The National Health Service (NHS) in England has a capital budget of approximately £4bn per year to spend on the construction and refurbishment of new and existing buildings. The majority of capital costs are committed by early stage design decisions, which have a large impact on operations, costs and performance. It is necessary to incorporate a sociotechnical approach to design as healthcare is a service environment in which patients are part of the system. The design of facilities determines the allocation of space and the interacting flows including: patients, clinicians, visitors, medication, supplies, equipment, and information. The design requires many trade-offs and has a major impact on the patient experience and the quality and efficiency of care. This paper evaluates the application of the Lean 3P (production, preparation, process) participative design method as part of a pilot project to design a new endoscopy unit at Gateshead Health NHS Foundation Trust. The research, which was funded by the Health Foundation, used participant observation, and an analysis of the layout drawings and the 7 flows of medicine to appraise 3P. The existing and proposed designs were compared. The results show that 3P is an effective tool that can develop designs that meet the requirements of multiple stakeholders. A framework was developed that positions 3P within the overall design process. The seven flows of medicine classification was extended to include subcategories and to identify interrelationships between the flows. This will help inform the design of healthcare facilities.
Archaeological evidence indicates that pig domestication had begun by ∼10,500 y before the present (BP) in the Near East, and mitochondrial DNA (mtDNA) suggests that pigs arrived in Europe alongside farmers ∼8,500 y BP. A few thousand years after the introduction of Near Eastern pigs into Europe, however, their characteristic mtDNA signature disappeared and was replaced by haplotypes associated with European wild boars. This turnover could be accounted for by substantial gene flow from local European wild boars, although it is also possible that European wild boars were domesticated independently without any genetic contribution from the Near East. To test these hypotheses, we obtained mtDNA sequences from 2,099 modern and ancient pig samples and 63 nuclear ancient genomes from Near Eastern and European pigs. Our analyses revealed that European domestic pigs dating from 7,100 to 6,000 y BP possessed both Near Eastern and European nuclear ancestry, while later pigs possessed no more than 4% Near Eastern ancestry, indicating that gene flow from European wild boars resulted in a near-complete disappearance of Near East ancestry. In addition, we demonstrate that a variant at a locus encoding black coat color likely originated in the Near East and persisted in European pigs. Altogether, our results indicate that while pigs were not independently domesticated in Europe, the vast majority of human-mediated selection over the past 5,000 y focused on the genomic fraction derived from the European wild boars, and not on the fraction that was selected by early Neolithic farmers over the first 2,500 y of the domestication process.
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