Adequate and proper diabetes care in any practice is paramount and deems to be the fundamental requirement for good diabetes control. This is an audit of type 2 diabetes care process in a public Polyclinic, with the objectives of studying the quality of diabetic care provided in terms of clinical and managerial performance and also to give recommendations on improving its diabetes care delivery. The audit was done on patients' medical records selected via systematic random sampling. Patients who have been diagnosed with type 2 diabetes mellitus for more than 2 years, and those who have come for follow-up at least twice in between 1st October 2008 and 30th September 2009 by the medical officer and/or family medicine specialist. Patients with gestational diabetes mellitus and Type 1 diabetes mellitus were excluded. A total of 100 medical records were audited. 51% were female and 82% were in the 40-69 age group. Measurements of blood glucose and blood pressure were done at each follow-up at the polyclinic at 96% and 93% of the times, respectively. Within the past one year, HbA1c was performed in 46% of the patients, while renal profile was screened in 66% of the patients and urine protein was tested in 59% of the diabetics. Only 15% had their eyes screened by fundus camera. The diabetes care process at this public polyclinic was unsatisfactory, as many annual blood tests were not done and complications screening were also omitted. Thus, an urgent intervention is recommend in order to rectify these inadequacies.
An audit of Diabetes Control and Management-Diabetes Registry Malaysia (ADCM-DRM) was started to monitor the provision of diabetes care in the country. A total of 20,646 patients were registered in the registry until 31st December 2008. This report set out to determine the Type 2 diabetes controls and treatment profiles of these cohorts of patients. This was a registry-based observational study conducted from May to December, 2008. An online standard case record form was available for site data providers to register their diabetic patients aged 18 years old and above annually. Demographic data, diabetes duration, treatment modalities, as well as various risk factors and diabetes complications were reported. Data were analyzed using Data Analysis and Statistical Software (Stata) version 9. A total of 81 centres, 6 of which were hospitals, participated in this registry until 31st December 2008, contributing a total of 20646 patients. A majority of them (99.2%) had Type 2 diabetes mellitus. The mean HbA1c was 8.0% (SD 2.10), with 30.1% and 17.9% of the patients who attained HbA1c < 7% and HbA1c < 6.5%, respectively. Metformin was prescribed more than sulfonylurea while only 11% had insulin. A review of the diabetic care policy and strategies in the primary health care clinics is needed to implement a more effective treatment of diabetes in this country.
Clinacanthus nutans, known to the locals as Belalai Gajah, is a medicinal plant widely used by Malaysians in the belief to cure various diseases including cancer. However, the production of Belalai Gajah hardly fulfils the market demand since the growing techniques of stem cutting and tissue culture are inefficient and expensive. Therefore, improvements in tissue culture techniques and materials application are required. Hence, this study tested Carica papaya (locally know as papaya) stem, an agricultural waste, to enhance the tissue culture of C. nutans. The effects of C. papaya stem powder and extract on the shoot proliferation of C. nutans parameters were investigated. The average number of shoot, leaves and length of leaves were observed. Phytochemicals screening was also conducted. Overall, C. papaya stem extract showed positive performance and 1% extract was found to be the optimum concentration to enhance the shoot proliferation. Meanwhile, C. papaya stem powder inhibited the shoot proliferation. It was also found that flavonoids, glycosides, steroid and terpenoid contributed in the shoot proliferation. In conclusion, the papaya stem extract is a potential in-vitro supplement for tissue culture studies. This study gained insights in sustainable green economy and showed that zero waste can be attained by converting local papaya stem waste to valuable product. In addition, sustainable technology in pharmaceutical approach could be addressed through in-vitro low cost large-scale production of Belalai Gajah medicinal plant.
The paper presents a simulation work conducted on the elastomer subjected to cyclic loads. A 3D finite element model of elastomer specimen, in accordance to ASTM D412, was developed using CATIA and ANSYS commercial finite element (FEM) packages. Fatigue life predicted from the simulation was compared with well-documented published data and it showed an acceptable agreement. Meanwhile, the simulated strain-life results are slightly lower than the experimental data. Several factors which potentially influenced the variations of the results were noted. Finally, some recommendations are offered at the end of this study to further improve the simulation
This case report highlights delay in the diagnosis of adenoma carcinoma of the lung in a female patient who has never smoked. It took three months to reach the diagnosis of stage IV lung carcinoma despite the presence of symptoms and an abnormal chest radiograph finding from the beginning. The clinical characteristics and predictors of missed opportunities for an early diagnosis of lung cancer are discussed. In this case, patient and doctor factors contributed to the delay in diagnosis. Thus, early suspicions of lung cancer in a woman with the presence of respiratory symptoms despite being a non-smoker are important in primary care setting.
With the proliferation of Web 2.0 technologies, folksonomy which is also known as social tagging or
collaborative tagging is widely used by learners to annotate and categorize their learning resources. In
a folksonomy system, the tags are added by learners to the learning resources, hence the tags are often
ambiguous, overly personalised and imprecise. In addition, conjugated words, compound words and
nonsense words may be used in tagging and shared among a group of learners. This has resulted in an
uncontrolled and chaotic set of tagging terms that cause learning resources searching, reuse and sharing
to become ineffective. In this paper, we present a content-based approach which automatically generates
tags from a learning resource using Part-Of-Speech Tagging and K-Means Clustering techniques. The
generated tags are more precise and unambiguous which can improve learning resources searching,
reuse and sharing among learners.
Score-based structure learning algorithm is commonly used in learning the Bayesian Network. Other than searching strategy, scoring functions play a vital role in these algorithms. Many studies proposed various types of scoring functions with different characteristics. In this study, we compare the performances of five scoring functions: Bayesian Dirichlet equivalent-likelihood (BDe) score (equivalent sample size, ESS of 4 and 10), Akaike Information Criterion (AIC) score, Bayesian Information Criterion (BIC) score and K2 score. Instead of just comparing networks with different scores, we included different learning algorithms to study the relationship between score functions and greedy search learning algorithms. Structural hamming distance is used to measure the difference between networks obtained and the true network. The results are divided into two sections where the first section studies the differences between data with different number of variables and the second section studies the differences between data with different sample sizes. In general, the BIC score performs well and consistently for most data while the BDe score with an equivalent sample size of 4 performs better for data with bigger sample sizes.
The nonlinear conjugate gradient (CG) methods have widely been used in solving unconstrained optimization problems. They are well-suited for large-scale optimization problems due to their low memory requirements and least computational costs. In this paper, a new diagonal preconditioned conjugate gradient (PRECG) algorithm is designed, and this is motivated by the fact that a pre-conditioner can greatly enhance the performance of the CG method. Under mild conditions, it is shown that the algorithm is globally convergent for strongly convex functions. Numerical results are presented to show that the new diagonal PRECG method works better than the standard CG method.
Older adults are at risk of osteoporotic fractures. Osteoporotic vertebral fractures are associated with a reduced cross-sectional area and muscle strength of the back extensor muscles, increased intramuscular fat infiltration and thoracic and lumbar curvature alterations. This study proposed a protocol to examine in more detail the contributions of altered spinal morphological, physical performance and biochemical markers to the risk of developing osteoporotic vertebral fractures. In this cross-sectional study, we plan to recruit 100 adults aged 50 years and above from an orthopaedic clinic, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia. The fracture prediction tool (FRAX) will be used to categorise high and low risk groups. Back muscle strength will be quantified using a load cell system. Thoracolumbar curvatures will be examined using an electromagnetic tracking system and intramuscular fat infiltration in the lumbar muscles will be measured using Magnetic Resonance Imaging. The Short Physical Performance Battery and JAMA dynamometer will quantify physical performance and the European Quality of Life Questionnaire will be used to assess self-perceived quality of life. Biochemical markers of serum C terminal telopeptide and N terminal propeptide of type I procollagen will be assessed using an enzyme-linked immunosorbent assays kit. A spine-specific model using regression analysis will be developed to predict osteoporotic vertebral fractures using the measured parameters in the present study.
The crab carapace is a waste which cannot be decomposed. This waste was used to
remove the Reactive Orange 16 (RO16) and Basic Blue 3 (BB3) from aqueous solution
at different operational parameters such as pH, mass load, the concentrations of dye and
the temperature. The crab collected was modified to obtain quaternized crab (QC) using
(3-chloro-2-hydroxypropyl) trimethylammonium chloride solution (C6H15Cl2NO, 65% w/w
in water). The pH of the dyes solution was varied from pH 4 to 10. The highest adsorption
percentage was achieved at pH 7 for both dyes. Increasing the QC mass for the adsorption
process had granted an increase of dyes removal percentage. The highest adsorption
percentage was achieved at 91.00% for RO16 and 29.40% for BB3 dyes with 7.5 g/L QC
used. However, the adsorption capacity of QC decreased with higher QC mass because the
dye molecules occupied on the surface and prevented other molecules to diffuse into the
QC. At higher concentration beyond 20 mg/L and 10 mg/L of RO16 and BB3, respectively,
the maximum adsorption was achieved at 2.5362 mg/g and 0.6812 mg/g. The adsorption of
both dyes by QC was best fitted using Langmuir isotherm model, explaining the adsorption
mainly occurred as a single layer on the surface of QC. Comparison to the results obtained
from the kinetic models, the adsorption was
chemisorption in nature. According to the
thermodynamic studies, the adsorption of
RO16 was an exothermic, while BB3 was
an endorthermic process.
Soil plays an important role in ground designing. Engineers normally consider only soil resistivity under normal or steady state condition when designing the grounding system. Under certain circumstances such as lightning, electrical response of the soil will change accordingly and thus, the performance of the grounding system will be affected. The purpose of this study is to investigate the effect of moisture content on the electrical behaviour of sand and clay under high impulse voltage condition. Both soil samples are dried in the oven at 110 ± 5°C to remove the water content until became 0%. The samples are subjected to 30 shots of standard (1.2/50μs) lightning impulse voltage for both positive and negative impulse polarities. This is followed by moistening the samples with 5% amount of water over the volume of the samples. The corresponding V50% for both sand and clay was calculated and the value obtained was converted to standard atmospheric condition. The voltage at breakdown and time to breakdown for each soil sample was analysed a statistical analysis conducted for these two parameters to determine if type of soil and moisture content have an effect on the breakdown voltage. In general, it was found that clay is more efficient in neutralising high impulse voltage than sand likely due to the former’s low resistivity and porosity.
Sludge is an unavoidable product of wastewater treatment that creates problems of disposal. Increasingly, strict environmental control regulations have resulted in limitations on sludge disposal options.Disposal by incineration has been found to be a good option. In this research, application of domestic waste sludge powder (DWSP) was used as cement replacement in concrete mix. This study utilised replacement of 3 %, 5 %, 7 %, 10 % and 15 % by weight of OPC with water binder (w/b) ratio of 0.60, 0.55 and 0.40 for Grade 30, Grade 40 and Grade 50 respectively. The performance of DWSP concrete in terms of its compressive strength, water absorption, water permeability and Rapid Chloride Ion penetration were investigated. All values of compressive strength for DWSP concrete were lower compared to the OPC control, and the strength decreased as the percentage of replacement with DWSP increased for Grade 30 and Grade 50, except for Grade 40 at replacement of 7 %. Meanwhile, water absorption and water permeability for the DWSP concrete increased as the replacement increased. Overall, with further research in producing quality DWSP, the potential of using this waste as a cement replacement material is very promising.
Clustering is basically one of the major sources of primary data mining tools. It makes
researchers understand the natural grouping of attributes in datasets. Clustering is an
unsupervised classification method with the major aim of partitioning, where objects in the
same cluster are similar, and objects which belong to different clusters vary significantly,
with respect to their attributes. However, the classical Standardized Euclidean distance,
which uses standard deviation to down weight maximum points of the ith features on the
distance clusters, has been criticized by many scholars that the method produces outliers,
lack robustness, and has 0% breakdown points. It also has low efficiency in normal
distribution. Therefore, to remedy the problem, we suggest two statistical estimators
which have 50% breakdown points namely the Sn and Qn estimators, with 58% and 82%
efficiency, respectively. The proposed methods evidently outperformed the existing methods
in down weighting the maximum points of the ith features in distance-based clustering
analysis.
Astrocytic gliomas are the most common primary brain tumours that originated from human glial cells. The tumours rely upon endothelial progenitor cells (EPCs) for neoangiogenesis. This study aimed to investigate the association between tissue resident EPCs in a brain tumour and normal adjacent tissue in relation to age and grade of astrocytic glioma. Astrocytic glioma patients (n=22), grade I to grade IV were consented from Hospital Universiti Sains Malaysia. Brain tumour tissue and normal adjacent brain tissue samples were obtained from each patient during surgery. The EPCs were stained with CD133+ and VEGFR-2+ markers. The tissue residents EPCs for each sample were determined using the immunofluorescence microscopy method. The age of the patients increased by disease severity in the following order (Grade I: 21.33±20.79 years) < (Grade II: 46.50±0.707 years) < (Grade III: 47.38±11.95 years) < (Grade IV: 48.44 ±10.66 years). The EPCs in brain tumour correlated significantly with the age of the patients with positive correlation (Spearman’s rho correlation test, r=0.52; p=0.013). The tissue resident EPCs in the brain tumour (median=0.40, IqR=0.59) were significantly higher compared with the adjacent normal brain (median=0.067, IqR=0.29) (Wilcoxon Signed-Rank Test, Z stat=-3.587, p
The objective of this study was to determine the prevalence of symptoms and problems in Malaysian brain pathology patients. A total of 100 respondents in Kuala Lumpur Hospital were included in this cross-sectional study. The study utilized European Organization for Research and Treatment of Cancer Quality Of Life questionnaire (EORTC QLQ-C30). Patient with a “symptom/problem” having the minimum response of “a little”. A response of “quite a bit” was defined as having a “severe symptom/problem”. The two most prevalent “symptoms/problems” among the neurological disorder patients were fatigue (65%; severe: 28%) and reduced cognitive functioning (64%; severe: 25%). The mean number of “symptoms/problems” ranged from 4.63 (meningioma) to 6.80 (cerebellar edema) while the mean number of “severe symptoms/problems” ranged from 1.39 (astrocytic glioma) to 2.8 (cerebellar edema). Therefore special attention should be given to these patients in order to improve the overall quality of life of the patients.
The aims of this study were to fabricate cellulose acetate (CA) film from oil palm empty fruit bunch (OP-EPB), as well as to characterize and evaluate their biocompatibility. Several processes were carried out, and these included prehydrolysis-soda method, chlorine free bleaching method, including oxygen, ozone and peroxide, to produce the cellulose pulp. Then, a liquid phase acetylation method was applied through acetic acid-acetic anhydride-sulphuric acid. Triethyl citrate (TEC) ester was used as additive at different percentages of 10, 20, 30 and 40 wt%. The film produced was characterized by FTIR to identify the functional group of the CA film and their tensile properties were further characterized. Biocompatibility of the film was evaluated using cytotoxicity test. Stem cell derived from human deciduous teeth (SHED) was used with MTS assay. The results showed at 30% of TEC, the tensile strength and elongation of CA (OP-EFB) film was at the optimum and is therefore suitable to be used in dental application. The cytotoxicity evaluated showed that the fabricated CA (OP-EFB) films were non-toxic up to the concentration tested, and are thus compatible with SHED.
Epoxidised Natural Rubber (ENR) is now a commercially available polymer produced by chemical modification of natural rubber. Currently, three types of ENR are commercially available, and these are ENR 10, ENR 25, and ENR 50 with 10%, 25%, and 50% mol epoxidation, respectively. Studies on prevulcanisation of ENR 50 and postvulcanisation of the latex films were carried out. The objective of this study was to develop ENR 50 that could be dipped easily in coagulant dipping solution to produce dipped products. Several attempts were made by compounding prevulcanised ENR 50 at various sulphur levels ranging from 0.5 to 3.0 pphr. Using suitable coagulant dipping systems, ENR 50 film could be formed despite the high contents of non-ionic surfactant. It was found that the tensile strength of prevulcanised ENR 50 film decreased with the increase in the sulphur level. The results show that as level of sulphur increased, M300 also increased to an optimum value of 1.5 pphr of sulphur. For the postvulcanised ENR 50 film, however, the tensile strength increased and then decreased with the increasing sulphur level. Meanwhile M300 increased with the increasing postvulcanization time and sulphur level. The postvulcanisation of ENR 50 film seems to be a more effective way of increasing tensile properties than by prevulcanisation of ENR 50.
Determining the response of basin water resources to rainfall and temperature fluctuations is a crucial source of information for basins water resources planning and management. The study used a descriptive, Mann-Kendall trend test (M-K) and Multiple Linear Regression (MLR). The mean, standard deviations and variations were spatially interpolated using the geostatistical technique. The trend results showed an increase in both rainfall and temperature series. However, the only statistically significant trends were in June and September for rainfall series and in February, May, and April for the temperature series. Rainfall exhibited high temporal variability whereas temperature showed high spatial variability. The intra-annual variability was higher than the inter-annual variability, suggesting that the local climate is largely controlled by natural force. The result of the multiple linear regression (R2=0.431), indicates that the hydrology and water resources of the basin are impacted largely by factors not considered in this study such as land use changes, infiltration, and rate of evaporation among others. However, among the factor considered, rainfall (Beta = 0.505; P = 001) has the highest impacts on the river discharge behavior and should be given preference while addressing water resources predicaments in the catchment.
This paper looks at electrical power generation from solar concentrator using thermoelectric generator. An experiment was conducted on a concentrator thermoelectric generator (CTEG) utilising solar thermal energy. The CTEG used a parabolic dish as concentrator with thermoelectric device installed at the focal point to convert thermal energy to generate electricity. The investigation covered the cooling effect of the cold side of the thermoelectric generator using natural and forced convection cooling for optimum output. Forced convection cooling with a fan provided 69% more power output from the CTEG system as the temperature difference across the TEG was greater than the system cooled by natural convection. The outcome of this project showed maximum power output was obtained for the CTEG system cooled by forced convection cooling.
The Gleason grading system assists in evaluating the prognosis of men with prostate cancer. Cancers with a higher score are more aggressive and have a worse prognosis. The pathologists observe the tissue components (e.g. lumen, nuclei) of the histopathological image to grade it. The differentiation between Grade 3 and Grade 4 is the most challenging, and receives the most consideration from scholars. However, since the grading is subjective and time-consuming, a reliable computer-aided prostate cancer diagnosing techniques are in high demand. This study proposed an ensemble computer-added system (CAD) consisting of two single classifiers: a) a specialist, trained specifically for texture features of the lumen and the other for nuclei tissue component; b) a fusion method to aggregate the decision of the single classifiers. Experimental results show promising results that the proposed ensemble system (area under the ROC curve (Az) of 88.9% for Grade 3 versus Grad 4 classification task) impressively outperforms the single classifier of nuclei (Az=87.7) and lumen (Az=86.6).