Noise-induced hearing loss among manufacturing factory workers in Kuching, Sarawak: Prevalence and associated risk factors.

INTRODUCTION: Noise-induced hearing loss (NIHL) is a common problem worldwide. Increased globalisation, as well as industrialisation, gives rise to an increase in the incidence of NIHL worldwide. Malaysia is not spared from this problem, either. The objectives were to determine the prevalence of NIHL and its associated factors among manufacturing factory workers. MATERIAL AND METHODS: A cross-sectional study was done in Kuching, Sarawak, involving 173 randomly selected respondents among manufacturing factory workers. Data collected were respondents' workplace monitoring data and their audiometry records obtained from the factory record, and the otoscopy examinations performed. In addition, respondents were required to fill up an interviewer-guided questionnaire. RESULTS: The prevalence of NIHL was high (49.7%). The factors which were found to have a significant association with NIHL in bivariate analysis were age (p < 0.05, 95% CI), male gender (p < 0.05; OR - 7.60; CI 3.34 -18.38), duration of employment (p <0.05), knowledge of noise level (p < 0.05; OR - 4.11; CI 1.10 - 15.28), working at polishing department (p < 0.05; OR - 4.23; CI 2.13 - 8.43), and smoking (p < 0.05; OR - 39.6; CI 16.5 - 94.8). Pack-years of smoking were also found to have a significant association with p < 0.05. However, only smoking was statistically significant in multivariate analysis, where the risk of developing NIHL was 27.55 (p < 0.005; CI 10.74 - 70.64) among smokers. CONCLUSION: The high prevalence of NIHL despite the existing Hearing Conservation Program (HCP) may indicate that there may be some elements in HCP that require close monitoring by the factory management, and the importance of smoking cessation among the workers exposed to noise at the workplace should be highlighted.

Auditory neural correlates and neuroergonomics of driving assistance in a simulated virtual environment.

Objective.Driver assistance systems play an increasingly important role in modern vehicles. In the current level of technology, the driver must continuously supervise the driving and intervene whenever necessary when using driving assistance systems. The driver's attentiveness plays an important role in this human-machine interaction. Our aim was to design a simplistic technical framework for studying neural correlates of driving situations in a functional magnetic resonance imaging (fMRI) setting. In this work we assessed the feasibility of our proposed platform.Methods.We proposed a virtual environment (VE) simulation of driver assistance as a framework to investigate brain states related to partially automated driving. We focused on the processing of auditory signals during different driving scenarios as they have been shown to be advantageous as warning stimuli in driving situations. This provided the necessary groundwork to study brain auditory attentional networks under varying environmental demands in an fMRI setting. To this end, we conducted a study with 20 healthy participants to assess the feasibility of the VE simulation.Results.We demonstrated that the proposed VE can elicit driving related brain activation patterns. Relevant driving events evoked, in particular, responses in the bilateral auditory, sensory-motor, visual and insular cortices, which are related to perceptual and behavioral processes during driving assistance. Conceivably, attentional mechanisms increased somatosensory integration and reduced interoception, which are relevant for requesting interactions during partially automated driving.Significance.In modern vehicles, driver assistance technologies are playing an increasingly prevalent role. It is important to study the interaction between these systems and drivers' attentional responses to aid in future optimizations of the assistance systems. The proposed VE provides a foundational first step in this endeavor. Such simulated VEs provide a safe setting for experimentation with driving behaviors in a semi-naturalistic environment.

Workplace violence among nurses in a Penang hospital: Prevalence and risk factors.

INTRODUCTION: Workplace violence (WPV) has become a universal concern and is perceived as a serious safety and health threat, especially in healthcare settings. Very few studies have been done previously to determine the prevalence of WPV and associated risk factors among nurses in Malaysia. Among the health professionals, nurses spend most of their time with patients compared to other healthcare professionals. Several studies suggested that nurses had a higher risk of experiencing WPV. This study determined the prevalence and associated risk factors of WPV among nurses in a government hospital. MATERIALS AND METHODS: This cross-sectional study involved 410 randomly selected respondents among nurses in a government hospital in Penang, Malaysia. Data were gathered through a self-administered questionnaire consisting of a standardised questionnaire regarding WPV. RESULTS: The prevalence of reported WPV was 43.9%. The most common forms of WPV were verbal abuse (82.2%), followed by psychological violence (8.9%), physical violence (8.3%), and sexual violence (0.6%). The perpetrators were primarily among relatives of patients (51.7%), followed by patients (30%). Multiple logistic regression demonstrated that nurses working in the emergency department (ED) were six times more likely to experience WPV than in other departments (adjusted odds ratio (AOR) 6.139, 95% CI: 1.28 - 4.03). In addition, nurses in the age group of ≤30 years old were twice more likely to experience WPV (AOR 2.275, 95% CI: 3.4-11.08). CONCLUSION: This study indicates that the prevalence of WPV among nurses is high and most common among young nurses and those working in ED. Hence, hospital management should develop guidelines and comprehensive policies to prevent WPV. In addition, education and training, especially among young nurses and those working in the ED, are needed to increase their knowledge in the management and prevention of WPV and counselling sessions for nurses who have experienced WPV.

Compliance of Malaysian healthcare workers towards tuberculosis prevention programmes in workplace: An exploratory sequential mixed method study protocol.

INTRODUCTION: The World Health Organization (WHO) stated that the incidence of tuberculosis among healthcare workers is increasing yearly and exceeds the incidence of tuberculosis in the community in almost all the countries that report to the WHO. The problem is greater in countries with high burden of tuberculosis disease in the community. The cause of this problem may be contributed by the attitudes of the healthcare workers themselves, such as non-compliance of the procedures at their work tasks meant to prevent them from contracting the disease. Therefore, this study aims to assess the perceptions and the behaviours of healthcare workers in relation to compliance towards prevention activities on tuberculosis at their workplace. MATERIALS AND METHODS: We plan to conduct a two-phase exploratory sequential mixed method study to determine the factors affecting compliance of Malaysian healthcare workers towards tuberculosis prevention programmes in their workplace based on the guidelines of the Ministry of Health, Malaysia. Phase one is a qualitative study with a focus group discussion and questionnaire development and phase two is a quantitative study where data will be collected among healthcare workers in government clinics and hospitals in Selangor. The data from phase one will be analysed using Atlas.Ti software for thematic analysis and data from phase two will be analysed using SEM AMOS software for structural equation modelling.

Microenvironmental pH-modified Amisulpride-Labrasol matrix tablets: development, optimization and in vivo pharmacokinetic study.

Amisulpride (AMS) is atypical antipsychotic with a weak basic nature (pKa 9.37), which results in low solubility in the high pH of the intestine. It is also recognized as a substrate of P-glycoprotein efflux pump. Both factors lead to its low oral bioavailability (48%). The daily dose of AMS is between 200 and 1200 mg to be taken in divided doses which compromise patient compliance. Therefore, controlled release formulation of AMS is of clinical significance. AMS was formulated into matrix tablets containing Labrasol, P-glycoprotein efflux inhibitor, and a penetration enhancer, using direct compression technique. The tablets were prepared according to 21·41 factorial design using two polymers, namely, HPMC and Carbopol 934 at four concentrations (20%, 30%, 40%, 50%). Percentage AMS released after 2 h (Q2hr%) and 8 h (Q8hr%) were chosen as dependent variables. Two acidic pH modifiers (fumaric acid and tartaric acid) at two levels (15% and 30%) were incorporated in the tablet according to 22 factorial design. All formulae with acidic pH modifier had similarity factor (f2) ≥ 50 proving the pH independent release of AMS. The pharmacokinetic study in rabbits revealed 30% enhancement of the oral absorption AMS imparted by the pH-modified matrix tablet containing Labrasol. Graphical abstract.

A Novel Brain-Computer Interface Virtual Environment for Neurofeedback During Functional MRI.

Virtual environments (VEs), in the recent years, have become more prevalent in neuroscience. These VEs can offer great flexibility, replicability, and control over the presented stimuli in an immersive setting. With recent developments, it has become feasible to achieve higher-quality visuals and VEs at a reasonable investment. Our aim in this project was to develop and implement a novel real-time functional magnetic resonance imaging (rt-fMRI)-based neurofeedback (NF) training paradigm, taking into account new technological advances that allow us to integrate complex stimuli into a visually updated and engaging VE. We built upon and developed a first-person shooter in which the dynamic change of the VE was the feedback variable in the brain-computer interface (BCI). We designed a study to assess the feasibility of the BCI in creating an immersive VE for NF training. In a randomized single-blinded fMRI-based NF-training session, 24 participants were randomly allocated into one of two groups: active and reduced contingency NF. All participants completed three runs of the shooter-game VE lasting 10 min each. Brain activity in a supplementary motor area region of interest regulated the possible movement speed of the player's avatar and thus increased the reward probability. The gaming performance revealed that the participants were able to actively engage in game tasks and improve across sessions. All 24 participants reported being able to successfully employ NF strategies during the training while performing in-game tasks with significantly higher perceived NF control ratings in the NF group. Spectral analysis showed significant differential effects on brain activity between the groups. Connectivity analysis revealed significant differences, showing a lowered connectivity in the NF group compared to the reduced contingency-NF group. The self-assessment manikin ratings showed an increase in arousal in both groups but failed significance. Arousal has been linked to presence, or feelings of immersion, supporting the VE's objective. Long paradigms, such as NF in MRI settings, can lead to mental fatigue; therefore, VEs can help overcome such limitations. The rewarding achievements from gaming targets can lead to implicit learning of self-regulation and may broaden the scope of NF applications.

Correction to: Enhanced Oral Absorption of Amisulpride Via a Nanostructured Lipid Carrier-Based Capsules: Development, Optimization Applying the Desirability Function Approach and In Vivo Pharmacokinetic Study.

The second author's name was incorrectly published as "Niha F. Younes". The correct name is "Nihal Farid Younes" as shown above in the list of authors.

Enhanced Oral Absorption of Amisulpride Via a Nanostructured Lipid Carrier-Based Capsules: Development, Optimization Applying the Desirability Function Approach and In Vivo Pharmacokinetic Study.

Amisulpride (AMS), a second generation antipsychotic, suffers from low oral bioavailability (48%). This might be due to its pH-dependent solubility or being a substrate of P-glycoprotein efflux pump. Nanostructured lipid carriers (NLCs) were proposed in this study to enhance the oral absorption of AMS. AMS-NLCs were prepared by solvent evaporation technique according to (21.41.31) factorial design, whereas the type of solid lipid (tripalmitin or Gelucire® 43/1), lipid to drug ratio (7:1, 10:1, or 13:1) and type of external suspending medium (double distilled water, 0.5% TSP pH 12, 1% HPMC or 2.5% glycerin) were the independent variables. The average entrapment efficiency, particle size, polydispersity index, and zeta potential of the prepared formulations ranged from 29.01 to 69.06%, 184.9 to 708.75 nm, 0.21 to 0.59, and - 21 to - 33.55 mV, respectively. AMS-NLCs were optimized according to the desirability function to maximize the entrapment efficiency and minimize the particle size. Formulae G12, G10, and G7 with the highest desirability values of 0.915, 0.84, and 0.768, respectively, were chosen for further investigations. Novel AMS-NLCs capsules were prepared from the lyophilized formulations (TG7 and MG10) to enhance stability and increase patient compliance. The capsules were evaluated in terms of weight variation, content uniformity, and in vitro release pattern. The pharmacokinetics of AMS-NLCs capsules (formula TG7) were tested in rabbits compared to the commercial Amipride® tablets. The relative bioavailability of AMS-NLCs capsules was found to be 252.78%. In conclusion, the NLC-based capsules show potential to improve the oral bioavailability of AMS.

A rare glimpse into the morbid world of necrotising fasciitis: Flesh-eating bacteria Vibrio vulnificus.

Necrotising fasciitis is one of the fatal skin and soft tissue infections. Vibrio vulnificus is a rare cause of necrotising fasciitis; however, the disease is one of the major manifestations of the bacteria. Here, we report one such case in a middle-aged male patient. He presented with the signs of bilateral lower limb cellulitis and altered sensorium. V. vulnificus was isolated from blood culture and also from debrided tissue. Though the organism is well characterised, it is a rare causative agent of necrotising fasciitis. This case is a re-emphasis on active look out for this bacterium in patients presenting with necrotizsing fasciitis.

Low-Cost Wearable for Fatigue and Back-Stress Measurement in Nursing.

In recent years the need for informal home care in European countries is growing quickly due to increased life expectancy and demographic change. Informal caregivers have to overcome many obstacles ranging from a lack of adequate training to misjudging their physical and psychological abilities. The aim of this project is to create a low cost wearable device, which unobtrusively measures the physical stress load on caregivers. Two parameters with the most impact on performance and well-being of the caregiver have been identified: (i) fatigue and (ii) back-stress. Based on the measurements, an alert is issued if caregivers are not performing a task correctly, or if they are overexerting themselves. This paper discusses the design of such device and description of an initial prototype, its advantages and possible further development and applications.

[Onychomycosis in Casablanca (Morocco)]. / Les onychomycoses à Casablanca (Maroc).

UNLABELLED: Onychomycosis is the most common nail disease and its prevalence in the literature is estimated between 18 and 50%. The main objective of this study is to describe the epidemiology of onychomycosis and specify the most frequently fungal agents isolated at the University Hospital of Casablanca. MATERIAL AND METHODS: [corrected] In a retrospective study, performed at the laboratory of Parasitology and Mycology, University Hospital Center of Casablanca (Morocco), over a period of 5 years (2006-2010), mycological results (microscopic study and culture) of 2070 nail samples made during this period were analysed. All onychomycosis cases included in this study had positive microscopy and culture. RESULTS: Totally, during this period, mycological aetiology was confirmed in 64.5% of cases. Dermatophytes were isolated in 65% of cases (n = 858), yeasts in 30% (n = 405) and molds from 72 nails. Candida albicans is the predominant yeast species in this study (49%), essentially in the fingernails. Onyxis in toenails is essentially dermatophytic, and Trichophyton rubrum is isolated in 75% of onychomycosis of foot. CONCLUSION: Onychomycosis is a frequent disease in our context, due to diversified fungal agents: dermatophytis in toenail and Candida at the fingernails.

A phase 2 study of the combination of gemcitabine and cisplatin in patients with locally advanced or metastatic breast cancer previously treated with anthracyclines with/without taxanes.

BACKGROUND AND OBJECTIVES: Many patients with relapsed metastatic breast cancer are pre-treated with taxanes and anthracyclines, which are usually given in the neoadjuvant/adjuvant setting or as first-line treatment for metastatic disease. The primary objective of this study was to determine the overall response rate for combination treatment with gemcitabine and cisplatin in patients with locally advanced or metastatic breast cancer who had relapsed after receiving one adjuvant/neoadjuvant or first-line metastatic chemotherapy regimen containing an anthracycline with/without a taxane. Secondary endpoints included duration of response, time to progression, one-year survival probability, and toxicity. DESIGN AND SETTING: A single-arm, open-label, phase 2 study conducted at 17 investigative sites in Egypt. PATIENTS AND METHODS: treatment consisted of gemcitabine (1250 mg/m2) on Days 1 and 8 and cisplatin (70 mg/m2) on Day 1 of each 21-day cycle. Treatment continued until disease progression or a maximum of 6 cycles. RESULTS: Of 144 patients all were evaluable for safety and 132 patients were evaluable for efficacy. The overall response rate was 33.3% and 45.5% of the patients with stable disease as their best response. The median time-to-progression was 5.1 months and the one-year survival probability was 73%. The most common grade 3/4 adverse events were nausea/vomiting (20.1%), neutropenia (19.4%), anemia (13.9%), asthenia (11.1%), diarrhea (9.7%), stomatitis (7.6%), leucopenia (7.6%), and thrombocytopenia (6.2%). twelve (8.3%) patients had serious adverse events. CONCLUSIONS: The results of this study indicate that gemcitabine and cisplatin were active and generally well tolerated in pretreated patients with locally advanced or metastatic breast cancer.

Characteristics and control of the normal menstrual cycle.

The most important activity during the follicular phase of the cycle is the secretion of gonadotropins, which control folliculogenesis and influence uterine proliferation. The dominant events of the periovulatory phase are the LH surge and ovulation. The significant change during the luteal phase is the production of a nutritive mucus by the endometrial glands in preparation for an embryonic blastocyst. The cardinal passage of the menstrual phase is the menstrual flow itself. These different events (and the metabolic processes that regulate them) have wide-ranging effects on the integrity of the body. As Havelock Ellis, the eminent English psychologist, stated at the turn of this century, "the omnipresent process of sex, as it is woven into the whole texture of our body, is the pattern of all the process of our life" (source unknown). The sweeping influences of the menstrual cycle illustrate the extent to which the process of reproduction is indeed woven into the whole of the human body.