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Malaysia is gradually experiencing a demographic shift, evolving into an aging society. The problem arises concerning the economic sustainability of urban farming ventures undertaken by elderly individuals. Limited attention has been given to incorporating social science perspectives to understand its broader social and cultural implications, especially for the intergenerational aspects of urban farming, specifically among the elderly. This research investigates the adoption of smart urban farming (SUF) to enhance senior citizens' social and economic well-being (SEW). The study involved 130 elderly participants from Klang Valley, Malaysia. Data was collected through surveys and subsequently analyzed using the SPSS statistics tool. The study reveals that while Social Entrepreneurship alone may not be enough to encourage elderly adoption of SUF when combined with social innovation, it significantly increases adoption. The study also indicated that the adoption of SUF enhances the elderly SEW. This study represents a valuable addition to the existing body of literature on the adoption of SUF, particularly in its impact on the social and economic aspects of elderly individuals' lives. This study further advances the current understanding of SUF adoption, utilizing established theories such as the Resource-Based View Theory (RBT) and Social Cognitive Theory (SCT) to reinforce its conclusions. The findings offer practical insights for governments and local authorities in developing policies to promote and facilitate SUF. Doi: 10.28991/HEF-2024-05-03-012 Full Text: PDF

Abstract Background The randomized, dose-optimization, open-label ReDOS study in US patients with metastatic colorectal cancer (CRC) showed that, compared with a standard dosing approach, initiating regorafenib at 80 mg/day and escalating to 160 mg/day depending on tolerability increased the proportion of patients reaching their third treatment cycle and reduced the incidence of adverse events without compromising efficacy. Subsequently, the ReDOS dose-escalation strategy was included as an alternative regorafenib dosing option in the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines. A retrospective analysis was conducted using a US claims database to assess whether inclusion of this dose-escalation strategy in NCCN Guidelines has influenced the use of flexible dosing in routine US clinical practice, and to describe clinical outcomes pre- and post-inclusion in NCCN Guidelines. Methods Patients with CRC in the Optum’s de-identified Clinformatics® Data Mart database initiating regorafenib for the first time between January 2016 and June 2020 were stratified based on whether they initiated regorafenib pre- or post-inclusion of ReDOS in NCCN Guidelines, and in two groups: flexible dosing (

Amid unprecedented challenges in Malaysia’s economy and labour markets, there is a growing inclination among workers to resign in pursuit of a more balanced work-life equilibrium. This shift indicates a changing perspective on employment, where competitive compensation and benefits remain important, but job seekers actively prioritize companies fostering a comprehensive work environment that champions a healthier work-life balance. This study delves into the impact of participative leadership on work-life balance as a means to alleviate emotional fatigue. Employing a quantitative approach and a structured questionnaire distributed through convenience sampling, the research gathered 257 qualified responses from diverse industries. Framed within bounded theory and role theory, the study explores how individuals in Malaysian society manage the interplay between their personal and professional lives to enhance overall well-being. The findings emphasize the substantial role of work interference in personal life, and vice versa, contributing to emotional exhaustion among Malaysian employees. However, the study identifies participative leadership as a crucial mitigating factor against exhaustion. Consequently, fostering empathetic and emotionally intelligent leadership is deemed essential for supporting employees in reducing stress and exhaustion. This research represents a pioneering endeavour in addressing the issue of emotional exhaustion within the distinctive context of work-life balance in Malaysia.

Abstract Many countries with tropical reef systems face hard choices preserving coral reefs in the face of climate change on limited budgets. One approach to maximising regional reef resilience is targeting management efforts and resources at reefs that export large numbers of larvae to other reefs. However, this requires reef connectivity to be quantified. To map coral connectivity in the Seychelles reef system we carried out a population genomic study of the Porites lutea species complex using 241 sequenced colonies from multiple islands. To identify oceanographic drivers of this connectivity and quantify variability, we further used a 2 km resolution regional ocean simulation coupled with a larval dispersal model to predict the flow of coral larvae between reef sites. Patterns of admixture and gene flow are broadly supported by model predictions, but the realised connectivity is greater than that predicted from model simulations. Both methods detected a biogeographic dispersal barrier between the Inner and Outer Islands of Seychelles. However, this barrier is permeable and substantial larval transport is possible across Seychelles, particularly for one of two putative species found in our genomic study. The broad agreement between predicted connectivity and observed genetic patterns supports the use of such larval dispersal simulations in reef system management in Seychelles and the wider region.

Businesses globally heavily invest in Enterprise Resource Planning (ERP) implementation to meet high customer demands and maintain competitiveness. Despite significant investments, underutilization hampers reaping the system's full benefits, leading to stagnant or adverse performance. Hence, this study aims to uncover reasons for the lack of end-user adoption of ERP systems. It focuses on the correlation between performance expectancy, effort expectancy, social influence, and organizational support in determining ERP system acceptance by end users. This study utilized a quantitative methodology. Data were collected from 392 respondents within a Malaysian shared service center. Multiple regression analysis was conducted employing the UTAUT model and perceived organizational support theory to evaluate and interpret the collected data. The study’s key findings include the significant positive association between performance expectancy and ERP system adoption, reinforcing the influence of effort expectancy on technology adoption. Despite its positive effects, social influence had little effect on end-user adoption. Additionally, it was observed that ERP system adoption was consistently facilitated by organizational support. This study confirms the essential factors that drive the adoption of ERP systems by end-users. It emphasizes the crucial role of leadership in prioritizing these elements for organizations to enhance user acceptance and ensure the successful implementation of ERP systems. Doi: 10.28991/HIJ-2023-04-04-013 Full Text: PDF

AbstractThe aim of the present study was to investigate the relationship between early-career employees’ emotional exhaustion and turnover intention in the information technology sector. Given the scarce empirical evidence on how turnover intention and emotional exhaustion can be reduced among early-career employees, ethical leadership was investigated as a mediator in this relationship based on the Social Exchange Theory (SET). Furthermore, using the Conservation of Resource Theory (COR), this study sought to understand the moderating role of a specific organizational ethical climate (i.e. self-interest climate) in the relationships among emotional exhaustion, ethical leadership, and turnover intention. Data was collected using convenience sampling from 243 early-career employees working in small and medium enterprises in the information technology sector. The results of structural equation modeling (SEM) indicated that early-career employees’ emotional exhaustion significantly increases their turnover intention. This effect was found to be mediated by low ethical leadership and moderated by the self-interest ethical climate. However, the findings did not support the moderating effect of the self-interest ethical climate on the relationship between ethical leadership and employees’ turnover intention. This study contributes to the existing knowledge on COR and SET by incorporating the antecedents of turnover intention, which have a significant impact on employees’ decision-making regarding withdrawal. Additionally, the study addresses the underexplored topic of specific ethical climates and their effects on employees. By examining how a key antecedent of turnover intention operates within an organizational self-interest ethical climate, this paper advances our understanding of this complex phenomenon. A discussion of the study’s limitations and suggestions for future research conclude the paper.

The remarkable advancements in technology have affected the way people engage, work, and learn. Digital literacy, also known as virtual learning, has the potential to improve lifelong learning. Workplace skills evolve at such a rapid pace that no school system can keep up with the continual need to alter how we work and live. Most crucially, our society's profound changes require young people to acquire new abilities. Malaysia has a long-term vision that calls for sustainable and productivity-driven growth that can only be accomplished with digitally literate employees. Although to some extent Malaysia education system has been initiating, there is very limited research that focuses on what drives digital literacy. There is no proper framework or guidelines that can be used as a blueprint to prepare the young graduates in the 21st-century workforce. The purpose of the study is to examine the drivers of digital literacy that can be taught in higher institutions and apply in today's digital workplace. This research focused on young adults as a unit of analysis and a quantitative method was used to collect the data. A total of 300 young individuals responded through self-administered questionnaires. The finding of the research showed that critical skills, operational skills, visual learning style, collaborative learning style and learning system enhance digital literacy. Finding further recommend that digital literacy improve both academic performance and employability. From this research, solutions can be proposed to both academicians and employers in achieving the digital literate graduates for the 21st-century workforce.

Previous work suggests that HIV controllers with protective human leukocyte antigen class I alleles (VC+) possess a high breadth of Gag-specific CD8+ T cell responses, while controllers without protective alleles (VC-) have a different unknown mechanism of control. We aimed to gain further insight into potential mechanisms of control in VC+ and VC-. We studied 15 VC+, 12 VC- and 4 healthy uninfected individuals (UI). CD8+ T cell responses were measured by ELISpot. Flow cytometry was performed to analyse surface markers for activation, maturation, and exhaustion on natural killer (NK) cell and T cells, as well as cytokine secretion from stimulated NK cells. We measured plasma neutralization activity against a panel of 18 Env-pseudotyped viruses using the TZM-bl neutralization assay. We found no significant differences in the magnitude and breadth of CD8+ T cell responses between VC+ and VC-. However, NK cells from VC- had higher levels of activation markers (HLA-DR and CD38) (p = 0.03), and lower cytokine expression (MIP-1β and TNF-α) (p = 0.05 and p = 0.04, respectively) than NK cells from VC+. T cells from VC- had higher levels of activation (CD38 and HLA-DR co-expression) (p = 0.05), as well as a trend towards higher expression of the terminal differentiation marker CD57 (p = 0.09) when compared to VC+. There was no difference in overall neutralization breadth between VC+ and VC- groups, although there was a trend for higher neutralization potency in the VC- group (p = 0.09). Altogether, these results suggest that VC- have a more activated NK cell profile with lower cytokine expression, and a more terminally differentiated and activated T cell profile than VC+. VC- also showed a trend of more potent neutralizing antibody responses that may enhance viral clearance. Further studies are required to understand how these NK, T cell and antibody profiles may contribute to differing mechanisms of control in VC+ and VC-.

Environmental protection is a heavily debated topic along with development. Uncontrolled development will sacrifice our environmental and causing issues such as pollution, land slide, flash flood, etc. The objective of this study is to understand drivers of the implementation of environmental protection strategy among industries in Malaysia. Questionnaire was designed and tested with 130 Malaysian organizations. The framework consisted of independent variables such as Client’s Requirement, Corporate Social Responsibility, Government Grants and Subsidy versus the dependent variable Environmental Protection Strategy. From the Exploratory Factor Analysis (EFA), it was found out that only client’s requirement and corporate social responsibility are relevant towards implementation of environmental protection strategy. One of the important findings is that government regulation is no longer a mandatory driver for organizations to implement environmental protection strategy. This could be a positive sign that organizations are working the self-regulatory direction than instrumental enforcement. This is in par with department of environment’s latest focus to implement guided self-regulation through environmental mainstreaming tools. The outcome of the study can help the policy makers, regulatory bodies,, and non-government organizations (NGOs) to shape their direction to form strategies that are most effective.

Background: Cybercrime is a fast-growing digital crime and legislation falling behind with the fast-moving advancement of technology. One important factor projected by literature in combating cybercrime is legislation. In order to combat cybercrime, the role of cybercrime legislation is a challenge that has not been clearly studied before. This paper thus aims to recapitulate the literature on cybercrime legislation in combating cybercrime. The literature in this context emphasises on existing studies relating to cybercrime legislation and addressing the importance of adequate and efficient responses in place in order to combat cybercrime efficiently. Methods: This paper finds an extensive literature review using the “Preferred Reporting Items for Systematic Review and Meta-Analysis” method based on legislation to combat cybercrime and explains a systematic analysis of the legislation in most advanced countries in both technology and legal framework. The study was done by selecting keywords, validated by the experts to discover research trends of cybercrime legislation. A search was then run across seven academic databases, including the ACM Digital Library, Emerald, Hein Online, ProQuest, ScienceDirect, Scopus, and Westlaw Asia. Initially, five hundred and forty-eight articles were retrieved and out of which seventy-two studies met the inclusion criteria and were fully reviewed. Results: The findings of the study revealed that comprehensive cybercrime legislation plays a vital role in combating cybercrime and cybercrime legislation should be strengthened, enhanced, and made up to date with the rapid advancement of technology in order to address the rising number of cybercrime. Discussion: This systematic review is timely and highlights future research directions to improve a comprehensive legal framework to combat the rising of cybercrime effectively. To fill the research gap, the findings also have fundamental practical implications for the policy makers, in enacting an up to date cybercrime legislation by highlighting the role of legislation in combating cybercrime.

This study was carried out to produce low-emitting biomass pellets biofuel from selected forest trees such as (Cedrus deodara and Pinus wallichiana) and agricultural crop residues such as (Zea mays and Triticum aestivum) in Gilgit-Baltistan, Pakistan using indigenously developed technology called pelletizer machine. Characterization, environmental life cycle impact assessment, and cumulative energy demand of biomass pellets biofuel produced from selected agriculture crops and forest tree residues were conducted. The primary data for biomass pellets production was collected by visiting various wood processing factories, sawmills, and agricultural crop fields in the study area. Biomass pellets are a type of biofuel that is often made by compressing sawdust and crushing biomass material into a powdery form. The particles are agglomerated as the raw material is extensively compressed and pelletized. Biomass pellets have lower moisture content, often less than 12%. Physically, the produced pellets were characterized to determine moisture content, pellet dimensions, bulk density, higher heating value, ash content, lower heating value, and element analysis. A functional unit of one kilogram (kg) biomass pellets production was followed in this study.The life cycle impact assessment of one kg biomass pellets biofuel produced from selected agro-forest species revealed environmental impact categories such as acidification (0.006 kg SO2 eq/kg pellets), abiotic depletion (0.018 kg Sb eq/kg pellets), marine aquatic ecotoxicity (417.803 kg 1,4-DB eq/kg pellets), human toxicity (1.107 kg 1,4-DB eq/kg pellets), freshwater aquatic ecotoxicity (0.191 kg 1,4-DB eq/kg pellets), eutrophication (0.001 kg PO4 eq/kg pellets), global warming (0.802 kg CO2 eq/kg pellets), and terrestrial ecotoxicity (0.008 kg 1,4-DB eq/kg pellets). Fossil fuel consumption was the hotspot source to all environmental impacts investigated. To measure the cumulative energy demand of biomass pellets made from different agroforestry species leftovers showed that the maximum cumulative energy was from wheat straw pellets (13.737 MJ), followed by corncob pellets (11.754 MJ), deodar sawdust pellets (10.905 MJ) and blue pine sawdust pellets (10.877 MJ). Among the various production activities, collection and transportation of primary raw material, crushing, screening, adding adhesives, pelletizing, cooling, final screening, and packing have the maximum contribution to the water scarcity index, followed by lubricating oil (0.00147m3). In contrast, the minimum contribution to water footprint was from electricity (0.00008m3) and wheat starch (0.00005m3). The highest contribution to the ecological footprint impact categories such as carbon dioxide, nuclear, and land occupation was lubricating oil and less contribution of wheat starch and electricity for manufacturing one kg pellets biofuel. It is concluded that physico-mechanical and combustion properties of the biomass pellets biofuel developed in the present study were following the Italian recommended standards. Therefore, it is strongly recommended that the Government of Pakistan should introduce the renewable biomass pellets industry in the country to reduce dependency on fossil fuels for cooking and heating purposes.

ABSTRACT: The rapid growth of the ageing population has increased the attention paid towards the provision of retirement village (RV). RV is a new form of housing on the ageing landscape that provides a full range of care from independent to assisted living to meet the diverse needs of the elderly. Numerous studies conducted in the past examined factors that influence elderly intention to relocate to the RV and the intention to adopt the smart home technology. The current study focused on the intention of elderly to relocate to the smart retirement village (SRV) (i.e., RV with the smart home technology). A customer-driven open innovation survey was conducted to solicit opinions from the elderlies. This paper applied the Theory of Planned Behavior to examine such intention among the elderly in Malaysia. The types of smart home technology preferred by the elderly at the SRV were determined. The results from the multiple regression analysis (N = 305) indicated that attitudes, social norm, and perceived behavioural control contributed significantly to the elderly intention to relocate to the SRV. Further investigation revealed that 83% of the elderly choose the smart emergency contact system as the most important smart home technology to be included.

Abstract Background The objective of this study is to describe variations in the healthcare resource utilization (HRU) among individuals with Angelman syndrome (AS) over the first 12 years of life. Data for this study were drawn from the AS Natural History study (ASNHS), which is an observational study on the developmental progress, behavior, and medical morbidity of individuals with AS conducted over eight years. Caregiver-reported information on hospitalization, surgery, and medication utilization was used to assess HRU. Repeated measures mixed effect models were used to assess the relationship between age and probability of hospitalization, surgery, and prescription medication utilization. Results Mean age at study enrollment was 6 years of age and both sexes were equally represented. The mean number of visits per participant was three. Results from this study suggest that individuals with AS have a high HRU burden. Hospitalization and surgery burden were highest in the first year of life. Use of medications for seizures and sleep disturbance increased over time. Conclusions The study highlights the significant healthcare burden among individuals with AS. Future studies that estimate cost and caregiver burden associated with AS are needed to assess the lifelong economic impact of AS on families and healthcare system.

Background: A percent brain volume change (PBVC) cut-off of −0.4% per year has been proposed to distinguish between pathological and physiological changes in multiple sclerosis (MS). Unfortunately, standardized PBVC measurement is not always feasible on scans acquired outside research studies or academic centers. Percent lateral ventricular volume change (PLVVC) is a strong surrogate measure of PBVC, and may be more feasible for atrophy assessment on real-world scans. However, the PLVVC rate corresponding to the established PBVC cut-off of −0.4% is unknown. Objective: To establish a pathological PLVVC expansion rate cut-off analogous to −0.4% PBVC. Methods: We used three complementary approaches. First, the original follow-up-length-weighted receiver operating characteristic (ROC) analysis method establishing whole brain atrophy rates was adapted to a longitudinal ventricular atrophy dataset of 177 relapsing-remitting MS (RRMS) patients and 48 healthy controls. Second, in the same dataset, SIENA PBVCs were used with non-linear regression to directly predict the PLVVC value corresponding to −0.4% PBVC. Third, in an unstandardized, real world dataset of 590 RRMS patients from 33 centers, the cut-off maximizing correspondence to PBVC was found. Finally, correspondences to clinical outcomes were evaluated in both datasets. Results: ROC analysis suggested a cut-off of 3.09% (AUC = 0.83, p

The white shark (Carcharodon carcharias) is responsible for 49% of shark-related injuries in South Africa, yet no information currently exists on the composition or antibiotic resistance of bacteria hosted by these apex predators in South African waters. This study aimed to address this gap by sampling the bacteria present in the oral cavities of 28 live C. carcharias along South Africa’s southern coastline. The antibiotic resistance of the range of microbiota was also assessed using antibiotic disc diffusion tests. A total of 51 strains from at least 20 species of bacteria were isolated from the oral cavities of C. carcharias. Of these strains, the most common bacteria present were Serratia spp., Proteus vulgaris and Vibrio alginolyticus. The overall antibiotic resistance was relatively higher in this study than that reported for bacterial microbiota sampled from other shark species. Results indicate that the combination therapy of imipenem (carbapenem antibiotic) and vancomycin (glycopeptide antibiotic) might be the most parsimonious option to effectively treat infections resulting from white shark bites, particularly in South Africa. It is hoped that, in addition to assisting medical professionals to treat shark bite victims, these findings enhance the understanding of the microbial communities present in large coastal predators and their surrounding environments. Significance: • Overall antibiotic resistance of bacteria in the oral cavities of C. carcharias was relatively high. • Combination therapy of imipenem (carbapenem antibiotic) and vancomycin (glycopeptide antibiotic) is recommended for the treatment of white shark bites, particularly in South Africa. • The findings add to understanding of the microbial communities present in large coastal predators and their surrounding environments.

Abstract Background The objective of this study is to describe healthcare resource utilization (HRU) and supportive therapy utilization (STU) among individuals with Angelman syndrome (AS), and to compare such usage by molecular etiology. Methods Participants were categorized into deletion and non‐deletion genotypes. Statistical differences were assessed using an independent samples t test. Results Data were available on 302 individuals. Mean age of participants was 5.5 years, 92% of whom were less than 13 years, and 71% had the deletion etiology. About 68% of participants had at least one hospitalization since birth to enrollment in the study; the average number of hospitalizations during that time period was 2.3 and average length of stay was 4.5 days. The most common reasons for hospitalization were seizures, lower respiratory infections, and surgery. The most common reasons for surgery were myringotomy, strabismus surgery, tonsillectomy or adenoidectomy, and gastrostomy tube insertion/fundoplication. Anticonvulsants, gastroesophageal reflux disease, sleep, and behavioral medications were the most commonly prescribed drugs. STU was high among individuals with AS. Conclusions This study shows that individuals with AS have high HRU/STU, and apart from a few differences, HRU/STU was similar across molecular etiology. These results reflect usage in younger individuals and studies that describe HRU/STU in older individuals are needed.

Lifelong learning is an option to fulfil societal needs in order to create a dynamic society. The rising in participation in lifelong learning programmes contributed due to the pressure of globalization and technologies in Malaysia’s changing demography. Therefore, this study aimed at identifying the factors that influence the intention of the Malaysian working adults towards lifelong learning and to develop marketing strategies for Malaysian education providers. The foundation of this study is based on the Theory of Planned Behaviour. However, two additional variables were included as the extension to the current model which is trust and perceived usefulness. This research was designed as a cross-sectional field survey, where questionnaire were used for data collection. The target population for this study were the Malaysian working adults who are working in different organizations within the Klang Valley area. The sample size for this research is 210. The hypothesized path analysis was conducted through the Structural Equation Modelling (SEM). All the hypotheses were accepted due to the fact that they were statistically significant. The study provides the management of lifelong education centre an insight to develop effective marketing strategies to satisfy that value of potential customers. The findings will also be beneficial to government agencies, policy maker and higher education practitioner by creating insight into adult learner perception and building intentional behaviour to purchase the product. Finally, limitations were discussed and future study direction is proposed.

This paper evaluates the effect of prescription drug insurance coverage on prescription drug use among the elderly. Estimates were obtained using multivariate regression and a fixed-effects (within-person) research design that controls for unmeasured person-specific effects that may confound the relationships of interest. Estimates showed prescription drug coverage was associated with a 4% to 10% increase in the utilization of prescription drugs, depending on the type and generosity of the coverage.

Background: Cybercrime is a fast-growing digital crime and legislation falling behind with the fast-moving advancement of technology. One important factor projected by literature in combating cybercrime is legislation. In order to combat cybercrime, the role of cybercrime legislation is a challenge that has not been clearly studied before. This paper thus aims to recapitulate the literature on cybercrime legislation in combating cybercrime. The literature in this context emphasises on existing studies relating to cybercrime legislation and addressing the importance of adequate and efficient responses in place in order to combat cybercrime efficiently. Methods: This paper finds an extensive literature review using the “Preferred Reporting Items for Systematic Review and Meta-Analysis” method based on legislation to combat cybercrime and explains a systematic analysis of the legislation in most advanced countries in both technology and legal framework. The study was done by selecting keywords, validated by the experts to discover research trends of cybercrime legislation. A search was then run across seven academic databases, including the ACM Digital Library, Emerald, Hein Online, ProQuest, ScienceDirect, Scopus, and Westlaw Asia. Initially, five hundred and forty-eight articles were retrieved and out of which seventy-two studies met the inclusion criteria and were fully reviewed. Results: The findings of the study revealed that comprehensive cybercrime legislation plays a vital role in combating cybercrime and cybercrime legislation should be strengthened, enhanced, and made up to date with the rapid advancement of technology in order to address the rising number of cybercrime. Discussion: This systematic review is timely and highlights future research directions to improve a comprehensive legal framework to combat the rising of cybercrime effectively. To fill the research gap, the findings also have fundamental practical implications for the policy makers, in enacting an up to date cybercrime legislation by highlighting the role of legislation in combating cybercrime.

Background - The Malaysian ageing community’s IT aptitude is limited and is a key factor preventing Malaysia’s ageing population from successfully entering Industry 4.0. This study aims to digitalize Malaysian older people with e-commerce. This will require cybersecurity awareness training due to potential cybersecurity threats when conducting business online. Furthermore, this study advances the Industry 4.0 initiatives set by Malaysia’s National Industry 4.0 Policy Framework by means of a voluntary community-based training program. It also creates a policy that elevates Malaysia’s senior citizens’ current level of ICT innovation baseline commensurate with Industry 4.0 transformation standards. Methods – Participatory action research was conducted with members in a Senior Citizen Activity Centre (PAWE) through focus group discussions. Each focus group consisted of 6-8 people. Through identifying the community’s problem in the focus groups, an e-commerce platform was developed for the elderly to commercialise their existing products. The dissemination of e-commerce training and cybersecurity awareness were also conducted as part of mitigating fraud relating to online transactions. Results – The findings show that PAWE members’ IT aptitude was limited, that they needed assistance with understanding the e-commerce platform, and that they had limited cybersecurity awareness. Conclusions – The country’s ageing population programs and services are preparing for an ageing nation. In order for Malaysia’s ageing population to become self-sustainable, researchers suggest that Malaysian older persons become entrepreneurs. Third generation entrepreneurs must also be supported by social innovation, technological innovation, and cybersecurity awareness, which leads to achieving IR 4.0 and meets the economic, social and sustainable environmental goals.

We examine the effect of gaining prescription drug insurance, as a result of Medicare Part D, on use of prescription drugs and other medical services for a nationally representative sample of Medicare beneficiaries. Given the heightened importance of prescription drugs for those with chronic illness, we provide separate estimates for elderly in poorer health. We find that Medicare Part D significantly reduced socioeconomic and geographic disparities in prescription drug insurance among the elderly. Gaining prescription drug insurance through Medicare Part D was associated with a 30 percent increase in the number of annual prescriptions and a 40 percent increase in expenditures on prescription drugs for both the general population of the elderly and the elderly in poorer health. We find little evidence that prescription drug insurance was strongly associated with the use of outpatient and inpatient services, although our investigation of these associations was limited by a lack of statistical power. (Contains 19 footnotes and 8 tables.)