Search results for: service failure

Authors: Rahul Malhotra

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Fiber based access networks can deliver performance that can support the increasing demands for high speed connections. One of the new technologies that have emerged in recent years is Passive Optical Networks. This paper is targeted to show the simultaneous delivery of triple play service (data, voice and video). The comparative investigation and suitability of various data rates is presented. It is demonstrated that as we increase the data rate, number of users to be accommodated decreases due to increase in bit error rate.

Keywords: BER, PON, TDMPON, GPON, CWDM, OLT, ONT

Procedia PDF Downloads 533

Authors: Ye Zhang, Chuanjun Liu

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In-service aircraft is exposed to different types of threaten, e.g. bird strike, ground vehicle impact, and run-way debris, or even lightning strike, etc. To satisfy the aircraft damage tolerance design requirements, the designer has to understand the threatening level for different types of the aircraft structures, either metallic or composite. Exposing to low-velocity impacts may produce very serious internal damages such as delaminations and matrix cracks without leaving visible mark onto the impacted surfaces for composite structures. This internal damage can cause significant reduction in the load carrying capacity of structures. The semi-probabilistic method provides a practical and proper approximation to establish the impact-threat based energy cut-off level for the damage tolerance evaluation of the aircraft components. Thus, the probabilistic distribution of impact threat and the realistic impact energy level cut-offs are the essential establishments required for the certification of aircraft composite structures. A new survey of impact threat to civil aircraft in-service has recently been carried out based on field records concerning around 500 civil aircrafts (mainly single aisles) and more than 4.8 million flight hours. In total 1,006 damages caused by low-velocity impact events had been screened out from more than 8,000 records including impact dents, scratches, corrosions, delaminations, cracks etc. The impact threat dependency on the location of the aircraft structures and structural configuration was analyzed. Although the survey was mainly focusing on the metallic structures, the resulting low-energy impact data are believed likely representative to general civil aircraft, since the service environments and the maintenance operations are independent of the materials of the structures. The probability of impact damage occurrence (Po) and impact energy exceedance (Pe) are the two key parameters for describing the statistic distribution of impact threat. With the impact damage events from the survey, Po can be estimated as 2.1x10-4 per flight hour. Concerning the calculation of Pe, a numerical model was developed using the commercial FEA software ABAQUS to backward estimate the impact energy based on the visible damage characteristics. The relationship between the visible dent depth and impact energy was established and validated by drop-weight impact experiments. Based on survey results, Pe was calculated and assumed having a log-linear relationship versus the impact energy. As the product of two aforementioned probabilities, Po and Pe, it is reasonable and conservative to assume Pa=PoxPe=10-5, which indicates that the low-velocity impact events are similarly likely as the Limit Load events. Combing Pa with two probabilities Po and Pe obtained based on the field survey, the cutoff level of realistic impact energy was estimated and valued as 34 J. In summary, a new survey was recently done on field records of civil aircraft to investigate the probabilistic distribution of impact threat. Based on the data, two probabilities, Po and Pe, were obtained. Considering a conservative assumption of Pa, the cutoff energy level for the realistic impact energy has been determined, which provides potential applicability in damage tolerance certification of future civil aircraft.

Keywords: composite structure, damage tolerance, impact threat, probabilistic

Procedia PDF Downloads 292

Authors: J. Waita, S. Wamuhu, J. Makoyo, M. Rachel, T. Ngangari, W. Christine, M. Zipporah

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Contraceptive use is one of the key global strategies to alleviate maternal mortality. Global efforts through advocating for contraceptive uptake and service provision has led improved contraceptive prevalence. In Kenya maternal mortality rate has remained a challenged despites efforts by government and non-governmental organizations. Objective: To describe the uptake of contraceptives among women in Tunza Clinics, Kenya. Design and Methods: Ps Kenya through health care marketing fund is implementing a family planning program among its 350 Tunza fractional franchise facilities. Through private partnership, private owned facilities in low socio-economic areas are recruited and trained on contraceptive technology update. The providers are supported through facilitative supervision through a mobile based application Health Network Quality Improvement System (HNQIS) and interpersonal communication through 150 community based volunteers. The data analyzed in this paper was collected between January to July 2017 to show the uptake of modern Contraceptives among women in the Tunza franchise, method mix, age and distribution among the age bracket. Further analysis compares two different service delivery strategies; outreach and walk ins. Supportive supervision HNQIS scores was analyzed. Results: During the time period, a total of 132121 family planning clients were attended in 350 facilities. The average age of clients was 29.6 years. The average number of clients attended in the facilities per month was 18874. 73.7 %( n=132121) of the clients attended in the Tunza facilities were aged above 25 years while 22.1% 20-24 years and 4.2% 15-19 years. On contraceptive method mix, intra uterine device insertions clients contributed to 7.5%, implant insertions 15.3%, pills 11.2%, injections 62.7% while condoms and emergency pills had 2.7% and 0.6% respectively. Analysis of service delivery strategy indicated more than 79% of the clients were walk ins while 21% were attended to during outreaches. Uptake of long term contraceptive methods during outreaches was 73% of the clients while short term modern methods were 27%. Health Network Quality Improvement system assessment scores indicated 51% of the facilities scored over 90%, 25% scoring 80-89% while 21% scored below 80%. Conclusion: Preference for short term methods by women is possibly associated to cost as they are cheaper and easy to administer. When the cost of intra uterine device Implants is meant affordable during outreaches, the uptake is observed to increase. Making intra uterine device and implants affordable to women is a key strategy in increasing contraceptive prevalence hence averting maternal mortality.

Keywords: contraceptives, contraceptive uptake, low socio economic, supportive supervision

Procedia PDF Downloads 148

Authors: Berkas Khaoula

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Based on selection characteristics, high-density polyethylene (HDPE) extruded pipes are among the most economical and durable materials as well-designed solutions for water and gas transmission systems. The main reasons for such a choice are the high quality-performance ratio and the long-term service durability under aggressive conditions. Due to inevitable interactions with soils of different chemical compositions and transported fluids, aggressiveness becomes a key factor in studying resilient strength and life prediction limits. This phenomenon is known as environmental stress cracking resistance (ESCR). In this work, the effect of 3 acidic environments (5% acetic, 20% hydrochloric and 20% sulfuric) on HDPE-100 samples (~10x11x24 mm3). The results presented in the form (Δm/m0, %) as a function of √t indicate that the absorption, in the case of strong acids (HCl and H2SO4), evolves towards negative values involving material losses such as antioxidants and some additives. On the other hand, acetic acid and deionized water (DW) give a form of linear Fickean (LF) and B types, respectively. In general, the acids cause a slow but irreversible alteration of the chemical structure, composition and physical integrity of the polymer. The DW absorption is not significant (~0.02%) for an immersion duration of 69 days. Such results are well accepted in actual applications, while changes caused by acidic environments are serious and must be subjected to particular monitoring of the OIT factor (Oxidation Induction Time). After 55 days of aging, the H2SO4 and HCl media showed particular values with a loss of % mass in the interval [0.025-0.038] associated with irreversible chemical reactions as well as physical degradations. This state is usually explained by hydrolysis of the polymer, causing the loss of functions and causing chain scissions. These results are useful for designing and estimating the lifetime of the tube in service and in contact with adverse environments.

Keywords: HDPE, environmental stress cracking, absorption, acid media, chemical aging

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Authors: Y. Smirlis, G. Koronakos, S. Plitsos

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Shipbrokers assist the ship companies in chartering or selling and buying vessels, acting as intermediates between them and the market. They facilitate deals, providing their expertise, negotiating skills, and knowledge about ship market bargains. Their role is very important as it affects the profitability and market position of a shipping company. Due to their significant contribution, the shipping companies have to employ systematic procedures to evaluate the shipbrokers’ services in order to select the best and, consequently, to achieve the best deals. Towards this, in this paper, we consider shipbrokers as financial service providers, and we formulate the problem of evaluating and selecting shipbrokers’ services as a multi-criteria decision making (MCDM) procedure. The proposed methodology comprises a first normalization step to adjust different scales and orientations of the criteria and a second step that includes the mathematical model to evaluate the performance of the shipbrokers’ services involved in the assessment. The criteria along which the shipbrokers are assessed may refer to their size and reputation, the potential efficiency of the services, the terms and conditions imposed, the expenses (e.g., commission – brokerage), the expected time to accomplish a chartering or selling/buying task, etc. and according to our modelling approach these criteria may be assigned different importance. The mathematical programming model performs a comparative assessment and estimates for the shipbrokers involved in the evaluation, a relative score that ranks the shipbrokers in terms of their potential performance. To illustrate the proposed methodology, we present a case study in which a shipping company evaluates and selects the most suitable among a number of sale and purchase (S&P) brokers. Acknowledgment: This study is supported by the OptiShip project, implemented within the framework of the National Recovery Plan and Resilience “Greece 2.0” and funded by the European Union – NextGenerationEU programme.

Keywords: shipbrokers, multi-criteria decision making, mathematical programming, service-provider selection

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Authors: Atefeh Abdollahi, Maryam Bahreini, Babak Choobi Anzali, Fatemeh Rasooli

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Introduction: Triage becomes the main part of organization of care in Emergency department (ED)s. It is used to describe the sorting of patients for treatment priority in ED. The accurate triage of injured patients has reduced fatalities and improved resource usage. Besides, the nurses’ knowledge and skill are important factors in triage decision-making. The ability to define an appropriate triage level and their need for intervention is crucial to guide to a safe and effective emergency care. Methods: This is a prospective cross-sectional study designed for emergency nurses working in four public university hospitals. Five triage workshops have been conducted every three months for emergency nurses based on a standard triage Emergency Severity Index (ESI) IV slide set - approved by Iranian Ministry of Health. Most influential items on triage performance were discussed through brainstorming in workshops which then, were peer reviewed by five emergency physicians and two head registered nurses expert panel. These factors that might distract nurse’ attention from proper decisions included patients’ past medical diseases, the natural tricks of triage and system failure. After permission had been taken, emergency nurses participated in the study and were given the structured questionnaire. Data were analysed by SPSS 21.0. Results: 92 emergency nurses enrolled in the study. 30 % of nurses reported the past history of chronic disease as the most influential confounding factor to ascertain triage level, other important factors were the history of prior admission, past history of myocardial infarction and heart failure to be 20, 17 and 11 %, respectively. Regarding the concept of difficulties in triage practice, 54.3 % reported that the discussion with patients and family members was difficult and 8.7 % declared that it is hard to stay in a single triage room whole day. Among the participants, 45.7 and 26.1 % evaluated the triage workshops as moderately and highly effective, respectively. 56.5 % reported overcrowding as the most important system-based difficulty. Nurses were mainly doubtful to differentiate between the triage levels 2 and 3 according to the ESI VI system. No significant correlation was found between the work record of nurses in triage and the uncertainty in determining the triage level and difficulties. Conclusion: The work record of nurses hardly seemed to be effective on the triage problems and issues. To correct the deficits, training workshops should be carried out, followed by continuous refresher training and supportive supervision.

Keywords: assessment, education, nurse, triage

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Authors: Onur Ozveri, Korkut Karabag, Cagri Keles

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It is an important issue that the occurring of production downtime and repair costs when machines fail in the machine intensive production industries. In the case of failure of more than one machine at the same time, which machines will have the priority to repair, how to determine the optimal repair time should be allotted for this machines and how to plan the resources needed to repair are the key issues. In recent years, Business Process Management (BPM) technique, bring effective solutions to different problems in business. The main feature of this technique is that it can improve the way the job done by examining in detail the works of interest. In the industries, maintenance and repair works are operating as a process and when a breakdown occurs, it is known that the repair work is carried out in a series of process. Maintenance main-process and repair sub-process are evaluated with process management technique, so it is thought that structure could bring a solution. For this reason, in an international manufacturing company, this issue discussed and has tried to develop a proposal for a solution. The purpose of this study is the implementation of maintenance and repair works which is integrated with process management technique and at the end of implementation, analyzing the maintenance related parameters like quality, cost, time, safety and spare part. The international firm that carried out the application operates in a free region in Turkey and its core business area is producing original equipment technologies, vehicle electrical construction, electronics, safety and thermal systems for the world's leading light and heavy vehicle manufacturers. In the firm primarily, a project team has been established. The team dealt with the current maintenance process again, and it has been revised again by the process management techniques. Repair process which is sub-process of maintenance process has been discussed again. In the improved processes, the ABC equipment classification technique was used to decide which machine or machines will be given priority in case of failure. This technique is a prioritization method of malfunctioned machine based on the effect of the production, product quality, maintenance costs and job security. Improved maintenance and repair processes have been implemented in the company for three months, and the obtained data were compared with the previous year data. In conclusion, breakdown maintenance was found to occur in a shorter time, with lower cost and lower spare parts inventory.

Keywords: ABC equipment classification, business process management (BPM), maintenance, repair performance

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Authors: Gunnar Oskarsson, Gudjon Helgi Egilsson

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Due to globalization, small and medium-sized enterprises (SME) increasingly offer their products and services in foreign markets. The main reasons are either to compensate for a decreased market share in their home market or to exploit opportunities in foreign markets, which are becoming less distant and better accessible than before. International markets are particularly important for companies located in a small economy and offering specialized products. Although more accessible, entering international markets is both expensive and difficult. In order to select the most appropriate markets, it is, therefore, important to gain an insight into the factors that have an impact on success, or potential failure. Although there has been a reasonable volume of research into the theory of internationalization, there is still a need to gain further understanding of the decision-making process of SMEs in small economies and the most important characteristics that distinguish between success and failure. The main objective of this research is to enhance knowledge on the internationalization of SMEs, including the drivers for the decision to internationalize, and the most important factors contributing to success in their internationalization activities. A qualitative approach was found to be most appropriate for this kind of research, with the objective of gaining a deeper understanding and discovering factors which impact a company’s decision-making and potential success. In-depth interviews were conducted with 14 companies in different industries located in Iceland, a country extensively dependent on export revenues. The interviews revealed several factors as drivers of internationalization and, not surprisingly, the most frequently mentioned source of motivation was that the local market is inadequate to maintain a sustainable operation. Good networking relationships were seen as a particular priority for potential success, searching for new markets was mainly carried out through the internet, although sales exhibitions and sales trips were also considered important. When it comes to the final decision as to whether a market should be considered for further analysis, economy, labor cost, legal environment, and cultural barriers were the most common factors to be weighted. The ultimate answer to successful internationalization, however, is largely dependent on a coordinated and experienced management team. The main contribution of this research is offering an insight into factors affecting decision-making in the internationalization process of SMEs, based on the opinion and experience of managers of SMEs in a small economy.

Keywords: internationalization, success factors, small and medium-sized enterprises (SMEs), drivers, decision making

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Authors: Birendra Kumar Jha, Mingma L. Sherpa, Binod Kumar Dahal

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Background: The metabolic syndrome is emerging as a major public health concern in the world. Urbanization, surplus energy uptake, compounded by decreased physical activities, and increasing obesity are the major factors contributing to the epidemic of metabolic syndrome worldwide. However, prevalence of metabolic syndrome and its risk factors are little studied in Terai region of Nepal. The objectives of this research were to estimate the prevalence and to identify the risk factors of metabolic syndrome among adults in Terai region of Nepal. Method: We used a community based cross sectional study design. A total of 225 adults (age: 18 to 80 years) were selected from three district of Terai region of Nepal using cluster sampling by camp approach. IDF criteria (central obesity with any two of following four factors: triglycerides ≥ 150 mg/dl or specific treatment for lipid abnormality, reduced HDL, raised blood pressure and raised fasting plasma glucose or previously diagnosed type 2 diabetes) were used to assess metabolic syndrome. Interview, physical and clinical examination, measurement of fasting blood glucose and lipid profile were conducted for all participants. Chi-square test and multivariable logistic regression were employed to explore the risk factors of metabolic syndrome. Result: The overall prevalence of metabolic syndrome was 70.7%. Hypertension, increased fasting blood sugar, increased triglycerides and decreased HDL were observed in 50.7%, 32.4%, 41.8% and 79.1% of the subjects respectively. Socio-economic and behavioral risk factors significantly associated with metabolic syndrome were gender male (OR=2.56, 955 CI: 1.42-4.63; p=0.002), in service or retired from service (OR=3.72, 95% CI: 1.72-8.03; p=0.001) and smoking (OR= 4.10, 95% CI: 1.19-14.07; p=0.016). Conclusion: Higher prevalence of Metabolic syndrome along with presence of behavioral risk factors in Terai region of Nepal likely suggest lack of awareness and health promotion activities for metabolic syndrome and indicate the need to promote public health programs in this region to maintain quality of life.

Keywords: metabolic syndrome, Nepal, prevalence, risk factors, Terai

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Authors: Huang Wei-Chi, Li Wei, Yu Tien-Chieh

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Medication adherence is crucial for treatment success. Adherence problem is common in patients with polypharmacy, especially in the geriatric population who are vulnerable to multiple chronic conditions but averagely less knowledgeable about diseases and medications. In order to help patients take medications appropriately and enhance the understanding of diseases or medications, a Line official account named e-Pharmacist was designed. The line is a popular freeware app with the highest penetration rate (95.7%) in Taiwan. The interface of e-Pharmacist is user-friendly for easy-to-read and convenient operating. Differ from other medication adherence apps, users just added e-Pharmacist as a LINE friend without installing any more apps and the drug lists were automatically downloaded from the personal electronic medical records with security permission. Over and above medication reminder, several additional capabilities were set up and engaged in the platform of e-Pharmacist including prescription refill reservation, laboratory examination consultation, medical appointment registration, and “Daily Health Log” where patients can record and track data of blood pressure/blood sugar and daily meals for self-health management as well as can share the important information to clinical professionals when seeking medical help. Additionally, a Line chatbot was utilized to provide tailored medicine information for the individual user. From July 2020 to March 2022, around 3000 patients added e-pharmacist as Line friends. Every day more than 1500 patients receive messages from e-pharmacist to notify them to take medicine. Thanks to the e-pharmacist alert system and Chatbot, the low-compliance patients (defined by Program on Adherence to Medication, PAM) significantly dropped from 36% to 6%, whereas the high-compliance patients dramatically increased from 13% to 77%. The user satisfaction is 98%. In brief, an e-pharmacist is not only a medication reminder but also a tailored personal assistant with value-added service for health management.

Keywords: e-pharmacist, self-health management, medication reminder, value-added service

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Authors: Muhammad Younas, Sidra Sawati, M. Razzaq Athar

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Organizational development history reveals that it has ever been a challenge to identify and fathom the role of talent management, career development and compensation management towards employees’ retention and organizational performance. Organizations strive hard to measure the impact of all those factors which affect employee retention and organizational performance. Researchers have worked in great deal in order to know the relationship of independent variables i.e. Talent Management, Career Development and Compensation Management on dependent variables i.e. Employee Retention and Organizational Performance. Employees adorned with latest skills with long lasting loyalty play a significant role towards successful achievement of short term as well as long term goals of the organizations. Retention of valuable and resourceful employees for a longer time is equally essential for meeting the set goals. The organizations which spend reasonable chunk of their resources for taking such measures that help to retain their employees through talent management and satisfactory career development always enjoy a competitive edge over their competitors. Human resource is regarded as one of the most precious and difficult resource to management. It has its own needs and requirement. It becomes an easy prey to monotony when lacks career development. Wants and aspirations of this resource are seldom met completely but can be managed through career development and compensation management. In this era of competition, organizations have to take viable steps to management their resources especially human resource. Top management and Managers keep on working for an amenable solution in order to address the challenges relating career development and compensation management as their ultimate goal is to ensure the organizational performance on optimum level. The current study was conducted to examine the impact of Talent Management, Career Development and Compensation Management towards Employees Retention and Organizational Performance with mediating effect of Employees Motivation in Service Sector of Pakistan. The current study is based on Resource Based View (RBV) and Ability Motivation Opportunity (AMO) theories. It explains that by increasing internal resources we can manage employee talent, career development through compensation management and employee motivation more effectively. It will result in effective execution of HRM practices for employee retention enabling an organization to achieve and sustain competitive advantage through optimal performance. Data collection was made through a structured questionnaire which was based upon adopted instruments after testing reliability and validity. A total 300 employees of 30 firms in service sector of Pakistan were sampled through non-probability sampling technique. Regression analysis revealed that talent management, career development and compensation management have significant positive impact on employee retention and perceived organizational performance. The results further showed that employee motivation have a significant mediating effect on employee retention and organizational performance. The interpretation of the findings and limitations, theoretical and managerial implications are also discussed.

Keywords: career development, compensation management, employee retention, organizational performance, talent management

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Authors: Borhan Marzougui

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Road and Transport Authority (RTA) is moving ahead with the implementation of the leader’s vision in exploring all avenues that may bring better security and safety services to the community. Smart transport means using smart technologies such as IoT (Internet of Things). This technology continues to affirm its important role in the context of Information and Transportation Systems. In fact, IoT is a network of Internet-connected objects able to collect and exchange different data using embedded sensors. With the growth of IoT, Distributed Denial of Service (DDoS) attacks is also growing exponentially. DDoS attacks are the major and a real threat to various transportation services. Currently, the defense mechanisms are mainly passive in nature, and there is a need to develop a smart technique to handle them. In fact, new IoT devices are being used into a botnet for DDoS attackers to accumulate for attacker purposes. The aim of this paper is to provide a relevant understanding of dangerous types of DDoS attack related to IoT and to provide valuable guidance for the future IoT security method. Our methodology is based on development of the distributed algorithm. This algorithm manipulates dedicated intelligent and cooperative agents to prevent and to mitigate DDOS attacks. The proposed technique ensure a preventive action when a malicious packets start to be distributed through the connected node (Network of IoT devices). In addition, the devices such as camera and radio frequency identification (RFID) are connected within the secured network, and the data generated by it are analyzed in real time by intelligent and cooperative agents. The proposed security system is based on a multi-agent system. The obtained result has shown a significant reduction of a number of infected devices and enhanced the capabilities of different security dispositives.

Keywords: IoT, DDoS, attacks, botnet, security, agents

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Authors: C. C .D. Kulathilake, M. Jayatilake, T. Takahashi

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The myocardium is composed of specialized muscle which relies mainly on fatty acid and sugar metabolism and it is widely contribute to the heart functioning. The changes of the cardiac energy-producing system during heart failure have been proved using autoradiography techniques. This study focused on evaluating sugar and fatty acid metabolism in myocardium as cardiac energy getting system using heart-accumulated radiopharmaceuticals. Two sets of autoradiographs of heart cross sections of Lewis male rats were analyzed and the time- accumulation curve obtained with use of the MATLAB image processing software to evaluate fatty acid and sugar metabolic functions.

Keywords: autoradiographs, fatty acid, radiopharmaceuticals, sugar

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Authors: Ezekiel Mwangi, Stephen Kimani, Agnes Mindila

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Usability is one of the key factors that determine the success or failure of any WebGIS (technology normally applied on the internet to analyze and present spatial data on the Internet). However, not all the usability attributes have the same impact on usability. It is, therefore, necessary to prioritize WebGIS usability elements and determine the ones that are more crucial to the success of the WebGIS. This research aims to identify the main elements of WebGIS usability, investigate the order of importance and priority of the usability elements of WebGIS, and propose a WebGIS development framework that incorporates the prioritization of the usability elements. This will be achieved through a literature review. The outcome of this research will help usability specialists and WebGIS developers in determining specific usability elements that should be accorded more emphasis during the design and development of WebGIS.

Keywords: framework, prioritization, usability, WebGIS

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Authors: Amin Tarzi

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The government of the Islamic Republic of Afghanistan was expected to keep the Taliban insurgents at bay after the departure of North Atlantic Treaty Organization (NATO)-led forces in 2021, especially given the two decades of effort to establish security forces to safeguard Western-backed governing institutions. This articles reviews the reasons for the failure of the much larger and better-equipped Afghan National Security Forces (ANSF) to stop the Taliban from taking over the Afghan capital of Kabul in a few days and analyzes the often-forgotten dimension of strategic calculations in this dialogue—namely the societal dimension. In this article, the author argues that this is one of the primary reasons that the ANSF and the Afghan government collapsed.

Keywords: societal warfare, Afghanistan, NATO, Taliban, military strategy

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Authors: Yen-Jong Chen, Jei-An Su

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Public use facilities provide the basic infrastructure supporting the needs of urban sustainable development. These facilities include roads (streets), parking areas, green spaces, public schools, and city parks. However, how to acquire land with the proper location and size still remains uncertain in a capitalist economy where land is largely privately owned, such as in cities in Taiwan. The issue concerning the proper acquisition of reserved land for local public facilities (RLPF) policies has been continuously debated by the Taiwanese government for more than 30 years. Lately, the government has been re-evaluating projects connected with existing RLPF policies from the viewpoints of the needs of local residents, including the living environments of older adults. This challenging task includes addressing the requests of official bureau administrators, citizens whose property rights and current use status are affected, and other stakeholders, along with the means of development. To simplify the decision to acquire or release public land, we selected only public facilities that are needed for living in the local community, including parks, green spaces, plaza squares, and land for kindergartens, schools, and local stadiums. This study categorized these spaces as the community’s “leisure public facilities” (LPF). By constructing an accessibility index of the services of such multi-function facilities, we computed and produced a GIS map of spatial buffer zones for each LPF. Through these procedures, the service needs provided by each LPF were clearly identified. We then used spatial buffer zone envelope mapping to evaluate these service areas. The results obtained can help decide which RLPF should be acquired or released so that community services can be maximized under a limited budget.

Keywords: urban public facilities, community demand, accessibility, spatial buffer zone, Taiwan

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Authors: Priya Jaswal, Vivek, S. K. Sinha

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One of the most important and complicated factors influencing the functional performance of unpaved roads is traffic loading. The complexity of traffic loading is caused by the variable magnitude and frequency of load, which causes unpaved roads to fail prematurely. Unpaved roads are low-volume roads, and as peri-urbanization increases, unpaved roads act as a means to boost the rural economy. This has also increased traffic on unpaved roads, intensifying the issue of settlement, rutting, and fatigue failure. This is a major concern for unpaved roads built on poor subgrade soil, as excessive rutting caused by heavy loads can cause driver discomfort, vehicle damage, and an increase in maintenance costs. Some researchers discovered that when a consistent static load is exerted as opposed to a rapidly changing load, the rate of deformation of unpaved roads increases. Previously, some of the most common methods for overcoming the problem of rutting and fatigue failure included chemical stabilisation, fibre reinforcement, and so on. However, due to their high cost, engineers' attention has shifted to geotextiles which are used as reinforcement in unpaved roads. Geotextiles perform the function of filtration, lateral confinement of base material, vertical restraint of subgrade soil, and the tension membrane effect. The use of geotextiles in unpaved roads increases the strength of unpaved roads and is an economically viable method because it reduces the required aggregate thickness, which would need less earthwork, and is thus recommended for unpaved road applications. The majority of geotextiles used previously were polymeric, but with a growing awareness of sustainable development to preserve the environment, researchers' focus has shifted to natural fibres. Coir is one such natural fibre that possesses the advantage of having a higher tensile strength than other bast fibres, being eco-friendly, low in cost, and biodegradable. However, various researchers have discovered that the surface of coir fibre is covered with various impurities, voids, and cracks, which act as a plane of weakness and limit the potential application of coir geotextiles. To overcome this limitation, chemical surface modification of coir geotextiles is widely accepted by researchers because it improves the mechanical properties of coir geotextiles. The current paper reviews the effect of using treated coir geotextiles as reinforcement on the load-deformation behaviour of a two-layered unpaved road model.

Keywords: coir, geotextile, treated, unpaved

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Authors: Maria Evnevich

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In modern conditions, in most markets, price competition is becoming less effective. On the one hand, there is a gradual decrease in the level of marginality in main traditional sectors of the economy, so further price reduction becomes too ‘expensive’ for the company. On the other hand, the effect of price reduction is leveled, and the reason for this phenomenon is likely to be informational. As a result, it turns out that even if the company reduces prices, making its products more accessible to the buyer, there is a high probability that this will not lead to increase in sales unless additional large-scale advertising and information campaigns are conducted. Similarly, a large-scale information and advertising campaign have a much greater effect itself than price reductions. At the same time, the cost of mass informing is growing every year, especially when using the main information channels. The article presents generalization, systematization and development of theoretical approaches and best practices in the field of customer focus approach to business management and in the field of relationship marketing in the modern digital economy. The research methodology is based on the synthesis and content-analysis of sociological and marketing research and on the study of the systems of working with consumer appeals and loyalty programs in the 50 largest client-oriented companies in Russia. Also, the analysis of internal documentation on customers’ purchases in one of the largest retail companies in Russia allowed to identify if buyers prefer to buy goods for complex purchases in one retail store with the best price image for them. The cost of attracting a new client is now quite high and continues to grow, so it becomes more important to keep him and increase the involvement through marketing tools. A huge role is played by modern digital technologies used both in advertising (e-mailing, SEO, contextual advertising, banner advertising, SMM, etc.) and in service. To implement the above-described client-oriented omnichannel service, it is necessary to identify the client and work with personal data provided when filling in the loyalty program application form. The analysis of loyalty programs of 50 companies identified the following types of cards: discount cards, bonus cards, mixed cards, coalition loyalty cards, bank loyalty programs, aviation loyalty programs, hybrid loyalty cards, situational loyalty cards. The use of loyalty cards allows not only to stimulate the customer to purchase ‘untargeted’, but also to provide individualized offers, as well as to produce more targeted information. The development of digital technologies and modern means of communication has significantly changed not only the sphere of marketing and promotion, but also the economic landscape as a whole. Factors of competitiveness are the digital opportunities of companies in the field of customer orientation: personalization of service, customization of advertising offers, optimization of marketing activity and improvement of logistics.

Keywords: customer focus, digital economy, loyalty program, relationship marketing

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Authors: K. Vandenboer, L. Dolphen, A. Bezuijen

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Backward erosion piping is an important failure mechanism for water-retaining structures, a phenomenon that results in the formation of shallow pipes at the interface of a sandy or silty foundation and a cohesive cover layer. This paper studies the effect of two soil types on backward erosion piping; both in case of a homogeneous sand layer, and in a vertically layered sand sample, where the pipe is forced to subsequently grow through the different layers. Two configurations with vertical sand layers are tested; they both result in wider pipes and higher critical gradients, thereby making this an interesting topic in research on measures to prevent backward erosion piping failures.

Keywords: backward erosion piping, embankments, physical modeling, sand

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Authors: Wenru Wang

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Over the past decades, Asia has emerged as the ‘diabetes epicentre’ in the world due to rapid economic development, urbanization and nutrition transition. There is an urgent need to develop more effective and cost-effective care management strategies in response to this rising diabetes epidemic. This study aims to develop and compare a nurse-led smartphone-based self-management programme with an existing nurse-led diabetes service on health-related outcomes among type 2 diabetes patients with poor glycemic control in Singapore. We proposed a randomized controlled trial with pre- and repeated post-tests control group design. A total of 128 type 2 diabetes patients with poor glycemic control will be recruited from the diabetes clinic of an acute public hospital in Singapore through convenience sampling. Study participants will be either randomly allocated to the experimental group or control group. Outcome measures used will include the 10-item General Self-Efficacy Scale, 11-item Revised Summary of Diabetes Self-care Activities, and 19-item Diabetes-Dependent Quality of Life. Data will be collected at 3-time points: baseline, three months and six months from the baseline, respectively. It is expected that this programme will be an alternative offered to diabetes patients to master their self-care management skills, in addition to the existing diabetes service provided in diabetes clinics in Singapore hospitals. Also, the self-supporting and less resource-intensive nature of this programme, through the use of smartphone app as a mode of intervention delivery, will greatly reduce nurses’ direct contact time with patients and allow more time to be allocated to those who require more attention. The study has been registered with clinicaltrials.gov. The trial registration number is NCT03088475.

Keywords: type 2 diabetes, poor glycaemic control, nurse-led, smartphone-based, self-management, health-relevant outcomes

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Authors: Qian Zhao, Shi-Qi Liu, Bo Guo, Zhi-Jun Cheng, Xiao-Yue Wu

Abstract:

Cold standby redundancy is considered to be an effective mechanism for improving system reliability and is widely used in industrial engineering. However, because of the complexity of the reliability structure, there is little literature studying on the residual life of cold standby system consisting of complex components. In this paper, a simulation method is presented to predict the residual life of k-out-of-n cold standby system. In practical cases, failure information of a system is either unknown, partly unknown or completely known. Our proposed method is designed to deal with the three scenarios, respectively. Differences between the procedures are analyzed. Finally, numerical examples are used to validate the proposed simulation method.

Keywords: cold standby system, k-out-of-n, residual life, simulation sampling

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Authors: Rebeca V. Tholen, Elaine Bundy

Abstract:

Background: Liver transplantation (LT) is considered the only curative treatment for end-stage liver disease Background: Liver transplantation (LT) is considered the only curative treatment for end-stage liver disease (ESLD). The effects of alcoholism can cause irreversible liver damage, cirrhosis and subsequent liver failure. Alcohol relapse after transplant occurs in 20-50% of patients and increases the risk for recurrent cirrhosis, organ rejection, and graft failure. Alcohol relapse after transplant has been identified as a problem among liver transplant recipients at a large urban academic transplant center in the United States. Transplantation will reverse the complications of ESLD, but it does not treat underlying alcoholism or reduce the risk of relapse after transplant. The purpose of this quality improvement project is to implement and evaluate the effectiveness of a High-Risk Alcoholism Relapse (HRAR) Scale to screen and identify patients at high-risk for alcohol relapse after receiving an LT. Methods: The HRAR Scale is a predictive tool designed to determine the severity of alcoholism and risk of relapse after transplant. The scale consists of three variables identified as having the highest predictive power for early relapse including, daily number of drinks, history of previous inpatient treatment for alcoholism, and the number of years of heavy drinking. All adult liver transplant recipients at a large urban transplant center were screened with the HRAR Scale prior to hospital discharge. A zero to two ordinal score is ranked for each variable, and the total score ranges from zero to six. High-risk scores are between three to six. Results: Descriptive statistics revealed 25 patients were newly transplanted and discharged from the hospital during an 8-week period. 40% of patients (n=10) were identified as being high-risk for relapse and 60% low-risk (n=15). The daily number of drinks were determined by alcohol content (1 drink = 15g of ethanol) and number of drinks per day. 60% of patients reported drinking 9-17 drinks per day, and 40% reported ≤ 9 drinks. 50% of high-risk patients reported drinking ≥ 25 years, 40% for 11-25 years, and 10% ≤ 11 years. For number of inpatient treatments for alcoholism, 50% received inpatient treatment one time, 20% ≥ 1, and 30% reported never receiving inpatient treatment. Findings reveal the importance and value of a validated screening tool as a more efficient method than other screening methods alone. Integration of a structured clinical tool will help guide the drinking history portion of the psychosocial assessment. Targeted interventions can be implemented for all high-risk patients. Conclusions: Our findings validate the effectiveness of utilizing the HRAR scale to screen and identify patients who are a high-risk for alcohol relapse post-LT. Recommendations to help maintain post-transplant sobriety include starting a transplant support group within the organization for all high-risk patients. (ESLD). The effects of alcoholism can cause irreversible liver damage, cirrhosis and subsequent liver failure. Alcohol relapse after transplant occurs in 20-50% of patients, and increases the risk for recurrent cirrhosis, organ rejection, and graft failure. Alcohol relapse after transplant has been identified as a problem among liver transplant recipients at a large urban academic transplant center in the United States. Transplantation will reverse the complications of ESLD, but it does not treat underlying alcoholism or reduce the risk of relapse after transplant. The purpose of this quality improvement project is to implement and evaluate the effectiveness of a High-Risk Alcoholism Relapse (HRAR) Scale to screen and identify patients at high-risk for alcohol relapse after receiving a LT. Methods: The HRAR Scale is a predictive tool designed to determine severity of alcoholism and risk of relapse after transplant. The scale consists of three variables identified as having the highest predictive power for early relapse including, daily number of drinks, history of previous inpatient treatment for alcoholism, and the number of years of heavy drinking. All adult liver transplant recipients at a large urban transplant center were screened with the HRAR Scale prior to hospital discharge. A zero to two ordinal score is ranked for each variable, and the total score ranges from zero to six. High-risk scores are between three to six. Results: Descriptive statistics revealed 25 patients were newly transplanted and discharged from the hospital during an 8-week period. 40% of patients (n=10) were identified as being high-risk for relapse and 60% low-risk (n=15). The daily number of drinks were determined by alcohol content (1 drink = 15g of ethanol) and number of drinks per day. 60% of patients reported drinking 9-17 drinks per day, and 40% reported ≤ 9 drinks. 50% of high-risk patients reported drinking ≥ 25 years, 40% for 11-25 years, and 10% ≤ 11 years. For number of inpatient treatments for alcoholism, 50% received inpatient treatment one time, 20% ≥ 1, and 30% reported never receiving inpatient treatment. Findings reveal the importance and value of a validated screening tool as a more efficient method than other screening methods alone. Integration of a structured clinical tool will help guide the drinking history portion of the psychosocial assessment. Targeted interventions can be implemented for all high-risk patients. Conclusions: Our findings validate the effectiveness of utilizing the HRAR scale to screen and identify patients who are a high-risk for alcohol relapse post-LT. Recommendations to help maintain post-transplant sobriety include starting a transplant support group within the organization for all high-risk patients.

Keywords: alcoholism, liver transplant, quality improvement, substance abuse

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Authors: Jang-Hwan Jo

Abstract:

The supply management of ecosystem services of local forests is an essential issue as it is linked to the ecological welfare of local residents. This study aims to estimate the supply, trade-offs, and synergies of local forest regulating ecosystem services using a land cover classification map (LCCM) and a forest types map (FTM). Rigorous literature reviews and Expert Delphi analysis were conducted using the detailed variables of 1:5,000 LCCM and FTM. Land-use scoring method and Getis-Ord Gi* Analysis were utilized on detailed variables to propose a method for estimating supply, trade-offs, and synergies of the local forest regulating ecosystem services. The analysis revealed that the rank order (1st to 5th) of supply of regulating ecosystem services was Erosion prevention, Air quality regulation, Heat island mitigation, Water quality regulation, and Carbon storage. When analyzing the correlation between defined services of the entire city, almost all services showed a synergistic effect. However, when analyzing locally, trade-off effects (Heat island mitigation – Air quality regulation, Water quality regulation – Air quality regulation) appeared in the eastern and northwestern forest areas. This suggests the need to consider not only the synergy and trade-offs of the entire forest between specific ecosystem services but also the synergy and trade-offs of local areas in managing the regulating ecosystem services of local forests. The study result can provide primary data for the stakeholders to determine the initial conditions of the planning stage when discussing the establishment of policies related to the adjustment of the supply of regulating ecosystem services of the forests with limited access. Moreover, the study result can also help refine the estimation of the supply of the regulating ecosystem services with the availability of other forms of data.

Keywords: ecosystem service, getis ord gi* analysis, land use scoring method, regional forest, regulating service, synergies, trade-offs

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Authors: A. Pensiri, K. Nantaporn, P. Parichut

Abstract:

Tourism is very important to the economy of many countries due to the large contribution in the areas of employment and income generation. However, the rapid growth of tourism can also be considered as one of the major uses of water user, and therefore also have a significant and detrimental impact on the environment. Guest behavior in water usage can be used to manage water in hotels for sustainable water resources management. This research presents a study of hotel guest water usage behavior at two hotels, namely Hotel A (located in Kathu district) and Hotel B (located in Muang district) in Phuket Province, Thailand, as case studies. Primary and secondary data were collected from the hotel manager through interview and questionnaires. The water flow rate was measured in-situ from each water supply device in the standard room type at each hotel, including hand washing faucets, bathroom faucets, shower and toilet flush. For the interview, the majority of respondents (n = 204 for Hotel A and n = 244 for Hotel B) were aged between 21 years and 30 years (53% for Hotel A and 65% for Hotel B) and the majority were foreign (78% in Hotel A, and 92% in Hotel B) from American, France and Austria for purposes of tourism (63% in Hotel A, and 55% in Hotel B). The data showed that water consumption ranged from 188 litres to 507 liters, and 383 litres to 415 litres per overnight guest in Hotel A and Hotel B (n = 244), respectively. These figures exceed the water efficiency benchmark set for Tropical regions by the International Tourism Partnership (ITP). It is recommended that guest water saving initiatives should be implemented at hotels. Moreover, the results showed that guests have high satisfaction for the hotels, the front office service reveal the top rates of average score of 4.35 in Hotel A and 4.20 in Hotel B, respectively, while the luxury decoration and room cleanliness exhibited the second satisfaction scored by the guests in Hotel A and B, respectively. On the basis of this information, the findings can be very useful to improve customer service satisfaction and pay attention to this particular aspect for better hotel management.

Keywords: hotel, tourism, Phuket, water usage

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Authors: Jesús Ulloa

Abstract:

The creation, rise, and consolidation of far right-wing, ultranationalist, and eurosceptic parties in Europe after the Second World War pose a real threat towards the disintegration of the European Union. Starting more than thirty years ago with Jean-Marie Le Pen's FN and Margaret Thatcher's policies, to Marine Le Pen's current FN and anti-immigration proposals along with Nigel Farage's UKIP and their intentions to leave the European Union, the progress of right-wing parties should be noted, taking into account that they may have very important differences within their postures but that they also reach common ground in certain areas. The actual disintegration of the EU would represent an enormous failure of the new liberal world order. Through this essay, the roots of this political parties will be analyzed and the conclusion of whether the disintegration may become a reality or if the principles of cooperation and unity will prevail will be answered.

Keywords: eurosceptic, ultarnationalist, right-wing, European Union

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Authors: Rashid Mahmood

Abstract:

The network as a service (NaaS) usage has been well-known from the last few years in the many applications, like mission critical applications. In the NaaS, prevention method is not adequate as the security concerned, so the detection method should be added to the security issues in NaaS. The authentication and encryption are considered the first solution of the NaaS problem whereas now these are not sufficient as NaaS use is increasing. In this paper, we are going to present the concept of intrusion detection and then survey some of major intrusion detection techniques in NaaS and aim to compare in some important fields.

Keywords: IDS, cloud, naas, detection

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Authors: A. Tamimi, S. Greatrex-White, A. Narayanasamy

Abstract:

Background: Spirituality has been increasingly acknowledged in the nursing literature as an important element of holistic patient care. To date there have been numerous studies investigating the meaning of spirituality in Western cultures. Spirituality in Middle Eastern countries however remains under-researched. We will present a study which aimed to address this gap. Aim: The study aimed to explore how spirituality manifests in the lives of Jordanian End Stage Renal Failure (ESRF) patients. Methodology and Method: A hermeneutic phenomenological approach was adopted informed by the philosophy of Martin Heidegger. Participants (n=27) were recruited from four different dialysis units: in a public hospital, a private hospital, an educational hospital and a refugee’s hospital in Jordan. Data was collected through in-depth unstructured interviews. Data Analysis: Analysis was guided by the tenets of hermeneutic phenomenology namely: gaining immediate sense of what was said both during and after each interview, transcribing data verbatim, translating interviews into the English language, intensive reading and re-reading, seeking meaning units by line to line coding, developing situated structures (how spirituality was manifest in each text), developing a general structure from the individual situated structures (how the phenomenon ‘spirituality’ comes into being). Findings: Three major themes emerged from analysis: Religion, Relationships and Desperation. We will argue that a ‘secular’ concept of spirituality had no meaning for the participants in the study. Spirituality is fundamentally part of religion and vice versa. Discussion: The findings may have consequences for the use of spirituality in multi-cultural settings in Western countries. Additionally, findings highlighted an important emphasis on the practice of spirituality, often underestimated in previous literature for Arab-Muslim Jordanian patients. Conclusion: The study findings contribute to the existing gap in knowledge regarding how Arab-Muslim Jordanian ESRF patients experience spirituality during their illness. It provides valuable insights into the importance of spirituality for this patient group and suggests how nurses, educators and policy makers might help address ESRF patients’ spiritual needs and provide appropriate spiritual care. We suggest the findings may have relevance beyond the Jordanian context in educating nurses’ on the importance of appreciating the religious dimension of spirituality.

Keywords: spirituality, nursing, muslim, Jordan

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Authors: Yibeltal T. Bayou, Yohana S. Mashalla, Gloria Thupayagale-Tshweneagae

Abstract:

Background: According to the World Health Organization, caesarean section delivery rates of more than 10-15% caesarean section deliveries in any specific geographic region in the world are not justifiable. The aim of the study was to describe the level and analyse determinants of caesarean section delivery in Addis Ababa. Methods: Data was collected in Addis Ababa using a structured questionnaire administered to 901 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary logistic regression model was employed to identify predictors of caesarean section delivery. Results: Among the 835 women who delivered their last birth at healthcare facilities, 19.2% of them gave birth by caesarean section. About 9.0% of the caesarean section births were due to mother’s request or service provider’s influence without any medical indication. The caesarean section delivery rate was much higher than the recommended rate particularly among the non-slum residents (27.2%); clients of private healthcare facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women belonging to the highest wealth quintile household (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery by service providers. The logistic regression model shows that older age (30-49), secondary and above education, non-slum residence, high-risk pregnancy and receiving adequate antenatal care were significantly positively associated with caesarean section delivery. Conclusion: Despite the unreserved effort towards achieving MDG 5 through safe skilled delivery assistance among others, the high caesarean section rate beyond the recommend limit, and the finding that caesarean sections done without medical indications were also alarming. The government and city administration should take appropriate measures before the problems become setbacks in healthcare provision. Further investigations should focus on the effect of caesarean section delivery on maternal and child health outcomes in the study area.

Keywords: Addis Ababa, caesarean section, mode of delivery, slum residence

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Authors: Alua Masalimova, Dameli Sulubecova, Talgat Isaev, Raushan Magzumova

Abstract:

The usual relation to nurses of heads of medical organizations in Kazakhstan is to use them only for per performing medical manipulations, but new economic conditions require the introduction of nursing innovations. There is an increasing need for managers of hospital departments and regions of ambulatory clinics to ensure comfortable conditions for doctors, nurses, aides, as well as monitoring marketing technology (the needs and satisfaction of staff work, the patient satisfaction of the department). It is going to the past the nursing activities as physician assistant performing his prescriptions passively. We are suggesting a model for the developing the head nurse as the manager on the example of Blood Service. We have studied in the scientific-production center of blood transfusion head nurses by the standard method of interviewing for involvement in coordinating the flow of information, promoting the competitiveness of the department. Results: the average age of the respondents 43,1 ± 9,8, female - 100%; manager in the Organization – 9,3 ± 10,3 years. Received positive responses to the knowledge of the nearest offices in providing similar medical service - 14,2%. The cost of similar medical services in other competitive organizations did not know 100%, did a study of employee satisfaction Division labour-85,7% answered negatively, the satisfaction donors work staff studied in 50.0% of cases involved in attracting paid Services Division showed a 28.5% of the respondent. Participation in management decisions medical organization: strategic planning - 14,2%, forming analysis report for the year – 14,2%, recruitment-30.0%, equipment-14.2%. Participation in the social and technical designing workplaces Division staff showed 85,0% of senior nurses. Participate in the cohesion of the staff of the Division method of the team used the 10.0% of respondents. Further, we have studied the behavioral competencies for senior sisters: customer focus – 20,0% of respondents have attended, the ability to work in a team – 40,0%. Personal qualities senior nurses were apparent: sociability – 80,0%, the ability to manage information – 40,0%, to make their own decisions - 14,2%, 28,5% creativity, the desire to improve their professionalism – 50,0%. Thus, the modern market conditions dictate this organization, which works for the rights of economic management; include the competence of the post of the senior nurse knowledge and skills of Marketing Management Department. Skills to analyses the information collected and use of management offers superior medical leadership organization. The medical organization in the recruitment of the senior nurse offices take into account personal qualities: flexibility, fluency of thinking, communication skills and ability to work in a team. As well as leadership qualities, ambition, high emotional and social intelligence, that will bring out the medical unit on competitiveness within the country and abroad.

Keywords: blood service, head nurse, manager, skills

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Authors: Ayman M. Mansour, Bilal Hawashin, Hesham Alsalem

Abstract:

Faster delivery of laboratory test results is one of the most noticeable signs of good laboratory service and is often used as a key performance indicator of laboratory performance. Despite the availability of technology, the delivery time of clinical laboratory test results continues to be a cause of customer dissatisfaction which makes patients feel frustrated and they became careless to get their laboratory test results. The Medical Clinical Laboratory test results are highly sensitive and could harm patients especially with the severe case if they deliver in wrong time. Such results affect the treatment done by physicians if arrived at correct time efforts should, therefore, be made to ensure faster delivery of lab test results by utilizing new trusted, Robust and fast system. In this paper, we proposed a distributed Multi-Agent System to enhance and faster the process of laboratory test results delivery using SMS. The developed system relies on SMS messages because of the wide availability of GSM network comparing to the other network. The software provides the capability of knowledge sharing between different units and different laboratory medical centers. The system was built using java programming. To implement the proposed system we had many possible techniques. One of these is to use the peer-to-peer (P2P) model, where all the peers are treated equally and the service is distributed among all the peers of the network. However, for the pure P2P model, it is difficult to maintain the coherence of the network, discover new peers and ensure security. Also, security is a quite important issue since each node is allowed to join the network without any control mechanism. We thus take the hybrid P2P model, a model between the Client/Server model and the pure P2P model using GSM technology through SMS messages. This model satisfies our need. A GUI has been developed to provide the laboratory staff with the simple and easy way to interact with the system. This system provides quick response rate and the decision is faster than the manual methods. This will save patients life.

Keywords: multi-agent system, delivery process, GSM technology, clinical laboratory results

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