Unavailability Of Services Research Articles

Reducing the harms of cannabis use in youth post-legalization: insights from Ontario youth, parents, and service providers

BackgroundCanada has one of the highest prevalence of cannabis use globally, particularly among young adults aged 20–24 (50%) and youth aged 16–19 (37%). In 2018, Canada legalized recreational cannabis with the aim of protecting youth by restricting their access and raising public awareness of health risks. However, there has been limited qualitative research on the perceptions of harms associated with youth cannabis use since legalization, which is crucial for developing effective harm reduction strategies. This qualitative study examined perceptions of cannabis use among youth from the perspectives of youth, parents, and service providers. We explored how participants described the perceived risks or harms associated with youth cannabis use, as well as how they described their own and others’ approaches to reducing cannabis-related risks and harms.MethodsThis qualitative study used a community-based participatory research approach in partnership with Families for Addiction Recovery (FAR), a national charity founded by parents of youth and young adults with addiction issues. Virtual semi-structured interviews were conducted, and the data were analyzed using thematic analysis.ResultsThe study included 88 participants from three key groups (n = 31 youth, n = 26 parents, n = 31 service providers). Two main themes emerged regarding perceived risks or harms associated with cannabis use: (1) concerns about cannabis-related risks and harms, including addiction, brain development, impact on family, and various adverse effects on areas such as motivation, concentration, finances, employment, education, physical and mental health; and (2) minimization of risks and harms, featuring conflicting messages, normalization, and perceptions of cannabis being less harmful than other substances. Additionally, two themes related to harm reduction approaches were identified: (1) implementation of harm reduction, and (2) challenges in implementing a harm reduction approach. Specific challenges for each participant group were noted, along with structural barriers such as unavailable and inaccessible services, easy access to cannabis, inadequate public education, and insufficient information on lower-risk cannabis use guidelines.ConclusionsYouth cannabis use is a significant public health concern that requires a multi-pronged approach. Developing youth-centered harm reduction strategies that recognize the developmental needs and vulnerabilities of youth, as well as the important role of families, is imperative.

From legislation to actual health service: evaluation of health provisions in the disability law of Ghana by adolescents with mobility and visual impairments and their families

BackgroundDespite Ghana’s Persons with Disability Act, 2006 (Act 715) making provisions for access to healthcare services for adolescents with disabilities and their families, a corpus of literature has reported that persons with disabilities continue to face challenges in accessing healthcare services. However, the voices of adolescents with disabilities and their families are very scarce in such discourse. This study explored the experiences of adolescents with disabilities and their families in accessing healthcare services as per the provisions described in Ghana’s Act 715.MethodsThis study involved 45 participants, including 25 adolescents with disabilities and 20 family members from a municipality in Ghana. Employing a qualitative descriptive design, semi-structured interviews were conducted which was then analyzed thematically and interpreted using Critical Disability Theory.ResultsThe study identified two major categories of barriers to healthcare access: environmental (socio-economic difficulties, poor built environment, unavailability of rehabilitation services) and systemic (cultural beliefs, poor support at healthcare facilities and inadequate healthcare legislative provisions for families of children with disabilities). Despite legal provisions for free healthcare, participants faced significant financial barriers, with specialist services often not covered by the National Health Insurance Scheme.ConclusionsThe study calls for policy adjustments to fully cover specialist care under Ghana’s National Health Insurance Scheme, establishment of local-level health assessment and resource centers, educational campaigns to change cultural perceptions, and training of healthcare workers to promote quality access to healthcare.

Force majeure in the Supreme Court: MUR Shipping BV v RTI Ltd [2024] UKSC 18

Force majeure (FM) clauses are designed to free both parties to a contract from liability when an event beyond their control prevents one or both of them from performing the contract. Examples of such events include inclement weather, natural catastrophes, political upheaval, changes in applicable rules or regulations, or unavailability of essential supplies or services. It is common to include FM clauses in manufacturing, construction or transportation contracts, where there is a high risk of such events occurring due to the length of time required to perform the contract, or the complexity of the performance obligations. Often a lot of money is at stake and pre-allocating the risk of such events is crucial to avoid disputes further down the line. While disputes regarding the meaning and effect of FM clauses may not be unusual, such disputes rarely reach the Supreme Court. MUR Shipping was one such rare case.

Living conditions in Italian administrative detention centres for migrants: a scoping review

Abstract Since 2011, Italy has experienced a growing flow of migrants, despite the implementation of restrictive and detention-oriented procedures. Detention facilities for migrants must provide health protection and general assistance to the person. Considering the critical state of the centres reported by various sources, this study gives an overview of the conditions in Italian detention facilities for migrants from a public health perspective. A scoping search of the peer-reviewed and grey literature was performed to investigate the public health standards currently in force in Italian detention facilities for migrants and refugees (Hotspot and CPR-Pre-removal Detention Centres). Articles published from 2009 to 2021 in English and Italian were included and qualitatively described in five categories: provision of healthcare, living conditions, protection of vulnerable detainees, access to legal advice, and the Covid-19 pandemic. 11 peer-reviewed studies and 24 grey documents were included. Guidelines on screening procedures for infectious diseases or vaccines appeared to be hastily followed; chronic and mental diseases were not appropriately addressed. The facilities were described as run-down, with scarce and poor-quality meals, and lacking of educational activities. A lack of protection for vulnerable categories was reported, including unaccompanied minors. The Covid-19 pandemic further exacerbated pre-existing issues, highlighting systemic weaknesses in preparedness and response. Life conditions within the centres for migrants in Italy fall significantly short of acceptable standards. The main problems are the unavailability of cultural mediation services and the insufficient protection of mental health. The overall conditions appeared to be not dignifying and violations of the law are, if not frequent, present and well recognised. Urgent reforms are warranted to address these shortcomings and ensure the humane treatment and protection of migrants within these facilities. Key messages • Italy is responding to the recent inflow of migrants with policies oriented to detention and repatriation. To this, it established de-facto detention centres for migrants, namely Hotspot and CPRs. • The public health standards of migrants’ repatriation centres are poorly followed and life inside the centres appears misereble.

PADV-01 CHALLENGES OF NEURO-ONCOLOGY CARE IN ZIMBABWE

Abstract Due to the advent of covid 19 coupled with the socio-economic crisis in Zimbabwe, this has resulted in numerous challenges in terms of health care access and resultant diagnostic and treatment barriers for neuro-oncology cases. A retrospective analysis of the burden of neuro-oncology cases which have been seen at a single center in Zimbabwe over the past 5 years and the resultant diagnostic and treatment barriers that have incurred. METHODS An audit of brain tumor cases was done through the analysis of Outpatient department records, Neurosurgery Admission records, and Neurosurgery theatre records at Sally Mugabe Central hospital. RESULTS Total number of cases recorded for the period were 71. Meningiomas 11 (15,5%), Posterior fossa tumors 12 (17%), Gliomas 6 (0.08%), Craniopharyngiomas 6(0.08%), Metastasis 5(0.07%), Pituitary tumors 4(0.06%), choroid plexus papilloma 3(0.04%), Lymphoma 2(0.03%), Pineal region tumor 1(0.01%). 21(30%) tumors were unclassified. Posterior fossa tumors were most common in the pediatric population less than 10years of age. Meningiomas had a female to male ratio of 1.75: 1. 9 (12%) patients were operated on during the same period mostly pediatric tumors. CONCLUSION There is a great deal of institutional as well as patient related factors affecting the diagnosing and treatment of neuro-oncology care in Zimbabwe. This includes lack of operating time, inadequate intensive care facilities, a general unavailability of medical imaging services, delay in pathological reporting, unavailability and costly adjuvant treatment. This is leading to late diagnosis and suboptimal treatment of the various tumors. Although brain tumors are rare, they are not uncommon and there is thus need to improve service delivery to ensure early diagnosis and treatment to have good outcomes.

Reliability and line loading enhancement of distribution systems using optimal integration of renewable energy and compressed air energy storages simultaneously under uncertainty

Recently, with the significant growth of load demand, further interest in renewable energy sources (RESs) incorporated into electric distribution systems (DSs) has become important. However, the output powers' stochastic fluctuations of the photovoltaic (PV) and wind turbine (WT) generation sources, as well as the load demand, result in obvious operational challenges related to the reliability and line loading of these systems. Therefore, this present study is intended to enhance the load-oriented reliability indices (LORIs), the customer-oriented reliability indices (CORIs), and the line loading index (LLI) of the DSs by assigning the optimal integration of RESs and compressed air energy storages (CAESs) through the determination of both the optimal placement and capacities of RESs and CAESs simultaneously, as well as the optimal charging and discharging powers of the CAESs and their initial state of charge based on the red-tailed hawk (RTH) optimization technique. The Monte Carlo Simulation (MCS) and the Scenario-based Reduction (SBR) uncertainty methods are implemented to address the uncertainties of RESs and loading. The influences of the linear failure rate of DS's feeders and the installation of protective devices are also demonstrated. The efficiency of the intended methodology is demonstrated on the IEEE 69-bus and IEEE 33-bus DSs associated with voltage-dependent, time-varying mixed loads. The outcomes obtained from the suggested RTH are compared to those of other reported optimization techniques to validate its effectiveness. The results reveal that the optimal integration of RESs along with CAESs in the IEEE 69-bus test DS can improve the energy not supplied (ENS), system average interruption duration index (SAIDI), system average interruption frequency index (SAIFI), average service unavailability index (ASUI), and LLI by 1.09 %, 1.86 %, 1.73 %, 1.89 %, and 64.53 %, respectively.

Component-based modeling of cascading failure propagation in directed dual-weight software networks

Software vulnerabilities often lead to cascading failures, resulting in service unavailability and potential breaches of user data. However, existing models for cascading failure propagation typically focus solely on the static design’s calling relationships, disregarding dynamic runtime propagation paths. Moreover, current network topology models primarily consider function calling frequency while overlooking critical factors like internal failure probability and component failure tolerance rates. Yet, these factors significantly influence the actual propagation of software cascading failures. In this study, we address these limitations by incorporating internal failure probabilities and calling frequencies as node and edge weights, respectively. This forms the basis of our component-based directed dual-weight software network cascading failure propagation model. This model encompasses the evaluation of cascading failure propagation through intra-component and inter-component propagation probabilities, alongside the constraint of component failure tolerance rates. Through extensive experiments conducted on six real-world software applications, our model has demonstrated its effectiveness in predicting software cascading failure propagation processes. This method deepens our understanding of software failures and structures, equipping software testers with the knowledge to make well-informed judgments regarding software quality concerns.

Voices from the Frontline: Insights on Aboriginal and Torres Strait Islander Housing Advocacy

ABSTRACT Homelessness is a significant issue in Australia, particularly for Aboriginal and Torres Strait Islander people, who are disproportionally affected compared to non-Indigenous Australians. In this article, we present new findings into the barriers and enablers of housing stability for Aboriginal and Torres Strait Islander people in the Brisbane and Logan areas of Queensland. The aim of the study was to document workers perceptions of barriers and enablers faced by Aboriginal and Torres Strait Islander people in Queensland when seeking to access housing. We drew on extensive interview data with front-line staff from an Aboriginal Community-Controlled Health Organisation (ACCHO) and in doing so identified five key themes: Bureaucratic Barriers and Inaccessibility of Services; Experiences of Discrimination; Impact of Family Dynamics on Housing Stability; Geographic Location; Comprehensive Support Needs. We demonstrated that consistent with the scholarly literature the interplay of systemic, structural, and cultural factors continues to impact housing stability. These findings suggest more work is required if governments are to address housing stability for Aboriginal and Torres Strait Islander individuals and families. IMPLICATIONS Presenting original data from social workers at an Aboriginal Community-Controlled Health Organisation (ACCHO) contributes to available understandings. In addressing housing challenges, cultural connection and competency are of vital importance. Voices from social workers can provide guidance for policymakers aiming to address homelessness for Aboriginal and Torres Strait Islander people.

Nephrologists’ Views on a Workflow for Returning Genetic Results to Research Participants

IntroductionReturning research-based genetic results (gRoR) to participants in nephrology research can improve care but the practice raises implementational questions and no established guidelines for this process currently exists. Nephrologists' views on this issue can inform the process but are understudied. MethodsWe developed a conceptual workflow for gRoR from literature and experience, covering aspects such as which results to return, how, and by whom. We surveyed U.S. nephrologists to gauge their views on the workflow and anticipated barriers and collected participants' demographics including professional backgrounds. ResultsA total of 201 adult and pediatric nephrologists completed the survey. Most agreed that all diagnostic kidney-related results (93%), secondary findings (80%), and kidney-related risk variants (83%) should be returned. No significant differences were found between adult and pediatric nephrologists’ responses, except that 48% of adult nephrologists vs. 26% of pediatric nephrologists supported returning polygenic risk scores (p<0.01). Seventy-nine percent wanted to know about research results before clinical confirmation. Most (63%) believed a genetic counselor should return clinically confirmed results. Key barriers included the cost of clinical validation (77%) and unavailability of genetic counseling services (63%). Facilitators included educational resources on genetic kidney diseases (91%), a referral list of experts (89%), and clear clinical care guidelines (89%). We discuss findings’ implications and provide “points-to-consider”. ConclusionThere is significant interest in gRoR among nephrologists, but logistical and economic concerns need addressing. Identified facilitators can help large nephrology studies planning to return genetic results to participants.

Parental Stress and Psychological Distress and Their Association With Spousal Support Among Parents of School-Age Children During the COVID-19 Pandemic in South India: A Cross-Sectional Observational Study.

The COVID-19 pandemic presented unprecedented challenges to families in the form of social isolation, economic difficulties and inaccessibility of educational and supportive services. To assess the levels of parental stress and psychological distress among parents of school-age children during the COVID-19 pandemic and to analyse its correlation with spousal support. A cross-sectional, web-based study was conducted among the parents of school-age children in south India. One hundred thirty-two completed responses were obtained. Study tools included Parental Stress Scale, Spouse Support Scale and Kessler's psychological distress scale-6 item version. The mean parental stress score was 42.39 ± 9.679. Sixty percent of the participants reported moderate to high levels of psychological distress. Parental stress and psychological distress scores were noted to have a significant negative correlation with spousal support scores (r=-.486, p=.000 and r=-.401, p=.000 respectively). Our study findings show that the COVID-19 pandemic has taken a toll on the psychological well-being of parents of school-age children. Supportive interventions to address parenting difficulties need to be undertaken to prevent long-term adverse mental health outcomes. Lessons learnt from the pandemic are important for clinicians and policymakers to take measures to alleviate parental stress as well as to promote the psychological well-being of parents and children.

Why app-hailed transportation remains inadequately accessible to wheelchair users

People with disabilities in general and wheelchair users in particular face challenges in transportation services hailed using smartphone apps such as as Uber and Lyft. Although some riders who use wheelchairs use the services successfully, others experience various challenges from shortage of accessible vehicles, service denial by drivers, and long wait times. This article explains how in the U.S. these companies position themselves as technology platforms, an intermediary entity between drivers and riders, and therefore not accountable for accessibility regulations and labor standards. This positioning leads to inaccessible services for wheelchair users. This paper highlights considerations for change that can improve the prospects of wheelchair users to travel using these apps.

Economic impact of COVID-19 on patients with type 2 diabetes in Kenya and Tanzania: a costing analysis

IntroductionCOVID-19 affected healthcare access, utilisation and affordability, especially for patients suffering from chronic diseases, including type 2 diabetes (T2D). This study measured the occurrence and magnitude of changes in healthcare...

Perceptions of Antenatal Care among Ghanaian Mothers

In Ghana, some pregnant women may not seek antenatal care due to the unavailability of such services in their communities, although preventive service can help reduce maternal mortality with high-quality care. This study aimed to understand the antenatal care opinions of Ghanaian mothers who sought antenatal care, the barriers they faced, and their suggestions for improvement in antenatal care in Ghana. This study’s data were collected in the Central and Ashanti regions in Ghana from June 2023 to January 2024. Four hundred and fifty mothers in Ghana who indicated that they had given birth within the last 10 years of the data collection period took part in the study. Our findings revealed that 93.6% of Ghanaian mothers perceived their antenatal care to be of good quality due to proper examinations, friendly provider–patient interactions, reassurance, fair treatment, and proper education, whereas 6.5% of Ghanaian mothers perceived their care to be of poor quality due to long wait times, impersonal interactions, inadequate facility resources, and barriers to communication. For Ghanaian mothers to receive better outcomes for themselves and their children, it is worth improving healthcare facilities, healthcare provider preparedness, local transportation, and addressing financial constraints to go from suboptimal to optimal health services.

2311 Doing nothing is NOT an option—successful collaboration as part of wider quality improvement exercise in frailty services

Abstract Introduction Population is growing old worldwide and UK is no exception. Health service models designed to cater the needs of service users are under immense pressure due to the ageing phenomenon. With unprecedented demand, their often low acuity, hence low priority and delayed conveyance to hospital and unavailability of services to address their needs due to delayed arrival; frail older patients often have to wait longer in emergency department (ED) to receive care in ED. Innovation and news models of care are therefore need of the hour to address this challenging situation. Methods Quality improvement initiative to establish acute frailty service. Development of Older Person assessment unit (OPAU) in Oct 2022 with already established and functional acute frailty team. Plan for direct referral to OPAU from South East coast ambulance service (SECAmb) colleagues. Weekly meetings with SECAmb. Geriatrician of the Day supporting alternative pathways instead of ED. Development of frailty poster with criteria to referral and uploaded on SECAmb work iPads, displayed in ambulances delivery area and ambulance queuing area inside the hospital. Single point of access phone number launched April 2023 to access frailty team &amp; other alternative services from outside the hospital. SECAmb webinar for education and awareness of alternative pathways (UCR, SDEC, frailty, virtual ward), attended by 40 front line SECAMB staff. Results October 2022–0 patients. November 2022–2 patients. December 2022–8 patients. January 2023–18 patients. February 2023–32 patients. March 2023–33 patients. April 2023–39 patients. Conclusion With sustained efforts and effective collaboration, number of patients being referred to alternate pathway (frailty team) are increasing with anticipated significant reduction to SECAmb conveyance to ED in the long run, addressing overcrowding issues.

Clients’ satisfaction with cervical cancer screening services and influencing factors at public health facilities in Debre Markos town, Northwest Ethiopia, 2022/23: a convergent parallel mixed method

BackgroundSatisfaction is defined as the perceived fulfillment of patient or client needs and desires through the delivery of healthcare services. In developed countries, more than 60% of women have been screened for cervical cancer. However, only 12% of women in sub-Saharan Africa have been screened for precancerous cervical lesions. There is limited evidence on client satisfaction with cervical cancer screening services (CSCCSS) in Ethiopia, particularly, there is no study conducted by mixed method in the Amhara region.ObjectiveThe study aimed to assess clients’ satisfaction with cervical cancer screening services and influencing factors among women screened in Debre Markos town public health facilities in Northwest Ethiopia, 2022/23.MethodsA convergent parallel mixed methods design was conducted in Debre Markos town’s public health facilities from October 10th, 2022 to January 10th, 2023. For the quantitative wing, a total of 401 cervical cancer screening service users were selected using a systematic random sampling technique. Data were collected using an interviewer-administered structured questionnaire. Clients were interviewed on exit in a private area far from the screening unit and the data were entered into Epi-data version 4.6.0.2, then exported to STATA version 14 for analysis. A binary logistic regression model was fitted to identify factors associated with client satisfaction with cervical cancer screening services. The qualitative data were collected through in-depth and key informant interviews using a semi-structured topic guide. The data were analyzed using a thematic analysis approach with Open code software (version 4.0.2.3).ResultThe quantitative wing revealed that overall, 65% (95% CI: 60–69) of respondents were satisfied with the cervical cancer screening services they received. Gender of the provider (AOR: 6.11, 95% CI: 3.23–11.55, p-value = 0.000), waiting time (AOR: 4.77, 95% CI: 1.32–17.31, p-value = 0.017), clients’ knowledge (AOR: 0.26, 95% CI: 0.12–0.59, p-value = 0.001), and clients’ attitude (AOR: 6.43, 95% CI: 3.43–12.03, p-value = 0.000) were significantly associated with CSCCSS.Qualitative resultThe thematic analysis revealed three themes. Theme 1: facility-related barriers (shortage of skilled manpower, shortage of infrastructure, providers’ skill gap, unavailability of full service, leadership problem, long waiting time). Theme 2: client-related barriers (poor knowledge and attitude, gender preference). Theme 3: facility-related facilitators (free service, presence of supportive partners).ConclusionAccording to the findings of this study, two-thirds of clients were satisfied with cervical cancer screening services, which was lower than the national target of 80%. Long waiting time, male gender of the service provider, unfavorable attitude, and good knowledge of clients were identified as significant factors negatively affecting client satisfaction with cervical cancer screening.

Implementation of the clinical practice guidelines among family medicine doctors at primary health care facilities in Khartoum and Gezira states of Sudan

IntroductionThe health system in Sudan faces several challenges, including increasing numbers of patients, shortages of health supplies, and disparities in the distribution of health services. Guidelines implementation improves patients’ outcomes and ensures efficient use of the resources in such a resource limited country. The study aimed to assess the implementation of the clinical practice guidelines among family medicine doctors working in the primary health care centers in Khartoum and Gezira states to provide baseline data about the current practice in Sudan.MethodsDescriptive cross-sectional facility-based survey, conducted from April to December 2021, on 373 of the practicing family-medicine doctors. A total of 101 Primary health care centers were surveyed (77 centers in Khartoum state and 24 in Gezira state). The questionnaire was pilot tested on a small group of physicians to improve clarity and reduce response bias. Descriptive statistics were used to summarize the data and analyzed by frequency tables. Chi square and logistic regression tests were used to determine the association between categorized variables. P value < 0.05 was considered statistically significant.ResultsMost of the practicing family-medicine doctors (98.4%) reported implementation of the guidelines. Moreover, (68.6%) of them received training programs which were organized and funded by the Sudan Ministry of Health. The local Sudanese guidelines were difficult to access and not regularly updated. Services unavailability and inaccessibility (87.1%), health insurance factors (83.9%), and patient factors (81.2%) were the most frequent barriers to guidelines implementation. Service cost (79.9%), lack of regular training programs (79.9%), absence of local guidelines (77.2%), lack of continuity in the comprehensive care process (63.0%), and lack of time (57.1%) were also reported as barriers to guidelines implementation.ConclusionGuidelines implementation is limited by unavailability and inaccessibility of the health services and the health insurance limited coverage. Expansion of the health insurance coverage, organization of continuous training programs, encouragement of regular auditing and issuing regulations to ensure the use of updated guidelines, dissemination of the updated national guidelines along with establishing clinical governance in Sudan can be useful tools for policymakers in the optimum allocation of public health resources.

Exploring patient-, provider-, and health facility-level determinants of blood pressure among patients with hypertension: A multicenter study in Ghana.

Optimal blood pressure (BP) control is essential in averting cardiovascular disease and associated complications, yet multiple factors influence the achievement of BP targets. We explored patient-, provider-, and health facility-level factors of systolic and diastolic BP and controlled BP status among patients with hypertension in Ghana. Using a cross-sectional design, we recruited 15 health facilities, and from each facility, we recruited four healthcare providers involved in managing hypertension and 15 patients diagnosed with hypertension. The primary outcome of interest was systolic and diastolic BP; the secondary outcome was BP control (<140/90 mmHg) in compliance with Ghana's national standard treatment guidelines. We used mixed-effects regression models to explore the patient- and facility-level predictors of the outcomes. Two hundred twenty-four patients and 67 healthcare providers were sampled across 15 health facilities. The mean (SD) age of providers and patients was 32 (7) and 61 (13) years, respectively. Most (182 [81%]) of the patient participants were female, and almost half (109 [49%]) had controlled BP. At the patient level, traveling for 30 minutes to one hour to the health facility was associated with higher diastolic BP (Coeff.:3.75, 95% CI: 0.12, 7.38) and lower odds of BP control (OR: 0.51, 95% CI: 0.28, 0.92) compared to traveling for less than 30 minutes. Receiving hypertension care at government health facilities than at private health facilities was associated with lower systolic BP (Coeff.: -13.89; 95% CI: -23.99, -3.79). A higher patient-to-physician or physician-assistant ratio was associated with elevated systolic BP (Coeff.: 21.34; 95% CI: 8.94, 33.74) and lower odds of controlled BP (OR: 0.19, 95% CI: 0.05, 0.72). Along with addressing the patient-level factors influencing BP outcomes in Ghana, there is a need for public health and policy interventions addressing the inaccessibility of hypertension services, the shortage of clinical care providers, and the underperformance of private health facilities.

Optimizing pre-copy live virtual machine migration in cloud computing using machine learning-based prediction model

One of the preconditions for efficient cloud computing services is the continuous availability of services to clients. However, there are various reasons for temporary service unavailability due to routine maintenance, load balancing, cyber-attacks, power management, fault tolerance, emergency incident response, and resource usage. Live Virtual Machine Migration (LVM) is an option to address service unavailability by moving virtual machines between hosts without disrupting running services. Pre-copy memory migration is a common LVM approach used in cloud systems, but it faces challenges due to the high rate of frequently updated memory pages known as dirty pages. Transferring these dirty pages during pre-copy migration prolongs the overall migration time. If there are large numbers of remaining memory pages after a predefined iteration of page transfer, the stop-and-copy phase is initiated, which significantly increases downtime and negatively impacts service availability. To mitigate this issue, we introduce a prediction-based approach that optimizes the migration process by dynamically halting the iteration phase when the predicted downtime falls below a predefined threshold. Our proposed machine learning method was rigorously evaluated through experiments conducted on a dedicated testbed using KVM/QEMU technology, involving different VM sizes and memory-intensive workloads. A comparative analysis against proposed pre-copy methods and default migration approach reveals a remarkable improvement, with an average 64.91% reduction in downtime for different RAM configurations in high-write-intensive workloads, along with an average reduction in total migration time of approximately 85.81%. These findings underscore the practical advantages of our method in reducing service disruptions during live virtual machine migration in cloud systems.

Challenges of ICT Tools for Managerial Functions in Private Secondary Schools

The study examined the challenges of Information and Communication Technology (ICT) tools for managerial functions among private secondary school administrators in Ilorin metropolis, Kwara State, Nigeria. Both primary and secondary data were used in the paper. Using a standardized questionnaire, the principals of the private secondary schools in the Ilorin Metropolis provided the data. The total population of Private Secondary Schools within Ilorin Metropolis is 141. The entire population was used as a sample for the study. Findings from the study showed that the majority of the respondents strongly disagreed that there is a non-availability of computers in private secondary schools. The respondents disagreed with the unavailability of internet services in the Ilorin metropolis. The majority of the respondents agree that inadequate Information and Communication Technology tools in private secondary schools. The study concluded that fear of technology use among principals, inadequate Information and Communication Technology tools, and power failure are the challenges confronting the effective use of ICT among principals in private secondary schools in the Ilorin metropolis. The paper recommended that the proprietors of private secondary schools in the Ilorin metropolis should procure more Information and Communication Technology tools. Computer literacy experts should be appointed as the principal. The management should introduce solar energy to save the school from the interrupted power supply.

Healthcare system barriers and facilitators to hypertension management in Ghana.

Background: Hypertension continues to pose a significant burden on the health systems in Sub-Saharan Africa (SSA). Multiple challenges at the health systems level could impact patients' blood pressure outcomes. There is a need to understand the gaps in health systems to improve their readiness to manage the rising burden of hypertension Objective: To explore health system barriers and opportunities for improved management of hypertension in Ghana, West Africa. Methods: We conducted 5 focus group discussions involving 9 health facility leaders and 24 clinicians involved in hypertension treatment at 15 primary-level health facilities in Kumasi, Ghana. We held discussions remotely over Zoom and used thematic analysis methods. Results: Four themes emerged from the focus group discussions: (1) financial and geographic inaccessibility of hypertension services; (2) facilities' struggle to maintain the supply of antihypertensive medications and providers' perceptions of suboptimal quality of insured medications; (3) shortage of healthcare providers, especially physicians; and (4) patients' negative self-management practices. Facilitators identified included presence of wellness and hypertension clinics for screening and management of hypertension at some health facilities, nurses' request for additional roles in hypertension management, and the rising positive practice of patient home blood pressure monitoring. Conclusion: Our findings highlight critical barriers to hypertension service delivery and providers' abilities to provide quality services. Health facilities should build on ongoing innovations in hypertension screening, task-shifting strategies, and patient self-management to improve hypertension control. In Ghana and other countries, policies to equip healthcare systems with the resources needed for hypertension management could lead to a high improvement in hypertension outcomes among patients.