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  1. Rahmat S, O'Beirne GA
    Hear Res, 2015 Dec;330(Pt A):125-33.
    PMID: 26209881 DOI: 10.1016/j.heares.2015.07.013
    Schroeder-phase masking complexes have been used in many psychophysical experiments to examine the phase curvature of cochlear filtering at characteristic frequencies, and other aspects of cochlear nonlinearity. In a normal nonlinear cochlea, changing the "scalar factor" of the Schroeder-phase masker from -1 through 0 to +1 results in a marked difference in the measured masked thresholds, whereas this difference is reduced in ears with damaged outer hair cells. Despite the valuable information it may give, one disadvantage of the Schroeder-phase masking procedure is the length of the test - using the conventional three-alternative forced-choice technique to measure a masking function takes around 45 min for one combination of probe frequency and intensity. As an alternative, we have developed a fast method of recording these functions which uses a Békésy tracking procedure. Testing at 500 Hz in normal hearing participants, we demonstrate that our fast method: i) shows good agreement with the conventional method; ii) shows high test-retest reliability; and iii) shortens the testing time to 8 min.
  2. Dzulkarnain AA, Rahmat S, Mohd Puzi NA, Badzis M
    Med J Malaysia, 2017 02;72(1):37-45.
    PMID: 28255138 MyJurnal
    INTRODUCTION: This discussion paper reviews and synthesises the literature on simulated learning environment (SLE) from allied health sciences, medical and nursing in general and audiology specifically. The focus of the paper is on discussing the use of high-fidelity (HF) SLE and describing the challenges for developing a HF SLE for clinical audiology training.

    METHODS: Through the review of the literature, this paper discusses seven questions, (i) What is SLE? (ii) What are the types of SLEs? (iii) How is SLE classified? (iv) What is HF SLE? (v) What types of SLEs are available in audiology and their level of fidelity? (vi) What are the components needed for developing HF SLE? (vii) What are the possible types of HF SLEs that are suitable for audiology training? Publications were identified by structured searches from three major databases PubMed, Web of Knowledge and PsychInfo and from the reference lists of relevant articles. The authors discussed and mapped the levels of fidelity of SLE audiology training modules from the literature and the learning domains involved in the clinical audiology courses.

    RESULTS: The discussion paper has highlighted that most of the existing SLE audiology training modules consist of either low- or medium-fidelity types of simulators. Those components needed to achieve a HF SLE for audiology training are also highlighted.

    CONCLUSION: Overall, this review recommends that the combined approach of different levels and types of SLE could be used to obtain a HF SLE training module in audiology training.

  3. Dzulkarnain AAA, Sani MKA, Rahmat S, Jusoh M
    J Audiol Otol, 2019 Jul;23(3):121-128.
    PMID: 30857383 DOI: 10.7874/jao.2018.00381
    BACKGROUND AND OBJECTIVES: There is a scant evidence on the use of simulations in audiology (especially in Malaysia) for case-history taking, although this technique is widely used for training medical and nursing students. Feedback is one of the important components in simulations training; however, it is unknown if feedback by instructors could influence the simulated patient (SP) training outcome for case-history taking among audiology students. Aim of the present study is to determine whether the SP training with feedback in addition to the standard role-play and seminar training is an effective learning tool for audiology case-history taking.

    SUBJECTS AND METHODS: Twenty-six second-year undergraduate audiology students participated. A cross-over study design was used. All students initially attended two hours of seminar and role-play sessions. They were then divided into three types of training, 1) SP training (Group A), 2) SP with feedback (Group B), and 3) a non-additional training group (Group C). After two training sessions, the students changed their types of training to, 1) Group A and C: SP training with feedback, and 2) Group B: non-additional training. All the groups were assessed at three points: 1) pre-test, 2) intermediate, and 3) post-test. The normalized median score differences between and within the respective groups were analysed using non-parametric tests at 95% confidence intervals.

    RESULTS: Groups with additional SP trainings (with and without feedback) showed a significantly higher normalized gain score than no training group (p<0.05).

    CONCLUSIONS: The SP training (with/ without feedback) is a beneficial learning tool for history taking to students in audiology major.

  4. Normaznah Y, Azizah MA, Azuan MI, Latifah I, Rahmat S, Nasir MA
    PMID: 26521512
    Numerous studies have reported the prevalence of toxoplasmosis among Malaysians and various domestic animals; but there is paucity of information on its prevalence among rodents which could potentially contribute to the transmission of Toxoplasma gondii in both domestic and sylvatic fauna. Five hundred twenty-six rodents were captured from six locations in Malaysia and identified to species. Serum samples were collected from these rodents and tested for T.gondii antibodies using an immunofluorescent antibody test (IFAT). T.gondii antibodies were found in 5.9% (31/526) of the tested samples. Most of the positive antibodies were from commensal rats: Rattus exulans (9/64, 14.0%), Rattus argentiventer (2/8, 25%), Rattus rattus diardii (10/166, 6.0%) and Rattus tiomanicus (6/215, 2.7%). Only two of the forest rats were positive: Maxomys rajah (1/9, 11.1%) and Rattus bowersi (1/12, 8.3%). Eighteen point one percent of ground squirrels (Tupaia glis) tested (2/11) were positive for antibodies. The highest antibodies titer (1:1024) was found in Rattus exulans followed by T.glis (1:256). Sabak Bernam, Selangor had the highest prevalence (10.8%) followed by Baling, Kedah (5.0%) and Bagan Terap, Selangor (4.0%). None of the serum samples of rodents collected from Gua Musang, Kelantan; Jasin, Malacca; or Labis, Johor were positive. Our study reports for the first time the serologic prevalence of T.gondii antibodies among rodents in Peninsular Malaysia. Further studies are needed to confirm T.gondii infection among wild rodents, such as a bioassay, to assess their potential role in transmission of the parasite.
  5. Dzulkarnain AA, Wan Mhd Pandi WM, Rahmat S, Zakaria N'
    Int J Audiol, 2015;54(12):881-8.
    PMID: 26197885 DOI: 10.3109/14992027.2015.1055840
    To systematically review the relevant peer-review literature investigating the outcome of simulated learning environment (SLE) training in audiology education.
  6. Rahmat S, Rahman SA, Tukiran NH, Musa R, Othman NA, Dzulkarnain AAA
    Med J Malaysia, 2021 03;76(2):205-211.
    PMID: 33742629
    OBJECTIVE: This study is a preliminary work to develop a Malay version questionnaire named 'Inventori Persepsi bagi Muslim yang Memiliki Masalah Pendengaran (IPM3P)' to assess the perception on Islamic understanding and practice among Muslim adults with hearing impairment.

    METHODS: The scale development involved three phases: i) generation of domains based on the literature, ii) generation of sub-domains based on literature review and Islamic panel survey, and iii) generation of items.

    RESULTS: Preliminary version of IPM3P consists of 59 items was produced, representing three domains: Obligation (18 items), Practice (21 items), and Difficulty (20 items), and seven sub-domains ('Ibadah', 'Aqidah', 'Muamalat', 'Tasawwuf', 'Akhlak','Da'wah', and 'Sirah').

    CONCLUSION: The preliminary version of IPM3P needs to be psychometrically tested. This pioneering study may become an impetus towards more research pertaining to understanding the effect of hearing loss towards religious life in the future in Malaysia.

  7. Zam Zam TZHBT, Dzulkarnain AAA, Rahmat S, Jusoh M
    J Audiol Otol, 2019 Jul;23(3):129-134.
    PMID: 30727717 DOI: 10.7874/jao.2018.00395
    BACKGROUND AND OBJECTIVES: Sine a self-reported questionnaire for hearing-impaired listeners is not available by Malay language yet, it is important to develop or translate any available existing questionnaires. The aim of this study was to translate, adapt and validate the Hearing Handicap Inventory for Adult (HHIA) to be used by the audiologist among the hearing-impaired population in Malaysia.

    SUBJECTS AND METHODS: The HHIAs was translated to Malay language using forward-backward translation techniques by four-panellists (two for each level). The translated HHIA was then reconciled and harmonized for cultural aspects and content of the questionnaire by the researchers and two expert panels before being pilot-tested among 10 hearing-impaired patients. Questionnaire validation was conducted among 80 adults with a hearing loss to calculate for Cronbach's α (internal reliability), Spearman's correlation (inter-item correlation) and factor analysis.

    RESULTS: None of the translated items were removed from the scale. The overall Cronbach's α was 0.964; 0.927 and 0.934 for both social and emotional subscales, respectively. The factor analysis (force-concept inventory) demonstrated a two-structure with a strong correlation between all items in either component 1 or 2, that resembled the original scale. The Mann-Whitney test revealed significantly higher scores for those adults with a hearing loss than those adults with normal hearing.

    CONCLUSIONS: The Malay HHIA has been successfully translated and validated for the purpose of determining the psychosocial aspects of adults with hearing loss in the local population.

  8. Dzulkarnain AAA, Rahmat S, Ismail AW, Musa R, Badzis M, Tengku Zam Zam TZH
    Med J Malaysia, 2019 04;74(2):168-173.
    PMID: 31079129
    INTRODUCTION: This paper describes the development and the evaluation of a new Two-dimensional (2D) computer-based (CB) Simulated Learning Environment (SLE) software for routine audiology tests that comes with learning assistance for audiology students. The aim of the study was to serve as preliminary evaluation on the effectiveness of the new 2D CB SLE audiology software among audiology students.

    MATERIALS AND METHODS: The development process of the new 2D CB SLE includes, (i) the identification of common errors made by students in the audiology clinic, (ii) the development of five case simulations that include four routine audiology tests incorporating learning assistance derived from the errors commonly made by audiology students and, (iii) the development of 2D CB SLE from a technical perspective. A preliminary evaluation of the use of the 2D CB SLE software was conducted among twenty-six second-year undergraduate audiology students.

    RESULTS: The pre-analysis evaluation of the new 2D CB SLE showed that the majority of the students perceived the new 2D CB SLE software as realistic and helpful for them in achieving the course learning outcomes and in improving their clinical skills. The mean overall scores among the twenty-six students using the self-reported questionnaire were significantly higher when using the 2D CB SLE software than with the existing software typically used in their SLE training.

    CONCLUSIONS: This new 2D CB SLE software has the potential for use by audiology students for enhancing their learning.

  9. Isa INC, Rahmat SMS, Dom SM, Kayun Z, Karim MKA
    J Xray Sci Technol, 2019;27(4):631-639.
    PMID: 31205011 DOI: 10.3233/XST-190491
    There are several factors that may contribute to the increase in radiation dose of CT including the use of unoptimized protocols and improper scanning technique. In this study, we aim to determine significant impact on radiation dose as a result of mis-centering during CT head examination. The scanning was performed by using Toshiba Aquilion 64 slices multi-detector CT (MDCT) scanner and dose were measured by using calibrated ionization chamber. Two scanning protocols of routine CT head; 120 kVp/ 180 mAs and 100 kVp/ 142 mAs were used represent standard and low dose, respectively. As reference measurement, the dose was first measured on standard cylindrical polymethyl methacrylate (PMMA) phantom that positioned at 104 cm from the floor (reference isocenter). The positions then were varied to simulate mis-centering by 5 cm from isocenter, superiorly and inferiorly at 109 cm, 114 cm, 119 cm, 124 cm and 99 cm, 94 cm, 89 cm, 84 cm, respectively. Scanning parameter and dose information from the console were recorded for the radiation effective dose (E) measurement. The highest mean CTDIvol value for MCS and MCI were 105.06 mGy (at +10 cm) and 105.51 mGy (at - 10 cm), respectively which differed significantly (p 
  10. Jusoh M, Dzulkarnain AAA, Rahmat S, Musa R, Che Azemin MZ
    Asia Pac Psychiatry, 2021 Jun;13(2):e12414.
    PMID: 32815284 DOI: 10.1111/appy.12414
    The aim of this study is to evaluate the psychometric properties of the Malay version of the Swanson, Nolan, and Pelham Parent Rating Scale of attention deficit hyperactivity disorders (ADHD) symptoms (M-SNAP-IV). For this purpose, the SNAP-IV scale was translated into the Malay language and was pilot-tested on 91 parents of children aged 8 to 11 years (ADHD [n = 36] and non-ADHD children [n = 55]). The findings depicted that the M-SNAP-IV has excellent content validity, internal consistency, and test-retest reliability. The M-SNAP-IV is a valid and reliable screening tool to detect ADHD symptoms in children and has the advantages to assess the specific presentation of ADHD.
  11. Rahmat S, Yati IES, Musa R, A Rahman S, Ahmad NS, Dzulkarnain AAA
    Med J Malaysia, 2021 09;76(5):672-679.
    PMID: 34508373
    OBJECTIVE: The aims of this study are to measure the psychometric properties of the newly developed preliminary version of hearing impairment inventory for religious duties for Muslim adults, i.e., the Inventori Persepsi Bagi Muslim Yang Memiliki Masalah Pendengaran (IPM3P), and to produce a final version of IPM3P.

    METHODS: The preliminary version of IPM3P that is used to investigate the perception of Muslim adults with hearing impairment towards Islamic understanding and practice has been tested in this study. The preliminary version of IPM3P consists of three domains (obligation, practice, and difficulty) with 59 items in total. Four phases of validity and reliability testing involved were: i) Content validation, ii) Pretesting, face validity and proofreading, iii) Pilot study, and iv) Psychometric evaluation.

    RESULTS: The final version of IPM3P consists of 36 items. The findings from the present study suggest that the final version of IPM3P has excellent psychometric properties manifested by: i) good content validity, ii) excellently pretested, iii) good face validity, iv) good construct validity shown by principal component analysis and convergent validity, and v) good discriminant validity showed by divergent validity.

    CONCLUSION: IPM3P shows good potential to be used as a tool in investigating perception of Muslim adults towards Islamic understanding and practice.

  12. Amirullah NA, Rahmat S, Dzulkarnain AAA, Maamor N, Jamaludin MKA, Che Azemin MZ
    Med J Malaysia, 2022 Jan;77(1):12-19.
    PMID: 35086989
    INTRODUCTION: Sound therapy is one of the complementary or alternative interventions for various populations. The intensity of the sounds for sound therapy needs to be properly calibrated to ensure their accuracy and effectiveness. This paper aims to provide a general guideline for calibrating sound files using free software, specifically Audacity®.

    MATERIALS AND METHODS: Six sounds (broadband noise, rain, ocean, waterfall, Quranic chapters Al-Fatihah, and Yasin recitations) were calibrated at the intensity levels of 45, 50, 55, 60, 65, 70, 75, and 80dBA. The sounds were delivered through a pair of Sennheiser HD 280 Pro headphones connected to the Sound Blaster X-Fi Surround 5.1 Pro sound card. The long-term average of the sound pressure level over the time of recording (LAseq) was recorded using the 3M SoundPro Class 1 1/3 Octave RTA sound level meter (SLM). The desired intensity levels were obtained by making adjustments to the sound files via the Audacity® software.

    RESULTS: All sound files were calibrated at the targeted levels as verified by the value of LAseq.

    CONCLUSIONS: Calibration of audio files can be done using a free/open-source software, as all six sound files were successfully calibrated at the targeted levels of 45, 50, 55, 60, 65, 70, 75, and 80dBA. The calibration steps provided in this paper can be easily applied by other researchers for similar purposes, with precautions when calibrating at low levels.

  13. Rahmat S, Othman N, Asharuddin SM, Ahmad SN, Din MFM, Sarani NA
    Int J Biol Macromol, 2024 Sep 08;279(Pt 3):135499.
    PMID: 39255888 DOI: 10.1016/j.ijbiomac.2024.135499
    Cationic Manihot esculenta (ME) peel starch was synthesized through etherification method using 3-chloro-2-hydroxypropyl trimethylammonium chloride (CHPTAC) as cationizing monomer. The optimization of the main factors influencing the degree of substitution (DS) was conducted using central composite design (CCD) and response surface methodology (RSM). The factors assessed include CHPTAC concentration, catalyst sodium hydroxide (NaOH) concentration, and reaction time. The DS values of the cationic starches were obtained between 0.39 and 0.99. The maximum DS value was up to 0.99 at 0.615 mol/L of CHPTAC, 30 % (w/v) NaOH, and a reaction time of 5 h. The finding based on the optimization using RSM reflected that CHPTAC and NaOH concentrations are the key variables determining the DS value, while reaction time has a negligible impact on the etherification process. Furthermore, the chemical composition, morphology, and structure of the cationic ME peel starch were characterized by scanning electron microscopy with energy dispersive X-ray spectrometry (SEM-EDX), Fourier transform infrared spectroscopy (FTIR), X-ray diffractometry (XRD) and nuclear magnetic resonance spectroscopy (1H NMR). It was confirmed that the modifying monomers penetrated the surface layer of the starch granules and attached to the starch backbone.
  14. Dzulkarnain AAA, Noor Ibrahim SHM, Anuar NFA, Abdullah SA, Tengku Zam Zam TZH, Rahmat S, et al.
    Int J Audiol, 2017 Oct;56(10):723-732.
    PMID: 28415891 DOI: 10.1080/14992027.2017.1313462
    OBJECTIVE: To investigate the influence of two different electrode montages (ipsilateral: reference to mastoid and vertical: reference to nape of neck) to the ABR results recorded using a level-specific (LS)-CE-Chirp® in normally hearing subjects at multiple intensities levels.

    DESIGN: Quasi-experimental and repeated measure study designs were applied in this study. Two different stopping criteria were used, (1) a fixed-signal averaging 4000 sweeps and, (2) a minimum quality indicator of Fmp = 3.1 with a minimum of 800 sweeps.

    STUDY SAMPLE: Twenty-nine normally hearing adults (18 females, 11 male) participated.

    RESULTS: Wave V amplitudes were significantly larger in the LS CE-Chirp® recorded from the vertical montage than the ipsilateral montage. Waves I and III amplitudes were significantly larger from the ipsilateral LS CE-Chirp® than from the other montages and stimulus combinations. The differences in the quality of the ABR recording between the vertical and ipsilateral montages were marginal.

    CONCLUSIONS: Overall, the result suggested that the vertical LS CE-Chirp® ABR had a high potential for a threshold-seeking application, because it produced a higher wave V amplitude. The Ipsilateral LS CE-Chirp® ABR, on the other hand, might also have a high potential for the site of lesion application, because it produced larger waves I and III amplitudes.

  15. Hatah E, Rahim N, Makmor-Bakry M, Mohamed Shah N, Mohamad N, Ahmad M, et al.
    PLoS One, 2020;15(11):e0241909.
    PMID: 33157549 DOI: 10.1371/journal.pone.0241909
    Medication non-adherence remains a significant barrier in achieving better health outcomes for patients with chronic diseases. Previous self-reported medication adherence tools were not developed in the context of the Malaysia population. The most commonly used tool, MMAS-8, is no longer economical because it requires a license and currently every form used is charged. Hence, there is a need to develop and validate a new medication adherence tool. The Malaysia Medication Adherence Assessment Tool (MyMAAT) was developed by a multidisciplinary team with expertise in medication adherence and health literacy. The face and content validities of the MyMAAT was established by a panel of experts. A total of 495 patients with type 2 diabetes were recruited from the Ministry of Health facilities consisting of five hospitals and five primary health clinics. A test-retest was conducted on 42 of the patients one week following their first data collection. Exploratory factor analysis was performed to evaluate the validity of the MyMAAT. The final item for MyMAAT was compared with SEAMS, HbA1c%, Medication Possession ratio (MPR) score, and pharmacist's subjective assessment for its hypothesis testing validity. The MyMAAT-12 achieved acceptable internal consistency (Cronbach's alpha = 0.910) and stable reliability as the test-retest score showed good to excellent correlation (Spearman's rho = 0.96, p = 0.001). The MyMAAT has significant moderate association with SEAMS (Spearman's rho = 0.44, p = < 0.001) and significant relationship with HbA1c (< 8% and ≥ 8%) (χ2(1) = 13.4, p < 0.001), MPR (χ2(1) = 13.6, p < 0.001) and pharmacist's subjective assessment categories (χ2(1) = 31, p < 0.001). The sensitivity of MyMAAT-12, tested against HbA1c% was 72.9% while its specificity was 43%. This study demonstrates that the MyMAAT-12 together with other methods of assessment may make a better screening tool to identify patients who were non-adherence to their medications.
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