Cost effectiveness analysis of using different monitoring modalities in treating severe traumatic brain injury (CESTBI) in neuro-ICU, HUSM, Kelantan

Introduction: There are two schools of thought in practicing neurotrauma monitoring for patients with severe traumatic brain injury (TBI); the application of the baseline neuro-monitoring (BNM) and the use of multiple modalities neurotrauma monitoring (M3) which is very expensive. The answer of which of the two monitoring systems is more eflicient and worth doing should be sought. Objective: To determine the cost effectiveness analysis between BNM and M3 monitoring modalities in the management of severe TBI. Methodology: Sixty-two patients with severe TBI admitted to Neuro-ICU, USM who fulfilled the predetermined criteria were selected using systematic random sampling. The macro and micro costing were performed on each of patient. Barthel Index was used to measure physical performance as an outcome six months after discharge. The analyses used were the Independent t- test, ANCOVA, and Repeated Measure ANOVA. Results: The mean total equipment cost of M3 was significantly higher at p = 0.049 (mean difference of RM23.74) after controlling other variables. The mean difference in Barthel Index after six months was significance between the two groups (p = 0.031), patients that were treated with M3 had higher score 163.7 (SD 30.03)J compared to those who were treated with BNM 146.83 (SD 30.36)]. However, the cost-effectiveness ratio of using M3 was significantly lowered (p=O.031) with a mean of RM476.29 was needed to increase a unit improvement in mean Barthel Index compared to RM629.12 if we used BNM. Conclusion: Although M3 is more costly, the outcome of patients treated with M3 was better than that of BNM. Therefore we can conclude that the used of multiple neuro-monitoring was more cost effective than the use of only baseline neuro-monitoring in treating severe traumatic brain injury

Evaluation of architecture student classroom communication at Universiti Kebangsaan Malaysia

Classroom communication is a very important and complex aspect in teaching and learning. Its complexity is attributed to a host of factors that include participants, messages, encoding, decoding, and channels. Not much is currently known concerning classroom communication in the context of architecture education in Malaysian universities. This paper evaluates classroom communication of students undertaking architecture degree programs at Universiti Kebangsaan Malaysia. Four factors of student classroom communication were investigated to understand student abilities and issues in classroom communication. Forty-four students undertook the self administered survey. The majority of the students exhibited good non-verbal communication practices, and scored favourably in the aspect of adapting the way they communicate to others. However, students seemed to have some difficulty to express ideas in class presentations. Additionally, some students appeared to be handicapped in actively participating and leading class discussions. Last but not least, a number of students were not comfortable in using English in the classroom, but not to the extent of hindering them in participating in classroom discussions. Further studies are needed to uncover classroom communication issues in student learning among architecture students at Universiti Kebangsaan Malaysia

The University Development Planning From The Aspects Of Accessibility And Circulation : A Comparative Study Of Four Malaysian Universities

The purpose of this research is to review the existing university campus planning development in Malaysia and to identify the advantages and the disadvantages of every planning in order to create a sustainable campus. Case study method has been used in this research. This research was confined to the campus of public institutions of higher learning and campus physical planning only. There are four institutions that have been selected, which are Universiti Kebangsaan Malaysia (UKM), Universiti Malaya (UM), Universiti Sains Malaysia (USM) and Universiti Putra Malaysia (UPM). The techniques used are the survey form, behavioral observation and visual research. Data obtained were compared between research campus.This research found out that there are a lot of disadvantages arising because of the existing planning from accessibility, circulation, building design, landscape design as well as lightning and security aspect. This paper is part of the study and will be discussing on two main aspects which are accessibility and circulation

Prediction of field dependent-rheological properties of magnetorheological grease using extreme learning machine method

Magnetorheological grease is seen as a promising material for replacing the magnetorheological fluid owing to its higher stability and the lesser production of leakage. As such, it is important that the rheological properties of the magnetorheological grease as a function of a composition are conducted in the modeling studies of a magnetorheological grease model so that its optimum properties, as well as the time and cost reduction in the development process, can be achieved. Therefore, this article had proposed a machine learning method–based simulation model via the extreme learning machine and backpropagation artificial neural network methods for characterizing and predicting the relationship of the magnetorheological grease rheological properties with shear rate, magnetic field, and its compositional elements. The results were then evaluated and compared with a constitutive equation known as the state transition equation. Apart from the shear stress results, where it had demonstrated the extreme learning machine models as having a better performance than the other methods with R2 more than 0.950 in the training and testing data, the predicted rheological variables such as shear stress, yield stress, and apparent viscosity were also proven to have an agreeable accuracy with the experimental data

Field dependent-shear stress prediction of magnetorheological fluid using an optimum extreme learning machine model

Extreme learning machine (ELM) application to model the shear stress of magnetorheological (MR) fluids has superiority over the existing methods, such as Herschel-Bulkley. Although the shear stress has been successfully predicted, the hidden node numbers are too high reaching up to 10,000 that will hinder the application of the models. Furthermore, the existing works have tried to determine the hidden node number only by trial and error method. Therefore, this paper aims to reduce the hidden node number by employing the particle swarm optimization (PSO) considering the accuracy and the hidden node numbers. The ELM based-shear stress model was firstly defined by treating the magnetic field and shear rate as the inputs and shear stress as output. The objective function optimization method was then formulated to minimize the normalized error and the hidden node numbers. Finally, the proposed methods were tested at various ELM activation functions and samples. The results have shown that the platform has successfully reduced the hidden node numbers from 10,000 to 571 while maintaining the error of less than 1%. In summary, the proposed objective function for PSO optimization has successfully built the optimum shear stress model automatically

Aedes larval population dynamics and risk for dengue epidemics in Malaysia

Early detection of a dengue outbreak is an important first step towards implementing effective dengue interventions resulting in reduced mortality and morbidity.A dengue mathematical model would be useful for the prediction of an outbreak and evaluation of control measures.However, such a model must be carefully parameterized and validated with epidemiological, ecological and entomological data.A field study was conducted to collect and analyse various parameters to model dengue transmission and outbreak.Dengue-prone areas in Kuala Lumpur, Pahang, Kedah and Johor were chosen for this study.Ovitraps were placed outdoor and used to determine the effects of meteorological parameters on vector breeding.Vector population in each area was monitored weekly for 87 weeks.Weather stations, consisting of a temperature and relative humidity data logger and an automated rain gauge, were installed at key locations in each study site.Correlation and Autoregressive Distributed Lag (ADL) model were used to study the relationship among the variables. Previous week rainfall plays a significant role in increasing the mosquito population, followed by maximum humidity and temperature. The secondary data of rainfall, temperature and humidity provided by the meteorological department showed an insignificant relationship with the mosquito population compared to the primary data recorded by the researchers.A well fit model was obtained for each locality to be used as a predictive model to foretell possible outbreak

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat