922 resultados para medically fragile
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1908/04/16 (Numéro 130).
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1907/04/25 (Numéro 79).
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1906/01/25 (Numéro 14).
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1907/10/31 (Numéro 106).
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1908/11/05 (Numéro 159).
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1907/10/03 (Numéro 102).
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1908/03/26 (Numéro 127).
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1908/09/17 (Numéro 152).
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1906/03/01 (Numéro 19).
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1908/10/08 (Numéro 155).
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The profitability on transportation field has been low for a long time. The re-cession that started in the fall of 2008 has caused even more trouble to transportation companies as the number of transportations has gone down and the competition has gotten tougher since the time before the recession. Because the low profitability level does not allow competing with prices, transportation companies must come up with other means to differ from their competitors. The main goal of the research was to find out how a small and medium-sized enterprise (SME) on transportation field should manage its customer relationships. Due to limited resources, companies should direct their resources to serving their most valuable customers. Companies should first make a determination of their customer base. This works as a base for establishing customer portfolios, in other words making customer groups based on e.g. profitability, buying volumes and loyalty. Companies can gain competitive advantage also by improving their service quality. Important information regarding the selection criteria of a transporta-tion company, transaction methods, service time and accessibility of person-nel, customers’ expectations on transportation company’s personnel, utiliza-tion of IT-solutions as a part of transportation service, the image of a transportation company and necessity of quality control meetings was gathered for this research by interviewing customers. By utilizing this information, transportation company can adapt its service offering to equal the customer needs and expectations better. A service process example was created to improve the service quality of the transportation company. It shows the whole process from the customer sending the transportation order to the point when the customer receives an invoice from the transportation company. The example process shows the most fragile stages of the service process: the interaction points. An example of this is when the driver and the customer meet at the unloading place. The results show that even a SME can have the opportunity to succeed in competitive markets by managing CRM. Expensive software are usually out of reach of a SME, but having a CRM software does not automatically guar-antee success in customer relationship management. Small and medium-sized firms can commit their current customers and recruit new customers by utilizing customer knowledge, offering top quality service, being innovative and offering functional services.
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Rising population, rapid urbanisation and growing industrialisation have severely stressed water quality and its availability in Malawi. In addition, financial and institutional problems and the expanding agro industry have aggravated this problem. The situation is worsened by depleting water resources and pollution from untreated sewage and industrial effluent. The increasing scarcity of clean water calls for the need for appropriate management of available water resources. There is also demand for a training system for conceptual design and evaluation for wastewater treatment in order to build the capacity for technical service providers and environmental practitioners in the country. It is predicted that Malawi will face a water stress situation by 2025. In the city of Blantyre, this situation is aggravated by the serious pollution threat from the grossly inadequate sewage treatment capacity. This capacity is only 23.5% of the wastewater being generated presently. In addition, limited or non-existent industrial effluent treatment has contributed to the severe water quality degradation. This situation poses a threat to the ecologically fragile and sensitive receiving water courses within the city. This water is used for domestic purposes further downstream. This manuscript outlines the legal and policy framework for wastewater treatment in Malawi. The manuscript also evaluates the existing wastewater treatment systems in Blantyre. This evaluation aims at determining if the effluent levels at the municipal plants conform to existing standards and guidelines and other associated policy and regulatory frameworks. The raw material at all the three municipal plants is sewage. The typical wastewater parameters are Biochemical Oxygen Demand (BOD5), Chemical Oxygen Demand (COD), and Total Suspended Solids (TSS). The treatment target is BOD5, COD, and TSS reduction. Typical wastewater parameters at the wastewater treatment plant at MDW&S textile and garments factory are BOD5 and COD. The treatment target is to reduce BOD5 and COD. The manuscript further evaluates a design approach of the three municipal wastewater treatment plants in the city and the wastewater treatment plant at Mapeto David Whitehead & Sons (MDW&S) textile and garments factory. This evaluation utilises case-based design and case-based reasoning principles in the ED-WAVE tool to determine if there is potential for the tool in Blantyre. The manuscript finally evaluates the technology selection process for appropriate wastewater treatment systems for the city of Blantyre. The criteria for selection of appropriate wastewater treatment systems are discussed. Decision support tools and the decision tree making process for technology selection are also discussed. Based on the treatment targets and design criteria at the eight cases evaluated in this manuscript in reference to similar cases in the ED-WAVE tool, this work confirms the practical use of case-based design and case-based reasoning principles in the ED-WAVE tool in the design and evaluation of wastewater treatment 6 systems in sub-Sahara Africa, using Blantyre, Malawi, as the case study area. After encountering a new situation, already collected decision scenarios (cases) are invoked and modified in order to arrive at a particular design alternative. What is necessary, however, is to appropriately modify the case arrived at through the Case Study Manager in order to come up with a design appropriate to the local situation taking into account technical, socio-economic and environmental aspects. This work provides a training system for conceptual design and evaluation for wastewater treatment.
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With the increase of use of digital media the need for the methods of multimedia protection becomes extremely important. The number of the solutions to the problem from encryption to watermarking is large and is growing every year. In this work digital image watermarking is considered, specifically a novel method of digital watermarking of color and spectral images. An overview of existing methods watermarking of color and grayscale images is given in the paper. Methods using independent component analysis (ICA) for detection and the ones using discrete wavelet transform (DWT) and discrete cosine transform (DCT) are considered in more detail. A novel method of watermarking proposed in this paper allows embedding of a color or spectral watermark image into color or spectral image consequently and successful extraction of the watermark out of the resultant watermarked image. A number of experiments have been performed on the quality of extraction depending on the parameters of the embedding procedure. Another set of experiments included the test of the robustness of the algorithm proposed. Three techniques have been chosen for that purpose: median filter, low-pass filter (LPF) and discrete cosine transform (DCT), which are a part of a widely known StirMark - Image Watermarking Robustness Test. The study shows that the proposed watermarking technique is fragile, i.e. watermark is altered by simple image processing operations. Moreover, we have found that the contents of the image to be watermarked do not affect the quality of the extraction. Mixing coefficients, that determine the amount of the key and watermark image in the result, should not exceed 1% of the original. The algorithm proposed has proven to be successful in the task of watermark embedding and extraction.
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Food systems in Sub-Saharan Africa have been rapidly transforming during the recent decades with diverse outcomes on human development and environment. This study explores the food system change in rural villages in eastern Tanzania where subsistence agriculture has traditionally been the main source of livelihood. The focus is on the salient changes in the spatial dimensions and structural composition of the food system in the context of economic liberalization that has taken place after the end of the socialist ujamaa era in the mid-1980s. In addition, the linkages of the changes are examined in relation to food security, socio-economic situation, livelihoods, and local environment. The approach of the study is geographical, but also involves various multi-disciplinary elements, particularly from development studies. The research methods included thematic and questionnaire interviews, participatory tools, and the analysis of land use/ cover data and official documents. Several earlier studies that were made in the area during the late 1970s and 1980s provided an important reference base. The study shows that subsistence farming has lost its dominant role in food provisioning due to the declining productivity of land, livestock losses, and the increasing shift of labour to non-farm sectors. Also rapid population growth has added to the pressure on land and other natural resources. Despite the increasing need for money for buying marketed foods and other necessities, the nutritional situation shows improvement and severe malnutrition has diminished. However, the long-term sustainability of this transformation raises concerns. Firstly, the food security situation continues to be fragile and prone to shocks such as adverse climatic conditions, crop failures and price hikes. Secondly, the commodification of the food system and livelihoods in general is linked to rapid environmental degradation in the area, particularly the loss of soil fertility and deforestation. The situation calls for efforts that take more determined and holistic approaches towards sustainable development of the rural food system with particular focus on the role and viability of small-scale farming.
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The aims of this study were to validate an international Health-Related Quality of Life (HRQL) instrument, to describe child self and parent-proxy assessed HRQL at child age 10 to 12 and to compare child self assessments with parent-proxy assessments and school nursing documentation. The study is part of the Schools on the Move –research project. In phase one, a cross-cultural translation and validation process was performed to develop a Finnish version of Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0). The process included a two-way translation, cognitive interviews (children n=7, parents n=5) and a survey (children n=1097, parents n=999). In phase two, baseline and follow-up surveys (children n=986, parents n=710) were conducted to describe and compare the child self and parent-proxy assessed HRQL in school children between the ages 10 and 12. Phase three included two separate data, school nurse documented patient records (children n=270) and a survey (children n=986). The relation between child self assessed HRQL and school nursing documentation was evaluated. Validity and reliability of the Finnish version of PedsQL™ 4.0 was good (Child Self Report α=0.91, Parent-Proxy Report α=0.88). Children reported lower HRQL scores at the emotional (mean 76/80) than the physical (mean 85/89) health domains and significantly lower scores at the age of 10 than 12 (dMean=4, p=<0.001). Agreement between child self and parent-proxy assessment was fragile (r=0,4, p=<0.001) but increased as the child grew from age 10 to 12 years. At health check-ups, school nurses documented frequently children’s physical health, such as growth (97%) and posture (98/99%) but seldom emotional issues, such as mood (2/7%). The PedsQLTM 4.0 is a valid instrument to assess HRQL in Finnish school children although future research is recommended. Children’s emotional wellbeing needs future attention. HRQL scores increase during ages between childhood and adolescence. Concordance between child self and parent-proxy assessed HRQL is low. School nursing documentation, related to child health check-ups, is not in line with child self assessed HRQL and emotional issues need more attention.