Porphyromonas gingivalis is implicated in chronic periodontal disease and secretes virulence factors, including Porphyromonas gingivalis peptidylarginine deiminase (PPAD), which catalyzes the conversion of arginine to citrulline in proteins, leading to the production of autoantigens. These autoantigens are associated with autoimmune responses in rheumatoid arthritis (RA). Epidemiological studies suggest a link between periodontal disease and RA, highlighting the potential of PPAD inhibition as a therapeutic strategy [1,2]. The present study aims to identify potential inhibitors of PPAD through a combination of 2D ligand-based similarity search, molecular docking and clustering studies from approved drugs databases as well as structural features essential for the inhibitory activity against PPAD [2]. The study employed a ligand-based virtual screening (LBVS) approach, leveraging the SwissSimilarity web tool to perform 2D similarity searches [3]. Hit compounds identified from prior PPAD inhibitory activity studies, namely Flucytosine, Cl-Amidine, Cytarabine and Carmustine, served as query molecules for this process [5]. 15 hits with the highest similarity score under each fingerprinting method of respective query molecules were identified from the similarity search, which were subjected to molecular docking via Schrödinger Glide docking program to evaluate their binding interactions in the PPAD binding site and structural determinants [4]. 5 final hit compounds were found to have higher docking scores than that of dipeptide reference ligand (-4.913 kcal/mol) ranging between -5.487 kcal/mol to -7.076 kcal/mol. Additionally, ChemMine web tool was used to cluster compounds obtained from similarity search of respective query molecules by structural similarities. 4 out 5 final hit compounds identified from molecular docking studies were found clustered in the respective major cluster bin consisting of higher number of compounds with similar structures than the other cluster bins, thus suggesting the corresponding chemical motif that contributes to ligand recognition within the PPAD binding pocket [5]. It was generally found that structural features, particularly hydrogen bond acceptors with electronegative oxygen atoms or nitrogen atoms, aromatic ring or heterocycle, cyclic ring with hydroxyl groups are essential for the inhibition of PPAD. Indeed, this silico study has identified potential PPAD inhibitors and provided insights into the structural features that could be crucial for PPAD inhibitory activity.

The offshore oil and gas industry remains one of the most complex, hazardous, and strategically significant sectors of the global economy, with operations conducted both on fixed platforms and on offshore vessels such as tankers, floating production storage and offloading units (FPSOs), and support vessels. While both environments share the overarching goal of ensuring safe and efficient energy production, they differ substantially in terms of occupational health risks, medical readiness, and security challenges. This report presents a comparative evaluation of occupational health, medical, and security measures implemented in offshore platforms and vessel operations, emphasizing their effectiveness, limitations, and adaptability in mitigating workplace hazards and safeguarding personnel. The study adopts a multidisciplinary approach, drawing on occupational health and safety (OHS) frameworks, maritime medical standards, and international security risk assessment protocols. A semi- structured interview was conducted with the participant to obtain in-depth insights while allowing flexibility for emergent themes. This method facilitated the collection of rich qualitative data by combining guided questions with open-ended exploration. The report evaluates vessel-specific risks such as dynamic marine conditions, piracy, and prolonged isolation against platform-based hazards, including confined spaces, high-pressure systems, and process-related incidents. The findings revealed that offshore vessels often face higher incidence of acute injuries and security threats due to mobility, navigational risks, and exposure to external aggressors, whereas fixed platforms are more prone to process-related accidents and chronic occupational illnesses linked to long-term exposure to industrial environments. Medical preparedness also differs platforms typically benefit from more stable infrastructure and onsite medical facilities, while vessels rely heavily on telemedicine, limited onboard medical staff, and rapid evacuation protocols, which are frequently constrained by weather and distance to shore. Security assessments further highlight the vulnerabilities of vessels to piracy and armed robbery, requiring layered defensive strategies beyond conventional OHS measures. This report argued that while both platforms and vessels have established frameworks for health, medical, and security management, significant gaps remain in the integration of these systems, particularly in dynamic vessel operations.

BACKGROUND: Informal caregivers are friends or relative who offer to care for stroke patients after discharge. The care deliveries typically occur without formal training or compensation. The COVID-19 pandemic may increase the level of responsibility of caregivers, resulting in potential negative effects on their overall well-being. METHODS: A cross-sectional study of 94 unpaid informal caregivers of stroke survivors completed an online survey. The stroke caregivers’ burden was measured using the Caregiver Burden Inventory (CBI). Social connection such as social isolation, loneliness and perceived social support was measured using the Lubben Social Network Scale-6 items, UCLA-3 items and Duke Social Support Index (DSSI-11 item), respectively. Sociodemographic data were also collected and analysed. RESULTS: Multiple linear regression analysis revealed that social support (β = -0.34, t = -3.46, p < .001) and loneliness (β = 0.33, t = 3.35, p = .001) significantly predicted the stroke caregivers’ burden. Social support had the major predictive effect, explaining 12% of the variance in caregivers’ burden (R2 = 0.12). Loneliness explained 11% (R2 = 0.11) and 8% (R2 = 0.08) of the variance in developmental and physical burdens, respectively. Social isolation was excluded and not a significant predictor of caregivers’ burden. Caregivers with tertiary education reported significantly higher burden (β = 0.28, t = 2.81, p = .006) than caregivers with secondary education. Education was also a significant predictor of developmental burden (β = 0.25, t = 2.47, p = .016), physical burden (β = 0.29, t = 2.89, p = .005), and emotional burden (β = 0.22, t = 2.12, p = .037). CONCLUSION: The burden experienced by stroke caregivers is linked to their social support, loneliness and educational levels. These findings provide further insight on the role of social support during COVID-19 and its contribution towards caregiver’ burden in an unprecedented time. Interventions that aim to enhance social support for caregivers could help to mitigate this issue and improve their overall well-being.

The COVID-19 pandemic created widespread uncertainty, leading many people to stockpile medications out of fear and misinformation. This study explores how pharmacists in Klang Valley, Malaysia, experienced and managed public behavior during various situations that are not pandemic-related. Using a qualitative approach, twelve pharmacists from retail and government settings were interviewed to understand their perspectives and strategies. Thematic analysis revealed five key themes: the reasons behind medication stockpiling, how pharmacists responded to it, the emotional and operational challenges they faced, their efforts to educate patients, and the broader systemic factors that influenced their work. Pharmacists reported that stockpiling was often driven by fear of price increases, the desire for preventive medication, and misleading information shared on social media. In response, they implemented measures such as limiting purchases, counseling patients, forecasting inventory needs, and sourcing alternative brands. Despite their efforts, pharmacists faced significant stress, multitasking demands, and financial strain. The study highlights the vital role pharmacists play during health crises—not only in dispensing medications but also in educating the public and managing supply challenges. These findings point to the need for better support systems, flexible policies, and stronger public education to promote safe and responsible medication use in future emergencies.

There is a substantial body of literature that examines health insurance participation among the general population in Malaysia. However, limited attention has been directed to the involvement of healthcare personnel in Malaysia in relation to their participation in health insurance. The primary aim of this research is to examine the impact of sociodemographic factors, attitude, general perceptions, and perceptions regarding health insurance benefits and ease of claims on the participation in personal health insurance among healthcare personnel in a private and a public hospital in Malaysia. This study employed self-administered questionnaires as the primary data collection instrument. The findings of the study indicate a notable disparity with regard to the participation in personal health insurance between gender, professional category, and healthcare sector that the healthcare personnel work in. Whereas there is no statistically significant difference found between age and length of service in relation to participation in personal health insurance among healthcare personnel. Furthermore, a significant and strong positive correlation exists between individuals' attitude, general perceptions, and perceptions of health insurance benefits, and their likelihood of engaging in personal health insurance. Having said that, collaboration among government bodies, healthcare institutions, and insurance providers in Malaysia is crucial to effectively implement programmes, strategies, and initiatives that aim to improve awareness and comprehension among healthcare personnel in Malaysia regarding the significance of personal health insurance. Keywords: Health insurance Participation, Attitude, General Perception, Benefits

Background: Neural tube defects (NTDs) are congenital malformations of the brain, spine, or spinal cord resulting from genetics or nutritional deficiencies in folates and other micronutrients during early embryonic development. Inadequate folate increases homocysteine, which increases the risk of NTDs. Numerous discussions and studies on the efficacy of supplementation with activated 5-Methylhydrofolate (5-MTHF) versus synthetic folic acid in improving blood folate levels in women of childbearing age. This systematic review and meta-analysis aim to evaluate the available evidence and synthesise data on the comparative impact of these two forms of folate supplementation. Methods: A systematic review and meta-analysis were conducted by PRISMA guidelines. Relevant studies were identified through electronic searches of PubMed, Scopus, and ScienceDirect, covering randomised controlled trials published up to March 2024. Inclusion criteria focus on trials comparing 5-MTHF and folic acid supplementation across various populations, including pre-pregnancy, pregnancy, postpartum, lactation, and women with MTHFR gene polymorphisms. Risk of bias was assessed using the Cochrane Risk of Bias tool, which evaluated factors such as randomisation, blinding, and completeness of outcome data. Meta-analysis was performed using Comprehensive Meta-Analysis (CMA) and RevMan software to synthesize data on plasma folate, and red blood cell folate levels. Results: The study aims to review existing evidence from a total of ten studies involving 1,351 women across various stages of pre-pregnancy, pregnancy, post-partum, and lactation, as well as women with MTHFR gene polymorphism. The methodologies included randomised, controlled trials with different dosages of folic acid, 5-MTHF, or placebos. Key biomarkers measured included plasma folate, red blood cell (RBC) folate, homocysteine, and unmetabolised folic acid levels. Results indicate variability among studies where four studies showed higher blood or plasma folate levels with 5-MTHF compared to folic acid/placebo, while three others showed similar increases in folate levels but with potential additional benefits such as reduced unmetabolised folic acid or lower homocysteine levels in the 5-MTHF groups. The remaining three studies found comparable efficacy between the two forms of folate, one of which suggested a relationship between the MTHFR (methylenetetrahydrofolate reductase) genotype and high levels of plasma homocysteine, which can contribute to various health risks. There were ten studies assessed for risk of bias. Two studies were of some concerns due to lack of clarity in the reported outcome data and the remaining eight studies have a low risk of bias. Of the eight studies included in the analysis, two studies, short-term duration of 12 weeks or less weeks, reported significant positive differences in favour of 5-MTHF while six studies, long-term duration of more than 12 weeks, favoured folic acid over 5-MTHF. Discussion: Optimal blood folate levels are important in preventing NTDs. Many variations exist in these studies that warrant further standardised research to clarify optimal dosages and durations of supplementation with 5-MTHF versus folic acid. The benefits of reduced homocysteine and unmetabolised folic acid through 5-MTHF supplementation may bring additional benefits to high-risk groups. Conclusion: This review highlights the substantial heterogeneity among studies comparing 5-MTHF and folic acid supplementation. While short-term studies favour 5-MTHF, long-term studies generally favour folic acid. These findings highlight the need for further research to standardize methodologies and clarify supplementation guidelines.

Students frequently react negatively to academic remediation. Moreover, research shows that remediations tends to offer “more of the same” without addressing the underlying factors contributing to poor performance of the students. Recognizing this gap, the present study seeks to explore the experiences, challenges, and coping strategies of underperforming pre-clinical medical students during their period of academic remediation. This study was guided by two theories: the self-regulated learning theory and the Lazarus coping theory. Eight participants were purposely sampled based on the inclusion criteria of failing more than two consecutive assessments in a semester and/or failing a summative examination, and they underwent academic remediation as a result. A descriptive qualitative research design with semi-structured individual interviews was employed for data gathering. The interviews were transcribed, and the data were analysed using Braun and Clarke’s Six Phases of Thematic Analysis. A total of five themes were established. The themes include “Remedial Sessions Helpful and Great”, “Academic Pressure & Emotional Turmoil”, “Academic Exposure of Failure”, “Acceptance of Failure & Self-Directed Growth After Academic Setbacks” and “Peer Influence & Alumni Support in Academic Recovery”. Students provided insights into their perspectives while on academic remediation and its effects on their personal, social and academic life. Several significant trends were found related to academic gains, students’ participation, as well as faculty and peer interactions during academic remediation. However, students frequently expressed concerns about privacy in online grouped remediation sessions and the strong emotional toll that arose from academic setback and failure. The results of this study support the need for proactive academic remediation efforts which focus on fostering skills like goal setting, effective course revisions within a limited time, resourcefulness and self-reflection, while also creating a supportive environment that encourages active participation and builds confidence rather than content remediation. The study's findings add to the body of research on academic remediation efforts aimed at resolving students' difficulties and promoting their general well-being in a vulnerable state to improve their overall experiences during the remediation phase. The insights of this study from the viewpoint of underperforming pre-clinical medical students would be helpful for the educators while designing academic remediation.

Background: University students of the current generation face a plethora of stressors including family, academics, finances and social. Research indicates that academic stressors can affect eating habits in various ways. Students tend to eat an unbalanced meal or have diets consisting of too much starch, sugar and fat. Unbalanced nutrition due to stress can contribute to the development of diseases and impact their cognitive abilities. The prevalence of obesity has been on a rise in Malaysia and the prevalence of overweight and obesity had increased by 80 percent and 70 percent respectively in just under two decades. Objective: This study aims to determine the association of academic stressors and eating behaviours among students in a private university in Kuala Lumpur, Malaysia. Methodology: A cross-sectional quantitative research study was conducted among 183 pre-university students. Students were emailed an online questionnaire after systematic random sampling. The academic stressors of the subjects were assessed using the Academic Stress Questionnaire comprising of four categories of stressors: personal, relating to other people, environmental and scholarly. The Three Eating Factor Questionnaire Revised-18 Items was used to determine the eating behaviours of students which was categorised into: cognitive restraint, uncontrolled eating and emotional eating. Results: The results of this study were significant as there is an evidence of association between academic stressors and eating habits. The increase in academic stressors increases Cognitive Restraint, Uncontrolled Eating, and Emotional Eating. The results of the Pearson Correlation test reveal the mean of academic stressor to be 3.48 and mean of eating behaviour to be 2.23. R- value and p- value are 0.455 and 0.000 respectively. There is a positive correlation and statistically significant difference between both variables. Conclusion: The findings of this study illustrate the need for university initiatives focusing on academic stressors to combat unhealthy eating habits that hamper the wellbeing of students and may progress to disease. This may include revision of curriculum where there is shift away from exam assessments and more towards coursework. Other strategies could include support groups and awareness workshops. Keywords: Academic Stressors, Eating Behaviour, Students

Aims: With the rapid proliferation of data in healthcare it has provided an opportune platform creation of Artificial Intelligence (AI). AI has brought a paradigm shift for healthcare professionals, promising improvement in delivery and quality. This study aims to determine the perception of healthcare personnel on perceived ease of use, perceived usefulness, and subjective norm toward attitude for artificial intelligence acceptance. Methods: This is a cross-sectional single institutional study of employees’ perception of adopting AI in the hospital. The study population is all healthcare personnel of a private hospital. The inclusion criteria include all healthcare personnel involved with clinical management such as doctors, nurses, and others. The survey was conducted using a questionnaire adapted from Technology Acceptance Model and a four-point Likert scale was used for the measurement variables in this study. Data were analysed using IBM Statistical Package for the Social Sciences (SPSS) Version 26. Results: There were 96 respondents. This study started off with three hypotheses but has found that only two hypotheses have been accepted and one hypothesis has been rejected. H2 to H3 perceived usefulness and subjective norm respectively, showed positive relationship between their perception on artificial intelligence acceptance and were accepted However, H1 which was ease of use, was rejected as it did not generate a positive relationship between ease of use on attitude and artificial intelligence acceptance. Conclusion: This study has shown the significant relationship and the importance of ease of use, perceived usefulness, and subjective norm to the acceptance of AI. In the study results, there are determining factor and mostly those with most interaction with the patients and clinical management have a strong acceptance of AI in their practices. Key words: Artificial Intelligence, Acceptance, Healthcare, Healthcare Professionals

The rising cost of healthcare in Malaysia has prompted significant policy reforms, including the introduction of co-payment mechanisms in health insurance by Bank Negara Malaysia effective September 2024. While co-payment is expected to reduce premiums and promote cost-sharing, its acceptance among insured patients remains uncertain. This study investigates the acceptance of insurance co-payment among patients visiting private General Practitioner (GP) clinics in Klang Valley using the Health Belief Model (HBM) as the theoretical framework. The research adopts a quantitative and qualitative, cross-sectional design, targeting adults aged 18–70 with active co-payment health insurance plans. A structured questionnaire was disseminated, encompassing socio-demographic data and HBM constructs such as perceived susceptibility, severity, benefits, barriers, and cues to action. Data analysis was performed using SPSS and Partial Least Squares Structural Equation Modelling (PLS-SEM) to examine relationships between variables and test proposed hypotheses. As for the qualitative analysis, coding and categorization of themes related to attitudes toward co-payment was performed and NVivo or manual coding was done for identifying recurring patterns. Preliminary literature suggests that socio-economic status, health literacy, and prior insurance experience strongly influence patient attitudes toward co-payment systems. Global comparisons show that co-payment adoption varies based on population awareness, affordability, and healthcare delivery models. This study fills a local research gap by evaluating the behavioural factors shaping co-payment acceptance within the Malaysian context. Findings are expected to inform healthcare policymakers and insurance providers on how to design more equitable and patient-sensitive health financing models. Insights from this study may enhance communication strategies, reduce perceived financial barriers, and support sustainable healthcare delivery. Keywords: Co-payment, Health Belief Model, Health Insurance, Patient Acceptance, Klang Valley

Dietary fat when consumed reduces hunger and impairs food intake by eliciting satiety signals and these signals are evoked by entry of triacylglycerol after hydrolization to fatty acids into the small intestine. 1,3-dipalmitoyl-2-oleoyglycerol (POP-), 1,3-distearoyl-2-oleoylglycerol (SOS-) and 1,2,3-triolein (OOO-) type of fats have different melting characteristics that may affect postprandial blood lipids, gut hormone concentrations, insulinemic response and selected cardiovascular disease markers in human volunteers. The main objective of this study is to compare the effects of edible fats with either palmitic acid (16:0) (palm mid-fraction) or stearic acid (18:0) (shea stearin) predominantly at the sn-1 and sn-3 positions on postprandial lipemia and gut hormone concentrations. A randomized, double-blind crossover (3 × 3 arms) orthogonal Latin-square design was used on 36 healthy adults (18 males, 18 females; mean age = 23 years). Each subject received 3 different test muffins (each containing 53 g of test fat) in random order separated by 2 weeks over a 6-week period. The test fats of different melting points were palm mid- fraction (PMF; POP-rich), shea stearin (SS; SOS-rich) and high- oleic sunflower oil (HOSF; OOO-rich) During a postprandial test, each subject was provided with a test muffin plus milkshake (total 3.67 MJ or 876 kcal) in the morning and blood samples were collected at half-hourly intervals until 4.0 hours. No significant difference (p>0.05) was observed between the 3 test meals for postprandial responses in plasma TC, Lp(a), apo(B), NEFA, GLP-1, PYY, ghrelin, VAS, PAI-1, IL-6, TNF-α, glucose, insulin and satiety (VAS scores). Plasma TAG peaked at about 4 hours; levels in the PMF- and HOSF- subjects were significantly higher (p<0.05) compared with SS-subjects after 90 minutes. PMF and HOSF exerted a higher postprandial GIP response (p<0.05) as compared to SS. Plasma C-peptide levels, as a measure of insulinemic response, rose sharply 5.5- folds in all groups, peaking after 90 minutes; levels in the SS group declined at a faster rate (p<0.05) than in the PMF- and HOSF- groups. The POP- and OOO- fats induced similar effects on all the biochemical/physiological outcome measures investigated. In contrast, the SOS- type fat (shea stearin) induced a slower rise (p<0.05) in postprandial TAG and GIP levels and a faster return of plasma C-peptide levels to baseline.

This management project examines the rising healthcare costs and increasing insurance coverage gaps affecting Pantai Hospital Manjung (PHM), particularly the growing rate of Guarantee Letter (GL) denials and delays that disrupt patient access and hospital operations. The project adopts a mixed-methods design, combining analysis of PHM’s GL rejection data with qualitative insights from clinicians, administrative staff, and financial teams to understand the organisational and systemic contributors to these issues. The findings show that pre-existing conditions and waiting-period clauses account for a significant proportion of denials, leading to deferred admissions and reduced continuity of care. Policy exclusions and medical-necessity disputes further highlight misalignment between clinical judgement and insurer requirements. Although administrative errors form a smaller share, they indicate workflow inconsistencies that contribute to avoidable delays. These patterns collectively affect patient behaviour, financial predictability, insurer–provider relationships, and PHM’s operational efficiency. The project concludes that targeted interventions—such as Value-Driven Outcomes (VDO) expansion, DRG-supported digital claims integration, structured insurer–provider governance and enhanced pre-admission counselling—are essential to reduce inefficiencies and support timely, equitable, and sustainable care delivery at PHM. Keywords: Healthcare Costs, Insurance Coverage, Healthcare Financing, Value-Based Healthcare, Private Healthcare

Airborne algae and cyanobacteria (AAC) have received much attention as their occurrence have been documented in several studies, including indoor environment. There has been concern whether AAC can trigger allergic response and thus, they may have ill health effects, especially in relation to sick building syndrome (SBS). There have been very few studies reported on the allergenicity of AAC. The main objective of this study was to assess the allergenic potential of three AAC, namely Scenedesmus sp., Cylindrospermum sp. and Hapalosiphon sp.1, which were isolated from an office building in Kuala Lumpur. The study was based on a mouse model, with the suspension of AAC powder in phosphate buffered saline (PBS) administered via nasal route. Naïve mice were sensitised to 1 mg/mL of AAC for 10 consecutive days during Phase I immunisation. In Phase II immunisation which was given after five resting weeks, the mice were re-challenged with 20 μL of AAC at two concentrations (0.01 and 1 mg/mL) for three consecutive days before they were sacrificed. The immune response was assessed based on white blood cell profiles, quantification of humoural and intracellular expression of IgE, TH2 predominant and inflammatory cytokines and histopathological examination. In general, the three AAC elicited greater immune response in mice challenged with high (1 mg/mL) concentration of AAC than with low (0.01 mg/mL) concentration. In mice challenged with Scenedesmus sp. at both low and high concentrations, there were elevated peripheral eosinophil and monocyte counts. Significantly higher levels of serum IgE (P<0.05) and IFN-γ (P<0.05) compared to negative control were also observed. The data collected 48 h after the last dose of immunisation also indicated possible cause of allergic airway inflammation, a chronic manifestation of respiratory allergy upon nasal exposure to the algal particles. On the other hand, Cylindrospermum sp. and Hapalosiphon sp.1 did not elicit type-1 hypersensitivity as both eosinophil counts and serum IgE levels were not elevated in the sensitised mice. The results suggest that the two airborne cyanobacteria provoked immune response differently. In mice challenged with Cylindrospermum sp. (1 mg/mL), there were elevated serum IL-4 (22.1 pg/mL, P<0.05). However, the increase in peripheral neutrophil counts (9.2%) against Cylindrospermum sp. (1 mg/mL) was not significant when negative control was compared. In comparison, in mice challenged with Hapalosiphon sp.1, there were elevations of serum IL-6 (4.8 pg/mL, P<0.05) yet the observed increase of peripheral lymphocyte counts (9.2%) was not statistically significant. In addition, the elevations in serum IFN-γ levels were highest in mice nasal challenged with Cylindrospermum sp. (71.9 pg/mL, P<0.05), followed by Hapalosiphon sp.1 (50.6 pg/mL, P<0.05). Taken together, the results suggest that nasal exposure to Cylindrospermum sp. and Hapalosiphon sp.1 may provoke inflammatory immune responses in the airway. Further studies are warranted to assess the potential health impact due to the allergenic potential of the AAC, especially with regards to the effect of continual exposure to low concentration of the algal particles over extended period of time.

This management project evaluates the Environmental, Social, and Governance (ESG) performance of Asia OneHealthcare (A1Health), one of the region’s major private healthcare providers, with the objective of developing a structured and actionable ESG improvement roadmap. The study adopts a mixed-method approach, combining qualitative analysis of corporate disclosures, policies, and stakeholder practices with quantitative benchmarking against regional and global healthcare peers, with particular reference to IHH Healthcare as an industry best-in-class comparator. The ESG assessment framework is aligned with recognized standards such as GRI, SASB (Healthcare Delivery), and selected UN Sustainable Development Goals to ensure relevance, comparability, and credibility. Findings indicate that while A1Health demonstrates foundational strengths in clinical quality, patient safety, and community access, gaps remain in environmental management, workforce sustainability, and governance maturity. Based on these findings, the project proposes a phased three-year ESG improvement roadmap, prioritizing high-impact, feasible initiatives supported by measurable KPIs, governance structures, and change management considerations. This project contributes practical insights for healthcare executives by translating ESG principles into an implementable strategy that balances sustainability, regulatory compliance, and financial performance. The proposed roadmap positions A1Health to strengthen stakeholder trust, enhance operational resilience, and improve long-term value creation in an increasingly sustainability-driven healthcare landscape.

Background: Since ancient times, Acupuncture was used to treat painful conditions in patient. Currently there is limited research evidence as to whether pregnant women are supportive of acupuncture treatment in maternity services for labour pain management in Malaysia. Objective: To evaluate the perception and acceptance of acupuncture as an alternative, non - pharmacological labour pain management (NPLPM) among antenatal women in a district region, Sandakan, state of Sabah in Malaysia. Method: This is a descriptive, cross-sectional study conducted using a convenient and voluntary sampling method. A total of 201 antenatal women were recruited in the antenatal clinic in a private hospital in Sandakan, Sabah, Malaysia. Data collection tool was a validated, self-administered bilingual questionnaire form consisting of Malay and English language version. All antenatal women regardless of their gestational age, who were attending the antenatal clinic, were included during the study period. The collected data were analysed using SPSS software. Results: 201(100%) respondents had completed and returned the questionnaire form. The study population generally have positive perceptions towards acupuncture. 51.7% of the responders are willing to accept acupuncture as an alternative NPLPM method if available. 35.8% of the responders are in the neutral group and 12 .5% of the responders are not willing to accept acupuncture as an option for their labour pain management. There was a statistically significant difference in acceptance of acupuncture as an alternative NPLPM method among those with and without acupuncture knowledge. Conclusion: About half of the study population are willing to accept acupuncture as a NPLPM method. Introduction of acupuncture for labour pain management can be beneficial and considered especially for woman who refused pharmacological treatment, who has contraindication for labour epidural and in rural region with limited resources. Patients' knowledge, awareness and past experience of acupuncture had a significant effect on acceptance of acupuncture for labour pain management. Keywords Perception, attitudes, knowledge, acupuncture, labour pain, Sabah

Medical students frequently experience inconsistent and inadequately structured mentorship. Moreover, research shows that mentorship programmes tend to focus narrowly on academic monitoring without addressing the underlying factors contributing to students' holistic developmental needs. Recognising this gap, the present study seeks to explore the experiences and needs of undergraduate medical students regarding mentorship during their medical training. This study was guided by three theories: Kram's Mentoring Functions Theory, Social Support Theory, and Developmental Network Theory. Nine participants were purposely sampled based on their enrolment in Semesters 4-8. A descriptive qualitative research design with semi-structured individual interviews conducted via Microsoft Teams was employed for data gathering. The interviews were transcribed, and the data were analysed using Braun and Clarke's six steps of thematic analysis. The themes for the mentorship experiences and needs were constructed. The experience themes include "Mentorship as Multifaceted Support System," "Quality of Mentor-Mentee Relationship and Communication," "Mentorship as Catalyst for Growth," "Mentor Attributes and Credibility," and "Structure of Systems." Meanwhile the themes for need of mentorship include "Academic Support," "Trusting Relationship," "Driver of Growth," "Systems that Enable Support," and "Credible, Well-Prepared Mentors." Students provided insights on their mentorship experiences and needs as well as its effects on their personal, academic, and professional development. Several significant trends were found related to academic guidance, emotional support, career preparation, networking, and research engagement. However, students frequently expressed concerns about poor mentor responsiveness, inadequate career guidance, dysfunctional communication infrastructure, and strong emotional impact from a lack of proactive support and unclear expectations. The results supported the need for comprehensive mentorship programmes focusing on career planning, time management, stress management, networking, and research competencies, whilst creating supportive environments characterised by psychological safety, genuine engagement, and structured meeting frequencies rather than perfunctory monitoring. The study's findings add to the literature on mentorship programmes aimed at addressing students' multidimensional needs and promoting holistic wellbeing during medical training. The insights from the undergraduate medical students' viewpoint are helpful for institutions in designing evidence-based mentorship programmes.

Objective: This systematic review aimed to determine the analgesic efficacy and safety of transdermal fentanyl patch as compared to other opioid therapy or placebo in pain management among the patients from different medical condition. Methods: 30 studies (22 randomised controlled trials and eight observational studies) were included for data synthesis, after searching and screening through PubMed, Excerpta Medica database (Embase), International Pharmaceutical Abstracts (IPA), Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Turning Research into Practice (TRiP) databases. Two authors independently screened the articles and assessed the quality of the studies. SIGN checklist and Cochrane Collaboration’s tool were applied to assess the risk of bias in observational and randomized controlled studies. Data on study background, interventions, outcomes measured and outcomes were synthesized into table forms. Results: Pain scores, adverse events and addiction risks were the primary outcomes in this systematic review. Transdermal fentanyl patch showed significant improvement in terms of pain scores when compared to placebo. When fentanyl patch was compared to other opioid treatment, the results were mostly comparable. In terms of adverse events, fentanyl patch and opioid treatment shared similar incidence adverse events with no significant difference. Conclusions: Transdermal fentanyl patch improved pain scores significantly compared to placebo while the opioid efficacy and safety were similar when compared with other opioid therapies. Other than that, the adverse events reported in fentanyl patch group has no statistical significant difference as compared to other opioid treatment. This result showed that transdermal fentanyl patches could be use as an alternative treatment in patients with moderate-to-severe chronic pain and who prefer non-invasive route of administration and much less frequent dosing. However, the outcome on addiction risk is limited.

The achievement of learning goals in laboratory practicals depends on both extrinsic and intrinsic factors, and could be limited by laboratory time, incurred cost, safety, self-efficacy, inadequate prior preparation by learners and different learning styles. Besides, face to face laboratory sessions could be continuously interrupted as seen during the COVID-19 pandemic. Hence, virtual laboratory simulation (vLAB) may be an appropriate e-learning tool to overcome these restrictions. In this study, students' perception about the usefulness of vLAB was determined by using DNA gel electrophoresis and PCR as case examples. The perception of Year 2 and 3 health science undergraduate students’ (N=87) was studied using a questionnaire consisting of 12 items, rated on a 5-point Likert-scale. In addition, students experience and learning from the vLAB was further explored using qualitative analysis. Results showed that all participants perceived vLAB well, with a median score of 4(Agree for all items in the questionnaire. It provides a meaningful learning experience and an authentic environment where students feel safe to practice what they have learnt in lectures. Moreover, vLAB facilitates individualised learning and enhances selfefficacy among students. In conclusion, vLAB prepares students for physical laboratory sessions by activating the prehension dimension of the Kolb’s learning cycle, hence complementing and strengthening the attainments of health sciences laboratory learning goals and outcomes.

The COVID-19 pandemic has had an immense impact on healthcare systems worldwide particularly in terms of infection control measures. Hospital Sungai Buloh has implemented a novel walk-away queuing system for outpatient clinics, namely the iQMS. This system enables infection control via facilitating social distancing whilst waiting for their appointments and affords waiting location flexibility. However, the factors affecting outpatients’ intention to use the iQMS is yet unknown, and this is the subject of this study. The Technology Acceptance Model (TAM), Perceived System Usability and sociodemographic factors were used to study this relationship. This study used a cross-sectional quantitative design utilizing a self-administered questionnaire to obtain data. The questionnaire comprised of sociodemographic factors, Perceived Usefulness, Perceived Ease of Use, Intention to use the iQMS and Perceived System Usability. Two hundred and fifty-four respondents completed the questionnaire, corresponding to a response rate of 87.8%. The questionnaire showed satisfactory construct validity, discriminant validity and reliability. Perceived Usefulness and Perceived Ease of Use had a significant impact on the Intention to use the iQMS, while Perceived System Usability showed a moderate positive relationship with the Perceived Ease of Use. Sociodemographic factors did not influence the Intention to use the iQMS. In conclusion, the Intention to use the iQMS is associated with the Perceived Ease of Use and Perceived Usefulness of the system. Keywords: COVID-19, Queue Management System, Technology Acceptance Model, System Usability Scale

Diabetes mellitus is a chronic metabolic disease and predicted to increase about 366 million cases globally by end of 2030. Type 2 Diabetes is characterized by abnormal insulin secretion followed by inability of beta cells to compensate for insulin resistance. Most individuals diagnosed with diabetes are found to be obese and obesity as well is one of the major risk factors contributing to diabetes. Although modern medicine is used to control blood glucose level in diabetic patients but there is demand for natural products as anti-diabetic agents due to the side effects seen in the current drugs. In this study, we explore Nephelium lappaceum.L’s (or locally known as rambutan rind) ability as an anti-hyperglycemic agent in a type 2 diabetic animal model. The rind of N. lappaceum is found to consist of high antioxidant activity and possess in-vitro anti-hyperglycemic activity. This study is aimed initially to prepare standardised ethanolic extracts of N. lappaceum rind, evaluate toxicity effects in rat model, develop obesity induced type 2 diabetes rat model and finally investigate the anti-glycemic effects of Nephelium lappaceum rind in the diabetic rat model. Ethanolic extraction was followed as previously described to obtain N. lappaceum rind extract. Geraniin being the major bioactive compound in N. lappaceum rind was detected in LC/MS and quantified using HPLC chromatogram method to ensure a standardised sample was prepared. Biological standardisation was also carried out by subjecting the N. lappaceum rind to both alpha glucosidase and alpha amylase assay’s and to establish its in-vitro anti-hyperglycemic activity. Toxicity studies of N. lappaceum rind were carried out in Sprague dawley rats. In the acute toxicity study, rats were given 50mg, 200mg, 1000mg and 2000mg/kg of N.lappaceum rind orally for 14 days whereas in the sub-chronic toxicity study the rats were given a low and high concentration of N. lappaceum rind for 28days (500mg and 2000mg/kg). Type 2 diabetes was seen to develop in the rat model by feeding them with a high fat diet for 12 weeks and injected with 55mg/kg streptozotocin and 210mg/kg nicotinamide. Then, the diabetes induced rats were treated with N. lappaceum rind at 500mg and 2000mg concentrations for 28 days. Positive control rats were treated with 200mg metformin. In this study, we obtained a 41.06% yield of ethanolic extracts from powdered N. lappaceum rind, while geraniin present in the extract was quantified at 33.0 ± 0.2 mg geraniin/g extract. N. lappaceum rind did not show any toxic effect in the rats both during acute and sub-chronic toxicity study. All biochemical analysis, histology of organs, body weight and relative organ weight clearly showed that there were no significant changes in treated rats. Our study also revealed that, the diabetes induced rats treated with 2000mg N. lappaceum showed reduction in blood glucose level and improved insulin levels which were similar to metformin treated group. Pancreas histology revealed that, the group treated with 2000mg of N. lappaceum had a good distribution of healthy islets and the treatment is comparable to the effect of metformin-treated group. Immunohistochemical staining with Glut-4 and PPAR-gamma antibody also markers for regeneration was over expressed in N. lappaceum treated group with large regenerating islets and the effects were similar to metformin-treated group. In conclusion, N. lappaceum rind extract was able to display anti-hyperglycemic activity at a dose of 2000mg/kg without any toxic effects in high fat diabetes-induced rats.