Production Streamlining through Design, Implementation, and Analysis of Lean Manufacturing Methods

Through the correct implementation of lean manufacturing methods, a company can greatly improve their business. Over a period of three months at TTM Technologies, I utilized my knowledge to fix existing problems ans streamline production. In addition, other trouble areas in their production process were discovered and proper lean methods were used to address them. TTM Technologies saw many changed in the right direction over this time period.

Role of entorhinal cortical plasticity in spatial and contextual memory

It is well accepted that the hippocampus (HIP) is important for spatial and contextual memories, however, it is not clear if the entorhinal cortex (EC), the main input/output structure for the hippocampus, is also necessary for memory storage. Damage to the EC in humans results in memory deficits. However, animal studies report conflicting results on whether the EC is necessary for spatial and contextual memory. Memory consolidation requires gene expression and protein synthesis, mediated by signaling cascades and transcription factors. Extracellular-signal regulated kinase (ERK) cascade activity is necessary for long-term memory in several tasks, including those that test spatial and contextual memory. In this work, we explore the role of ERK-mediated plasticity in the EC on spatial and contextual memory. ^ To evaluate this role, post-training infusions of reversible pharmacological inhibitors specific for the ERK cascade that do not affect normal neuronal activity were targeted directly to the EC of awake, behaving animals. This technique provides spatial and temporal control over the inhibition of the ERK cascade without affecting performance during training or testing. Using the Morris water maze to study spatial memory, we found that ERK inhibition in the EC resulted in long-term memory deficits consistent with a loss of spatial strategy information. When animals were allowed to learn and consolidate a spatial strategy for solving the task prior to training and ERK inhibition, the deficit was alleviated. To study contextual memory, we trained animals in a cued fear-conditioning task and saw an increase in the activation of ERK in the EC 90 minutes following training. ERK inhibition in the EC over this time point, but not at an earlier time point, resulted in increased freezing to the context, but not to the tone, during a 48-hour retention test. In addition, animals froze maximally at the time the shock was given during training; similar to naïve animals receiving additional training, suggesting that ERK-mediated plasticity in the EC normally suppresses the temporal nature of the freezing response. These findings demonstrate that plasticity in the EC is necessary for both spatial and contextual memory, specifically in the retention of behavioral strategies. ^

The effect of triage team on time-in-department in a pediatric emergency department

Objective. To determine whether the use of a triage team would reduce the average time-in-department in a pediatric emergency department by 25%.^ Methods. A triage team consisting of a physician, a nurse, and a nurse's assistant initiated work-ups and saw patients who required minimal lab work-up and were likely to be discharged. Study days were randomized. Our inclusion criteria were all children seen in the emergency center between 6p and 2a Monday-Friday. Our exclusion criteria included resuscitations, inpatient-inpatient transfers, left without being seen, leaving against medical advice, any child seen outside of 6p-2am Monday-Friday and on the weekends. A Pearson-Chi square was used for comparison of the two groups for heterogeneity. For the time-in-department analysis, we performed a 2 sided t-test with a set alpha of 0.05 using Mann Whitney U looking for differences in time-in-department based on acuity level, disposition, and acuity level stratified by disposition. ^ Results. Among urgent and non-urgent patients, we found a statistically significant decrease in time-in-department in a pediatric emergency department. Urgent patients had a time-in-department that was 51 minutes shorter than patients seen on non-triage team days (p=0.007), which represents a 14% decrease in time-in-department. Non-urgent patients seen on triage team days had a time-in-department that was 24 minutes shorter than non-urgent patients seen on non-triage team days (p=0.009). From the disposition perspective, discharged patients seen on triage team days had a shorter time-in-department of 28 minutes as compared to those seen on non-triage team days (p=0.012). ^ Conclusion. Overall, there was a trend towards decreased time-in-department of 19 minutes (5.9% decrease) during triage team times. There was a statistically significant decrease in the time-in-department among urgent patients of 51 minutes (13.9% decrease) and among discharged patients of 28 minutes (8.4% decrease). Urgent care patients make up nearly a quarter of the emergency patient population and decreasing their time-in-department would likely make a significant impact on overall emergency flow.^

Prevalence and trends of substance abuse in Harris County, Texas, 1989 to 1991

In the late 1980s, Harris County, Texas began experiencing an escalation of drug-related activities. Various indicators used in this analysis tracked drug-related trends from 1989 to 1991 to determine patterns for comparison of local (Houston/Harris County, Texas) to national levels.^ An important indicator of the drug scenario was drug-related activities among youths, which increased during the period of this study. The Harris County Juvenile Probation Department showed that among arrests for drug-related activities, felonies increased from 25% in 1988 to 53% in 1991. With the rise in drug-related crimes, and substance abuse among the student body, school districts were forced to institute drug education programs in an effort to curtail such activities.^ Law enforcement agencies in the county saw increased demands for their services as a result of drug activities. Harris County Sheriffs Department reported a 32% plus increase in drug-related charges between 1986 and 1991. Houston Police Department reported an increase of 109% for the same period.^ Data from the Harris County Medical Examiner, the National Institute of Justice's Drug Use Forecasting System (Houston), and drug treatment facilities around Houston/Harris County, Texas indicated similar drug usage trends. Over a four-year period (1988-91), the drugs most frequently detected during blood and urine analyses were cocaine, followed by marijuana, heroin, LSD, and methamphetamines.^ From 1988 to 1991, most drug rehabilitation organizations experienced increased demands for their services by approximately 35%. Several other organizations experienced as much as a 70 percent increase. Males accounted for roughly 70% and females about 30% of persons seeking treatment. However, the number of females pursuing treatment increased, thereby reducing the gender gap.^ Blacks in Houston/Harris County were at higher risk for drug usage among the general population, but sought treatment more readily than other ethnic groups. Whites sought treatment in similar numbers as Blacks, but overall the risk appeared smaller because they made up a larger portion of the Houston/Harris County population.^ This analysis concluded that drug trends for the Houston/Harris County, Texas did not follow national trends, but showed patterns of its own. It was recommended that other communities carry out similar studies to determine drug use trends particular to their local. ^

ECONOMIC ANALYSIS OF THE DEMAND FOR PRESCRIPTION MEDICINE IN THE UNITED STATES

The purpose of this study was to understand the role of principle economic, sociodemographic and health status factors in determining the likelihood and volume of prescription drug use. Econometric demand regression models were developed for this purpose. Ten explanatory variables were examined: family income, coinsurance rate, age, sex, race, household head education level, size of family, health status, number of medical visits, and type of provider seen during medical visits. The economic factors (family income and coinsurance) were given special emphasis in this study.^ The National Medical Care Utilization and Expenditure Survey (NMCUES) was the data source. The sample represented the civilian, noninstitutionalized residents of the United States in 1980. The sample method used in the survey was a stratified four-stage, area probability design. The sample was comprised of 6,600 households (17,123 individuals). The weighted sample provided the population estimates used in the analysis. Five repeated interviews were conducted with each household. The household survey provided detailed information on the United States health status, pattern of health care utilization, charges for services received, and methods of payments for 1980.^ The study provided evidence that economic factors influenced the use of prescription drugs, but the use was not highly responsive to family income and coinsurance for the levels examined. The elasticities for family income ranged from -.0002 to -.013 and coinsurance ranged from -.174 to -.108. Income has a greater influence on the likelihood of prescription drug use, and coinsurance rates had an impact on the amount spent on prescription drugs. The coinsurance effect was not examined for the likelihood of drug use due to limitations in the measurement of coinsurance. Health status appeared to overwhelm any effects which may be attributed to family income or coinsurance. The likelihood of prescription drug use was highly dependent on visits to medical providers. The volume of prescription drug use was highly dependent on the health status, age, and whether or not the individual saw a general practitioner. ^

Attitudes About Predictive MEN1 Genetic Testing in Minors

Multiple Endocrine Neoplasia type 1 (MEN1) is a hereditary cancer syndrome characterized by tumors of the endocrine system. Tumors most commonly develop in the parathyroid glands, pituitary gland, and the gastro-entero pancreatic tract. MEN1 is a highly penetrant condition and age of onset is variable. Most patients are diagnosed in early adulthood; however, rare cases of MEN1 present in early childhood. Expert consensus opinion is that predictive genetic testing should be offered at age 5 years, however there are no evidence-based studies that clearly establish that predictive genetic testing at this age would be beneficial since most symptoms do not present until later in life. This study was designed to explore attitudes about the most appropriate age for predictive genetic testing from individuals at risk of having a child with MEN1. Participants who had an MEN1 mutation were invited to complete a survey and were asked to invite their spouses to participate as well. The survey included several validated measures designed to assess participants’ attitudes about predictive testing in minors. Fifty-eight affected participants and twenty-two spouses/partners completed the survey. Most participants felt that MEN1 genetic testing was appropriate in healthy minors. Younger age and increased knowledge of MEN1 genetics and inheritance predicted genetic testing at a younger age. Additionally, participants who saw more positive than negative general outcomes from genetic testing were more likely to favor genetic testing at younger ages. Overall, participants felt genetic testing should be offered at a younger age than most adult onset conditions and most felt the appropriate time for testing was when a child could understand and participate in the testing process. Psychological concerns seemed to be the primary focus of participants who favored later ages for genetic testing, while medical benefits were more commonly cited for younger age. This exploratory study has implications for counseling patients whose children are at risk of developing MEN1 and illustrates issues that are important to patients and their spouses when considering testing in children.

Editorial: Family Preservation: Collaboration and Teamwork

Tis the season of the National Basketball Association finals and the beginning of the Professional Women's Basketball Association. The skills of collaboration and teamwork required to achieve the ballet of basketball is learned by players over a number of years. On school grounds everywhere, children are learning the techniques and skills necessary to play the game of basketball. Recently, I saw a coach on the sidelines screaming at a young player to make her free-throws, and if she missed, she would have to run laps. This reminded me of traditional services to families which threaten, or at best demand a certain level of performance of parents without providing any true "coaching". I often watch our college coach work from a strengths perspective with the team on minute techniques such as the match-up defense and in-bounds plays. This is the approach that family preservation must employ with families, programs, and their communities.

Application of the general linear model to assess the effect of missing data on bone marrow mononuclear cell therapy with infusion timing and follow-up MRI

With most clinical trials, missing data presents a statistical problem in evaluating a treatment's efficacy. There are many methods commonly used to assess missing data; however, these methods leave room for bias to enter the study. This thesis was a secondary analysis on data taken from TIME, a phase 2 randomized clinical trial conducted to evaluate the safety and effect of the administration timing of bone marrow mononuclear cells (BMMNC) for subjects with acute myocardial infarction (AMI).^ We evaluated the effect of missing data by comparing the variance inflation factor (VIF) of the effect of therapy between all subjects and only subjects with complete data. Through the general linear model, an unbiased solution was made for the VIF of the treatment's efficacy using the weighted least squares method to incorporate missing data. Two groups were identified from the TIME data: 1) all subjects and 2) subjects with complete data (baseline and follow-up measurements). After the general solution was found for the VIF, it was migrated Excel 2010 to evaluate data from TIME. The resulting numerical value from the two groups was compared to assess the effect of missing data.^ The VIF values from the TIME study were considerably less in the group with missing data. By design, we varied the correlation factor in order to evaluate the VIFs of both groups. As the correlation factor increased, the VIF values increased at a faster rate in the group with only complete data. Furthermore, while varying the correlation factor, the number of subjects with missing data was also varied to see how missing data affects the VIF. When subjects with only baseline data was increased, we saw a significant rate increase in VIF values in the group with only complete data while the group with missing data saw a steady and consistent increase in the VIF. The same was seen when we varied the group with follow-up only data. This essentially showed that the VIFs steadily increased when missing data is not ignored. When missing data is ignored as with our comparison group, the VIF values sharply increase as correlation increases.^

Factors associated with HPV16 status and survival among patients with squamous cell carcinoma of the oropharynx

Background: Squamous cell carcinoma of the oropharynx (SCCOP) is characterized by local tumor aggressiveness, high recurrence rates, a high incidence of second primary tumors, and medical comorbidities. Significant trends in demographic and clinical characteristics as well as survival among SCCOP patients have been observed over time, likely owing to the changing etiology of the disease. Human papillomavirus type 16 (HPV16) infection is associated with a significant proportion of these cancers. Biomarkers that may aid in identifying patients that are at higher risk of recurrence and death are important so that these patients may be followed more closely to improve their quality of life. ^ Study population and methods: The retrospective review (Specific Aim 2) included 3891 newly diagnosed, previously untreated patients presenting to our institution between 1955 and 2004. A total of 2299 patients treated at our institution were included in survival and recursive partitioning analysis. The prospective cohort study (Specific Aim 3) included 266 patients presenting to our institution between January 2006 and September 2009. ^ Results: The results from the retrospective review showed that over time, patients presented at younger ages and were more likely to have base of tongue/tonsil tumors and to be never/former smokers and moreover survival improved significantly over time. In survival and recursive partitioning analyses, the TNM staging system was efficient in prognosticating patients prior to 1995. However, in the recent decade, the TNM staging system was completely inadequate. The factors having the greatest positive effect on overall survival since 1995 were those common to HPV-associated SCCOP. The results from the prospective cohort study indicate that patients with high nodal stage and those with late stage disease have increased levels of pretreatment serum HPV DNA. ^ Conclusions: We saw a distinct improvement in survival among SCCOP patients over the past 50 years at our institution. The main factors contributing to this were changes in clinical characteristics, in particular surrogates for HPV status. The current TNM staging system for SCCOP is inadequate and incorporation of HPV status (and perhaps smoking status) is encouraged. Furthermore, although pretreatment circulating levels of HPV DNA was associated with higher N category and overall disease stage, it has limited utility as a marker for recurrence among SCCOP patients.^

Hospital district viability and Medicaid /market changes

Hospital districts (HD) that serve the uninsured and the needy face new challenges with the implementation of Medicaid managed. The potential loss of Medicaid patients and revenues may affect the ability to cost-shift and subsequently decrease the ability of the HD to meet its legal obligation of providing care for the uninsured. ^ To investigate HD viability in the current market, the aims of this study were to: (1) describe HD's environment, (2) document the HDs strategic response, (3) document changes in the HD's performance (patient volume) and financial status, and (4) determine whether relationships or trends exist between HD strategy, performance and financial status. ^ To achieve these aims, three Texas HDs (Fort Worth, Lubbock, and San Antonio) were selected to be evaluated. For each HD four types of strategic responses were documented and evaluated for change. In addition, the ability of each HD to sustain operations was evaluated by documenting performance and financial status changes (patient volume and financial ratios). A pre-post case study design method was used in which the Medicaid managed care “rollout'” date, at each site, was the central date. First, a descriptive analysis was performed which documented the environment, strategy, financial status, and patient volume of each hospital district. Second, to compare hospital districts, each hospital district was: (i) classified by a risk index, (ii) classified by its strategic response profile, and (iii) given a performance score based upon pre-post changes in patient volume and financial indicators. ^ Results indicated that all three HDs operate in a high risk environment compared to the rest of the nation. Two HDs chose the “Status Quo” response whereas one HD chose the “Competitive Proactive” response. Medicaid patient volume decreased in two of three HDs whereas indigent patient volume increased in two of the three (an indication of increasing financial risk). Total patient revenues for all HDs increased over the study period; however, the rate of increase slowed for all three after the Medicaid rollout date. All HDs experienced a decline in financial status between pre-post periods with the greatest decline observed in the HD that saw the greatest increase in indigent patient volume. ^ The pre-post case study format used and the lack of control study sites do not allow for assignment of causality. However, the results suggest possible adverse effects of Medicaid managed care and the need for a larger study, based on a stronger evaluation research design. ^

Gregorio Weinberg : el hombre que se hizo libro

Sucinta semblanza y temprana valoración de la vida y la obra de Gregorio Weinberg sobre su quehacer ligado a un vasto proyecto cultural para sentar las bases de un nuevo humanismo incluyente, que tiene en el libro su símbolo más alto. En una primera aproximación se lo descubre siempre preocupado por repensar y corregir la tentación esencialista, a histórica y excluyente en que puede incurrir el quehacer filosófico. Su labor consistió en una vida al servicio de la reflexión crítica, la educación y la edición. Vio en libros, editoriales y bibliotecas, auténticas empresas culturales de largo alcance y radical incidencia en el avance de una sociedad.

Elisabeth de Austria : la mirada de una emperatriz de incógnito

Elísabeth de Austria (1837-1898) no pudo escapar a su destino de emperatriz y reina, pero eso no la detuvo en la búsqueda de la libertad que anhelaba y que desató la crítica de la sociedad vienesa. La artifícialidad y los intereses cortesanos tan diferentes a los suyos, hicieron que escapara cada vez más lejos y durante más tiempo. A los 22 años, seis después de su matrimonio, luego de haber dado a luz al heredero, y por una serie de desavenencias con su marido, comenzó la búsqueda de su individualidad y ya no se detuvo. Madeira, Corfú, Venecia, las termas de Austria y Alemania, su amada Hungría, las ruinas de Grecia y la pasión por los lugares que vieron al legendario Aquiles la llevaron de uno a otro lado. La escritura de sus poemas comenzó cuando ya casi contaba 50 años, y por cuatro años consecutivos llevó un Diario Poético que quedó inconcluso cuando su hijo fue encontrado muerto en Mayerling. Son poemas que denuncian la caducidad de la monarquía, la corrupción de la corte, la falta de amor y comprensión, y que logran su efecto cuando Elísabeth describe los lugares que la conectan con la naturaleza del mundo.

Paleoclimate reconstructions from sediment core MD01-2378

On the basis of the radiocarbon (14C) plateau-tuning method a new age model for Timor Sea Core MD01-2378 was established. It revealed a precise centennial-scale phasing of climate events in the ocean, cryo-, and atmosphere during the last deglacial and provides important new insights into causal linkages controlling events of global climate change. At Site MD01-2378 reservoir ages of surface waters dropped from 1600 yr prior to 20 cal ka to 250-500 yr after 18.8 cal ka. This evidence was crucial for generating a high-resolution age model for deglacial events in the Indo-Pacific Warm Pool. Sea-surface temperatures (SST) started to change near 18.8 cal ka, that is ~500 yr after the start of, presumably northern hemispheric, deglacial melt and sea level rise as shown by the benthic foraminiferal oxygen isotope ratio (d18O). However, the SST rise occurred 500-1000 yr prior to the onset of deglacial Antarctic warming and the first major rise in atmospheric carbon dioxide at about 18 ka. The increase in SST may partly reflect reduced seasonal upwelling of cold subsurface waters along the eastern margin of the Indian Ocean, which is reflected by a doubling of the thermal gradient between the sea surface and the thermocline, a halving of chlorin productivity from 19 to 18.5 cal ka, and in particular, by the strong decrease in surface water reservoir ages. Two significant increases in deglacial Timor Sea surface salinities from 19-18.5 and 15.5-14.5 cal ka, may partly reflect the deglacial increase in the distance of local river mouths, partly an inter-hemispheric millennial-scale see-saw in tropical monsoon intensity, possibly linked to a deglacial increase in the dominance of Pacific El Niño regimes over Heinrich stadial 1.

Stable carbon and oxygen isotope ratios of Paleogene planktonic foraminifera from the Maud Rise

The oxygen and carbon isotopic composition has been measured for numerous Paleogene planktonic foraminifer species from Maud Rise, Weddell Sea (ODP Sites 689 and 690), the first such results from the Antarctic. The results provide information about large-scale changes in the evolution of temperatures, seasonally, and structure of the upper water column prior to the development of a significant Antarctic cryosphere. The early Paleocene was marked by cooler surface-water conditions compared to the Cretaceous and possibly a less well developed thermocline. The late Paleocene and early Eocene saw the expansion of the thermocline as Antarctic surface waters became warm-temperate to subtropical. The late Paleocene to early Eocene thermal maximum was punctuated by two brief excursions during which time the entire Antarctic water column warmed and the meridional temperature gradient was reduced. The first of these excursions occurred at the Paleocene/Eocene boundary, in association with a major extinction in deep sea benthic foraminifers. The second excursion occurred within the early Eocene at ~54.0 Ma. These excursions are of global importance and represent the warmest intervals of the entire Cenozoic. The excursions were associated with fundamental changes in deep-water circulation and global heat transport. The thermal maximum of the early Eocene ended with the initiation of a long-term cooling trend at 52.0 Ma. This cooling trend was associated with reduced seasonality, and diminished structure and/or duration of the seasonal thermocline. The cooling trend was punctuated by three major cooling steps at 43.0, 40.0, and -36.0 Ma.

Théorie des jeux expérimentale & action motrice

How do sportspeople succeed in a non-collaborative game? An illustration of a perverse side effect of altruism Are team sports specialists predisposed to collaboration? The scientific literature on this topic is divided. The present article attempts to end this debate by applying experimental game theory. We constituted three groups of volunteers (all students aged around 20): 25 team sports specialists; 23 individual sports specialists (gymnasts, track & field athletes and swimmers) and a control group of 24 non-sportspeople. Each subgroup was divided into 3 teams that played against each other in turn (and not against teams from other subgroups). The teams played a game based on the well-known Prisoner's Dilemma (Tucker, 1950) - the paradoxical "Bluegill Sunbass Game" (Binmore, 1999) with three Nash equilibria (two suboptimal equilibria with a pure strategy and an optimal equilibrium with a mixed, egotistical strategy (p= 1/2)). This game also features a Harsanyi equilibrium (based on constant compliance with a moral code and altruism by empathy: "do not unto others that which you would not have them do unto you"). How, then, was the game played? Two teams of 8 competed on a handball court. Each team wore a distinctive jersey. The game lasted 15 minutes and the players were allowed to touch the handball ball with their feet or hands. After each goal, each team had to return to its own half of the court. Players were allowed to score in either goal and thus cooperate with their teammates or not, as they saw fit. A goal against the nominally opposing team (a "guardian" strategy, by analogy with the Bluegill Sunbass Game) earned a point for everyone in the team. For an own goal (a "sneaker" strategy), only the scorer earned a point - hence the paradox. If all the members of a team work together to score a goal, everyone is happy (the Harsanyi solution). However, the situation was not balanced in the Nashian sense: each player had a reason to be disloyal to his/her team at the merest opportunity. But if everyone adopts a "sneaker" strategy, the game becomes a free-for-all and the chances of scoring become much slimmer. In a context in which doubt reigns as to the honesty of team members and "legal betrayals", what type of sportsperson will score the most goals? By analogy with the Bluegill Sunbass Game, we recorded direct motor interactions (passes and shots) based on either a "guardian" tactic (i.e. collaboration within the team) or a "sneaker" tactic (shots and passes against the player's designated team). So, was the group of team sports specialist more collaborative than the other two groups? The answer was no. A statistical analysis (difference from chance in a logistic regression) enabled us to draw three conclusions: ?For the team sports specialists, the Nash equilibrium (1950) was stronger than the Harsanyi equilibrium (1977). ?The sporting principles of equilibrium and exclusivity are not appropriate in the Bluegill Sunbass Game and are quickly abandoned by the team sports specialists. The latter are opportunists who focus solely on winning and do well out of it. ?The most altruistic players are the main losers in the Bluegill Sunbass Game: they keep the game alive but contribute to their own defeat. In our experiment, the most altruistic players tended to be the females and the individual sports specialists