Keistimewaan pendidikan agama Islam dan pandangan pentadbir British terhadap sistem pendidikan di Tanah Melayu: The Privileges of Islamic religious education and British administrator’s views on the education system in Malaya

Majoriti pentadbir British berpegang dengan falsafah positivisme empirik logik iaitu fahaman yang mementingkan penggunaan akal sepenuhnya sebagai pendekatan utama bagi mendapatkan sesuatu fakta keilmuan dengan tepat berdasarkan kaedah penelitian yang teliti dan sistematik. Falsafah ini menolak pembuktian sesuatu fakta menggunakan sumber wahyu kerana dianggap tidak releven dalam pembuktian sejarah dan telah mewujudkan pandangan yang berat sebelah serta meragukan terhadap masyarakat Melayu di Tanah Melayu. Artikel ini menumpukan kepada analisa terhadap pandangan pentadbir British berkenaan sistem pendidikan di Tanah Melayu merangkumi pendidikan agama dan sekular, dan untuk mengetahui keistimewaan pendidikan agama Islam ke atas masyarakat Melayu. Penulis menggunakan kaedah pensejarahan, perbandingan dan analisis kandungan bagi menyiapkan kajian ini. Hasil kajian mendapati pentadbir British memperkecilkan sumbangan sistem pendidikan agama Islam di Tanah Melayu dan beranggapan kegagalan Tanah Melayu mencapai ketamadunan yang tinggi disebabkan berpegang kepada Islam yang dianggap tidak releven dengan perkembangan semasa. Justeru, bagi memperbaiki kelemahan tersebut perlaksanaan sistem pendidikan Barat dilihat sebagai langkah yang tepat bagi menerapkan fahaman sekularisme ke dalam pemikiran masyarakat Melayu di Tanah Melayu

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

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

Summary 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 middleincome 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 lowincome 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 lowincome, 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

REMOVAL OF BORON FROM PRODUCED WATER BY CO-PRECIPITATION / ADSORPTION FOR REVERSE OSMOSIS CONCENTRATE

Co-precipitation and absorption methods were investigated for removal of boron from produced water, which is groundwater brought to the surface during oil and natural gas extraction. Boron can be toxic to many crops and often needs to be controlled to low levels in irrigation water. The present research focused on synthetic reverse osmosis (RO) concentrate modeled on concentrate expected from a future treatment facility at the Arroyo Grande Oil Field on the central coast of California. The produced water at this site is brackish with a boron concentration of 8 mg/L and an expected temperature of 80°C. The future overall produced water treatment process will include lime softening, micro-filtration, cooling, ion exchange, and finally RO. Projected boron concentrations in the RO concentrate are 20 to 25 mg/L. Concentrate temperature will be near ambient. This RO concentrate will be injected back into the formation. To prevent an accumulation of boron in the formation, it is desired to reduce boron concentrations in this concentrate and partition the boron into a solid sludge that could be transported out of the area. The primary method explored for boron removal during this study was adsorption and co-precipitation by magnesium chloride. Some magnesium oxide tests were also conducted. Jar testing was used to determine the degree of boron removal as a function of initial concentration, pH, temperature, and reaction time. Synthetic RO concentrate was used to control background water quality factors that could potentially influence boron removal. The standard synthetic RO concentrate contained 8 g NaCl/L, 150 mg Si/L and 30 mg B/L. After synthetic RO concentrate was prepared, amendments (e.g. sulfate, sodium chloride) were added and the pH adjusted to the desired value. Each solution was then carried through a mixing and settling protocol (5 min at 200 RPM, 10 min at 20 RPM, followed by 30 min settling and filtration). Boron concentrations from the jar tests were determined using the Carmine colorimetric method. Boron removal with magnesium chloride was greatest at a pH of 11.0. At this pH 87% of boron was removed using 5.0 g/L MgCl2◦6H2O at 20°C. Mixing time did not greatly affect boron removal for mixing periods of 5 to 1321 minutes. This result indicates equilibrium was achieved during the 45-min experimental protocol. Maximum boron removal was observed in the temperature range of 29°C to 41°C. At 68°C boron removal decreased five-fold compared to the reduction observed at 29°C to 41°C. For treatment of the cool concentrate, this relatively low optimal temperature range gives magnesium chloride an advantage over magnesium oxide, which is effective only at high temperatures. Neither sodium chloride nor sodium sulfate affected boron removal by magnesium chloride for the chloride and sulfate concentrations expected in the produced water at this site. In contrast, silica did inhibit boron removal, with removal decreasing from 30% to 5% when silica concentration was increased from 0 to 100 mmols/L. This result was unexpected because other researchers have reported silica is necessary for effective removal of boron by magnesium chloride. To investigate the reasons for the differing boron removal results for magnesium chloride and magnesium oxide, solids produced by the two reagents were compared using X-ray diffraction spectroscopy (XRD). Solids from magnesium chloride contained 30% amorphous material versus 10% for magnesium oxide. The crystalline components from the magnesium oxide treatment were for the most part magnesium oxide, whereas magnesium chloride crystalline solids were a combination of brucite (Mg(OH)2) and magnesium chloride hydroxide. The greater boron adsorption observed with magnesium chloride could thus either be attributed to the greater surface area of the amorphous precipitate and/or the higher boron affinity of brucite and magnesium chloride hydroxide. Adsorption isotherms were plotted for boron removal by magnesium compounds formed during precipitation. Boron adsorption followed a linear isotherm (r2= 0.92) for boron concentrations up to 37.8 mg B/L. While the data also fit Langmuir and Freundlich models the data fell in the linear range of those models. The linearity of the adsorption curves indicates that adsorption sites for boron were not saturated at these concentrations. The linearity means that higher boron concentrations in the RO concentrate will lead to greater mass removal, up to concentrations of at least 37.8 mg/L boron. Using magnesium chloride, boron removal by co-precipitation was more effective than by adsorption to pre-formed precipitate. Removal approximately doubled for a given dose of magnesium chloride. The effectiveness of co-precipitation presumably occurs due to entrapment of boron as the precipitate forms. This study has shown the potential of magnesium chloride as an agent for boron removal by determining those conditions most effective for boron co-precipitation and adsorption. Magnesium chloride has been shown to be more effective than magnesium oxide. Magnesium chloride also out-performed treatment with slaked quicklime, which was tested previously by others. Two important limitations of boron removal with magnesium chloride are the high chemical requirements (5 g/L MgCl2) and sludge production (1 g/g MgCl2 used). These are greatly mitigated by treatment of RO concentrate rather than the full produced water flow. In addition, reagent use and sludge production might be decreased by recycling sludge from the up-front lime softening process. Compared to magnesium oxide, magnesium chloride removes greater quantities of boron per mole of magnesium added (20 mg B/g MgCl2). The magnesium chloride isotherm demonstrated that treatment of RO concentrate required less reagent and produced less sludge per mass of boron removed than treatment of the more dilute feed water

Standard pressure deposition of crack-free AlN buffer layer grown on c-plane sapphire by PALE technique via MOCVD

A high-quality aluminium nitride buffer layers were grown on (0 0 0 1) sapphire substrate at standard pressure with a subsequent low growth temperature via metal organic chemical vapour deposition. The preparation of aluminium nitride buffer layers was accomplished by growing a thin aluminium nitride nucleation layer through a nominal growth condition followed by depositing a thick aluminium nitride film using pulsed atomic-layer epitaxy technique. In 13.3 kPa ambient, the influence of aluminium nitride nucleation layer on the crystal quality of the aluminium nitride film atop was studied by varying the nucleation layer growth temperature at 700, 800, 900, 1000 and 1100 °C, respectively. It was observed that the growth temperature of nucleation layer substantially affected the structural properties of the top aluminium nitride film where the lowest value for symmetric (0 0 0 2) and asymmetric (1 0–1 2) x-ray rocking curve analysis were achieved at 1100 °C, indicating the reduction of dislocation density in the aluminium nitride films. In line with that, this result was sustained by the root mean square surface roughness evaluated via atomic force microscopy. Moreover, an atomically-flat crack-free aluminium nitride buffer layer was demonstrated by field emission scanning electron microscopy measurement

A review on green economy and development of green roads and highways using carbon neutral materials

An estimated 2.2 billion people in 108 countries are expected to survive on multidimensional poverty and almost 1.5 billion out of 2.2 billion people survived on or less than US$1.25 a day. This review highlights the concept of a green economy that promotes an attractive green revolution to the present economic crises affecting developing countries for sustainable economic and environmental improvement. Green roads and highways can reduce the emissions released from fossil fuels and greenhouse gases if constructed with carbon neutral materials. Thus, carbon neutral materials used for the construction of green roads and highways can absorb temperature and excess emissions released by the vehicles because of their neutralities. This is because of the massive quantity of natural aggregates used during construction. Problems associated with green roads and highways made from carbon neutral materials are incompatibles with land use, geology, topography, substructure, landscape, rainfall, and other physical features. Therefore, physical features, geology, landscape, transportation, and development substructures were measured as crucial problems for national development. Most of the approaches used in this study are based on the context of a green economy and the development of green roads and highways. The USA possesses the highest GDP per capita of US$52,194.90 and Bangladesh possesses the lowest GDP per capita of US$1029.60. This implies that the GDP for USA is 50.70 times higher than that of Bangladesh. The study highlights positive solutions to the above global challenges. It can be concluded that global challenges will be addressed through the concept of green revolutions