Search results for: elderly care service model

Authors: David P. Horton, Gary Lynch-Wood

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Western populations are aging, prone to various lifestyle health problems, and increasing their demand for health and social care services. This demand has created enormous fiscal and regulatory challenges. In response, government institutions have deployed strategies of behavior modification to encourage people to exercise greater personal responsibility over their health and care needs (i.e., welfare responsibilisation). Policy strategies are underpinned by the assumption that people if properly supported, will make better health and lifestyle selections. Not only does this absolve governments of the responsibility for meeting all health and care needs, but it also enables government institutions to assert fiscal control over welfare spending. Looking at the regulation of health and social care in the UK, the authors identify and outline a suite of regulatory tools that are designed to extract and manage the resources of health and social care services users and to encourage them to make (‘better’) use of these resources. This is important for our understanding of how health and social care regulation is responding to ongoing social and economic challenges. It is also important because there has been a failure to systematically examine the relevance of resources for regulation, which is surprising given that resources are crucial to how and whether regulation succeeds or fails. In particular, drawing from the regulatory welfare state concept, the authors analyse the key legal and regulatory changes and mechanisms that have been introduced since the 2008 financial crisis, focusing on critical measures such as the Health and Social Care Act and regulations introduced under the National Health Service Act. The authors show how three types of user resources (i.e., tangible, labor, and data) are being used to assert fiscal control and increase welfare responsibilisation. Amongst other things, the paper concludes that service users have become more than rule followers and targets of behavioral modification; rather, they are producers of resources that regulatory systems have come to rely on.

Keywords: health care, regulation, resources, social care

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Authors: John M. Frimpong, Matilda K. Owusu-Bio, Caleb Annan

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Business today is highly competitive, and the automobile industry is no exception. Therefore, it is necessary to determine the customer value and service quality measures that lead to customer satisfaction which in turn lead to customer loyalty. However, in the automobile industry, the role of logistics service support in these relationships cannot be undermined. It could be inferred that logistics service supports and its management has a direct correlation with customer service and or service quality. But this is not always the same for all industries. Therefore, this study was to investigate how automobile companies implement the concept of customer service through logistics service supports. In order to ascertain this, two automobile companies in Ghana were selected, and these are Toyota Ghana Limited and Mechanical Lloyd Company Ltd. The study developed a conceptual model to depict the study’s objectives from which questionnaires were developed from for data collection. Respondents were made up of customers and staff of the two companies. The findings of the study revealed that the automobile industry partly attributes their customer satisfaction to the customer value, service quality or customer value. It shows a positive relationship between logistics service supports and service quality and customer value. However, the results indicate that customer satisfaction is not predicted by logistics services. This implies that in the automobile industry, it is not always the case that when customer service is implemented through logistics service supports, it leads to customer satisfaction. Therefore, there is the need for all players and stakeholders in the automobile industry investigate other factors which help to increase customer satisfaction in addition to logistics service supports. It is recommended that logistics service supports should be geared towards meeting customer expectations and not just based on the organization’s standards and procedures. It is necessary to listen to the voice of the customer to tailor the service package to suit the needs and expectations of the customer.

Keywords: customer loyalty, customer satisfaction, customer service, customer value, logistics service supports

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Authors: Imran Badshah

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Pedestrian service time reflects the performance of the facility, and it’s a key parameter to analyze the capability of facilities provided to serve pedestrians. The level of service of pedestrians (LOS) mainly depends on pedestrian time and safety. The pedestrian time utilized by taking a service is mainly influenced by the number of available services and the time utilized by each pedestrian in receiving a service; that is called a delay time. In this paper, we analyzed the simulated pedestrian service time with different delay times. A simulation is performed in AnyLogic by developing a model that reflects the real scenario of pedestrian services such as ticket machine gates at rail stations, airports, shopping malls, and cinema halls. The simulated pedestrian time is determined for various delay values. The simulated result shows how pedestrian time changes with the delay pattern. The histogram and time plot graph of a model gives the mean, maximum and minimum values of the pedestrian time. This study helps us to check the behavior of pedestrian time at various services such as subway stations, airports, shopping malls, and cinema halls.

Keywords: agent-based simulation, anylogic model, pedestrian behavior, time delay

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Authors: Man-Yu Wong, Siyu Zhou, Zhiqiang Cao

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In quality of life, health service utilization is an important determinant of medical resource expenditures on Colorectal cancer (CRC) care, a better understanding of the increased utilization of health services is essential for optimizing the allocation of healthcare resources to services and thus for enhancing the service quality, especially for high expenditure on CRC care like Hong Kong region. In assessing the association between the health-related quality of life (HRQOL) and health service utilization in patients with colorectal neoplasm, count data models can be used, which account for over dispersion or extra zero counts. In our data, the HRQOL evaluation is a self-reported measure obtained from a questionnaire completed by the patients, misreports and variations in the data are inevitable. Besides, there are more zero counts from the observed number of clinical consultations (observed frequency of zero counts = 206) than those from a Poisson distribution with mean equal to 1.33 (expected frequency of zero counts = 156). This suggests that excess of zero counts may exist. Therefore, we study tests for detecting zero-inflation in models with measurement error in covariates. Method: Under classical measurement error model, the approximate likelihood function for zero-inflation Poisson regression model can be obtained, then Approximate Maximum Likelihood Estimation(AMLE) can be derived accordingly, which is consistent and asymptotically normally distributed. By calculating score function and Fisher information based on AMLE, a score test is proposed to detect zero-inflation effect in ZIP model with measurement error. The proposed test follows asymptotically standard normal distribution under H0, and it is consistent with the test proposed for zero-inflation effect when there is no measurement error. Results: Simulation results show that empirical power of our proposed test is the highest among existing tests for zero-inflation in ZIP model with measurement error. In real data analysis, with or without considering measurement error in covariates, existing tests, and our proposed test all imply H0 should be rejected with P-value less than 0.001, i.e., zero-inflation effect is very significant, ZIP model is superior to Poisson model for analyzing this data. However, if measurement error in covariates is not considered, only one covariate is significant; if measurement error in covariates is considered, only another covariate is significant. Moreover, the direction of coefficient estimations for these two covariates is different in ZIP regression model with or without considering measurement error. Conclusion: In our study, compared to Poisson model, ZIP model should be chosen when assessing the association between condition-specific HRQOL and health service utilization in patients with colorectal neoplasm. and models taking measurement error into account will result in statistically more reliable and precise information.

Keywords: count data, measurement error, score test, zero inflation

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Authors: Arellano Karina, Diego Avila-Pesántez, Leticia Vaca-Cárdenas, Alberto Arellano, Carmen Mantilla

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Nowadays, security threats in Voice over IP (VoIP) systems are an essential and latent concern for people in charge of security in a corporate network, because, every day, new Denial-of-Service (DoS) attacks are developed. These affect the business continuity of an organization, regarding confidentiality, availability, and integrity of services, causing frequent losses of both information and money. The purpose of this study is to establish the necessary measures to mitigate DoS threats, which affect the availability of VoIP systems, based on the Session Initiation Protocol (SIP). A Security Model called MS-DoS-SIP is proposed, which is based on two approaches. The first one analyzes the recommendations of international security standards. The second approach takes into account weaknesses and threats. The implementation of this model in a VoIP simulated system allowed to minimize the present vulnerabilities in 92% and increase the availability time of the VoIP service into an organization.

Keywords: Denial-of-Service SIP attacks, MS-DoS-SIP, security model, VoIP-SIP vulnerabilities

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Authors: Badino Manuel, Farias María Alejandra

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Anxiety and depression are considered the main mental health issues found in people with substance-related disorders. Furthermore, substance-related disorders, anxiety-related and depressive disorders are among the leading causes of disability and are associated with increased mortality. The co-occurrence of substance-related disorders and these mental health conditions affect the accuracy in diagnosis, treatment plan, and recovery process. The aim is to describe the prevalence of anxiety and depression in patients with substance-related disorders in a mental health service in Córdoba, Argentina. A descriptive cross-sectional study was conducted among patients with substance-related disorders (N=305). Anxiety and depression were assessed using the Patient Health Questionnaire-4 (PHQ-4) during the period from December 2021 to March 2022. For a total of 305 participants, 71,8% were male, 25,6% female and 2,6% non-binary. As regards marital status, 51,5% were single, 21,6% as a couple, 5,9% married, 15,4% separated and 5,6% divorced. In relation to education status, 26,2% finished university, 56,1% high school, 16,4% only primary school and 1,3% no formal schooling. Regarding age, 10,8% were young, 84,3% were adults, and 4,9% were elderly. In-person treatment represented 64,6% of service users, and 35,4% were conducted through teleconsultation. 15,7% of service users scored 3 or higher for anxiety, and 32,1% scored 3 or higher for depression in the PHQ-4. 13,1% obtained a score of 3 or higher for both anxiety and depression. It is recommended to identify anxiety and depression among patients with substance-related disorders to improve the quality of diagnosis, treatment, and recovery. It is suggested to apply PHQ-4, PHQ-9 within the protocol of care for these patients.

Keywords: addiction, anxiety, depression, mental health

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Authors: Suppawan Lertpongpakpoom, Anongnat Boonrat, Kunya BoontummoSuppawan

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This descriptive cost analysis aimed to analyze the unit cost of patients in medical intensive care unit. Purposive sampling was used to select 20 nurses, 6 practical nurses, 5 nurses aid and select samples 30 patients. Data were collected from both primary source (activity and average time of nursing care) and secondary source Z bill of payment and patient record). Instruments were cost recording form, activity observation form, and service recording form. Content validity of all instruments were evaluated by three experts (CVI = 0.87). Descriptive statistics was employed for data analysis. The results of the Activity-Based Costing Analysis showed that total activity cost of 4 service types for the patients was 14,776.92 Bath. The highest cost was nursing record was 5,674.78 Bath, followed direct nursing activity was 5,176.18 Bath, medical treatment was 1,976.6 Bath. The lowest cost was management activity was 1,003.64 Bath per visit. The result suggested that Activity-Base Costing Analysis could be applied to give better understanding of cost structure, enabling better consideration wasted expense and non-value-added activity, and improvement of effective utilization.

Keywords: activity-based costing, medical intensive care, nursing care, cost analysis

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Authors: Rachel Baruch

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This article describes the implementation of an experimental model for teaching ICT tools and digital environments in teachers training college. In most educational systems in the Western world, new programs were developed in order to bridge the digital gap between teachers and students. In spite of their achievements, these programs are limited due to several factors: The teachers in the schools implement new methods incorporating technological tools into the curriculum, but meanwhile the technology changes and advances. The interface of tools changes frequently, some tools disappear and new ones are invented. These conditions require an experimental model of training the pre-service teachers. The appropriate method for instruction within the domain of ICT tools should be based on exposing the learners to innovations, helping them to gain experience, teaching them how to deal with challenges and difficulties on their own, and training them. This study suggests some principles for this approach and describes step by step the implementation of this model.

Keywords: ICT tools, e-learning, pre-service teachers, new model

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Authors: Bindhiya Thomas, Rehana Hafeez

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Background: The Surgical Ambulatory Unit (SAU) also known as the Same Day Emergency Care (SDEC) is an established part of many hospitals providing same day emergency care service to surgical patients who would have otherwise required admission through the A&E. Prior to Covid, the SAU was functioning as a 12-hour service, but during the Covid crisis this service was transformed to a 24 hour functioning Surgical Ambulatory Assessment unit (SAAU). We studied the effects that this change brought about in-patient care in our hospital. Objective: The objective of the study was to assess the impact of a 24-hour Surgical Ambulatory Assessment unit on patient care during the time of Covid, in particular its role in freeing A&E capacity and delivering effective patient care. Methods: We collected two sets of data retrospectively. The first set was collected over a 6-week period when the SAU was functioning at the Princess Royal University Hospital. On March 23rd, 2020, the SAU was transformed into a 24-hour SAAU. Following this transformation, a second set of patient data was collected over a period of 6 weeks. A comparison was made between data collected from when the hospital had a 12-hour Surgical Ambulatory unit and later when it was transformed into a 24-hour facility. Its effects on the change in the number of patients breaching the four hour waiting period and the number of emergency surgical admissions. Results: The 24-hour Surgical Ambulatory Assessment unit brought significant reductions in the number of patients breaching the waiting period of 4 hours in A&E from 44% during the period of the 12-hour Surgical Ambulatory care facility to 0% from when the 24-hour Surgical Ambulatory Assessment Unit was established. A 28% reduction was also seen in the number of surgical patients' admissions from A&E. Conclusions: The 24-hour SAAU was found to have a profound positive impact on emergency care of surgical patients. Especially during the Covid crisis, it played a crucial role in providing not only effective and accessible patient care but also in reducing the A&E workload and admissions. It thus proved to be a strategic tool that helped to deal with the immense workload in emergency care during the Covid crisis and helped free much needed headspace at a time of uncertainty for the A&E to better configure their services. If sustained, the 24-hour SAAU could be relied on to augment the NHS emergency services in the future, especially in the event of another crisis.

Keywords: Princess Royal University Hospital, surgical ambulatory assessment unit, surgical ambulatory unit, same day emergency care

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Authors: Patcharaporn Sakulpong, Wiriya Phokhwang

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Background: Banpunrug (Love Sharing House) established in 2013 provides a community-based palliative care for patients with cancer from 7 provinces in southern Thailand. These patients come to receive outpatient chemotherapy and radiotherapy at Suratthani Cancer Hospital. They are poor and uneducated; they need an accommodation during their 30-45 day course of therapy. Methods: A community-participatory action research (PAR) was employed to establish a model of palliative care for patients with cancer. The participants included health care providers, community, and patients and families. The PAR process includes problem identification and need assessment, community and team establishment, field survey, organization founding, model of care planning, action and inquiry (PDCA), outcome evaluation, and model distribution. Results: The model of care at Banpunrug involves the concepts of HHHS model, in that Banpunrug is a Home for patients; patients live in a house comfortable like in a Hotel resource; the patients are given care and living facilities similarly to those in a Hospital; the house is a School for patients to learn how to take care themselves, how to live well with cancer, and most importantly how to prepare themselves for a good death. The house is also a humanized care school for health care providers. Banpunrug’s philosophy of care is based on friendship therapy, social and spiritual support, community partnership, patient-family centeredness, Live & Love sharing house, and holistic and humanized care. With this philosophy, the house is managed as a home of the patients and everyone involved; everything is costless for all eligible patients and their family members; all facilities and living expense are donated from benevolent people, friends, and community. Everyone, including patients and family, has a sense of belonging to the house and there is no authority between health care providers and the patients in the house. The house is situated in a temple and a community and supported by many local nonprofit organizations and healthcare facilities such as a health promotion hospital at sub-disctrict level and Suratthani Cancer Hospital. Village health volunteers and multi-professional health care volunteers have contributed not only appropriate care, but also knowledge and experience to develop a distinguishing HHHS community-based palliative care model for patients with cancer. Since its opening the house has been a home for more than 400 patients and 300 family members. It is also a model for many national and international healthcare organizations and providers, who come to visit and learn about palliative care in and by community. Conclusions: The success of this palliative care model comes from community involvement, multi-professional volunteers and distributions, and concepts of HHHS model. Banpunrug promotes a consistent care across the cancer trajectory independent of prognosis in order to strengthen a full integration of palliative

Keywords: community-based palliative care, model, participatory action research, patients with cancer

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Authors: Christian Louis Kühner, Florian Pfeffel, Valentin Nickolai

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Taking care of children, dependents, or pets can be a difficult and time-consuming task. Especially for part- and full-time employees, it can feel exhausting and overwhelming to meet these obligations besides working a job. Thus, working mostly at home and not having to drive to the company can save valuable time and stress. This study aims to show the influence that the working model has on the job satisfaction of employees with care responsibilities in comparison to employees who do not have such obligations. Using structural equation modeling (SEM), the three work models, “work from home”, “working remotely”, and a hybrid model, have been analyzed based on 13 influencing constructs on job satisfaction. These 13 factors have been further summarized into three groups “classic influencing factors”, “influencing factors changed by remote working”, and “new remote working influencing factors”. Based on the influencing factors on job satisfaction, an online survey was conducted with n = 684 employees from the service sector. Here, Cronbach’s alpha of the individual constructs was shown to be suitable. Furthermore, the construct validity of the constructs was confirmed by face validity, content validity, convergent validity (AVE > 0.5: CR > 0.7), and discriminant validity. In addition, confirmatory factor analysis (CFA) confirmed the model fit for the investigated sample (CMIN/DF: 2.567; CFI: 0.927; RMSEA: 0.048). The SEM-analysis has shown that the most significant influencing factor on job satisfaction is “identification with the work” with β = 0.540, followed by “Appreciation” (β = 0.151), “Compensation” (β = 0.124), “Work-Life-Balance” (β = 0.116), and “Communication and Exchange of Information” (β = 0.105). While the significance of each factor can vary depending on the work model, the SEM-analysis shows that the identification with the work is the most significant factor in all three work models and, in the case of the traditional office work model, it is the only significant influencing factor. The study shows that among the employees with care responsibilities, the higher the proportion of working from home in comparison to working from the office, the more satisfied the employees are with their job. Since the work models that meet the requirements of comprehensive care led to higher job satisfaction amongst employees with such obligations, adapting as a company to such private obligations by employees can be crucial to sustained success. Conversely, the satisfaction level of the working model where employees work at the office is higher for workers without caregiving responsibilities.

Keywords: care responsibilities, home office, job satisfaction, structural equation modeling

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Authors: E. V. Kuzmicheva

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An attention is concentrated on a service quality estimation of sport services. A typical mathematical model was developed at the base of the «general economic theory of mass service» accounting pedagogical requirements of fitness services. Also it took into account a dependence of the club member number versus on a value of square of sport facilities. Final recommendations were applied to the fitness club resulted in some improvement of the quality sport service, an increasing of the revenue from club members and profit of clubs.

Keywords: fitness club, efficiency of operation, facilities, service quality, mass service

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Authors: Amina Boukelkoul, Rahil Boukelkoul, Leila Maachia

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The cumulative vapors emitted from the service stations may represent a hazard to the environment and the population. Besides fuel spill and their penetration into deep soil layers are the main contributors to soil and ground-water contamination in the vicinity of the petrol stations. The amount of the effluents from the service stations depends on strategy of maintenance and the policy adopted by the management to reduce the pollution. One key of the proposed approach is the idea of managing the effluents from the service stations which can be captured via use of a finite state Markov chain. Such a model can be embedded within a probabilistic operation and maintenance simulation reflecting the action to be done. In this paper, an approach of estimating a probabilistic percentage of the amount of emitted pollutants is presented. The finite state Markov model is used for decision problems with number of determined periods (life cycle) to predict the amount according to various options of operation.

Keywords: environment, markov modeling, pollution, service station

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Authors: S. K. Subah, R. Tasnim, M. I. Jahan, M. R. Islam

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While talking about how comfortable and convenient Dhaka's bus service is, the minimum emphasis is placed on the female commuters of the Dhaka city. Recognizing the contemporary situation, the supreme focus is to develop experimental model based on statistical methods. SEM has been adopted to quantify passenger satisfaction, which is affected by the perceived service quality. The study deals with 16 observed variables and three latent variables, which were correlated to identify their significance on the regulation of perceived SQ (Service Quality). To calibrate the model, a dataset of 250 responses from female users of local buses has been utilized through survey. A questionnaire structured with SQ variables was prepared in consultation with prevailing literature, practitioners, academicians, and users. The result concludes that the attributes of safe and secured environment have the most significant impact on the overall bus service quality according to the insight of female respondents. The study outcome might be a great help for the policymakers, women's organizations, and NGOs to formulate transport policy that will ensure a women-friendly public bus service.

Keywords: bus service quality, female perception, structural equation modelling, safety-security, women friendly bus

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Authors: Ali Soroush, Mehdi Mirzaei Alavijeh, Touraj Ahmadi Jouybari, Fazel Zinat-Motlagh, Abbas Aghaei, Mari Ataee

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Diabetes is a disease with long cardiovascular, renal, ophthalmic and neural complications. It is prevalent all around the world including Iran, and its prevalence is increasing. The aim of this study was to determine the factors related to self-care behavior based on health belief model among sample of Iranian diabetic patients. This cross-sectional study was conducted among 301 type 2 diabetic patients in Gachsaran, Iran. Data collection was based on an interview and the data were analyzed by SPSS version 20 using ANOVA, t-tests, Pearson correlation, and linear regression statistical tests at 95% significant level. Linear regression analyses showed the health belief model variables accounted for 29% of the variation in self-care behavior; and perceived severity and perceived self-efficacy are more influential predictors on self-care behavior among diabetic patients.

Keywords: diabetes, patients, self-care behaviors, health belief model

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Authors: Zainab Magaji Musa, Nordin M. A. Rahman, Julaily Aida Jusoh

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The web services applications for digital reference service (WSDRS) of LIS model is an informal model that claims to reduce the problems of digital reference services in libraries. It uses web services technology to provide efficient way of satisfying users’ needs in the reference section of libraries. The formal WSDRS model consists of the Z specifications of all the informal specifications of the model. This paper discusses the formal validation of the Z specifications of WSDRS model. The authors formally verify and thus validate the properties of the model using Z/EVES theorem prover.

Keywords: validation, verification, formal, theorem prover

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Authors: Zhankun Wang, Timothy Makubuya

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The efficiency of public sports service of prefecture-level cities in Zhejiang from 2008 to 2012 was evaluated by applying the DEA method, then its influencing factors were also analyzed through Tobit model. Upon analysis, the results revealed the following; (i) the change in average efficiency of public sports service in Zhejiang present a smooth uptrend and at a relatively high level from 2008 to 2012 (ii) generally, the productivity of public sports service in Zhejiang improved from 2008 to 2012, the productivity efficiency varied greatly in different years, and the regional difference of production efficiency increased. (iii) The correlations for urbanization rate, aging rate, per capita GDP and the population density were significantly positive with the public sports service efficiency in Zhejiang, of which the most significant was the aging rate. However, the population density and per capita GDP had less impact on the efficiency of public sports service in Zhejiang. In addition, whether the efficiency of public sports services in different areas in Zhejiang reciprocates to overall benefits in public wellbeing in both rural and urban settings is still arguable.

Keywords: DEA model, public sports service, efficiency, Tobit model, Malmquist productivity index, Zhejiang

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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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Authors: Wai Sang Wu, Florence Pik Sze Mok

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Introduction: Ageing population is one of the hot topics nowadays in the world and this phenomenon is believed to exacerbate continuously in the future. According to the latest information from World Health Organization (WHO) in 2016, the proportion of people aged more than 60 years is projected to be doubled from 12% in 2015 to 22% in 2050 of the world's population. Similarly, according to figures released by the Census and Statistic Department of Hong Kong in 2015, the contribution of elderly aged more than 65 years olds is projected to increase from 15% in 2014 to 34% in 2064 in local community. On the other hand, falls in elderly is a common problem, and it can bring along many negative consequences among elders, such as reducing their mobility level as well as their quality of life. In addition, it can also increase the caring stress of their family caregivers and as well increase the reliance and burden on the medical care system of Hong Kong. Therefore, appropriate measures should be implemented in order to minimize the risk of fall among elders. The objective of this study is to evaluate the effectiveness of the chair-based exercise programme in affecting the balance of the elderly in Hong Kong. Methods: Thirteen healthy subjects (males = 2; females = 11; mean age: 76.2 ± 7.8 years old) were recruited from an elderly social centre in the community to participate in a structural chair-based exercise programme for 6 weeks (1 session per week; 60-minutes per session). Subjects were being assessed on their balance ability using three commonly used clinical assessments, namely, 1) single leg stance (SLS) test, 2) functional reach test, and 3) 360-degree turn test, before and after their participation in the chair-based exercise programme. Pre and post within-subject comparison was adopted to assess the effectiveness of the programme. Results: There was significant improvement (p < 0.05) in all balance parameters of the subjects after their participation in the exercise programme. Elderly demonstrated significant improvement in SLS (p < 0.012), functional reach (p < 0.030) and 360 degree turn (p < 0.043). Conclusions: This study showed that a community chair-based exercise programme is effective in improving the balance ability of the elders. It seems to be another exercise regime that should be promoted among the elders in order to minimize their risk of falls and its negative consequence.

Keywords: balance, chair-based exercise programme, community, elderly

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Authors: Man Kumar Tamang, Uday Narayan Yadav

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Background and objectives: Every country in the world is facing a demographic challenge due to drastic growth of population over 60 years. Adequate diet and nutritional status are important determinants of health in elderly populations. This study aimed to assess the nutritional status among the elderly population and factors associated with malnutrition at the community setting in rural Nepal. Methods: This is a community-based cross-sectional study among elderly of age 60 years or above in the three randomly selected VDCs of Morang district in eastern Nepal, between August and November, 2016. A multi stage cluster sampling was adopted with sample size of 345 of which 339 participated in the study. Nutritional status was assessed by MNA tool and associated socio-economic, demographic, psychological and nutritional factors were checked by binary logistic regression analysis. Results: Among 339 participants, 24.8% were found to be within normal nutritional status, 49.6% were at risk of malnutrition and 24.8% were malnourished. Independent factors associated with malnutrition status among the elderly people after controlling the cofounders in the bivariate analysis were: elderly who were malnourished were those who belonged to backward caste according to traditional Hindu caste system [OR=2.69, 95% CI: 1.17-6.21), being unemployed (OR=3.23, 95% CI: 1.63-6.41),who experienced any mistreatment from caregivers (OR=4.05, 95% CI: 1.90-8.60), being not involved in physical activity (OR=4.67, 95% CI: 1.87-11.66) and those taking medication for any co-morbidities. Conclusion: Many socio-economic, psychological and physiological factors affect nutritional status in our sample population and these issues need to be addressed for bringing improvement in elderly nutrition and health status.

Keywords: elderly, eastern Nepal, malnutrition, nutritional status

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Authors: Chaliya Wamaloon, Malee Chaisaena, Nusara Prasertsri

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Informal caregivers providing home-based palliative and end-of-life (EOL) care to people with advanced cancer is needed, however, there has not been develop caregiver skills for the EOL in cancer patients. The aim of this research was to study the model development of caregiver skills for the EOL in cancer patients. Mixed methods research was conducted in 3 phases. All subjects were in Ubon Rathchathani Cancer Hospital including 30 EOL cancer patient caregivers, 30 EOL cancer patients, and 111 health care professionals who provided care for the EOL cancer patients and 30 EOL target participants who had been trained to be cancer patient caregivers. The research tools were questionnaires, semi structured interviews, and caregiver skills questionnaires. Data were analyzed by using percentage, mean, standard deviation, pair t-test, and content analysis. The result from this study showed the model development of caregiver skills for cancer patients consisted of 9 domains skills: 1. monitoring, 2. interpreting, 3. making decisions, 4. taking action, 5. making adjustments, 6. providing hands-on care, 7. accessing resources, 8. working together with the ill patients, and 9. navigating the healthcare system. The model composed of skills development curriculum for cancer patient caregivers, Manual of palliative care for caregivers, diary of health care records for cancer patients, and the evaluation model of development of caregiver skills for EOL cancer patients. The results of the evaluation in the development model of caregiver skills for EOL cancer patients showed that the caregivers were satisfied with the model of development for caregiver skills at a high level. The comparison of the caregiver skills before and after obtaining the development of caregivers skills revealed that it improved at a statistically significant level (p < 0.05).

Keywords: caregiver, caregiver skills, cancer patients, end of life

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Authors: Asma Batool

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Immigrant families raising a child with developmental disabilities in Canada encounter many challenges during the process of disability care. Starting from the early screening of their child for diagnosis followed by challenges associated with treatment, access and service utilization. A substantial amount of research focuses on identifying barriers. However, the functional aspects of barriers in terms of their potential influences on parents and children with disabilities are unexplored yet. This paper presents functional analysis of barriers in disability care research by adopting a method of integrated approach. Juxtaposition of two developmental approaches, Bronfenbrenner’s ecological model and parents ‘transformational process model is generating multiple hypotheses to be considered while empirically investigating causal relationships and mediating or moderating factors among various variables related with disability care research. This functional analysis suggests that barriers have negative impacts on the physical and emotional development of children with disabilities as well as on the overall quality of family life (QOFL). While, barriers have facilitating impacts on parents, alternatively, the process of transformation in parents expedite after experiencing barriers. Consequently, parents reconstruct their philosophy of life and experience irreversible but continuous developmental change in terms of transformations simultaneously with their developing child and may buffer the expected negative impacts of barriers on disabled child and QOFL. Overall, this paper is suggesting implications for future research and parents’ transformations are suggesting potential pathways to minimize the negative influences of barriers that parents experience during disability care, hence improving satisfaction in QOFL in general.

Keywords: barriers in disability care, developmental disabilities, parents’ transformations, quality of family life

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Authors: Vahid Bairami Rad

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With the rapid growth of the Internet and the globalization of the market, most enterprises are trying to attract and win customers in the highly competitive electronic market. Better e-service quality will enhance the relationship with customers and their satisfaction. So the measurement of eservice quality is very important but it is a complex process due to the complex nature of services. Literature predicts that there is a lack of universal definition of e-service quality. The e-service quality measures in banking have great importance in achieving high customer base. This paper proposes a conceptual model for measuring e-service quality in Iranian Banking Iran. Nine dimensions reliability, ease of use, personalization, security and trust, website aesthetic, responsiveness, contact and speed of delivery had been identified. The results of this paper may help to develop a proper scale to measure the e-service quality in Iranian Banking Industry, which may assist to maintain and improve the performance and effectiveness of e-service quality to retain customers.

Keywords: electronic banking, Dimensions, customer service quality, electronic, communication

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Authors: K. Malak, A. Nourah, S.Liyakathunisa

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Nowadays, healthcare services are facing many challenges since they are becoming more complex and more needed. Every detail of a patient’s interactions with health care providers is maintained in Electronic Health Records (ECR) and Healthcare information systems (HIS). However, most of the existing systems are often focused on documenting what happens in manual health care process, rather than providing the highest quality patient care. Healthcare business processes and stakeholders can no longer rely on manual processes, to provide better patient care and efficient utilization of resources, Healthcare processes must be automated wherever it is possible. In this research, a detail survey and analysis is performed on the existing health care systems in Saudi Arabia, and an automated smart medical healthcare business process model is proposed. The business process management methods and rules are followed in discovering, collecting information, analysis, redesign, implementation and performance improvement analysis in terms of time and cost. From the simulation results, it is evident that our proposed smart medical records system can improve the quality of the service by reducing the time and cost and increasing efficiency

Keywords: business process management, electronic health records, efficiency, cost, time

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Authors: Zhao Jiashen, Serene Goh, Jerry Goo, Anthony Li, Lim Woan Wui, Paul Drakeford, Chen Qing Yan

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Introduction: Emergency laparotomy (EL) is one of the most common surgeries done in Singapore to treat acute abdominal pathologies. A significant proportion of these surgeries are performed in the geriatric population (65 years and older), who tend to have the highest postoperative morbidity, mortality, and highest utilization of intensive care resources. Frailty, the state of vulnerability to adverse outcomes from an accumulation of physiological deficits, has been shown to be associated with poorer outcomes after surgery and remains a strong driver of healthcare utilization and costs. To date, there is little understanding of the impact it has on emergency laparotomy outcomes. The objective of this study is to examine the impact of frailty on postoperative morbidity, mortality, and length of stay after EL. Methods: A retrospective study was conducted in two tertiary centres in Singapore, Tan Tock Seng Hospital and Khoo Teck Puat Hospital the period from January to December 2019. Patients aged 65 years and above who underwent emergency laparotomy for intestinal obstruction, perforated viscus, bowel ischaemia, adhesiolysis, gastrointestinal bleed, or another suspected acute abdomen were included. Laparotomies performed for trauma, cholecystectomy, appendectomy, vascular surgery, and non-GI surgery were excluded. The Clinical Frailty Score (CFS) developed by the Canadian Study of Health and Aging (CSHA) was used. A score of 1 to 4 was defined as non-frail and 5 to 7 as frail. We compared the clinical outcomes of elderly patients in the frail and non-frail groups. Results: There were 233 elderly patients who underwent EL during the study period. Up to 26.2% of patients were frail. Patients who were frail (CFS 5-9) tend to be older, 79 ± 7 vs 79 ± 5 years of age, p <0.01. Gender distribution was equal in both groups. Indication for emergency laparotomies, time from diagnosis to surgery, and presence of consultant surgeons and anaesthetists in the operating theatre were comparable (p>0.05). Patients in the frail group were more likely to receive postoperative geriatric assessment than in the non-frail group, 49.2% vs. 27.9% (p<0.01). The postoperative complications were comparable (p>0.05). The length of stay in the critical care unit was longer for the frail patients, 2 (IQR 1-6.5) versus 1 (IQR 0-4) days, p<0.01. Frailty was found to be an independent predictor of 90-day mortality but not age, OR 2.9 (1.1-7.4), p=0.03. Conclusion: Up to one-fourth of the elderly who underwent EL were frail. Patients who were frail were associated with a longer length of stay in the critical care unit and a 90-day mortality rate of more than three times that of their non-frail counterparts. PPOSSUM was a better predictor of 90-day mortality in the non-frail group than in the frail group. As frailty scoring was a significant predictor of 90-day mortality, its integration into acute surgical units to facilitate shared decision-making and discharge planning should be considered.

Keywords: frailty elderly, emergency, laparotomy

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Authors: Dae-gun Kim, Hyun-joo Kang

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Purpose: The purpose of this study was to investigate the effects of aging on center of pressure, gait angle and gait time. Methods: 29 healthy female college students(FCS) and 28 elderly women (EW) were recruited to participate in this study. A gait analysis system( Gaitview, Korea) was used to collect the center of pressure in static state and gait angle with gait time in dynamic state. Results: Results of the center of pressure do not have significant differences between two groups. In the gait angle test, the FCS showed 1.56±5.2° on their left while the EW showed 9.76±6.54° on their left. In their right, the FCS showed 2.85±6.47° and the EW showed 10.27±6.97°. In the gait angle test, there was a significant difference in the gait time between the female college students and elderly women. A significant difference was evident in the gait time. The FCS on the left was 0.87±0.1sec while the EW’s was 1.28±0.44sec. The FCS on the right was 0.86±0.09sec and the EW was 1.1±0.21sec. The results of this study revealed that the elderly participants aging musculoskeletal system and subsequent changes in their posture altered gait angle and gait time. Therefore, this widening is due to their need to leave their feet on the ground longer for stability slowing their movement. Conclusions: In conclusion, it is advisable to develop an exercise program for the elderly focusing on stability the prevention of falls.

Keywords: center of pressure, gait angle, gait time, elderly women

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Authors: Anu Paul, Varghese Paul

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The focal aspire of e-Government (eGovt) is to offer citizen-centered service delivery. Accordingly, the citizenry consumes services from multiple government agencies through national portal. Thus, eGovt is an enterprise with the primary business motive of transparent, efficient and effective public services to its citizenry and its logical structure is the eGovernment Enterprise Architecture (eGEA). Since eGovt is IT oriented multifaceted service-centric system, EA doesn’t do much on an automated enterprise other than the business artifacts. Service-Oriented Architecture (SOA) manifestation led some governments to pertain this in their eGovts, but it limits the source of business artifacts. The concurrent use of EA and SOA in eGovt executes interoperability and integration and leads to Service-Oriented e-Government Enterprise (SOeGE). Consequently, agile eGovt system becomes a reality. As an IT perspective eGovt comprises of centralized public service artifacts with the existing application logics belong to various departments at central, state and local level. The eGovt is renovating to SOeGE by apply the Service-Orientation (SO) principles in the entire system. This paper explores IT perspective of SOeGE in India which encompasses the public service models and illustrated with a case study the Passport service of India.

Keywords: enterprise architecture, service-oriented e-Government enterprise, service interface layer, service model

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Authors: Tsegahun Manyazewal, Francesco Marinucci, Getachew Belay, Abraham Tesfaye, Gonfa Ayana, Amaha Kebede, Tsegahun Manyazewal, Francesco Marinucci, Getachew Belay, Abraham Tesfaye, Gonfa Ayana, Amaha Kebede, Yewondwossen Tadesse, Susan Lehman, Zelalem Temesgen

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In-service health trainings in Sub-Saharan Africa are mostly content-centered with higher disconnection with the real practice in the facility. This study intended to evaluate in-service training approach aimed to strengthen health care human resources. A combined web-based and face-to-face training was designed and piloted in Ethiopia with the diagnosis of tuberculosis. During the first part, which lasted 43 days, trainees accessed web-based material and read without leaving their work; while the second part comprised a one-day hands-on evaluation. Trainee’s competency was measured using multiple-choice questions, written-assignments, exercises and hands-on evaluation. Of 108 participants invited, 81 (75%) attended the course and 71 (88%) of them successfully completed. Of those completed, 73 (90%) scored a grade from A to C. The approach was effective to transfer knowledge and turn it into practical skills. In-service health training should transform from a passive one-time-event to a continuous behavioral change of participants and improvements on their actual work.

Keywords: Ethiopia, health care, Mycobacterium tuberculosis, training

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Authors: Ajit Kumar Sah, Rajesh Kumar Jha, Phoolgen Sah, Dev Kumar Shah

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Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The purpose of this study was to determine the prevalence of potentially inappropriate medicine (PIM) prescribing in older Nepalese patients in a medicine outpatient department. Beers’ criteria are the most widely used tools to assess PIM to elderly patients. Prospective observational analysis of drugs prescribed in medicine out-patient department (OPD) of a hospital of Bharatpur, Chitwan, Nepal during November 2011 to October 2012 to 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM) in elderly patients was analyzed using Beers Criteria updated to 2013. In the 869 patients included the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%), amlodipine (23.16%), paracetamol (17.6%), salbutamol (15.72%) and vitamin B complex (13.26%). The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with a number of medications prescribed. Further research is warranted to study the impact of PIMs towards health-related outcomes in these elderly.

Keywords: Beers criteria, elderly, polypharmacy, potentially inappropriate medicines

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Authors: Jui-Hung Hung, Ching-Liang Hsieh, Yi-Wen Lin

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Modern medicine highly emphasizes the importance of palliative treatment. The inception of palliative and hospice care recently developed into the concept of caring for the patients’ and families’ physical, psychological and spiritual problems. There are several benefits related to palliative care such as reducing medical expenses, decreasing patients’ suffer, and supporting patient go through the finale of the life. Nowadays, in Taiwan, over 60-70% terminal cancer patients were covered in hospice care, and the coverage rate increased annually. Acupuncture is a well-known therapy used more than thousand years to relieve symptoms of cancer patient. Many reports showed that, even in the Western society, many reputable medical centers can provide Acupuncture therapy for patients. Accordingly, using Acupuncture for cancer patient care is a global trend. There are increased evidences indicate that Acupuncture can relieve the symptoms for cancer patients including pain, reduce the dosage of anesthetic, improve the cancer-related fatigue, relieve the chemotherapy-related nausea and vomiting, ease anxiety mood and even improving the quality of life. Furthermore, some trials show that Acupuncture may help relieve xerostomia, hot flash, sleep disorders, and some GI discomfort and so on. Acupuncture therapy has many advantages for clinical use with effective, low-cost, minimal side effect, suitable for cancer patients and even for elderly population. Especially in nowadays, there are more diversified challenges in modern medicine, all of them will make the higher medical budget. We suggest that Acupuncture will be one of methods for palliative care for cancer patients.

Keywords: Acupuncture, cancer, integrative medicine, palliative care

Procedia PDF Downloads 330