Integrating Lean Six Sigma and discrete-event simulation for shortening the appointment lead-time in gynecobstetrics departments: a case study

Long waiting time to appointment may be a worry for pregnant women, particularly those who need perinatology consultation since it could increase anxiety and, in a worst case scenario, lead to an increase in fetal, infant, and maternal mortality. Treatment costs may also increase since pregnant women with diverse pathologies can develop more severe complications. As a step towards improving this process, we propose a methodological approach to reduce the appointment lead-time in outpatient gynecobstetrics departments. This framework involves combining the Six Sigma method to identify defects in the appointment scheduling process with a discrete-event simulation (DES) to evaluate the potential success of removing such defects in simulation before we resort to changing the real-world healthcare system. To do these, we initially characterize the gynecobstetrics department using a SIPOC diagram. Then, six sigma performance metrics are calculated to evaluate how well the department meets the government target in relation to the appointment lead-time. Afterwards, a cause-and-effect analysis is undertaken to identify potential causes of appointment lead-time variation. These causes are later validated through ANOVA, regression analysis, and DES. Improvement scenarios are next designed and pretested through computer simulation models. Finally, control plans are deployed to maintain the results achieved through the implementation of the DES-Six sigma approach. The aforementioned framework was validated in a public gynecobstetrics outpatient department. The results revealed that mean waiting time decreased from 6.9 days to 4.1 days while variance passed from 2.46 days2 to 1.53 days2

Rings in the Solar System: a short review

Rings are ubiquitous around giant planets in our Solar System. They evolve jointly with the nearby satellite system. They could form either during the giant planet formation process or much later, as a result of large scale dynamical instabilities either in the local satellite system, or at the planetary scale. We review here the main characteristics of rings in our solar system, and discuss their main evolution processes and possible origin. We also discuss the recent discovery of rings around small bodies.Comment: Accepted for the Handbook of Exoplanet

2016 Philippine Climate Change Assessment (PhilCCA): The Physical Science Basis

This initial assessment of the state of climate change science in the Philippines indicates that climate science in the country is still in its infancy. This report identifies many areas that need further examination, such as the influence of large-scale climate drivers (e.g., ENSO, the Madden-Julian Oscillation, the Pacific Decadal Oscillation) on Philippine climate, the effect of sea level rise on saltwater intrusion and storm surges along coastal areas, and local climate impacts of aerosols and land use change, as well as their interaction with the enhanced greenhouse effect

Genetic characterization by amplified fragment length polymorphism (AFLP) markers and morphochemical traits of Carica papaya L. genotypes

Carica papaya L. is a native fruit from Central America and Mexico and it is an economically important fruit. As a pre-breeding genetic study, the variability of both parents (L7 and M22) and the F1 individuals derived from their crosses (L7 × M22), was evaluated in terms of 32 morphochemical traits, and contrasted with their genetic diversity indicated by amplified fragment length polymorphism (AFLP) markers. According to morphochemical traits, L7 and M22 were grouped in two different clades. The first group included L7 and 13 genotypes from the F1, while a second group included the parent M22 and 15 other genotypes from the F1 progeny. The analysis based on morphochemical traits showed an average correlation of 0.652 among genotypes. For AFLP analysis the combination of the primers E-ACA/M-CTA had the best polymorphic index (72.73%). When they were grouped based on AFLPs markers, it was confirmed that both parents are genetically distant, and they were again grouped in two different clades. Five genotypes from the F1 population were grouped in the same clade as L7 and shared 55% similarity. Twenty six genotypes were grouped in the same clade as M22, showing 63.3% similarity. Another 12 genotypes (mainly female genotypes) were grouped in a third independent clade. This relative general agreement between the grouping based on a large number of morphochemical traits (including both plant and fruit traits) and that based on its genetic diversity using AFLPs, suggests that morphochemical characterization, together with genetic analysis by AFLPs, can be complementary and useful techniques for the identification and assessment of genetic diversity within C. papaya L. genotypes, that should be useful for genetic breeding programs of this important species.Key words: Morphological markers, AFLP markers, genetic similarity, Carica papaya L

Applying multi-phase DES approach for modelling the patient journey through accident and emergency departments

Accident and Emergency departments (A&ED) are in charge of providing access to patients requiring urgent acute care. A&ED are difficult to model due to the presence of interactions, different pathways and the multiple outcomes that patients may undertake depending on their health status. In addition, public concern has focused on the presence of overcrowding, long waiting times, patient dissatisfaction and cost overruns associated with A&ED. There is then a need for tackling these problems through developing integrated and explicit models supporting healthcare planning. However, the studies directly concentrating on modelling the A&EDs are largely limited. Therefore, this paper presents the use of a multi-phase DES framework for modelling the A&ED and facilitating the assessment of potential improvement strategies. Initially, the main components, critical variables and different states of the A&ED are identified to correctly model the entire patient journey. In this step, it is also necessary to characterize the demand in order to categorize the patients into pipelines. After this, a discrete-event simulation (DES) model is developed. Then, validation is conducted through the 2-sample t test to demonstrate whether the model is statistically comparable with the real-world A&ED department. This is followed by the use of Markov phase-type models for calculating the total costs of the whole system. Finally, various scenarios are explored to assess their potential impact on multiple outcomes of interest. A case study of a mixed-patient environment in a private A&E department is provided to validate the effectiveness of the multi-phase DES approach

Using an Indoor Localization System for Activity Recognition

Recognizing the activity performed by users is importantin many application domains, from e-health to home automation. Thispaper explores the use of a fine-grained indoor localization system, basedon ultra-wideband, for activity recognition. The user is supposed to weara number of active tags. The position of active tags is first determinedwith respect to the space where the user is moving, then some position-independent metrics are estimated and given as input to a previouslytrained system. Experimental results show that accuracy values as highas∼95% can be obtained when using a personalized model

Patent Human Infections with the Whipworm, Trichuris trichiura, Are Not Associated with Alterations in the Faecal Microbiota

Background: The soil-transmitted helminth (STH), Trichuris trichiura colonises the human large intestine where it may modify inflammatory responses, an effect possibly mediated through alterations in the intestinal microbiota. We hypothesised that patent T. trichiura infections would be associated with altered faecal microbiota and that anthelmintic treatment would induce a microbiota resembling more closely that observed in uninfected individuals. Materials and Methods: School children in Ecuador were screened for STH infections and allocated to 3 groups: uninfected, T. trichiura only, and mixed infections with T. trichiura and Ascaris lumbricoides. A sample of uninfected children and those with T. trichiura infections only were given anthelmintic treatment. Bacterial community profiles in faecal samples were studied by 454 pyrosequencing of 16 S rRNA genes. Results: Microbiota analyses of faeces were done for 97 children: 30 were uninfected, 17 were infected with T. trichiura, and 50 with T. trichiura and A. lumbricoides. Post-treatment samples were analyzed for 14 children initially infected with T. trichiura alone and for 21 uninfected children. Treatment resulted in 100% cure of STH infections. Comparisons of the microbiota at different taxonomic levels showed no statistically significant differences in composition between uninfected children and those with T. trichiura infections. We observed a decreased proportional abundance of a few bacterial genera from the Clostridia class of Firmicutes and a reduced bacterial diversity among children with mixed infections compared to the other two groups, indicating a possible specific effect of A. lumbricoides infection. Anthelmintic treatment of children with T. trichiura did not alter faecal microbiota composition. Discussion: Our data indicate that patent human infections with T. trichiura may have no effect on faecal microbiota but that A. lumbricoides colonisation might be associated with a disturbed microbiota. Our results also catalogue the microbiota of rural Ecuadorians and indicate differences with individuals from more urban industrialised societies