PERFORMANCE EVOLUTION OF PEER TO PEER NETWORKS

This thesis work concerns about the Performance evolution of peer to peer networks, where we used different distribution technique’s of peer distribution like Weibull, Lognormal and Pareto distribution process. Then we used a network simulator to evaluate the performance of these three distribution techniques.During the last decade the Internet has expanded into a world-wide network connecting millions of hosts and users and providing services for everyone. Many emerging applications are bandwidth-intensive in their nature; the size of downloaded files including music and videos can be huge, from ten megabits to many gigabits. The efficient use of network resources is thus crucial for the survivability of the Internet. Traffic engineering (TE) covers a range of mechanisms for optimizing operational networks from the traffic perspective. The time scale in traffic engineering varies from the short-term network control to network planning over a longer time period.Here in this thesis work we considered the peer distribution technique in-order to minimise the peer arrival and service process with three different techniques, where we calculated the congestion parameters like blocking time for each peer before entering into the service process, waiting time for a peers while the other peer has been served in the service block and the delay time for each peer. Then calculated the average of each process and graphs have been plotted using Matlab to analyse the results

Simulation of Sawmill Yard Operations Using Software Agents

Bergkvist insjön AB is a sawmill yard which is capable of producing 350,000 cubic meter of timber every year this requires lot of internal resources. Sawmill operations can be classified as unloading, sorting, storage and production of timber. In the company we have trucks arriving at random they have to be unloaded and sent back at the earliest to avoid queuing up of trucks creating a problem for truck owners. The sawmill yard has to operate with two log stackers that does several tasks including transporting the logs from trucks to measurement station where the logs will be sorted into classes and dropped into pockets from pockets to the sorted timber yard where they are stored and finally from there to sawmill for final processing. The main issue that needs to be answered here is the lining up trucks that are waiting to be unload, creating a problem for both sawmill as well as the truck owners and given huge production volume, it is certain that handling of resources is top priority. A key challenge in handling of resources would be unloading of trucks and finding a way to optimize internal resources.To address this problem i have experimented on different ways of using internal resources, i have designed different cases, in case 1 we have both the log stackers working on sawmill and measurement station. The main objective of having this case is to make sawmill and measurement station to work all the time. Then in case 2, i have divided the work between both the log stackers, one log stacker will be working on sawmill and pocket_control and second log stacker will be working on measurement station and truck. Then in case 3 we have only one log stacker working on all the agents, this case was designed to reduce cost of production, as the experiment cannot be done in real-time due to operational cost, for this purpose simulation is used, preliminary investigation into simulation results suggested that case 2 is the best option has it reduced waiting time of trucks considerably when compared with other cases and it showed 50% increase in optimizing internal resources.

QoS evaluation of Bandwidth Schedulers in IPTV Networks Offered SRD Fluid Video Traffic

Internet protocol TV (IPTV) is predicted to be the key technology winner in the future. Efforts to accelerate the deployment of IPTV centralized model which is combined of VHO, encoders, controller, access network and Home network. Regardless of whether the network is delivering live TV, VOD, or Time-shift TV, all content and network traffic resulting from subscriber requests must traverse the entire network from the super-headend all the way to each subscriber's Set-Top Box (STB). IPTV services require very stringent QoS guarantees When IPTV traffic shares the network resources with other traffic like data and voice, how to ensure their QoS and efficiently utilize the network resources is a key and challenging issue. For QoS measured in the network-centric terms of delay jitter, packet losses and bounds on delay. The main focus of this thesis is on the optimized bandwidth allocation and smooth data transmission. The proposed traffic model for smooth delivering video service IPTV network with its QoS performance evaluation. According to Maglaris et al [5] first, analyze the coding bit rate of a single video source. Various statistical quantities are derived from bit rate data collected with a conditional replenishment inter frame coding scheme. Two correlated Markov process models (one in discrete time and one in continuous time) are shown to fit the experimental data and are used to model the input rates of several independent sources into a statistical multiplexer. Preventive control mechanism which is to be including CAC, traffic policing used for traffic control. QoS has been evaluated of common bandwidth scheduler( FIFO) by use fluid models with Markovian queuing method and analysis the result by using simulator and analytically, Which is measured the performance of the packet loss, overflow and mean waiting time among the network users.

A systematic review of triage-related interventions to improve patient flow in emergency departments

Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.

Patienters upplevelser av att vårdas på en akutmottagning : -en litteraturöversikt

Bakgrund: Vårdpersonalen på en akutmottagning har stora krav på sig, ansvar för många patienter och måste fatta många egna beslut, ibland med mycket kort betänketid. Vårdpersonalen möter många olika patienter med olika problem och personligheter, och måste bemöta varje patient så att denne känner sig bekräftad och sedd. Syfte: Syftet med litteraturöversikten är att undersöka patienters upplevelse av att vårdas på en akutmottagning. Metod: Artiklar till arbetet har söks i olika databaser. Aktuella artiklar har lästs och relevanta fynd har markerats, för att analyseras och sammanställa ett resultat. Resultat: Analysen resulterade i tre underrubriker: Information, Bemötande och Vårdmiljö, med uppdelning av positiva och negativa upplevelser. Många patienter var nöjda med vården, men hade låga förväntningar från början. Patienterna har förstående för personalens tuffa arbetsmiljö, men önskade att få bättre information om väntetid och undersökningar. De tyckte att väntetiden var för lång, och kände sig ofta ensamma och övergivna. Slutsats: Mycket behöver förändras för att patienterna ska få en mer positiv upplevelse av akuten. Detta arbeta kan hjälpa till att belysa vilka punkter som vården måste arbeta extra mycket med för att patienterna ska känna sig trygga, exempelvis bättre information om väntetider och ett bemötande där sjusköterskan ser hela patienten.

Faktorer som påverkar patienters upplevelse av omvårdnad under sin vistelse på akutmottagning. : - En litteraturstudie

Bakgrund: På en akutmottagning kommer patienter i olika tillstånd och behov. Det är sjuksköterskan som ofta gör de första bedömningarna och därför är det av stor vikt att bemötandet från sjuksköterskan är positivt för att skapa trygghet. Ökat patientflöde och långa väntetider är några faktorer som är påvisade att kunna påverka upplevelsen för patienterna av sin vistelse på akutmottagningen. Syfte: Syftet med litteraturöversikten var att beskriva faktorer som påverkar patienters upplevelse av omvårdnad under sin vistelse på akutmottagning. Metod: Studien genomfördes som en litteraturöversikt. Databaserna CINAHL och PubMed användes för att söka efter artiklar. Resultat: Sex underkategorier valdes ut: bemötande, delaktighet, information, väntetid, kommunikation och kontinuitet, sjuksköterskans kunskap och kompetens. Resultatet visade att många patienter ansåg att sjuksköterskan var skicklig i sina arbetsuppgifter och var nöjda med bemötandet från sjuksköterskan, men att långa väntetider och bristande information påverkade upplevelsen av omvårdnad. Det fanns en tydlig önskan över att få mer information om sin väntetid, behandling och undersökningar. Brister i detta, skapade en otrygghet och en känsla av vara bortglömd hos patienterna. Slutsats: Sjuksköterskor på en akutmottagning behöver besitta en stor kommunikationsförmåga. Detta för att kunna ge patienterna en så bra upplevelse som möjligt. Slutsatser av resultatet har påvisat att det krävs förbättring inom flera områden för att ge patienter en bättre upplevelse av omvårdnaden under sin vistelse på akutmottagningen.

An efficient algorithm for application-layering anycasting

Anycasting communication is proposed in IPv6, and it is designed to support server replication by allowing applications to select and communicate with the “best” server, according to some performance or policy criteria, among the replicated servers. Originally any-cast researchers focus on network layer. In this paper we pay more attention to application-layer anycasting, because at application layer we can obtain more flexibility and scalability. First of all, we describe the application-layer anycast model, and then summarize the previous work in application-layer anycasting, especially the periodical probing algorithms for updating the database of anycast resolver. After that, we present our algorithm, the requirement-based probing algorithm, an efficient and practical algorithm. In the end, we analyse the algorithms using the queuing theory and the statistics characteristics of Internet traffic. The results show that the requirement-base probing algorithm has better performance not only in the average waiting time for all anycast queries, but also in the average time used for an anycast query.

Wait no more : the use of private dental services by welfare recipients in Australia

Dental services in Australia are available both privately and publicly. However, access to public dental services, like access to public hospital services for non-urgent treatment, is subject to a considerable waiting period. Moreover, access to public dental services is restricted to certain categories of welfare beneficiaries who qualify for a health care card. Because of the waiting time for public treatment, there is a frequent call for more public dental resources. This paper addresses the issue of what the waiting time for public dental services represents. One view largely confirmed by our research is that state governments are using the waiting time as a way of trying to push more and more people into the private sector. We find that more and more health care card holders are using the
private sector for dental services.

An evidence-based practice approach to improving nursing care of acute stroke in an Australian emergency department

Aims. The aim of this study was to improve the emergency nursing care of acute stroke by enhancing the use of evidence regarding prevention of early complications.
Background. Preventing complications in the first 24–48 hours decreases stroke-related mortality. Many patients spend considerable part of the first 24 hours following stroke in the Emergency Department therefore emergency nurses play a key role in patient outcomes following stroke.
Design. A pre-test/post-test design was used and the study intervention was a guideline for Emergency Department nursing management of acute stroke.
Methods. The following outcomes were measured before and after guideline implementation: triage category, waiting time, Emergency Department length of stay, time to specialist assessment, assessment and monitoring of vital signs, temperature and blood glucose and venous-thromboembolism and pressure injury risk assessment and interventions.
Results. There was significant improvement in triage decisions (21Æ4% increase in triage category 2, p = 0Æ009; 15Æ6% decrease in triage category 4, p = 0Æ048). Frequency of assessments of respiratory rate (p = 0Æ009), heart rate (p = 0Æ022), blood pressure (p = 0Æ032) and oxygen saturation (p = 0Æ001) increased. In terms of risk management, documentation of pressure area
interventions increased by 28Æ8% (p = 0Æ006), documentation of nil orally status increased by 13Æ8% (ns), swallow assessment prior to oral intake increased by 41Æ3% (p = 0Æ003), speech pathology assessment in Emergency Department increased by 6Æ1% (ns) and there was 93Æ5 minute decrease in time to speech pathology assessment for admitted patients (ns).
Relevance to clinical practice. An evidence-based guideline can improve emergency nursing care of acute stroke and optimise patient outcomes following stroke. As the continuum of stroke care begins in the Emergency Department, detailed recommendations for evidence-based emergency nursing care should be included in all multidisciplinary guidelines for the management of acute stroke.

Effect of clinician designation on emergency department fast track performance

Objective To examine the effect of clinician designation on emergency department (ED) fast track performance.
Design and Setting A retrospective audit of patients managed in the fast track area of an ED in metropolitan Melbourne, Australia.
Participants Patients triaged to ED fast track from 1 January 2008 to 31 December 2008 (n=8714).
Main Outcome Measures Waiting times in relation to Australasian triage scale (ATS) recommendations and ED length of stay (LOS) for non-admitted patients were examined for each clinician group.
Results Compliance with ATS waiting time recommendations was highest (82.5%) for emergency nurse practitioners/candidates and lowest (48.2%) for junior medical officers. Median ED LOS was less than 3 h for non-admitted patients, and 85.8% of non-admitted fast track patients (n=6278) left the ED within 4 h. Patients managed by emergency nurse practitioners/ candidates had the shortest ED LOS (median 1.7 h) and patients managed by junior medical officers and locum medical officers the longest ED LOS (median 2.7 h) (x²=498.539, df=6, p<0.001).
Conclusions Clinician designation does impact on waiting times and, to a lesser extent, ED LOS for patients managed in ED fast track systems. Future research should focus on obtaining a better understanding of the relationship between clinician expertise, time-based performance measures and quality of care indicators.

How bank branches affect customer service quality perceptions.

The Australian banking industry has changed significantly with the introduction of electronic banking technology. This has led to a situation where facilities such as ATM machines and Internet Banking have become increasingly important in the service delivery process. Traditionally, there has been relatively little research into the role facilities play in service satisfaction. There is also little literature about how customers interact with service facilities. This has left banks grappling with facility design and planning issues. This article examines how Australian bank customers interact with local banking facilities by investigating five aspects of the service facility: Access, Atmospherics, Waiting Time, Technology, and Security. Findings suggest that facilities have a significant impact on customer satisfaction levels. Convenient and easy access, security, and a comfortable level of technology were identified by customers as the most important factors influencing their satisfaction levels.

Shared care for chronic eye diseases : perspectives of ophthalmologists, optometrists and patients

Objective: To report the perspectives of optometrists, ophthalmologists and patients on a model of shared care for patients with chronic eye diseases.

Design, setting and participants: Qualitative study of a model of shared care between optometrists and ophthalmologists for patients with stable age-related macular degeneration, diabetic retinopathy and glaucoma, trialled by the Royal Victorian Eye and Ear Hospital in Melbourne during 2007–2009. Semi-structured interviews were conducted with optometrists, ophthalmologists and patients at completion of the project to obtain their perspectives on this model.

Results: Seventeen optometrists submitted expressions of interest to participate, and 12 completed web-based training modules and clinical observerships and adhered to specified examination and reporting protocols. All five participating ophthalmologists and 11 of the optometrists were interviewed. Ninety-eight patients participated and 37 were interviewed. Optometrists not only met ophthalmologists’ expectations but exceeded them, appropriately detecting and referring patients with additional, previously undetected conditions. Patients reported savings in travel time and were satisfied with the quality of care they received. Optometrists, ophthalmologists and patients indicated a general acceptance of shared care arrangements, although there were some issues relating to interprofessional trust.

Conclusions: Shared care between local optometrists and hospital-based ophthalmologists can help to reduce patient waiting time for review and offers an opportunity for these two groups of eye care professionals to collaborate in providing localised care for the benefit of patients. However, trust and relationship building need to be further developed.

Medical tourism: a conceptual framework for an innovation in global healthcare provision

The purpose of this chapter is to establish a conceptual model that can potentially fill research gaps in the literature about medical tourism as an innovative concept in global healthcare provision by developing emerging economies as they are providing low cost alternatives in medical treatment at internationally accredited medical facilities to treat patients from developed countries. Major databases such as Ebscohost and Emerald have been used to search relevant literature. The literature on medical tourism is reviewed so as to understand the key drivers of medical tourism as well as research gaps in the existing literature. Three major drivers of medical tourism have been identified, namely cost, waiting time, and perceived quality. Further empirical research is needed to test the conceptual model in order to better understand what drives a decision to engage in medical tourism. This chapter makes three major contributions; firstly, the identification of the medical tourism literature from the service marketing and management perspectives; secondly, to propose a conceptual model representing innovation in medical tourism for global healthcare by developing emerging economies; thirdly, the identification of research gaps in the medical tourism literature through which future research can further the knowledge of why people travel to developing countries for medical treatment.

Nurse-led clinic: Effective and efficient delivery of assessment and review of patients with Hepatitis B and C

Hepatology and gastroenterology services are increasingly utilising the skills and experience of nurse practitioners and nurse specialists to help meet the increasing demand for health care. A new nurse-led assessment clinic has been established in the liver clinic at Geelong Hospital to utilise the expertise of nurses to assess and triage new patients and streamline their pathway through the health care system. The aim of this study is to quantitatively assess the first two years of operation of the nurse assessment clinic at Geelong Hospital, and to assess advantages and disadvantages of the nurse-led clinic. Data was extracted retrospectively from clinical records of new patients at the liver clinic. Quarterly one-month periods were recorded over two-years. Patients were categorised according to the path via which they saw a physician, including missed and rescheduled appointments. The number of appointments, the waiting time from referral to appointments and the number of ‘did-not-attend’ occasions were analysed before and after the institution of the nurse-led assessment clinic. The Mann-Whitney rank sum test of ordinal data was used to generate median wait times. There was shown to be a statistically significant longer waiting time for physician appointment if seen by the nurse first. The difference in waiting time was 10 days. However, there was also a reduction in the number of missed appointments at the subsequent physician clinic. Other advantages have also been identified including effective triage of patients, and organisation of appropriate investigations from the initial nurse assessment.

Patient admission prediction using a pruned fuzzy min–max neural network with rule extraction

A useful patient admission prediction model that helps the emergency department of a hospital admit patients efficiently is of great importance. It not only improves the care quality provided by the emergency department but also reduces waiting time of patients. This paper proposes an automatic prediction method for patient admission based on a fuzzy min–max neural network (FMM) with rules extraction. The FMM neural network forms a set of hyperboxes by learning through data samples, and the learned knowledge is used for prediction. In addition to providing predictions, decision rules are extracted from the FMM hyperboxes to provide an explanation for each prediction. In order to simplify the structure of FMM and the decision rules, an optimization method that simultaneously maximizes prediction accuracy and minimizes the number of FMM hyperboxes is proposed. Specifically, a genetic algorithm is formulated to find the optimal configuration of the decision rules. The experimental results using a large data set consisting of 450740 real patient records reveal that the proposed method achieves comparable or even better prediction accuracy than state-of-the-art classifiers with the additional ability to extract a set of explanatory rules to justify its predictions.