The management of clinical solid waste (CSW) continues to be a major challenge, particularly, in most healthcare facilities of the developing world. Poor conduct and inappropriate disposal methods exercised during handling and disposal of CSW is increasing significant health hazards and environmental pollution due to the infectious nature of the waste. This article summarises a literature review into existing CSW management practices in the healthcare centers. The information gathered in this paper has been derived from the desk study of open literature survey. Numerous researches have been conducted on the management of CSW. Although, significant steps have been taken on matters related to safe handling and disposal of the clinical waste, but improper management practice is evident from the point of initial collection to the final disposal. In most cases, the main reasons of the mismanagement of CSW are the lack of appropriate legislation, lack of specialized clinical staffs, lack of awareness and effective control. Furthermore, most of the healthcare centers of the developing world have faced financial difficulties and therefore looking for cost effective disposal methods of clinical waste. This paper emphasizes to continue the recycle-reuse program of CSW materials after sterilization by using supercritical fluid carbon dioxide (SF-CO2) sterilization technology at the point of initial collection. Emphasis is on the priority to inactivate the infectious micro-organisms in CSW. In that case, waste would not pose any threat to healthcare workers. The recycling-reuse program would be carried out successfully with the non-specialized clinical staffs. Therefore, the adoption of SF-CO2 sterilization technology in management of clinical solid waste can reduce exposure to infectious waste, decrease labor, lower costs, and yield better compliance with regulatory. Thus healthcare facilities can both save money and provide a safe environment for patients, healthcare staffs and clinical staffs.
Matched MeSH terms: Environment*; Environmental Pollution/analysis; Environmental Pollution/prevention & control
Dengue virus (DENV) circulates in human and sylvatic cycles. Sylvatic strains are both ecologically and evolutionarily distinct from endemic viruses. Although sylvatic dengue cycles occur in West African countries and Malaysia, only a few cases of mild human disease caused by sylvatic strains and one single case of dengue hemorrhagic fever in Malaysia have been reported. Here we report a case of dengue hemorrhagic fever (DHF) with thrombocytopenia (13000/µl), a raised hematocrit (32% above baseline) and mucosal bleeding in a 27-year-old male returning to Spain in November 2009 after visiting his home country Guinea Bissau. Sylvatic DENV-2 West African lineage was isolated from blood and sera. This is the first case of DHF associated with sylvatic DENV-2 in Africa and the second case worldwide of DHF caused by a sylvatic strain.
The current study examined normative beliefs about aggression as a mediator between narcissistic exploitativeness and cyberbullying using two Asian adolescent samples from Singapore and Malaysia. Narcissistic exploitativeness was significantly and positively associated with cyberbullying and normative beliefs about aggression and normative beliefs about aggression were significantly and positively associated with cyberbullying. Normative beliefs about aggression were a significant partial mediator in both samples; these beliefs about aggression served as one possible mechanism of action by which narcissistic exploitativeness could exert its influence on cyberbullying. Findings extended previous empirical research by showing that such beliefs can be the mechanism of action not only in offline but also in online contexts and across cultures. Cyberbullying prevention and intervention efforts should include modification of norms and beliefs supportive of the legitimacy and acceptability of cyberbullying.
The study was couducted to investigate the effects of gamma irradiation and CO₂ on flavonoid content and leaf gas exchange in C.asiatica. For flavonoid determination, the design was a split split plot based on Randomized Complete Block Design (RCBD). For other parameters, the designs were split plots. Statistical tests revealed significant differences in flavonoid contents of Centella asiatica leaves between different growth stages and various CO₂ treatments. CO₂ 400, G20 (400 = ambient CO₂; G20 = Plants exposed to 20 Gy) showed 82.90% higher total flavonoid content (TFC) in the 5th week than CO₂ 400 as control at its best harvest time (4th week). Increasing the concentration of CO₂ from 400 to 800 μmol/mol had significant effects on TFC and harvesting time. In fact, 800 μmol/mol resulted in 171.1% and 66.62% increases in TFC for control and irradiated plants, respectively. Moreover, increasing CO₂ concentration reduced the harvesting time to three and four weeks for control and irradiated plants, respectively. Enhancing CO₂ to 800 µmol/mol resulted in a 193.30% (CO₂ 800) increase in leaf biomass compared to 400 µmol/mol and 226.34% enhancement in irradiated plants (CO₂ 800, G20) [800 = Ambient CO₂; G20 = Plants exposed to 20 Gy] than CO₂ 400, G20. In addition, the CO₂ 800, G20 had the highest amount of flavonoid*biomass in the 4th week. The results of this study indicated that all elevated CO₂ treatments had higher PN than the ambient ones. The findings showed that when CO₂ level increased from 400 to 800 µmol/mol, stomatal conductance, leaf intercellular CO₂ and transpiration rate had the tendency to decrease. However, water use efficiency increased in response to elevated CO₂ concentration. Returning to the findings of this study, it is now possible to state that the proposed method (combined CO₂ and gamma irradiation) has the potential to increase the product value by reducing the time to harvest, increasing the yield per unit area via boosting photosynthesis capacity, as well as increasing biochemicals (flavonoids) per gram DM.
Care management providing a high quality of life (QoL) is a crucial issue in dealing with increasing numbers of dementia patients. Although the transition from informal (home-based) care to formal (institutional) care is often a function of dementia stage, for those with early dementia there is currently no definitive evidence showing that informal or formal care provides a higher QoL, particularly where informal care is favored for local cultural reasons. This paper outlines the research protocol for a study comparing formal and informal care in Malaysia. It seeks to provide evidence regarding which is more appropriate and results in higher QoL in early dementia.
The prevalence of lifestyle-related chronic diseases is increasing and gene-diet interaction studies are limited among the Malaysian population. This study was conducted to evaluate the association and interaction effects of vascular endothelial growth factor receptor-2(VEGFR2) gene polymorphisms and dietary patterns on anthropometric and biochemical risk factors of chronic diseases in 179 Chinese Malaysian adults.
OBJECTIVE: The objectives were to determine the prevalence and associated factors for smoking among university students in Malaysia.
METHODOLOGY: A cross-sectional study was conducted among 199 students in the period from December of academic year 2009 until April of academic year 2010 in Management and Science University (MSU), Shah Alam, Selangor, Malaysia. The questionnaire was distributed randomly to all faculties of MSU by choosing one of every 3 lecture rooms, as well as the library and cafeterias of the campus randomly by choosing one from every 3 tables. Questions concerned socio-demographic variables, knowledge, attitudes and practice toward smoking. Participant's consent was obtained and ethical approval was provided by the ethics committee of the University. Data entry and analysis were performed using descriptive statistics, chi square test, Student t- test and logistic multiple regression with the SPSS version 13.0, statistical significance being concluded at p < 0.05.
RESULTS: About one third of students were smokers (29%). The most important reason of smoking was stress (20%) followed by 'influenced by friends' (16 %). Prevalence of smoking was significantly higher among male and those in advanced semesters (p = >0.001, p = 0.047). Smokers had low level of knowledge (p < 0.05), had wrong beliefs on smoking (p < 0.05), and negative attitude toward tobacco control policies compared to non smokers (p < 0.05). On multiple logistic regression, significant predictors of smoking in the model were gender (p = 0.025), age (p = 0.037), semester of study (p = 0.025) and attitude toward smoking (p < 0.001).
CONCLUSION: This study found that 29% of university students were smokers. Males and students in advanced semesters were more likely to smoke. The results provide baseline data to develop an anti-smoking program to limit smoking in the university by implementing policies against smoking.
Burkholderia pseudomallei is the causative agent of melioidosis, a disease of significant morbidity and mortality in both human and animals in endemic areas. Much remains to be known about the contributions of genotypic variations within the bacteria and the host, and environmental factors that lead to the manifestation of the clinical symptoms of melioidosis.
Background: Competence-based curriculum has become the need of medical education to meet the objectives of institutions aiming to produce skilled physicians. To achieve the optimal competence and performance of graduates a number of traditional evaluation exercises have been practiced. Some of these e.g. OSCE although meet the acceptable standard of reliability and validity is the assessment done in a controlled environment. This leaves the room for performance-based assessment in real clinical situation such as mini clinical evaluation exercise (Mini-CEX). To practice and meet the challenges of Mini-CEX it is vital to undertake faculty development program with a comprehensively chalked down Mini-CEX protocol and its objectives to achieve the intended outcome. Objective: To undertake faculty development on Mini-CEX for its feasibility and acceptability as a method of formative assessment to evaluate the clinical competence of trainees in postgraduate program of Otolaryngology and Head-Neck Surgery. Method: 25 trainees from the four classes of master of surgery program of 2009 in Otolaryngology and Head-Neck Surgery (ORL-HNS) undertook Mini-CEX encounters and assessed by 9 supervisors in a 12-week period of study. Faculty development program was carried out through prior lectures deliberating on background, concept and procedure of Mini-CEX followed by demonstrations using video clip of Mini-CEX encounter recorded in own clinical environment. Students were also exposed to similar settings to take up the Mini-CEX encounter without any hesitation. Trainees were assessed in outpatient clinical setting. Program was evaluated for its feasibility and acceptability with respect to patient’s factors, clinical attributes, supervisor and trainee’s performance and their reported level of satisfaction.
Result: Faculty development and trainees orientation in Min-CEX was achieved as feasible and acceptable. Higher rating of satisfaction was reported by majority assessors and trainees as they found Mini-CEX acceptable for formative assessment. Among clinical skills highest rating was received in physical examination and lowest rating in therapeutic skills. Conclusion: A motivated faculty and organized approach towards a comprehensive knowledge on Mini-CEX for its background communication, demonstration of procedure and method to complete the rating forms is the useful guide to adopt Mini-CEX. The faculty and trainees in department of ORL-HNS found Mini-CEX as feasible and acceptable assessment tool to monitor educational activity of postgraduate program through performance-based evaluation in a real clinical situation.
Background: In order to achieve the desired performance of graduates a number of traditional evaluation exercises have been practiced to assess their competence as medical students. Many of these assessments are done in a controlled environment and mostly reflect on tests of competence than performance. Mini-CEX or direct observed procedural skills (DOPS) are the real performance-based assessment of clinical skills. Increased opportunity for observation and just-in-time feedback from the role model superiors produce a positive educational impact on students learning. This also provides trainees with formative assessment to monitor their learning objectives. However, to implement assessment strategies with Mini-CEX or DOPS needs to develop institution’s clear policy for a different teaching and learning culture of workplace based assessment. It also needs to develop user friendly rating form, checklist, elaboration of clinical competence and its attributes and procedural guidelines for practice. A precise role of these tools in the assessment of postgraduate program must be established before practicing them to evaluate and monitor trainee’s progress.
Objective: To determine DOPS for its acceptability and feasibility as a method of formative assessment of clinical skills in postgraduate program of Otolaryngology and Head-Neck Surgery.
Method: A total of 25 trainees were assessed for DOPS by 8 supervisors in this 12-weeks pilot study. A faculty development program for faculty members and trainees was run for DOPS. Trainees were advised to undertake at least one DOPS encounter out of 42 shortlisted procedures. Assessors were asked to mark trainees by completing a rating form using a checklist developed for each procedure. Trainees and assessors were asked to endorse their opinion on feasibility and acceptance of DOPS for practice of formative assessment in future. Data was analyzed to determine feasibility and acceptability of DOPS in assessment program. Result: Faculty development and trainees orientation in DOPS were found satisfactory for its acceptance and feasible for its practice. Trainees were mostly assessed in outpatient clinical setting. Majority reported higher rating of satisfaction by assessors and trainees. Among clinical skills higher rating was received in procedural skills performed by the senior trainees. Conclusion: DOPS was found feasible for practice of formative assessment of trainees in postgraduate program of Otolaryngology and Head-Neck Surgery in School of Medical Sciences (SMS) at Universiti Sains Malaysia (USM). It was well accepted by the trainees to help monitor their quality of procedural skills as self-directed learning.
Warm compaction is an advanced manufacturing technique which consists of two consecutive steps, i.e. powder compaction at above ambient temperature and sintering in a controlled environment. Due to the relative movement between the powder mass and die wall as well as sliding among powder particles, frictional force is generated during the compaction stage. Admixed lubricant is used during the compaction step in order to minimize friction and hence improve the uniformity of the density of distribution inside the component. However, during the sintering process, trapped lubricant is often found to be burnt out hence leaving pores or voids which result in the lower strength of the final products. Warm compaction was initiated in the nineties, however not much information has been published about the effects of lubrication on the quality of the components produced through this route. Therefore, this paper presents the outcome of an experimental investigation about the effects of lubrication on manufacturing near-net shape components through the warm compaction route. Iron powder ASC 100.29 was mixed mechanically with zinc stearate to prepare the feedstock. Mixing time, weight percentage of lubricant content and compaction temperature were varied during green compact generation while sintering temperature, heating rate and holding time were manipulated during sintering. The relative densities and strengths of the final products were investigated at every compaction as well as sintering parameter. The results revealed that lubrication could provide significant effects at the compaction temperature of 180ºC while no significant effect of lubrication was observed during sintering. The suitable lubricant content was found to be 0.4 wt% and mixing time was around 30 min and the sintering temperature was around 990ºC.
This research focuses on the ASTER DEM generation for visual and mathematical analysis of topography, landscapes and landforms, as well as modeling of surface processes of Central Alborz, Iran. ASTER DEM 15 m generated using tie points over the Central Alborz and Damavand volcano with 5671 m height from ASTER (Advanced Space borne Thermal Emission and Reflection Radiometer) satellite data using PCI Geomatica 9.1. Geomorphic parameters are useful to identify and describe geomorphologic forms and processes, which were extracted from ASTER DEM in GIS environment such as elevation, aspect, slope angle, vertical curvature, and tangential curvature. Although the elevation values are slightly low in altitudes above 5500 m asl., the ASTER DEM is useful in interpretation of the macro- and meso-relief, and provides the opportunity for mapping especially at medium scales (1:100,000 and 1:50,000). ASTER DEM has potential to be a best tool to study 3D model for to geomorphologic mapping and processes of glacial and per glacial forms above 4300 m asl.
Shotcrete is a process where concrete is projected or “shot” under pressure, using a feeder or a
“gun” onto a surface to form structural shapes including walls, floors, and roofs. The surface can
be wood, steel, polystyrene, or any other surfaces that concrete can be projected onto. The surface
can be trowel led smooth while the concrete is still wet. Shotcrete has high strength, durability, low
permeability, excellent bond, and limitless shape possibilities. These properties allow shotcrete
to be used as a structural material in most cases. Although the hardened properties of shotcrete
are similar to conventional cast-in-place concrete, the nature of the placement process provides
additional benefits, such as excellent bond with most substrates and instant or rapid capabilities,
particularly on complex forms or shapes. In addition to building homes, shotcrete can also be used
to build pools. The practice of underground tunneling shows that the degree of stability of tunnels
is dependent on the state of the soil, rock mass, and shotcrete around the tunnel contour. The
development in the urban or suburban areas leads to the construction of tunnels in all kinds of soil
and rock. Meanwhile, the construction of tunnels in shallow depth or soft soils causes the ground
to displace. The determination of soil and rock mechanical properties to assess the stability of New
Austrian Tunnelling Method (NATM) tunnels and design the support system is one of the most
important steps in tunnelling. This paper provides information pertaining to the safety and increase
the stability of NATM tunnel before, during and after the operation of the tunnel. Therefore, the
shotcrete process is a recognized method for cemented sandy silt stabilization, with the aid of high
pressure shot concrete to increase the stability of tunnels.
Linear density polyethylene (LDPE)/thermoplastic sago starch (TPSS), blended with and without the addition of compatibilizer [Polyethylene-grafted-Maleic Anhydride, (PE-g-MA)] were prepared for soil burial test. The test was conducted in the natural soil environment for 3 and 6 months. Different loading of TPSS (10, 20, 30, 40, and 50 wt. %) were used in this study. After soil burial, the blends were evaluated for their tensile properties and scanning electron microscopy (SEM) to observe the surface morphology properties after the test. For LDPE/TPSS, it was observed that the tensile strength decreased with the increase of soil burial time, as well as Young modulus and elongation at break (EB). The LDPE/TPSS/PE-g-MA also showed the same trend for the tensile properties, but with higher properties as compared to uncompatibilized blends. The tensile properties also decreased with the increase in the TPSS loading for both the LDPE/TPSS and LDPE/TPSS/PE-g-MA. Meanwhile,
the scanning electron microscopy (SEM) on the blend surfaces after the soil burial test showed that degradability increased with the increase in the exposure time as well as the TPSS loading.
Termites are the major decomposers in tropical region but yet their occurrences in oil palm plantation especially in peat soil are generally treated as pest. Study of termite species in peat land was conducted in selected oil palm plantations in North Sarawak with 5-7 years old palms and South Sarawak with 13-15 years old palms with two sites in each area. Results of quadrate (25 x 25 x 30 cm) sampling showed termite was significantly higher in relative density with increasing depth of soil (0-10 = 21.23, 10-20 = 42.52 and 20-30 cm = 81.12%) which could be advantaged from being predated by ants (Hymenoptera: Formicidae) which were higher in density from soil surface to 10 cm soil depth with relative density of 31.84%. Modified transect sampling (50x6 m) had successfully sampled 18 species of termites from 2 families (Rhinotermitidae and Termitidae), 5 subfamilies (Rhinotermitinae, Coptotermitinae, Termitinae, Macrotermitinae and Nasutitermitinae) and 11 genera (Coptotermes, Schedorhinotermes, Termes, Macrotermes, Nasutitermes, Globitermes, Amitermes, Parrhinotermes, Pericapritermes, Havilanditermes and Prohamitermes). Both plantation sites have termite dominantly feeding on rotten wood as a result of abundant dead woods. However, Coptotermes curvignathus Holmgren was identified to feed on the living tissues of oil palm causing damage or death of the tree. Study showed higher encounter of soil-feeding termite in longer established plantation. It indicates the gradually shifting of soil condition towards a stabilized environment which favors the successful settlement of soil feeder termite species. Termite control should be more targets specific to avoid harming beneficial termites.
The palm oil industry has played an important role in the economic development of Malaysia and has enhanced the economic welfare of its people. To determine the environmental impact of the oil palm seedling at the nursery stage, information on inputs and outputs need to be assessed. The oil palm nursery is the first link in the palm oil supply chain. A gate-to-gate study was carried out whereby the system boundary was set to only include the process of the oil palm seedling. The starting point was a germinated seed in a small polyethylene bag (6 in × 9 in) in which it remained until the seedling was approximately 3 to 4 months old. The seedling was then transferred into a larger polyethylene bag (12 in × 15 in), where it remained until it was 10-12 months old, when it was planted in the field (plantation). The functional unit for this life cycle inventory (LCI) is based on the production of one seedling. Generally, within the system boundary, the production of an oil palm seedling has only two major environmental impact points, the polybags used to grow the seedling and the fungicide (dithiocarbamate) used to control pathogenic fungi, as both the polybags and the dithiocarbamate are derived from fossil fuel.
The use of chemical pesticides increased considerably after World War II, and ecological damage was noticeable by the late 1940s. This paper outlines some ecological problems experienced during the post-war period in the UK, and in parts of what is now Malaysia. Also discussed is the government's response. Although Rachel Carson's book, Silent Spring (1962), was important in bringing the problems to a wider public, she was not alone in sounding the alarm. Pressure from the public and from British scientists led, among other things, to the founding of the Natural Environment Research Council in 1965. By the 1970s, environmentalism was an important movement, and funding for ecological and environmental research was forthcoming even during the economic recession. Some of the recipients were ecologists working at Imperial College London. Moved by the political climate, and by the evidence of ecological damage, they carried out research on the biological control of insect pests.
In Malaysia, landfills are being filled up rapidly due to the current daily generation of approximately 30,000 tonnes of municipal solid waste. This situation creates the crucial need for improved landfilling practices, as sustainable landfilling technology is yet to be achieved here. The objective of this paper is to identify and evaluate the development and trends in landfilling practices in Malaysia. In 1970, the disposal sites in Malaysia were small and prevailing waste disposal practices was mere open-dumping. This network of relatively small dumps, typically located close to population centres, was considered acceptable for a relatively low population of 10 million in Malaysia. In the 1980s, a national programme was developed to manage municipal and industrial wastes more systematically and to reduce adverse environmental impacts. The early 1990s saw the privatization of waste management in many parts of Malaysia, and the establishment of the first sanitary landfills for MSW and an engineered landfill (called 'secure landfill' in Malaysia) for hazardous waste. A public uproar in 2007 due to contamination of a drinking water source from improper landfilling practices led to some significant changes in the government's policy regarding the country's waste management strategy. Parliament passed the Solid Waste and Public Cleansing Management (SWPCM) Act 2007 in August 2007. Even though the Act is yet to be implemented, the government has taken big steps to improve waste management system further. The future of the waste management in Malaysia seems somewhat brighter with a clear waste management policy in place. There is now a foundation upon which to build a sound and sustainble waste management and disposal system in Malaysia.
A cholera outbreak in Terengganu, Malaysia, in November 2009 was caused by 2 El Tor Vibrio cholerae variants resistant to typical antimicrobial drugs. Evidence of replacement of treatable V. cholerae infection in the region with antimicrobial-resistant strains calls for increased surveillance and prevention measures.
Hypothalamic gonadotropin-releasing hormone (GnRH) is a key hormone for reproductive functions in vertebrates and non-vertebrates. Although GnRH neuronal system is regulated by several factors such as steroids, neurotransmitters and neuropeptides, it is not fully understood how environmental signals control the GnRH neuronal system. RFamide peptides, members of peptides possessing an Arg-Phe-NH(2) motif at their C-terminus, have recently been characterized as major regulators of GnRH neurons. In particular, two key RFamide peptides, kisspeptin and gonadotropin-inhibitory hormone (GnIH), are emerging as important regulators of the reproductive axis. Kisspeptin acts as the accelerator, directly driving GnRH neurons, whereas GnIH acts as the restraint. In addition, other RFamide peptides such as prolactin-releasing peptide (PrRP), PQRFa peptide, 26RFa/QRFP are also known to control reproduction. These RFamide peptides are regulated by environmental factors such as photoperiods, steroid hormones, metabolic signals, and stress. How environmental signals are integrated by RFamide peptides to regulate reproduction through the GnRH neurons?