The outcome of hospitalized patients with community-acquired pneumonia in Hospital Universiti Sains Malaysia

Background: Community-acquired pneumonia (CAP) remains an important cause of hospital admission. Studies have shown that the mortality of patients admitted with community-acquired pneumonia is high. The outcomes have been shown to be influenced by various clinical variables at presentation. Applications of these variables as predictor of severity have been shown to improve patients management outcome. The outcome of patients admitted due to CAP has not been studied in Hospital University Science Malaysia (HUSM). The main purpose of this study was to evaluate outcome in patients who required admission due to community acquired pneumonia in HUSM and to determine factors that influenced their poor outcome. Methodology: This was a retrospective cohort study between January 2004 to December 2004. Records of patients with community-acquired pneumonia admitted to HUSM were screened. This study included all patients aged more than 12 years old who met the inclusion criteria. The following information; demographic data, initial clinical findings, laboratory investigations and type of antibiotics regime given were recorded into customized data collection sheet. Variables obtained were examined for association with mortality. Severity prediction criteria were formulated from identified variables that showed significant association with mortality. Results: Records of 155 patients' that met the inclusion criteria were evaluated. The mean age at presentation was 62 ± 17 years. The mortality rate was 19.4%. Variables that significantly influenced the mortality on multivariate analysis at presentation were presence of important co-morbid illnesses (OR 11.13; p = 0.001 ), confusion (OR 18.72; p = 0.001) and hypoxaemia (OR 10.62; p = 0.002). Other factors identified were low diastolic blood pressure and random blood sugar greater than 13 mmol/1 with odds ratio of 1.08 (p=0.002) and 6.37 (p=0.007) respectively. The presence of any three of following variables on admission; presence of comorbid illness, confusion, low diastolic blood pressure of s 60 mmHg, low oxygen saturation and random blood sugar equal or greater than 13 mmol/1 was associated with a 46.3 fold increase in death. The suggested predictive severity rule identified 21 of the 27 patients who died as having severe community acquired pneumonia. The sensitivity of the suggested severity model for predicting death was 0. 70 and specificity of 0.95. The rule had a negative predictive value of 0.93. Conclusion: The mortality from community-acquired pneumonia requiring hospitalization in our centre is high compared to previous studies. We found that certain factors that influenced the outcome of our patients were almost similar with other previous studies. We found that the presences of three of the five variables (comorbid illness, confusion, low diastolic blood pressure, hypoxaemia and hyperglycaemia) would allow us to detect patients who at risk of poor outcome

Ciri-ciri perlu ada bagi mencapai ketahanan yang cemerlang dalam sebuah organisasi

Isu ketahanan sesebuah negara menjadi hangat berikutan peristiwa serangan terhadap Pusat Dagangan Dunia di New York pada tahun 2001. Ia menjadi topik perbincangan yang penting di kalangan pemimpin negara, pembuat polisi, ahli akademik serta pelaksana undang-undang berikutan rentetan kejadian bencana alam, serangan pengganas dan krisis ekonomi/kewangan global yang berlaku masa kini. Isu ketahanan, keupayaan dan kemampuan dalam menghadapi sesuatu krisis atau gangguan ini sebenarnya tidak hanya tertumpu kepada ketahanan negara sahaja tetapi boleh merangkumi pelbagai bidang yang lebih luas seperti ketahanan organisasi, persekitaran, ekologi, komuniti, pengoperasian, individu dan lain-lain. Setiap satu bidang ini mempunyai tujuan yang sama iaitu keupayaan dan kemampuan bidang tersebut untuk bertahan dalam menghadapi, mengatasi serta pulih malah, jika perlu, mengadaptasi strategi baru bila mana menghadapi sesuatu krisis atau gangguan (sama ada gangguan kecil atau besar), tetapi tahap ketahanan yang perlu dicapai adalah berbeza mengikut bidang tertentu. Gangguan besar yang dimaksudkan dalam konteks ini termasuklah kejadian bencana alam, krisis ekonomi, serangan pengganas dan kebakaran. Sementara gangguan kecil termasuk kesilapan teknikal, teknologi serta manusia/kakitangan. Perbincangan kertas kerja ini akan tertumpu kepada ketahanan organisasi. Sering kali kedengaran pengurusan sesebuah organisasi mengatakan organisasi mereka mempunyai daya ketahanan organisasi yang cemerlang dalam menghadapi gangguan (kecil atau besar), tetapi kenyataannya, organisasi ini tidak berkeupayaan menangani gangguan tersebut dalam operasi harian mereka kerana tidak mempunyai rangka kerja dan ciri-ciri perlu-ada dalam mencapai tahap ketahanan organisasi yang cemerlang. Organisasi bertahap cemerlang harus mempunyai keupayaan untuk menghadapi risiko, tekanan potensi, kemampuan mengawal dan bertindak balas ancaman sekitarnya untuk bangkit semula selepas sesuatu gangguan dan juga, jika diperlukan, berkebolehan untuk mengadaptasi setiap perubahan persekitaran. Organisasi memerlukan satu rangka kerja sebagai panduan dalam usaha mencapai tahap ketahanan yang cemerlang. Kertas kerja ini akan membincangkan ciri-ciri perlu-ada serta isu-isu yang timbul bagi sesebuah organisasi mencapai tahap ketahanan cemerlang

Impact of price shock of palm oil and rubber toward economy growth of Malaysia / Muhammad Naim Shaharudin

Palm oil currently is the most consumed edible oil the world, with Malaysia and Indonesia being top two producers in the worlds, however the changes to oil palm as the main commodity in Malaysia had decreased the contribution and total number of estate rubber in Malaysia. The price shocks may affect the health of the Malaysian economy since Malaysia is a net exporter of the two commodities. Therefore, the current research aims to examine whether the prices of these commodities affect the economic growth of Malaysia both in the long run and short run. The data collected within 36 years (1980-2016) for price of oil palm, price of rubber and annual economy growth of Malaysia from Malaysia Palm Oil Board (MPOB). The data been analyzed by E-Views through unit root and co-integration test. The result of the research reveals that both variable only has short run relationship toward economy growth and from co– integration test show price of palm oil has positive relationship and statistically significant and affected the economy growth, meanwhile from Granger Causality Test show that price of rubber affected the Malaysian’s economy growth. The conclusion can be drawn that price shock on palm oil and rubber price will affected the economy growth of Malaysia. Government of Malaysia needs to take an action in policy maker, price floor and make variety production of crop through Research and Development

The Macroeconomic Effects of Corporate Income Tax Rate Reductions

This study examines the impact of the corporate income tax rate reduction on the Malaysian macro economy and its relationship with economic growth. The reduction in the tax rate coincides with the Keynesian theory that suggests a government should intervene to halt sluggishness in the economy by lowering the corporate income tax rate or escalating public spending, or both as it has a relationship with economic growth. The government could correct the sluggishness by raising their spending or lowering tax rate to transfer funds from public to private sector in terms of this tax incentive or increase public spending to stimulate aggregate demand for the goods and services in the country. Advocates claim that the country's economic growth during the 1990s was evidence on how this theory works. The multiplying effect of this short-term economic stimulus is that when companies increase their investments: more jobs are created, increase in productivity, boost exports, generate more profits and paying more tax to the Government that will improve budget position and gross domestic product and the economy starts growing again. When the economy starts grow again, more foreign investments both through direct investment and portfolio capital will be attracted to do business in this country as they seek opportunity for profits and growth. Advocates claim that the country's economic growth during the 1990s was evidence on how the theory works. There are many findings published in the developed economies discuss the macroeconomic effect of the corporate income tax rate on the economy and its relationship with the economic growth. However, there is no documented evidence avail so far to address this topic in the Malaysian context and research in this area is still lacking as well. Data collected from published reports by the Treasury Department, the Statistics Department, the Central Bank of Malaysia and cross-checked against the International Monetary Fund publications. A time series econometric analysis was used to study the macroeconomic effect of the reduction in the corporate income tax rate and the relationship with the country's economic growth. This method normally employed by researchers to ascertain the macroeconomic effect of changes in the government policy. The findings indicate that lowered corporate income tax rate had minimal effect on the country's macro economy. All selected macroeconomic variables had insignificant effect with the reduction in the tax rate except for the foreign exchange rate and gross domestic product (GOP). The significant level for both variables is 0.01. The significant increased in the exchange rate might not directly due to the reduction in the tax rate but instead from the changes in the Government monetary policy. The significant increased in the GOP confirms with the Keynesian theory that claim lower tax rate has relationship with the country's economic growth. This study, however, do not supports the application of the Keynesian theory in the Malaysian context especially when the whole world is currently facing with the economic uncertainty. Malaysia currently has not incurred any budget surplus or intention to increase its public debt to finance this tax incentive. Thus the Government has no avail means to finance the short-term reduced in their real income whenever they reduced the corporate income tax rate. This short-term stimulus incentive needs to be backed up either by budget surplus or borrowing money otherwise the nation savings are likely affected which will aggravate the country's future economic growth. Surprisingly, lowered tax rate is found not effective in attracting long-term foreign investments to do business in this country. Whilst the transformation done on the tax assessment system in 2000 was found not significantly improving the country's macro economy but it has significant relationship with the Government Financial Position group. The significant level is at 0.10. The findings are inconclusive for the period under study

Ontology-based islamic banking product information for informed decision making and product innovation / Ahmad Shaharudin Abdul Latiff

The Islamic banks need to remove the grievances on them and gain support of their customers. There were presumptions that the issues were due to the customers’ lack of understanding. Hence, there was need to identify the actual root causes of the issues and the factors that had been impeding the customers’ understanding. The issue of the grievances could be attended by improving the customers’ decision making with the use of information systems. Yet, such systems need to hold the information on the banking products. The information on the Islamic banking products could be modelled in form of a domain ontology. The objectives of this research were to ascertain the real issues of the grievances on the Islamic banks, the effect of lack of understanding of the product on the grievances, and then build a domain ontology on the Islamic banking products which is capable to facilitate customers’ informed decision making and innovation of new products. The research was done qualitatively to identify the issue of the customers’ grievances by identifying the factors that are causing the grievances and also the factors that have been hindering the understanding. Among the factors that had hindered the customers’ understanding was due to the distinct concepts and terminologies, predominant use of Arabic terms, variation of practices by different banks and also the diverse Shariah concepts adopted by products of similar nature. With the use of software engineering approach, the research studied the characteristics of the Islamic banking products to design an ontology on the Islamic banking products. The conceptualised ontology includes knowledge on the prevailing Islamic banking Shariah concepts and contracts, the commercial banking processes and others. It also defined the roles played by the bank and its customers respectively according to the different Shariah concepts. The ontology was evaluated with the use of competency questions related to the information needed for decision making and interviews were conducted with customers, non-customers and also the bank staff. With such ontology, the customers will be supported to make informed decision making which would satisfy their need and the banks may innovate more new products. These would eventually remove the grievances in the long run

Digitizing Wayang Kulit Using Core Elements for Education

This research intends to develop a digital wayang krllit prototype that illustrates how multimedia approach could be used to enhance teaching and learning of Science subject in primary school as well as to preserve wayaizg kulit for younger generation. This research is camed out to tackle the problem related to ineffective teaching approach of Science subject at the primary level by using a multimedia to create a learning environment which is more student-centered instead of teacher-centered. Besides that, this digital wayang kulit prototype is also intended to be used as one of the way to preserve wayang kulit as one of the national cultural heritage so that it could continue to live and appreciated by future generation. The development of the prototype involved the use of three methods; Arrifin methodology, Rapid Application Development (RAD) methodology, and Laudon & Laudon methodology. After the prototype was developed and implemented, user satisfaction evaluation has been carried out by teachers and students from two primary schools. The results of the evaluation indicated that the digital wayang kulit prototype has succeeded in providing a high level of satisfaction among the users in term of usability and user interface

A Study On Ambulance Services And Emergency Care At Local Hospitals: Perception Of Clients And Health Care Providers.

This prospective study attempts to identify and evaluate the clients and other service care providers' perception towards emergency care and ambulance services for the year starting from January to December of 2004 at Hospital University Science Malaysia (HUSM) and Hospital Kota Bharu (HKB), now known as the Hospital Raja Perempuan Zainab II (HRPZ II).Kajian prospektif ini bertujuan untuk mengenalpasti dan menilai tanggapan pelanggan dan kakitangan kesihatan yang lain terhadap perkhidmatan kecemasan dan ambulans

Education for sustainable development in Malaysia: a study of teacher and student awareness

Sustainable development is seen as a modern development idea that is most proactive and practical in addressing the issues of development demand and environmental conservation. This paper examined two variables influencing teachers’ and students’ awareness of education for sustainable development (ESD), namely, school location and school participation in the Sustainable School Environmental Award (SLAAS) Programme. Primary data were gathered from 447 students and 245 teachers of six secondary schools in urban areas and six secondary schools in rural areas which participated in the SLAAS Programme. Results of the statistical analysis revealed a difference in terms of content knowledge, attitude and behaviour between students in rural and urban areas and no difference for the teachers. This meant that the application of ESD as the outcome of SLAAS Programme between urban and rural students is different according to the ESD awareness variable, but not so for urban and rural teachers. Findings also revealed differences with respect to knowledge practice and behaviour for students and teachers according to school participation in the SLAAS where a significant relationship existed for schools that participated in the SLAAS at the national level. These findings might be useful in informing further effort to enhance ESD awareness of the school community particularly through sustainability activities

Summer mid-day-night composition and abundance of zooplankton from Lake Ikeda, Japan

Variations between midday and midnight in the species composition and abundance of the main zooplankton assemblage of Lake Ikeda, a crater-lake were analyzed during the summer of 1986. The protozoans, comprising more than 70% of the whole zooplankton population were the most abundant followed l7y the rotifers (12%), eopepods (8 %) and cladocerans (7 %). Except for the copepods and a few rotifers, most of the other zooplankton were evident at a slightly higher abundance at night. Total zooplankton abundance was highest during early summer but decreased gradually until the end of summer. Species composition was highest in early summer, and persisted until the middle of summer but gradually decreased with rare occurrences of some species at the end of summer, where some species were either rarely sampled or entirely absent from the samples

Adrenal insufficiency resulting from immunotherapy: a rare but life-threatening side effect

A 73-year-old male whom suffers from stage 4 adeno-squamous lung carcinoma with high programmed death-ligand 1 (PD-L1 immunohistochemistry-tumor proportion score (TPS)>50 began his treatment with a type of immune checkpoint inhibitors (ICI) therapy. After 8th cycle of treatment, patient experiences vague symptoms of fever, lethargy and drowsy. Initial working diagnosis was infection and empirical treatment was initiated. Subsequently as patient’s condition did not improve despite appropriate antibiotics, other diagnosis was considered which include adrenal insufficiency and this confirms after checking cortisol level. Hydrocortisone was started promptly and patient clinical condition improved. Decision was to stop ICI treatment interim. Consideration to re-challenge again with ICI may be considered once patient is more fit in the future. Adrenal insufficiency following ICI treatments are rare and misdiagnosed due to its non-specific symptoms. Nonetheless, it comes with high morbidity and mortality. Hence, we wanted to emphasize more on this condition as more elderly patients whom suffers from various type of cancers will be exposed towards ICI treatment.