Flexible Service Research Articles

Exploring Quality Differences in Telemedicine Between Hospital Outpatient Departments and Community Clinics: Cross-sectional Study.

BackgroundTelemedicine is a care delivery modality that has the potential to broaden the reach and flexibility of health care services. In the United Arab Emirates, telemedicine services are mainly delivered through either integrated hospital outpatient department (OPDs) or community clinics. However, it is unknown if patients’ perceptions of, and satisfaction with, telemedicine services differ between these two types of health care systems during the COVID-19 pandemic.ObjectiveWe aimed to explore the differences in patients’ perceptions of, and satisfaction with, telemedicine between hospital OPDs and community clinics during the COVID-19 pandemic. We also aimed to identify patient- or visit-related characteristics contributing to patient satisfaction with telemedicine.MethodsIn this cross-sectional study that was conducted at Abu Dhabi health care centers, we invited outpatients aged 18 years or over, who completed a telemedicine visit during the COVID-19 pandemic, to participate in our study. Patients’ perceptions of, and satisfaction with, telemedicine regarding the two system types (ie, hospital OPDs and community clinics) were assessed using an online survey that was sent as a link through the SMS system. Regression models were used to describe the association between patient- and visit-related characteristics, as well as the perception of, and satisfaction with, telemedicine services.ResultsA total of 515 patients participated in this survey. Patients’ satisfaction with telemedicine services was equally high among the settings, with no statistically significant difference between the two setting types (hospital OPDs: 253/343, 73.8%; community clinics: 114/172, 66.3%; P=.19). Video consultation was significantly associated with increased patient satisfaction (odds ratio [OR] 2.57, 95% CI 1.04-6.33; P=.04) and patients’ support of the transition to telemedicine use during and after the pandemic (OR 2.88, 95% CI 1.18-7.07; P=.02). Patients who used video consultations were more likely to report that telemedicine improved access to health care services (OR 3.06, 95% CI 1.71-8.03; P=.02), reduced waiting times and travel costs (OR 4.94, 95% CI 1.15-21.19; P=.03), addressed patients’ needs (OR 2.63, 95% CI 1.13-6.11; P=.03), and eased expression of patients’ medical concerns during the COVID-19 pandemic (OR 2.19, 95% CI 0.89-5.38; P=.09). Surprisingly, middle-aged patients were two times more likely to be satisfied with telemedicine services (OR 2.12, 95% CI 1.09-4.14; P=.03), as compared to any other age group in this study.ConclusionsThese findings suggest that patient satisfaction was unaffected by the health system setting in which patients received the teleconsultations, whether they were at hospitals or community clinics. Video consultation was associated with increased patient satisfaction with telemedicine services. Efforts should be focused on strategic planning for enhanced telemedicine services, video consultation in particular, for both emergent circumstances, such as the COVID-19 pandemic, and day-to-day health care delivery.

A joint optimisation model for designing demand responsive connectors fed by shared bikes

ABSTRACT Demand Responsive Connectors (DRCs) have become a more general-purpose flexible transit service that caters to patrons’ personal needs. The traditional DRC operation, however, suffers from low efficiency due to excessive detours and incurs diseconomies of scale with respect to the demand and service area. To tackle this issue, we propose a novel DRC fed by shared bikes, which functions as an access/egress mode for certain request points. Analytical models are derived for the joint design of such a hybrid system. A mixed-integer non-linear programme is established to minimise the total system cost. A heuristic solution algorithm is developed by combining the simulated annealing and branch-and-bound algorithms. A series of numerical cases are designed to evaluate the proposed system’s performance against the traditional ones. The results demonstrate that the introduction of shared bikes can reduce the DRC tour length and consequently save total system costs.

Access to healthcare for street sex workers in the UK: perspectives and best practice guidance from\xa0a national cross-sectional survey of frontline workers

BackgroundStreet sex workers (SSWs) are a highly marginalised and stigmatised group who carry an extremely high burden of unmet health need. They experience multiple and interdependent health and social problems and extreme health inequality. Despite high levels of chronic physical and mental ill-health, there is little evidence of effective healthcare provision for this group. They are often considered ‘hard to reach’, but many individuals and organisations have extensive experience of working with this group.MethodsWe conducted a cross-sectional survey of professionals who work with SSWs in the UK on their perspectives on their access to primary care, mental health, sexual health and drug and alcohol services, how well these services met the needs of SSWs and suggestions of best practice.Results50 professionals mostly from England, responded. Mainstream general practice and mental health services were found to be largely inaccessible to SSWs. Sexual health, drug and alcohol services and homeless health services better met their needs; this was mostly attributed to flexible services and collaborations with organisations who work closely with SSWs. The main challenges in providing healthcare to SSWs were services being inflexible, under-resourced services and services not being trauma-informed. Best practice in providing healthcare to SSWs includes- seamless partnership working between agencies with case worker support; peer-involvement in service development and engagement, a range of health provision including outreach, presence in community spaces and fast-track access into mainstream services; trauma-informed, gender-sensitive health services in a welcoming environment with flexible, responsive appointment and drop-in systems and consistent clinicians with specialist knowledge of substance misuse, mental health, domestic violence and homelessness.ConclusionsAccess to healthcare for SSWs in the UK is highly variable but largely inadequate with regards to primary care and mental health provision. The examples of positive healthcare provision and partnership working presented here demonstrate the feasibility of accessible healthcare that meets the needs of SSWs. These need to be systematically implemented and evaluated to understand their impact and implications. As we build back from COVID-19 there is an urgent need to make accessible healthcare provision for marginalised groups the norm, not the exception.

Quantitative Assessment of Flexibility at the TSO/DSO Interface Subject to the Distribution Grid Limitations

In the last years, renewable energy sources have been changing the power system by making it more challenging to balance the generation and demand at every single point in time. The increasing penetration of distributed generation represents another trend at the distribution level that impacts the exploitation of existing distribution assets. In this context, the flexibility of distributed energy resources connected to the distribution systems may play an important role. The flexibility products are represented by variations in the scheduled/expected active and reactive power setpoints. Recently, regulatory bodies suggested many proposals and undertook actions for enabling new players, such as the distributed energy resources connected to the distribution systems, to provide both system and local services. However, currently, there are still barriers that might limit their effective involvement. Market schemes have been proposed for opening the participation of distributed energy resources in the service markets. This paper proposes an analytical quantification of how much the use of flexibility by the transmission system operator can influence the distribution system operator activities and the expected costs. The final goal is quantifying the flexibility that the transmission system operator can procure from the distribution system without a harmful impact on the distribution network operation. The paper investigates the expected interactions between the use of flexibility for power system balancing and security and the operation of distribution systems. The application of the methodology to a significant Case Study showed that even though the fit and forget approach causes a hypertrophic development of distribution systems to host distributed generation, the transmission system operator cannot obtain the required flexibility services or has to pay extra costs for bottlenecks caused by distribution system operational issues.

New insights into the measurement model of a new scale for evaluating restaurant service quality during major infectious disease outbreaks

PurposeConsumers prefer to choose restaurants that value hygiene and safety; therefore, appropriate epidemic prevention measures could restore 30% of lost customers and enhance a restaurant’s reputation during infectious disease outbreaks. Providing customers with safe epidemic prevention service quality is an important mission of the restaurant industry during an epidemic. This study aims to construct an epidemic prevention service quality scale for restaurants (REP-SERV scale).Design/methodology/approachThe REP-SERV scale was constructed through internet big data analytics and qualitative and quantitative research procedures.FindingsA total of 16 key service factors for restaurant epidemic prevention were extracted through internet big data analytics. The REP-SERV scale contained 28 items in six dimensions, including hygiene, empathy, flexible service, support service, personnel management and body temperature and seating arrangement.Practical implicationsThe REP-SERV scale can help many restaurant operators clearly determine the deficiencies and risks of restaurant epidemic prevention services.Originality/valueThe findings can provide references to effectively measure and improve the epidemic prevention service quality in restaurants, thereby providing customers with a comfortable and safe dining environment.

The growth of distributed generation and associated challenges: A Great Britain case study

Great Britain has reached high penetrations of distributed generation (DG). Historically, there has been a lack of technical requirements for DG to provide system support and for network operators to monitor, control and gather detailed information on DG installations. As a result, much of it is unobservable and uncontrollable. This work has analysed the available data sources for the amount, size and type of DG installations in GB. It is found that the lack of transparency and consistency of data are likely to act as an obstacle to the development of a more active distribution network. The impact that high DG has on system operation and system stability is discussed, including the potential for DG to offer flexibility services. A system disturbance in GB on August 9th 2019 brought a number of issues into focus: Slow action to change inappropriate settings of DG loss-of-mains protection and the uncertainty that DG adds to the effectiveness of under frequency load shedding schemes. Finally, it is argued that coordination between transmission and distribution networks is central to addressing many of the challenges and is a key enabler to utilising the flexibility available from DERs and releasing capacity for more DERs to be connected.

Characterizing flexibility in power markets and systems

The increasing share of variable renewable energy sources creates a need for flexibility resources in the power system operations. This paper presents suggestions for characterizing flexibility, including dimensions of time, spatiality, resource type, and risk in power systems. We present interrelations between these flexibility dimensions, products, services, and suitable market designs. In light of this, we discuss TSO–DSO coordination and optimal flexibility resource allocation.

An examination of the implementation of a patient navigation program to improve breast and cervical cancer screening rates of Chinese immigrant women: a qualitative study

BackgroundChinese Americans have lower breast and cervical cancer screening rates than the national average and experience multiple barriers to cancer care. Patient navigators have improved screening and follow-up rates for medically underserved populations, yet investigations of cancer navigation programs and their implementation among Chinese Americans are limited. To address this gap, we used the Consolidated Framework for Implementation Research (CFIR) to examine facilitators and barriers to implementing the Chicago-based Chinatown Patient Navigation Program (CPNP) for breast and cervical cancer screening, follow-up, and treatment.MethodsStakeholders from clinical care, supportive care services, and community organizations were invited to participate in qualitative interviews to illuminate implementation processes and stakeholder perspectives of facilitators and barriers to implementing the CPNP. Interviews were audio-recorded, transcribed, and deductively coded according to CFIR domains, including (1) intervention characteristics; (2) outer setting; (3) inner setting; and (4) the implementation process.ResultsWe interviewed a convenience sample of 16 stakeholders representing a range of roles in cancer care, including nurses, clinical team members, administrators, physicians, a community-based organization leader, and a CPNP navigator. Findings detail several facilitators to implementing the CPNP, including patient navigators that prepared Chinese-speaking patients for their clinic visits, interpretation services, highly accessible patient navigators, and high-quality flexible services. Barriers to program implementation included limited regular feedback provided to stakeholders regarding their program involvement. Also, early in the program’s implementation there was limited awareness of the CPNP navigators’ roles and responsibilities, insufficient office space for the navigators, and few Chinese language patient resource materials.ConclusionsThese findings provide valuable information on implementation of future patient navigation programs serving Chinese American and other limited-English speaking immigrant populations.

Risky business: Impact of outcomes-based contracting on nongovernment out-of-home-care services

This article examines the impacts of commercialised contracting in helping or hindering policy objectives relating to Out-of-Home Care (OOHC) reforms in one Australian jurisdiction, New South Wales (NSW). Its particular focus is the impact of outcomes-based contracting on nongovernment organisations rendering foster and residential care services. Though contracting has long been present in government NGO funding models, of particular concern is the impact of the commercialisation of OOHC contracts. The author argues that this shift has had a detrimental impact on the nongovernment sector’s capacity to provide quality services to children and families. Contextualising commercialisation within the narrative of risk, it argues that political and ideological shifts in government policy and action reflect a strategy that absolves the government of the risks inherent in reforming the OOHC system or of managing OOHC contracts, a process that also minimises government accountability. The article presents evidence to show that reforms to the OOHC system in NSW have failed to achieve their intended outcomes partly due to the challenges to the nongovernment sector and its relationship with the government brought by contracting arrangements. As reported in other welfare systems internationally, it shows that a narrow conceptualisation of outcomes in conjunction with an emphasis on performance measures can detract from flexible and innovative service provision that is responsive to the needs of individual clients. The article adds to international evidence relating to the efficacy of contracting of services to meet policy objectives and identifies areas of management improvement.

NFV Anomaly Detection: Case Study through a Security Module

Network function virtualization (NFV) is a key networking concept whose benefits include scalability, flexibility, and cost-effective service provisioning. In NFV, service function chains (SFCs) adaptable to customers' needs are created by chaining virtualized network functions (VNFs). VNFs and SFCs are sensitive elements that, if compromised, would affect network security. The detection of compromised VNFs and SFCs is imperative, and although anomaly detection can be used in such a context, there is a lack of research work on the use of anomaly detection in NFV. In this article, we exploit the use of anomaly detection mechanisms to identify suspicious VNFs and SFCs. We introduce, into a widely accepted NFV architecture, an NFV security module (NSM) that, by analyzing VNFs and SFCs' operations, detects anomalies possibly resulting from security attacks. To prove the concept, three mechanisms have been implemented and deployed in NSM to observe how anomaly detection performs, given quantitative and qualitative information. We found out that anomaly detection is effective for VNF and SFC security and, in the case of using entropy as anomaly detection technique, it presents accuracy of up to 98 percent without harming NFV environment operations.

Flexibility pricing in the active distribution network including renewable and flexibility sources as a bi-level optimization model

This article models the flexibility services pricing (FSP) for an active distribution network (ADN) with renewable and flexibility resources. In this scheme, flexible resources include incentive-based demand response program and energy storage systems. The scheme is formulated as a bi-level problem. The upper-level formulation includes an objective function that maximizes the expected flexibility profits of flexible resources with considering constraints of the flexibility power model of these resources and the ADN. The lower-level problem is used to calculate the flexibility incentive price. Hence, it contains the ADN optimal operation formulation, where it minimizes the expected operating cost of the network limited to linearized AC optimal power flow equations, resources’ models, and flexibility constraints of the ADN. The Karush-Kuhn-Tucker method obtains the single-level formulation for this scheme. Also, the stochastic programming is used to model the uncertainties of load, renewable power, and energy price. In the end, the mentioned method applies on the radial 69-bus network, then the obtained numerical results confirm the potential of the approach in the improvement of economic, operation, and flexibility indices of the ADN.

Built-in security framework research for 6G network

6G will enable seamless coverage across land, sea, sky, and space, and provide users with on-demand services. 6G requires high security and its security capabilities are expected to serve as an independent logical plane under the 6G network architecture to provide services and guarantee for 6G networks and applications. This article analyzes and summarizes the three aspects of 6G security evolution requirements. First, the distributed autonomy of network architecture increases the exposure surface of network equipment and functions, and puts forward the requirements for high security of network elements and subnets themselves. Second, the cloud and virtualization technologies increase the risk of internal attacks, and require security protection mechanisms within network elements and the internal network based on the concept of zero trust. Third, providing on-demand services to customers requires intelligent collaboration mechanisms within the network, as well as an elastic and programmable security capability pool. Based on the above requirements and the development of security technologies, this paper proposes a 6G security construction idea with the built-in security framework as the basis, which includes security capability layer, security policy controller, security intelligence center and security management center, collaborating with the trusted infrastructure, orchestration capabilities and artificial intelligence abilities. The framework is built upon the security capability inside the network, coordinated with the trust consensus and the intelligent collaboration, which forms a security architecture and related operating mechanisms with active immunity, trustworthiness, and collaborative elasticity. By means of the practical case of building a trust link, the framework is proved to be able to provide flexible and on-demand security services for 6G networks and applications.

Frequent Flyer Cost Estimation

The marketing activity of a modern airline is quite diverse. Under the conditions of an oligopoly, airlines develop their business in competition for a passenger.In modern conditions in Russia, the use of dumping methods of the early 1990s is very ineffective. There are no weak airlines left on the long-distance air transportation market, and in regional markets large companies lose to small regional carriers due to the high cost of performing flights on large-capacity aircrafts of the airline’s fleet.Generally, non-price methods of competition come out on top. Flexible tariff policy, advertising, and high service in servicing passengers remain leading traditional methods of competing for a passenger.This article is devoted to the study of another marketing method for attracting passengers, or rather retaining passengers on the airline’s flights, which is development of bonus programs, frequent flyer programs. PJSC Russian Airlines (Aeroflot) was chosen as the object for the study. The subject of the research is the «Aeroflot Bonus» program.The objective of the study is to study the cost of the program. For research purposes, this is the value of the frequent flyer program point. The problem proposed to be solved is to determine the amount of expenses for implementation of the bonus program of frequent flyers. When solving the problem in its staging part, the assessment is not limited to direct costs associated with the costs of marketing efforts in the form of costs for organising a special advertising department, issuing bonus cards, software, and wages. The estimation refers also to indirect costs in the form of unreceived proceeds from free bonus tickets. Besides, a rough estimate has been made of the airline’s hidden costs due to an unpaid seat on the plane. The study conclusions indicate that hidden costs will be taken into account in calculating the cost of a flight and the bonus program has a right to exist.

Implementing energy transition and SDGs targets throughout energy community schemes

Abstract Citizens are expected to play a great role in the future global energy transition, being able to give a decisive contribution to limit global warming to 1.5° and avoid the worst consequences. Empowering citizens is crucial and assigning them the role of prosumers in the new energy market is necessary to ensure a sustainable and fair pathway to the low-carbon energy transition. Creating energy communities (ECs) can also engage citizens by providing flexibility and ancillary services, reducing losses and curtailments in the grid. It also yields environmental and social benefits, activating virtuous circles in the local economy aligned with the SDGs of Agenda 2030. We illustrate the experience of an EC implementation, using GECO-Green Energy COmmunity project, as a case study. In particular, the in-depth qualitative analysis of the project from a social and technical perspective is provided. The GECO Project is active in the districts of Pilastro and Roveri, Bologna, Italy, being implemented by a consortium including the Energy and Sustainable Development Agency (AESS), the National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA) and the University of Bologna (UniBo). Our findings show the potential interconnections among the development of an ECs and SDGs, especially goals 7, 11, 12 and 13. Placing ECs and prosumers at the centre of the international debate may deliver a more sustainable paradigm in the energy sector, in line with the climate change needs and community approaches.

A Flexibility Market Platform for Electricity System Operators Using Blockchain Technology

The paper’s main objective is to demonstrate the trading and flexibility of services amongst TSOs, DSOs, and Prosumers in a transparent, secure, and cost-effective manner using Blockchain-based TSO-DSO flexibility marketplace (EFLEX). The aim is to look for ways to help DSOs/TSOs be more flexible and more directly engaged in managing energy flows on the network. EFLEX will streamline the needs of both TSO and DSO on the same platform. Based on the paper’s proposed services, the pilot service demonstration will be carried out in Bulgaria and Romania, and the main focus will be on congestion management, TSO-DSO Coordination, and Marketplace. The proposed objective is achieved by using Blockchain-based smart contracts and distributed ledger technology.

Service Implementation Analysis of Adolescent Reproductive Health toward Adolescents’ Expectations and Needs

Lack of knowledge and information on sexual and reproductive health has led to an increase in reproductive health problems, such as sexual violence and abuse, marriage and teenage pregnancy. There are several government programs related to youth health, but only a few young people can use and take advantage of these programs. This study aims to outline the needs and expectations of adolescents in sexual education and reproductive health. The method used is a qualitative method and an in-depth interview was conducted. Use deliberate sampling techniques to determine samples. The interview results showed that all adolescents had heard of adolescent reproductive health (KRR), but they could not fully explain the definition and scope of KRR. The availability of KRR information and services around the residence is still poor, and although there is no regular schedule and incomplete, most are obtained from the school. The services that young people need include youth-friendly counseling, counseling and health checks. The expected facilities are easy-to-use facilities, affordable costs and flexible service hours. Support from policy makers, plan implementers, schools and youth residential communities are needed to provide youth-friendly and easily accessible KRR services.

Preference of Older Adults for Flexibility in Service and Providers in Community-Based Social Care: A Discrete Choice Experiment.

Empowerment of control and choice of the service users in health and social care has been incorporated into service provision in various countries. This study aimed to elicit the preference of community-based long-term care (LTC) service users on levels of flexibility in service provision. A discrete choice experiment was performed among older community care service users to measure their preference for attributes of LTC services identified from a prior qualitative study. Each participant was asked to make choices in six choice tasks with two alternatives of hypothetical LTC services that were generated from the attributes. A generalized multinomial logistic model was applied to determine the relative importance and willingness to pay for the attributes. It found that the participants preferred multiple flexible providers, determining services by themselves, meeting case managers every month and social workers as sources of information on service provision. Significant preference heterogeneity was found for flexibility in providers and flexibility in services between those with and without activity of daily living impairment. The findings highlighted the preference of older adults for greater flexibility in LTC, while they rely heavily on social workers in decision making. The enhancement of flexibility in LTC should be supported by policies that allow the older service users to make decisions based on their own preferences or communication with social workers instead of determining the services and providers for them. Options should be offered to users to decide their preferred level of flexibility to better reflect their divided preferences.

Service-based Analytics for 5G open experimentation platforms

A scalable, flexible and reliable Analytics service has become a requirement toward building efficient Fifth Generation (5G) experimental platforms that can support a suite of end-user experiments and verticals. Our paper presents the challenges that come with designing such a service-based Analytics component, and shows how we have used it in the context of open experimental platforms in the 5GENESIS project. Our Analytics service was designed both for enabling the efficient setup and configuration of the underlying platform, and also for ensuring that it provides useful insights into the experimentation Key Performance Indicators (KPIs) toward the end-user. Thus, Analytics proved to be a useful tool across several stages, starting from ensuring correct operation during the initial phases of the network setup and continuing into the normal day-to-day experimentation. Our experiments show how the tool was used in our setup and provide information on how to apply it to different environments. The Analytics component, designed as a set of microservices that serve several goals in the analytics workflow, is also provided as open source, being part of the Open5Genesis suite.

The Flexible Scheduled Service Network Design Problem

The scheduled service network design problem (SSNDP) can support planning the transportation operations of consolidation carriers given shipment-level service commitments regarding available and due times. These available and due times impact transportation costs by constraining potential consolidation opportunities. However, such available and due times may be changed, either because of negotiations with customers or redesigned internal operations to increase shipment consolidation and reduce transportation costs. As changing these times can lead to customer service and operational issues, we presume a carrier seeks to do so for a limited number of shipments. We propose a new variant of the SSNDP, the flexible scheduled service network design problem, that identifies the shipments for which these times should be changed to minimize total transportation and handling costs. We present a solution approach for this problem that outperforms a commercial optimization solver on instances derived from the operations of a U.S. less-than-truckload freight transportation carrier. With an extensive computational study, we study the savings potential of leveraging flexibility and the operational settings that are fertile ground for doing so.

Brown-Field Migration Aware Routing and Spectrum Assignment in Backbone Optical Networks

With the development of optical networks technology, broad attention has been paid to flexible grid technology in optical networks due to its ability to carry large-capacity information as well as provide flexible and fine-grained services through on-demand spectrum resource allocation. However, a one-time green-field deployment of a flexible grid network may not be practical. The transition technology called the fixed/flex-grid optical networks is more applicable and highly pragmatic. In such network, many nodes would likely be upgraded from a fixed-grid to flex-grid. In fact, dynamic service provisioning during the process of a node upgrade in fixed/flex-grid optical networks have become a challenge because the service connection can be easily interrupted, which leads to considerable data loss because of node upgrade. To overcome this challenge, we propose a brown-field migration aware routing and spectrum assignment (BMA-RSA) algorithm in fixed/flex-grid optical networks. The aim is to construct a probabilistic migration label (PML) model. The well-designed label setting of PML can balance the relationship between distance and node-upgrade probability. Dynamic service provisioning operations are undertaken based on the PML model to achieve a migration-aware dynamic connection before network migration occurs. We also evaluate the performance of different service provisioning strategies under different traffic models. The simulation results show that the BMA-RSA algorithm can achieve: (1) the tradeoff between distance and node upgrade probability during the process of service provisioning; (2) lower service interruption compared with the traditional non-migration aware K-shortest-path routing and spectrum assignment algorithm.