On automated sequential steady-state simulation.

The credibility of the final results from stochastic simulation has had limited discussion in the simulation literature so far. However, it is important that the final results from any simulations be credible. To achieve this, validation, which determines whether the conceptual simulation model is an accurate representation of the system under study, has to be done carefully. Additionally, a proper statistical analysis of simulation output data, including a confidence interval or other assessment of statistical errors, has to be conducted before any valid inferences or conclusions about the performance of simulated dynamic systems, such as for example telecommunication networks, are made. There are many other issues, such as choice of a good pseudo-random number generator, elimination of initialisation bias in steady-state simulations, and consideration of auto correlations in collected observations, which have to be appropriately addressed for the final results to be credible. However, many of these issues are not trivial, particularly for simulation users who may not be experts in these areas. As a consequence, a fully-automated simulation package, which can control all important aspects of stochastic simulation, is needed. This dissertation focuses on the following contributions to such a package for steady-state simulation: properties of confidence intervals (CIs) used in coverage analysis, heuristic rules for improving the coverage of the final CIs in practical applications, automated sequential analysis of mean values by the method of regenerative cycles, automatic detection of the initial transient period for steady-state quantile estimation, and sequential steady-state quantile estimation with the automated detection of the length of initial transient period. One difficulty in obtaining precise estimates of a system using stochastic simulation can be the cost of the computing time needed to collect the large amount of output data required. Indeed there are situations, such as estimation of rare events, where, even assuming an appropriate statistical analysis procedure is available, the cost of collecting the number of observations needed by the analysis procedure can be prohibitively large. Fortunately, inexpensive computer network resources enable computationally intensive simulations by allowing us to run parallel and distributed simulations. Therefore, where possible, we extend the contributions to the distributed stochastic simulation scenario known as the Multiple Replications In Parallel (MRIP), in which multiple processors run their own independent replications of the simulated system but cooperate with central analysers that collect data to estimate the final results

Nurses' perceptions of online continuing education

<p>Abstract</p> <p>Background</p> <p>There is increasing attention to online learning as a convenient way of getting professional training. The number and popularity of online nursing continuing education programs are increasing rapidly in many countries. Understanding these may contribute to designing these programs to maximize success. Also, knowing the perceptions and preferences in online learning aids development and orientation of online programs. The aims of this study are to show nurses' perceptions of online continuing education and to determine perceptions of various groups; area groups, working companies, frequency of computer usage and age.</p> <p>Methods</p> <p>The survey method was used in this quantitative study to reveal perception levels and relationship with related variables. Data were collected through an online instrument from a convenience sample of 1041 Registered Nurses (RNs) at an online bachelor's degree program. Descriptive and inferential analysis techniques were performed.</p> <p>Results</p> <p>Nurses generally have positive perceptions about online learning (<it>X </it>= 3.86; SD = 0.48). A significant difference was seen between nurses who used computers least and those with the highest computer usage [<it>F </it>(3, 1033) = 3.040; <it>P </it>< .05]. Neither nurses' ages nor lengths of working experience are significantly related to perceptions of online programs (<it>r </it>= -.013; <it>P </it>> .05 and <it>r </it>= -.036; <it>P </it>> .05, respectively). Nurses' perceptions are significantly different depending on the settings where they work [<it>F </it>(3,989) = 3.193; <it>P </it>< .05]. The difference between perceptions of nurses living in urban areas (<it>X </it>= 3.82; SD = .51) and those living in rural areas (<it>X </it>= 3.88; SD = .47) was not significant [<it>t </it>(994) = -1.570, <it>P </it>> .05].</p> <p>Conclusions</p> <p>We found that nurses regard online learning opportunities as suitable for their working conditions and needs. Nurses should be provided with continued training through online learning alternatives, regardless of age, working experience or area of residence.</p

Human-centred automation to simplify the path to social and economic sustainability

Musculoskeletal Disorders (MSDs) pose a serious threat to sustainability in manufacturing. In particular, this phenomenon impacts the sustainability indicators of worker health and safety and the Gross Domestic Product (GDP). Effective MSD prevention measures would therefore constitute a remarkable contribution to social and economic sustainability. This chapter provides first an outline of existing methods to prevent MSD at the workplace. Analysis of the approaches yields that effective solutions require earmarked finances as well as qualified personnel, both of which are not affordable for many companies. In pursuit of solutions, Human-centred Automation (HCA), a recent paradigm in manufacturing, proposes the design of manufacturing systems using intelligent technology to support the worker instead of replacing him/her. HCA has the unique potential of reducing the effort needed to implement MSD prevention strategies by simplifying the path to social and economic sustainability. This chapter demonstrates this process with the example of the “Working Posture Controller” (WPC), which illustrates how the HCA concept can be applied. Finally, the lessons learned from the case are outlined, providing a vision of how future workplaces can benefit from HCA

Coping strategies of women with postpartum depression symptoms in rural Ethiopia: a cross-sectional community study

Background: Most women with postpartum depression (PPD) in low- and middle-income countries remain undiagnosed and untreated, despite evidence for adverse effects on the woman and her child. The aim of this study was to identify the coping strategies used by women with PPD symptoms in rural Ethiopia to inform the development of socio-culturally appropriate interventions. Methods: A population-based, cross-sectional study was conducted in a predominantly rural district in southern Ethiopia. All women with live infants between one and 12 months post-partum (n = 3147) were screened for depression symptoms using the validated Patient Health Questionnaire, 9 item version (PHQ-9). Those scoring five or more, ‘high PPD symptoms’, (n = 385) were included in this study. The Brief Coping with Problems Experienced (COPE-28) scale was used to assess coping strategies. Construct validity of the brief COPE was evaluated using confirmatory factor analysis. Results: Confirmatory factor analysis of the brief COPE scale supported the previously hypothesized three dimensions of coping (problem-focused, emotion-focused, and dysfunctional). Emotion-focused coping was the most commonly employed coping strategy by women with PPD symptoms. Urban residence was associated positively with all three dimensions of coping. Women who had attended formal education and who attributed their symptoms to a physical cause were more likely to use both problem-focused and emotion-focused coping strategies. Women with better subjective wealth and those who perceived that their husband drank too much alcohol were more likely to use emotion-focused coping. Dysfunctional coping strategies were reported by women who had a poor relationship with their husbands. Conclusions: As in high-income countries, women with PPD symptoms were most likely to use emotion-focused and dysfunctional coping strategies. Poverty and the low level of awareness of depression as an illness may additionally impede problem-solving attempts to cope. Prospective studies are needed to understand the prognostic significance of coping styles in this setting and to inform psychosocial intervention development

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

An estimated 108,000 people die each year from potentially preventable iatrogenic injury. One in 50 hospitalized patients experiences a preventable adverse event. Up to 3% of these injuries and events take place in emergency departments. With long and detailed training, morbidity and mortality conferences, and an emphasis on practitioner responsibility, medicine has traditionally faced the challenges of medical error and patient safety through an approach focused almost exclusively on individual practitioners. Yet no matter how well trained and how careful health care providers are, individuals will make mistakes because they are human. In general medicine, the study of adverse drug events has led the way to new methods of error detection and error prevention. A combination of chart reviews, incident logs, observation, and peer solicitation has provided a quantitative tool to demonstrate the effectiveness of interventions such as computer order entry and pharmacist order review. In emergency medicine (EM), error detection has focused on subjects of high liability: missed myocardial infarctions, missed appendicitis, and misreading of radiographs. Some system-level efforts in error prevention have focused on teamwork, on strengthening communication between pharmacists and emergency physicians, on automating drug dosing and distribution, and on rationalizing shifts. This article reviews the definitions, detection, and presentation of error in medicine and EM. Based on review of the current literature, recommendations are offered to enhance the likelihood of reduction of error in EM practice.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74930/1/j.1553-2712.2000.tb00466.x.pd

Access to Adequate Outpatient Depression Care for Mothers in the USA: A Nationally Representative Population-Based Study

Maternal depression is often untreated, resulting in serious consequences for mothers and their children. Factors associated with receipt of adequate treatment for depression were examined in a population-based sample of 2,130 mothers in the USA with depression using data from the 1996–2005 Medical Expenditure Panel Survey. Chi-squared analyses were used to evaluate differences in sociodemographic and health characteristics by maternal depression treatment status (none, some, and adequate). Multivariate regression was used to model the odds of receiving some or adequate treatment, compared to none. Results indicated that only 34.8% of mothers in the USA with depression received adequate treatment. Mothers not in the paid workforce and those with health insurance were more likely to receive treatment, while minority mothers and those with less education were less likely to receive treatment. Understanding disparities in receipt of adequate treatment is critical to designing effective interventions, reducing treatment inequities, and ultimately improving the mental health and health of mothers and their families

Pesan Moral Islami Dalam Film Le Grand Voyage Karya Ismael Ferroukhi: Sebuah Tinjauan Struktural

Kata kunci : Film, sastra, struktural, pesan moral, Islam.Film merupakan produk budaya yang tidak hanya menjadi hiburan di masyarakat, tetapi juga sebagai sarana penyampaian pesan moral yang mengarifkan. Salah satufilm Perancis yang dianggap menginspirasi adalah film berjudul Le grand voyageyang ditulis dan disutradarai oleh Ismaël Ferroukhi. Film ini bercerita tentang perjalanan seorang muslim keturunan Maroko dan anaknya yang bernama Reda.Mereka menempuh jarak ribuan mil dari Perancis menuju ke kota Makah untukmelaksanakan haji hanya dengan mengendarai sebuah mobil tua. Penelitian inibertujuan untuk mengetahui pesan moral islami apa saja yang terkandung dalamfilm Le grand voyage dan bagaimana pesan tersebut dimunculkan dalam film.Penelitian ini menggunakan teori Struktural untuk menjawab rumusan masalah.Penelitian ini merupakan penelitian kualitatif dengan menggunakan teknik studipustaka serta dokumentasi sebagai metode pengumpulan data, dan teknikdeskriptif dalam proses analisis data.Berdasarkan hasil penelitian ini, terdapat 13 pesan moral islami yang terkandungdalam film Le grand voyage. Semua pesan moral tersebut mengacu pada sebuahproses perbaikan moral dan spiritual antara manusia dengan manusia dan alam,serta antara manusia dengan TuhanPenulis menyarankan pada penelitian selanjutnya untuk meneliti film Le grandvoyage menggunakan pendekatan sosiologi sastra yang nantinya dapat mengupashal apa saja yang melatarbelakangi pembuatan film ini dan tujuan sebenarnyayang ingin dicapai oleh pembuat film Le grand voyage