Challenges in managing dementia in a primary health care setting: A case report

Dementia is a condition that is frequently associated with ageing. However, many fail to recognise that dementia is a treatable condition if detected early. This case report illustrates a 64-year-old man who was initially presented in a primary health care (PHC) centre in Kuala Lumpur Malaysia, with gradual changes in his behaviour. Initial assessment concluded that he suffered from depression and he was treated accordingly. However, over time his condition deteriorated and the diagnosis was re-evaluated from depression to dementia when he developed poor cognitive and memory function. The patient defaulted on his follow-up appointments due to poor understanding of the illness and poor family support.Keywords: dementia; elderly; primary health car

Modus Operandi Extraction in Police Report

Background: This paper analyzes the modus operandi extraction in Malay language using information retrieval technique. The similarity of modus operandi will be measured according to the cosine of the angle between query and document vectors. Our research focuses on phrase identification to find out the rules of forming modus operandi from free-text of police reports. Modus operandi is the most important aspect in a police investigation. The valuable data that relevant to the user's information needed in free-text report is a challenge and difficult to be detected or tracked by the police. It would be better if modus operandi from text reports such as location of crime and crime behavior could be identified automatically. This paper also shows that modus operandi extraction can improve the performance of similarity measurement using precision, recall and F-measures. It evaluates the accuracy of modus operandi extraction on each report from ten different police reports. The best F-measure is 0.960 with recall and precision at 1.0 and 0.933 respectively for retrieval performance of modus operandi extraction

Measuring achievement emotions questionnaire for physical education (AEQ-PE): a confirmatory study in Malay language

Availability of data and materials: The dataset used and analysed during the current study is available from the corresponding author on reasonable request.Background: This study aimed to verify a translated Malay version of the Achievement Emotions Questionnaire for Physical Education (AEQ-PE) by assessing the level of achievement emotions in six constructs among the Malaysian primary school pupils using the Confirmatory Factor Analysis (CFA). Methods: A total of 607 Malay pupils, comprising 240 (39.5%) boys and 367 (60.5%) girls aged between 10 and 11, were recruited from 10 schools to answer the questionnaire, which measured their views on 24 items through a five-point Likert scale. The AEQ-PE was translated into Malay language (AEQ-PE-M) using forwarding to backward translation techniques. Certain phrases were adopted in accordance with the local culture and vocabulary appropriate for primary school pupils. CFA was performed using the Mplus 8.0 software, and the final model demonstrated high reliability in terms of the composite reliability and Cronbach’s alpha. Results: Analysis of the CFA showed an acceptable fit indices in CFI (0.936), TLI (0.926), RMSEA = 0.039 (90% CI, 0.034, 0.045) and SRMR (0.049) of the AEQ-PE measurement model. All of the items in the original AEQ-PE version were retained and deemed suitable for Malay primary school pupils. Conclusion: The AEQ-PE-M with 24 items was a suitable tool for measuring the level of school children’s involvement in determining achievement emotions and their motivation towards physical education.This study was supported by Research University’s Individual Grant (1001/PPSK/8012370) from Universiti Sains Malaysia

Psychometric properties of the malay-language quality of life enjoyment and satisfaction scale: A confirmatory study on malaysian children

Data Availability Statement: The data is available upon request from the authors.Copyright © 2021 by the authors. The objective of this study was to validate the translated Malay version of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-M) scale among Malaysian primary school children using the confirmatory factor analysis (CFA). The Q-LES-Q-M measures the level of enjoyment and satisfaction experienced with relation to physical health, feelings, homework, and leisure. The participants were 607 Malay students, 240 (39.5%) boys and 367 (60.5%) girls, with an age range from 10 to 11 years old. The original version of the Q-LES-Q was translated into the Malay language by forward to backward translation procedures with consideration for the local culture and suitable vocabulary for primary school students. The participants then completed the Q-LES-Q-M. CFA was performed using Mplus 8 software. Using CFA, the initial model did not result in a good data fit. Further analysis of the CFA suggested some changes to the model to improve the fit indices. Model modification included the deletion of three problematic items and co-varying some error items. This resulted in improved fit indices and 40 items remained in the final model. The final model showed good reliability based on two indicators of composite reliability (CR) and Cronbach’s alpha (CA). The factors with their CR and CA were physical activity (CR = 0.857, CA = 0.854), feelings (CR = 0.808, CA = 0.813), homework (CR = 0.837, CA = 0.837) and leisure (CR = 0.742, CA = 0.737). The final measurement consists of 40 items. The retained items were deemed suitable for Malay primary school children. The revised Q-LES-Q-M with 40 items is suitable for measuring the levels of children’s involvement in determining the enjoyment and satisfaction of learning and physical activity.The research was partially supported by the Exercise Medicine Research Grant (EMRG/19004)

Exploring clusters of rare events using unsupervised random forests

Given highly imbalanced data, most learning algorithms face the challenge of accurately predicting rare events, while such cases are the ones that carry importance and useful knowledge. In a binary class label dataset, the rare events are the ones in the minority class. This study used a stroke dataset with a binary class label and the class imbalance ratio was 54:1. In addition to that, the dataset contained missing values and mixed data types. To identify the intrinsic structures in the minority class (the stroke group), Random Forest Clustering was used to produce the proximity matrix and fed to Partition around Medoid (PAM) clustering method to identify the optimal number of clusters. The proximity plot seems to show there could be cluster tendency as Hopkins’s statistics test value was H = 0.8735 and k=2 was identified to be the optimal number of clusters. Based on the internal cluster validation, however, the silhouette coefficient width was small (0.1), indicating that many of the data objects were within the other boundary of the other class. We have suggested a further investigation plan in this paper for the next action

Identifying clusters structure of rare events using random forest clustering

Given highly imbalanced data, most learning algorithms faced the challenge to accurately predict rare events, while such cases were the ones that carry importance and useful knowledge. In a binary class label dataset, the rare events are the ones in the minority class. This study used a stroke dataset with a binary class label and the class imbalance ratio was 54:1. In addition to that, the dataset contained missing values and mixed data types. To identify the intrinsic structures in the minority class (the stroke group), Random Forest Clustering was used to produce the proximity matrix and fed to Partition around Medoid (PAM) clustering method to identify the optimal number of clusters. The proximity plot seems to show there could be cluster tendency and k=2 was identified to be the best as compared to k=3 to k=5. Based on the internal cluster validation, however, the silhouette coefficient width was small (0.1) indicating much of the data objects were within the other boundary of the other class. We have suggested a further investigation plan in this paper for the next action

Role of virgin coconut oil VCO as co-extractant for obtaining xanthones from mangosteen Garcinia mangostana pericarp with supercritical carbon dioxide extraction

Virgin coconut oil (VCO) was used as co-extractant with supercritical carbon dioxide (scCO2) extraction for obtaining xanthones from mangosteen pericarp (MP) without organic co-solvents. In each experiment, 120 g of dried MP that had median particle sizes of 0.85 mm was used. Extraction of MP with 40% VCO co-extractant using scCO2 (1.08 kg/h) for 420 min at 430 bar and 70 °C gave α-mangostin (32.2 mg/g), γ-mangostin (7.2 mg/g), xanthones (28.2 mg/g) in extract and an extraction yield of 31%. The role of VCO is that it promotes dissolution of xanthones and mass transfer into the scCO2 phase as elucidated with the Pardo-Castaño model. The Lentz equation was generalized in terms of (P, T, %VCO, ρCO2) to correlate all extraction curve data to within 7.4% and to estimate extraction yield crossover regions. Xanthones can be separated from mangosteen pericarp with VCO and scCO2 extraction without organic co-solvents

Vacuum/Compression Valving (VCV) Using Parrafin-Wax on a Centrifugal Microfluidic CD Platform

This paper introduces novel vacuum/compression valves (VCVs) utilizing paraffin wax. A VCV is implemented by sealing the venting channel/hole with wax plugs (for normally-closed valve), or to be sealed by wax (for normally-open valve), and is activated by localized heating on the CD surface. We demonstrate that the VCV provides the advantages of avoiding unnecessary heating of the sample/reagents in the diagnostic process, allowing for vacuum sealing of the CD, and clear separation of the paraffin wax from the sample/reagents in the microfluidic process. As a proof of concept, the microfluidic processes of liquid flow switching and liquid metering is demonstrated with the VCV. Results show that the VCV lowers the required spinning frequency to perform the microfluidic processes with high accuracy and ease of control.open5

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030