Search results for: fleet provider
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 406

Search results for: fleet provider

376 Petri Net Modeling and Simulation of a Call-Taxi System

Authors: T. Godwin

Abstract:

A call-taxi system is a type of taxi service where a taxi could be requested through a phone call or mobile app. A schematic functioning of a call-taxi system is modeled using Petri net, which provides the necessary conditions for a taxi to be assigned by a dispatcher to pick a customer as well as the conditions for the taxi to be released by the customer. A Petri net is a graphical modeling tool used to understand sequences, concurrences, and confluences of activities in the working of discrete event systems. It uses tokens on a directed bipartite multi-graph to simulate the activities of a system. The Petri net model is translated into a simulation model and a call-taxi system is simulated. The simulation model helps in evaluating the operation of a call-taxi system based on the fleet size as well as the operating policies for call-taxi assignment and empty call-taxi repositioning. The developed Petri net based simulation model can be used to decide the fleet size as well as the call-taxi assignment policies for a call-taxi system.

Keywords: call-taxi, discrete event system, petri net, simulation modeling

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375 Mobile Number Portability

Authors: R. Geetha, J. Arunkumar, P. Gopal, D. Loganathan, K. Pavithra, C. Vikashini

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Mobile Number Portability is an attempt to switch over from one network to another network facility for mobile based on applications. This facility is currently not available for mobile handsets. This application is intended to assist the mobile network and its service customers in understanding the criteria; this will serve as a universal set of requirements which must be met by the customers. This application helps the user's network portability. Accessing permission from the network provider to enable services to the user and utilizing the available network signals. It is enabling the user to make a temporary switch over to other network. The main aim of this research work is to adapt multiple networks at the time of no network coverage. It can be accessed at rural and geographical areas. This can be achieved by this mobile application. The application is capable of temporary switch over between various networks. With this application both the service provider and the network user are benefited. The service provider is benefited by charging a minimum cost for utilizing other network. It provides security in terms of password that is unique to avoid unauthorized users and to prevent loss of balance. The goal intended to be attained is a complete utilization of available network at significant situations and to provide feature that satisfy the customer needs. The temporary switch over is done to manage emergency calls when user is in rural or geographical area, where there will be a very low network coverage. Since people find it trend in using Android mobile, this application is designed as an Android applications, which can be freely downloaded and installed from Play store. In the current scenario, the service provider enables the user to change their network without shifting their mobile network. This application affords a clarification for users while they are jammed in a critical situation. This application is designed by using Android 4.2 and SQLite Version3.

Keywords: mobile number, random number, alarm, imei number, call

Procedia PDF Downloads 331
374 Assessment of Air Pollution Impacts On Population Health in Béjaia City

Authors: Benaissa Fatima, Alkama Rezak, Annesi-Maesano Isabella

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To assess the health impact of the air pollution on the population of Béjaia, we carried out a descriptive epidemiologic inquiry near the medical establishments of three areas. From the registers of hospital admissions, we collected data on the hospital mortality and admissions relating to the various cardiorespiratory pathologies generated by this type of pollution. In parallel, data on the automobile fleet of Bejaia and other measurements were exploited to show that the concentrations of the pollutants are strongly correlated with the concentration the urban traffic. This study revealed that the whole of the population is touched, but the sensitivity to pollution can show variations according to the age, the sex and the place of residence. So the under population of the town of Bejaia marked the most raised death and morbidity rates, followed that of Kherrata. Weak rates are recorded for under rural population of Feraoun. This approach enables us to conclude that the population of Béjaia could not escape the urban pollution generated by her old automobile fleet. To install a monitoring and measuring site of the air pollution in this city could provide a beneficial tool to protect its inhabitants by them informing on quality from the air that they breathe and measurements to follow to minimize the impacts on their health and by alerting the authorities during the critical situations.

Keywords: air, urban pollution, health, impacts

Procedia PDF Downloads 330
373 The Right to Data Portability and Its Influence on the Development of Digital Services

Authors: Roman Bieda

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The General Data Protection Regulation (GDPR) will come into force on 25 May 2018 which will create a new legal framework for the protection of personal data in the European Union. Article 20 of GDPR introduces a right to data portability. This right allows for data subjects to receive the personal data which they have provided to a data controller, in a structured, commonly used and machine-readable format, and to transmit this data to another data controller. The right to data portability, by facilitating transferring personal data between IT environments (e.g.: applications), will also facilitate changing the provider of services (e.g. changing a bank or a cloud computing service provider). Therefore, it will contribute to the development of competition and the digital market. The aim of this paper is to discuss the right to data portability and its influence on the development of new digital services.

Keywords: data portability, digital market, GDPR, personal data

Procedia PDF Downloads 446
372 Cloud Enterprise Application Provider Selection Model for the Small and Medium Enterprise: A Pilot Study

Authors: Rowland R. Ogunrinde, Yusmadi Y. Jusoh, Noraini Che Pa, Wan Nurhayati W. Rahman, Azizol B. Abdullah

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Enterprise Applications (EAs) aid the organizations achieve operational excellence and competitive advantage. Over time, most Small and Medium Enterprises (SMEs), which are known to be the major drivers of most thriving global economies, use the costly on-premise versions of these applications thereby making business difficult to competitively thrive in the same market environment with their large enterprise counterparts. The advent of cloud computing presents the SMEs an affordable offer and great opportunities as such EAs can be cloud-hosted and rented on a pay-per-use basis which does not require huge initial capital. However, as there are numerous Cloud Service Providers (CSPs) offering EAs as Software-as-a-Service (SaaS), there is a challenge of choosing a suitable provider with Quality of Service (QoS) that meet the organizations’ customized requirements. The proposed model takes care of that and goes a step further to select the most affordable among a selected few of the CSPs. In the earlier stage, before developing the instrument and conducting the pilot test, the researchers conducted a structured interview with three experts to validate the proposed model. In conclusion, the validity and reliability of the instrument were tested through experts, typical respondents, and analyzed with SPSS 22. Results confirmed the validity of the proposed model and the validity and reliability of the instrument.

Keywords: cloud service provider, enterprise application, quality of service, selection criteria, small and medium enterprise

Procedia PDF Downloads 159
371 Process Assessment Model for Process Capability Determination Based on ISO/IEC 20000-1:2011

Authors: Harvard Najoan, Sarwono Sutikno, Yusep Rosmansyah

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Most enterprises are now using information technology services as their assets to support business objectives. These kinds of services are provided by the internal service provider (inside the enterprise) or external service provider (outside enterprise). To deliver quality information technology services, the service provider (which from now on will be called ‘organization’) either internal or external, must have a standard for service management system. At present, the standard that is recognized as best practice for service management system for the organization is international standard ISO/IEC 20000:2011. The most important part of this international standard is the first part or ISO/IEC 20000-1:2011-Service Management System Requirement, because it contains 22 for organization processes as a requirement to be implemented in an organizational environment in order to build, manage and deliver quality service to the customer. Assessing organization management processes is the first step to implementing ISO/IEC 20000:2011 into the organization management processes. This assessment needs Process Assessment Model (PAM) as an assessment instrument. PAM comprises two parts: Process Reference Model (PRM) and Measurement Framework (MF). PRM is built by transforming the 22 process of ISO/IEC 20000-1:2011 and MF is based on ISO/IEC 33020. This assessment instrument was designed to assess the capability of service management process in Divisi Teknologi dan Sistem Informasi (Information Systems and Technology Division) as an internal organization of PT Pos Indonesia. The result of this assessment model can be proposed to improve the capability of service management system.

Keywords: ISO/IEC 20000-1:2011, ISO/IEC 33020:2015, process assessment, process capability, service management system

Procedia PDF Downloads 439
370 Autonomy not Automation: Using Metacognitive Skills in ESL/EFL Classes

Authors: Marina Paula Carreira Rolim

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In order to have ELLs take responsibility for their own learning, it is important that they develop skills to work their studies strategically. The less they rely on the instructor as the content provider, the more they become active learners and have a higher sense of self-regulation and confidence in the learning process. This e-poster proposes a new teacher-student relationship that encourages learners to reflect, think critically, and act upon their realities. It also suggests the implementation of different autonomy-supportive teaching tools, such as portfolios, written journals, problem-solving activities, and strategy-based discussions in class. These teaching tools enable ELLs to develop awareness of learning strategies, learning styles, study plans, and available learning resources as means to foster their creative power of learning outside of classroom. In the role of a learning advisor, the teacher is no longer the content provider but a facilitator that introduces skills such as ‘elaborating’, ‘planning’, ‘monitoring’, and ‘evaluating’. The teacher acts as an educator and promotes the use of lifelong metacognitive skills to develop learner autonomy in the ESL/EFL context.

Keywords: autonomy, metacognitive skills, self-regulation, learning strategies, reflection

Procedia PDF Downloads 345
369 Computer-Aided Depression Screening: A Literature Review on Optimal Methodologies for Mental Health Screening

Authors: Michelle Nighswander

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Suicide can be a tragic response to mental illness. It is difficult for people to disclose or discuss suicidal impulses. The stigma surrounding mental health can create a reluctance to seek help for mental illness. Patients may feel pressure to exhibit a socially desirable demeanor rather than reveal these issues, especially if they sense their healthcare provider is pressed for time or does not have an extensive history with their provider. Overcoming these barriers can be challenging. Although there are several validated depression and suicide risk instruments, varying processes used to administer these tools may impact the truthfulness of the responses. A literature review was conducted to find evidence of the impact of the environment on the accuracy of depression screening. Many investigations do not describe the environment and fewer studies use a comparison design. However, three studies demonstrated that computerized self-reporting might be more likely to elicit truthful and accurate responses due to increased privacy when responding compared to a face-to-face interview. These studies showed patients reported positive reactions to computerized screening for other stigmatizing health conditions such as alcohol use during pregnancy. Computerized self-screening for depression offers the possibility of more privacy and patient reflection, which could then send a targeted message of risk to the healthcare provider. This could potentially increase the accuracy while also increasing time efficiency for the clinic. Considering the persistent effects of mental health stigma, how these screening questions are posed can impact patients’ responses. This literature review analyzes trends in depression screening methodologies, the impact of setting on the results and how this may assist in overcoming one barrier caused by stigma.

Keywords: computerized self-report, depression, mental health stigma, suicide risk

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368 Air Quality Assessment for a Hot-Spot Station by Neural Network Modelling of the near-Traffic Emission-Immission Interaction

Authors: Tim Steinhaus, Christian Beidl

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Urban air quality and climate protection are two major challenges for future mobility systems. Despite the steady reduction of pollutant emissions from vehicles over past decades, local immission load within cities partially still reaches heights, which are considered hazardous to human health. Although traffic-related emissions account for a major part of the overall urban pollution, modeling the exact interaction remains challenging. In this paper, a novel approach for the determination of the emission-immission interaction on the basis of neural network modeling for traffic induced NO2-immission load within a near-traffic hot-spot scenario is presented. In a detailed sensitivity analysis, the significance of relevant influencing variables on the prevailing NO2 concentration is initially analyzed. Based on this, the generation process of the model is described, in which not only environmental influences but also the vehicle fleet composition including its associated segment- and certification-specific real driving emission factors are derived and used as input quantities. The validity of this approach, which has been presented in the past, is re-examined in this paper using updated data on vehicle emissions and recent immission measurement data. Within the framework of a final scenario analysis, the future development of the immission load is forecast for different developments in the vehicle fleet composition. It is shown that immission levels of less than half of today’s yearly average limit values are technically feasible in hot-spot situations.

Keywords: air quality, emission, emission-immission-interaction, immission, NO2, zero impact

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367 Multisignature Schemes for Reinforcing Trust in Cloud Software-As-A-Service Services

Authors: Mustapha Hedabou, Ali Azougaghe, Ahmed Bentajer, Hicham Boukhris, Mourad Eddiwani, Zakaria Igarramen

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Software-as-a-service (SaaS) is emerging as a dominant approach to delivering software. It encompasses a range of business, technical opportunities, issue, and challenges. Trustiness in the cloud services regarding the security and the privacy of the delivered data is the most critical issue with the SaaS model. In this paper, we survey the security concerns related to the SaaS model, and we propose the design of a trusted SaaS model that gives users more confidence into SaaS services by leveraging a trust in a neutral source code certifying authority. The proposed design is based on the use of the multisignature mechanism for signing the source code of the application service. In our model, the cloud provider acts as a root of trust by ensuring the integrity of the application service when it was running on its platform. The proposed design prevents insider attacks from tampering with application service before and after it was launched in a cloud provider platform.

Keywords: cloud computing, SaaS Platform, TPM, trustiness, code source certification, multi-signature schemes

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366 Real-Time Big-Data Warehouse a Next-Generation Enterprise Data Warehouse and Analysis Framework

Authors: Abbas Raza Ali

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Big Data technology is gradually becoming a dire need of large enterprises. These enterprises are generating massively large amount of off-line and streaming data in both structured and unstructured formats on daily basis. It is a challenging task to effectively extract useful insights from the large scale datasets, even though sometimes it becomes a technology constraint to manage transactional data history of more than a few months. This paper presents a framework to efficiently manage massively large and complex datasets. The framework has been tested on a communication service provider producing massively large complex streaming data in binary format. The communication industry is bound by the regulators to manage history of their subscribers’ call records where every action of a subscriber generates a record. Also, managing and analyzing transactional data allows service providers to better understand their customers’ behavior, for example, deep packet inspection requires transactional internet usage data to explain internet usage behaviour of the subscribers. However, current relational database systems limit service providers to only maintain history at semantic level which is aggregated at subscriber level. The framework addresses these challenges by leveraging Big Data technology which optimally manages and allows deep analysis of complex datasets. The framework has been applied to offload existing Intelligent Network Mediation and relational Data Warehouse of the service provider on Big Data. The service provider has 50+ million subscriber-base with yearly growth of 7-10%. The end-to-end process takes not more than 10 minutes which involves binary to ASCII decoding of call detail records, stitching of all the interrogations against a call (transformations) and aggregations of all the call records of a subscriber.

Keywords: big data, communication service providers, enterprise data warehouse, stream computing, Telco IN Mediation

Procedia PDF Downloads 151
365 Intermittent Demand Forecast in Telecommunication Service Provider by Using Artificial Neural Network

Authors: Widyani Fatwa Dewi, Subroto Athor

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In a telecommunication service provider, quantity and interval of customer demand often difficult to predict due to high dependency on customer expansion strategy and technological development. Demand arrives when a customer needs to add capacity to an existing site or build a network in a new site. Because demand is uncertain for each period, and sometimes there is a null demand for several equipments, it is categorized as intermittent. This research aims to improve demand forecast quality in Indonesia's telecommunication service providers by using Artificial Neural Network. In Artificial Neural Network, the pattern or relationship within data will be analyzed using the training process, followed by the learning process as validation stage. Historical demand data for 36 periods is used to support this research. It is found that demand forecast by using Artificial Neural Network outperforms the existing method if it is reviewed on two criteria: the forecast accuracy, using Mean Absolute Deviation (MAD), Mean of the sum of the Squares of the Forecasting Error (MSE), Mean Error (ME) and service level which is shown through inventory cost. This research is expected to increase the reference for a telecommunication demand forecast, which is currently still limited.

Keywords: artificial neural network, demand forecast, forecast accuracy, intermittent, service level, telecommunication

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364 Analyzing the Market Growth in Application Programming Interface Economy Using Time-Evolving Model

Authors: Hiroki Yoshikai, Shin’ichi Arakawa, Tetsuya Takine, Masayuki Murata

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API (Application Programming Interface) economy is expected to create new value by converting corporate services such as information processing and data provision into APIs and using these APIs to connect services. Understanding the dynamics of a market of API economy under the strategies of participants is crucial to fully maximize the values of the API economy. To capture the behavior of a market in which the number of participants changes over time, we present a time-evolving market model for a platform in which API providers who provide APIs to service providers participate in addition to service providers and consumers. Then, we use the market model to clarify the role API providers play in expanding market participants and forming ecosystems. The results show that the platform with API providers increased the number of market participants by 67% and decreased the cost to develop services by 25% compared to the platform without API providers. Furthermore, during the expansion phase of the market, it is found that the profits of participants are mostly the same when 70% of the revenue from consumers is distributed to service providers and API providers. It is also found that when the market is mature, the profits of the service provider and API provider will decrease significantly due to their competition, and the profit of the platform increases.

Keywords: API economy, ecosystem, platform, API providers

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363 Financial Modeling for Net Present Benefit Analysis of Electric Bus and Diesel Bus and Applications to NYC, LA, and Chicago

Authors: Jollen Dai, Truman You, Xinyun Du, Katrina Liu

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Transportation is one of the leading sources of greenhouse gas emissions (GHG). Thus, to meet the Paris Agreement 2015, all countries must adopt a different and more sustainable transportation system. From bikes to Maglev, the world is slowly shifting to sustainable transportation. To develop a utility public transit system, a sustainable web of buses must be implemented. As of now, only a handful of cities have adopted a detailed plan to implement a full fleet of e-buses by the 2030s, with Shenzhen in the lead. Every change requires a detailed plan and a focused analysis of the impacts of the change. In this report, the economic implications and financial implications have been taken into consideration to develop a well-rounded 10-year plan for New York City. We also apply the same financial model to the other cities, LA and Chicago. We picked NYC, Chicago, and LA to conduct the comparative NPB analysis since they are all big metropolitan cities and have complex transportation systems. All three cities have started an action plan to achieve a full fleet of e-bus in the decades. Plus, their energy carbon footprint and their energy price are very different, which are the key factors to the benefits of electric buses. Using TCO (Total Cost Ownership) financial analysis, we developed a model to calculate NPB (Net Present Benefit) /and compare EBS (electric buses) to DBS (diesel buses). We have considered all essential aspects in our model: initial investment, including the cost of a bus, charger, and installation, government fund (federal, state, local), labor cost, energy (electricity or diesel) cost, maintenance cost, insurance cost, health and environment benefit, and V2G (vehicle to grid) benefit. We see about $1,400,000 in benefits for a 12-year lifetime of an EBS compared to DBS provided the government fund to offset 50% of EBS purchase cost. With the government subsidy, an EBS starts to make positive cash flow in 5th year and can pay back its investment in 5 years. Please remember that in our model, we consider environmental and health benefits, and every year, $50,000 is counted as health benefits per bus. Besides health benefits, the significant benefits come from the energy cost savings and maintenance savings, which are about $600,000 and $200,000 in 12-year life cycle. Using linear regression, given certain budget limitations, we then designed an optimal three-phase process to replace all NYC electric buses in 10 years, i.e., by 2033. The linear regression process is to minimize the total cost over the years and have the lowest environmental cost. The overall benefits to replace all DBS with EBS for NYC is over $2.1 billion by the year of 2033. For LA, and Chicago, the benefits for electrification of the current bus fleet are $1.04 billion and $634 million by 2033. All NPB analyses and the algorithm to optimize the electrification phase process are implemented in Python code and can be shared.

Keywords: financial modeling, total cost ownership, net present benefits, electric bus, diesel bus, NYC, LA, Chicago

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362 Communication Barriers and Challenges for Accessing Autism Care: Conventional Versus Alternative Medicine

Authors: M. D. Antoine

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Despite the widespread use of complementary and alternative medicine (CAM) for autistic children, little is known about the communication flow between the different parties involved in autism care (e.g., parents/caregivers, conventional providers, alternative practitioners). This study aimed to describe how communication occurs through the first year following an autism spectrum disorder (ASD) diagnosis to identify challenges and potential barriers to communication within the healthcare system in Ottawa, Canada. From an ecological perspective, we collected qualitative data through 12 semi-structured interviews with six parents/caregivers, three conventional providers (e.g., family doctor, neurodevelopmental pediatrician, psychologist), and three alternative practitioners (e.g., naturopath, occupational therapist, speech and language pathologist) operating in Ottawa. We interpreted the data using thematic analysis. Findings revealed communication challenges between the parents/caregivers and conventional providers while they experience better communication flow with fewer challenges in alternative care settings. However, parents/caregivers are the only links between the health professionals of both streams. From the five contexts examined: organizational, interpersonal, media, cultural, and political-legal, we found four themes (provider knowledge, care integration, flexible care, and time constraints) underlining specific barriers to communication flow between the parties involved in the care of autistic children. The increasing interest in alternative medicine is forcing changes in the healthcare system. Communications occur outside the norms making openings for better communication and information-sharing increasingly essential. Within the identified themes in the current study, the necessity for better communication between all parties involved in the care of autistic children is evident. More ASD and CAM-related training for providers would support effective parent/caregiver-provider communication. The findings of the current study contribute to a better understanding of the role of communication in the care management of autism, which has implications for effective autism care.

Keywords: alternative medicine, autism care management, autism spectrum disorder, conventional medicine, parent-provider communication

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361 The Strategic Role of Accommodation Providers in Encouraging Travelers to Adopt Environmentally-Friendly Modes of Transportation: An Experiment from France

Authors: Luc Beal

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Introduction. Among the stakeholders involved in the tourist decision-making process, the accommodation provider has the potential to play a crucial role in raising awareness, disseminating information, and thus influencing the tourists’ choice of transportation. Since the early days of tourism, the accommodation provider has consistently served as the primary point of contact with the destination, and consequently, as the primary source of information for visitors. By offering accommodation and hospitality, the accommodation provider has evolved into a trusted third party, functioning as an 'ambassador' capable of recommending the finest attractions and activities available at the destination. In contemporary times, when tourists plan their trips, they make a series of consecutive decisions, with the most important decision being to lock-in the accommodation reservation for the earliest days, so as to secure a safe arrival. Consequently, tourists place their trust in the accommodation provider not only for lodging but also for recommendations regarding restaurants, activities, and more. Thus, the latter has the opportunity to inform and influence tourists well in advance of their arrival, particularly during the booking phase, namely when it comes to selecting their mode of transportation. The pressing need to reduce greenhouse gas emissions within the tourism sector presents an opportunity to underscore the influence that accommodation providers have historically exerted on tourist decision-making . Methodology A participatory research, currently ongoing in south-western France, in collaboration with a nationwide hotel group and several destination management organizations, aims at examining the factors that determine the ability of accommodation providers to influence tourist transportation choices. Additionally, the research seeks to identify the conditions that motivate accommodation providers to assume a proactive role, such as fostering customer loyalty, reduced distribution costs, and financial compensation mechanisms. A panel of hotels participated in a series of focus group sessions with tourists, with the objective of modeling the decision-making process of tourists regarding their choice of transportation mode and to identify and quantify the types and levels of incentives liable to encourage environmentally responsible choices. Individual interviews were also conducted with hotel staff, including receptionists and guest relations officers, to develop a framework for interactions with tourists during crucial decision-making moments related to transportation choices. The primary finding of this research indicates that financial incentives significantly outweigh symbolic incentives in motivating tourists to opt for eco-friendly modes of transportation. Another noteworthy result underscores the crucial impact of organizational conditions governing interactions with tourists both before and during their stay. These conditions greatly influence the ability to raise awareness at key decision-making moments and the possibility of gathering data about the chosen transportation mode during the stay. In conclusion, this research has led to the formulation of practical recommendations for accommodation providers and Destination Marketing Organizations (DMOs). These recommendations pertain to communication protocols with tourists, the collection of evidences confirming chosen transportation modes, and the implementation of necessary incentives. Through these measures, accommodation provider can assume a central role in guiding tourists towards making responsible choices in terms of transportation.

Keywords: accommodation provider, trusted third party, environmentally-friendly transportation, green house gas, tourist decision-making process

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360 Minimizing Ship’S Breakdown Maintenance Due to Rope Entangled In Propeller With “Si Kuman” On Mooring Boat PSC I in Surabaya

Authors: Jogi Prayogo, Dwi Qaqa Prasetyatama, Rahmad Dwi Afandi, Kunto Arief Prasetyo, Viorel Herniza Leksono

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PT. Pertamina Trans Kontinental managed a fleet of 364 ships in 2018 - 2020. In that period, there were 8 incidents of ship damage, causing breakdown maintenance on 6 ships belonging to PT Pertamina Trans Kontinental throughout Indonesia's operational areas due to ropes entangled in propellers. The company's losses that were caused by the fouled propellers amounted to 306.35 Million Rupiah. Of the 8 incidents, Mooring Boat PSC I was taken as a pilot project for further analysis considering the location of the ship which is in Surabaya and Mooring Boat PSC I has experienced 2 incidents of rope entanglement that caused the company's losses due to the largest Breakdown Maintenance amounted to 200.99 Million Rupiah. After analyzing the rope entanglement in the ship's propeller based on the data of Mooring Boat PSC I related to the location of propellers that are often fouled in the conventional propulsion system, it was found that there is a suitable location for the implementation of SI KUMAN tool that serves to cut ropes to prevent the occurrence of rope entangled in ship propellers. The determination of SI KUMAN tool is based on the strength of the ship's material to be installed and a suitable design to prevent the occurrence of ropes being entangled in propellers. After the installation of the "SI KUMAN" tool and monitoring carried out for 1 year period (August 2020 - August 2021), it was found that SI KUMAN tool can eliminate the risk of fouled propeller incidents which previously occurred twice in one year so that the company's loss amounted to 200.99 Million Rupiah can be eliminated and SI KUMAN tool can still operate optimally.

Keywords: breakdown maintenance, mooring boat, fleet, fouled propeller, rope entangled, cut

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359 Improving Urban Mobility: Analyzing Impacts of Connected and Automated Vehicles on Traffic and Emissions

Authors: Saad Roustom, Hajo Ribberink

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In most cities in the world, traffic has increased strongly over the last decades, causing high levels of congestion and deteriorating inner-city air quality. This study analyzes the impact of connected and automated vehicles (CAVs) on traffic performance and greenhouse gas (GHG) emissions under different CAV penetration rates in mixed fleet environments of CAVs and driver-operated vehicles (DOVs) and under three different traffic demand levels. Utilizing meso-scale traffic simulations of the City of Ottawa, Canada, the research evaluates the traffic performance of three distinct CAV driving behaviors—Cautious, Normal, and Aggressive—at penetration rates of 25%, 50%, 75%, and 100%, across three different traffic demand levels. The study employs advanced correlation models to estimate GHG emissions. The results reveal that Aggressive and Normal CAVs generally reduce traffic congestion and GHG emissions, with their benefits being more pronounced at higher penetration rates (50% to 100%) and elevated traffic demand levels. On the other hand, Cautious CAVs exhibit an increase in both traffic congestion and GHG emissions. However, results also show deteriorated traffic flow conditions when introducing 25% penetration rates of any type of CAVs. Aggressive CAVs outperform all other driving at improving traffic flow conditions and reducing GHG emissions. The findings of this study highlight the crucial role CAVs can play in enhancing urban traffic performance and mitigating the adverse impact of transportation on the environment. This research advocates for the adoption of effective CAV-related policies by regulatory bodies to optimize traffic flow and reduce GHG emissions. By providing insights into the impact of CAVs, this study aims to inform strategic decision-making and stimulate the development of sustainable urban mobility solutions.

Keywords: connected and automated vehicles, congestion, GHG emissions, mixed fleet environment, traffic performance, traffic simulations

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358 Investigation of a Technology Enabled Model of Home Care: the eShift Model of Palliative Care

Authors: L. Donelle, S. Regan, R. Booth, M. Kerr, J. McMurray, D. Fitzsimmons

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Palliative home health care provision within the Canadian context is challenged by: (i) a shortage of registered nurses (RN) and RNs with palliative care expertise, (ii) an aging population, (iii) reliance on unpaid family caregivers to sustain home care services with limited support to conduct this ‘care work’, (iv) a model of healthcare that assumes client self-care, and (v) competing economic priorities. In response, an interprofessional team of service provider organizations, a software/technology provider, and health care providers developed and implemented a technology-enabled model of home care, the eShift model of palliative home care (eShift). The eShift model combines communication and documentation technology with non-traditional utilization of health human resources to meet patient needs for palliative care in the home. The purpose of this study was to investigate the structure, processes, and outcomes of the eShift model of care. Methodology: Guided by Donebedian’s evaluation framework for health care, this qualitative-descriptive study investigated the structure, processes, and outcomes care of the eShift model of palliative home care. Interviews and focus groups were conducted with health care providers (n= 45), decision-makers (n=13), technology providers (n=3) and family care givers (n=8). Interviews were recorded, transcribed, and a deductive analysis of transcripts was conducted. Study Findings (1) Structure: The eShift model consists of a remotely-situated RN using technology to direct care provision virtually to patients in their home. The remote RN is connected virtually to a health technician (an unregulated care provider) in the patient’s home using real-time communication. The health technician uses a smartphone modified with the eShift application and communicates with the RN who uses a computer with the eShift application/dashboard. Documentation and communication about patient observations and care activities occur in the eShift portal. The RN is typically accountable for four to six health technicians and patients over an 8-hour shift. The technology provider was identified as an important member of the healthcare team. Other members of the team include family members, care coordinators, nurse practitioners, physicians, and allied health. (2) Processes: Conventionally, patient needs are the focus of care; however within eShift, the patient and the family caregiver were the focus of care. Enhanced medication administration was seen as one of the most important processes, and family caregivers reported high satisfaction with the care provided. There was perceived enhanced teamwork among health care providers. (3) Outcomes: Patients were able to die at home. The eShift model enabled consistency and continuity of care, and effective management of patient symptoms and caregiver respite. Conclusion: More than a technology solution, the eShift model of care was viewed as transforming home care practice and an innovative way to resolve the shortage of palliative care nurses within home care.

Keywords: palliative home care, health information technology, patient-centred care, interprofessional health care team

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357 Opportunities for Effective Communication Through the Delivery of an Autism Spectrum Disorder Diagnosis: A Scoping Review

Authors: M. D. Antoine

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When a child is diagnosed with an illness, condition, or developmental disorder, the process involved in understanding and accepting this diagnosis can be a very stressful and isolating experience for parents and families. The healthcare providers’ ability to effectively communicate in such situations represents a vital lifeline for parents. In this context, communication becomes a crucial element not only for getting through the period of grief but also for the future. We mobilized the five stages of grief model to summarize existing literature regarding the ways in which the experience ofan autism spectrum disorder diagnosis disclosurealigns with the experience of grief to explore how this can inform best practices for effective communication with parents through the diagnosis disclosure. Fifteen publications met inclusion criteria. Findings from the scoping review of empirical studies show that parents/families experience grief-like emotions during the diagnosis disclosure. However, grief is not an outcome of the encounter itself. In fact, the experience of the encounter can help mitigate the grief experience. The way parents/families receive and react to the ‘news’ depends on their preparedness, knowledge, and the support received through the experience. Individual communication skills, as well as policies and regulations, should be examined to alleviate adverse reactions in this context. These findings highlight the importance of further research into effective parent-provider communication strategies and their place in supporting quality autism care.

Keywords: autism spectrum disorder, autism spectrum disorder diagnosis, diagnosis disclosure, parent-provider communication, parental grief

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356 Geotechnical Evaluation and Sizing of the Reinforcement Layer on Soft Soil in the Construction of the North Triage Road Clover, in Brasilia Federal District, Brazil

Authors: Rideci Farias, Haroldo Paranhos, Joyce Silva, Elson Almeida, Hellen Silva, Lucas Silva

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The constant growth of the fleet of vehicles in the big cities, makes that the Engineering is dynamic, with respect to the new solutions for traffic flow in general. In the Federal District (DF), Brazil, it is no different. The city of Brasilia, Capital of Brazil, and Cultural Heritage of Humanity by UNESCO, is projected to 500 thousand inhabitants, and today circulates more than 3 million people in the city, and with a fleet of more than one vehicle for every two inhabitants. The growth of the city to the North region, made that the urban planning presented solutions for the fleet in constant growth. In this context, a complex of viaducts, road accesses, creation of new rolling roads and duplication of the Bragueto bridge over Paranoa lake in the northern part of the city was designed, giving access to the BR-020 highway, denominated Clover of North Triage (TTN). In the geopedological context, the region is composed of hydromorphic soils, with the presence of the water level at some times of the year. From the geotechnical point of view, are soils with SPT < 4 and Resistance not drained, Su < 50 kPa. According to urban planning in Brasília, special art works can not rise in the urban landscape, contrasting with the urban characteristics of the architects Lúcio Costa and Oscar Niemeyer. Architects hired to design the new Capital of Brazil. The urban criterion then created the technical impasse, resulting in the technical need to ‘bury’ the works of art and in turn the access greenhouses at different levels, in regions of low support soil and water level Outcrossing, generally inducing the need for this study and design. For the adoption of the appropriate solution, Standard Penetration Test (SPT), Vane Test, Diagnostic peritoneal lavage (DPL) and auger boring campaigns were carried out. With the comparison of the results of these tests, the profiles of resistance of the soils and water levels were created in the studied sections. Geometric factors such as existing sidewalks and lack of elevation for the discharge of deep drainage water have inhibited traditional techniques for total removal of soft soils, thus avoiding the use of temporary drawdown and shoring of excavations. Thus, a structural layer was designed to reinforce the subgrade by means of the ‘needling’ of the soft soil, without the need for longitudinal drains. In this context, the article presents the geological and geotechnical studies carried out, but also the dimensioning of the reinforcement layer on the soft soil with a view to the main objective of this solution that is to allow the execution of the civil works without the interference in the roads in use, Execution of services in rainy periods, presentation of solution compatible with drainage characteristics and soft soil reinforcement.

Keywords: layer, reinforcement, soft soil, clover of north triage

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355 A Bi-Objective Model to Optimize the Total Time and Idle Probability for Facility Location Problem Behaving as M/M/1/K Queues

Authors: Amirhossein Chambari

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This article proposes a bi-objective model for the facility location problem subject to congestion (overcrowding). Motivated by implementations to locate servers in internet mirror sites, communication networks, one-server-systems, so on. This model consider for situations in which immobile (or fixed) service facilities are congested (or queued) by stochastic demand to behave as M/M/1/K queues. We consider for this problem two simultaneous perspectives; (1) Customers (desire to limit times of accessing and waiting for service) and (2) Service provider (desire to limit average facility idle-time). A bi-objective model is setup for facility location problem with two objective functions; (1) Minimizing sum of expected total traveling and waiting time (customers) and (2) Minimizing the average facility idle-time percentage (service provider). The proposed model belongs to the class of mixed-integer nonlinear programming models and the class of NP-hard problems. In addition, to solve the model, controlled elitist non-dominated sorting genetic algorithms (Controlled NSGA-II) and controlled elitist non-dominated ranking genetic algorithms (NRGA-I) are proposed. Furthermore, the two proposed metaheuristics algorithms are evaluated by establishing standard multiobjective metrics. Finally, the results are analyzed and some conclusions are given.

Keywords: bi-objective, facility location, queueing, controlled NSGA-II, NRGA-I

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354 Predicting Provider Service Time in Outpatient Clinics Using Artificial Intelligence-Based Models

Authors: Haya Salah, Srinivas Sharan

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Healthcare facilities use appointment systems to schedule their appointments and to manage access to their medical services. With the growing demand for outpatient care, it is now imperative to manage physician's time effectively. However, high variation in consultation duration affects the clinical scheduler's ability to estimate the appointment duration and allocate provider time appropriately. Underestimating consultation times can lead to physician's burnout, misdiagnosis, and patient dissatisfaction. On the other hand, appointment durations that are longer than required lead to doctor idle time and fewer patient visits. Therefore, a good estimation of consultation duration has the potential to improve timely access to care, resource utilization, quality of care, and patient satisfaction. Although the literature on factors influencing consultation length abound, little work has done to predict it using based data-driven approaches. Therefore, this study aims to predict consultation duration using supervised machine learning algorithms (ML), which predicts an outcome variable (e.g., consultation) based on potential features that influence the outcome. In particular, ML algorithms learn from a historical dataset without explicitly being programmed and uncover the relationship between the features and outcome variable. A subset of the data used in this study has been obtained from the electronic medical records (EMR) of four different outpatient clinics located in central Pennsylvania, USA. Also, publicly available information on doctor's characteristics such as gender and experience has been extracted from online sources. This research develops three popular ML algorithms (deep learning, random forest, gradient boosting machine) to predict the treatment time required for a patient and conducts a comparative analysis of these algorithms with respect to predictive performance. The findings of this study indicate that ML algorithms have the potential to predict the provider service time with superior accuracy. While the current approach of experience-based appointment duration estimation adopted by the clinic resulted in a mean absolute percentage error of 25.8%, the Deep learning algorithm developed in this study yielded the best performance with a MAPE of 12.24%, followed by gradient boosting machine (13.26%) and random forests (14.71%). Besides, this research also identified the critical variables affecting consultation duration to be patient type (new vs. established), doctor's experience, zip code, appointment day, and doctor's specialty. Moreover, several practical insights are obtained based on the comparative analysis of the ML algorithms. The machine learning approach presented in this study can serve as a decision support tool and could be integrated into the appointment system for effectively managing patient scheduling.

Keywords: clinical decision support system, machine learning algorithms, patient scheduling, prediction models, provider service time

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353 Dynamic Environmental Impact Study during the Construction of the French Nuclear Power Plants

Authors: A. Er-Raki, D. Hartmann, J. P. Belaud, S. Negny

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This paper has a double purpose: firstly, a literature review of the life cycle analysis (LCA) and secondly a comparison between conventional (static) LCA and multi-level dynamic LCA on the following items: (i) inventories evolution with time (ii) temporal evolution of the databases. The first part of the paper summarizes the state of the art of the static LCA approach. The different static LCA limits have been identified and especially the non-consideration of the spatial and temporal evolution in the inventory, for the characterization factors (FCs) and into the databases. Then a description of the different levels of integration of the notion of temporality in life cycle analysis studies was made. In the second part, the dynamic inventory has been evaluated firstly for a single nuclear plant and secondly for the entire French nuclear power fleet by taking into account the construction durations of all the plants. In addition, the databases have been adapted by integrating the temporal variability of the French energy mix. Several iterations were used to converge towards the real environmental impact of the energy mix. Another adaptation of the databases to take into account the temporal evolution of the market data of the raw material was made. An identification of the energy mix of the time studied was based on an extrapolation of the production reference values of each means of production. An application to the construction of the French nuclear power plants from 1971 to 2000 has been performed, in which a dynamic inventory of raw material has been evaluated. Then the impacts were characterized by the ILCD 2011 characterization method. In order to compare with a purely static approach, a static impact assessment was made with the V 3.4 Ecoinvent data sheets without adaptation and a static inventory considering that all the power stations would have been built at the same time. Finally, a comparison between static and dynamic LCA approaches was set up to determine the gap between them for each of the two levels of integration. The results were analyzed to identify the contribution of the evolving nuclear power fleet construction to the total environmental impacts of the French energy mix during the same period. An equivalent strategy using a dynamic approach will further be applied to identify the environmental impacts that different scenarios of the energy transition could bring, allowing to choose the best energy mix from an environmental viewpoint.

Keywords: LCA, static, dynamic, inventory, construction, nuclear energy, energy mix, energy transition

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352 The Geographic Distribution of Complementary, Alternative, and Traditional Medicine in the United States in 2018

Authors: Janis E. Campbell

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Most of what is known about complementary, alternative or traditional medicine (CATM) in the United States today is known from either the National Health Interview Survey a cross-sectional survey with a few questions or from small cross-sectional or cohort studies with specific populations. The broad geographical distribution in CATM use or providers is not known. For this project, we used geospatial cluster analysis to determine if there were clusters of CATM provider by county in the US. In this analysis, we used the National Provider Index to determine the geographic distribution of providers in the US. Of the 215,769 CAMT providers 211,603 resided in the contiguous US: Acupuncturist (26,563); Art, Poetry, Music and Dance Therapist (2,752); Chiropractor (89,514); Doula/Midwife (3,535); Exercise (507); Homeopath (380); Massage Therapist (36,540); Mechanotherapist (1,888); Naprapath (146); Naturopath (4,782); Nutrition (42,036); Reflexologist (522); Religious (2,438). ESRI® spatial autocorrelation was used to determine if the geographic location of CATM providers were random or clustered. For global analysis, we used Getis-Ord General G and for Local Indicators of Spatial Associations with an Optimized Hot Spot Analysis using an alpha of 0.05. Overall, CATM providers were clustered with both low and high. With Chiropractors, focusing in the Midwest, religious providers having very small clusters in the central US, and other types of CAMT focused in the northwest and west coast, Colorado and New Mexico, the great lakes areas and Florida. We will discuss some of the implications of this study, including associations with health, economic, social, and political systems.

Keywords: complementary medicine, alternative medicine, geospatial, United States

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351 To Cloudify or Not to Cloudify

Authors: Laila Yasir Al-Harthy, Ali H. Al-Badi

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As an emerging business model, cloud computing has been initiated to satisfy the need of organizations and to push Information Technology as a utility. The shift to the cloud has changed the way Information Technology departments are managed traditionally and has raised many concerns for both, public and private sectors. The purpose of this study is to investigate the possibility of cloud computing services replacing services provided traditionally by IT departments. Therefore, it aims to 1) explore whether organizations in Oman are ready to move to the cloud; 2) identify the deciding factors leading to the adoption or rejection of cloud computing services in Oman; and 3) provide two case studies, one for a successful Cloud provider and another for a successful adopter. This paper is based on multiple research methods including conducting a set of interviews with cloud service providers and current cloud users in Oman; and collecting data using questionnaires from experts in the field and potential users of cloud services. Despite the limitation of bandwidth capacity and Internet coverage offered in Oman that create a challenge in adopting the cloud, it was found that many information technology professionals are encouraged to move to the cloud while few are resistant to change. The recent launch of a new Omani cloud service provider and the entrance of other international cloud service providers in the Omani market make this research extremely valuable as it aims to provide real-life experience as well as two case studies on the successful provision of cloud services and the successful adoption of these services.

Keywords: cloud computing, cloud deployment models, cloud service models, deciding factors

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350 Discover Your Power: A Case for Contraceptive Self-Empowerment

Authors: Oluwaseun Adeleke, Samuel Ikan, Anthony Nwala, Mopelola Raji, Fidelis Edet

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Background: The risks associated with each pregnancy is carried almost entirely by a woman; however, the decision about whether and when to get pregnant is a subject that several others contend with her to make. The self-care concept offers women of reproductive age the opportunity to take control of their health and its determinants with or without the influence of a healthcare provider, family, and friends. DMPA-SC Self-injection (SI) is becoming the cornerstone of contraceptive self-care and has the potential to expand access and create opportunities for women to take control of their reproductive health. Methodology: To obtain insight into the influences that interfere with a woman’s capacity to make contraceptive choices independently, the Delivering Innovations in Selfcare (DISC) project conducted two intensive rounds of qualitative data collection and triangulation that included provider, client, and community mobilizer interviews, facility observations, and routine program data collection. Respondents were sampled according to a convenience sampling approach and data collected analyzed using a codebook and Atlas-TI. The research team members came together for participatory analysis workshop to explore and interpret emergent themes. Findings: Insights indicate that women are increasingly finding their voice and independently seek services to prevent a deterioration of their economic situation and achieve personal ambitions. Women who hold independent decision-making power still prefer to share decision making power with their male partners. Male partners’ influence on women’s use of family planning and self-inject was most dominant. There were examples of men’s support for women’s use of contraception to prevent unintended pregnancy, as well as men withholding support. Other men outrightly deny their partners from obtaining contraceptive services and their partners cede this sexual and reproductive health right without objection. A woman’s decision to initiate family planning is affected by myths and misconceptions, many of which have cultural and religious origins. Some tribes are known for their reluctance to use contraception and often associate stigma with the pursuit of family planning (FP) services. Information given by the provider is accepted, and, in many cases, clients cede power to providers to shape their SI user journey. A provider’s influence on a client’s decision to self-inject is reinforced by their biases and concerns. Clients are inhibited by the presence of peers during group education at the health facility. Others are motivated to seek FP services by the interest expressed by peers. There is also a growing trend in the influence of social media on FP uptake, particularly Facebook fora. Conclusion: The convenience of self-administration at home is a benefit for those that contend with various forms of social influences as well as covert users. Beyond increasing choice and reducing barriers to accessing Sexual and Reproductive Health (SRH) services, it can initiate the process of self-discovery and agency in the contraceptive user journey.

Keywords: selfcare, self-empowerment, agency, DMPA-SC, contraception, family planning, influences

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349 Evaluation of the Standard Practice of Availability of Anti-Tuberculosis Drugs in Community Pharmacies

Authors: Udaykumar R., M. S. Ganachari

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In order to engage community pharmacies in Tuberculosis care, a survey has been conducted in Belgaum city, Karnataka state, India. After the survey divided into two groups one is control group and another one is intervention group. One is dispensing of anti-tuberculosis drugs, and another one is non-availability of anti-tuberculosis drugs. Those community pharmacists who are voluntarily interesting for becoming DOTS (Directly observed treatment short course) provider and RNTCP (Revised national tuberculosis control programme) objectives. Structured training is conducted for community pharmacist who are dispensing anti-tuberculosis drugs. The training module includes record maintaining, reporting to the RNTCP, Medication adherence etc. In case of non-availability of anti-tuberculosis drugs, the district RNTCP has been given training for community pharmacist by providing free of drugs to the community pharmacies. So, community pharmacies can dispense anti-tuberculosis drugs to the patients. The target of this study is Private community pharmacies. A simple random sampling method is used and 550 private community pharmacy shops has been involved in Belgaum city of Karnataka state, India. Significance of the Study: This study mainly focused on training of DOTS (Directly observed treatment short course) to the private community pharmacist. Indian Govt. Considers Private Providers as Assets for TB Control and Care to Achieve National Strategic Plan for TB Elimination 2017-2025. The Govt. has not fully tapped the Potential of Private Pharmacies to Fight TB. Providing DOTS as per patient’s convenience through community DOT Providers with periodic monitoring may reduce the treatment Default. We explore RNTCP objectives interventions that can have directly managed by private community pharmacy shop. Objectives: Survey of anti-tuberculosis drugs in Community pharmacy shop in Belgaum city. Interested community pharmacist who are willing to become DOTS (Directly observed treatment short course) Provider. Major Findings:Most of the community pharmacist are dispensing anti-tuberculosis drugs without having knowledge of DOTS therapy and RNTCP objectives. No community pharmacist is aware of RNTCP and Tuberculosis burden in India. Most of the Pharmacist agreed to come for RNTCP Training module for the community pharmacist. Some of the community pharmacist not dispensing anti-tuberculosis drugs and they agreed to become official DOTS provider. Concluding Statement: Awareness of role of community pharmacist on tuberculosis control and care has been neglected. More than 50% of tuberculosis patients seeking treatments from privatesector. In this study finds the major gap between government and private sector on tuberculosis treatment.

Keywords: community pharmacist, directly observed treatment short course(DOTS), revised national tuberculosis control programme (RNTCP), private pharmacies, anti-tuberculosis drugs

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348 Advocating for Those with Limited Mobility

Authors: Dorothy I. Riddle

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Limited mobility (or an inability to walk more than 15 meters without sitting down to rest) restricts full community participation for 13 percent of Canadian adults or 4.2 million persons), yet Canadian accessibility standards are silent on distance to be walked as an accessibility barrier to be addressed. Instead, they focus on ensuring access for the wheeled mobility devices used regularly by le The Accessible Canada Act mandates that Canada be barrier free by 2040, which will necessitate eliminating distance to be walked as a barrier in federal programs and services. This paper details the results of a multi-year research project funded by Accessibility Standards Canada to document the lived experience of those struggling with limited mobility and make recommendations regarding how to ensure accessibility for those with limited mobility. Over 2,600 Canadians from across Canada participated in an online survey and follow-up focus groups. The results underscored the importance of providing not only mobility supports in public facilities but also the information necessary for planning access to federal programs and services. As numerous participants indicated, if they weren’t sure how far they would have to walk, they simply stayed home and depended on friends and relatives for help with errands or appointments. This included failing to participate in civic activities, such as voting, for fear of having to walk too far and stand unsupported for too long. Types of information that were deemed critical included whether or not mobility aids were available, where seating to rest was located throughout the facility, what alternatives to standing while waiting for service and having to walk to the service provider (rather than the provider coming to the customer) were available, and diagrams of accessible parking and its relationship to elevators and services.

Keywords: accessibility standards, distance to be walked, limited mobility, mobility aids, service to customer

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347 Telemedicine in Physician Assistant Education: A Partnership with Community Agency

Authors: Martina I. Reinhold, Theresa Bacon-Baguley

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A core challenge of physician assistant education is preparing professionals for lifelong learning. While this conventionally has encompassed scientific advances, students must also embrace new care delivery models and technologies. Telemedicine, the provision of care via two-way audio and video, is an example of a technological advance reforming health care. During a three-semester sequence of Hospital Community Experiences, physician assistant students were assigned experiences with Answer Health on Demand, a telemedicine collaborative. Preceding the experiences, the agency lectured on the application of telemedicine. Students were then introduced to the technology and partnered with a provider. Prior to observing the patient-provider interaction, patient consent was obtained. Afterwards, students completed a reflection paper on lessons learned and the potential impact of telemedicine on their careers. Thematic analysis was completed on the students’ reflection papers (n=13). Preceding the lecture and experience, over 75% of students (10/13) were unaware of telemedicine. Several stated they were 'skeptical' about the effectiveness of 'impersonal' health care appointments. After the experience, all students remarked that telemedicine will play a large role in the future of healthcare and will provide benefits by improving access in rural areas, decreasing wait time, and saving cost. More importantly, 30% of students (4/13) commented that telemedicine is a technology they can see themselves using in their future practice. Initial results indicate that collaborative interaction between students and telemedicine providers enhanced student learning and exposed students to technological advances in the delivery of care. Further, results indicate that students perceived telemedicine more favorably as a viable delivery method after the experience.

Keywords: collaboration, physician assistant education, teaching innovative health care delivery method, telemedicine

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