Lean healthcare assets challenge FM performance measurement conventions

Purpose; To show how Lean Asset thinking can be applied to health care facilities using different measures to compare the estates contribution to the business of health care providers. The challenge to conventional wisdom matches that posed by Lean Production to Mass Manufacturing. Methodology; Data Envelope Analysis examines the income generated and patient occupied area as outputs from the Gross Area of a Trust’s estate. Findings; The approach yield strategic comparisons that conventional FM measures of cost per m2 hide. The annual cost of an excess estate is conservatively estimated at £600,000,000(in England alone) Research limitations/implications; Further research to understand the causes of the excess is needed and is in hand. Meanwhile the research illustrates the power of an alternative way of assessing facilities performance. Practical implications Have already been demonstrated in two trusts who have used such an analysis to define strategic estates targets, Originality. The author’s are not aware of the Lean Asset perspective previously being applied to healthcare facilities. The research shows the underlying fallacy of relying on cost per m2 as the primary measure of asset performance.</p

A revised approach to performance measurement for health-care estates

The purpose of the research was to show how lean asset thinking can be applied to UK health-care facilities using different measures to compare the estates contribution to the business of health-care providers. The challenge to conventional wisdom matches that posed by ‘Lean Production’ to ‘Mass Manufacturing’. Data envelope analysis examined the income generated and patient-occupied area as outputs from the gross area of a NHS Trust’s estate. The approach yielded strategic comparisons that conventional facilities management measures of cost per square metre hide. The annual cost of an excess estate is conservatively estimated at £600,000,000 (in England alone). Further research to understand the causes of the excess is needed. Meanwhile the research illustrates the power of an alternative way of assessing facilities performance. The authors are not aware of the lean asset perspective previously being applied to health-care facilities. The research shows the underlying fallacy of relying on cost per square metre as the primary measure of asset performance. The results and discussion will be particularly useful to senior estates and facilities managers wishing to use new measures to define strategic estates targets

The Neuroscience of Moral Judgment: Empirical and Philosophical Developments

We chart how neuroscience and philosophy have together advanced our understanding of moral judgment with implications for when it goes well or poorly. The field initially focused on brain areas associated with reason versus emotion in the moral evaluations of sacrificial dilemmas. But new threads of research have studied a wider range of moral evaluations and how they relate to models of brain development and learning. By weaving these threads together, we are developing a better understanding of the neurobiology of moral judgment in adulthood and to some extent in childhood and adolescence. Combined with rigorous evidence from psychology and careful philosophical analysis, neuroscientific evidence can even help shed light on the extent of moral knowledge and on ways to promote healthy moral development

A BRIEF BUT INTENSIVE LANGUAGE-LITERACY INTERVENTION FOR AN ADOLESCENT

The current service delivery model most frequently used in a school setting involves short, infrequent sessions over a 180-day school year. To date, there is no research that supports the current service delivery model as being the most effective and efficient model of intervention. As students transition from elementary to middle school, this model is particularly problematic for the adolescent student because of a rotating school schedule, increasing language demands of the academic curriculum, and development of self-perception and academic self-concept. A brief but intensive language-literacy intervention that takes place outside of the school year may be an effective and efficient alternative to adolescents who struggle with written language. The purpose of this study was to determine whether an adolescent who participates in a two-week intensive language-literacy intervention program would make significant gains in written narrative composition, complexity and accuracy of sentence composition, and encoding/decoding skills. Additionally, the investigator wished to determine whether or not an adolescent would demonstrate an increase in self-perception of literacy skills following participation in the aforementioned program. A multiple-baseline design across behaviors was used to examine written narratives collected from the adolescent during each session. There were four phases in this experiment: Baseline Phase - baseline data were collected; Phase A- intervention focused on discourse level literacy skills; Phase B- intervention focused on sentence level and discourse level skills; and Phase C- intervention focused on word/morpheme level, sentence level, and discourse level skills. In addition, pre and post test data were collected to examine word, sentence, and discourse level writing skills as well as self-perception of literacy skills. Preliminary results suggest a brief but intensive intervention did result in significant gains in language-literacy skills and self-perception of literacy skills. Further investigation is needed to determine if a gains can be generalized into the academic setting. Future studies in which the intensity of the intervention is manipulated (e.g. three weeks instead of two, a cycles approach addressing various aspects of language, etc.) could provide even stronger evidence for intervention programs of varied intensity

Eigenvalue Separation in Some Random Matrix Models

The eigenvalue density for members of the Gaussian orthogonal and unitary ensembles follows the Wigner semi-circle law. If the Gaussian entries are all shifted by a constant amount c/Sqrt(2N), where N is the size of the matrix, in the large N limit a single eigenvalue will separate from the support of the Wigner semi-circle provided c > 1. In this study, using an asymptotic analysis of the secular equation for the eigenvalue condition, we compare this effect to analogous effects occurring in general variance Wishart matrices and matrices from the shifted mean chiral ensemble. We undertake an analogous comparative study of eigenvalue separation properties when the size of the matrices are fixed and c goes to infinity, and higher rank analogues of this setting. This is done using exact expressions for eigenvalue probability densities in terms of generalized hypergeometric functions, and using the interpretation of the latter as a Green function in the Dyson Brownian motion model. For the shifted mean Gaussian unitary ensemble and its analogues an alternative approach is to use exact expressions for the correlation functions in terms of classical orthogonal polynomials and associated multiple generalizations. By using these exact expressions to compute and plot the eigenvalue density, illustrations of the various eigenvalue separation effects are obtained.Comment: 25 pages, 9 figures include

Human Papillomavirus (HPV) Vaccination Status Among University Freshmen in Hawai‘i

Purpose/Background: The HPV vaccine provides immunity against nine HPV strains that cause cancer and genital warts. It is recommended for 11 to 12 year olds, and catch-up immunization is recommended for females 13 to 26 years old and males 13 to 21 years old. College students represent an important population for HPV vaccination due to their increased risk for HPV infection. Despite the benefits of the HPV vaccine, its coverage rates are low in Hawaii. Hawai‘i is the home of two large universities on two islands that are representative of Hawai‘i’s populations, including Native Hawaiians, Filipinos, and Pacific Islanders. The purpose of this study was to assess the current HPV and HPV vaccine knowledge, barriers and beliefs among incoming Freshmen university students at University of Hawai‘i at Mānoa and University of Hawai‘i at Hilo. Materials & Methods: In 2016, 200 University of Hawai‘i at Mānoa (UHM) and University of Hawai‘i at Hilo (UHH) Freshmen students responded to a survey that assessed their knowledge and awareness of HPV, the HPV vaccine, their current vaccination status, and barriers and motivators to vaccination. Descriptive statistics were used to summarize each survey variable first for all students and then separately for each campus. Results: Overall 76% of Freshmen from both campuses heard of the HPV vaccine and 54% reported hearing it from their health care provider. Only 28% UHM and 23% UHH Freshmen students have received partial (1-2 shots) or completed doses of the HPV vaccine. For those who received the vaccine, 45% reported that they were told by their parent and 43% were told by their doctor. For the 147 students who did not receive the vaccine, 28% reported that they are still not sure to get it and 20% need more information. Their main reasons for not receiving the HPV vaccine were: their doctor did not mention the vaccine to him/her (44%), he/she never knew about the vaccine (18%), and they don\u27t know enough about the vaccine (17%). Discussion/Conclusion: Although the HPV vaccine has been available for 13 years, young adults remain unvaccinated. Freshmen students reported that they are informed about the vaccine, but were not vaccinated because of the lack of parental and/or healthcare provider recommendation. With no active education campaigns in Hawaii promoting the HPV vaccine at college campuses, a first step to increasing vaccination rates is to develop a health education campaign to inform students of the HPV vaccine and its availability at campus clinics and neighboring pharmacies

Secondary literacy across the curriculum: Challenges and possibilities

This paper discusses the challenges and possibilities attendant upon successfully implementing literacy across the curriculum initiatives – or ‘school language policies’ as they have come to be known - particularly at the secondary or high school level. It provides a theoretical background to these issues, exploring previous academic discussions of school language policies, and highlights key areas of concern as well as opportunity with respect to school implementation of such policies. As such, it provides a necessary conceptual background to the subsequent papers in this special issue, which focus upon the Secondary Schools’ Literacy Initiative (SSLI) – a New Zealand funded programme that aims to establish cross-curricular language and literacy policies in secondary schools

Ionising radiation exposure from medical imaging – A review of Patient's (un) awareness

Introduction: Medical imaging is the main source of artificial radiation exposure. Evidence, however, suggests that patients are poorly informed about radiation exposure when attending diagnostic scans. This review provides an overview of published literature with a focus on nuclear medicine patients on the level of awareness of radiation exposure from diagnostic imaging. Methods: A review of available literature on awareness, knowledge and perception of ionising radiation in medical imaging was conducted. Articles that met the inclusion criteria were subjected to critical appraisal using the Mixed Methods Appraisal Tool. Results: 140 articles identified and screened for eligibility, 24 critically assessed and 4 studies included in synthesis. All studies demonstrated that patients were generally lacking awareness about radiation exposure and highlighted a lack of communication between healthcare professionals and patients with respect to radiation exposure. Conclusion: Studies demonstrate a need to better inform patients about their radiation exposure, and further studies focusing on nuclear medicine patients are particularly warranted. Implications for practice: Adequate and accurate information is crucial to ensure the principle of informed consent is present