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Background Attitudes towards smoking, lung cancer screening, and perceived risk of lung cancer have not been widely studied in Malaysia. The primary objective of this study was to describe the factors affecting the willingness of high-risk current smokers and ex-smokers to undergo low-dose computed tomography (LDCT) screening for lung cancer. Methods A prospective, cross-sectional questionnaire study was conducted in current smokers or ex-smokers aged between 55 and 80 years at three hospitals in Kota Kinabalu, Sabah, Malaysia. The questionnaire recorded the following parameters: perceived lung cancer risk; Prostate Lung Colon Ovarian Cancer 2012 risk prediction model excluding race and ethnicity predictor (PLCOm2012norace); demographic characteristics; psychosocial characteristics; and attitudes towards lung cancer and lung cancer screening. Results A vast majority of the 95 respondents (94.7%) indicated their willingness to undergo screening. Stigma of lung cancer, low levels of knowledge about lung cancer symptoms, concerns about financial constraints, and a preference for traditional medication were still prevalent among the respondents, and they may represent potential barriers to lung cancer screening uptake. A desire to have an early diagnosis (odds ratio [OR], 11.33; 95% confidence interval [CI], 1.53 to 84.05; p=0.02), perceived time constraints (OR, 3.94; 95% CI, 1.32 to 11.73; p=0.01), and proximity of LDCT screening facilities (OR, 14.33; 95% CI, 1.84 to 111.4; p=0.01) had significantly higher odds of willingness to undergo screening. Conclusion Although high-risk current smokers and ex-smokers are likely to undergo screening for lung cancer, several psychosocial barriers persist. The results of this study may guide the policymakers and clinicians regarding the need to improve lung cancer awareness in our population.

This study investigated the use of i-THINK Mapping in teaching reading comprehension by ESL teachers to a group of Form Five students, and the factors and challenges the ESL teachers faced in teaching reading comprehension using i-THINK Mapping. A qualitative approach, specifically a case study design, was employed in this study. Classroom observations, semi-structured interviews, and document analysis of their lesson plans were used to collect the data. Four ESL teachers with a minimum of 5-year teaching experience in a rural secondary school in Hulu Selangor, Malaysia, were selected using a purposive sampling technique to participate in this study. Thematic analysis was used to analyse the data obtained from classroom observations and interviews. The findings show that the teachers had applied five i-THINK maps, including a Circle Map to define in context, a Bubble Map to describe, a Double Bubble Map to compare and contrast, a Flow Map to show the sequence of an event, and a Tree Map to classify different ideas. The i-THINK Mapping motivated the students to discuss, brainstorm, and cooperate with their peers to detect the details from the given reading texts. The teachers’ challenges include the time constraints in preparing the lesson with i-THINK Mapping and a low level of student English proficiency. One implication of this study is that teachers’ use of i-THINK Mapping to teach reading comprehension could assist students in generating ideas, expanding ideas, and expressing them orally.

Introduction The top research priority for cavernoma, identified by a James Lind Alliance Priority setting partnership was ‘Does treatment (with neurosurgery or stereotactic radiosurgery) or no treatment improve outcome for people diagnosed with a cavernoma?’ This pilot randomised controlled trial (RCT) aims to determine the feasibility of answering this question in a main phase RCT.Methods and analysis We will perform a pilot phase, parallel group, pragmatic RCT involving approximately 60 children or adults with mental capacity, resident in the UK or Ireland, with an unresected symptomatic brain cavernoma. Participants will be randomised by web-based randomisation 1:1 to treatment with medical management and with surgery (neurosurgery or stereotactic radiosurgery) versus medical management alone, stratified by prerandomisation preference for type of surgery. In addition to 13 feasibility outcomes, the primary clinical outcome is symptomatic intracranial haemorrhage or new persistent/progressive focal neurological deficit measured at 6 monthly intervals. An integrated QuinteT Recruitment Intervention (QRI) evaluates screening logs, audio recordings of recruitment discussions, and interviews with recruiters and patients/parents/carers to identify and address barriers to participation. A Patient Advisory Group has codesigned the study and will oversee its progress.Ethics and dissemination This study was approved by the Yorkshire and The Humber—Leeds East Research Ethics Committee (21/YH/0046). We will submit manuscripts to peer-reviewed journals, describing the findings of the QRI and the Cavernomas: A Randomised Evaluation (CARE) pilot trial. We will present at national specialty meetings. We will disseminate a plain English summary of the findings of the CARE pilot trial to participants and public audiences with input from, and acknowledgement of, the Patient Advisory Group.Trial registration number ISRCTN41647111.

There is no clear definition of what constitutes an ideal teacher educator, particularly from the perspective of Malaysian educators. Developing teacher educators’ vision of an ideal teacher ensures that teachers have high levels of professional, personal, and contextual dimensions in teaching practices, including competence in the practice of professional teaching, knowledge, and understanding. Therefore, the objective of this study was to find out the range of visions of what it is to be a good teacher educator in a Malaysian teacher education institution. Seventeen teacher educators from an established university in Malaysia participated in the study. A survey consisting of eight questions was used as the research instrument. The data obtained from the questionnaire were analysed by using descriptive and textual analysis techniques. The findings reveal certain criteria of an ideal teacher such as possessing sound subject matter knowledge, mastery of both generic and content-specific pedagogy, and hands-on teaching skills. The teacher educators shared that they have to adjust their goals to attain their vision, namely the need to adapt to the current policies, new ideas, and the ever-changing educational trends. The findings also show that an ideal teacher is the one who is responsible to nurture and bring about the best learning experience for students. This research has unfolded the teacher educators’ vision of the ideal teacher and pedagogical implications reflected in every facet of their educational practices.

ObjectiveNormal pressure hydrocephalus (NPH) is a neurological condition characterized by a clinical triad of gait disturbance, cognitive impairment, and urinary incontinence in conjunction with ventriculomegaly. Other neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease, and vascular dementia share some overlapping clinical features. However, there is evidence that patients with comorbid NPH and Alzheimer's or Parkinson's disease may still exhibit good clinical response after CSF diversion. This study aims to evaluate clinical responses after ventriculo-peritoneal shunt (VPS) in a cohort of patients with coexisting NPH and neurodegenerative disease.MethodsThe study has two components; (i) a pilot study was performed that specifically focused upon patients with Complex NPH and following the inclusion of the Complex NPH subtype into consideration for the clinical NPH programme, (ii) a retrospective snapshot study was performed to confirm and characterize differences between Classic and Complex NPH patients being seen consecutively over the course of 1 year within a working subspecialist NPH clinic. We studied the characteristics of patients with Complex NPH, utilizing clinical risk stratification and multimodal biomarkers.ResultsThere was no significant difference between responders and non-responders to CSF diversion on comorbidity scales. After VPS insertion, significantly more Classic NPH patients had improved cognition compared to Complex NPH patients (p = 0.005). Improvement in gait and urinary symptoms did not differ between the groups. 26% of the Classic NPH group showed global improvement of the triad, and 42% improved in two domains. Although only 8% showed global improvement of the triad, all Complex NPH patients improved in gait.ConclusionsOur study has demonstrated that the presence of neurodegenerative disorders co-existing with NPH should not be the sole barrier to the consideration of high-volume tap test or lumbar drainage via a specialist NPH programme. Further characterization of distinct cohorts of NPH with differing degrees of CSF responsiveness due to overlay from neurodegenerative or comorbidity risk burden may aid toward more precise prognostication and treatment strategies. We propose a simplistic conceptual framework to describe NPH by its Classic vs. Complex subtypes to promote the clinical paradigm shift toward subspecialist geriatric neurosurgery by addressing needs for rapid screening tools at the clinical-research interface.

Introduction: Gamification has been shown to improve academic gains, but the mechanism remains elusive. We aim to understand how psychological constructs interact, and influence medical education using mathematical modelling. Methods: Studying a group of medical students (n=100; average age: 20) over a period of 4 years with the Personal Responsibility Orientation to Self-Direction in Learning Scale (PRO-SDLS) survey. Statistical tests (Paired t-test) and models (logistic regression) were used to decipher the changes within these psychometric constructs (Motivation, Control, Self-efficacy & Initiative), with gamification as a tool. Students were encouraged to partake in a maze (10 stations) that challenged them to answer anatomical questions using potted human specimens. Results: We found that the combinatorial effects of the maze and Script Concordance Test (SCT) resulted in a significant improvement for “Self-Efficacy” and “Initiative” (p

The effectiveness of the 5E Inquiry Learning Model as compared to the teacher-centred traditional method on science achievement in electricity was examined in this study. The quasi-experimental pretest-posttest control group research design was utilized. A total of 65 students (33 and 32 students in the experimental and the control groups, respectively) from two Year 5 intact classes in Malaysia participated in this study. A test comprising 54 dichotomously scored items with overall KR-20 reliability of 0.84 was used in the pretest and posttest. Given the significant difference in the pretest and posttest, it was presumed that the analysis could be done using the ANCOVA. However, on further analysis, the assumption for homogeneity of the regression slope was violated and ANCOVA could not be performed. Instead, the covariate was categorized into two equally-spaced categories (i.e., low and average achievers) and further t-test supported the equivalency of the experimental and control groups. When analyzed using the t-test, the two groups differed significantly in the posttest means across the two categories of students. These findings unequivocally indicate the effectiveness of employing the 5E Inquiry Learning Model in enhancing students’ science achievement among the low and average achieving students.

This study examined the test taking strategies of weak ESL students of an English language proficiency course. Test taking strategies are known as the methods that test takers use as an alternative aimed at attaining correct answers on a specified form of language assessment. The study adopted a qualitative study. The participants in this study were forty-four learners from the Bachelor of Arts Program. The learners were asked to think aloud while reading an assigned text to answer the questions. Four learners’ thinking aloud recordings were transcribed and analysed. Focus group interviews were carried out for triangulation purposes. Data collected were analysed manually. The ESL learners implemented many test taking strategies as they coped with the reading comprehension test. The findings of the study show how ESL students used cognitive, metacognitive, compensating, and social strategies. Participants expressed that understanding and reading the passage allowed them to draw conclusions better in answering the multiple choice questions. The findings revealed that they used a compensation strategy whereby they tried guessing the answers on a number of occasions. The findings of the study implicate teachers’ roles in L2 reading and also to guide the ESL learners in the process of answering reading passage and answer the comprehension questions.

This study aimed to determine the effectiveness of a professional development program on the use of a STEM-based 5E Inquiry Learning Model in enhancing the learning of STEM-based Inquiry Learning Model among 78 in- and pre-service science teachers. The topic electric circuit was used as the context of the study. Given the aim and the exploratory nature of this study, a triangulation mixed-methods design was employed: One-group pretest-posttest design which involved a single group that was pre-tested, exposed to the STEM-based 5E Inquiry Learning Model, and post-tested. This was triangulated by the qualitative responses from the participants’ reflections. The analysis of the quantitative dataset using the paired samples t-test indicated that the post-test mean score was statistically significantly higher than the pre-test mean score and that the effect size obtained was educationally significant. Further analyses by gender and participants’ teacher status, indicated a non-significant difference, giving credence that this result was truly the outcome of the intervention (treatment) effect instead of any disguised effect. The analysis of qualitative data through a recursive process resulted in the crystallization of three overarching key themes: Enhanced knowledge on the content used, empowered pedagogical skills on STEM-based Inquiry Learning, and heightened classroom management skill on promoting collaboration in the classroom.

Purpose - This research focuses on ESL teachers’ strategies to foster higher-order thinking skills to teach writing to weak ESL learners in two selected secondary schools in Malaysia. ESL teachers’ strategies to foster higher-order thinking skills to teach writing to weak ESL learners were captured and encapsulated to enable the ESL learners to understand and master higher order thinking to improve their writing. Methodology – A qualitative descriptive case study design was employed in the study. The sample was based on a snowball sampling and 4 ESL teachers were selected from two different secondary schools in Malaysia. The main data collection method was classroom observation while thematic analysis was used for data analysis. Each teacher was observed twice. Classroom observation forms and video recordings were used as a main source in data collection. Findings – Findings showed that ESL teachers selected strategies to foster higher-order thinking skills to teach writing including the general procedures in implementing higher-order thinking skills for teaching writing and major considerations at each stage of the implementation. ESL teachers exposed learners to the general procedures of the higher-order thinking skills which were explaining and helping students to understand what higher-order thinking is, leading students to connect to concepts in writing, helping students to infer through real-life situations, using more graphic organizers and teaching problem-solving skills. Significance – The findings can be used to guide decisions on higher-order thinking skills training for ESL teachers, educators and curriculum developers regarding the thinking skills strategies to be mastered in teaching writing.

The electric vehicle (EV) charging scheme can reduce the power generation costs and improve the smart grid resilience. However, the huge penetrations of EVs can impact the voltage stability and operating costs. In this paper, a novel EV participation charging scheme is proposed for a decentralized blockchain-enabled smart grid system. Our objectives are to minimize the power fluctuation level in the grid network and the overall charging cost for EV users. We first formulate the power fluctuation level problem of the smart grid system that take into accounts of EV battery capacities, charging rates, and EV users charging behavior. And then, we propose a novel adaptive blockchain-based electric vehicle participation (AdBEV) scheme that uses the Iceberg order execution algorithm to obtain an improved EV charging and discharging schedule. The simulation results show the proposed scheme outperforms the scheme that applying genetic algorithm approach in term of lowering the power fluctuation level and overall charging costs.

This study was conducted to characterise the teaching practices in a teacher education institution so as to inform us the existing practices which could then be compared with the aspired practices, uncovering the pedagogical shortfall. This study employed a form of implementation study using classroom observation. A total of 20 lessons drawn from Early Childhood Education, Mathematics, Science, Secondary School TESL (Teaching of English as a Second Language), History, Physical and Health Education, and Moral Education taught by lecturers in one Teacher Education Institution were observed over a one-semester period. A psychometrically-supported Observation Checklist comprising 50 items or indicators that spread across six principles was utilised in the observation whereby observers checked in terms of presence or absence of each indicator during the classroom observations. This study provides the characterisation of evidenced-based practices, uncovering the pedagogical gap which could be subsequently addressed by various means such as the providence of continuous in-service courses. Empowering lecturers pedagogically will produce quality teachers which in turn, produce quality students.

An ex-postfacto study was conducted to determine which teacher practices can promote critical thinking among secondary school students. A total of 1200 students in 12 schools in a district in Selangor participated in the study. The study employed an extreme group causal comparative design where students who tested high in critical thinking as measured using the Cornell Critical Thinking Test Level X (CCTT-X) were compared with students who obtained low scores in the CCTT-X. Twelveexperiences with regard to teacher practices in the classroom differed significantly between the high and the low scorers when analysed with the Mann-Whitney U Test. Implications of the study, particularly on ways to teach better to promote critical thinking are discussed.

This study aimed to determine the effects of a four-week in-service professional development course on Acehnese science teachers’ pedagogical knowledge and skills. A triangulation mixed-methods research design was employed: The participants’ self-perceivedlevel of pedagogical knowledge and skills in pretest-posttest, and their written responses on what they have learnt constituted the quantitative and qualitative data respectively. The participants consisted of 26 Acehnese science teachers and were selected by means of a stratified purposive sampling. The quantitative data of pretest-posttest differences were analysed using a paired samples t-test, while the qualitative data were analysed recursively to uncover emerging themes. The findings indicated that the Acehnese science teachers perceived that their pedagogical knowledge and skills have elevated as the outcome of the professional development course. The significant gains observed were further supported by the participants’ self-written responses which upon analysis, crystallized into two major themes, namely “pedagogical knowledge gained” and the “applicability of the pedagogical knowledge gained”. A reflection on the course implementation was provided; ending with some recommendations should similar course be conducted in the future

The traditional grid operation is unfortunately lacking the resilience and responsiveness in reacting to contingency events due to the poor utilization of available resources in mitigating the shortfalls. Such an unaddressed issue may affect the grid stability and the ultimate grid blackout. Therefore, this paper models a grid optimization module consisting of a mid and low (microgrid) voltage level grid component of an urban grid network for a disaster recovery. The model minimizes the cost of generation required to meet the demand through the economic dispatch in combination with the unit commitment. Two optimization problems are formulated that resemble the grid operation: normal (grid-connected) and islanded. A constrained-based linear programming optimization problem is used to solve the formulated problems, where the dual-simplex algorithm is used as the linear solver. The model ensures sufficient demand to be met during the outages through the N-1 contingency criterion for critical infrastructures. The simulation length is limited to 24 h and is solved using the MATLAB® R2017b software. Three different cases are established to evaluated the modelled grid resilience during the grid-connected or the islanding of operations subject to adversed events. The simulated results provide the economical outage recovery that will maintain the grid resilience across the grid.

Abstract Background Treatment of choroidal melanoma with radiation often involves placement of customized brachytherapy eye-plaques. However, the dosimetric properties inherent in source-based radiotherapy preclude facile dose optimization to critical ocular structures. Consequently, we have constructed a novel system for utilizing small beam low-energy radiation delivery, the Beamlet Low-kVp X-ray, or "BLOKX" system. This technique relies on an isocentric rotational approach to deliver dose to target volumes within the eye, while potentially sparing normal structures. Methods Monte Carlo N-Particle (MCNP) transport code version 5.0(14) was used to simulate photon interaction with normal and tumor tissues within modeled right eye phantoms. Five modeled dome-shaped tumors with a diameter and apical height of 8 mm and 6 mm, respectively, were simulated distinct positions with respect to the macula iteratively. A single fixed 9 × 9 mm2 beamlet, and a comparison COMS protocol plaque containing eight I-125 seeds (apparent activity of 8 mCi) placed on the scleral surface of the eye adjacent to the tumor, were utilized to determine dosimetric parameters at tumor and adjacent tissues. After MCNP simulation, comparison of dose distribution at each of the 5 tumor positions for each modality (BLOKX vs. eye-plaque) was performed. Results Tumor-base doses ranged from 87.1–102.8 Gy for the BLOKX procedure, and from 335.3–338.6 Gy for the eye-plaque procedure. A reduction of dose of at least 69% to tumor base was noted when using the BLOKX. The BLOKX technique showed a significant reduction of dose, 89.8%, to the macula compared to the episcleral plaque. A minimum 71.0 % decrease in dose to the optic nerve occurred when the BLOKX was used. Conclusion The BLOKX technique allows more favorable dose distribution in comparison to standard COMS brachytherapy, as simulated using a Monte Carlo iterative mathematical modeling. Future series to determine clinical utility of such an approach are warranted.

Abstract Background The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE) at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001–2002. Methods A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. Thenumber and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspectedPE during an eight month period prior to the clinical trial (January 2002 -August 2002) were compared with the number and type of diagnostic tests in745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were usedas unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. Results The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. Conclusion Extrapolating the observed cost-savings of $59.30 per patient to the wholeof Australia could potentially result in annual savings between $3.1 million to $3.7 million.