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.
Background: One of important educational climate roles is to provide an environment that promotes positive development of medical students' psychological wellbeing during training. Unfortunately, many studies have reported that educational climate in medical education are not favourable to them. Therefore, it is a real need for a simple, valid, reliable and stable tool that will help medical schools to screen psychological wellbeing of their students so that early intervention could be done.
Objective: This study aimed to explore the psychometric properties of the Medical Student Wellbeing Index (MSWBI) to measure psychological wellbeing at different interval of measurements in a cohort of medical students.
Method: A prospective study was done on a cohort of medical students. MSWBI was administered to the medical students at five different intervals. The confirmatory factor analysis, Cronbach's alpha and intra-class correlation analysis were applied to measure construct validity, internal consistency and agreement level at different interval of measurements.
Result: A total of 153 (89.5%) medical students responded completely to the MSWBI. The MSWBI showed that the one-factor model had acceptable values for most of the goodness of fit indices signified its construct was stable across multiple measurements. The overall Cronbach's alpha values for the MSWBI at the five measurements ranged between 0.69 and 0.78. The ICC coefficient values for the MSWBI total score was 0.58 to 0.59.
Conclusion: This study found that the MSWBI had stable psychometric properties as a screening tool for measuring psychological wellbeing among medical students at different time and occasions. Continued research is required to refine and verify its psychometric credentials at different educational settings.
The zoonotic malaria species Plasmodium knowlesi has become the main cause of human malaria in Malaysian Borneo. Deforestation and associated environmental and population changes have been hypothesized as main drivers of this apparent emergence. We gathered village-level data for P. knowlesi incidence for the districts of Kudat and Kota Marudu in Sabah state, Malaysia, for 2008-2012. We adjusted malaria records from routine reporting systems to reflect the diagnostic uncertainty of microscopy for P. knowlesi. We also developed negative binomial spatial autoregressive models to assess potential associations between P. knowlesi incidence and environmental variables derived from satellite-based remote-sensing data. Marked spatial heterogeneity in P. knowlesi incidence was observed, and village-level numbers of P. knowlesi cases were positively associated with forest cover and historical forest loss in surrounding areas. These results suggest the likelihood that deforestation and associated environmental changes are key drivers in P. knowlesi transmission in these areas.
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.
Obesity-associated metabolic illnesses are increasing at an alarming rate in Asian countries. A common feature observed in the Asian population is a higher incidence of abdominal obesity-the "skinny-fat" Asian syndrome. In this review, we critically evaluate the relative roles of genetics and environmental factors on fat distribution in Asian populations. While there is an upward trend in obesity among most Asian countries, it appears particularly conspicuous in Malaysia. We propose a novel theory, the Malaysian gene-environment multiplier hypothesis, which explains how ancestral variations in feast-and-famine cycles contribute to inherited genetic predispositions that, when acted on by modern-day stressors-most notably, urbanization, westernization, lifestyle changes, dietary transitions, cultural pressures, and stress-contribute to increased visceral adiposity in Asian populations. At present, the major determinants contributing to visceral adiposity in Asians are far from conclusive, but we seek to highlight critical areas for further research.
Health has been the main driver for many urban environmental interventions, particularly in cases of significant health problems linked to poor urban environmental conditions. This paper examines empirically the links between climate change mitigation and health in urban areas, when health is the main driver for improvements. The paper aims to understand how systems of urban governance can enable or prevent the creation of health outcomes via continuous improvements in the environmental conditions in a city. The research draws on cases from two Indian cities where initiatives were undertaken in different sectors: Surat (waste) and Delhi (transportation). Using the literature on network effectiveness as an analytical framework, the paper compares the cases to identify the possible ways to strengthen the governance and policy making process in the urban system so that each intervention can intentionally realize multiple impacts for both local health and climate change mitigation in the long term as well as factors that may pose a threat to long-term progress and revert back to the previous situation after initial achievements.
Nepenthes pitcher plants are colonized by a variety of specialized arthropods. As Aedes mosquitoes are container breeders, Nepenthes pitchers are a potential candidate oviposition site for vector species, such as Aedes aegypti (L.) and Aedes albopictus (Skuse). However, Aedes spp. are not commonly encountered in Nepenthes pitchers, and the environment inside the pitchers of some species is lethal to them. One exception is Nepenthes ampullaria Jack, whose pitchers are known to be colonized by Ae. albopictus on very rare occasions. Given that Ae. albopictus larvae can survive in N. ampullaria pitcher fluids, we sought to determine why pitcher colonization is rare, testing the hypothesis that gravid Aedes mosquitoes are deterred from ovipositing into container habitats that have similar characteristics to N. ampullaria pitchers. Using plastic ovitraps of different sizes, colors, and with different types of fluids (based on the characteristics of N. ampullaria pitchers), we compared oviposition rates by Aedes mosquitoes in urban and rural areas within the geographical range of N. ampullaria near Kuala Lumpur, Malaysia. Ovitraps that were black and large (>250-ml capacity) accumulated significantly more eggs than ovitraps that were smaller, or green in color. In terms of size and color, small, green ovitraps are analogous to N. ampullaria pitchers, indicating that these pitchers are not particularly attractive to gravid Ae. albopictus. Although Aedes spp. are capable of colonizing N. ampullaria pitchers, the pitchers are relatively unattractive to gravid females and do not represent a significant habitat for larvae of dengue vectors at present.
The study of human-environmental relations is complex and by nature draws on theories and practices from multiple disciplines. There is no single research strategy or universal set of methods to which researchers must adhere. Particularly for scholars interested in a political ecology approach to understanding human-environmental relationships, very little has been written examining the details of "how to" design a project, develop appropriate methods, produce data, and, finally, integrate multiple forms of data into an analysis. A great deal of attention has been paid, appropriately, to the theoretical foundations of political ecology, and numerous scholarly articles and books have been published recently. But beyond Andrew Vayda's "progressive contextualization" and Piers Blaikie and Harold Brookfield's "chains of explanation," remarkably little is written that provides a research model to follow, modify, and expand. Perhaps one of the reasons for this gap in scholarship is that, as expected in interdisciplinary research, researchers use a variety of methods that are suitable (and perhaps unique) to the questions they are asking. To start a conversation on the methods available for researchers interested in adopting a political ecology perspective to human-environmental interactions, I use my own research project as a case study. This research is by no means flawless or inclusive of all possible methods, but by using the details of this particular research process as a case study I hope to provide insights into field research that will be valuable for future scholarship.
Land-use change models are important tools for integrated environmental management. Through scenario analysis they can help to identify near-future critical locations in the face of environmental change. A dynamic, spatially explicit, land-use change model is presented for the regional scale: CLUE-S. The model is specifically developed for the analysis of land use in small regions (e.g., a watershed or province) at a fine spatial resolution. The model structure is based on systems theory to allow the integrated analysis of land-use change in relation to socio-economic and biophysical driving factors. The model explicitly addresses the hierarchical organization of land use systems, spatial connectivity between locations and stability. Stability is incorporated by a set of variables that define the relative elasticity of the actual land-use type to conversion. The user can specify these settings based on expert knowledge or survey data. Two applications of the model in the Philippines and Malaysia are used to illustrate the functioning of the model and its validation.
Although pharmaceuticals treat illnesses and prevent diseases in humans and animals, ironically, they are now among the emerging pollutants in the environment. As individuals continue to consume medicines, households can become a primary source of pharmaceutical pollutants. This paper explains relevant Malaysian law and policy on the issue. Using a questionnaire survey, it also assesses public perception concerning the environmental impact of pharmaceutical waste and the current methods of disposal that are practiced in Selangor. The survey used a convenience sampling and the data collected were analysed using statistical descriptive analysis. Most of the participants were aware that pharmaceutical waste can have an adverse impact on the environment and public health. Half of the participants disposed of their pharmaceutical waste in trash bins. About 2.9% of the respondents poured their household pharmaceutical waste (HPW) directly down the drain, while 8.8% poured them down the sink in the kitchen or toilet. The study also discovered that while 73.8% of the respondents felt that HPW should be separated from other household solid waste, only 25.2% returned their medicinal waste through the medicine return-back programme. The majority of the respondents (82.5%) agreed that information concerning the proper disposal of HPW is insufficient. The study concludes that while the respondents were aware of the adverse impact of HPW, their practices to ensure proper disposal is discouraging. There is a need for effective unwanted medicines return-back programme as a more prudent disposal method of HPW to avoid any risk to the environment or human health.
Thermal structure and water quality in a large and shallow lake in Malaysia were studied between January 2012 and June 2013 in order to understand variations in relation to water level fluctuations and in-stream mining activities. Environmental variables, namely temperature, turbidity, dissolved oxygen, pH, electrical conductivity, chlorophyll-A and transparency, were measured using a multi-parameter probe and a Secchi disk. Measurements of environmental variables were performed at 0.1 m intervals from the surface to the bottom of the lake during the dry and wet seasons. High water level and strong solar radiation increased temperature stratification. River discharges during the wet season, and unsustainable sand mining activities led to an increased turbidity exceeding 100 NTU, and reduced transparency, which changed the temperature variation and subsequently altered the water quality pattern.
It is accepted that occupants who are more satisfied with their workplace's building internal environment are more productive. The main objective of the study was to measure the occupants' level of satisfaction and the perceived importance of the design or refurbishment on office conditions. The study also attempted to determine the factors affecting the occupants' satisfaction with their building or office conditions. Post-occupancy evaluations were conducted using a structured questionnaire developed by the Built Environment Research Group at the University of Manchester, UK. Our questionnaires incorporate 22 factors relating to the internal environment and rate these in terms of "user satisfaction" and "degree of importance." The questions were modified to reflect the specific setting of the study and take into consideration the local conditions and climate in Malaysia. The overall mean satisfaction of the occupants toward their office environment was 5.35. The results were measured by a single item of overall liking of office conditions in general. Occupants were more satisfied with their state of health in the workplace, but they were extremely dissatisfied with the distance away from a window. The factor analysis divided the variables into three groups, namely intrusion, air quality, and office appearance. Structural equation modeling (SEM) was then used to determine which factor had the most significant influence on occupants' satisfaction: appearance. The findings from the study suggest that continuous improvement in aspects of the building's appearance needs to be supported with effective and comprehensive maintenance to sustain the occupants' satisfaction.
Coastal waters in South Johore, Malaysia are polluted to various degrees. The major pollution sources are domestric wastes from human settlements, agro-based wastes from palm oil mills and rubber processing factories, industrial effluents from industrial estates and discharges from animal farms. These pollution problems have adversely affected resources such as fisheries, recreational potential as well as the general aesthetic quality of the coastal environment particularly the Inner Johore Strait. Hence proper management and control measures are urgently needed to protect and further enhance the water quality to ensure environmentally sustainable development. This study examines various management options to control the pollution in the Inner Johore Strait. The options involve partial opening as well as complete removal of the Causeway to improve the tidal flow for more effective dilution and dispersion of pollutants. Computer simulation models are used to assess the impacts of the proposed options.
The objective of this study was to identify the spatial and temporal variabilities of selected nutrients in the Setiu Wetlands Lagoon (SWL), Malaysia. Water samples were collected quarterly at ten monitoring sites. This study presents results from a 10-year field investigation (2003 to 2010 and 2014 to 2015) of water quality in the SWL. For the spatial pattern, four clusters were identified with hierarchical cluster analysis. Analysis of the temporal trend shows that the high total suspended solid loading in 2010 was due to large-scale land clearing upstream of the SWL. The enrichment of ammonium after 2010 could plausibly be due to land-based aquaculture diffuse discharges. In 2005-2007, expansion of oil palm plantations within the Setiu catchment had doubled the phosphorus concentration in the SWL. The natural and anthropogenic alterations of the lagoon inlets profoundly influenced the spatial distribution patterns of nutrients in the SWL. These results suggest that intense anthropogenic disturbances close to the SWL accounted for the water quality deterioration.
Spatio-temporal land-use change modeling, simulation, and prediction have become one of the critical issues in the last three decades due to uncertainty, structure, flexibility, accuracy, the ability for improvement, and the capability for integration of available models. Therefore, many types of models such as dynamic, statistical, and machine learning (ML) models have been used in the geographic information system (GIS) environment to fulfill the high-performance requirements of land-use modeling. This paper provides a literature review on models for modeling, simulating, and predicting land-use change to determine the best approach that can realistically simulate land-use changes. Therefore, the general characteristics of conventional and ML models for land-use change are described, and the different techniques used in the design of these models are classified. The strengths and weaknesses of the various dynamic, statistical, and ML models are determined according to the analysis and discussion of the characteristics of these models. The results of the review confirm that ML models are the most powerful models for simulating land-use change because they can include all driving forces of land-use change in the simulation process and simulate linear and non-linear phenomena, which dynamic models and statistical models are unable to do. However, ML models also have limitations. For instance, some ML models are complex, the simulation rules cannot be changed, and it is difficult to understand how ML models work in a system. However, this can be solved via the use of programming languages such as Python, which in turn improve the simulation capabilities of the ML models.
In this study, we assess the intense pollution episode of June 2013, in Riau province, Indonesia from land clearing. We relied on satellite retrievals of aerosols and Carbon monoxide (CO) due to lack of ground measurements. We used both the yearly and daily data for aerosol optical depth (AOD), fine mode fraction (FMF), aerosol absorption optical depth (AAOD) and UV aerosol index (UVAI) for characterizing variations. We found significant enhancement in aerosols and CO during the pollution episode. Compared to mean (2008-2012) June AOD of 0.40, FMF-0.39, AAOD-0.45, UVAI-1.77 and CO of 200 ppbv, June 2013 values reached 0.8, 0.573, 0.672, 1.77 and 978 ppbv respectively. Correlations of fire counts with AAOD and UVAI were stronger compared to AOD and FMF. Results from a trajectory model suggested transport of air masses from Indonesia towards Malaysia, Singapore and southern Thailand. Our results highlight satellite-based mapping and monitoring of pollution episodes in Southeast Asia.
The use of agro-biowaste compost fertilizers in agriculture is beneficial from technical, financial, and environmental perspectives. Nevertheless, the physical, mechanical, and agronomical attributes of agro-biowaste compost fertilizers should be engineered to reduce their storage, handling, and utilization costs and environmental impacts. Pelletizing and drying are promising techniques to achieve these goals. In the present work, the effects of process parameters, including compost particle size/moisture content, pelletizing compression ratio, and drying air temperature/velocity, were investigated on the density, specific crushing energy, and moisture diffusion of agro-biowaste compost pellet. The Taguchi technique was applied to understand the effects of independent parameters on the output responses, while the optimal pellet properties were found using the iterative thresholding method. The soil and plant (sweet basil) response to the optimal biocompost pellet was experimentally evaluated. The farm application of the optimal pellet was also compared with the untreated agro-biowaste compost using the life cycle assessment approach to investigate the potential environmental impact mitigation of the pelletizing and drying processes. Generally, the compost moisture content was the most influential factor on the density and specific crushing energy of the dried pellet, while the moisture diffusion of the wet pellet during the drying process was significantly influenced by the pelletizing compression ratio. The density, specific crushing energy, and moisture diffusion of agro-biowaste compost pellet at the optimal conditions were 1242.49 kg/m3, 0.5054 MJ/t, and 8.2 × 10-8 m2/s, respectively. The optimal biocompost pellet could release 80% of its nitrogen content evenly over 98 days, while this value was 28 days for the chemical urea fertilizer. Besides, the optimal pellet could significantly improve the agronomical attributes of the sweet basil plant compared with the untreated biocompost. The applied strategy could collectively mitigate the weighted environmental impact of farm application of the agro-biowaste compost by more than 63%. This reduction could be attributed to the fact that the pelletizing-drying processes could avoid methane emissions from the untreated agro-biowaste compost during the farm application. Overall, pelletizing-drying of the agro-biowaste compost could be regarded as a promising strategy to improve the environmental and agronomical performance of farm application of organic biofertilizers.
Pangasius production in Vietnam is widely known as a success story in aquaculture, the fastest growing global food system because of its tremendous expansion by volume, value and the number of international markets to which Pangasius has been exported in recent years. While certification schemes are becoming significant features of international fish trade and marketing, an increasing number of Pangasius producers have followed at least one of the certification schemes recognised by international markets to incorporate environmental and social sustainability practices in aquaculture, typically the Pangasius Aquaculture Dialogue (PAD) scheme certified by the Aquaculture Stewardship Council (ASC). An assessment of the environmental benefit of applying certification schemes on Pangasius production, however, is still needed. This article compared the environmental impact of ASC-certified versus non-ASC certified intensive Pangasius aquaculture, using a statistically supported LCA. We focused on both resource-related (water, land and total resources) and emissions-related (global warming, acidification, freshwater and marine eutrophication) categories. The ASC certification scheme was shown to be a good approach for determining adequate environmental sustainability, especially concerning emissions-related categories, in Pangasius production. However, the non-ASC certified farms, due to the large spread, the impact (e.g., water resources and freshwater eutrophication) was possibly lower for a certain farm. However, this result was not generally prominent. Further improvements in intensive Pangasius production to inspire certification schemes are proposed, e.g., making the implementation of certification schemes more affordable, well-oriented and facilitated; reducing consumed feed amounts and of the incorporated share in fishmeal, especially domestic fishmeal, etc. However, their implementation should be vetted with key stakeholders to assess their feasibility.
Plastic consumption and its end-of-life management pose a significant environmental footprint and are energy intensive. Waste-to-resources and prevention strategies have been promoted widely in Europe as countermeasures; however, their effectiveness remains uncertain. This study aims to uncover the environmental footprint patterns of the plastics value chain in the European Union Member States (EU-27) through exploratory data analysis with dimension reduction and grouping. Nine variables are assessed, ranging from socioeconomic and demographic to environmental impacts. Three clusters are formed according to the similarity of a range of characteristics (nine), with environmental impacts being identified as the primary influencing variable in determining the clusters. Most countries belong to Cluster 0, consisting of 17 countries in 2014 and 18 countries in 2019. They represent clusters with a relatively low global warming potential (GWP), with an average value of 2.64 t CO2eq/cap in 2014 and 4.01 t CO2eq/cap in 2019. Among all the assessed countries, Denmark showed a significant change when assessed within the traits of EU-27, categorised from Cluster 1 (high GWP) in 2014 to Cluster 0 (low GWP) in 2019. The analysis of plastic packaging waste statistics in 2019 (data released in 2022) shows that, despite an increase in the recovery rate within the EU-27, the GWP has not reduced, suggesting a rebound effect. The GWP tends to increase in correlation with the higher plastic waste amount. In contrast, other environmental impacts, like eutrophication, abiotic and acidification potential, are identified to be mitigated effectively via recovery, suppressing the adverse effects of an increase in plastic waste generation. The five-year interval data analysis identified distinct clusters within a set of patterns, categorising them based on their similarities. The categorisation and managerial insights serve as a foundation for devising a focused mitigation strategy.
Microplastic fibers from textiles have been known to significantly contribute to marine microplastic pollution. However, little is known about the microfiber formation and discharge during textile production. In this study, we have quantified microfiber emissions from one large and representative textile factory during different stages, spanning seven different materials, including cotton, polyester, and blended fabrics, to further guide control strategies. Wet-processing steps released up to 25 times more microfibers than home laundering, with dyeing contributing to 95.0% of the total emissions. Microfiber release could be reduced by using white coloring, a lower dyeing temperature, and a shorter dyeing duration. Thinner, denser yarns increased microfiber pollution, whereas using tightly twisted fibers mitigated release. Globally, wet textile processing potentially produced 6.4 kt of microfibers in 2020, with China, India, and the US as significant contributors. The study underlined the environmental impact of textile production and the need for mitigation strategies, particularly in dyeing processes and fiber choice. In addition, no significant difference was observed between the virgin polyesters and the used ones. Replacing virgin fibers with recycled fibers in polyester fabrics, due to their increasing consumption, might offer another potential solution. The findings highlighted the substantial impact of textile production on microfiber released into the environment, and optimization of material selection, knitting technologies, production processing, and recycled materials could be effective mitigation strategies.