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- ThesisRestrictedIMAGE SEGMENTATION OF CARBOHYDRATES ON PLATES OF COOKED MEALS(IMU University, 2024)The accurate assessment of dietary intake is crucial for promoting health and managing diet-related conditions such as diabetes and obesity. Traditional methods of dietary assessment are often prone to inaccuracies and time-consuming. This study evaluates the effectiveness of three deep learning models U-Net with 16 filters, U-Net with 64 filters, and the Segment Anything Model (SAM) for segmenting carbohydrate regions in food images. The models were assessed using metrics such as accuracy, Intersection over Union (IoU), and Dice Score. The SAM model outperformed the U-Net models, achieving an overall accuracy of 99.24%, an IoU of 90.59%, and a Dice Score of 94.21%. The UNet 16-filter model showed better performance than the 64-filter model, with an accuracy of 97.86% and an IoU of 81.15%. These results highlight SAM's advanced capabilities in promptable segmentation and zero-shot transfer, making it the most effective model for this task. Future research should focus on expanding the dataset, integrating texture-based segmentation methods, and exploring data augmentation techniques to further enhance model robustness.
- ThesisRestrictedDASHBOARD ON KEY FACTORS INFLUENCING WORK EXPERIENCE AMONG DOCTORS IN PUBLIC HOSPITALS IN KLANG VALLEY(IMU University, 2024)Introduction: Advancement in information technology in healthcare and data visualisation should be leveraged to address the challenge of high doctor turnover, ultimately improving healthcare services for the public. The Malaysian government is currently gappling with issues related to brain drain, as highlighted by the Prime Minister during the Malaysia Madani economic development event in September 2023. Methodology: This research has three primary objectives: (I) to identify the key factors influencing doctors' work experience in the public hospital, (2) to design a dashboard for monitoring these key factors, and (3) to validate the dashboard with associated experts. The study utilised 301 primary datasets from Hospital Kuala Lumpur and Hospital Tunku Azizah, employing a cross-sectional, convenience purposive sampling method. The focus is on sociodemographic, socioeconomic, work, psychosocial and job satisfaction factors. The study used a structured questionnaire consisting of 80 questions. Results: Six key factors were identified through simple logistic regression (P<0.05): age group, total length of service, job position, total income, job satisfaction and burnout. Among these, job position and job satisfaction were selected as predictors through the hierarchical multiple logistic regression. The customised dashboard, designed using Tableau version 2023.2.1, provides interactive and actionable insights. The dashboard was validated by respective experts to ensure accuracy, usability, and functionality. Conclusion: Identifying key factors and designing an interactive dashboard are crucial for understanding and improving with doctors' work experiences in public hospitals. These insights can guide government policy-making to help retain the doctors and enhance the national healthcare system. Keywords: Doctor, Work experience, Job satisfaction, burnout, dashboard
- ThesisRestrictedFEATURE INTERACTION MODELLING FOR IMPROVED DENTAL IMPLANT FAILURE PREDICTION WITH MACHINE LEARNING(IMU University, 2024)Dental implants success poses a significant challenge in oral rehabilitation, influenced by various patients-specific and surgical factors. The objective of this study is to employ supervised machine learning (ML) algorithms to predict dental implant failure emphasizing on feature interaction analysis and its impact on model accuracy and reliability. 747 implants record dataset was utilised consisting of features related to patient surgeon and surgery. Features were selected based on statistical test and backward elimination. Greenwell's method and Freidman's H statistical method were employed to identify interacting pairs, followed by modelling with Random Forest, K Nearest Neighbor and Extreme Gradient Boosting with hyper parameter tuning via Standardized Search CV and Grid Search CV. While some interacting pairs improved model accuracy marginally, not all interactions led to improvement. With 'ridge augmentation and age' interacting pair, XG Boost achieved the highest accuracy of 89.04%. However, it could not surpass the Random Forest accuracy of 90.4% achieved through feature selection and hyperparameter tuning without interactions. The study demonstrated the potential oi feature interaction modelling in predicting dental implant failure but emphasized the careful selection of interactions. Future research can refine the understanding of feature interactions and its impact on predictive models, leading to enhanced clinical decision making in dental implantology.
- ThesisRestrictedTHE IMPACTS OF HEALTH EXPENDITURES AND ECONOMIC GROWTH ON HEALTH OUTCOMES: EMPIRICAL EVIDENCE FROM ASEAN COUNTRIES(IMU University, 2024)This study examines the relationship between health expenditures, economic growth, and health outcomes in ASEAN region. It specifically looks at the impact on life expectancy and infant mortality rates. Using annual dataset from 2000 to 2021 taken from the World Development Index by World Bank, the study applies econometric technique panel ARDL and Dumitrescu-Hurlin causality tests. The findings reveal a significant positive association between public and private health expenditures with life expectancy in the long term, emphasizing the critical role of government spending in improving health outcomes, with the complementing support of the private sectors. However, the mixed impacts of public health expenditure on infant mortality rates suggest potential inefficiencies and mis-allocations in health spending. There is a clear link between economic growth with increased life expectancy and infant mortality reduction, which highlights the importance of sustained economic development for better health outcomes. The study also identifies bidirectional causality between GDP per capita and life expectancy. In order to achieve significant improvements in population health, it is crucial to make strategic health investments. Policy implications include the need for targeted policies to address healthcare financing and service delivery disparities in ASEAN countries. Governments should effectively allocate health expenditure to ensure equitable access to healthcare services, particularly for vulnerable populations. Future research should focus on examining the impact of health interventions and policies, by including other health indicators and factors to gain more comprehensive view into the progress of UHC and to identify best practices. Keywords: health expenditure, economic growth, health outcome, ASEAN
- ThesisRestrictedFACTORS INFLUENCING THE PURCHASE INTENTION OF TRAVEL INSURANCE AMONG TRAVELLERS IN KLANG VALLEY, MALAYSIA(IMU University, 2024)Travel insurance is becoming more widely recognised as a critical financial safeguard against unforeseen travel-related complications on a global scale. However, its adoption rate in Malaysia remains below the global average, necessitating a deeper understanding of the contributing factors. This quantitative study investigates the behaviours and perceptions of Malaysian travellers, with a particular emphasis on the Klang Valley region, to provide actionable insights for boosting travel insurance adoption in Malaysia. This study investigates the impact of attitudes, subjective norms, and perceived behavioural control on the intention to purchase travel insurance, using the Theory of Planned Behaviour (TPB) as its foundation. Furthermore, it incorporates insurance literacy as an additional predictor into the TPB model. A bilingual online questionnaire was implemented to gather data from travellers in the Klang Valley, employing non-random sampling. The results indicate that demographic variables, including age, education, income, attitudes, risk perceptions, and travel insurance knowledge significantly influence purchase intentions. These insights can assist the insurance industry and policymakers in promoting travel insurance, thereby fostering socioeconomic development through the tourism sector.
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- ThesisRestrictedIDENTIFICATION OF EFFECTIVE DRUGS OR DRUG COMBINATIONS TARGETING NON – STEM BREAST CANCER CELLS AND BREAST CANCER STEM CELLS(International Medical University, 2016)Breast cancer stem cells (BCSCs), as a subset of cancer cells with enriched capacity to generate breast tumors, have recently been attributed to driving cancer recurrence and metastasis. Although the importance of developing strategies to target BCSCs has been highlighted, it is conceivable that the depletion of BCSCs within a breast tumor would not lead to complete regression since non-BCSCs might still be capable of sustaining tumor growth or regaining BCSC potential. As either of these possibilities would confound the effectiveness of therapeutic agents that exclusively target BCSCs, this study aimed to develop combinatory therapeutics that apply agents targeting both BCSCs and non-BCSCs. By utilising parental cells and mammospheres as screening platforms, a total of 193 candidate molecules were identified as potent hit compounds inhibiting both BCSCs and non-BCSCs. Subsequent analysis suggested histone deacetylase (HDAC) inhibitors as a class of anti-cancer agents targeting both BCSCs and non-BCSCs. When combined with conventional chemotherapeutics, HDAC inhibitors were found to synergise DNA-damaging chemotherapeutics, namely doxorubicin and cisplatin, against BCSCs and non-BCSCs derived from MDA-MB- 468; whereas their combined treatment with anti-mitotic chemotherapy, namely paclitaxel, only exerted synergy in MDA-MB-468 non-BCSCs. Intriguingly, neither pan-HDAC, hydroxamate-based inhibitor nor class I specific, benzamide-based HDAC inhibitor was superior to be combined with conventional chemotherapeutics against these BCSCs and non-BCSCs. Further evaluations indicated that quisinostat, as the most potent HDAC inhibitor tested, managed to enhance the doxorubicininduced cytotoxicity in both BCSCs and non-BCSCs derived from different subtypes, including basal-like triple negative breast cancer (TNBC) subtypes (MDA-MB-468 and HCC38), mesenchymal-like TNBC (MDA-MB-231), and luminal-like breast cancer (MCF-7). Conversely, the synergism between quisinostat and cisplatin was TNBC subtype-dependent. Also, it was observed that both BCSCs and non-BCSCs of TNBC subtypes were more sensitive to the co-treatment of quisinostat with DNA damaging chemotherapeutics, as compared to luminal-like breast cancer subtype. Moreover, the dose reduction potentials of these combinatory regimens that revealed in this study may be exploited to reduce the dose-limited toxicities in clinical oncology. In summary, this study offered HDAC inhibitors as novel therapeutic options, either as monotherapy or combination therapy, for refractory breast cancer treatment which warrants detailed investigations.
- ThesisRestrictedMethodological Quality And Concordance Of Recommendations Across Clinical Practice Guidelines For The Management Of Hypertension In Southeast Asia(International Medical University, 2021-05)Background The regional epidemic of hypertension in Southeast Asia indicates an important role for clinical practice guidelines (CPGs) to optimize its management. This study aimed to evaluate the methodological quality and the rate of concordance of recommendations across the CPGs in Southeast Asia with internationally reputable CPGs. Methods CPGs for the management of hypertension in Southeast Asia were retrieved from the websites of Ministry of Health or cardiovascular specialty societies of the individual countries during November to December 2020. Two reviewers independently appraised the methodological quality of all the included CPGs using the Appraisal of Guideline ResEarch and Evaluation instrument. The recommendations for the management of hypertension specified in the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and the 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guideline were selected to be the reference standards; the recommendations concerning the management of hypertension in the included CPGs in Southeast Asia were assessed if they were concordant with the reference recommendations. Results We identified six CPGs for the management of hypertension in Southeast Asia. Upon quality appraisal, except for the CPG originated from Malaysia which could be “recommended” for use in practice, the remaining five CPGs could only be “weakly recommended”. Considering the six included CPGs from Southeast Asia, concordance was observed for 30 out of 59 (50.8%) reference recommendations generated from the 2017 ACC/AHA guideline and for 31 out of 51 (69.8%) reference recommendations derived from the 2018 ESC/ESH guideline. Conclusion More efforts should be invested to improve the methodological quality of the CPGs for the management of hypertension in Southeast Asia. While the CPGs in Southeast Asia have a high rate of non-concordance with internationally reputable CPGs, the concordant recommendations could perhaps be considered a standard of care for the regional management of hypertension in Southeast Asia. Keywords: AGREE II; CPG; Guideline; Hypertension; Recommendation
- ThesisRestrictedInhibition Of Cancer Cell Proliferation And Survival Through Synergistic Effects Of Traditional Anti-Cancer Drug Action In Combination With Targeted Knockdown Of Cancer-Related Genes(International Medical University, 2012)Chemotherapy remains as the option for treating cancer in increasing the lifetime of the patient. The severe effects of chemotherapy drugs contribute to the developments of approaches based on silencing of cancer-causing genes using siRNA. Nonetheless, siRNA delivery vehicle is needed as they cannot diffuse across cellular membranes; thus leading to the development of carbonate apatite nanoparticle. By employing carbonate apatite nanoparticles, we showed that codelivery of siRNAs and drugs managed to block signalling pathways. Simultaneous delivery of ROS1 siRNA and 40nM Pax by carbonate apatite exhibited better effects in MCF7 cells where the cell viability was significantly reduced to 26% with 42% more sensitive towards the drug. Further analysis showed the treatment caused the disruption of phosphorylation in ERK1/2 pathway. Besides, silencing of RAF1 gene concurrently with 40nM Dox in MCF7 cells also resulted in low cell viability and relatively high enhancement of chemosensitivity, but this co-treatment did not affect the phosphorylation of ERK1/2 pathway. GRB2 gene seemed to be vital in MCF7 as its knockdown showed prominent cell death and chemosensitivity towards 8nM Pax, 40nM Pax and 40nM Cis. Nevertheless, all these three combinations failed to block the phosphorylation of ERK1/2 pathway. In 4T1 cells, co-delivery of SHC1 siRNA and 8nM or 40nM of Pax greatly decreased the cell viability to 29% and 17% respectively owing to the high sensitivity towards drug. Moreover, co-treatment of ROS1 siRNA and 40nM Dox reduced cell viability to 30% with the sensitivity for the drugs increased by 51%. Western blot results proved that this treatment had successfully blocked the phosphorylation of AKT1 (Ser473) pathway while partially blocked the phosphorylation of ERK1/2. From the in vitro results, treatment of ROS1 siRNA and Dox demonstrated effective cytotoxicity as well as interruption in AKT1 (Ser473) and ERK1/2 pathways. Thus, this combination was then used in in vivo study. Intratumoural injection of carbonate apatite conjugated with ROS1 siRNA and Dox also blocked the phosphorylation of AKT1 (Ser473) pathway. This concluded that carbonate apatite can be a promising tool for both in vitro and in vivo delivery of siRNAs targeting important cancer-related genes.
- ThesisRestrictedCINNAMOMUM, ITS ANTIBACTERIAL EFFECTS AND CINNAMOMUM IMPRESSICOSTATUM, IDENTIFICATION OF BIOACTIVE CONSTITUENTS AND POSSIBLE MECHANISMS OF ACTION AGAINST METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS(International Medical University, 2014-03)The emergence of Methicillin Resistant Staphylococcus aureus (MRSA) which is resistant to many available antibacterial agents, especially the β-lactam antibiotics, has become a major threat to the health sector worldwide, giving impetus to the search for novel antibacterial agents efficacious against this bacterium. Four (4) Cinnamomum species i.e. C.iners, C.altissimum, C.impressicostatum and C. porrectum were investigated against a range of multidrug resistant bacteria, including Methicillin Resistant Staphylococcus aureus, our main subject of interest, for potential antibacterial activity and elucidation of their modes and mechanisms of action. Characterisations of their bioactive fractions were performed using bioassay guided isolation techniques. C.impressiscostatum stem-bark extract recorded the highest zone of inhibition and lowest minimum inhibitory concentration against MRSA. The presence of salt enhanced the killing efficiency of the plant extract against MRSA. Cellular materials leaked from MRSA after treatment with the plant extract and this was concomitant with marked cell wall damage, as observed using scanning electron microscopy (SEM). A total of 136 genes were found to be differentially regulated by C. impressicostatum stem-bark extract. Amongst these, 73 genes were upregulated and 63 genes were downregulated. The MRSA genes that fluctuated in expression when treated with the plant extract involved various pathways, such as amino acid metabolism, carbohydrate metabolism, lipid metabolism, nucleotide metabolism, membrane transport, metabolism of cofactors and vitamins, metabolism of terpenoids and polyketides, biosynthesis of secondary metabolites, energy metabolism, folding, sorting and degradation, glycan metabolism, pathways in pathogenesis, replication and repair, signal transduction, transcription, translation, translational ribosomal structure and biogenesis and xenobiotic degradation and metabolism. The possible mechanisms underlying the killing action of C.impressicostatum active fraction of water extract against MRSA are via inhibition of biofilm formation, inhibition of nucleotide metabolism as well as DNA replication and repair, downregulation of the mismatch repair mechanism, thereby enabling maintenance of deleterious and lethal mutations, ultimately causing cell death, induction of increased cellular vulnerability to the effects of reactive oxygen and nitrogen species, inhibition of essential lipid biosynthesis required for cellular structure and metabolism as well as the induction of apoptosis.
- ThesisRestrictedALLERGENIC POTENTIAL OF THREE AIRBORNE ALGAE AND CYANOBACTERIA ISOLATED FROM AN OFFICE BUILDING IN KUALA LUMPUR(International Medical University, 2017)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.