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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.

Traditional teaching and learning process referring to chalk-and-talk has become outdated in lessons.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.

Abdulaziz Alsaedi,1 Surianti Sukeri,2 Najib Majdi Yaccob3 1Department of Medical Services, Prince Mohammed Bin Abdulaziz Hospital, National Guard Health Affairs, Madinah, Saudi Arabia; 2Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia; 3Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, MalaysiaCorrespondence: Surianti Sukeri, Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia, Tel +60 193640963, Email surianti@usm.myBackground: Healthcare organizations worldwide tend to implement hospital accreditation programs to improve the quality of care they provide. However, the literature shows inconsistent findings on the impact of such programs on the quality of care due to improper implementation of accreditation programs.Purpose: This study explored the enabling factors for the effective implementation of the Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) program in the Ministry of Health (MOH) hospitals in Madinah, Saudi Arabia.Methods: This qualitative study involved 22 professionals from five CBAHI-accredited MOH hospitals in Madinah, Saudi Arabia. A purposive sampling technique was applied, and data were collected through in-depth, semi-structured interviews. A thematic analysis approach was applied to the interview transcripts.Results: Four themes and 11 subthemes emerged. The emerging themes included the development of human capital, resolving quality management issues, ensuring the availability of resources, and strategizing CBAHI-specific solutions.Conclusion: The current study fills this knowledge gap by identifying the factors leading to the effective implementation of the CBAHI accreditation program in the MOH hospitals. Only the effective execution of the CBAHI will increase healthcare quality and, as a result, justify the significant resources and efforts invested in these programs. Future research should replicate similar study in other governments or private hospitals.Keywords: hospital accreditation, enabling factors, CBAHI, quality of care

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.

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.

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.

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.

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.

Four genetic populations ( P1 , P2 , F1 , F2) were used in this study . The parental cross in barley ( P1 barakq and P2 Pakistan ) was done . Many quantitative pheno types were estimated such as plants length , tillers number , grains yield , capsules number , the number of grains per capsule and the weight of 1000 grains . The results showed significant differences in genetic variance values in the seconed filial generation ( F2) for all the studied phenotypes : High values for the heritability were observed for all the studied phenotypes . These results indicated the effect of additive and non-additive genes on the quantitative phenotypes . Finally , the selection of first generation can utilized for improving the quantitative traits . specially the grain yield in plant