DMAIC for process digitalization: a hospital case study

Purpose - This paper presents how to implement the DMAIC cycle as an element to X-ray the progress of a digitalization initiative focused on the ambulance's request system for daily transport of patients initiated in a Portuguese hospital, which was not achieving the expected results. The research has the goal of not only contributing to the literature on the application of the Lean Six Sigma methodology to healthcare operations but also, of giving practical recommendations on how managers can leverage on the same approach, and apply the concept in their internal process improvement initiatives to reduce friction in digitalized processes. Ultimately, it is shown how a methodology like DMAIC, presents in itself a great option to start and methodically lead a business process digitalization project. Methodology - The authors chose to follow an Action Research methodology while approaching the problem at stake with the DMAIC framework. Findings - DMAIC can be a relevant problem-solving structure to measure the success and support the digitalization of business processes. Originality - The originality of this paper lies in the application of a logical structure such as the DMAIC cycle to analyze the quality issues inherent to the digital version of an ambulance's request system. Practical implications - This case study depicts how the operationalization of digitalization initiatives using the DMAIC framework can be more effective while allowing organizations to adequately and actively react to the implementation problems. It presents improvements of 23% lower lead times for a redesigned digitalized ambulance's request system.(undefined

Tailoring TcT_c by symmetry principles: The concept of Superconducting Fitness

We propose a generalization of the concept of superconducting fitness, which allows us to make statements analogous to Anderson's theorems concerning the stability of different superconducting states. This concept can be applied to complex materials with several orbital, layer, sublattice or valley degrees of freedom. The superconducting fitness parameters $F_A(\bf{k})$ and $F_C(\bf{k})$ give a direct measure of the robustness of the weak coupling instability and of the presence of detrimental terms in the Hamiltonian, respectively. These two parameters can be employed as a guide to engineer normal state Hamiltonians in order to favour or suppress superconducting order parameters with different symmetries and topological properties. To illustrate the applicability and power of this concept we study three cases: the non-centrosymmetric heavy fermion $\text{CePt}_3\text{Si}$, the hole doped iron pnictide $\text{KFe}_2\text{As}_2$ and the doped topological insulator $\text{Cu}_x\text{Bi}_2\text{Se}_3$

Agentes infecciosos em ateromas coronarianos: um possível papel na patogênese da ruptura da placa e infarto agudo do miocárdio

In this review we report our recent findings of histopathological features of plaque instability and the association with Mycoplasma pneumoniae (MP) and Chlamydia pneumoniae (CP) infection, studying thrombosed coronary artery segments (CAS) of patients who died due to acute myocardial infarction. Vulnerable plaques are known to be associated with fat atheromas and inflammation of the plaque. Here we demonstrated that vulnerability is also related with focal positive vessel remodeling that maintains relatively well preserved lumen even in the presence of large atheromatous plaques. This phenomena may explain why the cinecoronariography may not detect large and dangerous vulnerable plaques. Greater amount of these bacteria in vulnerable plaques is associated with adventitial inflammation and positive vessel remodeling: the mean numbers of lymphocytes were significantly higher in adventitia than in the plaque, good direct correlation was obtained between numbers of CD20 B cells and numbers of CP infected cells in adventitia, and between % area of MP-DNA in the plaque and cross sectional area of the vessel, suggesting a cause-effect relationship. Mycoplasma is a bacterium that needs cholesterol for proliferation and may increase virulence of other infectious agents. In conclusion, co-infection by Mycoplasma pneumoniae and Chlamydia pneumoniae may represent an important co-factor for plaque instability, leading to coronary plaque thrombosis and acute myocardial infarction, since larger amount of these bacteria strongly correlated with histological signs of more vulnerability of the plaque. The search of CMV and Helicobacter pilori in these tissues resulted negative.Nesta revisão relatamos recentes achados nossos sobre aspectos histológicos de instabilidade da placa e a associação com Mycoplasma pneumoniae (MP) e Chlamydia pneumoniae (CP), estudando segmentos de artéria coronária trombosados de pacientes que faleceram por infarto agudo do miocárdio. Placas vulneráveis são conhecidas como sendo placas gordurosas e com inflamação. Aqui demonstramos que a vulnerabilidade está também relacionada com remodelamento positivo do vaso o qual pode preservar a luz do vaso mesmo na presença de uma placa de ateroma grande. Grande quantidade dessas bactérias em placas vulneráveis está associada a inflamação da adventícia e remodelamento positivo do vaso: o número médio de linfócitos foi significativamente maior na adventícia do que na placa, e boas correlações diretas foram obtidas entre os números médios de células B CD20 e os números de células infectadas por CP na adventícia, e entre as % de áreas positivas para MP na placa e as áreas em secção transversal dos respectivos vasos, sugerindo uma relação de causa - efeito entre esses agentes infecciosos e vulnerabilidade da placa. Micoplasma é uma bactéria que necessita colesterol para a proliferação e pode aumentar a virulência de outros agentes infecciosos. Em conclusão, co-infecção por Mycoplasma pneumoniae e Chlamydia pneumoniae pode representar um importante co-fator de instabilidade da placa, levando a trombose da placa coronariana e infarto agudo do miocárdio, pois a maior quantidade dessas bactérias mostrou forte correlação com sinais histológicos de maior vulnerabilidade da placa. A pesquisa nesses tecidos de CMV e Helicobacter pilori foi negativa

Fluctuations in a superconducting quantum critical point of multi-band metals

In multi-band metals quasi-particles arising from different atomic orbitals coexist at a common Fermi surface. Superconductivity in these materials may appear due to interactions within a band (intra-band) or among the distinct metallic bands (inter-band). Here we consider the suppression of superconductivity in the intra-band case due to hybridization. The fluctuations at the superconducting quantum critical point (SQCP) are obtained calculating the response of the system to a fictitious space and time dependent field, which couples to the superconducting order parameter. The appearance of superconductivity is related to the divergence of a generalized susceptibility. For a single band superconductor this coincides with the \textit{Thouless criterion}. For fixed chemical potential and large hybridization, the superconducting state has many features in common with breached pair superconductivity with unpaired electrons at the Fermi surface. The T=0 phase transition from the superconductor to the normal state is in the universality class of the density-driven Bose-Einstein condensation. For fixed number of particles and in the strong coupling limit, the system still has an instability to the normal sate with increasing hybridization.Comment: 10 pages, 8 figure

A different approach to real web accessibility

Accessibility is sometimes taken for granted, however for people with certain disabilities there are still a number of obstacles between them and the Information Society. At a time where the Information Society is becoming more and more important it is imperative to make sure that no one is left out. The web is becoming the centerpiece of this new information age; therefore if the sentence Information Society for All is to have any meaning then the web must be accessible to everyone. Nevertheless the web is turning into a showcase for designers and technology experts. Although this is pushing many people to the web it does drive some sectors away. People with specific disabilities, namely the blind community, find it harder and harder to read common web pages. This paper reports on a work on a talking browser showing some features that either are not yet widely implemented or, in some cases, have never been reported. Furthermore a new approach is presented, based on information extraction scripts for template urls, to provide real accessibility for blind users. This latter approach, although restricted to a small subset of the web by its nature, aims at giving blind users further views of a web page which will provide them with a clean extraction of the main information on a web page.Secretariado Nacional para a Reabilitação e Integração das Pessoas com Deficiência - Programa CITE IV

Percepción del estrés competitivo y cultura en futbolistas profesionales de Brasil y Portugal

The main purpose of this study was to compare how soccer players with different cultural backgrounds and a similar level of experience perceive the concept of stress. 18 Brazilian soccer players from the Brazilian National Team and 20 Portuguese players from the Portuguese National Team with mean of age 26.69 +- 4.1 and 26.05 +- 2.3 years were assessed using a Stress in Football Inventory. One trend was very clear. When items were assessed as being positive by both groups,the Brazilians tended to rate them in a significantly more positive way. Likewise, when items were negatively assessed by both groups, the Brazilians tended to assess them more negatively. What was perhaps most interesting was the high number of items that were assessed as having a totally opposite effect, with what was perceived by the Brazilians to be negative being seen as neutral or positive by the Portuguese. Cultural factors very probably explain the variance in perceptions of stress

NEFRECTOMIA PARCIAL – A EXPERIÊNCIA DE 10 ANOS DO HOSPITAL DE SANTO ANTÓNIO

A nefrectomia parcial (NP) é uma técnica reconhecida no tratamento de diferentes patologias renais,nomedamente na oncológica. Os autores apresentam a sua casuística dos últimos 10 anos, com avaliação dos índices de recorrência e sobrevivência

Trends in ischemic heart disease and stroke death ratios in brazilian women and men

OBJECTIVE: Cardiovascular diseases are the main cause of death in women and men in Brazil, but the trends for the death ratios for ischemic heart disease and stroke in women and men remain unknown. METHOD: In this study, the trends for the death ratios among women and men who were over 30 years of age were analyzed from 1980 to 2005. Data were collected for both the Brazilian population and the metropolitan area of São Paulo. Estimates of the population size and data for mortality were then obtained from the Brazilian Institute of Geography and Statistics and the Ministry of Health. The risk for death was adjusted using a direct method. RESULTS: Death rates due to cardiovascular disease, ischemic heart disease, and stroke have declined in both Brazil and the metropolitan region of São Paulo. A linear regression analysis revealed a similar trend for ischemic heart disease and demonstrated a male/female ratio of 1.653 ± 0.001 (r=0.228; p=0.262) in Brazil and 1.763 ± 0.008 (r=0.863;

A dynamic approach to teaching LSS at universities

Alongside the European Students of Industrial Engineering and Management (ESTIEM) a team of students from the University of Minho, in cooperation with a corporate partner, developed a free and scalable Lean Six Sigma (LSS) Green-Belt level course for Engineering students. Purpose: The authors aim to depict how free access to LSS Green-Belt knowledge before graduation can positively impact both engineering education and the students when in real-life projects. The purpose is not to build on existing literature, but to provide a practical teaching structure. Methodology: The authors chose to follow the hypothetico-deductive method which consists of formulating hypotheses and comparing them with real-life brought up from their personal experiences while teaching the course. Findings: This case study found a positive impact on both the students responsible for facilitating the training sessions, as well as the ones receiving practical and theoretical knowledge. With more than 60 course graduates, this model is generating positive results in growing awareness for LSS methods. Practical implications: This paper describes a practical application of a novel approach to teaching LSS in Universities along the obstacles surpassed to design it, blending it in the course curricula. It aims to foster similar implementations in other institutions. Originality: A teaching system built with students for students is scalable, low-cost, and highly engaging. Its deployment not only shows how it is possible to advance education by blending an existing LSS course structure but also how students can greatly benefit from a deeper LSS knowledge before their graduation.(undefined