Implementation of lean in health care environments: an update of systematic reviews

Purpose – Even though the implementation of Lean in healthcare environments is relatively recent, it has been receiving a lot of attention in recent years. Partly due to the fact that it is a recent field of practice and research and partly because the number of works developed in this field has grown rapidly, it is important to frequently update the perspectives on this field of investigation. Thus, this article aims to systematically review the implementation of Lean tools and techniques applied to hospital organizational areas in a 5-year period, between 2014 to 2018, complementing some of the most relevant reviews already published. The most important criteria such as tools, methods and principles, hospital areas intervened, improvements and difficulties were assessed and quantified. Methodology - As starting point for this systematic literature review, a set of selected pre-existing review publications was used to support the current work and as the ground base for the expansion of the studies about Lean Healthcare. The current study contemplated 114 articles from a 5-year period between 2014 and 2018. A subset of 58 of these articles was critically assessed to understand the application of lean tools and methods in different hospital areas. Findings - The thorough analysis of selected articles show a lack of works in Continuous Improvement approaches when compared to the application of work organization, visual management, and diagnosing and problem-solving tools. The reported improvement results demonstrate alignment with the principles and foundations of lean philosophy, but such results are presented in isolated initiatives and without robust evidence of long-term maintenance. Moreover, this study shows an evolution in the number of articles referring to lean implementation in hospital areas, but in its great majority, such articles report isolated implementations in different areas, not spreading those for the global organization. Thus, some of the main recommendations, are the need to implement studies on complete flows of patients, drugs and materials, instead of isolated initiatives, and strive to promote cultural change of hospitals through structural changes, following new visions and strategic objectives, supported by real models of continuous structural and sustained improvement. Originality – The current work develops a new perspective of the articles published under the thematic of Lean Healthcare, published in a recent period of 5 years, which are not completely covered by other works. Additionally, it explicitly applied, in an innovative way, an approach that used a set of previous reviews as the starting point for this SLR. In this way, it integrates approaches and categories from different SLRs, creating a framework of analysis that can be used by future researchers. Finally, it shows the most recent implementations of Lean Healthcare, exposing the current trends, improvements and also the main gaps.This work has been supported by FCT–Fundação para a Ciência e Tecnologia within the R&D Units Project Scope UIDB/00319/2020 and project POCI-01-0145-FEDER-03029

Molecular gas properties of UV-bright star-forming galaxies at low redshift

Lyman break analogues (LBAs) are a population of star-forming galaxies at low redshift (z ∼ 0.2) selected in the ultraviolet (UV). These objects present higher star formation rates and lower dust extinction than other galaxies with similar masses and luminosities in the local universe. In this work, we present results from a survey with the Combined Array for Research in Millimeter-wave Astronomy (CARMA) array to detect CO(1–0) emission in LBAs, in order to analyse the properties of the molecular gas in these galaxies. Our results show that LBAs follow the same Schmidt–Kennicutt law as local galaxies. On the other hand, they have higher gas fractions (up to 66 per cent) and faster gas depletion time-scales (below 1 Gyr). These characteristics render these objects more akin to high-redshift star-forming galaxies. We conclude that LBAs are a great nearby laboratory for studying the cold interstellar medium in low-metallicity, UV-bright compact star-forming galaxies

Does early specialization provide an advantage in physical fitness development in youth basketball?

The present study examined the influence of the specialization onset on the magnitude and patterns of changes in basketball-specific physical fitness within a competitive season and developmental fitness trends between 11 and 17 years in young basketball players. Repeated measures of 181 young basketball players (female, n = 40; male, n = 141) were examined. Anthropometry, age, estimated maturity status, and basketball-specific physical fitness (assessed with the countermovement jump, line drill, and yo-yo intermittent recovery level-1 and fitness score) were considered. Players were grouped by the onset of specialization as related to biological maturation milestones (pre-puberty, mid-puberty, and late-puberty specialization). The within-season and developmental changes in physical fitness were fitted using multilevel modeling in a fully Bayesian framework. The fitness outcomes were similar between-player and within-player changes when grouped by specialization across a season. Fitness improvements across a season were apparent for female players, while male players maintained their performance levels. There was no variation in the patterns of physical fitness development between 11 and 17 years associated with the onset of specialization. Conditional on our data and models, the assumption that early sport specialization provides a physical fitness advantage for future athletic success does not hold

Efficacy of naproxen with or without esomeprazole for pain and inflammation in patients after bilateral third molar extractions : a double blinded crossover study

Using a double-blinded randomized crossover design, this study aimed to evaluate acute postoperative pain management, swelling and trismus in 46 volunteers undergoing extractions of the two lower third molars, in similar positions, at two different appointments who consumed a tablet of either NE (naproxen 500 mg + esomepraz ole 20 mg) or only naproxen (500 mg) every 12 hours for 4 days. Parameters were analyzed: self-reported pain intensity using a visual analog scale (VAS) pre- and postoperative mouth opening; incidence, type and severity of adverse reactions; total quantity consumed of rescue medication; and pre- and postoperative swelling. Female volunteers reported significantly more postoperative pain at 1, 1.5, 2, 3 and 4hrs after surgery while also taking their first rescue medication at a time significantly earlier when consuming NE when compared to naproxen (3.7hrs and 6.7hrs). Conversely, no differences were found between each drug group in males. In conclusion, throughout the entire study, pain was mild after using either drug in both men and women with pain scores on average well below 40mm (VAS), although in women naproxen improved acute postoperative pain management when compared to NE

In vitro Efficacy of Photoprotection in Sunscreens: a Comparison Between Methods

Sunscreens are known to play an important role on the prevention of skin cancer, as they act by blocking the carcinogenic solar radiations. The currently methods for determining the sun protection efficacy of these products are all based on in vivo tests. In this light, the aim of the present study was to compare the performance of two spectrophotometric in vitro methods, in order to determine which one generates more trustworthy Sun Protection Factors (SPF) values: the classical UV spectrophotometry or the diffuse transmittance reflectance spectrophotometry. For that, twenty-five SPF 30 commercial sunscreen samples were used. The methods generated different results, being the diffuse transmittance spectrophotometry more appropriate and reliable for determining the SPF of these products. Moreover, it provides as additional advantage the possibility of quantifying the protection against UVA radiation through the UVA/UVB Ratio and the Critical Wavelength.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Exploring glycoside hydrolases and accessory proteins from wood decay fungi to enhance sugarcane bagasse saccharification

Abstract\ud \ud Background\ud Glycoside hydrolases (GHs) and accessory proteins are key components for efficient and cost-effective enzymatic hydrolysis of polysaccharides in modern, biochemically based biorefineries. Currently, commercialized GHs and accessory proteins are produced by ascomycetes. However, the role of wood decay basidiomycetes proteins in biomass saccharification has not been extensively pursued. Wood decay fungi degrade polysaccharides in highly lignified tissues in natural environments, and are a promising enzyme source for improving enzymatic cocktails that are designed for in vitro lignocellulose conversion.\ud \ud \ud Results\ud GHs and accessory proteins were produced by representative brown- and white-rot fungi, Laetiporus sulphureus and Pleurotus ostreatus, respectively. Concentrated protein extracts were then used to amend commercial enzymatic cocktails for saccharification of alkaline-sulfite pretreated sugarcane bagasse. The main enzymatic activities found in the wood decay fungal protein extracts were attributed to endoglucanases, xylanases and β-glucosidases. Cellobiohydrolase (CBH) activities in the L. sulphureus and P. ostreatus extracts were low and nonexistent, respectively. The initial glucan conversion rates were boosted when the wood decay fungal proteins were used to replace half of the enzymes from the commercial cocktails. L. sulphureus proteins increased the glucan conversion levels, with values above those observed for the full load of commercial enzymes. Wood decay fungal proteins also enhanced the xylan conversion efficiency due to their high xylanase activities. Proteomic studies revealed 104 and 45 different proteins in the P. ostreatus and L. sulphureus extracts, respectively. The enhancement of the saccharification of alkaline-pretreated substrates by the modified enzymatic cocktails was attributed to the following protein families: GH5- and GH45-endoglucanases, GH3-β-glucosidases, and GH10-xylanases.\ud \ud \ud Conclusions\ud The extracellular proteins produced by wood decay fungi provide useful tools to improve commercial enzyme cocktails that are currently used for the saccharification of alkaline-pretreated lignocellulosic substrates. The relevant proteins encompass multiple glycoside hydrolase families, including the GH5- and GH45-endoglucanases, GH3-β-glucosidases, and GH10-xylanases.The authors thank J.M. Silva and J.C. Tavares for technical assistance. This work\ud was supported by FAPESP (contract numbers 08/56256-5 and 2014/06923-6),\ud CNPq (contract numbers 442333/2014-5; 310186/2014-5 and 140796/2013-\ud 4), and CAPES. We gratefully acknowledge the provision of time on the MAS\ud and NGS facilities (LNBio and CTBE, respectively) at the National Center for\ud Research in Energy and Materials (CNPEM).\ud The work was supported by Fundação de Amparo à Pesquisa do Estado de\ud São Paulo (FAPESP), contract numbers 08/56256-5 and 2014/06923-6, and by\ud Conselho Nacional de Pesquisa (CNPq), contract numbers 442333/2014-5;\ud 310186/2014-5, 140796/2013-4

Bar properties as a function of wavelength: a local baseline with S4G for high-redshift studies

The redshift evolution of bars is an important signpost of the dynamic maturity of disc galaxies. To characterize the intrinsic evolution safe from band-shifting effects, it is necessary to gauge how bar properties vary locally as a function of wavelength. We investigate bar properties in 16 nearby galaxies from the Spitzer Survey of Stellar Structure in Galaxies (S4G) at ultraviolet, optical, and mid-infrared wavebands. Based on the ellipticity and position angle profiles from fitting elliptical isophotes to the two-dimensional light distribution, we find that both bar length and ellipticity – the latter often used as a proxy for bar strength – increase at bluer wavebands. Bars are 9 per cent longer in the B band than at 3.6 μm. Their ellipticity increases typically by 8 per cent in the B band, with a significant fraction (>40 per cent) displaying an increase up to 35 per cent. We attribute the increase in bar length to the presence of star-forming knots at the end of bars: these regions are brighter in bluer bands, stretching the bar signature further out. The increase in bar ellipticity could be driven by the apparent bulge size: the bulge is less prominent at bluer bands, allowing for thinner ellipses within the bar region. Alternatively, it could be due to younger stellar populations associated with the bar. The resulting effect is that bars appear longer and thinner at bluer wavebands. This indicates that band-shifting effects are significant and need to be corrected for high-redshift studies to reliably gauge any intrinsic evolution of the bar properties with redshift

The complex globular cluster system of the S0 galaxy NGC 4382 in the outskirts of the Virgo Cluster

NGC 4382 is a merger-remnant galaxy that has been classified as morphological type E2, S0, and even Sa. In this work, we performed a photometric and spectroscopic analysis of the globular cluster (GC) system of this peculiar galaxy in order to provide additional information about its history. We used a combination of photometric data in different filters, and multiobject and long-slit spectroscopic data obtained using the Gemini/GMOS instrument. The photometric analysis of the GC system, using the Gaussian Mixture Model algorithm in the colour plane, reveals a complex colour distribution within Rgal < 5 arcmin (26.1 kpc), showing four different groups: the typical blue and red subpopulations, a group with intermediate colours, and the fourth group towards even redder colours. From the spectroscopic analysis of 47 GCs, confirmed members of NGC 4382 based on radial velocities, we verified 3 of the 4 photometric groups from the analysis of their stellar populations using the ULySS code. NGC 4382 presents the classic blue (10.4 ± 2.8 Gyr, [Fe/H] = −1.48 ± 0.18 dex), and red (12.1 ± 2.3 Gyr, [Fe/H] = −0.64 ± 0.26 dex) GCs formed earlier in the lifetime of the galaxy, and a third group of young GCs (2.2 ± 0.9 Gyr; [Fe/H] = −0.05 ± 0.28 dex). Finally, analysis of long-slit data of the galaxy reveals a luminosity-weighted mean age for the stellar population of ∼2.7 Gyr, and an increasing metallicity from [Fe/H] = −0.1 to +0.2 dex in Rgal < 10 arcsec (0.87 kpc). These values, and other morphological signatures in the galaxy, are in good agreement with the younger group of GCs, indicating a common origin as a result of a recent merger