Clinically, it is sometimes diffi cult to distinguish an infection of the spine from a metastasis. Spinal tuberculosis is common according to its endemic region and adenocarcinoma of the lung is also rising in the incidence worldwide. Similar presentations, with unknown primary, clinical fi ndings and hematological investigations rarely conclude a true diagnosis. Radiologically, the hallmark of spinal infection is erosion of adjacent vertebral endplates and narrowing of the disc space with or without a paravertebral shadow. Metastasis typically does not involve the disc space with erosion of the adjacent vertebral endplates. It usually presents as a lytic/sclerotic lesion in the vertebral body or “winkle owl” sign. These distinguishing features of infection versus metastasis are not certainties. Biopsy is mandatory whenever in doubt or patient is not responded with provisional treatment. The author presents a case with so-called radiological features of spinal tuberculosis infection, which turns out to be a metastatic adenocarcinoma of the lung.
The underutilization of e-learning among university lecturers is an important issue that needs to be resolved. This study aimed to formulate an e-learning postadoption model for Malaysian universities. Data were collected using self-administered questionnaires involving 36 e-learning experts who from lecturers in public and private universities in Malaysia. The data collected was then analyzed using the extent analysis method proposed by Chang (European Journal of Operational Research, 95(3), 649-655, 1996) to examine the weights and rankings of the factors and subfactors. This study showed that for e-learning postadoption, the most important factor is institution service quality, followed by system quality, content quality, instructors' characteristics, and learners' characteristics. This study extends the information systems success model into the e-learning postadoption context. In particular, this study offered insights concerning the dependencies among the factors in the model within the Malaysian university context. The findings are useful for the long-range strategic management of university administrators, and the model can be adopted as a reference to form a rating system to analyze e-learning postadoption. University administrators can analyze critical factors that increase e-learning's post adoption and lead to more efficient resource allocation and management of e-learning.