Satisfaction with the oral health services. A qualitative study among non-commissioned officers in the Malaysian armed forces

Patient satisfaction is critical for the growth and prosperity of any oral health service or practice. The success of any oral health service can be assessed by an evaluation of the degree of satisfaction/dissatisfaction of its patients. Objective The aim of this study is to assess satisfaction/dissatisfaction with the oral health services among Non-Commissioned Officers (NCOs) in the Malaysian Armed Forces (MAF). Method A qualitative study using the Nominal Group Technique was undertaken. Eighty subjects from the Rasah Camp, Seremban were randomly selected from four lists, namely privates, male and female corporals and sergeants and were Grouped into 10 discussion groups of eight participants each. Of the 10 groups, four groups comprised male corporals.. three groups of privates, two groups of sergeants and one group of female corporals. Two separate discussion sessions were conducted to elicit factors/items causing dissatisfaction and satisfaction expressed by the participants. Every participant then scored all the factors perceived as important by members of the group. The score ranged from 0-9 i.e., the least to the most important. Scores were weighted, and the weighted score of every participant for each item was added. The ratings of the factors were determined by comparing the sum Of the weighted scores. Results The six most important factors/items rated in the satisfaction discussion were modern equipment (9.07), friendly dentist (8.27), pleasant surgery (8.23), good quality treatment (7.93), friendly staff (7.18) and pain alleviation (6.07). These factors were further regrouped into three broad categories i.e. (1) Clinic set-Lip, (2) Patient-personnel interaction (PPI) and (3) Technical competency (TC). In the dissatisfaction discussion six factors/items were rated i.e. long waiting time (10.39), sequence of treatment not followed (7.18), non-availability of dentist (7.16), unfriendly staff (7.05), poor quality treatment (6.80) and restricted time for treatment (5.98). The three most important categories in the dissatisfaction discussion were (1) Administrative efficiency, (2) PPI and (3) TC. Conclusion A conceptual model was developed to explain the factors affecting patients' satisfaction/dissatisfaction with the oral health services. It is recommended that a questionnaire Survey be undertaken to validate and reflect the entire population of the MAF. Remedial measures highlighted in the areas of dissatisfaction should be addressed accordingly based on the quantitative study

Firm size, technological capability, exports and economic performance: the case of electronics industry in Malaysia

This paper examines the joint effects of technology and exports on the economic performances of electronics firms in Malaysia. The empirical results based on the Partial Least Square (PLS) estimate procedure show that technological capability plays a multiple role in that it influences both the exports and performance of a firm simultaneously. More importantly, we find evidence that exports act as a mediating variable between technological capability and firm performance. Size is found to influence all three: product capabilities, exports and firm performance but not process capabilities. This paper concludes that researchers, in future studies, need to examine the dynamism between size, technology, exports and performance

Malaysian Manufacturing Systems of Innovation and Internationalization of R&D

The study of innovation and technological upgrading experienced a significant interest in the academic literature, especially within the developing countries (Lall, 1998, 2001; Kim and Nelson, 2000; Ariffin and Figueiredo, 2004). The lack of involvement by developing countries in radical innovative capabilities (Rasiah, 1994; Hobday, 2005) and the interest of scholars in learning technological capability building and technological catch up processes has directed researchers to analyze various mechanisms or drivers that contribute to technological upgrading, especially in developing countries, more so in the manufacturing sector. This study aims to investigate the R&D activities and the internationalization of these activities undertaken by foreign firms within the Malaysian manufacturing sector. The study aims to provide answers to the following questions: 1. What is the status of the systems of innovation within the Malaysian manufacturing sector? 2. What is the role played by the agents of innovation, in particular TNCs or MNCs, in relation to R&D activities and its internationalization? and, 3. How is the Malaysian manufacturing (local and foreign) technological and R&D progress to date? This study confirms that the Malaysian manufacturing systems of innovation is weakly positioned but shows limited evidence of process innovation and not product innovation. However, evidence of innovation differs among states and sectors owing to differences in the systems of innovation. Although, Malaysia has not been chosen as a site for offshoring or outsorcing of R&D activities to a significant degree, it is found that one very important driver of innovation is the central role that multinational enterprises play in the Malaysian manufacturing systems of innovation. Process innovation is conducted by foreign subsidiaries and is on the rise in key the electronics industry. It is also found that technological learning by local firms is mainly through linkages, sub-contracting and technological transfer

Endovascular Therapy vs Medical Management for Patients With Acute Stroke With Medium Vessel Occlusion in the Anterior Circulation

Importance Randomized clinical trials have shown the efficacy of endovascular therapy (EVT) for acute large vessel occlusion strokes. The benefit of EVT in acute stroke with distal, medium vessel occlusion (DMVO) remains unclear. Objective To examine the efficacy and safety outcomes associated with EVT in patients with primary DMVO stroke when compared with a control cohort treated with medical management (MM) alone. Design, Setting, and Participants This multicenter, retrospective cohort study pooled data from patients who had an acute stroke and a primary anterior circulation emergency DMVO, defined as any segment of the anterior cerebral artery (ACA) or distal middle cerebral artery, between January 1, 2015, and December 31, 2019. Those with a concomitant proximal occlusion were excluded. Outcomes were compared between the 2 treatment groups using propensity score methods. Data analysis was performed from March to June 2021. Exposures Patients were divided into EVT and MM groups. Main Outcomes and Measures Main efficacy outcomes included 3-month functional independence (modified Rankin Scale [mRS] scores, 0-2) and 3-month excellent outcome (mRS scores, 0-1). Safety outcomes included 3-month mortality and symptomatic intracranial hemorrhage. Results A total of 286 patients with DMVO were evaluated, including 156 treated with EVT (mean [SD] age, 66.7 [13.7] years; 90 men [57.6%]; median National Institute of Health Stroke Scale [NIHSS] score, 13.5 [IQR, 8.5-18.5]; intravenous tissue plasminogen activator [IV tPA] use, 75 [49.7%]; ACA involvement, 49 [31.4%]) and 130 treated with medical management (mean [SD] age, 69.8 [14.9] years; 62 men [47.7%]; median NIHSS score, 7.0 [IQR, 4.0-14.0], IV tPA use, 58 [44.6%]; ACA involvement, 31 [24.0%]). There was no difference in the unadjusted rate of 3-month functional independence in the EVT vs MM groups (151 [51.7%] vs 124 [50.0%]; P = .78), excellent outcome (151 [38.4%] vs 123 [31.7%]; P = .25), or mortality (139 [18.7%] vs 106 [11.3%]; P = .15). The rate of symptomatic intracranial hemorrhage was similar in the EVT vs MM groups (weighted: 4.0% vs 3.1%; P = .90). In inverse probability of treatment weighting propensity analyses, there was no significant difference between groups for functional independence (adjusted odds ratio [aOR], 1.36; 95% CI, 0.84-2.19; P = .20) or mortality (aOR, 1.24; 95% CI, 0.63-2.43; P = .53), whereas the EVT group had higher odds of an excellent outcome (mRS scores, 0-1) at 3 months (aOR, 1.71; 95% CI, 1.02-2.87; P = .04). Conclusions and Relevance The findings of this multicenter cohort study suggest that EVT may be considered for selected patients with ACA or distal middle cerebral artery strokes. Further larger randomized investigation regarding the risk-benefit ratio for DMVO treatment is indicated

Women's views and experiences of two alternative consent pathways for participation in a preterm intrapartum trial: a qualitative study

BACKGROUND: The Cord Pilot Trial compared alternative policies for timing of cord clamping at very preterm birth at eight UK hospitals. In addition to standard written consent, an oral assent pathway was developed for use when birth was imminent. The aim of this study was to explore women's views and experiences of two alternative consent pathways to participate in the Cord Pilot Trial. METHODS: We conducted a qualitative study using semi-structured interviews. A total of 179 participants in the Cord Pilot Trial were sent a postal invitation to take part in interviews. Women who agreed were interviewed in person or by telephone to explore their experiences of two consent pathways for a preterm intrapartum trial. Data were analysed using inductive systematic thematic analysis. RESULTS: Twenty-three women who gave either written consent (n = 18) or oral assent followed by written consent (n = 5) to participate in the trial were interviewed. Five themes were identified: (1) understanding of the implications of randomisation, (2) importance of staff offering participation, (3) information about the trial and time to consider participation, (4) trial secondary in women's minds and (5) reasons for agreeing to take part in the trial. Experiences were similar for the two consent pathways. Women recruited by the oral assent pathway reported being given less information about the trial but felt it was sufficient to make a decision regarding participation. There were gaps in women's understanding of the trial and intervention, regardless of the consent pathway. CONCLUSIONS: Overall, women were positive about their experiences of being invited to participate in the trial. The oral assent pathway seems an acceptable option for women if the intervention is low-risk and time is limited. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN21456601 . Registered on 28 February 2013

Integrability of Lie systems through Riccati equations

Integrability conditions for Lie systems are related to reduction or transformation processes. We here analyse a geometric method to construct integrability conditions for Riccati equations following these approaches. This approach provides us with a unified geometrical viewpoint that allows us to analyse some previous works on the topic and explain new properties. Moreover, this new approach can be straightforwardly generalised to describe integrability conditions for any Lie system. Finally, we show the usefulness of our treatment in order to study the problem of the linearisability of Riccati equations.Comment: Corrected typo

MMP-1 activation contributes to airway smooth muscle growth and asthma severity

Introduction: Matrix metalloproteinase-1 and mast cells are present in the airways of people with asthma. We hypothesised that matrix metalloproteinase-1 could be activated by mast cells and increase asthma severity. Methods: Patients with stable asthma and healthy controls underwent spirometry, methacholine challenge, bronchoscopy and their airway smooth muscle cells were grown in culture. A second asthma group and controls had symptom scores, spirometry and bronchoalveolar lavage before and after rhinovirus-induced asthma exacerbations. Extra-cellular matrix was prepared from decellularised airway smooth muscle cultures. Matrix metalloproteinase-1 protein and activity were assessed. Results: Airway smooth muscle cells generated pro-matrix metalloproteinase-1 which was proteolytically activated by mast cell tryptase. Airway smooth muscle treated with activated mast cell supernatants produced extra-cellular matrix which enhanced subsequent airway smooth muscle growth by 1.5 fold (p<0.05) which was dependent on matrix metalloproteinase-1 activation. In asthma, airway pro-matrix metalloproteinase-1 was 5.4 fold higher than control subjects (p=0.002). Mast cell numbers were associated with airway smooth muscle proliferation and matrix metalloproteinase-1 protein associated with bronchial hyper-responsiveness. During exacerbations, matrix metalloproteinase-1 activity increased and was associated with fall in FEV1 and worsening asthma symptoms. Conclusions: Matrix metalloproteinase-1 is activated by mast cell tryptase resulting in a pro-proliferative extra-cellular matrix. In asthma, mast cells are associated with airway smooth muscle growth, matrix metalloproteinase-1 levels are associated with bronchial hyper-responsiveness and matrix metalloproteinase-1 activation with exacerbation severity. Our findings suggest that airway smooth muscle/mast cell interactions contribute to asthma severity by transiently increasing matrix metalloproteinase activation, airway smooth muscle growth and airway responsiveness