Optimizing the stake holder’s perspective on enhancing the service quality in health care

For the success of health care organizations, accurate measurement of health care service quality is as important as understanding the nature of the service delivery system. Without a valid measure, it would be difficult to establish and implement appropriate tactics or strategies for service quality management. Experts have struggled for decades to formulate a concise, meaningful and generally applicable definition of the quality of health care. However, the complexity and variability of many definitions are very confusing even to experts. Patients, service providers and other parties involved in the process of health care service delivery, understand and describe service quality in different ways. Different perspectives on health care quality lead to different expectations and different methods of quality measurement. Patients tend to evaluate health care quality according to the responsiveness to their specific needs. Most patients define quality as efforts of physicians to do everything possible for a patient. Patient’s expectations about the health care system may differ from those of health care professionals and managers. On the other hand, patients cannot evaluate many technical aspects of health care service quality. Physicians can provide a high level technical quality but still be rated low by patients because of the lack of humanity, responsiveness or satisfaction. For physicians and other health care providers measurement of service quality has typically been driven by medical outcomes. However, outcomes indicative of quality may differ for a patient and physician. Health care administrators often use managerial input measures such as the average number of nursing hours required for an outpatient surgery. This research paper aims to explore the ways and means towards optimizing the competing stake holders perspectives on enhancing the service quality in health care.Service quality; Healthcare; Optimization; India;

EVALUATION OF IN VITRO ANTIOXIDANT AND ANTIDIABETIC POTENTIALS OF DIFFERENT FRACTIONS OF MAYTENUS HEYNEANA ROOT EXTRACT

Objective: In an attempt to explore herbal drug which may become useful in the prevention of diabetes and antioxidant potential by the ethanol extracts of Maytenus heyneana (MH) root belonging to the family Celastraceae and their different fractions were studied.Methods: Different fractionation was done using chloroform, ethyl acetate, and methanol on ethanolic extract of MH and preliminary phytochemical analysis was done by standard methods to identify the presence of important compounds. In vitro antioxidants activities were carried by 2,2-diphenyl- 2-picrylhydrazyl (DPPH) and 2,2-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid (ABTS) cation radical scavenging assays. For antidiabetic potential, α-amylase and α-glucosidase enzyme inhibitory studies were carried on different fractions.Results: Phytochemical studies show the presence of alkaloids, flavonoids, phenols, cardiac glycosides, and terpenoids in all fractionations; however, tannins and quinones were present in ethyl acetate fraction and saponins in methanolic fraction. For antioxidant activity, ethyl acetate fraction shows concentration of the sample causing 50% inhibition (IC50) values in 22.31 μg/ml and methanolic fraction shows in 12.82 μg/ml concentrations for DPPH and ABTS radical scavenging assay, respectively. In case of antidiabetic activity, methanolic fraction offered significant result in inhibitory action of α-glucosidase and also for α-amylase assay IC50 (5.28 and 3.14 μg/ml) than other fractions.Conclusion: From the results of our studies, it can be concluded that MH shows antidiabetic and antioxidant values and methanolic fraction of MH could be possessed potential constituents in the prevention of diabetes and antioxidant than other fractions. However, further studies are required to validate

A Quality of Experience-based Recommender System for E-learning Resources

Web services are a rapidly developing and generally acknowledged technology across all areas of management. Independent software systems that can be shared and called from anywhere online. The creation of educational tools (such LMSs, MOOCs, and e-learning) now typically makes use of web services. Having these learning tools readily accessible online is a great method to acquire and disseminate information. The primary objective of this paper is to describe how web services can effectively manage educational resources by leveraging Quality of Experience and to develop an effective E-learning recommender system in the context of web services that help the user choose a course based on his needs in terms of availability, cost, and reputation

ARCUATE FORAMEN OF ATLAS VERTEBRA

ABSTRACTThe Arcuate foramen is a bony arch which connects the posterior end of the superior articular fossa with the posterior arch of atlas. In case of presence of arcuate foramen the vertebral artery follows the normal course but it has to traverse through the osseo fibrous ring (arcuate foramen).Aim & ObjectivesTo determine the height, width, and area of arcuate foramen and to determine the morphometric difference between the transverse foramen and the canal formed by bony bridges over the vertebral artery of the atlas vertebra.Materials & MethodsA total of 75 dry human atlas vertebrae were taken for the study. These vertebrae were examined carefully for the presence of arcuate foramen. Measurements of the maximum dimensions of the arcuate foramen and foramen transversarium were taken. Area of the arcuate foramen was calculated. Differences in dimension of arcuate foramen  and foramen transversarium were compared. Side differences of arcuate foramen were compared using the unpaired Student's t test.ResultsThe dimension of arcuate foramen of both sides as compared with dimension of foramen transversarium was found to be more, so the chance of compression of vertebral artery on both sides was less. The percentage of occurrence of arcuate foramen was 2.25% (bilateral) and ponticles was (1.5%) unilateral. ConclusionThe dimension of arcuate foramen was more when compared to foramen Transversarium dimensions so the chances of compression of vertebral artery would be less. The knowledge of these foramina may be important for orthopedic surgeons, radiologists, neurosurgeons, and anthropologists. KEYWORDS -Ponticulus Posticus, Arcuate Foramen, Atlas Vertebra, Foramen Transversarium

Active Vibration Control of Structures using an Impedance Matching Control Technique

Active vibration control of structures has gained a lot of interest in recent years. This paper presents an active vibration control methodology of a structure using piezoelectric actuators. The proposed methodology is useful in practical applications where the system to be controlled is difficult to model due to the presence of complex boundary conditions. The impedance matching control technique uses a power flow approach wherein the controller is designed such that the power flow into the structure is minimized. The system transfer function is obtained from the experimental collocated actuator/sensor pair data using Eigen Realisation Algorithm (ERA). The controller is designed for the system transfer function according to impedance matching theory. The above approach is targeted towards the vibration control of wind tunnel stings, which suffer from flow-induced vibration. A wind tunnel sting model is designed and fabricated for this study. The real time implementation of the impedance matching controller has been carried out using dSPACE® Digital Signal Processor (DSP) card. The results are encouraging and demonstrate the feasibility of applying this technique in the wind tunne

Post-Modern Feminist Ideology in Mahesh Dattani’s Where There’s a Will and Final Solutions

A true art is not meant for teaching and preaching. Its primary function is to give delight; its purpose is chiefly aesthetic. Only a writer, who maintains a perfect blending of both feeling and form, can push upward the art at its zenith. Mahesh Dattani exposes the illusion of perfect and complete control over the family for a longer period. Here the question arises in our mind why a man aspires too much for authority and power. Does it signify any value of life? Apparently it doesn’t attach any meaning to human existence. Nor does, it helps in improving quality of human life. Dattani is convinced that it is an attempt to make one-self secure and survive. So, man’s drive for the domination arises out of his own apprehension of insecurity. The dramatist mainly reflects on the issues of gender discrimination and evil of patriarch along with host of other issues like father-son, husband-wife relationship, evil of capitalism in the post colonial purview.

Outcomes of limb salvage surgery in patients with extremity osteosarcoma.

INTRODUCTION : Osteosarcoma is the most common malignant neoplasm of bone1 . It occurs most often in bones around knee joint and humerus of young people. Due to rapid and aggressive nature of the disease, the traditional treatment for osteosarcoma was amputation of the affected limb. In the 1970s, two year survival rates were fifteen to twenty percent2. However over the past 3 decades, the prognosis for these patients has changed dramatically. The development of chemotherapy agents have revolutionised the treatment of osteosarcoma by reducing the mortality. In addition the advances in imaging and new materials have provided the surgeon broader range of operative alternatives. AIMS AND OBJECTIVES : 1. To study long term survival of patients with extremity osteosarcoma treated by limb salvage surgery. 2. To identify prognostic factors influencing survival. 3. To identify risk factors for local recurrence. 4. To assess functional assessment of patients following limb salvage Surgery. CONCLUSION : Treatment of osteosarcoma has seen a paradigm shift in the management and today limb salvage surgery is possible in a majority of patients. Survival outcomes are excellent in our study and in par with international standards. Needle biopsy is the preferred method of obtaining diagnosis, preferably to be done by the centre planning the definitive treatment. Tumor response to neoadjuvant chemotherapy is the most important and valid prognostic factor predicting survival. Extensive soft tissue involvement and tumor necrosis following neoadjuvant chemotherapy were found to be risk factors, for the increased local recurrence, that has been observed in this study. In patients with extensive soft tissue extension, limb salvage surgery can be considered if technically feasible, although they have decreased survival similar to patients undergoing amputations. Our study has got its limitations as the results of the analysis of this group of patients are not statistically significant and due to lesser number of patients. The influence of this subgroup of patients undergoing limb salvage surgery, on local recurrence and survival needs to be validated in a prospective study involving more number of patients. Functional outcome after limb salvage surgery is excellent in our patients

Interactive Etiquette Activities and Work Dimensions in Secondary Language Learners: A Study

Etiquette in simpler words is defined as good behavior which distinguishes human beings from animals. Human Being is a social animal and it is really important for him to behave in an appropriate way. Etiquette refers to behave in a socially responsible way. Etiquettes is a code of behavior that delineates expectations for social behavior according to contemporary conventional norms within a society, social class, or group. The French word etiquette, literally signifying a tag or label, was used in a modern sense in English around 1750. Etiquette has changed and evolved over the years. It is essential for an individual to behave in a responsible manner acceptable to the society. People around us must not feel embarrassed by our behaviour.One should not behave irrationally or illogically in public

Pre Clinical and Clinical study on Mathumegam

The aim of the study was to evaluate the safty and efficacy of the drug Atthippattaiyathi kasayam in the treatment of Mathumegam. • Before initiating the clinical trial, approval was got from the Institutional Animal Ethical Committee (IAEC: 1248/ac/09/CPCSEA/4-07/2011 - Dt. 20.12.2011) and Institutional Ethical Committee (IEC: NIS/IEC/2011/3/07 - Dt. 24.12.2011) for conducting the pre clinical studies and clinical studies respectively by submitting the well defined protocol and proforma. • The raw drugs were authenticated by the concerned department and the trial drug was prepared in the Gunapadam lab of National Institute of Siddha as per the Standard Operating Procedure mentioned in the protocol. • The medicine was then subjected to toxicity studies (Acute and long term toxicity studies) as per the protocol and the safety of the drug was ensured. • The qualitative and quantitative bio chemical studies were done at the biochemistry lab of National Institute of Siddha. • SEM analysis and trace metals detection were done at Sophisticated Analytical Instrument Facility, IIT, Chennai. • The Biochemical analysis of the trial drug was done in Biochemistry laboratory National Institute of Siddha. Biochemical analysis showed the presence of inevitable constituents like Calcium, Iron, Sulphate. • Oral toxicity studies conducted ensured the safety usage of the drug to animals up to a maximum dose of 270 mg/animal for mice and 2700 mg/animal for wister rat. • Histopathological studies was done in pathology lab, Vels University, it shows that there is no abnormalities in the studies. • Among the 60 cases screened at the OPD of Branch-I, Ayothidoss Pandithar Hospital, NIS, 40 cases were recruited for the trial as per the inclusion and exclusion criteria of the Protocol. • Clinical diagnosis of Mathumegam was made by Siddha and Modern methodology. • Before inducement into the trial informed consent was obtained from the patients. • Out of the 40 cases 30 cases were treated in OPD and 10 cases in IPD in Branch-I. • The clinical trial was conducted with the trial medicine Atthippattaiyathi kasayam 5g t.i.d for a period of 40 days, referred under the Siddha literature Yoogi Vaithiya Chinthamani. • Diet restriction was strictly followed during the period of drug administration as per noted in the form IV D (Dietary advice form). • Required lab investigations were carried out before and after the treatment and the concerned data was recorded in the proforma. • Clinical assessment was done daily in all the IP patients and in OP patients it was assessed once in 10 days. • During the study period, there was no event of any adverse reactions owing to the drug or disease. • The clinical and labarotary Obserevation in the Mathumegam patient treated with the trial drug Atthippattaiyathi kasayam showed significant control in their blood glucose level and upgrading with in general health. • Statistical analysis showed significant difference between before and after treatment in the level of blood sugar at Fasting and Postprandial [P < 0.0001]. • In these studies out of 40 cases, 25 cases (62.5%) had good clinical improvement, 6 cases (15%) had moderate and 9 cases (22.5%) had poor improvement. CONCLUSION: The safety studies (the acute toxicity and long term toxicity) studies conducted revealed that the trial drug was safe even at higher dosage of 270 mg/animal for mice and 2700 mg/animal for wister rat. There were no abnormalities found in histopathological examination. Hence it can be reasonably assumed that the drug is safe for human. • Clinical study revealed that the trial drug posses’ good clinical improvement in 25 (62.5%) cases, 6 (15%) cases had moderate results and 9 (22.5%) cases had poor results. • The clinical and labarotary Obserevation in the Mathumegam patient treated with the trial drug Atthippattaiyathi kasayam showed significant control in their blood glucose level and upgrading with in general health. • It is undoubtedly marked that the Medicine used in the siddha system do not have any harmful side effects. • Because of the hopeful results clinically, the study may be undertaken with the same drug for a prolonged period of time in more number of cases and it may throw new lights in the management of Mathumegam