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.

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.

"The largest Lean transformation in the world": the implementation and evaluation of lean in Saskatchewan healthcare.

PubMed

Kinsman, Leigh; Rotter, Thomas; Stevenson, Katherine; Bath, Brenna; Goodridge, Donna; Harrison, Liz; Dobson, Roy; Sari, Nazmi; Jeffery, Cathy; Bourassa, Carrie; Westhorp, Gill

2014-01-01

The Saskatchewan Ministry of Health has committed to a multi-million dollar investment toward the implementation of Lean methodology across the province's healthcare system. Originating as a production line discipline (the Toyota Production System), Lean has evolved to encompass process improvements including inventory management, waste reduction and quality improvement techniques. With an initial focus on leadership, strategic alignment, training and the creation of a supportive infrastructure (Lean promotion offices), the goal in Saskatchewan is a whole health system transformation that produces "better health, better value, better care, and better teams." Given the scope and scale of the initiative and the commitment of resources, it is vital that a comprehensive, longitudinal evaluation plan be implemented to support ongoing decision-making and program design. The nature of the initiative also offers a unique opportunity to contribute to health quality improvement science by advancing our understanding of the implementation and evaluation of complex, large-scale healthcare interventions. The purpose of this article is to summarize the background to Lean in Saskatchewan and the proposed evaluation methods. Copyright © 2014 Longwoods Publishing.

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.

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.

Review of Lean Construction Conference Proceedings and Relationship to the Toyota Production System Framework

ERIC Educational Resources Information Center

Jacobs, Gideon Francois

2010-01-01

The objective of this study was to align the International Group of Lean Construction (IGLC) conference proceedings against the Toyota Production System (TPS) to determine how well research themes in construction studies align with the TPS framework. Factories around the world that have implemented the TPS framework have experienced impressive…

Clinically lean; "cutting the crap".

PubMed

Caldwell, G

2012-01-01

Proponents of Lean Philosophy believe that successful businesses must reduce waste in working time and resources to a minimum, and maximise their use in productive work. The productive work of the Acute Medical Unit is to provide effective clinical management to a daily cohort of acutely ill patients. Many Clinicians are cynical about Lean. In this article, Dr Caldwell discusses how many clinicians complain of too much crap in the workplace, which gets in the way of swift, safe high quality clinical care. He argues that "Cutting the Crap" in the Acute Medical Unit is entirely consistent with Lean approaches to management of complex systems.

The positive impact of simultaneous implementation of the BD FocalPoint GS Imaging System and lean principles on the operation of gynecologic cytology.

PubMed

Wong, Rebecca; Levi, Angelique W; Harigopal, Malini; Schofield, Kevin; Chhieng, David C

2012-02-01

Our cytology laboratory, like many others, is under pressure to improve quality and provide test results faster while decreasing costs. We sought to address these issues by introducing new technology and lean principles. To determine the combined impact of the FocalPoint Guided Screener (GS) Imaging System (BD Diagnostics-TriPath, Burlington, North Carolina) and lean manufacturing principles on the turnaround time (TAT) and productivity of the gynecologic cytology operation. We established a baseline measure of the TAT for Papanicolaou tests. We then compared that to the performance after implementing the FocalPoint GS Imaging System and lean principles. The latter included value-stream mapping, workflow modification, and a first in-first out policy. The mean (SD) TAT for Papanicolaou tests before and after the implementation of FocalPoint GS Imaging System and lean principles was 4.38 (1.28) days and 3.20 (1.32) days, respectively. This represented a 27% improvement in the average TAT, which was statistically significant (P < .001). In addition, the productivity of staff improved 17%, as evidenced by the increase in slides screened from 8.85/h to 10.38/h. The false-negative fraction decreased from 1.4% to 0.9%, representing a 36% improvement. In our laboratory, the implementation of FocalPoint GS Imaging System in conjunction with lean principles resulted in a significant decrease in the average TAT for Papanicolaou tests and a substantial increase in the productivity of cytotechnologists while maintaining the diagnostic quality of gynecologic cytology.

Critical Success Factors for Lean Thinking in the Application of Industrialised Building System (IBS)

NASA Astrophysics Data System (ADS)

Yunus, Riduan; Noor, Siti Rahimah Mohd; Halid Abdullah, Abd; Nagapan, Sasitharan; Hamid, Abdul Rahim Abdul; Tajudin, Saiful Azhar Ahmad; Rohani Mat Jusof, Siti

2017-08-01

Productivity in the manufacturing process of building components can be increased by optimising each advantage that is available in each activity. Identification of critical success factors (CSFs) for lean thinking in the Industrialised Building System (IBS) will be able to minimise cost and reduce time needed to complete a project. The focus of lean thinking in construction is on the production process and the client’s requirement. In developing countries such as Malaysia, the integration of lean thinking in IBS applications is still low and there is a shortage of comprehensive strategies to integrate lean thinking. As key stakeholders, feedback from contractors, manufacturers, developers and the local authority will be able to help the identification of CSFs in integrating lean thinking in IBS applications. The data was collected through a questionnaire survey and analysed quantitatively. There are 31 CSFs for lean thinking in IBS which have been identified in this study. A conceptual model was developed to assist researchers in investigating the influences of CSFs for lean thinking in IBS applications. This study will assist construction players to improvise their manufacturing process in the implementation of IBS to eliminate unnecessary activities and focus instead on significant processes without generating physical and non-physical waste.

Improving preanalytic processes using the principles of lean production (Toyota Production System).

PubMed

Persoon, Thomas J; Zaleski, Sue; Frerichs, Janice

2006-01-01

The basic technologies used in preanalytic processes for chemistry tests have been mature for a long time, and improvements in preanalytic processes have lagged behind improvements in analytic and postanalytic processes. We describe our successful efforts to improve chemistry test turnaround time from a central laboratory by improving preanalytic processes, using existing resources and the principles of lean production. Our goal is to report 80% of chemistry tests in less than 1 hour and to no longer recognize a distinction between expedited and routine testing. We used principles of lean production (the Toyota Production System) to redesign preanalytic processes. The redesigned preanalytic process has fewer steps and uses 1-piece flow to move blood samples through the accessioning, centrifugation, and aliquoting processes. Median preanalytic processing time was reduced from 29 to 19 minutes, and the laboratory met the goal of reporting 80% of chemistry results in less than 1 hour for 11 consecutive months.

Can lean save lives?

PubMed

Fillingham, David

2007-01-01

The purpose of this paper is to show how over the last 18 months Bolton Hospitals NHS Trust have been exploring whether or not lean methodologies, often known as the Toyota Production System, can indeed be applied to healthcare. This paper is a viewpoint. One's early experience is that lean really can save lives. The Toyota Production System is an amazingly successful way of manufacturing cars. It cannot be simply translated unthinkingly into a hospital but lessons can be learned from it and the method can be adapted and developed so that it becomes owned by healthcare staff and focused towards the goal of improved patient care. Working in healthcare is a stressful and difficult thing. Everyone needs a touch of inspiration and encouragement. Applying lean to healthcare in Bolton seems to be achieving just that for those who work there.

Ergonomics and Kaizen as strategies for competitiveness: a theoretical and practical in an automotive industry.

PubMed

Vieira, Leandro; Balbinotti, Giles; Varasquin, Adriano; Gontijo, Leila

2012-01-01

With increased international competitiveness in the automotive industry, came the concern of the companies save costs and lower production costs. For this purpose many ways are designed to reduce costs and waste of raw materials and reduce activities that do not aggregate value to manufacturing processes. In the early XVII appears the manufacturing system, which processes were hard with little concern for the health and safety of employees and conditions of the workplace. After the advent of the production system called lean manufacturing, a new paradigm in terms of production system capable of providing high levels of productivity and quality. It is based on waste elimination that occur during the production process. After began a new way of thinking, creating a culture of continuous improvement and lean process with no waste and reducing costs, without neglecting the welfare worker and improving the conditions of their work environment. This paper presents a reflection on the application of ergonomics in a lean production system of an automotive industry, using methodology based on the Kaizen (Continuous Improvement) to gain performance and improving the conditions of the workplace, also will be presented with positive and negative points in using this methodology in relation to ergonomics. The research will be conducted by collecting data 'in loco' and interviews with workers. Some studies show that in companies that are lean system and using the methodology of Kaizen, the results of product quality, levels of absenteeism and accidents are better than those obtained in companies that do not apply the same concept.

Comparative study: TQ and Lean Production ownership models in health services

PubMed Central

Eiro, Natalia Yuri; Torres-Junior, Alvair Silveira

2015-01-01

Objective: compare the application of Total Quality (TQ) models used in processes of a health service, cases of lean healthcare and literature from another institution that has also applied this model. Method: this is a qualitative research that was conducted through a descriptive case study. Results: through critical analysis of the institutions studied it was possible to make a comparison between the traditional quality approach checked in one case and the theoretical and practice lean production approach used in another case and the specifications are described below. Conclusion: the research identified that the lean model was better suited for people that work systemically and generate the flow. It also pointed towards some potential challenges in the introduction and implementation of lean methods in health. PMID:26487134

Effective management of patients with acute ischemic stroke based on lean production on thrombolytic flow optimization.

PubMed

Liang, Zhuoyuan; Ren, Lijie; Wang, Ting; Hu, Huoyou; Li, Weiping; Wang, Yaping; Liu, Dehong; Lie, Yi

2016-12-01

The efficacy of thrombolytic therapy for acute ischemic stroke (AIS) decreases when the administration of tissue plasminogen activator (tPA) is delayed. Derived from Toyota Production System, lean production aims to create top-quality products with high-efficiency procedures, a concept that easily applies to emergency medicine. In this study, we aimed to determine whether applying lean principles to flow optimization could hasten the initiation of thrombolysis. A multidisciplinary team (Stroke Team) was organized to implement an ongoing, continuous loop of lean production that contained the following steps: decomposition, recognition, intervention, reengineering and assessment. The door-to-needle time (DNT) and the percentage of patients with DNT ≤ 60 min before and after the adoption of lean principles were used to evaluate the efficiency of our flow optimization. Thirteen patients with AIS in the pre-lean period and 43 patients with AIS in the lean period (23 in lean period I and 20 patients in lean period II) were consecutively enrolled in our study. After flow optimization, we reduced DNT from 90 to 47 min (p < 0.001 ¤ ). In addition, the percentage of patients treated ≤60 min after hospital arrival increased from 38.46 to 75.0 % (p = 0.015 ¤ ). Adjusted analysis of covariance confirmed a significant influence of optimization on delay of tPA administration (p < 0.001). The patients were more likely to have a good prognosis (mRS ≤ 2 at 90 days) after the flow optimization (30.77-75.00 %, p = 0.012 ¤ ). Our study may offer an effective approach for optimizing the thrombolytic flow in the management of AIS.

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.

'Lean' approach gives greater efficiency.

PubMed

Call, Roger

2014-02-01

Adapting the 'Lean' methodologies used for many years by many manufacturers on the production line - such as in the automotive industry - and deploying them in healthcare 'spaces' can, Roger Call, an architect at Herman Miller Healthcare in the US, argues, 'easily remedy many of the inefficiencies' found within a healthcare facility. In an article that first appeared in the September 2013 issue of The Australian Hospital Engineer, he explains how 'Lean' approaches such as the 'Toyota production system', and 'Six Sigma', can be harnessed to good effect in the healthcare sphere.

Virtual modelling of components of a production system as the tool of lean engineering

NASA Astrophysics Data System (ADS)

Monica, Z.

2015-11-01

Between the most effective techniques of manufacturing management is considered the Lean Engineering. The term “lean engineering” was created by Japanese manufacturers. The high efficiency of this method resulted in a meaningful growth in concern in the philosophy of Lean among European companies, and consequently the use of its European markets. Lean philosophy is an approach to manufacturing to minimize the use of all resources, including time. These are resources that are used in the company for a variety of activities. This implies, first identify and then eliminate activities which does not generate added value in the field of design, manufacturing, supply chain management, and customer relations. The producers of these principles not only employ teams multi-professional employees at all levels of the organization, but also use a more automated machines to produce large quantities of products with a high degree of diversity. Lean Engineering is to use a number of principles and practical guidelines that allow you to reduce costs by eliminating absolute extravagance, and also simplification of all manufacturing processes and maintenance. Nowadays it could be applied the powerful engineering programs to realize the concept of Lean Engineering. They could be described using the term CAD/CAM/CAE. They consist of completely different packages for both the design of elements, as well process design. Their common feature is generally considered with their application area. They are used for computer programs assisting the design, development and manufacturing phases of a manufacturing process. The idea of the presented work is to use the Siemens NX software for aiding the process of Lean Engineering system creating. The investigated system is a robotized workcell. In the NX system are created the components of the designed workcell such as machine tools, as industrial robot, as conveyors and buffers. The system let to functionally link these components to simulate the work process and to introduce the rules of Lean Engineering. The purpose is also to determine the rules of Lean designing in such advanced design and simulation environments.

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.

Study on lean thinking among MSMEs in the Machine tool sector in India

NASA Astrophysics Data System (ADS)

Priyaadarshini, R. G.; Sathish Kumar, V. R.; Aishwarya Rajlakshmi, S.

2018-02-01

In the era of stiff competition and customer expectations, manufacturing organizations across the world are struggling hard to minimize their costs and maximise their performance. Micro, Small and Medium enterprises (MSMEs), who are dependent on large corporate for business and support have a tall task of keeping pace quality in processes and output. They are in the constant vigil to adopt new systems and practices so that they can minimise their cost and maximize the productivity. This study has been conducted in the machine tool sector of Coimbatore, India; which houses more than 9000 companies and offers employment to over one lakh employees. They have a tremendous pressure to use scientific processes to increase their product quality and productivity. While Lean manufacturing has been the thrust to improve the competitiveness among MSMEs in India, this study has attempted to understand their attitude towards lean management and understand the extent to which companies practice lean tools and practices. It has been found that most of the organizations in the study possess a culture of lean thinking and possess the support of top management and employees also towards the initiative. It is also seen that the organizations that incorporated lean in their daily operations have been able to scale up their productivity.

Simulation Design for Off-Line Training of Practical Lean Manufacturing Concepts for Visual Inspection

ERIC Educational Resources Information Center

Tetteh, Edem; McWilliams, Douglas

2010-01-01

Customer needs for high-quality goods and the risk of product-liability litigation against businesses have made companies look for a way to sustain quality assurance in their products and services. Lean manufacturing is the latest and most successful system being used by companies to turn their business around. Visual inspection plays an important…

Scaling Lean in primary care: impacts on system performance.

PubMed

Hung, Dorothy Y; Harrison, Michael I; Martinez, Meghan C; Luft, Harold S

2017-03-01

We examined a wide range of performance outcomes after Lean methodology-a leading strategy to enhance efficiency and patient value-was implemented and scaled across all primary care clinics in a nonprofit, ambulatory care delivery system. Using a stepped wedge approach, we assessed changes associated with the phased introduction of Lean-based redesigns across 46 primary care departments in 17 different clinic locations. Longitudinal analysis of operational metrics included: workflow efficiency, physician productivity, operating expenses, clinical quality, and satisfaction among patients, physicians, and staff. We used interrupted time series analysis with generalized linear mixed models to estimate Lean impacts over time. Projected outcomes in the absence of changes (ie, counterfactuals) were compared with observed outcomes after Lean redesigns were implemented, and mean differences were assessed using 95% bias-corrected bootstrap confidence intervals (CIs). We observed systemwide improvements in workflow efficiencies (eg, 95% CI, 5.8-10.4) and physician productivity (95% CI, 3.9-27.2), with no adverse effects on clinical quality. Patient satisfaction increased with respect to access to care (95% CI, 15.2-20.7), handling of personal issues (95% CI, 2.1-6.9), and overall experience of care (95% CI, 11.0-17.0), but decreased with respect to interactions with care providers (95% CI, -13.4 to -5.7). Departmental operating costs decreased, and annual staff and physician satisfaction scores increased particularly among early adopters, with key improvements in employee engagement, connection to purpose, relationships with staff, and physician time spent working. Lean redesigns can benefit primary care patients, physicians, and staff without negatively impacting the quality of clinical care. Study results may lead other delivery system leaders to innovate using Lean techniques and may further enhance support for Lean learning among public and private payers.

Effects of NOX Storage Component on Ammonia Formation in TWC for Passive SCR NOX Control in Lean Gasoline Engines

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

Prikhodko, Vitaly Y.; Pihl, Josh A.; Toops, Todd J.

A prototype three-way catalyst (TWC) with NOX storage component was evaluated for ammonia (NH3) generation on a 2.0-liter BMW lean burn gasoline direct injection engine as a component in a passive ammonia selective catalytic reduction (SCR) system. The passive NH3 SCR system is a potential approach for controlling nitrogen oxides (NOX) emissions from lean burn gasoline engines. In this system, NH3 is generated over a close-coupled TWC during periodic slightly-rich engine operation and subsequently stored on an underfloor SCR catalyst. Upon switching to lean, NOX passes through the TWC and is reduced by the stored NH3 on the SCR catalyst.more » Adding a NOX storage component to a TWC provides two benefits in the context of a passive SCR system: (1) enabling longer lean operation by storing NOX upstream and preserving NH3 inventory on the downstream SCR catalyst; and (2) increasing the quantity and rate of NH3 production during rich operation. Since the fuel penalty associated with passive SCR NOX control depends on the fraction of time that the engine is running rich rather than lean, both benefits (longer lean times and shorter rich times achieved via improved NH3 production) will decrease the passive SCR fuel penalty. However, these benefits are primarily realized at low to moderate temperatures (300-500 °C), where the NOX storage component is able to store NOX, with little to no benefit at higher temperatures (>500 °C), where NOX storage is no longer effective. This study discusses engine parameters and control strategies affecting the NH3 generation over a TWC with NOX storage component.« less

Lean healthcare.

PubMed

Weinstock, Donna

2008-01-01

As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

Participative Work Design in Lean Production: A Strategy for Dissolving the Paradox between Standardized Work and Team Proactivity by Stimulating Team Learning?

ERIC Educational Resources Information Center

Lantz, Annika; Hansen, Niklas; Antoni, Conny

2015-01-01

Purpose: The purpose of this paper is to explore job design mechanisms that enhance team proactivity within a lean production system where autonomy is uttermost restricted. We propose and test a model where the team learning process of building shared meaning of work mediates the relationship between team participative decision-making, inter team…

The joint use of resilience engineering and lean production for work system design: A study in healthcare.

PubMed

Rosso, Caroline Brum; Saurin, Tarcisio Abreu

2018-09-01

Although lean production (LP) has been increasingly adopted in healthcare systems, its benefits often fall short of expectations. This might be partially due to the failure of lean to account for the complexity of healthcare. This paper discusses the joint use of principles of LP and resilience engineering (RE), which is an approach for system design inspired by complexity science. Thus, a framework for supporting the design of socio-technical systems, which combines insights from LP and RE, was developed and tested in a system involving a patient flow from an emergency department to an intensive care unit. Based on this empirical study, as well as on extant theory, eight design propositions that support the framework application were developed. Both the framework and its corresponding propositions can contribute to the design of socio-technical systems that are at the same time safe and efficient. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Use of Lean Six Sigma Methodology in Increasing Capacity of a Chemical Production Facility at DSM.

PubMed

Meeuwse, Marco

2018-03-30

Lean Six Sigma is an improvement method, combining Lean, which focuses on removing 'waste' from a process, with Six Sigma, which is a data-driven approach, making use of statistical tools. Traditionally it is used to improve the quality of products (reducing defects), or processes (reducing variability). However, it can also be used as a tool to increase the productivity or capacity of a production plant. The Lean Six Sigma methodology is therefore an important pillar of continuous improvement within DSM. In the example shown here a multistep batch process is improved, by analyzing the duration of the relevant process steps, and optimizing the procedures. Process steps were performed in parallel instead of sequential, and some steps were made shorter. The variability was reduced, giving the opportunity to make a tighter planning, and thereby reducing waiting times. Without any investment in new equipment or technical modifications, the productivity of the plant was improved by more than 20%; only by changing procedures and the programming of the process control system.

Improvement of nuclear power plants within the perspective of applications of lean manufacturing practices

NASA Astrophysics Data System (ADS)

Malek, A. K.; Muhammad, H. I.; Rosmaini, A.; Alaa, A. S.; Falah, A. M.

2017-09-01

Development and improvement process are essential to the companies and factories of various kinds and this necessity is related aspects of cost, time and risk that can be avoided, these aspects are available at the nuclear power stations essential demands cannot be ignored. The lean management technique is one of the recent trends in the management system. Where the lean management is stated as the system increases the customer value and reduces the wastage process in an industry or in a power plants. Therefore, there is an urgent necessity to ensure the development and improvement in nuclear power plants in the pre-established in process of being established and stage of the management and production. All of these stages according to the study are closely related to the necessity operationalize and apply lean manufacturing practices that these applications are ineffective and clear contribution to reduce costs and control of production processes and the process of reducing future risks that could be exposed to the station.

A case study on implementing lean ergonomic manufacturing systems (LEMS) in an automobile industry

NASA Astrophysics Data System (ADS)

Srinivasa Rao, P.; Niraj, Malay

2016-09-01

Lean manufacturing is a business strategy developed in Japan. In the present scenario, the global market is developing new techniques for getting more and more production rate with a good quality under low cost. In this context, human factors have to be given importance to their working conditions. The study demonstrates the adoption of ergonomic conditions in lean manufacturing for the improvement of organizational performance of the industry. The aim of ergonomics is to adapt the new techniques to their work in efficient and safe ways in order to optimize the human health conditions and increasing the production rate. By conducting survey on various disciplines and showed how the production rate and human ergonomic conditions is affected.

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.

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

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 good work--a Swedish trade union vision in the shadow of lean production.

PubMed

Johansson, Jan; Abrahamsson, Lena

2009-07-01

"The Good Work" (Det goda arbetet) was established as a highly praised and established concept in the Swedish working life debate in the middle of the 1980s. In this paper, we are going to discuss the concept in relation to the massive introduction of lean production in Swedish industry. The aim of this paper is to restore the theory of the good work into the industrial society of today. We will search for a model for 'good work' in balance between the demands from production and good conditions for a learning environment. The theoretical base for this paper will be found in both organisational research and research on production technology systems. We identify three strong trends in Swedish industrial companies giving both pitfalls and possibilities for the good work; the learning focus as a way to increase productivity and improve working conditions; Lean Production in most cases imply narrow short-cyclic work tasks; and the global market that reduces national discretion. As a result, we formulate a new set of criteria for "the good work".

Ammonia Generation and Utilization in a Passive SCR (TWC+SCR) System on Lean Gasoline Engine

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

Prikhodko, Vitaly Y; Parks, II, James E; Pihl, Josh A

Lean gasoline engines offer greater fuel economy than the common stoichiometric gasoline engine, but the current three-way catalyst (TWC) on stoichiometric engines is unable to control nitrogen oxide (NOX) emissions in the oxygen-rich exhaust. Thus, lean NOX emission control is required to meet existing Tier 2 and upcoming Tier 3 emission regulations set by the U.S. Environmental Protection Agency (EPA). While urea-based selective catalytic reduction (SCR) has proven effective in controlling NOX from diesel engines, the urea storage and delivery components can add significant size and cost. As such, onboard NH3 production via a passive SCR approach is of interest.more » In a passive SCR system, NH3 is generated over a close-coupled TWC during periodic slightly rich engine operation and subsequently stored on an underfloor SCR catalyst. Upon switching to lean operation, NOX passes through the TWC and is reduced by the stored NH3 on the SCR catalyst. In this work, a passive SCR system was evaluated on a 2.0-liter BMW lean burn gasoline direct injection engine to assess NH3 generation over a Pd-only TWC and utilization over a Cu-based SCR catalyst. System NOX reduction efficiency and fuel efficiency improvement compared to stoichiometric engine operation were measured. A feedback control strategy based on cumulative NH3 produced by the TWC during rich operation and NOX emissions during lean operation was implemented on the engine to control lean/rich cycle timing. 15% excess NH3 production over a 1:1 NH3:NOX ratio was required (via longer rich cycle timing) to achieve 99.7% NOX conversion at an SCR average inlet temperature of 350 C. Increasing NH3 generation further resulted in even higher NOX conversion; however, tailpipe NH3 emissions resulted. At higher temperatures, NH3 oxidation becomes important and limits NH3 availability for NOX reduction. At the engine conditions studied here, greater than 99% NOX conversion was achieved with passive SCR while delivering fuel efficiency benefits ranging between 6-11% compared with stoichiometric operation.« less

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.

Using LEAN principles to improve quality, patient safety, and workflow in histology and anatomic pathology.

PubMed

Serrano, Leo; Hegge, Pamela; Sato, Brendon; Richmond, Barbara; Stahnke, Lennis

2010-05-01

Histology and anatomic pathology have historically been slow to accept many of the process changes that have been widely accepted in the clinical laboratory. In this article, we describe the application of the Toyota Production System (LEAN) to histology and anatomic pathology as implemented at the Avera McKennan Hospital laboratory. Avera McKennan is the flagship hospital of the Avera Health System, a faith based, not for profit healthcare system based in South Dakota. Comprised of 235 hospitals, clinics, and physicians, with over 12,000 employees, Avera Health is one of the largest healthcare systems in the region. Beginning in 2004, Avera McKennan's laboratory began its "LEAN journey" and in the intervening years has expanded it throughout all areas of the laboratory. Following the example set by the laboratory, many other areas of the hospital have joined in the LEAN Process Improvement journey. In January 2009, the Avera McKennan Laboratory became the first hospital laboratory in the US to achieve the CAP ISO-15189 accreditation in both clinical and anatomic pathology.

Leptin production during early starvation in lean and obese women.

PubMed

Klein, S; Horowitz, J F; Landt, M; Goodrick, S J; Mohamed-Ali, V; Coppack, S W

2000-02-01

We evaluated abdominal adipose tissue leptin production during short-term fasting in nine lean [body mass index (BMI) 21 +/- 1 kg/m(2)] and nine upper body obese (BMI 36 +/- 1 kg/m(2)) women. Leptin kinetics were determined by arteriovenous balance across abdominal subcutaneous adipose tissue at 14 and 22 h of fasting. At 14 h of fasting, net leptin release from abdominal adipose tissue in obese subjects (10.9 +/- 1.9 ng x 100 g tissue x (-1) x min(-1)) was not significantly greater than the values observed in the lean group (7.6 +/- 2.1 ng x 100 g(-1) x min(-1)). Estimated whole body leptin production was approximately fivefold greater in obese (6.97 +/- 1.18 microg/min) than lean subjects (1.25 +/- 0.28 microg/min) (P < 0.005). At 22 h of fasting, leptin production rates decreased in both lean and obese groups (to 3.10 +/- 1.31 and 10.5 +/- 2.3 ng x 100 g adipose tissue(-1) x min(-1), respectively). However, the relative declines in both arterial leptin concentration and local leptin production in obese women (arterial concentration 13.8 +/- 4.4%, local production 10.0 +/- 12.3%) were less (P < 0.05 for both) than the relative decline in lean women (arterial concentration 39.0 +/- 5.5%, local production 56.9 +/- 13.0%). This study demonstrates that decreased leptin production accounts for the decline in plasma leptin concentration observed after fasting. However, compared with lean women, the fasting-induced decline in leptin production is blunted in women with upper body obesity. Differences in leptin production during fasting may be responsible for differences in the neuroendocrine response to fasting previously observed in lean and obese women.

Lean management-the journey from toyota to healthcare.

PubMed

Teich, Sorin T; Faddoul, Fady F

2013-04-01

The evolution of production systems is tightly linked to the story of Toyota Motor Company (TMC) that has its roots around 1918. The term "lean" was coined in 1990 following the exploration of the Toyota model that led to the "transference" thesis sustaining the concept that manufacturing problems and technologies are universal problems faced by management and that these concepts can be emulated in non-Japanese enterprises. Lean is a multi-faceted concept and requires organizations to exert effort along several dimensions simultaneously; some consider a successful implementation either achieving major strategic components of lean, implementing practices to support operational aspects, or providing evidence that the improvements are sustainable in the long term. The article explores challenges and opportunities faced by organizations that intend incorporating lean management principles and presents the specific context of the healthcare industry. Finally, the concepts of "essential few" and customer value are illustrated through a simple example of process change following lean principles, which was implemented in a dental school in the United States.

Error-free pathology: applying lean production methods to anatomic pathology.

PubMed

Condel, Jennifer L; Sharbaugh, David T; Raab, Stephen S

2004-12-01

The current state of our health care system calls for dramatic changes. In their pathology department, the authors believe these changes may be accomplished by accepting the long-term commitment of applying a lean production system. The ideal state of zero pathology errors is one that should be pursued by consistently asking, "Why can't we?" The philosophy of lean production systems began in the manufacturing industry: "All we are doing is looking at the time from the moment the customer gives us an order to the point when we collect the cash. And we are reducing that time line by removing non-value added wastes". The ultimate goals in pathology and overall health care are not so different. The authors' intention is to provide the patient (customer) with the most accurate diagnostic information in a timely and efficient manner. Their lead histotechnologist recently summarized this philosophy: she indicated that she felt she could sleep better at night knowing she truly did the best job she could. Her chances of making an error (in cutting or labeling) were dramatically decreased in the one-by-one continuous flow work process compared with previous practices. By designing a system that enables employees to be successful in meeting customer demand, and by empowering the frontline staff in the development and problem solving processes, one can meet the challenges of eliminating waste and build an improved, efficient system.

Lean thinking across a hospital: redesigning care at the Flinders Medical Centre.

PubMed

Ben-Tovim, David I; Bassham, Jane E; Bolch, Denise; Martin, Margaret A; Dougherty, Melissa; Szwarcbord, Michael

2007-02-01

Lean thinking is a method for organising complex production processes so as to encourage flow and reduce waste. While the principles of lean thinking were developed in the manufacturing sector, there is increasing interest in its application in health care. This case history documents the introduction and development of Redesigning Care, a lean thinking-based program to redesign care processes across a teaching general hospital. Redesigning Care has produced substantial benefits over the first two-and-a-half years of its implementation, making care both safer and more accessible. Redesigning Care has not been aimed at changing the specifics of clinical practice. Rather, it has been concerned with improving the flow of patients through clinical and other systems. Concepts that emerged in the manufacturing sector have been readily translatable into health care. Lean thinking may play an important role in the reform of health care in Australia and elsewhere.

Application of lean six sigma to waste minimization in cigarette paper industry

NASA Astrophysics Data System (ADS)

Syahputri, K.; Sari, R. M.; Anizar; Tarigan, I. R.; Siregar, I.

2018-02-01

The cigarette paper industry is one of the industry that is always experiencing increasing demand from consumers. Consumer expectations for the products produced also increased both in terms of quality and quantity. The company continuously improves the quality of its products by trying to minimize nonconformity, waste and improve the efficiency of the whole production process of the company. In this cigarette industry, there is a disability whose value is above the company’s defect tolerance that is 10% of the production amount per month. Another problem also occurs in the production time is too long due to the many activities that are not value added (non value added activities) on the production floor. To overcome this problem, it is necessary to improve the production process of cigarette paper and minimize production time by reducing non value added activities. Repairs done with Lean Six Sigma. Lean Six Sigma is a combination of Lean and Six Sigma concept with DMAIC method (Define, Measure, Analyze, Improve, Control). With this Lean approach, obtained total production time of 1479.13 minutes proposal with cycle efficiency process increased by 12.64%.

Expanding lean thinking to the product and process design and development within the framework of sustainability

NASA Astrophysics Data System (ADS)

Sorli, M.; Sopelana, A.; Salgado, M.; Pelaez, G.; Ares, E.

2012-04-01

Companies require tools to change towards a new way of developing and producing innovative products to be manufactured considering the economic, social and environmental impact along the product life cycle. Based on translating Lean principles in Product Development (PD) from the design stage and, along the entire product life cycle, it is aimed to address both sustainability and environmental issues. The drivers of sustainable culture within a lean PD have been identified and a baseline for future research on the development of appropriate tools and techniques has been provided. This research provide industry with a framework which balance environmental and sustainable factors with lean principles to be considered and incorporated from the beginning of product design and development covering the entire product lifecycle.

Disturbing Practices: Training Workers to Be Lean

ERIC Educational Resources Information Center

Yasukawa, Keiko; Brown, Tony; Black, Stephen

2014-01-01

Purpose: The purpose of this paper is to explore the possibilities for expansive learning during organisational change. It considers the introduction of "lean production" as a disturbance to the existing work practices. Design/methodology/approach: The paper considers two case studies of "lean production" training with…

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".

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.

Implementing "lean" principles to improve the efficiency of the endoscopy department of a community hospital: a case study.

PubMed

Laing, Karen; Baumgartner, Katherine

2005-01-01

Many endoscopy units are looking for ways to improve their efficiency without increasing the number of staff, purchasing additional equipment, or making the patients feel as if they have been rushed through the care process. To accomplish this, a few hospitals have looked to other industries for help. Recently, "lean" methods and tools from the manufacturing industry, have been applied successfully in health care systems, and have proven to be an effective way to eliminate waste and redundancy in workplace processes. The "lean" method and tools in service organizations focuses on providing the most efficient and effective flow of service and products. This article will describe the journey of one endoscopy department within a community hospital to illustrate application of "lean" methods and tools and results.

Lean Management—The Journey from Toyota to Healthcare

PubMed Central

Teich, Sorin T.; Faddoul, Fady F.

2013-01-01

The evolution of production systems is tightly linked to the story of Toyota Motor Company (TMC) that has its roots around 1918. The term “lean” was coined in 1990 following the exploration of the Toyota model that led to the “transference” thesis sustaining the concept that manufacturing problems and technologies are universal problems faced by management and that these concepts can be emulated in non-Japanese enterprises. Lean is a multi-faceted concept and requires organizations to exert effort along several dimensions simultaneously; some consider a successful implementation either achieving major strategic components of lean, implementing practices to support operational aspects, or providing evidence that the improvements are sustainable in the long term. The article explores challenges and opportunities faced by organizations that intend incorporating lean management principles and presents the specific context of the healthcare industry. Finally, the concepts of “essential few” and customer value are illustrated through a simple example of process change following lean principles, which was implemented in a dental school in the United States. PMID:23908857

Heat production and body temperature during cooling and rewarming in overweight and lean men.

PubMed

Claessens-van Ooijen, Anne M J; Westerterp, Klaas R; Wouters, Loek; Schoffelen, Paul F M; van Steenhoven, Anton A; van Marken Lichtenbelt, Wouter D

2006-11-01

To compare overweight and lean subjects with respect to thermogenesis and physiological insulation in response to mild cold and rewarming. Ten overweight men (mean BMI, 29.2 +/- 2.8 kg/m(2)) and 10 lean men (mean BMI, 21.1 +/- 2.0 kg/m(2)) were exposed to cold air for 1 hour, followed by 1 hour of rewarming. Body composition was determined by hydrodensitometry and deuterium dilution. Heat production and body temperatures were measured continuously by indirect calorimetry and thermistors, respectively. Muscle activity was recorded using electromyography. In both groups, heat production increased significantly during cooling (lean, p = 0.004; overweight, p = 0.006). The increase was larger in the lean group compared with the overweight group (p = 0.04). During rewarming, heat production returned to baseline in the overweight group and stayed higher compared with baseline in the lean group (p = 0.003). The difference in heat production between rewarming and baseline was larger in the lean (p = 0.01) than in the overweight subjects. Weighted body temperature of both groups decreased during cold exposure (lean, p = 0.002; overweight, p < 0.001) and did not return to baseline during rewarming. Overweight subjects showed a blunted mild cold-induced thermogenesis. The insulative cold response was not different among the groups. The energy-efficient response of the overweight subjects can have consequences for energy balance in the long term. The results support the concept of a dynamic heat regulation model instead of temperature regulation around a fixed set point.

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

Design of production process main shaft process with lean manufacturing to improve productivity

NASA Astrophysics Data System (ADS)

Siregar, I.; Nasution, A. A.; Andayani, U.; Anizar; Syahputri, K.

2018-02-01

This object research is one of manufacturing companies that produce oil palm machinery parts. In the production process there is delay in the completion of the Main shaft order. Delays in the completion of the order indicate the low productivity of the company in terms of resource utilization. This study aimed to obtain a draft improvement of production processes that can improve productivity by identifying and eliminating activities that do not add value (non-value added activity). One approach that can be used to reduce and eliminate non-value added activity is Lean Manufacturing. This study focuses on the identification of non-value added activity with value stream mapping analysis tools, while the elimination of non-value added activity is done with tools 5 whys and implementation of pull demand system. Based on the research known that non-value added activity on the production process of the main shaft is 9,509.51 minutes of total lead time 10,804.59 minutes. This shows the level of efficiency (Process Cycle Efficiency) in the production process of the main shaft is still very low by 11.89%. Estimation results of improvement showed a decrease in total lead time became 4,355.08 minutes and greater process cycle efficiency that is equal to 29.73%, which indicates that the process was nearing the concept of lean production.

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.

A sustainable manufacturing system design: A fuzzy multi-objective optimization model.

PubMed

Nujoom, Reda; Mohammed, Ahmed; Wang, Qian

2017-08-10

In the past decade, there has been a growing concern about the environmental protection in public society as governments almost all over the world have initiated certain rules and regulations to promote energy saving and minimize the production of carbon dioxide (CO 2 ) emissions in many manufacturing industries. The development of sustainable manufacturing systems is considered as one of the effective solutions to minimize the environmental impact. Lean approach is also considered as a proper method for achieving sustainability as it can reduce manufacturing wastes and increase the system efficiency and productivity. However, the lean approach does not include environmental waste of such as energy consumption and CO 2 emissions when designing a lean manufacturing system. This paper addresses these issues by evaluating a sustainable manufacturing system design considering a measurement of energy consumption and CO 2 emissions using different sources of energy (oil as direct energy source to generate thermal energy and oil or solar as indirect energy source to generate electricity). To this aim, a multi-objective mathematical model is developed incorporating the economic and ecological constraints aimed for minimization of the total cost, energy consumption, and CO 2 emissions for a manufacturing system design. For the real world scenario, the uncertainty in a number of input parameters was handled through the development of a fuzzy multi-objective model. The study also addresses decision-making in the number of machines, the number of air-conditioning units, and the number of bulbs involved in each process of a manufacturing system in conjunction with a quantity of material flow for processed products. A real case study was used for examining the validation and applicability of the developed sustainable manufacturing system model using the fuzzy multi-objective approach.

Using lean methodology to improve productivity in a hospital oncology pharmacy.

PubMed

Sullivan, Peter; Soefje, Scott; Reinhart, David; McGeary, Catherine; Cabie, Eric D

2014-09-01

Quality improvements achieved by a hospital pharmacy through the use of lean methodology to guide i.v. compounding workflow changes are described. The outpatient oncology pharmacy of Yale-New Haven Hospital conducted a quality-improvement initiative to identify and implement workflow changes to support a major expansion of chemotherapy services. Applying concepts of lean methodology (i.e., elimination of non-value-added steps and waste in the production process), the pharmacy team performed a failure mode and effects analysis, workflow mapping, and impact analysis; staff pharmacists and pharmacy technicians identified 38 opportunities to decrease waste and increase efficiency. Three workflow processes (order verification, compounding, and delivery) accounted for 24 of 38 recommendations and were targeted for lean process improvements. The workflow was decreased to 14 steps, eliminating 6 non-value-added steps, and pharmacy staff resources and schedules were realigned with the streamlined workflow. The time required for pharmacist verification of patient-specific oncology orders was decreased by 33%; the time required for product verification was decreased by 52%. The average medication delivery time was decreased by 47%. The results of baseline and postimplementation time trials indicated a decrease in overall turnaround time to about 70 minutes, compared with a baseline time of about 90 minutes. The use of lean methodology to identify non-value-added steps in oncology order processing and the implementation of staff-recommended workflow changes resulted in an overall reduction in the turnaround time per dose. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

THE EFFECT OF SULFUR ON METHANE PARTIAL OXIDATION AND REFORMING PROCESSES FOR LEAN NOX TRAP CATALYSIS

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

Parks, II, James E; Ponnusamy, Senthil

2006-01-01

Lean NOx trap catalysis has demonstrated the ability to reduce NOx emissions from lean natural gas reciprocating engines by >90%. The technology operates in a cyclic fashion where NOx is trapped on the catalyst during lean operation and released and reduced to N2 under rich exhaust conditions; the rich cleansing operation of the cycle is referred to as "regeneration" since the catalyst is reactivated for more NOx trapping after NOx purge. Creating the rich exhaust conditions for regeneration can be accomplished by catalytic partial oxidation of methane in the exhaust system. Furthermore, catalytic reforming of partial oxidation exhaust can enablemore » increased quantities of H2 which is an excellent reductant for lean NOx trap regeneration. It is critical to maintain clean and efficient partial oxidation and reforming processes to keep the lean NOx trap functioning properly and to reduce extra fuel consumption from the regeneration process. Although most exhaust constituents do not impede partial oxidation and reforming, some exhaust constituents may negatively affect the catalysts and result in loss of catalytic efficiency. Of particular concern are common catalyst poisons sulfur, zinc, and phosphorous. These poisons form in the exhaust through combustion of fuel and oil, and although they are present at low concentrations, they can accumulate to significant levels over the life of an engine system. In the work presented here, the effects of sulfur on the partial oxidation and reforming catalytic processes were studied to determine any durability limitations on the production of reductants for lean NOx trap catalyst regeneration.« less

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.

Ammonia Generation and Utilization in a Passive SCR (TWC+SCR) System on Lean Gasoline Engine

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

Prikhodko, Vitaly Y.; James E. Parks, II; Pihl, Josh A.

Lean gasoline engines offer greater fuel economy than the common stoichiometric gasoline engine, but the current three way catalyst (TWC) on stoichiometric engines is unable to control nitrogen oxide (NOX) emissions in oxidizing exhaust. For these lean gasoline engines, lean NOX emission control is required to meet existing Tier 2 and upcoming Tier 3 emission regulations set by the U.S. Environmental Protection Agency (EPA). While urea-based selective catalytic reduction (SCR) has proven effective in controlling NOX from diesel engines, the urea storage and delivery components can add significant size and cost. As such, onboard NH 3 production via a passivemore » SCR approach is of interest. In a passive SCR system, NH 3 is generated over a close-coupled TWC during periodic slightly rich engine operation and subsequently stored on an underfloor SCR catalyst. Upon switching to lean operation, NOX passes through the TWC and is reduced by the stored NH 3 on the SCR catalyst. In this work, a passive SCR system was evaluated on a 2.0-liter BMW lean burn gasoline direct injection engine to assess NH 3 generation over a Pd-only TWC and utilization over a Cu-based SCR catalyst. System NOX reduction efficiency and fuel efficiency improvement compared to stoichiometric engine operation were measured. A feedback control strategy based on cumulative NH 3 produced by the TWC during rich operation and NOX emissions during lean operation was implemented on the engine to control lean/rich cycle timing. At an SCR average inlet temperature of 350 °C, an NH 3:NOX ratio of 1.15:1 (achieved through longer rich cycle timing) resulted in 99.7 % NOX conversion. Increasing NH 3 generation further resulted in even higher NOX conversion; however, tailpipe NH 3 emissions resulted. At higher underfloor temperatures, NH 3 oxidation over the SCR limited NH 3 availability for NOX reduction. At the engine conditions studied, greater than 99 % NOX conversion was achieved with passive SCR while delivering fuel efficiency benefits ranging between 6-11 % compared with stoichiometric operation.« less

Ammonia Generation and Utilization in a Passive SCR (TWC+SCR) System on Lean Gasoline Engine

DOE PAGES

Prikhodko, Vitaly Y.; James E. Parks, II; Pihl, Josh A.; ...

2016-04-05

Lean gasoline engines offer greater fuel economy than the common stoichiometric gasoline engine, but the current three way catalyst (TWC) on stoichiometric engines is unable to control nitrogen oxide (NOX) emissions in oxidizing exhaust. For these lean gasoline engines, lean NOX emission control is required to meet existing Tier 2 and upcoming Tier 3 emission regulations set by the U.S. Environmental Protection Agency (EPA). While urea-based selective catalytic reduction (SCR) has proven effective in controlling NOX from diesel engines, the urea storage and delivery components can add significant size and cost. As such, onboard NH 3 production via a passivemore » SCR approach is of interest. In a passive SCR system, NH 3 is generated over a close-coupled TWC during periodic slightly rich engine operation and subsequently stored on an underfloor SCR catalyst. Upon switching to lean operation, NOX passes through the TWC and is reduced by the stored NH 3 on the SCR catalyst. In this work, a passive SCR system was evaluated on a 2.0-liter BMW lean burn gasoline direct injection engine to assess NH 3 generation over a Pd-only TWC and utilization over a Cu-based SCR catalyst. System NOX reduction efficiency and fuel efficiency improvement compared to stoichiometric engine operation were measured. A feedback control strategy based on cumulative NH 3 produced by the TWC during rich operation and NOX emissions during lean operation was implemented on the engine to control lean/rich cycle timing. At an SCR average inlet temperature of 350 °C, an NH 3:NOX ratio of 1.15:1 (achieved through longer rich cycle timing) resulted in 99.7 % NOX conversion. Increasing NH 3 generation further resulted in even higher NOX conversion; however, tailpipe NH 3 emissions resulted. At higher underfloor temperatures, NH 3 oxidation over the SCR limited NH 3 availability for NOX reduction. At the engine conditions studied, greater than 99 % NOX conversion was achieved with passive SCR while delivering fuel efficiency benefits ranging between 6-11 % compared with stoichiometric operation.« less

Lean production tools and decision latitude enable conditions for innovative learning in organizations: a multilevel analysis.

PubMed

Fagerlind Ståhl, Anna-Carin; Gustavsson, Maria; Karlsson, Nadine; Johansson, Gun; Ekberg, Kerstin

2015-03-01

The effect of lean production on conditions for learning is debated. This study aimed to investigate how tools inspired by lean production (standardization, resource reduction, visual monitoring, housekeeping, value flow analysis) were associated with an innovative learning climate and with collective dispersion of ideas in organizations, and whether decision latitude contributed to these associations. A questionnaire was sent out to employees in public, private, production and service organizations (n = 4442). Multilevel linear regression analyses were used. Use of lean tools and decision latitude were positively associated with an innovative learning climate and collective dispersion of ideas. A low degree of decision latitude was a modifier in the association to collective dispersion of ideas. Lean tools can enable shared understanding and collective spreading of ideas, needed for the development of work processes, especially when decision latitude is low. Value flow analysis played a pivotal role in the associations. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Utilization of lean management principles in the ambulatory clinic setting.

PubMed

Casey, Jessica T; Brinton, Thomas S; Gonzalez, Chris M

2009-03-01

The principles of 'lean management' have permeated many sectors of today's business world, secondary to the success of the Toyota Production System. This management method enables workers to eliminate mistakes, reduce delays, lower costs, and improve the overall quality of the product or service they deliver. These lean management principles can be applied to health care. Their implementation within the ambulatory care setting is predicated on the continuous identification and elimination of waste within the process. The key concepts of flow time, inventory and throughput are utilized to improve the flow of patients through the clinic, and to identify points that slow this process -- so-called bottlenecks. Nonessential activities are shifted away from bottlenecks (i.e. the physician), and extra work capacity is generated from existing resources, rather than being added. The additional work capacity facilitates a more efficient response to variability, which in turn results in cost savings, more time for the physician to interact with patients, and faster completion of patient visits. Finally, application of the lean management principle of 'just-in-time' management can eliminate excess clinic inventory, better synchronize office supply with patient demand, and reduce costs.

Increased Butyrate Production During Long-Term Fermentation of In Vitro-Digested High Amylose Cornstarch Residues with Human Feces.

PubMed

Li, Li; Jiang, Hongxin; Kim, Hyun-Jung; Yum, Man-Yu; Campbell, Mark R; Jane, Jay-Lin; White, Pamela J; Hendrich, Suzanne

2015-09-01

An in vitro semi-continuous long-term (3 wk) anaerobic incubation system simulating lower gut fermentation was used to determine variability in gut microbial metabolism between 4 predigested high amylose-resistant starch residues (SR): SRV, SRVI, SRVII, and SRGEMS in human fecal samples. Subjects participated twice, 5 mo apart: 30 in Phase I (15 lean, 9 overweight and 6 obese), 29 in Phase II (15 lean, 9 overweight, 5 obese); 13 of 15 lean subjects participated in both phases. Of the 4 SRs, SRV displayed the highest gelatinization temperature, peak temperature, enthalpy changes, and the least digestibility compared with the other SRs. In both phases, compared with blank controls, all SRs increased butyrate ∼2-fold which stabilized at week 2 and only SRV caused greater propionate concentration (∼30%) after 3 wk which might have been partly mediated by its lesser digestibility. Fecal samples from lean and overweight/obese subjects incubated with SRs showed similar short-chain fatty acid production across both time points, which suggests that resistant starch may benefit individuals across BMIs. © 2015 Institute of Food Technologists®

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.

[Lean thinking and brain-dead patient assistance in the organ donation process].

PubMed

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

2013-02-01

Organ donation is a complex process that challenges health system professionals and managers. This study aimed to introduce a theoretical model to organize brain-dead patient assistance and the organ donation process guided by the main lean thinking ideas, which enable production improvement through planning cycles and the development of a proper environment for successful implementation. Lean thinking may make the process of organ donation more effective and efficient and may contribute to improvements in information systematization and professional qualifications for excellence of assistance. The model is configured as a reference that is available for validation and implementation by health and nursing professionals and managers in the management of potential organ donors after brain death assistance and subsequent transplantation demands.

Plasma Amino Acids Stimulate Uncoupled Respiration of Muscle Subsarcolemmal Mitochondria in Lean but Not Obese Humans.

PubMed

Kras, Katon A; Hoffman, Nyssa; Roust, Lori R; Patel, Shivam H; Carroll, Chad C; Katsanos, Christos S

2017-12-01

Obesity is associated with mitochondrial dysfunction in skeletal muscle. Increasing the plasma amino acid (AA) concentrations stimulates mitochondrial adenosine triphosphate (ATP) production in lean individuals. To determine whether acute elevation in plasma AAs enhances muscle mitochondrial respiration and ATP production in subsarcolemmal (SS) and intermyofibrillar (IMF) mitochondria in obese adults. Assessment of SS and IMF mitochondrial function during saline (i.e., control) and AA infusions. Eligible participants were healthy lean (body mass index, <25 kg/m2; age, 37 ± 3 years; n = 10) and obese (body mass index >30 kg/m2; age 35 ± 3 years; n = 11) subjects. Single trial of saline infusion followed by AA infusion. SS and IMF mitochondria were isolated from muscle biopsies collected at the end of the saline and AA infusions. Mitochondrial respiration and ATP production. AA infusion increased adenosine 5'-diphosphate (ADP)-stimulated respiration and ATP production rates of SS mitochondria in the lean (P < 0.05), but not obese, subjects. Furthermore, AA infusion increased the uncoupled (i.e., non-ADP-stimulated) respiration of SS mitochondria in the lean subjects only (P < 0.05). AA infusion had no effect on any of these parameters in IMF mitochondria in either lean or obese subjects (P > 0.05). Increasing the plasma AA concentrations enhances the capacity for respiration and ATP production of muscle SS, but not IMF, mitochondria in lean individuals, in parallel with increases in uncoupled respiration. However, neither of these parameters increases in muscle SS or IMF mitochondria in obese individuals. Copyright © 2017 Endocrine Society

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.

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%.

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.

Lean management in academic surgery.

PubMed

Collar, Ryan M; Shuman, Andrew G; Feiner, Sandra; McGonegal, Amy K; Heidel, Natalie; Duck, Mary; McLean, Scott A; Billi, John E; Healy, David W; Bradford, Carol R

2012-06-01

Lean is a management system designed to enhance productivity by eliminating waste. Surgical practice offers many opportunities for improving efficiency. Our objective was to determine whether systematic implementation of lean thinking in an academic otolaryngology operating room improves efficiency and profitability and preserves team morale and educational opportunities. In an 18-month prospective quasi-experimental study, a multidisciplinary task force systematically implemented lean thinking within an otolaryngology operating room of an academic health system. Operating room turnover time and turnaround time were measured during a baseline period; an observer-effect period in which workers were made aware that their efficiency was being measured but before implementing lean changes; and an intervention period after redesign principles had been used. The impact on teamwork, morale, and surgical resident education were measured during the baseline and intervention periods through validated surveys. A profit model was applied to estimate the financial implications of the study. There was no difference between the baseline and observer-effect periods of the study for turnover time (p = 0.98) or turnaround time (p = 0.20). During the intervention period, the mean turnover time and turnaround time were significantly shorter than during the baseline period (29 vs 38 minutes; p < 0.001 and 69 vs 89 minutes; p < 0.001, respectively). The composite morale score suggested improved morale after implementation (p = 0.011). Educational metrics were unchanged before and after implementation. The annual opportunity revenue for the involved operating room is $330,000; when extrapolated throughout the operating rooms, lean thinking could create 6,500 hours of capacity annually. Application of lean management techniques to a single operating room and surgical service improved operating room efficiency and morale, sustained resident education, and can provide considerable financial gains when scaled to an entire academic surgical suite. Copyright © 2012. Published by Elsevier Inc.

Lean consumption.

PubMed

Womack, James P; Jones, Daniel T

2005-03-01

During the past 20 years, the real price of most consumer goods has fallen worldwide, the variety of goods and the range of sales channels offering them have continued to grow, and product quality has steadily improved. So why is consumption often so frustrating? It doesn't have to be--and shouldn't be--the authors say. They argue that it's time to apply lean thinking to the processes of consumption--to give consumers the full value they want from goods and services with the greatest efficiency and the least pain. Companies may think they save time and money by off-loading work to the consumer but, in fact, the opposite is true. By streamlining their systems for providing goods and services, and by making it easier for customers to buy and use those products and services, a growing number of companies are actually lowering costs while saving everyone time. In the process, these businesses are learning more about their customers, strengthening consumer loyalty, and attracting new customers who are defecting from less user-friendly competitors. The challenge lies with the retailers, service providers, manufacturers, and suppliers that are not used to looking at total cost from the standpoint of the consumer and even less accustomed to working with customers to optimize the consumption process. Lean consumption requires a fundamental shift in the way companies think about the relationship between provision and consumption, and the role their customers play in these processes. It also requires consumers to change the nature of their relationships with the companies they patronize. Lean production has clearly triumphed over similar obstacles in recent years to become the dominant global manufacturing model. Lean consumption, its logical companion, can't be far behind.

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.

Unraveling molecular mechanistic differences in liver metabolism between lean and fat lines of Pekin duck (Anas platyrhynchos domestica): a proteomic study.

PubMed

Zheng, Aijuan; Chang, Wenhuan; Hou, Shuisheng; Zhang, Shu; Cai, Huiyi; Chen, Guilan; Lou, Ruiying; Liu, Guohua

2014-02-26

Duck is one of the major poultry meat sources for human consumption. To satisfy different eating habits, lean and fat strains of Pekin ducks have been developed. The objective of this study was to determine the molecular mechanistic differences in liver metabolism between two duck strains. The liver proteome of the Pekin duck lines was compared on days 1, 14, 28, and 42 posthatching using 2-DE based proteomics. There was a different abundance of 76 proteins in the livers of the two duck lines. Fat ducks strongly expressed proteins related to pathways of glycolysis, ATP synthesis, and protein catabolism, suggesting enhanced fat deposition rather than protein retention. In contrast, highly expressed proteins in lean ducks improved protein anabolism and reduced protein catabolism, resulting in an enhancement of lean meat deposition. Along with the decrease in fat deposition, the immune system of the lean duck strain may be enhanced by enhanced expression of proteins involved in stress response, immune defense, and antioxidant functions. These results indicate that selection pressure has shaped the two duck lines differently resulting in different liver metabolic capacities. These observed variations between the two strains at the molecular level are matched with physiological changes in growth performance and meat production. This information may have beneficial impacts in areas such as genetic modification through the manipulation of target proteins or genes in specific pathways to improve the efficiency of duck meat production. The objective of this study was to unravel molecular mechanistic differences in liver metabolism between lean and fat Pekin duck (Anas platyrhynchos domestica) strains. There was a different abundance of 76 proteins in the livers of the two duck lines. Enhanced protein expression in the fat ducks related to pathways of glycolysis, ATP synthesis and protein catabolism suggesting increased fat deposition rather than protein retention. In contrast, highly expressed proteins in the lean ducks facilitated protein deposition by increasing protein anabolism and reducing protein catabolism to enhance the lean meat percentage. Along with the decrease of fat deposition, the immunity of lean duck appeared to be enhanced by increased expression of proteins involved in stress response, defense and antioxidant function. This study provides potential target proteins or genes for further functional analysis and genetic manipulation to increase the efficiency of duck meat production and help satisfy the global demand for poultry meat. Crown Copyright © 2014. Published by Elsevier B.V. All rights reserved.

Addressing the medicinal chemistry bottleneck: a lean approach to centralized purification.

PubMed

Weller, Harold N; Nirschl, David S; Paulson, James L; Hoffman, Steven L; Bullock, William H

2012-09-10

The use of standardized lean manufacturing principles to improve drug discovery productivity is often thought to be at odds with fostering innovation. This manuscript describes how selective implementation of a lean optimized process, in this case centralized purification for medicinal chemistry, can improve operational productivity and increase scientist time available for innovation. A description of the centralized purification process is provided along with both operational and impact (productivity) metrics, which indicate lower cost, higher output, and presumably more free time for innovation as a result of the process changes described.

The Henry Ford Production System: LEAN Process Redesign Improves Service in the Molecular Diagnostic Laboratory

PubMed Central

Cankovic, Milena; Varney, Ruan C.; Whiteley, Lisa; Brown, Ron; D'Angelo, Rita; Chitale, Dhananjay; Zarbo, Richard J.

2009-01-01

Accurate and timely molecular test results play an important role in patient management; consequently, there is a customer expectation of short testing turnaround times. Baseline data analysis revealed that the greatest challenge to timely result generation occurred in the preanalytic phase of specimen collection and transport. Here, we describe our efforts to improve molecular testing turnaround times by focusing primarily on redesign of preanalytic processes using the principles of LEAN production. Our goal was to complete greater than 90% of the molecular tests in less than 3 days. The project required cooperation from different laboratory disciplines as well as individuals outside of the laboratory. The redesigned processes involved defining and standardizing the protocols and approaching blood and tissue specimens as analytes for molecular testing. The LEAN process resulted in fewer steps, approaching the ideal of a one-piece flow for specimens through collection/retrieval, transport, and different aspects of the testing process. The outcome of introducing the LEAN process has been a 44% reduction in molecular test turnaround time for tissue specimens, from an average of 2.7 to 1.5 days. In addition, extending LEAN work principles to the clinician suppliers has resulted in a markedly increased number of properly collected and shipped blood specimens (from 50 to 87%). These continuous quality improvements were accomplished by empowered workers in a blame-free environment and are now being sustained with minimal management involvement. PMID:19661386

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.

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.

Barriers of lean construction implementation in the Moroccan construction industry

NASA Astrophysics Data System (ADS)

Bajjou, Mohamed Saad; Chafi, Anas

2018-04-01

Improving the production system performance has become a fundamental pillar that must be taken into consideration in the construction industry. Recent developments in the construction sector have led to renewed interest in new techniques of management. Lean Construction is a very effective approach that has gained a high popularity by its ability to eliminate waste and maximize the value for the customer. Although both developed and developing countries have gained large benefits by implementing Lean Construction approach, several experiences showed many barriers that are hindering its implementation especially in developing countries. This paper aims to assess the critical barriers to the successful implementation in the Moroccan construction industry. Based on a literature review, followed by an analysis of data collected from a questionnaire survey which targeted 330 practitioners in the Moroccan construction field, several barriers were identified as key barriers. The findings of this investigation revealed that there are significant barriers such as Lack of knowledge about Lean Construction concepts, Unskilled Human Resources, and insufficient financial resources.

Lean in healthcare: A comprehensive review.

PubMed

D'Andreamatteo, Antonio; Ianni, Luca; Lega, Federico; Sargiacomo, Massimo

2015-09-01

Lean seems to be the next revolution for a better, improved, value-based healhcare. In the last 15 years Lean has been increasingly adapted and adopted in healthcare. Accordingly, Lean healthcare has been developing into a major strand of research since the early 2000s. The aim of this work is to present a comprehensive overview of the main issues highlighted by research on implementation of Lean in a complex contest such as the healthcare one. Comprehensive literature review was conducted in order to identify empirical and theoretical articles published up to September 2013. Thematic analysis was performed in order to extract and synthesis data. 243 articles were selected for analysis. Lean is best understood as a means to increase productivity. Hospital is the more explored setting, with emergency and surgery as the pioneer departments. USA appears to be the leading country for number of applications. The theoretical works have been focused mainly on barriers, challenges and success factors. Sustainability, framework for measurement and critical appraisal remain underestimated themes. Evaluations of "system wide approach" are still low in number. Even though Lean results appear to be promising, findings so far do not allow to draw a final word on its positive impacts or challenges when introduced in the healthcare sector. Scholars are called to explore further the potentiality and the weaknesses of Lean, above all as for the magnitude of investments required and for the engagement of the whole organization it represents increasingly strategic choice, whilst health professionals, managers and policy makers could and should learn from research how to play a pivotal role for a more effective implementation of lean in different health contexts. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Experimenting `learn by doing' and `learn by failing'

NASA Astrophysics Data System (ADS)

Pozzi, Rossella; Noè, Carlo; Rossi, Tommaso

2015-01-01

According to the literature, in recent years, developing experiential learning has fulfilled the requirement of a deep understanding of lean philosophy by engineering students, demonstrating the advantages and disadvantages of some of the key principles of lean manufacturing. On the other hand, the literature evidences how some kinds of game-based experiential learning overlook daily difficulties, which play a central role in manufacturing systems. To fill the need of a game overcoming such lack of vision, an innovative game direct in-field, named Kart Factory, has been developed. Actual production shifts are simulated, while keeping all the elements peculiar to a real production set (i.e. complexity, effort, safety). The working environment is a real pedal car assembly department, the products to be assembled have relevant size and weight (i.e. up to 35 kg approximately), and the provided tools are real production equipment (e.g. keys, screwdrivers, trans-pallets, etc.). Due to the need to maximise the impact on students, a labour-intensive process characterises the production department. The whole training process is based on three educational principles: Experience Value Principle, Error Value Principle, and Team Value Principle. As the 'learn by doing' and 'learn by failing' are favoured, the theory follows the practice, while crating the willingness to 'do' instead of just designing or planning. The gathered data prove the Kart Factory's effectiveness in reaching a good knowledge of lean concepts, notwithstanding the students' initial knowledge level.

Genetic variation in efficiency to deposit fat and lean meat in Norwegian Landrace and Duroc pigs.

PubMed

Martinsen, K H; Ødegård, J; Olsen, D; Meuwissen, T H E

2015-08-01

Feed costs amount to approximately 70% of the total costs in pork production, and feed efficiency is, therefore, an important trait for improving pork production efficiency. Production efficiency is generally improved by selection for high lean growth rate, reduced backfat, and low feed intake. These traits have given an effective slaughter pig but may cause problems in piglet production due to sows with limited body reserves. The aim of the present study was to develop a measure for feed efficiency that expressed the feed requirements per 1 kg deposited lean meat and fat, which is not improved by depositing less fat. Norwegian Landrace ( = 8,161) and Duroc ( = 7,202) boars from Topigs Norsvin's testing station were computed tomography scanned to determine their deposition of lean meat and fat. The trait was analyzed in a univariate animal model, where total feed intake in the test period was the dependent variable and fat and lean meat were included as random regression cofactors. These cofactors were measures for fat and lean meat efficiencies of individual boars. Estimation of fraction of total genetic variance due to lean meat or fat efficiency was calculated by the ratio between the genetic variance of the random regression cofactor and the total genetic variance in total feed intake during the test period. Genetic variance components suggested there was significant genetic variance among Norwegian Landrace and Duroc boars in efficiency for deposition of lean meat (0.23 ± 0.04 and 0.38 ± 0.06) and fat (0.26 ± 0.03 and 0.17 ± 0.03) during the test period. The fraction of the total genetic variance in feed intake explained by lean meat deposition was 12% for Norwegian Landrace and 15% for Duroc. Genetic fractions explained by fat deposition were 20% for Norwegian Landrace and 10% for Duroc. The results suggested a significant part of the total genetic variance in feed intake in the test period was explained by fat and lean meat efficiency. These new efficiency measures may give the breeders opportunities to select for animals with a genetic potential to deposit lean meat efficiently and at low feed costs in slaughter pigs rather than selecting for reduced the feed intake and backfat.

Redesigning assembly stations using ergonomic methods as a lean tool.

PubMed

Eswaramoorthi, M; John, Mervyn; Rajagopal, C Arjun; Prasad, P S S; Mohanram, P V

2010-01-01

With the current state of the global economy, demand for various products plummeting. To sustain in the market, companies have to reduce cost and improve quality. Today, companies have started implementing new philosophies like TQM, TPM, six sigma and lean manufacturing techniques to remain competitive in the market. Lean manufacturing is an emerging philosophy which continuously strives to reduce waste. The main objective of analyzing the assembly line with a lean perspective is to identify the areas related to human interface with other systems that could lead to the generation of waste. Improper workplace design leads to unreasonable mental or physical burden and results in waste generation like slow work (delay and inventory), and defects, which is named as muri waste. An attempt has been made in this paper to locate muri waste and create a "Lean assembly line". The proposed method, based on the use of Rapid Upper Limb Assessment (RULA) with CATIA V5 platform, has allowed the measurement of a large set of operator posture parameters and assessment of ergonomic stresses. Based on the results, the process stations in the assembly line were redesigned to prevent the generation of waste.

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

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.

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.

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

Lean manufacturing comes to China: a case study of its impact on workplace health and safety.

PubMed

Brown, Garrett D; O'Rourke, Dara

2007-01-01

Lean manufacturing, which establishes small production "cells," or teams of workers, who complete an entire product from raw material processing through final assembly and shipment, increases health and safety hazards by mixing previously separated exposures to various chemicals (with possible additive and cumulative effects) and noise. The intensification of work leads to greater ergonomic and stress-related adverse health effects, as well as increased safety hazards. The standard industrial hygiene approach of anticipation, recognition, evaluation, and hazard control is applicable to lean operations. A focus on worker participation in identifying and solving problems is critical for reducing negative impacts. A key to worker safety in lean production operations is the development of informed, empowered, and active workers with the knowledge, skills, and opportunity to act in the workplace to eliminate or reduce hazards.

Interaction of turbulent premixed flames with combustion products: Role of stoichiometry

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

Coriton, Bruno Rene Leon; Frank, Jonathan H.; Gomez, Alessandro

Stabilization methods of turbulent flames often involve mixing of reactants with hot products of combustion. The stabilizing effect of combustion product enthalpy has been long recognized, but the role played by the chemical composition of the product gases is typically overlooked. We employ a counterflow system to pinpoint the effects of the combustion product stoichiometry on the structure of turbulent premixed flames under conditions of both stable burning and local extinction. To that end, a turbulent jet of lean-to-rich, CH 4/O 2/N 2-premixed reactants at a turbulent Reynolds number of 1050 was opposed to a stream of hot products ofmore » combustion that were generated in a preburner. While the combustion product stream temperature was kept constant, its stoichiometry was varied independently from that of the reactant stream, leading to reactant-to-product stratification of relevance to practical combustion systems. The detailed structure of the turbulent flame front was analyzed in two series of experiments using laser-induced fluorescence (LIF): joint CH 2O LIF and OH LIF measurements and joint CO LIF and OH LIF measurements. Results revealed that a decrease in local CH 2O+OH and CO+OH reaction rates coincide with the depletion of OH radicals in the vicinity of the combustion product stream. These critical combustion reaction rates were more readily quenched in the presence of products of combustion from a stoichiometric flame, whereas they were favored by lean combustion products. As a result, stoichiometric combustion products contributed to a greater occurrence of local extinction. Furthermore, they limited the capacity of premixed reactants to ignite and of the turbulent premixed flames to stabilize. In contrast, lean and rich combustion products facilitated flame ignition and stability and reduced the rate of local extinction. The influence of the combustion product stream on the turbulent flame front was limited to a zone of approximately two millimeters from the gas mixing layer interface (GMLI) of the product stream. As a result, flame fronts that were separated from the GMLI by larger distances were unaffected by the product stream stoichiometry.« less

Interaction of turbulent premixed flames with combustion products: Role of stoichiometry

DOE PAGES

Coriton, Bruno Rene Leon; Frank, Jonathan H.; Gomez, Alessandro

2016-05-30

Stabilization methods of turbulent flames often involve mixing of reactants with hot products of combustion. The stabilizing effect of combustion product enthalpy has been long recognized, but the role played by the chemical composition of the product gases is typically overlooked. We employ a counterflow system to pinpoint the effects of the combustion product stoichiometry on the structure of turbulent premixed flames under conditions of both stable burning and local extinction. To that end, a turbulent jet of lean-to-rich, CH 4/O 2/N 2-premixed reactants at a turbulent Reynolds number of 1050 was opposed to a stream of hot products ofmore » combustion that were generated in a preburner. While the combustion product stream temperature was kept constant, its stoichiometry was varied independently from that of the reactant stream, leading to reactant-to-product stratification of relevance to practical combustion systems. The detailed structure of the turbulent flame front was analyzed in two series of experiments using laser-induced fluorescence (LIF): joint CH 2O LIF and OH LIF measurements and joint CO LIF and OH LIF measurements. Results revealed that a decrease in local CH 2O+OH and CO+OH reaction rates coincide with the depletion of OH radicals in the vicinity of the combustion product stream. These critical combustion reaction rates were more readily quenched in the presence of products of combustion from a stoichiometric flame, whereas they were favored by lean combustion products. As a result, stoichiometric combustion products contributed to a greater occurrence of local extinction. Furthermore, they limited the capacity of premixed reactants to ignite and of the turbulent premixed flames to stabilize. In contrast, lean and rich combustion products facilitated flame ignition and stability and reduced the rate of local extinction. The influence of the combustion product stream on the turbulent flame front was limited to a zone of approximately two millimeters from the gas mixing layer interface (GMLI) of the product stream. As a result, flame fronts that were separated from the GMLI by larger distances were unaffected by the product stream stoichiometry.« less

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.

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.

Manufacturing Enhancement through Reduction of Cycle Time using Different Lean Techniques

NASA Astrophysics Data System (ADS)

Suganthini Rekha, R.; Periyasamy, P.; Nallusamy, S.

2017-08-01

In recent manufacturing system the most important parameters in production line are work in process, TAKT time and line balancing. In this article lean tools and techniques were implemented to reduce the cycle time. The aim is to enhance the productivity of the water pump pipe by identifying the bottleneck stations and non value added activities. From the initial time study the bottleneck processes were identified and then necessary expanding processes were also identified for the bottleneck process. Subsequently the improvement actions have been established and implemented using different lean tools like value stream mapping, 5S and line balancing. The current state value stream mapping was developed to describe the existing status and to identify various problem areas. 5S was used to implement the steps to reduce the process cycle time and unnecessary movements of man and material. The improvement activities were implemented with required suggested and the future state value stream mapping was developed. From the results it was concluded that the total cycle time was reduced about 290.41 seconds and the customer demand has been increased about 760 units.

Comprehensive Study on Wastages of Supply Chain Information Sharing in Automotive Industries

NASA Astrophysics Data System (ADS)

Sendhil Kumar, R.; Pugazhendhi, S.; Muralidharan, C.; Murali, S.

2017-03-01

A supply chain is a very extensive concept, which encompasses many problems and features when it comes to controlling. Now a day’s lean concept is a very common method to several areas, such as service sectors and manufacturing. Applying the lean concept to supply chain management is a very popular study part, it has attracted many industrial practices and researchers with different applications. Information sharing and technology remain one of the key factors of integrating the supply chain members. Current scenario the competition is no longer between the competing companies, but it happens between the supply chains. So the efficiency of the supply chain is very important. And the effective sharing of information can enhance the supply chain efficiency through minimizing the inventories and Information sharing can increase supply chain efficiency by reducing inventories and stabilizing the production. This paper describes and discusses about the seven deadly wastes of supply chain information with the comparative principle of Toyota production system (TPS) principle approach. How the TPS can be applied to supply chain information sharing And lean tool of 5S concept possibility improve the information sharing.

Improving the layout of recycling centres by use of lean production principles.

PubMed

Sundin, Erik; Björkman, Mats; Eklund, Mats; Eklund, Jörgen; Engkvist, Inga-Lill

2011-06-01

There has been increased focus on recycling in Sweden during recent years. This focus can be attributed to external environmental factors such as tougher legislation, but also to the potential gains for raw materials suppliers. Recycling centres are important components in the Swedish total recycling system. Recycling centres are manned facilities for waste collection where visitors can bring, sort and discard worn products as well as large-sized, hazardous, and electrical waste. The aim of this paper was to identify and describe the main flows and layout types at Swedish recycling centres. The aim was also to adapt and apply production theory for designing and managing recycling centre operations. More specifically, this means using lean production principles to help develop guidelines for recycling centre design and efficient control. Empirical data for this research was primarily collected through interviews and questionnaires among both visitors and employees at 16 Swedish recycling centres. Furthermore, adapted observation protocols have been used in order to explore visitor activities. There was also close collaboration with a local recycling centre company, which shared their layout experiences with the researchers in this project. The recycling centres studied had a variety of problems such as queues of visitors, overloading of material and improper sorting. The study shows that in order to decrease the problems, the recycling centres should be designed and managed according to lean production principles, i.e. through choosing more suitable layout choices with visible and linear flows, providing better visitor information, and providing suitable technical equipment. Improvements can be achieved through proper planning of the layout and control of the flow of vehicles, with the result of increased efficiency and capacity, shorter visits, and cleaner waste fractions. The benefits of a lean production mindset include increased visitor capacity, waste flexibility, improved sorting quality, shorter time for visits and improved working conditions. Copyright © 2011 Elsevier Ltd. All rights reserved.

New operation strategy for driving the selectivity of NO x reduction to N 2, NH 3 or N 2O during lean/rich cycling of a lean NO x trap catalyst

DOE PAGES

Mráček, David; Koci, Petr; Choi, Jae -Soon; ...

2015-09-08

Periodical regeneration of NO x storage catalyst (also known as lean NO x trap) by short rich pulses of CO, H 2 and hydrocarbons is necessary for the reduction of nitrogen oxides adsorbed on the catalyst surface. Ideally, the stored NO x is converted into N 2, but N 2O and NH 3 by-products can be formed as well, particularly at low-intermediate temperatures. The N 2 and N 2O products are formed concurrently in two peaks. The primary peaks appear immediately after the rich-phase inception, and tail off with the breakthrough of the reductant front accompanied by NH 3 product.more » In addition, the secondary N 2 and N 2O peaks then appear at the rich-to-lean transition as a result of reactions between surface-deposited reductants/intermediates (CO, HC, NH 3, — NCO) and residual stored NO x under increasingly lean conditions.« less

Creating an environment for caring using lean principles of the Virginia Mason Production System.

PubMed

Nelson-Peterson, Dana L; Leppa, Carol J

2007-06-01

As healthcare leaders search for viable options to cut costs, increase efficiencies, and improve the product that they offer to customers, many are looking at different business models to adopt. At the same time, an aging workforce of nurses feel the pressure of being overworked and understaffed, resulting in both decreased job and patient satisfaction. Virginia Mason Medical Center in Seattle, Wash, has implemented the Virginia Mason Production System, using proven concepts adapted from the Toyota Production System that effectively eliminate "muda" or waste, in workplace processes. The authors discuss the application of the Virginia Mason Production System and how it has resulted in increased time for nurses to care for their patients.

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.

Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department.

PubMed

Ng, David; Vail, Gord; Thomas, Sophia; Schmidt, Nicki

2010-01-01

In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds. In 2005 all staff in the ED at Hôtel-Dieu Grace Hospital began a transformation, employing Toyota Lean manufacturing principles to improve ED wait times and quality of care. Lean techniques such as value-stream mapping, just-in-time delivery techniques, workplace organization, reduction of systemic wastes, use of the worker as the source of quality improvement and ongoing refinement of our process steps formed the basis of our project. Our ED has achieved major improvements in departmental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles. Lean manufacturing principles can improve the flow of patients through the ED, resulting in greater patient satisfaction along with reduced time spent by the patient in the ED.

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.

Implementing Lean Six Sigma to achieve inventory control in supply chain management

NASA Astrophysics Data System (ADS)

Hong, Chen

2017-11-01

The inventory cost has important impact on the production cost. In order to get the maximum circulation of funds of enterprise with minimum inventory cost, the inventory control with Lean Six Sigma is presented in supply chain management. The inventory includes both the raw material and the semi-finished parts in manufacturing process. Though the inventory is often studied, the inventory control in manufacturing process is seldom mentioned. This paper reports the inventory control from the perspective of manufacturing process by using statistical techniques including DMAIC, Control Chart, and Statistical Process Control. The process stability is evaluated and the process capability is verified with Lean Six Sigma philosophy. The demonstration in power meter production shows the inventory is decreased from 25% to 0.4%, which indicates the inventory control can be achieved with Lean Six Sigma philosophy and the inventory cost in production can be saved for future sustainable development in supply chain management.

Network model of project "Lean Production"

NASA Astrophysics Data System (ADS)

Khisamova, E. D.

2018-05-01

Economical production implies primarily new approaches to culture of management and organization of production and offers a set of tools and techniques that allows reducing losses significantly and making the process cheaper and faster. Economical production tools are simple solutions that allow one to see opportunities for improvement of all aspects of the business, to reduce losses significantly, to constantly improve the whole spectrum of business processes, to increase significantly the transparency and manageability of the organization, to take advantage of the potential of each employee of the company, to increase competitiveness, and to obtain significant economic benefits without making large financial expenditures. Each of economical production tools solves a specific part of the problems, and only application of their combination will allow one to solve the problem or minimize it to acceptable values. The research of the governance process project "Lean Production" permitted studying the methods and tools of lean production and developing measures for their improvement.

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…

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.

Simulation of value stream mapping and discrete optimization of energy consumption in modular construction

NASA Astrophysics Data System (ADS)

Chowdhury, Md Mukul

With the increased practice of modularization and prefabrication, the construction industry gained the benefits of quality management, improved completion time, reduced site disruption and vehicular traffic, and improved overall safety and security. Whereas industrialized construction methods, such as modular and manufactured buildings, have evolved over decades, core techniques used in prefabrication plants vary only slightly from those employed in traditional site-built construction. With a focus on energy and cost efficient modular construction, this research presents the development of a simulation, measurement and optimization system for energy consumption in the manufacturing process of modular construction. The system is based on Lean Six Sigma principles and loosely coupled system operation to identify the non-value adding tasks and possible causes of low energy efficiency. The proposed system will also include visualization functions for demonstration of energy consumption in modular construction. The benefits of implementing this system include a reduction in the energy consumption in production cost, decrease of energy cost in the production of lean-modular construction, and increase profit. In addition, the visualization functions will provide detailed information about energy efficiency and operation flexibility in modular construction. A case study is presented to validate the reliability of the system.

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.

Characterization of Swirl-Venturi Lean Direct Injection Designs for Aviation Gas-Turbine Combustion

NASA Technical Reports Server (NTRS)

Heath, Christopher M.

2013-01-01

Injector geometry, physical mixing, chemical processes, and engine cycle conditions together govern performance, operability and emission characteristics of aviation gas-turbine combustion systems. The present investigation explores swirl-venturi lean direct injection combustor fundamentals, characterizing the influence of key geometric injector parameters on reacting flow physics and emission production trends. In this computational study, a design space exploration was performed using a parameterized swirl-venturi lean direct injector model. From the parametric geometry, 20 three-element lean direct injection combustor sectors were produced and simulated using steady-state, Reynolds-averaged Navier-Stokes reacting computations. Species concentrations were solved directly using a reduced 18-step reaction mechanism for Jet-A. Turbulence closure was obtained using a nonlinear ?-e model. Results demonstrate sensitivities of the geometric perturbations on axially averaged flow field responses. Output variables include axial velocity, turbulent kinetic energy, static temperature, fuel patternation and minor species mass fractions. Significant trends have been reduced to surrogate model approximations, intended to guide future injector design trade studies and advance aviation gas-turbine combustion research.

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.

Lean Government Methods Guide

EPA Pesticide Factsheets

This Guide focuses primarily on Lean production, which is an organizational improvement philosophy and set of methods that originated in manufacturing but has been expanded to government and service sectors.

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.

Workplace ergonomics in lean production environments: A literature review.

PubMed

Arezes, Pedro M; Dinis-Carvalho, José; Alves, Anabela Carvalho

2015-01-01

Lean Production Systems (LPS) have become very popular among manufacturing industries, services and large commercial areas. A LPS must develop and consider a set of work features to bring compatibility with workplace ergonomics, namely at a muscular, cognitive and emotional demands level. Identify the most relevant impacts of the adoption of LPS from the ergonomics point of view and summarizes some possible drawbacks for workplace ergonomics due to a flawed application of the LPS. The impacts identified are focused in four dimensions: work pace, intensity and load; worker motivation, satisfaction and stress; autonomy and participation; and health outcome. This paper also discusses the influence that the work organization model has on workplace ergonomics and on the waste elimination previewed by LPS. Literature review focused LPS and its impact on occupational ergonomics conditions, as well as on the Health and Safety of workers. The main focus of this research is on LPS implementations in industrial environments and mainly in manufacturing industry workplaces. This is followed by a discussion including the authors' experience (and previous research). From the reviewed literature it seems that there is no consensus on how Lean principles affect the workplace ergonomics since most authors found positive (advantages) and negative (disadvantages) impacts. The negative impacts or disadvantages of LPS implementations reviewed may result from the misunderstanding of the Lean principles. Possibly, they also happen due to partial Lean implementations (when only one or two tools were implemented) that may be effective in a specific work context but not suitable to all possible situations as the principles of LPS should not lead, by definition, to any of the reported drawbacks in terms of workplace ergonomics.

Analysis of Lean Initiatives in the Production of Naval Aviators

DTIC Science & Technology

2012-09-01

originated in the 1950s with an engineer named Eji Toyoda, and a production genius Taiichi Ohno at Toyota in Japan. Toyoda and Ohno are credited with...to flow wastes must be eliminated. Taiichi Ohno, the designer of the Toyota Production System, was obsessed with making materials flow and to...pooling between phases or blocks.  Producing quality defects . Delays (waiting).–Varying scheduling priorities for students during different blocks of

Lean Production as Promoter of Thinkers to Achieve Companies' Agility

ERIC Educational Resources Information Center

Alves, Anabela C.; Dinis-Carvalho, Jose; Sousa, Rui M.

2012-01-01

Purpose: This paper aims to explore the lean production paradigm as promoter of workers' creativity and thinking potential, and recognize this human potential as a fundamental asset for companies' growth and success, being a major factor to face the disturbing and unpredictable needs of current markets, providing companies with the necessary…

[Lean logistics management in healthcare: a case study].

PubMed

Aguilar-Escobar, V G; Garrido-Vega, P

2013-01-01

To study the applicability of the principles of Lean Production to manage the supply chain of a hospital. In particular, to determine which Lean practices and principles are applicable, the benefits obtained and the main barriers for its implementation. Managing the hospital supply chain is an important issue, both for its effect on the quality of care and its impact on costs. This study is based on a case study. 2005-10. Hospital Virgen Macarena in Seville. Process of implementing a comprehensive logistics management plan based on Lean principles and technological investments. The implementation of the comprehensive plan has reduced inventory, decreased lead times and improved service quality. Also, there have been other important improvements: enhanced employee satisfaction and increased staff productivity, both dedicated to health and the logistics. The experience analysed has shown the applicability and appropriateness of Lean principles and some of its techniques in managing the logistics of hospitals. It also identifies some of the main difficulties that may arise. Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.

Developing a lean culture in the laboratory.

PubMed

Napoles, Leyda; Quintana, Maria

2006-07-25

The Director of Pathology at Jackson Memorial Hospital was interested in improving the operational efficiencies of the department in order to enhance the department's level of service in conjunction with the expansion of the overall health system. The decision was made to implement proven Lean practices in the laboratory under the direction of a major consulting firm. This article details the scope of the initial project as well as the operating principles of Lean manufacturing practices as applied to the clinical laboratory. The goals of the project were to improve turnaround times of laboratory results, reduce inventory and supply costs, improve staff productivity, maximize workflow, and eliminate waste. Extensive data gathering and analysis guided the work process by highlighting the areas of highest opportunity. This systematic approach resulted in recommendations for the workflow and physical layout of the laboratory. It also included the introduction of "standard workflow" and "visual controls" as critical items that streamlined operational efficiencies. The authors provide actual photographs and schematics of the reorganization and improvements to the physical layout of the laboratory. In conclusion, this project resulted in decreased turnaround times and increased productivity, as well as significant savings in the overall laboratory operations.

Lean and Green Hand Surgery.

PubMed

Van Demark, Robert E; Smith, Vanessa J S; Fiegen, Anthony

2018-02-01

Health care in the United States is both expensive and wasteful. The cost of health care in the United States continues to increase every year. Health care spending for 2016 is estimated at $3.35 trillion. Per capita spending ($10,345 per person) is more than twice the average of other developed countries. The United States also leads the world in solid waste production (624,700 metric tons of waste in 2011). The health care industry is second only to the food industry in annual waste production. Each year, health care facilities in the United States produce 4 billion pounds of waste (660 tons per day), with as much as 70%, or around 2.8 billion pounds, produced directly by operating rooms. Waste disposal also accounts for up to 20% of a hospital's annual environmental services budget. Since 1992, waste production by hospitals has increased annually by a rate of at least 15%, due in part to the increased usage of disposables. Reduction in operating room waste would decrease both health care costs and potential environmental hazards. In 2015, the American Association for Hand Surgery along with the American Society for Surgery of the Hand, American Society for Peripheral Nerve Surgery, and the American Society of Reconstructive Microsurgery began the "Lean and Green" surgery project to reduce the amount of waste generated by hand surgery. We recently began our own "Lean and Green" project in our institution. Using "minor field sterility" surgical principles and Wide Awake Local Anesthesia No Tourniquet (WALANT), both surgical costs and surgical waste were decreased while maintaining patient safety and satisfaction. As the current reimbursement model changes from quantity to quality, "Lean and Green" surgery will play a role in the future health care system. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

The work of Glendon Lean on the counting systems of Papua New Guinea and Oceania

NASA Astrophysics Data System (ADS)

Owens, Kay

2001-04-01

Glendon Lean collated data on nearly 900 counting systems of Papua New Guinea, Oceania, and Irian Jaya (West Papua). Lean's data came from a questionnaire completed by students and talks with village elders. He read old documents written in English, German, and Dutch. He made comparisons between older and new accounts of the counting systems and compared neighbouring counting systems from both Austronesian and non-Austronesian languages. His work drew attention to the rich diversity of the systems and suggested that systems based on body parts and cyclic systems developed spontaneously. Digit tally systems were also relatively common. Lean's thesis on spontaneous developments of these ancient cultures challenged traditional theories describing the spread of number systems from Middle East cultures.

Does Lean Production Sacrifice Learning in a Manufacturing Environment? An Action Learning Case Study.

ERIC Educational Resources Information Center

Scott, Fiona M.; Butler, Jim; Edwards, John

2001-01-01

An action learning program was implemented by a manufacturer using lean production practices. Action learning practices were accommodated during times of stability, but abandoned in times of crisis. The meaning of work in this organizational culture excluded all practices, such as reflection, that were not visible and targeted at immediate…

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.

Pharmacy Dashboard: An Innovative Process for Pharmacy Workload and Productivity.

PubMed

Kinney, Ashley; Bui, Quyen; Hodding, Jane; Le, Jennifer

2017-03-01

Background: Innovative approaches, including LEAN systems and dashboards, to enhance pharmacy production continue to evolve in a cost and safety conscious health care environment. Furthermore, implementing and evaluating the effectiveness of these novel methods continues to be challenging for pharmacies. Objective: To describe a comprehensive, real-time pharmacy dashboard that incorporated LEAN methodologies and evaluate its utilization in an inpatient Central Intravenous Additives Services (CIVAS) pharmacy. Methods: Long Beach Memorial Hospital (462 adult beds) and Miller Children's and Women's Hospital of Long Beach (combined 324 beds) are tertiary not-for-profit, community-based hospitals that are served by one CIVAS pharmacy. Metrics to evaluate the effectiveness of CIVAS were developed and implemented on a dashboard in real-time from March 2013 to March 2014. Results: The metrics that were designed and implemented to evaluate the effectiveness of CIVAS were quality and value, financial resilience, and the department's people and culture. Using a dashboard that integrated these metrics, the accuracy of manufacturing defect-free products was ≥99.9%, indicating excellent quality and value of CIVAS. The metric for financial resilience demonstrated a cost savings of $78,000 annually within pharmacy by eliminating the outsourcing of products. People and value metrics on the dashboard focused on standard work, with an overall 94.6% compliance to the workflow. Conclusion: A unique dashboard that incorporated metrics to monitor 3 important areas was successfully implemented to improve the effectiveness of CIVAS pharmacy. These metrics helped pharmacy to monitor progress in real-time, allowing attainment of production goals and fostering continuous quality improvement through LEAN work.

Pharmacy Dashboard: An Innovative Process for Pharmacy Workload and Productivity

PubMed Central

Bui, Quyen; Hodding, Jane; Le, Jennifer

2017-01-01

Background: Innovative approaches, including LEAN systems and dashboards, to enhance pharmacy production continue to evolve in a cost and safety conscious health care environment. Furthermore, implementing and evaluating the effectiveness of these novel methods continues to be challenging for pharmacies. Objective: To describe a comprehensive, real-time pharmacy dashboard that incorporated LEAN methodologies and evaluate its utilization in an inpatient Central Intravenous Additives Services (CIVAS) pharmacy. Methods: Long Beach Memorial Hospital (462 adult beds) and Miller Children's and Women's Hospital of Long Beach (combined 324 beds) are tertiary not-for-profit, community-based hospitals that are served by one CIVAS pharmacy. Metrics to evaluate the effectiveness of CIVAS were developed and implemented on a dashboard in real-time from March 2013 to March 2014. Results: The metrics that were designed and implemented to evaluate the effectiveness of CIVAS were quality and value, financial resilience, and the department's people and culture. Using a dashboard that integrated these metrics, the accuracy of manufacturing defect-free products was ≥99.9%, indicating excellent quality and value of CIVAS. The metric for financial resilience demonstrated a cost savings of $78,000 annually within pharmacy by eliminating the outsourcing of products. People and value metrics on the dashboard focused on standard work, with an overall 94.6% compliance to the workflow. Conclusion: A unique dashboard that incorporated metrics to monitor 3 important areas was successfully implemented to improve the effectiveness of CIVAS pharmacy. These metrics helped pharmacy to monitor progress in real-time, allowing attainment of production goals and fostering continuous quality improvement through LEAN work. PMID:28439134

Utilizing lean tools to improve value and reduce outpatient wait times in an Indian hospital.

PubMed

Miller, Richard; Chalapati, Nirisha

2015-01-01

This paper aims to demonstrate how lean tools were applied to some unique issues of providing healthcare in a developing country where many patients face challenges not found in developed countries. The challenges provide insight into how lean tools can be utilized to provide similar results across the world. This paper is based on a qualitative case study carried out by a master's student implementing lean at a hospital in India. This paper finds that lean tools such as value-stream mapping and root cause analysis can lead to dramatic reductions in waste and improvements in productivity. The problems of the majority of patients paying for their own healthcare and lacking transportation created scheduling problems that required patients to receive their diagnosis and pay for treatment within a single day. Many additional wastes were identified that were significantly impacting the hospital's ability to provide care. As a result of this project, average outpatient wait times were reduced from 1 hour to 15 minutes along with a significant increase in labor productivity. The results demonstrate how lean tools can increase value to the patients. It also provides are framework that can be utilized for healthcare providers in developed and developing countries to analyze their value streams to reduce waste. This paper is one of the first to address the unique issues of implementing lean to a healthcare setting in a developing country.

Effects of fasting on insulin action and glucose kinetics in lean and obese men and women.

PubMed

Bergman, Bryan C; Cornier, Marc-Andre; Horton, Tracy J; Bessesen, Daniel H

2007-10-01

The development of insulin resistance in the obese individual could impair the ability to appropriately adjust metabolism to perturbations in energy balance. We investigated a 12- vs. 48-h fast on hepatic glucose production (R(a)), peripheral glucose uptake (R(d)), and skeletal muscle insulin signaling in lean and obese subjects. Healthy lean [n = 14; age = 28.0 +/- 1.4 yr; body mass index (BMI) = 22.8 +/- 0.42] and nondiabetic obese (n = 11; age = 34.6 +/- 2.3 yr; BMI = 36.1 +/- 1.5) subjects were studied following a 12- and 48-h fast during 2 h of rest and a 3-h 40 mUxm(-2)xmin(-1) hyperinsulinemic-euglycemic clamp (HEC). Basal glucose R(a) decreased significantly from the 12- to 48-h fast (lean 1.96 +/- 0.23 to 1.63 +/- 0.15; obese 1.23 +/- 0.07 to 1.07 +/- 0.07 mgxkg(-1)xmin(-1); P = 0.004) and was equally suppressed during the HEC after both fasts. The increase in glucose R(d) during the HEC after the 12-h fast was significantly decreased in lean and obese subjects after the 48-h fast (lean 9.03 +/- 1.17 to 4.16 +/- 0.34, obese 6.10 +/- 0.77 to 3.56 +/- 0.30 mgxkg FFM(-1)xmin(-1); P < 0.001). After the 12- but not the 48-h fast, insulin-stimulated AKT Ser(473) phosphorylation was greater in lean than obese subjects. We conclude that 1) 48 h of fasting produces a marked decline in peripheral insulin action, while suppression of hepatic glucose production is maintained in lean and obese men and women; and 2) the magnitude of this decline is greater in lean vs. obese subjects.

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.

Using Toyota's A3 Thinking for Analyzing MBA Business Cases

ERIC Educational Resources Information Center

Anderson, Joe S.; Morgan, James N.; Williams, Susan K.

2011-01-01

A3 Thinking is fundamental to Toyota's benchmark management philosophy and to their lean production system. It is used to solve problems, gain agreement, mentor team members, and lead organizational improvements. A structured problem-solving approach, A3 Thinking builds improvement opportunities through experience. We used "The Toyota…

E3 Success Story - Making an Investment in the Company: C.U.E.

EPA Pesticide Factsheets

C.U.E. in Mount Hope, West Virginia, makes molded and cast parts.An array of opportunities were found by WVMEP to implement lean production principles in areas such as mistake proofing, kanban systems, rapid exchange of dies, 5S, and value stream mapping.

Evaluation of Columbia, USMARC-Composite, Suffolk, and Texel rams at terminal sires in an extensive rangeland production system

USDA-ARS?s Scientific Manuscript database

Crossing proven, superior terminal-sire sheep breeds with well-adapted maternal breeds provide opportunity to increase lamb carcass value, while maintaining acceptable environmental adaptation in crossbred lambs. Large, lean terminal-sire breeds, such as the Suffolk and Columbia, have been typicall...

Comparison of rankings for lean meat based on results from a CT scanner and a video image analysis system.

PubMed

Jay, N P; van de Ven, R J; Hopkins, D L

2014-10-01

Coopworth cross lambs born over three years were examined in this study. Differences between two machines; a computer tomography (CT) scanner and a VIAScan® system for the estimation of carcase lean weight in lamb carcases was examined. The CT scanner provided a significantly higher estimate of carcase lean. The rank correlation (0.84) between the CT scanner and the VIAScan® system for the prediction of carcase lean was significant, but there was a different ranking for carcase lean depending on which machine was used. This has important ramifications for the use of VIAScan® data in the New Zealand Sheep Improvement Ltd genetic programme. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Power of ROFO Principle Together with Companywide Training in Executing Lean Production Strategy

ERIC Educational Resources Information Center

Goh, Ah Bee; Chakpitak, Nopasit; Sureephong, Pradorn

2015-01-01

This paper reports the findings of the case study conducted at Schaffner Thailand (ST) factory regarding the application of the ROFO principle coupled with companywide training on the execution of Lean Production (LP) strategy. The case study was motivated by 3 main objectives: 1) to examine the effectiveness of the ROFO principle and companywide…

Applying lean principles to continuous renal replacement therapy processes.

PubMed

Benfield, C Brett; Brummond, Philip; Lucarotti, Andrew; Villarreal, Maria; Goodwin, Adam; Wonnacott, Rob; Talley, Cheryl; Heung, Michael

2015-02-01

The application of lean principles to continuous renal replacement therapy (CRRT) processes in an academic medical center is described. A manual audit over six consecutive weeks revealed that 133 5-L bags of CRRT solution were discarded after being dispensed from pharmacy but before clinical use. Lean principles were used to examine the workflow for CRRT preparation and develop and implement an intervention. An educational program was developed to encourage and enhance direct communication between nursing and pharmacy about changes in a patient's condition or CRRT order. It was through this education program that the reordering workflow shifted from nurses to pharmacy technicians. The primary outcome was the number of CRRT solution bags delivered in the preintervention and postintervention periods. Nurses and pharmacy technicians were surveyed to determine their satisfaction with the workflow change. After implementation of lean principles, the mean number of CRRT solution bags dispensed per day of CRRT decreased substantially. Respondents' overall satisfaction with the CRRT solution preparation process increased during the postintervention period, and the satisfaction scores for each individual component of the workflow after implementation of lean principles. The decreased solution waste resulted in projected annual cost savings exceeding $70,000 in product alone. The use of lean principles to identify medication waste in the CRRT workflow and implementation of an intervention to shift the workload from intensive care unit nurses to pharmacy technicians led to reduced CRRT solution waste, improved efficiency of CRRT workflow, and increased satisfaction among staff. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Systems and methods for controlling diesel engine emissions

DOEpatents

Webb, Cynthia Chaffin; Weber, Phillip Anthony; Khair, Magdi K.

2004-06-01

Systems and methods for controlling diesel engine emissions, including, for example, oxides of nitrogen emissions, particulate matter emissions, and the like. The emission control system according to this invention is provided in the exhaust passageway of a diesel engine and includes a catalyst-based particulate filter; and first and second lean NO.sub.x trap systems coupled to the catalyst-based particulate filter. The first and second lean NO.sub.x trap systems are arranged in a parallel flow configuration with each other. Each of the first and second lean NO.sub.x trap systems include a carbon monoxide generating catalyst device, a sulfur trap device, a lean NO.sub.x device, a supplemental fuel injector device, and a plurality of flow diverter devices.

Rethinking Lean Service

NASA Astrophysics Data System (ADS)

Seddon, John; O'Donovan, Brendan; Zokaei, Keivan

Ever since Levitt's influential Harvard Business Review article 'Production-Line Approach to Service' was published in 1972, it has been common for services to be treated like production lines in both the academic literature and more widely in management practice. The belief that achieving economies of scale will reduce unit costs is a common feature of management decision-making. As technological advancement has produced ever more sophisticated IT and telephony, it has become increasingly easier for firms to standardise and off-shore services. The development of the 'lean' literature has only helped to emphasise the same underlying management assumptions: by managing cost and workers' activity, organisational performance is expected to improve. This chapter argues that through misinterpretation of the core paradigm 'lean' has become subsumed into the 'business as usual' of conventional service management. As a result, 'lean' has become synonymous with 'process efficiency' and the opportunity for significant performance improvement - as exemplified by Toyota - has been missed.

Acceptance of lean redesigns in primary care: A contextual analysis.

PubMed

Hung, Dorothy; Gray, Caroline; Martinez, Meghan; Schmittdiel, Julie; Harrison, Michael I

Lean is a leading change strategy used in health care to achieve short-term efficiency and quality improvement while promising longer-term system transformation. Most research examines Lean intervention to address isolated problems, rather than to achieve broader systemic changes to care delivery. Moreover, no studies examine contextual influences on system-wide Lean implementation efforts in primary care. The aim of this study was to identify contextual factors most critical to implementing and scaling Lean redesigns across all primary care clinics in a large, ambulatory care delivery system. Over 100 interviews and focus groups were conducted with frontline physicians, clinical staff, and operational leaders. Data analysis was guided by a modified Consolidated Framework for Implementation Research (CFIR), a popular implementation science framework. On the basis of expert recommendations, the modified framework targets factors influencing the implementation of process redesigns. This modified framework, the CFIR-PR, informed our identification of contextual factors that most impacted Lean acceptance among frontline physicians and staff. Several domains identified by the CFIR-PR were critical to acceptance of Lean redesigns. Regarding the implementation process acceptance was influenced by time and intensity of exposure to changes, "top-down" versus "bottom-up" implementation styles, and degrees of employee engagement in developing new workflows. Important factors in the inner setting were the clinic's culture and style of leadership, along with availability of information about Lean's effectiveness. Last, implementation efforts were impacted by individual and team characteristics regarding changed work roles and related issues of professional identity, authority, and autonomy. This study underscores the need for change leaders to consider the contextual factors that surround efforts to implement Lean in primary care. As Lean redesigns are scaled across a system, special attention is warranted with respect to the implementation approach, internal clinic setting, and implications for professional roles and identities of physicians and staff.

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.

Applying Lean/Toyota production system principles to improve phlebotomy patient satisfaction and workflow.

PubMed

Melanson, Stacy E F; Goonan, Ellen M; Lobo, Margaret M; Baum, Jonathan M; Paredes, José D; Santos, Katherine S; Gustafson, Michael L; Tanasijevic, Milenko J

2009-12-01

Our goals were to improve the overall patient experience and optimize the blood collection process in outpatient phlebotomy using Lean principles. Elimination of non-value-added steps and modifications to operational processes resulted in increased capacity to handle workload during peak times without adding staff. The result was a reduction of average patient wait time from 21 to 5 minutes, with the goal of drawing blood samples within 10 minutes of arrival at the phlebotomy station met for 90% of patients. In addition, patient satisfaction increased noticeably as assessed by a 5-question survey. The results have been sustained for 10 months with staff continuing to make process improvements.

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.

Human Behavior Based Exploratory Model for Successful Implementation of Lean Enterprise in Industry

ERIC Educational Resources Information Center

Sawhney, Rupy; Chason, Stewart

2005-01-01

Currently available Lean tools such as Lean Assessments, Value Stream Mapping, and Process Flow Charting focus on system requirements and overlook human behavior. A need is felt for a tool that allows one to baseline personnel, determine personnel requirements and align system requirements with personnel requirements. Our exploratory model--The…

[Lean production and psychosocial risks: the case of a multinational merger in a metallurgical company in Brazil].

PubMed

Stenger, Eunice; Monteiro, Maria Inês; Sabino, Marcos Oliveira; Miquilin, Isabella de Oliveira Campos; Corrêa Filho, Heleno Rodrigues

2014-08-01

This study focused on the method known as "lean production" as a work-related psychosocial risk factor in a Brazilian multinational auto parts company after its merger with other multinational companies. The authors conducted a qualitative analysis of two time points: the first using on-site observation and key interviews with managers and workers during implementation of lean production in 1996; the second, 16 years later, comparing data from a document search in labor inspection records from the Ministry of Labor and Employment and legal proceedings initiated by the Office of the Public Prosecutor for Labor Affairs. The merger led to layoffs, replacements, and an increase in the workday. A class action suit was filed on grounds of aggravated working conditions. The new production model led to psychosocial risks that increased the need for workers' health precautions when changes in the production process introduced new and increased risks of physical and mental illnesses.

Implications of Lean Manufacturing for Human Resource Strategy.

ERIC Educational Resources Information Center

Forrester, Rosalind

1995-01-01

Lean production changes organizational style and structure, roles of team leaders and members, training needs, problem-solving approaches, labor relations, and pay practices. The profound cultural changes it causes may trigger defenses that cause it to fail. (SK)

A first-generation software product line for data acquisition systems in astronomy

NASA Astrophysics Data System (ADS)

López-Ruiz, J. C.; Heradio, Rubén; Cerrada Somolinos, José Antonio; Coz Fernandez, José Ramón; López Ramos, Pablo

2008-07-01

This article presents a case study on developing a software product line for data acquisition systems in astronomy based on the Exemplar Driven Development methodology and the Exemplar Flexibilization Language tool. The main strategies to build the software product line are based on the domain commonality and variability, the incremental scope and the use of existing artifacts. It consists on a lean methodology with little impact on the organization, suitable for small projects, which reduces product line start-up time. Software Product Lines focuses on creating a family of products instead of individual products. This approach has spectacular benefits on reducing the time to market, maintaining the know-how, reducing the development costs and increasing the quality of new products. The maintenance of the products is also enhanced since all the data acquisition systems share the same product line architecture.

Effects of milk powder and its components on texture, yield, and color of a lean poultry meat model system.

PubMed

Barbut, S

2010-06-01

The effects of whole milk powder, 2 skim milk powders, caseinate, and 2 modified whey proteins (2% protein level in the final product) were evaluated in lean chicken meat batters and compared with controls with and without added lactose. All dairy proteins significantly (P<0.05) reduced cook losses when compared against the controls, with the 2 skim milk powders and modified whey-I showing the best results. Hardness and fracturability were also higher for all test batters compared with controls. Skim milk-II showed the highest fracturability value (21.9 vs. 7.1 N for the control) and was also found to be the most cost-effective ingredient for improving moisture binding and texture; skim milk-I and modified whey-I followed behind. Springiness and fracture distance were higher for all of the dairy proteins, except caseinate, indicating a positive contribution to the lean meat system's elasticity. In terms of color, adding the skim milk powders, modified whey-II, and whole milk powder resulted in lighter cooked meat batters as evidenced by the higher L* values and higher spectra curves.

How much of Toyota's philosophy is embedded in health care at the organisational level? A review.

PubMed

Antierens, Alain; Beeckman, Dimitri; Verhaeghe, Sofie; Myny, Dries; Van Hecke, Ann

2018-05-01

Identify which of Toyota's principles are reported in health care institutions at the organisational level and to identify the type of reported outcomes related to the effectiveness of lean production reported in these studies. No scientific research has been conducted to determine which of Toyota's principles are embedded in health care systems. This knowledge is needed to perform targeted adjustments in health care. Sixty studies were identified for the final analysis. Some Toyota Way principles appear more deeply embedded in health care institutions than others are. Not all principles of Toyota's philosophy and production system were embedded in the studies in this review. The type of reported outcomes at the organisational level was diverse. This literature review increases our knowledge about how many (and which) of the Toyota Way principles are embedded in health care. This knowledge may support reflection by nursing managers about how the full range of lean management principles could be embedded at the managerial and/or operational level. © 2018 John Wiley & Sons Ltd.

Convergence in insulin resistance between very severely obese and lean women at the end of pregnancy.

PubMed

Forbes, Shareen; Barr, Sarah M; Reynolds, Rebecca M; Semple, Scott; Gray, Calum; Andrew, Ruth; Denison, Fiona C; Walker, Brian R; Norman, Jane E

2015-11-01

Disrupted intermediary metabolism may contribute to the adverse pregnancy outcomes in women with very severe obesity. Our aim was to study metabolism in such pregnancies. We recruited a longitudinal cohort of very severely obese (n = 190) and lean (n = 118) glucose-tolerant women for anthropometric and metabolic measurements at early, mid and late gestation and postpartum. In case-control studies of very severely obese and lean women we measured glucose and glycerol turnover during low- and high-dose hyperinsulinaemic-euglycaemic clamps (HEC) at early and late pregnancy and in non-pregnant women (each n = 6-9) and body fat distribution by MRI in late pregnancy (n = 10/group). Although greater glucose, insulin, NEFA and insulin resistance (HOMA-IR), and greater weight and % fat mass (FM) was observed in very severely obese vs lean participants, the degree of worsening was attenuated in the very severely obese individuals with advancing gestation, with no difference in triacylglycerol (TG) concentrations between very severely obese and lean women at term. Enhanced glycerol production was observed in early pregnancy only in very severely obese individuals, with similar intrahepatic FM in very severely obese vs lean women by late gestation. Offspring from obese mothers were heavier (p = 0.04). Pregnancies complicated by obesity demonstrate attenuation in weight gain and insulin resistance compared with pregnancies in lean women. Increased glycerol production is confined to obese women in early pregnancy and obese and lean individuals have similar intrahepatic FM by term. When targeting maternal metabolism to treat adverse pregnancy outcomes, therapeutic intervention may be most effective applied early in pregnancy.

An exploration of the leadership attributes and methods associated with successful lean system deployments in acute care hospitals.

PubMed

Steed, Airica

2012-01-01

The lean system has been shown to be a viable and sustainable solution for the growing number of cost, quality, and efficiency issues in the health care industry. While there is a growing body of evidence to support the outcomes that can be achieved as a result of the successful application of the lean system in hospital organizations, there is not a complete understanding of the leadership attributes and methods that are necessary to achieve successful widespread mobilization and sustainment. This study was an exploration of leadership and its relevant association with successful lean system deployments in acute care hospitals. This research employed an exploratory qualitative research design encompassing a research questionnaire and telephonic interviews of 25 health care leaders in 8 hospital organizations across the United States. The results from this study identified the need to have a strong combination of personal characteristics, learned behaviors, strategies, tools, and tactics that evolved into a starting adaptable framework for health care leaders to leverage when starting their own transformational change journeys using the lean system. Health care leaders could utilize the outcomes reported in this study as a conduit to enhance the effective deployment, widespread adoption, and sustainment of the lean system in practice.

The Work of Glendon Lean on the Counting Systems of Papua New Guinea and Oceania.

ERIC Educational Resources Information Center

Owens, Kay

2001-01-01

Introduces data collated by Glendon Lean on nearly 900 counting systems in Papua New Guinea, Oceania, and Irian Jaya (West Papua) which came from a questionnaire completed by students and talks with village elders. Lean's thesis on the spontaneous developments of these ancient cultures challenged traditional theories describing the spread of…

It Cuts Both Ways: Workers, Management and the Construction of a "Community of Fate" on the Shop Floor in a Mexican Garment Factory

ERIC Educational Resources Information Center

Videla, Nancy Plankey

2006-01-01

Most studies of lean production are based on surveys of managers. This article examines the labor process under lean production at a high-end garment factory in Central Mexico through ethnographic research, consisting of nine months of work at the factory, and in-depth interviews with 25 managers and 26 workers. The author found that…

Applying lean techniques in the delivery of transportation infrastructure construction projects.

DOT National Transportation Integrated Search

2011-07-01

It is well documented that construction productivity has been declining since the 1960s. Additionally, studies have shown that only : 40% of construction workers time is considered to be value-added work. Interest in the use of Lean techniques ...

Efficient Project Delivery Using Lean Principles - An Indian Case Study

NASA Astrophysics Data System (ADS)

Kovvuri, P. Ramachandra Reddy; Sawhney, Anil; Ahuja, Ritu; Sreekumar, Aiswarya

2016-03-01

Construction industry in India is growing at a rapid pace. Along with this growth, the industry is facing numerous challenges that are making delivery of projects inefficient. Experts believe that capacity constraints in the industry need to be addressed immediately. Government has recommended `introduction of efficient technologies and modern management techniques' to increase the productivity of the industry. In this context, lean principles can act as a lever to make project delivery more efficient and provide the much needed impetus to the Indian construction sector. Around the globe lean principles are showing positive results on the projects. Project teams are reporting improvements in construction time, cost and quality along with softer benefits of enhanced collaboration, coordination and trust in project teams. Can adoption of lean principles provide similar benefits in the Indian construction sector? This research was conducted to answer this question. Using an action research approach a key lean construction tool called Last Planner System (LPS) was tested on a large Indian construction project. The work described in this work investigates the improvements achieved in project delivery by adopting LPS in Indian construction sector. Comparison in pre- and post-implementation data demonstrates increase in the certainty of work-flow and improves schedule compliance. This is measured through a simple LPS metric called percent plan complete. Explicit improvements in schedule performance are seen during 8 week LPS implementation along with implicit improvements in coordination, collaboration and trust in the project team. This work reports the findings of LPS implementation on the case study project outlining the barriers and drivers to adoption, strategies needed to ensure successful implementation and roadmap for implementation. Based on the findings the authors envision that lean construction can make project delivery more efficient in India.

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.

Future Software Sizing Metrics and Estimation Challenges

DTIC Science & Technology

2011-07-01

systems 4. Ultrahigh software system assurance 5. Legacy maintenance and Brownfield development 6. Agile and Lean/ Kanban development. This paper...refined as the design of the maintenance modifications or Brownfield re-engineering is determined. VII. 6. AGILE AND LEAN/ KANBAN DEVELOPMENT The...difficulties of software maintenance estimation can often be mitigated by using lean workflow management techniques such as Kanban [25]. In Kanban

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 marketing group and production focus on quality and variability of adipose tissue and bellies sourced from a commercial processing facility.

PubMed

Overholt, M F; Arkfeld, E K; Wilson, K B; Mohrhauser, D A; King, D A; Wheeler, T L; Dilger, A C; Shackelford, S D; Boler, D D

2016-12-01

Objectives were to determine the effects of marketing group on quality and variability of belly and adipose tissue quality traits of pigs sourced from differing production focuses (lean vs. quality). Pigs ( = 8,042) raised in 8 barns representing 2 seasons (cold and hot) were used. Three groups were marketed from each barn with 2 barns per production focus marketed per season. Data were collected on 7,684 carcasses at a commercial abattoir. Fresh belly characteristics, American Oil Chemists' Society iodine value (AOCS-IV), and near-infrared iodine value were measured on a targeted 50, 10, and 100% of carcasses, respectively. Data were analyzed as a split-plot design in the MIXED procedure of SAS 9.4 with production focus as the whole-plot factor and marketing group as the split-plot factor. Barn (block), season, and sex were random variables. A multivariance model was fit using the REPEATED statement with the marketing group × production focus interaction as the grouping variable. Variances for production focus and marketing groups were calculated using the MEANS procedure. Homogeneity of variance was tested on raw data using the Levene's test of the GLM procedure. Among quality focus carcasses, marketing group 3 bellies weighed less ( ≤ 0.03) than those from either marketing group 1 or 2, but there was no difference ( ≥ 0.99) among marketing groups of the lean focus carcasses. There was no effect ( ≥ 0.11) of production focus on fresh belly measures, SFA, or iodine value (IV), but lean focus carcasses had decreased ( = 0.04) total MUFA and increased ( < 0.01) total PUFA compared with quality focus carcasses. Marketing group did not affect ( ≥ 0.10) fresh belly dimensions, total SFA, total MUFA, total PUFA, or IV. Belly weight, flop score, width, and all depth measurements were less variable ( ≤ 0.01); whereas, belly length, total SFA, and total MUFA were more variable ( < 0.0001) in lean focus carcasses than in quality focus carcasses. There was no difference ( ≥ 0.17) in total PUFA or AOCS-IV variability between production focuses. Variance of flop score, total MUFA, and total PUFA were not equal ( ≤ 0.01) among marketing groups. Belly weight, length, width, and depth measurements; SFA; or IV variance did not differ ( ≥ 0.06) among marketing groups. Although a multiple-marketing strategy was effective at minimizing differences in belly characteristics, differences in the variability of these traits exist among marketing groups and are likely dependent on the production system used.

Lean Six Sigma Application in Rear Combination Automotive Lighting Process

NASA Astrophysics Data System (ADS)

Sodkomkham, Thanwarhat; Chutima, Parames

2016-05-01

The case study company produces various front and rear lightings for automobiles and motorcycles. Currently, it faces two problems, i.e. high defective rate and high inventory. Lean Six Sigma was applied as a tool to solve the first problem, whereas the other problem was managed by changing the production concept from push to pull. The results showed that after applying all new settings to the process, the defect rate was reduced from 36,361 DPPM to 3,029 DPPM. In addition, after the implementation of the Kanban system, the company achieved substantial improvement in lead time reduction by 44%, in-process inventory reduction by 42%, finished good inventory reduction by 50%, and finished good area increased by 16%.

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.

Regulation of adiponectin production by insulin: interactions with tumor necrosis factor-α and interleukin-6.

PubMed

Hajri, Tahar; Tao, Huan; Wattacheril, Julia; Marks-Shulman, Pamela; Abumrad, Naji N

2011-02-01

Obesity is often associated with insulin resistance, low-grade systemic inflammation, and reduced plasma adiponectin. Inflammation is also increased in adipose tissue, but it is not clear whether the reductions of adiponectin levels are related to dysregulation of insulin activity and/or increased proinflammatory mediators. In this study, we investigated the interactions of insulin, tumor necrosis factor-α (TNF-α) and interleukin 6 (IL-6) in the regulation of adiponectin production using in vivo and in vitro approaches. Plasma adiponectin and parameters of insulin resistance and inflammation were assessed in a cohort of lean and obese insulin-resistant subjects. In addition, the effect of insulin was examined in vivo using the hyperinsulinemic-euglycemic clamp, and in adipose tissue (AT) cultures. Compared with lean subjects, the levels of total adiponectin, and especially the high-molecular-weight (HMW) isomer, were abnormally low in obese insulin-resistant subjects. The hyperinsulinemic clamp data confirmed the insulin-resistant state in the obese patients and showed that insulin infusion significantly increased the plasma adiponectin in lean but not obese subjects (P < 0.01). Similarly, insulin increased total adiponectin release from AT explants of lean and not obese subjects. Moreover, expression and secretion of TNF-α and IL-6 increased significantly in AT of obese subjects and were negatively associated with expression and secretion of adiponectin. In 3T3-L1 and human adipocyte cultures, insulin strongly enhanced adiponectin expression (2-fold) and secretion (3-fold). TNF-α, and not IL-6, strongly opposed the stimulatory effects of insulin. Intriguingly, the inhibitory effect of TNF-α was especially directed toward the HMW isomer of adiponectin. In conclusion, these studies show that insulin upregulates adiponectin expression and release, and that TNF-α opposes the stimulatory effects of insulin. A combination of insulin resistance and increased TNF-α production could explain the decline of adiponectin levels and alterations of isomer composition in plasma of obese insulin-resistant subjects.

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.

Lessons from industry: one school's transformation toward "lean" curricular governance.

PubMed

Stratton, Terry D; Rudy, David W; Sauer, Marlene J; Perman, Jay A; Jennings, C Darrell

2007-04-01

As medical education grapples with organizational calls for centralized curricular oversight, programs may be compelled to respond by establishing highly vertical, stacked governance structures. Although these models offer discrete advantages over the horizontal, compartmentalized structures they are designed to replace, they pose new challenges to ensuring curricular quality and the educational innovations that drive the curricula. The authors describe a hybrid quality-assurance (QA) governance structure introduced in 2003 at the University of Kentucky College of Medicine (UKCOM) that ensures centralized curricular oversight of the educational product while allowing individualized creative control over the educational process. Based on a Lean production model, this approach draws on industry experiences that strategically separate institutional accountability (management) for a quality curriculum from the decision-making processes required to ensure it (production). In so doing, the authors acknowledge general similarities and key differences between overseeing the manufacture of a complex product versus the education of a physician-emphasizing the structured, sequential, and measurable nature of each process. Further, the authors briefly trace the emergence of quality approaches in manufacturing and discuss the philosophical changes that accompany transition to an institutional governance system that relies on vigorous, robust performance measures to offer continuous feedback on curricular quality.

Increasing Therapist Productivity: Using Lean Principles in the Rehabilitation Department of an Academic Medical Center.

PubMed

Johnson, Diana; Snedeker, Kristie; Swoboda, Michael; Zalieckas, Cheryl; Dorsey, Rachel; Nohe, Cassandra; Smith, Paige; Roche, Renuka

The Department of Rehabilitation Services, within the University of Maryland Medical Center's 650-bed academic medical center, was experiencing difficulty in meeting productivity standards. Therapists in the outpatient division believed they were not spending enough time performing billable patient care activities. Therapists in the inpatient division had difficulty keeping pace with the volume of incoming referrals. Collectively, these issues caused dissatisfaction among referral sources and frustration among the staff within the rehabilitation department. The department undertook a phased approach to address these issues that included examining the evidence, using Lean process improvement principles, and employing transformational leadership strategies to drive improvements in productivity and efficiency. The lessons learned support the importance of having meaningful metrics appropriate for the patient population served, the use of Lean as an effective tool for improving productivity in rehabilitation departments, the impact of engaging staff at the grassroots level, and the importance of having commitment from leaders. The study findings have implications for not only rehabilitation and hospital leadership, but CEOs and managers of any business who need to eliminate waste or increase staff productivity.

Improving healthcare using Lean processes.

PubMed

Baker, G Ross

2014-01-01

For more than a decade, healthcare organizations across Canada have been using Lean management tools to improve care processes, reduce preventable adverse events, increase patient satisfaction and create better work environments. The largest system-wide effort in Canada, and perhaps anywhere, is currently under way in Saskatchewan. The jury is still out on whether Lean efforts in that province, or elsewhere in Canada, are robust enough to transform current delivery systems and sustain new levels of performance. This issue of Healthcare Quarterly features several articles that provide a perspective on Lean methods in healthcare. Copyright © 2014 Longwoods Publishing.

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…

Incorporation of lean methodology into pharmacy residency programs.

PubMed

John, Natalie; Snider, Holly; Edgerton, Lisa; Whalin, Laurie

2017-03-15

The implementation of lean methodology into pharmacy residency programs at a community teaching hospital is described. New Hanover Regional Medical Center, a community teaching hospital in southeastern North Carolina, fully adopted a lean culture in 2010. Given the success of lean strategies organizationally, this methodology was used to assist with the evaluation and development of its pharmacy residency programs in 2014. Lean tools and activities have also been incorporated into residency requirements and rotation learning activities. The majority of lean events correspond to the required competency areas evaluating leadership and management, teaching, and education. These events have included participation in and facilitation of various lean problem-solving and communication tools. The application of the 4 rules of lean has resulted in enhanced management of the programs and provides a set of tools by which continual quality improvement can be ensured. Regular communication and direct involvement of all invested parties have been critical in developing and sustaining new improvements. In addition to program enhancements, lean methodology offers novel methods by which residents may be incorporated into leadership activities. The incorporation of lean methodology into pharmacy residency programs has translated into a variety of realized and potential benefits for the programs, the preceptors and residents, and the health system. Specific areas of growth have included quality-improvement processes, the expansion of leadership opportunities for residents, and improved communication among program directors, preceptors, and residents. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Proliferation and differentiation of adipose tissue in prolonged lean and obese critically ill patients.

PubMed

Goossens, Chloë; Vander Perre, Sarah; Van den Berghe, Greet; Langouche, Lies

2017-12-01

In prolonged non-obese critically ill patients, preservation of adipose tissue is prioritized over that of the skeletal muscle and coincides with increased adipogenesis. However, we recently demonstrated that in obese critically ill mice, this priority was switched. In the obese, the use of abundantly available adipose tissue-derived energy substrates was preferred and counteracted muscle wasting. These observations suggest that different processes are ongoing in adipose tissue of lean vs. overweight/obese critically ill patients. We hypothesize that to preserve adipose tissue mass during critical illness, adipogenesis is increased in prolonged lean critically ill patients, but not in overweight/obese critically ill patients, who enter the ICU with excess adipose tissue. To test this, we studied markers of adipogenesis in subcutaneous and visceral biopsies of matched lean (n = 24) and overweight/obese (n = 24) prolonged critically ill patients. Secondly, to further unravel the underlying mechanism of critical illness-induced adipogenesis, local production of eicosanoid PPARγ agonists was explored, as well as the adipogenic potential of serum from matched lean (n = 20) and overweight/obese (n = 20) critically ill patients. The number of small adipocytes, PPARγ protein, and CEBPB expression were equally upregulated (p ≤ 0.05) in subcutaneous and visceral adipose tissue biopsies of lean and overweight/obese prolonged critically ill patients. Gene expression of key enzymes involved in eicosanoid production was reduced (COX1, HPGDS, LPGDS, ALOX15, all p ≤ 0.05) or unaltered (COX2, ALOX5) during critical illness, irrespective of obesity. Gene expression of PLA2G2A and ALOX15B was upregulated in lean and overweight/obese patients (p ≤ 0.05), whereas their end products, the PPARγ-activating metabolites 15s-HETE and 9-HODE, were not increased in the adipose tissue. In vitro, serum of lean and overweight/obese prolonged critically ill patients equally stimulated adipocyte proliferation (p ≤ 0.05) and differentiation (lipid accumulation, DLK1, and CEBPB expression, p ≤ 0.05). Contrary to what was hypothesized, adipogenesis increased independently of initial BMI in prolonged critically ill patients. Not the production of local eicosanoid PPARγ agonists but circulating adipogenic factors seem to be involved in critical illness-induced adipogenesis. Importantly, our findings suggest that abundantly available energy substrates from the adipose tissue, rather than excess adipocytes, can play a beneficial role during critical illness.

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/.

Classification of trace elements in tissues from organic and conventional French pig production.

PubMed

Parinet, Julien; Royer, Eric; Saint-Hilaire, Mailie; Chafey, Claude; Noël, Laurent; Minvielle, Brice; Dervilly-Pinel, Gaud; Engel, Erwan; Guérin, Thierry

2018-07-01

This study assesses the impact of the farming system on the levels of copper, zinc, arsenic, cadmium, lead and mercury in pig tissues from three types of production (Organic (n = 28), Label Rouge (n = 12) and Conventional (n = 30)) randomly sampled in different slaughterhouses. All the concentrations were below regulatory limits. In muscles, Cu, Zn and As were measured at slightly higher levels in organic samples but no differences between organic and Label Rouge was observed. Livers from conventional and Label Rouge pig farms exhibited higher Zn and Cd contents than the organic ones, probably due to different practice in zinc or phytase supplementation of fattening diets. Principal component analysis indicated a correlation between Cu and As concentrations in liver and carcass weight, and between Zn and Cd liver levels and lean meat percentage. The linear discriminant analysis succeeded in predicting the farming process on the basis of the lean meat percentage and the liver Cd level. Copyright © 2018 Elsevier Ltd. All rights reserved.

LEAN AND GREEN? AN EMPIRICAL EXAMINATION OF THE RELATIONSHIP BETWEEN LEAN PRODUCTION AND ENVIRONMENTAL PERFORMANCE. (R827918)

EPA Science Inventory

The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

Simulation Modeling of a Facility Layout in Operations Management Classes

ERIC Educational Resources Information Center

Yazici, Hulya Julie

2006-01-01

Teaching quantitative courses can be challenging. Similarly, layout modeling and lean production concepts can be difficult to grasp in an introductory OM (operations management) class. This article describes a simulation model developed in PROMODEL to facilitate the learning of layout modeling and lean manufacturing. Simulation allows for the…

Method and apparatus for controlling fuel/air mixture in a lean burn engine

DOEpatents

Kubesh, John Thomas; Dodge, Lee Gene; Podnar, Daniel James

1998-04-07

The system for controlling the fuel/air mixture supplied to a lean burn engine when operating on natural gas, gasoline, hydrogen, alcohol, propane, butane, diesel or any other fuel as desired. As specific humidity of air supplied to the lean burn engine increases, the oxygen concentration of exhaust gas discharged by the engine for a given equivalence ratio will decrease. Closed loop fuel control systems typically attempt to maintain a constant exhaust gas oxygen concentration. Therefore, the decrease in the exhaust gas oxygen concentration resulting from increased specific humidity will often be improperly attributed to an excessive supply of fuel and the control system will incorrectly reduce the amount of fuel supplied to the engine. Also, the minimum fuel/air equivalence ratio for a lean burn engine to avoid misfiring will increase as specific humidity increases. A relative humidity sensor to allow the control system to provide a more enriched fuel/air mixture at high specific humidity levels. The level of specific humidity may be used to compensate an output signal from a universal exhaust gas oxygen sensor for changing oxygen concentrations at a desired equivalence ratio due to variation in specific humidity specific humidity. As a result, the control system will maintain the desired efficiency, low exhaust emissions and power level for the associated lean burn engine regardless of the specific humidity level of intake air supplied to the lean burn engine.

Lean Manufacturing Auto Cluster at Chennai

NASA Astrophysics Data System (ADS)

Bhaskaran, E.

2012-10-01

Due the presence of lot of automotive Industry, Chennai is known as Detroit of India, that producing over 40 % of the Indian vehicle and components. Lean manufacturing concepts have been widely recognized as an important tool in improving the competitiveness of industries. This is a continuous process involving everyone, starting from management to the shop floor. Automotive Component Industries (ACIs) in Ambattur Industrial Estate, Chennai has formed special purpose vehicle (SPV) society namely Ambattur Industrial Estate Manufacturers Association (AIEMA) Technology Centre (ATC) lean manufacturing cluster (ATC-LMC) during July 2010 under lean manufacturing competitiveness scheme, that comes under National Manufacturing Competitiveness Programme of Government of India. The Tripartite Agreement is taken place between National Productivity Council, consultants and cluster (ATC-LMC). The objective is to conduct diagnostic study, study on training and application of various lean manufacturing techniques and auditing in ten ACIs. The methodology adopted is collection of primary data/details from ten ACIs. In the first phase, diagnostic study is done and the areas for improvement in each of the cluster member companies are identified. In the second phase, training programs and implementation is done on 5S and other areas. In the third phase auditing is done and found that the lean manufacturing techniques implementation in ATC-LMC is sustainable and successful in every cluster companies, which will not only enhance competitiveness but also decrease cost, time and increase productivity. The technical efficiency of LMC companies also increases significantly.

Low NOx Heavy Fuel Combustor Concept Program

NASA Technical Reports Server (NTRS)

Novick, A. S.; Troth, D. L.

1981-01-01

The development of the technology required to operate an industrial gas turbine combustion system on minimally processed, heavy petroleum or residual fuels having high levels of fuel-bound nitrogen (FBN) while producing acceptable levels of exhaust emissions is discussed. Three combustor concepts were designed and fabricated. Three fuels were supplied for the combustor test demonstrations: a typical middle distillate fuel, a heavy residual fuel, and a synthetic coal-derived fuel. The primary concept was an air staged, variable-geometry combustor designed to produce low emissions from fuels having high levels of FBN. This combustor used a long residence time, fuel-rich primary combustion zone followed by a quick-quench air mixer to rapidly dilute the fuel rich products for the fuel-lean final burnout of the fuel. This combustor, called the rich quench lean (RQL) combustor, was extensively tested using each fuel over the entire power range of the model 570 K engine. Also, a series of parameteric tests was conducted to determine the combustor's sensitivity to rich-zone equivalence ratio, lean-zone equivalence ratio, rich-zone residence time, and overall system pressure drop. Minimum nitrogen oxide emissions were measured at 50 to 55 ppmv at maximum continuous power for all three fuels. Smoke was less than a 10 SAE smoke number.

Finding a balance between "value added" and feeling valued: revising models of care. The human factor of implementing a quality improvement initiative using Lean methodology within the healthcare sector.

PubMed

Deans, Rachel; Wade, Shawna

2011-01-01

Growing demand from clients waiting to access vital services in a healthcare sector under economic constraint, coupled with the pressure for ongoing improvement within a multi-faceted organization, can have a significant impact on the front-line staff, who are essential to the successful implementation of any quality improvement initiative. The Lean methodology is a management system for continuous improvement based on the Toyota Production System; it focuses on two main themes: respect for people and the elimination of waste or non-value-added activities. Within the Lean process, value-added is used to describe any activity that contributes directly to satisfying the needs of the client, and non-value-added refers to any activity that takes time, space or resources but does not contribute directly to satisfying client needs. Through the revision of existing models of service delivery, the authors' organization has made an impact on increasing access to care and has supported successful engagement of staff in the process, while ensuring that the focus remains on the central needs of clients and families accessing services. While the performance metrics continue to exhibit respectable results for this strategic priority, further gains are expected over the next 18-24 months.

Effects of Partial Substitution of Lean Meat with Pork Backfat or Canola Oil on Sensory Properties of Korean Traditional Meat Patties (Tteokgalbi)

PubMed Central

Imm, Bue-Young; Kim, Chung Hwan; Imm, Jee-Young

2014-01-01

Korean traditional meat patties (Tteokgalbi) were prepared by replacing part of the lean meat content with either pork backfat or canola oil and the effect of substitution on sensory quality of the meat patties was investigated. Compared to the control patties, pork-loin Tteokgalbi with 10% pork backfat or 10% canola oil had significantly higher overall acceptability and higher perceived intensity of meat flavor, sweetness, umami, and oiliness. The pork-loin patties containing 10% fat also had lower perceived firmness, toughness, and chalkiness of than the control Tteokgalbi. The chicken breast Tteokgalbi with 10% canola oil had the lowest perceived firmness and chalkiness (control > pork backfat > canola oil). No significant difference was noted in the overall acceptability of chicken breast patties with 10% pork backfat and those with 10% canola oil. These results indicate that substituting 10% of lean meat of Tteokgalbi with fat improved the sensory acceptability of the product for Korean customers regardless of the lean meat and/or fat source used in the patties. Lean meat patties formulated with a limited amount of vegetable oil such as canola oil can be a healthy option for Korean consumers by providing desirable fatty acid profiles without sacrificing sensory quality of the product. PMID:26761287

Effects of Partial Substitution of Lean Meat with Pork Backfat or Canola Oil on Sensory Properties of Korean Traditional Meat Patties (Tteokgalbi).

PubMed

Imm, Bue-Young; Kim, Chung Hwan; Imm, Jee-Young

2014-01-01

Korean traditional meat patties (Tteokgalbi) were prepared by replacing part of the lean meat content with either pork backfat or canola oil and the effect of substitution on sensory quality of the meat patties was investigated. Compared to the control patties, pork-loin Tteokgalbi with 10% pork backfat or 10% canola oil had significantly higher overall acceptability and higher perceived intensity of meat flavor, sweetness, umami, and oiliness. The pork-loin patties containing 10% fat also had lower perceived firmness, toughness, and chalkiness of than the control Tteokgalbi. The chicken breast Tteokgalbi with 10% canola oil had the lowest perceived firmness and chalkiness (control > pork backfat > canola oil). No significant difference was noted in the overall acceptability of chicken breast patties with 10% pork backfat and those with 10% canola oil. These results indicate that substituting 10% of lean meat of Tteokgalbi with fat improved the sensory acceptability of the product for Korean customers regardless of the lean meat and/or fat source used in the patties. Lean meat patties formulated with a limited amount of vegetable oil such as canola oil can be a healthy option for Korean consumers by providing desirable fatty acid profiles without sacrificing sensory quality of the product.

Lean Six Sigma in Healthcare: Combating the Military’s Escalating Pharmacy Costs

DTIC Science & Technology

2009-04-30

Management journal . Prior to his career in academia, Dr. Apte worked for over ten years in managing operations and information systems in the financial... journals including Management Science, Interfaces, Production and Operations Management , Journal of Operations Management , Decision Sciences, IIE...Telecommunication Management , Naval Logistics Quarterly, and other technical journals and conference proceedings. He has been involved in

From Toyota to the bedside: nurses can lead the lean way in health care reform.

PubMed

Johnson, Joyce E; Smith, Amy L; Mastro, Kari A

2012-01-01

The advent of health care reform means new pressures on American hospitals, which will be forced to do more with less. In the next decade, increased use of "Lean" principles and practices in hospitals can create real value by reducing waste and improving productivity, costs, quality, and the timely delivery of patient care services. In 2010, the Institute of Medicine recommended that nurses lead collaborative quality improvement efforts and assume a major role in redesigning health care in the United States. In this article, we provide an overview of the use of Lean techniques in health care and 2 case studies of successful, nurse-directed Lean initiatives at the Robert Wood Johnson University Hospital. The article concludes with some lessons we have learned and implications for nursing education in the future that must include the concepts, tools, and skills required for adapting Lean to the patient care environment.

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.

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

Measuring and improving quality of care in an academic medical center.

PubMed

Blayney, Douglas W

2013-05-01

The Donabedian definition of quality—structure, process, and outcome—provides a useful framework. A relentless focus on measuring process adherence and outcome is critical. Systemic improvements usually require teams to plan and to implement them. The lean or Toyota production system for process improvement is one useful method of organizing work, although different approaches are often necessary at the physician, practice unit, and statewide level. Challenges include scalability of the change (ie, rolling them out across the institution or system), tailoring the information technology tools, and building systems for sustainability.

Implementing a Lean Management System in Primary Care: Facilitators and Barriers From the Front Lines.

PubMed

Hung, Dorothy; Martinez, Meghan; Yakir, Maayan; Gray, Caroline

2015-01-01

Although Lean management techniques are increasingly used in health care to improve quality and reduce costs, lessons about how to successfully implement this approach on the front lines of care delivery are not well documented. In this study, we highlight key facilitators and barriers to implementing Lean among frontline primary care providers. This case study took place at a large, ambulatory care delivery system serving nearly 1 million patients. In-depth interviews were conducted with primary care physicians, staff, and administrators to identify key factors impacting Lean redesigns in primary care. Overall, staff engagement and performance management, sensitivity to the professional values and culture of medicine, and perceived adequacy of organizational resources were critical when introducing Lean changes. Specific drivers of change included empowerment of staff at all levels, visual display of performance metrics, and a culture of innovation and collaboration. Barriers included physician resistance to standardized work, difficulty transferring management responsibilities to non-physician staff, and time and staffing required for participating in improvement efforts. Although Lean offers a new approach to delivering care, the implementation process itself is both complex and crucial to success. Understanding early facilitators and barriers can maximize Lean's, potential to improve health care delivery.

Using data to make decisions and drive results: a LEAN implementation strategy.

PubMed

Panning, Rick

2005-03-28

During the process of facility planning, Fairview Laboratory Services utilized LEAN manufacturing to maximize efficiency, simplify processes, and improve laboratory support of patient care services. By incorporating the LEAN program's concepts in our pilot program, we were able to reduce turnaround time by 50%, improve productivity by greater than 40%, reduce costs by 31%, save more than 440 square feet of space, standardize work practices, reduce errors and error potential, continuously measure performance, eliminate excess unused inventory and visual noise, and cross-train 100% of staff in the core laboratory. In addition, we trained a core team of people that is available to coordinate future LEAN projects in the laboratory and other areas of the organization.

The relative merits of lean, enriched, and empowered offices: an experimental examination of the impact of workspace management strategies on well-being and productivity.

PubMed

Knight, Craig; Haslam, S Alexander

2010-06-01

Principles of lean management encourage managers to exert tight control over office space and the people within it. Alternative, design-led approaches promote the value of offices that are enriched, particularly by plants and art. On the basis of a social identity perspective, we argue that both of these approaches may compromise organizational outcomes by disempowering workers and failing to give them input into the design of their office space. This hypothesis is tested in two experiments (ns = 112, 47). The first was conducted in an interior office in a psychology department, the second in a commercial city office. In 4 independent conditions we examine the impact of space management strategies in which the office is either (a) lean, (b) decorated by the experimenter (with plants and art), (c) self-decorated, or (d) self-decorated and then redecorated by the experimenter. We examine the impact of these conditions on organizational identification, well-being, and various forms of productivity (attention to detail, information processing, information management, and organizational citizenship). In both experiments, superior outcomes are observed when offices are decorated rather than lean. However, further improvements in well-being and productivity are observed when workers have input into office decoration. Moreover, these effects are attenuated if this input is overridden. Implications for theory and practice are discussed. In particular, findings point to the need to question assumptions about the merits of lean office space management that have been dominant throughout the last century. PsycINFO Database Record (c) 2010 APA, all rights reserved.

[Research on the Application of Lean Management in Medical Consumables Material Logistics Management].

PubMed

Yang, Chai; Zhang, Wei; Gu, Wei; Shen, Aizong

2016-11-01

Solve the problems of high cost, low utilization rate of resources, low medical care quality problem in medical consumables material logistics management for scientific of medical consumables management. Analysis of the problems existing in the domestic medical consumables material logistics management in hospital, based on lean management method, SPD(Supply, Processing, Distribution) for specific applications, combined HBOS(Hospital Business Operation System), HIS (Hospital Information System) system for medical consumables material management. Achieve the lean management in medical consumables material purchase, warehouse construction, push, clinical use and retrospect. Lean management in medical consumables material can effectively control the cost in logistics management, optimize the alocation of resources, liberate unnecessary time of medical staff, improve the quality of medical care. It is a scientific management method.

Running Lean Startup in the Classroom: From Idea to Experiment in 1 Week

ERIC Educational Resources Information Center

Armstrong, Craig E.

2017-01-01

Entrepreneurship education is increasingly shifting from learning about entrepreneurship to developing entrepreneurial skills. One skill all entrepreneurship students need to develop is the ability to assess whether or not there is a market for their new product or service. Recent popular trade books like Eric Ries's "Lean Startup" and…

Evaluation of RFID for Information Visibility Based Job-Shop Scheduling in Lean Manufacturing Environments

ERIC Educational Resources Information Center

Chongwatpol, Jongsawas

2012-01-01

This dissertation investigates the impact of radio frequency identification (RFID) in manufacturing. Two simulation studies of an organization that is considering implementing RFID on a production line are conducted. First, we investigate whether addition of RFID technologies in the manufacturing process can complement Lean initiatives.…

Florida hospital saves 5.3 M dollars by adopting principles of lean manufacturing.

PubMed

2005-01-01

Florida hospital saves 5.3M dollars by adopting principles of lean manufacturing. Surgery cancellations have been slashed from 13% of cases to less than 3%, while emergency department admissions have increased by 20%. Those are just two of the results of a quality improvement project at Lee Memorial Health System in Fort Myers, FL, that focused on using the principles of lean manufacturing to improve patient flow in the five-hospital system

The effects of short-term overfeeding on insulin action in lean and reduced-obese individuals.

PubMed

Cornier, Marc-Andre; Bergman, Bryan C; Bessesen, Daniel H

2006-09-01

Insulin resistance is clearly associated with obesity. However, the role of excess energy intake per se as opposed to increased fat mass in the development of insulin resistance has not been clearly defined. It may be that the nutrient load provided by short-term overfeeding is sufficient to induce measurable changes in insulin action in skeletal muscle and the liver. We examined the effects of 3 days of overfeeding on insulin action and glucose kinetics in 13 lean (body mass index, 20.9 +/- 2.4 kg/m(2); 6 men, 7 women) and 9 reduced-obese (RO) (body mass index, 29.1 +/- 2.2 kg/m(2); 4 men, 5 women) individuals. A two-step euglycemic hyperinsulinemic clamp study (5 and 40 mU m(-2) min(-1)) with a primed, constant infusion of [6,6-(2)H(2)]glucose was performed after 3 days of a weight-maintenance diet and again after 3 days of overfeeding by 50% (50% carbohydrate, 30% fat, 20% protein). At baseline, lean individuals were more insulin sensitive, as measured by glucose infusion rate, than RO individuals (12.08 +/- 0.8 vs 7.62 +/- 1.0 mg x kg(-1) x min(-1), P < .01) with lean women being more insulin sensitive than lean men (P < .01). Overfeeding resulted in a reduction in glucose infusion rate in lean women (13.37 +/- 1.3 to 11.42 +/- 1.0 mg x kg(-1) x min(-1), P < .05), but no change was noted in lean men or RO individuals. Basal and insulin-stimulated glucose disposal remained unchanged with overfeeding in all groups. Low-dose insulin suppression of endogenous glucose production was impaired after overfeeding in lean women (euenergetic, 1.92 +/- 0.36 to 0.36 +/- 0.16 mg x kg(-1) x min(-1); overfeeding: 2.13 +/- 0.17 to 0.86 +/- 0.12 mg x kg(-1) x min(-1); P = .04) but remained unchanged in the other groups. These findings demonstrate that insulin action is reduced in lean, obese-resistant women after short-term overfeeding primarily because of an inhibition of insulin-mediated suppression of endogenous glucose production, whereas short-term overfeeding does not appear to effect insulin action in lean men and RO individuals. This response may be indirectly involved in the ability of lean women to maintain weight in the face of an obesigenic environment.

System and method for treatment of a flue gas

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

Spiry, Irina Pavlovna; Wood, Benjamin Rue; Singh, Surinder Prabhjot

A method for treatment of a flue gas involves feeding the flue gas and a lean solvent to an absorber. The method further involves reacting the flue gas with the lean solvent within the absorber to generate a clean flue gas and a rich solvent. The method also involves feeding the clean flue gas from the absorber and water from a source, to a wash tower to separate a stripped portion of the lean solvent from the clean flue gas to generate a washed clean flue gas and a mixture of the water and the stripped portion of the leanmore » solvent. The method further involves treating at least a portion of the mixture of the water and the stripped portion of the lean solvent via a separation system to separate the water from the stripped portion of the lean solvent.« less

Lean production in improving supply chain performance through hybrid model SCOR 11.0 - system dynamics

NASA Astrophysics Data System (ADS)

Saleh, Chairul; Fatcha Mubiena, Ghaida; Immawan, Taufiq; Hassan, Azmi

2016-02-01

Supply Chain Operation Reference (SCOR) is a method to measure supply chain serving the business process framework, performance indicators and unique technologies to support communication and collaboration among supply chain partners. The objective of this paper is to measure Supply Chain Management performance by using SCOR version 11.0 for production typology of MTS-MTO in Indonesian Batik Industry. This research combines SCOR's model and System Dynamics in order to predict the complex activities on batik industry. The hybrid SCOR-SD could identify the interaction among five attributes with the associated variables simultaneously. The results are obtained after the performance of lean production application is increased and the targets are achieved, even exceeding the target. For reliability attributes that associated with perfect order fulfilment started from 2015 to 2019 respectively are calculated as 80.06%, 103.53%, 105.58%, 93.76%, and 72.17%. Responsiveness attributes associated with the order fulfilment cycle time, respectively 122.45%, 149.10%, 159.26%, 131.53%, and 119.36%. Attributes associated with the total cost of service charge respectively 93.46%, 93.53%, 93.45%, 93.49, and 93.49%. Attributes associated with cash management assets to cash cycle time in a row were 160%, 153%, 146.3%, 150%, and 126.7%. The latter attribute is agility attributes associated with supply chain flexibility upside respectively 100%, 87.2%, 100%, 82%, and 82%.

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.

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

Model predictive control of a lean-burn gasoline engine coupled with a passive selective catalytic reduction system

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

Chen, Pingen; Lin, Qinghua; Prikhodko, Vitaly Y.

Lean-burn gasoline engines have demonstrated 10–20% engine efficiency gain over stoichiometric engines and are widely considered as a promising technology for meeting the 54.5 miles-per-gallon (mpg) Corporate Average Fuel Economy standard by 2025. Nevertheless, NOx emissions control for lean-burn gasoline for meeting the stringent EPA Tier 3 emission standards has been one of the main challenges towards the commercialization of highly-efficient lean-burn gasoline engines in the United States. Passive selective catalytic reduction (SCR) systems, which consist of a three-way catalyst and SCR, have demonstrated great potentials of effectively reducing NOx emissions for lean gasoline engines but may cause significant fuelmore » penalty due to ammonia generation via rich engine combustion. The purpose of this study is to develop a model-predictive control (MPC) scheme for a lean-burn gasoline engine coupled with a passive SCR system to minimize the fuel penalty associated with passive SCR operation while satisfying stringent NOx and NH3 emissions requirements. Simulation results demonstrate that the MPC-based control can reduce the fuel penalty by 47.7% in a simulated US06 cycle and 32.0% in a simulated UDDS cycle, compared to the baseline control, while achieving over 96% deNOx efficiency and less than 15 ppm tailpipe ammonia slip. The proposed MPC control can potentially enable high engine efficiency gain for highly-efficient lean-burn gasoline engine while meeting the stringent EPA Tier 3 emission standards.« less

Applying Value Stream Mapping Technique for Production Improvement in a Manufacturing Company: A Case Study

NASA Astrophysics Data System (ADS)

Jeyaraj, K. L.; Muralidharan, C.; Mahalingam, R.; Deshmukh, S. G.

2013-01-01

The purpose of this paper is to explain how value stream mapping (VSM) is helpful in lean implementation and to develop the road map to tackle improvement areas to bridge the gap between the existing state and the proposed state of a manufacturing firm. Through this case study, the existing stage of manufacturing is mapped with the help of VSM process symbols and the biggest improvement areas like excessive TAKT time, production, and lead time are identified. Some modifications in current state map are suggested and with these modifications future state map is prepared. Further TAKT time is calculated to set the pace of production processes. This paper compares the current state and future state of a manufacturing firm and witnessed 20 % reduction in TAKT time, 22.5 % reduction in processing time, 4.8 % reduction in lead time, 20 % improvement in production, 9 % improvement in machine utilization, 7 % improvement in man power utilization, objective improvement in workers skill level, and no change in the product and semi finished product inventory level. The findings are limited due to the focused nature of the case study. This case study shows that VSM is a powerful tool for lean implementation and allows the industry to understand and continuously improve towards lean manufacturing.

Deficiency of angiotensinogen in hepatocytes markedly decreases blood pressure in lean and obese male mice.

PubMed

Yiannikouris, Frederique; Wang, Yu; Shoemaker, Robin; Larian, Nika; Thompson, Joel; English, Victoria L; Charnigo, Richard; Su, Wen; Gong, Ming; Cassis, Lisa A

2015-10-01

We recently demonstrated that adipocyte deficiency of angiotensinogen (AGT) ablated high-fat diet-induced elevations in plasma angiotensin II (Ang II) concentrations and obesity-hypertension in male mice. Hepatocytes are the predominant source of systemic AGT. Therefore, in this study, we defined the contribution of hepatocyte-derived AGT to obesity-induced elevations in plasma AGT concentrations and hypertension. Male Agt(fl/fl) mice expressing albumin-driven Cre recombinase were bred to female Agt(fl/fl) mice to generate Agt(fl/fl) or hepatocyte AGT-deficient male mice (Agt(Alb)). Mice were fed a low-fat or high-fat diet for 16 weeks. Hepatocyte AGT deficiency had no significant effect on body weight. Plasma AGT concentrations were increased in obese Agt(fl/fl) mice. Hepatocyte AGT deficiency markedly reduced plasma AGT and Ang II concentrations in lean and obese mice. Moreover, hepatocyte AGT deficiency reduced the content and release of AGT from adipose explants. Systolic blood pressure was markedly decreased in lean (by 18 mm Hg) and obese Agt(Alb) mice (by 54 mm Hg) compared with Agt(fl/fl) controls. To define mechanisms, we quantified effects of Ang II on mRNA abundance of megalin, an AGT uptake transporter, in 3T3-L1 adipocytes. Ang II stimulated adipocyte megalin mRNA abundance and decreased media AGT concentrations. These results demonstrate that hepatocytes are the predominant source of systemic AGT in both lean and obese mice. Moreover, reductions in plasma angiotensin concentrations in obese hepatocyte AGT-deficient mice may have limited megalin-dependent uptake of AGT into adipocytes for the production of Ang II in the development of obesity-hypertension. © 2015 American Heart Association, Inc.

Teaching Lean Manufacturing with Simulations and Games: A Survey and Future Directions

ERIC Educational Resources Information Center

Badurdeen, Fazleena; Marksberry, Philip; Hall, Arlie; Gregory, Bob

2010-01-01

Problem-based learning focuses on small groups using authentic problems as a means to help participants obtain knowledge and problem-solving skills. This approach makes problem-based learning ideal for teaching lean manufacturing, which is driven by a culture of problem solving that values learning as one key output of manufacturing production.…

[Metalworking industry management evolution].

PubMed

Mattucci, Massimo

2011-01-01

Analysis of the evolution drivers of the management systems in the metalworking industry, mainly characterized as "automotive", starting with the "mass production" model, followed for the development of Italian industry in the '50. Through the socio-economic changes of the '90/10, the metalworking plants were deeply restructured with the introduction of computers in the production systems, and then with the first global benchmarks such as the "lean production", towards the needed operational flexibility to respond to the market dynamics. Plants change radically, company networks become real, ICT services are fundamental elements for the integration. These trends help visualizing a new "Factory of the Future" for the years 2020/30, where the competition will be based on the socio-economical, technological and environmental factors included in the "Competitive Sustainable Manufacturing" paradigm.

The relationship between IL-18 and atherosclerotic cardiovascular risk in Egyptian lean women with polycystic ovary syndrome.

PubMed

Dawood, Alaaeldin; Alkafrawy, Nabil; Saleh, Said; Noreldin, Rasha; Zewain, Shimaa

2018-04-01

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. The evidence in support of low-grade inflammation in PCOS as an etiology is emerging. Inflammation is likely to be associated with other prominent aspects of PCOS including insulin resistance (IR) and cardiovascular disease (CVD) risk. Interleukin-18 (IL-18) is considered as a strong marker of inflammation. Evaluation of the relation between serum IL-18 and atherosclerotic CVD (ASCVD) risk in Egyptian lean females with PCO. This study included control group of healthy lean normally menstruating females, lean PCOS group (BMI < 25 kg/m 2 ), and obese PCOS group (BMI > 25 kg/m 2 ) presented with infertility and diagnosed according to Rotterdam criteria. Measurements of serum lipid profile, IR, and IL-18 were done. Lipid accumulation product (LAP), IR and ASCVD risk were significantly higher in PCOS patients (lean and obese) compared to controls and in obese compared to lean. Serum IL-18 was significantly higher in the PCOV groups compared to the controls and correlated directly with LAP, IR and ASCVD risk. IL-18 is elevated in PCOS patients even in lean ones and is correlated with IR and ASCVD risk.

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.

Rich-burn, flame-assisted fuel cell, quick-mix, lean-burn (RFQL) combustor and power generation

NASA Astrophysics Data System (ADS)

Milcarek, Ryan J.; Ahn, Jeongmin

2018-03-01

Micro-tubular flame-assisted fuel cells (mT-FFC) were recently proposed as a modified version of the direct flame fuel cell (DFFC) operating in a dual chamber configuration. In this work, a rich-burn, quick-mix, lean-burn (RQL) combustor is combined with a micro-tubular solid oxide fuel cell (mT-SOFC) stack to create a rich-burn, flame-assisted fuel cell, quick-mix, lean-burn (RFQL) combustor and power generation system. The system is tested for rapid startup and achieves peak power densities after only 35 min of testing. The mT-FFC power density and voltage are affected by changes in the fuel-lean and fuel-rich combustion equivalence ratio. Optimal mT-FFC performance favors high fuel-rich equivalence ratios and a fuel-lean combustion equivalence ratio around 0.80. The electrical efficiency increases by 150% by using an intermediate temperature cathode material and improving the insulation. The RFQL combustor and power generation system achieves rapid startup, a simplified balance of plant and may have applications for reduced NOx formation and combined heat and power.

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

Lean burn natural gas fueled S.I. engine and exhaust emissions

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

Varde, K.S.; Patro, N.; Drouillard, K.

1995-12-31

An experimental study was undertaken to study exhaust emission from a lean-burn natural gas spark ignition engine. The possibility that such an engine may help to reduce exhaust emissions substantially by taking advantage of natural gas fuel properties, such as its antiknock properties and extended lean flammability limit compared to gasoline, was the main motivation behind the investigation. A four cylinder, automotive type spark ignition engine was used in the investigation. The engine was converted to operate on natural gas by replacing its fuel system with a gaseous carburetion system. A 3-way metal metrix catalytic converter was used in themore » engine exhaust system to reduce emission levels. The engine operated satisfactorily at an equivalence ratio as lean as 0.6, at all speeds and loads. As a result NOx emissions were significantly reduced. However, hydrocarbon emissions were high, particularly at very lean conditions and light loads. Most of these hydrocarbons were made up of methane with small concentrations of ethane and propane. Coefficient of variations in hydrocarbons were generally high at very lean operating conditions and light loads, but decreased with increasing equivalence ratio and engine speed. Methane concentrations in the engine exhaust decreased with increasing load and equivalence ratio. At lean air-to-fuel ratios and light loads oxidation of methane in the catalyst was substantially limited and no NOx reduction was achieved. In addition, the proportion of nitric oxide in oxides of nitrogen increased with increasing amount of NOx in the engine exhaust. A major problem encountered in the study was the inability of the fuel system to maintain near constant air-to-fuel ratios at steady operating conditions.« less

Manager traits and quality-of-care performance in hospitals.

PubMed

Aij, Kjeld Harald; Aernoudts, René L M C; Joosten, Gepke

2015-07-06

This paper aims to assess the impact of the leadership traits of chief executive officers (CEOs) on hospital performance in the USA. The effectiveness and efficiency of the CEO is of critical importance to the performance of any organization, including hospitals. Management systems and manager behaviours (traits) are of crucial importance to any organization because of their connection with organizational performance. To identify key factors associated with the quality of care delivered by hospitals, the authors gathered perceptions of manager traits from chief executive officers (CEOs) and followers in three groups of US hospitals delivering different levels of quality of care performance. Three high- and three low-performing hospitals were selected from the top and bottom 20th percentiles, respectively, using a national hospital ranking system based on standard quality of care performance measures. Three lean hospitals delivering intermediate performance were also selected. A survey was used to gather perceptions of manager traits (providing a modern or lean management system inclination) from CEOs and their followers in the three groups, which were compared. Four traits were found to be significantly different (alpha < 0.05) between lean (intermediate-) and low-performing hospitals. The different perceptions between these two hospital groups were all held by followers in the low-performing hospitals and not the CEOs, and all had a modern management inclination. No differences were found between lean (intermediate-) and high-performing hospitals, or between high- and low-performing hospitals. These findings support a need for hospital managers to acquire appropriate traits to achieve lean transformation, support a benefit of measuring manager traits to assess progress towards lean transformation and lend weight to improved quality of care that can be delivered by hospitals adopting a lean system of management.

An integrated lean-methods approach to hospital facilities redesign.

PubMed

Nicholas, John

2012-01-01

Lean production methods for eliminating waste and improving processes in manufacturing are now being applied in healthcare. As the author shows, the methods are appropriate for redesigning hospital facilities. When used in an integrated manner and employing teams of mostly clinicians, the methods produce facility designs that are custom-fit to patient needs and caregiver work processes, and reduce operational costs. The author reviews lean methods and an approach for integrating them in the redesign of hospital facilities. A case example of the redesign of an emergency department shows the feasibility and benefits of the approach.

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

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

Reduction of gaseous pollutant emissions from gas turbine combustors using hydrogen-enriched jet fuel

NASA Technical Reports Server (NTRS)

Clayton, R. M.

1976-01-01

Recent progress in an evaluation of the applicability of the hydrogen enrichment concept to achieve ultralow gaseous pollutant emission from gas turbine combustion systems is described. The target emission indexes for the program are 1.0 for oxides of nitrogen and carbon monoxide, and 0.5 for unburned hydrocarbons. The basic concept utilizes premixed molecular hydrogen, conventional jet fuel, and air to depress the lean flammability limit of the mixed fuel. This is shown to permit very lean combustion with its low NOx production while simulataneously providing an increased flame stability margin with which to maintain low CO and HC emission. Experimental emission characteristics and selected analytical results are presented for a cylindrical research combustor designed for operation with inlet-air state conditions typical for a 30:1 compression ratio, high bypass ratio, turbofan commercial engine.

Production Time Loss Reduction in Sauce Production Line by Lean Six Sigma Approach

NASA Astrophysics Data System (ADS)

Ritprasertsri, Thitima; Chutima, Parames

2017-06-01

In all industries, time losses, which are incurred in processing are very important. As a result, losses are incurred in productivity and cost. This research aimed to reduce lost time that occurs in sauce production line by using the lean six sigma approach. The main objective was to reduce the time for heating sauce which causes a lot of time lost in the production line which affects productivity. The methodology was comprised of the five-phase improvement model of Six Sigma. This approach begins with defining phase, measuring phase, analysing phase, improving phase and controlling phase. Cause-and-effect matrix and failure mode and effect analysis (FMEA) were adopted to screen the factors which affect production time loss. The results showed that the percentage of lost time from heating sauce reduced by 47.76%. This increased productivity to meet the plan.

Developing a performance data suite to facilitate lean improvement in a chemotherapy day unit.

PubMed

Lingaratnam, Senthil; Murray, Danielle; Carle, Amber; Kirsa, Sue W; Paterson, Rebecca; Rischin, Danny

2013-07-01

A multidisciplinary team from the Peter MacCallum Cancer Centre in Melbourne, Australia, developed a performance data suite to support a service improvement project based on lean manufacturing principles in its 19-chair chemotherapy day unit (CDU) and cytosuite chemotherapy production facility. The aims of the project were to reduce patient wait time and improve equity of access to the CDU. A project team consisting of a pharmacist and CDU nurse supported the management team for 10 months in engaging staff and customers to identify waste in processes, analyze root causes, eliminate non-value-adding steps, reduce variation, and level workloads to improve quality and flow. Process mapping, staff and patient tracking and opinion surveys, medical record audits, and interrogation of electronic treatment records were undertaken. This project delivered a 38% reduction in median wait time on the day (from 32 to 20 minutes; P < .01), 7-day reduction in time to commencement of treatment for patients receiving combined chemoradiotherapy regimens (from 25 to 18 days; P < .01), and 22% reduction in wastage associated with expired drug and pharmacy rework (from 29% to 7%; P < .01). Improvements in efficiency enabled the cytosuite to increase the percentage of product manufactured within 10 minutes of appointment times by 29% (from 47% to 76%; P < .01). A lean improvement methodology provided a robust framework for improved understanding and management of complex system constraints within a CDU, resulting in improved access to treatment and reduced waiting times on the day.

Are Agile and Lean Manufacturing Systems Employing Sustainability, Complexity and Organizational Learning?

ERIC Educational Resources Information Center

Flumerfelt, Shannon; Siriban-Manalang, Anna Bella; Kahlen, Franz-Josef

2012-01-01

Purpose: This paper aims to peruse theories and practices of agile and lean manufacturing systems to determine whether they employ sustainability, complexity and organizational learning. Design/methodology/approach: The critical review of the comparative operational similarities and difference of the two systems was conducted while the new views…

An economic analysis of a system wide Lean approach: cost estimations for the implementation of Lean in the Saskatchewan healthcare system for 2012-2014.

PubMed

Sari, Nazmi; Rotter, Thomas; Goodridge, Donna; Harrison, Liz; Kinsman, Leigh

2017-08-03

The costs of investing in health care reform initiatives to improve quality and safety have been underreported and are often underestimated. This paper reports direct and indirect cost estimates for the initial phase of the province-wide implementation of Lean activities in Saskatchewan, Canada. In order to obtain detailed information about each type of Lean event, as well as the total number of corresponding Lean events, we used the Provincial Kaizen Promotion Office (PKPO) Kaizen database. While the indirect cost of Lean implementation has been estimated using the corresponding wage rate for the event participants, the direct cost has been estimated using the fees paid to the consultant and other relevant expenses. The total cost for implementation of Lean over two years (2012-2014), including consultants and new hires, ranged from $44 million CAD to $49.6 million CAD, depending upon the assumptions used. Consultant costs accounted for close to 50% of the total. The estimated cost of Lean events alone ranged from $16 million CAD to $19.5 million CAD, with Rapid Process Improvement Workshops requiring the highest input of resources. Recognizing the substantial financial and human investments required to undertake reforms designed to improve quality and contain cost, policy makers must carefully consider whether and how these efforts result in the desired transformations. Evaluation of the outcomes of these investments must be part of the accountability framework, even prior to implementation.

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.

Low NO sub x heavy fuel combustor concept program phase 1A gas tests

NASA Technical Reports Server (NTRS)

Cutrone, M. B.; Beebe, K. W.; Cutrone, M. B.

1982-01-01

The emissions performance of a rich lean combustor (developed for liquid fuels) for combustion of simulated coal gases ranging in heating value from 167 to 244 Btu/scf were assessed. The 244 Btu/scf gas is typical of the product gas from an oxygen blown gasifier, while the 167 Btu/scf gas is similar to that from an air blown gasifier. Although meeting NOx goals for the 167 Btu/scf gas, NOx performance of the rich lean combustor did not meet program goals with the 244 Btu/scf gas because of high thermal NOx, similar to levels expected from conventional lean burning combustors. The NOx emissions are attributed to inadequate fuel air mixing in the rich stage resulting from the design of the large central fuel nozzle delivering 71% of the total gas flow. NOx generation from NH3 was significant at ammonia concentrations significantly less tha 0.5%. These levels occur depending on fuel gas cleanup system design, However, NOx yield from ammonia injected into the fuel gas decreased rapidly with increasing ammonia level, and is projected to be less than 10% at NH3 levels of 0.5% or higher.

Utilization of Lean Methodology to Refine Hiring Practices in a Clinical Research Center Setting

ERIC Educational Resources Information Center

Johnson, Marcus R.; Bullard, A. Jasmine; Whitley, R. Lawrence

2018-01-01

Background & Aims: Lean methodology is a continuous process improvement approach that is used to identify and eliminate unnecessary steps (or waste) in a process. It increases the likelihood that the highest level of value possible is provided to the end-user, or customer, in the form of the product delivered through that process. Lean…

Microbiota source impact in vitro metabolite colonic production and anti-proliferative effect of spent coffee grounds on human colon cancer cells (HT-29).

PubMed

Hernández-Arriaga, Angélica María; Dave Oomah, B; Campos-Vega, Rocio

2017-07-01

Human gut flora-mediated non-digestible fraction of spent coffee grounds (hgf-NDSCG) was evaluated for its chemopreventive effect and molecular mechanisms involved on human colon adenocarcinoma HT-29 cell survival using two different microbiota source [lean (L) and overweight (OW)]. The source of human gut flora (hgf) (L or OW) affected the pH of hgf-NDSCG only minimally, but linearly reduced those of hgf-inulin. The variability between lean and overweight microbiota was characterized by the metabolism and/or bioaccessibility of different phenolic metabolites, their intermediate and end products as well as by variable time courses. Apoptosis of colon cancer HT-29 cells depended on the microbiota source with the lean microbiota expressing a low lethal concentration 50 (LC 50 /L-hgf-NDSCG=13.5%). We demonstrate that NDSCG and its colonic metabolite from lean microbiota induced HT-29 cell apoptosis by reducing catalase and 8-iso-prostaglandin F2α as biomarkers of in vivo oxidative stress as the primary mechanism underlying its overall chemoprotection against colon cancer. Copyright © 2017 Elsevier Ltd. All rights reserved.

Insulin sensitivity, fat distribution, and adipocytokine response to different diets in lean and obese cats before and after weight loss.

PubMed

Hoenig, M; Thomaseth, K; Waldron, M; Ferguson, D C

2007-01-01

Obesity is a major health problem in cats and a risk factor for diabetes. It has been postulated that cats are always gluconeogenic and that the rise in obesity might be related to high dietary carbohydrates. We examined the effect of a high-carbohydrate/low-protein (HC) and a high-protein/low-carbohydrate (HP) diet on glucose and fat metabolism during euglycemic hyperinsulinemic clamp, adipocytokines, and fat distribution in 12 lean and 16 obese cats before and after weight loss. Feeding diet HP led to greater heat production in lean but not in obese cats. Regardless of diet, obese cats had markedly decreased glucose effectiveness and insulin resistance, but greater suppression of nonesterified fatty acids during the euglycemic hyperinsulinemic clamp was seen in obese cats on diet HC compared with lean cats on either diet or obese cats on diet HP. In contrast to humans, obese cats had abdominal fat equally distributed subcutaneously and intra-abdominally. Weight loss normalized insulin sensitivity; however, increased nonesterified fatty acid suppression was maintained and fat loss was less in cats on diet HC. Adiponectin was negatively and leptin positively correlated with fat mass. Lean cats and cats during weight loss, but not obese cats, adapted to the varying dietary carbohydrate/protein content with changes in substrate oxidation. We conclude that diet HP is beneficial through maintenance of normal insulin sensitivity of fat metabolism in obese cats, facilitating the loss of fat during weight loss, and increasing heat production in lean cats. These data also show that insulin sensitivity of glucose and fat metabolism can be differentially regulated in cats.

Basal ganglia systems in ritualistic social displays: reptiles and humans; function and illness.

PubMed

Baxter, Lewis R

2003-08-01

Complex, situation-specific territorial maintenance routines are similar across living terrestrial vertebrates (=amniotes). Decades ago, Paul MacLean et al., at the Laboratory of Brain Evolution and Behavior of the National Institute of Mental Health, postulated that these are evolutionarily conserved behaviors whose expression is mediated by the similarly conserved amniote basal ganglia and related brain systems (BG systems). Therefore, they undertook studies in nonhuman primates and in small social lizards (the common green anole, Anolis carolinensis) to examine this idea. MacLean et al. also postulated that when BG systems misfunction in humans, behavioral abnormalities result, some of them under the rubric of psychiatric illnesses. Obsessive-compulsive disorder (OCD) was singled out as one likely candidate. In the last dozen years, functional brain imaging studies of OCD patients have validated the contention that this is, in fact, a condition involving dysfunctioning BG systems. Inspired by the MacLean group's original investigations, my colleagues and I have now applied related functional imaging techniques in naturalistic experiments using Anolis to better understand BG systems' roles in the mediation of complex behavioral routines in healthy amniotes. Here, I will review this functional imaging work in primates (man, and a little in monkey) and in lizards. I believe the literature not only supports MacLean et al.'s contentions about BG systems and behavior in general, but also validates Paul MacLean's life-long contention that human behavioral medicine can profit from a broad comparative approach.

Primary problems associated with the health and welfare of employees observed when implementing lean manufacturing projects.

PubMed

Rampasso, Izabela Simon; Anholon, Rosley; Gonçalves Quelhas, Osvaldo Luiz; Filho, Walter Leal

2017-01-01

Lean philosophy is used by companies to increase productivity and reduce costs. Although uncontested benefits are created, it is necessary to highlight the problems related to employees' health and welfare caused by implementing lean manufacturing projects. The primary objective of this paper is to review the literature and identify the most relevant problems created by lean philosophy for employees. Research about the theme was performed on many international databases over three months, and an initial sample of 77 papers was found. Twenty-seven sources were utilized. We identified 22 categories of problems related to health and welfare of employees. The most cited problem was work intensification, mentioned by thirteen papers. Increased stress and increased responsibilities, demands and, consequently, pressure on the workers are among the primary problems observed in the research.

Hydrogen peroxide production is not primarily increased in human myotubes established from type 2 diabetic subjects.

PubMed

Minet, A D; Gaster, M

2011-09-01

Increased oxidative stress and mitochondrial dysfunction have been implicated in the development of insulin resistance in type 2 diabetes. To date, it is unknown whether increased mitochondrial reactive oxygen species (ROS) production in skeletal muscle from patients with type 2 diabetes is primarily increased or a secondary adaptation to environmental, lifestyle, and hormonal factors. This study investigates whether ROS production is primarily increased in isolated diabetic myotubes. Mitochondrial membrane potential, hydrogen peroxide (H(2)O(2)), superoxide, and mitochondrial mass were determined in human myotubes precultured under normophysiological conditions. Furthermore, the corresponding ATP synthesis was measured in isolated mitochondria. Muscle biopsies were taken from 10 lean subjects, 10 obese subjects, and 10 subjects with type 2 diabetes; satellite cells were isolated, cultured, and differentiated to myotubes. Mitochondrial mass, membrane potential/mitochondrial mass, and superoxide-production/mitochondrial mass were not different between groups. In contrast, H(2)O(2) production/mitochondrial mass and ATP production were significantly reduced in diabetic myotubes compared to lean controls (P < 0.05). The ATP/H(2)O(2) ratios were not significantly different between groups. Our result indicates that the ROS production is not primarily increased in diabetic myotubes but rather is reduced. Moreover, the comparable ATP/H(2)O(2) ratios indicate that the reduced ROS production in diabetic myotubes parallels the reduced ATP production because ROS production in diabetic myotubes must be considered to be in a proportion comparable to lean. Thus, the increased ROS production seen in skeletal muscle of type 2 diabetic patients is an adaptation to the in vivo conditions.

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.

You say "lean finely textured beef," I say "pink slime".

PubMed

Reid, Rita-Marie Cain

2014-01-01

In 2012, American Broadcasting Companies, Inc. (ABC) broadcast a segment on its evening news show regarding the manufacture of "lean finely textured beef" by Beef Products, Inc. (BPI). The broadcast, as well as follow-up reports and social media communications, repeatedly referred to the product as "pink slime," a term originated by a United States Department of Agriculture (USDA) employee for the processed meat. The market backlash against the product was immediate and intense. Ultimately, BPI closed three processing plants, cut hundreds of jobs, and filed for bankruptcy. BPI sued ABC and others for food libel, defamation, and tortious interference. This research analyzes those claims and defenses and discusses the future of such cases.

TRIENNIAL GROWTH AND DEVELOPMENT SYMPOSIUM: Genetics and breeding for intramuscular fat and oleic acid content in pigs.

PubMed

Estany, J; Ros-Freixedes, R; Tor, M; Pena, R N

2017-05-01

The intramuscular fat (IMF) and oleic acid (OL) content have been favorably related to pork quality and human health. This influences the purchasing behavior of consumers and, therefore, also shifts the attention of breeding companies toward whether these traits are included into the breeding goal of the lines producing for high-valued markets. Because IMF and OL are unfavorably associated with lean content, a key economic trait, the real challenge for the industry is not simply to increase IMF and OL, but rather to come up with the right trade-off between them and lean content. In this paper we review the efforts performed to genetically improve IMF and OL, with particular reference to the research we conducted in a Duroc line aimed at producing high quality fresh and dry-cured pork products. Based on this research, we conclude that there are selection strategies that lead to response scenarios where IMF, OL, and lean content can be simultaneously improved. Such scenarios involve regular recording of IMF and OL, so that developing a cost-efficient phenotyping system for these traits is paramount. With the economic benefits of genomic selection needing further assessment in pigs, selection on a combination of pedigree-connected phenotypes and genotypes from a panel of selected genetic markers is presented as a suitable alternative. Evidence is provided supporting that at least a polymorphism in the leptin receptor and another in the stearoyl-CoA desaturase genes should be in that panel. Selection for IMF and OL results in an opportunity cost on lean growth. The extent to which it is affordable relies on the consumers' willingness to pay for premium products and on the cost to benefit ratio of alternative management strategies, such as specific dietary manipulations. How the genotype can influence the effect of the diet on IMF and OL remains a topic for further research.

Illusion or delusion--Lean management in the health sector.

PubMed

McIntosh, Bryan; Sheppy, Bruce; Cohen, Ivan

2014-01-01

There has been considerable interest in the implementation of practices imported from manufacturing into healthcare as a solution to rising healthcare spending and disappointing patient safety indicators. One approach that has attracted particular interest is Lean management and the purpose of this paper is to engage with this topic. Secondary research. Despite widespread enthusiasm about the potential of Lean management processes, evidence about its contribution to higher organisational performance remains inconsistent. This paper engages with the major Lean concepts of operations management and human resource management, including just-in-time, total quality management, total productive maintenance and does not engage in-depth with concepts related to employee empowerment, and training This paper contributes to the organisational management literature in healthcare by showing that although Lean management seems to have the potential to improve organisational performance it is far from a panacea against under performing hospitals. It informs policy making by suggesting that a progressive managerial philosophy has a stronger impact on healthcare performance than the adoption of practices from any particular managerial approach. This paper provides a critical evaluation of the impact of Lean practices in informing healthcare policy. The paper contributes to the organisational management literature in healthcare by showing that even though Lean management in healthcare appears to have the potential to improve organisational performance; there remain problems with its application.

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.

Lean Six Sigma Implementation for Military Logistics to Improve Readiness

DTIC Science & Technology

2007-04-30

mistake-proofing ( poka - yoke ). Lean, as a management philosophy, is also very focused on creating a better workplace through the Toyota principle...Techniques • Pull System • Visual Control • Mistake proofing ( poka yoke ) • Equipment Changeover 37 Pull System • Issuance of an RFI engine would “trigger

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.

Emission characteristics of a premix combustor fueled with a simulated partial-oxidation product gas

NASA Technical Reports Server (NTRS)

Clayton, R. M.

1979-01-01

A two-stage gas turbine combustor concept employing a very fuel-rich partial oxidation stage is being explored for broadening the combustion margin between ultralow emissions and the lean stability limit. Combustion and emission results are presented for a series of experiments where a simulated partial oxidation product gas was used in a premix combustor operated with inlet air state conditions typical of cruise power for high-performance aviation engines (12 atm and 850 F). Ultralow NOx, CO, and HC emissions and an extended lean burning limit were achieved simultaneously.

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.

A waste walk through clinical pharmacy: how do the 'seven wastes' of Lean techniques apply to the practice of clinical pharmacists.

PubMed

Green, Christopher F; Crawford, Victoria; Bresnen, Gaynor; Rowe, Philip H

2015-02-01

This study used a 'Lean' technique, the 'waste walk' to evaluate the activities of clinical pharmacists with reference to the seven wastes described in 'Lean' including 'defects', 'unnecessary motion', 'overproduction', 'transport of products or material', 'unnecessary waiting', 'unnecessary inventory' and 'inappropriate processing'. The objectives of the study were to categorise the activities of ward-based clinical pharmacists into waste and non-waste, provide detail around what constitutes waste activity and quantify the proportion of time attributed to each category. This study was carried out in a district general hospital in the North West of England. Staff were observed using work-sampling techniques, to categorise activity into waste and non-waste, with waste activities being allocated to each of the seven wastes described earlier and subdivided into recurrent themes. Twenty different pharmacists were observed for 1 h on two separate occasions. Of 1440 observations, 342 (23.8%) were categorised as waste with 'defects' and 'unnecessary motion' accounting for the largest proportions of waste activity. Observation of clinical pharmacists' activities has identified that a significant proportion of their time could be categorised as 'waste'. There are practical steps that could be implemented in order to ensure their time is used as productively as possible. Given the challenges facing the UK National Health Service, the adoption of 'Lean' techniques provides an opportunity to improve quality and productivity while reducing costs. © 2014 Royal Pharmaceutical Society.

Lean systems approaches to health technology assessment: a patient-focused alternative to cost-effectiveness analysis.

PubMed

Bridges, John F P

2006-12-01

Many countries now use health technology assessment (HTA) to review new and emerging technologies, especially with regard to reimbursement, pricing and/or clinical guidelines. One of the common, but not universal, features of these systems is the use of economic evaluation, normally cost-effectiveness analysis (CEA), to confirm that new technologies offer value for money. Many have criticised these systems as primarily being concerned with cost containment, rather than advancing the interests of patients or innovators. This paper calls into question the underlying principles of CEA by arguing that value in the healthcare system may in fact be unconstrained. It is suggested that 'lean management principles' can be used not only to trim waste from the health system, but as a method of creating real incentives for innovation and value creation. Following the lean paradigm, this value must be defined purely from the patients' perspective, and the entire health system needs to work towards the creation of such value. This paper offers as a practical example a lean approach to HTA, arguing that such an approach would lead to better incentives for innovation in health, as well as more patient-friendly outcomes in the long run.

Informatics applied to cytology

PubMed Central

Hornish, Maryanne; Goulart, Robert A.

2008-01-01

Automation and emerging information technologies are being adopted by cytology laboratories to augment Pap test screening and improve diagnostic accuracy. As a result, informatics, the application of computers and information systems to information management, has become essential for the successful operation of the cytopathology laboratory. This review describes how laboratory information management systems can be used to achieve an automated and seamless workflow process. The utilization of software, electronic databases and spreadsheets to perform necessary quality control measures are discussed, as well as a Lean production system and Six Sigma approach, to reduce errors in the cytopathology laboratory. PMID:19495402

17 CFR Appendix A to Part 18 - Form 40

Code of Federal Regulations, 2014 CFR

2014-04-01

... either visiting the CFTC's web-based Form 40 portal to review, verify, and/or update their information... Product Merchant Wholesaler Farm Product Raw Material Merchant Wholesalers Chemical and Allied Products... CATTLE PORK BELLIES FEEDER CATTLE LEAN HOGS DAIRY PRODUCTS MILK BUTTER CHEESE OILSEED AND PRODUCTS...

Are we prepared to implement a Lean philosophy within cancer-care service in Oman?

PubMed

Mehdi, Itrat; Al Bahrani, Bassim J

2017-07-01

Lean, as it applies to business, has come to signify simplicity, swift response, and efficiency. The concept is to do more with less; namely, to use resources in the most productive way possible through the elimination of all types of waste. The Lean approach can be applied to any field, including healthcare, in which the exponential growth of costs is widespread. Hospitals began experimenting with Lean healthcare in 1990s.  Equal accessibility to healthcare is consistent with the tenets of social justice and a society's duty to ensure basic healthcare to everyone. However, the gap between a state's constitutional responsibility and resource availability is widening, creating a need for an evolution in healthcare provision based on relevance, objectivity, and impartiality. Health-services providers must juggle limited resources to ensure even-handed healthcare availability to all in the era of cost explosion.

Are we prepared to implement a Lean philosophy within cancer-care service in Oman?

PubMed Central

Mehdi, Itrat; Bahrani, Bassim J. Al

2017-01-01

Lean, as it applies to business, has come to signify simplicity, swift response, and efficiency. The concept is to do more with less; namely, to use resources in the most productive way possible through the elimination of all types of waste. The Lean approach can be applied to any field, including healthcare, in which the exponential growth of costs is widespread. Hospitals began experimenting with Lean healthcare in 1990s. Equal accessibility to healthcare is consistent with the tenets of social justice and a society’s duty to ensure basic healthcare to everyone. However, the gap between a state’s constitutional responsibility and resource availability is widening, creating a need for an evolution in healthcare provision based on relevance, objectivity, and impartiality. Health-services providers must juggle limited resources to ensure even-handed healthcare availability to all in the era of cost explosion. PMID:28674713

Lean, premixed, prevaporized combustion for aircraft gas turbine engines

NASA Technical Reports Server (NTRS)

Mularz, E. J.

1979-01-01

The application of lean, premixed, prevaporized combustion to aircraft turbine engine systems can result in benefits in terms of superior combustion performance, improved combustor and turbine durability, and environmentally acceptable pollutant emissions. Lean, premixed prevaporized combustion is particularly attractive for reducing the oxides of nitrogen emissions during high altitude cruise. The NASA stratospheric cruise emission reduction program will evolve and demonstrate lean, premixed, prevaporized combustion technology for aircraft engines. This multiphased program is described. In addition, the various elements of the fundamental studies phase of the program are reviewed, and results to date of many of these studies are summarized.

Relationship-centered health care as a Lean intervention.

PubMed

Dunsford, Jennifer; Reimer, Laura E

2017-12-01

Continuous improvement efforts, recognized in much literature as Lean management techniques have been used in efforts to improve efficiency in democratic health care contexts for some time to varying degrees of success. The complexity of the health care system is magnified by the sheer number of processes and sub processes required to deliver value within a bureaucratic environment, while maintaining some level of compassionate and personalized care. There is inherent tension between what is required to be efficient and what is required to be caring and this conflict presses against Lean practice at the level of delivery.Administration and care intersect at the point of the patient's experience. In order to achieve the dual goals of improved value and lower costs, the application of Lean thinking for meaningful health care reform must acknowledge the fundamental dichotomy between the impersonal tasks required to provide health services, and human interactions. Meaningful health care reform requires an acknowledgement of this distinction, currently not recognized in literature. While administrative process improvements are necessary, they are insufficient to achieve a sustainable and caring health care system. Lean thinking must be applied differently for administrative processes and patient care encounters, because these are fundamentally different processes. In this way, Lean principles will effectively contribute to sustainable health system improvements. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Alterations of local cerebral glucose utilization in lean and obese fa/fa rats after acute adrenalectomy.

PubMed

Doyle, P; Rohner-Jeanrenaud, F; Jeanrenaud, B

1994-08-29

An animal model often used to investigate the aetiology of obesity is the genetically obese fa/fa rat. It has many abnormalities, including hyperphagia, hyper-insulinemia, insulin resistance, low cerebral glucose utilization and an overactive hypothalamo-pituitary adrenal (HPA) axis with resulting hypercorticism. Due to the latter consideration, the aim of this work was to study the impact of acute adrenalectomy (ADX) on the local cerebral glucose utilization (LCGU) of lean and obese fa/fa rats. ADX resulted in discrete increases in LCGU of regions common to both lean and obese rats. These common regions were found to belong to be related to the limbic system. Within this system, the LCGU of the brain of obese rats was either normalized to lean sham operated values or increased by ADX to a similar degree in both groups on a percentage basis. It was concluded that the LCGU of both lean and obese animals appears to be negatively regulated, albeit to different extents, by glucocorticoids. Such negative regulation is particularly salient within the limbic system of the lean rat and even more so in the fa/fa rat. It is suggested that the long-term hypercorticism of obese fa/fa rats due to abnormal regulation of the HPA axis may result in a decreased LCGU in limbic and related regions of the brain of fa/fa rats and contribute to the expression of the obese phenotype.

Assessing eLearning Systems Success in Nigeria: An Application of the DeLone and McLean Information Systems Success Model

ERIC Educational Resources Information Center

Yakubu, M. Nasiru; Dasuki, Salihu Ibrahim

2018-01-01

Aim/Purpose: This study is based on the DeLone and McLean's Information Systems Success (D&M ISS) model, which was modified to determine the success factors responsible for the acceptance of an e-learning system called Canvas by students of a Nigerian University. Background: The adoption of eLearning has been under studied within the context…

76 FR 54770 - Public Meeting: Notification by Capital One Financial Corporation, McLean, VA, To Acquire ING...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-02

... FEDERAL RESERVE SYSTEM Public Meeting: Notification by Capital One Financial Corporation, McLean, VA, To Acquire ING Bank, FSB, Wilmington, DE, and Indirectly To Acquire Shares of Sharebuilder... Reserve System. ACTION: Notice of public meeting. SUMMARY: Three public meetings will be held regarding...

The influence of crop production and socioeconomic factors on seasonal household dietary diversity in Burkina Faso.

PubMed

Somé, Jérôme W; Jones, Andrew D

2018-01-01

Households in low-income settings are vulnerable to seasonal changes in dietary diversity because of fluctuations in food availability and access. We assessed seasonal differences in household dietary diversity in Burkina Faso, and determined the extent to which household socioeconomic status and crop production diversity modify changes in dietary diversity across seasons, using data from the nationally representative 2014 Burkina Faso Continuous Multisectoral Survey (EMC). A household dietary diversity score based on nine food groups was created from household food consumption data collected during four rounds of the 2014 EMC. Plot-level crop production data, and data on household assets and education were used to create variables on crop diversity and household socioeconomic status, respectively. Analyses included data for 10,790 households for which food consumption data were available for at least one round. Accounting for repeated measurements and controlling for the complex survey design and confounding covariates using a weighted multi-level model, household dietary diversity was significantly higher during both lean seasons periods, and higher still during the harvest season as compared to the post-harvest season (mean: post-harvest: 4.76 (SE 0.04); beginning of lean: 5.13 (SE 0.05); end of lean: 5.21 (SE 0.05); harvest: 5.72 (SE 0.04)), but was not different between the beginning and the end of lean season. Seasonal differences in household dietary diversity were greater among households with higher food expenditures, greater crop production, and greater monetary value of crops sale (P<0.05). Seasonal changes in household dietary diversity in Burkina Faso may reflect nutritional differences among agricultural households, and may be modified both by households' socioeconomic status and agricultural characteristics.

Developing a Performance Data Suite to Facilitate Lean Improvement in a Chemotherapy Day Unit

PubMed Central

Lingaratnam, Senthil; Murray, Danielle; Carle, Amber; Kirsa, Sue W.; Paterson, Rebecca; Rischin, Danny

2013-01-01

Purpose: A multidisciplinary team from the Peter MacCallum Cancer Centre in Melbourne, Australia, developed a performance data suite to support a service improvement project based on lean manufacturing principles in its 19-chair chemotherapy day unit (CDU) and cytosuite chemotherapy production facility. The aims of the project were to reduce patient wait time and improve equity of access to the CDU. Methods: A project team consisting of a pharmacist and CDU nurse supported the management team for 10 months in engaging staff and customers to identify waste in processes, analyze root causes, eliminate non–value-adding steps, reduce variation, and level workloads to improve quality and flow. Process mapping, staff and patient tracking and opinion surveys, medical record audits, and interrogation of electronic treatment records were undertaken. Results: This project delivered a 38% reduction in median wait time on the day (from 32 to 20 minutes; P < .01), 7-day reduction in time to commencement of treatment for patients receiving combined chemoradiotherapy regimens (from 25 to 18 days; P < .01), and 22% reduction in wastage associated with expired drug and pharmacy rework (from 29% to 7%; P < .01). Improvements in efficiency enabled the cytosuite to increase the percentage of product manufactured within 10 minutes of appointment times by 29% (from 47% to 76%; P < .01). Conclusion: A lean improvement methodology provided a robust framework for improved understanding and management of complex system constraints within a CDU, resulting in improved access to treatment and reduced waiting times on the day. PMID:23942927

The Relative Merits of Lean, Enriched, and Empowered Offices: An Experimental Examination of the Impact of Workspace Management Strategies on Well-Being and Productivity

ERIC Educational Resources Information Center

Knight, Craig; Haslam, S. Alexander

2010-01-01

Principles of lean management encourage managers to exert tight control over office space and the people within it. Alternative, design-led approaches promote the value of offices that are enriched, particularly by plants and art. On the basis of a social identity perspective, we argue that both of these approaches may compromise organizational…

The combined positive impact of Lean methodology and Ventana Symphony autostainer on histology lab workflow

PubMed Central

2010-01-01

Background Histologic samples all funnel through the H&E microtomy staining area. Here manual processes intersect with semi-automated processes creating a bottleneck. We compare alternate work processes in anatomic pathology primarily in the H&E staining work cell. Methods We established a baseline measure of H&E process impact on personnel, information management and sample flow from historical workload and production data and direct observation. We compared this to performance after implementing initial Lean process modifications, including workstation reorganization, equipment relocation and workflow levelling, and the Ventana Symphony stainer to assess the impact on productivity in the H&E staining work cell. Results Average time from gross station to assembled case decreased by 2.9 hours (12%). Total process turnaround time (TAT) exclusive of processor schedule changes decreased 48 minutes/case (4%). Mean quarterly productivity increased 8.5% with the new methods. Process redesign reduced the number of manual steps from 219 to 182, a 17% reduction. Specimen travel distance was reduced from 773 ft/case to 395 ft/case (49%) overall, and from 92 to 53 ft/case in the H&E cell (42% improvement). Conclusions Implementation of Lean methods in the H&E work cell of histology can result in improved productivity, improved through-put and case availability parameters including TAT. PMID:20181123

Ares Launch Vehicles Lean Practices Case Study

NASA Technical Reports Server (NTRS)

Doreswamy, Rajiv; Self, Timothy A.

2007-01-01

The Ares launch vehicles team, managed by the Ares Projects Office (APO) at NASA Marshall Space Flight Center, has completed the Ares I Crew Launch Vehicle System Requirements Review and System Definition Review and early design work for the Ares V Cargo Launch Vehicle. This paper provides examples of how Lean Manufacturing, Kaizen events, and Six Sigma practices are helping APO deliver a new space transportation capability on time and within budget, while still meeting stringent technical requirements. For example, Lean philosophies have been applied to numerous process definition efforts and existing process improvement activities, including the Ares I-X test flight Certificate of Flight Readiness (CoFR) process, risk management process, and review board organization and processes. Ares executives learned Lean practices firsthand, making the team "smart buyers" during proposal reviews and instilling the team with a sense of what is meant by "value-added" activities. Since the goal of the APO is to field launch vehicles at a reasonable cost and on an ambitious schedule, adopting Lean philosophies and practices will be crucial to the Ares Project's long-term SUCCESS.

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.

Theory for broadband Noise of Rotor and Stator Cascades with Inhomogeneous Inflow Turbulence Including Effects of Lean and Sweep

NASA Technical Reports Server (NTRS)

Hanson, Donald B.

2001-01-01

The problem of broadband noise generated by turbulence impinging on a downstream blade row is examined from a theoretical viewpoint. Equations are derived for sound power spectra in terms of 3 dimensional wavenumber spectra of the turbulence. Particular attention is given to issues of turbulence inhomogeneity associated with the near field of the rotor and variations through boundary layers. Lean and sweep of the rotor or stator cascade are also handled rigorously with a full derivation of the relevant geometry and definitions of lean and sweep angles. Use of the general theory is illustrated by 2 simple theoretical spectra for homogeneous turbulence. Limited comparisons are made with data from model fans designed by Pratt & Whitney, Allison, and Boeing. Parametric studies for stator noise are presented showing trends with Mach number, vane count, turbulence scale and intensity, lean, and sweep. Two conventions are presented to define lean and sweep. In the "cascade system" lean is a rotation out of its plane and sweep is a rotation of the airfoil in its plane. In the "duct system" lean is the leading edge angle viewing the fan from the front (along the fan axis) and sweep is the angle viewing the fan from the side (,perpendicular to the axis). It is shown that the governing parameter is sweep in the plane of the airfoil (which reduces the chordwise component of Mach number). Lean (out of the plane of the airfoil) has little effect. Rotor noise predictions are compared with duct turbulence/rotor interaction noise data from Boeing and variations, including blade tip sweep and turbulence axial and transverse scales are explored.

The Applicability of Lean and Six Sigma Techniques to Clinical and Translational Research

PubMed Central

Schweikhart, Sharon A.; Dembe, Allard E

2010-01-01

Background Lean and Six Sigma are business management strategies commonly used in production industries to improve process efficiency and quality. During the past decade, these process improvement techniques increasingly have been applied outside of the manufacturing sector, for example, in health care and in software development. This article concerns the potential use of Lean and Six Sigma to improve the processes involved in clinical and translational research. Improving quality, avoiding delays and errors, and speeding up the time to implementation of biomedical discoveries are prime objectives of the NIH Roadmap for Biomedical Research and the NIH Clinical and Translational Science Award (CTSA) program. Methods This article presents a description of the main principles, practices, and methodologies used in Lean and Six Sigma. Available literature involving applications of Lean and Six Sigma to health care, laboratory science, and clinical and translational research is reviewed. Specific issues concerning the use of these techniques in different phases of translational research are identified. Results Examples are provided of Lean and Six Sigma applications that are being planned at a current CTSA site, which could potentially be replicated elsewhere. We describe how different process improvement approaches are best adapted for particularly translational research phases. Conclusions Lean and Six Sigma process improvement methodologies are well suited to help achieve NIH’s goal of making clinical and translational research more efficient and cost-effective, enhancing the quality of the research, and facilitating the successful adoption of biomedical research findings into practice. PMID:19730130

The applicability of Lean and Six Sigma techniques to clinical and translational research.

PubMed

Schweikhart, Sharon A; Dembe, Allard E

2009-10-01

Lean and Six Sigma are business management strategies commonly used in production industries to improve process efficiency and quality. During the past decade, these process improvement techniques increasingly have been applied outside the manufacturing sector, for example, in health care and in software development. This article concerns the potential use of Lean and Six Sigma in improving the processes involved in clinical and translational research. Improving quality, avoiding delays and errors, and speeding up the time to implementation of biomedical discoveries are prime objectives of the National Institutes of Health (NIH) Roadmap for Medical Research and the NIH's Clinical and Translational Science Award program. This article presents a description of the main principles, practices, and methods used in Lean and Six Sigma. Available literature involving applications of Lean and Six Sigma to health care, laboratory science, and clinical and translational research is reviewed. Specific issues concerning the use of these techniques in different phases of translational research are identified. Examples of Lean and Six Sigma applications that are being planned at a current Clinical and Translational Science Award site are provided, which could potentially be replicated elsewhere. We describe how different process improvement approaches are best adapted for particular translational research phases. Lean and Six Sigma process improvement methods are well suited to help achieve NIH's goal of making clinical and translational research more efficient and cost-effective, enhancing the quality of the research, and facilitating the successful adoption of biomedical research findings into practice.

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.

Impact of Individualized Diet Intervention on Body Composition and Respiratory Variables in Children With Respiratory Insufficiency: A Pilot Intervention Study.

PubMed

Martinez, Enid E; Bechard, Lori J; Smallwood, Craig D; Duggan, Christopher P; Graham, Robert J; Mehta, Nilesh M

2015-07-01

Diet modification may improve body composition and respiratory variables in children with respiratory insufficiency. Our objective was to examine the effect of an individualized diet intervention on changes in weight, lean body mass, minute ventilation, and volumetric CO2 production in children dependent on long-term mechanical ventilatory support. Prospective, open-labeled interventional study. Study subjects' homes. Children, 1 month to 17 years old, dependent on at least 12 hr/d of transtracheal mechanical ventilatory support. Twelve weeks of an individualized diet modified to deliver energy at 90-110% of measured energy expenditure and protein intake per age-based guidelines. During a multidisciplinary home visit, we obtained baseline values of height and weight, lean body mass percent by bioelectrical impedance analysis, actual energy and protein intake by food record, and measured energy expenditure by indirect calorimetry. An individualized diet was then prescribed to optimize energy and protein intake. After 12 weeks on this interventional diet, we evaluated changes in weight, height, lean body mass percent, minute ventilation, and volumetric CO2 production. Sixteen subjects, mean age 9.3 years (SD, 4.9), eight male, completed the study. For the diet intervention, a majority of subjects required a change in energy and protein prescription. The mean percentage of energy delivered as carbohydrate was significantly decreased, 51.7% at baseline versus 48.2% at follow-up, p = 0.009. Mean height and weight increased on the modified diet. Mean lean body mass percent increased from 58.3% to 61.8%. Minute ventilation was significantly lower (0.18 L/min/kg vs 0.15 L/min/kg; p = 0.04), and we observed a trend toward lower volumetric CO2 production (5.4 mL/min/kg vs 5.3 mL/min/kg; p = 0.06) after 12 weeks on the interventional diet. Individualized diet modification is feasible and associated with a significant decrease in minute ventilation, a trend toward significant reduction in CO2 production, and improved body composition in children on long-term mechanical ventilation. Optimization of respiratory variables and lean body mass by diet modification may benefit children with respiratory insufficiency in the ICU.

Effect of an alternating electric field on the polluting emission from propane flame.

NASA Astrophysics Data System (ADS)

Ukradiga, I.; Turlajs, D.; Purmals, M.; Barmina, I.; Zake, M.

2001-12-01

The experimental investigations of the AC field effect on the propane combustion and processes that cause the formation of polluting emissions (NO_x, CO, CO_2) are performed. The AC-enhanced variations of the temperature and composition of polluting emissions are studied for the fuel-rich and fuel-lean conditions of the flame core. The results show that the AC field-enhanced mixing of the fuel-rich core with the surrounding air coflow enhances the propane combustion with increase in the mass fraction of NO_x and CO_2 in the products. The reverse field effect on the composition of polluting emissions is observed under the fuel-lean conditions in the flame core. The field-enhanced CO_2 destruction is registered when the applied voltage increase. The destruction of CO_2 leads to a correlating increase in the mass fraction of CO in the products and enhances the process of NO_x formation within the limit of the fuel lean and low temperature combustion. Figs 11, Refs 18.

Performance of a Model Rich Burn-quick Mix-lean Burn Combustor at Elevated Temperature and Pressure

NASA Technical Reports Server (NTRS)

Peterson, Christopher O.; Sowa, William A.; Samuelsen, G. S.

2002-01-01

As interest in pollutant emission from stationary and aero-engine gas turbines increases, combustor engineers must consider various configurations. One configuration of increasing interest is the staged, rich burn - quick mix - lean burn (RQL) combustor. This report summarizes an investigation conducted in a recently developed high pressure gas turbine combustor facility. The model RQL combustor was plenum fed and modular in design. The fuel used for this study is Jet-A which was injected from a simplex atomizer. Emission (CO2, CO, O2, UHC, NOx) measurements were obtained using a stationary exit plane water-cooled probe and a traversing water-cooled probe which sampled from the rich zone exit and the lean zone entrance. The RQL combustor was operated at inlet temperatures ranging from 367 to 700 K, pressures ranging from 200 to 1000 kPa, and combustor reference velocities ranging from 10 to 20 m/s. Variations were also made in the rich zone and lean zone equivalence ratios. Several significant trends were observed. NOx production increased with reaction temperature, lean zone equivalence ratio and residence time and decreased with increased rich zone equivalence ratio. NOx production in the model RQL combustor increased to the 0.4 power with increased pressure. This correlation, compared to those obtained for non-staged combustors (0.5 to 0.7), suggests a reduced dependence on NOx on pressure for staged combustors. Emissions profiles suggest that rich zone mixing is not uniform and that the rich zone contributes on the order of 16 percent to the total NOx produced.

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.

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

Romm, J.J.

Many American companies have found that saving energy and cutting pollution dramatically improves the bottom line. But beyond these gains, businesses that launch energy efficiency programs to save money are often astonished to discover unforeseen benefits: energy efficient lighting, heating, cooling, motors, and industrial processes can increase worker productivity, decrease absenteeism, and improve the quality of work performed. Profits created by the jump in worker productivity can exceed energy savings by a factor of ten. Energy efficiency and pollution prevention represent the next wave in manufacturing, following the quality revolution launched by the Japanese in the 1960s. Unless America leadsmore » the lean and clean revolution, economic health will be undermined as other countries develop clean processes and products and US companies suffer competitively. Also, developing countries will leapfrog their wasteful model and buy products and manufacturing processes from foreign firms already practicing lean and clean.« less

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.

Effect of Alloying Type and Lean Sintering Atmosphere on the Performance of PM Components

NASA Astrophysics Data System (ADS)

Sundaram, M. Vattur; Shvab, R.; Millot, S.; Hryha, E.; Nyborg, L.

2017-12-01

In order to be cost effective and to meet increasing performance demands, powder metallurgy steel components require continuous improvement in terms of materials and process development. This study demonstrates the feasibility of manufacturing structural components using two different alloys systems, i.e. lean Cr-prealloyed and diffusion bonded water atomised powders with different processing conditions. The components were sintered at two different temperatures, i.e. 1120 and 1250 °C for 30 minutes in three different atmospheres: vacuum, N2- 10%H2 atmosphere as well as lean N2-5%H2-0.5%CO-(0.1-0.4)%CH4 sintering atmosphere. Components after sintering were further processed by either low pressure carburizing, sinterhardening or case hardening. All trials were performed in the industrial furnaces to simulate the actual production of the components. Microstructure, fractography, apparent and micro hardness analyses were performed close to the surface and in the middle of the sample to characterize the degree of sintering (temperature and atmosphere) and the effect of heat treatment. In all cases, components possess mostly martensitic microstructure with a few bainitic regions. The fracture surface shows well developed sinter necks. Inter- and trans-granular ductile and cleavage fracture modes are dominant and their fraction is determined by the alloy and processing route.

Organisational readiness and Lean Thinking implementation: findings from three emergency department case studies in New Zealand.

PubMed

Rees, Gareth H

2014-01-01

This paper describes and contrasts the implementation of Lean Thinking – a quality methodology that emphasises waste reduction and performing at higher levels of productivity with the same or less resources – into New Zealand's healthcare system. As the field is relatively new, three literature-based exemplar cases were developed to provide an analysis framework to analyse the three New Zealand research sites, which had activities, teamwork, leadership and sustainability as its core themes. Each research site's case was developed from primary data gathered through interviews, augmented by secondary data from project reports, District Health Board websites and media stories. The results highlight the benefits of a supportive quality-focussed organisational culture, executive management involvement and cross-functional teams as enablers. Further, work intensification and workplace resistance were also evident in varying levels within the sites. The study, while reiterating the problems of introducing quality methods from other domains into healthcare, presents the New Zealand context and reinforces that organisational preparedness as a significant factor which contributes to implementation success. This study goes beyond investigations of the use of Lean tools, changing improvement metrics and descriptive statistics to identify the contexts and variables which surround quality and process improvement implementations. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

A prescription for Lean healthcare.

PubMed

Wood, David

2014-01-01

The adoption of Lean in the healthcare industry has been an important advancement, and not just for healthcare management. Evidence suggests that Lean can improve labour and capital efficiencies, reduce the throughput time for patients and enhance the quality of care. However, the adoption of Lean has generated large variations in results and even wider-ranging suggestions on how to implement Lean in a healthcare setting. In this article, the author examines three very similar hospitals that implemented Lean in the emergency department during the same time. Through an examination of longitudinal data and a collection of unstructured interviews, the author found that implementation does make a substantial difference to long-term results. Although the presence of strong and persistent leadership can have favourable results on performance in the short term, these performance improvements are not sustainable. To have a long-term impact, healthcare providers need to engage all of the stakeholders in the healthcare system and create a culture that is continuously focused on the improvement of the patient healthcare experience. Copyright © 2014 Longwoods Publishing.

Obesity-stimulated aldosterone release is not related to an S1P-dependent mechanism.

PubMed

Werth, Stephan; Müller-Fielitz, Helge; Raasch, Walter

2017-12-01

Aldosterone has been identified as an important factor in obesity-associated hypertension. Here, we investigated whether sphingosine-1-phosphate (S1P), which has previously been linked to obesity, increases aldosterone release. S1P-induced aldosterone release was determined in NCI H295R cells in the presence of S1P receptor (S1PR) antagonists. In vivo release of S1P (100-300 µg/kg bw ) was investigated in pithed, lean Sprague Dawley (SD) rats, diet-obese spontaneous hypertensive rats (SHRs), as well as in lean or obese Zucker rats. Aldosterone secretion was increased in NCI H295R cells by S1P, the selective S1PR1 agonist SEW2871 and the selective S1PR2 antagonist JTE013. Treatment with the S1PR1 antagonist W146 or fingolimod and the S1PR1/3 antagonist VPbib2319 decreased baseline and/or S1P-stimulated aldosterone release. Compared to saline-treated SD rats, plasma aldosterone increased by ~50 pg/mL after infusing S1P. Baseline levels of S1P and aldosterone were higher in obese than in lean SHRs. Adrenal S1PR expression did not differ between chow- or CD-fed rats that had the highest S1PR1 and lowest S1PR4 levels. S1P induced a short-lasting increase in plasma aldosterone in obese, but not in lean SHRs. However, 2-ANOVA did not demonstrate any difference between lean and obese rats. S1P-induced aldosterone release was also similar between obese and lean Zucker rats. We conclude that S1P is a local regulator of aldosterone production. S1PR1 agonism induces an increase in aldosterone secretion, while stimulating adrenal S1PR2 receptor suppresses aldosterone production. A significant role of S1P in influencing aldosterone secretion in states of obesity seems unlikely. © 2017 Society for Endocrinology.

Assessment of adult body composition using bioelectrical impedance: comparison of researcher calculated to machine outputted values.

PubMed

Franco-Villoria, Maria; Wright, Charlotte M; McColl, John H; Sherriff, Andrea; Pearce, Mark S

2016-01-07

To explore the usefulness of Bioelectrical Impedance Analysis (BIA) for general use by identifying best-evidenced formulae to calculate lean and fat mass, comparing these to historical gold standard data and comparing these results with machine-generated output. In addition, we explored how to best to adjust lean and fat estimates for height and how these overlapped with body mass index (BMI). Cross-sectional observational study within population representative cohort study. Urban community, North East England Sample of 506 mothers of children aged 7-8 years, mean age 36.3 years. Participants were measured at a home visit using a portable height measure and leg-to-leg BIA machine (Tanita TBF-300MA). Height, weight, bioelectrical impedance (BIA). Lean and fat mass calculated using best-evidenced published formulae as well as machine-calculated lean and fat mass data. Estimates of lean mass were similar to historical results using gold standard methods. When compared with the machine-generated values, there were wide limits of agreement for fat mass and a large relative bias for lean that varied with size. Lean and fat residuals adjusted for height differed little from indices of lean (or fat)/height(2). Of 112 women with BMI >30 kg/m(2), 100 (91%) also had high fat, but of the 16 with low BMI (<19 kg/m(2)) only 5 (31%) also had low fat. Lean and fat mass calculated from BIA using published formulae produces plausible values and demonstrate good concordance between high BMI and high fat, but these differ substantially from the machine-generated values. Bioelectrical impedance can supply a robust and useful field measure of body composition, so long as the machine-generated output is not used. 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/

Applying value stream mapping techniques to eliminate non-value-added waste for the procurement of endovascular stents.

PubMed

Teichgräber, Ulf K; de Bucourt, Maximilian

2012-01-01

OJECTIVES: To eliminate non-value-adding (NVA) waste for the procurement of endovascular stents in interventional radiology services by applying value stream mapping (VSM). The Lean manufacturing technique was used to analyze the process of material and information flow currently required to direct endovascular stents from external suppliers to patients. Based on a decision point analysis for the procurement of stents in the hospital, a present state VSM was drawn. After assessment of the current status VSM and progressive elimination of unnecessary NVA waste, a future state VSM was drawn. The current state VSM demonstrated that out of 13 processes for the procurement of stents only 2 processes were value-adding. Out of the NVA processes 5 processes were unnecessary NVA activities, which could be eliminated. The decision point analysis demonstrated that the procurement of stents was mainly a forecast driven push system. The future state VSM applies a pull inventory control system to trigger the movement of a unit after withdrawal by using a consignment stock. VSM is a visualization tool for the supply chain and value stream, based on the Toyota Production System and greatly assists in successfully implementing a Lean system. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

LPG gaseous phase electronic port injection on performance, emission and combustion characteristics of Lean Burn SI Engine

NASA Astrophysics Data System (ADS)

Bhasker J, Pradeep; E, Porpatham

2016-08-01

Gaseous fuels have always been established as an assuring way to lessen emissions in Spark Ignition engines. In particular, LPG resolved to be an affirmative fuel for SI engines because of their efficient combustion properties, lower emissions and higher knock resistance. This paper investigates performance, emission and combustion characteristics of a microcontroller based electronic LPG gaseous phase port injection system. Experiments were carried out in a single cylinder diesel engine altered to behave as SI engine with LPG as fuel at a compression ratio of 10.5:1. The engine was regulated at 1500 rpm at a throttle position of 20% at diverse equivalence ratios. The test results were compared with that of the carburetion system. The results showed that there was an increase in brake power output and brake thermal efficiency with LPG gas phase injection. There was an appreciable extension in the lean limit of operation and maximum brake power output under lean conditions. LPG injection technique significantly reduces hydrocarbon and carbon monoxide emissions. Also, it extremely enhances the rate of combustion and helps in extending the lean limit of LPG. There was a minimal increase of NOx emissions over the lean operating range due to higher temperature. On the whole it is concluded that port injection of LPG is best suitable in terms of performance and emission for LPG fuelled lean burn SI engine.

Fetuin-A levels in lean and obese women with polycystic ovary syndrome.

PubMed

Kozakowski, Jarosław; Jeske, Wojciech; Zgliczyński, Wojciech

2014-01-01

The aim of this study was to estimate serum fetuin-A levels in lean and obese women with polycystic ovary syndrome (PCOS) and to find possible relationships between fetuin-A, metabolic factors and androgens in these patients. In 25 lean (18-38 years, BMI 17.5-25.0 kg/m2) and 15 obese women (20-41 years, BMI 28.1-53.2 kg/m2) with PCOS, anthropometric indices and body composition were measured. Fasting serum fetuin-A, adiponectin, leptin, glucose, lipids, hsCRP, insulin, androgens and SHGB levels were estimated. There was no significant difference in serum fetuin-A levels between lean and obese patients: 0.54 ± 0.13 g/L and 0.60 ± 0.14 g/L, respectively. We noted a correlation between BMI and leptin levels (r = 0.88; p < 0.0001) and a nearly significant negative correlation between BMI and adiponectin levels (r = -0.53; p = 0.11) in all subjects. In lean patients, we found a correlation between fetuin-A levels and ALT activity (r = 0.44; p < 0.05). In all participants, fetuin-A correlated directly with DHEA-S levels (r = 0.44; p < 0.03). Serum fetuin-A levels were similar in lean and obese women with PCOS. We found an association between fetuin-A levels and ALT activity in lean patients and between fetuin-A levels and DHEA-S in all women. The role of fetuin-A in the mechanisms of insulin resistance, and its potential impact on androgenic hormones production in women with PCOS, need to be tested in further studies.

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.

Mechanism study on pressure fluctuation of pump-turbine runner with large blade lean angle

NASA Astrophysics Data System (ADS)

Yulin, Fan; Xuhe, Wang; Baoshan, Zhu; Dongyue, Zhou; Xijun, Zhou

2016-11-01

Excessive pressure fluctuations in the vaneless space can cause mechanical vibration and even mechanical failures in pump-turbine operation. Mechanism studies on the pressure fluctuations and optimization design of blade geometry to reduce the pressure fluctuations have important significance in industrial production. In the present paper, two pump-turbine runners with big positive and negative blade lean angle were designed by using a multiobjective design strategy. Model test showed that the runner with negative blade lean angle not only had better power performance, but also had lower pressure fluctuation than the runner with positive blade lean angle. In order to figure out the mechanism of pressure fluctuation reduction in the vaneless;jik8space, full passage model for both runners were built and transient CFD computations were conducted to simulate the flow states inside the channel. Detailed flow field analyses indicated that the difference of low-pressure area in the trailing edge of blade pressure side were the main causes of pressure fluctuation reduction in the vaneless space.

Real-Time Culture Change Improves Lean Success: Sequenced Culture Change Gets Failing Grades.

PubMed

Kusy, Mitchell; Diamond, Marty; Vrchota, Scott

2015-01-01

Success with the Lean management system is rooted in a culture of stakeholder engagement and commitment. Unfortunately, many leaders view Lean as an "add-on" tool instead of one that requires a new way of thinking and approaching culture. This article addresses the "why, how, and what" to promote a Lean culture that works. We present a five-phased approach grounded in evidence-based practices of real-time culture change. We further help healthcare leaders understand the differences between traditional "sequenced" approaches to culture change and "real-time" methods--and why these real-time practices are more sustainable and ultimately more successful than traditional culture change methods.

Passive SCR for lean gasoline NO X control: Engine-based strategies to minimize fuel penalty associated with catalytic NH 3 generation

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

Prikhodko, Vitaly Y.; Parks, James E.; Pihl, Josh A.

Lean gasoline engines offer greater fuel economy than common stoichiometric gasoline engines. However, excess oxygen prevents the use of the current three-way catalyst (TWC) to control nitrogen oxide (NO X) emissions in lean exhaust. A passive SCR concept, introduced by General Motors Global R&D, makes use of a TWC that is already onboard to generate NH 3 under slightly rich conditions, which is stored on the downstream SCR. The stored NH 3 is then used to reduce NO X emissions when the engine switches to lean operation. In this work, the effect of engine parameters, such as air-fuel equivalence ratiomore » and spark timing, on NH 3 generation over a commercial Pd-only TWC with no dedicated oxygen storage component was evaluated on a 2.0-liter BMW lean burn gasoline direct injection engine. NO X reduction, NH 3 formation, and reductant utilization processes were evaluated, and fuel efficiency was assessed and compared to the stoichiometric engine operation case. We found air-fuel equivalence ratio to be one of the most important parameters in controlling the NH 3 production; however, the rich operation necessary for NH 3 production results in a fuel consumption penalty. The fuel penalty can be minimized by adjusting spark timing to increase rich-phase engine out NO X emissions and, thereby, NH 3 levels. Additionally, higher engine out NO X during engine load increase to simulate acceleration resulted in additional fuel savings. Ultimately, a 10% fuel consumption benefit was achieved with the passive SCR approach by optimizing rich air-fuel equivalence ratio and spark timing while also utilizing acceleration load conditions.« less

Passive SCR for lean gasoline NO X control: Engine-based strategies to minimize fuel penalty associated with catalytic NH 3 generation

DOE PAGES

Prikhodko, Vitaly Y.; Parks, James E.; Pihl, Josh A.; ...

2016-02-18

Lean gasoline engines offer greater fuel economy than common stoichiometric gasoline engines. However, excess oxygen prevents the use of the current three-way catalyst (TWC) to control nitrogen oxide (NO X) emissions in lean exhaust. A passive SCR concept, introduced by General Motors Global R&D, makes use of a TWC that is already onboard to generate NH 3 under slightly rich conditions, which is stored on the downstream SCR. The stored NH 3 is then used to reduce NO X emissions when the engine switches to lean operation. In this work, the effect of engine parameters, such as air-fuel equivalence ratiomore » and spark timing, on NH 3 generation over a commercial Pd-only TWC with no dedicated oxygen storage component was evaluated on a 2.0-liter BMW lean burn gasoline direct injection engine. NO X reduction, NH 3 formation, and reductant utilization processes were evaluated, and fuel efficiency was assessed and compared to the stoichiometric engine operation case. We found air-fuel equivalence ratio to be one of the most important parameters in controlling the NH 3 production; however, the rich operation necessary for NH 3 production results in a fuel consumption penalty. The fuel penalty can be minimized by adjusting spark timing to increase rich-phase engine out NO X emissions and, thereby, NH 3 levels. Additionally, higher engine out NO X during engine load increase to simulate acceleration resulted in additional fuel savings. Ultimately, a 10% fuel consumption benefit was achieved with the passive SCR approach by optimizing rich air-fuel equivalence ratio and spark timing while also utilizing acceleration load conditions.« less

Intelligent Engine Systems: Alternate Fuels Evaluation

NASA Technical Reports Server (NTRS)

Ballal, Dilip

2008-01-01

The performance and gaseous emissions were measured for a well-stirred reactor operating under lean conditions for two fuels: JP8 and a synthetic Fisher-Tropsch fuel over a range of equivalence ratios from 0.6 down to the lean blowout. The lean blowout characteristics were determined in LBO experiments at loading parameter values from 0.7 to 1.4. The lean blowout characteristics were then explored under higher loading conditions by simulating higher altitude operation with the use of nitrogen as a dilution gas for the air stream. The experiments showed that: (1) The lean blowout characteristics for the two fuels were close under both low loading and high loading conditions. (2) The combustion temperatures and observed combustion efficiencies were similar for the two fuels. (3) The gaseous emissions were similar for the two fuels and the differences in the H2O and CO2 emissions appear to be directly relatable to the C/H ratio for the fuels.

The Influencing Factor Analysis on the Performance Evaluation of Assembly Line Balancing Problem Level 1 (SALBP-1) Based on ANOVA Method

NASA Astrophysics Data System (ADS)

Chen, Jie; Hu, Jiangnan

2017-06-01

Industry 4.0 and lean production has become the focus of manufacturing. A current issue is to analyse the performance of the assembly line balancing. This study focus on distinguishing the factors influencing the assembly line balancing. The one-way ANOVA method is applied to explore the significant degree of distinguished factors. And regression model is built to find key points. The maximal task time (tmax ), the quantity of tasks (n), and degree of convergence of precedence graph (conv) are critical for the performance of assembly line balancing. The conclusion will do a favor to the lean production in the manufacturing.

Cycle time reduction using lean six sigma in make-to-order (MTO) environment: Conceptual framework

NASA Astrophysics Data System (ADS)

Man, Siti Mariam; Zain, Zakiyah; Nawawi, Mohd Kamal Mohd

2015-12-01

This paper outlines the framework for application of lean six sigma (LSS) methodology to improve semiconductor assembly cycle time in a make-to-order (MTO) business environment. The cycle time reduction is the prime objective in the context of an overall productivity improvement particularly in the MTO environment. The interaction of the production rate and cycle time is described, while the emphasis is on Define-Measure-Analyze-Improve-Control (DMAIC) and Plan-Do-Check-Act (PDCA) activities. A framework for the conceptual understanding is provided along with practical implementation issues. A relevant measure for the degree of flexibility (DOF) in the context of quick setup is also discussed.

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.

Altered cortisol metabolism in polycystic ovary syndrome: insulin enhances 5alpha-reduction but not the elevated adrenal steroid production rates.

PubMed

Tsilchorozidou, Tasoula; Honour, John W; Conway, Gerard S

2003-12-01

Androgen excess in women with polycystic ovary syndrome (PCOS) may be ovarian and/or adrenal in origin, and one proposed contributing mechanism is altered cortisol metabolism. Increased peripheral metabolism of cortisol may occur by enhanced inactivation of cortisol by 5alpha-reductase (5alpha-R) or impaired reactivation of cortisol from cortisone by 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD1) resulting in decreased negative feedback suppression of ACTH secretion maintaining normal plasma cortisol concentrations at the expense of androgen excess. We have tested whether any enzyme dysregulation was related to circulating insulin or androgen concentrations in women with PCOS and have sought to clarify their relationship with obesity. First, to avoid obesity-related effects on cortisol metabolism, 18 lean women with PCOS were compared with 19 lean controls who were closely matched for body mass index (BMI). Second, the impact of obesity was studied in a cross-section of 42 PCOS women of a broad range of BMI. We measured 24-h urinary excretion of steroid metabolites by gas chromatography/mass spectrometry and fasting metabolic and hormone profiles. Urinary excretion of androgens [androsterone (P = 0.003), etiocholanolone (P = 0.02), and C19 steroid sulfates (P = 0.009)], cortisone metabolites [tetrahydrocortisone (THE) (P = 0.02), alpha-cortolone (P < 0.001), beta-cortol + beta-cortolone (P < 0.001), cortolones (P < 0.001), and E metabolites (P < 0.001)], and TCM (P = 0.002) were raised in lean PCOS subjects when compared with controls. A significantly higher 5alpha-tetrahydrocortisol (5alpha-THF)/5beta-THF ratio (P = 0.04) and a significantly lower alpha-THF + THF + alpha-cortol/THE + cortolones ratio (P = 0.01) were found in lean PCOS women compared with lean controls, indicating both enhanced 5alpha-R and reduced 11beta-HSD1 activities. A decreased THE/cortolones ratio (P = 0.03) was also found in lean PCOS women compared with lean controls, indicating increased 20 alpha/beta-HSD activity. In the group of 42 PCOS subjects, measures of 5alpha/5beta reduction were positively correlated with the homeostasis model insulin resistance index (HOMA-R): alpha-THF/THF and HOMA-R (r = 0.34; P = 0.03), androsterone/etiocholanolone and HOMA-R (r = 0.32; P = 0.04), and total 5alpha /total 5beta and HOMA-R (r = 0.37; P = 0.02). A positive correlation was also found between measures of 5alpha-R and BMI (r = 0.37; P = 0.02). No correlation was found between measures of 11beta-HSD1 activity and indices of insulin sensitivity or BMI. We have demonstrated that there is an increased production rate of cortisol and androgens as measured in vivo in lean PCOS women. Insulin seems to enhance 5alpha reduction of steroids in PCOS but was not associated with the elevated cortisol production rate. The changes in 5alpha-R, 11beta-HSD1, and 20alpha/beta-HSD enzyme activities observed in PCOS may contribute to the increased production rates of cortisol and androgens, supporting the concept of a widespread dysregulation of steroid metabolism. This dysregulation does not seem to be the primary cause of PCOS because no correlation was found between serum androgen levels or urinary excretion of androgens with measurements of either 5alpha-R or 11beta-HSD1 activities.

Feasibility study for converting traditional line assembly into work cells for termination of fiber optics cable

NASA Astrophysics Data System (ADS)

Caldeira, Rylan; Honnungar, Sunilkumar

2018-04-01

Most of small to medium industries tend to follow traditional systems of manufacturing which aims at maximum resource utilization irrespective of giving attention to customers volatile demand. In recent times manufacturing is being shifted to be consumers centered, with intense competition among industries to satisfy the customer needs in the required quantity and at the right time. To achieve this, companies investigate the possibility of implementation of cellular manufacturing which is characterized by high variety with optimum usage of resources. Cellular layout coupled with the application of lean methodology, places focus on the production process rather than the production methods so as to identify the wastage and apply methods to further improve productivity.

Meat quality and health implications of organic and conventional beef production.

PubMed

Kamihiro, S; Stergiadis, S; Leifert, C; Eyre, M D; Butler, G

2015-02-01

Recommendation to reduce fat consumption from ruminant meat does not consider the contribution of nutritionally beneficial fatty acids in lean beef. Here we report effects of production system (organic vs conventional) and finishing season on meat and fat quality of sirloin steaks from retail outlets and simulated fatty acid intakes by consumers. There was little difference in meat quality (pH, shear force and colour), but the fat profiles varied considerably between production systems and season. Meat fat from organic and summer finished cattle contained higher concentrations of conjugated linoleic acid, its precursor vaccenic acid and individual omega-3 fatty acids and had a lower ratio of omega-6 to omega-3 fatty acids compared with non-organic and winter finished cattle respectively. The fat profile from summer finished organic beef aligns better to recommended dietary guideline including those for long chain omega-3 fatty acids compared with that from winter finished, non-organic steak.

Exaggerated haemodynamic and neural responses to involuntary contractions induced by whole-body vibration in normotensive obese versus lean women.

PubMed

Dipla, Konstantina; Kousoula, Dimitra; Zafeiridis, Andreas; Karatrantou, Konstantina; Nikolaidis, Michalis G; Kyparos, Antonios; Gerodimos, Vassilis; Vrabas, Ioannis S

2016-06-01

What is the central question of this study? In obesity, the exaggerated blood pressure response to voluntary exercise is linked to hypertension, yet the mechanisms are not fully elucidated. We examined whether involuntary contractions elicit greater haemodynamic responses and altered neural control of blood pressure in normotensive obese versus lean women. What is the main finding and its importance? During involuntary contractions induced by whole-body vibration, there were augmented blood pressure and spontaneous baroreflex responses in obese compared with lean women. This finding is suggestive of an overactive mechanoreflex in the exercise-induced hypertensive response in obesity. Passive contractions did not elicit differential heart rate responses in obese compared with lean women, implying other mechanisms for the blunted heart rate response reported during voluntary exercise in obesity. In obesity, the exaggerated blood pressure (BP) response to exercise is linked to hypertension, yet the mechanisms are not fully elucidated. In this study, we examined whether involuntary mechanical oscillations, induced by whole-body vibration (WBV), elicit greater haemodynamic responses and altered neural control of BP in obese versus lean women. Twenty-two normotensive, premenopausal women (12 lean and 10 obese) randomly underwent a passive WBV (25 Hz) and a control protocol (similar posture without WVB). Beat-by-beat BP, heart rate, stroke volume, systemic vascular resistance, cardiac output, parasympathetic output (evaluated by heart rate variability) and spontaneous baroreceptor sensitivity (sBRS) were assessed. We found that during WBV, obese women exhibited an augmented systolic BP response compared with lean women that was correlated with body fat percentage (r = 0.77; P < 0.05). The exaggerated BP rise was driven mainly by the greater increase in cardiac output index in obese versus lean women, associated with a greater stroke volume index in obese women. Involuntary contractions did not elicit a differential magnitude of responses in heart rate, heart rate variability indices and systemic vascular resistance in obese versus lean women; however, they did result in greater sBRS responses (P < 0.05) in obese women. In conclusion, involuntary contractions elicited an augmented BP and sBRS response in normotensive obese versus lean women. The greater elevations in circulatory haemodynamics in obese women are suggestive of an overactive mechanoreflex in the exercise-induced hypertensive response in obesity. © 2016 The Authors. Experimental Physiology © 2016 The Physiological Society.

Applying the Principles of Lean Production to Gastrointestinal Biopsy Handling: From the Factory Floor to the Anatomic Pathology Laboratory.

PubMed

Sugianto, Jessica Z; Stewart, Brian; Ambruzs, Josephine M; Arista, Amanda; Park, Jason Y; Cope-Yokoyama, Sandy; Luu, Hung S

2015-01-01

To implement Lean principles to accommodate expanding volumes of gastrointestinal biopsies and to improve laboratory processes overall. Our continuous improvement (kaizen) project analyzed the current state for gastrointestinal biopsy handling using value-stream mapping for specimens obtained at a 487-bed tertiary care pediatric hospital in Dallas, Texas. We identified non-value-added time within the workflow process, from receipt of the specimen in the histology laboratory to the delivery of slides and paperwork to the pathologist. To eliminate non-value-added steps, we implemented the changes depicted in a revised-state value-stream map. Current-state value-stream mapping identified a total specimen processing time of 507 minutes, of which 358 minutes were non-value-added. This translated to a process cycle efficiency of 29%. Implementation of a revised-state value stream resulted in a total process time reduction to 238 minutes, of which 89 minutes were non-value-added, and an improved process cycle efficiency of 63%. Lean production principles of continuous improvement and waste elimination can be successfully implemented within the clinical laboratory.

Effect of cassava bioethanol by-product and crude palm oil in Brahman x Thai native yearling heifer cattle diets: II. Carcass characteristics and meat quality.

PubMed

Phoemchalard, Chirasak; Uriyapongson, Suthipong

2015-12-01

This experiment was conducted to determine the effects of cassava bioethanol by-product (CEP) and crude palm oil (CPO) on the carcass characteristics and meat quality of yearling heifer cattle. Eighteen crossbred Brahman × Thai heifers were randomly allotted to 2 × 3 factorial arrangement consisting of two levels of CEP (15 or 30 %, LCEP or HCEP) and 3 levels of CPO (0, 2, and 4 %). The results obtained showed that lean meat was greater (P < 0.05) in HCEP-fed cattle, but bone percentage and lean/bone ratio were less (P < 0.05) than LCEP-fed cattle. Carcass fat (P < 0.05) and fat content (P < 0.01) were significantly increased with levels of dietary CPO. Diets with 4 % CPO supplementation had better effects on redness (a*, P < 0.01) and chroma (C*, P < 0.001) values. In conclusion, up to 30 % CEP can be used to improve lean carcass and 4 % CPO can improve the redness of the meat.

Circadian rhythms of temperature and activity in obese and lean Zucker rats

NASA Technical Reports Server (NTRS)

Murakami, D. M.; Horwitz, B. A.; Fuller, C. A.

1995-01-01

The circadian timing system is important in the regulation of feeding and metabolism, both of which are aberrant in the obese Zucker rat. This study tested the hypothesis that these abnormalities involve a deficit in circadian regulation by examining the circadian rhythms of body temperature and activity in lean and obese Zucker rats exposed to normal light-dark cycles, constant light, and constant dark. Significant deficits in both daily mean and circadian amplitude of temperature and activity were found in obese Zucker female rats relative to lean controls in all lighting conditions. However, the circadian period of obese Zucker rats did not exhibit differences relative to lean controls in either of the constant lighting conditions. These results indicate that although the circadian regulation of temperature and activity in obese Zucker female rats is in fact depressed, obese rats do exhibit normal entrainment and pacemaker functions in the circadian timing system. The results suggest a deficit in the process that generates the amplitude of the circadian rhythm.

The effect of a high protein diet on leucine and alanine turnover in acid maltase deficiency.

PubMed Central

Umpleby, A M; Trend, P S; Chubb, D; Conaglen, J V; Williams, C D; Hesp, R; Scobie, I N; Wiles, C M; Spencer, G; Sönksen, P H

1989-01-01

Leucine and alanine production rate was measured in 5 patients with acid maltase deficiency in the postabsorptive state, following 6 months on a normal diet with placebo and 6 months on an isocaloric high protein diet (16-22% protein). Whole body leucine production rate, a measure of protein degradation, expressed in terms of lean body mass was significantly greater than in five control subjects. Following the high protein diet, leucine production rate was decreased in four of the five patients but this was not statistically significant. Alanine production rate expressed in terms of lean body mass was significantly greater than in control subjects. After the high protein diet, alanine production rate and concentration were significantly decreased (p less than 0.05). There were no significant improvements in any of the clinically relevant variables measured in these patients. It is possible that a larger increase in protein intake over a longer time period may have a clinical effect. PMID:2507747

Consumer Perception of Retail Pork Bacon Attributes Using Adaptive Choice-based Conjoint Analysis and Maximum Differential Scaling.

PubMed

McLean, K G; Hanson, D J; Jervis, S M; Drake, M A

2017-11-01

Bacon is one of the most recognizable consumer pork products and is differentiated by appearance, flavor, thickness, and several possible product claims. The objective of this study was to explore the attributes of retail bacon that influence consumers to purchase and consume bacon. An Adaptive Choice-Based Conjoint (ACBC) survey was designed for attributes of raw American-style bacon. An ACBC survey (N = 1410 consumers) and Kano questioning were applied to determine the key attributes that influenced consumer purchase. Attributes included package size, brand, thickness, label claims, flavor, price, and images of the bacon package displaying fat:lean ratio. Maximum Difference Scaling (MaxDiff) was used to rank appeal of 20 different bacon images with variable fat:lean ration and slice shape. The most important attribute for bacon purchase was price followed by fat:lean appearance and then flavor. Three consumer clusters were identified with distinct preferences. For 2 clusters, price was not the primary attribute. Understanding preferences of distinct consumer clusters will enable manufacturers to target consumers and make more appealing bacon. Adaptive Choice-Based Conjoint (ACBC) is a research technique that allows consumers to react to assembled products and identify product attributes that they prefer. Kano questions allow researchers to look at the individual aspects of a product and understand consumer sentiment and expectations towards those product qualities while Maximum Difference scaling allows consumers to directly rank single attributes of a product relative to one another. A combination of these 3 approaches can provide key understandings on consumer perception of retail bacon allowing companies to optimize and maximize their development and advertising resources. © 2017 Institute of Food Technologists®.

[Work organisation improvement methods applied to activities of Blood Transfusion Establishments (BTE): Lean Manufacturing, VSM, 5S].

PubMed

Bertholey, F; Bourniquel, P; Rivery, E; Coudurier, N; Follea, G

2009-05-01

Continuous improvement of efficiency as well as new expectations from customers (quality and safety of blood products) and employees (working conditions) imply constant efforts in Blood Transfusion Establishments (BTE) to improve work organisations. The Lean method (from "Lean" meaning "thin") aims at identifying wastages in the process (overproduction, waiting, over-processing, inventory, transport, motion) and then reducing them in establishing a mapping of value chain (Value Stream Mapping). It consists in determining the added value of each step of the process from a customer perspective. Lean also consists in standardizing operations while implicating and responsabilizing all collaborators. The name 5S comes from the first letter of five operations of a Japanese management technique: to clear, rank, keep clean, standardize, make durable. The 5S method leads to develop the team working inducing an evolution of the way in the management is performed. The Lean VSM method has been applied to blood processing (component laboratory) in the Pays de la Loire BTE. The Lean 5S method has been applied to blood processing, quality control, purchasing, warehouse, human resources and quality assurance in the Rhône-Alpes BTE. The experience returns from both BTE shows that these methods allowed improving: (1) the processes and working conditions from a quality perspective, (2) the staff satisfaction, (3) the efficiency. These experiences, implemented in two BTE for different processes, confirm the applicability and usefulness of these methods to improve working organisations in BTE.

Internal combustion engine using premixed combustion of stratified charges

DOEpatents

Marriott, Craig D [Rochester Hills, MI; Reitz, Rolf D [Madison, WI

2003-12-30

During a combustion cycle, a first stoichiometrically lean fuel charge is injected well prior to top dead center, preferably during the intake stroke. This first fuel charge is substantially mixed with the combustion chamber air during subsequent motion of the piston towards top dead center. A subsequent fuel charge is then injected prior to top dead center to create a stratified, locally richer mixture (but still leaner than stoichiometric) within the combustion chamber. The locally rich region within the combustion chamber has sufficient fuel density to autoignite, and its self-ignition serves to activate ignition for the lean mixture existing within the remainder of the combustion chamber. Because the mixture within the combustion chamber is overall premixed and relatively lean, NO.sub.x and soot production are significantly diminished.

Exercise training prevents the attenuation of anesthetic pre-conditioning-mediated cardioprotection in diet-induced obese rats.

PubMed

Li, L; Meng, F; Li, N; Zhang, L; Wang, J; Wang, H; Li, D; Zhang, X; Dong, P; Chen, Y

2015-01-01

Obesity abolishes anesthetic pre-conditioning-induced cardioprotection due to impaired reactive oxygen species (ROS)-mediated adenosine monophosphate-activated protein kinase (AMPK) pathway, a consequence of increased basal myocardial oxidative stress. Exercise training has been shown to attenuate obesity-related oxidative stress. This study tests whether exercise training could normalize ROS-mediated AMPK pathway and prevent the attenuation of anesthetic pre-conditioning-induced cardioprotection in obesity. Male Sprague-Dawley rats were divided into lean rats fed with control diet and obese rats fed with high-fat diet. After 4 weeks of feeding, lean and obese rats were assigned to sedentary conditions or treadmill exercise for 8 weeks. There was no difference in infarct size between lean sedentary and obese sedentary rats after 25 min of myocardial ischemia followed by 120 min reperfusion. In lean rats, sevoflurane equally reduced infarct size in lean sedentary and lean exercise-trained rats. Molecular studies revealed that AMPK activity, endothelial nitric oxide synthase, and superoxide production measured at the end of ischemia in lean rats were increased in response to sevoflurane. In obese rats, sevoflurane increased the above molecular parameters and reduced infarct size in obese exercise-trained rats but not in obese sedentary rats. Additional study showed that obese exercise-trained rats had decreased basal oxidative stress than obese sedentary rats. The results indicate that exercise training can prevent the attenuation of anesthetic cardioprotection in obesity. Preventing the attenuation of this strategy may be associated with reduced basal oxidative stress and normalized ROS-mediated AMPK pathway, but the causal relationship remains to be determined. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Lean coding machine. Facilities target productivity and job satisfaction with coding automation.

PubMed

Rollins, Genna

2010-07-01

Facilities are turning to coding automation to help manage the volume of electronic documentation, streamlining workflow, boosting productivity, and increasing job satisfaction. As EHR adoption increases, computer-assisted coding may become a necessity, not an option.

Ob/ob Mouse Livers Show Decreased Oxidative Phosphorylation Efficiencies and Anaerobic Capacities after Cold Ischemia

PubMed Central

Tagaloa, Sherry; Zhang, Linda; Dare, Anna J.; MacDonald, Julia R.; Yeong, Mee-Ling; Bartlett, Adam S. J. R.; Phillips, Anthony R. J.

2014-01-01

Background Hepatic steatosis is a major risk factor for graft failure in liver transplantation. Hepatic steatosis shows a greater negative influence on graft function following prolonged cold ischaemia. As the impact of steatosis on hepatocyte metabolism during extended cold ischaemia is not well-described, we compared markers of metabolic capacity and mitochondrial function in steatotic and lean livers following clinically relevant durations of cold preservation. Methods Livers from 10-week old leptin-deficient obese (ob/ob, n = 9) and lean C57 mice (n = 9) were preserved in ice-cold University of Wisconsin solution. Liver mitochondrial function was then assessed using high resolution respirometry after 1.5, 3, 5, 8, 12, 16 and 24 hours of storage. Metabolic marker enzymes for anaerobiosis and mitochondrial mass were also measured in conjunction with non-bicarbonate tissue pH buffering capacity. Results Ob/ob and lean mice livers showed severe (>60%) macrovesicular and mild (<30%) microvesicular steatosis on Oil Red O staining, respectively. Ob/ob livers had lower baseline enzymatic complex I activity but similar adenosine triphosphate (ATP) levels compared to lean livers. During cold storage, the respiratory control ratio and complex I-fueled phosphorylation deteriorated approximately twice as fast in ob/ob livers compared to lean livers. Ob/ob livers also demonstrated decreased ATP production capacities at all time-points analyzed compared to lean livers. Ob/ob liver baseline lactate dehydrogenase activities and intrinsic non-bicarbonate buffering capacities were depressed by 60% and 40%, respectively compared to lean livers. Conclusions Steatotic livers have impaired baseline aerobic and anaerobic capacities compared to lean livers, and mitochondrial function indices decrease particularly from after 5 hours of cold preservation. These data provide a mechanistic basis for the clinical recommendation of shorter cold storage durations in steatotic donor livers. PMID:24956382

Experimental and Computational Study of Trapped Vortex Combustor Sector Rig with Tri-pass Diffuser

NASA Technical Reports Server (NTRS)

Hendricks, Robert C.; Shouse, D. T.; Roquemore, W. M.; Burrus, D. L.; Duncan, B. S.; Ryder, R. C.; Brankovic, A.; Liu, N.-S.; Gallagher, J. R.; Hendricks, J. A.

2001-01-01

The Trapped Vortex Combustor (TVC) potentially offers numerous operational advantages over current production gas turbine engine combustors. These include lower weight, lower pollutant emissions, effective flame stabilization, high combustion efficiency, excellent high altitude relight capability, and operation in the lean burn or RQL (Rich burn/Quick mix/Lean burn) modes of combustion. The present work describes the operational principles of the TVC, and provides detailed performance data on a configuration featuring a tri-pass diffusion system. Performance data include EINOx (NO(sub x) emission index) results for various fuel-air ratios and combustor residence times, combustion efficiency as a function of combustor residence time, and combustor lean blow-out (LBO) performance. Computational fluid dynamics (CFD) simulations using liquid spray droplet evaporation and combustion modeling are performed and related to flow structures observed in photographs of the combustor. The CFD results are used to understand the aerodynamics and combustion features under different fueling conditions. Performance data acquired to date are favorable in comparison to conventional gas turbine combustors. Further testing over a wider range of fuel-air ratios, fuel flow splits, and pressure ratios is in progress to explore the TVC performance. In addition, alternate configurations for the upstream pressure feed, including bi-pass diffusion schemes, as well as variations on the fuel injection patterns, are currently in test and evaluation phases.

Cycling peak power in obese and lean 6- to 8-year-old girls and boys.

PubMed

Aucouturier, Julien; Lazaar, Nordine; Doré, Eric; Meyer, Martine; Ratel, Sebastien; Duché, Pascale

2007-06-01

The purpose of this study was to investigate the possible effect of the difference in percentage body fat (%BF) and fat-free mass (FFM) on cycling peak power (CPP) in 6- to 8-year-old obese and lean untrained girls and boys. Obese (35 girls, 35 boys) and lean (35 girls, 35 boys) children were measured for obesity, %BF, calculated from skinfold measurements. FFM was calculated as body mass (BM) minus body fat. A force-velocity test on a cycle ergometer was used to measure CPP. CPP was related to anthropometric variables using standard and allometric models. CPP in absolute terms was higher in obese children than in lean children irrespective of gender. BM-related CPP was significantly lower in obese children than in lean ones, whereas no effect of obesity appeared on FFM-related CPP. Velocity at CPP (Vopt) was significantly lower and force at CPP (Fopt) was significantly higher in girls than in boys. Muscle power production was unaffected by obesity in children. Low BM-related CPP could explain the difficulty of taking up physical activities that are body-mass related in obese children. Gender difference for Vopt and Fopt shows that girls and boys may have different maturation patterns affecting CPP.

Lean Six Sigma: a new approach to the management of patients undergoing prosthetic hip replacement surgery.

PubMed

Improta, Giovanni; Balato, Giovanni; Romano, Maria; Carpentieri, Francesco; Bifulco, Paolo; Alessandro Russo, Mario; Rosa, Donato; Triassi, Maria; Cesarelli, Mario

2015-08-01

In 2012, health care spending in Italy reached €114.5 billion, accounting for 7.2% of the Gross Domestic Product (GDP) and 14.2% of total public spending. Therefore, reducing waste in health facilities could generate substantial cost savings. The objective of this study is to show that Lean Six Sigma represents an appropriate methodology for the development of a clinical pathway which allows to improve quality and to reduce costs in prosthetic hip replacement surgery. The methodology used for the development of a new clinical pathway was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC (Define, Measure, Analyse, Improve, Control) roadmap, characterized by five operational phases which make possible to reach fixed goals through a rigorous process of defining, measuring, analysing, improving and controlling business problems. The following project indicated several variables influencing the inappropriate prolongation of the length of stay for inpatient treatment and corrective actions were performed to improve the effectiveness and efficiency of the process of care. The average length of stay was reduced from 18.9 to 10.6 days (-44%). This article shows there is no trade-off between quality and costs: Lean Six Sigma improves quality and, at the same time, reduces costs. © 2015 John Wiley & Sons, Ltd.

NPITxt, a 21st-Century Reporting System: Engaging Residents in a Lean-Inspired Process.

PubMed

Raja, Pushpa V; Davis, Michael C; Bales, Alicia; Afsarmanesh, Nasim

2015-05-01

Operational waste, or workflow processes that do not add value, is a frustrating but nonetheless largely tolerated barrier to efficiency and morale for medical trainees. In this article, the authors tested a novel reporting system using several submission formats (text messaging, e-mail, Web form, mobile application) to allow residents to report various types of operational waste in real time. This system informally promoted "lean" principles of waste identification and continuous improvement. In all, 154 issues were submitted between March 30, 2011, and June 30, 2012, and categorized as closely as possible into lean categories of operational waste; 131 issues were completely addressed with the requested outcome partially or fully implemented or with successful clarification of existing policies. A real-time, voluntary reporting system can effectively capture trainee observations of waste in health care and training processes, give trainees a voice in a hierarchical system, and lead to meaningful operations improvement. © 2014 by the American College of Medical Quality.

Overview of the TriBITS Lifecycle Model: Lean/Agile Software Lifecycle Model for Research-based Computational Science and Engineering Software

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

Bartlett, Roscoe A; Heroux, Dr. Michael A; Willenbring, James

2012-01-01

Software lifecycles are becoming an increasingly important issue for computational science & 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 many CSE software projects thatmore » 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. Indeed this lifecycle process, if followed, will enable large-scale sustainable integration of many complex CSE software efforts across several institutions.« less

Effects of 2-AG on the reinforcing properties of wheel activity in obese and lean Zucker rats.

PubMed

Smith, Shilo L; Rasmussen, Erin B

2010-07-01

The endocannabinoid system plays a role in obesity, primarily by its role in food reward. Activity, also involved in obesity, seems to be at least partially controlled by the endocannabinoid system, but the relevant behavioral and neurochemical mechanisms have not been well established. This study represents an attempt to begin elucidating these mechanisms by examining the effects of an endogenous cannabinoid ligand, 2-arachidonoylglycerol (2-AG), on the reinforcing properties of exercise reinforcement in lean and obese Zucker rats. Ten obese and 10 lean Zucker rats pressed a locked door under a progressive ratio schedule of reinforcement that, when unlocked, provided access to a running wheel for 2-min periods. After baseline breakpoints were established, doses of 2-AG (0.3-3 mg/kg) were administered before experimental sessions. Obese rats exhibited lower breakpoints for wheel activity, lower response rates, and fewer revolutions compared with lean rats. 2-AG decreased breakpoints, response rates, and revolutions for obese rats, and revolutions only for lean rats. These data suggest that 2-AG may reduce the reinforcing properties of activity, and that obese Zuckers may show a greater sensitivity to 2-AG. The data also suggest that endocannabinoids may play a role in the reinforcing properties of exercise.

Axiomatic Design of a Framework for the Comprehensive Optimization of Patient Flows in Hospitals

PubMed Central

Matt, Dominik T.

2017-01-01

Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design. The demand for patient-oriented and efficient health services leads to use these methodologies to improve hospital processes. In the framework, patients with similar characteristics are clustered in families to achieve homogeneous flows through the value stream. An optimization checklist is outlined as the result of the mapping between Functional Requirements and Design Parameters, with the right sequence of the steps to optimize the patient flow according to the principles of Axiomatic Design. The Axiomatic Design-based top-down implementation of Health Care evidence, according to Lean principles, results in a holistic optimization of hospital patient flows, by reducing the complexity of the system. PMID:29065578

Examining the functionality of the DeLone and McLean information system success model as a framework for synthesis in nursing information and communication technology research.

PubMed

Booth, Richard G

2012-06-01

In this review, studies examining information and communication technology used by nurses in clinical practice were examined. Overall, a total of 39 studies were assessed spanning a time period from 1995 to 2008. The impacts of the various health information and communication technology evaluated by individual studies were synthesized using the DeLone and McLean's six-dimensional framework for evaluating information systems success (ie, System Quality, Information Quality, Service Quality, Use, User Satisfaction, and Net Benefits). Overall, the majority of researchers reported results related to the overall Net Benefits (positive, negative, and indifferent) of the health information and communication technology used by nurses. Attitudes and user satisfaction with technology were also commonly measured attributes. The current iteration of DeLone and McLean model is effective at synthesizing basic elements of health information and communication technology use by nurses. Regardless, the current model lacks the sociotechnical sensitivity to capture deeper nurse-technology relationalities. Limitations and recommendations are provided for researchers considering using the DeLone and McLean model for evaluating health information and communication technology used by nurses.

Axiomatic Design of a Framework for the Comprehensive Optimization of Patient Flows in Hospitals.

PubMed

Arcidiacono, Gabriele; Matt, Dominik T; Rauch, Erwin

2017-01-01

Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design. The demand for patient-oriented and efficient health services leads to use these methodologies to improve hospital processes. In the framework, patients with similar characteristics are clustered in families to achieve homogeneous flows through the value stream. An optimization checklist is outlined as the result of the mapping between Functional Requirements and Design Parameters, with the right sequence of the steps to optimize the patient flow according to the principles of Axiomatic Design. The Axiomatic Design-based top-down implementation of Health Care evidence, according to Lean principles, results in a holistic optimization of hospital patient flows, by reducing the complexity of the system.

Axiomatic Design of a Framework for the Comprehensive Optimization of Patient Flows in Hospitals

PubMed

Arcidiacono, Gabriele; Matt, Dominik T.; Rauch, Erwin

2017-01-01

Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design. The demand for patient-oriented and efficient health services leads to use these methodologies to improve hospital processes. In the framework, patients with similar characteristics are clustered in families to achieve homogeneous flows through the value stream. An optimization checklist is outlined as the result of the mapping between Functional Requirements and Design Parameters, with the right sequence of the steps to optimize the patient flow according to the principles of Axiomatic Design. The Axiomatic Design-based top-down implementation of Health Care evidence, according to Lean principles, results in a holistic optimization of hospital patient flows, by reducing the complexity of the system. © 2017 Gabriele Arcidiacono et al.

A Lean Six Sigma journey in radiology.

PubMed

Bucci, Ronald V; Musitano, Anne

2011-01-01

The department of radiology at Akron Children's Hospital embarked on a Lean Six Sigma mission as part of a hospital wide initiative to show increased customer satisfaction, reduce employee dissatisfaction and frustration, and decrease costs. Three processes that were addressed were reducing the MRI scheduling back-log, reconciling discrepancies in billing radiology procedures, and implementing a daily management system. Keys to success is that managers provide opportunities to openly communicate between department sections to break down barriers. Executive leaders must be engaged in Lean Six Sigma for the company to be successful.

The Strategic Value of HRD in Lean Strategy Implementation

ERIC Educational Resources Information Center

Alagaraja, Meera; Egan, Toby

2013-01-01

Central to the relevance of HRD is the inclusion of HRD professionals and functions in organizational strategy. Understanding how HRD units and professionals contribute to or hinder organizational strategy is important for the field. We describe an organizational case in which a systemic strategic initiative involving "Lean strategy" is deployed…

Increasing Operational Stability in Low NOX GT Combustor Using Fuel Rich Concentric Pilot Combustor

NASA Astrophysics Data System (ADS)

Levy, Yeshayahou; Erenburg, Vladimir; Sherbaum, Valery; Ovcharenko, Vitali; Rosentsvit, Leonid; Chudnovsky, Boris; Herszage, Amiel; Talanker, Alexander

2012-03-01

Lean combustion is a method in which combustion takes place under low equivalence ratio and relatively low combustion temperatures. As such, it has the potential to lower the effect of the relatively high activation energy nitrogen-oxygen reactions which are responsible for substantial NOX formation during combustion processes. However, lowering temperature reduces the reaction rate and deteriorates combustion stability. The objective of the present study is to reduce the lower equivalence ratio limit of the stable combustion operational boundary in lean Gas Turbine (GT) combustors while still maintaining combustion stability. A lean premixed gaseous combustor was equipped with a surrounding concentric pilot flame operating under rich conditions, thus generating a hot stream of combustion products with significant amount of reactive radicals. The main combustor's fuel-air composition was varied from stoichiometric to lean mixtures. The pilot's mixture composition was also varied by changing the air flow rate, within a limited rich mixtures range. The pilot fuel flow rate was always lower than five percent of the total fuel supply at the specific stage of the experiments.

Lean, Premixed-Prevaporized (LPP) combustor conceptual design study

NASA Technical Reports Server (NTRS)

Dickman, R. A.; Dodds, W. J.; Ekstedt, E. E.

1979-01-01

Four combustion systems were designed and sized for the energy efficient engine. A fifth combustor was designed for the cycle and envelope of the twin-spool, high bypass ratio, high pressure ratio turbofan engine. Emission levels, combustion performance, life, and reliability assessments were made for these five combustion systems. Results of these design studies indicate that cruise NOx emission can be reduced by the use of lean, premixed-prevaporaized combustion and airflow modulation.

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.

Subcutaneous and gonadal adipose tissue transcriptome differences in lean and obese female dogs.

PubMed

Grant, Ryan W; Vester Boler, Brittany M; Ridge, Tonya K; Graves, Thomas K; Swanson, Kelly S

2013-12-01

Canine obesity leads to shortened life span and increased disease incidence. Adipose tissue depots are known to have unique metabolic and gene expression profiles in rodents and humans, but few comparisons of depot gene expression have been performed in the dog. Using microarray technology, our objective was to identify differentially expressed genes and enriched functional pathways between subcutaneous and gonadal adipose of lean and obese dogs to better understand the pathogenesis of obesity in the dog. Because no depot × body weight status interactions were identified in the microarray data, depot differences were the primary focus. A total of 946 and 703 transcripts were differentially expressed (FDR P < 0.05) between gonadal and subcutaneous adipose tissue in obese and lean dogs respectively. Of the adipose depot-specific differences in gene expression, 162 were present in both lean and obese dogs, with the majority (85%) expressed in the same direction. Both lean and obese dog gene lists had enrichment of the complement and coagulation cascade and systemic lupus erythematosus pathways. Obese dogs had enrichment of lysosome, extracellular matrix-receptor interaction, renin-angiotensin system and hematopoietic cell lineage pathways. Lean dogs had enrichment of glutathione metabolism and synthesis and degradation of ketone bodies. We have identified a core set of genes differentially expressed between subcutaneous and gonadal adipose tissue in dogs regardless of body weight. These genes contribute to depot-specific differences in immune function, extracellular matrix remodeling and lysosomal function and may contribute to the physiological differences noted between depots. © 2013 The Authors, Animal Genetics © 2013 Stichting International Foundation for Animal Genetics.

Impulsive-choice patterns for food in genetically lean and obese Zucker rats

PubMed Central

Boomhower, Steven R.; Rasmussen, Erin B.; Doherty, Tiffany S.

2012-01-01

Behavioral-economic studies have shown that differences between lean and obese Zuckers in food consumption depend on the response requirement for food. Since a response requirement inherently increases the delay to reinforcement, differences in sensitivity to delay may also be a relevant mechanism of food consumption in the obese Zucker rat. Furthermore, the endocannabinoid neurotransmitter system has been implicated in impulsivity, but studies that attempt to characterize the effects of cannabinoid drugs (e.g., rimonabant) on impulsive choice may be limited by floor effects. The present study aimed to characterize impulsive-choice patterns for sucrose using an adjusting-delay procedure in genetically lean and obese Zuckers. Ten lean and ten obese Zucker rats chose between one lever that resulted in one pellet after a standard delay (either 1 s or 5 s) and a second lever that resulted in two or three pellets after an adjusting delay. After behavior stabilized under baseline, rimonabant (0–10 mg/kg) was administered prior to some choice sessions in the two-pellet condition. Under baseline, obese Zuckers made more impulsive choices than leans in three of the four standard-delay/pellet conditions. Additionally, in the 2-pellet condition, rimonabant increased impulsive choice in lean rats in the 1-s standard-delay condition; however, rimonabant decreased impulsive choice in obese rats in the 1-s and 5-s standard-delay conditions. These data suggest that genetic factors that influence impulsive choice are stronger in some choice conditions than others, and that the endocannabinoid system may be a relevant neuromechanism. PMID:23261877

Impulsive-choice patterns for food in genetically lean and obese Zucker rats.

PubMed

Boomhower, Steven R; Rasmussen, Erin B; Doherty, Tiffany S

2013-03-15

Behavioral-economic studies have shown that differences between lean and obese Zuckers in food consumption depend on the response requirement for food. Since a response requirement inherently increases the delay to reinforcement, differences in sensitivity to delay may also be a relevant mechanism of food consumption in the obese Zucker rat. Furthermore, the endocannabinoid neurotransmitter system has been implicated in impulsivity, but studies that attempt to characterize the effects of cannabinoid drugs (e.g., rimonabant) on impulsive choice may be limited by floor effects. The present study aimed to characterize impulsive-choice patterns for sucrose using an adjusting-delay procedure in genetically lean and obese Zuckers. Ten lean and ten obese Zucker rats chose between one lever that resulted in one pellet after a standard delay (either 1 s or 5 s) and a second lever that resulted in two or three pellets after an adjusting delay. After behavior stabilized under baseline, rimonabant (0-10 mg/kg) was administered prior to some choice sessions in the two-pellet condition. Under baseline, obese Zuckers made more impulsive choices than leans in three of the four standard-delay/pellet conditions. Additionally, in the 2-pellet condition, rimonabant increased impulsive choice in lean rats in the 1-s standard-delay condition; however, rimonabant decreased impulsive choice in obese rats in the 1-s and 5-s standard-delay conditions. These data suggest that genetic factors that influence impulsive choice are stronger in some choice conditions than others, and that the endocannabinoid system may be a relevant neuromechanism. Copyright © 2012 Elsevier B.V. All rights reserved.

How to Reduce Head CT Orders in Children with Hydrocephalus Using the Lean Six Sigma Methodology: Experience at a Major Quaternary Care Academic Children's Center.

PubMed

Tekes, A; Jackson, E M; Ogborn, J; Liang, S; Bledsoe, M; Durand, D J; Jallo, G; Huisman, T A G M

2016-06-01

Lean Six Sigma methodology is increasingly used to drive improvement in patient safety, quality of care, and cost-effectiveness throughout the US health care delivery system. To demonstrate our value as specialists, radiologists can combine lean methodologies along with imaging expertise to optimize imaging elements-of-care pathways. In this article, we describe a Lean Six Sigma project with the goal of reducing the relative use of pediatric head CTs in our population of patients with hydrocephalus by 50% within 6 months. We applied a Lean Six Sigma methodology using a multidisciplinary team at a quaternary care academic children's center. The existing baseline imaging practice for hydrocephalus was outlined in a Kaizen session, and potential interventions were discussed. An improved radiation-free workflow with ultrafast MR imaging was created. Baseline data were collected for 3 months by using the departmental radiology information system. Data collection continued postintervention and during the control phase (each for 3 months). The percentage of neuroimaging per technique (head CT, head ultrasound, ultrafast brain MR imaging, and routine brain MR imaging) was recorded during each phase. The improved workflow resulted in a 75% relative reduction in the percentage of hydrocephalus imaging performed by CT between the pre- and postintervention/control phases (Z-test, P = .0001). Our lean interventions in the pediatric hydrocephalus care pathway resulted in a significant reduction in head CT orders and increased use of ultrafast brain MR imaging. © 2016 by American Journal of Neuroradiology.

Implementation of lean manufacturing for frozen fish process at PT. XYZ

NASA Astrophysics Data System (ADS)

Setiyawan, D. T.; Pertiwijaya, H. R.; Effendi, U.

2018-03-01

PT. XYZ is a company specialized in the processing of fishery products particularly in frozen fish fillet. The purpose of this research was to identify the type of waste and determine the recommendations of minimizing waste Lean manufacturing approach was used in the identification of waste by describing the Value Stream Mapping (VSM) and selecting tools in the Value Stream Analysis Tools (VALSAT). The results of this research showed that the highest waste that generated was the defect of leak packaging on fillet products with an average of 1.21%. In addition to defect, other insufficiencies were found such as: unnecessary motion, unnecessary overhead, and waiting time. Recommendations for improvements that given include reduction of time at several stages of the process, making production schedules, and conducting regular machine maintenance. VSM analysis shows reduced lead time of 582.04 minutes to 572.01 minutes.

Leanergy(TM): how lean manufacturing can improve energy efficiency.

PubMed

Riche, Jean-Pierre

2013-01-01

Energy efficiency has become a competitive issue for industrial companies. The evolution of energy prices and regulation will make this issue even more important in the future. For several years, the energy-intensive chemical industry has been implementing corrective actions. Helped by the absorption of base load energy consumption by larger production volumes, specific energy consumption (KWh per production unit) has been significantly reduced in recent years. However, most plants have reached the end of their first action plan based on improving the utilities performance. The Leanergy(TM) method developed by the consultancy company Okavango-energy, is a structured approach based on lean manufacturing which widens the scope of saving sources to process and operations. Starting from the analysis of actual production requirements, Okavango is able to adjust consumption to minimum requirements and so remove any energy consumption that does not contribute to the added value creation.

Effect of acute ozone exposure on the lung metabolomes of obese and lean mice.

PubMed

Mathews, Joel Andrew; Kasahara, David Itiro; Cho, Youngji; Bell, Lauren Nicole; Gunst, Philip Ross; Karoly, Edward D; Shore, Stephanie Ann

2017-01-01

Pulmonary responses to the air pollutant, ozone, are increased in obesity. Both obesity and ozone cause changes in systemic metabolism. Consequently, we examined the impact of ozone on the lung metabolomes of obese and lean mice. Lean wildtype and obese db/db mice were exposed to acute ozone (2 ppm for 3 h) or air. 24 hours later, the lungs were excised, flushed with PBS to remove blood and analyzed via liquid-chromatography or gas-chromatography coupled to mass spectrometry for metabolites. Both obesity and ozone caused changes in the lung metabolome. Of 321 compounds identified, 101 were significantly impacted by obesity in air-exposed mice. These included biochemicals related to carbohydrate and lipid metabolism, which were each increased in lungs of obese versus lean mice. These metabolite changes may be of functional importance given the signaling capacity of these moieties. Ozone differentially affected the lung metabolome in obese versus lean mice. For example, almost all phosphocholine-containing lysolipids were significantly reduced in lean mice, but this effect was attenuated in obese mice. Glutathione metabolism was also differentially affected by ozone in obese and lean mice. Finally, the lung metabolome indicated a role for the microbiome in the effects of both obesity and ozone: all measured bacterial/mammalian co-metabolites were significantly affected by obesity and/or ozone. Thus, metabolic derangements in obesity appear to impact the response to ozone.

Improving the medical records department processes by lean management.

PubMed

Ajami, Sima; Ketabi, Saeedeh; Sadeghian, Akram; Saghaeinnejad-Isfahani, Sakine

2015-01-01

Lean management is a process improvement technique to identify waste actions and processes to eliminate them. The benefits of Lean for healthcare organizations are that first, the quality of the outcomes in terms of mistakes and errors improves. The second is that the amount of time taken through the whole process significantly improves. The purpose of this paper is to improve the Medical Records Department (MRD) processes at Ayatolah-Kashani Hospital in Isfahan, Iran by utilizing Lean management. This research was applied and an interventional study. The data have been collected by brainstorming, observation, interview, and workflow review. The study population included MRD staff and other expert staff within the hospital who were stakeholders and users of the MRD. The MRD were initially taught the concepts of Lean management and then formed into the MRD Lean team. The team then identified and reviewed the current processes subsequently; they identified wastes and values, and proposed solutions. The findings showed that the MRD units (Archive, Coding, Statistics, and Admission) had 17 current processes, 28 wastes, and 11 values were identified. In addition, they offered 27 comments for eliminating the wastes. The MRD is the critical department for the hospital information system and, therefore, the continuous improvement of its services and processes, through scientific methods such as Lean management, are essential. The study represents one of the few attempts trying to eliminate wastes in the MRD.

77 FR 64546 - Certain Devices With Secure Communication Capabilities, Components Thereof, and Products...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-22

... Communication Capabilities, Components Thereof, and Products Containing Same; Institution of Investigation... VirnetX, Inc., of Zephyr Cove, Nevada and Science Applications International Corporation of McLean... sale within the United States after importation of certain devices with secure communication...

40 CFR 86.1232-96 - Vehicle preconditioning.

Code of Federal Regulations, 2011 CFR

2011-07-01

... preconditioned separately. If production evaporative canisters are equipped with a functional service port... production evaporative canisters are equipped with a functional service port designed for vapor load or purge... provides at least a 4:1 safety factor against the lean flammability limit. (iii) The FID hydrocarbon...

Central nervous system neuropeptide Y signaling via the Y1 receptor partially dissociates feeding behavior from lipoprotein metabolism in lean rats.

PubMed

Rojas, Jennifer M; Stafford, John M; Saadat, Sanaz; Printz, Richard L; Beck-Sickinger, Annette G; Niswender, Kevin D

2012-12-15

Elevated plasma triglyceride (TG) levels contribute to an atherogenic dyslipidemia that is associated with obesity, diabetes, and metabolic syndrome. Numerous models of obesity are characterized by increased central nervous system (CNS) neuropeptide Y (NPY) tone that contributes to excess food intake and obesity. Previously, we demonstrated that intracerebroventricular (icv) administration of NPY in lean fasted rats also elevates hepatic production of very low-density lipoprotein (VLDL)-TG. Thus, we hypothesize that elevated CNS NPY action contributes to not only the pathogenesis of obesity but also dyslipidemia. Here, we sought to determine whether the effects of NPY on feeding and/or obesity are dissociable from effects on hepatic VLDL-TG secretion. Pair-fed, icv NPY-treated, chow-fed Long-Evans rats develop hypertriglyceridemia in the absence of increased food intake and body fat accumulation compared with vehicle-treated controls. We then modulated CNS NPY signaling by icv injection of selective NPY receptor agonists and found that Y1, Y2, Y4, and Y5 receptor agonists all induced hyperphagia in lean, ad libitum chow-fed Long-Evans rats, with the Y2 receptor agonist having the most pronounced effect. Next, we found that at equipotent doses for food intake NPY Y1 receptor agonist had the most robust effect on VLDL-TG secretion, a Y2 receptor agonist had a modest effect, and no effect was observed for Y4 and Y5 receptor agonists. These findings, using selective agonists, suggest the possibility that the effect of CNS NPY signaling on hepatic VLDL-TG secretion may be relatively dissociable from effects on feeding behavior via the Y1 receptor.

Contribution to the Optimization of Strategy of Maintenance by Lean Six Sigma

NASA Astrophysics Data System (ADS)

Youssouf, Ayadi; Rachid, Chaib; Ion, Verzea

The efficiency of the maintenance of the industrial systems is a major economic stake for their business concern. The main difficulties and the sources of ineffectiveness live in the choice of the actions of maintenance especially when the machine plays a vital role in the process of production. But as Algeria has embarked on major infrastructure projects in transport, housing, automobile, manufacturing industry and construction (factories, housing, highway, subway, tram, etc.) requiring new implications on maintenance strategies that meet industry requirements imposed by the exploitation. From then on and seen the importance of the maintenance on the economic market and sound impacts on the performances of the installations, methods of optimization were developed. For this purpose, to ensure the survival of businesses, be credible, contributing and competitive in the market, maintenance services must continually adapt to the progress of technical areas, technological and organizational even help maintenance managers to construct or to modify maintenance strategies, objective of this work. Our contribution in this work focuses on the optimization of maintenance for industrial systems by the use of Lean six Sigma bases. Lean Six Sigma is a method of improving the quality and profitability based on mastering statically of process and it is also a management style that based on a highly regulated organization dedicated to managing project. The method is based on five main steps summarized in the acronym (DMAIC): Define Measure, Analyze, Improve and Control. Application of the method on the maintenance processes with using maintenance methods during the five phases of the method will help to reduce costs and losses in order to strive for optimum results in terms of profit and quality.

40 CFR 86.1810-01 - General standards; increase in emissions; unsafe conditions; waivers.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 2 and interim non-Tier 2 ethanol fueled vehicles. (a) Any device, system or element of design... “lean-on-cruise” strategies are incorporated into the vehicle design. A “lean-on-cruise” air-fuel... standard. The Administrator may require the manufacturer to provide comparative test data which clearly...

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.

Augmented Endothelial-Specific L-Arginine Transport Blunts the Contribution of the Sympathetic Nervous System to Obesity Induced Hypertension in Mice.

PubMed

Rajapakse, Niwanthi W; Karim, Florian; Evans, Roger G; Kaye, David M; Head, Geoffrey A

2015-01-01

Augmenting endothelial specific transport of the nitric oxide precursor L-arginine via cationic amino acid transporter-1 (CAT1) can prevent obesity related hypertension. We tested the hypotheses that CAT1 overexpression prevents obesity-induced hypertension by buffering the influence of the sympathetic nervous system (SNS) on the maintenance of arterial pressure and by buffering pressor responses to stress. Wild type (WT; n=13) and CAT1 overexpressing mice (CAT+; n=13) were fed a normal or a high fat diet for 20 weeks. Mice fed a high fat diet were returned to the control diet before experiments commenced. Baseline mean arterial pressure (MAP) and effects of restraint-, shaker- and almond feeding-stress and ganglionic blockade (pentolinium; 5 mg/kg; i.p.) on MAP were determined in conscious mice. Fat feeding increased body weight to a similar extent in WT and CAT+ but MAP was greater only in WT compared to appropriate controls (by 29%). The depressor response to pentolinium was 65% greater in obese WT than lean WT (P < 0.001), but was similar in obese and lean CAT+ (P = 0.65). In lean WT and CAT+, pressor responses to shaker and feeding stress, but not restraint stress, were less in the latter genotype compared to the former (P ≤ 0.001). Pressor responses to shaker and feeding stress were less in obese WT than lean WT (P ≤ 0.001), but similar in obese and lean CAT+. The increase in MAP in response to restraint stress was less in obese WT (22 ± 2%), but greater in obese CAT+ (37 ± 2%), when compared to respective lean WT (31 ± 3%) and lean CAT+ controls (27 ± 2%; P ≤ 0.02). We conclude that CAT1 overexpression prevents obesity-induced hypertension by reducing the influence of the SNS on the maintenance of arterial pressure but not by buffering pressor responses to stress.

[Improving a hospital's supply chain through lean management].

PubMed

Aguilar-Escobar, V G; Garrido-Vega, P; Godino-Gallego, N

2013-01-01

Supply management is an area where hospitals have significant opportunities for improvement. The main objective of this paper has been to analyze how the application of Lean principles can improve logistics costs and user satisfaction. In connection with satisfaction, it also aimed to examine which aspects of the service define it and check for differences between different groups of users. The results of an experience to reorganize the hospital logistic system based on some Lean principles have been studied. This is therefore a case study, which combine different methods of data collection. The logistics cost calculation was carried out using the full costing method. To measure satisfaction of healthcare personnel, the internal logistics service users, an anonymous survey was conducted. Processing of the data obtained from the survey have included exploratory analysis, factor analysis and ANOVAs. The data have showed an improvement in logistics management after the implementation of Lean principles. Logistics costs were reduced and the satisfaction level of the internal users with the new logistics system was increased. Some differences in the degree of satisfaction by different groups of users were also detected, although they did not seem to distinguish between different aspects of logistic service. The analyzed experience shows the applicability and suitability of Lean principles to improve logistics operational costs and increase user satisfaction. Copyright © 2012 SECA. Published by Elsevier Espana. 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

The Gut Microbiota from Lean and Obese Subjects Contribute Differently to the Fermentation of Arabinogalactan and Inulin

PubMed Central

Aguirre, Marisol; Bussolo de Souza, Carlota; Venema, Koen

2016-01-01

Background An aberrant metabolic activity or a compositional alteration of the gut microbiota has been proposed as a factor that makes us more prone to disease. Therefore, we explored the effect of two dietary fibers (arabinogalactan and inulin) on the microbiota from lean and obese subjects during 72 h in vitro fermentation experiments using the validated TNO dynamic in vitro model of the proximal colon: TIM-2. Metabolically, arabinogalactan fermentation showed a higher production of propionate when compared to n-butyrate in the obese microbiota fermentations. In general, lean microbiota produced more n-butyrate from the fermentation of both substrates when compared to the obese microbiota. Furthermore, the obese microbiota extracted more energy from the fermentation of both fibers. Results Compositionally, bacteria belonging to Gemmiger, Dorea, Roseburia, Alistipes, Lactobacillus and Bifidobacterium genera were found to be highly abundant or stimulated by the prebiotics in the lean microbiota suggesting a potential role in leanness. Furthermore, a significant correlation between known butyrogenic strains including B. adolescentis, an unclassified Bifidobacterium and F. prausnitzii with this metabolite in the fermentation of inulin in both microbiotas was found. Conclusions Although supplementary in vivo studies are needed, the current study provides more evidence for the consumption of specific ingredients with the aim of modulating the gut microbiota in the context of obesity. PMID:27410967

Lean manufacturing analysis to reduce waste on production process of fan products

NASA Astrophysics Data System (ADS)

Siregar, I.; Nasution, A. A.; Andayani, U.; Sari, R. M.; Syahputri, K.; Anizar

2018-02-01

This research is based on case study that being on electrical company. One of the products that will be researched is the fan, which when running the production process there is a time that is not value-added, among others, the removal of material which is not efficient in the raw materials and component molding fan. This study aims to reduce waste or non-value added activities and shorten the total lead time by using the tools Value Stream Mapping. Lean manufacturing methods used to analyze and reduce the non-value added activities, namely the value stream mapping analysis tools, process mapping activity with 5W1H, and tools 5 whys. Based on the research note that no value-added activities in the production process of a fan of 647.94 minutes of total lead time of 725.68 minutes. Process cycle efficiency in the production process indicates that the fan is still very low at 11%. While estimates of the repair showed a decrease in total lead time became 340.9 minutes and the process cycle efficiency is greater by 24%, which indicates that the production process has been better.

Evaluation of Safety, Quality and Productivity in Construction

NASA Astrophysics Data System (ADS)

Usmen, M. A.; Vilnitis, M.

2015-11-01

This paper examines the success indicators of construction projects, safety, quality and productivity, in terms of their implications and impacts during and after construction. First safety is considered during construction with a focus on hazard identification and the prevention of occupational accidents and injuries on worksites. The legislation mandating safety programs, training and compliance with safety standards is presented and discussed. Consideration of safety at the design stage is emphasized. Building safety and the roles of building codes in prevention of structural failures are also covered in the paper together with factors affecting building failures and methods for their prevention. Quality is introduced in the paper from the perspective of modern total quality management. Concepts of quality management, quality control, quality assurance and Six Sigma and how they relate to building quality and structural integrity are discussed with examples. Finally, productivity concepts are presented with emphasis on effective project management to minimize loss of productivity, complimented by lean construction and lean Six Sigma principles. The paper concludes by synthesizing the relationships between safety, quality and productivity.

Foodborne Illnesses

MedlinePlus

... toast or bread, cereal, lean meat, applesauce, and bananas avoiding fatty foods, sugary foods, dairy products, caffeine, ... vegetables, including lettuce and fruit salads, unless they peel the fruits or vegetables themselves eating raw or ...

Integration of Energy Consumption and CO2 Emissions into the DES Tool with Lean Thinking

NASA Astrophysics Data System (ADS)

Nujoom, Reda; Wang, Qian

2018-01-01

Products are often made by accomplishing a number of manufacturing processes on a sequential flow line which is also known as manufacturing systems. In a traditional way, design or evaluation of a manufacturing system involves a determination or an analysis of the system performance by adjusting system parameters relating to such as system capacity, material processing time, material-handling and transportation and shop-floor layout. Environment related parameters, however, are not considered or considered as separate issues. In the past decade, there has been a growing concern about the environmental protection and governments almost in all over the world enforced certain rules and regulation to promote energy saving and reduce carbon dioxide (CO2) emissions in manufacturing industry. To date, development of a sustainable manufacturing system requires designers who need not merely to apply traditional methods of improving system efficiency and productivity but also examine the environmental issues in production of the developed manufacturing system. Most researchers, however, focused on operational systems, which do not incorporate the effect of environmental factors that may also affect the system performance. This paper presents a research work aiming to addresses these issues in design and evaluation of sustainable manufacturing systems incorporating parameters of energy consumption and CO2 emissions into a DES (discrete event simulation) tool.

Influence of selected dietary components on the functioning of the human nervous system

PubMed

Wendołowicz, Agnieszka; Stefańska, Ewa; Ostrowska, Lucyna

The diet is directly connected not only with the physical status but also with the functioning of the brain and the mental status. The potentially beneficial nutrients with a protective effect on the nervous system function include amino acids (tryptophan, phenylalanine, tyrosine, taurine), glucose and vitamins C, E, D and beta-carotene, B group vitamins (vitamin B12, vitamin B6, vitamin B4, vitamin B1) and minerals (selenium, zinc, magnesium, sodium, iron, copper, manganese, iodine). The presence of antioxidants in the diet protects against oxidative damage to nervous system cells. Biochemical data indicate that polyunsaturated fatty acids such as arachidonic acid (AA), docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and gamma-linolenic acid (GLA) as structural components of the nervous system play a key role in its function. The nutrition of the entire body also influences the production of neurotransmitters in the brain. A diet without an appropriate supply of protein, mineral nutrients or vitamins may result in a failure to form appropriately balanced numbers of neurotransmitters, which, as a result, may lead to neurotransmission dysfunction. This is the reason why proper nutrition is based on vegetables, fruits, whole-grain cereal products supplemented with products providing full-value protein (dairy products, fish, lean meat) and high-quality fat products (vegetable oils, fish fats).

Effects of different acute hypoxic regimens on tissue oxygen profiles and metabolic outcomes.

PubMed

Reinke, Christian; Bevans-Fonti, Shannon; Drager, Luciano F; Shin, Mi-Kyung; Polotsky, Vsevolod Y

2011-09-01

Obstructive sleep apnea (OSA) causes intermittent hypoxia (IH) during sleep. Both obesity and OSA are associated with insulin resistance and systemic inflammation, which may be attributable to tissue hypoxia. We hypothesized that a pattern of hypoxic exposure determines both oxygen profiles in peripheral tissues and systemic metabolic outcomes, and that obesity has a modifying effect. Lean and obese C57BL6 mice were exposed to 12 h of intermittent hypoxia 60 times/h (IH60) [inspired O₂ fraction (Fi(O₂)) 21-5%, 60/h], IH 12 times/h (Fi(O₂) 5% for 15 s, 12/h), sustained hypoxia (SH; Fi(O₂) 10%), or normoxia while fasting. Tissue oxygen partial pressure (Pti(O₂)) in liver, skeletal muscle and epididymal fat, plasma leptin, adiponectin, insulin, blood glucose, and adipose tumor necrosis factor-α (TNF-α) were measured. In lean mice, IH60 caused oxygen swings in the liver, whereas fluctuations of Pti(O₂) were attenuated in muscle and abolished in fat. In obese mice, baseline liver Pti(O₂) was lower than in lean mice, whereas muscle and fat Pti(O₂) did not differ. During IH, Pti(O₂) was similar in obese and lean mice. All hypoxic regimens caused insulin resistance. In lean mice, hypoxia significantly increased leptin, especially during SH (44-fold); IH60, but not SH, induced a 2.5- to 3-fold increase in TNF-α secretion by fat. Obesity was associated with striking increases in leptin and TNF-α, which overwhelmed effects of hypoxia. In conclusion, IH60 led to oxygen fluctuations in liver and muscle and steady hypoxia in fat. IH and SH induced insulin resistance, but inflammation was increased only by IH60 in lean mice. Obesity caused severe inflammation, which was not augmented by acute hypoxic regimens.

ENVIRONMENTAL CHALLENGE OF THE 1990'S PROCEEDINGS - INTERNATIONAL CONFERENCE ON POLLUTION PREVENTION: CLEAN TECHNOLOGIES AND CLEAN PRODUCTS

EPA Science Inventory

The International Conference on Pollution Prevention: lean Technologies and Clean Products was held in Washington, DC, June 10-13, 1990. ith support from the Department of Defense, the Department of Energy, and the International Association for Clean Technology, this conference e...

Restructuring, Teams, and Learning: The Case of a Clothing Company.

ERIC Educational Resources Information Center

Brown, Tony

1999-01-01

Interviews with female employees of a clothing company moving to lean production and teamwork indicate that Taylorism is being reinvented in the contemporary workplace. Restructuring produces higher productivity but greater work pressures and lower wages, despite rhetoric about autonomy, job satisfaction, and workplace democracy. (Contains 57…

High cholesterol - children

MedlinePlus

... and milk products Avoid sugary drinks such as soda and flavored fruit drinks Eat lean meat and ... day. Other steps include teaching children about the dangers of tobacco use. Make your home a smoke- ...

Evaluation of advanced combustion concepts for dry NO sub x suppression with coal-derived, gaseous fuels

NASA Technical Reports Server (NTRS)

Beebe, K. W.; Symonds, R. A.; Notardonato, J. J.

1982-01-01

The emissions performance of a rich lean combustor (developed for liquid fuels) was determined for combustion of simulated coal gases ranging in heating value from 167 to 244 Btu/scf (7.0 to 10.3 MJ/NCM). The 244 Btu/scf gas is typical of the product gas from an oxygen blown gasifier, while the 167 Btu/scf gas is similar to that from an air blown gasifier. NOx performance of the rich lean combustor did not meet program goals with the 244 Btu/scf gas because of high thermal NOx, similar to levels expected from conventional lean burning combustors. The NOx emissions are attributed to inadequate fuel air mixing in the rich stage resulting from the design of the large central fuel nozzle delivering 71% of the total gas flow. NOx yield from ammonia injected into the fuel gas decreased rapidly with increasing ammonia level, and is projected to be less than 10% at NH3 levels of 0.5% or higher. NOx generation from NH3 is significant at ammonia concentrations significantly less than 0.5%. These levels may occur depending on fuel gas cleanup system design. CO emissions, combustion efficiency, smoke and other operational performance parameters were satisfactory. A test was completed with a catalytic combustor concept with petroleum distillate fuel. Reactor stage NOx emissions were low (1.4g NOx/kg fuel). CO emissions and combustion efficiency were satisfactory. Airflow split instabilities occurred which eventually led to test termination.

Improving the medical records department processes by lean management

PubMed Central

Ajami, Sima; Ketabi, Saeedeh; Sadeghian, Akram; Saghaeinnejad-Isfahani, Sakine

2015-01-01

Background: Lean management is a process improvement technique to identify waste actions and processes to eliminate them. The benefits of Lean for healthcare organizations are that first, the quality of the outcomes in terms of mistakes and errors improves. The second is that the amount of time taken through the whole process significantly improves. Aims: The purpose of this paper is to improve the Medical Records Department (MRD) processes at Ayatolah-Kashani Hospital in Isfahan, Iran by utilizing Lean management. Materials and Methods: This research was applied and an interventional study. The data have been collected by brainstorming, observation, interview, and workflow review. The study population included MRD staff and other expert staff within the hospital who were stakeholders and users of the MRD. Statistical Analysis Used: The MRD were initially taught the concepts of Lean management and then formed into the MRD Lean team. The team then identified and reviewed the current processes subsequently; they identified wastes and values, and proposed solutions. Results: The findings showed that the MRD units (Archive, Coding, Statistics, and Admission) had 17 current processes, 28 wastes, and 11 values were identified. In addition, they offered 27 comments for eliminating the wastes. Conclusion: The MRD is the critical department for the hospital information system and, therefore, the continuous improvement of its services and processes, through scientific methods such as Lean management, are essential. Originality/Value: The study represents one of the few attempts trying to eliminate wastes in the MRD. PMID:26097862

Lean Mission Operations Systems Design - Using Agile and Lean Development Principles for Mission Operations Design and Development

NASA Technical Reports Server (NTRS)

Trimble, Jay Phillip

2014-01-01

The Resource Prospector Mission seeks to rove the lunar surface with an in-situ resource utilization payload in search of volatiles at a polar region. The mission operations system (MOS) will need to perform the short-duration mission while taking advantage of the near real time control that the short one-way light time to the Moon provides. To maximize our use of limited resources for the design and development of the MOS we are utilizing agile and lean methods derived from our previous experience with applying these methods to software. By using methods such as "say it then sim it" we will spend less time in meetings and more time focused on the one outcome that counts - the effective utilization of our assets on the Moon to meet mission objectives.

Understanding waste for lean health information systems: a preliminary review.

PubMed

Kalong, Nadia Awang; Yusof, Maryati Mohd

2013-01-01

Despite the rapid application of the Lean method in healthcare, its study in IT environments, particularly in Health Information Systems (HIS), is still limited primarily by a lack of waste identification. This paper aims to review the literature to provide an insight into the nature of waste in HIS from the perspective of Lean management. Eight waste frameworks within the context of healthcare and information technology were reviewed. Based on the review, it was found that all the seven waste categories from the manufacturing sector also exist in both the healthcare and IT domains. However, the nature of the waste varied depending on the processes of the domains. A number of additional waste categories were also identified. The findings reveal that the traditional waste model can be adapted to identify waste in both the healthcare and IT sectors.

Analysis of production flow process with lean manufacturing approach

NASA Astrophysics Data System (ADS)

Siregar, Ikhsan; Arif Nasution, Abdillah; Prasetio, Aji; Fadillah, Kharis

2017-09-01

This research was conducted on the company engaged in the production of Fast Moving Consumer Goods (FMCG). The production process in the company are still exists several activities that cause waste. Non value added activity (NVA) in the implementation is still widely found, so the cycle time generated to make the product will be longer. A form of improvement on the production line is by applying lean manufacturing method to identify waste along the value stream to find non value added activities. Non value added activity can be eliminated and reduced by utilizing value stream mapping and identifying it with activity mapping process. According to the results obtained that there are 26% of value-added activities and 74% non value added activity. The results obtained through the current state map of the production process of process lead time value of 678.11 minutes and processing time of 173.94 minutes. While the results obtained from the research proposal is the percentage of value added time of 41% of production process activities while non value added time of the production process of 59%. While the results obtained through the future state map of the production process of process lead time value of 426.69 minutes and processing time of 173.89 minutes.

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.

Chemical and toxicological properties of emissions from CNG transit buses equipped with three-way catalysts compared to lean-burn engines and oxidation catalyst technologies

NASA Astrophysics Data System (ADS)

Yoon, Seungju; Hu, Shaohua; Kado, Norman Y.; Thiruvengadam, Arvind; Collins, John F.; Gautam, Mridul; Herner, Jorn D.; Ayala, Alberto

2014-02-01

Chemical and toxicological properties of emissions from compressed natural gas (CNG) fueled transit buses with stoichiometric combustion engines and three-way catalyst (TWC) exhaust control systems were measured using a chassis dynamometer testing facility and compared to the data from earlier CNG engine and exhaust control technologies. Gaseous and particulate matter emissions from buses with stoichiometric engines and TWC were significantly lower than the emissions from buses with lean-burn engines. Carbonyls and volatile organic compounds (VOCs) from buses with stoichiometric engines and TWC were lower by more than 99% compared to buses with lean-burn engines. Elemental and organic carbons (EC and OC), polycyclic aromatic hydrocarbons (PAHs), and trace elements from buses with stoichiometric engines and TWC were effectively controlled and significantly lower than the emissions from buses with lean-burn engines. Potential mutagenicity measured using a microsuspension modification of the Salmonella/microsome assay was lower by more than 99% for buses with stoichiometric engines and TWC, compared to buses with lean-burn engines and OxC.

Validation of a quantitative magnetic resonance method for measuring human body composition.

PubMed

Napolitano, Antonella; Miller, Sam R; Murgatroyd, Peter R; Coward, W Andrew; Wright, Antony; Finer, Nick; De Bruin, Tjerk W; Bullmore, Edward T; Nunez, Derek J

2008-01-01

To evaluate a novel quantitative magnetic resonance (QMR) methodology (EchoMRI-AH, Echo Medical Systems) for measurement of whole-body fat and lean mass in humans. We have studied (i) the in vitro accuracy and precision by measuring 18 kg Canola oil with and without 9 kg water (ii) the accuracy and precision of measures of simulated fat mass changes in human subjects (n = 10) and (iii) QMR fat and lean mass measurements compared to those obtained using the established 4-compartment (4-C) model method (n = 30). (i) QMR represented 18 kg of oil at 40 degrees C as 17.1 kg fat and 1 kg lean while at 30 degrees C 15.8 kg fat and 4.7 kg lean were reported. The s.d. of repeated estimates was 0.13 kg for fat and 0.23 kg for lean mass. Adding 9 kg of water reduced the fat estimates, increased misrepresentation of fat as lean, and degraded the precision. (ii) the simulated change in the fat mass of human volunteers was accurately represented, independently of added water. (iii) compared to the 4-C model, QMR underestimated fat and over-estimated lean mass. The extent of difference increased with body mass. The s.d. of repeated measurements increased with adiposity, from 0.25 kg (fat) and 0.51 kg (lean) with BMI <25 kg/m(2) to 0.43 kg and 0.81 kg respectively with BMI >30 kg/m(2). EchoMRI-AH prototype showed shortcomings in absolute accuracy and specificity of fat mass measures, but detected simulated body composition change accurately and with precision roughly three times better than current best measures. This methodology should reduce the study duration and cohort number needed to evaluate anti-obesity interventions.

Incorporation of nisin into a meat binding system to inhibit bacteria on beef surfaces.

PubMed

Cutter, C N; Siragusa, G R

1998-07-01

In two separate experiments, the bacteriocin, nisin, was incorporated into a commercially available meat binding system (Fibrimex) and applied to meat surfaces as a way of inhibiting the meat spoilage organism, Brochothrix thermosphacta during extended refrigerated storage. In experiment 1, pre-rigor lean beef carcass tissue (BCT) was inoculated with B. thermosphacta, left untreated (U), treated with 10 micrograms ml-1 nisin (N), Fibrimex (F) or Fibrimex containing 10 micrograms ml-1 nisin (FN), held aerobically at 4 degrees C for up to 7 d, and populations of B. thermosphacta and nisin activity determined. Experiment 2 determined the effects of the same treatments but on post-rigor, frozen and thawed lean BCT that was inoculated, vacuum-packaged, and stored at 4 degrees C for up to 14 d. In both experiments, N- and FN-treated tissues exhibited significantly lower populations of B. thermosphacta compared to U- and F-treated tissues, for the duration of refrigerated storage. Nisin activity was detected up to 7 d in N- and FN-treated samples from experiment 1. However, activity was detected only to days 0 and 2 in FN- and N-treated samples, respectively, from experiment 2. These studies indicate that the addition of a bacteriocin to a meat binding system and application to meat surfaces may be useful in reducing undesirable bacteria in restructured meat products.

The political economy of the public-private mix in heath expenditure: an empirical review of thirteen OECD countries.

PubMed

Mou, Haizhen

2013-12-01

This study investigates the factors that may have influenced the public-private mix of health expenditure in 13 OECD countries from 1981 to 2007. The degree to which health services are socialized is regarded as the product of a trade-off between the desire to redistribute income through the fiscal system and the losses some citizens will incur when the public health care system expands. The estimation results show that, greater income inequality and population aging are associated with a smaller share of public health expenditure in total health expenditure. The more ideologically left-leaning the electorate is, the larger the share of public health expenditure. Private health insurance tends to erode the political support for the public health care systems in countries with private duplicate health insurance, but not in countries with private primary health insurance. The findings suggest that the role of private sources of funding for health care is likely to grow in developed countries. The expansion of public coverage to include pharmaceuticals and long-term care in some countries may (theoretically) encounter less opposition if the current insurance holders have no duplicate coverage, if the voters as a whole share more left-leaning political ideology, and if low-income voters are more politically mobilized. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Getting Ready for Pregnancy

MedlinePlus

... acid from food, like fortified bread, breakfast cereal, pasta and products made from a kind of flour ... foods , like fruits, vegetables, whole-grain bread and pasta, and lean meat and chicken. Limit sweets, salty ...

Antihypertensive effect of alpha- and beta-adrenergic blockade in obese and lean hypertensive subjects.

PubMed

Wofford, M R; Anderson, D C; Brown, C A; Jones, D W; Miller, M E; Hall, J E

2001-07-01

The purpose of this study was to determine the contribution of the adrenergic system in mediating hypertension in obese and lean patients. Thirteen obese, hypertensive patients with a body mass index (BMI) > or =28 kg/m2 (obese) and nine lean patients with a BMI < or =25 kg/m2 (lean) were recruited. After a 1-week washout period, participants underwent daytime ambulatory blood pressure monitoring (ABPM). Participants were then treated with the alpha-adrenergic antagonist doxazosin, titrating to 4 mg QHS in 1 week. In the next week, the beta-adrenergic antagonist atenolol was added at an initial dose of 25 mg/day and titrated to 50 mg/day within 1 week. One month after the addition of atenolol, all patients underwent a second ABPM session. There were no differences between the obese and lean subjects in baseline systolic (SBP), diastolic (DBP), or mean arterial pressures (MAP) measured by office recording or ABPM. However, obese subjects had higher heart rates than lean subjects (87.5+/-2.4 v 76.8+/-4.9 beats/min). After 1 month of treatment with the adrenergic blockers, obese patients had a significantly lower SBP (130.0+/-2.5 v 138.9+/-2.1 mm Hg, P = .02) and MAP (99.6+/-2.3 v 107.0+/-1.5 mm Hg, P = .02) than lean patients. Obese patients also tended to have a lower DBP than lean patients (84.3+/-2.5 v 90.9+/-1.6 mm Hg, P = .057), but there was no significant difference in heart rate after 1 month of adrenergic blockade. These results indicate that blood pressure is more sensitive to adrenergic blockade in obese than in lean hypertensive patients and suggest that increased sympathetic activity may be an important factor in the maintenance of hypertension in obesity.

Lean energy analysis of CNC lathe

NASA Astrophysics Data System (ADS)

Liana, N. A.; Amsyar, N.; Hilmy, I.; Yusof, MD

2018-01-01

The industrial sector in Malaysia is one of the main sectors that have high percentage of energy demand compared to other sector and this problem may lead to the future power shortage and increasing the production cost of a company. Suitable initiatives should be implemented by the industrial sectors to solve the issues such as by improving the machining system. In the past, the majority of the energy consumption in industry focus on lighting, HVAC and office section usage. Future trend, manufacturing process is also considered to be included in the energy analysis. A study on Lean Energy Analysis in a machining process is presented. Improving the energy efficiency in a lathe machine by enhancing the cutting parameters of turning process is discussed. Energy consumption of a lathe machine was analyzed in order to identify the effect of cutting parameters towards energy consumption. It was found that the combination of parameters for third run (spindle speed: 1065 rpm, depth of cut: 1.5 mm, feed rate: 0.3 mm/rev) was the most preferred and ideal to be used during the turning machining process as it consumed less energy usage.

LES/FMDF of turbulent jet ignition in a rapid compression machine

NASA Astrophysics Data System (ADS)

Validi, Abdoulahad; Schock, Harold; Toulson, Elisa; Jaberi, Farhad; CFD; Engine Research Labs, Michigan State University Collaboration

2015-11-01

Turbulent Jet Ignition (TJI) is an efficient method for initiating and controlling combustion in combustion systems, e.g. internal combustion engines. It enables combustion in ultra-lean mixtures by utilizing hot product turbulent jets emerging from a pre-chamber combustor as the ignition source for the main combustion chamber. Here, we study the TJI-assisted ignition and combustion of lean methane-air mixtures in a Rapid Compression Machine (RCM) for various flow/combustion conditions with the hybrid large eddy simulation/filtered mass density function (LES/FMDF) computational model. In the LES/FMDF model, the filtered form of compressible Navier-Stokes equations are solved with a high-order finite difference scheme for the turbulent velocity, while the FMDF transport equation is solved with a Lagrangian stochastic method to obtain the scalar (species mass fraction and temperature) field. The LES/FMDF data are used to study the physics of TJI and combustion in RCM. The results show the very complex behavior of the reacting flow and the flame structure in the pre-chamber and RCM.

Comparison of the longissimus muscle proteome between obese and lean pigs at 180 days.

PubMed

Li, Anning; Mo, Delin; Zhao, Xiao; Jiang, Wei; Cong, Peiqing; He, Zuyong; Xiao, Shuqi; Liu, Xiaohong; Chen, Yaosheng

2013-02-01

Production of high-quality meat is important to satisfy the consumer and make the pig industry competitive. Obese and lean breeds of pig show clear differences in adipogenic capacity and meat quality, but the underlying molecular mechanism remains unclear. We have compared protein expression of the longissimus muscle between Lantang (LT, obese) and Landrace (LR, lean) pigs at the age of 180 days using two-dimensional fluorescence difference gel electrophoresis. Of the 1,400 protein spots detected per gel, 18 were differentially expressed between the two breeds. Using peptide mass fingerprint and tandem mass spectrometry, 17 protein spots were identified, corresponding to ten different proteins that could be divided into four groups: metabolism-related, structure-related, stress-related, and other (unclassified). Among the metabolism-related proteins, COX5A and ATP5B, which participate in oxidative phosphorylation, were highly expressed in LT, whereas ENO3, which is involved in glycolysis, was highly expressed in LR. These results may contribute valuable information to our understanding of the molecular mechanism responsible for differences between obese and lean pigs, such as growth rate and meat quality.

Lean production and work-related musculoskeletal disorders: overviews of international and Swedish studies.

PubMed

Brännmark, Mikael; Håkansson, Malin

2012-01-01

This paper aimed at summarizing the knowledge of the relationship between Lean and work related musculoskeletal disorders (WMSD), and WMSD risk factors, in manufacturing companies. Literature search processes identified 23 publications studying this, in scientific journals. Eight included measurements of WMSD; three were mostly negative, two showed mixed results, one showed no results and two were mostly positive. Eighteen publications included measurements of WMSD risk factors; seven showed mostly negative results, eight showed mixed results, two showed mostly positive results and one was inconclusive. Three literature reviews were identified, which studied this question; two were mostly negative, while the third was inconclusive. Also, 12 publications of grey literature studying Lean and WMSD risk factors in Swedish organizations were identified; nine showed mixed results, two showed mostly positive results and one showed mostly negative results. Due to the varying quality and study design of the publications, together with the few identified studies, it is difficult to compare them. The context and the implementation also likely affect the results. The general conclusion was that a Lean implementation may increase the risk of WMSD and risk factors for WMSD, if it is not accompanied with an ergonomic intervention.

Improving a Dental School's Clinic Operations Using Lean Process Improvement.

PubMed

Robinson, Fonda G; Cunningham, Larry L; Turner, Sharon P; Lindroth, John; Ray, Deborah; Khan, Talib; Yates, Audrey

2016-10-01

The term "lean production," also known as "Lean," describes a process of operations management pioneered at the Toyota Motor Company that contributed significantly to the success of the company. Although developed by Toyota, the Lean process has been implemented at many other organizations, including those in health care, and should be considered by dental schools in evaluating their clinical operations. Lean combines engineering principles with operations management and improvement tools to optimize business and operating processes. One of the core concepts is relentless elimination of waste (non-value-added components of a process). Another key concept is utilization of individuals closest to the actual work to analyze and improve the process. When the medical center of the University of Kentucky adopted the Lean process for improving clinical operations, members of the College of Dentistry trained in the process applied the techniques to improve inefficient operations at the Walk-In Dental Clinic. The purpose of this project was to reduce patients' average in-the-door-to-out-the-door time from over four hours to three hours within 90 days. Achievement of this goal was realized by streamlining patient flow and strategically relocating key phases of the process. This initiative resulted in patient benefits such as shortening average in-the-door-to-out-the-door time by over an hour, improving satisfaction by 21%, and reducing negative comments by 24%, as well as providing opportunity to implement the electronic health record, improving teamwork, and enhancing educational experiences for students. These benefits were achieved while maintaining high-quality patient care with zero adverse outcomes during and two years following the process improvement project.

Lean burn combustor technology at GE Aircraft Engines

NASA Technical Reports Server (NTRS)

Dodds, Willard J.

1992-01-01

This presentation summarizes progress to date at GE Aircraft Engines in demonstration of a lean combustion system for the High Speed Civil Transport (HSCT). These efforts were supported primarily by NASA contracts, with the exception of initial size and weight estimates and development of advanced diagnostics which were conducted under GE Independent Research and Development projects. Key accomplishments to date are summarized below.

Dietary strawberry powder reduces blood glucose concentrations in obese and lean C57BL/6 mice and selectively lowers plasma C-reactive protein in lean mice

USDA-ARS?s Scientific Manuscript database

Obesity is a public health problem in the United States and is often accompanied by hyperglycemia, insulin resistance, and low grade systemic inflammation. Strawberries contain polyphenols with anti-inflammatory potential. The purpose of this study was to test the anti-inflammatory and blood gluc...

Lean limit phenomena

NASA Technical Reports Server (NTRS)

Law, C. K.

1984-01-01

The concept of flammability limits in the presence of flame interaction, and the existence of negative flame speeds are discussed. Downstream interaction between two counterflow premixed flames of different stoichiometries are experimentally studied. Various flame configurations are observed and quantified; these include the binary system of two lean or rich flames, the triplet system of a lean and a rich flame separated by a diffusion flame, and single diffusion flames with some degree of premixedness. Extinction limits are determined for methane/air and butane/air mixtures over the entire range of mixture concentrations. The results show that the extent of flame interaction depends on the separation distance between the flames which are functions of the mixtures' concentrations, the stretch rate, and the effective Lewis numbers (Le). In particular, in a positively-stretched flow field Le 1 ( 1) mixtures tend to interact strongly (weakly), while the converse holds for flames in a negatively-stretched flow. Also established was the existence of negative flames whose propagation velocity is in the same general direction as that of the bulk convective flow, being supported by diffusion alone. Their existence demonstrates the tendency of flames to resist extinction, and further emphasizes the possibility of very lean or rich mixtures to undergo combustion.

The effect of material productivity on scrap reduction on aluminum reduction pot process

NASA Astrophysics Data System (ADS)

Huda, L. N.

2018-02-01

Scrap in the production process is defined as part of production that can not be accepted as the final product due to production failure. The amount of scarp occurring in the reduction pot production process of one of the aluminum smelting furnaces exceeds the acceptance standard of 5 to 10%. This affects the amount of production produced. The purpose of this study is to reduce the amount of scrap produced to increase the productivity of the materials used. The solution is carried-out by making improvements using Lean Six Sigma method. In the initial calculation, material productivity ranged from 0.88. Based on the study, the factors that cause the high amount of scrap produced is the use of Na2O which is inserted into the alumina is different in size and the influence of noise that occurs in pots that are difficult to control. The analysis base on Lean Six Sigma obtained process cycle efficiency (PCE) equal to 86,92% for actual condition. Process improvement is carried-out through define, measure, analyze, improve and control procedure on Na2O feeding process and PCE value decrease 6,05%. This indicates that increased process capability will reduce scrap. A decrease in scrap amount of about 6% will be able to increase material productivity by 0.05%. This indicates that continuous process control is needed to decrease the number of scraps and increase productivity.

The ability of video image analysis to predict lean meat yield and EUROP score of lamb carcasses.

PubMed

Einarsson, E; Eythórsdóttir, E; Smith, C R; Jónmundsson, J V

2014-07-01

A total of 862 lamb carcasses that were evaluated by both the VIAscan® and the current EUROP classification system were deboned and the actual yield was measured. Models were derived for predicting lean meat yield of the legs (Leg%), loin (Loin%) and shoulder (Shldr%) using the best VIAscan® variables selected by stepwise regression analysis of a calibration data set (n=603). The equations were tested on validation data set (n=259). The results showed that the VIAscan® predicted lean meat yield in the leg, loin and shoulder with an R 2 of 0.60, 0.31 and 0.47, respectively, whereas the current EUROP system predicted lean yield with an R 2 of 0.57, 0.32 and 0.37, respectively, for the three carcass parts. The VIAscan® also predicted the EUROP score of the trial carcasses, using a model derived from an earlier trial. The EUROP classification from VIAscan® and the current system were compared for their ability to explain the variation in lean yield of the whole carcass (LMY%) and trimmed fat (FAT%). The predicted EUROP scores from the VIAscan® explained 36% of the variation in LMY% and 60% of the variation in FAT%, compared with the current EUROP system that explained 49% and 72%, respectively. The EUROP classification obtained by the VIAscan® was tested against a panel of three expert classifiers (n=696). The VIAscan® classification agreed with 82% of conformation and 73% of the fat classes assigned by a panel of expert classifiers. It was concluded that VIAscan® provides a technology that can directly predict LMY% of lamb carcasses with more accuracy than the current EUROP classification system. The VIAscan® is also capable of classifying lamb carcasses into EUROP classes with an accuracy that fulfils minimum demands for the Icelandic sheep industry. Although the VIAscan® prediction of the Loin% is low, it is comparable to the current EUROP system, and should not hinder the adoption of the technology to estimate the yield of Icelandic lambs as it delivered a more accurate prediction for the Leg%, Shldr% and overall LMY% with negligible prediction bias.

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.

7 CFR 59.104 - Mandatory reporting of boxed beef sales.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Choice or better, USDA Choice, USDA Select, ungraded no-roll product); (iv) The grade for cow beef or packer yield and/or quality sort for cow beef (e.g., Breakers, Boners, White Cow, Cutters (lean)); (v... product delivery period; and (ix) The beef type (steer/heifer, dairy steer/heifer, or cow). (b...

Performance excellence: using Lean Six Sigma tools to improve the US Army behavioral health surveillance process, boost team morale, and maximize value to customers and stakeholders.

PubMed

Watkins, Eren Youmans; Kemeter, Dave M; Spiess, Anita; Corrigan, Elizabeth; Kateley, Keri; Wills, John V; Mancha, Brent Edward; Nichols, Jerrica; Bell, Amy Millikan

2014-01-01

Lean Six Sigma (LSS) is a process improvement, problem-solving methodology used in business and manufacturing to improve the speed, quality, and cost of products. LSS can also be used to improve knowledge-based products integral to public health surveillance. An LSS project by the Behavioral Social Health Outcomes Program of the Army Institute of Public Health reduced the number of labor hours spent producing the routine surveillance of suicidal behavior publication. At baseline, the total number of labor hours was 448; after project completion, total labor hours were 199. Based on customer feedback, publication production was reduced from quarterly to annually. Process improvements enhanced group morale and established best practices in the form of standard operating procedures and business rules to ensure solutions are sustained. LSS project participation also fostered a change in the conceptualization of tasks and projects. These results demonstrate that LSS can be used to inform the public health process and should be considered a viable method of improving knowledge-based products and processes.

Quality and patient safety in the diagnosis of breast cancer.

PubMed

Raab, Stephen S; Swain, Justin; Smith, Natasha; Grzybicki, Dana M

2013-09-01

The media, medical legal, and safety science perspectives of a laboratory medical error differ and assign variable levels of responsibility on individuals and systems. We examine how the media identifies, communicates, and interprets information related to anatomic pathology breast diagnostic errors compared to groups using a safety science Lean-based quality improvement perspective. The media approach focuses on the outcome of error from the patient perspective and some errors have catastrophic consequences. The medical safety science perspective does not ignore the importance of patient outcome, but focuses on causes including the active events and latent factors that contribute to the error. Lean improvement methods deconstruct work into individual steps consisting of tasks, communications, and flow in order to understand the affect of system design on current state levels of quality. In the Lean model, system redesign to reduce errors depends on front-line staff knowledge and engagement to change the components of active work to develop best practices. In addition, Lean improvement methods require organizational and environmental alignment with the front-line change in order to improve the latent conditions affecting components such as regulation, education, and safety culture. Although we examine instances of laboratory error for a specific test in surgical pathology, the same model of change applies to all areas of the laboratory. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

Evaluation of Columbia, USMARC-Composite, Suffolk, and Texel rams as terminal sires in an extensive rangeland production system: VIII. Quality measures of lamb longissimus dorsi.

PubMed

Mousel, M R; Notter, D R; Leeds, T D; Zerby, H N; Moeller, S J; Taylor, J B; Lewis, G S

2014-07-01

Quality measures of lamb longissimus dorsi were evaluated in 514 crossbred wether lambs to assess sire breed differences. Wethers were produced over 3 yr from single-sire matings of 22 Columbia, 22 U.S. Meat Animal Research Center (USMARC)-Composite (Composite), 21 Suffolk, and 17 Texel rams to adult Rambouillet ewes. Lambs were reared to weaning in an extensive western rangeland production system and finished in a feedlot on a high-energy finishing diet. One of three harvest groups were randomly assigned to each lamb, and lambs were transported to The Ohio State University abattoir when the mean BW of wethers remaining in the feedlot reached 54.4, 61.2, or 68.0 kg. After harvest, subjective lean quality scores were assigned and LM pH (immediately after and 24 h after harvest), color (quantified as Minolta L*, a*, and b*), intramuscular fat (IMF), cooking loss percentage, and Warner-Bratzler shear force (WBSF) were determined. Statistical models included fixed effects of sire breed, year of birth, and harvest group and random effects of sire (nested within sire breed and year) and maternal grandsire. Year and harvest group were significant (P < 0.04) for all traits, except harvest group was not for WBSF and lean quality (P > 0.28). At comparable numbers of days on feed, Texel-sired wethers had the greatest (more desirable; P < 0.01) subjective lean quality scores while Composite- and Suffolk-sired lambs were intermediate and Columbia-sired lambs had the lowest (less desirable). Minolta L* values were greater (P < 0.02) for Texel- than Columbia-sired lambs, although this difference is not visually discernible by humans. No significant (P > 0.05) sire breed effects were detected for LM pH at or 24 h after harvest, Minolta a* and b*, IMF, percentage of cooking loss, and WBSF at comparable numbers of days on feed. At comparable chilled carcass weight, significant (P < 0.01) sire breed effects were detected for subjective lean quality score. Texel-sired lambs had greater scores than Columbia- and Suffolk-sired lambs, but Composite-sired lambs did not differ from lambs sired by the other sire breeds. Sire breed effects were not detected (P > 0.15) for LM pH at or 24 h after harvest, Minolta L*, a*, and b*, cooking loss percentage, IMF, and WBSF at comparable chilled carcass weight. Therefore, results of the present study indicated that the 4 sire breeds produced crossbred lamb carcasses that had similar and desirable LM quality measurements, meeting consumer expectations.

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.

Daily Management System of the Henry Ford Production System: QTIPS to Focus Continuous Improvements at the Level of the Work.

PubMed

Zarbo, Richard J; Varney, Ruan C; Copeland, Jacqueline R; D'Angelo, Rita; Sharma, Gaurav

2015-07-01

To support our Lean culture of continuous improvement, we implemented a daily management system designed so critical metrics of operational success were the focus of local teams to drive improvements. We innovated a standardized visual daily management board composed of metric categories of Quality, Time, Inventory, Productivity, and Safety (QTIPS); frequency trending; root cause analysis; corrective/preventive actions; and resulting process improvements. In 1 year (June 2013 to July 2014), eight laboratory sections at Henry Ford Hospital employed 64 unique daily metrics. Most assessed long-term (>6 months), monitored process stability, while short-term metrics (1-6 months) were retired after successful targeted problem resolution. Daily monitoring resulted in 42 process improvements. Daily management is the key business accountability subsystem that enabled our culture of continuous improvement to function more efficiently at the managerial level in a visible manner by reviewing and acting based on data and root cause analysis. Copyright© by the American Society for Clinical Pathology.

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.

Hospital quality: a product of good management as much as good treatment.

PubMed

Hyde, Andy; Frafjord, Anders

2013-01-01

In Norway, as in most countries, the demands placed on hospitals to reduce costs and improve the quality of services are intense. Although many say that improving quality reduces costs, few can prove it. Futhermore, how many people can show that improving quality improves patient satisfaction. Diakonhjemmet hospital in Norway has designed and implemented a hospital management system based on lean principles and the PDCA (Plan-Do-Check-Act) quality circle introduced by WE Deming (Deming 2000). The results are quite impressive with improvements in quality and patient satisfaction. The hospital also runs at a profit.

Utilizing protein-lean coproducts from corn containing recombinant pharmaceutical proteins for ethanol production.

PubMed

Paraman, Ilankovan; Moeller, Lorena; Scott, M Paul; Wang, Kan; Glatz, Charles E; Johnson, Lawrence A

2010-10-13

Protein-lean fractions of corn (maize) containing recombinant (r) pharmaceutical proteins were evaluated as a potential feedstock to produce fuel ethanol. The levels of residual r-proteins in the coproduct, distillers dry grains with solubles (DDGS), were determined. Transgenic corn lines containing recombinant green fluorescence protein (r-GFP) and a recombinant subunit vaccine of Escherichia coli enterotoxin (r-LTB), primarily expressed in endosperm, and another two corn lines containing recombinant human collagen (r-CIα1) and r-GFP, primarily expressed in germ, were used as model systems. The kernels were either ground and used for fermentation or dry fractionated to recover germ-rich fractions prior to grinding for fermentation. The finished beers of whole ground kernels and r-protein-spent endosperm solids contained 127-139 and 138-155 g/L ethanol concentrations, respectively. The ethanol levels did not differ among transgenic and normal corn feedstocks, indicating the residual r-proteins did not negatively affect ethanol production. r-Protein extraction and germ removal also did not negatively affect fermentation of the remaining mass. Most r-proteins were inactivated during the mashing process used to prepare corn for fermentation. No functionally active r-GFP or r-LTB proteins were found after fermentation of the r-protein-spent solids; however, a small quantity of residual r-CIα1 was detected in DDGS, indicating that the safety of DDGS produced from transgenic grain for r-protein production needs to be evaluated for each event. Protease treatment during fermentation completely hydrolyzed the residual r-CIα1, and no residual r-proteins were detectable in DDGS.

Patterns of body image concerns and disordered weight- and shape-related behaviors in heterosexual and sexual minority adolescent males.

PubMed

Calzo, Jerel P; Masyn, Katherine E; Corliss, Heather L; Scherer, Emily A; Field, Alison E; Austin, S Bryn

2015-09-01

This study investigates body image concerns and disordered weight- and shape-related behaviors across adolescence and young adulthood in males and how patterns vary by sexual orientation. Participants were 5,388 males from the U.S. national Growing Up Today Study. In 2001, 2003, and 2005 (spanning ages 15-20 years), participants reported sexual orientation, past-year desire for toned/defined muscles and concerns with weight and shape, and past-year binge eating, restrictive dieting, purging (vomiting or laxative use), and use of products to increase muscularity (e.g., creatine, steroids). Latent class analyses identified 2 patterns at ages 15-16 years and 3 patterns at 17-18 and 19-20 years: healthy (all ages; low body image concerns and weight- and shape-related behaviors; 54-74% of observations), muscle-concerned (ages 17-18 and 19-20; relatively high muscularity concern and product use; 18-21% of observations), and lean-concerned (all ages; relatively high weight and shape concern, dieting, and binge eating; 19-28% of observations). Latent transition analyses revealed that sexual minority males (i.e., mostly heterosexual, gay, and bisexual) were more likely than completely heterosexual males to be lean-concerned at ages 17-18 and 19-20 years and to transition to the lean-concerned class from the healthy class. There were no sexual orientation differences in odds of being muscle-concerned. Both heterosexual and sexual minority males are at risk for presenting body image concerns and weight- and shape-related behaviors that may have deleterious health consequences. Results suggest the need for screening for concerns and behaviors related to leanness and muscularity in early adolescence among all males, regardless of sexual orientation. (c) 2015 APA, all rights reserved).

Patterns of Body Image Concerns and Disordered Weight- and Shape-Related Behaviors in Heterosexual and Sexual Minority Adolescent Males

PubMed Central

Calzo, Jerel P.; Masyn, Katherine E.; Corliss, Heather L.; Scherer, Emily A.; Field, Alison E.; Austin, S. Bryn

2015-01-01

This study investigates body image concerns and disordered weight- and shape-related behaviors across adolescence and young adulthood in males and how patterns vary by sexual orientation. Participants were 5,388 males from the US national Growing Up Today Study. In 2001, 2003, and 2005 (spanning ages 15–20 years) participants reported sexual orientation, past-year desire for toned/defined muscles and concerns with weight and shape, and past-year binge eating, restrictive dieting, purging (vomiting or laxative use) and use of products to increase muscularity (e.g., creatine, steroids). Latent class analyses identified two patterns at ages 15–16 years and three patterns at 17–18 and 19–20 years: Healthy (all ages; low body image concerns and weight-and shape-related behaviors; 54%–74% of observations), Muscle-Concerned (ages 17–18 and 19– 20; relatively high muscularity concern and product use; 18%–21% of observations), and Lean-Concerned (all ages; relatively high weight and shape concern, dieting, and binge eating; 19%– 28% of observations). Latent transition analyses revealed that sexual minority males (i.e., mostly heterosexual, gay, and bisexual) were more likely than completely heterosexual males to be Lean-Concerned at ages 17–18 and 19–20 years and to transition to the Lean-Concerned class from the Healthy class. There were no sexual orientation differences in odds of being Muscle-Concerned. Both heterosexual and sexual minority males are at risk for presenting body image concerns and weight- and shape-related behaviors that may have deleterious health consequences. Results suggest the need for screening for concerns and behaviors related to leanness and muscularity in early adolescence among all males, regardless of sexual orientation. PMID:26098578

Lean six sigma methodologies improve clinical laboratory efficiency and reduce turnaround times.

PubMed

Inal, Tamer C; Goruroglu Ozturk, Ozlem; Kibar, Filiz; Cetiner, Salih; Matyar, Selcuk; Daglioglu, Gulcin; Yaman, Akgun

2018-01-01

Organizing work flow is a major task of laboratory management. Recently, clinical laboratories have started to adopt methodologies such as Lean Six Sigma and some successful implementations have been reported. This study used Lean Six Sigma to simplify the laboratory work process and decrease the turnaround time by eliminating non-value-adding steps. The five-stage Six Sigma system known as define, measure, analyze, improve, and control (DMAIC) is used to identify and solve problems. The laboratory turnaround time for individual tests, total delay time in the sample reception area, and percentage of steps involving risks of medical errors and biological hazards in the overall process are measured. The pre-analytical process in the reception area was improved by eliminating 3 h and 22.5 min of non-value-adding work. Turnaround time also improved for stat samples from 68 to 59 min after applying Lean. Steps prone to medical errors and posing potential biological hazards to receptionists were reduced from 30% to 3%. Successful implementation of Lean Six Sigma significantly improved all of the selected performance metrics. This quality-improvement methodology has the potential to significantly improve clinical laboratories. © 2017 Wiley Periodicals, Inc.

76 FR 5610 - Notice Pursuant to the National Cooperative Research and Production Act of 1993-Network Centric...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-01

... Production Act of 1993--Network Centric Operations Industry Consortium, Inc. Notice is hereby given that, on..., 15 U.S.C. 4301 et seq. (``the Act''), Network Centric Operations Industry Consortium, Inc. (``NCOIC...&D Institute, Gdynia, POLAND; Solera Networks, Lindon, UT; and Dataline, LLC, McLean, VA, have...

78 FR 7428 - Clean Air Act Operating Permit Program; Petition for Objection to State Operating Permit for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-01

... the March 28, 2011 petition, submitted by the Louisiana Environmental Action Network (LEAN), Sierra..., 2011 to Noranda Alumina, LLC, for the operation of the alumina production plant located in Gramercy, St... production plant in Gramercy, St. James Parish, Louisiana for the following reasons: (1) The Title V Permit...

Energy requirements, protein-energy metabolism and balance, and carbohydrates in preterm infants.

PubMed

Hay, William W; Brown, Laura D; Denne, Scott C

2014-01-01

Energy is necessary for all vital functions of the body at molecular, cellular, organ, and systemic levels. Preterm infants have minimum energy requirements for basal metabolism and growth, but also have requirements for unique physiology and metabolism that influence energy expenditure. These include body size, postnatal age, physical activity, dietary intake, environmental temperatures, energy losses in the stool and urine, and clinical conditions and diseases, as well as changes in body composition. Both energy and protein are necessary to produce normal rates of growth. Carbohydrates (primarily glucose) are principle sources of energy for the brain and heart until lipid oxidation develops over several days to weeks after birth. A higher protein/energy ratio is necessary in most preterm infants to approximate normal intrauterine growth rates. Lean tissue is predominantly produced during early gestation, which continues through to term. During later gestation, fat accretion in adipose tissue adds increasingly large caloric requirements to the lean tissue growth. Once protein intake is sufficient to promote net lean body accretion, additional energy primarily produces more body fat, which increases almost linearly at energy intakes >80-90 kcal/kg/day in normal, healthy preterm infants. Rapid gains in adiposity have the potential to produce later life obesity, an increasingly recognized risk of excessive energy intake. In addition to fundamental requirements for glucose, protein, and fat, a variety of non-glucose carbohydrates found in human milk may have important roles in promoting growth and development, as well as production of a gut microbiome that could protect against necrotizing enterocolitis. © 2014 S. Karger AG, Basel.

Assessment of lamb carcass composition from live animal measurement of bioelectrical impedance or ultrasonic tissue depths.

PubMed

Berg, E P; Neary, M K; Forrest, J C; Thomas, D L; Kauffman, R G

1996-11-01

Market weight lambs, average weight 52.5 kg (+/-6.1), were used to evaluate nontraditional live animal measurements as predictors of carcass composition. The sample population (n = 106) represented U.S. market lambs and transcended geographic location, breed, carcass weight, yield grade, and production system. Realtime ultrasonic (RU) measurements and bioelectrical impedance analysis (BIA) were used for development and evaluation of prediction equations for % boneless, closely trimmed primal cuts (BCTPC), weight or % of dissected lean tissue (TDL), and chemically derived weight or % fat-free lean (FFL). Longitudinal ultrasonic images were obtained parallel to the longissimus thoracis et lumborum (LTL), positioning the last costae in the center of the transducer head. Images were saved and fat and LTL depths were derived from printed images of the ultrasonic scans. Bioelectrical impedance analysis was administered via a four-terminal impedance plethysmograph operating at 800 microA at 50 kHz. Impedance measurements of whole-body resistance and reactance were recorded. Prediction equations including common linear measurements of live weight, heart girth, hindsaddle length, and shoulder height were also evaluated. All measurements were taken just before slaughter. Bioelectrical impedance measurements (as compared to RU and linear measurements) provided equations for %BCTPC, TDL, %TDL, FFL and %FFL with the highest R2 and lowest root mean square error. Even though BIA provided the best equations of the three methodologies tested, prediction of proportional yield (%BCTPC, %TDL, and %FFL) was marginal (R2 = .296, .551, and .551, respectively). Equations combining BIA, RU, and linear measurements greatly improved equations for prediction of proportional lean yield.

Low NO(x) potential of gas turbine engines

NASA Technical Reports Server (NTRS)

Tacina, Robert R.

1990-01-01

The purpose is to correlate emission levels of gas turbine engines. The predictions of NO(x) emissions are based on a review of the literature of previous low NO(x) combustor programs and analytical chemical kinetic calculations. Concepts included in the literature review consisted of lean-premixed-prevaporized (LPP), rich burn/quick quench/lean burn (RQL), and direct injection. The NO(x) emissions were found to be an exponential function of adiabatic combustion temperature over a wide range of inlet temperatures, pressures and (lean) fuel-air ratios. A simple correlation of NO(x) formation with time was not found. The LPP and direct injection (using gaseous fuels) concepts have the lowest NO(x) emissions of the three concepts. The RQL data has higher values of NO(x) than the LPP concept, probably due to the stoichiometric temperatures and NO(x) production that occur during the quench step. Improvements in the quick quench step could reduce the NO(x) emissions to the LPP levels. The low NO(x) potential of LPP is offset by the operational disadvantages of its narrow stability limits and its susceptibility to autoignition/flashback. The Rich-Burn/Quick-Quench/Lean-Burn (RQL) and the direct injection concepts have the advantage of wider stability limits comparable to conventional combustors.

Trimetazidine therapy for diabetic mouse hearts subjected to ex vivo acute heart failure.

PubMed

Breedt, Emilene; Lacerda, Lydia; Essop, M Faadiel

2017-01-01

Acute heart failure (AHF) is the most common primary diagnosis for hospitalized heart diseases in Africa. As increased fatty acid β-oxidation (FAO) during heart failure triggers detrimental effects on the myocardium, we hypothesized that trimetazidine (TMZ) (partial FAO inhibitor) offers cardioprotection under normal and obese-related diabetic conditions. Hearts were isolated from 12-14-week-old obese male and female diabetic (db/db) mice versus lean non-diabetic littermates (db/+) controls. The Langendorff retrograde isolated heart perfusion system was employed to establish an ex vivo AHF model: a) Stabilization phase-Krebs Henseleit buffer (10 mM glucose) at 100 mmHg (25 min); b) Critical Acute Heart Failure (CAHF) phase-(1.2 mM palmitic acid, 2.5 mM glucose) at 20 mmHg (25 min); and c) Recovery Acute Heart Failure phase (RAHF)-(1.2 mM palmitic acid, 10 mM glucose) at 100 mmHg (25 min). Treated groups received 5 μM TMZ in the perfusate during either the CAHF or RAHF stage for the full duration of each respective phase. Both lean and obese males benefited from TMZ treatment administered during the RAHF phase. Sex differences were observed only in lean groups where the phases of the estrous cycle influenced therapy; only the lean follicular female group responded to TMZ treatment during the CAHF phase. Lean luteal females rather displayed an inherent cardioprotection (without treatments) that was lost with obesity. However, TMZ treatment initiated during RAHF was beneficial for obese luteal females. TMZ treatment triggered significant recovery for male and obese female hearts when administered during RAHF. There were no differences between lean and obese male hearts, while lean females displayed a functional recovery advantage over lean males. Thus TMZ emerges as a worthy therapeutic target to consider for AHF treatment in normal and obese-diabetic individuals (for both sexes), but only when administered during the recovery phase and not during the very acute stages.

An Overview of NASA Research on Positive Displacement Type General Aviation Engines

NASA Technical Reports Server (NTRS)

Kempke, E. E.; Willis, E. A.

1979-01-01

The general aviation positive displacement engine program encompassing conventional, lightweight diesel, and rotary combustion engines is described. Lean operation of current production type spark ignition engines and advanced alternative engine concepts are emphasized.

Chemical cleaning re-invented: clean, lean and green.

PubMed

Hanson, Margaret; Vangeel, Michel

2014-01-01

A project undertaken in the Central Cleaning Department of Janssen, a Johnson and Johnson pharmaceutical company, demonstrates how ergonomics, environmental and industrial hygiene risks and quality concerns can be tackled simultaneously. The way equipment was cleaned was re-designed by an in-house cross-functional team to ensure a 'clean, lean and green' process. Initiatives included a new layout of the area, and new work processes and equipment to facilitate cleaning and handling items. This resulted in significant improvements: all ergonomics high risk tasks were reduced to moderate or low risk; hearing protection was no longer required; respirator requirement reduced by 67%; solvent use reduced by 73%; productivity improved, with 55% fewer operator hours required; and quality improved 40-fold. The return on investment was estimated at 3.125 years based on an investment of over €1.5 million (2008 prices). This win-win intervention allowed ergonomics, environmental, industrial hygiene, productivity and quality concerns all to be addressed.

Effects of different acute hypoxic regimens on tissue oxygen profiles and metabolic outcomes

PubMed Central

Bevans-Fonti, Shannon; Drager, Luciano F.; Shin, Mi-Kyung; Polotsky, Vsevolod Y.

2011-01-01

Obstructive sleep apnea (OSA) causes intermittent hypoxia (IH) during sleep. Both obesity and OSA are associated with insulin resistance and systemic inflammation, which may be attributable to tissue hypoxia. We hypothesized that a pattern of hypoxic exposure determines both oxygen profiles in peripheral tissues and systemic metabolic outcomes, and that obesity has a modifying effect. Lean and obese C57BL6 mice were exposed to 12 h of intermittent hypoxia 60 times/h (IH60) [inspired O2 fraction (FiO2) 21–5%, 60/h], IH 12 times/h (FiO2 5% for 15 s, 12/h), sustained hypoxia (SH; FiO2 10%), or normoxia while fasting. Tissue oxygen partial pressure (PtiO2) in liver, skeletal muscle and epididymal fat, plasma leptin, adiponectin, insulin, blood glucose, and adipose tumor necrosis factor-α (TNF-α) were measured. In lean mice, IH60 caused oxygen swings in the liver, whereas fluctuations of PtiO2 were attenuated in muscle and abolished in fat. In obese mice, baseline liver PtiO2 was lower than in lean mice, whereas muscle and fat PtiO2 did not differ. During IH, PtiO2 was similar in obese and lean mice. All hypoxic regimens caused insulin resistance. In lean mice, hypoxia significantly increased leptin, especially during SH (44-fold); IH60, but not SH, induced a 2.5- to 3-fold increase in TNF-α secretion by fat. Obesity was associated with striking increases in leptin and TNF-α, which overwhelmed effects of hypoxia. In conclusion, IH60 led to oxygen fluctuations in liver and muscle and steady hypoxia in fat. IH and SH induced insulin resistance, but inflammation was increased only by IH60 in lean mice. Obesity caused severe inflammation, which was not augmented by acute hypoxic regimens. PMID:21737828

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.

Lean methodology in health care.

PubMed

Kimsey, Diane B

2010-07-01

Lean production is a process management philosophy that examines organizational processes from a customer perspective with the goal of limiting the use of resources to those processes that create value for the end customer. Lean manufacturing emphasizes increasing efficiency, decreasing waste, and using methods to decide what matters rather than accepting preexisting practices. A rapid improvement team at Lehigh Valley Health Network, Allentown, Pennsylvania, implemented a plan, do, check, act cycle to determine problems in the central sterile processing department, test solutions, and document improved processes. By using A3 thinking, a consensus building process that graphically depicts the current state, the target state, and the gaps between the two, the team worked to improve efficiency and safety, and to decrease costs. Use of this methodology has increased teamwork, created user-friendly work areas and processes, changed management styles and expectations, increased staff empowerment and involvement, and streamlined the supply chain within the perioperative area. Copyright (c) 2010 AORN, Inc. Published by Elsevier Inc. All rights reserved.

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

Using lean manufacturing principles to evaluate wait times for HIV-positive patients in an urban clinic in Kenya.

PubMed

Monroe-Wise, Aliza; Reisner, Elizabeth; Sherr, Kenneth; Ojakaa, David; Mbau, Lilian; Kisia, Paul; Muhula, Samuel; Farquhar, Carey

2017-12-01

As human immunodeficiency virus (HIV) treatment programs expand in Africa, delivery systems must be strengthened to support patient retention. Clinic characteristics may affect retention, but a relationship between clinic flow and attrition is not established. This project characterized HIV patient experience and flow in an urban Kenyan clinic to understand how these may affect retention. We used Toyota's lean manufacturing principles to guide data collection and analysis. Clinic flow was evaluated using value stream mapping and time and motion techniques. Clinic register data were analyzed. Two focus group discussions were held to characterize HIV patient experience. Results were shared with clinic staff. Wait times in the clinic were highly variable. We identified four main barriers to patient flow: inconsistent patient arrivals, inconsistent staffing, filing system defects, and serving patients out of order. Focus group participants explained how clinic operations affected their ability to engage in care. Clinic staff were eager to discuss the problems identified and identified numerous low-cost potential solutions. Lean manufacturing methodologies can guide efficiency interventions in low-resource healthcare settings. Using lean techniques, we identified bottlenecks to clinic flow and low-cost solutions to improve wait times. Improving flow may result in increased patient satisfaction and retention.

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.

Thromboxane production in morbidly obese subjects.

PubMed

Graziani, Francesca; Biasucci, Luigi M; Cialdella, Pio; Liuzzo, Giovanna; Giubilato, Simona; Della Bona, Roberta; Pulcinelli, Fabio M; Iaconelli, Amerigo; Mingrone, Geltrude; Crea, Filippo

2011-06-01

Postmortem studies have demonstrated that morbidly obese subjects, surprisingly, have less coronary atherosclerosis than obese subjects. However, the reasons for this apparent protection from atherosclerosis are not yet clear. Thromboxane A2, a marker of platelet activation, is greater in obese subjects than in lean subjects, and this might be a clue to their increased cardiovascular risk. However, data on thromboxane A2 in morbidly obese subjects are lacking; therefore, we hypothesized that lower levels of thromboxane A2 in morbidly obese subjects might play a role in their lower atherothrombotic burden. We measured the serum levels of thromboxane B2 (TxB2), a stable metabolite of thromboxane A2, high-sensitivity C-reactive protein (hs-CRP) and leptin in 17 lean subjects (body mass index [BMI] 22.9 ± 1.6 kg/m(2)), 25 obese subjects (BMI 32.6 ± 2.4 kg/m(2)), and 23 morbidly obese subjects (BMI 48.6 ± 7.1 kg/m(2)), without insulin resistance, diabetes, or overt cardiovascular disease. The serum TxB2 levels were lower in the lean subjects than in the obese subjects (p = 0.046) and in the morbidly obese subjects than in the lean and obese subjects (p = 0.015 and p <0.001, respectively). In contrast, the hs-CRP and leptin levels were greater in the obese than in the lean subjects (hs-CRP, p <0.001; leptin, p <0.001) and in the morbidly obese subjects than in the lean subjects (p <0.001 for both). Leptin was also higher in the morbidly obese subjects than in the obese subjects (p <0.001). TxB2 negatively correlated with leptin and BMI. hs-CRP correlated with leptin, and both also correlated with waist circumference, BMI, and homeostasis model assessment of insulin-resistance. In conclusion, insulin-sensitive morbidly obese subjects had lower levels of TxB2 than the obese subjects and lean subjects, suggesting that reduced platelet activation could play a role in the paradoxical protection of morbidly obese subjects from atherosclerosis, despite the greater levels of leptin. Copyright © 2011 Elsevier Inc. All rights reserved.

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

Validation of double Langmuir probe in-orbit performance onboard a nano-satellite

NASA Astrophysics Data System (ADS)

Tejumola, Taiwo Raphael; Zarate Segura, Guillermo Wenceslao; Kim, Sangkyun; Khan, Arifur; Cho, Mengu

2018-03-01

Many plasma measurement systems have been proposed and used onboard different satellites to characterize space plasma. Most of these systems employed the technique of Langmuir probes either using the single or double probes methods. Recent growth of lean satellites has positioned it on advantage to be used for space science missions using Langmuir probes because of its simplicity and convenience. However, single Langmuir probes are not appropriate to be used on lean satellites because of their limited conducting area which leads to spacecraft charging and drift of the instrument's electrical ground during measurement. Double Langmuir probes technique can overcome this limitation, as a measurement reference in relation to the spacecraft is not required. A double Langmuir probe measurement system was designed and developed at Kyushu Institute of Technology for HORYU-IV satellite, which is a 10 kg, 30 cm cubic class lean satellite launched into Low Earth Orbit on 17th February 2016. This paper presents the on-orbit performance and validation of the double Langmuir probe measurement using actual on-orbit measured data and computer simulations.

Targeting the gut microbiome to treat the osteoarthritis of obesity.

PubMed

Schott, Eric M; Farnsworth, Christopher W; Grier, Alex; Lillis, Jacquelyn A; Soniwala, Sarah; Dadourian, Gregory H; Bell, Richard D; Doolittle, Madison L; Villani, David A; Awad, Hani; Ketz, John P; Kamal, Fadia; Ackert-Bicknell, Cheryl; Ashton, John M; Gill, Steven R; Mooney, Robert A; Zuscik, Michael J

2018-04-19

Obesity is a risk factor for osteoarthritis (OA), the greatest cause of disability in the US. The impact of obesity on OA is driven by systemic inflammation, and increased systemic inflammation is now understood to be caused by gut microbiome dysbiosis. Oligofructose, a nondigestible prebiotic fiber, can restore a lean gut microbial community profile in the context of obesity, suggesting a potentially novel approach to treat the OA of obesity. Here, we report that - compared with the lean murine gut - obesity is associated with loss of beneficial Bifidobacteria, while key proinflammatory species gain in abundance. A downstream systemic inflammatory signature culminates with macrophage migration to the synovium and accelerated knee OA. Oligofructose supplementation restores the lean gut microbiome in obese mice, in part, by supporting key commensal microflora, particularly Bifidobacterium pseudolongum. This is associated with reduced inflammation in the colon, circulation, and knee and protection from OA. This observation of a gut microbiome-OA connection sets the stage for discovery of potentially new OA therapeutics involving strategic manipulation of specific microbial species inhabiting the intestinal space.

Targeting the gut microbiome to treat the osteoarthritis of obesity

PubMed Central

Schott, Eric M.; Farnsworth, Christopher W.; Grier, Alex; Lillis, Jacquelyn A.; Soniwala, Sarah; Dadourian, Gregory H.; Bell, Richard D.; Doolittle, Madison L.; Villani, David A.; Ketz, John P.; Kamal, Fadia; Ackert-Bicknell, Cheryl; Ashton, John M.; Gill, Steven R.; Mooney, Robert A.

2018-01-01

Obesity is a risk factor for osteoarthritis (OA), the greatest cause of disability in the US. The impact of obesity on OA is driven by systemic inflammation, and increased systemic inflammation is now understood to be caused by gut microbiome dysbiosis. Oligofructose, a nondigestible prebiotic fiber, can restore a lean gut microbial community profile in the context of obesity, suggesting a potentially novel approach to treat the OA of obesity. Here, we report that — compared with the lean murine gut — obesity is associated with loss of beneficial Bifidobacteria, while key proinflammatory species gain in abundance. A downstream systemic inflammatory signature culminates with macrophage migration to the synovium and accelerated knee OA. Oligofructose supplementation restores the lean gut microbiome in obese mice, in part, by supporting key commensal microflora, particularly Bifidobacterium pseudolongum. This is associated with reduced inflammation in the colon, circulation, and knee and protection from OA. This observation of a gut microbiome–OA connection sets the stage for discovery of potentially new OA therapeutics involving strategic manipulation of specific microbial species inhabiting the intestinal space. PMID:29669931

Using lean methodology to decrease wasted RN time in seeking supplies in emergency departments.

PubMed

Richardson, David M; Rupp, Valerie A; Long, Kayla R; Urquhart, Megan C; Ricart, Erin; Newcomb, Lindsay R; Myers, Paul J; Kane, Bryan G

2014-11-01

Timely stocking of essential supplies in an emergency department (ED) is crucial to efficient and effective patient care. The objective of this study was to decrease wasted nursing time in obtaining needed supplies in an ED through the use of Lean process controls. As part of a Lean project, the team conducted a "before and after" prospective observation study of ED nurses seeking supplies. Nurses were observed for an entire shift for the time spent outside the patient room obtaining supplies at baseline and after implementation of a point-of-use storage system. Before implementation, nurses were leaving patient rooms a median of 11 times per 8-hour shift (interquartile range [IQR], 8 times per 8-hour shift) and 10 times per 12-hour shift (IQR, 23 times per 12-hour shift). After implementation of the new system, the numbers decreased to 2.5 per 8-hour shift (IQR, 2 per 8-hour shift) and 1 per 12-hour shift (IQR, 1 per 12-hour shift). A redesigned process including a standardized stocking system significantly decreases the number of searches by nurses for supplies.

[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.

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.

Total and Lower Extremity Lean Mass Percentage Positively Correlates With Jump Performance.

PubMed

Stephenson, Mitchell L; Smith, Derek T; Heinbaugh, Erika M; Moynes, Rebecca C; Rockey, Shawn S; Thomas, Joi J; Dai, Boyi

2015-08-01

Strength and power have been identified as valuable components in both athletic performance and daily function. A major component of strength and power is the muscle mass, which can be assessed with dual-energy x-ray absorptiometry (DXA). The primary purpose of this study was to quantify the relationship between total body lean mass percentage (TBLM%) and lower extremity lean mass percentage (LELM%) and lower extremity force/power production during a countermovement jump (CMJ) in a general population. Researchers performed a DXA analysis on 40 younger participants aged 18-35 years, 28 middle-aged participants aged 36-55 years, and 34 older participants aged 56-75 years. Participants performed 3 CMJ on force platforms. Correlations revealed significant and strong relationships between TBLM% and LELM% compared with CMJ normalized peak vertical ground reaction force (p < 0.001, r = 0.59), normalized peak vertical power (p < 0.001, r = 0.73), and jump height (p < 0.001, r = 0.74) for the combined age groups. Most relationships were also strong within each age group, with some relationships being relatively weaker in the middle-aged and older groups. Minimal difference was found between correlation coefficients of TBLM% and LELM%. Coefficients of determination were all below 0.6 for the combined group, indicating that between-participant variability in CMJ measures cannot be completely explained by lean mass percentages. The findings have implications in including DXA-assessed lean mass percentage as a component for evaluating lower extremity strength and power. A paired DXA analysis and CMJ jump test may be useful for identifying neuromuscular deficits that limit performance.

The Participative Design of an Endoscopy Facility using Lean 3P

PubMed Central

Smith, Iain

2016-01-01

In the UK, bowel cancer is the second largest cancer killer. Diagnosing people earlier can save lives but demand for endoscopies is increasing and this can put pressure on waiting times. To address this challenge, an endoscopy unit in North East England decided to improve their facilities to increase capacity and create environments that improve the experience of users. This presented a significant opportunity for step change improvement but also a problem in terms of creating designs that meet user requirements whilst addressing structural or space constraints. The Lean design process known as ‘3P' (standing for the production preparation process) was utilised as a participative design strategy to engage stakeholders in the design of the new department. This involved a time-out workshop (or 3P event) in which Lean and participative design tools were utilised to create an innovative design based on ‘point of delivery' (POD) principles. The team created a design that demonstrated an increase in treatment room capacity by 25% and bed capacity by 70% whilst reducing travel distance for patients by 25.8% and staff by 27.1%. This was achieved with an increase in available space of only 13%. The Lean 3P method provided a structured approach for corporate and clinical staff to work together with patient representatives as cross-functional teams. This participative approach facilitated communication and learning between stakeholders about care processes and personal preferences. Lean 3P therefore appears to be a promising approach to improving the healthcare facilities design process to meet user requirements. PMID:27493744

Research on information security system of waste terminal disposal process

NASA Astrophysics Data System (ADS)

Zhou, Chao; Wang, Ziying; Guo, Jing; Guo, Yajuan; Huang, Wei

2017-05-01

Informatization has penetrated the whole process of production and operation of electric power enterprises. It not only improves the level of lean management and quality service, but also faces severe security risks. The internal network terminal is the outermost layer and the most vulnerable node of the inner network boundary. It has the characteristics of wide distribution, long depth and large quantity. The user and operation and maintenance personnel technical level and security awareness is uneven, which led to the internal network terminal is the weakest link in information security. Through the implementation of security of management, technology and physics, we should establish an internal network terminal security protection system, so as to fully protect the internal network terminal information security.

Quality Management in Astronomical Software and Data Systems

NASA Astrophysics Data System (ADS)

Radziwill, N. M.

2007-10-01

As the demand for more sophisticated facilities increases, the complexity of the technical and organizational challenges faced by operational space- and ground-based telescopes also increases. In many organizations, funding tends not to be proportional to this trend, and steps must be taken to cultivate a lean environment in both development and operations to consistently do more with less. To facilitate this transition, an organization must be aware of how it can meet quality-related goals, such as reducing variation, improving productivity of people and systems, streamlining processes, ensuring compliance with requirements (scientific, organizational, project, or regulatory), and increasing user satisfaction. Several organizations are already on this path. Quality-based techniques for the efficient, effective development of new telescope facilities and maintenance of existing facilities are described.

The Application of Lean Thinking to the Care of Patients With Bone and Brain Metastasis With Radiation Therapy

PubMed Central

Kim, Christopher S.; Hayman, James A.; Billi, John E.; Lash, Kathy; Lawrence, Theodore S.

2007-01-01

Purpose Patients with bone and brain metastases are among the most symptomatic nonemergency patients treated by radiation oncologists. Treatment should begin as soon as possible after the request is generated. We tested the hypothesis that the operational improvement method based on lean thinking could help streamline the treatment of our patients referred for bone and brain metastases. Methods University of Michigan Health System has adopted lean thinking as a consistent approach to quality and process improvement. We applied the principles and tools of lean thinking, especially value as defined by the customer, value stream mapping processes, and one piece flow, to improve the process of delivering care to patients referred for bone or brain metastases. Results and Conclusion The initial evaluation of the process revealed that it was rather chaotic and highly variable. Implementation of the lean thinking principles permitted us to improve the process by cutting the number of individual steps to begin treatment from 27 to 16 and minimize variability by applying standardization. After an initial learning period, the percentage of new patients with brain or bone metastases receiving consultation, simulation, and treatment within the same day rose from 43% to nearly 95%. By implementing the ideas of lean thinking, we improved the delivery of clinical care for our patients with bone or brain metastases. We believe these principles can be applied to much of the care administered throughout our and other health care delivery areas. PMID:20859409

Toward lean satellites reliability improvement using HORYU-IV project as case study

NASA Astrophysics Data System (ADS)

Faure, Pauline; Tanaka, Atomu; Cho, Mengu

2017-04-01

Lean satellite programs are programs in which the satellite development philosophy is driven by fast delivery and low cost. Though this concept offers the possibility to develop and fly risky missions without jeopardizing a space program, most of these satellites suffer infant mortality and fail to achieve their mission minimum success. Lean satellites with high infant mortality rate indicate that testing prior to launch is insufficient. In this study, the authors monitored failures occurring during the development of the lean satellite HORYU-IV to identify the evolution of the cumulative number of failures against cumulative testing time. Moreover, the sub-systems driving the failures depending on the different development phases were identified. The results showed that half to 2/3 of the failures are discovered during the early stage of testing. Moreover, when the mean time before failure was calculated, it appeared that for any development phase considered, a new failure appears on average every 20 h of testing. Simulations were also performed and it showed that for an initial testing time of 50 h, reliability after 1 month launch can be improved by nearly 6 times as compared to an initial testing time of 20 h. Through this work, the authors aim at providing a qualitative reference for lean satellites developers to better help them manage resources to develop lean satellites following a fast delivery and low cost philosophy while ensuring sufficient reliability to achieve mission minimum success.

The application of lean thinking to the care of patients with bone and brain metastasis with radiation therapy.

PubMed

Kim, Christopher S; Hayman, James A; Billi, John E; Lash, Kathy; Lawrence, Theodore S

2007-07-01

Patients with bone and brain metastases are among the most symptomatic nonemergency patients treated by radiation oncologists. Treatment should begin as soon as possible after the request is generated. We tested the hypothesis that the operational improvement method based on lean thinking could help streamline the treatment of our patients referred for bone and brain metastases. University of Michigan Health System has adopted lean thinking as a consistent approach to quality and process improvement. We applied the principles and tools of lean thinking, especially value as defined by the customer, value stream mapping processes, and one piece flow, to improve the process of delivering care to patients referred for bone or brain metastases. The initial evaluation of the process revealed that it was rather chaotic and highly variable. Implementation of the lean thinking principles permitted us to improve the process by cutting the number of individual steps to begin treatment from 27 to 16 and minimize variability by applying standardization. After an initial learning period, the percentage of new patients with brain or bone metastases receiving consultation, simulation, and treatment within the same day rose from 43% to nearly 95%. By implementing the ideas of lean thinking, we improved the delivery of clinical care for our patients with bone or brain metastases. We believe these principles can be applied to much of the care administered throughout our and other health care delivery areas.

A critical review of the research literature on Six Sigma, Lean and StuderGroup's Hardwiring Excellence in the United States: the need to demonstrate and communicate the effectiveness of transformation strategies in healthcare

PubMed Central

Vest, Joshua R; Gamm, Larry D

2009-01-01

Background U.S. healthcare organizations are confronted with numerous and varied transformational strategies promising improvements along all dimensions of quality and performance. This article examines the peer-reviewed literature from the U.S. for evidence of effectiveness among three current popular transformational strategies: Six Sigma, Lean/Toyota Production System, and Studer's Hardwiring Excellence. Methods The English language health, healthcare management, and organizational science literature (up to December 2007) indexed in Medline, Web of Science, ABI/Inform, Cochrane Library, CINAHL, and ERIC was reviewed for studies on the aforementioned transformation strategies in healthcare settings. Articles were included if they: appeared in a peer-reviewed journal; described a specific intervention; were not classified as a pilot study; provided quantitative data; and were not review articles. Nine references on Six Sigma, nine on Lean/Toyota Production System, and one on StuderGroup meet the study's eligibility criteria. Results The reviewed studies universally concluded the implementations of these transformation strategies were successful in improving a variety of healthcare related processes and outcomes. Additionally, the existing literature reflects a wide application of these transformation strategies in terms of both settings and problems. However, despite these positive features, the vast majority had methodological limitations that might undermine the validity of the results. Common features included: weak study designs, inappropriate analyses, and failures to rule out alternative hypotheses. Furthermore, frequently absent was any attention to changes in organizational culture or substantial evidence of lasting effects from these efforts. Conclusion Despite the current popularity of these strategies, few studies meet the inclusion criteria for this review. Furthermore, each could have been improved substantially in order to ensure the validity of the conclusions, demonstrate sustainability, investigate changes in organizational culture, or even how one strategy interfaced with other concurrent and subsequent transformation efforts. While informative results can be gleaned from less rigorous studies, improved design and analysis can more effectively guide healthcare leaders who are motivated to transform their organizations and convince others of the need to employ such strategies. Demanding more exacting evaluation of projects consultants, or partnerships with health management researchers in academic settings, can support such efforts. PMID:19570218

A critical review of the research literature on Six Sigma, Lean and StuderGroup's Hardwiring Excellence in the United States: the need to demonstrate and communicate the effectiveness of transformation strategies in healthcare.

PubMed

Vest, Joshua R; Gamm, Larry D

2009-07-01

U.S. healthcare organizations are confronted with numerous and varied transformational strategies promising improvements along all dimensions of quality and performance. This article examines the peer-reviewed literature from the U.S. for evidence of effectiveness among three current popular transformational strategies: Six Sigma, Lean/Toyota Production System, and Studer's Hardwiring Excellence. The English language health, healthcare management, and organizational science literature (up to December 2007) indexed in Medline, Web of Science, ABI/Inform, Cochrane Library, CINAHL, and ERIC was reviewed for studies on the aforementioned transformation strategies in healthcare settings. Articles were included if they: appeared in a peer-reviewed journal; described a specific intervention; were not classified as a pilot study; provided quantitative data; and were not review articles. Nine references on Six Sigma, nine on Lean/Toyota Production System, and one on StuderGroup meet the study's eligibility criteria. The reviewed studies universally concluded the implementations of these transformation strategies were successful in improving a variety of healthcare related processes and outcomes. Additionally, the existing literature reflects a wide application of these transformation strategies in terms of both settings and problems. However, despite these positive features, the vast majority had methodological limitations that might undermine the validity of the results. Common features included: weak study designs, inappropriate analyses, and failures to rule out alternative hypotheses. Furthermore, frequently absent was any attention to changes in organizational culture or substantial evidence of lasting effects from these efforts. Despite the current popularity of these strategies, few studies meet the inclusion criteria for this review. Furthermore, each could have been improved substantially in order to ensure the validity of the conclusions, demonstrate sustainability, investigate changes in organizational culture, or even how one strategy interfaced with other concurrent and subsequent transformation efforts. While informative results can be gleaned from less rigorous studies, improved design and analysis can more effectively guide healthcare leaders who are motivated to transform their organizations and convince others of the need to employ such strategies. Demanding more exacting evaluation of projects consultants, or partnerships with health management researchers in academic settings, can support such efforts.

Body mass index predicts aldosterone production in normotensive adults on a high-salt diet.

PubMed

Bentley-Lewis, Rhonda; Adler, Gail K; Perlstein, Todd; Seely, Ellen W; Hopkins, Paul N; Williams, Gordon H; Garg, Rajesh

2007-11-01

The mechanisms underlying obesity-mediated cardiovascular disease are not fully understood. Aldosterone and insulin resistance both are associated with obesity and cardiovascular disease. The objectives of this study were to test the hypotheses that aldosterone production is elevated and associated with insulin resistance in overweight adults on a high-sodium diet. Healthy normotensive adults were categorized as lean body mass index (BMI) less than 25 kg/m(2) (n = 63) or overweight BMI 25 kg/m(2) or greater (n = 57). After 7 d of a high-sodium diet, participants fasted overnight and remained supine throughout hemodynamic and laboratory assessments and angiotensin II (AngII) stimulation. The overweight group, compared with the lean group, had higher 24-h urinary aldosterone (9.0 +/- 0.8 vs. 6.6 +/- 0.5 microg per 24 h; P = 0.003) and higher AngII-stimulated serum aldosterone (11.4 +/- 1.0 vs. 9.0 +/- 0.6 ng/dl; P = 0.04). There were no differences in 24-h urinary cortisol or sodium or supine measurements of plasma renin activity, serum aldosterone, or serum potassium. The homeostasis model assessment of insulin resistance was predicted by urinary aldosterone excretion (r = 0.32, P = 0.03) and serum aldosterone response to AngII stimulation (r = 0.28, P = 0.02) independent of age and BMI. Urinary aldosterone excretion and AngII-stimulated aldosterone are increased in overweight, compared with lean, normotensive adults. The correlation of these measures of aldosterone production with insulin resistance suggests a potential role for aldosterone in the pathophysiology of obesity-mediated insulin resistance.

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.

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.

Method and apparatus to selectively reduce NO.sub.x in an exhaust gas feedstream

DOEpatents

Schmieg, Steven J [Troy, MI; Blint, Richard J [Shelby Township, MI; Den, Ling [Sterling Heights, MI; Viola, Michael B [Macomb Township, MI; Lee, Jong-Hwan [Rochester Hills, MI

2011-08-30

A method and apparatus are described to selectively reduce NO.sub.x emissions of an internal combustion engine. An exhaust aftertreatment system includes an injection device operative to dispense a hydrocarbon reductant upstream of a silver-alumina catalytic reactor device. A control system determines a NO.sub.x concentration and hydrocarbon/NOx ratio based upon selected parameters of the exhaust gas feedstream and dispenses hydrocarbon reductant during lean engine operation. Included is a method to control elements of the feedstream during lean operation. The hydrocarbon reductant may include engine fuel.

Gout Diet

MedlinePlus

... provide complex carbohydrates. Avoid foods and beverages with high-fructose corn syrup, and limit consumption of naturally sweet fruit juices. Water. Stay well-hydrated by drinking water. Fats. Cut back on saturated ... fatty poultry and high-fat dairy products. Proteins. Focus on lean meat ...

Operationalising the Lean principles in maternity service design using 3P methodology

PubMed Central

Smith, Iain

2016-01-01

The last half century has seen significant changes to Maternity services in England. Though rates of maternal and infant mortality have fallen to very low levels, this has been achieved largely through hospital admission. It has been argued that maternity services may have become over-medicalised and service users have expressed a preference for more personalised care. NHS England's national strategy sets out a vision for a modern maternity service that continues to deliver safe care whilst also adopting the principles of personalisation. Therefore, there is a need to develop maternity services that balance safety with personal choice. To address this challenge, a maternity unit in North East England considered improving their service through refurbishment or building new facilities. Using a design process known as the production preparation process (or 3P), the Lean principles of understanding user value, mapping value-streams, creating flow, developing pull processes and continuous improvement were applied to the design of a new maternity department. Multiple stakeholders were engaged in the design through participation in a time-out (3P) workshop in which an innovative pathway and facility for maternity services were co-designed. The team created a hybrid model that they described as “wrap around care” in which the Lean concept of pull was applied to create a service and facility design in which expectant mothers were put at the centre of care with clinicians, skills, equipment and supplies drawn towards them in line with acuity changes as needed. Applying the Lean principles using the 3P method helped stakeholders to create an innovative design in line with the aspirations and objectives of the National Maternity Review. The case provides a practical example of stakeholders applying the Lean principles to maternity services and demonstrates the potential applicability of the Lean 3P approach to design healthcare services in line with policy requirements. PMID:27933146

Operationalising the Lean principles in maternity service design using 3P methodology.

PubMed

Smith, Iain

2016-01-01

The last half century has seen significant changes to Maternity services in England. Though rates of maternal and infant mortality have fallen to very low levels, this has been achieved largely through hospital admission. It has been argued that maternity services may have become over-medicalised and service users have expressed a preference for more personalised care. NHS England's national strategy sets out a vision for a modern maternity service that continues to deliver safe care whilst also adopting the principles of personalisation. Therefore, there is a need to develop maternity services that balance safety with personal choice. To address this challenge, a maternity unit in North East England considered improving their service through refurbishment or building new facilities. Using a design process known as the production preparation process (or 3P), the Lean principles of understanding user value, mapping value-streams, creating flow, developing pull processes and continuous improvement were applied to the design of a new maternity department. Multiple stakeholders were engaged in the design through participation in a time-out (3P) workshop in which an innovative pathway and facility for maternity services were co-designed. The team created a hybrid model that they described as "wrap around care" in which the Lean concept of pull was applied to create a service and facility design in which expectant mothers were put at the centre of care with clinicians, skills, equipment and supplies drawn towards them in line with acuity changes as needed. Applying the Lean principles using the 3P method helped stakeholders to create an innovative design in line with the aspirations and objectives of the National Maternity Review. The case provides a practical example of stakeholders applying the Lean principles to maternity services and demonstrates the potential applicability of the Lean 3P approach to design healthcare services in line with policy requirements.

Computer modeling of obesity links theoretical energetic measures with experimental measures of fuel use for lean and obese men.

PubMed

Rossow, Heidi A; Calvert, C Chris

2014-10-01

The goal of this research was to use a computational model of human metabolism to predict energy metabolism for lean and obese men. The model is composed of 6 state variables representing amino acids, muscle protein, visceral protein, glucose, triglycerides, and fatty acids (FAs). Differential equations represent carbohydrate, amino acid, and FA uptake and output by tissues based on ATP creation and use for both lean and obese men. Model parameterization is based on data from previous studies. Results from sensitivity analyses indicate that model predictions of resting energy expenditure (REE) and respiratory quotient (RQ) are dependent on FA and glucose oxidation rates with the highest sensitivity coefficients (0.6, 0.8 and 0.43, 0.15, respectively, for lean and obese models). Metabolizable energy (ME) is influenced by ingested energy intake with a sensitivity coefficient of 0.98, and a phosphate-to-oxygen ratio by FA oxidation rate and amino acid oxidation rate (0.32, 0.24 and 0.55, 0.65 for lean and obese models, respectively). Simulations of previously published studies showed that the model is able to predict ME ranging from 6.6 to 9.3 with 0% differences between published and model values, and RQ ranging from 0.79 to 0.86 with 1% differences between published and model values. REEs >7 MJ/d are predicted with 6% differences between published and model values. Glucose oxidation increases by ∼0.59 mol/d, RQ increases by 0.03, REE increases by 2 MJ/d, and heat production increases by 1.8 MJ/d in the obese model compared with lean model simulations. Increased FA oxidation results in higher changes in RQ and lower relative changes in REE. These results suggest that because fat mass is directly related to REE and rate of FA oxidation, body fat content could be used as a predictor of RQ. © 2014 American Society for Nutrition.

Increased consumption of dairy foods and protein during diet- and exercise-induced weight loss promotes fat mass loss and lean mass gain in overweight and obese premenopausal women.

PubMed

Josse, Andrea R; Atkinson, Stephanie A; Tarnopolsky, Mark A; Phillips, Stuart M

2011-09-01

Weight loss can have substantial health benefits for overweight or obese persons; however, the ratio of fat:lean tissue loss may be more important. We aimed to determine how daily exercise (resistance and/or aerobic) and a hypoenergetic diet varying in protein and calcium content from dairy foods would affect the composition of weight lost in otherwise healthy, premenopausal, overweight, and obese women. Ninety participants were randomized to 3 groups (n = 30/group): high protein, high dairy (HPHD), adequate protein, medium dairy (APMD), and adequate protein, low dairy (APLD) differing in the quantity of total dietary protein and dairy food-source protein consumed: 30 and 15%, 15 and 7.5%, or 15 and <2% of energy, respectively. Body composition was measured by DXA at 0, 8, and 16 wk and MRI (n = 39) to assess visceral adipose tissue (VAT) volume at 0 and 16 wk. All groups lost body weight (P < 0.05) and fat (P < 0.01); however, fat loss during wk 8-16 was greater in the HPHD group than in the APMD and APLD groups (P < 0.05). The HPHD group gained lean tissue with a greater increase during 8-16 wk than the APMD group, which maintained lean mass and the APLD group, which lost lean mass (P < 0.05). The HPHD group also lost more VAT as assessed by MRI (P < 0.05) and trunk fat as assessed by DXA (P < 0.005) than the APLD group. The reduction in VAT in all groups was correlated with intakes of calcium (r = 0.40; P < 0.05) and protein (r = 0.32; P < 0.05). Therefore, diet- and exercise-induced weight loss with higher protein and increased dairy product intakes promotes more favorable body composition changes in women characterized by greater total and visceral fat loss and lean mass gain.

Resistin production from adipose tissue is decreased in db/db obese mice, and is reversed by rosiglitazone.

PubMed

Ye, Hongying; Zhang, Herbert J; Xu, Aimin; Hoo, Ruby L C

2013-01-01

This study was designed to (1) investigate the expression profiles of resistin in db/db mice and its dynamic association with metabolic parameters; and (2) evaluate the effects of Rosiglitazone on production of resistin. Db/db mice and their lean litter mates were used for this study. Epididymal fat tissue was excised from mice of different age (from 5 to 12 weeks) for ex vivo incubation. Resistin,along with adiponectin,in serum and conditioned culture medium of epididymal fat pads were measured with immunoassays. The gene expression of resistin was determined by real-time PCR. Rosiglitazone or the vehicle (PBS) was administered into db/db mice by daily intra-gastric gavage. Differentiated 3T3-L1 adipocytes were used for in vitro evaluation. The secretion of resistin from the fat pads in db/db mice was significantly lower than that in lean mice (P<0.01). The mRNA expression of the resistin gene in fat tissue of db/db mice at the age of 5 weeks was decreased by 60.5% compared to lean controls (p<0.05). Serum levels of resistin were comparable between the obese and lean groups, perhaps due to the increased total fat mass in db/db mice. Correlation analysis showed that serum resistin levels were positively correlated to resistin secretion from fat pads(r = 0.844,P = 0.000), while negatively associated with the body weight (r = -0.515, P = 0.000) and fasting glucose level (r = -0.357, P = 0.002). Notably, treatment with rosiglitazone increased the serum resistin levels by 66.4%(P<0.05)in db/db mice. In 3T3-L1 adipocytes, Rosiglitazone (10 uM) markedly enhanced the secretion of resistin by 120% (P<0.01) and its gene expression by 78.1% (P<0.05). Both resistin gene expression and its secretion from the epididymal adipose tissue were decreased in db/db obese mice, while the insulin-sensitizing drug rosiglitazone increased resistin production. Our results do not support the role of resistin as an etiological link between obesity and diabetes.

Myeloid-Cell-Derived VEGF Maintains Brain Glucose Uptake and Limits Cognitive Impairment in Obesity.

PubMed

Jais, Alexander; Solas, Maite; Backes, Heiko; Chaurasia, Bhagirath; Kleinridders, André; Theurich, Sebastian; Mauer, Jan; Steculorum, Sophie M; Hampel, Brigitte; Goldau, Julia; Alber, Jens; Förster, Carola Y; Eming, Sabine A; Schwaninger, Markus; Ferrara, Napoleone; Karsenty, Gerard; Brüning, Jens C

2016-05-05

High-fat diet (HFD) feeding induces rapid reprogramming of systemic metabolism. Here, we demonstrate that HFD feeding of mice downregulates glucose transporter (GLUT)-1 expression in blood-brain barrier (BBB) vascular endothelial cells (BECs) and reduces brain glucose uptake. Upon prolonged HFD feeding, GLUT1 expression is restored, which is paralleled by increased expression of vascular endothelial growth factor (VEGF) in macrophages at the BBB. In turn, inducible reduction of GLUT1 expression specifically in BECs reduces brain glucose uptake and increases VEGF serum concentrations in lean mice. Conversely, myeloid-cell-specific deletion of VEGF in VEGF(Δmyel) mice impairs BBB-GLUT1 expression, brain glucose uptake, and memory formation in obese, but not in lean mice. Moreover, obese VEGF(Δmyel) mice exhibit exaggerated progression of cognitive decline and neuroinflammation on an Alzheimer's disease background. These experiments reveal that transient, HFD-elicited reduction of brain glucose uptake initiates a compensatory increase of VEGF production and assign obesity-associated macrophage activation a homeostatic role to restore cerebral glucose metabolism, preserve cognitive function, and limit neurodegeneration in obesity. Copyright © 2016 Elsevier Inc. All rights reserved.

The Effect of Air Preheat at Atmospheric Pressure on the Formation of NO(x) in the Quick-Mix Sections of an Axially Staged Combustor

NASA Technical Reports Server (NTRS)

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

1999-01-01

The Rich-burn/Quick-mix/Lean-burn (RQL) combustor concept has been proposed to minimize the formation of nitrogen oxides (NO(x)) in gas turbine systems. The success of this combustor strategy is dependent upon the efficiency of the mixing section bridging the fuel-rich and fuel-lean stages. Note that although these results were obtained from an experiment designed to study an RQL mixer, the link between mixing and NOx signatures is considerably broader than this application, in that the need to understand this link exists in most advanced combustors. The experiment reported herein was designed to study the effects of inlet air temperature on NO(x) formation in a mixing section. The results indicate that NO(x) emission is increased for all preheated cases compared to non-preheated cases. When comparing the various mixing modules, the affect of jet penetration is important, as this determines where NO(x) concentrations peak, and affects overall NO(x) production. Although jet air comprises 70 percent of the total airflow, the impact that jet air preheat has on overall NO(x) emissions is small compared to preheating both main and jet air flow.

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.

Effects of marketing group and production focus on quality and variability of adipose tissue and bellies sourced from a commercial processing facility

USDA-ARS?s Scientific Manuscript database

Objectives were to determine the effects of marketing group on quality and variability of belly and adipose tissue quality traits of pigs sourced from differing production focuses (lean vs. quality). Pigs (N = 8,042) raised in 8 barns representing 2 seasons (cold and hot) were used. Three groups wer...

The science of sustainable supply chains.

PubMed

O'Rourke, Dara

2014-06-06

Recent advances in the science and technology of global supply chain management offer near-real-time demand-response systems for decision-makers across production networks. Technology is helping propel "fast fashion" and "lean manufacturing," so that companies are better able to deliver products consumers want most. Yet companies know much less about the environmental and social impacts of their production networks. The failure to measure and manage these impacts can be explained in part by limitations in the science of sustainability measurement, as well as by weaknesses in systems to translate data into information that can be used by decision-makers inside corporations and government agencies. There also remain continued disincentives for firms to measure and pay the full costs of their supply chain impacts. I discuss the current state of monitoring, measuring, and analyzing information related to supply chain sustainability, as well as progress that has been made in translating this information into systems to advance more sustainable practices by corporations and consumers. Better data, decision-support tools, and incentives will be needed to move from simply managing supply chains for costs, compliance, and risk reduction to predicting and preventing unsustainable practices. Copyright © 2014, American Association for the Advancement of Science.

Obesity and Prader-Willi Syndrome Affect Heart Rate Recovery from Dynamic Resistance Exercise in Youth.

PubMed

Castner, Diobel M; Clark, Susan J; Judelson, Daniel A; Rubin, Daniela A

2016-01-15

Following exercise, heart rate decline is initially driven by parasympathetic reactivation and later by sympathetic withdrawal. Obesity delays endurance exercise heart rate recovery (HRR) in both children and adults. Young people with Prader-Willi Syndrome (PWS), a congenital cause for obesity, have shown a slower 60-s endurance exercise HRR compared to lean and obese children, suggesting compromised regulation. This study further evaluated effects of obesity and PWS on resistance exercise HRR at 30 and 60 s in children. PWS (8-18 years) and lean and obese controls (8-11 years) completed a weighted step-up protocol (six sets x 10 reps per leg, separated by one-minute rest), standardized using participant stature and lean body mass. HRR was evaluated by calculated HRR value (HRRV = difference between HR at test termination and 30 (HRRV30) and 60 (HRRV60) s post-exercise). PWS and obese had a smaller HRRV30 than lean ( p < 0.01 for both). Additionally, PWS had a smaller HRRV60 than lean and obese ( p = 0.01 for both). Obesity appears to delay early parasympathetic reactivation, which occurs within 30 s following resistance exercise. However, the continued HRR delay at 60 s in PWS may be explained by either blunted parasympathetic nervous system reactivation, delayed sympathetic withdrawal and/or poor cardiovascular fitness.

Prioritizing lean management practices in public and private hospitals.

PubMed

Hussain, Matloub; Malik, Mohsin

2016-05-16

Purpose - The purpose of this paper is to prioritize 21 healthcare wastes in public and private hospitals of United Arab Emirates (UAE). Design/methodology/approach - Seven healthcare wastes linked with lean management are further decomposed in to sub-criteria and to deal with this complexity of multi criteria decision-making process, analytical hierarchical process (AHP) method is used in this research. Findings - AHP framework for this study resulted in a ranking of 21 healthcare wastes in public and private hospitals of UAE. It has been found that management in private healthcare systems of UAE is putting more emphasis on the inventory waste. On the other hand, over processing waste has got highest weight in public hospitals of UAE. Research limitations/implications - The future directions of this research would be to apply a lean set of tools for the value stream optimization of the prioritized key improvement areas. Practical implications - This is a contribution to the continuing research into lean management, giving practitioners and designers a practical way for measuring and implementing lean practices across health organizations. Originality/value - The contribution of this research, through successive stages of data collection, measurement analysis and refinement, is a set of reliable and valid framework that can be subsequently used in conceptualization, prioritization of the waste reduction strategies in healthcare management.

Uncertainty in the analysis of the overall equipment effectiveness on the shop floor

NASA Astrophysics Data System (ADS)

Rößler, M. P.; Abele, E.

2013-06-01

In this article an approach will be presented which supports transparency regarding the effectiveness of manufacturing equipment by combining the fuzzy set theory with the method of the overall equipment effectiveness analysis. One of the key principles of lean production and also a fundamental task in production optimization projects is the prior analysis of the current state of a production system by the use of key performance indicators to derive possible future states. The current state of the art in overall equipment effectiveness analysis is usually performed by cumulating different machine states by means of decentralized data collection without the consideration of uncertainty. In manual data collection or semi-automated plant data collection systems the quality of derived data often diverges and leads optimization teams to distorted conclusions about the real optimization potential of manufacturing equipment. The method discussed in this paper is to help practitioners to get more reliable results in the analysis phase and so better results of optimization projects. Under consideration of a case study obtained results are discussed.

The lean ergonomics in green design of crude palm oil plant

NASA Astrophysics Data System (ADS)

Huda, L. N.; Matondang, R.

2018-02-01

Ergonomics can help manufacturing and industrial engineersmaximum work output without physical harm to workers.Physiology, biomechanics, anthropometrics, and allocation are the areas of ergonomics most useful to manufacturing in apllying the concept of Lean and Green in manufacturing. These systems require efficient production and low use of resources such as energy and material. Its philosophy encourage worker to look at waste. This concept is applied in one of national plant of Crude Palm Oil (CPO) that located in North Sumatera. The problem found in the company are the working posture and excessive workload of the workers. These conditions are affects to the their job performance. The study was carried out by evaluated the worker body position using the Work Posture Assesment (WPA) and Biomechanics method. The WPA results shows the operator’s working position was mostly bent more than 30 degrees. This indicates that almost all workers are felt musculoskeletal disorders during work hours. While the biomechanics analysis found the significant relation between the values of Recommended Weight Limit (RWL) and Lifting Index (LI) which the increase of RWL value will decrease the LI value. This indicated that the recommended load for a worker under certain circumstances affects the appointment made so as not to contain the risk of spinal injury. In fact these condition are due to in-efficiency in production which can be maintaned the green design of CPO plant by improving the existing work.

Implementation of Inventory Management System (IMS) case study on XYZ online store business unit

NASA Astrophysics Data System (ADS)

Bagus Yosan, R.; Kholil, Muhammad; Hanum, Bhetriza

2018-03-01

XYZ baby and child shop is a new player in the business of selling toys and baby gears. Consumers target for XYZ toy shop is segmentation of middle and upper financial ability buyers. XYZ toy store sells imported toys and baby products with high quality products, using international grade production materials and ISO production certificates: 9002. With this conceptual, establishment XYZ business line is as a provider (seller) toys and baby equipment premium brand; then the scope of the product sold must meet all expectations of market demands. Meet the expectations of market demand is not easy; because by fulfilling all expectations, then the impact is the high stock of goods that must be available. The high stock of goods will directly impact on the needs of a large storage area of goods and reduce money. Based on the previous description, the formulation of the problem in this research is: "What inventory management strategy can be applied to improve the productivity of Lean Manufacturing business unit of XYZ online store?"

Lean principles to optimize instrument utilization for spine surgery in an academic medical center: an opportunity to standardize, cut costs, and build a culture of improvement.

PubMed

Lunardini, David; Arington, Richard; Canacari, Elena G; Gamboa, Kelly; Wagner, Katiri; McGuire, Kevin J

2014-09-15

Case study OBJECTIVE.: To optimize the utilization of operating room instruments for orthopedic and neurosurgical spine cases in an urban level 1 academic medical center through application of Lean principles. Process improvement systems such as Lean have been adapted to health care and offer an opportunity for frank assessment of surgical routines to increase efficiency and enhance value. The goal has been to safely reduce the financial burden to the health care system without compromising care and if possible reallocate these resources or gains in efficiency to further improve the value to the patient. The investigators identified instruments as a source of waste in the operating room and proposed a Lean process assessment. The instruments and the instrument processing workflow were described. An audit documented the utilization of each instrument by orthopedic surgeons and neurosurgeons through observation of spine cases. The data were then presented to the stakeholders, including surgeons, the perioperative director, and representatives from nursing, central processing, and the surgical technicians. Of the 38 cases audited, only 89 (58%) of the instruments were used at least once. On the basis of the data and stakeholder consensus, 63 (41%) of the instruments were removed, resulting in a weight reduction of 17.5 lb and consolidation of 2 instrument sets into 1. Projected cost savings were approximately $41,000 annually. Although new instruments were purchased to standardize sets, the return on investment was estimated to be 2 years. Inefficient surgical routines may comprise significant resource waste in an institution. Process assessment is an important tool in decreasing health care costs, with objectivity provided by Lean or similar principles, and essential impetus to change provided by stakeholders. 4.

The Politics of Management Knowledge.

ERIC Educational Resources Information Center

Clegg, Stewart R., Ed.; Palmer, Gill, Ed.

This book recognizes the political nature of management knowledge, as a discourse produced from, and reproducing, power processes within and between organizations. Critical examinations of certain current management theories--lean production, excellence, entrepreneurship--are examples of relations of power that intermingle with relations of…

Flashback Detection Sensor for Hydrogen Augmented Natural Gas Combustion

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

Thornton, J.D.; Chorpening, B.T.; Sidwell, T.

2007-05-01

The use of hydrogen augmented fuel is being investigated by various researchers as a method to extend the lean operating limit, and potentially reduce thermal NOx formation in natural gas fired lean premixed (LPM) combustion systems. The resulting increase in flame speed during hydrogen augmentation, however, increases the propensity for flashback in LPM systems. Real-time in-situ monitoring of flashback is important for the development of control strategies for use of hydrogen augmented fuel in state-of-the-art combustion systems, and for the development of advanced hydrogen combustion systems. The National Energy Technology Laboratory (NETL) and Woodward Industrial Controls are developing a combustionmore » control and diagnostics sensor (CCADS), which has already been demonstrated as a useful sensor for in-situ monitoring of natural gas combustion, including detection of important combustion events such as flashback and lean blowoff. Since CCADS is a flame ionization sensor technique, the low ion concentration produced in pure hydrogen combustion raises concerns of whether CCADS can be used to monitor flashback in hydrogen augmented combustion. This paper discusses CCADS tests conducted at 0.2-0.6 MPa (2-6 atm), demonstrating flashback detection with fuel compositions up to 80% hydrogen (by volume) mixed with natural gas. NETL’s Simulation Validation (SimVal) combustor offers full optical access to pressurized combustion during these tests. The CCADS data and high-speed video show the reaction zone moves upstream into the nozzle as the hydrogen fuel concentration increases, as is expected with the increased flame speed of the mixture. The CCADS data and video also demonstrate the opportunity for using CCADS to provide the necessary in-situ monitor to control flashback and lean blowoff in hydrogen augmented combustion applications.« less

Validation of the DeLone and McLean Information Systems Success Model.

PubMed

Ojo, Adebowale I

2017-01-01

This study is an adaptation of the widely used DeLone and McLean information system success model in the context of hospital information systems in a developing country. A survey research design was adopted in the study. A structured questionnaire was used to collect data from 442 health information management personnel in five Nigerian teaching hospitals. A structural equation modeling technique was used to validate the model's constructs. It was revealed that system quality significantly influenced use (β = 0.53, p < 0.001) and user satisfaction (β = 0.17, p < 0.001). Information quality significantly influenced use (β = 0.24, p < 0.001) and user satisfaction (β = 0.17, p < 0.001). Also, service quality significantly influenced use (β = 0.22, p < 0.001) and user satisfaction (β = 0.51, p < 0.001). However, use did not significantly influence user satisfaction (β = 0.00, p > 0.05), but it significantly influenced perceived net benefits (β = 0.21, p < 0.001). Furthermore, user satisfaction did not significantly influence perceived net benefits (β = 0.00, p > 0.05). The study validates the DeLone and McLean information system success model in the context of a hospital information system in a developing country. Importantly, system quality and use were found to be important measures of hospital information system success. It is, therefore, imperative that hospital information systems are designed in such ways that are easy to use, flexible, and functional to serve their purpose.

Validation of the DeLone and McLean Information Systems Success Model

PubMed Central

2017-01-01

Objectives This study is an adaptation of the widely used DeLone and McLean information system success model in the context of hospital information systems in a developing country. Methods A survey research design was adopted in the study. A structured questionnaire was used to collect data from 442 health information management personnel in five Nigerian teaching hospitals. A structural equation modeling technique was used to validate the model's constructs. Results It was revealed that system quality significantly influenced use (β = 0.53, p < 0.001) and user satisfaction (β = 0.17, p < 0.001). Information quality significantly influenced use (β = 0.24, p < 0.001) and user satisfaction (β = 0.17, p < 0.001). Also, service quality significantly influenced use (β = 0.22, p < 0.001) and user satisfaction (β = 0.51, p < 0.001). However, use did not significantly influence user satisfaction (β = 0.00, p > 0.05), but it significantly influenced perceived net benefits (β = 0.21, p < 0.001). Furthermore, user satisfaction did not significantly influence perceived net benefits (β = 0.00, p > 0.05). Conclusions The study validates the DeLone and McLean information system success model in the context of a hospital information system in a developing country. Importantly, system quality and use were found to be important measures of hospital information system success. It is, therefore, imperative that hospital information systems are designed in such ways that are easy to use, flexible, and functional to serve their purpose. PMID:28261532

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,…

Applying Lean: Implementation of a Rapid Triage and Treatment System

PubMed Central

Murrell, Karen L.; Offerman, Steven R.; Kauffman, Mark B.

2011-01-01

Objective: Emergency department (ED) crowding creates issues with patient satisfaction, long wait times and leaving the ED without being seen by a doctor (LWBS). Our objective was to evaluate how applying Lean principles to develop a Rapid Triage and Treatment (RTT) system affected ED metrics in our community hospital. Methods: Using Lean principles, we made ED process improvements that led to the RTT system. Using this system, patients undergo a rapid triage with low-acuity patients seen and treated by a physician in the triage area. No changes in staffing, physical space or hospital resources occurred during the study period. We then performed a retrospective, observational study comparing hospital electronic medical record data six months before and six months after implementation of the RTT system. Results: ED census was 30,981 in the six months prior to RTT and 33,926 after. Ambulance arrivals, ED patient acuity and hospital admission rates were unchanged throughout the study periods. Mean ED length of stay was longer in the period before RTT (4.2 hours, 95% confidence interval [CI] = 4.2–4.3; standard deviation [SD] = 3.9) than after (3.6 hours, 95% CI = 3.6–3.7; SD = 3.7). Mean ED arrival to physician start time was 62.2 minutes (95% CI = 61.5–63.0; SD = 58.9) prior to RTT and 41.9 minutes (95% CI = 41.5–42.4; SD = 30.9) after. The LWBS rate for the six months prior to RTT was 4.5% (95% CI = 3.1–5.5) and 1.5% (95% CI = 0.6–1.8) after RTT initiation. Conclusion: Our experience shows that changes in ED processes using Lean thinking and available resources can improve efficiency. In this community hospital ED, use of an RTT system decreased patient wait times and LWBS rates. PMID:21691524

Effects of Momordica charantia (Bitter Melon) on Ischemic Diabetic Myocardium.

PubMed

Czompa, Attila; Gyongyosi, Alexandra; Szoke, Kitti; Bak, Istvan; Csepanyi, Evelin; Haines, David D; Tosaki, Arpad; Lekli, Istvan

2017-03-20

Objective : A rat model is here used to test a hypothesis that Momordica charantia (Bitter melon (BM)) extract favorably alters processes in cardiovascular tissue and is systemically relevant to the pathophysiology of type 2 diabetes (T2DM) and related cardiovascular disease. Methods : Male Lean and Zucker Obese (ZO) rats were gavage-treated for six weeks with 400 mg/kg body weight bitter melon (BM) extract suspended in mucin-water vehicle, or with vehicle (Control). Animals were segregated into four treatment groups, 10 animals in each group, according to strain (Lean or ZO) and treatment (Control or BM). Following six-week treatment periods, peripheral blood was collected from selected animals, followed by sacrifice, thoracotomy and mounting of isolated working heart setup. Results : Body mass of both Lean and ZO rats was unaffected by treatment, likewise, peripheral blood fasting glucose levels showed no significant treatment-related effects. However, some BM treatment-related improvement was noted in postischemic cardiac functions when Lean, BM-treated animals were compared to vehicle treated Lean control rats. Treatment of Lean, but not ZO, rats significantly reduced the magnitude of infarcted zone in isolated hearts subjected to 30 min of ischemia followed by 2 h of working mode reperfusion. Immunohistochemical demonstration of caspase-3 expression by isolated heart tissues subjected to 30 min of ischemia followed by 2 h of reperfusion, revealed significant correlation between BM treatment and reduced expression of this enzyme in hearts obtained from both Lean and ZO animals. The hierarchy and order of caspase-3 expression from highest to lowest was as follows: ZO rats receiving vehicle > ZO rats receiving BM extract > Lean rats treated receiving vehicle > Lean rats administered BM extract. Outcomes of analyses of peripheral blood content of cardiac-related analytics: with particular relevance to clinical application was a significant elevation in blood of ZO and ZO BM-treated, versus Lean rats of total cholesterol (high density lipoprotein HDL-c + low density lipoprotein LDL-c), with an inferred increase in HDL-c/LDL-c ratio-an outcome associated with decreased risk of atherosclerotic disease. Conclusions : BM extract failed to positively affect T2DM- and cardiovascular-related outcomes at a level suggesting use as a standalone treatment. Nevertheless, the encouraging effects of BM in enhancement of cardiac function, suppression of post-ischemic/reperfused infarct size extent and capacity to modulate serum cholesterol, will likely make it useful as an adjuvant therapy for the management of T2DM and related cardiovascular diseases.

Multiorgan insulin sensitivity in lean and obese subjects.

PubMed

Conte, Caterina; Fabbrini, Elisa; Kars, Marleen; Mittendorfer, Bettina; Patterson, Bruce W; Klein, Samuel

2012-06-01

To provide a comprehensive assessment of multiorgan insulin sensitivity in lean and obese subjects with normal glucose tolerance. The hyperinsulinemic-euglycemic clamp procedure with stable isotopically labeled tracer infusions was performed in 40 obese (BMI 36.2 ± 0.6 kg/m(2), mean ± SEM) and 26 lean (22.5 ± 0.3 kg/m(2)) subjects with normal glucose tolerance. Insulin was infused at different rates to achieve low, medium, and high physiological plasma concentrations. In obese subjects, palmitate and glucose R(a) in plasma decreased with increasing plasma insulin concentrations. The decrease in endogenous glucose R(a) was greater during low-, medium-, and high-dose insulin infusions (69 ± 2, 74 ± 2, and 90 ± 2%) than the suppression of palmitate R(a) (52 ± 4, 68 ± 1, and 79 ± 1%). Insulin-mediated increase in glucose disposal ranged from 24 ± 5% at low to 253 ± 19% at high physiological insulin concentrations. The suppression of palmitate R(a) and glucose R(a) were greater in lean than obese subjects during low-dose insulin infusion but were the same in both groups during high-dose insulin infusion, whereas stimulation of glucose R(d) was greater in lean than obese subjects across the entire physiological range of plasma insulin. Endogenous glucose production and adipose tissue lipolytic rate are both very sensitive to small increases in circulating insulin, whereas stimulation of muscle glucose uptake is minimal until high physiological plasma insulin concentrations are reached. Hyperinsulinemia within the normal physiological range can compensate for both liver and adipose tissue insulin resistance, but not skeletal muscle insulin resistance, in obese people who have normal glucose tolerance.

Plasma endocannabinoid levels in lean, overweight and obese humans: relationships with intestinal permeability markers, inflammation and incretin secretion.

PubMed

Little, Tanya J; Cvijanovic, Nada; DiPatrizio, Nicholas V; Argueta, Donovan A; Rayner, Christopher K; Feinle-Bisset, Christine; Young, Richard L

2018-02-13

Intestinal production of endocannabinoid and oleoylethanolamide (OEA) is impaired in high-fat diet/obese rodents, leading to reduced satiety. Such diets also alter the intestinal microbiome in association with enhanced intestinal permeability and inflammation, however little is known of these effects in humans. This study aimed to: (i) evaluate effects of lipid on plasma anandamide (AEA), 2-arachidonyl-sn-glycerol (2-AG) and OEA in humans, and (ii) examine relationships with intestinal permeability, inflammation markers and incretin hormone secretion. 20 lean, 18 overweight and 19 obese participants underwent intraduodenal Intralipid® infusion (2 kcal/min) with collection of endoscopic duodenal biopsies and blood. Plasma AEA, 2-AG, and OEA (HPLC/tandem mass spectrometry), tumour necrosis factor-α (TNF-α), glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) (multiplex), and duodenal expression of occludin, zona-occludin-1 (ZO-1), intestinal-alkaline-phosphatase (IAP), and toll-like receptor-4 (TLR4) (RT-PCR), were assessed. Fasting plasma AEA was increased in obese, compared with lean and overweight (P<0.05), with no effect of BMI group or ID lipid infusion on plasma 2-AG or OEA. Duodenal expression of IAP and ZO-1 was reduced in obese, compared with lean (P<0.05), and these levels related negatively to plasma AEA (P<0.05). The iAUC for AEA was positively related to iAUC GIP (r=0.384, P=0.005). Obese individuals have increased plasma AEA and decreased duodenal expression of ZO-1 and IAP, in comparison to lean and overweight. The relationships between plasma AEA with duodenal ZO-1 and IAP, and GIP, suggest that altered endocannabinoid signalling may contribute to changes in intestinal permeability, inflammation and incretin release in human obesity.

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

Reliability of the EchoMRI-Infant System for Water and Fat Measurements in Newborns

PubMed Central

Toro-Ramos, Tatiana; Paley, Charles; Wong, William W.; Pi-Sunyer, F. Xavier; Yu, W.; Thornton, John; Gallagher, Dympna

2017-01-01

Objective The precision and accuracy of a quantitative magnetic resonance (EchoMRI-Infants™) system in newborn was determined. Methods: Canola oil and drinking water phantoms (increments of 10g to 1.9kg) were scanned four times. Instrument reproducibility was assessed from 3 scans (within 10-minutes) in 42 healthy term newborns (12–70 hours post-birth). Instrument precision was determined from the coefficient of variation (CV) of repeated scans for total water, lean, and fat measures for newborns and the mean difference between weight and measurement for phantoms. In newborns, the system accuracy for total body water (TBW) was tested against deuterium dilution (D2O). Results In phantoms, the repeatability and accuracy of fat and water measurements increased as the weight of oil and water increased. TBW was overestimated in amounts >200g. In newborns weighing 3.14kg, fat, lean and TBW were 0.52kg (16.48%), 2.28kg and 2.40kg, respectively. EchoMRI’s reproducibility (CV) was 3.27%, 1.83% and 1.34% for total body fat, lean, and TBW, respectively. EchoMRI-TBW values did not differ from D2O; mean difference − 1.95±6.76%, p=0.387; mean bias (limits of agreement) 0.046 kg (−0.30 to 0.39 kg). Conclusions EchoMRI infant system’s precision and accuracy for total body fat and lean are better than established techniques and equivalent to D2O for TBW in phantoms and newborns. PMID:28712143

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.

A Cross-Disciplinary Partnership to Improve Manufacturing Education.

ERIC Educational Resources Information Center

Stephens, Matthew P.; Kraebber, Henry W.

1998-01-01

An exemplary university/business partnership involved the development of a training program to enhance workplace productivity for a relatively small manufacturing facility. The objectives were to educate the work force in the principles of workplace organization and lean manufacturing practices. (Author/JOW)

Product Lifecycle Management and the Quest for Sustainable Space Exploration Solutions

NASA Technical Reports Server (NTRS)

Caruso, Pamela W.; Dumbacher, Daniel L.; Grieves, Michael

2011-01-01

Product Lifecycle Management (PLM) is an outcome of lean thinking to eliminate waste and increase productivity. PLM is inextricably tied to the systems engineering business philosophy, coupled with a methodology by which personnel, processes and practices, and information technology combine to form an architecture platform for product design, development, manufacturing, operations, and decommissioning. In this model, which is being implemented by the Marshall Space Flight Center (MSFC) Engineering Directorate, total lifecycle costs are important variables for critical decision-making. With the ultimate goal to deliver quality products that meet or exceed requirements on time and within budget, PLM is a powerful concept to shape everything from engineering trade studies and testing goals, to integrated vehicle operations and retirement scenarios. This briefing will demonstrate how the MSFC Engineering Directorate is implementing PLM as part of an overall strategy to deliver safe, reliable, and affordable space exploration solutions and how that strategy aligns with the Agency and Center systems engineering policies and processes. Sustainable space exploration solutions demand that all lifecycle phases be optimized, and engineering the next generation space transportation system requires a paradigm shift such that digital tools and knowledge management, which are central elements of PLM, are used consistently to maximum effect. Adopting PLM, which has been used by the aerospace and automotive industry for many years, for spacecraft applications provides a foundation for strong, disciplined systems engineering and accountable return on investment. PLM enables better solutions using fewer resources by making lifecycle considerations in an integrative decision-making process.

Muscle-specific inflammation induced by MCP-1 overexpression does not affect whole-body insulin sensitivity in mice.

PubMed

Evers-van Gogh, Inkie J A; Oteng, Antwi-Boasiako; Alex, Sheril; Hamers, Nicole; Catoire, Milene; Stienstra, Rinke; Kalkhoven, Eric; Kersten, Sander

2016-03-01

Obesity is associated with a state of chronic low-grade inflammation that is believed to contribute to the development of skeletal muscle insulin resistance. However, the extent to which local and systemic elevation of cytokines, such as monocyte chemoattractant protein 1 (MCP-1), interferes with the action of insulin and promotes insulin resistance and glucose intolerance in muscle remains unclear. Here, we aim to investigate the effect of muscle-specific overexpression of MCP-1 on insulin sensitivity and glucose tolerance in lean and obese mice. We used Mck-Mcp-1 transgenic (Tg) mice characterised by muscle-specific overexpression of Mcp-1 (also known as Ccl2) and elevated plasma MCP-1 levels. Mice were fed either chow or high-fat diet for 10 weeks. Numerous metabolic variables were measured, including glucose and insulin tolerance tests, muscle insulin signalling and plasma NEFA, triacylglycerol, cholesterol, glucose and insulin. Despite clearly promoting skeletal muscle inflammation, muscle-specific overexpression of Mcp-1 did not influence glucose tolerance or insulin sensitivity in either lean chow-fed or diet-induced obese mice. In addition, plasma NEFA, triacylglycerol, cholesterol, glucose and insulin were not affected by MCP-1 overexpression. Finally, in vivo insulin-induced Akt phosphorylation in skeletal muscle did not differ between Mcp-1-Tg and wild-type mice. We show that increased MCP-1 production in skeletal muscle and concomitant elevated MCP-1 levels in plasma promote inflammation in skeletal muscle but do not influence insulin signalling and have no effect on insulin resistance and glucose tolerance in lean and obese mice. Overall, our data argue against MCP-1 promoting insulin resistance in skeletal muscle and raise questions about the impact of inflammation on insulin sensitivity in muscle.

Emission measurements for a lean premixed propane/air system at pressures up to 30 atmospheres

NASA Technical Reports Server (NTRS)

Roffe, G.; Venkataramani, K. S.

1978-01-01

The emissions of a lean premixed system of propane/air were measured in a flametube apparatus. Tests were conducted at inlet temperatures of 600K and 800K and pressures of 10 atm and 30 atm over a range of equivalence ratios. The data obtained were combined with previous data taken in the same apparatus to correlate nitrogen oxide emissions with operating conditions. Sampling probe design was found to have a pronounced effect on measured CO levels but did not influence measurements. The most effective probe tested was one which combined thermal and pressure quenching of the gas sample.

Study of amended reports to evaluate and improve surgical pathology processes.

PubMed

Meier, Frederick A; Varney, Ruan C; Zarbo, Richard J

2011-09-01

: Amended surgical pathology reports record defects in the process of transforming tissue specimens into diagnostic information. : Systematic study of amended reports tests 2 hypotheses: (a) that tracking amendment frequencies and the distribution of amendment types reveals relevant aspects of quality in surgical pathology's daily transformation of specimens into diagnoses and (b) that such tracking measures the effect, or lack of effect, of efforts to improve surgical pathology processes. : We applied a binary definition of altered reports as either amendments or addenda and a taxonomy of defects that caused amendments as misidentifications, specimen defects, misinterpretations, and report defects. During the introduction of a LEAN process improvement approach-the Henry Ford Productions System-we followed trends in amendment rates and defect fractions to (a) evaluate specific interventions, (b) sort case-by-case root causes of misidentifications, specimen defects, and misinterpretations, and (c) audit the ongoing accuracy of the classification of changed reports. LEAN is the management and production system of the Toyota Motor Corporation that promotes continuous improvement; it considers wasted resources expended for purposes other than creating value for end customers and targets such expenditures for elimination. : Introduction of real-time editing of amendments saw annual amendment rates increase from 4.8/1000 to 10.1/1000 and then decrease in an incremental manner to 5.6/1000 as Henry Ford Productions System-specific interventions were introduced. Before introduction of HFPS interventions, about a fifth of the amendments were due to misidentifications, a 10th were due to specimen defects, a quarter due to misinterpretation, and almost half were due to report defects. During the period of the initial application of HFPS, the fraction of amendments due to misidentifications decreased as those due to report defects increased, in a statistically linked manner. As HFPS interventions took hold, misidentifications fell from 16% to 9%, specimen defect rates remained variable, ranging between 2% and 11%, and misinterpretations fell from 18% to 3%. Reciprocally, report defects rose from 64% to 83% of all amendment-causing defects. A case-by-case study of misidentifications, specimen defects, and misinterpretations found that (a) intervention at the specimen collection level had disappointingly little effect on patient misidentifications; (b) standardization of specimen accession and gross examination reduced only specimen defects surrounding ancillary testing; but (c) a double review of breast and prostate cases was associated with drastically reduced misinterpretation defects. Finally, audit of both amendments and addenda demonstrated that 10% of the so-called addenda actually qualified as amendments. : Monitored by the consistent taxonomy, rates of amended reports first rose, then fell. Examining specific defect categories provided information for evaluating specific LEAN interventions. Tracking the downward trend of amendment rates seemed to document the overall success of surgical pathology quality improvement efforts. Process improvements modestly decreased fractions of misidentifications and markedly decreased misinterpretation fractions. Classification integrity requires real time, independent editing of both amendments (changed reports) and addenda (addition to reports).

Potential roles of force cues in human stance control.

PubMed

Cnyrim, Christian; Mergner, Thomas; Maurer, Christoph

2009-04-01

Human stance is inherently unstable. A small deviation from upright body orientation is enough to yield a gravitational component in the ankle joint torque, which tends to accelerate the body further away from upright ('gravitational torque'; magnitude is related to body-space lean angle). Therefore, to maintain a given body lean position, a corresponding compensatory torque must be generated. It is well known that subjects use kinematic sensory information on body-space lean from the vestibular system for this purpose. Less is known about kinetic cues from force/torque receptors. Previous work indicated that they are involved in compensating external contact forces such as a pull or push having impact on the body. In this study, we hypothesized that they play, in addition, a role when the vestibular estimate of the gravitational torque becomes erroneous. Reasons may be sudden changes in body mass, for instance by a load, or an impairment of the vestibular system. To test this hypothesis, we mimicked load effects on the gravitational torque in normal subjects and in patients with chronic bilateral vestibular loss (VL) with eyes closed. We added/subtracted extra torque to the gravitational torque by applying an external contact force (via cable winches and a body harness). The extra torque was referenced to body-space lean, using different proportionality factors. We investigated how it affected body-space lean responses that we evoked using sinusoidal tilts of the support surface (motion platform) with different amplitudes and frequencies (normals +/-1 degrees, +/-2 degrees, and +/-4 degrees at 0.05, 0.1, 0.2, and 0.4 Hz; patients +/-1 degrees and +/-2 degrees at 0.05 and 0.1 Hz). We found that added/subtracted extra torque scales the lean response in a systematic way, leading to increase/decrease in lean excursion. Expressing the responses in terms of gain and phase curves, we compared the experimental findings to predictions obtained from a recently published sensory feedback model. For the trials in which the extra torque tended to endanger stance control, predictions in normals were better when the model included force cues than without these cues. This supports our notion that force cues provide an automatic 'gravitational load compensation' upon changes in body mass in normals. The findings in the patients support our notion that the presumed force cue mechanism provides furthermore vestibular loss compensation. Patients showed a body-space stabilization that cannot be explained by ankle angle proprioception, but must involve graviception, most likely by force cues. Our findings suggest that force cues contribute considerably to the redundancy and robustness of the human stance control system.

A case study on Measurement of Degree of Performance of an Industry by using Lean Score Technique

NASA Astrophysics Data System (ADS)

Srinivasa Rao, P.; Niraj, Malay

2016-09-01

Lean manufacturing concept is becoming a very important strategy for both academicians and practitioners in the recent times, and Japanese are using this practice for more than a decade. In this present scenario, this paper describes an innovative approach for lean performance evaluation by using fuzzy membership functions before and after implementing lean manufacturing techniques and formulating a model to establish the lean score through the lean attributes by eliminating major losses. It shows a systematic lean performance measurement by producing a final integrated unit less-score.

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.

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

Flashback detection sensor for lean premix fuel nozzles

DOEpatents

Thornton, Jimmy Dean [Morgantown, WV; Richards, George Alan [Morgantown, WV; Straub, Douglas L [Morgantown, WV; Liese, Eric Arnold [Morgantown, WV; Trader, Jr., John Lee; Fasching, George Edward [Morgantown, WV

2002-08-06

A sensor for detecting the flame occurring during a flashback condition in the fuel nozzle of a lean premix combustion system is presented. The sensor comprises an electrically isolated flashback detection electrode and a guard electrode, both of which generate electrical fields extending to the walls of the combustion chamber and to the walls of the fuel nozzle. The sensor is positioned on the fuel nozzle center body at a location proximate the entrance to the combustion chamber of the gas turbine combustion system. The sensor provides 360.degree. detection of a flashback inside the fuel nozzle, by detecting the current conducted by the flame within a time frame that will prevent damage to the gas turbine combustion system caused by the flashback condition.

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.

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.

Elemente moderner, schlanker Produktionssysteme

NASA Astrophysics Data System (ADS)

Bartholomay, Christian; Boppert, Julia; Dickmann, Eva; Dickmann, Philipp; Gröbner, Michael; Harting, Lothar; Leikep, Sabine; Michels, Friedhelm; Pfister, Johannes; Reitz, Andreas; Schedlbauer, Michael; Takeda, Hitoshi; Thews, Michael; Wilbert, Fred

Meilensteine der modernen Produktion mit Lean Production, Total Quality Management, Six Sigma, Supply Chain Management, Lean Management und Lean Enterprise können zu effizienteren Abläufen führen. In der betrieblichen Praxis existiert jedoch eine Vielzahl von Zielkonflikten basierend auf Richtlinien von Material Requirements Planning- (MRP), Controlling- und anderen Systemen. Nur wenige Spezialisten in größeren Unternehmen sind im Stande, die Komplexität über die Grenzen eines Fachgebiets hinaus im Detail zu verstehen. Fachübergreifendes Verständnis scheitert an der Komplexität der Gesamtproblematik. Entscheidungen verschiedenster Fachbereiche begrenzen die maximal erreichbare Effizienz des Materialflusses. Logistik und Materialfluss werden daher in vielen Unternehmen als unabdingbare Kernkompetenz verstanden. Um eine schlanke Produktion, einen optimalen Materialfluss und somit minimale Produktkosten zu erreichen, sind folglich vielfältige andere Fachthemen als Vorraussetzungen zu beherrschen. Erst dann ist es in der Produktionslogistik möglich, im Vergleich zu einem Top-Benchmark erfolgreich zu sein. Um im täglichen Konkurrenzkampf die Nase auch morgen noch vorne zu haben" ist es nötig, über den Preis hinaus auch noch völlig andere Problemstellungen zu beherrschen.

Systematic Review of the Application of Lean and Six Sigma Quality Improvement Methodologies in Radiology.

PubMed

Amaratunga, Thelina; Dobranowski, Julian

2016-09-01

Preventable yet clinically significant rates of medical error remain systemic, while health care spending is at a historic high. Industry-based quality improvement (QI) methodologies show potential for utility in health care and radiology because they use an empirical approach to reduce variability and improve workflow. The aim of this review was to systematically assess the literature with regard to the use and efficacy of Lean and Six Sigma (the most popular of the industrial QI methodologies) within radiology. MEDLINE, the Allied & Complementary Medicine Database, Embase Classic + Embase, Health and Psychosocial Instruments, and the Ovid HealthStar database, alongside the Cochrane Library databases, were searched on June 2015. Empirical studies in peer-reviewed journals were included if they assessed the use of Lean, Six Sigma, or Lean Six Sigma with regard to their ability to improve a variety of quality metrics in a radiology-centered clinical setting. Of the 278 articles returned, 23 studies were suitable for inclusion. Of these, 10 assessed Six Sigma, 7 assessed Lean, and 6 assessed Lean Six Sigma. The diverse range of measured outcomes can be organized into 7 common aims: cost savings, reducing appointment wait time, reducing in-department wait time, increasing patient volume, reducing cycle time, reducing defects, and increasing staff and patient safety and satisfaction. All of the included studies demonstrated improvements across a variety of outcomes. However, there were high rates of systematic bias and imprecision as per the Grading of Recommendations Assessment, Development and Evaluation guidelines. Lean and Six Sigma QI methodologies have the potential to reduce error and costs and improve quality within radiology. However, there is a pressing need to conduct high-quality studies in order to realize the true potential of these QI methodologies in health care and radiology. Recommendations on how to improve the quality of the literature are proposed. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

IL-15 concentrations in skeletal muscle and subcutaneous adipose tissue in lean and obese humans: local effects of IL-15 on adipose tissue lipolysis

PubMed Central

Pierce, Joseph R.; Maples, Jill M.

2015-01-01

Animal/cell investigations indicate that there is a decreased adipose tissue mass resulting from skeletal muscle (SkM) IL-15 secretion (e.g., SkM-blood-adipose tissue axis). IL-15 could regulate fat mass accumulation in obesity via lipolysis, although this has not been investigated in humans. Therefore, the purpose was to examine whether SkM and/or subcutaneous adipose tissue (SCAT) IL-15 concentrations were correlated with SCAT lipolysis in lean and obese humans and determine whether IL-15 perfusion could induce lipolysis in human SCAT. Local SkM and abdominal SCAT IL-15 (microdialysis) and circulating IL-15 (blood) were sampled in lean (BMI: 23.1 ± 1.9 kg/m2; n = 10) and obese (BMI: 34.7 ± 3.5 kg/m2; n = 10) subjects at rest/during 1-h cycling exercise. Lipolysis (SCAT interstitial glycerol concentration) was compared against local/systemic IL-15. An additional probe in SCAT was perfused with IL-15 to assess direct lipolytic responses. SkM IL-15 was not different between lean and obese subjects (P = 0.45), whereas SCAT IL-15 was higher in obese vs. lean subjects (P = 0.02) and was correlated with SCAT lipolysis (r = 0.45, P = 0.05). Exercise increased SCAT lipolysis in lean and obese (P < 0.01), but exercise-induced SCAT lipolysis changes were not correlated with exercise-induced SCAT IL-15 changes. Microdialysis perfusion resulting in physiological IL-15 concentrations in the adipose tissue interstitium increased lipolysis in lean (P = 0.04) but suppressed lipolysis in obese (P < 0.01). Although we found no support for a human IL-15 SkM-blood-adipose tissue axis, IL-15 may be produced in/act on the abdominal SCAT depot. The extent to which this autocrine/paracrine IL-15 action regulates human body composition remains unknown. PMID:25921578

Association of obesity with serum leptin, adiponectin, and serotonin and gut microflora in beagle dogs.

PubMed

Park, H-J; Lee, S-E; Kim, H-B; Isaacson, R E; Seo, K-W; Song, K-H

2015-01-01

Serotonin (5-hydroxytryptamine, 5HT) is involved in hypothalamic regulation of energy consumption. Also, the gut microbiome can influence neuronal signaling to the brain through vagal afferent neurons. Therefore, serotonin concentrations in the central nervous system and the composition of the microbiota can be related to obesity. To examine adipokine, and, serotonin concentrations, and the gut microbiota in lean dogs and dogs with experimentally induced obesity. Fourteen healthy Beagle dogs were used in this study. Seven Beagle dogs in the obese group were fed commercial food ad libitum, over a period of 6 months to increase their weight and seven Beagle dogs in lean group were fed a restricted amount of the same diet to maintain optimal body condition over a period of 6 months. Peripheral leptin, adiponectin, 5HT, and cerebrospinal fluid (CSF-5HT) levels were measured by ELISA. Fecal samples were collected in lean and obese groups 6 months after obesity was induced. Targeted pyrosequencing of the 16S rRNA gene was performed using a Genome Sequencer FLX plus system. Leptin concentrations were higher in the obese group (1.98 ± 1.00) compared to those of the lean group (1.12 ± 0.07, P = .025). Adiponectin and 5-hydroytryptamine of cerebrospinal fluid (CSF-5HT) concentrations were higher in the lean group (27.1 ± 7.28) than in the obese group (14.4 ± 5.40, P = .018). Analysis of the microbiome revealed that the diversity of the microbial community was lower in the obese group. Microbes from the phylum Firmicutes (85%) were predominant group in the gut microbiota of lean dogs. However, bacteria from the phylum Proteobacteria (76%) were the predominant group in the gut microbiota of dogs in the obese group. Decreased 5HT levels in obese group might increase the risk of obesity because of increased appetite. Microflora enriched with gram-negative might be related with chronic inflammation status in obese dogs. Copyright © 2014 by the American College of Veterinary Internal Medicine.

Obesity and Prader-Willi Syndrome Affect Heart Rate Recovery from Dynamic Resistance Exercise in Youth

PubMed Central

Castner, Diobel M.; Clark, Susan J.; Judelson, Daniel A.; Rubin, Daniela A.

2016-01-01

Following exercise, heart rate decline is initially driven by parasympathetic reactivation and later by sympathetic withdrawal. Obesity delays endurance exercise heart rate recovery (HRR) in both children and adults. Young people with Prader-Willi Syndrome (PWS), a congenital cause for obesity, have shown a slower 60-s endurance exercise HRR compared to lean and obese children, suggesting compromised regulation. This study further evaluated effects of obesity and PWS on resistance exercise HRR at 30 and 60 s in children. PWS (8–18 years) and lean and obese controls (8–11 years) completed a weighted step-up protocol (six sets x 10 reps per leg, separated by one-minute rest), standardized using participant stature and lean body mass. HRR was evaluated by calculated HRR value (HRRV = difference between HR at test termination and 30 (HRRV30) and 60 (HRRV60) s post-exercise). PWS and obese had a smaller HRRV30 than lean (p < 0.01 for both). Additionally, PWS had a smaller HRRV60 than lean and obese (p = 0.01 for both). Obesity appears to delay early parasympathetic reactivation, which occurs within 30 s following resistance exercise. However, the continued HRR delay at 60 s in PWS may be explained by either blunted parasympathetic nervous system reactivation, delayed sympathetic withdrawal and/or poor cardiovascular fitness. PMID:28933384

Lean NOx catalysis for gasoline fueled European cars

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

NONE

1997-02-01

There is increasing interest in operating gasoline fueled passenger cars lean of the stoichiometric air/fuel (A/F) ratio to improve fuel economy. These types of engines will operate at lean A/F ratios while cruising at partial load, and return to stoichiometric or even rich conditions when more power is required. The challenge for the engine and catalyst manufacturer is to develop a system which will combine the high activity rates of a state-of-the-art three-way catalyst (TWC) with the ability to reduce nitrogen oxides (NOx) in the presence of excess oxygen. The objective is to achieve the future legislative limits (EURO III/IV)more » in the European Union. Recent developments in automotive pollution control catalysis show that the use of NOx adsorption materials is a suitable way to reduce NOx emissions of gasoline-fueled lean-burn engines. However, the primary task for the implementation of this technology in the European market will be to improve the catalyst`s high-temperature stability and to decrease its susceptibility to sulfur poisoning. Outlined here are results of a recent R and D program to achieve NOx reduction under lean-burn gasoline engine conditions. Model gas test results as well as engine bench data are used for discussion of the parameters which control NOx adsorption efficiency under various conditions.« less

Response mechanisms of attached premixed flames subjected to harmonic forcing

NASA Astrophysics Data System (ADS)

Shreekrishna

The persistent thrust for a cleaner, greener environment has prompted air pollution regulations to be enforced with increased stringency by environmental protection bodies all over the world. This has prompted gas turbine manufacturers to move from nonpremixed combustion to lean, premixed combustion. These lean premixed combustors operate quite fuel-lean compared to the stochiometric, in order to minimize CO and NOx productions, and are very susceptible to oscillations in any of the upstream flow variables. These oscillations cause the heat release rate of the flame to oscillate, which can engage one or more acoustic modes of the combustor or gas turbine components, and under certain conditions, lead to limit cycle oscillations. This phenomenon, called thermoacoustic instabilities, is characterized by very high pressure oscillations and increased heat fluxes at system walls, and can cause significant problems in the routine operability of these combustors, not to mention the occasional hardware damages that could occur, all of which cumulatively cost several millions of dollars. In a bid towards understanding this flow-flame interaction, this research works studies the heat release response of premixed flames to oscillations in reactant equivalence ratio, reactant velocity and pressure, under conditions where the flame preheat zone is convectively compact to these disturbances, using the G-equation. The heat release response is quantified by means of the flame transfer function and together with combustor acoustics, forms a critical component of the analytical models that can predict combustor dynamics. To this end, low excitation amplitude (linear) and high excitation amplitude (nonlinear) responses of the flame are studied in this work. The linear heat release response of lean, premixed flames are seen to be dominated by responses to velocity and equivalence ratio fluctuations at low frequencies, and to pressure fluctuations at high frequencies which are in the vicinity of typical screech frequencies in gas turbine combustors. The nonlinear response problem is exclusively studied in the case of equivalence ratio coupling. Various nonlinearity mechanisms are identified, amongst which the crossover mechanisms, viz., stoichiometric and flammability crossovers, are seen to be responsible in causing saturation in the overall heat release magnitude of the flame. The response physics remain the same across various preheat temperatures and reactant pressures. Finally, comparisons between the chemiluminescence transfer function obtained experimentally and the heat release transfer functions obtained from the reduced order model (ROM) are performed for lean, CH4/Air swirl-stabilized, axisymmetric V-flames. While the comparison between the phases of the experimental and theoretical transfer functions are encouraging, their magnitudes show disagreement at lower Strouhal number gains show disagreement.

Managing a Special Library. Parts I and II.

ERIC Educational Resources Information Center

Labovitz, Judy; Swanigan, Meryl

1985-01-01

Various concepts from "In Search of Excellence" are described in context of authors' personal styles. Discussions address thinking in terms of options, using statistics, learning value of corporate politics, a bias toward action, productivity through people, the "lean-machine" concept, staying close to client, entrepreneurship…

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.

Endogenous Opioid Mechanisms Are Implicated in Obesity and Weight Loss in Humans.

PubMed

Burghardt, Paul R; Rothberg, Amy E; Dykhuis, Kate E; Burant, Charles F; Zubieta, Jon-Kar

2015-08-01

Successful long-term weight loss is challenging. Brain endogenous opioid systems regulate associated processes; however, their role in the maintenance of weight loss has not been adequately explored in humans. In a preliminary study, the objective was to assess central μ-opioid receptor (MOR) system involvement in eating behaviors and their relationship to long-term maintenance of weight loss. This was a case-control study with follow-up of the treatment group at 1 year after intervention. The study was conducted at a tertiary care university medical center. Lean healthy (n = 7) and chronically obese (n = 7) men matched for age and ethnicity participated in the study. MOR availability measures were acquired with positron emission tomography and [(11)C]carfentanil. Lean healthy men were scanned twice under both fasted and fed conditions. Obese men were placed on a very low-calorie diet to achieve 15% weight loss from baseline weight and underwent two positron emission tomography scans before and two after weight loss, incorporating both fasted and fed states. Brain MOR availability and activation were measured by reductions in MOR availability (nondisplaceable binding potential) from the fed compared with the fasted-state scans. Baseline MOR nondisplaceable binding potential was reduced in obese compared with the lean and partially recovered obese after weight loss in regions that regulate homeostatic, hedonic, and emotional responses to feeding. Reductions in negative affect and feeding-induced MOR system activation in the right temporal pole were highly correlated in leans but not in obese men. A trend for an association between MOR activation in the right temporal pole before weight loss and weight regain 1 year was found. Although these preliminary studies have a small sample size, these results suggest that obesity and diet-induced weight loss impact central MOR binding and endogenous opioid system function. MOR system activation in response to an acute meal may be related to the risk of weight regain.

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.

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.

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.

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…

Effects of equivalence ratio variation on lean, stratified methane-air laminar counterflow flames

NASA Astrophysics Data System (ADS)

Richardson, E. S.; Granet, V. E.; Eyssartier, A.; Chen, J. H.

2010-11-01

The effects of equivalence ratio variations on flame structure and propagation have been studied computationally. Equivalence ratio stratification is a key technology for advanced low emission combustors. Laminar counterflow simulations of lean methane-air combustion have been presented which show the effect of strain variations on flames stabilized in an equivalence ratio gradient, and the response of flames propagating into a mixture with a time-varying equivalence ratio. 'Back supported' lean flames, whose products are closer to stoichiometry than their reactants, display increased propagation velocities and reduced thickness compared with flames where the reactants are richer than the products. The radical concentrations in the vicinity of the flame are modified by the effect of an equivalence ratio gradient on the temperature profile and thermal dissociation. Analysis of steady flames stabilized in an equivalence ratio gradient demonstrates that the radical flux through the flame, and the modified radical concentrations in the reaction zone, contribute to the modified propagation speed and thickness of stratified flames. The modified concentrations of radical species in stratified flames mean that, in general, the reaction rate is not accurately parametrized by progress variable and equivalence ratio alone. A definition of stratified flame propagation based upon the displacement speed of a mixture fraction dependent progress variable was seen to be suitable for stratified combustion. The response times of the reaction, diffusion, and cross-dissipation components which contribute to this displacement speed have been used to explain flame response to stratification and unsteady fluid dynamic strain.

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.

Process Improvement for Interinstitutional Research Contracting

PubMed Central

Logan, Jennifer; Bjorklund, Todd; Whitfield, Jesse; Reed, Peggy; Lesher, Laurie; Sikalis, Amy; Brown, Brent; Drollinger, Sandy; Larrabee, Kristine; Thompson, Kristie; Clark, Erin; Workman, Michael; Boi, Luca

2015-01-01

Abstract Introduction Sponsored research increasingly requires multiinstitutional collaboration. However, research contracting procedures have become more complicated and time consuming. The perinatal research units of two colocated healthcare systems sought to improve their research contracting processes. Methods The Lean Process, a management practice that iteratively involves team members in root cause analyses and process improvement, was applied to the research contracting process, initially using Process Mapping and then developing Problem Solving Reports. Results Root cause analyses revealed that the longest delays were the individual contract legal negotiations. In addition, the “business entity” was the research support personnel of both healthcare systems whose “customers” were investigators attempting to conduct interinstitutional research. Development of mutually acceptable research contract templates and language, chain of custody templates, and process development and refinement formats decreased the Notice of Grant Award to Purchase Order time from a mean of 103.5 days in the year prior to Lean Process implementation to 45.8 days in the year after implementation (p = 0.004). Conclusions The Lean Process can be applied to interinstitutional research contracting with significant improvement in contract implementation. PMID:26083433

A ring stabilizer for lean premixed turbulent flames

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

Johnson, M.R.; Kostiuk, L.W.; Cheng, R.K.

1998-08-01

In previous experiments on conical flame behavior in microgravity, which were conducted in drop-towers and in airplanes, the use of a pilot flame was not an option. To permit combustion of stable lean premixed conical flames without a pilot, a ring stabilizer was developed. Although similar types of bluff-body stabilization have been used in the past, the ring stabilizer is somewhat unique. It is designed to fit inside the burner exit port and has demonstrated to be highly effective in stabilizing flames over a very wide range of conditions (including ultra-lean flames at high flow-rates) without adversely affecting flame emissions.more » Unlike a simple rod stabilizer or a stagnation flame system, the benefit of having the stabilizer conform to the burner port is that there is very little leakage of the unburned fuel. The purpose of this brief communication is to offer this simple and highly useful device to the combustion research community. Presented are highlights of a parametric study that measured the stabilization limits and pollutant emissions of several different rings, and demonstrated their potential for use in practical systems.« less

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.

Process Improvement for Interinstitutional Research Contracting.

PubMed

Varner, Michael; Logan, Jennifer; Bjorklund, Todd; Whitfield, Jesse; Reed, Peggy; Lesher, Laurie; Sikalis, Amy; Brown, Brent; Drollinger, Sandy; Larrabee, Kristine; Thompson, Kristie; Clark, Erin; Workman, Michael; Boi, Luca

2015-08-01

Sponsored research increasingly requires multiinstitutional collaboration. However, research contracting procedures have become more complicated and time consuming. The perinatal research units of two colocated healthcare systems sought to improve their research contracting processes. The Lean Process, a management practice that iteratively involves team members in root cause analyses and process improvement, was applied to the research contracting process, initially using Process Mapping and then developing Problem Solving Reports. Root cause analyses revealed that the longest delays were the individual contract legal negotiations. In addition, the "business entity" was the research support personnel of both healthcare systems whose "customers" were investigators attempting to conduct interinstitutional research. Development of mutually acceptable research contract templates and language, chain of custody templates, and process development and refinement formats decreased the Notice of Grant Award to Purchase Order time from a mean of 103.5 days in the year prior to Lean Process implementation to 45.8 days in the year after implementation (p = 0.004). The Lean Process can be applied to interinstitutional research contracting with significant improvement in contract implementation. © 2015 Wiley Periodicals, Inc.

Reversibility after inhaling salbutamol in different body postures in asthmatic children: a pilot study.

PubMed

Visser, R; van der Palen, J; de Jongh, F H C; Thio, B J

2015-04-01

Pulmonary medication is mostly delivered in the form of medical aerosols to minimize systemic side effects. A major drawback of inhaled medication is that the majority of inhaled particles impacts in the oropharynx at the sharp bend of the airway. Stretching the airway by a forward leaning body posture with the neck extended ("sniffing position") may improve pulmonary deposition and clinical effects. 41 asthmatic children who were planned for standard reversibility testing at the pulmonary function lab, alternately inhaled 200 μgr salbutamol with an Autohaler(®) in the standard or in the forward leaning body posture. Forced Expiratory Volume in 1 s (FEV1), Forced Vital Capacity (FVC), Peak Expiratory Flow (PEF), Mean Expiratory Flow at 25% of vital capacity (MEF25) and Mean Expiratory Flow at 75% of vital capacity (MEF75) were analysed. The children in the forward leaning body posture group showed a significantly higher mean FEV1 reversibility than the control group after inhalation of 200 μgr salbutamol (10.2% versus 4.1%, p = 0.019). Additionally, mean MEF75 was significantly more reversible in the forward leaning body posture group versus the standard body posture group (32.2% resp. 8.9%, p = 0.013). This pilot study showed a higher reversibility of FEV1 and MEF75 after inhaling salbutamol in a forward leaning body posture compared to the standard body posture in asthmatic children. This suggests that pulmonary effects of salbutamol can be improved by inhaling in a forward leaning body posture with the neck extended. This effect is possibly due to a higher pulmonary deposition of salbutamol and should be confirmed in a randomized controlled trial. Copyright © 2015 Elsevier Ltd. All rights reserved.

Lipid Partitioning, Incomplete Fatty Acid Oxidation, and Insulin Signal Transduction in Primary Human Muscle Cells: Effects of Severe Obesity, Fatty Acid Incubation, and Fatty Acid Translocase/CD36 Overexpression

PubMed Central

Bell, Jill A.; Reed, Melissa A.; Consitt, Leslie A.; Martin, Ola J.; Haynie, Kimberly R.; Hulver, Matthew W.; Muoio, Deborah M.; Dohm, G. Lynis

2010-01-01

Context: Intracellular lipid partitioning toward storage and the incomplete oxidation of fatty acids (FA) have been linked to insulin resistance. Objective: To gain insight into how intracellular lipid metabolism is related to insulin signal transduction, we examined the effects of severe obesity, excess FA, and overexpression of the FA transporter, FA translocase (FAT)/CD36, in primary human skeletal myocytes. Design, Setting, and Patients: Insulin signal transduction, FA oxidation, and metabolism were measured in skeletal muscle cells harvested from lean and severely obese women. To emulate the obesity phenotype in our cell culture system, we incubated cells from lean individuals with excess FA or overexpressed FAT/CD36 using recombinant adenoviral technology. Results: Complete oxidation of FA was significantly reduced, whereas total lipid accumulation, FA esterification into lipid intermediates, and incomplete oxidation were up-regulated in the muscle cells of severely obese subjects. Insulin signal transduction was reduced in the muscle cells from severely obese subjects compared to lean controls. Incubation of muscle cells from lean subjects with lipids reduced insulin signal transduction and increased lipid storage and incomplete FA oxidation. CD36 overexpression increased FA transport capacity, but did not impair complete FA oxidation and insulin signal transduction in muscle cells from lean subjects. Conclusions: Cultured myocytes from severely obese women express perturbations in FA metabolism and insulin signaling reminiscent of those observed in vivo. The obesity phenotype can be recapitulated in muscle cells from lean subjects via exposure to excess lipid, but not by overexpressing the FAT/CD36 FA transporter. PMID:20427507

Body lean angle in sound dressage horses in-hand, on the lunge and ridden.

PubMed

Greve, Line; Dyson, Sue

2016-11-01

Animals can minimise the risk of falling by leaning into a curve. The aims of this study were: (1) to quantify the difference between observed (measured by an inertial measurement unit, IMU) and predicted body lean angle (calculated as a cyclist when turning) in horses; and (2) to compare circles versus straight lines ridden versus in-hand and trot with canter, and investigate the influence of age, rein and ridden work quality in trot (Fédération Equestre Internationale grading scale 1-10) in horses. Thirteen non-lame horses were assessed prospectively in a non-random, cross-sectional survey. The horses were trotted in straight lines, lunged and ridden on both reins. A global positioning system-aided IMU attached to the skin over the tuber sacrale quantified body lean and recorded the velocity and the radius, which were used to calculate predicted lean. Horses ≤ 6 years of age leant more than predicted (mean ± standard deviation 2.9 ± 2.6°) and more than horses ≥ 7 years old (0.4 ± 3°) (P = 0.01). Horses that scored ≥ 7 in ridden work quality leant less than predicted (-1.1 ± 2.7°) and less than horses which scored ≤ 6 in ridden work quality (2.4 ± 1.5°) (P = 0.02). There were no significant differences between trot and canter, either on the lunge or ridden (P = 0.3), or between left and right reins (P = 0.2). Asymmetry of body lean between reins may be abnormal and may be helpful for recognition of lameness. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Performance Evaluation of a Lean Reparable Pipeline in Various Demand Environments

DTIC Science & Technology

2004-03-23

of defects (Dennis, 2002:90). Shingo espoused the true goal should be zero defects and to this end, invented the poka - yoke , or a simple, inexpensive...92). Despite the inability to eliminate human errors, poka - yoke devices can still enable the elimination of production defects (Dennis, 2002:91... Poka - yoke devices are essentially foolproofing mechanisms which incorporate automatic inspection into the production process. Despite the fact

Evaluation of concepts for controlling exhaust emissions from minimally processed petroleum and synthetic fuels

NASA Technical Reports Server (NTRS)

Russell, P. L.; Beal, G. W.; Sederquist, R. A.; Shultz, D.

1981-01-01

Rich-lean combustor concepts designed to enhance rich combustion chemistry and increase combustor flexibility for NO(x) reduction with minimally processed fuels are examined. Processes such as rich product recirculation in the rich chamber, rich-lean annihilation, and graduated air addition or staged rich combustion to release bound nitrogen in steps of reduced equivalence ratio are discussed. Variations to the baseline rapid quench section are considered, and the effect of residence time in the rich zone is investigated. The feasibility of using uncooled non-metallic materials for the rich zone combustion construction is also addressed. The preliminary results indicate that rich primary zone staged combustion provides environmentally acceptable operation with residual and/or synthetic coal-derived liquid fuels

Mechanical swirler for a low-NO{sub x}, weak-swirl burner

DOEpatents

Cheng, R.K.; Yegian, D.T.

1999-03-09

Disclosed is a mechanical swirler for generating diverging flow in lean premixed fuel burners. The swirler of the present invention includes a central passage with an entrance for accepting a feed gas, a flow balancing insert that introduces additional pressure drop beyond that occurring in the central passage in the absence of the flow balancing insert, and an exit aligned to direct the feed gas into a combustor. The swirler also has an annular passage about the central passage and including one or more vanes oriented to impart angular momentum to feed gas exiting the annular passage. The diverging flow generated by the swirler stabilizes lean combustion thus allowing for lower production of pollutants, particularly oxides of nitrogen. 16 figs.

Mechanical swirler for a low-NO.sub.x, weak-swirl burner

DOEpatents

Cheng, Robert K.; Yegian, Derek T.

1999-01-01

Disclosed is a mechanical swirler for generating diverging flow in lean premixed fuel burners. The swirler of the present invention includes a central passage with an entrance for accepting a feed gas, a flow balancing insert that introduces additional pressure drop beyond that occurring in the central passage in the absence of the flow balancing insert, and an exit aligned to direct the feed gas into a combustor. The swirler also has an annular passage about the central passage and including one or more vanes oriented to impart angular momentum to feed gas exiting the annular passage. The diverging flow generated by the swirler stabilizes lean combustion thus allowing for lower production of pollutants, particularly oxides of nitrogen.

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.

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.

The use KPI's to determine the waste in production process

NASA Astrophysics Data System (ADS)

Borsos, G.; Iacob, C. C.; Calefariu, G.

2016-11-01

In theory and practice of management is well-known Lean approach about forms of waste from production processes (Muda) and the method VSM (Value Stream Map), one of the most effective methods for determining the activities generating value within industrial companies. It is also obvious concern of the specialists for performance measurement regardless of purview of the organizations. The literature review has shown that the link between performance indicators and the objectives of the companies is researched in detail. However, the correlation between indicators and the forms of waste that generate deviations from the setpoints is rather nature practical and it depends on the talent and managerial skills of those directing production processes. The paper presents the results of a applied study, performed by the authors, through which it was has sought to will create a system of performance indicators specific to manufacturing activity that to be a useful tool to quantify the losses and to determining ways to improve default losses.

Breadboard Facility

NASA Technical Reports Server (NTRS)

1977-01-01

In the sixties, Chrysler was NASA's prime contractor for the Saturn I and IB test launch vehicles. The company installed and operated at Huntsville what was known as the Saturn I/IB Development Breadboard Facility. "Breadboard," means an array of electrical and electronic equipment for performing a variety of development and test functions. This work gave Chrysler a broad capability in computerized testing to assure quality control in development of solid-state electronic systems. Today that division is manufacturing many products not destined for NASA, most of them being associated with the company's automotive line. A major project is production and quality-control testing of the "lean-burn" engine, one that has a built-in Computer to control emission timing, and allow the engine to run on a leaner mixture of fuel and air. Other environment-related products include vehicle emission analyzers. The newest of the line is an accurate, portable solid state instrument for testing auto exhaust gases. The exhaust analyzers, now being produced for company dealers and for service

Numerical Simulation of Wall Heat Load in Combustor Flow

NASA Astrophysics Data System (ADS)

Panara, D.; Hase, M.; Krebs, W.; Noll, B.

2007-09-01

Due to the major mechanism of NOx generation, there is generally a temperature trade off between improved cycle efficiency, material constraints and low NOx emission. The cycle efficiency is proportional to the highest cycle temperature, but unfortunately also the NOx production increases with increasing combustion temperature. For this reason, the modern combustion chamber design has been oriented towards lean premixed combustion system and more and more attention must be focused on the cooling air management. The challenge is to ensure sufficiently low temperature of the combustion liner with very low amount of film or effusion cooling air. Correct numerical prediction of temperature fields and wall heat load are therefore of critical interest in the modern combustion chamber design. Moreover, lean combustion technology has shown the appearance of thermo-acoustic instabilities which have to be taken into account in the simulation and, more in general, in the design of reliable combustion systems. In this framework, the present investigation addresses the capability of a commercial multiphysics code (ANSYS CFX) to correctly predict the wall heat load and the core flow temperature field in a scaled power generation combustion chamber with a simplified ceramic liner. Comparison are made with the experimental results from the ITS test rig at the University of Karlsruhe [1] and with a previous numerical campaign from [2]. In addition the effect of flow unsteadyness on the wall heat load is discussed showing some limitations of the traditional steady state flow thermal design.

Heat production and storage are positively correlated with measures of body size/composition and heart rate drift during vigorous running.

PubMed

Buresh, Robert; Berg, Kris; Noble, John

2005-09-01

The purposes of this study were to determine the relationships between: (a) measures of body size/composition and heat production/storage, and (b) heat production/storage and heart rate (HR) drift during running at 95% of the velocity that elicited lactate threshold, which was determined for 20 healthy recreational male runners. Subsequently, changes in skin and tympanic temperatures associated with a vigorous 20-min run, HR, and VO2 data were recorded. It was found that heat production was significantly correlated with body mass (r = .687), lean mass (r = .749), and body surface area (BSA, r = .699). Heat storage was significantly correlated with body mass (r = .519), fat mass (r = .464), and BSA (r = .498). The percentage of produced heat stored was significantly correlated with body mass (r = .427), fat mass (r = .455), and BSA (r = .414). Regression analysis showed that the sum of body mass, percentage of body fat, BSA, lean mass, and fat mass accounted for 30% of the variability in heat storage. It was also found that HR drift was significantly correlated with heat storage (r = .383), percentage of produced heat stored (r = .433), and core temperature change (r = .450). It was concluded that heavier runners experienced greater heat production, heat storage, and core temperature increases than lighter runners during vigorous running.

Dynamic micro- and macrovascular remodeling in coronary circulation of obese Ossabaw pigs with metabolic syndrome

PubMed Central

Katz, Paige S.; Kelly, Amy P.; Galantowicz, Maarten L.; Cismowski, Mary J.; West, T. Aaron; Neeb, Zachary P.; Berwick, Zachary C.; Goodwill, Adam G.; Alloosh, Mouhamad; Tune, Johnathan D.; Sturek, Michael; Lucchesi, Pamela A.

2012-01-01

Previous studies from our laboratory showed that coronary arterioles from type 2 diabetic mice undergo inward hypertrophic remodeling and reduced stiffness. The aim of the current study was to determine if coronary resistance microvessels (CRMs) in Ossabaw swine with metabolic syndrome (MetS) undergo remodeling distinct from coronary conduit arteries. Male Ossabaw swine were fed normal (n = 7, Lean) or hypercaloric high-fat (n = 7, MetS) diets for 6 mo, and then CRMs were isolated and mounted on a pressure myograph. CRMs isolated from MetS swine exhibited decreased luminal diameters (126 ± 5 and 105 ± 9 μm in Lean and MetS, respectively, P < 0.05) with thicker walls (18 ± 3 and 31 ± 3 μm in Lean and MetS, respectively, P < 0.05), which doubled the wall-to-lumen ratio (14 ± 2 and 30 ± 2 in Lean and MetS, respectively, P < 0.01). Incremental modulus of elasticity (IME) and beta stiffness index (BSI) were reduced in CRMs isolated from MetS pigs (IME: 3.6 × 106 ± 0.7 × 106 and 1.1 × 106 ± 0.2 × 106 dyn/cm2 in Lean and MetS, respectively, P < 0.001; BSI: 10.3 ± 0.4 and 7.3 ± 1.8 in Lean and MetS, respectively, P < 0.001). BSI in the left anterior descending coronary artery was augmented in pigs with MetS. Structural changes were associated with capillary rarefaction, decreased hyperemic-to-basal coronary flow velocity ratio, and augmented myogenic tone. MetS CRMs showed a reduced collagen-to-elastin ratio, while immunostaining for the receptor for advanced glycation end products was selectively increased in the left anterior descending coronary artery. These data suggest that MetS causes hypertrophic inward remodeling of CRMs and capillary rarefaction, which contribute to decreased coronary flow and myocardial ischemia. Moreover, our data demonstrate novel differential remodeling between coronary micro- and macrovessels in a clinically relevant model of MetS. PMID:22837170

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/

The evaluation of a virtual education system based on the DeLone and McLean model:  A path analysis.

PubMed

Mahmoodi, Zohreh; Esmaelzadeh-Saeieh, Sara; Lotfi, Razieh; Baradaran Eftekhari, Monir; Akbari Kamrani, Mahnaz; Mehdizadeh Tourzani, Zahra; Salehi, Katayoun

2017-01-01

Background : The Internet has dramatically influenced the introduction of virtual education. Virtual education is a term that involves online education and e-learning. This study was conducted to evaluate a virtual education system based on the DeLone and McLean model. Methods : This descriptive analytical study was conducted using the census method on all the students of the Nursing and Midwifery Department of Alborz University of Medical Sciences who had taken at least one online course in 2016-2017. Data were collected using a researcher-made questionnaire based on the DeLone and McLean model in six domains and then analyzed in SPSS-16 and LISREL-8.8 using the path analysis. Results : The goodness of fit indices (GFI) of the model represent the desirability and good fit of the model, and the rational nature of the adjusted relationships between the variables based on a conceptual model (GFI = 0.98; RMSEA = 0.014).The results showed that system quality has the greatest impact on the net benefits of the system through both direct and indirect paths (β=0.52), service quality through the indirect path (β=0.03) and user satisfaction through the direct path (β=0.73). Conclusions : According to the results, system quality has the greatest overall impact on the net benefits of the system, both directly and indirectly by affecting user satisfaction and the intention to use. System quality should therefore be further emphasized, to use these systems more efficiently.

Modelling and model predictive control for a bicycle-rider system

NASA Astrophysics Data System (ADS)

Chu, T. D.; Chen, C. K.

2018-01-01

This study proposes a bicycle-rider control model based on model predictive control (MPC). First, a bicycle-rider model with leaning motion of the rider's upper body is developed. The initial simulation data of the bicycle rider are then used to identify the linear model of the system in state-space form for MPC design. Control characteristics of the proposed controller are assessed by simulating the roll-angle tracking control. In this riding task, the MPC uses steering and leaning torques as the control inputs to control the bicycle along a reference roll angle. The simulation results in different cases have demonstrated the applicability and performance of the MPC for bicycle-rider modelling.

Application potential for some sugar substitutes in some low energy and diabetic foods.

PubMed

Bakr, A A

1997-06-01

Preparation of acceptable low energy fiber enriched and diabetic jams, cakes and biscuits using different formulas of sucrose substitutes with the partial replacement of wheat flour with bran as a source of dietary fibre, was studied. Special care was paid to evaluate the nutritional plus keeping qualities and the potential effect of the most acceptable formulae from each food stuffs group on the blood glucose level in lean and obese diabetes mellitus patients. It was technologically possible to prepare acceptable, high nutritional diabetic and low energy apricot, guava and strawberry jams and jellies by combinations of sweeteners using xylitol (i.e. xylitol-sorbitol-aspartame and xylitol-fructose). The attainment of a suitable texture may be more difficult in xylitol and sorbitol jams, therefore 0.2 g CaCl2. 2H2O was added. Storage of these jams at 4 degrees C improved their keeping quality significantly (p < 0.05), where the microbial load was less than 20 cells per gram and the products were free from molds and yeasts. Also, high nutritional and acceptable cakes and biscuits for low energy supply and for diabetic subjects can be sweetened with low level of aspartame in combination with fructose, sorbitol and xylitol. Consumption of such low energic and diabetic food items reduces significantly (p < 0.05) the plasma glucose level in lean and obese diabetics. Addition of wheat bran in bakery products not only reduced both energy value of these foods and blood glucose, but it also improved peripheral insulin activity by its system modification.

Development of a compressed product made with sardine.

PubMed

Bourges, H; Morales de León, J C; Sierra, H

1985-09-01

The per capita consumption of marine products is very low in Mexico, averaging less than 4 g/day. This fact has been partially attributed to the costly techniques used in their preservation, which result in high market prices unaffordable for large segments of the population. Previous research lead to the development of pressed and salted patties based on lean fish species, the low cost and easy preservation of which would contribute to a higher fish consumption among the low socio-economic strata of the Mexican population. The present work was directed to adapt the procedure to sardine, which is more abundant and less expensive than lean fish species. Since defatting the sardine lead to poor sensorial characteristics of the patties, measures were taken to protect the fat from oxidation, through the use of BHT and citric acid. The best results were obtained with descaled sardine, and with the addition of 8% NaCl, 10% corn flour and a condiment mixture. The resulting product had 32% of high-quality protein and a shelf life of at least six months under environmental conditions. Its cost per gram of protein was one-third lower than the price of fresh or canned sardine. Sensorial tests revealed an acceptability of 82%.

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