Recent publications
Objective
This national study assessed the economic impact of treating patients with antimicrobial resistance (AMR) pathogens within Malaysia’s Ministry of Health (MoH) hospitals.
Design
A cross-sectional study design and top-down costing approach, analysing Malaysian diagnosis-related group (DRG) data for AMR patients admitted to MoH hospitals from 2017 to 2020.
Setting and participants
A total of 1190 cases were identified using International Statistical Classification of Diseases-10 version 2010 codes for AMR pathogens.
Outcome measures
The study aims to estimate direct healthcare costs for treating AMR patients. Costs per admission were calculated based on each patient’s length of stay (LOS). A binary logistic regression model identified cost determinants, with significant factors (p<0.05) further analysed using a multivariate multiple logistic regression. ORs with 95% CIs were determined, and treatment costs were categorised as above or below the annual national base rate.
Results
Findings showed that costs are influenced by the volume of cases identified through DRG codes and LOS, which averaged between 21.7 and 36.4 days. Median admission costs for AMR patients ranged from RM12 476.28 (IQR RM 15 655.93) to RM19 295.11 (IQR RM20 200.28). Both LOS and total costs increased annually, from RM3 711 046.10 in 2017 to RM9 700 249.08 in 2019. Patients over 56 years old and those with severity levels II and III were more likely exceeding the national base rate.
Conclusions
These findings, explaining 9.3% of the variance in the regression model, can inform policies to reduce the economic burden of AMR and improve patient outcomes, highlighting the need for a comprehensive strategy to address this global health threat.
Acacia invasion has shown a negative impact on the water resources of forest streams. Therefore, studies need to be conducted demonstrating the importance of managing invasive species to preserve stream and forest ecosystems. This study investigates the effects of Acacia invasion on the water quality of Kerangas forest streams in Brunei. Water samples were collected from an Acacia-invaded (IN) stream and a non-invaded (NIN) stream during the dry season at three locations along each stream. Water properties, including pH, conductivity, salinity, total dissolved solids (TDS), phosphate, nitrate, ammonia, and nitrite, were analyzed using in situ and laboratory methods. The results showed that Acacia invasion significantly increased pH (from 4.01 to 5.68), nitrate (by 256%), and phosphate (by 250%) levels, while reducing conductivity (by 208%) and salinity (by 20%) compared to non-invaded streams. These findings suggest that Acacia invasion alters water chemistry, potentially posing risks to aquatic ecosystems. Effective management strategies, such as controlling Acacia spread and restoring native vegetation, are essential to mitigate these impacts and preserve forest water resources.
Wireless network-on-chip has emerged as an innovative and effective solution to meet the growing demands for efficient data communication in multi-core processors. It offers an alternative approach to overcoming scalability challenges in communication systems. This study offers an in-depth performance assessment of network-on-chip and wireless network-on-chip multicore system architectures in the context of a 64-core and 256-core system. The analysis includes four synthetic traffic patterns—random, shuffle, butterfly, and transpose—giving a detailed overview of how each impacts system performance. Key metrics such as data transmission delay, network throughput efficiency, and energy consumption were thoroughly analyzed. To support our conclusions, simulations were conducted on 64-core and 256-core for NoC and WiNoC multicore system. The results highlight the effectiveness of the WiNoC multicore system design, demonstrating its advantage in network performance based on the simulations carried out with Noxim. WiNoC’s enhanced ability to handle higher traffic loads and achieve lower latency across all traffic profiles showcases its advantage over the traditional NoC setup.
Oryza sativa L. or commonly known as rice belongs to the family of Poaceae. In Malaysia, rice is normally cultivated either as lowland or upland rice. The present study was undertaken with the objective to characterise and document the variations in anatomical traits of leaf, midrib and the root of 22 lowland and 22 upland rice accessions. The leaf, midrib and root anatomy of the lowland and upland rice accessions have the same fundamental anatomical structure. Stomata were found abundant on the abaxial surface as compared to the adaxial surface in general. It is interesting to note that the upland rice accessions, in general, had higher stomatal density on the adaxial surface. In addition, the upland rice accessions, in general, had larger root and stele diameters as compared to lowland rice accessions. The variation in root diameter is associated to the changes in the number and size or width of cortical cells and stele diameter. Wider stele may allow higher plant water status under water deficit, due to higher hydraulic conductivity. In addition, greater xylem
diameter (indicated by larger stele diameters) is linked to better axial conductance, which improved rice’s ability to absorb and hold more water during water-limiting conditions. These traits are possibly advantageous for upland rice for efficient
water capture, especially under water-deficit stress.
This study aimed to assess the organization, infrastructure, workforce, and adherence to protocols in neurocritical care across low- and middle-income countries (LMICs), with the goal of identifying key gaps and opportunities for improvement.
We conducted a cross-sectional survey of 408 health care providers from 42 LMICs. The survey collected data on the presence of dedicated neurointensive care units, workforce composition, access to critical care technologies, and adherence to evidence-based protocols. Data were analyzed using descriptive statistics, and comparisons were made across different geographical regions (East Asia and the Pacific, Europe and Central Asia, Latin America and the Caribbean, the Middle East and North Africa, and South Asia and sub-Saharan Africa) and economic strata [low-income countries (LICs), lower middle-income countries (LoMICs), and upper middle-income countries (UMICs)].
Only 36.8% of respondents reported access to dedicated neurointensive care units: highest in the Middle East (100%), lowest in sub-Saharan Africa (11.5%), highest in LoMICs (42%), and lowest in LICs (13%). Access to critical care technologies, such as portable computed tomography scanners (9.3%; UMICs 11%, LICs 0%) and tele-intensive care unit services (14.9%; UMICs 19%, LICs 10%), was limited. Workforce shortages were evident, with many institutions relying on anesthesia residents for 24-h care. Adherence to protocols, including those for acute ischemic stroke (61.7%) and traumatic brain injury (55.6%), was highest in Latin America and the Caribbean (72% and 73%, respectively) and higher in UMICs (66% and 60%, respectively) but remained low in LICs (22% and 32%, respectively).
The study highlights critical gaps in infrastructure, workforce, and technology across LMICs, yet it also underscores the potential for improvement. Strategic investments in neurointensive care unit capacity, workforce development, and affordable technologies are an unmet need in resource-limited settings. These findings offer a road map for policymakers and global health stakeholders to prioritize neurocritical care and reduce the disparities in patient outcomes globally.
Rice is an important staple food and the main source of income and livelihood, especially for rural communities in Malaysia. However, the area under rice cultivation in Malaysia has decreased due to poor quality of rice fields due to low productivity and climate change. Agroforestry is a system that combines trees with crops or livestock. It not only counteracts the effects of climate change by increasing the resilience of agriculture, but also combats poverty, food security, and land degradation. The aim of this study was to determine the awareness and perception of rice farmers in Siburan, Sarawak, toward agroforestry. The data for the study were obtained through questionnaire‐based interviews in Kampung Skuduk and Kampung Chupak. Statistical tests were used to analyze and compare the data. Farmers’ knowledge of agroforestry practices was limited, especially among non‐agroforestry practitioners. There is no significant income difference between agroforestry practitioners and non‐agroforestry practitioners as agroforestry is practiced on a small scale and for household consumption as there are no commercial market opportunities for the products. Governmental or non‐governmental organizations should organize educational activities on agroforestry to disseminate information on these practices appropriate to the education level and age group of the target farmers. Awareness raising and information dissemination activities are important as lack of awareness hinders the implementation of agroforestry, for example, through awareness campaigns and training programs on agroforestry. The results of this study will serve as a guide for the authority to plan measures to increase the knowledge and importance of the agroforestry sector and the implementation of agroforestry.
The urgent penetration of the Industrial Internet of Things (IIoT) in industrial sectors has fostered unmatched benefits in terms of efficiency, productivity, and overall performance. Although current security frameworks already offer a sound level of protection, they do not adequately scale to the growing diversity and number of devices integrated into the Industrial Internet of Things. They rely on static, centralized network organization and management, which cannot ensure data integrity across a huge number of highly distributed devices. The proposed research provides insight into an innovative end-to-end security solution model, which caters to the needs of IIoT via the introduction of the blockchain. The current security solutions seem to fail in terms of security, scalability, data efficiency, integrity, and the actual needs of IIoT. As a result, the top chance of a cyberattack or similar threat remains high. The proposed work demonstrates that IIoTs may benefit from blockchain frameworks because blockchains reuse existing security mechanisms, enable transaction validation without central trust, and implement appropriate authorization. Additionally, the IIoT environment can benefit from implementing security frameworks that reflect their characteristics. In this paper, an overall solution that employed the decentralized setup of blockchain was proposed for authentication, authorization, and data integrity for all devices. Our approach is free from the need for any central authority. That mechanism is based on smart contracts that enforce security policies. Our framework allows for the switching of any access rule at any time, as well as it can immediately react to some suspicious behavior. In our paper, we proposed some lightweight cryptographic schemes, and Data management overhead which could fit any device. Moreover, our algorithm for the blockchain implementation is hybrid because this approach incorporates all the best features of the private and public implementation due to the individual blocks containing feasible information rather than the entire history.
The treatment of brackish peat water presents a formidable challenge due to its elevated levels of natural organic
matter and salinity which not only hinder conventional water treatment systems but also necessitate an innovative
approach to effectively manage these complex water characteristics. In response to these challenges,
electrocoagulation has emerged as a promising alternative by utilizing electrochemical processes to efficiently
destabilize and eliminate contaminants in brackish peat water sources. As such, this review aims to unveil
challenges of aluminium electrodes fouling and passivation in electrocoagulation treatment system for sustainable
water management of coastal Borneo peatlands. Several studies in the literature highlight that key operating
parameters, especially electric current and voltage which play a pivotal role in influencing the overall effectiveness
of these electrocoagulation systems. Although aluminium electrodes demonstrate high contaminants
removal efficiencies, it remains susceptible to fouling and passivation due to contaminant buildup and oxide
layer formation which increase electrical resistance and decrease electroactivity of redox reactions. The novelty
of this review lies in its focused synthesis of fouling and passivation dynamics through the integration of Tafel
plot analyses and advanced characterization techniques, particularly Energy Dispersive X-Ray (EDX) spectroscopy.
Furthermore, a thorough understanding of the adsorption mechanisms, particularly through the interaction
between aluminium hydroxides and contaminants is essential for enhancing system efficiency and mitigating
fouling. Additionally, optimizing the electrocoagulation treatment system and conducting a detailed analysis of
adsorption mechanisms, particularly through Tafel plot analysis are pivotal for enhancing the system efficiency.
Advanced analytical methods such as Energy Dispersive X-Ray (EDX) spectroscopy provide deeper insights into
floc composition that essential for improving contaminants removal strategies. Overall, this review offers a
focused assessment on the interplay between brackish peat water and electrocoagulation in order to provide a
foundation for future research aimed at developing sustainable treatment systems for coastal Borneo peatlands.
The discussion about how to use instructional humor in class to promote teaching and learning efficiency has always been a concern of researchers in recent decades. The present project summarizes extant studies on instructional humor and provides a detailed review of research findings. First, the definition and classification of instructional humor are overviewed. Then, the study introduces three theoretical frameworks, namely Instructional Humor Processing Theory (IHPT) and other two alternative models, which, respectively, based on Self-Determination Theory (SDT) or from an integrative perspective of cognition and affection, explaining how humor works in education settings. Based on the theoretical clarification of instructional humor, the paper further reviews existing empirical evidence regarding teachers’ use of humor in class and its impact on students’ learning, with emphasis on explaining inconsistencies in previous conclusions and identifying limitations in extant relevant works. The detailed analysis and comparison of previous results regarding instructional humor offer potential directions for further relevant research. Finally, the study concludes with feasible advice for teachers to maximize the positive benefits of humor in class.
Masyarakat Iban mempunyai cara pandangan dunia yang tersendiri dalam menginterpretasikan kepercayaan mereka terhadap dunia dan kehidupan. Amalan kepercayaan masyarakat Iban mengenai kewujudan susunan alam didorong oleh Pengarap Lama, iaitu ajaran agama nenek moyang terdahulu yang menjadi platform terawal yang membentuk pemikiran mereka pada ketika itu. Kepercayaan tersebut berkait rapat dengan pengaruh alam semula jadi yang membentuk manifestasi kebudayaan mereka. Oleh itu, penulisan artikel ini adalah bertujuan untuk menganalisis pengaruh alam dalam pembentukan kosmologi masyarakat Iban di Sarawak. Kajian ini mengaplikasikan kaedah pendekatan kualitatif berbentuk etnografi berdasarkan pemerhatian biasa, pemerhatian turut serta dan temu bual informan secara mendalam melalui teknik ingatan kolektif. Pensampelan kajian ini menggunakan teknik pensampelan bukan kebarangkalian, iaitu informan yang ditemu bual merekrut informan lain yang dikenalinya serta mempunyai bidang kepakaran yang berkaitan dengan kajian ini. Kajian mendapati bahawa pengaruh alam semula jadi adalah penting dalam membentuk kosmologi (susunan alam semesta) dan membantu masyarakat Iban mencorakkan cara pandangan dunia mereka yang tersendiri. Kajian ini diharapkan dapat menjadi rujukan tentang cara pandangan dunia masyarakat Iban di Sarawak dalam pembentukan kosmologi dalam masyarakat mereka.
The safety, stability, and long-term performance of reinforced concrete (RC) structures depend significantly on soil-structure interaction (SSI), a critical phenomenon governing the dynamic relationship between soil and structural behaviour. SSI plays a pivotal role in seismic design, influencing the stiffness, damping, and natural frequency of structures, yet its application in practical design remains underutilized due to challenges in modelling and integrating code provisions. This review synthesizes existing knowledge on SSI, emphasizing its impact on buildings, bridges, and foundations under static and dynamic loads. It highlights advancements in analytical, numerical, and experimental modelling methods, such as finite element analysis and discrete element methods, and evaluates their effectiveness in capturing the complex interactions between soil and structural systems. The review identifies key gaps, including a lack of unified guidelines in international codes, inadequate integration of SSI in real-world design processes, and limited exploration of its role in emerging engineering challenges like sustainability and climate resilience. Historical seismic events, such as the Kobe and Loma Prieta earthquakes, are analysed to underscore the detrimental consequences of neglecting SSI considerations. Additionally, the review discusses recent innovations, including the application of machine learning and advanced computational tools, and their potential to enhance the accuracy and efficiency of SSI analysis. This study offers actionable insights for improving design practices, such as adapting SSI frameworks for structures on soft soils and incorporating dynamic interactions in seismic design codes. It concludes with a call for interdisciplinary collaboration and future research into novel SSI applications, including its integration with smart sensing technologies and sustainable infrastructure design. This review bridges the gap between theoretical advancements and practical applications of soil-structure interaction (SSI) by synthesizing current knowledge, identifying critical research gaps, and proposing innovative solutions to enhance structural resilience, sustainability, and seismic safety.
Graphical Abstract
We examined the relationship between socioeconomic status (SES) and endorsement of honor. We studied the SES-honor link in 5 studies (N = 13,635) with participants recruited in different world regions (the Mediterranean and MENA, East Asian, South-East Asian, and Anglo-Western regions) using measures that tap into various different facets of honor. Findings from these studies revealed that individuals who subjectively perceived themselves as belonging to a higher (vs. lower) SES endorsed various facets of honor more strongly (i.e., defense of family honor values and concerns, self-promotion and retaliation values, masculine honor beliefs, emphasis on personal and family social image, the so-called street code). We discuss implications of these findings for the cultural dynamics linked to SES.
This research addresses the critical need for robust usability evaluation tools in Wearable Virtual Reality Educational Applications. We developed a comprehensive set of Wearable Virtual Reality Educational Applications usability heuristics through a multi-stage process. Initial heuristics were established through a literature review. Validation occurred in three phases, first with academics and industry practitioners (n = 25), second with experts in academics and industry (n = 15), and third with end-user schoolteachers (n = 15) and finally, refinement based on feedback from all phases. Expert validation surveys refined the heuristics based on feedback regarding utility, clarity, ease of use, and the need for additional checklists. The revised heuristics received positive feedback from experts in human–computer interaction and virtual reality, as well as school teachers, indicating their effectiveness in addressing usability issues. This research establishes a foundation for standardised WVREA usability practices, providing a valuable tool for the WVREA development community. Future exploration could involve longitudinal studies and developing additional user interface-focused heuristics.
This paper proposes a sustainable competitiveness indicator for the state of tourism vulnerability in the Malaysian tourism market. Further investigation has also been done on the time-frequency and lead-lag relationship of the indicator with tourism development and economic growth. The resultant indicator is consisted of 12 variables, identified based on the pillars of sustainability and competitiveness to extract a common vulnerability component using a dynamic approximate factor model. The model’s accuracy rate was at a promising 92% based on the variable importance assessment using random forest algorithms. Through the implementation of bivariate wavelet coherence analysis, the empirical results indicated that the constructed indicator has a positive leading role in Malaysian tourism development and economic growth. This indicator can be embedded within an early warning system to signify vulnerabilities in the Malaysian tourism market.
Endolaryngeal microsurgery is a well-established procedure, with proper laryngeal exposure is critical for success. However, there are instances where achieving complete visualization of the laryngeal inlet, particularly the anterior commissure, can be challenging, termed as difficult laryngeal exposure (DLE). The Laryngoscore, introduced in 2014, can accurately predict DLE and assist in preoperative planning. We report a case of DLE encountered during transoral laser microsurgery in a 50-year-old obese woman with bilateral vocal fold paralysis following total thyroidectomy and describe the maneuvers applied, which led to successful surgery. This case underscores the importance of the role of Laryngoscore in preoperative assessment and discusses the useful maneuvers in managing DLE.
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