A Simulation Study of Workforce Management for a Two-Stage Multi-Skill Customer Service Center

This paper considers the parameter optimization of a two-stage multi-skill customer service center, which provides e-commerce services to customers and bears the major operating cost in hiring service agents. Based on the customer flow in the two-stage mixed queueing system, a simulation model is developed to determine the system performance of interest. We present a sensitivity analysis to achieve better savings in the staffing cost and waiting time at a guaranteed service level. A series of simulation experiments are conducted via an Arena simulation platform to figure out the optimal system configurations. The contribution of our works is to provide a decision-making tool for workforce managers to evaluate the performance of the studied customer service centers

The Evaluation And Using Intention For Digital Teaching Materials Of Penghu Basalt

The Bureau of Culture of Penghu County produced the Penghu Basalt Digital Teaching Materials, which are supplementary teaching materials for local curriculums in elementary and middle schools in Penghu County. But just what are the teachers’ and students’ opinions of the said teaching materials? Are they willing to use them? Are they suitable? These questions are, indeed, worth further research. The questionnaire survey was conducted to gather the opinions of 142 teachers and 151 students of elementary and middle schools in Penghu County. In addition, using the quasi-experimental and experimental teaching methods, after comparing the pre-test and post-test results to the control group, the learning effectiveness was determined. The results indicate that teachers and students have the highest evaluation for the interface design aspect of this teaching material. The teachers’ evaluation for the teaching materials is significantly higher than the students’. Furthermore, the teaching materials are evaluated highly in terms of attracting attention, generating interest and willingness to use, indicating that the digital teaching materials have potential for promotion in Penghu. After the experimental teaching, only the vocational high school students’ scores before and after the experiment showed significantly improvement, while the scores of the students in the other levels of schools did not. &nbsp

Traditional Chinese Medicine Diagnosis “ Yang-Xu Zheng

Pathogenesis of sepsis includes complex interaction between pathogen activities and host response, manifesting highly variable signs and symptoms, possibly delaying diagnosis and timely life-saving interventions. This study applies traditional Chinese medicine (TCM) Zheng diagnosis in patients with severe sepsis and septic shock to evaluate its adaptability and use as an early predictor of sepsis mortality. Three-year prospective observational study enrolled 126 septic patients. TCM Zheng diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and blood samples for host response cytokines measurement (tumor necrosis factor-α, Interleukin-6, Interleukin-8, Interleukin-10, Interleukin-18) were collected within 24 hours after admission to Intensive Care Unit. Main outcome was 28-day mortality; multivariate logistic regression analysis served to determine predictive variables of the sepsis mortality. APACHE II score, frequency of Nutrient-phase heat, and Qi-Xu and Yang-Xu Zhengs were significantly higher in nonsurvivors. The multivariate logistic regression analysis identified Yang-Xu Zheng as the outcome predictor. APACHE II score and levels of five host response cytokines between patients with and without Yang-Xu Zheng revealed significant differences. Furthermore, cool extremities and weak pulse, both diagnostic signs of Yang-Xu Zheng, were also proven independent predictors of sepsis mortality. TCM diagnosis “Yang-Xu Zheng” may provide a new mortality predictor for septic patients

A rare, highly aggressive primitive neuroectodermal tumor of the kidney: Case report and literature review

AbstractWe report a case of a 14-year-old boy who initially suffered from a sudden onset of abdominal pain for 2 weeks with a protrusive soft mass over the left upper abdomen. No obvious symptomatic symptoms or body weight loss were observed. However, early lung metastasis was detected after an initial computed tomographic examination. Even after we performed salvage en bloc resection of the huge retroperitoneal tumor after primary neoadjuvant chemotherapy, the final outcome was still poor. A diagnosis according to radiologic findings was uncharacteristic. Finally, a pathologic diagnosis based on histologic and immunohistochemical results revealed a rare renal peripheral primitive neuroectodermal tumor

Stepwise Increases in Left Ventricular Mass Index and Decreases in Left Ventricular Ejection Fraction Correspond with the Stages of Chronic Kidney Disease in Diabetes Patients

Aims. Patients with diabetic nephropathy are reported to have a high prevalence of left ventricular structural and functional abnormalities. This study was designed to assess the determinants of left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF) in diabetic patients at various stages of chronic kidney disease (CKD). Methods. This cross-sectional study enrolled 285 diabetic patients with CKD stages 3 to 5 from our outpatient department of internal medicine. Clinical and echocardiographic parameters were compared and analyzed. Results. We found a significant stepwise increase in LVMI (P < 0.001), LVH (P < 0.001), and LVEF <55% (P = 0.013) and a stepwise decrease in LVEF (P = 0.038) corresponding to advance in CKD stages. Conclusions. Our findings suggest that increases in LVMI and decreases in LVEF coincide with advances in CKD stages in patients with diabetes

Reduced Health-Related Quality of Life in Body Constitutions of Yin-Xu, and Yang-Xu, Stasis in Patients with Type 2 Diabetes: Taichung Diabetic Body Constitution Study

Aim. To evaluate how health-related quality of life (HRQOL) and traditional Chinese medicine (TCM) constitutions of Yin-Xu, Yang-Xu, and Stasis are related in type 2 diabetes patients. Method. Seven hundred and five subjects were recruited in 2010 for this study from a Diabetes Shared Care Network in Taiwan. Generic and disease-specific HRQOL were assessed by the short form 36 (SF-36) and the diabetes impact measurement scale (DIMS). Constitutions of Yin-Xu, Yang-Xu, and Stasis were then assessed by the body constitution questionnaire (BCQ), a questionnaire consisting of 44 items that evaluate the physiological state based on subjective symptoms and signs. Results. Estimated effects of the Ying-Xu and Stasis on all scales of the SF-36 were significantly negative, while estimated effects of the Yang-Xu on all scales (except for SF, RE, MH, and MCS) were significantly negative. For DIMS, the estimated effects of the Ying-Xu and Stasis on all scales were significantly negative except for Stasis on well-being, while Yang-Xu has a significantly negative effect only on symptoms. Conclusions. This study demonstrates that TCM constitutions of Yin-Xu, Yang-Xu, and Stasis are closely related to a reduction in HRQOL. These findings support the need for further research into the impact of intervention for TCM constitutions on HRQOL in patients with type 2 diabetes

A comparative technical and economic analysis of different processes for shale gas conversion to high value products

Natural gas is a clean fuel and proper feed for chemical industries. However, its transportation to consumer markets is harder and more expensive than that of crude oil because of some specific properties. Therefore, natural gas conversion to chemicals and exporting them instead of gas is safer, and this is also more profitable. Up until now, many methods and alternative techniques have been presented in this field. In this study, three important processes of shale gas conversion to more valuable compounds including gas to liquid (GTL), gas to methanol (GTM), and gas to ethylene (GTE) have been simulated by Aspen HYSYS software. Then the economic parameters of each process have been calculated. Eventually, the initial investment costs for GTM, GTL, and GTE are 422, 249, and 967, respectively. Incommands allowed only within braces addition, the return on investment values for GTM, GTL, and GTE have been estimated as 40, 37, and 20%, respectively