Malaysia's services industry towards the global environment

Nowadays, services sector is an important engine of the global economy development and it continues to grow vigorously. The progress of globalization, government liberalization, and the rapid advancement of information and communication technology (ICT) contributes to the continual acceleration of this sector. Since the services sector is playing its role fruitfully as one of the main economic builders to many economies throughout the world, most governments are putting greater emphasis on services sector in their countries’ economic planning. Therefore, this paper describes briefly the evolution of services sector in Malaysia, the services world trade and the current global trend in this outstanding sector. Despite all the potential opportunities that the services sector would generate, the multifaceted challenges will be invoked simultaneously. Hence, this paper also will describe in broad the opportunities and challenges, which services sector will stimulate for service industry players specifically Malaysia. To survive in the dynamic and competitive service environment, there is an ultimate necessity for services players to build a competitive edge. At the end of the paper, three competitive service strategies namely positioning, people, and system is discussed

Evaluation of maize-soybean flour blends for sour maize bread production in Nigeria

Examination of the functional properties of three different flours/meals and two blends of maize meal and soybean-flour (ratios 9:1 and 8:2, maize:soybean) were carried out. Properties examined included amylose content, bulk density, dispersibility, swelling power, water absorption capacity and viscoelastic properties. The effect of the different flour/meal samples on the properties of sour maize bread were evaluated by baking bread samples with the different flours/meals using a mixed starter culture of Lactobacillus plantarum and Saccharomyces cerevisiae. All flour/meal samples differed, sometimes significantly (p 0.05) in their functional properties. Significant positive correlations existed among the functional properties of the flours at the 1% level (2-tailed). The maize meal/soy flour blends MSA (maize meal and soybean flour mixed in ratio 9:1) and MSB (maize meal and soybean flour mixed in ratio 8:2) did not differ significantly from each other in functional properties except for amylose content. MSA was adjudged the best flour blend for sour maize bread production as its bread had the highest score for overall acceptability (6.1) and other sensory parameters evaluated

Consumption Values and Smartphone Choice in Taiwan and China

The purpose of this research is to discover which consumption values differentiate between domestic smartphone users and foreign smartphone users and the correlation between smartphone consumption choice and demographic characteristics in Taiwan and China respectively. Besides, a cross-cultural comparison is made. This research used 457 respondents as samples. A self-developed consumption values survey based on Sheth-Newman-Gross model (1991) is conducted. The findings regarding consumers in Taiwan revealed that demographic characteristics have little to do with smartphone choice and functional value plays the most important role in influencing smartphone choice. On the other hand, social value and epistemic value are two salient consumption values that drive people to choose foreign smartphone over domestic smartphone in China. Besides, male consumers and consumers with higher educational attainment possess a higher tendency to buy foreign smartphone than domestic smartphone. To bring to an end, difference in scoring the importance of each consumption value between Taiwan and China has detected and demonstrated

Erlotinib as salvage treatment after failure to first-line Gefitinib in non-small cell lung cancer

Purpose Chemotherapy is the mainstay treatment for advanced non-small cell lung cancer (NSCLC). Gefitinib, an epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), has been recently shown to be effective as a first-line treatment in Asian patients with advanced NSCLC, especially for those with favourable clinical features such as female, non-smoker and adenocarcinoma. However, resistance to gefitinib ensues invariably and there is little evidence as for the effectiveness of subsequent salvage treatment. The purpose of this study is to evaluate the efficacy of erlotinib, another EGFR-TKI, after failed first-line use of gefitinib. Method Retrospective review of NSCLC patients with favourable clinical features who received gefitinib as firstline treatment and subsequent salvage treatment with erlotinib. Results A total of 21 patients with NSCLC were included in the study. Among them, 18 (85.7%) patients had disease control with gefitinib and 12 (57.1%) patients with salvage erlotinib. There was an association between the disease control with gefitinib and erlotinib (p = 0.031). The disease control rate of erlotinib was independent of the chemotherapy use between the two EGFR-TKIs. Conclusion For NSCLC patients with favourable clinical features, erlotinib was effective in those who had prior disease control with first-line gefitinib. © Springer-Verlag 2009.published_or_final_versionSpringer Open Choice, 01 Dec 201

Transportation Brokerage Services and Medicaid Beneficiaries' Access to Care

To examine the effect of capitated transportation brokerage services on Medicaid beneficiaries' access to care and expenditures. Data Sources/Study Setting . The study period from 1996 to 1999 corresponds to the period of a natural experiment during which Georgia and Kentucky implemented transportation brokerage services. Effects were estimated for asthmatic children and diabetic adults. Study Design . We used difference-in-differences models to assess the effects of transportation brokerage services on access to care, measured by Medicaid expenditures and health services use. The study design is strengthened by the staggered implementation dates between states and within each state. Principal Findings . For asthmatic children, transportation brokerage services increased nonemergency transportation expenditures and the likelihood of using any services; reductions in monthly expenditures more than offsetting the increased transportation costs. For diabetic adults, nonemergency transportation costs decreased despite increased monthly use of health services; average monthly medical expenditures and the likelihood of hospital admission for an ambulatory care-sensitive condition (ACSC) also decreased. Conclusions . The shift to transportation brokerage services improved access to care among Medicaid beneficiaries and decreased the expenditures. The increase in access combined with reduced hospitalizations for asthmatic children and ACSC admissions for diabetic adults are suggestive of improvements in health outcomes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73049/1/j.1475-6773.2008.00907.x.pd

Reconstruction with a pectoralis major myocutaneous flap after left first rib and clavicular chest wall resection for a metastasis from laryngeal cancer

We presented a case of recurrent metastasis from epidermoid cancer that occurred in the left clavicle of a patient with a history of laryngeal cancer treated on April 2005 with extended hemilaryngectomy, neck dissection and chemoradiation therapy. On September 2008, he developed a left clavicular metastasis. The disease was initially well controlled by chemoradiotherapy but it recurred 17 months later. The optimal treatment plan was established by several multidisciplinary meetings and the patient subsequently underwent an en bloc resection of the left clavicle, first rib and all the other involved structures. Coverage of the thoracic defect was achieved using pectoralis major myocutaneous flap. The patient had a successful surgical outcome. At 1-year follow-up, he had no evidence of disease, a good cosmetic result and returned to normal daily activity. He died for bone metastasis with an overall 21 months post-surgical survival.We presented a case of recurrent metastasis from epidermoid cancer that occurred in the left clavicle of a patient with a history of laryngeal cancer treated on April 2005 with extended hemilaryngectomy, neck dissection and chemoradiation therapy. On September 2008, he developed a left clavicular metastasis. The disease was initially well controlled by chemoradiotherapy but it recurred 17 months later. The optimal treatment plan was established by several multidisciplinary meetings and the patient subsequently underwent an en bloc resection of the left clavicle, first rib and all the other involved structures. Coverage of the thoracic defect was achieved using pectoralis major myocutaneous flap. The patient had a successful surgical outcome. At 1-year follow-up, he had no evidence of disease, a good cosmetic result and returned to normal daily activity. He died for bone metastasis with an overall 21 months post-surgical survival

Using Megamaser Disks to Probe Black Hole Accretion

We examine the alignment between H_2O megamaser disks on sub-pc scales with circumnuclear disks and bars on <500 pc scales observed with HST/WFC3. The HST imaging reveals young stars, indicating the presence of gas. The megamaser disks are not well aligned with the circumnuclear bars or disks as traced by stars in the HST images. We speculate on the implications of the observed misalignments for fueling supermassive black holes in gas-rich spiral galaxies. In contrast, we find a strong preference for the rotation axes of the megamaser disks to align with radio continuum jets observed on >50 pc scales, in those galaxies for which radio continuum detections are available. Sub-arcsecond observations of molecular gas with ALMA will enable a more complete understanding of the interplay between circumnuclear structures.Comment: Error in Figure 4 corrected, references added. 7 pages, 4 figures, to be published in the Astrophysical Journa

Laparotomic vs laparoscopic ovariectomy: comparing the two methods. The ovariectomy in the bitch in laparoscopic era

BACKGROUND: The aim of the present work is to evaluate the effectiveness of the use of ultrasound scalpel during laparoscopic ovariectomy in the bitch. METHODS: Two groups of 10 subjects each, of different races and ages, were compared. In the first group, ovariectomy was performed laparoscopically, using harmonic scalpel to remove ovary. In the second group surgery was performed by means of classical laparotomy. RESULTS: Pre-operative time was similar in both groups. Total operative time, from incision to skin suture, showed significant difference between the two groups, being laparoscopy faster than laparotomy. Partial operative time for bilateral oophorectomy resulted lower using open technique, but, considering each ovary, there was no significant difference in both groups. CONCLUSIONS: The use of harmonic scalpel to perform ovariectomy during laparoscopy is an effective time-sparing surgical approach compared to the already great practicality of laparotomy

Designing theoretically-informed implementation interventions

Clinical and health services research is continually producing new findings that may contribute to effective and efficient patient care. However, the transfer of research findings into practice is unpredictable and can be a slow and haphazard process. Ideally, the choice of implementation strategies would be based upon evidence from randomised controlled trials or systematic reviews of a given implementation strategy. Unfortunately, reviews of implementation strategies consistently report effectiveness some, but not all of the time; possible causes of this variation are seldom reported or measured by the investigators in the original studies. Thus, any attempts to extrapolate from study settings to the real world are hampered by a lack of understanding of the effects of key elements of individuals, interventions, and the settings in which they were trialled. The explicit use of theory offers a way of addressing these issues and has a number of advantages, such as providing: a generalisable framework within which to represent the dimensions that implementation studies address, a process by which to inform the development and delivery of interventions, a guide when evaluating, and a way to allow for an exploration of potential causal mechanisms. However, the use of theory in designing implementation interventions is methodologically challenging for a number of reasons, including choosing between theories and faithfully translating theoretical constructs into interventions. The explicit use of theory offers potential advantages in terms of facilitating a better understanding of the generalisability and replicability of implementation interventions. However, this is a relatively unexplored methodological area

The long-term effects of probiotics in the therapy of ulcerative colitis: a clinical study

Aim. Intestinal dysbiosis seems to be the leading cause of inflammatory bowel diseases, and probiotics seems to represent the proper support against their occurrence. Actually, probiotic blends and anti-inflammatory drugs represent a weapon against inflammatory bowel diseases. The present study evaluates the long-term (2 years) effects of combination therapy (mesalazine plus a probiotic blend of Lactobacillus salivarius, Lactobacillus acidophilus and Bifidobacterium bifidus strain BGN4) on ulcerative colitis activity. Method. Sixty patients with moderate-to-severe ulcerative colitis were enrolled: 30 of them were treated with a single daily oral administration of mesalazine 1200 mg; 30 patients received a single daily oral administration of mesalazine 1200 mg and a double daily administration of a probiotic blend of Lactobacillus salivarius, Lactobacillus acidophilus and Bifidobacterium bifidus strain BGN4. The treatment was carried out for two years and the clinical response evaluated according to the Modified Mayo Disease Activity Index. Results. All patients treated with combination therapy showed better improvement compared to the controls. In particular, the beneficial effects of probiotics were evident even after two years of treatment. Conclusions. A long-term treatment modality of anti-inflammatory drugs and probiotics is viable and could be an alternative to corticosteroids in mild-to moderate ulcerative colitis