916 resultados para THE EMERGENCY SERVICES CALL CENTER


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To improving efficiency and transparency of government services, government authorities may increase the frequency of interaction between citizens and government as well as improving the quality of the government services and trust. Electronic Government (E-Government) in definition is the delivery of government services to citizens, businesses, and government organizations through the use of internet, web based applications, and Information and Communication Technologies (ICTs) is the solution to build more reliable and efficient contact with citizens. Like the developing and developed countries, Iran also has been processing the various aspects of ICT, IT, and e-Government. Though, in order to implement and improve e-Government; Iran has faced with some obstacles. Therefore, the purpose of this thesis is to study progress of e- Government and identify obstacles of implementing and improving e Government in Iran. In this thesis, based on the literature review, the progress of e-Government in Iran was studied and various obstacles were identified. Therefore, as a result, e- Government of Iran is said to be in the transactional stage of the United Nations’ e-Government maturity stages. In addition, establishing more reliable, efficient, and accurate e-Government initiatives, plans, guidelines, and strategies will extremely enhance e-Government status of Iran. On the other hand, the needs of the citizens should always be under consideration when implementing and improving e-Government services; because citizens are considered to be at the core of every e-Government services and the responsibilities of the authorities.

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The aim of this study was to evaluate the possible impacts caused in the soil and in the percolate in lysimeters of drainage with application of different rates of swine wastewater (SW) during the cycle of soybean culture and to assess the productivity of it. The experiment was conducted at the Agricultural Engineering Experimental Center of UNIOESTE. The soil was classified as typical Distroferric Red Latosol. There were twenty-four drainage lysimeters in the area in which the soybean was cultivated, cultivar CD 214. Four SW depths (0; 100; 200 and 300 m³ ha-1) were applied to the soil seven days before the sowing in a single application combined with two mineral fertilizations in the sowing (with and without recommended fertilization during sowing), and three repetitions per treatment. It was realized three collections of percolate in each experimental portion, the first was conducted 40 days after sowing (DAS); the second at 72 DAS, and the third at the end of crop cycle (117 DAS). It was evaluated in the percolate the pH, calcium, magnesium, potassium, phosphorus, and total nitrogen. Based on the results, it was possible to observe that the level of K, P and N in the soil increased according tothe increase of SW rates. The levels of K and P in the percolate were higher for higher rates of SW. The productivity was not influenced by the application of SW or by fertilization.

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OBJECTIVE: to determine predictive factors for prognosis of decompressive craniectomy in patients with severe traumatic brain injury (TBI), describing epidemiological findings and the major complications of this procedure.METHODS: we conducted a retrospective study based on analysis of clinical and neurological outcome, using the extended Glasgow outcome in 56 consecutive patients diagnosed with severe TBI scale treated in the emergency department from February 2004 to July 2012. The variables assessed were age, mechanism of injury, presence of pupillary changes, Glasgow coma scale (GCS) score on admission, CT scan findings (volume, type and association of intracranial lesions, deviation from the midline structures and classification in the scale of Marshall and Rotterdam).RESULTS: we observed that 96.4% of patients underwent unilateral decompressive craniectomy (DC) with expansion duraplasty, and the remainder to bilateral DC, 53.6% of cases being on the right 42.9% on the left, and 3.6% bilaterally, with predominance of the fourth decade of life and males (83.9%). Complications were described as transcalvarial herniation (17.9%), increased volume of brain contusions (16.1%) higroma (16.1%), hydrocephalus (10.7%), swelling of the contralateral lesions (5.3%) and CSF leak (3.6%).CONCLUSION: among the factors studied, only the presence of mydriasis with absence of pupillary reflex, scoring 4 and 5 in the Glasgow Coma Scale, association of intracranial lesions and diversion of midline structures (DML) exceeding 15mm correlated statistically as predictors of poor prognosis.

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Objective: To retrospectively analyze the relationship of time of care, combined with possible post-appendectomy complications, with the promptness of transfer of patients seen in Emergency Care Units (UPA) to the emergency hospital.Methods: We analyzed patients with preoperative diagnosis of acute appendicitis undergoing appendectomy from January to July 2012. Patients were divided into two groups according to the site of the first care. Group A included patients who received initial care directly in the emergency department of the Lourenço Jorge County Hospital (HMLJ) and group B consisted of patients seen in the UPA and forwarded to HMLJ to undergo surgical treatment.Results: the average time between initial treatment and surgery in group A was 29 hours (SD = 21.95) and 54 hours in group B (SD = 54.5). Considering the onset of symptoms, the patients in group A were operated on average 67 hours after (SD = 42.55), while group B, 90 hours (SD = 59.58). After the operation, patients in group A were hospitalized, on average, for 94 hours (SD = 73.53) and group B, 129 hours (SD = 193.42).Conclusion: there was no significant difference in the time elapsed between the onset of symptoms, initial treatment and early surgical treatment, or time elapsed between surgery and discharge.

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ABSTRACTObjective:to investigate the effect of standardized interventions in the management of tube thoracostomy patients and to assess the independent effect of each intervention.Methods:A chest tube management protocol was assessed in a retrospective cohort study. The tube thoracostomy protocol (TTP) was implemented in August 2012, and consisted of: antimicrobial prophylaxis, chest tube insertion in the operating room (OR), admission post chest tube thoracostomy (CTT) in a hospital floor separate from the emergency department (ED), and daily respiratory therapy (RT) sessions post-CTT. The inclusion criteria were, hemodynamic stability, patients between the ages of 15 and 59 years, and injury severity score (ISS) < 17. All patients had isolated injuries to the chest wall, lung, and pleura. During the study period 92 patients were managed according to the standardized protocol. The outcomes of those patients were compared to 99 patients treated before the TTP. Multivariate logistic regression analysis was performed to assess the independent effect of each variable of the protocol on selected outcomes.Results:Demographics, injury severity, and trauma mechanisms were similar among the groups. As expected, protocol compliance increased after the implementation of the TTP. There was a significant reduction (p<0.05) in the incidence of retained hemothoraces, empyemas, pneumonias, surgical site infections, post-procedural complications, hospital length of stay, and number of chest tube days. Respiratory therapy was independently linked to significant reduction (p<0.05) in the incidence of seven out of eight undesired outcomes after CTT. Antimicrobial prophylaxis was linked to a significant decrease (p<0.05) in retained hemothoraces, despite no significant (p<0.10) reductions in empyema and surgical site infections. Conversely, OR chest tube insertion was associated with significant (p<0.05) reduction of both complications, and also significantly decreased the incidence of pneumonias.Conclusion:Implementation of a TTP effectively reduced complications after CTT in trauma patients.

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This research is focused on deriving framework for the value thought for from the Customer Relationship Management system adopted by an enterprise operating in the financial services industry. It will analyze existing academic work to derive a conceptual value model, while applying secondary industry specific case studies provided by the CRM vendors to check the validity and commonality of these drivers. Furthermore this work locates the variances and correlation between value thought for from CRM system, scope of enterprise operations and size of the enterprise.

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The growing importance of global sustainability issues has been causing many changes to the financial services industry. Facts such as climate change, social development and the financial crisis in 2008 have been making banks reconsider the manner that they consider environmental, social and economic factors in their decision-making process. At the same time, information technology (IT) has been transforming the financial service industry and its fast development has casted doubts on the way it should be managed within an organization. This current changing environment brings a number of uncertainties to the future that cannot be addressed using traditional forecasting techniques. This research investigates how IT can bring value to sustainability in the financial service industry in 2020. Through the use of a scenario planning technique, we analyzed how trends in the current environment (considering the relation between sustainability, financial institutions an IT) can lead to four different future scenarios. Then, we discussed how IT can improve a bank’s sustainability performance, considering the limitations of each scenario.

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Tutkimuksen tavoitteena on tutkia globaalin taloushallinnon palvelukeskuksen perustamisprosessia ja palvelukeskusmalliin liittyviä hyötyjä. Tarkoituksena on määrittää palvelukeskuksen perustamiseen liittyvät vaiheet sekä ne kriittiset tekijät, jotka on huomioitava ennen perustamisprosessia sekä sen aikana. Empiirinen osuus on suoritettu kvalitatiivisena tutkimuksena suorittamalla neljä puolistrukturoitua teemahaastattelua globaalin taloushallinnon palvelukeskuksen perustaneissa organisaatioissa. Tutkimustulokset osoittavat, että merkittävimmät palvelukeskusmalliin liitetyt edut ovat tuottavuuden, tehokkuuden ja laadun paraneminen sekä kustannussäästöt. Kriittisimpiä menestystekijöitä ovat muutoksen suunnitteluun ja hallintaan liittyvät tekijät. Malliin liitetyt haasteet liittyvät pääasiassa globaalin toimintaympäristön monimuotoisuuteen, henkilöstöön, teknologiaan ja prosesseihin. Saadut tulokset ovat erittäin yhteneväisiä aikaisempien tutkimusten kanssa. Empiirisen tutkimuksen tulosten sekä aikaisemman tutkimustiedon perusteella on luotu viisivaiheinen malli globaalin taloushallinnon palvelukeskuksen perustamisprosessista.

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Syksyllä 2012 Valtion IT-palvelukeskuksen teettämässä asiakastyytyväisyyskyselyssä alle puolet vastanneista oli tyytyväisiä palveluiden tuotteistamiseen, joka heijastui asiakkaan kokemaan palvelun arvoon. Tutkimuksen tavoitteena oli selvittää valtionhallinnon asiakkaille tarjottavien ICT-palveluiden asiakaslähtöiseen tuotteistamiseen vaikuttavat oleelliset osa-alueet. Tutkimus oli luonteeltaan kvalitatiivinen ja tutkimusmenetelmänä käytettiin grounded theory -menetelmää. Tutkimusaineisto koostui 11 johtajahaastattelusta. Tutkimustuloksia käsiteltiin kolmessa teemassa: ICT-palvelu, tuotteistaminen ja asiakaslähtöisyys. Tutkimustulosten perusteella asiakaslähtöiseen tuotteistukseen vaikuttavia tekijöitä ovat yhteinen tavoite ja yhteistyö; asiakasymmärrys, hyödyt ja lisäarvo, laatu ja luottamus, osaaminen ja oppiminen, vastuut ja roolit sekä vuorovaikutus. Tutkimustulokset antavat hyvän lähtökohdan asiakaslähtöisen tuotteistuksen kehittämiseen ja palveluiden laadun parantamisen kehitystoimenpiteiden suunnitteluun.

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The importance of services in the global economy has grown steadily in the past decades and the growth of services sector’s direct investments has been increasing. Nowadays, all companies are influenced by the much changing global environment and the financial services companies are no exception. The internationalization of financial services companies is an expanding and accelerating phenomenon which has various motivations. The overall aim of this thesis is to shed light on the market entry processes of the Nordic financial services companies when they have entered the Russian market. In this study, the factors affecting Nordic banks’ market entry to Russia are presented in order to better understand what have been the main motives for market entry, what kind of processes the banks have used and what kind of challenges they have faced along the way. A case study approach was used in conducting the empirical research and it aims at investigating a specific case: Nordic banks’ entry into the Russian market. The empirical research was carried out by conducting qualitative interviews for employees involved in entry processes of the case banks. These interviews aimed at examining the Nordic banks’ motives for entering the Russian financial market. This includes reflections on the reasons why the studied banks have decided to enter Russia and what have been the motives behind these decisions. Also, the market entry processes the banks have used when they have entered the Russian market were investigated. The findings allowed comparing the related theories and different market entry modes the case banks have used. Furthermore, the market-related challenges faced by the case banks were mapped and described. In addition, the main factors related to the entry processes of the studied banks were identified and key elements of successful market entry were mapped. The findings suggest that the main motivator for banks have been to follow their customers and hence, increase the revenues and add the value to the shareholders; consequently, being a win-win-win situation to all the related parties. It was also discovered that the banks market entry processes have had resemblances but the banks have taken different paths to get where they are nowadays. As the Russian market environment differs from the one in Nordic countries, also challenges were faced by the case banks. However, the internal challenges were considered more troublesome than the external ones. As the foreign market entry process is complex as well as time and resources consuming, it is vital to understand the specifics of the target market, organizational capabilities and individuals enabling a successful entry process.

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Abstract: The VHS and CTR were assessed using computerized thoracic radiographs of ten clinically healthy tufted capuchin monkeys (five males and five females) from the Wild Animal Screening Center in São Luís (Centro de Triagem de Animais Silvestres de São Luís-MA-CETAS). Radiographs were taken in laterolateral and dorsoventral projections to calculate the cardiothoracic ratio (VHS) and vertebral heart size (CTR). The VHS showed mean values of 9.34±0.32v (males) and 9.16±0.34v (females) and there was no statistical difference between males and females (p>0.05). The CTR showed mean values of 0.55±0.04 (males) and 0.52±0.03 (females) and there was no statistical difference between the sexes (p>0.05). There was positive correlation between VHS and CTR (r=0.78). The thoracic and heart diameters showed mean values of 5.70±0.48cm and 2.16±0.40cm in the males, respectively. In the females they measured 5.32±0.39cm and 2.94±0.32cm. There was no statistical difference between the sexes. Our results show that the high correlation found between VHS and CTR permitted the verification with similar clinical precision between the two methods to estimate alterations in the heart silhouette by radiographic examination of tufted capuchin, making it an easy technique to apply that can be considered in the investigation of heart problems for this wild species.

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Workshop at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

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Tämän tutkimuksen tavoitteena oli selvittää millainen hinnoittelumalli koetaan asiakkaiden mielestä tasapuolisimmaksi ja millainen rooli luottamuksella on seudullisen perustietotekniikkapalvelukeskuksen ja sen asiakasorganisaatioiden sekä myös liikelaitoksen toimintaa ohjaavan asiakasyhteistyöryhmän jäsenten kesken palvelujen tuotteistamiseen ja hinnoitteluun liittyen. Teoreettisessa osuudessa selvitetään mitä tuotteistamisella tarkoitetaan ja miten tuotteistaminen liittyy hinnoitteluun, mitä hinnoitteluvaihtoehtoja julkishallinnon organisaatiossa voidaan käyttää, mitä luottamuksella käsitetään ja mitä seudullisen yhteistyön eri toimintamuotoja tässä palvelukeskuksessa on käytetty. Empiirisessä osuudessa on kuvattu ICT Kymiin kohdistuvaa tutkimusta ja sen tuloksia. Työ toteutettiin keväällä 2014 toimintatutkimuksena, jossa ICT Kymi -kunnallisen liikelaitoksen asiakasyhteistyöryhmä osallistui uuden hinnoittelumallin suunnitteluun. Aineistoa kerättiin haastatteluin sekä ryhmän työpajatapaamisissa ja kokouksissa. Tutkimuksen tuloksena havaittiin, että luottamus mahdollistaa tuotteistuksen tasosta poikkeavan, yksinkertaisemman hinnoittelumallin käytön.

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Työn tavoitteena oli tutkia, millä tavalla perusterveydenhuollon perinteisestä terveysasemamallista hyvinvointiasemamalliin siirtyminen vaikuttaa sosiaali- ja terveyspalvelujen tarjonnan kustannuksiin, mikäli vaikutus on havaittavissa. Toisaalta tavoitteena oli kartoittaa, millä keinoilla hyvinvointiasemien kustannustehokkuutta voitaisiin parantaa tulevaisuudessa ja mitä kustannushyötyjä tiiviimmällä sosiaali- ja terveystoimen yhteistyöllä on mahdollista saavuttaa. Tutkimuksessa käsiteltiin terveyden ja hyvinvoinnin edistämisen roolin merkitystä perusterveydenhuollossa, sähköistä asiointipalveluja ja terveydenhuollon ammattiryhmien välistä työnjakoa sekä edelleen, miten näillä voidaan vaikuttaa tuottavuuteen ja vaikuttavuuteen. Havaittiin, että sähköisellä asioinnilla ja työnjaolla on selkeä yhteys kustannuksiin. Työn empiirisessä osassa tarkasteltiin kolmea hyvinvointiasemamallin pilottihankkeessa mukana olevaa asemaa Lauritsalassa, Lemillä ja Ruokolahdella. Kustannusten tarkastelu keskittyi henkilöstö- ja tilakustannuksiin. Tutkittiin myös, miten sähköinen asiointi ja Eksoten alueen puhelinpalvelujen keskittäminen vaikuttaa edellä mainittuihin kustannuseriin. Tutkimuksen tuloksina havaittiin, että hyvinvointiasemamallin pilotointi ei ole tutkittavilla asemilla merkittävästi vaikuttanut kustannuksiin henkilöstön osalta; tilakustannukset olivat pienentyneet Lemillä ja Ruokolahdella. Laskelmien perusteella muodostettujen tavoitteiden mukaisesti on hyvinvointiasemilla kuitenkin pyrittävä vähintään noin 14 % tai enintään 32 % säästöön henkilöstö- ja tilakustannuksissa pilottivaiheen kustannuksiin verrattuna. Tulevaisuudessa olennaiseksi kustannusten hallinnan edellytykseksi havaittiin työnjaon muuttaminen hoitajavetoisemmaksi ja sähköisten asiointipalvelujen lisääntyvä tarjonta. Sähköisten asioinnin lisääntyvällä käytöllä on mahdollista vähentää hoitohenkilöstön tarvetta kokonaisuudessaan. Sekä sähköisen asioinnin käytön lisäämisellä että puhelinpalvelujen keskittämisellä tulevaisuudessa havaittiin olevan huomattava vaikutus henkilöstöresurssien käyttöön ja edelleen kustannustehokkuuteen.

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The aim of this Master’s thesis was to study the antecedents of customer satisfaction and behavioral intentions and their relative relationships in the sports sponsorship context. The possible antecedents under investigation in the current research are service value and service quality. As the academic background in the sports sponsorship literature is still rather modest there was a need for further empirical testing. The theoretical part of the research builds on the existing services marketing literature with sports sponsorship and business-to-business contexts in mind. The empirical study focused on the case company Liiga-SaiPa Oy. The data for the empirical analysis was collected via quantitative online survey. The total sample consisted of 357 the case company’s business customers and a total of 80 usable responses were collected. The data was analyzed by using statistical analysis software, SPSS. According to the results of the empirical analysis the most important antecedent of behavioral intentions in the underlying context is customer satisfaction. Also service value was found to have a direct and positive relationship with behavioral intentions. Moreover no indirect relationships through satisfaction were found between service quality and service value and behavioral intentions. However both constructs of service value and service quality were diagnosed to have a direct and positive effect on customer satisfaction. Service quality was also found to be a direct antecedent of service value with other service value benefits. However a contradicting finding with the current literature was, that service value sacrifices were not found to have a significant relationship with overall service value perceptions.