A Model for the Implementation of Lean Improvements in Healthcare Environments as Applied in a Primary Care Center

[EN] Companies operate in a competitive and changing environment requiring increasingly effective and efficient management strategies. Lean is a proven philosophy in the industrial sector having helped companies to adapt to rapid market changes; to economic, technical, and social complexities; and to customer needs. For this reason, companies in the service sector are adopting Lean to improve their service management and to achieve economic, social, and environmental sustainability. This paper presents a model which uses Lean tools to facilitate the introduction of Lean in the management of primary care centers. The results show the implementation of Lean improved primary care center management, achieved stated objectives, and demonstrated faster adaptation to environmental needs and changes. The Lean philosophy developed and applied in the primary care center proved useful at a professional level facilitating developmental changes and prompting lasting improvements by developing a sustainable work culture.Morell-Santandreu, O.; Santandreu Mascarell, C.; García Sabater, JJ. (2021). A Model for the Implementation of Lean Improvements in Healthcare Environments as Applied in a Primary Care Center. International Journal of Environmental research and Public Health (Online). 18(6):1-33. https://doi.org/10.3390/ijerph18062876S13318

Sustainability and Kaizen: Business Model Trends in Healthcare

[EN] Kaizen, or continuous improvement, is a management tool that allows the identification of activities that have no value in the processes examined. This identification leads to the improvement of these processes within any organization and promotes economic and social sustainability, and to a lesser extent environmental sustainability. Kaizen, already widely and successfully employed in the industrial sector, is now being applied in the health sector. However, the health sector tends to publish only the results of how processes have been improved in finely focused areas and the resulting benefits. The majority of the benefits focus on time and cost reduction. In this study, the authors carried out a bibliometric analysis using the Scimat program, which maps the thematic evolution of Kaizen in the health sector and its relationship with sustainability, in order to promote the interest of the health sector for this type of process improvement. The findings confirm that the implementation of Kaizen is recent and constantly evolves and grows, and that it can help economic and social sustainability, and to a lesser extent environmental sustainability.Morell-Santandreu, O.; Santandreu Mascarell, C.; García Sabater, JJ. (2020). Sustainability and Kaizen: Business Model Trends in Healthcare. Sustainability. 12(24):1-28. https://doi.org/10.3390/su122410622S1281224Sepetis, A. (2019). Sustainable Health Care Management in the Greek Health Care Sector. Open Journal of Social Sciences, 07(12), 386-402. doi:10.4236/jss.2019.712030Sustainable Healthcare—Working towards the Paradigm Shift https://www.anhinternational.org/wp-content/uploads/old/files/100617SustainableHealthcare_White-Paper.pdfWeisz, U., Haas, W., Pelikan, J. M., & Schmied, H. (2011). Sustainable Hospitals: A Socio-Ecological Approach. GAIA - Ecological Perspectives for Science and Society, 20(3), 191-198. doi:10.14512/gaia.20.3.10McGain, F., & Naylor, C. (2014). 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(2019). El profesional de la información (EPI): Bibliometric and thematic analysis (2006-2017). El Profesional de la Información, 28(4). doi:10.3145/epi.2019.jul.17WOS Database Available from the Spanish Foundation for Science and Technology https://www.recursoscientificos.fecyt.es/Fundación Española para la Ciencia y la Tecnología (FECYT) www.fecyt.esJiménez-García, M., Ruiz-Chico, J., Peña-Sánchez, A. R., & López-Sánchez, J. A. (2020). A Bibliometric Analysis of Sports Tourism and Sustainability (2002–2019). Sustainability, 12(7), 2840. doi:10.3390/su12072840Chiarini, A., Baccarani, C., & Mascherpa, V. (2018). Lean production, Toyota Production System and Kaizen philosophy. The TQM Journal, 30(4), 425-438. doi:10.1108/tqm-12-2017-0178Garcia, J. A. M., Sabater, J. J. G., & Bonavia, T. (2009). The impact of Kaizen Events on improving the performance of automotive components’ first-tier suppliers. 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The Jak2 Pathway Is Activated In Idiopathic Pulmonary Fibrosis

Background: Idiopathic pulmonary fibrosis (IPF) is the most rapidly progressive and fatal fibrotic disorder, with no curative therapies. The signal transducer and activator of transcription 3 (STAT3) protein is activated in lung fibroblasts and alveolar type II cells (ATII), thereby contributing to lung fibrosis in IPF. Although activation of Janus kinase 2 (JAK2) has been implicated in proliferative disorders, its role in IPF is unknown. The aim of this study was to analyze JAK2 activation in IPF, and to determine whether JAK2/STAT3 inhibition is a potential therapeutic strategy for this disease. Methods and results: JAK2/p-JAK2 and STAT3/pSTAT3 expression was evaluated using quantitative real time-PCR, western blotting, and immunohistochemistry. Compared to human healthy lung tissue (n = 10) both proteins were upregulated in the lung tissue of IPF patients (n = 12). Stimulating primary ATII and lung fibroblasts with transforming growth factor beta 1 or interleukin (IL)-6/IL-13 activated JAK2 and STAT3, inducing epithelial to mesenchymal and fibroblast to myofibroblast transitions. Dual p-JAK2/p-STAT3 inhibition with JSI-124 or silencing of JAK2 and STAT3 genes suppressed ATII and the fibroblast to myofibroblast transition, with greater effects than the sum of those obtained using JAK2 or STAT3 inhibitors individually. Dual rather than single inhibition was also more effective for inhibiting fibroblast migration, preventing increases in fibroblast senescence and Bcl-2 expression, and ameliorating impaired autophagy. In rats administered JSI-124, a dual inhibitor of p-JAK2/p-STAT3, at a dose of 1 mg/kg/day, bleomycin-induced lung fibrosis was reduced and collagen deposition in the lung was inhibited, as were JAK2 and STAT3 activation and several markers of fibrosis, autophagy, senescence, and anti-apoptosis. Conclusions: JAK2 and STAT3 are activated in IPF, and their dual inhibition may be an attractive strategy for treating this disease

The U.S. Integrated Ocean Observing System: Governance Milestones and Lessons From Two Decades of Growth

Reflecting on two decades of the U.S. Integrated Ocean Observing System (IOOS) is particularly timely during the OceanObs'19 meeting. Over the past twenty years since the first OceanObs meeting was convened, U.S. IOOS has advanced from regional proofs of concept to a national, sustained enterprise. U.S. IOOS has grown to include 17 Federal partners and 11 Regional Associations (RAs) that implement regional observing systems covering all U.S. coasts and Great Lakes with activities spanning from head of tide to the U.S. exclusive economic zone (EEZ). The National Oceanographic and Atmospheric Administration (NOAA), as lead agency, provides guidance and national-level coordination. An interagency body, the Integrated Ocean Observation Committee (IOOC), communicates across federal agencies and ensures IOOS maintains strong connections to the Global Ocean Observing System (GOOS). Additionally, a federal advisory committee, non-federal association, and various informal partnerships further inform and advance the IOOS enterprise. This governance structure fosters both national consistency, regional flexibility, and global contributions addressing the diverse needs of U.S. coastal and Great Lakes stakeholders

Using present-day observations to detect when anthropogenic change forces surface ocean carbonate chemistry outside preindustrial bounds

© The Author(s), 2016. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Biogeosciences 13 (2016): 5065-5083, doi:10.5194/bg-13-5065-2016.One of the major challenges to assessing the impact of ocean acidification on marine life is detecting and interpreting long-term change in the context of natural variability. This study addresses this need through a global synthesis of monthly pH and aragonite saturation state (Ωarag) climatologies for 12 open ocean, coastal, and coral reef locations using 3-hourly moored observations of surface seawater partial pressure of CO2 and pH collected together since as early as 2010. Mooring observations suggest open ocean subtropical and subarctic sites experience present-day surface pH and Ωarag conditions outside the bounds of preindustrial variability throughout most, if not all, of the year. In general, coastal mooring sites experience more natural variability and thus, more overlap with preindustrial conditions; however, present-day Ωarag conditions surpass biologically relevant thresholds associated with ocean acidification impacts on Mytilus californianus (Ωarag < 1.8) and Crassostrea gigas (Ωarag < 2.0) larvae in the California Current Ecosystem (CCE) and Mya arenaria larvae in the Gulf of Maine (Ωarag < 1.6). At the most variable mooring locations in coastal systems of the CCE, subseasonal conditions approached Ωarag =  1. Global and regional models and data syntheses of ship-based observations tended to underestimate seasonal variability compared to mooring observations. Efforts such as this to characterize all patterns of pH and Ωarag variability and change at key locations are fundamental to assessing present-day biological impacts of ocean acidification, further improving experimental design to interrogate organism response under real-world conditions, and improving predictive models and vulnerability assessments seeking to quantify the broader impacts of ocean acidification.The CO2 and ocean acidification observations were funded by NOAA’s Climate Observation Division (COD) in the Climate Program Office and NOAA’s Ocean Acidification Program. The maintenance of the Stratus and WHOTS Ocean Reference Stations were also supported by NOAA COD (NA09OAR4320129). Additional support for buoy equipment, maintenance, and/or ancillary measurements was provided by NOAA through the US Integrated Ocean Observing System office: for the La Parguera buoy under a Cooperative Agreement (NA11NOS0120035) with the Caribbean Coastal Ocean Observing System, for the Chá b˘a buoy under a Cooperative Agreement (NA11NOS0120036) with the Northwest Association of Networked Ocean Observing System, for the Gray’s Reef buoy under a Cooperative Agreement (NA11NOS0120033) with the Southeast Coastal Ocean Observing Regional Association, and for the Gulf of Main buoy under a Cooperative Agreement (NA11NOS0120034) with the Northeastern Regional Association of Coastal and Ocean Observing Systems

Autonomous and Lagrangian ocean observations for Atlantic tropical cyclone studies and forecasts

Author Posting. © The Oceanography Society, 2017. This article is posted here by permission of The Oceanography Society for personal use, not for redistribution. The definitive version was published in Oceanography 30, no. 2 (2017): 92–103, doi:10.5670/oceanog.2017.227.The tropical Atlantic basin is one of seven global regions where tropical cyclones (TCs) commonly originate, intensify, and affect highly populated coastal areas. Under appropriate atmospheric conditions, TC intensification can be linked to upper-ocean properties. Errors in Atlantic TC intensification forecasts have not been significantly reduced during the last 25 years. The combined use of in situ and satellite observations, particularly of temperature and salinity ahead of TCs, has the potential to improve the representation of the ocean, more accurately initialize hurricane intensity forecast models, and identify areas where TCs may intensify. However, a sustained in situ ocean observing system in the tropical North Atlantic Ocean and Caribbean Sea dedicated to measuring subsurface temperature, salinity, and density fields in support of TC intensity studies and forecasts has yet to be designed and implemented. Autonomous and Lagrangian platforms and sensors offer cost-effective opportunities to accomplish this objective. Here, we highlight recent efforts to use autonomous platforms and sensors, including surface drifters, profiling floats, underwater gliders, and dropsondes, to better understand air-sea processes during high-wind events, particularly those geared toward improving hurricane intensity forecasts. Real-time data availability is key for assimilation into numerical weather forecast models.The NOAA/AOML component of this work was originally funded by the Disaster Relief Appropriations Act of 2013, also known as the Sandy Supplemental, and is currently funded through NOAA research grant NA14OAR4830103 by AOML and CARICOOS, as well as NOAA’s Integrated Ocean Observing System (IOOS). The TEMPESTS component of this work is supported by NOAA through the Cooperative Institute for the North Atlantic Region (NA13OAR4830233) with additional analysis support from the WHOI Summer Student Fellowship Program, Nortek Student Equipment Grant, and the Rutgers University Teledyne Webb Graduate Student Fellowship Program. The drifter component of this work is funded through NOAA grant NA15OAR4320071(11.432) in support of the Global Drifter Program

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio