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Background Patient’s awareness and satisfaction towards ward pharmacy services may influence perception towards effectiveness and safety of drugs, affecting medication adherence and clinical outcome. Nevertheless, studies on local ward pharmacy services were lacking. This study evaluated awareness, expectation and satisfaction of ward pharmacy services among patients in medical wards and determined their association with demographic characteristics. Methods This was a cross-sectional study using self-administered questionnaire conducted in medical wards of fourteen Perak state public hospitals from September to October 2020. In-patients aged ≥18 years old were included. The validated questionnaire had four domains. The student’s t-test, one-way analysis of variance (ANOVA) and multiple linear regression were was employed to evaluate the association between patients’ demographic characteristics with their awareness, expectation and satisfaction towards ward pharmacy services. Results 467 patients agreed to participate (response rate = 83.8%) but only 441 were analysed. The mean age of the patients was 54.9 years. Majority was male (56.2%), Malay (77.3%), with secondary education (62.9%), rural resident (57.1%) and reported good medication adherence (61.6%). The mean awareness score was 49.6 out of 60. Patients were least aware about drug-drug interaction (3.85 ± 1.15) and proper storage of medications (3.98 ± 1.06). Elderly patients (β = − 2.82,PP= 0.001), rural residents (β = 3.65,PP= 0.002) had higher awareness score. The mean expectation score was 44.0 out of 50. The patients had higher expectation to encounter a polite ward pharmacist (4.51 ± 0.56). Patients with tertiary education (β = 1.86,P= 0.024), rural residents (β = 1.79,P= 0.001) and with good medication adherence (β = 1.48,P= 0.006) demonstrated higher expectation. The mean satisfaction score was 43.6 out of 50. The patients had high satisfaction in language used (4.45 ± 0.57) and level of knowledge demonstrated (4.41 ± 0.62) by the ward pharmacists. Patients with tertiary education (β = 2.16,P= 0.009), rural residents (β = 1.82,P= 0.001) and with good medication adherence (β = 1.44,P= 0.009) demonstrated higher satisfaction, while elderly patients (β = − 1.17,P= 0.031) had lower satisfaction towards ward pharmacy services. Conclusion There was a high level of awareness, expectation and satisfaction towards ward pharmacy services in public hospitals of Perak, Malaysia.

Background High-flow nasal cannula (HFNC) is a non-invasive positive pressure ventilation which delivers adjustable mixture of heated and humidified air and oxygen at rates that exceed spontaneous inspiratory flow. It’s easy to initiate, relatively safe, and usually well tolerated by children (1). A lot of studies have suggested that HFNC may reduce the work of breathing (1). Early initiation of HFNC has been associated with reduced rate of endotracheal intubation. Objectives This study aims to provide an overview of HFNC usage in paediatrics general ward setting, outside ICU setting. Methods A retrospective study was carried out to evaluate the usage of HFNC in paediatric patients in HSIP general ward settings from April 2019 to March 2020. Results A total of 177 children’s record (boys: 112, girls: 65, age: 1 month to 12 years old) were analysed. A total of 112 patients were referral from district hospital, while 55 patients were referral from our emergency department. From the analysis, we noted the age group of 12 to 24 months had the highest number of admissions requiring HFNC. Most of the patients were put on HFNC immediately upon admission to ward. The duration of its usage ranges from 2–4 days [interquartile range (IQR)], with median of 3 days. Length of hospital stay were 6 days (IQR: 4 to 8 days). Multiple linear regression analysis showed that duration of HFNC usage and delaying its initiation >6 hours were associated with significantly longer hospital stay (p-value Among the indications for the usage of HFNC, pneumonia is the main cause, followed by acute bronchiolitis, heart failure, sepsis and laryngomalacia. Almost one third (38%) of the patients that required HFNC had underlying disease(s), mainly respiratory disease. SpO2 on arrival were mostly 96% (IQR: 92 to 99%). Respiratory rates were analysed according to age group as well. The median white cell count (WCC) is 12.96 × 103/uL (IQR: 9.67 to 17.27), while C-reactive protein (CRP) is 22 mg/L (IQR: 10.91 to 52.62). Linear regression was used to analyse the correlation between these two parameters, which showed that WCC and CRP are two independent variables. Nasopharyngeal aspiration (NPA) for viruses sent yielded 24% positive culture. Among the viruses detected, RSV accounted for 66% of the positive culture. As for outcome, 98% (N=174) of them recovered well while 3% (N=3) required escalation of therapy to BIPAP and intubation. Unfortunately, 3 patients succumbed to death in which one had severe malnourished and the other two patients with had congenital cyanotic heart with prolonged hospital stay. No major adverse effect was reported but 1 patient had minor burn on cheeks. Conclusions HFNC is an excellent choice of NIV in providing respiratory support in district hospital with no or very limited intensive care unit. Our study showed that it is relatively safe to use with regular vital signs monitoring, with occasionally some patients requiring continuous SpO2 monitoring. Detailed studies on its indication, safety protocol and cost effectiveness are needed to improve the outcome of patients.

Background Acute post streptococcal glomerulonephritis (PSGN) is well known sequel of group A β-hemolytic streptococcus infections and may be complicated with hypertensive encephalopathy followed by Posterior reversible encephalopathy syndrome (PRES). PRES is also known as acute hypertension encephalopathy, usually present with seizures, hypertension, headache, encephalopathy and/or visual disturbance. The pathophysiology behind PRES is poorly understood. It is usually associated with hypertensive encephalopathy, kidney disease, autoimmune disease, immunosuppressive drug and organ transplantation. Contrast-enhanced computed tomography imaging allows for fast assessment which shows features of edema of the posterior cerebral hemisphere, especially at the parieto-occipital region. PRES can be a presenting sign of PSGN and vice versa. Objectives To study relationship between PSGN and PRES Methods Two case reports PSGN with PRES, based on contrast-enhanced computed tomography (CECT) brain. Results We reported two cases of PSGN with PRES. First case is a 11 years old boy, who presented with status epilepticus, following one-day history of headache and vomiting. He was afebrile, no history of epilepsy or recent trauma and any drug intake. He had history of left facial cellulitis secondary to odontogenic infection one-week prior the onset of seizure. He was initially diagnosed with PRES after CECT brain. Second case is a 6 years old boy, who presented with multiple infected impetigo lesions over bilateral lower limb, fever and vomiting. He also developed blurry vision and recurrent vomiting, requiring ICU care due to hypertensive crisis. CECT brain was performed and reported as PRES. Similarly, both children had persistent microscopic hematuria and hypertension, and investigations show low C3 and normal C4 levels with raised Anti-streptolysin O titer (ASOT), fulfilling the criteria of PSGN. Conclusions The incidence of PRES is rare in children, but should always be a diagnosis to be considered in children with PSGN presenting with hypertensive crisis and/or rapidly progressive neurological manifestations, e.g. status epilepticus. Early recognition and prompt treatment are important measures in reducing morbidity and mortality.

Background Head and neck cancer is increasingly being managed through nonsurgical approaches. Evidence comes from studies that have mainly examined patients with laryngeal cancer. Few studies, with limited sample size, have focused on the comparative outcomes of surgical and nonsurgical approaches in patients with advanced oropharyngeal or hypopharyngeal cancer. Methods Using a national cancer database, we identified 1603 and 1512 patients with clinical stage III/IVA oropharyngeal and hypopharyngeal cancer, respectively, treated between 2004 and 2009. The study cohort was followed until 2012, and analyzed through Kaplan-Meier survival analysis and Cox regression. Results Overall, 31.4% of patients with advanced oropharyngeal cancer and 42.2% of patients with hypopharyngeal cancer received surgery as their primary treatment. Receiving primary surgery for advanced oropharyngeal and hypopharyngeal cancer was associated with higher survival rates after controlling for potential confounders. Conclusion We recommend that surgery be considered a first-line treatment for advanced oropharyngeal and hypopharyngeal cancers.

Rationale: Non-cystic fibrosis bronchiectasis (NCFB) is a chronic inflammatory airway disease with significant morbidity and mortality. We studied the association of bronchodilator response and the clinical characteristics of patients with bronchiectasis. Methodology: All patients of the bronchiectasis clinic in between 2014 and Oct 2017 were studied. Significant bronchodilator reversibility was defined by >12% and >200ml change in force expiratory volume in 1 second (FEV1) post-bronchodilator therapy. Group 1 patients had no bronchodilator reversibility, while group 2 had significant reversibility. Demographics, co-morbidities, lung function, rate of emergency department (ED) and hospital admissions were analysed. Results: A total of 195 patients (105 female) with a median age of 69 years were studied. 16 (8.2%) patients had significant bronchodilator reversibility. The median (IQR) FEV1 predicted was similar in both groups (66(51-84) vs.78(54-90),p=0.2). Current smokers were more common in group 2 than 1 (18.8% vs.5.6%,p=0.002). The mean (SD) rate of ED attendance was significantly lower in group 2 (0.65(1.06) vs.0.13(0.34),p Conclusion: This study demonstrates the presence of significant bronchodilator reversibility is associated with a lower ED attendance rate. The potential explanations are anti-inflammatory effect of the ICS may have beneficial effect on bronchiectasis airways and these patients are more compliant with treatment.

The accounting cycle is an important yet difficult topic for introductory financial accounting students to learn. These students often lack the business context to understand the accounting cycle and find the traditional teaching approach dry. This problem motivates the authors to examine whether a blended learning approach via online tutorials can improve students’ perceived knowledge of the accounting cycle for the undergraduate introductory financial accounting course. The authors developed four innovative online tutorials with a coherent storyline to enable students to learn the accounting cycle and to supplement in-class learning. To test the effectiveness of online tutorials, an independent survey was conducted by the Centre of Teaching Excellence at the authors’ University. The survey results suggest that the accounting cycle online tutorials substantially improve students’ perceived knowledge of the topic (an increase of 59.8% in the perceived knowledge) and the improvement is statistically significant. Meanwhile, the results indicate that the online tutorials are valued by students for the enjoyable learning experience. Students credited the online tutorials for increasing their interest in the course and providing the business context to understand the accounting cycle, which enhanced their learning. Given the positive impact reported by students, the paper recommends instructors for introductory financial accounting course to use these accounting cycle online tutorials to supplement in-class learning as there is only minimum cost of implementation. One caveat of the paper is that students’ perceived knowledge may not reflect the actual knowledge of the accounting cycle.

Cancer survivors experience significant psychosocial distress even after completion of cancer treatment. The association between cancer coping and cancer recovery is not well established. The present study investigated the cancer-coping profile and cancer outcomes in breast cancer survivors. A three-wave longitudinal study was conducted. In 2009 (wave 1), 248 breast cancer survivors completed a package of psychological inventories to evaluate cancer copying style, psychological distress, anxiety and depression, and quality of life. They received follow-up survey in 2012 (wave 2) and 2016 (wave 3). A latent profile analysis (LPA) was conducted among participants in wave 1 to identify cancer-coping class. Identified cancer-coping class was used to predict psychological and survival outcomes in waves 2 and 3. Two cancer-coping classes were identified through LPA, namely adaptive cancer coping (class I; 52%) and maladaptive cancer coping (class II; 47.8%). Demographic and clinical factors did not differ significantly between the two classes. Subsequent analyses demonstrated that the cancer-coping style in wave 1 predicted the psychological symptoms and quality of life outcomes at the two follow-ups (waves 2 and 3). Survivors in the adaptive group (class I) exhibited lower cancer distress, anxiety and depression scores, and higher quality of life scores than those in the maladaptive group did. Cancer coping were not found to be significantly associated with cancer survival or recurrence. The identified cancer-coping styles were predictive of the survivors’ psychological symptoms, psychological well-being, and health-related quality of life but not cancer survival or recurrence.

Background: The effect of single-incision thoracoscopic surgery for lung cancer on long-term survival is unknown and no studies have investigated whether there are differences in survival between single and multiple incision approaches. We aimed to compare long-term overall survival and disease-free survival of patients who underwent single-incision thoracoscopic surgery with those who received multiple-incision thoracoscopic surgery for lung cancer. Methods: We retrospectively analyzed 532 patients with lung cancer who underwent either single-incision (n=150) or multiple-incision thoracoscopic resection (n=382) during the period January 2000 to December 2014. Patients were matched on propensity score at a 1:2 ratio to estimate the effect of treatment on longterm and disease-free survival. Overall survival and disease-free survival were assessed using the Kaplan- Meier method, the log-rank test and Cox proportional-hazards regression. Results: Propensity matching resulted in 138 patients in the single-incision group and 276 patients in the multiple-incision group. The matched patients in the single-incision group had a significantly better 5-year overall survival than those in the multiple-incision group (P=0.027). Disease-free survival was similar between the two groups before and after matching. The number of chest wall incisions did not influence overall survival or disease-free survival. Conclusions: The long-term outcomes of single-incision thoracoscopic surgery are comparable to those of multiple-incision thoracoscopic surgery for lung cancer.

Aim To assess the safety and tolerability of adjuvant subcutaneous trastuzumab (Herceptin ® SC, H SC), delivered from an H SC Vial via hand-held syringe (Cohort A) or single-use injection device (Cohort B), with or without chemotherapy, for human epidermal growth factor receptor 2 (HER2)-positive stage I to IIIC early breast cancer (EBC) in the phase III SafeHer study (NCT01566721). Methods Patients received 600 mg fixed-dose H SC every 3 weeks for 18 cycles. The chemotherapy partner was at the investigators' discretion (H SC monotherapy was limited to ≤10% of the population). Data from the first H SC dose until 28 days (plus a 5-day window) after the last dose are presented. Results are descriptive. Results In the overall population, 2282/2573 patients (88.7%) experienced adverse events (AEs). Of the above, 128 (5.0%) patients experienced AEs leading to study drug discontinuation; 596 (23.2%) experienced grade ≥ 3 AEs and 326 (12.7%) experienced serious AEs. Grade ≥ 3 cardiac disorders were reported in 24 patients (0.9%), including congestive heart failure in eight (0.3%). As expected, the AE rates varied according to the timing of chemotherapy in both cohorts, with higher rates in concurrent versus sequential chemotherapy subgroups. In the concurrent chemotherapy subgroup, AEs were more common during the actual period of concurrent chemotherapy compared with the period when patients did not receive concurrent chemotherapy. Conclusion SafeHer confirms the safety and tolerability of the H SC 600 mg fixed dose for 1 year (every 3 weeks for 18 cycles) as adjuvant therapy with concurrent or sequential chemotherapy for HER2-positive EBC. These primary analysis results are consistent with the known safety profile for intravenous H and H SC.

The Taiwanese FRAXUsing previous data from Taiwan and literature, we determined cost-effectiveness thresholds for prevention of osteoporotic fractures by alendronate with a Markov model, as well as using two other translational approaches. Sensitivity analysis was applied using different alendronate prices. A clinical sample was used to test these Taiwan-specific thresholds by determining the percentages of high-risk patients who would be qualified for current National Health Insurance reimbursement.With the Markov model, the intervention threshold for hip fracture was 7% for women and 6% for men; for major osteoporotic fracture, it was 15% for women and 12.5% for men. Both translational approach models were cost effective only for certain age groups. However, if branded alendronate was reimbursed at 60% of the current price, they became cost effective in almost all age groups. This clinical screening study showed that the National Health Insurance Administration model identified the highest proportion (44%) of patients qualified for National Health Insurance reimbursements, followed by the Markov model (30%), and the United States model (22%).Three FRAX

This study seeks to evaluate the stability of financial ratios across industry and over time. The sample comprises companies listed on the Stock Exchange of Singapore from 1980 to 1991 over six industry groupings. A set of 29 most commonly used ratios was selected for the study. Descriptive statistics, factor analysis and analysis of variance were performed. From the factor analysis results, eight representative ratios were identified. Analysis of variance and multiple comparisons were subsequently performed for each representative ratio to test if it is significantly different across industry and over time. The results indicate that financial ratio averages of the various industries are significantly different. This implies that the appropriate benchmark for evaluating company performance and position should be industry‐specific instead of economy based. Also, five of the representative ratios are significantly different over time and not all the industrial averages move consistently over time (i.e., interaction effects of industry and time exist). Thus, industry averages are not necessarily appropriate benchmarks for setting and evaluating performance through time.

The Mapping Digital Media project examines the global opportunities and risks created by the transition from traditional to digital media. Covering 60 countries, the project examines how these changes affect the core democratic service that any media system should provide: news about political, economic, and social affairs. Malaysia has had a torrid relationship with digital. Mahathir Mohamad, the former Malaysian prime minister, fell in love with it in the 1990s when he launched the Multimedia Super Corridor, a sort of East Asian Silicon Valley, to develop the local information and communications technology industry. Two out of three Malaysians regularly use the internet (even though large areas of the East Malaysian states of Sabah and Sarawak, where nearly a fifth of the population lives, pose logistical challenges regarding infrastructure) and a third of the population have a 3G mobile subscription. Broadband household penetration in the capital, Kuala Lumpur, is 112 percent because many citizens have both fixed and mobile accounts. Nearly half the population is on Facebook with an average of 233 friends each, the greatest proportion in the world, all on social networks for an average nine hours a week. And they still seem to find enough time to watch television for three and a half hours a day and to listen to the radio for three hours. The outlook is for an expansion of internet and mobile-based platforms for news, comment, social networking, activism, and entertainment. However, a change of government is probably a prerequisite for the kinds of changes that would usher in greater diversity in broadcast and print, such as regulatory independence, repeal of the Printing Presses and Publications Act, and the dismantling of monopolies, rules on cross ownership, and political parties’ ownership of media companies., Mapping Digital Media

L-Homocysteine thiolactone (L-HCTL) was evaluated for its potential as an intravenously-administered central nervous system (CNS) radioprotector in C3H mice and F344 rats. Toxicity assessments in the mouse yielded a LD50 of 297 mg/kg and in the rat 389 mg/kg. Biodistribution studies in tumor-bearing mice showed that brain specimens contained more label at 10 min than the tumors but less at 30 or 60 min. Brain uptake relative to the tumors, the brain/tumor ratio, ranged between 0.5 and 3.3. The cervical spinal cord of non-tumor-bearing rats was irradiated with 32 Gy 137Cs with or without prior treatment with L-HCTL following which the time to forelimb or hindlimb paralysis was measured to determine the relative protective factors (RPFs) for this radiation dose. For forelimb paralysis the RPF was 1.9 (+/- 1.0, SD) and for hindlimb it was 2.0 (+/- 1.1, SD). 36B-10 glioma cells irradiated in vitro with or without L-HCTL and assayed for colony forming capacity demonstrated a dose modifying factor (DMF) of only 1.15 (+/- 0.16, SE). Rats bearing intracerebral 36B-10 glioma received 137Cs irradiation with or without L-HCTL after which the tumors were similarly assayed in vitro. From this the glioma DMF was 1.2 (+/- 0.30, SE). Compared to prior results with phosphorothioates our data show that the toxicity of L-HCTL is roughly the same as WR2721, WR77913 and WR3689 and that it distributes at higher levels in the CNS after systemic administration. L-HCTL may well equal these phosphorothioates at protecting normal CNS tissue without requiring administration directly into the cerebrospinal fluid-containing spaces and it does not protect the 36B-10 glioma.

The tourism industry depends by and large on travellers and tourists. While it has become a practical precept that most travel decisions are made by males, women travellers of late, have become a very important consumer segment within the tourism industry. As recent as 2005, women travellers accounted for approximately 43% of the business travellers worldwide and are seen as a growing lucrative demographic by industry experts. Marketing experts opine that 85 % of all buying decisions are made by the fairer sex. In addition to this, the majority of corporate purchasing agents and managers are women. This translates to the fact that women make approximately 70% of travel decisions for the family as well as for other people, for instance employers or employees. With the inherent distinctiveness of the female psyche, there is bound to be a rather specific preference or inclination on accommodation characteristics that these women travellers would look for. Women travellers are perceived to be especially interested in security, cleanliness, communication facilities, style and ambience of space, smooth check-in/check-out procedures as well as in comfortable access and/or transfers.

AIM: To evaluate the usefulness of differentially expressed proteins from colorectal cancer (CRC) tissues for differentiating cancer and normal tissues. METHODS: A Proteomic approach was used to identify the differentially expressed proteins between CRC and normal tissues. The proteins were extracted using Tris buffer and thiourea lysis buffer (TLB) for extraction of aqueous soluble and membrane-associated proteins, respectively. Chemometrics, namely principal component analysis (PCA) and linear discriminant analysis (LDA), were used to assess the usefulness of these proteins for identifying the cancerous state of tissues. RESULTS: Differentially expressed proteins identified were 37 aqueous soluble proteins in Tris extracts and 24 membrane-associated proteins in TLB extracts. Based on the protein spots intensity on 2D-gel images, PCA by applying an eigenvalue > 1 was successfully used to reduce the number of principal components (PCs) into 12 and seven PCs for Tris and TLB extracts, respectively, and subsequently six PCs, respectively from both the extracts were used for LDA. The LDA classification for Tris extract showed 82.7% of original samples were correctly classified, whereas 82.7% were correctly classified for the cross-validated samples. The LDA for TLB extract showed that 78.8% of original samples and 71.2% of the cross-validated samples were correctly classified. CONCLUSION: The classification of CRC tissues by PCA and LDA provided a promising distinction between normal and cancer types. These methods can possibly be used for identification of potential biomarkers among the differentially expressed proteins identified.

Fab arm exchange by a stabilized anti-IL-31 IgG(4)S228P monoclonal antibody (mAb) was studied using physiologically relevant antibody concentrations and thiol exchange conditions, and directly compared to that of matched wild type IgG(4) (IgG(4)wt) and IgG(1) control antibodies. In vitro arm exchange between the test mAbs and a purified IgG(4)wt exchange partner was monitored using capillary isoelectric focusing and a size-exclusion peak shift assay. Arm exchange between the test mAbs and IgG exchange partners with unknown specificity was monitored using only the shift assay. Studies were performed using single isotype human and mouse mAbs, unfractionated human, mouse, and cynomolgus monkey IgG, and human serum as the sources of the exchange partners. In vitro studies using human serum demonstrated that anti-IL-31 IgG(4)S228P did not undergo significant Fab arm exchange with endogenous human IgG(4) whereas anti-IL-31 IgG(4)wt underwent rapid and extensive Fab arm exchange. The in vitro results were corroborated by in vivo studies in which mice were injected with a mixture of either form of the test mAb and an excess of non-specific human IgG(4) exchange partner.

The response of mouse intestine to d(22 MeV) + Be neutrons, p(50.5 MeV) + Be neutrons, or 137Cs γ-rays was examined using intestinal crypt-cell survival as an endpoint. The RBEs for 50.5 MeV neutrons relative to 137Cs-γ-rays of response levels of 5 and 50 surviving cells/circumference were 1.80 and 1.86. For d(22 MeV) + Be neutrons, the RBEs at comparable cell survivals were 1.86 and 1.93. For LD507 day (gastrointestinal syndrome), the RBE for 50.5 MeV neutrons was 1.56 and for LD5030 (bone marrow syndrome), the RBE was 1.29. The ability of the phosphorothioates WR-3689 [S-2-(3-methylaminopropylamino) ethylphosphorothioic acid, 450 mg/kg] and WR-77913 [S-2-(3-amino-2-hydroxypropyl) phosphorothioic acid, 800 mg/kg] to protect against p(50.5 MeV) + Be neutrons and γ-rays also was examined in mice using lethality at seven or 30 days as the endpoints. Results were compared to previous studies with d(22 MeV) + Be neutrons WR-2721 (400 mg/kg), an appropriate comparison given the similar RBEs of the two neutron sources relative to γ-rays. WR-77913 is a less effective protector than is WR-2721 while in some cases WR-3689 is as effective as WR-2721. The neutron DMFs for LD507 were 1.12 for WR-3689 and 0.99 for WR-77913. For the bone marrow syndrome (LD5030) the neutron DMFs were 1.47 for WR-3689 and 1.21 for WR-77913. For a given type of radiation, WR-3689 is more effective than WR-77913. Both phosphorothioates protect less well against neutron radiation than against photons, as was reported previously for WR-2721. Protective factors are higher for bone marrow than for gut. Our results differ from other investigators who have reported that some phosphorothioates protect better against fission neutrons than against X- or γ-rays.

The subject matter of this paper focuses on the services provided by Global Logistics Service Providers (GLSPs) and how these can present alternatives to multinational companies in managing their logistics needs. The study first looks at how logistics have developed over time from a supplementary role to becoming a vital contributor in supporting strategic initiatives of multinational companies. This is made possible by the globalisation of businesses. In today's context, the constant search for competitive advantage forces companies to locate warehouses and production facilities wherever opportunities arise. In supporting this need, companies are likely to require the specialised services of GLSPs. Master of Business Administration (Business Law)