Presence Of Equipment Research Articles

Perceptions, Satisfaction, and Barriers to Telemedicine Use: A Community-Based Study From Jeddah, Saudi Arabia.

Background Telemedicine has expanded significantly, driven by technology and the necessity for accessible healthcare. However, users' knowledge, attitudes, and perceived barriers determine its application. This study aimed to assess these factors among patients in Jeddah, Saudi Arabia. Methodology We conducted a cross-sectional study on 403 participants from Ministry of Health centers in Jeddah from February to May 2023. A structured questionnaire was used for data collection, and subsequent analysis was performed using SPSS version 28.0 (IBM Corp., Armonk, NY, USA). Results Most participants (93.1%) agreed that telehealth services have improved healthcare accessibility and expressed willingness to participate in future telemedicine consultations. However, 73.7% felt potential embarrassment or discomfort due to camera and equipment presence. Remarkably, 76.2% of participants believed telemedicine suits all medical conditions, and 95% recommended its use. Barriers to telemedicine use were identified, including the need to travel to access healthcare services in the absence of telemedicine and the associated inconvenience and cost. The overall satisfaction score was 4.56 ± 0.78, with the highest satisfaction reported for the ability to talk freely over telemedicine (4.64 ± 0.76) and the ease of registration/scheduling (4.63 ± 0.82). Significant differences (p < 0.001) in satisfaction scores were found across various age groups, gender, nationality, employment status, and education level. Patients aged >55 years and those who used telemedicine services for the first time were associated with a significantly increased risk of poor satisfaction (odds ratio (OR) = 8.068, p = 0.011 and OR = 8.919, p = 0.005, respectively). Conclusions The findings suggest high satisfaction and positive attitudes toward telemedicine services in Jeddah, Saudi Arabia, despite identifiable barriers such as potential discomfort from camera presence. Patient age and familiarity with telemedicine services significantly influenced satisfaction levels, indicating areas that require attention for the successful implementation and expansion of telemedicine in Saudi Arabia.

INJURIES RISK ASSESSMENT FOR EMPLOYEES WITH DISABILITIES AT THE MANUAL TRANSFERRING OF LOADS

The employment of persons with permanent functional changes in health state is a difficult issue taking into account the fact that, in addition to objective risks caused by the presence of equipment, vehicles and other sources of potential hazards in the production environment, there are subjective risks related to psychophysiological features of a person. The vulnerability of persons with disabilities, compared to other workers, leads to discrimination in employment on the workplaces, because employers tend to consider them as a potential direct or indirect source of increasing the level of injuries or accidents in the company. The lack of qualified specialists in most Ukrainian enterprises capable to assess the risks and implement the principle of reasonable adaptation of equipment and technological processes to the special needs of persons with disabilities determines the need to develop risk assessment methods that will allow effective management decisions to be made to ensure safety at employees' workplaces. The article proposes a method that allows assessing the risks of manual transferring of loads and takes into account the limitations of the life activities of persons with disabilities who, according to the conclusions of the medical and social expert commission, can do this work. The risk assessment methodology was developed on the basis of the international standard EN 1005-2 Safety of machinery – Human physical performance and adapted taking into account the peculiarities of the national legal framework. At the calculation of the risk, it is suggested to use a coefficient that depends on the degree of severity of life restrictions in relation to loads on the musculoskeletal system, established by the medical and social expert commission. This allows making the effective preventive decisions. For example, obtaining the value of the RІІ risk index at the level of 1.42 at the lifting a load weighing 10 kg, which is characterized as an unacceptable risk, can be adjusted both by changing the organization of the workplace and by reducing the weight of the load by 4 kg. The use of the methodology allows specialists who are responsible for the safety to assess risks and use the labour potential of employees without harming their health and increasing the level of industrial injuries. Keywords: risk, worker with disability, trauma, manual transferring of loads.

An Evaluation of the Quality of CPR Chest Compressions Performed on Football-Equipped and Obese Simulation Manikins

Objective Protective athletic equipment may hamper the delivery of effective chest compressions. Unfortunately, an algorithm for managing cardiac arrest emergencies with equipment-laden athletes has yet to be established by national CPR certifying agencies. Further, athletes classified as being overweight or obese carry adipose in the thoracic region, which has been reported to inhibit the ability of rescuers to provide quality chest compressions. Thus, the purpose of this study was two-fold. The first purpose was to assess the ability of emergency responders to perform CPR chest compressions on an obese manikin. The second purpose was to analyze the effect of American football protective equipment on the performance of chest compressions by emergency responders. Methods Fifty emergency responders completed four 2-minute bouts of compression-only CPR. The scenarios included performing chest compressions on both traditional and obese CPR manikins, and performing chest compressions over a set of shoulder pads/chest protector that is used in the sport of American football on both traditional and obese manikins. Results The most notable outcomes in this study were related to chest compression depth, which fell well below the minimum recommended depth published by the American Heart Association in all conditions. Mean compression depth was significantly lower when performed on the obese manikin (avg over pads = 32.8, SD = 9.2 mm; avg no pads = 38.2, SD = 9.1 mm) compared to the traditional manikin (avg over pads = 40.0, SD = 10.9 mm; avg no pads = 40.8, SD = 14.8 mm), with statistical analyses revealing a significant effect due to both manikin size (p < 0.001) and the presence of equipment (p = 0.003), and a statistically significant interaction effect (p = 0.035). Chest recoil data revealed a statistically significant effect due to both manikin size (p = 0.017) and the presence of chest/shoulder safety pads (p = 0.003). Conclusion Within this sample of emergency responders, chest compressions were adversely affected both by the equipment and obesity. Additionally, the traditional manikin received comparable chest compressions regardless of the presence or absence of football protective equipment, albeit both conditions resulted in poor depth performance.

Analysis of the Influence of the Gas Infrared Heater and Equipment Element Relative Positions on Industrial Premises Thermal Conditions

The creation of local heated areas in large-sized premises using systems based on gas infrared heaters has recently become the most rational alternative in terms of energy efficiency. However, the lack of information about the thermal characteristics in such areas limits the effective application of these systems. To determine the main thermal parameters characterizing the scheduled thermal conditions in heated local working areas of industrial premises, experimental and mathematical modeling of heat transfer processes in a closed area with the presence of equipment in it was carried out. The experimental area was equipped with a gas infrared heater and a model of the equipment (a horizontally oriented panel). The system of equations of thermal conductivity, radiant heat transfer, as well as energy and Navier–Stokes was solved by the finite element method. A significant influence of the equipment position on the temperature field and the air movement hydrodynamics in the local working area has been established. The equipment presence in the room intensifies the air movement due to thermal convection and, as a result, a more uniform temperature distribution over the local working area was obtained. Analysis of the obtained results shows the possibility to control the temperature fields’ formation in local working areas during the gas infrared heater operation by varying the position and configuration of the equipment in the room.

An Image Processing Protocol to Extract Variables Predictive of Human Embryo Fitness for Assisted Reproduction

Despite the use of new techniques on embryo selection and the presence of equipment on the market, such as EmbryoScope® and Geri®, which help in the evaluation of embryo quality, there is still a subjectivity between the embryologist’s classifications, which are subjected to inter- and intra-observer variability, therefore compromising the successful implantation of the embryo. Nonetheless, with the acquisition of images through the time-lapse system, it is possible to perform digital processing of these images, providing a better analysis of the embryo, in addition to enabling the automatic analysis of a large volume of information. An image processing protocol was developed using well-established techniques to segment the image of blastocysts and extract variables of interest. A total of 33 variables were automatically generated by digital image processing, each one representing a different aspect of the embryo and describing a different characteristic of the blastocyst. These variables can be categorized into texture, gray-level average, gray-level standard deviation, modal value, relations, and light level. The automated and directed steps of the proposed processing protocol exclude spurious results, except when image quality (e.g., focus) prevents correct segmentation. The image processing protocol can segment human blastocyst images and automatically extract 33 variables that describe quantitative aspects of the blastocyst’s regions, with potential utility in embryo selection for assisted reproductive technology (ART).

Children's Views Toward Their Peers With Disabilities During Early Childhood

In this study, it was aimed to examine the opinions of preschool children towards their peers with disabilities and the characteristics that affect these views. This research is a qualitative study. In the research in which qualitative data analysis techniques are used, the basic data collection source is the semi-structured interview form. The study group consisted of 68 children between the months of 36 and 72 who attend kindergarten. In the analysis of the research findings, qualitative data were evaluated by content analysis. As a result of the research; In the post-test application regarding the appearance features of dolls with disabilities, the children in the age group of 3, 4 and 5; It was seen that they made definitions in the category of " describing the disability condition ". In the post-test application regarding the playmate preference of the children, the majority; It has been observed that they accept dolls with disabilities as playmates on the grounds of "not having experience" and "presence of equipment" in the age group of 3, and "activity content" and "having experience" in the age group 4 and 5. In addition "What games would you like to play?" question’s answers were evaluated, it was seen that all the children gave answers in the "games adapted to the disability condition" category in the post-test application.

Multidimensional routing with the increased navigation accuracy with the maintenance of flight notifications of the flight vehicles

The article covers the problem the multidimensional routing of flights for the transportation of cargo and mail, with the condition of the corresponding equipment presence for performing navigation of increased precision to obtain the possibility of the formation flights under any weather conditions. The given circumstances are capably essential to reduce load while using the airspace, which will make it possible to achieve transportation independent of its saturation. While planning the routes it is also necessary to consider the interests of different interested groups, which are often opposite to one another. In the view of the different directivity of the tasks in question, the solution can require the sorting as excessively as large, so the smaller quantity of possible situations (versions of the solution), the lower the level of the calculation of these versions is, and the greater their quantity is. The exact example of multidimensional routing, which is affected by the interests of operational nature and the interests of the urgency of the performance of the claims, expressed by weight coefficients, is depicted in this work. The only version in favour of the general production process, which is obtained with the help of a genetic algorithm, is a solution of this problem. It was necessary to introduce some designations and assumptions, the enumeration of which can be supplemented. Optimal solution can be obtained both by the enumeration of the solution versions and with the help of the genetic algorithm, which is allowed for a smaller number of iterations, to obtain suboptimal in real time, which corresponds to the conditions of the task solution. In that the example dynamic priorities are assigned, based on multiplicative form by expert evaluation, which form criteria for the ranking of request for each step of route planning. As a result, there are the exact versions of the solution, which correspond to the interests of different groups and the version, obtained with the help of a genetic algorithm, which satisfy the opposite interests of these groups. All versions of the solution are proved to be different, which indicates the need of applying the objective and substantiated apparatus for making the decision, which the genetic algorithm actually is. The proposed mathematical apparatus has prospects for implementation.

Improvement of Indoor Residual Spraying and Long\u2010Lasting Insecticidal Net services through structured monitoring and supervision as part of the Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh

BackgroundThe Government of Madhya Pradesh employed Indoor Residual Spraying (IRS) with alpha-cypermethrin synthetic pyrethroids in sub-centres with Annual Parasite Incidence (API) from 2 to 4.99. In sub-centres with API more than 5, Long-Lasting Insecticidal Nets (LLINs) were distributed. At the request of the State Government, the Malaria Elimination Demonstration Project (MEDP) staff observed and provided support to both IRS and LLINs campaigns. In the year 2017, the study team monitored only the IRS campaigns, however, in the year 2018, the supportive supervision was provided to the IRS campaign teams along with post-distribution monitoring of the LLINs.MethodsThe study was carried out during IRS spraying using a pre-tested, closed-ended monitoring checklist which consisted of two parts- observations of spraying team and observation of sprayed houses. For LLINs, a sample of the households that received the bed nets was taken for the study. For IRS, the spraying teams were monitored for quality and technique for a total of 159 times in 2017 and 183 times in the year 2018, respectively. For post spraying observations, a total of 1261 and 1791 households were observed in the years 2017 and 2018, respectively. The use of LLINs was observed in 5 % of the households in 2018 and 2020, which is about 2,000 houses in each survey where each house received about 2.5 LLINs per household. The results of surveys were compared to assess impact of supportive supervision and monitoring.ResultsSignificant improvement was noted after supportive supervision in year 2018 in various aspects of spraying. Preparedness of spraying, such as advance information to villagers, presence of equipment and records improved by up to 70 %. The methodology of spraying preparation improved from 50 to 90 %, spraying technique improved from 54 to 80 %, and proper use equipment during spraying improved from 51 to 92 %. After eight months post distribution of the LLINs in 2019, improvement was seen in regular usage of LLINs by 28 %. It was found that on-spot demonstrations during distribution and carrying of LLINs when sleeping outside homes increased by 56 %. Results of IEC campaigns revealed the reduction in adverse effects by 64 % and increase in awareness by 97 %.ConclusionsEffective supervision improved the quality of IRS and usage of LLINs in the study area. Based on these results, continued training and monitoring of staff that is deployed to spraying houses and distribute bed nets was suggested. The study also revealed that proper IEC/BCC drives help increase community acceptance of vector control measures and their rational usage.

Multiscale deep bidirectional gated recurrent neural networks based prognostic method for complex non-linear degradation systems

Reliable estimation of the remaining useful life (RUL) of complex engineered systems plays a vital role in avoiding undue maintenance situations while guaranteeing system safety. However, efficient tracking of RUL often gets hampered by the prerequisite for prior knowledge regarding degradation characteristics of critical components, which are not available in most cases. Additionally, machine learning techniques face difficulties in adapting and modeling degradation trends in the presence of equipment’s complex working environments. To address these issues, we present a novel data-driven feature learning approach based on a multi-scale deep bidirectional gated recurrent neural network (MDBGRU). The MDBGRU network can: i) automatically learns both local and global information in addition to temporal variations in the multivariate sensor data; ii) capture salient discriminative features characterizing the system complexity; iii) overcome the pre-expertise requirement on multiple sub-components of the system; and iv) curb shortcomings of machine learning methods. Extensive experiments are performed on the C-MAPSS dataset to evaluate the prognostic capability of the proposed method. Compared with the existing works, our network attains enhanced prediction accuracy with an overall improvement of 13.54%, suggesting this as a new and promising RUL estimation approach.

Peculiarities of Spondylitis in the Patients Undergoing Program Hemodialysis (Case Report)

Relevance. The surgical treatment of spinal diseases and injuries in the patients on hemodialysis is one of the most complicated problems of the spine surgery, since such a surgery is associated with an increased risk of infectious complications and perioperative mortality. The case description. A 59-year-old female came to the clinic complaining back pain. Th8-9 vertebrae spondylitis complicated by an epidural and paravertebral abscess with pertinent neurological disorders and bilateral pneumonia were diagnosed. The patient had been on hemodialysis for 18 years due to the end-stage chronic kidney disease complicated by uremic osteodystrophy. The surgical debridement and stabilization of the spine were performed in one stage posterior approach using a titanium mesh implant in combination with autologous bone and posterior instrumentation. A regression of neurological disorders and the pain syndrome relief were achieved. In the late postoperative period, the instability of the posterior fixation developed twice, requiring restabilization. Within the following 3.5 years after the operation, the pain syndrome had not returned. Conclusion. The presence of equipment for hemodialysis and a multidisciplinary approach allow to achieve the positive results in the surgical treatment of inflammatory diseases of the spine in the patients with endstage chronic kidney disease.

Analysis of infant physical activity in the childcare environment: An observational study

This study utilized behavior-mapping to describe behavior and levels of activity in infants attending Early Childhood Education and Care (ECEC). Descriptive statistics were used to determine proportion of time spent in certain locations, body positions, activities and engagement with others. To establish whether location, the presence of equipment or engagement with others influenced levels of activity, a paired t-test was used. Results indicated that of all locations, infants spent the greatest amount of time in the meals area (35%), with half of this period spent physically inactive (sedentary). The indoor play area was where infants were most active. Infants also spent a significantly greater proportion of their upright time (64%) supported by either furniture or equipment than without (MD 28, 95% CI 13–44, p < 0.01). Interestingly, infants displayed more sedentary behavior when engaged with others than when not engaged (MD 21, 95% CI 6–36, p < 0.01). The environment, presence of others and equipment availability appear to influence activity levels of infants in ECEC centers. Findings suggest that time spent in meal areas, provisions of furniture/equipment, and opportunities for infants to play independently warrant further exploration to determine their influence on activity levels in typically-developing infants.

Environmental factors to promote the use of a Public Park in adults

The aim of this study was to describe environmental factors that motivate public park use according to users’ sociodemographic characteristics. A cross-sectional study was carried out in 2014/2015 in a park in the city of Florianopolis, Brazil. A face-to-face interview was performed, including sociodemographic data and environmental factors that stimulate park use. Descriptive analysis, chi-square and Z-tests were used to compare the proportions between groups, adopting a significance level of p &lt; 0,05. The sample included 377 park users, aged 18 years or older (59.7% women). The architectural beauty of structures, geographic location, technological factors, normative policies, values and attitudes were reported as the main factors that motivate park use (p &lt; 0.05). The presence of equipment and public programs in parks were more frequently mentioned as motivational factors for park use among women than men (p &lt; 0.05). Architectural structures and notice boards and posters had higher proportions among users who had an elementary and high school level (p &lt; 0.05). In conclusion, the existing environmental factors seem to have an impact on the motivation for park use, changing according to users’ sociodemographic aspects.

A Comparison of Cervical Spine Motion After Immobilization With a Traditional Spine Board and Full-Body Vacuum-Mattress Splint.

Background:The National Athletic Trainers’ Association (NATA) advocates for cervical spine immobilization on a rigid board or vacuum splint and for removal of athletic equipment before transfer to an emergency medical facility.Purpose:To (1) compare triplanar cervical spine motion using motion capture between a traditional rigid spine board and a full-body vacuum splint in equipped and unequipped athletes, (2) assess cervical spine motion during the removal of a football helmet and shoulder pads, and (3) evaluate the effect of body mass on cervical spine motion.Study Design:Controlled laboratory study.Methods:Twenty healthy male participants volunteered for this study to examine the influence of immobilization type and presence of equipment on triplanar angular cervical spine motion. Three-dimensional cervical spine kinematics was measured using an electromagnetic motion analysis system. Independent variables included testing condition (static lift and hold, 30° tilt, transfer, equipment removal), immobilization type (rigid, vacuum-mattress), and equipment (on, off). Peak sagittal-, frontal-, and transverse-plane angular motions were the primary outcome measures of interest.Results:Subjective ratings of comfort and security did not differ between immobilization types (P > .05). Motion between the rigid board and vacuum splint did not differ by more than 2° under any testing condition, either with or without equipment. In removing equipment, the mean peak motion ranged from 12.5° to 14.0° for the rigid spine board and from 11.4° to 15.4° for the vacuum-mattress splint, and more transverse-plane motion occurred when using the vacuum-mattress splint compared with the rigid spine board (mean difference, 0.14 deg/s [95% CI, 0.05-0.23 deg/s]; P = .002). In patients weighing more than 250 lb, the rigid board provided less motion in the frontal plane (P = .027) and sagittal plane (P = .030) during the tilt condition and transfer condition, respectively.Conclusion:The current study confirms similar motion in the vacuum-mattress splint compared with the rigid backboard in varying sized equipped or nonequipped athletes. Cervical spine motion occurs when removing a football helmet and shoulder pads, at an unknown risk to the injured athlete. In athletes who weighed more than 250 lb, immobilization with the rigid board helped to reduce cervical spine motion.Clinical Relevance:Athletic trainers and team physicians should consider immobilization of athletes who weigh more than 250 lb with a rigid board.

Setting-related influences on physical inactivity of older adults in residential care settings: a review

BackgroundDespite the detrimental effects of physical inactivity for older adults, especially aged residents of residential care settings may spend much time in inactive behavior. This may be partly due to their poorer physical condition; however, there may also be other, setting-related factors that influence the amount of inactivity. The aim of this review was to review setting-related factors (including the social and physical environment) that may contribute to the amount of older adults’ physical inactivity in a wide range of residential care settings (e.g., nursing homes, assisted care facilities).MethodsFive databases were systematically searched for eligible studies, using the key words ‘inactivity’, ‘care facilities’, and ‘older adults’, including their synonyms and MeSH terms. Additional studies were selected from references used in articles included from the search. Based on specific eligibility criteria, a total of 12 studies were included. Quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT).ResultsBased on studies using different methodologies (e.g., interviews and observations), and of different quality (assessed quality range: 25-100%), we report several aspects related to the physical environment and caregivers. Factors of the physical environment that may be related to physical inactivity included, among others, the environment’s compatibility with the abilities of a resident, the presence of equipment, the accessibility, security, comfort, and aesthetics of the environment/corridors, and possibly the presence of some specific areas. Caregiver-related factors included staffing levels, the available time, and the amount and type of care being provided.ConclusionsInactivity levels in residential care settings may be reduced by improving several features of the physical environment and with the help of caregivers. Intervention studies could be performed in order to gain more insight into causal effects of improving setting-related factors on physical inactivity of aged residents.

Tecnología educativa: evolución y retos

Las actividades cotidianas, industriales, comerciales, administrativas, gubernamentales, de investigación, de formación y de muy diversas índoles han recurrido a una computadora como un medio para facilitar los procesos, mejorar los controles, tomar decisiones, realizar predicciones, étc. La educación, la formación académica, no ha quedado al margen de esta aparición que realizan las computadoras en las instituciones académicas, desde sus inicios en 1960 hasta nuestros días, sus aplicaciones en el aula ha ido evolucionando, modificando tanto los aspectos metodológicos del proceso de enseñanza - aprendizaje, de formación docente, es decir de las habilidades que se les demanda a los docentes para su uso y aprovechamiento en los ambientes de aprendizaje, garantizando un aumento en los aprendizajes significativos de los estudiantes.La llegada del internet, supone un "re-evolución" de la presencia de los equipos de cómputo con aplicaciones locales a espacios virtuales de aprendizaje, comunidades, acceso a recursos, disponibles en cantidad infinitesimal, algunos mejores que otros, pero sin duda alguna, un universo de información, es labor del docente navegar en este mar de información, para obtener aquellos recursos que puede llevar al aula a fin de propiciar aprendizajes significativos en los estudiantes, adicionalmente, como ciudadanos digitales tenemos la obligación moral de contribuir, de aportar, más y mejores recursos, con la finalidad de seguir fortaleciendo esta aldea digital en la que todos estamos inmersos.

Influence of Environmental and Physical Factors on Capture of Tribolium castaneum (Coleoptera: Tenebrionidae) in a Flour Mill

Variation in environmental and physical factors within food processing facilities can influence both the distribution of stored-product pests and trapping efficiency. Data from a long-term Tribolium castaneum (Herbst) (Coleoptera: Tenebrionidae) monitoring program was used to evaluate spatial variation in captures among trap locations and to determine relationships with environmental and physical variables. From the complete monitoring data set, different subsets were created for the cool and warm seasons, and period of time when environmental and physical factors were measured (2009-2010), with all data sets showing significant differences among trap locations in terms of beetle captures and proportion of time that traps exceeded 2.5 beetles per trap per monitoring period. There was also considerable temporal variation in distribution among the different levels of the mill. Among the environmental and physical variables measured, mean temperature and flour dust accumulation showed the most significant positive relationships with variation of beetle captures at trap locations. More beetles were captured in traps located in close proximity to milling equipment. Presence of equipment near traps was also associated with an increase in flour dust accumulation and temperature. Overall the environmental and physical factors seemed to have a limited influence on variation in captures among trap locations, with temporal variation in distribution perhaps overwhelming potential influences of local trap conditions.

Client perceptions of the quality of primary care services in Afghanistan

To identify factors associated with client perceptions of the quality of primary care services in Afghanistan. Cross-sectional survey of outpatient health facilities, health workers, patients and caretakers. Primary health care facilities in every province of Afghanistan. Main outcome measure Numerical scale of client perceptions of service quality. Clients report relatively high levels of perceived quality in Afghanistan. Most of the variation that is explained relates specifically to the patient's interaction with the health worker and not to other health facility characteristics, such as cleanliness, infrastructure, service capacity and the presence of equipment or drugs. The strongest determinants of client-perceived quality identified are health worker thoroughness in taking patient histories, conducting physical examinations and communicating with patients. Being seen by a doctor and being from a household in the poorest quintile are also associated with higher perceived quality. For female patients, being seen by a female provider is associated with higher perceived quality, while for male patients time and money spent for travel to the health facility are negatively associated with perceived quality. Clinical quality and client perceived quality appear to be mutually reinforcing, and efforts to improve health worker performance in taking histories, conducting exams and communicating with patients are likely to increase client perceived quality in this setting. Client perceptions of service quality assume additional importance in Afghanistan, where the perceived legitimacy of the government may depend partially on its ability to convince the population that it can deliver essential health services.

Improving Health Outcomes in Uganda: Linkages between the Public and Private Health Sectors

Introduction This study deals with the type of linkages, collaboration and competition of health providers. The study attempted to assess and evaluate who is competing with whom in the health care delivery system. It further attempted to establish the type of linkages among the actors, their general nature, and which health facility links with which among the health care providers. Methods included interviewing health care providers of various skills and training backgrounds in both public and private health facilities in the districts of Iganga, Masaka and Mpigi. Objective To identify the nature of public-private provider Linkages, Collaboration, Competition and referral structures in the health care system Methodology The study was conducted in three Uganda districts, namely Iganga, Mpigi and Masaka. The research strategies included a household survey, a health facility survey, census mapping of all health service providers in 19 parishes, focus group discussions in the community and interviews with policy makers and selected stakeholders in the health sector. Results Referral is a common practice and some 60% of facilities participate in the referral process either as recipients or as referring facilities. Most of this, however, is done informally in an undocumented manner. Sharing services is a less common practice with only some 20% of facilities reporting sharing services such as x-rays or laboratory work. It mainly occurs within sectors. Sharing of personnel is quite rare. Only 8% of facilities reported doing it to some degree and it occurs mainly within sectors. Perceived competition is fairly common and occurs between and within sectors. Some 40% of facilities reported this perception. Important relationships do exist between quality of care, educational levels of health providers and the presence of equipment, although these are not always obvious to the clientele. Conclusions Well managed linkages are more likely to improve health outcomes in the short to medium term.

Rural School Vehicle Routing Problem

The school bus routing problem traditionally has been defined in an urban context. However, because of the unique attributes of the problem in rural areas, traditional heuristic methods for solving the problem may produce impractical results. In many cases, these characteristics also provide the opportunity to investigate what size and mix of vehicles, whether large or small buses, conforming vans, or other modes, are most efficient. In addition, these vehicles may be further differentiated by the presence of equipment for transporting students with special needs. To address this situation, a mathematical model of the problem was constructed and a new heuristic was developed. This heuristic consists of two parts: constructing the initial route and then improving it by using a fixed tenure tabu search algorithm. This rural routing heuristic, in addition to several existing ones, is then applied to a randomly generated school district with rural characteristics. For the relevant measure, a function of stude...

P -γ characteristics for the unified power flow controller-analysis inclusive of equipment ratings and line limits

The paper presents a direct and systematic method for determining the entire operating range of a UPFC in the presence of equipment and system operating limits. The method is inclusive of all limits: series converter voltage and current limits, shunt converter current limit, and voltage limits at the equipment terminals. The formulation is general and permits calculation of P-/spl delta/ curves for a UPFC installed at any point along the transmission line. Equipment and system operating limits are shown to significantly impact the P-/spl delta/ curves of the UPFC. The methodology presented in the paper provides system planners a means to realistically quantify potential benefits of a UPFC installation for a transmission system.