological properties of the starch-based foods. It is evident that the physicochemical and rheological characteristics of the biopolymers mixture are highly dependent on the type of starch and other biopolymers that make them up mixing ratios, mixing procedure and presence of other food ingredients in the mixture. Understanding these properties will lead to improve the formulation of starch-based foods and minimize the need to resort to chemically modified starch.
  18. Shehabi Y, Chan L, Kadiman S, Alias A, Ismail WN, Tan MA, et al.
    Intensive Care Med, 2013 May;39(5):910-8.
    PMID: 23344834 DOI: 10.1007/s00134-013-2830-2
    PURPOSE: To ascertain the relationship among early (first 48 h) deep sedation, time to extubation, delirium and long-term mortality.

    METHODS: We conducted a multicentre prospective longitudinal cohort study in 11 Malaysian hospitals including medical/surgical patients (n = 259) who were sedated and ventilated ≥24 h. Patients were followed from ICU admission up to 28 days in ICU with 4-hourly sedation and daily delirium assessments and 180-day mortality. Deep sedation was defined as Richmond Agitation Sedation Score (RASS) ≤-3.

    RESULTS: The cohort had a mean (SD) age of 53.1 (15.9) years and APACHE II score of 21.3 (8.2) with hospital and 180-day mortality of 82 (31.7%) and 110/237 (46.4%). Patients were followed for 2,657 ICU days and underwent 13,836 RASS assessments. Midazolam prescription was predominant compared to propofol, given to 241 (93%) versus 72 (28%) patients (P < 0.0001) for 966 (39.6%) versus 183 (7.5%) study days respectively. Deep sedation occurred in (182/257) 71% patients at first assessment and in 159 (61%) patients and 1,658 (59%) of all RASS assessments at 48 h. Multivariable Cox proportional hazard regression analysis adjusting for a priori assigned covariates including sedative agents, diagnosis, age, APACHE II score, operative, elective, vasopressors and dialysis showed that early deep sedation was independently associated with longer time to extubation [hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.89-0.97, P = 0.003], hospital death (HR 1.11, 95% CI 1.05-1.18, P < 0.001) and 180-day mortality (HR 1.09, 95% CI 1.04-1.15, P = 0.002), but not time to delirium (HR 0.98, P = 0.23). Delirium occurred in 114 (44%) of patients.

    CONCLUSION: Irrespective of sedative choice, early deep sedation was independently associated with delayed extubation and higher mortality, and thus was a potentially modifiable risk in interventional trials.

  19. Shehabi Y, Bellomo R, Kadiman S, Ti LK, Howe B, Reade MC, et al.
    Crit Care Med, 2018 06;46(6):850-859.
    PMID: 29498938 DOI: 10.1097/CCM.0000000000003071
    OBJECTIVES: In the absence of a universal definition of light or deep sedation, the level of sedation that conveys favorable outcomes is unknown. We quantified the relationship between escalating intensity of sedation in the first 48 hours of mechanical ventilation and 180-day survival, time to extubation, and delirium.

    DESIGN: Harmonized data from prospective multicenter international longitudinal cohort studies SETTING:: Diverse mix of ICUs.

    PATIENTS: Critically ill patients expected to be ventilated for longer than 24 hours.

    INTERVENTIONS: Richmond Agitation Sedation Scale and pain were assessed every 4 hours. Delirium and mobilization were assessed daily using the Confusion Assessment Method of ICU and a standardized mobility assessment, respectively.

    MEASUREMENTS AND MAIN RESULTS: Sedation intensity was assessed using a Sedation Index, calculated as the sum of negative Richmond Agitation Sedation Scale measurements divided by the total number of assessments. We used multivariable Cox proportional hazard models to adjust for relevant covariates. We performed subgroup and sensitivity analysis accounting for immortal time bias using the same variables within 120 and 168 hours. The main outcome was 180-day survival. We assessed 703 patients in 42 ICUs with a mean (SD) Acute Physiology and Chronic Health Evaluation II score of 22.2 (8.5) with 180-day mortality of 32.3% (227). The median (interquartile range) ventilation time was 4.54 days (2.47-8.43 d). Delirium occurred in 273 (38.8%) of patients. Sedation intensity, in an escalating dose-dependent relationship, independently predicted increased risk of death (hazard ratio [95% CI], 1.29 [1.15-1.46]; p < 0.001, delirium hazard ratio [95% CI], 1.25 [1.10-1.43]), p value equals to 0.001 and reduced chance of early extubation hazard ratio (95% CI) 0.80 (0.73-0.87), p value of less than 0.001. Agitation level independently predicted subsequent delirium hazard ratio [95% CI], of 1.25 (1.04-1.49), p value equals to 0.02. Delirium or mobilization episodes within 168 hours, adjusted for sedation intensity, were not associated with survival.

    CONCLUSIONS: Sedation intensity independently, in an ascending relationship, predicted increased risk of death, delirium, and delayed time to extubation. These observations suggest that keeping sedation level equivalent to a Richmond Agitation Sedation Scale 0 is a clinically desirable goal.

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