Cooperative International Direct Marketing: An Alternative for Asian-Pacific Countries to Increase Exports to Industrial Market Economies

Exporters from Asian-Pacific Countries can successfully establish marketing presence in Industrial Market Economies by directly marketing products in these country markets. Direct marketing potential in Industrial Marketing Economies can be determined by examining two critical factors: the direct marketing infrastructure and emerging environmental changes. Although the resource requirement for direct marketing is quite substantial, exporters, who combine their resources to engage in cooperative international direct marketing, will find it easier to establish marketing presence in Industrial Market Economics

Improved detection of Probe Request Attacks : Using Neural Networks and Genetic Algorithm

The Media Access Control (MAC) layer of the wireless protocol, Institute of Electrical and Electronics Engineers (IEEE) 802.11, is based on the exchange of request and response messages. Probe Request Flooding Attacks (PRFA) are devised based on this design flaw to reduce network performance or prevent legitimate users from accessing network resources. The vulnerability is amplified due to clear beacon, probe request and probe response frames. The research is to detect PRFA of Wireless Local Area Networks (WLAN) using a Supervised Feedforward Neural Network (NN). The NN converged outstandingly with train, valid, test sample percentages 70, 15, 15 and hidden neurons 20. The effectiveness of an Intruder Detection System depends on its prediction accuracy. This paper presents optimisation of the NN using Genetic Algorithms (GA). GAs sought to maximise the performance of the model based on Linear Regression (R) and generated R > 0.95. Novelty of this research lies in the fact that the NN accepts user and attacker training data captured separately. Hence, security administrators do not have to perform the painstaking task of manually identifying individual frames for labelling prior training. The GA provides a reliable NN model and recognises the behaviour of the NN for diverse configurations

An ANFIS approach to transmembrane protein prediction

This paper is concerned with transmembrane prediction analysis. Most of novel drug design requires the use of Membrane proteins. Transmembrane protein structure allows pharmaceutical industry to design new drugs based on structural layout. However, laboratory experimental structure determination by X-ray crystallography is difficult to be achieved as the hydrophobic molecules do not crystalize easily. Moreover, the sheer number of proteins demands a computational solution to transmembrane regions identifications. This research therefore presents a novel Adaptive Neural Fuzzy Inference System (ANFIS) approach to predict and analyze of membrane helices in amino acid sequences. The ANFIS technique is implemented to predict membrane helices using sliding window data capturing. The paper uses hydrophobicity and propensity to encode the datasets using the conventional one letter symbol of amino acid residues. The computer simulation results show that the offered ANFIS methodology predicts transmembrane regions with high accuracy for randomly selected proteins

NN approach and its comparison with NN-SVM to beta-barrel prediction

This paper is concerned with applications of a dual Neural Network (NN) and Support Vector Machine (SVM) to prediction and analysis of beta barrel trans membrane proteins. The prediction and analysis of beta barrel proteins usually offer a host of challenges to the research community, because of their low presence in genomes. Current beta barrel prediction methodologies present intermittent misclassifications resulting in mismatch in the number of membrane spanning regions within amino-acid sequences. To address the problem, this research embarks upon a NN technique and its comparison with hybrid- two-level NN-SVM methodology to classify inter-class and intra-class transitions to predict the number and range of beta membrane spanning regions. The methodology utilizes a sliding-window-based feature extraction to train two different class transitions entitled symmetric and asymmetric models. In symmet- ric modelling, the NN and SVM frameworks train for sliding window over the same intra-class areas such as inner-to-inner, membrane(beta)-to-membrane and outer-to-outer. In contrast, the asymmetric transi- tion trains a NN-SVM classifier for inter-class transition such as outer-to-membrane (beta) and membrane (beta)-to-inner, inner-to-membrane and membrane-to-outer. For the NN and NN-SVM to generate robust outcomes, the prediction methodologies are analysed by jack-knife tests and single protein tests. The computer simulation results demonstrate a significant impact and a superior performance of NN-SVM tests with a 5 residue overlap for signal protein over NN with and without redundant proteins for pre- diction of trans membrane beta barrel spanning regions

Saddle Pulmonary Embolism in a Cancer Patient with Thrombocytopenia: A Treatment Dilemma

The association between cancer and venous thromboembolism (VTE) is well established. Saddle pulmonary embolism is not uncommon in hospitalized cancer patients and confers a higher mortality. We report a case of saddle pulmonary embolism in a cancer patient with thrombocytopenia, discuss the bleeding risks, complexity of managing such patients and review current guidelines

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The association between cancer and venous thromboembolism (VTE) is well established. Saddle pulmonary embolism is not uncommon in hospitalized cancer patients and confers a higher mortality. We report a case of saddle pulmonary embolism in a cancer patient with thrombocytopenia, discuss the bleeding risks, complexity of managing such patients and review current guidelines

Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia

The Kingdom of Saudi Arabia (KSA) has seen an increase in chronic diseases. International evidence suggests that early intervention is the best approach to reduce the burden of chronic disease. However, the limited research available suggests that health care access remains unequal, with rural populations having the poorest access to and utilisation of primary health care centres and, consequently, the poorest health outcomes. This study aimed to examine the factors influencing the access to and utilisation of primary health care centres in urban and rural areas of Riyadh province of the KSA

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan : results of pre-COVID and COVID-19 lockdown stakeholder engagements

Abstract Introduction With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. Methods In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns. Results Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate. Conclusion Slum residents’ ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered

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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised