Associations between lean maturity in primary care and musculoskeletal complaints among staff: a longitudinal study.

OBJECTIVE: This study had two aims: (1) to determine the prevalence of musculoskeletal complaints among staff in primary care and (2) to determine to what extent lean maturity of the primary care unit can predict musculoskeletal complaints 1 year later. DESIGN: Descriptive, correlational and longitudinal design. SETTING: Primary care units in mid-Sweden. PARTICIPANTS: In 2015, staff members responded to a web survey addressing lean maturity and musculoskeletal complaints. The survey was completed by 481 staff members (response rate 46%) at 48 units; 260 staff members at 46 units also completed the survey in 2016. OUTCOME MEASURES: Associations with musculoskeletal complaints were determined both for lean maturity in total and for four Lean domains entered separately in a multivariate model, that is, philosophy, processes, people and partners, and problem solving. RESULTS: The shoulders (12-month prevalence: 58%), neck (54%) and low back (50%) were the most common sites of 12-month retrospective musculoskeletal complaints at baseline. Shoulders, neck and low back also showed the most complaints for the preceding 7 days (37%, 33% and 25%, respectively). The prevalence of complaints was similar at the 1-year follow-up. Total lean maturity in 2015 was not associated with musculoskeletal complaints, neither cross-sectionally nor 1 year later, for shoulders (1 year ß: -0.002, 95% CI -0.03 to 0.02), neck (ß: 0.006, 95% CI -0.01 to 0.03), low back (ß: 0.004, 95% CI -0.02 to 0.03) and upper back (ß: 0.002, 95% CI -0.02 to 0.02). CONCLUSION: The prevalence of musculoskeletal complaints among primary care staff was high and did not change within a year. The extent of lean maturity at the care unit was not associated with complaints among staff, neither in cross-sectional analyses nor in a 1-year predictive analysis.

Complex dynamics of water quality mixing in a warm mono-mictic reservoir.

Cycling of water quality constituents in lakes is affected by thermal stratification and homo-thermal conditions and other factors such as oligotrophication, eutrophication, and microbial activities. In addition, hydrological variability can cause greater differences in water residence time and cycling of constituents in man-made lakes (reservoirs) than in natural lakes. Thus, investigations are needed on vertical mixing of constituents in new impounded reservoirs, especially those constructed to supply domestic water. In this study, sampling campaigns were conducted in the Sabalan reservoir, Iran, to investigate vertical changes in constituent concentrations during the year in periods with thermal stratification and homo-thermal conditions. The results revealed incomplete mixing of constituents, even during cold months when the reservoir was homo-thermal. These conditions interacted to create a bottom-up regulated reservoir with sediment that released settled pollutants, impairing water quality in the Sabalan reservoir during both thermal stratification and homo-thermal conditions. Analysis of total nitrogen and total phosphorus concentrations revealed that the reservoir was eutrophic. External pollution loads, internal cycling of pollutants diffusing out from bottom sediments, reductions in inflow to the reservoir, and reservoir operations regulated vertical mixing and concentrations of constituents in the Sabalan reservoir throughout the year.

The electron affinity of astatine.

One of the most important properties influencing the chemical behavior of an element is the electron affinity (EA). Among the remaining elements with unknown EA is astatine, where one of its isotopes, 211At, is remarkably well suited for targeted radionuclide therapy of cancer. With the At- anion being involved in many aspects of current astatine labeling protocols, the knowledge of the electron affinity of this element is of prime importance. Here we report the measured value of the EA of astatine to be 2.41578(7) eV. This result is compared to state-of-the-art relativistic quantum mechanical calculations that incorporate both the Breit and the quantum electrodynamics (QED) corrections and the electron-electron correlation effects on the highest level that can be currently achieved for many-electron systems. The developed technique of laser-photodetachment spectroscopy of radioisotopes opens the path for future EA measurements of other radioelements such as polonium, and eventually super-heavy elements.

Staff perception of Lean, care-giving, thriving and exhaustion: a longitudinal study in primary care.

BACKGROUND: Lean is commonly adopted in healthcare to increase quality of care and efficiency. Few studies of Lean involve staff-related outcomes, and few have a longitudinal design. Thus, the aim was to examine the extent to which changes over time in Lean maturity are associated with changes over time in care-giving, thriving and exhaustion, as perceived by staff, with a particular emphasis on the extent to which job demands and job resources, as perceived by staff, have a moderated mediation effect. METHOD: A longitudinal study with a correlational design was used. In total, 260 staff at 46 primary care units responded to a web survey in 2015 and 2016. All variables in the study were measured using staff ratings. Ratings of Lean maturity reflect participants' judgements regarding the entire unit; ratings of care-giving, thriving, exhaustion and job demands and resources reflect participants' judgements regarding their own situation. RESULTS: First, over time, increased Lean maturity was associated with increased staff satisfaction with their care-giving and increased thriving, mediated by increased job resources. Second, over time, increased Lean maturity was associated with decreased staff exhaustion, mediated by decreased job demands. No evidence was found showing that job demands and job resources had a moderated mediation effect. CONCLUSION: The results indicate that primary care staff may benefit from working in organizations characterized by high levels of Lean maturity and that caregiving may also be improved as perceived by staff.

Lean maturity and quality in primary care.

PURPOSE: The purpose of this paper is twofold: first, to describe Lean maturity in primary care using a questionnaire based on Liker's description of Lean, complemented with observations; and second, to determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines (NG). High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff. DESIGN/METHODOLOGY/APPROACH: Data were collected using a survey based on Liker's four principles, divided into 16 items ( n=298 staff in 45 units). Complementary observations ( n=28 staff) were carried out at four units. FINDINGS: Lean maturity varied both between and within units. The highest Lean maturity was found for "adhering to routines" and the lowest for "having a change agent at the unit." Lean maturity was positively associated with satisfaction with care and with adherence to NG to improve healthcare quality. PRACTICAL IMPLICATIONS: Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker's principles and using the results as guidance for further development. ORIGINALITY/VALUE: This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker's principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.

A questionnaire measuring staff perceptions of Lean adoption in healthcare: development and psychometric testing.

BACKGROUND: During the past decade, the concept of Lean has spread rapidly within the healthcare sector, but there is a lack of instruments that can measure staff's perceptions of Lean adoption. Thus, the aim of the present study was to develop a questionnaire measuring Lean in healthcare, based on Liker's description of Lean, by adapting an existing instrument developed for the service sector. METHODS: A mixed-method design was used. Initially, items from the service sector instrument were categorized according to Liker's 14 principles describing Lean within four domains: philosophy, processes, people and partners and problem-solving. Items were lacking for three of Liker's principles and were therefore developed de novo. Think-aloud interviews were conducted with 12 healthcare staff from different professions to contextualize and examine the face validity of the questionnaire prototype. Thereafter, the adjusted questionnaire's psychometric properties were assessed on the basis of a cross-sectional survey among 386 staff working in primary care. RESULTS: The think-aloud interviews led to adjustments in the questionnaire to better suit a healthcare context, and the number of items was reduced. Confirmatory factor analysis of the adjusted questionnaire showed a generally acceptable correspondence with Liker's description of Lean. Internal consistency, measured using Cronbach's alpha, for the factors in Liker's description of Lean was 0.60 for the factor people and partners, and over 0.70 for the three other factors. Test-retest reliability measured by the intra-class correlation coefficient ranged from 0.77 to 0.88 for the four factors. CONCLUSIONS: We designed a questionnaire capturing staff's perceptions of Lean adoption in healthcare on the basis of Liker's description. This Lean in Healthcare Questionnaire (LiHcQ) showed generally acceptable psychometric properties, which supports its usability for measuring Lean adoption in healthcare. We suggest that further research focus on verifying the usability of LiHcQ in other healthcare settings, and on adjusting the instrument if needed.

A microcontroller-based lock-in amplifier for sub-milliohm resistance measurements.

This paper presents a novel approach to the design of a digital ohmmeter with a resolution of <60 µΩ based on a general-purpose microcontroller and a high-impedance instrumentation amplifier only. The design uses two digital I/O-pins to alternate the current through the sample resistor and combined with a proper firmware routine, the design is a lock-in detector that discriminates any signal that is out of phase/frequency with the reference signal. This makes it possible to selectively detect the µV drop across sample resistors down to 55.6 µΩ using only the current that can be supplied by the digital output pins of a microcontroller. This is achieved without the need for an external reference signal generator and does not rely on the computing processing power of a digital signal processor.

Implementation of high-resolution time-to-digital converter in 8-bit microcontrollers.

This paper will demonstrate how a time-to-digital converter (TDC) with sub-nanosecond resolution can be implemented into an 8-bit microcontroller using so called "direct" methods. This means that a TDC is created using only five bidirectional digital input-output-pins of a microcontroller and a few passive components (two resistors, a capacitor, and a diode). We will demonstrate how a TDC for the range 1-10 µs is implemented with 0.17 ns resolution. This work will also show how to linearize the output by combining look-up tables and interpolation.

The influence of extensive vegetated roofs on runoff water quality.

The influence of extensive sedum-moss vegetated roofs on runoff water quality was studied for four full scale installations located in southern Sweden. The aim of the study was to ascertain whether the vegetated roof behaves as a sink or a source of pollutants and whether the age of a vegetated roof influences runoff quality. The runoff quality from vegetated roofs was also compared with the runoff quality from non-vegetated roofs located in study areas. The following metals and nutrients were investigated: Cd, Cr, Cu, Fe, K, Mn, Pb, Zn, NO3-N, NH4-N, Tot-N, PO4-P, and Tot-P. The results show that, with the exception of nitrogen, vegetated roofs behave as source of contaminants. While in lower concentrations than normally found in urban runoff, some metals appear in concentrations that would correspond to moderately polluted natural water. Nitrate nitrogen is retained by the vegetation or soil or both. Apart from the oldest, the studied vegetated roofs contribute phosphate phosphorus to the runoff. The maintenance of the vegetation systems on the roofs has to be carefully designed in order to avoid storm-water contamination; for instance, the use of easily dissolvable fertilizers should be avoided.