An artificial neural network (ANN) was applied for the determination of V(V) based on immobilized fatty hydroxamic acid (FHA) in poly(methyl methacrylate) (PMMA). Spectra obtained from the V(V)-FHA complex at single wavelengths was used as the input data for the ANN. The V(V)-FHA complex shows a limited linear dynamic range of V(V) concentration of 10 - 100 mg/ L. After training with ANN, the linear dynamic range was extended with low calibration error. A three layer feed forward neural network using backpropagation (BP) algorithm was employed in this study. The input layer consisted of single neurons, 30 neurons in hidden a layer and one output neuron was found appropriate for the multivariate calibration used. The network were trained up to 10000 epochs with 0.003 % learning rate. This reagent also provided a good analytical pedormance with reproducibility characters of the method yielding relative standard deviation (RSD) of 9.29% and 7.09% for V(V) at concentrations of 50 mg/ L and 200 mg/ L, respectively. The limit of detection of the method was 8.4 mg/ L.
Cephalometric analyses using computer software have more advantages than manual analyses. However, the software should be evaluated for the accuracy and reproducibility before it can be used. The aims of the present study were: 1) to compare the differences in accuracy and precision between utilizing scanned images and soft copy images with the software 2) to assess the reproducibility of software and manual cephalometric analyses. Fifteen cephalograms were selected randomly from the Record Unit, Hospital Universiti Sains Malaysia. All films had 10 fiducial points marked and were scanned at 75 dots per inch (dpi) and 300 dpi. Manual and digital measurements were compared to obtain magnification factors. Seven digital x-ray images of a caliper were taken. The mean differences were measured between the fixed caliper measurement and digital measurements. Subsequently, 37 cephalograms were traced manually and digitally with Computer-Assisted Simulation System for Orthognathic Surgery (CASSOS) software to assess its accuracy and reproducibility after applying the obtained magnification factor. Steiner analysis was utilized and T tests were used to evaluate the mean difference. P
The study aimed to develop Mandarin speech perception tests for Malaysian Chinese children. Two tests were developed which were the Syllabic Pattern Perception Test (SPPT) and the Tone Perception Test (TPT). Both tests were designed for children aged between three to six years-old. A total of 80 normal hearing children aged 3 years to 6 years and 11 months from several kindergartens around Kuala Lumpur and Ipoh participated in this study. Results showed that the mean scores for the SPPT did not differ significantly across age (p > 0.05), possibly due to a ceiling effect. Although the SPPT showed relatively low test-retest and inter-rater Spearman correlation coefficients (r = 0.68 for correct syllable pattern response and r = 0.38 for correct item response), the scores were highly repeatable in both test-retest and interrater conditions. For the TPT, the mean scores of five and six year old children were significantly higher than three year old subjects while the mean score of four year old subjects was significantly poorer than the six years old. The test-retest and inter-rater reliability were high and the coefficients approximated 0.80 (p < 0.05). For both tests, gender and dialects or languages used as the second language did not have significant effect on the test scores. Content validity evidence was also collected from a group of panelists. In conclusion, SPPT and TPT are reliable and valid Mandarin speech tests to be used on Malaysian Chinese children who speak Mandarin.
The aim of this study was to validate the translation of the Overactive Bladder (OAB) Screener (OAB V8) to the Malay language. It was to assess the reliability of the screener in the context of a Malaysian population. The original screener consists of eight symptoms indicative of OAB that has been proven to be highly sensitive and reliable. Translation was done with a modification of the Brislin Method using back translation and a panel of experts as a final review panel. The pilot study had two groups; a symptomatic (n=19 patients) and an asymptomatic group (n=18 patients). All patients performed the test twice at two week intervals once at the clinic and subsequently at home. Test-retest method was used for reliability and Cronbach's alpha for internal consistency. The translated questionnaire demonstrated good internal consistency in both groups of patients for all eight items individually and for the total score. Cronbach's alphas ranged from 0.972 to 0.981 for the symptomatic group and from 0.750 to 0.976 for the asymptomatic group. Testretest correlation for all items was highly significant. Intraclass orrelation (ICC) was high for both the asymptomatic (ICC ranging from 0.600 to 0.953) and the symptomatic group (ranging from 0.944 to 0.989).The Malay OAB V8 showed itself to be suitable for use, reliable in distinguishing symptomatic and asymptomatic patients and a valid instrument.
Objective: The aim of this study was to evaluate the validity and reliability of the Malay version of the Fagerstrom Test for Nicotine Dependence (FTND-M) based on a group of male staffs in the hospital. This study will also determine whether an abbreviated version of the FTND-M can be used as a screening tool for nicotine dependence. Method: 107 male staffs participated in the study. They were given the FTND-M and Malay version of Mini-International Neuropsychiatric Interview (M.I.N.I.)-L component. Their carbon monoxide level measured in their breath by using exhaled air. One week later, these participants were again given FTND-M. Results: The discriminatory ability of FTND-M was good with AUC 0.74 (P2 with the sensitivity of 70.1%, specificity of 70%, PPV of 79.7% and NPV of 58.3%. The FTND-M had moderate internal consistency with a Cronbach’s alpha of 0.67. The testretest reliability after 1 week was fair (Spearman’s rho=0.5, p)
Objective: This study intends to investigate the reliability, validity and patients’ perception towards the Malay Hospital Anxiety Depression Scale (HADS) and Malay McGill Quality of Life Questionnaire (MMQoL) in Terengganu cancer patients. Methods: It was conducted cross-sectionally in Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu, Malaysia
recruiting 80 patients fulfilling the inclusion criteria. Socio-demographic data was analyzed descriptively and presented as frequencies. To examine patients’ perception towards the applicability and practicality, completion time, comprehension, comprehensiveness difficulty and instrusiveness of the instruments were inquired via a 5-item survey. For reliability purposes, the internal consistency reliability (Cronbach's α) was calculated while
Spearman’s rank correlation coefficient (rs) was used to examine the strength of associations between and within instruments (convergent/divergent validity). Results: To the majority of patients, both HADS and MMQoL instruments were considered clear, comprehensive and not difficult to complete (completion time < 10 minutes). The internal consistency reliability
for both HADS and MMQoL domains ranged from moderate to high. Within HADS itself, the individual items produced strong correlations with their own domains than with other domains (rs ≥ 4.0). Similarly, majority of individual items in MMQoL correlated stronger within their own domains compared to other domains (except Existential Well-Being and Support Issues) supporting validity. Conclusion: The overall findings suggested that both instruments have exhibited adequate evidence of reliability and validity plus being perceived as favourable for assessing health outcomes among cancer sufferers.
Study site: Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu, Malaysia
Device, Questionnaire & Scale: Malay Hospital Anxiety Depression Scale (HADS); Malay McGill Quality of Life Questionnaire
Background: Up to date, there are handful questionnaires that have been validated in Bahasa Malaysia (BM). This study aimed to translate the Depression Anxiety Stress Scales 21-item (DASS-21) and measure its psychometric properties. Objectives: To determine the construct validity and acceptability of the DASS, BM. Methods: Two forward and backward translations were done in BM in accordance to guideline, and its validation was determined by using confirmatory factor analysis. A total of 263 subjects were selected by systematic random sampling to represent Malaysian population for reliability and validity purposes. Results: The BM DASS-21 had very good Cronbach’s alpha values of .84, .74 and .79, respectively, for depression, anxiety and stress. In addition, it had good factor loading values for most items (.39 to .73). Correlations among scales were between .54 and .68. Conclusions: BM DASS-21 is correctly and adequately translated to Bahasa Malaysia with high psychometric properties. Further studies are required to support these findings.
To ensure the reliability of manual blood pressure (BP) readings in a clinical trial, sources of error due to measurement must be reduced as much as possible. Apart from following standard procedure for BP measurement and ensuring good equipments, the measurement errors that come from the assessors themselves should be assessed. Objective: To demonstrate the use of two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) intraclass correlation coefficient (ICC) in the assessment of reliability of manual BP readings among assessors involved in a clinical trial using manual BP measurement, by using an interrater reliability study conducted by the authors as an example study. Methods: The steps involved in obtaining ICC in the study were discussed. Sample size given the number of assessors in the study was calculated. BP was measured using regularly maintained mercury sphygnomanometers, following recommendations by Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) for BP measurement in office setting. The outcomes were systolic and diastolic BP readings. A type of ICC, two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) ICC was chosen for the analysis and specifically discussed. Pre-requisite assumptions for ICC were meticulously checked and described. The interrater reliability for systolic and diastolic BP readings as expressed by ICC (single measure) were presented with confidence interval (CI). The ICCs obtained in the example study were discussed and concluded. The flaws of the study were also criticised. Results: The interrater reliability for systolic and diastolic BP measurements as expressed by ICC (single measure) were 0.87 (95% confidence interval [CI] 0.722, 0.956) and 0.77 (95% CI 0.560, 0.918) respectively. Conclusion: We demonstrated the steps required to obtain ICC. Since the use of manual BP measurement using mercury sphygmomanometer is still considered as gold standard of BP measurement, it is important that studies in which the BP outcome is measured using such method conduct interrater reliability studies properly.
Objective: To determine the sensitivity, specificity and internal consistency of the Malay version GHQ-30 among medical student population. This study also determined the level of agreement between GHQ-30 and M-BDI.
Methods: The Malay version GHQ-30 and Malay version Beck Depression Inventory (M-BDI) were administered to 190 medical students. ROC curve analysis was applied to determine the sensitivity and specificity of the GHQ-30 by testing against the M-BDI diagnoses. Reliability and Kappa analysis were applied to test internal consistency of the GHQ and to determine the level of agreement between GHQ-30 and M-BDI respectively.
Results: 141 (74.2%) medical students participated in this study. The GHQ-30 sensitivity and specificity at cut-off point of 5/6 was 87.5% and 80.6% respectively with positive predictive value (PPV) of 70% as well as area under ROC curve was 0.84. The Cronbach’s alpha value of the GHQ-30 was 0.93. The Kappa coefficient was 0.64 (p<0.001).
Conclusion: This study showed the Malay version GHQ-30 is a valid and reliable screening tool in detecting distressed medical students. The GHQ-30 score equal to or more than 6 was considered as significant distress. The GHQ-30 showed a good level of agreement with M-BDI in detecting distressed medical students.
Keywords: Kelantan; Malaysia; medical student
Objective: To determine the construct validity and the internal consistency of the Postgraduate Stressor Questionnaire (PSQ) among postgraduate medical trainees hence it could be used as a valid and reliable instrument to identify stressors among them.
Methods: Items of the PSQ were derived from a review of literature on the subject and a discussion with experts in the field. It comprised of 28 items with seven hypothetical groups. The content and face validity was established through discussion with experts from field of Medical Education and Psychiatry. It was administered to all participants (N = 34) of postgraduate personal and professional development programme in a Malaysian university. Data was analysed using Statistical Package Social Sciences (SPSS) version 18. Factor analysis was applied to test construct validity whereas reliability analysis was applied to test internal consistency of the PSQ.
Results: Thirty three postgraduate medical trainees participated in this study. Factor analysis found that the 28 items of the PSQ were loaded nicely into the seven pre-determined groups as their factor loading values were more than 0.3. The reliability analysis showed that the Cronbach's alpha value for The PSQ was 0.95. Whereas, The Cronbach's alpha values for academic, poor relationship with superior, bureaucratic constraints, work-family conflicts, poor relationship with colleagues, performance pressure, and poor job prospect domains were 0.63, 0.84, 0.81, 0.65, 0.73, 0.78, and 0.70 respectively.
Conclusion: This study showed that the PSQ is a reliable and valid instrument to identify stressors of postgraduate medical trainees. It is a promising instrument that can be used in future to explore further on this area.
The agricultural industry scenario in many industrialized countries has adopted an image processing system as a solution to automate the grading process in order to provide accurate, reliable, consistent and quantitative information in addition to the large volumes, which human graders are not able to perform. In Malaysia, the grading of palm oil Fresh Fruit Bunches (FFB) is still performed manually through visual inspection using the surface color as the main quality attribute. It is the intention here to introduce an automated grading system for palm oil FFB using a computer assisted photogrammetric methodology which correlate the surface color of fruit bunches, not the fruitlets, to their ripeness and eventually sorts the fruit to two predefined fruit categories. The methodology consists of five main phases, i.e. image acquisition, image pre-processing, image segmentation, calculation of color Digital Numbers (DN) (data manipulation) and finally the classification of ripeness. This computerized photogrammetric image processing technique using MATLAB® package which is integrated to a sorting system differs in various aspects from other digital imaging technique or machine vision system adopted for classifying fruit ripeness. A comprehensive discussion will be presented based on the results achieved through actual fruit testing on the prototype grading system. The main concern was to ensure the reliability of the computerized photogrammetric technique achievable and the system’s mechanism working as intended. The fruit classification ability of the system yields above 90% accuracy and taking not more than 25 seconds to classify and sort each fruit.
Industrial statistics is an important part of the management system in any industry that strives to continuously improve quality and increase productivity and efficiency. That system covers supply chain management, production design and prototyping, production process and marketing. Industrial statisticians, industrial engineers and industrial leaders should work together hand in hand, in the same language, to ensure that the process and products are as expected. The system itself is never complete. Thus, the usefulness, manageability and reliability of all statistical models used in the system are to be considered as first priority, but those skills are not sufficient. Industrial statisticians should also, of course, be able to come and go between the two poles: statistics and industry. This requirement needs a good understanding about the culture of these poles and how to conduct a mutual symbiosis. One of the principal bridges between these cultures is statistical process control (SPC). This paper is to show that modern industry cannot escape from SPC, especially in a multivariate setting. This setting, which characterizes modern industry, consists of two philosophical problems: how to order data and how to measure process variability. Our recent research results sponsored by the Government of Malaysia will be presented to illustrate the challenging statistical problems in modern industry.
Introduction: There is an appealing need to have a validated Bahasa Malaysia (BM) questionnaire that is able to gauge stress coping styles among Malaysian population. A culturally accepted questionnaire will generate further research in the aspect of stress coping patterns in the Malaysia population. Objective: To translate the Coping Inventory for Stressful Situations (CISS) questionnaire into BM and to determine the construct validity, reliability and other psychometric properties of the translated BM version of the English CISS 48-item. Method: Two parallel forward and backward translations were done in BM in accordance to guideline and its validation was determined by using confirmatory factor analysis among 200 Malaysian subjects. Results: The BM CISS had very good Cronbach’s alpha values, 0.91, 0.89 and 0.85 respectively for Task-, Emotional- and Avoidance-oriented. The overall Cronbach’s alpha was 0.91. It also had good factor loading for most of its items where 44 items out of 48 had Confirmatory Factor Analysis values of more than 4.0. Conclusions: BM CISS had been adequately and correctly translated into Bahasa Malaysia with high psychometric properties. Minimal readjustment may be required in a few of its items to obtain excellent results.
Background: The Malay short version of Depressive Anxiety and Stress Scale (DASS-21) has been widely used as a tool to measure psychological parameters in studies in Malaysia. The version has been found to be reliable for clinical and non-clinical populations. Objectives: To analyse and establish the psychometric properties of the Malay version of the DASS 42-item (BM DASS-42) among medical students. Methods: Concurrent forward and backward translations of original English DASS-42 were completed. Construct validity of the DASS-42 was established by looking at its exploratory factor analysis. Malay DASS-42 and Malay HADS were administered to a total of 411 medical students. Results: Reliability of DASS-
42 revealed excellent Cronbach’s alpha values of 0.94, 0.90 and 0.87 for depressive, anxiety and stress domains respectively. Construct validity yielded 38 items out of 42 items (90%) had good factor loadings of 0.4 and more. DASS and HADS were strongly correlated for both anxiety (r=0.87) and depression (r=0.68) domains. Conclusions: The BM DASS-42 had admirable psychometric properties among the tested population. Further studies are needed to verify these preliminary outcomes in other Malaysian subjects.
Objectives: The aim of this study is to validate the Malay version of the Aggression Questionnaire (AQ) for the purpose of the future study related to aggression. Furthermore, the study seeks to identify types of aggression hold by the female inmates.
Methods: A cross-sectional study was designed involving 90 Malaysian female prisoners. The analyses include descriptive analysis, confirmatory factor analysis, and reliability testing. After one-week interval, a test-retest was conducted.
Results: The preliminary analysis confirmed that factor analysis was appropriate for the Malay-translated version of the AQ. The four factors structure was assessed but the factor loadings are remarkable different from the original versions. The total Cronbach's alpha coefficients is very high (α= 0.91). The Pearson's correlation however is low (r = 0.48) but acceptable for the instrument. Reliability of the subscales and the factors were also found satisfactory. Consequently, anger and hostility were identified as the most common types of aggression among the participants, followed by verbal aggression. In contrast, physical aggression was the least scored type of aggression.
Conclusion: The Malay-translated version of the AQ was found to be valid and reliable to be used in future studies.
Introduction: A clear concept and understanding about the measure and the measuring tools is essential for good practice of assessment. Assessors need to have information about the full range of assessment tools inclusive of psychometric validity and purpose of its use. Subjective inferences drawn from the readily available data as numbers of summative scores over the years and statistical evidences of reliability and validity of assessment tools used to measure student’s performance are good sources of feedback for competent assessment program. It also provides meaningful evaluation of learning and teaching in medical education. Method: A retrospective study of 119 candidates was carried out to analyze the summative assessment scores of their certifying examination of Masters of Surgery in School of Medical Sciences (SMS) at Universiti Sains Malaysia. Subjective judgment of raw data followed by internal consistency as reliability, convergent validity and discriminant validity as constructs of individual assessment tool was analyzed. Finally each assessment tool as a measure of written or clinical construct was evaluated against six aspects of Messick’s criteria for quality control. Result: The correlation coefficient for validity and Cronbach’s alpha for reliability was evaluated for clinical measures. However, the test of internal reliability was not possible for essay being the only measure in written construct of summative assessment in surgery. All measures of clinical construct were found highly reliable with Cronbach’s alpha between 0.962-0.979. Long case and the short cases have shown excellent correlations (r=0.959 at p
Health traditionally has been compared using mortality and morbidity and in recent years health related instruments have been utilized along to complement those measures. Health related quality oflife instruments are important because they provide patient's opinion and decision of management and for monitoring and evaluating health status. The quality of life instruments such as health related quality of life questionnaires are increasingly being used and these questionnaires are classified into disease specific and generic questionnaires. They require proper assessment using psychometric analysis of reliability and validity, For reliability, the two common analyses are the test-retest and internal consistency and for validity, it requires the assessment of content validity and analyses of construct validity and criterion validity. Reliable and valid quality of lhfe questionnaires provide consistent and accurate information. The purpose of this paper is to provide crucial assessment and analyses of the reliability and validity of health related quality of life questionnaires.
This is a cross sectional study to assess the performance of Putrajaya Health Clinic in meeting the client's expectation among 403 clients who came to seek medical treatment through a systematic random sampling in the month of July 2006. Our aim is not only to reduce dissatisfaction among clients but also try to meet their expectations; we have adopted SERVQUAL method which defined satisfaction as the difference between perceptions and expectations. We would also like to refer this dissatisfaction as not able to meet clients' expectations. It was found that there were only 6.9% of clients dissatisfied in Putrajaya Health Clinic, but they had not been able to meet 81.5% of clients' expectation. As for demographic characteristics, there appeared to be a significant association between client's satisfaction and age, gender, ethnicity and educational level. For outpatient's, the greatest dissatisfaction is in the dimension of Reliability. Clients were not happy with the waiting time at the clinic. Apart from recruiting more staff, management should develop a comfortable waiting environment to reduce the agony of waiting.
Background: Vertigo Symptom Scale (VSS) by Yardley et al. (1992) is one of the disease specific
questionnaires used widely in clinical settings. It is conducted in English and had been translated into six languages including Dutch, French, German, Spanish, Swedish, and Turkish. It has been acknowledged as a good subjective tool to determine the severity of balance disorders. Objective: To develop a valid Malay version of VSS (MVVSS) using appropriate translation methods and validation technique. Method: Forward and backward translation was performed by four professionals from different fields. The translated questionnaire was then assessed for its test reliability based on an experiment on 30 normal subjects. Further, to determine the cultural adaptation issues, the face validity of MVVSS was assessed from 32 normal subjects. They were asked to fill in the MVVSS questionnaire accordingly and give opinions regarding its language, understanding and overall format of questionnaire. Results: Final results of the translation process showed sufficient concurrence among the professionals involved. The reliability test among the normal subjects also showed a high Cronbach’s alpha value (0.90). The face validity method on 32 subjects (mean age of 29.9 ± 9.2 years) showed good feedbacks in terms of language, understanding and overall format of the MVVSS. Conclusion: The translation process was successful and the further validation showed an adequate face validity response. This suggests that our MVVSS has been culturally adapted and can be used in all Malay conversing patients.
Background: The General Health Questionnaire is a widely used scale to measure psychological distress. This scale is available in many languages. The original version comprised of 60 items. It is available in 30-items, 28- items, 20-items and 12-items. The shorter version is as good as the longer version of the scale. Objective: The aim of this investigation was to determine the sensitivity, specificity and reliability of the 12-item. General Health Questionnaire (GHQ-12) among university students. Method: A total of 280 undergraduate students were selected using convenient sampling. Result: The results of this study showed that the GHQ-12 is multidimensional and contains three factor structures. It has a high internal consistency and a useful instrument to measure the psychological wellbeing of university students in Malaysia Previous authors have suggested that the cut-off point is determined by the mean. Findings from this study, based on sensitivity and specificity, suggests that mean may not be a good option. This study recommends the best cut-off point is determined by the ROC. Conclusion: This study shows that the GHQ-12 is a valid and reliable instrument to detect psychological distress among university students. The optimum cut-off point
of the GHQ-12 score to detect psychological distress was 15/16.