Sustainability risk management: Are Malaysian companies ready?

The sustainability issues resulting from Malaysian palm oil production have garnered much interest in the palm oil industry. Consequently, Malaysian palm oil industry is indirectly exposed to sustainability risks, including boycott and reputational and regulatory risks. Hence, the industry encounters intense pressure from numerous stakeholders to address sustainability issues. Prior studies propounded that sustainability risk management (SRM) could minimise the adverse impact of sustainability risks by addressing sustainability issues. Nevertheless, the implementation of sustainability risk management in Malaysia remains low as numerous companies are not ready for it. Drawing on contingency theory, the objective of this study is to investigate the influence of contextual factors that can influence companies' readiness in implementing sustainability risk management. Data was collected through the distribution of questionnaires between July and December 2020. A total of 407 questionnaires were distributed, with a response rate of 29 %. Resultantly, sustainability strategy, business size, top management support, and regulatory pressure positively and significantly influenced sustainability risk management implementation. The findings also expanded the current theoretical knowledge with valuable insights for policymakers regarding the factors influencing to companies' readiness in implementing SRM.

Surface water, sediment, and biota: The first multi-compartment analysis of microplastics in the Karnafully river, Bangladesh.

The Karnafullly River, which flows through Chattogram and falls into the Bay of Bengal, Bangladesh, is vulnerable to microplastic contamination. In this study, we looked at microplastics in the Karnafully River's surface water (5 sites), sediment (9 sites), and biota (4 species). Microplastic concentrations ranged from 0.57 ± 0.07 to 6.63 ± 0.52 items/L in surface water, 143.33 ± 3.33 to 1240 ± 5.77 items/kg dry weight in sediment, and 5.93 ± 0.62 to 13.17 ± 0.76 items/species in biota. A significant difference (P < 0.05) was found in the concentration of MPs in the Karnafully River's sediment, biota, and surface water. High percentage of fiber-shaped and small-sized MPs (<1 mm) were detected throughout the samples. Water and sediment MPs were often transparent/white and blue, whereas biota MPs were mostly black and red, indicating a color preference during biological uptake. The Bay of Bengal received 61.3 × 109 microplastic items per day. The feeding zone of biota influenced the level of microplastics, with a trend of pelagic > demersal > benthic > benthopelagic. Polyethylene and polyethylene terephthalate were the most abundant polymer. Using the average fish intake rate in Bangladesh, we computed a possible consumption of 4015-7665 items of MPs/person/year.

Detection of mobile colistin-resistance gene variants (mcr-1 and mcr-2) in urinary tract pathogens in Bangladesh: the last resort of infectious disease management colistin efficacy is under threat.

Background: Currently, colistin-resistant pathogens emerged has become a global health concern. This study assessed the distribution of mcr-1 to mcr-5 variants with the phenotypic colistin-resistance in bacterial isolates from urinary tract infection (UTI) patients in Bangladesh.Methods: A cross-sectional study was conducted between April 2017 and March 2018 to enroll uncomplicated UTI patients, and 142 urine samples were analyzed. Uropathogens were identified using the API-20E biochemical panel and 16s rRNA gene sequencing. Polymerase chain reactions detected the mcr gene variants in the UTI isolates. The phenotypic colistin-susceptibility was determined by the Kirby-Bauer disc-diffusion method and the minimal inhibitory concentration (MIC) measurement.Results: The combined carriage of mcr-1 and mcr-2 genes in 11.4% (14/123) of urinary tract pathogens. The mcr-positive pathogens include five Escherichia coli, three Klebsiella pneumoniae, three Pseudomonas putida, two Enterobacter cloacae, and one Enterobacter hormaechei. The mcr-positive variant showed significantly higher phenotypic colistin resistance with MIC between >16 µg/mL and >128 µg/mL (p< 0.001). Over 85% of colistin-resistant isolates showed MDR phenomena.Conclusions: The emergence of the clinical MDR pathogens with resistance to a highly selective drug may lead to a lack of treatment options for the infectious diseases and spread of infection to the unaffected cohorts.

Genotypic to Phenotypic Resistance Discrepancies Identified Involving ß-Lactamase Genes, blaKPC, blaIMP, blaNDM-1, and blaVIM in Uropathogenic Klebsiella pneumoniae.

INTRODUCTION: Klebsiella pneumoniae carbapenemase (KPC) belongs to the Group-A ß-lactamases that incorporate serine at their active site and hydrolyze various penicillins, cephalosporins, and carbapenems. Metallo-beta-lactamases (MBLs) are group-B enzymes that contain one or two essential zinc ions in the active sites and hydrolyze almost all clinically available ß-lactam antibiotics. Klebsiella pneumoniae remains the pathogen with the most antimicrobial resistance to KPC and MBLs. METHODS: This research investigated the blaKPC, and MBL genes, namely, blaIMP, blaVIM, and blaNDM-1 and their phenotypic resistance to K. pneumoniae isolated from urinary tract infections (UTI) in Bangladesh. Isolated UTI K. pneumoniae were identified by API-20E and 16s rDNA gene analysis. Their phenotypic antimicrobial resistance was examined by the Kirby-Bauer disc diffusion method, followed by minimal inhibitory concentration (MIC) determination. blaKPC, blaIMP, blaNDM-1, and blaVIM genes were evaluated by polymerase chain reactions (PCR) and confirmed by sequencing. RESULTS: Fifty-eight K. pneumoniae were identified from 142 acute UTI cases. Their phenotypic resistance to amoxycillin-clavulanic acid, cephalexin, cefuroxime, ceftriaxone, and imipenem were 98.3%, 100%, 96.5%, 91.4%, 75.1%, respectively. Over half (31/58) of the isolates contained either blaKPC or one of the MBL genes. Individual prevalence of blaKPC, blaIMP, blaNDM-1, and blaVIM were 15.5% (9), 10.3% (6), 22.4% (13), and 19% (11), respectively. Of these, eight isolates (25.8%, 8/31) were found to have two genes in four different combinations. The co-existence of the ESBL genes generated more resistance than each one individually. Some isolates appeared phenotypically susceptible to imipenem in the presence of blaKPC, blaIMP, blaVIM, and blaNDM-1 genes, singly or in combination. CONCLUSION: The discrepancy of genotype and phenotype resistance has significant consequences for clinical bacteriology, precision in diagnosis, the prudent selection of antimicrobials, and rational prescribing. Heterogeneous phenotypes of antimicrobial susceptibility testing should be taken seriously to avoid inappropriate diagnostic and therapeutic decisions.

Oyster breakwater reefs promote adjacent mudflat stability and salt marsh growth in a monsoon dominated subtropical coast.

Oyster reefs have the potential as eco-engineers to improve coastal protection. A field experiment was undertaken to assess the benefit of oyster breakwater reefs to mitigate shoreline erosion in a monsoon-dominated subtropical system. Three breakwater reefs with recruited oysters were deployed on an eroding intertidal mudflat at Kutubdia Island, the southeast Bangladesh coast. Data were collected on wave dissipation by the reef structures, changes in shoreline profile, erosion-accretion patterns, and lateral saltmarsh movement and related growth. This was done over four seasons, including the rainy monsoon period. The observed wave heights in the study area ranged 0.1-0.5 m. The reefs were able to dissipate wave energy and act as breakwaters for tidal water levels between 0.5-1.0 m. Waves were totally blocked by the vertical relief of the reefs at water levels <0.5 m. On the lee side of the reefs, there was accretion of 29 cm clayey sediments with erosion reduction of 54% as compared to control sites. The changes caused by the deployed reefs also facilitated seaward expansion of the salt marsh. This study showed that breakwater oyster reefs can reduce erosion, trap suspended sediment, and support seaward saltmarsh expansion demonstrating the potential as a nature-based solution for protecting the subtropical coastlines.

A verified habitat suitability model for the intertidal rock oyster, Saccostrea cucullata.

There is growing interest to restore oyster populations and develop oyster reefs for their role in ecosystem health and delivery of ecosystem services. Successful and sustainable oyster restoration efforts largely depend on the availability and selection of suitable sites that can support long-term growth and survival of oysters. Hence, in the present study a habitat suitability index (HSI) model was developed for the intertidal rock oyster (Saccostrea cucullata), with special attention: (1) to the role of the monsoon in the suitability of oyster habitats, and (2) to identify potential suitable sites along the south-eastern Bangladesh coast. Seven habitat factors were used as input variables for the HSI model: (1) water temperature; (2) salinity; (3) dissolved oxygen; (4) particulate inorganic matter (PIM); (5) pH; (6) Chlorophyll-a; and (7) water flow velocity. Seven field surveys were conducted at 80 locations to collect geo-spatial environmental data, which were then used to determine HSI scores using habitat suitability functions. The model results showed that the areas suitable (HSI >0.50) for oyster settlement and growth were characterized by relatively high salinities, Chlorophyll-a, dissolved oxygen and pH values. In contrast, freshwater dominated estuaries and nearby coastal areas with high suspended sediment were found less suitable (HSI <0.50) for oysters. HSI model results were validated with observed oyster distribution data. There was strong correlation between the HSI calculated by the model and observed oyster densities (r = 0.87; n = 53), shell height (r = 0.95; n = 53) and their condition index (r = 0.98; n = 53). The good correspondence with field data enhances the applicability of the HSI model as a quantitative tool for evaluating the quality of a site for oyster restoration and culture.

Utility of Maximum Standard Uptake Value as a Predictor for Differentiating the Invasiveness of T1 Stage Pulmonary Adenocarcinoma.

BACKGROUND: The present study was performed to investigate the maximum standardized uptake value (SUVmax) in 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) to preoperatively distinguish invasive from less-invasive pulmonary adenocarcinoma. PATIENTS AND METHODS: A total of 106 patients with resectable pulmonary adenocarcinoma (≤ 3 cm) who had undergone whole-body 18F-FDG PET/CT were enrolled. The SUVmax, diameter, and consolidation/tumor (C/T) ratio of the lung tumors were measured with 18F-FDG PET/CT and regional thin-section CT. RESULTS: Of the 106 patients, 32 had adenocarcinoma in situ (AIS), 13 had minimally invasive adenocarcinoma (MIA), and 61 had invasive adenocarcinoma (IAC). IAC lesions showed greater uptake of 18F-FDG, a larger tumor diameter, and greater C/T ratios than AIS and MIA (P < .001 for all). A multivariate analysis revealed that only the SUVmax, tumor diameter, and C/T ratio were independent risk factors for tumor invasiveness (P < .05 for all). The best cutoff values for the prediction of invasiveness were 2.15 for the SUVmax, 1.36 cm for the tumor diameter, and 0.36 for the C/T ratio. The SUVmax, tumor diameter, and C/T ratio showed similar predictive sensitivity (83.6%, 82.0%, and 88.5%, respectively). However, the SUVmax showed a greater predictive specificity than the C/T ratio (93.3% vs. 73.3%, respectively; P = .011) but similar to that of the tumor diameter. The predictive sensitivity and specificity were not improved using the 3 combined parameters compared with SUVmax alone. CONCLUSION: The present study has demonstrated that the SUVmax is a good preoperative predictor for the invasiveness of pulmonary adenocarcinoma (≤ 3 cm). It will help surgeons plan low invasive treatment of preinvasive tumors.

Effect of provision of home-based curative health services by public sector health-care providers on neonatal survival: a community-based cluster-randomised trial in rural Pakistan.

BACKGROUND: Although the effectiveness of community mobilisation and promotive care delivered by community health workers in reducing perinatal and neonatal mortality is well established, evidence in support of home-based neonatal resuscitation and infection management is mixed. We assessed the effectiveness of adding training in neonatal bag and mask resuscitation and oral antibiotic therapy for suspected neonatal infections to a basic preventive and promotive interventions package delivered by public sector community-based lady health workers (LHWs) in rural Pakistan. METHODS: We did a cluster-randomised controlled trial in two subdistricts of Naushahro Feroze in rural Sindh, Pakistan, between April 15, 2009, and Dec 10, 2012. LHWs, trained in basic newborn resuscitation and in recognition and treatment (with oral amoxicillin) of suspected neonatal respiratory infections, were linked with traditional birth attendants and encouraged to attend home births. Control clusters received routine care through the existing national programme. The primary outcome was all-cause neonatal mortality. Independent data collection teams recorded data for all pregnancies and their outcomes, morbidity, mortality, and household practices related to maternal and newborn care. FINDINGS: Of the 27 randomised clusters with functional LHW programmes, 13 were allocated to the intervention group (n=242 749) and 14 to the control group (n=256 985). In the intervention group, LHWs did 80% of the planned community mobilisation sessions, but were able to attend only 1184 (14%) of 8425 deliveries and 4318 (25%) of 17 288 neonatal visits within 72 h of birth (p<0·0001 for both variables compared with the control group). The neonatal mortality rate was 42 deaths per 1000 livebirths in intervention clusters compared with 55 per 1000 in the control group (risk ratio 0·80, 95% CI 0·68-0·93; p=0·005). INTERPRETATION: The reduction in neonatal mortality in intervention clusters occurred against a background of improvements in domiciliary practices for maternal and newborn care. However, the poor reach of LHWs in accessing newborn infants at birth and in the early postnatal period underscores the limitations of tasking community health workers in public sector programmes working in similar circumstances with such complex interventions. Such community-based interventions in health systems should be accompanied by concerted efforts to improve quality of care in facilities and referral systems. FUNDING: Saving Newborn Lives, Save the Children USA.

[Combined use of thin-section CT and 18F-FDG PET/CT for characterization of solitary pulmonary nodules].

OBJECTIVE: To investigate whether fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) combined with thin-section CT improves the diagnostic performance for solitary pulmonary nodules (SPNs). METHODS: A total of 267 patients underwent examinations with 18F-FDG PET/CT and thin-section CT for evaluating the SPNs with undetermined nature, which was further confirmed by pathological examination or clinical follow-up. The performance of two diagnostic criteria based on findings in PET/CT alone (Criterion 1) and in PET/CT combined with thin-section CT (Criterion 2) were compared. RESULTS: Thin-section CT provided greater diagnostic information for SPNs in 84.2% of the patients. Compared with Criterion 1, the diagnosis based on Criterion 2 significantly increased the diagnostic sensitivity (80.4% vs 91%, P<0.01) and accuracy (76.4% vs 87.2%, P<0.01) for lung cancer. The lesion size and the CT features including lobulation, air bronchogram, and feeding vessel, but not SUVmax, were all helpful for characterizing non-solid SPNs. Thin-section CT rectified diagnostic errors in 50% (20/40) of the cancerous lesions, which had been diagnosed as benign by PET due to their low metabolism. For non-solid SPNs, Criterion 2 showed a significantly higher diagnostic sensitivity than Criterion 1 (90.0% vs 40.0%, P=0.000) but their diagnostic specificity were comparable (75.2% vs 58.3%, P=0.667). For solid nodules, the use of thin-section CT resulted in no significant improvement in the diagnostic performance (P<0.05). CONCLUSION: The combination of PET/CT and thin-section CT creates a synergistic effect for the characterization of SPNs, especially non-solid nodules.

Transradial approach for coronary procedures in the elderly population.

Transradial cardiac catheterisation has been reported to be more beneficial compared to other approaches with easier and safer post-procedural haemostasis, better patient comfort, earlier ambulation and possibility of performing procedure and discharge on the same day. There is only limited data examining transradial access in the elderly population. In this review we looked at the available literature to give an insight into how the transradial approach compared to the transfemoral and other approaches in the elderly population. Elderly population is at higher risk of vascular access site bleeding and the transradial approach has shown equal efficacy to transfemoral approach. However, transradial approach significantly reduces vascular complications, hospital stay, mobilization times and adverse cardiac events. Therefore, transradial approach should be considered as the preferred vascular access site in the elderly population.

18F-FDG super bone marrow uptake: A highly potent indicator for the malignant infiltration.

The present study was performed to investigate whether the markedly 2-deoxy-2-(fluorine-18) fluoro-D-glucose (F-FDG) uptake in the bone marrow (BM) is a presentation of malignant infiltration (MI).Super bone marrow uptake (super BMU) was used to name the markedly F-FDG uptake on BM, which was similar to or higher than that of the brain. From April 2008 to December 2015, 31 patients with such presentation were retrospectively reviewed. The F-FDG uptake was semiquantified using SUVmax and BM to cerebellum (BM/C) ratio. The origin of super BMU was diagnosed by pathology. Some blood parameters, as well as fever, were also collected and analyzed. For comparison, 106 patients with mildly and moderately uptake in BM and 20 healthy subjects were selected as the control group.Bone marrow MI was diagnosed in 93.5% (29/31) patients with super BMU, which mostly originated from acute leukemia and highly aggressive lymphoma. The super BMU group had markedly higher F-FDG uptake in the BM than those of mildly and moderately uptake, and the control subjects (all P = 0.000) and the BM/C ratio reached a high of 1.24 ±â€Š0.36. The incidence of bone marrow MI in the super BMU group was markedly higher than that of mildly and moderately uptake (93.5% vs 36.8%, P = 0.000). Based on the receiver operating characteristic analysis, when cut-off values of BM/C and SUVmax were set at 0.835 and 6.560, the diagnostic specificity for bone marrow MI reached the high levels of 91.4% and 95.7%, respectively. In 15 patients with bone marrow MI, the extra-BM malignant lesions were simultaneously detected by F-FDG PET/CT. The liver and the nasal cavity involvements were only found in the patients with lymphoma, but not in those with leukemia. A decrease of leukocyte, hemoglobin, and platelet counts was noted in 48.4%, 86.2%, and 51.5% of patients with bone marrow MI, respectively.The present study revealed that super BMU was a highly potent indicator for the bone marrow MI.

False-Positive Finding on 18F FDG PET/CT: Report of a Rare Case With Xanthogranulomatous Inflammation in the Spinal Epidural Space.

Xanthogranulomatous inflammation in the spinal epidural space is extremely rare. We report a case of a 62-year-old man with a xanthogranulomatous inflammation in the spinal epidural space mistaken for lymphoma because of its avid F FDG uptake on PET/CT. This case emphasizes the need for caution when evaluating a spinal epidural mass using F FDG PET/CT as xanthogranulomatous inflammation can induce a false-positive reading on F-FDG PET/CT.

BSL-3 Laboratory User Training Program at NUITM-KEMRI

Pathogens handled in a Biosafety Level 3 (BSL-3) containment laboratory pose significant risks to laboratory staff and the environment. It is therefore necessary to develop competency and proficiency among laboratory workers, and promote behaviors and practices that enhance safety through biosafety training. Following installation of our BSL-3 laboratory at the Center for Microbiology Research-Kenya Medical Research Institute, in 2006, a biosafety training program was developed to provide training on BSL-3 safety practices and procedures. The training program was developed based on the World Health Organization specifications, with adjustments to fit our research activities and biosafety needs. The program is composed of three phases namely; initial assessment, a training phase that includes theory and practicum, and final assessment. This article reports the content of our training program.

BSL-3 Laboratory User Training Program at NUITM-KEMRI

Pathogens handled in a Biosafety Level 3 (BSL-3) containment laboratory pose significant risks to laboratory staff and the environment. It is therefore necessary to develop competency and proficiency among laboratory workers and to promote appropriate behavior and practices that enhance safety through biosafety training. Following the installation of our BSL-3 laboratory at the Center for Microbiology Research-Kenya Medical Research Institute in 2006, a biosafety training program was developed to provide training on BSL-3 safety practices and procedures. The training program was developed based on World Health Organization specifications, with adjustments to fit our research activities and biosafety needs. The program is composed of three phases, namely initial assessment, a training phase including theory and a practicum, and a final assessment. This article reports the content of our training program.