Trunk lean gait decreases multi-segmental coordination in the vertical direction.

PubMed

Tokuda, Kazuki; Anan, Masaya; Sawada, Tomonori; Tanimoto, Kenji; Takeda, Takuya; Ogata, Yuta; Takahashi, Makoto; Kito, Nobuhiro; Shinkoda, Koichi

2017-11-01

[Purpose] The strategy of trunk lean gait to reduce external knee adduction moment (KAM) may affect multi-segmental synergy control of center of mass (COM) displacement. Uncontrolled manifold (UCM) analysis is an evaluation index to understand motor variability. The purpose of this study was to investigate how motor variability is affected by using UCM analysis on adjustment of the trunk lean angle. [Subjects and Methods] Fifteen healthy young adults walked at their preferred speed under two conditions: normal and trunk lean gait. UCM analysis was performed with respect to the COM displacement during the stance phase. The KAM data were analyzed at the points of the first KAM peak during the stance phase. [Results] The KAM during trunk lean gait was smaller than during normal gait. Despite a greater segmental configuration variance with respect to mediolateral COM displacement during trunk lean gait, the synergy index was not significantly different between the two conditions. The synergy index with respect to vertical COM displacement during trunk lean gait was smaller than that during normal gait. [Conclusion] These results suggest that trunk lean gait is effective in reducing KAM; however, it may decrease multi-segmental movement coordination of COM control in the vertical direction.

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 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.

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.

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

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.

Quality improvement in basic histotechnology: the lean approach.

PubMed

Clark, David

2016-01-01

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

Low NOx, Lean Direct Wall Injection Combustor Concept Developed

NASA Technical Reports Server (NTRS)

Tacina, Robert R.; Wey, Changlie; Choi, Kyung J.

2003-01-01

The low-emissions combustor development at the NASA Glenn Research Center is directed toward advanced high-pressure aircraft gas turbine applications. The emphasis of this research is to reduce nitrogen oxides (NOx) at high-power conditions and to maintain carbon monoxide and unburned hydrocarbons at their current low levels at low-power conditions. Low-NOx combustors can be classified into rich burn and lean burn concepts. Lean burn combustors can be further classified into lean-premixed-prevaporized (LPP) and lean direct injection (LDI) combustors. In both concepts, all the combustor air, except for liner cooling flow, enters through the combustor dome so that the combustion occurs at the lowest possible flame temperature. The LPP concept has been shown to have the lowest NOx emissions, but for advanced high-pressure-ratio engines, the possibly of autoignition or flashback precludes its use. LDI differs from LPP in that the fuel is injected directly into the flame zone and, thus, does not have the potential for autoignition or flashback and should have greater stability. However, since it is not premixed and prevaporized, the key is good atomization and mixing of the fuel quickly and uniformly so that flame temperatures are low and NOx formation levels are comparable to those of LPP.

Odel of Dynamic Integration of Lean Shop Floor Management Within the Organizational Management System

NASA Astrophysics Data System (ADS)

Iuga, Virginia; Kifor, Claudiu

2014-12-01

The key to achieve a sustainable development lies in the customer satisfaction through improved quality, reduced cost, reduced delivery lead times and proper communication. The objective of the lean manufacturing system (LMS) is to identify and eliminate the processes and resources which do not add value to a product. The following paper aims to present a proposal of further development of integrated management systems in organizations through the implementation of lean shop floor management. In the first part of the paper, a dynamic model of the implementation steps will be presented. Furthermore, the paper underlines the importance of implementing a lean culture parallel with each step of integrating the lean methods and tools. The paper also describes the Toyota philosophy, tools, and the supporting lean culture necessary to implementing an efficient lean system in productive organizations

A Review and Perspective on Lean in Higher Education

ERIC Educational Resources Information Center

Balzer, William K.; Francis, David E.; Krehbiel, Timothy C.; Shea, Nicholas

2016-01-01

Purpose: The purpose of this paper is to synthesize the accumulated body of research on Lean in higher education, draw conclusions to help guide successful Lean implementations and propose future research directions to establish a rich base of knowledge that informs both practice and research. Design/methodology/approach This literature review…

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-ISD.

ERIC Educational Resources Information Center

Wallace, Guy W.

2001-01-01

Explains lean instructional systems design/development (ISD) as it relates to curriculum architecture design, based on Japan's lean production system. Discusses performance-based systems; ISD models; processes for organizational training and development; curriculum architecture to support job performance; and modular curriculum development. (LRW)

Filter-based control of particulate matter from a lean gasoline direct injection engine

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

Parks, II, James E; Lewis Sr, Samuel Arthur; DeBusk, Melanie Moses

New regulations requiring increases in vehicle fuel economy are challenging automotive manufacturers to identify fuel-efficient engines for future vehicles. Lean gasoline direct injection (GDI) engines offer significant increases in fuel efficiency over the more common stoichiometric GDI engines already in the marketplace. However, particulate matter (PM) emissions from lean GDI engines, particularly during stratified combustion modes, are problematic for lean GDI technology to meet U.S. Environmental Protection Agency Tier 3 and other future emission regulations. As such, the control of lean GDI PM with wall-flow filters, referred to as gasoline particulate filter (GPF) technology, is of interest. Since lean GDImore » PM chemistry and morphology differ from diesel PM (where more filtration experience exists), the functionality of GPFs needs to be studied to determine the operating conditions suitable for efficient PM removal. In addition, lean GDI engine exhaust temperatures are generally higher than diesel engines which results in more continuous regeneration of the GPF and less presence of the soot cake layer common to diesel particulate filters. Since the soot layer improves filtration efficiency, this distinction is important to consider. Research on the emission control of PM from a lean GDI engine with a GPF was conducted on an engine dynamometer. PM, after dilution, was characterized with membrane filters, organic vs. elemental carbon characterization, and size distribution techniques at various steady state engine speed and load points. The engine was operated in three primary combustion modes: stoichiometric, lean homogeneous, and lean stratified. In addition, rich combustion was utilized to simulate PM from engine operation during active regeneration of lean NOx control technologies. High (>95%) PM filtration efficiencies were observed over a wide range of conditions; however, some PM was observed to slip through the GPF at high speed and load conditions. The PM characterization at various engine speeds and loads will help enable optimized GPF design and control to achieve more fuel efficient lean GDI vehicles with low PM emissions.« less

Teaming. The Key to World Class Manufacturing.

ERIC Educational Resources Information Center

Wright, John R.

1999-01-01

Lean manufacturing, a streamlined system of flow and job shop techniques, relies on self-directed work teams. Technology educators can prepare students for work in this environment by using problem-solving teams in the classroom to work on design briefs and other group projects. (SK)

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.

Simulation of a Single-Element Lean-Direct Injection Combustor Using a Polyhedral Mesh Derived from Hanging-Node Elements

NASA Technical Reports Server (NTRS)

Wey, Thomas; Liu, Nan-Suey

2013-01-01

This paper summarizes the procedures of generating a polyhedral mesh derived from hanging-node elements as well as presents sample results from its application to the numerical solution of a single element lean direct injection (LDI) combustor using an open-source version of the National Combustion Code (NCC).

Slag processing system for direct coal-fired gas turbines

DOEpatents

Pillsbury, Paul W.

1990-01-01

Direct coal-fired gas turbine systems and methods for their operation are provided by this invention. The systems include a primary combustion compartment coupled to an impact separator for removing molten slag from hot combustion gases. Quenching means are provided for solidifying the molten slag removed by the impact separator, and processing means are provided forming a slurry from the solidified slag for facilitating removal of the solidified slag from the system. The released hot combustion gases, substantially free of molten slag, are then ducted to a lean combustion compartment and then to an expander section of a gas turbine.

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.

Getting 'Lean': hardwiring process excellence into Northeast Health.

PubMed

Brown, Tricia; Duthe, Robert

2009-01-01

Many healthcare organizations are turning to the "Lean" Toyota Production System as a means to hardwire process excellence into their organizations. Northeast Health, an integrated delivery system in New York's capital region, introduced the Lean concept into its culture in 2004. After four years, the organization is beginning to see its staff hardwire Lean thinking into day-to-day behaviors. This paper focuses on the approach used by Northeast Health to introduce Lean concepts into its culture, challenges faced, lessons learned and the factors critical to success.

The effect of technique change on knee loads during sidestep cutting.

PubMed

Dempsey, Alasdair R; Lloyd, David G; Elliott, Bruce C; Steele, Julie R; Munro, Bridget J; Russo, Kylie A

2007-10-01

To identify the effect of modifying sidestep cutting technique on knee loads and predict what impact such change would have on the risk of noncontact anterior cruciate ligament injury. A force platform and motion-analysis system were used to record ground-reaction forces and track the trajectories of markers on 15 healthy males performing sidestep cutting tasks using their normal technique and nine different imposed techniques. A kinematic and inverse dynamic model was used to calculate the three-dimensional knee postures and moments. The imposed techniques of foot wide and torso leaning in the opposite direction to the cut resulted in increased peak valgus moments experienced in weight acceptance. Higher peak internal rotation moments were found for the foot wide and torso rotation in the opposite direction to the cut techniques. The foot rotated in technique resulted in lower mean flexion/extension moments, whereas the foot wide condition resulted in higher mean flexion/extension moments. The flexed knee, torso rotated in the opposite direction to the cut and torso leaning in the same direction as the cut techniques had significantly more knee flexion at heel strike. Sidestep cutting technique had a significant effect on loads experienced at the knee. The techniques that produced higher valgus and internal rotation moments at the knee, such as foot wide, torso leaning in the opposite direction to the cut and torso rotating in the opposite direction to the cut, may place an athlete at higher risk of injury because these knee loads have been shown to increase the strain on the anterior cruciate ligament. Training athletes to avoid such body positions may result in a reduced risk of noncontact anterior cruciate ligament injures.

Gaseous Emissions Results from a Three-Cup Flametube Test of a Third-Generation Swirl-Venturi Lean Direct Injection Combustion Concept

NASA Technical Reports Server (NTRS)

Tacina, Kathleen M.; Podboy, Derek P.; Lee, Phil; Dam, Bidhan

2017-01-01

This paper summarizes the development of lean direct injection (LDI) combustor technology at, or in collaboration with, the NASA Glenn Research Center. These configurations differ mainly in fuel-air mixing strategy. The paper reviews the NOx performance and operability characteristics of multiple LDI configurations tested at NASA Glenn.

Leaning toward the Centers: International Networking at China's Five C[subscript 9] League Universities

ERIC Educational Resources Information Center

Yang, Rui; Xie, Meng

2015-01-01

Scholarly relations between developed and developing countries have long been characterized by imbalances and asymmetries. The "centers" in the North give direction, provide models, produce research and function as the pinnacles of the academic system while institutions in developing countries copy their development from the…

LEAN thinking in Finnish healthcare.

PubMed

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

2016-01-01

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

The 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.

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.

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.

Implementation of lean thinking: one health system's journey.

PubMed

Kim, Christopher S; Spahlinger, David A; Kin, Jeanne M; Coffey, Richard J; Billi, John E

2009-08-01

Lean Thinking is a management philosophy derived from the manufacturing industry, where Toyota has long been the gold standard. Health care organizations have started to apply this approach to patient care. After initial experimentation, the University of Michigan Health System (UMHS) has adopted Lean Thinking as its uniform approach to quality improvement and is striving to become a complete Lean organization. In 2005, the senior leadership selected an initial set of projects in areas that traced the patient's journey across different care settings within our health system. Four of the projects were as follows: orthopedic surgery clinic scheduling, radiation oncology therapy, peripherally inserted central catheter (PICC) services, and coordination of care to the outpatient setting. Lean Thinking encourages service providers to focus on value as defined by the customer and the relentless elimination of waste that impedes the flow of value. A series of learning projects were conducted to test whether Lean methods would work at UMHS. The following factors were found to be key to LEAN PROJECT SUCCESS: expert guidance for initial efforts, leadership in the form of clinical champions and senior management support of the improvement work, frontline worker engagement in mapping out "current state" processes, identifying waste and designing an improved "future state," using metrics to develop and track interventions, and defining realistic project scope. As UMHS's experience applying Lean Thinking to our patient care processes has grown, so have support, enthusiasm, and expertise within the organization. UMHS's Lean Thinking system, now known as the Michigan Quality System, has emerged as the core improvement strategy.

Lean management systems: creating a culture of continuous quality improvement.

PubMed

Clark, David M; Silvester, Kate; Knowles, Simon

2013-08-01

This is the first in a series of articles describing the application of Lean management systems to Laboratory Medicine. Lean is the term used to describe a principle-based continuous quality improvement (CQI) management system based on the Toyota production system (TPS) that has been evolving for over 70 years. Its origins go back much further and are heavily influenced by the work of W Edwards Deming and the scientific method that forms the basis of most quality management systems. Lean has two fundamental elements--a systematic approach to process improvement by removing waste in order to maximise value for the end-user of the service and a commitment to respect, challenge and develop the people who work within the service to create a culture of continuous improvement. Lean principles have been applied to a growing number of Healthcare systems throughout the world to improve the quality and cost-effectiveness of services for patients and a number of laboratories from all the pathology disciplines have used Lean to shorten turnaround times, improve quality (reduce errors) and improve productivity. Increasingly, models used to plan and implement large scale change in healthcare systems, including the National Health Service (NHS) change model, have evidence-based improvement methodologies (such as Lean CQI) as a core component. Consequently, a working knowledge of improvement methodology will be a core skill for Pathologists involved in leadership and management.

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

PubMed

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

2015-03-01

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

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

PubMed Central

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

2014-01-01

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

Effect of Air Swirler Configuration on Lean Direct Injector Flow Structure and Combustion Performance with a 7-Point Lean Direct Injector Array

NASA Technical Reports Server (NTRS)

Hicks, Yolanda R.; Tacina, Kathleen M.; Anderson, Robert C.

2017-01-01

Studies of various injector configurations in a 7-point Lean Direct Injector (LDI) array are reported for both non-reacting (cold) flow and for Jet-A/air reacting flows. For cold flow, central recirculation zone (CRZ) formation is investigated and for reacting flows, combustor operability and dynamics are of interest. 2D Particle Image Velocimetry (PIV) measurements are described for the cold flow experiments and flame chemiluminescence imaging and dynamic pressure results are discussed for the reacting flow cases. PIV results indicate that for this configuration the close spacing between swirler elements leads to strong interaction that affects whether a CRZ forms, and pilot recess and counter-swirl helps to isolate swirlers from one another. Dynamics results focus on features identified near 500-Hz.

Healthcare Lean.

PubMed

Long, John C

2003-01-01

Lean Thinking is an integrated approach to designing, doing and improving the work of people that have come together to produce and deliver goods, services and information. Healthcare Lean is based on the Toyota production system and applies concepts and techniques of Lean Thinking to hospitals and physician practices.

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.

Reduction of Brochothrix thermosphacta on beef surfaces following immobilization of nisin in calcium alginate gels.

PubMed

Cutter, C N; Siragusa, G R

1996-07-01

Lean and adipose beef carcass tissues inoculated with Brochothrix thermosphacta (BT) (approx. 4.50 log10 cfu cm-2) were left untreated (U) or treated with 100 micrograms ml-1 nisin (N), calcium alginate (A) or 100 micrograms ml-1 nisin immobilized in a calcium alginate gel (AN). Tissue samples were refrigerated after treatments and bacterial populations and nisin activity were determined at 0, 1, 2 and 7 d. U, A and N treatments of lean and adipose tissues did not suppress bacterial growth ( > 6 log10 cfu cm-2 by day 7) while treatments of lean and adipose tissues with AN suppressed bacteria ( > 2.42 log10 cfu cm-2 by day 7). Bacteriocin titres from both tissues were higher in AN vs N samples after the 7 d incubation. This study demonstrates that immobilization of nisin in a gel may be a more effective delivery system of a bacteriocin to the carcass surface than direct application.

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.

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.

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.

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…

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

Sevik, James; Wallner, Thomas; Pamminger, Michael

The efficiency improvement and emissions reduction potential of lean and exhaust gas recirculation (EGR)-dilute operation of spark-ignition gasoline engines is well understood and documented. However, dilute operation is generally limited by deteriorating combustion stability with increasing inert gas levels. The combustion stability decreases due to reduced mixture flame speeds resulting in significantly increased combustion initiation periods and burn durations. A study was designed and executed to evaluate the potential to extend lean and EGR-dilute limits using a low-energy transient plasma ignition system. The low-energy transient plasma was generated by nanosecond pulses and its performance compared to a conventional transistorized coilmore » ignition (TCI) system operated on an automotive, gasoline direct-injection (GDI) single-cylinder research engine. The experimental assessment was focused on steady-state experiments at the part load condition of 1500 rpm 5.6 bar indicated mean effective pressure (IMEP), where dilution tolerance is particularly critical to improving efficiency and emission performance. Experimental results suggest that the energy delivery process of the low-energy transient plasma ignition system significantly improves part load dilution tolerance by reducing the early flame development period. Statistical analysis of relevant combustion metrics was performed in order to further investigate the effects of the advanced ignition system on combustion stability. Results confirm that at select operating conditions EGR tolerance and lean limit could be improved by as much as 20% (from 22.7 to 27.1% EGR) and nearly 10% (from λ = 1.55 to 1.7) with the low-energy transient plasma ignition system.« less

Using Simulation to Explore Lean Manufacturing Implementation Strategies

ERIC Educational Resources Information Center

Shannon, Patrick W.; Krumwiede, Kip R.; Street, Jeffrey N.

2010-01-01

Lean manufacturing, an outgrowth of the Toyota Production System, has spread far beyond the automobile industry and is seen by many leaders as a key management philosophy in the battle to compete on an international scale. Successful implementation of lean requires that managers and employees be educated in the proper application of lean tools and…

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

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.

Temperature and Species Measurements of Combustion Produced by a 9-Point Lean Direct Injector

NASA Technical Reports Server (NTRS)

Tedder, Sarah A.; Hicks, Yolanda R.; Locke, Randy J.

2013-01-01

This paper presents measurements of temperature and relative species concentrations in the combustion flowfield of a 9-point swirl venturi lean direct injector fueled with JP-8. The temperature and relative species concentrations of the flame produced by the injector were measured using spontaneous Raman scattering (SRS). Results of measurements taken at four flame conditions are presented. The species concentrations reported are measured relative to nitrogen and include oxygen, carbon dioxide, and water.

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…

A nontransferring dry adhesive with hierarchical polymer nanohairs.

PubMed

Jeong, Hoon Eui; Lee, Jin-Kwan; Kim, Hong Nam; Moon, Sang Heup; Suh, Kahp Y

2009-04-07

We present a simple yet robust method for fabricating angled, hierarchically patterned high-aspect-ratio polymer nanohairs to generate directionally sensitive dry adhesives. The slanted polymeric nanostructures were molded from an etched polySi substrate containing slanted nanoholes. An angled etching technique was developed to fabricate slanted nanoholes with flat tips by inserting an etch-stop layer of silicon dioxide. This unique etching method was equipped with a Faraday cage system to control the ion-incident angles in the conventional plasma etching system. The polymeric nanohairs were fabricated with tailored leaning angles, sizes, tip shapes, and hierarchical structures. As a result of controlled leaning angle and bulged flat top of the nanohairs, the replicated, slanted nanohairs showed excellent directional adhesion, exhibiting strong shear attachment (approximately 26 N/cm(2) in maximum) in the angled direction and easy detachment (approximately 2.2 N/cm(2)) in the opposite direction, with a hysteresis value of approximately 10. In addition to single scale nanohairs, monolithic, micro-nanoscale combined hierarchical hairs were also fabricated by using a 2-step UV-assisted molding technique. These hierarchical nanoscale patterns maintained their adhesive force even on a rough surface (roughness <20 microm) because of an increase in the contact area by the enhanced height of hierarchy, whereas simple nanohairs lost their adhesion strength. To demonstrate the potential applications of the adhesive patch, the dry adhesive was used to transport a large-area glass (47.5 x 37.5 cm(2), second-generation TFT-LCD glass), which could replace the current electrostatic transport/holding system with further optimization.

A nontransferring dry adhesive with hierarchical polymer nanohairs

PubMed Central

Jeong, Hoon Eui; Lee, Jin-Kwan; Kim, Hong Nam; Moon, Sang Heup; Suh, Kahp Y.

2009-01-01

We present a simple yet robust method for fabricating angled, hierarchically patterned high-aspect-ratio polymer nanohairs to generate directionally sensitive dry adhesives. The slanted polymeric nanostructures were molded from an etched polySi substrate containing slanted nanoholes. An angled etching technique was developed to fabricate slanted nanoholes with flat tips by inserting an etch-stop layer of silicon dioxide. This unique etching method was equipped with a Faraday cage system to control the ion-incident angles in the conventional plasma etching system. The polymeric nanohairs were fabricated with tailored leaning angles, sizes, tip shapes, and hierarchical structures. As a result of controlled leaning angle and bulged flat top of the nanohairs, the replicated, slanted nanohairs showed excellent directional adhesion, exhibiting strong shear attachment (≈26 N/cm2 in maximum) in the angled direction and easy detachment (≈2.2 N/cm2) in the opposite direction, with a hysteresis value of ≈10. In addition to single scale nanohairs, monolithic, micro-nanoscale combined hierarchical hairs were also fabricated by using a 2-step UV-assisted molding technique. These hierarchical nanoscale patterns maintained their adhesive force even on a rough surface (roughness <20 μm) because of an increase in the contact area by the enhanced height of hierarchy, whereas simple nanohairs lost their adhesion strength. To demonstrate the potential applications of the adhesive patch, the dry adhesive was used to transport a large-area glass (47.5 × 37.5 cm2, second-generation TFT-LCD glass), which could replace the current electrostatic transport/holding system with further optimization. PMID:19304801

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

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.

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.

"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.

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.

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.

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.

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.

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

PubMed Central

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

2006-01-01

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

Lean mass and insulin resistance in women with polycystic ovary syndrome.

PubMed

Comerford, Kevin B; Almario, Rogelio U; Kim, Kyoungmi; Karakas, Sidika E

2012-09-01

Insulin resistance is common in women with polycystic ovary syndrome (PCOS). Muscle is the major tissue utilizing glucose while excess adipose tissue relates to insulin resistance. Thus, body composition is likely to be an important regulator of insulin sensitivity. Thirty-nine PCOS patients (age: 29.9±1.0 years; BMI: 33.8±1.2 kg/m(2)) participated in a cross sectional study. Body composition was measured by dual energy x-ray absorptiometry (DEXA). Insulin resistance and secretion were assessed using oral glucose tolerance test (OGTT) and frequently sampled intravenous glucose tolerance test (FS-IVGTT). In contrast with the conventional expectations, lean mass correlated directly (P<.05) with the insulin resistance measure HOMA (r=0.440); and inversely with the insulin sensitivity index QUICKI (r=-0.522) independent of fat mass. In 11 pairs of subjects matched for fat mass (35.6±2.2 and 35.6±2.4 kg) but with discordant lean mass (52.8±1.8 vs 44.4±1.6 kg), those with higher lean mass had a higher glucose response during OGTT (AUC(Glucose); P=.034). In contrast, 17 pairs matched for lean mass (48.7±1.7 and 48.9±1.6 kg) but discordant for fat mass (43.3±2.6 vs 30.3±8.9 kg) showed no differences in insulin resistance parameters. These novel findings indicate that lean mass relates directly to insulin resistance in PCOS. Published by Elsevier Inc.

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.

Direct fired reciprocating engine and bottoming high temperature fuel cell hybrid

DOEpatents

Geisbrecht, Rodney A [New Alexandria, PA; Holcombe, Norman T [McMurray, PA

2006-02-07

A system of a fuel cell bottoming an internal combustion engine. The engine exhaust gas may be combined in varying degrees with air and fed as input to a fuel cell. Reformer and oxidizers may be combined with heat exchangers to accommodate rich and lean burn conditions in the engine in peaking and base load conditions without producing high concentrations of harmful emissions.

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.

Relationship Between Lean Production and Operational Performance in the Manufacturing Industry

NASA Astrophysics Data System (ADS)

Rasi, Raja Zuraidah R. M.; Syamsyul Rakiman, Umol; Ahmad, Md Fauzi Bin

2015-05-01

Nowadays, more and more manufacturing firms have started to implement lean production system in their operations. Lean production viewed as one of the mechanism to maintain the organisation's position and to compete globally. However, many fail to apply the lean concepts successfully in their operations. Based on previous studies, implementation of lean production in the manufacturing industry is more focused on the relationship between Lean and Operational Performance of one dimension only. Therefore, this study attempted to examine the relationship between Lean Production (LP) and Operational Performance in 4 dimensions which are quality, delivery, cost and flexibility. This study employed quantitative study using questionnaires. Data was collected from 50 manufacturing industries. The data was analysed using Statistical Package for Social Science (SPSS) 22.0. This study is hoped to shed new understanding on the concept of Lean Production (LP) in regards of Operational Performance covering the 4 dimensions.

Lean oncology: a new model for oncologists.

PubMed

Montesarchio, Vincenzo; Grimaldi, Antonio Maria; Fox, Bernard A; Rea, Antonio; Marincola, Francesco M; Ascierto, Paolo A

2012-04-25

The history of the term Lean is relatively recent and originates from the Toyota Production System (TPS). The term "Lean" means "thin", which refers to a mental process, operational, productive, no-frills, quick but not hasty, consequential to the previous event. The Lean process flows seamlessly into the result, eliminates unnecessary complications to the effect, prevents unnecessary equipment processes. The idea is to 'do more with less', like using the (few) available resources in the most productive way possible, through the elimination of all types of waste that inevitably accompanies every stage of a production process. Lean management is primarily a management philosophy, a system of values and behaviors that goes beyond the mere application of the instrument and that, once internalized, will form the nucleus of the corporate culture. "Lean Oncology" is a term coined to identify a methodology of care and treatment to cancer patients, consisting on process simplification, streamlining of the organizational and routes of drug treatment, detection and elimination of waste. Its main objective is the centrality of the patient.

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.…

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

The Importance of Measuring Strength-of-Preference Scores for Health Care Options in Preference-Sensitive Care

PubMed Central

Crump, R. Trafford; Llewellyn-Thomas, Hilary A.

2012-01-01

Objective The objective was to determine whether a paired-comparison/leaning scale method: a) could feasibly be used to elicit strength-of-preference scores for elective health care options in large community-based survey settings; and b) could reveal preferential sub-groups that would have been overlooked if only a categorical-response format had been used. Study Design Medicare beneficiaries in four different regions of the United States were interviewed in person. Participants considered 8 clinical scenarios, each with 2 to 3 different health care options. For each scenario, participants categorically selected their favored option, then indicated how strongly they favored that option relative to the alternative on a paired-comparison bi-directional Leaning Scale. Results Two hundred and two participants were interviewed. For 7 of the 8 scenarios, a clear majority (> 50%) indicated that, overall, they categorically favored one option over the alternative(s). However, the bi-directional strength-of-preference Leaning Scale scores revealed that, in 4 scenarios, for half of those participants, their preference for the favored option was actually “weak” or “neutral”. Conclusion Investigators aiming to assess population-wide preferential attitudes towards different elective health care scenarios should consider gathering ordinal-level strength-of-preference scores and could feasibly use the paired-comparison/bi-directional Leaning Scale to do so. PMID:22494579

Systems Thinking, Lean Production and Action Learning

ERIC Educational Resources Information Center

Seddon, John; Caulkin, Simon

2007-01-01

Systems thinking underpins "lean" management and is best understood through action-learning as the ideas are counter-intuitive. The Toyota Production System is just that--a system; the failure to appreciate that starting-place and the advocacy of "tools" leads many to fail to grasp what is, without doubt, a significant…

Are Water-lean Solvent Systems Viable for Post-Combustion CO 2 Capture?

DOE PAGES

Heldebrant, David J.; Koech, Phillip K.; Rousseau, Roger; ...

2017-08-18

Here, we present here an overview of water-lean solvents that compares their projected costs and performance to aqueous amine systems, emphasizing critical areas of study needed to evaluate their performance against their water-based brethren. The work presented her focuses on bridging these knowledge gaps. Because the majority of water-lean solvents are still at the lab scale, substantial studies are still needed to model their performance at scale. This presents a significant challenge as eachformulation has different physical and thermodynamic properties and behavior, and quantifying how these different properties manifest themselves in conventional absorber-stripper configurations, or identifying new configurations that aremore » specific for a solvent’s signature behavior. We identify critical areas of study that are needed, and our efforts (e.g. custom infrastructure, molecular models) to predict, measure, and model these behaviors. Such findings are critical for determining the rheology required for heat exchanger design; absorber designs and packing to accommodate solvents with gradient changes (e.g. viscosity, contact angle, surface tension), and stripper configurations without direct steam utilization or water reflux. Another critical area of research need is to understand the molecular structure of the liquid interface and bulk as a function of CO 2 loading, and to assess whether conventional film theories accurately quantify solvent behavior, or if thermodynamic models adequately quantify activity coefficients of ions in solution. We conclude with an assessment of our efforts to aid in bridging the knowledge gaps in understanding water-lean solvents, and suggestions of what is needed to enable large-scale demonstrations to meet the United States Department of Energy’s year 2030 goal.« less

Center of mass trajectory and orientation to ankle and knee in sagittal plane is maintained with forward lean when backpack load changes during treadmill walking.

PubMed

Caron, Robert R; Wagenaar, Robert C; Lewis, Cara L; Saltzman, Elliot; Holt, Kenneth G

2013-01-04

Maintaining the normal shape and amplitude of the vertical trajectory of the center of mass (COM) during stance has been shown to maximize the efficiency of unloaded gait. Kinematic adaptations to load carriage, such as forward lean have yet to be understood in relation to COM movement. The purpose of this study is to better understand how load impacts the vertical COM(TSYS) trajectory and to clarify the impact of forward lean as it relates to the dynamics of sagittal plane COM(TSYS) movement during stance with changing load. 17 subjects walked on treadmill at a constant preferred walking velocity while nine different loads ranging from 12.5% to 40% bodyweight were systematically added and removed from a backpack. Kinematic data were collected using an Optotrak, three-dimensional motion analysis system and used to estimate position of the COM as well as segment and COM-to-joint vector orientation angles. The shape and amplitude of the COM vertical trajectory was maintained across all loaded conditions. The orientations of COM-to-ankle and -knee vectors were maintained in all loaded conditions except the heaviest load (40% BW). Results suggest that forward lean changed linearly with changes in load to maintain the COM-to-ankle and -knee vector orientations. COM vertical trajectory was maintained by a combination of invariants including lower-limb segment angles and a constant direction of toe-off impulse vector. The kinematic invariants found suggest a simplified control mechanism by which the system limits degrees of freedom and potentially minimizes torque about lower-extremity joints with added load. Copyright © 2012 Elsevier Ltd. All rights reserved.

Are Water-lean Solvent Systems Viable for Post-Combustion CO 2 Capture?

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

Heldebrant, David J.; Koech, Phillip K.; Rousseau, Roger

Here, we present here an overview of water-lean solvents that compares their projected costs and performance to aqueous amine systems, emphasizing critical areas of study needed to evaluate their performance against their water-based brethren. The work presented her focuses on bridging these knowledge gaps. Because the majority of water-lean solvents are still at the lab scale, substantial studies are still needed to model their performance at scale. This presents a significant challenge as eachformulation has different physical and thermodynamic properties and behavior, and quantifying how these different properties manifest themselves in conventional absorber-stripper configurations, or identifying new configurations that aremore » specific for a solvent’s signature behavior. We identify critical areas of study that are needed, and our efforts (e.g. custom infrastructure, molecular models) to predict, measure, and model these behaviors. Such findings are critical for determining the rheology required for heat exchanger design; absorber designs and packing to accommodate solvents with gradient changes (e.g. viscosity, contact angle, surface tension), and stripper configurations without direct steam utilization or water reflux. Another critical area of research need is to understand the molecular structure of the liquid interface and bulk as a function of CO 2 loading, and to assess whether conventional film theories accurately quantify solvent behavior, or if thermodynamic models adequately quantify activity coefficients of ions in solution. We conclude with an assessment of our efforts to aid in bridging the knowledge gaps in understanding water-lean solvents, and suggestions of what is needed to enable large-scale demonstrations to meet the United States Department of Energy’s year 2030 goal.« less

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.

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.

[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.

Determination of the NOx Loading of an Automotive Lean NOx Trap by Directly Monitoring the Electrical Properties of the Catalyst Material Itself

PubMed Central

Fremerey, Peter; Reiß, Sebastian; Geupel, Andrea; Fischerauer, Gerhard; Moos, Ralf

2011-01-01

Recently, it has been shown that the degree of loading of several types of automotive exhaust aftertreatment devices can be directly monitored in situ and in a contactless way by a microwave-based method. The goal of this study was to clarify whether this method can also be applied to NOx storage and reduction catalysts (lean NOx traps) in order to obtain further knowledge about the reactions occurring in the catalyst and to compare the results with those obtained by wirebound NOx loading sensors. It is shown that both methods are able to detect the different catalyst loading states. However, the sensitivity of the microwave-based method turned out to be small compared to that previously observed for other exhaust aftertreatment devices. This may limit the practical applicability of the microwave-based NOx loading detection in lean NOx traps. PMID:22164074

Relationship Between Changes in Fat and Lean Depots Following Weight Loss and Changes in Cardiovascular Disease Risk Markers.

PubMed

Clifton, Peter M

2018-04-04

Gluteofemoral fat mass has been associated with improved cardiovascular disease risk factors. It is not clear if loss of this protective fat during weight loss partially negates the effect of loss of visceral fat. The aim of this study was to examine regional fat loss in a large weight-loss cohort from one center and to determine if fat loss in the leg and total lean tissue loss is harmful. We combined the data from 7 of our previously published 3-month weight-loss studies and examined the relationship between regional fat and lean tissue loss and changes in cardiovascular disease risk factors in 399 participants. At baseline, leg fat was positively associated with high-density lipoprotein cholesterol in women and inversely with fasting triglyceride level in both sexes. Abdominal lean tissue was also related to systolic blood pressure in men. Changes in regional fat and lean tissue were positively associated with changes in glucose, insulin, total cholesterol, triglycerides, low-density lipoprotein cholesterol and systolic and diastolic blood pressure ( r =0.11-0.22, P <0.05) with leg fat and arm lean tissue dominating in multivariate regression. After adjustment for total weight or total fat change, these relationships disappeared except for a positive relationship between arm and lean leg mass loss and changes in triglycerides and systolic blood pressure. Loss of leg fat and leg lean tissue was directly associated with beneficial changes in cardiovascular disease risk markers. Loss of lean tissue may not have an adverse effect on cardiovascular disease risk, and measures to retain lean tissue during weight loss may not be necessary. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Investigation of the prominent barriers to lean manufacturing implementation in Malaysian food and beverages industry using Rasch Model

NASA Astrophysics Data System (ADS)

Khusaini, N. S.; Ismail, A.; Rashid, A. A.

2016-02-01

This paper presents a preliminary study on the prominent barriers to lean manufacturing implementation in Malaysian Food and Beverages Industry. A survey was carried out to determine the most prominent barriers of lean manufacturing implementation that are currently being faced in this industry. The amount of barriers identified for this study is twenty seven. Out of 1309 available organizations, a total of 300 organizations have been randomly selected as respondents, and 53 organizations responded. From the variable map, the analysis shows that, the negative perception towards lean manufacturing top the list as the most agreeable barrier, while the technical barriers came after it. It can also be seen from the variable map that averagely, lack of vision and direction is the barrier that is being faced. Finally, this is perhaps the first attempt in investigating the prominent barriers to Lean Manufacturing implementation in Malaysian food and beverages industry using Rasch Model.

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

Correlation and prediction of dynamic human isolated joint strength from lean body mass

NASA Technical Reports Server (NTRS)

Pandya, Abhilash K.; Hasson, Scott M.; Aldridge, Ann M.; Maida, James C.; Woolford, Barbara J.

1992-01-01

A relationship between a person's lean body mass and the amount of maximum torque that can be produced with each isolated joint of the upper extremity was investigated. The maximum dynamic isolated joint torque (upper extremity) on 14 subjects was collected using a dynamometer multi-joint testing unit. These data were reduced to a table of coefficients of second degree polynomials, computed using a least squares regression method. All the coefficients were then organized into look-up tables, a compact and convenient storage/retrieval mechanism for the data set. Data from each joint, direction and velocity, were normalized with respect to that joint's average and merged into files (one for each curve for a particular joint). Regression was performed on each one of these files to derive a table of normalized population curve coefficients for each joint axis, direction, and velocity. In addition, a regression table which included all upper extremity joints was built which related average torque to lean body mass for an individual. These two tables are the basis of the regression model which allows the prediction of dynamic isolated joint torques from an individual's lean body mass.

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.

A Second Generation Swirl-Venturi Lean Direct Injection Combustion Concept

NASA Technical Reports Server (NTRS)

Tacina, Kathleen M.; Chang, Clarence T.; He, Zhuohui Joe; Lee, Phil; Dam, Bidhan; Mongia, Hukam

2014-01-01

A low-NO (sub x) aircraft gas turbine engine combustion concept was developed and tested. The concept is a second generation swirl-venturi lean direct injection (SV-LDI) concept. LDI is a lean-burn combustion concept in which the fuel is injected directly into the flame zone. Three second generation SV-LDI configurations were developed. All three were based on the baseline 9-point SV-LDI configuration reported previously. These second generation configurations had better low power operability than the baseline 9-point configuration. Two of these second generation configurations were tested in a NASA Glenn Research Center flametube; these two configurations are called the at dome and 5-recess configurations. Results show that the 5-recess configuration generally had lower NO (sub x) emissions than the flat dome configuration. Correlation equations were developed for the flat dome configuration so that the landing-takeoff NO (sub x) emissions could be estimated. The flat dome landing-takeoff NO (sub x) is estimated to be 87-88 percent below the CAEP/6 standards, exceeding the ERA project goal of 75 percent reduction.

Factors influencing the movement biology of migrant songbirds confronted with an ecological barrier

USGS Publications Warehouse

Smolinsky, J. A.; Diehl, Robert H.; Radzio, T. A.; Delaney, D. K.; Moore, F. R

2013-01-01

Whether or not a migratory songbird embarks on a long-distance flight across an ecological barrier is likely a response to a number of endogenous and exogenous factors. During autumn 2008 and 2009, we used automated radio tracking to investigate how energetic condition, age, and weather influenced the departure timing and direction of Swainson’s thrushes (Catharus ustulatus) during migratory stopover along the northern coast of the Gulf of Mexico. Most birds left within 1 h after sunset on the evening following capture. Those birds that departed later on the first night or remained longer than 1 day were lean. Birds that carried fat loads sufficient to cross the Gulf of Mexico generally departed in a seasonally appropriate southerly direction, whereas lean birds nearly always flew inland in a northerly direction. We did not detect an effect of age or weather on departures. The decision by lean birds to reorient movement inland may reflect the suitability of the coastal stopover site for deposition of fuel stores and the motivation to seek food among more extensive forested habitat away from the barrier.

Experimental Combustion Dynamics Behavior of a Multi-Element Lean Direct Injection (LDI) Gas Turbine Combustor

NASA Technical Reports Server (NTRS)

Acosta, Waldo A.; Chang, Clarence T.

2016-01-01

An experimental investigation of the combustion dynamic characteristics of a research multi-element lean direct injection (LDI) combustor under simulated gas turbine conditions was conducted. The objective was to gain a better understanding of the physical phenomena inside a pressurized flametube combustion chamber under acoustically isolated conditions. A nine-point swirl venturi lean direct injection (SV-LDI) geometry was evaluated at inlet pressures up to 2,413 kPa and non-vitiated air temperatures up to 867 K. The equivalence ratio was varied to obtain adiabatic flame temperatures between 1388 K and 1905 K. Dynamic pressure measurements were taken upstream of the SV-LDI, in the combustion zone and downstream of the exit nozzle. The measurements showed that combustion dynamics were fairly small when the fuel was distributed uniformly and mostly due to fluid dynamics effects. Dynamic pressure fluctuations larger than 40 kPa at low frequencies were measured at 653 K inlet temperature and 1117 kPa inlet pressure when fuel was shifted and the pilot fuel injector equivalence ratio was increased to 0.72.

Low Emission Hydrogen Combustors for Gas Turbines Using Lean Direct Injection

NASA Technical Reports Server (NTRS)

Marek, C. John; Smith, Timothy D.; Kundu, Krishna

2005-01-01

One of the key technology challenges for the use of hydrogen in gas turbine engines is the performance of the combustion system, in particular the fuel injectors. To investigate the combustion performance of gaseous hydrogen fuel injectors flame tube combustor experiments were performed. Tests were conducted to measure the nitrogen oxide (NOx) emissions and combustion performance at inlet conditions of 600 to 1000 deg F, 60 to 200 pounds per square inch absolute (psia), and equivalence ratios up to 0.48. All the injectors were based on Lean Direct Injection (LDI) technology with multiple injection points and quick mixing. One challenge to hydrogen based premixing combustion systems is flashback since hydrogen has a reaction rate over seven times that of Jet-A. To reduce the risk, design mixing times were kept short and velocities high to minimize flashback. Five fuel injector designs were tested in 2.5 and 3.5-in. diameter flame tubes with non-vitiated heated air and gaseous hydrogen. Data is presented on measurements of NOx emissions and combustion efficiency for the hydrogen injectors at 1.0, 3.125, and 5.375 in. from the injector face. Results show that for some configurations, NOx emissions are comparable to that of state of the art Jet-A LDI combustor concepts.

Low-Emission Hydrogen Combustors for Gas Turbines Using Lean Direct Injection

NASA Technical Reports Server (NTRS)

Marek, C. John; Smith, Timothy D.; Kundu, Krishna

2007-01-01

One of the key technology challenges for the use of hydrogen in gas turbine engines is the performance of the combustion system, in particular the fuel injectors. To investigate the combustion performance of gaseous hydrogen fuel injectors flame tube combustor experiments were performed. Tests were conducted to measure the nitrogen oxide (NO(x)) emissions and combustion performance at inlet conditions of 588 to 811 K, 0.4 to 1.4 MPa, and equivalence ratios up to 0.48. All the injectors were based on Lean Direct Injection (LDI) technology with multiple injection points and quick mixing. One challenge to hydrogen-based premixing combustion systems is flashback since hydrogen has a reaction rate over 7 times that of Jet-A. To reduce the risk, design mixing times were kept short and velocities high to minimize flashback. Five fuel injector designs were tested in 6.35- and 8.9-cm-diameter flame tubes with non-vitiated heated air and gaseous hydrogen. Data is presented on measurements of NO(x) emissions and combustion efficiency for the hydrogen injectors at 2.540, 7.937, and 13.652 cm from the injector face. Results show that for some configurations, NO(x) emissions are comparable to that of state of the art Jet-A LDI combustor concepts.

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

Birth weight and growth from infancy to late adolescence in relation to fat and lean mass in early old age: findings from the MRC National Survey of Health and Development.

PubMed

Bann, D; Wills, A; Cooper, R; Hardy, R; Aihie Sayer, A; Adams, J; Kuh, D

2014-01-01

High birth weight and greater weight gain in infancy have been associated with increased risk of obesity as assessed using body mass index, but few studies have examined associations with direct measures of fat and lean mass. This study examined associations of birth weight and weight and height gain in infancy, childhood and adolescence with fat and lean mass in early old age. A total of 746 men and 812 women in England, Scotland and Wales from the MRC National Survey of Health and Development whose heights and weights had been prospectively ascertained across childhood and adolescence and who had dual energy X-ray absorptiometry measures at age 60-64 years. Associations of birth weight and standardised weight and height (0-2 (weight only), 2-4, 4-7, 7-11, 11-15, 15-20 years) gain velocities with outcome measures were examined. Higher birth weight was associated with higher lean mass and lower android/gynoid ratio at age 60-64 years. For example, the mean difference in lean mass per 1 standard deviation increase in birth weight was 1.54 kg in males (95% confidence interval=1.04, 2.03) and 0.78 kg in females (0.41, 1.14). Greater weight gain in infancy was associated with higher lean mass, whereas greater gains in weight in later childhood and adolescence were associated with higher fat and lean mass, and fat/lean and android/gynoid ratios. Across growth intervals greater height gain was associated with higher lean but not fat mass, and with lower fat/lean and android/gynoid ratios. Findings suggest that growth in early life may have lasting effects on fat and lean mass. Greater weight gain before birth and in infancy may be beneficial by leading to higher lean mass, whereas greater weight gain in later childhood and adolescence may be detrimental by leading to higher fat/lean and android/gynoid ratios.

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.

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.

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

The productive operating theatre and lean thinking systems.

PubMed

Kasivisvanathan, R; Chekairi, A

2014-11-01

The concept of 'lean thinking' first originated in the manufacturing industry as a means of improving productivity whilst maintaining quality through eliminating wasteful processes. The purpose of this article is to demonstrate how the principles of 'lean thinking' are relevant to healthcare and the operating theatre, with reference to our own institutional experience.

Benchmarking performance measurement and lean manufacturing in the rough mill

Treesearch

Dan Cumbo; D. Earl Kline; Matthew S. Bumgardner

2006-01-01

Lean manufacturing represents a set of tools and a stepwise strategy for achieving smooth, predictable product flow, maximum product flexibility, and minimum system waste. While lean manufacturing principles have been successfully applied to some components of the secondary wood products value stream (e.g., moulding, turning, assembly, and finishing), the rough mill is...

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

The lean service machine.

PubMed

Swank, Cynthia Karen

2003-10-01

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

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.

Experiences of leaders in the implementation of Lean in a teaching hospital—barriers and facilitators in clinical practices: a qualitative study

PubMed Central

Aij, Kjeld Harald; Simons, Frederique Elisabeth; Widdershoven, Guy A M; Visse, Merel

2013-01-01

Objectives To date, experiences of leaders in the implementation of Lean after a Lean Training Programme have not been systematically investigated within teaching hospitals. Existing studies have identified barriers and facilitators only from an improvement programme perspective and have not considered the experiences of leaders themselves. This study aims to bridge this gap. Design Semistructured, indepth interviews. Setting One of largest teaching hospitals in the Netherlands. Participants 31 medical, surgical and nursing professionals with an average of 19.2 years of supervisory experience. All professionals were appointed to a Lean Training Programme and were directly involved in the implementation of Lean. Results The evidence obtained in this study shows that, from the perspectives of participants, leadership management support, a continuous learning environment and cross-departmental cooperation play a significant role in successful Lean implementation. The results suggest that a Lean Training Programme contributed to positive outcomes in personal and professional skills that were evident during the first 4 months after programme completion. Conclusions Implementing Lean in a teaching hospital setting is a challenge because of the ambiguous and complex environment of a highly professionalised organisation. The study found that leadership management support and a continuous learning environment are important facilitators of Lean implementation. To increase the successful outcomes of leadership actions, training should be supplemented with actions to remove perceived barriers. This requires the involvement of all professionals, the crossing of departmental boundaries and a focus on meaning-making processes rather than simply ‘implementing’ facts. Therefore, this research suggests that programme participants, such as staff members and leaders, can mutually explore the meanings of Lean thinking and working for their own contexts. By entering this shared learning process (eg, learning on the job) the ownership of Lean implementation could also increase. PMID:24171938

The impact of lean production on musculoskeletal and psychosocial risks: an examination of sociotechnical trends over 20 years.

PubMed

Koukoulaki, Theoni

2014-03-01

This paper provides an extensive review of studies carried out in lean production environments in the last 20 years. It aims to identify the effects of lean production (negative or positive) on occupational health and related risk factors. Thirty-six studies of lean effects were accepted from the literature search and sorted by sector and type of outcome. Lean production was found to have a negative effect on health and risk factors; the most negative outcomes being found in the earliest studies in the automotive industry. However, examples of mixed and positive effects were also found in the literature. The strongest correlations of lean production with stress were found for characteristics found in Just-In-Time production that related to reduced cycle time and reduction of resources. Increased musculoskeletal risk symptoms were related to increases of work pace and lack of recovery time also found in Just-In-Time systems. An interaction model is developed to propose a pathway from lean production characteristics to musculoskeletal and psychosocial risk factors and also positive outcomes. An examination is also made of the changing focus of studies investigating the consequences of lean production over a 20-year period. Theories about the effects of lean production have evolved from a conceptualization that it is an inherently harmful management system, to a view that it can have mixed effects depending on the management style of the organization and the specific way it is implemented. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

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.

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".

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.

Lean Stability augmentation study

NASA Technical Reports Server (NTRS)

Mcvey, J. B.; Kennedy, J. B.

1979-01-01

An analytical and experimental program was conducted to investigate techniques and develop technology for improving the lean combustion limits of premixing, prevaporizing combustors applicable to gas turbine engine main burners. Three concepts for improving lean stability limits were selected for experimental evaluation among twelve approaches considered. Concepts were selected on the basis of the potential for improving stability limits and achieving emission goals, the technological risks associated with development of practical burners employing the concepts, and the penalties to airline direct operating costs resulting from decreased combustor performance, increased engine cost, increased maintenance cost and increased engine weight associated with implementation of the concepts. Tests of flameholders embodying the selected concepts were conducted.

Slag processing system for direct coal-fired gas turbines

DOEpatents

Pillsbury, Paul W.

1990-01-01

Direct coal-fired gas turbine systems and methods for their operation are provided by this invention. The gas turbine system includes a primary zone for burning coal in the presence of compressed air to produce hot combustion gases and debris, such as molten slag. The turbine system further includes a secondary combustion zone for the lean combustion of the hot combustion gases. The operation of the system is improved by the addition of a cyclone separator for removing debris from the hot combustion gases. The cyclone separator is disposed between the primary and secondary combustion zones and is in pressurized communication with these zones. In a novel aspect of the invention, the cyclone separator includes an integrally disposed impact separator for at least separating a portion of the molten slag from the hot combustion gases.

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

ERIC Educational Resources Information Center

Yorks, Lyle; Barto, Jody

2013-01-01

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

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

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.

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…

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.

Anticipatory postural adjustments for altering direction during walking.

PubMed

Xu, Dali; Carlton, Les G; Rosengren, Karl S

2004-09-01

The authors examined how individuals adapt their gait and regulate their body configuration before altering direction during walking. Eight young adults were asked to change direction during walking with different turning angles (0 degree, 45 degree, 90 degree), pivot foot (left, right), and walking speeds (normal and fast). The authors used video and force platform systems to determine participants' whole-body center of mass and the center of pressure during the step before they changed direction. The results showed that anticipatory postural adjustments occurred during the prior step and occurred earlier for the fast walking speed. Anticipatory postural adjustments were affected by all 3 variables (turn angle, pivot foot, and speed). Participants leaned backward and sideward on the prior step in anticipation of the turn. Those findings indicate that the motor system uses central control mechanisms to predict the required anticipatory adjustments and organizes the body configuration on the basis of the movement goal.

The impact of lean production and related new systems of work organization on worker health.

PubMed

Landsbergis, P A; Cahill, J; Schnall, P

1999-04-01

New systems of work organization, such as lean production and total quality management, have been introduced by employers throughout the industrialized world to improve productivity, quality, and profitability. However, few studies have examined the impact of such systems on occupational injuries or illnesses or on job characteristics related to job strain, which has been linked to hypertension and cardiovascular disease. The studies reviewed provide little evidence to support the hypothesis that lean production "empowers" auto workers. In fact, auto industry studies suggest that lean production creates intensified work pace and demands. Increases in decision authority and skill levels are modest or temporary, whereas decision latitude typically remains low. Thus, such work can be considered to have job strain. In jobs with ergonomic stressors, intensification of labor appears to lead to increases in musculoskeletal disorders. The evidence for adverse health effects remains inconclusive for related new work systems in other industries, such as modular manufacturing or patient-focused care.

Diet-induced obese mice retain endogenous leptin action.

PubMed

Ottaway, Nickki; Mahbod, Parinaz; Rivero, Belen; Norman, Lee Ann; Gertler, Arieh; D'Alessio, David A; Perez-Tilve, Diego

2015-06-02

Obesity is characterized by hyperleptinemia and decreased response to exogenous leptin. This has been widely attributed to the development of leptin resistance, a state of impaired leptin signaling proposed to contribute to the development and persistence of obesity. To directly determine endogenous leptin activity in obesity, we treated lean and obese mice with a leptin receptor antagonist. The antagonist increased feeding and body weight (BW) in lean mice, but not in obese models of leptin, leptin receptor, or melanocortin-4 receptor deficiency. In contrast, the antagonist increased feeding and BW comparably in lean and diet-induced obese (DIO) mice, an increase associated with decreased hypothalamic expression of Socs3, a primary target of leptin. These findings demonstrate that hyperleptinemic DIO mice retain leptin suppression of feeding comparable to lean mice and counter the view that resistance to endogenous leptin contributes to the persistence of DIO in mice. Copyright © 2015 Elsevier Inc. All rights reserved.

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.

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.

Direct Numerical Simulation of a Plane Transitional Wall Jet

NASA Astrophysics Data System (ADS)

Ramesh, O.; Varghese, Joel

2017-11-01

A transitional plane wall jet is studied using direct numerical simulation. The presence of an inflectional point leads to the outer layer rolling up into vortices that interacts with the inner region resulting in a double array of counter rotating vortices before breakdown into turbulence. Past studies have focused on forced wall jet which results in shorter transition region and prominent vortical structures. In the present work, natural transition will be discussed by analysing the coherent structures and scaled frequency spectra. Clear hairpin like structures leaning downstream in the inner region(as in a boundary layer) and leaning upstream in the outerstream (as in a jet) are evident.

Flame Tube NOx Emissions Using a Lean-Direct-Wall-Injection Combustor Concept

NASA Technical Reports Server (NTRS)

Tacina, Robert R.; Wey, Changlie; Choi, Kyung J.

2001-01-01

A low-NOx emissions combustor concept has been demonstrated in flame tube tests. A lean-direct injection concept was used where the fuel is injected directly into the flame zone and the overall fuel-air mixture is lean. In this concept the air is swirled upstream of a venturi section and the fuel is injected radially inward into the air stream from the throat section using a plain-orifice injector. Configurations have two-, four-, or six-wall fuel injectors and in some cases fuel is also injected from an axially located simplex pressure atomizer. Various orifice sizes of the plain-orifice injector were evaluated for the effect on NOx. Test conditions were inlet temperatures up to 8 1 OK, inlet pressures up to 2760 kPa, and flame temperatures up to 2100 K. A correlation is developed relating the NOx emissions to inlet temperature, inlet pressure, fuel-air ratio and pressure drop. Assuming that 15 percent of the combustion air would be used for liner cooling and using an advanced engine cycle, for the best configuration, the NOx emissions using the correlation is estimated to be <75 percent of the 1996 ICAO standard.

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

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.

Lean manufacturing: A better way for enhancement in productivity

NASA Astrophysics Data System (ADS)

Kumar Ahir, Pankaj; Kumar Yadav, Lalit; Singh Chandrawat, Saurabh

2012-03-01

Productivity is the impact of peoples working together. Machines are merely an extended way of collective imagination and energy. Lean Manufacturing is the most used method for continues improvement of business. Organization management philosophy focusing on the reduction of wastage to improve overall customer value. "Lean" operating principles began in manufacturing environments and are known by a variety of synonyms; Lean Manufacturing, Lean Production, Toyota Production System, etc. It is commonly believed that Lean started in Japan "The notable activities in keeping the price of Ford products low is the steady restriction of the production cycle. The longer an article is in the process of manufacture and the more it is moved about, the greater is its ultimate cost." "A systematic approach to identifying and eliminating waste through continuous improvement, flowing the product at the pull of the customer in pursuit of perfection."

Readiness for change and job satisfaction in a case of lean management application - a comparative study.

PubMed

Lipińska-Grobelny, Agnieszka; Papieska, Ewelina

2012-09-01

This current study investigates the effect of lean management system on work attitudes of workers of two manufacturing companies. "Lean management" is a concept of work processes and human relations that determines company's productivity and profitability. Workers of two enterprises, the first one with lean production and the second one with old mass production, were compared for their readiness for change and job satisfaction (both emotional and cognitive aspect). The sample of 102 employees completed a battery of instruments such as: the Job Description Inventory by Neuberger and Allerbeck, the Job Affect Scale by Burke et al. and the Change-Readiness Scale by Kriegel and Brandt. Individuals from the lean manufacturing company were characterized by higher level of readiness for change, positive affect at work, and cognitive job satisfaction. In this approach the introduction of lean production positively affected company's human resource attitudes.

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.

Lean implementation in primary care health visiting services in National Health Service UK.

PubMed

Grove, A L; Meredith, J O; Macintyre, M; Angelis, J; Neailey, K

2010-10-01

This paper presents the findings of a 13-month lean implementation in National Health Service (NHS) primary care health visiting services from May 2008 to June 2009. Lean was chosen for this study because of its reported success in other healthcare organisations. Value-stream mapping was utilised to map out essential tasks for the participating health visiting service. Stakeholder mapping was conducted to determine the links between all relevant stakeholders. Waste processes were then identified through discussions with these stakeholders, and a redesigned future state process map was produced. Quantitative data were provided through a 10-day time-and-motion study of a selected number of staff within the service. This was analysed to provide an indication of waste activity that could be removed from the system following planned improvements. The value-stream map demonstrated that there were 67 processes in the original health visiting service studied. Analysis revealed that 65% of these processes were waste and could be removed in the redesigned process map. The baseline time-and-motion data demonstrate that clinical staff performed on average 15% waste activities, and the administrative support staff performed 46% waste activities. Opportunities for significant waste reduction have been identified during the study using the lean tools of value-stream mapping and a time-and-motion study. These opportunities include simplification of standard tasks, reduction in paperwork and standardisation of processes. Successful implementation of these improvements will free up resources within the organisation which can be redirected towards providing better direct care to patients.

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.

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.

Lean methodology for performance improvement in the trauma discharge process.

PubMed

O'Mara, Michael Shaymus; Ramaniuk, Aliaksandr; Graymire, Vickie; Rozzell, Monica; Martin, Stacey

2014-07-01

High-volume, complex services such as trauma and acute care surgery are at risk for inefficiency. Lean process improvement can reduce health care waste. Lean allows a structured look at processes not easily amenable to analysis. We applied lean methodology to the current state of communication and discharge planning on an urban trauma service, citing areas for improvement. A lean process mapping event was held. The process map was used to identify areas for immediate analysis and intervention-defining metrics for the stakeholders. After intervention, new performance was assessed by direct data evaluation. The process was completed with an analysis of effect and plans made for addressing future focus areas. The primary area of concern identified was interservice communication. Changes centering on a standardized morning report structure reduced the number of consult questions unanswered from 67% to 34% (p = 0.0021). Physical therapy rework was reduced from 35% to 19% (p = 0.016). Patients admitted to units not designated to the trauma service had 1.6 times longer stays (p < 0.0001). The lean process lasted 8 months, and three areas for new improvement were identified: (1) the off-unit patients; (2) patients with length of stay more than 15 days contribute disproportionately to length of stay; and (3) miscommunication exists around patient education at discharge. Lean process improvement is a viable means of health care analysis. When applied to a trauma service with 4,000 admissions annually, lean identifies areas ripe for improvement. Our inefficiencies surrounded communication and patient localization. Strategies arising from the input of all stakeholders led to real solutions for communication through a face-to-face morning report and identified areas for ongoing improvement. This focuses resource use and identifies areas for improvement of throughput in care delivery.

Gas turbine topping combustor

DOEpatents

Beer, Janos; Dowdy, Thomas E.; Bachovchin, Dennis M.

1997-01-01

A combustor for burning a mixture of fuel and air in a rich combustion zone, in which the fuel bound nitrogen in converted to molecular nitrogen. The fuel rich combustion is followed by lean combustion. The products of combustion from the lean combustion are rapidly quenched so as to convert the fuel bound nitrogen to molecular nitrogen without forming NOx. The combustor has an air radial swirler that directs the air radially inward while swirling it in the circumferential direction and a radial fuel swirler that directs the fuel radially outward while swirling it in the same circumferential direction, thereby promoting vigorous mixing of the fuel and air. The air inlet has a variable flow area that is responsive to variations in the heating value of the fuel, which may be a coal-derived fuel gas. A diverging passage in the combustor in front of a bluff body causes the fuel/air mixture to recirculate with the rich combustion zone.

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.

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...

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.

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.

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.

Methods and systems to facilitate reducing NO.sub.x emissions in combustion systems

DOEpatents

Lacy, Benjamin Paul [Greer, SC; Kraemer, Gilbert Otto [Greer, SC; Varatharajan, Balachandar [Clifton Park, NY; Yilmaz, Ertan [Albany, NY; Lipinski, John Joseph [Simpsonville, SC; Ziminsky, Willy Steve [Simpsonville, SC

2011-02-15

A method for assembling a gas turbine combustor system is provided. The method includes providing a combustion liner including a center axis, an outer wall, a first end, and a second end. The outer wall is orientated substantially parallel to the center axis. The method also includes coupling a transition piece to the liner second end. The transition piece includes an outer wall. The method further includes coupling a plurality of lean-direct injectors along at least one of the liner outer wall and the transition piece outer wall such that the injectors are spaced axially apart along the wall.

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.

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

Implementation of Lean System on Erbium Doped Fibre Amplifier Manufacturing Process to Reduce Production Time

NASA Astrophysics Data System (ADS)

Maneechote, T.; Luangpaiboon, P.

2010-10-01

A manufacturing process of erbium doped fibre amplifiers is complicated. It needs to meet the customers' requirements under a present economic status that products need to be shipped to customers as soon as possible after purchasing orders. This research aims to study and improve processes and production lines of erbium doped fibre amplifiers using lean manufacturing systems via an application of computer simulation. Three scenarios of lean tooled box systems are selected via the expert system. Firstly, the production schedule based on shipment date is combined with a first in first out control system. The second scenario focuses on a designed flow process plant layout. Finally, the previous flow process plant layout combines with production schedule based on shipment date including the first in first out control systems. The computer simulation with the limited data via an expected value is used to observe the performance of all scenarios. The most preferable resulted lean tooled box systems from a computer simulation are selected to implement in the real process of a production of erbium doped fibre amplifiers. A comparison is carried out to determine the actual performance measures via an analysis of variance of the response or the production time per unit achieved in each scenario. The goodness of an adequacy of the linear statistical model via experimental errors or residuals is also performed to check the normality, constant variance and independence of the residuals. The results show that a hybrid scenario of lean manufacturing system with the first in first out control and flow process plant lay out statistically leads to better performance in terms of the mean and variance of production times.

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.

An Idealized, Single Radial Swirler, Lean-Direct-Injection (LDI) Concept Meshing Script

NASA Technical Reports Server (NTRS)

Iannetti, Anthony C.; Thompson, Daniel

2008-01-01

To easily study combustor design parameters using computational fluid dynamics codes (CFD), a Gridgen Glyph-based macro (based on the Tcl scripting language) dubbed BladeMaker has been developed for the meshing of an idealized, single radial swirler, lean-direct-injection (LDI) combustor. BladeMaker is capable of taking in a number of parameters, such as blade width, blade tilt with respect to the perpendicular, swirler cup radius, and grid densities, and producing a three-dimensional meshed radial swirler with a can-annular (canned) combustor. This complex script produces a data format suitable for but not specific to the National Combustion Code (NCC), a state-of-the-art CFD code developed for reacting flow processes.

Lean manufacturing and Toyota Production System terminology applied to the procurement of vascular stents in interventional radiology.

PubMed

de Bucourt, Maximilian; Busse, Reinhard; Güttler, Felix; Wintzer, Christian; Collettini, Federico; Kloeters, Christian; Hamm, Bernd; Teichgräber, Ulf K

2011-08-01

OBJECTIVES: To apply the economic terminology of lean manufacturing and the Toyota Production System to the procurement of vascular stents in interventional radiology. METHODS: The economic- and process-driven terminology of lean manufacturing and the Toyota Production System is first presented, including information and product flow as well as value stream mapping (VSM), and then applied to an interdisciplinary setting of physicians, nurses and technicians from different medical departments to identify wastes in the process of endovascular stent procurement in interventional radiology. RESULTS: Using the so-called seven wastes approach of the Toyota Production System (waste of overproducing, waiting, transport, processing, inventory, motion and waste of defects and spoilage) as well as further waste characteristics (gross waste, process and method waste, and micro waste), wastes in the process of endovascular stent procurement in interventional radiology were identified and eliminated to create an overall smoother process from the procurement as well as from the medical perspective. CONCLUSION: Economic terminology of lean manufacturing and the Toyota Production System, especially VSM, can be used to visualise and better understand processes in the procurement of vascular stents in interventional radiology from an economic point of view.

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.

Estimation of lipids and lean mass of migrating sandpipers

USGS Publications Warehouse

Skagen, Susan K.; Knopf, Fritz L.; Cade, Brian S.

1993-01-01

Estimation of lean mass and lipid levels in birds involves the derivation of predictive equations that relate morphological measurements and, more recently, total body electrical conductivity (TOBEC) indices to known lean and lipid masses. Using cross-validation techniques, we evaluated the ability of several published and new predictive equations to estimate lean and lipid mass of Semipalmated Sandpipers (Calidris pusilla) and White-rumped Sandpipers (C. fuscicollis). We also tested ideas of Morton et al. (1991), who stated that current statistical approaches to TOBEC methodology misrepresent precision in estimating body fat. Three published interspecific equations using TOBEC indices predicted lean and lipid masses of our sample of birds with average errors of 8-28% and 53-155%, respectively. A new two-species equation relating lean mass and TOBEC indices revealed average errors of 4.6% and 23.2% in predicting lean and lipid mass, respectively. New intraspecific equations that estimate lipid mass directly from body mass, morphological measurements, and TOBEC indices yielded about a 13% error in lipid estimates. Body mass and morphological measurements explained a substantial portion of the variance (about 90%) in fat mass of both species. Addition of TOBEC indices improved the predictive model more for the smaller than for the larger sandpiper. TOBEC indices explained an additional 7.8% and 2.6% of the variance in fat mass and reduced the minimum breadth of prediction intervals by 0.95 g (32%) and 0.39 g (13%) for Semipalmated and White-rumped Sandpipers, respectively. The breadth of prediction intervals for models used to predict fat levels of individual birds must be considered when interpreting the resultant lipid estimates.

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.

National Directions in Education Research Planning. A Conference Co-Sponsored by the National Educational Research Policy and Priorities Board and the Office of Educational Research and Improvement, U.S. Department of Education (McLean, Virginia, June 17-18, 1998). Report on the Conference.

ERIC Educational Resources Information Center

Timpane, Michael

A conference was convened to bring together representatives of educational research planning efforts underway in federal agencies and professional and scientific organizations. This report identifies the principal emphases and tentative agreements from the sessions. The clear sense of the conference was that the educational research system has…

Optical Characterization of a Multipoint Lean Direct Injector for Gas Turbine Combustors: Velocity and Fuel Drop Size Measurements

NASA Technical Reports Server (NTRS)

Heath, Christopher M.; Anderson, Robert C.; Locke, Randy J.; Hicks, Yolanda R.

2010-01-01

Performance of a multipoint, lean direct injection (MP-LDI) strategy for low emission aero-propulsion systems has been tested in a Jet-A fueled, lean flame tube combustion rig. Operating conditions for the series of tests included inlet air temperatures between 672 and 828 K, pressures between 1034 and 1379 kPa and total equivalence ratios between 0.41 and 0.45, resulting in equilibrium flame temperatures approaching 1800 K. Ranges of operation were selected to represent the spectrum of subsonic and supersonic flight conditions projected for the next-generation of commercial aircraft. This document reports laser-based measurements of in situ fuel velocities and fuel drop sizes for the NASA 9-point LDI hardware arranged in a 3 3 square grid configuration. Data obtained represent a region of the flame tube combustor with optical access that extends 38.1-mm downstream of the fuel injection site. All data were obtained within reacting flows, without particle seeding. Two diagnostic methods were employed to evaluate the resulting flow path. Three-component velocity fields have been captured using phase Doppler interferometry (PDI), and two-component velocity distributions using planar particle image velocimetry (PIV). Data from these techniques have also offered insight into fuel drop size and distribution, fuel injector spray angle and pattern, turbulence intensity, degree of vaporization and extent of reaction. This research serves to characterize operation of the baseline NASA 9- point LDI strategy for potential use in future gas-turbine combustor applications. An additional motive is the compilation of a comprehensive database to facilitate understanding of combustor fuel injector aerodynamics and fuel vaporization processes, which in turn may be used to validate computational fluid dynamics codes, such as the National Combustor Code (NCC), among others.

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…

A Comparison of Three Second-generation Swirl-Venturi Lean Direct Injection Combustor Concepts

NASA Technical Reports Server (NTRS)

Tacina, Kathleen M.; Podboy, Derek P.; He, Zhuohui Joe; Lee, Phil; Dam, Bidhan; Mongia, Hukam

2016-01-01

Three variations of a low emissions aircraft gas turbine engine combustion concept were developed and tested. The concept is a second generation swirl-venturi lean direct injection (SV-LDI) concept. LDI is a lean-burn combustion concept in which the fuel is injected directly into the flame zone. All three variations were based on the baseline 9- point SV-LDI configuration reported previously. The three second generation SV-LDI variations are called the 5-recess configuration, the flat dome configuration, and the 9- recess configuration. These three configurations were tested in a NASA Glenn Research Center medium pressure flametube. All three second generation variations had better low power operability than the baseline 9-point configuration. All three configurations had low NO(sub x) emissions, with the 5-recess configuration generally having slightly lower NO(x) than the flat dome or 9-recess configurations. Due to the limitations of the flametube that prevented testing at pressures above 20 atm, correlation equations were developed for the at dome and 9-recess configurations so that the landing-takeoff NO(sub x) emissions could be estimated. The flat dome and 9-recess landing-takeoff NO(x) emissions are estimated to be 81-88% below the CAEP/6 standards, exceeding the project goal of 75% reduction.

A Comparison of Combustion Dynamics for Multiple 7-Point Lean Direct Injection Combustor Configurations

NASA Technical Reports Server (NTRS)

Tacina, K. M.; Hicks, Y. R.

2017-01-01

The combustion dynamics of multiple 7-point lean direct injection (LDI) combustor configurations are compared. LDI is a fuel-lean combustor concept for aero gas turbine engines in which multiple small fuel-air mixers replace one traditionally-sized fuel-air mixer. This 7-point LDI configuration has a circular cross section, with a center (pilot) fuel-air mixer surrounded by six outer (main) fuel-air mixers. Each fuel-air mixer consists of an axial air swirler followed by a converging-diverging venturi. A simplex fuel injector is inserted through the center of the air swirler, with the fuel injector tip located near the venturi throat. All 7 fuel-air mixers are identical except for the swirler blade angle, which varies with the configuration. Testing was done in a 5-atm flame tube with inlet air temperatures from 600 to 800 F and equivalence ratios from 0.4 to 0.7. Combustion dynamics were measured using a cooled PCB pressure transducer flush-mounted in the wall of the combustor test section.

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.

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.

Hypersensitivity of prediabetic JCR:LA-cp rats to fine airborne combustion particle-induced direct and noradrenergic-mediated vascular contraction.

PubMed

Proctor, Spencer D; Dreher, Kevin L; Kelly, Sandra E; Russell, James C

2006-04-01

Particulate matter with mean aerodynamic diameter < or =2.5 microm (PM(2.5)), from diesel exhaust, coal or residual oil burning, and from industrial plants, is a significant component of airborne pollution. Type 2 diabetes is associated with enhanced risk of adverse cardiovascular events following exposure to PM(2.5). Particle properties, sources, and pathophysiological mechanisms responsible are unknown. We studied effects of residual oil fly ash (ROFA) from a large U.S. powerplant on vascular function in a prediabetic, hyperinsulinemic model, the JCR:LA-cp rat. Residual oil fly ash leachate (ROFA-L) was studied using aortic rings from young-adult, obese, insulin-resistant rats and lean normal rats in vitro. Contractile response to phenylephrine and relaxant response to acetylcholine were determined in the presence and absence of L-NAME (N(G)-nitro-L-arginine methyl ester). In a separate series of studies, the direct contractile effects of ROFA-L on repeated exposure were determined. ROFA-L (12.5 microg ml(-1)) increased phenylephrine-mediated contraction in obese (p < 0.05), but not in lean rat aortae, with the effect being exacerbated by L-NAME, and it reduced acetylcholine-mediated relaxation of both obese and lean aortae (p < 0.0001). Initial exposure of aortae to ROFA-L caused a small contractile response (<0.05 g), which was markedly greater on second exposure in the obese (approximately 0.6 g, p < 0.0001) aortae but marginal in lean (approximately 0.1 g) aortae. Our data demonstrate that bioavailable constituents of oil combustion particles enhance noradrenergic-mediated vascular contraction, impair endothelium-mediated relaxation, and induce direct vasocontraction in prediabetic rats. These observations provide the first direct evidence of the causal properties of PM(2.5) and identify the pathophysiological role of the early prediabetic state in susceptibility to environmentally induced cardiovascular disease. These are important implications for public health and public policy.

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.

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

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.

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.

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.

Evaluation of MRI acquisition workflow with lean six sigma method: case study of liver and knee examinations.

PubMed

Roth, Christopher J; Boll, Daniel T; Wall, Lisa K; Merkle, Elmar M

2010-08-01

The purpose of this investigation was to assess workflow for medical imaging studies, specifically comparing liver and knee MRI examinations by use of the Lean Six Sigma methodologic framework. The hypothesis tested was that the Lean Six Sigma framework can be used to quantify MRI workflow and to identify sources of inefficiency to target for sequence and protocol improvement. Audio-video interleave streams representing individual acquisitions were obtained with graphic user interface screen capture software in the examinations of 10 outpatients undergoing MRI of the liver and 10 outpatients undergoing MRI of the knee. With Lean Six Sigma methods, the audio-video streams were dissected into value-added time (true image data acquisition periods), business value-added time (time spent that provides no direct patient benefit but is requisite in the current system), and non-value-added time (scanner inactivity while awaiting manual input). For overall MRI table time, value-added time was 43.5% (range, 39.7-48.3%) of the time for liver examinations and 89.9% (range, 87.4-93.6%) for knee examinations. Business value-added time was 16.3% of the table time for the liver and 4.3% of the table time for the knee examinations. Non-value-added time was 40.2% of the overall table time for the liver and 5.8% for the knee examinations. Liver MRI examinations consume statistically significantly more non-value-added and business value-added times than do knee examinations, primarily because of respiratory command management and contrast administration. Workflow analyses and accepted inefficiency reduction frameworks can be applied with use of a graphic user interface screen capture program.

Numerical Study of Low Emission Gas Turbine Combustor Concepts

NASA Technical Reports Server (NTRS)

Yang, Song-Lin

2002-01-01

To further reduce pollutant emissions, such as CO, NO(x), UHCs, etc., in the next few decades, innovative concepts of gas turbine combustors must be developed. Several concepts, such as the LIPP (Lean- Premixed- Prevaporized), RQL (Rich-Burn Quick-Quench Lean-Burn), and LDI (Lean-Direct-Injection), have been under study for many years. To fully realize the potential of these concepts, several improvements, such as inlet geometry, air swirler, aerothermochemistry control, fuel preparation, fuel injection and injector design, etc., must be made, which can be studied through the experimental method and/or the numerical technique. The purpose of this proposal is to use the CFD technique to study, and hence, to guide the design process for low emission gas turbine combustors. A total of 13 technical papers have been (or will be) published.

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.

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.

Lean Body Mass and Bone Health in Urban Adolescents From Northern India.

PubMed

Marwaha, Raman K; Garg, M K; Bhadra, Kuntal; Mahalle, Namita; Mithal, Ambrish; Tandon, Nikhil

2017-03-15

To prepare percentile charts of lean body mass (LBM) among Indian urban children and adolescents; and to evaluate gender differences in LBM, and its relation with pubertal status. Secondary data analysis. School in city of Delhi, India. 1403 apparently healthy children and adolescents (826 boys) with mean (SD) age 13.2 (2.7) years. Lean body mass assessed by dual energy absorptiometry. Total and regional lean mass were greater in older age groups in both sexes. LBM showed rising trends up to the age of 18 years in boys, whereas it plateaued after the age of 15 years in girls. The age-associated increase in LBM was significantly higher in boys (130%) compared to girls (83%) (P<0.001). Total and regional lean mass increased with progression of pubertal staging in both genders. During pubertal development, LBM almost doubled (100% increase) from stage-2 to stage-5 in boys, as opposed to a 73% rise in girls (P<0.001). Total and regional lean mass and Appendicular skeletal muscle mass index (ASMI) was positively correlated with age, body mass index (BMI), serum 25(OH)D, total fat mass, and bone mineral content (BMC). Relation between LBM and BMC remained significant even after adjusting for age, fat mass and various biochemical parameters. Total and regional LBM rise with age and pubertal maturation in both genders, but more so in boys when compared to girls. LBM has direct bearing on BMC even after adjusting for age, fat mass and biochemical parameters.

FTO Obesity Risk Variants Are Linked to Adipocyte IRX3 Expression and BMI of Children - Relevance of FTO Variants to Defend Body Weight in Lean Children?

PubMed Central

Landgraf, Kathrin; Scholz, Markus; Kovacs, Peter; Kiess, Wieland; Körner, Antje

2016-01-01

Background Genome-wide association studies have identified variants within the FTO (fat mass and obesity associated) locus as the strongest predictors of obesity amongst all obesity-associated gene loci. Recent evidence suggests that variants in FTO directly affect human adipocyte function through targeting IRX3 and IRX5 and thermogenesis regulation. Aim We addressed the relevance of this proposed FTO-IRX pathway in adipose tissue (AT) of children. Results Expression of IRX3 was higher in adipocytes compared to SVF. We found increased adipocyte-specific expression of IRX3 and IRX5 with the presence of the FTO risk haplotype in lean children, whereas it was unaffected by risk variants in obese peers. We further show that IRX3 expression was elevated in isolated adipocytes and AT of lean compared to obese children, particularly in UCP1-negative adipocytes, and inversely correlated with BMI SDS. Independent of BMI, IRX3 expression in adipocytes was significantly related to adipocyte hypertrophy, and subsequent associations with AT inflammation and HOMA-IR in the children. Conclusion One interpretation of our observation of FTO risk variants linked to IRX3 expression and adipocyte size restricted to lean children, along with the decreased IRX3 expression in obese compared to lean peers, may reflect a defense mechanism for protecting body-weight, which is pertinent for lean children. PMID:27560134

Downregulation of Adipose Tissue Fatty Acid Trafficking in Obesity

PubMed Central

McQuaid, Siobhán E.; Hodson, Leanne; Neville, Matthew J.; Dennis, A. Louise; Cheeseman, Jane; Humphreys, Sandy M.; Ruge, Toralph; Gilbert, Marjorie; Fielding, Barbara A.; Frayn, Keith N.; Karpe, Fredrik

2011-01-01

OBJECTIVE Lipotoxicity and ectopic fat deposition reduce insulin signaling. It is not clear whether excess fat deposition in nonadipose tissue arises from excessive fatty acid delivery from adipose tissue or from impaired adipose tissue storage of ingested fat. RESEARCH DESIGN AND METHODS To investigate this we used a whole-body integrative physiological approach with multiple and simultaneous stable-isotope fatty acid tracers to assess delivery and transport of endogenous and exogenous fatty acid in adipose tissue over a diurnal cycle in lean (n = 9) and abdominally obese men (n = 10). RESULTS Abdominally obese men had substantially (2.5-fold) greater adipose tissue mass than lean control subjects, but the rates of delivery of nonesterified fatty acids (NEFA) were downregulated, resulting in normal systemic NEFA concentrations over a 24-h period. However, adipose tissue fat storage after meals was substantially depressed in the obese men. This was especially so for chylomicron-derived fatty acids, representing the direct storage pathway for dietary fat. Adipose tissue from the obese men showed a transcriptional signature consistent with this impaired fat storage function. CONCLUSIONS Enlargement of adipose tissue mass leads to an appropriate downregulation of systemic NEFA delivery with maintained plasma NEFA concentrations. However the implicit reduction in adipose tissue fatty acid uptake goes beyond this and shows a maladaptive response with a severely impaired pathway for direct dietary fat storage. This adipose tissue response to obesity may provide the pathophysiological basis for ectopic fat deposition and lipotoxicity. PMID:20943748

Effects of wheelchair cushions and pressure relief maneuvers on ischial interface pressure and blood flow in people with spinal cord injury.

PubMed

Sonenblum, Sharon E; Vonk, Teddie E; Janssen, Thomas W; Sprigle, Stephen H

2014-07-01

To investigate the effectiveness and interactions of 2 methods of pressure ulcer prevention, wheelchair cushions and pressure relief maneuvers, on interface pressure (IP) and blood flow of the buttocks. Within-subject repeated measures. Rehabilitation center. Wheelchair users with a spinal cord injury or disorder (N=17). Participants performed 3 forward leans and 2 sideward leans with different degrees of lean while seated on each of 3 different wheelchair cushions. IP measured with a custom sensor and blood flow measured with laser Doppler flowmetry were collected at the ischial tuberosity. Pressure relief maneuvers had a significant main effect on the ischial IP (P<.001); all maneuvers except for the small frontward lean resulted in a significant reduction in IP compared with upright sitting. Blood flow significantly varied across postures (P<.001) with flow during upright sitting and small forward leans being significantly lower than during the full and intermediate leans in both the forward and sideward directions. The results of the study highlight the importance of positioning wheelchair users in a manner that facilitates in-seat movement. Regardless of the cushion being used, the pressure relief maneuvers resulted in very large reductions in IPs and significant increases in buttock blood flow. Only the small frontward lean was shown to be ineffective in reducing pressure or increasing blood flow. Because these pressure relief maneuvers involved postural changes that can occur during functional activities, these pressure relief maneuvers can become a part of volitional pressure relief and functional weight shifts. Therefore, clinical instruction should cover both as a means to impart sitting behaviors that may lead to better tissue health. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Righting response of artificially inclined maritime pine (Pinus pinaster) saplings to wind loading.

PubMed

Berthier, Stephane; Stokes, Alexia

2006-01-01

To determine if trees respond to dynamic and static loading in the same manner, 2-year-old maritime pine (Pinus pinaster Ait.) trees were subjected to different types of mechanical loading in the field. One block of trees (the control) were kept in pots and planted in the field at an angle of 0 or 45 degrees to the vertical. A similar block of leaning potted trees was planted nearby and subjected to frequent, unilateral wind loading for a period of 1 s every 2 min. Half the leaning trees were oriented toward the direction of wind loading and half were oriented along the axis of wind loading. The stem profile was measured three times during the growing season to quantify the rate of stem straightening. Compression wood formation and stem shape were measured in all plants. No differences in mean height or diameter were observed between blocks and all leaning trees straightened, but not at the same rate. Although no difference in the rate of apical straightening occurred between control and wind-treated trees, the righting response of the basal part of the stem of leaning trees subjected to wind was four times greater than that of leaning trees without wind. No differences in the righting response were observed between leaning trees growing toward and trees growing away from the source of wind. No significant differences in compression wood formation were found between control trees and wind-treated trees, indicating that other factors must determine the reorientation rate of leaning trees. Results are discussed with reference to the quality of compression wood in conifers and the mechanotransductive pathway in plants.

Detailed characterization of particulate matter emitted by lean-burn gasoline direct injection engine

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

Zelenyuk, Alla; Wilson, Jacqueline; Imre, Dan

This study presents detailed characterization of the chemical and physical properties of PM emitted by a 2.0L BMW lean-burn turbocharged GDI engine operated under a number of combustion strategies that include lean homogeneous, lean stratified, stoichiometric, and fuel rich conditions. We characterized PM number concentrations, size distributions, and the size, mass, compositions, and effective density of fractal and compact individual exhaust particles. For the fractal particles, these measurements yielded fractal dimension, average diameter of primary spherules, and number of spherules, void fraction, and dynamic shape factors as function of particle size. Overall, the PM properties were shown to vary significantlymore » with engine operation condition. Lean stratified operation yielded the most diesel-like size distribution and the largest PM number and mass concentrations, with nearly all particles being fractal agglomerates composed of elemental carbon with small amounts of ash and organics. In contrast, stoichiometric operation yielded a larger fraction of ash particles, especially at low speed and low load. Three distinct forms of ash particles were observed, with their fractions strongly dependent on engine operating conditions: sub-50 nm ash particles, abundant at low speed and low load, ash-containing fractal particles, and large compact ash particles that significantly contribute to PM mass loadings« less

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.

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.

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.

Gas turbine topping combustor

DOEpatents

Beer, J.; Dowdy, T.E.; Bachovchin, D.M.

1997-06-10

A combustor is described for burning a mixture of fuel and air in a rich combustion zone, in which the fuel bound nitrogen in converted to molecular nitrogen. The fuel rich combustion is followed by lean combustion. The products of combustion from the lean combustion are rapidly quenched so as to convert the fuel bound nitrogen to molecular nitrogen without forming NOx. The combustor has an air radial swirler that directs the air radially inward while swirling it in the circumferential direction and a radial fuel swirler that directs the fuel radially outward while swirling it in the same circumferential direction, thereby promoting vigorous mixing of the fuel and air. The air inlet has a variable flow area that is responsive to variations in the heating value of the fuel, which may be a coal-derived fuel gas. A diverging passage in the combustor in front of a bluff body causes the fuel/air mixture to recirculate with the rich combustion zone. 14 figs.

National Combustion Code Validated Against Lean Direct Injection Flow Field Data

NASA Technical Reports Server (NTRS)

Iannetti, Anthony C.

2003-01-01

Most combustion processes have, in some way or another, a recirculating flow field. This recirculation stabilizes the reaction zone, or flame, but an unnecessarily large recirculation zone can result in high nitrogen oxide (NOx) values for combustion systems. The size of this recirculation zone is crucial to the performance of state-of-the-art, low-emissions hardware. If this is a large-scale combustion process, the flow field will probably be turbulent and, therefore, three-dimensional. This research dealt primarily with flow fields resulting from lean direct injection (LDI) concepts, as described in Research & Technology 2001. LDI is a concept that depends heavily on the design of the swirler. The LDI concept has the potential to reduce NOx values from 50 to 70 percent of current values, with good flame stability characteristics. It is cost effective and (hopefully) beneficial to do most of the design work for an LDI swirler using computer-aided design (CAD) and computer-aided engineering (CAE) tools. Computational fluid dynamics (CFD) codes are CAE tools that can calculate three-dimensional flows in complex geometries. However, CFD codes are only beginning to correctly calculate the flow fields for complex devices, and the related combustion models usually remove a large portion of the flow physics.

A Design Methodology for Rapid Implementation of Active Control Systems Across Lean Direct Injection Combustor Platforms

NASA Technical Reports Server (NTRS)

Baumann, William T.; Saunders, William R.; Vandsburger, Uri; Saus, Joseph (Technical Monitor)

2003-01-01

The VACCG team is comprised of engineers at Virginia Tech who specialize in the subject areas of combustion physics, chemical kinetics, dynamics and controls, and signal processing. Currently, the team's work on this NRA research grant is designed to determine key factors that influence combustion control performance through a blend of theoretical and experimental investigations targeting design and demonstration of active control for three different combustors. To validiate the accuracy of conclusions about control effectiveness, a sequence of experimental verifications on increasingly complex lean, direct injection combustors is underway. During the work period January 1, 2002 through October 15, 2002, work has focused on two different laboratory-scale combustors that allow access for a wide variety of measurements. As the grant work proceeds, one key goal will be to obtain certain knowledge about a particular combustor process using a minimum of sophisticated measurements, due to the practical limitations of measurements on full-scale combustors. In the second year, results obtained in the first year will be validated on test combustors to be identified in the first quarter of that year. In the third year, it is proposed to validate the results at more realistic pressure and power levels by utilizing the facilities at the Glenn Research Center.

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 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.

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.

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.

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.

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.

Effects of Fuel Laminar Flame Speed Compared to Engine Tumble Ratio, Ignition Energy, and Injection Strategy on Lean and EGR Dilute Spark Ignition Combustion

DOE PAGES

Kolodziej, Christopher P.; Pamminger, Michael; Sevik, James; ...

2017-03-28

Previously we show that fuels with higher laminar flame speed also have increased tolerance to EGR dilution. In this work, the effects of fuel laminar flame speed on both lean and EGR dilute spark ignition combustion stability were examined. Fuels blends of pure components (iso-octane, n-heptane, toluene, ethanol, and methanol) were derived at two levels of laminar flame speed. Each fuel blend was tested in a single-cylinder spark-ignition engine under both lean-out and EGR dilution sweeps until the coefficient of variance of indicated mean effective pressure increased above thresholds of 3% and 5%. The relative importance of fuel laminar flamemore » speed to changes to engine design parameters (spark ignition energy, tumble ratio, and port vs. direct injection) was also assessed. Our results showed that fuel laminar flame speed can have as big an effect on lean or EGR dilute engine operation as engine design parameters, with the largest effects seen during EGR dilute operation and when changes were made to cylinder charge motion.« less

Effects of Fuel Laminar Flame Speed Compared to Engine Tumble Ratio, Ignition Energy, and Injection Strategy on Lean and EGR Dilute Spark Ignition Combustion

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

Kolodziej, Christopher P.; Pamminger, Michael; Sevik, James

Previously we show that fuels with higher laminar flame speed also have increased tolerance to EGR dilution. In this work, the effects of fuel laminar flame speed on both lean and EGR dilute spark ignition combustion stability were examined. Fuels blends of pure components (iso-octane, n-heptane, toluene, ethanol, and methanol) were derived at two levels of laminar flame speed. Each fuel blend was tested in a single-cylinder spark-ignition engine under both lean-out and EGR dilution sweeps until the coefficient of variance of indicated mean effective pressure increased above thresholds of 3% and 5%. The relative importance of fuel laminar flamemore » speed to changes to engine design parameters (spark ignition energy, tumble ratio, and port vs. direct injection) was also assessed. Our results showed that fuel laminar flame speed can have as big an effect on lean or EGR dilute engine operation as engine design parameters, with the largest effects seen during EGR dilute operation and when changes were made to cylinder charge motion.« less

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.

Jogging on a Carousel

ERIC Educational Resources Information Center

Wilson, Alpha E.

2011-01-01

To jog around the periphery of a carousel at rest requires that the jogger experience a constant state of acceleration perpendicular to the direction of motion and directed toward the axis of rotation (centripetal). The jogger could achieve this centripetal acceleration by leaning inward, thereby using a horizontal weight component to provide the…

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.

Exploratory Causal Analysis in Bivariate Time Series Data

NASA Astrophysics Data System (ADS)

McCracken, James M.

Many scientific disciplines rely on observational data of systems for which it is difficult (or impossible) to implement controlled experiments and data analysis techniques are required for identifying causal information and relationships directly from observational data. This need has lead to the development of many different time series causality approaches and tools including transfer entropy, convergent cross-mapping (CCM), and Granger causality statistics. In this thesis, the existing time series causality method of CCM is extended by introducing a new method called pairwise asymmetric inference (PAI). It is found that CCM may provide counter-intuitive causal inferences for simple dynamics with strong intuitive notions of causality, and the CCM causal inference can be a function of physical parameters that are seemingly unrelated to the existence of a driving relationship in the system. For example, a CCM causal inference might alternate between ''voltage drives current'' and ''current drives voltage'' as the frequency of the voltage signal is changed in a series circuit with a single resistor and inductor. PAI is introduced to address both of these limitations. Many of the current approaches in the times series causality literature are not computationally straightforward to apply, do not follow directly from assumptions of probabilistic causality, depend on assumed models for the time series generating process, or rely on embedding procedures. A new approach, called causal leaning, is introduced in this work to avoid these issues. The leaning is found to provide causal inferences that agree with intuition for both simple systems and more complicated empirical examples, including space weather data sets. The leaning may provide a clearer interpretation of the results than those from existing time series causality tools. A practicing analyst can explore the literature to find many proposals for identifying drivers and causal connections in times series data sets, but little research exists of how these tools compare to each other in practice. This work introduces and defines exploratory causal analysis (ECA) to address this issue along with the concept of data causality in the taxonomy of causal studies introduced in this work. The motivation is to provide a framework for exploring potential causal structures in time series data sets. ECA is used on several synthetic and empirical data sets, and it is found that all of the tested time series causality tools agree with each other (and intuitive notions of causality) for many simple systems but can provide conflicting causal inferences for more complicated systems. It is proposed that such disagreements between different time series causality tools during ECA might provide deeper insight into the data than could be found otherwise.

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.

'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.

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…

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

NASA Technical Reports Server (NTRS)

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

2002-01-01

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

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.

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.

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

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, 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.

Rapid starting methanol reactor system

DOEpatents

Chludzinski, Paul J.; Dantowitz, Philip; McElroy, James F.

1984-01-01

The invention relates to a methanol-to-hydrogen cracking reactor for use with a fuel cell vehicular power plant. The system is particularly designed for rapid start-up of the catalytic methanol cracking reactor after an extended shut-down period, i.e., after the vehicular fuel cell power plant has been inoperative overnight. Rapid system start-up is accomplished by a combination of direct and indirect heating of the cracking catalyst. Initially, liquid methanol is burned with a stoichiometric or slightly lean air mixture in the combustion chamber of the reactor assembly. The hot combustion gas travels down a flue gas chamber in heat exchange relationship with the catalytic cracking chamber transferring heat across the catalyst chamber wall to heat the catalyst indirectly. The combustion gas is then diverted back through the catalyst bed to heat the catalyst pellets directly. When the cracking reactor temperature reaches operating temperature, methanol combustion is stopped and a hot gas valve is switched to route the flue gas overboard, with methanol being fed directly to the catalytic cracking reactor. Thereafter, the burner operates on excess hydrogen from the fuel cells.

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.

Strong Relation between Muscle Mass Determined by D3-creatine Dilution, Physical Performance and Incidence of Falls and Mobility Limitations in a Prospective Cohort of Older Men.

PubMed

Cawthon, Peggy M; Orwoll, Eric S; Peters, Katherine E; Ensrud, Kristine E; Cauley, Jane A; Kado, Deborah M; Stefanick, Marcia L; Shikany, James M; Strotmeyer, Elsa S; Glynn, Nancy W; Caserotti, Paolo; Shankaran, Mahalakshmi; Hellerstein, Marc; Cummings, Steven R; Evans, William J

2018-06-12

Direct assessment of skeletal muscle mass in older adults is clinically challenging. Relationships between lean mass and late-life outcomes have been inconsistent. The D3-creatine dilution method provides a direct assessment of muscle mass. Muscle mass was assessed by D3-creatine (D3Cr) dilution in 1,382 men (mean age, 84.2 yrs). Participants completed the Short Physical Performance Battery (SPPB); usual walking speed (6 meters); and DXA lean mass. Men self-reported mobility limitations (difficulty walking 2-3 blocks or climbing 10 steps); recurrent falls (2+); and serious injurious falls in the subsequent year. Across quartiles of D3Cr muscle mass/body mass, multivariate linear models calculated means for SPPB and gait speed; multivariate logistic models calculated odds ratios for incident mobility limitations or falls. Compared to men in the highest quartile, those in the lowest quartile of D3Cr muscle mass/body mass had slower gait speed (Q1: 1.04 vs Q4: 1.17 m/s); lower SPPB (Q1: 8.4 vs Q4: 10.4 points); greater likelihood of incident serious injurious falls (OR Q1 vs Q4: 2.49, 95% CI: 1.37, 4.54); prevalent mobility limitation (OR Q1 vs Q4,: 6.1, 95%CI: 3.7, 10.3) and incident mobility limitation (OR Q1 vs Q4: 2.15 95% CI: 1.42, 3.26); p for trend <.001 for all. Results for incident recurrent falls were in the similar direction (p=0.156). DXA lean mass had weaker associations with the outcomes. Unlike DXA lean mass, low D3Cr muscle mass/body mass is strongly related to physical performance, mobility and incident injurious falls in older me.

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.

Deposition of dietary fatty acids in young Zucker rats fed a cafeteria diet.

PubMed

Rafecas, I; Esteve, M; Fernández-López, J A; Remesar, X; Alemany, M

1992-10-01

The content and accretion of fatty acids in 30, 45 and 60-day-old Zucker lean Fa/? and obese fa/fa rats fed either reference chow or a cafeteria diet has been studied, together with their actual fatty acid intake during each period. Diet had little overall effect on the pattern of deposition of fatty acids, but quantitatively the deposition of fat was much higher in cafeteria-fed rats. The fat-rich cafeteria diet allowed the direct incorporation of most fatty acids into the rat lipids, whilst chow feeding activated lipogenesis and the deposition of a shorter chain and more saturated pattern of fatty acids. Genetic, obesity induced a significant expansion of net lipogenesis when compared with lean controls. Cafeteria-fed obese rats accrued a high proportion of fatty acids, which was close to that ingested, but nevertheless showed a net de novo synthesis of fatty acids. It is postulated that the combined effects of genetic obesity and a fat-rich diet result in high rates of fat accretion with limited net lipogenesis. Lean Zucker rats show a progressive impairment of their delta 5-desaturase system, a situation also observed in obese rats fed a reference diet. In Zucker obese rats, cafeteria feeding resulted in an alteration of the conversion of C18:2 into C20:3. The cafeteria diet fully compensated for these drawbacks by supplying very high amounts of polyunsaturated fatty acids.

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...

Effects of training and detraining on adiponectin plasma concentration and muscle sensitivity in lean and overweight men.

PubMed

Gastebois, Caroline; Villars, Clément; Drai, Jocelyne; Canet-Soulas, Emmanuelle; Blanc, Stéphane; Bergouignan, Audrey; Lefai, Etienne; Simon, Chantal

2016-12-01

To delineate the direct effect of physical activity on adiponectin metabolism, we investigated the impact of contrasted physical activity changes, independent of body mass changes, on adiponectin plasma concentration and muscle sensitivity in lean and overweight adult males. Eleven physically active lean men (70.6 ± 2.1 kg) were subjected to 1-month detraining; 9 sedentary lean men (73.1 ± 3.3 kg); and 11 sedentary overweight men (97.5 ± 3.0 kg) participated in a 2-month aerobic-exercise training program. Diet was controlled to maintain stable energy balance. Body composition, VO 2peak , circulating adiponectin, adipose and muscle tissue adiponectin, muscle adiponectin receptors, and APPL1 mRNAs were measured before and after the interventions. At baseline, plasma high-molecular-weight adiponectin concentration was lower in both active lean (5.44 ± 0.58 µg/mL) and sedentary overweight (5.30 ± 1.06 µg/mL) than in sedentary lean participants (7.44 ± 1.06 µg/mL; both p < 0.05). Training reduced total and high-molecular-weight adiponectin concentrations by, respectively, -32 and -42 % in sedentary lean, and -26 and -35 % in sedentary overweight, while detraining increased them by +25 and +27 % in active lean participants. Total and high-molecular-weight adiponectin changes were inversely correlated with VO 2peak changes (respectively, R 2  = 0.45, R 2  = 0.59; both p < 0.001) and positively with changes in fasting plasma insulin (both p < 0.05). Muscle and adipose tissue adiponectin mRNA did not differ between groups and with interventions. Muscle AdipoR2 and APPL1 mRNAs were lower in sedentary groups compared with the active group; and were positively associated with VO 2peak and inversely with fasting plasma insulin concentration. Plasma adiponectin concentration is inversely correlated with aerobic capacity. Future investigations will need to confirm the contribution of changes in muscle adiponectin sensitivity.

Could bioelectric impedance spectroscopy (BIS) measured appendicular intracellular water serve as a lean mass measurement in sarcopenia definitions? A pilot study.

PubMed

Siglinsky, E; Buehring, B; Krueger, D; Binkley, N; Yamada, Y

2018-03-25

DXA lean mass measurement for sarcopenia diagnosis is not always possible. Bioelectric impedance spectroscopy (BIS), a portable technology, is a potential alternative to DXA-measured lean mass. This pilot study explores the possibility and proposes an arbitrarily chosen potential cut-point for appendicular intracellular water corrected by height (aICW/ht 2 ). Sarcopenia definitions often include DXA lean mass measurement. However, DXA is not always available. We explored the potential of a less-expensive mobile method, bioelectric impedance spectroscopy (BIS), to assess lean mass for sarcopenia determination. We hypothesized that BIS-measured appendicular intracellular water (aICW/ht 2 ) would correlate with DXA-measured appendicular lean mass (ALM)/ht 2 and with functional parameters. If so, establishing an aICW/ht 2 cut-point in sarcopenia definitions may be feasible. Sixty-one community-dwelling women, mean age 79.9, had BIS and DXA lean mass, grip strength, gait speed, and jumping mechanography assessments. BIS aICW was calculated using limb length and intracellular water resistance. aICW/ht 2 was compared to DXA-measured ALM/ht 2 by linear regression. The European Working Group ALM/ht 2 and an exploratory aICW/ht 2 cut-point were utilized. In this cohort, ALM/ht 2 and aICW/ht 2 were moderately correlated, R 2  = 0.55, p < 0.0001. Lean mass was low in 7 and normal in 44 by BIS and DXA. Those with low aICW/ht 2 had lower grip strength (p = 0.04) and jump power (p = 0.0002) than those with normal aICW/ht 2 and ALM/ht 2 . Subjects with low ALM/ht 2 had lower jump power (p = 0.0006) but were not different in gait speed or grip strength. BIS aICW is correlated with DXA-measured ALM directly, and when height adjusted. An aICW/ht 2 cut-point of 6.5 L/m 2 identified 70% of women with low ALM/ht 2 . Women with low lean mass by DXA and BIS had poorer function measured by jump power. These pilot data support further evaluation of BIS measurement inclusion into sarcopenia definitions.

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.

Associations among body composition, inflammatory profile and disease extent in ulcerative colitis patients.

PubMed

Urbano, Ana Paula Signori; Sassaki, Ligia Yukie; Dorna, Mariana de Souza; Presti, Paula Torres; Carvalhaes, Maria Antonieta de Barros Leite; Martini, Ligia Araújo; Ferreira, Ana Lucia Anjos

2018-02-01

The aim of our study was to assess body composition status and its association with inflammatory profile and extent of intestinal damage in ulcerative colitis patients during clinical remission. This is a cross-sectional study in which body composition data (phase angle [PhA], fat mass [FM], triceps skin fold thickness [TSFt], mid-arm circumference [MAC], mid-arm muscle circumference [MAMC], adductor pollicis muscle thickness [APMt]), inflammatory profile (C-reactive protein [CRP], a1-acid glycoprotein, erythrocyte sedimentation rate [ESR]) and disease extent were recorded. The mean age of the 59 patients was 48.1 years; 53.3% were women. Most patients were in clinical remission (94.9%) and 3.4% was malnourished according to body mass index. PhA was inversely correlated with inflammatory markers such as CRP (R=-0.59; p<0.001) and ESR (R=-0.46; p<0.001) and directly correlated with lean mass: MAMC (R=0.31; p=0.01) and APMt (R=0.47; p<0.001). Lean mass was inversely correlated with non-specific inflammation marker (APMt vs. ESR) and directly correlated with hemoglobin values (MAMC vs. hemoglobin). Logistic regression analysis revealed that body cell mass was associated with disease extent (OR 0.92; 95CI 0.87-0.97; p<0.01). PhA was inversely correlated with inflammatory markers and directly correlated with lean mass. Acute inflammatory markers were correlated with disease extent. Body cell mass was associated with disease extent.

Field Effects of Buoyancy on Lean Premixed Turbulent Flames

NASA Technical Reports Server (NTRS)

Cheng, R. K.; Johnson, M. R.; Greenberg, P. S.; Wernet, M. P.

2003-01-01

The study of field effects of buoyancy on premixed turbulent flames is directed towards the advancement of turbulent combustion theory and the development of cleaner combustion technologies. Turbulent combustion is considered the most important unsolved problem in combustion science and laboratory studies of turbulence flame processes are vital to theoretical development. Although buoyancy is dominant in laboratory flames, most combustion models are not yet capable to consider buoyancy effects. This inconsistency has impeded the validation of theories and numerical simulations with experiments. Conversely, the understanding of buoyancy effects is far too limited to help develop buoyant flame models. Our research is also relevant to combustion technology because lean premixed combustion is a proven method to reduce the formation of oxides of nitrogen (NOx). In industrial lean premixed combustion systems, their operating conditions make them susceptible to buoyancy thus affecting heat distribution, emissions, stability, flashback and blowoff. But little knowledge is available to guide combustion engineers as to how to avoid or overcome these problems. Our hypothesis is that through its influence on the mean pressure field, buoyancy has direct and indirect effects on local flame/turbulence interactions. Although buoyancy acts on the hot products in the farfield the effect is also felt in the nearfield region upstream of the flame. These changes also influence the generation and dissipation of turbulent kinetic energy inside the flame brush and throughout the flowfield. Moreover, the plume of an open flame is unstable and the periodic fluctuations make additional contributions to flame front dynamics in the farfield. Therefore, processes such as flame wrinkling, flow acceleration due to heat release and flame- generated vorticity are all affected. Other global flame properties (e.g. flame stabilization limits and flame speed) may all be coupled to buoyancy. This problem poses major challenges to combustion modeling due to its need for a computation domain extending into the farfield and full specifications of upstream, wall and downstream boundary conditions.

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.

Follicle-stimulating hormone is independently associated with lean mass but not BMD in younger postmenopausal women

PubMed Central

Gourlay, Margaret L.; Specker, Bonny L.; Li, Chenxi; Hammett-Stabler, Catherine A.; Renner, Jordan B.; Rubin, Janet E.

2011-01-01

Purpose Increased follicle-stimulating hormone (FSH) has been associated with lower bone mineral density (BMD) in animal models and longitudinal studies of women, but a direct effect has not been demonstrated. Methods We tested associations between FSH, non-bone body composition measures and BMD in 94 younger (aged 50 to 64 years) postmenopausal women without current use of hormone therapy, adjusting for sex hormone concentrations and clinical risk factors for osteoporosis. Lean mass, fat mass and areal BMD (aBMD) at the spine, femoral neck and total hip were measured using dual energy X-ray absorptiometry (DXA). Volumetric BMD (vBMD) was measured at the distal radius using peripheral quantitative computed tomography (pQCT). Results: FSH was inversely correlated with lean and fat mass, bioavailable estradiol, spine and hip aBMD, and vBMD at the ultradistal radius. In the multivariable analysis, FSH was independently associated with lean mass (β= −0.099, p=0.005) after adjustment for age, race, years since menopause, bioavailable estradiol, bioavailable testosterone, LH, PTH, SHBG and urine N-telopeptide. FSH showed no statistically significant association with aBMD at any site or pQCT measures at the distal radius in adjusted models. Race was independently associated with aBMD, and race and urine N-telopeptide were independently associated with bone area and vBMD. Conclusions After adjustment for hormonal measures and osteoporosis risk factors, higher concentrations of FSH were independently associated with lower lean mass, but not with BMD. Previously reported correlations between FSH and BMD might have been due to indirect associations via lean mass or weight. PMID:22086136

[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.

Motion direction estimation based on active RFID with changing environment

NASA Astrophysics Data System (ADS)

Jie, Wu; Minghua, Zhu; Wei, He

2018-05-01

The gate system is used to estimate the direction of RFID tags carriers when they are going through the gate. Normally, it is difficult to achieve and keep a high accuracy in estimating motion direction of RFID tags because the received signal strength of tag changes sharply according to the changing electromagnetic environment. In this paper, a method of motion direction estimation for RFID tags is presented. To improve estimation accuracy, the machine leaning algorithm is used to get the fitting function of the received data by readers which are deployed inside and outside gate respectively. Then the fitted data are sampled to get the standard vector. We compare the stand vector with template vectors to get the motion direction estimation result. Then the corresponding template vector is updated according to the surrounding environment. We conducted the simulation and implement of the proposed method and the result shows that the proposed method in this work can improve and keep a high accuracy under the condition of the constantly changing environment.

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.

Point-of-care-testing of standing posture with Wii balance board and Microsoft Kinect during transcranial direct current stimulation: a feasibility study.

PubMed

Dutta, Arindam; Chugh, Sanjay; Banerjee, Alakananda; Dutta, Anirban

2014-01-01

Non-invasive brain stimulation (NIBS) is a promising tool for facilitating motor function. NIBS therapy in conjunction with training using postural feedback may facilitate physical rehabilitation following posture disorders (e.g., Pusher Syndrome). The objectives of this study were, 1) to develop a low-cost point-of-care-testing (POCT) system for standing posture, 2) to investigate the effects of anodal tDCS on functional reach tasks using the POCT system. Ten community-dwelling elderly (age >50 years) subjects evaluated the POCT system for standing posture during functional reach tasks where their balance score on Berg Balance Scale was compared with that from Center-of-Mass (CoM) - Center-of-Pressure (CoP) posturography. Then, in a single-blind, sham-controlled study, five healthy right-leg dominant subjects (age: 26.4 ± 5.3 yrs) were evaluated using the POCT system under two conditions - with anodal tDCS of primary motor representations of right tibialis anterior muscle and with sham tDCS. The maximum CoP-CoM lean-angle was found to be well correlated with the BBS score in the elderly subjects The anodal tDCS strongly (p = 0.0000) affected the maximum CoP excursions but not the return reaction time in healthy. It was concluded that the CoM-CoP lean-line could be used for posture feedback and monitoring during tDCS therapy in conjunction with balance training exercises.

Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation.

PubMed

Trzeciak, Stephen; Mercincavage, Michael; Angelini, Cory; Cogliano, William; Damuth, Emily; Roberts, Brian W; Zanotti, Sergio; Mazzarelli, Anthony J

Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV. Before-and-after cohort study. Multidisciplinary intensive care unit (ICU) in an academic medical center. Adult patients admitted to the ICU and treated with PMV, as defined by diagnosis-related group (DRG). We implemented a clinical redesign intervention based on LSS principles. We identified eight distinct processes in preparing patients with PMV for post-acute care. Our clinical redesign included reengineering daily patient care rounds ("Lean ICU rounds") to reduce variation and waste in these processes. We compared hospital LOS and direct cost per case in patients with PMV before (2013) and after (2014) our LSS intervention. Among 259 patients with PMV (131 preintervention; 128 postintervention), median hospital LOS decreased by 24% during the intervention period (29 vs. 22 days, p < .001). Accordingly, median hospital direct cost per case decreased by 27% ($66,335 vs. $48,370, p < .001). We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV.

Fundamental Study of a Single Point Lean Direct Injector. Part I: Effect of Air Swirler Angle and Injector Tip Location on Spray Characteristics

NASA Technical Reports Server (NTRS)

Tedder, Sarah A.; Hicks, Yolanda R.; Tacina, Kathleen M.; Anderson, Robert C.

2014-01-01

Lean direct injection (LDI) is a combustion concept to reduce oxides of nitrogen (NOx) for next generation aircraft gas turbine engines. These newer engines have cycles that increase fuel efficiency through increased operating pressures, which increase combustor inlet temperatures. NOx formation rates increase with higher temperatures; the LDI strategy avoids high temperature by staying fuel lean and away from stoichiometric burning. Thus, LDI relies on rapid and uniform fuel/air mixing. To understand this mixing process, a series of fundamental experiments are underway in the Combustion and Dynamics Facility at NASA Glenn Research Center. This first set of experiments examines cold flow (non-combusting) mixing using air and water. Using laser diagnostics, the effects of air swirler angle and injector tip location on the spray distribution, recirculation zone, and droplet size distribution are examined. Of the three swirler angles examined, 60 deg is determined to have the most even spray distribution. The injector tip location primarily shifts the flow without changing the structure, unless the flow includes a recirculation zone. When a recirculation zone is present, minimum axial velocity decreases as the injector tip moves downstream towards the venturi exit; also the droplets become more uniform in size and angular distribution.

Fundamental Study of a Single Point Lean Direct Injector. Part I: Effect of Air Swirler Angle and Injector Tip Location on Spray Characteristics

NASA Technical Reports Server (NTRS)

Tedder, Sarah A.; Hicks, Yolanda R.; Tacina, Kathleen M.; Anderson, Robert C.

2015-01-01

Lean direct injection (LDI) is a combustion concept to reduce oxides of nitrogen (NOx) for next generation aircraft gas turbine engines. These newer engines have cycles that increase fuel efficiency through increased operating pressures, which increase combustor inlet temperatures. NOx formation rates increase with higher temperatures; the LDI strategy avoids high temperature by staying fuel lean and away from stoichiometric burning. Thus, LDI relies on rapid and uniform fuel/air mixing. To understand this mixing process, a series of fundamental experiments are underway in the Combustion and Dynamics Facility at NASA Glenn Research Center. This first set of experiments examines cold flow (non-combusting) mixing using air and water. Using laser diagnostics, the effects of air swirler angle and injector tip location on the spray distribution, recirculation zone, and droplet size distribution are examined. Of the three swirler angles examined, 60 degrees is determined to have the most even spray distribution. The injector tip location primarily shifts the flow without changing the structure, unless the flow includes a recirculation zone. When a recirculation zone is present, minimum axial velocity decreases as the injector tip moves downstream towards the venturi exit; also the droplets become more uniform in size and angular distribution.

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.

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.

Genetic variation in exon 17 of INSR is associated with insulin resistance and hyperandrogenemia among lean Indian women with polycystic ovary syndrome.

PubMed

Mukherjee, Srabani; Shaikh, Nuzhat; Khavale, Sushma; Shinde, Gayatri; Meherji, Pervin; Shah, Nalini; Maitra, Anurupa

2009-05-01

Polycystic ovary syndrome (PCOS) is a multigenic disorder, and insulin resistance is one of its hallmark features. Polymorphisms in exon 17 of insulin receptor (INSR) gene are reported to be associated with PCOS. We investigated this association in Indian women and its putative relationship with PCOS associated traits, which has not been explored so far. In this case control study, the polymorphisms were investigated by direct sequencing in 180 women with PCOS and 144 age matched controls. Clinical, anthropometric, biochemical, and hormonal parameters were also estimated. The silent C/T polymorphism at His1058 in exon 17 of INSR was found to be present in our study population. The polymorphic genotype (CT+TT) was significantly associated with PCOS in lean women (chi(2)=8.493, df=1, P=0.004). It showed association with higher fasting insulin levels (P=0.02), homeostasis model assessment of insulin resistance (P=0.005), free androgen index (P=0.03), and lower quantitative insulin sensitivity check index (P=0.004) in lean PCOS women. No other novel or known polymorphism was identified in exon 17 in this cohort. The study shows significant association of C/T polymorphism at His1058 of INSR with PCOS in the lean rather than obese Indian women. Its association with indices of insulin resistance and hyperandrogenemia is also seen in the same group. The findings strengthen the concept that pathogenesis of PCOS is different in lean and obese women.

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.

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.

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.

Flame Interactions and Thermoacoustics in Multiple-Nozzle Combustors

NASA Astrophysics Data System (ADS)

Dolan, Brian

The first major chapter of original research (Chapter 3) examines thermoacoustic oscillations in a low-emission staged multiple-nozzle lean direct injection (MLDI) combustor. This experimental program investigated a relatively practical combustor sector that was designed and built as part of a commercial development program. The research questions are both practical, such as under what conditions the combustor can be safely operated, and fundamental, including what is most significant to driving the combustion oscillations in this system. A comprehensive survey of operating conditions finds that the low-emission (and low-stability) intermediate and outer stages are necessary to drive significant thermoacoustics. Phase-averaged and time-resolved OH* imaging show that dramatic periodic strengthening and weakening of the reaction zone downstream of the low-emission combustion stages. An acoustic modal analysis shows the pressure wave shapes and identifies the dominant thermoacoustic behavior as the first longitudinal mode for this combustor geometry. Finally, a discussion of the likely significant coupling mechanisms is given. Periodic reaction zone behavior in the low-emission fuel stages is the primary contributor to unsteady heat release. Differences between the fuel stages in the air swirler design, the fuel number of the injectors, the lean blowout point, and the nominal operating conditions all likely contribute to the limit cycle behavior of the low-emission stages. Chapter 4 investigates the effects of interaction between two adjacent swirl-stabilized nozzles using experimental and numerical tools. These studies are more fundamental; while the nozzle hardware is the same as the lean direct injection nozzles used in the MLDI combustion concept, the findings are generally applicable to other swirl-stabilized combustion systems as well. Much of the work utilizes a new experiment where the distance between nozzles was varied to change the level of interaction between the two nozzles. A decrease in inter-nozzle spacing resulted in a penalty to the lean blowout point and NO X emissions. Particle image velocimetry shows that the nozzle spacing also has an important effect on the flowfield of the nozzles including the shape of the recirculation region and the quantitative flow velocities. In particular, interaction in the tangential velocity between the two nozzles has large effects on the swirl number and the recirculation zone. Numerical simulations of the isothermal airflows of two pilot nozzles are validated using experimental measurements and used to provide flowfield information outside of the measurement domain. At wider inter-nozzle spacings under certain reacting conditions, an alternating flow pattern develops in the combustion chamber. The shear layers of one nozzle extent into the combustion chamber whereas the inlet reactants from the other nozzle attach near the dome wall to create a very wide recirculation region. Combustion properties, including the fuel type, are shown experimentally to affect whether or not a system will develop an alternating pattern. Simplified computational models of two interacting swirling flows are used to parametrically study the effects of nozzle exit geometry and swirl number on an alternating pattern. Both parameters are shown to be potential drivers of an alternating pattern under some conditions. A hypothesis that proposes a physical mechanism explaining the alternating flow pattern, consistent with the work in this proposal and the research of other groups, is presented. When the nozzle design, flow, or combustion characteristics cause the shear layers of the adjacent nozzles to become sufficiently opposite in direction, the two flows can no longer mix. Instead, one shear layer goes underneath the other which results in the differing flow features of the adjacent nozzles.

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.

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.

Optical Measurements in a Combustor Using a 9-Point Swirl-Venturi Fuel Injector

NASA Technical Reports Server (NTRS)

Hicks, Yolanda R.; Anderson, Robert C.; Locke, Randy J.

2007-01-01

This paper highlights the use of two-dimensional data to characterize a multipoint swirl-venturi injector. The injector is based on a NASA-conceived lean direct injection concept. Using a variety of advanced optical diagnostic techniques, we examine the flows resultant from multipoint, lean-direct injectors that have nine injection sites arranged in a 3 x 3 grid. The measurements are made within an optically-accessible, jet-A-fueled, 76-mm by 76-mm flame tube combustor. Combustion species mapping and velocity measurements are obtained using planar laser-induced fluorescence of OH and fuel, planar laser scatter of liquid fuel, chemiluminescence from CH*, NO*, and OH*, and particle image velocimetry of seeded air (non-fueled). These measurements are used to study fuel injection, mixedness, and combustion processes and are part of a database of measurements that will be used for validating computational combustion models.

Catalysts as sensors--a promising novel approach in automotive exhaust gas aftertreatment.

PubMed

Moos, Ralf

2010-01-01

Sensors that detect directly and in situ the status of automotive exhaust gas catalysts by monitoring the electrical properties of the catalyst coating itself are overviewed. Examples included in this review are the in-situ determination of the electrical impedance of three-way catalysts based on ceria-zirconia solutions and of lean NO(x) traps of earth-alkaline based coatings, as well as approaches to determine the ammonia loading in Fe-SCR-zeolites with electrical ac measurements. Even more sophisticated approaches based on interactions with electromagnetic waves are also reviewed. For that purpose, metallic stick-like antennas are inserted into the exhaust pipe. The catalyst properties are measured in a contactless manner, directly indicating the catalyst status. The radio frequency probes gauge the oxygen loading degree of three-way catalysts, the NO(x)-loading of lean NO(x) traps, and the soot loading of Diesel particulate filters.

Numerical Simulations of Two-Phase Reacting Flow in a Single-Element Lean Direct Injection (LDI) Combustor Using NCC

NASA Technical Reports Server (NTRS)

Liu, Nan-Suey; Shih, Tsan-Hsing; Wey, C. Thomas

2011-01-01

A series of numerical simulations of Jet-A spray reacting flow in a single-element lean direct injection (LDI) combustor have been conducted by using the National Combustion Code (NCC). The simulations have been carried out using the time filtered Navier-Stokes (TFNS) approach ranging from the steady Reynolds-averaged Navier-Stokes (RANS), unsteady RANS (URANS), to the dynamic flow structure simulation (DFS). The sub-grid model employed for turbulent mixing and combustion includes the well-mixed model, the linear eddy mixing (LEM) model, and the filtered mass density function (FDF/PDF) model. The starting condition of the injected liquid spray is specified via empirical droplet size correlation, and a five-species single-step global reduced mechanism is employed for fuel chemistry. All the calculations use the same grid whose resolution is of the RANS type. Comparisons of results from various models are presented.

Catalysts as Sensors—A Promising Novel Approach in Automotive Exhaust Gas Aftertreatment

PubMed Central

Moos, Ralf

2010-01-01

Sensors that detect directly and in situ the status of automotive exhaust gas catalysts by monitoring the electrical properties of the catalyst coating itself are overviewed. Examples included in this review are the in-situ determination of the electrical impedance of three-way catalysts based on ceria-zirconia solutions and of lean NOx traps of earth-alkaline based coatings, as well as approaches to determine the ammonia loading in Fe-SCR-zeolites with electrical ac measurements. Even more sophisticated approaches based on interactions with electromagnetic waves are also reviewed. For that purpose, metallic stick-like antennas are inserted into the exhaust pipe. The catalyst properties are measured in a contactless manner, directly indicating the catalyst status. The radio frequency probes gauge the oxygen loading degree of three-way catalysts, the NOx-loading of lean NOx traps, and the soot loading of Diesel particulate filters. PMID:22163575

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…

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...

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.

Experimental Assessment of the Emissions Control Potential of a Rich/Quench/Lean Combustor for High Speed Civil Transport Aircraft Engines

NASA Technical Reports Server (NTRS)

Rosfjord, T. J.; Padget, F. C.; Tacina, Robert R. (Technical Monitor)

2001-01-01

In support of Pratt & Whitney efforts to define the Rich burn/Quick mix/Lean burn (RQL) combustor for the High Speed Civil Transport (HSCT) aircraft engine, UTRC conducted a flametube-scale study of the RQL concept. Extensive combustor testing was performed at the Supersonic Cruise (SSC) condition of a HSCT engine cycle, Data obtained from probe traverses near the exit of the mixing section confirmed that the mixing section was the critical component in controlling combustor emissions. Circular-hole configurations, which produced rapidly-, highly-penetrating jets, were most effective in limiting NOx. The spatial profiles of NOx and CO at the mixer exit were not directly interpretable using a simple flow model based on jet penetration, and a greater understanding of the flow and chemical processes in this section are required to optimize it. Neither the rich-combustor equivalence ratio nor its residence time was a direct contributor to the exit NOx. Based on this study, it was also concluded that (1) While NOx formation in both the mixing section and the lean combustor contribute to the overall emission, the NOx formation in the mixing section dominates. The gas composition exiting the rich combustor can be reasonably represented by the equilibrium composition corresponding to the rich combustor operating condition. Negligible NOx exits the rich combustor. (2) At the SSC condition, the oxidation processes occurring in the mixing section consume 99 percent of the CO exiting the rich combustor. Soot formed in the rich combustor is also highly oxidized, with combustor exit SAE Smoke Number <3. (3) Mixing section configurations which demonstrated enhanced emissions control at SSC also performed better at part-power conditions. Data from mixer exit traverses reflected the expected mixing behavior for off-design jet to crossflow momentum-flux ratios. (4) Low power operating conditions require that the RQL combustor operate as a lean-lean combustor to achieve low CO and high efficiency. (5) A RQL combustor can achieve the emissions goal of EINOX = 5 at the Supersonic Cruise operating condition for a HSCT engine.

Experimental Assessment of the Emissions Control Potential of a Rich/Quench/ Lean Combustor for High Speed Civil Transport Aircraft Engines

NASA Technical Reports Server (NTRS)

Tacina, Robert R. (Technical Monitor); Rosfjord, T. J.; Padget, F. C.

2001-01-01

In support of Pratt & Whitney efforts to define the Rich burn/Quick mix/Lean burn (RQL) combustor for the High Speed Civil Transport (HSCT) aircraft engine, UTRC conducted a flametube-scale study of the RQL concept. Extensive combustor testing was performed at the Supersonic Cruise (SSC) condition of an HSCT engine cycle. Data obtained from probe traverses near the exit of the mixing section confirmed that the mixing section was the critical component in controlling combustor emissions. Circular-hole configurations, which produced rapidly-, highly-penetrating jets, were most effective in limiting NO(x). The spatial profiles of NO(x) and CO at the mixer exit were not directly interpretable using a simple flow model based on jet penetration, and a greater understanding of the flow and chemical processes in this section are required to optimize it. Neither the rich-combustor equivalence ratio nor its residence time was a direct contributor to the exit NO(x). Based on this study, it was also concluded that: (1) While NO(x) formation in both the mixing section and the lean combustor contribute to the overall emission, the NOx formation in the mixing section dominates. The gas composition exiting the rich combustor can be reasonably represented by the equilibrium composition corresponding to the rich combustor operating condition. Negligible NO(x) exits the rich combustor. (2) At the SSC condition, the oxidation processes occurring in the mixing section consume 99 percent of the CO exiting the rich combustor. Soot formed in the rich combustor is also highly oxidized, with combustor exit SAE Smoke Number <3. (3) Mixing section configurations which demonstrated enhanced emissions control at SSC also performed better at part-power conditions. Data from mixer exit traverses reflected the expected mixing behavior for off-design jet to crossflow momentum-flux ratios. (4) Low power operating conditions require that the RQL combustor operate as a lean-lean combustor to achieve low CO and high efficiency. (5) An RQL combustor can achieve the emissions goal of EINO(x) = 5 at the Supersonic Cruise operating condition for an HSCT engine.

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.

Effect of supervised, periodized exercise training vs. self-directed training on lean body mass and other fitness variables in health club members.

PubMed

Storer, Thomas W; Dolezal, Brett A; Berenc, Matthew N; Timmins, John E; Cooper, Christopher B

2014-07-01

Conventional wisdom suggests that exercise training with a personal trainer (PTr) is more beneficial for improving health-related fitness than training alone. However, there are no published data that confirm whether fitness club members who exercise with a PTr in the fitness club setting obtain superior results compared with self-directed training. We hypothesized that club members randomized to receive an evidence-based training program would accrue greater improvements in lean body mass (LBM) and other fitness measures than members randomized to self-training. Men, aged 30-44 years, who were members of a single Southern California fitness club were randomized to exercise with a PTr administering a nonlinear periodized training program (TRAINED, N = 17) or to self-directed training (SELF, N = 17); both groups trained 3 days per week for 12 weeks. Lean body mass was determined by dual-energy x-ray absorptiometry. Secondary outcomes included muscle strength 1 repetition maximum (1RM), leg power (vertical jump), and aerobic capacity (V[Combining Dot Above]O2max). TRAINED individuals increased LBM by 1.3 (0.4) kg, mean (SEM) vs. no change in SELF, p = 0.029. Similarly, significantly greater improvements were seen for TRAINED vs. SELF in chest press strength (42 vs. 19%; p = 0.003), peak leg power (6 vs. 0.6%; p < 0.0001), and V[Combining Dot Above]O2max (7 vs. -0.3%; p = 0.01). Leg press strength improved 38 and 25% in TRAINED and SELF, respectively (p = 0.14). We have demonstrated for the first time in a fitness club setting that members whose training is directed by well-qualified PTrs administering evidence-based training regimens achieve significantly greater improvements in LBM and other dimensions of fitness than members who direct their own training.

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.

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.

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.

Collateral fattening: When a deficit in lean body mass drives overeating.

PubMed

Dulloo, Abdul G

2017-02-01

In his last review entitled "Some Adventures in Body Composition," Gilbert Forbes reminded us that "lean body mass and body fat are in a sense companions." To what extent the lean body mass (or fat-free mass) component in this companionship impacts on energy intake is rarely a topic for discussion, amid a dominant adipocentric view of appetite control. Yet an analysis of the few human studies that have investigated the relationships between objectively measured food intake and body composition reveals a potentially important role for both an increase and a decrease in fat-free mass in the drive to eat. These studies are highlighted here, together with the implications of their findings for research directed as much toward the elucidation of peripheral signals and energy-sensing mechanisms that drive hunger and appetite, as toward understanding the mechanisms by which dieting and sedentariness predispose to fatness. © 2017 The Authors. Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).

Epilogue: Looking Back to Look Ahead

ERIC Educational Resources Information Center

Alvermann, Donna E.; Price, LaTasha Hutcherson; Jackson, A. J.

2016-01-01

By definition, an epilogue is a concluding segment of a literary work that often describes the futures of its main characters. It can also be a short speech at the end of a play or musical interlude that addresses the audience directly. Leaning in the direction of the latter, we propose as writers of this epilogue to engage in a bit of poetic…

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.

The effect of covert changes in energy density of preloads on subsequent ad libitum energy intake in lean and obese human subjects.

PubMed

Durrant, M L; Royston, J P; Wloch, R T; Garrow, J S

1982-01-01

1. Covert changes in energy intake were made by giving preloads of disguised energy density three times daily to 14 obese and 6 lean subjects. 2. The preloads contained 2.51 MJ (600 kcal)/d on days 2 and 3 and either 3.77 MJ (900 kcal)/d or 1.26 MJ (300 kcal/d) on days 4 and 5 and 1.26 MJ (300 kcal)/d or 3.77 MJ (900 kcal)/d on days 6 and 7. The order of testing was alternated for each subject. 3. Subsequent energy intake at each meal (lunch, dinner and breakfast) was measured with an automated food-dispensing machine. 4. Overall the obese subjects ate significantly less from the machine, 3.28 +/- 1.89 MJ (785 +/- 452 kcal)/d, than the lean subjects, 6.03 +/- 1.26 MJ (1442 +/- 300 kcal)/d. 5. Both groups of subjects adjusted their energy intake in the right direction to counterbalance the effect of the preloads but the lean subjects changed their intake by an average of 0.74 MJ (176 kcal)/d compared with the obese subjects who changed their intake by an average of 0.29 MJ (70 kcal)/d. 6. Although the lean subjects were better at adjusting their energy intake than the obese subjects, regulation was still imprecise relative to the 2.51 MJ (600 kcal)/d difference in energy intake that was imposed. 7. There were no significant differences in hunger or appetite between subjects or test situations.

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…

Methodological evaluation of indirect calorimetry data in lean and obese rats.

PubMed

Rafecas, I; Esteve, M; Fernández-López, J A; Remesar, X; Alemany, M

1993-11-01

1. The applicability of current indirect calorimetry formulae to the study of energy and substrate balances on obese rats has been evaluated. The energy consumption of series of 60-day rats of Wistar, lean and obese Zucker stock were studied by means of direct and indirect calorimetry, and by establishing their energy balance through measurement of food intake and retention. Calorimetric studies encompassed a 24 h period, with gas and heat output measurements every 2 or 5 min, respectively, for direct and indirect calorimetry. 2. The analysis of fat composition (diet, whole rat, and synthesized and oxidized fat) showed only small variations that had only a limited effect on the overall energy equation parameters. 3. A gap in the nitrogen balance, which represents a urinary N excretion lower than the actual protein oxidized, resulted in significant deviations in the estimation of carbohydrate and lipid oxidized when using the equations currently available for indirect calorimetry. 4. Analysis of the amino acid composition of diet and rat protein as well as of the portion actually oxidized, and correcting for the nitrogen gap allowed the establishment of a set of equations that gave better coincidence of the calculated data with the measured substrate balance. 5. The measured heat output of all rats was lower than the estimated values calculated by means of either indirect calorimetry of direct energy balance measurement; the difference corresponded to the energy lost in water evaporation, and was in the range of one-fifth of total energy produced in the three rat stocks. 6. Wistar rats showed a biphasic circadian rhythm of substrate utilization, with alternate lipid synthesis/degradation that reversed that of carbohydrate, concordant with nocturnal feeding habits. Zucker rats did not show this rhythm; obese rats synthesized large amounts of fat during most of the light period, consuming fat at the end of the dark period, which suggests more diurnal feeding habits. Lean Zucker rats showed a similar, but less marked pattern. 7. The results obtained indicate that lean and obese rats can be studied using the same indirect calorimetry formulae provided that there is an adequate measure of protein oxidation and the composition of diet does not differ.

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.

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.

Combustor technology for future small gas turbine aircraft

NASA Technical Reports Server (NTRS)

Lyons, Valerie J.; Niedzwiecki, Richard W.

1993-01-01

Future engine cycles proposed for advanced small gas turbine engines will increase the severity of the operating conditions of the combustor. These cycles call for increased overall engine pressure ratios which increase combustor inlet pressure and temperature. Further, the temperature rise through the combustor and the corresponding exit temperature also increase. Future combustor technology needs for small gas turbine engines is described. New fuel injectors with large turndown ratios which produce uniform circumferential and radial temperature patterns will be required. Uniform burning will be of greater importance because hot gas temperatures will approach turbine material limits. The higher combustion temperatures and increased radiation at high pressures will put a greater heat load on the combustor liners. At the same time, less cooling air will be available as more of the air will be used for combustion. Thus, improved cooling concepts and/or materials requiring little or no direct cooling will be required. Although presently there are no requirements for emissions levels from small gas turbine engines, regulation is expected in the near future. This will require the development of low emission combustors. In particular, nitrogen oxides will increase substantially if new technologies limiting their formation are not evolved and implemented. For example, staged combustion employing lean, premixed/prevaporized, lean direct injection, or rich burn-quick quench-lean burn concepts could replace conventional single stage combustors.

Sarcopenia and its relationship with osteoarthritis: risk factor or direct consequence?

PubMed

Papalia, R; Zampogna, B; Torre, G; Lanotte, A; Vasta, S; Albo, E; Tecame, A; Denaro, V

2014-06-01

The aim of this review is to evaluate the clinical role of sarcopenia in patients affected by osteoarthritis (OA) of major joints. An online database research was performed, in order to retrieve all articles investigating the relationship between sarcopenia and OA. No peer-reviewed journal was excluded. Papers in English, French, Spanish and Italian language were considered. After consulting the full-text article, five studies have been included in the review. Of the five studies included, four are prospective studies and only one is a cross-sectional study which retrieved data retrospectively. A total of 4,231 patients, presenting a mean age of 62.0 years, were studied. Three studies evaluated only female subjects. Weight, height and body mass index were reported in all the articles. Knee OA has been assessed using the Kellgren-Lawrence grading system and the American college of rheumatology criteria. Alterations of the lean body mass on body weight ratio have been reported to be as a significant predictive parameter in two studies. Relationship between radiographic OA and an increase in the leg lean mass has been observed in one study. We cannot support neither the thesis of a direct effect of sarcopenia on OA development nor the opposite relation, because the up-to-date literature lacks basic science studies concerning these topics. The absence of clinical studies regarding measurements and tools to compare sarcopenia and OA do not allow to definitely clarify this relationship.

Reference standards for lean mass measures using GE dual energy x-ray absorptiometry in Caucasian adults

PubMed Central

Imboden, Mary T.; Swartz, Ann M.; Finch, Holmes W.; Harber, Matthew P.; Kaminsky, Leonard A.

2017-01-01

Body composition assessments commonly focus predominantly on fat mass, however lean mass (LM) measurements also provide useful information regarding clinical and nutritional status. LM measurements help predict health outcomes and diagnose sarcopenia, which has been associated with frailty. Dual energy x-ray absorptiometry (DXA) is an established technique used in clinical and research settings to assess body composition including total and regional LM. Currently, there are no reference values available that were derived from GE-Healthcare DXA systems directly for US adults for LM, LM index (LMI), percent LM (%LM), and appendicular lean mass index (ALMI) and it is known that whole-body and regional LM measures differ by DXA manufacturer. Objective To develop reference values by age and sex for LM measures using GE-Healthcare DXA systems. Methods A de-identified sample was obtained from Ball State University’s Clinical Exercise Physiology Laboratory and University of Wisconsin-Milwaukee’s Physical Activity & Health Research Laboratory. DXA scans of 2,076 women and 1,251 men were completed using a GE Lunar Prodigy or iDXA. Percentiles (%ile) were calculated for all variables of interest (LM, LMI, %LM, and ALMI) and a factorial ANOVA was used to assess differences for each variable between 10-year age groups and sex, as well as the interaction between age and sex. Results Men had higher mean total LM, %LM, LMI, and ALMI than women (p<0.01), across all age groups. All LM variables decreased significantly over the 5 decades in men, however in women only total LM, %LM, and ALMI decreased from the youngest to oldest age groups (p<0.01). Conclusion These reference values provide for a more accurate interpretation of GE-Healthcare DXA-derived LM measurements offering clinicians and researchers with an initial resource to aid in the early detection and assessment of LM deficits. PMID:28426779

Lean mass in obese adult subjects correlates with higher levels of vitamin D, insulin sensitivity and lower inflammation.

PubMed

Fornari, R; Francomano, D; Greco, E A; Marocco, C; Lubrano, C; Wannenes, F; Papa, V; Bimonte, V M; Donini, L M; Lenzi, A; Aversa, A; Migliaccio, S

2015-03-01

Several chronic metabolic alterations are present in obese subjects. While it is well known about the detrimental effect of abdominal adipose tissue on chronic metabolic clinical condition, less is known on the role of lean mass in obese subjects. Thus, the aim of our study was to evaluate the potential correlation of muscle mass, metabolic condition and inflammation status in obese individuals. The study included 426 obese subjects (86 men and 340 female; mean age 44.8 ± 14 years; BMI: 34.9 ± 6.1 kg/m(2)). Exclusion criteria were chronic medical conditions or use of medications affecting bone metabolism, alterations of hormonal and nutritional status, vitamin D supplementation, recent weight loss and prior bariatric surgery. Patients underwent measurements of bone mineral density (lumbar and hip) and body composition (lean mass, total and trunk fat mass) by dual X-ray absorptiometry and were evaluated for hormonal and metabolic profile and inflammatory markers. Higher lean body mass (LM%) was inversely correlated with homeostasis model assessment of insulin resistance (p < 0.0091; r(2) 0.03938) and associated with lower fibrinogen levels (p < 0.0001; r(2) 0.1263). Interestingly, in obese subjects, LM% was associated with higher levels of vitamin D (p < 0.0001, r(2) 0.1140), osteocalcin (p < 0.0001, r(2) 0.2401) and insulin-like growth factor-1 (IGF-1) (p < 0.0002, r(2) 0.1367). Our results show for the first time that in obese patients, higher amounts of lean mass are directly linked to a lower inflammatory profile and to better insulin sensitivity, but also to the presence of higher level of vitamin D and IGF-1. Moreover, these data suggest that higher levels of lean mass in obese people correlate with a better metabolic profile and, thus, strongly suggest the need to develop programs to facilitate an increase in physical activity in obese people.

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.

Hepatitis C Care in the Department of Veterans Affairs: Building a Foundation for Success.

PubMed

Belperio, Pamela S; Chartier, Maggie; Gonzalez, Rachel I; Park, Angela M; Ross, David B; Morgan, Tim R; Backus, Lisa I

2018-06-01

The Department of Veterans Affairs (VA) has made significant progress in treating hepatitis C virus, experiencing more than a 75% reduction in veterans remaining to be treated since the availability of oral direct-acting antivirals. Hepatitis C Innovation Teams use lean process improvement and system redesign, resulting in practice models that address gaps in care. The key to success is creative improvements in veteran access to providers, including expanded use of nonphysician providers, video telehealth, and electronic technologies. Population health management tools monitor and identify trends in care, helping the VA tailor care and address barriers. Published by Elsevier Inc.

Determination of the boar taint compound skatole in meat juice by means of stable isotope dilution analysis-direct immersion-solid phase microextraction-gas chromatography/mass spectrometry.

PubMed

Fischer, Jochen; Brinkmann, Detert; Elsinghorst, Paul W; Wüst, Matthias

2012-07-01

A novel SIDA-DI-SPME-GC/MS procedure for the quantitation of skatole in pork meat juice was developed and validated as a substitute for back fat sample analysis. System suitability was evaluated by determining the correlation between skatole concentrations in a subset of 38 paired meat juice and back fat samples selected from 90 fattened boars. High correlation was observed between both matrices and conclusions about the partitioning of skatole as well as of androstenone between fat and lean compartments in vivo were drawn. Copyright © 2012 Elsevier Ltd. All rights reserved.

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.

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

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.

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.

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.

Chaotic dynamics in premixed hydrogen/air channel flow combustion

NASA Astrophysics Data System (ADS)

Pizza, Gianmarco; Frouzakis, Christos E.; Mantzaras, John

2012-04-01

The complex oscillatory behaviour observed in fuel-lean premixed hydrogen/air atmospheric pressure flames in an open planar channel with prescribed wall temperature is investigated by means of direct numerical simulations, employing detailed chemistry descriptions and species transport, and nonlinear dynamics analysis. As the inflow velocity is varied, the sequence of transitions includes harmonic single frequency oscillations, intermittency, mixed mode oscillations, and finally a period-doubling cascade leading to chaotic dynamics. The observed modes are described and characterised by means of phase-space portraits and next amplitude maps. It is shown that the interplay of chemistry, transport, and wall-bounded developing flow leads to considerably richer dynamics compared to fuel-lean hydrogen/air continuously stirred tank reactor studies.

Simulation of a Single-Element Lean-Direct Injection Combustor Using Arbitrary Polyhedral Mesh

NASA Technical Reports Server (NTRS)

Wey, Thomas; Liu, Nan-Suey

2012-01-01

This paper summarizes procedures of generating the arbitrary polyhedral mesh as well as presents sample results from its application to the numerical solution of a single-element LDI combustor using a preliminary version of the new OpenNCC.

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

PubMed

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

2018-01-01

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

The 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.

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.

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.

[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.

The contribution of visual and proprioceptive information to the perception of leaning in a dynamic motorcycle simulator.

PubMed

Lobjois, Régis; Dagonneau, Virginie; Isableu, Brice

2016-11-01

Compared with driving or flight simulation, little is known about self-motion perception in riding simulation. The goal of this study was to examine whether or not continuous roll motion supports the sensation of leaning into bends in dynamic motorcycle simulation. To this end, riders were able to freely tune the visual scene and/or motorcycle simulator roll angle to find a pattern that matched their prior knowledge. Our results revealed idiosyncrasy in the combination of visual and proprioceptive information. Some subjects relied more on the visual dimension, but reported increased sickness symptoms with the visual roll angle. Others relied more on proprioceptive information, tuning the direction of the visual scenery to match three possible patterns. Our findings also showed that these two subgroups tuned the motorcycle simulator roll angle in a similar way. This suggests that sustained inertially specified roll motion have contributed to the sensation of leaning in spite of the occurrence of unexpected gravito-inertial stimulation during the tilt. Several hypotheses are discussed. Practitioner Summary: Self-motion perception in motorcycle simulation is a relatively new research area. We examined how participants combined visual and proprioceptive information. Findings revealed individual differences in the visual dimension. However, participants tuned the simulator roll angle similarly, supporting the hypothesis that sustained inertially specified roll motion contributes to a leaning sensation.

The mechanisms of flame holding in the wake of a bluff body

NASA Technical Reports Server (NTRS)

Strehlow, R. A.; Malik, S.

1985-01-01

The flame holding mechanism for lean methane- and lean propane-air flames is examined under conditions where the recirculation zone is absent. The main objective of this work is to study the holding process in detail in an attempt to determine the mechanism of flame holding and also the conditions where this mechanism is viable and when it fails and blow-off occurs. Inverted flames held in the wake of a flat strip were studied. Experiments with different sizes of flame holders were performed. The velocity flow field was determined using a laser Doppler velocimetry technique. Equation of continuity was used to calculate the flame temperature from the change in area of flow streamlines before and after the flame. Observations of the inverted flame itself were obtained using schlieren and direct photography. Results show that there are different mechanisms operative at the time of blow-off for lean propane and methane flames. Blow-off or extinction occurs for lean propane-air flame in spite of the reaction going to completion and the disparity between the heat loss and the gain in mass diffusion in the reaction zone i.e., Le 1.0 causes the flame to blow-off. For methane-air flame the controlling factor or blow-off is incomplete reaction due to higher blowing rate leading to reduced residence time in the reaction zone.

Drive cycle simulation of high efficiency combustions on fuel economy and exhaust properties in light-duty vehicles

DOE PAGES

Gao, Zhiming; Curran, Scott J.; Parks, James E.; ...

2015-04-06

We present fuel economy and engine-out emissions for light-duty (LD) conventional and hybrid vehicles powered by conventional and high-efficiency combustion engines. Engine technologies include port fuel-injected (PFI), direct gasoline injection (GDI), reactivity controlled compression ignition (RCCI) and conventional diesel combustion (CDC). In the case of RCCI, the engine utilized CDC combustion at speed/load points not feasible with RCCI. The results, without emissions considered, show that the best fuel economies can be achieved with CDC/RCCI, with CDC/RCCI, CDC-only, and lean GDI all surpassing PFI fuel economy significantly. In all cases, hybridization significantly improved fuel economy. The engine-out hydrocarbon (HC), carbon monoxidemore » (CO), nitrogen oxides (NOx), and particulate matter (PM) emissions varied remarkably with combustion mode. The simulated engine-out CO and HC emissions from RCCI are significantly higher than CDC, but RCCI makes less NOx and PM emissions. Hybridization can improve lean GDI and RCCI cases by increasing time percentage for these more fuel efficient modes. Moreover, hybridization can dramatically decreases the lean GDI and RCCI engine out emissions. Importantly, lean GDI and RCCI combustion modes decrease exhaust temperatures, especially for RCCI, which limits aftertreatment performance to control tailpipe emissions. Overall, the combination of engine and hybrid drivetrain selected greatly affects the emissions challenges required to meet emission regulations.« less

Regulation of plasma agouti-related protein and its relationship with hunger in lean and obese men.

PubMed

Hazell, Tom J; Sawula, Laura; Edgett, Brittany A; Walsh, Jeremy J; Gurd, Brendon J

2016-12-01

Agouti-related protein (AgRP) is an orexigenic (appetite stimulating) neuropeptide suggested to exert tonic control over long-term energy balance. While some have speculated AgRP is not involved in the episodic (i.e. meal to meal energy intake) control, acute decreases in plasma agouti-related protein (AgRP) following a meal have been observed in humans in a role consistent with episodic control for AgRP. Whether changes in plasma AgRP are associated with episodic, and/or tonic changes in appetite has yet to be directly examined. The present study examined the relationship between agouti-related protein (AgRP), leptin and the regulation of appetite following a 48-h fast and an acute meal challenge. Blood samples were obtained from young lean and obese men before and after a 48 h fast (lean n = 10; obese n = 7). Fasting resulted in an increase in AgRP and a decrease in leptin with these changes being greater in lean than obese. In addition, blood samples were obtained from lean men before and 1, 2, 3 and 4 h after a meal (n = 8). Following a meal, AgRP was reduced from 2 to 4 h, a change that was dissociated from both leptin and subjective measures of hunger and satiety. These results demonstrate that AgRP is not associated with changes in hunger or satiety, and can change without corresponding changes in leptin. This suggests that AgRP may not be involved in the episodic control of appetite and the release of AgRP may involve signals other than leptin. Copyright © 2016 Elsevier Ltd. All rights reserved.

Relationship between body composition and vertical ground reaction forces in obese children when walking.

PubMed

Villarrasa-Sapiña, Israel; Serra-Añó, Pilar; Pardo-Ibáñez, Alberto; Gonzalez, Luis-Millán; García-Massó, Xavier

2017-01-01

Obesity is now a serious worldwide challenge, especially in children. This condition can cause a number of different health problems, including musculoskeletal disorders, some of which are due to mechanical stress caused by excess body weight. The aim of this study was to determine the association between body composition and the vertical ground reaction force produced during walking in obese children. Sixteen children participated in the study, six females and ten males [11.5 (1.2) years old, 69.8 (15.5) kg, 1.56 (0.09) m, and 28.36 (3.74) kg/m 2 of body mass index (BMI)]. Total weight, lean mass and fat mass were measured by dual-energy X-ray absorptiometry and vertical forces while walking were obtained by a force platform. The vertical force variables analysed were impact and propulsive forces, and the rate of development of both. Multiple regression models for each vertical force parameter were calculated using the body composition variables as input. The impact force regression model was found to be positively related to the weight of obese children and negatively related to lean mass. The regression model showed lean mass was positively related to the propulsive rate. Finally, regression models for impact and propulsive force showed a direct relationship with body weight. Impact force is positively related to the weight of obese children, but lean mass helps to reduce the impact force in this population. Exercise could help obese persons to reduce their total body weight and increase their lean mass, thus reducing impact forces during sports and other activities. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

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

Ethanol is a very effective reductant of nitrogen oxides (NOX) over silver/alumina (Ag/Al2O3) catalysts in lean exhaust environment. With the widespread availability of ethanol/gasoline-blended fuel in the USA, lean gasoline engines equipped with an Ag/Al2O3 catalyst have the potential to deliver higher fuel economy than stoichiometric gasoline engines and to increase biofuel utilization while meeting exhaust emissions regulations. In this work a pre-commercial 2 wt% Ag/Al2O3 catalyst was evaluated on a 2.0-liter BMW lean burn gasoline direct injection engine for the selective catalytic reduction (SCR) of NOX with ethanol/gasoline blends. The ethanol/gasoline blends were delivered via in-pipe injection upstream ofmore » the Ag/Al2O3 catalyst with the engine operating under lean conditions. A number of engine conditions were chosen to provide a range of temperatures and space velocities for the catalyst performance evaluations. High NOX conversions were achieved with ethanol/gasoline blends containing at least 50% ethanol; however, higher C1/N ratio was needed to achieve greater than 90% NOX conversion, which also resulted in significant HC slip. Temperature and HC dosing were important in controlling selectivity to NH3 and N2O. At high temperatures, NH3 and N2O yields increased with increased HC dosing. At low temperatures, NH3 yield was very low, however, N2O levels became significant. The ability to generate NH3 under lean conditions has potential for application of a dual SCR approach (HC SCR + NH3 SCR) to reduce fuel consumption needed for NOX reduction and/or increased NOX conversion, which is discussed in this work.« less

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

Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal

PubMed Central

Naidoo, Logandran

2016-01-01

Background Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload. Aim The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital. Setting The study was conducted at the Catherine Booth Hospital (CBH) – a rural district hospital in KwaZulu-Natal, South Africa. Methods This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times. Results All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention). Conclusion The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators. PMID:27543283

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

Socioeconomic position across life and body composition in early old age: findings from a British birth cohort study

PubMed Central

Bann, David; Cooper, Rachel; Wills, Andrew K; Adams, Judith; Kuh, Diana

2014-01-01

Background Previous studies have reported associations between lower lifetime socioeconomic position (SEP) and higher body mass index in adulthood, but few have examined associations with direct measures of fat and lean mass which are likely to have independent roles in health and physical functioning. Methods We examined associations of SEP across life with dual-energy X-ray absorptiometry measures of fat and lean mass at 60–64 years using data from a total of 1558 men and women participating in the Medical Research Council (MRC) National Survey of Health and Development. We also examined whether associations of childhood SEP with fat and lean mass were explained by preadulthood weight gain (birth weight, 0–7 and 7–20 years) and adult SEP. Results Lower SEP across life was associated with higher fat mass and higher android to gynoid fat mass ratio. For example, the mean difference in fat mass index comparing the lowest with the highest paternal occupational class at 4 years (slope index of inequality) was 1.04 kg/m1.2 in men (95% CI 0.09 to 1.99) and 2.61 in women (1.34 to 3.89), equivalent to a 8.6% and 16.1% difference, respectively. After adjustment for fat mass, lower SEP across life was associated with lower lean mass in women, while only contemporaneous household income was associated in men. Associations between childhood SEP and outcomes were partly explained by preadulthood weight gain and adult SEP. Conclusions This study identified lifetime socioeconomic patterning of fat and lean mass in early old age. This is likely to have important implications and may partly explain socioeconomic inequalities in health and physical functioning. PMID:24567442

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

NASA Technical Reports Server (NTRS)

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

2002-01-01

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

Development of a fast, lean and agile direct pelletization process using experimental design techniques.

PubMed

Politis, Stavros N; Rekkas, Dimitrios M

2017-04-01

A novel hot melt direct pelletization method was developed, characterized and optimized, using statistical thinking and experimental design tools. Mixtures of carnauba wax (CW) and HPMC K100M were spheronized using melted gelucire 50-13 as a binding material (BM). Experimentation was performed sequentially; a fractional factorial design was set up initially to screen the factors affecting the process, namely spray rate, quantity of BM, rotor speed, type of rotor disk, lubricant-glidant presence, additional spheronization time, powder feeding rate and quantity. From the eight factors assessed, three were further studied during process optimization (spray rate, quantity of BM and powder feeding rate), at different ratios of the solid mixture of CW and HPMC K100M. The study demonstrated that the novel hot melt process is fast, efficient, reproducible and predictable. Therefore, it can be adopted in a lean and agile manufacturing setting for the production of flexible pellet dosage forms with various release rates easily customized between immediate and modified delivery.

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.

Comparison of estimates of body fat content in childhood-onset systemic lupus erythematosus.

PubMed

Sinicato, N A; Peres, F A; de Oliveira Peliçari, K; de Oliveira Santos, A; Ramos, C D; Marini, R; Appenzeller, S

2017-04-01

Objective We aimed to compare estimates of body fat content with respect to their ability to predict the percentage of body fat, confirmed by dual-energy X-ray absorptiometry scans in childhood-onset systemic lupus erythematosus. Methods We included 64 consecutive childhood-onset systemic lupus erythematosus patients and 64 healthy age and sex-matched controls in a cross-sectional study. Anthropometric data, body mass index and body adiposity index were calculated for all subjects. Childhood-onset systemic lupus erythematosus patients were further assessed for clinical and laboratory childhood-onset systemic lupus erythematosus manifestations and fat mass, lean mass and percentage of body fat evaluated by dual-energy X-ray absorptiometry. Results Elevated waist/hip ratio was observed in childhood-onset systemic lupus erythematosus patients when compared to controls ( p < 0.001). We did not find differences between body mass index and body adiposity index classification in childhood-onset systemic lupus erythematosus patients and controls. Using dual-energy X-ray absorptiometry as gold standard we observed that all indirect estimates of body fat were correlated with whole body fat mass. We observed a correlation between height and cumulative corticosteroid dose adjusted by weight ( r = 0.429, p = 0.005) in childhood-onset systemic lupus erythematosus. On whole body analysis we observed a correlation between lean mass and ACR Damage Index scores ( r = -0.395; p = 0.019); percentage of body fat and adjusted Systemic Lupus Erythematosus Disease Activity Index ( r = 0.402; p = 0.008), disease duration ( r = -0.370; p = 0.012). On trunk analysis we observed a correlation between lean mass and ACR Damage Index ( r = -0.319; p = 0.042); percentage of body fat with adjusted Systemic Lupus Erythematosus Disease Activity Index ( r = 0.402; p = 0.005), disease duration ( r = -0.408; p = 0.005). Conclusions This is the first study analyzing body adiposity index in childhood-onset systemic lupus erythematosus patients. We observed that all indirect estimates of body fat were correlated with whole body fat mass. This study shows that we should not replace body mass index by body adiposity index to evaluating fat levels in childhood-onset systemic lupus erythematosus. In consideration of the importance of overweight classification in cardiovascular diseases, any direct estimates of body fat can be used in an attempt to improve the prognosis of patients. Note We believe that we have presented evidence of body adiposity index accuracy in childhood-onset systemic lupus erythematosus patients but further research on the generalizability of body adiposity index to other patient groups needs to be done.

Quality Improvement of Ground Works Process with the Use of Chosen Lean Management Tools - Case Study

NASA Astrophysics Data System (ADS)

Nowotarski, Piotr; Paslawski, Jerzy; Wysocki, Bartosz

2017-12-01

Ground works are one of the first processes connected with erecting structures. Based on ground conditions like the type of soil or level of underground water different types and solutions for foundations are designed. Foundations are the base for the buildings, and their proper design and execution is the key for the long and faultless use of the whole construction and might influence on the future costs of the eventual repairs (especially when ground water level is high, and there is no proper water insulation made). Article presents the introduction of chosen Lean Management tools for quality improvement of the process of ground works based on the analysis made on the construction site of vehicle control station located in Poznan, Poland. Processes assessment is made from different perspectives taking into account that 3 main groups of workers were directly involved in the process: blue collar-workers, site manager and site engineers. What is more comparison is made on the 3 points of view to the problems that might occur during this type of works, with details analysis on the causes of such situation? Authors presents also the change of approach of workers directly involved in the mentioned processes regarding introduction of Lean Management methodology, which illustrates the problem of scepticism for new ideas of the people used to perform works and actions in traditional way. Using Lean Management philosophy in construction is a good idea to streamline processes in company, get rid of constantly recurring problems, and in this way improve the productivity and quality of executed activities. Performed analysis showed that different groups of people have very different idea and opinion on the problems connected with executing the same process - ground works and only having full picture of the situation (especially in construction processes) management can take proper problems-preventing actions that consequently can influence on the amount of waste generated on the construction cite which positively influence on the external environment.

Direct control of peripheral lipid deposition by CNS GLP-1 receptor signaling is mediated by the sympathetic nervous system and blunted in diet-induced obesity.

PubMed

Nogueiras, Ruben; Pérez-Tilve, Diego; Veyrat-Durebex, Christelle; Morgan, Donald A; Varela, Luis; Haynes, William G; Patterson, James T; Disse, Emmanuel; Pfluger, Paul T; López, Miguel; Woods, Stephen C; DiMarchi, Richard; Diéguez, Carlos; Rahmouni, Kamal; Rohner-Jeanrenaud, Françoise; Tschöp, Matthias H

2009-05-06

We investigated a possible role of the central glucagon-like peptide (GLP-1) receptor system as an essential brain circuit regulating adiposity through effects on nutrient partitioning and lipid metabolism independent from feeding behavior. Both lean and diet-induced obesity mice were used for our experiments. GLP-1 (7-36) amide was infused in the brain for 2 or 7 d. The expression of key enzymes involved in lipid metabolism was measured by real-time PCR or Western blot. To test the hypothesis that the sympathetic nervous system may be responsible for informing adipocytes about changes in CNS GLP-1 tone, we have performed direct recording of sympathetic nerve activity combined with experiments in genetically manipulated mice lacking beta-adrenergic receptors. Intracerebroventricular infusion of GLP-1 in mice directly and potently decreases lipid storage in white adipose tissue. These effects are independent from nutrient intake. Such CNS control of adipocyte metabolism was found to depend partially on a functional sympathetic nervous system. Furthermore, the effects of CNS GLP-1 on adipocyte metabolism were blunted in diet-induced obese mice. The CNS GLP-1 system decreases fat storage via direct modulation of adipocyte metabolism. This CNS GLP-1 control of adipocyte lipid metabolism appears to be mediated at least in part by the sympathetic nervous system and is independent of parallel changes in food intake and body weight. Importantly, the CNS GLP-1 system loses the capacity to modulate adipocyte metabolism in obese states, suggesting an obesity-induced adipocyte resistance to CNS GLP-1.

Contribution of regional brain melanocortin receptor subtypes to elevated activity energy expenditure in lean, active rats

PubMed Central

Shukla, Charu; Koch, Lauren G.; Britton, Steven L.; Cai, Minying; Hruby, Victor J.; Bednarek, Maria; Novak, Colleen M.

2015-01-01

Physical activity and non-exercise activity thermogenesis (NEAT) are crucial factors accounting for individual differences in body weight, interacting with genetic predisposition. In the brain, a number of neuroendocrine intermediates regulate food intake and energy expenditure (EE); this includes the brain melanocortin (MC) system, consisting of melanocortin peptides as well as their receptors (MCR). MC3R and MC4R have emerged as critical modulators of EE and food intake. To determine how variance in MC signaling may underlie individual differences in physical activity levels, we examined behavioral response to MC receptor agonists and antagonists in rats that show high and low levels of physical activity and NEAT, that is, high- and low-capacity runners (HCR, LCR), developed by artificial selection for differential intrinsic aerobic running capacity. Focusing on the hypothalamus, we identified brain region-specific elevations in expression of MCR 3, 4, and also MC5R, in the highly active, lean HCR relative to the less active and obesity-prone LCR. Further, the differences in activity and associated EE as a result of MCR activation or suppression using specific agonists and antagonists were similarly region-specific and directly corresponded to the differential MCR expression patterns. The agonists and antagonists investigated here did not significantly impact food intake at the doses used, suggesting that the differential pattern of receptor expression may by more meaningful to physical activity than to other aspects of energy balance regulation. Thus, MCR-mediated physical activity may be a key neural mechanism in distinguishing the lean phenotype and a target for enhancing physical activity and NEAT. PMID:26404873

Enhanced leavening ability of baker's yeast by overexpression of SNR84 with PGM2 deletion.

PubMed

Lin, Xue; Zhang, Cui-Ying; Bai, Xiao-Wen; Xiao, Dong-Guang

2015-06-01

Dough-leavening ability is one of the main aspects considered when selecting a baker's yeast strain for baking industry. Generally, modification of maltose metabolic pathway and known regulatory networks of maltose metabolism were used to increase maltose metabolism to improve leavening ability in lean dough. In this study, we focus on the effects of PGM2 (encoding for the phosphoglucomutase) and SNR84 (encoding for the H/ACA snoRNA) that are not directly related to both the maltose metabolic pathway and known regulatory networks of maltose metabolism on the leavening ability of baker's yeast in lean dough. The results show that the modifications on PGM2 and/or SNR84 are effective ways in improving leavening ability of baker's yeast in lean dough. Deletion of PGM2 decreased cellular glucose-1-phosphate and overexpression of SNR84 increased the maltose permease activity. These changes resulted in 11, 19 and 21% increases of the leavening ability for PGM2 deletion, SNR84 overexpression and SNR84 overexpression combining deleted PGM2, respectively.

Advanced Light-Duty SI Engine Fuels Research: Multiple Optical Diagnostics of Well-mixed and Stratified Operation.

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

Sjoberg, Carl Magnus Goran; Vuilleumier, David

Ever tighter fuel economy standards and concerns about energy security motivate efforts to improve engine efficiency and to develop alternative fuels. This project contributes to the science base needed by industry to develop highly efficient direct injection spark ignition (DISI) engines that also beneficially exploit the different properties of alternative fuels. Here, the emphasis is on lean operation, which can provide higher efficiencies than traditional non-dilute stoichiometric operation. Since lean operation can lead to issues with ignition stability, slow flame propagation and low combustion efficiency, the focus is on techniques that can overcome these challenges. Specifically, fuel stratification is usedmore » to ensure ignition and completeness of combustion but this technique has soot and NOx emissions challenges. For ultra-lean well-mixed operation, turbulent deflagration can be combined with controlled end-gas autoignition to render mixed-mode combustion for sufficiently fast heat release. However, such mixed-mode combustion requires very stable inflammation, motivating studies on the effects of near-spark flow and turbulence, and the use of small amounts of fuel stratification near the spark plug.« less

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.

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

Reducing door-to-needle times using Toyota's lean manufacturing principles and value stream analysis.

PubMed

Ford, Andria L; Williams, Jennifer A; Spencer, Mary; McCammon, Craig; Khoury, Naim; Sampson, Tomoko R; Panagos, Peter; Lee, Jin-Moo

2012-12-01

Earlier tissue-type plasminogen activator (tPA) treatment for acute ischemic stroke increases efficacy, prompting national efforts to reduce door-to-needle times. We used lean process improvement methodology to develop a streamlined intravenous tPA protocol. In early 2011, a multidisciplinary team analyzed the steps required to treat patients with acute ischemic stroke with intravenous tPA using value stream analysis (VSA). We directly compared the tPA-treated patients in the "pre-VSA" epoch with the "post-VSA" epoch with regard to baseline characteristics, protocol metrics, and clinical outcomes. The VSA revealed several tPA protocol inefficiencies: routing of patients to room, then to CT, then back to the room; serial processing of workflow; and delays in waiting for laboratory results. On March 1, 2011, a new protocol incorporated changes to minimize delays: routing patients directly to head CT before the patient room, using parallel process workflow, and implementing point-of-care laboratories. In the pre and post-VSA epochs, 132 and 87 patients were treated with intravenous tPA, respectively. Compared with pre-VSA, door-to-needle times and percent of patients treated ≤60 minutes from hospital arrival were improved in the post-VSA epoch: 60 minutes versus 39 minutes (P<0.0001) and 52% versus 78% (P<0.0001), respectively, with no change in symptomatic hemorrhage rate. Lean process improvement methodology can expedite time-dependent stroke care without compromising safety.

Reducing Door-to-Needle Times using Toyota’s Lean Manufacturing Principles and Value Stream Analysis

PubMed Central

Ford, Andria L.; Williams, Jennifer A.; Spencer, Mary; McCammon, Craig; Khoury, Naim; Sampson, Tomoko; Panagos, Peter; Lee, Jin-Moo

2012-01-01

Background Earlier tPA treatment for acute ischemic stroke increases efficacy, prompting national efforts to reduce door-to-needle times (DNTs). We utilized lean process improvement methodology to develop a streamlined IV tPA protocol. Methods In early 2011, a multi-disciplinary team analyzed the steps required to treat acute ischemic stroke patients with IV tPA, utilizing value stream analysis (VSA). We directly compared the tPA-treated patients in the “pre-VSA” epoch to the “post-VSA” epoch with regard to baseline characteristics, protocol metrics, and clinical outcomes. Results The VSA revealed several tPA protocol inefficiencies: routing of patients to room, then to CT, then back to room; serial processing of work flow; and delays in waiting for lab results. On 3/1/2011, a new protocol incorporated changes to minimize delays: routing patients directly to head CT prior to patient room, utilizing parallel process work-flow, and implementing point-of-care labs. In the pre-and post-VSA epochs, 132 and 87 patients were treated with IV tPA, respectively. Compared to pre-VSA, DNTs and percent of patients treated ≤60 minutes from hospital arrival were improved in the post-VSA epoch: 60 min vs. 39 min (p<0.0001) and 52% vs. 78% (p<0.0001), respectively, with no change in symptomatic hemorrhage rate. Conclusions Lean process improvement methodology can expedite time-dependent stroke care, without compromising safety. PMID:23138440

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.

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.

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

PubMed

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

2012-07-01

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

Prevalence and hemodynamic effects of leaning during CPR

PubMed Central

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

2013-01-01

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

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 revised limbic system model for memory, emotion and behaviour.

PubMed

Catani, Marco; Dell'acqua, Flavio; Thiebaut de Schotten, Michel

2013-09-01

Emotion, memories and behaviour emerge from the coordinated activities of regions connected by the limbic system. Here, we propose an update of the limbic model based on the seminal work of Papez, Yakovlev and MacLean. In the revised model we identify three distinct but partially overlapping networks: (i) the Hippocampal-diencephalic and parahippocampal-retrosplenial network dedicated to memory and spatial orientation; (ii) The temporo-amygdala-orbitofrontal network for the integration of visceral sensation and emotion with semantic memory and behaviour; (iii) the default-mode network involved in autobiographical memories and introspective self-directed thinking. The three networks share cortical nodes that are emerging as principal hubs in connectomic analysis. This revised network model of the limbic system reconciles recent functional imaging findings with anatomical accounts of clinical disorders commonly associated with limbic pathology. Copyright © 2013 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.

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.

Time-Filtered Navier-Stokes Approach and Emulation of Turbulence-Chemistry Interaction

NASA Technical Reports Server (NTRS)

Liu, Nan-Suey; Wey, Thomas; Shih, Tsan-Hsing

2013-01-01

This paper describes the time-filtered Navier-Stokes approach capable of capturing unsteady flow structures important for turbulent mixing and an accompanying subgrid model directly accounting for the major processes in turbulence-chemistry interaction. They have been applied to the computation of two-phase turbulent combustion occurring in a single-element lean-direct-injection combustor. Some of the preliminary results from this computational effort are presented in this paper.

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.

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.

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.

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.

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.

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

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.

Diesel Combustion and Emission Using High Boost and High Injection Pressure in a Single Cylinder Engine

NASA Astrophysics Data System (ADS)

Aoyagi, Yuzo; Kunishima, Eiji; Asaumi, Yasuo; Aihara, Yoshiaki; Odaka, Matsuo; Goto, Yuichi

Heavy-duty diesel engines have adopted numerous technologies for clean emissions and low fuel consumption. Some are direct fuel injection combined with high injection pressure and adequate in-cylinder air motion, turbo-intercooler systems, and strong steel pistons. Using these technologies, diesel engines have achieved an extremely low CO2 emission as a prime mover. However, heavy-duty diesel engines with even lower NOx and PM emission levels are anticipated. This study achieved high-boost and lean diesel combustion using a single cylinder engine that provides good engine performance and clean exhaust emission. The experiment was done under conditions of intake air quantity up to five times that of a naturally aspirated (NA) engine and 200MPa injection pressure. The adopted pressure booster is an external supercharger that can control intake air temperature. In this engine, the maximum cylinder pressure was increased and new technologies were adopted, including a monotherm piston for endurance of Pmax =30MPa. Moreover, every engine part is newly designed. As the boost pressure increases, the rate of heat release resembles the injection rate and becomes sharper. The combustion and brake thermal efficiency are improved. This high boost and lean diesel combustion creates little smoke; ISCO and ISTHC without the ISNOx increase. It also yields good thermal efficiency.

A Unique, Optically Accessible Flame Tube Facility for Lean Combustor Studies

NASA Technical Reports Server (NTRS)

Hicks, Yolanda R.; Locke, Randy J.; Wey, Chowen C.; Bianco, Jean

1995-01-01

A facility that allows interrogation of combusting flows by advanced diagnostic methods and instrumentation has been developed at the NASA Lewis Research Center. An optically accessible flame tube combustor is described which has high temperature, pressure, and air flow capabilities. The windows in the combustor measure 3.8 cm axially by 5.1 cm radially, providing 67% optical access to the 7.6 cm x 7.6 cm cross section flow chamber. Advanced gas analysis instrumentation is available through a gas chromatography/mass spectrometer system (GC/MS), which has on-line capability for heavy hydrocarbon measurement with resolution to the parts per billion level. The instrumentation allows one to study combusting flows and combustor subcomponents, such as fuel injectors and air swirlers. Planar Laser Induced Fluorescence (PLIF) can measure unstable combustion species, which cannot be obtained with traditional gas sampling. This type of data is especially useful to combustion modellers. The optical access allows measurements to have high spatial and temporal resolution. GC/MS data and PLIF images of OH- are presented from experiments using a lean direct injection (LDI) combustor burning Jet-A fuel at inlet temperatures ranging from 810 K to 866 K, combustor pressures up to 1380 kPa, and equivalence ratios from 0.41 to 0.59.

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.

Classification of antecedents towards safety use of health information technology: A systematic review.

PubMed

Salahuddin, Lizawati; Ismail, Zuraini

2015-11-01

This paper provides a systematic review of safety use of health information technology (IT). The first objective is to identify the antecedents towards safety use of health IT by conducting systematic literature review (SLR). The second objective is to classify the identified antecedents based on the work system in Systems Engineering Initiative for Patient Safety (SEIPS) model and an extension of DeLone and McLean (D&M) information system (IS) success model. A systematic literature review (SLR) was conducted from peer-reviewed scholarly publications between January 2000 and July 2014. SLR was carried out and reported based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. The related articles were identified by searching the articles published in Science Direct, Medline, EMBASE, and CINAHL databases. Data extracted from the resultant studies included are to be analysed based on the work system in Systems Engineering Initiative for Patient Safety (SEIPS) model, and also from the extended DeLone and McLean (D&M) information system (IS) success model. 55 articles delineated to be antecedents that influenced the safety use of health IT were included for review. Antecedents were identified and then classified into five key categories. The categories are (1) person, (2) technology, (3) tasks, (4) organization, and (5) environment. Specifically, person is attributed by competence while technology is associated to system quality, information quality, and service quality. Tasks are attributed by task-related stressor. Organisation is related to training, organisation resources, and teamwork. Lastly, environment is attributed by physical layout, and noise. This review provides evidence that the antecedents for safety use of health IT originated from both social and technical aspects. However, inappropriate health IT usage potentially increases the incidence of errors and produces new safety risks. The review cautions future implementation and adoption of health IT to carefully consider the complex interactions between social and technical elements propound in healthcare settings. Copyright © 2015. Published by Elsevier Ireland Ltd.

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 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…

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.

Higher Protein Intake Is Associated with Higher Lean Mass and Quadriceps Muscle Strength in Adult Men and Women.

PubMed

Sahni, Shivani; Mangano, Kelsey M; Hannan, Marian T; Kiel, Douglas P; McLean, Robert R

2015-07-01

The impact of dietary protein intake on lower extremity lean mass and strength in community-dwelling adult Americans is not fully understood. The objective was to determine the associations between total protein (TP), animal protein (AP), and plant protein (PP) intakes and lean mass of the legs and quadriceps muscle strength. We further examined whether the associations with quadriceps strength may be explained by lean mass of the legs. This cross-sectional study included men (n = 1166) and women (n = 1509) from the Framingham Offspring Cohort in Massachusetts. Protein intake in grams per day was measured in either 1995-1998 or 1998-2001. Leg lean mass and isometric quadriceps strength, both in kilograms, were measured in 1996-2001. Multilinear regression models estimated adjusted least squares means of each of the muscle measures by quartile categories of protein intake, adjusting for relevant confounders and covariates. Mean age was 59 ± 9 y (range: 29-86 y) and TP intake was 80 ± 27 g/d in men and 76 ± 26 g/d in women. In men and women, leg lean mass was higher in participants in the highest quartiles of TP and AP intake compared with those in the lowest quartiles of intake [least squares means (kg): TP-17.6 vs. 17.1 in men, P-trend: 0.005, and 11.7 vs. 11.4 in women, P-trend: 0.006; AP-17.6 vs. 17.1 in men, P-trend: 0.002, and 11.7 vs. 11.4 in women, P-trend: 0.003]. PP intake was not associated with lean mass in either sex. In men and women, quadriceps strength was higher in participants in the highest quartile of PP intake compared with those in the lowest quartile [least squares means (kg): 22.9 vs. 21.7 in men, P-trend: 0.01, and 19.0 vs. 18.2 in women, P-trend: 0.01]; this association was no longer significant after adjustment for fruit and vegetable intake (P-trend: 0.06 in men and 0.10 in women). Although no significant association was observed for AP intake in either sex, nonsignificant protective trends were observed for TP intake (P-trend: 0.08 in men and 0.10 in women). Our findings suggest that maintaining adequate protein intake with age may help preserve muscle mass and strength in adult men and women. Dietary protein types may differentially affect muscle mass and strength. Whether PP is a marker of dietary quality or has a direct effect on muscle strength (independent of lean mass) needs to be further clarified. © 2015 American Society for Nutrition.

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

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.

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.

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.

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.

Removal of oxides of nitrogen from gases in multi-stage coal combustion

DOEpatents

Mollot, D.J.; Bonk, D.L.; Dowdy, T.E.

1998-01-13

Polluting NO{sub x} gas values are removed from off-gas of a multi-stage coal combustion process which includes an initial carbonizing reaction, firing of char from this reaction in a fluidized bed reactor, and burning of gases from the carbonizing and fluidized bed reactions in a topping combustor having a first, fuel-rich zone and a second, fuel-lean zone. The improvement by means of which NO{sub x} gases are removed is directed to introducing NO{sub x}-free oxidizing gas such as compressor air into the second, fuel-lean zone and completing combustion with this source of oxidizing gas. Excess air fed to the fluidized bed reactor is also controlled to obtain desired stoichiometry in the first, fuel-rich zone of the topping combustor. 2 figs.

Removal of oxides of nitrogen from gases in multi-stage coal combustion

DOEpatents

Mollot, Darren J.; Bonk, Donald L.; Dowdy, Thomas E.

1998-01-01

Polluting NO.sub.x gas values are removed from off-gas of a multi-stage coal combustion process which includes an initial carbonizing reaction, firing of char from this reaction in a fluidized bed reactor, and burning of gases from the carbonizing and fluidized bed reactions in a topping combustor having a first, fuel-rich zone and a second, fuel-lean zone. The improvement by means of which NO.sub.x gases are removed is directed to introducing NO.sub.x -free oxidizing gas such as compressor air into the second, fuel-lean zone and completing combustion with this source of oxidizing gas. Excess air fed to the fluidized bed reactor is also controlled to obtain desired stoichiometry in the first, fuel-rich zone of the topping combustor.

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

PubMed

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

2018-03-21

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

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

PubMed

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

2009-02-01

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

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.

Effect of reducing and replacing pork fat on the physicochemical, instrumental and sensory characteristics throughout storage time of small caliber non-acid fermented sausages with reduced sodium content.

PubMed

Mora-Gallego, Héctor; Serra, Xavier; Guàrdia, Maria Dolors; Arnau, Jacint

2014-05-01

The effect of pork fat reduction (from 44% to 20% final fat content) and its partial substitution by sunflower oil (3% addition) on the physicochemical, instrumental and sensory properties throughout storage time of small caliber non-acid fermented sausages (fuet type) with reduced sodium content (with partial substitution of NaCl by KCl and K-lactate) and without direct addition of nitrate and nitrite (natural nitrate source used instead) was studied. Results showed that sausages with reduced fat (10% initial fat content) and with acceptable sensory characteristics can be obtained by adding to the shoulder lean (8% fat content) during the grinding, either 3.3% backfat (3% fat content) or 3% sunflower oil, both previously finely comminuted with lean. Furthermore, sunflower oil showed to be suitable for partial pork backfat substitution in very lean fermented sausages, conferring desirable sensory properties similar to those of sausages with standard fat content. The sensory quality of the sausages was maintained after three-month cold storage in modified atmosphere. Copyright © 2014 Elsevier Ltd. All rights reserved.

Risk for non-obese Japanese workers to develop metabolic syndrome.

PubMed

Inada, Fumi; Moriguchi, Jiro; Okuda, Tomoko; Ide, Yoko; Ejima, Kiriko; Sakuragi, Sonoko; Takeda, Kazuo; Ohashi, Fumiko; Ikeda, Masayuki

2010-01-01

With regard to metabolic syndrome-related risks (MS risks), obese workers have been the focus of attention, and less attention has been paid to non-obese subjects as if they were free from the risks. The present analysis was initiated to know if no-obesity means no-MS risks. Participants of the study were 804 male workers, who showed no pathological findings in 12 MS-related and other health parameters in 2003, and had complete sets of data in 2008. They were classified by BMI in 2003 into lean (< 18.5), normal (> or = 18.5 to < 25) and obese groups (> or =25). Proportion of MS in 2008 was examined by use of the second phase of MS criteria. Proportions for the lean, normal and obese subjects who met MS criteria in 2008 were 3.2, 4.8 and 5.3%, respectively, with no significant difference in proportions among them. In the non-obese (i.e., lean+normal) group, age was not significantly influential to increase BMI. Thus, the MS risk exists even in non-obese young workers. Anti-MS effort should be directed not only to obese but to non-obese workers, and care should be extended irrespective of ages.

A Typology of Approaches to Peer Tutoring: Unraveling Peer Tutors' Behavioural Strategies

ERIC Educational Resources Information Center

Berghmans, Inneke; Neckebroeck, Fanny; Dochy, Filip; Struyven, Katrien

2013-01-01

Peer tutors' behaviour has been stated to have the power to create and increase learning opportunities within peer tutoring programs. However, previous studies have shown that peer tutors struggle to adopt facilitative and constructivist-oriented strategies, as they lean more towards directive and knowledge-telling strategies. This study aims…

Educating Adults: A Matter of Balance.

ERIC Educational Resources Information Center

Tice, Elizabeth T.

1997-01-01

In the conceptual debate over the appropriate methods for adult learning, both those who think learning only occurs at the feet of the master and those who think that adults should be totally self-directed are right to an extent. A balance is needed, considering the age, leaning style, and desired outcomes of the student. (JOW)

Industrial Hardening and Population Blast Shelter Tests at the DIRECT COURSE Event

DTIC Science & Technology

1984-03-01

517 EAAt Bayshore, Redwood City, CA 94053 Wr nt12 It. CONTROLLING OFFICE NAME AND ADDRESS 12- REPORT DATS March 1984 Federal Emergency Mdanagement...Organization 1710 Goodridge Drive 1110 NATO P.O. Box 1303 Brussels, BELGIUM McLean, VA 22101 Ministero dell Interno Dr. Joseph E. Minor, Director Direzione

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.

An Assessment of Combustion Dynamics in a Low-Nox, Second-Generation Swirl-Venturi Lean Direct Injection Combustion Concept

NASA Technical Reports Server (NTRS)

Tacina, K. M.; Chang, C. T.; Lee, P.; Mongia, H.; Podboy, D. P.; Dam, B.

2015-01-01

Dynamic pressure measurements were taken during flame-tube emissions testing of three second-generation swirl-venturi lean direct injection (SV-LDI) combustor configurations. These measurements show that combustion dynamics were typically small. However, a small number of points showed high combustion dynamics, with peak-to-peak dynamic pressure fluctuations above 0.5 psi. High combustion dynamics occurred at low inlet temperatures in all three SV-LDI configurations, so combustion dynamics were explored further at low temperature conditions. A point with greater than 1.5 psi peak-to-peak dynamic pressure fluctuations was identified at an inlet temperature of 450!F, a pressure of 100 psia, an air pressure drop of 3%, and an overall equivalence ratio of 0.35. This is an off design condition: the temperature and pressure are typical of 7% power conditions, but the equivalence ratio is high. At this condition, the combustion dynamics depended strongly on the fuel staging. Combustion dynamics could be reduced significantly without changing the overall equivalence ratio by shifting the fuel distribution between stages. Shifting the fuel distribution also decreased NOx emissions.

Critical factors for optimising skill-grade-mix based on principles of Lean Management - a qualitative substudy

PubMed

Inauen, Alice; Rettke, Horst; Fridrich, Annemarie; Spirig, Rebecca; Bauer, Georg F

2017-01-01

Background: Due to scarce resources in health care, staff deployment has to meet the demands. To optimise skill-grade-mix, a Swiss University Hospital initiated a project based on principles of Lean Management. The project team accompanied each participating nursing department and scientifically evaluated the results of the project. Aim: The aim of this qualitative sub-study was to identify critical success factors of this project. Method: In four focus groups, participants discussed their experience of the project. Recruitment was performed from departments assessing the impact of the project retrospectively either positive or critical. In addition, the degree of direct involvement in the project served as a distinguishing criterion. Results: While the degree of direct involvement in the project was not decisive, conflicting opinions and experiences appeared in the groups with more positive or critical project evaluation. Transparency, context and attitude proved critical for the project’s success. Conclusions: Project managers should ensure transparency of the project’s progress and matching of the project structure with local conditions in order to support participants in their critical or positive attitude towards the project.

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

PubMed

Kumar, Ramesh; Mohan, Shantam

2017-09-28

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

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

PubMed Central

Kumar, Ramesh; Mohan, Shantam

2017-01-01

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

Method for rubblizing an oil shale deposit for in situ retorting

DOEpatents

Lewis, Arthur E.

1977-01-01

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

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.

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

PubMed

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

2016-08-01

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

Real-time combustion controls and diagnostics sensors (CCADS)

DOEpatents

Thornton, Jimmy D.; Richards, George A.; Dodrill, Keith A.; Nutter, Jr., Roy S.; Straub, Douglas

2005-05-03

The present invention is directed to an apparatus for the monitoring of the combustion process within a combustion system. The apparatus comprises; a combustion system, a means for supplying fuel and an oxidizer, a device for igniting the fuel and oxidizer in order to initiate combustion, and a sensor for determining the current conducted by the combustion process. The combustion system comprises a fuel nozzle and an outer shell attached to the combustion nozzle. The outer shell defines a combustion chamber. Preferably the nozzle is a lean premix fuel nozzle (LPN). Fuel and an oxidizer are provided to the fuel nozzle at separate rates. The fuel and oxidizer are ignited. A sensor positioned within the combustion system comprising at least two electrodes in spaced-apart relationship from one another. At least a portion of the combustion process or flame is between the first and second electrodes. A voltage is applied between the first and second electrodes and the magnitude of resulting current between the first and second electrodes is determined.

Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal.

PubMed

Naidoo, Logandran; Mahomed, Ozayr H

2016-07-26

Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload. The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital. The study was conducted at the Catherine Booth Hospital (CBH) - a rural district hospital in KwaZulu-Natal, South Africa. This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times. All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention). The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators.

Applying Lean Six Sigma to improve medication management.

PubMed

Nayar, Preethy; Ojha, Diptee; Fetrick, Ann; Nguyen, Anh T

2016-01-01

A significant proportion of veterans use dual care or health care services within and outside the Veterans Health Administration (VHA). In this study conducted at a VHA medical center in the USA, the authors used Lean Six Sigma principles to develop recommendations to eliminate wasteful processes and implement a more efficient and effective process to manage medications for dual care veteran patients. The purpose of this study is to: assess compliance with the VHA's dual care policy; collect data and describe the current process for co-management of dual care veterans' medications; and draft recommendations to improve the current process for dual care medications co-management. Input was obtained from the VHA patient care team members to draw a process map to describe the current process for filling a non-VHA prescription at a VHA facility. Data were collected through surveys and direct observation to measure the current process and to develop recommendations to redesign and improve the process. A key bottleneck in the process that was identified was the receipt of the non-VHA medical record which resulted in delays in filling prescriptions. The recommendations of this project focus on the four domains of: documentation of dual care; veteran education; process redesign; and outreach to community providers. This case study describes the application of Lean Six Sigma principles in one urban Veterans Affairs Medical Center (VAMC) in the Mid-Western USA to solve a specific organizational quality problem. Therefore, the findings may not be generalizable to other organizations. The Lean Six Sigma general principles applied in this project to develop recommendations to improve medication management for dual care veterans are applicable to any process improvement or redesign project and has valuable lessons for other VAMCs seeking to improve care for their dual care veteran patients. The findings of this project will be of value to VA providers and policy makers and health care managers who plan to apply Lean Six Sigma techniques in their organizations to improve the quality of care for their patients.

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

PubMed

Goyal, Manu; Dawood, Ayman S

2017-01-01

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

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

PubMed Central

Goyal, Manu; Dawood, Ayman S.

2017-01-01

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

Acquiring skill at medical image inspection: learning localized in early visual processes

NASA Astrophysics Data System (ADS)

Sowden, Paul T.; Davies, Ian R. L.; Roling, Penny; Watt, Simon J.

1997-04-01

Acquisition of the skill of medical image inspection could be due to changes in visual search processes, 'low-level' sensory learning, and higher level 'conceptual learning.' Here, we report two studies that investigate the extent to which learning in medical image inspection involves low- level learning. Early in the visual processing pathway cells are selective for direction of luminance contrast. We exploit this in the present studies by using transfer across direction of contrast as a 'marker' to indicate the level of processing at which learning occurs. In both studies twelve observers trained for four days at detecting features in x- ray images (experiment one equals discs in the Nijmegen phantom, experiment two equals micro-calcification clusters in digitized mammograms). Half the observers examined negative luminance contrast versions of the images and the remainder examined positive contrast versions. On the fifth day, observers swapped to inspect their respective opposite contrast images. In both experiments leaning occurred across sessions. In experiment one, learning did not transfer across direction of luminance contrast, while in experiment two there was only partial transfer. These findings are consistent with the contention that some of the leaning was localized early in the visual processing pathway. The implications of these results for current medical image inspection training schedules are discussed.

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®

Skeletal muscle mass and exercise performance in stable ambulatory patients with heart failure.

PubMed

Lang, C C; Chomsky, D B; Rayos, G; Yeoh, T K; Wilson, J R

1997-01-01

The purpose of this study was to determine whether skeletal muscle atrophy limits the maximal exercise capacity of stable ambulatory patients with heart failure. Body composition and maximal exercise capacity were measured in 100 stable ambulatory patients with heart failure. Body composition was assessed by using dual-energy X-ray absorption. Peak exercise oxygen consumption (VO2peak) and the anaerobic threshold were measured by using a Naughton treadmill protocol and a Medical Graphics CardioO2 System. VO2peak averaged 13.4 +/- 3.3 ml.min-1.kg-1 or 43 +/- 12% of normal. Lean body mass averaged 52.9 +/- 10.5 kg and leg lean mass 16.5 +/- 3.6 kg. Leg lean mass correlated linearly with VO2peak (r = 0.68, P < 0.01), suggesting that exercise performance is influences by skeletal muscle mass. However, lean body mass was comparable to levels noted in 1,584 normal control subjects, suggesting no decrease in muscle mass. Leg muscle mass was comparable to levels noted in 34 normal control subjects, further supporting this conclusion. These findings suggest that exercise intolerance in stable ambulatory patients with heart failure is not due to skeletal muscle atrophy.

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

PubMed Central

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

2011-01-01

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

Application of the enterprise management tools Lean Six Sigma and PMBOK in developing a program of research management.

PubMed

Hors, Cora; Goldberg, Anna Carla; Almeida, Ederson Haroldo Pereira de; Babio Júnior, Fernando Galan; Rizzo, Luiz Vicente

2012-01-01

Introduce a program for the management of scientific research in a General Hospital employing the business management tools Lean Six Sigma and PMBOK for project management in this area. The Lean Six Sigma methodology was used to improve the management of the institution's scientific research through a specific tool (DMAIC) for identification, implementation and posterior analysis based on PMBOK practices of the solutions found. We present our solutions for the management of institutional research projects at the Sociedade Beneficente Israelita Brasileira Albert Einstein. The solutions were classified into four headings: people, processes, systems and organizational culture. A preliminary analysis of these solutions showed them to be completely or partially compliant to the processes described in the PMBOK Guide. In this post facto study, we verified that the solutions drawn from a project using Lean Six Sigma methodology and based on PMBOK enabled the improvement of our processes dealing with the management of scientific research carried out in the institution and constitutes a model to contribute to the search of innovative science management solutions by other institutions dealing with scientific research in Brazil.

Direct Numerical Simulations of Turbulent Autoigniting Hydrogen Jets

NASA Astrophysics Data System (ADS)

Asaithambi, Rajapandiyan

Autoignition is an important phenomenon and a tool in the design of combustion engines. To study autoignition in a canonical form a direct numerical simulation of a turbulent autoigniting hydrogen jet in vitiated coflow conditions at a jet Reynolds number of 10,000 is performed. A detailed chemical mechanism for hydrogen-air combustion and non-unity Lewis numbers for species transport is used. Realistic inlet conditions are prescribed by obtaining the velocity eld from a fully developed turbulent pipe flow simulation. To perform this simulation a scalable modular density based method for direct numerical simulation (DNS) and large eddy simulation (LES) of compressible reacting flows is developed. The algorithm performs explicit time advancement of transport variables on structured grids. An iterative semi-implicit time advancement is developed for the chemical source terms to alleviate the chemical stiffness of detailed mechanisms. The algorithm is also extended from a Cartesian grid to a cylindrical coordinate system which introduces a singularity at the pole r = 0 where terms with a factor 1/r can be ill-defined. There are several approaches to eliminate this pole singularity and finite volume methods can bypass this issue by not storing or computing data at the pole. All methods however face a very restrictive time step when using a explicit time advancement scheme in the azimuthal direction (theta) where the cell sizes are of the order DelrDeltheta. We use a conservative finite volume based approach to remove the severe time step restriction imposed by the CFL condition by merging cells in the azimuthal direction. In addition, fluxes in the radial direction are computed with an implicit scheme to allow cells to be clustered along the jet's shear layer. This method is validated and used to perform the large scale turbulent reacting simulation. The resulting flame structure is found to be similar to a turbulent diusion flame but stabilized by autoignition at the flame base. Mass-fraction of the hydroperoxyl radical, HO2, peaks in magnitude upstream of the flame's stabilization point indicating autoignition. A flame structure similar to a triple-flame, with a lean premixed flame and a rich premixed flame flanking a thick diffusion flame is identified by the flame index. Radicals formed in the shear layer ahead of ignition and oxygen from the coflow do not get fully consumed by the flame and are transported along the edges of the flame brush into the core of the jet. Ignition delays from a well-stirred reactor model and an autoigniting diffusion flame model are able predict the lift-off height of the turbulent flame. The local entrainment rate was observed to increase with axial distance until the flame stabilization point and then decrease downstream. Data from probes placed along the flame reveals a highly turbulent flow field with variable composition at a given location. In general however, it is observed that the turbulent kinetic energy (TKE) is very high in cold fuel rich mixtures and is lowest in hot fuel lean mixtures. Autoignition occurs at the most-reactive hot and lean mixture fractions where the TKE is the lowest.

Cardiac β-adrenergic responsiveness of obese Zucker rats: The role of AMPK.

PubMed

Bussey, Carol T; Thaung, Hp Aye; Hughes, Gillian; Bahn, Andrew; Lamberts, Regis R

2018-06-05

What is the central question of the study? What is the main finding and its importance? 1. Is the reduced signalling of AMPK, a key regulator of energy homeostasis in the heart, responsible for the reduced β-adrenergic responsiveness of the heart in obesity? 2. Inhibition of AMPK in isolated hearts prevented the reduced cardiac β-adrenergic responsiveness of obese rats, which was accompanied by reduced phosphorylation of AMPK, a proxy of AMPK activity. This suggests a direct functional link between β-adrenergic responsiveness and AMPK signalling in the heart, and that AMPK might be an important target to restore the β-adrenergic responsiveness in the heart in obesity. The obesity epidemic impacts heavily on cardiovascular health, in part due to changes in cardiac metabolism. AMP-activated protein kinase (AMPK) is a key regulator of energy homeostasis in the heart, and is regulated by β-adrenoceptors (AR) under normal conditions. In obesity, chronic sympathetic overactivation leads to impaired cardiac β-AR responsiveness, although it is unclear whether AMPK signalling, downstream of β-AR, contributes to this dysfunction. Therefore, we aimed to determine whether reduced AMPK signalling is responsible for the reduced β-AR responsiveness in obesity. In isolated hearts of lean and obese Zucker rats, we tested β-AR responsiveness to β 1 -AR agonist isoproterenol (ISO, 1 × 10 -10 - 5 × 10 -8  M) in the absence and presence of the AMPK inhibitor compound C (CC, 10 μM). β 1 -AR expression and AMPK phosphorylation were assessed by Western blot. β-Adrenergic responsiveness was reduced in the hearts of obese rats (LogEC50 of ISO-developed pressure dose-response curves: lean -8.53 ± 0.13 vs. obese -8.35 ± 0.10 10 x M; p < 0.05 lean vs. obese, n = 6 per group). This difference was not apparent after AMPK inhibition (LogEC50 of ISO-developed pressure curves: lean CC -8.19 ± 0.12 vs. obese CC 8.17 ± 0.13 10 x M, p > 0.05, n = 6 per group). β 1 -AR expression and AMPK phosphorylation were reduced in hearts of obese rats (AMPK at Thr 172 : lean 1.73 ± 0.17 vs. lean CC 0.81 ± 0.13, and obese 1.18 ± 0.09 vs. obese CC 0.81 ± 0.16 arbitrary units, p < 0.05, n = 6 per group). Thus, a direct functional link between β-adrenergic responsiveness and AMPK signalling in the heart exists, and AMPK might be an important target to restore the reduced cardiac β-adrenergic responsiveness in obesity. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

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

PubMed

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

2016-06-01

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

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

PubMed

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

2017-11-01

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

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

USGS Publications Warehouse

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

2016-01-01

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

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

Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus.

PubMed

Aragona, Elena; El-Magbri, Eussra; Wang, Justin; Scheckelhoff, Tessa; Scheckelhoff, Trevor; Hyacinthe, Assata; Nair, Suja; Khan, Amina; Nino, Gustavo; Pillai, Dinesh K

2016-04-01

The prevalence of both childhood asthma and obesity remain at historically high levels and disproportionately affect urban children. Asthma is a common and costly cause for pediatric hospitalization. Our objective was to determine the effect of obesity on outcomes among urban children hospitalized with status asthmaticus. A retrospective cohort study was performed by using billing system data and chart review to evaluate urban children admitted for asthma. Demographics, asthma severity, reported comorbidities, and outcomes were assessed. Obesity was defined by BMI percentile (lean<85%, overweight 85%-95%, obese≥95%). Outcomes were length of stay, hospitalization charges, ICU stay, repeat admissions, and subsequent emergency department (ED) visits. Bivariate analysis assessed for differences between overweight/obese and lean children. Multivariable regression assessed the relationship between overweight status and primary outcomes while controlling for other variables. Post hoc age-stratified analysis was also performed. The study included 333 subjects; 38% were overweight/obese. Overweight/obese children admitted with asthma were more likely than lean children to have subsequent ED visits (odds ratio 1.6, 95% confidence interval 1.0-2.6). When stratified by age, overweight/obese preschool-age children (<5 years) were >2 times as likely to have repeat ED visits than lean preschool-age children (odds ratio 2.3, 95% confidence interval 1.0-5.6). There were no differences in the other outcomes between overweight/obese and lean individuals within the entire cohort or within other age groups. Copyright © 2016 by the American Academy of Pediatrics.

Application of Lean Healthcare methodology in a urology department of a tertiary hospital as a tool for improving efficiency.

PubMed

Boronat, F; Budia, A; Broseta, E; Ruiz-Cerdá, J L; Vivas-Consuelo, D

To describe the application of the Lean methodology as a method for continuously improving the efficiency of a urology department in a tertiary hospital. The implementation of the Lean Healthcare methodology in a urology department was conducted in 3 phases: 1) team training and improvement of feedback among the practitioners, 2) management by process and superspecialisation and 3) improvement of indicators (continuous improvement). The indicators were obtained from the Hospital's information systems. The main source of information was the Balanced Scorecard for health systems management (CUIDISS). The comparison with other autonomous and national urology departments was performed through the same platform with the help of the Hospital's records department (IASIST). A baseline was established with the indicators obtained in 2011 for the comparative analysis of the results after implementing the Lean Healthcare methodology. The implementation of this methodology translated into high practitioner satisfaction, improved quality indicators reaching a risk-adjusted complication index (RACI) of 0.59 and a risk-adjusted mortality rate (RAMR) of 0.24 in 4 years. A value of 0.61 was reached with the efficiency indicator (risk-adjusted length of stay [RALOS] index), with a savings of 2869 stays compared with national Benchmarking (IASIST). The risk-adjusted readmissions index (RARI) was the only indicator above the standard, with a value of 1.36 but with progressive annual improvement of the same. The Lean methodology can be effectively applied to a urology department of a tertiary hospital to improve efficiency, obtaining significant and continuous improvements in all its indicators, as well as practitioner satisfaction. Team training, management by process, continuous improvement and delegation of responsibilities has been shown to be the fundamental pillars of this methodology. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Sulfation of K-based Lean NOx Trap while Cycling Between Lean and Rich Conditions: I. Microreactor Study

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

Toops, Todd J; Pihl, Josh A

2008-01-01

Exposure of Pt/K/Al{sub 2}O{sub 3} to 15 ppm SO{sub 2} reduces the NOx activity at 200, 300, and 400 C at significantly different rates--1.5, 8.5, and 18.0 {micro}mol NOx/(h g{sub cat}), respectively. During the initial sulfation, NOx conversion is directly linked to lean phase storage capacity, and sulfation does not impact the reduction kinetics since the amount of unconverted NOx was constant or decreased with increasing sulfation time. A portion of sulfur stored at 200 C desorbs upon mild heating to 400 C while cycling between lean and rich conditions. This apparently is a result of sulfur being released frommore » Al{sub 2}O{sub 3}; however, performance is not significantly recovered as much of the sulfur is re-adsorbed on the K-phase. This is apparent from analysis of the NOx storage and release profiles. Additional analysis of these profiles suggests that SO{sub 2} initially adsorbs near Pt before interacting with other sites further away from Pt at 300 C. At 400 C, it appears that SO{sub 2} either preferentially adsorbs near Pt and then quickly diffuses along the surface to other less proximal sites, or it directly adsorbs on sites further away from Pt. De-sulfurization up to 800 C using a temperature programmed reduction (TPR) procedure and rich conditions with both CO{sub 2} and H{sub 2}O restored 73=94% of the LNT performance at 300 and 400 C. However, the recovered performance measured at 200 C was only 34-49% of the original NOx reduction activity. H{sub 2}S and SO{sub 2} were the primary de-sulfurization products with H{sub 2}S having a maximum release between 690 and 755 C, while SO{sub 2} had a peak release between 770 and 785 C. The sulfation temperature does not have a significant impact on the recovered performance, the de-sulfurization products or the sulfur release temperature.« less

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.

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

PubMed

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

2017-07-19

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

Serum Predictors of Percent Lean Mass in Young Adults.

PubMed

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

2016-08-01

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

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

NASA Astrophysics Data System (ADS)

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

2014-09-01

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

Lean-driven improvements slash wait times, drive up patient satisfaction scores.

PubMed

2012-07-01

Administrators at LifePoint Hospitals, based in Brentwood, TN, used lean manufacturing techniques to slash wait times by as much as 30 minutes and achieve double-digit increases in patient satisfaction scores in the EDs at three hospitals. In each case, front-line workers took the lead on identifying opportunities for improvement and redesigning the patient-flow process. As a result of the new efficiencies, patient volume is up by about 25% at all three hospitals. At each hospital, the improvement process began with Kaizen, a lean process that involves bringing personnel together to flow-chart the current system, identify problem areas, and redesign the process. Improvement teams found big opportunities for improvement at the front end of the flow process. Key to the approach was having a plan up front to deal with non-compliance. To sustain improvements, administrators gather and disseminate key metrics on a daily basis.

Discovery of Novel NOx Catalysts for CIDI Applications by High-throughput Methods

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

Blint, Richard J.

DOE project DE-PS26-00NT40758 has developed very active, lean exhaust, NOx reduction catalysts that have been tested on the discovery system, laboratory reactors and engine dynamometer systems. The goal of this project is the development of effective, affordable NOx reduction catalysts for lean combustion engines in the US light duty vehicle market which can meet Tier II emission standards with hydrocarbons based reductants for reducing NOx. General Motors (prime contractor) along with subcontractors BASF (Engelhard) (a catalytic converter developer) and ACCELRYS (an informatics supplier) carried out this project which began in August of 2002. BASF (Engelhard) has run over 16,000 testsmore » of 6100 possible catalytic materials on a high throughput discovery system suitable for automotive catalytic materials. Accelrys developed a new database informatics system which allowed material tracking and data mining. A program catalyst was identified and evaluated at all levels of the program. Dynamometer evaluations of the program catalyst both with and without additives show 92% NOx conversions on the HWFET, 76% on the US06, 60% on the cold FTP and 65% on the Set 13 heavy duty test using diesel fuel. Conversions of over 92% on the heavy duty FTP using ethanol as a second fluid reductant have been measured. These can be competitive with both of the alternative lean NOx reduction technologies presently in the market. Conversions of about 80% were measured on the EUDC for lean gasoline applications without using active dosing to adjust the C:N ratio for optimum NOx reduction at all points in the certification cycle. A feasibility analysis has been completed and demonstrates the advantages and disadvantages of the technology using these materials compared with other potential technologies. The teaming agreements among the partners contain no obstacles to commercialization of new technologies to any potential catalyst customers.« less

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.

Modulation of genetic associations with serum urate levels by body-mass-index in humans.

PubMed

Huffman, Jennifer E; Albrecht, Eva; Teumer, Alexander; Mangino, Massimo; Kapur, Karen; Johnson, Toby; Kutalik, Zoltán; Pirastu, Nicola; Pistis, Giorgio; Lopez, Lorna M; Haller, Toomas; Salo, Perttu; Goel, Anuj; Li, Man; Tanaka, Toshiko; Dehghan, Abbas; Ruggiero, Daniela; Malerba, Giovanni; Smith, Albert V; Nolte, Ilja M; Portas, Laura; Phipps-Green, Amanda; Boteva, Lora; Navarro, Pau; Johansson, Asa; Hicks, Andrew A; Polasek, Ozren; Esko, Tõnu; Peden, John F; Harris, Sarah E; Murgia, Federico; Wild, Sarah H; Tenesa, Albert; Tin, Adrienne; Mihailov, Evelin; Grotevendt, Anne; Gislason, Gauti K; Coresh, Josef; D'Adamo, Pio; Ulivi, Sheila; Vollenweider, Peter; Waeber, Gerard; Campbell, Susan; Kolcic, Ivana; Fisher, Krista; Viigimaa, Margus; Metter, Jeffrey E; Masciullo, Corrado; Trabetti, Elisabetta; Bombieri, Cristina; Sorice, Rossella; Döring, Angela; Reischl, Eva; Strauch, Konstantin; Hofman, Albert; Uitterlinden, Andre G; Waldenberger, Melanie; Wichmann, H-Erich; Davies, Gail; Gow, Alan J; Dalbeth, Nicola; Stamp, Lisa; Smit, Johannes H; Kirin, Mirna; Nagaraja, Ramaiah; Nauck, Matthias; Schurmann, Claudia; Budde, Kathrin; Farrington, Susan M; Theodoratou, Evropi; Jula, Antti; Salomaa, Veikko; Sala, Cinzia; Hengstenberg, Christian; Burnier, Michel; Mägi, Reedik; Klopp, Norman; Kloiber, Stefan; Schipf, Sabine; Ripatti, Samuli; Cabras, Stefano; Soranzo, Nicole; Homuth, Georg; Nutile, Teresa; Munroe, Patricia B; Hastie, Nicholas; Campbell, Harry; Rudan, Igor; Cabrera, Claudia; Haley, Chris; Franco, Oscar H; Merriman, Tony R; Gudnason, Vilmundur; Pirastu, Mario; Penninx, Brenda W; Snieder, Harold; Metspalu, Andres; Ciullo, Marina; Pramstaller, Peter P; van Duijn, Cornelia M; Ferrucci, Luigi; Gambaro, Giovanni; Deary, Ian J; Dunlop, Malcolm G; Wilson, James F; Gasparini, Paolo; Gyllensten, Ulf; Spector, Tim D; Wright, Alan F; Hayward, Caroline; Watkins, Hugh; Perola, Markus; Bochud, Murielle; Kao, W H Linda; Caulfield, Mark; Toniolo, Daniela; Völzke, Henry; Gieger, Christian; Köttgen, Anna; Vitart, Veronique

2015-01-01

We tested for interactions between body mass index (BMI) and common genetic variants affecting serum urate levels, genome-wide, in up to 42569 participants. Both stratified genome-wide association (GWAS) analyses, in lean, overweight and obese individuals, and regression-type analyses in a non BMI-stratified overall sample were performed. The former did not uncover any novel locus with a major main effect, but supported modulation of effects for some known and potentially new urate loci. The latter highlighted a SNP at RBFOX3 reaching genome-wide significant level (effect size 0.014, 95% CI 0.008-0.02, Pinter= 2.6 x 10-8). Two top loci in interaction term analyses, RBFOX3 and ERO1LB-EDARADD, also displayed suggestive differences in main effect size between the lean and obese strata. All top ranking loci for urate effect differences between BMI categories were novel and most had small magnitude but opposite direction effects between strata. They include the locus RBMS1-TANK (men, Pdifflean-overweight= 4.7 x 10-8), a region that has been associated with several obesity related traits, and TSPYL5 (men, Pdifflean-overweight= 9.1 x 10-8), regulating adipocytes-produced estradiol. The top-ranking known urate loci was ABCG2, the strongest known gout risk locus, with an effect halved in obese compared to lean men (Pdifflean-obese= 2 x 10-4). Finally, pathway analysis suggested a role for N-glycan biosynthesis as a prominent urate-associated pathway in the lean stratum. These results illustrate a potentially powerful way to monitor changes occurring in obesogenic environment.

Using lean to improve medication administration safety: in search of the "perfect dose".

PubMed

Ching, Joan M; Long, Christina; Williams, Barbara L; Blackmore, C Craig

2013-05-01

At Virginia Mason Medical Center (Seattle), the Collaborative Alliance for Nursing Outcomes (CALNOC) Medication Administration Accuracy Quality Study was used in combination with Lean quality improvement efforts to address medication administration safety. Lean interventions were targeted at improving the medication room layout, applying visual controls, and implementing nursing standard work. The interventions were designed to prevent medication administration errors through improving six safe practices: (1) comparing medication with medication administration record, (2) labeling medication, (3) checking two forms of patient identification, (4) explaining medication to patient, (5) charting medication immediately, and (6) protecting the process from distractions/interruptions. Trained nurse auditors observed 9,244 doses for 2,139 patients. Following the intervention, the number of safe-practice violations decreased from 83 violations/100 doses at baseline (January 2010-March 2010) to 42 violations/100 doses at final follow-up (July 2011-September 2011), resulting in an absolute risk reduction of 42 violations/100 doses (95% confidence interval [CI]: 35-48), p < .001). The number of medication administration errors decreased from 10.3 errors/100 doses at baseline to 2.8 errors/100 doses at final follow-up (absolute risk reduction: 7 violations/100 doses [95% CI: 5-10, p < .001]). The "perfect dose" score, reflecting compliance with all six safe practices and absence of any of the eight medication administration errors, improved from 37 in compliance/100 doses at baseline to 68 in compliance/100 doses at the final follow-up. Lean process improvements coupled with direct observation can contribute to substantial decreases in errors in nursing medication administration.

Modulation of Genetic Associations with Serum Urate Levels by Body-Mass-Index in Humans

PubMed Central

Huffman, Jennifer E.; Albrecht, Eva; Teumer, Alexander; Mangino, Massimo; Kapur, Karen; Johnson, Toby; Kutalik, Zoltán; Pirastu, Nicola; Pistis, Giorgio; Lopez, Lorna M.; Haller, Toomas; Salo, Perttu; Goel, Anuj; Li, Man; Tanaka, Toshiko; Dehghan, Abbas; Ruggiero, Daniela; Malerba, Giovanni; Smith, Albert V.; Nolte, Ilja M.; Portas, Laura; Phipps-Green, Amanda; Boteva, Lora; Navarro, Pau; Johansson, Asa; Hicks, Andrew A.; Polasek, Ozren; Esko, Tõnu; Peden, John F.; Harris, Sarah E.; Murgia, Federico; Wild, Sarah H.; Tenesa, Albert; Tin, Adrienne; Mihailov, Evelin; Grotevendt, Anne; Gislason, Gauti K.; Coresh, Josef; D'Adamo, Pio; Ulivi, Sheila; Vollenweider, Peter; Waeber, Gerard; Campbell, Susan; Kolcic, Ivana; Fisher, Krista; Viigimaa, Margus; Metter, Jeffrey E.; Masciullo, Corrado; Trabetti, Elisabetta; Bombieri, Cristina; Sorice, Rossella; Döring, Angela; Reischl, Eva; Strauch, Konstantin; Hofman, Albert; Uitterlinden, Andre G.; Waldenberger, Melanie; Wichmann, H-Erich; Davies, Gail; Gow, Alan J.; Dalbeth, Nicola; Stamp, Lisa; Smit, Johannes H.; Kirin, Mirna; Nagaraja, Ramaiah; Nauck, Matthias; Schurmann, Claudia; Budde, Kathrin; Farrington, Susan M.; Theodoratou, Evropi; Jula, Antti; Salomaa, Veikko; Sala, Cinzia; Hengstenberg, Christian; Burnier, Michel; Mägi, Reedik; Klopp, Norman; Kloiber, Stefan; Schipf, Sabine; Ripatti, Samuli; Cabras, Stefano; Soranzo, Nicole; Homuth, Georg; Nutile, Teresa; Munroe, Patricia B.; Hastie, Nicholas; Campbell, Harry; Rudan, Igor; Cabrera, Claudia; Haley, Chris; Franco, Oscar H.; Merriman, Tony R.; Gudnason, Vilmundur; Pirastu, Mario; Penninx, Brenda W.; Snieder, Harold; Metspalu, Andres; Ciullo, Marina; Pramstaller, Peter P.; van Duijn, Cornelia M.; Ferrucci, Luigi; Gambaro, Giovanni; Deary, Ian J.; Dunlop, Malcolm G.; Wilson, James F.; Gasparini, Paolo; Gyllensten, Ulf; Spector, Tim D.; Wright, Alan F.; Hayward, Caroline; Watkins, Hugh; Perola, Markus; Bochud, Murielle; Kao, W. H. Linda; Caulfield, Mark; Toniolo, Daniela; Völzke, Henry; Gieger, Christian; Köttgen, Anna; Vitart, Veronique

2015-01-01

We tested for interactions between body mass index (BMI) and common genetic variants affecting serum urate levels, genome-wide, in up to 42569 participants. Both stratified genome-wide association (GWAS) analyses, in lean, overweight and obese individuals, and regression-type analyses in a non BMI-stratified overall sample were performed. The former did not uncover any novel locus with a major main effect, but supported modulation of effects for some known and potentially new urate loci. The latter highlighted a SNP at RBFOX3 reaching genome-wide significant level (effect size 0.014, 95% CI 0.008-0.02, Pinter= 2.6 x 10-8). Two top loci in interaction term analyses, RBFOX3 and ERO1LB-EDARADD, also displayed suggestive differences in main effect size between the lean and obese strata. All top ranking loci for urate effect differences between BMI categories were novel and most had small magnitude but opposite direction effects between strata. They include the locus RBMS1-TANK (men, Pdifflean-overweight= 4.7 x 10-8), a region that has been associated with several obesity related traits, and TSPYL5 (men, Pdifflean-overweight= 9.1 x 10-8), regulating adipocytes-produced estradiol. The top-ranking known urate loci was ABCG2, the strongest known gout risk locus, with an effect halved in obese compared to lean men (Pdifflean-obese= 2 x 10-4). Finally, pathway analysis suggested a role for N-glycan biosynthesis as a prominent urate-associated pathway in the lean stratum. These results illustrate a potentially powerful way to monitor changes occurring in obesogenic environment. PMID:25811787

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/.

Implementing Lean Manufacturing in Malaysian Small and Medium Startup Pharmaceutical Company

NASA Astrophysics Data System (ADS)

Ibrahim, Wan Mohd Khairi bin Wan; Rahman, Mohamed Abdul; Abu Bakar, Mohd Rushdi bin

2017-03-01

Domestic pharmaceutical industry has been identified by the Malaysian government as an industry to be developed under its 11th economic development plan. Most homegrown pharmaceutical companies fall under the category of small and medium enterprises (SME) and therefore need to be highly efficient in their operations to compete with the multinationals. Though lean manufacturing is a well-known methodology to achieve an efficient operation, only a small percentage of the local SMEs implement it. The study aims to determine the real success factors in lean implementation through systematic review of relevant literature on lean manufacturing implementation in local companies, onsite observation of a selected SME company, Global Factor Sdn. Bhd. (GFSB), that successfully implemented lean manufacturing followed by actual implementation of lean project at IKOP Sdn. Bhd., a small startup pharmaceutical company. Lean tools like Gemba, value stream map (VSM) and spaghetti diagram were used to analyze and improve a process at IKOP Sdn. Bhd. The literature review showed that the implementation of lean manufacturing at Malaysian SMEs involved in pharmaceutical industry is at its infancy. Study at GFSB indicated that successful implementation of lean manufacturing stems from management support, employee’s commitment, government support and knowledge on lean among employees. Application of lean tools in IKOP Sdn. Bhd. to improve the process cycle efficiency of hand sanitizer, i-Hand 4.0, has shown that the GMP guidelines are not jeopardized. The Kaizen improvement project resulted in 46.3% reduction in lead time. It may be concluded that implementing lean manufacturing in any small local startup pharmaceutical company is beneficial in reducing operational costs and increasing the efficiency and effectiveness and does not conflict with the existing GMP guidelines.

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

NASA Astrophysics Data System (ADS)

Azim Khairi, M.; Rahman, Mohamed Abd

2018-01-01

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

Physical fitness as an indicator of health status and its relationship to academic performance during the prepubertal period.

PubMed

Fonseca Del Pozo, Francisco Javier; Alonso, Joaquín Valle; Álvarez, Manuel Vaquero; Orr, Siobhan; Cantarero, Francisco Jesús Llorente

2017-01-01

Background: Physical activity (PA) is considered one of the most important determinants of the health status in children, and predictor of morbidity/mortality in adults. The aim is to examine the relationship between physical fitness (PF), PA, obesity and academic performance (AP) in primary school children. Methods: Cross-sectional studies including 91 primary school students, aged 9 to 12 years, from the province of Córdoba. Data was collected from April to June 2014. We measured PF using part of the EUROFIT fitness testing battery. The level of PA was measured as low or high PF and the level of obesity was measured using body mass index, waist circumference, percentage of fat mass, lean body mass, percentage of lean mass and basal metabolism. AP by scores on the second quarter was based on the total average of scores of basic subjects and other subjects, including physical education. Cognitive performance was assessed by the Spanish overall and factorial intelligence test. Results: The results of AP were positively related to levels of PF. Students who achieve better PF score better in Maths, (P=0.019), Natural Sciences (P=0.024), Religion (P=0.018) and Physical Education (P<0.001). A direct association between maximal aerobic capacity with Mathematics (r=0.325, P=0.02), AP (r=0.349, P=0.001) and cognitive performance (CP)(r=0.312, P=0.003) was observed. There was also a direct association of better jump tests with higher AP (r=0.328, P=0.002). Conclusion: The AP is associated with higher levels of fitness. Therefore, the education system should consider implementing curriculum strategies favouring the improvement of the PF, and therefore the health and AP of students.

Lean Participative Process Improvement: Outcomes and Obstacles in Trauma Orthopaedics

PubMed Central

New, Steve; Hadi, Mohammed; Pickering, Sharon; Robertson, Eleanor; Morgan, Lauren; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter

2016-01-01

Objectives To examine the effectiveness of a “systems” approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches. Setting A controlled before-after study using the orthopaedic trauma theatre of a UK Trust hospital as the active site and an elective orthopaedic theatre in the same Trust as control. Participants All staff involved in surgical procedures in both theatres. Interventions A one-day “lean” training course delivered by an experienced specialist team was followed by support and assistance in developing a 6 month improvement project. Clinical staff selected the subjects for improvement and designed the improvements. Outcome Measures We compared technical and non-technical team performance in theatre using WHO checklist compliance evaluation, “glitch count” and Oxford NOTECHS II in a sample of directly observed operations, and patient outcome (length of stay, complications and readmissions) for all patients. We collected observational data for 3 months and clinical data for 6 months before and after the intervention period. We compared changes in measures using 2-way analysis of variance. Results We studied 576 cases before and 465 after intervention, observing the operation in 38 and 41 cases respectively. We found no significant changes in team performance or patient outcome measures. The intervention theatre staff focused their efforts on improving first patient arrival time, which improved by 20 minutes after intervention. Conclusions This version of “lean” system improvement did not improve measured safety processes or outcomes. The study highlighted an important tension between promoting staff ownership and providing direction, which needs to be managed in “lean” projects. Space and time for staff to conduct improvement activities are important for success. PMID:27124012

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

PubMed

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

2009-10-01

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

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

7 CFR 59.200 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

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

7 CFR 59.200 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

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

Transcriptional analysis of abdominal fat in genetically fat and lean chickens reveals adipokines, lipogenic genes and a link between hemostasis and leanness

PubMed Central

2013-01-01

Background This descriptive study of the abdominal fat transcriptome takes advantage of two experimental lines of meat-type chickens (Gallus domesticus), which were selected over seven generations for a large difference in abdominal (visceral) fatness. At the age of selection (9 wk), the fat line (FL) and lean line (LL) chickens exhibit a 2.5-fold difference in abdominal fat weight, while their feed intake and body weight are similar. These unique avian models were originally created to unravel genetic and endocrine regulation of adiposity and lipogenesis in meat-type chickens. The Del-Mar 14K Chicken Integrated Systems microarray was used for a time-course analysis of gene expression in abdominal fat of FL and LL chickens during juvenile development (1–11 weeks of age). Results Microarray analysis of abdominal fat in FL and LL chickens revealed 131 differentially expressed (DE) genes (FDR≤0.05) as the main effect of genotype, 254 DE genes as an interaction of age and genotype and 3,195 DE genes (FDR≤0.01) as the main effect of age. The most notable discoveries in the abdominal fat transcriptome were higher expression of many genes involved in blood coagulation in the LL and up-regulation of numerous adipogenic and lipogenic genes in FL chickens. Many of these DE genes belong to pathways controlling the synthesis, metabolism and transport of lipids or endocrine signaling pathways activated by adipokines, retinoid and thyroid hormones. Conclusions The present study provides a dynamic view of differential gene transcription in abdominal fat of chickens genetically selected for fatness (FL) or leanness (LL). Remarkably, the LL chickens over-express a large number of hemostatic genes that could be involved in proteolytic processing of adipokines and endocrine factors, which contribute to their higher lipolysis and export of stored lipids. Some of these changes are already present at 1 week of age before the divergence in fatness. In contrast, the FL chickens have enhanced expression of numerous lipogenic genes mainly after onset of divergence, presumably directed by multiple transcription factors. This transcriptional analysis shows that abdominal fat of the chicken serves a dual function as both an endocrine organ and an active metabolic tissue, which could play a more significant role in lipogenesis than previously thought. PMID:23947536

Direct CP asymmetry in D → π-π+ and D → K-K+ in QCD-based approach

NASA Astrophysics Data System (ADS)

Khodjamirian, Alexander; Petrov, Alexey A.

2017-11-01

We present the first QCD-based calculation of hadronic matrix elements with penguin topology determining direct CP-violating asymmetries in D0 →π-π+ and D0 →K-K+ nonleptonic decays. The method is based on the QCD light-cone sum rules and does not rely on any model-inspired amplitude decomposition, instead leaning heavily on quark-hadron duality. We provide a Standard Model estimate of the direct CP-violating asymmetries in both pion and kaon modes and their difference and comment on further improvements of the presented computation.

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

PubMed

Faulkner, Beth

2013-10-01

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

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

PubMed

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

2017-01-01

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

An experimental study of flame stability in a directly-fueled wall cavity with a supersonic free stream

NASA Astrophysics Data System (ADS)

Rasmussen, Chadwick Clifford

An extensive study of flame stability in a cavity-based fuel injector/flameholder has been performed. Flames were stabilized in cavities with two different aft wall configurations and length to depth ratios of 3 and 4. Fuel was injected directly into the cavity using two injector configurations. Fuel injected from the aft wall of the cavity entered directly into the recirculation zone and provided desirable performance near the lean blowout limit. At high fuel flowrates, the cavity became flooded with fuel and rich blowout occurred. When fuel was injected from the floor of the cavity, excess fuel was directed out of the cavity which allowed for flame stabilization at extremely high fuel flowrates; however, this phenomenon also resulted in suboptimal performance near the lean limit where the blowout point was less predictable. Images of planar laser-induced fluorescence (PLIF) of CH, OH, and formaldehyde give insight into the flameholding mechanisms. CH layers in the cavity are thin and continuous and show structure that is comparable to lifted jet flames, while broad CH zones are sometimes observed in the shear layer. OH PLIF images show that hot recirculated products are always present at the location of flame stabilization, whereas images of formaldehyde indicate that partial premixing takes place in the shear layer portion of the flame. Nonreacting measurements of the boundary layer and the free stream velocity profiles were obtained to provide necessary boundary conditions for computational modeling. Mean and instantaneous velocity profiles were determined for the nonreacting flow using particle image velocimetry (PIV). A correlation of the blowout points for a directly-fueled cavity in a supersonic flow was accomplished using a Damkohler number and an equivalence ratio based upon an effective air mass flowrate. The chemical time was formulated using a generic measure of the reaction rate, tauc ˜ alpha/ S2L , which was found to be adequate for correlating lean blowout data from methane, ethylene, acetylene, and hydrogen flames. Blowout data was collected at a number of conditions with varied pressure and temperature and Mach numbers of 2, 2.4, and 3. The effective air mass flowrate was determined using scaling laws for compressible mixing layers, which correctly incorporated the impact of compressibility on air entrainment.

The Application of Lean Thinking Principles and Kaizen Practices for the Successful Development and Implementation of the Ares I-X Flight Test Rocket and Mission

NASA Technical Reports Server (NTRS)

Askins, B. R.; Davis, S. R.; Heitzman, K. S.; Olsen, R. A.

2011-01-01

On October 28, 2009 the Ares I-X flight test rocket launched from Kennedy Space Center and flew its suborbital trajectory as designed. The mission was successfully completed as data from the test, and associated development activities were analyzed, transferred to stakeholders, and well documented. A positive lesson learned from Ares I-X was that the application of lean thinking principles and kaizen practices was very effective in streamlining development activities. Ares I-X, like other historical rocket development projects, was hampered by technical, cost, and schedule challenges and if not addressed boldly could have resulted in cancellation of the test. The mission management team conducted nine major meetings, referred to as lean events, across its elements to assess plans, procedures, processes, requirements, controls, culture, organization, use of resources, and anything that could be changed to optimize schedule or reduce risk. The preeminent aspect of the lean events was the focus on value added activities and the removal or at least reduction in non-value added activities. Trained Lean Six Sigma facilitators assisted the Ares I-X developers in conducting the lean events. They indirectly helped formulate the mission s own unique methodology for assessing schedule. A core team was selected to lead the events and report to the mission manager. Each activity leveraged specialized participants to analyze the subject matter and its related processes and then recommended alternatives and solutions. Stakeholders were the event champions. They empowered and encouraged the team to succeed. The keys to success were thorough preparation, honest dialog, small groups, adherence to the Ares I-X ground rules, and accountability through disciplined reporting and tracking of actions. This lean event formula was game-changing as demonstrated by Ares I-X. It is highly recommended as a management tool to help develop other complex systems efficiently. The key benefits for Ares I-X were obtaining unambiguous schedule margin, defining enabling options for risk reduction, and most importantly a stronger more unified team.

The Application of Lean Thinking Principles and Kaizen Practices for the Successful Development and Implementation of the Ares I-X Flight Test Rocket and Mission

NASA Technical Reports Server (NTRS)

Askins, B. R.; Davis, S. R.; Heitzman, K. S.; Olsen, R. A.

2011-01-01

On October 28, 2009 the Ares I-X flight test rocket launched from Kennedy Space Center and flew its suborbital trajectory as designed. The mission was successfully completed as data from the test, and associated development activities were analyzed, transferred to stakeholders, and well documented. Positive lessons learned from Ares I-X were that the application of lean thinking principles and kaizen practices are effective in streamlining development activities. Ares I-X, like other historical rocket development projects, was hampered by technical, cost, and schedule challenges and if not addressed boldly could have resulted in cancellation of the test. The mission management team conducted nine major meetings, referred to as lean events, across its elements to assess plans, procedures, processes, requirements, controls, culture, organization, use of resources, and anything that could be changed to optimize schedule or reduce risk. The preeminent aspect of the lean events was the focus on value added activities and the removal or at least reduction in non-value activities. Trained Lean Six Sigma facilitators assisted the Ares I-X developers in conducting the lean events. They indirectly helped formulate the mission s own unique methodology for assessing schedule. A core team was selected to lead the events and report to the mission manager. Each activity leveraged specialized participants to analyze the subject matter and its related processes and then recommended alternatives and solutions. Stakeholders were the event champions. They empowered and encouraged the team to succeed. The keys to success were thorough preparation, honest dialog, small groups, adherence to the Ares I-X ground rules, and accountability through disciplined reporting and tracking of actions. This lean event formula was game-changing as demonstrated by the success of Ares I-X. It is highly recommended as a management tool to help develop other complex systems efficiently. The key benefits for Ares I-X were obtaining unambiguous schedule margin, defining enabling options for risk reduction, and most importantly a stronger more unified team.

High intensity interval exercise decreases IL-8 and enhances the immunomodulatory cytokine interleukin-10 in lean and overweight-obese individuals.

PubMed

Dorneles, Gilson P; Haddad, Desirée O; Fagundes, Viviane O; Vargas, Bruna K; Kloecker, Alana; Romão, Pedro R T; Peres, Alessandra

2016-01-01

To compare the effects of two interval exercises with different intensities on acute inflammatory response in lean and overweight-obese subjects. Ten lean (BMI<24.9kg/m(2)) and 12 overweight-obese (BMI 25 to <34.9kg/m(2)) males performed two conditions in randomly assigned: (1) high intensity interval exercise (HIIE) 10×60s (85-90%PMax)/75s (50%PMax); (2) moderate intensity interval exercise (MIIE) 10×60s (70-75%PMax)/60s (50%PMax), with blood collections at pre, immediately and 30min post each exercise bouts to evaluate total and differential leukocyte counts, serum creatine kinase (CK), lactate dehydrogenase (LDH) and systemic levels of IL-1ra, IL-6, IL-8, IL-10, IL-17a and CCL2. In lean group, HIIE induced a significant increase in total leukocytes and monocyte, while MIIE session did not change the number of leukocytes. Overweight-obese group presented similar increase in leukocytes, monocytes and lymphocytes in both HIIE and MIIE sessions. At baseline, overweight-obese group showed high levels of CK, IL-8, IL-6 and CCL2 and lower concentrations of IL-10 compared to lean group. The MIIE did not alter the cytokine concentrations in both groups, independently of the time analysis. The HIIE induced significant decrease in IL-8 levels 30min post session in both the groups, and a progressive elevation in IL-10 levels immediately and 30min post in lean and overweight-obese. Regarding IL-6, overweight-obese subjects presented progressive increase either immediately and 30min after HIIE, while lean individuals presented significant increase only 30min after exercise. The acute inflammatory response to interval exercise is intensity-dependent. Although obesity influences the basal concentrations of several cytokines, only HIIE induced important alterations in IL-8 and IL-10 levels, which may have important implications in the control of chronic low-grade inflammation in obesity. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

PubMed Central

Samuel, Linoj

2014-01-01

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

Beta Testing of CFD Code for the Analysis of Combustion Systems

NASA Technical Reports Server (NTRS)

Yee, Emma; Wey, Thomas

2015-01-01

A preliminary version of OpenNCC was tested to assess its accuracy in generating steady-state temperature fields for combustion systems at atmospheric conditions using three-dimensional tetrahedral meshes. Meshes were generated from a CAD model of a single-element lean-direct injection combustor, and the latest version of OpenNCC was used to calculate combustor temperature fields. OpenNCC was shown to be capable of generating sustainable reacting flames using a tetrahedral mesh, and the subsequent results were compared to experimental results. While nonreacting flow results closely matched experimental results, a significant discrepancy was present between the code's reacting flow results and experimental results. When wide air circulation regions with high velocities were present in the model, this appeared to create inaccurately high temperature fields. Conversely, low recirculation velocities caused low temperature profiles. These observations will aid in future modification of OpenNCC reacting flow input parameters to improve the accuracy of calculated temperature fields.

Symposium on Direct Instruction: The Follow Through Data Show That Some Programs Work Better Than Others.

ERIC Educational Resources Information Center

Becker, Wesley C.

The Abt Associates' final report on the Follow-Through Planned Variation Experiment is defended against the critique published by a blue ribbon panel funded by the Ford Foundation. In contrast to the conclusions drawn by House, Glass, McLean, and Walker that Follow Through showed no "winners" or "losers", the National…

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

PubMed Central

Brännmark, Mikael; Holden, Richard J.

2013-01-01

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

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

NASA Astrophysics Data System (ADS)

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

2015-06-01

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

Lean blowoff detection sensor

DOEpatents

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

2007-04-03

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

What Do Organizational Leaders Need from Lean Graduate Programming

ERIC Educational Resources Information Center

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

2016-01-01

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

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.

Enhancing Financial Performance: An Application of Lean Six Sigma to Reduce Insurance Claim Denials.

PubMed

Kovach, Jamison V; Borikar, Shrutika

Health systems typically lose approximately 3% to 5% of net revenues annually due to insurance claim denials. While most denials can be appealed, the administrative burden of sorting through and appealing them can be time consuming and delays the revenue collection process. This article describes how the Lean Six Sigma methodology was used to improve the revenue cycle by reducing insurance claim denials for a leading pediatric hospital in the United States. The use of this approach is demonstrated through a case example focused on reducing denials by improving the hospital's Emergency Center registration process. Multiple pilot tests were performed to ensure the proposed changes sufficiently addressed the problem of missing/incomplete insurance information. Results indicated that the revised registration form reduced missing/incomplete fields by 67%. As a result, the revised form was implemented, which helped greatly reduce insurance claim denials. In addition to providing an example from which other health systems can learn to successfully implement Lean Six Sigma to enhance the performance of their revenue cycle, this work helped the hospital in which this research was performed improve its patient experience by making it easier for patients to complete their Emergency Center registration form.

Application of a mathematical model for ergonomics in lean manufacturing.

PubMed

Botti, Lucia; Mora, Cristina; Regattieri, Alberto

2017-10-01

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

Incidental rewarding cues influence economic decisions in people with obesity.

PubMed

Simmank, Jakob; Murawski, Carsten; Bode, Stefan; Horstmann, Annette

2015-01-01

Recent research suggests that obesity is linked to prominent alterations in learning and decision-making. This general difference may also underlie the preference for immediately consumable, highly palatable but unhealthy and high-calorie foods. Such poor food-related inter-temporal decision-making can explain weight gain; however, it is not yet clear whether this deficit can be generalized to other domains of inter-temporal decision-making, for example financial decisions. Further, little is known about the stability of decision-making behavior in obesity, especially in the presence of rewarding cues. To answer these questions, obese and lean participants (n = 52) completed two sessions of a novel priming paradigm including a computerized monetary delay discounting task. In the first session, general differences between groups in financial delay discounting were measured. In the second session, we tested the general stability of discount rates. Additionally, participants were primed by affective visual cues of different contextual categories before making financial decisions. We found that the obese group showed stronger discounting of future monetary rewards than the lean group, but groups did not differ in their general stability between sessions nor in their sensitivity toward changes in reward magnitude. In the obese group, a fast decrease of subjective value over time was directly related to a higher tendency for opportunistic eating. Obese in contrast to lean people were primed by the affective cues, showing a sex-specific pattern of priming direction. Our findings demonstrate that environments rich of cues, aiming at inducing unhealthy consumer decisions, can be highly detrimental for obese people. It also underscores that obesity is not merely a medical condition but has a strong cognitive component, meaning that current dietary and medical treatment strategies may fall too short.

Incidental rewarding cues influence economic decisions in people with obesity

PubMed Central

Simmank, Jakob; Murawski, Carsten; Bode, Stefan; Horstmann, Annette

2015-01-01

Recent research suggests that obesity is linked to prominent alterations in learning and decision-making. This general difference may also underlie the preference for immediately consumable, highly palatable but unhealthy and high-calorie foods. Such poor food-related inter-temporal decision-making can explain weight gain; however, it is not yet clear whether this deficit can be generalized to other domains of inter-temporal decision-making, for example financial decisions. Further, little is known about the stability of decision-making behavior in obesity, especially in the presence of rewarding cues. To answer these questions, obese and lean participants (n = 52) completed two sessions of a novel priming paradigm including a computerized monetary delay discounting task. In the first session, general differences between groups in financial delay discounting were measured. In the second session, we tested the general stability of discount rates. Additionally, participants were primed by affective visual cues of different contextual categories before making financial decisions. We found that the obese group showed stronger discounting of future monetary rewards than the lean group, but groups did not differ in their general stability between sessions nor in their sensitivity toward changes in reward magnitude. In the obese group, a fast decrease of subjective value over time was directly related to a higher tendency for opportunistic eating. Obese in contrast to lean people were primed by the affective cues, showing a sex-specific pattern of priming direction. Our findings demonstrate that environments rich of cues, aiming at inducing unhealthy consumer decisions, can be highly detrimental for obese people. It also underscores that obesity is not merely a medical condition but has a strong cognitive component, meaning that current dietary and medical treatment strategies may fall too short. PMID:26528158

Fatty acid chain length, postprandial satiety and food intake in lean men.

PubMed

Poppitt, S D; Strik, C M; MacGibbon, A K H; McArdle, B H; Budgett, S C; McGill, A-T

2010-08-04

High-fat diets are associated with obesity, and the weak satiety response elicited in response to dietary lipids is likely to play a role. Preliminary evidence from studies of medium (MCT) and long chain triglycerides (LCT) supports greater appetite suppression on high-MCT diets, possibly a consequence of direct portal access, more rapid oxidation and muted lipaemia. No data is as yet available on high-SCT diets which also have direct hepatic access. In this study SCT- (dairy fats), MCT- (coconut oil) and LCT-enriched (beef tallow) test breakfasts (3.3 MJ) containing 52 g lipid (58 en% fat) were investigated in a randomized, cross-over study in 18 lean men. All participants were required to complete the 3 study days in randomised order. Participants rated appetite sensations using visual analogue scales (VAS), and energy intake (EI) was measured by covert weighing of an ad libitum lunch meal 3.5 h postprandially. Blood samples were collected by venous cannulation. There were no detectable differences between breakfasts in perceived pleasantness, visual appearance, smell, taste, aftertaste and palatability (P>0.05). There was no significant effect of fatty acid chain length on ratings of hunger, fullness, satisfaction or current thoughts of food, nor did energy (mean, sem: SCT: 4406, 366 kJ; MCT: 4422, 306 kJ; LCT: 4490, 324 kJ; P>0.05) or macronutrient intake at lunch differ between diets. The maximum difference in EI between diets was less than 2%. Postprandial lipaemia also did not differ significantly. We conclude that there was no evidence that fatty acid chain length has an effect on measures of appetite and food intake when assessed following a single high-fat test meal in lean participants. Copyright 2010 Elsevier Inc. All rights reserved.

Eye Movement Patterns of the Elderly during Stair Descent:Effect of Illumination

NASA Astrophysics Data System (ADS)

Kasahara, Satoko; Okabe, Sonoko; Nakazato, Naoko; Ohno, Yuko

The relationship between the eye movement pattern during stair descent and illumination was studied in 4 elderly people in comparison with that in 5 young people. The illumination condition was light (85.0±30.9 lx) or dark (0.7±0.3 lx), and data of eye movements were obtained using an eye mark recorder. A flight of 15 steps was used for the experiment, and data on 3 steps in the middle, on which the descent movements were stabilized, were analyzed. The elderly subjects pointed their eyes mostly directly in front in the facial direction regardless of the illumination condition, but the young subjects tended to look down under the light condition. The young subjects are considered to have confirmed the safety of the front by peripheral vision, checked the stepping surface by central vision, and still maintained the upright position without leaning forward during stair descent. The elderly subjects, in contrast, always looked at the visual target by central vision even under the light condition and leaned forward. The range of eye movements was larger vertically than horizontally in both groups, and a characteristic eye movement pattern of repeating a vertical shuttle movement synchronous with descent of each step was observed. Under the dark condition, the young subjects widened the range of vertical eye movements and reduced duration of fixation. The elderly subjects showed no change in the range of eye movements but increased duration of fixation during stair descent. These differences in the eye movements are considered to be compensatory reactions to narrowing of the vertical visual field, reduced dark adaptation, and reduced dynamic visual acuity due to aging. These characteristics of eye movements of the elderly lead to an anteriorly leaned posture and lack of attention to the front during stair descent.

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

PubMed

Aij, Kjeld Harald; Rapsaniotis, Sofia

2017-01-01

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

Teaching Special Decisions in a Lean Accounting Environment

ERIC Educational Resources Information Center

Haskin, Daniel

2010-01-01

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

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

PubMed

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

2016-10-19

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

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

NASA Astrophysics Data System (ADS)

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

1995-01-01

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

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

PubMed

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

2017-05-01

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

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

PubMed

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

2010-12-01

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

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

PubMed Central

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

2014-01-01

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

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

PubMed Central

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

2016-01-01

Background Maintenance of lean muscle mass and related strength is associated with lower risk for numerous chronic diseases of aging in women. Objective To evaluate whether the association between dietary protein and lean mass differs by physical activity level, amino acid composition, and body mass index categories. Design Cross-sectional analysis of a prospective cohort. Participants/setting Postmenopausal women from the Women’s Health Initiative with body composition measurements by dual-energy X-ray absorptiometry (n=8,298). Main outcome measures Percent lean mass, percent fat mass and lean body mass index. Statistical analyses performed Linear regression models adjusted for scanner serial number, age, calibrated energy intake, race/ethnicity, neighborhood socioeconomic status, and recreational physical activity were used to determine the relationship between protein intake and body composition measures. Likelihood ratio tests and stratified analysis were used to investigate physical activity and body mass index as potential effect modifiers. Results Biomarker-calibrated protein intake was positively associated with percent lean mass; women in the highest protein quintile had 6.3 percentage points higher lean mass than the lowest quintile (P < 0.001). This difference rose to 8.5 percentage points for physically active women in the highest protein quintile (Pinteraction = 0.023). Percent fat mass and lean body mass index were both inversely related to protein intake (both P < 0.001). Physical activity further reduced percent fat mass (Pinteraction = 0.022) and lean body mass index (Pinteraction = 0.011). Leucine intake was associated with lean mass, as were branched chain amino acids combined (both P < 0.001), but not independent of total protein. All associations were observed for normal-weight, overweight, and obese women. Conclusions Protein consumption up to 2.02 g/kg body weight daily is positively associated with lean mass in postmenopausal women. Importantly, those that also engage in physical activity have the highest lean mass across body mass index categories. PMID:27914915

Cardiovascular and metabolic responses to fasting and thermoneutrality are conserved in obese Zucker rats.

PubMed

Overton, J M; Williams, T D; Chambers, J B; Rashotte, M E

2001-04-01

The primary purpose of the study was to test the hypothesis that reduced leptin signaling is necessary to elicit the cardiovascular and metabolic responses to fasting. Lean (Fa/?; normal leptin receptor; n = 7) and obese (fa/fa; mutated leptin receptor; n = 8) Zucker rats were instrumented with telemetry transmitters and housed in metabolic chambers at 23 degrees C (12:12-h light-dark cycle) for continuous (24 h) measurement of metabolic and cardiovascular variables. Before fasting, mean arterial pressure (MAP) was higher (MAP: obese = 103 +/- 3; lean = 94 +/- 1 mmHg), whereas oxygen consumption (VO(2): obese = 16.5 +/- 0.3; lean = 18.6 +/- 0.2 ml. min(-1). kg(-0.75)) was lower in obese Zucker rats compared with their lean controls. Two days of fasting had no effect on MAP in either lean or obese Zucker rats, whereas VO(2) (obese = -3.1 +/- 0.3; lean = -2.9 +/- 0.1 ml. min(-1). kg(-0.75)) and heart rate (HR: obese = -56 +/- 4; lean = -42 +/- 4 beats/min) were decreased markedly in both groups. Fasting increased HR variability both in lean (+1.8 +/- 0.4 ms) and obese (+2.6 +/- 0.3 ms) Zucker rats. After a 6-day period of ad libitum refeeding, when all parameters had returned to near baseline levels, the cardiovascular and metabolic responses to 2 days of thermoneutrality (ambient temperature 29 degrees C) were determined. Thermoneutrality reduced VO(2) (obese = -2.4 +/- 0.2; lean = -3.3 +/- 0.2 ml. min(-1). kg(-0.75)), HR (obese = -46 +/- 5; lean = -55 +/- 4 beats/min), and MAP (obese = -13 +/- 6; lean = -10 +/- 1 mmHg) similarly in lean and obese Zucker rats. The results indicate that the cardiovascular and metabolic responses to fasting and thermoneutrality are conserved in Zucker rats and suggest that intact leptin signaling may not be requisite for the metabolic and cardiovascular responses to reduced energy intake.

Physical Activity Modifies the Association between Dietary Protein and Lean Mass of Postmenopausal Women.

PubMed

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

2017-02-01

Maintenance of lean muscle mass and related strength is associated with lower risk for numerous chronic diseases of aging in women. Our aim was to evaluate whether the association between dietary protein and lean mass differs by physical activity level, amino acid composition, and body mass index categories. We performed a cross-sectional analysis of a prospective cohort. Participants were postmenopausal women from the Women's Health Initiative with body composition measurements by dual-energy x-ray absorptiometry (n=8,298). Our study measured percent lean mass, percent fat mass, and lean body mass index. Linear regression models adjusted for scanner serial number, age, calibrated energy intake, race/ethnicity, neighborhood socioeconomic status, and recreational physical activity were used to determine the relationship between protein intake and body composition measures. Likelihood ratio tests and stratified analysis were used to investigate physical activity and body mass index as potential effect modifiers. Biomarker-calibrated protein intake was positively associated with percent lean mass; women in the highest protein quintile had 6.3 percentage points higher lean mass than the lowest quintile (P<0.001). This difference rose to 8.5 percentage points for physically active women in the highest protein quintile (P interaction =0.023). Percent fat mass and lean body mass index were both inversely related to protein intake (both P<0.001). Physical activity further reduced percent fat mass (P interaction =0.022) and lean body mass index (P interaction =0.011). Leucine intake was associated with lean mass, as were branched chain amino acids combined (both P<0.001), but not independent of total protein. All associations were observed for normal-weight, overweight, and obese women. Protein consumption up to 2.02 g/kg body weight daily is positively associated with lean mass in postmenopausal women. Importantly, those that also engage in physical activity have the highest lean mass across body mass index categories. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Exploring nursing e-learning systems success based on information system success model.

PubMed

Chang, Hui-Chuan; Liu, Chung-Feng; Hwang, Hsin-Ginn

2011-12-01

E-learning is thought of as an innovative approach to enhance nurses' care service knowledge. Extensive research has provided rich information toward system development, courses design, and nurses' satisfaction with an e-learning system. However, a comprehensive view in understanding nursing e-learning system success is an important but less focused-on topic. The purpose of this research was to explore net benefits of nursing e-learning systems based on the updated DeLone and McLean's Information System Success Model. The study used a self-administered questionnaire to collected 208 valid nurses' responses from 21 of Taiwan's medium- and large-scale hospitals that have implemented nursing e-learning systems. The result confirms that the model is sufficient to explore the nurses' use of e-learning systems in terms of intention to use, user satisfaction, and net benefits. However, while the three exogenous quality factors (system quality, information quality, and service quality) were all found to be critical factors affecting user satisfaction, only information quality showed a direct effect on the intention to use. This study provides useful insights for evaluating nursing e-learning system qualities as well as an understanding of nurses' intentions and satisfaction related to performance benefits.

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

PubMed Central

2012-01-01

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

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

PubMed

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

2012-02-01

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

Using Lean Management to Reduce Emergency Department Length of Stay for Medicine Admissions.

PubMed

Allaudeen, Nazima; Vashi, Anita; Breckenridge, Julia S; Haji-Sheikhi, Farnoosh; Wagner, Sarah; Posley, Keith A; Asch, Steven M

The practice of boarding admitted patients in the emergency department (ED) carries negative operational, clinical, and patient satisfaction consequences. Lean tools have been used to improve ED workflow. Interventions focused on reducing ED length of stay (LOS) for admitted patients are less explored. To evaluate a Lean-based initiative to reduce ED LOS for medicine admissions. Prospective quality improvement initiative performed at a single university-affiliated Department of Veterans Affairs (VA) medical center from February 2013 to February 2016. We performed a Lean-based multidisciplinary initiative beginning with a rapid process improvement workshop to evaluate current processes, identify root causes of delays, and develop countermeasures. Frontline staff developed standard work for each phase of the ED stay. Units developed a daily management system to reinforce, evaluate, and refine standard work. The primary outcome was the change in ED LOS for medicine admissions pre- and postintervention. ED LOS at the intervention site was compared with other similar VA facilities as controls over the same time period using a difference-in-differences approach. ED LOS for medicine admissions reduced 26.4%, from 8.7 to 6.4 hours. Difference-in-differences analysis showed that ED LOS for combined medicine and surgical admissions decreased from 6.7 to 6.0 hours (-0.7 hours, P = .003) at the intervention site compared with no change (5.6 hours, P = .2) at the control sites. We utilized Lean management to significantly reduce ED LOS for medicine admissions. Specifically, the development and management of standard work were key to sustaining these results.

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.

Metabolic profiling of muscle contraction in lean compared with obese rodents.

PubMed

Thyfault, John P; Cree, Melanie G; Tapscott, Edward B; Bell, Jill A; Koves, Timothy R; Ilkayeva, Olga; Wolfe, Robert R; Dohm, G Lynis; Muoio, Deborah M

2010-09-01

Interest in the pathophysiological relevance of intramuscular triacylglycerol (IMTG) accumulation has grown from numerous studies reporting that abnormally high glycerolipid levels in tissues of obese and diabetic subjects correlate negatively with glucose tolerance. Here, we used a hindlimb perfusion model to examine the impact of obesity and elevated IMTG levels on contraction-induced changes in skeletal muscle fuel metabolism. Comprehensive lipid profiling was performed on gastrocnemius muscles harvested from lean and obese Zucker rats immediately and 25 min after 15 min of one-legged electrically stimulated contraction compared with the contralateral control (rested) limbs. Predictably, IMTG content was grossly elevated in control muscles from obese rats compared with their lean counterparts. In muscles of obese (but not lean) rats, contraction resulted in marked hydrolysis of IMTG, which was then restored to near resting levels during 25 min of recovery. Despite dramatic phenotypical differences in contraction-induced IMTG turnover, muscle levels of diacylglycerol (DAG) and long-chain acyl-CoAs (LCACoA) were surprisingly similar between groups. Tissue profiles of acylcarnitine metabolites suggested that the surfeit of IMTG in obese rats fueled higher rates of fat oxidation relative to the lean group. Muscles of the obese rats had reduced lactate levels immediately following contraction and higher glycogen resynthesis during recovery, consistent with a lipid-associated glucose-sparing effect. Together, these findings suggest that contraction-induced mobilization of local lipid reserves in obese muscles promotes beta-oxidation, while discouraging glucose utilization. Further studies are necessary to determine whether persistent oxidation of IMTG-derived fatty acids contributes to systemic glucose intolerance in other physiological settings.

Using lean principles to improve outpatient adult infusion clinic chemotherapy preparation turnaround times.

PubMed

Lamm, Matthew H; Eckel, Stephen; Daniels, Rowell; Amerine, Lindsey B

2015-07-01

The workflow and chemotherapy preparation turnaround times at an adult infusion clinic were evaluated to identify opportunities to optimize workflow and efficiency. A three-phase study using Lean Six Sigma methodology was conducted. In phase 1, chemotherapy turnaround times in the adult infusion clinic were examined one year after the interim goal of a 45-minute turnaround time was established. Phase 2 implemented various experiments including a five-day Kaizen event, using lean principles in an effort to decrease chemotherapy preparation turnaround times in a controlled setting. Phase 3 included the implementation of process-improvement strategies identified during the Kaizen event, coupled with a final refinement of operational processes. In phase 1, the mean turnaround time for all chemotherapy preparations decreased from 60 to 44 minutes, and a mean of 52 orders for adult outpatient chemotherapy infusions was received each day. After installing new processes, the mean turnaround time had improved to 37 minutes for each chemotherapy preparation in phase 2. In phase 3, the mean turnaround time decreased from 37 to 26 minutes. The overall mean turnaround time was reduced by 26 minutes, representing a 57% decrease in turnaround times in 19 months through the elimination of waste and the implementation of lean principles. This reduction was accomplished through increased efficiencies in the workplace, with no addition of human resources. Implementation of Lean Six Sigma principles improved workflow and efficiency at an adult infusion clinic and reduced the overall chemotherapy turnaround times from 60 to 26 minutes. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Interactions between lean management and the psychosocial work environment in a hospital setting - a multi-method study.

PubMed

Ulhassan, Waqar; von Thiele Schwarz, Ulrica; Thor, Johan; Westerlund, Hugo

2014-10-22

As health care struggles to meet increasing demands with limited resources, Lean has become a popular management approach. It has mainly been studied in relation to health care performance. The empirical evidence as to how Lean affects the psychosocial work environment has been contradictory. This study aims to study the interaction between Lean and the psychosocial work environment using a comprehensive model that takes Lean implementation information, as well as Lean theory and the particular context into consideration. The psychosocial work environment was measured twice with the Copenhagen Psychosocial Questionnaire (COPSOQ) employee survey during Lean implementations on May-June 2010 (T1) (n = 129) and November-December 2011 (T2) (n = 131) at three units (an Emergency Department (ED), Ward-I and Ward-II). Information based on qualitative data analysis of the Lean implementations and context from a previous paper was used to predict expected change patterns in the psychosocial work environment from T1 to T2 and subsequently compared with COPSOQ-data through linear regression analysis. Between T1 and T2, qualitative information showed a well-organized and steady Lean implementation on Ward-I with active employee participation, a partial Lean implementation on Ward-II with employees not seeing a clear need for such an intervention, and deterioration in already implemented Lean activities at ED, due to the declining interest of top management. Quantitative data analysis showed a significant relation between the expected and actual results regarding changes in the psychosocial work environment. Ward-I showed major improvements especially related to job control and social support, ED showed a major decline with some exceptions while Ward-II also showed improvements similar to Ward-I. The results suggest that Lean may have a positive impact on the psychosocial work environment given that it is properly implemented. Also, the psychosocial work environment may even deteriorate if Lean work deteriorates after implementation. Employee managers and researchers should note the importance of employee involvement in the change process. Employee involvement may minimize the intervention's harmful effects on psychosocial work factors. We also found that a multi-method may be suitable for investigating relations between Lean and the psychosocial work environment.

Obesity resistant mechanisms in the Lean polygenic mouse model as indicated by liver transcriptome and expression of selected genes in skeletal muscle

PubMed Central

2011-01-01

Background Divergently selected Lean and Fat mouse lines represent unique models for a polygenic form of resistance and susceptibility to obesity development. Previous research on these lines focused mainly on obesity-susceptible factors in the Fat line. This study aimed to examine the molecular basis of obesity-resistant mechanisms in the Lean line by analyzing various fat depots and organs, the liver transcriptome of selected metabolic pathways, plasma and lipid homeostasis and expression of selected skeletal muscle genes. Results Expression profiling using our custom Steroltalk v2 microarray demonstrated that Lean mice exhibit a higher hepatic expression of cholesterol biosynthesis genes compared to the Fat line, although this was not reflected in elevation of total plasma or liver cholesterol. However, FPLC analysis showed that protective HDL cholesterol was elevated in Lean mice. A significant difference between the strains was also found in bile acid metabolism. Lean mice had a higher expression of Cyp8b1, a regulatory enzyme of bile acid synthesis, and the Abcb11 bile acid transporter gene responsible for export of acids to the bile. Additionally, a higher content of blood circulating bile acids was observed in Lean mice. Elevated HDL and upregulation of some bile acids synthesis and transport genes suggests enhanced reverse cholesterol transport in the Lean line - the flux of cholesterol out of the body is higher which is compensated by upregulation of endogenous cholesterol biosynthesis. Increased skeletal muscle Il6 and Dio2 mRNA levels as well as increased activity of muscle succinic acid dehydrogenase (SDH) in the Lean mice demonstrates for the first time that changes in muscle energy metabolism play important role in the Lean line phenotype determination and corroborate our previous findings of increased physical activity and thermogenesis in this line. Finally, differential expression of Abcb11 and Dio2 identifies novel strong positional candidate genes as they map within the quantitative trait loci (QTL) regions detected previously in crosses between the Lean and Fat mice. Conclusion We identified novel candidate molecular targets and metabolic changes which can at least in part explain resistance to obesity development in the Lean line. The major difference between the Lean and Fat mice was in increased liver cholesterol biosynthesis gene mRNA expression, bile acid metabolism and changes in selected muscle genes' expression in the Lean line. The liver Abcb11 and muscle Dio2 were identified as novel positional candidate genes to explain part of the phenotypic difference between the Lean and Fat lines. PMID:21291556

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

NASA Astrophysics Data System (ADS)

Wang, Zhiyan; Abraham, John

2017-08-01

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

Development and validation of a predictive equation for lean body mass in children and adolescents.

PubMed

Foster, Bethany J; Platt, Robert W; Zemel, Babette S

2012-05-01

Lean body mass (LBM) is not easy to measure directly in the field or clinical setting. Equations to predict LBM from simple anthropometric measures, which account for the differing contributions of fat and lean to body weight at different ages and levels of adiposity, would be useful to both human biologists and clinicians. To develop and validate equations to predict LBM in children and adolescents across the entire range of the adiposity spectrum. Dual energy X-ray absorptiometry was used to measure LBM in 836 healthy children (437 females) and linear regression was used to develop sex-specific equations to estimate LBM from height, weight, age, body mass index (BMI) for age z-score and population ancestry. Equations were validated using bootstrapping methods and in a local independent sample of 332 children and in national data collected by NHANES. The mean difference between measured and predicted LBM was - 0.12% (95% limits of agreement - 11.3% to 8.5%) for males and - 0.14% ( - 11.9% to 10.9%) for females. Equations performed equally well across the entire adiposity spectrum, as estimated by BMI z-score. Validation indicated no over-fitting. LBM was predicted within 5% of measured LBM in the validation sample. The equations estimate LBM accurately from simple anthropometric measures.

Visualization and minimization of clustering of micro-pillars and walls due to liquid film evaporation

NASA Astrophysics Data System (ADS)

Kim, Tae-Hong; Kim, Jungchul; Kim, Ho-Young

2013-11-01

The spin drying, in which a rinsing liquid deposited on a wafer is rapidly dried by wafer spinning, is an essential step in the semiconductor manufacturing process. While the liquid evaporates, its meniscus straddles neighboring submicron-size patterns such as pillars and walls. Then the capillary effects that pull the patterns together may lead to direct contact of the patterns, which is often referred to as pattern leaning. This poses a problem becoming more and more serious as the pattern size shrinks and the aspect ratio of the patterns increases. While the clustering behavior of high-aspect-ratio micro- and nanopillars was investigated before, a technical strategy to prevent such clustering has been pursed in industrial practices without being supported by the recently established theory of elastocapillarity. Here we visualize the clustering behavior of polymer micropatterns with the evaporation of liquid film while varying the sizes and temperature of the micropatterns. We find a critical role of substrate temperature in preventing the leaning of the patterns via changing the evaporation rate and behavior of the liquid film. Also, we construct a regime map that guides us to find a process condition to avoid pattern leaning in semiconductor manufacturing. This work was supported by the National Research Foundation of Korea (grant no. 2012-008023).

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

Skeletal muscle myotubes of the severely obese exhibit altered ubiquitin-proteasome and autophagic/lysosomal proteolytic flux

PubMed Central

Bollinger, Lance M.; Powell, Jonathan J. S.; Houmard, Joseph A.; Witczak, Carol A.; Brault, Jeffrey J.

2015-01-01

Objective Whole-body protein metabolism is dysregulated with obesity. Our goal was to determine if activity and expression of major protein degradation pathways are compromised specifically in human skeletal muscle with obesity. Methods We utilized primary Human Skeletal Muscle cell (HSkM) cultures since cellular mechanisms can be studied absent of hormones and contractile activity that could independently influence metabolism. HSkM from 10 lean (BMI ≤ 26.0 kg/m2) and 8 severely obese (BMI ≥ 39.0) women were examined basally and when stimulated to atrophy (serum and amino acid starvation). Results HSkM from obese donors had a lower proportion of type I myosin heavy chain and slower flux through the autophagic/lysosomal pathway. During starvation, flux through the ubiquitin-proteasome system diverged according to obesity status, with a decrease in the lean and an increase in HSkM from obese subjects. HSkMC from the obese also displayed elevated proteasome activity despite no difference in proteasome content. Atrophy-related gene expression and myotube area were similar in myotubes derived from lean and obese individuals under basal and starved conditions. Conclusions Our data indicate that muscle cells of the lean and severely obese have innate differences in management of protein degradation, which may explain their metabolic differences. PMID:26010327

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.

Overweight and the feline gut microbiome - a pilot study.

PubMed

Kieler, I N; Mølbak, L; Hansen, L L; Hermann-Bank, M L; Bjornvad, C R

2016-06-01

Compared with lean humans, the gut microbiota is altered in the obese. Whether these changes are due to an obesogenic diet, and whether the microbiota contributes to adiposity is currently discussed. In the cat population, where obesity is also prevalent, gut microbiome changes associated with obesity have not been studied. Consequently, the aim of this study was to compare the gut microbiota of lean cats, with that of overweight and obese cats. Seventy-seven rescue-shelter cats housed for ≥3 consecutive days were included in the study. Faecal samples were obtained by rectal swab and, when available, by a paired litter box sample. Body condition was assessed using a 9-point scoring system. DNA was extracted, and the 16S rRNA gene was amplified with a high-throughput quantitative real-time PCR chip. Overweight and obese cats had a significantly different gut microbiota compared to lean cats (p < 0.05), but this finding could not be linked to differences in specific bacterial groups. The rectal samples obtained higher DNA concentration than litter box samples (p < 0.0001). In conclusion, overweight and obese cats seem to have an altered gut microbiome as compared to lean cats. Journal of Animal Physiology and Animal Nutrition © 2015 Blackwell Verlag GmbH.

Combustion characteristics of hydrogen. Carbon monoxide based gaseous fuels

NASA Technical Reports Server (NTRS)

Notardonato, J. J.; White, D. J.; Kubasco, A. J.; Lecren, R. T.

1981-01-01

An experimental rig program was conducted with the objective of evaluating the combuston performance of a family of fuel gases based on a mixture of hydrogen and carbon monoxide. These gases, in addition to being members of a family, were also representative of those secondary fuels that could be produced from coal by various gasification schemes. In particular, simulated Winkler, Lurgi, and Blue-water low and medium energy content gases were used as fuels in the experimental combustor rig. The combustor used was originally designed as a low NOx rich-lean system for burning liquid fuels with high bound nitrogen levels. When used with the above gaseous fuels this combustor was operated in a lean-lean mode with ultra long residence times. The Blue-water gas was also operated in a rich-lean mode. The results of these tests indicate the possibility of the existence of an 'optimum' gas turbine hydrogen - carbon monoxide based secondary fuel. Such a fuel would exhibit NOx and high efficiency over the entire engine operating range. It would also have sufficient stability range to allow normal light-off and engine acceleration. Solar Turbines Incorporated would like to emphasize that the results presented here have been obtained with experimental rig combustors. The technologies generated could, however, be utilized in future commercial gas turbines.

Floating wind turbine system

NASA Technical Reports Server (NTRS)

Viterna, Larry A. (Inventor)

2009-01-01

A floating wind turbine system with a tower structure that includes at least one stability arm extending therefrom and that is anchored to the sea floor with a rotatable position retention device that facilitates deep water installations. Variable buoyancy for the wind turbine system is provided by buoyancy chambers that are integral to the tower itself as well as the stability arm. Pumps are included for adjusting the buoyancy as an aid in system transport, installation, repair and removal. The wind turbine rotor is located downwind of the tower structure to allow the wind turbine to follow the wind direction without an active yaw drive system. The support tower and stability arm structure is designed to balance tension in the tether with buoyancy, gravity and wind forces in such a way that the top of the support tower leans downwind, providing a large clearance between the support tower and the rotor blade tips. This large clearance facilitates the use of articulated rotor hubs to reduced damaging structural dynamic loads. Major components of the turbine can be assembled at the shore and transported to an offshore installation site.

Using Dynamic Value Stream Mapping and Lean Accounting Box Scores to Support Lean Implementation

ERIC Educational Resources Information Center

Woehrle, Stephen L.; Abou-Shady, Louay

2010-01-01

Lean has proven to be an effective management philosophy for improving businesses in a competitive market by eliminating waste and improving operations. An impact of implementing lean projects is the rapid reduction in inventory levels, which gives management the false impression that profits are decreasing while workers on the shop floor observe…

Building Lean Supply Chain and Manufacturing Skills through an Interactive Case Study

ERIC Educational Resources Information Center

Ozelkan, Ertunga C.; Teng, S. Gary; Johnson, Thomas; Benson, Tom; Nestvogel, Dean

2007-01-01

With the ongoing global pressure to cut costs and focus on quality, many companies have been implementing "lean manufacturing" concepts to survive in the competitive marketplace. Thus it is imperative that engineering and business graduates are equipped with the lean principles, and are ready to take ownership of lean initiatives as they enter the…

A Very Large Eddy Simulation of the Nonreacting Flow in a Single-Element Lean Direct Injection Combustor Using PRNS with a Nonlinear Subscale Model

NASA Technical Reports Server (NTRS)

Shih, Tsan-Hsing; Liu, Nan-Suey

2009-01-01

Very large eddy simulation (VLES) of the nonreacting turbulent flow in a single-element lean direct injection (LDI) combustor has been successfully performed via the approach known as the partially resolved numerical simulation (PRNS/VLES) using a nonlinear subscale model. The grid is the same as the one used in a previous RANS simulation, which was considered as too coarse for a traditional LES simulation. In this study, we first carry out a steady RANS simulation to provide the initial flow field for the subsequent PRNS/VLES simulation. We have also carried out an unsteady RANS (URANS) simulation for the purpose of comparing its results with that of the PRNS/VLES simulation. In addition, these calculated results are compared with the experimental data. The present effort has demonstrated that the PRNS/VLES approach, while using a RANS type of grid, is able to reveal the dynamically important, unsteady large-scale turbulent structures occurring in the flow field of a single-element LDI combustor. The interactions of these coherent structures play a critical role in the dispersion of the fuel, hence, the mixing between the fuel and the oxidizer in a combustor.

Quantitative Laser-Saturated Fluorescence Measurements of Nitric Oxide in a Heptane Spray Flame

NASA Technical Reports Server (NTRS)

Cooper, Clayton S.; Laurendeau, Normand M.; Lee, Chi (Technical Monitor)

1997-01-01

We report spatially resolved laser-saturated fluorescence measurements of NO concentration in a pre-heated, lean-direct injection (LDI) spray flame at atmospheric pressure. The spray is produced by a hollow-cone, pressure-atomized nozzle supplied with liquid heptane. NO is excited via the Q2(26.5) transition of the gamma(0,0) band. Detection is performed in a 2-nm region centered on the gamma(0,1) band. Because of the relatively close spectral spacing between the excitation (226 nm) and detection wavelengths (236 nm), the gamma(0,1) band of NO cannot be isolated from the spectral wings of the Mie scattering signal produced by the spray. To account for the resulting superposition of the fluorescence and scattering signals, a background subtraction method has been developed that utilizes a nearby non-resonant wavelength. Excitation scans have been performed to locate the optimum off-line wavelength. Detection scans have been performed at problematic locations in the flame to determine possible fluorescence interferences from UHCs and PAHs at both the on-line and off-line excitation wavelengths. Quantitative radial NO profiles are presented and analyzed so as to better understand the operation of lean-direct injectors for gas turbine combustors.

Effects of a Modified German Volume Training Program on Muscular Hypertrophy and Strength.

PubMed

Amirthalingam, Theban; Mavros, Yorgi; Wilson, Guy C; Clarke, Jillian L; Mitchell, Lachlan; Hackett, Daniel A

2017-11-01

Amirthalingam, T, Mavros, Y, Wilson, GC, Clarke, JL, Mitchell, L, and Hackett, DA. Effects of a modified German volume training program on muscular hypertrophy and strength. J Strength Cond Res 31(11): 3109-3119, 2017-German Volume Training (GVT), or the 10 sets method, has been used for decades by weightlifters to increase muscle mass. To date, no study has directly examined the training adaptations after GVT. The purpose of this study was to investigate the effect of a modified GVT intervention on muscular hypertrophy and strength. Nineteen healthy men were randomly assign to 6 weeks of 10 or 5 sets of 10 repetitions for specific compound resistance exercises included in a split routine performed 3 times per week. Total and regional lean body mass, muscle thickness, and muscle strength were measured before and after the training program. Across groups, there were significant increases in lean body mass measures, however, greater increases in trunk (p = 0.043; effect size [ES] = -0.21) and arm (p = 0.083; ES = -0.25) lean body mass favored the 5-SET group. No significant increases were found for leg lean body mass or measures of muscle thickness across groups. Significant increases were found across groups for muscular strength, with greater increases in the 5-SET group for bench press (p = 0.014; ES = -0.43) and lat pull-down (p = 0.003; ES = -0.54). It seems that the modified GVT program is no more effective than performing 5 sets per exercise for increasing muscle hypertrophy and strength. To maximize hypertrophic training effects, it is recommended that 4-6 sets per exercise be performed, as it seems gains will plateau beyond this set range and may even regress due to overtraining.