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To address an imbalance between congested specialist hospitals and underutilised district non-specialist hospitals, Ministry of Health Malaysia introduced Cluster Hospital (CH) in 2014. Following successful implementations from countries with similar healthcare system such as Hong Kong, and Australia, CH merges hospitals to establish an integrated network of specialist and non-specialist hospitals through shared resources, streamlined services and care coordination. A qualitative study was conducted to explore perceived barriers and boosters towards CH implementation and its sustainability among healthcare providers via semi-structured focus group discussions and in-depth interviews with purposefully selected respondents from the first six CHs. An Interview protocol was developed based on Consolidated Framework for Implementation Research (CFIR) covering five domains; intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. This paper will only highlight the perceived barriers in the intervention characteristics domain. A total of 274 participants from varying professions were interviewed. Interviews were audio-recorded, transcribed and thematic analysis was performed. In this domain, barriers to implementation were found within three constructs; complexity, design quality & packaging, and cost. Issues highlighted include intervention was designed with vague guidelines & policies, distance and travel costs within a CH, medical record safety, huge capital and operating cost involved. It was found that adaptation of evidence-based interventions needs to take into account the local context of an organisation for the implementation to be successful and produce desired outcomes. Thus, these perceived barriers raised by ground-level implementers should be considered and acted upon when strategising towards CH sustainability.

This study aimed to determine the effect of different solvents and temperatures on the citral concentration and antioxidant properties of freeze-dried lemongrass powder extract. Freeze-dried lemongrass powder was extracted using three solvent extractions of hexane, petroleum ether, and methanol at three different temperatures of 27°C, 40°C, and 60°C. Citral concentrations of lemongrass extract were identified and quantified by gas chromatography and flame ionization detector (GC-FID) while antioxidant properties were determined using analysis of total phenolic content, DPPH radical scavenging activity, and ferric reducing antioxidant power (FRAP) assay. Results from this study show that the methanol extract at 40°C obtained the highest total yield (37.70 ± 1.78%). Hexane was found to be the most effective solvent to extract citral compound from freeze-dried lemongrass powder with 239.08 ± 1.28 mg/mL of concentration at temperature extraction of 27°C. However, the efficiency of hexane decreasing upon heating. This study suggested that the solvent extraction using methanol at 40°C is the efficient extraction for total phenolic compound (7419.33 ± 110.78 mg GAE/L), DPPH radical scavenging activity (87.45 ± 2.70%), and FRAP assay (52.11 ± 0.07 TE/mL) of freeze-dried lemongrass powder.

The main objective of this study was to determine effect of different heat pretreatments on chemical and antioxidant properties of Melon Manis Terengganu (MMT) seed oil. The seeds were treated with four different heat pretreatment which were untreated (control), roasting, steaming and microwaving. Then the MMT seed oil was extracted from each treated seed using conventional extraction method. The chemical tests determined on the MMT seed oil were free fatty acid (FFA), iodine value (IV), saponification value and fatty acid composition. The antioxidant properties for MMT seed oil evaluated was total phenolic content (TPC), 1,1- diphenyl-2-picrylhdrazyl (DPPH) scavenging capacity and Ferric reducing antioxidant power (FRAP). It was found that different heat pretreatments of MMT seed significantly (p

Public health activities under district health offices (DHOs) play a major role in Malaysia’s fight against COVID-19. This article aims to describe and illustrate the public health activity pathway in combating the COVID-19 pandemic, and a team of public health workers who are familiar with DHO work settings was created in April 2020 for that purpose. Review of documents and the Ministry of Health’s updates was carried out, followed by a series of discussions with stakeholders. Based on the steps in the outbreak investigation tasks, the flow of activities from January to May 2020 was listed in line with the phases of the country’s National Movement Control Order 2020. Results show that the activities can be classified into three different sections—namely, the main action areas, category of cases, and level of care. The main process flow of activities comprised the case management and support activities. Case management flow was split into tasks for patients under investigation and persons under surveillance, while the support services existed throughout the phases. The pathways illustrate that the progression of the pandemic translated directly to changes in the pattern of activities, with additional subgroups of activities in accordance with all imposed guidelines.

Moringa oleifera seed oil is a promising medicinal oil and converting it into a functional food emulsion is of current interest to widen its consumption. This study was aimed to investigate physicochemical properties and stability of M. oleifera seed oil-in-water emulsions as affected by interaction between polysaccharide i.e. xanthan gum (XG), guar gum (GG), carboxymethyl cellulose (CMC) and emulsifier i.e. sodium caseinate (NaCas) and whey protein isolate (WPI). Significant (p < 0.05) lower pH values in XG-WPI (4.98) and XG-NaCas (4.72) emulsions were observed as opposed to other emulsions (5.19-5.40). The interaction between XG-WPI and XG-NaCas has resulted in significant (p < 0.05) higher apparent viscosity values (at 0.42s-1) of their respective emulsions with 35.10 and 10.75 Pa.s respectively, as compared to other emulsions (0.35–0.85 Pa.s). These desirable characteristics of pH and viscosity profile had favoured an excellent creaming stability (no phase separation) of the emulsions. Regardless of emulsifier used, XG emulsions exhibited a significant (p < 0.05) higher scavenging activity (34.84 – 41.52%) towards 1,1-diphenyl-2-picrylhydrazyl free radicals than other emulsions. Total oxidation values (11.18 – 24.93) under an accelerated oxidation period (48 hours, 60°C) were more influenced by peroxide value rather than anisidine value. All WPI emulsions and CMC-NaCas emulsion showed significant (p < 0.05) low total oxidation values relative to other emulsions. All emulsions however showed no significant difference in their turbidity loss rate (1.2 – 3.3 x 10-3). These findings have made possible of producing a good quality of a functional food emulsion based on M. oliefera seed oil, particularly when the system was stabilized by XG-WPI. This was mainly due to their positive interaction that has affected on pH and viscosity of emulsion, which eventually led to a good stability towards creaming and inhibition of lipid oxidation.

Biopolymer interaction in oil-in-water (o/w) emulsions has been demonstrated to positively modify the emulsion physicochemical properties which lead to desirable stability. The present work focused on the effect of pea protein isolate (PPI), pectin, carboxymethyl cellulose (CMC) and their interaction on physicochemical properties and oxidative stability of o/w emulsions using a mixture design approach. The emulsions were prepared with 40 % sunflower oil stabilized with 1 % of PPI, pectin and CMC, respectively, as well as their mixtures according to a simplex-centroid design (10 points). The pH values for all emulsions were within acidic condition (3.22 to 4.66) and increased significantly (p 96%) and insignificant lack of fit (p>0.05) of the fitted models, this study also proved that the mixture design with regression modelling was useful in elucidating PPI, CMC and pectin interactions and also able to empirically predict the responses to any blend of combination of the components.

introductionCOVID-19 has became an unprecedented crisis from December 2019 and declared as pandemic by WHO in March 2020. Malaysia recorded its first case on 24th January 2020. To contain the outbreak, Malaysian government implemented Movement Control Order (MCO) effective 18th March 2020. Hulu Langat District Health Office (PKDHL) reported its first case on 2nd March 2020. Not long after, it was declared as red zone district (having reported more than 40 cases). As of 22nd April 2020, 456 cases were reported. This poster describes the processes involved from case investigation to contact tracing. Methodology[Refer to Poster]. Results[Refer to Poster]. ConclusionIntroduction of MCO and early contact tracing during pandemic are effective to contain the spread of Covid-19 as evidenced by the marked reduction of cases and contacts following implementation of MCO.

IntroductionPublic health activities under District Health Office (DHO) played a major role in Malaysia’s fight against COVID-19. ObjectiveTo understand the COVID-19 outbreak response activities at DHO in combating the pandemic from a provider's perspective. Materials and MethodsReview of literatures and verification with experts in the field were done before finalizing the framework (Figure 1). The study defined the activities by health care workers at DHO from 16 January until 12 May 2020 in line with the country’s response to COVID-19 Pandemic. ResultsThe framework (Figure 2) describes the overview flow of patient and community care from case notification until they were released from surveillance in keeping with the prevention and control strategies for COVID-19.Within the respective outbreak phases (Figure 3), there were three main sub frameworks of activities (Figure 2) identified namely Patient under Investigation (PUI), Person under Surveillance (PUS) and concurrent relevant support activities. The activities continued and expanded or reorganised from phase 1 to 2 and 3. DiscussionThe increasing number of days in the pandemic translated directly to the increasing number of activities with different complexities. There were further additional sub activities catering to Standard Operating Procedures, guidelines and newly imposed policies. The framework is useful to determine resources required by DHO and can be extended to other DHOs to show the varieties of adoption and adaptation in outbreak response. The findings allow opportunities for future research in COVID-19 disease management and valuations. ConclusionPublic health activities in combating the COVID-19 pandemic by the providers were notable. The outbreak response activities at DHO varied and evolved by phases in accordance to the local occurrences

IntroductionCluster Hospital (CH) initiative groups hospitals together whereby resources, facilities, manpower and equipment can be shared in order to collaboratively align patient flow and clinical services under the governance of the Ministry of Health (MOH), Malaysia and State Health Departments. This paper aims to exemplify the application of CFIR to systematically assess multilevel implementation contexts of the CH initiative for identifying barriers and boosters influencing its implementation, effectiveness and sustainability. MethodologyThis was an exploratory study using the qualitative methodology. 247 healthcare providers fulfilling inclusion criteria were purposively selected from 6 CHs. The respondents represented varying professions ranging from hospital directors, specialists, medical officers (MO) to nurses, assistant medical officers (AMO), to clerks, record officers and drivers. All the respondents had personal experience in working in a CH and have participated in CH activities as part of their daily responsibilities for at least 3 months. 47 focus group discussions and 10 indepth interviews were conducted between March and May 2018 using a semi-structured guide. Informed consent for their participation and audio recording were obtained prior to all interview sessions. The interviews were transcribed verbatim and analysed thematically using the CFIR for all 5 domains, which were 1)Implementation process 2)Intervention characteristics, 3)Outer setting, 4)Inner setting, and 5)Characteristic of individuals. This paper will focus on some of the findings in only the ‘Implementation process’ domain. Results[Refer to Poster]. ConclusionCFIR allowed for a comprehensive exploration of all aspects of intervention implementation through a systematic approach. The complexity of implementation process could be evaluated for clear identification of factors that were perceived as either barriers or booster to implementation. Stakeholders should fine-tune future CH implementation and strategic planning for expansion guided by these perceived boosters and barriers identified to achieve CH sustainability.

The COVID-19 pandemic that emerged in 2019 has inflicted numerous clinical and public health challenges worldwide. It was declared a public health emergency by the World Health Organization and activated response teams at almost all Malaysian healthcare facilities. Upon activation of the National Crisis Preparedness and Response Center in January 2020, the National Institutes of Health Malaysia established a COVID-19 operation room at the facility level to address the rise in COVID-19 infection cases each day. The National Institutes of Health COVID-19 operation room committee formed a workforce mobilization team for an effective and efficient mobilization system to fulfill requests received for human resource aid within the Ministry of Health Malaysia facilities. Selected personnel would be screened for health and availability before mobilization letters and logistics arrangements if necessary. The workforce from the National Institutes of Health, consisting of various job positions, were mobilized every week, with each deployment cycle lasting 2 weeks. A total of 128 personnel from the six institutes under the National Institutes of Health were mobilized: tasks included fever screening, active case detection, health management at quarantine centers, and management of dead bodies. A well-organized data management system with a centralized online system integration could allow more rapid deployment and answer some of the key questions in managing a similar pandemic in the future. With improving infected COVID-19 cases throughout the country, the National Institutes of Health COVID-19 operation room was effectively closed on June 15, 2020, following approval from the Deputy Director-General of Health.

The seafood processing industry is bringing in a lot of waste every year around the world However crustacean rsquo s residues contain valuable compounds such as calcium carbonate that could potentially be used as a sunscreen Thus Polymesoda erosa shells were discovered and calcium carbonate was synthesized for the use in dermal applications The properties of Polymesoda erosa shells have been characterized by Fourier Transform Infrared Ray FTIR and Cytotoxicity tests Emulsions were formulated and tested on Visible Ultraviolet UV Vis Spectroscopy The results showed the shells that were dissolved with MnCl portrayed a higher tendency to be sun protective than FeO and the unmodified shell Therefore the use of waste from Polymesoda shells will not only add value to the by products but also help reduce environmental Therefore the formulation of emulsions synthesized from crustacean rsquo s shells is designed as a new hybrid in cosmetics products and improves the skin s protective efficacy against UV rays

Fringescalesardinella or TambanSisik bones have been discovered can be utilized as sunscreen agent in cosmeceuticals. Its flesh is the main ingredient in keropoklekor or fish crackers in Malaysia and the bones contained very high hydroxyapatite (HAp), (Ca10(PO4)6(OH)2) compound which exhibit as UV light absorber. The percentage yields obtained from the hydrothermal extraction consist of 41.2 ± 0.66 % (w/w) of HApwhich was almost half of the dry weight of 100 g samples.The additional of manganeseand ferum,initiated the novel sunscreen materials from hydroxyapatite-Fe and hydroxyapatite-Mn doped (modified bones). The unmodified HAp recorded with SPF 20 and modified HAp-Mn measured with SPF 40. Modified HAp-Fe emulsions were recorded with SPF 50 as the highest SPF value. Therefore, the bones have been characterized using Fourier Transform Infrared Radiation (FTIR)spectroscopy and x-Ray diffraction (XRD).The results obtained clearly indicated that the HAp existence in waste of Fringescalesardinella bones with addition of FeCl2which exhibits high potential as sunscreen compared to manganese and unmodified bones. Thus, the utilization of waste from the fish bones not only produce value-added products from low-cost resources, but also help in reducing pollution to the environment and preserved the global sustainability.

The aim of this study was to investigate the effect(s) of a mixture ofNigella sativaseeds (N. sativa; black cumin or fennel) and honey on (i) the modulation of cardiovascular disease (CVD) risks among hypercholesterolemic and healthy subjects; and (ii) to assess the lipid-soluble antioxidants capacity of samples using the photochemiluminescence (PCL) method. Sixty-five subjects, aged twenty-five to fifty-eight, were enrolledand assigned to three groups. Two groups of healthy andhypercholesterolemic subjects were supplemented with N. sativa seeds and honey at 50 mg/kg (body weight) daily for three months. The third group served as control (healthy subjects without supplementation). Fasting blood samples were taken at baseline and again after three months of supplementation to measure (i) total cholesterol (TC), (ii) triglycerides (TG), (iii) low density lipoprotein-cholesterol (LDL-c), (iv) high density lipoprotein-cholesterol (HDL-c), (v) blood glucose, and (vi) hemoglobin concentrations. The findings were significant (p  0.05),indicatingthat N. sativa seeds mixed with honey had hypolipidemic, antiobesity and hypotensive effects.Results showed significant reductions in TG (20.1%), TC:HDL-c (12.3%),accompanied by increased HDL-c (15.0%) among healthy subjects.Supplementation also significantly decreased TC (6.2%), TG (13.3%), TC:HDL-c (19.5%),with increased HDL-c (8.4%) in the hypercholesterolemic group. Furthermore, there were significant reductions in body weight, body mass index and body fat by 2.3%, 2.2%, 4.5%, and by 1.8%, 1.9%, 4.5% in healthy and hypercholesterolemic subjects, respectively. Blood pressureslowering werealso observed in hypercholesterolemic subjects with significant reductions in systolic blood pressure (3.9%) and diastolic blood pressure (5.5%). There were no significant effectsfromsupplementation on blood glucose or hemoglobin concentrations. It is postulated that the positive effects observed may be due to antioxidant activity. The combination of of N. sativa seeds with honey showed higher synergistic effectswhen compared withsupplementation ofN. sativa seeds or honey on their own. Overall, these findings suggest that a mixture of N. sativa seeds with honey hasbeneficial effects in loweringthe citedrisk indicators for cardiovascular disease as a natural source of antioxidant activity; thus aidingthe maintainence of health bylowering CVD risk factors.

This research was undertaken to investigate the effect of Roselle (Hibiscus sabdariffa. L) extract on the physical properties and stability of extra virgin olive oil emulsions. Four different emulsions were prepared with methanolic Roselle extract (0.01 and 0.02%) and 0.02% BHT (commercial antioxidant) as well as without the extract/ antioxidant (control). The physical properties were studied in terms of pH, droplet size distribution, microstructure, viscosity and stability towards phase separation and lipid oxidation (under accelerated oxidation at 60°C for 10 days). The emulsions with Roselle extract was found to exhibit lower polydispersity and more uniform droplet size as compared to control and BHT emulsions. The highest viscosity was observed for the emulsion with 0.02%. The BHT emulsion was the most unstable towards phase separation after 15 days of storage at 5°C. A protective effect of Roselle extract against lipid oxidation in the emulsions was clearly observed at 0, 2, 8 and 10 days of accelerated storage (at 60°C) with considerably low total oxidation values (5.4 to 13). All emulsions showed insignificant deterioration with peroxide value < 20 meq/kg after oxidation period. This study provided important preliminary data on possibility of applying Roselle extract (which is known to content a significant amount of bioactive compounds) in producing functional food emulsions with acceptable properties and stability. Keywords: antioxidants, emulsion, roselle extract, stability, properties

This study was conducted in order to determine the physical properties and stability of mayonnaise-like emulsions as affected by modified yam starches. Native yam starch was modified via pre-gelatinization and cross-linking phosphorylation procedures. The emulsions (50% oil dispersed phase) were prepared with 0.3% native potato, native yam, pre-gelatinized yam and cross-linking phosphorylation yam starches. The droplet size of surface weighted mean diameter was found to be significantly (p < 0.05) lower in the sample with cross-linking phosphorylation yam starch as compared to other samples. Moreover, the viscosity of the sample with pregelatinized yam starch was observed to be higher than that of other samples. The phase separation stability was low in the freshly prepared and stored (45 days, 5°C) emulsions containing native yam starch. This study thus generally suggested that modified yam starches were more suitable (i.e. better physical properties and stability) to be used as stabilizers in a similar system i.e. light mayonnaises, rather than a native yam starch., {"references":["L. Jayakody, R. Hoover, Q. Liu, and E. Donner, \"Studies on tuber\nstarches. II. Molecular structure, composition and physicochemical\nproperties of yam (Dioscorea sp.) starches grown in Sri Lanka,\" J.\nCarbohyd Poly. 2007, vol 69, pp. 148-163.","J. Bao, and C. J. Bergman, \"Starch as An ingredients : Manufacture and\nApplications- in Starch in Food (Structure, Function and Applications),\n(Eliasson, A., ed) Woodhead Publishing Limited, Abington Hall,\nEngland, 2004, pp. 258 - 283.","J. Singh, O. J. McCarthy, H. Singh, P. J. Moughan, and L. Kaur,\n\"Morphological, thermal and rheological characterization of starch\nisolated from New Zealand Kamo Kamo (Cucurbita pepo) fruit - A novel\nsource,\" J. 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Silva, \"Gelling\nproperties of extruded yam (Dioscorea alata) starch,\" J. Food Chem.\n199, vol 67, pp. 123-127.","K. N. Waliszewski, A. A. Maria, A. B. Luis, and A. M. Jose, \"Changes of\nbanana starch by chemical and physical modification,\" J. Carbohyd Poly.\n2004, vol 52, pp. 237-242.\n[10] C. G. Mothé, A. D. Azevedo, and R. Antoniassi, \"Rheological\ncharacterization of emulsions from soymilk,\" 3rd international\nSymposium on Food Rheology and Structure, 2001, pp. 531 - 532.\n[11] H. Mirhosseini, C. P. Tan, A. Aghlara, S. A. H. Nazimah, Y. Salmah, and\nH. C. Boo, \"Influence of pectin and CMC on physical stability, turbidity\nloss rate, cloudiness and flavor release of orange beverage emulsion\nduring storage,\" J. Carbohyd Poly. 2008, vol 73, pp. 83-91.\n[12] O. A. Odeku, W. Schmid, and K. M. Picker-Freyer, \"Material and tablet\nproperties of pregelatinized (thermally modified) Dioscorea starches,\"\nEuropean J. Pharm Biopharm. 2008, vol 70, pp. 357-371.\n[13] C. 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Nor Aini, \"Stability and\nrheology of concentrated o/w emulsions based on soybean oil/palm\nkernel olein blends\" Food Res Inter. 2007, vol 40, pp. 1051-1061.\n[19] S. Mishra, and T. Rai, \"Morphology and functional properties of corn,\npotato and tapioca starches,\" J. Food Hydro. 2007, vol 20, pp. 557-566."]}

Interaction effects of xanthan gum (XG), carboxymethyl cellulose (CMC), and locust bean gum (LBG) on the flow properties of oil-in-water emulsions were investigated by a mixture design experiment. Blends of XG, CMC and LBG were prepared according to an augmented simplex-centroid mixture design (10 points) and used at 0.5% (wt/wt) in the emulsion formulations. An appropriate mathematical model was fitted to express each response as a function of the proportions of the blend components that are able to empirically predict the response to any blend of combination of the components. The synergistic interaction effect of the ternary XG:CMC:LBG blends at approximately 33-67% XG levels was shown to be much stronger than that of the binary XG:LBG blend at 50% XG level (p < 0.05). Nevertheless, an antagonistic interaction effect became significant as CMC level in blends was more than 33% (p < 0.05). Yield stress and apparent viscosity (at 10 s-1) responses were successfully fitted with a special quartic model while flow behaviour index and consistency coefficient were fitted with a full quartic model (R2 adjusted ≥ 0.90). This study found that a mixture design approach could serve as a valuable tool in better elucidating and predicting the interaction effects beyond the conventional twocomponent blends., {"references":["P. A. Williams, and G. O. Phillips, \"Introduction to Food\nHydrocolloids\" in Handbook of Hydrocolloids (Phillips, G.O and P.A.\nWilliams, eds). Woodhead Publishing Limited, Cambridge, U.K.,\n2001.","J. Higiro, T. J. Herald, S. Alavi, and S. Bean, \"Rheological study of\nxanthan and locust bean gum interaction in dilute solution,\" Food Res\nInt. 2006, vol 39, pp. 163 - 175.","S. Secouard, M. Grisel, and C. Malhiac, \"Flavour release study as a\nway to explain xanthan-galactomannan interactions,\" Food Hydro.\n2007, vol 21, pp. 1237 - 1244.","C. Jouquand, Y. 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Kong, \"Aqueous polysaccharide blends based on\nhydroxypropyl guar gum and carboxymethyl cellulose: Synergistic\nviscosity and thixotropic properties,\" Col Polym Sci., 2006, vol 285,\npp. 145 - 151.\n[18] D. D. Roberts, J. S. Elmore, K. R. Langley, and J. Bakker, \"Effects of\nsucrose, guar gum, and carboxymethylcellulose on the release of\nvolatile flavour compounds under dynamic conditions,\" J. Agri Food\nChem. 1996, vol 44, pp. 1321-1326.\n[19] M. Rinaudo, and A. Moroni, \"Rheological behavior of binary and\nternary mixtures of polysaccharides in aqueous medium,\" Food\nHydro. 2009, vol 23, pp. 1720 - 1728.\n[20] G. Tabilo-Munizaga, and G. V. Barbosa-Canovas, \"Rheology for the\nfood industry,\" J. Food Engine. 2005, vol 67, pp. 147 - 156.\n[21] S. P. J. Namal Senanayake, and F. Shahidi, \"Lipase-catalysed\nincorporation of docosahexaenoic acid (DHD) into borage oil:\nOptimization using response surface methodology,\" Food Chem.,\n2002, vol 77, pp. 115 - 123."]}