Service Area Research Articles

Career Change: Are there options after failing at the first attempt?

For university students, the choice of a career represents a fundamental step in what will be their professional and personal life once they graduate. Before the beginning of a school cycle, the student faces one of the most important processes of analysis and choice in his life, which, if not done conscientiously, will lead to disappointment, frustration and low morale, asking himself if the career he has chosen was really the best option or if he had a last chance to change his plans. Studying an academic career implies that after finishing it, the student is faced with the possibility of improving his knowledge by studying a postgraduate degree that will improve his skills and raise his self-esteem. Higher education institutions present in their entrance schemes a series of educational programs, but if the student for some reason cannot advance from the beginning, he/she has a last option to change careers. Therefore, the present research is carried out in a university in the southeast of Mexico. Its purpose is to show the statistics of career alternatives that the student would have as a second opportunity in the case that in the career that was his first option he has not satisfactorily covered the academic requirements. A statistical methodology is applied that would help the school services area to recommend a second opportunity.

Age-friendly initiatives – GHANA

The global increase in the population of older persons has profound inter-sectoral implications, necessitating the development of age-friendly initiatives at the global and national levels. While progress has been relatively slower across Sub-Saharan African countries, highlighting existing commendable initiatives is essential to identify the current gaps and promote the development of strategies and interventions to promote age-friendly societies. This mini-review highlights some of the key initiatives in Ghana in the areas of policy, healthcare, finance, social services, education and research and in promoting dementia-friendly communities.

Effect of Health Service Area on Primary Care Physician Provision of Low-Value Cancer Screening.

Using a health systems approach to investigate low-value care (LVC) may provide insights into structural drivers of this pervasive problem. To evaluate the influence of service area practice patterns on low-value mammography and prostate-specific antigen (PSA) testing. Retrospective study analyzing LVC rates between 2008 and 2018, leveraging physician relocation in 3-year intervals of matched physician and patient groups. U.S. Medicare claims data. 8254 physicians and 56 467 patients aged 75 years or older. LVC rates for physicians staying in their original service area and those relocating to new areas. Physicians relocating from higher-LVC areas to low-LVC areas were more likely to provide lower rates of LVC. For mammography, physicians staying in high-LVC areas (LVC rate, 10.1% [95% CI, 8.8% to 12.2%]) or medium-LVC areas (LVC rate, 10.3% [CI, 9.0% to 12.4%]) provided LVC at a higher rate than physicians relocating from those areas to low-LVC areas (LVC rates, 6.0% [CI, 4.4% to 7.5%] [difference, -4.1 percentage points {CI, -6.7 to -2.3 percentage points}] and 5.9% [CI, 4.6% to 7.8%] [difference, -4.4 percentage points {CI, -6.7 to -2.4 percentage points}], respectively). For PSA testing, physicians staying in high- or moderate-LVC service areas provided LVC at a rate of 17.5% (CI, 14.9% to 20.7%) or 10.6% (CI, 9.6% to 13.2%), respectively, compared with those relocating from those areas to low-LVC areas (LVC rates, 9.9% [CI, 7.5% to 13.2%] [difference, -7.6 percentage points {CI, -10.9 to -3.8 percentage points}] and 6.2% [CI, 3.5% to 9.8%] [difference, -4.4 percentage points {CI, -7.6 to -2.2 percentage points}], respectively). Physicians relocating from lower- to higher-LVC service areas were not more likely to provide LVC at a higher rate. Use of retrospective observational data, possible unmeasured confounding, and potential for relocating physicians to practice differently from those who stay. Physicians relocating to service areas with lower rates of LVC provided less LVC than physicians who stayed in areas with higher rates of LVC. Systemic structures may contribute to LVC. Understanding which factors are contributing may present opportunities for policy and interventions to broadly improve care. National Cancer Institute of the National Institutes of Health.

Practice variation in surgical treatment for lumbar degenerative disc disease: exploring regional and hospital factors influencing surgical rates

The presence of significant, unwarranted variation in treatment suggests that clinical decision making also depends on where patients live instead of what they need and prefer. Historically, high practice variation in surgical treatment for lumbar degenerative disc disease (LDDD) has been documented. This study aimed to investigate current regional variation in surgical treatment for sciatica resulting from LDDD. We conducted a retrospective, cross-sectional analysis of all Dutch adults (>18 years) between 2016 and 2019. Demographic data from Statistics Netherlands were merged with a nationwide claims database, covering over 99% of the population. Inclusion criteria comprised LDDD diagnosis codes and relevant surgical codes. Practice variation was assessed at the level of postal code areas and hospital service areas (HSAs). Multivariable logistic regression analysis was employed to identify variables associated with surgical treatment. Among the 119,148 hospital visitors with LDDD, 14,840 underwent surgical treatment. Practice variation for laminectomies and discectomies showed less than two-fold variation in both postal code and HSAs. However, instrumented fusion surgery demonstrated a five-fold variation in postal code areas and three-fold variation in HSAs. Predictors of receiving surgical treatment included opioid prescription and patient referral status. Gender differences were observed, with males more likely to undergo laminectomy or discectomy, and females more likely to receive instrumented fusion surgery. Our study revealed low variation rates for discectomies and laminectomies, while indicating a high variation rate for instrumented fusion surgery in LDDD patients. High-quality research is needed on the extent of guideline implementation and its influence on practice variation.

Charging station service scope division and real-time pricing strategy based on the strongest occupation method

With the rapid construction of charging stations (CSs), charging station operators need to enhance their core competitiveness by precisely planning their service areas and formulating reasonable and effective pricing strategies. However, the regional competition among multiple charging station operators is generally ignored. In the traditional model, the service scope of CSs appears as regular circles, which is inconsistent with the market distribution law. In response to the irregular relationship between the dynamic service scope of CSs and the real-time charging price, a charging station service scope (CSSS) model is proposed by introducing the variable service field strength (SFS). First, the competitiveness of CSs is evaluated quantitatively, and the SFS of CSs is defined to describe the service scope of CSs by the strongest occupation method. Second, the impact of the charging price on the charging demand is analyzed based on the CSSS division model. In addition, the revenue of charging station operators and the stability of the power grid are considered to establish a real-time pricing optimization model. Finally, the numerical simulation is operated in Furong District of Changsha. It is shown that the proposed method effectively achieves more profits for charging stations and decreases the average power deviation of the whole region.

Alcohol screening in 22 Australian Aboriginal Community Controlled Health Organisations: Clinical context and who is screened.

Alcohol screening among Indigenous Australians is important to identify individuals needing support to reduce their drinking. Understanding clinical contexts in which clients are screened, and which clients are more or less likely to be screened, could help identify areas of services and communities that might benefit from increased screening. We analysed routinely collected data from 22 Aboriginal Community Controlled Health Organisations Australia-wide. Data collected between February 2016 and February 2021 were analysed using R, and aggregated to describe screening activity per client, within 2-monthly extraction periods. Descriptive analyses were performed to identify contexts in which clients received an Alcohol Use Disorders Identification Test consumption (AUDIT-C) screen. Multi-level logistic regression determined demographic factors associated with receiving an AUDIT-C screen. Three models are presented to examine if screening was predicted by: (i) age; (ii) age and gender; (iii) age, gender and service remoteness. We observed 83,931 occasions where AUDIT-C was performed at least once during a 2-monthly extraction period. Most common contexts were adult health check (55.0%), followed by pre-consult examination (18.4%) and standalone item (9.9%). For every 10 years' increase in client age, odds of being screened with AUDIT-C slightly decreased (odds ratio 0.98; 95% confidence interval [CI] 0.98, 0.99). Women were less likely to be screened with AUDIT-C (odds ratio 0.95; 95% CI 0.93, 0.96) than men. This study identified areas where alcohol screening can be increased (e.g., among women). Increasing AUDIT-C screening across entire communities could help reduce or prevent alcohol-related harms. Future Indigenous-led research could help identify strategies to increase screening rates.

The Effect of the COVID-19 Pandemic on the Distribution of Traffic Accident Hotspots in New York City

The COVID-19 pandemic has had a substantial impact on the lives of city residents and has reshaped working patterns, with a concomitant impact on traffic accidents. We correlated data from multiple sources to explore the impact of residents’ mobility and residents’ travel behavior on the spatiotemporal distribution characteristics of urban traffic accident hotspots and its internal mechanism under the impact of the pandemic and subsequent policy measures. The results showed that the pandemic and policy measures inhibited the mobility of residents, had a significant impact on working patterns, and changed the composition structure of the purpose of residents’ travel behavior, which substantially impacted the spatiotemporal distribution characteristics of urban traffic accident hotspots. The quantity of traffic accidents decreased significantly, and the spatial distribution characteristics of urban traffic accident hotspots changed substantially, with accident hotspots changing from the single-center spatial distribution before the pandemic to the multi-center spatial distribution during the pandemic; urban accident-prone areas changed from being mainly distributed in the central business district before the pandemic to being more widely distributed in public service areas during the pandemic. The results of this study may be helpful to better understand the spatiotemporal distribution characteristics of urban traffic accident hotspots and their intrinsic mechanism.

A care coordination program to support patients with hepatitis B virus at Kaiser Permanente Mid-Atlantic States

BackgroundEliminating hepatitis B virus (HBV) is a significant worldwide challenge requiring innovative approaches for vaccination, screening, disease management, and the prevention of related conditions. Programs that support patients in accessing needed clinical services can help optimize access to preventive services and treatment resources for hepatitis B.MethodsHere, we outline a coordinator-supported program (HBV Pathway) that connects patients infected with HBV to laboratory testing, imaging, and specialty care for treatment initiation and/or liver cancer surveillance (screening of high-risk patients for liver cancer). This study describes the HBV Pathway steps and reports sociodemographic factors of patients by initiation and completion.ResultsResults showed a 72.5% completion rate (defined as completing all Pathway steps including the final specialty visit) among patients who initiated the Pathway. Differences in completion were observed by age, race, ethnicity, and service area, with higher rates for younger ages, Asian race, non-Hispanic ethnicity, and lower rates for patients within one service area. Of those who completed the specialty visit, 59.5% were referred for hepatocellular carcinoma surveillance.ConclusionsThe HBV Pathway offers dual benefits– care coordination support for patients to promote Pathway completion and a standardized testing and referral program to reduce physician burden. This program provides an easy and reliable process for patients and physicians to obtain updated clinical information and initiate treatment and/or liver cancer screening if needed.

How far? Travel burdens for children admitted to hospitals in the Western Cape Province of South Africa.

The ability to access effective hospital care for children is a significant determinant of good health outcomes. The Western Cape is a large land area with a wide array of human settlements- both in urban and rural spaces. For many children in the Western Cape, after-hours access to healthcare becomes constrained when primary care clinics close and hospitals are either far away or difficult to get to. The cumulative travel burden of communities across this area is not known. The recently established data gathering capacity of the Provincial Health Data Centre of the Western Cape represents a new capacity to study this. This study intends to describe the cumulative travel burdens of children in communities throughout the Western Cape, and how they compare relative to one another, with a particular focus on the after-hours period in a week. Over a period of 5 years from 2017-2021, all the admission details to every hospital in the Western Cape of children under 18 years of age were collected, with basic demographic and disease data including place of residence. The distance each child travelled to their first admission facility was calculated and represented within defined communities across the metro of Cape Town and the rural Western Cape. There were 574 220 admissions over the 5-year period, of which 360 783 were able to be used for travel analysis. The majority of admissions were for children under 5 years of age, were in the City of Cape Town and occurred after hours. Median travel distance was less for children outside of Cape Town, but the range of travelled distances was greater. Communities across the Western Cape, particularly rural communities, reflected significant variation in their cumulative travel burdens. Using a large health dataset, this study demonstrates in a novel way for South Africa, the distances children travel to access admission facilities. A wide variation exists across all parts of the province, but particularly in rural areas. These findings could be further interrogated for people's choices of facility and method of travel. Detailed service area modelling and extending primary care working hours are potential considerations for improving access at scale and at the local community level.

How Nurse Faculty in Saudi Arabia View Their Competencies in All Aspects of the Faculty Role: A Descriptive Study.

This study used a quantitative descriptive survey with a sample of 92 participants to assess perceived nurse faculty competency in their role at Saudi Arabian universities. Participants' perceptions overall were highly positive in the areas of teaching, scholarship, and service competencies. Participants reported less competence in the areas of scholarship and service when they started in their role. Orientation and a mentor relationship with senior faculty were reported to aid in their transition to the faculty role. The findings of the study identify strategies to support the new nurse educator.

The Study of the Components of the Excellent Service Provision of the Primary Educational Service Area Offices in the Office of the Basic Education Commission

Education plays a pivotal role in societal development and nation-building, particularly in the 21st century, marked by rapid changes and globalization. Ensuring quality education that meets the needs of both the job market and national development is paramount for Thailand’s vision of becoming a “Stable, Prosperous, and Sustainable Country” as outlined in its 20-year National Strategy (2018–2037). Within this framework, the Primary Educational Service Area Offices in the Office of the Basic Education Commission are tasked with providing essential educational services. However, various challenges, including resource inadequacy and service delivery issues, hinder their effectiveness. This research aims to investigate the components of the excellent service provision of the Primary Educational Service Area Offices in the Office of the Basic Education Commission, along with analysing the desired conditions, and the essential needs for providing excellent service. The study employs a mixed-methods approach, including literature review, expert consultations, questionnaire development, and data analysis. The research methodology has been conducted in two phases. Phase 1 of the research focuses on identifying the components of excellent service provision through a literature review and expert consultations. Six core components, including (1) the Development of Personnel Service Providers, (2) the Development of Service Procedures, (3) the Relationships Management with Service Recipients, (4) the Service Quality, (5) the Establishment of Service Culture, and (6) the Service Environment, Technology and Facilities, are identified and validated by the nine qualified experts. Phase 2 involves assessing the current conditions, the desired conditions, and the essential needs for service provision. Data collected from a sample group of 620 individuals across 124 Primary Educational Service Area Offices reveal high levels of current conditions and the highest levels of the desired conditions. The most essential need identified is the Development of Personnel Service Providers. The findings suggest that policies should be implemented to promote the development of personnel service providers and support the implementation of identified components for excellent service provision. Additionally, further qualitative research is recommended to compare service levels among different educational service areas and develop tailored models for excellent service provision.

An ANALYSIS OF DVB-T2 TV BROADCAST TESTING DRIVE TEST AND FIELD STRENGTH METHODS IN THE JAKARTA SERVICE AREA

Indonesia has adopted DVB-T2 as the technology standard for terrestrial digital television broadcasting. This research aims to test and analyze the reception quality of DVB-T2 TV broadcasts in the DKI Jakarta service area. The research was conducted using drive test and field strength methods to test and evaluate the quality of digital television broadcasts. Tests were conducted in various locations in the DKI Jakarta service area using the Gsertel Hexylon TV Analyzer technical device to test DVB-T2 TV broadcast signals. The field strength test results were more accurate and higher values were generated than the drive test. Several parameters such as signal level and MER are evaluated and analyzed to find out what affects their values. The transmitter parameter settings such as modulation, FEC code rate, FFT Mode, Guard Interval, and Pilot Pattern greatly affect the signal level and MER values. The optimization performed on CH 24 also managed to maintain its signal level value of 18.19 dB and its MER of 55.01 dBµV to maintain broadcast stability during a technical failure of the transmitter on CH 1.

Urban public transport system accessibility for different groups of residents: Case of Bratislava city

The main goal of the article is to characterize the functioning of the Urban Public Transport System (UPTS) in the capital city of the Slovak Republic (Bratislava) during different time periods (morning rush, evening, night, average working day, and weekend − Sunday) and express its accessibility for various groups of city residents (low-income households, unemployed individuals, seniors (age 60+), children (age 0–14), women (for comparison, men as well). To achieve this goal, we combined datasets of UPTS in Bratislava with the pedestrian communication network and identified an effective service area for which we subsequently determined the sizes of the respective population groups of residents. Finally, we verified the functionality of the entire UPTS model by measuring the accessibility of the selected destination, Ružinov Hospital. Our results could be summarized as follows: The functioning of UPTS is very similar during the morning rush, evening, average working day (Monday to Friday), and weekend − Sunday. During these time periods, approximately the same main lines operate, and there is a higher utilization of the same transfer points. The difference lies mainly in the frequency of departures of specific lines. During the night, the system operates based on different lines compared to the daytime, with transfers possible only at one central point/corridor. This fact also affects the usability and accessibility of UPTS, reflected in the accessibility of Ružinov Hospital, which is very limited during the night-time period. However, the accessibility of the hospital by UPTS is higher for the unemployed residents, low-income individuals, and children than the overall residents average, which is also reflected in the distribution of women. A negative aspect is that UPTS is less accessible for seniors. It must be said that this fact varies significantly in the heterogeneous spatial layout of the city. This was confirmed in our measurement of the accessibility to Ružinov Hospital, where seniors have roughly the same level of accessibility as the overall residents average.

Clinical and epidemiological features of cutaneous mastocytosis among the pediatric population of Moscow

BACKGROUND: Cutaneous mastocytosis is a rare disease that primarily develops in childhood.
 AIM: This study aimed to determine the clinical and epidemiological characteristics and frequency of detection of cutaneous mastocytosis among children in Moscow.
 MATERIALS AND METHODS: A single-center epidemiological retrospective study was conducted. Data from Form № 12 of the federal statistical observation "Information on the number of diseases registered in patients living in the service area of a medical organization" were used as a statistical source of information. To calculate the incidence rate in intensive indicators per 100 thousand population, data on the population of Moscow for the period 2019–2022 were used.
 RESULTS: Over the period 2019–2022, a gradual trend towards an increase in the number of newly identified cases of cutaneous mastocytosis in children and adolescents in Moscow was revealed. Number of initial applications from children and adolescents (0–17 years old) for this period increased by 4.8 times. The share of cutaneous mastocytosis in the structure of skin diseases and congenital anomalies (malformations) of the skin increases every year. In 2019, for every 1,834 pediatric visits (age category 0–17 years) regarding skin diseases, there was 1 case of mastocytosis; in 2020 the ratio was 1,863:1; in 2021 ― 491:1; in 2022 ― 376:1. Since 2019, there has been an increase in the primary incidence of cutaneous mastocytosis from 3.63 cases per 100,000 child population to 16.61 cases per 100,000 child population in 2022.
 CONCLUSION: The increase in incidence in the pediatric population and the share of cutaneous mastocytosis in the structure of skin diseases in recent years demonstrates the need to generate interest and attention of the medical community to this pathology.

A novel stop-and-go kinematic positioning method for PPP–RTK

ABSTRACT The technology of precise point positioning – real time kinematic (PPP – RTK) can realize regional accurate positioning. However, poor quality atmospheric corrections can greatly impact the integer ambiguity resolution. The low reliability of interpolated corrections may arise from blocked transmission of the updated corrections, atmospheric disturbance, and when the user is located outside the service area. Therefore, to maintain a continuous ambiguity-fixed state in an inaccurate correction observation environment, we propose a novel stop-and-go (SAG) kinematic positioning method. Integer ambiguities inherited from the last epoch are used to estimate the ionospheric errors of the current epoch using an inversion calculation method. Unmodeled errors contained in the ionospheric corrections are also considered. We then experimentally compare the proposed method and traditional PPP – RTK and SAG methods with the results of the PPP-ambiguity resolution calculation using geomagnetic storm-influenced data. All indicators, including the number of fixed ambiguities, errors of corrections, successful fix rate, and correct fix rate, confirm the superiority of the proposed method. The proposed method achieves a horizontal correct fix rate of 98% and maintains the vertical correct fix rate above 96% throughout the day. It is proved that for most of the time the novel method can provide continuous ambiguity-fixed solutions for users in an inaccurate correction observation environment.

Evaluation of Ecosystem Services in Ruoergai National Park, China

This study utilizes ArcGIS10.8 and ENVI5.3 software and the InVEST model to analyze and operate field survey data and remote sensing image data from Ruoergai National Park. The work simulates the soil retention, carbon storage, water supply, and habitat quality of the park to evaluate and analyze its four major ecosystem services. Subsequently, important areas of ecosystem services are zoned based on the results, aiming to provide decision-makers with a theoretical and scientific basis for formulating ecological environment restoration, protection, and management measures in Ruoergai National Park. The results showed the following: (1) In the study area, the land use types, ranked from largest to smallest, are grassland, unused land, forest, water area, and construction land. (2) Soil retention and water supply show an increasing trend, while carbon storage shows a decreasing trend. Habitat quality remains relatively stable, with most areas maintaining a high level of quality. (3) The importance zoning of ecosystem services in the study area exhibited a trend of “four increases and one decrease”. Specifically, the areas classified as moderately important, highly important, and extremely important all increased, while the area designated as generally important decreased. The findings indicate that climate change, land use type changes, and human activities are the primary factors influencing changes in ESs. It is crucial to prioritize highly important and extremely important areas for protection and utilization within Ruoergai National Park. Moving forward, it will be essential to minimize human activities that disrupt the ecosystem, while also focusing on the conservation and sustainable use of forest and grassland.

Equity issues associated with the widespread implementation of autonomous vehicles

Abstract Autonomous vehicles (AVs), either shared or privately owned, are predicted to become a common transport mode used by the general population in coming decades. Policies governing the use of AVs may increase or decrease social inequities. This review synthesizes existing literature and provides policy recommendations to enhance equity as the use of AVs becomes more widespread. We identified nine areas in which AVs could impact equity: (i) assessment of community mobility needs and priorities, (ii) education and outreach, (iii) disparities in infrastructure quality, (iv) equitable distribution of customer services, (v) access to AVs by persons with low incomes, (vi) shared infrastructure services, (vii) barriers to shared AV use, (viii) access to AVs by persons with disabilities and (ix) disruption of existing transportation jobs. Recommendations for promoting equitable use of AVs include (i) policies governing how jurisdictions oversee AV implementation and (ii) policies addressing how jurisdictions issue permits to AV service providers. Oversight policies include ensuring input from disadvantaged communities, providing subsidies for low-income users, establishing ride-sharing rules to protect vulnerable populations, reviewing the equity implications of proposed AV infrastructure improvements, providing retraining opportunities for those who may lose jobs due to AV implementation and monitoring the impact of AV policies implemented. Permitting processes include ensuring equitable access to AVs for low-income, minority, and older users and persons with disabilities, ensuring equitable distribution of AV service areas and verifying that data from all communities are incorporated into the artificial intelligence algorithms used to guide AVs.

Techno-economic evaluation of developing a zero-carbon highway service area energy system

ABSTRACT To further reduce CO2 emissions from highway service areas, this study proposes a novel zero-carbon highway service area energy system (S3). This system not only addresses energy supply challenges in remote locations but also expedites the reduction of CO2 emissions. A mixed-integer linear programming problem is formulated to optimize the configuration and operation of the proposed system. The system is compared with the conventional (S1) and low-carbon (S2) highway service area systems. Focused on northwest China, the results indicate that S3 can achieve zero CO2 emissions. However, the energy efficiency ratio (EER) of S1 is the highest at 84%, surpassing S3 by 2.4% (82%). In terms of economic analysis, the total cost and levelized cost of electricity (LCOE) of S1 are the highest at 1.62 MUSD and 0.14 USD/kWh, respectively. These values are 100% and 180% higher than those of S3, which are 0.81 MUSD and 0.05 USD/kWh.

Mobility Energy Productivity Evaluation of On-Demand Transit: A Case Study in Arlington, Texas

On-demand transit (ODT) systems are increasing in number and size. To evaluate and quantify outcomes, the research team utilizes the mobility energy productivity (MEP) metric, which is a holistic accessibility measure, to analyze and compare the mobility of various transportation modes in Arlington, Texas. The MEP tool is applied to the ODT system in Arlington, Texas, as well as to five existing transportation modes (driving, transportation network company, transit, biking, and walking). Six ODT scenarios are also analyzed and compared. The analysis is focused on the opportunities that an ODT system presents for transportation disadvantaged communities (DACs) with low rates of car ownership. Although driving received the highest MEP score—a finding typical for a U.S.A. city— the results for the ODT system reveal that it serves those in DACs effectively, helping to achieve an equity design goal. ODT improved the average MEP score across the service area by 83% when considering only accessible, nonprivate vehicle modes (biking, transit, and ODT). For the ODT scenarios, decreasing the wait time by 50% compared with the baseline scenario led to a nearly 160% increase in the MEP score, whereas increasing the ODT travel speed by 21% led to an 80% improvement in the MEP score. As analyzed through the MEP tool, this paper demonstrates how ODT can enhance mobility, particularly for DACs. The results of an MEP analysis can be used by researchers and transit agencies to compare transportation modes and improve the effectiveness of transportation systems across a service area.

Civil Procedure Takes a Bold Step: Unravelling the changes to service out of the jurisdiction and the Civil Procedure Rules in the British Virgin Islands

Abstract Following years of consultation, the ECSC Civil Procedure Rules 2000 gave way to the revamped and refreshed ECSC Civil Procedure Rules, Revised Edition 2023 (Civil Procedure Rules, Revised 2023), which came into effect on 31 July 2023. The Civil Procedure Rules, Revised 2023, brought sweeping and significant changes to civil practice and procedure, particularly in the areas of service out of the jurisdiction, relief from sanctions, and costs. The Civil Procedure Rules, Revised 2023, gave birth to a novel alternative dispute resolution mechanism, the Judicial Settlement Conference, intended to complement the well-established out-of-court arrangement of court-ordered mediations.