A Study of Malaysian Audit Market Concentration

This study presents the extent and nature of audit market concentration of companies listed in KLSE in year 2008 and 2009. Given the current interest in auditor choice, this study also analyzed in detail at the individual audit firm level and by industry sector and market segments. Auditor concentration that measured in this study can use to determine current audit structure. The link between concentration measures with competitiveness is more complex than often assumed. In this study, I only focus on concentration measures and do not make any inferences about the competitive aspect of the market. The Big Four firms held more than 80% of the market share (based on audit fees) in both years 2008 and 2009. KPMG retained its position as a 'dominant firm' while Deloitte is the 'least dominant firm' among the Big Four firms. The Big Four hold 100% share of 3 sectors (fixed line telecommunications, life insurance and tobacco) in 2008 and increase to 4 sectors (bank, exchange traded funds, life insurance and tobacco) in 2009.The main concerns of auditor concentration are reduction in audit firm choice that will lead to increase of conflict of interest and issues concerning the governance and accountability of audit firms

Level of fear towards COVID-19 and its determinants among healthcare providers in Malaysia: A cross-sectional study

Introduction: Malaysia is one of the hardest-hit countries by COVID-19 in Asia. The rapidly rising number of cases had sparked fear among healthcare providers. This study aimed to assess the determinants of fear towards COVID-19 among healthcare providers in primary care settings. Methods: This online-based cross-sectional study was conducted among 1280 healthcare providers aged ≥18 years from 30 primary care clinics in the state of Selangor, Malaysia. The Fear of COVID-19 Scale was used to assess the level of fear, and the results were analysed using multiple linear regression. Results: The mean age of the respondents was 36 years, and the mean working experience was 11 years. The majority of the respondents were women (82.4%) and Malays (82.3%). The factors that were significantly correlated with higher levels of fear were underlying chronic disease (ß=1.12, P=0.002, 95% confidence interval [CI]=0.08, 3.15), concern about mortality from COVID-19 (ß=3.3, P<0.001, 95% CI=0.19, 7.22), higher risk of exposure (ß=0.8, P<0.001, 95% CI=0.14, 5.91), concern for self at work (ß=2.8, P=0.002, 95% CI=0.08, 3.10) and work as a nurse (ß=3.6, P<0.001, 95% CI=0.30, 7.52), medical laboratory worker (ß=3.0, P<0.001, 95% CI=0.12, 4.27) and healthcare assistant (ß=3.9, P<0.001, 95% CI=0.17, 5.73). The level of fear was inversely correlated with a higher work-related stress management score (ß=−0.9, P<0.001, 95% CI=−0.14, −5.07) and a higher sleep quality score (ß=−1.8, P<0.001, 95% CI=−0.28, −10.41). Conclusion: Family physicians should be vigilant and identify healthcare providers at risk of developing COVID-19-related fear to initiate early mental health intervention

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

A comparison on efficiency of domestic and foreign banks in Malaysia: a DEA approach

This study utilizes non parametric Data Envelopment Analysis (DEA) to analyze and compare the efficiency of foreign and domestic banks in Malaysia. The analysis is based on a panel data set of 9 domestic banks and 12 foreign banks in Malaysia over the period of 2002 - 2009. Intermediation approach is used to define the inputs and outputs in computerizing the efficiency scores. Surprisingly, the findings are inconsistent with most of the findings of previous studies where the foreign banks were outperforming their domestic peers in term of efficiency. Conversely, the finding of this study shows that domestic banks have a higher efficiency level than foreign banks, this imply that domestic banks are relatively more managerially efficient in controlling their costs. The second stage of the empirical results is based on the Tobit model, which suggests that the pure technical efficiency (PTE) of banks in Malaysia is mainly affect by capital strength, loan quality, expenses and asset size

International asset allocation

This study examines the effects of different hedging and volatility estimation models on portfolio performance

Smile toothgether : an early childhood oral health campaign

This paper presents a health communication campaign “Smile Toothgether”, by Queenie, Keith, Gladys, and Rebecca, four final year undergraduates from the Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore. The campaign was designed and launched in response to tackle the high incidence of early childhood caries (ECC) among children below the age of six in Singapore. This paper details Smile Toothgether’s research, campaign development, and evaluation. Secondary research revealed that the prevalence of early childhood oral health-related issues such as dental caries were increasingly evident globally as well as in Singapore. This was due to transmission of bacteria species, poor feeding practices, and inadequate oral health practices. Dentists recommend that parents first bring their children to the dentist by the age of one, but most parents did not do so, only making an appointment when oral health problems arose. Primary research revealed that parents held many misconceptions surrounding cariogenic substances, dental visits, and administering oral care routines for their children below the age of six. This was accompanied by high perceived self-efficacy, meaning that many parents in Singapore were overconfident when it came to caring for their children’s oral health. Smile Toothgether was launched and targeted at parents with children aged six years and under. The campaign tactics utilised tailored content and several online interactive approaches to educate parents on the benefits of early preventive oral health behaviours. The campaign also communicated the importance of early dental visits to minimise the onset of ECC. The campaign was effective, amplifying risk perception of cariogenic substances and early oral health diseases in the target audience. The campaign also decreased the perceived financial costs of early dental visits, increasing their perceived accessibility to parents. Despite the campaign’s success, its post-campaign research indicated that further sustained communication efforts are necessary to fight ECC in Singapore.Bachelor of Communication Studie

Mesenchymal stem cells facilitate cardiac differentiation in Sox2‐expressing cardiac C‐kit cells in coculture

Stem cell therapy offers hope to reconstitute injured myocardium and salvage heart from failing. A recent approach using combinations of derived Cardiac-derived c-kit expressing cells (CCs) and mesenchymal stem cells (MSCs) in transplantation improved infarcted hearts with a greater functional outcome, but the effects of MSCs on CCs remain to be elucidated. We used a novel two-step protocol to clonogenically amplify colony forming c-kit expressing cells from 4- to 6-week-old C57BL/6N mice. This method yielded highly proliferative and clonogenic CCs with an average population doubling time of 17.2 ± 0.2, of which 80% were at the G1 phase. We identified two distinctly different CC populations based on its Sox2 expression, which was found to inversely related to their nkx2.5 and gata4 expression. To study CCs after MSC coculture, we developed micron-sized particles of iron oxide-based magnetic reisolation method to separate CCs from MSCs for subsequent analysis. Through validation using the sex and species mismatch CC-MSC coculture method, we confirmed that the purity of the reisolated cells was greater than 85%. In coculture experiment, we found that MSCs prominently enhanced Ctni and Mef2c expressions in Sox2 pos CCs after the induction of cardiac differentiation, and the level was higher than that of conditioned medium Sox2 pos CCs. However, these effects were not found in Sox2 neg CCs. Immunofluorescence labeling confirmed the presence of cardiac-like cells within Sox2 pos CCs after differentiation, identified by its cardiac troponin I and α-sarcomeric actinin expressions. In conclusion, this study shows that MSCs enhance CC differentiation toward cardiac myocytes. This enhancement is dependent on CC stemness state, which is determined by Sox2 expression. ,,,,,,