Healthcare services are facing challenges in increasing their efficiency, quality of care, and coping with surges in demand. To this end, some hospitals have implemented lean healthcare. The aim of this systematic review is to evaluate the effects of lean healthcare (LH) interventions on inpatient care and determine whether patient flow and efficiency outcomes improve. The review was performed according to PRISMA. We used six databases to search for studies published from 2002 to 2019. Out of 5732 studies, 39 measuring one or more defined outcomes were included. Hospital length of stay (LOS) was measured in 23 studies, 16 of which reported a reduction, turnover time (TOT) decreased in six out of eight studies, while the turnaround time (TAT) and on-time starts (OTS) improved in all five and seven studies, respectively. Moreover, eight out of nine studies reported an earlier discharge time, and the boarding time decreased in all four cases. Meanwhile, the readmission rate did not increase in all nine studies. Lastly, staff and patient satisfaction improved in all eight studies. Our findings show that by focusing on reducing non-value-added activities, LH contributed to improving patient flow and efficiency within inpatient care.

It has been recently shown that the presence of macrotextures on superhydrophobic materials can markedly modify the dynamics of water impacting them, and in particular significantly reduce the contact time of bouncing drops, compared with what is observed on a flat surface. This finding constitutes a significant step in the maximization of water repellency, since it enables to minimize even further the contact between solid and liquid. It also opens a new axis of research on the design of super-structures to induce specific functions such as anti-freezing, liquid fragmentation and/or recomposition, guiding, trapping and so on. Here we show that the contact time of drops bouncing on a repellent macrotexture takes discrete values when varying the impact speed. This allows us to propose a quantitative analysis of the reduction of contact time and thus to understand how and why macrotextures can control the dynamical properties of bouncing drops.

Isotropic hyperelastic models have been used to determine the material properties of normal human cartilage, but there remains an incomplete understanding of how these properties may be altered by osteoarthritis. The aims of this study were to (1) measure the material constants of normal and osteoarthritic human knee cartilage using isotropic hyperelastic models; (2) determine whether the material constants correlate with histological measures of structure and/or cartilage tissue damage; and (3) quantify the abilities of two common isotropic hyperelastic material models, the neo-Hookean and Yeoh models, to describe articular cartilage contact force, area, and pressure. Small osteochondral specimens of normal and osteoarthritic condition were retrieved from human cadaveric knees and from the knees of patients undergoing total knee arthroplasty and tested in unconfined compression at loading rates and large strains representative of weight-bearing activity. Articular surface contact area and lateral deformation were measured concurrently and specimen-specific finite element models then were used to determine the hyperelastic material constants. Structural parameters were measured using histological techniques while the severity of cartilage damage was quantified using the OARSI grading scale. The hyperelastic material constants correlated significantly with OARSI grade, indicating that the mechanical properties of cartilage for large strains change with tissue damage. The measurements of contact area described anisotropy of the tissue constituting the superficial zone. The Yeoh model described contact force and pressure more accurately than the neo-Hookean model, whereas both models under-predicted contact area and poorly described the anisotropy of cartilage within the superficial zone. These results identify the limits by which isotropic hyperelastic material models may be used to describe cartilage contact variables. This study provides novel data for the mechanical properties of normal and osteoarthritic human articular cartilage and enhances our ability to model this tissue using simple isotropic hyperelastic materials.

Highly turbulent Taylor–Couette flow with spanwise-varying roughness is investigated experimentally and numerically (direct numerical simulations with an immersed boundary method) to determine the effects of the spacing and spanwise width ss of the spanwise-varying roughness on the total drag and on the flow structures. We apply sandgrain roughness, in the form of alternating rough and smooth bands to the inner cylinder. Numerically, the Taylor number is O(109)O(109) and the roughness width is varied in the range 0.47⩽s~=s/d⩽1.230.47⩽s~=s/d⩽1.23 , where dd is the gap width. Experimentally, we explore Ta=O(1012)Ta=O(1012) and 0.61⩽s~⩽3.740.61⩽s~⩽3.74 . For both approaches the radius ratio is fixed at η=ri/ro=0.716𝜂=ri/ro=0.716 , with riri and roro the radius of the inner and outer cylinder respectively. We present how the global transport properties and the local flow structures depend on the boundary conditions set by the roughness spacing s~s~ . Both numerically and experimentally, we find a maximum in the angular momentum transport as a function of s~s~ . This can be attributed to the re-arrangement of the large-scale structures triggered by the presence of the rough stripes, leading to correspondingly large-scale turbulent vortices.

Laser capture microscopy (LCM) coupled with global transcriptome profiling could enable precise analyses of cell populations without the need for tissue dissociation, but has so far required relatively large numbers of cells. Here we report a robust and highly efficient strategy for LCM coupled with full-length mRNA-sequencing (LCM-seq) developed for single-cell transcriptomics. Fixed cells are subjected to direct lysis without RNA extraction, which both simplifies the experimental procedures as well as lowers technical noise. We apply LCM-seq on neurons isolated from mouse tissues, human post-mortem tissues, and illustrate its utility down to single captured cells. Importantly, we demonstrate that LCM-seq can provide biological insight on highly similar neuronal populations, including motor neurons isolated from different levels of the mouse spinal cord, as well as human midbrain dopamine neurons of the substantia nigra compacta and the ventral tegmental area.

UNLABELLED: Determination of haplotypes is important for modelling the phenotypic consequences of genetic variation in diploid organisms, including cis-regulatory control and compound heterozygosity. We realized that single-cell RNA-seq (scRNA-seq) data are well suited for phasing genetic variants, since both transcriptional bursts and technical bottlenecks cause pronounced allelic fluctuations in individual single cells. Here we present scphaser, an R package that phases alleles at heterozygous variants to reconstruct haplotypes within transcribed regions of the genome using scRNA-seq data. The devised method efficiently and accurately reconstructed the known haplotype for ≥93% of phasable genes in both human and mouse. It also enables phasing of rare and de novo variants and variants far apart within genes, which is hard to attain with population-based computational inference. AVAILABILITY AND IMPLEMENTATION: scphaser is implemented as an R package. Tutorial and code are available at https://github.com/edsgard/scphaser CONTACT: rickard.sandberg@ki.se SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Two distinct phenomena of airborne transmission of variola virus (smallpox) were described in the pre-eradication era-direct respiratory transmission, and a unique phenomenon of transmission over greater distances, referred to as "aerial convection". We conducted an analysis of data obtained from a systematic review following the PRISMA criteria, on the long-distance transmission of smallpox. Of 8179 studies screened, 22 studies of 17 outbreaks were identified-12 had conclusive evidence of aerial convection and five had partially conclusive evidence. Aerial convection was first documented in 1881 in England, when smallpox incidence had waned substantially following mass vaccination, making unusual transmissions noticeable. National policy at the time stipulated spatial separation of smallpox hospitals from other buildings and communities. The evidence supports the transmission of smallpox through aerial convection at distances ranging from 0.5 to 1 mile, and one instance of 15 km related to bioweapons testing. Other explanations are also possible, such as missed chains of transmission, fomites or secondary aerosolization from contaminated material such as bedding. The window of observation of aerial convection was within the 100 years prior to eradication. Aerial convection appears unique to the variola virus and is not considered in current hospital infection control protocols. Understanding potential aerial convection of variola should be an important consideration in planning for smallpox treatment facilities and protecting potential contacts and surrounding communities.

The resolution of contact location is important in many applications in robotics and automation. This is generally done by using an array of contact or tactile receptors, which increases cost and complexity as the required resolution or area is increased. Tactile sensors have also been developed using a continuous deformable medium between the contact and the receptors, which allows few receptors to interpolate the information among them, avoiding the weakness highlighted in the former approach. The latter is generally used to measure contact force intensity or magnitude but rarely used to identify the contact locations. This paper presents a systematic design and characterisation procedure for magnetic-based soft tactile sensors (utilizing the latter approach with the deformable contact medium) with the goal of locating the contact force location. This systematic procedure provides conditions under which design parameters can be selected, supported by a selected machine learning algorithm, to achieve the desired performance of the tactile sensor in identifying the contact location. An illustrative example, which combines a particular sensor configuration (magnetic hall effect sensor as the receptor, a selected continuous medium and a selected sensing resolution) and a specific data-driven algorithm, is used to illustrate the proposed design procedure. The results of the illustrative example design demonstrates the efficacy of the proposed design procedure and the proposed sensing strategy in identifying a contact location. The resulting sensor is also tested on a robotic hand (Allegro Hand, SimLab Co) to demonstrate its application in real-world scenarios.

In the last two decades, numerous powered ankle-foot orthoses have been developed. Despite similar designs and control strategies being shared by some of these devices, their performance in terms of achieving a comparable goal varies. It has been shown that the effect of powered ankle-foot orthoses on healthy users is altered by some factors of the testing protocol. This paper provides an overview of the effect of powered walking on healthy and weakened users. It identifies a set of key factors influencing the performance of powered ankle-foot orthoses, and it presents the effects of these factors on healthy subjects, highlighting the similarities and differences of the results obtained in different works. Furthermore, the outcomes of studies performed on elderly and impaired subjects walking with powered ankle-foot orthoses are compared, to outline the effects of powered walking on these users. This article shows that several factors mutually influence the performance of powered ankle-foot orthoses on their users and, for this reason, the determination of their effects on the user is not straightforward. One of the key factors is the adaptation of users to provided assistance. This factor is very important for the assessment of the effects of powered ankle-foot orthoses on users, however, it is not always reported by studies. Moreover, future works should report, together with the results, the list of influencing factors used in the protocol, to facilitate the comparison of the obtained results. This article also underlines the need for a standardized method to benchmark the actuators of powered ankle-foot orthoses, which would ease the comparison of results between the performed studies. In this paper, the lack of studies on elderly and impaired subjects is highlighted. The insufficiency of these studies makes it difficult to assess the effects of powered ankle-foot orthoses on these users.To summarize, this article provides a detailed overview of the work performed on powered ankle-foot orthoses, presenting and analyzing the results obtained, but also emphasizing topics on which more research is still required.

We examine the behaviour of turbulent boundary layers over surfaces composed of spanwise-alternating smooth and rough strips, where the width of the strips varies such that, where is the boundary-layer thickness averaged over one spanwise wavelength of the heterogeneity. The experiments are configured to examine the influences of spanwise variation in wall shear stress over a large range. Hot-wire anemometry and particle image velocimetry (PIV) reveal that the half-wavelength governs the diameter and strength of the resulting mean secondary flows and hence the observed isovels of the mean streamwise velocity. Three possible cases are observed: limiting cases (either or), where the secondary flows are confined near the wall or near the roughness change, and intermediate cases (), where the secondary flows are space filling and at their strongest. These secondary flows, however, exhibit a time-dependent behaviour which might be masked by time averaging. Further analysis of the energy spectrogram and fluctuating flow fields obtained from PIV show that the secondary flows meander in a similar manner to that of large-scale structures occurring naturally in turbulence over smooth walls. The meandering of the secondary flows is a function of and is most prominent when.

The segregation of the trophectoderm (TE) from the inner cell mass (ICM) in the mouse blastocyst is determined by position-dependent Hippo signaling. However, the window of responsiveness to Hippo signaling, the exact timing of lineage commitment and the overall relationship between cell commitment and global gene expression changes are still unclear. Single-cell RNA sequencing during lineage segregation revealed that the TE transcriptional profile stabilizes earlier than the ICM and prior to blastocyst formation. Using quantitative Cdx2-eGFP expression as a readout of Hippo signaling activity, we assessed the experimental potential of individual blastomeres based on their level of Cdx2-eGFP expression and correlated potential with gene expression dynamics. We find that TE specification and commitment coincide and occur at the time of transcriptional stabilization, whereas ICM cells still retain the ability to regenerate TE up to the early blastocyst stage. Plasticity of both lineages is coincident with their window of sensitivity to Hippo signaling.

Individual neurons vary widely in terms of their gene expression, morphology, and electrophysiological properties. While many techniques exist to study single-cell variability along one or two of these dimensions, very few techniques can assess all three features for a single cell. We recently developed Patch-seq, which combines whole-cell patch clamp recording with single-cell RNA-sequencing and immunohistochemistry to comprehensively profile the transcriptomic, morphologic, and physiologic features of individual neurons. Patch-seq can be broadly applied to characterize cell types in complex tissues such as the nervous system, and to study the transcriptional signatures underlying the multidimensional phenotypes of single cells.