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Therapeutic challenges and mortality outcomes in HFrEF patients with CKD:a multi-centre and multi-ethnic experience
No full textIntroduction: The presence of chronic kidney disease (CKD) in patients with heart failure (HF) is associated with increased complications, readmissions, and mortality.
CKD can also limit the application of guideline-directed medical therapy (GDMT) for HF in routine clinical practice. The comparative clinical outcomes of HF patients with
CKD versus non-CKD patients in dedicated HF clinics remain uncertain.
Purpose: To evaluate the characteristics and clinical outcomes of patients with chronic heart failure with reduced ejection fraction (HFrEF) and CKD compared to
non-CKD patients.
Methods: A retrospective, multi-center cohort study analyzed 465 patients with HFrEF who attended dedicated HF clinics in ten hospitals between January 1, 2021, and June 30, 2023. Clinical records, baseline characteristics, and six-month
clinical outcomes were evaluated. CKD is defined as having an estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73m2 according to the 2021 CKD-EPI.
Results: Among the 465 patients, 129 (27.7%) had CKD and 336 (72.3%) were non-CKD. CKD patients were significantly older (61±11 years vs. 53±13 years, p=0.002), but both groups had a similar male predominance (77% vs. 77%, p=0.487). CKD patients exhibited higher rates of hypertension (79% vs. 61%, p<0.001), diabetes mellitus (50% vs. 35%, p=0.002), dyslipidemia (61% vs. 49%, p=0.014), cerebrovascular accidents (12% vs. 6%, p=0.033), and anemia (39% vs.
22%, p<0.001). However, there were no significant differences in the prevalence of ischemic heart disease (50% vs. 44%, p=0.157) or atrial fibrillation (25% vs.
22%, p=0.292). The prescription of renin-angiotensin-aldosterone system (RAAS) inhibitors was significantly lower in the CKD group at first clinic visit (69% vs. 88%,
p<0.001), three months (73% vs. 93%, p<0.001), and six months (78% vs. 92%, p<0.001). In contrast, prescriptions of beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors were similar across groups at all time points. Both groups demonstrated significant improvement in left ventricular ejection fraction (LVEF) over six months, with no intergroup differences: 29.3±9.8% to 37.2±14.1% (CKD) vs. 26.9±7.8% to 38.3±13.0% (non-CKD, p=0.161). Similarly, there was no significant difference in improvement in NYHA
functional class (p=0.795). However, the CKD group experienced higher six-month all-cause mortality (16.5% vs. 5.6%, p<0.001), while the six-month HF readmission
rate was comparable (10.9% vs. 6.0%, p=0.057).
Conclusion: Both CKD and non-CKD patients with HFrEF showed improvement in LVEF and NYHA functional class during follow-up in dedicated HF clinics. However, CKD patients had lower RAAS inhibitor prescriptions and significantly higher
six-month all-cause mortality, emphasizing the need for optimized management strategies for this high-risk group
Analisis Pengaruh Bahasa Iban dalam Dialek Melayu Sarawak: Satu Kajian Linguistik
No full textThis study examines the influence of the Iban language on the Malay dialect of Sarawak
from both linguistic and sociocultural perspectives. Three main objectives were outlined:
identifying Iban lexical items integrated into the Sarawak Malay dialect, analyzing
phonological changes, and evaluating the social and cultural factors contributing to this
phenomenon. A mixed-method research design was used, incorporating semi-structured
interviews with seven respondents and distribution of questionnaires.
Findings show that words such as makai, anang, kitai, nuan, and bisi are widely used
with retained Iban phonological features. Social factors such as interethnic relations,
intermarriage, and early cultural exposure have significantly influenced this linguistic
integration. Despite concerns over dialectal identity erosion, the Malay Sarawak community
demonstrates adaptability in incorporating Iban elements into their linguistic identity. Overall,
this study confirms that language mixing reflects ethnic harmony and enriches linguistic
identity in a multicultural society
Analysis Of Factors Influencing Success In College-Level Advertising Design Competitions: A Quantitative Study Of College Awards
No full textThis study examines patterns in award-winning graphic advertising designs to identify factors that increase students' chances of success in university competitions. The research specifically analyzes creative advertising approaches, visual representations, and submission strategies of gold-winning entries in the AD CAMPUS competition (2019–2023). Findings show that using metaphors, flat illustrations, and submitting three pieces as a cohesive series are the most effective strategies for winning. This study provides valuable insights for instructors guiding students in creative advertising competitions, offering a foundation for future design instruction and competition strategies
Gamification of Regional Tourism Engagement: Analysis and Design of a Web-Based Information System
No full textRegional tourism often faces challenges in achieving deep and lasting tourist engagement. Gamification has emerged as a promising strategy to enhance user participation across various sectors, including tourism. This paper presents the design and development of NusaQuest, a gamified tourism learning application aimed at engaging users with Indonesian culture and destinations through quizzes, multiplayer challenges, and reward-based progression. The system integrates a structured gamification algorithm with a scalable relational database model, built using React.js and Firebase, to ensure responsive and consistent user experiences. Preliminary validation was conducted through a competition involving 15 participants, providing early evidence of user engagement and learning outcomes. A comprehensive experimental design and quantitative evaluation framework are proposed to assess usability, satisfaction, and knowledge gain through structured user studies. The findings suggest that NusaQuest holds strong potential for enhancing regional tourism engagement and promoting sustainable cultural education through digital gamification
Overview of Grounding System Improvements: Design, Simulation, Grounding Enhancement Materials
No full textGrounding systems are essential for dissipating electrical discharges, preventing equipment damage and human casualties from lightning strikes. Traditional grounding methods using steel or copper rods face challenges in highresistivity soils and space-limited areas. Alternatives like Ufer grounding depend on soil moisture, while Ground Enhancement Materials (GEMs) like bentonite improve conductivity but raise cost and environmental concerns. Advancements in simulation tools and testing methodologies have enhanced grounding system design, enabling precise resistance predictions and corrosion detection. This review explores recent innovations in GEMs, modeling techniques, and performance assessments, emphasizing the shift toward safer, more efficient, and sustainable grounding solutions
BALANCING SUSTAINABILITY AND INNOVATION: EXPLORING THE INTERVENTION OF STRATEGIC AMBIDEXTERITY IN PROCESS INNOVATION
No full textAccomplishing sustainable performance notwithstanding an inexorably uncertain environment has become both a basic test and a convincing objective inside the domain of contemporary business. Even with rising uncertainty, accomplishing sustainable performance has arisen as a foremost test and a convincing objective in contemporary business. The study aims to address the imperative set by the United Nations Sustainable Development Goals (UN-SDGs) by exploring the mediation role of strategic ambidexterity in the relationship between intellectual capital dimensions (Structural Capital, Relational Capital, Human Capital, Social Capital) and sustainable performance within businesses. Given the increasing global challenges, particularly the call for sustainability, this research investigates the intricate connections among these variables. Employing quantitative methods and Smart PLS, the study conducted an online survey distributed to managers of selected hotels, yielding 385 workable responses out of 500. The results reveal a positive correlation among the
variables of interest, confirming the acceptance of all hypotheses. In conclusion, the findings suggest that
hotels strategically leveraging their intellectual capital for innovative exploration and exploitation processes
exhibit enhanced capabilities to attain sustainable performance, aligning with the broader goals of global sustainability. The managers could benefit from the implementation of putting resources into the turn of
maintenance of a very capable workforce, supporting social ties inside and outside the association.
Furthermore, executing situation arranging and possibility techniques empower fast arrangement, adding to
sustained performance
Navigating Sustainability A Bibliometric Analysis Of Carbon Management Accounting
No full textIn the era of increasing concerns over climate change and sustainable development, Carbon Management
Accounting (CMA) research gains paramount attention. Previous studies focused on specific aspects of carbon
accounting, leaving a gap in comprehensive exploration of CMA's holistic approach to sustainability
challenges. This study aims to provide a comprehensive overview of the current state of CMA research and
its implications for sustainability efforts. Bibliometric and network analyses, utilizing Harzing's Publish or
Perish (PoP) and VOSviewer (VOS) software, 200 Scopus-indexed documents from 2013 to 2022 were
examined. Performance analysis, citation analysis, journal analysis, and network analysis were employed to
examine the field from research practice and system perspectives. From a practice-perspective, the analysis
reveals CMA research as an "advancement," depicting progressive, impactful, and dynamism within the field.
The system-perspective displays a “transformative” role characterized by prominence, synergy, and
integration. Popular themes among researchers and countries include keywords like "carbon," "carbon
accounting," "environmental policy," and "climate change." A significant gap between sustainability
development and the carbon accounting model in CMA is identified, emphasizing the need for further
integrated research. This study is pivotal for practitioners, policymakers, and researchers, aiding sustainability
efforts and addressing global climate change
Exploring the Relationship Between Person, Behaviour and Environment in Learning
No full textThis study examines the intricate relationship between cognitive, behavioural, and environmental factors in learning, based on Bandura's (1986) social cognitive theory and Wenden & Rubin's (1987) research on learning strategies. Understanding how these elements interact is crucial for enhancing educational practices and student outcomes. The research is set in Johor, Malaysia, focusing on public university students to provide a real-world educational context. The objective is to identify the combined effects of cognitive strategies, behaviour, and environmental management on academic performance. This quantitative study utilized a 5-point Likert scale survey to gather data from 113 respondents. The findings indicate that effective cognitive and behavioural strategies and well-managed learning environments significantly enhance student performance. The study's implications suggest that integrating these strategies into educational practices and fostering supportive environments can improve academic outcomes. This research highlights the need for a holistic approach to learning, emphasizing the interplay of cognitive, behavioural, and environmental factors
DESIGN AND DEVELOPMENT OF USABLE FURNITURE FOR DEWAN SERBAGUNA IN TAMAN SAMARINDAH COMMUNITY
No full textThis service-learning project aimed to empower students to contribute to community development by addressing fundamental needs, strengthening their technical and interpersonal skills, fostering a sense of civic responsibility, and ultimately promoting sustainable social impact through education. By guiding students through the whole engineering design cycle from community consultation to final implementation the project helped them reframe their roles as future engineers who innovate not only for industry but also for society. It provided a transformative platform where academic learning was directly applied to real-world challenges, allowing students to witness the
tangible outcomes of their work. This initiative also demonstrated how university-community collaboration can serve as a powerful driver for inclusive development and experiential learning excellence
University Students' Perspectives on Adopting Internet of Things Technologies in Smart Farming: An Analysis Using the Extended Technology Acceptance Model
No full textSmart farming leverages advanced technologies to promote sustainable agriculture by reducing carbon emissions, conserving resources and increasing output. At the forefront of this innovation is the Internet of Things (IoT), a network of linked devices enabling efficient monitoring and control of agricultural processes. Despite its benefits, IoT adoption in agriculture remains limited. This pilot study explores factors influencing university students' adoption of IoT technology, as they represent future agricultural innovators. Using an expanded technology acceptance model (TAM) and student survey data, the study identifies key drivers of IoT acceptance in agriculture. The findings provide valuable insights into the factors shaping IoT adoption and offer a foundation for strategies to advance sustainable farming and resource management. This research enriches the existing literature on technology adoption in agriculture. It is a reference for stakeholders aiming to enhance agricultural sustainability and productivity