System State Analysis Using Value Stream Mapping, Discrete Event Simulation, and Fuzzy Logic

Offsite construction (OSC) is a construction method commonly used for its benefits in improving quality, saving costs, and decreasing delivery time. Research on OSC production covers a wide range of applications, methodologies, and approaches, as attempts to optimize different aspects of any production system. However, a gap exists in the myopic approach of optimizing a production system, whereby studies focus on certain metrics that highlight a part of the system that overshadows another. This leads to suboptimal results and in some cases might lead to negative impacts on the production system. This research presents a framework to study and optimize OSC production systems on micro and macro levels. The framework is based on lean concepts and lean thinking. A case study of an OSC facility for making cabinets is used to apply and validate the framework. The research includes the application of value stream mapping (VSM) as a conceptual model to understand the current state of the system. Discrete-event simulation (DES) is used to study performance metrics on a micro level, including production lead time (PLT), production rate, station utilization, and levels of work in progress (WIP). Along with the analysis conducted to study the relationship between the different metrics evaluated, a new metric, total processing time / production lead time (TPT/PLT), is introduced as a single indicator of the overall state of the production system. TPT/PLT is analysed using fuzzy logic, since production system state is a linguistic variable. Lastly, lean interventions aimed to improve production are suggested and studied using the presented techniques to evaluate their impact on the production system, particularly with respect to certain metrics and holistically with respect to the system state. The results demonstrate that these interventions improve certain aspects of the production system; however, some lead to negative or neutral impact on the overall system state. This highlights the importance of a having a holistic approach when optimizing production systems with the consideration of the whole and not only the parts

Patient Interview Simulator: An innovative tool to learn and practice clinical medicine

Purpose: There is a lack of materials for simulating and testing the medical diagnostic procedure. Studies show that this is a trend nationwide, where not enough emphasis is put on clinical skills acquisition and assessments. We have designed a simulator to supplement the integration of medical knowledge in clinical scenarios. We designed this tool to be used as an add-on to medical school curricula. Methods: Twenty second-year medical students participated in this innovative project, as they had the necessary foundations of medical knowledge, and have not had many patient interactions yet. During the pilot study, participants played four cases regarding chest pain, and we analyzed their feedback using the first level of the Kirkpatrick scale. We used this level of the scale to determine the enjoyment of the simulator and whether participants would be willing to continue using it as a supplement. Results and Conclusions: 71% of responders (n=14) said they would use this game as a supplement in medical education. 94% of responders (n=17) reported that the game was very intuitive to learn. 73% of responders (n=15) reported they would likely play this game again. The results indicate that there is interest in this simulator as a supplemental educational tool. This simulator allows for practical application of the vast information we acquire as students, without the medical risks of clinical practice. This innovation is of benefit to students by increasing experience and providing a great supplement to medical schools

Patient Interview Simulator: Designed to increase confidence and knowledge in clinical medicine

Purpose: Studies have shown a nationwide trend in which medical students seldom get one-on-one interactions with a standardized patient conducting a full medical visit before their clerkship years. We have designed a simulator that allows students to practice their clinical skills with each other, using a variety of cases that emulate case-based learning as well as clinical skills exams. Methods: Twenty second-year medical students participated in the game’s pilot study. The measured variables in the study included game and confidence scores. We randomized participants into pairs, and each person completed two cases with their scores compared using a paired t-test. Confidence was measured as a baseline and after completion of the game with an additional paired t-test. Results and Conclusions: The results show a significant increase in confidence and game scores. Mean confidence scores increased from a baseline of 15 to 21 (n = 8, p \u3c 0.001, 95% CI [4, 8]) out of a maximal score of 25. Mean game scores increased from 415.15 to 443.95 (n = 20, p \u3c 0.001, 95% CI [12, 50]) out of a score of 500. The simulator had a significantly positive effect as an education tool and on increasing student proficiency and should be considered an appropriate supplement for medical education. While additional studies need to be conducted with more participants, the results show that continuous game use can lead to significant increases in patient interaction confidence and game scores

Social media and protest mobilization: evidence from the Tunisian revolution

This article explores how social media acted as a catalyst for protest mobilization during the Tunisian revolution in late 2010 and early 2011. Using evidence from protests we argue that social media acted as an important resource for popular mobilization against the Ben Ali regime. Drawing on insights from “resource mobilization theory”, we show that social media (1) allowed a “digital elite” to break the national media blackout through brokering information for mainstream media; (2) provided a basis for intergroup collaboration for a large “cycle of protest”; (3) reported event magnitudes that raised the perception of success for potential free riders, and (4) provided additional “emotional mobilization” through depicting the worst atrocities associated with the regime’s response to the protests. These findings are based on background talks with Tunisian bloggers and digital activists and a revealed preference survey conducted among a sample of Tunisian internet users (February–May 2012)

Preventing corneal calcification associated with xylazine for longitudinal optical coherence tomography in young rodents

PURPOSE. Spectral-domain optical coherence tomography (SD-OCT) is widely used in clinical ophthalmology and recently gained popularity in laboratory research involving small rodents. Its noninvasive nature allows repeated measurements, thereby decreasing the number of animals required. However, when used at a conventional dosage, xylazine (an a2- adrenoceptor) can cause irreversible corneal calcification, especially among young rodents. In the present study, we test whether corneal calcification associated with xylazine is mediated by the a2-adrenoceptor. METHODS. Our study tested Sprague-Dawley rats, Long-Evans rats, and CD-1 mice (postnatal day [P]14). Retinal images were captured by SD-OCT. Quantitative PCR (qPCR) was used to study gene expression, whereas receptor localization was examined by immunofluorescent staining followed by confocal microscopy. Calcium deposits were detected via von Kossa staining. RESULTS. When used at dosages appropriate for adult animals, ketamine-xylazine anesthetics led to a high rate of respiratory failure, increased apoptotic activity in the corneal epithelium, and irreversible corneal calcification in P14 rat pups. Meanwhile, OCT image quality decreased drastically as a result of corneal calcification among animals recovering from anesthesia. a2-Adrenoceptor subtypes were highly expressed on P14, in line with rodents’ age-specific sensitivity to xylazine. Clonidine, a potent a2-adrenoceptor agonist, dosedependently induced corneal calcification, which could be prevented by an a2-adrenoceptor antagonist. CONCLUSIONS. These data suggest that a2-adrenoceptors contribute to corneal calcification in young rodents. Therefore, we developed a suitable OCT imaging protocol for this cohort, including a carefully tailored ketamine-xylazine dosage (60 mg/kg and 2.5 kg/mg, respectively)

The SMS domain of Trs23p is responsible for the in vitro appearance of the TRAPP I complex in Saccharomyces cerevisiae

Saccharomyces cerevisiae transport protein particle (TRAPP) is a family of related multisubunit complexes required for endoplasmic reticulum-to-Golgi transport (TRAPP I), endosome-to-Golgi transport (TRAPP II) or cytosol to vacuole targeting (TRAPP III). To gain insight into the relationship between these complexes, we generated random and targeted mutations in the Trs23p core subunit. Remarkably, at physiological salt concentrations only two peaks (TRAPP I and a high molecular weight peak) are detected in wild-type cells. As the salt was raised, the high molecular weight peak resolved into TRAPP II and III peaks. Deletion of a Saccharomycotina-specific domain of Trs23p resulted in destabilization of TRAPP I but had no effect on TRAPP II or III. This mutation had no observable growth phenotype, normal levels of Ypt1p-directed guanine nucleotide exchange factor activity in vivo and did not display any in vivo nor in vitro blocks in membrane traffic. Biochemical analysis indicated that TRAPP I could be produced from the TRAPP II/III peak in vitro by increasing the salt concentration. Our data suggest that the SMS domain of Trs23p is responsible for the in vitro appearance of TRAPP I in S. cerevisiae. The implications of these findings are discussed

Unsupervised tracking and automated analysis of multi-population neural activity under anesthesia

Volatile anesthetics play an essential role in the practice of modern medicine due to their widespread use in general anesthesia. Research on anesthetics has mainly involved studies of molecular effects on ion channels and receptors, or on alterations of gross neural activity across large brain regions. We still lack an understanding of how these volatile anesthetics affect the neuronal network activity and bring about the anesthetized state at the mesoscale, composed of hundreds of identified excitatory and inhibitory neurons. To address these issues, we developed a system that enables optical recording from multiple neuronal populations during extended, controlled states of anesthesia. We also built a pipeline that automates the processing of multisession datasets. By optimizing and using dual-color imaging, we recorded simultaneously the activity of excitatory neurons and subsets of inhibitory interneurons at different stages of anesthesia. The automated analysis pipeline allowed us to study the behavior of the same individual neurons across multiple states, which enabled us to determine the concentration-dependent effects isoflurane has on the excitatory and inhibitory populations in layer 2/3 of the primary somatosensory cortex. Although neuronal activity decreases at deeper levels of anesthesia, excitation and inhibition remain balanced when anesthetic concentrations are equilibrated. In contrast, the network reliably goes out of balance for several minutes when the level of anesthesia is changed. Correlations in activity of neighboring neurons increased globally during anesthesia, while the local spatial gradients in correlation were remarkably independent of the anesthetic state. By studying the effects of volatile anesthetics at the level of cortical microcircuits, we have developed a better understanding of these effects on neuronal populations and consequently how the state of anesthesia is produced. This understanding can help improve medical practice for populations susceptible to debilitating effects due to anesthetic exposure, specifically infants that can suffer from developmental problems and the elderly that can develop post-operative delirium and cognitive impairment. For a broader range of patients, our results suggest that anesthetization protocols should be designed to keep the patient in a quasi-steady-state of anesthetization, with as few transitions as is practical.2023-05-23T00:00:00