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Julianna E Murray, Aaron S Gold, Azeema Latiff, Timothy G Murray Private Practice, Miami Ocular Oncology & Retina, Miami, FL, USACorrespondence: Timothy G MurrayMiami Ocular Oncology & Retina, 6705 Red Road Suite 412, Miami, FL, 33143, USAEmail tmurray@murraymd.comObjective: To report a consecutive series of compassionate, off-label use of intravitreal brolucizumab as a rescue therapy for complex, non-responsive macular edema. This report delineates primary diagnosis, indications for treatment, adverse events, and visual and anatomic outcomes after intravitreal brolucizumab.Methods: A retrospective review of a consecutive clinical case series of 110 eyes treated with intravitreal brolucizumab between January 1st and March 1st. 2020. All patients were included if they received intravitreal brolucizumab in an off-label delivery and had ongoing macular edema in the setting of prior, multiple intravitreal anti-VEGF and/or intravitreal triamcinolone acetonide. All patients had spectral domain OCT documented before, at the time of, and in serial follow-up after intravitreal brolucizumab.Results: Ninety-eight of 98 patients had marked decrease in macular edema. Indications for treatment were assigned to the primary etiologic diagnosis leading to the macular edema secondary to radiation retinopathy, complex epiretinal membrane, or complex diabetic retinopathy. In this series, sdOCT central point thickness decreased by an average of 71.5 microns, subretinal fluid resolved, and visual acuity was improved in 40% (greater than two Snellen lines) and stable in 60% (within two Snellen lines). No patient experienced a severe adverse event to specifically include vitritis and/or vasculitis.Conclusion: In this series, brolucizumab intravitreal injection was associated with significant improvement in macular edema in each diagnostic category. No serious complications to treatment were found in this series. Brolucizumab, though associated with known intraocular inflammation and vasculitis, demonstrated marked benefit in these complex eyes previously unresponsive to aggressive intravitreal pharmacotherapy.Keywords: brolucizumab, off-label usage, retinal vasculitis, vitreous inflammation, intraocular inflammation, macular edema

Arisaema filiforme and A. brichangense are a perennial herbaceous plant (family Araceae) found distributed in mossy forest, Cameron Highlands, with the elevation of 1,900 meters above sea level (a.s.l). The unique inflorescence formation resembling cobra has given this plant the name Cobra lilies, and suitable to be planted as ornamental plant. In addition, it has been used traditionally as a herb. However, the population of these two species are very limited, only thrive in higher elevation and also considered as an endangered. Therefore, realizing its potential in the future as one of the new ornamental plant and materials for the herb bioindustry, a micropropagation approach was employed to produce these species in mass production. Seeds, rhizomes, and petioles were used as the explant materials, cultured onto Murashige and Skoog (MS) media supplemented with different concentrations (0, 0.5, 1, 2 mg L-1) of 6-Benzylaminopurine (BAP). The findings revealed rhizomes and seeds to be significant explants for micropropagation, where the survival rate for these two are more than 80%. Petioles had 0% of survivability after week eight of culture due to the fungi infection and tissue necrosis. This study provides an insight into explant selection, where different plant organs have different survival rate due to the tissue mechanical strength. Also, optimum surface sterilization process is very critical in micropropagation to avoid the contamination of the culture and also necrotizing.

Assessing research impact and the practical value of research output can be effectively accomplished by considering various Sustainable Development Goals (SDGs), as they may interpret and measure research impact in distinct ways. This paper aims to identify research grants that are aligned to SDGs, identify researchers' perceptions of the research impact on SDGs and frame the research impact on SDGs. This paper is a qualitative study that involves content analysis on research grant documents, online responses and focus group discussion with university's researchers. The study analyzed 1,495 research grants received by researchers at the Universiti Sains Malaysia (USM) and the views of 46 principal investigators through online responses and focus group discussions, The study found that research impact on SDGs could be modelled based on the sustainability dimensions of the 17 SDGs, leading to seven types of impact: economic impact, social impact, environmental impact, cultural impact, public policy impact, organizational impact, and educational impact. By referring to the Elsevier 2021 SDG keywords, we concluded that while the majority of research grants focus on one SDG, interrelated SDGs also exist in many SDGs, cutting across several research impacts. The perception of PIs towards research impact stems from their understanding of SDGs and the conventional research output of networking, patent and commercialization, publication and citation, and students. To achieve a better future, it is essential to have thorough and structured monitoring and evaluation of research grants. This ensures that their results and outputs consistently contribute to the accomplishment of the SDGs.

Sophia El Hamichi, Aaron S Gold, Veronica Kon Graversen, Azeema Latiff, Timothy G Murray Murray Ocular Oncology and Retina (MOOR), Miami, FL, USACorrespondence: Sophia El HamichiMurray Ocular Oncology and Retina (MOOR), 6705 Red Road, Suite 412, Miami, FL 33143, USATel +12675519677Email sophiaelhamichi@gmail.comPurpose: A private tertiary care ophthalmology practice was analyzed to see how Hurricane Irma affected patient care.Methods: Eighty-two patients (96 eyes) that missed their scheduled appointments due to Hurricane Irma were reviewed. Patients were being treated with intravitreal injection therapy for diabetic retinopathy, radiation retinopathy, vein occlusions, choroidal neovascularization, or neovascular age-related macular degeneration. The authors assessed patients’ visual acuity and macular thickness changes before the hurricane and their initial visit after the storm. Emergency preparedness was also evaluated in this setting.Results: Patients on average were delayed 19.6 days. On average, best-corrected visual acuity was 20/97 (0.7 logMAR) before the hurricane and 20/82 (0.6 logMAR) after the storm. The average central macular thickness change was −1.30 μm. Intraocular pressure was not significantly affected and there were no ocular complications associated with the delay in therapy. A back-up electrical system was in place to maintain appropriate temperature for storage of medications and proper access to medical records.Conclusion: The authors believe that minimizing delay in treatment was the most important contributing factor to preventing worsening of ocular disease. Ophthalmology clinics should strive for appropriate treatment modality regarding injection intervals prior to a natural disaster and emergency planning with excellent patient communication both before and after natural disasters.Keywords: ophthalmology, intravitreal injections, hurricane, natural disaster, tertiary care

Timothy G Murray,1,2 Andrew J Layton,3 Kuo B Tong,3 Michael Gittelman,2 Azeema Latiff,1,2 Daniel Gologorsky,2 Michael M Vigoda21Murray Ocular Oncology and Retina, Miami, FL, USA; 2Bascom Palmer Eye Institute, Anne Bates Leach Eye Hospital, Departments of Ophthalmology, Anesthesiology and Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA; 3Quorum Consulting, San Francisco, CA, USABackground: Microincisional vitrectomy surgery (MIVS) is the current standard surgical approach for pars plana vitrectomy. Historically, the most common surgical platform for vitrectomy surgery, since its introduction in 1997, has been the Accurus vitrectomy system. Recent introduction of the next generation of vitrectomy platforms has generated concerns associated with transitioning to new technology in the operating room environment. This study compared, in a matched fashion, surgical use of the Accurus vitrectomy system and the next generation Constellation Vision System to evaluate surgical efficiencies, complications, and user perceptions of this transition.Methods: Electronic health records were abstracted as a hospital quality assurance activity and included all vitreoretinal surgical procedures at the Bascom Palmer Eye Institute, Anne Bates Leach Eye Hospital, during two discrete 12-month time periods. These two periods reflected dedicated usage of the Accurus (June 2008–May 2009) and Constellation Vision (July 2009–June 2010) systems. Data were limited to a single surgeon and evaluated for operating room (OR) total time usage/day, OR case time/case, and OR surgical time/case. Further analysis evaluated all patients undergoing combined MIVS and clear cornea phacoemulsification/intraocular lens (IOL) implantation during each individual time period to determine the impact of the instrumentation on these parameters. All records were evaluated for intraoperative complications.Results: Five hundred and fourteen eligible patients underwent MIVS during the 2-year study windows, with 281 patients undergoing surgery with the Accurus system and 233 patients undergoing surgery with the Constellation system. Combined MIVS and phacoemulsification with IOL implantation was performed 141 times during this period with the Accurus and 158 times during the second study period with the Constellation. Total number of patients operated per day increased from 7.55 with Accurus to 8.53 with Constellation. Surgical room time decreased from 56 minutes with Accurus to 52 minutes with Constellation, and procedure time decreased from 35 minutes with Accurus to 31 minutes with Constellation (P < 0.004). Combined MIVS/phacoemulsification surgery saw similar declines in surgical room time and procedure time (P < 0.001). Subset analysis of procedures limited by case number per day (eg, four cases/day, five cases/day, six cases/day, and seven or more cases/day) showed similar outcomes with a decrease in surgical room time and procedure time. No increases in surgery-related complications were noted by quality assurance review during these time periods.Discussion: Transitioning to advanced surgical technology is a complex issue for the surgeon, the hospital team, and the hospital administration. This study documents improvement in three significant measures of surgical efficiency: operative number of patients per day, operative room time, and surgical procedure time that reflect the positive impact of the novel, combined, integrated, posterior and anterior, ophthalmologic surgical platform of the Constellation Vision System. These data are imperative to evaluate the impact of transition from one surgical platform to another. During this transition, hospital quality assurance review and surgeon evaluation of operative complications showed no increased concerns for the shift from the Accurus to the Constellation Vision System surgical platform. Further, both operative staff and surgeons felt that the transition to the Constellation was not associated with increases in difficulty with setup, turnover, or use and that the Constellation decreased safety concerns for surgical usage. Ultimately, in this case, new technology benefited the surgeon, the patient, and the hospital.Keywords: MIVS, vitrectomy, new technology

The Malaysian government has long recognized the significance of mastering the English language among its citizenry. The government has planned, and subsequently, implemented many policies to ensure Malaysians master the English language. Although civil servants have a strong desire to master the English language to perform their duties more efficiently, poor English communication skills have become a major concern in this regard. Therefore, this research aims to investigate common errors in writing the English language among non-academic staff at "Universiti Sultan Zainal Abidin" (UniSZA), a public university in Malaysia. The study employed an Error Analysis approach by conducting document analysis where every respondent was required to write a paragraph in the English language in about 150-200 words on the topic "My greatest challenge as a UniSZA officer". The findings revealed that a sizeable number of non-academic staff committed different types of errors in writing the English language, including errors related to subject-verb agreement, passive voice, plurality, choice of word, omission of word, use of article, tense sequence, word ordering, gerund, addition of word/redundancy, and comparison of adjective. It was observed that lack of linguistic skills, lack of exposure, and inadequate practices in written English were the main factors contributing to the English writing errors among the non-academic staff. These findings could help the university management to develop appropriate programs that can assist the non-academic staff to develop English writing competence. However, this study is limited to English writing errors. Further research may focus on other language skills such as speaking and listening.

Michael M Vigoda, Azeema Latiff, Timothy G Murray, Jacqueline L Tutiven, Audina M Berrocal, Steven GayerBascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USAPurpose: To document that with proper patient and procedure selection, children undergoing general inhalational anesthesia for ophthalmologic exams (with or without photos, ultrasound, laser treatment, peri-ocular injection of chemotherapy, suture removal, and/or replacement of ocular prosthesis) can be safely anesthetized without the use of an intravenous (IV) line. Children are rarely anesthetized without IV access placement. We performed a retrospective study to determine our incidence of IV access placement during examinations under anesthesia (EUA) and the incidence of adverse events that required intraoperative IV access placement.Methods: Data collected from our operating room (OR) information system includes but is not limited to diagnosis, anesthesiologist, surgeon, and location of IV catheter (if applicable), patient’s date of birth, actual procedure, and anesthesia/procedure times. We reviewed the OR and anesthetic records of children (>1 month and

This paper is a pilot study that examines the perceptions of transformational leadership among cooperative movements’ boards. Past studies have shown that transformational leadership is a strong predictor of firm performance (effectiveness). This study aims to examine on the perceptions of transformational leadership style among Malaysian cooperatives board of directors. Among the major problems faced by Malaysian cooperatives are the lack of board of directors’ commitments, directors failed to perform their duties effectively and weak leadership from Board of Directors which affected the board effectiveness and performance.

Reading is a complex process that involves cognitive, physical, intellectual, cultural, and linguistic processes. Research shows that learners who read extensively tend to accomplish a high level of academic achievement. In Malaysia, the educational goal has shifted from simply forming literate citizens to nurturing a well-educated and intellectual society. Promoting efficient reading habits can be an effective approach to realizing this goal. This study, therefore, aims to examine reading habits and ascertain their correlation with reading achievement among final-year English as a Second Language (ESL) learners in selected Malaysian secondary schools. The study utilized a cross-sectional survey in which data were gathered from a sample of 351 ESL learners using questionnaires and written tests as data-gathering instruments. The analysis was conducted by means of descriptive statistics, Pearson correlation, and simple linear regression. The findings revealed a significant relationship between ESL learners' reading habits and their reading achievement. Additionally, ESL learners' reading habits contribute significantly to their reading achievement. These findings highlight the significance of reading habits in determining ESL learners' reading achievement itself. However, this study is limited to reading habits and reading achievement among students in selected secondary schools. Thus, further research may replicate this study in the context of computer-assisted or blended learning.

There has been an increased reliance on Web-based learning, particularly in higher learning institutions, due to the outbreak of COVID-19. However, learners require knowledge and skills on how to use Web 2.0- based learning tools. Thus, there is a need to focus on how Web-based tools can be used to enhance learning outcomes. Therefore, this study aims to explore the challenges and benefits of Web 2.0-based learning among international students of English as a Second Language (ESL) at the Eastern Mediterranean University (EMU), North Cyprus during the COVID-19 pandemic. The data were collected from a purposive sample of 15 ESL learners at EMU using focus group interviews. The interview data were analyzed using inductive thematic analysis. The findings showed that challenges faced by international students of English at EMU during the COVID-19 pandemic include inadequate knowledge of technology and technical issues such as poor internet connectivity, inability to upload large files, and loss of password. Additionally, the findings showed that Web 2.0 technologies can help the students to enhance collaborative learning, independent learning, flexible learning, as well as competence in using technology for learning purposes. It was envisaged that this study would be beneficial to the management of higher learning institutions, educationists, and students in general. However, this study is limited to international ESL students at EMU with a few participants. To provide generalizable outcomes, further studies may adopt a quantitative or mixed-method approach.

Financial sustainability had become a primary concern among public universities worldwide due to the declining trend of government's funding and the unceasing growth in higher education cost. Hence, public universities are forced to generate alternative income sources. Resource dependency theory asserts that revenue diversification is a prudent strategy for non-profit organisations to mitigate their financial challenges. However, studies that focused on revenue diversification strategy's potential among public universities are yet to be proven. Thus, this study examined the effect of revenue diversification on the financial sustainability of 20 Malaysian public universities using a panel data approach. Revenue diversification is measured using the Hirschman Herfindahl Index, while financial sustainability was proxied by the Return on Assets (ROA) and Net Profit Margin. The result discovered that revenue diversification had a significant positive relationship with financial sustainability when ROA is used as a proxy. This study contributes to resource dependency theory, whereby the revenue diversification effect was tested and found to be significant in the context of public universities. It also highlighted the importance of revenue diversification to overcome the financial sustainability issue, which became a primary concern of Malaysian public universities in recent years.

The mass media are blamed for constructing a negative image of Islam through the use of Islam-related terms in reporting terrorism. It is presumed that when Islam-related terms are used without regard to their original connotations, they are likely to lose their original meanings and begin to take on altered meanings created by the media. Therefore, this study aims to explore the use of Islam-related terminologies in selected eastern and western mass media outlets in relation to their semantic and linguistic interpretations. The study employed a qualitative approach in which content analysis was used. Using purposive sampling, "The Jordan Times" and "Al-Jazeera" were chosen from the eastern Arab world while "The BBC" and "The Guardian" were chosen from the western media. A total of 368 news articles focusing on Islam and Muslims were collected from the selected news media outlets using internet-based search from March 2018 until October 2019. The findings showed significant differences (P = 0.000/P < 0.05) exist between the selected eastern and western mass media outlets in using Islam-related terminologies. The terms are used more frequently in the western media outlets than in the eastern media outlets. Further analysis of the findings revealed that the selected media outlets use Islam-related terminologies, such as "Islamist" and "Jihadist", in negative contexts. The use of Islam-related terminologies in the selected media outlets could be influential in making the audience to perceive Islam as a religion of terrorism. The negative use of Islam-related terms could be minimized through training of journalists on news coverage of religion, provision of proper guidelines on religious reporting and ensuring that these guidelines are strictly followed. It was envisaged that this study would be useful to the media outlets, particularly in the process of news gathering, production, and dissemination.

The manner in which language is utilized in reporting Islam is disheartening. This is because sensationalized language, especially in the news media, could reinforce negative stereotypes. As such, those who rely on the media to understand Islam are likely to develop negative preconceptions about the religion. This study aims to investigate how the non-western online newspapers use language in news coverage of Islam. Content analysis was used to collect and analyze the data. Using purposive sampling, "Punch and Vanguard" were selected from Nigeria while "The Star and New Straits Times" were selected from Malaysia. A total of 599 Islam-related news articles were collected from the selected newspapers using internet-based search from November 2015 until September 2016. The findings showed that almost half of the overall Islam-related articles conveyed negative tone toward Islam while very few conveyed positive tone. This shows that the language used in news coverage of Islam is inappropriate and sensational. Hence, there is a need to enhance the reporters' knowledge and writing skills through inter-media exchange program, exposure to different religious, social and cultural lives, workshops, seminars, conferences, as well as sensitivity training and retraining on reporting religions.