269 resultados para Management Services


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The major purpose of Vehicular Ad Hoc Networks (VANETs) is to provide safety-related message access for motorists to react or make a life-critical decision for road safety enhancement. Accessing safety-related information through the use of VANET communications, therefore, must be protected, as motorists may make critical decisions in response to emergency situations in VANETs. If introducing security services into VANETs causes considerable transmission latency or processing delays, this would defeat the purpose of using VANETs to improve road safety. Current research in secure messaging for VANETs appears to focus on employing certificate-based Public Key Cryptosystem (PKC) to support security. The security overhead of such a scheme, however, creates a transmission delay and introduces a time-consuming verification process to VANET communications. This paper proposes an efficient public key management system for VANETs: the Public Key Registry (PKR) system. Not only does this paper demonstrate that the proposed PKR system can maintain security, but it also asserts that it can improve overall performance and scalability at a lower cost, compared to the certificate-based PKC scheme. It is believed that the proposed PKR system will create a new dimension to the key management and verification services for VANETs.

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Aim: To review the management of heart failure in patients not enrolled in specialist multidisciplinary programs. Method: A prospective clinical audit of patients admitted to hospital with either a current or past diagnosis of heart failure and not enrolled in a specialist heart failure program or under the direct care of the cardiology unit. Results: 81 eligible patients were enrolled (1 August to 1 October 2008). The median age was 81 9.4 years and 48% were male. Most patients (63%) were in New York Heart Association Class II or Class III heart failure. On discharge, 59% of patients were prescribed angiotensin converting enzyme inhibitors and 43% were prescribed beta-blockers. During hospitalisation, 8.6% of patients with a past diagnosis of heart failure were started on an angiotensin converting enzyme inhibitor and 4.9% on a beta-blocker. There was evidence of suboptimal dosage on admission and discharge for angiotensin converting enzyme inhibitors (19% and 7.4%) and beta-blockers (29% and 17%). The results compared well with international reports regarding the under-treatment of heart failure. Conclusion: The demonstrated practice gap provides excellent opportunities for the involvement of pharmacists to improve the continuation of care for heart failure patients discharged from hospital in the areas of medication management review, dose titration and monitoring.

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Objective: To compare the location and accessibility of current Australian chronic heart failure (CHF) management programs and general practice services with the probable distribution of the population with CHF. Design and setting: Data on the prevalence and distribution of the CHF population throughout Australia, and the locations of CHF management programs and general practice services from 1 January 2004 to 31 December 2005 were analysed using geographic information systems (GIS) technology. Outcome measures: Distance of populations with CHF to CHF management programs and general practice services. Results: The highest prevalence of CHF (20.3–79.8 per 1000 population) occurred in areas with high concentrations of people over 65 years of age and in areas with higher proportions of Indigenous people. Five thousand CHF patients (8%) discharged from hospital in 2004–2005 were managed in one of the 62 identified CHF management programs. There were no CHF management programs in the Northern Territory or Tasmania. Only four CHF management programs were located outside major cities, with a total case load of 80 patients (0.7%). The mean distance from any Australian population centre to the nearest CHF management program was 332 km (median, 163 km; range, 0.15–3246 km). In rural areas, where the burden of CHF management falls upon general practitioners, the mean distance to general practice services was 37 km (median, 20 km; range, 0–656 km). Conclusion: There is an inequity in the provision of CHF management programs to rural Australians.

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Objective: To determine whether primary care management of chronic heart failure (CHF) differed between rural and urban areas in Australia. Design: A cross-sectional survey stratified by Rural, Remote and Metropolitan Areas (RRMA) classification. The primary source of data was the Cardiac Awareness Survey and Evaluation (CASE) study. Setting: Secondary analysis of data obtained from 341 Australian general practitioners and 23 845 adults aged 60 years or more in 1998. Main outcome measures: CHF determined by criteria recommended by the World Health Organization, diagnostic practices, use of pharmacotherapy, and CHF-related hospital admissions in the 12 months before the study. Results: There was a significantly higher prevalence of CHF among general practice patients in large and small rural towns (16.1%) compared with capital city and metropolitan areas (12.4%) (P < 0.001). Echocardiography was used less often for diagnosis in rural towns compared with metropolitan areas (52.0% v 67.3%, P < 0.001). Rates of specialist referral were also significantly lower in rural towns than in metropolitan areas (59.1% v 69.6%, P < 0.001), as were prescribing rates of angiotensin-converting enzyme inhibitors (51.4% v 60.1%, P < 0.001). There was no geographical variation in prescribing rates of β-blockers (12.6% [rural] v 11.8% [metropolitan], P = 0.32). Overall, few survey participants received recommended “evidence-based practice” diagnosis and management for CHF (metropolitan, 4.6%; rural, 3.9%; and remote areas, 3.7%). Conclusions: This study found a higher prevalence of CHF, and significantly lower use of recommended diagnostic methods and pharmacological treatment among patients in rural areas.

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Usability in HCI (Human-Computer Interaction) is normally understood as the simplicity and clarity with which the interaction with a computer program or a web site is designed. Identity management systems need to provide adequate usability and should have a simple and intuitive interface. The system should not only be designed to satisfy service provider requirements but it has to consider user requirements, otherwise it will lead to inconvenience and poor usability for users when managing their identities. With poor usability and a poor user interface with regard to security, it is highly likely that the system will have poor security. The rapid growth in the number of online services leads to an increasing number of different digital identities each user needs to manage. As a result, many people feel overloaded with credentials, which in turn negatively impacts their ability to manage them securely. Passwords are perhaps the most common type of credential used today. To avoid the tedious task of remembering difficult passwords, users often behave less securely by using low entropy and weak passwords. Weak passwords and bad password habits represent security threats to online services. Some solutions have been developed to eliminate the need for users to create and manage passwords. A typical solution is based on generating one-time passwords, i.e. passwords for single session or transaction usage. Unfortunately, most of these solutions do not satisfy scalability and/or usability requirements, or they are simply insecure. In this thesis, the security and usability aspects of contemporary methods for authentication based on one-time passwords (OTP) are examined and analyzed. In addition, more scalable solutions that provide a good user experience while at the same time preserving strong security are proposed.

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The primary goal of the Vehicular Ad Hoc Network (VANET) is to provide real-time safety-related messages to motorists to enhance road safety. Accessing and disseminating safety-related information through the use of wireless communications technology in VANETs should be secured, as motorists may make critical decisions in dealing with an emergency situation based on the received information. If security concerns are not addressed in developing VANET systems, an adversary can tamper with, or suppress, the unprotected message to mislead motorists to cause traffic accidents and hazards. Current research on secure messaging in VANETs focuses on employing the certificate-based Public Key Infrastructure (PKI) scheme to support message encryption and digital signing. The security overhead of such a scheme, however, creates a transmission delay and introduces a time-consuming verification process to VANET communications. This thesis has proposed a novel public key verification and management approach for VANETs; namely, the Public Key Registry (PKR) regime. Compared to the VANET PKI scheme, this new approach can satisfy necessary security requirements with improved performance and scalability, and at a lower cost by reducing the security overheads of message transmission and eliminating digital certificate deployment and maintenance issues. The proposed PKR regime consists of the required infrastructure components, rules for public key management and verification, and a set of interactions and associated behaviours to meet these rule requirements. This is achieved through a system design as a logic process model with functional specifications. The PKR regime can be used as development guidelines for conforming implementations. An analysis and evaluation of the proposed PKR regime includes security features assessment, analysis of the security overhead of message transmission, transmission latency, processing latency, and scalability of the proposed PKR regime. Compared to certificate-based PKI approaches, the proposed PKR regime can maintain the necessary security requirements, significantly reduce the security overhead by approximately 70%, and improve the performance by 98%. Meanwhile, the result of the scalability evaluation shows that the latency of employing the proposed PKR regime stays much lower at approximately 15 milliseconds, whether operating in a huge or small environment. It is therefore believed that this research will create a new dimension to the provision of secure messaging services in VANETs.

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Objective: In Australia and comparable countries, case management has become the dominant process by which public mental health services provide outpatient clinical services to people with severe mental illness. There is recognition that caseload size impacts on service provision and that management of caseloads is an important dimension of overall service management. There has been little empirical investigation, however, of caseload and its management. The present study was undertaken in the context of an industrial agreement in Victoria, Australia that required services to introduce standardized approaches to caseload management. The aims of the present study were therefore to (i) investigate caseload size and approaches to caseload management in Victoria's mental health services; and (ii) determine whether caseload size and/or approach to caseload management is associated with work-related stress or case manager self-efficacy among community mental health professionals employed in Victoria's mental health services. Method: A total of 188 case managers responded to an online cross-sectional survey with both purpose-developed items investigating methods of case allocation and caseload monitoring, and standard measures of work-related stress and case manager personal efficacy. Results: The mean caseload size was 20 per full-time case manager. Both work-related stress scores and case manager personal efficacy scores were broadly comparable with those reported in previous studies. Higher caseloads were associated with higher levels of work-related stress and lower levels of case manager personal efficacy. Active monitoring of caseload was associated with lower scores for work-related stress and higher scores for case manager personal efficacy, regardless of size of caseload. Although caseloads were most frequently monitored by the case manager, there was evidence that monitoring by a supervisor was more beneficial than self-monitoring. Conclusion: Routine monitoring of caseload, especially by a workplace supervisor, may be effective in reducing work-related stress and enhancing case manager personal efficacy. Keywords: case management, caseload, stress

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Open-source software systems have become a viable alternative to proprietary systems. We collected data on the usage of an open-source workflow management system developed by a university research group, and examined this data with a focus on how three different user cohorts – students, academics and industry professionals – develop behavioral intentions to use the system. Building upon a framework of motivational components, we examined the group differences in extrinsic versus intrinsic motivations on continued usage intentions. Our study provides a detailed understanding of the use of open-source workflow management systems in different user communities. Moreover, it discusses implications for the provision of workflow management systems, the user-specific management of open-source systems and the development of services in the wider user community.

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Intensive Case Management (ICM) is widely claimed to be an evidence-based and cost effective program for people with high levels of disability as a result of mental illness. However, the findings of recent randomized controlled trials comparing ICM with ‘usual services’ suggest that both clinical and cost effectiveness of ICM may be weakening. Possible reasons for this, including fidelity of implementation, researcher allegiance effects and changes in the wider service environment within which ICM is provided, are considered. The implications for service delivery and research are discussed.