Website quality of Malaysian Technical University

University website is the platform for university to interact with people. It is also an interphase for people to infer and getting known about the university. In addition, quality of the university website is vital to let people get positive response to the university. Therefore, university website should be evaluated for better performance. This study evaluate website of Malaysian Technical University (MTUN) on year of 2016 based on the criteria selected using online web diagnostics tools. There are nine criteria selected to measure the website; load time, response time, page rank, traffic, design optimization, page size, number of items, markup validation and broken link. The result shows website of UMP performed better in design optimization, page rank and markup validation. Meanwhile, UTHM performed in page rank, load time and page size. UTEM excellences in response time, number of items and broken link. Lastly, UniMAP performed in traffic criteria only. However, the (MTUN) University website is almost not meets with the criteria that selected with the quality standard that have been suggested.

Dynamic dyssynchrony and impaired contractile reserve of the left ventricle in beta-thalassaemia major: an exercise echocardiographic study.

BACKGROUND: Performance of the left ventricle during exercise stress in thalassaemia patients is uncertain. We aimed to explore the phenomenon of dynamic dyssynchrony and assess contractile reserve in patients with beta-thalassaemia major and determine their relationships with myocardial iron load. METHODS AND RESULTS: Thirty-two thalassaemia patients (16 males), aged 26.8 ± 6.9 years, without heart failure and 17 healthy controls were studied. Their left ventricular (LV) volumes, ejection fraction, systolic dyssynchrony index (SDI), and myocardial acceleration during isovolumic LV contraction (IVA) were determined at rest and during submaximal bicycle exercise testing using 3-dimensional and tissue Doppler echocardiography. Myocardial iron load as assessed by T2* cardiac magnetic resonance in patients were further related to indices of LV dyssynchrony and contractile reserve. At rest, patients had significantly greater LV SDI (p4.6%, control+2SD) increased from baseline 25% to 84% in patients. Δ SDI(exercise-baseline) correlated with exercise-baseline differences in LV ejection fraction (p<0.001) and stroke volume (p = 0.006). Compared with controls, patients had significantly less exercise-induced increase in LV ejection fraction, cardiac index, and IVA (interaction, all p<0.05) and had impaired contractile reserve as reflected by the gentler IVA-heart rate slope (p = 0.018). Cardiac T2* in patients correlated with baseline LV SDI (r = -0.44, p = 0.011) and IVA-heart rate slope (r = 0.36, p = 0.044). CONCLUSIONS: Resting LV dyssynchrony is associated with myocardial iron load. Exercise stress further unveils LV dynamic dyssynchrony and impaired contractile reserve in patients with beta-thalassaemia major

Constraining in reimbursement criteria and the adherence to anti-osteoporosis medications (AOMs) in Taiwan: Urbanization makes the difference

Background: The Bureau of National Health Insurance in Taiwan implemented a new reimbursement scheme incorporating bone mineral density (BMD) criteria on Jan. 1, 2011. This study aimed to investigate a real-life 11-year secular trend of adherence in new AOMs users and evaluated the change of adherence to AOMs therapy in different urbanization areas after reimbursement criteria were restrained. Methods: We used Taiwan's National Health Insurance Research Database to identify new AOMs users as our study population. The AOMs in this study included denosumab, zoledronate, ibandronate, alendronate, raloxifene, and risedronate. The first prescription date of AOMs was defined as the cohort entry date. The adherence rates within one year after initiation were assessed. Results: High adherence (≥75%) in the first year increased markedly after the new reimbursement scheme in 2011, changing from 31.8% in 2008, and 41.7% in 2011 to 54.2% in 2018. On the other hand, low adherence (<25%) decreased from 38.8% in 2008 to 14.6% in 2018. In addition, the switchers increased from 5.9% in 2008 to 9.3% in 2018, indicating a more flexible choice of AOMs. The proportion of high adherence to AOMs was highest in high-urbanization areas, and the proportion increased about two times from 30% in 2008 to 60% in 2018. Conclusion: The implementation of new reimbursement criteria in 2011 was associated with increased adherence to AOMs and the increase was most apparent in high-urbanization areas

Eleven years secular trend of the initiation of anti-osteoporosis medications and subsequent fractures in Taiwan: From 2008 to 2018

Background: Osteoporosis is a common metabolic bone disease that benefits from many newly developed anti-osteoporosis medications (AOMs). Reimbursement policies need to allocate medical budgets properly based on evidence-based data. This study aimed to investigate the 11-year secular trend, focusing on older age and males in this adjustment wave of the National Health Insurance reimbursement. Methods: We adopted a nationwide cohort from Taiwan's National Health Insurance Research Database (NHIRD). Patients undergoing newly initiated AOMs from 2008 to 2018 were included. The AOMs in this study included denosumab, zoledronate, ibandronate, alendronate, raloxifene, and risedronate. Patients <50 years, pathological fractures, missing data, and two AOMs prescribed were excluded. The real-world trends related to subsequent fragility fracture and death within 1 and 3 years were used to evaluate the potential effects due to revision of reimbursement policies. Results: Of 393,092 patients, among them, 336,229 patients met the criteria, whose mean age ranged from 73.3 to 74.4 years, and nearly 80% were female. Further analysis showed a steady increase of AOMs from 5567 (17.1%) and 8802 (27.0%) in 2008–6697 (18.3%) and 10,793 (29.5%) in 2018 for males and 80+ years respectively. The subsequent fragility fracture within one and three years post AOMs initiation was 5.81% and 11.80% in 2018. Conclusion: This study showed an immediate drop in AOMs prescription after the implementation of a new stricter reimbursement policy. It took 5 years to return the annual prescription number

Exercise testing parameters.

*<p>Statistically significant.</p><p>DBP, diastolic blood pressure, SBP, systolic blood pressure.</p

Scatter plot showing a negative correlation between exercise-baseline differences in left ventricular (LV) systolic dyssynchrony index (SDI) and exercise-baseline differences in (a) LV ejection fraction (EF) and (b) indexed LV stroke volume (closed circles: patients, open circles: controls).

<p>Scatter plot showing a negative correlation between exercise-baseline differences in left ventricular (LV) systolic dyssynchrony index (SDI) and exercise-baseline differences in (a) LV ejection fraction (EF) and (b) indexed LV stroke volume (closed circles: patients, open circles: controls).</p

Differences (Δ) between exercise and baseline echocardiographic parameters.

*<p>Statistically significant.</p><p>Abbreviations as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0045265#pone-0045265-t002" target="_blank">table 2</a>.</p

Scatter plots showing (a) baseline left ventricular systolic dyssynchrony index (SDI) at rest, (b) SDI during exercise when target heart rate was reached, and (c) exercise-baseline differences in SDI in patients and controls.

<p>Solid horizontal lines represent the mean, while the dotted line represents the upper limit of normal LV SDI.</p

Regional volume curves, normalized to individual maximum, of the 16 LV segments over a cardiac cycle.

<p>The upper panels show synchronous contraction of the 16 left ventricular segments in a control at rest and during exercise, while the lower panels demonstrate dyssynchronous contraction at rest and its exaggeration during exercise in a thalassaemia patient.</p