Improving the registration process in a healthcare facility with lean principles

Purpose: Process improvement in service industries, like the registration process in a hospital, can be achieved with the application of lean principles. In this specific case, lean principles were essential to analyze and improve patient satisfaction in a hospital in Montana. The clinics involved in the study included pediatrics (P), internal medicine (IM), and cardiology/pulmonary (CP). The purpose of this study was to address difficulties regarding patient satisfaction on the registration and check-in processes. Design/methodology/approach: Direct observations and patient surveys were initially made to understand the processes and identify the initial causes of dissatisfaction. A value stream map (VSM) was then used to further break down the patient flow’s complexity. A Fishbone diagram and a Concept Map were completed to find the root of the dissatisfaction. Findings: The information obtained from the lean tools showed that patients questioned the need for having a central registration in combination with the check-in process when this combination generates duplications of steps that cause unwanted delays. Several recommendations were explored by the engineering team to mitigate these delays and improve the registration process reducing the number of patients complaints by 40%. Practical implications: This project illustrated the application of lean principles to resolve issues regarding a central registration format in a healthcare facility. Originality/value: A Concept Map was used as a tool to help the organization develop creative and new ways of looking at and solving process deficienciesPeer Reviewe

Machine learning for ecosystem services

Recent developments in machine learning have expanded data-driven modelling (DDM) capabilities, allowing artificial intelligence to infer the behaviour of a system by computing and exploiting correlations between observed variables within it. Machine learning algorithms may enable the use of increasingly available ‘big data’ and assist applying ecosystem service models across scales, analysing and predicting the flows of these services to disaggregated beneficiaries. We use the Weka and ARIES software to produce two examples of DDM: firewood use in South Africa and biodiversity value in Sicily, respectively. Our South African example demonstrates that DDM (64–91% accuracy) can identify the areas where firewood use is within the top quartile with comparable accuracy as conventional modelling techniques (54–77% accuracy). The Sicilian example highlights how DDM can be made more accessible to decision makers, who show both capacity and willingness to engage with uncertainty information. Uncertainty estimates, produced as part of the DDM process, allow decision makers to determine what level of uncertainty is acceptable to them and to use their own expertise for potentially contentious decisions. We conclude that DDM has a clear role to play when modelling ecosystem services, helping produce interdisciplinary models and holistic solutions to complex socio-ecological issues

Tumor Repression of VCaP Xenografts by a Pyrrole-Imidazole Polyamide

Pyrrole-imidazole (Py-Im) polyamides are high affinity DNA-binding small molecules that can inhibit protein-DNA interactions. In VCaP cells, a human prostate cancer cell line overexpressing both AR and the TMPRSS2-ERG gene fusion, an androgen response element (ARE)-targeted Py-Im polyamide significantly downregulates AR driven gene expression. Polyamide exposure to VCaP cells reduced proliferation without causing DNA damage. Py-Im polyamide treatment also reduced tumor growth in a VCaP mouse xenograft model. In addition to the effects on AR regulated transcription, RNA-seq analysis revealed inhibition of topoisomerase-DNA binding as a potential mechanism that contributes to the antitumor effects of polyamides in cell culture and in xenografts. These studies support the therapeutic potential of Py-Im polyamides to target multiple aspects of transcriptional regulation in prostate cancers without genotoxic stress

Basidiomycete DyPs: Genomic diversity, structural–functional aspects, reaction mechanism and environmental significance

The first enzyme with dye-decolorizing peroxidase (DyP) activity was described in 1999 from an arthroconidial culture of the fungus Bjerkandera adusta. However, the first DyP sequence had been deposited three years before, as a peroxidase gene from a culture of an unidentified fungus of the family Polyporaceae (probably Irpex lacteus). Since the first description, fewer than ten basidiomycete DyPs have been purified and characterized, but a large number of sequences are available from genomes. DyPs share a general fold and heme location with chlorite dismutases and other DyP-type related proteins (such as Escherichia coli EfeB), forming the CDE superfamily. Taking into account the lack of an evolutionary relationship with the catalase-peroxidase superfamily, the observed heme pocket similarities must be considered as a convergent type of evolution to provide similar reactivity to the enzyme cofactor. Studies on the Auricularia auricula-judae DyP showed that high-turnover oxidation of anthraquinone type and other DyP substrates occurs via long-range electron transfer from an exposed tryptophan (Trp377, conserved in most basidiomycete DyPs), whose catalytic radical was identified in the H2O2-activated enzyme. The existence of accessory oxidation sites in DyP is suggested by the residual activity observed after site-directed mutagenesis of the above tryptophan. DyP degradation of substituted anthraquinone dyes (such as Reactive Blue 5) most probably proceeds via typical one-electron peroxidase oxidations and product breakdown without a DyP-catalyzed hydrolase reaction. Although various DyPs are able to break down phenolic lignin model dimers, and basidiomycete DyPs also present marginal activity on nonphenolic dimers, a significant contribution to lignin degradation is unlikely because of the low activity on high redox-potential substratesThis work was supported by the INDOX (KBBE-2013-7-613549; www.indoxproject.eu) European project, the BIO2011-26694 (HIPOP) and CTQ2013-48287 projects of the Spanish Ministry of Economy and Competitiveness (MINECO), and the PRIN 2009-STNWX3 project of the Italian Ministry of Education, University and Research (MIUR). FJR-D thanks a Ramón y Cajal contract of MINECO. The authors thank Verónica Sáez-Jiménez for data on Reactive Blue 5 decolorization by VP and its heme-channel variants.Peer ReviewedPostprint (published version

Consistent phenological shifts in the making of a biodiversity hotspot: the Cape flora

Background The best documented survival responses of organisms to past climate change on short (glacial-interglacial) timescales are distributional shifts. Despite ample evidence on such timescales for local adaptations of populations at specific sites, the long-term impacts of such changes on evolutionary significant units in response to past climatic change have been little documented. Here we use phylogenies to reconstruct changes in distribution and flowering ecology of the Cape flora - South Africa's biodiversity hotspot - through a period of past (Neogene and Quaternary) changes in the seasonality of rainfall over a timescale of several million years. Results Forty-three distributional and phenological shifts consistent with past climatic change occur across the flora, and a comparable number of clades underwent adaptive changes in their flowering phenology (9 clades; half of the clades investigated) as underwent distributional shifts (12 clades; two thirds of the clades investigated). Of extant Cape angiosperm species, 14-41% have been contributed by lineages that show distributional shifts consistent with past climate change, yet a similar proportion (14-55%) arose from lineages that shifted flowering phenology. Conclusions Adaptive changes in ecology at the scale we uncover in the Cape and consistent with past climatic change have not been documented for other floras. Shifts in climate tolerance appear to have been more important in this flora than is currently appreciated, and lineages that underwent such shifts went on to contribute a high proportion of the flora's extant species diversity. That shifts in phenology, on an evolutionary timescale and on such a scale, have not yet been detected for other floras is likely a result of the method used; shifts in flowering phenology cannot be detected in the fossil record

Development of a Kemp\u27s Ridley Sea Turtle Stock Assessment Model

We developed a Kemp’s ridley (Lepidochelys kempii) stock assessment model to evaluate the relative contributions of conservation efforts and other factors toward this critically endangered species’ recovery. The Kemp’s ridley demographic model developed by the Turtle Expert Working Group (TEWG) in 1998 and 2000 and updated for the binational recovery plan in 2011 was modified for use as our base model. The TEWG model uses indices of the annual reproductive population (number of nests) and hatchling recruitment to predict future annual numbers of nests on the basis of a series of assumptions regarding age and maturity, remigration interval, sex ratios, nests per female, juvenile mortality, and a putative ‘‘turtle excluder device effect’’ multiplier starting in 1990. This multiplier was necessary to fit the number of nests observed in 1990 and later. We added the effects of shrimping effort directly, modified by habitat weightings, as a proxy for all sources of anthropogenic mortality. Additional data included in our model were incremental growth of Kemp’s ridleys marked and recaptured in the Gulf of Mexico, and the length frequency of stranded Kemp’s ridleys. We also added a 2010 mortality factor that was necessary to fit the number of nests for 2010 and later (2011 and 2012). Last, we used an empirical basis for estimating natural mortality, on the basis of a Lorenzen mortality curve and growth estimates. Although our model generated reasonable estimates of annual total turtle deaths attributable to shrimp trawling, as well as additional deaths due to undetermined anthropogenic causes in 2010, we were unable to provide a clear explanation for the observed increase in the number of stranded Kemp’s ridleys in recent years, and subsequent disruption of the species’ exponential growth since the 2009 nesting season. Our consensus is that expanded data collection at the nesting beaches is needed and of high priority, and that 2015 be targeted for the next stock assessment to evaluate the 2010 event using more recent nesting and in-water data

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

The Household Water Insecurity Experiences (HWISE) Scale: comparison scores from 27 sites in 22 countries

Abstract Household survey data from 27 sites in 22 countries were collected in 2017–2018 in order to construct and validate a cross-cultural household-level water insecurity scale. The resultant Household Water Insecurity Experiences (HWISE) scale presents a useful tool for monitoring and evaluating water interventions as a complement to traditional metrics used by the development community. It can also help track progress toward achievement of Sustainable Development Goal 6 ‘clean water and sanitation for all’. We present HWISE scale scores from 27 sites as comparative data for future studies using the HWISE scale in low- and middle-income contexts. Site-level mean scores for HWISE-12 (scored 0–36) ranged from 1.64 (SD 4.22) in Pune, India, to 20.90 (7.50) in Cartagena, Colombia, while site-level mean scores for HWISE-4 (scored 0–12) ranged from 0.51 (1.50) in Pune, India, to 8.21 (2.55) in Punjab, Pakistan. Scores tended to be higher in the dry season as expected. Data from this first implementation of the HWISE scale demonstrate the diversity of water insecurity within and across communities and can help to situate findings from future applications of this tool

Mature Andean forests as globally important carbon sinks and future carbon refuges

It is largely unknown how South America’s Andean forests affect the global carbon cycle, and thus regulate climate change. Here, we measure aboveground carbon dynamics over the past two decades in 119 monitoring plots spanning a range of >3000 m elevation across the subtropical and tropical Andes. Our results show that Andean forests act as strong sinks for aboveground carbon (0.67 ± 0.08 Mg C ha−1 y−1) and have a high potential to serve as future carbon refuges. Aboveground carbon dynamics of Andean forests are driven by abiotic and biotic factors, such as climate and size-dependent mortality of trees. The increasing aboveground carbon stocks offset the estimated C emissions due to deforestation between 2003 and 2014, resulting in a net total uptake of 0.027 Pg C y−1. Reducing deforestation will increase Andean aboveground carbon stocks, facilitate upward species migrations, and allow for recovery of biomass losses due to climate change.Fil: Duque, Alvaro. Universidad Nacional de Colombia; ColombiaFil: Peña, Miguel A.. Universidad Nacional de Colombia; ColombiaFil: Cuesta, Francisco. Universidad de Las Américas; EcuadorFil: González Caro, Sebastián. Universidad Nacional de Colombia; ColombiaFil: Kennedy, Peter. University of Minnesota; Estados UnidosFil: Phillips, Oliver L.. University of Leeds; Reino UnidoFil: Calderón Loor, Marco. Universidad de Las Américas; EcuadorFil: Blundo, Cecilia Mabel. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional; ArgentinaFil: Carilla, Julieta. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional; ArgentinaFil: Cayola, Leslie. Missouri Botanical Garden; Estados UnidosFil: Farfán Ríos, William. Washington University in St. Louis; Estados UnidosFil: Fuentes, Alfredo. Missouri Botanical Garden; Estados UnidosFil: Grau, Hector Ricardo. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional; ArgentinaFil: Homeier, Jürgen. Universität Göttingen; AlemaniaFil: Loza-Rivera, María I.. Missouri Botanical Garden; Estados UnidosFil: Malhi, Yadvinder. University of Oxford; Reino UnidoFil: Malizia, Agustina. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional; ArgentinaFil: Malizia, Lucio Ricardo. Universidad Nacional de Jujuy; ArgentinaFil: Martínez Villa, Johanna A.. Université du Québec a Montreal; CanadáFil: Myers, Jonathan A.. Washington University in St. Louis; Estados UnidosFil: Osinaga Acosta, Oriana. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional; ArgentinaFil: Peralvo, Manuel. No especifíca;Fil: Pinto, Esteban. No especifíca;Fil: Saatchi, Sassan. Jet Propulsion Laboratory; Estados UnidosFil: Silman, Miles. Center For Energy, Environment And Sustainability; Estados UnidosFil: Tello, J. Sebastián. Missouri Botanical Garden; Estados UnidosFil: Terán Valdez, Andrea. No especifíca;Fil: Feeley, Kenneth J.. University of Miami; Estados Unido

Mature Andean forests as globally important carbon sinks and future carbon refuges

It is largely unknown how South America’s Andean forests affect the global carbon cycle, and thus regulate climate change. Here, we measure aboveground carbon dynamics over the past two decades in 119 monitoring plots spanning a range of >3000 m elevation across the subtropical and tropical Andes. Our results show that Andean forests act as strong sinks for aboveground carbon (0.67 ± 0.08 Mg C ha−1 y−1) and have a high potential to serve as future carbon refuges. Aboveground carbon dynamics of Andean forests are driven by abiotic and biotic factors, such as climate and size-dependent mortality of trees. The increasing aboveground carbon stocks offset the estimated C emissions due to deforestation between 2003 and 2014, resulting in a net total uptake of 0.027 Pg C y−1. Reducing deforestation will increase Andean aboveground carbon stocks, facilitate upward species migrations, and allow for recovery of biomass losses due to climate change.Fil: Duque, Alvaro. Universidad Nacional de Colombia; ColombiaFil: Peña, Miguel A.. Universidad Nacional de Colombia; ColombiaFil: Cuesta, Francisco. Universidad de Las Américas; EcuadorFil: González Caro, Sebastián. Universidad Nacional de Colombia; ColombiaFil: Kennedy, Peter. University of Minnesota; Estados UnidosFil: Phillips, Oliver L.. University of Leeds; Reino UnidoFil: Calderón Loor, Marco. Universidad de Las Américas; EcuadorFil: Blundo, Cecilia Mabel. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional; ArgentinaFil: Carilla, Julieta. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional; ArgentinaFil: Cayola, Leslie. Missouri Botanical Garden; Estados UnidosFil: Farfán Ríos, William. Washington University in St. Louis; Estados UnidosFil: Fuentes, Alfredo. Missouri Botanical Garden; Estados UnidosFil: Grau, Hector Ricardo. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional; ArgentinaFil: Homeier, Jürgen. Universität Göttingen; AlemaniaFil: Loza-Rivera, María I.. Missouri Botanical Garden; Estados UnidosFil: Malhi, Yadvinder. University of Oxford; Reino UnidoFil: Malizia, Agustina. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional; ArgentinaFil: Malizia, Lucio Ricardo. Universidad Nacional de Jujuy; ArgentinaFil: Martínez Villa, Johanna A.. Université du Québec a Montreal; CanadáFil: Myers, Jonathan A.. Washington University in St. Louis; Estados UnidosFil: Osinaga Acosta, Oriana. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional; ArgentinaFil: Peralvo, Manuel. No especifíca;Fil: Pinto, Esteban. No especifíca;Fil: Saatchi, Sassan. Jet Propulsion Laboratory; Estados UnidosFil: Silman, Miles. Center For Energy, Environment And Sustainability; Estados UnidosFil: Tello, J. Sebastián. Missouri Botanical Garden; Estados UnidosFil: Terán Valdez, Andrea. No especifíca;Fil: Feeley, Kenneth J.. University of Miami; Estados Unido