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Abdulaziz Alsaedi,1 Surianti Sukeri,2 Najib Majdi Yaccob,3 Abdulhadi Almazroea4 1Medical Services, NGHA, Madinah, Saudi Arabia; 2Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; 3Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; 4Medical College, Taibah University, Madinah, Saudi ArabiaCorrespondence: Najib Majdi Yaccob, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia, Tel +6097673000, Fax +6097673370, Email najibmy@usm.myBackground: Although hospital accreditation is recognized as a tool for improving healthcare, there are inconsistent results regarding its impact on healthcare quality. In Saudi Arabia, it is mandatory for all Ministry of Health (MOH) hospitals to be accredited by the Central Board for Accreditation of Healthcare Institutions (CBAHI).Purpose: This study measured the impact of the CBAHI accreditation program on the Institute of Medicine’s (IOM) safety dimension in Madinah.Methods: A cross-sectional study was conducted using retrospective data gathered from a review of hospital records over 60 months (ie, 12 months before, 36 during, and 12 post-accreditation). The data were analyzed using piecewise (segmented) regression analysis.Results: The three indicators (ie: incident reports, medication errors, and nosocomial infection) were continuously improved compared to the data before accreditation, as a results of implementing the CBAHI accreditation program. Therefore, the CBAHI had a significantly positively impacts on MOH hospitals’ safety dimension.Conclusion: Complying with the CBAHI standards can help reduce the rates of incident reports, medication errors, nosocomial infections, and post-admission mortality. This study provides insight for MOH hospitals and opportunities to expand the accreditation program to improve the quality of healthcare services.Keywords: healthcare, hospital accreditation, quality of care, safety, Saudi Arabia

Education evolves and progresses globally in a technology-driven world, highlighting the integration of VUCA elements of volatility, uncertainty, complexity, and ambiguity in lessons. Learners are molded to equip themselves with the world and real-life knowledge in their readiness to adapt to the VUCA world. Global education consists of preparing learners for the VUCA world. This study aimed to investigate the current English as a Second Language (ESL) teaching practices and the ESL teachers’ incorporation of VUCA elements in ESL lessons. This study was conducted quantitatively using a survey questionnaire. This study was administered to 30 ESL teachers from different secondary schools in a district in Malacca. The results from the questionnaire revealed that the ESL participants had positive perceptions toward the adaptation of VUCA in the current ESL lessons. Most of the ESL teachers agreed that they adapted VUCA elements into the activities during lessons, although some showed uncertainty about their knowledge and understanding of VUCA. From the high agreement levels in the findings, it can be concluded that the ESL teachers agreed that VUCA elements through problem-based, digital-based, collaborative, and challenging activities in English lessons are beneficial to assist students’ meaningful and autonomous learning. Based on these findings, implications were made for enhancing ESL teachers’ knowledge, understanding, and skills in adapting VUCA in lessons in response to global education demand.

Modern trends lead to innovative technologies in education, including the birth of digital and gamified learning or gamification. In English language classrooms, meaningful teaching and learning are significant to developing students’ English proficiency, focusing on linguistics and communicative competence. Various language activities and games are employed in lessons to instil anticipation for language learning. However, the concerns are how gamified learning is applied in English as a Second Language (ESL) lessons and the factors assisting students’ meaningful English learning. Therefore, this paper, based on the review of past literature, explores the application of gamification or gamified learning in ESL teaching and learning. Based on the review, the researchers highlighted that motivation, engagement, and competition in learning through a gamification approach could assist students’ meaningful ESL learning. It is found that gamification has its own motivation structure to arouse students’ active participation. The elements in games that enhance students’ engagement might improve students’ learning. Although competition naturally arouses students’ participation during ESL lessons, the findings indicated the need to create a safe environment to prevent students from feeling demotivated. This review paper contributes to the literature surrounding gamified ESL lessons.

Due to the implementation of global education and global citizenship education in the 21st century, more focus is given to developing teachers’ global competence in English language teaching. This study aims to examine the perceptions of English as a Second Language (ESL) teachers of (1) global competence integration in English teaching and (2) the professional development programs organized by the Ministry of Education (MOE) for their global competence development. A web-survey questionnaire was distributed to 172 Malaysian ESL teachers based on selected criteria. The data collected were analyzed descriptively. The main findings indicated that most ESL teachers showed positive perceptions regarding the importance of global competence and integration in English lessons. Although 83.1% of the 172 participants agreed to have attended 10 or more programs related to developing global competence, the descriptive analysis found the ESL teachers’ moderate knowledge and understanding of what constitutes global competence. In contrast, a high agreement was found regarding their perceptions of the importance of global competence in ESL lessons. Also, most respondents revealed the lack of support from the MOE through professional development programs specifically structured to develop ESL teachers’ global competence. The findings served as a template for a larger-scale study that focuses on implementing global competence in the local non-western context.

Purpose of the study: This study examined the predictors of intention in career development, specifically the intention of applying for promotion among Malaysian excellent teacher candidates. Methodology: The premise of the theoretical analyses in this study was based on the Theory of Planned Behavior. The correlational study design was employed to determine the relationship among the variables that ascertain any prediction towards the intention to apply for promotion. 500 respondents were sampled and consist of male (226) and female (274) teachers who are qualified to apply for promotion. Confirmatory Factor Analyses (CFA) was performed to test and validate the measurement model. Main Findings: This study had ascertained that gender does moderate relationships among the study's independent variables and the dependent variable. The result also indicates that the theory of planned behavior is applicable in predicting intention to apply for promotion. For teachers in Malaysia, the intention to apply for promotion will increase if the expectation of others towards applying for promotion also positively increase. Applications of this study: Gender-related specific assessment can be applied within the teachers’ performance appraisal system, particularly for the evaluation on ‘Guru Cemerlang’ or Excellent Teacher Award by the Ministry of Education in Malaysia. Novelty/Originality of this study: There is a scarcity of recent studies on the intention of Malaysian teachers to apply for promotion. By using the novel approach of Theory of Planned Behavior and the combination of structural equation modeling analyses, gender was found to moderate the relationship between the expectation of others and their intention to apply for promotion.

Research in the globalization era has emphasized the importance of global competence and its integration into language teaching and learning. This article discussed the current focus of global education through the integration of global competence in English as a Second Language (ESL) in Malaysia. The country’s global competence development among ESL teachers and students, along with its integration into English lessons, were identified, satisfying the need to achieve quality education. The global competence integration of ESL teachers will meet the fourth United Nations Sustainable Development Goal (SDG 4), which strives for quality education. The global education goals form a critical starting point of this article, which articulates the connection to the targets in SDG 4. Hence, this article investigated the significance of global competence in language teaching and learning in Malaysia. Overall, the integration of global competence among ESL teachers can provide life-long learning, enhancing the quality of education.

This research investigates motivations to donate to charity among Muslims living in the UK. The research conducts in-depth interviews and explores charitable causes which Muslims support while examining the extent to which Muslims integrate religion into charitable donation behavior. Participants support a range of charitable causes – both internationally and locally that allows them to develop a sense of attachment and interdependence with others. Findings point to five ways in which religiousness manifests itself in the context of charitable behavior: role modelling, seeking rewards in the hereafter, seeking self-satisfaction, avoiding guilt and seeking congruence. The paper discusses implications for theory and for practice.

Hepatitis C virus (HCV) is a leading cause of cirrhosis and hepatocellular carcinoma worldwide. Several viral and host factors related to viral response have been reported in the era of treatment with pegylated (PEG)-interferon and ribavirin.To quantify histological findings from patients with chronic HCV using computerized morphometry and to investigate whether the results can predict response to medical treatment with peg-interferon and ribavirin.We followed 58 patients with chronic HCV infection with METAVIR score F1 and F2 in our liver unit who were grouped according to treatment response sustained viral response (SVR) and non-SVR. Liver needle biopsies from these patients were evaluated and histological variables, such as inflammatory cells, collagen fibers and liver architecture, were quantified using computerized morphometrics. The pathologist who performed the histomorphometric analysis was blinded to previous patient clinical and histological information.Histomorphometric variables including the density of collagen fibers were collected. The number of inflammatory cells in the portal space and textural variable were found to be statistically significant and could be used together in a formula to predict response to treatment, with a sensitivity of 93% and a 100% specificity.Histomorphometry may help to predict a patient's response to treatment at an early stage.

Background Colorectal cancer is a significant cause of mortality and morbidity in western countries. Polypectomy reduces the incidence and mortality of colorectal cancer. Following polypectomy, recommendations regarding the frequency and duration of surveillance rely mostly on features of the resected polyps and are summarized in various gastroenterological societal guidelines. In this study, we aimed to delineate the accuracy of current post-polypectomy surveillance recommendations and to check whether active intervention would lead to an improvement in accuracy and consistency with societal guidelines. Methods We prospectively collected polypectomy reports over a 3-month period in 2 tertiary medical centers. We then performed an intervention that included: 1) presentation of results from 1st phase; 2) re-affirming the guidelines in a departmental meeting; 3) addition of a dedicated reporting form for post-polypectomy surveillance recommendations in the patients’ electronic medical file. Finally, we conducted a second prospective collection of post-polypectomy recommendations, over a second 3-month period. Results Prior to the intervention, 76% of the colonoscopies with polypectomy had a recommendation for surveillance, compared to 85% after the intervention (P=0.003). Prior to the intervention, 65% of patients received a recommendation consistent with societal guidelines, compared with 78% after the intervention (P=0.001). Conclusion Intervention, including re-affirmation of the current guidelines and creation of a dedicated reporting platform, significantly increases the number of follow-up recommendations after polypectomy and their consistency with societal guidelines.

Mixed orientation marriages refers to marriages involving a partner who is gay or lesbian while the other partner may be heterosexuals or bi-sexual as well. Parties to such marriage are men and women who are gender fluid or transgender who wish to maintain their relationship that exist before or after the existing marriage commenced. In United States of America, there are as many as three million of such marriages – perhaps even more. Homosexuality or bisexuality is illegal in Malaysia and thus, the existence of mixed orientation marriage in Malaysia often hide behind a normal marriage. It has been difficult to quantify such marriage unless the courts that handle divorce matters identified such grounds to these divorces. Plus, mixed orientation marriage is an oppression towards the wives who are heterosexual. This paper will dwell on; (a) the definition of mixed-orientation marriage; (b) the factors that cause a bisexual husband to pursue a marriage with a heterosexual wife without her knowing of the fact ; (c) to find out the effects of such relationships to a heterosexual spouse in terms of her health, emotion and psychological impacts; (d) To identify the legal redress on heterosexual wife and her rights in such marriage; and (e) to analyse some strategies and the legal remedies available to deal with such kind of marriages, which denied the vary basis of contractual relationship acknowledge by civil and sharia marriages laws in Malaysia.

It is a difficult task to measure the importance of South West Arabia to the Ottomans and the British prior to and during World War I. Early history of imperial expansion in the area which followed by constant conflicts and involved a considerable amount of diplomacy and intrigues with the natives may suggest that South West Arabia was considered as equally as important to other areas within the empire. However from the beginning of the 20th century South West Arabia was considered something of a backwater. It may also be observed that during the First World War the position of South West Arabia to these powers in relation to other war theatres remained practically the same except in the episodes of British action at Sheikh Said and the Ottomans advance at Lahej. The Indian authorities who believed that the Ottomans were contemplating a move to Sheikh Sa‘id with the aim of acting against British Perim with the telegraphic communication, convoys and shipping, only two miles away, took the opportunity of the movement of the troops through the Red Sea to attack the fort of Sheikh Sa‘id. The action was quickly taken before obtaining official approval from the Admiralty and the India Office in London. The action was taken due to the persistent reports of the Ottoman reinforcement with guns had been sent to Sheikh Sa‘id, further to take advantage of the presence of transports with troops for Egypt. Subsequently future military operations at Sheikh Sa‘id and the Red Sea appeared to dominate the discussions among the authorities at the India Office, the Admiralty, the Indian authorities and the Resident at Aden throughout the war without materializing any further military action.

Traditional teaching and learning process referring to chalk-and-talk has become outdated in lessons. Teachers and learners are exposed to various task-based process to encourage a better participation among learners throughout the lesson. One of the most common and preferred teaching strategies is the use of language games to aid the teaching of various skills. The growth of digital learning tools and web applications being used in lessons taking the use of language games to a modern and advanced platform for learners to engage in lessons. The use of interesting and suitable materials along with the various approaches when conducting language games during lessons helps to cater to learners' needs and interests on the subject-matter especially in learning grammar in context. Many researches have used various language games to show its effects on learners ' knowledge, competency and motivation in learning a language, focusing on different targeted language areas and skills such as grammar. Therefore, this paper, based on reviews of past literature, will explore the use of language games in teaching and learning grammar, with reference to second language (ESL) learners. The findings indicate the beneficial usage of language games to teaching and learning of grammar in for ESL learners. This study is useful to prove the importance of language games as a teaching strategy to help enhance learners ' English grammar acquisition.

Idiopathic hypereosinophilic syndrome (HES) is a rare, heterogeneous disorder characterized by a strikingly high eosinophil count (>1,500 cells/μL), over a long period of time (>6 months), with end organ damage. We present a 60-year-old patient with idiopathic HES with isolated liver involvement, a rare systemic disease and a rare solid organ involvement. The patient had a thorough investigational work up until HES was established, including liver biopsy. He needed intensive immunosuppressive treatment at first with steroids, then with azathioprine in conjunction with a low dose of steroids. After 16 years of follow-up, the patient showed no evidence of liver dysfunction. To the best of our knowledge, this is the longest follow-up for a patient with HES-associated chronic hepatitis. Our observation suggests that, with appropriate treatment, liver involvement in HES may be well controlled without deterioration to advanced liver failure.

Nitrate is one of the primary nutrients associated with sedimentation and fuels eutrophication in reservoir systems. In this study, water samples from Bukit Merah Reservoir (BMR) were analysed using a combination of water chemistry, water stable isotopes (δ2H-H2O and δ18O-H2O) and nitrate stable isotopes (δ15N-NO3- and δ18O-NO3-). The objective was to evaluate nitrate sources and processes in BMR, the oldest man-made reservoir in Malaysia. The δ15N-NO3- values in the river and reservoir water samples were in the range +0.4 to +14.9‰ while the values of δ18O-NO3- were between -0.01 and +39.4‰, respectively. The dual plots of δ15N-NO3- and δ18O-NO3- reflected mixing sources from atmospheric deposition (AD) input, ammonium in fertilizer/rain, soil nitrogen, and manure and sewage (MS) as the sources of nitrate in the surface water of BMR. Nitrate stable isotopes suggested that BMR undergoes processes such as nitrification and mixing. Denitrification and assimilation were not prevalent in the system. The Bayesian mixing model highlighted the dominance of MS sources in the system while AD contributed more proportion in the reservoir during both seasons than in the river. The use of δ13C, δ15N, and C:N ratios enabled the identification of terrestrial sources of the organic matter in the sediment, enhancing the understanding of sedimentation associated with nutrients previously reported in BMR. Overall, the nitrate sources and processes should be considered in decision-making in the management of the reservoir for irrigation, Arowana fish culture and domestic water supply.

ObjectiveAnti-tumor necrosis factor (Anti-TNF) therapy improves the prognosis and reduces the morbidity and mortality associated with many chronic inflammatory autoimmune diseases. However, as it is linked to an increased infection risk, appropriate vaccination is required. The study aimed at investigating the vaccination status of patients receiving Anti-TNF therapy and physicians' perceptions of and views about vaccinating these patients.MethodsA sequential explanatory mixed-methods approach was used. The study comprised a quantitative, retrospective drug utilization review for determining institutional consumption of Anti-TNF therapy and an assessment of vaccination status in patients prescribed Anti-TNF therapy to audit physicians' adherence to Anti-TNF therapy-related vaccination recommendations. Patient data from electronic medical records (EMRs) obtained from tertiary care hospitals between September 2015 and September 2017 were used. Further, a qualitative study using a phenomenographic approach with semi-structured interviews of 12 physicians was carried out to explore the physicians' perceptions, views, and recommendations of vaccinating patients who are undergoing Anti-TNF therapy and identifying factors that may cause poor adherence to vaccination recommendations.ResultsForty-three of 310 patients receiving Anti-TNF therapy were vaccinated. Infliximab was the most frequently prescribed agent, accounting for 96.7% of total orders. Eight of the 12 physicians stated that they were aware of vaccination guidelines and seven viewed pre-Anti-TNF therapy vaccination as essential because of the high infection risk and claimed to incorporate it in their daily practice. Barriers to adherence included ignorance of recommendations, workload, vaccine unavailability, and advanced disease state.ConclusionAlthough the recommendations published by professional medical societies emphasized the importance of vaccination before initiating Anti-TNF therapy, few patients were vaccinated. Medical administration in hospitals should develop policies, procedures, and guidelines for vaccination; implement education programs for physicians and patients and procure vaccines in a timely way to improve their use.

This work aims to compare the effects on the morphology and optical properties of ZnO NRs (Eg: 3.33 eV) when coupled with metal oxides of various bandgaps, i.e. CuO (Eg: 1.72eV), NiO (Eg: 3.76 eV), and Al2O3 (Eg: 7.07 eV). The amount of metal oxide deposited on the hydrothermally grown ZnO NRs was controlled by the UV irradiation duration of the photo-oxidation process. The deposition of CuO on ZnO NRs produced flake-like structures while Al2O3 deposition created tubular structures. However, when coupled with NiO, ZnO NRs were uniformly covered by a thin layer of NiO without morphological change. The optical bandgap of ZnO NRs was modified slightly from 3.20 eV to 3.17, 3.28 or 3.16 eV after coupling with CuO, NiO, or Al2O3, respectively. The strongest enhancement of IUV/Ivis ratio in the RTPL spectra of ZnO NRs was achieved from Al2O3 coupling.

The need of high performance and high range devices is increasing drastically as rapid growth is accumulating in Information and communication technology (ICT). In Gb/s transmission system high speed optical transmitter requires high power for transmitting information at long distance. The high power transmitters consumes enormous power and exhibits heating effect in devices, leakage power problems as well due to that the device response became slower. In this work, high performance and high range design of 100Gb/s optical DPSK transmitter is designed in 20 nm Field Programming Gate Array (FPGA) using multiple IO standards. The high performance and high range design is achieved using proposed technique by integrating the two IO Standards one is Pseudo Open Drain (POD) and other is PointtoPoint Differential Signaling (PPDS). The POD IO standards is consuming less power feature, while PPDS IO Standard provides the faster response time. It is determined that using proposed technique the 95% power consumption is recorded with 85% improved efficiency in response time for mid-range infrared frequencies such as 200 GHz, 500 GHz, 90 GHz, 5 THz and 20 THz. The designed energy efficient optical transmitter can be assimilate with further optical components in optical communication systems to high performance and high range future generation networks.

Thermoacoustic refrigerator is an alternative cooling system, which is environmentally safe due to the absence of any refrigerants. The resonator tube of the system is of great importance; its design and dimensions influence the design and performance of the entire refrigerator. This work describes the design of the stack and the resonator along with the influence of its dimensions on the performance of the standing-wave thermoacoustic refrigerator. The resonator consists of two tubes, one larger than the other, characterized by the diameter ratio of the smaller over the larger diameter. A Lagrange multiplier method is used as a technique to optimize the coefficient of performance (COP) of the system. Results show that the resonator small diameter tube dissipates a minimum acoustic power at a diameter ratio of 0.46, which is 17 percent less than the published values. Moreover, the results show that the resonator length increases gradually with the increase of the mean design temperature which leads to the increase of the total acoustic power dissipated by the resonator, reducing the COP of the standing-wave thermoacoustic refrigerator.

The rapid growth of population cause to increase demand of electricity supply. The increasing growth in population is an alternative solution to this concern, in which, human’s activity can contribute to generate electricity through energy-based released activities such as walking. Walking is an example of human activities that may do every day. When a person walks, the energy may lose to the surface in form of impact and vibration. This energy will be tapped and will convert to electrical energy. Therefore, the feasibility study on potential pedestrians’ footstep-based energy harvesting can be analyzed. UiTM Pulau Pinang has been selected as a case study because by doing in UiTM Pulau Pinang it can be seen clearly the percentage of successful of the study. Sidewalk in UiTM Pulau Pinang has the potential to be a basic medium for the study. Primary data was collected through site observation and measurement site. Meanwhile, the secondary data was by distributing questionnaire to the community in UiTM Pulau Pinang. From the questionnaire collected, the frequency of using sidewalk for each zone can be obtained. Distribution according to zones have been created to simplify the process of collecting data. After data from both methods used is obtained, the potential of footsteps-based energy harvesting can be analyzed.

This paper is to study the quality of sidewalk facilities. In order to promote sustainable mobilization through public transportation, a good quality of sidewalk facilities is actually should be first been reviewed. The pedestrian sidewalk is very important to be improved. A quality sidewalk is a basic infrastructure in order to encourage public to choose public transports as their main medium of mobilization. Questionnaire survey are applied as to assess the critical dimension of current pedestrian facilities and to analyze the pedestrian perception of sidewalk quality. UiTM Pulau Pinang campus been selected as case study. The method uses in this study are qualitative and quantitative method. Qualitative method refer to observation and taking picture on the study area, meanwhile quantitative method refers to questionnaire survey distributed to 100 respondents including students, admin staffs and also lecturers. All the collected data have been analyzed by using Statistical Package for Social Science (SPSS). The result indicates that, there are 3 factor of dimension and 13 items are significant for this study area. The dimensions are Physical Facilities, Accessibility and Safety. From these 3 dimensions, the most critical dimension is Physical Facilities. Therefore, the most dissatisfaction dimension by the respondents is Physical Facilities with the gap value is -19.070. Based on the final research findings through both methods, it is found that the existing sidewalks are not in good quality. There are recommendations based on the 3 factors, which is provide the roof protection from bad weather along the sidewalk in UiTM Pulau Pinang campus, needs to increase the levels of pedestrian accessibility for sidewalk and ramps and lastly needs to provide more street lamp that in good condition along the sidewalk and more separate the sidewalk from vehicle.

Chronic constipation (CC) is a common disorder in the elderly population globally and is associated with comorbidities and negative implications on the quality of life. Constipation prevalence varies in different studies, primarily owing to the nonuniformity of the diagnostic criteria. However, 15%-30% of individuals aged >60 years are diagnosed with CC. Primary care physicians are the main healthcare providers that manage constipation in elderly patients in parallel with increased population aging and increased prevalence of constipation. Physical inactivity, polypharmacy, chronic medical conditions, rectal hyposensitivity, and defecatory disorders all play a role in the pathogenesis of CC in elderly patients. Detailed anamnesis, particularly history related to chronic medication use, with digital rectal examination may assist in identifying constipation causes. Additionally, blood tests and colonoscopy may identify organic causes of CC. Physiologic tests (i.e., anorectal manometry, colonic transit time with radiopaque markers, and defecography) can evaluate the physiologic function of the colon, rectum, and anus. However, generally, there are several causes of constipation in older patients, and an individualized approach is recommended. Treatment of chronic idiopathic constipation is empiric, based on the stepwise approach. Lifestyle advice, adjustment of chronic medications, and prescription of laxatives are the first steps of management. Several laxatives are available, and the treatment is evolving in the last decade. Biofeedback is an effective therapy especially for defecatory disorders. This review aimed to summarize the most updated knowledge for primary care physicians in the approach and management of CC in elderly patients.

Hepatobiliary disorders are frequent extraintestinal manifestations in inflammatory bowel disease (IBD) and may appear at any time point during the natural course of the disease. Conceptually, these manifestations can be categorised as: (1) disorders that have an association with IBD; (2) diseases directly and structurally related to intestinal inflammation; (3) diseases related to the adverse effects of IBD treatment; and (4) disorders stemming from the metabolic derangements caused by IBD. The clinical presentations of these disorders range from a mild transient elevation of liver enzymes to liver failure and death. Given this wide differential diagnosis and spectrum of severity, it is understandable that the evaluation of patients with IBD with a hepatobiliary abnormality is often challenging. In this review, we present a concise summary of the common hepatic manifestations seen in patients with IBD and focus on the relevant practical issues encountered by gastroenterologists caring for patients with IBD. A practical clinical approach to the evaluation of liver enzyme abnormalities in patients with IBD is provided based on the predominant enzyme elevation pattern (hepatocellular vs cholestatic), before presenting a working scheme for the prevention of hepatitis B virus (HBV) reactivation in patients with IBD receiving immunosuppressive medications. Finally, we specify several laboratory alterations seen in patients with IBD that can potentially interfere with the interpretation of liver function tests, before defining the specific circumstances when a referral for a hepatological consultation is required for further assessment.

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease that encompasses esophageal symptoms along with eosinophilic infiltration of the esophageal epithelium. EoE is an evolving disease that has been a subject of interest to many researchers since the first studies recognized this condition as a new and distinct clinicopathological entity 25 years ago. Clinical presentation in adult patients may include dysphagia, food impaction, vomiting, and reflux symptoms. The diagnosis of EoE is based on the combination of clinical history suggestive of esophageal dysfunction, endoscopic features indicative of the disease, and histology revealing eosinophilic infiltration of the esophageal epithelium that persists after a trial of proton pump inhibitor therapy along with the exclusion of other disorders that may be associated with esophageal tissue eosinophilia. The interplay between EoE and gastroesophageal reflux disease (GERD) is complex, and differentiating these two conditions continues to be difficult and challenging in clinical practice. The mainstay treatment includes dietary modification, topical steroids, and/or endoscopic dilation. The primary care physician (PCP) plays an important role in improving patient care and quality of life by ensuring early referral and participating in management and follow-up. This article provides an overview of the current knowledge base regarding the disease including epidemiology, genetics, pathogenesis, common clinical presentations, the interplay between EoE and GERD, diagnostic approaches, and therapeutic options available to the PCP.

Hypoacusis is the most prevalent sensory disability in the world and consequently, it can lead to impede speech in human beings. One best approach to tackle this issue is to conduct early and effective hearing screening test using Electroencephalogram (EEG). EEG based hearing threshold level determination is most suitable for persons who lack verbal communication and behavioral response to sound stimulation. Auditory evoked potential (AEP) is a type of EEG signal emanated from the brain scalp by an acoustical stimulus. The goal of this review is to assess the current state of knowledge in estimating the hearing threshold levels based on AEP response. AEP response reflects the auditory ability level of an individual. An intelligent hearing perception level system enables to examine and determine the functional integrity of the auditory system. Systematic evaluation of EEG based hearing perception level system predicting the hearing loss in newborns, infants and multiple handicaps will be a priority of interest for future research.

In today's complex communication environment, emotional intelligence, communication effectiveness, and strategic alignment remain a key topic of concern among managers and employees worldwide. Communication effectiveness is a key for organization’s performance and progress. The interrelationship between emotional intelligence, communication effectiveness, and strategic alignment plays a vital role in the growth and success of organizations of Iran. Emotional intelligence (EI) and communication effectiveness are proposed as an important predictor of key organizational outcomes including strategic alignment. The paper is undertaken to understand the relationship between demographic variables (age and gender) and emotional intelligence, and communications effectiveness to improve strategic alignment in the organizations of Iran. The dimension of emotional intelligence in this study includes: happiness and optimism. Data (N = 82) for this study were collected through questionnaires and the participants were managers in Agriculture Bank and Educational Administrations of Iran. The aim of this paper is to assess the emotional intelligence and communication effectiveness and relationship with strategic alignment. The results showed emotional intelligence can impact on communications effectiveness through demographic variable and also communication effectiveness has a positive impact on strategic alignment. Key words: Emotional intelligence, communications effectiveness, strategic alignment, demographic factors.

This paper describes the synthesis of Yttrium Aluminum Garnet (YAG), Y3Al5O12 nanoparticles (NPs) and their application in Enhanced Oil Recovery (EOR). YAG NPs were synthesized by using sol-gel method. These NPs were then synthesized by using Thermal Gravimetric Analysis (TGA), X-Ray Diffraction (XRD) and Transmission Electron Microscope (TEM). The monophasic YAG having crystallites size of 40.98 nm and 40.91 nm were obtained at annealed temperature of 1100 °C and 1200 °C as determined by XRD. Magnetic measurement results show that initial permeability of YAG increased and relative loss factor decreased at high frequency. In this paper, the feasibility of application of YAG nanofluid in EOR was determined by measuring oil-nanofluid interfacial tension and also viscosity of the nanofluid. YAG with 0.5 wt% yielded the lowest IFT. It can be concluded that the synthesized YAG nanoparticle has great potential in EOR applications in the near future.

Background Neonatal splice variant of Nav1.5 (nNav1.5) is a known tumor-associated antigen (TAA), re-expressed in adult aggressive breast cancer/tumor biopsies positive for lymph node metastasis. Accurate assessment of nNav1.5 protein in breast cancer cells/tissue is important in validating its potential value as a prognostic or predictive marker. Mouse polyclonal antibody (pAb) against nNav1.5 has been obtained. Herein, the ability of the pAb to selectively recognize nNav1.5 protein was evaluated on a panel of cell lines using fluorescence immunostaining. Methods Mouse mammary cell line, 4T1, human breast cancer cell lines, MDA-MB-231, and MCF-7 as well as human non-cancerous epithelial cell line, MCF-10A were acquired (ATCC) and maintained. Accordingly, the cells were cultured in its respective complete media supplemented with 5% fetal bovine serum (FBS), L-glutamine (4mM) and penicillin-streptomycin (1%) at 37 °C in a 5% CO2, relatively humidified atmosphere. For fluorescence immunostaining, the cells were seeded overnight on a cover-slip in 24-well culture plate, fixed, permeabilized and stained with primary pAb followed by incubation with secondary antibody conjugated with AlexaFluor-555. Fluorescence microscopy was conducted using Leica Inverted DMi8 Fluorescence and captured using DFC 365 FX Camera. Results Red fluorescence (secondary AlexaFlour-555) signals were prominent in aggressive human breast cancer cells, MDA-MB-231 and aggressive mouse mammary cancer cells, 4T1; both cell lines are known as positive for nNav1.5 expression. On the contrary, in less aggressive human breast cancer cells, MCF-7 and non-cancerous human breast epithelial cells, MCF-10A which lacks nNav1.5 expression, red fluorescence signals were not detected similar to the no-primary and no-primary/secondary controls. Conclusions The obtained mouse pAb against nNav1.5 could serve as a useful tool in validating nNav1.5 protein expression in breast cancer cells. Legal entity responsible for the study The authors. Funding Ministry of Energy, Science, Technology, Environment and Climate Change, Malaysia (Science Fund CIPPM/6113610). Disclosure All authors have declared no conflicts of interest.

In construction industry, rapid development will increase the demand versus supply which leads to increasing the production of construction waste. Recycle Concrete Aggregate (RCA) was proposed as the one of the component in the pervious concrete for sustainability in the construction industry to reduce the wastage. The pervious concrete was function as a medium to allow the water penetrate through porosity of the concrete and avoiding water from pooling at the surface. Therefore, this study is conducted to investigate the properties of the pervious concrete by infiltration test and compression strength test using Recycle Concrete Aggregate (RCA) and Natural Aggregate (NA) as the main composition. The cement aggregate ratio of 1:3 and 1:5 were choosing as variable to produce the workability pervious concrete that similar to conventional concrete. The replacement of NA with RCA is likely a viable option for structural use.

Stress management remains a key topic of concern among managers and employees worldwide. The most significant contribution of this research is the discovery the stress management related to communication effectiveness, and on the other hand, communication effectiveness related to job satisfaction within organizations of Iran. Communication effectiveness is a crucial factor for organization's performance and growth and plays an important role in stress management, and job satisfaction of today’s competitive organizations. According to literature on business area and logical arguments we proposed that communication effectiveness can moderators the link between stress management with job satisfaction. The respondents consist of 133 form educational administrations and Agriculture Bank of Iran. The method that used to maintain the stress management, communication effectiveness and job satisfaction is Kendall’s coefficient of concordance. Results indicate stress management of emotional intelligence has a positive relationship with communication effectiveness and also communication effectiveness plays a key role in job satisfaction.

The infrared radiation from Nd:YAG laser (1604 nm, 8ns, 125mJ, 15.6MW) is focused by IR lens (20cm) to irradiate Cu and Al (99.99%) target in air. The angular distribution and arrival of ions are collected by Faraday Cups (FC). For anisotropic investigation, the cups are arranged at different positions (5cm and 10cm) from the targets at different angles (5° , 30° , 45° , 60° and 90° ) with respect to the normal on targets surface. Faraday Cups are biased at -100V and the ion current signals are obtained on Tektronix TDS 3054B Digital Storage oscilloscope (500 MHz) through integrated circuit. The average kinetic energy of ions is also calculated. Maximum arrival rate of ions is observed at angle 5° and minimum ions flux is at angle 90° to normal on the target surface. The results show that the plume is peaked strongly in forward direction. The laser matter interaction is good for the laser based ion sources generation, which can produce a collimated beam of ions because of forward peaking.

Electroencephalogram (EEG) is used to measure the bioelectric potential on the brain scalp. The recorded EEG signal can have different types of artifacts and the interpretation of a noisy EEG signal is difficult. In this research work, a simple method is proposed to minimize the artifacts present in the EEG signals recorded while perceiving a pure tone. The recorded EEG signal can contain artifacts, such as movement artifacts, muscle contraction artifacts and saturation artifacts. In the proposed method, fractal dimension based features with different interval length and time-domain based energy features were extracted from the EEG signals with and without simulated noise. Using the extracted features, neural network models were developed to classify the EEG signal as a normal or a noisy signal. Further, the performance of the model is also evaluated in terms of classification rate. From the results, it is observed that the neural network model developed with the combined fractal dimension features of interval length 2,3,4,5 and 6 with frame size 128 has the highest classification accuracy of 95.5%.

An auditory loss is one of the most common disabilities present in newborns and infants in the world. A conventional hearing screening test's applicability is limited as it requires a feedback response from the subject under test. To overcome such problems, the primary focus of this study is to develop an intelligent hearing ability level assessment system using auditory evoked potential signals (AEP). AEP signal is a non-invasive tool that can reflect the stimulated interactions with neurons along the stations of the auditory pathway. The AEP responses of fourteen normal hearing subjects to auditory stimuli (20 dB, 30 dB, 40 dB, 50 dB and 60 dB) were derived from electroencephalogram (EEG) recordings. Higuchi's fractal method is applied to extract the fractal features from the recorded AEP signals. The extracted fractal features were then associated to different hearing perception levels of the subjects. Feed-forward and feedback neural networks are employed to distinguish the different hearing perception levels. The performance of the proposed intelligent hearing ability level assessment found to exceed 85% accuracy. This study indicates that AEP responses to the auditory stimuli to the normal hearing persons can predict the higher order auditory stimuli followed by the lower order auditory stimuli and consequently the state of auditory development of subjects

The primary focus of this study is to develop a hearing ability level assessment system using auditory evoked potential signals (AEP). AEP signal is a non-invasive tool that provides auditory pathway information content and its stimulated interactions with neurons. To record the hearing perception levels at different sound intensity levels, namely, 20 dB, 30 dB, 40 dB, 50 dB and 60 dB in both the ears of a normal subject, a simple AEP based hearing perception level protocol has been proposed. The detrended fluctuation analysis (DFA) has been used to estimate the fractal values of different hearing perception levels of the recorded AEP signals. The extracted fractal features were then associated to different hearing perception levels of a subject and neural network models were developed. The maximum classification accuracy of the developed neural network models for the left and right ears are observed as 78.57% and 80.71% respectively. From the classification accuracy, it has been inferred that the neural network models are able to discriminate the five distinct hearing perception levels of a normal hearing person.

In this paper, a simple analysis has been made to distinguish the normal and abnormal hearing subjects using acoustically stimulated EEG signals. Independent power spectral features of the brain rhythms (delta, theta, alpha, beta, and gamma) were extracted from the recorded EEG signals. The extracted power spectral features were then associated to the auditory perception and neural network models for the left and right ears were developed. The result indicates that the gamma-power derived from the electrodes can be deployed independently to characterize the EEG dynamics of normal hearing and abnormal hearing perception of a person. The effects of brain rhythms on perceiving two different auditory frequencies namely 500 Hz and 1000 Hz their associated auditory response have been investigated. From the network models, it has been inferred that the neural network models were able to discriminate the normal hearing and abnormal hearing persons.