Types Of Services Research Articles

Warfare in Serbian State from the End of the 14th to the Middle of the 15th Century

The aim of this paper is to present the changes in the way of warfare in the Serbian state in the late Middle Ages. The Ottoman pressure on Serbian territories, starting from the eighth decade of the 14th century, influenced changes in the military organisation of their rulers. In order to defend themselves more effectively from attackers, they established various types of military service. Despot Stefan Lazarević implemented a reform of the local government system by creating new administrative units. During the period that is the subject of research, there were also changes in armaments.

THE STRATEGIES FOR ENHANCING TRANSPORTATION MANAGEMENT AT THE BORDER PORTS BETWEEN MONGOLIA AND CHINA

Effective management of border port road transport is crucial for enhancing trade and economic potential at border ports and free zones. This involves long-term, medium-term, and short-term planning, as well as the implementation of integrated development policies to ensure sustainable and accessible improvements. By connecting border ports with railways and paved roads, enhancing transport and logistics competitiveness, optimizing cargo flow, and laying the groundwork for future transit capabilities, economic relations and cooperation between Mongolia and China can flourish, fostering the sustainable development of both nations. To boost trade turnover and establish free economic zones and road ports, it is imperative to enhance the management of border port road transport in alignment with Mongolia's regional development strategy. Currently, the concentration of the economy on only four ports leads to goods shortages, price hikes, and hindered business operations. Therefore, enhancing the type, quality, and availability of road transport services at border ports is essential to increase the throughput capacity of these crucial transportation hubs.

Fusion of Telecommunications and IT Services Boosted by Application Programming Interfaces

Our long journey on the road of telecommunications is continuously evolving. We have experienced several technological changes, modernizations, optimizations, and various mergers in the past decades. Virtualization and ‘cloudification’ of legacy telecommunication equipment has made communication networks not only more flexible, but also opened new doors. Brand new types of services have become available thanks to the ongoing fusion of the two domains of telecommunications and IT (Information Technology). This overview paper first discusses the evolution of services with an enhanced focus on mobile networks. Then, the possibilities offered by IT are shown. Finally, some examples are given of how Communication Service Providers and end users can benefit from these recent changes.

Survey of clinical microbiology and infectious disease testing capabilities among institutions in Africa.

Inadequate laboratory infrastructure and testing capabilities are a major impediment to addressing the infectious disease burden in Africa. Therefore, the aims of this study were to characterize the clinical microbiology/infectious disease laboratory capabilities among countries in Africa. A survey to assess the microbiological testing capabilities at hospitals, government laboratories, and free-standing public and private laboratories in African countries was developed by subject matter experts. Questions included institutional demographics and microbiology services in the broad categories of bacteriology, virology, mycology, parasitology, and rapid diagnostics/point-of-care testing. The survey was distributed using the American Society of Clinical Pathology email listserv between June and August 2022. In total, 131 unique institutions in 28 countries endorsed at least 1 type of microbiology service, with parasitology (80.9%, 106/131) and bacteriology (77.9%, 102/131) being most common, while mycology (45.0%, 59/131) and virology (45.8%, 60/131) laboratories were less prevalent. The most frequently performed bacteriology test was bacterial identification (90.2%, 92/102), followed by aerobic bacterial cultures and antimicrobial susceptibility testing (both 89.2%, 91/102). Among all clinical microbiology/infectious disease laboratories, the most commonly tested agents were HIV (90.8%, 119/131), Treponema pallidum (78.6%, 103/131), Plasmodium falciparum (76.3%, 100/131), Mycobacterium tuberculosis (76.3%, 100/131), and hepatitis C virus (74.8%, 98/131). These findings provide contemporary data regarding the availability of critical infectious disease testing capabilities among institutions in Africa. These results and future additional studies will be crucial for understanding where strategic investment in the laboratory and public health infrastructure is warranted.

Accessibility services needs of visually impaired patrons in public libraries: a grounded theory study of China

PurposePublic libraries are strong advocates of the development of accessibility for people with disabilities. Understanding the accessibility services needs of visually impaired patrons is highly beneficial for increasing satisfaction with public library services. The purpose of this research is to assess the service capabilities of visually impaired patrons in public libraries and to improve the accessibility of services provided by public libraries for visually impaired patrons.Design/methodology/approachThis research adopts a mixed methods approach. Qualitative data collection involves interviews and surveys with 34 visually impaired individuals in China, applying grounded theory and expectancy theory. Quantitative analysis is then carried out using the Kano model.FindingsThe research reveals four types of accessibility service needs, with visually impaired patrons prioritizing value-added information services and self-service options. In addition, visually impaired patrons are also highly interested in the integration of assistive and innovative technologies within libraries.Originality/valueBy emphasizing a patron-centered approach, this research provides insights into innovative service approaches in public libraries that address the specific needs of visually impaired patrons and contribute essential strategies for bridging the digital divide.

Franchise Sözleşmesinin Kuramsal Çerçevesinin Özel Hukuk Bağlamında İncelenmesi

Firstly, in the franchise agreement, there is no relationship between the parties such as dependent or independent merchant assistance, on the contrary, the parties to the agreement are completely independent of each other. Dec. Secondly, the parties to this agreement do the work they do on their own behalf and accounts. Franchise refers to a system consisting of intellectual or industrial property rights related to trademarks, trade names, store signs, utility models, designs, copyrights, know-how or patents that will be used for the resale of goods or the provision of services to on users. The franchise agreement, on the other hand, includes a number of obligations of the franchisor in which the franchisor grants the franchisor the right to use a franchise for the purpose of marketing certain types of goods or services in exchange for direct or indirect financial contribution, and at least; the use of a common brand or business name and the uniform appearance of facilities or means of transportation; the transfer of know-how by the franchisor to the franchisor; the continuous commercial and technical support of the franchisor by the franchisor during the agreement. In this context, the franchise agreement; it is possible to define the right to sell, distribute or operate a product or service belonging to the franchisor as a concession in a certain region in favor of the franchisee, including the use of intangible assets such as names, brands, signs, know-how, presentation and marketing strategies belonging to it, as well as a bilateral, urgent legal framework agreement that includes the inclusion of the franchisee in the organization and concept established by the franchisor with certain obligations, goals and limitations. Key Words: Franchise, Franchise Agreement, Competition, Private Law

Survey‐based insights from choice‐based conjoint analyses on customer preferences for company characteristics of life insurers

AbstractThe aim of this paper is to investigate customer preferences for certain company characteristics when purchasing life insurance products. We focus on ratings provided by aggregators, namely financial strength, sustainability, service quality, and type of customer touchpoint (online vs. in person), while also studying potential product‐specific differences between annuities and term life policies. Toward this end, we conduct two choice‐based conjoint analyses with 529 and 543 German respondents to estimate individual preference structures. Consistent with economic expectations, we observe statistically significant higher preferences for better ratings of the life insurer, which also materialize in the respondents' marginal willingness to pay. One main finding is that customer preferences in our sample are asymmetric, with a strong focus on avoiding below‐average ratings. Furthermore, for both annuities and term life insurances, the relatively most important life insurer attribute for customers is financial strength, followed by service quality, sustainability, and type of customer touchpoint.

Validation and Reliability Study of The Turkish Version of The Health Services Access Scale

Background/aim: The aim of this study is to establish the Turkish validity and reliability of the Healthcare Access Scale and to determine whether perceptions of healthcare access vary according to demographic variables. Materials and methods: Data for the research were collected through surveys of 468 participants across Turkey. Exploratory factor analysis and confirmatory factor analysis were conducted in the process of adapting the Healthcare Access Scale. In addition, t-tests and ANOVA tests were used to determine variations in access to healthcare according to demographic variables. The factors obtained from the exploratory factor analysis were confirmed by confirmatory factor analysis. The fit index values of the five-dimension health care access scale were found to be in the good fit range. Results: As a result of the difference analyses carried out, no significant differences were found in the perceptions of access to healthcare according to gender, age and educational level. However, various differences were observed between the groups in terms of the type of hospital services received, income level and frequency of hospital visits in the past year. In conclusion, this study makes a significant contribution to the literature by testing the appropriateness, validity and reliability of the Healthcare Access Scale. Conclusion: This study makes a significant contribution to the literature by testing the appropriateness, validity and reliability of the Healthcare Access Scale. Key words: Health Services, Health System, Validity and Reliability, Access to Health Services, Turkish Validity, Health

A case study of the development of a valid and pragmatic implementation science measure: the Barriers and Facilitators in Implementation of Task-Sharing Mental Health interventions (BeFITS-MH) measure

BackgroundFew implementation science (IS) measures have been evaluated for validity, reliability and utility – the latter referring to whether a measure captures meaningful aspects of implementation contexts. We present a real-world case study of rigorous measure development in IS that assesses Barriers and Facilitators in Implementation of Task-Sharing in Mental Health services (BeFITS-MH), with the objective of offering lessons-learned and a framework to enhance measurement utility.MethodsWe summarize conceptual and empirical work that informed the development of the BeFITS-MH measure, including a description of the Delphi process, detailed translation and local adaptation procedures, and concurrent pilot testing. As validity and reliability are key aspects of measure development, we also report on our process of assessing the measure’s construct validity and utility for the implementation outcomes of acceptability, appropriateness, and feasibility.ResultsContinuous stakeholder involvement and concurrent pilot testing resulted in several adaptations of the BeFITS-MH measure’s structure, scaling, and format to enhance contextual relevance and utility. Adaptations of broad terms such as “program,” “provider type,” and “type of service” were necessary due to the heterogeneous nature of interventions, type of task-sharing providers employed, and clients served across the three global sites. Item selection benefited from the iterative process, enabling identification of relevance of key aspects of identified barriers and facilitators, and what aspects were common across sites. Program implementers’ conceptions of utility regarding the measure’s acceptability, appropriateness, and feasibility clustered across several common categories.ConclusionsThis case study provides a rigorous, multi-step process for developing a pragmatic IS measure. The process and lessons learned will aid in the teaching, practice and research of IS measurement development. The importance of including experiences and knowledge from different types of stakeholders in different global settings was reinforced and resulted in a more globally useful measure while allowing for locally-relevant adaptation. To increase the relevance of the measure it is important to target actionable domains that predict markers of utility (e.g., successful uptake) per program implementers’ preferences. With this case study, we provide a detailed roadmap for others seeking to develop and validate IS measures that maximize local utility and impact.

Effects of COVID-19 pandemic on psychiatric and psychological consultation-liaison contacts in a general hospital in North-East of Italy: a retrospective study

BackgroundThe COVID-19 pandemic has prompted significant changes in healthcare, particularly affecting psychiatric and psychological Consultation-Liaison (CL) services in general hospital settings.AimTo assess the effects of COVID-19-related restrictions on utilization of psychiatric and psychological CL services in Northeast Italy during 2020, and to compare it to the use of services in the previous year (2019).MethodsThe study collected data on psychiatric and psychological consultations in 2019 and 2020 from a hospital database. It categorizes consultations by type of patient (inpatient or outpatient) and referral source (hospital wards, general practitioners, other specialists). Pandemic-related restrictions were classified as “lockdown,” “intermediate restrictions,” and “no or reduced restrictions” based on the Covid Stringency Index (CSI). Poisson regression models were employed to analyze the data.ResultsThe findings reveal a significant 28% increase in the number of psychiatric and psychological consultations in 2020. Consultations for outpatients increased by 51%, while those for inpatients decreased by 11%. However, the lockdown and intermediate restriction phases were deemed responsible of a decrease of 42.9% and 19.5% in consultations respectively.DiscussionThis study highlights the persistent psychological burden during the COVID-19 pandemic, alongside reduced CL services due to lockdown measures. Integrating telemedicine into these types of services becomes imperative for meeting patient needs during restrictions. These findings can inform policies and practices to improve effective mental health care delivery during and beyond pandemics. Future research should explore the impact of pandemic-related restrictions on mental healthcare across settings and clinical factors affecting service accessibility.

Multi‐Objective Federated Averaging Algorithm

ABSTRACTThe recent global trend is the convergence of information and communications technology (ICT). By applying ICT in various fields such as the humanities, new types of products and services are created, and new values that help people's lives can be created. AI can be selected as a representative technology in such convergence ICT. However, applying AI technology to actual production requires ensuring data security. Federated learning (FL) can achieve secure sharing of data, where all parties participate in model training locally and upload it to the server for aggregation. The data never leaves the parties involved, thus solving the problems of data privacy and data silos. However, FL faces issues such as high communication cost, imbalanced performance distribution among participants, and low privacy protection. To achieve a balance between model accuracy, communication cost, fairness, and privacy, this paper proposes a multi‐objective optimization‐based FL algorithm (M‐FedAvg). The multi‐objective optimization problem of maximising the accuracy of the global model, minimising the communication cost, minimising the variance of the accuracy, and minimising the privacy budget is solved by NSGA‐III. The experimental results show that the algorithm proposed can effectively reduce the communication cost of FL and achieve privacy protection for participants without affecting the accuracy of the global model.

АНАЛІЗ ЦІНОВИХ СТРАТЕГІЙ ТА СПОЖИВЧА ПОВЕДІНКА В КОНТЕКСТІ МАРКЕТИНГОВИХ ДОСЛІДЖЕНЬ

Abstract introduction. The article examines the views of scientists regarding the formation of price strategies. The main approaches to pricing are considered, with the help of which companies set optimal prices for their services and goods. Factors affecting the company's choice of pricing strategy and affecting consumer behavior are considered. It is conducted research in relation to behavior of consumers and built model of satisfaction of consumer necessities. The purpose of the article. Consideration of pricing strategies of companies and their impact on consumer behavior. Researching consumer behavior and building a model for satisfying consumer needs in goods or services. Methods. Carrying out research the methods of abstraction, analysis, logical, theoretical and historical generalization and comparison are used. For basis of research a dialectical method is taken. Results. The article examines the main approaches to pricing, with the help of which companies set optimal prices for their services and goods. The factors affecting the company's choice of price strategy are considered, and the factors influencing consumer behavior are highlighted. Conducted research on consumer behavior. The proposed model of meeting the needs of consumers in goods or services, which contains 8 sections: the consumer's awareness of the need for the need for a product or service; collection of information; selection of goods or services; decision-making; purchase (payment) of goods or services; evaluation of the choice made and enrichment of experience; the degree of satisfaction of the need for a product or service and consumption of the results. Conclusiоns. After researching and analyzing the available types of marketing price strategies, business entities choose their own price strategy, taking into account certain existing tools, taking into account: characteristics of the service or product, market segment, market competition, competitor analysis, level of market demand, marketing strategies, etc. .. The use of the correct price strategy and the concept of pricing contributes to the achievement of goals: ensuring the stable financial condition of the business entity, meeting the needs of consumers. The offered model in relation to satisfaction of necessities of consumers in commodities or services gives understanding to the process of making decision by consumers in relation to a purchase that is the basic factor of success of company in a competition environment. Companies, that is able to adapt oneself to the necessities of consumers and, to their requirements, that understand the customers, have more chances to retain and attract clients, promote a competitiveness and score a success at the market. The question of the method of determining prices for certain types of services and the behavioral reaction of consumers requires further research.

ICU follow-up services and their impact on post-intensive care syndrome: a scoping review protocol

IntroductionPost-intensive care syndrome (PICS) seriously affects the quality of life of intensive care unit (ICU) survivors, their ability to return to work and society and the quality of life of...

Usefulness of self-guided digital services among mental health patients: The role of health confidence and sociodemographic characteristics

BackgroundRemote services provided via telephone or the internet have become an essential part of mental health provision. Alongside services involving healthcare personnel (HCP), self-guided digital services hold great promise for improved self-management and health outcomes without increasing the burden on HCP. Therefore, better understanding of patients’ use and experienced benefits of these services are needed. This study investigated how health confidence and sociodemographic background are associated with mental health patients’ experiences of self-guided digital services. MethodsThis cross-sectional survey study was performed in 2022 at a Finnish Mental Health and Substance Abuse Services (MHSAS) unit of a regional public service provider that serves a population of about 163000 people. All patients who had visited the unit up to 6 months before the study were invited to respond to an online survey on their experiences with the remote MHSAS. We report the average subjective usefulness of telephone, guided digital and self-guided digital services. Regression models were fitted to study the associations of patient characteristics with use of any digital service, and with experienced usefulness of self-guided digital services.Findings. The respondents (n = 438) rated the usefulness of telephone, guided digital and self-guided digital services similarly (4.0/5.0, 3.9/5.0, and 3.9/5.0, respectively). Health confidence was associated with not using digital services at all as well as with high perceived usefulness of self-guided services. While elderly patients were more likely to avoid using digital services, age was not associated with experienced usefulness of self-guided digital services. No association between unemployment status and experiences of digital services was found. ConclusionsDifferent types of remote services are perceived as beneficial by mental health patients. To ensure effectiveness and equity, patients’ health confidence should be considered when directing them to self-guided services. Elderly mental health patients who use digital services are equally able as younger patients to benefit from self-guided services.

Effect of elevated temperature on the bond behaviour of adhesive shear joints between glass substrate and iron-based shape memory alloy strip

Glass has been increasingly used as structural elements, such as glass beams or fins. Previous feasibility studies have shown increased initial and post-fracture load-bearing capacity of laminated glass beams post-tensioned with adhesively bonded iron-based shape memory alloy (Fe-SMA) strips. However, the potential elevated service temperatures were not considered, which significantly degraded the material properties of the adhesive. This study experimentally investigated the mechanical behaviour of Fe-SMA-to-glass lap-shear joints with an epoxy adhesive at different temperatures of 23 °C, 50 °C, and 80 °C, representing room temperature and typical elevated service temperatures. The results showed that, compared with the one at room temperature, the load-carrying capacity remained nearly unchanged at 50 °C and decreased by approximately 20% at 80 °C. On the contrary, the effective bond length increased from approximately 116mm to 250-300mm. The failure modes, the tensile strain of the iron-based shape memory alloy, the bond-slip behaviour, and the fracture energy of the joints were also evaluated. The current study fills a significant research gap in the engineering application of strengthening glass structures by bonded pre-stressed Fe-SMA strips. Moreover, the results may also significantly contribute to the future application of the selected adhesive at elevated temperatures.

A two-echelon multi-trip vehicle routing problem with synchronization for an integrated water- and land-based transportation system

This study focuses on two-echelon synchronized logistics problems in the context of integrated water- and land-based transportation (IWLT) systems. The aim is to meet the increasing demand in city logistics as a result of the growth in transport activities, including parcel delivery, food delivery, and waste collection. We propose two models, a novel mixed integer linear joint model, and a logic-based Benders’ decomposition (LBBD) model, for a two-echelon problem under realistic settings such as multi-trips, time windows, and synchronization at the satellites with no storage and limited resource capacities. The objective is to optimize transfers and satellite assignments, thereby reducing overall logistics costs for street vehicles and vessels. Computational experiments demonstrate that the LBBD model is more robust in terms of solution quality and solution time on average while the added value of the LBBD is more evident when solving large-scale instances with 100 customers, reducing the overall costs by 10.6% on average and significantly reducing the fleet costs on both networks. Furthermore, we assess the effect of changing cost parameters and satellite locations in the proposed IWLT system–analyzing system behavior and suggesting potential improvements–and evaluate several system alternatives in city logistics–consisting of different transportation network designs (single- and two-echelon), vehicle types, and operational constraints. On average, the proposed two-echelon IWLT system reduces the number of kilometers traveled by vehicles at street level by ranging from 20% to 30% compared to a typical single-echelon service design that relies solely on trucks.

Service Migration Algorithm Based on Markov Decision Process with Multiple Service Types and Multiple System Factors

Service Migration Algorithm Based on Markov Decision Process with Multiple Service Types and Multiple System Factors

Universal Health Care Coverage for Aging Population

The term Universal Health Coverage (UHC) refers to a situation where “all people (both males and females, boys and girls) have access, without financial hardship, to the full range of type of quality health services when and where they need them, now and at times”. The UHC envisages coverage of the full range of essential health care services: from health promotion to (1) ‘Prevention’, (2) ‘Treatment’, (3) ‘Rehabilitation’, and (4) ‘Palliative care’ [aimed at improving quality of life of people (adults and children) and their families confronted with life-threatening illness]. It is pertinent to note that the UHC aligns with the SDG (Sustainable Development Goal) Target 3.8: achieve universal health coverage. The UHC is, thus, global commitment. However, in to deliver this promise, national governments need and inter-governmental organizations need to have health systems that are rooted in the locations communities they serve. Also, such health systems need to be • Need-based, • Efficient, and • Equitable. The author of this review paper argues that Primary Health Care (PHC) is the most effective and cost-efficient way to reach out to people with the UHC, with consideration of “need-based approach”. Further, it is due to this consideration of need-based theory that every country, with its own socio-economic and demographic profile, adopts a different strategy for the purpose of achieving the UHC. Furthermore, national governments decide what to cover, depending on the needs of their populations, including availability of health infrastructure (resources). Investment in the scientifically designed UHC programs has the potential to ensures that health needs of people are (a) ‘Identified’, (b) ‘Prioritized’, and (c) ‘Addressed’. The conceptual framework of the UHC is of increased relevance for aging population (individuals above the age of 65). The author of this work is of the considered research view that objective of achieving the SDG-3.8 target cannot be fully and adequately realized without transforming health care system that has significant impact on functional ability in older age people (or aging population). Objective of this evidence-based review paper is to investigate into significance and implications of the UHC for aging population. Also, it briefly outlines renewed strategies needed for the UHC for aging population. Secondary data (largely ‘qualitative’ in nature) have been used. The method of data analysis is ‘descriptive’, involving non-statistical (mathematical) techniques. The paper briefly concludes that scientifically-designed mechanism for offering the UHC for older people, without financial burden, is crucial. It is important that health financing systems of the national governments are designed to cater to health needs of older people, while protecting them from to access services when they are needed, but also to protect them from financial catastrophe (by abolishing “out of pocket spending”).

Retraction of "Home visiting impacts during the pandemic: Evidence from a randomized controlled trial of Child First" by Xia et al. (2023).

Reports the retraction of "Home visiting impacts during the pandemic: Evidence from a randomized controlled trial of child first" by Samantha Xia, Mervett Hefyan, Meghan P. McCormick, Maya Goldberg, Emily Swinth and Sharon Huang (Journal of Family Psychology, 2023[Aug], Vol 37[5], 569-580). This article is being retracted at the request of the publisher, and the editor and all authors of the original article consented. The MDRC study team identified two caregivers who were enrolled at baseline but were, themselves, minors. (The following abstract of the original article appeared in record 2023-81526-001.) Existing research has found that home visiting programs for families with young children can improve children's development and strengthen caregiver and family well-being. However, the pandemic created numerous challenges for home visiting programs, forcing them to deliver services online or in a hybrid format to respond to pandemic-related challenges. Questions remain about the impacts of these programs when delivered at-scale via a hybrid model, especially during this uniquely challenging time. The present study reports 12-month impacts from a randomized controlled trial of Child First-an evidence-based home visiting program that provides psychotherapeutic, parent-child intervention (children ages 0-5) embedded in a coordinated system of care-when implemented as a hybrid service. This study estimates impacts within four domains: families' receipt of services, caregiver psychological well-being and parenting, child behavior, and family economic well-being. After randomly assigning families (N = 226) to receive Child First or typical community services, the research team surveyed caregivers (N = 183) about a year after study enrollment. Results from regression models with site fixed effects revealed suggestive evidence that Child First reduced caregivers' job loss, residential mobility, and self-reported substance abuse, and increased receipt of virtual services during the pandemic. There were null impacts on caregivers' psychological well-being, families' involvement with the child welfare system, children's behaviors, and other indicators of economic well-being. Implications for future research and policy are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adolescent reproductive health care services: knowledge, perspectives, and challenges among service providers in Makurdi, Benue State Nigeria

Adolescence is a phase of life characterized by several reproductive health challenges that require support to navigate. However, access to adolescent and youth-friendly health service (AYFHS) centers to provide this support is limited. Perspective of healthcare workers (HCW) towards understanding the challenges to service provision has not been systematically documented. This study therefore documents the perspectives of HCWs on the types of services accessed by adolescents, and associated challenges in Makurdi, Benue State, Nigeria. The facility-based descriptive qualitative study used an in-depth interview guide among program officers in the 11 youth-friendly health centers. The interviews were recorded, transcribed, and analyzed thematically. The provision of HIV prevention services and AYFHS was appropriate while adolescents have preferences for facilities where their confidentiality is protected, and other needs are met. Reported challenges were lack of privacy, high cost of transportation to facilities, high staff attrition, poor awareness of the facilities and services, and parental consent. Suggestions for improvement included prolonged retention of youth-friendly trained staff, better client confidentiality, and economic empowerment of the adolescents to access services when needed. While the providers’ perspective on AYFHS for adolescents was positive, related challenges were also identified. Government and other stakeholders should collaborate to ensure the right environment for accessibility and utilization of AYFHS.