A comparison of soda lime (Intersurgical) with Amsorb® plus: the cost implications

This was a prospective study comparing the cost implications between two carbon dioxide (CO2) absorbers, soda lime (Intersurgical) and AMSORB® PLUS. The study was conducted over two 4-week periods in two dedicated operating theatres using Datex Ohmeda Aestiva/5 anaesthetic machines. AMSORB® PLUS was used during the first four weeks and soda lime (Intersurgical) the following four weeks. General anaesthesia was administered as routinely done but fresh gas flow (FGF) during the maintenance phase was limited to a maximum flow of 2 L/min. The CO2 absorber was only changed when there was evidence of exhaustion. Total duration of anaesthesia, sevoflurane (bottles) and CO2 absorber (kg) consumption, and amount of waste product (kg) was calculated at the end of each study period. The total cost of delivering general anaesthesia was lower in the AMSORB® PLUS group, RM82.40 (USD19.89)/hour versus the soda lime group, RM91.50 (USD 22.09)/hour (p=0.17), which translates to a 10% reduction in cost per hour. Reduction in sevoflurane consumption in the AMSORB® PLUS compared to the soda lime group was also not statistically significant (p=0.22). The only significant finding was the reduction in CO2 absorber consumption in the AMSORB® PLUS group as compared to soda lime group (p=0.001). In conclusion, AMSORB® PLUS consumption was significantly reduced compared to that of soda lime. However, the use of AMSORB® PLUS did not significantly reduce sevoflurane consumption nor the total cost of delivering general anaesthesia. Given the superior safety profile, AMSORB® PLUS may be a suitable, cost-effective alternative to soda lime in the daily practice of anaesthesia

eWOM : The effect of online review and food quality on the intention to visit a restaurant / Arnieyantie Abdul Hadi

The rapid development of the food establishment industry witnessed the online reviews for restaurants becoming a significant tools for restaurant owners to increase their sales, image and customers. Thus, this research is conducted to measure the effect of online reviews on intention to visit restaurants. The study was conducted by distributing a self administered questionnaire involving 156 respondents and analyzed using Statistical Package for the Social Sciences (SPSS) version 20. All variables measured was significantly influence the consumer's intention to visit restaurants, especially in terms of positive online reviews (eWOM), negative online reviews (eWOM) and online food quality reviews. Moreover, the results showed a positive relationship between positive online reviews, negative online reviews and food towards consumer intention to visit restaurant. The result also demonstrated that food quality online reviews was least effected on consumer intention to visit restaurant with lowest correlation value. The study confirmed that the online reviews became crutial in improving the quality of sales, image, food and also service of the restaurant

Exploring possibilities of Islamic tourism in Malaysia

Malaysia is one of the country that rich in diversities, heritages and cultures, however, it is clearly declared that the official religion of the country is Islam. The fact, Islam is the official religion makes it easier to market Malaysia as an Islamic tourism destination. This research paper aims to analyses the current trends and opportunities of Islamic Tourism industry in Malaysia. A document analysis was initially employed to identify the objectives of this research paper. The results of the study have shown the current trends of some travel agents and service providers who have creatively came out with Muslim-friendly packages and tours to attract and gain the attention of Muslim travellers. Besides that, the results of this study have determined three major opportunities of Islamic tourism in Malaysia which are halal holidays, halal tourism smart phone apps and promotions. The futuristic elements of this paper are aimed to promote Islamic products that can be further developed in terms of its quality of production, the benefit of decision-making among Islamic countries, and the ability to raise the dignity of Islam in the eyes of the world

Determining of tourist’s spatial behaviour and tourist movement pattern in Muar royal town, Johor

Travelling acquire movement. The movement pattern was formed to deliver a meaningful purpose to travel that closely related with personal behavior characteristic. However, tourists nowadays faces limitation in their movement of journey while visiting plenty of attractions. The movement limitations can be occurred due to unsystematic transportation system and accessibility, less of tourism packages supply, and disorganized digital marketing strategy by tourism destination management. Hence, this study aims to explore the characteristic of tourist’s spatial behaviour and tourist movement pattern in urban heritage area at Muar. The research design applied in this study is qualitative method which involved grounded theory approach. Therefore, the construction of theories through gathering and analysis of data by using inductive reasoning from fieldwork observation and interviewing method. The result of this study demonstrates that the tourist spatial behaviour has influenced the tourist movement pattern in aspect socio-cultural background characteristic on visitors travel life style that consist of accommodation location, travelling purpose, mode of transportation used and special interest. In short, it will be significantly useful to know sociocultural visitor behaviour towards tourist movement pattern in Muar Royal Town Johor

Analgesia combinada raquiperidural em trabalho de parto: seus efeitos sobre o desfecho do parto

ResumoJustificativa e objetivosA analgesia combinada raquiperidural (RP) tornou‐se uma opção cada vez mais popular para o trabalho de parto tradicional devido ao seu rápido início de ação e ao resultado confiável. Este foi um estudo prospectivo de amostragem conveniente para determinar os efeitos da RP sobre o desfecho do parto.MétodosForam incluídas 110 parturientes primigestas saudáveis, com gestação única de ≥ 37 semanas e na fase ativa do trabalho de parto. As pacientes foram designadas para os grupos RP (n=55) ou não RP (n=55) com base em seus consentimentos para a analgesia combinada RP. As parturientes do grupo não RP receberam outros métodos de analgesia para o parto. As durações do primeiro e segundo estágio do trabalho de parto, as taxas de parto vaginal instrumental e cesariana de emergência e os escores de Apgar foram comparados.ResultadosA média de duração do primeiro e segundo estágio do trabalho de parto não foi significativamente diferente entre os dois grupos. As taxas de parto instrumental não foram significativamente diferentes entre os grupos, RP (11%) versus não RP (16%). A incidência ligeiramente maior de cesariana no grupo RP (16% versus 15% no não RP) não foi estatisticamente significativa. O desfecho neonatal em termos de índice de Apgar foi inferior a 7.ConclusãoNão houve diferenças significativas em relação à duração do trabalho, às taxas de parto vaginal instrumental e cesariana de emergência e ao desfecho neonatal em parturientes que receberam RP para analgesia de parto em comparação com aquelas que não receberam.AbstractBackground and objectivesCombined spinal–epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome.MethodsOne hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n=55) or Non‐CSE (n=55) group based on whether they consented to CSE analgesia. Non‐CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared.ResultsThe mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non‐CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non‐CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5min was similar in both groups.ConclusionThere were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia

Statistics of rainfall rate at 60 minutes integration time in Malaysia

Background: This paper presents the statistics of rainfall at 60- minute integration time in Malaysia for the period of 12 months from January to December 2009. Objective: To analyze the statistics and characteristics of rainfall intensity measurement at KLIA, Malaysia. To study the behavior of measured rainfall intensity and represent the annual distribution of the measured rainfall through cumulative distribution functions together with different types of rainfall that occurred in 2009. Results: The results obtained show the cumulative distribution functions and amount of the rainfall rate for that particular year. The results also show the different cumulative distribution functions for four different rainfall types that occur in 2009. Conclusion: The study of the 12-month tipping bucket data has given the characteristics of the collected rainfall. From the results obtained, it shows that Malaysia is within equatorial region with the characteristics of two distinguishable rainfall rates that occurs during the whole year

Comparing Postoperative Sore Throat (POST) following intubation using Macintosh Laryngoscope Versus C-MAC® Video Laryngoscope

Postoperative sore throat (POST) is a common complication with incidence of 30-90% when intubation was done using conventional Macintosh laryngoscope. Although POST is usually self-limiting and with no long-term morbidity, it can lead to patient’s discomfort and dissatisfaction in the postoperative period. The objective of this study was to compare the incidence of POST following intubation using Macintosh laryngoscope and C-MAC® videolaryngoscope (VL) at various time intervals post anaesthesia. This prospective randomised controlled study comprised of 128 patients with American Society of Anesthesiologists (ASA) I and II status who underwent elective surgery under general anaesthesia in Universiti Kebangsaan Malaysia Medical Centre. All recruited patients have normal airway and divided randomly into Group 1 and Group 2 that used Macintosh laryngoscope and C-MAC® VL during intubation, respectively. Patients were evaluated for sore throat, hoarseness of voice, dysphagia and coughing at recovery, 6 hours, 12 hours and 24 hours after intubation. Severity of POST was assessed using numerical rating scale (NRS). Incidence of POST was found to be higher in the Macintosh laryngoscope group (61.9%) compared to C-MAC® VL group (47.9%) although the difference was not statistically significant (p=0.107). Median pain score was used to assess the severity of POST, showing low and comparable in both groups at all time intervals. There were also no significant differences seen in hoarseness of voice, coughing and dysphagia for both groups during postoperation. Incidence of POST following intubation using C-MAC® VL and conventional Macintosh laryngoscope were comparable. This study revealed that severity of POST was generally low in both groups

Hasrat Muda Sdn Bhd / Hishamudin Hasbullah ... [et al.]

As the entrepreneurs, we would like to introduce our business plan and its basic features. The idea of starting the business came to our minds because we observed that there are some imperfections in current products, which is battery manufacturing. In addition to that, for the time being this industry is considered quite new. Hence we have minimal competition over market share. We see that as an opportunity to take a piece of the industry. Because the blooming of transportation industry by the government owned companies like Proton, Perodua and Modenas, as well as government agencies such as police department, and other government agencies, we plan to tie up a tender with the government itself to assure loyal clients. The six of us decided to pull in every inch of resource we can muster to start a manufacturing company. We register the company as a private limited company under the name Hasrat Muda Sdn Bhd. consisting of the following members:

A comparison between continuous indirect calorimetry and single weight-based formula in estimating resting energy expenditure in nutritional therapy: a prospective randomized controlled study in critically ill patients

Optimal nutritional therapy is important to improve outcome in critically ill population in an intensive care unit (ICU). Although indirect calorimetry (IC) is currently a gold standard for resting energy expenditure (REE) measurement, yet it is still not routinely used in the ICU. A total of 146 mechanically ventilated patients were randomised to receive enteral nutrition (EN) with energy targeted based on continuous indirect calorimetry (IC) measurements (IC group, n=73) or according to 25 kcal/kg/day (SWB group, n=73). Patient characteristics were equally distributed and the IC group showed lower mean measured REE (1668.1 + 231.7 vs 1512.0 + 177.1 kcal, p<0.001). Results also showed a significant deficiency in the daily (-148.8 + 105.1 vs. -4.99 + 44.0 kcal, p<0.001) and total cumulative energy balances (-1165.3 + 958.1 vs. 46.5 + 369.5 kcal, p<0.001) in the SWB group as compared to the IC group. From the Kaplan-Meier survival analysis, we found that ICU mortality was significantly lower in the IC group with better survival probability compared to the SWB group (log-rank test, p = 0.03). However, both groups showed comparable results in terms of ICU length of stay, duration of mechanical ventilation and incidence of feeding intolerance. In conclusion, this study showed that tightly supervised nutritional therapy based on continuous IC measurement provides significantly less mean daily and cumulative energy deficits as well as significantly reduced ICU mortality rate

Estimates of glomerular filtration rate in critically ill patients with sepsis: comparisons of different equations

INTRODUCTION: Accurate assessment of glomerular filtration rate (GFR) is important in the critically ill. Kinetic estimate of GFR (keGFR) considers the changes of creatinine, creatinine production rate, and volume of distribution hence postulated to be a more accurate estimate of GFR, where there are rapidly changing kidney functions. We evaluated the association of the estimated GFR by established equations and keGFR with creatinine clearance (CrCl) measurement. MATERIALS AND METHODS: This is a prospective observational study of critically ill patients. Inclusion criteria were patients older than 18 years old with sepsis (clinical infection and increase in SOFA score>2), and plasma procalcitonin>0.5ng/ml. Plasma creatinine and Cystatin C (CysC) were measured on admission and 4 hours later, and the eGFR was calculated by the Cockcroft Gault (CG), MDRD, CKD-EPI, and keGFR equations, and compared to the CrCl measurement. RESULTS: A total of 70 patients were recruited. eGFR by all 4 equations strongly correlates with CrCl. keGFR had the least bias depicted by the mean differences nearest to zero (-18ml/min). Similarly, keGFRCysC had less bias than eGFRCysC, with a mean difference of -21ml/min. eGFRCG had the greatest precision depicted by the narrower SD lines, however, the precision of both keGFR were not much different compared to those of eGFRCG. CONCLUSIONS: In critically ill patients with sepsis, keGFRCr and keGFRCysC had the least bias and fair precision when compared to creatinine clearance measurement. In the absence of creatinine clearance measurement, keGFR calculations are useful as a surrogate for kidney function