Application of a mathematical model for ergonomics in lean manufacturing.

PubMed

Botti, Lucia; Mora, Cristina; Regattieri, Alberto

2017-10-01

The data presented in this article are related to the research article "Integrating ergonomics and lean manufacturing principles in a hybrid assembly line" (Botti et al., 2017) [1]. The results refer to the application of the mathematical model for the design of lean processes in hybrid assembly lines, meeting both the lean principles and the ergonomic requirements for safe assembly work. Data show that the success of a lean strategy is possible when ergonomics of workers is a parameter of the assembly process design.

Integration of Lean Method in English Language Teaching and Learning: A New Perspective

ERIC Educational Resources Information Center

Tilfarlioglu, Filiz Yalçin; Anwer, Jivan Kamal

2017-01-01

Lean is regarded as a systematic approach to maximizing value by minimizing waste, and by flowing the product or service at the pull of the customer demand. These key concepts of "value," "flow," and "pull," align with the ultimate lean goal: "perfection," or a continuous striving for improvement in the…

The Finnish healthcare services lean management.

PubMed

Hihnala, Susanna; Kettunen, Lilja; Suhonen, Marjo; Tiirinki, Hanna

2018-02-05

Purpose The purpose of this paper is to discuss health services managers' experiences of management in a special health-care unit and development efforts from the point of view of the Lean method. Additionally, the aim is to deepen the knowledge of the managers' work and nature of the Lean method development processes in the workplace. The research focuses on those aspects and results of Lean method that are currently being used in health-care environments. Design/methodology/approach These data were collected through a number of thematic interviews. The participants were nurse managers ( n = 7) and medical managers ( n = 7) who applied Lean management in their work at the University Hospital in the Northern Ostrobothnia Health Care District. The data were analysed with a qualitative content analysis. Findings A common set of values in specialized health-care services, development of activities and challenges for management in the use of the Lean manager development model to improve personal management skills. Practical implications Managers in specialized health-care services can develop and systematically manage with the help of the Lean method. This emphasizes assumptions, from the point of view of management, about systems development when the organization uses the Lean method. The research outcomes originate from specialized health-care settings in Finland in which the Lean method and its associated management principles have been implemented and applied to the delivery of health care. Originality/value The study shows that the research results and in-depth knowledge on Lean method principles can be applied to health-care management and development processes. The research also describes health services managers' experiences of using the Lean method. In the future, these results can be used to improve Lean management skills, identify personal professional competencies and develop skills required in development processes. Also, the research findings can be used in the training of health services managers in the health-care industry worldwide and to help them survive the pressure to change repeatedly.

Lean Production as an Innovative Approach to Construction

NASA Astrophysics Data System (ADS)

Spišáková, Marcela; Kozlovská, Mária

2013-06-01

Lean production presents a new approach to the construction management which has enabled enterprises to attain very high levels of efficiency, competitiveness and flexibility in production systems. Nowadays, a number of industrial processes are managed in accordance with these advanced management principles [1]. The principles of lean production are applied within the integrated design and delivery solutions (IDDS) and prefabricated construction. IDDS uses collaborative work processes and enhanced skills, with integrated data, information, and knowledge management to minimize structural and process inefficiencies and to enhance the value delivered during design, build, and operation, and across projects. Prefabrication presents a one of opportunities for construction methods, which allows the compliance with principles of sustainable design, provides the potential benefits such as faster construction, fewer housing defects, reduction in energy use and waste and elimination of environmental and safety risks. This paper presents the lean production within the IDDS and its potential in the modern prefabrication. There is created a field providing of benefits of lean production in construction industry.

Integrating Behavioral Health in Primary Care Using Lean Workflow Analysis: A Case Study

PubMed Central

van Eeghen, Constance; Littenberg, Benjamin; Holman, Melissa D.; Kessler, Rodger

2016-01-01

Background Primary care offices are integrating behavioral health (BH) clinicians into their practices. Implementing such a change is complex, difficult, and time consuming. Lean workflow analysis may be an efficient, effective, and acceptable method for integration. Objective Observe BH integration into primary care and measure its impact. Design Prospective, mixed methods case study in a primary care practice. Measurements Change in treatment initiation (referrals generating BH visits within the system). Secondary measures: primary care visits resulting in BH referrals, referrals resulting in scheduled appointments, time from referral to scheduled appointment, and time from referral to first visit. Providers and staff were surveyed on the Lean method. Results Referrals increased from 23 to 37/1000 visits (P<.001). Referrals resulted in more scheduled (60% to 74%, P<.001) and arrived visits (44% to 53%, P=.025). Time from referral to first scheduled visit decreased (Hazard Ratio (HR) 1.60; 95% Confidence Interval (CI) 1.37, 1.88; P<0.001) as did time to first arrived visit (HR 1.36; 95% CI 1.14, 1.62; P=0.001). Surveys and comments were positive. Conclusions This pilot integration of BH showed significant improvements in treatment initiation and other measures. Strengths of Lean included workflow improvement, system perspective, and project success. Further evaluation is indicated. PMID:27170796

Participation in leanness sports but not training volume is associated with menstrual dysfunction: a national survey of 1276 elite athletes and controls

PubMed Central

Torstveit, M; Sundgot-Borgen, J

2005-01-01

Objective: To examine the prevalence of menstrual dysfunction in the total population of Norwegian elite female athletes and national representative controls in the same age group. Methods: A detailed questionnaire that included questions on training and/or physical activity patterns, menstrual, dietary, and weight history, oral contraceptive use, and eating disorder inventory subtests was administered to all elite female athletes representing the country at the junior or senior level (aged 13–39 years, n = 938) and national representative controls in the same age group (n = 900). After exclusion, a total of 669 athletes (88.3%) and 607 controls (70.2%) completed the questionnaire satisfactorily. Results: Age at menarche was significantly (p<0.001) later in athletes (13.4 (1.4) years) than in controls (13.0 (1.3) years), and differed among sport groups. A higher percentage of athletes (7.3%) than controls (2.0%) reported a history of primary amenorrhoea (p<0.001). A similar percentage of athletes (16.5%) and controls (15.2%) reported present menstrual dysfunction, but a higher percentage of athletes competing in leanness sports reported present menstrual dysfunction (24.8%) than athletes competing in non-leanness sports (13.1%) (p<0.01) and controls (p<0.05). Conclusions: These novel data include virtually all eligible elite athletes, and thus substantially extend previous studies. Age at menarche occurred later and the prevalence of primary amenorrhoea was higher in elite athletes than in controls. A higher percentage of athletes competing in sports that emphasise thinness and/or a specific weight reported present menstrual dysfunction than athletes competing in sports focusing less on such factors and controls. On the basis of a comparison with a previous study, the prevalence of menstrual dysfunction was lower in 2003 than in 1993. PMID:15728691

The LEAN Payload Integration Process

NASA Technical Reports Server (NTRS)

Jordan, Lee P.; Young, Yancy; Rice, Amanda

2011-01-01

It is recognized that payload development and integration with the International Space Station (ISS) can be complex. This streamlined integration approach is a first step toward simplifying payload integration; making it easier to fly payloads on ISS, thereby increasing feasibility and interest for more research and commercial organizations to sponsor ISS payloads and take advantage of the ISS as a National Laboratory asset. The streamlined integration approach was addressed from the perspective of highly likely initial payload types to evolve from the National Lab Pathfinder program. Payloads to be accommodated by the Expedite the Processing of Experiments for Space Station (EXPRESS) Racks and Microgravity Sciences Glovebox (MSG) pressurized facilities have been addressed. It is hoped that the streamlined principles applied to these types of payloads will be analyzed and implemented in the future for other host facilities as well as unpressurized payloads to be accommodated by the EXPRESS Logistics Carrier (ELC). Further, a payload does not have to be classified as a National Lab payload in order to be processed according to the lean payload integration process; any payload that meets certain criteria can follow the lean payload integration process.

System-wide lean implementation in health care: A multiple case study.

PubMed

Centauri, Federica; Mazzocato, Pamela; Villa, Stefano; Marsilio, Marta

2018-05-01

Background Lean practices have been widely used by health care organizations to meet efficiency, performance and quality improvement needs. The lean health care literature shows that the effective implementation of lean requires a holistic system-wide approach. However, there is still limited evidence on what drives effective system-wide lean implementation in health care. The existing literature suggests that a deeper understanding of how lean interventions interact with the organizational context is necessary to identify the critical variables to successfully sustain system-wide lean strategies. Purpose and methodology: A multiple case study of three Italian hospitals is conducted with the aim to explore the organizational conditions that are relevant for an effective system-wide lean implementation. A conceptual framework, built on socio-technical system schemas, is used to guide data collection and analysis. The analysis points out the importance to support lean implementation with an integrated and coordinated strategy involving the social, technical, and external components of the overall hospital system.

How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children's hospital, Stockholm, Sweden

PubMed Central

2012-01-01

Background There is growing interest in applying lean thinking in healthcare, yet, there is still limited knowledge of how and why lean interventions succeed (or fail). To address this gap, this in-depth case study examines a lean-inspired intervention in a Swedish pediatric Accident and Emergency department. Methods We used a mixed methods explanatory single case study design. Hospital performance data were analyzed using analysis of variance (ANOVA) and statistical process control techniques to assess changes in performance one year before and two years after the intervention. We collected qualitative data through non-participant observations, semi-structured interviews, and internal documents to describe the process and content of the lean intervention. We then analyzed empirical findings using four theoretical lean principles (Spear and Bowen 1999) to understand how and why the intervention worked in its local context as well as to identify its strengths and weaknesses. Results Improvements in waiting and lead times (19-24%) were achieved and sustained in the two years following lean-inspired changes to employee roles, staffing and scheduling, communication and coordination, expertise, workspace layout, and problem solving. These changes resulted in improvement because they: (a) standardized work and reduced ambiguity, (b) connected people who were dependent on one another, (c) enhanced seamless, uninterrupted flow through the process, and (d) empowered staff to investigate problems and to develop countermeasures using a "scientific method". Contextual factors that may explain why not even greater improvement was achieved included: a mismatch between job tasks, licensing constraints, and competence; a perception of being monitored, and discomfort with inter-professional collaboration. Conclusions Drawing on Spear and Bowen's theoretical propositions, this study explains how a package of lean-like changes translated into better care process management. It adds new knowledge regarding how lean principles can be beneficially applied in healthcare and identifies changes to professional roles as a potential challenge when introducing lean thinking there. This knowledge may enable health care organizations and managers in other settings to configure their own lean program and to better understand the reasons behind lean's success (or failure). PMID:22296919

How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children's hospital, Stockholm, Sweden.

PubMed

Mazzocato, Pamela; Holden, Richard J; Brommels, Mats; Aronsson, Håkan; Bäckman, Ulrika; Elg, Mattias; Thor, Johan

2012-02-01

There is growing interest in applying lean thinking in healthcare, yet, there is still limited knowledge of how and why lean interventions succeed (or fail). To address this gap, this in-depth case study examines a lean-inspired intervention in a Swedish pediatric Accident and Emergency department. We used a mixed methods explanatory single case study design. Hospital performance data were analyzed using analysis of variance (ANOVA) and statistical process control techniques to assess changes in performance one year before and two years after the intervention. We collected qualitative data through non-participant observations, semi-structured interviews, and internal documents to describe the process and content of the lean intervention. We then analyzed empirical findings using four theoretical lean principles (Spear and Bowen 1999) to understand how and why the intervention worked in its local context as well as to identify its strengths and weaknesses. Improvements in waiting and lead times (19-24%) were achieved and sustained in the two years following lean-inspired changes to employee roles, staffing and scheduling, communication and coordination, expertise, workspace layout, and problem solving. These changes resulted in improvement because they: (a) standardized work and reduced ambiguity, (b) connected people who were dependent on one another, (c) enhanced seamless, uninterrupted flow through the process, and (d) empowered staff to investigate problems and to develop countermeasures using a "scientific method". Contextual factors that may explain why not even greater improvement was achieved included: a mismatch between job tasks, licensing constraints, and competence; a perception of being monitored, and discomfort with inter-professional collaboration. Drawing on Spear and Bowen's theoretical propositions, this study explains how a package of lean-like changes translated into better care process management. It adds new knowledge regarding how lean principles can be beneficially applied in healthcare and identifies changes to professional roles as a potential challenge when introducing lean thinking there. This knowledge may enable health care organizations and managers in other settings to configure their own lean program and to better understand the reasons behind lean's success (or failure).

What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review.

PubMed

Rotter, Thomas; Plishka, Christopher; Lawal, Adegboyega; Harrison, Liz; Sari, Nazmi; Goodridge, Donna; Flynn, Rachel; Chan, James; Fiander, Michelle; Poksinska, Bonnie; Willoughby, Keith; Kinsman, Leigh

2018-01-01

Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization's mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.

The lean service machine.

PubMed

Swank, Cynthia Karen

2003-10-01

Jefferson Pilot Financial, a life insurance and annuities firm, like many U.S. service companies at the end of the 1990s was looking for new ways to grow. Its top managers recognized that JPF needed to differentiate itself in the eyes of its customers, the independent life-insurance advisers who sell and service policies. To establish itself as these advisers' preferred partner, it set out to reduce the turnaround time on policy applications, simplify the submission process, and reduce errors. JPF's managers looked to the "lean production" practices that U.S. manufacturers adopted in response to competition from Japanese companies. Lean production is built around the concept of continuous-flow processing--a departure from traditional production systems, in which large batches are processed at each step. JPF appointed a "lean team" to reengineer its New Business unit's operations, beginning with the creation of a "model cell"--a fully functioning microcosm of JPF's entire process. This approach allowed managers to experiment and smooth out the kinks while working toward an optimal design. The team applied lean-manufacturing practices, including placing linked processes near one another, balancing employees' workloads, posting performance results, and measuring performance and productivity from the customer's perspective. Customer-focused metrics helped erode the employees' "My work is all that matters" mind-set. The results were so impressive that JPF is rolling out similar systems across many of its operations. To convince employees of the value of lean production, the lean team introduced a simulation in which teams compete to build the best paper airplane based on invented customer specifications. This game drives home lean production's basic principles, establishing a foundation for deep and far-reaching changes in the production system.

Association of fat to lean mass ratio with metabolic dysfunction in women with polycystic ovary syndrome

PubMed Central

Ezeh, Uche; Pall, Marita; Mathur, Ruchi; Azziz, Ricardo

2014-01-01

STUDY QUESTION Are differences in metabolic dysfunction between polycystic ovary syndrome (PCOS) and control women related to differences in their fat to lean mass (F/L) ratio? SUMMARY ANSWER Compared with controls of similar body mass index (BMI), women with PCOS demonstrate adverse body composition characterized by increased whole body fat relative to lean mass (i.e. a higher F/L ratio), which is associated with differences in metabolic dysfunction between the two groups. WHAT IS KNOWN ALREADY Previous studies examining body composition and insulin resistance (IR) in PCOS have yielded conflicting results. Excess total fat mass (i.e. fat mass index [fat BMI]) correlates with IR, whereas increased total lean mass (i.e. lean BMI) has been associated with higher insulin sensitivity. However, the role of the F/L ratio, which integrates the antagonistic effects of both fat and lean mass depots, on IR in PCOS, has not been investigated. STUDY DESIGN, SIZE, DURATION We conducted a prospective cross-sectional study of 120 women between the ages of 22–44 years to study the relation of the F/L ratio with measures of insulin action and secretion in both steady and dynamic states. PARTICIPANTS/MATERIALS, SETTING, METHODS Sixty PCOS (by NIH, 1990 criteria) and 60 control (age, race and BMI-matched) women were prospectively studied for body composition (by bioelectrical impedance analysis [BIA]) and basal IR and insulin secretion by the homeostasis model assessment (HOMA-IR and HOMA-%β-cell function, respectively) in a tertiary care academic referral center. A subset of 12 PCOS and 12 matched control women also underwent a modified frequently sampled intravenous glucose tolerance test (FSIVGTT) to determine glucose uptake and insulin secretion in dynamic state. MAIN RESULTS AND THE ROLE OF CHANCE Our results indicate that women with PCOS demonstrated greater degrees of hyperandrogenism, and higher waist-to-hip ratio (WHR), %body fat, fat BMI, F/L, fasting insulin levels, and HOMA-IR and HOMA-%β-cell values, than controls. In models adjusted for WHR and free testosterone and diagnostic groups, fasting insulin levels, HOMA-IR, and HOMA-%beta cell function were positively related to the F/L ratio. A positive relationship was also found in both study groups between F/L and the FSIVGTT measures insulin sensitivity (Si) and acute insulin response to glucose (AIRg). The F/L tended to negatively correlate with glucose effectiveness or non-insulin-mediated glucose transport (Sg) only in PCOS women. LIMITATIONS, REASONS FOR CAUTION Regional tissue sub-compartments, which have been shown to have potential independent associations with metabolic variables, cannot be determined by bioelectrical impedance analysis (BIA). WIDER IMPLICATIONS OF THE FINDINGS The current results suggest that BIA could be used to assess F/L in place of dual energy X-ray absorptiometry (DXA) in research protocols, and that F/L could possibly be used as an alternative to WHR as a surrogate marker of metabolic dysfunction in clinical practice. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by grants R01-DK073632 and R01-HD29364 from the NIH and an endowment of the Helping Hand of Los Angeles, Inc. (to R.A.). The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER Not applicable. PMID:24813197

Integrating Behavioral Health in Primary Care Using Lean Workflow Analysis: A Case Study.

PubMed

van Eeghen, Constance; Littenberg, Benjamin; Holman, Melissa D; Kessler, Rodger

2016-01-01

Primary care offices are integrating behavioral health (BH) clinicians into their practices. Implementing such a change is complex, difficult, and time consuming. Lean workflow analysis may be an efficient, effective, and acceptable method for use during integration. The objectives of this study were to observe BH integration into primary care and to measure its impact. This was a prospective, mixed-methods case study in a primary care practice that served 8,426 patients over a 17-month period, with 652 patients referred to BH services. Secondary measures included primary care visits resulting in BH referrals, referrals resulting in scheduled appointments, time from referral to the scheduled appointment, and time from the referral to the first visit. Providers and staff were surveyed on the Lean method. Referrals increased from 23 to 37 per 1000 visits (P < .001). Referrals resulted in more scheduled (60% to 74%; P < .001) and arrived visits (44% to 53%; P = .025). Time from referral to the first scheduled visit decreased (hazard ratio, 1.60; 95% confidence interval, 1.37-1.88) as did time to first arrived visit (hazard ratio, 1.36; 95% confidence interval, 1.14-1.62). Survey responses and comments were positive. This pilot integration of BH showed significant improvements in treatment initiation and other measures. Strengths of Lean analysis included workflow improvement, system perspective, and project success. Further evaluation is indicated. © Copyright 2016 by the American Board of Family Medicine.

Lean Gasoline System Development for Fuel Efficient Small Cars

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, Stuart R.

2013-11-25

The General Motors and DOE cooperative agreement program DE-EE0003379 is completed. The program has integrated and demonstrated a lean-stratified gasoline engine, a lean aftertreatment system, a 12V Stop/Start system and an Active Thermal Management system along with the necessary controls that significantly improves fuel efficiency for small cars. The fuel economy objective of an increase of 25% over a 2010 Chevrolet Malibu and the emission objective of EPA T2B2 compliance have been accomplished. A brief review of the program, summarized from the narrative is: The program accelerates development and synergistic integration of four cost competitive technologies to improve fuel economymore » of a light-duty vehicle by at least 25% while meeting Tier 2 Bin 2 emissions standards. These technologies can be broadly implemented across the U.S. light-duty vehicle product line between 2015 and 2025 and are compatible with future and renewable biofuels. The technologies in this program are: lean combustion, innovative passive selective catalyst reduction lean aftertreatment, 12V stop/start and active thermal management. The technologies will be calibrated in a 2010 Chevrolet Malibu mid-size sedan for final fuel economy demonstration.« less

Application of lean thinking to health care: issues and observations

PubMed Central

Joosten, Tom; Bongers, Inge; Janssen, Richard

2009-01-01

Background Incidents and quality problems are a prime cause why health care leaders are calling to redesign health care delivery. One of the concepts used is lean thinking. Yet, lean often leads to resistance. Also, there is a lack of high quality evidence supporting lean premises. In this paper, we present an overview of lean thinking and its application to health care. Development, theory and application of lean thinking to health care Lean thinking evolved from a tool designed to improve operational shop-floor performance at an automotive manufacturer to a management approach with both operational and sociotechnical aspects. Sociotechnical dynamics have until recently not received much attention. At the same time a balanced approach might lead to a situation where operational and sociotechnial improvements are mutually reinforcing. Application to health care has been limited and focussed mainly on operational aspects using original lean tools. A more integrative approach would be to pay more attention to sociotechnical dynamics of lean implementation efforts. Also, the need to use the original lean tools may be limited, because health care may have different instruments and tools already in use that are in line with lean thinking principles. Discussion We believe lean thinking has the potential to improve health care delivery. At the same time, there are methodological and practical considerations that need to be taken into account. Otherwise, lean implementation will be superficial and fail, adding to existing resistance and making it more difficult to improve health care in the long term. PMID:19696048

Lean thinking in health and nursing: an integrative literature review 1

PubMed Central

Magalhães, Aline Lima Pestana; Erdmann, Alacoque Lorenzini; da Silva, Elza Lima; dos Santos, José Luís Guedes

2016-01-01

ABSTRACT Objectives: to demonstrate the scientific knowledge developed on lean thinking in health, highlighting the impact and contributions in health care and nursing. Method: an integrative literature review in the PubMed, CINAHL, Scopus, Web of Science, Emerald, LILACS and SciELO electronic library databases, from 2006 to 2014, with syntax keywords for each data base, in which 47 articles were selected for analysis. Results: the categories were developed from the quality triad proposed by Donabedian: structure, process and outcome. Lean thinking is on the rise in health surveys, particularly internationally, especially in the USA and UK, improving the structure, process and outcome of care and management actions. However, it is an emerging theme in nursing. Conclusion: this study showed that the use of lean thinking in the context of health has a transforming effect on care and organizational aspects, promoting advantages in terms of quality, safety and efficiency of health care and nursing focused on the patient. PMID:27508906

A healthcare Lean Six Sigma System for postanesthesia care unit workflow improvement.

PubMed

Kuo, Alex Mu-Hsing; Borycki, Elizabeth; Kushniruk, Andre; Lee, Te-Shu

2011-01-01

The aim of this article is to propose a new model called Healthcare Lean Six Sigma System that integrates Lean and Six Sigma methodologies to improve workflow in a postanesthesia care unit. The methodology of the proposed model is fully described. A postanesthesia care unit case study is also used to demonstrate the benefits of using the Healthcare Lean Six Sigma System model by combining Lean and Six Sigma methodologies together. The new model bridges the service gaps between health care providers and patients, balances the requirements of health care managers, and delivers health care services to patients by taking the benefits of the Lean speed and Six Sigma high-quality principles. The full benefits of the new model will be realized when applied at both strategic and operational levels. For further research, we will examine how the proposed model is used in different real-world case studies.

Lean principles and defense information technology acquisition: An investigation of the determinants of successful application

NASA Astrophysics Data System (ADS)

Haley, M.

The purpose of this study was to investigate whether or not there have been successful applications of lean manufacturing principles in highly variable defense IT environments. Specifically, the study assessed if implementation of the lean philosophies by a defense organization yielded repeatable, predictable results in software release schedules reductions. Additionally, the study set out to determine what potential critical success factors (CSF's) were documented in the secondary data captured for each release, and extracted the variables used in the decision making for acceptability of fielding. In evaluating lean applicability to the high variability environment of USAF IT acquisitions, the research was conducted using non-experimental quantitative methods of archival secondary data. The sample for this case study was compiled from a USAF office that had implemented these techniques in pre-development, development and testing, and fielding phases. Based on the research data, acquisitionists and lean practitioners are inherently interconnected. Therefore, an understanding that critical success factors (CSFs) are integral to successful lean application in DoD IT acquisitions is crucial. Through a combination of synergistic alignments, plyometric CSFs were discovered to maximize the effects of each single CSF to produce rapid results in defense IT acquisitions. These include: (1) Enterprise Incorporation, (2) Team Trust, (3) Transformational Leadership, (4) Recursive Improvement, (5) Integrated Synergy, (6) Customer-Centric Culture and (7) Heuristic Communication.

Application of Hands-On Simulation Games to Improve Classroom Experience

ERIC Educational Resources Information Center

Hamzeh, Farook; Theokaris, Christina; Rouhana, Carel; Abbas, Yara

2017-01-01

While many construction companies claim substantial productivity and profit gains when applying lean construction principles, it remains a challenge to teach these principles in a classroom. Lean construction emphasises collaborative processes and integrated delivery practices. Consequently, new teaching methods that nurture such values should…

[Sustainable process improvement with application of 'lean philosophy'].

PubMed

Rouppe van der Voort, Marc B V; van Merode, G G Frits; Veraart, Henricus G N

2013-01-01

Process improvement is increasingly being implemented, particularly with the aid of 'lean philosophy'. This management philosophy aims to improve quality by reducing 'wastage'. Local improvements can produce negative effects elsewhere due to interdependence of processes. An 'integrated system approach' is required to prevent this. Some hospitals claim that this has been successful. Research into process improvement with the application of lean philosophy has reported many positive effects, defined as improved safety, quality and efficiency. Due to methodological shortcomings and lack of rigorous evaluations it is, however, not yet possible to determine the impact of this approach. It is, however, obvious that the investigated applications are fragmentary, with a dominant focus on the instrumental aspect of the philosophy and a lack of integration in a total system, and with insufficient attention to human aspects. Process improvement is required to achieve better and more goal-oriented healthcare. To achieve this, hospitals must develop integrated system approaches that combine methods for process design with continuous improvement of processes and with personnel management. It is crucial that doctors take the initiative to guide and improve processes in an integral manner.

Creating a Meaningful Learning Environment: Reflection in Leadership Education

ERIC Educational Resources Information Center

White, Jillian Volpe; Guthrie, Kathy L.

2016-01-01

This article examines the use of a book discussion as an instructional tool for developing leadership exploration competency skills in university students, as it pertains to the study of women and leadership. A book discussion centered on Sheryl Sandberg's book "Lean In" was held as a means to conceptualize discourse regarding leadership…

77 FR 11195 - Announcement of Competition Under the America COMPETES Reauthorization Act of 2011: Badges for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-24

....dmlcompetition.net/Competition/4/badges-projects.php?id=2667 . VA does not anticipate that it will issue badges... lean Six Sigma. Law Enforcement, which may include specialties such as criminal investigation and... alternative fuels. Information Technology, including all phases of software development and IT project...

Evaluation de l'effet des concepts de la production allegee dans une entreprise aeronautique

NASA Astrophysics Data System (ADS)

Moknine, Myriam

This research focuses on a project to implement a Lean approach in Quebec's aerospace business, that of Bombardier Aerospace. Developed for the automobile industry since the 1950s, the Lean has expanded its practices to various industry sectors, including the international aircraft industry, and more specifically the Quebec aircraft industry. Today, numerous companies turn more and more to the Lean Manufacturing approach to improve their competitiveness and their performance levels. The review of the literature on the Lean has allowed us to further understand the topic and more specifically its application in the aerospace sector. The Lean approach allows the improvement of operational performance indicators such as the reduction of production costs, cycle times, travel and inventories, as well as the improvement of the versatility of employees. The Lean has succeeded where many other organisational models have failed. Several success factors such as employee involvement, leadership commitment, proper integration of all tools and many others must be used in the implementation of such production practice. However, this approach is sometimes criticized by some authors who suggest that the improvements made by the Lean result in an increase in the workload of employees and a deterioration of their stress levels. Our research on the Lean has revealed gaps in available and existing research and data on the subject, particularly in the aerospace sector. This research has helped to fill this important gap, by documenting the context and highlighting the impact of the Lean on a production system in the Quebec aerospace components. A machining center having deployed a Lean approach was chosen to conduct a case study in post-implantation. Tools for data collection such as observations on the production floor, semi-structured interviews, as well as the Lean checklist, were used to perform this case study. The case study has confirmed the positive impact of Lean on operational performance indicators of the company. The results of this case study showed a reduction of cycle time of 49%, a reduction of unnecessary employee travels of 50% and a reduction of production costs by about 50%. In addition to these positive discoveries, our study has highlighted an important human benefit in the business such as an improvement in the versatility of employees by 25%. In addition, the study also demonstrated that the integration and assimilation of the Lean concepts is made with a proven success. Indeed, analysis on results from the checklist showed that the level of Lean concepts maturity progressed favorably in the period from pre-project until that in post-project. This research brings an added value to the scientific literature. It thus helps to disseminate data in a Lean implementation in a production area of Quebec aerospace products.

Proposal for a Conceptual Model for Evaluating Lean Product Development Performance: A Study of LPD Enablers in Manufacturing Companies

NASA Astrophysics Data System (ADS)

Osezua Aikhuele, Daniel; Mohd Turan, Faiz

2016-02-01

The instability in today's market and the emerging demands for mass customized products by customers, are driving companies to seek for cost effective and time efficient improvements in their production system and this have led to real pressure for the adaptation of new developmental architecture and operational parameters to remain competitive in the market. Among such developmental architecture adopted, is the integration of lean thinking in the product development process. However, due to lack of clear understanding of the lean performance and its measurements, many companies are unable to implement and fully integrate the lean principle into their product development process and without a proper performance measurement, the performance level of the organizational value stream will be unknown and the specific area of improvement as it relates to the LPD program cannot be tracked. Hence, it will result in poor decision making in the LPD implementation. This paper therefore seeks to present a conceptual model for evaluation of LPD performances by identifying and analysing the core existing LPD enabler (Chief Engineer, Cross-functional teams, Set-based engineering, Poka-yoke (mistakeproofing), Knowledge-based environment, Value-focused planning and development, Top management support, Technology, Supplier integration, Workforce commitment and Continuous improvement culture) for assessing the LPD performance.

The relative benefits of green versus lean office space: three field experiments.

PubMed

Nieuwenhuis, Marlon; Knight, Craig; Postmes, Tom; Haslam, S Alexander

2014-09-01

Principles of lean office management increasingly call for space to be stripped of extraneous decorations so that it can flexibly accommodate changing numbers of people and different office functions within the same area. Yet this practice is at odds with evidence that office workers' quality of life can be enriched by office landscaping that involves the use of plants that have no formal work-related function. To examine the impact of these competing approaches, 3 field experiments were conducted in large commercial offices in The Netherlands and the U.K. These examined the impact of lean and "green" offices on subjective perceptions of air quality, concentration, and workplace satisfaction as well as objective measures of productivity. Two studies were longitudinal, examining effects of interventions over subsequent weeks and months. In all 3 experiments enhanced outcomes were observed when offices were enriched by plants. Implications for theory and practice are discussed. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Car Assembly Line Efficiency Improvement by Lean Principle

NASA Astrophysics Data System (ADS)

Sawassalung, Suwalee; Chutima, Parames

2017-06-01

This research aimed to increase the efficiency of actual working time to compare to design standard time ratio (DSTR) as per analysing process of Lean System of the assembly line in a car manufacturer in Thailand. Currently, the case study factory and its group of factories, which have many branches all over the world, have competed with each other on quality, delivered time and production cost. The production cost which can reduce without affecting quality and acceptable by clients is the manpower cost. The index of competition is DSTR. The factory now has DSTR of 6.13 and DSTR of the assembly department is 4.24 which is very high comparing to other departments. The low DSTR indicates that the factory has good quality. The ways to solve the problem are to apply the following tools, i.e. Lean principle, Value Stream Mapping (VSM), Waste Analysis and ECRS. After implementing the above tools, the results showed that DSTR decreased from 4.24 to 4.06 or 4.25%.

Much Needed Structure [Structured Decision-Making with DMRCS. Define-Measure-Reduce-Combine-Select

DOE PAGES

Anderson-Cook, Christine M.; Lu, Lu

2015-10-01

We have described a new DMRCS process for structured decision making, which mirrors the approach of the DMAIC process which has become so popular within Lean Six Sigma. By dividing a complex often unstructured process into distinct steps, we hope to have made the task of balancing multiple competing objectives less daunting.

Does Lean healthcare improve patient satisfaction? A mixed-method investigation into primary care.

PubMed

Poksinska, Bozena Bonnie; Fialkowska-Filipek, Malgorzata; Engström, Jon

2017-02-01

Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction. This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time. Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time. Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Acoustic Benefits of Stator Sweep and Lean for a High Tip Speed Fan

NASA Technical Reports Server (NTRS)

Woodward, Richard P.; Gazzaniga, John A.; Bartos, Linda J.; Hughes, Christopher E.

2002-01-01

A model high-speed fan stage was acoustically tested in the NASA Glenn 9- by 15-Foot Low Speed Wind Tunnel at takeoff/approach flight conditions. The fan was designed for a corrected rotor tip speed of 442 m/s (1450 ft/s), and had a powered core, or booster stage, giving the model a nominal bypass ratio of 5. The model also had a simulated engine pylon and nozzle bifurcation contained within the bypass duct. The fan was tested with three stator sets to evaluate acoustic benefits associated with a swept and leaned stator and with a swept integral vane/frame stator which incorporated some of the swept and leaned features as well as eliminated some of the downstream support structure. The baseline fan with the wide chord rotor and baseline stator approximated a current GEAE CF6 engine. A flyover effective perceived noise level (EPNL) code was used to generate relative EPNL values for the various configurations. Flyover effective perceived noise levels (EPNL) were computed from the model data to help project noise benefits. A tone removal study was also performed. The swept and leaned stator showed a 3 EPNdB reduction at lower fan speeds relative to the baseline stator; while the swept integral vane/frame stator showed lowest noise levels at intermediate fan speeds. Removal of the bypass blade passage frequency rotor tone (BPF) showed a 4 EPNdB reduction for the baseline and swept and leaned stators, and a 6 EPNdB reduction for the swept integral vane/ frame stator. Therefore, selective tone removal techniques such as active noise control and/or tuned liner could be particularly effective in reducing noise levels for certain fan speeds.

A fuzzy model for achieving lean attributes for competitive advantages development using AHP-QFD-PROMETHEE

NASA Astrophysics Data System (ADS)

Roghanian, E.; Alipour, Mohammad

2014-06-01

Lean production has become an integral part of the manufacturing landscape as its link with superior performance and its ability to provide competitive advantage is well accepted among academics and practitioners. Lean production helps producers in overcoming the challenges organizations face through using powerful tools and enablers. However, most companies are faced with restricted resources such as financial and human resources, time, etc., in using these enablers, and are not capable of implementing all these techniques. Therefore, identifying and selecting the most appropriate and efficient tool can be a significant challenge for many companies. Hence, this literature seeks to combine competitive advantages, lean attributes, and lean enablers to determine the most appropriate enablers for improvement of lean attributes. Quality function deployment in fuzzy environment and house of quality matrix are implemented. Throughout the methodology, fuzzy logic is the basis for translating linguistic judgments required for the relationships and correlation matrix to numerical values. Moreover, for final ranking of lean enablers, a multi-criteria decision-making method (PROMETHEE) is adopted. Finally, a case study in automotive industry is presented to illustrate the implementation of the proposed methodology.

Low NOx heavy fuel combustor concept program. Phase 1: Combustion technology generation

NASA Astrophysics Data System (ADS)

Lew, H. G.; Carl, D. R.; Vermes, G.; Dezubay, E. A.; Schwab, J. A.; Prothroe, D.

1981-10-01

The viability of low emission nitrogen oxide (NOx) gas turbine combustors for industrial and utility application. Thirteen different concepts were evolved and most were tested. Acceptable performance was demonstrated for four of the combustors using ERBS fuel and ultralow NOx emissions were obtained for lean catalytic combustion. Residual oil and coal derived liquids containing fuel bound nitrogen (FBN) were also used at test fuels, and it was shown that staged rich/lean combustion was effective in minimizing the conversion of FBN to NOx. The rich/lean concept was tested with both modular and integral combustors. While the ceramic lined modular configuration produced the best results, the advantages of the all metal integral burners make them candidates for future development. An example of scaling the laboratory sized combustor to a 100 MW size engine is included in the report as are recommendations for future work.

Analytic network process model for sustainable lean and green manufacturing performance indicator

NASA Astrophysics Data System (ADS)

Aminuddin, Adam Shariff Adli; Nawawi, Mohd Kamal Mohd; Mohamed, Nik Mohd Zuki Nik

2014-09-01

Sustainable manufacturing is regarded as the most complex manufacturing paradigm to date as it holds the widest scope of requirements. In addition, its three major pillars of economic, environment and society though distinct, have some overlapping among each of its elements. Even though the concept of sustainability is not new, the development of the performance indicator still needs a lot of improvement due to its multifaceted nature, which requires integrated approach to solve the problem. This paper proposed the best combination of criteria en route a robust sustainable manufacturing performance indicator formation via Analytic Network Process (ANP). The integrated lean, green and sustainable ANP model can be used to comprehend the complex decision system of the sustainability assessment. The finding shows that green manufacturing is more sustainable than lean manufacturing. It also illustrates that procurement practice is the most important criteria in the sustainable manufacturing performance indicator.

Low NOx heavy fuel combustor concept program. Phase 1: Combustion technology generation

NASA Technical Reports Server (NTRS)

Lew, H. G.; Carl, D. R.; Vermes, G.; Dezubay, E. A.; Schwab, J. A.; Prothroe, D.

1981-01-01

The viability of low emission nitrogen oxide (NOx) gas turbine combustors for industrial and utility application. Thirteen different concepts were evolved and most were tested. Acceptable performance was demonstrated for four of the combustors using ERBS fuel and ultralow NOx emissions were obtained for lean catalytic combustion. Residual oil and coal derived liquids containing fuel bound nitrogen (FBN) were also used at test fuels, and it was shown that staged rich/lean combustion was effective in minimizing the conversion of FBN to NOx. The rich/lean concept was tested with both modular and integral combustors. While the ceramic lined modular configuration produced the best results, the advantages of the all metal integral burners make them candidates for future development. An example of scaling the laboratory sized combustor to a 100 MW size engine is included in the report as are recommendations for future work.

Toward a Greater Understanding: Utilizing Book Discussions to Effectively Engage Students in the Exploration of Women and Leadership Issues

ERIC Educational Resources Information Center

Scott, Heather Inez Ricks

2016-01-01

This article examines the use of a book discussion as an instructional tool for developing leadership competency skills in female university students. A book discussion centered on Sheryl Sandberg's book "Lean In" was held as a means to conceptualize discourse regarding leadership issues in the arena of women and leadership in a…

Abnormal cholesterol is associated with prefrontal white matter abnormalities among obese adults, a diffusion tensor imaging study

PubMed Central

Cohen, Jessica I.; Cazettes, Fanny; Convit, Antonio

2011-01-01

The brain is the most cholesterol-rich organ in the body. Although most of the cholesterol in the brain is produced endogenously, some studies suggest that systemic cholesterol may be able to enter the brain. We investigated whether abnormal cholesterol profiles correlated with diffusion-tensor-imaging-based estimates of white matter microstructural integrity of lean and overweight/obese (o/o) adults. Twenty-two lean and 39 obese adults underwent magnetic resonance imaging, kept a 3-day food diary, and had a standardized assessment of fasting blood lipids. The lean group ate less cholesterol rich food than o/o although both groups ate equivalent servings of food per day. Voxelwise correlational analyses controlling for age, diabetes, and white matter hyperintensities, resulted in two significant clusters of negative associations between abnormal cholesterol profile and fractional anisotropy, located in the left and right prefrontal lobes. When the groups were split, the lean subjects showed no associations, whereas the o/o group expanded the association to three significant clusters, still in the frontal lobes. These findings suggest that cholesterol profile abnormalities may explain some of the reductions in white matter microstructural integrity that are reported in obesity. PMID:22163070

Real-Time Control of Lean Blowout in a Turbine Engine for Minimizing No(x) Emissions

NASA Technical Reports Server (NTRS)

Zinn, Ben

2004-01-01

This report describes research on the development and demonstration of a controlled combustor operates with minimal NO, emissions, thus meeting one of NASA s UEET program goals. NO(x) emissions have been successfully minimized by operating a premixed, lean burning combustor (modeling a lean prevaporized, premixed LPP combustor) safely near its lean blowout (LBO) limit over a range of operating conditions. This was accomplished by integrating the combustor with an LBO precursor sensor and closed-loop, rule-based control system that allowed the combustor to operate far closer to the point of LBO than an uncontrolled combustor would be allowed to in a current engine. Since leaner operation generally leads to lower NO, emissions, engine NO, was reduced without loss of safety.

Evaluation of the clinical process in a critical care information system using the Lean method: a case study

PubMed Central

2012-01-01

Background There are numerous applications for Health Information Systems (HIS) that support specific tasks in the clinical workflow. The Lean method has been used increasingly to optimize clinical workflows, by removing waste and shortening the delivery cycle time. There are a limited number of studies on Lean applications related to HIS. Therefore, we applied the Lean method to evaluate the clinical processes related to HIS, in order to evaluate its efficiency in removing waste and optimizing the process flow. This paper presents the evaluation findings of these clinical processes, with regards to a critical care information system (CCIS), known as IntelliVue Clinical Information Portfolio (ICIP), and recommends solutions to the problems that were identified during the study. Methods We conducted a case study under actual clinical settings, to investigate how the Lean method can be used to improve the clinical process. We used observations, interviews, and document analysis, to achieve our stated goal. We also applied two tools from the Lean methodology, namely the Value Stream Mapping and the A3 problem-solving tools. We used eVSM software to plot the Value Stream Map and A3 reports. Results We identified a number of problems related to inefficiency and waste in the clinical process, and proposed an improved process model. Conclusions The case study findings show that the Value Stream Mapping and the A3 reports can be used as tools to identify waste and integrate the process steps more efficiently. We also proposed a standardized and improved clinical process model and suggested an integrated information system that combines database and software applications to reduce waste and data redundancy. PMID:23259846

Evaluation of the clinical process in a critical care information system using the Lean method: a case study.

PubMed

Yusof, Maryati Mohd; Khodambashi, Soudabeh; Mokhtar, Ariffin Marzuki

2012-12-21

There are numerous applications for Health Information Systems (HIS) that support specific tasks in the clinical workflow. The Lean method has been used increasingly to optimize clinical workflows, by removing waste and shortening the delivery cycle time. There are a limited number of studies on Lean applications related to HIS. Therefore, we applied the Lean method to evaluate the clinical processes related to HIS, in order to evaluate its efficiency in removing waste and optimizing the process flow. This paper presents the evaluation findings of these clinical processes, with regards to a critical care information system (CCIS), known as IntelliVue Clinical Information Portfolio (ICIP), and recommends solutions to the problems that were identified during the study. We conducted a case study under actual clinical settings, to investigate how the Lean method can be used to improve the clinical process. We used observations, interviews, and document analysis, to achieve our stated goal. We also applied two tools from the Lean methodology, namely the Value Stream Mapping and the A3 problem-solving tools. We used eVSM software to plot the Value Stream Map and A3 reports. We identified a number of problems related to inefficiency and waste in the clinical process, and proposed an improved process model. The case study findings show that the Value Stream Mapping and the A3 reports can be used as tools to identify waste and integrate the process steps more efficiently. We also proposed a standardized and improved clinical process model and suggested an integrated information system that combines database and software applications to reduce waste and data redundancy.

Invited Reaction: The Strategic Value of HRD in Lean Strategy Implementation

ERIC Educational Resources Information Center

Yorks, Lyle; Barto, Jody

2013-01-01

This study by Meera Alagaraja and Toby Egan provides a case study of a Lean strategy implementation in which HRD was an integrated part of the process and offers a model that can give direction for both future research and strategic advocacy on behalf of HRD practice. The case is actually more a study of the importance of cross-functional and…

Precision Strike Training in Lean Manufacturing: A Workplace Literacy Guidebook [and] Final Report on Precision Strike Workplace Literacy Training at CertainTeed Corporation.

ERIC Educational Resources Information Center

National Alliance of Business, Inc., Washington, DC.

CertainTeed's Precision Strike training program was designed to close the gaps between the current status of its workplace and where that work force needed to be to compete successfully in global markets. Precision Strike included Skills and Knowledge in Lifelong Learning (SKILL) customized, computerized lessons in basic skills, one-on-one…

Lean practices for quality results: a case illustration.

PubMed

Hwang, Pauline; Hwang, David; Hong, Paul

2014-01-01

Increasingly, healthcare providers are implementing lean practices to achieve quality results. Implementing lean healthcare practices is unique compared to manufacturing and other service industries. The purpose of this paper is to present a model that identifies and defines the lean implementation key success factors in healthcare organisations. The model is based on an extant literature review and a case illustration that explores actual lean implementation in a major USA hospital located in a Midwestern city (approximately 300,000 people). An exploratory/descriptive study using observation and follow-up interviews was conducted to identify lean practices in the hospital. Lean practice key drivers include growing elderly populations, rising medical expenses, decreasing insurance coverage and decreasing management support. Effectively implementing lean practices to increase bottom-line results and improve organisational integrity requires sharing goals and processes among healthcare managers and professionals. An illustration explains the model and the study provides a sound foundation for empirical work. Practical implications are included. Lean practices minimise waste and unnecessary hospital stays while simultaneously enhancing customer values and deploying resources in supply systems. Leadership requires clear project targets based on sound front-end planning because initial implementation steps involve uncertainty and ambiguity (i.e. fuzzy front-end planning). Since top management support is crucial for implementing lean practices successfully, a heavyweight manager, who communicates well both with top managers and project team members, is an important success factor when implementing lean practices. Increasingly, green orientation and sustainability initiatives are phrases that replaced lean practices. Effective results; e.g. waste reduction, employee satisfaction and customer values are applicable to bigger competitive challenges arising both in specific organisations and inter-organisational networks. Healthcare managers are adopting business practices that improve efficiency and productivity while ensuring their healthcare mission and guaranteeing that customer values are achieved. Shared understanding about complex goals (e.g. reducing waste and enhancing customer value) at the front-end is crucial for implementing successful lean practices. In particular, this study shows that nursing practices, which are both labour intensive and technology enabled, are good candidates for lean practice.

Technology integration performance assessment using lean principles in health care.

PubMed

Rico, Florentino; Yalcin, Ali; Eikman, Edward A

2015-01-01

This study assesses the impact of an automated infusion system (AIS) integration at a positron emission tomography (PET) center based on "lean thinking" principles. The authors propose a systematic measurement system that evaluates improvement in terms of the "8 wastes." This adaptation to the health care context consisted of performance measurement before and after integration of AIS in terms of time, utilization of resources, amount of materials wasted/saved, system variability, distances traveled, and worker strain. The authors' observations indicate that AIS stands to be very effective in a busy PET department, such as the one in Moffitt Cancer Center, owing to its accuracy, pace, and reliability, especially after the necessary adjustments are made to reduce or eliminate the source of errors. This integration must be accompanied by a process reengineering exercise to realize the full potential of AIS in reducing waste and improving patient care and worker satisfaction. © The Author(s) 2014.

Lean Big Data integration in systems biology and systems pharmacology.

PubMed

Ma'ayan, Avi; Rouillard, Andrew D; Clark, Neil R; Wang, Zichen; Duan, Qiaonan; Kou, Yan

2014-09-01

Data sets from recent large-scale projects can be integrated into one unified puzzle that can provide new insights into how drugs and genetic perturbations applied to human cells are linked to whole-organism phenotypes. Data that report how drugs affect the phenotype of human cell lines and how drugs induce changes in gene and protein expression in human cell lines can be combined with knowledge about human disease, side effects induced by drugs, and mouse phenotypes. Such data integration efforts can be achieved through the conversion of data from the various resources into single-node-type networks, gene-set libraries, or multipartite graphs. This approach can lead us to the identification of more relationships between genes, drugs, and phenotypes as well as benchmark computational and experimental methods. Overall, this lean 'Big Data' integration strategy will bring us closer toward the goal of realizing personalized medicine. Copyright © 2014 Elsevier Ltd. All rights reserved.

TriBITS lifecycle model. Version 1.0, a lean/agile software lifecycle model for research-based computational science and engineering and applied mathematical software.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Willenbring, James M.; Bartlett, Roscoe Ainsworth; Heroux, Michael Allen

2012-01-01

Software lifecycles are becoming an increasingly important issue for computational science and engineering (CSE) software. The process by which a piece of CSE software begins life as a set of research requirements and then matures into a trusted high-quality capability is both commonplace and extremely challenging. Although an implicit lifecycle is obviously being used in any effort, the challenges of this process - respecting the competing needs of research vs. production - cannot be overstated. Here we describe a proposal for a well-defined software lifecycle process based on modern Lean/Agile software engineering principles. What we propose is appropriate for manymore » CSE software projects that are initially heavily focused on research but also are expected to eventually produce usable high-quality capabilities. The model is related to TriBITS, a build, integration and testing system, which serves as a strong foundation for this lifecycle model, and aspects of this lifecycle model are ingrained in the TriBITS system. Here, we advocate three to four phases or maturity levels that address the appropriate handling of many issues associated with the transition from research to production software. The goals of this lifecycle model are to better communicate maturity levels with customers and to help to identify and promote Software Engineering (SE) practices that will help to improve productivity and produce better software. An important collection of software in this domain is Trilinos, which is used as the motivation and the initial target for this lifecycle model. However, many other related and similar CSE (and non-CSE) software projects can also make good use of this lifecycle model, especially those that use the TriBITS system. Indeed this lifecycle process, if followed, will enable large-scale sustainable integration of many complex CSE software efforts across several institutions.« less

Modelling Lean and Green Supply Chain

NASA Astrophysics Data System (ADS)

Duarte, Susana Carla Vieira Lino Medina

The success of an organization depends on the effective control of its supply chain. It is important to recognize new opportunities for organization and its supply chain. In the last few years the approach to lean, agile, resilient and green supply chain paradigms has been addressed in the scientific literature. Research in this field shows that the integration of these concepts revealed some contradictions among so many paradigms. This thesis is mainly focused on the lean and green approaches. Thirteen different management frameworks, embodied in awards, standards and tools were studied to understand if they could contribute for the modelling process of a lean and green approach. The study reveals a number of categories that are common in most management frameworks, providing adequate conditions for a lean and green supply chain transformation. A conceptual framework for the evaluation of a lean and green organization`s supply chain was proposed. The framework considers six key criteria, namely, leadership, people, strategic planning, stakeholders, processes and results. It was proposed an assessment method considering a criteria score for each criterion. The purpose is to understand how lean and green supply chain can be compatible, using principles, practices, techniques or tools (i.e. elements) that support both, a lean and a green approach, in all key criteria. A case study in the automotive upstream supply chain was performed to understand more deeply if the elements proposed for the conceptual framework could be implemented in a real-scenario. Based on the conceptual framework and the case study, a roadmap to achieve a lean-green transformation is presented. The proposed roadmap revealed its contribution to the understanding on how and when an organization`s supply chain should apply the lean and green elements. This study is relevant to practice, as it may assist managers in the adoption of a lean and green supply chain approach, giving insights for the implementation of a hybrid supply chain.

An integrative review of the literature on registered nurses' medication competence.

PubMed

Sulosaari, Virpi; Suhonen, Riitta; Leino-Kilpi, Helena

2011-02-01

The aim of this integrative literature review was to describe registered nurses' medication competence. The objectives of the literature review were to chart the need for future studies and use the results for instrument development. Nurses play a vital role in different phases of a patient's medication process and thus need adequate competence to fulfil their role. Research on nurses' level of medication competence in different competency areas has been published. However, previous studies have lacked a comprehensive or integrated definition or description of medication competence in nursing. Integrative literature review. The integrative literature review followed five stages: (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis and (5) presentation. Eligible articles were identified via systematic literature search of research and evidence-based--databases. Twenty-one studies met the selection criteria. Eleven competency areas that constitute nurses' medication competence were identified: (1) anatomy and physiology, (2) pharmacology, (3) communication, (4) interdisciplinary collaboration, (5) information seeking, (6) mathematical and medication calculation, (7) medication administration, (8) medication education, (9) assessment and evaluation, (10) documentation and (11) promoting medication safety as part of patient safety. The analysis revealed three major categories which integrate these competency areas: (1) decision making competence, (2) theoretical competence and (3) practical competence. Medication competence requires a solid knowledge base and the ability to apply that knowledge in real-life situations during often complex and dynamic patient medication processes. Decision making competence was found to be an important and integral part of a nurses' theoretical and practical competence. These main competence categories integrated all of the 11 competency areas identified in this review. It is important to determine registered nurses' medication competence in the context of developing nursing education and migration of the nursing workforce. This literature review contributes an integrated perspective on nurses' medication competence and in doing so has clinical relevance for curriculum development and to future research in this area. © 2010 Blackwell Publishing Ltd.

The role of pyridoxine as a countermeasure for in-flight loss of lean body mass

NASA Technical Reports Server (NTRS)

Gilbert, Joyce A.

1992-01-01

Ground based and in flight research has shown that humans, under conditions of microgravity, sustain a loss of lean body tissue (protein) and changes in several biological processes including, reductions in red blood cell mass, and neurotransmitters. The maintenance of muscle mass, the major component of lean body mass, is required to meet the needs of space station EVAs. Central to the biosynthesis of amino acids, the building blocks of protein, is pyridoxine (vitamin B-6). Muscle mass integrity requires the availability of vitamin B-6 for protein metabolism and neurotransmitter synthesis. Furthermore, the formation of red blood cells require pyridoxine as a cofactor in the biosynthesis of hemoglobin, a protein that carries oxygen to tissues. In its active form, pyridoxal-5'-phosphate (PLP), vitamin B-6 serves as a link between amino acid and carbohydrate metabolism through intermediates of glycolysis and the tricarboxylic acid cycle. In addition to its role in energy metabolism, PLP is involved in the biosynthesis of hemoglobin and neurotransmitter which are necessary for neurological functions. Alterations in pyridoxine metabolism may affect countermeasures designed to overcome some of these biochemical changes. The focus of this research is to determine the effects of microgravity on the metabolic utilization of vitamin B-6, integrating nutrition as an integral component of the countermeasure (exercise) to maintain lean body mass and muscle strength. The objectives are: 1) to determine whether microgravity effects the metabolic utilization of pyridoxine and 2) to quantitate changes in B-6 vitamer distribution in tissue and excreta relative to loss of lean body tissue. The rationale for this study encompasses the unique challenge to control biochemical mechanisms effected during space travel and the significance of pyridoxine to maintain and counter muscle integrity for EVA activities. This experiment will begin to elucidate the importance of biochemical interactions between micronutrients and the homeostasis condition of biological processes in the space environment. To address this research topic a simulated microgravity model has been developed. The experiment uses radioisotopically labelled pyridoxine administered as an oral dose to rats which are maintained by tail suspension to simulate a microgravity environment. At the termination of the study, liver, muscle, blood and urine are collected and analyzed by reverse phase high pressure liquid chromatography to determine the quantity and distribution of the B-6 vitamers in tissue and excreta relative to lean body tissue loss. Earlier studies, published by this investigator, have shown that differences in vitamer distribution among samples from experimental versus control subjects indicate changes in metabolic utilization and storage of vitamin B-6.

Archaea in Organic-Lean and Organic-Rich Marine Subsurface Sediments: An Environmental Gradient Reflected in Distinct Phylogenetic Lineages

PubMed Central

Durbin, Alan M.; Teske, Andreas

2012-01-01

Examining the patterns of archaeal diversity in little-explored organic-lean marine subsurface sediments presents an opportunity to study the association of phylogenetic affiliation and habitat preference in uncultured marine Archaea. Here we have compiled and re-analyzed published archaeal 16S rRNA clone library datasets across a spectrum of sediment trophic states characterized by a wide range of terminal electron-accepting processes. Our results show that organic-lean marine sediments in deep marine basins and oligotrophic open ocean locations are inhabited by distinct lineages of archaea that are not found in the more frequently studied, organic-rich continental margin sediments. We hypothesize that different combinations of electron donor and acceptor concentrations along the organic-rich/organic-lean spectrum result in distinct archaeal communities, and propose an integrated classification of habitat characteristics and archaeal community structure. PMID:22666218

Application of hands-on simulation games to improve classroom experience

NASA Astrophysics Data System (ADS)

Hamzeh, Farook; Theokaris, Christina; Rouhana, Carel; Abbas, Yara

2017-09-01

While many construction companies claim substantial productivity and profit gains when applying lean construction principles, it remains a challenge to teach these principles in a classroom. Lean construction emphasises collaborative processes and integrated delivery practices. Consequently, new teaching methods that nurture such values should form the basis of lean construction education. One of the proposed methods is 'hands-on team simulation games' which can be employed to replicate various real-life processes, projects, or systems for the purpose of teaching, analysing, and understanding. This study aims at assessing this simulation games and understanding their impact on students' learning and satisfaction. Surveys and tests are administered to assess changes in student's perception of their learning styles and their understanding of key lean construction concepts. Results show a positive student reaction to hands-on simulation games, provide pedagogical insights, and highlight suggestions for improvement.

Leveraging lean principles in creating a comprehensive quality program: The UCLA health readmission reduction initiative.

PubMed

Afsar-Manesh, Nasim; Lonowski, Sarah; Namavar, Aram A

2017-12-01

UCLA Health embarked to transform care by integrating lean methodology in a key clinical project, Readmission Reduction Initiative (RRI). The first step focused on assembling a leadership team to articulate system-wide priorities for quality improvement. The lean principle of creating a culture of change and accountability was established by: 1) engaging stakeholders, 2) managing the process with performance accountability, and, 3) delivering patient-centered care. The RRI utilized three major lean principles: 1) A3, 2) root cause analyses, 3) value stream mapping. Baseline readmission rate at UCLA from 9/2010-12/2011 illustrated a mean of 12.1%. After the start of the RRI program, for the period of 1/2012-6/2013, the readmission rate decreased to 11.3% (p<0.05). To impact readmissions, solutions must evolve from smaller service- and location-based interventions into strategies with broader approach. As elucidated, a systematic clinical approach grounded in lean methodologies is a viable solution to this complex problem. Copyright © 2017 Elsevier Inc. All rights reserved.

Energy deficiency, menstrual disturbances, and low bone mass: what do exercising Australian women know about the female athlete triad?

PubMed

Miller, Stephanie M; Kukuljan, Sonja; Turner, Anne I Turner; van der Pligt, Paige; Ducher, Gaele

2012-04-01

Prevention of the female athlete triad is essential to protect female athletes' health. The aim of this study was to investigate the knowledge, attitudes, and behaviors of regularly exercising adult women in Australia toward eating patterns, menstrual cycles, and bone health. A total of 191 female exercisers, age 18-40 yr, engaging in ≥2 hr/wk of strenuous activity, completed a survey. After 11 surveys were excluded (due to incomplete answers), the 180 participants were categorized into lean-build sports (n = 82; running/athletics, triathlon, swimming, cycling, dancing, rowing), non-lean-build sports (n = 94; basketball, netball, soccer, hockey, volleyball, tennis, trampoline, squash, Australian football), or gym/fitness activities (n = 4). Mean (± SD) training volume was 9.0 ± 5.5 hr/wk, with participants competing from local up to international level. Only 10% of respondents could name the 3 components of the female athlete triad. Regardless of reported history of stress fracture, 45% of the respondents did not think that amenorrhea (absence of menses for ≥3 months) could affect bone health, and 22% of those involved in lean-build sports would do nothing if experiencing amenorrhea (vs. 3.2% in non-lean-build sports, p = .005). Lean-build sports, history of amenorrhea, and history of stress fracture were all significantly associated with not taking action in the presence of amenorrhea (all p < .005). Few active Australian women are aware of the detrimental effects of menstrual dysfunction on bone health. Education programs are needed to prevent the female athlete triad and ensure that appropriate actions are taken by athletes when experiencing amenorrhea.

Integration of human factors principles in LARG organizations--a conceptual model.

PubMed

Figueira, Sara; Machado, V Cruz; Nunes, Isabel L

2012-01-01

Nowadays many companies are undergoing organizational transformations in order to meet the changing market demands. Thus, in order to become more competitive, supply chains (SC) are adopting new management paradigms to improve SC performance: lean, agile, resilient and green (LARG paradigms). The implementation of new production paradigms demands particular care with the issues related with Human Factors to avoid health and safety problems to workers and losses to companies. Thus, the successful introduction of these new production paradigms depends among others on a Human Factors oriented approach. This work presents a conceptual framework that allows integrating ergonomic and safety design principles during the different implementation phases of lean, agile, resilient and green practices.

Lean and leadership practices: development of an initial realist program theory.

PubMed

Goodridge, Donna; Westhorp, Gill; Rotter, Thomas; Dobson, Roy; Bath, Brenna

2015-09-07

Lean as a management system has been increasingly adopted in health care settings in an effort to enhance quality, capacity and safety, while simultaneously containing or reducing costs. The Ministry of Health in the province of Saskatchewan, Canada has made a multi-million dollar investment in Lean initiatives to create "better health, better value, better care, and better teams", affording a unique opportunity to advance our understanding of the way in which Lean philosophy, principles and tools work in health care. In order to address the questions, "What changes in leadership practices are associated with the implementation of Lean?" and "When leadership practices change, how do the changed practices contribute to subsequent outcomes?", we used a qualitative, multi-stage approach to work towards developing an initial realist program theory. We describe the implications of realist assumptions for evaluation of this Lean initiative. Formal theories including Normalization Process Theory, Theories of Double Loop and Organization Leaning and the Theory of Cognitive Dissonance help understand this initial rough program theory. Data collection included: key informant consultation; a stakeholder workshop; documentary review; 26 audiotaped and transcribed interviews with health region personnel; and team discussions. A set of seven initial hypotheses regarding the manner in which Lean changes leadership practices were developed from our data. We hypothesized that Lean, as implemented in this particular setting, changes leadership practices in the following ways. Lean: a) aligns the aims and objectives of health regions; b) authorizes attention and resources to quality improvement and change management c) provides an integrated set of tools for particular tasks; d) changes leaders' attitudes or beliefs about appropriate leadership and management styles and behaviors; e) demands increased levels of expertise, accountability and commitment from leaders; f) measures and uses data effectively to identify actual and relevant local problems and the root causes of those problems; and g) creates or supports a 'learning organization' culture. This study has generated initial hypotheses and realist program theory that can form the basis for future evaluation of Lean initiatives. Developing leadership capacity and culture is theorized to be a necessary precursor to other systemic and observable changes arising from Lean initiatives.

Exploring Integration in Action: Competencies as Building Blocks of Expertise.

PubMed

Mylopoulos, Maria; Borschel, Debaroti Tina; O'Brien, Tara; Martimianakis, Sofia; Woods, Nicole N

2017-12-01

Competency frameworks such as the CanMEDS roles and the ACGME core competencies may lead to the implicit assumption that physicians can learn and practice individual competencies in isolation. In contrast, models of adaptive expertise suggest that the integration of competencies reflects the capabilities of an expert physician. Thus, educational programming aimed at teaching discrete roles or competencies might overlook expert physician capabilities that are central to patient care. To develop expertise, learning opportunities must reflect expert capabilities. To better understand the relationship between competency-based medical education and expert development, the authors sought to explore how integrated competencies are enacted during patient care by postgraduate medical trainees. Using a cognitive ethnographic approach, in 2014-2015 the authors conducted observations and-to refine and elaborate these observations-ad hoc informal interviews with 13 postgraduate trainee participants. Data collection resulted in 92 hours of observation, 26 patient case portraits, and a total of 220 pages of field notes for analysis. Through analysis, the authors identified and examined moments when postgraduate trainees appeared to be simultaneously enacting multiple competencies. The authors identified two key expert capabilities in moments of integrated competence: finding complexity and being patient-centered. They described two mechanisms for these forms of integration: valuing the patient's narrative of their illness, and integrated understanding. Understanding integrated competencies as the building blocks of expert capabilities, along with recognizing the importance of mechanisms that support integration, offers an opportunity to use existing competency-based frameworks to understand and teach adaptive expertise.

Competency in integrative psychotherapy: perspectives on training and supervision.

PubMed

Boswell, James F; Nelson, Dana L; Nordberg, Samuel S; McAleavey, Andrew A; Castonguay, Louis G

2010-03-01

Increasingly, many psychotherapists identify with an integrative approach to psychotherapy. In recent years, more attention has been directed toward the operationalization and evaluation of competence in professional psychology and health care service delivery. Aspects of integrative psychotherapy competency may differ from competency in other psychotherapy orientations, although convergence is more often the case. Despite the potential differences, there exist very few formal training programs or guidelines to systematically guide clinicians in developing a competent integrative practice. This paper attempts to distill the essential elements of competent integrative psychotherapy practice and focuses on how these might be developed in training and supervision. We address most of these complex issues from a specific integrative perspective: principle-based assimilative integration. PsycINFO Database Record (c) 2010 APA, all rights reserved

Can a Healthcare "Lean Sweep" Deliver on What Matters to Patients? Comment on "Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping".

PubMed

Verma, Jennifer Y; Amar, Claudia

2015-07-28

Disconnects and defects in care - such as duplication, poor integration between services or avoidable adverse events - are costly to the health system and potentially harmful to patients and families. For patients living with multiple chronic conditions, such disconnects can be particularly detrimental. Lean is an approach to optimizing value by reducing waste (eg, duplication and defects) and containing costs (eg, improving integration of services) as well as focusing on what matters to patients. Lean works particularly well to optimize existing processes and services. However, as the burden of chronic illness and frailty overtake episodic care needs, health systems require far greater complex, adaptive change. Such change ought to take into account outcomes in population health in addition to care experiences and costs (together, comprising the Triple Aim); and involve patients and families in co-designing new models of care that better address complex, longer-term health needs. © 2015 by Kerman University of Medical Sciences.

Association of fat to lean mass ratio with metabolic dysfunction in women with polycystic ovary syndrome.

PubMed

Ezeh, Uche; Pall, Marita; Mathur, Ruchi; Azziz, Ricardo

2014-07-01

Are differences in metabolic dysfunction between polycystic ovary syndrome (PCOS) and control women related to differences in their fat to lean mass (F/L) ratio? Compared with controls of similar body mass index (BMI), women with PCOS demonstrate adverse body composition characterized by increased whole body fat relative to lean mass (i.e. a higher F/L ratio), which is associated with differences in metabolic dysfunction between the two groups. Previous studies examining body composition and insulin resistance (IR) in PCOS have yielded conflicting results. Excess total fat mass (i.e. fat mass index [fat BMI]) correlates with IR, whereas increased total lean mass (i.e. lean BMI) has been associated with higher insulin sensitivity. However, the role of the F/L ratio, which integrates the antagonistic effects of both fat and lean mass depots, on IR in PCOS, has not been investigated. We conducted a prospective cross-sectional study of 120 women between the ages of 22-44 years to study the relation of the F/L ratio with measures of insulin action and secretion in both steady and dynamic states. Sixty PCOS (by NIH, 1990 criteria) and 60 control (age, race and BMI-matched) women were prospectively studied for body composition (by bioelectrical impedance analysis [BIA]) and basal IR and insulin secretion by the homeostasis model assessment (HOMA-IR and HOMA-%β-cell function, respectively) in a tertiary care academic referral center. A subset of 12 PCOS and 12 matched control women also underwent a modified frequently sampled intravenous glucose tolerance test (FSIVGTT) to determine glucose uptake and insulin secretion in dynamic state. Our results indicate that women with PCOS demonstrated greater degrees of hyperandrogenism, and higher waist-to-hip ratio (WHR), %body fat, fat BMI, F/L, fasting insulin levels, and HOMA-IR and HOMA-%β-cell values, than controls. In models adjusted for WHR and free testosterone and diagnostic groups, fasting insulin levels, HOMA-IR, and HOMA-%beta cell function were positively related to the F/L ratio. A positive relationship was also found in both study groups between F/L and the FSIVGTT measures insulin sensitivity (Si) and acute insulin response to glucose (AIRg). The F/L tended to negatively correlate with glucose effectiveness or non-insulin-mediated glucose transport (Sg) only in PCOS women. Regional tissue sub-compartments, which have been shown to have potential independent associations with metabolic variables, cannot be determined by bioelectrical impedance analysis (BIA). The current results suggest that BIA could be used to assess F/L in place of dual energy X-ray absorptiometry (DXA) in research protocols, and that F/L could possibly be used as an alternative to WHR as a surrogate marker of metabolic dysfunction in clinical practice. This work was supported by grants R01-DK073632 and R01-HD29364 from the NIH and an endowment of the Helping Hand of Los Angeles, Inc. (to R.A.). The authors have no competing interests to declare. Not applicable.

A Hybrid Fuzzy Model for Lean Product Development Performance Measurement

NASA Astrophysics Data System (ADS)

Osezua Aikhuele, Daniel; Mohd Turan, Faiz

2016-02-01

In the effort for manufacturing companies to meet up with the emerging consumer demands for mass customized products, many are turning to the application of lean in their product development process, and this is gradually moving from being a competitive advantage to a necessity. However, due to lack of clear understanding of the lean performance measurements, many of these companies are unable to implement and fully integrated the lean principle into their product development process. Extensive literature shows that only few studies have focus systematically on the lean product development performance (LPDP) evaluation. In order to fill this gap, the study therefore proposed a novel hybrid model based on Fuzzy Reasoning Approach (FRA), and the extension of Fuzzy-AHP and Fuzzy-TOPSIS methods for the assessment of the LPDP. Unlike the existing methods, the model considers the importance weight of each of the decision makers (Experts) since the performance criteria/attributes are required to be rated, and these experts have different level of expertise. The rating is done using a new fuzzy Likert rating scale (membership-scale) which is designed such that it can address problems resulting from information lost/distortion due to closed-form scaling and the ordinal nature of the existing Likert scale.

Robotic implementation of assays: tissue-nonspecific alkaline phosphatase (TNAP) case study.

PubMed

Chung, Thomas D Y

2013-01-01

Laboratory automation and robotics have "industrialized" the execution and completion of large-scale, enabling high-capacity and high-throughput (100 K-1 MM/day) screening (HTS) campaigns of large "libraries" of compounds (>200 K-2 MM) to complete in a few days or weeks. Critical to the success these HTS campaigns is the ability of a competent assay development team to convert a validated research-grade laboratory "benchtop" assay suitable for manual or semi-automated operations on a few hundreds of compounds into a robust miniaturized (384- or 1,536-well format), well-engineered, scalable, industrialized assay that can be seamlessly implemented on a fully automated, fully integrated robotic screening platform for cost-effective screening of hundreds of thousands of compounds. Here, we provide a review of the theoretical guiding principles and practical considerations necessary to reduce often complex research biology into a "lean manufacturing" engineering endeavor comprising adaption, automation, and implementation of HTS. Furthermore we provide a detailed example specifically for a cell-free in vitro biochemical, enzymatic phosphatase assay for tissue-nonspecific alkaline phosphatase that illustrates these principles and considerations.

The Brazilian Air Force Uniform Distribution Process: Using Lean Thinking, Statistical Process Control and Theory of Constraints to Address Improvement Opportunities

DTIC Science & Technology

2015-03-26

universal definition” (Evans & Lindsay, 1996). Heizer and Render (2010) argue that several definitions of this term are user-based, meaning, that quality...for example, really good ice cream has high butterfat levels.” ( Heizer & Render , 2010). Garvin, in his Competing in Eight Dimensions of Quality...Montgomery, 2005). As for definition purposes, the concept adopted by this research was provided by Heizer and Render (2010), for whom Statistical Process

Some numerical methods for the Hele-Shaw equations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Whitaker, N.

1994-03-01

Tryggvason and Aref used a boundary integral method and the vortex-in-cell method to evolve the interface between two fluids in a Hele-Shaw cell. The method gives excellent results for intermediate values of the nondimensional surface tension parameter. The results are different from the predicted results of McLean and Saffman for small surface tension. For large surface tension, there are some numerical problems. In this paper, we implement the method of Tryggvason and Aref but use the point vortex method instead of the vortex-in-cell method. A parametric spline is used to represent the interface. The finger widths obtained agree well withmore » those predicted by McLean and Saffman. We conclude the the method of Tryggvason and Aref can provide excellent results but that the vortex-in-cell method may not be the method of choice for extreme values of the surface tension parameter. In a second method, we represent the interface with a Fourier representation. In addition, an alternative way of discretizing the boundary integral is used. Our results are compared to the linearized theory and the results of McLean and Saffman and are shown to be highly accurate. 21 refs., 4 figs., 2 tabs.« less

Students' Role Confusion when Working with Older Adults: The Voices of Foundation Students

ERIC Educational Resources Information Center

Smith, Judith R.

2013-01-01

A qualitative research project was carried out to investigate how first-year graduate students integrated their field work learning with their classroom leaning ("N"?=?17). The study reveals the students' difficulty in integrating their practical learning with theoretical classroom knowledge. Using grounded theory analysis, two…

Improving Autopsy Report Turnaround Times by Implementing Lean Management Principles.

PubMed

Cromwell, Susan; Chiasson, David A; Cassidy, Debra; Somers, Gino R

2018-01-01

The autopsy is an integral part of the service of a large academic pathology department. Timely reporting is central to providing good service and is beneficial for many stakeholders, including the families, the clinical team, the hospital, and the wider community. The current study aimed to improve hospital-consented autopsy reporting times (turnaround time, TAT) by using lean principles modified for a healthcare setting, with an aim of signing out 90% of autopsies in 90 days. An audit of current and historical TATs was performed, and a working group incorporating administrative, technical, and professional staff constructed a value stream map documenting the steps involved in constructing an autopsy report. Two areas of delay were noted: examination of the microscopy and time taken to sign-out the report after the weekly autopsy conference. Several measures were implemented to address these delays, including visual tracking using a whiteboard and individualized tracking sheets, weekly whiteboard huddles, and timelier scheduling of clinicopathologic conference rounds. All measures resulted in an improvement of TATs. In the 30 months prior to the institution of lean, 37% of autopsies (53/144) were signed out in 90 days, with a wide variation in reporting times. In the 30 months following the institution of lean, this improved to 74% (136/185) ( P < .0001, Fisher exact test), with a marked reduction in variability. Further, the time from autopsy to presentation at weekly clinicopathological rounds was also reduced (median: 73 days prior to lean; 63 days post-lean). The application of lean principles to autopsy sign-out workflow can significantly improve TATs and reduce variability, without changing staffing levels or significantly altering scheduling structure.

The stigma of obesity surgery: negative evaluations based on weight loss history.

PubMed

Vartanian, Lenny R; Fardouly, Jasmine

2013-10-01

The present study investigated the stigma of obesity surgery by examining whether attitudes towards a lean person can change after learning that the person used to be obese but recently lost weight either through surgery or through diet and exercise. Participants (total N = 135) initially viewed an image of a lean woman or man and rated their impression of that individual on a variety of characteristics. Participants were then shown an image of the individual before she/he lost weight and were informed that the weight loss was achieved through surgery or through diet and exercise. Participants once again rated their impressions of that individual. After learning about the previous weight loss, participants rated the individual who lost weight through surgery as significantly more lazy and sloppy, less competent and sociable, less attractive, and having less healthy eating habits. The individual who lost weight through diet and exercise, in contrast, was not evaluated as harshly. Mediation analysis further showed that the difference between the two weight loss conditions in ratings of laziness, competence, and sociability was due to participants viewing surgery patients as less responsible for their weight loss. These findings suggest that learning about someone's weight history can negatively impact the way that person is seen by others. Furthermore, these findings suggest that the stigma may be strongest for people who lose weight through obesity surgery because those individuals are not seen as being responsible for their weight loss.

Marine Corps Vision & Strategy 2025

DTIC Science & Technology

2008-01-01

integral part of our history as a Corps. In the South Pacific after Pearl Harbor, in Korea after the communist invasion in 1950, in the jungle outposts...we have experience integrating many organizations with different levels of capability into an effective team. In the future, Marine Corps forces may...and foremost a disciplined warrior. Expeditionary Naval Force. Marines are “soldiers of the sea,” an integral part of the naval Services — lean

Integrative Medicine in Preventive Medicine Education

PubMed Central

Jani, Asim A.; Trask, Jennifer; Ali, Ather

2016-01-01

During 2012, the USDHHS’s Health Resources and Services Administration funded 12 accredited preventive medicine residencies to incorporate an evidence-based integrative medicine curriculum into their training programs. It also funded a national coordinating center at the American College of Preventive Medicine, known as the Integrative Medicine in Preventive Medicine Education (IMPriME) Center, to provide technical assistance to the 12 grantees. To help with this task, the IMPriME Center established a multidisciplinary steering committee, versed in integrative medicine, whose primary aim was to develop integrative medicine core competencies for incorporation into preventive medicine graduate medical education training. The competency development process was informed by central integrative medicine definitions and principles, preventive medicine’s dual role in clinical and population-based prevention, and the burgeoning evidence base of integrative medicine. The steering committee considered an interdisciplinary integrative medicine contextual framework guided by several themes related to workforce development and population health. A list of nine competencies, mapped to the six general domains of competence approved by the Accreditation Council of Graduate Medical Education, was operationalized through an iterative exercise with the 12 grantees in a process that included mapping each site’s competency and curriculum products to the core competencies. The competencies, along with central curricular components informed by grantees’ work presented elsewhere in this supplement, are outlined as a roadmap for residency programs aiming to incorporate integrative medicine content into their curricula. This set of competencies adds to the larger efforts of the IMPriME initiative to facilitate and enhance further curriculum development and implementation by not only the current grantees but other stakeholders in graduate medical education around integrative medicine training. PMID:26477897

Case Study: The Effect of 32 Weeks of Figure-Contest Preparation on a Self-Proclaimed Drug-Free Female's Lean Body and Bone Mass.

PubMed

Petrizzo, John; DiMenna, Frederick J; Martins, Kimberly; Wygand, John; Otto, Robert M

2017-12-01

To achieve the criterion appearance before competing in a physique competition, athletes undergo preparatory regimens involving high-volume intense resistance and aerobic exercise with hypocaloric energy intake. As the popularity of "drug-free" competition increases, more athletes are facing this challenge without the recuperative advantage provided by performance-enhancing drugs. Consequently, the likelihood of loss of lean body and/or bone mass is increased. The purpose of this investigation was to monitor changes in body composition for a 29-year-old self-proclaimed drug-free female figure competitor during a 32-week preparatory regimen comprising high-volume resistance and aerobic exercise with hypocaloric energy intake. We used dual-energy x-ray absorptiometry (DXA) to evaluate regional fat and bone mineral density. During the initial 22 weeks, the subject reduced energy intake and engaged in resistance (4-5 sessions/week) and aerobic (3 sessions/week) training. During the final 10 weeks, the subject increased exercise frequency to 6 (resistance) and 4 (aerobic) sessions/week while ingesting 1130-1380 kcal/day. During this 10-week period, she consumed a high quantity of protein (~55% of energy intake) and nutritional supplements. During the 32 weeks, body mass and fat mass decreased by 12% and 55%, respectively. Conversely, lean body mass increased by 1.5%, an amount that exceeded the coefficient of variation associated with DXA-derived measurement. Total bone mineral density was unchanged throughout. In summary, in preparation for a figure competition, a self-proclaimed drug-free female achieved the low body-fat percentage required for success in competition without losing lean mass or bone density by following a 32-week preparatory exercise and nutritional regimen.

TPACK Competencies and Technology Integration Self-Efficacy Perceptions of Pre-Service Teachers

ERIC Educational Resources Information Center

Keser, Hafize; Karaoglan Yilmaz, Fatma Gizem; Yilmaz, Ramazan

2015-01-01

This study compared the technological pedagogical content knowledge (TPACK) competency of pre-service teachers with their self-efficacy perception towards technology integration, based on various variables; and the correlation between their TPACK competencies and self-efficacy perceptions towards technology integration were examined. The study…

Effectiveness of Adaptive Contextual Learning Model of Integrated Science by Integrating Digital Age Literacy on Grade VIII Students

NASA Astrophysics Data System (ADS)

Asrizal, A.; Amran, A.; Ananda, A.; Festiyed, F.

2018-04-01

Educational graduates should have good competencies to compete in the 21st century. Integrated learning is a good way to develop competence of students in this century. Besides that, literacy skills are very important for students to get success in their learning and daily life. For this reason, integrated science learning and literacy skills are important in 2013 curriculum. However, integrated science learning and integration of literacy in learning can’t be implemented well. Solution of this problem is to develop adaptive contextual learning model by integrating digital age literacy. The purpose of the research is to determine the effectiveness of adaptive contextual learning model to improve competence of grade VIII students in junior high school. This research is a part of the research and development or R&D. Research design which used in limited field testing was before and after treatment. The research instruments consist of three parts namely test sheet of learning outcome for assessing knowledge competence, observation sheet for assessing attitudes, and performance sheet for assessing skills of students. Data of student’s competence were analyzed by three kinds of analysis, namely descriptive statistics, normality test and homogeneity test, and paired comparison test. From the data analysis result, it can be stated that the implementation of adaptive contextual learning model of integrated science by integrating digital age literacy is effective to improve the knowledge, attitude, and literacy skills competences of grade VIII students in junior high school at 95% confidence level.

Lean methodology improves efficiency in outpatient academic uro-oncology clinics.

PubMed

Skeldon, Sean C; Simmons, Andrea; Hersey, Karen; Finelli, Antonio; Jewett, Michael A; Zlotta, Alexandre R; Fleshner, Neil E

2014-05-01

To determine if lean methodology, an industrial engineering tool developed to optimize manufacturing efficiency, can successfully be applied to improve efficiencies and quality of care in a hospital-based high-volume uro-oncology clinic. Before the lean initiative, baseline data were collected on patient volumes, wait times, cycle times (patient arrival to discharge), nursing assessment time, patient teaching, and physician ergonomics (via spaghetti diagram). Value stream analysis and a rapid improvement event were carried out, and significant changes were made to patient check-in, work areas, and nursing face time. Follow-up data were obtained at 30, 60, and 90 days. The Student t test was used for analysis to compare performance metrics with baseline. The median cycle time before the lean initiative was 46 minutes. This remained stable at 46 minutes at 30 days but improved to 35 minutes at 60 days and 41 minutes at 90 days. Shorter wait times allowed for increased nursing and physician face time. The average length of the physician assessment increased from 7.5 minutes at baseline to 10.6 minutes at 90 days. The average proportion of value-added time compared with the entire clinic visit increased from 30.6% at baseline to 66.3% at 90 days. Using lean methodology, we were able to shorten the patient cycle time and the time to initial assessment as well as integrate both an initial registered nurse assessment and registered nurse teaching to each visit. Lean methodology can effectively be applied to improve efficiency and patient care in an academic outpatient uro-oncology clinic setting. Copyright © 2014 Elsevier Inc. All rights reserved.

Integrating Competency-Based Instruction into Vocational Education. Microcomputer Applications for Vocational Teachers: A Competency-Based Approach--Book B.

ERIC Educational Resources Information Center

Roth, Gene; Tesolowski, Dennis

This handbook is the second in a series of five competency-based resource guides on microcomputer applications for vocational teachers. The seven units of instruction in this handbook are concerned with the content of the eight competencies included in the category, "Integrating Competency-Based Instruction into Vocational Education." Units are…

Study on HOPE Management Mode of Coal Enterprises Based on Systematic Thinking

NASA Astrophysics Data System (ADS)

Zhaoran, Zhang; Tianzhu, Zhang; Wenjing, Tong

2018-02-01

The extensive management mode of coal enterprises is no longer applicable to the demand of enterprise development under the new economic situation. Combined with the characteristics of coal mine production, based on the system of thinking, integration of lean, people, comprehensive, job management theory, formed HOPE management model, including a core system and three support systems and 18 elements. There are three stages in the development and implementation of this model. To 6S site management for the initial stage to job process reengineering for the intermediate stage to post value process control for the advanced stage. The successful implementation of HOPE model in coal enterprises needs comprehensive control from five aspects: lean culture construction, flattening organizational structure, cost control system, performance appraisal system and lean information management platform. HOPE model can be implemented smoothly and make “win-win” between enterprises and employees.

Mixing of Pure Air Jets with a Reacting Fuel-Rich Crossflow

NASA Technical Reports Server (NTRS)

Leong, M. Y.; Samuelsen, G. S.; Holdeman, J. D.

1997-01-01

Jets in a crossflow play an integral role in practical combustion systems such as can and annular gas turbine combustors in conventional systems, and the Rich-burn/Quick-mix/Lean-burn (RQL) combustor utilized in stationary applications and proposed for advanced subsonic and supersonic transports. The success of the RQL combustor rests with the performance of the quick-mixing section that bridges the rich and lean zones. The mixing of jet air with a rich crossflow to bring the reaction to completion in the lean zone must be performed rapidly and thoroughly in order to decrease the extent of near-stoichiometric fluid pocket formation. Fluid pockets at near-stoichiometric equivalence ratios are undesirable because the high temperatures attained accelerate pollutant formation kinetics associated with nitric oxide (NO). The present study develops a model experiment designed to reveal the processes that occur when jet air is introduced into hot effluent emanating from a fuel-rich reaction zone.

Competencies for optimal practice in integrated environments: examining attributes of a consensus interprofessional practice document from the licensed integrative health disciplines.

PubMed

Goldblatt, Elizabeth; Wiles, Michael; Schwartz, Jan; Weeks, John

2013-01-01

The Academic Consortium for Complementary and Alternative Health Care (ACCAHC) is committed to advancing human health through the advancement and integration of the complementary and alternative medicine (CAM) professions within the American healthcare system. This will involve the maturation and integration of the licensed CAM professions into conventional healthcare delivery, and in turn, it will involve the development of competency in integrative healthcare and interprofessional education within the CAM professions. In 2010, ACCAHC resolved to identify the competencies necessary for this transformation, and in the process, discovered a parallel process of competency development within conventional healthcare, the Interprofessional Education Collaborative (IPEC), representing the six major conventional healthcare professions. The ACCAHC competency document, its development, and its similarity to the IPEC document are discussed. The ACCAHC competency document identified two domains of competence that were not present in the IPEC document: evidence-informed practice and institutional healthcare practices. These two domains of competency are discussed with respect to their significance in both CAM and conventional healthcare practices. ACCAHC's goal is to foster collaboration among its member professions and with conventional healthcare professions, and to use these competency documents to improve and optimize healthcare delivery, practices, and outcomes in America. It is hoped that ACCAHC's competency document will catalyze interaction with IPEC leading to the adoption of a single shared competency document that will meet the needs of all healthcare providers and educators. © 2013 Elsevier Inc. All rights reserved.

Electronics. FasTrak Specialization Integrated Technical and Academic Competency (ITAC). Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.

This document contains an introduction to the Ohio Integrated Technical and Academic Competency (ITAC) and Specialization ITAC; and overview of the electronics field; an list acknowledging the professionals who helped develop the competency list; and the comprehensive listing of the professional or occupational competencies deemed essential for…

Integrating Key Competences in School Physical Education Programmes

ERIC Educational Resources Information Center

Lleixà, Teresa; González-Arévalo, Carles; Braz-Vieira, Marcelo

2016-01-01

In 2006, the European Union published its recommendations on competences for lifelong learning. Since then, key competences have been integrated into the official curriculum in Spain. The objectives of the present study are: a) to describe the strategies used most frequently by physical education teachers to incorporate key competences in their…

Drafting. FasTrak Specialization Integrated Technical and Academic Competency (ITAC). Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.

This document contains an introduction to the Ohio Integrated Technical and Academic Competency (ITAC) and Specialization ITAC; an overview of the drafting industry; a list acknowledging professionals who helped develop the competency list; and the comprehensive list of the professional or occupational competencies deemed essential for graduates…

Dental Assistant. FasTrak Specialization Integrated Technical and Academic Competency (ITAC). Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.

This document contains an introduction to the Ohio Integrated Technical and Academic Competency (ITAC) and Specialization ITAC; an overview of the dental assistant occupation; a list acknowledging professionals who helped develop the competency list; and the comprehensive list of the professional or occupational competencies deemed essential for…

Nurse Assistant. FasTrak Specialization Integrated Technical and Academic Competency (ITAC). Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.

This document contains an introduction to the Ohio Integrated Technical and Academic Competency (ITAC) and Specialization ITAC; an overview of the nurse assistant occupation; a list acknowledging professionals who helped develop the competency list; and the comprehensive list of the professional or occupational competencies deemed essential for…

Visual Communications Art. FasTrak Specialization Integrated Technical and Academic Competency (ITAC). Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.

This document contains an introduction to the Ohio Integrated Technical and Academic Competency (ITAC) and Specialization ITAC; an overview of the visual communications art profession; a list acknowledging professionals who helped develop the competency list; and the comprehensive list of the professional or occupational competencies deemed…

Graphic Communications. FasTrak Specialization Integrated Technical and Academic Competency (ITAC). Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.

This document contains an introduction to the Ohio Integrated Technical and Academic Competency (ITAC) and Specialization ITAC; an overview of the graphic communications field; a list acknowledging professionals who helped develop the competency list; and a comprehensive list of the professional or occupational competencies deemed essential for…

Lean Middleware

NASA Technical Reports Server (NTRS)

Maluf, David A.; Bell, David g.; Ashish, Naveen

2005-01-01

This paper describes an approach to achieving data integration across multiple sources in an enterprise, in a manner that is cost efficient and economically scalable. We present an approach that does not rely on major investment in structured, heavy-weight database systems for data storage or heavy-weight middleware responsible for integrated access. The approach is centered around pushing any required data structure and semantics functionality (schema) to application clients, as well as pushing integration specification and functionality to clients where integration can be performed on-the-fly .

JEDI - an executive dashboard and decision support system for lean global military medical resource and logistics management.

PubMed

Sloane, Elliot B; Rosow, Eric; Adam, Joe; Shine, Dave

2006-01-01

Each individual U.S. Air Force, Army, and Navy Surgeon General has integrated oversight of global medical supplies and resources using the Joint Medical Asset Repository (JMAR). A Business Intelligence system called the JMAR Executive Dashboard Initiative (JEDI) was developed over a three-year period to add real-time interactive data-mining tools and executive dashboards. Medical resources can now be efficiently reallocated to military, veteran, family, or civilian purposes and inventories can be maintained at lean levels with peaks managed by interactive dashboards that reduce workload and errors.

37 CFR 10.22 - Maintaining integrity and competence of the legal profession.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Maintaining integrity and competence of the legal profession. 10.22 Section 10.22 Patents, Trademarks, and Copyrights UNITED STATES... integrity and competence of the legal profession. (a) A practitioner is subject to discipline if the...

Investigating Variables Predicting Turkish Pre-service Teachers' Integration of ICT into Teaching Practices

ERIC Educational Resources Information Center

Aslan, Aydin; Zhu, Chang

2017-01-01

Pre-service teachers need to acquire information and communications technology (ICT) competency in order to integrate ICT into their teaching practices. This research was conducted to investigate to what extent ICT-related variables--such as perceived ICT competence, perceived competence in ICT integration, attitudes toward ICT, anxiety around ICT…

Competencies and Training Guidelines for Behavioral Health Providers in Pediatric Primary Care.

PubMed

Njoroge, Wanjiku F M; Williamson, Ariel A; Mautone, Jennifer A; Robins, Paul M; Benton, Tami D

2017-10-01

This article focuses on the cross-discipline training competencies needed for preparing behavioral health providers to implement integrated primary care services. After a review of current competencies in the disciplines of child and adolescent psychiatry, psychology, and social work, cross-cutting competencies for integrated training purposes are identified. These competencies are comprehensive and broad and can be modified for use in varied settings and training programs. An existing and successful integrated care training model, currently implemented at Children's Hospital of Philadelphia, is described. This model and the training competencies are discussed in the context of recommendations for future work and training. Copyright © 2017 Elsevier Inc. All rights reserved.

Special Interests and the Media: Theory and an Application to Climate Change.

PubMed

Shapiro, Jesse M

2016-12-01

A journalist reports to a voter on an unknown, policy-relevant state. Competing special interests can make claims that contradict the facts but seem credible to the voter. A reputational incentive to avoid taking sides leads the journalist to report special interests' claims to the voter. In equilibrium, the voter can remain uninformed even when the journalist is perfectly informed. Communication is improved if the journalist discloses her partisan leanings. The model provides an account of persistent public ignorance on climate change that is consistent with narrative and quantitative evidence.

Special Interests and the Media

PubMed Central

Shapiro, Jesse M.

2017-01-01

A journalist reports to a voter on an unknown, policy-relevant state. Competing special interests can make claims that contradict the facts but seem credible to the voter. A reputational incentive to avoid taking sides leads the journalist to report special interests’ claims to the voter. In equilibrium, the voter can remain uninformed even when the journalist is perfectly informed. Communication is improved if the journalist discloses her partisan leanings. The model provides an account of persistent public ignorance on climate change that is consistent with narrative and quantitative evidence. PMID:28725092

Lean thinking in health and nursing: an integrative literature review.

PubMed

Magalhães, Aline Lima Pestana; Erdmann, Alacoque Lorenzini; Silva, Elza Lima da; Santos, José Luís Guedes Dos

2016-08-08

to demonstrate the scientific knowledge developed on lean thinking in health, highlighting the impact and contributions in health care and nursing. an integrative literature review in the PubMed, CINAHL, Scopus, Web of Science, Emerald, LILACS and SciELO electronic library databases, from 2006 to 2014, with syntax keywords for each data base, in which 47 articles were selected for analysis. the categories were developed from the quality triad proposed by Donabedian: structure, process and outcome. Lean thinking is on the rise in health surveys, particularly internationally, especially in the USA and UK, improving the structure, process and outcome of care and management actions. However, it is an emerging theme in nursing. this study showed that the use of lean thinking in the context of health has a transforming effect on care and organizational aspects, promoting advantages in terms of quality, safety and efficiency of health care and nursing focused on the patient. evidenciar o conhecimento científico desenvolvido sobre pensamento Lean na área da saúde, destacando o impacto e as contribuições no cuidado em saúde e enfermagem. revisão integrativa da literatura a partir das bases de dados PubMed, CINAHL, Scopus, Web of Science, Emerald, LILACS e na biblioteca eletrônica SciELO, de 2006 a 2014, com sintaxe de palavras-chaves para cada base, selecionados 47 artigos para análise. as categorias foram elaboradas a partir da tríade de qualidade proposta por Donabedian: estrutura, processo e resultado. O pensamento Lean está em ascensão nas pesquisas sobre saúde, principalmente no âmbito internacional, com destaque para os Estados Unidos e Reino Unido, melhorando a estrutura, o processo e o resultado a partir das ações assistenciais e gerenciais. Porém, é uma temática incipiente na enfermagem. por meio desse estudo observou-se que a utilização do pensamento Lean, no contexto da saúde, tem um efeito transformador nos aspectos assistenciais e organizacionais, promovendo vantagens em termos de qualidade, segurança e eficiência dos cuidados de saúde e enfermagem com foco no paciente. evidenciar el conocimiento científico desarrollado sobre el pensamiento Lean en el área de la salud (destacando el impacto y las contribuciones en el cuidado de la salud) y en la enfermería. revisión integradora de la literatura a partir de las bases de datos PubMed, CINAHL, Scopus, Web of Science, Emerald, LILACS y en la biblioteca electrónica SciELO, de 2006 a 2014, con sintaxis de palabras clave para cada base; fueron seleccionados 47 artículos para análisis. las categorías fueron elaboradas a partir de la tríade de calidad propuesta por Donabedian: estructura, proceso y resultado. El pensamiento Lean está en ascensión en las investigaciones sobre salud, principalmente en el ámbito internacional, con destaque para los Estados Unidos y Reino Unido, mejorando la estructura, el proceso y el resultado a partir de acciones asistenciales y administrativas. Sin embargo, es una temática incipiente en la enfermería. por medio de ese estudio se observó que la utilización del pensamiento Lean, en el contexto de la salud, tiene un efecto transformador en los aspectos asistenciales y organizacionales, promoviendo ventajas en términos de calidad, seguridad y eficiencia de los cuidados de salud y enfermería con enfoque en el paciente.

Practical Nursing. FasTrak Specialization Integrated Technical and Academic Competency (ITAC). Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.

This document contains an introduction to the Ohio Integrated Technical and Academic Competency (ITAC) and Specialization ITAC; an overview of the field of practical nursing; a list acknowledging professionals who helped develop the competency list; and the comprehensive list of the professional or occupational competencies deemed essential for…

Influencing Factors and Integration of ICT into Teaching Practices of Pre- Service and Starting Teachers

ERIC Educational Resources Information Center

Aslan, Aydin; Zhu, Chang

2016-01-01

Teachers need to be competent in integrating ICT into education to support teaching and learning process. This study aims to investigate both the pre-service and starting teachers' perceptions for ICT-related variables--perceived ICT competence, perceived competence in ICT integration, attitudes towards ICT, anxiety around ICT usage, external…

Oak Ridge National Laboratory Core Competencies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roberto, J.B.; Anderson, T.D.; Berven, B.A.

1994-12-01

A core competency is a distinguishing integration of capabilities which enables an organization to deliver mission results. Core competencies represent the collective learning of an organization and provide the capacity to perform present and future missions. Core competencies are distinguishing characteristics which offer comparative advantage and are difficult to reproduce. They exhibit customer focus, mission relevance, and vertical integration from research through applications. They are demonstrable by metrics such as level of investment, uniqueness of facilities and expertise, and national impact. The Oak Ridge National Laboratory (ORNL) has identified four core competencies which satisfy the above criteria. Each core competencymore » represents an annual investment of at least $100M and is characterized by an integration of Laboratory technical foundations in physical, chemical, and materials sciences; biological, environmental, and social sciences; engineering sciences; and computational sciences and informatics. The ability to integrate broad technical foundations to develop and sustain core competencies in support of national R&D goals is a distinguishing strength of the national laboratories. The ORNL core competencies are: 9 Energy Production and End-Use Technologies o Biological and Environmental Sciences and Technology o Advanced Materials Synthesis, Processing, and Characterization & Neutron-Based Science and Technology. The distinguishing characteristics of each ORNL core competency are described. In addition, written material is provided for two emerging competencies: Manufacturing Technologies and Computational Science and Advanced Computing. Distinguishing institutional competencies in the Development and Operation of National Research Facilities, R&D Integration and Partnerships, Technology Transfer, and Science Education are also described. Finally, financial data for the ORNL core competencies are summarized in the appendices.« less

Implementation Science: New Approaches to Integrating Quality and Safety Education for Nurses Competencies in Nursing Education.

PubMed

Dolansky, Mary A; Schexnayder, Julie; Patrician, Patricia A; Sales, Anne

Although quality and safety competencies were developed and disseminated nearly a decade ago by the Quality and Safety Education for Nurses (QSEN) project, the uptake in schools of nursing has been slow. The use of implementation science methods may be useful to accelerate quality and safety competency integration in nursing education. The article includes a definition and description of implementation science methods and practical implementation strategies for nurse educators to consider when integrating the QSEN competencies into nursing curriculum.

Integrating learning assessment and supervision in a competency framework for clinical workplace education.

PubMed

Embo, M; Driessen, E; Valcke, M; van der Vleuten, C P M

2015-02-01

Although competency-based education is well established in health care education, research shows that the competencies do not always match the reality of clinical workplaces. Therefore, there is a need to design feasible and evidence-based competency frameworks that fit the workplace reality. This theoretical paper outlines a competency-based framework, designed to facilitate learning, assessment and supervision in clinical workplace education. Integration is the cornerstone of this holistic competency framework. Copyright © 2014 Elsevier Ltd. All rights reserved.

SLAE–CPS: Smart Lean Automation Engine Enabled by Cyber-Physical Systems Technologies

PubMed Central

Ma, Jing; Wang, Qiang; Zhao, Zhibiao

2017-01-01

In the context of Industry 4.0, the demand for the mass production of highly customized products will lead to complex products and an increasing demand for production system flexibility. Simply implementing lean production-based human-centered production or high automation to improve system flexibility is insufficient. Currently, lean automation (Jidoka) that utilizes cyber-physical systems (CPS) is considered a cost-efficient and effective approach for improving system flexibility under shrinking global economic conditions. Therefore, a smart lean automation engine enabled by CPS technologies (SLAE–CPS), which is based on an analysis of Jidoka functions and the smart capacity of CPS technologies, is proposed in this study to provide an integrated and standardized approach to design and implement a CPS-based smart Jidoka system. A set of comprehensive architecture and standardized key technologies should be presented to achieve the above-mentioned goal. Therefore, a distributed architecture that joins service-oriented architecture, agent, function block (FB), cloud, and Internet of things is proposed to support the flexible configuration, deployment, and performance of SLAE–CPS. Then, several standardized key techniques are proposed under this architecture. The first one is for converting heterogeneous physical data into uniform services for subsequent abnormality analysis and detection. The second one is a set of Jidoka scene rules, which is abstracted based on the analysis of the operator, machine, material, quality, and other factors in different time dimensions. These Jidoka rules can support executive FBs in performing different Jidoka functions. Finally, supported by the integrated and standardized approach of our proposed engine, a case study is conducted to verify the current research results. The proposed SLAE–CPS can serve as an important reference value for combining the benefits of innovative technology and proper methodology. PMID:28657577

SLAE-CPS: Smart Lean Automation Engine Enabled by Cyber-Physical Systems Technologies.

PubMed

Ma, Jing; Wang, Qiang; Zhao, Zhibiao

2017-06-28

In the context of Industry 4.0, the demand for the mass production of highly customized products will lead to complex products and an increasing demand for production system flexibility. Simply implementing lean production-based human-centered production or high automation to improve system flexibility is insufficient. Currently, lean automation (Jidoka) that utilizes cyber-physical systems (CPS) is considered a cost-efficient and effective approach for improving system flexibility under shrinking global economic conditions. Therefore, a smart lean automation engine enabled by CPS technologies (SLAE-CPS), which is based on an analysis of Jidoka functions and the smart capacity of CPS technologies, is proposed in this study to provide an integrated and standardized approach to design and implement a CPS-based smart Jidoka system. A set of comprehensive architecture and standardized key technologies should be presented to achieve the above-mentioned goal. Therefore, a distributed architecture that joins service-oriented architecture, agent, function block (FB), cloud, and Internet of things is proposed to support the flexible configuration, deployment, and performance of SLAE-CPS. Then, several standardized key techniques are proposed under this architecture. The first one is for converting heterogeneous physical data into uniform services for subsequent abnormality analysis and detection. The second one is a set of Jidoka scene rules, which is abstracted based on the analysis of the operator, machine, material, quality, and other factors in different time dimensions. These Jidoka rules can support executive FBs in performing different Jidoka functions. Finally, supported by the integrated and standardized approach of our proposed engine, a case study is conducted to verify the current research results. The proposed SLAE-CPS can serve as an important reference value for combining the benefits of innovative technology and proper methodology.

Perceived and actual competence among overweight and non-overweight children.

PubMed

Jones, Rachel A; Okely, Anthony D; Caputi, Peter; Cliff, Dylan P

2010-11-01

Child overweight and obesity continues to be a global public health concern. The aim of this study was to investigate whether children's actual and perceived physical competence and parental perception's of their child's competence differ by weight status. Understanding these differences is important because physical activity levels are significantly lower among overweight children than their lean counterparts and children's motivation to participate in physical activity is influenced by their perceived and actual competence and their parents perceptions of their competence. Cross-sectional data were collected from 1414 9- and 11-year-old children and their parents from 20 primary schools in New South Wales, Australia. Outcomes measured included child and parental perceptions of physical competence and children's actual physical competence. Parents of overweight boys perceived them to be significantly less competent than parents of non-overweight boys. For 11-year-old girls, parent's perception of their daughter's ability to run (mean diff=1.06 [95% CI 0.73, 1.40]), jump (mean diff=0.54 [95% CI 0.15, 0.93]) and leap (mean diff=0.78 [95% CI 0.41, 1.17]) was lower among parents of overweight children. Overweight children also reported lower perceived physical competence than non-overweight children. 9- and 11-year-old overweight boys had lower actual physical competence than non-overweight boys (mean diff=1.32 [95% CI 0.29, 2.35]; mean diff=1.26 [95% CI 0.37, 2.15], respectively). Overweight 11-year-old girls had lower actual competence than non-overweight 11-year-old girls (mean diff=1.14 [95% CI 0.70, 2.12]). This study highlighted several differences between overweight and non-overweight children. Better understanding these differences at different stages of development may lead to identifying more specific and appropriate intervention points to promote physical activity in overweight children. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

Education and Training for Clinical Neuropsychologists in Integrated Care Settings.

PubMed

Roper, Brad L; Block, Cady K; Osborn, Katie; Ready, Rebecca E

2018-05-01

The increasing importance of integrated care necessitates that education and training experiences prepare clinical neuropsychologists for competent practice in integrated care settings, which includes (a) general competence related to an integrated/interdisciplinary approach and (b) competence specific to the setting. Formal neuropsychology training prepares neuropsychologists with a wide range of knowledge and skills in assessment, intervention, teaching/supervision, and research that are relevant to such settings. However, less attention has been paid to the knowledge and skills that directly address functioning within integrated teams, such as the ability to develop, maintain, and expand collaboration across disciplines, bidirectional clinical-research translation and implementation in integrated team settings, and how such collaboration contributes to clinical and research activities. Foundational knowledge and skills relevant to interdisciplinary systems have been articulated as part of competencies for entry into clinical neuropsychology, but their emphasis in education and training programs is unclear. Recommendations and resources are provided regarding how competencies relevant to integrated care can be provided across the continuum of education and training (i.e., doctoral, internship, postdoctoral, and post-licensure).

A retrospective evaluation of the Perfecting Patient Care University training program for health care organizations.

PubMed

Morganti, Kristy Gonzalez; Lovejoy, Susan; Beckjord, Ellen Burke; Haviland, Amelia M; Haas, Ann C; Farley, Donna O

2014-01-01

This study evaluated how the Perfecting Patient Care (PPC) University, a quality improvement (QI) training program for health care leaders and clinicians, affected the ability of organizations to improve the health care they provide. This training program teaches improvement methods based on Lean concepts and principles of the Toyota Production System and is offered in several formats. A retrospective evaluation was performed that gathered data on training, other process factors, and outcomes after staff completed the PPC training. A majority of respondents reported gaining QI competencies and cultural achievements from the training. Organizations had high average scores for the success measures of "outcomes improved" and "sustainable monitoring" but lower scores for diffusion of QI efforts. Total training dosage was significantly associated with the measures of QI success. This evaluation provides evidence that organizations gained the PPC competencies and cultural achievements and that training dosage is a driver of QI success.

Integrating Lean Exploration Loops Into Healthcare Facility Design.

PubMed

Mazur, Lukasz M; Johnson, Kendra; Pooya, Pegah; Chadwick, Janet; McCreery, John

2017-04-01

To explore what, when, and how Lean methods and tools can add value during the programming phase of design through providing additional resources and support to project leadership and the architectural design team. This case study-based research took place at one large academic hospital during design efforts of a surgical tower to house 19 operating rooms (ORs) and support spaces including pre- and postop, central processing and distribution, and materials management. Surgical services project leadership asked for support from Lean practitioners during the design process. Lean exploration loops (LELs) were conducted to generate evidence to support stakeholders, as they made important decisions about the new building design. The analyses conducted during LELs were primarily focused on the relative advantages of a large footprint with few floors or a smaller footprint with more floors and support spaces not collocated adjacent to ORs on the same floor. LELs resulted in quantifications of key operational and design features (e.g., design preferences of employees and patients, horizontal distance travel, and elevator utilization studies), which in turn complemented the architectural design process and created an opportunities to gain buy-in and consensus from stakeholders through their active participation in many of the analyses. We found Lean tools and methods to be of most value during programming phase when focused on the high-level operational and design issues to help establish buy-in and consensus among stakeholders, while acknowledging that there is often not enough design detail to perform accurate analysis.

Integrating Lean Exploration Loops Into Healthcare Facility Design.

PubMed

Johnson, Kendra; M Mazur, Lukasz; Chadwick, Janet; Pooya, Pegah; Amos, Alison; McCreery, John

2017-04-01

To explore how Lean can add value during the schematic phase of design through providing additional resources and support to project leadership and the architectural design team. This case study-based research took place at one large academic hospital during design efforts of surgical tower to house 19 operating rooms (ORs) and support spaces including pre- and post-op, central processing and distribution, and materials management. Surgical services project leadership asked for Lean practitioners' support during the design process. Lean Exploration Loops (LELs) were conducted to generate evidence to support stakeholders, as they made important decisions about the new building design. The analyses conducted during LELs during the schematic phase were primarily conducted using express workouts (EWOs) and were focused on the flow of patients, staff, and family throughout the pavilion. LELs resulted in recommendations for key design features (e.g., number of pre- and post-op bays per OR floor, location of doors, scrub sinks, stretcher alcoves, equipment storage, and sterile core areas). Two-sided pre- and post-op bays with an inner clinical workspace and an outer patient transport corridor were recommended. Communicating elevator and a centrally located stairwell for staff to alleviate stress on the main bank of elevators at peak usage times were also suggested. We found Lean tools and methods to be of most value during schematic phase when focused on detailed process and layout analysis, while acknowledging the usefulness of focused EWOs to generate the evidence needed for the decision-making.

Influence of Teacher Competency on Integration of ICT in Teaching and Learning in Public Secondary Schools in Machakos

ERIC Educational Resources Information Center

Michael, Felistas Mbithe; Maithya, Redempta; Cheloti, Selpher K.

2016-01-01

This study was set to investigate the influence of teachers' competency on the integration of ICT in teaching and learning in public secondary schools in Machakos County. The study hypothesis was that: There is no significant relationship between teacher competency and the integration of ICT in teaching and learning. The study used a sample of…

Computer-Integrated Manufacturing Technology. Tech Prep Competency Profile.

ERIC Educational Resources Information Center

Lakeland Tech Prep Consortium, Kirtland, OH.

This tech prep competency profile for computer-integrated manufacturing technology begins with definitions for four occupations: manufacturing technician, quality technician, mechanical engineering technician, and computer-assisted design/drafting (CADD) technician. A chart lists competencies by unit and indicates whether entire or partial unit is…

Integrating information literacy into the education of public health professionals: roles for librarians and the library

PubMed Central

Cobus, Laura

2008-01-01

Objective: The paper reviews the core competencies for public health professionals presented in the Institute of Medicine's (IOM's) report, Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st Century; describes improving information literacy (IL) as a mechanism for integrating the core competencies in public health education; and showcases IL as an opportunity for solidifying partnerships between academic librarians and public health educators. Methods: The IOM competencies, along with explicit examples of library support from a literature review of current IL trends in the health sciences, are analyzed. Results: Librarians can play a fundamental role in implementing the IOM's core competencies in shaping public health education for the twenty-first century. A partnership between public health educators and librarians through a transdisciplinary approach is recommended. Conclusions: IL skills and competencies integrated into public health curricula through a collaborative partnership between public health educators and librarians can help integrate the IOM's core competencies and improve public health education. PMID:18219378

Integrating Research Competencies in Massage Therapy Education.

ERIC Educational Resources Information Center

Hymel, Glenn M.

The massage therapy profession is currently engaged in a competency-based education movement that includes an emphasis on promoting massage therapy research competencies (MTRCs). A systems-based model for integrating MTRCs into massage therapy education was therefore proposed. The model and an accompanying checklist describe an approach to…

Assessing Integration of Clinical and Public Health Skills in Preventive Medicine Residencies: Using Competency Mapping

PubMed Central

Sarigiannis, Amy N.; Boulton, Matthew L.

2012-01-01

Objectives. We evaluated the utility of a competency mapping process for assessing the integration of clinical and public health skills in a newly developed Community Health Center (CHC) rotation at the University of Michigan School of Public Health Preventive Medicine residency. Methods. Learning objectives for the CHC rotation were derived from the Accreditation Council for Graduate Medical Education core clinical preventive medicine competencies. CHC learning objectives were mapped to clinical preventive medicine competencies specific to the specialty of public health and general preventive medicine. Objectives were also mapped to The Council on Linkages Between Academia and Public Health Practice’s tier 2 Core Competencies for Public Health Professionals. Results. CHC learning objectives mapped to all 4 (100%) of the public health and general preventive medicine clinical preventive medicine competencies. CHC population-level learning objectives mapped to 32 (94%) of 34 competencies for public health professionals. Conclusions. Utilizing competency mapping to assess clinical–public health integration in a new CHC rotation proved to be feasible and useful. Clinical preventive medicine learning objectives for a CHC rotation can also address public health competencies. PMID:22690972

Towards an integrated model of nursing competence: an overview of the literature reviews and concept analysis.

PubMed

Caruso, Roberto; Fida, Roberta; Sili, Alessandro; Arrigoni, Cristina

2016-01-01

Competence is considered a fundamental element when measuring a nurse's or student's ability to provide nursing care, but there is no consensus on what competence really is. This paper aims to review the existing meanings and models of nursing competence. The overview of literature reviews and concept analysis was performed through a search on Pubmed, Cinahl and PsychINFO from January 2005 to September 2014. It included key words, such as: Competence Model; Professional Competence; Nursing Competence; Competency Model; Professional Competency; Nursing Competency. A total of 14 papers were found, coming from educational or clinical nursing field. It was possible to identify some common themes: description of competence determinants; confu- sion around the competence concept; lack in competence evaluation; lack when competence have to be operationalized. The overview results, enriched by the literature coming out from the organiza- tional studies, build the conceptual basis of an integrated model of nursing competence. More empirical research is needed to test the theoretical assumptions.

Building a Competency-Based Curriculum in Social Work Education

ERIC Educational Resources Information Center

Bracy, Wanda

2018-01-01

The focus on competency in social work education makes the development of a competency-based curriculum critical. This article describes an approach to curriculum building taking into account the integration, coherency, and integrity of such a curriculum. A presentation of how performance outcomes are fundamental to the relationship between the…

Carpentry. FasTrak Specialization Integrated Technical and Academic Competency (ITAC). 2001 Revision.

ERIC Educational Resources Information Center

Ohio State Board of Education, Columbus.

This Ohio Integrated Technical and Academic Competency (ITAC) profile provides the professional or occupational competencies deemed essential for a graduate to perform proficiently in carpentry when he or she graduates from the specialization work force development program in industrial and engineering systems. The profile includes competency…

Formal and Integrated Strategies for Competence Development in SMEs

ERIC Educational Resources Information Center

Kock, Henrik; Ellstrom, Per-Erik

2011-01-01

Purpose: The purpose of this paper is to increase understanding of the relationships among the workplace as a learning environment, strategies for competence development used by SMEs and learning outcomes. Specifically, there is a focus on a distinction between formal and integrated strategies for competence development, the conditions under which…

Cultural Competence Integration in the Nursing Curriculum

ERIC Educational Resources Information Center

Stegman, Boniface C.

2013-01-01

With an increasingly diverse population, it is important to ensure that graduates of nursing programs are able to deliver culturally competent care (Krainovich-Miller et al., 2008; Allen, 2010). This study was undertaken to address this call to include cultural competence integration into nursing curriculum. The purpose of this study was to…

Recommended integrative medicine competencies for family medicine residents.

PubMed

Locke, Amy B; Gordon, Andrea; Guerrera, Mary P; Gardiner, Paula; Lebensohn, Patricia

2013-01-01

The use of complementary and alternative medicine (CAM) and Integrative Medicine (IM) has grown steadily over the past decade. Patients seek physician guidance, yet physicians typically have limited knowledge and training. There is some coverage of IM/CAM topics in medical schools and residencies but with little coordination or consistency. In 2008, the Society of Teachers of Family Medicine (STFM) group on Integrative Medicine began the process of designing a set of competencies to educate Family Medicine residents in core concepts of IM. The goal was creation of a set of nationally recognized competencies tied to the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies were to be achievable by diverse programs, including those without significant internal resources. The group compiled existing curricula from programs around the country and distilled these competencies through multiple reviews and discussions. Simultaneously, the Integrative Medicine in Residency program run by the University of Arizona underwent a similar process. In 2009, these competencies were combined and further developed at the STFM annual meeting by a group of experts. In 2010, the STFM Board approved 19 measurable competencies, each categorized by ACGME domain, as recommended for Family Medicine residencies. Programs have implemented these competencies in various ways given individual needs and resources. This paper reviews the development of IM competencies for residency education in Family Medicine and presents those endorsed by STFM. By educating physicians in training about IM/CAM via competency-based curricula, we aim to promote comprehensive patient-centered care. © 2013 Elsevier Inc. All rights reserved.

Integrating Prevention of Mother to Child HIV Transmission competencies into the nursing curriculum: Methodological lessons from a university-based undergraduate programme.

PubMed

Mbombo, Nomafrench; Bimerew, Million

2012-11-14

South Africa (SA) has the highest number of women infected with HIV and AIDS during pregnancy, which results in more than 70 000 infected babies being born each year AIDS is the major contributor to maternal and child morbidities and mortalities in the country. To combat this, the SA government has developed a national policy to prevent mother-to-child HIV transmission (PMTCT). However, for effective implementation of this policy, there is a dire need for a competent, skilled health worker to render the service. In response to this, the School of Nursing at the University of the Western Cape has integrated PMTCT competencies into the undergraduate Bachelor of Nursing Science curriculum. In this paper, we described teaching and learning approaches used to integrate PMTCT competencies, including the skills laboratory methodology and case-based learning, as well as a portfolio of evidence assessment tool. A quantitative descriptive design was used to analyse data collected from students in regard to assessment of PMTCT competencies achieved. The study used the conceptual framework of Lenburg's competency outcomes and performance assessment model, which focuses on competency development and assessment in a clinical environment. HIV competencies, including PMTCT, should be integrated both theoretically and at service delivery into other nursing and midwifery competencies, including assessment strategies. Provincial policies in provision of antiretrovirals by nurses and midwives become barriers to successful implementation of PMTCT, resulting in limited learning opportunities for students to practice PMTCT competencies. Further research is required to assess an attribute, affect, which is another prong for competencies.

A Low NO(x) Lean-Direct Injection, Multipoint Integrated Module Combuster Concept for Advanced Aircraft Gas Turbines

NASA Technical Reports Server (NTRS)

Tacina, Robert; Wey, Changlie; Laing, Peter; Mansour, Adel

2002-01-01

A low NO(x) emissions combustor has been demonstrated in flame-tube tests. A multipoint, lean-direct injection concept was used. Configurations were tested that had 25- and 36- fuel injectors in the size of a conventional single fuel injector. An integrated-module approach was used for the construction where chemically etched laminates, diffusion bonded together, combine the fuel injectors, air swirlers and fuel manifold into a single element. Test conditions were inlet temperatures up to 810 K, inlet pressures up to 2760 kPa, and flame temperatures up to 2100 K. A correlation was developed relating the NO(x) emissions with the inlet temperature, inlet pressure, fuel-air ratio and pressure drop. Assuming that 10 percent of the combustion air would be used for liner cooling and using a hypothetical engine cycle, the NO(x) emissions using the correlation from flame-tube tests were estimated to be less than 20 percent of the 1996 ICAO standard.

A Lean Six Sigma quality improvement project to increase discharge paperwork completeness for admission to a comprehensive integrated inpatient rehabilitation program.

PubMed

Neufeld, Nathan J; Hoyer, Erik H; Cabahug, Philippines; González-Fernández, Marlís; Mehta, Megha; Walker, N Colbey; Powers, Richard L; Mayer, R Samuel

2013-01-01

Lean Six Sigma (LSS) process analysis can be used to increase completeness of discharge summary reports used as a critical communication tool when a patient transitions between levels of care. The authors used the LSS methodology as an intervention to improve systems process. Over the course of the project, 8 required elements were analyzed in the discharge paperwork. The authors analyzed the discharge paperwork of patients (42 patients preintervention and 143 patients postintervention) of a comprehensive integrated inpatient rehabilitation program (CIIRP). Prior to this LSS project, 61.8% of required discharge elements were present. The intervention improved the completeness to 94.2% of the required elements. The percentage of charts that were 100% complete increased from 11.9% to 67.8%. LSS is a well-established process improvement methodology that can be used to make significant improvements in complex health care workflow issues. Specifically, the completeness of discharge documentation required for transition of care to CIIRP can be improved.

STS-52 PS MacLean, backup PS Tryggvason, and PI pose on JSC's CCT flight deck

NASA Technical Reports Server (NTRS)

1992-01-01

STS-52 Columbia, Orbiter Vehicle (OV) 102, Canadian Payload Specialist (PS) Steven G. MacLean (left) and backup Payload Specialist Bjarni V. Tryggvason (right) take a break from a camera training session in JSC's Crew Compartment Trainer (CCT). The two Canadian Space Agency (CSA) representatives pose on the CCT's aft flight deck with Canadian scientist David Zimick, the principal investigator (PI) for the materials experiment in low earth orbit (MELEO). MELEO is a component of the CANEX-2 experiment package, manifest to fly on the scheduled October 1992 STS-52 mission. The CCT is part of the shuttle Mockup and Integration Laboratory (MAIL) Bldg 9NE.

Driving Performance Improvements by Integrating Competencies with Human Resource Practices

ERIC Educational Resources Information Center

Lee, Jin Gu; Park, Yongho; Yang, Gi Hun

2010-01-01

This study explores the issues in the development and application of a competency model and provides implications for more precise integration of competencies into human resource (HR) functions driving performance improvement. This research is based on a case study from a Korean consumer corporation. This study employed document reviews,…

Administrative Office Technology. FasTrak Specialization Integrated Technical and Academic Competency (ITAC). Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.

This document presents the Ohio Integrated Technical and Academic Competency (ITAC) profile for administrative office technology, which is a comprehensive listing of 58 occupational skill competencies deemed essential for Ohio graduates of programs in office technology. The document begins with an introduction to the ITAC system, a list of…

Validity of Subjective Self-Assessment of Digital Competence among Undergraduate Preservice Teachers

ERIC Educational Resources Information Center

Maderick, Joseph Andrew

2013-01-01

Technology is now integrated into the Technological Pedagogical Content Knowledge (TPACK) required to be a highly qualified 21st century teacher. Accurate measurement of digital competence has become critical. Self-assessment has been used widely to measure the digital competence of preservice teachers who are expected to integrate technology into…

Developing Career Management Competencies among Undergraduates and the Role of Work-Integrated Learning

ERIC Educational Resources Information Center

Jackson, Denise; Wilton, Nicholas

2016-01-01

This paper explores undergraduate capabilities in career self-management and the influence of work-integrated learning (WIL). Career management competencies are an important aspect of individual employability and impact on wellbeing, graduate job attainment and long-term career success. Enhanced competencies among graduates can assist Faculty in…

Public Safety Core. Integrated Academic and Technical Competencies (ITAC).

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.

This document, which lists the public safety core competencies that are part of the Integrated Academic and Technical Competencies (ITAC) in Ohio, is intended to assist individuals and organizations develop a course to provide students with knowledge and skills applicable to public safety careers, including but not limited to firefighter,…

The stimulus integration area for horizontal vergence.

PubMed

Allison, Robert S; Howard, Ian P; Fang, Xueping

2004-06-01

Over what region of space are horizontal disparities integrated to form the stimulus for vergence? The vergence system might be expected to respond to disparities within a small area of interest to bring them into the range of precise stereoscopic processing. However, the literature suggests that disparities are integrated over a fairly large parafoveal area. We report the results of six experiments designed to explore the spatial characteristics of the stimulus for vergence. Binocular eye movements were recorded using magnetic search coils. Each dichoptic display consisted of a central target stimulus that the subject attempted to fuse, and a competing stimulus with conflicting disparity. In some conditions the target was stationary, providing a fixation stimulus. In other conditions, the disparity of the target changed to provide a vergence-tracking stimulus. The target and competing stimulus were combined in a variety of conditions including those in which (1) a transparent textured-disc target was superimposed on a competing textured background, (2) a textured-disc target filled the centre of a competing annular background, and (3) a small target was presented within the centre of a competing annular background of various inner diameters. In some conditions the target and competing stimulus were separated in stereoscopic depth. The results are consistent with a disparity integration area with a diameter of about 5 degrees. Stimuli beyond this integration area can drive vergence in their own right, but they do not appear to be summed or averaged with a central stimulus to form a combined disparity signal. A competing stimulus had less effect on vergence when separated from the target by a disparity pedestal. As a result, we propose that it may be more useful to think in terms of an integration volume for vergence rather than a two-dimensional retinal integration area.

Information Technology. DOD Needs to Strengthen Management of Its Statutorily Mandated Software and System Process Improvement Efforts

DTIC Science & Technology

2009-09-01

NII)/CIO Assistant Secretary of Defense for Networks and Information Integration/Chief Information Officer CMMI Capability Maturity Model...a Web-based portal to share knowledge about software process-related methodologies, such as the SEI’s Capability Maturity Model Integration ( CMMI ...19 SEI’s IDEALSM model, and Lean Six Sigma.20 For example, the portal features content areas such as software acquisition management, the SEI CMMI

2006 DoD Diminishing Manufacturing Sources and Material Shortages (DMSMS) Conference, Exhibition and Workshop

DTIC Science & Technology

2006-07-13

echnology T ervicesS Integrated Systems & Solutions Integrated yste s S olutionsS • 30,000 Employees • 5 Principal Businesses Organized Into 3 Major...Solutions -Data Sources -Search Engine -Notification Policy -DSCC/IST Lead -Industry Capabilities - Organic Capabilities -Pro-active upgrades -DMEA Lead...needs to TLCSM EC. Cathi Crabtree Voting Members Accomplishments WG Organization we can build on DAU Distance Leaning Modules WG Strategic Plan Re

Competence for older people nursing in care and nursing homes: An integrative review.

PubMed

Kiljunen, Outi; Välimäki, Tarja; Kankkunen, Päivi; Partanen, Pirjo

2017-09-01

People living in care and nursing homes are vulnerable individuals with complex needs; therefore, a wide array of nursing competence is needed to ensure their well-being. When developing the quality of care in these units, it is essential to know what type of competence is required for older people nursing. The aim of this integrative review was to identify the competence needed for older people nursing in licensed practical nurses' and registered nurses' work in care and nursing homes. Integrative literature review. We performed an integrative review using Whittemore and Knafl's method. The CINAHL, MEDLINE, PsycINFO, SocINDEX and Scopus databases were searched for studies published from 2006 to April 2016. We assessed the quality of the studies using Joanna Briggs Institute critical appraisal tools and analysed the data by applying qualitative content analysis. Ten articles were included in the review. Most of the studies focused on registered nurses' work. We identified five competence areas that are needed for older people nursing in registered nurses' work in care and nursing homes: attitudinal and ethical, interactional, evidence-based care, pedagogical, and leadership and development competence. Empirical evidence of competence requirements related to licensed practical nurses' work in these facilities was scarce. The competence required for registered nurses and licensed practical nurses should be clearly identified to support competence management in the care and nursing home context. Well-educated nursing staff are needed in care and nursing homes to provide high-quality care because comprehensive and advanced nurse competence is required to meet the needs of older people. © 2016 John Wiley & Sons Ltd.

Muscle mass is associated with incident fracture in postmenopausal women: The OFELY study.

PubMed

Sornay-Rendu, E; Duboeuf, F; Boutroy, S; Chapurlat, R D

2017-01-01

The relationships between body composition and bone mineral density are well established but the contribution of body composition to the risk of fracture (Fx) has rarely been evaluated prospectively. We analyzed the risk of Fx by body composition in 595 postmenopausal women (mean age 66±8years) from a longitudinal cohort study (Os des Femmes de Lyon). We assessed the risk of the first incident fragility Fx according to body composition obtained from whole-body DXA: abdominal visceral (VFAT) and subcutaneous fat mass (SFAT), total body fat mass (FM), lean mass index (LMI) and appendicular skeletal muscle mass index (ASMI). During a median [IQ] follow-up of 13.1years [1.9], 138 women sustained a first incident Fx, including 85 women with a major osteoporotic Fx (MOP Fx: hip, clinical spine, humerus or wrist). After adjustment for age, women who sustained Fx had lower BMI (-4%, p=0.01), LMI (-6%, p=0.002) and ASMI (-3%, p=0.003), compared with women without Fx. After adjustment for age, prevalent Fx, physical activity, incident falls and FN BMD, each SD increase of baseline values of LMI and ASMI was associated with decreased Fx risk with adjusted hazard ratios of 0.76 for both of p≤0.02. Those associations were similar after accounting for the competing risk of death. VFAT and SFAT were associated with Fx risk in the multivariate model only for MOP Fx and the association did not persist after consideration of competing mortality. We conclude that lean mass and appendicular muscle mass indexes are associated with the risk of fracture in postmenopausal women independently of BMD and clinical risk factors. Copyright © 2016 Elsevier Inc. All rights reserved.

Core Competencies in Integrative Pain Care for Entry-Level Primary Care Physicians.

PubMed

Tick, Heather; Chauvin, Sheila W; Brown, Michael; Haramati, Aviad

2015-11-01

The objective was to develop a set of core competencies for graduating primary care physicians in integrative pain care (IPC), using the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies build on previous work in competencies for integrative medicine, interprofessional education, and pain medicine and are proposed for inclusion in residency training. A task force was formed to include representation from various professionals who are involved in education, research, and the practice of IPC and who represent broad areas of expertise. The task force convened during a 1.5-day face-to-face meeting, followed by a series of surveys and other vetting processes involving diverse interprofessional groups, which led to the consensus of a final set of competencies. The proposed competencies focus on interprofessional knowledge, skills, and attitudes (KSAs) and are in line with recommendations by the Institute of Medicine, military medicine, and professional pain societies advocating the need for coordination and integration of services for effective pain care with reduced risk and cost and improved outcomes. These ACGME domain compatible competencies for physicians reflect the contributions of several disciplines that will need to be included in evolving interprofessional settings and underscore the need for collaborative care. These core competencies can guide the incorporation of KSAs within curricula. The learning experiences should enable medical educators and graduating primary care physicians to focus more on integrative approaches, interprofessional team-based, patient-centered care that use evidence-based, traditional and complementary disciplines and therapeutics to provide safe and effective treatments for people in pain. Wiley Periodicals, Inc.

Use of a service evaluation and lean thinking transformation to redesign an NHS 111 refer to community Pharmacy for Emergency Repeat Medication Supply Service (PERMSS)

PubMed Central

Nazar, Hamde; Nazar, Zachariah; Simpson, Jill; Yeung, Andre; Whittlesea, Cate

2016-01-01

Objectives To demonstrate the contribution of community pharmacy from NHS 111 referrals out of hours (OOH) for emergency supply repeat medication requests via presentation of service activity, community pharmacist feedback and lean thinking transformation. Design Descriptive service evaluation using routine service activity data over the pilot period; survey of community pharmacists, and service redesign through lean thinking transformation. Setting North East of England NHS 111 provider and accredited community pharmacies across the North East of England. Participants Patients calling the North East of England NHS 111 provider during OOH with emergency repeat medication supply requests. Interventions NHS 111 referral to community pharmacies for assessment and if appropriate, supply of emergency repeat medication. Main outcome measures Number of emergency repeat medication supply referrals, completion rates, reasons for rejections, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist feedback and lean thinking transformation of the patient pathway. Results NHS 111 referred 1468 patients to 114 community pharmacies (15/12/2014–7/4/2015). Most patients presented on Saturdays, with increased activity over national holidays. Community pharmacists completed 951 (64.8%) referrals providing 2297 medications; 412 were high risk. The most common reason for rejecting referrals was no medication in stock. Community pharmacists were positive about the provision of this service. The lean thinking transformation reduced the number of non-added value steps, waits and bottlenecks in the patient pathway. Conclusions NHS 111 can redirect callers OOH from urgent and emergency care services to community pharmacy for management of emergency repeat medication supply. Existing IT and community pharmacy regulations allowed patients to receive a medication supply and pharmaceutical advice. Community pharmacists supported integration into the NHS OOH services. Adopting lean thinking provided a structured framework to evaluate and redesign the service with the aim to improve effectiveness and efficiency. PMID:27566629

How dieting makes some fatter: from a perspective of human body composition autoregulation.

PubMed

Dulloo, Abdul G; Jacquet, Jean; Montani, Jean-Pierre

2012-08-01

Dieting makes you fat - the title of a book published in 1983 - embodies the notion that dieting to control body weight predisposes the individual to acquire even more body fat. While this notion is controversial, its debate underscores the large gap that exists in our understanding of basic physiological laws that govern the regulation of human body composition. A striking example is the key role attributed to adipokines as feedback signals between adipose tissue depletion and compensatory increases in food intake. Yet, the relative importance of fat depletion per se as a determinant of post-dieting hyperphagia is unknown. On the other hand, the question of whether the depletion of lean tissues can provide feedback signals on the hunger-appetite drive is rarely invoked, despite evidence that food intake during growth is dominated by the impetus for lean tissue deposition, amidst proposals for the existence of protein-static mechanisms for the regulation of growth and maintenance of lean body mass. In fact, a feedback loop between fat depletion and food intake cannot explain why human subjects recovering from starvation continue to overeat well after body fat has been restored to pre-starvation values, thereby contributing to 'fat overshooting'. In addressing the plausibility and mechanistic basis by which dieting may predispose to increased fatness, this paper integrates the results derived from re-analysis of classic longitudinal studies of human starvation and refeeding. These suggest that feedback signals from both fat and lean tissues contribute to recovering body weight through effects on energy intake and thermogenesis, and that a faster rate of fat recovery relative to lean tissue recovery is a central outcome of body composition autoregulation that drives fat overshooting. A main implication of these findings is that the risk of becoming fatter in response to dieting is greater in lean than in obese individuals.

Integrating economic parameters into genetic selection for Large White pigs.

PubMed

Dube, Bekezela; Mulugeta, Sendros D; Dzama, Kennedy

2013-08-01

The objective of the study was to integrate economic parameters into genetic selection for sow productivity, growth performance and carcass characteristics in South African Large White pigs. Simulation models for sow productivity and terminal production systems were performed based on a hypothetical 100-sow herd, to derive economic values for the economically relevant traits. The traits included in the study were number born alive (NBA), 21-day litter size (D21LS), 21-day litter weight (D21LWT), average daily gain (ADG), feed conversion ratio (FCR), age at slaughter (AGES), dressing percentage (DRESS), lean content (LEAN) and backfat thickness (BFAT). Growth of a pig was described by the Gompertz growth function, while feed intake was derived from the nutrient requirements of pigs at the respective ages. Partial budgeting and partial differentiation of the profit function were used to derive economic values, which were defined as the change in profit per unit genetic change in a given trait. The respective economic values (ZAR) were: 61.26, 38.02, 210.15, 33.34, -21.81, -68.18, 5.78, 4.69 and -1.48. These economic values indicated the direction and emphases of selection, and were sensitive to changes in feed prices and marketing prices for carcasses and maiden gilts. Economic values for NBA, D21LS, DRESS and LEAN decreased with increasing feed prices, suggesting a point where genetic improvement would be a loss, if feed prices continued to increase. The economic values for DRESS and LEAN increased as the marketing prices for carcasses increased, while the economic value for BFAT was not sensitive to changes in all prices. Reductions in economic values can be counterbalanced by simultaneous increases in marketing prices of carcasses and maiden gilts. Economic values facilitate genetic improvement by translating it to proportionate profitability. Breeders should, however, continually recalculate economic values to place the most appropriate emphases on the respective traits during genetic selection.

Integrating Knowledge, Skills and Attitudes: Conceptualising Learning Processes towards Vocational Competence

ERIC Educational Resources Information Center

Baartman, Liesbeth K. J.; de Bruijn, Elly

2011-01-01

Current research focuses on competence development and complex professional tasks. However, "learning processes" towards the integration of knowledge, skills and attitudes largely remain a black box. This article conceptualises three integration processes, in analogy to theories on transfer. Knowledge, skills and attitudes are defined, reconciling…

Integrated Sensing and Processing (ISP) Phase II: Demonstration and Evaluation for Distributed Sensor Netowrks and Missile Seeker Systems

DTIC Science & Technology

2007-02-28

Shah, D. Waagen, H. Schmitt, S. Bellofiore, A. Spanias, and D. Cochran, 32nd International Conference on Acoustics, Speech , and Signal Processing...Information Exploitation Office kNN k-Nearest Neighbor LEAN Laplacian Eigenmap Adaptive Neighbor LIP Linear Integer Programming ISP

Arts Integration: A Strategy to Improve Teaching and Learning, Promote Personal Competencies, and Turn Around Low-Performing Schools

ERIC Educational Resources Information Center

Biscoe, Belinda; Wilson, Kirk

2015-01-01

This paper connects the dots between arts integration, students' personal competencies, and school turnaround. Its thesis is that by intertwining art forms and methods with content in all subject areas, students learn more about art and the other subjects and build their personal competencies for learning. The paper includes the story of an…

High School Work and Family Life ITAC [Integrated Technical & Academic Competencies] for Career-Focused Education.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This document contains a guide to implementing the Ohio Work and Family Life ITAC (Integrated Technical and Academic Competencies), which connects to the Ohio Model Competency-Based Program documents in arts, foreign languages, language arts, mathematics, science, and social studies, as well as the Core ITAC document. The Work and Family Life ITAC…

Developing an Objective Structured Clinical Examination to Assess Work-Integrated Learning in Exercise Physiology

ERIC Educational Resources Information Center

Naumann, Fiona; Moore, Keri; Mildon, Sally; Jones, Philip

2014-01-01

This paper aims to develop a valid method to assess the key competencies of the exercise physiology profession acquired through work-integrated learning (WIL). In order to develop a competency-based assessment, the key professional tasks needed to be identified and the test designed so students' competency in different tasks and settings could be…

Development and validation of a competency framework for veterinarians.

PubMed

Bok, Harold G J; Jaarsma, Debbie A D C; Teunissen, Pim W; van der Vleuten, Cees P M; van Beukelen, Peter

2011-01-01

Changing demands from society and the veterinary profession call for veterinary medical curricula that can deliver veterinarians who are able to integrate specific and generic competencies in their professional practice. This requires educational innovation directed by an integrative veterinary competency framework to guide curriculum development. Given the paucity of relevant information from the veterinary literature, a qualitative multi-method study was conducted to develop and validate such a framework. A competency framework was developed based on the analysis of focus group interviews with 54 recently graduated veterinarians and clients and subsequently validated in a Delphi procedure with a panel of 29 experts, representing the full range and diversity of the veterinary profession. The study resulted in an integrated competency framework for veterinary professionals, which consists of 16 competencies organized in seven domains: veterinary expertise, communication, collaboration, entrepreneurship, health and welfare, scholarship, and personal development. Training veterinarians who are able to use and integrate the seven domains in their professional practice is an important challenge for today's veterinary medical schools. The Veterinary Professional (VetPro) framework provides a sound empirical basis for the ongoing debate about the direction of veterinary education and curriculum development.

KSC-06pd2077

NASA Image and Video Library

2006-09-08

KENNEDY SPACE CENTER, FLA. - In the Operations and Checkout Building at NASA Kennedy Space Center, STS-115 Mission Specialist Steven MacLean dons his launch and re-entry suit before heading to the launch pad. MacLean is with the Canadian Space Agency. MacLean is making his second shuttle flight on this mission to the International Space Station aboard Space Shuttle Atlantis. On its second attempt for launch, Atlantis is scheduled to lift off at 11:41 a.m. EDT today from Launch Pad 39B. During the STS-115 mission, Atlantis' astronauts will deliver and install the 17.5-ton, bus-sized P3/P4 integrated truss segment on the station. The girder-like truss includes a set of giant solar arrays, batteries and associated electronics and will provide one-fourth of the total power-generation capability for the completed station. This mission is the 116th space shuttle flight, the 27th flight for orbiter Atlantis, and the 19th U.S. flight to the ISS. STS-115 is scheduled to last 11 days with a planned landing at KSC. Photo credit: NASA/Kim Shiflett

Preparing Pre-Service Teachers to Integrate Technology: An Analysis of the Emphasis on Digital Competence in Teacher Education Curricula

ERIC Educational Resources Information Center

Instefjord, Elen; Munthe, Elaine

2016-01-01

This article focuses on integration of digital competence in curriculum documents for teacher education in Norway. A model inspired by the work of Zhao, Pugh, Sheldon and Byers, as well as Krumsvik and Mishra and Koehler, has been developed as an analytical framework. Teachers' digital competence is here understood as comprising three knowledge…

Competency Analytics Tool: Analyzing Curriculum Using Course Competencies

ERIC Educational Resources Information Center

Gottipati, Swapna; Shankararaman, Venky

2018-01-01

The applications of learning outcomes and competency frameworks have brought better clarity to engineering programs in many universities. Several frameworks have been proposed to integrate outcomes and competencies into course design, delivery and assessment. However, in many cases, competencies are course-specific and their overall impact on the…

Assessing treatment integrity in cognitive-behavioral therapy: comparing session segments with entire sessions.

PubMed

Weck, Florian; Grikscheit, Florian; Höfling, Volkmar; Stangier, Ulrich

2014-07-01

The evaluation of treatment integrity (therapist adherence and competence) is a necessary condition to ensure the internal and external validity of psychotherapy research. However, the evaluation process is associated with high costs, because therapy sessions must be rated by experienced clinicians. It is debatable whether rating session segments is an adequate alternative to rating entire sessions. Four judges evaluated treatment integrity (i.e., therapist adherence and competence) in 84 randomly selected videotapes of cognitive-behavioral therapy for major depressive disorder, social anxiety disorder, and hypochondriasis (from three different treatment outcome studies). In each case, two judges provided ratings based on entire therapy sessions and two on session segments only (i.e., the middle third of the entire sessions). Interrater reliability of adherence and competence evaluations proved satisfactory for ratings based on segments and the level of reliability did not differ from ratings based on entire sessions. Ratings of treatment integrity that were based on entire sessions and session segments were strongly correlated (r=.62 for adherence and r=.73 for competence). The relationship between treatment integrity and outcome was comparable for ratings based on session segments and those based on entire sessions. However, significant relationships between therapist competence and therapy outcome were only found in the treatment of social anxiety disorder. Ratings based on segments proved to be adequate for the evaluation of treatment integrity. The findings demonstrate that session segments are an adequate and cost-effective alternative to entire sessions for the evaluation of therapist adherence and competence. Copyright © 2014. Published by Elsevier Ltd.

Effectiveness of integrated science instructional material on pressure in daily life theme to improve digital age literacy of students

NASA Astrophysics Data System (ADS)

Asrizal; Amran, A.; Ananda, A.; Festiyed; Khairani, S.

2018-04-01

Integrated science learning and literacy skills are relevant issues in Indonesian’s education. However, the use of the integrated science learning and the integration of literacy in learning cannot be implemented well. An alternative solution of this problem is to develop integrated science instructional material on pressure in daily life theme by integrating digital age literacy. Purpose of research is to investigate the effectiveness of the use of integrated science instructional material on pressure in daily life theme to improve knowledge competence, attitudes competence and literacy skills of students. This research was a part of development research which has been conducted. In the product testing stage of this research and development was used before and after design of treatment for one sample group. Instruments to collect the data consist of learning outcomes test sheet, attitude observation sheet, and performance assessment sheet of students. Data analysis techniques include descriptive statistics analysis, normality test, homogeneity test, and paired comparison test. Therefore, the important result of research is the use of integrated science instructional material on pressure in daily life theme is effective in scientific approach to improve knowledge competence, attitudes competence, and digital age literacy skills of grade VIII students at 95% confidence level.

Developing Social Competence and Other Generic Skills in Teacher Education: Applying the Model of Integrative Pedagogy

ERIC Educational Resources Information Center

Tynjälä, Päivi; Virtanen, Anne; Klemola, Ulla; Kostiainen, Emma; Rasku-Puttonen, Helena

2016-01-01

The purpose of the study was to examine how social competence and other generic skills can be developed in teacher education using a pedagogical model called Integrative Pedagogy. This model is based on the idea of integrating the four basic components of expertise: Theoretical knowledge, practical knowledge, self-regulative knowledge, and…

Orchestrating French Music Conservatories: European Political Interventions and Local Governance

ERIC Educational Resources Information Center

Raevskikh, Elena

2017-01-01

Supported by the omnipresent State in the past, French music education leans increasingly towards a more liberal and competitive model. In the current context of a decentralized economy and European integration, music conservatories are called upon to contribute to regional and municipal development and enhance European student mobility. How do…

Most Comprehension Tests Do Measure Reading Comprehension: A Response to McLean and Goldstein.

ERIC Educational Resources Information Center

Stenner, A. Jackson; And Others

1988-01-01

Rebuffs Leslie Maclean and Harvey Goldstein's claims that the National Assessment of Educational Progress (NAEP) Reading Proficiency Scale is unidimensional. Critics' confusion may stem from failing to separate what a test measures from a score's usefulness. The Lexile Reading Scale should be integrated with the NAEP scale. Includes eight…

Obesity associated advanced glycation end products within the human uterine cavity adversely impact endometrial function and embryo implantation competence.

PubMed

Antoniotti, Gabriella S; Coughlan, Melinda; Salamonsen, Lois A; Evans, Jemma

2018-04-01

Do obese levels of advanced glycation end products (AGEs) within the uterine cavity detrimentally alter tissue function in embryo implantation and placental development? Obese levels of AGEs activate inflammatory signaling (p65 NFκB) within endometrial epithelial cells and alter their function, cause endoplasmic reticulum (ER) stress in endometrial stromal cells and impair decidualization, compromise implantation of blastocyst mimics and inhibit trophoblast invasion. Obese women experience a higher incidence of infertility, recurrent miscarriage and pregnancy complications compared with lean women. Oocyte donation cycles suggest a detrimental uterine environment plays a role in these outcomes. Uterine lavage and tissues from lean (BMI 19.5-24.9, n = 17) and obese (BMI > 30, n = 16) women examined. Cell culture experiments utilizing human endometrial epithelial, trophectoderm and trophoblast cell lines and primary human stromal cells used to examine the functional impact of obese levels of AGEs. Levels of AGEs examined within uterine lavage assessed by ELISA to determine differences between lean and obese women. Expression and localization of AGEs, receptor for AGEs (RAGE) and NFκB within endometrial tissues obtained from lean and obese women determined by immunohistochemistry. Endometrial epithelial cells (ECC-1), primary human stromal cells and trophoblast cells (HTR8-SVneo) treated with lean (2000 nmol/mol lysine) or obese (8000 nmol/mol lysine) uterine levels of AGEs and p65 NFκB (western immunoblot), real-time adhesion, proliferation migration and invasion (xCelligence real-time cell function analysis), decidualization (cell morphology and prolactin release), ER stress (western immunoblot for p-PERK) determined. Co-cultures of endometrial epithelial cells and blastocyst mimics (trophectoderm spheroids) similarly treated with lean or obese uterine levels of AGEs to determine their impact on embryo implantation. AGEs were significantly elevated (P = 0.004) within the obese (6503.59 μmol/mol lysine) versus lean (2165.88 μmol/mol lysine) uterine cavity (uterine lavage) with increased immunostaining for AGEs, RAGE and NFkB within obese endometrial tissues during the proliferative phase of the menstrual cycle. Obese uterine levels of AGEs inhibited adhesion and proliferation of endometrial epithelial (ECC-1) cells compared to treatment with lean uterine levels of AGEs. Obese uterine AGE levels impacted primary human endometrial stromal cell decidualization and activated ER stress within these cells. Obese uterine levels of AGEs also inhibited trophectodermal spheroid adhesion to hormonally primed endometrial epithelial cells and trophoblast cell line HTR8/SV-neo invasion. N/A. Mechanistic studies are performed in vitro and may not completely recapitulate cell function in vivo. These data corroborate clinical data suggesting the presence of an altered uterine environment in obese women and demonstrate that elevated uterine levels of AGEs within these women may detrimentally impact endometrial function, embryo implantation and placental development. Uterine AGE assessment in infertility work up may prove useful in determining underlying causes of infertility. AGEs can be targeted pharmacologically and such treatments may prove effective in improving reproductive complications experience by obese women. Supported by NHMRC Fellowship (#1002028 to L.A.S.), and the Victorian Government's Operational Infrastructure Support Program. MTC is supported by a JDRF Australia Clinical Research Network Career Development Award. The authors have declared that no conflict of interest exists.

Industrial training approach using GPM P5 Standard for Sustainability in Project Management: a framework for sustainability competencies in the 21st century

NASA Astrophysics Data System (ADS)

Johan, Kartina; Mohd Turan, Faiz

2016-11-01

Malaysian Engineering Accreditation (Engineering Programme Accreditation Manual, 2007) requires all bachelor degree in engineering programmes to incorporate a minimum of two months industrial training in order for the programme to be accredited by the council. The industrial training has the objective to provide students on the insights of being an engineer at the workplace hence increasing their knowledge in employability skills prior to graduation. However the current structure of industrial training is not able to inculcate good leadership ability and prepare students with sustainability competencies needed in the era of Sustainable Development (SD). This paper aims to study project management methodology as a framework to create a training pathway in industrial training for students in engineering programs using Green Project Management (GPM) P5 standard for sustainability in project management. The framework involves students as interns, supervisors from both university and industry and also participation from NonProfit Organisation (NPO). The framework focus on the development of the student's competency in employability skills, lean leadership and sustainability competencies using experiential learning approach. Deliverables of the framework include internship report, professional sustainability report using GPM P5 standard and competency assessment. The post-industrial phase of the framework is constructed for students to be assessed collaboratively by the university, industry and the sustainability practitioner in the country. The ability for the interns to act as a change agent in sustainability practices is measured by the competency assessment and the quality of the sustainability report. The framework support the call for developing holistic students based on Malaysian Education Blueprint (Higher Education) 2015-2025 and address the gap between the statuses of engineering qualification to the sustainability competencies in the 21st century in particular by achieving the Sustainability Graduates (SG) attributes outlined in the framework.

Chronic care coordination by integrating care through a team-based, population-driven approach: a case study.

PubMed

van Eeghen, Constance O; Littenberg, Benjamin; Kessler, Rodger

2018-05-23

Patients with chronic conditions frequently experience behavioral comorbidities to which primary care cannot easily respond. This study observed a Vermont family medicine practice with integrated medical and behavioral health services that use a structured approach to implement a chronic care management system with Lean. The practice chose to pilot a population-based approach to improve outcomes for patients with poorly controlled Type 2 diabetes using a stepped-care model with an interprofessional team including a community health nurse. This case study observed the team's use of Lean, with which it designed and piloted a clinical algorithm composed of patient self-assessment, endorsement of behavioral goals, shared documentation of goals and plans, and follow-up. The team redesigned workflows and measured reach (patients who engaged to the end of the pilot), outcomes (HbA1c results), and process (days between HbA1c tests). The researchers evaluated practice member self-reports about the use of Lean and facilitators and barriers to move from pilot to larger scale applications. Of 20 eligible patients recruited over 3 months, 10 agreed to participate and 9 engaged fully (45%); 106 patients were controls. Relative to controls, outcomes and process measures improved but lacked significance. Practice members identified barriers that prevented implementation of all changes needed but were in agreement that the pilot produced useful outcomes. A systematized, population-based, chronic care management service is feasible in a busy primary care practice. To test at scale, practice leadership will need to allocate staffing, invest in shared documentation, and standardize workflows to streamline office practice responsibilities.

Breaking barriers: a competency-based framework for promoting the integration of the pediatrician's education.

PubMed

Naghettini, Alessandra V; Bollela, Valdes R; Costa, Nilce M S C; Salgado, Luciana M R

2011-01-01

To describe the process of integration and revision of a pediatric program curriculum which resulted in the creation of a competency-based framework recommended in the Brazilian National Curricular Guidelines. Quali-quantitative analysis of an intervention evaluating the students and professors' perception of the pediatric program curriculum (focus groups and semi-structured interviews). Results were discussed during teaching development workshops. A competency-based framework was suggested for the pediatric program from the 3rd to the 6th year. The new curriculum was approved, implemented, and reevaluated six months later. Twelve students (12%) from the 3rd to the 6th year participated in the focus groups, and 11 professors (78.5%) answered the questionnaire. Most participants reported lack of integration among the courses, lack of knowledge about the learning goals of the internships, few opportunities of practice, and predominance of theoretical evaluation. In the training workshops, a competency-based curriculum was created after pediatrics and collective health professors reached an agreement. The new curriculum was focused on general competency, learning goals, opportunities available to learn these goals, and evaluation system. After six months, 93% (104/112) of students and 79% (11/14) of professors reported greater integration of the program and highlighted the inclusion of the clinical performance evaluation. The collective creation of a competency-based curriculum promoted higher satisfaction of students and professors. After being implemented, the new curriculum was considered to integrate the teaching practices and contents, improving the quality of the clinical performance evaluation.

Competencies for the Contemporary Career: Development and Preliminary Validation of the Career Competencies Questionnaire

ERIC Educational Resources Information Center

Akkermans, Jos; Brenninkmeijer, Veerle; Huibers, Marthe; Blonk, Roland W. B.

2013-01-01

A new and promising area of research has recently emerged in the field of career development: career competencies. The present article provides a framework of career competencies that integrates several perspectives from the literature. The framework distinguishes between reflective, communicative, and behavioral career competencies. Six career…

Participatory design in lean production: which contribution from employees? For what end?

PubMed

Perez Toralla, M S; Falzon, P; Morais, A

2012-01-01

The proponents of lean production have pointed to the positive effects of the work organization on employees in terms of autonomy, enhanced skills and empowerment mainly by their participation into the continuous improvement of work process. But studies that have examined this issue suggest that the increase in autonomy is not sufficient to compensate for increases work intensity. Participatory design has grown extensively in manufacturing since the 1980's under the impulsion of the Scandinavian socio-technical system approach and it's central in the model of lean production performance. Its main objectives are to improve quality, increase productivity and safety through employee's participation to the reduction of non-value added activities, such as defined by lean production. In the line of the studies on participatory design and continuous improvement the present study examines the functioning of work groups, based on the kaizen model, the aim of which was to improve the proportion of "value-added activities" and working conditions, essentially physical constraints. The main results are consistent with the literature and show that accelerated forms of re-conception activities give employees limited room for maneuver to elaborate solutions based on the analysis of the real activity. This study is part of a broader initiative that goes in the direction of continuous improvement of the design process itself so that it integrates the real constraints of work and propose changes bases on work as it actually takes place, beyond pre-established performance goals bases on the reduction of "non added value activities".

Asian International Students at an Australian University: Mapping the Paths between Integrative Motivation, Competence in L2 Communication, Cross-Cultural Adaptation and Persistence with Structural Equation Modelling

ERIC Educational Resources Information Center

Yu, Baohua

2013-01-01

This study examined the interrelationships of integrative motivation, competence in second language (L2) communication, sociocultural adaptation, academic adaptation and persistence of international students at an Australian university. Structural equation modelling demonstrated that the integrative motivation of international students has a…

Creating Competence: Perspectives and Practices in Organizations.

ERIC Educational Resources Information Center

Mulder, Martin

Creating competence has become a major issue in organizations. Various authors contend that competency management has the potential of integrating organizational strategy, human-resource instruments, and human-resource development; that competency development can lead to performance improvement; and that it can help Human Resource Development…

Developing and implementing core competencies for integrative medicine fellowships.

PubMed

Ring, Melinda; Brodsky, Marc; Low Dog, Tieraona; Sierpina, Victor; Bailey, Michelle; Locke, Amy; Kogan, Mikhail; Rindfleisch, James A; Saper, Robert

2014-03-01

The Consortium of Academic Health Centers for Integrative Medicine defines integrative medicine as "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health and healing." Over the past three decades, the U.S. public increasingly has sought integrative medicine approaches. In an effort to train medical professionals to adequately counsel patients on the safe and appropriate use of these approaches, medical schools and residencies have developed curricula on integrative medicine for their trainees. In addition, integrative medicine clinical fellowships for postresidency physicians have emerged to provide training for practitioners interested in gaining greater expertise in this emerging field. Currently, 13 clinical fellowships in integrative medicine exist in the United States, and they are predominantly connected to academic medical centers or teaching affiliate hospitals. In 2010, the Consortium of Academic Health Centers for Integrative Medicine, represented by 56 member academic health care institutions with a shared commitment to advance the principles and practices of integrative medicine, convened a two-year task force to draft integrative medicine fellowship core competencies. These competencies would guide fellowship curriculum development and ensure that graduates possessed a common body of knowledge, skills, and attitudes. In this article, the authors discuss the competencies and the task force's process to develop them, as well as associated teaching and assessment methods, faculty development, potential barriers, and future directions.

Ares Launch Vehicles Lean Practices Case Study

NASA Technical Reports Server (NTRS)

Doreswamy, Rajiv, N.; Self, Timothy A.

2008-01-01

This viewgraph presentation describes test strategies and lean philisophies and practices that are applied to Ares Launch Vehicles. The topics include: 1) Testing strategy; 2) Lean Practices in Ares I-X; 3) Lean Practices Applied to Ares I-X Schedule; 4) Lean Event Results; 5) Lean, Six Sigma, and Kaizen Practices in the Ares Projects Office; 6) Lean and Kaizen Success Stories; and 7) Ares Six Sigma Practices.

Use of a service evaluation and lean thinking transformation to redesign an NHS 111 refer to community Pharmacy for Emergency Repeat Medication Supply Service (PERMSS).

PubMed

Nazar, Hamde; Nazar, Zachariah; Simpson, Jill; Yeung, Andre; Whittlesea, Cate

2016-08-26

To demonstrate the contribution of community pharmacy from NHS 111 referrals out of hours (OOH) for emergency supply repeat medication requests via presentation of service activity, community pharmacist feedback and lean thinking transformation. Descriptive service evaluation using routine service activity data over the pilot period; survey of community pharmacists, and service redesign through lean thinking transformation. North East of England NHS 111 provider and accredited community pharmacies across the North East of England. Patients calling the North East of England NHS 111 provider during OOH with emergency repeat medication supply requests. NHS 111 referral to community pharmacies for assessment and if appropriate, supply of emergency repeat medication. Number of emergency repeat medication supply referrals, completion rates, reasons for rejections, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist feedback and lean thinking transformation of the patient pathway. NHS 111 referred 1468 patients to 114 community pharmacies (15/12/2014-7/4/2015). Most patients presented on Saturdays, with increased activity over national holidays. Community pharmacists completed 951 (64.8%) referrals providing 2297 medications; 412 were high risk. The most common reason for rejecting referrals was no medication in stock. Community pharmacists were positive about the provision of this service. The lean thinking transformation reduced the number of non-added value steps, waits and bottlenecks in the patient pathway. NHS 111 can redirect callers OOH from urgent and emergency care services to community pharmacy for management of emergency repeat medication supply. Existing IT and community pharmacy regulations allowed patients to receive a medication supply and pharmaceutical advice. Community pharmacists supported integration into the NHS OOH services. Adopting lean thinking provided a structured framework to evaluate and redesign the service with the aim to improve effectiveness and efficiency. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Risk of Disordered Eating Among Division I Female College Athletes

PubMed Central

WELLS, ELIZABETH K.; CHIN, ALEXANDRA D.; TACKE, JENNIFER A.; BUNN, JENNIFER A.

2015-01-01

The purpose of this study was to assess the risk of disordered eating (DE) among female athletes in lean and non-lean sports using the ATHLETE survey. The ATHLETE survey is divided into six different constructs, and a high score indicates a high risk for DE. Eighty-three varsity female athletes from eight Campbell University sports teams completed the survey and a medical history form anonymously. The sports were divided into sports that traditionally have a high risk for DE (lean sports) and those with a low risk (non-lean sports). The lean sports included: cheerleading, cross country/track and field, swimming, and volleyball. The non-lean sports included: basketball, golf, soccer, and softball. The total mean score of the ATHLETE survey for the lean sports was 100.1 ± 17.4, compared to the non-lean sports scoring 90.1 ± 16.9, p = 0.011. The two constructs that showed significant difference between lean and non-lean sports were Social Pressure on Body Shape (lean: 12.2 ± 3.9, non-lean: 9.4 ± 4.6, p = 0.005) and Team Trust (lean: 7.4 ± 3.3, non-lean: 5.6 ± 2.2, p = 0.004). The results indicate that lean sports exhibited a higher risk for development of DE compared to athletes participating in non-lean sports. It appears that the primary influence of DE in these female athletes came from external social pressures that may therefore dictate their exercise and nutritional habits. PMID:27293502

Evaluating Lean in healthcare.

PubMed

Burgess, Nicola; Radnor, Zoe

2013-01-01

The purpose of this paper is to present findings relating to how Lean is implemented in English hospitals. Lean implementation snapshots in English hospitals were conducted by content analysing all annual reports and web sites over two time periods, giving a thorough analysis of Lean's status in English healthcare. The article identifies divergent approaches to Lean implementation in English hospitals. These approaches are classified into a typology to facilitate an evaluation of how Lean is implemented. The findings suggest that implementation tends to be isolated rather than system-wide. A second dataset conveys Lean implementation trajectory across the time period. These data signal Lean's increasing use by English hospitals and shows progression towards an increasingly systemic approach. Data were collected using content analysis methods, which relies on how "Lean" methods were articulated within the annual report and/or on the organisation's web site, which indicates approaches taken by hospital staff implementing Lean. This research is the first to examine more closely "how" Lean is implemented in English hospitals. The emergent typology could prove relevant to other public sector organizations and service organisations more generally. The research also presents a first step to understanding Lean thinking in the English NHS. This article empirically analyses Lean implementation in English hospitals. It identifies divergent approaches that allow inferences about how far Lean is implemented in an organisation. Data represent a baseline for further analysis so that Lean implementation can be tracked.

Integration Models for Indigenous Public Health Curricula

ERIC Educational Resources Information Center

Coombe, Leanne; Lee, Vanessa; Robinson, Priscilla

2017-01-01

All graduates of Master of Public Health (MPH) programmes in Australia are expected to achieve a core set of Indigenous public health competencies designed to train "judgement safe practitioners". A curriculum framework document was developed alongside the competencies to assist programme providers to integrate appropriate Indigenous…

Competencies in Organizational E-Learning: Concepts and Tools

ERIC Educational Resources Information Center

Sicilia, Miguel-Angel, Ed.

2007-01-01

"Competencies in Organizational E-Learning: Concepts and Tools" provides a comprehensive view of the way competencies can be used to drive organizational e-learning, including the main conceptual elements, competency gap analysis, advanced related computing topics, the application of semantic Web technologies, and the integration of competencies…

An Integrative Approach to Cultural Competence in the Psychiatric Curriculum

ERIC Educational Resources Information Center

Fung, Kenneth; Andermann, Lisa; Zaretsky, Ari; Lo, Hung-Tat

2008-01-01

Objective: As it is increasingly recognized that cultural competence is an essential quality for any practicing psychiatrist, postgraduate psychiatry training programs need to incorporate cultural competence training into their curricula. This article documents the unique approach to resident cultural competence training being developed in the…

A case study of lean drug discovery: from project driven research to innovation studios and process factories.

PubMed

Ullman, Fredrik; Boutellier, Roman

2008-06-01

At the operational level, the number of investigational new drugs or candidates for development per dollar spent in research, and the number of patents per year are highly integrated measures of productivity and, thus, difficult to influence at the individual or lab level. Hence, different metrics are needed to assess and thereby improve productivity in research at the individual and group level. This review centers on a case study, including over 70 interviews, in a research department of a global pharmaceutical company as well as over 40 interviews in contract research organizations (CROs) and 5 in small biotechnology firms. For each lab, its value adding process was plotted according to lean six sigma methods and appropriate metrics were defined. We suggest a strong focus on short feedback loops in research as an indicator for efficiency. Our results reveal two categories of activities: creativity-driven ones and process-driven ones, both discussed with respect to the methodology used. The fundamental differences in nature of these activities require different sets of metrics to assess them. On the basis of these metrics, different organizational forms can be derived to achieve a lean research structure: innovation studios and process factories, respectively.

Improving Performance of Your CMMI Mature Organization Through Lean and Agile Techniques

DTIC Science & Technology

2011-05-01

difficulty CMM Level 3 many years ago; 2008 CMMI Level 3 2008 CMMI motivation : •Vice-President (VP) understood could use CMMI to address changing customer...Integration Scrum– Not an acronym, mechanisms in game of rugby for getting an out-of-play ball back into play Copyright by PEM Systems 2011 35

Integrating Group-Self Evaluation in Open and Distance Learning System

ERIC Educational Resources Information Center

Osuji, U. S. Ajunwa

2010-01-01

Every instructional process involves a strategic assessment system for a complete teaching leaning circle. Any assessment system which is seriously flawed, should call for a change, a rethink or a repackaging for sustainability, and to be a part of teaching and learning. Assessment should be meaningful to both the assessors and the assessees. The…

The SWAT Team: Successfully Integrating Technology into the Curriculum.

ERIC Educational Resources Information Center

Cathey, Marcy E.

The Madeira School (McLean, Virginia) had been behind on advanced technology as compared to many of its competitor schools. In the fall of 1996, the cornerstone for the Savvy With All Technology (SWAT) team program was laid. The idea of SWAT was to infiltrate departments with technology specialists and users so that technology would be used across…

A survey of risk factors for digit injuries among dogs training and competing in agility events.

PubMed

Sellon, Debra C; Martucci, Katherine; Wenz, John R; Marcellin-Little, Denis J; Powers, Michelle; Cullen, Kimberley L

2018-01-01

OBJECTIVE To identify potential risk factors for digit injuries in dogs training and competing in agility events. DESIGN Internet-based, retrospective, cross-sectional survey. ANIMALS 1,081 dogs training or competing in agility events. PROCEDURES Data were collected for eligible animals via retrospective surveys distributed electronically to handlers of dogs participating in agility-related activities. Variables evaluated included demographic (handlers) and signalment (dogs) information, physical characteristics of dogs, and injury characteristics. A separate survey of dogs competing in similar agility-related activities but without digit injuries was also administered. Multivariable logistic regression was used to develop a model for assessment of risk factors. RESULTS Data were collected from 207 agility dogs with digit injuries and 874 agility dogs without digit injuries. Factors associated with significantly increased odds of injury included Border Collie breed (OR, 2.3; 95% confidence interval [CI], 1.5 to 3.3), long nails (OR, 2.4; 95% CI, 1.3 to 4.5), absence of front dewclaws (OR, 1.9; 95% CI, 1.3 to 2.6), and greater weight-to-height ratio (OR, 1.5; 95% CI, 1.1 to 2.0). Odds of injury decreased with increasing age of the dog (OR, 0.8; 95% CI, 0.76 to 0.86). CONCLUSIONS AND CLINICAL RELEVANCE Results should be cautiously interpreted because of potential respondent and recall bias and lack of review of medical records. Nevertheless, results suggested that retaining healthy dewclaws, maintaining lean body mass, and trimming nails short for training and competition may decrease the likelihood of digit injuries. Research to investigate training practices, obstacle construction specifcations, and surface considerations for dogs competing in agility activities is indicated.

An integrative approach to cultural competence in the psychiatric curriculum.

PubMed

Fung, Kenneth; Andermann, Lisa; Zaretsky, Ari; Lo, Hung-Tat

2008-01-01

As it is increasingly recognized that cultural competence is an essential quality for any practicing psychiatrist, postgraduate psychiatry training programs need to incorporate cultural competence training into their curricula. This article documents the unique approach to resident cultural competence training being developed in the Department of Psychiatry at the University of Toronto, which has the largest residency training program in North America and is situated in an ethnically diverse city and country. The authors conducted a systematic review of cultural competence by searching databases including PubMed, PsycINFO, PsycArticles, CINAHL, Social Science Abstracts, and Sociological Abstracts; by searching government and professional association publications; and through on-site visits to local cross-cultural training programs. Based on the results of the review, a resident survey, and a staff retreat, the authors developed a deliberate "integrative" approach with a mindful, balanced emphasis on both generic and specific cultural competencies. Learning objectives were derived from integrating the seven core competencies of a physician as defined by the Canadian Medical Education Directions for Specialists (CanMEDS) roles framework with the tripartite model of attitudes, knowledge, and skills. The learning objectives and teaching program were further integrated across different psychiatric subspecialties and across the successive years of residency. Another unique strategy used to foster curricular and institutional change was the program's emphasis on evaluation, making use of insights from modern educational theories such as formative feedback and blueprinting. Course evaluations of the core curriculum from the first group of residents were positive. The authors propose that these changes to the curriculum may lead to enhanced cultural competence and clinical effectiveness in health care.

Antecedents and characteristics of lean thinking implementation in a Swedish hospital: a case study.

PubMed

Ulhassan, Waqar; Sandahl, Christer; Westerlund, Hugo; Henriksson, Peter; Bennermo, Marie; von Thiele Schwarz, Ulrica; Thor, Johan

2013-01-01

Despite the reported success of Lean in health care settings, it is unclear why and how organizations adopt Lean and how Lean transforms work design and, in turn, affects employees' work. This study investigated a cardiology department's journey to adopt and adapt Lean. The investigation was focused on the rationale and evolution of the Lean adoption to illuminate how a department with a long quality improvement history arrived at the decision to introduce Lean, and how Lean influenced employees' daily work. This is an explanatory single case study based on semistructured interviews, nonparticipant observations, and document studies. Guided by a Lean model, we undertook manifest content analysis of the data. We found that previous improvement efforts may facilitate the introduction of Lean but may be less important when forecasting whether Lean will be sustained over time. Contextual factors seemed to influence both what Lean tools were implemented and how well the changes were sustained. For example, adoption of Lean varied with the degree to which staff saw a need for change. Work redesign and teamwork were found helpful to improve patient care whereas problem solving was found helpful in keeping the staff engaged and sustaining the results over time.

Authentic Diversity: A Case Study on College Students' Engagement with Diversity Competencies in an Integrative Studies Degree Program

ERIC Educational Resources Information Center

Saunders, Kimberly

2009-01-01

This qualitative study provided a lens into the context of a senior capstone experience in an Integrative Studies degree program. The primary aim of this case study was to explore the use of capstone portfolio pedagogy as a reflection tool to demonstrate how students engage with authentic diversity competencies in an Integrative Studies degree…

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rangaraj, D; Chan, K; Boddu, S

Lean thinking has revolutionized the manufacturing industry. Toyota has pioneered and leveraged this aspect of Lean thinking. Application of Lean thinking and Lean Six Sigma techniques into Healthcare and in particular in Radiation Oncology has its merits and challenges. To improve quality, safety and patient satisfaction with available resources or reducing cost in terms of time, staff and resources is demands of today's healthcare. Radiation oncology treatment involves many processes and steps, identifying and removing the non-value added steps in a process can significantly improve the efficiency. Real projects undertaken in radiation oncology department in cutting down the procedure timemore » for MRI guided brachytherapy to 40% less using lean thinking will be narrated. Simple Lean tools and techniques such as Gemba walk, visual control, daily huddles, standard work, value stream mapping, error-proofing, etc. can be applied with existing resources and how that improved the operation in a Radiation Oncology department's two year experience will be discussed. Lean thinking focuses on identifying and solving the root-cause of a problem by asking “Why” and not “Who” and this requires a culture change of no blame. Role of leadership in building lean culture, employee empowerment and trains and develops lean thinkers will be presented. Why Lean initiatives fail and how to implement lean successfully in your clinic will be discussed. Learning Objectives: Concepts of lean management or lean thinking. Lean tools and techniques applied in Radiation Oncology. Implement no blame culture and focus on system and processes. Leadership role in implementing lean culture. Challenges for Lean thinking in healthcare.« less

Sector Tests of a Low-NO(sub x), Lean, Direct- Injection, Multipoint Integrated Module Combustor Concept Conducted

NASA Technical Reports Server (NTRS)

Tacina, Robert R.; Wey, Chang-Lie; Laing, Peter; Mansour, Adel

2002-01-01

The low-emissions combustor development described is directed toward advanced high pressure aircraft gas-turbine applications. The emphasis of this research is to reduce nitrogen oxides (NOx) at high-power conditions and to maintain carbon monoxide and unburned hydrocarbons at their current low levels at low power conditions. Low-NOx combustors can be classified into rich-burn and lean-burn concepts. Lean-burn combustors can be further classified into lean-premixed-prevaporized (LPP) and lean direct injection (LDI) concepts. In both concepts, all the combustor air, except for liner cooling flow, enters through the combustor dome so that the combustion occurs at the lowest possible flame temperature. The LPP concept has been shown to have the lowest NOx emissions, but for advanced high-pressure-ratio engines, the possibility of autoignition or flashback precludes its use. LDI differs from LPP in that the fuel is injected directly into the flame zone, and thus, it does not have the potential for autoignition or flashback and should have greater stability. However, since it is not premixed and prevaporized, good atomization is necessary and the fuel must be mixed quickly and uniformly so that flame temperatures are low and NOx formation levels are comparable to those of LPP. The LDI concept described is a multipoint fuel injection/multiburning zone concept. Each of the multiple fuel injectors has an air swirler associated with it to provide quick mixing and a small recirculation zone for burning. The multipoint fuel injection provides quick, uniform mixing and the small multiburning zones provide for reduced burning residence time, resulting in low NOx formation. An integrated-module approach was used for the construction where chemically etched laminates, diffusion bonded together, combine the fuel injectors, air swirlers, and fuel manifold into a single element. The multipoint concept combustor was demonstrated in a 15 sector test. The configuration tested had 36 fuel injectors and fuel-air mixers that replaced two fuel injectors in a conventional dual-annular combustor. During tests, inlet temperatures were up to 870 K and inlet pressures were up to 5400 kPa. A correlation was developed that related the NOx emissions with the inlet temperature, inlet pressure, fuel-air ratio, and pressure drop. At low-power conditions, fuel staging was used so that high combustion efficiency was obtained with only one-fourth of the fuel injectors flowing. The test facility had optical access, and visual images showed the flame to be very short, approximately 25 mm long.

Nurses' barriers to learning: an integrative review.

PubMed

Santos, Marion C

2012-07-01

This integrative review of the literature describes nurses' barriers to learning. Five major themes emerged: time constraints, financial constraints, workplace culture, access/relevance, and competency in accessing electronic evidence-based practice literature. The nurse educator must address these barriers for the staff to achieve learning and competency.

Competency Based Competitive Events. Integrating DECA into the DE Instructional Program.

ERIC Educational Resources Information Center

Cosgrove, Glenna; Moore, Harold W.

Designed to be integrated into a competency-based distributive education program, these competitive DECA (Distributive Education Clubs of America) events were developed, utilized, and evaluated by distributive education and cooperative education coordinators in Arkansas. These events are organized under the following occupational categories: food…

Spherical Model Integrating Academic Competence with Social Adjustment and Psychopathology.

ERIC Educational Resources Information Center

Schaefer, Earl S.; And Others

This study replicates and elaborates a three-dimensional, spherical model that integrates research findings concerning social and emotional behavior, psychopathology, and academic competence. Kindergarten teachers completed an extensive set of rating scales on 100 children, including the Classroom Behavior Inventory and the Child Adaptive Behavior…

"La Orquesta": Symbolic Performance in a Multilingual Community of Practice

ERIC Educational Resources Information Center

Back, Michele

2013-01-01

Researchers in second language socialization (SLS) often examine those interactions relating to a learner's integration within a target community. Kramsch and Whiteside (2008) noted the importance of "symbolic competence" in this integration. Symbolic competence, defined as the ability to access contextually relevant social and political…

Self-Perceived Stability and Change in Children's Competence

ERIC Educational Resources Information Center

Vandenplas-Holper, Christiane; Roskam, Isabelle; Fontaine, Anne-Marie

2010-01-01

Using Harter's ("Child Dev" 53(1):87-97, 1982) perceived competence scale, this study integrates several paradigms related to the issues of self-perceived competence, stability or change and attributional theory. It examines how 268 Belgian and Portuguese fifth graders consider their scholastic, social and physical competence at present…

Interprofessional Competencies in Integrative Primary Healthcare

PubMed Central

Brooks, Audrey J.; Maizes, Victoria; Goldblatt, Elizabeth; Klatt, Maryanna; Koithan, Mary S.; Kreitzer, Mary Jo; Lee, Jeannie K.; Lopez, Ana Marie; McClafferty, Hilary; Rhode, Robert; Sandvold, Irene; Saper, Robert; Taren, Douglas; Wells, Eden; Lebensohn, Patricia

2015-01-01

In October 2014, the National Center for Integrative Primary Healthcare (NCIPH) was launched as a collaboration between the University of Arizona Center for Integrative Medicine and the Academic Consortium for Integrative Health and Medicine and supported by a grant from the Health Resources and Services Administration. A primary goal of the NCIPH is to develop a core set of integrative healthcare (IH) competencies and educational programs that will span the interprofessional primary care training and practice spectra and ultimately become a required part of primary care education. This article reports on the first phase of the NCIPH effort, which focused on the development of a shared set of competencies in IH for primary care disciplines. The process of development, refinement, and adoption of 10 “meta-competencies” through a collaborative process involving a diverse interprofessional team is described. Team members represent nursing, the primary care medicine professions, pharmacy, public health, acupuncture, naturopathy, chiropractic, nutrition, and behavioral medicine. Examples of the discipline-specific sub-competencies being developed within each of the participating professions are provided, along with initial results of an assessment of potential barriers and facilitators of adoption within each discipline. The competencies presented here will form the basis of a 45-hour online curriculum produced by the NCIPH for use in primary care training programs that will be piloted in a wide range of programs in early 2016 and then revised for wider use over the following year. PMID:26421232

Core ITAC for Career-Focused Education. Integrated Technical & Academic Competencies.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This document introduces the underlying principles and components of Ohio's Integrated Technical and Academic Competencies (ITAC) system of career-focused education, which combines high-level academics and technical skills with a real-life context for learning that maximizes students' present and future academic and career success. The document…

48 CFR 19.601 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... BUSINESS PROGRAMS Certificates of Competency and Determinations of Responsibility 19.601 General. (a) A Certificate of Competency (COC) is the certificate issued by the Small Business Administration (SBA) stating... limited to, capability, competency, capacity, credit, integrity, perseverance, tenacity, and limitations...

Commentary on a framework for multicultural education

PubMed Central

Hammerich, Karin F.

2014-01-01

Today’s changing demographics require that multicultural factors be considered in the delivery of quality patient-centred health care in chiropractic. Yet minimal training in cultural competency in chiropractic education leaves graduates ill-equipped to treat a diverse population. This commentary examines cultural competency training in current literature, demonstrates frameworks for curriculum integration, and suggests how cultural competency might be included in a chiropractic college curriculum. A database search yielded little evidence that cultural competency is integrated into curricula of chiropractic schools. Some journal articles note that promoting multicultural education and cultural sensitivity is an important goal. However, they provide no mechanisms as to how this can be achieved within training programs. Thus, although an undeniable need exists for all healthcare practitioners to develop cultural competency in the face of an increasingly diverse population, cultural competency education has not kept pace. Chiropractic schools must review their curricula to develop the cultural competencies of their graduates and a basic framework is suggested. PMID:25202156

Analysis of ICT Literacy Competence among Vocational High School Teachers

NASA Astrophysics Data System (ADS)

Nurhabibah; Setiawan, A.; Yanti, H.; Miraj, Y. Z.; Yannuar

2018-02-01

To realize learning quality in Vocational Secondary School, and to achieve educational goal, teacher competence is needed. The application of ICT Literacy in vocational secondary school is intended to upgrade teachers’ knowledge, skill and competence in ICT. This paper is aimed to describe the process of teachers’ competence adaptation to ICT integrity in learning in Vocational Secondary School. This study use descriptive method with literature study and documentation technique. The source in this study is research journal and research report book. The study result showed that teachers lack of self-confident in using ICT, and gender factor influence ICT integration in which the level of ICT literacy in male is higher than female. The group of young teachers aged 21-40 have higher level of ICT literacy compared with the older group. Demographic factor in ICT literacy competence are gender, education level and age. This study suggest that teachers enhance the ability in ICT literacy competence, increase their knowledge and knowledge creation in each aspect of ICT literacy competence.

Asteroid Crewed Segment Mission Lean Development

NASA Technical Reports Server (NTRS)

Gard, Joe; McDonald, Mark; Jermstad, Wayne

2014-01-01

The next generation of human spaceflight missions presents numerous challenges to designers that must be addressed to produce a feasible concept. The specific challenges of designing an exploration mission utilizing the Space Launch System and the Orion spacecraft to carry astronauts beyond earth orbit to explore an asteroid stored in a distant retrograde orbit around the moon will be addressed. Mission designers must carefully balance competing constraints including cost, schedule, risk, and numerous spacecraft performance metrics including launch mass, nominal landed mass, abort landed mass, mission duration, consumable limits and many others. The Asteroid Redirect Crewed Mission will be described along with results from the concurrent mission design trades that led to its formulation. While the trades presented are specific to this mission, the integrated process is applicable to any potential future mission. The following trades were critical in the mission formulation and will be described in detail: 1) crew size, 2) mission duration, 3) trajectory design, 4) docking vs grapple, 5) extravehicular activity tasks, 6) launch mass and integrated vehicle performance, 7) contingency performance, 8) crew consumables including food, clothing, oxygen, nitrogen and water, and 9) mission risk. The additional Orion functionality required to perform the Asteroid Redirect Crewed Mission and how it is incorporated while minimizing cost, schedule and mass impacts will be identified. Existing investments in the NASA technology portfolio were leveraged to provide the added functionality that will be beneficial to future exploration missions. Mission kits are utilized to augment Orion with the necessary functionality without introducing costly new requirements to the mature Orion spacecraft design effort. The Asteroid Redirect Crewed Mission provides an exciting early mission for the Orion and SLS while providing a stepping stone to even more ambitious missions in the future.

TRUNK LEAN DURING A SINGLE-LEG SQUAT IS ASSOCIATED WITH TRUNK LEAN DURING PITCHING.

PubMed

Plummer, Hillary A; Oliver, Gretchen D; Powers, Christopher M; Michener, Lori A

2018-02-01

Impaired trunk motion during pitching may be a risk factor for upper extremity injuries. Specifically, increased forces about the shoulder and elbow have been observed in pitchers with excessive contralateral trunk lean during pitching. Because of the difficulty in identifying abnormal trunk motions during a high-speed task such as pitching, a clinical screening test is needed to identify pitchers who have impaired trunk motion during pitching. The purpose of this study was to determine the relationship between the degree of lateral trunk lean during the single-leg squat and amount of trunk lean during pitching and if trunk lean during pitching can be predicted from lean during the single-leg squat. Controlled Laboratory Study; Cross-sectional. Seventy-three young baseball pitchers (11.4 ± 1.7 years; 156.3 ± 11.9 cm; 50.5 ± 8.8 kg) participated. An electromagnetic tracking system was used to obtain trunk kinematic data during a single-leg squat task (lead leg) and at maximum shoulder external rotation of a fastball pitch. Pearson correlation coefficients for trunk lean during the single-leg squat and pitching were calculated. A linear regression analysis was performed to determine if trunk lean during pitching can be predicted from lean during the single-leg squat. There was a positive correlation between trunk lean during the single-leg squat and trunk lean during pitching (r = 0.53; p<0.001). Lateral trunk lean during the single-leg squat predicted the amount of lateral trunk lean during pitching (R 2 = 0.28; p < 0.001). A moderate positive correlation was observed between trunk lean during an SLS and pitching. Trunk lean during the single-leg squat explained 28% of the variance in trunk lean during pitching. Diagnosis, level 3.

TRUNK LEAN DURING A SINGLE-LEG SQUAT IS ASSOCIATED WITH TRUNK LEAN DURING PITCHING

PubMed Central

Oliver, Gretchen D.; Powers, Christopher M.; Michener, Lori A.

2018-01-01

Background Impaired trunk motion during pitching may be a risk factor for upper extremity injuries. Specifically, increased forces about the shoulder and elbow have been observed in pitchers with excessive contralateral trunk lean during pitching. Because of the difficulty in identifying abnormal trunk motions during a high-speed task such as pitching, a clinical screening test is needed to identify pitchers who have impaired trunk motion during pitching. Hypothesis/Purpose The purpose of this study was to determine the relationship between the degree of lateral trunk lean during the single-leg squat and amount of trunk lean during pitching and if trunk lean during pitching can be predicted from lean during the single-leg squat. Study Design Controlled Laboratory Study; Cross-sectional. Methods Seventy-three young baseball pitchers (11.4 ± 1.7 years; 156.3 ± 11.9 cm; 50.5 ± 8.8 kg) participated. An electromagnetic tracking system was used to obtain trunk kinematic data during a single-leg squat task (lead leg) and at maximum shoulder external rotation of a fastball pitch. Pearson correlation coefficients for trunk lean during the single-leg squat and pitching were calculated. A linear regression analysis was performed to determine if trunk lean during pitching can be predicted from lean during the single-leg squat. Results There was a positive correlation between trunk lean during the single-leg squat and trunk lean during pitching (r = 0.53; p<0.001). Lateral trunk lean during the single-leg squat predicted the amount of lateral trunk lean during pitching (R2 = 0.28; p < 0.001). Conclusions A moderate positive correlation was observed between trunk lean during an SLS and pitching. Trunk lean during the single-leg squat explained 28% of the variance in trunk lean during pitching. Level of Evidence Diagnosis, level 3 PMID:29484242

NOx results from two combustors tested on medium BTU coal gas

NASA Technical Reports Server (NTRS)

Sherlock, T. P.; Carl, D. E.; Vermes, G.; Schwab, J.; Notardonato, J. J.

1982-01-01

The results of tests of two combustor configurations using coal gas from a 25 ton/day fluidized bed coal gasifier are reported. The trials were run with a ceramic-lined, staged rich/lean burner and an integral, all metal multiannular swirl burner (MASB) using a range of temperatures and pressures representative of industrial turbine inlet conditions. A lean mixture was examined at 104, 197, and 254 Btu/Scf, yielding NO(x) emissions of 5, 20, and 70 ppmv, respectively. The MASB was employed only with a gas rated at 220-270 Btu/Scf, producing 80 ppmv NO(x) at rated engine conditions. The results are concluded to be transferrable to current machines. Further tests on the effects of gas composition, the scaling of combustors to utility size, and the development of improved wall cooling techniques and variable geometry are indicated.

How to Increase Value in the Footwear Supply Chain

NASA Astrophysics Data System (ADS)

Fornasiero, Rosanna; Tescaro, Mauro; Scarso, Enrico; Gottardi, Giorgio

The Lean approach has been implemented in many different sectors as a methodology to improve industrial performance at company level. In the latest years this approach has been further developed in literature and in practice to integrate the principles of agility, adaptability and the mass customization paradigm where product and services have to be designed together to meet specific requirements, and where value originated by the supply chain enhance the value of single company thanks to the use of ICT and remote control. In this paper we analyze the Beyond-Lean paradigm and propose a path for companies in the footwear sector to improve their performance based on high-value-added products and processes. A detailed process analysis based on Value Stream Mapping is used to define criticalities and suggest improvements paths both at technological and organizational level.

Reliability Centered Maintenance - Methodologies

NASA Technical Reports Server (NTRS)

Kammerer, Catherine C.

2009-01-01

Journal article about Reliability Centered Maintenance (RCM) methodologies used by United Space Alliance, LLC (USA) in support of the Space Shuttle Program at Kennedy Space Center. The USA Reliability Centered Maintenance program differs from traditional RCM programs because various methodologies are utilized to take advantage of their respective strengths for each application. Based on operational experience, USA has customized the traditional RCM methodology into a streamlined lean logic path and has implemented the use of statistical tools to drive the process. USA RCM has integrated many of the L6S tools into both RCM methodologies. The tools utilized in the Measure, Analyze, and Improve phases of a Lean Six Sigma project lend themselves to application in the RCM process. All USA RCM methodologies meet the requirements defined in SAE JA 1011, Evaluation Criteria for Reliability-Centered Maintenance (RCM) Processes. The proposed article explores these methodologies.

Analysis of coals and biomass pyrolysis using the distributed activation energy model.

PubMed

Li, Zhengqi; Liu, Chunlong; Chen, Zhichao; Qian, Juan; Zhao, Wei; Zhu, Qunyi

2009-01-01

The thermal decomposition of coals and biomass was studied using thermogravimetric analysis with the distributed activation energy model. The integral method resulted in Datong bituminous coal conversions of 3-73% at activation energies of 100-486 kJ/mol. The corresponding frequency factors were e(19.5)-e(59.0)s(-1). Jindongnan lean coal conversions were 8-52% at activation energies of 100-462 kJ/mol. Their corresponding frequency factors were e(13.0)-e(55.8)s(-1). The conversion of corn-stalk skins were 1-84% at activation energies of 62-169 kJ/mol with frequency factors of e(10.8)-e(26.5)s(-1). Datong bituminous coal, Jindongnan lean coal and corn-stalk skins had approximate Gaussian distribution functions with linear ln k(0) to E relationships.

Advanced Natural Gas Reciprocating Engine(s)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pike, Edward

The objective of the Cummins ARES program, in partnership with the US Department of Energy (DOE), is to develop advanced natural gas engine technologies that increase engine system efficiency at lower emissions levels while attaining lower cost of ownership. The goals of the project are to demonstrate engine system achieving 50% Brake Thermal Efficiency (BTE) in three phases, 44%, 47% and 50% (starting baseline efficiency at 36% BTE) and 0.1 g/bhp-hr NOx system out emissions (starting baseline NOx emissions at 2 – 4 g/bhp-hr NOx). Primary path towards above goals include high Brake Mean Effective Pressure (BMEP), improved closed cyclemore » efficiency, increased air handling efficiency and optimized engine subsystems. Cummins has successfully demonstrated each of the phases of this program. All targets have been achieved through application of a combined set of advanced base engine technologies and Waste Heat Recovery from Charge Air and Exhaust streams, optimized and validated on the demonstration engine and other large engines. The following architectures were selected for each Phase: Phase 1: Lean Burn Spark Ignited (SI) Key Technologies: High Efficiency Turbocharging, Higher Efficiency Combustion System. In production on the 60/91L engines. Over 500MW of ARES Phase 1 technology has been sold. Phase 2: Lean Burn Technology with Exhaust Waste Heat Recovery (WHR) System Key Technologies: Advanced Ignition System, Combustion Improvement, Integrated Waste Heat Recovery System. Base engine technologies intended for production within 2 to 3 years Phase 3: Lean Burn Technology with Exhaust and Charge Air Waste Heat Recovery System Key Technologies: Lower Friction, New Cylinder Head Designs, Improved Integrated Waste Heat Recovery System. Intended for production within 5 to 6 years Cummins is committed to the launch of next generation of large advanced NG engines based on ARES technology to be commercialized worldwide.« less

Cultural Integrity and Social and Emotional Competence Promotion: Work Notes on Moral Competence.

ERIC Educational Resources Information Center

Jagers, Robert J.

2001-01-01

Describes evolving efforts to promote African American children's social and emotional competencies, examining moral competence. Proposes a cultural psychology framework to highlight the theme of communalism and morality of care. Identifies various moral events, offering knowledge of moral emotions and moral self-efficacy as key constructs.…

Suicide Risk Assessment Training for Psychology Doctoral Programs: Core Competencies and a Framework for Training

PubMed Central

Cramer, Robert J.; Johnson, Shara M.; McLaughlin, Jennifer; Rausch, Emilie M.; Conroy, Mary Alice

2014-01-01

Clinical and counseling psychology programs currently lack adequate evidence-based competency goals and training in suicide risk assessment. To begin to address this problem, this article proposes core competencies and an integrated training framework that can form the basis for training and research in this area. First, we evaluate the extent to which current training is effective in preparing trainees for suicide risk assessment. Within this discussion, sample and methodological issues are reviewed. Second, as an extension of these methodological training issues, we integrate empirically- and expert-derived suicide risk assessment competencies from several sources with the goal of streamlining core competencies for training purposes. Finally, a framework for suicide risk assessment training is outlined. The approach employs Objective Structured Clinical Examination (OSCE) methodology, an approach commonly utilized in medical competency training. The training modality also proposes the Suicide Competency Assessment Form (SCAF), a training tool evaluating self- and observer-ratings of trainee core competencies. The training framework and SCAF are ripe for empirical evaluation and potential training implementation. PMID:24672588

Suicide Risk Assessment Training for Psychology Doctoral Programs: Core Competencies and a Framework for Training.

PubMed

Cramer, Robert J; Johnson, Shara M; McLaughlin, Jennifer; Rausch, Emilie M; Conroy, Mary Alice

2013-02-01

Clinical and counseling psychology programs currently lack adequate evidence-based competency goals and training in suicide risk assessment. To begin to address this problem, this article proposes core competencies and an integrated training framework that can form the basis for training and research in this area. First, we evaluate the extent to which current training is effective in preparing trainees for suicide risk assessment. Within this discussion, sample and methodological issues are reviewed. Second, as an extension of these methodological training issues, we integrate empirically- and expert-derived suicide risk assessment competencies from several sources with the goal of streamlining core competencies for training purposes. Finally, a framework for suicide risk assessment training is outlined. The approach employs Objective Structured Clinical Examination (OSCE) methodology, an approach commonly utilized in medical competency training. The training modality also proposes the Suicide Competency Assessment Form (SCAF), a training tool evaluating self- and observer-ratings of trainee core competencies. The training framework and SCAF are ripe for empirical evaluation and potential training implementation.

Nursing competency standards in primary health care: an integrative review.

PubMed

Halcomb, Elizabeth; Stephens, Moira; Bryce, Julianne; Foley, Elizabeth; Ashley, Christine

2016-05-01

This paper reports an integrative review of the literature on nursing competency standards for nurses working in primary health care and, in particular, general practice. Internationally, there is growing emphasis on building a strong primary health care nursing workforce to meet the challenges of rising chronic and complex disease. However, there has been limited emphasis on examining the nursing workforce in this setting. Integrative review. A comprehensive search of relevant electronic databases using keywords (e.g. 'competencies', 'competen*' and 'primary health care', 'general practice' and 'nurs*') was combined with searching of the Internet using the Google scholar search engine. Experts were approached to identify relevant grey literature. Key websites were also searched and the reference lists of retrieved sources were followed up. The search focussed on English language literature published since 2000. Limited published literature reports on competency standards for nurses working in general practice and primary health care. Of the literature that is available, there are differences in the reporting of how the competency standards were developed. A number of common themes were identified across the included competency standards, including clinical practice, communication, professionalism and health promotion. Many competency standards also included teamwork, education, research/evaluation, information technology and the primary health care environment. Given the potential value of competency standards, further work is required to develop and test robust standards that can communicate the skills and knowledge required of nurses working in primary health care settings to policy makers, employers, other health professionals and consumers. Competency standards are important tools for communicating the role of nurses to consumers and other health professionals, as well as defining this role for employers, policy makers and educators. Understanding the content of competency standards internationally is an important step to understanding this growing workforce. © 2016 John Wiley & Sons Ltd.

Cultural Competence for Evaluators: A Guide for Alcohol and Other Drug Abuse Prevention Practitioners Working with Ethnic/Racial Communities. OSAP Cultural Competence Series 1.

ERIC Educational Resources Information Center

Orlandi, Mario A., Ed.; And Others

As an introduction to a series on the array of issues in the implementation and evaluation of substance abuse prevention programs, this volume attempts to integrate two types of competence for alcohol and other drug abuse prevention program practitioners: program evaluation competence and cultural competence. The chapters in this document provide…

A Web-Based Lean Simulation Game for Office Operations: Training the Other Side of a Lean Enterprise

ERIC Educational Resources Information Center

Kuriger, Glenn W.; Wan, Huang-da; Mirehei, S. Moussa; Tamma, Saumya; Chen, F. Frank

2010-01-01

This research proposes a Web-based version of a lean office simulation game (WeBLOG). The game is designed to be used to train lean concepts to office and administrative personnel. This group belongs to the frequently forgotten side of a lean enterprise. Over four phases, the game presents the following seven lean tools: one-piece flow,…

Agile, a guiding principle for health care improvement?

PubMed

Tolf, Sara; Nyström, Monica E; Tishelman, Carol; Brommels, Mats; Hansson, Johan

2015-01-01

The purpose of this paper is to contribute to increased understanding of the concept agile and its potential for hospital managers to optimize design of organizational structures and processes to combine internal efficiency and external effectiveness. An integrative review was conducted using the reSEARCH database. Articles met the following criteria: first, a definition of agility; second, descriptions of enablers of becoming an agile organization; and finally, discussions of agile on multiple organizational levels. In total, 60 articles qualified for the final analysis. Organizational agility rests on the assumption that the environment is uncertain, ranging from frequently changing to highly unpredictable. Proactive, reactive or embracive coping strategies were described as possible ways to handle such uncertain environments. Five organizational capacities were derived as necessary for hospitals to use the strategies optimally: transparent and transient inter-organizational links; market sensitivity and customer focus; management by support for self-organizing employees; organic structures that are elastic and responsive; flexible human and resource capacity for timely delivery. Agile is portrayed as either the "new paradigm" following lean, the needed development on top of a lean base, or as complementary to lean in distinct hybrid strategies. Environmental uncertainty needs to be matched with coping strategies and organizational capacities to design processes responsive to real needs of health care. This implies that lean and agile can be combined to optimize the design of hospitals, to meet different variations in demand and create good patient management. While considerable value has been paid to strategies to improve the internal efficiency within hospitals, this review raise the attention to the value of strategies of external effectiveness.

Internet Usage, User Satisfaction, Task-Technology Fit, and Performance Impact among Public Sector Employees in Yemen

ERIC Educational Resources Information Center

Isaac, Osama; Abdullah, Zaini; Ramayah, T.; Mutahar, Ahmed M.

2017-01-01

Purpose: The internet technology becomes an essential tool for individuals, organizations, and nations for growth and prosperity. The purpose of this paper is to integrate the DeLone and McLean IS success model with task-technology fit (TTF) to explain the performance impact of Yemeni Government employees. Design/methodology/approach:…

Ares Project Overview - Quality in Design

NASA Technical Reports Server (NTRS)

Cianciola, Chris; Crane, Kenneth

2008-01-01

This presentation introduces the audience to the overall goals of the Ares Project, which include providing human access to low-Earth orbit, the Moon, and beyond. The presentation also provides an overview of with the vehicles that will execute those goals and progress made on the vehicles to date. The briefing will provide an introduction to Lean, Six Sigma, and Kaizen practices Ares will use to improve the overall effectiveness and quality of its efforts. Finally, the briefing includes a summary of Safety and Mission Assurance practices being implemented within[Ares to ensure safety and quality early in the design process. Integrating Safety and Mission Assurance in Design: This presentation describes how the Ares Projects are learning from the successes and failures of previous launch systems in order to maximize safety and reliability while maintaining fiscal responsibility. The Ares Projects are integrating Safer T and Mission Assurance into design activities and embracing independent assessments by Quality experts in thorough reviews of designs and processes. Incorporating Lean thinking into the design process, Ares is also streamlining existing processes and future manufacturing flows which will yield savings during production. Understanding the value of early involvement of Quality experts, the Ares Projects are leading launch vehicle development into the 21st century.

Essential Public Health Competencies for Medical Students: Establishing a Consensus in Family Medicine.

PubMed

Morley, Christopher P; Rosas, Scott R; Mishori, Ranit; Jordan, William; Jarris, Yumi Shitama; Competencies Work Group, Family Medicine/Public Health; Prunuske, Jacob

2017-01-01

Phenomenon: The integration of public health (PH) competency training into medical education, and further integration of PH and primary care, has been urged by the U.S. Institute of Medicine. However, PH competencies are numerous, and no consensus exists over which competencies are most important for adoption by current trainees. Our objective was to conduct a group concept mapping exercise with stakeholders identifying the most important and feasible PH skills to incorporate in medical and residency curricula. We utilized a group concept mapping technique via the Concept System Global Max ( http://www.conceptsystems.com ), where family medicine educators and PH professionals completed the phrase, "A key Public Health competency for physicians-in-training to learn is …" with 1-10 statements. The statement list was edited for duplication and other issues; stakeholders then sorted the statements and rated them for importance and feasibility of integration. Multidimensional scaling and cluster analysis were used to create a two-dimensional point map of domains of PH training, allowing visual comparison of groupings of related ideas and relative importance of these ideas. There were 116 nonduplicative statements (225 total) suggested by 120 participants. Three metacategories of competencies emerged: Clinic, Community & Culture, Health System Understanding, and Population Health Science & Data. Insights: We identified and organized a set of topics that serve as a foundation for the integration of family medicine and PH education. Incorporating these topics into medical education is viewed as important and feasible by family medicine educators and PH professions.

Lean leadership attributes: a systematic review of the literature.

PubMed

Aij, Kjeld Harald; Teunissen, Maurits

2017-10-09

Purpose Emphasis on quality and reducing costs has led many health-care organizations to reconfigure their management, process, and quality control infrastructures. Many are lean, a management philosophy with roots in manufacturing industries that emphasizes elimination of waste. Successful lean implementation requires systemic change and strong leadership. Despite the importance of leadership to successful lean implementation, few researchers have probed the question of ideal leadership attributes to achieve lean thinking in health care. The purpose of this paper is to provide insight into applicable attributes for lean leaders in health care. Design/methodology/approach The authors systematically reviewed the literature on principles of leadership and, using Dombrowski and Mielke's (2013) conceptual model of lean leadership, developed a parallel theoretical model for lean leadership in health care. Findings This work contributes to the development of a new framework for describing leadership attributes within lean management of health care. Originality/value The summary of attributes can provide a model for health-care leaders to apply lean in their organizations.

Cull sow knife-separable lean content evaluation at harvest and lean mass content prediction equation development.

PubMed

Abell, Caitlyn E; Stalder, Kenneth J; Hendricks, Haven B; Fitzgerald, Robert F

2012-07-01

The objectives of this study were to develop a prediction equation for carcass knife-separable lean within and across USDA cull sow market weight classes (MWC) and to determine carcass and individual primal cut knife separable lean content from cull sows. There were significant percent lean and fat differences in the primal cuts across USDA MWC. The two lighter USDA MWC had a greater percent carcass lean and lower percent fat compared to the two heavier MWC. In general, hot carcass weight explained the majority of carcass lean variation. Additionally, backfat was a significant variation source when predicting cull sow carcass lean. The findings support using a single lean prediction equation across MWC to assist processors when making cull sow purchasing decisions and determine the mix of animals from various USDA MWC that will meet their needs when making pork products with defined lean:fat content. Copyright © 2012 Elsevier Ltd. All rights reserved.

Prevalence and hemodynamic effects of leaning during CPR

PubMed Central

Niles, Dana E.; Sutton, Robert M.; Nadkarni, Vinay M.; Glatz, Andrew; Zuercher, Mathias; Maltese, Matthew R.; Eilevstjønn, Joar; Abella, Benjamin S.; Becker, Lance B.; Berg, Robert A.

2013-01-01

Background Cardiopulmonary resuscitation (CPR) guidelines recommend complete release between chest compressions (CC). Objective Evaluate the hemodynamic effects of leaning (incomplete chest wall release) during CPR and the prevalence of leaning during CPR. Results In piglet ventricular fibrillation cardiac arrests, 10% and 20% (1.8 kg and 3.6 kg, respectively), leaning during CPR increased right atrial pressures, decreased coronary perfusion pressures, and decreased cardiac index and left ventricular myocardial blood flow by nearly 50%. In contrast, residual leaning of a 260 g accelerometer/ force feedback device did not adversely affect cardiac index or myocardial blood flow. Among 108 adult in-hospital CPR events, leaning ≥2.5 kg was demonstrable in 91% of the events and 12% of the evaluated CC. For 12 children with in-hospital CPR, 28% of CC had residual leaning ≥2.5 kg and 89% had residual leaning ≥0.5 kg. Conclusions Leaning during CPR increases intrathoracic pressure, decreases coronary perfusion pressure, and decreases cardiac output and myocardial blood flow. Leaning is common during CPR. PMID:22208173

A Blended Learning Environment for Individualized English Listening and Speaking Integrating Critical Thinking

ERIC Educational Resources Information Center

Yang, Ya-Ting Carolyn; Chuang, Ya-Chin; Li, Lung-Yu; Tseng, Shin-Shang

2013-01-01

Critical thinking (CT) and English communication are recognized as two essential 21st century competencies. To equip students with these competencies and respond to the challenges of global competition, educational technology is being developed to enhance teaching and learning. This study examined the effectiveness of integrating CT into…

Development of Articulated Competency-Based Curriculum in Computer Integrated Manufacturing Technology. Final Report.

ERIC Educational Resources Information Center

Luzerne County Community Coll., Nanticoke, PA.

A project was conducted at the Community College of Luzerne County (Pennsylvania) to develop, in cooperation with area vocational-technical schools, the first year of a competency-based curriculum in computer-integrated manufacturing. Existing programs were reviewed and private sector input was sought in developing the curriculum and identifying…

Marketing Technology. FasTrak Specialization Integrated Technical and Academic Competency (ITAC). Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.

This document presents the Ohio Integrated Technical and Academic Competency profile for marketing technology. The profile is to serve as the basis for curriculum development in Ohio's secondary, adult, and postsecondary programs. The profile includes a comprehensive listing of 580 specialty and foundation key indicators for evaluating mastery of…

Integrating Bar-Code Medication Administration Competencies in the Curriculum: Implications for Nursing Education and Interprofessional Collaboration.

PubMed

Angel, Vini M; Friedman, Marvin H; Friedman, Andrea L

This article describes an innovative project involving the integration of bar-code medication administration technology competencies in the nursing curriculum through interprofessional collaboration among nursing, pharmacy, and computer science disciplines. A description of the bar-code medication administration technology project and lessons learned are presented.

Towards an Integrated Approach to the Recognition of Professional Competence and Academic Learning

ERIC Educational Resources Information Center

Bravenboer, Darryll; Lester, Stan

2016-01-01

Purpose: The purpose of this paper is to discuss the benefits of reclaiming the idea of professional competence and challenges fragmented approaches to academic qualification and professional recognition. It is argued that academic programmes that are integrated with the requirements for professional recognition can resolve the potentially…

The PCOS Patients differ in Lipid Profile According to their Phenotypes.

PubMed

Spałkowska, Magdalena; Mrozińska, Sandra; Gałuszka-Bednarczyk, Anna; Gosztyła, Katarzyna; Przywara, Agnieszka; Guzik, Justyna; Janeczko, Marek; Milewicz, Tomasz; Wojas-Pelc, Anna

2018-01-31

Polycystic ovary syndrome (PCOS) affects 4-18% of women of reproductive age. The number of reports exploring the lipid profiles among PCOS patients and number of studied patients are limited. The aim of our study was to assess the lipid profile separately in lean and non-lean women with polycystic ovary syndrome divided according to hyperandrogenemia, defined as free androgen index (FAI)≥5. The second aim was to compare the lipid profiles among lean and non-lean PCOS patients with respect to hyperandrogenemia and regularity of menstruation cycles. We evaluated 232 patients from Department of Endocrinological Gynecology, Jagiellonian University Medical College in Krakow diagnosed with PCOS. The population consisted of 166 lean and 66 non-lean women. We observed higher levels of total cholesterol, high-density lipoprotein cholesterol (HDL-C) in lean patients with FAI<5 than in lean patients with FAI≥5. There were no differences in lipid profile between non-lean patients with FAI≥5 and non-lean patients with FAI<5. Among lean patients higher total cholesterol levels were observed in those with irregular menstruation cycles and FAI<5 than in patients with FAI≥5 and regular cycles. There were no differences in lipid profiles between four phenotypes among non-lean PCOS patients. The results of our study showed differences in lipid profile between lean PCOS patients according to their phenotype based on androgens' level. This effect was abandoned by fat tissue mass in non-lean ones. Further studies should be conducted to explore these associations. © Georg Thieme Verlag KG Stuttgart · New York.

Eating disorder pathology in elite adolescent athletes.

PubMed

Giel, Katrin Elisabeth; Hermann-Werner, Anne; Mayer, Jochen; Diehl, Katharina; Schneider, Sven; Thiel, Ansgar; Zipfel, Stephan

2016-06-01

We aimed to investigate eating disorder pathology in German elite adolescent athletes. Evidence suggests that eating disorder pathology is more common in adult elite sports, especially in female athletes and in sports emphasizing leanness. There is a scarcity of studies in elite adolescent athletes who are in a vulnerable developmental stage and are affected by general as well as sport-specific risk factors. Our data was derived from the German Young Olympic Athletes' Lifestyle and Health Management Study (GOAL) which conducted a survey in 1138 elite adolescent athletes. In this sample, we assessed body weight, weight control behavior, body acceptance and screened overall for core symptoms of eating disorders, depression and anxiety. We performed a tree analysis to identify high risk groups for eating disorder pathology. High risk groups comprised (a) athletes competing in weight dependent sports, and among athletes competing in disciplines other than weight dependent sports (b) athletes who are high on negative affectivity, (c) female athletes and (d) male athletes competing in endurance, technical or power sports. Athletes competing in weight dependent disciplines reported wide spread use of compensatory behaviors to influence body weight. Athletes reporting eating disorder pathology showed higher levels of depression and anxiety than athletes without eating disorder pathology. Increased psychosocial burden in athletes with eating disorder pathology suggests that eating disorder symptoms should not be accepted as an unproblematic and functional part of elite sports. The prevention and management of eating disorder pathology is especially important in weight dependent sports. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:553-562). © 2016 Wiley Periodicals, Inc.

Getting Ready for Micros.

ERIC Educational Resources Information Center

Roth, Gene L.; And Others

1984-01-01

Four colleagues at Idaho State University describe how they used the DACUM (Developing A Curriculum) process to figure out what microcomputer competencies vocational educators need. Competencies include developing a personal plan for microcomputer competency; integrating computer-based instruction (CBI) into the vocational curriculum; planning,…

Testing can counteract proactive interference by integrating competing information.

PubMed

Wahlheim, Christopher N

2015-01-01

Testing initially learned information before presenting new information has been shown to counteract the deleterious effects of proactive interference by segregating competing sources of information. The present experiments were conducted to demonstrate that testing can also have its effects in part by integrating competing information. Variations of classic A-B, A-D paired-associate learning paradigms were employed that included two lists of word pairs and a cued-recall test. Repeated pairs appeared in both lists (A-B, A-B), control pairs appeared in List 2 only (A-B, C-D), and changed pairs appeared with the same cue in both lists but with different responses (A-B, A-D). The critical manipulation was whether pairs were tested or restudied in an interpolated phase that occurred between Lists 1 and 2. On a final cued-recall test, participants recalled List 2 responses and then indicated when they recollected that responses had earlier changed between lists. The change recollection measure indexed the extent to which competing responses were integrated during List 2. Change was recollected more often for tested than for restudied pairs. Proactive facilitation was obtained in cued recall when change was recollected, whereas proactive interference was obtained when change was not recollected. These results provide evidence that testing counteracted proactive interference in part by making List 1 responses more accessible during List 2, thus promoting integration and increasing later recollection of change. These results have theoretical implications because they show that testing can counteract proactive interference by integrating or segregating competing information.

National standards in pathology education: developing competencies for integrated medical school curricula.

PubMed

Sadofsky, Moshe; Knollmann-Ritschel, Barbara; Conran, Richard M; Prystowsky, Michael B

2014-03-01

Medical school education has evolved from department-specific memorization of facts to an integrated curriculum presenting knowledge in a contextual manner across traditional disciplines, integrating information, improving retention, and facilitating application to clinical practice. Integration occurs throughout medical school using live data-sharing technologies, thereby providing the student with a framework for lifelong active learning. Incorporation of educational teams during medical school prepares students for team-based patient care, which is also required for pay-for-performance models used in accountable care organizations. To develop learning objectives for teaching pathology to medical students. Given the rapid expansion of basic science knowledge of human development, normal function, and pathobiology, it is neither possible nor desirable for faculty to teach, and students to retain, this vast amount of information. Courses teaching the essentials in context and engaging students in the learning process enable them to become lifelong learners. An appreciation of pathobiology and the role of laboratory medicine underlies the modern practice of medicine. As such, all medical students need to acquire 3 basic competencies in pathology: an understanding of disease mechanisms, integration of mechanisms into organ system pathology, and application of pathobiology to diagnostic medicine. We propose the development of 3 specific competencies in pathology to be implemented nationwide, aimed at disease mechanisms/processes, organ system pathology, and application to diagnostic medicine. Each competency will include learning objectives and a means to assess acquisition, integration, and application of knowledge. The learning objectives are designed to be a living document managed (curated) by a group of pathologists representing Liaison Committee on Medical Education-accredited medical schools nationally. Development of a coherent set of learning objectives will assist medical students nationally to gain the basic competencies in pathology necessary for clinical practice. Having national standards for competencies preserves schools' independence in specific curriculum design while assuring all students meet the evolving needs of medical practice.

Development of framework for sustainable Lean implementation: an ISM approach

NASA Astrophysics Data System (ADS)

Jadhav, Jagdish Rajaram; Mantha, S. S.; Rane, Santosh B.

2014-07-01

The survival of any organization depends upon its competitive edge. Even though Lean is one of the most powerful quality improvement methodologies, nearly two-thirds of the Lean implementations results in failures and less than one-fifth of those implemented have sustained results. One of the most significant tasks of top management is to identify, understand and deploy the significant Lean practices like quality circle, Kanban, Just-in-time purchasing, etc. The term `bundle' is used to make groups of inter-related and internally consistent Lean practices. Eight significant Lean practice bundles have been identified based on literature reviewed and opinion of the experts. The order of execution of Lean practice bundles is very important. Lean practitioners must be able to understand the interrelationship between these practice bundles. The objective of this paper is to develop framework for sustainable Lean implementation using interpretive structural modelling approach.

Using Lean Process Improvement to Enhance Safety and Value in Orthopaedic Surgery: The Case of Spine Surgery.

PubMed

Sethi, Rajiv; Yanamadala, Vijay; Burton, Douglas C; Bess, Robert Shay

2017-11-01

Lean methodology was developed in the manufacturing industry to increase output and decrease costs. These labor organization methods have become the mainstay of major manufacturing companies worldwide. Lean methods involve continuous process improvement through the systematic elimination of waste, prevention of mistakes, and empowerment of workers to make changes. Because of the profit and productivity gains made in the manufacturing arena using lean methods, several healthcare organizations have adopted lean methodologies for patient care. Lean methods have now been implemented in many areas of health care. In orthopaedic surgery, lean methods have been applied to reduce complication rates and create a culture of continuous improvement. A step-by-step guide based on our experience can help surgeons use lean methods in practice. Surgeons and hospital centers well versed in lean methodology will be poised to reduce complications, improve patient outcomes, and optimize cost/benefit ratios for patient care.

Lost in translation: a case-study of the travel of lean thinking in a hospital.

PubMed

Andersen, Hege; Røvik, Kjell Arne

2015-09-21

Lean thinking as a quality improvement approach is introduced in hospitals worldwide, although evidence for its impact is scarce. Lean initiatives are social, complex and context-dependent. This calls for a shift from cause-effect to conditional attributions to understand how lean works. In this study, we bring attention to the transformative power of local translation, which creates different versions of lean in different contexts, and thereby affect the evidence for lean as well as the success of lean initiatives within and among hospitals. We explored the travel of lean within a hospital in Norway by identifying local actors' perceptions of lean through their images of enablers for successful interventions. These attributions describe the characteristics of lean in use, i.e. the prevailing version of lean. Local actors' perceptions of enablers for lean interventions were collected through focus group interviews with three groups of stakeholders: managers, internal consultants and staff. A questionnaire was used to reveal the enablers relative importance. The enablers known from the literature were retrieved at the case hospital. The only exception was that external expert change agents were not believed to promote lean. In addition, the stakeholders added a number of new and supplementary enablers. Two-thirds of the most important enablers for success were novel, local ones. Among these were a problem, not method focus, a bottom-up approach, the need of internal consultants, credibility, realism and patience. The local actors told different stories about local enablers and had different images of lean depending on their hierarchical level. By comparing and analyzing the findings from the literature review, the focus groups and the survey, we deduced that the travel of lean within the hospital was affected by three principles of translation: the practical, the pragmatic, and the sceptical. Further, three logics of translation were in play: translation as a funnel, a conscious sell-in, and a wash-out. This resulted in various local versions of lean. We conclude that lean, introduced by the management, communicated by the internal consultants, and used by the staff, is transformed more than once within the hospital. Translation is part of the explanation for the lack of evidence for lean, and translation can be decisive for outcomes.

Multicultural Counseling Competence Training: Adding Value with Multicultural Consultation

ERIC Educational Resources Information Center

Jones, Janine M.; Kawena Begay, Kristin; Nakagawa, Yoko; Cevasco, Molly; Sit, Janelle

2016-01-01

This study addresses the culturally responsive training process and highlights the integration of multicultural competence building in counseling consultation. Consultation was structured as client-centered case consultation. Before and after the intervention, clinician competence was assessed with the California Brief Multicultural Counseling…

A Systematic Approach to Applying Lean Techniques to Optimize an Office Process at the Y-12 National Security Complex

DOE Office of Scientific and Technical Information (OSTI.GOV)

Credille, Jennifer; Owens, Elizabeth

This capstone offers the introduction of Lean concepts to an office activity to demonstrate the versatility of Lean. Traditionally Lean has been associated with process improvements as applied to an industrial atmosphere. However, this paper will demonstrate that implementing Lean concepts within an office activity can result in significant process improvements. Lean first emerged with the conception of the Toyota Production System. This innovative concept was designed to improve productivity in the automotive industry by eliminating waste and variation. Lean has also been applied to office environments, however the limited literature reveals most Lean techniques within an office are restrictedmore » to one or two techniques. Our capstone confronts these restrictions by introducing a systematic approach that utilizes multiple Lean concepts. The approach incorporates: system analysis, system reliability, system requirements, and system feasibility. The methodical Lean outline provides tools for a successful outcome, which ensures the process is thoroughly dissected and can be achieved for any process in any work environment.« less

Lean thinking in emergency departments: concepts and tools for quality improvement.

PubMed

Bruno, Frances

2017-10-12

The lean approach is a viable framework for reducing costs and enhancing the quality of patient care in emergency departments (EDs). Reports on lean-inspired quality improvement initiatives are rapidly growing but there is little emphasis on the philosophy behind the processes, which is the essential ingredient in sustaining transformation. This article describes lean philosophy, also referred to as lean, lean thinking and lean healthcare, and its main concepts, to enrich the knowledge and vocabulary of nurses involved or interested in quality improvement in EDs. The article includes examples of lean strategies to illustrate their practical application in EDs. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

The Integrated Personnel Development System: The Training and Development of Competent Firefighters

ERIC Educational Resources Information Center

Moran, Peter; Starling, Paul

2005-01-01

This article enquires into the nature of an emergent continuous professional development (CPD) mechanism for firefighters in the form of an Integrated Personnel Development System (IPDS), which proposes to base future training for every rank in the service on the acquisition and demonstration of competence for role. IPDS is due to be introduced…

Pre-Service Teachers' TPACK Competencies for Spreadsheet Integration: Insights from a Mathematics-Specific Instructional Technology Course

ERIC Educational Resources Information Center

Agyei, Douglas D.; Voogt, Joke M.

2015-01-01

This article explored the impact of strategies applied in a mathematics instructional technology course for developing technology integration competencies, in particular in the use of spreadsheets, in pre-service teachers. In this respect, 104 pre-service mathematics teachers from a teacher training programme in Ghana enrolled in the mathematics…

Identifying Core Mobile Learning Faculty Competencies Based Integrated Approach: A Delphi Study

ERIC Educational Resources Information Center

Elbarbary, Rafik Said

2015-01-01

This study is based on the integrated approach as a concept framework to identify, categorize, and rank a key component of mobile learning core competencies for Egyptian faculty members in higher education. The field investigation framework used four rounds Delphi technique to determine the importance rate of each component of core competencies…

Empirical and Clinical Methods in the Assessment of Personality and Psychopathology: An Integrative Approach for Training

ERIC Educational Resources Information Center

Flanagan, Rosemary; Esquivel, Giselle B.

2006-01-01

School psychologists have a critical role in identifying social-emotional problems and psychopathology in youth based on a set of personality-assessment competencies. The development of competencies in assessing personality and psychopathology is complex, requiring a variety of integrated methods and approaches. Given the limited extent and scope…

Advanced Low-Emissions Catalytic-Combustor Program, phase 1. [aircraft gas turbine engines

NASA Technical Reports Server (NTRS)

Sturgess, G. J.

1981-01-01

Six catalytic combustor concepts were defined, analyzed, and evaluated. Major design considerations included low emissions, performance, safety, durability, installations, operations and development. On the basis of these considerations the two most promising concepts were selected. Refined analysis and preliminary design work was conducted on these two concepts. The selected concepts were required to fit within the combustor chamber dimensions of the reference engine. This is achieved by using a dump diffuser discharging into a plenum chamber between the compressor discharge and the turbine inlet, with the combustors overlaying the prediffuser and the rear of the compressor. To enhance maintainability, the outer combustor case for each concept is designed to translate forward for accessibility to the catalytic reactor, liners and high pressure turbine area. The catalytic reactor is self-contained with air-cooled canning on a resilient mounting. Both selected concepts employed integrated engine-starting approaches to raise the catalytic reactor up to operating conditions. Advanced liner schemes are used to minimize required cooling air. The two selected concepts respectively employ fuel-rich initial thermal reaction followed by rapid quench and subsequent fuel-lean catalytic reaction of carbon monoxide, and, fuel-lean thermal reaction of some fuel in a continuously operating pilot combustor with fuel-lean catalytic reaction of remaining fuel in a radially-staged main combustor.

Effects of Karlovitz number on turbulent kinetic energy transport in turbulent lean premixed methane/air flames

NASA Astrophysics Data System (ADS)

Wang, Zhiyan; Abraham, John

2017-08-01

Direct numerical simulations of lean methane/air flames are carried out to study the effects of premixed combustion on turbulence. The equivalence ratio of the flame is 0.5 and non-dimensional turbulence intensities (urms/SL) are between 2 and 25. The mixture pressure is 20 bars and temperature is 810 K to simulate approximate conditions in lean-burn natural gas engines. The Karlovitz number (Ka) varies from 1.1 to 49.4, and the Damköhler number (Da) varies from 0.26 to 3.2 corresponding to turbulent premixed combustion in the thin reaction zone (TRZ) regime. It is found that turbulence kinetic energy (TKE) and its dissipation rate decrease monotonically across the flame brush while the integral length scale increases monotonically for flames in the TRZ regime. The transport equation of TKE is then examined, and the scaling of the terms in the equation is discussed. It is found that the sink term which represents molecular diffusion and viscous dissipation is the dominant term in the TKE balance and it scales with the square of Ka. The relative importance of the other terms with respect to the dissipation term is studied. With increasing Ka, the other terms in the TKE balance become less important compared to the dissipation term.

Innovation leading the way: application of lean manufacturing to sample management.

PubMed

Allen, M; Wigglesworth, M J

2009-06-01

Historically, sample management successfully focused on providing compound quality and tracking distribution within a diverse geographic. However, if a competitive advantage is to be delivered in a changing environment of outsourcing, efficiency and customer service must now improve or face reconstruction. The authors have used discrete event simulation to model the compound process from chemistry to assay and applied lean manufacturing techniques to analyze and improve these processes. In doing so, they identified a value-adding process time of just 11 min within a procedure that took days. Modeling also allowed the analysis of equipment and human resources necessary to complete the expected demand in an acceptable cycle time. Layout and location of sample management and screening departments are key in allowing process integration, creating rapid flow of work, and delivering these efficiencies. Following this analysis and minor process changes, the authors have demonstrated for 2 programs that solid compounds can be converted to assay-ready plates in less than 4 h. In addition, it is now possible to deliver assay data from these compounds within the same working day, allowing chemistry teams more flexibility and more time to execute the next chemistry round. Additional application of lean manufacturing principles has the potential to further decrease cycle times while using fewer resources.

The effect of incomplete fuel-air mixing on the lean blowout limit, lean stability limit and NO(x) emissions in lean premixed gas turbine combustors

NASA Technical Reports Server (NTRS)

Shih, W.-P.; Lee, J. G.; Santavicca, D. A.

1994-01-01

Gas turbine engines for both land-based and aircraft propulsion applications are facing regulations on NOx emissions which cannot be met with current combustor technology. A number of alternative combustor strategies are being investigated which have the potential capability of achieving ultra-low NOx emissions, including lean premixed combustors, direct injection combustors, rich burn-quick quench-lean burn combustors and catalytic combustors. The research reported in this paper addresses the effect of incomplete fuel-air mixing on the lean limit performance and the NOx emissions characteristics of lean premixed combustors.

The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation

PubMed Central

Fried, David A.; Leary, Marion; Smith, Douglas A.; Sutton, Robert M.; Niles, Dana; Herzberg, Daniel L.; Becker, Lance B.; Abella, Benjamin S.

2011-01-01

Objective Successful resuscitation from cardiac arrest requires the delivery of high-quality chest compressions, encompassing parameters such as adequate rate, depth, and full recoil between compressions. The lack of compression recoil (“leaning” or “incomplete recoil”) has been shown to adversely affect hemodynamics in experimental arrest models, but the prevalence of leaning during actual resuscitation is poorly understood. We hypothesized that leaning varies across resuscitation events, possibly due to rescuer and/or patient characteristics and may worsen over time from rescuer fatigue during continuous chest compressions. Methods This was an observational clinical cohort study at one academic medical center. Data were collected from adult in-hospital and Emergency Department arrest events using monitor/defibrillators that record chest compression characteristics and provide real-time feedback. Results We analyzed 112,569 chest compressions from 108 arrest episodes from 5/2007 to 2/2009. Leaning was present in 98/108 (91%) cases; 12% of all compressions exhibited leaning. Leaning varied widely across cases: 41/108 (38%) of arrest episodes exhibited <5% leaning yet 20/108 (19%) demonstrated >20% compression leaning. When evaluating blocks of continuous compressions (>120 sec), only 4/33 (12%) had an increase in leaning over time and 29/33 (88%) showed a decrease (p<0.001). Conclusions Chest compression leaning was common during resuscitation care and exhibited a wide distribution, with most leaning within a subset of resuscitations. Leaning decreased over time during continuous chest compression blocks, suggesting that either leaning may not be a function of rescuer fatiguing, or that it may have been mitigated by automated feedback provided during resuscitation episodes. PMID:21482010

Risk Factors for the Loss of Lean Body Mass After Gastrectomy for Gastric Cancer.

PubMed

Aoyama, Toru; Sato, Tsutomu; Segami, Kenki; Maezawa, Yukio; Kano, Kazuki; Kawabe, Taiichi; Fujikawa, Hirohito; Hayashi, Tsutomu; Yamada, Takanobu; Tsuchida, Kazuhito; Yukawa, Norio; Oshima, Takashi; Rino, Yasushi; Masuda, Munetaka; Ogata, Takashi; Cho, Haruhiko; Yoshikawa, Takaki

2016-06-01

Lean body mass loss after surgery, which decreases the compliance of adjuvant chemotherapy, is frequently observed in gastric cancer patients who undergo gastrectomy for gastric cancer. However, the risk factors for loss of lean body mass remain unclear. The current study retrospectively examined the patients who underwent curative gastrectomy for gastric cancer between June 2010 and March 2014 at Kanagawa Cancer Center. All the patients received perioperative care for enhanced recovery after surgery. The percentage of lean body mass loss was calculated by the percentile of lean body mass 1 month after surgery to preoperative lean body mass. Severe lean body mass loss was defined as a lean body mass loss greater than 5 %. Risk factors for severe lean body mass loss were determined by both uni- and multivariate logistic regression analyses. This study examined 485 patients. The median loss of lean body mass was 4.7 %. A lean body mass loss of 5 % or more occurred for 225 patients (46.4 %). Both uni- and multivariate logistic analyses demonstrated that the significant independent risk factors for severe lean body mass loss were surgical complications with infection or fasting (odds ratio [OR] 3.576; p = 0.001), total gastrectomy (OR 2.522; p = 0.0001), and gender (OR 1.928; p = 0.001). Nutritional intervention or control of surgical invasion should be tested in future clinical trials for gastric cancer patients with these risk factors to maintain lean body mass after gastrectomy.

Measures of Cultural Competence in Nurses: An Integrative Review

PubMed Central

2013-01-01

Background. There is limited literature available identifying and describing the instruments that measure cultural competence in nursing students and nursing professionals. Design. An integrative review was undertaken to identify the characteristics common to these instruments, examine their psychometric properties, and identify the concepts these instruments are designed to measure. Method. There were eleven instruments identified that measure cultural competence in nursing. Of these eleven instruments, four had been thoroughly tested in either initial development or in subsequent testing, with developers providing extensive details of the testing. Results. The current literature identifies that the instruments to assess cultural competence in nurses and nursing students are self-administered and based on individuals' perceptions. The instruments are commonly utilized to test the effectiveness of educational programs designed to increase cultural competence. Conclusions. The reviewed instruments measure nurses' self-perceptions or self-reported level of cultural competence but offer no objective measure of culturally competent care from a patient's perspective which can be problematic. Comparison of instruments reveals that they are based on a variety of conceptual frameworks and that multiple factors should be considered when deciding which instrument to use. PMID:23818818

Lean leadership: an ethnographic study.

PubMed

Aij, Kjeld Harald; Visse, Merel; Widdershoven, Guy A M

2015-01-01

The purpose of this study is to provide a critical analysis of contemporary Lean leadership in the context of a healthcare practice. The Lean leadership model supports professionals with a leading role in implementing Lean. This article presents a case study focusing specifically on leadership behaviours and issues that were experienced, observed and reported in a Dutch university medical centre. This ethnographic case study provides auto-ethnographic accounts based on experiences, participant observation, interviews and document analysis. Characteristics of Lean leadership were identified to establish an understanding of how to achieve successful Lean transformation. This study emphasizes the importance for Lean leaders to go to the gemba, to see the situation for one's own self, empower health-care employees and be modest. All of these are critical attributes in defining the Lean leadership mindset. In this case study, Lean leadership is specifically related to healthcare, but certain common leadership characteristics are relevant across all fields. This article shows the value of an auto-ethnographic view on management learning for the analysis of Lean leadership. The knowledge acquired through this research is based on the first author's experiences in fulfilling his role as a health-care leader. This may help the reader examining his/her own role and reflecting on what matters most in the field of Lean leadership.

Integrating Critical Spreadsheet Competencies into the Accounting Curriculum

ERIC Educational Resources Information Center

Walters, L. Melissa; Pergola, Teresa M.

2012-01-01

The American Institute of Certified Public Accountants (AICPA) and the International Accounting Education Standards Board (IAESB) identify spreadsheet technology as a key information technology (IT) competency for accounting professionals. However requisite spreadsheet competencies are not specifically defined by the AICPA or IAESB nor are they…

Addiction Competencies in the 2009 CACREP Clinical Mental Health Counseling Program Standards

ERIC Educational Resources Information Center

Lee, Tiffany K.; Craig, Stephen E.; Fetherson, Bianca T. L.; Simpson, C. Dennis

2013-01-01

The Council for Accreditation of Counseling and Related Educational Programs developed addiction competencies for clinical mental health counseling students. This article highlights these competencies, provides an overview of current addiction training, and describes methods to integrate addiction education into curricula.

Holistic Competence: Putting Judgements First

ERIC Educational Resources Information Center

Beckett, David

2008-01-01

Professional practice can be conceptualised holistically, and in fact during the 1990s the "Australian model" of integrated or holistic competence emerged empirically. This piece outlines that story, and then develops a more rigorous conceptual analysis of what it is to make competent practical judgements, through inferences, in…

EPA Lean Government Initiative: How to Replicate Lean Successes

EPA Pesticide Factsheets

This Lean Replication Primer describes how EPA Offices and Regions can identify and adapt successful practices from previous Lean projects to “replicate” their successes and generate further improvements.

Hospital nursing leadership-led interventions increased genomic awareness and educational intent in Magnet settings.

PubMed

Calzone, Kathleen A; Jenkins, Jean; Culp, Stacey; Badzek, Laurie

2017-11-13

The Precision Medicine Initiative will accelerate genomic discoveries that improve health care, necessitating a genomic competent workforce. This study assessed leadership team (administrator/educator) year-long interventions to improve registered nurses' (RNs) capacity to integrate genomics into practice. We examined genomic competency outcomes in 8,150 RNs. Awareness and intention to learn more increased compared with controls. Findings suggest achieving genomic competency requires a longer intervention and support strategies such as infrastructure and policies. Leadership played a role in mobilizing staff, resources, and supporting infrastructure to sustain a large-scale competency effort on an institutional basis. Results demonstrate genomic workforce competency can be attained with leadership support and sufficient time. Our study provides evidence of the critical role health-care leaders play in facilitating genomic integration into health care to improve patient outcomes. Genomics' impact on quality, safety, and cost indicate a leader-initiated national competency effort is achievable and warranted. Published by Elsevier Inc.

Competency Modeling in Extension Education: Integrating an Academic Extension Education Model with an Extension Human Resource Management Model

ERIC Educational Resources Information Center

Scheer, Scott D.; Cochran, Graham R.; Harder, Amy; Place, Nick T.

2011-01-01

The purpose of this study was to compare and contrast an academic extension education model with an Extension human resource management model. The academic model of 19 competencies was similar across the 22 competencies of the Extension human resource management model. There were seven unique competencies for the human resource management model.…

The implementation of integrated science teaching materials based socio-scientific issues to improve students scientific literacy for environmental pollution theme

NASA Astrophysics Data System (ADS)

Yenni, Rita; Hernani, Widodo, Ari

2017-05-01

The study aims to determine the increasing of students' science literacy skills on content aspects and competency of science by using Integrated Science teaching materials based Socio-scientific Issues (SSI) for environmental pollution theme. The method used in the study is quasi-experiment with nonequivalent pretest and posttest control group design. The students of experimental class used teaching materials based SSI, whereas the students of control class were still using the usual textbooks. The result of this study showed a significant difference between the value of N-gain of experimental class and control class, whichalso occurred in every indicator of content aspects and competency of science. This result indicates that using of Integrated Science teaching materials based SSI can improve content aspect and competency of science and can be used as teaching materials alternative in teaching of Integrated Science.

Nursing Students' Attitudes Toward Lesbian, Gay, Bisexual, and Transgender Persons: An Integrative Review.

PubMed

Lim, Fidelindo A; Hsu, Richard

2016-01-01

The aim of this study was to critically appraise and synthesize findings from studies on the attitudes of nursing students toward lesbian, gay, bisexual, and transgender (LGBT) persons. There is paucity of research to assess the attitudes of nursing students toward LGBT persons. An electronic search was conducted using PubMed, Medline, Web of Science, EbscoHost, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature using medical subject headings terminologies. Search terms used included gay, lesbian, transgender, bisexual, LGBT, nursing students, baccalaureate nursing, undergraduate nursing, homophobia, homosexuality, sexual minority, attitudes, discrimination, and prejudice. Less than 50 percent of the studies (5 out of 12) suggested positively leaning attitudes of nursing students toward LGBT persons; six studies reported negative attitudes, and one study reported neutral attitudes. There are some indications that student attitudes may be moving toward positively leaning. Studies published before 2000 reported a preponderance of negative attitudes.

Bipartisan politics and practical knowledge: advertising of public science in two London newspapers, 1695-1720.

PubMed

Wigelsworth, Jeffrey R

2008-12-01

This article explores the enticement of consumers for natural philosophy (buyers of books, audiences at public lectures and purchasers of instruments) in London between 1695 and 1720 through advertisements placed in two political newspapers. This twenty-five-year period witnessed both the birth of public science and the rage of party politics. A consideration of public science adverts within the Whig-leaning Post Man and the Tory-leaning Post Boy reveals that members of both the Whig and Tory parties were equally targeted and that natural philosophy was sold to London's reading population in bipartisan fashion. In the process of integrating natural philosophy into the wider culture through commercial sales, political allegiances were not imprinted on the advertising process. This conclusion raises questions regarding the historiographical assertion of Whig-supported public science and Tory opposition to it at the level of consumers.

A Methodology for the Assessment of Experiential Learning Lean: The Lean Experience Factory Study

ERIC Educational Resources Information Center

De Zan, Giovanni; De Toni, Alberto Felice; Fornasier, Andrea; Battistella, Cinzia

2015-01-01

Purpose: The purpose of this paper is to present a methodology to assess the experiential learning processes of learning lean in an innovative learning environment: the lean model factories. Design/methodology/approach: A literature review on learning and lean management literatures was carried out to design the methodology. Then, a case study…

Lean and Information Technology Toolkit

EPA Pesticide Factsheets

The Lean and Information Technology Toolkit is a how-to guide which provides resources to environmental agencies to help them use Lean Startup, Lean process improvement, and Agile tools to streamline and automate processes.

The Perfect Process Storm: Integration of CMMI, Agile, and Lean Six Sigma

DTIC Science & Technology

2012-12-01

struggled over the past few decades with a blizzard of process improvement methodologies such as Total Quality Manage- ment (TQM), Kaizen , JIT...the Japanese Kaizen system, targeting quality, effort, employee involvement, willingness to change, communication, and elimina- tion of waste in...blizzard of process improvement methodologies such as Total Quality Management (TQM), Kaizen , JIT Production, and Re-Engineering. These operations are

Packages of participation: Swedish employees' experience of Lean depends on how they are involved.

PubMed

Brännmark, Mikael; Holden, Richard J

2013-01-01

Lean Production is a dominant approach in Swedish and global manufacturing and service industries. Studies of Lean's employee effects are few and contradictory. Employee effects from Lean are likely not uniform. This paper investigates the effect of employees' participation on their experiences of Lean. This study investigated how different packages of employee participation in Lean affected manufacturing workers' experiences of Lean. During 2008-2011, qualitative and quantitative data were collected from Swedish manufacturing companies participating in the national Swedish Lean Production program Produktionslyftet. Data from 129 surveys (28 companies), 39 semi-structured interviews, and 30 reports were analyzed. In the main analysis, comparisons were made of the survey-reported Lean experiences of employees in three groups: temporary group employees (N = 36), who participated in Lean mostly through intermittent projects; continuous group employees (N = 69), who participated through standing improvement groups; and combined group employees (N = 24), who participated in both ways. Continuous group employees had the most positive experience of Lean, followed by the combined group. Temporary group employees had the least positive experiences, being less likely than their counterparts to report that Lean improved teamwork, occupational safety, and change-related learning, decision making, and authority. These findings support the importance of continuous, structured opportunities for participation but raise the possibility that more participation may result in greater workload and role overload, mitigating some benefits of employee involvement. Consequently, companies should consider involving employees in change efforts but should attend to the specific design of participation activities.

Integrating Safety and Mission Assurance in Design

NASA Technical Reports Server (NTRS)

Cianciola, Chris; Crane, Kenneth

2008-01-01

This presentation describes how the Ares Projects are learning from the successes and failures of previous launch systems in order to maximize safety and reliability while maintaining fiscal responsibility. The Ares Projects are integrating Safety and Mission Assurance into design activities and embracing independent assessments by Quality experts in thorough reviews of designs and processes. Incorporating Lean thinking into the design process, Ares is also streamlining existing processes and future manufacturing flows which will yield savings during production. Understanding the value of early involvement of Quality experts, the Ares Projects are leading launch vehicle development into the 21st century.

Lean Management Systems in Radiology: Elements for Success.

PubMed

Schultz, Stacy R; Ruter, Royce L; Tibor, Laura C

2016-01-01

This article is a review of the literature on Lean and Lean Management Systems and how they have been implemented in healthcare organizations and particularly in radiology departments. The review focuses on the elements required for a successful implementation of Lean by applying the principles of a Lean Management System instead of a Lean tools-only approach. This review shares the successes and failures from healthcare organizations' efforts to improve the quality and safety of the services they provide. There are a limited number of healthcare organizations in the literature who have shared their experiences and additional research is necessary to determine whether a Lean Management System is a viable alternative to the current management structure in healthcare.

Forming Professional Competency of Education Managers in Central European Countries

ERIC Educational Resources Information Center

Tovkanets, Oksana

2017-01-01

The article deals with the problem of forming education managers' professional competency in the context of European integration educational processes. The peculiarities of education managers' competences as well as directions of their professional training in motivational, cognitive and metacognitive spheres have been theoretically justified. The…

Summer Study-Abroad Program as Experiential Learning: Examining Similarities and Differences in International Communication

ERIC Educational Resources Information Center

Levine, Kenneth J.; Garland, Michelle E.

2015-01-01

This paper examines how the study-abroad experience enhances intercultural communication competence. This study used Bennett's (1986, 1993) model of ethnorelative typology of acceptance, adaptation, and integration to explore intercultural communication competency. Central to intercultural communication competency is intercultural sensitivity and…

Developing Idiomatic Competence in the ESOL Classroom: A Pragmatic Account

ERIC Educational Resources Information Center

Liontas, John I.

2015-01-01

Building on previous theoretical constructs and empirical findings on idioms, this article advances an integrated theoretical and methodological framework for developing idiomatic competence in English for speakers of other languages (ESOL). Beginning with a definition of the term "idiomatic competence," the author then presents a…

Improving Social Competence through Character Education

ERIC Educational Resources Information Center

Cheung, Chau-kiu; Lee, Tak-yan

2010-01-01

Character education is supposed to meet early adolescents' need (i.e., eighth and ninth graders) for strengthening social competence. Moreover, adolescents' engagement in character education is integral to their learning from the education. The engagement and deficit in social competence are therefore plausible conditions for the effectiveness of…

Alcohol produces distinct hepatic lipidome and eicosanoid signature in lean and obese[S

PubMed Central

Puri, Puneet; Xu, Jun; Vihervaara, Terhi; Katainen, Riikka; Ekroos, Kim; Daita, Kalyani; Min, Hae-Ki; Joyce, Andrew; Mirshahi, Faridoddin; Tsukamoto, Hidekazu; Sanyal, Arun J.

2016-01-01

Alcohol- and obesity-related liver diseases often coexist. The hepatic lipidomics due to alcohol and obesity interaction is unknown. We characterized the hepatic lipidome due to 1) alcohol consumption in lean and obese mice and 2) obesity and alcohol interactions. In the French-Tsukamoto mouse model, intragastric alcohol or isocaloric dextrose were fed with either chow (lean) or high-fat, high-cholesterol diet (obese). Four groups (lean, lean alcohol, obese, and obese alcohol) were studied. MS was performed for hepatic lipidomics, and data were analyzed. Alcohol significantly increased hepatic cholesteryl esters and diacyl­glycerol in lean and obese but was more pronounced in obese. Alcohol produced contrasting changes in hepatic phospholipids with significant enrichment in lean mice versus significant decrease in obese mice, except phosphatidylglycerol, which was increased in both lean and obese alcohol groups. Most lysophospholipids were increased in lean alcohol and obese mice without alcohol use only. Prostaglandin E2; 5-, 8-, and 11-hydroxyeicosatetraenoic acids; and 9- and 13-hydroxyoctadecadienoic acids were considerably increased in obese mice with alcohol use. Alcohol consumption produced distinct changes in lean and obese with profound effects of obesity and alcohol interaction on proinflammatory and oxidative stress-related eicosanoids. PMID:27020313

Improving first case start times using Lean in an academic medical center.

PubMed

Deldar, Romina; Soleimani, Tahereh; Harmon, Carol; Stevens, Larry H; Sood, Rajiv; Tholpady, Sunil S; Chu, Michael W

2017-06-01

Lean is a process improvement strategy that can improve efficiency of the perioperative process. The purpose of this study was to identify etiologies of late surgery start times, implement Lean interventions, and analyze their effects. A retrospective review of all first-start surgery cases was performed. Lean was implemented in May 2015, and cases 7 months before and after implementation were analyzed. A total of 4,492 first-start cases were included; 2,181 were pre-Lean and 2,311 were post-Lean. The post-Lean group had significantly higher on-time starts than the pre-Lean group (69.0% vs 57.0%, P < .01). The most common delay etiology was surgeon-related for both groups. Delayed post-Lean cases were significantly less likely to be due to preoperative assessment (14.9% vs 9.9%, P < .01) and more likely due to patient-related (16.5% vs 22.3%, P < .01) or chaplain (1.8% vs 4.0%, P < .01) factors. Delayed starts occurred more often on snowy and cold days, and less often on didactic days (P < .01). Modifying preoperative tasks using Lean methods can improve operating room efficiency and increase on-time starts. Copyright © 2016 Elsevier Inc. All rights reserved.

Sire carcass breeding values affect body composition in lambs - 1. Effects on lean weight and its distribution within the carcass as measured by computed tomography.

PubMed

Anderson, F; Williams, A; Pannier, L; Pethick, D W; Gardner, G E

2015-10-01

Data are obtained from computed tomography scanning of 1665 lambs at locations around Australia. Lambs were progeny of Terminal, Maternal and Merino sires with known Australian Sheep Breeding Values for post weaning c-site eye muscle depth (mm; PEMD) and fat depth (mm; PFAT), and post weaning weight (kg; PWWT). Across the 7.8 unit range of sire PEMD, carcass lean weight increased by 7.7%. This lean was distributed to the saddle section (mid-section) where lean became 3.8% heavier, with fore section lean becoming 3.5% lighter. Reducing sire PFAT across its 5.1 unit range increased carcass lean weight by 9.5%, and distributed lean to the saddle section which was 3.7% heavier. Increasing sire PWWT increased lean at some sites in some years, and on average increased saddle lean by 4% across the 24.7 unit PWWT range. Changes in lean weight and distribution due to selection for carcass breeding values will increase carcass value, particularly through increased weight of high value loin cuts. Copyright © 2015. Published by Elsevier Ltd.

Testing can counteract proactive interference by integrating competing information

PubMed Central

Wahlheim, Christopher N.

2015-01-01

Testing initially learned information before presenting new information has been shown to counteract the deleterious effects of proactive interference by segregating competing sources of information. The present experiments were conducted to demonstrate that testing can also have its effects in part by integrating competing information. Variations of classic A–B, A–D paired-associate learning paradigms were employed that included two lists of word pairs and a cued-recall test. Repeated pairs appeared in both lists (A–B, A–B), control pairs appeared in List 2 only (A–B, C–D), and changed pairs appeared with the same cue in both lists but with different responses (A–B, A–D). The critical manipulation was whether pairs were tested or restudied in an interpolated phase that occurred between Lists 1 and 2. On a final cued-recall test, participants recalled List 2 responses and then indicated when they recollected that responses had earlier changed between lists. The change recollection measure indexed the extent to which competing responses were integrated during List 2. Change was recollected more often for tested than for restudied pairs. Proactive facilitation was obtained in cued recall when change was recollected, whereas proactive interference was obtained when change was not recollected. These results provide evidence that testing counteracted proactive interference in part by making List 1 responses more accessible during List 2, thus promoting integration and increasing later recollection of change. These results have theoretical implications because they show that testing can counteract proactive interference by integrating or segregating competing information. PMID:25120241

Prevalence of Suspected Nonalcoholic Fatty Liver Disease In Lean Adolescents In The United States.

PubMed

Selvakumar, Praveen Kumar Conjeevaram; Kabbany, Mohammad Nasser; Lopez, Rocio; Rayas, Maria S; Lynch, Jane L; Alkhouri, Naim

2018-03-21

Nonalcoholic fatty liver disease (NAFLD) can develop in lean subjects referred to as lean NAFLD. We aim to evaluate the prevalence and risk factors of NAFLD in lean adolescents in the United States (US). Cross sectional data from 1482 lean subjects (body mass index < 85 percentile) aged between 12 and 18 years, who were enrolled in the National Health and Examination Survey during the 2005-2014 cycles were included. We defined suspected NAFLD as alanine aminotransferase > 25.8 U/L for boys and > 22.1 U/L for girls; hypertriglyceridemia as triglycerides ≥ 150 mg/dL; low HDL as HDL < 40 mg/dL and insulin resistance (IR) as homeostatic model assessment of IR ≥ 3. The mean weighted prevalence of suspected NAFLD among lean adolescents during 2005-2014 cycles was 8% (95% CI: 6.2, 9.9). Lean subjects with suspected NAFLD were significantly older compared to lean non-NAFLD subjects (15.5 vs. 15 years, p-value < 0.05). Low HDL (15.5% vs. 6.8%; p-value 0.016) and hypertriglyceridemia (10% vs. 3.9%; p-value 0.028) were also found to be more common among lean NAFLD subjects compared to their non-NAFLD counterparts. Presence of IR increased the risk of having suspected NAFLD by 4-fold among lean adolescents. Non-Hispanic black lean adolescents were less likely to have suspected NAFLD compared to non-Hispanic white lean adolescents. The estimated prevalence of suspected NAFLD among lean adolescents in the US was found to be 8% with evidence of metabolic derangements such as low HDL, hypertriglyceridemia and IR.

Gene expression microarray profiles of cumulus cells in lean and overweight-obese polycystic ovary syndrome patients.

PubMed

Kenigsberg, Shlomit; Bentov, Yaakov; Chalifa-Caspi, Vered; Potashnik, Gad; Ofir, Rivka; Birk, Ohad S

2009-02-01

The aim of this work was to study gene expression patterns of cultured cumulus cells from lean and overweight-obese polycystic ovary syndrome (PCOS) patients using genome-wide oligonucleotide microarray. The study included 25 patients undergoing in vitro fertilization and intra-cytoplasmic sperm injection: 12 diagnosed with PCOS and 13 matching controls. Each of the groups was subdivided into lean (body mass index (BMI) < 24) and overweight (BMI > 27) subgroups. The following comparisons of gene expression data were made: lean PCOS versus lean controls, lean PCOS versus overweight PCOS, all PCOS versus all controls, overweight PCOS versus overweight controls, overweight controls versus lean controls and all overweight versus all lean. The largest number of differentially expressed genes (DEGs), with fold change (FC) |FC| >or= 1.5 and P-value < 0.01, was found in the lean PCOS versus lean controls comparison (487) with most of these genes being down-regulated in PCOS. The second largest group of DEGs originated from the comparison of lean PCOS versus overweight PCOS (305). The other comparisons resulted in a much smaller number of DEGs (174, 109, 125 and 12, respectively). In the comparison of lean PCOS with lean controls, most DEGs were transcription factors and components of the extracellular matrix and two pathways, Wnt/beta-catenin and mitogen-activated protein kinase. When comparing overweight PCOS with overweight controls, most DEGs were of pathways related to insulin signaling, metabolism and energy production. The finding of unique gene expression patterns in cumulus cells from the two PCOS subtypes is in agreement with other studies that have found the two to be separate entities with potentially different pathophysiologies.

Effects of organizational context on Lean implementation in five hospital systems.

PubMed

Harrison, Michael I; Paez, Kathryn; Carman, Kristin L; Stephens, Jennifer; Smeeding, Lauren; Devers, Kelly J; Garfinkel, Steven

2016-01-01

Despite broad agreement among researchers about the value of examining how context shapes implementation of improvement programs and projects, limited attention has been paid to contextual effects on implementation of Lean. To help reduce gaps in knowledge of effects of intraorganizational context, we researched Lean implementation initiatives in five organizations and examined 12 of their Lean rapid improvement projects. All projects aimed at improving clinical care delivery. On the basis of the literature on Lean, innovation, and quality improvement, we developed a framework of factors likely to affect Lean implementation and outcomes. Drawing on the framework, we conducted semistructured interviews and applied qualitative codes to the transcribed interviews. Available documents, data, and observations supplemented the interviews. We constructed case studies of Lean implementation in each organization, compared implementation across organizations, and compared the 12 projects. Intraorganizational characteristics affecting organization-wide Lean initiatives and often also shaping project outcomes included CEO commitment to Lean and active support for it, prior organizational capacity for quality improvement-based performance improvement, alignment of the Lean initiative with the organizational mission, dedication of resources and experts to Lean, staff training before and during projects, establishment of measurable and relevant project targets, planning of project sequences that enhance staff capabilities and commitment without overburdening them, and ensuring communication between project members and other affected staff. Dependence of projects on inputs of new information technology was a barrier to project success. Incremental implementation of Lean produced reported improvements in operational efficiency and occasionally in care quality. However, even under the relatively favorable circumstances prevailing in our study sites, incremental implementation did not readily change organizational culture. This study should alert researchers, managers, and teachers of management to ways that contexts shape Lean implementation and may affect other types of process redesign and quality improvement.

Application of lean manufacturing techniques in the Emergency Department.

PubMed

Dickson, Eric W; Singh, Sabi; Cheung, Dickson S; Wyatt, Christopher C; Nugent, Andrew S

2009-08-01

"Lean" is a set of principles and techniques that drive organizations to continually add value to the product they deliver by enhancing process steps that are necessary, relevant, and valuable while eliminating those that fail to add value. Lean has been used in manufacturing for decades and has been associated with enhanced product quality and overall corporate success. To evaluate whether the adoption of Lean principles by an Emergency Department (ED) improves the value of emergency care delivered. Beginning in December 2005, we implemented a variety of Lean techniques in an effort to enhance patient and staff satisfaction. The implementation followed a six-step process of Lean education, ED observation, patient flow analysis, process redesign, new process testing, and full implementation. Process redesign focused on generating improvement ideas from frontline workers across all departmental units. Value-based and operational outcome measures, including patient satisfaction, expense per patient, ED length of stay (LOS), and patient volume were compared for calendar year 2005 (pre-Lean) and periodically after 2006 (post-Lean). Patient visits increased by 9.23% in 2006. Despite this increase, LOS decreased slightly and patient satisfaction increased significantly without raising the inflation adjusted cost per patient. Lean improved the value of the care we delivered to our patients. Generating and instituting ideas from our frontline providers have been the key to the success of our Lean program. Although Lean represents a fundamental change in the way we think of delivering care, the specific process changes we employed tended to be simple, small procedure modifications specific to our unique people, process, and place. We, therefore, believe that institutions or departments aspiring to adopt Lean should focus on the core principles of Lean rather than on emulating specific process changes made at other institutions.

Competency Maps: an Effective Model to Integrate Professional Competencies Across a STEM Curriculum

NASA Astrophysics Data System (ADS)

Sánchez Carracedo, Fermín; Soler, Antonia; Martín, Carme; López, David; Ageno, Alicia; Cabré, Jose; Garcia, Jordi; Aranda, Joan; Gibert, Karina

2018-05-01

Curricula designed in the context of the European Higher Education Area need to be based on both domain-specific and professional competencies. Whereas universities have had extensive experience in developing students' domain-specific competencies, fostering professional competencies poses a new challenge we need to face. This paper presents a model to globally develop professional competencies in a STEM (science, technology, engineering, and mathematics) degree program, and assesses the results of its implementation after 4 years. The model is based on the use of competency maps, in which each competency is defined in terms of competency units. Each competency unit is described by a set of expected learning outcomes at three domain levels. This model allows careful analysis, revision, and iteration for an effective integration of professional competencies in domain-specific subjects. A global competency map is also designed, including all the professional competency learning outcomes to be achieved throughout the degree. This map becomes a useful tool for curriculum designers and coordinators. The results were obtained from four sources: (1) students' grades (classes graduated from 2013 to 2016, the first 4 years of the new Bachelor's Degree in Informatics Engineering at the Barcelona School of Informatics); (2) students' surveys (answered by students when they finished the degree); (3) the government employment survey, where former students evaluate their satisfaction of the received training in the light of their work experience; and (4) the Everis Foundation University-Enterprise Ranking, answered by over 2000 employers evaluating their satisfaction regarding their employees' university training, where the Barcelona School of Informatics scores first in the national ranking. The results show that competency maps are a good tool for developing professional competencies in a STEM degree.

Does lean management improve patient safety culture? An extensive evaluation of safety culture in a radiotherapy institute.

PubMed

Simons, Pascale A M; Houben, Ruud; Vlayen, Annemie; Hellings, Johan; Pijls-Johannesma, Madelon; Marneffe, Wim; Vandijck, Dominique

2015-02-01

The importance of a safety culture to maximize safety is no longer questioned. However, achieving sustainable culture improvements are less evident. Evidence is growing for a multifaceted approach, where multiple safety interventions are combined. Lean management is such an integral approach to improve safety, quality and efficiency and therefore, could be expected to improve the safety culture. This paper presents the effects of lean management activities on the patient safety culture in a radiotherapy institute. Patient safety culture was evaluated over a three year period using triangulation of methodologies. Two surveys were distributed three times, workshops were performed twice, data from an incident reporting system (IRS) was monitored and results were explored using structured interviews with professionals. Averages, chi-square, logistical and multi-level regression were used for analysis. The workshops showed no changes in safety culture, whereas the surveys showed improvements on six out of twelve dimensions of safety climate. The intention to report incidents not reaching patient-level decreased in accordance with the decreasing number of reports in the IRS. However, the intention to take action in order to prevent future incidents improved (factorial survey presented β: 1.19 with p: 0.01). Due to increased problem solving and improvements in equipment, the number of incidents decreased. Although the intention to report incidents not reaching patient-level decreased, employees experienced sustained safety awareness and an increased intention to structurally improve. The patient safety culture improved due to the lean activities combined with an organizational restructure, and actual patient safety outcomes might have improved as well. Copyright © 2014 Elsevier Ltd. All rights reserved.

Improving wait times to care for individuals with multimorbidities and complex conditions using value stream mapping.

PubMed

Sampalli, Tara; Desy, Michel; Dhir, Minakshi; Edwards, Lynn; Dickson, Robert; Blackmore, Gail

2015-04-05

Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely - an adaptation of Value Stream Mapping (VSM) to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC) and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS) intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions. © 2015 by Kerman University of Medical Sciences.

The Quality of a "Local Values Based" Fuctional Literacy Program: Its Contribution to the Improvement of the Learner's Basic Competencies

ERIC Educational Resources Information Center

Wahyudin, Uyu

2015-01-01

Literacy facilitators across the archipelago are currently faced with the challenge to integrate local values in functional literacy education programs, because its integration is a new aspect. This makes localized literacy content a hard thing to implement. Yet, if properly conducted, it can lead to improved learner's basic competencies. In an…

Enhancing Competence in Health Social Work Education through Simulation-Based Learning: Strategies from a Case Study of a Family Session

ERIC Educational Resources Information Center

Craig, Shelley L.; McInroy, Lauren B.; Bogo, Marion; Thompson, Michelle

2017-01-01

Simulation-based learning (SBL) is a powerful tool for social work education, preparing students to practice in integrated health care settings. In an educational environment addressing patient health using an integrated care model, there is growing emphasis on students developing clinical competencies prior to entering clinical placements or…

Do Mathematics and Reading Competencies Integrated into Career and Technical Education Courses Improve High School Student State Assessment Scores?

ERIC Educational Resources Information Center

Pierce, Kristin B.; Hernandez, Victor M.

2015-01-01

A quasi experimental study tested a contextual teaching and learning model for integrating reading and mathematics competencies through 13 introductory career and technical education (CTE) courses. The treatment group consisted of students in the 13 introductory courses taught by the CTE teachers who designed the units and the control group…

Integration of Audio Visual Multimedia for Special Education Pre-Service Teachers' Self Reflections in Developing Teaching Competencies

ERIC Educational Resources Information Center

Sediyani, Tri; Yufiarti; Hadi, Eko

2017-01-01

This study aims to develop a model of learning by integrating multimedia and audio-visual self-reflective learners. This multimedia was developed as a tool for prospective teachers as learners in the education of children with special needs to reflect on their teaching competencies before entering the world of education. Research methods to…

Non-alcoholic Fatty Liver Disease in Lean Subjects: Characteristics and Implications.

PubMed

Kumar, Ramesh; Mohan, Shantam

2017-09-28

Non-alcoholic fatty liver disease (NAFLD) is commonly diagnosed in obese subjects; however, it is not rare among lean individuals. Given the absence of traditional risk factors, it tends to remain under-recognised. The metabolic profiles of lean NAFLD patients are frequently comparable to those of obese NAFLD patients. Though results from several studies have been mixed, it has been generally revealed that lean subjects with NAFLD have minor insulin resistance compared to that in obese NAFLD. Several genetic variants are associated with NAFLD without insulin resistance. Some data suggest that the prevalence of steatohepatitis and advanced fibrosis do not differ significantly between lean and obese NAFLD; however, the former tend to have less severe disease at presentation. The underlying pathophysiology of lean NAFLD may be quite different. Genetic predispositions, fructose- and cholesterol-rich diet, visceral adiposity and dyslipidaemia have potential roles in the pathogenic underpinnings. Lean NAFLD may pose a risk for metabolic disturbances, cardiovascular morbidity or overall mortality. Secondary causes of hepatic steatosis are also needed to be ruled out in lean subjects with NAFLD. The effectiveness of various treatment modalities, such as exercise and pharmacotherapy, on lean NAFLD is not known. Weight loss is expected to help lean NAFLD patients who have visceral obesity. Further investigation is needed for many aspects of lean NAFLD, including mechanistic pathogenesis, risk assessment, natural history and therapeutic approach.

Non-alcoholic Fatty Liver Disease in Lean Subjects: Characteristics and Implications

PubMed Central

Kumar, Ramesh; Mohan, Shantam

2017-01-01

Abstract Non-alcoholic fatty liver disease (NAFLD) is commonly diagnosed in obese subjects; however, it is not rare among lean individuals. Given the absence of traditional risk factors, it tends to remain under-recognised. The metabolic profiles of lean NAFLD patients are frequently comparable to those of obese NAFLD patients. Though results from several studies have been mixed, it has been generally revealed that lean subjects with NAFLD have minor insulin resistance compared to that in obese NAFLD. Several genetic variants are associated with NAFLD without insulin resistance. Some data suggest that the prevalence of steatohepatitis and advanced fibrosis do not differ significantly between lean and obese NAFLD; however, the former tend to have less severe disease at presentation. The underlying pathophysiology of lean NAFLD may be quite different. Genetic predispositions, fructose- and cholesterol-rich diet, visceral adiposity and dyslipidaemia have potential roles in the pathogenic underpinnings. Lean NAFLD may pose a risk for metabolic disturbances, cardiovascular morbidity or overall mortality. Secondary causes of hepatic steatosis are also needed to be ruled out in lean subjects with NAFLD. The effectiveness of various treatment modalities, such as exercise and pharmacotherapy, on lean NAFLD is not known. Weight loss is expected to help lean NAFLD patients who have visceral obesity. Further investigation is needed for many aspects of lean NAFLD, including mechanistic pathogenesis, risk assessment, natural history and therapeutic approach. PMID:28936403

Method for rubblizing an oil shale deposit for in situ retorting

DOEpatents

Lewis, Arthur E.

1977-01-01

A method for rubblizing an oil shale deposit that has been formed in alternate horizontal layers of rich and lean shale, including the steps of driving a horizontal tunnel along the lower edge of a rich shale layer of the deposit, sublevel caving by fan drilling and blasting of both rich and lean overlying shale layers at the distal end of the tunnel to rubblize the layers, removing a substantial amount of the accessible rubblized rich shale to permit the overlying rubblized lean shale to drop to tunnel floor level to form a column of lean shale, performing additional sublevel caving of rich and lean shale towards the proximate end of the tunnel, removal of a substantial amount of the additionally rubblized rich shale to allow the overlying rubblized lean shale to drop to tunnel floor level to form another column of rubblized lean shale, similarly performing additional steps of sublevel caving and removal of rich rubble to form additional columns of lean shale rubble in the rich shale rubble in the tunnel, and driving additional horizontal tunnels in the deposit and similarly rubblizing the overlying layers of rich and lean shale and forming columns of rubblized lean shale in the rich, thereby forming an in situ oil shale retort having zones of lean shale that remain permeable to hot retorting fluids in the presence of high rubble pile pressures and high retorting temperatures.

The Effect of Diet and Exercise on Intestinal Integrity and Microbial Diversity in Mice.

PubMed

Campbell, Sara C; Wisniewski, Paul J; Noji, Michael; McGuinness, Lora R; Häggblom, Max M; Lightfoot, Stanley A; Joseph, Laurie B; Kerkhof, Lee J

2016-01-01

The gut microbiota is now known to play an important role contributing to inflammatory-based chronic diseases. This study examined intestinal integrity/inflammation and the gut microbial communities in sedentary and exercising mice presented with a normal or high-fat diet. Thirty-six, 6-week old C57BL/6NTac male mice were fed a normal or high-fat diet for 12-weeks and randomly assigned to exercise or sedentary groups. After 12 weeks animals were sacrificed and duodenum/ileum tissues were fixed for immunohistochemistry for occludin, E-cadherin, and cyclooxygenase-2 (COX-2). The bacterial communities were assayed in fecal samples using terminal restriction fragment length polymorphism (TRFLP) analysis and pyrosequencing of 16S rRNA gene amplicons. Lean sedentary (LS) mice presented normal histologic villi while obese sedentary (OS) mice had similar villi height with more than twice the width of the LS animals. Both lean (LX) and obese exercise (OX) mice duodenum and ileum were histologically normal. COX-2 expression was the greatest in the OS group, followed by LS, LX and OX. The TRFLP and pyrosequencing indicated that members of the Clostridiales order were predominant in all diet groups. Specific phylotypes were observed with exercise, including Faecalibacterium prausnitzi, Clostridium spp., and Allobaculum spp. These data suggest that exercise has a strong influence on gut integrity and host microbiome which points to the necessity for more mechanistic studies of the interactions between specific bacteria in the gut and its host.

Epistemic Evaluation of the Training and Managerial Competence Development Process

ERIC Educational Resources Information Center

Machado, Evelio F.; Zambrano, Marcos T.; Montes de Oca, Nancy

2015-01-01

This article presents the problem of defining the concept of "competence", due to it being an integral and complex term that has been applied in many domains as well as in a more general sense for everyday life. However, no doubt, a competence can only be tested and valuated in the practice, and it is a person who becomes competent in a…

Recursive Model of a Methodical Competency Formation of a High School Teacher in the Context of Competency-Based Education

ERIC Educational Resources Information Center

??lekhina, ??rina Borisovna

2015-01-01

The present study examines the professional development problems of a high school teacher. A high school teacher is both a scientist and a teacher. Teaching and research activities are integrated by using methodical activity. Methodical competency of a teacher is defined as a basis in the context of Competence-based Education. The methodical…

Professional Competencies for Student Affairs Practice

ERIC Educational Resources Information Center

Munsch, Patty; Cortez, Lori

2014-01-01

The purpose of this chapter is to explore the integration of the ACPA/NASPA Professional Competency Areas for Student Affairs Practitioners (ACPA/NASPA, 2010) on community college campuses. The competencies provide specific skill sets for a broad range of student affairs practice areas that should be met by professionals throughout their careers.…

Linking Reflection and Technical Competence: The Logbook as an Instrument in Teacher Education.

ERIC Educational Resources Information Center

Korthagen, Fred A. J.

1999-01-01

Describes a framework for integrating reflection and teacher competency development into teacher education programs, introducing a spiral model for reflection, standard reflection questions, and a method of structuring logbooks, all designed to develop a competency for self-directed professional growth in interpersonal classroom behavior. An…

Competence: A Tale of Two Constructs

ERIC Educational Resources Information Center

Lum, Gerard

2013-01-01

This article examines the "integrated conception of competence" as conceived by Paul Hager and David Beckett and suggests that its characterization in terms intended to distance it from behaviouristic and reductionist notions of competence is not sufficient to differentiate it from other models. Taking up Hager and Beckett's idea that…

An Integrative Literature Review of Student Affairs Competencies: A Meta-Analysis

ERIC Educational Resources Information Center

Herdlein, Richard; Riefler, Laurel; Mrowka, Kaleigh

2013-01-01

The study reviewed 17 years of research extending the work of Lovell and Kosten (2000) on student affairs competencies important for professional preparation and practice. A meta-analysis was used to organize and present data on 22 articles concerned with knowledge, skills, dispositions, curriculum, multicultural competency, and professional…

Precision Machining. FasTrak Specialization Integrated Technical and Academic Competency (ITAC). 2002 Revision.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.

This publication provided the competencies and key indicators for a program that enables students to prepare for a number of occupations within the broader metalworking industry. Specializations include machinist, computer numerical control programmers, and maintenance and machine builders. Competencies and the related key indicators are presented…

High intake of fatty fish, but not of lean fish, affects serum concentrations of TAG and HDL-cholesterol in healthy, normal-weight adults: a randomised trial.

PubMed

Hagen, Ingrid V; Helland, Anita; Bratlie, Marianne; Brokstad, Karl A; Rosenlund, Grethe; Sveier, Harald; Mellgren, Gunnar; Gudbrandsen, Oddrun A

2016-08-01

The aim of the present study was to examine whether high intake of lean or fatty fish (cod and farmed salmon, respectively) by healthy, normal-weight adults would affect risk factors of type 2 diabetes and CVD when compared with lean meat (chicken). More knowledge is needed concerning the potential health effects of high fish intake (>300 g/week) in normal-weight adults. In this randomised clinical trial, thirty-eight young, healthy, normal-weight participants consumed 750 g/week of lean or fatty fish or lean meat (as control) for 4 weeks at dinner according to provided recipes to ensure similar ways of preparations and choices of side dishes between the groups. Energy and macronutrient intakes at baseline and end point were similar in all groups, and there were no changes in energy and macronutrient intakes within any of the groups during the course of the study. High intake of fatty fish, but not lean fish, significantly reduced TAG and increased HDL-cholesterol concentrations in fasting serum when compared with lean meat intake. When compared with lean fish intake, fatty fish intake increased serum HDL-cholesterol. No differences were observed between lean fish, fatty fish and lean meat groups regarding fasting and postprandial glucose regulation. These findings suggest that high intake of fatty fish, but not of lean fish, could beneficially affect serum concentrations of TAG and HDL-cholesterol, which are CVD risk factors, in healthy, normal-weight adults, when compared with high intake of lean meat.

Debates Regarding Lean Patients with Polycystic Ovary Syndrome: A Narrative Review.

PubMed

Goyal, Manu; Dawood, Ayman S

2017-01-01

Polycystic ovary syndrome (PCOS) is a complex syndrome showing the clinical features of an endocrine/metabolic disorder, including hyperinsulinemia and hyperandrogenism. Two phenotypes are present, either lean or obese, with different biochemical, hormonal, and metabolic profiles. Evidence suggests many treatment modalities that can be applied. However, many of these modalities were found to be not suitable for the lean phenotype of PCOS. Much contradictory research was found regarding lean patients with PCOS. The aim of this narrative review is to shed light on the debate prevailing regarding characteristics, as well as metabolic, hematological, and potential management modalities. Literature review was performed from January 1, 2000 to March 31, 2017 with specific word search such as lean PCOS, hormonal abnormalities in lean PCOS, and the management of lean PCOS. All retrieved articles were carefully assessed, and data were obtained. We could conclude that the debate is still prevailing regarding this specific lean population with PCOS, especially with regard to their characteristics and management modalities. Further studies are still required to resolve this debate on the presence of PCOS in lean women.

Debates Regarding Lean Patients with Polycystic Ovary Syndrome: A Narrative Review

PubMed Central

Goyal, Manu; Dawood, Ayman S.

2017-01-01

Polycystic ovary syndrome (PCOS) is a complex syndrome showing the clinical features of an endocrine/metabolic disorder, including hyperinsulinemia and hyperandrogenism. Two phenotypes are present, either lean or obese, with different biochemical, hormonal, and metabolic profiles. Evidence suggests many treatment modalities that can be applied. However, many of these modalities were found to be not suitable for the lean phenotype of PCOS. Much contradictory research was found regarding lean patients with PCOS. The aim of this narrative review is to shed light on the debate prevailing regarding characteristics, as well as metabolic, hematological, and potential management modalities. Literature review was performed from January 1, 2000 to March 31, 2017 with specific word search such as lean PCOS, hormonal abnormalities in lean PCOS, and the management of lean PCOS. All retrieved articles were carefully assessed, and data were obtained. We could conclude that the debate is still prevailing regarding this specific lean population with PCOS, especially with regard to their characteristics and management modalities. Further studies are still required to resolve this debate on the presence of PCOS in lean women. PMID:29142442

Extended Pausing by Humans on Multiple Fixed-Ratio Schedules with Varied Reinforcer Magnitude and Response Requirements

PubMed Central

Williams, Dean C; Saunders, Kathryn J; Perone, Michael

2011-01-01

We conducted three experiments to reproduce and extend Perone and Courtney's (1992) study of pausing at the beginning of fixed-ratio schedules. In a multiple schedule with unequal amounts of food across two components, they found that pigeons paused longest in the component associated with the smaller amount of food (the lean component), but only when it was preceded by the rich component. In our studies, adults with mild intellectual disabilities responded on a touch-sensitive computer monitor to produce money. In Experiment 1, the multiple-schedule components differed in both response requirement and reinforcer magnitude (i.e., the rich component required fewer responses and produced more money than the lean component). Effects shown with pigeons were reproduced in all 7 participants. In Experiment 2, we removed the stimuli that signaled the two schedule components, and participants' extended pausing was eliminated. In Experiment 3, to assess sensitivity to reinforcer magnitude versus fixed-ratio size, we presented conditions with equal ratio sizes but disparate magnitudes and conditions with equal magnitudes but disparate ratio sizes. Sensitivity to these manipulations was idiosyncratic. The present experiments obtained schedule control in verbally competent human participants and, despite procedural differences, we reproduced findings with animal participants. We showed that pausing is jointly determined by past conditions of reinforcement and stimuli correlated with upcoming conditions. PMID:21541121

Alcohol produces distinct hepatic lipidome and eicosanoid signature in lean and obese.

PubMed

Puri, Puneet; Xu, Jun; Vihervaara, Terhi; Katainen, Riikka; Ekroos, Kim; Daita, Kalyani; Min, Hae-Ki; Joyce, Andrew; Mirshahi, Faridoddin; Tsukamoto, Hidekazu; Sanyal, Arun J

2016-06-01

Alcohol- and obesity-related liver diseases often coexist. The hepatic lipidomics due to alcohol and obesity interaction is unknown. We characterized the hepatic lipidome due to 1) alcohol consumption in lean and obese mice and 2) obesity and alcohol interactions. In the French-Tsukamoto mouse model, intragastric alcohol or isocaloric dextrose were fed with either chow (lean) or high-fat, high-cholesterol diet (obese). Four groups (lean, lean alcohol, obese, and obese alcohol) were studied. MS was performed for hepatic lipidomics, and data were analyzed. Alcohol significantly increased hepatic cholesteryl esters and diacyl-glycerol in lean and obese but was more pronounced in obese. Alcohol produced contrasting changes in hepatic phospholipids with significant enrichment in lean mice versus significant decrease in obese mice, except phosphatidylglycerol, which was increased in both lean and obese alcohol groups. Most lysophospholipids were increased in lean alcohol and obese mice without alcohol use only. Prostaglandin E2; 5-, 8-, and 11-hydroxyeicosatetraenoic acids; and 9- and 13-hydroxyoctadecadienoic acids were considerably increased in obese mice with alcohol use. Alcohol consumption produced distinct changes in lean and obese with profound effects of obesity and alcohol interaction on proinflammatory and oxidative stress-related eicosanoids. Copyright © 2016 by the American Society for Biochemistry and Molecular Biology, Inc.

Loss of lean body mass affects low bone mineral density in patients with rheumatoid arthritis - results from the TOMORROW study.

PubMed

Okano, Tadashi; Inui, Kentaro; Tada, Masahiro; Sugioka, Yuko; Mamoto, Kenji; Wakitani, Shigeyuki; Koike, Tatsuya; Nakamura, Hiroaki

2017-11-01

Osteoporosis is one of the complications for patients with rheumatoid arthritis (RA). Rheumatoid cachexia, the loss of lean body mass, is another. However, the relationship between decreased lean body mass and reduced bone mineral density (BMD) in patients with RA has not been well studied. This study included 413 participants, comprising 208 patients with RA and 205 age- and sex-matched healthy volunteers. Clinical data, BMD, bone metabolic markers (BMM) and body composition, such as lean body mass and percent fat, were collected. Risk factors for osteoporosis in patients with RA including the relationship BMD and body composition were analyzed. Patients with RA showed low BMD and high BMM compared with controls. Moreover, lean body mass was lower and percent fat was higher in patients with RA. Lean body mass correlated positively and percent fat negatively with BMD. Lean body mass was a positive and disease duration was a negative independent factor for BMD in multivariate statistical analysis. BMD and lean body mass were significantly lower in patients with RA compared to healthy controls. Lean body mass correlated positively with BMD and decreased lean body mass and disease duration affected low BMD in patients with RA. [UMIN Clinical Trials Registry, http://www.umin.ac.jp/ctr/ , UMIN000003876].

Life history differences between fat and lean morphs of lake charr (Salvelinus namaycush) in Great Slave Lake, Northwest Territories, Canada

USGS Publications Warehouse

Hansen, Michael J.; Nate, Nancy A.; Chavarie, Louise; Muir, Andrew M.; Zimmerman, Mara S.; Krueger, Charles C.

2016-01-01

Life history characteristics (size, age, plumpness, buoyancy, survival, growth, and maturity) were compared between fat and lean morphs of lake charr Salvelinus namaycush in Great Slave Lake, Canada, to determine if differences may reflect effects of resource polymorphism. Lake charr were sampled using graded-mesh gill nets set in three depth strata. Of 236 lake charr captured, 122 were a fat morph and 114 were a lean morph. Males and females did not differ from each other in any attributes for either fat or lean morphs. The fat morph averaged 15 mm longer, 481 g heavier, and 4.7 years older than the lean morph. The fat morph averaged 26% heavier and 48% more buoyant at length than the lean morph. Survival of the fat morph was 1.7% higher than that of the lean morph. The fat morph grew at a slower annual rate to a shorter asymptotic length than the lean morph. Fat and lean morphs matured at similar lengths and ages. We concluded that the connection between resource polymorphism and life histories in lean versus fat lake charr suggests that morph-specific restoration objectives may be needed in lakes where lake charr diversity is considered to be a restoration goal.

Anthropometric and Three-Compartment Body Composition Differences between Super League and Championship Rugby League Players: Considerations for the 2015 Season and Beyond

PubMed Central

Jones, Ben; Till, Kevin; Barlow, Matthew; Lees, Matthew; O’Hara, John Paul; Hind, Karen

2015-01-01

Super League (SL) and Championship (RLC) rugby league players will compete against each other in 2015 and beyond. To identify possible discrepancies, this study compared the anthropometric profile and body composition of current SL (full-time professional) and RLC (part-time semi-professional) players using dual-energy X-ray absorptiometry (DXA). A cross-sectional design involved DXA scans on 67 SL (n=29 backs, n=38 forwards) and 46 RLC (n=20 backs, n=26 forwards) players during preseason. A one-way ANOVA was used to compare age, stature, body mass, soft tissue fat percentage, bone mineral content (BMC), total and regional (i.e., arms, legs and trunk) fat and lean mass between SL forwards, SL backs, RLC forwards and RLC backs. No significant differences in age, stature or body mass were observed. SL forwards and backs had relatively less soft tissue fat (17.5 ± 3.7 and 14.8 ± 3.6 vs. 21.4 ± 4.3 and 20.8 ± 3.8%), greater BMC (4,528 ± 443 and 4,230 ± 447 vs. 4,302 ± 393 and 3,971 ± 280 g), greater trunk lean mass (37.3 ± 3.0 and 35.3 ± 3.8 vs. 34.9 ± 32.3 and 32.3 ± 2.6 kg) and less trunk fat mass (8.5 ± 2.7 and 6.2 ± 2.1 vs. 10.7 ± 2.8 and 9.5 ± 2.9 kg) than RLC forwards and backs. Observed differences may reflect selection based on favourable physical attributes, or training adaptations. To reduce this discrepancy, some RLC players should reduce fat mass and increase lean mass, which may be of benefit for the 2015 season and beyond. PMID:26221720

Model Development and Process Analysis for Lean Cellular Design Planning in Aerospace Assembly and Manufacturing

NASA Astrophysics Data System (ADS)

Hilburn, Monty D.

Successful lean manufacturing and cellular manufacturing execution relies upon a foundation of leadership commitment and strategic planning built upon solid data and robust analysis. The problem for this study was to create and employ a simple lean transformation planning model and review process that could be used to identify functional support staff resources required to plan and execute lean manufacturing cells within aerospace assembly and manufacturing sites. The lean planning model was developed using available literature for lean manufacturing kaizen best practices and validated through a Delphi panel of lean experts. The resulting model and a standardized review process were used to assess the state of lean transformation planning at five sites of an international aerospace manufacturing and assembly company. The results of the three day, on-site review were compared with baseline plans collected from each of the five sites to determine if there analyzed, with focus on three critical areas of lean planning: the number and type of manufacturing cells identified, the number, type, and duration of planned lean and continuous kaizen events, and the quantity and type of functional staffing resources planned to support the kaizen schedule. Summarized data of the baseline and on-site reviews was analyzed with descriptive statistics. ANOVAs and paired-t tests at 95% significance level were conducted on the means of data sets to determine if null hypotheses related to cell, kaizen event, and support resources could be rejected. The results of the research found significant differences between lean transformation plans developed by site leadership and plans developed utilizing the structured, on-site review process and lean transformation planning model. The null hypothesis that there was no difference between the means of pre-review and on-site cell counts was rejected, as was the null hypothesis that there was no significant difference in kaizen event plans. These factors are critical inputs into the support staffing resources calculation used by the lean planning model. Null hypothesis related to functional support staff resources was rejected for most functional groups, indicating that the baseline site plan inadequately provided for cross-functional staff involvement to support the lean transformation plan. Null hypotheses related to total lean transformation staffing could not be rejected, indicating that while total staffing plans were not significantly different than plans developed during the on-site review and through the use of the lean planning model, the allocation of staffing among various functional groups such as engineering, production, and materials planning was an issue. The on-site review process and simple lean transformation plan developed was determined to be useful in identifying short-comings in lean transformation planning within aerospace manufacturing and assembly sites. It was concluded that the differences uncovered were likely contributing factors affecting the effectiveness of aerospace manufacturing sites' implementation of lean cellular manufacturing.

The BRAIN Initiative Provides a Unifying Context for Integrating Core STEM Competencies into a Neurobiology Course.

PubMed

Schaefer, Jennifer E

2016-01-01

The Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative introduced by the Obama Administration in 2013 presents a context for integrating many STEM competencies into undergraduate neuroscience coursework. The BRAIN Initiative core principles overlap with core STEM competencies identified by the AAAS Vision and Change report and other entities. This neurobiology course utilizes the BRAIN Initiative to serve as the unifying theme that facilitates a primary emphasis on student competencies such as scientific process, scientific communication, and societal relevance while teaching foundational neurobiological content such as brain anatomy, cellular neurophysiology, and activity modulation. Student feedback indicates that the BRAIN Initiative is an engaging and instructional context for this course. Course module organization, suitable BRAIN Initiative commentary literature, sample primary literature, and important assignments are presented.

Large meta-analysis of genome-wide association studies identifies five loci for lean body mass.

PubMed

Zillikens, M Carola; Demissie, Serkalem; Hsu, Yi-Hsiang; Yerges-Armstrong, Laura M; Chou, Wen-Chi; Stolk, Lisette; Livshits, Gregory; Broer, Linda; Johnson, Toby; Koller, Daniel L; Kutalik, Zoltán; Luan, Jian'an; Malkin, Ida; Ried, Janina S; Smith, Albert V; Thorleifsson, Gudmar; Vandenput, Liesbeth; Hua Zhao, Jing; Zhang, Weihua; Aghdassi, Ali; Åkesson, Kristina; Amin, Najaf; Baier, Leslie J; Barroso, Inês; Bennett, David A; Bertram, Lars; Biffar, Rainer; Bochud, Murielle; Boehnke, Michael; Borecki, Ingrid B; Buchman, Aron S; Byberg, Liisa; Campbell, Harry; Campos Obanda, Natalia; Cauley, Jane A; Cawthon, Peggy M; Cederberg, Henna; Chen, Zhao; Cho, Nam H; Jin Choi, Hyung; Claussnitzer, Melina; Collins, Francis; Cummings, Steven R; De Jager, Philip L; Demuth, Ilja; Dhonukshe-Rutten, Rosalie A M; Diatchenko, Luda; Eiriksdottir, Gudny; Enneman, Anke W; Erdos, Mike; Eriksson, Johan G; Eriksson, Joel; Estrada, Karol; Evans, Daniel S; Feitosa, Mary F; Fu, Mao; Garcia, Melissa; Gieger, Christian; Girke, Thomas; Glazer, Nicole L; Grallert, Harald; Grewal, Jagvir; Han, Bok-Ghee; Hanson, Robert L; Hayward, Caroline; Hofman, Albert; Hoffman, Eric P; Homuth, Georg; Hsueh, Wen-Chi; Hubal, Monica J; Hubbard, Alan; Huffman, Kim M; Husted, Lise B; Illig, Thomas; Ingelsson, Erik; Ittermann, Till; Jansson, John-Olov; Jordan, Joanne M; Jula, Antti; Karlsson, Magnus; Khaw, Kay-Tee; Kilpeläinen, Tuomas O; Klopp, Norman; Kloth, Jacqueline S L; Koistinen, Heikki A; Kraus, William E; Kritchevsky, Stephen; Kuulasmaa, Teemu; Kuusisto, Johanna; Laakso, Markku; Lahti, Jari; Lang, Thomas; Langdahl, Bente L; Launer, Lenore J; Lee, Jong-Young; Lerch, Markus M; Lewis, Joshua R; Lind, Lars; Lindgren, Cecilia; Liu, Yongmei; Liu, Tian; Liu, Youfang; Ljunggren, Östen; Lorentzon, Mattias; Luben, Robert N; Maixner, William; McGuigan, Fiona E; Medina-Gomez, Carolina; Meitinger, Thomas; Melhus, Håkan; Mellström, Dan; Melov, Simon; Michaëlsson, Karl; Mitchell, Braxton D; Morris, Andrew P; Mosekilde, Leif; Newman, Anne; Nielson, Carrie M; O'Connell, Jeffrey R; Oostra, Ben A; Orwoll, Eric S; Palotie, Aarno; Parker, Stephen C J; Peacock, Munro; Perola, Markus; Peters, Annette; Polasek, Ozren; Prince, Richard L; Räikkönen, Katri; Ralston, Stuart H; Ripatti, Samuli; Robbins, John A; Rotter, Jerome I; Rudan, Igor; Salomaa, Veikko; Satterfield, Suzanne; Schadt, Eric E; Schipf, Sabine; Scott, Laura; Sehmi, Joban; Shen, Jian; Soo Shin, Chan; Sigurdsson, Gunnar; Smith, Shad; Soranzo, Nicole; Stančáková, Alena; Steinhagen-Thiessen, Elisabeth; Streeten, Elizabeth A; Styrkarsdottir, Unnur; Swart, Karin M A; Tan, Sian-Tsung; Tarnopolsky, Mark A; Thompson, Patricia; Thomson, Cynthia A; Thorsteinsdottir, Unnur; Tikkanen, Emmi; Tranah, Gregory J; Tuomilehto, Jaakko; van Schoor, Natasja M; Verma, Arjun; Vollenweider, Peter; Völzke, Henry; Wactawski-Wende, Jean; Walker, Mark; Weedon, Michael N; Welch, Ryan; Wichmann, H-Erich; Widen, Elisabeth; Williams, Frances M K; Wilson, James F; Wright, Nicole C; Xie, Weijia; Yu, Lei; Zhou, Yanhua; Chambers, John C; Döring, Angela; van Duijn, Cornelia M; Econs, Michael J; Gudnason, Vilmundur; Kooner, Jaspal S; Psaty, Bruce M; Spector, Timothy D; Stefansson, Kari; Rivadeneira, Fernando; Uitterlinden, André G; Wareham, Nicholas J; Ossowski, Vicky; Waterworth, Dawn; Loos, Ruth J F; Karasik, David; Harris, Tamara B; Ohlsson, Claes; Kiel, Douglas P

2017-07-19

Lean body mass, consisting mostly of skeletal muscle, is important for healthy aging. We performed a genome-wide association study for whole body (20 cohorts of European ancestry with n = 38,292) and appendicular (arms and legs) lean body mass (n = 28,330) measured using dual energy X-ray absorptiometry or bioelectrical impedance analysis, adjusted for sex, age, height, and fat mass. Twenty-one single-nucleotide polymorphisms were significantly associated with lean body mass either genome wide (p < 5 × 10 -8 ) or suggestively genome wide (p < 2.3 × 10 -6 ). Replication in 63,475 (47,227 of European ancestry) individuals from 33 cohorts for whole body lean body mass and in 45,090 (42,360 of European ancestry) subjects from 25 cohorts for appendicular lean body mass was successful for five single-nucleotide polymorphisms in/near HSD17B11, VCAN, ADAMTSL3, IRS1, and FTO for total lean body mass and for three single-nucleotide polymorphisms in/near VCAN, ADAMTSL3, and IRS1 for appendicular lean body mass. Our findings provide new insight into the genetics of lean body mass.Lean body mass is a highly heritable trait and is associated with various health conditions. Here, Kiel and colleagues perform a meta-analysis of genome-wide association studies for whole body lean body mass and find five novel genetic loci to be significantly associated.

Serum Predictors of Percent Lean Mass in Young Adults.

PubMed

Lustgarten, Michael S; Price, Lori L; Phillips, Edward M; Kirn, Dylan R; Mills, John; Fielding, Roger A

2016-08-01

Lustgarten, MS, Price, LL, Phillips, EM, Kirn, DR, Mills, J, and Fielding, RA. Serum predictors of percent lean mass in young adults. J Strength Cond Res 30(8): 2194-2201, 2016-Elevated lean (skeletal muscle) mass is associated with increased muscle strength and anaerobic exercise performance, whereas low levels of lean mass are associated with insulin resistance and sarcopenia. Therefore, studies aimed at obtaining an improved understanding of mechanisms related to the quantity of lean mass are of interest. Percent lean mass (total lean mass/body weight × 100) in 77 young subjects (18-35 years) was measured with dual-energy x-ray absorptiometry. Twenty analytes and 296 metabolites were evaluated with the use of the standard chemistry screen and mass spectrometry-based metabolomic profiling, respectively. Sex-adjusted multivariable linear regression was used to determine serum analytes and metabolites significantly (p ≤ 0.05 and q ≤ 0.30) associated with the percent lean mass. Two enzymes (alkaline phosphatase and serum glutamate oxaloacetate aminotransferase) and 29 metabolites were found to be significantly associated with the percent lean mass, including metabolites related to microbial metabolism, uremia, inflammation, oxidative stress, branched-chain amino acid metabolism, insulin sensitivity, glycerolipid metabolism, and xenobiotics. Use of sex-adjusted stepwise regression to obtain a final covariate predictor model identified the combination of 5 analytes and metabolites as overall predictors of the percent lean mass (model R = 82.5%). Collectively, these data suggest that a complex interplay of various metabolic processes underlies the maintenance of lean mass in young healthy adults.

Practical Use of ICT in Science and Mathematics Teachers' Training at Dar es Salaam University College of Education: An Analysis of Prospective Teachers' Technological Pedagogical Content Knowledge

ERIC Educational Resources Information Center

Kafyulilo, Ayoub C.

2010-01-01

This study investigated the ways through which pre-service science and mathematics teachers at Dar es Salaam University College of Education (DUCE) can acquire competencies for integrating technology pedagogy and content in teaching. Specifically the study investigated the preservice teachers' ICT integration competencies; practices that can be…

Study of the Results in the Acquisition of Core Competencies in Schools That Integrate Primary Education and Music

ERIC Educational Resources Information Center

Andreu Duran, Maria; Godall Castell, Pere; Amador Guillem, Miquel; Castro Morera, Maria

2017-01-01

The goal of this research was to carry out an exploratory study on how music education integrated into primary schooling (children from 6 to 12 years old) can help in acquiring the core competencies characteristic of this stage. The study was conducted by developing a validated instrument, pilot-tested for reliability, to assess the eight core…

Making safety an integral part of 5S in healthcare.

PubMed

Ikuma, Laura H; Nahmens, Isabelina

2014-01-01

Healthcare faces major challenges with provider safety and rising costs, and many organizations are using Lean to instigate change. One Lean tool, 5S, is becoming popular for improving efficiency of physical work environments, and it can also improve safety. This paper demonstrates that safety is an integral part of 5S by examining five specific 5S events in acute care facilities. We provide two arguments for how safety is linked to 5S:1. Safety is affected by 5S events, regardless of whether safety is a specific goal and 2. Safety can and should permeate all five S's as part of a comprehensive plan for system improvement. Reports of 5S events from five departments in one health system were used to evaluate how changes made at each step of the 5S impacted safety. Safety was affected positively in each step of the 5S through initial safety goals and side effects of other changes. The case studies show that 5S can be a mechanism for improving safety. Practitioners may reap additional safety benefits by incorporating safety into 5S events through a safety analysis before the 5S, safety goals and considerations during the 5S, and follow-up safety analysis.

Case study of lean manufacturing application in a die casting manufacturing company

NASA Astrophysics Data System (ADS)

Ching, Ng Tan; Hoe, Clarence Chan Kok; Hong, Tang Sai; Ghobakhloo, Morteza; Pin, Chen Kah

2015-05-01

The case study of lean manufacturing aims to study the application of lean manufacturing in a die casting manufacturing company located in Pulau Penang, Malaysia. This case study describes mainly about the important concepts and applications of lean manufacturing which could gradually help the company in increasing the profit by studying and analyzing their current manufacturing process and company culture. Many approaches of lean manufacturing are studied in this project which includes: 5S housekeeping, Kaizen, and Takt Time. Besides, the lean tools mentioned, quality tool such as the House of Quality is being used as an analysis tool to continuously improve the product quality. In short, the existing lean culture in the company is studied and analyzed, with recommendations written at the end of this paper.

Global and public health core competencies for nursing education: A systematic review of essential competencies.

PubMed

Clark, Megan; Raffray, Marie; Hendricks, Kristin; Gagnon, Anita J

2016-05-01

Nurses are learning and practicing in an increasingly global world. Both nursing schools and nursing students are seeking guidance as they integrate global health into their learning and teaching. This systematic review is intended to identify the most common global and public health core competencies found in the literature and better inform schools of nursing wishing to include global health content in their curricula. Systematic review. An online search of CINAHL and Medline databases, as well as, inclusion of pertinent gray literature was conducted for articles published before 2013. Relevant literature for global health (GH) and public and community health (PH/CH) competencies was reviewed to determine recommendations of both competencies using a combination of search terms. Studies must have addressed competencies as defined in the literature and must have been pertinent to GH or PH/CH. The databases were systematically searched and after reading the full content of the included studies, key concepts were extracted and synthesized. Twenty-five studies were identified and resulted in a list of 14 global health core competencies. These competencies are applicable to a variety of health disciplines, but particularly can inform the efforts of nursing schools to integrate global health concepts into their curricula. Copyright © 2016 Elsevier Ltd. All rights reserved.

Creativity and connections: the future of nursing education and practice: the Massachusetts Initiative.

PubMed

Sroczynski, Maureen; Gravlin, Gayle; Route, Paulette Seymour; Hoffart, Nancy; Creelman, Patricia

2011-01-01

Education and practice partnerships are key to effective academic program design and implementation in a time of decreasing supply and increasing demands on the nursing profession. An integrated education/practice competency model can positively impact patient safety, improve patient care, increase retention, and ensure a sufficient and competent nursing workforce, which is paramount to survival of the health care system. Through the contributions of nursing leaders from the broad spectrum of nursing and industry organizations within the state, the Massachusetts Nurse of the Future project developed a competency-based framework for the future design of nursing educational programs to meet current and future practice needs. The Massachusetts Nurse of the Future Nursing Core Competencies(©) expand on the Institute of Medicine's core competencies for all health care professionals and the Quality and Safety Education for Nurses competencies for quality and safety to define the expectations for all professional nurses of the future. The Massachusetts Nurse of the Future Nursing Core Competencies define the knowledge, attitude, and skills required as the minimal expectations for initial nursing practice following completion of a prelicensure professional nursing education program. These competencies are now being integrated into new models for seamless, coordinated nursing curriculum and transition into practice within the state and beyond. Copyright © 2011 Elsevier Inc. All rights reserved.

Innovation in transformative nursing leadership: nursing informatics competencies and roles.

PubMed

Remus, Sally; Kennedy, Margaret Ann

2012-12-01

In a recent brief to the Canadian Nurses Association's National Expert Commission on the Health of Our Nation, the Academy of Canadian Executive Nurses (ACEN) discussed leadership needs in the Canadian healthcare system, and promoted the pivotal role of nursing executives in transforming Canada's healthcare system into an integrated patient-centric system. Included among several recommendations was the need to develop innovative leadership competencies that enable nurse leaders to lead and advance transformative health system change. This paper focuses on an emerging "avant-garde executive leadership competency" recommended for today's health leaders to guide health system transformation. Specifically, this competency is articulated as "state of the art communication and technology savvy," and it implies linkages between nursing informatics competencies and transformational leadership roles for nurse executive. The authors of this paper propose that distinct nursing informatics competencies are required to augment traditional executive skills to support transformational outcomes of safe, integrated, high-quality care delivery through knowledge-driven care. International trends involving nursing informatics competencies and the evolution of new corporate informatics roles, such as chief nursing informatics officers (CNIOs), are demonstrating value and advanced transformational leadership as nursing executive roles that are informed by clinical data. Copyright © 2013 Longwoods Publishing.

The portfolio approach to competency-based assessment at the Cleveland Clinic Lerner College of Medicine.

PubMed

Dannefer, Elaine F; Henson, Lindsey C

2007-05-01

Despite the rapid expansion of interest in competency-based assessment, few descriptions of assessment systems specifically designed for a competency-based curriculum have been reported. The purpose of this article is to describe the design of a portfolio approach to a comprehensive, competency-based assessment system that is fully integrated with the curriculum to foster an educational environment focused on learning. The educational design goal of the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University was to create an integrated educational program-curriculum and instructional methods, student assessment processes, and learning environment-to prepare medical students for success in careers as physician investigators. The first class in the five-year program matriculated in 2004. To graduate, a student must demonstrate mastery of nine competencies: research, medical knowledge, communication, professionalism, clinical skills, clinical reasoning, health care systems, personal development, and reflective practice. The portfolio provides a tool for collecting and managing multiple types of assessment evidence from multiple contexts and sources within the curriculum to document competence and promote reflective practice skills. This article describes how the portfolio was developed to provide both formative and summative assessment of student achievement in relation to the program's nine competencies.

Qualitative Description of Global Health Nursing Competencies by Nursing Faculty in Africa and the Americas

PubMed Central

Wilson, Lynda; Moran, Laura; Zarate, Rosa; Warren, Nicole; Ventura, Carla Aparecida Arena; Tamí-Maury, Irene; Mendes, Isabel Amélia Costa

2016-01-01

Abstract Objective: to analyze qualitative comments from four surveys asking nursing faculty to rate the importance of 30 global health competencies for undergraduate nursing programs. Method: qualitative descriptive study that included 591 individuals who responded to the survey in English (49 from Africa and 542 from the Americas), 163 who responded to the survey in Spanish (all from Latin America), and 222 Brazilian faculty who responded to the survey in Portuguese. Qualitative comments were recorded at the end of the surveys by 175 respondents to the English survey, 75 to the Spanish survey, and 70 to the Portuguese survey. Qualitative description and a committee approach guided data analysis. Results: ten new categories of global health competencies emerged from the analysis. Faculty also demonstrated concern about how and when these competencies could be integrated into nursing curricula. Conclusion: the additional categories should be considered for addition to the previously identified global health competencies. These, in addition to the guidance about integration into existing curricula, can be used to guide refinement of the original list of global health competencies. Further research is needed to seek consensus about these competencies and to develop recommendations and standards to guide nursing curriculum development. PMID:27276020

Implementing lean in Malaysian universities: Lean awareness level in an engineering faculty of a local university

NASA Astrophysics Data System (ADS)

Azim Khairi, M.; Rahman, Mohamed Abd

2018-01-01

Many academic articles were published in Malaysia promoting the goodness of lean in manufacturing and industrial sectors but less attention was apparently given to the possibility of obtaining the same universal benefits when applying lean in non-manufacturing sectors especially higher education. This study aims to determine the level of lean awareness among a local university’s community taking its Faculty of Engineering (FoE) as the case study. It also seeks to identify typical FoE’s staff perception on lean regarding its benefits and the obstacles in implementing it. A web-based survey using questionnaires was carried out for 215 respondents consisting of academic and administrative staff of the faculty. Statistical Package for the Social Science (SPSS) was used to analyze the survey data collected. A total of 13.95% of respondents returned the forms. Slightly more than half of those responded (56.7%) have encountered some of the lean terms with mean 1.43 and standard deviation 0.504. However, the large amount of standard deviation somewhat indicates that the real level of lean awareness of FoE as a group was low. In terms of lean benefits, reduction of waste was favored (93.3%) by the respondents with mean 0.93 and standard deviation 0.254. For obstacles in implementing lean, lack of knowledge was selected by most respondents (86.7%) to be the major factor with mean 0.87 and standard deviation 0.346. Through the analysis done, the study may conclude that level of lean awareness among the university‘s community was low thus may hinder implementation of lean concept.

Critical review of membrane bioreactor models--part 2: hydrodynamic and integrated models.

PubMed

Naessens, W; Maere, T; Ratkovich, N; Vedantam, S; Nopens, I

2012-10-01

Membrane bioreactor technology exists for a couple of decades, but has not yet overwhelmed the market due to some serious drawbacks of which operational cost due to fouling is the major contributor. Knowledge buildup and optimisation for such complex systems can heavily benefit from mathematical modelling. In this paper, the vast literature on hydrodynamic and integrated MBR modelling is critically reviewed. Hydrodynamic models are used at different scales and focus mainly on fouling and only little on system design/optimisation. Integrated models also focus on fouling although the ones including costs are leaning towards optimisation. Trends are discussed, knowledge gaps identified and interesting routes for further research suggested. Copyright © 2012 Elsevier Ltd. All rights reserved.

Four-way-leaning test shows larger limits of stability than a circular-leaning test.

PubMed

Thomsen, Mikkel Højgaard; Støttrup, Nicolai; Larsen, Frederik Greve; Pedersen, Ann-Marie Sydow Krogh; Poulsen, Anne Grove; Hirata, Rogerio Pessoto

2017-01-01

Limits of stability (LOS) have extensive clinical and rehabilitational value yet no standard consensus on measuring LOS exists. LOS measured using a leaning or a circling protocol is commonly used in research and clinical settings, however differences in protocols and reliability problems exist. This study measured LOS using a four-way-leaning test and a circular-leaning test to test which showed larger LOS measurements. Furthermore, number of adaptation trials needed for consistent results was assessed. Limits of stability were measured using a force plate (Metitur Good Balance System ® ) sampling at 50Hz. Thirty healthy subjects completed 30 trials assessing LOS alternating between four-way-leaning test and circular-leaning test. A main effect of methods (ANOVA:F(1,28)=45.86, P<0.01) with the four-way-leaning test showing larger values than the circular-leaning test (NK, P<0.01). An interaction between method×directions was found (ANOVA:F(3, 84)=24.87, P<0.01). The four-way-leaning test showed larger LOS in anterior (NK, P<0.05), right (NK, P<0.01) and left direction (NK, P<0.01). Analysis of LOS for the four-way-leaning test showed a difference between trials (ANOVA:F(14,392)=7.81, P<0.01). Differences were found between trial 1 and 7 (NK, P<0.03), trial 6 and 8 (NK, P<0.02) and trial 7 and 15 (NK, P<0.02). Four-way-leaning test showed high correlation (ICC>0.87) between first and second trial for all directions. Four-way-leaning test yields larger LOS in anterior, right and left direction making it more reliable when measuring LOS. A learning effect was found up to the 8th trial, which suggests using 8 adaptation trials before reliable LOS is measured. Copyright © 2016 Elsevier B.V. All rights reserved.

Correlates of increased lean muscle mass in women with polycystic ovary syndrome.

PubMed

Carmina, E; Guastella, E; Longo, R A; Rini, G B; Lobo, R A

2009-10-01

Muscle mass plays an important role in determining cardiovascular and metabolic risks in polycystic ovary syndrome (PCOS). In addition, whether lean mass influences carotid intima-media thickness (IMT) in PCOS has not been assessed. Prospective investigation. Ninety-five women with PCOS were age- and weight-matched to 90 ovulatory controls. All women had dual X-ray absorptiometry for lean, fat and bone mass, and bone mass density (BMD). Serum testosterone, sex hormone-binding globulin, insulin, and glucose and carotid IMT were determined. Free androgen index (FAI) and insulin resistance (by QUICKI) were calculated. In PCOS, waist circumference and insulin were higher and QUICKI lower than in controls (P<0.01). Trunk fat mass, % trunk fat, and lean mass were higher in PCOS compared to controls (P<0.01), while total bone mass and BMD were similar. IMT was increased in PCOS (P<0.01) but only 15% of PCOS patients had abnormal (> or = 0.9 mm) values. Lean mass correlated with fat parameters, insulin, QUICKI, and FAI, but not with total testosterone; and after adjustments for insulin and QUICKI, lean mass still correlated with fat mass (P<0.01) but not FAI. Lean mass correlated with IMT (P<0.01), but this was dependent on insulin. However, excluding those patients with abnormal IMT values, IMT correlated with lean mass independently of insulin. Bone mass correlated with lean and fat mass, but not with insulin or androgen. PCOS patients with 'pathological' IMT values had higher % trunk fat, lean mass, and insulin, lower QUICKI, and higher testosterone and FAI compared with those with normal IMT. Lean mass is increased in PCOS, while bone mass is similar to that of matched controls. The major correlates of lean mass are fat mass and insulin but not androgen. Lean mass also correlated with IMT, and although influenced by insulin, small changes in IMT may partially reflect changes in muscle mass, while clearly abnormal values relate to more severe abnormalities of PCOS.

7 CFR 59.200 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... these same swine. Average lean percentage. The term “average lean percentage” means the value equal to the average percentage of the carcass weight comprised of lean meat for the swine slaughtered during the applicable reporting period. Whenever the packer changes the manner in which the average lean...

7 CFR 59.200 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... these same swine. Average lean percentage. The term “average lean percentage” means the value equal to the average percentage of the carcass weight comprised of lean meat for the swine slaughtered during the applicable reporting period. Whenever the packer changes the manner in which the average lean...

The human side of lean teams.

PubMed

Wackerbarth, Sarah B; Strawser-Srinath, Jamie R; Conigliaro, Joseph C

2015-05-01

Organizations use lean principles to increase quality and decrease costs. Lean projects require an understanding of systems-wide processes and utilize interdisciplinary teams. Most lean tools are straightforward, and the biggest barrier to successful implementation is often development of the team aspect of the lean approach. The purpose of this article is to share challenges experienced by a lean team charged with improving a hospital discharge process. Reflection on the experience provides an opportunity to highlight lessons from The Team Handbook by Peter Scholtes and colleagues. To improve the likelihood that process improvement initiatives, including lean projects, will be successful, organizations should consider providing training in organizational change principles and team building. The authors' lean team learned these lessons the hard way. Despite the challenges, the team successfully implemented changes throughout the organization that have had a positive impact. Training to understand the psychology of change might have decreased the resistance faced in implementing these changes. © 2014 by the American College of Medical Quality.

Supervisors' Perceptions of Research Competencies in the Final-Year Project

ERIC Educational Resources Information Center

Reguant, Mercedes; Martínez-Olmo, Francesc; Contreras-Higuera, Williams

2018-01-01

Background: This paper analyses the development of research competencies in higher education students, particularly with regard to the undergraduate Final-Year Project (FYP). The FYP is understood as an assignment that requires the integration of learning outcomes and demonstration of competencies for the successful completion of the degree.…

Teachers' Conceptualization and Enactment of Twenty-First Century Competences: Exploring Dimensions for New Curricula

ERIC Educational Resources Information Center

van de Oudeweetering, Karmijn; Voogt, Joke

2018-01-01

Despite the advocated importance of twenty-first century competences in education, it appears that they are not systematically integrated in national curricula, school curricula and classroom activities. Potential explanations can be found in the current ambiguity of definitions for twenty-first century competences and the absence of educational…

Professional Competence of Teachers in the Age of Globalization

ERIC Educational Resources Information Center

Orazbayeva, Kuldarkhan O.

2016-01-01

Current challenges of globalization in a democratic post-industrial information society make the competency-based approach a standard in the creation of the global educational environment. This study describes the special aspects of the integration of the competency-based approach into the educational theory and practice of post-Soviet countries,…

Decision-Making Competence in Biology Education: Implementation into German Curricula in Relation to International Approaches

ERIC Educational Resources Information Center

Steffen, Benjamin; Hößle, Corinna

2014-01-01

The integration of decision-making competence or comparable constructs into science education has been strongly enforced during the last twenty years. Germany captured the tendency with the introduction of national standards for science education that included a domain that refers to decision-making competence. This domain--"evaluation and…

A Competency Model for Higher Education: An Assessment Based on Placements

ERIC Educational Resources Information Center

Gómez, Mar; Aranda, Evangelina; Santos, Jesús

2017-01-01

The European Higher Education Area, which is based on competency acquisition, has led to changes in teaching methods and student evaluations. In this new context, placements represent the best university-business connection for the development of competencies and integration of students into the employment market. Therefore, the primary objective…

Curricular Integration and Measurement of Cultural Competence Development in a Group of Physical Therapy Students

ERIC Educational Resources Information Center

Palombaro, Kerstin M.; Dole, Robin L.; Black, Jill D.

2015-01-01

Introduction and Background: The link between cultural competence and effective physical therapy encounters is established. Physical therapist educational programs face the challenge of fostering the cultural competence of students in effective and meaningful ways within the curriculum. They also face the challenge of measuring the development of…

International WIL Placements: Their Influence on Student Professional Development, Personal Growth and Cultural Competence

ERIC Educational Resources Information Center

Gribble, Nigel; Dender, Alma; Lawrence, Emma; Manning, Kirrily; Falkmer, Torbjorn

2014-01-01

In the increasingly global world, skills in cultural competence now form part of the minimum standards of practice required for allied health professionals. During an international work-integrated learning (WIL) placement, allied health students' cultural competence is expected to be enhanced. The present study scrutinized reflective journals of…

Application of mathematical methods of analysis in selection of competing information technologies

NASA Astrophysics Data System (ADS)

Semenov, V. L.; Kadyshev, E. N.; Zakharova, A. N.; Patianova, A. O.; Dulina, G. S.

2018-05-01

The article discusses the use of qualimetry methods using the apparatus of mathematical analysis in the formation of the integral index that allows one to select the best option among competing information technology. The authors propose the use of affine space in the evaluation and selection of competing information technologies.

Unified Model for Academic Competence, Social Adjustment, and Psychopathology.

ERIC Educational Resources Information Center

Schaefer, Earl S.; And Others

A unified conceptual model is needed to integrate the extensive research on (1) social competence and adaptive behavior, (2) converging conceptualizations of social adjustment and psychopathology, and (3) emerging concepts and measures of academic competence. To develop such a model, a study was conducted in which teacher ratings were collected on…

Integrating Soft Skill Competencies through Project-Based Learning across the Information Systems Curriculum

ERIC Educational Resources Information Center

Woodward, Belle S.; Sendall, Patricia; Ceccucci, Wendy

2010-01-01

Contemporary Information Systems graduates will be more marketable in the workplace upon graduation if they have combined competencies in both technical and soft skills: interpersonal communication, teamwork, time management, planning and organizational skills. Team and project-based learning can be used to incorporate soft skill competencies with…

Government agencies soften stance on what constitutes price fixing.

PubMed

Ettinger, D A; Lasser, M L

1997-02-01

The Federal Trade Commission and the Department of Justice have modified their views on what constitutes price fixing by integrated delivery systems. Recently released enforcement policy statements indicate that joint agreements on price between competing providers will not necessarily constitute price fixing, even without risk sharing, if the system is sufficiently integrated. The enforcement policy statements indicate that if integration arises from the combined efforts of previously competing providers, involves improvements in clinical efficiency or quality, and demonstrates no anticompetitive intent, it will be sufficient to withstand Federal scrutiny.

Applying lean management principles to the creation of a postpartum hemorrhage care bundle.

PubMed

Faulkner, Beth

2013-10-01

A lean management process is a set of interventions, each of which creates value for the customer. Lean management is not a new concept, but is relatively new to health care. Postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide in both developing and developed countries. We applied lean management principles as an innovative approach to improving outcomes in patients with PPH. Initial results using principles of lean management indicated significant improvements in response time and family-centered care. When applied rigorously and throughout the organization, lean principles can have a dramatic effect on productivity, cost and quality. © 2013 AWHONN.

Escape from rich-to-lean transitions: Stimulus change and timeout.

PubMed

Retzlaff, Billie J; Parthum, Elizabeth T P; Pitts, Raymond C; Hughes, Christine E

2017-01-01

Extended pausing during discriminable transitions from rich-to-lean conditions can be viewed as escape (i.e., rich-to-lean transitions function aversively). In the current experiments, pigeons' key pecking was maintained by a multiple fixed-ratio fixed-ratio schedule of rich or lean reinforcers. Pigeons then were provided with another, explicit, mechanism of escape by changing the stimulus from the transition-specific stimulus used in the multiple schedule to a mixed-schedule stimulus (Experiment 1) or by producing a period of timeout in which the stimulus was turned off and the schedule was suspended (Experiment 2). Overall, escape was under joint control of past and upcoming reinforcer magnitudes, such that responses on the escape key were most likely during rich-to-lean transitions, and second-most likely during lean-to-lean transitions. Even though pigeons pecked the escape key, they paused before doing so, and the latency to begin the fixed ratio (i.e., the pause) remained extended during rich-to-lean transitions. These findings suggest that although the stimulus associated with rich-to-lean transitions functioned aversively, pausing is more than simply escape responding from the stimulus. © 2017 Society for the Experimental Analysis of Behavior.

LEAN thinking in Finnish healthcare.

PubMed

Jorma, Tapani; Tiirinki, Hanna; Bloigu, Risto; Turkki, Leena

2016-01-01

Purpose - The purpose of this study is to evaluate how LEAN thinking is used as a management and development tool in the Finnish public healthcare system and what kind of outcomes have been achieved or expected by using it. The main focus is in managing and developing patient and treatment processes. Design/methodology/approach - A mixed-method approach incorporating the Webropol survey was used. Findings - LEAN is quite a new concept in Finnish public healthcare. It is mainly used as a development tool to seek financial savings and to improve the efficiency of patient processes, but has not yet been deeply implemented. However, the experiences from LEAN initiatives have been positive, and the methodology is already quite well-known. It can be concluded that, because of positive experiences from LEAN, the environment in Finnish healthcare is ready for the deeper implementation of LEAN. Originality/value - This paper evaluates the usage of LEAN thinking for the first time in the public healthcare system of Finland as a development tool and a management system. It highlights the implementation and achieved results of LEAN thinking when used in the healthcare environment. It also highlights the expectations for LEAN thinking in Finnish public healthcare.

The Role of the Clinical Laboratory in the Future of Health Care: Lean Microbiology

PubMed Central

Samuel, Linoj

2014-01-01

This commentary will introduce lean concepts into the clinical microbiology laboratory. The practice of lean in the clinical microbiology laboratory can remove waste, increase efficiency, and reduce costs. Lean, Six Sigma, and other such management initiatives are useful tools and can provide dividends but must be accompanied by organizational leadership commitment to sustaining the lean culture in the laboratory setting and providing resources and time to work through the process. PMID:24574289

Apparatus and method for burning a lean, premixed fuel/air mixture with low NOx emission

DOEpatents

Kostiuk, Larry W.; Cheng, Robert K.

1996-01-01

An apparatus for enabling a burner to stably burn a lean fuel/air mixture. The burner directs the lean fuel/air mixture in a stream. The apparatus comprises an annular flame stabilizer; and a device for mounting the flame stabilizer in the fuel/air mixture stream. The burner may include a body having an internal bore, in which case, the annular flame stabilizer is shaped to conform to the cross-sectional shape of the bore, is spaced from the bore by a distance greater than about 0.5 mm, and the mounting device mounts the flame stabilizer in the bore. An apparatus for burning a gaseous fuel with low NOx emissions comprises a device for premixing air with the fuel to provide a lean fuel/air mixture; a nozzle having an internal bore through which the lean fuel/air mixture passes in a stream; and a flame stabilizer mounted in the stream of the lean fuel/air mixture. The flame stabilizer may be mounted in the internal bore, in which case, it is shaped and is spaced from the bore as just described. In a method of burning a lean fuel/air mixture, a lean fuel/air mixture is provided, and is directed in a stream; an annular eddy is created in the stream of the lean fuel/air mixture; and the lean fuel/air mixture is ignited at the eddy.

The current state of Lean implementation in health care: literature review.

PubMed

Poksinska, Bozena

2010-01-01

The purpose of this article is to discuss the current state of implementation of Lean production in health care. The study focuses on the definition of Lean in health care and implementation process, barriers, challenges, enablers, and outcomes of implementing Lean production methods in health care. A comprehensive search of the literature concerning the implementation of Lean production in health care was used to generate a synthesis of the literature around the chosen research questions. Lean production in health care is mostly used as a process improvement approach and focuses on 3 main areas: (1) defining value from the patient point of view, (2) mapping value streams, and (3) eliminating waste in an attempt to create continuous flow. Value stream mapping is the most frequently applied Lean tool in health care. The usual implementation steps include conducting Lean training, initiating pilot projects, and implementing improvements using interdisciplinary teams. One of the barriers is lack of educators and consultants who have their roots in the health care sector and can provide support by sharing experience and giving examples from real-life applications of Lean in health care. The enablers of Lean in health care seem not to be different from the enablers of any other change initiative. The outcomes can be divided into 2 broad areas: the performance of the health care system and the development of employees and work environment.

Packages of participation: Swedish employees’ experience of Lean depends on how they are involved

PubMed Central

Brännmark, Mikael; Holden, Richard J.

2013-01-01

Background Lean Production is a dominant approach in Swedish and global manufacturing and service industries. Studies of Lean’s employee effects are few and contradictory. Purpose Employee effects from Lean are likely not uniform. This paper investigates the effect of employees' participation on their experiences of Lean. Method This study investigated how different packages of employee participation in Lean affected manufacturing workers’ experiences of Lean. During 2008–2011, qualitative and quantitative data were collected from Swedish manufacturing companies participating in the national Swedish Lean Production program Produktionslyftet. Data from 129 surveys (28 companies), 39 semi-structured interviews, and 30 reports were analyzed. In the main analysis, comparisons were made of the survey-reported Lean experiences of employees in three groups: temporary group employees (N = 36), who participated in Lean mostly through intermittent projects; continuous group employees (N = 69), who participated through standing improvement groups; and combined group employees (N = 24), who participated in both ways. Results Continuous group employees had the most positive experience of Lean, followed by the combined group. Temporary group employees had the least positive experiences, being less likely than their counterparts to report that Lean improved teamwork, occupational safety, and change-related learning, decision making, and authority. Conclusions These findings support the importance of continuous, structured opportunities for participation but raise the possibility that more participation may result in greater workload and role overload, mitigating some benefits of employee involvement. Consequently, companies should consider involving employees in change efforts but should attend to the specific design of participation activities. PMID:24665370

Roadmap for Lean implementation in Indian automotive component manufacturing industry: comparative study of UNIDO Model and ISM Model

NASA Astrophysics Data System (ADS)

Jadhav, J. R.; Mantha, S. S.; Rane, S. B.

2015-06-01

The demands for automobiles increased drastically in last two and half decades in India. Many global automobile manufacturers and Tier-1 suppliers have already set up research, development and manufacturing facilities in India. The Indian automotive component industry started implementing Lean practices to fulfill the demand of these customers. United Nations Industrial Development Organization (UNIDO) has taken proactive approach in association with Automotive Component Manufacturers Association of India (ACMA) and the Government of India to assist Indian SMEs in various clusters since 1999 to make them globally competitive. The primary objectives of this research are to study the UNIDO-ACMA Model as well as ISM Model of Lean implementation and validate the ISM Model by comparing with UNIDO-ACMA Model. It also aims at presenting a roadmap for Lean implementation in Indian automotive component industry. This paper is based on secondary data which include the research articles, web articles, doctoral thesis, survey reports and books on automotive industry in the field of Lean, JIT and ISM. ISM Model for Lean practice bundles was developed by authors in consultation with Lean practitioners. The UNIDO-ACMA Model has six stages whereas ISM Model has eight phases for Lean implementation. The ISM-based Lean implementation model is validated through high degree of similarity with UNIDO-ACMA Model. The major contribution of this paper is the proposed ISM Model for sustainable Lean implementation. The ISM-based Lean implementation framework presents greater insight of implementation process at more microlevel as compared to UNIDO-ACMA Model.

Approaches to the study of gender in marriage and family therapy curricula.

PubMed

Filkowski, M B; Storm, C L; York, C D; Brandon, A D

2001-01-01

This study compares two accredited marriage and family therapy programs: One includes a separate course on gender, and the other integrates gender throughout the curriculum. Students from the two programs rated their own and their peers' experience of how gender education effects therapy, program culture, and personal life. Results indicate that students from the integrated program view their peers as incorporating gender ideas in therapy to a significantly greater extent (t = 2.83, p < .05) than do students in the gender course program. However, students from the program that has a gender course leaned more toward agreement with feminist concepts than did students from the integrated program. Overall, students appear to be learning about gender and integrating these concepts into their work as therapists. Discussion is included on how to choose a gender curriculum.

Lean blowoff detection sensor

DOEpatents

Thornton, Jimmy [Morgantown, WV; Straub, Douglas L [Morgantown, WV; Chorpening, Benjamin T [Morgantown, WV; Huckaby, David [Morgantown, WV

2007-04-03

Apparatus and method for detecting incipient lean blowoff conditions in a lean premixed combustion nozzle of a gas turbine. A sensor near the flame detects the concentration of hydrocarbon ions and/or electrons produced by combustion and the concentration monitored as a function of time are used to indicate incipient lean blowoff conditions.

What Do Organizational Leaders Need from Lean Graduate Programming

ERIC Educational Resources Information Center

Flumerfelt, Shannon; Alves, Anabela Carvalho; Leão, Celina Pinto; Wade, Dennis L.

2016-01-01

Purpose: This paper aims to assess the needs for a lean continuous improvement professional certificate and/or lean leadership cognate for a Doctorate of Education in leadership focused in three main research questions: "What do organizational leaders need from a Lean graduate programming?"; "What are the preferable methods of…

Hybrid performance measurement of a business process outsourcing - A Malaysian company perspective

NASA Astrophysics Data System (ADS)

Oluyinka, Oludapo Samson; Tamyez, Puteri Fadzline; Kie, Cheng Jack; Freida, Ayodele Ozavize

2017-05-01

It's no longer new that customer perceived value for product and services are now greatly influenced by its psychological and social advantages. In order to meet up with the increasing operational cost, response time, quality and innovative capabilities many companies turned their fixed operational cost to a variable cost through outsourcing. Hence, the researcher explored different underlying outsourcing theories and infer that these theories are essential to performance improvement. In this study, the researcher evaluates the performance of a business process outsource company by a combination of lean and agile method. To test the hypotheses, we analyze different variability that a business process company faces, how lean and agile have been used in other industry to address such variability and discuss the result using a predictive multiple regression analysis on data collected from companies in Malaysia. The findings from this study revealed that while each method has its own advantage, a business process outsource company could achieve more (up to 87%) increase in performance level by developing a strategy which focuses on a perfect mixture of lean and agile improvement methods. Secondly, this study shows that performance indicator could be better evaluated with non-metrics variables of the agile method. Thirdly, this study also shows that business process outsourcing company could perform better when they concentrate more on strengthening internal process integration of employees.

In healthy elderly postmenopausal women variations in BMD and BMC at various skeletal sites are associated with differences in weight and lean body mass rather than by variations in habitual physical activity, strength or VO2max.

PubMed

Schöffl, I; Kemmler, W; Kladny, B; Vonstengel, S; Kalender, W A; Engelke, K

2008-01-01

The objective of this study was an integrated cross-sectional investigation for answering the question whether differences in bone mineral density in elderly postmenopausal women are associated with differences in habitual physical activity and unspecific exercise levels. Two hundred and ninety nine elderly women (69-/+3 years), without diseases or medication affecting bone metabolism were investigated. The influence of weight, body composition and physical activity on BMD was measured at multiple sites using different techniques (DXA, QCT, and QUS). Physical activity and exercise level were assessed by questionnaire, maximum strength of the legs and aerobic capacity. Variations in physical activity or habitual exercise had no effect on bone. The only significant univariate relation between strength/VO(2)max and BMD/BMC that remained after adjusting for confounding variables was between arm BMD (DXA) and hand-grip strength. The most important variable for explaining BMD was weight and for cortical BMC of the femur (QCT) lean body mass. Weight and lean body mass emerge as predominant predictors of BMD in normal elderly women, whereas the isolated effect of habitual physical activity, unspecific exercise participation, and muscle strength on bone parameters is negligible. Thus, an increase in the amount of habitual physical activity will probably have no beneficial impact on bone.

Testing a Technology Integration Education Model for Millennial Preservice Teachers: Exploring the Moderating Relationships of Goals, Feedback, Task Value, and Self-Regulation among Motivation and Technological, Pedagogical, and Content Knowledge Competencies

ERIC Educational Resources Information Center

Holland, Denise D.; Piper, Randy T.

2016-01-01

The technology integration education model is a 12 construct model that includes 8 primary constructs and 4 moderator constructs. By testing the relationships among two primary constructs (motivation and technological, pedagogical, and content knowledge competencies) and four moderator constructs (goals, feedback, task value, and self-regulation),…

Startup Diagnostics of the Degree of Well-Formedness of Student Design Competence as an Integral Means of Students Plotting Their Own Individual Learning Route

ERIC Educational Resources Information Center

Ignatovich, Vladlen K.; Ignatovich, Svetlana S.

2015-01-01

This article seeks to substantiate the need for the prognostic assessment of the degree to which school students are prepared to master new types of activity, which underlie their design of an individual learning route at an appropriate senior stage of learning. The authors discuss the concept of project competence as an integral characteristic of…

The development of learning competency and skills for the 21st century to integrate "TPCK" of world life with local environment in students grade 11

NASA Astrophysics Data System (ADS)

Jedaman, Pornchai; Kinboon, Nittayaporn; Suksup, Chareon; Kinboon, Wutcharapong

2018-01-01

The teaching strategies of append were the technological pedagogical content knowledge; TPCK. This description knowledge in a content to corresponds of a effective teaching. This article aims to address the relevance of; 1) the learning competency and skills for the 21st Century to integrate "TPCK" of a world life with local environment in the students grade 11, 2) the effective achievement of the learning competency and skills to integrate "TPCK" of world life with local environment in the students grade 11 were the passing score of a percentage 80 upwards (EI.), and 3) the attitudes for learning activities in the students grade 11. The study employed both quantitative and qualitative approaches for 9teachers of third schools were the participatory action research (PAR) in collecting data including a instructional, a testing, and a questionnaire surveywith 33 students grade 11 of Phuwiengwittayakom school. The participants werecluster random sampling. The data analysis of descriptive statistical, percentage, mean average, standard deviation. The findings in the study were to learning competency and skills for the 21st Century to integrate "TPCK" of a world life with local environment on TK, PK, CK, and TCK at a excellent levels (X¯ = 3.62, 3.57, 3.54, 3.51) respectively, and PCK, TPK,TPCK at a good levels (X¯ = 3.36, 3.23, 3.17) respectively. The effective achievement of the learning competency and skills to integrate "TPCK" of world life with local environment in 30 students grade 11 were the passing score (EI.) of a percentage at 90.91. The attitudes for learning activities in the students grade 11 at a high levels (X¯ =3.29). In addition of the students grade 11 to understanding of the importance were a local learning resources including the value integrating technology of the knowledge technology and to choose the right were create of an effective information.

Nurses' competence in genetics: An integrative review.

PubMed

Wright, Helen; Zhao, Lin; Birks, Melanie; Mills, Jane

2018-01-29

The aim of this integrative review was to update a mixed method systematic review by Skirton, O'Connor, and Humphreys (2012) that reported on nurses' levels of competence in using genetics in clinical practice. Three electronic databases were searched using selected key words. Research studies published in English between January 2011 and September 2017 reporting levels of nurse competence in genetics or genomics were eligible for inclusion. The selected studies were subjected to thematic analysis. Three main themes were identified: (i) genomic knowledge and utilization, (ii) perceived relevance to practice, and (iii) genomic education. While the reviewed papers produced varied findings, many nurses were shown to have poor genomic knowledge and/or competency, and yet there was a consensus that most nurses believe genomics is important to their practice. The present review indicated that in the past 5 years nurses have made minimal progress toward achieving the core genomic competencies appropriate for clinical practice. © 2018 John Wiley & Sons Australia, Ltd.

Far-Field Acoustic Characteristics of Multiple Blade-Vane Configurations for a High Tip Speed Fan

NASA Technical Reports Server (NTRS)

Woodward, Richard P.; Gazzaniga, John A.; Hughes, Christopher

2004-01-01

The acoustic characteristics of a model high-speed fan stage were measured in the NASA Glenn 9- by 15-Foot Low Speed Wind Tunnel at takeoff and approach flight conditions. The fan was designed for a corrected rotor tip speed of 442 m/s (1450 ft/s), and had a powered core, or booster stage, giving the model a nominal bypass ratio of 5. A simulated engine pylon and nozzle bifurcation was contained within the bypass duct. The fan stage consisted of all combinations of 3 possible rotors, and 3 stator vane sets. The 3 rotors were (1) wide chord, (2) forward swept, and (3) shrouded. The 3 stator sets were (1) baseline, moderately swept, (2) swept and leaned, and (3) swept integral vane/frame which incorporated some of the swept and leaned features as well as eliminated the downstream support structure. The baseline configuration is considered to be the wide chord rotor with the radial vane stator. A flyover Effective Perceived Noise Level (EPNL) code was used to generate relative EPNL values for the various configurations. The swept and leaned stator showed a 3 EPNdB reduction at lower fan speeds relative to the baseline stator; while the swept integral vane/frame stator showed lowest noise levels at high fan speeds. The baseline, wide chord rotor was typically the quietest of the three rotors. A tone removal study was performed to assess the acoustic benefits of removing the fundamental rotor interaction tone and its harmonics. Reprocessing the acoustic results with the bypass tone removed had the most impact on reducing fan noise at transonic rotor speeds. Removal of the bypass rotor interaction tones (BPF and nBPF) showed up to a 6 EPNdB noise reduction at transonic rotor speeds relative to noise levels for the baseline (wide chord rotor and radial stator; all tones present) configuration.

Advanced engine management of individual cylinders for control of exhaust species

DOEpatents

Graves, Ronald L [Knoxville, TN; West, Brian H [Knoxville, TN; Huff, Shean P [Knoxville, TN; Parks, II, James E

2008-12-30

A method and system controls engine-out exhaust species of a combustion engine having a plurality of cylinders. The method typically includes various combinations of steps such as controlling combustion parameters in individual cylinders, grouping the individual cylinders into a lean set and a rich set of one or more cylinders, combusting the lean set in a lean combustion parameter condition having a lean air:fuel equivalence ratio, combusting the rich set in a rich combustion parameter condition having a rich air:fuel equivalence ratio, and adjusting the lean set and the rich set of one or more cylinders to generate net-lean combustion. The exhaust species may have elevated concentrations of hydrogen and oxygen.

Leadership requirements for Lean versus servant leadership in health care: a systematic review of the literature.

PubMed

Aij, Kjeld Harald; Rapsaniotis, Sofia

2017-01-01

As health care organizations face pressures to improve quality and efficiency while reducing costs, leaders are adopting management techniques and tools used in manufacturing and other industries, especially Lean. Successful Lean leaders appear to use a coaching leadership style that shares underlying principles with servant leadership. There is little information about specific similarities and differences between Lean and servant leaderships. We systematically reviewed the literature on Lean leadership, servant leadership, and health care and performed a comparative analysis of attributes using Russell and Stone's leadership framework. We found significant overlap between the two leadership styles, although there were notable differences in origins, philosophy, characteristics and behaviors, and tools. We conclude that both Lean and servant leaderships are promising models that can contribute to the delivery of patient-centered, high-value care. Servant leadership may provide the means to engage and develop employees to become successful Lean leaders in health care organizations.

Quality improvement in basic histotechnology: the lean approach.

PubMed

Clark, David

2016-01-01

Lean is a comprehensive system of management based on the Toyota production system (TPS), encompassing all the activities of an organization. It focuses management activity on creating value for the end-user by continuously improving operational effectiveness and removing waste. Lean management creates a culture of continuous quality improvement with a strong emphasis on developing the problem-solving capability of staff using the scientific method (Deming's Plan, Do, Check, Act cycle). Lean management systems have been adopted by a number of histopathology departments throughout the world to simultaneously improve quality (reducing errors and shortening turnround times) and lower costs (by increasing efficiency). This article describes the key concepts that make up a lean management system, and how these concepts have been adapted from manufacturing industry and applied to histopathology using a case study of lean implementation and evidence from the literature. It discusses the benefits, limitations, and pitfalls encountered when implementing lean management systems.

Cosmetology. FasTrak Specialization Integrated Technical and Academic Competency (ITAC). 2002 Revision.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.

This publication provides the competencies and key indicators for a cosmetology program that prepares students to become licensed in the State of Ohio to work in the area of hair, skin, and/or nail care. Competencies and the related key indicators are presented for these 14 units: orientation to the cosmetology profession; dispensary operations…

Symmetrical and Asymmetrical Scaffolding of L2 Collocations in the Context of Concordancing

ERIC Educational Resources Information Center

Rezaee, Abbas Ali; Marefat, Hamideh; Saeedakhtar, Afsaneh

2015-01-01

Collocational competence is recognized to be integral to native-like L2 performance, and concordancing can be of assistance in gaining this competence. This study reports on an investigation into the effect of symmetrical and asymmetrical scaffolding on the collocational competence of Iranian intermediate learners of English in the context of…

Promotion of Social and Emotional Competence: Experiences from a Mental Health Intervention Applying a Whole School Approach

ERIC Educational Resources Information Center

Nielsen, Line; Meilstrup, Charlotte; Nelausen, Malene Kubstrup; Koushede, Vibeke; Holstein, Bjørn Evald

2015-01-01

Purpose: Within the framework of Health Promoting Schools "Up" is an intervention using a whole school approach aimed at promoting mental health by strengthening social and emotional competence among schoolchildren. Social and emotional competence is an integral part of many school-based mental health interventions but only a minority of…

Validation of Competencies in E-Portfolios: A Qualitative Analysis

ERIC Educational Resources Information Center

Zawacki-Richter, Olaf; Hanft, Anke; Baecker, Eva Maria

2011-01-01

This paper uses the example of an Internet-based advanced studies course to show how the portfolio method, as a competence-based form of examination, can be integrated in a blended learning design. Within the framework of a qualitative analysis of project portfolios, we examined which competencies are documented and how students reflected on their…

Exploring the Sociodemographic, Organizational and Other Correlates Affecting the Promotion of Cultural and Linguistic Competence: Implications for Mental Health Disparities

ERIC Educational Resources Information Center

Francis, Karen Belinda

2012-01-01

Background: Cultural and linguistic competence is widely viewed as a strategy for addressing disparities in health and mental health care. Organizational activities towards the integration and implementation of cultural and linguistic competence span the gamut to include training, workforce development, policy development and standards that inform…

Teaching Special Decisions in a Lean Accounting Environment

ERIC Educational Resources Information Center

Haskin, Daniel

2010-01-01

Lean accounting has become increasingly important as more and more companies adopt the lean enterprise model or some variation of it. Cost and managerial accounting textbooks continue to use, almost exclusively, models based on standard overhead absorption, which if used in a lean environment will not accurately reflect the benefits from the…

Healthcare workers' perceptions of lean: a context-sensitive, mixed methods study in three Swedish hospitals.

PubMed

Holden, Richard J; Eriksson, Andrea; Andreasson, Jörgen; Williamsson, Anna; Dellve, Lotta

2015-03-01

As the application of lean in healthcare expands, further research is needed in at least two areas: first, on the role of context in shaping lean and its consequences and second, on how healthcare workers perceive lean. Accordingly, this context-sensitive, mixed methods study addressed how hospital workers' perceptions of lean varied across contexts in three Swedish hospitals. Registered nurses and physicians at the hospitals and across units differing in acuity completed standardized surveys (N = 236, 57% response rate) about their perceptions of hospital-wide lean implementation. Perceptions varied by: hospital context, with one hospital's employees reporting the least favorable perceptions; unit acuity, with higher-acuity units reporting more favorable perceptions; and professional role, with nurses reporting more favorable perceptions than physicians. Individual interviews, group interviews, and observations provided insight about these dissimilar contexts and possible explanations for context-specific variability. Findings are discussed with respect to strategies for implementing lean in healthcare; the importance of attending to levels, context, and worker consequences of lean; and directions for future research. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Healthcare workers' perceptions of lean: A context-sensitive, mixed methods study in three Swedish hospitals

PubMed Central

Holden, Richard J.; Eriksson, Andrea; Andreasson, Jörgen; Williamsson, Anna; Dellve, Lotta

2014-01-01

As the application of lean in healthcare expands, further research is needed in at least two areas: first, on the role of context in shaping lean and its consequences and second, on how healthcare workers perceive lean. Accordingly, this context-sensitive, mixed methods study addressed how hospital workers' perceptions of lean varied across contexts in three Swedish hospitals. Registered nurses and physicians at the hospitals and across units differing in acuity completed standardized surveys (N=236, 57% response rate) about their perceptions of hospital-wide lean implementation. Perceptions varied by: hospital context, with one hospital's employees reporting the least favorable perceptions; unit acuity, with higher-acuity units reporting more favorable perceptions; and professional role, with nurses reporting more favorable perceptions than physicians. Individual interviews, group interviews, and observations provided insight about these dissimilar contexts and possible explanations for context-specific variability. Findings are discussed with respect to strategies for implementing lean in healthcare; the importance of attending to levels, context, and worker consequences of lean; and directions for future research. PMID:25479987

Waste in health information systems: a systematic review.

PubMed

Awang Kalong, Nadia; Yusof, Maryati

2017-05-08

Purpose The purpose of this paper is to discuss a systematic review on waste identification related to health information systems (HIS) in Lean transformation. Design/methodology/approach A systematic review was conducted on 19 studies to evaluate Lean transformation and tools used to remove waste related to HIS in clinical settings. Findings Ten waste categories were identified, along with their relationships and applications of Lean tool types related to HIS. Different Lean tools were used at the early and final stages of Lean transformation; the tool selection depended on the waste characteristic. Nine studies reported a positive impact from Lean transformation in improving daily work processes. The selection of Lean tools should be made based on the timing, purpose and characteristics of waste to be removed. Research limitations/implications Overview of waste and its category within HIS and its analysis from socio-technical perspectives enabled the identification of its root cause in a holistic and rigorous manner. Practical implications Understanding waste types, their root cause and review of Lean tools could subsequently lead to the identification of mitigation approach to prevent future error occurrence. Originality/value Specific waste models for HIS settings are yet to be developed. Hence, the identification of the waste categories could guide future implementation of Lean transformations in HIS settings.

Readiness factors for lean implementation in healthcare settings--a literature review.

PubMed

Al-Balushi, S; Sohal, A S; Singh, P J; Al Hajri, A; Al Farsi, Y M; Al Abri, R

2014-01-01

The purpose of this paper is to determine the readiness factors that are critical to the application and success of lean operating principles in healthcare organizations through a review of relevant literature. A comprehensive review of literature focussing on lean and lean healthcare was conducted. Leadership, organizational culture, communication, training, measurement, and reward systems are all commonly attributed readiness factors throughout general change management and lean literature. However, directly related to the successful implementation of lean in healthcare is that a setting is able to authorize a decentralized management style and undertake an end-to-end process view. These can be particularly difficult initiatives for complex organizations such as healthcare settings. The readiness factors identified are based on a review of the published literature. The external validity of the findings could be enhanced if tested using an empirical study. The readiness factors identified will enable healthcare practitioners to be better prepared as they begin their lean journeys. Sustainability of the lean initiative will be at stake if these readiness factors are not addressed. To the best of the knowledge, this is the first paper that provides a consolidated list of key lean readiness factors that can guide practice, as well as future theory and empirical research.

Does lean muddy the quality improvement waters? A qualitative study of how a hospital management team understands lean in the context of quality improvement.

PubMed

Savage, Carl; Parke, Louise; von Knorring, Mia; Mazzocato, Pamela

2016-10-19

Health care has experimented with many different quality improvement (QI) approaches with greater variation in name than content. This has been dubbed pseudoinnovation. However, it could also be that the subtleties and differences are not clearly understood. To explore this further, the purpose of this study was to explore how hospital managers perceive lean in the context of QI. We used a qualitative study design with semi-structured interviews to explore twelve top managers' perceptions of the relationship between lean and quality improvement (QI) at a university-affiliated hospital. Managers described that QI and lean shared the same overall purpose: focus on patient needs and improve efficiency and effectiveness. Employee involvement was emphasized in both strategies, as well as the support offered by managers of staff initiatives. QI was perceived as a strategy that could support structural changes at the organizational level whereas lean was seen as applicable at the operational level. Moreover, lean carried a negative connotation, lacked the credibility of QI, and was perceived as a management fad. Aspects of QI and lean were misunderstood. In a context where lean remains an abstract term, and staff associate lean with automotive applications and cost reduction, it may be fruitful for managers to invest time and resources to develop a strategy for continual improvement and utilize vocabulary that resonates with health care staff. This could reduce the risk that improvement efforts are rejected out of hand.

Estimation of lean and fat composition of pork ham using image processing measurements

NASA Astrophysics Data System (ADS)

Jia, Jiancheng; Schinckel, Allan P.; Forrest, John C.

1995-01-01

This paper presents a method of estimating the lean and fat composition in pork ham from cross-sectional area measurements using image processing technology. The relationship between the quantity of ham lean and fat mass with the ham lean and fat areas was studied. The prediction equations for pork ham composition based on the ham cross-sectional area measurements were developed. The results show that ham lean weight was related to the ham lean area (r equals .75, P < .0001) while ham fat weight was related tot the ham fat area (r equals .79, P equals .0001). Ham lean weight was highly related to the product of ham total weight times percentage ham lean area (r equals .96, P < .0001). Ham fat weight was highly related to the product of ham total weight times percentage ham fat area (r equals .88, P < .0001). The best combination of independent variables for estimating ham lean weight was trimmed wholesale ham weight and percentage ham fat area with a coefficient of determination of 92%. The best combination of independent variables for estimating ham fat weight was trimmed wholesale ham weight and percentage ham fat area with a coefficient of determination of 78%. Prediction equations with either two or three independent variables did not significantly increase the accuracy of prediction. The results of this study indicate that the weight of ham lean and fat could be predicted from ham cross-sectional area measurements using image analysis in combination with wholesale ham weight.

Strategic Technology Selection and Classification in Multimodel Environments

DTIC Science & Technology

2008-05-01

processes. Specifically, the organization chose a blend of CMMI (portions of which were being implemented in engineering), ISO 12207 and the SA CMM...whole- product support Improve product field performance Strategy to accomplish goal Reference models CMMI, SA CMM, IEEE/ ISO 12207 Leverage CMMI...ro u p Lean Six Sigma SOX ISO /IEC 15288 ISO 9000 CMMI ISO 12207 P-CMM AS9100 IEEE 830 PSMIDEAL PPSLockheed Martin Integrated Enterprise Process Agile

A Statement on the Posture of the United States Army 2008

DTIC Science & Technology

2008-02-26

Organization Defense Integrated Military Human Resourece System Deployment Cycle Support Diversity Equal Opportunity and Prevention of Sexual Harassment...Component Soldiers. “America’s ground forces have borne the brunt of underfunding in the past and the bulk of the costs–both human and material–of the...Congress and to free human and fi nancial resources for higher priority operational needs. Through the use of innovations such as Lean Six Sigma we are

Increased Coagulation and Decreased Fibrinolysis as Measured with Overall Hemostatic Potential Are Dependent on BMI and Not Associated with PCOS.

PubMed

Rakusa, Matej; Jensterle, Mojca; Božič-Mijovski, Mojca; Janez, Andrej

2017-05-01

Overall hemostatic potential (OHP) captures all factors that affect coagulation and fibrinolysis cascade. It has not yet been assessed in polycystic ovary syndrome (PCOS). The aim of the study was to identify the relationship of OHP with a syndrome per se and body mass index (BMI). In 90 women with PCOS aged 30.9 ± 8.1 years (50 obese, 13 overweight, and 27 lean) and 21 healthy age-matched controls (11 obese and 10 lean), OHP with overall coagulation potential (OCP) and overall fibrinolytic potential (OFP) was determined spectrophotometrically. OFP was calculated. OHP increased with BMI in PCOS (9.6 ± 2.3 in lean, 12.5 ± 5.1 in overweight, and 15.5 ± 3.8 Abs-sum in obese) and in controls (9.1 ± 1.0 in lean and 17.3 ± 4.6 Abs-sum in obese). There was significant difference between lean and obese PCOS (P < 0.001) and between lean and obese controls (P < 0.001). OCP also increased with BMI in PCOS (P < 0.001 for lean vs. obese) and in controls (P < 0.001 for lean vs. obese). OFP decreased with BMI in PCOS (P < 0.001 for obese vs. overweight vs. lean) and in controls (P < 0.001 for obese vs. lean). OHP in healthy obese and obese PCOS did not differ significantly, while OHP for healthy obese was increased in comparison to overweight and lean PCOS (P < 0.001). PCOS was not associated with increased OHP compared with BMI and age-matched controls. However, increase in OHP was positively associated with BMI in PCOS and healthy women.

Validation of a skinfold based index for tracking proportional changes in lean mass

PubMed Central

Slater, G J; Duthie, G M; Pyne, D B; Hopkins, W G

2006-01-01

Background The lean mass index (LMI) is a new empirical measure that tracks within‐subject proportional changes in body mass adjusted for changes in skinfold thickness. Objective To compare the ability of the LMI and other skinfold derived measures of lean mass to monitor changes in lean mass. Methods 20 elite rugby union players undertook full anthropometric profiles on two occasions 10 weeks apart to calculate the LMI and five skinfold based measures of lean mass. Hydrodensitometry, deuterium dilution, and dual energy x ray absorptiometry provided a criterion choice, four compartment (4C) measure of lean mass for validation purposes. Regression based measures of validity, derived for within‐subject proportional changes through log transformation, included correlation coefficients and standard errors of the estimate. Results The correlation between change scores for the LMI and 4C lean mass was moderate (0.37, 90% confidence interval −0.01 to 0.66) and similar to the correlations for the other practical measures of lean mass (range 0.26 to 0.42). Standard errors of the estimate for the practical measures were in the range of 2.8–2.9%. The LMI correctly identified the direction of change in 4C lean mass for 14 of the 20 athletes, compared with 11 to 13 for the other practical measures of lean mass. Conclusions The LMI is probably as good as other skinfold based measures for tracking lean mass and is theoretically more appropriate. Given the impracticality of the 4C criterion measure for routine field use, the LMI may offer a convenient alternative for monitoring physique changes, provided its utility is established under various conditions. PMID:16505075

Guiding inpatient quality improvement: a systematic review of Lean and Six Sigma.

PubMed

Glasgow, Justin M; Scott-Caziewell, Jill R; Kaboli, Peter J

2010-12-01

Two popular quality improvement (QI) approaches in health care are Lean and Six Sigma. Hospitals continue to adopt these QI approaches-or the hybrid Lean Sigma approach-with little knowledge on how well they produce sustainable improvements. A systematic literature review was conducted to determine whether Lean, Six Sigma, or Lean Sigma have been effectively used to create and sustain improvements in the acute care setting. Databases were searched for articles published in the health care, business, and engineering literatures. Study inclusion criteria required identification of a Six Sigma, Lean, or Lean Sigma project; QI efforts focused on hospitalized patients; descriptions of project improvements; and reported results. Depending on the quality of data reported, articles were classified as summary reports, pre-post observational studies, or time-series reports. Database searches identified 539 potential articles. After review of titles, abstracts, and full text, 47 articles met inclusion criteria--10 articles summarized multiple projects, 12 reported Lean projects, 20 reported Six Sigma projects, and 5 reported Lean Sigma projects. Generally, the studies provided limited data, with only 15 articles providing any sort of follow-up data; of the 15, only 3 report a follow-up period greater than two years. Lean, Six Sigma, and Lean Sigma as QI approaches can aid institutions in tackling a wide variety of problems encountered in acute care. However, the true impact of these approaches is difficult to judge, given that the lack of rigorous evaluation or clearly sustained improvements provides little evidence supporting broad adoption. There is still a need for future work that will improve the evidence base for understanding more about QI approaches and how to achieve sustainable improvement.

Lean thinking in hospitals: is there a cure for the absence of evidence? A systematic review of reviews

PubMed Central

Andersen, Hege; Røvik, Kjell Arne; Ingebrigtsen, Tor

2014-01-01

Objective Lean interventions aim to improve quality of healthcare by reducing waste and facilitate flow in work processes. There is conflicting evidence on the outcomes of lean thinking, with quantitative and qualitative studies often contradicting each other. We suggest that reviewing the literature within the approach of a new contextual framework can deepen our understanding of lean as a quality-improvement method. This article theorises the concept of context by establishing a two-dimensional conceptual framework acknowledging lean as complex social interventions, deployed in different organisational dimensions and domains. The specific aim of the study was to identify factors facilitating intended outcomes from lean interventions, and to understand when and how different facilitators contribute. Design A two-dimensional conceptual framework was developed by combining Shortell's Dimensions of capability with Walshes’ Domains of an intervention. We then conducted a systematic review of lean review articles concerning hospitals, published in the period 2000–2012. The identified lean facilitators were categorised according to the intervention domains and dimensions of capability provided by the framework. Results We provide a framework emphasising context by relating facilitators to domains and dimensions of capability. 23 factors enabling a successful lean intervention in hospitals were identified in the systematic review, where management and a supportive culture, training, accurate data, physicians and team involvement were most frequent. Conclusions In the absence of evidence, the two-dimensional framework, incorporating the context, may prove useful for future research on variation in outcomes from lean interventions. Findings from the review suggest that characteristics and local application of lean, in addition to strategic and cultural capability, should be given further attention in healthcare quality improvement. PMID:24435890

Physical activity modifies the association between dietary protein and lean mass of postmenopausal women

PubMed Central

Martinez, Jessica A.; Wertheim, Betsy C.; Thomson, Cynthia A.; Bea, Jennifer W.; Wallace, Robert; Allison, Matthew; Snetselaa, Linda; Chen, Zhao; Nassir, Rami; Thompson, Patricia A.

2016-01-01

Background Maintenance of lean muscle mass and related strength is associated with lower risk for numerous chronic diseases of aging in women. Objective To evaluate whether the association between dietary protein and lean mass differs by physical activity level, amino acid composition, and body mass index categories. Design Cross-sectional analysis of a prospective cohort. Participants/setting Postmenopausal women from the Women’s Health Initiative with body composition measurements by dual-energy X-ray absorptiometry (n=8,298). Main outcome measures Percent lean mass, percent fat mass and lean body mass index. Statistical analyses performed Linear regression models adjusted for scanner serial number, age, calibrated energy intake, race/ethnicity, neighborhood socioeconomic status, and recreational physical activity were used to determine the relationship between protein intake and body composition measures. Likelihood ratio tests and stratified analysis were used to investigate physical activity and body mass index as potential effect modifiers. Results Biomarker-calibrated protein intake was positively associated with percent lean mass; women in the highest protein quintile had 6.3 percentage points higher lean mass than the lowest quintile (P < 0.001). This difference rose to 8.5 percentage points for physically active women in the highest protein quintile (Pinteraction = 0.023). Percent fat mass and lean body mass index were both inversely related to protein intake (both P < 0.001). Physical activity further reduced percent fat mass (Pinteraction = 0.022) and lean body mass index (Pinteraction = 0.011). Leucine intake was associated with lean mass, as were branched chain amino acids combined (both P < 0.001), but not independent of total protein. All associations were observed for normal-weight, overweight, and obese women. Conclusions Protein consumption up to 2.02 g/kg body weight daily is positively associated with lean mass in postmenopausal women. Importantly, those that also engage in physical activity have the highest lean mass across body mass index categories. PMID:27914915

Cardiovascular and metabolic responses to fasting and thermoneutrality are conserved in obese Zucker rats.

PubMed

Overton, J M; Williams, T D; Chambers, J B; Rashotte, M E

2001-04-01

The primary purpose of the study was to test the hypothesis that reduced leptin signaling is necessary to elicit the cardiovascular and metabolic responses to fasting. Lean (Fa/?; normal leptin receptor; n = 7) and obese (fa/fa; mutated leptin receptor; n = 8) Zucker rats were instrumented with telemetry transmitters and housed in metabolic chambers at 23 degrees C (12:12-h light-dark cycle) for continuous (24 h) measurement of metabolic and cardiovascular variables. Before fasting, mean arterial pressure (MAP) was higher (MAP: obese = 103 +/- 3; lean = 94 +/- 1 mmHg), whereas oxygen consumption (VO(2): obese = 16.5 +/- 0.3; lean = 18.6 +/- 0.2 ml. min(-1). kg(-0.75)) was lower in obese Zucker rats compared with their lean controls. Two days of fasting had no effect on MAP in either lean or obese Zucker rats, whereas VO(2) (obese = -3.1 +/- 0.3; lean = -2.9 +/- 0.1 ml. min(-1). kg(-0.75)) and heart rate (HR: obese = -56 +/- 4; lean = -42 +/- 4 beats/min) were decreased markedly in both groups. Fasting increased HR variability both in lean (+1.8 +/- 0.4 ms) and obese (+2.6 +/- 0.3 ms) Zucker rats. After a 6-day period of ad libitum refeeding, when all parameters had returned to near baseline levels, the cardiovascular and metabolic responses to 2 days of thermoneutrality (ambient temperature 29 degrees C) were determined. Thermoneutrality reduced VO(2) (obese = -2.4 +/- 0.2; lean = -3.3 +/- 0.2 ml. min(-1). kg(-0.75)), HR (obese = -46 +/- 5; lean = -55 +/- 4 beats/min), and MAP (obese = -13 +/- 6; lean = -10 +/- 1 mmHg) similarly in lean and obese Zucker rats. The results indicate that the cardiovascular and metabolic responses to fasting and thermoneutrality are conserved in Zucker rats and suggest that intact leptin signaling may not be requisite for the metabolic and cardiovascular responses to reduced energy intake.

Filter-based control of particulate matter from a lean gasoline direct injection engine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Parks, II, James E; Lewis Sr, Samuel Arthur; DeBusk, Melanie Moses

New regulations requiring increases in vehicle fuel economy are challenging automotive manufacturers to identify fuel-efficient engines for future vehicles. Lean gasoline direct injection (GDI) engines offer significant increases in fuel efficiency over the more common stoichiometric GDI engines already in the marketplace. However, particulate matter (PM) emissions from lean GDI engines, particularly during stratified combustion modes, are problematic for lean GDI technology to meet U.S. Environmental Protection Agency Tier 3 and other future emission regulations. As such, the control of lean GDI PM with wall-flow filters, referred to as gasoline particulate filter (GPF) technology, is of interest. Since lean GDImore » PM chemistry and morphology differ from diesel PM (where more filtration experience exists), the functionality of GPFs needs to be studied to determine the operating conditions suitable for efficient PM removal. In addition, lean GDI engine exhaust temperatures are generally higher than diesel engines which results in more continuous regeneration of the GPF and less presence of the soot cake layer common to diesel particulate filters. Since the soot layer improves filtration efficiency, this distinction is important to consider. Research on the emission control of PM from a lean GDI engine with a GPF was conducted on an engine dynamometer. PM, after dilution, was characterized with membrane filters, organic vs. elemental carbon characterization, and size distribution techniques at various steady state engine speed and load points. The engine was operated in three primary combustion modes: stoichiometric, lean homogeneous, and lean stratified. In addition, rich combustion was utilized to simulate PM from engine operation during active regeneration of lean NOx control technologies. High (>95%) PM filtration efficiencies were observed over a wide range of conditions; however, some PM was observed to slip through the GPF at high speed and load conditions. The PM characterization at various engine speeds and loads will help enable optimized GPF design and control to achieve more fuel efficient lean GDI vehicles with low PM emissions.« less

Physical Activity Modifies the Association between Dietary Protein and Lean Mass of Postmenopausal Women.

PubMed

Martinez, Jessica A; Wertheim, Betsy C; Thomson, Cynthia A; Bea, Jennifer W; Wallace, Robert; Allison, Matthew; Snetselaar, Linda; Chen, Zhao; Nassir, Rami; Thompson, Patricia A

2017-02-01

Maintenance of lean muscle mass and related strength is associated with lower risk for numerous chronic diseases of aging in women. Our aim was to evaluate whether the association between dietary protein and lean mass differs by physical activity level, amino acid composition, and body mass index categories. We performed a cross-sectional analysis of a prospective cohort. Participants were postmenopausal women from the Women's Health Initiative with body composition measurements by dual-energy x-ray absorptiometry (n=8,298). Our study measured percent lean mass, percent fat mass, and lean body mass index. Linear regression models adjusted for scanner serial number, age, calibrated energy intake, race/ethnicity, neighborhood socioeconomic status, and recreational physical activity were used to determine the relationship between protein intake and body composition measures. Likelihood ratio tests and stratified analysis were used to investigate physical activity and body mass index as potential effect modifiers. Biomarker-calibrated protein intake was positively associated with percent lean mass; women in the highest protein quintile had 6.3 percentage points higher lean mass than the lowest quintile (P<0.001). This difference rose to 8.5 percentage points for physically active women in the highest protein quintile (P interaction =0.023). Percent fat mass and lean body mass index were both inversely related to protein intake (both P<0.001). Physical activity further reduced percent fat mass (P interaction =0.022) and lean body mass index (P interaction =0.011). Leucine intake was associated with lean mass, as were branched chain amino acids combined (both P<0.001), but not independent of total protein. All associations were observed for normal-weight, overweight, and obese women. Protein consumption up to 2.02 g/kg body weight daily is positively associated with lean mass in postmenopausal women. Importantly, those that also engage in physical activity have the highest lean mass across body mass index categories. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Birth weight and growth from infancy to late adolescence in relation to fat and lean mass in early old age: findings from the MRC National Survey of Health and Development.

PubMed

Bann, D; Wills, A; Cooper, R; Hardy, R; Aihie Sayer, A; Adams, J; Kuh, D

2014-01-01

High birth weight and greater weight gain in infancy have been associated with increased risk of obesity as assessed using body mass index, but few studies have examined associations with direct measures of fat and lean mass. This study examined associations of birth weight and weight and height gain in infancy, childhood and adolescence with fat and lean mass in early old age. A total of 746 men and 812 women in England, Scotland and Wales from the MRC National Survey of Health and Development whose heights and weights had been prospectively ascertained across childhood and adolescence and who had dual energy X-ray absorptiometry measures at age 60-64 years. Associations of birth weight and standardised weight and height (0-2 (weight only), 2-4, 4-7, 7-11, 11-15, 15-20 years) gain velocities with outcome measures were examined. Higher birth weight was associated with higher lean mass and lower android/gynoid ratio at age 60-64 years. For example, the mean difference in lean mass per 1 standard deviation increase in birth weight was 1.54 kg in males (95% confidence interval=1.04, 2.03) and 0.78 kg in females (0.41, 1.14). Greater weight gain in infancy was associated with higher lean mass, whereas greater gains in weight in later childhood and adolescence were associated with higher fat and lean mass, and fat/lean and android/gynoid ratios. Across growth intervals greater height gain was associated with higher lean but not fat mass, and with lower fat/lean and android/gynoid ratios. Findings suggest that growth in early life may have lasting effects on fat and lean mass. Greater weight gain before birth and in infancy may be beneficial by leading to higher lean mass, whereas greater weight gain in later childhood and adolescence may be detrimental by leading to higher fat/lean and android/gynoid ratios.

Optimizing clinical operations as part of a global emergency medicine initiative in Kumasi, Ghana: application of Lean manufacturing principals to low-resource health systems.

PubMed

Carter, Patrick M; Desmond, Jeffery S; Akanbobnaab, Christopher; Oteng, Rockefeller A; Rominski, Sarah D; Barsan, William G; Cunningham, Rebecca M

2012-03-01

Although many global health programs focus on providing clinical care or medical education, improving clinical operations can have a significant effect on patient care delivery, especially in developing health systems without high-level operations management. Lean manufacturing techniques have been effective in decreasing emergency department (ED) length of stay, patient waiting times, numbers of patients leaving without being seen, and door-to-balloon times for ST-elevation myocardial infarction in developed health systems, but use of Lean in low to middle income countries with developing emergency medicine (EM) systems has not been well characterized. To describe the application of Lean manufacturing techniques to improve clinical operations at Komfo Anokye Teaching Hospital (KATH) in Ghana and to identify key lessons learned to aid future global EM initiatives. A 3-week Lean improvement program focused on the hospital admissions process at KATH was completed by a 14-person team in six stages: problem definition, scope of project planning, value stream mapping, root cause analysis, future state planning, and implementation planning. The authors identified eight lessons learned during our use of Lean to optimize the operations of an ED in a global health setting: 1) the Lean process aided in building a partnership with Ghanaian colleagues; 2) obtaining and maintaining senior institutional support is necessary and challenging; 3) addressing power differences among the team to obtain feedback from all team members is critical to successful Lean analysis; 4) choosing a manageable initial project is critical to influence long-term Lean use in a new environment; 5) data intensive Lean tools can be adapted and are effective in a less resourced health system; 6) several Lean tools focused on team problem-solving techniques worked well in a low-resource system without modification; 7) using Lean highlighted that important changes do not require an influx of resources; and 8) despite different levels of resources, root causes of system inefficiencies are often similar across health care systems, but require unique solutions appropriate to the clinical setting. Lean manufacturing techniques can be successfully adapted for use in developing health systems. Lessons learned from this Lean project will aid future introduction of advanced operations management techniques in low- to middle-income countries. © 2012 by the Society for Academic Emergency Medicine.

Interactions between lean management and the psychosocial work environment in a hospital setting - a multi-method study.

PubMed

Ulhassan, Waqar; von Thiele Schwarz, Ulrica; Thor, Johan; Westerlund, Hugo

2014-10-22

As health care struggles to meet increasing demands with limited resources, Lean has become a popular management approach. It has mainly been studied in relation to health care performance. The empirical evidence as to how Lean affects the psychosocial work environment has been contradictory. This study aims to study the interaction between Lean and the psychosocial work environment using a comprehensive model that takes Lean implementation information, as well as Lean theory and the particular context into consideration. The psychosocial work environment was measured twice with the Copenhagen Psychosocial Questionnaire (COPSOQ) employee survey during Lean implementations on May-June 2010 (T1) (n = 129) and November-December 2011 (T2) (n = 131) at three units (an Emergency Department (ED), Ward-I and Ward-II). Information based on qualitative data analysis of the Lean implementations and context from a previous paper was used to predict expected change patterns in the psychosocial work environment from T1 to T2 and subsequently compared with COPSOQ-data through linear regression analysis. Between T1 and T2, qualitative information showed a well-organized and steady Lean implementation on Ward-I with active employee participation, a partial Lean implementation on Ward-II with employees not seeing a clear need for such an intervention, and deterioration in already implemented Lean activities at ED, due to the declining interest of top management. Quantitative data analysis showed a significant relation between the expected and actual results regarding changes in the psychosocial work environment. Ward-I showed major improvements especially related to job control and social support, ED showed a major decline with some exceptions while Ward-II also showed improvements similar to Ward-I. The results suggest that Lean may have a positive impact on the psychosocial work environment given that it is properly implemented. Also, the psychosocial work environment may even deteriorate if Lean work deteriorates after implementation. Employee managers and researchers should note the importance of employee involvement in the change process. Employee involvement may minimize the intervention's harmful effects on psychosocial work factors. We also found that a multi-method may be suitable for investigating relations between Lean and the psychosocial work environment.

Optimizing Clinical Operations as part of a Global Emergency Medicine Initiative in Kumasi, Ghana: Application of Lean Manufacturing Principals to Low Resource Health Systems

PubMed Central

Carter, Patrick M.; Desmond, Jeffery S.; Akanbobnaab, Christopher; Oteng, Rockefeller A.; Rominski, Sarah; Barsan, William G.; Cunningham, Rebecca

2012-01-01

Background Although many global health programs focus on providing clinical care or medical education, improving clinical operations can have a significant effect on patient care delivery, especially in developing health systems without high-level operations management. Lean manufacturing techniques have been effective in decreasing emergency department (ED) length of stay, patient waiting times, numbers of patients leaving without being seen, and door-to-balloon times for ST-elevation myocardial infarction in developed health systems; but use of Lean in low to middle income countries with developing emergency medicine systems has not been well characterized. Objectives To describe the application of Lean manufacturing techniques to improve clinical operations at Komfo Anokye Teaching Hospital in Ghana and to identify key lessons learned to aid future global EM initiatives. Methods A three-week Lean improvement program focused on the hospital admissions process at Komfo Anokye Teaching Hospital was completed by a 14-person team in six stages: problem definition, scope of project planning, value stream mapping, root cause analysis, future state planning, and implementation planning. Results The authors identified eight lessons learned during our use of Lean to optimize the operations of an ED in a global health setting: 1) the Lean process aided in building a partnership with Ghanaian colleagues; 2) obtaining and maintaining senior institutional support is necessary and challenging; 3) addressing power differences among the team to obtain feedback from all team members is critical to successful Lean analysis; 4) choosing a manageable initial project is critical to influence long-term Lean use in a new environment; 5) data intensive Lean tools can be adapted and are effective in a less resourced health system; 6) several Lean tools focused on team problem solving techniques worked well in a low resource system without modification; 7) using Lean highlighted that important changes do not require an influx of resources; 8) despite different levels of resources, root causes of system inefficiencies are often similar across health care systems, but require unique solutions appropriate to the clinical setting. Conclusions Lean manufacturing techniques can be successfully adapted for use in developing health systems. Lessons learned from this Lean project will aid future introduction of advanced operations management techniques in low to middle income countries. PMID:22435868

Obesity resistant mechanisms in the Lean polygenic mouse model as indicated by liver transcriptome and expression of selected genes in skeletal muscle

PubMed Central

2011-01-01

Background Divergently selected Lean and Fat mouse lines represent unique models for a polygenic form of resistance and susceptibility to obesity development. Previous research on these lines focused mainly on obesity-susceptible factors in the Fat line. This study aimed to examine the molecular basis of obesity-resistant mechanisms in the Lean line by analyzing various fat depots and organs, the liver transcriptome of selected metabolic pathways, plasma and lipid homeostasis and expression of selected skeletal muscle genes. Results Expression profiling using our custom Steroltalk v2 microarray demonstrated that Lean mice exhibit a higher hepatic expression of cholesterol biosynthesis genes compared to the Fat line, although this was not reflected in elevation of total plasma or liver cholesterol. However, FPLC analysis showed that protective HDL cholesterol was elevated in Lean mice. A significant difference between the strains was also found in bile acid metabolism. Lean mice had a higher expression of Cyp8b1, a regulatory enzyme of bile acid synthesis, and the Abcb11 bile acid transporter gene responsible for export of acids to the bile. Additionally, a higher content of blood circulating bile acids was observed in Lean mice. Elevated HDL and upregulation of some bile acids synthesis and transport genes suggests enhanced reverse cholesterol transport in the Lean line - the flux of cholesterol out of the body is higher which is compensated by upregulation of endogenous cholesterol biosynthesis. Increased skeletal muscle Il6 and Dio2 mRNA levels as well as increased activity of muscle succinic acid dehydrogenase (SDH) in the Lean mice demonstrates for the first time that changes in muscle energy metabolism play important role in the Lean line phenotype determination and corroborate our previous findings of increased physical activity and thermogenesis in this line. Finally, differential expression of Abcb11 and Dio2 identifies novel strong positional candidate genes as they map within the quantitative trait loci (QTL) regions detected previously in crosses between the Lean and Fat mice. Conclusion We identified novel candidate molecular targets and metabolic changes which can at least in part explain resistance to obesity development in the Lean line. The major difference between the Lean and Fat mice was in increased liver cholesterol biosynthesis gene mRNA expression, bile acid metabolism and changes in selected muscle genes' expression in the Lean line. The liver Abcb11 and muscle Dio2 were identified as novel positional candidate genes to explain part of the phenotypic difference between the Lean and Fat lines. PMID:21291556

Clinical supervision: the state of the art.

PubMed

Falender, Carol A; Shafranske, Edward P

2014-11-01

Since the recognition of clinical supervision as a distinct professional competence and a core competence, attention has turned to ensuring supervisor competence and effective supervision practice. In this article, we highlight recent developments and the state of the art in supervision, with particular emphasis on the competency-based approach. We present effective clinical supervision strategies, providing an integrated snapshot of the current status. We close with consideration of current training practices in supervision and challenges. © 2014 Wiley Periodicals, Inc.

Closing the Health Care Gap in Communities: A Safety Net System Approach.

PubMed

Gabow, Patricia A

2016-10-01

The goal of U.S. health care should be good health for every American. This daunting goal will require closing the health care gap in communities with a particular focus on the most vulnerable populations and the safety net institutions that disproportionately serve these communities. This Commentary describes Denver Health's (DH's) two-pronged approach to achieving this goal: (1) creating an integrated system that focuses on the needs of vulnerable populations, and (2) creating an approach for financial viability, quality of care, and employee engagement. The implementation and outcomes of this approach at DH are described to provide a replicable model. An integrated delivery system serving vulnerable populations should go beyond the traditional components found in most integrated health systems and include components such as mental health services, school-based clinics, and correctional health care, which address the unique and important needs of, and points of access for, vulnerable populations. In addition, the demands that a safety net system experiences from an open-door policy on access and revenue require a disciplined approach to cost, quality of care, and employee engagement. For this, DH chose Lean, which focuses on reducing waste to respect the patients and employees within its health system, as well as all citizens. DH's Lean effort produced almost $195 million of financial benefit, impressive clinical outcomes, and high employee engagement. If this two-pronged approach were widely adopted, health systems across the United States would improve their chances of giving better care at costs they can afford for every person in society.

The Effect of Diet and Exercise on Intestinal Integrity and Microbial Diversity in Mice

PubMed Central

Wisniewski, Paul J.; Noji, Michael; McGuinness, Lora R.; Lightfoot, Stanley A.

2016-01-01

Background The gut microbiota is now known to play an important role contributing to inflammatory-based chronic diseases. This study examined intestinal integrity/inflammation and the gut microbial communities in sedentary and exercising mice presented with a normal or high-fat diet. Methods Thirty-six, 6-week old C57BL/6NTac male mice were fed a normal or high-fat diet for 12-weeks and randomly assigned to exercise or sedentary groups. After 12 weeks animals were sacrificed and duodenum/ileum tissues were fixed for immunohistochemistry for occludin, E-cadherin, and cyclooxygenase-2 (COX-2). The bacterial communities were assayed in fecal samples using terminal restriction fragment length polymorphism (TRFLP) analysis and pyrosequencing of 16S rRNA gene amplicons. Results Lean sedentary (LS) mice presented normal histologic villi while obese sedentary (OS) mice had similar villi height with more than twice the width of the LS animals. Both lean (LX) and obese exercise (OX) mice duodenum and ileum were histologically normal. COX-2 expression was the greatest in the OS group, followed by LS, LX and OX. The TRFLP and pyrosequencing indicated that members of the Clostridiales order were predominant in all diet groups. Specific phylotypes were observed with exercise, including Faecalibacterium prausnitzi, Clostridium spp., and Allobaculum spp. Conclusion These data suggest that exercise has a strong influence on gut integrity and host microbiome which points to the necessity for more mechanistic studies of the interactions between specific bacteria in the gut and its host. PMID:26954359

Foreign Language Competence and Content and Language Integrated Learning in Multilingual Schools in Catalonia: An "Ex Post Facto" Study Analysing the Results of State Key Competences Testing

ERIC Educational Resources Information Center

Coral, Josep; Lleixà, Teresa; Ventura, Carles

2018-01-01

The member states of the European Union have funded many initiatives supporting the teaching and learning of foreign languages. Content and language integrated learning is one of the experimental language programmes that have been introduced in Catalonia, in the north-east of Spain. The aims of this study are to analyse the results achieved by…

Assessing the Influence of the PTTC Principal's Competency in ICT on the Teachers' Integration of ICT in Teaching Science in PTTCs in Nyanza Region, Kenya

ERIC Educational Resources Information Center

Omwenga, Ezekiel; Nyabero, Charles; Okioma, Lazarous

2015-01-01

The study was conducted to assess the influence of Primary Teacher Training College (PTTC) principal's competency in ICT on the teacher's integration of ICT in teaching science in PTTC's in Nyanza region in Kenya. The one research question and one research hypothesis guided the study. The population comprised of 21 principals and 159 tutors. Data…

Deliberate Integration of Student Leadership Development in Doctor of Pharmacy Programs

PubMed Central

Nelson, Michael H.; Bzowyckyj, Andrew S.; Fuentes, David G.; Rosenberg, Ettie; DiCenzo, Robert

2016-01-01

The CAPE 2013 Outcomes answered the call for increased student leadership development (SLD) by identifying leadership as a desired curricular goal. To meet this outcome, colleges and schools of pharmacy are advised to first identify a set of SLD competencies aligned with their institution’s mission and goals and then organize these competencies into a SLD framework/model. Student leadership development should be integrated vertically and horizontally within the curriculum in a deliberate and longitudinal manner. It should include all student pharmacists, begin at the point of admission, and extend beyond extracurricular activities. The school’s assessment plan should be aligned with the identified SLD competencies so student learning related to leadership is assessed. To accomplish these recommendations, a positive environment for SLD should be cultivated within the school, including administrative backing and resources, as well as support among the broader faculty for integrating SLD into the curriculum. PMID:26941428

Deliberate Integration of Student Leadership Development in Doctor of Pharmacy Programs.

PubMed

Janke, Kristin K; Nelson, Michael H; Bzowyckyj, Andrew S; Fuentes, David G; Rosenberg, Ettie; DiCenzo, Robert

2016-02-25

The CAPE 2013 Outcomes answered the call for increased student leadership development (SLD) by identifying leadership as a desired curricular goal. To meet this outcome, colleges and schools of pharmacy are advised to first identify a set of SLD competencies aligned with their institution's mission and goals and then organize these competencies into a SLD framework/model. Student leadership development should be integrated vertically and horizontally within the curriculum in a deliberate and longitudinal manner. It should include all student pharmacists, begin at the point of admission, and extend beyond extracurricular activities. The school's assessment plan should be aligned with the identified SLD competencies so student learning related to leadership is assessed. To accomplish these recommendations, a positive environment for SLD should be cultivated within the school, including administrative backing and resources, as well as support among the broader faculty for integrating SLD into the curriculum.

General practice, primary care, and health service psychology: concepts, competencies, and the Combined-Integrated model.

PubMed

Schulte, Timothy J; Isley, Elayne; Link, Nancy; Shealy, Craig N; Winfrey, LaPearl Logan

2004-10-01

The profession of psychology is being impacted profoundly by broader changes within the national system of health care, as mental and behavioral health services are being recognized as essential components of a comprehensive, preventive, and cost-efficient primary care system. To fully define and embrace this role, the discipline of professional psychology must develop a shared disciplinary identity of health service psychology and a generalized competency-based model for doctoral education and training. This very framework has been adopted by Combined-Integrated (C-I) doctoral programs in professional psychology, which train across the practice areas (clinical, counseling, and school psychology) to provide a general and integrative foundation for their students. Because C-I programs produce general practitioners who are competent to function within a variety of health service settings, this innovative training approach has great potential to educate and train psychologists for a changing health care marketplace. Copyright 2004 Wiley Periodicals, Inc.

Using Dynamic Value Stream Mapping and Lean Accounting Box Scores to Support Lean Implementation

ERIC Educational Resources Information Center

Woehrle, Stephen L.; Abou-Shady, Louay

2010-01-01

Lean has proven to be an effective management philosophy for improving businesses in a competitive market by eliminating waste and improving operations. An impact of implementing lean projects is the rapid reduction in inventory levels, which gives management the false impression that profits are decreasing while workers on the shop floor observe…

Building Lean Supply Chain and Manufacturing Skills through an Interactive Case Study

ERIC Educational Resources Information Center

Ozelkan, Ertunga C.; Teng, S. Gary; Johnson, Thomas; Benson, Tom; Nestvogel, Dean

2007-01-01

With the ongoing global pressure to cut costs and focus on quality, many companies have been implementing "lean manufacturing" concepts to survive in the competitive marketplace. Thus it is imperative that engineering and business graduates are equipped with the lean principles, and are ready to take ownership of lean initiatives as they enter the…

Assessment of Reduced-Kinetics Mechanisms for Combustion of Jet Fuel in CFD Applications

NASA Technical Reports Server (NTRS)

Ajmani, Kumud; Kundu, Krihna P.; Yungster, Shaye J.

2014-01-01

A computational effort was undertaken to analyze the details of fluid flow in Lean-Direct Injection (LDI) combustors for next-generation LDI design. The National Combustor Code (NCC) was used to perform reacting flow computations on single-element LDI injector configurations. The feasibility of using a reduced chemical-kinetics approach, which optimizes the reaction rates and species to model the emissions characteristics typical of lean-burning gas-turbine combustors, was assessed. The assessments were performed with Reynolds- Averaged Navier-Stokes (RANS) and Time-Filtered Navier Stokes (TFNS) time-integration, with a Lagrangian spray model with the NCC code. The NCC predictions for EINOx and combustor exit temperature were compared with experimental data for two different single-element LDI injector configurations, with 60deg and 45deg axially swept swirler vanes. The effects of turbulence-chemistry interaction on the predicted flow in a typical LDI combustor were studied with detailed comparisons of NCC TFNS with experimental data.

Application of Student Book Based On Integrated Learning Model Of Networked Type With Heart Electrical Activity Theme For Junior High School

NASA Astrophysics Data System (ADS)

Gusnedi, G.; Ratnawulan, R.; Triana, L.

2018-04-01

The purpose of this study is to determine the effect of the use of Integrated Science IPA books Using Networked Learning Model of knowledge competence through improved learning outcomes obtained. The experimental design used is one group pre test post test design to know the results before and after being treated. The number of samples used is one class that is divided into two categories of initial ability to see the improvement of knowledge competence. The sample used was taken from the students of grade VIII SMPN 2 Sawahlunto, Indonesia. The results of this study indicate that most students have increased knowledge competence.

Evaluation of Social Competencies in Chemical Engineering: Application and Results of the Pilot Test (Academic Year 2012-2013)

ERIC Educational Resources Information Center

Grande, Francisco José Suñé; Witt, Hans Jörg; Avalos, Josep Bonet

2015-01-01

The Escola Tècnica Superior d'Enginyeria Química has a long tradition in the deployment of social competencies in engineering curricula through Integrated Projects (IP) carried out in structured teams. Social competencies are taught and practiced during the development of the IPs. We conceptually introduce a methodology for a 360 degrees…

The Essence and Structure of History and Legal Studies Teacher's Competency: Analysis of Ukrainian and Foreign Scholars' Approaches

ERIC Educational Resources Information Center

Riabovol, Liliia

2017-01-01

For a teacher to be professionally successful, they should possess relevant competencies. A history and legal studies teacher's competency as an integrated entity has not been the subject of scientific researches yet. The paper aims to analyze legal documents as well as scientific literature, generalize and systematize the approaches to…

A customized, integrated approach to cultural competence education.

PubMed

Mancuso, Lorraine

2011-01-01

As the racial and ethnic composition of our communities become more diverse, staff educators prepare healthcare workers to recognize the need to adapt their approach to each patient based on their values, beliefs, and lifestyle and to acquire new skills to accomplish this aim. Effective curriculum for cultural competence education customizes the context of the message to align it with the mission, the philosophy, and the strategic goals of the organization and tailors the content of programs to include the specific ethnic groups most frequently encountered in the organization. This article describes a process for developing and implementing a customized, integrated approach to staff cultural competence by the diversity committee of a community hospital in New Hampshire. This approach engages individuals in readiness to learn and supports changes in behavior to promote health equity and cultural proficiency within the framework of the J. Camphina-Bacote (2005) model for cultural competence. Cultural competence education is not an event, but a process. Staff educators can be alert to the need for updated educational programs based on staff and patient outcomes and recommend systems changes that promote cultural competence and support organizational adherence to the Joint Commission standards for culturally and linguistically appropriate care.

Integrative platform based on the mechatronics model for educational technologies focused on competence

NASA Astrophysics Data System (ADS)

Vlaşin, I.; Greta, S.; Dache, L.; Mătieş, V.

2016-08-01

Mechatronics is a model of transdisciplinary integration, entirely functional, with remarkable results for mankind. The incredible progress that the global economy has taken in the last decades is based on this new approach, the integrative type, which is present at the foundation of mechatronics. This kind of integrative approach is necessary for building a quality education focused on competence. The requirements from the social and economic environment, the needs of the young people who prepare themselves for an active life and the offers of the education providers are still not too interconnected to offer a satisfying education. This is the reason why the efforts to balance the demand, the needs and the offer are essential to ensure a better integration of students into society. Using a transcultural perspective, we can achieve a constructive approach. The education providers, together with the socio-economic environment, establish a clear structure of competence in multiple domains and of the instruments which can assure it. The scientific demarche, in the spirit of this paper approach the, answers the natural questions from the educational process: „Why, How and What do I learn?”.

Comparison of the gut microbial community between obese and lean peoples using 16S gene sequencing in a Japanese population.

PubMed

Andoh, Akira; Nishida, Atsushi; Takahashi, Kenichiro; Inatomi, Osamu; Imaeda, Hirotsugu; Bamba, Shigeki; Kito, Katsuyuki; Sugimoto, Mitsushige; Kobayashi, Toshio

2016-07-01

Altered gut microbial ecology contributes to the development of metabolic diseases including obesity. In this study, we performed 16S rRNA sequence analysis of the gut microbiota profiles of obese and lean Japanese populations. The V3-V4 hypervariable regions of 16S rRNA of fecal samples from 10 obese and 10 lean volunteers were sequenced using the Illumina MiSeq(TM)II system. The average body mass index of the obese and lean group were 38.1 and 16.6 kg/m(2), respectively (p<0.01). The Shannon diversity index was significantly higher in the lean group than in the obese group (p<0.01). The phyla Firmicutes and Fusobacteria were significantly more abundant in obese people than in lean people. The abundance of the phylum Bacteroidetes and the Bacteroidetes/Firmicutes ratio were not different between the obese and lean groups. The genera Alistipes, Anaerococcus, Corpococcus, Fusobacterium and Parvimonas increased significantly in obese people, and the genera Bacteroides, Desulfovibrio, Faecalibacterium, Lachnoanaerobaculum and Olsenella increased significantly in lean people. Bacteria species possessing anti-inflammatory properties, such as Faecalibacterium prausnitzii, increased significantly in lean people, but bacteria species possessing pro-inflammatory properties increased in obese people. Obesity-associated gut microbiota in the Japanese population was different from that in Western people.

Lean in healthcare from employees' perspectives.

PubMed

Drotz, Erik; Poksinska, Bozena

2014-01-01

The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations. The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies. The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers. Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations' working environment, staff development, and organizational performance. In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.

Assessing clinical competency in the health sciences

NASA Astrophysics Data System (ADS)

Panzarella, Karen Joanne

To test the success of integrated curricula in schools of health sciences, meaningful measurements of student performance are required to assess clinical competency. This research project analyzed a new performance assessment tool, the Integrated Standardized Patient Examination (ISPE), for assessing clinical competency: specifically, to assess Doctor of Physical Therapy (DPT) students' clinical competence as the ability to integrate basic science knowledge with clinical communication skills. Thirty-four DPT students performed two ISPE cases, one of a patient who sustained a stroke and the other a patient with a herniated lumbar disc. Cases were portrayed by standardized patients (SPs) in a simulated clinical setting. Each case was scored by an expert evaluator in the exam room and then by one investigator and the students themselves via videotape. The SPs scored each student on an overall encounter rubric. Written feedback was obtained from all participants in the study. Acceptable reliability was demonstrated via inter-rater agreement as well as inter-rater correlations on items that used a dichotomous scale, whereas the items requiring the use of the 4-point rubric were somewhat less reliable. For the entire scale both cases had a significant correlation between the Expert-Investigator pair of raters, for the CVA case r = .547, p < .05 and for the HD case r = .700, p < .01. The SPs scored students higher than the other raters. Students' self-assessments were most closely aligned with the investigator. Effects were apparent due to case. Content validity was gathered in the process of developing cases and patient scenarios that were used in this study. Construct validity was obtained from the survey results analyzed from the experts and students. Future studies should examine the effect of rater training upon the reliability. Criterion or predictive validity could be further studied by comparing students' performances on the ISPE with other independent estimates of students' competence. The unique integration questions of the ISPE were judged to have good content validity from experts and students, suggestive that integration, a most crucial element of clinical competence, while done in the mind of the student, can be practiced, learned and assessed.

Trunk lean gait decreases multi-segmental coordination in the vertical direction.

PubMed

Tokuda, Kazuki; Anan, Masaya; Sawada, Tomonori; Tanimoto, Kenji; Takeda, Takuya; Ogata, Yuta; Takahashi, Makoto; Kito, Nobuhiro; Shinkoda, Koichi

2017-11-01

[Purpose] The strategy of trunk lean gait to reduce external knee adduction moment (KAM) may affect multi-segmental synergy control of center of mass (COM) displacement. Uncontrolled manifold (UCM) analysis is an evaluation index to understand motor variability. The purpose of this study was to investigate how motor variability is affected by using UCM analysis on adjustment of the trunk lean angle. [Subjects and Methods] Fifteen healthy young adults walked at their preferred speed under two conditions: normal and trunk lean gait. UCM analysis was performed with respect to the COM displacement during the stance phase. The KAM data were analyzed at the points of the first KAM peak during the stance phase. [Results] The KAM during trunk lean gait was smaller than during normal gait. Despite a greater segmental configuration variance with respect to mediolateral COM displacement during trunk lean gait, the synergy index was not significantly different between the two conditions. The synergy index with respect to vertical COM displacement during trunk lean gait was smaller than that during normal gait. [Conclusion] These results suggest that trunk lean gait is effective in reducing KAM; however, it may decrease multi-segmental movement coordination of COM control in the vertical direction.

The challenges of lean manufacturing implementation in kitting assembly

NASA Astrophysics Data System (ADS)

Fansuri, A. F. H.; Rose, A. N. M.; Nik Mohamed, N. M. Z.; Ahmad, H.

2017-10-01

Literature studies shows that lean manufacturing goes way back with the original founder Eli Whitney in year 1799. The main purpose of lean manufacturing is to identify and eliminate waste in production. The application of lean manufacturing can be carried out in any industrial processes with regards to the understanding of lean principles, theories and practices. Kitting is one of the important aspects in a successful production. The continuous supply of materials from store to production has to be systematic and able to achieve lean standard for it to be successful. The objective of this paper is to review the implementation of lean manufacturing in kitting assembly. Previous papers show that, the implementation of lean manufacturing in kitting assembly may be beneficial to the organization such as reduce in space occupancy, part shortages, lead time and manpower. Based on previous research, some industries may tend to change between kitting and line stocking which are due to lack of understanding when implementing kitting and causes longer lead time and materials overflow in store. With a proper understanding on what to kit, where to kit, how to kit, why to kit and who kits the material with a standardised process flow may ensure the success of kitting.

Leadership requirements for Lean versus servant leadership in health care: a systematic review of the literature

PubMed Central

Aij, Kjeld Harald; Rapsaniotis, Sofia

2017-01-01

As health care organizations face pressures to improve quality and efficiency while reducing costs, leaders are adopting management techniques and tools used in manufacturing and other industries, especially Lean. Successful Lean leaders appear to use a coaching leadership style that shares underlying principles with servant leadership. There is little information about specific similarities and differences between Lean and servant leaderships. We systematically reviewed the literature on Lean leadership, servant leadership, and health care and performed a comparative analysis of attributes using Russell and Stone’s leadership framework. We found significant overlap between the two leadership styles, although there were notable differences in origins, philosophy, characteristics and behaviors, and tools. We conclude that both Lean and servant leaderships are promising models that can contribute to the delivery of patient-centered, high-value care. Servant leadership may provide the means to engage and develop employees to become successful Lean leaders in health care organizations. PMID:29355240

The impact of genetics on retail meat value in Australian lamb.

PubMed

Anderson, F; Pethick, D W; Gardner, G E

2016-07-01

Lean (muscle), fat, and bone composition of 1554 lamb carcasses from Maternal, Merino and Terminal sired lambs was measured using computed tomography scanning. Lamb sires were diverse in their range of Australian Sheep Breeding Values for post weaning c-site eye muscle depth (PEMD) and fat depth (PFAT), and post weaning weight (PWWT). Lean value, representing predicted lean weight multiplied by retail value, was determined for lambs at the same carcass weight or the same age. At the same carcass weight, lean value was increased the most by reducing sire PFAT, followed by increasing PEMD and PWWT. However for lambs of the same age, increasing sire PWWT increased lean value the most. Terminal sired lambs, on average, had greater lean value irrespective of whether comparisons were made at the same age or weight. Lean value was greater in Merino compared to Maternal sired lambs at equal carcass weight, however the reverse was true when comparisons were made at the same age. Copyright © 2016 Elsevier Ltd. All rights reserved.

Method for automatically evaluating a transition from a batch manufacturing technique to a lean manufacturing technique

DOEpatents

Ivezic, Nenad; Potok, Thomas E.

2003-09-30

A method for automatically evaluating a manufacturing technique comprises the steps of: receiving from a user manufacturing process step parameters characterizing a manufacturing process; accepting from the user a selection for an analysis of a particular lean manufacturing technique; automatically compiling process step data for each process step in the manufacturing process; automatically calculating process metrics from a summation of the compiled process step data for each process step; and, presenting the automatically calculated process metrics to the user. A method for evaluating a transition from a batch manufacturing technique to a lean manufacturing technique can comprise the steps of: collecting manufacturing process step characterization parameters; selecting a lean manufacturing technique for analysis; communicating the selected lean manufacturing technique and the manufacturing process step characterization parameters to an automatic manufacturing technique evaluation engine having a mathematical model for generating manufacturing technique evaluation data; and, using the lean manufacturing technique evaluation data to determine whether to transition from an existing manufacturing technique to the selected lean manufacturing technique.

The promise of Lean in health care.

PubMed

Toussaint, John S; Berry, Leonard L

2013-01-01

An urgent need in American health care is improving quality and efficiency while controlling costs. One promising management approach implemented by some leading health care institutions is Lean, a quality improvement philosophy and set of principles originated by the Toyota Motor Company. Health care cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing. When well executed, Lean transforms how an organization works and creates an insatiable quest for improvement. In this article, we define Lean and present 6 principles that constitute the essential dynamic of Lean management: attitude of continuous improvement, value creation, unity of purpose, respect for front-line workers, visual tracking, and flexible regimentation. Health care case studies illustrate each principle. The goal of this article is to provide a template for health care leaders to use in considering the implementation of the Lean management system or in assessing the current state of implementation in their organizations. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Lean sigma--will it work for healthcare?

PubMed

Bahensky, James A; Roe, Janet; Bolton, Romy

2005-01-01

The manufacturing industry has been using Lean Sigma for years in pursuit of continuous improvement to obtain a competitive advantage. The objectives of these efforts are to use the Lean techniques for reducing cycle times and the Six Sigma concepts for reducing product defects. The Iowa Business Council with several advocates worked with the University of Iowa Hospital and Clinics (UIHC) and two other Iowa hospitals to determine whether Lean Sigma is adaptable in healthcare. A team of 15 people at UIHC used the Kaizen Breakthrough Methodology over a five-day period in an aggressive identification and elimination of non-value added activities in Radiology CT scanning. The results exceeded the initial project objectives and indicated that Lean Sigma is applicable in healthcare. Overall, the Lean Sigma project increased revenue by approximately $750,000 per year. The Kaizen process proved to be successful and interesting. Within three days, the team installed new work flow processes. This implementation-oriented approach is what differentiates Lean Sigma from other quality improvement processes.

Developing high-level change and innovation agents: competencies and challenges for executive leadership.

PubMed

Malloch, Kathy; Melnyk, Bernadette Mazurek

2013-01-01

The work of health care reform and revolution requires leadership competencies that integrate the digital realities of time, space, and media. Leadership skills and behaviors of command, control, and directing from predigital times are no longer effective, given the impacts of the digital changes. Developing leadership competence in evidence-driven processes, facilitation, collaborative teamwork, and instilling a sense of urgency is the work of today's executive leaders. Ten competencies necessary for contemporary executive leadership are presented in this article.

Leaning to the left makes the Eiffel Tower seem smaller: posture-modulated estimation.

PubMed

Eerland, Anita; Guadalupe, Tulio M; Zwaan, Rolf A

2011-12-01

In two experiments, we investigated whether body posture influences people's estimation of quantities. According to the mental-number-line theory, people mentally represent numbers along a line with smaller numbers on the left and larger numbers on the right. We hypothesized that surreptitiously making people lean to the right or to the left would affect their quantitative estimates. Participants answered estimation questions while standing on a Wii Balance Board. Posture was manipulated within subjects so that participants answered some questions while they leaned slightly to the left, some questions while they leaned slightly to the right, and some questions while they stood upright. Crucially, participants were not aware of this manipulation. Estimates were significantly smaller when participants leaned to the left than when they leaned to the right.

Writing a Wikipedia Article on Cultural Competence in Health Care.

PubMed

Zhang, Yingting; Lin, Yu-Hung

2016-01-01

This article describes how librarians created a Wikipedia article on cultural competence in health care to support the medical school's curriculum. Wikipedia, often considered not as reliable as scholarly articles, continues to be popular. Rutgers librarians conducted a Wikipedia project to improve its content to benefit students. The importance of cultural competency in health care is widely recognized due to increasingly diverse patient populations. Medical schools integrate cultural competency in curricula to train students to be culturally competent. Therefore, this topic was chosen for the Wikipedia Project. It is hoped that health sciences librarians and educators will benefit from their experience.

The Lean and Environment Toolkit

EPA Pesticide Factsheets

This Lean and Environment Toolkit assembles practical experience collected by the U.S. Environmental Protection Agency (EPA) and partner companies and organizations that have experience with coordinating Lean implementation and environmental management.

Agile: From Software to Mission Systems

NASA Technical Reports Server (NTRS)

Trimble, Jay; Shirley, Mark; Hobart, Sarah

2017-01-01

To maximize efficiency and flexibility in Mission Operations System (MOS) design, we are evolving principles from agile and lean methods for software, to the complete mission system. This allows for reduced operational risk at reduced cost, and achieves a more effective design through early integration of operations into mission system engineering and flight system design. The core principles are assessment of capability through demonstration, risk reduction through targeted experiments, early test and deployment, and maturation of processes and tools through use.

HSCT Sector Combustor Hardware Modifications for Improved Combustor Design

NASA Technical Reports Server (NTRS)

Greenfield, Stuart C.; Heberling, Paul V.; Moertle, George E.

2005-01-01

An alternative to the stepped-dome design for the lean premixed prevaporized (LPP) combustor has been developed. The new design uses the same premixer types as the stepped-dome design: integrated mixer flameholder (IMFH) tubes and a cyclone swirler pilot. The IMFH fuel system has been taken to a new level of development. Although the IMFH fuel system design developed in this Task is not intended to be engine-like hardware, it does have certain characteristics of engine hardware, including separate fuel circuits for each of the fuel stages. The four main stage fuel circuits are integrated into a single system which can be withdrawn from the combustor as a unit. Additionally, two new types of liner cooling have been designed. The resulting lean blowout data was found to correlate well with the Lefebvre parameter. As expected, CO and unburned hydrocarbons emissions were shown to have an approximately linear relationship, even though some scatter was present in the data, and the CO versus flame temperature data showed the typical cupped shape. Finally, the NOx emissions data was shown to agree well with a previously developed correlation based on emissions data from Configuration 3 tests performed at GEAE. The design variations of the cyclone swirler pilot that were investigated in this study did not significantly change the NOx emissions from the baseline design (GEAE Configuration 3) at supersonic cruise conditions.

Quality of doctor-patient communication through the eyes of the patient: variation according to the patient's educational level.

PubMed

Aelbrecht, Karolien; Rimondini, Michela; Bensing, Jozien; Moretti, Francesca; Willems, Sara; Mazzi, Mariangela; Fletcher, Ian; Deveugele, Myriam

2015-10-01

Good doctor-patient communication may lead to better compliance, higher patient satisfaction, and finally, better health. Although the social variance in how physicians and patients communicate is clearly demonstrated, little is known about what patients with different educational attainments actually prefer in doctor-patient communication. In this study we describe patients' perspective in doctor-patient communication according to their educational level, and to what extent these perspectives lean towards the expert opinion on doctor-patient communication. In a multi-center study (Belgium, The Netherlands, UK and Italy), focus group discussions were organised using videotaped medical consultations. A mixed methods approach was used to analyse the data. Firstly, a difference in perspective in communication style was found between the lower educated participants versus the middle and higher educated participants. Secondly, lower educated participants referred positively most to aspects related to the affective/emotional area of the medical consultation, followed by the task-oriented/problem-focused area. Middle and higher educated participants positively referred most to the task-oriented/problem-focused area. The competency of the physician was an important category of communication for all participants, independent of social background. The results indicate that the preferences of lower educated participants lean more towards the expert opinion in doctor-patient communication than the middle and higher educated participants. Patients' educational level seems to influence their perspective on communication style and should be taken into account by physicians. Further quantitative research is needed to confirm these results.

Experiences of leaders in the implementation of Lean in a teaching hospital—barriers and facilitators in clinical practices: a qualitative study

PubMed Central

Aij, Kjeld Harald; Simons, Frederique Elisabeth; Widdershoven, Guy A M; Visse, Merel

2013-01-01

Objectives To date, experiences of leaders in the implementation of Lean after a Lean Training Programme have not been systematically investigated within teaching hospitals. Existing studies have identified barriers and facilitators only from an improvement programme perspective and have not considered the experiences of leaders themselves. This study aims to bridge this gap. Design Semistructured, indepth interviews. Setting One of largest teaching hospitals in the Netherlands. Participants 31 medical, surgical and nursing professionals with an average of 19.2 years of supervisory experience. All professionals were appointed to a Lean Training Programme and were directly involved in the implementation of Lean. Results The evidence obtained in this study shows that, from the perspectives of participants, leadership management support, a continuous learning environment and cross-departmental cooperation play a significant role in successful Lean implementation. The results suggest that a Lean Training Programme contributed to positive outcomes in personal and professional skills that were evident during the first 4 months after programme completion. Conclusions Implementing Lean in a teaching hospital setting is a challenge because of the ambiguous and complex environment of a highly professionalised organisation. The study found that leadership management support and a continuous learning environment are important facilitators of Lean implementation. To increase the successful outcomes of leadership actions, training should be supplemented with actions to remove perceived barriers. This requires the involvement of all professionals, the crossing of departmental boundaries and a focus on meaning-making processes rather than simply ‘implementing’ facts. Therefore, this research suggests that programme participants, such as staff members and leaders, can mutually explore the meanings of Lean thinking and working for their own contexts. By entering this shared learning process (eg, learning on the job) the ownership of Lean implementation could also increase. PMID:24171938

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

PubMed

Kaltenbrunner, Monica; Bengtsson, Lars; Mathiassen, Svend Erik; Engström, Maria

2017-03-24

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. 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. 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. 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.

[Tendencies on ability related to competence education when realizing undergraduate public health study system].

PubMed

Sveikauskas, Vaclovas

2006-01-01

The aim of this paper is to reveal tendencies on competence and ability education when realizing undergraduate public health study program in the interaction context of traditional and modern higher education features. Competence is implementation of qualification or the ability to act, conditioned by individual's knowledge, skills, motives, personal characteristics, and values. The integrated competence is necessary for the change of the internal and external work conditions; it is based on the integrity of behavior and knowledge that conditions the essential change of activity. The holistic competence is necessary for a new work development and the transfer of qualification to new situations; it is conditioned by holistic approach toward education. When researching undergraduate public health study program in the context of traditional and modern higher education features at Kaunas University of Medicine, the following problems were stated: insufficient qualities of student's self-analysis, self-directed learning and formation of communication skills; insufficient communication of teachers and students during study process; limited possibilities team work with representatives of other professions when solving problems of public health improvement.

Promotion of Healthy Weight-Control Practices in Young Athletes.

PubMed

Carl, Rebecca L; Johnson, Miriam D; Martin, Thomas J

2017-09-01

Children and adolescents may participate in sports that favor a particular body type. Some sports, such as gymnastics, dance, and distance running, emphasize a slim or lean physique for aesthetic or performance reasons. Participants in weight-class sports, such as wrestling and martial arts, may attempt weight loss so they can compete at a lower weight class. Other sports, such as football and bodybuilding, highlight a muscular physique; young athletes engaged in these sports may desire to gain weight and muscle mass. This clinical report describes unhealthy methods of weight loss and gain as well as policies and approaches used to curb these practices. The report also reviews healthy strategies for weight loss and weight gain and provides recommendations for pediatricians on how to promote healthy weight control in young athletes. Copyright © 2017 by the American Academy of Pediatrics.

Curriculum: To Integrate or Not To Integrate.

ERIC Educational Resources Information Center

Miller, Kathleen A.

Teachers who use cooperative, integrated methods will produce students more competent in problem solving techniques, communicating effectively, and working cooperatively with others. Benefits of an integrated curriculum include: (1) reaching students with different learning types; (2) developing critical and divergent thinking skills in students;…

Relationship Between Changes in Fat and Lean Depots Following Weight Loss and Changes in Cardiovascular Disease Risk Markers.

PubMed

Clifton, Peter M

2018-04-04

Gluteofemoral fat mass has been associated with improved cardiovascular disease risk factors. It is not clear if loss of this protective fat during weight loss partially negates the effect of loss of visceral fat. The aim of this study was to examine regional fat loss in a large weight-loss cohort from one center and to determine if fat loss in the leg and total lean tissue loss is harmful. We combined the data from 7 of our previously published 3-month weight-loss studies and examined the relationship between regional fat and lean tissue loss and changes in cardiovascular disease risk factors in 399 participants. At baseline, leg fat was positively associated with high-density lipoprotein cholesterol in women and inversely with fasting triglyceride level in both sexes. Abdominal lean tissue was also related to systolic blood pressure in men. Changes in regional fat and lean tissue were positively associated with changes in glucose, insulin, total cholesterol, triglycerides, low-density lipoprotein cholesterol and systolic and diastolic blood pressure ( r =0.11-0.22, P <0.05) with leg fat and arm lean tissue dominating in multivariate regression. After adjustment for total weight or total fat change, these relationships disappeared except for a positive relationship between arm and lean leg mass loss and changes in triglycerides and systolic blood pressure. Loss of leg fat and leg lean tissue was directly associated with beneficial changes in cardiovascular disease risk markers. Loss of lean tissue may not have an adverse effect on cardiovascular disease risk, and measures to retain lean tissue during weight loss may not be necessary. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

The effect of high-fat diet on the composition of the gut microbiota in cloned and non-cloned pigs of lean and obese phenotype

PubMed Central

Pedersen, Rebecca; Andersen, Anders Daniel; Hermann-Bank, Marie Louise; Stagsted, Jan; Boye, Mette

2013-01-01

The aim of this study was to investigate the effect of high-far-high-energy diet on cloned and non-cloned domestic pigs of both lean and obese phenotype and to evaluate if the lean cloned pigs had a lower inter-individual variation as compared with non-cloned pigs. The microbiota of colon and terminal ileum was investigated in cloned and non-cloned pigs that received a high-far-high-energy diet with either restricted or ad libitum access to feed, resulting in lean and obese phenotypes, respectively. The fecal microbiota of lean pigs was investigated by terminal restriction fragment length polymorphism (T-RFLP). The intestinal microbiota of lean and obese cloned and non-cloned pigs was analyzed by quantitative real time PCR and a novel high-throughput qPCR platform (Fluidigm). Principal component analysis (PCA) of the T-RFLP profiles revealed that lean cloned and non-cloned pigs had a different overall composition of their gut microbiota. The colon of lean cloned pigs contained relatively more bacteria belonging to the phylum Firmicutes and less from the phylum Bacteroidetes than obese cloned pigs as estimated by qPCR. Fluidigm qPCR results revealed differences in specific bacterial groups in the gut microbiota of both lean and obese pigs. Our results suggest that high-far-high-energy diet is associated with changes in the gut microbiota even in the absence of obesity. Overall, the cloned pigs had a different gut microbiota from that of non-cloned pigs. To our knowledge this is the first study to investigate the gut microbiota of cloned domestic pigs of lean and obese phenotype. PMID:23974297

Clinical and Metabolic Characterization of Lean Caucasian Subjects With Non-alcoholic Fatty Liver.

PubMed

Feldman, Alexandra; Eder, Sebastian K; Felder, Thomas K; Kedenko, Lyudmyla; Paulweber, Bernhard; Stadlmayr, Andreas; Huber-Schönauer, Ursula; Niederseer, David; Stickel, Felix; Auer, Simon; Haschke-Becher, Elisabeth; Patsch, Wolfgang; Datz, Christian; Aigner, Elmar

2017-01-01

Non-alcoholic fatty liver disease (NAFLD) is closely linked to obesity; however, 5-8% of lean subjects also have evidence of NAFLD. We aimed to investigate clinical, genetic, metabolic and lifestyle characteristics in lean Caucasian subjects with NAFLD. Data from 187 subjects allocated to one of the three groups according to body mass index (BMI) and hepatic steatosis on ultrasound were obtained: lean healthy (BMI≤25 kg/m 2 , no steatosis, N=71), lean NAFLD (BMI≤25 kg/m 2 , steatosis, N=55), obese NAFLD (BMI≥30 kg/m 2 , steatosis; N=61). All subjects received a detailed clinical and laboratory examination including oral glucose tolerance test. The serum metabolome was assessed using the Metabolomics AbsoluteIDQ p180 kit (BIOCRATES Life Sciences). Genotyping for single-nucleotide polymorphisms (SNPs) associated with NAFLD was performed. Lean NAFLD subjects had fasting insulin concentrations similar to lean healthy subjects but had markedly impaired glucose tolerance. Lean NAFLD subjects had a higher rate of the mutant PNPLA3 CG/GG variant compared to lean controls (P=0.007). Serum adiponectin concentrations were decreased in both NAFLD groups compared to controls (P<0.001 for both groups) The metabolomics study revealed a potential role for various lysophosphatidylcholines (lyso-PC C18:0, lyso-PC C17:0) and phosphatidylcholines (PCaa C36:3; false discovery rate (FDR)-corrected P-value<0.001) as well as lysine, tyrosine, and valine (FDR<0.001). Lean subjects with evidence of NAFLD have clinically relevant impaired glucose tolerance, low adiponectin concentrations and a distinct metabolite profile with an increased rate of PNPLA3 risk allele carriage.

Weight-adjusted lean body mass and calf circumference are protective against obesity-associated insulin resistance and metabolic abnormalities.

PubMed

Takamura, Toshinari; Kita, Yuki; Nakagen, Masatoshi; Sakurai, Masaru; Isobe, Yuki; Takeshita, Yumie; Kawai, Kohzo; Urabe, Takeshi; Kaneko, Shuichi

2017-07-01

To test the hypothesis that preserved muscle mass is protective against obesity-associated insulin resistance and metabolic abnormalities, we analyzed the relationship of lean body mass and computed tomography-assessed sectional areas of specific skeletal muscles with insulin resistance and metabolic abnormalities in a healthy cohort. A total of 195 subjects without diabetes who had completed a medical examination were included in this study. Various anthropometric indices such as circumferences of the arm, waist, hip, thigh, and calf were measured. Body composition (fat and lean body mass) was determined by bioelectrical impedance analysis. Sectional areas of specific skeletal muscles (iliopsoas, erector spinae, gluteus, femoris, and rectus abdominis muscles) were measured using computed tomography. Fat and lean body mass were significantly correlated with metabolic abnormalities and insulin resistance indices. When adjusted by weight, relationships of fat and lean body mass with metabolic parameters were mirror images of each other. The weight-adjusted lean body mass negatively correlated with systolic and diastolic blood pressures; fasting plasma glucose, HbA1c, alanine aminotransferase, and triglyceride, and insulin levels; and hepatic insulin resistance indices, and positively correlated with HDL-cholesterol levels and muscle insulin sensitivity indices. Compared with weight-adjusted lean body mass, weight-adjusted sectional areas of specific skeletal muscles showed similar, but not as strong, correlations with metabolic parameters. Among anthropometric measures, the calf circumference best reflected lean body mass, and weight-adjusted calf circumference negatively correlated with metabolic abnormalities and insulin resistance indices. Weight-adjusted lean body mass and skeletal muscle area are protective against weight-associated insulin resistance and metabolic abnormalities. The calf circumference reflects lean body mass and may be useful as a protective marker against obesity-associated metabolic abnormalities.

The effect of high-fat diet on the composition of the gut microbiota in cloned and non-cloned pigs of lean and obese phenotype.

PubMed

Pedersen, Rebecca; Andersen, Anders Daniel; Hermann-Bank, Marie Louise; Stagsted, Jan; Boye, Mette

2013-01-01

The aim of this study was to investigate the effect of high-far-high-energy diet on cloned and non-cloned domestic pigs of both lean and obese phenotype and to evaluate if the lean cloned pigs had a lower inter-individual variation as compared with non-cloned pigs. The microbiota of colon and terminal ileum was investigated in cloned and non-cloned pigs that received a high-far-high-energy diet with either restricted or ad libitum access to feed, resulting in lean and obese phenotypes, respectively. The fecal microbiota of lean pigs was investigated by terminal restriction fragment length polymorphism (T-RFLP). The intestinal microbiota of lean and obese cloned and non-cloned pigs was analyzed by quantitative real time PCR and a novel high-throughput qPCR platform (Fluidigm). Principal component analysis (PCA) of the T-RFLP profiles revealed that lean cloned and non-cloned pigs had a different overall composition of their gut microbiota. The colon of lean cloned pigs contained relatively more bacteria belonging to the phylum Firmicutes and less from the phylum Bacteroidetes than obese cloned pigs as estimated by qPCR. Fluidigm qPCR results revealed differences in specific bacterial groups in the gut microbiota of both lean and obese pigs. Our results suggest that high-far-high-energy diet is associated with changes in the gut microbiota even in the absence of obesity. Overall, the cloned pigs had a different gut microbiota from that of non-cloned pigs. To our knowledge this is the first study to investigate the gut microbiota of cloned domestic pigs of lean and obese phenotype.

Effects of age and lean direction on the threshold of single-step balance recovery in younger, middle-aged and older adults.

PubMed

Carbonneau, Evelyne; Smeesters, Cécile

2014-01-01

Several studies have quantified and compared balance recovery between healthy younger and older adults, using a variety of large postural perturbations and loss of balance directions. However, to the best of our knowledge, no studies at the threshold of balance recovery, where avoiding a fall is not always possible, have included middle-aged adults. We thus determined the maximum lean angle from which 20 younger, 16 middle-aged and 16 older healthy adults could be suddenly released and still recover balance using a single step for forward, sideways and backward leans. Results showed that the maximum lean angles of younger adults were 23% greater than middle-aged adults and 48% greater than older adults. The maximum lean angles for forward leans were 23% greater than sideways leans and 22% greater than backward leans. These declines with age and lean direction were associated with declines in response initiation, execution and geometry. Finally exponential regressions showed that the critical ages at which the ability to recover balance and avoid a fall significantly decreases were 51.0, 60.6 and 69.9 yrs for forward, sideways and backward leans, respectively. Therefore, we have demonstrated that age affects the ability to recover balance nearly a decade earlier than the rate of falls. Future studies should thus not only include older adults over 65 yrs, but also middle-aged adults under 65 yrs, or recruit all ages from 18 to 85 yrs. Finally, the critical ages identified in this study may justify an earlier screening of aging adults to prevent future falls, especially the first fall. Copyright © 2013 Elsevier B.V. All rights reserved.

Adipokines, oxidized low-density lipoprotein, and C-reactive protein levels in lean, overweight, and obese portuguese patients with type 2 diabetes.

PubMed

Neuparth, Maria João; Proença, Jorge Brandão; Santos-Silva, Alice; Coimbra, Susana

2013-01-01

Aim. Our aim was to study how different BMI scores may influence the levels of inflammation, oxidative stress, adipogenesis, glucose, and lipid metabolism, in lean, overweight, and obese Portuguese patients with type 2 diabetes mellitus (T2DM). Methods. We studied 28 lean, 38 overweight, and 17 obese patients with T2DM and 20 controls (gender and age matched). The circulating levels of oxLDL, CRP, and some adipokines-adiponectin, leptin, and chemerin-and the lipid profile were evaluated. Results. Obese patients presented significantly lower levels of adiponectin and higher leptin, oxLDL, and chemerin levels, as compared to the overweight, lean, and control groups. Overweight, compared to lean and control, subjects showed significantly lower adiponectin and higher leptin and chemerin levels; oxLDL values were significantly higher in overweight than in lean patients. Lean patients presented significantly higher chemerin values than the control. Obese patients presented significantly higher CRP values, as compared to lean patients and the control group. Obese and overweight patients presented significantly higher triglycerides values than lean patients. Except for CRP, all the observed significant changes between control and patients remained significant after statistical adjustment for the body mass index (BMI). Conclusion. The levels of leptin, adiponectin, oxLDL, CRP, and triglycerides in patients with T2DM seem to be more associated with obesity and less with diabetes. Chemerin levels were raised in lean, overweight, and obese patients, suggesting that, independently of BMI, an adipocyte dysfunction occurs. Moreover, chemerin may provide an important early biomarker of adipocyte dysfunction and a link between obesity and type 2 diabetes mellitus.

Adipokines, Oxidized Low-Density Lipoprotein, and C-Reactive Protein Levels in Lean, Overweight, and Obese Portuguese Patients with Type 2 Diabetes

PubMed Central

Neuparth, Maria João; Proença, Jorge Brandão; Santos-Silva, Alice; Coimbra, Susana

2013-01-01

Aim. Our aim was to study how different BMI scores may influence the levels of inflammation, oxidative stress, adipogenesis, glucose, and lipid metabolism, in lean, overweight, and obese Portuguese patients with type 2 diabetes mellitus (T2DM). Methods. We studied 28 lean, 38 overweight, and 17 obese patients with T2DM and 20 controls (gender and age matched). The circulating levels of oxLDL, CRP, and some adipokines—adiponectin, leptin, and chemerin—and the lipid profile were evaluated. Results. Obese patients presented significantly lower levels of adiponectin and higher leptin, oxLDL, and chemerin levels, as compared to the overweight, lean, and control groups. Overweight, compared to lean and control, subjects showed significantly lower adiponectin and higher leptin and chemerin levels; oxLDL values were significantly higher in overweight than in lean patients. Lean patients presented significantly higher chemerin values than the control. Obese patients presented significantly higher CRP values, as compared to lean patients and the control group. Obese and overweight patients presented significantly higher triglycerides values than lean patients. Except for CRP, all the observed significant changes between control and patients remained significant after statistical adjustment for the body mass index (BMI). Conclusion. The levels of leptin, adiponectin, oxLDL, CRP, and triglycerides in patients with T2DM seem to be more associated with obesity and less with diabetes. Chemerin levels were raised in lean, overweight, and obese patients, suggesting that, independently of BMI, an adipocyte dysfunction occurs. Moreover, chemerin may provide an important early biomarker of adipocyte dysfunction and a link between obesity and type 2 diabetes mellitus. PMID:24634792

Lean health care: what can hospitals learn from a world-class automaker?

PubMed

Kim, Christopher S; Spahlinger, David A; Kin, Jeanne M; Billi, John E

2006-05-01

With health care costs continuing to rise, a variety of process improvement methodologies have been proposed to address the reported inefficiencies in health care delivery. Lean production is one such method. The management philosophy and tools of lean production come from the manufacturing industry, where they were pioneered by Toyota Motor Corporation, which is viewed as the leader in utilizing these performance improvement methods. Lean has already enjoyed tremendous success in improving quality and efficiency in both the manufacturing and the service sector industries. Health care systems have just begun to utilize lean methods, with reports of improvements just beginning to appear in the literature. We describe some of the basic philosophy and principles of lean production methods and how these concepts can be applied in the health care environment. We describe some of the early success stories and ongoing endeavors of lean production in various health care organizations. We believe the hospital is an ideal setting for use of the lean production method, which could significantly affect how health care is delivered to patients. We conclude by discussing some of the potential challenges in introducing and implementing lean production methods in the health care environment. Lean production is a novel approach to delivering high-quality and efficient care to patients, and we believe that the health care sector can anticipate the same high level of success that the manufacturing and service industries have achieved using this approach. Hospitalists are primed to take action in delivering care of greater quality with more efficiency by applying these new principles in the hospital setting. (c) 2006 Society of Hospital Medicine.

Lean muscle mass in classic or ovulatory PCOS: association with central obesity and insulin resistance.

PubMed

Mario, F M; do Amarante, F; Toscani, M K; Spritzer, P M

2012-10-01

This age-matched case-control study assessed total and segmental lean muscle mass in classic or ovulatory polycystic ovary syndrome (PCOS) patients and investigated whether lean mass is associated with hormone and metabolic features. Participants underwent anthropometric and clinical evaluation. Habitual physical activity was assessed with a digital pedometer, and body composition by dual-energy X-ray absorptiometry. Laboratory measurements included total cholesterol, cholesterol fractions, triglycerides, glucose, total serum testosterone, serum insulin, estradiol, luteinizing hormone, and SHBG. Energy intake was calculated using a food frequency questionnaire. Classic PCOS patients had higher body mass index (BMI), waist circumference, testosterone and lipid accumulation product values than ovulatory PCOS and controls. Energy consumption, homeostasis model assessment index, SHBG, free androgen index and triglycerides, total and trunk lean mass were higher only in classic PCOS women vs. controls. Arm, leg, trunk, total or limb lean masses were not correlated with hormone levels in any of the groups. However, in PCOS women lipid accumulation product was positively correlated with total (r=0.56, p=0.001), trunk (r=0.59, p=0.001), arm (r=0.54, p=0.001), leg (r=0.44, p=0.03) and limb (r=0.48, p=0.001) lean masses. BMI was positively correlated with all lean mass segments and independently associated with total lean mass. Lipid accumulation product and BMI were independently associated with trunk lean mass variation. The increase in lean mass in classic PCOS appears to be associated with insulin resistance and central obesity rather than with energy intake, physical activity or androgens. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York.

Educational Policies for Integrating College Competencies and Workforce Needs: Cases from Brazil, Mongolia, Ukraine, and the United States. Issue Brief

ERIC Educational Resources Information Center

Bastedo, Michael; Batkhuyag, Batjargal; Prates, Eufrasio; Prytula, Yaroslav

2009-01-01

In the past decade, the role of higher education in workforce development has emerged as a key issue around the world. Leading authorities inside and outside of government have begun questioning whether colleges and universities are preparing graduates with the competencies and skills necessary to compete in a dynamic global economy. As part of a…

Teacher's Guide for Home Economics Curriculum Competency Based Modules for Integrating Basic Skills in Reading, Writing, and Mathematics.

ERIC Educational Resources Information Center

Crabtree, Myrna P.; Maltby, Carolyn T.

This teacher's guide is designed to encourage home economics teachers to plan and implement units of study that will facilitate student competency development in home economics content areas as well as in basic skills. It is intended to assist teachers in the effective use of "Home Economics Curriculum Competency Based Modules in Reading,…

Very-low-calorie ketogenic diet with aminoacid supplement versus very low restricted-calorie diet for preserving muscle mass during weight loss: a pilot double-blind study.

PubMed

Merra, G; Miranda, R; Barrucco, S; Gualtieri, P; Mazza, M; Moriconi, E; Marchetti, M; Chang, T F M; De Lorenzo, A; Di Renzo, L

2016-07-01

Obesity plays a relevant pathophysiological role in the development of health problems, arising as result of complex interaction of genetic, nutritional and metabolic factors. We conducted a dietary intervention case-control randomized trial, to compare the effectiveness on body composition of two nutritional protocols: a very-low-carbohydrate ketogenic diet (VLCKD), integrated by an aminoacid supplement with whey protein, and very low restricted-calorie diet (VLCD). The clinical study was conducted with a randomized case-control in which twenty-five healthy subjects gave informed consent to participate in the interventional study and were evaluated for their health and nutritional status, by anthropometric, and body composition evaluation. The results of this pilot study show that a diet low in carbohydrates, associated with a decreased caloric intake, is effective in weight loss. After VLCKD, versus VLCD, no significant differences in body lean of the trunk, body lean distribution (android and gynoid), total body lean were observed (p > 0.05). After VLCKD, no increasing of sarcopenia frequency, according ASSMI, was observed. Many studies have shown the effectiveness of the ketogenic diet on weight loss; even if not know how to work effectively, as some researchers believe that the weight loss is due to reduced calorie intake, satiety could also be induced by the effect of the proteins, rather than the low-carbohydrates. Our pilot study showed that a VLCKD was highly effective in terms of body weight reduction without to induce lean body mass loss, preventing the risk of sarcopenia. Further clinical trials are needed on a larger population and long-term body weight maintenance and risk factors management effects of VLCKD. There is no doubt, however, that a proper dietary approach would impact significantly on the reduction of public expenditure costs, in view of prospective data on increasing the percentage of obese people in our nation.

Lean in Air Permitting Guide

EPA Pesticide Factsheets

The Lean in Air Permitting Guide is designed to help air program managers at public agencies better understand the potential value and results that can be achieved by applying Lean improvement methods to air permitting processes.

Drive for leanness and health-related behavior within a social/cultural perspective.

PubMed

Tod, David; Edwards, Christian; Hall, Gareth

2013-09-01

We examined relationships between drive for leanness and perceived media pressure to change appearance, internalization of an ideal physique, exercise frequency, and dieting. Men and women (N=353) completed the Drive for Leanness Scale, the Sociocultural Attitudes Toward Appearance Questionnaire-3, the Eating Attitudes Test-26, and a demographic inventory. Drive for leanness was significantly correlated with athletic internalization (.52), pressure to attain an ideal physique (.25), exercise frequency (.36), and dieting (.25). Structural equation modeling revealed a good fitting model (χ(2)=2.85, p<.241; CFI=.99; NNFI=.98; RMSEA=.04; SRMR=.02) with internalization predicting drive for leanness, which in turn predicted dieting and exercise. Results reveal social/cultural theory helps enhance the understanding of the drive for leanness and its relationship with health-related behavior. Copyright © 2013 Elsevier Ltd. All rights reserved.

Methods of Genomic Competency Integration in Practice

PubMed Central

Jenkins, Jean; Calzone, Kathleen A.; Caskey, Sarah; Culp, Stacey; Weiner, Marsha; Badzek, Laurie

2015-01-01

Purpose Genomics is increasingly relevant to health care, necessitating support for nurses to incorporate genomic competencies into practice. The primary aim of this project was to develop, implement, and evaluate a year-long genomic education intervention that trained, supported, and supervised institutional administrator and educator champion dyads to increase nursing capacity to integrate genomics through assessments of program satisfaction and institutional achieved outcomes. Design Longitudinal study of 23 Magnet Recognition Program® Hospitals (21 intervention, 2 controls) participating in a 1-year new competency integration effort aimed at increasing genomic nursing competency and overcoming barriers to genomics integration in practice. Methods Champion dyads underwent genomic training consisting of one in-person kick-off training meeting followed by monthly education webinars. Champion dyads designed institution-specific action plans detailing objectives, methods or strategies used to engage and educate nursing staff, timeline for implementation, and outcomes achieved. Action plans focused on a minimum of seven genomic priority areas: champion dyad personal development; practice assessment; policy content assessment; staff knowledge needs assessment; staff development; plans for integration; and anticipated obstacles and challenges. Action plans were updated quarterly, outlining progress made as well as inclusion of new methods or strategies. Progress was validated through virtual site visits with the champion dyads and chief nursing officers. Descriptive data were collected on all strategies or methods utilized, and timeline for achievement. Descriptive data were analyzed using content analysis. Findings The complexity of the competency content and the uniqueness of social systems and infrastructure resulted in a significant variation of champion dyad interventions. Conclusions Nursing champions can facilitate change in genomic nursing capacity through varied strategies but require substantial training in order to design and implement interventions. Clinical Relevance Genomics is critical to the practice of all nurses. There is a great opportunity and interest to address genomic knowledge deficits in the practicing nurse workforce as a strategy to improve patient outcomes. Exemplars of champion dyad interventions designed to increase nursing capacity focus on improving education, policy, and healthcare services. PMID:25808828

Effect of hormone therapy on lean body mass, falls, and fractures: Six-year results from the Women’s Health Initiative Hormone Trials

PubMed Central

Bea, Jennifer W.; Zhao, Qiuhong; Cauley, Jane A.; LaCroix, Andrea Z.; Bassford, Tamsen; Lewis, Cora E.; Jackson, Rebecca D.; Tylavsky, Frances A.; Chen, Zhao

2010-01-01

Objective Loss of lean body mass with aging may contribute to falls and fractures. The objective of this analysis was to determine if taking postmenopausal hormone therapy (HT: estrogen plus progestogen therapy, EPT or estrogen therapy alone, ET) favorably affects age-related changes in lean body mass and if these changes partially account for decreased falls or fractures with HT. Methods Participants randomly assigned to either EPT (n=543) or control (n=471) and ET (n= 453) or control (n= 474) and receiving dual-energy X-ray absorptiometry (DXA) scans to estimate body composition during the Women’s Health Initiative (WHI) were evaluated. Falls and fracture occurrence were obtained by annual self-report. Fractures were confirmed by clinical chart review. Results At 6yrs post-randomization, lean body mass was not different between HT and control groups. Although lean body mass positively influenced BMD, independent of HT status, the preserved lean body mass observed in the HT arms in the first 3 years did not significantly contribute to models evaluating HT influence on falls and fractures between years 3 and 6. Women taking at least 80% of their medication in the HT arms demonstrated fewer falls compared to placebo; this difference was not attributable to change in lean body mass. Conclusions Despite early preservation of lean body mass with HT (3years), HT did not ameliorate long-term (6 years) loss in lean body mass with aging. PMID:20689466

Effect of hormone therapy on lean body mass, falls, and fractures: 6-year results from the Women's Health Initiative hormone trials.

PubMed

Bea, Jennifer W; Zhao, Qiuhong; Cauley, Jane A; LaCroix, Andrea Z; Bassford, Tamsen; Lewis, Cora E; Jackson, Rebecca D; Tylavsky, Frances A; Chen, Zhao

2011-01-01

Loss of lean body mass with aging may contribute to falls and fractures. The objective of this analysis was to determine if taking postmenopausal hormone therapy (or HT: estrogen plus progestogen therapy or estrogen therapy alone) favorably affects age-related changes in lean body mass and if these changes partially account for decreased falls or fractures with HT. Participants randomly assigned to either estrogen plus progestogen therapy (n = 543) or control (n = 471) and estrogen therapy alone (n = 453) or control (n = 474) and receiving dual-energy x-ray absorptiometry scans to estimate body composition during the Women's Health Initiative were evaluated. Falls and fracture occurrence were obtained by annual self-report. Fractures were confirmed by a clinical chart review. At 6 years postrandomization, lean body mass was not different between HT and control groups. Although lean body mass positively influenced bone mineral density, independent of HT status, the preserved lean body mass observed in the HT arms in the first 3 years did not significantly contribute to models evaluating HT influence on falls and fractures between years 3 and 6. Women taking at least 80% of their medication in the HT arms demonstrated fewer falls compared with placebo; this difference was not attributable to change in lean body mass. Despite early preservation of lean body mass with HT (3 y), HT did not ameliorate long-term (6 y) loss in lean body mass with aging.

An exploratory analysis for Lean and Six Sigma implementation in hospitals: Together is better?

PubMed

Lee, Jung Young; McFadden, Kathleen L; Gowen, Charles R

Despite the increasing interest for Lean and Six Sigma implementations in hospitals, there has been little empirical evidence that goes beyond descriptive case studies to address the current status and the effectiveness of the implementations. The aim of this study was to explore existing patterns of Lean and Six Sigma implementation in U.S. hospitals and compare the performance of the different patterns. We collected data from 215 U.S. hospitals via a survey that includes measurement items developed from related literature. Using the cross-sectional data, we conducted a cluster analysis, followed by t tests, chi-square tests, and regression analyses for cluster verification. The cluster analysis identifies two clusters, a Moderate Six Sigma group and a Lean Six Sigma group. Results show that the Lean Six Sigma group outperforms the Moderate Six Sigma group across many performance dimensions: responsiveness capability, patient safety, and possibly cost saving. In addition, the Lean Six Sigma group tends to be composed of larger, private teaching hospitals located in more urban areas, and they employ more resources for quality improvement. Our research contributes to the quality management literature by supporting the possible complementary relationship between Lean and Six Sigma in hospitals. Our study encourages practitioners and managers to pay more attention to Lean implementation. Although Lean seems to be conducted in a limited fashion in many hospitals, it should be expanded and combined with Six Sigma for better results.

Serum visfatin in relation to insulin resistance and markers of hyperandrogenism in lean and obese women with polycystic ovary syndrome.

PubMed

Kowalska, Irina; Straczkowski, Marek; Nikolajuk, Agnieszka; Adamska, Agnieszka; Karczewska-Kupczewska, Monika; Otziomek, Elzbieta; Wolczynski, Slawomir; Gorska, Maria

2007-07-01

Visfatin, a protein secreted by adipose tissue, is suggested to play a role in pathogenesis of insulin resistance. In polycystic ovary syndrome (PCOS), insulin resistance might be involved in the development of endocrine and metabolic abnormalities. The aim of the study was to asses the relation between serum visfatin concentration and insulin sensitivity and markers of hyperandrogenism in lean and obese PCOS patients. The study group consisted of 70 women with PCOS (23 lean and 47 obese) and 45 healthy women (25 lean and 20 obese). Euglycemic hyperinsulinemic clamp and the measurements of serum visfatin, sex hormones were performed. The PCOS group had lower insulin sensitivity (P=0.00049) and higher serum visfatin (P=0.047) in comparison to the control group. The decrease in insulin sensitivity was present in both the lean (P=0.019) and obese (P=0.0077) PCOS subjects, whereas increase in serum visfatin was observed only in lean PCOS subjects (P=0.012). In the whole group, serum visfatin was negatively correlated with insulin sensitivity (r=-0.27, P=0.004). This relationship was also observed in the subgroup of lean (r=-0.30, P=0.038), but not obese women. Additionally, in lean women, visfatin was associated with serum testosterone (r=0.47, P=0.002) and free androgen index (r=0.48, P=0.002), independently of other potential confounding factors. Visfatin is associated with insulin resistance and markers of hyperandrogenism in lean PCOS patients.

Lean NOx Trap Catalysis for Lean Natural Gas Engine Applications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Parks, II, James E; Storey, John Morse; Theiss, Timothy J

Distributed energy is an approach for meeting energy needs that has several advantages. Distributed energy improves energy security during natural disasters or terrorist actions, improves transmission grid reliability by reducing grid load, and enhances power quality through voltage support and reactive power. In addition, distributed energy can be efficient since transmission losses are minimized. One prime mover for distributed energy is the natural gas reciprocating engine generator set. Natural gas reciprocating engines are flexible and scalable solutions for many distributed energy needs. The engines can be run continuously or occasionally as peak demand requires, and their operation and maintenance ismore » straightforward. Furthermore, system efficiencies can be maximized when natural gas reciprocating engines are combined with thermal energy recovery for cooling, heating, and power applications. Expansion of natural gas reciprocating engines for distributed energy is dependent on several factors, but two prominent factors are efficiency and emissions. Efficiencies must be high enough to enable low operating costs, and emissions must be low enough to permit significant operation hours, especially in non-attainment areas where emissions are stringently regulated. To address these issues the U.S. Department of Energy and the California Energy Commission launched research and development programs called Advanced Reciprocating Engine Systems (ARES) and Advanced Reciprocating Internal Combustion Engines (ARICE), respectively. Fuel efficiency and low emissions are two primary goals of these programs. The work presented here was funded by the ARES program and, thus, addresses the ARES 2010 goals of 50% thermal efficiency (fuel efficiency) and <0.1 g/bhp-hr emissions of oxides of nitrogen (NOx). A summary of the goals for the ARES program is given in Table 1-1. ARICE 2007 goals are 45% thermal efficiency and <0.015 g/bhp-hr NOx. Several approaches for improving the efficiency and emissions of natural gas reciprocating engines are being pursued. Approaches include: stoichiometric engine operation with exhaust gas recirculation and three-way catalysis, advanced combustion modes such as homogeneous charge compression ignition, and extension of the lean combustion limit with advanced ignition concepts and/or hydrogen mixing. The research presented here addresses the technical approach of combining efficient lean spark-ignited natural gas combustion with low emissions obtained from a lean NOx trap catalyst aftertreatment system. This approach can be applied to current lean engine technology or advanced lean engines that may result from related efforts in lean limit extension. Furthermore, the lean NOx trap technology has synergy with hydrogen-assisted lean limit extension since hydrogen is produced from natural gas during the lean NOx trap catalyst system process. The approach is also applicable to other lean engines such as diesel engines, natural gas turbines, and lean gasoline engines; other research activities have focused on those applications. Some commercialization of the technology has occurred for automotive applications (both diesel and lean gasoline engine vehicles) and natural gas turbines for stationary power. The research here specifically addresses barriers to commercialization of the technology for large lean natural gas reciprocating engines for stationary power. The report presented here is a comprehensive collection of research conducted by Oak Ridge National Laboratory (ORNL) on lean NOx trap catalysis for lean natural gas reciprocating engines. The research was performed in the Department of Energy's ARES program from 2003 to 2007 and covers several aspects of the technology. All studies were conducted at ORNL on a Cummins C8.3G+ natural gas engine chosen based on industry input to simulate large lean natural gas engines. Specific technical areas addressed by the research include: NOx reduction efficiency, partial oxidation and reforming chemistry, and the effects of sulfur poisons on the partial oxidation, reformer, and lean NOx trap catalysts. The initial work on NOx reduction efficiency demonstrated that NOx emissions <0.1 g/bhp-hr (the ARES goal) can be achieved with the lean NOx trap catalyst technology. Subsequent work focused on cost and size optimization and durability issues which addressed two specific ARES areas of interest to industry ('Cost of Power' and 'Availability, Reliability, and Maintainability', respectively). Thus, the research addressed the approach of the lean NOx trap catalyst technology toward the ARES goals as shown in Table 1-1.« less

Accuracy of Body Mass Index Versus Lean Mass Index for Prediction of Sarcopenia in Older Women.

PubMed

Benton, M J; Silva-Smith, A L

2018-01-01

We compared accuracy of body mass index (BMI) versus lean mass index (LMI) to predict sarcopenia in 58 community-dwelling women (74.1±0.9 years). Lean mass was measured with multi-frequency bioelectrical impedance analysis, and strength was measured with Arm Curl test, Chair Stand test, and handgrip dynamometry. Sarcopenia was defined as low LMI. When categorized by BMI, normal women had less absolute lean mass (37.6±1.0 vs. 42.6±0.9 kg; P<0.001) and less relative lean mass (14.1±0.2 vs. 16.1±0.2 kg/m2; P<0.001) compared to overweight/obese women, but no differences in strength. When categorized by LMI, normal women had more absolute lean mass (44.0±0.7 vs. 35.7±0.7 kg; P<0.001), more relative lean mass (16.2±0.2 vs. 13.8±0.2 kg/m2; P<0.001), and greater upper body strength (16.7±0.9 vs. 14.2±0.6 arm curls; P<0.05) compared to women with low LMI. BMI failed to accurately predict low values of lean mass and strength. For clinical assessment, calculation of LMI rather than BMI is appropriate.

Stability of leaning column at Devils Tower National Monument, Wyoming

USGS Publications Warehouse

Harp, Edwin L.; Lindsay, Charles R.

2006-01-01

In response to reports from climbers that an 8-meter section (referred to as the leaning column) of the most popular climbing route on Devils Tower in northeastern Wyoming is now moving when being climbed, scientists from the U.S. Geological Survey inspected the site to determine the stability of the column and the underlying column that serves as a support pedestal. Evidence of a recent tensile spalling failure was observed on the pedestal surface immediately beneath the contact with the overlying leaning column. The spalling of a flake-shaped piece of the pedestal, probably due to the high stress concentration exerted by the weight of the leaning column along a linear contact with the pedestal, is likely causing the present movement of the leaning column. Although it is unlikely that climbers will dislodge the leaning column by their weight alone, the possibility exists that additional spalling failures may occur from the pedestal surface and further reduce the stability of the leaning column and result in its toppling. To facilitate detection of further spalling failures from the pedestal, its surface has been coated with a layer of paint. Any new failures from the pedestal could result in the leaning column toppling onto the climbing route or onto the section of the Tower trail below.

Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations

PubMed Central

Andrulis, Dennis P.; Brach, Cindy

2016-01-01

Objective To understand the interrelationship of literacy, culture, and language and the importance of addressing their intersection. Methods Health literacy, cultural competence, and linguistic competence strategies to quality improvement were analyzed. Results Strategies to improve health literacy for low-literate individuals are distinct from strategies for culturally diverse and individuals with limited English proficiency (LEP). The lack of integration results in health care that is unresponsive to some vulnerable groups’ needs. A vision for integrated care is presented. Conclusion Clinicians, the health care team, and health care organizations have important roles to play in addressing challenges related to literacy, culture, and language. PMID:17931131

Competing Activation during Fantasy Text Comprehension

ERIC Educational Resources Information Center

Creer, Sarah D.; Cook, Anne E.; O'Brien, Edward J.

2018-01-01

During comprehension, readers' general world knowledge and contextual information compete for influence during integration and validation. Fantasy narratives, in which general world knowledge often conflicts with fantastical events, provide a setting to examine this competition. Experiment 1 showed that with sufficient elaboration, contextual…

Sustainable sewage management and the inertia to change

NASA Astrophysics Data System (ADS)

Öberg, G.

2012-12-01

Increasing economic costs and environmental concerns have led to that planners around the world are progressively questioning the prevailing sewage management paradigm, calling for a shift in the hydrosocial contract to embrace more sustainable solutions, to be based on closed-loops rather than linear end-of-pipe solutions. Despite considerable attention to the technical possibilities for delivering sewage services in a more integrated and sustainable fashion, shifts in planning and management have been slow. Based on an extensive study of Australian cities, Brown et al (2009) have developed a model with six transitional stages and argue that "while there may be cognitive changes (best practice thinking such as water sustainable urban design), there has not been sufficient normative and regulative change to support new practice." They contrast three historic transition stages with three successive sustainable stages. Unfortunately, the study ends in a rather vague outline of "the Water Sensitive City", with little sign-posts indicating how one might transition to this seemingly utopian last stage. In the present paper, we discuss the normative tensions created between the different actors in this increasingly complex playing field, who represent different and often competing values. We suggest that cities have difficulties transitioning from the old contract to one of the newer ones because the hydro-social contract promised by these new stages create normative tensions not only between the new and the old, but also between what one might call different types of environmentalists: naturalists and pragmatists. The naturalists, who for example are very voiced in several cities along the North American west coast, tend to embrace the perception of Nature described by environmental historians as Untouched Wilderness, where technology is pinpointed as the root of the problems. In contrast, the other side lean more on the idea of modernity, with a more pragmatic approach to nature, which first and foremost is seen as a provider of material resources and technology is a tool that aids solving the problem with the limited supply. The naturalists' cognitive response points to solutions that are perceived as 'natural' such as composting and constructed wetlands, but do to not easily embrace solutions that are perceived as 'technical', such as smart metering, biogas reactors, and recovery of pelleted phosphorous compounds. We suggest that transition to the 'Water Sensitive City' requires explicit recognition that sewage management is a context-dependent multi-dimensional, multi-objective challenge in which competing objectives must be identified and trade-offs made, which includes recognizing and finding ways to manage the tacit tensions caused by competing normative underpinnings among different types of environmentalism.

Why Lean doesn't work for everyone.

PubMed

Kaplan, Gary S; Patterson, Sarah H; Ching, Joan M; Blackmore, C Craig

2014-12-01

Popularisation of Lean in healthcare has led to emphasis on Lean quality improvement tools in isolation, with inconsistent results. We argue that delivery of safer, more efficient, and higher quality-patient focused care requires organisational transformation of which the Lean toolkit is only one component. To successfully facilitate system transformation toward higher quality care at lower cost, Lean tools must be part of a comprehensive management system, within a supportive institutional culture, and with committed leadership. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Role of Lean Process Improvement in Implementation of Evidence-Based Practices in Behavioral Health Care.

PubMed

Steinfeld, Bradley; Scott, Jennifer; Vilander, Gavin; Marx, Larry; Quirk, Michael; Lindberg, Julie; Koerner, Kelly

2015-10-01

To effectively implement evidence-based practices (EBP) in behavioral health care, an organization needs to have operating structures and processes that can address core EBP implementation factors and stages. Lean, a widely used quality improvement process, can potentially address the factors crucial to successful implementation of EBP. This article provides an overview of Lean and the relationship between Lean process improvement steps, and EBP implementation models. Examples of how Lean process improvement methodologies can be used to help plan and carry out implementation of EBP in mental health delivery systems are presented along with limitations and recommendations for future research and clinical application.

Integrating Electronic Health Record Competencies into Undergraduate Health Informatics Education.

PubMed

Borycki, Elizabeth M; Griffith, Janessa; Kushniruk, Andre W

2016-01-01

In this paper we report on our findings arising from a qualitative, interview study of students' experiences in an undergraduate health informatics program. Our findings suggest that electronic health record competencies need to be integrated into an undergraduate curriculum. Participants suggested that there is a need to educate students about the use of the EHR, followed by best practices around interface design, workflow, and implementation with this work culminating in students spearheading the design of the technology as part of their educational program of study.

Latino Definitions of Success: A Cultural Model of Intercultural Competence

PubMed Central

Torres, Lucas

2010-01-01

The present study sought to examine Latino intercultural competence via two separate methodologies. Phase 1 entailed discovering and generating themes regarding the features of intercultural competence based on semistructured interviews of 15 Latino adults. Phase 2 included conducting a cultural consensus analysis from the quantitative responses of 46 Latino adults to determine the cultural model of intercultural competence. The major results indicated that the participants, despite variations in socioeconomic and generational statuses, shared a common knowledge base regarding the competencies needed for Latinos to successfully navigate different cultures. Overall, the cultural model of Latino intercultural competence includes a set of skills that integrates traditional cultural values along with attributes of self-efficacy. The findings are discussed within a competence-based conceptualization of cultural adaptation and potential advancements in acculturation research. PMID:20333325

Nurse competence: a concept analysis.

PubMed

Smith, Sarah A

2012-10-01

  The purpose of this analysis was to explore the concept of nurse competence.   Data sources include EBSCOhost, Gale PowerSearch, ProQuest, PubMed Medline, Google Scholar, and Online Journal of Issues in Nursing.   This paper utilizes Rodgers' evolutionary method to analyze the concept of nurse competence.   Antecedents to nurse competence include personal and external motivations. Attributes include integrating knowledge into practice, experience, critical thinking, proficient skills, caring, communication, environment, motivation, and professionalism. Consequences include confidence, safe practice, and holistic care. Implications for nursing responsibility regarding defining nurse competence and ensuring nurse competence need to be identified. More research is needed to determine the best evaluation methods for the different facets of nurse competence. © 2012, The Author. International Journal of Nursing Knowledge © 2012, NANDA International.

lean-ISD.

ERIC Educational Resources Information Center

Wallace, Guy W.

2001-01-01

Explains lean instructional systems design/development (ISD) as it relates to curriculum architecture design, based on Japan's lean production system. Discusses performance-based systems; ISD models; processes for organizational training and development; curriculum architecture to support job performance; and modular curriculum development. (LRW)

A Cultural Resources Inventory of Eastern Portions of Lake Sakakawea, North Dakota (Mercer and McLean Counties).

DTIC Science & Technology

1982-09-15

34esources Inventory of Eastern Portions of Lake Sakakawee, North Dakota (Mercer and McLean August - September 1982 Counties ) 6. PERFORMING ORG. REPORT...of Lake Sakakawea (Mercer and McLean Counties ), North Dakota, Identif ied 56 sites. The site types include: stone circles (36), stone cairn (1), linear...9 A CULTURAL RESOURCES INVENTORY OF EASTERN PORTIONS OF LAUE SAKAKAWRA, NORTH DAKOTA (MERCER AND XcLEAN COUNTIES

Lean manufacturing: A better way for enhancement in productivity

NASA Astrophysics Data System (ADS)

Kumar Ahir, Pankaj; Kumar Yadav, Lalit; Singh Chandrawat, Saurabh

2012-03-01

Productivity is the impact of peoples working together. Machines are merely an extended way of collective imagination and energy. Lean Manufacturing is the most used method for continues improvement of business. Organization management philosophy focusing on the reduction of wastage to improve overall customer value. "Lean" operating principles began in manufacturing environments and are known by a variety of synonyms; Lean Manufacturing, Lean Production, Toyota Production System, etc. It is commonly believed that Lean started in Japan "The notable activities in keeping the price of Ford products low is the steady restriction of the production cycle. The longer an article is in the process of manufacture and the more it is moved about, the greater is its ultimate cost." "A systematic approach to identifying and eliminating waste through continuous improvement, flowing the product at the pull of the customer in pursuit of perfection."

Individualisation of Lean Concept in Companies Dealing with Mass Production

NASA Astrophysics Data System (ADS)

Bednár, Roman

2012-12-01

The methods of lean manufacturing primarily designed for businesses dealing with serial production, are also used in other types of production. However the concept of lean production was not designed for these types of businesses, they are utilized only partially. Paper focuses on applying methods of lean concept in companies which are dealing with mass production and their options of exchange for other methods in the event of disagreement. Basis of the article is a list of lean methods with its description and its utilization in practice. The questionnaire was utilized to identify information from the practice. Based on this survey were identified the critical methods that are no longer appropriate for companies dealing with mass production. However, there are alternative methods of describing the problem. It is possible to say that companies are trying to get closer to their goal by modification of the basic concepts. And the concept of Lean Enterprise serves as a standard.

Readiness for change and job satisfaction in a case of lean management application - a comparative study.

PubMed

Lipińska-Grobelny, Agnieszka; Papieska, Ewelina

2012-09-01

This current study investigates the effect of lean management system on work attitudes of workers of two manufacturing companies. "Lean management" is a concept of work processes and human relations that determines company's productivity and profitability. Workers of two enterprises, the first one with lean production and the second one with old mass production, were compared for their readiness for change and job satisfaction (both emotional and cognitive aspect). The sample of 102 employees completed a battery of instruments such as: the Job Description Inventory by Neuberger and Allerbeck, the Job Affect Scale by Burke et al. and the Change-Readiness Scale by Kriegel and Brandt. Individuals from the lean manufacturing company were characterized by higher level of readiness for change, positive affect at work, and cognitive job satisfaction. In this approach the introduction of lean production positively affected company's human resource attitudes.

Computer-Integrated Manufacturing Technology. Tech Prep Competency Profile.

ERIC Educational Resources Information Center

Lakeland Tech Prep Consortium, Kirtland, OH.

This tech prep competency profile covers these occupations: manufacturing technician, computer-assisted design and drafting (CADD) technician, quality technician, and mechanical technician. Section 1 provides occupation definitions. Section 2 lists development committee members. Section 3 provides the leveling codes---abbreviations for grade level…

The neural bases of key competencies of emotional intelligence.

PubMed

Krueger, Frank; Barbey, Aron K; McCabe, Kevin; Strenziok, Maren; Zamboni, Giovanna; Solomon, Jeffrey; Raymont, Vanessa; Grafman, Jordan

2009-12-29

Emotional intelligence (EI) refers to a set of competencies that are essential features of human social life. Although the neural substrates of EI are virtually unknown, it is well established that the prefrontal cortex (PFC) plays a crucial role in human social-emotional behavior. We studied a unique sample of combat veterans from the Vietnam Head Injury Study, which is a prospective, long-term follow-up study of veterans with focal penetrating head injuries. We administered the Mayer-Salovey-Caruso Emotional Intelligence Test as a valid standardized psychometric measure of EI behavior to examine two key competencies of EI: (i) Strategic EI as the competency to understand emotional information and to apply it for the management of the self and of others and (ii) Experiential EI as the competency to perceive emotional information and to apply it for the integration into thinking. The results revealed that key competencies underlying EI depend on distinct neural PFC substrates. First, ventromedial PFC damage diminishes Strategic EI, and therefore, hinders the understanding and managing of emotional information. Second, dorsolateral PFC damage diminishes Experiential EI, and therefore, hinders the perception and integration of emotional information. In conclusion, EI should be viewed as complementary to cognitive intelligence and, when considered together, provide a more complete understanding of human intelligence.

Health workforce governance: Processes, tools and actors towards a competent workforce for integrated health services delivery.

PubMed

Barbazza, Erica; Langins, Margrieta; Kluge, Hans; Tello, Juan

2015-12-01

A competent health workforce is a vital resource for health services delivery, dictating the extent to which services are capable of responding to health needs. In the context of the changing health landscape, an integrated approach to service provision has taken precedence. For this, strengthening health workforce competencies is an imperative, and doing so in practice hinges on the oversight and steering function of governance. To aid health system stewards in their governing role, this review seeks to provide an overview of processes, tools and actors for strengthening health workforce competencies. It draws from a purposive and multidisciplinary review of literature, expert opinion and country initiatives across the WHO European Region's 53 Member States. Through our analysis, we observe distinct yet complementary roles can be differentiated between health services delivery and the health system. This understanding is a necessary prerequisite to gain deeper insight into the specificities for strengthening health workforce competencies in order for governance to rightly create the institutional environment called for to foster alignment. Differentiating between the contribution of health services and the health system in the strengthening of health workforce competencies is an important distinction for achieving and sustaining health improvement goals. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

The neural bases of key competencies of emotional intelligence

PubMed Central

Krueger, Frank; Barbey, Aron K.; McCabe, Kevin; Strenziok, Maren; Zamboni, Giovanna; Solomon, Jeffrey; Raymont, Vanessa; Grafman, Jordan

2009-01-01

Emotional intelligence (EI) refers to a set of competencies that are essential features of human social life. Although the neural substrates of EI are virtually unknown, it is well established that the prefrontal cortex (PFC) plays a crucial role in human social-emotional behavior. We studied a unique sample of combat veterans from the Vietnam Head Injury Study, which is a prospective, long-term follow-up study of veterans with focal penetrating head injuries. We administered the Mayer-Salovey-Caruso Emotional Intelligence Test as a valid standardized psychometric measure of EI behavior to examine two key competencies of EI: (i) Strategic EI as the competency to understand emotional information and to apply it for the management of the self and of others and (ii) Experiential EI as the competency to perceive emotional information and to apply it for the integration into thinking. The results revealed that key competencies underlying EI depend on distinct neural PFC substrates. First, ventromedial PFC damage diminishes Strategic EI, and therefore, hinders the understanding and managing of emotional information. Second, dorsolateral PFC damage diminishes Experiential EI, and therefore, hinders the perception and integration of emotional information. In conclusion, EI should be viewed as complementary to cognitive intelligence and, when considered together, provide a more complete understanding of human intelligence. PMID:20080795

Teaching nurses teamwork: Integrative review of competency-based team training in nursing education.

PubMed

Barton, Glenn; Bruce, Anne; Schreiber, Rita

2017-12-20

Widespread demands for high reliability healthcare teamwork have given rise to many educational initiatives aimed at building team competence. Most effort has focused on interprofessional team training however; Registered Nursing teams comprise the largest human resource delivering direct patient care in hospitals. Nurses also influence many other health team outcomes, yet little is known about the team training curricula they receive, and furthermore what specific factors help translate teamwork competency to nursing practice. The aim of this review is to critically analyse empirical published work reporting on teamwork education interventions in nursing, and identify key educational considerations enabling teamwork competency in this group. CINAHL, Web of Science, Academic Search Complete, and ERIC databases were searched and detailed inclusion-exclusion criteria applied. Studies (n = 19) were selected and evaluated using established qualitative-quantitative appraisal tools and a systematic constant comparative approach. Nursing teamwork knowledge is rooted in High Reliability Teams theory and Crew or Crisis Resource Management sources. Constructivist pedagogy is used to teach, practice, and refine teamwork competency. Nursing teamwork assessment is complex; involving integrated yet individualized determinations of knowledge, skills, and attitudes. Future initiatives need consider frontline leadership, supportive followership and skilled communication emphasis. Collective stakeholder support is required to translate teamwork competency into nursing practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evaluating competency to stand trial with evidence-based practice.

PubMed

Rogers, Richard; Johansson-Love, Jill

2009-01-01

Evaluations for competency to stand trial are distinguished from other areas of forensic consultation by their long history of standardized assessment beginning in the 1970s. As part of a special issue of the Journal on evidence-based forensic practice, this article examines three published competency measures: the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA), the Evaluation of Competency to Stand Trial-Revised (ECST-R), and the Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR). Using the Daubert guidelines as a framework, we examined each competency measure regarding its relevance to the Dusky standard and its error and classification rates. The article acknowledges the past polarization of forensic practitioners on acceptance versus rejection of competency measures. It argues that no valuable information, be it clinical acumen or standardized data, should be systematically ignored. Consistent with the American Academy of Psychiatry and the Law Practice Guideline, it recommends the integration of competency interview findings with other sources of data in rendering evidence-based competency determinations.

Integrating Mathematics and Composition Instruction.

ERIC Educational Resources Information Center

Kirtland, Joseph; Hoh, Pau-San

2002-01-01

Describes the development of an integrated approach for teaching mathematics and writing to freshmen. The goals are to strengthen mathematical skills, develop writing competencies, and foster interdisciplinary awareness. (Author/MM)

Dietary Variety and Decline in Lean Mass and Physical Performance in Community-Dwelling Older Japanese: A 4-year Follow-Up Study.

PubMed

Yokoyama, Y; Nishi, M; Murayama, H; Amano, H; Taniguchi, Y; Nofuji, Y; Narita, M; Matsuo, E; Seino, S; Kawano, Y; Shinkai, S

2017-01-01

To examine associations of dietary variety with changes in lean mass and physical performance during a 4-year period in an elderly Japanese population. Four-year prospective study. The Hatoyama Cohort Study and Kusatsu Longitudinal Study, Japan. 935 community-dwelling Japanese aged 65 years or older. Dietary variety was assessed using a 10-item food frequency questionnaire. Body composition was determined by multifrequency bioelectrical impedance analysis, and physical performance (grip strength and usual gait speed) was measured in surveys at baseline and 4 years later. Longitudinal analysis included only participants who were originally in the upper three quartiles of lean body mass, appendicular lean mass, grip strength, and usual gait speed. The outcome measures were decline in lean body mass, appendicular lean mass, grip strength, and usual gait speed, defined as a decrease to the lowest baseline quartile level at the 4-year follow-up survey. Associations of dietary variety with the outcome measures were examined by logistic regression analysis adjusted for potential confounders. In the fully adjusted model, the odds ratios for decline in grip strength and usual gait speed were 0.43 (95% confidence interval, 0.19-0.99) and 0.43 (confidence interval, 0.19-0.99), respectively, for participants in the highest category of dietary variety score as compared with those in the lowest category. Dietary variety was not significantly associated with changes in lean body mass or appendicular lean mass. Among older adults, greater dietary variety may help maintain physical performance, such as grip strength and usual gait speed, but not lean mass.

Dudrick Research Symposium 2015-Lean Tissue and Protein in Health and Disease.

PubMed

Earthman, Carrie P; Wolfe, Robert R; Heymsfield, Steven B

2017-02-01

The 2015 Dudrick Research Symposium "Lean Tissue and Protein in Health and Disease: Key Targets and Assessment Strategies" was held on February 16, 2015, at Clinical Nutrition Week in Long Beach, California. The Dudrick Symposium honors the many pivotal and innovative contributions to the development and advancement of parenteral nutrition made by Dr Stanley J. Dudrick, physician scientist, academic leader, and a founding member of the American Society for Parenteral and Enteral Nutrition. As the 2014 recipient of the Dudrick award, Dr Carrie Earthman chaired the symposium and was the first of 3 speakers, followed by Dr Robert Wolfe and Dr Steven Heymsfield. The symposium addressed the importance of lean tissue to health and response to disease and injury, as well as the many opportunities and challenges in its assessment at the bedside. Lean tissue assessment is beneficial to clinical care in chronic and acute care clinical settings, given the strong relationship between lean tissue and outcomes, including functional status. Currently available bioimpedance techniques, including the use of bioimpedance parameters, for lean tissue and nutrition status assessment were presented. The connection between protein requirements and lean tissue was discussed, highlighting the maintenance of lean tissue as one of the most important primary end points by which protein requirements can be estimated. The various tracer techniques to establish protein requirements were presented, emphasizing the importance of practical considerations in research protocols aimed to establish protein requirements. Ultrasound and other new and emerging technologies that may be used for lean tissue assessment were discussed, and areas for future research were highlighted.

The impact of lean production on musculoskeletal and psychosocial risks: an examination of sociotechnical trends over 20 years.

PubMed

Koukoulaki, Theoni

2014-03-01

This paper provides an extensive review of studies carried out in lean production environments in the last 20 years. It aims to identify the effects of lean production (negative or positive) on occupational health and related risk factors. Thirty-six studies of lean effects were accepted from the literature search and sorted by sector and type of outcome. Lean production was found to have a negative effect on health and risk factors; the most negative outcomes being found in the earliest studies in the automotive industry. However, examples of mixed and positive effects were also found in the literature. The strongest correlations of lean production with stress were found for characteristics found in Just-In-Time production that related to reduced cycle time and reduction of resources. Increased musculoskeletal risk symptoms were related to increases of work pace and lack of recovery time also found in Just-In-Time systems. An interaction model is developed to propose a pathway from lean production characteristics to musculoskeletal and psychosocial risk factors and also positive outcomes. An examination is also made of the changing focus of studies investigating the consequences of lean production over a 20-year period. Theories about the effects of lean production have evolved from a conceptualization that it is an inherently harmful management system, to a view that it can have mixed effects depending on the management style of the organization and the specific way it is implemented. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Implementation of lean thinking: one health system's journey.

PubMed

Kim, Christopher S; Spahlinger, David A; Kin, Jeanne M; Coffey, Richard J; Billi, John E

2009-08-01

Lean Thinking is a management philosophy derived from the manufacturing industry, where Toyota has long been the gold standard. Health care organizations have started to apply this approach to patient care. After initial experimentation, the University of Michigan Health System (UMHS) has adopted Lean Thinking as its uniform approach to quality improvement and is striving to become a complete Lean organization. In 2005, the senior leadership selected an initial set of projects in areas that traced the patient's journey across different care settings within our health system. Four of the projects were as follows: orthopedic surgery clinic scheduling, radiation oncology therapy, peripherally inserted central catheter (PICC) services, and coordination of care to the outpatient setting. Lean Thinking encourages service providers to focus on value as defined by the customer and the relentless elimination of waste that impedes the flow of value. A series of learning projects were conducted to test whether Lean methods would work at UMHS. The following factors were found to be key to LEAN PROJECT SUCCESS: expert guidance for initial efforts, leadership in the form of clinical champions and senior management support of the improvement work, frontline worker engagement in mapping out "current state" processes, identifying waste and designing an improved "future state," using metrics to develop and track interventions, and defining realistic project scope. As UMHS's experience applying Lean Thinking to our patient care processes has grown, so have support, enthusiasm, and expertise within the organization. UMHS's Lean Thinking system, now known as the Michigan Quality System, has emerged as the core improvement strategy.

Lean healthcare in developing countries: evidence from Brazilian hospitals.

PubMed

Costa, Luana Bonome Message; Filho, Moacir Godinho; Rentes, Antonio Freitas; Bertani, Thiago Moreno; Mardegan, Ronaldo

2017-01-01

The present study evaluates how five sectors of two Brazilian hospitals have implemented lean healthcare concepts in their operations. The main characteristics of the implementation process are analyzed in the present study: the motivational factor for implementation, implementation time, form (consultancy or internal), team (hospital and consultants), lean implementation continuity/sustainability, lean healthcare tools and methods implemented, problems/improvement opportunities, lean healthcare barriers faced during the implementation process, and critical factors that affected the implementation and the results obtained in each case. The case studies indicate that reducing patient lead times and costs and making financial improvements were the primary factors that motivated lean healthcare implementation in the hospitals studied. Several tools and methods were used in the cases studied, especially value stream mapping and DMAIC. The barriers found in both hospitals are primarily associated with the human factor. Additionally, the results obtained after implementation were analyzed and improvements in financial aspects, productivity and capacity, and lead time reduction of the analyzed sectors were observed. Further, this study also exhibited four propositions elaborated from the results obtained from the cases that highlighted barriers and challenges to lean healthcare implementation in developing countries. Two of these barriers are hospital organizational structure (and, consequently, how the senior management works with medical staff), and outsourcing hospital activities. This study also concluded that the initialization and maintenance of lean healthcare implementation rely heavily on external support because lean healthcare subject knowledge is not yet available in the healthcare organization, which represents a challenge. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

NO{sub x}-abatement potential of lean-premixed GT combustors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sattelmayer, T.; Polifke, W.; Winkler, D.

1998-01-01

The influence of the structure of perfectly premixed flames on NO{sub x} formation is investigated theoretically. Since a network of reaction kinetics modules and model flames is used for this purpose, the results obtained are independent of specific burner geometries. Calculations are presented for a mixture temperature of 630 K, an adiabatic flame temperature of 1840 K, and 1 and 15 bars combustor pressure. In particular, the following effects are studied separately from each other: molecular diffusion of temperature and species, flame strain, local quench in highly strained flames and subsequent reignition, turbulent diffusion (no preferential diffusion), and small scalemore » mixing (stirring) in the flame front. Either no relevant influence or an increase in NO{sub x} burners is to avoid excessive turbulent stirring in the flame front. Turbulent flames that exhibit locally and instantaneously near laminar structures (flamelets) appear to be optimal. Using the same methodology, the scope of the investigation is extended to lean-lean staging, since a higher NO{sub x}-abatement potential can be expected in principle. As long as the chemical reactions of the second stage take place in the boundary between the fresh mixture of the second stage and the combustion products from upstream, no advantage can be expected from lean-lean staging. Only if the preliminary burner exhibits much poorer mixing than the second stage can lean-lean staging be beneficial. In contrast, if full mixing between the two stages prior to afterburning can be achieved (lean-mix-lean technique), the combustor outlet temperature can in principle be increased somewhat without NO penalty.« less

Role of insulin in the hyperandrogenemia of lean women with polycystic ovary syndrome and normal insulin sensitivity.

PubMed

Baillargeon, Jean-Patrice; Carpentier, André

2007-10-01

To determine the effect of reducing insulin secretion on hyperandrogenemia in lean normoinsulinemic women with polycystic ovary syndrome (PCOS) and normal metabolic insulin sensitivity. Transversal assessment at baseline and prospective follow-up of lean PCOS group after 8 days of diazoxide, which reduces insulin secretion, and 1 month of leuprolide, which suppresses LH. Clinical research center of an academic hospital. Nine lean women (body mass index

Engaging Frontline Leaders and Staff in Real-Time Improvement.

PubMed

Phillips, Jennifer; Hebish, Linda J; Mann, Sharon; Ching, Joan M; Blackmore, C Craig

2016-04-01

The relationship of staff satisfaction and engagement to organizational success, along with the integral influence of frontline managers on this dimension, is well established in health care and other industries. To specifically address staff engagement, Virginia Mason Medical Center, an integrated, single-hospital health system, developed an approach that involved leaders, through the daily use of standard work for leaders, as well as staff, through a Lean-inspired staff idea system. Kaizen Promotion Office (KPO) staff members established three guiding principles: (1) Staff engagement begins with leader engagement; (2) Integrate daily improve- ment (kaizen) as a habitual way of life not as an add-on; and (3) Create an environment in which staff feel psycho- logically safe and valued. Two design elements--Standard Work for Leaders (SWL) and Everyday Lean Ideas (ELIs) were implemented. For the emergency department (ED), an early adopter of the staff engagement work, the challenge was to apply the guiding principles to improve staff engagement while improving quality and patient and staff satisfaction, even as patient volumes were increasing. Daily huddles for the KPO staff members and weekly leader rounds are used to elicit staff ideas and foster ELIs in real time. Overall progress to date has been tracked in terms of staff satisfaction surveys, voluntary staff turnover, adoption of SWL, and testing and implementation of staff ideas. For example, voluntary turnover of ED staff decreased from 14.6% in 2011 to 7.5% in 2012, and 2.0% in 2013. Organizationwide, at least 800 staff ideas are in motion at any given time, with finished ones posted in an idea supermarket website. A leadership and staff engagement approach that focuses on SWL and on capturing staff ideas for daily problem solving and improvement can contribute to organization success and improve the quality of health care delivery.

Indigenous cultural competence: A dental faculty curriculum review.

PubMed

Forsyth, C; Irving, M; Tennant, M; Short, S; Gilroy, J

2017-12-30

Indigenous Australians have more than double the rate of poor oral health than their non-Indigenous counterparts. Cultural competence of dental and oral health practitioners is fundamental to health care and quality of life in addressing health disparities in minority cultural groups in Australia. Higher education curricula reviews have identified the need for institutions to incorporate Indigenous culture and knowledge more widely into the curricula to improve educational outcomes for Indigenous Australians and to increase cultural competence for all students. The aim of this research was to provide a baseline analysis of Indigenous cultural competence curricula practices to ascertain changes required within Faculty of Dentistry programmes at the University of Sydney to enable students to become more culturally competent upon graduation. Staff and students of the Doctor of Dental Medicine and Bachelor of Oral Health programmes at the Faculty of Dentistry, University of Sydney participated in an online survey. Quantitative analysis of the survey data was conducted using integrated research electronic data capture survey tools, with open-ended questions being coded to common responses for those questions. A total of 69 staff (71%) and 191 students (51%) participated in the online survey. The majority of participants perceived there was limited Indigenous content in the curriculum. Most participants reported that Indigenous curriculum was integrated into several units of study. The main pedagogical method for curriculum delivery was lectures, followed by case studies and group discussions. Although some Indigenous content exists in dental faculty curriculum, in-depth investigation is required to develop a comprehensive, evidenced-based Indigenous cultural competence teaching framework, for integration into Doctor of Dental Medicine and Bachelor of Oral Health curricula. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Lean Mixture Engines Testing and Evaluation Program : Volume 3. Appendices.

DOT National Transportation Integrated Search

1975-01-01

This report is aimed at defining analytically and demonstrating experimentally the potential of the 'lean-burn concept.' Fuel consumption and emissions data are obtained on the engine dynamometer for the baseline engine, and two lean-burn configurati...

Kit para aplicar la metodología de Lean en el gobierno

EPA Pesticide Factsheets

Este Kit para comenzar a aplicar la metodología Lean (Gobierno optimizado) ofrece información para ayudar a las agencias de protección ambiental a planificar e implementar iniciativas Lean exitosas.

Equipping providers with principles, knowledge and skills to successfully integrate behaviour change counselling into practice: a primary healthcare framework.

PubMed

Vallis, M; Lee-Baggley, D; Sampalli, T; Ryer, A; Ryan-Carson, S; Kumanan, K; Edwards, L

2018-01-01

There is an urgent need for healthcare providers and healthcare systems to support productive interactions with patients that promote sustained health behaviour change in order to improve patient and population health outcomes. Behaviour change theories and interventions have been developed and evaluated in experimental contexts; however, most healthcare providers have little training, and therefore low confidence in, behaviour change counselling. Particularly important is how to integrate theory and method to support healthcare providers to engage in behaviour change counselling competently. In this article, we describe a general training model developed from theory, evidence, experience and stakeholder engagement. This model will set the stage for future evaluation research on training needed to achieve competency, sustainability of competency, as well as effectiveness/cost-effectiveness of training in supporting behaviour change. A framework to support competency based training in behaviour change counselling is described in this article. This framework is designed to be integrative, sustainable, scalable and capable of being evaluated in follow-up studies. Effective training in behaviour change counselling is critical to meet the current and future healthcare needs of patients living with, or at risk of, chronic diseases. Increasing competency in establishing change-based relationships, assessing and promoting readiness to change, implementing behaviour modification and addressing psychosocial issues will be value added to the healthcare system. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

STS-26 simulation activities in JSC Mission Control Center (MCC)

NASA Technical Reports Server (NTRS)

1987-01-01

In JSC Mission Control Center (MCC) Bldg 30 Flight Control Room (FCR), flight controller Granvil A. Pennington, leaning on console, listens to communications during the STS-26 integrated simulations in progress between MCC and JSC Mission Simulation and Training Facility Bldg 5 fixed-base (FB) shuttle mission simulator (SMS). MCC FCR visual displays are seen in background. Five veteran astronauts were in the FB-SMS rehearsing their roles for the scheduled June 1988 flight aboard Discovery, Orbiter Vehicle (OV) 103.

Leadership, Management, and Organization for National Security Space: Report to Congress of the Independent Assessment Panel on the Organization and Management of National Security Space

DTIC Science & Technology

2008-07-01

Engineering. General Ronald R. Fogleman, United States Air Force - Retired General Ron Fogleman is the Chairman of the Board of The Durango ...serves on the board of directors for AAR Corp, Alpha Security, Alliant Techsystems, First National Bank of Durango , Integrated Data Corporation...headquartered in McLean, Virginia. He is based in Colorado Springs. Specializing in strategic planning and the management of complex organizations

Lean in service industries: A literature review

NASA Astrophysics Data System (ADS)

V, Vignesh; Suresh, M.; Aramvalarthan, S.

2016-09-01

Lean service is an amalgamation of tools and practices which, if applied appropriately, would definitely improve the existing quality of operations and ensure the generation of a large amount of favourable financial and economic outcomes and improve the behaviour of the workforce. As a result, it assumes of great significance in the fiercely competitive modern world. This article presents a comprehensive bibliographic study about the various lean service practices through a variety of approaches like service improvement, manufacturing, supply chain, market and retailing approaches, etc. Thus it gives a clear view on how the lean services are implemented in various sectors and the contribution of lean service towards improving the quality in the services provided while reducing the costs.

ED becomes 'lean' and cuts LBTC, LOS times.

PubMed

2008-04-01

Lean manufacturing techniques, first developed by Toyota, can be successfully adapted to help improve processes in your ED. St. Luke's Episcopal Hospital in Houston, has used Lean to reduce median length of stay, frequency of diversions, and the percentage of patients who left before treatment was complete (LBTC). Here's why "Lean" can help improve the performance of your ED: It enables you and your staff to see things from the patient's point of view. Lean tools enable you to view the status of your department in real-time and to compare that status with your performance goals. Exercises help identify areas where your processes break down and determine the most likely solutions.

[Four awareness of clinical lean management].

PubMed

Xiong, L Z; Zhang, C F

2017-01-20

Along with changes of medical model, hospitals need to provide best outcome with lowest cost and best patient's experience rather than merely medical treatments. It is the cultivation of lean awareness to the doctors that could acquire such outcome. The healthcare lean awareness can be summarized as responsibility awareness, digitalized awareness, detail awareness, and outstanding awareness. Through the cultivation of lean awareness, humanism can immerse into the doctors'practice, which is conducive to train for the great masters of the medicine.

Organizational change through Lean Thinking.

PubMed

Tsasis, Peter; Bruce-Barrett, Cindy

2008-08-01

In production and manufacturing plants, Lean Thinking has been used to improve processes by eliminating waste and thus enhancing efficiency. In health care, Lean Thinking has emerged as a comprehensive approach towards improving processes embedded in the diagnostic, treatment and care activities of health-care organizations with cost containment results. This paper provides a case study example where Lean Thinking is not only used to improve efficiency and cost containment, but also as an approach to effective organizational change.

Medical and scientific writing: Time to go lean and mean.

PubMed

Bhardwaj, Payal; Sinha, Sudip; Yadav, Raj Kumar

2017-01-01

The Lean Six Sigma methodology for process improvements and driving efficiency is old, but lean writing was adopted late by the pharmaceutical world in terms of size of the documents. The documents were lean earlier, and then became voluminous, and now we are about to complete a full circle in this regard, i.e., coming back to the lean documents again using e-formats and hyperlinking. Furthermore, writing has become more and more precise over time. The need for this lean and mean medical and scientific writing arose from voluminous research globally, both industry and academia which are abuzz with skyrocketing regulatory and scientific submission volumes. The quantum of literature is so much that reviewers or information seekers firmly believe that going through even selected and relevant literature has become highly challenging. Considering this, there has been much insistence on downsizing the medical writing documents, which could be tempting enough to be leveraged for scientific publications as well. Here, we present the need for lean and mean medical writing, discuss this concept in relation to the pharmaceutical industry, and how to apply this to key documents. Furthermore, presented is the proposed algorithm for lean and mean clinical study reports and manuscripts. These thoughts are aligned to the recently established concept of data transparency, and can be easily achieved by web links between the protocols and clinical trial results disclosed publicly, and the corresponding manuscripts.

Lean in healthcare: the unfilled promise?

PubMed

Radnor, Zoe J; Holweg, Matthias; Waring, Justin

2012-02-01

In an effort to improve operational efficiency, healthcare services around the world have adopted process improvement methodologies from the manufacturing sector, such as Lean Production. In this paper we report on four multi-level case studies of the implementation of Lean in the English NHS. Our results show that this generally involves the application of specific Lean 'tools', such as 'kaizen blitz' and 'rapid improvement events', which tend to produce small-scale and localised productivity gains. Although this suggests that Lean might not currently deliver the efficiency improvements desired in policy, the evolution of Lean in the manufacturing sector also reveals this initial focus on the 'tool level'. In moving to a more system-wide approach, however, we identify significant contextual differences between healthcare and manufacturing that result in two critical breaches of the assumptions behind Lean. First, the customer and commissioner in the private sector are the one and the same, which is essential in determining 'customer value' that drives process improvement activities. Second, healthcare is predominantly designed to be capacity-led, and hence there is limited ability to influence demand or make full use of freed-up resources. What is different about this research is that these breaches can be regarded as not being primarily 'professional' in origin but actually more 'organisational' and 'managerial' and, if not addressed could severely constrain Lean's impact on healthcare productivity at the systems level. Copyright © 2011 Elsevier Ltd. All rights reserved.

Medical and scientific writing: Time to go lean and mean

PubMed Central

Bhardwaj, Payal; Sinha, Sudip; Yadav, Raj Kumar

2017-01-01

The Lean Six Sigma methodology for process improvements and driving efficiency is old, but lean writing was adopted late by the pharmaceutical world in terms of size of the documents. The documents were lean earlier, and then became voluminous, and now we are about to complete a full circle in this regard, i.e., coming back to the lean documents again using e-formats and hyperlinking. Furthermore, writing has become more and more precise over time. The need for this lean and mean medical and scientific writing arose from voluminous research globally, both industry and academia which are abuzz with skyrocketing regulatory and scientific submission volumes. The quantum of literature is so much that reviewers or information seekers firmly believe that going through even selected and relevant literature has become highly challenging. Considering this, there has been much insistence on downsizing the medical writing documents, which could be tempting enough to be leveraged for scientific publications as well. Here, we present the need for lean and mean medical writing, discuss this concept in relation to the pharmaceutical industry, and how to apply this to key documents. Furthermore, presented is the proposed algorithm for lean and mean clinical study reports and manuscripts. These thoughts are aligned to the recently established concept of data transparency, and can be easily achieved by web links between the protocols and clinical trial results disclosed publicly, and the corresponding manuscripts. PMID:28828305

Comparison of effects of Wasabia japonica and allyl isothiocyanate on the growth of four strains of Vibrio parahaemolyticus in lean and fatty tuna meat suspensions.

PubMed

Hasegawa, N; Matsumoto, Y; Hoshino, A; Iwashita, K

1999-08-01

Lean tuna meat suspensions (LEAN), with a fat content of 0.006%, and fatty tuna meat suspension (FATTY), with a fat content of 3.0% were inoculated with four strains of Vibrio parahaemolyticus and wasabi (Wasabia japonica Matsumura) or allyl isothiocyanate (AIT) was added before incubation at 37 degrees C. During the incubation, viable Vibrio counts were determined on TCBS agar plates. Both LEAN and FATTY suspensions were inoculated with V. parahaemolyticus AOTO-81, (1.28+/-0.20) x 10(2) CFU/ml, followed by addition of 20 mg wasabi/ml, and incubation for 8 h. The viable Vibrio counts were (7.76+/-5.93) x 10(5) CFU/ml in LEAN and (3.50+/-2.65) x 10(1) CFU/ml in FATTY. When the same strain, at (1.18+/-0.22) x 10(2) CFU/ml, was incubated for 8 h with 50.9 microg AIT/ml, viable Vibrio counts were (4.79+/-1.78) x 10(4) CFU/ml in LEAN and (1.80+/-1.30) x 10(1) CFU/ml in FATTY. Growth of the other three strains with wasabi or AIT was shown to be less in FATTY than in LEAN. These results indicate that growth of V. parahaemolyticus is inhibited more in FATTY than in LEAN by wasabi and allyl isothiocyanate.

Blunted Suppression of Acyl-Ghrelin in Response to Fructose Ingestion in Obese Adolescents: the Role of Insulin Resistance

PubMed Central

Van Name, Michelle; Giannini, Cosimo; Santoro, Nicola; Jastreboff, Ania; Kubat, Jessica; Li, Fangyong; Kursawe, Romy; Savoye, Mary; Duran, Elvira; Dziura, James; Sinha, Rajita; Sherwin, Robert; Cline, Gary; Caprio, Sonia

2015-01-01

Objective Fructose consumption has risen alongside obesity and diabetes. Gut hormones involved in hunger and satiety (ghrelin and PYY) may respond differently to fructose compared to glucose ingestion. We evaluated the effects of glucose and fructose ingestion on ghrelin and PYY in lean and obese adolescents with differing insulin sensitivity. Methods Adolescents were divided into lean (n=14), obese insulin sensitive (n=12) (OIS), and obese insulin resistant (n=15) (OIR). In a double-blind, cross-over design, subjects drank 75g of glucose or fructose in random order, serum was obtained every 10 minutes for 60 minutes. Results Baseline acyl-ghrelin was highest in lean and lowest in OIR (p=0.02). After glucose ingestion acyl-ghrelin decreased similarly in lean and OIS, but appeared lower in OIR (vs lean p=0.03). Suppression differences were more pronounced after fructose (lean vs. OIS p=0.008, lean vs. OIR p<0.001). OIS became significantly hungrier after fructose (p=0.015). PYY was not significantly different at baseline, varied minimally after glucose, and rose after fructose. Conclusion Compared to lean, OIS adolescents have impaired acyl-ghrelin responses to fructose but not glucose, whereas OIR adolescents have blunted responses to both. Diminished suppression of acyl-ghrelin in childhood obesity, particularly if accompanied by insulin resistance, may promote hunger and overeating. PMID:25645909

Calculation of Glucose Dose for Intraperitoneal Glucose Tolerance Tests in Lean and Obese Mice.

PubMed

Jørgensen, Mikkel S; Tornqvist, Kristina S; Hvid, Henning

2017-01-01

Glucose tolerance tests are used frequently in nonclinical research with laboratory animals, for example during characterization of obese phenotypes. Despite published standard operating procedures for glucose tolerance tests in rodents, how glucose doses should be calculated when obese and lean animals are compared is not well documented. Typically the glucose dose is calculated as 2 g/kg body weight, regardless of body composition. With this approach, obese mice receive larger glucose doses than do lean animals, potentially leading to overestimation of glucose intolerance in obese animals. In this study, we performed intraperitoneal glucose tolerance tests in mice with diet-induced obesity and their lean controls, with glucose doses based on either the total body weight or the lean body mass of the animals. To determine glucose tolerance, we determined the blood glucose AUC during the glucose tolerance test. We found that the blood glucose AUC was increased significantly in obese mice compared with lean mice by 75% on average when glucose was dosed according to the lean body mass and by 87% when the glucose dose was calculated according to total body weight. Therefore, mice with diet-induced obesity were approximately equally glucose intolerant between the 2 dose-calculation protocols. However, we recommend calculating the glucose dose according to the lean body mass of the mice, because doing so eliminates the concern regarding overdosing of obese animals.

SUCCESSFUL IMPLEMENTATION OF LEAN AS A MANAGERIAL PRINCIPLE IN HEALTH CARE: A CONCEPTUAL ANALYSIS FROM SYSTEMATIC LITERATURE REVIEW.

PubMed

Maijala, Riikka; Eloranta, Sini; Reunanen, Tero; Ikonen, Tuija S

2018-01-01

The aim of this study was to identify and analyze the characteristics of leadership and management associated with a successful Lean thinking adaptation in healthcare. A systematic literature review was undertaken using electronic databases: PubMed, PubMed Systematic Review, ABI/INFORM, Business Source Complete, Emerald, JBI, and Cinahl. Inclusion criteria were: (i) a description of Lean management or leadership in health care, (ii) a reference to Lean thinking, (iii) a peer-reviewed original research article or a literature review, and (iv) a full text article available in English. Among the 1,754 peer-reviewed articles identified, nine original articles and three systematic reviews met the inclusion criteria. Data on informants, methods, and settings were extracted and collated. Content analysis was used to conduct a review of the nine original studies describing and analyzing the success factors of Lean adaptation. The characteristics of leadership and management were analyzed by using the concept of a managerial windshield that divides leadership and management into four ontological dimensions: activities, style, focus, and purpose, each with typical developmental stages of skills and capabilities. The current study has some limitations: some papers from the journals not indexed in the searched databases may have been overlooked and the literature searches were carried out only for a 5-year period. Considering the results using the windshield concept emphasizes the philosophy, principles, and tools of Lean thinking. Lean leadership and management factors in health care were mainly conceptualized as skills and capabilities such as problem solving, making changes occur, empowering, communicating, coaching, supporting, facilitating, being democratic, organizational learning, and organizational success, all of which represented middle-stage or advanced managerial skills and capabilities. A conceptual analysis of systematically reviewed studies of Lean leadership and management point to certain traits as being typical when adapting Lean thinking to health care. The concept of a managerial windshield is useful when categorizing and analyzing essential managerial skills and capabilities for Lean implementation. Findings are beneficial when learning and educating the skills required for Lean transformation in healthcare organizations.

Dietary Protein Intake and Lean Muscle Mass in Survivors of Childhood Acute Lymphoblastic Leukemia: Report From the St. Jude Lifetime Cohort Study.

PubMed

Boland, Alexandra M; Gibson, Todd M; Lu, Lu; Kaste, Sue C; DeLany, James P; Partin, Robyn E; Lanctot, Jennifer Q; Howell, Carrie R; Nelson, Heather H; Chemaitilly, Wassim; Pui, Ching-Hon; Robison, Leslie L; Mulrooney, Daniel A; Hudson, Melissa M; Ness, Kirsten K

2016-07-01

Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for low lean muscle mass and muscle weakness, which may contribute to inactivity and early development of chronic diseases typically seen in older adults. Although increasing protein intake, in combination with resistance training, improves lean muscle mass in other populations, it is not known whether muscular tissue among survivors of ALL, whose impairments are treatment-related, will respond similarly. The aim of this study was to evaluate associations among dietary protein intake, resistance training, and lean muscle mass in survivors of ALL and age-, sex-, and race-matched controls. This was a cross-sectional study. Lean muscle mass was determined with dual-energy x-ray absorptiometry, dietary information with 24-hour recalls, and participation in resistance training with a questionnaire. Participants were 365 survivors of ALL (52% male; 87% white; median age=28.5 years, range=23.6-31.7) and 365 controls with no previous cancer. Compared with controls, survivors of ALL had lower lean muscle mass (55.0 versus 57.2 kg, respectively) and lower percentage of lean muscle mass (68.6% versus 71.4%, respectively) than controls. Similar proportions of survivors (71.1%) and controls (69.7%) met recommended dietary protein intake (0.8 g/kg/d). Survivors (45.4%) were less likely to report resistance training than controls (53.8%). In adjusted models, 1-g higher protein intake per kilogram of body mass per day was associated with a 7.9% increase and resistance training ≥1×wk, with a 2.8% increase in lean muscle mass. The cross-sectional study design limits temporal evaluation of the association between protein intake and lean muscle mass. The findings suggest that survivors of childhood ALL with low lean muscle mass may benefit from optimizing dietary protein intake in combination with resistance training. Research is needed to determine whether resistance training with protein supplementation improves lean muscle mass in survivors of childhood ALL. © 2016 American Physical Therapy Association.

Elimination of waste: creation of a successful Lean colonoscopy program at an academic medical center.

PubMed

Damle, Aneel; Andrew, Nathan; Kaur, Shubjeet; Orquiola, Alan; Alavi, Karim; Steele, Scott R; Maykel, Justin

2016-07-01

Lean processes involve streamlining methods and maximizing efficiency. Well established in the manufacturing industry, they are increasingly being applied to health care. The objective of this study was to determine feasibility and effectiveness of applying Lean principles to an academic medical center colonoscopy unit. Lean process improvement involved training endoscopy personnel, observing patients, mapping the value stream, analyzing patient flow, designing and implementing new processes, and finally re-observing the process. Our primary endpoint was total colonoscopy time (minutes from check-in to discharge) with secondary endpoints of individual segment times and unit colonoscopy capacity. A total of 217 patients were included (November 2013-May 2014), with 107 pre-Lean and 110 post-Lean intervention. Pre-Lean total colonoscopy time was 134 min. After implementation of the Lean process, mean colonoscopy time decreased by 10 % to 121 min (p = 0.01). The three steps of the process affected by the Lean intervention (time to achieve adequate sedation, time to recovery, and time to discharge) decreased from 3.7 to 2.4 min (p < 0.01), 4.0 to 3.4 min (p = 0.09), and 41.2 to 35.4 min (p = 0.05), respectively. Overall, unit capacity of colonoscopies increased from 39.6 per day to 43.6. Post-Lean patient satisfaction surveys demonstrated an average score of 4.5/5.0 (n = 73) regarding waiting time, 4.9/5.0 (n = 60) regarding how favorably this experienced compared to prior colonoscopy experiences, and 4.9/5.0 (n = 74) regarding professionalism of staff. One hundred percentage of respondents (n = 69) stated they would recommend our institution to a friend for colonoscopy. With no additional utilization of resources, a single Lean process improvement cycle increased productivity and capacity of our colonoscopy unit. We expect this to result in increased patient access and revenue while maintaining patient satisfaction. We believe these results are widely generalizable to other colonoscopy units as well as other process-based interventions in health care.

Dietary Protein Intake and Lean Muscle Mass in Survivors of Childhood Acute Lymphoblastic Leukemia: Report From the St. Jude Lifetime Cohort Study

PubMed Central

Boland, Alexandra M.; Gibson, Todd M.; Lu, Lu; Kaste, Sue C.; DeLany, James P.; Partin, Robyn E.; Lanctot, Jennifer Q.; Howell, Carrie R.; Nelson, Heather H.; Chemaitilly, Wassim; Pui, Ching-Hon; Robison, Leslie L.; Mulrooney, Daniel A.; Hudson, Melissa M.

2016-01-01

Background Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for low lean muscle mass and muscle weakness, which may contribute to inactivity and early development of chronic diseases typically seen in older adults. Although increasing protein intake, in combination with resistance training, improves lean muscle mass in other populations, it is not known whether muscular tissue among survivors of ALL, whose impairments are treatment-related, will respond similarly. Objective The aim of this study was to evaluate associations among dietary protein intake, resistance training, and lean muscle mass in survivors of ALL and age-, sex-, and race-matched controls. Design This was a cross-sectional study. Methods Lean muscle mass was determined with dual-energy x-ray absorptiometry, dietary information with 24-hour recalls, and participation in resistance training with a questionnaire. Participants were 365 survivors of ALL (52% male; 87% white; median age=28.5 years, range=23.6–31.7) and 365 controls with no previous cancer. Results Compared with controls, survivors of ALL had lower lean muscle mass (55.0 versus 57.2 kg, respectively) and lower percentage of lean muscle mass (68.6% versus 71.4%, respectively) than controls. Similar proportions of survivors (71.1%) and controls (69.7%) met recommended dietary protein intake (0.8 g/kg/d). Survivors (45.4%) were less likely to report resistance training than controls (53.8%). In adjusted models, 1-g higher protein intake per kilogram of body mass per day was associated with a 7.9% increase and resistance training ≥1×wk, with a 2.8% increase in lean muscle mass. Limitations The cross-sectional study design limits temporal evaluation of the association between protein intake and lean muscle mass. Conclusions The findings suggest that survivors of childhood ALL with low lean muscle mass may benefit from optimizing dietary protein intake in combination with resistance training. Research is needed to determine whether resistance training with protein supplementation improves lean muscle mass in survivors of childhood ALL. PMID:26893509

Changes in Body Composition According to Age and Sex among Young Non-Diabetic Korean Adults: The Kangbuk Samsung Health Study.

PubMed

Kim, Seul Ki; Kwon, Yu Hyun; Cho, Jung Hwan; Lee, Da Young; Park, Se Eun; Oh, Hyung Geun; Park, Cheol Young; Lee, Won Young; Oh, Ki Won; Park, Sung Woo; Rhee, Eun Jung

2017-12-01

Age-related decreases in lean mass represent a serious health problem. We aimed to analyze the risks of rapid decreases in lean mass by age and sex in relatively young Korean adults during a 4-year follow-up study. A total of 65,856 non-diabetic participants (59.5% men, mean age 39.1 years) in a health screening program were subjected to bioimpedance body composition analyses and metabolic parameter analyses at baseline and after 4 years. The participants were sub-divided according to age, and additionally to six groups by age and the degree of body weight change over the 4-year period. The actual changes in body weight, lean mass, and fat mass and the percent changes over the 4-year period were assessed. The percent change in lean mass decreased and the percent change of fat mass increased with increasing age in every age and sex group. However, the annual percent decrease in lean mass and percent increase in fat mass were significantly higher among women than among men (-0.26% vs. -0.15% and 0.34% vs. 0.42%, respectively; P<0.01). Participants who were older than 50 years and had a weight loss <-5% during the 4 years had significantly greater decreases in lean mass and smaller decreases in fat mass, compared to those who were younger than 50 years. An odds ratio analysis to determine the lowest quartile of the percent change in lean mass according to age group revealed that participants older than 60 years had a significantly increased risk of a rapid decrease in the lean mass percentage (2.081; 95% confidence interval, 1.678 to 2.581). Even in this relatively young study population, the lean mass decreased significantly with age, and the risk of a rapid decrease in lean mass was higher among women than among men. Furthermore, the elderly exhibited a significantly more rapid decrease in lean mass, compared with younger participants. Copyright © 2017 Korean Endocrine Society

MO-B-BRB-01: Optimize Treatment Planning Process in Clinical Environment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feng, W.

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequentialmore » events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.« less

MO-B-BRB-00: Optimizing the Treatment Planning Process

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequentialmore » events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.« less

MO-B-BRB-03: Systems Engineering Tools for Treatment Planning Process Optimization in Radiation Medicine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kapur, A.

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequentialmore » events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.« less

MO-B-BRB-02: Maintain the Quality of Treatment Planning for Time-Constraint Cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chang, J.

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequentialmore » events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.« less

T-DNA transfer and T-DNA integration efficiencies upon Arabidopsis thaliana root explant cocultivation and floral dip transformation.

PubMed

Ghedira, Rim; De Buck, Sylvie; Van Ex, Frédéric; Angenon, Geert; Depicker, Ann

2013-12-01

T-DNA transfer and integration frequencies during Agrobacterium-mediated root explant cocultivation and floral dip transformations of Arabidopsis thaliana were analyzed with and without selection for transformation-competent cells. Based on the presence or absence of CRE recombinase activity without or with the CRE T-DNA being integrated, transient expression versus stable transformation was differentiated. During root explant cocultivation, continuous light enhanced the number of plant cells competent for interaction with Agrobacterium and thus the number of transient gene expression events. However, in transformation competent plant cells, continuous light did not further enhance cotransfer or cointegration frequencies. Upon selection for root transformants expressing a first T-DNA, 43-69 % of these transformants showed cotransfer of another non-selected T-DNA in two different light regimes. However, integration of the non-selected cotransferred T-DNA occurred only in 19-46 % of these transformants, indicating that T-DNA integration in regenerating root cells limits the transformation frequencies. After floral dip transformation, transient T-DNA expression without integration could not be detected, while stable T-DNA transformation occurred in 0.5-1.3 % of the T1 seedlings. Upon selection for floral dip transformants with a first T-DNA, 8-34 % of the transformants showed cotransfer of the other non-selected T-DNA and in 93-100 % of them, the T-DNA was also integrated. Therefore, a productive interaction between the agrobacteria and the female gametophyte, rather than the T-DNA integration process, restricts the floral dip transformation frequencies.

Lean Mixture Engines Testing and Evaluation Program : Volume 2. Comprehensive Discussion.

DOT National Transportation Integrated Search

1975-11-01

This report is aimed at defining analytically and demonstrating experimentally the potential of the 'lean-burn concept.' Fuel consumption and emissions data are obtained on the engine dynamometer for the baseline engine, and two lean-burn configurati...

Lean Mixture Engines Testing and Evaluation Program : Volume 1. Executive Summary.

DOT National Transportation Integrated Search

1975-01-01

This report is aimed at defining analytically and demonstrating experimentally the potential of the 'lean-burn concept'. Fuel consumption and emissions data are obtained on the engine dynamometer for the baseline engine, and two lean-burn configurati...

Environmental Professional’s Guide to Lean and Six Sigma: Executive Summary

EPA Pesticide Factsheets

Introduction to the guide that describes how Lean and Six Sigma relate to the environment and provides guidance on how environmental professionals can connect with Lean and Six Sigma activities to generate better environmental and operational results.