Small Service Research Articles

Care pathways for reduced fetal movements: Acost-consequence analysis.

This study aimed to evaluate the costs and consequences of a new midwife-navigator-facilitated care pathway for reduced fetal movements. This study was conducted at a tertiary obstetric centre in Queensland, Australia and modelling occurred for this and smaller services. Two months of data from pre (n = 112 in 2019) and post (n = 141 in 2020) implementation of the care pathway were analysed with T-tests and logistic regression models to evaluate maternal and neonatal outcomes. A Markov model was built to estimate the costs and consequences of the intervention. Sensitivity analysis was conducted to test various scenarios including modelling for smaller centres. There were no statistically significant differences in clinical outcome between the intervention and usual care groups. Intervention patients spent one hour and eight minutes less time in hospital (P < 0.001). This resulted in a saving to the centre of AU$135 per patient (AU$159 083 annually). One-way sensitivity analysis suggested that cost savings would be found in all scenarios except for smaller units providing services for less than 1900 births per annum. To our knowledge, no other care pathway involving acute obstetric care has been economically evaluated to date. Our model based on real-world presentations for reduced fetal movements confirms that midwife-navigators may be an economically beneficial implementation strategy for dealing with common obstetric conditions.

High performance microservice communication technology based on modified remote procedure call

Microservice architecture is a programming method that decomposes a single application into various smaller services and then executes them. However, this approach introduces new challenges in communication between services because of the different data structures and technology types among the multiple services. Therefore, interprocess communication (IPC) between services has become one of the important challenges facing microservice architecture. Additionally, the choice of IPC technology is an important decision that can affect the nonfunctional requirements of the entire architecture. To address this problem, this study proposes a microservice communication technology based on remote procedure calls (RPC) called RPCX to improve the communication performance between services. The RPCX communication mechanism based on RPC uses the nonblocking IO communication model and Protobuf data serialization standard method. It identifies RPC communication at the client and server ends using dynamic proxy and annotation configuration technology. We use RPCX and two traditional service communication technologies to conduct performance stress benchmarking and evaluate the performance of RPCX through the time consumed to process the requests and transactions per second (TPS) performance stress indicators. The results show that the performance of RPCX is better than that of the other two technologies under different threads and requests. In this study, we show that RPCX has overall better performance than the other two service communication techniques under different threads and requests.

PATH-13. IMAGE-BASED PHENOTYPING OF GLIOMAS FOR CLINICAL USE

Abstract Adult-type diffuse gliomas have been classified according to histopathological characteristics only. Based on molecular profiles, the World Health Organization (WHO) classification defines three distinct biologic and prognostic types of diffuse gliomas: (i) IDH wild type (IDHwt), (ii) IDH mutant, 1p19q intact (IDHmut-non-codel), and (iii) IDH mutant, 1p19q codeleted (IDHmut-codel). Gliomas with missing molecular information are classified as “Not otherwise specified” (NOS). A histopathological signature that distinguishes IDH status in gliomas using hematoxylin &amp; eosin (H&amp;E)-stained whole slide images (WSIs) has yet to be developed to be used as proxy for molecular alterations. We employed WSIs with corresponding molecular data from The Cancer Genome Atlas (TCGA) and reclassified the gliomas according to the 2021 WHO guidelines. Weakly supervised deep learning approaches, i.e. the Uncertainty-Aware CNN (UA-CNN), and accompanying workflows developed by our group were successful in the segmentation and classification of other cancers. We used the weak labels of IDHwt or IDHmut for given WSIs and utilized an informative sampling algorithm to identify the most relevant tiles that are predictive of their WSI-level label. Next, a second UA-CNN was trained on the relevant subset of tiles determined from the screening stage. For inferencing, given a WSI, the trained UA-CNN model yielded both a predicted label and uncertainty measure for each tile. When reassembled into a WSI, an aggregated uncertainty classification map is formed, which will allow neuropathologists to more rapidly identify regions of interest. While molecular testing is indispensable for current glioma classification, our tool may help reduce the number of NOS diagnosis, mainly in smaller services, by identifying image features that can differentiate between IDHwt and IDHmut. We expect to develop and deploy a method to increase the amount of information extracted from the H&amp;E stain, and help prioritize downstream molecular analyses mandatory for the layered diagnosis of gliomas.

Middleware 101

Whether segregating a sophisticated software component into smaller services, transferring data between computers, or creating a general gateway for seamless communication, you can rely on middleware to achieve communication between different devices, applications, and software layers. Following the increasing agile movement, the tech industry has adopted the use of fast waterfall models to create stacks of layers for each structural need, including integration, communication, data, and security. Given this scope, emphasis must now be on endpoint connection and agile development. This means that middleware should not serve solely as an object-oriented solution to execute simple request-response commands. Middleware can incorporate pull-push events and streams via multiple gateways by combining microservices architectures to develop a holistic decentralized ecosystem.

3D-Printed Personal Protective Face Shields During the COVID-19 Pandemic: A Survey of Canadian Frontline Workers.

BackgroundDuring the coronavirus disease 2019 pandemic, three-dimensional (3D) printing was utilized to rapidly produce face shields for frontline workers in response to an acute shortage of personal protective equipment (PPE). In this study, we examine the perceived utility and performance of 3D-printed (3DP) face shields through a survey of frontline workers in Ontario, Canada.MethodologyFrontline workers who received community-produced 3DP face shields from the Canadian initiative “3DPPE GTHA” (March-December 2020) were invited to participate in the study. The survey response rate was 54.3%. Of 63 respondents, 39 were patient-facing and 24 were community-facing frontline workers. Participants were asked to rate performance measures in 10 categories on a five-point Likert scale. Data were categorized by organization and frontline worker type, and a t-test was used to determine statistically significant differences among subgroups.ResultsThe mean preference for 3DP face shields among respondents was 3.2 out of 5 (95% confidence interval [CI]: 2.1-4.3). Community-facing respondents reported significantly greater overall utility scores for 3DP face shields (3.58, 95% CI: 3.38-3.79) compared to respondents working in a patient-facing profession (2.95, 95% CI: 2.77-3.13; p < 0.05). However, no differences were reported in portability and compatibility with other PPE. Respondents from organizations with large service volumes reported significantly lower overall utility scores (2.67, 95% CI: 2.44-2.89) than respondents in organizations with smaller service volumes (3.45, 95% CI: 3.28-3.62; p < 0.05).ConclusionsCommunity-facing frontline workers and those from smaller service volume organizations endorse higher utility for 3DP face shields than patient-facing frontline workers. Despite this, frontline workers generally rate 3DP face shields positively. 3DP face shields are a viable option for personal and community use and can be used to supplement supply in a community setting.

Survey of Telemedicine by Pediatric Nephrologists During the COVID-19 Pandemic

IntroductionThe slow increase in use of telemedicine began to expand rapidly, along with reimbursement changes, during the coronavirus disease-2019 (COVID-19) pandemic. Standardized protocols for these services are lacking but are needed for effective and equitable health care. In this study, we queried pediatric nephrologists and their patients about their telemedicine experiences during the pandemic.MethodsSurveys that were in compliance with the Health Insurance Portability and Accountability Act were deployed online to patients and physicians.ResultsWe collected survey responses from 400 patients and 197 pediatric nephrologists. Patients reported positive experiences with telemedicine visits as it was logistically easier than in-person visits. Patients also felt that the quality of their visits were equivalent to what they would receive in person. Physicians used a wide variety of online systems to conduct synchronous telemedicine with Zoom (23%), EPIC (9%), Doxy.me (7%), services not specified (37%), or a mix of local or smaller services (24%). Most physicians' concerns were related to technological issues and the ability to procure physical exams and/or laboratory results.ConclusionsThere is a paucity of published trials on telemedicine services in pediatric nephrology. Virtual care was feasible and acceptable for patients, caregivers, and providers during the COVID-19 pandemic.

Managing impacts of extreme hydrological events on urban water services: the Australian experience

ABSTRACT Australia experiences a wide range and increasing incidence of extreme hydrological events, including step changes in stream flows, extreme drought, bushfires followed by heavy rain, and storm events, which impact water availability and water quality. This article discusses the management of these events in the provision of water services in urban Australia. These events are being actively and effectively managed by large water service providers, covering around 80% of the population. But the experience for the remaining 20% is mixed, with smaller service providers often struggling to meet community expectations. This suggests a need for further governance reforms.

Predictive-Trend-Aware Composition of Web Services With Time-Varying Quality-of-Service

Service composition is a technology capable of combing a collection of existing services where many smaller services are coordinated together to form a larger one. Functionally similar services can often show different quality-of-service (QoS) properties. For a specific service composition request, how to choose from a bag of suitable services that fulfill the required functions under given quality-of-service constraints is widely believed to be a great challenge. The traditional approach usually tackles this problem by assuming fixed, bounded, or statistic QoS and views the decision-making of service composition as a static process. Instead, we address this problem by considering time-varying and fluctuating QoS and presenting a predictive-trend-aware service composition method by using a time series prediction model and genetic algorithms. We conduct extensive case studies based on multiple randomly-generated service templates with varying process configurations and show that our method outperforms existing ones.

Benchmarking Australian mental health court liaison services – results from the first national study

ABSTRACTMental health court liaison services (CLS) are a key component of the forensic mental health sector in Australia with a service present in each state and territory to identify and treat those with mental illness in contact with the courts. To date, limited research has been undertaken into how these services are delivered and which model is most effective. This paper describes the process and outcomes of the first national collaboration to trial a set of key performance indicators (KPIs) for Australian mental health court liaison services (CLS) using a benchmarking model. A set of nationally endorsed KPIs were found to be useful and relevant to policy and practice in terms of enabling services to compare resources and highlight areas for quality improvement. Wide variation in performance across services was observed. The ability of smaller services to provide data emerged as an issue, with several identifying the need to improve reporting capability. Benchmarking of specialised forensic mental health services was found to be a valuable process for services. Future collaborations for CLS may include refinements to the KPIs and will continue to enhance the knowledge base of this specialised area of forensic mental health service provision.

Context matters for primary health care access: a multi-method comparative study of contextual influences on health service access arrangements across models of primary health care

BackgroundEquitable access to primary health care (PHC) is an important component of integrated chronic disease management. Whilst context is known to influence access to PHC, it is poorly researched. The aim of this study was to determine the contextual influences associated with access arrangements in four Australian models of integrated PHC.MethodsA multi-method comparative case study design. Purposive sampling identified four models of PHC across six sites in two Australian states. Complexity theory informed the choice of contextual factors that influenced access arrangements, which were analysed across five dimensions: availability and accommodation, affordability, acceptability, appropriateness and approachability. Semi-structured interviews, document/website analysis and non-participant observation were used to collect data from clinicians, administrative staff and other key stakeholders. Within and cross-case thematic analysis identified interactions between context and access across sites.ResultsOverall, financial viability, objectives of the PHC model and relationships with the local hospital network (LHN) underpinned access arrangements. Local supply of general practitioners and financial viability were strong influences on availability of after-hours services. Influences on affordability were difficult to determine because all models had nil/low out-of-pocket costs for general practitioner services. The biggest influence on acceptability was the goal/objectives of the PHC model. Appropriateness and to a lesser degree affordability arrangements were influenced by the relationship with the LHN. The provision of regular outreach services was strongly influenced by perceived population need, referral networks and model objectives.ConclusionsThese findings provide valuable insights for policy makers charged with improving access arrangements in PHC services. A financially sustainable service underpins attempts to improve access that meets the needs of the service population. Smaller services may lack infrastructure and capacity, suggesting there may be a minimum size for enhancing access. Access arrangements may be facilitated by aligning the objectives between PHC, LHN and other stakeholder models. While some access arrangements are relatively easy to modify, improving resource intensive (e.g. acceptability) access arrangements for vulnerable and/or chronic disease populations will require federal and state policy levers with input from primary health networks and LHNs.

IMPROVING ACCESS TO BANKING PRODUCTS AND SERVICES FOR SMALL AND MEDIUM ENTERPRISES IN KENYA.

Purpose: The purpose of this study was to highlight the need for banks to develop financial products and services for small and medium enterprises.Methodology:The research design was descriptive survey study. The target population was 46 commercial banks .The sampling frame was the list of commercial banks given at the Central bank of Kenya Website. A sample of 17 banks was selected using random sampling. The second stage of sampling involved the selection of the respondents using a stratified sampling approach. The strata were the various departments that interact with SMEs in a bank. The respondents were the head of departments of the respective departments that form the strata. Both qualitative and quantitative data was collected using a questionnaire that consisted of both open ended and close ended questions. Data was analysed using Statistical Package for Social Sciences (SPSS.Results: One of the study objectives was to establish the level of access to financial products and services offered by the banks to SMEs. Results from the bank manager’s perspective indicated that the level of access to finance was high, but the bank clients indicated otherwise, that it was low. The other objective of the study was to determine the factors that hinder the SMEs from accessing the financial products offered by banks. Results indicated that several factors influence access of SMEs to finance. These factors include gender, level of education, size of the business, age of the entrepreneur, collateral, and level of income for the entrepreneurs. All the factors had a negative effect on the access of finances from the banks by SMEs and hence indicate SMEs low access to financial products. Another objective of the study was to establish the tools or systems required to improve accessibility to financial products offered. Results indicated that there are tools and systems put in place by banks to improve accessibility to financial products offered to small and medium enterprises.Unique contribution to theory, practice and policy:The study recommended that training be emphasized to SME entrepreneurs on financial matters, all gender to be treated equally, the banks to introduce financial education programs for SMEs to improve their access to credit, banks to further make use of a credit scoring system to assess the credit worthiness of small businesses and to introduce the use of new credit bureau regulations to increase SME finances.

Leveraging lean principles in creating a comprehensive quality program: The UCLA health readmission reduction initiative

IntroductionUCLA Health embarked to transform care by integrating lean methodology in a key clinical project, Readmission Reduction Initiative (RRI). MethodsThe first step focused on assembling a leadership team to articulate system-wide priorities for quality improvement. The lean principle of creating a culture of change and accountability was established by: 1) engaging stakeholders, 2) managing the process with performance accountability, and, 3) delivering patient-centered care. The RRI utilized three major lean principles: 1) A3, 2) root cause analyses, 3) value stream mapping. ResultsBaseline readmission rate at UCLA from 9/2010–12/2011 illustrated a mean of 12.1%. After the start of the RRI program, for the period of 1/2012–6/2013, the readmission rate decreased to 11.3% (p<0.05). ConclusionTo impact readmissions, solutions must evolve from smaller service- and location-based interventions into strategies with broader approach. As elucidated, a systematic clinical approach grounded in lean methodologies is a viable solution to this complex problem.

The Effect of Customer Orientation on Smaller Sized Service Firms and on the Market: A Multilevel Application Embracing Firms and Customers

The aim of the present work is to ascertain the importance of customer orientation as a business strategy within the smaller services sector. The adoption of customer orientation is measured from the firm’s point of view, and its effect on financial performance is analyzed. Customer perception is analyzed, using two variables, perceived value and loyalty. The sample consists of 100 Spanish rural tourism enterprises and 572 customers. The findings reveal that customer orientation has a direct effect on perceived value, and perceived value has a direct effect on loyalty toward the firm. Furthermore, customer orientation contributes to the achievement of financial performance.

Provisioning of Inter-Domain QoS-Aware Services

Cooperation among service providers, network providers, and access providers in the Internet allows the creation of new services to offer to customers that are in other domains, thus increasing revenue. However, the Internet heterogeneous environment, where each provider has its own policies, infrastructure and business goals, hinders the deployment of more advanced communication services. This paper presents a Quality of Service (QoS) for Inter-Domain Services (QIDS) model that allows inter-domain QoS-aware services to be defined, configured, and adapted in a dynamic and on-demand fashion, among service providers. This is accomplished by: 1) the use of a common communication channel (business layer) where service providers publish and search for services, and interact with each other to contract and manage these services; 2) the templates to specify the business and technical characteristics of the services; 3) the automatic composition of services using service elements (smaller services) according to performance and service-specific QoS parameters; and 4) the creation and enforcement of configuration rules for the underlying infrastructure. A prototype was implemented to validate QIDS and performance tests were conducted on an inter-domain Border Gateway Protocol (BGP)/Multiprotocol Label Switching (MPLS) Virtual Private Network (VPN) scenario.

Optimisation of Experimental Techniques to Enhance the Efficiency of Polymer Photovoltaic Cell

The idea of generating electricity from plastics itself sounds enthralling, but it is equally challenging to achieve in the lab and then take it to the production level. Polymer Solar Cells (PSCs) have the advantage of lower cost and flexibility but they do suffer from problems like low efficiency and smaller service life which is mainly due to limited absorption spectra, poor charge mobility and the degradation of the polymers. A combination of narrow band donor and fullerene derivative is one of the possible approaches to fabricate a working device. In this work, various experimental techniques have been optimised in order to achieve better efficiency of the PSCs in atmospheric condition. Optimized parameters from polymer mixing ratio, spin coating, annealing and others were used to enhance efficiency of device. Parameters were optimized with the help various techniques viz. Viscometer, Thermo Gravity Analysis, UV-vis spectroscopy, Scanning Electron Microscopy and I-V measurement system. We report 0.76% efficiency in these solar cells, which were fabricated in open atmospheric condition. The as-prepared device showed a good performance with an open-circuit voltage (Voc) 0.74 V, short circuit current (Isc) 0.6 mA, a fill factor (FF) of 35%.

Mathematical model for performance analysis of a context-aware device with composite service

Recent advances in the development of smart devices and wireless network infrastructures have made it possible to provide a variety of rich services to diverse user groups. In order to make the best use of these technological benefits, the services provided by the device need to be developed and supplied with consideration for the user context that contains information about the environments with which the device and the user interact. The user context is mostly inferred based on the data that are dispersed in the user’s environment and can trigger a service when enough data are gathered to infer a certain degree of user context. A service provided by the device usually consists of one or more smaller services taking the form of a composite service. In this regard, we investigate a context-aware composite service provision process and present an analytical tool for assessing the performance of the process by means of a mathematical model. The results from extensive experimental simulations indicate that a performance assessment based on the proposed mean value analysis model effectively confirms the characteristics of the composite service systems.

Impact of Market Orientation and ICT on the Performance of Rural Smaller Service Enterprises

Market orientation (MO) is considered as a competitive strategy for the smaller service enterprises based in rural locations. A model is proposed and validated for the rural tourism sector that encompasses the effects of MO and of the use of information and communications technology (ICT) on business activity, taking into account the business's financial results, improvements to the rural location, and the more personal, intangible impact on the local entrepreneur. ICT is found to have a positive impact on MO and outcomes, whereas, similarly, the adoption of MO is found to have a positive effect on outcomes.

A hybrid of monopoly and perfect competition model for hi-tech products

For Hi-tech products, the demand rate, the component cost as well as the selling price usually decline significantly with time. In the case of perfect competition, shortages usually result in lost sales; while in a monopoly, shortages will be completely backordered. However, neither perfect competition nor monopoly exists. Therefore, there is a need to develop a replenishment model considering a hybrid of perfect competition and monopoly when the cost, price and demand are decreasing simultaneously. A numerical example and sensitivity analysis are carried out to illustrate this model. The results show that a higher decline-rate in the component cost leads to a smaller service level and a larger replenishment interval. When the component cost decline rate increases and the selling price decline rate decreases simultaneously, the replenishment interval decreases. In perfect competition it is better to have a high service level, while for the case with monopoly, keeping a low service level is better due to complete backordering.

Is There a Doctor in the House?

Unexpected emergencies requiring urgent intervention can arise in the course of labor even among uncomplicated pregnancies in low-risk women. The possibility of such emergencies requires that responsible practitioners be available for management. The recent National Institutes of Health-sponsored consensus conference on vaginal birth after cesarean delivery highlighted this issue in discussing alternate standards of "ready" and "immediate" availability. The merits, feasibility, and ethics of alternate systems for coverage of all laboring women have not been widely or previously discussed and are considered in this opinion. Although there are potential advantages to having a responsible practitioner immediately available, logistic and economic considerations will make immediate availability unfeasible in all centers and systems, particularly on smaller services where distance or other factors may limit the option of consolidation (ie, the merging of different hospitals' obstetric services). We discuss training, systems, and planning to optimize response to emergencies in all systems, whether practitioners are readily or immediately available. Finally, we suggest that the ethical principle of respect for autonomy argues that particularly where alternate systems exist, practitioners and patients discuss the details, merits, and limitations of individual centers' clinical systems and plans for responding to emergencies.

Chemical Programming of Future Service-oriented Architectures

Service-based infrastructures are shaping tomorrow’s distributed computing systems by allowing the design of loosely-coupled distributed applications based on the composition of services spread over a set of resources available on the Internet. Compared to previous approaches such as remote procedure call, distributed objects or components, this new paradigm makes feasible the loose coupling of software modules, encapsulated into services, by allowing a late binding to them at runtime. In this context, an important issue is how to express the composition of services while keeping this loosely-coupled property. Different approaches have been proposed to express services composition, mostly using specialized languages. This article presents and explore an unconventional new approach for service composition based on a programming language, inspired by a chemical metaphor, called the High-Order Chemical Language (HOCL). The proposed approach provides a very abstract and generic way of programming service composition thanks to the high-order property of HOCL. We illustrated this approach by applying it to a simple example that aims at providing a travel organizer service based on the composition of several basic and smaller services.