Workflow Optimization of Kennestone Sterile Processing Department

Our team took on the task to create an optimization plan for the sterile processing department of Wellstar Kennestone Hospital in Marietta. It was brought to our attention that the department experiences difficulties that result in a reduction of on-time starts for surgeries. In order to increase on-time starts, our team’s primary goal was to reduce the total cycle time of instrument trays through the Sterile Process Department. The outdated system also faces the following challenges: inconsistent supply numbers, multiple supply returns, lack of organizational flow of instruments and inefficient work patterns in instrument processing. Our team made use of Six Sigma principles and Continuous Improvement tools like 5S, Kaizen events, and simulation software such as Arena Software to perform data analyses on the current system and suggest improvements. These suggestions included the enforcement of a standardized order of operations for dirty cart processing, a modified clean zone layout, and an additional cart washer to increase throughput of carts and containers. The results gathered from simulated data supported the implementation of a standardized order of operations and the modified clean zone layout but did not provide sufficient evidence to justify the investment in an additional cart washer

Infection-dependent phenotypes in MHC-congenic mice are not due to MHC: can we trust congenic animals?

BACKGROUND: Congenic strains of mice are assumed to differ only at a single gene or region of the genome. These mice have great importance in evaluating the function of genes. However, their utility depends on the maintenance of this true congenic nature. Although, accumulating evidence suggests that congenic strains suffer genetic divergence that could compromise interpretation of experimental results, this problem is usually ignored. During coinfection studies with Salmonella typhimurium and Theiler's murine encephalomyelitis virus (TMEV) in major histocompatibility complex (MHC)-congenic mice, we conducted the proper F(2 )controls and discovered significant differences between these F(2 )animals and MHC-genotype-matched P(0 )and F(1 )animals in weight gain and pathogen load. To systematically evaluate the apparent non-MHC differences in these mice, we infected all three generations (P(0), F(1 )and F(2)) for 5 MHC genotypes (b/b, b/q and q/q as well as d/d, d/q, and q/q) with Salmonella and TMEV. RESULTS: Infected P(0 )MHC q/q congenic homozygotes lost significantly more weight (p = 0.02) and had significantly higher Salmonella (p < 0.01) and TMEV (p = 0.02) titers than the infected F(2 )q/q homozygotes. Neither weight nor pathogen load differences were present in sham-infected controls. CONCLUSIONS: These data suggest that these strains differ for genes other than those in the MHC congenic region. The most likely explanation is that deleterious recessive mutations affecting response to infection have accumulated in the more than 40 years that this B10.Q-H-2(q )MHC-congenic strain has been separated from its B10-H-2(b )parental strain. During typical experiments with congenic strains, the phenotypes of these accumulated mutations will be falsely ascribed to the congenic gene(s). This problem likely affects any strains separated for appreciable time and while usually ignored, can be avoided with the use of F(2 )segregants

A complexity view of organisational reputation

This paper looks at the concept of reputation from four angles: costbenefit, semiotics, quality and complexity. The complexity outlook may include all the other approaches in certain conditions but is in comparison wider, deeper, evolutionary and more fickle. It can embrace apparently contradictory states that evolve through interaction. The focus is on ambiguity, one of the less-known principles of complexity and is argued that it can act as a stem cell to build sustainable reputation. Two cases from industry are reviewed

Immediate Activation Fails To Rescue Efficient Human Immunodeficiency Virus Replication in Quiescent CD4(+) T Cells

Unlike activated T cells, quiescent CD4(+) T cells have shown resistance to human immunodeficiency virus (HIV) infection due to a block in the early events of the viral life cycle. To further investigate the nature of this block, we infected quiescent CD4(+) T cells with HIV-1(NL4-3) and immediately stimulated them. Compared to activated (prestimulated) cells, these poststimulated cells showed slightly decreased viral entry and delays in the completion of reverse transcription. However, the relative efficiency of integration was similar to that of prestimulated cells. Together, this resulted in decreased expression of tat/rev mRNA and synthesis of viral protein. Furthermore, based on cell cycle staining and BrdU incorporation, poststimulated cells expressing viral protein failed to initiate a second round of their cell cycle, independently of Vpr-mediated arrest. Together, these data demonstrate that the early stages of the HIV life cycle are inefficient in these poststimulated cells and that efficient replication cannot be induced by subsequent activation