Clinical and economic impact of medication administration errors among neonates in neonatal intensive care units.

Despite efforts in improving medication safety, medication administration errors are still common, resulting in significant clinical and economic impact. Studies conducted using a valid and reliable tool to assess clinical impact are lacking, and to the best of our knowledge, studies evaluating the economic impact of medication administration errors among neonates are not yet available. Therefore, this study aimed to determine the potential clinical and economic impact of medication administration errors in neonatal intensive care units and identify the factors associated with these errors. A national level, multi centre, prospective direct observational study was conducted in the neonatal intensive care units of five Malaysian public hospitals. The nurses preparing and administering the medications were directly observed. After the data were collected, two clinical pharmacists conducted independent assessments to identify errors. An expert panel of healthcare professionals assessed each medication administration error for its potential clinical and economic outcome. A validated visual analogue scale was used to ascertain the potential clinical outcome. The mean severity index for each error was subsequently calculated. The potential economic impact of each error was determined by averaging each expert's input. Multinomial logistic regression and multiple linear regression were used to identify factors associated with the severity and cost of the errors, respectively. A total of 1,018 out of 1,288 (79.0%) errors were found to be potentially moderate in severity, while only 30 (2.3%) were found to be potentially severe. The potential economic impact was estimated at USD 27,452.10. Factors significantly associated with severe medication administration errors were the medications administered intravenously, the presence of high-alert medications, unavailability of a protocol, and younger neonates. Moreover, factors significantly associated with moderately severe errors were intravenous medication administration, younger neonates, and an increased number of medications administered. In the multiple linear regression analysis, the independent variables found to be significantly associated with cost were the intravenous route of administration and the use of high-alert medications. In conclusion, medication administration errors were judged to be mainly moderate in severity costing USD 14.04 (2.22-22.53) per error. This study revealed important insights and highlights the need to implement effective error reducing strategies to improve patient safety among neonates in the neonatal intensive care unit.

Association of Pedal Acceleration Time With Healing and Amputation Free Survival in Patients With Ulceration and Gangrene.

OBJECTIVE: Pedal acceleration time (PAT) is a novel non-invasive perfusion measurement that may be useful in the management of patients with ulceration and gangrene. The objective of this study was to report the association between PAT and wound healing, amputation free survival (AFS), and mortality at one year. METHODS: This prospective observational study reviewed all patients who underwent PAT after presentation with ulceration or gangrene from 1 January 2020 to 30 June 2022. PAT was defined as the time (in milliseconds) from the onset of systole to the peak of systole in the mid artery. The final PAT of a limb was used to assess outcomes (presenting PAT if no revascularisation, or post-revascularisation PAT). Wound healing, major limb amputation, and death at one year were collected. Healing was assessed with Fine-Gray competing risks model, AFS via logistic regression, and survival using Cox proportional hazards model. RESULTS: Overall, 265 patients (307 limbs) were included. The median patient age was 71 years and 74.0% (196/265) had diabetes mellitus. Patient demographics were similar among the final PAT category cohorts. Compared with a final PAT category 1, analysis of one year outcomes showed that the final PAT categories 2 - 4 had lower wound healing (category 2, hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.43 - 0.9, p = .012; category 3, HR 0.21, 95% CI 0.08 - 0.58, p = .002; category 4, HR 0.12, 95% CI 0.04 - 0.34, p < .001), lower AFS (category 2, odds ratio [OR] 2.86, 95% CI 1.64 - 5.0, p < .001; category 3, OR 5.1, 95% CI 1.71 - 15.22, p = .003; category 4, OR 12.59, 95% CI 4.34 - 36.56, p < .001), and lower survival (category 2, HR 1.89, 95% CI 1.17 - 3.03, p =.009; category 3, HR 2.37, 95% CI 1.05 - 5.36, p = .039; category 4, HR 4.52, 95% CI 2.48 - 8.21, p < .001). CONCLUSION: The final PAT measurement is associated with wound healing, AFS, and death at one year. PAT may be a valuable tool to assess perfusion of the foot.

Sustaining ex-mining lake-converted constructed wetlands as nature-based solutions: A comprehensive assessment of the carbon-water nexus in Paya Indah Wetlands, Malaysia.

Water and carbon, essential for Earth's well-being, face imminent threats from human activities that fuel climate change. This study investigates nature-based solutions, focusing on the carbon-water nexus of ex-mining lake-converted constructed wetlands, specifically in Malaysia's Paya Indah Wetlands (PIW). Addressing research gaps, it assesses the ecosystem services of these wetlands, emphasising integrated evaluations for informed land management and employing a top-down conservation approach. Methodologically, spatial assessments, soil and water sampling, carbon quantification, water quality index calculations, land cover classification and stakeholder surveys were conducted. Results underscore the significant carbon sequestration and water quality improvement potential of constructed wetlands, with soil and sediment carbon accumulation reaching 1553.11 Mg C ha-1 (equivalent to 5700 Mg CO2 ha-1), translating to an annual sequestration capacity of 67.5 Mg C ha-1 year-1. Water quality index values ranged from 58 to 81 (Classes II to III). PIW's establishment led to a reduction of over 90% in barren land, with increases in water bodies (36%) and vegetation-covered land (38%), boosting wildlife populations by 30%. Spatial variations in organic carbon density and water quality underscore the complexity of the carbon-water nexus and its impacts on ecosystem health and water security. Despite land use changes, PIW demonstrates resilience, contributing to climate change mitigation. Stakeholder perceptions vary, emphasising the need for adaptive strategies. The study proposes transdisciplinary conservation initiatives and adaptive plans, stressing the pivotal role of ex-mining lake-converted constructed wetlands in enhancing climate resilience.

Reconciling and contextualising multi-dimensional aspects for consolidated water security index: A synthesis.

The present paper aims to review and develop a Consolidated Water Security Index (CWSI) as a tool to evaluate water security status within river basins by considering five key dimensions, namely (i) water supply and sanitation, (ii) water demand and socio-economic, (iii) water ecosystem and environment, (iv) water-related disaster and (v) water governance. This index is a holistic assessment since it aims to capture the interconnected and complex nature of water-related issues by considering multiple dimensional aspects which helps stakeholders and policymakers to understand the overall status of water security. This framework uses the Analytic Hierarchy Process (AHP), involving pairwise comparison, normalisation and weighting. Then, a CWSI will be calculated using the Linear Aggregation method. The robustness of this consolidated index is validated using sensitivity analysis by modifying the weight in the linear aggregation formula. By following each step cautiously, a CWSI can be constructed and interpreted correctly, thus, becoming a powerful tool for conveying complex information to the different stakeholders and assessing the status of water security with river basins. The CWSI allows decision-makers to prioritise areas that are most at risk and facilitate sustainable planning and management of water resources.

Predicting neural activity of whole body cast shadow through object cast shadow in dynamic environments.

Shadows, as all other objects that surround us, are incorporated into the body and extend the body mediating perceptual information. The current study investigates the hypothesis according to which the perception of object shadows would predict the perception of body shadows. 38 participants (19 males and 19 females) aged 23 years on average were immersed into a virtual reality environment and instructed to perceive and indicate the coincidence or non coincidence between the movement of a ball shadow with regard to ball movement on the one hand, and between their body shadow and their body position in space on the other. Their brain activity was recording via a 32-channel EEG system, in which beta (13.5-30 Hz) oscillations were analyzed. A series of Multiple Regression Analysis (MRA) revealed that the beta dynamic oscillations patterns of the bilateral occipito-parieto-frontal pathway associated with the perception of ball shadow appeared to be a significant predictor of the increase in beta oscillations across frontal areas related to the body shadow perception and the decrease in beta oscillations across frontal areas connected to the decision making of the body shadow. Taken together, the findings suggest that inferential thinking ability relative to body shadow would be reliably predicted from object shadows and that the bilateral beta oscillatory modulations would be indicative of the formation of predictive neural frontal assemblies, which encode and infer body shadow neural representation, that is, a substitution of the physical body.

Quantifying carbon pool in ex-mining lake-converted constructed wetlands of Paya Indah Wetlands, Selangor, Malaysia.

Ex-mining lake-converted constructed wetlands play a significant role in the carbon cycle, offering a great potential to sequester carbon and mitigate climate change and global warming. Investigating the quantity of carbon storage capacity of ex-mining lake-converted constructed wetlands provides information and justification for restoration and conservation efforts. The present study aims to quantify the carbon pool of the ex-mining lake-converted constructed wetlands and characterise the physicochemical properties of the soil and sediment. Pearson's correlation and a one-way ANOVA were performed to compare the different sampling stations at Paya Indah Wetland, Selangor, Malaysia. An analysis of 23 years of ex-mining lake-converted constructed wetlands of Paya Indah Wetlands, Selangor, Malaysia, revealed that the estimated total carbon pool in soil and sediment accumulated to 1553.11 Mg C ha-1 (equivalent to 5700 Mg CO2 ha-1), which translates to an annual carbon sink capacity of around 67.5 Mg C ha-1 year-1. The characterisation showed that the texture of all soil samples was dominated by silt, whereas sediments exhibited texture heterogeneity. Although the pH of the soil and sediment was both acidic, the bulk density was still optimal for plant growth and did not affect root growth. FT-IR and WDXRF results supported that besides the accumulation and degradation of organic substances, which increase the soil and sediment carbon content, mineral carbonation is a mechanism by which soil and sediment can store carbon. Therefore, this study indicates that the ex-mining lake-converted constructed wetlands of Paya Indah Wetlands, Selangor, Malaysia have a significant carbon storage potential.

A substantial number of patients with rest pain, ulceration or gangrene are unable to undergo current non-invasive perfusion testing-Could another modality be utilised?

Rest pain, ulceration and gangrene are hallmark features of chronic limb-threatening ischaemia (CLTI). Wound healing can be challenging, and this is compounded by an inability to measure lower limb perfusion via non-invasive tools such as toe pressure (TP). Novel perfusion tests, such as pedal acceleration time (PAT), may overcome some limitations. This study aimed to quantify the proportion of patients with CLTI that were unable to undergo TP measurement. Over a three-year duration, 344 consecutive patients with CLTI underwent PAT assessment (403 limbs). Overall, 32% of limbs were unable to undergo first toe TP, and 12.9% were unable to undergo first and second toe TP due to forefoot/digit amputation or tissue loss. Inability to measure first toe TP disproportionately impacted CLTI patients with diabetes compared to patients without diabetes (39.6% limbs (106/268); vs. 17% limbs (23/135); p < 0.001). Novel modalities may provide a useful tool for assessing perfusion in CLTI.

A simple and high efficiency purification of His-tagged turnip yellow mosaic virus-like particle (TYMV-VLP) by nickel ion affinity precipitation.

Virus-like particles (VLPs) is one of the most favourable subjects of study, especially in the field of nanobiotechnology and vaccine development because they possess good immunogenicity and self-adjuvant properties. Conventionally, VLPs can be tagged and purified using affinity chromatography or density gradient ultracentrifugation which is costly and time-consuming. Turnip yellow mosaic virus (TYMV) is a plant virus, where expression of the viral coat protein (TYMVc) in Escherichia coli (E. coli) has been shown to form VLP. In this study, we report a non-chromatographic method for VLP purification using C-terminally His-tagged TYMVc (TYMVcHis6) as a protein model. Firstly, the TYMVcHis6 was cloned and expressed in E. coli. Upon clarification of cell lysate, nickel (II) chloride [NiCl2; 15 µM or equivalent to 0.0000194% (w/v)] was added to precipitate TYMVcHis6. Following centrifugation, the pellet was resuspended in buffer containing 1 mM EDTA to chelate Ni2+, which is then removed via dialysis. A total of 50% of TYMVcHis6 was successfully recovered with purity above 0.90. Later, the purified TYMVcHis6 was analysed with sucrose density ultracentrifugation, dynamic light scattering (DLS), and transmission electron microscopy (TEM) to confirm VLP formation, which is comparable to TYMVcHis6 purified using the standard immobilized metal affinity chromatography (IMAC) column. As the current method omitted the need for IMAC column and beads while significantly reducing the time needed for column washing, nickel affinity precipitation represents a novel method for the purification of VLPs displaying poly-histidine tags (His-tags).

Integrated care at the emergency department: an investment for better health.

It is crucial that policy makers, healthcare providers and relevant stakeholders understand how integrated care may be improved at our emergency departments (EDs) and what benefits that would bring. The potential that exists for right-siting care of special patient groups who could be managed in an ambulatory setting with the integration of a variety of hospital-based and community-based clinical support services is tremendous. This review describes the best practice and value of integrated care at the EDs. Local evidence is cited and compared with findings from overseas. The opportunities of care transition interventions among discharged patients are outlined, including that for paediatric patients, palliative care patients and patients with chronic diseases. This review also suggests ways to move forward to meet the aim of providing holistic care at EDs through integrated care programmes, innovation and research.

The integration of nature values and services in the nature-based solution assessment framework of constructed wetlands for carbon-water nexus in carbon sequestration and water security.

As the climate change impacts are expected to become increasingly disruptive, affecting water security, environmental health and ecosystem, constructed wetlands receive attention for their functions in delivering various life-sustaining services to human and environmental systems. In this article, a systematic review was conducted through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard to identify the current research on constructed wetlands' nature values and services from 2011 to 2020 of two databases, namely Scopus and Web of Science. The criteria of assessment focus on holistic deliberation of subject matters, namely carbon sequestration and water security as regulating and provisioning services, as well as nature values of constructed wetlands, namely instrumental and intrinsic values. As a result, 38 articles were selected and comprehensively examined. As the lack of an interdisciplinary approach makes data and information integration difficult, this study derived an integrated classification of constructed wetlands' services and mapped with its nature values, guided by the Millennium Ecosystem Assessment framework. Besides, mechanisms and factors affecting carbon sequestration and water security were also discussed. The carbon-water nexus was then conceptualised as interlinkages between engineered and natural physicochemical processes at the interface between carbon and water cycles. To fill the gaps, based on the carbon-water nexus concept, a new framework was synthesised at the end of the deliberation for constructed wetlands in regulating local climate through carbon sequestration and ensuring water security through water treatment and purification as well as influencing socio-cultural values, which needs an integrated approach that is the novelty of this work. The framework integrates the dichotomy of the instrumental-intrinsic nature values of constructed wetlands to evaluate the importance and benefit of the carbon-water nexus. The framework that reveals the vitality of nature values provided by constructed wetlands can help improve the decision-making to prioritise ecosystem services and conservation efforts, particularly in the sustainable management of constructed wetlands.

Risk Factors for Ankle Fractures in Asian Adolescents Seen in a Pediatric Emergency Department.

OBJECTIVES: Pediatric ankle injuries remain one of the most common presenting complaints to the pediatric emergency department (PED). In this study, we aimed to describe risk factors associated with simple ankle fractures and ankle fractures that require surgery, among adolescents presenting to the PED with ankle injuries. METHODS: We analyzed a retrospective cohort study of adolescents 12 to 16 years old who presented to our PED with an acute ankle injury and received an ankle radiograph from November 1, 2016, to October 31, 2017. Demographic, anthropometric variables, physical examination findings including those of the Ottawa Ankle Rules were obtained. We recorded any surgical interventions required, as well as follow-up and to return to physical activity. RESULTS: Five hundred fifty-six cases of adolescent ankle injuries were reviewed, of which 109 adolescents had ankle fractures, whereas 19 had ankle fractures requiring surgery. Sports-related injuries remained the most common cause of ankle fractures. Age (adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.56-0.83; P < 0.001), male sex (aOR, 2.12; 95% CI, 1.34-3.35; P < 0.001), clinical findings of tenderness over the lateral malleolus (aOR, 3.13; 95% CI, 1.74-5.64; P < 0.001) or medial malleolus (aOR, 3.55; 95% CI, 2.18-5.78; P < 0.001), and inability to walk (aOR, 3.09; 95% CI, 1.95-4.91; P < 0.001) were significant independent risk factors for ankle fractures.Patients with a weight more than 90th centile for age were at greater risk of ankle fractures requiring surgery (aOR, 2.64; 95% CI, 1.05-6.64; P = 0.04). CONCLUSIONS: We found that younger age, male sex, and clinical findings in the Ottawa Ankle Rules correlated well with predicting ankle fractures and are well suited for application in the Southeast Asian population. Weight greater than the 90th percentile for age was a significant risk factor for ankle fractures requiring surgery.

Deep Learning Fuzzy Inference: An Interpretable Model for Detecting Indirect Immunofluorescence Patterns Associated with Nasopharyngeal Cancer.

The detection of serum Epstein-Barr virus antibodies by immunofluorescence assay (IFA) is considered the gold standard screening test for nasopharyngeal cancer (NPC) in high-risk populations. Given the high survival rate after early detection in asymptomatic patients, compared to the poor prognosis in patients with late-stage NPC, screening using IFA has tremendous potential for saving lives in the general population. However, IFA requires visual interpretation of cellular staining patterns by trained pathology staff, making it labor intensive and hence nonscalable. In this study, an automated fuzzy inference (FI) system achieved high agreement with a human IFA expert in identifying cellular patterns associated with NPC (κ = 0.82). The integration of a deep learning module into FI further improved the performance of FI (κ = 0.90) and reduced the number of uncertain cases that required manual evaluation. The performance of the resulting hybrid model, termed deep learning FI (DeLFI), was then evaluated with a separate testing set of clinical samples. In this clinical validation, DeLFI outperformed human evaluation on the area under the curve (0.926 versus 0.821) and closely matched human performance on Youden J index (0.81 versus 0.80). Data from this study indicate that the combination of deep learning with FI in DeLFI has the potential to improve the scalability and accuracy of NPC detection.

Pyrexia in a young infant - is height of fever associated with serious bacterial infection?

BACKGROUND: Febrile infants ≤ 90 days old make up a significant proportion of patients seeking care in the emergency department (ED). These infants are vulnerable to serious bacterial infections (SBIs) and early identification is required to initiate timely investigations and interventions. We aimed to study if height of an infant's temperature on presentation to the ED is associated with SBI. METHODS: We performed a retrospective chart review on febrile infants ≤ 90 days old presenting to our ED between 31st March 2015 and 28th February 2016. We compared triage temperature of febrile infants with and without SBIs. We presented sensitivity, specificity, positive and negative predictive values (PPV and NPV) of fever thresholds at triage. A multivariable regression was performed to study the association between height of temperature and the presence of SBI, and presented the adjusted odds ratio (aOR) with corresponding 95% confidence intervals (CI). RESULTS: Among 1057 febrile infants analysed, 207 (19.6%) had a SBI. Mean temperature of infants with a SBI was significantly higher than those without (mean 38.5 °C, standard deviation, SD 0.6 vs. 38.3 °C, SD 0.5, p < 0.005). For temperature ≥ 39 °C, sensitivity, specificity, PPV and NPV for SBI was 15.5% (95%CI 10.8-21.1%), 90.4% (95%CI 88.2-92.3%), 28.1% (95%CI 21.1-36.3%) and 81.4% (95%CI 80.5-82.4%) respectively. The height of fever was consistently associated with SBI after adjusting for age, gender and SIS (aOR 1.76, 95% CI 1.32-2.33, p < 0.001). However, 32 (15.5%) infants with SBIs had an initial triage temperature ≤ 38 °C. CONCLUSIONS: A higher temperature at triage was associated with a higher risk of SBI among febrile infants ≤ 90 days old. However, height of temperature must be used in conjunction with other risk factors to identify SBIs in young infants.

Associations of initial haemodynamic profiles and neurological outcomes in children with traumatic brain injury: a secondary analysis.

INTRODUCTION: Initial low systolic blood pressure (SBP) in paediatric traumatic brain injury (TBI) is associated with mortality. There is limited literature on how other haemodynamic parameters including heart rate (HR); diastolic blood pressure (DBP); mean arterial pressure (MAP); and shock index, paediatric age-adjusted (SIPA) affect not only mortality but also long-term neurological outcomes in paediatric TBI. We aimed to analyse the associations of these haemodynamic variables (HR, SBP, MAP, DBP and SIPA) with mortality and long-term neurological outcomes in isolated moderate-to-severe paediatric TBI. METHODS: This was a secondary analysis of our primary study that analysed the association of TBI-associated coagulopathy with mortality and neurological outcome in isolated, moderate-to-severe paediatric head injury. A trauma registry-based, retrospective study of children <18 years old who presented to the emergency department with isolated, moderate-to-severe TBI from January 2010 to December 2016 was conducted. The association between initial haemodynamic variables and less favourable outcomes using Glasgow Outcome Scale-Extended Paediatric) at 6 months post injury was analysed using logistic regression. RESULTS: Among 152 children analysed, initial systolic and diastolic hypotension (<5th percentile) (OR) for SBP 11.40, 95% CI 3.60 to 36.05, p<0.001; OR for DBP 15.75, 95% CI 3.09 to 80.21, p<0.001) and Glasgow Coma Scale scores <8 (OR 14.50, 95% CI 3.65 to 57.55, p<0.001) were associated with 'moderate-to-severe neurological disabilities', 'vegetative state' and 'death'. After adjusting for confounders, only SBP was significant (adjusted OR 5.68, 95% CI 1.40 to 23.08, p=0.015). CONCLUSIONS: Initial systolic hypotension was independently associated with mortality and moderate-to-severe neurological deficits at 6 months post injury. Further work is required to understand if early correction of hypotension will improve long-term outcomes.

Phage T7 as a Potential Platform for Vaccine Development.

Bacteriophages have been explored for their uses in vaccine development, due to the ease of propagation while displaying epitopes in high density. Bacteriophage T7 has been demonstrated to be useful in the production of potential vaccine candidates for various diseases, including influenza A, foot-and mouth disease (FMD), and cancers. In this chapter, we described the use of phage T7 to display potential foot-and-mouth disease virus (FMDV) epitope, from cloning to expression, purification, and immunization in a mouse model.

Differences in radiation dose for computed tomography of the brain among pediatric patients at the emergency departments: an observational study.

BACKGROUND: Computed tomography (CT) is associated with a risk of cancer development. Strategies to reduce radiation doses vary between centers. We compared radiation doses of CT brain studies between pediatric and general emergency departments (EDs), and determine the proportion studies performed within the reference levels recommended by the International Commission on Radiological Protection (ICRP). METHODS: A retrospective review was carried out in a healthcare network consisting of one pediatric ED and three general hospital EDs. Pediatric patients less than 16 years old with CT brain studies performed between 1 January 2015 and 31 December 2018 were included. Information on demographic, diagnosis, volume-averaged computed-tomography dose index and dose length product (DLP) were collected. Effective dose was then calculated from DLP using conversion factors, termed k-coefficients which were derived using a 16 cm head CT dose phantom. RESULTS: Four hundred and seventy-nine CT brain studies were performed - 379 (79.1%) at the pediatric ED. Seizure (149, 31.1%), head injury (147, 30.7%) and altered mental status (44, 9.2%) were the top three ED diagnoses. The median effective dose estimates were higher in general than pediatric EDs, particularly for those aged > 3 to ≤6 years old [1.57 mSv (IQR 1.42-1.79) versus 1.93 mSv (IQR 1.51-2.28), p = 0.047], > 6 to ≤10 years old [1.43 mSv (IQR 1.27-1.67) versus 1.94 mSv (IQR 1.61-2.59), p = 0.002) and > 10 years old (1.68 mSv (IQR 1.32-1.72) versus 2.03 mSv (IQR 1.58-2.88), p < 0.001). Overall, 233 (48.6%) and 13 (2.7%) studies were within the reference levels recommended by ICRP 60 and 103 respectively. CONCLUSIONS: Radiation doses for CT brain studies were significantly higher at general EDs and less than half of the studies were within the reference levels recommended by ICRP. The development of diagnostic reference levels (DRLs) as a benchmark and clinical justification for performing CT studies can help reduce the radiation risks in the pediatric population.

Deep Neural Network-Based Respiratory Pathology Classification Using Cough Sounds.

Intelligent systems are transforming the world, as well as our healthcare system. We propose a deep learning-based cough sound classification model that can distinguish between children with healthy versus pathological coughs such as asthma, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI). To train a deep neural network model, we collected a new dataset of cough sounds, labelled with a clinician's diagnosis. The chosen model is a bidirectional long-short-term memory network (BiLSTM) based on Mel-Frequency Cepstral Coefficients (MFCCs) features. The resulting trained model when trained for classifying two classes of coughs-healthy or pathology (in general or belonging to a specific respiratory pathology)-reaches accuracy exceeding 84% when classifying the cough to the label provided by the physicians' diagnosis. To classify the subject's respiratory pathology condition, results of multiple cough epochs per subject were combined. The resulting prediction accuracy exceeds 91% for all three respiratory pathologies. However, when the model is trained to classify and discriminate among four classes of coughs, overall accuracy dropped: one class of pathological coughs is often misclassified as the other. However, if one considers the healthy cough classified as healthy and pathological cough classified to have some kind of pathology, then the overall accuracy of the four-class model is above 84%. A longitudinal study of MFCC feature space when comparing pathological and recovered coughs collected from the same subjects revealed the fact that pathological coughs, irrespective of the underlying conditions, occupy the same feature space making it harder to differentiate only using MFCC features.

Community-Based Monitoring in the New Normal: A Strategy for Tackling the COVID-19 Pandemic in Malaysia.

In 2020, the COVID-19 pandemic severely impacted the global public health system and led to many deaths worldwide. COVID-19 is highly contagious and can be spread by symptomatic or asymptomatic individuals. As such, determining the risk of infection within a community is difficult. To mitigate the risk of the spread of COVID-19, the government of Malaysia implemented seven phases of the movement control order (MCO) from 18 March to 31 December 2020. However, the socioeconomic cost was substantial despite the effectiveness of the MCO in bringing down cases of infection. As noted by the Prime Minister of Malaysia, the final criterion that should be met is community empowerment. In other words, community-based mitigation measures through which communities unite to contain the pandemic are essential before the completion of the vaccination program. As a measure for controlling the pandemic, mitigation strategies in the new normal should be feasible, practical, and acceptable to communities. In this paper, we present a deliberation of a set of community-based monitoring criteria to ensure health and well-being in communities, such as efficacy, technicality, feedback, and sustainability. The proposed criteria will be instrumental in developing community-based monitoring initiatives to achieve the desired goals in coping with the pandemic as well as in empowering communities to be part of the governance process.