A lean case study in an oncological hospital: implementation of a telephone triage system in the emergency service

Abstract: Lean practices and thinking have increased substantially in the last few years. Applications of lean practices to health care are found worldwide. Despite that, new contributions are required because the application of lean thinking to hospitals has a long way to go. Lean practices and thinking do not include, in the literature or practice programs, any references to triage systems in health care units. The common triage systems require physical presence, but there are alternative methods to avoid the need to move patients: these alternative triage systems, given their characteristics, may be included in the spectrum of lean practices. Currently, patients that are already known to suffer from cancer are encouraged to go to hospital (public or private, with an oncological focus) when facing side effects from chemotherapy or radiation treatments; they are then submitted to a triage system (present themselves to the hospital for examination). The authors of this paper propose the introduction of telephone or email triage for impaired patients as a valid substitute for moving them physically, thereby often avoiding several unnecessary moves. This approach has, in fact, characteristics similar to a lean practice in that it reduces costs and maintains, if done properly, the overall service offered. The proposed ‘remote’ triage emerged from the results of a large survey sent to patients and also as the outcome of a set of semistructured interviews conducted with hospital nurses. With the results they obtained, the authors felt comfortable proposing this approach both to public and private hospitals, because the study was conducted in the most important, largest, and best-known oncological unit in Spain. As a final result, the health care unit studied is now taking the first steps to implement a remote triage system by telephone, and has begun to reduce the previously necessary movement of impaired patients

Spin-orbit induced mixed-spin ground state in RRNiO3_3 perovskites probed by XAS: new insight into the metal to insulator transition

We report on a Ni L$_{2,3}$ edges x-ray absorption spectroscopy (XAS) study in $R$NiO$_3$ perovskites. These compounds exhibit a metal to insulator ($MI$) transition as temperature decreases. The L$_{3}$ edge presents a clear splitting in the insulating state, associated to a less hybridized ground state. Using charge transfer multiplet calculations, we establish the importance of the crystal field and 3d spin-orbit coupling to create a mixed-spin ground state. We explain the $MI$ transition in $R$NiO$_3$ perovskites in terms of modifications in the Ni$^{3+}$ crystal field splitting that induces a spin transition from an essentially low-spin (LS) to a mixed-spin state.Comment: 4 pages, 4 figures, accepted as PRB - Rapid Comm. Dez. 200

Respostas fisiológicas e metabólicas de gramíneas ao alagamento.

Vários estudos têm mostrado que o alagamento do solo é capaz de interferir na capacidade fotossintética e, consequentemente, no desenvolvimento de gramíneas. Visando obter mais informações sobre a tolerância de plantas ao alagamento, estudou-se as respostas morfológicas e metabólicas em plantas de Brachiaria brizantha e Paspalum fasciculatum, submetidas a 21 dias de alagamento. Em B. brizantha, o alagamento reduziu significativamente a taxa fotossintética e alterou o padrão de alocação e translocação de componentes bioquímicos, com aumento significativo nos teores de açúcares solúveis totais nas folhas e raízes, açúcares redutores e amido nas folhas, e aminoácidos nas raízes. Nas plantas alagadas de P. fasciculatum não ocorreu diferença significativa na taxa fotossintética, amido e aminoácidos, apresentando acúmulo de açúcares solúveis totais somente nas raízes. As respostas apresentadas pelas plantas B. brizantha permitem afirmar que esta espécie é mais sensível ao alagamento, enquanto a espécie P. fasciculatum é mais tolerante

O uso de unidades de referência como ferramenta para a construção de sistemas agrícolas biodiversos para a agricultura familiar.

Resumo: Os sistemas de produção biodiversos são formas inovadoras de agricultura e pecuária que buscam aliar benefícios econômicos e ambientais, apoiados no incremento da biodiversidade. O Programa ?Sistemas agrícolas familiares biodiversos?, desenvolvido pela Equipe de Agroecologia da Embrapa Meio Ambiente, se caracteriza pela gradual formação de redes sócio-técnicas, articuladas em torno de Unidades de Referência (URs). As URs são parcelas ou unidades produtivas onde se desenvolvem todas as atividades técnicas sobre sistemas biodiversos (experimentação, capacitação e irradiação do conhecimento). O objetivo principal das URs é o de se tornarem inspiração para os demais agricultores na forma de exemplos práticos que possam ser adaptados à situação dos agricultores beneficiários finais, servindo como base para a criação de pequenas redes interligando URs em nível de microrregiões. Por meio destas estratégias de gestão reforça-se a replicabilidade dos conhecimentos gerados e o impacto sobre um número maior de beneficiários, podendo servir de base para a formulação de políticas públicas para a diversificação produtiva da agricultura familiar. Abstract: Biodiverse production systems are innovative forms of agriculture and livestock willing to align economic and environmental benefits, supported in increasing biodiversity. The 'family biodiverse agricultural systems' program, developed by Embrapa Environment Team Agroecology, is characterized by the gradual formation of socio-technical networks, articulated around the Reference Units (RUs ). The RUs are plots or production units where they develop all technical activities on biodiverse systems (experimentation, training and knowledge irradiation). The main objective of RUs is to become inspiration for other farmers in the form of practical examples that can be adapted to the situation of the beneficiaries end farmers, serving as a basis for creating small networks interconnecting RUs. Through these management strategies reinforces the replicability of knowledge generated and the impact on a larger number of beneficiaries, could be a basis for the formulation of public policies for productive diversification of family farming