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Sample records for leg lean tissue

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

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    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; plean during the single-leg squat predicted the amount of lateral trunk lean during pitching (R 2 = 0.28; p 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.

  2. Six weeks' aerobic retraining after two weeks' immobilization restores leg lean mass and aerobic capacity but does not fully rehabilitate leg strenght in young and older men

    DEFF Research Database (Denmark)

    Vigelsø Hansen, Andreas; Gram, Martin; Wiuff, Caroline

    2015-01-01

    OBJECTIVE: To determine the effect of aerobic retraining as rehabilitation after short-term leg immobilization on leg strength, leg work capacity, leg lean mass, leg muscle fibre type composition and leg capillary supply, in young and older men. SUBJECTS AND DESIGN: Seventeen young (23 ± 1 years...... immobilization had marked effects on leg strength, and work capacity and 6 weeks' retraining was sufficient to increase, but not completely rehabilitate, muscle strength, and to rehabilitate aerobic work capacity and leg lean mass (in the young men)....

  3. Leg strength and lean mass symmetry influences kicking performance in Australian football.

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    Hart, Nicolas H; Nimphius, Sophia; Spiteri, Tania; Newton, Robert U

    2014-01-01

    Differential loading patterns during game-based participation may produce or exacerbate strength imbalances between the lower limbs. It is currently unknown whether such imbalances are functionally beneficial or detrimental to performance. This study assessed the influence of lower limb strength and lean mass symmetry on kicking accuracy in Australian Football. Thirty-one Australian footballers were required to perform a kicking assessment, producing ten drop punt kicks over twenty metres to a player target. Athletes were subsequently separated into accurate (n = 15) and inaccurate (n = 16) groups, with lower-body lean mass assessed using whole body DXA scans, and lower-body strength assessed using an isometric protocol. Accurate kickers demonstrated significantly higher relative lean mass (~8% to 16%; p = 0. 001 to 0.004) and significantly lower relative fat mass (~21% to 40%; p = 0.001 to 0.024) than inaccurate kickers. Accurate kickers did not contain any significant difference in lean mass or unilateral strength between lower limbs. Inaccurate kickers displayed significant asymmetry in lean mass (~3%; p ≤ 0.003), producing significant imbalances in strength (~8%; p ≤ 0.002) highlighting a deficiency in their support leg. Greater relative strength and improved lower limb symmetry in strength and muscularity could increase the capacity of an athlete to be technically proficient in favour of greater accuracy. Key PointsStrength deficits in the support leg may lead to inaccurate kicking outcomes.An asymmetry of 3% in lean mass generated an 8% imbalance in leg strength.Greater levels of relative lower-body strength and muscle mass are associated with improved kicking accuracy performance.

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

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    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 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.

  5. Dudrick Research Symposium 2015-Lean Tissue and Protein in Health and Disease.

    Science.gov (United States)

    Earthman, Carrie P; Wolfe, Robert R; Heymsfield, Steven B

    2017-02-01

    The 2015 Dudrick Research Symposium "Lean Tissue and Protein in Health and Disease: Key Targets and Assessment Strategies" was held on February 16, 2015, at Clinical Nutrition Week in Long Beach, California. The Dudrick Symposium honors the many pivotal and innovative contributions to the development and advancement of parenteral nutrition made by Dr Stanley J. Dudrick, physician scientist, academic leader, and a founding member of the American Society for Parenteral and Enteral Nutrition. As the 2014 recipient of the Dudrick award, Dr Carrie Earthman chaired the symposium and was the first of 3 speakers, followed by Dr Robert Wolfe and Dr Steven Heymsfield. The symposium addressed the importance of lean tissue to health and response to disease and injury, as well as the many opportunities and challenges in its assessment at the bedside. Lean tissue assessment is beneficial to clinical care in chronic and acute care clinical settings, given the strong relationship between lean tissue and outcomes, including functional status. Currently available bioimpedance techniques, including the use of bioimpedance parameters, for lean tissue and nutrition status assessment were presented. The connection between protein requirements and lean tissue was discussed, highlighting the maintenance of lean tissue as one of the most important primary end points by which protein requirements can be estimated. The various tracer techniques to establish protein requirements were presented, emphasizing the importance of practical considerations in research protocols aimed to establish protein requirements. Ultrasound and other new and emerging technologies that may be used for lean tissue assessment were discussed, and areas for future research were highlighted.

  6. The effect of hemiplegia on bone mass and soft tissue body composition

    International Nuclear Information System (INIS)

    Iversen, E.; Hassager, C.; Christiansen, C.

    1989-01-01

    The content of bone mineral (BMC), lean tissue, and fat tissue were measured by single and dual photon absorptiometry in both the paretic and the nonparetic limbs of 15 patients, hemiplegic due to cerebrovascular accident 23-38 weeks earlier. Compared with the non-paretic arm, the paretic arm had approximately 10% lower (P < 0.01) BMC. This difference was largest at the measuring site with the highest ratio of trabecular to compact bone. The paretic leg had a 4% (P < 0.001) lower BMC than the non-paretic leg. For both the arms and the legs, the lean content was lower (P < 0.05) and the fat content higher (P < 0.01) in the paretic than in the non-paretic. This was relatively more pronounced in the arms than in the legs. We conclude that partial immobilization, owing to parasis after a cerebrovascular accident, results in characteristic changes in the affected limbs, with a marked decrease in the content of bone and lean tissue and a pronounced increase in fatty tissue. (author)

  7. Correlated responses in tissue weights measured in vivo by computer tomography in Dorset Down sheep selected for lean tissue growth

    International Nuclear Information System (INIS)

    Nsoso, S.J.; Young, M.J.; Beatson, P.R.

    2003-01-01

    The aim of this study was to estimate correlated responses in lean, fat and bone weights in vivo in Dorset Down sheep selected for lean tissue growth. Over the period 1986-1992 inclusive, the lean tissue growth line had been selected using two economic indices for an increased aggregate breeding value incorporating predicted lean and fat weights with positive and negative economic weightings, respectively. The control line was selected for no change in lean tissue growth each year. Animals were born and run on pasture all year round. X-ray computer tomography was used to estimate the weights of lean, fat and bone in vivo in the 1994-born sheep, aged 265-274 days and selected randomly into 12 rams and 12 ewes from the selected line and 10 rams and 9 ewes from the control line. The lean tissue growth line had significantly greater responses in lean weight (+0.65 + 0.10 kg) and lean percentage (+1.19 + 0.17%) and significantly lesser fat weight (-0.36 + 0.08 kg) and fat percentage (-1.88 + 0.20%) compared to the control line. There was a significant increase in bone weight (+0.27 + 0.03 kg) and bone percentage (+0.69 + 0.09%) in the lean tissue growth line compared to the control line. Responses differed significantly between sexes of the lean tissue growth line, rams having a greater response in weight of lean (+1.22 + 0.20 vs. +0.08 + 0.22 kg) and bone (+0.45 + 0.06 vs. +0.09 + 0.07 kg), and a lesser response in weight of fat (-0.03 + 0.15 vs. -0.70 + 0.16 kg) than the ewes. Selection led to significant changes in lean (increase) and fat weights (decrease), and bone weight increased. Although responses in the lean tissue growth line differed significantly between sexes, there were confounding factors due to differences in management and lack of comparison at equal stage of development. Therefore, to assess real genetic differences further studies should be conducted taking these factors into consideration

  8. Distribution of α-aminoisobutyric acid in tissues of lean and genetically obese mice

    International Nuclear Information System (INIS)

    Tews, J.K.; Harper, A.E.

    1989-01-01

    Distribution of tracer amounts of the nonmetabolizable neutral amino acid α-[1- 14 C]aminoisobutyric acid (AIB) between blood and several tissues was measured in lean and ob/ob mice over an 8-hr period. As AIB was injected on the basis of body weight and as ob/ob mice have a relatively low blood volume, absolute concentrations of AIB in blood and tissues were almost always higher in the obese than the lean mice. However, the ratio of AIB concentration in the tissues to that in the blood was clearly higher in skeletal muscle, diaphragm, and brain, and possibly higher in liver of the lean than of the obese animals. Ratios in heart were similar. The results suggest that lean and genetically obese mice differ in their capacity to transport amino acids between blood and various tissues

  9. Development of a bedside viable ultrasound protocol to quantify appendicular lean tissue mass.

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    Paris, Michael T; Lafleur, Benoit; Dubin, Joel A; Mourtzakis, Marina

    2017-10-01

    Ultrasound is a non-invasive and readily available tool that can be prospectively applied at the bedside to assess muscle mass in clinical settings. The four-site protocol, which images two anatomical sites on each quadriceps, may be a viable bedside method, but its ability to predict musculature has not been compared against whole-body reference methods. Our primary objectives were to (i) compare the four-site protocol's ability to predict appendicular lean tissue mass from dual-energy X-ray absorptiometry; (ii) optimize the predictability of the four-site protocol with additional anatomical muscle thicknesses and easily obtained covariates; and (iii) assess the ability of the optimized protocol to identify individuals with low lean tissue mass. This observational cross-sectional study recruited 96 university and community dwelling adults. Participants underwent ultrasound scans for assessment of muscle thickness and whole-body dual-energy X-ray absorptiometry scans for assessment of appendicular lean tissue. Ultrasound protocols included (i) the nine-site protocol, which images nine anterior and posterior muscle groups in supine and prone positions, and (ii) the four-site protocol, which images two anterior sites on each quadriceps muscle group in a supine position. The four-site protocol was strongly associated (R 2  = 0.72) with appendicular lean tissue mass, but Bland-Altman analysis displayed wide limits of agreement (-5.67, 5.67 kg). Incorporating the anterior upper arm muscle thickness, and covariates age and sex, alongside the four-site protocol, improved the association (R 2  = 0.91) with appendicular lean tissue and displayed narrower limits of agreement (-3.18, 3.18 kg). The optimized protocol demonstrated a strong ability to identify low lean tissue mass (area under the curve = 0.89). The four-site protocol can be improved with the addition of the anterior upper arm muscle thickness, sex, and age when predicting appendicular lean tissue mass

  10. Corticosterone binding to tissues of adrenalectomized lean and obese Zucker rats.

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    Grasa, M M; Cabot, C; Balada, F; Virgili, J; Sanchis, D; Monserrat, C; Fernández-López, J A; Remesar, X; Alemany, M

    1998-12-01

    The binding of corticosterone, dexamethasone and aldosterone was investigated in plasma and in homogenates of liver, kidney, brain, brown adipose tissue and visceral (periovaric) and subcutaneous white adipose tissues of Zucker lean and obese rats: intact controls, adrenalectomized and sham-operated. Corticosterone-binding globulin (CBG) accounted for most of the binding, whereas that of glucocorticoid and mineralocorticoid receptors was much lower. Plasma corticosterone levels increased in sham-operated and obviously decreased in the adrenalectomized animals. Sham-operated and adrenalectomized lean rats showed decreased plasma CBG; in the obese, CBG levels were lower than in controls and were not affected by either surgery. No variation with obesity or surgery was observed either in dexamethasone or aldosterone binding, the latter being practically zero in most samples. When expressed per unit of tissue protein, CBG activity was maximal in adipose tissues, with lowest values in brain and liver. In lean rats, tissue CBG activity decreased with either surgical treatment; no changes were observed in the obese, which also had lower CBG tissue levels. The relative lack of changes in CBG of obese rats suggests that they have lost -- at least in part -- the ability to counter-modulate the changes in glucocorticoid levels through CBG modulation, thus relying only on the control of corticosterone levels. This interpretation agrees with the postulated role of CBG modulating the availability of glucocorticoids to target cells.

  11. Android subcutaneous adipose tissue topography in lean and obese women suffering from PCOS: comparison with type 2 diabetic women.

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    Horejsi, R; Möller, R; Rackl, S; Giuliani, A; Freytag, U; Crailsheim, K; Sudi, K; Tafeit, E

    2004-07-01

    The new optical device, the lipometer, enables the noninvasive, quick, safe, and precise determination of the thickness of subcutaneous adipose tissue (SAT) layers at any given site of the human body. Fifteen anatomically well-defined body sites from neck to calf describe a SAT topography (SAT-Top) like an individual "fingerprint" of a subject. This SAT-Top was examined in 16 women with polycystic ovary syndrome (PCOS) and compared to the body fat distribution of 87 age-matched healthy controls and 20 type-2 diabetic women. SAT-Top differences of these three groups were described and, to render the possibility of visual comparison, the 15-dimensional body fat information was condensed to a two-dimensional factor plot by factor analysis. All PCOS patients had an android body fat distribution with significantly thinner SAT layers on the legs as compared to healthy controls. Moreover, a hierarchical cluster analysis resulted in two distinctly different groups of PCOS women, a lean (PCOSL) and an obese (PCOSO) cluster: compared to healthy women, lean PCOS patients had significantly lower total SAT development, even though height, weight, and body mass index did not deviate significantly. Especially on the legs, their SAT layers were significantly lowered, indicating a more "apple-like" fat distribution type. Obese PCOS women showed a SAT-Top pattern very similar to that of women with type-2 diabetes, although the mean age difference between these groups was more than 30 years. Compared to healthy controls, the SAT-Top of these obese PCOS patients was strongly shifted into the android direction, appearing as "super-apples" with a significantly increased upper trunk obesity to 237.8% and a significantly decreased leg SAT development to 79.8%. Copyright 2004 Wiley-Liss, Inc.

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

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

    2017-12-01

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

  13. Leg tissue composition and physico-chemical parameters of sheep meat fed annatto coproduct

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    Dorgival Morais de Lima Júnior

    2017-10-01

    Full Text Available Our objective was to evaluate leg tissue composition and physico-chemical quality parameters of sheep meat fed with increasing levels of annatto coproduct. 32 male uncastrated animals without a defined breed were randomized in four treatments (0, 100, 200 and 300 g kg-1 of annatto coproduct in the DM diet. After 78 days of confinement, the animals were slaughtered and body components were recorded. Reconstituted leg weight, total muscle weight, biceps weight and semitendinosus weight showed a negative linear behavior (P 0.05 were found for leg tissue composition (%, muscle:bone ratio, relative fat or leg muscle. Meat physico-chemical parameters (color, shear force, water retention capacity and cooking losses were not affected by the inclusion of the annatto coproduct in the diet. The annatto coproduct can be included in up to 300 g kg-1 of dietary dry matter without negative effects to the leg tissue composition (% and physical parameters of confined sheep meat.

  14. Relationship between Leg Mass, Leg Composition and Foot Velocity on Kicking Accuracy in Australian Football.

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    Hart, Nicolas H; Nimphius, Sophia; Spiteri, Tania; Cochrane, Jodie L; Newton, Robert U

    2016-06-01

    Kicking a ball accurately over a desired distance to an intended target is arguably the most important skill to acquire in Australian Football. Therefore, understanding the potential mechanisms which underpin kicking accuracy is warranted. The aim of this study was to examine the relationship between leg mass, leg composition and foot velocity on kicking accuracy in Australian Football. Thirty-one Australian Footballers (n = 31; age: 22.1 ± 2.8 years; height: 1.81 ± 0.07 m; weight: 85.1 ± 13.0 kg; BMI: 25.9 ± 3.2) each performed ten drop punt kicks over twenty metres to a player target. Athletes were separated into accurate (n = 15) and inaccurate (n = 16) kicking groups. Leg mass characteristics were assessed using whole body DXA scans. Foot velocity was determined using a ten-camera optoelectronic, three-dimensional motion capture system. Interactions between leg mass and foot velocity evident within accurate kickers only (r = -0.670 to -0.701). Relative lean mass was positively correlated with kicking accuracy (r = 0.631), while no relationship between foot velocity and kicking accuracy was evident in isolation (r = -0.047 to -0.083). Given the evident importance of lean mass, and its interaction with foot velocity for accurate kickers; future research should explore speed-accuracy, impulse-variability, limb co-ordination and foot-ball interaction constructs in kicking using controlled with-in subject studies to examine the effects of resistance training and skill acquisition programs on the development of kicking accuracy. Key pointsAccurate kickers expressed a very strong inverse relationship between leg mass and foot velocity. Inaccurate kickers were unable to replicate this, with greater volatility in their performance, indicating an ability of accurate kickers to mediate foot velocity to compensate for leg mass in order to deliver the ball over the required distance.Accurate kickers exhibited larger quantities of relative lean mass and lower quantities

  15. Distinct effects of calorie restriction on adipose tissue cytokine and angiogenesis profiles in obese and lean mice

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    Kurki Eveliina

    2012-06-01

    Full Text Available Abstract Background Obesity associates with low-grade inflammation and adipose tissue remodeling. Using sensitive high-throughput protein arrays we here investigated adipose tissue cytokine and angiogenesis-related protein profiles from obese and lean mice, and in particular, the influence of calorie restriction (CR. Methods Tissue samples from visceral fat were harvested from obese mice fed with a high-fat diet (60% of energy, lean controls receiving low-fat control diet as well as from obese and lean mice kept under CR (energy intake 70% of ad libitum intake for 50 days. Protein profiles were analyzed using mouse cytokine and angiogenesis protein array kits. Results In obese and lean mice, CR was associated with 11.3% and 15.6% reductions in body weight, as well as with 4.0% and 4.6% reductions in body fat percentage, respectively. Obesity induced adipose tissue cytokine expressions, the most highly upregulated cytokines being IL-1ra, IL-2, IL-16, MCP-1, MIG, RANTES, C5a, sICAM-1 and TIMP-1. CR increased sICAM-1 and TIMP-1 expression both in obese and lean mice. Overall, CR showed distinct effects on cytokine expressions; in obese mice CR largely decreased but in lean mice increased adipose tissue cytokine expressions. Obesity was also associated with increased expressions of angiogenesis-related proteins, in particular, angiogenin, endoglin, endostatin, endothelin-1, IGFBP-3, leptin, MMP-3, PAI-1, TIMP-4, CXCL16, platelet factor 4, DPPIV and coagulation factor III. CR increased endoglin, endostatin and platelet factor 4 expressions, and decreased IGFBP-3, NOV, MMP-9, CXCL16 and osteopontin expressions both in obese and lean mice. Interestingly, in obese mice, CR decreased leptin and TIMP-4 expressions, whereas in lean mice their expressions were increased. CR decreased MMP-3 and PAI-1 only in obese mice, whereas CR decreased FGF acidic, FGF basic and coagulation factor III, and increased angiogenin and DPPIV expression only in lean mice

  16. Skeletal muscle tissue transcriptome differences in lean and obese female beagle dogs.

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    Grant, R W; Vester Boler, B M; Ridge, T K; Graves, T K; Swanson, K S

    2013-08-01

    Skeletal muscle is a large and insulin-sensitive tissue that is an important contributor to metabolic homeostasis and energy expenditure. Many metabolic processes are altered with obesity, but the contribution of muscle tissue in this regard is unclear. A limited number of studies have compared skeletal muscle gene expression of lean and obese dogs. Using microarray technology, our objective was to identify genes and functional classes differentially expressed in skeletal muscle of obese (14.6 kg; 8.2 body condition score; 44.5% body fat) vs. lean (8.6 kg; 4.1 body condition score; 22.9% body fat) female beagle adult dogs. Alterations in 77 transcripts was observed in genes pertaining to the functional classes of signaling, transport, protein catabolism and proteolysis, protein modification, development, transcription and apoptosis, cell cycle and differentiation. Genes differentially expressed in obese vs. lean dog skeletal muscle indicate oxidative stress and altered skeletal muscle cell differentiation. Many genes traditionally associated with lipid, protein and carbohydrate metabolism were not altered in obese vs. lean dogs, but genes pertaining to endocannabinoid metabolism, insulin signaling, type II diabetes mellitus and carnitine transport were differentially expressed. The relatively small response of skeletal muscle could indicate that changes are occurring at a post-transcriptional level, that other tissues (e.g., adipose tissue) were buffering skeletal muscle from metabolic dysfunction or that obesity-induced changes in skeletal muscle require a longer period of time and that the length of our study was not sufficient to detect them. Although only a limited number of differentially expressed genes were detected, these results highlight genes and functional classes that may be important in determining the etiology of obesity-induced derangement of skeletal muscle function. © 2013 The Authors, Animal Genetics © 2013 Stichting International Foundation

  17. The reliability of a segmentation methodology for assessing intramuscular adipose tissue and other soft-tissue compartments of lower leg MRI images.

    Science.gov (United States)

    Karampatos, Sarah; Papaioannou, Alexandra; Beattie, Karen A; Maly, Monica R; Chan, Adrian; Adachi, Jonathan D; Pritchard, Janet M

    2016-04-01

    Determine the reliability of a magnetic resonance (MR) image segmentation protocol for quantifying intramuscular adipose tissue (IntraMAT), subcutaneous adipose tissue, total muscle and intermuscular adipose tissue (InterMAT) of the lower leg. Ten axial lower leg MRI slices were obtained from 21 postmenopausal women using a 1 Tesla peripheral MRI system. Images were analyzed using sliceOmatic™ software. The average cross-sectional areas of the tissues were computed for the ten slices. Intra-rater and inter-rater reliability were determined and expressed as the standard error of measurement (SEM) (absolute reliability) and intraclass coefficient (ICC) (relative reliability). Intra-rater and inter-rater reliability for IntraMAT were 0.991 (95% confidence interval [CI] 0.978-0.996, p soft tissue compartments, the ICCs were all >0.90 (p soft-tissue compartments of the lower leg. A standard operating procedure manual is provided to assist users, and SEM values can be used to estimate sample size and determine confidence in repeated measurements in future research.

  18. Reproducibility of regional DEXA examinations of abdominal fat and lean tissue.

    Science.gov (United States)

    Tallroth, Kaj; Kettunen, Jyrki A; Kujala, Urho M

    2013-01-01

    The aim of this study was to develop and test the validity of a new repeatable method to delimit abdominal areas for follow-up of fat mass (FM) and lean tissue mass (LM) in DEXA examinations. 37 male volunteers underwent two DEXA examinations. Total body FM and LM measurements and corresponding abdominal measurements in a carefully defined region were calculated from the first scan. After repositioning of the subjects and a second scan, the delimited region was copied and the abdominal tissues re-calculated. The mean LM of the abdominal area was 2.804 kg (SD 0.556), and the mean FM was 1.026 kg (SD 0.537). The intra-class correlation coefficient for the repeated abdominal LM, FM, and LM/FM ratio measurements was 0.99. The mean difference (bias) for the repeated abdominal LM measurements was -13 g (95% confidence interval (CI) -193.0 to 166.8), and for the repeated abdominal FM measurements it was -35 g (95% CI -178.9 to 108.5). The results indicate that regional DEXA is a sensitive method with excellent reproducibility in the measurements of the abdominal fat and lean tissues. The method may serve as a useful tool for evaluation and follow-up of various dietary and training programmes.

  19. Per meal dose and frequency of protein consumption is associated with lean mass and muscle performance.

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    Loenneke, Jeremy P; Loprinzi, Paul D; Murphy, Caoileann H; Phillips, Stuart M

    2016-12-01

    It has been hypothesized that for older adults evenly distributing consumption of protein at 30-40 g per meal throughout the day may result in more favorable retention of lean mass and muscular strength. Such a thesis has not, to our knowledge, been tested outside of short-term studies or acute measures of muscle protein synthesis. To examine whether the number of times an individual consumed a minimum of 30 g of protein at a meal is associated with leg lean mass and knee extensor strength. Data from the 1999-2002 NHANES were used, with 1081 adults (50-85 y) constituting the analytic sample. A "multiple pass" 24-h dietary interview format was used to collect detailed information about the participants' dietary intake. Knee extensor strength was assessed objectively using the Kin Com MP dynamometer. Leg lean mass was estimated from whole-body dual-energy X-ray absorptiometry (DXA) scans. Participants with 1 vs. 0 (β adjusted  = 23.6, p = 0.002) and 2 vs. 0 (β adjusted  = 51.1, p = 0.001) meals of ≥30 g protein/meal had greater strength and leg lean mass (1 vs. 0, β adjusted  = 1160, p frequency with leg lean mass and strength plateaued at ∼45 g protein/meal for those consuming 2 vs. 0 meals above the evaluated protein/meal threshold. However, for those with only 1 meal at or above the evaluated threshold, the response plateaued at 30 g/meal. Leg lean mass mediated the relationship between protein frequency and strength, with the proportion of the total effect mediated being 64%. We found that more frequent consumption of meals containing between 30 and 45 g protein/meal produced the greatest association with leg lean mass and strength. Thus, the consumption of 1-2 daily meals with protein content from 30 to 45 g may be an important strategy for increasing and/or maintaining lean body mass and muscle strength with aging. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  20. Measurement of L-[1-14C]leucine kinetics in splanchnic and leg tissues in humans. Effect of amino acid infusion

    International Nuclear Information System (INIS)

    Gelfand, R.A.; Glickman, M.G.; Castellino, P.; Louard, R.J.; DeFronzo, R.A.

    1988-01-01

    Although whole-body leucine flux is widely measured to study body protein turnover in humans, the contribution of specific tissues to the total-body measurement remains unknown. By combining the organ-balance technique with the systemic infusion of L-[1-14C]leucine, we quantitated leucine production and disposal by splanchnic and leg tissues and by the whole body, simultaneously, in six normal men before and during amino acid infusion. At steady state, disposal of arterial leucine by splanchnic and leg tissues was calculated from the percent extraction (E) of L-[1-14C]leucine counts: uptake = E x [Leu]a x flow. Tissue release of cold leucine (from protein turnover) into vein was calculated as the difference between leucine uptake and the net tissue leucine balance. In the postabsorptive state, despite substantial (P less than .01) extraction of L-[1-14C]leucine by splanchnic (23 +/- 1%) and leg (18 +/- 2%) tissues, net leucine balance across both tissue beds was small, indicating active simultaneous disposal and production of leucine at nearly equivalent rates. Splanchnic tissues accounted for approximately 50% of the measured total-body leucine flux. During amino acid infusion, the net leucine balance across splanchnic and leg tissues became positive, reflecting not only an increase in leucine uptake but also a marked suppression (by approximately 50%, P less than .02) of cold leucine release. This reduction in splanchnic and leg leucine release was indicated by a sharp decline in whole-body endogenous leucine flux

  1. Relationship between Leg Mass, Leg Composition and Foot Velocity on Kicking Accuracy in Australian Football

    Directory of Open Access Journals (Sweden)

    Nicolas H. Hart, Jodie L. Cochrane, Tania Spiteri, Sophia Nimphius, Robert U. Newton

    2016-06-01

    Full Text Available Kicking a ball accurately over a desired distance to an intended target is arguably the most important skill to acquire in Australian Football. Therefore, understanding the potential mechanisms which underpin kicking accuracy is warranted. The aim of this study was to examine the relationship between leg mass, leg composition and foot velocity on kicking accuracy in Australian Football. Thirty-one Australian Footballers (n = 31; age: 22.1 ± 2.8 years; height: 1.81 ± 0.07 m; weight: 85.1 ± 13.0 kg; BMI: 25.9 ± 3.2 each performed ten drop punt kicks over twenty metres to a player target. Athletes were separated into accurate (n = 15 and inaccurate (n = 16 kicking groups. Leg mass characteristics were assessed using whole body DXA scans. Foot velocity was determined using a ten-camera optoelectronic, three-dimensional motion capture system. Interactions between leg mass and foot velocity evident within accurate kickers only (r = -0.670 to -0.701. Relative lean mass was positively correlated with kicking accuracy (r = 0.631, while no relationship between foot velocity and kicking accuracy was evident in isolation (r = -0.047 to -0.083. Given the evident importance of lean mass, and its interaction with foot velocity for accurate kickers; future research should explore speed-accuracy, impulse-variability, limb co-ordination and foot-ball interaction constructs in kicking using controlled with-in subject studies to examine the effects of resistance training and skill acquisition programs on the development of kicking accuracy.

  2. Protein-enriched diet, with the use of lean red meat, combined with progressive resistance training enhances lean tissue mass and muscle strength and reduces circulating IL-6 concentrations in elderly women: a cluster randomized controlled trial.

    Science.gov (United States)

    Daly, Robin M; O'Connell, Stella L; Mundell, Niamh L; Grimes, Carley A; Dunstan, David W; Nowson, Caryl A

    2014-04-01

    Physical inactivity, inadequate dietary protein, and low-grade systemic inflammation contribute to age-related muscle loss, impaired function, and disability. We assessed the effects of progressive resistance training (PRT) combined with a protein-enriched diet facilitated through lean red meat on lean tissue mass (LTM), muscle size, strength and function, circulating inflammatory markers, blood pressure, and lipids in elderly women. In a 4-mo cluster randomized controlled trial, 100 women aged 60-90 y who were residing in 15 retirement villages were allocated to receive PRT with lean red meat (∼160 g cooked) to be consumed 6 d/wk [resistance training plus lean red meat (RT+Meat) group; n = 53] or control PRT [1 serving pasta or rice/d; control resistance training (CRT) group; n = 47)]. All women undertook PRT 2 times/wk and received 1000 IU vitamin D3/d. The mean (± SD) protein intake was greater in the RT+Meat group than in the CRT group throughout the study (1.3 ± 0.3 compared with 1.1 ± 0.3 g · kg⁻¹ · d⁻¹, respectively; P < 0.05). The RT+Meat group experienced greater gains in total body LTM (0.45 kg; 95% CI: 0.07, 0.84 kg), leg LTM (0.22 kg; 95% CI: 0.02, 0.42 kg), and muscle strength (18%; 95% CI: 0.03, 0.34) than did the CRT group (all P < 0.05). The RT+Meat group also experienced a 10% greater increase in serum insulin-like growth factor I (P < 0.05) and a 16% greater reduction in the proinflammatory marker interleukin-6 (IL-6) (P < 0.05) after 4 mo. There were no between-group differences for the change in blood lipids or blood pressure. A protein-enriched diet equivalent to ∼1.3 g · kg⁻¹ · d⁻¹ achieved through lean red meat is safe and effective for enhancing the effects of PRT on LTM and muscle strength and reducing circulating IL-6 concentrations in elderly women. This trial was registered at the Australian Clinical Trials Registry as ACTRN12609000223235.

  3. Changes in the content of edible and non-edible components and distribution of tissue components in cockerels and capons

    Directory of Open Access Journals (Sweden)

    Magdalena Zawacka

    2018-04-01

    Full Text Available The aim of this study was to determine the effects of castration and age on the content of edible and non-edible components, and the distribution of tissue components in the carcasses of cockerels and capons. The study was conducted on 200 birds (Green-legged Partridge, divided into two sex categories (with 5 replications per group and 20 birds per replication, raised to 28 wk of age. At 8 wk of age, 100 birds were surgically castrated and afterwards at 12 wk of age and at four-wk intervals, 10 intact cockerels and 10 capons were selected randomly and slaughtered. Cockerels, compared with capons, were characterized by a higher proportion of edible components at 24 and 28 wk of age, and a more desirable carcass tissue composition due to a higher content of lean meat in total body weight (BW. Capons had higher abdominal fat content than cockerels, which resulted in a higher percentage of non-edible components in their BW at 24 and 28 wk of age. Differences in the distribution of lean meat in the carcass were noted from 20 wk of age in both castrated and intact birds. The content of breast muscles increased in capons, and the content of leg muscles (thigh and drumstick increased in cockerels. The results of this study indicate that in view of the optimal lean meat content of the carcass and the optimal distribution of major tissue components, Green-legged Partridge capons should be fattened for a maximum period of 24 wk.

  4. Changes in the content of edible and non-edible components and distribution of tissue components in cockerels and capons

    International Nuclear Information System (INIS)

    Zawacka, M.; Gesek, M.; Michalik, D.; Murawska, D.

    2018-01-01

    The aim of this study was to determine the effects of castration and age on the content of edible and non-edible components, and the distribution of tissue components in the carcasses of cockerels and capons. The study was conducted on 200 birds (Green-legged Partridge), divided into two sex categories (with 5 replications per group and 20 birds per replication), raised to 28 wk of age. At 8 wk of age, 100 birds were surgically castrated and afterwards at 12 wk of age and at four-wk intervals, 10 intact cockerels and 10 capons were selected randomly and slaughtered. Cockerels, compared with capons, were characterized by a higher proportion of edible components at 24 and 28 wk of age, and a more desirable carcass tissue composition due to a higher content of lean meat in total body weight (BW). Capons had higher abdominal fat content than cockerels, which resulted in a higher percentage of non-edible components in their BW at 24 and 28 wk of age. Differences in the distribution of lean meat in the carcass were noted from 20 wk of age in both castrated and intact birds. The content of breast muscles increased in capons, and the content of leg muscles (thigh and drumstick) increased in cockerels. The results of this study indicate that in view of the optimal lean meat content of the carcass and the optimal distribution of major tissue components, Green-legged Partridge capons should be fattened for a maximum period of 24 wk.

  5. Prediction equation for lower limbs lean soft tissue in circumpubertal boys using anthropometry and biological maturation.

    Directory of Open Access Journals (Sweden)

    João Valente-dos-Santos

    Full Text Available Lean soft tissue (LST, a surrogate of skeletal muscle mass, is largely limited to appendicular body regions. Simple and accurate methods to estimate lower limbs LST are often used in attempts to partition out the influence of body size on performance outputs. The aim of the current study was to develop and cross-validate a new model to predict lower limbs LST in boys aged 10-13 years, using dual-energy X-ray absorptiometry (DXA as the reference method. Total body and segmental (lower limbs composition were assessed with a Hologic Explorer-W QDR DXA scanner in a cross-sectional sample of 75 Portuguese boys (144.8±6.4 cm; 40.2±9.0 kg. Skinfolds were measured at the anterior and posterior mid-thigh, and medial calf. Circumferences were measured at the proximal, mid and distal thigh. Leg length was estimated as stature minus sitting height. Current stature expressed as a percentage of attained predicted mature stature (PMS was used as an estimate of biological maturity status. Backward proportional allometric models were used to identify the model with the best statistical fit: ln (lower limbs LST  = 0.838× ln (body mass +0.476× ln (leg length - 0.135× ln (mid-thigh circumference - 0.053× ln (anterior mid-thigh skinfold - 0.098× ln (medial calf skinfold - 2.680+0.010× (percentage of attained PMS (R = 0.95. The obtained equation was cross-validated using the predicted residuals sum of squares statistics (PRESS method (R2PRESS = 0.90. Deming repression analysis between predicted and current lower limbs LST showed a standard error of estimation of 0.52 kg (95% limits of agreement: 0.77 to -1.27 kg. The new model accurately predicts lower limbs LST in circumpubertal boys.

  6. Ad hoc posterior tibial vessels perforator propeller flaps for the reconstruction of lower third leg soft- tissue defects

    Directory of Open Access Journals (Sweden)

    Thalaivirithan Margabandu Balakrishnan

    2017-01-01

    Full Text Available Introduction: Lower third leg soft tissue defects with anatomical and pathological constraints are posing formidable challenges to reconstructive surgeon. Aim: This retrospective study was conducted to assess the effectiveness of ad hoc posterior tibial vessels perforator-propeller flaps for the reconstruction of small and medium sized soft tissue defects in the lower third leg. Patients and Methods: 22 patients (16 were males and 6 were females were involved in this study between period of January 2012 and December 2016.We followed the protocol of initial non delineating exploratory incision made to find out single best perforator in all patients. All the defects in leg reconstructed with adhoc posterior tibial vessel propeller flaps. Results: All 22 flaps survived well. All in an average of 13 months follow up period, had pain free walking, with minimal scarring and acceptable aesthesis at the reconstruction sites with no need for any secondary procedure. Conclusion: With inability of preoperatively dopplering the perforators in the lower third leg region, the exploratory posterior nondelineating incision was used in all cases to secure the single best perforator for the propeller flaps. Thus adhoc posterior tibial vessel propeller flaps are dependable, easily adoptable for the reconstruction of soft tissue defects of the lower third leg region.

  7. Alpha-1 adrenoceptors in brown adipose tissue of lean and ob/ob mice

    International Nuclear Information System (INIS)

    Behrens-Zaror, G.; Himms-Hagen, J.

    1986-01-01

    Obese (ob/ob) mice have a low capacity to increase thyroxine 5'-deiodinase (T4 5'-D) in brown adipose tissue (BAT) when exposed to cold. This effect is mediated by alpha-1 (A-1) adrenoceptors. The authors objective was to find out whether BAT of the ob/ob mouse has normal A-1 receptors. Saturation analysis of binding of [3H]-WB4101 at 0.05 nM to 10 μM to crude membrane preparations (100,000 g pellets from Polytron homogenates) using the LIGAND program of Munson and Rodbard, showed two populations of binding sites in BAT of lean (+/+, 11-15 wk old) mice. Acute exposure (12 h, 14 0 C) or acclimation to cold (3 wk, 14 0 C) did not alter affinity or concentration of sites. Displacement with yohimbine and prazosin indicated binding of WB4101 to A-1 receptors. Very young (5 wk) lean (+/.) and obese mice had similar affinity constants (lean 0.13 +/- 0.043 and 34.2 +/- 14.9; obese, 0.12 +/- 0.028 and 20.9 +/- 5.48 nM) and concentrations (lean 22.4 +/- 3.8 and 647 +/- 137; obese, 28.6 +/- 4.6 and 547 +/- 105 fmol/mg protein) of sites. Old (1 yr) mice had high affinity sites similar to those in younger animals (KD lean 0.19 +/- 0.028, obese, 0.25 +/- 0.075; Bmax lean, 60.2 +/- 12.1; obese, 63.1 +/- 13.5 fmol/mg protein). The authors conclude that the ob/ob mouse has normal high affinity A-1 receptors in BAT. Anomalous properties of low affinity binding in old ob/ob mice could not be characterized because of high nonspecific binding. BAT of the ob/ob mouse does not lack A-1 receptors but may have a post-receptor alteration in the A-1 adrenoceptor-mediated response

  8. Equilibrium Passive Sampling of POP in Lipid-Rich and Lean Fish Tissue: Quality Control Using Performance Reference Compounds.

    Science.gov (United States)

    Rusina, Tatsiana P; Carlsson, Pernilla; Vrana, Branislav; Smedes, Foppe

    2017-10-03

    Passive sampling is widely used to measure levels of contaminants in various environmental matrices, including fish tissue. Equilibrium passive sampling (EPS) of persistent organic pollutants (POP) in fish tissue has been hitherto limited to application in lipid-rich tissue. We tested several exposure methods to extend EPS applicability to lean tissue. Thin-film polydimethylsiloxane (PDMS) passive samplers were exposed statically to intact fillet and fish homogenate and dynamically by rolling with cut fillet cubes. The release of performance reference compounds (PRC) dosed to passive samplers prior to exposure was used to monitor the exchange process. The sampler-tissue exchange was isotropic, and PRC were shown to be good indicators of sampler-tissue equilibration status. The dynamic exposures demonstrated equilibrium attainment in less than 2 days for all three tested fish species, including lean fish containing 1% lipid. Lipid-based concentrations derived from EPS were in good agreement with lipid-normalized concentrations obtained using conventional solvent extraction. The developed in-tissue EPS method is robust and has potential for application in chemical monitoring of biota and bioaccumulation studies.

  9. Factors Associated with Decreased Lean Tissue Index in Patients with Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Yi-Wen Wang

    2017-04-01

    Full Text Available Muscle wasting is common and is associated with increased morbidity and mortality in patients with chronic kidney disease (CKD. However, factors associated with decreased muscle mass in CKD patients are seldom reported. We performed a cross-sectional study of 326 patients (age 65.8 ± 13.3 years with stage 3–5 CKD who were not yet on dialysis. Muscle mass was determined using the Body Composition Monitor (BCM, a multifrequency bioimpedance spectroscopy device, and was expressed as the lean tissue index (LTI, lean tissue mass/height2. An LTI of less than 10% of the normal value (low LTI indicates muscle wasting. Patients with low LTI (n = 40 tended to be diabetic, had significantly higher fat tissue index, urine protein creatinine ratio, and interleukin-6 and tumor necrosis factor-α levels, but had significantly lower serum albumin and hemoglobin levels compared with those with normal LTI. In multivariate linear regression analysis, age, sex, cardiovascular disease, and interleukin-6 were independently associated with LTI. Additionally, diabetes mellitus remained an independent predictor of muscle wasting according to low LTI by multivariate logistic regression analysis. We conclude that LTI has important clinical correlations. Determination of LTI may aid in clinical assessment by helping to identify muscle wasting among patients with stage 3–5 CKD.

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

    NARCIS (Netherlands)

    Zillikens, M.C.; 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, J.A.; 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.; Jager, De 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; Kilpelaïnen, 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 M.; 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, Stephan; Peacock, Munro; Perola, Markus; Peters, Annette; Polasek, Ozren; Prince, Richard L.; Raïkkönen, 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; Schoor, van Natasja M.; Verma, Arjun; Vollenweider, Peter; Völzke, Henry; Wactawski-Wende, Jean; Walker, Mark; Weedon, Michael N.; Welch, Ryan; Wichman, H.E.; Widen, Elisabeth; Williams, Frances M.K.; Wilson, James F.; Wright, Nicole C.; Xie, Weijia; Yu, Lei; Zhou, Yanhua; Chambers, John C.; Döring, Angela; Duijn, Van 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 M.; Loos, Ruth J.F.; Karasik, David; Harris, Tamara B.; Ohlsson, Claes; Kiel, Douglas P.

    2017-01-01

    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

  11. Leg mass characteristics of accurate and inaccurate kickers--an Australian football perspective.

    Science.gov (United States)

    Hart, Nicolas H; Nimphius, Sophia; Cochrane, Jodie L; Newton, Robert U

    2013-01-01

    Athletic profiling provides valuable information to sport scientists, assisting in the optimal design of strength and conditioning programmes. Understanding the influence these physical characteristics may have on the generation of kicking accuracy is advantageous. The aim of this study was to profile and compare the lower limb mass characteristics of accurate and inaccurate Australian footballers. Thirty-one players were recruited from the Western Australian Football League to perform ten drop punt kicks over 20 metres to a player target. Players were separated into accurate (n = 15) and inaccurate (n = 16) groups, with leg mass characteristics assessed using whole body dual energy x-ray absorptiometry (DXA) scans. Accurate kickers demonstrated significantly greater relative lean mass (P ≤ 0.004) and significantly lower relative fat mass (P ≤ 0.024) across all segments of the kicking and support limbs, while also exhibiting significantly higher intra-limb lean-to-fat mass ratios for all segments across both limbs (P ≤ 0.009). Inaccurate kickers also produced significantly larger asymmetries between limbs than accurate kickers (P ≤ 0.028), showing considerably lower lean mass in their support leg. These results illustrate a difference in leg mass characteristics between accurate and inaccurate kickers, highlighting the potential influence these may have on technical proficiency of the drop punt.

  12. Radioprotection by WR-151327 against the late normal tissue damage in mouse hind legs from gamma ray radiation

    International Nuclear Information System (INIS)

    Matsushita, Satoru; Ando, Koichi; Koike, Sachiko

    1994-01-01

    To evaluate the protective effect of WR-151327 on late radiation-induced damaged to normal tissues in mice, the right hind legs of mice with or without WR-151327 administration (400 mg/kg) were irradiated with 137 Cs gamma rays. Leg contracture and skin shrinkage assays were performed at 380 days after irradiation. The mice were killed on day 400 postirradiation and histological sections of the legs were made. The thickness of the dermis, epidermis, and skin (dermis plus epidermis) was measured. The muscular area of the legs and the posterior knee angle between the femur and tibia were also measured. The left hind legs were similarly assessed as nonirradiated controls. Group means and standard deviations were calculated and dose-response curves were drawn for every endpoint. Then, the dose modifying factor (DMF) for each endpoint and the correlations among endpoints were determined. Latae damage assayed by leg contracture and skin shrinkage progressed with increasing radiation dose. However, it was reduced by drug treatment. The significant effect was indicated for skin shrinkage by a DMF of 1.8 at 35%. The DMF for leg contracture was 1.3 at 6 mm. In the irradiated legs, epidermal hyperplasia and dermal fibrosis in the skin, muscular atrophy, and extension disturbance of the knee joint were observed. These changes progressed with increasing radiation dose. Skin damage assayed by the present endpoints was also reduced by drug treatment by DMFs of 1.4 to 1.7. However, DMFs for damage to the muscle and knee were not determined because no isoeffect was observed. There were good correlations between leg contracture or skin shrinkage and the other endpoints in both untreated and drug-treated mice. WR-151327 has the potential to protect against radiation-induced late normal tissue damage. 17 refs., 6 figs., 2 tabs

  13. Molecular adaptations of adipose tissue to 6 weeks of morning fasting vs. daily breakfast consumption in lean and obese adults.

    Science.gov (United States)

    Gonzalez, Javier T; Richardson, Judith D; Chowdhury, Enhad A; Koumanov, Francoise; Holman, Geoffrey D; Cooper, Scott; Thompson, Dylan; Tsintzas, Kostas; Betts, James A

    2018-02-15

    In lean individuals, 6 weeks of extended morning fasting increases the expression of genes involved in lipid turnover (ACADM) and insulin signalling (IRS2) in subcutaneous abdominal adipose tissue. In obese individuals, 6 weeks of extended morning fasting increases IRS2 expression in subcutaneous abdominal adipose tissue. The content and activation status of key proteins involved in insulin signalling and glucose transport (GLUT4, Akt1 and Akt2) were unaffected by extended morning fasting. Therefore, any observations of altered adipose tissue insulin sensitivity with extended morning fasting do not necessarily require changes in insulin signalling proximal to Akt. Insulin-stimulated adipose tissue glucose uptake rates are lower in obese versus lean individuals, but this difference is abolished when values are normalised to whole-body fat mass. This suggests a novel hypothesis which proposes that the reduced adipose glucose uptake in obesity is a physiological down-regulation to prevent excessive de novo lipogenesis. This study assessed molecular responses of human subcutaneous abdominal adipose tissue (SCAT) to 6 weeks of morning fasting. Forty-nine healthy lean (n = 29) and obese (n = 20) adults provided SCAT biopsies before and after 6 weeks of morning fasting (FAST; 0 kcal until 12.00 h) or daily breakfast consumption (BFAST; ≥700 kcal before 11.00 h). Biopsies were analysed for mRNA levels of selected genes, and GLUT4 and Akt protein content. Basal and insulin-stimulated Akt activation and tissue glucose uptake rates were also determined. In lean individuals, lipid turnover and insulin signalling genes (ACADM and IRS2) were up-regulated with FAST versus BFAST (ACADM: 1.14 (95% CI: 0.97-1.30) versus 0.80 (95% CI: 0.64-0.96), P = 0.007; IRS2: 1.75 (95% CI: 1.33-2.16) versus 1.09 (95% CI: 0.67-1.51), P = 0.03, respectively). In obese individuals, no differential (FAST versus BFAST) expression was observed in genes involved in lipid turnover (all

  14. Can tissue dielectric constant measurement aid in differentiating lymphoedema from lipoedema in women with swollen legs?

    DEFF Research Database (Denmark)

    Birkballe, Susanne; Jensen, Maj-Britt Raaby; Noerregaard, S

    2014-01-01

    BACKGROUND: Distinguishing lymphoedema from lipoedema in women with swollen legs can be difficult. Local tissue water content can be quantified using tissue dielectric constant (TDC) measurements. OBJECTIVES: To examine whether TDC measurements can differentiate untreated lower extremity...... controls. All subjects were measured at three predefined sites (foot, ankle and lower leg). All groups except U-LP were measured by three blinded investigators. Using a handheld device, a 300-MHz electromagnetic wave is transmitted into the skin via a 2.5-mm depth probe. TDC calculated from the reflected...... wave is directly proportional to tissue water content ranging from 1 (vacuum) to 78.5 (pure water). RESULTS: Mean ± SD TDC values for U-LP were 48.8 ± 5.2. TDC values of T-LP, LipP and controls were 34.0 ± 6.6, 29.5 ± 6.2 and 32.3 ± 5.7, respectively. U-LP had significantly higher TDC values in all...

  15. Lean muscle mass in classic or ovulatory PCOS: association with central obesity and insulin resistance.

    Science.gov (United States)

    Mario, F M; do Amarante, F; Toscani, M K; Spritzer, P M

    2012-10-01

    This age-matched case-control study assessed total and segmental lean muscle mass in classic or ovulatory polycystic ovary syndrome (PCOS) patients and investigated whether lean mass is associated with hormone and metabolic features. Participants underwent anthropometric and clinical evaluation. Habitual physical activity was assessed with a digital pedometer, and body composition by dual-energy X-ray absorptiometry. Laboratory measurements included total cholesterol, cholesterol fractions, triglycerides, glucose, total serum testosterone, serum insulin, estradiol, luteinizing hormone, and SHBG. Energy intake was calculated using a food frequency questionnaire. Classic PCOS patients had higher body mass index (BMI), waist circumference, testosterone and lipid accumulation product values than ovulatory PCOS and controls. Energy consumption, homeostasis model assessment index, SHBG, free androgen index and triglycerides, total and trunk lean mass were higher only in classic PCOS women vs. controls. Arm, leg, trunk, total or limb lean masses were not correlated with hormone levels in any of the groups. However, in PCOS women lipid accumulation product was positively correlated with total (r=0.56, p=0.001), trunk (r=0.59, p=0.001), arm (r=0.54, p=0.001), leg (r=0.44, p=0.03) and limb (r=0.48, p=0.001) lean masses. BMI was positively correlated with all lean mass segments and independently associated with total lean mass. Lipid accumulation product and BMI were independently associated with trunk lean mass variation. The increase in lean mass in classic PCOS appears to be associated with insulin resistance and central obesity rather than with energy intake, physical activity or androgens. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York.

  16. Effect of triiodothyronine and insulin on glucose metabolism in tissue explants and isolated adipocytes from lean and obese Zucker rats

    International Nuclear Information System (INIS)

    Bailey, J.W.

    1985-01-01

    Glucose metabolism in adipocytes from 6 week old lean and obese Zucker rats were sensitive to direct and chronic treatment with insulin and triidothyronine (T 3 ). Insulin had a large stimulatory effect on glucose metabolism in acutely isolated adipocytes. This effect was greater in the lean than in the obese. Fatty acid, CO 2 , and glycerol-glyceride formation from radiolabeled glucose was elevated in the obese over the leans. Pretreatment of isolated adipocytes with pharmacological concentrations of T 3 for 30 minutes prior to the measurement of glucose metabolism had a greater effect on lean than obese adipocytes. The presence of insulin was required to observe the acute effects of T 3 . A 2-hour exposure to physiological levels of T 3 in the presence of insulin in both lean and obese adipocytes decreased lipogenesis. In the absence of insulin, a 2 hour pretreatment with physiological levels of T 3 in tissue from a euthyroid animal produced increased lipogenesis

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

    DEFF Research Database (Denmark)

    Zillikens, M Carola; Demissie, Serkalem; Hsu, Yi-Hsiang

    2017-01-01

    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 absorpt...... a meta-analysis of genome-wide association studies for whole body lean body mass and find five novel genetic loci to be significantly associated.......-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 

  18. Perioperative Testosterone Supplementation Increases Lean Mass in Healthy Men Undergoing Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.

    Science.gov (United States)

    Wu, Brian; Lorezanza, Dan; Badash, Ido; Berger, Max; Lane, Christianne; Sum, Jonathan C; Hatch, George F; Schroeder, E Todd

    2017-08-01

    Rehabilitation after repair of the anterior cruciate ligament (ACL) is complicated by the loss of leg muscle mass and strength. Prior studies have shown that preoperative rehabilitation may improve muscle strength and postoperative outcomes. Testosterone supplementation may likewise counteract this muscle loss and potentially improve clinical outcomes. The purpose was to investigate the effect of perioperative testosterone administration on lean mass after ACL reconstruction in men and to examine the effects of testosterone on leg strength and clinical outcome scores. It was hypothesized that testosterone would increase lean mass and leg strength and improve clinical outcome scores relative to placebo. Randomized controlled trial; Level of evidence, 1. Male patients (N = 13) scheduled for ACL reconstruction were randomized into 2 groups: testosterone and placebo. Participants in the testosterone group received 200 mg of intramuscular testosterone weekly for 8 weeks beginning 2 weeks before surgery. Participants in the placebo group received saline following the same schedule. Both groups participated in a standard rehabilitation protocol. The primary outcome was the change in total lean body mass at 6 and 12 weeks. Secondary outcomes were extensor muscle strength, Tegner activity score, and Knee injury and Osteoarthritis Outcome Score. There was an increase in lean mass of a mean 2.7 ± 1.7 kg at 6 weeks postoperatively in the testosterone group compared with a decrease of a mean 0.1 ± 1.5 kg in the placebo group ( P = .01). Extensor muscle strength of the uninjured leg also increased more from baseline in the testosterone group (+20.8 ± 25.6 Nm) compared with the placebo group (-21.4 ± 36.7 Nm) at 12 weeks ( P = .04). There were no significant between-group differences in injured leg strength or clinical outcome scores. There were no negative side effects of testosterone noted. Perioperative testosterone supplementation increased lean mass 6 weeks after ACL

  19. Leptin production during early starvation in lean and obese women.

    Science.gov (United States)

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

    2000-02-01

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

  20. Lipid mobilization in subcutaneous adipose tissue during exercise in lean and obese humans. Roles of insulin and natriuretic peptides

    DEFF Research Database (Denmark)

    Koppo, Katrien; Larrouy, Dominique; Marques, Marie A

    2010-01-01

    The aim of this study was to evaluate the relative contributions of various hormones involved in the regulation of lipid mobilization in subcutaneous adipose tissue (SCAT) during exercise and to assess the impact of obesity on this regulation. Eight lean and eight obese men performed a 60-min cycle...... phentolamine and propranolol while another probe was perfused with the phosphodiesterase and adenosine receptor inhibitor aminophylline. Compared with the control condition, infusion of octreotide reduced plasma insulin levels in lean (from approximately 3.5 to 0.5 microU/ml) and in obese (from approximately 9...... to 2 microU/ml), blunted the exercise-induced rise in plasma GH and epinephrine levels in both groups, and enhanced the exercise-induced natriuretic peptide (NP) levels in lean but not in obese subjects. In both groups, octreotide infusion resulted in higher exercise-induced increases in dialysate...

  1. Lean maturity, lean sustainability

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Matthiesen, Rikke; Nielsen, Jacob

    2007-01-01

    . A framework for describing levels of lean capability is presented, based on a brief review of the literature and experiences from 12 Danish companies currently implementing lean. Although still in its emerging phase, the framework contributes to both theory and practice by describing developmental stages......Although lean is rapidly growing in popularity, its implementation is far from problem free and companies may experience difficulties sustaining long term success. In this paper, it is suggested that sustainable lean requires attention to both performance improvement and capability development...... that support lean capability development and consequently, lean sustainability....

  2. Expression of 11beta-hydroxysteroid dehydrogenase 1 and 2 in subcutaneous adipose tissue of lean and obese women with and without polycystic ovary syndrome.

    Science.gov (United States)

    Svendsen, P F; Madsbad, S; Nilas, L; Paulsen, S K; Pedersen, S B

    2009-11-01

    To investigate the expression of 11beta-hydroxysteroid dehydrogenase (11beta-HSD) type 1 and 2 and hexose-6-phosphate dehydrogenase (H6PDH) mRNA in subcutaneous abdominal tissue from lean and obese women with and without polycystic ovary syndrome (PCOS), and to investigate the association between these enzymes and different measures of insulin sensitivity. Cross-sectional study. A total of 60 women, 36 women with PCOS, 17 lean (lean PCOS, LP) and 19 obese (obese PCOS, OP) and 24 age- and weight-matched control women, 8 lean (lean controls, LC) and 16 obese (obese controls, OC). Subcutaneous adipose tissue was collected from the abdomen. Peripheral insulin sensitivity was assessed by the euglycemic hyperinsulinemic clamp and determined as glucose disposal rate and insulin sensitivity index. Whole-body insulin sensitivity was calculated using homeostasis model assessment insulin resistance index. Body composition was evaluated by dual X-ray absorptiometry. Adipose mRNA expression of leptin and adiponectin were determined by real-time PCR. Polycystic ovary syndrome (PPCOS or obesity on11beta-HSD2 or H6PDH mRNA expression. Decreased peripheral insulin sensitivity (P<0.001) and increased upper body fat distribution (P<0.01) were associated with increased expression of 11beta-HSD1, but neither 11beta-HSD2 nor H6PDH. Polycystic ovary syndrome and obesity are independently associated with increased expression of 11beta-HSD1. This may lead to increased conversion of cortisone to cortisol in the peripheral adipose tissue and subsequently increased glucocorticoid activity. Decreased peripheral insulin sensitivity and central obesity was associated with increased expression of 11beta-HSD1.

  3. Peak lean tissue mass accrual precedes changes in bone strength indices at the proximal femur during the pubertal growth spurt.

    Science.gov (United States)

    Jackowski, Stefan A; Faulkner, Robert A; Farthing, Jonathan P; Kontulainen, Saija A; Beck, Thomas J; Baxter-Jones, Adam D G

    2009-06-01

    We examined the timing of the age and the magnitude of peak lean tissue mass accrual (PLTV) relative to the age and magnitude of two variables of bone strength [peak cross sectional area velocity (PCSAV), and peak section modulus velocity, (PZV)] at the proximal femur in males and females during the adolescent growth spurt. We hypothesized that the age of PLTV would precede the ages of PCSAV and PZV and that there is a positive relationship between the magnitude of PLTV and both PCSAV and PZV in both genders. 41 males and 42 females aged 8-18 years were selected from the Saskatchewan Pediatric Bone Mineral Accrual Study (1991-2005). Participants' total body lean tissue mass was assessed annually for 6 consecutive years using DXA. Narrow neck and femoral shaft cross sectional areas (CSA) and section modulus (Z) were determined using the hip structural analysis (HSA) program. Participants were aligned by maturational age (years from peak height velocity). Lean tissue mass, CSA, and Z were converted into whole year velocities and the maturational age of peak tissue velocities was determined using a cubic spline curve fitting procedure. A 2 x 3 (gender x tissue) factorial MANOVA with repeated measures was used to test for differences between age of PLTV and the ages of PCSAV and PZV between genders. Multiple regression analyses were used to examine the relationship between PLTV and both PCSAV and PZV. There were no sex differences in the ages at which tissue peaks occurred when aligned by maturational age. There were significant differences between the age of PLTV and both PCSAV and PZV at the narrow neck (p=0.001) and femoral shaft (p=0.03), where the age of PLTV preceded both PCSAV and PZV when pooled by gender. PLTV was a significant predictor of the magnitude of both PCSAV and PZV at all sites (ptheory that muscle development is an important factor in affecting bone strength.

  4. The effect of preheated tendon as a lean meat replacement on the properties of fine emulsion sausages.

    Science.gov (United States)

    Sadler, D H; Young, O A

    1993-01-01

    Tendon from beef hind leg muscles was used to replace some of the lean in a conventional emulsion formulation. The tendon was homogenized and either used raw or preheated for 2·5 h at a range of temperatures (50, 60, 70, 80°C) before use. Texture analysis and sensory evaluation were performed on cylinders of cooked sausage. Texture analysis was carried out on formulations which had 20% of meat protein replaced by 20% tendons which were raw or had been preheated to 50, 60, 70, or 80°C. Fracturability decreased by about 40% with raw tendon, but was restored to within 20% of the no-replacement control if the tendon had been preheated. Hardness was approximately doubled by replacement with raw tendon or tendon heated at 50°C. At temperatures higher than that, hardness returned to approximately no-replacement levels. For sensory evaluation (0-25% replacement; preheating at 70°C), sausages were assessed by a 12-member panel for texture, flavour and overall acceptability. All attributes decreased with increasing collagen content, the decrease being less marked with preheated tendon. Thus more connective tissue could be added for the same panel score if the tissue was preheated. Comparison of the texture profile and the panel scores for texture at the same lean replacement level suggested that reduced fracturability was the texture parameter that panellists objected to when heated tendon replaced some of the lean. Other researchers have shown that connective tissue preheated to 100°C before addition in emulsion sausages results in improved yields and better sensory attributes, but the present results show that temperatures as low as 60°C can be effective for beef tendon. Copyright © 1993. Published by Elsevier Ltd.

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

    Science.gov (United States)

    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 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.

  6. Lower Lean Mass Measured by Dual-Energy X-ray Absorptiometry (DXA) is Not Associated with Increased Risk of Hip Fracture in Women: The Framingham Osteoporosis Study.

    Science.gov (United States)

    McLean, Robert R; Kiel, Douglas P; Berry, Sarah D; Broe, Kerry E; Zhang, Xiaochun; Cupples, L Adrienne; Hannan, Marian T

    2018-01-05

    Although muscle mass influences strength in older adults, it is unclear whether low lean mass measured by dual-energy X-ray absorptiometry (DXA) is an independent risk factor for hip fracture. Our objective was to determine the association between DXA lean mass and incident hip fracture risk among 1978 women aged 50 years and older participating in the Framingham Study Original and Offspring cohorts. Leg and total body lean mass (kg) were assessed from whole-body DXA scans collected in 1992-2001. Hip fracture follow-up extended from DXA assessment to the occurrence of fracture, death, drop-out, or end of follow-up in 2007. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) estimating the relative risk of hip fracture associated with a 1-kg increase in baseline lean mass. Mean age was 66 years (range 50-93). Over a median of 8 years of follow-up, 99 hip fractures occurred. In models adjusted for age, height, study cohort, and percent total body fat, neither leg (HR 1.11; 95% CI 0.94, 1.31) nor total body (HR 1.06; 95% CI 0.99, 1.13) lean mass were associated with hip fracture. After further adjustment for femoral neck bone mineral density, leg lean mass results were similar (HR 1.10; 95% CI 0.93, 1.30). In contrast, 1 kg greater total body lean mass was associated with 9% higher hip fracture risk (HR 1.09; 95% CI 1.02, 1.18). Our findings suggest that in women, lower lean mass measured by DXA is not associated with increased risk of hip fracture.

  7. Determination of the subcutaneous tissue to blood partition coefficient in patients with severe leg ischaemia by a double isotope washout technique

    DEFF Research Database (Denmark)

    Bjerre-Jepsen, K; Faris, I; Henriksen, O

    1982-01-01

    Knowledge of the tissue to blood partition coefficient (lambda) is essential for calculation of the perfusion coefficient in a single tissue based on measurements of the washout of locally injected isotopes. No measurements of lambda for Xenon in subcutaneous tissue in the leg have been done...... in patients with occlusive arterial disease. In 12 patients with occlusive arterial disease in the legs lambda for Xenon was determined in subcutaneous tissue in the calf region and foot as the ratio between the washout rate constant of 131I-Antipyrine and 133Xe. A mixture of the two indicators was injected....... Mean value was 3.7 ml X g-1 (range: 1 X 7-10 X 7) in the calf and 2 X 7 ml X g-1 (range: 1 X 2-4 X 9) in the foot. It is concluded that lambda measurements are necessary for determination of subcutaneous blood flow from 133Xe washout curves in these patients. Determination of lambda is especially...

  8. Tissue composition of the leg and meat quality of sheep fed castor bean hulls in replacement of tifton hay

    Directory of Open Access Journals (Sweden)

    Stela Antas Urbano

    2013-10-01

    Full Text Available The effects of replacing Tifton hay with castor bean hulls (0, 33, 66 and 100% on the leg tissue composition, chemical composition, physicochemical parameters and sensorial traits of sheep meat were studied. A total of 28 non-castrated sheep averaging seven months in age with an average initial weight of 19.5±4.3 kg were assigned to a randomized block design with four treatments and seven replicates and were slaughtered after 70 days of confinement. At slaughter, body weight and leg, muscle and bone weights decreased linearly, whereas the muscle-to-bone ratio increased linearly according to the treatments. There was a quadratic effect on yellow intensity (maximum of 8.05 with replacement of 54.5% and the percentage of cooking losses (minimum of 33.8% with replacement of 45.17%. The treatment employed did not affect either the chemical composition or sensorial traits of the lamb meat. Although replacing Tifton hay with castor bean hulls alters the tissue composition of the leg as well as some physicochemical parameters of the meat, the sensory analysis indicated good acceptability of the meat, regardless of the inclusion of this byproduct.

  9. Fat and lean tissue accretion in relation to reward motivation in children.

    Science.gov (United States)

    De Decker, Annelies; De Clercq, Bart; Verbeken, Sandra; Wells, Jonathan C K; Braet, Caroline; Michels, Nathalie; De Henauw, Stefaan; Sioen, Isabelle

    2017-01-01

    'Reward sensitivity' explains inter-individual differences in the motivation to obtain rewards when reward cues are perceived. This psychobiological trait has been linked to higher consumption of palatable food when exposed to palatable food cues. The current study aims to examine if reward sensitivity explains differences in patterns of fat and lean tissue accretion over time in children. A longitudinal observational study with measurement waves in 2011 (baseline), 2012, 2013, and 2015 was conducted. The sample was a population-based Flemish cohort of children (n = 446, 50% boys and 5.5-12 years at baseline; 38.8% of the baseline sample also participated in 2015). Baseline reward sensitivity of the children was assessed by parent ratings on the Drive subscale of the Behavioral Inhibition System/Behavioral Approach System scales. Age- and sex-independent Fat and Lean Mass Index z-scores (zFMI and zLMI respectively) were computed for each study wave based on air-displacement plethysmography. In girls, but not boys, reward sensitivity was positively associated with the baseline zFMI and zLMI (95% confidence intervals of unstandardized estimates: 0.01 to 0.11 and 0.01 to 0.10 respectively, P values 0.01 and 0.02 respectively). Further, reward sensitivity explained 14.8% and 11.6% of the change in girls' zFMI and zLMI respectively over four years: the zFMI and zLMI increased and decreased respectively in high reward sensitive girls (95% confidence intervals of unstandardized estimates: 0.01 to 0.11 and -0.12 to -0.01 respectively, P values 0.01 and 0.02 respectively). Hence, girls high in reward sensitivity had significantly higher adiposity gain over four years parallel with lower increase in lean mass than was expected on the basis of their age and height. These results may help to identify appropriate targets for interventions for obesity prevention. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Cytogenetic support for primacy prostatic cancer in a patient presenting with a soft tissue mass in the leg

    NARCIS (Netherlands)

    Molenaar, WM; Stoepker, MEJ; deRuiter, AJ; Hoekstra, HJ; vandenBerg, E

    A 65-year-old man presented with a soft tissue mass in the leg, clinically suspect of a sarcoma. Histologic examination suggested a metastatic adenocarcinoma of the prostate, which could not be confirmed by immunohistologic studies. However, cytogenetic analysis strongly supported this diagnosis. A

  11. Orosomucoid expression profiles in liver, adipose tissues and serum of lean and obese domestic pigs, Göttingen minipigs and Ossabaw minipigs.

    Science.gov (United States)

    Rødgaard, Tina; Stagsted, Jan; Christoffersen, Berit Ø; Cirera, Susanna; Moesgaard, Sophia G; Sturek, Michael; Alloosh, Mouhamad; Heegaard, Peter M H

    2013-02-15

    The acute phase protein orosomucoid (ORM) has anti-inflammatory and immunomodulatory effects, and may play an important role in the maintenance of metabolic homeostasis in obesity-induced low-grade inflammation. Even though the pig is a widely used model for obesity related metabolic symptoms, the expression of ORM has not yet been characterized in such pig models. The objective of this study was to investigate the expression of ORM1 mRNA in liver, visceral adipose tissue, subcutaneous adipose tissue (SAT) from the abdomen or retroperitoneal abdominal adipose tissue (RPAT) and SAT from the neck, as well as the serum concentration of ORM protein in three porcine obesity models; the domestic pig, Göttingen minipigs and Ossabaw minipigs. No changes in ORM1 mRNA expression were observed in obese pigs compared to lean pigs in the four types of tissues. However, obese Ossabaw minipigs, but none of the other breeds, showed significantly elevated ORM serum concentrations compared to their lean counterparts. Studies in humans have shown that the expression of ORM was unchanged in adipose tissue depots in obese humans with an increased serum concentration of ORM. Thus in this respect, obese Ossabaw minipigs behave more similarly to obese humans than the other two pig breeds investigated. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. [Pedicle flap transfer combined with external fixator to treat leg open fracture with soft tissue defect].

    Science.gov (United States)

    Luo, Zhongchun; Lou, Hua; Jiang, Junwei; Song, Chunlin; Gong, Min; Wang, Yongcai

    2008-08-01

    To investigate the clinical results of treating leg open fracture with soft tissue defect by pedicle flap transfer in combination with external fixator. From May 2004 to June 2007, 12 cases of leg open fracture with soft tissue defect, 9 males and 3 females aged 18-75 years, were treated. Among them, 8 cases were caused by traffic accidents, 2 crush, 1 falling and 1 mechanical accident. According to the Gustilo Classification, there were 2 cases of type II, 5 of type IIIA and 5 of type IIIB. There were 2 cases of upper-tibia fracture, 3 of middle-tibia and 7 of middle-lower. The sizes of soft tissue defect ranged from 5 cm x 3 cm to 22 cm x 10 cm.The sizes of exposed bone ranged from 3 cm x 2 cm to 6 cm x 3 cm. The course of the disease was 1-12 hours. Fracture fixation was reached by external fixators or external fixators and limited internal fixation with Kirschner wire. The wounds with exposed tendons and bones were repaired by ipsilateral local rotation flap, sural neurocutaneous flap and saphenous nerve flap. The size of selected flap ranged from 5 cm x 4 cm to 18 cm x 12 cm. Granulation wounds were repaired by skin grafting or direct suture. All patients were followed up for 6 months to 2 years. All patients survived, among whom 2 with the wound edge infection and 1 with the distal necrosis were cured by changing the dressing, 8 with pin hole infection were treated by taking out the external fixator, 1 with nonunion received fracture healing after bone graft in comminuted fracture of lower tibia, 2 suffered delayed union in middle-lower tibia fracture. The ROM of ankle in 3 cases was mildly poor with surpass-joint fixation, with plantar extension of 0-10 degrees and plantar flexion of 10-30 degrees, while the others had plantar extension of 10-20 degrees and plantar flexion of 30-50 degrees. The method of pedicle flap transfer combined with external fixator is safe and effective for the leg open fracture with soft tissue defect.

  13. Linear Growth and Fat and Lean Tissue Gain during Childhood: Associations with Cardiometabolic and Cognitive Outcomes in Adolescent Indian Children.

    Science.gov (United States)

    Krishnaveni, Ghattu V; Veena, Sargoor R; Srinivasan, Krishnamachari; Osmond, Clive; Fall, Caroline H D

    2015-01-01

    We aimed to determine how linear growth and fat and lean tissue gain during discrete age periods from birth to adolescence are related to adolescent cardiometabolic risk factors and cognitive ability. Adolescents born to mothers with normal glucose tolerance during pregnancy from an Indian birth cohort (N = 486, age 13.5 years) had detailed anthropometry and measurements of body fat (fat%), fasting plasma glucose, insulin and lipid concentrations, blood pressure and cognitive function. Insulin resistance (HOMA-IR) was calculated. These outcomes were examined in relation to birth measurements and statistically independent measures (conditional SD scores) representing linear growth, and fat and lean tissue gain during birth-1, 1-2, 2-5, 5-9.5 and 9.5-13.5 years in 414 of the children with measurements at all these ages. Birth length and linear growth at all ages were positively associated with current height. Fat gain, particularly during 5-9.5 years was positively associated with fat% at 13.5 years (0.44 SD per SD [99.9% confidence interval: 0.29,0.58]). Greater fat gain during mid-late childhood was associated with higher systolic blood pressure (5-9.5 years: 0.23 SD per SD [0.07,0.40]) and HOMA-IR (5-9.5 years: 0.24 [0.08,0.40], 9.5-13.5 years: 0.22 [0.06,0.38]). Greater infant growth (up to age 2 years) in linear, fat or lean components was unrelated to cardiometabolic risk factors or cognitive function. This study suggests that factors that increase linear, fat and lean growth in infancy have no adverse cardiometabolic effects in this population. Factors that increase fat gain in mid-late childhood may increase cardiometabolic risk, without any benefit to cognitive abilities.

  14. Linear Growth and Fat and Lean Tissue Gain during Childhood: Associations with Cardiometabolic and Cognitive Outcomes in Adolescent Indian Children.

    Directory of Open Access Journals (Sweden)

    Ghattu V Krishnaveni

    Full Text Available We aimed to determine how linear growth and fat and lean tissue gain during discrete age periods from birth to adolescence are related to adolescent cardiometabolic risk factors and cognitive ability.Adolescents born to mothers with normal glucose tolerance during pregnancy from an Indian birth cohort (N = 486, age 13.5 years had detailed anthropometry and measurements of body fat (fat%, fasting plasma glucose, insulin and lipid concentrations, blood pressure and cognitive function. Insulin resistance (HOMA-IR was calculated. These outcomes were examined in relation to birth measurements and statistically independent measures (conditional SD scores representing linear growth, and fat and lean tissue gain during birth-1, 1-2, 2-5, 5-9.5 and 9.5-13.5 years in 414 of the children with measurements at all these ages.Birth length and linear growth at all ages were positively associated with current height. Fat gain, particularly during 5-9.5 years was positively associated with fat% at 13.5 years (0.44 SD per SD [99.9% confidence interval: 0.29,0.58]. Greater fat gain during mid-late childhood was associated with higher systolic blood pressure (5-9.5 years: 0.23 SD per SD [0.07,0.40] and HOMA-IR (5-9.5 years: 0.24 [0.08,0.40], 9.5-13.5 years: 0.22 [0.06,0.38]. Greater infant growth (up to age 2 years in linear, fat or lean components was unrelated to cardiometabolic risk factors or cognitive function.This study suggests that factors that increase linear, fat and lean growth in infancy have no adverse cardiometabolic effects in this population. Factors that increase fat gain in mid-late childhood may increase cardiometabolic risk, without any benefit to cognitive abilities.

  15. Low lean tissue mass can be a predictor of one-year survival in hemodialysis patients.

    Science.gov (United States)

    Rymarz, Aleksandra; Gibińska, Julia; Zajbt, Maria; Piechota, Wiesław; Niemczyk, Stanisław

    2018-11-01

    Nutritional status has a significant impact on the outcomes in the dialysis population. The aim of this study was to evaluate the association between body composition and a one-year survival of hemodialysis patients. Forty-eight patients with chronic kidney disease stage V treated with hemodialysis for more than three months were included. Body composition was assessed by bioimpedance spectroscopy (Body Composition Monitor, Fresenius Medical Care). Blood samples for serum creatinine, serum albumin, serum prealbumin, high sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), insulin-like growth factor 1(IGF-1) concentrations were taken before the midweek dialysis session. Over the course of a one-year observation, seven patients died. We observed a significantly lower lean tissue index (LTI) (p = .013) and higher IL-6 (p = .032) and hsCRP levels (p = .011) among the patients who died. The remaining biochemical markers did not differ between these two groups. Kapplan-Meier analysis revealed a worse survival rate in patients with sarcopenia (lower than the 10th percentile for their age and gender) in comparison with those with normal LTI. However, it was not of statistical significance (p = .055). LTI inversely correlated with age and IL-6 and positively with IGF-1. Sarcopenia defined as decreased LTI, is a relatively common condition among patients undergoing maintenance hemodialysis, it can also be associated with a lower one-year survival rate. Decreased lean tissue mass can be associated with old age, lower IGF-1 levels and higher IL-6 levels. Body composition assessment may provide prognostic data for hemodialysis patients.

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

    Science.gov (United States)

    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 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.

  17. Creatine Loading Does Not Preserve Muscle Mass or Strength During Leg Immobilization in Healthy, Young Males

    NARCIS (Netherlands)

    Backx, Evelien M.P.; Hangelbroek, Roland; Snijders, Tim; Verscheijden, Marie Louise; Verdijk, Lex B.; Groot, de Lisette C.P.G.M.; Loon, van Luc J.C.

    2017-01-01

    Background: A short period of leg immobilization leads to rapid loss of muscle mass and strength. Creatine supplementation has been shown to increase lean body mass in active individuals and can be used to augment gains in muscle mass and strength during prolonged resistance-type exercise

  18. Lean Manufacturing measurement: The relationships between Lean activities and Lean metrics

    Directory of Open Access Journals (Sweden)

    Diego Fernando Manotas Duque

    2007-01-01

    Full Text Available Medición en Lean Manufacturing: Relaciones entre Actividades Lean y Métricas Lean Lean Manufacturing fue desarrollada por Toyota para satisfacer sus necesidades específicas en un mercado restringido y en tiempos de estrechez económica. Estos conceptos han sido estudiados y se ha comprobado su aplicabilidad en una amplia variedad de industrias. El objetivo de este artículo es el de integrar un conjunto de métricas que han sido propuestas por diferentes autores, de tal manera que sean consistentes con las etapas y elementos de implementaciones de Lean Manufacturing. Para lograrlo se presentan dos marcos de referencia para implementaciones Lean y los principales factores de éxito se utilizan como base para proponer métricas que identifiquen el avance en estos factores. Posteriormente se propone una tabla que cruza el impacto de las “Actividades Lean” sobre las métricas, postulando que muchos de los supuestos a priori sobre estos impactos deberían ser precisos. Finalmente se proponen algunas ideas para proyectos de investigación hacia el futuro y posibles extensiones de las aplicaciones propuestas aquí.

  19. Immune response in the adipose tissue of lean mice infected with the protozoan parasite Neospora caninum

    Science.gov (United States)

    Teixeira, Luzia; Moreira, João; Melo, Joana; Bezerra, Filipa; Marques, Raquel M; Ferreirinha, Pedro; Correia, Alexandra; Monteiro, Mariana P; Ferreira, Paula G; Vilanova, Manuel

    2015-01-01

    The adipose tissue can make important contributions to immune function. Nevertheless, only a limited number of reports have investigated in lean hosts the immune response elicited in this tissue upon infection. Previous studies suggested that the intracellular protozoan Neospora caninum might affect adipose tissue physiology. Therefore, we investigated in mice challenged with this protozoan if immune cell populations within adipose tissue of different anatomical locations could be differently affected. Early in infection, parasites were detected in the adipose tissue and by 7 days of infection increased numbers of macrophages, regulatory T (Treg) cells and T-bet+ cells were observed in gonadal, mesenteric, omental and subcutaneous adipose tissue. Increased expression of interferon-γ was also detected in gonadal adipose tissue of infected mice. Two months after infection, parasite DNA was no longer detected in these tissues, but T helper type 1 (Th1) cell numbers remained above control levels in the infected mice. Moreover, the Th1/Treg cell ratio was higher than that of controls in the mesenteric and subcutaneous adipose tissue. Interestingly, chronically infected mice presented a marked increase of serum leptin, a molecule that plays a role in energy balance regulation as well as in promoting Th1-type immune responses. Altogether, we show that an apicomplexa parasitic infection influences immune cellular composition of adipose tissue throughout the body as well as adipokine production, still noticed at a chronic phase of infection when parasites were already cleared from that particular tissue. This strengthens the emerging view that infections can have long-term consequences for the physiology of adipose tissue. PMID:25581844

  20. Association Between Manual Loading and Newly Developed Carpal Tunnel Syndrome in Subjects With Physical Disabilities: A Follow-Up Study.

    Science.gov (United States)

    Lin, Yen-Nung; Chiu, Chun-Chieh; Huang, Shih-Wei; Hsu, Wen-Yen; Liou, Tsan-Hon; Chen, Yi-Wen; Chang, Kwang-Hwa

    2017-10-01

    To identify the association between body composition and newly developed carpal tunnel syndrome (CTS) and to search for the best probabilistic cutoff value of associated factors to predict subjects with physical disabilities developing new CTS. Longitudinal. University-affiliated medical center. Subjects with physical disabilities (N=47; mean age ± SD, 42.1±7.7y). Not applicable. Median and ulnar sensory nerve conduction velocity (SNCV) were measured at the initial and follow-up tests (interval >2y). Total and regional body composition were measured with dual-energy x-ray absorptiometry at the initial test. Leg lean tissue percentage was calculated to delineate each participant's manual loading degree during locomotion. Leg lean tissue percentage is the lean tissue mass of both legs divided by body weight. Based on median SNCV changes, we divided all participants into 3 groups: subjects with bilateral CTS (median SNCV value normative ulnar SNCV value >37.8m/s) in the initial test (n=10), subjects with newly developed CTS in the follow-up test (n=8), and subjects without additional CTS in the follow-up test (n=27). Eight of 35 subjects not having bilateral CTS initially developed new CTS (8.8% per year; mean follow-up period, 2.6y). Leg lean tissue percentage was associated with the probability of newly developed CTS (adjusted odds ratio, .64; P12% were less likely to have developed new CTS at the follow-up test (sensitivity, .75; specificity, .85; area under the curve, .88; Pphysical disabilities. Therefore, a preventive program for those subjects at risk can start early. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. The mangled lower leg

    NARCIS (Netherlands)

    Hoogendoorn, Jochem Maarten

    2002-01-01

    A surgeon faced with a patient presenting with an open tibial/fibular fracture in combination with severe damage of the surrounding soft tissues, has to make the difficult decision whether to attempt salvage or to perform an immediate amputation of the leg. Until late in the nineteenth century the

  2. Efficacy of phosphatidic acid ingestion on lean body mass, muscle thickness and strength gains in resistance-trained men

    Directory of Open Access Journals (Sweden)

    Hoffman Jay R

    2012-10-01

    Full Text Available Abstract Background Phosphatidic acid (PA has been reported to activate the mammalian target of rapamycin (mTOR signaling pathway and is thought to enhance the anabolic effects of resistance training. The purpose of this pilot study was to examine if oral phosphatidic acid administration can enhance strength, muscle thickness and lean tissue accruement during an 8-week resistance training program. Methods Sixteen resistance-trained men were randomly assigned to a group that either consumed 750 mg of PA (n = 7, 23.1 ± 4.4 y; 176.7 ± 6.7 cm; 86.5 ± 21.2 kg or a placebo (PL, n = 9, 22.5 ± 2.0 y; 179.8 ± 5.4 cm; 89.4 ± 13.6 kg group. During each testing session subjects were assessed for strength (one repetition maximum [1-RM] bench press and squat and body composition. Muscle thickness and pennation angle were also measured in the vastus lateralis of the subject’s dominant leg. Results Subjects ingesting PA demonstrated a 12.7% increase in squat strength and a 2.6% increase in LBM, while subjects consuming PL showed a 9.3% improvement in squat strength and a 0.1% change in LBM. Although parametric analysis was unable to demonstrate significant differences, magnitude based inferences indicated that the Δ change in 1-RM squat showed a likely benefit from PA on increasing lower body strength and a very likely benefit for increasing lean body mass (LBM. Conclusions Results of this study suggest that a combination of a daily 750 mg PA ingestion, combined with a 4-day per week resistance training program for 8-weeks appears to have a likely benefit on strength improvement, and a very likely benefit on lean tissue accruement in young, resistance trained individuals.

  3. Repeatability of Volume and Regional Body Composition Measurements of the Lower Limb Using Dual-energy X-ray Absorptiometry

    DEFF Research Database (Denmark)

    Gjorup, Caroline A; Zerahn, Bo; Juul, Sarah

    2017-01-01

    was calculated using the density of bone mineral content, fat, and lean mass. The repeatability of the volume of the lower limb and regional thigh and lower leg tissue composition (bone mineral content, fat, and lean mass) was good with intraclass correlation coefficient values of 0.97 to 0.99, and narrow limits...

  4. MUSCLE-BONE INTERACTIONS ACROSS AGE IN MEN

    Directory of Open Access Journals (Sweden)

    Ian J. Palmer

    2006-03-01

    Full Text Available This study examined the relationship of muscular strength and lean tissue with age-related patterns in bone mineral density (BMD in men 20-81 years of age. Subjects were assigned to one of three age groups, Young Men (YM, (n = 25, 20-39 yrs, Middle-aged Men (MM (n = 24, 40-59 yrs, and Older Men (OM (n = 23, 60-81 yrs. Isotonic and isokinetic strength was assessed for the quadriceps and hamstrings muscle groups. DXA (Lunar DPX-IQ was used to measure spine, hip, and total body BMD and body composition. OM had significantly lower (p < 0.05 total lean body mass (LBM than MM and lower leg lean mass (LM than YM and MM. OM had significantly lower (p < 0.01 BMD than YM and MM at the femoral neck and total hip sites and a higher proportion of OM were osteopenic and osteoporotic at the total hip site. Isotonic and isokinetic strength for both muscle groups was positively related (p < 0.05 with the hip BMD sites (r = 0.38-.67. Leg LM also was positively related to hip BMD (r = 0.37-.58. Multiple Regression analyses determined that age and lean mass (LBM or leg LM were significant predictors (p < 0.05 of femoral neck, and total hip BMD, while lean mass (LBM or leg LM was a significant predictor (p < 0.05 of BMD at the spine and trochanter sites. Isotonic and isokinetic leg strength variables were significant predictors (p < 0.05 of the total body, total hip and trochanter BMD. In conclusion, leg strength, leg LM, and total LBM were significant predictors of BMD in men, independent of age. These findings emphasize the importance of maintaining lean body mass for the bone health of aging men

  5. Correlation of X-Ray Computed Tomography with Quantitative Nuclear Magnetic Resonance Methods for Pre-Clinical Measurement of Adipose and Lean Tissues in Living Mice

    Directory of Open Access Journals (Sweden)

    Matthew N. Metzinger

    2014-10-01

    Full Text Available Numerous obesity studies have coupled murine models with non-invasive methods to quantify body composition in longitudinal experiments, including X-ray computed tomography (CT or quantitative nuclear magnetic resonance (QMR. Both microCT and QMR have been separately validated with invasive techniques of adipose tissue quantification, like post-mortem fat extraction and measurement. Here we report a head-to-head study of both protocols using oil phantoms and mouse populations to determine the parameters that best align CT data with that from QMR. First, an in vitro analysis of oil/water mixtures was used to calibrate and assess the overall accuracy of microCT vs. QMR data. Next, experiments were conducted with two cohorts of living mice (either homogenous or heterogeneous by sex, age and genetic backgrounds to assess the microCT imaging technique for adipose tissue segmentation and quantification relative to QMR. Adipose mass values were obtained from microCT data with three different resolutions, after which the data were analyzed with different filter and segmentation settings. Strong linearity was noted between the adipose mass values obtained with microCT and QMR, with optimal parameters and scan conditions reported herein. Lean tissue (muscle, internal organs was also segmented and quantified using the microCT method relative to the analogous QMR values. Overall, the rigorous calibration and validation of the microCT method for murine body composition, relative to QMR, ensures its validity for segmentation, quantification and visualization of both adipose and lean tissues.

  6. Lean manufacturing measurement: the relationship between lean activities and lean metrics

    Directory of Open Access Journals (Sweden)

    Manotas Duque Diego Fernando

    2007-10-01

    Full Text Available Lean Manufacturing was developed by Toyota Motor company to address their specific needs in a restricted market in times of economic trouble. These concepts have been studied and proven to be transferrable and applicable to a wide variety of industries. This paper aims to integrate a set of metrics that have been proposed by different authors in such a way that they are consistent with the different stages and elements of Lean Manufacturing implementations. To achieve this, two frameworks for Lean implementations are presented and then the main factors for success are used as the basis to propose metrics that measure the advance in these factors. A tabular display of the impact of “Lean activities” on the metrics is presented, proposing that many a priori assumptions about the benefits on many different levels of improvement should be accurate. Finally, some ideas for future research and extension of the applications proposed on this paper are presented as closing points.

  7. Comparative Analysis between Lean, Six Sigma and Lean Six Sigma Concepts

    Directory of Open Access Journals (Sweden)

    Alexandra Mirela Cristina MUNTEANU

    2017-06-01

    Full Text Available This paper analyzes the benefits of Lean Six Sigma in comparison with Lean and Six Sigma, traditional improvement methodologies. The introduction highlights the appearance of Lean Six Sigma, early 2000s, as well as the benefits brought by the integrated approach. The following parts of the study emphasize the main differences between methodologies and their commonalities based on their synergy. Finally the advantages of Lean Six Sigma versus Lean and Six Sigma are analyzed and systematized by author in order to reveal Lean Six Sigma’s benefits.

  8. Healthcare Lean.

    Science.gov (United States)

    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.

  9. Increased Leg Bone Mineral Density and Content During the Initial Years of College Sport.

    Science.gov (United States)

    Scerpella, John J; Buehring, Bjoern; Hetzel, Scott J; Heiderscheit, Bryan C

    2018-04-01

    Scerpella, JJ, Buehring, B, Hetzel, SJ, and Heiderscheit, BC. Increased leg bone mineral density and content during the initial years of college sport. J Strength Cond Res 32(4): 1123-1130, 2018-Bone mineral density (BMD) and bone mineral content (BMC) data are useful parameters for evaluating how training practices promote bone health. We used dual-energy X-ray absorptiometry (DXA) to longitudinally assess sport-specific growth in leg and total body BMD/BMC over the initial 2 years of collegiate training. Eighty-five Division 1 collegiate basketball, hockey, and soccer athletes (50 males and 35 females; age 19.0 [0.8] years) underwent annual DXA scans. Leg and total body BMD/BMC were compared within and across two 1-year intervals (periods 1 and 2) using repeated-measures analysis of variance, adjusting for age, sex, race, and sport. Leg BMD, leg BMC, and total body BMC all increased over period 1 (0.05 g·cm [p = 0.001], 0.07 kg [p = 0.002], and 0.19 kg [p BMC (p BMC (p = 0.005). Leg lean mass increased more during period 2 than period 1 (p = 0.018). Sports participation was the only significant predictor of change in leg BMD. Significant increases in both leg BMD and BMC were demonstrated over both 2-year periods, with greater gains during period 1. These gains highlight the importance of attentive training procedures, capitalizing on attendant physical benefits of increased BMD/BMC. Additional research in young adults, evaluating bone mass acquisition, will optimize performance and decrease risk of bone stress injury among collegiate athletes.

  10. Lean versus Quick Response Manufacturing og andre koncepter - er Lean den eneste ene?

    DEFF Research Database (Denmark)

    Michelsen, Aage U

    2005-01-01

    Begrebet Lean har gennem de senere år vundet en enorm udbredelse. Antallet af publikationer om Lean har været eksplosivt stigende, og mange virksomheder har gennemført eller gennemfører Lean-projekter. Er Lean et nyt koncept? Er Lean den eneste løsning? Kan Lean kombineres med tankegange og princ...... løsning af en anden produktionsopgave. I fjerde afsnit skitseres kort relationerne mellem Lean og to andre begreber, Six Sigma og TPM, der begge har samme mål som Lean, men forskellige udgangspunkter og forskellige indfaldsvinkler....

  11. Comparative Analysis between Lean, Six Sigma and Lean Six Sigma Concepts

    OpenAIRE

    Alexandra Mirela Cristina MUNTEANU

    2017-01-01

    This paper analyzes the benefits of Lean Six Sigma in comparison with Lean and Six Sigma, traditional improvement methodologies. The introduction highlights the appearance of Lean Six Sigma, early 2000s, as well as the benefits brought by the integrated approach. The following parts of the study emphasize the main differences between methodologies and their commonalities based on their synergy. Finally the advantages of Lean Six Sigma versus Lean and Six Sigma are analyzed and systematized by...

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

    Science.gov (United States)

    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 (Plean 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.

  13. Negotiating Lean

    DEFF Research Database (Denmark)

    Rahbek Pedersen, Esben; Muniche, Mahad

    2011-01-01

    Purpose – The purpose of this paper is to analyse how negotiations between the constituencies affect the processes and outcomes of lean projects in Danish public sector organisations. Design/methodology/approach – The paper is based on a qualitative analysis of interviews with managers...... projects in the Danish public sector. It cannot be concluded that the findings can be generalised to reflect all types of lean projects across organisational and geographical settings. Originality/value – The paper adds value to the relatively scarce literature on lean management in the public sector...... and employees who have participated in lean projects in the Danish public sector. Negotiated order theory serves as the overarching theoretical framework for the analysis. Findings – The paper concludes that the processes and outcomes of lean depend not only on the technology itself, but also the negotiation...

  14. Lean og arbejdsmiljø

    DEFF Research Database (Denmark)

    Jensen, Kenneth

    Bogen tager udgangspunkt i en undersøgelse af 10 private og offentlige virksomheders erfaringer med lean. Undersøgelsen viser at der ikke findes entydige sammenhænge mellem lean og det psykosociale arbejdsmiljø. Bogen forholder sig til sammenhængen mellem lean og ledelse, lean og medarbejderens...... rolle, lean og lean og forandringsprocessen. Bogen kommer desuden med anbefalinger til hvorledes virksomheden kan gribe dialogen an for at opnå et godt lean forløb der inddrager hensynet til og effekterne af et godt psykosocialt arbejdsmiljø....

  15. Near infrared spectroscopy for controlling the quality of distal leg perfusion in remote access cardiopulmonary bypass.

    Science.gov (United States)

    Schachner, Thomas; Bonaros, Nikolaos; Bonatti, Johannes; Kolbitsch, Christian

    2008-12-01

    The prevention of leg ischemia is necessary in all patients undergoing femoral artery cannulation for extracorporeal circulation. Near infrared spectroscopy (NIRS) is an established non-invasive method for measuring tissue oxygen saturation. Ten patients underwent robotically assisted endoscopic coronary surgery or ASD repair on the arrested heart using aortic endo-occlusion catheters. They were monitored by transcutaneous NIRS (placed on both lower legs) for quality control of distal leg perfusion during femoral access cardiopulmonary bypass. The baseline NIRS values were 61 (52-80) on the cannulated side versus 70 (53-80) on the contralateral leg (p=n.s.). During clamping of the femoral artery for installation of the remote access perfusion system the tissue oxygen saturation dropped to 38 (18-58) (p=0.001 vs baseline) while it remained stable on the contralateral leg. After successful implantation of the distal leg perfusion the NIRS values normalized to similar amounts on both legs. We conclude that transcutaneous NIRS of the lower legs might be a useful non-invasive tool for monitoring leg perfusion in patients undergoing extracorporeal circulation via the femoral vessels.

  16. Effects of combined high intensity arm and leg training on performance and cardio-respiratory measures.

    Science.gov (United States)

    Zinner, Christoph; Sperlich, Billy; Born, Dennis-Peter; Michels, Guido

    2017-01-01

    The purpose of this study was to investigate the effects of combined arm and leg high-intensity low-volume interval training (HIITarm+leg) on maximal oxygen uptake, myocardial measures (i.e. stroke volume, cardiac output, ejection fraction), Tissue Oxygenation Index (TOI) of the vastus lateralis and triceps brachii, as well as power output in comparison to leg HIIT (HIITleg) only. The 20 healthy, male and female volunteers completed six sessions of either HIITleg on a cycle ergometer or HIITarm+leg on an arm and leg cycle ergometer. During pre- and post-testing, the volunteers completed a submaximal and incremental test to exhaustion on a cycle ergometer. Magnitude based interference revealed likely to very likely beneficial effects for HIITarm+leg compared to HIITleg in maximal oxygen uptake, cardiac measures as well peak power output. The TOI following HIITarm+leg demonstrated likely to very likely increased oxygenation in the triceps brachii or the vastus lateralis when compared to HIITleg. The results suggest that six sessions of HIITarm+leg may likely to very likely improve maximal oxygen uptake, some inotropy-related cardiac measures with improved tissue oxygenation of the triceps brachii and vastus lateralis muscles resulting in greater leg peak power output.

  17. EDUCATION FOR LEAN & LEAN FOR EDUCATION: A LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    Saveta Vukadinovic

    2017-03-01

    Full Text Available The purpose of this paper is to investigate and understand how tools and principles of Lean philosophy can be adopted to improve the effectiveness of engineering education by providing services beyond the competition and costs below the competition, and how engineering education can provide better prepared engineering professionals capable to work in dynamic Lean environments by developing multidisciplinary knowledge and skills. Paper will be based on analysis of relevant scientific and professional literature sources, including certain elements of description, classification, explanation and prediction. The authors will use detailed literature review to explain complex relationship and interdependence between Lean philosophy and engineering education and answer the question what benefits modern Lean enterprises may expect from properly educated and qualified engineers and how application of Lean tools and principles can improve the system of engineering education.

  18. Bevezetés a lean menedzsmentbe – a lean stratégiai alapjai = Introduction to lean management – basic strategic elements of lean

    OpenAIRE

    Losonci, Dávid

    2010-01-01

    A lean menedzsment az értékteremtő folyamatok stratégiai és operatív szintjének meghatározó formálójává vált az elmúlt évtizedekben. Jelen tanulmány stratégiai nézőpontból tárgyalja a lean menedzsment teljes bevezetését. Részletes áttekintést ad a Womack és Jones (2003) által lefektetett lean alapelvekről. Az operatív teljesítményjavulásból származó vevői értékteremtés mellett foglalkozik a tulajdonosi értékteremtéssel, az MRP és a lean szinergikus összekapcsolásával, valamint a lean ideális ...

  19. Internal lean practitioner's challenges in lean principles ...

    African Journals Online (AJOL)

    The approach to this paper is to answer the questions such as “how does internal management commitment impact the Lean principles?”, “how does Supply Chain Management practices impact the lean principles?”, “can Supply Chain Management practices be embedded with internal management commitment?

  20. Lean i Norge : opplever norske bedrifter som er mer lean, større økning i kundetilfredshet enn de som er mindre lean?

    OpenAIRE

    Fagereng, Hanne Eline; Askevold, Elisabeth Cathrine

    2010-01-01

    Vi ønsker å måle i hvor stor grad norske bedrifter har implementert lean, og for å måle grad av lean har vi utviklet et rammeverk basert på lean teori. Hovedformålet med lean er å øke kundeverdi med minst mulig ressursbruk, anstrengelse, energi, utstyr, tid, plass, material og kapital (Womack, Roos and Jones 2007). Vi vil utforske om høyere grad av lean fører til mer tilfredse kunder enn de som har lavere grad av lean. Altså om hovedformålet med lean blir oppnådd hvis man implementerer lean i...

  1. Age-related differences in lean mass, protein synthesis and skeletal muscle markers of proteolysis after bed rest and exercise rehabilitation.

    Science.gov (United States)

    Tanner, Ruth E; Brunker, Lucille B; Agergaard, Jakob; Barrows, Katherine M; Briggs, Robert A; Kwon, Oh Sung; Young, Laura M; Hopkins, Paul N; Volpi, Elena; Marcus, Robin L; LaStayo, Paul C; Drummond, Micah J

    2015-09-15

    Bed rest-induced muscle loss and impaired muscle recovery may contribute to age-related sarcopenia. It is unknown if there are age-related differences in muscle mass and muscle anabolic and catabolic responses to bed rest. A secondary objective was to determine if rehabilitation could reverse bed rest responses. Nine older and fourteen young adults participated in a 5-day bed rest challenge (BED REST). This was followed by 8 weeks of high intensity resistance exercise (REHAB). Leg lean mass (via dual-energy X-ray absorptiometry; DXA) and strength were determined. Muscle biopsies were collected during a constant stable isotope infusion in the postabsorptive state and after essential amino acid (EAA) ingestion on three occasions: before (PRE), after bed rest and after rehabilitation. Samples were assessed for protein synthesis, mTORC1 signalling, REDD1/2 expression and molecular markers related to muscle proteolysis (MURF1, MAFBX, AMPKα, LC3II/I, Beclin1). We found that leg lean mass and strength decreased in older but not younger adults after bedrest (P protein synthesis increased before bed rest in both age groups (P protein synthesis rates and increased MAFBX mRNA, p-AMPKα and the LC3II/I ratio (P protein synthesis and a marginal increase in proteolytic markers. Finally, rehabilitation restored bed rest-induced deficits in lean mass and strength in older adults. © 2015 The Authors. The Journal of Physiology © 2015 The Physiological Society.

  2. Lean information management

    NARCIS (Netherlands)

    Hammer, D.K.

    1997-01-01

    The concept of a Lean Enterprise has proven to be extremely valuable for making companies fit for today's competitive business environment. Lean Information Management denotes the type of information management that is appropriate for such all organization. According to the paradigm of a Lean

  3. Lean production

    OpenAIRE

    Veselková, Jana

    2011-01-01

    The goal of this Bachelor's Thesis is to describe the general principles of lean production and afterwards apply these principles in a particular company. Due to the changing conditions on the world market is among companies growing concern about such innovative business systems. The theoretical part of this work deals with the general characteristics of lean production, including their history and focus on Toyota, as the originator of most lean systems. Mentioned are also the economic aspect...

  4. Differences in Adipose Tissue and Lean Mass Distribution in Patients with Collagen VI Related Myopathies Are Associated with Disease Severity and Physical Ability.

    Science.gov (United States)

    Rodríguez, M A; Del Rio Barquero, Luís M; Ortez, Carlos I; Jou, Cristina; Vigo, Meritxell; Medina, Julita; Febrer, Anna; Ramon-Krauel, Marta; Diaz-Manera, Jorge; Olive, Montse; González-Mera, Laura; Nascimento, Andres; Jimenez-Mallebrera, Cecilia

    2017-01-01

    Mutations in human collagen VI genes cause a spectrum of musculoskeletal conditions in children and adults collectively termed collagen VI-related myopathies (COL6-RM) characterized by a varying degree of muscle weakness and joint contractures and which include Ullrich Congenital Muscular Dystrophy (UCMD) and Bethlem Myopathy (BM). Given that collagen VI is one of the most abundant extracellular matrix proteins in adipose tissue and its emerging role in energy metabolism we hypothesized that collagen VI deficiency might be associated with alterations in adipose tissue distribution and adipokines serum profile. We analyzed body composition by means of dual-energy X-ray absorptiometry in 30 pediatric and adult COL6-RM myopathy patients representing a range of severities (UCMD, intermediate-COL6-RM, and BM). We found a distinctive pattern of regional adipose tissue accumulation which was more evident in children at the most severe end of the spectrum. In particular, the accumulation of fat in the android region was a distinguishing feature of UCMD patients. In parallel, there was a decrease in lean mass compatible with a state of sarcopenia, particularly in ambulant children with an intermediate phenotype. All children and adult patients that were sarcopenic were also obese. These changes were significantly more pronounced in children with collagen VI deficiency than in children with Duchenne Muscular Dystrophy of the same ambulatory status. High molecular weight adiponectin and leptin were significantly increased in sera from children in the intermediate and BM group. Correlation analysis showed that the parameters of fat mass were negatively associated with motor function according to several validated outcome measures. In contrast, lean mass parameters correlated positively with physical performance and quality of life. Leptin and adiponectin circulating levels correlated positively with fat mass parameters and negatively with lean mass and thus may be relevant to

  5. Differences in Adipose Tissue and Lean Mass Distribution in Patients with Collagen VI Related Myopathies Are Associated with Disease Severity and Physical Ability

    Directory of Open Access Journals (Sweden)

    M. A. Rodríguez

    2017-08-01

    Full Text Available Mutations in human collagen VI genes cause a spectrum of musculoskeletal conditions in children and adults collectively termed collagen VI-related myopathies (COL6-RM characterized by a varying degree of muscle weakness and joint contractures and which include Ullrich Congenital Muscular Dystrophy (UCMD and Bethlem Myopathy (BM. Given that collagen VI is one of the most abundant extracellular matrix proteins in adipose tissue and its emerging role in energy metabolism we hypothesized that collagen VI deficiency might be associated with alterations in adipose tissue distribution and adipokines serum profile. We analyzed body composition by means of dual-energy X-ray absorptiometry in 30 pediatric and adult COL6-RM myopathy patients representing a range of severities (UCMD, intermediate-COL6-RM, and BM. We found a distinctive pattern of regional adipose tissue accumulation which was more evident in children at the most severe end of the spectrum. In particular, the accumulation of fat in the android region was a distinguishing feature of UCMD patients. In parallel, there was a decrease in lean mass compatible with a state of sarcopenia, particularly in ambulant children with an intermediate phenotype. All children and adult patients that were sarcopenic were also obese. These changes were significantly more pronounced in children with collagen VI deficiency than in children with Duchenne Muscular Dystrophy of the same ambulatory status. High molecular weight adiponectin and leptin were significantly increased in sera from children in the intermediate and BM group. Correlation analysis showed that the parameters of fat mass were negatively associated with motor function according to several validated outcome measures. In contrast, lean mass parameters correlated positively with physical performance and quality of life. Leptin and adiponectin circulating levels correlated positively with fat mass parameters and negatively with lean mass and thus may

  6. EPA Lean Government Initiative: How to Replicate Lean Successes

    Science.gov (United States)

    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.

  7. Clinical aspects of lower leg compartment syndrome

    NARCIS (Netherlands)

    Brand, Johan Gerard Henric van den

    2004-01-01

    A compartment syndrome is a condition in which increased pressure within a limited space compromises the circulation and function of tissues within that space. Although pathofysiology is roughly similar in chronic exertional and acute compartment syndrome of the lower leg, the clinical

  8. Analysis Of Lean Accounting JIT And Balance Scorecard In The Companys Lean Manufacturing

    OpenAIRE

    Irwan Sutirman Wahdiat

    2015-01-01

    This research purpose to analyze the concept of Lean Manufacturing which is influenced by the role of JIT. This research uses a theoretical approach. This study portrait thinking companies that have yet to implement lean manufacturing and after doing the concept of lean manufacturing. This study shows that the concept of lean manufacturing can make the company more efficient and effective. This paper shows some lean manufacturing dimensions of the researchers previous researchers. This study ...

  9. Independent associations of insulin resistance with high whole-body intermuscular and low leg subcutaneous adipose tissue distribution in obese HIV-infected women123

    Science.gov (United States)

    Albu, Jeanine B; Kenya, Sonjia; He, Qing; Wainwright, Marsha; Berk, Evan S; Heshka, Stanley; Kotler, Donald P; Engelson, Ellen S

    2009-01-01

    Background Obesity and insulin resistance are growing problems in HIV-positive (HIV+) women receiving highly active antiretroviral therapy (HAART). Objective The objective was to determine the contribution of adipose tissue (AT) enlargement and distribution to the presence of insulin resistance in obese HIV+ women. Design Whole-body intermuscular AT (IMAT), visceral AT (VAT), subcutaneous AT (SAT), and SAT distribution (leg versus upper body) were measured by whole-body magnetic resonance imaging. Insulin sensitivity (SI) was measured with an intravenous glucose tolerance test in obese HIV+ women recruited because of their desire to lose weight (n = 17) and in obese healthy controls (n = 32). Results The HIV+ women had relatively less whole-body SAT and more VAT and IMAT than did the controls (P < 0.05 for all). A significant interaction by HIV status was observed for the relation of total SAT with SI (P < 0.001 for the regression’s slope interactions after adjustment for age, height, and weight). However, relations of IMAT, VAT, and SAT distribution (leg SAT as a percentage of total SAT; leg SAT%) with SI did not differ significantly between groups. For both groups combined, the best model predicting a low SI included significant contributions by both high IMAT and low leg SAT%, independent of age, height, and weight, and no interaction between groups was observed (overall r2 = 0.44, P = 0.0003). Conclusion In obese HIV+ women, high whole-body IMAT and low leg SAT% distribution are independently associated with insulin resistance. PMID:17616768

  10. Increased tissue oxygenation explains the attenuation of hyperemia upon repetitive pneumatic compression of the lower leg.

    Science.gov (United States)

    Messere, Alessandro; Ceravolo, Gianluca; Franco, Walter; Maffiodo, Daniela; Ferraresi, Carlo; Roatta, Silvestro

    2017-12-01

    The rapid hyperemia evoked by muscle compression is short lived and was recently shown to undergo a rapid decrease even in spite of continuing mechanical stimulation. The present study aims at investigating the mechanisms underlying this attenuation, which include local metabolic mechanisms, desensitization of mechanosensitive pathways, and reduced efficacy of the muscle pump. In 10 healthy subjects, short sequences of mechanical compressions ( n = 3-6; 150 mmHg) of the lower leg were delivered at different interstimulus intervals (ranging from 20 to 160 s) through a customized pneumatic device. Hemodynamic monitoring included near-infrared spectroscopy, detecting tissue oxygenation and blood volume in calf muscles, and simultaneous echo-Doppler measurement of arterial (superficial femoral artery) and venous (femoral vein) blood flow. The results indicate that 1 ) a long-lasting (>100 s) increase in local tissue oxygenation follows compression-induced hyperemia, 2 ) compression-induced hyperemia exhibits different patterns of attenuation depending on the interstimulus interval, 3 ) the amplitude of the hyperemia is not correlated with the amount of blood volume displaced by the compression, and 4 ) the extent of attenuation negatively correlates with tissue oxygenation ( r  = -0,78, P < 0.05). Increased tissue oxygenation appears to be the key factor for the attenuation of hyperemia upon repetitive compressive stimulation. Tissue oxygenation monitoring is suggested as a useful integration in medical treatments aimed at improving local circulation by repetitive tissue compression. NEW & NOTEWORTHY This study shows that 1 ) the hyperemia induced by muscle compression produces a long-lasting increase in tissue oxygenation, 2 ) the hyperemia produced by subsequent muscle compressions exhibits different patterns of attenuation at different interstimulus intervals, and 3 ) the extent of attenuation of the compression-induced hyperemia is proportional to the level of

  11. Making it lean applying lean practices to the work of it

    CERN Document Server

    Williams, Howard

    2013-01-01

    Making IT Lean: Applying Lean Practices to the Work of IT presents Lean concepts and techniques for improving processes and eliminating waste in IT operations and IT Service Management, in a manner that is easy to understand. The authors provide a context for discussing several areas of application within this domain, allowing you to quickly gain insight into IT processes and Lean principles.The text reviews IT Service Management, with reference to the IT Infrastructure Library (ITIL®) as a framework for best practices-explaining how to use it to accommod

  12. Lean Startup and Lean Canvas Using for Innovative Product Development

    Directory of Open Access Journals (Sweden)

    Alena Buchalcevová

    2016-06-01

    Full Text Available Recently, new approaches to product development have emerged that focus on idea generation techniques and customer itself. One of them is the Lean Startup method that is described in this article along with the Lean Canvas method. The main goal of the article is to demonstrate the application of both methods to an innovative product development focused on providing interactive trips for families with children. The development of the product during individual phases is described and application of the Lean Startup and Lean Canvas principles is demonstrated. Finally, benefits of both methods contributing to the product success are discussed. Similar case studies start emerging worldwide, however in the Czech context are quite rare.

  13. Moving on - beyond lean thinking

    OpenAIRE

    Koskela, Lauri

    2004-01-01

    Lean Thinking is currently often positioned as the underlying theory of lean production among practitioners and academics, although its originators, Womack and Jones, seem not to have presented it as a theory. This paper endeavors to analyze whether Lean Thinking can be viewed as a theory of lean production. For this purpose, a critical assessment of Lean Thinking is carried out. Lean Thinking is argued to lack an adequate conceptualization of production, which has led to imprecise concepts, ...

  14. lean-ISD.

    Science.gov (United States)

    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)

  15. Lean Leadership - Organizational Buy - Ins

    Directory of Open Access Journals (Sweden)

    Dr. Revathi Iyer

    2017-05-01

    Full Text Available Great organizations have become leaders due to their leadership and sustainable initiatives. One such initiative is adoption of lean leadership to align core strategies with all functional areas of business. Leadership is likely to take place in a lean environment because improvements that happen are continual and can only be supported by leadership which understands this important aspect. The topic of lean leadership organizational buy ins speaks on how lean leadership could affect organizations that adopt lean and other quality tools. Purpose of the study This study has been undertaken to understand When leadership more of is likely to take place in lean . Leadership plays a very important role while adopting lean processes and how lean leadership can address the process problem. Application of leadership lenses to lean processes needs great foresight thought and creativity. It has been also observed that lean management and lean processes can happen only if leadership is able to effectively communicate the thought of continual improvement to bring in a lean organization and a future state of processes where everything of a firm process and procedure is continually improving and the best strategies to manage this change becomes a philosophy. Lean leadership is associated with such a change. This enables leadership vision to be clear as it paves the way for current state and is clear to everyone. It is this leadership vision which enables employees to think and act in a way that perpetrates continual improvement. Hence leadership buys ins for lean are very necessary. The purpose of the study is also to understand how leaders can not only use cost reduction but also reducing time-to-market improving service quality and reducing risk exposure by adopting lean methods . it has been also seen that there is overall productivity and efficiency in organizations holistically when leadership endorses lean methodology. Radnor Z. and Bucci G. 2007

  16. Performance effect of Lean

    DEFF Research Database (Denmark)

    Kristensen, Thomas Borup; Israelsen, Poul

    2016-01-01

    To understand how the practices of Lean affect performance, we tested and validated a system-wide approach using mediating relationships in a structural equation model. We used a cross-sectional survey of 200 Danish companies that indicated that they used Lean. Thus, this study is especially...... relevant to Denmark, but the approach is empirically more generalizable. We show that the effect of Lean standardized flow production practices on performance is mediated by analytical continuous improvement empowerment practices and by delegation of decision rights practices. Thus, standardized flow...... of decision rights. The paper provides evidence that supports the view that middle managers’ actions further enhance performance in Lean companies. The right Lean behavior by middle managers increases the level of analytical continuous improvement empowerment. In total, high-performing Lean companies...

  17. Possibility of management of lower leg war burns with free flaps

    Directory of Open Access Journals (Sweden)

    Panajotović Ljubomir

    2003-01-01

    Full Text Available Free flaps are used in the surgical treatment of burns for wound closure where the burn is too deep, and in case, when after necrotic tissue excision, the bones, tendons, nerves, and blood vessels remain bare. Covering of the exposed structures is commonly performed in the primary delayed, or in the secondary wound treatment. The possibilities of covering the defects of the lower leg with local flaps are limited. Free flaps are used when all the possibilities of the other reconstructive procedures have been exhausted. The defect of the soft tissue of the lower leg was covered with free flaps in the injured soldiers with deep burns, treated at the Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade. In one patient the wound closing was performed immediately after excision of necrotic tissues, and in the other two in the secondary management. The application of free microvascular flaps enabled the closure of large post excision defects of the lower leg in one operation. Our experience in the treatment of these soldiers point to the possibility of coverage of the exposed deep structures with free flaps as early as possible.

  18. Chronic exercise preserves lean muscle mass in masters athletes.

    Science.gov (United States)

    Wroblewski, Andrew P; Amati, Francesca; Smiley, Mark A; Goodpaster, Bret; Wright, Vonda

    2011-09-01

    Aging is commonly associated with a loss of muscle mass and strength, resulting in falls, functional decline, and the subjective feeling of weakness. Exercise modulates the morbidities of muscle aging. Most studies, however, have examined muscle-loss changes in sedentary aging adults. This leaves the question of whether the changes that are commonly associated with muscle aging reflect the true physiology of muscle aging or whether they reflect disuse atrophy. This study evaluated whether high levels of chronic exercise prevents the loss of lean muscle mass and strength experienced in sedentary aging adults. A cross-section of 40 high-level recreational athletes ("masters athletes") who were aged 40 to 81 years and trained 4 to 5 times per week underwent tests of health/activity, body composition, quadriceps peak torque (PT), and magnetic resonance imaging of bilateral quadriceps. Mid-thigh muscle area, quadriceps area (QA), subcutaneous adipose tissue, and intramuscular adipose tissue were quantified in magnetic resonance imaging using medical image processing, analysis, and visualization software. One-way analysis of variance was used to examine age group differences. Relationships were evaluated using Spearman correlations. Mid-thigh muscle area (P = 0.31) and lean mass (P = 0.15) did not increase with age and were significantly related to retention of mid-thigh muscle area (P lean mass (P = 0.4) and PT. This study contradicts the common observation that muscle mass and strength decline as a function of aging alone. Instead, these declines may signal the effect of chronic disuse rather than muscle aging. Evaluation of masters athletes removes disuse as a confounding variable in the study of lower-extremity function and loss of lean muscle mass. This maintenance of muscle mass and strength may decrease or eliminate the falls, functional decline, and loss of independence that are commonly seen in aging adults.

  19. Improving Healthcare through Lean Management

    DEFF Research Database (Denmark)

    Nielsen, Anders Paarup; Edwards, Kasper

    2011-01-01

    The ideas and principles from lean management are now widely being adopted within the healthcare sector. The analysis in this paper shows that organizations within healthcare most often only implement a limited set of tools and methods from the lean tool-box. Departing from a theoretical analysis...... of the well-known and universal lean management principles in the context of the healthcare this paper will attempt to formulate and test four hypotheses about possible barriers to the successful implementation of lean management in healthcare. The first hypothesis states that lean management in healthcare....... The paper concludes by discussing the implications of hypothesis two, three, and four for the successful application of lean management within healthcare. Is it concluded that this requires a transformative and contingent approach to lean management where the universal principles of the lean philosophy...

  20. Lean programm as a method of managing lean changes in the company

    Directory of Open Access Journals (Sweden)

    Suetina Tatiana Aleksandrovna

    2012-12-01

    Full Text Available This article is about methods and ways of providing changes on enterprices which introduce instruments of lean production. The main accent is how to use metodology of the project management by providing lean-changes. Lean program is proposed as a program of strategic developement of enterprices.

  1. Glycine regulates the production of pro-inflammatory cytokines in lean and monosodium glutamate-obese mice.

    Science.gov (United States)

    Alarcon-Aguilar, F J; Almanza-Perez, Julio; Blancas, Gerardo; Angeles, Selene; Garcia-Macedo, Rebeca; Roman, Ruben; Cruz, Miguel

    2008-12-03

    Fat tissue plays an important role in the regulation of inflammatory processes. Increased visceral fat has been associated with a higher production of cytokines that triggers a low-grade inflammatory response, which eventually may contribute to the development of insulin resistance. In the present study, we investigated whether glycine, an amino acid that represses the expression in vitro of pro-inflammatory cytokines in Kupffer and 3T3-L1 cells, can affect in vivo cytokine production in lean and monosodium glutamate-induced obese mice (MSG/Ob mice). Our data demonstrate that glycine treatment in lean mice suppressed TNF-alpha transcriptional expression in fat tissue, and serum protein levels of IL-6 were suppressed, while adiponectin levels were increased. In MSG/Ob mice, glycine suppressed TNF-alpha and IL-6 gene expression in fat tissue and significantly reduced protein levels of IL-6, resistin and leptin. To determine the role of peroxisome proliferator-activated receptor-gamma (PPAR-gamma) in the modulation of this inflammatory response evoked by glycine, we examined its expression levels in fat tissue. Glycine clearly increased PPAR-gamma expression in lean mice but not in MSG/Ob mice. Finally, to identify alterations in glucose metabolism by glycine, we also examined insulin levels and other biochemical parameters during an oral glucose tolerance test. Glycine significantly reduced glucose tolerance and raised insulin levels in lean but not in obese mice. In conclusion, our findings suggest that glycine suppresses the pro-inflammatory cytokines production and increases adiponectin secretion in vivo through the activation of PPAR-gamma. Glycine might prevent insulin resistance and associated inflammatory diseases.

  2. Implementation of lean leadership

    Directory of Open Access Journals (Sweden)

    Trenkner Małgorzata

    2016-12-01

    Full Text Available The Toyota case proves that lean leadership is of critical importance for the successful implementation and permanent functioning of Lean Production System. There is no ready formula for developing Toyota style lean leadership. However, one may gain inspiration from its experience.

  3. A stratified transcriptomics analysis of polygenic fat and lean mouse adipose tissues identifies novel candidate obesity genes.

    Directory of Open Access Journals (Sweden)

    Nicholas M Morton

    Full Text Available Obesity and metabolic syndrome results from a complex interaction between genetic and environmental factors. In addition to brain-regulated processes, recent genome wide association studies have indicated that genes highly expressed in adipose tissue affect the distribution and function of fat and thus contribute to obesity. Using a stratified transcriptome gene enrichment approach we attempted to identify adipose tissue-specific obesity genes in the unique polygenic Fat (F mouse strain generated by selective breeding over 60 generations for divergent adiposity from a comparator Lean (L strain.To enrich for adipose tissue obesity genes a 'snap-shot' pooled-sample transcriptome comparison of key fat depots and non adipose tissues (muscle, liver, kidney was performed. Known obesity quantitative trait loci (QTL information for the model allowed us to further filter genes for increased likelihood of being causal or secondary for obesity. This successfully identified several genes previously linked to obesity (C1qr1, and Np3r as positional QTL candidate genes elevated specifically in F line adipose tissue. A number of novel obesity candidate genes were also identified (Thbs1, Ppp1r3d, Tmepai, Trp53inp2, Ttc7b, Tuba1a, Fgf13, Fmr that have inferred roles in fat cell function. Quantitative microarray analysis was then applied to the most phenotypically divergent adipose depot after exaggerating F and L strain differences with chronic high fat feeding which revealed a distinct gene expression profile of line, fat depot and diet-responsive inflammatory, angiogenic and metabolic pathways. Selected candidate genes Npr3 and Thbs1, as well as Gys2, a non-QTL gene that otherwise passed our enrichment criteria were characterised, revealing novel functional effects consistent with a contribution to obesity.A focussed candidate gene enrichment strategy in the unique F and L model has identified novel adipose tissue-enriched genes contributing to obesity.

  4. Lean leadership: an ethnographic study.

    Science.gov (United States)

    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.

  5. Reduced adipose tissue lymphatic drainage of macromolecules in obese subjects

    DEFF Research Database (Denmark)

    Arngrim, Nanna Bjørkbom; Simonsen, L; Holst, J J

    2013-01-01

    The aim of this study was to investigate subcutaneous adipose tissue lymphatic drainage (ATLD) of macromolecules in lean and obese subjects and, furthermore, to evaluate whether ATLD may change in parallel with adipose tissue blood flow. Lean and obese male subjects were studied before and after ...... online publication, 3 July 2012; doi:10.1038/ijo.2012.98....

  6. LEAN and energy efficiency; Lean og energieffektivisering

    Energy Technology Data Exchange (ETDEWEB)

    Jespersen, Per T; Vesterager Christensen, D; Andersen, Hans [Teknologisk Institut, Energi og Klima, Taastrup (Denmark); Dam Wied, M; Dam, M [NRGi Raadgivning, Aarhus (Denmark); Thorndahl, M [Horsens Kommune, Horsens (Denmark); Weldingh, P [Lokal Energi, Viby J. (Denmark); Maagoee, P; Kristensen, Kenneth T [Viegand og Maagoee, Copenhagen (Denmark); Kirketerp Friis, A [Novozymes, Bagsvaerd (Denmark)

    2010-03-15

    By means of theoretical reports and three specific cases, the project showed how Lean principles can improve energy consulting efficiency, thus making it easier for end-users and energy consultants to record and document energy savings achieved. The three cases documented various types of extra benefits of integrating energy efficiency improvement in Lean processes. As a result of process optimisation, one manufacturing company successfully reduced both staffing and energy consumption, thus making production in Denmark competitive with out-sourced production in Asia. (LN)

  7. LEAN dig ikke tilbage

    DEFF Research Database (Denmark)

    Weirsøe, Mathilde

    2011-01-01

    Fit, slankere, hurtigst. Lean-konceptet ruller ind over de offentlige institutioner, hvor det skal trimme og effektivisere arbejdsprocesser. Men hvor er den maksimale grænse for effektivitet? Er der et ’tipping point’, hvor Lean ikke længere motiverer, men snarere udmatter......Fit, slankere, hurtigst. Lean-konceptet ruller ind over de offentlige institutioner, hvor det skal trimme og effektivisere arbejdsprocesser. Men hvor er den maksimale grænse for effektivitet? Er der et ’tipping point’, hvor Lean ikke længere motiverer, men snarere udmatter...

  8. The role of lean body mass and physical activity in bone health in children.

    Science.gov (United States)

    Baptista, Fátima; Barrigas, Carlos; Vieira, Filomena; Santa-Clara, Helena; Homens, Pedro Mil; Fragoso, Isabel; Teixeira, Pedro J; Sardinha, Luís B

    2012-01-01

    In the context of physical education curricula, markers of physical fitness (e.g., aerobic capacity, muscular strength, flexibility, and body mass index or body fat) are usually evaluated in reference to health standards. Despite their possible mediating role in the relationship between weight-bearing or muscle forces and features of bone tissue, these attributes of fitness may not be the most relevant to predict skeletal health. It is therefore important to analyze the relative contribution of these factors to the variability in bone tissue of different parts of the skeleton, and to analyze it by gender, as sensitivity to mechanical loading can diverge for boys and girls. We compared the effects of habitual physical activity (PA) and lean mass, as surrogates of weight-bearing and muscle forces, and of physical fitness (aerobic and muscle capacity of lower and upper limbs) on bone mineral content (BMC) and size of total body, lumbar spine, femoral neck, and 1/3 radius in 53 girls and 64 boys from 7.9 to 9.7 years of age. After controlling for bone age, body mass, body height, and calcium intake, lean mass was the most important predictor of bone size and/or mineral in both genders (p  608 counts/min/day (~105 min/day of moderate and vigorous intensity) showed 13-20% more BMC than those with less physical activity, and girls with a lean mass >19 kg showed 12-19% more BMC than those with less lean mass. These findings suggest that lean mass was the most important predictor of bone size and/or mineralization in both genders, while habitual weight-bearing PA appears to positively impact on bone mineral in prepubertal boys and that both lean mass and PA need to be considered in physical education curricula and other health-enhancing programs.

  9. Orchestrating Lean Implementation

    DEFF Research Database (Denmark)

    Riis, Jens Ove; Mikkelsen, Hans; Andersen, Jesper Rank

    2008-01-01

    The notion of Lean Manufacturing is not merely confined to a set of well defined techniques, but represents a broad approach to managing a company. Working with lean entails many aspects, such as production planning and control, production engineering, product development, supply chain......, and organizational issues. To become effective, many functional areas and departments must be involved. At the same time companies are embedded in a dynamic environment. The aim of the paper is to propose a comprehensive approach to better implementation of lean initiatives, based on two empirical studies. The paper...... will discuss how a concerted effort can be staged taking into account the interdependencies among individual improvement initiatives. The notion of orchestration will be introduced, and several means for orchestration will be presented. Critical behavioral issues for lean implementation will be discussed....

  10. Cultural Aspects when Implementing Lean Production and Lean Product Development – Experiences from a Swedish Perspective

    Directory of Open Access Journals (Sweden)

    Promporn Wangwacharakul

    2014-07-01

    Full Text Available Lean principles and methods, originating in a Japanese cultural context, have spread to a large number of companies throughout the world. The aim of this case study research is to identify and compare national cultural aspects that influence Lean Production and Lean Product Development implementation in Swedish companies. Data were collected through questionnaires, interviews and an industrial workshop with Swedish Lean practitioners. The study shows that some sub-areas in Lean, such as value definition, control systems, leadership, team development, knowledge management, and strategies, are highly dependent on contextual factors related to human, cultural and organizational aspects. These are related to the national culture and should be considered to a higher extent for successful sustainable implementation of Lean in different cultural contexts. As for implementing Lean in Sweden, national cultural characteristics, such as individualism, autonomy and supportive management style fit well with Lean thinking.

  11. Diccionario Lean Manufacturing

    OpenAIRE

    Muñoz Ellner, Sarah María

    2016-01-01

    El Diccionario Bilingüe de Lean Manufacturing pretende ser un instrumento de apoyo a todo aquel que tenga la responsabilidad de planear, ejecutar o simplemente algún interés con las actividades de Lean Manufacturing, aportando así también conceptos claros tanto en castellano como en inglés, con el fin de entender de forma integral el alcance mismo que puede llegar a tener dicha filosofía, al igual que se proporcionara una serie de siglas y herramientas para la implementación del Lean Manufact...

  12. Lean management beyond manufacturing a holistic approach

    CERN Document Server

    Bhasin, Sanjay

    2015-01-01

    Exploring Lean manufacturing in a holistic manner, this book helps organizations to implement Lean principles successfully by offering theoretical, empirical and practical knowledge. It empirically demonstrates how a successful Lean initiative can improve organizational efficiency, and incorporates valuable primary research to substantiate findings. It argues that Lean principles need to be applied throughout the value chain in order to be successful , and suggests that these tools need to be aligned with culture and change management. Chapters examine issues including Lean cultures, impediments to Lean, Lean and performance measurement, and the impact of Lean. Viewing Lean as a never-ending journey, this book provides a valuable resource to practising Lean managers, and specialist researchers and students, and also offers an important reference for organizations embarking on their Lean voyage.

  13. Lean approach in knowledge work

    Directory of Open Access Journals (Sweden)

    Hanna Kropsu-Vehkapera

    2018-05-01

    Full Text Available Purpose: Knowledge work productivity is a key area of improvement for many organisations. Lean approach is a sustainable way to achieve operational excellence and can be applied in many areas. The purpose of this novel study is to examine the potential of using lean approach for improving knowledge work practices. Design/methodology/approach: A systematic literature review has been carried out to study how lean approach is realised in knowledge work. The research is conceptual in nature and draws upon earlier research findings. Findings: This study shows that lean studies’ in knowledge work is an emerging research area. This study documents the methods and practices implemented in knowledge work to date, and presents a knowledge work continuum, which is an essential framework for effective lean approach deployment and to frame future research focus in knowledge work productivity. Research limitations/implications: This study structures the concept of knowledge work and outlines a concrete concept derived from earlier literature. The study summarises the literature on lean in knowledge work and highlights, which methods are used. More research is needed to understand how lean can be implemented in complex knowledge work environment and not only on the repetitive knowledge work. The limitations of this research are due to the limited availability of previous research. Practical implications: To analyse the nature of knowledge work, we implicate the areas where lean methods especially apply to improving knowledge work productivity. When applying lean in knowledge work context the focus should be using the people better and improving information flow. Originality/value: This study focuses on adapting lean methods into a knowledge work context and summarises earlier research done in this field. The study discusses the potential to improve knowledge work productivity by implementing lean methods and presents a unique knowledge work continuum to

  14. Muscle strength and regional lean body mass influence on mineral bone health in young male adults.

    Science.gov (United States)

    Guimarães, Bianca Rosa; Pimenta, Luciana Duarte; Massini, Danilo Alexandre; Dos Santos, Daniel; Siqueira, Leandro Oliveira da Cruz; Simionato, Astor Reis; Dos Santos, Luiz Gustavo Almeida; Neiva, Cassiano Merussi; Pessôa Filho, Dalton Muller

    2018-01-01

    The relationship between muscle strength and bone mineral content (BMC) and bone mineral density (BMD) is supposed from the assumption of the mechanical stress influence on bone tissue metabolism. However, the direct relationship is not well established in younger men, since the enhancement of force able to produce effective changes in bone health, still needs to be further studied. This study aimed to analyze the influence of muscle strength on BMC and BMD in undergraduate students. Thirty six men (24.9 ± 8.6 y/o) were evaluated for regional and whole-body composition by dual energy X-ray absorptiometry (DXA). One repetition maximum tests (1RM) were assessed on flat bench-press (BP), lat-pull down (LPD), leg-curl (LC), knee extension (KE), and leg-press 45° (LP45) exercises. Linear regression modelled the relationships of BMD and BMC to the regional body composition and 1RM values. Measurements of dispersion and error (R2adj and standard error of estimate (SEE)) were tested, setting ρ at ≤0.05. The BMD mean value for whole-body was 1.12±0.09 g/cm2 and BMC attained 2477.9 ± 379.2 g. The regional lean mass (LM) in upper-limbs (UL) (= 6.80±1.21 kg) was related to BMC and BMD for UL (R2adj = 0.74, pBMC and BMD for LL (R2adj = 0.68, pBMC (R2adj = 0.47, pBMC (R2adj = 0.36, pBMC and BMD in young men, strengthening the relationship between force and LM, and suggesting both to parametrizes bone mineral health.

  15. Lean and Information Technology Toolkit

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  17. Lean Production : Werkzeuge zur Realisierung

    OpenAIRE

    Binner, Hartmut F.

    2008-01-01

    INHALT: l. Einleitung und Standortbestimmung 2. Japanische Wertvorstellungen 3. Inhalte der Lean Production 4. Fertigungssegmentierung 5. Informationsmanagement mit CIM- und Logistik-Komponenten 6. Logistikgerechte Strukturen der Lean Production 7. Realisierung der Lean Production 8. Zusammenfassung

  18. Researching Lean: Methodological Implications of Loose Definitions

    Directory of Open Access Journals (Sweden)

    Mikael Brännmark

    2012-12-01

    Full Text Available Recently, Lean Production (Lean has become a prevailing management concept in Sweden. However, previous research seems to show that the Lean concept and the impact of Lean vary considerably between organizations. This paper illustrates some key methodological issues that need to be considered when researching loosely defined management concepts such as Lean. The paper is based on a review of the literature and five comparative Swedish cases studies. Our study indicates that Lean has changed over time and that operationalization and interpretations of the concept vary considerably. This study concludes that future Lean studies should include a thorough assessment of the Lean interventions, study settings, and in particular non-Lean factors mediating the outcomes of Lean-inspired change programs.

  19. Lean Application to Manufacturing Ramp-Up

    DEFF Research Database (Denmark)

    Christensen, Irene; Rymaszewska, Anna

    2016-01-01

    . Abstracting from the extant literature, the authors considered the competitiveness of manufacturing companies from two principal perspectives: the leanness of the ramp-up process and the new-value creation of quality managers. While much of the literature fails to acknowledge that the roots of lean actually......This article provides a theoretical overview of the concepts of lean and manufacturing ramp-up in an attempt to conceptualize the strategic areas in which lean philosophy and principles can be applied for continuous improvements. The application of lean principles during the final stage of a new...... product development process, that is, the ramp-up process, is a critical, early enabler of lean manufacturing. The manufacturing strategy literature conceptualizes a state of “leanness in operations,” which can consolidate both the concepts of lean and manufacturing ramp-up, providing a dual perspective...

  20. LEAN thinking in Finnish healthcare.

    Science.gov (United States)

    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.

  1. Effects of Exercise Training on Fat Loss and Lean Mass Gain in Mexican-American and Korean Premenopausal Women

    Directory of Open Access Journals (Sweden)

    Shenghui Wu

    2017-01-01

    Full Text Available We investigated the effect of exercise training on body composition change in women. Nineteen Mexican-American and 18 Korean premenopausal overweight/obese women were randomized into one of the following groups: control, low-intensity training group (LI, and high-intensity training group (HI. Subjects completed 12 weeks of training at 50–56% maximal oxygen consumption (LI or 65–70% maximal oxygen consumption (HI. Body composition components were measured at baseline and after training using dual-energy X-ray absorptiometry for Mexican-Americans, while whole-body composition was measured by the direct segmental multifrequency bioelectrical impedance analysis and abdominal fat was measured by single-slice computed tomography for Koreans. Data were analyzed using mixed-model repeated measures independent of age, ethnicity, and body mass index (BMI. Exercise training showed a significant effect on BMI, fat percentage, fat mass, lean mass, and visceral adipose tissue area. HI significantly decreased fat mass and fat percentage but increased lean mass (all P<0.05. LI significantly reduced BMI, fat mass, fat percentage, and visceral adipose tissue area but increased lean mass (all P<0.05. Exercise training had a beneficial effect on reducing BMI, fat percentage, fat mass, and visceral adipose tissue area but had no effect on increasing lean mass for Mexican-American and Korean premenopausal overweight/obese women.

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

    Science.gov (United States)

    Gilbert, Joyce A.

    1992-01-01

    Ground based and in flight research has shown that humans, under conditions of microgravity, sustain a loss of lean body tissue (protein) and changes in several biological processes including, reductions in red blood cell mass, and neurotransmitters. The maintenance of muscle mass, the major component of lean body mass, is required to meet the needs of space station EVAs. Central to the biosynthesis of amino acids, the building blocks of protein, is pyridoxine (vitamin B-6). Muscle mass integrity requires the availability of vitamin B-6 for protein metabolism and neurotransmitter synthesis. Furthermore, the formation of red blood cells require pyridoxine as a cofactor in the biosynthesis of hemoglobin, a protein that carries oxygen to tissues. In its active form, pyridoxal-5'-phosphate (PLP), vitamin B-6 serves as a link between amino acid and carbohydrate metabolism through intermediates of glycolysis and the tricarboxylic acid cycle. In addition to its role in energy metabolism, PLP is involved in the biosynthesis of hemoglobin and neurotransmitter which are necessary for neurological functions. Alterations in pyridoxine metabolism may affect countermeasures designed to overcome some of these biochemical changes. The focus of this research is to determine the effects of microgravity on the metabolic utilization of vitamin B-6, integrating nutrition as an integral component of the countermeasure (exercise) to maintain lean body mass and muscle strength. The objectives are: 1) to determine whether microgravity effects the metabolic utilization of pyridoxine and 2) to quantitate changes in B-6 vitamer distribution in tissue and excreta relative to loss of lean body tissue. The rationale for this study encompasses the unique challenge to control biochemical mechanisms effected during space travel and the significance of pyridoxine to maintain and counter muscle integrity for EVA activities. This experiment will begin to elucidate the importance of biochemical

  3. Carbenoxolone treatment ameliorated metabolic syndrome in WNIN/Ob obese rats, but induced severe fat loss and glucose intolerance in lean rats.

    Directory of Open Access Journals (Sweden)

    Siva Sankara Vara Prasad Sakamuri

    Full Text Available BACKGROUND: 11beta-hydroxysteroid dehydrogenase type 1 (11β-HSD1 regulates local glucocorticoid action in tissues by catalysing conversion of inactive glucocorticoids to active glucocorticoids. 11β-HSD1 inhibition ameliorates obesity and associated co-morbidities. Here, we tested the effect of 11β-HSD inhibitor, carbenoxolone (CBX on obesity and associated comorbidities in obese rats of WNIN/Ob strain, a new animal model for genetic obesity. METHODOLOGY/PRINCIPAL FINDINGS: Subcutaneous injection of CBX (50 mg/kg body weight or volume-matched vehicle was given once daily for four weeks to three month-old WNIN/Ob lean and obese rats (n = 6 for each phenotype and for each treatment. Body composition, plasma lipids and hormones were assayed. Hepatic steatosis, adipose tissue morphology, inflammation and fibrosis were also studied. Insulin resistance and glucose intolerance were determined along with tissue glycogen content. Gene expressions were determined in liver and adipose tissue. CBX significantly inhibited 11β-HSD1 activity in liver and adipose tissue of WNIN/Ob lean and obese rats. CBX significantly decreased body fat percentage, hypertriglyceridemia, hypercholesterolemia, insulin resistance in obese rats. CBX ameliorated hepatic steatosis, adipocyte hypertrophy, adipose tissue inflammation and fibrosis in obese rats. Tissue glycogen content was significantly decreased by CBX in liver and adipose tissue of obese rats. Severe fat loss and glucose- intolerance were observed in lean rats after CBX treatment. CONCLUSIONS/SIGNIFICANCE: We conclude that 11β-HSD1 inhibition by CBX decreases obesity and associated co-morbidities in WNIN/Ob obese rats. Our study supports the hypothesis that inhibition of 11β-HSD1 is a key strategy to treat metabolic syndrome. Severe fat loss and glucose -intolerance by CBX treatment in lean rats suggest that chronic 11β-HSD1 inhibition may lead to insulin resistance in normal conditions.

  4. Lean Design and Management for Manufactoring

    OpenAIRE

    NIU, Zhanwen

    2009-01-01

    Most enterprises inducting lean production were confined by the innate limitations of existing production systems, which make it difficult to fulfill lean production comprehensively. To solve this problem, the theory of lean design and management for the manufacturing enterprise lifecycle was proposed. First, the necessities of lean design were analyzed and its theoretical system was established; second, the principles, process, methods and tools for lean design was introduced. Techniques and...

  5. Brown adipose tissue activation as measured by infrared thermography by mild anticipatory psychological stress in lean healthy females.

    Science.gov (United States)

    Robinson, Lindsay J; Law, James M; Symonds, Michael E; Budge, Helen

    2016-04-01

    What is the central question of this study? Does psychological stress, which is known to promote cortisol secretion, simultaneously activate brown adipose tissue function in healthy adult females? What is the main finding and its importance? One explanation for the pronounced differences in brown adipose tissue function between individuals lies in their responsiveness to psychological stress and, as such, should be taken into account when examining its in vivo stimulation. Brown adipose tissue (BAT) has been implicated in the pathogenesis of obesity, type 2 diabetes and the metabolic syndrome and is a potential therapeutic target. Brown adipose tissue can have a significant impact on energy balance and glucose homeostasis through the action of uncoupling protein 1, dissipating chemical energy as heat following neuroendocrine stimulation. We hypothesized that psychological stress, which is known to promote cortisol secretion, would simultaneously activate BAT at thermoneutrality. Brown adipose tissue activity was measured using infrared thermography to determine changes in the temperature of the skin overlying supraclavicular BAT (TSCR ). A mild psychological stress was induced in five healthy, lean, female, Caucasian volunteers using a short mental arithmetic (MA) test. The TSCR was compared with a repeated assessment, in which the MA test was replaced with a period of relaxation. Although MA did not elicit an acute stress response, anticipation of MA testing led to an increase in salivary cortisol, indicative of an anticipatory stress response, that was associated with a trend towards higher absolute and relative TSCR . A positive correlation between TSCR and cortisol was found during the anticipatory phase, a relationship that was enhanced by increased cortisol linked to MA. Our findings suggest that subtle changes in the level of psychological stress can stimulate BAT, findings that may account for the high variability and inconsistency in reported BAT

  6. Venous leg ulcer management: single use negative pressure wound therapy.

    Science.gov (United States)

    Dowsett, Caroline; Grothier, Lorraine; Henderson, Valerie; Leak, Kathy; Milne, Jeanette; Davis, Lynn; Bielby, Alistair; Timmons, John

    2013-06-01

    A number of leg ulcer specialist/tissue viability specialists from across the UK were invited to evaluate PICO (Smith and Nephew, Hull) as a treatment for venous leg ulcers also in conjunction with a variety of compression bandages and garments. Patients across 5 sites had PICO applied in conjunction with compression therapy. This group of treating clinicians were then asked to give feedback on the outcome of the patients on whom they had used the new device. All feedback was recorded at a meeting and this was used to create a guideline for use.

  7. Task driven optimal leg trajectories in insect-scale legged microrobots

    Science.gov (United States)

    Doshi, Neel; Goldberg, Benjamin; Jayaram, Kaushik; Wood, Robert

    Origami inspired layered manufacturing techniques and 3D-printing have enabled the development of highly articulated legged robots at the insect-scale, including the 1.43g Harvard Ambulatory MicroRobot (HAMR). Research on these platforms has expanded its focus from manufacturing aspects to include design optimization and control for application-driven tasks. Consequently, the choice of gait selection, body morphology, leg trajectory, foot design, etc. have become areas of active research. HAMR has two controlled degrees-of-freedom per leg, making it an ideal candidate for exploring leg trajectory. We will discuss our work towards optimizing HAMR's leg trajectories for two different tasks: climbing using electroadhesives and level ground running (5-10 BL/s). These tasks demonstrate the ability of single platform to adapt to vastly different locomotive scenarios: quasi-static climbing with controlled ground contact, and dynamic running with un-controlled ground contact. We will utilize trajectory optimization methods informed by existing models and experimental studies to determine leg trajectories for each task. We also plan to discuss how task specifications and choice of objective function have contributed to the shape of these optimal leg trajectories.

  8. Lean With a Human Face

    DEFF Research Database (Denmark)

    Hasle, Peter; Jensen, Per Langaa

    2008-01-01

    The consequences for quality of work of lean manufacturing is discussed in the international litterature, and several authors suggest increased work speed, stress, and muscoskeletal diseases as a consequence of lean. The Danish experience with lean has been studied through interviews with managers...

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

    Science.gov (United States)

    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…

  10. Applying lean thinking in construction

    Directory of Open Access Journals (Sweden)

    Remon Fayek Aziz

    2013-12-01

    Full Text Available The productivity of the construction industry worldwide has been declining over the past 40 years. One approach for improving the situation is using lean construction. Lean construction results from the application of a new form of production management to construction. Essential features of lean construction include a clear set of objectives for the delivery process, aimed at maximizing performance for the customer at the project level, concurrent design, construction, and the application of project control throughout the life cycle of the project from design to delivery. An increasing number of construction academics and professionals have been storming the ramparts of conventional construction management in an effort to deliver better value to owners while making real profits. As a result, lean-based tools have emerged and have been successfully applied to simple and complex construction projects. In general, lean construction projects are easier to manage, safer, completed sooner, and cost less and are of better quality. Significant research remains to complete the translation to construction of lean thinking in Egypt. This research will discuss principles, methods, and implementation phases of lean construction showing the waste in construction and how it could be minimized. The Last Planner System technique, which is an important application of the lean construction concepts and methodologies and is more prevalent, proved that it could enhance the construction management practices in various aspects. Also, it is intended to develop methodology for process evaluation and define areas for improvement based on lean approach principles.

  11. Lean leadership: an ethnographic study

    NARCIS (Netherlands)

    Aij, K.H.; Visse, M.A.; Widdershoven, G.A.M.

    2015-01-01

    Purpose – 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 rolein implementing Lean.This article presents a case study focusing specifcally on

  12. Adapting lean to histology laboratories.

    Science.gov (United States)

    Buesa, René J

    2009-10-01

    Histology laboratories (histolabs) can increase productivity and reduce turnaround time and errors by using any one of several available management tools. After a few years of operation, all histolabs develop workflow problems. Histology laboratories handling more than 20,000 cases per year benefit the most from implementing management tools, as occurred in the 25 facilities summarized in this article. Discontinuous workflow, lack of "pulling" between steps, accepting unavoidable waiting times while working with small batches within work cells, and a workflow with an uneven rate of completion, are some of the adaptations required by the Lean system when it is used in histology because 70% of the tasks are manual and the flow has to be interrupted to add value to the pieces of tissue during tissue processing, no matter how short that step is. After all these adaptations are incorporated, the histolab becomes as "Lean" as it can be, and the qualifier is also a recognition of the effort and personnel involvement in the implementation. Given its service nature, productivity increments do not expand the histolab customer base and could lead to staffing reductions. This is one of the causes of reluctance by some employees for implementing these techniques which are mostly driven by cost reductions sought by insurance companies and administrators, and not necessarily because of a real medical need to reduce the turnaround time. Finally, any histolab wanting to improve its workflow can follow some easy steps presented here as a guide to accomplish that objective. These steps stress the need for the supervisors to insure that the personnel in the histology laboratory are being paid at a comparable rate as other histolabs in the area.

  13. THE EFFECTS OF SINGLE LEG HOP PROGRESSION AND DOUBLE LEGS HOP PROGRESSION EXERCISE TO INCREASE SPEED AND EXPLOSIVE POWER OF LEG MUSCLE

    Directory of Open Access Journals (Sweden)

    Nining W. Kusnanik

    2015-05-01

    Full Text Available The main purpose of this study was to determine the effect of single leg hop progression and double legs hop progression exercise to increase speed and explosive power of leg muscles. Plyometric is one of the training methods that can increase explosive power. There are many models of plyometric training including single leg hop progression and double leg hop progression. This research was experimental using match subject design techniques. The subjects of this study were 39 students who joined basketball school club. There were 3 groups in this study: Group 1 were 13 students who given sin¬gle leg hop progression exercise, Group 2 were 13 students who given double legs hop progression exercise, Group 3 were 13 students who given conventional exercise. The data was collected during pre test and post test by testing 30m speed running and vertical jump. The data was analyzed using Analysis of Varians (Anova. It was found that there were significantly increased on speed and explosive power of leg muscles of Group 1 and Group 2. It can be stated that single leg hop progression exercise was more effective than double leg hop progression exercise. The recent findings supported the hypothesis that single leg hop progression and double legs hop progression exercise can increase speed and explosive power of leg muscles. These finding were supported by some previous studies (Singh, et al, 2011; Shallaby, H.K., 2010. The single leg hop progression is more effective than double legs hop progression. This finding was consistent with some previous evidences (McCurdy, et al, 2005; Makaruk et al, 2011.

  14. Ares Launch Vehicles Lean Practices Case Study

    Science.gov (United States)

    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.

  15. Lean software development in action

    CERN Document Server

    Janes, Andrea

    2014-01-01

    This book illustrates how goal-oriented, automated measurement can be used to create Lean organizations and to facilitate the development of Lean software, while also demonstrating the practical implementation of Lean software development by combining tried and trusted tools. In order to be successful, a Lean orientation of software development has to go hand in hand with a company's overall business strategy. To achieve this, two interrelated aspects require special attention: measurement and experience management. In this book, Janes and Succi provide the necessary knowledge to establish "

  16. Lean Management

    OpenAIRE

    Picot, Arnold

    1994-01-01

    In this article the possibility of increase of competitiveness of the domestic enterprises by means of Lean management system is considered, and also the analysis of introduction of the mentioned system at the Russian enterprises is carried out. Besides, the key conditions necessary for successful introduction of system are presented. Lean management is a world-spread way of solving the problems, aimed at making the company competitive; it is the organized activity of staff of the company, fo...

  17. A Practical Standardized Composite Nutrition Score Based on Lean Tissue Index: Application in Nutrition Screening and Prediction of Outcome in Hemodialysis Population.

    Science.gov (United States)

    Chen, Huan-Sheng; Cheng, Chun-Ting; Hou, Chun-Cheng; Liou, Hung-Hsiang; Chang, Cheng-Tsung; Lin, Chun-Ju; Wu, Tsai-Kun; Chen, Chang-Hsu; Lim, Paik-Seong

    2017-07-01

    Rapid screening and monitoring of nutritional status is mandatory in hemodialysis population because of the increasingly encountered nutritional problems. Considering the limitations of previous composite nutrition scores applied in this population, we tried to develop a standardized composite nutrition score (SCNS) using low lean tissue index as a marker of protein wasting to facilitate clinical screening and monitoring and to predict outcome. This retrospective cohort used 2 databases of dialysis populations from Taiwan between 2011 and 2014. First database consisting of data from 629 maintenance hemodialysis patients was used to develop the SCNS and the second database containing data from 297 maintenance hemodialysis patients was used to validate this developed score. SCNS containing albumin, creatinine, potassium, and body mass index was developed from the first database using low lean tissue index as a marker of protein wasting. When applying this score in the original database, significantly higher risk of developing protein wasting was found for patients with lower SCNS (odds ratio 1.38 [middle tertile vs highest tertile, P < .0001] and 2.40 [lowest tertile vs middle tertile, P < .0001]). The risk of death was also shown to be higher for patients with lower SCNS (hazard ratio 4.45 [below median level vs above median level, P < .0001]). These results were validated in the second database. We developed an SCNS consisting of 4 easily available biochemical parameters. This kind of scoring system can be easily applied in different dialysis facilities for screening and monitoring of protein wasting. The wide application of body composition monitor in dialysis population will also facilitate the development of specific nutrition scoring model for individual facility. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  18. 11Beta-HSD type 1 expression in human adipose tissue: impact of gender, obesity, and fat localization

    DEFF Research Database (Denmark)

    Paulsen, Søren Kildeberg; Pedersen, Steen Bønløkke; Fisker, Sanne

    2007-01-01

    of the metabolic syndrome. Our objective was to compare 11beta-HSD1 gene expression in different fat depots (visceral, subcutaneous abdominal, and subcutaneous gluteal) in lean and obese men and women. RESEARCH METHODS AND PROCEDURES: A cross-sectional study design was used for healthy patients undergoing minor...... abdominal surgery (lean men, 10), minor gynecological surgery (lean woman, 10), or gastric banding operations (obese men, 10; and obese women, 10). Gene expressions of 11beta-HSD1 in adipose tissue samples were determined by real-time reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: Lean...... women had lower 11beta-HSD1 gene expression in subcutaneous adipose tissue compared with men (62% lower, p women. 11Beta-HSD1 mRNA in human adipose tissue was higher in obese subjects compared with lean subjects in both women...

  19. Aesthetic refinements in reconstructive microsurgery of the lower leg.

    Science.gov (United States)

    Rainer, Christian; Schwabegger, Anton H; Gardetto, Alexander; Schoeller, Thomas; Hussl, Heribert; Ninkovic, Milomir M

    2004-02-01

    Even if a surgical procedure is performed for reconstructive and functional reasons, a plastic surgeon must be responsible for the visible result of the work and for the social reintegration of the patient; therefore, the aesthetic appearance of a microsurgically reconstructed lower leg must be considered. Based on the experience of 124 free-tissue transfers to the lower leg performed in 112 patients between January 1994 and March 2001 (110 [88.7 percent] were transferred successfully), three cases are presented. Considerations concerning flap selection and technical refinements in designing and tailoring microvascular flaps to improve the quality of reconstruction, also according to the aesthetic appearance, are discussed.

  20. Leg contracture in mice after single and multifractionated 137Cs exposure

    International Nuclear Information System (INIS)

    Masuda, K.; Hunter, N.; Stone, H.B.; Withers, H.R.

    1987-01-01

    This is a report of studies of time-dose relationships for post-irradiation leg contractures in mice. The isoeffect doses for various degrees of contracture, measured 250 days after irradiation, increased with the number of fractions, but not with the overall treatment times, throughout 30 days. The isoeffect curves relating the total doses for given levels of responses to the doses per fraction were steeper for leg contractures than for acute skin reactions. The alpha/beta ratios ranged from 1.4 to 5.0 Gy, depending on the degrees of contracture. They were less than the 7.5 to 50 Gy for acute skin reactions as determined in previous experiments using the same animals and irradiation systems. Thus, the data resembled those from other slowly-responding normal tissues such as the spinal cord, kidney and lung. The leg contracture consisted of dermatogenic, myogenic, and arthrogenic components; after the mice were sacrificed there was residual contracture following removal of the skin and muscle. Inhibition of bone growth accounted for only a small proportion of the contracture. The overall response reflected responses of several tissue types

  1. Leg contracture in mice after single and multifractionated 137Cs exposure

    Energy Technology Data Exchange (ETDEWEB)

    Masuda, K.; Hunter, N.; Stone, H.B.; Withers, H.R.

    1987-08-01

    This is a report of studies of time-dose relationships for post-irradiation leg contractures in mice. The isoeffect doses for various degrees of contracture, measured 250 days after irradiation, increased with the number of fractions, but not with the overall treatment times, throughout 30 days. The isoeffect curves relating the total doses for given levels of responses to the doses per fraction were steeper for leg contractures than for acute skin reactions. The alpha/beta ratios ranged from 1.4 to 5.0 Gy, depending on the degrees of contracture. They were less than the 7.5 to 50 Gy for acute skin reactions as determined in previous experiments using the same animals and irradiation systems. Thus, the data resembled those from other slowly-responding normal tissues such as the spinal cord, kidney and lung. The leg contracture consisted of dermatogenic, myogenic, and arthrogenic components; after the mice were sacrificed there was residual contracture following removal of the skin and muscle. Inhibition of bone growth accounted for only a small proportion of the contracture. The overall response reflected responses of several tissue types.

  2. Nocturnal variations in lower-leg subcutaneous blood flow in paraplegic men

    DEFF Research Database (Denmark)

    Sindrup, J H; Wroblewski, H; Kastrup, J

    1992-01-01

    1. Lower-leg subcutaneous adipose tissue blood flow rates were measured over 12-20 h under ambulatory conditions by means of the 133Xe-washout technique in nine paraplegic men, all with complete spinal cord lesions at or below the Th 6 level, and in nine age-matched healthy men. Portable Cd......Te(Cl) detectors and data-storage units were used. 2. The central and local sympathetic vasoconstrictive activity at the lower leg was measured under laboratory conditions by means of the 133Xe-washout technique and a stationary NaI(Tl) detector system. 3. The paraplegic men were found to have intact central...... the paraplegic men suffered from complete lower-leg somaesthetic denervation. 5. A significant correlation was found between the time of going to bed and the nightly hyperaemic response in the right and left lower legs (P less than 0.01). 6. It is concluded that the present data are in accordance...

  3. Diurnal variations in lower leg subcutaneous blood flow rate in patients with chronic venous leg ulcers

    DEFF Research Database (Denmark)

    Sindrup, J H; Kastrup, J; Kristensen, J K

    1991-01-01

    The blood flow rate in subcutaneous adipose tissue was measured on the lower legs of 11 patients with chronic lower-leg venous insufficiency and ulceration and in eight age-matched control subjects for 12-20 h, under ambulatory conditions, using the 133Xe wash-out technique with portable Cadmium...... telluride (CdTe(Cl)) detectors. In both groups, the change from an upright to a supine position at the beginning of the night period elicited an instantaneous increment in the blood flow rate of 30-40% with a decrease in the central and local postural sympathetic vasoconstrictor activity. After...... approximately 1 h of sleep, a considerable increase in blood flow rate was seen in both patient and control groups which persisted for nearly 100 min. In the patient group, the mean increase was 137% compared to a mean increase of 68% in the control group (P less than 0.01). The blood flow then returned...

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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,…

  6. The maintenance management for lean organization

    Directory of Open Access Journals (Sweden)

    Daniel D. GEORGESCU

    2010-12-01

    Full Text Available The goal of lean maintenance approach is to maintain organization international competitiveness. In the spirit of continuously improvement, in the paper it is shown how by adjusting some Lean manufacturing specific techniques for Total Productive Maintenance (TPM system, was born new maintenance system named Lean TPM. This is a systemic approach with three techniques, which don’t exclude specific techniques of TPM pillars, but complete them: the 7Ss as a critical first step in any improvement program; instantaneous maintenance; improvement setup operations. In the spirit of Lean principle, Lean TPM adjusts overall equipment effectiveness concept for all supply-chain from supplier to customer. Maintaining equipment in its optimal state and continually improving its productivity is the whole strategy behind Lean TPM.

  7. CALCANEAL MINERAL DENSITY IN CHILDREN ATHLETES AND TAKE-OFF LEG

    Directory of Open Access Journals (Sweden)

    Borislav Obradović

    2010-06-01

    Full Text Available It is well-known that physical activity has an anabolic effect on the bone tissue. To examine the influence of the take-off lower limb to the bone density we studied a group of prepubertal boys and girls at the initial phase of their peak bone mass acquisition. A sample consisted of 60 subjects ie., 32 soccer players (boys, 10.7±0.5 years old and 28 swimmers (15 girls and 13 boys, 10.8±0.8 years old, who had performed at least one year of high-level sport training (10-15 hours per week for soccer players, 8-12 hours per week for swimmers. The sample was divided into two groups: the first consisted of 40 subjects, with the left take-off leg, while the second consisted of 20 subjects, with the right take-off leg. The bone mineral density (BMD measurements of the left and the right calcaneus were performed using ultrasound densitometer “Sahara” (Hologic, Inc., MA, USA. There were no significant differences between the groups in regard to BUA and SOS of both the left and the right take-off lower legs. Mean BUA of the take-off left leg and the take-off right leg were different, but not significantly (p>0.05. Likewise, mean SOS of the take-off left leg and the take-off right leg were different, but it was not significant (p>0.05. The results do not indicate that the take-off lower limb has an influence on calcaneal bone mineral density.

  8. Report of a man with heterotopic ossification of the legs.

    Science.gov (United States)

    García-Arpa, Mónica; Flores-Terry, Miguel A; Franco-Muñoz, Monserrat; Villasanti-Rivas, Natalia; González-Ruiz, Lucía; Banegas-Illescas, M Eugenia

    2018-05-21

    Heterotopic ossification is an uncommon disorder that consists of deposition of ectopic bone outside the extraskeletal tissues. In the skin, it can be primary, in association with genetic syndromes, or be secondary to different disorders. The latter include subcutaneous ossification of the legs in chronic venousinsufficiency, an infrequent and unrecognized complication. We report the case of a patient with subcutaneous ossification of both legs secondary to venous insufficiency and review the literature. Copyright © 2018 Sociedad Española de Reumatologña y Colegio Mexicano de Reumatologña. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. The human side of lean teams.

    Science.gov (United States)

    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.

  10. Industry 4.0 implies lean manufacturing: Research activities in industry 4.0 function as enablers for lean manufacturing

    Directory of Open Access Journals (Sweden)

    Adam Sanders

    2016-09-01

    Full Text Available Purpose: Lean Manufacturing is widely regarded as a potential methodology to improve productivity and decrease costs in manufacturing organisations. The success of lean manufacturing demands consistent and conscious efforts from the organisation, and has to overcome several hindrances. Industry 4.0 makes a factory smart by applying advanced information and communication systems and future-oriented technologies. This paper analyses the incompletely perceived link between Industry 4.0 and lean manufacturing, and investigates whether Industry 4.0 is capable of implementing lean. Executing Industry 4.0 is a cost-intensive operation, and is met with reluctance from several manufacturers. This research also provides an important insight into manufacturers’ dilemma as to whether they can commit into Industry 4.0, considering the investment required and unperceived benefits. Design/methodology/approach: Lean manufacturing is first defined and different dimensions of lean are presented. Then Industry 4.0 is defined followed by representing its current status in Germany. The barriers for implementation of lean are analysed from the perspective of integration of resources. Literatures associated with Industry 4.0 are studied and suitable solution principles are identified to solve the abovementioned barriers of implementing lean. Findings: It is identified that researches and publications in the field of Industry 4.0 held answers to overcome the barriers of implementation of lean manufacturing. These potential solution principles prove the hypothesis that Industry 4.0 is indeed capable of implementing lean. It uncovers the fact that committing into Industry 4.0 makes a factory lean besides being smart. Originality/value: Individual researches have been done in various technologies allied with Industry 4.0, but the potential to execute lean manufacturing was not completely perceived. This paper bridges the gap between these two realms, and identifies

  11. Lean Production Applications in a Manufacturing Company

    OpenAIRE

    Ali Görener; Humeyra Baser; Ali Turkyilmaz

    2013-01-01

    Lean production is a production model which comes about the pursuit of companies to be able to meet competition and make effective production. The main purpose of lean production is to get control about the wastage. This study includes the requirements for the success of the lean production and how the lean production system can be established. In this paper, lean production techniques were applied to the electric water heater line. Measurements using lean initiatives were made, operation cyc...

  12. Objective assessment of leg edema using ultrasonography with a gel pad

    Science.gov (United States)

    Iuchi, Terumi; Tsuchiya, Sayumi; Ohno, Naoki; Dai, Misako; Matsumoto, Masaru; Ogai, Kazuhiro; Sato, Aya; Sawazaki, Takuto; Miyati, Tosiaki; Tanaka, Shinobu; Sugama, Junko

    2017-01-01

    Ultrasonography (US) is useful for visual detection of edematous tissues to assess subcutaneous echogenicity. However, visualization of subcutaneous echogenicity is interpreted differently among operators because the evaluation is subjective and individual operators have unique knowledge. This study objectively assessed leg edema using US with a gel pad including fat for normalization of echogenicity in subcutaneous tissue. Five younger adults and four elderly people with leg edema were recruited. We compared assessments of US and limb circumference before and after the intervention of vibration to decrease edema in younger adults, and edema prior to going to sleep and reduced edema in the early morning in elderly people. These assessments were performed twice in elderly people by three operators and reliability, interrater differences, and bias were assessed. For US assessment, echogenicity in subcutaneous tissue was normalized to that of the gel pad by dividing the mean echogenicity of subcutaneous tissue by the mean echogenicity of the gel pad. In younger adults, the normalized subcutaneous echogenicity before the intervention was significantly higher than that after the intervention. In elderly people, echogenicity indicating edema was significantly higher than that after edema reduction. Edema was detected with accuracy rates of 76.9% in younger adults and 75.0% in elderly people. Meanwhile, limb circumference could be used to detect edema in 50.0% of healthy adults and 87.8% of elderly people. The intra-reliability was excellent (intraclass correlation coefficient > 0.9, p 0.7, p edema with high reliability. Therefore, this method has the potential to become a new gold standard for objective assessment of leg edema in clinical practice. PMID:28792959

  13. Lean Production Applications in a Manufacturing Company

    Directory of Open Access Journals (Sweden)

    Ali Görener

    2016-01-01

    Full Text Available Lean production is a production model which comes about the pursuit of companies to be able to meet competition and make effective production. The main purpose of lean production is to get control about the wastage. This study includes the requirements for the success of the lean production and how the lean production system can be established. In this paper, lean production techniques were applied to the electric water heater line. Measurements using lean initiatives were made, operation cycle times were determined, and Kaizen improvement methods and line balancing methods were applied according to the results. And the last section of study showed conclusion of lean implementation.

  14. The lean service machine.

    Science.gov (United States)

    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.

  15. Establishment of an animal model of mice with radiation- injured soft tissue blood vessels

    International Nuclear Information System (INIS)

    Wang Daiyou; Yu Dahai; Wu Jiaxiao; Wei Shanliang; Wen Yuming

    2004-01-01

    Objective: The aim of this study was to establish an animal model of mice with radiation-injured soft tissue blood vessels. Methods: Forty male mice were irradiated with 30 Gy on the right leg. After the irradiation was finished each of the 40 male mice was tested with angiography, and its muscle tissues on the bilateral legs were examined with vessel staining assay and electron microscopy. Results: The results showed that the number of vessels on the right leg was less than that on the left leg, the microvessel density, average diameter and average sectional area of the right leg were all lower than those of the left, and the configuration and ultra-structure of vessels were also different between both sides of legs. Conclusion: In the study authors successfully established an animal model of mice with radiation-injured soft tissue blood vessels

  16. Training for successful lean manufacturing implementation

    OpenAIRE

    Ichimura, Maki; Jahankhani, Hamid; Arunachalam, Subramaniam

    2006-01-01

    Implementing lean manufacturing is a complex and everlasting task. The workers involving in production processes are the pivot of the lean manufacturing implementation. Training is known as a vehicle to assist the implementation process. Despite awareness of the training importance, so far, a little is available to assist to organise an efficient training. This paper summarises the overview of lean manufacturing and discuss the importance of human resource within lean implementation process. ...

  17. Adiponectin and leptin in overweight/obese and lean women with polycystic ovary syndrome.

    Science.gov (United States)

    Chen, Chin-I; Hsu, Ming-I; Lin, Shyh-Hsiang; Chang, Yuan-Chin I; Hsu, Chun-Sen; Tzeng, Chii-Ruey

    2015-04-01

    The objective of this study was to evaluate the adiponectin and leptin levels in overweight/obese and lean women with polycystic ovary syndrome (PCOS). This was a retrospective study. Of the 422 studied patients, 224 women with PCOS and 198 women without PCOS were evaluated. Insulin resistance and the metabolic components were assessed. The adiponectin and leptin levels were also evaluated. Adiponectin was negatively correlated with insulin resistance, body mass index (BMI), and total testosterone, triglyceride, and low-density lipoprotein (LDL) levels; conversely, leptin reversed the aforementioned reaction and was negatively correlated with adiponectin levels. The adiponectin to leptin ratios were significantly lower in PCOS women than in those without PCOS. Compared to women with non-PCOS, overweight/obese women with PCOS had lower serum adiponectin levels than women without PCOS, which was not the case for lean women. Conversely, lean women with PCOS had higher serum leptin levels than those without PCOS, which was not the case for overweight/obese women. Adipose tissue might play an important role in the metabolic complications in women with PCOS. To study the impact of obesity biomarkers in women with PCOS, overweight/obese and lean women should be considered separately.

  18. Lean Six Sigma in financial services

    NARCIS (Netherlands)

    de Koning, H.; Does, R.J.M.M.; Bisgaard, S.

    2008-01-01

    Lean Thinking and Six Sigma are typically considered as separate approaches to process innovation, with complementary strengths. When combined as Lean Six Sigma, this approach provides a unified framework for systematically developing innovations. Lean Six Sigma can also bring about significant

  19. Healthy Lean Through HRD

    DEFF Research Database (Denmark)

    Jørgensen, Frances

    2008-01-01

    The paper reports on findings from the initial, exploratory phase of a longitudinal research study aimed at developing a framework for implementing lean while ensuring employee well-being. Data from observations and in-depth dialogues with persons involved in lean implementation, along...

  20. Decreased muscle oxygenation and increased arterial blood flow in the non-exercising limb during leg exercise.

    Science.gov (United States)

    Shiroishi, Kiyoshi; Kime, Ryotaro; Osada, Takuya; Murase, Norio; Shimomura, Kousuke; Katsumura, Toshihito

    2010-01-01

    We evaluated arterial blood flow, muscle tissue oxygenation and muscle metabolism in the non-exercising limb during leg cycling exercise. Ten healthy male volunteers performed a graded leg cycling exercise at 0, 40, 80, 120 and 160 watts (W) for 5 min each. Tissue oxygenation index (TOI) of the non-exercising left forearm muscle was measured using a near-infrared spatially resolved spectroscopy (NIR(SRS)), and non-exercising forearm blood flow ((NONEX)FBF) in the brachial artery was also evaluated by a Doppler ultrasound system. We also determined O(2) consumption of the non-exercising forearm muscle (NONEXV(O)(2mus)) by the rate of decrease in O(2)Hb during arterial occlusion at each work rate. TOI was significantly decreased at 160 W (p exercising muscle may be reduced, even though (NONEX)FBF increases at high work rates during leg cycling exercise.

  1. Lean management - an effective way to arrange maintenance?; Lean Management - ein effektiver Weg zur Gestaltung der Instandhaltung?

    Energy Technology Data Exchange (ETDEWEB)

    Tschuschke, W. [Inst. fuer Instandhaltung gGmbH, Iserlohn (Germany)

    1996-08-01

    Lean management/lean production wishes to attain more through intelligent operation system/production at less expense (personnel, materials, energy, costs). The object is not harder but more intelligent and production work; we do not need to run faster but to find shorter routes. The idea of lean management`s effects and changes have consequences for the field of maintenance as an equivalent and legitimate business area which are discussed in this paper. (orig.) [Deutsch] Lean Management/Lean Production will durch ein intelligentes Arbeitssystem/Produzieren mit weniger Aufwand (Personal, Material, Energie, Kosten) mehr erreichen. Ziel ist nicht das haertere, sondern das intelligentere und produktivere Arbeiten; wir sollen nicht schneller laufen, sondern kuerzere Wege finden. Fuer den Bereich Instandhaltung als gleichwertiger und gleichberechtigter Unternehmensbereich haben die Gedanken des Lean Managements Auswirkungen und Veraenderungen zur Folge, die im Beitrag genannt werden. (orig.)

  2. The Relationship among Leg Strength, Leg Power and Alpine Skiing Success.

    Science.gov (United States)

    Gettman, Larry R.; Huckel, Jack R.

    The purpose of this study was to relate leg strength and power to alpine skiing success as measured by FIS points. Isometric leg strength was represented by the knee extension test described by Clarke. Leg power was measured by the vertical jump test and the Margaria-Kalamen stair run. Results in the strength and power tests were correlated with…

  3. Lean manufacturing in Indian context: A survey

    Directory of Open Access Journals (Sweden)

    Rakesh Kumar

    2015-04-01

    Full Text Available This paper is an attempt to examine the implementation of Lean Manufacturing system in the Indian industries. Predominant elements of Lean Manufacturing, benefits gained after its implementation and obstacles observed by Indian Industry have been recognized. The results of this survey support the opinion that Lean Manufacturing had potential to improve the organizational performance of Indian industries. Nevertheless, Indian industries are required to be passionate to transform their manufacturing by adopting Lean manufacturing to gain the full benefits. A large numbers of literature papers are available on the better side of Lean manufacturing approach and its benefits gained by manufacturing organizations after implementation. But the adverse impacts of Lean manufacturing are not discussed to a great extent. Some drawbacks of Lean manufacturing are also highlighted in this paper.

  4. The Finnish healthcare services lean management.

    Science.gov (United States)

    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

  5. Expression of 11beta-hydroxysteroid dehydrogenase 1 and 2 in subcutaneous adipose tissue of lean and obese women with and without polycystic ovary syndrome

    DEFF Research Database (Denmark)

    Svendsen, P F; Madsbad, S; Nilas, L

    2009-01-01

    OBJECTIVE: To investigate the expression of 11beta-hydroxysteroid dehydrogenase (11beta-HSD) type 1 and 2 and hexose-6-phosphate dehydrogenase (H6PDH) mRNA in subcutaneous abdominal tissue from lean and obese women with and without polycystic ovary syndrome (PCOS), and to investigate...... assessment insulin resistance index. Body composition was evaluated by dual X-ray absorptiometry. Adipose mRNA expression of leptin and adiponectin were determined by real-time PCR. RESULTS: Polycystic ovary syndrome (P... distribution (PPolycystic ovary syndrome and obesity are independently associated with increased expression of 11beta-HSD1. This may lead to increased conversion of cortisone to cortisol...

  6. Skaber lean bedre arbejdsmiljø?

    DEFF Research Database (Denmark)

    Hansen, Nanette Juhler

    2007-01-01

    rationalization strategies, among others Lean, claim to improve working conditions. The aim of this thesis is to identify whether the application of Lean strategies leads to a reduction of the occupational health and safety problem repetitive work. Repetitive work is a problem created by the Taylorisation of work......, and therefore it is to be expected that a break with one or more of the Tayloristic principles can lead to a reduction of repetitive work. This thesis points out a number of areas within which Lean breaks with Tayloristic principles, whilst other principles are maintained. These breaks between Lean...... and Taylorism are also found in the study of the case company. By linking breaks with Taylorism with solutions for the reduction of repetitive work, I point out a number of openings in Lean that may lead to a reduction of repetitive work. By using the concept of openings I present the possibilities offered...

  7. TOWARDS GREEN THROUGH LEAN/LEAN SIX SIGMA APPROACHES: A LITERATURE REVIEW AT SERVICE INDUSTRY

    Directory of Open Access Journals (Sweden)

    RODRIGO GOYANNES GUSMÃO CAIADO

    2017-08-01

    Full Text Available In the last decades, sustainable development have increasingly gained importance to service industry and lean/Six Sigma approaches are becoming more and more outstanding in order to improve sustainability performance. In the post-modern era the integration between those approaches are necessary in order to aid organisations to balance the need for operational efficiency in their production and service systems with environmental commitment and social fairness. Because of that, Lean Six Sigma practices are progressively becoming widespread in studies about service, as way to improve quality, efficiency, effectiveness and sustainability of services. The purpose of this paper is to critically review the Lean and Lean Six Sigma (L6σ methodologies and highlight their importance to achieve sustainable development in service industry. To do this, a systematic literature review (SLR of the subjects under investigation was conducted. We examine the compatibility and divergences of the green, lean and Six Sigma concepts and implications regarding its sustainable implementation in service industry. The study has two major contributions. First, it is one of the first researches that investigate the potential benefits of integrating green, lean and Six Sigma in service sector. Second, it supports and expands current literature, providing both academicians and practitioners a better panorama to understand the present status of L6σ for achieving sustainability in service sector.

  8. Testosterone therapy preserves muscle strength and power in aging men with type 2 diabete

    DEFF Research Database (Denmark)

    Magnussen, L V; Hvid, L G; Hermann, A P

    2017-01-01

    dual-energy X-ray absorptiometry (total lean body mass, lean leg mass, total fat mass, leg fat mass). Levels of total testosterone (TotalT), BioT, free testosterone (FreeT), and sex hormone-binding globulin were measured from fasting blood samples. Coefficients (b) represent the placebo-controlled mean......The purpose of the study was to evaluate whether testosterone replacement therapy improves muscle mechanical and physical function in addition to increasing lean leg mass and total lean body mass in aging men with type 2 diabetes and lowered bio-available testosterone (BioT) levels. Thirty-nine men.......9 kg, p = 0.001) and lean leg mass (b = 0.5 kg, p mass (b = -1.3 kg, p = 0.009) and leg fat mass (b = -0.7 kg, p = 0.025) decreased during testosterone replacement therapy compared with placebo. Total T (b = 14.5 nmol/L, p = 0.056), BioT (b = 7.6 nmol/L, p = 0...

  9. Testosterone therapy preserves muscle strength and power in aging men with type 2 diabetes - a randomized controlled trial

    DEFF Research Database (Denmark)

    Magnussen, Line Velling; Hvid, Lars Næsby; Hermann, Anne Pernille

    2017-01-01

    dual-energy X-ray absorptiometry (total lean body mass, lean leg mass, total fat mass, leg fat mass). Levels of total testosterone (TotalT), BioT, free testosterone (FreeT), and sex hormone-binding globulin were measured from fasting blood samples. Coefficients (b) represent the placebo-controlled mean......The purpose of the study was to evaluate whether testosterone replacement therapy improves muscle mechanical and physical function in addition to increasing lean leg mass and total lean body mass in aging men with type 2 diabetes and lowered bio-available testosterone (BioT) levels. Thirty-nine men.......9 kg, p = 0.001) and lean leg mass (b = 0.5 kg, p mass (b = -1.3 kg, p = 0.009) and leg fat mass (b = -0.7 kg, p = 0.025) decreased during testosterone replacement therapy compared with placebo. Total T (b = 14.5 nmol/L, p = 0.056), BioT (b = 7.6 nmol/L, p = 0...

  10. Exploiting HRM in support of lean manufacturing

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Matthiesen, Rikke

    The purpose of this paper is to investigate the ways in HRM practices are-and could potentially be-exploited to support lean manufacturing in practice. First, a review of the pertinent literature regarding HRM, SHRM, and lean manufacturing is presented to provide an understanding of the mechanisms...... by which HRM practices could, theoretically, be used to support a lean implementation. Data presented in the paper are derived from 1) a longitudinal case study on lean implementation and 2) from managers currently involved with lean manufacturing in a second company. The relevant literature and the data...... depicting the potential role in supporting HRM/lean integrated practices. The analysis of the model with respect to the theoretical background emphasizes a number of areas in which HRM could be more fully exploited in order to more successfully support lean implementation, for example, by stressing HRM...

  11. Lean Transformation Guidance: Why Organizations Fail To Achieve and Sustain Excellence Through Lean Improvement

    OpenAIRE

    Mohammed Hamed Ahmed

    2013-01-01

    Many companies are complaining that lean didn’t achieve their long-term goals, and the improvement impact was very short-lived. 7 out of each 10 lean projects fail as companies try to use lean like a toolkit, copying and pasting the techniques without trying to adapt the employee’s culture, manage the improvement process, sustain the results, and develop their leaders. When the Toyota production system was created, the main goal was to remove wastes from the shop floor us...

  12. An empirical review of lean manufacturing and their strategies

    Directory of Open Access Journals (Sweden)

    Virender Chahal

    2017-07-01

    Full Text Available The theory of lean manufacturing provides the quality of the products in minimum cost and pro-vides customer satisfaction. Today, the competition level is very high and every industry tries to supply high quality products in nominal cost, so lean is the latest tool to achieve. The objective of this paper is to study different lean concepts under various lean strategies. This study helps to find out the status of lean manufacturing and its ways of implementation. Also in this paper, there is a discussion about lean manufacturing concept, lean waste, lean strategies, lean barriers and cycle of lean implementation. This paper presents a literature review to clear the status of lean manufacturing and their strategies with help of collection of relevant papers.

  13. Implementing Lean Health Reforms in Saskatchewan

    Directory of Open Access Journals (Sweden)

    Greg Marchildon

    2013-07-01

    Full Text Available Saskatchewan has gone further than any other Canadian province in implementing health system process improvements using Lean, a production line discipline that originated with the automobile industry. The goal of the Lean reform is to reduce waste and improve quality and overall health system performance by long-term changes in behaviour. Lean enjoys a privileged position on the provincial government’s agenda because of the policy’s championing by the Deputy Minister of Health and the policy’s fit with the government’s patient-centred care agenda. The implementation of reform depends on a major investment of time in the training and Lean-certification of key leaders and managers in the provincial health system. The Saskatchewan Union of Nurses, the union representing the single largest group of health workers in the province, has agreed to co-operate with the provincial government in implementing Lean-type reforms. Thus far, the government has had limited independent evaluation of Lean while internal evaluations claim some successes.

  14. The one-leg standing radiograph

    OpenAIRE

    Pinsornsak, P.; Naratrikun, K.; Kanitnate, S.; Sangkomkamhang, T.

    2016-01-01

    Objectives The purpose of this study was to compare the joint space width between one-leg and both-legs standing radiographs in order to diagnose a primary osteoarthritis of the knee. Methods Digital radiographs of 100 medial osteoarthritic knees in 50 patients were performed. The patients had undergone one-leg standing anteroposterior (AP) views by standing on the affected leg while a both-legs standing AP view was undertaken while standing on both legs. The severity of the osteoarthritis wa...

  15. Changes in UCP expression in tissues of Zucker rats fed diets with different protein content.

    Science.gov (United States)

    Masanés, R M; Yubero, P; Rafecas, I; Remesar, X

    2002-09-01

    The effect of dietary protein content on the uncoupling proteins (UCP) 1, 2 and 3 expression in a number of tissues of Zucker lean and obese rats was studied. Thirty-day-old male Zucker lean (Fa/?) and obese (fa/fa) rats were fed on hyperproteic (HP, 30% protein), standard (RD, 17% protein) or hypoproteic (LP, 9% protein) diets ad libitum for 30 days. Although dietary protein intake affected the weights of individual muscles in lean and obese animals, these weights were similar. In contrast, huge differences were observed in brown adipose tissue (BAT) and liver weights. Lean rats fed on the LP diet generally increased UCP expression, whereas the HP group had lower values. Obese animals, HP and LP groups showed higher UCP expression in muscles, with slight differences in BAT and lower values for UCP3 in subcutaneous adipose tissue. The mean values of UCP expression in BAT of obese rats were lower than in their lean counterpart, whereas the expression in skeletal muscle was increased. Thus, expression of UCPs can be modified by dietary protein content, in lean and obese rats. A possible thermogenic function of UCP3 in muscle and WAT in obese rats must be taken into account.

  16. Increased protein intake reduces lean body mass loss during weight loss in athletes.

    Science.gov (United States)

    Mettler, Samuel; Mitchell, Nigel; Tipton, Kevin D

    2010-02-01

    To examine the influence of dietary protein on lean body mass loss and performance during short-term hypoenergetic weight loss in athletes. In a parallel design, 20 young healthy resistance-trained athletes were examined for energy expenditure for 1 wk and fed a mixed diet (15% protein, 100% energy) in the second week followed by a hypoenergetic diet (60% of the habitual energy intake), containing either 15% (approximately 1.0 g x kg(-1)) protein (control group, n = 10; CP) or 35% (approximately 2.3 g x kg(-1)) protein (high-protein group, n = 10; HP) for 2 wk. Subjects continued their habitual training throughout the study. Total, lean body, and fat mass, performance (squat jump, maximal isometric leg extension, one-repetition maximum (1RM) bench press, muscle endurance bench press, and 30-s Wingate test) and fasting blood samples (glucose, nonesterified fatty acids (NEFA), glycerol, urea, cortisol, free testosterone, free Insulin-like growth factor-1 (IGF-1), and growth hormone), and psychologic measures were examined at the end of each of the 4 wk. Total (-3.0 +/- 0.4 and -1.5 +/- 0.3 kg for the CP and HP, respectively, P = 0.036) and lean body mass loss (-1.6 +/- 0.3 and -0.3 +/- 0.3 kg, P = 0.006) were significantly larger in the CP compared with those in the HP. Fat loss, performance, and most blood parameters were not influenced by the diet. Urea was higher in HP, and NEFA and urea showed a group x time interaction. Fatigue ratings and "worse than normal" scores on the Daily Analysis of Life Demands for Athletes were higher in HP. These results indicate that approximately 2.3 g x kg(-1) or approximately 35% protein was significantly superior to approximately 1.0 g x kg(-1) or approximately 15% energy protein for maintenance of lean body mass in young healthy athletes during short-term hypoenergetic weight loss.

  17. Single-leg squats can predict leg alignment in dancers performing ballet movements in "turnout".

    Science.gov (United States)

    Hopper, Luke S; Sato, Nahoko; Weidemann, Andries L

    2016-01-01

    The physical assessments used in dance injury surveillance programs are often adapted from the sports and exercise domain. Bespoke physical assessments may be required for dance, particularly when ballet movements involve "turning out" or external rotation of the legs beyond that typically used in sports. This study evaluated the ability of the traditional single-leg squat to predict the leg alignment of dancers performing ballet movements with turnout. Three-dimensional kinematic data of dancers performing the single-leg squat and five ballet movements were recorded and analyzed. Reduction of the three-dimensional data into a one-dimensional variable incorporating the ankle, knee, and hip joint center positions provided the strongest predictive model between the single-leg squat and the ballet movements. The single-leg squat can predict leg alignment in dancers performing ballet movements, even in "turned out" postures. Clinicians should pay careful attention to observational positioning and rating criteria when assessing dancers performing the single-leg squat.

  18. Standardized uptake value of FDG corrected by lean body mass measured by DEXA

    International Nuclear Information System (INIS)

    Guirao, M.A.; Sanchez, A.M.; Saravi, F.D.; Mosconi, S.; Frias, L.

    2002-01-01

    Evaluating the metabolic activity of tumor lesion sometimes becomes important to evaluate grading of malignancy, prognosis, or response to therapy. The most used measure of the metabolic activity of [18F]-Fluorodeoxiglucose (FDG) in clinical PET is the Standardized Uptake Value (SUV). It relates the activity measured by the PET scan to the injected dose of FDG divided by the body mass. This approach overestimates SUV in 'heavy' patients, as the proportion of the 'low avid of FDG' fat mass increases. For this reason, different approaches are being evaluated to obtain a more accurate SUV measure. Aims: to compare the measured lean body mass by Dual X-Ray Absorptiometry with the previous methods of correction, to assess the more independent to the body constitution. Material and Methods: FDG metabolism was studied to 15 patients of both sexes, age between 28 and 72 y.o., body weight 55 to 92 Kg. One hour after the IV injection of 0.0045mCi/Kg of FDG, a whole body emission and transmission scan was performed to each subject in a positron emission tomograph (QUEST 250, GE-UGM, USA) for over 1 hour. Body lean mass composition was measured the same or next day by DEXA (Lunar DPX-L, USA.) ROIs were drawn on brain, liver and muscle. SUVbw =[(corrected mCi/g of tissue) / (mCi injected / body weight in grams)] was calculated for each tissue, and then recalculated replacing body weight with the measured lean body mass (SUVlm), calculated lean mass (SUVlc), body mass index (SUVmi) and body surface area (SUVsa). Corrected SUVs were normalized to each SUVbw average for a comparable visualization of results. Results: obtained data was analyzed by linear regression and curve estimation for each case in all tissues with the SPSS statistical software. A positive correlation between SUVbw and subject weight was confirmed for the 3 tissues. In Muscle and liver there was no significant correlation. The liver scanning time was variable ( 90 to 123 minutes after injection). Relating liver

  19. Lean in healthcare from employees' perspectives.

    Science.gov (United States)

    Drotz, Erik; Poksinska, Bozena

    2014-01-01

    The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations. The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies. The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers. Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations' working environment, staff development, and organizational performance. In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.

  20. Peritumoral adipose tissue as a source of inflammatory and angiogenic factors in colorectal cancer.

    Science.gov (United States)

    Amor, S; Iglesias-de la Cruz, M C; Ferrero, E; García-Villar, O; Barrios, V; Fernandez, N; Monge, L; García-Villalón, A L; Granado, M

    2016-02-01

    Obesity is a risk factor for the development of human colorectal cancer (CC). The aim of this work is to report the inflammatory and angiogenic scenario in lean (BMI  30 kg/m2) patients with and without CC and to assess the role of peritumoral adipose tissue in CC-induced inflammation. Patients were divided in four experimental groups: obese patients with CC (OB-CC), lean patients with CC (LEAN-CC), obese patients without CC (OB), and lean patients without CC (LEAN). Plasma levels of pro-inflammatory cytokines (interleukin (IL)-6, IL-4, IL-8) and granulocyte-macrophage colony-stimulating factor (GM-CSF) were increased in OB-CC patients. Peritumoral adipose tissue (TF) explants and cultured mature adipocytes secreted higher amounts of nitrites and nitrates than did control and non-tumoral (NTF) adipose tissue both alone and in response to lipopolysaccharide (LPS). Nitrite and nitrate secretion was also increased in TF explants from OB-CC patients compared with that from LEAN-CC patients. Gene expression of adiponectin, tumor necrosis factor alpha (TNF-α), insulin-like growth factor type I (IGF-I), cyclooxygenase-2 (COX-2), and peroxisome proliferator-activated receptor γ (PPAR-γ) was increased in TF explants from CC patients. LPS increased the gene expression of IL-6, IL-10, TNF-α, vascular endothelial growth factor (VEGF), and COX-2 in OB and in TF explants from OB-CC patients. COX-2 and PPAR-γ inhibition further increased LPS-induced release of nitrites and nitrates in TF explants and adipocytes from OB-CC patients. In conclusion, OB-CC patients have increased plasma levels of pro-inflammatory and angiogenic factors. TF from OB-CC patients shows an increased secretion of inflammatory markers compared with both TF from LEAN-CC and non-tumoral adipose tissue (AT) through a COX-2- and PPAR-γ-independent mechanism.

  1. Lean and the quality of work

    DEFF Research Database (Denmark)

    Jensen, Per Langaa

    2008-01-01

    Lean has for the last decade developed as the dominating model for developing productions processes not only within industry but also in health care, administration and service industries in general. With this development a discussion on human factors aspects of lean has developed internationally....... Literature studies documents that it is not possible to establish a clear relation between lean and the psychosocial aspects of work. The studies also indicate that the context and the implementations process play a dominating role in how lean is experienced. This has been the basis for establishing...

  2. Organizational change through Lean Thinking.

    Science.gov (United States)

    Tsasis, Peter; Bruce-Barrett, Cindy

    2008-08-01

    In production and manufacturing plants, Lean Thinking has been used to improve processes by eliminating waste and thus enhancing efficiency. In health care, Lean Thinking has emerged as a comprehensive approach towards improving processes embedded in the diagnostic, treatment and care activities of health-care organizations with cost containment results. This paper provides a case study example where Lean Thinking is not only used to improve efficiency and cost containment, but also as an approach to effective organizational change.

  3. Foot, leg, and ankle swelling

    Science.gov (United States)

    Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... Foot, leg, and ankle swelling is common when the person also: Is overweight Has a blood clot in the leg Is older Has ...

  4. Lean - set i et historisk perspektiv

    DEFF Research Database (Denmark)

    Michelsen, Aage U

    2006-01-01

    I kapitlet redegøres for, hvordan begrebet Lean opstod som en karakteristik af Toyota Production System (TPS), der igen har sin rod i scientific management. Gennem eksempler illustreres det, at centrale Lean-principper således har været anvendt i årtier. Der argumenteres for, at Lean i mange...

  5. A Case of Nonhealing Leg Ulcer: Basal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Didem Didar Balcı

    2008-06-01

    Full Text Available A 75-year-old woman was admitted to our outpatient clinic with a three-year history of a painless, nonhealing ulcer located on the left lower leg. She had no response to previous therapy with local wound care. Skin examination revealed an ulcer 2.7 x 3.7 cm in size, and the surrounding skin showed minimal erythema. The surface of the ulcer demonstrated shiny granulation tissue. Biopsy of the ulcer edge and base showed basal cell carcinoma. Venous Doppler ultrasonography and dermatological examination did not reveal chronic venous insufficiency. Basal cell carcinomas rarely arise from previous long-term ulcers or developing de novo. We suggest that patients who develop non-healing leg ulcers, should be examined for basal cell carcinoma.

  6. Modelling Lean and Green Supply Chain

    Science.gov (United States)

    Duarte, Susana Carla Vieira Lino Medina

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

  7. The Lean and Environment Toolkit

    Science.gov (United States)

    This Lean and Environment Toolkit assembles practical experience collected by the U.S. Environmental Protection Agency (EPA) and partner companies and organizations that have experience with coordinating Lean implementation and environmental management.

  8. Lean og professionel autonomi på hospitaler

    DEFF Research Database (Denmark)

    Hasle, Peter

    2014-01-01

    Hospitaler står overfor store udfordringer fra voksende krav fra både patienter og samfund samtidig med begrænsede budgetter og stadig flere medicinske muligheder. Hospitalsledelserne anvender lean som en af de væsentligste metoder til at løse disse udfordringer. Lean stammer imidlertid fra...... industrien, og det er spørgsmålet, hvordan lean bliver tilpasset i til en hospitalssammenhæng, og hvilke konsekvenser lean får for medarbejderne. Dette spørgsmål er undersøgt i forbindelse med introduktion af lean i en kræftafdeling på et universitetshospital. Det viste sig vanskeligere end forventet...... at implementere lean, og konsekvenserne for henholdsvis laboranter og sygeplejersker viste sig at være meget forskelligartede. Laboranterne oplevede et forbedret arbejdsmiljø, mens det modsatte var tilfældet for sygeplejerskerne. En mulig forklaring er, at lean øgede kontrollen over eget arbejde for laboranterne...

  9. Economic benefit of a polyacrylate-based hydrogel compared to an amorphous hydrogel in wound bed preparation of venous leg ulcers

    Directory of Open Access Journals (Sweden)

    Kaspar D

    2015-04-01

    Full Text Available Daniela Kaspar,1 Jörg Linder,1 Petra Zöllner,1 Ulrich Simon,2 Hans Smola1,31Medical Competence Centre, Paul Hartmann AG, Heidenheim, Germany; 2Scientific Computing Centre, Ulm University, Ulm, Germany; 3Department of Dermatology, University of Cologne, Cologne, GermanyObjective: To assess the cost-effectiveness of a polyacrylate (PA-based hydrogel compared to an amorphous hydrogel in wound bed preparation for venous leg ulcers.Method: A cost-effectiveness analysis was undertaken alongside a multicenter, randomized controlled trial performed in France. A total of 75 patients with venous leg ulcers extensively covered with fibrin and necrotic tissue were randomized to a PA-containing hydrogel or an amorphous hydrogel. Wounds were treated for 14 days and costs were estimated from the German payer's perspective. Medical costs included study treatment, wound treatment supply, and labor time. The clinical benefit was expressed as the number of patients with wounds >50% covered with granulation tissue within 14 days. The incremental cost-effectiveness ratio (ICER was expressed as the additional cost spent with >50% granulation tissue per day per patient within 14 days of leg ulcer care.Results: Because of individual pricing of wound dressings in hospitals, cost data were derived from the outpatient sector. A total of 33 patients were treated using the PA-based hydrogel and 37 patients using the amorphous hydrogel. The estimated total direct costs per patient and per 14 days of therapy were €306 for both treatment groups. However, with the PA-based hydrogel, 2.5 additional days with wounds covered >50% with granulation tissues were gained within 14 days of leg ulcer care compared to the comparator. The ICER was €0 per additional day spent with >50% granulation tissue.Conclusion: Although there were a greater number of dressing changes in the PA-based hydrogel treatment, the total treatment cost for 14 days of leg ulcer care was the same for both

  10. Lean automation development : applying lean principles to the automation development process

    OpenAIRE

    Granlund, Anna; Wiktorsson, Magnus; Grahn, Sten; Friedler, Niklas

    2014-01-01

    By a broad empirical study it is indicated that automation development show potential of improvement. In the paper, 13 lean product development principles are contrasted to the automation development process and it is suggested why and how these principles can facilitate, support and improve the automation development process. The paper summarises a description of what characterises a lean automation development process and what consequences it entails. Main differences compared to current pr...

  11. The Development Of A Theoretical Lean Culture Causal Framework To Support The Effective Implementation Of Lean In Automotive Component Manufacturers

    Directory of Open Access Journals (Sweden)

    Van der Merwe, Karl Robert

    2014-05-01

    Full Text Available Although it is generally accepted that lean manufacturing improves operational performance, many organisations are struggling to adapt to the lean philosophy. The purpose of this study is to contribute to a more effective strategy for implementing the lean manufacturing improvement philosophy. The study sets out both to integrate well-researched findings and theories related to generic organisational culture with more recent research and experience related to lean culture, and to examine the role that culture plays in the effective implementation of lean manufacturing principles and techniques. The ultimate aim of this exercise is to develop a theoretical lean culture causal framework.

  12. Prevalence and hemodynamic effects of leaning during CPR

    Science.gov (United States)

    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

  13. Lean Transformation Guidance: Why Organizations Fail To Achieve and Sustain Excellence Through Lean Improvement

    Directory of Open Access Journals (Sweden)

    Mohammed Hamed Ahmed

    2013-06-01

    Full Text Available Many companies are complaining that lean didn’t achieve their long-term goals, and the improvement impact was very short-lived. 7 out of each 10 lean projects fail as companies try to use lean like a toolkit, copying and pasting the techniques without trying to adapt the employee’s culture, manage the improvement process, sustain the results, and develop their leaders. When the Toyota production system was created, the main goal was to remove wastes from the shop floor using some lean techniques and tools. What was not clear is that this required from Toyota a long process of leadership development, and a high commitment to training and coaching their employee. A Failure to achieve and sustain the improvement is a problem of both management and leadership as well as the improper understanding of the human behavior, and the required culture to success.

  14. Lean management in a non-manufacturing organization

    Directory of Open Access Journals (Sweden)

    Mladen Žvorc

    2013-12-01

    Full Text Available This paper examines the possibilities of a lean approach to non-manufacturing functions, i.e. a market-oriented organization. This refers to purchasing, shipment, storage, sale and delivery of goods; marketing, etc. A lean approach to business operations is discussed and several lean business methods are developed on the basis of which lean management can be used not only in manufacturing, but also in non-manufacturing organizations.

  15. Lean in Air Permitting Guide

    Science.gov (United States)

    The Lean in Air Permitting Guide is designed to help air program managers at public agencies better understand the potential value and results that can be achieved by applying Lean improvement methods to air permitting processes.

  16. Lean-Prinzipien für verbesserte Kosteneffizienz: Instandhaltungseffizienz durch Lean Maintenance

    OpenAIRE

    Bandow, G.; Schmidt, A.

    2008-01-01

    Die Bedeutung der Instandhaltung nimmt weiter zu. In einem Lean Umfeld mit einer immer verschwendungsärmeren Produktion stehen nicht nur die Kosteneffizienz und Verfügbarkeit der Produktionsmittel im Fokus. Unplanmäßige Stillstände kosten Geld und gefährden häufig auch Personal und Produkt. Lean Maintenance vermeidet Verschwendung und optimiert so die Effektivität und Effizienz der Instandhaltung. Das zielgerichtete Zusammenspiel von Menschen, Prozessen und Technik garantiert dabei den Erfolg...

  17. TH-C-9A-01: Lean Tools and Methods

    International Nuclear Information System (INIS)

    Rangaraj, D; Chan, K; Boddu, S; Pawlicki, T; Dieterich, S

    2014-01-01

    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 time 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

  18. TH-C-9A-01: Lean Tools and Methods

    Energy Technology Data Exchange (ETDEWEB)

    Rangaraj, D [Baylor Scott and White Health, Temple, TX (United States); Chan, K [Princess Margaret Hospital, Toronto (Canada); Boddu, S [Temple, TX (United States); Pawlicki, T [UC San Diego, La Jolla, CA (United States); Dieterich, S [UC Davis Medical Center, Sacramento, CA (United States)

    2014-06-15

    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 time 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.

  19. Single-leg squats can predict leg alignment in dancers performing ballet movements in “turnout”

    Science.gov (United States)

    Hopper, Luke S; Sato, Nahoko; Weidemann, Andries L

    2016-01-01

    The physical assessments used in dance injury surveillance programs are often adapted from the sports and exercise domain. Bespoke physical assessments may be required for dance, particularly when ballet movements involve “turning out” or external rotation of the legs beyond that typically used in sports. This study evaluated the ability of the traditional single-leg squat to predict the leg alignment of dancers performing ballet movements with turnout. Three-dimensional kinematic data of dancers performing the single-leg squat and five ballet movements were recorded and analyzed. Reduction of the three-dimensional data into a one-dimensional variable incorporating the ankle, knee, and hip joint center positions provided the strongest predictive model between the single-leg squat and the ballet movements. The single-leg squat can predict leg alignment in dancers performing ballet movements, even in “turned out” postures. Clinicians should pay careful attention to observational positioning and rating criteria when assessing dancers performing the single-leg squat. PMID:27895518

  20. Lymphatic flow in humans as indicated by the clearance of 125I-labeled albumin from the subcutaneous tissue of the leg

    International Nuclear Information System (INIS)

    Fernandez, M.J.; Davies, W.T.; Owen, G.M.; Tyler, A.

    1983-01-01

    Since the removal of albumin from the extracellular space and its return to the vascular compartment is the essential function of the lymphatic system, the rate at which it is removed from the interstitial tissue may be regarded as a means of estimating lymphatic efficiency. An objective measure of lymphatic function can be obtained by monitoring the rate of clearance following injection of 125 I-labeled albumin (RIHSA) from the subcutaneous tissue of a limb. The clearance of 125 I-RIHSA from lower limb was monitored in a group of patients with normal limbs, patients with unilateral edema due to deep vein thrombosis, and patients with bilateral edema due to hypoproteinemia. The mean T1/2 in normal legs was 32.7 hr, compared to 23.7 hr in edematous limbs due to deep vein thrombosis and 19.4 in edematous limbs due to hypoproteinemia. There is a clear-cut difference in clearance rate between edematous and nonedematous limbs. This suggests that lymphatic flow is increased in edema due to venous obstruction and hypoproteinemia

  1. Rethinking Lean Service

    Science.gov (United States)

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

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

  2. Lean consumption.

    Science.gov (United States)

    Womack, James P; Jones, Daniel T

    2005-03-01

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

  3. Genetic parameters for claw and leg health, foot and leg conformation, and locomotion in Danish Holsteins

    DEFF Research Database (Denmark)

    Laursen, M. V.; Boelling, D.; Mark, Thomas

    2009-01-01

    was defined as absence of hock infection, swollen hock, and bruising. The potential indicators were locomotion and foot and leg conformation, represented by rear leg side view, rear leg rear view, foot angle, and apparent hock quality and bone structure. The study was conducted using records from 429......,877 Danish Holstein cows in first lactation. Binary health traits were divided into 3 subcategories: claw health, leg health, and absence of all claw and leg disorders. Genetic (r(g)) and phenotypic correlations were estimated using a bivariate linear sire model and REML. Estimated heritabilities were 0.......01 for all 3 combined claw and leg health traits (on the observed binary scale), 0.09 for locomotion, 0.14 for rear leg rear view, 0.19 for rear leg side view, 0.13 for foot angle, 0.22 for apparent hock quality, and 0.27 for apparent bone structure. Heritabilities were 0.06 and 0.01 for claw health and leg...

  4. Lean in the supply chain : research and practice

    OpenAIRE

    Ugochukwu, Paschal

    2012-01-01

    Lean is a management philosophy that enhances customer value through waste elimination and continuous improvement in a system by applying lean principles, practices, and techniques. The focus on lean implementations and research had been typically a single company without extension to the entire supply chain. When the concept of lean is implemented across the entire supply chain, however, it is referred to as lean supply chain. The purpose of this thesis is to create a structure from theory a...

  5. Lean Six Sigma in financial services

    OpenAIRE

    de Koning, H.; Does, R.J.M.M.; Bisgaard, S.

    2008-01-01

    Lean Thinking and Six Sigma are typically considered as separate approaches to process innovation, with complementary strengths. When combined as Lean Six Sigma, this approach provides a unified framework for systematically developing innovations. Lean Six Sigma can also bring about significant results and breakthrough improvements in financial services, as demonstrated with four case studies from Dutch multinational insurance companies. These cases demonstrate the importance of incremental i...

  6. Lean and psychosocial work environment in manufacturing

    DEFF Research Database (Denmark)

    Edwards, Kasper; Thye, Nina; Nielsen, Anders P.

    2011-01-01

    Lean is currently the rationalization method of choice in the Danish manufacturing industry. This paper reports finding from three lean implementation cases. All cases are manufacturing companies focusing on upmarket products produced in small series. Prior to lean production was organized as sel...

  7. Pathomechanisms of sciatica in lumbar disc herniation: effect of periradicular adhesive tissue on electrophysiological values by an intraoperative straight leg raising test.

    Science.gov (United States)

    Kobayashi, Shigeru; Takeno, Kenichi; Yayama, Takafumi; Awara, Kousuke; Miyazaki, Tsuyoshi; Guerrero, Alexander; Baba, Hisatoshi

    2010-10-15

    This study is aimed to investigate the changes of nerve root functions during the straight leg raising (SLR) test in vivo. To investigate the relationship between nerve root movement and the electrophysiological values during an intraoperative SLR test. The SLR test is one of the most significant signs for making a clinical diagnosis of lumbar disc herniation. A recent study showed that intraradicular blood flow apparently decreased during the SLR test in patients with disc herniation. The study included 32 patients who underwent microdiscectomy. During the surgery, the nerve root motion affected by the hernia was observed during the SLR test. The patients' legs were allowed to hang down to the angle at which sciatica had occurred and the change of nerve root action potentials was measured. After removal of the hernia, a similar procedure was repeated. The periradicular specimens collected during surgery were examined by light and electron microscope. In all patients intraoperative microscopy revealed that the hernia was adherent to the dura mater of the nerve roots. During the SLR test, the limitation of nerve root movement occurred by periradicular adhesive tissue and amplitude of action potential showed a sharp decrease at the angle that produced sciatica. After removal of the hernia, all the patients showed smooth gliding of the nerve roots during the test, and there was no marked decrease of amplitude. Our data suggest that temporary ischemic changes in the nerve root cause transient conduction disturbances. Pathologic examination showed that the periradicular tissue consisted of the granulation with vascularization and many inflammatory cell infiltrations. The presence of periradicular fibrosis will compound the nerve root pain by fixing the nerve in one position, thereby increasing the susceptibility of the nerve root to tension or compression.

  8. A Sand Cone Model of Lean Implementation

    OpenAIRE

    Yestemessov, Azamat

    2011-01-01

    Over the past 20 years Lean Production system has been a focus of researches by different academicians. A numerous works have been written in the field of Lean implementation in manufacturing companies. However, as shown, most of the academic topics relate to the issues of implementing Lean tools and techniques. Critical Success Factors have been also described widely; however, no efforts in systematization have been made. Only several works have a focus on integration of Lean implementation ...

  9. Stable walking with asymmetric legs

    International Nuclear Information System (INIS)

    Merker, Andreas; Rummel, Juergen; Seyfarth, Andre

    2011-01-01

    Asymmetric leg function is often an undesired side-effect in artificial legged systems and may reflect functional deficits or variations in the mechanical construction. It can also be found in legged locomotion in humans and animals such as after an accident or in specific gait patterns. So far, it is not clear to what extent differences in the leg function of contralateral limbs can be tolerated during walking or running. Here, we address this issue using a bipedal spring-mass model for simulating walking with compliant legs. With the help of the model, we show that considerable differences between contralateral legs can be tolerated and may even provide advantages to the robustness of the system dynamics. A better understanding of the mechanisms and potential benefits of asymmetric leg operation may help to guide the development of artificial limbs or the design novel therapeutic concepts and rehabilitation strategies.

  10. Lean in healthcare: the unfilled promise?

    Science.gov (United States)

    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.

  11. Influence of lean and fat mass on bone mineral density (BMD) in postmenopausal women with osteoporosis.

    Science.gov (United States)

    Dytfeld, Joanna; Ignaszak-Szczepaniak, Magdalena; Gowin, Ewelina; Michalak, Michał; Horst-Sikorska, Wanda

    2011-01-01

    Despite known positive association between body mass and bone mineral density (BMD), relative contribution of fat and lean tissue to BMD remains under debate. We aimed at investigating the effect of selected anthropometric parameters, including fat content and lean body mass (LBM) on BMD in postmenopausal, osteoporotic women with body mass index (BMI) > 20 kg/m(2). The study involved 92 never-treated women (mean age 69.5 ± 7.3). L1-L4 and femoral neck (FN) BMD were measured by dual energy X-ray absorptiometry (DEXA). Absolute (kg) and relative (%) fat and LBM were assessed by means of electric bioimpedance method. We showed both FN and L1-L4 BMD were positively correlated with body mass, waist circumference (WC), hip circumference (HC) and LBM (kg). Fat content correlated with FN BMD (r = 0.36, p obese. Obese women displayed the highest BMD. Both L1-L4 and FN BMD were higher in women with WC > 80 cm. In postmenopausal osteoporotic women with BMI > 20 kg/m(2) both fat and lean tissue might contribute to BMD. Positive association between body mass and BMD does not make obesity and osteoporosis mutually exclusive. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  12. Transferring lean management infrastructure for increasing productivity

    Directory of Open Access Journals (Sweden)

    Ph.D.Daniel Georgescu

    2010-12-01

    Full Text Available These years, manufacturing function have been transferred rapidly and globally from matured countries to emerging countries. In this paper is about the critical elements for successful transfer of lean management among sites and countries. Based on this general descriptive analysis, current global transfer activity of Lean as well as its future direction is also described. According to the gradual progress of lean management transfer, necessity of its refinement/reinforcement is recognized and some research subjects are proposed for contributing further encouragement of its global activities. In this paper, based on this understanding, requisites for transfer of lean management are discussed through investigating global activity of Lean and specification of infrastructure enabling its smooth transfer is examined

  13. Lean Implementation : the significance of people and dualism

    OpenAIRE

    Bengt, Halling

    2013-01-01

    Lean, with its origins at the Toyota Motor Company, is a concept that is known to increase effectiveness in manufacturing. The Lean concept is now argued to be relevant not only in manufacturing but in service and health-care delivery as well. The reported results of Lean implementation efforts are divided. There are reports that most of the Lean implementation efforts are not reaching the goal; on the other hand, there are reports of promising results. The divided results from Lean implement...

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

    Science.gov (United States)

    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.

  15. Lean Six Sigma implementation and organizational culture.

    Science.gov (United States)

    Knapp, Susan

    2015-01-01

    The purpose of this paper is to examine the relationship between four organizational cultural types defined by the Competing Values Framework and three Lean Six Sigma implementation components - management involvement, use of Lean Six Sigma methods and Lean Six Sigma infrastructure. The study involved surveying 446 human resource and quality managers from 223 hospitals located in Maine, New Hampshire, Vermont, Massachusetts and Rhode Island using the Organizational Culture Assessment Instrument. Findings - In total, 104 completed responses were received and analyzed using multivariate analysis of variance. Follow-up analysis of variances showed management support was significant, F(3, 100)=4.89, p cultures having significant interactions with management support. The relationship between organizational culture and Lean Six Sigma in hospitals provides information on how specific cultural characteristics impact the Lean Six Sigma initiative key components. This information assists hospital staff who are considering implementing quality initiatives by providing an understanding of what cultural values correspond to effective Lean Six Sigma implementation. Managers understanding the quality initiative cultural underpinnings, are attentive to the culture-shared values and norm's influence can utilize strategies to better implement Lean Six Sigma.

  16. Lean thinking for a maintenance process

    Directory of Open Access Journals (Sweden)

    Sherif Mostafa

    2015-01-01

    Full Text Available The maintenance process shares significant operating costs in an organisation. Lean thinking can be incorporated into maintenance activities through applying its principles and practices/tools. Lean maintenance (LM is a prerequisite for lean manufacturing systems. This research proposes a new structure for LM process based on a systematic literature review of a significant number of related articles that were published on LM. The process structure is designed based on the five lean principles to guide and support organisations to pursue maintenance excellence. This study establishes a scheme for LM tools that are structured into 2 level 4 bundles and 26 lean practices/tools and develops a House of Waste (HoW to demonstrate the association between maintenance wastes and the LM tools. With a successful accomplishment of the proposed scheme, the performance of a maintenance department can create more improvement opportunities over time to reach the maintenance excellence status.

  17. THE LEAN AND SIX SIGMA SINERGY

    Directory of Open Access Journals (Sweden)

    Mirko Sokovic

    2008-12-01

    Full Text Available Many organizations, dealing with continuous improvement methods, have realized that Lean and Six Sigma methodologies complement each other. Lean manufacturing focuses on the remova l of waste so that all processes in the total system add value from the customers' perspectives. The main emphasis of Six Sigma is the application of statistical tools in a disciplined manner, which requires data-driven decision-making. The integration of Lean and Six Sigma provides a synergetic effect, a rapid process improvement strategy for attaining organizational goals. When separated, Lean manufacturing cannot bring a process under statistical control, and Six Sigma cannot dramatically improve cycle time or reduce invested capital. Together, synergistic qualities are created to maximize the potential for a process improvement. The paper deals with Lean and Six Sigma principles and approaches used in modern manufacturing for process improvements, and bring forward benefits that are gained when these two methodologies are integrated.

  18. Performance Improvement through Implementation of Lean Maintenance

    OpenAIRE

    S. Kolanjiappan; Dr. K. Maran

    2011-01-01

    Lean Maintenance is a relatively new term, invented in the last decade of the twentieth century, but the principles are well established in Total Productive Maintenance (TPM). Lean Maintenance—taking its lead from Lean Manufacturing—applies some new techniques to TPM concepts to render a more structured implementation path. Tracing its roots back to Henry Ford with modern refinements born in Japanese manufacturing, specifically the Toyota Production System (TPS). Lean seeks to eliminate a...

  19. Lean in healthcare: A comprehensive review.

    Science.gov (United States)

    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.

  20. Lean Management Systems in Radiology: Elements for Success.

    Science.gov (United States)

    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.

  1. Lean practices for quality results: a case illustration.

    Science.gov (United States)

    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

  2. Lean Management Genesis

    Directory of Open Access Journals (Sweden)

    Parkes Aneta

    2015-12-01

    Full Text Available Lean Management is a philosophy and management concept, based on reduction of the waste and resources used in the process of producing goods and providing services. Lean Management genesis dates back to scientific management in America (for example concepts of H. Ford and F.W. Taylor and quality management, including development of TQM concept. Japanese Toyota Production System has been inspired by chosen elements of these concepts, and then it evolved towards global concept called Toyota Way (which connects production rules with values and work attitude.

  3. Venous leg ulcers

    Science.gov (United States)

    2008-01-01

    Introduction Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 80 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide, thromboxane alpha2 antagonists, zinc), peri

  4. Improving healthcare using Lean processes.

    Science.gov (United States)

    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.

  5. The Hybrid Lean System to Improve Manufacturing Environment

    Directory of Open Access Journals (Sweden)

    Ahmad Ahmad Nur Aizat

    2017-01-01

    Full Text Available Lean manufacturing is a systematic approch could increase manufacturing competitiveness by identifying and elminating waste through lean tools. However, these tools are often categorized into different groups, continues to be difficult for companies to select the most appropriate lean tool to be adopted, especially in respect of the SMEs whose knowledge of lean tools and associated principles are limited. This study is to propose solution on how to implement appropriate lean tools in food manufacturing industry located at Rengit, Johor. Qualitative method is used as a methodology to see the changes after the implementation of lean tools. Interview session also a part of method to collect data from respondents. The finding from this paper shows that implementation of an appropriate lean tool will help to eliminate waste in industry sector, maintain and control the inventory, improve quality of the product and improve overall operational process.

  6. Adipose gene expression response of lean and obese mice to short-term dietary restriction.

    NARCIS (Netherlands)

    Schothorst, Evert M van; Keijer, Jaap; Pennings, Jeroen L A; Opperhuizen, Antoon; Brom, Charissa E van den; Kohl, Thomas; Franssen-van Hal, Nicole L W; Hoebee, Barbara

    2006-01-01

    Overweight and obesity lead to higher morbidity risks, which are alleviated even by mild weight loss. To gain insight in the molecular effects of weight loss in adipose tissue, we analyzed the effects of short-term dietary restriction (DR) on mice fed a low-fat diet (lean mice) or a high-fat diet

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

    Science.gov (United States)

    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…

  8. Researching Lean: Methodological implications of loose definitions

    DEFF Research Database (Denmark)

    Brännmark, Mikael; Langstrand, Jostein; Johansson, Stina

    2012-01-01

    practices seem to overlap with other popular management concepts, such as High Performance Work Systems, World Class Manufacturing and Total Quality Management. This confusion, combined with different methodological and theoretical traditions, has led to much debate and contradictory conclusions regarding...... Lean. The purpose of the paper is to illustrate some key methodological issues that need to be considered in future Lean research to allow increased understanding of Lean effects for different stakeholders, primarily meaning the customer, employer and employees. Design/methodology/approach – The paper...... on the case studies, we suggest that future investigations describe the Lean interventions in more detail. General descriptions or analogies, e.g. ‘learning organizations’, presumably increase the present confusion regarding Lean impact on different stakeholders. The case studies also illustrate...

  9. Lean leadership attributes: a systematic review of the literature.

    Science.gov (United States)

    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.

  10. Lyden-af-Leg

    DEFF Research Database (Denmark)

    Toft, Herdis

    Præsentation af seniorforsker-projekt Lyden-af-Leg i et traderingsperspektiv og med indledende fokus på YouTube som traderings-platform.......Præsentation af seniorforsker-projekt Lyden-af-Leg i et traderingsperspektiv og med indledende fokus på YouTube som traderings-platform....

  11. The maintenance management for lean organization

    OpenAIRE

    Daniel D. GEORGESCU

    2010-01-01

    The goal of lean maintenance approach is to maintain organization international competitiveness. In the spirit of continuously improvement, in the paper it is shown how by adjusting some Lean manufacturing specific techniques for Total Productive Maintenance (TPM) system, was born new maintenance system named Lean TPM. This is a systemic approach with three techniques, which don’t exclude specific techniques of TPM pillars, but complete them: the 7Ss as a critical first step in any improvemen...

  12. Apply Lean Thinking in Project Management

    OpenAIRE

    Pham Ngoc, Lan

    2015-01-01

    The purpose of this thesis was to study the effects of Lean Thinking in Project Management and how applying Lean Project Management could enhance the productivity of project work. The study was carried using theoretical research and collecting empirical data from three interviews and one case study at a local company. At the end of the study, the major project management problems at the company were identified and analyzed following Lean Principles. It was also pointed out where there...

  13. Idiopathic Soft Tissue Calcification in an Extremity: A Case Report

    Directory of Open Access Journals (Sweden)

    Dinesh Dhar

    2013-03-01

    Full Text Available We report a case of a-15-days-old infant presenting with firm palpable thickening of the left leg soft tissues along with induration. Radiographs of the leg revealed generalized calcification of soft tissues. No obvious underlying cause could be identified for tissue calcification and hence termed as Idiopathic calcinois cutis. There are reports of this condition in Pediatric and Dermatology literature, but very few reports in orthopedic literature. The aim of this report is to highlight the pathogenesis, course and review of literature of this relatively uncommon condition which can easily be mistaken by Orthopedic or General Surgeons for infective bony of soft tissue infection.

  14. Serum visfatin in relation to insulin resistance and markers of hyperandrogenism in lean and obese women with polycystic ovary syndrome.

    Science.gov (United States)

    Kowalska, Irina; Straczkowski, Marek; Nikolajuk, Agnieszka; Adamska, Agnieszka; Karczewska-Kupczewska, Monika; Otziomek, Elzbieta; Wolczynski, Slawomir; Gorska, Maria

    2007-07-01

    Visfatin, a protein secreted by adipose tissue, is suggested to play a role in pathogenesis of insulin resistance. In polycystic ovary syndrome (PCOS), insulin resistance might be involved in the development of endocrine and metabolic abnormalities. The aim of the study was to asses the relation between serum visfatin concentration and insulin sensitivity and markers of hyperandrogenism in lean and obese PCOS patients. The study group consisted of 70 women with PCOS (23 lean and 47 obese) and 45 healthy women (25 lean and 20 obese). Euglycemic hyperinsulinemic clamp and the measurements of serum visfatin, sex hormones were performed. The PCOS group had lower insulin sensitivity (P=0.00049) and higher serum visfatin (P=0.047) in comparison to the control group. The decrease in insulin sensitivity was present in both the lean (P=0.019) and obese (P=0.0077) PCOS subjects, whereas increase in serum visfatin was observed only in lean PCOS subjects (P=0.012). In the whole group, serum visfatin was negatively correlated with insulin sensitivity (r=-0.27, P=0.004). This relationship was also observed in the subgroup of lean (r=-0.30, P=0.038), but not obese women. Additionally, in lean women, visfatin was associated with serum testosterone (r=0.47, P=0.002) and free androgen index (r=0.48, P=0.002), independently of other potential confounding factors. Visfatin is associated with insulin resistance and markers of hyperandrogenism in lean PCOS patients.

  15. Clinically lean; "cutting the crap".

    Science.gov (United States)

    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.

  16. The relationships between Lean manufacturing, management accounting and firm performance

    DEFF Research Database (Denmark)

    Kristensen, Thomas Borup; Nielsen, Henrik; Grasso, Lawrency

    2016-01-01

    with management accounting practices. Specifically, we document that Lean manufacturing is positively associated with Value Stream Costing, Lean visual controls and, more importantly, measures of labor and materials efficiency. Lean manufacturing is positively related to Lean thinking and both are positively...... associated with operational performance and so are Lean visual controls. We also document that the management accounting practices intervene affecting operational performance and they intervene with Lean thinking as well. Lastly, the relationship between Lean manufacturing and measures of labor and materials......Lean manufacturing has been adopted by numerous western companies as an answer to an increasing competitive environment. Lean manufacturing is seen as an enterprise-wide strategy encompassing a transformation of manufacturing practices, affecting companies’ management accounting practices and...

  17. The promise of Lean in health care.

    Science.gov (United States)

    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.

  18. Lean sigma--will it work for healthcare?

    Science.gov (United States)

    Bahensky, James A; Roe, Janet; Bolton, Romy

    2005-01-01

    The manufacturing industry has been using Lean Sigma for years in pursuit of continuous improvement to obtain a competitive advantage. The objectives of these efforts are to use the Lean techniques for reducing cycle times and the Six Sigma concepts for reducing product defects. The Iowa Business Council with several advocates worked with the University of Iowa Hospital and Clinics (UIHC) and two other Iowa hospitals to determine whether Lean Sigma is adaptable in healthcare. A team of 15 people at UIHC used the Kaizen Breakthrough Methodology over a five-day period in an aggressive identification and elimination of non-value added activities in Radiology CT scanning. The results exceeded the initial project objectives and indicated that Lean Sigma is applicable in healthcare. Overall, the Lean Sigma project increased revenue by approximately $750,000 per year. The Kaizen process proved to be successful and interesting. Within three days, the team installed new work flow processes. This implementation-oriented approach is what differentiates Lean Sigma from other quality improvement processes.

  19. Can lean save lives?

    Science.gov (United States)

    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.

  20. Increasing trunk flexion transforms human leg function into that of birds despite different leg morphology.

    Science.gov (United States)

    Aminiaghdam, Soran; Rode, Christian; Müller, Roy; Blickhan, Reinhard

    2017-02-01

    Pronograde trunk orientation in small birds causes prominent intra-limb asymmetries in the leg function. As yet, it is not clear whether these asymmetries induced by the trunk reflect general constraints on the leg function regardless of the specific leg architecture or size of the species. To address this, we instructed 12 human volunteers to walk at a self-selected velocity with four postures: regular erect, or with 30 deg, 50 deg and maximal trunk flexion. In addition, we simulated the axial leg force (along the line connecting hip and centre of pressure) using two simple models: spring and damper in series, and parallel spring and damper. As trunk flexion increases, lower limb joints become more flexed during stance. Similar to birds, the associated posterior shift of the hip relative to the centre of mass leads to a shorter leg at toe-off than at touchdown, and to a flatter angle of attack and a steeper leg angle at toe-off. Furthermore, walking with maximal trunk flexion induces right-skewed vertical and horizontal ground reaction force profiles comparable to those in birds. Interestingly, the spring and damper in series model provides a superior prediction of the axial leg force across trunk-flexed gaits compared with the parallel spring and damper model; in regular erect gait, the damper does not substantially improve the reproduction of the human axial leg force. In conclusion, mimicking the pronograde locomotion of birds by bending the trunk forward in humans causes a leg function similar to that of birds despite the different morphology of the segmented legs. © 2017. Published by The Company of Biologists Ltd.

  1. A Model to align the organizational culture to Lean

    Directory of Open Access Journals (Sweden)

    Mehrsa Taherimashhadi

    2018-04-01

    Full Text Available Purpose: Since the emergence of Lean Manufacturing many organizations strived to implement it. Nonetheless, sustainable Lean transformation is not as easy as to be simply achieved. Several aspects need to be taken into account before Lean implementation which national and organizational culture are important. By considering influences of national culture on the organizational culture, this paper aims at proposing an evaluation model to determine the cultural weaknesses of an organization and give some recommendations to manage people before implementing Lean. Design/methodology/approach: This research has been conducted based on literature review survey and semi-structured interviews. Research papers, conference proceedings, books, and official websites regarding Lean philosophy were reviewed to find the influence of national culture in Lean implementation. Different databases were scrutinized, from 2015 to 2017, containing Scopus and Web of Science with the time period of 1996-2016. A set of key terms and their combinations were used including: Toyota Production system, Lean production, Lean manufacturing, Lean management, Transformation, Implementation, Barriers/ Impediments/Challenges/Difficulties, Human resources, Success factors, Organizational culture, and National culture. Findings: The proposed evaluation model is a guide for organizations to determine cultural misalignments between the corporate culture and the Lean culture before its implementation and gives some managerial recommendations to correct them. Originality/value: This study is the first attempt to integrate the national models   with Lean culture to provide an evaluation model and some recommendations to help the organization to align its culture to Lean culture before its implementation.

  2. Single-leg squats can predict leg alignment in dancers performing ballet movements in “turnout”

    Directory of Open Access Journals (Sweden)

    Hopper LS

    2016-11-01

    Full Text Available Luke S Hopper,1 Nahoko Sato,2 Andries L Weidemann1 1Western Australian Academy of Performing Arts, Edith Cowan University, Mt Lawley, WA, Australia; 2Department of Physical Therapy, Nagoya Gakuin University, Seto, Japan Abstract: The physical assessments used in dance injury surveillance programs are often adapted from the sports and exercise domain. Bespoke physical assessments may be required for dance, particularly when ballet movements involve “turning out” or external rotation of the legs beyond that typically used in sports. This study evaluated the ability of the traditional single-leg squat to predict the leg alignment of dancers performing ballet movements with turnout. Three-dimensional kinematic data of dancers performing the single-leg squat and five ballet movements were recorded and analyzed. Reduction of the three-dimensional data into a one-dimensional variable incorporating the ankle, knee, and hip joint center positions provided the strongest predictive model between the single-leg squat and the ballet movements. The single-leg squat can predict leg alignment in dancers performing ballet movements, even in “turned out” postures. Clinicians should pay careful attention to observational positioning and rating criteria when assessing dancers performing the single-leg squat. Keywords: injury, motion capture, clinical assessment

  3. Når lean organiserer på hospitalet

    DEFF Research Database (Denmark)

    Hauge, Amalie Martinus

    Lean er kendt og anvendt af mange offentlige organisationer i Danmark. Selv om Leans anvendelighed de fleste steder er slået fast, bliver Lean imidlertid ved med at udfordre og skabe konflikt. Hvorfor det? Dette spørgsmål – og mange andre – bliver belyst i denne rapport, som er baseret på en Ph...

  4. Lean Accounting - An Ingenious Solution for Cost Optimization

    OpenAIRE

    Dimi Ofileanu; Dan Ioan Topor

    2014-01-01

    The aim of this work is to present a new concept in accounting management: Lean Accounting. This work explains the way the lean concept was born; its benefits for the production system of the factories and the necessity of applying lean accounting in the factories which have implemented lean production, taking into account both its advantages and the boundaries of the other cost management methods in those factories.

  5. Implementing lean manufacturing system: ISM approach

    Directory of Open Access Journals (Sweden)

    Naveen Kumar

    2013-09-01

    Full Text Available Purpose: Lean Manufacturing System has emerged as an important area of research in Indian context. The requirement of Lean Manufacturing has increased due to defects in products (semi finished and finished and subsequent increase in cost. In this context, this study is an attempt to develop a structural model of the variables, important to implement Lean Manufacturing System in Indian automobile industry. Design/Methodology/Approach: Various variables of lean manufacturing system implementation have been identified from literature review and experts’ opinions. Contextual relationship among these identified variables has been set after carrying out brainstorming session. Further, classification of the variables has been carried out based upon the driving power and dependence. In addition to this, a structural model of variables to implement lean concept in Indian automobile industry has also been developed using Interpretive Structural Modeling (ISM technique. Questionnaire based survey has also been conducted to rank these variables. Findings: Eighteen variables have been identified from the literature and subsequent discussions with experts. Out of which, nine variables have been identified as dependent and nine variables have been identified as driver. No variable has been identified as linkage variable and autonomous variable. From the model developed, ‘Relative cost benefits’ has been identified as top level dependent variable and top management commitment as bottom level most independent variable. Research limitations/Implications: The model so developed is a hypothetical model based upon experts’ opinions. The conclusions so drawn may be further modified to apply in real situation. Practical implication: Clear understanding of interactions among these variables will help organizations to prioritize and manage these variables more effectively and efficiently to draw advantage from lean manufacturing system implementation

  6. Dietary B vitamin needs of strains of pigs with high and moderate lean growth.

    Science.gov (United States)

    Stahly, T S; Williams, N H; Lutz, T R; Ewan, R C; Swenson, S G

    2007-01-01

    Ten sets of 5 littermate pigs from each of 2 genetic strains were utilized to determine the impact of the dietary concentration of 5 B vitamins (riboflavin, niacin, pantothenic acid, cobalamin, and folacin) on growth from 9 to 28 kg of BW in pigs with high or moderate capacity for lean growth. All pigs (penned individually) were reared via a segregated, early weaning scheme, so that the lean growth potential of each strain could be expressed. The basal diet provided the 5 test vitamins at concentrations of total and estimated bioavailability equivalent to a minimum of 100 and 70%, respectively, of their estimated requirements (NRC, 1998) for 5- to 10-kg pigs. At a BW of 9 +/- 0.9 kg, pigs within each litter were allotted to the basal diet supplemented with sources of the 5 test vitamins equivalent to an additional 0, 100, 200, 300, or 400% (bioavailable) of the NRC requirements. Pigs from the high lean strain consumed less feed (P vitamin concentrations were increased. However, the dietary B vitamin concentrations needed to optimize G:F were greater (P 470% of NRC, 1998) vs. moderate (270%) lean strain. Based on these data, the dietary needs for 1 or more of the 5 B vitamins are greater than current NRC (1998) estimates, particularly in pigs expressing a high rate of lean tissue growth. The greater need for these vitamins is not associated with greater dietary energy intake or body energy accretion rate but is potentially due to shifts in the predominant metabolic pathways.

  7. Primary Sjögren’s Syndrome with Sensory Ganglionopathy and Painful Legs and Moving Toes Syndrome

    Directory of Open Access Journals (Sweden)

    Mehmet Uğur Çevik

    2014-06-01

    Full Text Available Sjogren’s syndrome is characterized by the sicca syndrome, with dryness of the mouth (xerostomia and the eyes (xerophthalmia. Sjogren's syndrome is the only connective tissue disease that has been associated with sensory neuronopathy. The syndrome of painful legs and moving toes consisting of pain in the lower limbs with spontaneous movements of the toes or feet. The association between Sjogren’s syndrome and painful legs and moving toes syndrome is a rare condition

  8. EFFECT OF CHICKEN BONE-MARROW ADDITION TO BREAST AND LEG MEAT SUBJECTED TO DIFFERENT GRINDING PROCESSES

    OpenAIRE

    POLLONIO, MAR; ANTUNES, AJ

    1993-01-01

    Mechanical deboning makes chicken meat highly suscetible to lipid oxidation. Tissue disruption and the incorporation of unknown amounts of bone marrow are among the main factors involved. This research was undertaken to evaluate the effect of chicken bone marrow addition to breast and leg meat, ground in a regular meat grinder and passed through a mechanical deboner on lipid stability during frozen storage at -18-degrees-C. Breast and leg meat were manually deboned: a portion was processed th...

  9. Leg Injuries and Disorders

    Science.gov (United States)

    ... are important for motion and standing. Playing sports, running, falling, or having an accident can damage your legs. Common leg injuries include sprains and strains, joint dislocations, and fractures. ...

  10. The relationship between objectively assessed physical activity and bone health in older adults differs by sex and is mediated by lean mass.

    Science.gov (United States)

    McMillan, L B; Aitken, D; Ebeling, P; Jones, G; Scott, D

    2018-03-12

    Relationships between objectively assessed free-living physical activity (PA) and changes in bone health over time are poorly understood in older adults. This study suggests these relationships are sex-specific and that body composition may influence the mechanical loading benefits of PA. To investigate associations of objectively assessed PA and bone health in community-dwelling older adults. This secondary analysis of a subset of the Tasmanian Older Adult Cohort study included participants with PA assessed utilising ActiGraph GT1M accelerometers over 7 days (N = 209 participants, 53% female; mean ± SD age 64.5 ± 7.2 years). Steps/day and PA intensity were estimated via established thresholds. Bone mineral content (BMC) was acquired at the total hip, lumbar spine, legs and whole body by DXA at baseline and approximately 2.2 years later. Relationships between PA and BMC were assessed by multivariable linear regression analyses adjusted for age, smoking status, height and total lean mass. Men with above-median total hip BMC completed significantly less steps per day, but there was no significant difference in PA intensity compared with those with below-median BMC. There were no significant differences in PA in women stratified by median BMC. In women, steps/day were positively associated with leg BMC (B = 0.178; P = 0.017), and sedentary behaviour was negatively associated with leg BMC (- 0.165; 0.016) at baseline. After adjustment for confounders including lean mass and height, higher sedentary behaviour at baseline was associated with declines in femoral neck BMC (- 0.286; 0.011) but also with increases in pelvic BMC (0.246; 0.030) in men and increases in total hip BMC (0.215; 0.032) in women, over 2.2 years. No other significant longitudinal associations were observed after adjustment for body composition. Associations of accelerometer-determined sedentary behaviour and PA with bone health in older adults differ by sex and anatomical

  11. Lean management in academic surgery.

    Science.gov (United States)

    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 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

  12. Serum betaine is inversely associated with low lean mass mainly in men in a Chinese middle-aged and elderly community-dwelling population.

    Science.gov (United States)

    Huang, Bi-Xia; Zhu, Ying-Ying; Tan, Xu-Ying; Lan, Qiu-Ye; Li, Chun-Lei; Chen, Yu-Ming; Zhu, Hui-Lian

    2016-06-01

    Previous studies have demonstrated that betaine supplements increase lean body mass in livestock and improve muscle performance in human beings, but evidence for its effect on human lean mass is limited. Our study assessed the association of circulating betaine with lean mass and its composition in Chinese adults. A community-based study was conducted on 1996 Guangzhou residents (weight/mass: 1381/615) aged 50-75 years between 2008 and 2010. An interviewer-administered questionnaire was used to collect general baseline information. Fasting serum betaine was assessed using HPLC-MS. A total of 1590 participants completed the body composition analysis performed using dual-energy X-ray absorptiometry during a mean of 3·2 years of follow-up. After adjustment for age, regression analyses demonstrated a positive association of serum betaine with percentage of lean mass (LM%) of the entire body, trunk and limbs in men (all Pwomen (P=0·016). Each sd increase in serum betaine was associated with increases in LM% of 0·609 (whole body), 0·811 (trunk), 0·422 (limbs), 0·632 (arms) and 0·346 (legs) in men and 0·350 (trunk) in women. Multiple logistic regression analysis revealed that the prevalence of lower LM% decreased by 17 % (whole body) and 14 % (trunk) in women and 23 % (whole body), 28 % (trunk), 22 % (arms) and 26 % (percentage skeletal muscle index) in men with each sd increment in serum betaine. Elevated circulating betaine was associated with a higher LM% and lower prevalence of lower LM% in middle-aged and elderly Chinese adults, particularly men.

  13. [Ski boots versus the knee joint. 2: What produces the forward leaning position of the ski boot?].

    Science.gov (United States)

    Schaff, P; Hauser, W

    1990-03-01

    In contrast to the drop in the incidence of fracture of the lower leg that has been observed in recent years, the incidence of knee injuries has not decreased in skiing. There has even been a relative increase of severe knee lesions and isolated ACL ruptures, prompting us to conduct a comprehensive study of the causes of this phenomena. The goal of part 2 of the study was to comprehensively examine the forward movement in skiboots in the lab and on the slope. Studying nine beginners and eight experts, we found a 20% (sign. 0.05) lower forward-lean capability for the beginner group in the same boot. A randomized study with crossover design conducted on the slope, where we equipped 16 skiers with either soft or stiff boots for the duration of five ski days, revealed the learning behaviour and forward position on the slope depending on the boot. The pupils became definitely less adept at learning if they were required to wear stiff skiboots and showed a sign, lower forward flex angle. A skiiing style in backward lean position was adopted and supported by the fixed backward spoiler. Therefore another study was necessary and will follow (part 3) to examine the effect of a stiff backward spoiler and skiing in a backward lean position. In consideration of the facts known up to now, it is concluded that to improve safety in skiing recommendations must be given as to which boot to choose, according to the skiing level. In addition, the setting of safety bindings must consider the type of skiboot used.

  14. Whole-body electromyostimulation as a means to impact muscle mass and abdominal body fat in lean, sedentary, older female adults: subanalysis of the TEST-III trial

    Directory of Open Access Journals (Sweden)

    Kemmler W

    2013-10-01

    Full Text Available Wolfgang Kemmler, Simon von StengelInstitute of Medical Physics, University of Erlangen-Nürnberg, Erlangen, GermanyBackground: The primary aim of this study was to determine the effect of 12 months of whole-body electromyostimulation (WB-EMS exercise on appendicular muscle mass and abdominal fat mass in subjects specifically at risk for sarcopenia and abdominal obesity, but unable or unwilling to exercise conventionally.Methods: Forty-six lean, nonsportive (<60 minutes of exercise per week, elderly women (aged 75 ± 4 years with abdominal obesity according to International Diabetes Federation criteria were randomly assigned to either a WB-EMS group (n=23 which performed 18 minutes of intermittent, bipolar WB-EMS (85 Hz three sessions in 14 days or an "active" control group (n=23. Whole-body and regional body composition was assessed by dual energy X-ray absorptiometry to determine appendicular muscle mass, upper leg muscle mass, abdominal fat mass, and upper leg fat mass. Maximum strength of the leg extensors was determined isometrically by force plates.Results: After 12 months, significant intergroup differences were detected for the primary endpoints of appendicular muscle mass (0.5% ± 2.0% for the WB-EMS group versus −0.8% ± 2.0% for the control group, P=0.025 and abdominal fat mass (−1.2% ± 5.9% for the WB-EMS group versus 2.4% ± 5.8% for the control group, P=0.038. Further, upper leg lean muscle mass changed favorably in the WB-EMS group (0.5% ± 2.5% versus −0.9% ± 1.9%, in the control group, P=0.033, while effects for upper leg fat mass were borderline nonsignificant (−0.8% ± 3.5% for the WB-EMS group versus 1.0% ± 2.6% for the control group, P=0.050. With respect to functional parameters, the effects for leg extensor strength were again significant, with more favorable changes in the WB-EMS group (9.1% ± 11.2% versus 1.0% ± 8.1% in the control group, P=0.010.Conclusion: In summary, WB-EMS showed positive effects on the

  15. ANATOMIC AND PHYSIOLOGICAL FEATURES OF DISTAL LOWER LEG AND THEIR INFLUENCE ON THE PROCESS OF OSTEOGENESIS

    Directory of Open Access Journals (Sweden)

    Desimir Mladenović

    2010-06-01

    Full Text Available Osteogenesis is the process of bone tissue forming, i.e. bone or callus regeneration. This process is influenced by many factors, and the degree of bone fragments’ stability and vascularization in the fracture area are the basic local factors which determine the nature of reparative process. Regenerative process of all bone structures increases with increasing of blood supply.The distal lower leg has its specific biomechanical features, and plays an important role in the transfer of body weight to foot. The distal part of tibia has a small diameter, which as a consequence has reduced diameter in medullar cave. Through this anatomic feature, the medullar network in the lower tibia part is also reduced.As for anatomic aspect, vascularization in the lower end of tibia is poor. It primarily depends on periosteal vascularization, because medullar vascularization is reduced. Fasciae, tendons and skin cover the lower part of the leg, and there is no muscle mass. These tissues have poor vascular network and that is why the extraosseous blood circulation in tibia is poor, and does not participate in the osteogenesis process. For these reasons, distal lower leg represents a predelection site for delayed osteogenesis and pseudoarthrosys development.Osteosynthesis causes secondary damage to bone and soft tissue circulation. The screw plate damages the periosteal circulation – in the lower part of tibia it is the main source of vascularization, and for this reason, this method of osteosynthesis should not be applied. The external fixator has a sparing role regarding vascularization, and that is the reason why this method is recommended for fracture stabilization at the level of distal lower leg.

  16. Preliminary Investigation into a Potential Role for Myostatin and Its Receptor (ActRIIB) in Lean and Obese Horses and Ponies

    Science.gov (United States)

    Morrison, Philippa K.; Bing, Chen; Harris, Patricia A.; Maltin, Charlotte A.; Grove-White, Dai; Argo, Caroline McG.

    2014-01-01

    Obesity is a widespread problem across the leisure population of horses and ponies in industrialised nations. Skeletal muscle is a major contributor to whole body resting energy requirements and communicates with other tissues through the secretion of myokines into the circulation. Myostatin, a myokine and negative regulator of skeletal muscle mass, has been implicated in obesity development in other species. This study evaluated gene and protein expression of myostatin and its receptor, ActRIIB in adipose tissues and skeletal muscles and serum myostatin concentrations in six lean and six obese animals to explore putative associations between these factors and obesity in horses and ponies. Myostatin mRNA expression was increased while ActRIIB mRNA was decreased in skeletal muscles of obese animals but these differences were absent at the protein level. Myostatin mRNA was increased in crest fat of obese animals but neither myostatin nor ActRIIB proteins were detected in this tissue. Mean circulating myostatin concentrations were significantly higher in obese than in lean groups; 4.98 ng/ml (±2.71) and 9.00 ng/ml (±2.04) for the lean and obese groups, respectively. In addition, there was a significant positive association between these levels and myostatin gene expression in skeletal muscles (average R2 = 0.58; pmyostatin and its receptor may play a role in obesity in horses and ponies. PMID:25390640

  17. Rates and tissue sites of non-insulin- and insulin-mediated glucose uptake in humans

    International Nuclear Information System (INIS)

    Baron, A.D.; Brechtel, G.; Wallace, P.; Edelman, S.V.

    1988-01-01

    In vivo glucose uptake can occur via two mechanisms, namely, insulin-mediated glucose uptake (IMGU) and non-insulin-mediated glucose uptake (NIMGU). Although the principal tissue sites for IMGU are skeletal muscle, the tissue sites for NIMGU at a given serum glucose concentration are not known. To examine this issue, rates of whole body glucose uptake (Rd) were measured at basal and during glucose clamp studies performed at euglycemia (approximately 90 mg/dl) and hyperglycemia (approximately 220 mg/dl) in six lean healthy men. Studies were performed during hyperinsulinemia (approximately 70 microU/ml) and during somatostatin-induced insulinopenia to measure IMGU and NIMGU, respectively. During each study, leg glucose balance (arteriovenous catheter technique) was also measured. With this approach, rates of whole body skeletal muscle IMGU and NIMGU can be estimated, and the difference between overall Rd and skeletal muscle glucose uptake represents non-skeletal muscle Rd. The results indicate that approximately 20% of basal Rd is into skeletal muscle. During insulinopenia approximately 86% of body NIMGU occurs in non-skeletal muscle tissues at euglycemia. When hyperglycemia was created, whole body NIMGU increased from 128 +/- 6 to 213 +/- 18 mg/min (P less than 0.01); NIMGU into non-skeletal muscle tissues was 134 +/- 11 and 111 +/- 6 mg/min at hyperglycemia and euglycemia, respectively, P = NS. Therefore, virtually all the hyperglycemia induced increment in NIMGU occurred in skeletal muscle. During hyperinsulinemia, IMGU in skeletal muscle represented 75 and 95% of body Rd, at euglycemia and hyperglycemia, respectively

  18. Indførelse af Lean principper

    DEFF Research Database (Denmark)

    Balmer, Christian; Michelsen, Aage U

    2004-01-01

    I artiklen beskrives, hvorledes lean-principper er indført i en forsikringsvirksomhed samt de opnåede resultater.......I artiklen beskrives, hvorledes lean-principper er indført i en forsikringsvirksomhed samt de opnåede resultater....

  19. LEAN PRACTICES FOR PRODUCT DEVELOPMENT PROCESS

    Directory of Open Access Journals (Sweden)

    Guilherme Luz Tortorella

    2015-06-01

    Full Text Available Lean product development (LPD is an approach that comprises lean principles and management practices that aim to reduce waste and improve operational effectiveness throughout the entire value stream in continuous improvement endless journey. Due to that, the ability to innovate, change and learn continuously is a key element in order to minimize product development problems. Several LPD techniques are presented in the literature as possible enablers for lean implementation. However, little has been known about the impact of these enablers on the problems related to product development processes. Thus, this paper aims to examine the relationship between five LPD practices’ constructs and the occurrence frequency of eleven LPD problems’ constructs in companies that are implementing lean. Moreover, the identification of relevant relationships between LPD practices’ and problems’ constructs may contribute to specify the contexts in which problems are expected to occur. The study sample comprises sixty four companies already undergoing lean implementation both in shop floor and offices area. The results indicate that the same practices’ constructs, which are deemed as influential for minimizing LPD problems, present different relationship intensities among them.

  20. Why Lean doesn't work for everyone.

    Science.gov (United States)

    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.

  1. Lean education an overview of current issues

    CERN Document Server

    Flumerfelt, Shannon; Kahlen, Franz-Josef

    2017-01-01

    This edited volume presents a structured approach to a new lean education curriculum, implemented for the education of engineers, managers, administrators as well as human resources developers. The authorship comprises professors and lecturers, trainers and practitioners who educate future professionals in Lean Thinking principles and tools. This edited book provides a platform for authors to share their efforts in building a Body of Knowledge (BoK) for Lean Education. The topical spectrum is state-of-the-art in this field, but the book also includes a glimpse into future developments. This is a highly informative and carefully presented book, providing valuable insight for scholars with an interest in Lean Education.

  2. Insulin Plays a Permissive Role for the Vasoactive Effect of GIP Regulating Adipose Tissue Metabolism in Humans

    DEFF Research Database (Denmark)

    Asmar, Meena; Simonsen, Lene; Asmar, Ali

    2016-01-01

    CONTEXT AND OBJECTIVE: Glucose-dependent insulinotropic polypeptide (GIP) in combination with hyperinsulinemia increases blood flow and triglyceride (TAG) clearance in subcutaneous (sc) abdominal adipose tissue in lean humans. The present experiments were performed to further investigate the role...... of insulin for the vasoactive effect of GIP in adipose tissue metabolism and whether the vasodilatory effect of GIP is dependent on C-peptide. METHODS: Six lean healthy subjects were studied. The sc abdominal adipose tissue metabolism was assessed by Fick's principle during GIP infusion (1.5 pmol...

  3. Application of lean manufacturing techniques in the Emergency Department.

    Science.gov (United States)

    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.

  4. Leveraging lean in the office: Lean office needs a novel and differentiated approach

    OpenAIRE

    Rüttimann, Bruno G.; Fischer, Urs P.; Stöckli, Martin T.

    2014-01-01

    Lean Six Sigma tools have been increasingly employed also in the service industry, however with different success as field studies have shown. The reason not only has to be attributed to a poor Change Management, but can also be attributed to the intrinsic characteristics of the Lean techniques, which have been tailored to sustain a stable customer-takted pull-manufacturing principle. An office workplace shows significant differences to a procedural shop floor environment, as it comprises bot...

  5. Reducing waste in administrative services with lean principles

    NARCIS (Netherlands)

    Wijnhoven, Alphonsus B.J.M.; Beckers, David; Amrit, Chintan Amrit

    2016-01-01

    In the last few decades, lean techniques have been developed for removing with waste in manufacturing. More recently, lean is used outside the manufacturing context as well. This article focuses on using lean thinking for reducing waste in administrative services, i.e., business services with

  6. Histological properties of intramuscular connective tissues in native ...

    African Journals Online (AJOL)

    The conventional histological study revealed that except the endomysium which was similar in both muscles, the other intramuscular connective tissues' layers varied between leg and breast muscles and were affected by sex. All the connective tissue fibers were observed in all the intramuscular connective tissues of both ...

  7. Age-related differences in lean mass, protein synthesis and skeletal muscle markers of proteolysis after bed rest and exercise rehabilitation

    DEFF Research Database (Denmark)

    Tanner, Ruth E; Brunker, Lucille B; Agergaard, Jakob

    2015-01-01

    during a constant stable isotope infusion in the postabsorptive state and after essential amino acid (EAA) ingestion on three occasions: before (PRE), after bed rest and after rehabilitation. Samples were assessed for protein synthesis, mTORC1 signalling, REDD1/2 expression and molecular markers related...... to muscle proteolysis (MURF1, MAFBX, AMPKα, LC3II/I, Beclin1). We found that leg lean mass and strength decreased in older but not younger adults after bedrest (P protein synthesis increased before bed rest in both age groups...... (P protein synthesis rates and increased MAFBX mRNA, p-AMPKα and the LC3II/I ratio (P

  8. Temperature and blood flow distribution in the human leg during passive heat stress.

    Science.gov (United States)

    Chiesa, Scott T; Trangmar, Steven J; González-Alonso, José

    2016-05-01

    The influence of temperature on the hemodynamic adjustments to direct passive heat stress within the leg's major arterial and venous vessels and compartments remains unclear. Fifteen healthy young males were tested during exposure to either passive whole body heat stress to levels approaching thermal tolerance [core temperature (Tc) + 2°C; study 1; n = 8] or single leg heat stress (Tc + 0°C; study 2; n = 7). Whole body heat stress increased perfusion and decreased oscillatory shear index in relation to the rise in leg temperature (Tleg) in all three major arteries supplying the leg, plateauing in the common and superficial femoral arteries before reaching severe heat stress levels. Isolated leg heat stress increased arterial blood flows and shear patterns to a level similar to that obtained during moderate core hyperthermia (Tc + 1°C). Despite modest increases in great saphenous venous (GSV) blood flow (0.2 l/min), the deep venous system accounted for the majority of returning flow (common femoral vein 0.7 l/min) during intense to severe levels of heat stress. Rapid cooling of a single leg during severe whole body heat stress resulted in an equivalent blood flow reduction in the major artery supplying the thigh deep tissues only, suggesting central temperature-sensitive mechanisms contribute to skin blood flow alone. These findings further our knowledge of leg hemodynamic responses during direct heat stress and provide evidence of potentially beneficial vascular alterations during isolated limb heat stress that are equivalent to those experienced during exposure to moderate levels of whole body hyperthermia. Copyright © 2016 the American Physiological Society.

  9. Lean accounting – as a future accounting system

    Directory of Open Access Journals (Sweden)

    M.V. Koryagin

    2017-12-01

    Full Text Available The historical development of lean accounting is researched. The comparison of lean accounting and accounting is carried out. The article determines the lean accounting basic principles, which are the basis for the selection of main ten steps of upgrading to the system of lean accounting: the evaluation of the current situation and the expected development prospects of the enterprise; the development of the principles of implementing lean accounting; the determining the production parameters and methodology of the economic model construction; the organization of lean manufacturing environment and reducing most of the stock; the determining the flow of value creation; the rejection of variable accounting and reverse cancellation of all labor costs and the cost of materials; the rejection of tracking stocks and assign of the costs directly to the costs of sales when occurred; the definition of client-targeted spending; the relationship with suppliers and automation of the accounts payable; the relationship with customers and automation of the payments received.

  10. Quality improvement in basic histotechnology: the lean approach.

    Science.gov (United States)

    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.

  11. LEAN Tools in the IT Sector

    Directory of Open Access Journals (Sweden)

    Zoltan VAJNA

    2015-05-01

    Full Text Available Nowadays the LEAN tools with their proven efficiency are indispensable parts of the production management. I think there is no producing enterprise that cannot utilize a wide variety of these LEAN tools. The question now is how these tools can support companies in increasing the efficiency of their supporting IT processes. In this study I will demonstrate how these well-known LEAN tools from production management can be used in IT management to create more cost-effective, efficient and transparent solutions during the IT system development and IT operation activities. I will show respectively without attempting to be comprehensive the most important tools of the LEAN management and I will analyse how these tools can be used in the IT sector. At the end of this study I will demonstrate what the IT managers think about the practical use of these tools.

  12. Lean in service industries: A literature review

    Science.gov (United States)

    V, Vignesh; Suresh, M.; Aramvalarthan, S.

    2016-09-01

    Lean service is an amalgamation of tools and practices which, if applied appropriately, would definitely improve the existing quality of operations and ensure the generation of a large amount of favourable financial and economic outcomes and improve the behaviour of the workforce. As a result, it assumes of great significance in the fiercely competitive modern world. This article presents a comprehensive bibliographic study about the various lean service practices through a variety of approaches like service improvement, manufacturing, supply chain, market and retailing approaches, etc. Thus it gives a clear view on how the lean services are implemented in various sectors and the contribution of lean service towards improving the quality in the services provided while reducing the costs.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  15. De praktijk van Lean Six Sigma

    NARCIS (Netherlands)

    Does, R.J.M.M.; de Koning, H.

    2008-01-01

    Zowel Lean als Six Sigma zijn benaderingen van kwaliteits- en efficiëntieverbetering die op dit moment sterk in de belangstelling staan van zowel de industrie als de dienstverlening. Lean Six Sigma integreert beide benaderingen. Ze wordt door sommigen gezien als panacee voor alle mogelijke

  16. Just-in-Time og Lean Manufacturing

    DEFF Research Database (Denmark)

    Michelsen, Aage U.

    2004-01-01

    Filosofi, principper og teknikker i JIT. Princip i Kanban-styring og dimensionering af et Kanban-system. Lean Thinking og Value Stream Mapping.......Filosofi, principper og teknikker i JIT. Princip i Kanban-styring og dimensionering af et Kanban-system. Lean Thinking og Value Stream Mapping....

  17. Lean Six Sigma in a hospital

    NARCIS (Netherlands)

    van den Heuvel, J.; Does, R.J.M.M.; de Koning, H.

    2006-01-01

    Abstract Hospitals today face major challenges. Patients demand quality of care to be improved continuously. Health insurance companies demand the lowest possible prices. Lean Six Sigma is a program that can help healthcare providers to achieve these (seemingly) conflicting goals. Lean Six Sigma is

  18. Are the hamstrings from the drive leg or landing leg more active in baseball pitchers? An electromyographic study.

    Science.gov (United States)

    Erickson, Brandon J; Zaferiou, Antonia; Chalmers, Peter N; Ruby, Deana; Malloy, Phillip; Luchetti, Timothy J; Verma, Nikhil N; Romeo, Anthony A

    2017-11-01

    Ulnar collateral ligament reconstruction (UCLR) has become a common procedure among baseball players of all levels. There are several graft choices in performing UCLR, one of which is a hamstring (gracilis or semitendinosus) autograft. It is unclear whether the hamstring muscle from a pitcher's drive leg (ipsilateral side of the UCLR) or landing leg (contralateral side of the UCLR) is more active during the pitching motion. We hypothesized that the landing leg semitendinosus will be more electromyographically active than the drive leg. Healthy, elite male pitchers aged 16-21 years were recruited. Sixteen pitchers (average age, 17.6 ± 1.6 years; 67% threw right handed) underwent electromyographic analysis. Pitchers threw 5 fastballs at 100% effort from the wind-up with electromyographic analysis of every pitch. Activation of the semitendinosus and biceps femoris in both legs was compared within pitchers and between pitchers. Hamstring activity was higher in the drive leg than in the landing leg during each phase and in sum, although the difference was significant only during the double support phase (P = .021). On within-pitcher analysis, 10 of 16 pitchers had significantly more sum hamstring activity in the drive leg than in the landing leg, while only 4 of 16 had more activity in the landing leg (P = .043). During the baseball pitch, muscle activity of the semitendinosus was higher in the drive leg than in the landing leg in most pitchers. Surgeons performing UCLR using hamstring autograft should consider harvesting the graft from the pitcher's landing leg to minimize disruption to the athlete's pitching motion. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Using lean methodologies for economically and environmentally sustainable foundries

    Directory of Open Access Journals (Sweden)

    R. M. Torielli

    2011-02-01

    Full Text Available Lean manufacturing is often seen as a set of tools that reduce the total cost and improve the quality of manufactured products. The lean management philosophy is one which targets waste reduction in every facet of the manufacturing business; however, only recently have studies linked lean management philosophies with improving environmental sustainability. These studies suggest that lean manufacturing is more than a set of lean tools that can optimize manufacturing efficiencies; it is a process and mindset that needs to be integrated into daily manufacturing systems to achieve sustainability. The foundry industry, as well as manufacturing in general, has significant challenges in the current regulatory and political climate with developing an economically and environmentally sustainable business model. Lean manufacturing has proven itself as a model for both economic sustainability and environmental stewardship. Several recent studies have shown that both lean and green techniques and “zero-waste” policies also lead to reductions in overall cost. While these strategies have been examined for general manufacturing, they have not been investigated in detail for the foundry industry. This paper will review the current literature and describe how lean and green can provide a relevant framework for environmentally and economically sustainable foundries. Examples of lean and green technologies and techniques which can be applied to foundries in a global context will be described.

  20. Serum Predictors of Percent Lean Mass in Young Adults.

    Science.gov (United States)

    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.

  1. Teaching Special Decisions in a Lean Accounting Environment

    Science.gov (United States)

    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…

  2. Development of framework for sustainable Lean implementation: an ISM approach

    Science.gov (United States)

    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.

  3. Application of lean thinking to health care: issues and observations

    Science.gov (United States)

    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

  4. Implementation of Lean Manufacturing in Romanian Organisations

    Directory of Open Access Journals (Sweden)

    Ucenic Camelia Ioana

    2017-01-01

    Full Text Available The implementation of lean manufacturing is one of the main tools for attaining a higher performance level in the Romanian organisations. The study uses data collected at middle management level from organisations located in Transylvania. The organisations come from different fields of activity and are in different stages of lean implementation. The article makes use of quantitative and qualitative instruments for the evaluation of lean in the above mentioned companies. Characteristics as waste reduction, cost, quality, product design have different approaches in the companies. Their way of approach gives useful information regarding the type of company from the point of view of lean manufacturing implementation. This knowledge provides a useful support at different managerial levels in the process of decision making.

  5. A case study of lean, sustainable manufacturing

    Directory of Open Access Journals (Sweden)

    Geoff Miller

    2010-06-01

    Full Text Available A small furniture production company has integrated lean tools and sustainability concepts with discrete event simulation modeling and analysis as well as mathematical optimization to make a positive impact on the environment, society and its own financial success. The principles of lean manufacturing that aid in the elimination of waste have helped the company meet ever increasing customer demands while preserving valuable resources for future generations. The implementation of lean and sustainable manufacturing was aided by the use of discrete event simulation and optimization to overcome deficits in lean’s traditional implementation strategies. Lean and green manufacturing can have a more significant, positive impact on multiple measures of operational performance when implemented concurrently rather than separately. These ideas are demonstrated by three applications.

  6. Using Simulation to Explore Lean Manufacturing Implementation Strategies

    Science.gov (United States)

    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…

  7. Learning Lean: A Survey of Industry Lean Needs

    Science.gov (United States)

    Fliedner, Gene; Mathieson, Kieran

    2009-01-01

    The authors examined business practitioners' preferences for higher education curricula design in general and for what graduates should know about Lean, or waste-reduction efforts. The authors conducted a Web-based survey and found that practitioners are not as concerned about graduates' possessing specific technical skills as they are about them…

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

    Science.gov (United States)

    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.

  9. Allogeneic epidermal substitutes in the treatment of chronic diabetic leg and foot ulcers

    Directory of Open Access Journals (Sweden)

    Andrea Marchesi

    2014-09-01

    Full Text Available Aim: Diabetic foot ulcers are the most common cause of nontraumatic lower extremity amputations in the industrialized world. Tissue-engineering products offer a lower extremity salvage strategy when healing does not proceed according to the standard of care. New allogeneic sheets are available for the management of diabetic leg and foot ulcers. Methods: The endpoints of this case series study regard preliminary outcomes of the application of allogeneic keratinocytes composed of benzyl ester of hyaluronic acid to 16 diabetic foot and leg ulcers in 11 patients with type 2 diabetes mellitus. Results: Between 21 and 70 days after cellular therapy, 6 out of 16 lesions were completely healed, reducing the wound dimension by 70% and improving the wound bed score by 52%. Conclusion: The clinical results of the new allogeneic sheets indicate that allogeneic keratinocytes may represent an effective and safe therapy for diabetic foot and leg ulcers in the multidisciplinary approach to this diabetes-related complication.

  10. Principles of lean planning and control

    NARCIS (Netherlands)

    Riezebos, J.

    2015-01-01

    Lean production systems use teams instead of functional departments as well as simple shop floor control methods to manage the flow of orders at the shop floor. Lean shop floor control focuses on robust and visual methods that are able to cope with variation in processing times, routing sequences,

  11. Lean oncology: a new model for oncologists

    Directory of Open Access Journals (Sweden)

    Montesarchio Vincenzo

    2012-04-01

    Full Text Available Abstract 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.

  12. Lean oncology: a new model for oncologists.

    Science.gov (United States)

    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.

  13. Lean IT partnering : How partners create value by developing a lean culture for IT supply and management

    NARCIS (Netherlands)

    Zee, van der J.T.M.; Blijleven, V.B; Gong, Y.

    2015-01-01

    Lean, as a philosophy, has been around for quite some time, predominantly in the manufacturing domain. Since the 1990s Lean management provides organizations with a way to achieve superior performance by focusing on customer value, innovation and productivity. In 2011 Steven Bell and Michael Orzen

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

    Science.gov (United States)

    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.

  15. Lean Transformation of Multinational Concerns

    DEFF Research Database (Denmark)

    Matthiesen, Rikke Vestergaard; Johansen, John

    2008-01-01

    triggered. This paper reports on exploratory studies from a multinational company adopting centrally managed pilot projects as a transformation mechanism for continuous change towards a lean business system and an organizational culture of continuous improvements (CI). Competitive pressure demands...... from a multinational company adopting centrally managed pilot projects as a transformation mechanism for continuous change towards a lean business system and an organizational culture of continuous improvements (CI)....

  16. Lean healthcare from a change management perspective.

    Science.gov (United States)

    van Rossum, Lisa; Aij, Kjeld Harald; Simons, Frederique Elisabeth; van der Eng, Niels; Ten Have, Wouter Dirk

    2016-05-16

    Purpose - Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation of change initiatives due to an implementation gap: the gap between strategy and execution. From a change management perspective, the purpose of this paper is to increase scientific knowledge regarding factors that diminish the implementation gap and make the transition from the "toolbox lean" toward an actual transformation to lean healthcare. Design/methodology/approach - A cross-sectional study was executed in an operating theatre of a Dutch University Medical Centre. Transformational leadership was expected to ensure the required top-down commitment, whereas team leadership creates the required active, bottom-up behavior of employees. Furthermore, professional and functional silos and a hierarchical structure were expected to impede the workforce flexibility in adapting organizational elements and optimize the entire process flow. Findings - The correlation and regression analyses showed positive relations between the transformational leadership and team leadership styles and lean healthcare implementation. The results also indicated a strong relation between workforce flexibility and the implementation of lean healthcare. Originality/value - With the use of a recently developed change management model, the Change Competence Model, the authors suggest leadership and workforce flexibility to be part of an organization's change capacity as crucial success factor for a sustainable transformation to lean healthcare.

  17. Preliminary investigation into a potential role for myostatin and its receptor (ActRIIB in lean and obese horses and ponies.

    Directory of Open Access Journals (Sweden)

    Philippa K Morrison

    Full Text Available Obesity is a widespread problem across the leisure population of horses and ponies in industrialised nations. Skeletal muscle is a major contributor to whole body resting energy requirements and communicates with other tissues through the secretion of myokines into the circulation. Myostatin, a myokine and negative regulator of skeletal muscle mass, has been implicated in obesity development in other species. This study evaluated gene and protein expression of myostatin and its receptor, ActRIIB in adipose tissues and skeletal muscles and serum myostatin concentrations in six lean and six obese animals to explore putative associations between these factors and obesity in horses and ponies. Myostatin mRNA expression was increased while ActRIIB mRNA was decreased in skeletal muscles of obese animals but these differences were absent at the protein level. Myostatin mRNA was increased in crest fat of obese animals but neither myostatin nor ActRIIB proteins were detected in this tissue. Mean circulating myostatin concentrations were significantly higher in obese than in lean groups; 4.98 ng/ml (±2.71 and 9.00 ng/ml (±2.04 for the lean and obese groups, respectively. In addition, there was a significant positive association between these levels and myostatin gene expression in skeletal muscles (average R2 = 0.58; p<0.05. Together, these results provide further basis for the speculation that myostatin and its receptor may play a role in obesity in horses and ponies.

  18. Lean Manufacturing e Lean Accounting Cost: um enfoque no real desempenho em empresas de capital aberto na BOVESPA

    OpenAIRE

    Teixeira, Hipólito Francisco

    2016-01-01

    Esta pesquisa teve por alvo o campo de estudo denominado Lean Accounting (LA) aplicado as empresas que adotam os procedimentos de Produção Enxuta (PE). As empresas neste ambiente competitivo e muito imprevisivel têm procuradoadotar decisões e procedimentos voltadosa valorizar sua própria continuidade e diferencial para se expor perante ao mercado. Neste sentido novas tecnologias de produção e controles contábeis são necessários. Lean Accounting (LA) ou Contabilidade Lean ou “enxuta” pode s...

  19. Lean Construction Supply Chain : A Literature Review

    OpenAIRE

    Ren, Jiamei

    2012-01-01

    The aim of this thesis is to enhance the management of supply systems in construction industry using lean principles. This study is an attempt to identify what kind of activities causes’ construction process delay and how to perform lean concept into supply chain in practice. The objective is to assure on-time delivery of information and materials to construction sites at lowest cost and maximum value for the customer. These study problems have been analysed from a lean construction supply ch...

  20. Optimization of large scale food production using Lean Manufacturing principles

    DEFF Research Database (Denmark)

    Engelund, Eva Høy; Friis, Alan; Breum, Gitte

    2009-01-01

    This paper discusses how the production principles of Lean Manufacturing (Lean) can be applied in a large-scale meal production. Lean principles are briefly presented, followed by a field study of how a kitchen at a Danish hospital has implemented Lean in the daily production. In the kitchen...... not be negatively affected by the rationalisation of production procedures. The field study shows that Lean principles can be applied in meal production and can result in increased production efficiency and systematic improvement of product quality without negative effects on the working environment. The results...... show that Lean can be applied and used to manage the production of meals in the kitchen....

  1. Analysis of large break loss of coolant accident with simultaneous injection into cold leg and hot leg

    International Nuclear Information System (INIS)

    Luo Bangqi

    1997-01-01

    When a large break loss of coolant accident occurs, the most part of the safety injection water injected into the cold leg by the safety injection system will flow through the channel between the pressure vessel and the barrel out of the break into the containment, only a little part of the safety injection water can flow into the reactor core. If the safety injection can inject into both the cold leg and the hot leg simultaneously, the safety injection water injected from the cold leg will flow into the core more easily, because the safety injection water injected from the hot leg will carry out more heat from the upper plenum and the core, so the upper plenum and the core is depressed. In addition, a small part of the safety injection water injected from the hot leg will flow down in the core after impinging the guide tubes in the upper plenum, so the core will get more safety injection water than only cold leg injection, and the core will be much safer

  2. Large for Gestational Age Newborns from Mothers Without Diabetes Mellitus Tend to Become Tall and Lean Toddlers.

    Science.gov (United States)

    de Zegher, Francis; Pérez-Cruz, Miriam; Sebastiani, Giorgia; Díaz, Marta; López-Bermejo, Abel; Ibáñez, Lourdes

    2016-11-01

    A longitudinal study with dual x-ray absorptiometry disclosed that infants born large for gestational age from mothers without diabetes mellitus and without excessive gestational weight gain tend to be long with increased adipose tissue as newborns and tall and lean as toddlers. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Distally based superficial sural artery flap for soft tissue coverage in the distal 2/3 of leg and foot

    Directory of Open Access Journals (Sweden)

    Kamath B

    2005-01-01

    Full Text Available Background: Skin coverage for defects in the lower 2/3 of leg, ankle region and posterior heel has always been a difficult challenge for reconstructive surgeon. Methods: We describe our experience with the distally based superficial sural artery flap coverage in 48 patients with moderate sized defects in these difficult areas. Results: One out of 48 flaps (in 48 patients was lost totally and 3 suffered marginal necrosis which did not require any secondary procedure. These complications could have been avoided by proper selection of cases and refining technical skills. Conclusion: This simple procedure could be an important and versatile tool for any reconstructive surgeon in providing skin coverage in the distal leg and proximal foot. Preservation of major arteries of the lower limb, minimal donor defect, relatively uninjured donor area in compound fracture or poly trauma involving distal leg are some of the advantages of the flap.

  4. A case of cutaneous large B-cell lymphoma of the legs appearing as chronic venous ulceration

    Directory of Open Access Journals (Sweden)

    Marta Carlesimo

    2012-04-01

    Full Text Available We report here a case of a woman with a cutaneous large B-cell lymphoma of the legs. She had a plaque lesion, superficially ulcerated and necrotized with tumorous borders situated on the posterior side of the right leg and two red or bluish-red nodular lesions. A skin biopsy from both nodular and plaque lesion showed a diffuse infiltrate of atypical large B cells CD20+ and CD79a+, spanning epidermis, dermis and subcutaneous tissue. A therapeutic approach containing anti-CD20 monoclonal antibody (rituximab was suggested.

  5. Lean computing for the cloud

    CERN Document Server

    Bauer, Eric

    2016-01-01

    Applies lean manufacturing principles across the cloud service delivery chain to enable application and infrastructure service providers to sustainably achieve the shortest lead time, best quality, and value This book focuses on lean in the context of cloud computing capacity management of applications and the physical and virtual cloud resources that support them. Lean Computing for the Cloud considers business, architectural and operational aspects of efficiently delivering valuable services to end users via cloud-based applications hosted on shared cloud infrastructure. The work also focuses on overall optimization of the service delivery chain to enable both application service and infrastructure service providers to adopt leaner, demand driven operations to serve end users more efficiently. The book’s early chapters analyze how capacity management morphs with cloud computing into interlocked physical infrastructure capacity management, virtual resou ce capacity management, and application capacity ma...

  6. Whole-body adipose tissue and lean muscle volumes and their distribution across gender and age: MR-derived normative values in a normal-weight Swiss population.

    Science.gov (United States)

    Ulbrich, Erika J; Nanz, Daniel; Leinhard, Olof Dahlqvist; Marcon, Magda; Fischer, Michael A

    2018-01-01

    To determine age- and gender-dependent whole-body adipose tissue and muscle volumes in healthy Swiss volunteers in Dixon MRI in comparison with anthropometric and bioelectrical impedance (BIA) measurements. Fat-water-separated whole-body 3 Tesla MRI of 80 healthy volunteers (ages 20 to 62 years) with a body mass index (BMI) of 17.5 to 26.2 kg/m 2 (10 men, 10 women per decade). Age and gender-dependent volumes of total adipose tissue (TAT), visceral adipose tissue (VAT), total abdominal subcutaneous adipose tissue (ASAT) and total abdominal adipose tissue (TAAT), and the total lean muscle tissue (TLMT) normalized for body height were determined by semi-automatic segmentation, and correlated with anthropometric and BIA measurements as well as lifestyle parameters. The TAT, ASAT, VAT, and TLMT indexes (TATi, ASATi, VATi, and TLMTi, respectively) (L/m 2  ± standard deviation) for women/men were 6.4 ± 1.8/5.3 ± 1.7, 1.6 ± 0.7/1.2 ± 0.5, 0.4 ± 0.2/0.8 ± 0.5, and 5.6 ± 0.6/7.1 ± 0.7, respectively. The TATi correlated strongly with ASATi (r > 0.93), VATi, BMI and BIA (r > 0.70), and TAATi (r > 0.96), and weak with TLMTi for both genders (r > -0.34). The VAT was the only parameter showing an age dependency (r > 0.32). The BMI and BIA showed strong correlation with all MR-derived adipose tissue volumes. The TAT mass was estimated significantly lower from BIA than from MRI (both genders P muscle volumes might serve as normative values. The estimation of adipose tissue volumes was significantly lower from anthropometric and BIA measurements than from MRI. Magn Reson Med 79:449-458, 2018. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

  7. Investigating employee resistance to Lean transformation: UK case study.

    OpenAIRE

    Bruce, J.; Scott, Philip; Roberts, Martyn

    2011-01-01

    Lean is a business process transformation approach that eliminates ‘wastes’ – activities that generate no value for the customer. Lean originated from the production line but is widely implemented in the service sector. This study investigates human and social factors in a Lean transformation in a ‘knowledge worker’ environment. We identify a paradox: a successful Lean programme in the service sector develops staff who are educated and empowered and thus potential opponents to future business...

  8. The evolution of Lean organizations

    OpenAIRE

    Serafinas, Dalius; Ruželė, Darius

    2014-01-01

    Remiantis evoliucijos tyrimų modeliais bei autorių sudarytu evoliucionuojančios organizacijos modeliu,straipsnyje analizuojama Lean vadybos metodologija ir tiriama, kaip evoliucionuoja ją įgyvendinančios Lietuvosgamybinės organizacijos. The purpose of this paper is to examine the evolution of Lean organizations.Design/methodology/approach: a conceptual literature on the evolution of species, organisms and organizations was reviewed and an original model (framework) of the evolution of orga...

  9. Hyperbaric oxygen therapy and surgical delay improve flap survival of reverse pedicle flaps for lower third leg and foot reconstruction

    Directory of Open Access Journals (Sweden)

    Pradeoth Mukundan Korambayil

    2015-06-01

    Full Text Available Aim: The purpose of the study is to present a management protocol for various types of soft tissue defects of the distal third region of leg and foot treated with pedicle flaps, by including hyperbaric oxygen (HBO therapy in the treatment regimen with flap delay. Methods: We present a prospective study of 23 patients with various types of soft tissue defects of the foot, and lower third of leg managed in our institution from December 2012 to December 2013. All soft tissue defects were treated by a reverse pedicle flap. Twelve patients were managed with flap delay with HBO therapy and 11 patients with immediate flaps without HBO therapy. The postoperative period, hospital course, and follow-up were documented. Results: Of 12 patients with flap delay and HBO, 10 patients did not suffer any complications secondary to flap transfer. One patient had discoloration of the tip of the flap, which settled without the intervention, and 1 patient had recurrent abscess formation, which required debridement and closure. Of 11 patients with direct transfer, 6 patients presented with complications including flap congestion, partial flap loss, and tip necrosis, which required secondary intervention. Conclusion: HBO therapy is a useful adjunct in flap delay of the reverse pedicle flap for soft tissue reconstruction of the lower third of the leg and foot regions.

  10. Leg og dannelse

    DEFF Research Database (Denmark)

    Skovbjerg, Helle Marie

    2017-01-01

    lederen i det pædagogiske tidskrift Asterisk: ”Leg i skolen, leg i klasserummet, ja legende læring i skolen udgør derimod en enorm, seriøs og ubrugt læringsressource – ikke alene med effekter på kreativiteten, men også på den faglige læring” (Holm, 2015, p. 2). Legens værdi gøres altså først og fremmest...

  11. The Motor and the Brake of the Trailing Leg in Human Walking: Leg Force Control Through Ankle Modulation and Knee Covariance

    Science.gov (United States)

    Toney, Megan E.; Chang, Young-Hui

    2016-01-01

    Human walking is a complex task, and we lack a complete understanding of how the neuromuscular system organizes its numerous muscles and joints to achieve consistent and efficient walking mechanics. Focused control of select influential task-level variables may simplify the higher-level control of steady state walking and reduce demand on the neuromuscular system. As trailing leg power generation and force application can affect the mechanical efficiency of step-to-step transitions, we investigated how joint torques are organized to control leg force and leg power during human walking. We tested whether timing of trailing leg force control corresponded with timing of peak leg power generation. We also applied a modified uncontrolled manifold analysis to test whether individual or coordinated joint torque strategies most contributed to leg force control. We found that leg force magnitude was adjusted from step-to-step to maintain consistent leg power generation. Leg force modulation was primarily determined by adjustments in the timing of peak ankle plantar-flexion torque, while knee torque was simultaneously covaried to dampen the effect of ankle torque on leg force. We propose a coordinated joint torque control strategy in which the trailing leg ankle acts as a motor to drive leg power production while trailing leg knee torque acts as a brake to refine leg power production. PMID:27334888

  12. Wound care matrices for chronic leg ulcers: role in therapy

    Directory of Open Access Journals (Sweden)

    Sano H

    2015-07-01

    Full Text Available Hitomi Sano,1 Sachio Kouraba,2 Rei Ogawa11Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan; 2Sapporo Wound Care and Anti-Aging Laboratory, Sapporo, JapanAbstract: Chronic leg ulcers are a significant health care concern. Although deep wounds are usually treated by flap transfers, the operation is invasive and associates with serious complications. Skin grafts may be a less invasive means of covering wounds. However, skin grafts cannot survive on deep defects unless high-quality granulation tissue can first be generated in the defects. Technologies that generate high-quality granulation tissue are needed. One possibility is to use wound care matrices, which are bioengineered skin and soft tissue substitutes. Because they all support the healing process by providing a premade extracellular matrix material, these matrices can be termed “extracellular matrix replacement therapies”. The matrix promotes wound healing by acting as a scaffold for regeneration, attracting host cytokines to the wound, stimulating wound epithelialization and angiogenesis, and providing the wound bed with bioactive components. This therapy has lasting benefits as it not only helps large skin defects to be closed with thin skin grafts or patch grafts but also restores cosmetic appearance and proper function. In particular, since it acts as a layer that slides over the subcutaneous fascia, it provides skin elasticity, tear resistance, and texture. Several therapies and products employing wound care matrices for wound management have been developed recently. Some of these can be applied in combination with negative pressure wound therapy or beneficial materials that promote wound healing and can be incorporated into the matrix. To date, the clinical studies on these approaches suggest that wound care matrices promote spontaneous wound healing or can be used to facilitate skin grafting, thereby avoiding the need to use

  13. LEAN THINKING IN HEALTHCARE: REVIEW OF IMPLEMENTATION RESULTS

    Directory of Open Access Journals (Sweden)

    Marija Kovacevic

    2016-03-01

    Full Text Available For over decade, automotive industry originated lean concept has been successfully implemented in healthcare systems as a management method and philosophy with main focus on elimination of all types of wastes and looses in all tasks and processes so that time, materials, resources and medical procedures could be realized as effectively as it is possible. As main result lean concept implementation ensured to healthcare organizations to focus on their main core function and dedicate more time and efforts to patients without additional costs for them or healthcare system. However, lean implementation in healthcare could be much more difficult than in standard industrial environment and there are significant number of examples of lean in healthcare projects that failed to gain any measurable results and sustainable benefits from it. This paper presents review of some of the most successful implementations of lean tools and principles in healthcare organizations.

  14. The application of lean principles in product development

    DEFF Research Database (Denmark)

    Bjarnø, Ole-Christian

    2007-01-01

    Although Lean Manufacturing has been a megatrend for several years, its principles have not been broadly applied in product development processes. We have therefore found it useful to look into the theories of lean manufacturing and to discuss how and to what extent they could be applied in the p......Although Lean Manufacturing has been a megatrend for several years, its principles have not been broadly applied in product development processes. We have therefore found it useful to look into the theories of lean manufacturing and to discuss how and to what extent they could be applied...... in the product development processes, and this study is compared with industrial practices in several front running companies in Denmark. From this research a suggestion for a framework and a tool-box for lean product development is created and discussed from a HR management, an implementation, an operational...

  15. Lean healthcare.

    Science.gov (United States)

    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.

  16. A Hydroxyurea-induced Leg Ulcer

    OpenAIRE

    Hwang, Seon-Wook; Hong, Soon-Kwon; Kim, Sang-Hyun; Seo, Jong-Keun; Lee, Deborah; Sung, Ho-Suk

    2009-01-01

    Hydroxyurea is a cytostatic agent that has recently become the drug of choice in the treatment of various myeloproliferative diseases. The cutaneous side effects of hydroxyurea include xerosis, hyperpigmentation, nail discoloration, and scaling. Leg ulcers have only rarely been reported in association with hydroxyurea treatment. A 75-year-old woman presented with leg ulcers, nail discoloration, and xerosis. The leg ulcers were refractory to conventional treatment. She had been taking oral hyd...

  17. Experienced Barriers to Lean in Swedish Manufacturing and Health Care

    Directory of Open Access Journals (Sweden)

    Bengt Halling

    2013-12-01

    Full Text Available The purpose is to compare similarities and divergences in how the concepts of Lean and barriers to Lean are described by key informants at a production unit in a large manufacturing company and two emergency health care units in Sweden. Data was collected via semi-structured interviews and analyzed with the constant comparative method (CCM and Porras and Robertson’s (1992 change model. : In both organizations, the view of Lean changed from a toolbox to a human behavior view. Eight barriers were experienced in both organizations. Three barriers were unique to manufacturing or to health care, respectively. Nine barriers were elements of social factors; five were elements of organizing arrangements. Only people practically involved and responsible for the implementation at the two organizations participated in the study. Persons responsible for implementing Lean should consider organizational arrangements and social factors in order to limit barriers to successful implementation. Most research on Lean has been about successful Lean implementations. This study focuses on how Lean is viewed and what barriers personnel in manufacturing and health care have experienced. In comparing the barriers to Lean experienced in the two groups, common, archetypical, and unique barriers for manufacturing and health care can be identified, thus contributing to knowledge about barriers to Lean implementation.

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

    Science.gov (United States)

    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

  19. Six sigma and lean production adoption in a manufacturing company

    Directory of Open Access Journals (Sweden)

    Alisson Christian Scheller

    2014-11-01

    Full Text Available The connection among Lean Production with Six Sigma originated the Lean Six Sigma methodology, focused on processes variation and waste reduction. This methodology was developed on different ways in the companies and there is no consensus over its structure and its implementation. In this context, this paper aims to identify and analyze the main characteristics on the adoption and integration of Lean Six Sigma methodology through a case study conducted in a manufacturing company that adopts lean production and six sigma. The results show two important aspects of the Lean Six Sigma methodology. One of them is the adoption of the value stream mapping as a central tool on Lean Six Sigma. The other is the use of DMAIC for improvements actions. The study indicates that despite the difficulties on Lean Six Sigma implementation, the methodology offers benefits to the company that adopts it in the suitable way.

  20. Product innovation and commercialization in lean global start-ups

    DEFF Research Database (Denmark)

    Tanev, Stoyan; Rasmussen, Erik Stavnsager; Zijdemans, Erik

    2015-01-01

    The paper examines the distinctive characteristics of product innovation and commercialization in Lean Global Start-up (LGS) – new technology firms which have adopted a lean and global path from or near to their inception. It suggests an uncertainty vs risk framework which allows integrating two...... research streams – Born Global (BG) firms and lean start-ups. In addition to its integrative theoretical value, the paper offers insights for lean start-up managers dealing with the challenges of a global start....

  1. Using Lean to Advance Quality Improvement Research.

    Science.gov (United States)

    Blackmore, Christopher Craig; Williams, Barbara L; Ching, Joan M; Chafetz, Lynne A; Kaplan, Gary S

    2016-01-01

    Quality improvement research skills are not commonplace among quality improvement practitioners, and research on the effectiveness of quality improvement has not always kept pace with improvement innovation. However, the Lean tools applied to quality improvement should be equally relevant to the advancement of quality improvement research. We applied the Lean methods to develop a simplified quality improvement publication pathway enabling a small research methodology group to increase quality improvement research throughout the institution. The key innovations of the pathway are horizontal integration of the quality improvement research methods group across the institution, implementation of a Lean quality improvement research pathway, and application of a just-in-time quality improvement research toolkit. This work provides a road map and tools for the acceleration of quality improvement research. At our institution, the Lean quality improvement research approach was associated with statistically significant increases in the number (annual mean increase from 3.0 to 8.5, p = .03) and breadth of published quality improvement research articles, and in the number of quality improvement research projects currently in process. Application of Lean methods to the quality improvement research process can aid in increasing publication of quality improvement articles from across the institution.

  2. Effects of sheep production systems on oxidative storage stability of lean lamb patties.

    Science.gov (United States)

    Rhee, Ki Soon; Lupton, C J; Ziprin, Y A; Rhee, K C

    2003-10-01

    Rambouillet lambs were assigned to three production systems varying in physical environment and diet: RF (a new, raised-floor feeding structure, with animals fed a pelleted mixture of 85% oat hay, 7.5% barley and 7.5% molasses); FL (a feedlot, with animals fed high-concentrate rations); and P (a pasture, with animals given access to the pasture and a high-concentrate supplement). Lengths of time on feed were adjusted to produce similar final shorn weights for each system. Ground meat patties were made with knife-separable lean from hind legs and aerobically refrigerated. Fat content of patties was not significantly different between RF and FL or P, while total unsaturated fatty acid percentage was slightly lower (P<0.05) for RF treatment. Patty color (redness) was most stable for RF. Lipid oxidation in raw patties also was lower (P<0.05) for RF than FL, but oxidation in cooked patties was greater for RF.

  3. Indian girls have higher bone mineral content per unit of lean body than boys through puberty.

    Science.gov (United States)

    Khadilkar, Anuradha V; Sanwalka, Neha; Mughal, M Zulf; Chiplonkar, Shashi; Khadilkar, Vaman

    2018-05-01

    Our aim is to describe changes in the muscle-bone unit assessed as a ratio of bone mineral content (BMC) to lean body mass (LBM) through puberty at total body and various skeletal sites in Indian boys and girls. A cross-sectional study was conducted (888 children, 480 boys, aged 5-17 years) in Pune, India. Pubertal staging was assessed. BMC, LBM and fat percentage at the arms, legs, android, gynoid and total body (less the head) were assessed by dual energy X-ray absorptiometry. The amount of BMC per unit LBM (BMC/LBM) was computed. Changes in mean BMC/LBM at 5 Tanner (pubertal) stages after adjustment for age and fat percentage were calculated. In boys, adjusted BMC/LBM was significantly higher with successive Tanner stages [legs (TS-II vs TS-I), android (TS-III vs TS-II, TS-IV vs TS-III) and gynoid region (TS-III vs TS-II and TS-II vs TS-I) (p LBM was significantly higher with successive Tanner stages at total body, legs and gynoid (TS-III vs TS-II; TS-II vs TS-I; TS-V vs TS-IV), arms (TS-I to TS-V) and android regions (TS-V vs TS-IV) (p LBM than girls at earlier Tanner stages (TS-I to TS-III), whereas girls had significantly higher adjusted BMC/LBM than boys at later Tanner stages (TS-IV, TS-V) (p LBM with successive pubertal stages. Girls had higher BMC/LBM than boys which may possibly act as a reservoir for later demands of pregnancy and lactation.

  4. Is there a lean future for global startups?

    DEFF Research Database (Denmark)

    Tanev, Stoyan

    2017-01-01

    This article integrates insights from the latest research on the lean startup entrepreneurial method, born-global firms, and global startups. It contributes to the clarification of terminology referring to the global aspects of startups, summarizes insights from previous literature focusing on gl......-based global startup research and practice. The analysis should benefit both researchers and practitioners in technology entrepreneurship, international entrepreneurship, and global innovation management.......This article integrates insights from the latest research on the lean startup entrepreneurial method, born-global firms, and global startups. It contributes to the clarification of terminology referring to the global aspects of startups, summarizes insights from previous literature focusing...... on global startups, and further substantiates the articulation of the need for considering the lean global startup as a new type of firm. The main message is that the lessons learned from the emergence of lean startup entrepreneurship offer a basis for promoting a similar lean phase in technology...

  5. Lean-team effectiveness through leader values and members’ informing

    NARCIS (Netherlands)

    van Dun, Desirée Hermina; Wilderom, Celeste P.M.

    2016-01-01

    Purpose Although empirical tests of effective lean-team leadership are scarce, leaders are often blamed when lean work-floor initiatives fail. In the present study, a lean-team leader’s work values are assumed to affect his or her team members’ behaviors and, through them, to attain team

  6. [Anatomical study and clinical application of a leg flap pedicle-included with cutaneous nerve and its concomitant vessels].

    Science.gov (United States)

    Liu, B; Hao, X; Goan, M

    2000-05-01

    To investigate the blood supply patterns and the clinical liability of a leg flap pedicle-included with cutaneous nerve and its concomitant vessels. Fresh cadaver legs with thirty-two in infants and two in adults were anatomically examined after the intravenous injection of the red Chlorinated Poly Vingl Choride (CPVC). Five patients with the soft tissue defects were selected for the treatment with the flap pedicle-included with the cutaneous nerve and its concomitant vessels. Four main cutaneous nerves were found in the leg after they perforated the deep fascia out. They were companioned with their concomitant vessels with different blood-supply pateeerns, which the upper part of the leg was in an axial pattern and the lower part was in a "chain-type anastomosing" pattern. Following the above-mentioned findings, five cases were successfully treated with this led flap. The leg flap should be designed along the cutaneous nerve and its concomitant vessels. When the flap is applied in the area of blood supply with "chain-type anastomosing" pattern, the deep fascia should also be included in the flap.

  7. Pipe crawler with extendable legs

    International Nuclear Information System (INIS)

    Zollinger, W.T.

    1992-01-01

    A pipe crawler for moving through a pipe in inchworm fashion having front and rear leg assemblies separated by air cylinders to increase and decrease the spacing between assemblies. Each leg of the four legs of an assembly is moved between a wall-engaging, extended position and a retracted position by a separate air cylinder. The air cylinders of the leg assemblies are preferably arranged in pairs of oppositely directed cylinders with no pair lying in the same axial plane as another pair. Therefore, the cylinders can be as long as a leg assembly is wide and the crawler can crawl through sections of pipes where the diameter is twice that of other sections. The crawler carries a valving system, a manifold to distribute air supplied by a single umbilical air hose to the various air cylinders in a sequence controlled electrically by a controller. The crawler also utilizes a rolling mechanism, casters in this case, to reduce friction between the crawler and pipe wall thereby further extending the range of the pipe crawler. 8 figs

  8. Pipe crawler with extendable legs

    Science.gov (United States)

    Zollinger, W.T.

    1992-06-16

    A pipe crawler for moving through a pipe in inchworm fashion having front and rear leg assemblies separated by air cylinders to increase and decrease the spacing between assemblies. Each leg of the four legs of an assembly is moved between a wall-engaging, extended position and a retracted position by a separate air cylinder. The air cylinders of the leg assemblies are preferably arranged in pairs of oppositely directed cylinders with no pair lying in the same axial plane as another pair. Therefore, the cylinders can be as long as a leg assembly is wide and the crawler can crawl through sections of pipes where the diameter is twice that of other sections. The crawler carries a valving system, a manifold to distribute air supplied by a single umbilical air hose to the various air cylinders in a sequence controlled electrically by a controller. The crawler also utilizes a rolling mechanism, casters in this case, to reduce friction between the crawler and pipe wall thereby further extending the range of the pipe crawler. 8 figs.

  9. Lean Manufacturing Auto Cluster at Chennai

    Science.gov (United States)

    Bhaskaran, E.

    2012-10-01

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

  10. Adipocyte resistin mRNA levels are down-regulated by laparoscopic ovarian electrocautery in both obese and lean women with polycystic ovary syndrome.

    Science.gov (United States)

    Seow, Kok-Min; Juan, Chi-Chang; Ho, Low-Tone; Hsu, Yung-Pei; Lin, Yu-Hung; Huang, Lee-Wen; Hwang, Jiann-Loung

    2007-04-01

    The aim of this study was to investigate serum and adipocyte mRNA expression of resistin in lean and obese women with polycystic ovary syndrome (PCOS) before and 3 months after laparoscopic ovarian electrocauterization (LOE). Adipose tissue obtained from 12 women with PCOS (six obese and six lean, body mass index > 27 kg m(-1) as threshold point) before and after LOE was analysed. Gene expression of resistin was measured by semi-quantitative RT-PCR. Ten lean, age-matched healthy women served as controls. Both lean and obese women with PCOS had significantly higher fasting and 2 h insulin and homeostasis model insulin resistance index (HOMA(IR)) values and lower fasting glucose-to-insulin ratios (G(0)/I(0)) than did the controls. The serum levels of glucose and insulin and HOMA(IR) were significantly decreased, and the G(0)/I(0) ratio was significantly increased 3 months after LOE. No difference was found in serum resistin levels between controls and either obese or lean women with PCOS before LOE, nor between PCOS patients before and after LOE. However, resistin mRNA expression levels in both lean and obese women with PCOS before LOE were significantly higher than that in controls and were decreased significantly after LOE back to control levels. Local resistin activity may be actively involved in the pathogenesis of PCOS. LOE reduces insulin resistance and down-regulates resistin mRNA expression in lean and obese women with PCOS.

  11. Identification of Lean Implementation Hurdles in Indian Industries

    OpenAIRE

    Bhim Singh

    2016-01-01

    Due to increased pressure from global competitors, manufacturing organizations are switching over to lean philosophies from traditional mass production. Lean manufacturing is a manufacturing philosophy which focuses on elimination of various types of wastes and creates maximum value for the end customers. Lean thinking aims to produce high quality products and services at the lowest possible cost with maximum customer responsiveness. Indian Industry is facing lot of problems in this transform...

  12. Lean process management implementation through enhanced problem solving capabilities

    Directory of Open Access Journals (Sweden)

    Perumal Puvanasvaran

    2010-12-01

    Full Text Available All Original Equipment Manufacturers (OEM organizations in Aerospace, Automotive and Electronics industries had to upgrade their functions. These organizations including suppliers and solutions providers are duty bound to improve their functions through strategic initiatives. One such initiative is Lean Process Management. Lean Process Management has proven to aid organizations in developing manufacturing and administrative management solutions and make the organization a leaner at the same time a ‘fitter’ one, achieving World Class standards in terms of production, quality, marketing, etc, etc. The issue or problem is, although a number of authors, experts, researchers have discussed the lean process management as part organization centric issues, they failed to provide an effective lean process management system. Besides the need to formulate an effective lean process as suggested by some authors, another important reason suggested is the employee’s development aspect regarding how to unlock the infinite potential of their workforce. This employee’s development is basically the problem solving capabilities of the employees while implementing the Lean through clear cutting protocols or processes of Lean Process Management. The employees need to be developed and equipped to contribute optimally to the process. Because of this scenario, the main objective of this study is to develop an employees development system which the author has acronym or trademark it as People Development System (PDS to enhance problem solving capability among its employees while implementing the lean process management there. Although, the PDS can be implemented throughout the organization, if it is implemented in a particular department in an organization, it will be feasible to study and analyze its effectiveness in-depth. So, this study documents and analyzes the implementation of Lean process in the Kitting Department of the aerospace company, ABC Company

  13. Efficacy and efficiency of a lean cataract pathway: a comparative study.

    Science.gov (United States)

    van Vliet, Ellen Joan; Sermeus, Walter; van Gaalen, Claudia M; Sol, Johannes C A; Vissers, Jan M H

    2010-12-01

    The demand for cataract surgery is rising, calling for pathways that have good access and are cost-effective. Lean thinking is a management strategy, aimed at improving quality while reducing costs. Lean production processes are designed to identify gaps between expected and actual performance. To analyse the efficacy and efficiency of a lean cataract pathway. Lean care delivered to a prospective cohort (616 cataract patients) was compared (1) with traditional care delivered to a historical cohort (591 cataract patients) and (2) with expected lean care in the prospective cohort. To evaluate efficacy, the authors analysed how many patients received care that adhered to the lean pathway's specifications. To evaluate efficiency, the authors analysed how often patients visited the hospital and how many additional patients could access the pathway. In the lean pathway, patient visits decreased by 23%, and access to the cataract pathway increased with 42%. A 40% decrease in patient visits and a 76% increase in access could have been realised if healthcare staff would have adhered to the lean pathway's specifications. Lean pathways can realise large improvements, and still have a significant gap between expected and actual care delivery. The challenge for healthcare teams is not to improve care delivery by using lean pathways as opposed to using traditional pathways, but to strive for optimal performance by consistently adhering to the specifications of the lean pathway.

  14. Is There a Lean Future for Global Startups?

    Directory of Open Access Journals (Sweden)

    Stoyan Tanev

    2017-05-01

    Full Text Available This article integrates insights from the latest research on the lean startup entrepreneurial method, born-global firms, and global startups. It contributes to the clarification of terminology referring to the global aspects of startups, summarizes insights from previous literature focusing on global startups, and further substantiates the articulation of the need for considering the lean global startup as a new type of firm. The main message is that the lessons learned from the emergence of lean startup entrepreneurship offer a basis for promoting a similar lean phase in technology-based global startup research and practice. The analysis should benefit both researchers and practitioners in technology entrepreneurship, international entrepreneurship, and global innovation management.

  15. Lean principles adoption in environmental management system (EMS - ISO 14001

    Directory of Open Access Journals (Sweden)

    Perumal Puvanasvaran

    2012-12-01

    Full Text Available Purpose: The purpose of this study is to examine the characteristic of the lean principles into ISO 14001 and to propose linkage of the lean principles and ISO 14001.Design/methodology/approach: To achieve the objective of the study, literature survey and quantitative research method using questionnaires survey are used.Findings and Originality/value: The findings of this study confirm that ISO 14001 certified company adopted lean production practices.  The study also proves that lean principles have positive and significant relationship with ISO 14001 EMS and the linkage can be made between lean principles and ISO 14001 to achieve Continual Improvement.Research limitations/implications: The small sizes of the sample of the participating companies are the main limitations of this study and this research mainly focuses on the manufacturing environment and services industry.Practical implications: This research show that all ISO 14001 companies do adopt at least one lean production practices and the main findings are lean principles has positive and highly significant relationship with ISO 14001 requirements.  This is because the integration of lean principles into ISO 14001 will serve practical methods for ISO14001 EMS to achieve the continual improvement.Originality/value: This research is amongst the first to study the combined lean principles with ISO 1400.  Based on the current situation, there is no integration within this two management system. 

  16. Improving Healthcare through Lean Management: Experiences from the Danish healthcare system

    DEFF Research Database (Denmark)

    Edwards, Kasper; Nielsen, Anders Paarup

    still is in its infancy and it is just a matter of letting sufficient time pass in order have a successful implementation of lean in all areas of healthcare. The second hypothesis states that a major barrier to lean management in healthcare simply is lacking understanding of the lean concepts leading......The ideas and principles from lean management are now widely being adopted within the healthcare sector. The analysis in this paper shows that organizations within healthcare most often only implement a limited set of tools and methods from the lean tool-box. Departing from a theoretical analysis...... of the well-known and universal lean management principles in the context of the healthcare this paper will attempt to formulate and test four hypotheses about possible barriers to the successful implementation of lean management in healthcare. The first hypothesis states that lean management in healthcare...

  17. Lean Supply Chain Planning: A Performance Evaluation through Simulation

    Directory of Open Access Journals (Sweden)

    Rossini Matteo

    2016-01-01

    Full Text Available Nowadays companies look more and more for improving their efficiency to excel in the market. At the same time, the competition has moved from firm level to whole supply chain level. Supply chain are very complex systems and lacks of coordination among their members leads to inefficiency. Supply chain planning task is to improve coordination among supply chain members. Which is the best planning solution to improve efficiency is an open issue. On the other hand, Lean approach is becoming more and more popular among managers. Lean approach is recognize as efficiency engine for production systems, but effects of Lean implementation out of single firm boundaries is not clear. This paper aims at providing a theoretical and practical starting point for Lean implementation in supply chain planning issue. To reach it, a DES simulation model of a three-echelon and multi-product supply chain has been set. Lean management is a very broad topic and this paper focuses on two principles of “pull” and “create the flow”. Kanban system and setup-time and batch-size reductions are implemented in the lean-configured supply chain to apply “pull” and “create the flow” respectively. Lean principles implementations have been analyzed and compared with other supply chain planning policies: EOQ and information sharing (Visibility. Supported by the simulation study, this paper points Lean supply chain planning is a competitive planning policies to increase efficiency.

  18. The roles of communication process for an effective lean manufacturing implementation

    OpenAIRE

    Puvanasvaran, Perumal; Megat, Hamdan; Hong, Tang Sai; Razali, Muhamad Mohd.

    2009-01-01

    Many companies are implementing lean manufacturing concept in order to remain competitive and sustainable, however, not many of them are successful in the process due to various reasons. Communication is an important aspect of lean process in order to successfully implement lean manufacturing. This paper determines the roles of communication process in ensuring a successful implementation of leanness in manufacturing companies. All the information of lean manufacturing practice...

  19. Lean production and business performance: influences of ...

    African Journals Online (AJOL)

    Hence, this study aims to examine the influence of leadership style in the implementation of lean production. Data were gathered from randomly selected Malaysian manufacturing firms. Findings reveal a positive relationship between lean production and business performance. Specifically, democratic leadership style was ...

  20. LEAN SIX SIGMA – MULTIPLE CASE STUDY

    Directory of Open Access Journals (Sweden)

    Delvio Venanzi

    2017-12-01

    Full Text Available Lean Six Sigma é uma gestão focada na qualidade e desempenho produtivo em sistemas operacionais. Este artigo discute os fundamentos desta metodologia através de duas diferentes concepções de gestão, Lean Manufacturing e Six Sigma. Primeiro, o artigo explica o DMAIC (definir, medir, analisar, melhorar e controlar e suas respectivas fases, após a filosofia Lean com o sipoc e técnicas de mapeamento de fluxo de valor. O artigo pretende mostrar a integração destes dois conceitos e seus resultados. A metodologia consistiu em uma teoria baseada em uma pesquisa bibliográfica de pesquisa exploratória que consistiu de três estudos de caso em empresas de diferenças localizadas em Sorocaba, São Paulo. Neste artigo estuda a aplicação de Lean Seis Sigma e seus resultados.

  1. Lean six sigma application to transportation logistics

    Directory of Open Access Journals (Sweden)

    Simone Tavares Fernandes

    2012-06-01

    Full Text Available This work presents the application of Lean Six Sigma in a case study of a metallurgic industry. The Six Sigma and the Lean are two processes used by enterprises in Brazil and worldwide. Currently the integration of these processes is a challenge for these companies, which search a way more efficient to reduce their wastes and to adapt to the needs of their markets. The paper had as purpose to demonstrate the applicability of the Lean Six Sigma in a real logistical problem related to the transportation of goods among units of a metallurgic industry. The stages used for the solution of the problem follow the DMAIC cycle – Define, Measure, Analyze, Improve and Control. The paper presents in details the integrated approach of the improvement processes Lean and Six Sigma, their tools set, as well the excellent results obtained in the case study.

  2. Leg som ustyrlig deltagelseskultur

    DEFF Research Database (Denmark)

    Toft, Herdis

    2017-01-01

    - og spilteoretikere Johan Huizinga og Roger Caillois. Deres teorier og begrebsdannelser har været brugt til at påpege leg dels som et æstetisk baseret betydningssystem, dels som et affektivt og stemningsbaseret oplevelsessystem samt endelig som et socialt baseret relationssystem. I artiklen vælger vi...... at fokusere på leg som et socialt baseret relationssystem og yderligere zoome ind på et af legens systemiske væsenstræk, nemlig brugen af regulerbare regelsæt, som legerne uden ’politi’ forhandler sig frem til før, under og efter legen. Fælles for Huizinga og Caillois er, at de knytter leg uløseligt sammen...

  3. What Determines Lean Manufacturing Implementation? A CB-SEM Model

    Directory of Open Access Journals (Sweden)

    Tan Ching Ng

    2018-02-01

    Full Text Available This research aims to ascertain the determinants of effective Lean Manufacturing (LM. In this research, Covariance-based Structural Equation Modeling (CB-SEM analysis will be used in order to analyze the determinants. Through CB-SEM analysis, the significant key determinants can be determined and the direct relationships among determinants can be analyzed. Thus, the findings of this research can act as guidelines for achievement of LM effectiveness, not only providing necessary steps for successful implementation of lean, but also helping lean companies to achieve higher level of lean cost and time savings.

  4. Buildings Lean Maintenance Implementation Model

    Science.gov (United States)

    Abreu, Antonio; Calado, João; Requeijo, José

    2016-11-01

    Nowadays, companies in global markets have to achieve high levels of performance and competitiveness to stay "alive".Within this assumption, the building maintenance cannot be done in a casual and improvised way due to the costs related. Starting with some discussion about lean management and building maintenance, this paper introduces a model to support the Lean Building Maintenance (LBM) approach. Finally based on a real case study from a Portuguese company, the benefits, challenges and difficulties are presented and discussed.

  5. The challenges of lean manufacturing implementation in kitting assembly

    Science.gov (United States)

    Fansuri, A. F. H.; Rose, A. N. M.; Nik Mohamed, N. M. Z.; Ahmad, H.

    2017-10-01

    Literature studies shows that lean manufacturing goes way back with the original founder Eli Whitney in year 1799. The main purpose of lean manufacturing is to identify and eliminate waste in production. The application of lean manufacturing can be carried out in any industrial processes with regards to the understanding of lean principles, theories and practices. Kitting is one of the important aspects in a successful production. The continuous supply of materials from store to production has to be systematic and able to achieve lean standard for it to be successful. The objective of this paper is to review the implementation of lean manufacturing in kitting assembly. Previous papers show that, the implementation of lean manufacturing in kitting assembly may be beneficial to the organization such as reduce in space occupancy, part shortages, lead time and manpower. Based on previous research, some industries may tend to change between kitting and line stocking which are due to lack of understanding when implementing kitting and causes longer lead time and materials overflow in store. With a proper understanding on what to kit, where to kit, how to kit, why to kit and who kits the material with a standardised process flow may ensure the success of kitting.

  6. Improvement of emergency department patient flow using lean thinking.

    Science.gov (United States)

    Sánchez, Miquel; Suárez, Montse; Asenjo, María; Bragulat, Ernest

    2018-05-01

    To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time. A prospective interventional study. An ED of a tertiary care hospital. Triage acuity level-3 patients. To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff. Two periods were compared: (i) pre-lean: April-September, 2015; and (ii) post-lean: April-September, 2016. Variables included: median process time (time from beginning of nurse preparation to the end of nurse finalization after doctor disposition) of both discharged and transferred to observation patients; median length of stay; median waiting time; left without being seen, 72-h revisit and mortality rates, and daily number of visits. There was no additional staff or bed after lean implementation. Despite an increment in the daily number of visits (+8.3%, P lean implementation. No significant differences were registered in left without being seen rate (5.23% vs 4.95%), 72-h revisit rate (3.41% vs 3.93%), and mortality rate (0.23% vs 0.15%). Lean thinking is a methodology that can improve triage acuity level-3 patient flow in the ED, resulting in better throughput along with reduced waiting time.

  7. Performance effect of multiple control forms in a Lean organization

    DEFF Research Database (Denmark)

    Kristensen, Thomas Borup; Israelsen, Poul

    2012-01-01

    Over the last decades Lean has developed into a prominent management philosophy reaching beyond shop floor tools. However, substantial support of performance effects from Lean is still scarce and at best with mixed results. Recently, research has turned its focus towards perceiving Lean...... as a control package. In this paper we present statistical support for enhanced performance coming from Lean. Furthermore, our results strongly support the perception of Lean as a set of multiple control forms (output, behavioral, and social controls) that complement each other. Therefore, performance...... is increased if the average level of control forms is increased, and performance is further increased if the control forms are balanced at the same level representing a complementary effect between them. Our data are archival data spanning multiple years in a strong Lean organization. The dependent performance...

  8. Legāti

    OpenAIRE

    Segliņa, Aiga

    2010-01-01

    Autore teorētiski analizē legāta jēdzienu testamentārās mantošanas ietvaros un atspoguļo praktiska pētījuma rezultātus. Teorētiskā daļa apskata legāta nodibināšanas formu un spēkā esamību, tā iegūšanu un atraidīšanu, izpildi un zaudēšanu, novēlējuma robežas un aprobežojumus. Pētījums veikts aptaujas veidā ar mērķi noskaidrot, cik liela Latvijas iedzīvotāju daļa apzinās legāta nodrošinātās priekšrocības testamentārajā mantošanā. Apskatīts notāra neitralitātes jautājums attiecībā pret mantošana...

  9. Lean principles applied to software development – avoiding waste

    Directory of Open Access Journals (Sweden)

    Ionel NAFTANAILA

    2009-12-01

    Full Text Available Under the current economic conditions many organizations strive to continue the trend towards adopting better software development processes, in order to take advantage of the numerous benefits that these can offer. Those benefits include quicker return on investment, better software quality, and higher customer satisfaction. To date, however, there is little body of research that can guide organizations in adopting modern software development practices, especially when it comes to Lean thinking and principles. To address this situation, the current paper identifies and structures the main wastes (or muda in Lean terms in software development as described by Lean principles, in an attempt to bring into researchers’ and practitioners’ attention Lean Software Development, a modern development methodology based on well-established practices such as Lean Manufacturing or Toyota Production System.

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

    Directory of Open Access Journals (Sweden)

    Mazzocato Pamela

    2012-02-01

    Full Text Available Abstract 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

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

    Science.gov (United States)

    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

  12. Advancing lean manufacturing, the role of IT

    NARCIS (Netherlands)

    Riezebos, J.; Klingenberg, W.

    This introduction to the special issue discusses the changing role of information technology (IT) in advancing lean production. Lean principles and techniques have been applied in a wide variety of organisations, from make-to-stock to engineer-to-order industries, and even in typical service

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

    Science.gov (United States)

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

    2018-05-01

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

  14. Comparison of SUVs normalized by lean body mass determined by CT with those normalized by lean body mass estimated by predictive equations in normal tissues

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Woo Hyoung; Kim, Chang Guhn; Kim, Dae Weung [Wonkwang Univ. School of Medicine, Iksan (Korea, Republic of)

    2012-09-15

    Standardized uptake values (SUVs)normalized by lean body mass (LBM)determined by CT were compared with those normalized by LBM estimated using predictive equations (PEs)in normal liver, spleen, and aorta using {sup 18}F FDG PET/CT. Fluorine 18 fluorodeoxyglucose (F FDG)positron emission tomography/computed tomography (PET/CT)was conducted on 453 patients. LBM determined by CT was defined in 3 ways (LBM{sup CT1}-3). Five PEs were used for comparison (LBM{sup PE1}-5). Tissue SUV normalized by LBM (SUL) was calculated using LBM from each method (SUL{sup CT1}-3, SUL{sup PE1}-5). Agreement between methods was assessed by Bland Altman analysis. Percentage difference and percentage error were also calculated. For all liver SUL{sup CTS} vs. liver SUL{sup PES} except liver SUL{sup PE3}, the range of biases, SDs of percentage difference and percentage errors were -0.17-0.24 SUL, 6.15-10.17%, and 25.07-38.91%, respectively. For liver SUL{sup CTs} vs. liver SUL{sup PE3}, the corresponding figures were 0.47-0.69 SUL, 10.90-11.25%, and 50.85-51.55%, respectively, showing the largest percentage errors and positive biases. Irrespective of magnitudes of the biases, large percentage errors of 25.07-51.55% were observed between liver SUL{sup CT1}-3 and liver SUL{sup PE1}-5. The results of spleen and aorta SUL{sup CTs} and SUL{sup PEs} comparison were almost identical to those for liver. The present study demonstrated substantial errors in individual SUL{sup PEs} compared with SUL{sup CTs} as a reference value. Normalization of SUV by LBM determined by CT rather than PEs may be a useful approach to reduce errors in individual SUL{sup PEs}.

  15. Comparison of SUVs normalized by lean body mass determined by CT with those normalized by lean body mass estimated by predictive equations in normal tissues

    International Nuclear Information System (INIS)

    Kim, Woo Hyoung; Kim, Chang Guhn; Kim, Dae Weung

    2012-01-01

    Standardized uptake values (SUVs)normalized by lean body mass (LBM)determined by CT were compared with those normalized by LBM estimated using predictive equations (PEs)in normal liver, spleen, and aorta using 18 F FDG PET/CT. Fluorine 18 fluorodeoxyglucose (F FDG)positron emission tomography/computed tomography (PET/CT)was conducted on 453 patients. LBM determined by CT was defined in 3 ways (LBM CT1 -3). Five PEs were used for comparison (LBM PE1 -5). Tissue SUV normalized by LBM (SUL) was calculated using LBM from each method (SUL CT1 -3, SUL PE1 -5). Agreement between methods was assessed by Bland Altman analysis. Percentage difference and percentage error were also calculated. For all liver SUL CTS vs. liver SUL PES except liver SUL PE3 , the range of biases, SDs of percentage difference and percentage errors were -0.17-0.24 SUL, 6.15-10.17%, and 25.07-38.91%, respectively. For liver SUL CTs vs. liver SUL PE3 , the corresponding figures were 0.47-0.69 SUL, 10.90-11.25%, and 50.85-51.55%, respectively, showing the largest percentage errors and positive biases. Irrespective of magnitudes of the biases, large percentage errors of 25.07-51.55% were observed between liver SUL CT1 -3 and liver SUL PE1 -5. The results of spleen and aorta SUL CTs and SUL PEs comparison were almost identical to those for liver. The present study demonstrated substantial errors in individual SUL PEs compared with SUL CTs as a reference value. Normalization of SUV by LBM determined by CT rather than PEs may be a useful approach to reduce errors in individual SUL PEs

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

    Science.gov (United States)

    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.

  17. Immediate effects of the trunk stabilizing exercise on static balance parameters in double-leg and one-leg stances

    OpenAIRE

    Kim, Jwa-jun; Park, Se-yeon

    2016-01-01

    [Purpose] The purpose of this study was to evaluate the immediate effect of stabilizing exercise using the PNF technique on standing balance in one-leg and double-leg stances. [Subjects and Methods] The present study recruited 34 healthy participants from a local university. The Participants performed four balance tests (double-leg stance with and without vision, one-leg stance with and without vision), before and after exercise. The exercise consisted of exercises performed using PNF techniq...

  18. Simulation of lean premixed turbulent combustion

    International Nuclear Information System (INIS)

    Bell, J; Day, M; Almgren, A; Lijewski, M; Rendleman, C; Cheng, R; Shepherd, I

    2006-01-01

    There is considerable technological interest in developing new fuel-flexible combustion systems that can burn fuels such as hydrogen or syngas. Lean premixed systems have the potential to burn these types of fuels with high efficiency and low NOx emissions due to reduced burnt gas temperatures. Although traditional Scientific approaches based on theory and laboratory experiment have played essential roles in developing our current understanding of premixed combustion, they are unable to meet the challenges of designing fuel-flexible lean premixed combustion devices. Computation, with its ability to deal with complexity and its unlimited access to data, has the potential for addressing these challenges. Realizing this potential requires the ability to perform high fidelity simulations of turbulent lean premixed flames under realistic conditions. In this paper, we examine the specialized mathematical structure of these combustion problems and discuss simulation approaches that exploit this structure. Using these ideas we can dramatically reduce computational cost, making it possible to perform high-fidelity simulations of realistic flames. We illustrate this methodology by considering ultra-lean hydrogen flames and discuss how this type of simulation is changing the way researchers study combustion

  19. A new technique for measuring protein turnover in the gut, liver and kidneys of lean and obese mice with [3H] glutamic acid

    International Nuclear Information System (INIS)

    Miller, B.G.; Grimble, R.F.; Taylor, T.G.

    1978-01-01

    Measurements have been made of the incorporation of an intraperitoneal injection of [ 3 H]glutamate into the protein of the gut, liver and kidney of lean and obese siblings of the genetically obese mouse. Recycling of the 3 H was minimized by using glutamate labelled at the C-2 position. Loss of label from the amino acid pool by transamination and deamination was rapid, with a half-life of 4 h. In tissue protein the amino acid showing the highest 3 H radioactivity was glutamate. The half-lives for protein synthesis and catabolism were calculated from the decay curves of both specific and total radioactivity of [ 3 H] glutamate in tissue protein. No significant differences were found between kidney, liver and gut in lean and obese mice. (author)

  20. Improvement of laboratory turnaround time using lean methodology.

    Science.gov (United States)

    Gupta, Shradha; Kapil, Sahil; Sharma, Monica

    2018-05-14

    Purpose The purpose of this paper is to discuss the implementation of lean methodology to reduce the turnaround time (TAT) of a clinical laboratory in a super speciality hospital. Delays in report delivery lead to delayed diagnosis increased waiting time and decreased customer satisfaction. The reduction in TAT will lead to increased patient satisfaction, quality of care, employee satisfaction and ultimately the hospital's revenue. Design/methodology/approach The generic causes resulting in increasing TAT of clinical laboratories were identified using lean tools and techniques such as value stream mapping (VSM), Gemba, Pareto Analysis and Root Cause Analysis. VSM was used as a tool to analyze the current state of the process and further VSM was used to design the future state with suggestions for process improvements. Findings This study identified 12 major non-value added factors for the hematology laboratory and 5 major non-value added factors for the biochemistry lab which were acting as bottlenecks resulting in limiting throughput. A four-month research study by the authors together with hospital quality department and laboratory staff members led to reduction of the average TAT from 180 to 95minutes in the hematology lab and from 268 to 208 minutes in the biochemistry lab. Practical implications Very few improvement initiatives in Indian healthcare are based on industrial engineering tools and techniques, which might be due to a lack of interaction between healthcare and engineering. The study provides a positive outcome in terms of improving the efficiency of services in hospitals and identifies a scope for lean in the Indian healthcare sector. Social implications Applying lean in the Indian healthcare sector gives its own potential solution to the problem caused, due to a wide gap between lean accessibility and lean implementation. Lean helped in changing the mindset of an organization toward providing the highest quality of services with faster delivery at

  1. Artificial Leg Design and Control Research of a Biped Robot with Heterogeneous Legs Based on PID Control Algorithm

    Directory of Open Access Journals (Sweden)

    Hualong Xie

    2015-04-01

    Full Text Available A biped robot with heterogeneous legs (BRHL is proposed to provide an ideal test-bed for intelligent bionic legs (IBL. To make artificial leg gait better suited to a human, a four-bar mechanism is used as its knee joint, and a pneumatic artificial muscle (PAM is used as its driving source. The static mathematical model of PAM is established and the mechanical model of a single degree of freedom of a knee joint driven by PAM is analyzed. A control simulation of an artificial leg based on PID control algorithm is carried out and the simulation results indicate that the artificial leg can simulate precisely a normal human walking gait.

  2. Disturbing Practices: Training Workers to Be Lean

    Science.gov (United States)

    Yasukawa, Keiko; Brown, Tony; Black, Stephen

    2014-01-01

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

  3. Lean Thinking and Transferring Lean Management - The Best Defence against an Economic Recession?

    Directory of Open Access Journals (Sweden)

    Daniel D. GEORGESCU

    2011-06-01

    Full Text Available Productivity growth is a fundamental means for society to improve its living standards. Productivity growth comes from technological change (new ways of producing goods and services and better organisation of production (better ways of using available resources given available technology. Both processes operate simultaneously and, in practice, it is difficult to distinguish between the effects of each process. The processes are dynamic and affect individual activities differently over time. These years, manufacturing functions have been transferred rapidly and globally from mature countries to emerging countries. This paper is about the lean philosophy and the critical elements for successful transfer of lean management among sites and countries.

  4. Lean implementation strategies: how are the Toyota way principles addressed?

    Directory of Open Access Journals (Sweden)

    Coetzee, Rojanette

    2016-11-01

    Full Text Available Lean manufacturing is widely considered to be a proven organisational improvement philosophy, yet the success rate of lean implementation in industry remains relatively low. Neglect of the human aspect of lean manufacturing is often cited as the leading reason for this, despite the emphasis so clearly placed upon this aspect by the creators of the lean philosophy. This article reviews the extent to which the human dimensions of the lean philosophy, as described in the Toyota Way management principles, have been incorporated in lean implementation strategies. It is found that few of the principles feature prominently in these strategies. Notably absent are those linked to the ‘respect for people’ pillar , which forms half of the T oyota Way’s foundation. This conclusion indicates that the adoption of the lean philosophy runs contrary to the oft-repeated message from its creators that no tenet of the philosophy should be favoured at the expense of another. This may provide valuable insight into the reasons for the high implementation failure rate.

  5. Lean healthcare in developing countries: evidence from Brazilian hospitals.

    Science.gov (United States)

    Costa, Luana Bonome Message; Filho, Moacir Godinho; Rentes, Antonio Freitas; Bertani, Thiago Moreno; Mardegan, Ronaldo

    2017-01-01

    The present study evaluates how five sectors of two Brazilian hospitals have implemented lean healthcare concepts in their operations. The main characteristics of the implementation process are analyzed in the present study: the motivational factor for implementation, implementation time, form (consultancy or internal), team (hospital and consultants), lean implementation continuity/sustainability, lean healthcare tools and methods implemented, problems/improvement opportunities, lean healthcare barriers faced during the implementation process, and critical factors that affected the implementation and the results obtained in each case. The case studies indicate that reducing patient lead times and costs and making financial improvements were the primary factors that motivated lean healthcare implementation in the hospitals studied. Several tools and methods were used in the cases studied, especially value stream mapping and DMAIC. The barriers found in both hospitals are primarily associated with the human factor. Additionally, the results obtained after implementation were analyzed and improvements in financial aspects, productivity and capacity, and lead time reduction of the analyzed sectors were observed. Further, this study also exhibited four propositions elaborated from the results obtained from the cases that highlighted barriers and challenges to lean healthcare implementation in developing countries. Two of these barriers are hospital organizational structure (and, consequently, how the senior management works with medical staff), and outsourcing hospital activities. This study also concluded that the initialization and maintenance of lean healthcare implementation rely heavily on external support because lean healthcare subject knowledge is not yet available in the healthcare organization, which represents a challenge. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  6. Activity of thyroxine 5' deiodinase in brown fat of lean and obese zucker rats

    International Nuclear Information System (INIS)

    Wu, S.Y.; Fisher, D.A.; Stern, J.S.; Glick, Z.

    1986-01-01

    This study examines the possibility that the reduced brown adipose tissue (BAT) thermogenesis in the Zucker obese rat may result from a limited capacity for conversion of T 4 to T 3 in BAT, through activity of T 4 5' deiodinase. Eighteen lean (Fa/.) and 18 age matched obese (fa/fa), about 16 weeks old, were each divided into 3 groups (n=6 per group). Group 1 and 2 were fed Purina Rat Chow and a cafeteria diet respectively for 21 days, and maintained at 22 0 C+/-2. Group 3 was fed rat chow and maintained at 8 0 C+/-1 for 7 days. Activity of T 4 5'deiodinase was determined in vitro. T 3 was measured by a radioimmunoassay. The rate of T 4 to T 3 conversion was similar in the lean and the obese rats maintained at room temperature, whether fed rat chow or a cafeteria diet (about 40 to 50 pmol T 3 /scapular BAT depot, per hour). However, lean rats exposed to the cold displayed about a 5 fold increase in T 4 5' deiodinase activity (p 3 may account for the reduced tolerance of obese animals to cold, but it does not account for their reduced diet induced BAT thermogenesis

  7. Lean spare parts delivery chain

    OpenAIRE

    Sjöstrand, Niklas; Larsson, Mona-Liza

    2015-01-01

    AbstractWhen a product has been sold to a customer a new market arises for the company to earn profit from and to differentiate itself within. According to Bartwal, et al. (2010) the after sales market generally does not provide great revenues but good profits of the total revenue. In order to gain competiveness and live up to customer’s expectations a company needs to be efficient (Atkinson, 2004). He continuous that this can be accomplished if companies implement Lean. Lean is different too...

  8. Investigating emergency room service quality using lean manufacturing.

    Science.gov (United States)

    Abdelhadi, Abdelhakim

    2015-01-01

    The purpose of this paper is to investigate a lean manufacturing metric called Takt time as a benchmark evaluation measure to evaluate a public hospital's service quality. Lean manufacturing is an established managerial philosophy with a proven track record in industry. A lean metric called Takt time is applied as a measure to compare the relative efficiency between two emergency departments (EDs) belonging to the same public hospital. Outcomes guide managers to improve patient services and increase hospital performances. The patient treatment lead time within the hospital's two EDs (one department serves male and the other female patients) are the study's focus. A lean metric called Takt time is used to find the service's relative efficiency. Findings show that the lean manufacturing metric called Takt time can be used as an effective way to measure service efficiency by analyzing relative efficiency and identifies bottlenecks in different departments providing the same services. The paper presents a new procedure to compare relative efficiency between two EDs. It can be applied to any healthcare facility.

  9. Lean management-the journey from toyota to healthcare.

    Science.gov (United States)

    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.

  10. Lean manufacturing: A better way for enhancement in productivity

    Science.gov (United States)

    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."

  11. Lean Start-up in Established Companies

    DEFF Research Database (Denmark)

    Goduscheit, René Chester

    2018-01-01

    Lean start-up is an emergent perspective on how entrepreneurs can bring new products and services to the market. This approach challenges the dominant role of lengthy business plans, linear product development processes, and seeking complete overview of the potential of the new products....../services before market launch. Instead it suggests that start-ups could benefit from a ‘minimum-viable product’ approach where products and services are launched when they contain critical features. The emphasis in the lean start-up approach is on business models rather than the elaborate business plan...... at the companies (strategy meetings, development workshops etc.). The aim is to shed light on the implications for companies that seek to employ lean start-up. These implications will be aimed at aspects like innovation management, organizational structure, customer relations etc....

  12. Evaluation of protection systems for the lower extremity against the shock and blast effects resulting from anti-personnel mines using the Surrogate Lower Leg (SLL)

    CSIR Research Space (South Africa)

    Smit, E

    2012-10-01

    Full Text Available . Injury assessment Mine trauma score Injury No major injury 0 Salvageable limb 1 Closed 1A Open contained 1B Open contaminated Transtibial amputation 2 Closed 2A Open contained 2B Open contaminated Transtibial/transfemoral amputation 3... Transfemoral amputation 4 SURROGATE LOWER LEG DEVELOPMENT The Surrogate Lower Leg (SLL) approximates an actual human leg in terms of geometry and materials of construction. The SLL is intended for destructive testing in order to assess the degree of tissue...

  13. Robust and efficient walking with spring-like legs

    Energy Technology Data Exchange (ETDEWEB)

    Rummel, J; Blum, Y; Seyfarth, A, E-mail: juergen.rummel@uni-jena.d, E-mail: andre.seyfarth@uni-jena.d [Lauflabor Locomotion Laboratory, University of Jena, Dornburger Strasse 23, 07743 Jena (Germany)

    2010-12-15

    The development of bipedal walking robots is inspired by human walking. A way of implementing walking could be performed by mimicking human leg dynamics. A fundamental model, representing human leg dynamics during walking and running, is the bipedal spring-mass model which is the basis for this paper. The aim of this study is the identification of leg parameters leading to a compromise between robustness and energy efficiency in walking. It is found that, compared to asymmetric walking, symmetric walking with flatter angles of attack reveals such a compromise. With increasing leg stiffness, energy efficiency increases continuously. However, robustness is the maximum at moderate leg stiffness and decreases slightly with increasing stiffness. Hence, an adjustable leg compliance would be preferred, which is adaptable to the environment. If the ground is even, a high leg stiffness leads to energy efficient walking. However, if external perturbations are expected, e.g. when the robot walks on uneven terrain, the leg should be softer and the angle of attack flatter. In the case of underactuated robots with constant physical springs, the leg stiffness should be larger than k-tilde = 14 in order to use the most robust gait. Soft legs, however, lack in both robustness and efficiency.

  14. Robust and efficient walking with spring-like legs

    International Nuclear Information System (INIS)

    Rummel, J; Blum, Y; Seyfarth, A

    2010-01-01

    The development of bipedal walking robots is inspired by human walking. A way of implementing walking could be performed by mimicking human leg dynamics. A fundamental model, representing human leg dynamics during walking and running, is the bipedal spring-mass model which is the basis for this paper. The aim of this study is the identification of leg parameters leading to a compromise between robustness and energy efficiency in walking. It is found that, compared to asymmetric walking, symmetric walking with flatter angles of attack reveals such a compromise. With increasing leg stiffness, energy efficiency increases continuously. However, robustness is the maximum at moderate leg stiffness and decreases slightly with increasing stiffness. Hence, an adjustable leg compliance would be preferred, which is adaptable to the environment. If the ground is even, a high leg stiffness leads to energy efficient walking. However, if external perturbations are expected, e.g. when the robot walks on uneven terrain, the leg should be softer and the angle of attack flatter. In the case of underactuated robots with constant physical springs, the leg stiffness should be larger than k-tilde = 14 in order to use the most robust gait. Soft legs, however, lack in both robustness and efficiency.

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

    Science.gov (United States)

    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.

  16. Debates regarding lean patients with polycystic ovary syndrome: A narrative review

    Directory of Open Access Journals (Sweden)

    Manu Goyal

    2017-01-01

    Full Text Available 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.

  17. Frozen allogeneic human epidermal cultured sheets for the cure of complicated leg ulcers.

    Science.gov (United States)

    Bolívar-Flores, Y J; Kuri-Harcuch, W

    1999-08-01

    Skin ulcers due to venous stasis or diabetes are common among the elderly and are difficult to treat. Repeated applications of cell-based products have been reported to result in cure or improvement of leg ulcers of small size in a fraction of patients. To examine the effects of frozen human allogeneic epidermal cultures for the treatment of acute and chronic ulcers. We treated a series of 10 consecutive patients with leg ulcers of different etiology and duration with frozen human allogeneic epidermal cultures stored frozen and thawed for 5-10 minutes at room temperature before application. Three patients had ulcers with exposed Achilles or extensor tendon. The ulcers treated were as large as 160 cm2 in area and of up to 20-years' duration. After preliminary preparation of the wounds by debridement to remove necrotic tissue and application of silver sulfadiazine to control infection, thawed cultures were applied biweekly from 2 to 15 times depending on the size and complexity of the ulcer. All ulcers healed, including those with tendon exposure. After the first few applications, granulation tissue formed in the ulcer bed and on exposed tendons, and epidermal healing took place through proliferation and migration of cells from the margins of the wound. The time required for complete healing ranged from 1 to 31 weeks after the first application. The use of frozen human allogeneic epidermal cultures is a safe and effective treatment for venous or diabetic ulcers, even those with tendon exposure. It seems possible that any leg ulcer will be amenable to successful treatment by this method.

  18. Leading Lean: a Canadian healthcare leader's guide.

    Science.gov (United States)

    Fine, Benjamin A; Golden, Brian; Hannam, Rosemary; Morra, Dante

    2009-01-01

    Canadian healthcare organizations are increasingly asked to do more with less, and too often this has resulted in demands on staff to simply work harder and longer. Lean methodologies, originating from Japanese industrial organizations and most notably Toyota, offer an alternative - tried and tested approaches to working smarter. Lean, with its systematic approaches to reducing waste, has found its way to Canadian healthcare organizations with promising results. This article reports on a study of five Canadian healthcare providers that have recently implemented Lean. We offer stories of success but also identify potential obstacles and ways by which they may be surmounted to provide better value for our healthcare investments.

  19. Assessing the impacts of implementing lean construction Evaluando los impactos de la implementación de lean construction

    Directory of Open Access Journals (Sweden)

    Luis F Alarcón

    2008-04-01

    Full Text Available Over the last 10 years an increasing number of companies have implemented lean construction practices in an attempt to improve performance in construction projects. Most companies, and also some researchers, have reported satisfactory results from their implementation. However, there is still a need to provide more extensive analysis of the empirical evidence available to assess the impact of the implementation of lean construction. The authors have researched the implementation of the Last Planner System and other Lean Construction techniques in over one hundred construction projects over the last five years. They have also developed strategies and support tools for implementation. This paper analyzes some of the main impacts observed in the studied projects, and some of the lessons learned from implementations. The paper discusses difficulties and barriers for implementation, productivity improvements, variability reduction and effectiveness of implementation strategies. The paper also provides recommendations for future implementation and researchEn los últimos 10 años un creciente número de empresas constructoras ha implementado prácticas de Lean Construction para mejorar el desempeño de sus proyectos. La mayor parte de estas empresas, y también algunos investigadores, han informado sobre buenos resultados obtenidos en los proyectos. Sin embargo, todavía es necesario un análisis más completo de la evidencia empírica disponible para evaluar así el impacto de Lean Construction en los proyectos y empresas. Los autores han investigado la implementación del Sistema Ultimo Planificador y otras técnicas de Lean Construction en mas de un centenar de proyectos en los últimos 5 años y han desarrollado estrategias y herramientas de apoyo para su implementación. Este artículo analiza algunos de los principales impactos observados en los proyectos estudiados y las lecciones aprendidas en este proceso. Se discuten dificultades y barreras

  20. Quality and Competitiveness: A Lean Six Sigma Approach

    Directory of Open Access Journals (Sweden)

    Irina-Virginia Drăgulănescu

    2015-11-01

    Full Text Available Originally developed to improve the quality and production efficiency, Lean Six Sigma is now widely adopted in other non-manufacturing sectors such as financial, trade, services, etc. The methodology known as Lean Six Sigma combines the Six Sigma techniques, ‒ which allow companies to reduce manufacturing defects ‒ and the Lean Manufacturing principles, ‒ which help companies benefit from faster processing for lower costs and with superior quality. As a result of the research, the authors observed that, despite growing popularity and impressive outcomes obtained by some companies, the Lean Six Sigma model does not always offer the expected results. However, the research has shown that the analysed company, operating in the field of courier services has managed to boost productivity and competitiveness by implementing measures that generated added value.

  1. 'Lean' approach gives greater efficiency.

    Science.gov (United States)

    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.

  2. Does a crouched leg posture enhance running stability and robustness?

    Science.gov (United States)

    Blum, Yvonne; Birn-Jeffery, Aleksandra; Daley, Monica A; Seyfarth, Andre

    2011-07-21

    Humans and birds both walk and run bipedally on compliant legs. However, differences in leg architecture may result in species-specific leg control strategies as indicated by the observed gait patterns. In this work, control strategies for stable running are derived based on a conceptual model and compared with experimental data on running humans and pheasants (Phasianus colchicus). From a model perspective, running with compliant legs can be represented by the planar spring mass model and stabilized by applying swing leg control. Here, linear adaptations of the three leg parameters, leg angle, leg length and leg stiffness during late swing phase are assumed. Experimentally observed kinematic control parameters (leg rotation and leg length change) of human and avian running are compared, and interpreted within the context of this model, with specific focus on stability and robustness characteristics. The results suggest differences in stability characteristics and applied control strategies of human and avian running, which may relate to differences in leg posture (straight leg posture in humans, and crouched leg posture in birds). It has been suggested that crouched leg postures may improve stability. However, as the system of control strategies is overdetermined, our model findings suggest that a crouched leg posture does not necessarily enhance running stability. The model also predicts different leg stiffness adaptation rates for human and avian running, and suggests that a crouched avian leg posture, which is capable of both leg shortening and lengthening, allows for stable running without adjusting leg stiffness. In contrast, in straight-legged human running, the preparation of the ground contact seems to be more critical, requiring leg stiffness adjustment to remain stable. Finally, analysis of a simple robustness measure, the normalized maximum drop, suggests that the crouched leg posture may provide greater robustness to changes in terrain height

  3. Don't break a leg: running birds from quail to ostrich prioritise leg safety and economy on uneven terrain.

    Science.gov (United States)

    Birn-Jeffery, Aleksandra V; Hubicki, Christian M; Blum, Yvonne; Renjewski, Daniel; Hurst, Jonathan W; Daley, Monica A

    2014-11-01

    Cursorial ground birds are paragons of bipedal running that span a 500-fold mass range from quail to ostrich. Here we investigate the task-level control priorities of cursorial birds by analysing how they negotiate single-step obstacles that create a conflict between body stability (attenuating deviations in body motion) and consistent leg force-length dynamics (for economy and leg safety). We also test the hypothesis that control priorities shift between body stability and leg safety with increasing body size, reflecting use of active control to overcome size-related challenges. Weight-support demands lead to a shift towards straighter legs and stiffer steady gait with increasing body size, but it remains unknown whether non-steady locomotor priorities diverge with size. We found that all measured species used a consistent obstacle negotiation strategy, involving unsteady body dynamics to minimise fluctuations in leg posture and loading across multiple steps, not directly prioritising body stability. Peak leg forces remained remarkably consistent across obstacle terrain, within 0.35 body weights of level running for obstacle heights from 0.1 to 0.5 times leg length. All species used similar stance leg actuation patterns, involving asymmetric force-length trajectories and posture-dependent actuation to add or remove energy depending on landing conditions. We present a simple stance leg model that explains key features of avian bipedal locomotion, and suggests economy as a key priority on both level and uneven terrain. We suggest that running ground birds target the closely coupled priorities of economy and leg safety as the direct imperatives of control, with adequate stability achieved through appropriately tuned intrinsic dynamics. © 2014. Published by The Company of Biologists Ltd.

  4. Confidence and clinical judgement in community nurses managing venous leg ulceration - A judgement analysis.

    Science.gov (United States)

    Adderley, Una J; Thompson, Carl

    2017-11-01

    The variation in the management of venous leg ulceration in the UK is partly attributable to an uncertain clinical environment but the quality of judgements is influenced by the how well nurses' confidence and accuracy are aligned. To assess UK community nurses' confidence in the accuracy of their diagnostic judgements and treatment choices when managing venous leg ulceration. Judgement Analysis. UK community and primary care nursing services. 18 community non-specialist nurses working in district (home) nursing teams and general practitioner services and 18 community tissue viability specialist nurses. Using judgement analysis methods, 18 community non-specialist nurses and 18 community tissue viability specialist nurses made diagnoses and treatment judgements about compression therapy for 110 clinical scenarios and indicated their confidence for each judgement. An expert panel made consensus judgements for the same scenarios and these judgements were used as a standard against which to compare the participants. Confidence analysis was used to assess the nurses' confidence about their diagnostic judgements and treatment choices. Despite being very experienced, both non-specialist nurses' and specialist tissue viability nurses' levels of confidence were not well calibrated with their levels of accuracy. The results of this study are important as errors resulting from both over and under-confidence at the diagnostic phase of management may influence treatment choices, and thus increase the chances of treatment error. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    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.

  6. Relationship Between Lean Production and Operational Performance in the Manufacturing Industry

    Science.gov (United States)

    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.

  7. NOx storage and reduction over a lean-burn automotive catalyst

    NARCIS (Netherlands)

    Scholz, C.M.L.

    2007-01-01

    Nowadays, there is an increased interest in lean-burn technologies, i.e. diesel and lean-burn gasoline engines, mainly due to their higher fuel efficiency compared to conventional gasoline engines. Lean-burn engines work under excess oxygen and consequently produce oxygen-rich exhaust. This

  8. Bone and soft tissue components of the leg in infants with protein calorie malnutrition

    Energy Technology Data Exchange (ETDEWEB)

    Akamaguna, A I; Odita, J C; Ugbodaga, C I; Okolo, A A

    1986-01-01

    The measurements of muscle, fat and cortical thickness were made on leg radiographs of 40 kwashiorkhor infants and were compared with those of 32 normal infants. There is a significant decrease in muscle cylinder ratio, an index of the contribution of muscle to calf thickness in kwashiorkhor. The loss of bone cortex in kwashiorkhor is due mainly to failure of appositional growth. The muscle cylinder ratio in normal Nigerian infants in much higher than has been reported amongst Caucasians. (orig.).

  9. Bone and soft tissue components of the leg in infants with protein calorie malnutrition

    International Nuclear Information System (INIS)

    Akamaguna, A.I.; Odita, J.C.; Ugbodaga, C.I.; Okolo, A.A.

    1986-01-01

    The measurements of muscle, fat and cortical thickness were made on leg radiographs of 40 kwashiorkhor infants and were compared with those of 32 normal infants. There is a significant decrease in muscle cylinder ratio, an index of the contribution of muscle to calf thickness in kwashiorkhor. The loss of bone cortex in kwashiorkhor is due mainly to failure of appositional growth. The muscle cylinder ratio in normal Nigerian infants in much higher than has been reported amongst Caucasians. (orig.)

  10. 11Beta-HSD type 1 expression in human adipose tissue: impact of gender, obesity, and fat localization

    DEFF Research Database (Denmark)

    Paulsen, Søren Kildeberg; Pedersen, Steen Bønløkke; Fisker, Sanne

    2007-01-01

    of the metabolic syndrome. Our objective was to compare 11beta-HSD1 gene expression in different fat depots (visceral, subcutaneous abdominal, and subcutaneous gluteal) in lean and obese men and women. RESEARCH METHODS AND PROCEDURES: A cross-sectional study design was used for healthy patients undergoing minor...... women had lower 11beta-HSD1 gene expression in subcutaneous adipose tissue compared with men (62% lower, p difference was found between obese men and women. 11Beta-HSD1 mRNA in human adipose tissue was higher in obese subjects compared with lean subjects in both women...... and men and in both subcutaneous and visceral adipose tissue. No difference in mRNA expression of 11beta-HSD1 between visceral and subcutaneous adipose tissue or between subcutaneous adipose tissue from different depots was found. CONCLUSIONS: 11Beta-HSD1 in adipose tissue is increased in obesity in both...

  11. Lean start-up

    DEFF Research Database (Denmark)

    Rasmussen, Erik Stavnsager; Tanev, Stoyan

    2016-01-01

    The risk of launching new products and starting new firms is known to be extremely high. The Lean Start-up approach is a way of reducing these risks and enhancing the chances for success by validating the products and services in the market with customers before launching it in full scale. The ma...... and the final business model. In other words: The start-up must first nail the problem together with the customers, then develop the solution and test, and then in the end scale it to a full-grown business model.......The risk of launching new products and starting new firms is known to be extremely high. The Lean Start-up approach is a way of reducing these risks and enhancing the chances for success by validating the products and services in the market with customers before launching it in full scale. The main...

  12. Leg intravenous pressure during head-up tilt.

    NARCIS (Netherlands)

    Groothuis, J.T.; Poelkens, F.; Wouters, C.W.; Kooijman, H.M.; Hopman, M.T.E.

    2008-01-01

    Leg vascular resistance is calculated as the arterial-venous pressure gradient divided by blood flow. During orthostatic challenges it is assumed that the hydrostatic pressure contributes equally to leg arterial, as well as to leg venous pressure. Because of venous valves, one may question whether,

  13. Adipocyte triglyceride turnover and lipolysis in lean and overweight subjects.

    Science.gov (United States)

    Rydén, Mikael; Andersson, Daniel P; Bernard, Samuel; Spalding, Kirsty; Arner, Peter

    2013-10-01

    Human obesity is associated with decreased triglyceride turnover and impaired lipolysis in adipocytes. We determined whether such defects also occur in subjects with only moderate increase in fat mass. Human abdominal subcutaneous adipose tissue was investigated in healthy, nonobese subjects [body mass index (BMI) > 17 kg/m(2) and BMI lean subjects (P = 0.017) with triglyceride T1/2 of 14 and 9 months, respectively (P = 0.04). Triglyceride age correlated positively with BMI (P = 0.002) but not with adipocyte volume (P = 0.2). Noradrenaline-, isoprenaline- or dibutyryl cyclic AMP-induced lipolysis was inversely correlated with triglyceride age (P maintenance of excess body fat.

  14. Lean Production and information technology : Connection or contradiction?

    NARCIS (Netherlands)

    Riezebos, Jan; Klingenberg, Warse; Hicks, Christian

    The principles of Lean Production have enabled organisations in the manufacturing and service sectors to significantly improve their competitiveness. The application of Lean principles, derived from the Toyota Production System has enabled many organisations to Simultaneously improve productivity,

  15. Application of a mathematical model for ergonomics in lean manufacturing.

    Science.gov (United States)

    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.

  16. LEAN ACCOUNTING: SUATU ALTERNATIF TEKNIK AKUNTANSI MANAJEMEN DALAM INDUSTRI MANUFAKTUR

    Directory of Open Access Journals (Sweden)

    Eka Ardhani Sisdyani

    2010-07-01

    Full Text Available Manufacturing techniques have been developed to embrace theaims of continuous improvement. Continuous improvement would leadcompanies to win business competition. One technique that gains moreand more followers is lean manufacturing. Lean manufacturing hastwo main purposes, which are eliminating wastes and creating valuesto customers. It focuses on customer values, value stream, productionflows, demand-pull, and perfection. Lean accounting is needed tosupport and encourage the development of lean manufacturing, forinstances in product costing system, external reporting, and otherdecision making processes that need accounting data.

  17. Doppler ultrasound exam of an arm or leg

    Science.gov (United States)

    Peripheral vascular disease - Doppler; PVD - Doppler; PAD - Doppler; Blockage of leg arteries - Doppler; Intermittent claudication - Doppler; Arterial insufficiency of the legs - Doppler; Leg pain and ...

  18. Lean Maintenance Applied to Improve Maintenance Efficiency in Thermoelectric Power Plants

    Directory of Open Access Journals (Sweden)

    Orlando Duran

    2017-10-01

    Full Text Available Thermoelectric power plants consist of a set of critical equipment that require high levels of availability and reliability. Due to this, maintenance of these physical assets is gaining momentum in industry. Maintenance is considered as an activity that contributes to improving the availability, efficiency and productivity of each piece of equipment. Several techniques have been used to achieve greater efficiencies in maintenance, among which we can find the lean maintenance philosophy. Despite the wide diffusion of lean maintenance, there is no structured method that supports the prescription of lean tools applied to the maintenance function. This paper presents the experience gathered in two lean maintenance projects in thermoelectric power plants. The application of lean techniques was based on using a previously developed multicriterial decision making process that uses the Fuzzy Analytic Hierarchy Process (AHP methodology to carry out a diagnosis and prescription tasks. That methodology allowed the prescription of the appropriated lean techniques to resolve the main deficiencies in maintenance function. The results of applying such lean tools show that important results can be obtained, making the maintenance function in thermoelectric power plants more efficient and lean.

  19. Succesful Lean Manufacturing Implementation: Internal Key Influencing Factors

    Science.gov (United States)

    Virginia, Iuga; Claudiu, Kifor

    2015-09-01

    Manufacturing sectors and companies all over the world are successfully implementing lean principles within their processes. Nowadays, lean has become an indispensable part of global players. Companies worldwide need to be aware of multiple factors which weigh heavily on the success or failure of lean implementation. This paper focuses on giving a brief and structured overview over the fundamental organizational factors which play a substantial role for the lean manufacturing (LM) implementation process. The study below focuses on internal factors which are indispensable for a successful LM implementation within organizations. It is imperative that these internal factors are known, recognized and taken into consideration during the whole LM implementation process. Ignoring their influence on the process's implementation may lead to endangering the expected results or to making the process more difficult which could result in much higher human resource consumption.

  20. Ares Launch Vehicles Lean Practices Case Study

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  2. Leaning on lean: the reception of a management fashion in Germany

    NARCIS (Netherlands)

    Benders, J.G.J.M.; Bijsterveld, M.J.L. van

    2000-01-01

    The ‘fashionable’ concept of lean production has been discussed more intensively in Germany than elsewhere in Europe but has resulted not only in rationalisation measures such as downsizing and delayering but also in implementing ‘Gruppenarbeit’. Through interpretation processes at different levels,

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

    Science.gov (United States)

    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 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 (presuscitation 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

  4. Assessment of the vibration on the foam legged and sheet metal-legged passenger seat

    Directory of Open Access Journals (Sweden)

    L. Dahil

    2015-10-01

    Full Text Available In this study, it was aim ed to decrease the vibration reaching to passenger from the legs of vehicle seats. In order to determine the levels of vibrations reaching at passengers, a test pad placed under the passenger seat was used, and HVM100 device was used for digitizing the information obtained. By transferring the vibration data to system by using HVM100 device, the acceleration graphics were prepared with Blaze software. As a result, it was determined that the acceleration values of seat legs made of foam material were lower than that of seat legs made of 2 mm thick sheet metal, so they damped the vibration better.

  5. Implementing Lean Manufacturing in Malaysian Small and Medium Startup Pharmaceutical Company

    Science.gov (United States)

    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.

  6. Frustrated S = 1/2 Two-Leg Ladder with Different Leg Interactions

    Science.gov (United States)

    Tonegawa, Takashi; Okamoto, Kiyomi; Hikihara, Toshiya; Sakai, Tôru

    2017-04-01

    We explore the ground-state phase diagram of the S = 1/2 two-leg ladder. The isotropic leg interactions J1,a and J1,b between nearest neighbor spins in the legs a and b, respectively, are different from each other. The xy and z components of the uniform rung interactions are denoted by Jr and ΔJr, respectively, where Δ is the XXZ anisotropy parameter. This system has a frustration when J1,aJ1,b employ the physical consideration, the level spectroscopy analysis of the results obtained by the exact diagonalization method and also the density-matrix renormalization-group method. It is found that the non-collinear ferrimagnetic (NCFR) state appears as the ground state in the frustrated region of the parameters. Furthermore, the direct-product triplet-dimer (TD) state in which all rungs form the TD pair is the exact ground state, when J1,a + J1,b = 0 and 0≤ Δ ≲ 0.83. The obtained phase diagrams consist of the TD, XY and Haldane phases as well as the NCFR phase.

  7. Simulation-enhanced lean design process

    Directory of Open Access Journals (Sweden)

    Jon H. Marvel

    2009-07-01

    Full Text Available 72 Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} A traditional lean transformation process does not validate the future state before implementation, relying instead on a series of iterations to modify the system until performance is satisfactory. An enhanced lean process that includes future state validation before implementation is presented.  Simulation modeling and experimentation is proposed as the primary validation tool.  Simulation modeling and experimentation extends value stream mapping to include time, the behavior of individual entities, structural variability, random variability, and component interaction effects. Experiments to analyze the model and draw conclusions about whether the lean transformation effectively addresses the current state gap can be conducted.  Industrial applications of the enhanced lean process show it effectiveness.

  8. Lean Government Methods Guide

    Science.gov (United States)

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

  9. A girl with spina bifida, an extra leg, and ectopic intestinal loops--a "foetus in foetu" or a whim of the neural crest?

    Science.gov (United States)

    Lende, G; Wendemu, W; Mørk, S; Wester, K

    2007-10-01

    This article describes a girl with an extra leg attached to her lower back, combined with a spina bifida and a myelomeningocele. Despite lacking sensory or motor functions, the leg grew proportionately with the rest of the body. The bony structures were almost normal. A cross section showed fat tissue with some centrally situated blood vessels, nerve bundles, and muscular fragments. Proximally, an isolated colon loop was found. The extra leg and intestine respected the dorsal fascia, without connection with the peritoneal or retroperitoneal compartments. The finding is discussed with reference to existing hypotheses for limb formation.

  10. Simulation of operational processes in hospital emergency units as lean healthcare tool

    OpenAIRE

    Gomes, Andreia Macedo; Vieira, Pedro Senna; Reis, Augusto da Cunha

    2017-01-01

    Recently, the Lean philosophy is gaining importance due to a competitive environment, which increases the need to reduce costs. Lean practices and tools have been applied to manufacturing, services, supply chain, startups and, the next frontier is healthcare. Most lean techniques can be easily adapted to health organizations. Therefore, this paper intends to summarize Lean practices and tools that are already being applied in health organizations. Among the numerous techniques and lean tools ...

  11. The Effects of Application of Lean Concept in Retail

    Directory of Open Access Journals (Sweden)

    Radojko LUKIC

    2012-06-01

    Full Text Available Lean principles and techniques can be successfully applied in the retail sector. In the retail sector, lean approach improves operational flows. Lean retail encourages manufacturers to produce standard products in accordance with the created (placed orders from retailers pursuant to the demand of their consumers. Characteristics of the retail market are: strong competition, shorter product life cycle, longer product development time and high sensitivity of demand. In order to be more competitive and profitable today's retailers operate strategically oriented to lower prices and gain exemption from holding unnecessary stocks. Lean retail is an example of best practices of successful operational strategies which management need to accept - to maximize the operating efficiency of the retail process.

  12. Zinc finger protein rotund deficiency affects development of the thoracic leg in Bombyx mori.

    Science.gov (United States)

    Zhou, Chun-Yan; Zha, Xing-Fu; Liu, Hua-Wei; Xia, Qing-You

    2017-06-01

    The insect limb develops from the imaginal disc or larval leg during metamorphosis. The molecular mechanisms involved in the development from the larval to the adult leg are poorly understood. Herein, we cloned the full length of a zinc finger gene rotund from Bombyx mori (Bmrn), which contained a 1419 bp open reading frame, and encoded a 473 amino acid protein. Reverse transcription polymerase chain reaction and Western blot analyses demonstrated that Bmrn was expressed at higher levels in the epidermis than in other tissues tested, and it showed a very high expression level during metamorphosis. Knock-down of Bmrn produced defects in the tarsus and pretarsus, including the fusion and reduction of tarsomeres, and the developmental arrest of pretarsus. Our data showed that Bmrn is involved in the formation of the tarsus and pretarsus, whereas its homologous gene in Drosophila has been shown to affect three tarsal segments (t2-t4), suggesting that the remodeling of the leg has involved changes in the patterning of gene regulation during evolution. © 2016 Institute of Zoology, Chinese Academy of Sciences.

  13. Approach to leg edema

    Directory of Open Access Journals (Sweden)

    Fulvio Pomero

    2017-09-01

    Full Text Available Edema is defined as a palpable swelling caused by an increase in interstitial fluid volume. Leg edema is a common problem with a wide range of possible causes and is the result of an imbalance in the filtration system between the capillary and interstitial spaces. Major causes of edema include venous obstruction, increased capillary permeability and increased plasma volume secondary to sodium and water retention. In both hospital and general practice, the patient with a swollen leg presents a common dilemma in diagnosis and treatment. The cause may be trivial or life-threatening and it is often difficult to determine the clinical pathway. The diagnosis can be narrowed by categorizing the edema according to its duration, distribution (unilateral or bilateral and accompanying symptoms. This work provides clinically oriented recommendations for the management of leg edema in adults.

  14. The terminal complement complex is generated in chronic leg ulcers in the absence of protectin (CD59)

    DEFF Research Database (Denmark)

    Balslev, E; Thomsen, H K; Danielsen, L

    1999-01-01

    Loss of membrane complement regulators accompanied by complement activation is suggested to be involved in the pathophysiological processes leading to tissue damage in myocardial ischaemia. In the present study we have investigated whether the same phenomenon may occur in ischaemic and/or venous...... results suggest that loss of CD59 may enhance deposition of TCC and that complement-dependent inflammation may be an important factor in the tissue-damaging processes seen in chronic leg ulcers....

  15. Instill Lean A3 Thinking into Healthcare IT Services

    Directory of Open Access Journals (Sweden)

    Jihong Zeng

    2014-08-01

    Full Text Available Healthcare information technology is a key enabler for care transformation to provide quality care at low cost and better population health.  Many healthcare organizations have established IT Program Management and adopted ITIL best practice to manage IT services. However, ITIL and traditional project management are heavily process oriented, and neither flexible nor effective enough for swift response to changing business demand. Lean methodologies are increasingly deployed by healthcare providers to improve workflow process management but only has limited use cases documented in healthcare IT service. This paper introduces the Lean A3 Thinking methodology and its value in identifying and eliminating wastes to provide agile and effective solutions in response to customer requests. We present a case study of applying Lean A3 Thinking to improve clinical informatics reporting service. The initial evaluation results are promising and indicate that both ITIL and Lean A3 Thinking focus on customer and service quality, complementing each other well. ITIL provides a framework for ITSM based on a set of best practice to manage IT services. Lean A3 Thinking specifies a set of framework and tools for improving quality of services and processes by eliminating wastes. Proper balance between Lean and ITIL principles for ITSM needs more research and further study.

  16. A Simulation of Lean Manufacturing: The Lean Lemonade Tycoon 2

    Science.gov (United States)

    Ncube, Lisa B.

    2010-01-01

    This article discusses the functions and effectiveness of games and simulations in the learning processes, in particular as an experiential learning methodology. The application of the game Lemonade Tycoon in the development of lean manufacturing concepts is described. This article addresses the use of the game to teach the principles of lean…

  17. Effect of selection for lean growth on gonadal development of ...

    African Journals Online (AJOL)

    A primary objective of commercial pig production is lean meat yield in order to satisfy consumer needs. The majority of the commercial pig breeds in South Africa have been selected for high lean growth potential and reduced backfat thickness. There are indications that selection for high lean meat yield may affect the ...

  18. Developing A Strategy to Enact Lean

    Directory of Open Access Journals (Sweden)

    Nicola Morrey

    2013-01-01

    Full Text Available This paper explains the strategy employed by a case study company to implement lean across the business, and to reflect on the success of this approach so other companies may consider this learning and how it might be useful to them. The strategy to enact lean in the case study company was based on creating a number of standard tools/ways of working. These tools can be considered to be standardised work for key aspects of the construction process that the company undertakes. The aim of the tools was to ensure that critical tasks would be carried out to the correct standard (quality, time, cost, health and safety every time, across the business. Achievement of this is expected to lead to improved performance and elimination of variation (waste. To implement this strategy of using standardised work to eliminate variation and lead to improved performance, a step-by-step process was developed to create the tools/standardised work. The paper describes the process that was undertaken and how it aimed to not only produce a number of tools/standardised work, but also to involve people and managers from across the business such that lean philosophy and thinking might also begin to become embedded. The paper will firstly explain, with reference to the relevant literature, how and why the strategy to implement standardised work was chosen, the process that was defined to develop the standardised work, and what happened when that process was put into practice. The findings of the paper show that whilst the completed tools delivered business benefits, the development of the tools did not follow the planned process. The paper discusses how people within the business responded to this strategy and how the process had to be continuously adapted to cope with the current business environment and path dependencies, further evidencing that lean implementations need to be tailored to suit the needs of the individual firm, rather than there being a one size fits all

  19. Design thinking & lean

    DEFF Research Database (Denmark)

    Bravos, Cynthia; Adler, Isabel K.

    2015-01-01

    This paper aims at presenting how a Brazilian innovation consultancy guided a collaborative development of a mobile solution using the Design Thinking approach (Vianna et al, 2012) and Lean principles (Ries, 2011). It will describe tools and methods used and how it was applied to requirement gath...

  20. Industry 4.0 implies lean manufacturing: research activities in industry 4.0 function as enablers for lean manufacturing

    OpenAIRE

    Sanders, Adam; Elangeswaran, Chola; Wulfsberg, Jens

    2016-01-01

    Purpose: Lean Manufacturing is widely regarded as a potential methodology to improve productivity and decrease costs in manufacturing organisations. The success of lean manufacturing demands consistent and conscious efforts from the organisation, and has to overcome several hindrances. Industry 4.0 makes a factory smart by applying advanced information and communication systems and future-oriented technologies. This paper analyses the incompletely perceived link between Industr...

  1. Contribution of Lean Management to Excellence

    Directory of Open Access Journals (Sweden)

    López-Fresno Palmira

    2014-11-01

    Full Text Available To continuously and systematically improve efficiency and efficacy of processes, organizations need the implication of all employees in continuous improvement and innovation through suitable Quality Management Programs (QMPs. Effectiveness of these programs is directly linked to the requirement employees understand the methodologies and tools used for QM and the benefits that will derivate from their implementation, individually and collectively, so they can commit and implicate. Lean Management is a friendly methodology to continuously and systematically achieve process improvement, so helping the organization seeking operational excellence that contributes to overall excellence. This paper identifies Critical Success Factors (CSFs for an effective implementation of QMPs, suggests Lean Management as an easy-to-understand, powerful and friendly methodology for operational excellence and overall excellence, and presents a case experience of implementation of Lean Management in a health care organization that applies the EFQM model, and the lessons learnt.

  2. Implementing lean office: a successful case in public sector

    OpenAIRE

    Monteiro, Mónica F. J. R.; Pacheco, Claudia C. L.; Dinis-Carvalho, José; Paiva, Francisco C.

    2015-01-01

    Applying lean approaches in office areas can lead to performance improvements and other benefits as achieved in traditional manufacturing environments. The intangibility of office operations may appear as a major difficulty for lean implementations but in fact the benefits achievable are as important as the ones achieved in manufacturing environments. This paper reports a successful case of lean office implementation in a public sector organization giving emphasis to its major performance imp...

  3. Lean and Efficient Software: Whole-Program Optimization of Executables

    Science.gov (United States)

    2015-09-30

    Lean and Efficient Software: Whole-Program Optimization of Executables” Project Summary Report #5 (Report Period: 7/1/2015 to 9/30/2015...TYPE 3. DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Lean and Efficient Software: Whole-Program Optimization of Executables 5a...unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 Lean and Efficient Software: Whole-Program

  4. Comparison of problem solving tools in lean organizations

    Directory of Open Access Journals (Sweden)

    Iuga Maria Virginia

    2017-01-01

    Full Text Available As global market competition is getting fiercer, and companies are looking at ways to stay on top, more and more organizations are looking at Lean Manufacturing and lean tools to support them in achieving their goals. Especially within the automotive industry, lean practices are very well received. The speed at which the automotive industry is evolving, especially but not only, in countries like Romania, leads to the need to carefully analyze lean manufacturing concepts, examine them against local production conditions, and to develop and standardize them. One of the most important things to take into consideration here is the application of an adequate problem solving technique to avoid waste. The objective of this research paper lies in analyzing and comparing the problem-solving methods recommended by the Toyota Production System, and to propose their appropriate application at shop floor, in relation to the specific problem type.

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

    Science.gov (United States)

    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

  6. Evaluation of arm-leg coordination in flat breaststroke.

    Science.gov (United States)

    Chollet, D; Seifert, L; Leblanc, H; Boulesteix, L; Carter, M

    2004-10-01

    This study proposes a new method to evaluate arm-leg coordination in flat breaststroke. Five arm and leg stroke phases were defined with a velocity-video system. Five time gaps quantified the time between arm and leg actions during three paces of a race (200 m, 100 m and 50 m) in 16 top level swimmers. Based on these time gaps, effective glide, effective propulsion, effective leg insweep and effective recovery were used to identify the different stroke phases of the body. A faster pace corresponded to increased stroke rate, decreased stroke length, increased propulsive phases, shorter glide phases, and a shorter T1 time gap, which measured the effective body glide. The top level swimmers showed short time gaps (T2, T3, T4, measuring the timing of arm-leg recoveries), which reflected the continuity in arm and leg actions. The measurement of these time gaps thus provides a pertinent evaluation of swimmers' skill in adapting their arm-leg coordination to biomechanical constraints.

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

    Science.gov (United States)

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

    2014-01-01

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

  8. PRIORITISING LEAN CONSTRUCTION BARRIERS IN UGANDA'S CONSTRUCTION INDUSTRY

    Directory of Open Access Journals (Sweden)

    Henry Mwanaki Alinaitwe

    2009-06-01

    Full Text Available Engaging in lean construction efforts could prove to be highly rewarding for building firms in Uganda. However, lean construction is risky and can be disastrous if not properly managed. Lean production efforts in some other countries have not been successful due to the many barriers to its successful implementation. To enable sound lean construction efforts and to increase the chances of success in eliminating waste, a thorough investigation of the barriers is essential. This study presents 31 barriers and investigates their influence (strength on the success of lean construction initiatives. Structured interviews were carried out with technical managers of building firms to assess their perception of the barriers to lean production based on their experience at their firms. The strongest barrier is the provision of inputs exactly when required. Additionally, the barriers were ranked according to the ease of overcoming each. The easiest barrier to overcome is keeping the required items in the right place. Finally, a graphical aid is provided to enable decision makers to concentrate their efforts on the influential (strong, yet easy to overcome barriers. A lack of buildable designs and a participative management style for the workforce are the most important barriers to successful waste reduction in terms of strength and ease of overcoming. On the other hand, a lack of an organisational culture that supports teamwork, a lack of prefabrication and a lack of knowledgeable and skilled workers are regarded as low in strength, and at the same time difficult to overcome.

  9. The roles of communication process for an effective lean manufacturing implementation

    Directory of Open Access Journals (Sweden)

    Perumal Puvanasvaran

    2009-07-01

    Full Text Available Many companies are implementing lean manufacturing concept in order to remain competitive and sustainable, however, not many of them are successful in the process due to various reasons. Communication is an important aspect of lean process in order to successfully implement lean manufacturing.  This paper determines the roles of communication process in ensuring a successful implementation of leanness in manufacturing companies. All the information of lean manufacturing practices and roles of communication in the implementation were compiled from related journals, books and websites. A study was conducted in an aerospace manufacturing in Malaysia. A five-point scale questionnaire is used as the study instrument. These questionnaires were distributed to 45 employees working in a kitting department and to 8 top management people. The results indicate that the degree of leanness were moderate.

  10. Using adapted budget cost variance techniques to measure the impact of Lean – based on empirical findings in Lean case studies

    DEFF Research Database (Denmark)

    Kristensen, Thomas Borup

    2015-01-01

    Lean is dominating management philosophy, but the management accounting techniques that best supports this is still not fully understood. Especially how Lean fits traditional budget variance analysis, which is a main theme of every management accounting textbook. I have studied three Scandinavian...

  11. AN EXPLORATORY STUDY ON EMPLOYEE’S PERCEPTION TOWARDS LEAN MANUFACTURING SYSTEMS

    Directory of Open Access Journals (Sweden)

    Rajesh Kumar MEHTA

    2012-01-01

    Full Text Available Lean deals with generating more value for customers by eliminating factors that are merely considered waste. Lean Manufacturing is a systematic approach to identifying and eliminating waste through continuous improvement. Lean Manufacturing uses less of everything and attains its set objectives by excellent teamwork, communication, and competent use of available resources & continuous Improvement. The present paper is an attempt to study employee’s perception towards lean manufacturing systems in gear industry.

  12. Lean and the Learning Organization in Higher Education

    Science.gov (United States)

    Francis, David E.

    2014-01-01

    Canadian post-secondary institutions are seeking enhanced efficiencies due to ongoing funding shortfalls and expanding teaching, research, and service mandates. These institutions have considered or enacted Lean methodology based on results reported by public service and healthcare organizations worldwide. Lean requires a high level of…

  13. Theories of lean management: an empirical evaluation.

    Science.gov (United States)

    Handel, Michael J

    2014-03-01

    Debates within organization theory traditionally argued the relative merits of bureaucracy but today there is broad agreement across different perspectives that bureaucratic organization is inefficient and outmoded. Despite their differences, post-bureaucratic and neo-liberal theories argue that organizations with relatively flat hierarchies and low management overhead are better adapted to current market requirements. Post-bureaucratic theory also argues that employees, as well as firms, benefit from leaner management structures. This paper investigates trends in managerial leanness, proposed explanations for such trends, and the consequences of leanness for firms and employees. Although there is a trend toward flatter management hierarchies, there is only weak support for current claims regarding both the causes and consequences of lean management. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Reference Models for Multi-Layer Tissue Structures

    Science.gov (United States)

    2016-09-01

    function of multi-layer tissues (etiology and management of pressure ulcers ). What was the impact on other disciplines? As part of the project, a data...simplification to develop cost -effective models of surface manipulation of multi-layer tissues. Deliverables. Specimen- (or subject) and region-specific...simplification to develop cost -effective models of surgical manipulation. Deliverables. Specimen-specific surrogate models of upper legs confirmed against data

  15. A Lean Six Sigma program in higher education

    KAUST Repository

    Svensson, Carsten

    2015-01-01

    Purpose The objective of this paper is to contribute to the body of Lean Six Sigma knowledge within the field of higher education institutions. The paper will review the initial phase of an implementation and highlight future challenges of applying the Lean Six Sigma method in a complex transactional environment. Design/methodology/approach The observations presented in this paper originate from rolling out a large Lean Six Sigma implementation at a recently established university. The paper is supported with secondary data from literature. Findings The implementation of Lean Six Sigma methodology at King Abdullah University of Science and Technology (KAUST) has resulted in improvements in business processes and efficiency. This has been achieved through project execution and training programs. Approximately 350 staff members have completed awareness training, 50 yellow belts and 150 green belts have been trained, and the first round of seven black belts have completed training of which two have completed certification. Research limitations/implications This paper is based on an empirical study of a single instance and the authors’ experiences as practitioners. Originality/value This paper is the first description of what is believed to be one of the largest implementations of Lean Six Sigma in higher education.

  16. Duplex sonography of the near-surface leg veins

    International Nuclear Information System (INIS)

    Mendoza, E.

    2007-01-01

    The book contains the following contributions: The ultrasonograph, selection of the ultrasonic transducer, anatomy of the near-surface vein system, physiology of the near-surface vein system, varicose status classification, systematics of the duplex sonography of near-surface leg veins, provocational maneuver for the duplex sonographic varicose diagnostics, exploration of vena saphena parva, perforans veins, side branches, phlebitis, sonography for varicose therapy, postsurgical sonography, deep leg veins, examination of near-surface leg veins for the pathology of the deep vein system, differential diagnostic clarification of leg oedema from the phlebologic-lymphological view, diagnostic side features along the near-surface leg veins

  17. Effect of obesity on oxygen uptake and cardiovascular dynamics during whole-body and leg exercise in adult males and females.

    LENUS (Irish Health Repository)

    Green, Simon

    2018-05-01

    Obesity has been associated with a slowing of V˙O2 dynamics in children and adolescents, but this problem has not been studied in adults. Cardiovascular mechanisms underlying this effect are not clear. In this study, 48 adults (18 males, 30 females) grouped according to body mass index (BMI) (lean < 25 kg·m-2 , overweight = 25-29.9 kg·m-2 , obese ≥30 kg·m-2 ) provided a fasting blood sample, completed a maximal graded exercise test and six bouts of submaximal exercise on a cycle ergometer, and performed two protocols of calf exercise. Dynamic response characteristics of V˙O2 and leg vascular conductance (LVC) were assessed during cycling (80% ventilatory threshold) and calf exercise (30% MVC), respectively. Dynamic responses of cardiac output, mean arterial pressure and total systemic vascular conductance were also assessed during cycling based on measurements at 30 and 240 sec. The time constant of the second phase of the V˙O2 response was significantly greater in obese than lean subjects (39.4 (9.2) vs. 29.1 (7.6) sec); whereas dynamic responses of cardiac output and systemic vascular conductance were not affected by BMI. For calf exercise, the time constant of the second growth phase of LVC was slowed significantly in obese subjects (22.1 (12.7) sec) compared with lean and overweight subjects (11.6 (4.5) sec and 13.4 (6.7) sec). These data show that obesity slows dynamic responses of V˙O2 during cycling and the slower phase of vasodilation in contracting muscles of male and female adults.

  18. The lean product design and development journey a practical view

    CERN Document Server

    Pessôa, Marcus Vinicius Pereira

    2017-01-01

    This book presents a series of high performance product design (PD) and development best practices that can create or improve product development organization. In contrast to other books that focus only on Toyota or other individual companies applying lean IPD, this book explains the lean philosophy more broadly and includes discussions of systems engineering, design for X (DFX), agile development, integrated product development, and project management. The “Lean Journey” proposed here takes a value-centric approach, where the lean principles are applied to PD to allow the tools and methods selected to emerge from observation of the individual characteristics of each enterprise. This means that understanding lean product development (LPD) is not about knowing which tools are available but knowing how to apply the philosophy. The book comes with an accompanying manual with problems and solutions available on Springer Extras.

  19. Lean Enterprise Value Phase

    National Research Council Canada - National Science Library

    Shields, John T

    2005-01-01

    ... using a philosophy called "lean." LAl's mission is to research, develop, and promulgate practices, tools, and knowledge that enable and accelerate the envisioned transformation of the greater US aerospace enterprise through people and processes...

  20. Activity Behaviours in Lean and Morbidly Obese Pregnant Women.

    Science.gov (United States)

    Fazzi, Caterina; Mohd-Shukri, Nor; Denison, Fiona C; Saunders, David H; Norman, Jane E; Reynolds, Rebecca M

    2018-05-17

    Interventions to increase physical activity in pregnancy are challenging for morbidly obese women. Targeting sedentary behaviours may be a suitable alternative to increase energy expenditure. We aimed to determine total energy expenditure, and energy expended in sedentary activities in morbidly obese and lean pregnant women. We administered the Pregnancy Physical Activity Questionnaire PPAQ (non-objective) and the Actical accelerometer (objective) to morbidly obese (BMI≥40kg/m²) and lean (BMI≤25Kg/M²) pregnant women recruited in early (lean pregnant women. No differences were observed in the proportion of energy expended sedentary between lean and morbidly obese pregnant women. The greater total energy expenditure in morbidly obese pregnant women was corroborated by Actical accelerometer in early (n=14 per group, obese 1167.7 (313.6) Kcal; lean 781.1 (210.1) Kcal, plean 893.7 (175.9) Kcal, plean pregnant. Further studies are needed to determine whether sedentary behaviours are a suitable target for intervention in morbidly obese pregnancy. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  1. Green and lean management

    CERN Document Server

    Davim, J

    2017-01-01

    This book focusses on the challenges and changes organizational management faces in an era when the need to develop environmentally aware processes meets high levels of competition. It covers the synergetic effects, how re-use, recycling, waste reduction, and other sustainable production strategies can add value, low costs and time of production. Sustainable business behavior is not only an environmental perspective on management, but more and more contains an organizational perspective. Taking into account these issues, green and lean management appears as the way managers can drive their employees to continuously improve the management processes that add value to the organization and costumers. This book provides information on principles, strategies, models, and applications of green and lean management, and at the same time communicates the latest research activity relating to this scientific field world-wide.

  2. Successful Paths to Becoming a Lean Organization in the Construction Industry

    OpenAIRE

    Warcup, Robert D.

    2015-01-01

    Lean construction is considered a valuable solution for the declining productivity of the construction industry. This study seeks to answer the general research question: What does it take to become lean? The research explored the possible paths to becoming lean by examining the journeys of three successful lean construction firms in the U.S. The results are intended to assist other construction firms with their own transformations. This study is especially useful to executives and management...

  3. LEAN LABORATORY APPROACHES FOR QUALITY ASSURANCE IN FOOD

    Directory of Open Access Journals (Sweden)

    Laxmana Naik

    2011-09-01

    Full Text Available A lean laboratory is one which is focused on testing products and materials to deliver results in the most efficient way in terms of cost or speed or both; primarily focused on improving measurable performance and reducing costs. The goal of a lean laboratory is to use less effort, less resources and less time to test incoming samples. Laboratories have a critical role to play in establishing and improving process capability and key performance indicator (KPI of the organization. There are inevitably many opinions as to what a lean lab actually is; here is one version fr om. Quality assurance laboratories are crucial to the success of organization and this effectiveness needs to be measurable and demonstrable. To facilitate this, a method of measuring a laboratory's progress towards complete deployment has been created by lean tools. These tools allow laboratories to conduct gap analysis and identify opportunities for improvement.

  4. Lean management in the current context of evolution of an organization

    Directory of Open Access Journals (Sweden)

    AMALIA VENERA TODORUŢ

    2011-06-01

    Full Text Available In this paper I have approached issues concerning the importance of Lean Management method in the current context of evolution of an organization. With roots in the just in time method, Lean Management model focuses on the process of changes evolving and adapting to them and regards issues such as: the dimensioning of life cycle, the dimensioning of processes, the dimensioning of ranges of products. I have also presented the relationship between Lean Management method and the human factor as a determinant in forming an organizational culture which leads to the formation and development of Lean thinking. Relevant factors which determine the change and interact with the Lean Management method are: training, motivation, teamwork spirit, communication methods, training and motivation. An important aspect of this paper is to integrate Lean Management with Six Sigma, and with other managerial techniques leading to getting quality products at low costs

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    McIntosh, Bryan; Sheppy, Bruce; Cohen, Ivan

    2014-01-01

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

  7. Yalın düşünce ve Muhasebe (Lean Thinking and Accounting

    Directory of Open Access Journals (Sweden)

    Baki Rıza BALCI

    2011-01-01

    Full Text Available The aim of this article is to introduce the relationship between Lean Thinking and Accounting. It is explained in detail the kinds of reports generated when Lean Thinking implemented in accounting.It is identified that accounting, which could not keep pace with Lean Transformation and remain traditional, shares the failures of companies, who went Lean. This article emphasize that the companies that want to transform themselves into Lean, have to generate proper reports that suit Lean transformation. The types of reports are explained.Literature was scanned and some sample reports are submitted to the Turkish companies that want to go Lean and successful in their Lean efforts.

  8. Obesity And Laboratory Diets Affects Tissue Malondialdehyde (MDA) Levels In Obese Rats

    Science.gov (United States)

    Chowdhury, Parimal; Scott, Joseph; Holley, Andy; Hakkak, Reza

    2010-04-01

    This study was conducted to investigate the interaction of obesity and laboratory diets on tissue malondialdehyde levels in rats. Female Zucker obese and lean rats were maintained on either regular grain-based diet or purified casein diet for two weeks, orally gavaged at day 50 with 65 mg/kg DMBA and sacrificed 24 hrs later. Malondialdehyde (MDA) levels were measured in blood and harvested tissues. Data were recorded as mean ± SEM and analyzed statistically. Results show that the obese group on purified casein diet had reduction of MDA levels in the brain, duodenum, liver, lung and kidney tissues as compared to lean group, p <0.05. Obese group on grain-based diet showed significant increase in MDA levels only in the duodenum, p <0.05. We conclude that dietary intervention differentially affects the oxidative markers in obese rats. It appears that purified casein diets were more effective than grain-based diet in reduction of oxidative stress in obese rats.

  9. Lean tool used in the automotive industry

    OpenAIRE

    Manuela Ingaldi; Marta Jagusiak-Kocik

    2014-01-01

    In the paper basic concepts of Lean Manufacturing were presented. A company specializing in the development of vehicle dynamics, driver assistance systems, brake systems, seat belt sand electronics technology was characterized. The company is engaged in designing and manufacturing world-class products for the automotive market. The Lean tools used in the production hall, such as Yamazumi chart, machine motion analysis, MTM method and timing, were presented.

  10. Lean på sygehuset - del I: Introduktion

    DEFF Research Database (Denmark)

    Laursen, Martin Lindgaard; Gertsen, Frank

    2009-01-01

    Dette workpaper introducerer et forskningsprojekt baseret på case studier af Lean principper anvendt på et sygehus. Operationelle udfordringer i sygehusets arbejdsgange illustreres gennem et observeret patientforløb. Disse udfordringer, et oprids af sygehusenes vilkår, og gennemgang af tidligere...... tiltag omkring forbedringer på sygehusene leder frem til projektets problemstilling og tilgang i form af afprøvning af Lean principper....

  11. Chemical structures and theoretical models of lean premixed ...

    African Journals Online (AJOL)

    To better understand the chemistry involved in the lean-fuel combustion, the chemical structure of lean premixed propene-oxygen-nitrogen flames stabilized on a flat-flame burner at atmospheric pressure was determined experimentally. The species mole fraction profiles were also computed by the Premix code and three ...

  12. Effect of Lewis number on ball-like lean limit flames

    KAUST Repository

    Zhou, Zhen

    2017-10-13

    The lean limit flames for three different fuel compositions premixed with air, representing three different mixture Lewis numbers, stabilized inside a tube in a downward flow are examined by experiments and numerical simulations. The CH* chemiluminescence distribution in CH4–air and CH4–H2–air flames and the OH* chemiluminescence distribution in H2–air flames are recorded in the experiments. Cell-like flames are observed for the CH4–air mixture for all tested equivalence ratios. However, for CH4–H2–air and H2–air flames, ball-like lean limit flames are observed. Flame temperature fields are measured using Rayleigh scattering. The experimentally observed lean limit flames are predicted qualitatively by numerical simulation with the mixture-averaged transport model and skeletal mechanism of CH4. The results of the simulations show that the entire lean limit flames of CH4–H2–air and H2–air mixtures are located inside a recirculation zone. However, for the lean limit CH4–air flame, only the leading edge is located inside the recirculation zone. A flame structure with negative flame displacement speed is observed for the leading edges of the predicted lean limit flames with all three different fuel compositions. As compared with 1D planar flames, the fuel transport caused by convection is less significant in the present 2D lean limit flames for the three different fuel compositions. For the trailing edges of the three predicted lean limit flames, a diffusion dominated flame structure is observed.

  13. The Role of The Executive in Lean: A Qualitative Thesis Based

    OpenAIRE

    P. Marksberry; S. Hughes

    2011-01-01

    Lean manufacturing (Lean), as evolved from the Toyota Production System (TPS), has gained traction in many businesses as a tool for efficiency and improvement. However, the role of an executive or general manager within a Lean organization has not been clearly articulated in any official or proven way. This research looks at common approaches, theories, and problems concerning the role of the executive and how it can affect companies in their efforts to adopt Lean tools and principles. This r...

  14. Lean Manufacturing, Mass Customization and their relationships - empirical findings

    DEFF Research Database (Denmark)

    Christiansen, Thomas Bøhm

    2004-01-01

    manufacturing companies in 2001-02. This study fills a void in existing research by exploring relationships between bundles of lean manufacturing practices and bundles of mass customization practices. This study is based on a questionnaire that is developed from two existing questionnaires each investigating...... bundles of lean manufacturing practices and bundles of mass customization practices separately. Here, these bundles of practices are related. The results indicate that there are no direct relationships between the lean manufacturing and the mass customization practices, but that the combination of some...... sets of practices can explain differences in performance on important dimensions. The general conclusion, however, is that there are only weak relationships between the two concepts, hence this study suggests that the concepts of lean manufacturing and mass customization at present are more mutually...

  15. Establishing a Lean Six Sigma Program in Higher Education

    KAUST Repository

    Svensson, Carsten; Baessa, Mohamed A.; Bakhsh, Majed M.

    2013-01-01

    Purpose: The objective of this paper is a contribution to the body of Lean Six Sigma knowledge within the vertical of higher education institutions. The paper will review the initial phase of an implementation and highlight future challenges. Approach: The observations presented in this paper, originates from rolling out a large lean six sigma implementation at a newly established university. The paper is supported with secondary data from literature. Findings: The paper will discuss the challenges of applying the lean six sigma method in a complex transactional environment. Research limitations: This paper is based on an empirical study of a single instance and authors’ experiences as practitioners. Originality: This paper is the first description of what is believed to be one of the largest implementations of Lean Six Sigma in higher education.

  16. Establishing a Lean Six Sigma Program in Higher Education

    KAUST Repository

    Svensson, Carsten

    2013-09-12

    Purpose: The objective of this paper is a contribution to the body of Lean Six Sigma knowledge within the vertical of higher education institutions. The paper will review the initial phase of an implementation and highlight future challenges. Approach: The observations presented in this paper, originates from rolling out a large lean six sigma implementation at a newly established university. The paper is supported with secondary data from literature. Findings: The paper will discuss the challenges of applying the lean six sigma method in a complex transactional environment. Research limitations: This paper is based on an empirical study of a single instance and authors’ experiences as practitioners. Originality: This paper is the first description of what is believed to be one of the largest implementations of Lean Six Sigma in higher education.

  17. Interrelation of Lean and Green Management in Croatian Manufacturing Companies

    Directory of Open Access Journals (Sweden)

    Miro Hegedić

    2018-03-01

    Full Text Available The goal of this article is to explore the link between lean and green management, reasons for their implementation, their effect throughout the whole life cycle, as well as the current state of use of lean tools, economic and environmental indicators in the context of Croatian manufacturing companies. A semi-structured interview was used in this research. As a result, the frequency of economic and environmental performance indicators and lean tools in Croatian companies has been defined, as well as the reasons for the implementation of lean management. Additionally, the understanding of the use of Life Cycle Assessment methods, environmental standards has been obtained and the integration of lean and green management in Croatian companies has been explored. Further on, results were compared to the similar study done in the UK. Finally, it can be concluded that the integration of lean and green management is not yet sufficiently present in manufacturing companies, although there are cases in which these two approaches are integrated, primarily in the process and food industry. It is for these reasons that in the integration of these two approaches lies great potential.

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

    Science.gov (United States)

    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.

  19. Lean for Government: Eliminating the Seven Wastes

    Science.gov (United States)

    Shepherd, Christena C.

    2012-01-01

    With shrinking budgets and a slow economy, it is becoming increasingly important for all government agencies to become more efficient. Citizens expect and deserve efficient and effective services from federal, state and local government agencies. One of the best methods to improve efficiency and eliminate waste is to institute the business process improvement methodologies known collectively as Lean; however, with reduced budgets, it may not be possible to train everyone in Lean or to engage the services of a trained consultant. It is possible, however, to raise awareness of the "Seven Wastes" of Lean in each employee, and encourage them to identify areas for improvement. Management commitment is vital to the success of these initiatives, and it is also important to develop the right metrics that will track the success of these changes.

  20. Lean production teams and health in garment manufacture.

    Science.gov (United States)

    Jackson, P R; Mullarkey, S

    2000-04-01

    The impact of lean production on psychological health was assessed by comparing lean production teams in garment manufacture with a traditional system for making similar garments. Work design characteristics were examined as mediators of the impact of work organization on health. Findings indicate both positive and negative direct effects of teamworking on aspects of autonomy, work demands, and social climate. In turn, both positive and negative direct effects of work design on psychological health were found, which combine to give no overall difference between the groups. This study suggests that the balance between positive and negative effects of lean production teamworking depends on management choices in the form of work design.

  1. The use of a dermal substitute and thin skin grafts in the cure of "complex" leg ulcers.

    Science.gov (United States)

    Canonico, Silvestro; Campitiello, Ferdinando; Della Corte, Angela; Fattopace, Andrea

    2009-02-01

    In some chronic leg ulcers, a reconstructive operation using skin grafts may be extremely difficult or is quite likely to fail as a result of the position, the width, and the depth of the lesions. To evaluate the effectiveness of a dermal substitute and thin skin grafts in the treatment of patients suffering from deep and wide chronic leg ulcers. Twenty-six consecutive patients with leg ulcers at least 1 year old were admitted to the study. The ulcers were large (>100 cm2) and deep (>3 mm) over at least 50% of the surface area. After surgical debridement of the wounds, the dermal matrix was modeled and applied. After 21 days, the attachment of the artificial dermis was tested, and in positive cases, the patient was re-admitted for "thin" skin grafting. In all patients, at the first follow-up, a notable reduction in pain, exudate, and perilesional edema was ascertained. After 2 weeks, the progressive substitution of granulation tissue with new yellow or gold derma became evident in all patients. After 21 days, the dermal matrix was completely integrated with the guest tissue. In 23 patients (88.5%), attachment of the skin graft was complete, and in three patients (11.5%), it was partial but nevertheless larger than 70% of the surface. Even in these cases, complete healing of the lesions was achieved within 4 weeks at most. All patients were checked for a minimum of 3 months, and none suffered an ulcerous recurrence. In our series, the use of this dermal matrix allowed for the complete refilling of the loss of tissue, the rapid disappearance of pain, and the rapid regeneration of a permanent dermis.

  2. Soft Tissue Extramedullary Plasmacytoma

    Directory of Open Access Journals (Sweden)

    Fernando Ruiz Santiago

    2010-01-01

    Full Text Available We present the uncommon case of a subcutaneous fascia-based extramedullary plasmacytoma in the leg, which was confirmed by the pathology report and followed up until its remission. We report the differential diagnosis with other more common soft tissue masses. Imaging findings are nonspecific but are important to determine the tumour extension and to plan the biopsy.

  3. Managing paradoxical tensions during the implementation of Lean capabilities for improvement

    DEFF Research Database (Denmark)

    Maalouf, Malek Miguel; Gammelgaard, Britta

    2016-01-01

    Purpose: – Through the identification and investigation of the organisational paradoxes in lean, the purpose of this paper is to deepen the understanding of lean implementation intricacies, and contribute to sustaining lean in companies. Design/methodology/approach: – Case study based on semi...... also points to a range managerial responses used for dealing with the three paradoxes and facilitating lean transformation. Research limitations/implications: – This is a theory development paper which increases the understanding regarding the role of the organisational paradoxes in facilitating...

  4. Medical and scientific writing: Time to go lean and mean

    Directory of Open Access Journals (Sweden)

    Payal Bhardwaj

    2017-01-01

    Full Text Available The Lean Six Sigma methodology for process improvements and driving efficiency is old, but lean writing was adopted late by the pharmaceutical world in terms of size of the documents. The documents were lean earlier, and then became voluminous, and now we are about to complete a full circle in this regard, i.e., coming back to the lean documents again using e-formats and hyperlinking. Furthermore, writing has become more and more precise over time. The need for this lean and mean medical and scientific writing arose from voluminous research globally, both industry and academia which are abuzz with skyrocketing regulatory and scientific submission volumes. The quantum of literature is so much that reviewers or information seekers firmly believe that going through even selected and relevant literature has become highly challenging. Considering this, there has been much insistence on downsizing the medical writing documents, which could be tempting enough to be leveraged for scientific publications as well. Here, we present the need for lean and mean medical writing, discuss this concept in relation to the pharmaceutical industry, and how to apply this to key documents. Furthermore, presented is the proposed algorithm for lean and mean clinical study reports and manuscripts. These thoughts are aligned to the recently established concept of data transparency, and can be easily achieved by web links between the protocols and clinical trial results disclosed publicly, and the corresponding manuscripts.

  5. The lean approach for improvement of the sustainability of a remanufacturing process

    Directory of Open Access Journals (Sweden)

    Paulina Golińska

    2014-09-01

    Full Text Available Background: The lean production is a well-established managerial concept, which helps companies to provide the customer value and to reduce cost. Recently it gains a lot of attention among the remanufacturers. In this paper the assumption is made that remanufacturing process is more sustainable, if there will be efficient utilization of the resources. The resource utilization is efficient when there is no waste of resources. The implementation of lean principles and tools into a remanufacturing process can benefit to improved sustainability but also it suffers some constrains, which are identified in this paper. Methods: The research methodology consists of a literature review, where research papers from the Scopus, Science Direct and Business Source Premier databases were used. The search criterion was the phrase "lean remanufacturing". On the basis of literature review the lean remanufacturing problems are identified. The framework for lean remanufacturing analysis was established. Author presents also case studies on assessment of the leanness of remanufacturing process and discusses the potential for waste elimination in order to improve sustainability of remanufacturing process. Results: Problem identification and analysis framework of lean remanufacturing process is discussed. The case studies results are analysed in the context of the finding of the literature review. The advantages and constrains of lean remanufacturing are discussed. Conclusions: A remanufacturing process is more complex than the respective production process. The implementation of lean production principles and tools into remanufacturing process is at a very early stage comparing to the traditional manufacturing. There are evidences from the industrial studies and the academic research on lean remanufacturing benefits. There is a need to distinguish between lean remanufacturing on an operational and a strategic level. From the perspective of sustainability of

  6. Lean tool used in the automotive industry

    Directory of Open Access Journals (Sweden)

    Manuela Ingaldi

    2014-10-01

    Full Text Available In the paper basic concepts of Lean Manufacturing were presented. A company specializing in the development of vehicle dynamics, driver assistance systems, brake systems, seat belt sand electronics technology was characterized. The company is engaged in designing and manufacturing world-class products for the automotive market. The Lean tools used in the production hall, such as Yamazumi chart, machine motion analysis, MTM method and timing, were presented.

  7. The productive operating theatre and lean thinking systems.

    Science.gov (United States)

    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.

  8. Leg pain

    Science.gov (United States)

    ... in the blood Medicines (such as diuretics and statins) Muscle fatigue or strain from overuse, too much exercise, or holding a muscle in the same position for a long time An injury can also cause leg pain from: A torn or overstretched muscle ( strain ) Hairline ...

  9. Broken Leg

    Science.gov (United States)

    ... the leg, which can result in a fracture. Stress fractures outside of sport situations are more common in people who have: ... shoes. Choose the appropriate shoe for your favorite sports or activities. And ... can prevent stress fractures. Rotate running with swimming or biking. If ...

  10. Scaling Lean in primary care: impacts on system performance.

    Science.gov (United States)

    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.

  11. Waste Measurement Techniques For Lean Companies

    Directory of Open Access Journals (Sweden)

    Maciej Pieńkowski

    2014-12-01

    Full Text Available The paper is dedicated to answer the problem of measuring waste in companies, which are implementing Lean Manufacturing concept. Lack of complex identification, quantification an visualization of waste significantly impedes Lean transformation efforts. This problem can be solved by a careful investigation of Muda, Muri and Mura, which represent the essence of waste in the Toyota Production System. Measuring them facilitates complete and permanent elimination of waste in processes. The paper introduces a suggestion of methodology, which should enable company to quantify and visualize waste at a shop floor level.

  12. Improving the medical records department processes by lean management.

    Science.gov (United States)

    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.

  13. Individualisation of Lean Concept in Companies Dealing with Mass Production

    Science.gov (United States)

    Bednár, Roman

    2012-12-01

    The methods of lean manufacturing primarily designed for businesses dealing with serial production, are also used in other types of production. However the concept of lean production was not designed for these types of businesses, they are utilized only partially. Paper focuses on applying methods of lean concept in companies which are dealing with mass production and their options of exchange for other methods in the event of disagreement. Basis of the article is a list of lean methods with its description and its utilization in practice. The questionnaire was utilized to identify information from the practice. Based on this survey were identified the critical methods that are no longer appropriate for companies dealing with mass production. However, there are alternative methods of describing the problem. It is possible to say that companies are trying to get closer to their goal by modification of the basic concepts. And the concept of Lean Enterprise serves as a standard.

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

    Science.gov (United States)

    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

  15. Effect of Multi-layer Compression Bandage Systems on Leg Ulcers Associated with Chronic Venous Insufficiency

    Directory of Open Access Journals (Sweden)

    Hüseyin Kuplay

    2013-03-01

    Full Text Available Introduction: Venous leg ulcer is a major health problem in terms of high prevalence and high cost for treatment. Multi-layer compression bandage systems for venous leg ulcers are supposed to be the gold standard for the treatment of venous ulcers. The aim of the current study is to investigate the effectiveness of multi-layer compression bandage systems for the treatment of venous leg ulcers.Patients and Methods: Nineteen consecutive patients diagnosed to have leg ulcers were evaluated and four patients were excluded from the study due to the peripheral arterial disease. Fifteen patients, enrolled in the study, were classified according to CEAP classification and belonged to the same class. Betaven® multi-layer compression bandage was applied to patients. Patients were followed-up in terms of wound healing and reduction in wound diameter.Results: Twelve male and three female patients underwent multi-layer bandage system. Mean age of patients was 38.2 ± 4.2 years. Ulcer size was measured planimetrically and baseline ulcer size was 4-10 cm². The location of ulcer was on medial malloelus in seven patients, lateral malleolus in three patients, anterior surface of the leg in four patients and lateral side of the leg in one patient. Patients had chronic venous insuuficiency for a mean of 5.1 ± 2.1 years. CEAP classifications were C6, Ep, As2,3-p18, Pr2,3, 18. Each bandage was changed five days after application along with wound care. Mean duration of treatment was 6 ± 2 weeks. Complete healing of the venous ulcers occurred in all patients except for one. This patient was referred to plastic surgery clinic for reconstruction.Conclusion: Multi-layer compression bandage system is an effective method of treatment for venous leg ulcers associated with chronic venous insufficiency by reducing venous return and increasing intertitial tissue pressure. This effect occurred in the shortrun as well as with a low cost and prevented loss of labor.

  16. Intermittent hypoxia induces hyperlipidemia in lean mice.

    Science.gov (United States)

    Li, Jianguo; Thorne, Laura N; Punjabi, Naresh M; Sun, Cheuk-Kwan; Schwartz, Alan R; Smith, Philip L; Marino, Rafael L; Rodriguez, Annabelle; Hubbard, Walter C; O'Donnell, Christopher P; Polotsky, Vsevolod Y

    2005-09-30

    Obstructive sleep apnea, a syndrome leading to recurrent intermittent hypoxia (IH), has been associated previously with hypercholesterolemia, independent of underlying obesity. We examined the effects of experimentally induced IH on serum lipid levels and pathways of lipid metabolism in the absence and presence of obesity. Lean C57BL/6J mice and leptin-deficient obese C57BL/6J-Lep(ob) mice were exposed to IH for five days to determine changes in serum lipid profile, liver lipid content, and expression of key hepatic genes of lipid metabolism. In lean mice, exposure to IH increased fasting serum levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, phospholipids (PLs), and triglycerides (TGs), as well as liver TG content. These changes were not observed in obese mice, which had hyperlipidemia and fatty liver at baseline. In lean mice, IH increased sterol regulatory element binding protein 1 (SREBP-1) levels in the liver, increased mRNA and protein levels of stearoyl-coenzyme A desaturase 1 (SCD-1), an important gene of TG and PL biosynthesis controlled by SREBP-1, and increased monounsaturated fatty acid content in serum, which indicated augmented SCD-1 activity. In addition, in lean mice, IH decreased protein levels of scavenger receptor B1, regulating uptake of cholesterol esters and HDL by the liver. We conclude that exposure to IH for five days increases serum cholesterol and PL levels, upregulates pathways of TG and PL biosynthesis, and inhibits pathways of cholesterol uptake in the liver in the lean state but does not exacerbate the pre-existing hyperlipidemia and metabolic disturbances in leptin-deficient obesity.

  17. Implementation analysis of lean enablers for managing engineering programs

    DEFF Research Database (Denmark)

    von Arnim, Joachim; Oehmen, Josef; Rebentisch, Eric

    2014-01-01

    This paper presents research to improve the applicability of the Lean Enablers and consists of two parts. The first is a case study of a very successful project management maturity improvement initiative at Siemens Industry Sector’s Industry Automation division in the US. It views the initiative...... from the perspective of the Lean Enablers [Oehmen 2012] and is based on information from [Sopko 2012a], [Sopko 2012b], [Sopko 2010], [Sopko 2009], interviews, internal documentation, and the used MSP program management methodology [UK 2011]. The analysis of Lean Enablers incorporated in the MSP...

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

    Science.gov (United States)

    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.

  19. Not letting the left leg know what the right leg is doing: limb-specific locomotor adaptation to sensory-cue conflict.

    Science.gov (United States)

    Durgin, Frank H; Fox, Laura F; Hoon Kim, Dong

    2003-11-01

    We investigated the phenomenon of limb-specific locomotor adaptation in order to adjudicate between sensory-cue-conflict theory and motor-adaptation theory. The results were consistent with cue-conflict theory in demonstrating that two different leg-specific hopping aftereffects are modulated by the presence of conflicting estimates of self-motion from visual and nonvisual sources. Experiment 1 shows that leg-specific increases in forward drift during attempts to hop in place on one leg while blindfolded vary according to the relationship between visual information and motor activity during an adaptation to outdoor forward hopping. Experiment 2 shows that leg-specific changes in performance on a blindfolded hopping-to-target task are similarly modulated by the presence of cue conflict during adaptation to hopping on a treadmill. Experiment 3 shows that leg-specific aftereffects from hopping additionally produce inadvertent turning during running in place while blindfolded. The results of these experiments suggest that these leg-specific locomotor aftereffects are produced by sensory-cue conflict rather than simple motor adaptation.

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

    Science.gov (United States)

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

    2013-01-01

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

  1. Lean Production as an Innovative Approach to Construction

    Science.gov (United States)

    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.

  2. Lean Management—The Journey from Toyota to Healthcare

    Directory of Open Access Journals (Sweden)

    Sorin T. Teich

    2013-04-01

    Full Text Available 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.

  3. Lean Management—The Journey from Toyota to Healthcare

    Science.gov (United States)

    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

  4. Lean Thinking in systems with non-negligible process variability

    DEFF Research Database (Denmark)

    Nielsen, Erland Hejn; Simons, David

    2000-01-01

    Lean Thinking (Womack and Jones) improves quality, cost and delivery through the relentless elimination of wastes. For example, the exemplar of Lean, the Toyota Production system, focuses on improvement through the continual elimination of seven categorised wastes (Ohno). Time compression (Stalk ...

  5. Quantifying Leg Movement Activity During Sleep.

    Science.gov (United States)

    Ferri, Raffaele; Fulda, Stephany

    2016-12-01

    Currently, 2 sets of similar rules for recording and scoring leg movement (LM) exist, including periodic LM during sleep (PLMS) and periodic LM during wakefulness. The former were published in 2006 by a task force of the International Restless Legs Syndrome Study Group, and the second in 2007 by the American Academy of Sleep Medicine. This article reviews the basic recording methods, scoring rules, and computer-based programs for PLMS. Less frequent LM activities, such as alternating leg muscle activation, hypnagogic foot tremor, high-frequency LMs, and excessive fragmentary myoclonus are briefly described. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. PENERAPAN LEAN MANUFACTURING UNTUK MEREDUKSI WASTE DI INDUSTRI SKALA UKM

    Directory of Open Access Journals (Sweden)

    Darminto Pujotomo

    2012-08-01

    Full Text Available Lean Manufacturing merupakan konsep manufaktur untuk menghasilkan produk yang efisien dengan mengurangi biaya produksi melalui efisiensi. Dalam konsep Lean, dikenal 7 macam pemborosan yang meliputi produksi berlebih, transportasi material yang berlebihan, menunggu, proses yang tidak perlu, persediaan, pergerakan dan cacat produk. Penelitian ini menggunakan value stream mapping dalam mengidentifikasi pemborosan dan menelusuri potensi terjadinya pemborosan. Potensi pemborosan yang terjadi akan direduksi dengan menggunakan instrumen yang sesuai berdasarkan indikator terpilih. Penelitian diharapkan dapat menghasilkan proses produksi yang lebih efisiensi sehingga mampu mereduksi biaya produksi. Pada akhirnya akan menghasilkan profit yang lebih besar. Kata kunci : lean manufacturing, value stream mapping, waste   Lean Manufacturing is a manufacturing concepts to produce products that are efficient by reducing production costs through efficiencies. In the Lean concept, known seven kinds of waste, including overproduction, excessive material transportation, waiting, unnecessary processes, inventory, motion and product defects. This study uses value stream mapping to identify waste and exploring the potential for waste. Potential waste that occurs will be reduced by using appropriate instruments based on selected indicators. The study is expected to produce a more efficient production processes so as to reduce production costs.Will ultimately result in greater profits. Keywords: lean manufacturing, value stream mapping, waste

  7. Value Stream Mapping to Improve Workplace to support Lean Environment

    Directory of Open Access Journals (Sweden)

    Ahmad Ahmad Nur Aizat

    2017-01-01

    Full Text Available In recent years, lean manufacturing is being followed by various sectors in order to keep their competitiveness in the global markets. Lean manufacturing plays a vital role in improving the efficiency of operation by eliminating or reducing wastes. Nonetheless, most of small and medium enterprises (SMEs lack sufficient knowledge or information on the benefits of implementing lean manufacturing. The main objective of this study is to apply value stream mapping, one of lean manufacturing tools, for improving the productivity in a SME by eliminating non-value added activities. In this study, lean manufacturing was adopted at a SME, particularly a food industry. Value stream mapping was served as main tool to identify the wastes and improvement opportunities in production line. Subsequently, different lean manufacturing tools such as Kaizen Burst, one piece flow, and 5S were applied to eliminate or reduce identified wastes. Based on the future state value stream mapping, final results showed that the total operation time and non-added value activities time were successfully decreased from 1993 seconds to 1719 seconds, and 234 seconds to 104 seconds, respectively. The findings of this study indicate that value stream mapping is an effective approach to eliminate the wastes and improve the productivity.

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

    Science.gov (United States)

    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.

  9. Coordinated development of muscles and tendon-like structures: early interactions in the Drosophila leg

    Directory of Open Access Journals (Sweden)

    cedric esoler

    2016-02-01

    Full Text Available The formation of the musculoskeletal system is a remarkable example of tissue assembly. In both vertebrates and invertebrates, precise connectivity between muscles and skeleton (or exoskeleton via tendons or equivalent structures is fundamental for movement and stability of the body. The molecular and cellular processes underpinning muscle formation are well established and significant advances have been made in understanding tendon development. However, the mechanisms contributing to proper connection between these two tissues have received less attention. Observations of coordinated development of tendons and muscles suggest these tissues may interact during the different steps in their development. There is growing evidence that, depending on animal model and muscle type, these interactions can take place from progenitor induction to the final step of the formation of the musculoskeletal system. Here we briefly review and compare the mechanisms behind muscle and tendon interaction throughout the development of vertebrates and Drosophila before going on to discuss our recent findings on the coordinated development of muscles and tendon-like structures in Drosophila leg. By altering apodeme formation (the functional Drosophila equivalent of tendons in vertebrates during the early steps of leg development, we affect the spatial localisation of subsequent myoblasts. These findings provide the first evidence of the developmental impact of early interactions between muscle and tendon-like precursors, and confirm the appendicular Drosophila muscle system as a valuable model for studying these processes.

  10. Leg ulcers due to hyperhomocysteinemia

    Directory of Open Access Journals (Sweden)

    Krupa Shankar D

    2006-01-01

    Full Text Available Chronic leg ulcers are rare in young adults and generally indicate a vascular cause. We report a case of a 26-year-old man with leg ulcers of eight months duration. Doppler study indicated venous incompetence and a postphlebitic limb. However, as the distribution and number of ulcers was not consistent with stasis alone and no features of collagen vascular disease were noted, a hyperviscosity state was considered and confirmed with significantly elevated homocysteine level in the serum. Administration of vitamins B1, B2, B6 and B12, trimethyl-glycine, mecobalamine, folic acid and povidone iodine dressings with culture-directed antibiotic therapy led to a satisfactory healing of ulcers over a period of one month. Hyperhomocysteinemia must be considered in the differential diagnosis of leg ulcers in young individuals.

  11. Bioinspired template-based control of legged locomotion

    OpenAIRE

    Ahmad Sharbafi, Maziar

    2018-01-01

    cient and robust locomotion is a crucial condition for the more extensive use of legged robots in real world applications. In that respect, robots can learn from animals, if the principles underlying locomotion in biological legged systems can be transferred to their artificial counterparts. However, legged locomotion in biological systems is a complex and not fully understood problem. A great progress to simplify understanding locomotion dynamics and control was made by introducing simple mo...

  12. The Henry Ford production system: LEAN process redesign improves service in the molecular diagnostic laboratory: a paper from the 2008 William Beaumont hospital symposium on molecular pathology.

    Science.gov (United States)

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

    2009-09-01

    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.

  13. Lean Thinking in Systems with Non-Negligible Process Variability

    DEFF Research Database (Denmark)

    Nielsen, Erland Hejn; Simons, David

    2000-01-01

    Lean Thinking (Womack and Jones) improves quality, cost and delivery through the relentless elimination of the wastes. For example, the exemplar of Lean, the Toyota Production system, focuses on improvement through the continual elimination of seven categorised wastes (Ohno). Time compression (St...

  14. Dissemination strategy for Lean thinking in health care.

    Science.gov (United States)

    Dannapfel, Petra; Poksinska, Bozena; Thomas, Kristin

    2014-01-01

    The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare organisations. The Ostergötland county council, Sweden (CCO) was chosen as a case study for an healthcare Lean-thinking dissemination strategies. Document analysis and interviews were used and results were compared with similar strategies employed by staff at the National Health Service Institute for Innovation (NHSI) and improvement in Great Britain and the Odense University Hospital in Denmark. The Lean improvement programme was introduced to tackle challenges such as an ageing society, rising care expectations and budgetary and economic constraints. It was designed as a long-term programme to create added value for patients and employee involvement. The dissemination strategy was: forming clear visions and objectives; piloting; training potential adopters; and formal dissemination. The CCO strategy was focused primarily on managers and was not meant to involve all staff until the implementation stage. Staff at the NHSI attempted to address nurses needs during dissemination, which questioned whether the CCO managers' dissemination strategy is sustainable. This paper inspires healthcare managers and decision makers who aim to disseminate Lean production in their organisations. There are many case studies describing Lean implementation in single healthcare organisations, but little is known about effective dissemination and implementation strategies in large healthcare systems. The authors, therefore, suggest activities for developing and implementing dissemination strategies in multiple healthcare organisations.

  15. Relationship-centered health care as a Lean intervention.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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 lean weight was highly related to the product of ham total weight times percentage ham lean area (r equals .96, P product of ham total weight times percentage ham fat area (r equals .88, P 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.

  17. Prickle isoforms control the direction of tissue polarity by microtubule independent and dependent mechanisms

    Directory of Open Access Journals (Sweden)

    Katherine A. Sharp

    2016-03-01

    Full Text Available Planar cell polarity signaling directs the polarization of cells within the plane of many epithelia. While these tissues exhibit asymmetric localization of a set of core module proteins, in Drosophila, more than one mechanism links the direction of core module polarization to the tissue axes. One signaling system establishes a polarity bias in the parallel, apical microtubules upon which vesicles containing core proteins traffic. Swapping expression of the differentially expressed Prickle isoforms, Prickle and Spiny-legs, reverses the direction of core module polarization. Studies in the proximal wing and the anterior abdomen indicated that this results from their differential control of microtubule polarity. Prickle and Spiny-legs also control the direction of polarization in the distal wing (D-wing and the posterior abdomen (P-abd. We report here that this occurs without affecting microtubule polarity in these tissues. The direction of polarity in the D-wing is therefore likely determined by a novel mechanism independent of microtubule polarity. In the P-abd, Prickle and Spiny-legs interpret at least two directional cues through a microtubule-polarity-independent mechanism.

  18. INTRA-RATER RELIABILITY OF THE MULTIPLE SINGLE-LEG HOP-STABILIZATION TEST AND RELATIONSHIPS WITH AGE, LEG DOMINANCE AND TRAINING.

    Science.gov (United States)

    Sawle, Leanne; Freeman, Jennifer; Marsden, Jonathan

    2017-04-01

    Balance is a complex construct, affected by multiple components such as strength and co-ordination. However, whilst assessing an athlete's dynamic balance is an important part of clinical examination, there is no gold standard measure. The multiple single-leg hop-stabilization test is a functional test which may offer a method of evaluating the dynamic attributes of balance, but it needs to show adequate intra-tester reliability. The purpose of this study was to assess the intra-rater reliability of a dynamic balance test, the multiple single-leg hop-stabilization test on the dominant and non-dominant legs. Intra-rater reliability study. Fifteen active participants were tested twice with a 10-minute break between tests. The outcome measure was the multiple single-leg hop-stabilization test score, based on a clinically assessed numerical scoring system. Results were analysed using an Intraclass Correlations Coefficient (ICC 2,1 ) and Bland-Altman plots. Regression analyses explored relationships between test scores, leg dominance, age and training (an alpha level of p = 0.05 was selected). ICCs for intra-rater reliability were 0.85 for the dominant and non-dominant legs (confidence intervals = 0.62-0.95 and 0.61-0.95 respectively). Bland-Altman plots showed scores within two standard deviations. A significant correlation was observed between the dominant and non-dominant leg on balance scores (R 2 =0.49, ptest demonstrated strong intra-tester reliability with active participants. Younger participants who trained more, have better balance scores. This test may be a useful measure for evaluating the dynamic attributes of balance. 3.

  19. Agile and lean principles and systems engineering: a synergy?

    CSIR Research Space (South Africa)

    Joseph-Malherbe, SM

    2011-09-01

    Full Text Available not efficient and effective enough to support rapid fielding of products. The objective of this piece of work is multi-fold: (1) to explore and present fundamental Systems Engineering, Agile and Lean principles (2) the evolution or lack of Lean and Agile...

  20. Adaptive leg coordination with a biologically inspired neurocontroller

    Science.gov (United States)

    Braught, Grant; Thomopoulos, Stelios C.

    1996-10-01

    Natural selection is responsible for the creation of robust and adaptive control systems. Nature's control systems are created only from primitive building blocks. Using insect neurophysiology as a guide, a neural architecture for leg coordination in a hexapod robot has been developed. Reflex chains and sensory feedback mechanisms from various insects and crustacea form the basis of a pattern generator for intra-leg coordination. The pattern generator contains neural oscillators which learn from sensory feedback to produce stepping patterns. Using sensory feedback as the source of learning information allows the pattern generator to adapt to changes in the leg dynamics due to internal or external causes. A coupling between six of the single leg pattern generators is used to produce the inter-leg coordination necessary to establish stable gaits.