Does use of pooled cohort risk score overestimate the use of statin?: a retrospective cohort study in a primary care setting

BACKGROUND: Initiation of statin therapy as primary prevention particularly in those with mildly elevated cardiovascular disease risk factors is still being debated. The 2013 ACC/AHA blood cholesterol guideline recommends initiation of statin by estimating the 10-year atherosclerotic cardiovascular disease (ASCVD) risk using the new pooled cohort risk score. This paper examines the use of the pooled cohort risk score and compares it to actual use of statins in daily clinical practice in a primary care setting. METHODS: We examined the use of statins in a randomly selected sample of patients in a primary care clinic. The demographic data and cardiovascular risk parameters were captured from patient records in 1998. The pooled cohort risk score was calculated based on the parameters in 1998. The use of statins in 1998 and 2007, a 10-year interval, was recorded. RESULTS: A total of 847 patients were entered into the analysis. Mean age of the patients was 57.2 ± 8.4 years and 33.1% were male. The use of statins in 1998 was only 10.2% (n = 86) as compared to 67.5% (n = 572) in 2007. For patients with LDL 70-189 mg/dl and estimated 10-year ASCVD risk ≥7.5% (n = 190), 60% (n = 114) of patients were on statin therapy by 2007. There were 124 patients in whom statin therapy was not recommended according to ACC/AHA guideline but were actually receiving statin therapy. CONCLUSIONS: An extra 40% of patients need to be treated with statin if the 2013 ACC/AHA blood cholesterol guideline is used. However the absolute number of patients who needed to be treated based on the ACC/AHA guideline is lower than the number of patients actually receiving it in a daily clinical practice. The pooled cohort risk score does not increase the absolute number of patients who are actually treated with statins. However these findings and the use of the pooled cohort risk score need to be validated further

Design, purpose of usage and the impact of LMS on student learning: A preliminary findings

Knowledge management era give impact the world in many domains, including education sectors. Education sector moves to the online learning instead of traditional approach; face to face. Learning Management System (LMS) is one of the knowledge management tools that support knowledge sharing and communication among its participants.To date LMS has been found to be very popular among institution of higher learning in Malaysia.This study empirically investigate the effect of user based design and usability on LMS.Fifty respondents involved in this short survey.The findings are expecting useful for designers of LMS

Privacy Protection Policy for Big Data Analytics in the Malaysian Telecommunications Sector

The telecommunications sector has accessed to large amount of data. When use effectively, this Big Data enables the telcos to achieve efficiency and profitability across the entire telecommunications value chain. However, the potential advantage of Big Data may be tempered by increasing privacy concern among users. Countries across different parts of the world including Malaysia have enacted data protection policy. In Malaysia, the Personal Data Protection Act 2010 (PDPA) was officially enforced on November 15th, 2013. To date, its implementation remains challenging and its effect is unclear. This paper attempts to understand the state of data protection policy implementation and its challenges from the viewpoints of three major stakeholders: the users (i.e., the data owners and creators), the telcos (i.e., the data recipients), and the government (i.e., the policy enforcer). Guided by Giddens’ Structuration Theory and the Competing Value Framework, semi-structure interview data will be collected from the three stakeholders to understand how differing perspectives of the stakeholders shape the data protection structure/institution and vice versa

Microstructure And Kinetic Growth Of Aluminide Coating On 304 Stainless Steel By Slurry Aluminizing

Aluminide coating by slurry aluminizing has gained interest by industry to improve the corrosion resistance of structural materials operating in harsh environments. However, depletion of aluminium from the coating into the substrate and mismatch in coefficient thermal expansion (CTE) became obstacles in developing a good protective aluminide coating. Austenitic stainless steel 304 was chosen as the substate due to the smaller CTE mismatch between substrate and the coating. Furthermore, Al2O3 was added to the slurry composition as an aluminizing agent to slow the inward diffusion of aluminium into the substrate. The aim of this project is to study the effect of heat treatment temperature and time on the aluminide coating formation with the present of alumina. The slurry coated sample was heat treated at various temperatures (600, 630, 650, 680, and 700°C) and times (4, 6, 8 and 10 hours). At 600 and 630°C, a thin layer of aluminide was formed due to the low temperature which not able to induce the solid-state diffusion. Based on EDX, XRD, and nano hardness analysis, FeAl3 formed in the outer layer and FeAl phase developed in the interdiffusion zone (IDZ). The aluminide coating and FeAl thickness increase as heat treatment temperature and time increases. According to the Arrhenius equation, the activation energy for FeAl3 and FeAl phase was 214.630 kJ/mol, while the activation energy for FeAl phase was 343.153 kJ/mol. Heat-treated samples at 700°C for 10 hours had better corrosion resistance due to thicker coating thickness. Aluminide coating developed on austenitic stainless steel 304 yields promising results and has the potential to be used as a protective coating

Toll-like receptor 9 and 4 gene polymorphisms in susceptibility and severity of malaria: a meta-analysis of genetic association studies

Background: Malaria is still a major public health problem in sub-Saharan Africa and South-east Asia. The clinical presentations of malaria infection vary from a mild febrile illness to life-threatening severe malaria. Toll like receptors (TLRs) are postulated to be involved in the innate immune responses to malaria. Individual studies showed inconclusive findings. This study aimed to assess the role of TLR4 (D299G, T399I) and TLR9 (T1237C, T1486C) in severity or susceptibility of malaria by meta-analysis of data from eligible studies. Methods: Relevant case–control studies that assessed the association between TLR 4/9 and malaria either in susceptibility or progression were searched in health-related electronic databases. Quality of included studies was evaluated with Newcastle–Ottawa scale. Pooled analyses for specific genetic polymorphisms were done under five genetic models. Stratified analysis was done by age and geographical region (Asian countries vs non-Asian countries). Results: Eleven studies (2716 cases and 2376 controls) from nine endemic countries were identified. Five studies (45.4%) obtained high score in quality assessment. Overall, a significant association between TLR9 (T1486C) and severity of malaria is observed in allele model (OR: 1.26, 95% CI: 1.08–1.48, I2 = 0%) or homozygous model (OR: 1.55, 95% CI: 1.08–2.28, I2 = 0%). For TLR9 (T1237C), a significant association with severity of malaria is observed in in heterozygous model (OR:1.89, 95% CI: 1.11–3.22, I2 = 75%). On stratifications, TLR9 (T1486C) is only significantly associated with a subgroup of children of non-Asian countries under allele model (OR: 1.25, 95% CI: 1.02–1.38), while 1237 is with a subgroup of adults from Asian countries under heterozygous model (OR: 2.0, 95% CI: 1.09–3.64, I2 = 39%). Regarding the susceptibility to malaria, TLR9 (T1237C) is significantly associated only with the children group under recessive model (OR: 2.21, 95% CI: 1.06–4.57, I2=85%) and homozygous model (OR: 1.49, 95% CI: 1.09–2.0, I2 = 0%). For TLR4 (D299G, T399I), none is significantly associated with either severity of malaria or susceptibility to malaria under any genetic models. Conclusions: The findings suggest that TLR 9 (T1486C and T1237C) seems to influence the progression of malaria, under certain genetic models and in specific age group of people from specific geographical region. TLR 9 (T1237C) also plays a role in susceptibility to malaria under certain genetic models and only with children of non-Asian countries. To substantiate these, future well designed studies with larger samples across endemic countries are needed

The effects of ethnicity, gender and parental financial knowledge socialisation on financial knowledge among Gen Z: the case of Sarawak, Malaysia

Abstract Purpose – The purpose of this paper is to examine the relationship between financial socialisation experiences, socio-economic factors, demographic characteristics and the financial knowledge of first year undergraduate students. Design/methodology/approach – Using a questionnaire, data were collected from a sample of 450 first year university students from both private and public universities. A multivariate regression method was adopted to examine the influence of financial socialisation among respondents of different ethnic groups and their social backgrounds on the individual’s financial knowledge. Findings – The findings indicate that: firstly, financial knowledge is low among first-year university students in Sarawak. Secondly, male respondents outperform female counterparts in terms of financial knowledge. Thirdly, parental financial socialisation remains the main source of financial knowledge among the students. Fourthly, there are significant differences in financial knowledge across ethnic groups. Research limitations/implications – It is paramount to implement financial education programmes to elevate the financial literacy for both youth and parents since parents remain the primary source of financial socialisation for young adults. Practical implications – The study suggests that financial knowledge varies according to gender and ethnicity. Hence, financial education programmes should be designed to accommodate the differences between groups based on ethnicity and gender to achieve the best outcome. Originality/value – This is the first study that draws a representative sample of university students in Sarawak that examines the effects of ethnicity, gender and parental financial socialisation on financial knowledge among first year university students. Keywords Malaysia, University students, Financial knowledge, Sarawak, Ethnic differences, Financial socialisatio

Through-and-Through Mattress Suturing Versus Tie-Over Dressing in Full-Thickness Skin Graft Reconstruction

Objective:To compare the outcomes of securing full-thickness skin grafting (FTSG) with through- and-through mattress suturing versus the classic tie-over and pressure dressing and identify the associated risk factors of graft failure.Methods:A single-institution, retrospective case series of patients who had undergone excision of head and neck skin lesions requiring FTSG over a 10-year period was reviewed.Results:In total, 128 FTSG reconstructions were performed. The follow-up period ranged from 1 to 192 weeks. The observed graft take rate was 86.4%. There was no significant difference in the outcome when the surgical fixation technique was compared. Age, sex, or defect area did not affect the graft take rate. Smoking and the use of anticoagulants were not found to be contributory factors to graft failure.Conclusion:Simple through-and-through mattress suturing provides adequate graft take, while minimizing tissue handling of the graft and reducing surgical time in comparison to the traditional tie-over and pressure technique

Properties and bifunctional catalytic activity of niobium-doped silica-titania: effect of phosphoric acid treatment

The effect of phosphoric acid treatment on the physical-chemical properties and catalytic activity of the niobium-doped silica-titania bifunctional catalyst was investigated. As part of the synthesis procedure to produce xPO4−/Nb/TiO2-SiO2, different concentrations of phosphoric acid (H3PO4) were used (x= 0, 0.05, 0.10, 0.15, 0.20, 0.25 M). As shown by XRD analysis, the samples synthesized using 0–0.20 M H3PO4 were in amorphous form, as featureless diffractograms were obtained, indicating the PO4− groups were dispersed homogeneously on the surface of Nb doped SiO2-TiO2 . Due to the increased concentration of acid, other compounds were formed in the samples by reactions between PO4− and Nb and/or Ti. Additionally, UV-Vis DRS results indicated that the presence of the PO4− group accelerated the transformation of hydrated tetrahedral Ti species into isolated tetrahedral Ti species. An experimental investigation of the catalytic performance of the catalyst was conducted using 1,2-epoxyoctane as an oxidant for the epoxidation of 1-octene to 1,2-octanediol. It has been demonstrated that H3PO4 treatment was essential for oxidative and acidity active site formation. The current research findings strongly suggested that Nb-doped TiO2-SiO2 treated with 0.2 M H3PO4 was the most effective bifunctional catalyst in generating 1,2-octanediol

Exploring group work during Mandarin classes using Tuckman’s model / On Yee Min ... [et a.l]

Group work is commonly used to promote teamwork, problem-solving, and exchanging ideas and perspectives among group members. To explore how Malaysian students perceive the various stages of group work and investigate the relationship between all stages, quantitative research was conducted on 165 university students taking Mandarin as a Foreign Language course. The Tuckman's Model was implemented in this study. The study indicates that learners at the forming stage are more likely to assign specific roles to team members and try to define the goal and what tasks need to be accomplished. During the storming stage, where discussions take place, the findings show that learners agree with the statement that the team leader should be the one who tries to contribute to the task at hand. The norming stage demonstrates that learners tend to achieve harmony by avoiding conflict and accepting each other as team members. During the performing stage, learners agree that they got a lot of work done, they appear to perceive the interactions in the group as positive and cooperative, and they fully accept each other's strengths and weaknesses. The findings also indicate that various stages of group work are linked to one another in a constructive progression, revealing that these stages are not distinct from one another but rather interconnected in a positive progression. It can be helpful to gain awareness of these linkages to guide a group effectively