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

Mangrove mapping using Landsat imagery and aerial photographs: Kemaman District, Terengganu, Malaysia

Classification and distribution of mangrove vegetation are vital information for the proper development of a mangrove management plan. In this study, classification for the mangroves of the district of Kemaman were done using both 1 : 5000 aerial photographs and Landsat TM imageries. The coverage by aerial photographs is limited to the coastal and estuarine areas only. Thus, for areas further upstream of the aerial photo coverage, Landsat TM imageries were used. Analysis of aerial photographs and remote sensing images revealed that the mangroves of Kemaman could be classified into 14 different classes of vegetation. All the 14 classes were identified from areas covered by the aerial photographs. For areas covered by the Landsat images only 7 classes of vegetation were identified. The accuracy for aerial photograph and Landsat images are 91.2% and 87.8%, respectively. It can be concluded that although both techniques are useful in determining the mangrove vegetation classes, the large 1 : 5000 aerial photographs are more accurate and provided more detailed information comparatively

The preparation, delivery and outcome of COVID-19 pandemic training program among the Emergency Healthcare Frontliners (EHFs): the Malaysian teaching hospital experience

One of the strategies in strengthening the healthcare providers in mitigating the impact of COVID-19 pandemic is through training. Safety and disease unfamiliarity with COVID-19 was the main reason for developing this dedicated specialized training modules in order to address the issue. The training modules were developed based on three strategies that are learning from experience, design suitable dedicated module and identify weakness and vulnerability. The training modules created were donning-doffing of Personal Protective Equipment (PPE), airway management and cardiopulmonary resuscitation of suspected COVID-19 patients which were delivered through immersive life simulation technique. A total of 178 Emergency Healthcare Frontliners (EHFs) were trained. Each module was guided with a checklist that the participants found to be very useful. None of the participants reported developing symptoms of infection after undergoing the face-to-face simulation training even after two weeks of post-training periods. Seven important steps were found to be crucial that contributed to these findings which included room space, participants number per group, COVID-19 screening, taking of temperature, hand sanitization, PPE, and equipment sanitization before and after training. Hands-on training with guided-checklist was found to be very useful to the EHFs in managing an unfamiliar situation of COVID-19. In time-constraint-resource-limited conditions, training modules should be focused on addressing the pressing problem at hand. In conducting a face-to-face training, precautionary safety measures should be strictly adhered to prevent the spread of the disease

Effect on the physico-chemical properties of liberica green coffee beans under ambient storage

Green coffee beans are stored for a certain period and under certain conditions until they are finally utilized. The storage period may depend on customer demand while the storage conditions depend on where the coffee beans are stored. Thus, this research emphasizes the physico-chemical changes that occur in Liberica coffee beans during storage under the Malaysian climate (average temperature and relative humidity of 29.33ºC and 71.75% respectively). The changes in the physico-chemical (coffee size, mass, densities, colour, proximate analysis, sucrose, chlorogenic acid content) and microbiological (yeast and mould count) properties were evaluated during eight months of storage. After the storage, the physical properties of the coffee changed as the coffee beans expanded in size, reduced in mass and density and became brighter in colour. Changes in the chemical properties were also detected where the moisture decreased and the ash content increased. In addition, the sucrose level was found to decrease with a corresponding increase in chlorogenic acid. During storage, the counts of yeast and mould were reduced. Model equations describing the changes in the properties were developed. The overall conclusion was that the coffee beans reduced in quality during storage

Wasatiyyah Values Appreciation in the Syariah Governance as Consumer Understanding Education Mechanisme Towards Islamic Banking System

The concept and values of wasatiyyah are fundamental in Islamic banking practice as the syariahlaw has delineated basic muamalat principles as an operation guideline for the banking industry.So that, all kind of extreme characteristics may be prevented. The principles of wasatiyyah prohibitany element which overlooks the permitted limit namely gambling, uncertainty (gharar), usury,fraud and so on. These elements have to be avoided in life because they were clearly prohibited byAllah SWT due to their oppressive nature especially towards the unfortunate such as the poor orlow-income group. This prohibition is also attached with the heavy intimidation in the hereafter.The Islamic banking system upholds the concept of wasatiyyah through the values of fairness,trust, transparency and accountability which are instilled through the syariah governance system.The appreciation of these values is proposed to be a part of the new curriculum for the financialawareness subject has been presented by the Malaysia government in the 13th Parliamentarysession. It is important to educate and enhance the understanding of the public especially the youngabout the Islamic banking system as an alternative to avoid the prohibited conventional bankingsystem

How the three arches of the foot intercorrelate

Background: The foot is composed of medial, lateral and transverse arches which, particularly the medial arch, provide it with the ability to function both as a flexible and rigid structure for proper locomotion. Arches of the foot, as well as their effect on lower extremity function, have been studied. However, quantitative data on the relationship between these arches still remain scanty. The purpose of this study was, therefore, to examine how the three arches of the foot intercorrelate. Materials and methods: Seventy-six participants (58 males, 18 females) were recruited to participate in the study. Bilateral weight-bearing lateral radiographs of the right foot were taken from each participant. Navicular heights (NH), medial cuneiform height (MCH), calcaneal inclination angle (CIA) and calcaneal-first metatarsal angle (C1MA) were measured to represent the medial arch. The lateral arch was represented by cuboid height (CH) and calcaneal-fifth metatarsal angle (C5MA) whereas; MCH and CH represented the transverse arch. Mean difference of variables between males and females was compared using independent t-test while the correlation between the variables was determined using Pearson correlation. Results: All the variables were not significantly related to gender. Significant moderate to excellent linear correlations were observed between the variables. CIA showed the strongest correlation with C1MA (r = –0.90) and C5MA (r = –0.84) whereas, CH had the least correlation with other variables. Conclusions: The moderate to excellent correlations between the variables indicate that deformation or elevation of the medial arch may consequently result in similar movements of the lateral and transverse arches and vice versa

The effect of wrist braces on current perception threshold (CPT) among female data processing operators in Malaysia

A cross sectional study was conducted to evaluate the effect of wrist braces on current perception threshold value of median nerve among female data processing operators (n = 48). Respondents were interviewed using a validated questionnaire to obtain information such as demographics and background data, work history, symptoms pertaining to carpal tunnel syndrome. Electrodiagnostic examination was performed using Neurometer® CPT/C to obtain CPT level of median nerve on index and middle fingers among respondents before and after work, with and without wrist braces. CPT testing detected 15 respondents (31%) had median nerve abnormalities. Results from the paired t-test analysis showed no significant difference (p> 0.05) on CPT value after work with and without wrist brace used. However, this study suggests that CPT value showed an increased trend after data entry tasks when no wrist braces used and a reduced trend when wrist braces were used. This study concluded that wearing a wrist brace for a short period of time during repetitive activities has no immediate influence on CPT value among computer operators, however, this study suggests that wrist braces may be beneficial in protecting workers against median nerve compression