Improving Productivity Through Scheduling at the WMed Family Medicine Residency Clinic

INTRODUCTION: The Accreditation Council for Graduate Medical Education (ACGME) requires every family medicine residency program to have a practice site that supports, “continuous, comprehensive, convenient, accessible, and coordinated patient care”. The WMed Family Medicine Resident Clinic (Team Oakland), located within the Family Health Center (FHC) – Paterson location, has long been plagued by scheduling difficulties, as evidenced by high no-show rates, empty appointment slots, and frequent cancellations threatening the ability of our residents to achieve the required number of outpatient visits mandated by the Family Medicine Residency Review Committee (RRC) and the requirement for continuity from the ACGME. We believe many of these issues arise from the FHC’s open-access scheduling template, which heavily favors same day and walk in visits. PURPOSE: This quality improvement project aims to assess the productivity of the Western Michigan Family Medicine Clinic through a scheduling analysis to determine how we can better meet the needs of our patients while also meeting the visit numbers required of the RRC for our residents. STUDY DESIGN: This study is a retrospective scheduling analysis in which our no show rate and unfilled appointments will be considered. Scheduling data for Team Oakland was collected from December 1st, 2016 to January 31st, 2017 through customizable EPIC reports. RESULTS: Data shown below exhibits the total number of appointment slots for Team Oakland broken down by the number of appoints filled, unfilled appointment slots and no show appointments. Data was subsequently broken down by day of the week and hour of the day. The fill rate for the 8:00 hour is 51% compared to 80-90% for most other hours. Image Table 1. Scheduling data for Team Oakland December 2016 through January 2017 DISCUSSION: Literature review revealed conflicting evidence in support of open-access scheduling. We found limited alternative scheduling approaches and limited data specific to residency clinic productivity. Data analysis confirmed that we have a high proportion of appointments that go unfilled as well as a significant no-show rate. Proposed changes to the scheduling template include increasing the number of advanced scheduled appointments-particularly during early morning hours, obtaining an independent scheduler for the resident clinic, and a novel scheduling model targeted at filling no-show appointments with walk-in patients. CONCLUSION: The current scheduling model used at the FHC does not adequately meet the needs of the Family Medicine Residency clinic and data-driven alternative scheduling models should be explored

Delay Contributing Factors and Strategies Towards Its Minimization in IoT

Internet of Things (IoT) refers to various interconnected devices, typically supplied with limited computational and communication resources. Most of the devices are designed to operate with limited memory and processing capability, low bandwidth, short range and other characteristics of low cost hardware. The resulting networks are exposed to traffic loss and prone to other vulnerabilities. One of the major concerns is to ensure that the network communication among these deployed devices remains at required level of Quality of Service (QoS) of different IoT applications. The purpose of this paper is to highlight delay contributing factors in Low Power and Lossy Networks (LLNs) since providing low end-to-end delay is a crucial issue in IoT environment especially for mission critical applications. Various research efforts in relevance to this aspect are then presente

Security aspects and efforts towards secure Internet of things

Abstract—Internet of Things (IoT) consists of wired and wireless devices, typically supplied with minimum physical resources including limited computational and communication resources. Most of the devices are distinguished by their low bandwidth, short range, scarce memory capacity, limited processing capability and other attributes of inexpensive hardware. The resulting networks are more prone to traffic loss and other vulnerabilities. One of the potential networking challenges is to ensure the network communication among these deployed devices remains secure at less processing and communication overhead, and small packet size. The purpose of this paper is to highlight possible security attacks in Low Power and Lossy Networks (LLNs) as identifying pertinent security issues is an initial step to design the effective countermeasures. The IETF efforts in relevance to security implementation of this type of network are presented with focus on layer-2 and authentication mechanism at upper layer

Acceptance and usage of webcasting among users of selected cyber cafes in Klang Valley

The Malaysian public now has access to the Internet not only at home and the workplace, but also at cyber cafés. This study aims to examine the level of acceptance of webcasting among users of selected cyber cafés in the Klang Valley. The specific objectives of the study are: to determine the profile of webcasting users and its usage; to determine the types of webcasting technology most frequently used, level of knowledge of webcasting and the main source of knowledge in becoming aware of webcasting; to determine the acceptance of webcasting among non-users of webcasting; and to determine the relationship between behavioral intention to use and the actual usage of webcasting among users of webcasting. This study used the survey design, using purposive sampling to select the cyber cafés and visitors of these cafés. The findings indicate that usage of webcasting is still relatively low among users of selected cyber cafés in the Klang Valley. Users of webcasting were found to be mostly male, young and relatively well educated with at least a diploma as the highest level of education obtained

Vision based road lane detection system for vehicles guidance

Driver support system is one of the most important feature of the modern vehicles to ensure driver safety and decrease vehicle accident on roads. Apparently, the road lane detection or road boundaries detection is the complex and most challenging tasks. It is includes the localization of the road and the determination of the relative position between vehicle and road. A vision system using on-board camera looking outwards from the windshield is presented in this paper. The system acquires the front view using a camera mounted on the vehicle and detects the lanes by applying few processes. The lanes are extracted using Hough transform through a pair of hyperbolas which are fitted to the edges of the lanes. The proposed lane detection system can be applied on both painted and unpainted roads as well as curved and straight road in different weather conditions. The proposed system does not require any extra information such as lane width, time to lane crossing and offset between the center of the lanes. In addition, camera calibration and coordinate transformation are also not required. The system was investigated under various situations of changing illumination, and shadows effects in various road types without speed limits. The system has demonstrated a robust performance for detecting the road lanes under different conditions

IMPLEMENTATION OF DUAL DATA HIDING SCHEME WITH STEGANOGRAPHY

The Lossless data hiding provides the embedding of data in a host image without any loss of data. This research explain a lossless data hiding and image cryptography method based on Choas Block to image encryption the lossless means if the marked image is considered reliable, the embedding distortion can be totally removed from marked image afterward the embedded data has been extract. This procedure uses features of the pixel difference to embed more data than other randomly partition using Block based Sharpness Index Filtering and refine with single level wavelet decomposition shifting technique to prevent image distortion problems. In this work also manages reversible data hiding based on chaotic technique. In which initially image histogram processes to perceive the pixels which is chosen for hiding each bit of secret data, then by the logistic chaotic map compute an order of hiding each bit stream. Performances differentiate with other exist lossless data hiding plan providing show the superiority of the research. In this proposed research PSNR is found nearly 5.5*103 and existing 4.8*103 at 100 embedding rate which enhance for our existing technique that simulated in MATLAB 2017a

Machine Learning and Deep Learning Approaches for Brain Disease Diagnosis : Principles and Recent Advances

This work was supported in part by the National Research Foundation of Korea-Grant funded by the Korean Government (Ministry of Science and ICT) under Grant NRF 2020R1A2B5B02002478, and in part by Sejong University through its Faculty Research Program under Grant 20212023.Peer reviewedPublisher PD

A comprehensive analysis of improving the QoS of IMM traffic for high speed wireless campus network

Interactive Multimedia (IMM) applications such as voice and video conferencing are very important in our learning environment. They offer useful services that benefit its users but these services suffers performance degradation from today’s high speed Wireless Local Area Network (WLAN). However, guaranteed Quality of Service (QoS) remains the bottleneck in the network which becomes a great challenge in attempting to improve its performance. This work reviewed many approaches and considers mapping QoS class parameters such as Quality of Service Class Identifier (QCI), Maximum Bit Rate (MBR) and Allocation and Retention Priority (ARP) to the upstream and downstream data flowing in the network as an attempt to improve its performance. Priority is then given to the QoS bearer packets by associating Differentiated Services Code Point (DSCP). A comprehensive analysis of QoS in different protocols in wireless networks has been studied. Open issues and research directions have been addressed with a proposed mechanism to enhance the QoS of the wireless networ