Designing lean value streams in the fourth industrial revolution era: proposition of technology-integrated guidelines

Despite the envisioned interrelations, the way Industry 4.0 (I4.0) technologies can influence the design and implementation of lean value streams is still unknown and little empirical evidence is found in the literature. This article aims at proposing guidelines integrated with I4.0 technologies for designing lean value streams. We gathered experts’ opinions regarding the relationship between guidelines for designing a lean value stream and I4.0 technologies. The identification of the most important relationships provided arguments for the proposition of enhanced guidelines for designing lean value streams within the Fourth Industrial Revolution context. The integration of I4.0 technologies into the guidelines for designing a lean value stream raises a distinct approach that benefits from the simplicity and efficiency of Lean Production with ease and agility of the technologies typical of the Fourth Industrial Revolution. Such technology-integrated guidelines may allow overcoming existing barriers while lead companies to superior performance results

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Empirical Research to Integrate National Culture in the Design of Lean Systems

The focal point of this dissertation is to find the relevance that cultural difference at a societal level exercise on the design of lean systems as a strategic management practice, from the perspective of production operations involving the shop floor, support activities and management. A conceptual model derived from a thorough literature review provides the theoretical framework of the factors considered to affect the design of the lean practice, considering only human attributes such as individual competence and national culture.The analysis of culture as a determinant factor for the success and sustainability of lean systems has been a topic of recent interest; however, most of the focus has been placed on the organizational rather than the societal environment. As a Japanese Management System, the Lean Management Practice requires a contextualization process when implemented outside of the environment natural to the Japanese culture. An analysis of the relevance of factors is compared through a case study within two different societal contexts, considering the control variable the implementation of lean systems within an organization that has worked or implanted the Lean Management Practice. . A total of 152 subject responses were collected from this organization in two different facilities within the Americas: United States, and Mexico.The selected method for data collection is a questionnaire based on the proposed conceptual model factors. The useful sample responses for analysis consisted of 97 cases. The method of analysis is Partial Least Squares Structural Equation Modeling. The constructs were designed using three different methods, all with a starting point in Literature Review.The model was tested at a measurement and structural level for their reliability, convergent validity and discriminant validity and predictability, as corresponded to the type of model, based on established criterion. Mediation analysis was conducted to test whether cultural dimensions influence the relationship (path linkages) between the factors. Multi-Group Analysis (MGA) was conducted to test whether there is a difference in influence of cultural dimensions between the nationalities in the study. Results demonstrated that there are significant differences of national culture among the locations sampled for validation, though mediation effects were not significant

Uso del modelado de nicho ecológico como una herramienta para predecir la distribución potencial de Microcystis sp (cianobacteria) en la Presa Hidroeléctrica de Aguamilpa, Nayarit, México

El modelado de nicho ecológico es una herramienta importante para la evaluación de la distribución espacial de especies terrestres, sin embargo, su aplicabilidad ha sido poco explorada en el medio acuático. Microcystis sp., es una especie de cianobacteria con frecuencia conocida por la producción de toxinas del tipo microcistinas, cuya ingestión en altas concentraciones ocasiona la muerte de animales, desde pequeñas aves hasta el ganado. Como cualquier grupo taxonómico, ésta cianobacteria presenta umbrales ambientales, es decir; un nicho ecológico idóneo que va a delimitar su distribución. El presente estudio se realizó en la Presa Hidroeléctrica Aguamilpa, un ecosistema artificial que entró en operación en 1994. En este sistema se evaluó la distribución potencial de Microcystis sp., mediante la generación de un modelo de predicción basado en el concepto de nicho ecológico MAXENT; empleando un Modelo Digital de Elevación en celdas de 100 m x 100 m (1 ha) de resolución espacial y once variables físicas, químicas y biológicas del agua. La elaboración de los mapas de distribución, se realizó con ArcMap 9.2®. Los resultados indican que Microcystis sp., se distribuye principalmente en la cuenca alta del afluente del río Huaynamota, tanto en el estiaje frío, como en el cálido. Sin embargo, existe una menor probabilidad de encontrarla en todo el sistema de la presa durante el estiaje frío, mientras que durante el estiaje cálido también se localiza en la confluencia de ambos ríos. Para la época de lluvias no se tienen reportes de la presencia de ésta cianobacteria. Esta especie, generalmente está asociada a procesos tróficos derivados de la presencia de contaminantes de origen antropogénico. Las actividades humanas en la cuenca (por ejemplo, agricultura tradicional, ganadería, actividades industriales) y los escurrimientos, han afectado la distribución de Microcystis sp., dados los efectos deletéreos de la contaminación. Se requerirá atención en las áreas específicas que se han identificado en este trabajo, así como medidas de manejo y restauración de las cuencas. También se documenta una interacción entre fósforo y nitrógeno que determina la distribución de Microcystis sp. El modelado de nicho ecológico es una herramienta adecuada para la evaluación de la distribución espacial de microalgas en ambientes dulceacuícolas

Ecological niche model to predict the potential distribution of phytoplankton in the Aguamilpa Dam, Nayarit. Mexico

Phytoplankton species are an important basis of the food web for various systems such as pelagic, coastal and lake. Due to their photosynthetic capacity, this community is sensitive to changes in light availability, temperature, nutrient concentrations, herbivores consumption, parasitism and competition. Therefore, they show a high spatial and temporal variability related to environmental changes both natural and anthropogenic. However, as any taxonomic group, phytoplankton species have environmental thresholds, ecological niches that define their distribution. This study was located in Aguamilpa Dam, an artificial aquatic reservoir which started operations in 1994 for electric energy production. In this system the potential distribution of the phytoplankton was evaluated, where the highest species richness and restricted distribution areas were identified. Potential distribution models based on ecological niche definition were generated using ArcMap 9.2® with Maxent (Maximun Entropy Method). The development of distribution maps was carried out using Digital Elevation Models in cells of 100 m x 100 m (1 ha), based on nine physico-chemical and biological water parameters monitored in the reservoir. The highest species richness areas were found in the Huaynamota river tributary and at the station called La Confluencia, while the less abundance areas were found in the Santiago river tributary during warm and cold dry seasons with a great abundance of cyanophyta. During the rainfall season, the Huaynamota river tributary diversity areas were extended and the presence of some dominant species of cyanophyta were indentified. These species can be associated with trophic processes related to anthropogenic pollutants in the reservoir. This study illustrates the potential application of niche modeling approach in aquatic ecosystems

Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

BACKGROUND The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown.OBJECTIVES The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide.METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery.RESULTS Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing.CONCLUSIONS Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat