Malacca General Hospital

This study explores the design and development of an immersive Virtual Reality (VR) system particularly for enhancing traditional archery training. Traditional archery faces significant challenges in modern urban environments, including limited practice spaces and safety concerns. This project addresses these barriers by leveraging VR technology to create a dynamic, interactive training platform that replicates real-world archery techniques. The system integrates advanced algorithms, including Inverse Kinematics (IK) for accurate motion tracking and realistic body movements. Utilizing the ADDIE instructional design model, the VR platform provides real-time feedback on posture, aiming precision, and arrow dynamics. The system features two modes: Training Mode for self-paced practice and Challenge Mode for competitive gameplay. Usability testing with 20 participants yielded an average System Usability Scale (SUS) score of 84.9, indicating an excellent user experience. The results demonstrate that VR technology effectively bridges the gap between traditional practices and modern technological innovations, making archery more accessible and interactive for contemporary users while preserving its cultural heritage.

Abstract Wire Arc Additive Manufacturing (WAAM) is promising technique for producing large scale metallic components due to its high deposition rate, cost efficiency, and suitability for complex geometry. This study investigates the Cold Metal Transfer (CMT)-based Wire Arc Additive Manufacturing (WAAM) process for ER410 martensitic stainless steel, with a focus on the fundamental effects of process parameters. Single layer deposition was first conduct to evaluate the influence of travel speed on bead geometry, with optimal parameters identified at 95A current, 3.0 m/min wire feed speed, 10.8V voltage, and 2.75 mm/s travel speed. The optimal parameters produced bead heigh of 5.12 mm and width of 3.44 mm. Using these parameters, multilayer wall was fabricated and characterized. Microstructural analysis revealed predominant martensitic features with localized crack like indications increasing toward the top layers due to repeated thermal cycle. Hardness values reached up to 400 HV near the fusion line, attributed to grain refinement. Mechanical testing demonstrated anisotropy, with vertical specimen exhibited higher tensile strength average of 1116.25 MPa compare to 853.92 MPa for horizontal specimens. These finding provide essential baseline knowledge for WAAM processing of ER410 stainless steel and highlight its potential for manufacturing high strength.

To determine the frequency of computer vision syndromes among students during COVID-19 lockdown in Malaysia. This is a cross-sectional survey study. A total of 145 subjects studied in secondary school and pre-university programme were involved in this study. An exploratory survey questionnaire was used to assess the symptoms of computer vision syndromes encountered by the students and their electronic device usage behavior before and during fully remote learning started. Average time spent by students on outdoor activities reduced from one to two hours per day (40.7%) to less than an hour per day (56.6%) after fully remote learning. Average time spent on entertainment activities using electronic devices increased from one to two hours per day (38.6%) to four hours and above per day (40.0%) after fully remote learning. The majority of time spent on school assignments using electronic devices increased from one to two hours (44.8%) to three to four hours per day (33.8%) after fully remote learning. Increased frequency of students experienced eye pain (44.1%), eye fatigue (57.2%), headache (56.6%), eye itchiness (18.6%), glare (31.7%), dry eye (40.0%), blurry vision (31.7%) and double vision (7.6%) after fully remote learning began. An observed increase frequency of computer vision syndrome was noted in relation to the reduction of time spent on outdoor activities and increased usage of electronic devices for entertainment activities and completing school assignment during COVID-19 lockdown in Malaysia.

This study investigates the barriers to access and engagement in online education in China, focusing on socio-economic and regional disparities. Employing a quantitative research design, data was collected from middle and high school students across urban and rural regions using a structured survey. The findings revealed significant differences in access to digital resources, digital literacy, and parental support, contributing to unequal educational opportunities. Urban students were more likely to have reliable internet, access to devices, and better parental assistance compared to their rural counterparts, who faced challenges such as limited internet connectivity, lack of technological resources, and lower digital literacy. The study highlights that these disparities perpetuate cycles of educational inequality and hinder social mobility, potentially affecting long-term academic and professional outcomes. Addressing these barriers requires a comprehensive approach that includes improving infrastructure, enhancing teacher training, and promoting digital literacy among students and parents. Policy interventions should aim for equitable access to resources, alongside community engagement initiatives to support families. This research provides critical insights for policymakers, educators, and educational institutions seeking to create a more inclusive educational environment and reduce the digital divide in China. Future studies should explore the long-term impacts of digital learning inequalities, evaluate the effectiveness of digital literacy programs, and examine the psychological effects on students’ motivation and well-being. By addressing these challenges, China can take significant steps toward ensuring educational equity and fostering a skilled workforce prepared for the demands of the 21st century.

The rapid growth of the Information Technology (IT) industry in Shenzhen, China, has intensified the need for continuous innovation to maintain competitive advantage. Flexible work arrangements and employee engagement have emerged as potential drivers of innovative work behavior, especially in high-demand sectors like IT. This study aims to explore the combined impact of FWAs and employee engagement on IWB within Shenzhen’s IT industry, with a focus on understanding how employee engagement mediates the relationship between flexible work options and innovation. Using a quantitative research design, data were collected from 400 IT professionals in Shenzhen through a structured questionnaire, and analyzed using Structural Equation Modeling (SEM). The findings indicate that FWAs have a direct positive effect on IWB, while also indirectly fostering innovation by enhancing employee engagement. Additionally, the mediation analysis reveals that employee engagement significantly amplifies the impact of FWAs on innovative work behavior. This study contributes to the literature by providing empirical evidence on the dual pathway through which FWAs influence innovation, suggesting that companies can enhance their innovative capabilities by implementing flexible work policies that also prioritize employee engagement. These insights are valuable for HR practices and management strategies in the IT sector, highlighting the strategic benefits of fostering both flexibility and engagement to drive innovation.

Abstract Background Nasopharyngeal carcinoma (NPC) patients often face significant physical and psychological challenges. While disease control remains a clinical priority, the impact on distress and health-related quality of life (HRQOL) is often overlooked. This study will assess distress and the HRQOL prevalence, severity, and relationship among post-treatment nasopharyngeal carcinoma (NPC) patients and investigate its associated factors. Method A cross-sectional study at Hospital Melaka (HM) and Hospital Canselor Tuanku Muhriz (HCTM) involved post-treatment NPC patients with at least six months of follow-up. Distress was assessed using the Distress Thermometer (DT). Quality of life (QoL) and symptomatology were assessed with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and EORTC Head and Neck Module (QLQ-H&N 35). We conducted statistical analyses using Kruskal–Wallis and Mann–Whitney U tests for comparisons and Spearman Correlation for analyzing relationships. Results One hundred forty-four patients with a median age of 60.5 years (range 18–92) were recruited and completed the questionnaires. The median NPC surveillance follow-up time was seven years (6 months to 36 years). 84% of the patients received concurrent chemoradiotherapy. The majority of the patients were in late stage 57.6% (Stage III, n = 51[35.4%]; Stage IV, n = 32 [22.2%]). The median distress score is 4 (range, 1–8), and the median HRQOL score is 75 (range of 50–100). A significant negative correlation was found between distress and the HRQOL score. (r = -0.53, p < 0.01). Factors influencing distress and HRQOL scores were sticky saliva, dry mouth, fatigue, and less sexuality, with a significance of P < 0.01. Conclusion Overall distress and HRQOL scores among post-treatment NPC patients were good. Factors such as sticky saliva, dry mouth, fatigue, and decreased sexuality substantially impacted distress and HRQOL. Addressing these factors alongside cancer treatment may enhance HRQOL outcomes.

Hemophagocytic lymphohistiocytosis (HLH) is a lethal emergency. Delaysin diagnosis and treatment are detrimental to the health of patients. Classical clinical manifestations of HLH include fever, cytopenia, liver dysfunction, central nervous system involvement, and coagulopathy. We report seven cases of secondary HLH in adults diagnosed from a total of 1200 bone marrow aspiration and trephine biopsy (BMAT) examinations in our center, with various presentations and underlying triggers including infection, malignancy, and autoimmune disease. HLH can present with non-specific signs and symptoms. Early recognition of HLH is crucial to enable the commencement of therapy as early as possible to prevent mortality resulting from multi-organ failure.

Background:Treatment response to tofacitinib for patients with rheumatoid arthritis (RA) displays considerable heterogeneity. The interindividual variations in clinical response may have a genetic etiology. Understanding of the genetic basis of tofacitinib response will facilitate the translation of genetic discoveries to clinical benefit and personalised therapy.Objectives:To identify genetic predictors of tofacitinib response among RA patients.Methods:Genotypes of 58 tofacitinib-treated RA patients were determined by whole genome sequencing (WGS). Clinical endpoints were assessed from baseline to 6 months of Tofacitinib treatment based on overall 4-component disease activity (DAS)28. Variants obtained from sequencing were analysed for the association with tofacitinib response using Fisher’s Exact test with Odds ratio (OR) and 95% confidence interval (CI) estimation.Results:This study showed that four single nucleotide variants (SNV)s reached genome-wide statistical significance level with p value less than 1x10-7 and thirty-four variants achieved p value less than 1x10-6 for the outcome measure of tofacitinib response. The strongest evidence for association to satisfactory EULAR DAS28 ESR/CRP response was with rs12149039_C variant of CDH13 gene (OR: 62.2, p=8.82x10-8) followed by rs880559_C and rs732169_T variant of PCNX gene polymorphism (OR: 24.0, p=4.47x10-7). In addition, our data also revealed other genetic variants associated with tofacitinib non-responders when compared with the responders were rs13315685_C variant of SLC12A8 gene (OR: 13.89, p=2.03x10-7), rs4372384_T variant of GRID1 gene (OR: 9.72, p=4.88x10-7) and rs9619005_C variant of ADA2 gene (OR: 35.03, p=7.46x10-7). CDH13, SEMA3F, SSH1, RNF138 and ADA2 gene have been replicated from previous studies related to inflammatory and destructive process of RA. Moreover, we identified other genetic variants associated with tofacitinib non-responders, which have not been reported previously i.e PCNX2 (rs732168 and rs732169), FEZ2 (rs78397636), XRCC5 (rs9288517), ZNF736 (rs57374192, rs117800590), ARHGEF12 (rs661139), SLC12A8 (rs13315685) and EIF4ENIF1 (rs5749279).Conclusion:In summary, five out of twelve genetic risk variants were replicated from previous studies to be observed in the tofacitinib response individuals in this study. Other identified genetic variants may suggest novel genetic risk variants involved in tofacitinib response that warrants further investigations and may facilitate the treatment prediction in RA patients.REFERENCES:[1] Li Y, Lai-Han Leung E, Pan H, Yao X, Huang Q, Wu M, Xu T, Wang Y, Cai J, Li R, Liu W, Liu L. Identification of potential genetic causal variants for rheumatoid arthritis by whole-exome sequencing. Oncotarget. 2017;8(67):111119-111129. doi: 10.18632/oncotarget.22630. PMID: 29340042; PMCID: PMC5762310.[2] L. Abdel Salam, A. Q. Aldarwesh and H. H. Eleishi, Whole exome sequencing (WES) of methotrexate response/adverse event profile in rheumatoid arthritis patients, The Egyptian Rheumatologist, 2021; 4:287-291 doi:org/10.1016/j.ejr.2020.08.006.[3] Valli A, Kuuliala K, Virtanen A, Kuuliala A, Palmroth M, Peltomaa R, Vidqvist KL, Leirisalo-Repo M, Silvennoinen O, Isomäki P. Tofacitinib treatment modulates the levels of several inflammation-related plasma proteins in rheumatoid arthritis and baseline levels of soluble biomarkers associate with the treatment response. Clin Exp Immunol. 2022; 210(2):141-150. doi: 10.1093/cei/uxac085. PMID: 36124688.Acknowledgements:Special thanks to Director General of Health Malaysia for his permission to present this article and International Medical University Research Grant [PHMS I-2021 (04)] for financial support.Disclosure of Interests:None declared.