Reducing Unnecessary Respiratory Viral Testing to Promote High-Value Care

BACKGROUND AND OBJECTIVES: Viral respiratory infections are common in children, and practice guidelines do not recommend routine testing for typical viral illnesses. Despite results often not impacting care, nasopharyngeal swabs for viral testing are frequently performed and are an uncomfortable procedure. The aim of this initiative was to decrease unnecessary respiratory viral testing (RVT) in the emergency department (ED) and the pediatric medicine wards (PMWs) by 50% and 25%, respectively, over 36 months. METHODS: An expert panel reviewed published guidelines and appropriate evidence to formulate an RVT pathway using plan-do-study-act cycles. A multifaceted improvement strategy was developed that included implementing 2 newer, more effective tests when testing was deemed necessary; electronic order modifications with force functions; audit and feedback; and education. By using statistical process control charts, the outcomes analyzed were the percentage of RVT ordered in the ED and the rate of RVT ordered on the PMWs. Balancing measures included return visits leading to admission and inpatient viral nosocomial outbreaks. RESULTS: The RVT rate decreased from a mean of 3.0% to 0.5% of ED visits and from 44.3 to 30.1 per 1000 patient days on the PMWs and was sustained throughout the study. Even when accounting for the new rapid influenza test available in the ED, a 50% decrease in overall ED RVT was still achieved without any significant impact on return visits leading to admission or inpatient nosocomial infections. CONCLUSIONS: Through implementation of a standardized, electronically integrated RVT pathway, a decrease in unnecessary RVT was successfully achieved. Audit and feedback, reminders, and biannual education all supported long-term sustainability of this initiative.

Do poor environmental conditions drive trachoma transmission in Burundi? A mathematical modelling study

Trachoma is an infectious disease and it is the leading cause of preventable blindness worldwide. To achieve its elimination, the World Health Organization set a goal of reducing the prevalence in endemic areas to less than 55% by 2020, utilizing the SAFE (surgery, antibiotics, facial cleanliness, environmental improvement) strategy. However, in Burundi, trachoma prevalences of greater than 55% are still reported in 11 districts and it is hypothesized that this is due to the poor implementation of the environmental improvement factor of the SAFE strategy. In this paper, a model based on an ordinary differential equation, which includes an environmental transmission component, is developed and analysed. The model is calibrated to recent field data and is used to estimate the reductions in trachoma that would have occurred if adequate environmental improvements were implemented in Burundi. Given the assumptions in the model, it is clear that environmental improvement should be considered as a key component of the SAFE strategy and, hence, it is crucial for eliminating trachoma in Burundi. doi:10.1017/S1446181121000389

WINGKO INDUSTRY SUSTAINABILITY IMPROVEMENT STRATEGY USING THE BUSINESS MODEL CANVAS (BMC) METHOD

Wingko is one of Indonesian Snack from Babat of Lamongan Regency which is produced by UMKM Klapa Muda. Compete makes the production unstable, even decreased. Right now UMKM Klapa Muda must develop rapidly, because there are already many competitors selling similar products. In this study using the Business Model Canvas Development that is assisted using the Internal factor Evaluation matrix, External Factor Evaluation, Internal-External, SWOT matrix analysis, and QSPM (Quantitative Strategic Planning Matriks) analysis. For the weighting stage, 5th priority strategies used for market penetration and product development by applying Business Model Canvas (BMC) concept to UMKM Klapa Muda Babat strategy, it is 1) Customer Relationship Increasing promote activities with a value of 2,401, 2) Customer Segments establish customer loyalty with a value of 2,386, 3) Value Proposition guarantees production quality and mproves products with a value of 2.24, 4) Channels has a relationship with the government with a value of 2,015, 5) Key Resources Development of machine and equipment technology with a value of 1,308.

Harnessing Machine Learning Techniques for Mapping Aquaculture Waterbodies in Bangladesh

Aquaculture in Bangladesh has grown dramatically in an unplanned manner in the past few decades, becoming a major contributor to the rural economy in many parts of the country. National systems for the collection of statistics have been unable to keep pace with these rapid changes, and more accurate, up to date information is needed to inform policymakers. Using Sentinel-2 top of atmosphere reflectance data within Google Earth Engine, we proposed six different strategies for improving fishpond detection as the existing techniques seem unreliable. These techniques include: (1) identification of the best time period for image collection, (2) testing the buffer size for threshold optimization, (3) determining the best combination of image reducer and water-identifying indices, (4) introduction of a convolution filter to enhance edge-detection, (5) evaluating the impact of ground truthing data on machine learning algorithm training, and (6) identifying the best machine learning classifier. Each enhancement builds on the previous one to develop a comprehensive improvement strategy called the enhanced method for fishpond detection. We compared the results of each improvement strategy to known ground truthing fishponds as the metric of success. For machine learning classifiers, we compared the precision, recall, and F1 score to determine the quality of results. Among four machine learning methods studied here, the classification and regression trees performed the best with a precision of 0.738, recall of 0.827, and F1 score of 0.780. Overall, the proposed strategies enhanced fishpond area detection in all districts within the study area.

Assessment the Visual Clarity of the Projector in Classroom and Innovative Asymmetric Distribution LED Tube Applications

The paper aims to explore the relationship between the vertical plane luminance on projection screens and human visual clarity in the classroom or meeting room. While controlling the lighting environment conditions of the classroom to create different luminous distributions and luminance on the projection screen, a survey is conducted to understand students’ visual experience about screen clarity during the field experiment. The luminance of each picture on the projection screen is measured under the specified lighting conditions of luminaires in the classroom, and the relationship is formulated between the average luminance on the projection screen and the visual satisfaction based on clarity of experience. This will be useful for further studying the acceptable threshold of luminance distribution in the classroom to provide a better visual clarity and lighting quality of projection screens while teaching. In this study, the measurement and performance evaluation on a projection screen were carried out at a classroom in the National Taiwan University of Science and Technology (NTUST). By using an image luminance meter and analyzing the research results, we propose an improvement strategy for asymmetric luminous distribution design of LED light tube and light switch control mechanism of luminaires to resolve the inadequate luminance of the vertical projection screen area to improve the lighting quality and visual clarity of the projection screen while teaching with the least cost.

DO POOR ENVIRONMENTAL CONDITIONS DRIVE TRACHOMA TRANSMISSION IN BURUNDI? A MATHEMATICAL MODELLING STUDY

Trachoma is an infectious disease and it is the leading cause of preventable blindness worldwide. To achieve its elimination, the World Health Organization set a goal of reducing the prevalence in endemic areas to less than $5$ % by 2020, utilizing the SAFE (surgery, antibiotics, facial cleanliness, environmental improvement) strategy. However, in Burundi, trachoma prevalences of greater than $5$ % are still reported in 11 districts and it is hypothesized that this is due to the poor implementation of the environmental improvement factor of the SAFE strategy. In this paper, a model based on an ordinary differential equation, which includes an environmental transmission component, is developed and analysed. The model is calibrated to recent field data and is used to estimate the reductions in trachoma that would have occurred if adequate environmental improvements were implemented in Burundi. Given the assumptions in the model, it is clear that environmental improvement should be considered as a key component of the SAFE strategy and, hence, it is crucial for eliminating trachoma in Burundi.

Application of lean six sigma methodology to improve the weight inconsistency problem of coffee powder packaging

This paper presents a continuous improvement (CI) project based on the application of Lean Six Sigma (LSS) methodology. This project was carried out at coffee manufacturing industry located in northern area of Malaysia. The focus of this presented CI project is to improve the weight inconsistency problem of coffee powder packaging. The presented CI project was mainly guided with Six Sigma methodology of Define, Measure, Analyze, Improve and Control (DMAIC) steps, and related Lean tools applications. The step of Define summaries the overall view of CI project. In the step of Measure, current level of sigma based on defect per million of opportunities (DPMO) calculation was determined. Initially, 6% of rejected products were recorded, which it presents the sigma level at 3.1. In the step of Analyze, a series of team-based activities towards root cause identification was carried out. It included the applications of cause effect (CE) analysis and possible causes prioritization and close observations on packaging process. In the step of Improve, the related Lean tool was proposed to improve the problem under study. In the final step of Control, related supportive actions were suggested to sustain the effectiveness of the proposed solution. There are fourteen possible causes are initially identified in CE analysis and based on team’s evaluation process of possible causes prioritization four causes are collectively to be the most possible of root cause(s). Three close observation sessions were carried out to finalize the most possible root cause of the problem. Result strongly suggested that the high variation of coffee powder’s size and inconsistency is the root cause. An improvement strategy based on Lean Manufacturing approach called ‘poka yoke’ is proposed. The proposed improvement strategy was then validated based on real packaging process scenario. Result shows that the proposed improvement strategy is significantly effective to solve the problem with 0% of reject product was recorded so far, where it is not only produced the product within the acceptable weight of 215 and 208 grams, but also presents the reduction of weight fluctuation that close to ideal weight of 208 grams.

Metabolic Analysis of Schizochytrium Mutants With High DHA Content Achieved With ARTP Mutagenesis Combined With Iodoacetic Acid and Dehydroepiandrosterone Screening

High DHA production cost caused by low DHA titer and productivity of the current Schizochytrium strains is a bottleneck for its application in competition with traditional fish-oil based approach. In this study, atmospheric and room-temperature plasma with iodoacetic acid and dehydroepiandrosterone screening led to three mutants, 6–8, 6–16 and 6–23 all with increased growth and DHA accumulations. A LC/MS metabolomic analysis revealed the increased metabolism in PPP and EMP as well as the decreased TCA cycle might be relevant to the increased growth and DHA biosynthesis in the mutants. Finally, the mutant 6–23, which achieved the highest growth and DHA accumulation among all mutants, was evaluated in a 5 L fermentor. The results showed that the DHA concentration and productivity in mutant 6–23 were 41.4 g/L and 430.7 mg/L/h in fermentation for 96 h, respectively, which is the highest reported so far in literature. The study provides a novel strain improvement strategy for DHA-producing Schizochytrium.