Single Point Of Contact Research Articles

Associations between increased intervention coverage for mothers and newborns and the number and quality of contacts between families and health workers: An analysis of cluster level repeat cross sectional survey data in Ethiopia.

BackgroundSurvival of mothers and newborns depends on life-saving interventions reaching those in need. Recent evidence suggests that indicators of contact with health services are poor proxies for measures of coverage of life saving care and attention has shifted towards the quality of care provided during contacts.Methods and findingsRegression analysis using data from representative cluster-based household surveys and surveys of the frontline health workers and primary health facilities in four regions of Ethiopia in 2012 and 2015 was used to explore associations between increased numbers of contacts or improvements in quality and any change in the coverage of interventions (intervention coverage). In pregnancy, in multiple regression, an increase in the quality indicator ‘focused ANC behaviours’ was associated with a change in both the coverage of iron supplementation and syphilis prevention ((regression coefficients (95% CI)) 0·06 (0·01, 0·11); 0·07 (0·04, 0·10)). This equates to a 0.6% increase in the proportion of women taking iron supplementation and a 0.7% in women receiving syphilis prevention for a 10% increase in the quality indicator ‘focused ANC behaviours’. At delivery, in multiple regression the quality indicator ‘availability of uterotonic supplies amongst birth attendants’ was associated with improved coverage of prophylactic uterotonics (0·72 (0·50, 0·94)). No evidence of any relationships between contacts, quality and intervention coverage were observed within the early postnatal period.ConclusionsIncreases in both contacts and in quality of care are needed to increase the coverage of life saving interventions. For interventions that need to be delivered at multiple visits, such as antenatal vaccination, increasing the number of contacts had the strongest association with coverage. For those relying on a single point of contact, such as those delivered at birth, we found strong evidence to support current commitments to invest in both input and process quality.

Rethinking gamete donor care: A satisfaction survey of egg and sperm donors in the UK.

ObjectiveDespite poor clinic communication and staff treatment being reported by donors, high rates of overall satisfaction are still reported in surveys. This study will evaluate the importance of communication and interaction between donors and fertility clinic staff in gamete donor care.MethodsWe report on 120 egg and sperm donors’ responses to a UK-wide online satisfaction survey. The survey focused on donors’ interactions with fertility clinic staff pre-, during, and post- donation. Basic cross-tabulation was performed on the data using online survey software. Textual data was read and extracts identified, which illustrated and expanded on the findings from the numerical data. Diagrammatic modeling was also utilised to analyse the textual data, with particular focus to relationships between the donors and clinic staff, the main activities within the gamete donation process, and how these activities may affect donor satisfaction with the gamete donation process.ResultsDonors expressed concern for the infertile couple and the resulting child; conveyed frustration at not receiving information on the expenses they could claim; felt lost in the system regarding the ease of making clinic appointments, and once made they were routinely not seen on time for these appointments. Donors also negatively commented on aftercare, the location and condition of the donation room, and information on contraception. In addition, Ovarian Hyperstimulation Syndrome was frequently reported, with these egg donors believing that clinic staff were not concerned with their physical or emotional well-being, but were instead disproportionately focused on extracting the eggs.ConclusionsThe multifaceted notion of donors highlights the complexity inherent to the gamete donation process, which comprises various aspects of uncertainty in the donation system, and ambiguity in the donation process. Categorising donors as Altruist, Customer, and Patient, conveys the particular importance of staff communication and treatment in donor care. These categories are not mutually exclusive however, in that an individual donor may experience more than one of these perspectives during the course of their gamete donation journey. Finally, there were a number of exemplar cases, where donors reported high satisfaction throughout, and these correlated with them being given a single point of contact at the clinic. Subject to resource constraints, we suggest that this practice should be implemented throughout clinics in the UK, so that donors have access to dedicated clinic staff who not only support them emotionally and physically throughout the gamete donation process, but also ensure that communication is open, clear, timely, and consistent.

Load-dependent contact mechanics of particulate assemblies: Multi-variant particle size, shape and surface roughness in advanced materials and process applications

Many of the industrial manufacturing processes of particulate materials are presently modeled using Discrete Element Models (DEM), and in some instances hybrid multi-phase models combining DEM with CFD and other hydrodynamic variants, see Chareyre (2018) and Mehta (2007). The early tribology work in 80s and 90s on load-dependent particle contact mechanics for use in computational algorithms relied on considerations of single-point contacts between smooth elastic and rigid-plastic spheres and curvilinear surface contacts between cylindrical shapes; see Johnson (1985). Later developments included multiple-asperity surface contacts and elastic/plastic surface interactions as well as contact angle variations; see Tuzun and Walton (1992), Tuzun et al. (2004) and Smith and Tuzun (2002a) that include many other references. In this paper, the established theoretical framework is reviewed first for calculating bulk assembly stresses and bulk shear patterns from single-particle contact mechanics highlighting the importance of the particle shape, size and surface roughness. Subsequently, illustrations are provided of the effects of relaxing the assumptions of mono-disperse particle size and shape on the bulk shear patterns observed during slow-shearing, packed assembly flows as seen in chutes and hoppers and in particle heaps respectively. Finally, an analogy is provided between the studies of the deformation response of material composites comprising of particles embedded within a matrix structure to sustained stress-loading and unloading cycles; see Hull and Clyne (2017) and those observed in flowing particle assemblies under compression and shear. Such an analogy can be particularly useful in predicting the flow behaviour of particles “tailor-made” for advanced functionality commonly encountered in applications as widely ranging as multi-phase catalytic reactors and separators, drug manufacture, renewable energy production and storage and in chemical and physical abatement of harmful environmental emissions.

A STUDY OF KNOWLEDGE MANAGEMENT SYSTEM ACCEPTANCE IN HALO BCA

Contact Center is a form of Customer Relationship Management, where customers can interact with a company through its single point of contact and serves mainly as a tool for the company to maintain its service to the customers. Contact center is generally operated by many Agents and can accepts thousands of phone calls every day, depending on the company’s scale and customer base. In order to correctly serve the customers, Agents need to understand many knowledge which the company has, and this is the main reason why Agents need to master the company’s Knowledge Management System (KMS). Inability of Agents to interact with the KMS will be a serious problem for the company. In this paper, we studied the acceptance of Halo Info, a form of KMS in one of the biggest banking contact center in Indonesia, called Halo BCA. We used modified TAM version 2, with a total of 11 variables, 31 indicators, and 12 hypotheses. The research instrument was a 31 items questionnaire. We gathered 283 respondent data, and analyzed it using PLS-SEM. The research findings are: Usage Behaviour (UB) is significantly affected by Intention to Use (IU); IU is proven to be greatly affected by Perceived Ease of Use (PEU), Perceived Usefulness (PU), and Subjective Norm (SN); PEU is significantly affected by System Self-Efficacy (SSE) and Interface Usability (IUSB); PU is significantly affected by Job Relevance (JR) and PEU, but is not significantly affected by Output Quality (OQ), Image (I), Result Demonstrability (RD), and SN.

Effect Of Arm Deweighting Using End-Effector Based Robotic Devices On Muscle Activity.

Deweighting of the limb is commonly performed for patients with a neurological injury, such as stroke, as it allows these patients with limited muscle activity to perform movements. Deweighting has been implemented in exoskeletons and other multi-contact devices, but not on an end-effector based device with single contact point between the assisting robot and the human limb being assisted. This study inves-tigates the effects of deweighting using an end-effector based device on healthy subjects. The muscle activity of five subjects was measured in both static postures and dynamic movements. The results indicate a decrease in the activity of muscles which typically act against gravity - such as the anterior deltoid and the biceps brachii - but also suggest an increase in activity in muscles which act with gravity - such as the posterior deltoid and the lateral triceps. This can be explained by both the change in required muscle-generated torques and a conscious change in approach by the participants. These observations have implications for neurorehabilitation, particularly with respect to the muscle activation patterns which are trained through rehabilitation exercises.

Anomalous Nonlinear Shot Noise at High Voltage Bias.

Since the work of Walter Schottky, it is known that the shot-noise power for a completely uncorrelated set of electrons increases linearly with the time-averaged current. At zero temperature and in the absence of inelastic scattering, the linearity relation between noise power and average current is quite robust, in many cases even for correlated electrons. Through high-bias shot-noise measurements on single Au atom point contacts, we find that the noise power in the high-bias regime shows highly nonlinear behavior even leading to a decrease in shot noise with voltage. We explain this nonlinearity using a model based on quantum interference of electron waves with varying path difference due to scattering from randomly distributed defect sites in the leads, which makes the transmission probability for these electrons both energy and voltage dependent.

Analysis of Spur Gear with Tooth Circular Discontinuity for Weight Reduction

The design of gears and gear drives are becoming challenging in automobile applications in which low contact ratio gears are required to transmit higher loads and be lighter in weight. There are various methods available for optimizing the design. Some researches have been taken place in the areas of gear tooth profile modifications for providing internal stress relief and weight reduction. In most cases, the maximum loads are assumed to be acting on the tip of the tooth. In this study, investigations are carried out on the effect of circular discontinuity on the weight reduction without affecting the root stress. The maximum tangential load is applied on the highest point of single tooth contact. The results show that with the modified gear tooth having a combination of two circular discontinuities of size 0.4 times the module not only provides weight reduction but also gives stress relief at the root.

Effect of friction in a single-tooth fatigue test

The primary objective of the single tooth fatigue test is to generate gear-tooth bending fatigue data at a comparatively low price. Assuming a negligible influence on fatigue data, the effect of friction is not evaluated. The aim of this study is to evaluate the effect of tooth friction on tooth bending fatigue life and on the location of the crack initiation site in a single-tooth fatigue test of case carburized steel spur gear. By using Neuber’s rule, tooth root stresses predicted by means of two-dimensional elastic finite element analysis are translated into estimates of elastic-plastic stress and strain behaviour. The fatigue life and location of crack initiation site are predicted on the basis of the strain-life approach with consideration of mean stress, surface finish and residual stress effects. Two load models are considered. In the first load model, which represents the operating principle commonly used in practice, the test tooth is loaded through the actuating arm. In the second one, which is proposed in this study, the test tooth supports the reaction through the fixed anvil. In both load models, the test tooth is contacted at the highest point of single tooth contact, while the other one is contacted at a lower position along the tooth profile. The computational model is validated against experimental crack initiation lives from literature. The study revealed that friction has a more significant impact on tooth bending fatigue life and location of the crack initiation for the first load model as opposed to the second one.

Medical Home-Head Start Partnership to Promote Early Learning for Low-Income Children.

To improve Early Head Start/Head Start (EHS/HS) screening, referral, and enrollment for children from diverse, low-income communities. Using existing resources, we built a pediatric clinic-Head Start partnership. Key steps included (1) screening protocol and tracking system, (2) a community partner as a single point of referral contact, (3) provider education, and (4) monthly outcome reporting. A pre- and post-cross-sectional study design was used to evaluate outcomes, with medical chart review conducted for all wellness visits among children aged 0 to 4 years pre- and postintervention. The preintervention group included 223 patients. The postintervention group included 235 patients. EHS/HS screening improved significantly after the intervention, rising from 8% in the preintervention period to 46% in the postintervention period (odds ratio [OR] 10.5, 95% confidence interval [CI] [5.9, 19.4]). EHS/HS documented referral rates increased from 1% in the preintervention period to 20% in the postintervention period (OR 18.3, 95% CI [5.7, 93.6]). Thirty-two of the 42 patients in the postintervention group referred to EHS/HS were reached to determine enrollment status. Six children (14%) had enrolled in EHS/HS. With use of existing resources, a medical home-Head Start partnership can build an integrated system that significantly improves screening and referral rates to early learning programs.

Online Identification of Environment Hunt–Crossley Models Using Polynomial Linearization

Online environment dynamic estimates are often used for the control of robots, telerobots, and haptic systems. The nonlinear Hunt–Crossley (HC) model, which is physically consistent with the behavior of soft objects with limited deformation at a single point of contact, is being increasingly used in robotic control systems. The HC model can be identified online using a single-stage log linearization technique; however, the accuracy and applicability of the existing method is limited. We propose a two-stage polynomial identification method, which uses a quadratic approximation in the first stage to generate a linearly parameterized model of the HC dynamics (Quad-Poly). The coefficients of the Quad-Poly model are then used in the second stage to extract the HC parameters using a lookup table and recursive least squares parameter estimation. The proposed method is experimentally assessed against a previous natural logarithm linearization method, and further tested for time-varying environment dynamics and human-generated trajectories and for robustness against uncertainties in the measured data and system parameters.

Beliefs and expectations of rural hospital practitioners towards a developing trauma system: A qualitative case study

BackgroundAn understanding of stakeholders’ views is key to the successful development and operation of a rural trauma system. Scotland, which has large remote and rural areas, is currently implementing a national trauma system. The aim of this study was to identify key barriers and enablers to the development of an effective trauma system from the perspective of rural healthcare professionals. MethodsThis is a qualitative study, which was conducted in rural general hospitals (RGH) in Scotland, from April to June 2017. We used an opportunistic sampling strategy to include hospital providers of rural trauma care across the region. Semi-structured interviews were conducted, recorded, and transcribed. Thematic analysis was used to identify and group participant perspectives on key barriers and enablers to the development of the new trauma system. ResultsWe conducted 15 interviews with 18 participants in six RGHs. Study participants described barriers and enablers across three themes: 1) quality of care, 2) interfaces within the system and 3) interfaces with the wider healthcare system. For quality of care, enablers included confidence in basic trauma management, whilst a perceived lack of change from current management was seen as a barrier. The theme of interfaces within the system identified good interaction with other services and a single point of contact for referral as enablers. Perceived barriers included challenges in referring to tertiary care. The final theme of interfaces with the wider healthcare system included an improved transport system, increased audit resource and coordinated clinical training as enablers. Perceived barriers included a rural staffing crisis and problematic patient transfer to further care. ConclusionsThis study provides insight into rural professionals’ perceptions regarding the implementation of a trauma system in rural Scotland. Barriers included practical issues, such as retrieval, transfer and referral processes. Importantly, there is a degree of uncertainty, discontent and disengagement towards trauma system development, and concerns regarding staffing levels and governance. These issues are unlikely to be unique to Scotland and warrant further study to inform service planning and the effective delivery of rural trauma systems.

The Connected Care Program - changing the way we care for Queensland’s most vulnerable children with acute healthcare needs

Introduction: In 2013, Children’s Health Queensland Hospital and Health Service implemented the Connected Care Program (CCP), a statewide network of care coordinators to support children with medical complexity and their families. The coordinators, as part of the CCP, have worked in partnership with families, caregivers and health care teams across Queensland to improve communication and coordination of care, ensuring a child’s care program is managed seamlessly across the various services, specialists and facilities. Eligibility for CCP is children <16 for new patients or <18 for continuing patients, or until discharged from paediatric care. Eligibility criteria are based on chronicity, complexity, fragility and intensity of care needs. A referral is required from a clinical specialist.Practice Changes, Aims: The aim of the CCP is to coordinate access to health care providers and support services families need for their child, from their local hospital and health service (HHS) and, if required, across the state. CCP provides a single point of contact for families for support and assistance, which is done locally by a care coordinator or centrally by a team of coordinators for each child enrolled in the CCP. All medical specialists regularly involved in the care of the child are engaged as part of the child’s care team, including a General Practitioner. The creation of the care coordinator role, in partnership with lead specialists has enhanced clinical and family decision-making.Highlights: In the last two years of operations (2015-17), this statewide service delivered the following sustained improvements to patients’ care outcomes:56.5% reduction in total aggregated length of stay across all admissions;56.6% reduction in average inpatient length of stay;19.48% reduction in unplanned emergency department presentations;61.7% improvement in coordinated scheduling of Outpatient Department appointments;6% increase in patient visits to Lady Cilento Children’s Hospital (LCCH) where >2 outpatient services were combined;The 2015 pilot evaluation also identified the following outcomes:25.25% reduction patients needing to fly from regional, rural or remote communities to LCCH to access specialist paediatric services;18% increase in pharmacist medication reviews (eLMS)35% increase in pharmacy liaison support with local pharmacies to deliver local solutions;95% patient/family satisfaction; and92% Care Coordinator role satisfaction.Format/Model Structure: Through the CCP’s hub-and-spoke model, all 16 Queensland HHSs have access to the service via in-situ care coordinators or outreach provided by the LCCH Hub.20 FTE Care Coordinators (Clinical Nurses) located across Queensland1 FTE Senior Allied Health Coordinator1 FTE Welfare Officer (statewide support)1 FTE Senior Pharmacist (statewide support)1 FTE Allied Health Assistant1 FTE Indigenous Health Liaison Officer Conclusions/Learnings/Take away:Care coordination across Queensland can be delivered in a centrally-managed hub-and-spoke model to effect positive health outcomes for children with medical complexity.Local coordination can improve the way statewide services deliver care from a patient outcome and satisfaction perspective.How rewarding the work can be for health professionals when patient outcomes and satisfaction are realised through coordinating enhanced patient and family-centred services.Patients and families from across Queensland are highly satisfied with the model.

Defense and Veterans Brain Injury Center: The First 25 Years

Defense and Veterans Brain Injury Center: The First 25 Years

A Compact Single-Cantilever Multicontact RF-MEMS Switch With Enhanced Reliability

This letter presents a novel cantilever and electrode biasing design of a metal-contact radio frequency microelectromechanical systems (RF-MEMS) switch to integrate multiple contact points in a single cantilever to improve the reliability of the switch. In the design presented in this letter, multiple contact points are integrated in a single cantilever. The contact points are used to conduct RF current one by one until one point fails. To switch between the contact points, two actuator electrodes are placed under the cantilever and biased with different voltages and the touching point between the cantilever and bottom RF electrode are changed. The parasitic capacitance of the switch is kept to be the same with that of a single contact point RF-MEMS switch. The OFF-state isolation will not be worsen, while accumulation of the lifetime of each contact point can improve the overall lifetime of the switch. Without the need of shrinking the actuator to maintain small parasitics capacitance, the contact force is also not sacrificed when comparing to the case of putting several miniature switches together. The performance and reliability improvement of the switch are experimentally demonstrated. The insertion losses of the switch of different contact points are <1 dB, and the isolation is better than 10 dB up to 20 GHz.

EFEKTIVITAS KINERJA IT SUPPORT MENGGUNAKAN FUNGSI SERVICE DESK SEBAGAI SINGLE POINT OF CONTACT (SPOC): STUDI KASUS PT XYZ

Service desk is Single Point Of Contact (SPOC) for every problem in every organization that has implemented IT-IL (Information Technology Infrastructure Library.) As SPOC is the spearhead that connects between customer and organization to improve service in company IT Support PT XYZ has run Service desk function, the problem is: is there any influence of success factor servicedesk to servicedesk performance process in it support? The problems contained in the question above are the object of research, which is expected to produce the desired answer, by conducting the research, using the primary data of the sample. Primary data is taken from field survey that is spread questioner to the selected sample. The data obtained will be used for the purposes of multiple regression analysis process, as well as to test the hypothesis of the influence of success factors servicedesk on the performance of servicedesk in it support. The result of the test and analysis is expected to give improvement in support in daily operaional using service desk function.

Multidisciplinary coordinated care for Type 2 diabetes: A qualitative analysis of patient perspectives

AimsTo explore the patient perspective on coordinated multidisciplinary diabetes team care among a socioeconomically diverse group of adults with type 2 diabetes. MethodsQualitative research design using 8 focus groups (n=53). We randomly sampled primary care patients with type 2 diabetes and conducted focus groups at their primary care clinic. Discussion prompts queried current perceptions of team care. Each focus group was audio recorded, transcribed verbatim, and independently coded by three reviewers. Coding used an iterative process. Thematic saturation was achieved. Data were analyzed using content analysis. ResultsMost participants believed that coordinated multidisciplinary diabetes team care was a good approach, feeling that diabetes was too complicated for any one care team member to manage. Primary care physicians were seen as too busy to manage diabetes alone, and participants were content to be treated by other care team members, especially if there was a single point of contact and the care was coordinated. Participants suggested that an ideal multidisciplinary approach would additionally include support for exercise and managing socioeconomic challenges, components perceived to be missing from the existing approach to diabetes care. ConclusionsCoordinated, multidisciplinary diabetes team care is understood by and acceptable to patients with type 2 diabetes.

Single Point Contact Strip-Width-Maximization Machining Optimization for Sculptured Surface Using Non-ball-end

Single Point Contact Strip-Width-Maximization Machining Optimization for Sculptured Surface Using Non-ball-end

Computational domain discretization in numerical analysis of flow within granular materials

The discretization of computational domain is a crucial step in Computational Fluid Dynamics (CFD) because it influences not only the numerical stability of the analysed model but also the agreement of obtained results and real data. Modelling flow in packed beds of granular materials is a very challenging task in terms of discretization due to the existence of narrow spaces between spherical granules contacting tangentially in a single point. Standard approach to this issue results in a low quality mesh and unreliable results in consequence. Therefore the common method is to reduce the diameter of the modelled granules in order to eliminate the single-point contact between the individual granules. The drawback of such method is the adulteration of flow and contact heat resistance among others. Therefore an innovative method is proposed in the paper: single-point contact is extended to a cylinder-shaped volume contact. Such approach eliminates the low quality mesh elements and simultaneously introduces only slight distortion to the flow as well as contact heat transfer. The performed analysis of numerous test cases prove the great potential of the proposed method of meshing the packed beds of granular materials.

Computational domain discretization in numerical analysis of flow within granular materials

The discretization of computational domain is a crucial step in Computational Fluid Dynamics (CFD) because it influences not only the numerical stability of the analysed model but also the agreement of obtained results and real data. Modelling flow in packed beds of granular materials is a very challenging task in terms of discretization due to the existence of narrow spaces between spherical granules contacting tangentially in a single point. Standard approach to this issue results in a low quality mesh and unreliable results in consequence. Therefore the common method is to reduce the diameter of the modelled granules in order to eliminate the single-point contact between the individual granules. The drawback of such method is the adulteration of flow and contact heat resistance among others. Therefore an innovative method is proposed in the paper: single-point contact is extended to a cylinder-shaped volume contact. Such approach eliminates the low quality mesh elements and simultaneously introduces only slight distortion to the flow as well as contact heat transfer. The performed analysis of numerous test cases prove the great potential of the proposed method of meshing the packed beds of granular materials.

Experimental investigation of spur gear strength using photoelasticity

In this work, the maximum stresses, which are developed in the crucial toe section of spur gears being in contact and subjected to loading at the Highest Point of Single Tooth Contact (HPSTC), are numerically and experimentally studied. The results indicate that the deviation between the methods considered increase with increasing number of teeth of the gear, while the teeth number of the pinion remains constant. In addition it is shown that the deviations remain within acceptable limits.