Lean thinking: progettazione di un A3" lean trovabile"

Riassunto: immaginare il futuro non è semplice, tanto piùquando quest’ultimo riguarda una struttura complessa come il Pronto Soccorso . Diverse sono le variabili (struttura, tecnologia, organizzazione e funzione) che bisogna prendere in considerazione. A rendere il quadro assai più complesso, la crisi economica che fa si che si investa meno, tagliando le risorse, per di più, in maniera lineare senza andare a valutare caso per caso. La tesi propone la stesura di un progetto di miglioramento secondo il pensiero Lean attraverso la metodica dell’A3 dal titolo Lean Trovabile analizzando le criticità riguardanti l’informazione e l’attesa dell’utenza del Pronto Soccorso di Livorno. Summary: Envisioning the future is never easy, especially if this is about a such complex service as the Emergency Department. The variables we need to take into account are many: facility, technology, organization and roles. Moreover, to render the picture even more complicated, the economic crisis slowed the investments and cut the resources mostly in a linear way. My thesis proposes a project based on Lean Thinking which is based on A3 methodology and it is entitled “Lean Thinking: Analysing the criticality of information and daley in the Emergency Department”

Changing views at Banaras Hindu University on the Academic Study of Religion: A first report from an on-going research project

Given India’s vibrant religious landscape, there is a somewhat surprising paucity of depart‐ ments, centres or even programs for the academic study of religion. This article discusses this issue based on the preliminary results of an interview study conducted at Banaras Hindu University (BHU), Varanasi, India, in 2014 and 20 Its focus is on the views of university teachers and researchers concerning the place, role and function of religion and religious stud‐ ies at BHU. Twenty‐eight semi‐structured interviews were conducted. In the course of their analysis, six themes emerged: 1) the place and role of religion in society; 2) religion as ‘religi‐ osity/spirituality’ or sanatana dharma vs. political ideology/communitarianism; 3) religion vs. dharma; 4) secularization; 5) religion in education in general; and, 6) religion in the education at BHU. The informants agreed on the increasing importance of religion in India, and most of them viewed the meaning of secularization as being ‘equal respect for all religions’. Moreover, a majority distinguished between ‘religion’, in the Western sense, and the Indian conception of dharma, considering it regrettable that the latter, described as the common ground of all reli‐ gions, is not taught more extensively at BHU. They also considered the original ideal of BHU’s founder, Madan Mohan Malaviya, to be of signi cant importance. That ideal involved not only teaching students the knowledge and skill sets found in a standard modern university, but also equipping them with a value‐based education, grounded upon sanatana‐dharma. As our project progresses, further understanding of this turn toward dharma education is something we intend to pursue through the lens of multiple modernities, developed by Marian Burchardt et al. as multiple secularities

Violence against Christians in India: A Critical Discourse Analysis of Two Indian English Newspapers

During recent decades violence against Christians in India has increased significantly. In spite of this development the issue has received relatively little scholarly attention. Likewise, despite the massive transformation of the newspaper business, which has made contemporary India one of the largest newspaper markets in the world, only few studies have been done on the news coverage of religious minorities in India. In this article, we aim to contribute to both these areas of research. Using a critical discourse analysis, we examine the everyday representation of violence and harassment against Christians in the two largest English daily newspapers in India, Times of India and The Hindu. As pointed out by David A. Stout, news media is one of the main channels through which people gain knowledge about religion. They thus influence attitudes and ideas that may play a significant role for the intensity of conflicts and can facilitate or endanger the possibility of peaceful coexistence. We, therefore, consider the study of media representations to be an important tool to gain a better understanding of the underlying dynamics of violence against Christians in India

AVRA: Automatic Visual Ratings of Atrophy from MRI images using Recurrent Convolutional Neural Networks

Quantifying the degree of atrophy is done clinically by neuroradiologists following established visual rating scales. For these assessments to be reliable the rater requires substantial training and experience, and even then the rating agreement between two radiologists is not perfect. We have developed a model we call AVRA (Automatic Visual Ratings of Atrophy) based on machine learning methods and trained on 2350 visual ratings made by an experienced neuroradiologist. It provides fast and automatic ratings for Scheltens' scale of medial temporal atrophy (MTA), the frontal subscale of Pasquier's Global Cortical Atrophy (GCA-F) scale, and Koedam's scale of Posterior Atrophy (PA). We demonstrate substantial inter-rater agreement between AVRA's and a neuroradiologist ratings with Cohen's weighted kappa values of $\kappa_w$ = 0.74/0.72 (MTA left/right), $\kappa_w$ = 0.62 (GCA-F) and $\kappa_w$ = 0.74 (PA), with an inherent intra-rater agreement of $\kappa_w$ = 1. We conclude that automatic visual ratings of atrophy can potentially have great clinical and scientific value, and aim to present AVRA as a freely available toolbox.Comment: 11 pages, 6 figure

Immunonutrition before esophagectomy: Impact on immune surveillance mechanisms

Preoperative oral immunonutrition was demonstrated to improve immune response and to decrease the infection rate in patients with cancer. This study aimed to assess how immunonutrition could influence the immune cell response in the mucosal microenvironment of esophageal adenocarcinoma. Therefore, A prospective cohort of consecutive patients undergoing esophagectomy for esophageal adenocarcinoma was enrolled. A subgroup of them was given preoperative oral immunonutrition with Oral Impact and was compared to those who received no preoperative supplementation. Mucosal samples from healthy esophagus were obtained at esophagectomy. Histology, immunohistochemistry, gene expression analysis, and cytofluorimetry were performed. Markers of activation of antigen-presenting cells (CD80, CD86, and HLA-I), innate immunity (TLR4 and MyD88), and cytotoxic lymphocyte infiltration and activation (CD8, CD38, CD69, and CD107) were measured. In all, 50 patients received preoperative Oral Impact and 129 patients received no nutritional support. CD80, CD86, MyD88, and CD69 messenger RNA expression was significantly increased in patients receiving immunonutrition compared to controls. In the subgroup of patients with stages I-II cancer, the rate of epithelial cells expressing CD80 and HLA-ABC was significantly higher in those receiving immunonutrition compared to controls as well as CD8+ CD28+ cell rate. Immunonutrition administration before surgery was significantly associated to increased degranulating CD8 and natural killer cells (CD107+) infiltrating the healthy esophageal mucosa. All the comparisons were adjusted for cancer stage and preoperative therapy. In conclusion, in healthy esophageal mucosa of patients undergoing esophagectomy, a 5-day course of immunonutrition enhances expression of antigen-presenting cells activity and increased CD8+ T cell activation and degranulating activity. Further studies are warranted to understand the clinical implication in terms of cancer recurrence

Walls talk: Microbial biogeography of homes spanning urbanization.

Westernization has propelled changes in urbanization and architecture, altering our exposure to the outdoor environment from that experienced during most of human evolution. These changes might affect the developmental exposure of infants to bacteria, immune development, and human microbiome diversity. Contemporary urban humans spend most of their time indoors, and little is known about the microbes associated with different designs of the built environment and their interaction with the human immune system. This study addresses the associations between architectural design and the microbial biogeography of households across a gradient of urbanization in South America. Urbanization was associated with households' increased isolation from outdoor environments, with additional indoor space isolation by walls. Microbes from house walls and floors segregate by location, and urban indoor walls contain human bacterial markers of space use. Urbanized spaces uniquely increase the content of human-associated microbes-which could increase transmission of potential pathogens-and decrease exposure to the environmental microbes with which humans have coevolved

Tolerance and autoimmunity: novel therapeutic approaches

La función primaria del sistema inmune es resguardar al individuo de los patógenos potencialmente dañinos que invaden el medio ambiente en el cual nos desarrollamos. Este cuenta con dos grandes ramas, la inmunidad innata y la adaptativa, ambas con la propiedad de diferenciar lo peligroso de aquello inofensivo. Estos procesos se hallan regulados por mecanismos homeostáticos que constituyen la tolerancia inmunológica, a los fines de limitar aquellos procesos prolongados y silenciar los potencialmente autoagresivos. Ante la falla de estos mecanismos de control, surgen las enfermedades autoinmunes. Avances en el conocimiento de la fisiopatología de estas entidades, han abierto un nuevo capítulo en el terreno de la inmunofarmacología. Su prometedor potencial actualmente nos ofrece novedosas herramientas terapéuticas para controlar y atenuar el daño causado por este tipo de respuestas. No obstante, debe continuarse la investigación en el campo de los agentes biológicos, ya que ninguno de ellos se encuentra libre de inconvenientes. Seguramente, futuros hallazgos se concretarán en futuros aciertos. Y los aciertos, en Medicina, equivalen a esperanza.The main function of the immune system is to protect the individual against potentially dangerous pathogens. It comprises innate and adaptive cellular and soluble components, both with the capacity to discriminate between harmful and harmless. These processes are regulated by homeostatic mechanisms that constitute the so-called immunological tolerance, which aims to limit the prolonged action of immune mediators and to silence the generation of potentially autoaggressive components. Failure to silence self-reactive T and B cells results in the generation of autoimmune disease. Recent advances in our knowledge of these pathological entities have opened a new chapter in the pharmacology of the immune system. Its promising potential currently offers new therapeutic agents to control and attenuate pathological tissue damage. Nevertheless, further research regarding these biologic agents is required, since they are not free from inconveniences. It is without question that upcoming findings in this field will instill hope into the quest for the “magic bullet”.Fil: Ciliberti, Esteban. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Carambia, Leandro. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Ciencias Fisiológicas; ArgentinaFil: Cavallin, Sebastian. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Ciencias Fisiológicas; ArgentinaFil: Cerda, Osvaldo L.. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Poderoso, Juan J.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Rabinovich, Gabriel Adrián. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentin