A Systems Approach to Healthcare Efficiency Improvement

AbstractHealthcare patient outcomes and healthcare costs, in the context of the healthcare delivery system, is a prominent societal issue for the U.S. Although improvements have been achieved, they are silo-centric, specific to a single area or discipline. It is clear that improvements need to be transferred across the healthcare delivery system in a broader sense. To that end, the ability to measure a change in the system is paramount in determining progress and in what parts of the system are impacted. The research work presented describes a case of how an Electronic Medical Record (EMR) system implementation can be measured within a systems or systems engineering context. In the first phase, time motion study has been employed to assess physician workflow. In this manner, data collection, analysis, and inferences elicited can be quickly assessed by subject matter experts for effectiveness. The objective of this collaborative work is that it demonstrates a systems engineering driven application of the improvement of an orthopaedic office that may then be generalized to a broader context. This works employs a phased approach which allows for synchronization between one set of tools or methodologies from one phase that inform and provide insight for the next. Additionally it facilitates an iterative effort as each phase will assess and reassess the key stakeholders and take into account the process/product life cycle thus allowing refinement of the previous phase and its results. The progression from one phase to another provides the means of measuring the progress and impact. The partnership between the Department of Orthopaedics and the Department of Systems and Industrial Engineering at the University of Arizona, provides a real-life setting for testing our hypotheses. All of the features described in this implementation make up a methodological framework that will render implications for engineers, physicians, patients, and policy makers

Trapezius transfer to treat flail shoulder after brachial plexus palsy

BACKGROUND: After severe brachial palsy involving the shoulder, many different muscle transfers have been advocated to restore movement and stability of the shoulder. Paralysis of the deltoid and supraspinatus muscles can be treated by transfer of the trapezius. METHODS: We treated 10 patients, 8 males and 2 females, by transfer of the trapezius to the proximal humerus. In 6 patients the C5 and C6 roots had been injuried; in one C5, C6 and C7 roots; and 3 there were complete brachial plexus injuries. Eight of the 10 had had neurosurgical repairs before muscle transfer. Their average age was 28.3 years (range 17 to 41), the mean delay between injury and transfer was 3.1 years (range 14 months to 6.3 years) and the average follow-up was 17.5 months (range 6 to 52), reporting the clinical and radiological results. Evaluation included physical and radiographic examinations. A modification of Mayer's transfer of the trapezius muscle was performed. The principal goal of this work was to evaluate the results of the trapezius transfer for flail shoulder after brachial plexus injury. RESULTS: All 10 patients had improved function with a decrease in instability of the shoulder. The average gain in shoulder abduction was 46.2°; the gain in shoulder flexion average 37.4°. All patients had stable shoulder (no subluxation of the humeral head on radiographs). CONCLUSION: Trapezius transfer for a flail shoulder after brachial plexus palsy can provide satisfactory function and stability

Selección de una máquina termoformadora mediante la aplicación de técnicas de decisión multicriterio. Análisis comparativo

Trabajo presentado al XVI Congreso Internacional de Ingeniería de Proyectos (AEIPRO), celebrado en Valencia (España) del 11 al 13 de julio de 2012.[EN]: In the present work a comparative study between different techniques of Multi-Criteria Decision Analysis (AHP / ANP TOPSIS and PROMETHEE) applied to the problem of selection of industrial machinery have been done. This is a complex decision-making problem because different economic and technical criteria have to be considered. The whole decision making process and to what extent the results obtained depend on the technique is analyzed. The work has focused on the case of selecting a thermoforming machine whose investment volume is approximately € 190,000.[ES]: En el presente trabajo se realiza un estudio comparativo entre diferentes técnicas de Análisis Multicriterio de Decisiones (AHP/ANP, PROMETHEE y TOPSIS) aplicadas al problema de selección de maquinaria industrial. Se trata de un problema de toma de decisiones complejo debido a que hay que tener en cuenta diferentes criterios de tipo económico y técnico. Se analiza todo el proceso de toma de decisiones y hasta qué punto los resultados obtenidos dependen de la técnica utilizada.Peer reviewe

Propuesta de modelo para la obtención de ventajas competitivas en el sector hotelero

Este estudio del sector hotelero pretende identificar la relación entre el aprendizaje continuo, la transferencia de conocimiento y la innovación como un medio para lograr ventajas competitivas sostenibles. En un sector cada vez más complejo, los hoteles deben reinventarse continuamente para sobrevivir. El objetivo de este estudio es la identificación de áreas en dónde las empresas puedan mantener la supervivencia o crecer a pesar de la dura y dinámica competencia.This study of the hotel sector aims to identify the relationship between continuous learning, knowledge-sharing and innovation as a means of achieving profitable competitive advantages. In an ever more complex sector, hotels have to continually reinvent themselves to survive and this study identifies areas in which survival and growth can be sustained despite severe and dynamic competition

Spectrophotometric investigations of Blue Compact Dwarf Galaxies: Markarian 35

We present results from a detailed spectrophotometric analysis of the blue compact dwarf galaxy Mrk 35 (Haro 3), based on deep optical (B,V,R,I) and near-IR (J,H,K) imaging, Halpha narrow-band observations and long-slit spectroscopy. The optical emission of the galaxy is dominated by a central young starburst, with a bar-like shape, while an underlying component of stars, with elliptical isophotes and red colors, extends more than 4 kpc from the galaxy center. High resolution Halpha and color maps allow us to identify the star-forming regions, to spatially discriminate them from the older stars, and to recognize several dust patches. We derive colors and Halpha parameters for all the identified star-forming knots. Observables derived for each knot are corrected for the contribution of the underlying older stellar population, the contribution by emission lines, and from interstellar extinction, and compared with evolutionary synthesis models. We find that the contributions of these three factors are by no means negligible and that they significantly vary across the galaxy. Therefore, careful quantification and subtraction of emission lines, galaxy host contribution, and interstellar reddening at every galaxy position, are essential to derive the properties of the young stars in BCDs. We find that we can reproduce the colors of all the knots with an instantaneous burst of star formation and the Salpeter initial mass function with an upper mass limit of 100 M_solar. In all cases the knots are just a few Myr old. The underlying population of stars has colors consistent with being several Gyr old.Comment: 21 pages, 13 figures. Accepted for publication in ApJ, tentatively scheduled for the ApJ November 1, 2007 v669n1 issu

DNA damage profiles induced by sunlight at different latitudes

Despite growing knowledge on the biological effects of ultraviolet (UV) radiation on human health and ecosystems, it is still difficult to predict the negative impacts of the increasing incidence of solar UV radiation in a scenario of global warming and climate changes. Hence, the development and application of DNA-based biological sensors to monitor the solar UV radiation under different environmental conditions is of increasing importance. With a mind to rendering a molecular view-point of the genotoxic impact of sunlight, field experiments were undertaken with a DNA-dosimeter system in parallel with physical photometry of solar UVB/UVA radiation, at various latitudes in South America. Onapplying biochemical and immunological approaches based on specific DNA-repair enzymes and antibodies, for evaluating sunlight-induced DNA damage profiles, it became clear that the genotoxic potential of sunlight does indeed vary according to latitude. Notwithstanding, while induction of oxidized DNA bases is directly dependent on an increase in latitude, the generation of 6-4PPs is inversely so, whereby the latter can be regarded as a biomolecular marker of UVB incidence. This molecular DNA lesion-pattern largely reflects the relative incidence of UVA and UVB energy at any specific latitude. Hereby is demonstrated the applicability of this DNA-based biosensor for additional, continuous field experiments, as a means of registering variations in the genotoxic impact of solar UV radiation. Environ. Mol. Mutagen. 2012. (c) 2012 Wiley Periodicals, Inc.FAPESP (Sao Paulo, Brazil)FAPESP (Sao Paulo, Brazil)CNPq (Brasilia, Brazil)CNPq (Brasilia, Brazil)Ministry of Education, Culture, Sports, Science, and Technology (Japan)Ministry of Education, Culture, Sports, Science, and Technology of JapanLaboratory of Science and Engineering, Takushoku University, JapanLaboratory of Science and Engineering, Takushoku University, Japa

Inventario y criterios de gestión de los mamíferos del Parque Nacional de Ordesa y Monte Perdido

2 volúmenes + 1 vol. Anexos + Resumen.-- Informe Final del Convenio de Investigación entre el Organismo Autónomo de Parques Nacionales y el Instituto Pirenaico de Ecología (CSIC).Peer reviewe

Brain edema and inflammatory activation in bile duct ligated rats with diet-induced hyperammonemia: A model of hepatic encephalopathy in cirrhosis

Presented in part as a poster at 2005 Meeting EASL, Paris.Studies of the pathogenesis of hepatic encephalopathy are hampered by the lack of a satisfactory animal model. We examined the neurological features of rats after bile duct ligation fed a hyperammonemic diet (BDL+HD). Six groups were studied: sham, sham pair-fed, hyperammonemic, bile duct ligation (BDL), BDL pair fed, and BDL+HD. The BDL+HD rats were made hyperammonemic via an ammonia-containing diet that began 2 weeks after operation. One week later, the animals were sacrificed. BDL+HD rats displayed an increased level of cerebral ammonia and neuroanatomical characteristics of hepatic encephalopathy (HE), including the presence of type II Alzheimer astrocytes. Both BDL and BDL+HD rats showed activation of the inflammatory system. BDL+HD rats showed an increased amount of brain glutamine, a decreased amount of brain myo-inositol, and a significant increase in the level of brain water. In coordination tests, BDL+HD rats showed severe impairment of motor activity and performance as opposed to BDL rats, whose results seemed only mildly affected. In conclusion, the BDL+HD rats displayed similar neuroanatomical and neurochemical characteristics to human HE in liver cirrhosis. Brain edema and inflammatory activation can be detected under these circumstances.Supported by grants from Instituto de Salud Carlos III, Convocatoria de RedesTematicas (G03/155 and C03/02); Conselleria de Sanitat, Escuela Valenciana para Estudios de la Salud (BM-004/2002); Organisme Public Valencia d’Investigacio, Ajudes per a Accions Especials (21-2002), Generalitat Valenciana,GV Grupos 03/053, Junta de Comunidades de Castilla-La Mancha (GC-02-022)and Instituto de Salud Carlos III (PI03/0576).Peer reviewe