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Sample records for leg lean tissue

  1. Twelve weeks’ progressive resistance training combined with protein supplementation beyond habitual intakes increases upper leg lean tissue mass, muscle strength and extended gait speed in healthy older women.

    OpenAIRE

    Francis, P

    2016-01-01

    The age-related decline in functional capability is preceded by a reduction in muscle quality. The purpose of this study was to assess the combined effects of progressive resistance training (PRT) and protein supplementation beyond habitual intakes on upper leg lean tissue mass (LTM), muscle quality and functional capability in healthy 50 – 70y women. In a single-blinded, randomized, controlled design, 57 healthy older women (age 61.1 ± 5.1 years, 1.61 ± 0.65 m, 65.3 ± 15.3 kg) consumed 0.33 ...

  2. Twelve weeks' progressive resistance training combined with protein supplementation beyond habitual intakes increases upper leg lean tissue mass, muscle strength and extended gait speed in healthy older women.

    Science.gov (United States)

    Francis, Peter; Mc Cormack, William; Toomey, Clodagh; Norton, Catherine; Saunders, Jean; Kerin, Emmet; Lyons, Mark; Jakeman, Philip

    2017-12-01

    The age-related decline in functional capability is preceded by a reduction in muscle quality. The purpose of this study was to assess the combined effects of progressive resistance training (PRT) and protein supplementation beyond habitual intakes on upper leg lean tissue mass (LTM), muscle quality and functional capability in healthy 50-70 years women. In a single-blinded, randomized, controlled design, 57 healthy older women (age 61.1 ± 5.1 years, 1.61 ± 0.65 m, 65.3 ± 15.3 kg) consumed 0.33 g/kg body mass of a milk-based protein matrix (PRO) for 12 weeks. Of the 57 women, 29 also engaged in a PRT intervention (PRO + PRT). In comparison to the PRO group (n = 28), those in the PRO + PRT group had an increase in upper leg LTM [0.04 (95% CI -0.07 to 0.01) kg vs. 0.13 (95% CI 0.08-0.18) kg, P = 0.027], as measured by Dual-energy X-ray absorptiometry; an increase in knee extensor (KE) torque [-1.6 (95% CI -7.3 to 4.4 N m) vs. 10.2 (95% CI 4.3-15.8 N m), P = 0.007], as measured from a maximal voluntary isometric contraction (Con-Trex MJ; CMV AG); and an increase in extended gait speed [-0.01 (95% CI -0.52-0.04) m s -1 vs. 0.10 (95% CI 0.05-0.22) m s -1 , P = 0.001] as measured from a maximal 900 m effort. There was no difference between groups in the time taken to complete 5 chair rises or the number of chair rises performed in 30 s (P > 0.05). PRT in healthy older women ingesting a dietary protein supplement is an effective strategy to improve upper leg LTM, KE torque and extended gait speed in healthy older women.

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

    Science.gov (United States)

    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.

  4. 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)....

  5. Leg muscle activation patterns during walking and leg lean mass are different in children with and without developmental coordination disorder.

    Science.gov (United States)

    Yam, Timothy T T; Fong, Shirley S M

    2018-02-01

    Previous studies have shown that children with developmental coordination disorder (DCD) have a higher body fat and greater gait variability. Little research has investigated the gait muscle activity and lean mass measures in children with DCD. To compare the leg muscle activation patterns of the gait cycle and leg lean mass between children with and without DCD. Fifty-one children were in the DCD group (38 males and 13 females; 7.95 ± 1.04 years) and fifty-two in the control group (34 males and 18 females; 8.02 ± 1.00 years). Peak muscle activation patterns of treadmill walking in the right leg for the eight-gait phases were measured by means of surface electromyography, an electrogoniometer, and foot contact switches. Leg lean mass measures were evaluated using a whole-body dual energy X-ray absorptiometry scan. Children with DCD had a lower leg lean mass and appendicular lean mass index compared to the control group. Furthermore, they exhibited a less-pronounced peak muscle activation during the heel strike (gastrocnemius medialis), early swing (biceps femoris) and late swing phases (gastrocnemius medialis) of gait. Although lower limb total mass was similar between groups, the DCD group displayed lower lean mass measures than controls. Furthermore, children with DCD illustrated a lower leg peak muscle activation during the heel strike, early swing and late swing phases of gait when walking on a treadmill. Our results emphasize the need to incorporate lower limb phasic muscle strengthening components into gait rehabilitation programs for children with DCD. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Leg Strength and Lean Mass Symmetry Influences Kicking Performance in Australian Football

    Science.gov (United States)

    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 Points Strength 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. PMID:24570620

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

    Science.gov (United States)

    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.

  8. The effectiveness of leucine on muscle protein synthesis, lean body mass and leg lean mass accretion in older people: a systematic review and meta-analysis.

    Science.gov (United States)

    Xu, Zhe-rong; Tan, Zhong-ju; Zhang, Qin; Gui, Qi-feng; Yang, Yun-mei

    2015-01-14

    In the present study, we performed a meta-analysis to assess the ability of leucine supplementation to increase the muscle protein fraction synthetic rate and to augment lean body mass or leg lean mass in elderly patients. A literature search was conducted on Medline, Cochrane, EMBASE and Google Scholar databases up to 31 December 2013 for clinical trials that investigated the administration of leucine as a nutrient that affects muscle protein metabolism and muscle mass in elderly subjects. The included studies were randomised controlled trials. The primary outcome for the meta-analysis was the protein fractional synthetic rate. Secondary outcomes included lean body mass and leg lean mass. A total of nine studies were included in the meta-analysis. The results showed that the muscle protein fractional synthetic rate after intervention significantly increased in the leucine group compared with the control group (pooled standardised difference in mean changes 1·08, 95% CI 0·50, 1·67; Pmass (pooled standardised difference in mean changes 0·18, 95% CI - 0·18, 0·54; P= 0·318) or leg lean mass (pooled standardised difference in mean changes 0·006, 95% CI - 0·32, 0·44; P= 0·756). These findings suggest that leucine supplementation is useful to address the age-related decline in muscle mass in elderly individuals, as it increases the muscle protein fractional synthetic rate.

  9. Twins Bed Rest Project: LBNP/Exercise Minimizes Changes in Lean Leg Mass, Strength and Endurance

    Science.gov (United States)

    Amorim, Fabiano T.; Schneider, Suzanne M.; Lee, Stuart M. C.; Boda, Wanda L.; Watenpaugh, Donald E.; Hargens, Alan R.

    2006-01-01

    Decreases in muscle strength and endurance frequently are observed in non-weightbearing conditions such as bed rest (BR), spaceflight or limb immobilization. Purpose: Ow purpose was to determine if supine treadmill exercise against simulated gravity, by application of lower body negative pressure (LBNP), prevents loss of lean leg mass, strength and endurance during 30 d of 6deg head-down bed rest (BR). Methods: Fifteen pairs of monozygous twins (8 male, 7 female pairs; 26+/-4 yrs; 170+/-12 cm; 62.6+/-11.3 kg; mean+/-SD) were subjects in the present study. One sibling of each pair of twins was randomly assigned to either an exercise (EX) or non-exercise (CON) group. The EX twin walked/jogged on a vertical treadmill within LBNP chamber 6 d/wk using a 40-min interval exercise protocol at 40-80% of pre-BR VO(sub 2peak). LBNP was adjusted individually for each subject such that footward force was between 1.0 and 1.2 times body weight (-53+/-5 mmHg LBNP). The CON twin performed no exercise during BR. Subjects performed isokinetic knee (60 and 120deg/s) and ankle (60deg/s) testing to assess strength and endurance (End) before and after BR. They also had their lean leg mass (L(sub mass)) evaluated by DEXA before and after BR. Results: Changes in peak torque (T(sub pk)) were smaller for flexion (flex) than for extension (ext) after BR and did not differ between groups. The CON group had larger decreases (P<0.05) in L(sub mass), knee and ankle ext T(sub pk), and knee ext End.

  10. 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

  11. 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.

  12. Leg Strength and Lean Mass Symmetry Influences Kicking Performance in Australian Football

    OpenAIRE

    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 ...

  13. 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 lymphoed...

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

  16. Prediction Equation for Lower Limbs Lean Soft Tissue in Circumpubertal Boys Using Anthropometry and Biological Maturation

    NARCIS (Netherlands)

    Valente-dos-Santos, Joao; Coelho-e-Silva, Manuel J.; Machado-Rodrigues, Aristides M.; Elferink-Gemser, Marije T.; Malina, Robert M.; Petroski, Edio L.; Minderico, Claudia S.; Silva, Analiza M.; Baptista, Fatima; Sardinha, Luis B.

    2014-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

  19. Lean and obese coronary perivascular adipose tissue impairs vasodilation via differential inhibition of vascular smooth muscle K+ channels

    Science.gov (United States)

    Noblet, Jillian N.; Owen, Meredith K.; Goodwill, Adam G.; Sassoon, Daniel J.; Tune, Johnathan D.

    2015-01-01

    Objective The effects of coronary perivascular adipose tissue (PVAT) on vasomotor tone are influenced by an obese phenotype and are distinct from other adipose tissue depots. The purpose of this investigation was to examine the effects of lean and obese coronary PVAT on end-effector mechanisms of coronary vasodilation and to identify potential factors involved. Approach and Results Hematoxylin and eosin staining revealed similarities in coronary perivascular adipocyte size between lean and obese Ossabaw swine. Isometric tension studies of isolated coronary arteries from Ossabaw swine revealed that factors derived from lean and obese coronary PVAT attenuated vasodilation to adenosine. Lean coronary PVAT inhibited KCa and KV7, but not KATP channel mediated dilation in lean arteries. In the absence of PVAT, vasodilation to KCa and KV7 channel activation was impaired in obese arteries relative to lean arteries. Obese PVAT had no effect on KCa or KV7 channel mediated dilation in obese arteries. In contrast, obese PVAT inhibited KATP channel mediated dilation in both lean and obese arteries. The differential effects of obese versus lean PVAT were not associated with changes in either coronary KV7 or KATP channel expression. Incubation with calpastatin attenuated coronary vasodilation to adenosine in lean but not obese arteries. Conclusions These findings indicate that lean and obese coronary PVAT attenuates vasodilation via inhibitory effects on vascular smooth muscle K+ channels and that alterations in specific factors such as calpastatin are capable of contributing to the initiation and/or progression of smooth muscle dysfunction in obesity. PMID:25838427

  20. 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

  1. Different Levels of Eccentric Resistance during Eight Weeks of Training Affect Muscle Strength and Lean Tissue Mass

    Science.gov (United States)

    English, K. L.; Loehr, J. A.; Lee, S. M. C.; Laughlin, M. S.; Hagan, R. D.

    2008-01-01

    Coupling concentric and eccentric muscle contractions appears to be important in the development of muscle strength and hypertrophy. The interim Resistive Exercise Device (iRED) currently used aboard the International Space Station does not seem to be as effective as free weight training in ambulatory subjects and has not completely protected against muscular deconditioning due to space flight. The lack of protection during space flight could be caused by iRED's proportionally lower eccentric resistance (60-70%) compared to concentric resistance. PURPOSE: To determine the effects of 8 wks of lower body resistive exercise training using five levels of eccentric resistance on muscle strength and lean tissue mass. METHODS: Forty untrained males (34.9 +/- 7 yrs, 80.9 +/- 9.8 kg, 178.2 +/- 7.1 cm; mean +/- SD) completed three 1-repetition maximum (1-RM) strength tests for both the supine leg press (LP) and supine heel raise (HR) prior to training; subjects were matched for LP strength and randomly assigned to one of five training groups. Concentric load (% 1-RM) was constant across groups during training, but each group trained with different levels of eccentric load (0%, 33%, 66%, 100%, or 138% of concentric). Subjects trained 3 d / wk for 8 wks using a periodized program for LP and HR based on percentages of the highest pre-training 1-RM. LP and HR 1-RM and leg lean mass (LLM; assessed by DEXA) were measured pre- and post-training. A two-way ANOVA was used to analyze all dependent measures. Tukey's post hoc tests were used to test significant main effects. Within group pre- to post-training changes were compared using paired t-tests with a Bonferroni adjustment. Statistical significance was set a priori at p 0.05. All data are expressed as mean +/- SE. RESULTS: LP 1-RM strength increased significantly in all groups pre- to post-training. The 138% group increase (20.1 +/- 3.7%) was significantly greater than the 0% (7.9 +/- 2.8%), 33% (7.7 +/- 4.6%), and 66% (7.5 +/- 4

  2. 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

  3. Leanness of Lou/C rats does not require higher thermogenic capacity of brown adipose tissue.

    Science.gov (United States)

    Belouze, Maud; Sibille, Brigitte; Rey, Benjamin; Roussel, Damien; Romestaing, Caroline; Teulier, Loïc; Baetz, Delphine; Koubi, Harry; Servais, Stéphane; Duchamp, Claude

    2011-10-24

    Lou/C rats, an inbred strain of Wistar origin, remain lean throughout life and therefore represent a remarkable model of obesity resistance. To date, the exact mechanisms responsible for the leanness of Lou/C rats remain unknown. The aim of the present study was to investigate whether the leanness of Lou/C rats relies on increased thermogenic capacities in brown adipose tissue (BAT). Results showed that although daily energy expenditure was higher in Lou/C than in Wistar rats, BAT thermogenic capacity was not enhanced in Lou/C rats kept at thermoneutrality as demonstrated by reduced thermogenic response to norepinephrine in vivo, similar oxidative activity of BAT isolated mitochondria in vitro, similar levels of UCP1 mRNA and lower abundance of UCP1 protein in interscapular BAT depots. Relative abundance of β3-adrenergic receptor mRNA was lower in Lou/C BAT while that of GLUT4, FABP or CPT1 was not altered. Activity-related energy expenditure was however considerably increased at thermoneutrality as Lou/C rats demonstrated an impressively high spontaneous running activity in voluntary running wheels. Prolonged cold-exposure (4 °C) depressed the spontaneous running activity of Lou/C rats while BAT thermogenic capacity was increased as reflected by rises in BAT mass, oxidative activity and UCP1 expression. It is concluded that the leanness of Lou/C rats cannot be ascribed to higher thermogenic capacity of brown fat but rather to, at least in part, increased locomotor activity. BAT is not deficient in this rat strain as it can be stimulated by cold exposure when locomotor activity is reduced suggesting some substitution between these thermogenic processes. Copyright © 2011 Elsevier Inc. All rights reserved.

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

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    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.

  5. 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

  6. Non-Discriminant Relationships between Leg Muscle Strength, Mass and Gait Performance in Healthy Young and Old Adults

    NARCIS (Netherlands)

    Muehlbauer, Thomas; Granacher, Urs; Borde, Ron; Hortobagyi, Tibor

    2018-01-01

    Background: Gait speed declines with increasing age, but it is unclear if gait speed preferentially correlates with leg muscle strength or mass.  Objective: We determined the relationship between gait speed and (1) leg muscle strength measured at 3 lower extremity joints and (2) leg lean tissue mass

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

    Directory of Open Access Journals (Sweden)

    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

  8. Leg tissue composition of goat kids according to racial group, weight and gender

    Directory of Open Access Journals (Sweden)

    Brenda Batista Lemos Medeiros

    2011-01-01

    Full Text Available To evaluate the effect of breed group, slaughter weight and sex on tissue proportion of the leg and muscle, bone and fat ratio in confined kids, seventy-four goats of both sex were used and divided among breed groups: Alpine (A, ½ Nubian + ½ Alpine (½ ANA, ½ Boer + ½ Alpine (½ BA, ¾ Boer + ¼ Alpine (¾ BA and ½ Nubian + ¼ Alpine + ¼ Boer, (Three cross - TC, at three slaughter weights (25, 30 and 35 kg. Leg represented 31.01% of half carcass, where 62.29% was total muscle, 21.45% total bone and 8.35% total fat. Alpine animals had higher bone weight than other groups. Male kids had higher muscle and bone proportion, whereas females had higher subcutaneous and intramuscular fat in leg. The percentage of total weight of the muscle, five muscles, adductor muscle, quadriceps muscle and femur were higher in the slaughter weights of 25 and 30 kg.

  9. Repair of a large soft tissue defect in the leg with cross-leg bridge free transfer of a latissimus dorsi myocutaneous flap: a case report

    Directory of Open Access Journals (Sweden)

    ZHANG Gong-lin

    2012-12-01

    Full Text Available 【Abstract】A 48-year-old man sustained a traffic accident injury to his left leg. It was an open fracture of the left tibia and fibula accompanied by a large soft tissue de-fect (27 cm×7 cm. Doppler examination revealed the poste-rior tibial artery was occluded due to thrombosis. Three weeks after injury, the latissimus dors myocutaneous flap was elevated with a T-shaped vascular pedicle and was in-terposed between the two vascular ends of the posterior tibial vessel of the contralateral leg. Two end to end anasto-moses were performed between the two vascular ends of the posterior tibial vessel of the contralateral leg and the latissimus dors myocutaneous flap’s T-shaped vascular pedicle. The latissimus dorsi myocutaneous flap was used for repair of a large soft tissue defect of the left leg. The vascular pedicle was cut off after 28 days and the flap sur-vived completely. After 3-years’ follow-up postoperatively, a good contour was confirmed at the recipient area. The right tibia and fibula fractures were confirmed healing radiologically. The posterior tibial artery of contralateral leg was demonstrated patent by clinical and Doppler examinations. Key words: Surgical flaps; Leg injuries; Soft tissue injuries; Wound healing

  10. Subcutaneous Adipose Tissue from Obese and Lean Adults Does Not Release Hepcidin In Vivo

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    Lisa Tussing-Humphreys

    2011-01-01

    Full Text Available Hepcidin is the main regulator of systemic iron homeostasis and is primarily produced by the liver but is also expressed, at the mRNA-level, in periphery tissues including the subcutaneous and visceral adipose tissue. Obesity is associated with elevated hepcidin concentrations and iron depletion suggesting that the exaggerated fat mass in obesity could contribute significantly to circulating hepcidin levels consequently altering iron homeostasis. The objective of this study was to determine if abdominal subcutaneous adipose tissue (AbScAT releases hepcidin in vivo and if release is modified by obesity. Arterio-venous differences in concentrations of hepcidin were measured across AbScAT in 9 obese and 9 lean adults. Overall (n=18, mean plasma hepcidin concentrations were significantly higher in arterialized compared to AbScAT venous samples [mean difference (arterialized-AbScAT venous plasma hepcidin = 4.9±9.6 ng/mL, P=0.04]. Net regional release was not calculated because mean venous plasma hepcidin concentrations were lower than mean arterialized concentrations indicating no net release. Significant correlations between AbScAT venous and arterialized plasma hepcidin concentrations with anthropometric variables were not observed. Findings from this vein drainage study suggest there is no net release of hepcidin from the AbScAT depot and thereby no ability to signal systemically, even in obesity.

  11. 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 cyc...

  12. Activity and tissue-specific expression of lipases and tumor-necrosis factor alpha in lean and obese cats.

    NARCIS (Netherlands)

    Hoenig, M.; McGoldrick, J.B.; Beer, M. de; Demacker, P.N.M.; Ferguson, D.C.

    2006-01-01

    Post-heparin plasma activity of lipoprotein lipase (LPL) and hepatic lipase (HL), and fat and muscle activity of LPL were measured in neutered lean and obese cats. Lipoprotein lipase, hormone-sensitive lipase (HSL), and tumor necrosis factor a (TNF) mRNA were measured in muscle and fat tissue with

  13. Surface Accelerometer Fixation Method Affects Leg Soft Tissue Motion Following Heel Impacts

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    Jennifer M. Stefanczyk

    2013-10-01

    Full Text Available Surface-mounted accelerometers (SMA secured tightly to body segments with an elastic strap, are commonly used to quantify the impact response of bone.  However, the effect that this type of fixation has on segment soft tissue motion relative to bone has yet to be determined.  Heel impacts were collected from 20 participants using a human pendulum apparatus, with (strap and without (no strap a SMA attached to the proximal tibia.  Leg soft tissue motion was quantified using digital image analysis software which monitored positions of skin markers from a series of high speed photographs.  The strap was found to alter the natural physiological motion of the soft tissue, with significant displacement, velocity and sex differences occurring within the most proximal regions.  Future research should evaluate alternative methods for quantifying bone and soft tissue response to impact concurrently, to advance our understanding of impact-related injury mechanisms.

  14. Lean maturity, lean sustainability

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Matthiesen, Rikke; Nielsen, Jacob

    2007-01-01

    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....

  15. Lean maturity, lean sustainability

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Matthiesen, Rikke; Nielsen, Jacob

    2007-01-01

    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....... 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...... that support lean capability development and consequently, lean sustainability....

  16. 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

  17. Infrared thermography for indirect assessment of activation of brown adipose tissue in lean and obese male subjects.

    Science.gov (United States)

    El Hadi, Hamza; Frascati, Andrea; Granzotto, Marnie; Silvestrin, Valentina; Ferlini, Elisabetta; Vettor, Roberto; Rossato, Marco

    2016-12-01

    Brown adipose tissue (BAT) plays a key role in adaptive thermogenesis in mammals, and it has recently been considered as an attractive therapeutic target for tackling human obesity by increasing energy expenditure. Thermal imaging using infrared thermography (IRT) has emerged as a potential safe, rapid and inexpensive technique for detecting BAT in humans. However, little attention has been given to the reliability of this method in obese subjects. To this end, we evaluated the capacity of IRT to detect activated supraclavicular (SCV) BAT in 14 lean and 16 mildly obese young adults after acute cold exposure. Using IRT we measured the temperature of the skin overlying the SCV and sternal areas at baseline and after acute cold stimulation. Additionally, energy expenditure was measured by indirect calorimetry and body composition was estimated using bioelectrical impedance analysis. Energy expenditure and SCV skin temperature significantly increased in lean subjects upon cold exposure, while no significant changes were detected in the obese group. Furthermore, cold-induced variations in SCV skin temperature of obese subjects showed a negative correlation with body mass index. This study suggests that in lean individuals BAT is a rapidly activated thermogenic tissue possibly involved in the regulation of energy balance, and can be indirectly assessed using IRT. In obese subjects, BAT seems less prone to be activated by cold exposure, with the degree of adiposity representing a limiting factor for the indirect detection of BAT activation by measuring the skin temperature overlying BAT.

  18. 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.

  19. 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.

  20. Leg Injuries and Disorders

    Science.gov (United States)

    Your legs are made up of bones, blood vessels, muscles, and other connective tissue. They are important for motion ... falling, or having an accident can damage your legs. Common leg injuries include sprains and strains, joint ...

  1. 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 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 oxygenation achieved in the tissue. The results support the concept that tissue oxygenation is a key variable in blood flow regulation. Copyright © 2017 the American Physiological Society.

  2. 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...... the association between these enzymes and different measures of insulin sensitivity. DESIGN: Cross-sectional study. SUBJECTS: 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......beta-HSD1 mRNA. The subgroups LP and OC had increased 11beta-HSD1 and 11beta-HSD2 mRNA expression compared with LC (Pbeta-HSD2 or H6PDH mRNA expression. Decreased peripheral insulin sensitivity (P

  3. Connective Tissue Growth Factor Transgenic Mouse Develops Cardiac Hypertrophy, Lean Body Mass and Alopecia.

    Science.gov (United States)

    Nuglozeh, Edem

    2017-07-01

    Connective Tissue Growth Factor (CTGF/CCN2) is one of the six members of cysteine-rich, heparin-binding proteins, secreted as modular protein and recognised to play a major function in cell processes such as adhesion, migration, proliferation and differentiation as well as chondrogenesis, skeletogenesis, angiogenesis and wound healing. The capacity of CTGF to interact with different growth factors lends an important role during early and late development, especially in the anterior region of the embryo. CTGF Knockout (KO) mice have several craniofacial defects and bone miss shaped due to an impairment of the vascular system development during chondrogenesis. The aim of the study was to establish an association between multiple modular functions of CTGF and the phenotype and cardiovascular functions in transgenic mouse. Bicistronic cassette was constructed using pIRES expressing vector (Clontech, Palo Alto, CA). The construct harbours mouse cDNA in tandem with LacZ cDNA as a reporter gene under the control of Cytomegalovirus (CMV) promoter. The plasmid was linearised with NotI restriction enzyme, and 50 ng of linearised plasmid was injected into mouse pronucleus for the chimaera production. Immunohistochemical methods were used to assess the colocalisation renin and CTGF as well as morphology and rheology of the cardiovascular system. The chimeric mice were backcrossed against the wild-type C57BL/6 to generate hemizygous (F1) mouse. Most of the offsprings died as a result of respiratory distress and those that survived have low CTGF gene copy number, approximately 40 molecules per mouse genome. The copy number assessment on the dead pups showed 5×10 3 molecules per mouse genome explaining the threshold of the gene in terms of toxicity. Interestingly, the result of this cross showed 85% of the progenies to be positive deviating from Mendelian first law. All F2 progenies died excluding the possibility of establishing the CTGF transgenic mouse line, situation that

  4. Proteolytic activity in wound fluids and tissues derived from chronic venous leg ulcers.

    Science.gov (United States)

    Moor, Andrea N; Vachon, David J; Gould, Lisa J

    2009-01-01

    Venous leg ulcers affect approximately 1% of the general population and 3.6% of those over the age of 65. The goal of the research described herein is to shorten the time to healing by developing wound care alternatives that are based on a comprehensive understanding of the venous ulcer wound environment. The proteolytic and inflammatory components in wound fluids and tissue biopsy samples were characterized in subjects with documented long-standing venous ulcers that had showed resistance to standard therapy. All wounds showed polymicrobial colonization with greater than 10(6) CFU/g. Myeloperoxidase, a measure of leukocyte infiltration, was also markedly elevated in these wounds. Zymography revealed the presence of both pro-matrix metalloproteinase (MMP)-2 and pro-MMP-9 in wound fluids and to a lesser extent in tissue biopsies. Using an immunocapture activity assay we reveal a sevenfold excess of MMP-9 in wound fluid as compared to tissue, with 73% in the activated form. In contrast, MMP-8 total protein levels were nearly equal in wound fluids and biopsies. Fibronectin, a critical component of the extracellular matrix, was shown to be degraded in both wound fluids and biopsy samples. Finally, the potential of a novel wound dressing to neutralize several constituents of this hostile wound environment is shown.

  5. Glucose-induced thermogenesis in splanchnic and leg tissues in man

    DEFF Research Database (Denmark)

    Simonsen, L; Ryge, C; Bülow, J

    1995-01-01

    and lactate were taken from an artery, a hepatic vein and a femoral vein. Blood flow in the splanchnic region was measured by constant infusion of Indocyanine Green. Leg blood flow was measured by venous occlusion strain-gauge plethysmography. Oxygen uptake and carbon dioxide output in the splanchnic and leg...

  6. Human Adipose Tissue Conditioned Media from Lean Subjects Is Protective against H2O2 Induced Neurotoxicity in Human SH-SY5Y Neuronal Cells

    Directory of Open Access Journals (Sweden)

    Zhongxiao Wan

    2015-01-01

    Full Text Available Adipose tissue secretes numerous hormone-like factors, which are known as adipokines. Adipokine receptors have been identified in the central nervous system but the potential role of adipokine signaling in neuroprotection is unclear. The aim of this study is to determine (1 Whether adipokines secreted from cultured adipose tissue of lean humans is protective against oxidative stress-induced neurotoxicity in human SH-SY5Y neuronal cells; and (2 To explore potential signaling pathways involved in these processes. Adipose tissue conditioned media (ATCM from healthy lean subjects completely prevented H2O2 induced neurotoxicity, while this effect is lost after heating ATCM. ATCM activated the phosphorylation of ERK1/2, JNK and Akt at serine 308 in SH-SY5Y cells. PD98059 (25 µM, SP600125 (5 µM and LY29400 (20 µM partially blocked the protective effects of ATCM against H2O2 induced neurotoxicity. Findings demonstrate that heat-sensitive factors secreted from human adipose tissue of lean subjects are protective against H2O2 induced neurotoxicity and ERK1/2, JNK, and PI3K signaling pathways are involved in these processes. In conclusion, this study demonstrates preliminary but encouraging data to further support that adipose tissue secreted factors from lean human subjects might possess neuroprotective properties and unravel the specific roles of ERK1/2, JNK and PI3K in these processes.

  7. 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 muscle strength (18%; 95% CI: 0.03, 0.34) than did the CRT group (all P muscle strength and reducing circulating IL-6 concentrations in elderly women. This trial was registered at the Australian Clinical Trials Registry as ACTRN12609000223235.

  8. 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.

  9. Effectiveness of the Gastrocsoleous Flap for Coverage of Soft Tissue Defects in Leg with Emphasis on the Distal Third

    Directory of Open Access Journals (Sweden)

    Ali Karbalaeikhani

    2015-07-01

    Full Text Available Background: The standard methods for reconstruction of soft tissue defects in the leg include gastrocnemius flap for proximal third defects, soleus flap for middle third and free flap in the distal third. However, there are problems with the use of free flap, like increased operative time, damage of major vessels and the need for experienced microsurgeon. Mathods: This prospective study was undertaken on 23 patients (20 male and 3 female with the mean age 32.13 years (14 to 65. This group consisted of all of the patients referred to Dr Bahonar Hospital, Kerman with soft tissue defects between April 2011 and April 20012 and would give informed consent for participation in the study and treatment of the defect with muscle flaps. 8 patients with proximal third defects were treated with were treated with gastrocnemius flap, 4 with middle third defects with soleus flap and 3 with reverse soleus flap and 8 with distal third defects with reverse soleus flap. The patients were followed up for at least 1 year. Finally the results were analyzed by SPSS 16. Results: In patients with soft tissue defect in proximal and middle third of leg repair was successful in all. In 5 patients with soft tissue defect in distal third of leg repair was complete but in 3 of them flap failure was seen. Overall success rate for reverse soleous flap was 72.7%. Conclusion: The success rate of the flap for the upper and lower thirds was similar to other studies and seems that this is the standard method. In the distal third defects the reverse soleous flap failed in 3 cases and it seems that preoperative investigations such as angiography must be performed before embarking on such a procedure.

  10. 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 p...

  11. Acute exercise increases adipose tissue interstitial adiponectin concentration in healthy overweight and lean subjects

    DEFF Research Database (Denmark)

    Højbjerre, Lise; Rosenzweig, Mary; Dela, Flemming

    2007-01-01

    -) plasma concentration did not change during exercise in any of the groups, but SCAAT TNF- mRNA increased after exercise in both groups. Furthermore, exercise decreased SCAAT leptin mRNA with no change in resistin mRNA. CONCLUSIONS: Acute exercise increases adipose tissue interstitial adiponectin...

  12. 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.).

  13. 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.)

  14. Gender and obesity specific MicroRNA expression in adipose tissue from lean and obese pigs

    DEFF Research Database (Denmark)

    Mentzel, Caroline M. Junker; Anthon, Christian; Jacobsen, Mette Juul

    2015-01-01

    Obesity is a complex condition that increases the risk of life threatening diseases such as cardiovascular disease and diabetes. Studying the gene regulation of obesity is important for understanding the molecular mechanisms behind the obesity derived diseases and may lead to better intervention...... and treatment plans. MicroRNAs (miRNAs) are short non-coding RNAs regulating target mRNA by binding to their 3'UTR. They are involved in numerous biological processes and diseases, including obesity. In this study we use a mixed breed pig model designed for obesity studies to investigate differentially...... expressed miRNAs in subcutaneous adipose tissue by RNA sequencing (RNAseq). Both male and female pigs are included to explore gender differences. The RNAseq study shows that the most highly expressed miRNAs are in accordance with comparable studies in pigs and humans. A total of six mi...

  15. The effect of hydration status on the measurement of lean tissue mass by dual-energy X-ray absorptiometry.

    Science.gov (United States)

    Toomey, Clodagh M; McCormack, William G; Jakeman, Phil

    2017-03-01

    Athletes cycle between exercise and recovery. Exercise invokes changes in total body water from thermal sweating, muscle and hepatic glycogen depletion and metabolic water loss. Recovery from exercise results in rehydration, substrate repletion, and possible glycogen supercompensation. Such changes may corrupt the measurement of hydrated tissues, such as lean tissue mass (LTM), by dual-energy X-ray absorptiometry (DXA). The purpose of this study was to determine the effect of exercise and thermal dehydration and subsequent glycogen supercompensation on DXA-based measurement of body composition. Twelve active adult (18-29 years) males exercised at 70% VO 2max on a cycle ergometer in a thermal environment (30 °C) to induce a 2.5% reduction in body mass. Participants subsequently underwent a glycogen supercompensation phase, whereby a high carbohydrate diet (8-12 g/kg body mass/day) was consumed for a 48-h period. Whole-body DXA measurement was performed at baseline, following exercise and supercompensation. Following exercise, mean body mass decreased by -1.93 kg (95% CI -2.3, -1.5), while total LTM decreased by -1.69 kg (-2.4, -1.0). Supercompensation induced a mean body mass increase of 2.53 kg (2.0, 3.1) and a total LTM increase of 2.36 kg (1.8, 2.9). No change in total fat mass or bone mineral content was observed at any timepoint. Training regimens that typically induce dehydration and nutrition regimens that involve carbohydrate loading can result in apparent changes to LTM measurement by DXA. Accurate measurement of LTM in athletes requires strict observation of hydration and glycogen status to prevent manipulation of results.

  16. Venogram - leg

    Science.gov (United States)

    Phlebogram - leg; Venography - leg; Angiogram - leg ... into a vein in the foot of the leg being looked at. An intravenous (IV) line is ... vein. A tourniquet may be placed on your leg so the dye flows into the deeper veins. ...

  17. The Protective Role of Black Seeds (Nigella sativa) on the Tissues of Liver and Kidney in Female Rabbits Treated with Green Lean Body Capsule

    OpenAIRE

    Muna M. Ismail; Rabab A. Naser; Mohammed Saad Almuslehi; Ahmmed M. Salah

    2014-01-01

    The seeds of Nigella sativa (Ranunculaceae herbaceous plant), commonly known as black seed or black cumin, are used as herbal medicine all over the world for the treatment and prevention of a number of disease and conditions like asthma, diarrhea and dyslipidaemia. The present study was carried out to investigate the effects of Nigella sativa in protection of the liver and kidney tissues against pathological changes caused by green lean body capsule in female rabbits. Fifteen female rabbits w...

  18. 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.

  19. Changes in Intracellular Water Following Hemodialysis Treatment Lead to Changes in Estimates of Lean Tissue Using Bioimpedance Spectroscopy.

    Science.gov (United States)

    El-Kateb, Sally; Davenport, Andrew

    2016-06-01

    Bioelectrical impedance (BIA) devices are being introduced into hemodialysis (HD) centers to aid determining normohydrated weight and also provide body composition assessment by estimating lean tissue mass index (LTMI) and fat mass index (FMI). BIA devices differ, with most using a 2-body compartmental model, which can be affected by hydration status, and as such for reliable measurements, these should be made postdialysis when patients are not overhydrated, which is inconvenient for both patients and staff. The development of BIA devices using a 3-compartmental body model, separately estimating normohydrated LTMI potentially, now offers the advantage of making reliable measurements of body composition prior to dialysis. We measured body composition predialysis and postdialysis in 50 HD patients using a 3-body compartment model BIA device. Although there were no statistically significant differences for the whole cohort in LTMI and FMI (pre and post HD-13.5 ± 4.2 vs 13.9 ± 4.7 kg/m(2), and 10.5 ± 5.5 vs 10.6 ± 5.4 kg/m(2) respectively), the correlation (r(2)) between pre and post HD was only 0.27 and 0.37 kg/m(2) respectively, with a mean ± SD bias on Bland-Altman analysis, -0.67 ± 4.25 and 0.33 ± 4.77 kg/m(2) respectively. Changes in intracellular water were associated with changes in LTMI (r(2) = 0.99, P < .001). Similarly, a fall in LTMI was associated with a corresponding increase in FMI (r(2) = -0.86, P < .001). In clinical practice, predialysis bioimpedance measurements are more convenient. However, for more reliable and reproducible assessments of nutrition status, we suggest that measurements of body composition should be made when patients are not overhydrated. © 2015 American Society for Parenteral and Enteral Nutrition.

  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. 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

  2. Estimation of insulin secretion, glucose uptake by tissues, and liver handling of glucose using a mathematical model of glucose-insulin homeostasis in lean and obese mice.

    Science.gov (United States)

    Brenner, Michael; Abadi, Sakineh Esmaeili Mohsen; Balouchzadeh, Ramin; Lee, H Felix; Ko, Hoo Sang; Johns, Michael; Malik, Nehal; Lee, Joshua J; Kwon, Guim

    2017-06-01

    Destruction of the insulin-producing β-cells is the key determinant of diabetes mellitus regardless of their types. Due to their anatomical location within the islets of Langerhans scattered throughout the pancreas, it is difficult to monitor β-cell function and mass clinically. To this end, we propose to use a mathematical model of glucose-insulin homeostasis to estimate insulin secretion, glucose uptake by tissues, and hepatic handling of glucose. We applied the mathematical model by Lombarte et al. (2013) to compare various rate constants representing glucose-insulin homeostasis between lean (11% fat)- and high fat diet (HFD; 45% fat)-fed mice. Mice fed HFD (n = 12) for 3 months showed significantly higher body weights (49.97 ± 0.52 g vs. 29.86 ± 0.46 g), fasting blood glucose levels (213.08 ± 10.35 mg/dl vs. 121.91 ± 2.26 mg/dl), and glucose intolerance compared to mice fed lean diet (n = 12). Mice were injected with 1 g/kg glucose intraperitoneally and blood glucose levels were measured at various intervals for 120 min. We performed simulation using Arena™ software based on the mathematical model and estimated the rate constants (9 parameters) for various terms in the differential equations using OptQuest™. The simulated data fit accurately to the observed data for both lean and obese mice, validating the use of the mathematical model in mice at different stages of diabetes progression. Among 9 parameters, 5 parameters including basal insulin, k 2 (rate constant for insulin-dependent glucose uptake to tissues), k 3 (rate constant for insulin-independent glucose uptake to tissues), k 4 (rate constant for liver glucose transfer), and I pi (rate constant for insulin concentration where liver switches from glucose release to uptake) were significantly different between lean- and HFD-fed mice. Basal blood insulin levels, k 3 , and I pi were significantly elevated but k 2 and k 4 were reduced in mice fed a HFD compared to those fed a lean diet. Non

  3. 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 and employ......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...... 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...... context in which the planning and implementation of lean projects take place. Lean implementation is not a neutral and value-free activity; it is fluid and open for multiple interpretations, interests, and logics. Research limitations/implications – The project is based on qualitative data from lean...

  4. Repair of a soft tissue defect of medial malleolus with cross-leg bridge free transfer of anterolateral thigh muscle flap: a case report

    Directory of Open Access Journals (Sweden)

    ZHANG Gong-lin

    2012-11-01

    Full Text Available 【Abstract】A 38-year-old man sustained a traffic accident injury to his right medial malleolus and leg. It was an open fracture of the right tibia and fibula accompanied by a large soft tissue defect of the right medial malleolus sized 12 cm×4 cm. Doppler examination revealed that the tibialis posterior vessel was occluded due to thrombosis. The anterior tibial artery was patent. Three weeks after injury, the left anterolateral thigh muscle flap was harvested and transplanted to the right medial malleolus defect area for repair of the soft tissue defect, and an end-to-side anasto-mosis was performed between the posterior tibial vessel of the contralateral leg and the muscle flap’s vascular pedicle. A split thickness free skin graft was used to cover the muscle flap and around the flap’s vascular pedicle. The vascular pedicle was cut off after 28 days and the muscle flap sur-vived completely. After 3-year follow-up postoperatively, the right tibia and fibula fractures were confirmed healing radiologically. The posterior tibial artery of contralateral leg was patent by clinical and Doppler examinations. This tech-nique can be used to preserve the flow and patency of re-cipient arteries. Key words: Surgical flaps; Soft tissue injuries; Leg injuries; Wound healing

  5. 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...

  6. 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.

  7. 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

  8. 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.

  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. 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.

  11. Glucose-dependent insulinotropic polypeptide may enhance fatty acid re-esterification in subcutaneous abdominal adipose tissue in lean humans

    DEFF Research Database (Denmark)

    Asmar, Meena; Simonsen, Lene; Madsbad, Sten

    2010-01-01

    Glucose-dependent insulinotropic polypeptide (GIP) has been implicated in lipid metabolism in animals. In humans, however, there is no clear evidence of GIP effecting lipid metabolism. The present experiments were performed in order to elucidate the effects of GIP on regional adipose tissue metab...

  12. Protein Supplementation at Breakfast and Lunch for 24 Weeks beyond Habitual Intakes Increases Whole-Body Lean Tissue Mass in Healthy Older Adults.

    Science.gov (United States)

    Norton, Catherine; Toomey, Clodagh; McCormack, William G; Francis, Peter; Saunders, Jean; Kerin, Emmet; Jakeman, Philip

    2016-01-01

    Key areas of research on the preservation of lean tissue mass (LTM) during aging are determinations of the protein requirement and optimal protein intake at meals. The aim of this study was to determine the effect of protein supplementation at breakfast and lunch for 24 wk beyond habitual intakes on whole-body LTM in healthy adults aged 50-70 y. In a single-blinded, randomized, controlled design, 60 healthy older men and women (aged 61 ± 5 y) with a body mass index (in kg/m(2)) of 25.8 ± 3.6 consumed either 0.165 g/kg body mass of a milk-based protein matrix (PRO) or an isoenergetic, nonnitrogenous maltodextrin control (CON) at breakfast and midday meals, the lower protein-containing meals of the day, for 24 wk. Dual-energy X-ray absorptiometry was used to measure the change in LTM. After the intervention, protein intake in the PRO group increased from 0.23 ± 0.1 to 0.40 ± 0.1 g/kg for breakfast and from 0.31 ± 0.2 to 0.47 ± 2 g/kg for the midday meal. In response, LTM increased by 0.45 (95% CI: 0.06, 0.83) kg in the PRO group compared with a decrease of 0.16 (95% CI: -0.49, 0.17) kg in the CON group (P = 0.006). Appendicular LTM accounted for the majority of the difference in LTM, increasing by 0.27 (95% CI: 0.05, 0.48) kg in the PRO group compared with no change in the CON group (P = 0.002). Protein supplementation at breakfast and lunch for 24 wk in healthy older adults resulted in a positive (+0.6 kg) difference in LTM compared with an isoenergetic, nonnitrogenous maltodextrin control. These observations suggest that an optimized and balanced distribution of meal protein intakes could be beneficial in the preservation of lean tissue mass in the elderly. This trial was registered at clinicaltrials.gov as NCT02529124. © 2016 American Society for Nutrition.

  13. LEAN Manufacturing

    DEFF Research Database (Denmark)

    Bilberg, Arne

      As part of an employment as Technology Architect at the company Linak in combination with research at the University of Southern Denmark, this paper will present results from a strategy process where Lean has been pointed out as being a very strategic element in the Linak Production System......, organizational and management improvements in the company to what is named the Linak Production System.  ....... The mission with the strategy is to obtain competitive production in Denmark and in Western Europe based on the right combination of manufacturing principles, motivated and trained employees, level of automation, and cooperation with suppliers and customers worldwide. The strategy has resulted in technical...

  14. Fluoxetine induces lean phenotype in rat by increasing the brown/white adipose tissue ratio and UCP1 expression.

    Science.gov (United States)

    da Silva, A I; Braz, G R F; Pedroza, A A; Nascimento, L; Freitas, C M; Ferreira, D J S; Manhães de Castro, R; Lagranha, C J

    2015-08-01

    The serotonergic system plays a crucial role in the energy balance regulation. Energy balance is mediated by food intake and caloric expenditure. Thus, the present study investigated the mechanisms that might be associated with fluoxetine treatment-induced weight reduction. Wistar male rat pups received daily injections with subcutaneous fluoxetine (Fx-group) or vehicle solution (Ct-group) from day 1 until 21 days of age. Several analyses were conducted to verify the involvement of mitochondria in weight reduction. We found that body weight in the Fx-group was lower compared to control. In association to lower fat mass in the Fx-group (25%). Neither neonatal caloric intake nor food intake reveals significant differences. Evaluating caloric expenditure (locomotor activity and temperature after stimulus), we did not observe differences in locomotor activity. However, we observed that the Fx group had a higher capacity to maintain body temperature in a cold environment compared with the Ct-group. Since brown adipose tissue-(BAT) is specialized for heat production and the rate of heat production is related to mitochondrial function, we found that Fx-treatment increases respiration by 36%, although after addition of GDP respiration returned to Ct-levels. Examining ROS production we observe that Fx-group produced less ROS than control group. Evaluating uncoupling protein (UCP) expression we found that Fx-treatment increases the expression by 23%. Taken together, our results suggest that modulation of serotonin system results in positive modulation of UCP and mitochondrial bioenergetics in brown fat tissue.

  15. A reliable method for the treatment of lower third soft tissue defects of the leg: Use of a posterior tibial artery perforator flap

    Directory of Open Access Journals (Sweden)

    Fikret Eren

    2015-12-01

    Full Text Available Management of lower third limb defects is a common challenge for the reconstructive surgeon due to a lack of soft tissue in that anatomic area. Traditionally, lower third of the limb defects were usually reconstructed with free flaps. The evolution of reconstructive surgery enabled thinner and pliable flaps to be harvested for the purpose of minimizing morbidity from muscle inclusion into the flap. With the introduction of perforator flaps, repairing of small and medium size defects of the distal lower third of leg and ankle region is possible with minimal donor site morbidity. Perforator flaps are based on cutaneous, small diameter vessels that arise from a main pedicle that adjacently perforates the fascia to reach the skin. In this article, we present our experience with two cases involving the repair of these defects by using posterior tibial artery perforator flaps. [Hand Microsurg 2015; 4(3.000: 67-70

  16. 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.

  17. Leg Swelling

    Science.gov (United States)

    ... ed. New York, N.Y.: The McGraw Hill Companies; 2016. http://www.accessmedicine.com. Accessed Dec. 31, ... http://www.mayoclinic.org/symptoms/leg-swelling/basics/definition/SYM-20050910 . Mayo Clinic Footer Legal Conditions and ...

  18. Evaluating Lean in healthcare.

    Science.gov (United States)

    Burgess, Nicola; Radnor, Zoe

    2013-01-01

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

  19. 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

  20. High-Intensity Jump Training Is Tolerated during 60 Days of Bed Rest and Is Very Effective in Preserving Leg Power and Lean Body Mass: An Overview of the Cologne RSL Study.

    Directory of Open Access Journals (Sweden)

    Andreas Kramer

    Full Text Available Space agencies are looking for effective and efficient countermeasures for the degrading effects of weightlessness on the human body. The aim of this study was to assess the effects of a novel jump exercise countermeasure during bed rest on vitals, body mass, body composition, and jump performance.23 male participants (29±6 years, 181±6 cm, 77±7 kg were confined to a bed rest facility for 90 days: a 15-day ambulatory measurement phase, a 60-day six-degree head-down-tilt bed rest phase (HDT, and a 15-day ambulatory recovery phase. Participants were randomly allocated to the jump training group (JUMP, n = 12 or the control group (CTRL, n = 11. A typical training session consisted of 4x10 countermovement jumps and 2x10 hops in a sledge jump system. The training group had to complete 5-6 sessions per week.Peak force for the reactive hops (3.6±0.4 kN as well as jump height (35±4 cm and peak power (3.1±0.2 kW for the countermovement jumps could be maintained over the 60 days of HDT. Lean body mass decreased in CTRL but not in JUMP (-1.6±1.9 kg and 0±1.0 kg, respectively, interaction effect p = 0.03. Resting heart rate during recovery was significantly increased for CTRL but not for JUMP (interaction effect p<0.001.Participants tolerated the near-daily high-intensity jump training and maintained high peak forces and high power output during 60 days of bed rest. The countermeasure was effective in preserving lean body mass and partly preventing cardiac deconditioning with only several minutes of training per day.

  1. Textiloma in the leg

    Directory of Open Access Journals (Sweden)

    Patel Amol

    2007-01-01

    Full Text Available Textiloma is defined as a tumor formed due to retained gauze. It is rarely reported in the musculoskeletal system. We are presenting a case with a soft tissue swelling over the lateral aspect of the lower third of the leg, come for implant removal of the distal tibia and fibular fracture. We removed the soft tissue mass enbloc thinking it to be a benign tumor. On cutting the mass on the operation table, a gauze piece encased by fibrous tissue was found. Textiloma can present as tumoral forms and can mimic as a pseudo-tumor.

  2. 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...... with relevant theory, are used to construct a tentative framework for implementing "healthy lean". The role of HRD in facilitating implementation of healthy lean is central to the framework, which is presented and discussed....

  3. 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.

  4. 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 ...

  5. Night Leg Cramps

    Science.gov (United States)

    Symptoms Night leg cramps By Mayo Clinic Staff Night leg cramps, also called nocturnal leg cramps, are painful, involuntary contractions or spasms of muscles in your legs, usually occurring when you're in bed. Night ...

  6. 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...

  7. 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 organ......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...

  8. 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...

  9. 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

  10. 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.

  11. 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, ...

  12. 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)

  13. 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)

  14. Peripheral artery disease - legs

    Science.gov (United States)

    Peripheral vascular disease; PVD; PAD; Arteriosclerosis obliterans; Blockage of leg arteries; Claudication; Intermittent claudication; Vaso-occlusive disease of the legs; Arterial insufficiency of ...

  15. 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....

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

    Science.gov (United States)

    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

  17. 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...

  18. 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....

  19. 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.

  20. 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

  1. 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...

  2. Leg fluid accumulation during prolonged sitting.

    Science.gov (United States)

    Vena, Daniel; Rubianto, Jonathan; Popovic, Milos; Yadollahi, Azadeh

    2016-08-01

    The accumulation of fluid in the legs due to sedentariness can be a health risk in extreme cases. Negative health impacts associated with leg fluid accumulation include leg edema and risk of blood clots. Furthermore, fluid accumulating in the legs is accompanied by fluid shift into the upper body which is also associated with health risks such as: increased blood pressure when lying down, respiratory problems in people with heart failure, and increased sleep apnea. Understanding the pattern by which fluid accumulates in the legs can aid in the development of devices for reducing leg fluid accumulation. The purpose of this study was to characterize the time course of fluid accumulation over a two-and-half-hour seated period. Non-obese participants with sleep apnea and no other co-morbidities were included in the sample as part of a larger study. Leg fluid was measured continuously using a method of bioelectrical impedance. Participants were first asked to lie supine for 30 minutes as a washout, and then sat with their legs still for two and a half hours. The main finding of this study is that the pattern of leg fluid accumulation differed in the first 45 minutes compared to the latter 105 minutes. In the first 45 minutes, fluid accumulated according to first order exponential function. In the latter period, fluid accumulated according to a linear function. The initial exponential accumulation is likely due to the large increase in capillary pressure caused by rapid blood flow into the legs due to gravity, leading to substantial filtration of blood plasma into the tissue spaces. The latter linear portion likely represents continued slow filtration of fluid out of the vasculature and into the tissue spaces. This is the first study to show that fluid accumulation in the legs is a combination of an exponential and linear functions. The linear increase identifies that there is no foreseeable point in which leg fluid stops accumulating while sitting for prolonged periods.

  3. Brown adipose tissue volume in healthy lean south Asian adults compared with white Caucasians: a prospective, case-controlled observational study

    NARCIS (Netherlands)

    Bakker, Leontine E. H.; Boon, Mariëtte R.; van der Linden, Rianne A. D.; Arias-Bouda, Lenka Pereira; van Klinken, Jan B.; Smit, Frits; Verberne, Hein J.; Jukema, J. Wouter; Tamsma, Jouke T.; Havekes, Louis M.; van Marken Lichtenbelt, Wouter D.; Jazet, Ingrid M.; Rensen, Patrick C. N.

    2014-01-01

    Individuals of south Asian origin have a very high risk of developing type 2 diabetes compared with white Caucasians. We aimed to assess volume and activity of brown adipose tissue (BAT), which is thought to have a role in energy metabolism by combusting fatty acids and glucose to produce heat and

  4. Brown adipose tissue volume in healthy lean south Asian adults compared with white Caucasians: A prospective, case-controlled observational study

    NARCIS (Netherlands)

    Bakker, L.E.H.; Boon, M.R.; Linden, R.A.D. van der; Arias-Bouda, L.P.; Klinken, J.B. van; Smit, F.; Verberne, H.J.; Jukema, J.W.; Tamsma, J.T.; Havekes, L.M.; Marken Lichtenbelt, W.D. van; Jazet, I.M.; Rensen, P.C.N.

    2014-01-01

    Background: Individuals of south Asian origin have a very high risk of developing type 2 diabetes compared with white Caucasians. We aimed to assess volume and activity of brown adipose tissue (BAT), which is thought to have a role in energy metabolism by combusting fatty acids and glucose to

  5. 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.

  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. 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.

  8. 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.

  9. 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.

  10. Lean potilastutkimusprosessissa : kirjallisuuskatsaus

    OpenAIRE

    Sillankorva, Marja

    2013-01-01

    Tämän kehittämistehtävän tarkoituksena on kuvata Lean- toiminnalla toteutettuja potilastutkimusprosessiin liittyviä kehittämishankkeita ja tutkimuksia. Tavoitteena on saada tietoa Lean- toimintamallin käytöstä ja vaikuttavuudesta potilastutkimusprosessin kehittämisessä, sekä löytää lähtökohdat kliinisen neurofysiologian (KNF) potilastutkimusprosessin kehittämiselle. Kehittämistehtävän tiedonkeruu toteutettiin systemaattisen kirjallisuuskatsauksen avulla ja saatu aineisto analysoitiin teorialä...

  11. 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.

  12. Three cross leg flaps for lower leg reconstruction of Gustilo type III C open fracture

    Directory of Open Access Journals (Sweden)

    Kazufumi Sano

    2016-01-01

    Full Text Available A 60 year old male had Gustilo type III C open fracture of the right lower leg. After radical debridement, the large open defect including certain loss of the bone tissue was successfully augmented and covered, by consecutive three cross-leg flaps, which consisted of the free rectus abdominis musculocutaneous flap, the fibula osteocutaneous flap and the conventional sural flap. Although indication for amputation or preservation is decided with multiple factors in each case, a strategic combination of cross-leg flap, free flap, external fixation and vascular delay could increase the potential of preservation of the lower leg with even disastrous Gustilo type III C.

  13. Leg lengthening - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100127.htm Leg lengthening - series—Indications To use the sharing features ... with lengthening procedures are the bones of the leg, the tibia and the femur. Surgical treatment may ...

  14. Arterial bypass leg - slideshow

    Science.gov (United States)

    ... medlineplus.gov/ency/presentations/100155.htm Arterial bypass leg - series—Normal anatomy To use the sharing features ... Overview The arteries which supply blood to the leg originate from the aorta and iliac vessels. Review ...

  15. Leg lengthening and shortening

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002965.htm Leg lengthening and shortening To use the sharing features on this page, please enable JavaScript. Leg lengthening and shortening are types of surgery to ...

  16. 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

  17. First Lean, then modularisation

    DEFF Research Database (Denmark)

    Petersen, Kristian R.; Madsen, Erik Skov; Bilberg, Arne

    2016-01-01

    of Europe’s leading offshore wind power operators with more than 1,000 wind turbine generators in operation. By focusing on this company, in-depth insights into its operations and maintenance processes are investigated. Findings – Lean is identified to constitute an important first step before...... of offshore wind power. Furthermore, it adds to the emerging research area of service modularity...

  18. 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 ...

  19. 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.

  20. The effectiveness of exercise on recovery and clinical outcomes of soft tissue injuries of the leg, ankle, and foot: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

    Science.gov (United States)

    Woitzik, Erin; Jacobs, Craig; Wong, Jessica J; Côté, Pierre; Shearer, Heather M; Randhawa, Kristi; Sutton, Deborah; Southerst, Danielle; Varatharajan, Sharanya; Brison, Robert J; Yu, Hainan; van der Velde, Gabrielle; Stern, Paula J; Taylor-Vaisey, Anne; Stupar, Maja; Mior, Silvano; Carroll, Linda J

    2015-10-01

    Soft tissue injuries of the leg, ankle, or foot are common and often treated by exercise. The purpose of this study was to determine the effectiveness of exercise for the management of soft tissue injuries of the leg, ankle, or foot. A systematic review of the literature was conducted. We searched five databases from 1990 to 2015. Relevant articles were critically appraised using Scottish Intercollegiate Guidelines Network (SIGN) criteria. The evidence from studies with low risk of bias was synthesized using the best-evidence synthesis methodology. We screened 7946 articles. We critically appraised ten randomized trials and six had a low risk of bias. The evidence suggests that for recent lateral ankle sprain: 1) rehabilitation exercises initiated immediately post-injury are as effective as a similar program initiated one week post-injury; and 2) supervised progressive exercise plus education/advice and home exercise lead to similar outcomes as education/advice and home exercise. Eccentric exercises may be more effective than an AirHeel brace but less effective than acupuncture for Achilles tendinopathy of more than two months duration. Finally, for plantar heel pain, static stretching of the calf muscles and sham ultrasound lead to similar outcomes, while static plantar fascia stretching provides short-term benefits compared to shockwave therapy. We found little evidence to support the use of early or supervised exercise interventions for lateral ankle sprains. Eccentric exercises may provide short-term benefits over a brace for persistent Achilles tendinopathy and plantar fascia stretching provides short-term benefits for plantar heel pain. Copyright © 2015 Elsevier Ltd. 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. 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

  3. Venous leg ulcers.

    Science.gov (United States)

    Nelson, E Andrea; Adderley, Una

    2016-01-15

    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 in 1000 people have active leg ulcers. Prevalence increases with age to about 20 in 1000 people aged over 80 years. We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of treatments for venous leg ulcers? What are the effects of organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care 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 March 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). At this update, searching of electronic databases retrieved 116 studies. After deduplication and removal of conference abstracts, 63 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 43 studies and the further review of 20 full publications. Of the 20 full articles evaluated, four systematic reviews were updated and four RCTs were added at this update. We performed a GRADE evaluation for 23 PICO combinations. In this systematic overview, we categorised the efficacy for 13 interventions based on information about the effectiveness and safety of advice to elevate leg, advice to keep leg active, compression stockings for prevention of recurrence, compression bandages and stockings to treat venous leg ulcers, laser treatment (low level), leg ulcer clinics, pentoxifylline, skin grafting, superficial vein surgery for prevention of recurrence, superficial vein surgery to treat venous leg ulcers, therapeutic ultrasound, and topical negative pressure.

  4. Improving Healthcare through Lean Management

    DEFF Research Database (Denmark)

    Nielsen, Anders Paarup; Edwards, Kasper

    2011-01-01

    that different mind sets and different rationalities between different types of healthcare professionals act as a major barrier for lean management in healthcare. The hypotheses are tested and discussed through four case studies. Using empirical research from four case studies the paper will continue....... 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......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...

  5. 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.

  6. Applying lean thinking in construction

    OpenAIRE

    Remon Fayek Aziz; Sherif Mohamed Hafez

    2013-01-01

    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...

  7. 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.

  8. 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 "

  9. 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 main...... point is to develop a Minimum Viable Product that can be tested by potential customers and then pivot the idea if necessary around these customer evaluations. This iterative process goes through a number of stages with the purpose of validating the customers’ problems, the suggested solution...

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

    Science.gov (United States)

    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.

  11. Dynamically Stable Legged Locomotion.

    Science.gov (United States)

    1983-01-27

    balanced itself in 31) using a tabular ctontrol sclwnme. With only thUiee actuated degrees it used a shuffling gait to balance that reminds one of Charlie ... Chaplin . * The present study explores the control of a physical one-legged hopping machine. The objective of using a machine with only one leg was to

  12. 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....

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. Lean With a Human Face

    DEFF Research Database (Denmark)

    Hasle, Peter; Jensen, Per Langaa

    2008-01-01

    with a version of lean which is based on employee participation and with quality of work as a goal equal to the traditional productivity goals. This experience seems to indicate that a local approach based on social capital with employee participation but still with strong management support gives better......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...... and employees, and it is a somewhat different experience. This tra-dition for collaboration has been the framework for the development of lean into a form which is different from the descriptions found in the mainly Anglo-Saxon literature. Many Danish both private and public organizations have experience...

  19. 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.

  20. Single leg stance control in individuals with symptomatic gluteal tendinopathy.

    Science.gov (United States)

    Allison, Kim; Bennell, Kim L; Grimaldi, Alison; Vicenzino, Bill; Wrigley, Tim V; Hodges, Paul W

    2016-09-01

    Lateral hip pain during single leg loading, and hip abductor muscle weakness, are associated with gluteal tendinopathy, but it has not been shown how or whether kinematics in single leg stance differ in those with gluteal tendinopathy. To compare kinematics in preparation for, and during, single leg stance between individuals with and without gluteal tendinopathy, and the effect of hip abductor muscle strength on kinematics. Twenty individuals with gluteal tendinopathy and 20 age-matched pain-free controls underwent three-dimensional kinematic analysis of single leg stance and maximum isometric hip abductor strength testing. Maximum values of hip adduction, pelvic obliquity (contralateral pelvis rise/drop), lateral pelvic translation (ipsilateral/contralateral shift) and ipsilateral trunk lean during preparation for leg lift and average values in steady single leg stance, were compared between groups using an analysis of covariance, with and without anthropometric characteristics and strength as covariates. Individuals with gluteal tendinopathy demonstrated greater hip adduction (standardized mean difference (SMD)=0.70, P=0.04) and ipsilateral pelvic shift (SMD=1.1, P=0.002) in preparation for leg lift, and greater hip adduction (SMD=1.2, P=0.002) and less contralateral pelvic rise (SMD=0.86, P=0.02) in steady single leg stance than controls. When including strength as a covariate, only between-group differences in lateral pelvic shift persisted (SMD=1.7, P=0.01). Individuals with gluteal tendinopathy use different frontal plane kinematics of the hip and pelvis during single leg stance than pain-free controls. This finding is not influenced by pelvic dimension or the potentially modifiable factor of body mass index, but is by hip abductor muscle weakness. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. RESTLESS LEGS SYNDROME

    Directory of Open Access Journals (Sweden)

    Dmitriy Valer'evich Artem'ev

    2009-01-01

    Full Text Available The paper describes the epidemiology, etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, and treatment of restless legs syndrome. Recommendations are given how to choose therapeutic modalities and drugs in relation to different factors.

  2. Restless legs syndrome.

    Science.gov (United States)

    Venkateshiah, Saiprakash B; Ioachimescu, Octavian C

    2015-07-01

    Restless legs syndrome is a common sensorimotor disorder characterized by an urge to move, and associated with uncomfortable sensations in the legs (limbs). Restless legs syndrome can lead to sleep-onset or sleep-maintenance insomnia, and occasionally excessive daytime sleepiness, all leading to significant morbidity. Brain iron deficiency and dopaminergic neurotransmission abnormalities play a central role in the pathogenesis of this disorder, along with other nondopaminergic systems, although the exact mechanisms are still. Intensive care unit patients are especially vulnerable to have unmasking or exacerbation of restless legs syndrome because of sleep deprivation, circadian rhythm disturbance, immobilization, iron deficiency, and use of multiple medications that can antagonize dopamine. Published by Elsevier Inc.

  3. Profile of altered brain iron acquisition in restless legs syndrome

    Science.gov (United States)

    Ponnuru, Padmavathi; Wang, Xin-Sheng; Patton, Stephanie M.; Allen, Richard P.; Earley, Christopher J.

    2011-01-01

    Restless legs syndrome is a neurological disorder characterized by an urgency to move the legs during periods of rest. Data from a variety of sources provide a compelling argument that the amount of iron in the brain is lower in individuals with restless legs syndrome compared with neurologically normal individuals. Moreover, a significant percentage of patients with restless legs syndrome are responsive to intravenous iron therapy. The mechanism underlying the decreased iron concentrations in restless legs syndrome brains is unknown. We hypothesize that the source of the brain iron deficit is at the blood–brain interface. Thus we analysed the expression of iron management proteins in the epithelial cells of the choroid plexus and the brain microvasculature in post-mortem tissues. The choroid plexus, obtained at autopsy, from 18 neurologically normal controls and 14 individuals who had primary restless legs syndrome was subjected to histochemical staining for iron and immunostaining for iron management proteins. Iron and heavy chain ferritin staining was reduced in the epithelial cells of choroid plexus in restless legs syndrome. Divalent metal transporter, ferroportin, transferrin and its receptor were upregulated in the choroid plexus in restless legs syndrome. Microvessels were isolated from the motor cortex of 11 restless legs syndrome and 14 control brains obtained at autopsy and quantitative immunoblot analyses was performed. Expression of heavy chain ferritin, transferrin and its receptor in the microvessels from restless legs syndrome was significantly decreased compared with the controls but divalent metal protein 1, ferroportin, prohepcidin, mitochondrial ferritin and light-chain ferritin remained unchanged. The presence of an iron regulatory protein was demonstrated in the brain microvasculature and the activity of this protein is decreased in restless legs syndrome; a finding similar to our earlier report in neuromelanin cells from the substantia

  4. 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.

  5. Lean production of intensive cities

    DEFF Research Database (Denmark)

    Ratner, Helene Gad; Bojesen, Anders; Bramming, Pia

    2014-01-01

    This article analyses the introduction of Lean Production to ‘the Procurement Office’ (the Procurement Office is made anonymous due to promises of confidentiality in the research project ‘Lean without stress’), a work place marked by continuous organizational changes, unfavourable image and high......’. Through the depiction of four intensifications of Lean Production, the metaphors of Calvino's cities show how reality and illusion; hope and poverty; dreams and death and utopia and dystopia are intricately mingled and produce temporary and equally ambivalent affects of alienation, hypocrisy, self...

  6. 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.

  7. Correlated responses in tissue weights measured in vivo by ...

    African Journals Online (AJOL)

    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 ...

  8. Defect reduction through Lean methodology

    Science.gov (United States)

    Purdy, Kathleen; Kindt, Louis; Densmore, Jim; Benson, Craig; Zhou, Nancy; Leonard, John; Whiteside, Cynthia; Nolan, Robert; Shanks, David

    2010-09-01

    Lean manufacturing is a systematic method of identifying and eliminating waste. Use of Lean manufacturing techniques at the IBM photomask manufacturing facility has increased efficiency and productivity of the photomask process. Tools, such as, value stream mapping, 5S and structured problem solving are widely used today. In this paper we describe a step-by-step Lean technique used to systematically decrease defects resulting in reduced material costs, inspection costs and cycle time. The method used consists of an 8-step approach commonly referred to as the 8D problem solving process. This process allowed us to identify both prominent issues as well as more subtle problems requiring in depth investigation. The methodology used is flexible and can be applied to numerous situations. Advantages to Lean methodology are also discussed.

  9. Applying lean principles in healthcare.

    Science.gov (United States)

    Rinehart, Brenda

    2013-01-01

    Healthcare is charged to do more with less and improve patient satisfaction at the same time in order to balance the bottom line. Lean is a proven and effective way to remove waste, identify issues, and successfully implement change. The principle of Lean is based on the reality that there are value added and non-value added processes in every workflow. To improve quality and reduce loss, the non-value added processes need to be eliminated. In healthcare, value is determined from the perspective of the patient. While not exhaustive of the Lean processes that a healthcare system can employ, this article provides a general outline of Lean, definitions, and its benefits to any healthcare organization.

  10. 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.

  11. 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)....

  12. Business plan (model lean canvas)

    OpenAIRE

    Strupplová, Lucie

    2014-01-01

    The well arranged and instructivee business plan is the basic part of every business project.. Currently is very often used the lean canvas model of the business plan. This model shows us very istructively all the factors influencing the project realisation. The dissertation is divided into the two basic parts. In the thoretical were compared the essential forms of the business plan with their differences. The practical part consists of creating the lean canvas model for the progressive compa...

  13. 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.

  14. 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...

  15. Managing change in lean service organization

    OpenAIRE

    Semaškienė, Agnė

    2016-01-01

    Managing Change in Lean Service Organization 62 pages, 10 charts, 8 pictures, 31 references. The main purpose of this master thesis is to create a model of change management in Lean service organization. The paper consist of four main parts: (1) the analysis of literature about Lean implementation in service sector organizations, (2) the analysis of literature about change management and managing change in Lean service organizations, (3) the model of change management in Lean service organiza...

  16. Venous leg ulcers.

    Science.gov (United States)

    Nelson, E Andrea

    2011-12-21

    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. 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 advice about self-help interventions in people receiving usual care 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 June 2011 (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). We found 101 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. 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

  17. 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.

  18. Measuring Leanness of Manufacturing Systems and Identifying Leanness Target by Considering Agility

    OpenAIRE

    Wan, Hung-da

    2006-01-01

    The implementation of lean manufacturing concepts has shown significant impacts on various industries. Numerous tools and techniques have been developed to tackle specific problems in order to eliminate wastes and carry out lean concepts. With the focus on "how to make a system leaner," little effort has been made on determining "how lean the system is." Lean assessment surveys evaluate the current status of a system qualitatively against predefined lean indicators. Lean metrics are developed...

  19. 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....

  20. Leg Rejuvenation: A Combination Approach: A Review and Our Experience.

    Science.gov (United States)

    Weiss, Margaret; Mahoney, Anne M; Gold, Michael; Lawrence, Naomi

    2016-05-01

    Patients increasingly seek to enhance the appearance of their legs. Elimination of unwanted leg veins, reduction of epidermal photo-aging changes such as solar lentigines and keratoses, tightening of skin laxity and reduction of adipose tissue are among the most commonly requested goals. Many patients require a combination approach to address their concerns. It is important for dermatologists to be aware of the multitude of procedures that can be performed, often in combination, to rejuvenate the leg. The purpose of this review article was to discuss procedures for improving the appearance of the leg and to share the authors experience, especially in the combination approach to leg rejuvenation. A literature search was performed to investigate cosmetic procedures being performed on the leg, with an emphasis on controlled or randomized studies. In addition, the authors contributed their personal experience. Our discussion of the literature review highlights the treatments for leg veins, unwanted fat, cellulite, and photodamage of the legs that are most supported in peer-reviewed publications. A synergistic, combination approach to leg rejuvenation works best. This includes the use of injectable agents, energy-based devices, and more invasive surgical procedures.

  1. A prescription for Lean healthcare.

    Science.gov (United States)

    Wood, David

    2014-01-01

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

  2. 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...

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

    DEFF Research Database (Denmark)

    Michelsen, Aage U

    2005-01-01

    principper fra andre koncepter? Artiklen er opdelt i fire hovedafsnit. I første afsnit skitseres baggrunden for Lean. I andet afsnit skitseres kort indholdet i Lean. I tredje afsnit skitseres tankegangen bag Quick Response Manufacturing - et begreb, der har mange ligheder med Lean, men som har fokus på......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...... 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....

  4. 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...

  5. 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 lean thinking could create 6,500 hours of capacity annually. Application of lean management techniques to a single operating room and surgical service improved operating room efficiency and morale, sustained resident education, and can provide considerable financial gains when scaled to an entire academic surgical suite. Copyright © 2012. Published by Elsevier Inc.

  6. '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.

  7. 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…

  8. 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…

  9. A single bout of whole-leg, peristaltic pulse external pneumatic compression upregulates PGC-1α mRNA and endothelial nitric oxide sythase protein in human skeletal muscle tissue.

    Science.gov (United States)

    Kephart, Wesley C; Mobley, C Brooks; Fox, Carlton D; Pascoe, David D; Sefton, JoEllen M; Wilson, Trent J; Goodlett, Michael D; Kavazis, Andreas N; Roberts, Michael D; Martin, Jeffrey S

    2015-07-01

    What is the central question of this study? Does 60 min of peristaltic pulse external pneumatic compression (EPC) alter gene and protein expression patterns related to metabolism, vascular biology, redox balance and inflammation in vastus lateralis biopsy samples? What is the main finding and its importance? A single bout of EPC transiently upregulates PGC-1α mRNA, while also upregulating endothelial nitric oxide synthase protein and nitric oxide metabolite concentrations in vastus lateralis biopsy samples. We investigated whether a single 60 min bout of whole-leg, lower pressure external pneumatic compression (EPC) altered select vascular, metabolic, antioxidant and inflammation-related mRNAs. Ten participants (eight male, two female; aged 22.0 ± 0.4 years) reported to the laboratory 4 h postprandial, and vastus lateralis muscle biopsies were obtained before (PRE) and 1 and 4 h after EPC treatment. Messenger RNA expression was analysed using real-time RT-PCR, and significant mRNA findings were investigated further by Western blot analysis of respective protein concentrations. Peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) mRNA increased by 77% 1 h following EPC compared with PRE levels (P = 0.005), but no change in protein concentration 1 or 4 h post-EPC was observed. Increases in endothelial nitric oxide sythase (eNOS) mRNA (+44%) and superoxide dismutase 2 (SOD2) mRNA (+57%) 1 h post-EPC as well as an increase in interleukin-10 mRNA (+132%) 4 h post-EPC compared with PRE levels were observed, but only approached significance (P = 0.076, 0.077 and 0.074, respectively). Interestingly, eNOS protein (+40%, P = 0.025) and nitrate and nitrite (NOx) concentrations (+69%, P = 0.025) increased 1-4 h post-EPC. Moreover, SOD2 protein tended to increase from PRE to 4 h post-EPC (+43%, P = 0.074), although no changes in tissue 4-hydroxnonenal levels was observed. An acute bout of EPC transiently upregulates PGC-1α mRNA, while also upregulating e

  10. Lean Application to Manufacturing Ramp-Up

    DEFF Research Database (Denmark)

    Christensen, Irene; Rymaszewska, Anna

    2016-01-01

    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......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....... 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...

  11. 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 self...... organized teams. It is therefore hypothesized that lean would result in a worsening of the psychosocial environment. This was, however, not true and the paper enters into a discussion of possible reasons for this puzzling finding....

  12. 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...... organized teams. It is therefore hypothesized that lean would result in a worsening of the psychosocial environment. This was, however, not true and the paper enters into a discussion of possible reasons for this puzzling finding....

  13. ORTHOPEDIC LEG BRACE

    Science.gov (United States)

    Myers, William Neil (Inventor)

    2005-01-01

    Knee braces generally have been rigid in both the knee bending direction and in the knee straightening direction unless a manually operated release is incorporated in them to allow the knee to bend. Desirably a braced knee joint should effectively duplicate the compound, complex, actions of a normal knee. The key to knee braces is the knee joint housing. The housing herein carries a number of cam action pawls. with teeth adapted to engage the internal teeth of a ratchet ring mounted in the housing. Cam action return springs and the shape of the cam action pawl teeth allow rotation of the ratchet ring in a leg straightening direction while still supporting a load. The leg can then be extended during walking while at the same time being prevented by the cam action pawls from buckling in the knee bending direction.

  14. 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...

  15. 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

  16. 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...

  17. Change management in lean enterprise

    Directory of Open Access Journals (Sweden)

    Furman Joanna

    2016-06-01

    Full Text Available The main purpose of the paper is the analysis of a process of change focusing particularly on the concept of slimmed production (Lean and its implementation in the enterprise. A case study method was chosen as a research tool because it offers wide array of techniques and means of gaining and analysing data.

  18. USPS – Lean Green Teams

    Energy Technology Data Exchange (ETDEWEB)

    None

    2012-08-01

    Institutional change case study details the U.S. Postal Service's Lean Green Teams, which collaborate across functions to identify and implement low- and no-cost ways to conserve natural resources, purchase fewer consumable products, and reduce waste.

  19. Interleukin-6 release is higher across arm than leg muscles during whole-body exercise

    DEFF Research Database (Denmark)

    Helge, Jørn W; Klein, Ditte K; Andersen, Thor Munch

    2011-01-01

    ± 7 and 47 ± 7 µmol min(-1) (kg lean limb mass)(-1)) were lower, glucose uptake similar (51 ± 12 and 41 ± 8 mmol min(-1) (kg lean limb mass)(-1)) and lactate release higher (82 ± 32 and -2 ± 12 µmol min(-1) (kg lean limb mass)(-1)) in arms than legs, respectively, during exercise (P ....05). No correlations were present between IL-6 release and exogenous substrate uptakes. Muscle glycogen was similar in arms and legs before exercise (388 ± 22 and 428 ± 25 mmol (kg dry weight)(-1)), but after exercise it was only significantly lower in the leg (219 ± 29 mmol (kg dry weight)(-1)). The novel finding......Exercising muscle releases interleukin-6 (IL-6), but the mechanisms controlling this process are poorly understood. This study was performed to test the hypothesis that the IL-6 release differs in arm and leg muscle during whole-body exercise, owing to differences in muscle metabolism. Sixteen...

  20. 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.

  1. 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 ...

  2. , 1584), increase in lean body mass (ID 1579, 1582, 1583), increase in muscle strength (ID 1578, 1583, 1587), increase in endurance performance (ID 1580, 1581), skeletal muscle tissue repair (ID 1586) and faster recovery from muscle fatigue after exercise (ID 1576, 1585) pursuant to Article 13, EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of health claims related to β-hydroxy β-methylbutyrate monohydrate (HMB) alone or in combination with α-ketoisocaproic acid (KIC) and reduction of muscle tissue damage during exercise (ID 1577

    DEFF Research Database (Denmark)

    Tetens, Inge

    claims in relation to β-hydroxy β-methylbutyrate monohydrate (HMB) alone or in combination with α-ketoisocaproic acid (KIC) and reduction of muscle tissue damage during exercise, increase in lean body mass, increase in muscle strength, increase in endurance performance, skeletal muscle tissue repair...... and faster recovery from muscle fatigue after exercise. The scientific substantiation is based on the information provided by the Member States in the consolidated list of Article 13 health claims and references that EFSA has received from Member States or directly from stakeholders. The food constituent...

  3. Are substrate use during exercise and mitochondrial respiratory capacity decreased in arm and leg muscle in type 2 diabetes?

    DEFF Research Database (Denmark)

    Larsen, Steen; Ara, I; Rabøl, R

    2009-01-01

    AIM/HYPOTHESIS: The aim of the study was to investigate mitochondrial function, fibre type distribution and substrate oxidation in arm and leg muscle during exercise in patients with type 2 diabetes and in obese and lean controls. METHODS: Indirect calorimetry was used to calculate fat and carboh...

  4. 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......'s contribution to the change process itself and through bundling particular HRM practices that are aligned with the lean strategy. The paper contributes to both theory and practice, by suggesting specific ways in which HRM can be strategically aligned with a major change implementation such as lean manufacturing....

  5. 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.

  6. 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.

  7. 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.

  8. Work economy following strength training in elderly : alterations in muscle strength, muscle thickness and lean mass upon work economy in elderly men following 12 weeks of strength training

    OpenAIRE

    Salvesen, Svein

    2013-01-01

    Masteroppgave i idrettsvitenskap - Universitetet i Agder 2013 AIM: To investigate if alterations in muscle strength, muscle mass and muscle thickness were followed by changes in work economy. METHODS: Fifty elderly men (60 – 81 years) followed a 12 week undulating periodized strength training program: Lean mass (Muscle mass; Dual-energy X-ray absorptiometry), muscle strength (1RM; one repetition maximum, in leg press and leg extension), and muscle thickness (ultrasound; vastus lateralis a...

  9. Leg cramps and restless legs syndrome during pregnancy.

    Science.gov (United States)

    Hensley, Jennifer G

    2009-01-01

    Sleep disturbance during pregnancy can result in excessive daytime sleepiness, diminished daytime performance, inability to concentrate, irritability, and the potential for an increased length of labor and increased risk of operative birth. Sleep disturbance may be the result of a sleep disorder, such as leg cramps, a common yet benign disorder, or restless legs syndrome, a sensorimotor disorder. Both disrupt sleep, are distressing to the pregnant woman, and mimic one another and other serious disorders. During pregnancy, up to 30% of women can be affected by leg cramps, and up to 26% can be affected by restless legs syndrome.

  10. [Swollen leg with blisters].

    Science.gov (United States)

    Rafeiner, Ph; Templeton, A J; Vonesch, H J

    2005-10-05

    We report the case of a 84-year-old woman suffering from strong pain in her right leg initially resembling thrombosis of deep veins. Eight hours after admission a superficial blister developed at the calf with following hemorrhagic aspect and spontanous eruption of clear yellowish fluid. Later on a new blister appeared at the thigh. The patient died 33 hours after admission of streptococcal toxic shock syndrome. The latter was based on a necrotizing fasciitis. Streptoccus pyogenes (group A) could be cultivated from the blood and fluid of the blister. We discuss the clinical presentation of necrotizing fasciitis with "pain out of proportion" as characteristic complaint and the appropriate management.

  11. Protection against high intravascular pressure in giraffe legs.

    Science.gov (United States)

    Petersen, Karin K; Hørlyck, Arne; Ostergaard, Kristine H; Andresen, Joergen; Broegger, Torbjoern; Skovgaard, Nini; Telinius, Niklas; Laher, Ismael; Bertelsen, Mads F; Grøndahl, Carsten; Smerup, Morten; Secher, Niels H; Brøndum, Emil; Hasenkam, John M; Wang, Tobias; Baandrup, Ulrik; Aalkjaer, Christian

    2013-11-01

    The high blood pressure in giraffe leg arteries renders giraffes vulnerable to edema. We investigated in 11 giraffes whether large and small arteries in the legs and the tight fascia protect leg capillaries. Ultrasound imaging of foreleg arteries in anesthetized giraffes and ex vivo examination revealed abrupt thickening of the arterial wall and a reduction of its internal diameter just below the elbow. At and distal to this narrowing, the artery constricted spontaneously and in response to norepinephrine and intravascular pressure recordings revealed a dynamic, viscous pressure drop along the artery. Histology of the isolated median artery confirmed dense sympathetic innervation at the narrowing. Structure and contractility of small arteries from muscular beds in the leg and neck were compared. The arteries from the legs demonstrated an increased media thickness-to-lumen diameter ratio, increased media volume, and increased numbers of smooth muscle cells per segment length and furthermore, they contracted more strongly than arteries from the neck (500 ± 49 vs. 318 ± 43 mmHg; n = 6 legs and neck, respectively). Finally, the transient increase in interstitial fluid pressure following injection of saline was 5.5 ± 1.7 times larger (n = 8) in the leg than in the neck. We conclude that 1) tissue compliance in the legs is low; 2) large arteries of the legs function as resistance arteries; and 3) structural adaptation of small muscle arteries allows them to develop an extraordinary tension. All three findings can contribute to protection of the capillaries in giraffe legs from a high arterial pressure.

  12. Leaning in to "muddy" interviews

    DEFF Research Database (Denmark)

    Lippke, Lena; Tanggaard, Lene

    2014-01-01

    situated identities among the participants cross each other. We emphasize the value of daring to lean in to the muddiness of peopled research, use it as an analytical tool and present it in its imperfect form. This approach contributes to transparency in qualitative research, opens up the data in a new way......Over the last few decades, qualitative research has been acknowledged as a peopled practice in which subjectivities come into play. The main argument presented in this article is that qualitative research involves “muddy,” troublesome, interactional passages, because of a complex interplay between...... subjectivities, situated identities, emotions, and conversational genres. Based on ethnographic fieldwork at a Danish Vocational Educational Training College, we introduce the concept of “leaning in” to provide an analytical grasp of the “muddy” interactional tension field in an interview situation, in which...

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

    Directory of Open Access Journals (Sweden)

    Irwan Sutirman Wahdiat

    2015-08-01

    Full Text Available 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 also confirmed that lean manufacturing will not be separated from the concept of balance scorecard.

  14. 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.

  15. 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.

  16. Differentiating nocturnal leg cramps and restless legs syndrome.

    Science.gov (United States)

    Rana, Abdul Qayyum; Khan, Fatima; Mosabbir, Abdullah; Ondo, William

    2014-07-01

    Leg pain and discomfort are common complaints in any primary physician's clinic. Two common causes of pain or discomfort in legs are nocturnal leg cramps (NLC) and restless leg syndrome (RLS). NLC present as painful and sudden contractions mostly in part of the calf. Diagnosis of NLC is mainly clinical and sometimes involves investigations to rule out other mimics. RLS is a condition characterized by the discomfort or urge to move the lower limbs, which occurs at rest or in the evening/night. The similarity of RLS and leg cramps poses the issue of errors in diagnosing and differentiating the two. In this paper we review the pathopysiology of each entity and their diagnosis as well as treatment. The two conditions are then compared to appreciate the differences and similarities. Finally, suggestions are recommended for complete assessment.

  17. 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...... an intervention study comprising 9 Danish enterprises involved in implementing lean. Based on tentative results from cases from the present studies the findings from the literature study can be elaborated. It reveals some of the dynamics an ergonomist have to take into consideration in influencing the lean...

  18. 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.

  19. Klinefelter Syndrome With Leg Ulcers

    Directory of Open Access Journals (Sweden)

    Narendra G

    1999-01-01

    Full Text Available Leg ulcers are frequently caused by venous insufficiency, arterial insufficiency, neuropathy, or a combination of these factors. Klinefelter syndrome in association with chronic leg ulcers have been reported earlier. We report a case of Klinefelter syndrome with non- healing ulcer. The diagnosis of the Klinefelter syndrome was confirmed by karyotyping.

  20. 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...

  1. 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...

  2. [Four awareness of clinical lean management].

    Science.gov (United States)

    Xiong, L Z; Zhang, C F

    2017-01-20

    Along with changes of medical model, hospitals need to provide best outcome with lowest cost and best patient's experience rather than merely medical treatments. It is the cultivation of lean awareness to the doctors that could acquire such outcome. The healthcare lean awareness can be summarized as responsibility awareness, digitalized awareness, detail awareness, and outstanding awareness. Through the cultivation of lean awareness, humanism can immerse into the doctors'practice, which is conducive to train for the great masters of the medicine.

  3. Lean implementation frameworks: The challenges for SMEs

    OpenAIRE

    AlManei, Mohammed; Salonitis, Konstantinos; Xu, Yuchun

    2017-01-01

    Implementation of lean manufacturing in any type of organizations can bring many benefits, such as reducing waste and improving operating efficiency. However, lean implementation is not a straightforward process. Although a number of frameworks have been presented, still many companies find it difficult to implement lean. Furthermore, most of these roadmaps are for large manufacturing companies, and not for small and medium enterprises. Unfortunately, there is not a recipe that if used can gu...

  4. 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.

  5. 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.

  6. Kopplingen mellan Lean och kraftergonomi inom tillverkningsindustrin

    OpenAIRE

    Jonsson Egeman, Mathilda; Pettersson, Anna

    2016-01-01

    Syfte – Syftet med denna studie är att öka förståelsen för kopplingen mellan Lean och kraftergonomi inom tillverkningsindustrin samt undersöka varför de, inom viss forskning, anses oförenliga. För att uppfylla syftet har det gemensamma snittet mellan Lean och kraftergonomi undersökts samt vilka konflikter som kan uppstå mellan Lean och kraftergonomi vid arbete inom tillverkningsindustrin. Metod – Litteraturstudier, med fokus på samverkan mellan Lean och kraftergonomi, har utgjort ett teoretis...

  7. Lean and Green Hand Surgery.

    Science.gov (United States)

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

    2018-02-01

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

  8. 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.

  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. On Lean Turbulent Combustion Modeling

    Directory of Open Access Journals (Sweden)

    Constantin LEVENTIU

    2014-06-01

    Full Text Available This paper investigates a lean methane-air flame with different chemical reaction mechanisms, for laminar and turbulent combustion, approached as one and bi-dimensional problem. The numerical results obtained with Cantera and Ansys Fluent software are compared with experimental data obtained at CORIA Institute, France. First, for laminar combustion, the burn temperature is very well approximated for all chemical mechanisms, however major differences appear in the evaluation of the flame front thickness. Next, the analysis of turbulence-combustion interaction shows that the numerical predictions are suficiently accurate for small and moderate turbulence intensity.

  11. Lean methodology in health care.

    Science.gov (United States)

    Kimsey, Diane B

    2010-07-01

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

  12. The LEAN Payload Integration Process

    Science.gov (United States)

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

    2011-01-01

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

  13. Restless legs syndrome

    Directory of Open Access Journals (Sweden)

    Ovallath S

    2012-10-01

    Full Text Available Sujith Ovallath, P DeepaJames Parkinson's Movement Disorder Research Centre, Kannur Medical College, Kerala, IndiaBackground: Restless legs syndrome (RLS is a common sleep-related disorder characterized by abnormal sensation and an urge to move the lower limbs. Symptoms occur at rest in the evening or at night, and they are alleviated by moving the affected extremity or by walking. Although the exact etiopathogenesis of RLS remains elusive, the rapid improvement of symptoms with dopaminergic agents suggests that dopaminergic system dysfunction may be a basic mechanism. Dopaminergic agents are the best-studied agents, and are considered first-line treatment of RLS.Objective: To review the diagnostic criteria, clinical features, etiopathogenesis, and the treatment options of RLS.Methods: The suggestions are based on evidence from studies published in peer-reviewed journals, or upon a comprehensive review of the medical literature.Results/conclusion: Extensive data are available for proving the link between the dopaminergic system and RLS. A possible genetic link also has been studied extensively. Dopamine agonists, especially pramipexole and ropinirole, are particularly useful in the treatment of RLS. Pharmacological treatment should however be limited to those patients who suffer from clinically relevant RLS with impaired sleep quality or quality of life.Keywords: dopamine, levodopa, pramipexole

  14. Restless legs syndrome: literature review

    Directory of Open Access Journals (Sweden)

    Emmanouil Symvoulakis

    Full Text Available Restless legs syndrome is a distressing condition, with negative effects on sleep and daytime activities that affect personal, family and occupational life. The overall impact of restless legs syndrome on quality of life is comparable to that of chronic and frustrating conditions such as depression and diabetes. Misdiagnosis and inappropriate treatment may increase patients' suffering in terms of uncertainty, overuse or misuse of care services and lack of trust. Presenting a synthesis of the main topics in the literature on restless legs syndrome facilitates for a better understanding and its management in primary care settings.

  15. Measurement of body fat using leg to leg bioimpedance

    OpenAIRE

    Sung, R; Lau, P; Yu, C; Lam, P; Nelson, E

    2001-01-01

    AIMS—(1) To validate a leg to leg bioimpedance analysis (BIA) device in the measurement of body composition in children by assessment of its agreement with dual energy x ray absorptiometry (DXA) and its repeatability. (2) To establish a reference range of percentage body fat in Hong Kong Chinese children.
METHODS—Sequential BIA and DXA methods were used to determine body composition in 49 children aged 7-18 years; agreement between the two methods was calculated. Repea...

  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 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 ...

  18. 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…

  19. Applying Lean on Agile Scrum Development Methodology

    OpenAIRE

    SurendRaj Dharmapal; K. Thirunadana Sikamani

    2015-01-01

    This journal introduces the reader to Agile and Lean concepts and provides a basic level of understanding of each process. This journal will also provide a brief background about applying Lean concepts on each phase of agile scrum methodology and summarize their primary business advantages for delivering value to customer.

  20. 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

  1. 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,

  2. 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

  3. 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....

  4. The Lean and Global Start-up

    DEFF Research Database (Denmark)

    Tanev, Stoyan; Rasmussen, Erik Stavnsager

    Ventures research and research with a focus on the Lean Start-up company. It is our intention in this paper to give a short presentation of the two research streams and show how they can be merged into one with a focus on newly established technology oriented firms that are lean and global from...

  5. 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.

  6. 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.

  7. 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

  8. Researching Lean: Methodological implications of loose definitions

    DEFF Research Database (Denmark)

    Brännmark, Mikael; Langstrand, Jostein; Johansson, Stina

    2012-01-01

    – The findings from the case studies are in line with the existing literature, indicating that Lean has changed over time and that operationalization of the concept varies considerably between work life sectors. The findings demonstrate that approaches related to Lean differ significantly between the studied......Purpose – Lean Production has in Sweden become the dominating ideal for ‘best practice’ in rationalization, organizational development and how to organize the work system. However, research into the effects of Lean for different stakeholders has produced ambiguous results. Furthermore, Lean...... 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...

  9. 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.

  10. 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...

  11. Propeller Flap for Complex Distal Leg Reconstruction: A Versatile ...

    African Journals Online (AJOL)

    Reverse sural artery fasciocutaneous flap has become a workhorse for the reconstruction of distal leg soft tissue defects. When its use is not feasible, perforator‑based propeller flap offers a better, easier, faster, and cheaper alternative to free flap. We present our experience with two men both aged 34 years who sustained ...

  12. 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

  13. Leg pain and gynecologic malignancy.

    Science.gov (United States)

    Singh, Lilly; Stevens, Erin E

    2013-09-01

    Gynecologic malignancies affect more than 83 000 women in the United States, each year. Because the disease involves the pelvis, many patients have side effects distal to this area in their lower extremities. The differential diagnosis of leg pain can be divided into vascular, neurologic, and musculoskeletal causes. In this review article, we address numerous etiologies of leg pain, reviewing the prevalence of disease, physical examination findings, diagnostic as well as treatment modalities.

  14. 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...

  15. [Lipedema of the leg associated with dermatomyositis].

    Science.gov (United States)

    Ignjatović, M; Cerović, S

    1999-01-01

    Lipedema represents a form of lipodistrophy, which consists of abnormal accumulation of fat in subcutaneous tissue of the lower limbs with consecutive development of lymphostasis and lymphedema. The aim of this article was to review one clear case of lower limbs lipedema, of unusual occurrence and appearance, which was associated with dermatomyositis. A moderately manifested lipedema in 8 years old little girl was reported with its expressive segmental distribution to upper and lower legs, without significant increase in its size during last 10 years and without signs of lymphostasis. The hereditary influence was not confirmed. Histological examination of lipedematous tissue revealed significant presentation of immune component of the disease. According to the available literature, association between lipedema and dermatomyositis, lower limbs lipedema with segmental distribution as noticed above and its appearance as a consequence of corticosteroid therapy have not yet been published.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. Rendimentos de carcaça, composição tecidual e musculosidade da perna de cordeiros alimentados com silagem de milho ou cana-de-açúcar em dois níveis de concentrado Carcass yield, tissue composition, and leg muscularity of lambs fed corn silage or sugar cane in two levels of concentrate

    Directory of Open Access Journals (Sweden)

    G.M.B. Moreno

    2010-06-01

    Full Text Available Avaliou-se o efeito da relação volumoso:concentrado e do tipo de volumoso nos rendimentos de carcaça e dos cortes comerciais, e sobre a composição dos tecidos e musculosidade da perna de 32 cordeiros Ile de France, terminados em confinamento, alimentados com silagem de milho ou cana-de-açúcar, em duas relações volumoso:concentrado: de 60:40 ou 40:60. Os cordeiros foram abatidos aos 32kg de peso corporal; calcularam-se o peso e o rendimento da carcaça quente (PCQ e RCQ. Após 24 horas de refrigeração, obtiveram-se o peso e o rendimento da carcaça fria (PCF e RCF, o rendimento verdadeiro e as perdas por resfriamento. As carcaças foram divididas em cinco cortes comerciais, paleta, lombo, perna, costelas e pescoço, e a perna foi dissecada em músculo, osso e gordura, calculando-se as relações músculo:osso e músculo:gordura, além do índice de musculosidade da perna. Os cordeiros alimentados com silagem de milho apresentaram maiores PCQ (16,05kg, PCF (15,61kg, RCQ (50,4% e RCF (49,0%. O rendimento de lombo foi menor nos cordeiros alimentados com cana-de-açúcar (9,1%. A cana-de-açúcar e a silagem de milho nas duas relações volumoso:concentrado estudadas não afetaram as proporções de osso, músculo e gordura e musculosidade da perna, e podem constituir a dieta desses animais sem diminuir as proporções desses tecidos, responsáveis pela qualidade da carne.The effects of roughage:concentrate ratio and type of roughage were evaluated on the carcass yield and commercial cuts, and tissue composition and leg muscularity of 32 Ile de France lambs finished in feedlot and fed corn silage or sugar cane in two roughage:concentrate ratios: 60:40 or 40:60. The lambs were slaughtered with 32kg of body weight and the weight and yield of hot carcass (WHC and YHC were determined. After refrigerated for 24h in cold camera, the weight and yield of cold carcass (WCC and YCC, real yield, and weight loss for cooling were obtained. The carcass

  3. Restless Legs Syndrome and Leg Motor Restlessness in Parkinson's Disease.

    Science.gov (United States)

    Suzuki, Keisuke; Miyamoto, Masayuki; Miyamoto, Tomoyuki; Hirata, Koichi

    2015-01-01

    Sleep disturbances are important nonmotor symptoms in Parkinson's disease (PD) that are associated with a negative impact on quality of life. Restless legs syndrome (RLS), which is characterized by an urge to move the legs accompanied by abnormal leg sensations, can coexist with PD, although the pathophysiology of these disorders appears to be different. RLS and PD both respond favorably to dopaminergic treatment, and several investigators have reported a significant relationship between RLS and PD. Sensory symptoms, pain, motor restlessness, akathisia, and the wearing-off phenomenon observed in PD should be differentiated from RLS. RLS in PD may be confounded by chronic dopaminergic treatment; thus, more studies are needed to investigate RLS in drug-naïve patients with PD. Recently, leg motor restlessness (LMR), which is characterized by an urge to move the legs that does not fulfill the diagnostic criteria for RLS, has been reported to be observed more frequently in de novo patients with PD than in age-matched healthy controls, suggesting that LMR may be a part of sensorimotor symptoms intrinsic to PD. In this paper, we provide an overview of RLS, LMR, and PD and of the relationships among these disorders.

  4. El colgajo muscular de hemitríceps sural para la cobertura de grandes defectos en la pierna: Experiencia de 9 años The sural hemitriceps muscular flap for reconstruction of large tissue defects of the leg: A 9 year experience

    Directory of Open Access Journals (Sweden)

    R. Graciano Balcón

    2009-09-01

    Full Text Available En el Instituto Nacional de Ortopedia y Traumatología de Montevideo, Uruguay, utilizamos el colgajo muscular de hemitríceps sural para reconstruir defectos de cobertura en traumatismos graves de pierna que asientan en el tercio medio y en la unión del tercio medio con el distal. El colgajo de hemitríceps sural permite cubrir exposiciones óseas más extensas que el colgajo de hemisóleo en forma aislada, con un menor tiempo quirúrgico y sin afectar a la potencia en la flexión plantar. Presentamos una serie de 13 casos clínicos de fracturas expuestas con importantes defectos de cobertura cutánea de la pierna, tratados con colgajos de hemitríceps durante el período marzo de 1999 a julio de 2008. El seguimiento promedio fue de 15 meses.The sural hemitriceps muscular flap is used in the National Institute of Orthopedics and Traumatology in Montevideo to reconstruct soft-tissue defects after severe lower extremity trauma on the middle third and the union of the middle and inferior third of the leg. The hemitriceps sural flap can successfully cover more extensive osseous exposure than the hemisoleus flap alone, with less surgical time and without affecting plantar flexion strength. A series of 13 cases is presented of leg open fractures with important cutaneous soft-tissue defect treated with hemitriceps flaps, operated on the period from march 1999 to july 2008. Average follow-up time was 15 months.

  5. LEAN SIX SIGMA – MULTIPLE CASE STUDY

    OpenAIRE

    Delvio Venanzi; Diogo Luis Faustino; Orlando Roque Da Silva; Haroldo Lhou Hasegawa

    2017-01-01

    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...

  6. 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.

  7. 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

  8. Restless legs syndrome and periodic leg movements of sleep.

    Science.gov (United States)

    Rye, David B; Trotti, Lynn Marie

    2012-11-01

    Women are more commonly affected than men by restless legs syndrome, and prevalence is highest amongst those of northern European heritage. The motor manifestations include nonvolitional myoclonus (periodic leg movements). Disinhibition of spinal sensorimotor circuits may underlie these primary features and can be affected by peripheral as well as supraspinal networks. Insufficient mobilizable iron stores increase expressivity in some individuals. The sensorimotor features are relieved by dopamine, especially dopamine agonists, gabapentin and its derivatives, and opioids. A diagnosis relies on recognition of key primary and supportive features, and treatments are generally well tolerated, efficacious, and life-changing. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Lean in Construction Projects : Is lean suitable for all construction projects?

    OpenAIRE

    Tomas, Lindholm

    2014-01-01

    Due to the low productivity growth in the construction industry, there are discussions about theories and tools that could support an increased productivity in construction projects. One such ‘theory’ or package of tools is lean. Lean has been used successfully for decades in the car manufacturing industry, Toyota for example, and in other industries as the shipbuilding industry. In the construction industry, the use of the word lean is not frequently used and construction projects could migh...

  10. 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

  11. 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.

  12. Modelling green and lean supply chains

    DEFF Research Database (Denmark)

    Govindan, Kannan; Carvalho, Helena; Azevedo, Susana G.

    2017-01-01

    the trade-offs between lean and green practices. To illustrate the model application, a case study from an automotive supply chain is presented. Some management practices that are instituted for green or lean benefits have opposite effects on the environmental and economic performance of companies. One......This manuscript proposes a model to support decision making and to help managers identify the best set of green and lean supply chain management practices to improve their eco-efficiency. To attain this objective, a mathematical model based on eco-efficiency concepts is suggested to overcome...... of the main findings of our study is that not all companies belonging to the same supply chain can be absolutely lean or green. There should be compromises in the individual companies’ behaviour so the environmental and economic constraints of the supply chain are both satisfied. The proposed model represents...

  13. 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.

  14. 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.

  15. Implementing lean in a surgical ward

    DEFF Research Database (Denmark)

    Edwards, Kasper; Nielsen, Anders Paarup; Jacobsen, Peter

    be planned (in detail) in advance. The remaining operating rooms are allocated to this flow and there have been no significant changes to the organization of work in these theaters. Lean management is derived from the Toyota production system and is a comprehensive system of tools and techniques...... for productivity improvement. Lean management has its origins in industrial production, but it is now being transferred to many other sectors, e.g., health care. Two important prerequisites exist for implementing lean management: Firstly, stable and standardized processes and secondly leveling of production....... Stable and standardized processes ensure quality and predictability (e.g. process time). Leveling of production is essential for production planning. Based on the results of the case study of the surgical ward this paper will discuss three issues or challenges that emerged from the implementation of lean...

  16. 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.

  17. 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.

  18. 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.

  19. Lean Construction Applications for Bridge Inspection

    Science.gov (United States)

    2017-10-01

    Lean philosophy was used to analyze the efficiency of bridge inspection. Emphasis was put on identifying activities that add value to the final output, an owner approved bridge inspection report. 26 bridge inspections were shadowed. Time spent on bri...

  20. 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

  1. Promethus Hot Leg Piping Concept

    International Nuclear Information System (INIS)

    AM Girbik; PA Dilorenzo

    2006-01-01

    The Naval Reactors Prime Contractor Team (NRPCT) recommended the development of a gas cooled reactor directly coupled to a Brayton energy conversion system as the Space Nuclear Power Plant (SNPP) for NASA's Project Prometheus. The section of piping between the reactor outlet and turbine inlet, designated as the hot leg piping, required unique design features to allow the use of a nickel superalloy rather than a refractory metal as the pressure boundary. The NRPCT evaluated a variety of hot leg piping concepts for performance relative to SNPP system parameters, manufacturability, material considerations, and comparison to past high temperature gas reactor (HTGR) practice. Manufacturability challenges and the impact of pressure drop and turbine entrance temperature reduction on cycle efficiency were discriminators between the piping concepts. This paper summarizes the NRPCT hot leg piping evaluation, presents the concept recommended, and summarizes developmental issues for the recommended concept

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. INNOVATION LEAN PRINCIPLES IN AUTOMOTIVE GREEN MANUFACTURING

    Directory of Open Access Journals (Sweden)

    Dušan Sabadka

    2014-12-01

    Full Text Available Today, industries such as automotive and manufacturing industries deal with a lot of environmental regulations. Lean is a production strategy whose fundamental principles drive the industry towards a more effective production of goods and services. The eco-efficiency concept is primary to sustainable development and intends to provide more value with less environmental impact. The aim of this study is to identify and explore the contributions of Lean to reduce environmental impacts that naturally result from industrial activity.

  7. 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,…

  8. Design of Ski Boots for Alpine Ski Racing Based on Leg Frame of the Skier

    Science.gov (United States)

    Suzuki, Soichiro; Hayashi, Sueyoshi

    A ski boot is important to make progress in ski turning technique as an interface between a skier and a ski. Especially in alpine ski races, suitability of design of the boots for racers becomes more important to achieve accurate and quick lean of the leg in ski turns. This study is aimed at building a new design concept of a ski boot that can improve the results of alpine ski races. In this paper, new design of an upper shell of a ski boot that was adjusted to the features of the frame of alpine ski racers was experimentally examined. As a result, it was demonstrated that a front and a rear part of the upper shell of a ski boot should be separately adjusted to the length of a shank of each player for well-balanced quick lean of the leg in the ski turn. Finally, the effect of new design of an upper shell was examined in giant slalom and slalom tests by Japanese alpine ski racers of the first rank. Consequently, the results showed that lean angle during turns was increased and finish time was shortened when the skiers wore the newly designed boots.

  9. Is Czech health care going to be lean?

    OpenAIRE

    Vitásková, Edita

    2015-01-01

    There is a growing interest in applying lean in healthcare. Healthcare services around the world have adopted industrial engineering methods and process improvement methodologies from the manufacturing sector, known as lean production. The aim of this paper is to provide a review of the existing literature on lean healthcare and to publish basic results of survey focused on Czech medical staff's knowledge of lean healthcare philosophy. Focus of this article is not to detail lean principles an...

  10. 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...

  11. 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.

  12. Lean healthcare: rhetoric, ritual and resistance.

    Science.gov (United States)

    Waring, Justin J; Bishop, Simon

    2010-10-01

    This paper presents an ethnographic account of the implementation of Lean service redesign methodologies in one UK NHS hospital operating department. It is suggested that this popular management 'technology', with its emphasis on creating value streams and reducing waste, has the potential to transform the social organisation of healthcare work. The paper locates Lean healthcare within wider debates related to the standardisation of clinical practice, the re-configuration of occupational boundaries and the stratification of clinical communities. Drawing on the 'technologies-in-practice' perspective the study is attentive to the interaction of both the intent to transform work and the response of clinicians to this intent as an ongoing and situated social practice. In developing this analysis this article explores three dimensions of social practice to consider the way Lean is interpreted and articulated (rhetoric), enacted in social practice (ritual), and experienced in the context of prevailing lines of power (resistance). Through these interlinked analytical lenses the paper suggests the interaction of Lean and clinical practice remains contingent and open to negotiation. In particular, Lean follows in a line of service improvements that bring to the fore tensions between clinicians and service leaders around the social organisation of healthcare work. The paper concludes that Lean might not be the easy remedy for making both efficiency and effectiveness improvements in healthcare.

  13. 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.

  14. Cross-legged Gods and One-legged Foresters

    NARCIS (Netherlands)

    Petrovskaia, N.I.

    The present article is a re-evaluation of a marvellous element in a medieval Welsh romance, Chwedl Iarlles y Ffynnawn ‘Tale of the Lady of the Fountain’, also known as Owein. One of the characters encountered by the hero is a one-eyed one-legged dark giant forester who appears to have a particular

  15. 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...

  16. Bone transplantation and tissue engineering, part I. Mythology, miracles and fantasy: from Chimera to the Miracle of the Black Leg of Saints Cosmas and Damian and the cock of John Hunter.

    Science.gov (United States)

    Hernigou, Philippe

    2014-12-01

    The replacement of diseased organs and tissues by the healthy ones of others has been a unique milestone in modern medicine. However, even though cloning, member transplantation and regenerative therapies with stem cells are available in the twentieth and twenty-first centuries, one should remember that all these techniques were in the imagination more than 2,000 years ago. For centuries, transplantation remained a theme of mythology, miracle or fantasy and was found only in literature and arts. This first paper explains the concept of tissue transplantation from the period when it was relegated to the imagination to the work of the Scottish surgeon and anatomist, John Hunter, who demonstrated the viability of bone allograft.

  17. 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...

  18. Conservative management of distal leg necrosis in lung transplant recipients.

    Science.gov (United States)

    Aigner, F; Husmann, M; Huber, L C; Benden, C; Schuurmans, M M

    2017-05-01

    Critical limb ischemia (CLI) with distal leg necrosis in lung transplant recipients (LTR) is associated with a high risk for systemic infection and sepsis. Optimal management of CLI has not been defined so far in LTR. In immunocompetent individuals with leg necrosis, surgical amputation would be indicated and standard care. We report on the outcome of four conservatively managed LTR with distal leg necrosis due to peripheral arterial disease (PAD) with medial calcification of the distal limb vessels. Time interval from lung transplantation to CLI ranged from four years (n = 1) to more than a decade (n = 3). In all cases a multimodal therapy with heparin, acetylsalicylic acid, iloprost and antibiotic therapy was performed, in addition to a trial of catheter-based revascularization. Surgical amputation of necrosis was not undertaken due to fear of wound healing difficulties under long-term immunosuppression and impaired tissue perfusion. Intensive wound care and selective debridement were performed. Two patients developed progressive gangrene followed by auto-amputation during a follow-up of 43 and 49 months with continued ambulation and two patients died of unrelated causes 9 and 12 months after diagnosis of CLI. In conclusion, we report a conservative treatment strategy for distal leg necrosis in LTR without surgical amputation and recommend this approach based on our experience. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  19. Back Pain with Leg Pain.

    Science.gov (United States)

    Vulfsons, Simon; Bar, Negev; Eisenberg, Elon

    2017-07-01

    The clinical diagnostic dilemma of low back pain that is associated with lower limb pain is very common. In relation to back pain that radiates to the leg, the International Association for the Study of Pain (IASP) states: "Pain in the lower limb should be described specifically as either referred pain or radicular pain. In cases of doubt no implication should be made and the pain should be described as pain in the lower limb." Bogduks' editorial in the journal PAIN (2009) helps us to differentiate and define the terms somatic referred pain, radicular pain, and radiculopathy. In addition, there are other pathologies distal to the nerve root that could be relevant to patients with back pain and leg pain such as plexus and peripheral nerve involvement. Hence, the diagnosis of back pain with leg pain can still be challenging. In this article, we present a patient with back and leg pain. The patient appears to have a radicular pain syndrome, but has no neurological impairment and shows signs of myofascial involvement. Is there a single diagnosis or indeed two overlapping syndromes? The scope of our article encompasses the common diagnostic possibilities for this type of patient. A discussion of treatment is beyond the scope of this article and depends on the final diagnosis/diagnoses made.

  20. Kan leg skabe fremtidens vindere?

    DEFF Research Database (Denmark)

    Holm, Claus

    2006-01-01

    Dansk Boldspil Union skruer ned for den præstationsorienterede tilgang til børnefodbold. I stedet skal børnenes leg med bolden i fokus. Målet er at forhindre massivt frafald i børne- og ungdomsfodbolden og højne niveauet hos topspillerne....

  1. 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 ...

  2. 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…

  3. 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.

  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. 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.

  6. 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.

  7. 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.

  8. 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.

  9. A comparison of one-legged and two-legged countermovement jumps

    NARCIS (Netherlands)

    van Soest, A J; Roebroeck, M.E.; Bobbert, M F; Huijing, P A; van Ingen Schenau, G J

    1985-01-01

    Ten well-trained male volleyball players performed one-legged and two-legged vertical countermovement jumps. Ground reaction forces, cinematographic data, and electromyographic data were recorded. Jumping height in one-legged jumps was 58.5% of that reached in two-legged jumps. Mean net torques in

  10. Keep cool and stay lean

    NARCIS (Netherlands)

    Bähler, L.

    2017-01-01

    Numerous studies demonstrate the continuous growing pandemic of obesity. Obesity is the result of an imbalance between energy intake and energy expenditure. Tissues able to combust excess calories are an interesting target in the battle against obesity. The main aim of this thesis is to focus on

  11. [Restless legs syndrome and nocturnal leg pain : Differential diagnosis and treatment].

    Science.gov (United States)

    Hornyak, M; Stiasny-Kolster, K; Evers, S; Happe, S

    2011-09-01

    Pain in the legs belongs to the five most frequent regional pain symptoms. Restless legs syndrome (RLS) presents a particular differential diagnosis for pain in the legs, which is characterized by a nocturnal urge to move the legs often associated with painful sensations in the legs. It is one of the most common neurological disorders and probably the leading cause of nocturnal pain in the legs. In this overview, the diagnosis and therapy of RLS as well as aspects of pain therapy of the disorder are presented. In addition, the differential diagnoses for exclusion of other specific causes of nocturnal pain in the legs are discussed.

  12. 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....

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. [Etiological diagnosis of leg ulcers].

    Science.gov (United States)

    Debure, Clélia

    2010-09-20

    Etiological diagnosis of leg ulcers must be the first step of treatment, even if we know that veinous disease is often present. We can build a clinical decisional diagram, which helps us to understand and not forget the other causes of chronic wounds and choose some basic examination, like ultrasound and histological findings. This diagnosis helps to choose the right treatment in order to cure even the oldest venous ulcers. Educational programs should be improved to prevent recurrence.

  18. VLCD compliance and lean body mass

    DEFF Research Database (Denmark)

    Astrup, A; Quaade, F

    1989-01-01

    g of dietary fibre to VLCD. By the use of a VLCD which provides approximately 60 g of protein for women and approximately 70 g for men, the dietary regimen is safe and no excessive loss of lean body mass seems to occur during VLCD in obese patients. However, the changes in body composition that may...... occur after cycles of weight loss and regain have not been clarified. After weight cycles with weight losses obtained by conventional diets, obese women have lower lean body mass than obese non-dieting controls. Hence, more information about the changes in body composition during dieting on conventional...... diets and VLCD are needed....

  19. The role of outsourcing in Lean Manufacturing

    DEFF Research Database (Denmark)

    Bjarnø, Ole-Christian

    2003-01-01

    degree of complexity by introducing many new product lines, without phasing out very many of the old products could be changed into a far less complex organisation through reengineering and outsourcing. This again opened up for the application of the tool kit in Lean Manufacturing, and through...... demonstrates that strategic sourcing is a powerful tool in Lean Manufacturing with the achievement of marked improvements of performance, e.g. increased cost efficiency, higher flexibility and more management efficiency. One of the essential results was the verification that a company having evolved to a high...... this further productivity improvements could be achieved....

  20. 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.

  1. A Lean Six Sigma journey in radiology.

    Science.gov (United States)

    Bucci, Ronald V; Musitano, Anne

    2011-01-01

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

  2. Thick legs - not always lipedema.

    Science.gov (United States)

    Reich-Schupke, Stefanie; Altmeyer, Peter; Stücker, Markus

    2013-03-01

    Due to its increased presence in the press and on television, the diagnosis of lipedema is on the way to becoming a trendy diagnosis for those with thick legs. Despite this, one must recognize that lipedema is a very rare disease. It is characterized by disproportional obesity of the extremities, especially in the region of the hip and the legs, hematoma development after minimal trauma, and increased pressure-induced or spontaneous pain. Aids for making the correct diagnosis are (duplex) sonography, the waist-hip index or the waist-height index and lymphoscintigraphy. Important differential diagnoses are constitutional variability of the legs, lipohypertrophy in obesity, edema in immobility, edema in chronic venous insufficiency and rheumatic diseases. The symptom-based therapy of lipedema consists of conservative (compression, manual lymphatic drainage, exercise) and surgical treatments (liposuction). Until now there is no curative therapy. Obesity is an important risk factor for the severity and prognosis of lipedema. Further studies for a better understanding of the pathogenesis of lipedema and in the end possible curative treatments are urgently needed. © The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.

  3. 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.

  4. 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,

  5. 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.

  6. Alterations in oral [1-(14C] 18:1n-9 distribution in lean wild-type and genetically obese (ob/ob mice.

    Directory of Open Access Journals (Sweden)

    Xinxia Wang

    Full Text Available Obesity may result from altered fatty acid (FA disposal. Altered FA distribution in obese individuals is poorly understood. Lean wild-type C57BL/6J and obese C57BL/6Job/ob mice received an oral dose of [1-(14C]18:1n-9 (oleic acid, and the radioactivity in tissues was evaluated at various time points. The (14C concentration decreased rapidly in gastrointestinal tract but gradually increased and peaked at 96 h in adipose tissue, muscle and skin in lean mice. The (14C concentration was constant in adipose tissue and muscle of obese mice from 4 h to 168 h. (14C-label content in adipose tissue was significantly affected by genotype, whereas muscle (14C-label content was affected by genotype, time and the interaction between genotype and time. There was higher total (14C retention (47.7% in obese mice than in lean mice (9.0% at 168 h (P<0.05. The (14C concentrations in the soleus and gastrocnemius muscle were higher in obese mice than in lean mice (P<0.05. Perirenal adipose tissue contained the highest (14C content in lean mice, whereas subcutaneous adipose tissue (SAT had the highest (14C content and accounted for the largest proportion of total radioactivity among fat depots in obese mice. More lipid radioactivity was recovered as TAG in SAT from obese mice than from lean mice (P<0.05. Gene expression suggested acyl CoA binding protein and fatty acid binding protein are important for FA distribution in adipose tissue and muscle. The FA distribution in major tissues was altered in ob/ob mice, perhaps contributing to obesity. Understanding the disparity in FA disposal between lean and obese mice may reveal novel targets for the treatment and prevention of obesity.

  7. 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

  8. 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.

  9. 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.

  10. 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...

  11. 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.

  12. Towards an Operational Definition of Lean Construction Onsite

    OpenAIRE

    Sjögren Leong, Michelle; Ward, Steve; Koskela, Lauri

    2015-01-01

    Through literature review and drawing from a combined professional experience of over 20 years of lean construction implementation, this paper investigates the key success factor for the automotive industry’s uptake of lean production to see what the construction industry can derive from it. The paper concludes that there exist a variety of definitions of lean, but no existing definition is yet satisfactory to describe lean construction in a rigorously testable method. This is a major obstacl...

  13. Leg regeneration is epigenetically regulated by histone H3K27 methylation in the cricket Gryllus bimaculatus.

    Science.gov (United States)

    Hamada, Yoshimasa; Bando, Tetsuya; Nakamura, Taro; Ishimaru, Yoshiyasu; Mito, Taro; Noji, Sumihare; Tomioka, Kenji; Ohuchi, Hideyo

    2015-09-01

    Hemimetabolous insects such as the cricket Gryllus bimaculatus regenerate lost tissue parts using blastemal cells, a population of dedifferentiated proliferating cells. The expression of several factors that control epigenetic modification is upregulated in the blastema compared with differentiated tissue, suggesting that epigenetic changes in gene expression might control the differentiation status of blastema cells during regeneration. To clarify the molecular basis of epigenetic regulation during regeneration, we focused on the function of the Gryllus Enhancer of zeste [Gb'E(z)] and Ubiquitously transcribed tetratricopeptide repeat gene on the X chromosome (Gb'Utx) homologues, which regulate methylation and demethylation of histone H3 lysine 27 (H3K27), respectively. Methylated histone H3K27 in the regenerating leg was diminished by Gb'E(z)(RNAi) and was increased by Gb'Utx(RNAi). Regenerated Gb'E(z)(RNAi) cricket legs exhibited extra leg segment formation between the tibia and tarsus, and regenerated Gb'Utx(RNAi) cricket legs showed leg joint formation defects in the tarsus. In the Gb'E(z)(RNAi) regenerating leg, the Gb'dac expression domain expanded in the tarsus. By contrast, in the Gb'Utx(RNAi) regenerating leg, Gb'Egfr expression in the middle of the tarsus was diminished. These results suggest that regulation of the histone H3K27 methylation state is involved in the repatterning process during leg regeneration among cricket species via the epigenetic regulation of leg patterning gene expression. © 2015. Published by The Company of Biologists Ltd.

  14. 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

  15. 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…

  16. 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 ...

  17. 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…

  18. 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...

  19. 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.

  20. Lean leadership and change management skills

    NARCIS (Netherlands)

    Frank Willems

    2013-01-01

    Gastcollege Masteropleiding MIM Tilburg University/TiasNimbas Business School op 17 & 18 mei 2013. • Basic principles of Change Management • Group practice • TheoryU and Social Networking theory as framework for Leadership • Theory about Lean thinking as a method for improving Leadership skills and

  1. Simulation of lean premixed turbulent combustion

    Energy Technology Data Exchange (ETDEWEB)

    Bell, John B.; Day, Marcus S.; Almgren, Ann S.; Lijewski, MichaelJ.; Rendleman, Charles A.; Cheng, Robert K.; Shepherd, Ian G.

    2006-06-25

    There is considerable technological interest in developingnew fuel-flexible combustion systems that can burn fuels such ashydrogenor syngas. Lean premixed systems have the potential to burn thesetypes of fuels with high efficiency and low NOx emissions due to reducedburnt gas temperatures. Although traditional scientific approaches basedon theory and laboratory experiment have played essential roles indeveloping our current understanding of premixed combustion, they areunable to meet the challenges of designing fuel-flexible lean premixedcombustion devices. Computation, with itsability to deal with complexityand its unlimited access to data, hasthe potential for addressing thesechallenges. Realizing this potential requires the ability to perform highfidelity simulations of turbulent lean premixed flames under realisticconditions. In this paper, we examine the specialized mathematicalstructure of these combustion problems and discuss simulation approachesthat exploit this structure. Using these ideas we can dramatically reducecomputational cost, making it possible to perform high-fidelitysimulations of realistic flames. We illustrate this methodology byconsidering ultra-lean hydrogen flames and discuss how this type ofsimulation is changing the way researchers study combustion.

  2. Simulation of lean premixed turbulent combustion

    Science.gov (United States)

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

    2006-09-01

    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.

  3. Lean and global technology start-ups

    DEFF Research Database (Denmark)

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

    2015-01-01

    In this paper the authors introduce the concept of Lean Global Start-up (LGS) as a way of emphasizing the impossibility for new technology start-ups to deal separately with business development, innovation and early internationalization. For a newly established technology firm the task of being...... of their products and the insights from business supporting organizations....

  4. Lean Sygehuset - del I: En patienthistorie

    DEFF Research Database (Denmark)

    Laursen, Martin Lindgaard; Gertsen, Frank

    Denne forskningsrapport introducerer et forskningsprojekt baseret på case studier af Lean principper anvendt på Skejby sygehus. Operationelle udfordringer i sygehusets arbejdsgange illustreres gennem et observeret patientforløb. Disse udfordringer, et oprids af sygehusenes vilkår, og gennemgang af...

  5. Lowlands sociotechnical design theory and lean production

    NARCIS (Netherlands)

    J.H.P. Christis; Erik Soepenberg

    2015-01-01

    Lean Production (LP) can be regarded as a design approach in search of a theoretical foundation. In this paper we show that Lowlands’ Sociotechnical Design Theory (STSL) could function as such a foundation. To reach this goal, we first describe STSL as a system theoretical reformulation of Original

  6. Systems Thinking, Lean Production and Action Learning

    Science.gov (United States)

    Seddon, John; Caulkin, Simon

    2007-01-01

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

  7. The Scientific Underpinning of Lean Six Sigma

    NARCIS (Netherlands)

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

    2007-01-01

    The twentieth century saw an incredible development of professional organizations. The impact of technological advances is obvious, but besides these, innovations in management structures and methods have resulted in the highly productive organizations of today. Lean Six Sigma is not revolutionary.

  8. Lean Six Sigma for Service and Healthcare

    NARCIS (Netherlands)

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

    2006-01-01

    Lean Six Sigma is built on principles and methods that have proven themselves over the twentieth century. It has incorporated the most effective approaches and integrated them into a full programme. It offers a management structure for organizing continuous improvement of routine tasks, such as

  9. Measuring lean implementation for maintenance service companies

    NARCIS (Netherlands)

    de Jong, Stephan J.; Beelaerts van Blokland, W.W.A.

    2016-01-01

    Purpose – Implementation of lean manufacturing is currently performed in the production industry; however, for the airline maintenance service industry, it is still in its infancy. Indicators such as work in process, cycle time, on-time performance and inventory are useful indicators to measure

  10. Personality characteristics of excellent lean managers

    DEFF Research Database (Denmark)

    Steendahl Nielsen, Jacob; Boer, Harry; Lindgren, Peter

    2016-01-01

    Today many Danish companies are implementing Lean and hereby trying to implement a continuous improvement (CI) program and culture. We have observed that companies can easily implement the artifacts of CI, such as Kaizen boards, Kaizen meetings, Performance management (KPI), A3 and PDCA reports...

  11. Lean planning and control : principles and practice

    NARCIS (Netherlands)

    Riezebos, Jan; Suer, Gursel; Gen, Mitsuo

    2018-01-01

    A basic characteristic of lean, agile, and responsive production systems are the use of teams instead of functional departments. Another characteristic is the use of rather simple shop floor control methods to manage the flow of orders. The shop floor control methods provide robust and visual

  12. Lean and Agile: An Epistemological Reflection

    Science.gov (United States)

    Browaeys, Marie-Joelle; Fisser, Sandra

    2012-01-01

    Purpose: The aim of the paper is to contribute to the discussion of treating the concepts of lean and agile in isolation or combination by presenting an alternative view from complexity thinking on these concepts, considering an epistemological approach to this topic. Design/methodology/approach: The paper adopts an epistemological approach, using…

  13. 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...

  14. Body weight, body composition, and energy metabolism in lean and obese Zucker rats fed soybean oil or butter.

    Science.gov (United States)

    Rolland, Valérie; Roseau, Suzanne; Fromentin, Gilles; Nicolaidis, Stylianos; Tomé, Daniel; Even, Patrick C

    2002-01-01

    Dietary fat composition is thought to affect body weight regulation independent of the amount of fat ingested. We analyzed the feeding behavior, body weight gain, body composition, and energy metabolism in lean and obese rats fed a diet in which fat was in the form of either butter or soybean oil. Ten lean (Fa/?) and 10 obese (fa/fa) adult Zucker rats were divided into 4 groups according to a 2 x 2 experimental design. They were fed a normally balanced diet over 11 wk in which 30% of energy was either soybean oil or butter. Food intake, body weight gain, and body composition were measured. Indirect calorimetry was used to study energy metabolism at rest and in relation to feeding and activity. Food intake increased similarly in lean and obese rats after butter feeding. Body weight gain increased in obese rats and decreased in lean rats after butter feeding. Body weight gain in obese rats was due mainly to an increase in the weight of lean tissues besides muscle, whereas adiposity and distribution of fat between the various pads did not change. Resting metabolic rates and postprandial lipid oxidation increased in butter-fed obese rats. Lipid oxidation during exercise was not significantly different between obese and lean rats. Fat oxidation increased in butter-fed lean rats during treadmill running at moderate intensity. In obese rats, basal metabolism and postprandial lipid oxidation increased during butter feeding, which appeared to prevent fat accumulation in the long term. In lean rats, butter feeding favored lipid utilization by working muscles, an observation that deserves further investigation in terms of endurance and performance.

  15. 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.

  16. Epilepsy and restless legs syndrome.

    Science.gov (United States)

    Geyer, James D; Geyer, Emery E; Fetterman, Zachary; Carney, Paul R

    2017-03-01

    Restless legs syndrome (RLS) is a common neurological movement disorder occurring in approximately 10% of the general population. The prevalence of moderately severe RLS is 2.7% overall (3.7% for women and 1.7% for men). Epilepsy is also a common neurological disorder with significant associated morbidity and impact on quality of life. We evaluated the severity and frequency of primary RLS in patients with localization-related temporal lobe epilepsy (TLE) and investigated the role of prodromal RLS symptoms as a warning sign and lateralizing indicator. All epilepsy patients seen in the outpatient clinic were screened for movement disorders from 2005 to 2015. Ninety-eight consecutive patients with localization-related TLE (50 right TLE and 48 left TLE) who met inclusion criteria were seen in the outpatient clinic. The control group consisted of 50 individuals with no history or immediate family history of epilepsy. Each patient was evaluated with the International Restless Legs Study Group (IRLSSG) questionnaire, NIH RLS diagnostic criteria, ferritin level, and comprehensive sleep screening including polysomnography. Furthermore, patients with obstructive sleep apnea or a definite cause of secondary restless legs syndrome such as low serum ferritin or serum iron levels were also excluded from the study. There was a significant association between the type of epilepsy and whether or not patients had RLS χ 2 (1)=10.17, prestlessness was typically described as moderately severe. The RLS symptoms were more common and somewhat more severe in the right TLE group than the left TLE group. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Quinine for Nocturnal Leg Cramps

    Science.gov (United States)

    Man-Son-Hing, Malcolm; Wells, George; Lau, Anita

    1998-01-01

    OBJECTIVE With respect to the use of quinine for the treatment of nocturnal leg cramps, to determine whether the findings of a previously performed meta-analysis of published data are altered with the addition of unpublished data, and whether publication bias is present in this area. DESIGN A meta-analysis of eight (four published and four unpublished) randomized, double-blind, placebo-controlled trials, seven of which had a crossover design. SETTING Randomized trials that were available as of July 1997. SUBJECTS Ambulatory patients (659) who suffered from regular nocturnal leg cramps. MAIN RESULTS When individual patient data from all crossover studies were pooled, persons had 3.60 (95% confidence interval [CI] 2.15, 5.05) fewer cramps in a 4-week period when taking quinine compared with placebo. This compared with an estimate of 8.83 fewer cramps (95% CI 4.16, 13.49) from pooling published studies alone. The corresponding relative risk reductions were 21% (95% CI 12%, 30%) and 43% (95% CI 21%, 65%), respectively. Compared with placebo, the use of quinine was associated with an increased incidence of side effects, particularly tinnitus. Publication bias is present in the reporting of the efficacy of quinine for this indication, as almost all published studies reported larger estimates of its efficacy than did unpublished studies. CONCLUSIONS This study confirms that quinine is efficacious in the prevention of nocturnal leg cramps. However, its benefit may not be as large as reported from the pooling of published studies alone. Given the side effect profile of quinine, nonpharmacologic therapy (e.g., regular passive stretching of the affected muscle) is the best first-line treatment. For persons who find this ineffective and whose quality of life is significantly affected, a trial of quinine is warranted. Prescribing physicians must closely monitor the risks and benefits in individual patients. Publication bias is present in this area even though there is

  18. 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...

  19. Developing a Lean Startup Plan for Online Business

    OpenAIRE

    Myllykoski, Mari

    2015-01-01

    The purpose of this thesis was to develop a lean startup plan for an online company Kiddsafe Ltd. The company is a UK based startup company selling children’s locator devices, which resemble wristbands. The lean startup plan aimed to validate the bu-siness idea of the company by using practical methods of testing as defined in the lean startup methodology. The design and tactics of the research methods used were those defined by the lean startup methodology itself. The aim was to build a lean...

  20. The role of fat and lean mass in bone loss in older men: findings from the CHAMP study.

    Science.gov (United States)

    Bleicher, Kerrin; Cumming, Robert G; Naganathan, Vasikaran; Travison, Thomas G; Sambrook, Philip N; Blyth, Fiona M; Handelsman, David J; Le Couteur, David G; Waite, Louise M; Creasey, Helen M; Seibel, Markus J

    2011-12-01

    Weight loss is associated with bone loss; however, it is unclear whether loss of fat or loss of lean body mass plays the key role in this relationship. The aim of this longitudinal analysis was to clarify the relationship between hip BMD, hip BMC and whole body BMC with changes in fat and lean tissue mass in older men. The Concord Health and Aging in Men Project (CHAMP) is a population-based study in Sydney, Australia, involving 1705 men aged 70-97 years. Bone mineral density (BMD) of the total hip, and bone mineral content (BMC) of the hip and whole body (WB), lean mass and fat mass were measured with Dual X-ray Absorptiometry (DXA). Multivariate linear regression models were used to assess relationships. Over 2.2 years of follow-up, 368(33%) men lost at least 2% of their body weight, which included a mean loss of 0.8 kg/year of lean body mass and 0.9 kg/year of fat body mass. Fat loss was strongly associated with BMD loss in men who lost weight. As a group, weight losers lost 1.0% of hip BMD annually compared to 0.2% in men who gained weight, with each kilo of fat loss associated with 0.6%/year hip BMD loss (p<0.0001). Lean mass was not associated with hip BMD loss in weight losers, however, lean mass change was associated with BMD change in men who gained weight (0.3% hip BMD increase per kilo increase of lean mass p<0.01). Maintaining body weight is important for bone health in elderly men. Body fat plays an important role in this relationship, which may reflect the additional metabolic function of adipose tissue. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Protein intake and lean body mass preservation during energy intake restriction in overweight older adults.

    Science.gov (United States)

    Backx, E M P; Tieland, M; Borgonjen-van den Berg, K J; Claessen, P R; van Loon, L J C; de Groot, L C P G M

    2016-02-01

    Dietary-induced weight loss is generally accompanied by a decline in skeletal muscle mass. The loss of muscle mass leads to a decline in muscle strength and impairs physical performance. A high dietary protein intake has been suggested to allow muscle mass preservation during energy intake restriction. To investigate the impact of increasing dietary protein intake on lean body mass, strength and physical performance during 12 weeks of energy intake restriction in overweight older adults. Sixty-one overweight and obese men and women (63±5 years) were randomly assigned to either a high protein diet (HP; 1.7 g kg(-1) per day; n=31) or normal protein diet (NP; 0.9 g kg(-1) per day; n=30) during a 12-week 25% energy intake restriction. During this controlled dietary intervention, 90% of the diet was provided by the university. At baseline and after the intervention, body weight, lean body mass (dual-energy X-ray absorptiometry), leg strength (1-repetition maximum), physical performance (Short Physical Performance Battery, 400 m) and habitual physical activity (actigraph) were assessed. Body weight declined in both groups with no differences between the HP and NP groups (-8.9±2.9 versus -9.1±3.4 kg, respectively; P=0.584). Lean body mass declined by 1.8±2.2 and 2.1±1.4 kg, respectively, with no significant differences between groups (P=0.213). Leg strength had decreased during the intervention by 8.8±14.0 and 8.9±12.8 kg, with no differences between groups (P=0.689). Physical performance as measured by 400 m walking speed improved in both groups, with no differences between groups (P=0.219). Increasing protein intake above habitual intake levels (0.9 g kg(-1) per day) does not preserve lean body mass, strength or physical performance during prolonged energy intake restriction in overweight older adults.

  2. 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.

  3. 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.

  4. 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

  5. Running with a load increases leg stiffness.

    Science.gov (United States)

    Silder, Amy; Besier, Thor; Delp, Scott L

    2015-04-13

    Spring-mass models have been used to characterize running mechanics and leg stiffness in a variety of conditions, yet it remains unknown how running while carrying a load affects running mechanics and leg stiffness. The purpose of this study was to test the hypothesis that running with a load increases leg stiffness. Twenty-seven subjects ran at a constant speed on a force-measuring treadmill while carrying no load, and while wearing weight vests loaded with 10%, 20%, and 30% of body weight. We measured lower extremity motion and created a scaled musculoskeletal model of each subject, which we used to estimate lower extremity joint angles and leg length. We estimated dimensionless leg stiffness as the ratio of the peak vertical ground reaction force (normalized to body weight) and the change in stance phase leg length (normalized to leg length at initial foot contact). Leg length was calculated as the distance from the center of the pelvis to the center-of-pressure under the foot. We found that dimensionless leg stiffness increased when running with load (p=0.001); this resulted from an increase in the peak vertical ground reaction force (pleg length (p=0.025). When running with load, subjects had longer ground contact times (pleg stiffness to accommodate an added load. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Restless legs syndrome and periodic leg movements in patients with movement disorders: Specific considerations.

    Science.gov (United States)

    Högl, Birgit; Stefani, Ambra

    2017-05-01

    Restless legs syndrome is a frequent neurological disorder with potentially serious and highly distressing treatment complications. The role and potential implications of periodic leg movements during sleep range from being a genetic risk marker for restless legs syndrome to being a cardiovascular risk factor. The diagnosis of restless legs syndrome in patients with daytime movement disorders is challenging and restless legs syndrome needs to be differentiated from other sleep-related movement disorders. This article provides an update on the diagnosis of restless legs syndrome as an independent disorder and the role of periodic leg movements and reviews the association of restless legs syndrome with Parkinson's disease and other movement disorders. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

  7. 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

  8. Bone mineral content has stronger association with lean mass than fat mass among Indian urban adolescents

    Directory of Open Access Journals (Sweden)

    Raman K Marwaha

    2015-01-01

    Full Text Available Introduction: There are conflicting reports on the relationship of lean mass (LM and fat mass (FM with bone mineral content (BMC. Given the high prevalence of Vitamin D deficiency in India, we planned the study to evaluate the relationship between LM and FM with BMC in Indian children and adolescents. The objective of the study was to evaluate the relationship of BMC with LM and FM. Materials and Methods: Total and regional BMC, LM, and FM using dual energy X-ray absorptiometry and pubertal staging were assessed in 1403 children and adolescents (boys [B]: 826; girls [G]: 577. BMC index, BMC/LM and BMC/FM ratio, were calculated. Results: The age ranged from 5 to 18 years, with a mean age of 13.2 ± 2.7 years. BMC adjusted for height (BMC index and BMC/height ratio was comparable in both genders. There was no difference in total BMC between genders in the prepubertal group but were higher in more advanced stages of pubertal maturation. The correlation of total as well as regional BMC was stronger for LM (B: Total BMC - 0.880, trunk - 0.715, leg - 0.894, arm - 0.891; G: Total BMC - 0.827, leg - 0.846, arm - 0.815 (all value indicate r2 , P < 0.0001 for all when compared with FM (B: Total BMC - 0.776, trunk - 0.676, leg - 0.772, arm - 0.728; G: Total BMC - 0.781, leg - 0.741, arm - 0.689; all P < 0.0001 except at trunk BMC (LM - 0.682 vs. FM - 0.721; all P < 0.0001, even after controlling for age, height, pubertal stage, and biochemical parameters. Conclusions: BMC had a stronger positive correlation with LM than FM.

  9. ["Lean management" in hospitals: potentials and limitations].

    Science.gov (United States)

    Glossmann, J P; Schliebusch, O; Diehl, V; Walshe, R

    2000-08-15

    Little attention has yet been payed on establishing modern and competitive organizational structures in German hospitals. In this paper, we attempt to apply elements of lean management to the work of physicians working in an inpatient setting. Traditional ways of communication and their disadvantages are discussed. These include loss of motivation, bureaucratic structures and a lack of interdisciplinary cooperation. Using Maslow's theory of motivation, possible improvements are discussed, such as the reduction of restrictive job characteristics, an increase of physicians' spheres of competence and the use of their innovative potentials. These suggestions are explained using practical examples. The aim of the study is to contribute to quality management in hospitals by increasing personal responsibilities according to lean management.

  10. Lean Strategies in the Operating Room.

    Science.gov (United States)

    Robinson, Stephen T; Kirsch, Jeffrey R

    2015-12-01

    Lean strategies can be readily applied to health care in general and operating rooms specifically. The emphasis is on the patient as the customer, respect and engagement of all providers, and leadership from management. The strategy of lean is to use continuous improvement to eliminate waste from the care process, leaving only value-added activities. This iterative process progressively adds the steps of identifying the 7 common forms of waste (transportation, inventory, motion, waiting, overproduction, overprocessing, and defects), 5S (sort, simplify, sweep, standardize, sustain), visual controls, just-in-time processing, level-loaded work, and built-in quality to achieve the highest quality of patient care. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2015-07-01

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

  12. Restless legs syndrome mimicking S1 radiculopathy.

    Science.gov (United States)

    Zambelis, Th; Wolgamuth, B R; Papoutsi, S N; Economou, N T

    2016-01-01

    Α case of a chronic idiopathic form of a severe type of Restless Legs Syndrome (RLS), which developed during pregnancy and persisted after this, misdiagnosed for 34 years as radiculopathy S1, is reported. In spite of the thorough clinical and laboratory investigation, in addition to constant changes of the therapeutic approach, the diagnosis of S1 radiculopathy could not be confirmed, resulting in a chronic clinical course; the latter was characterized by relapses and remissions not attributed or linked in any way to the treatment (various types of). In fact, it was due to a routine workup in a sleep clinic, where the patient was referred because of a coincident chronic insomnia (Restless Legs Syndrome is a known and important cause of insomnia/chronic insomnia), which resulted in a proper diagnosis and treatment of this case. With the use of Restless Legs Syndrome appropriate treatment (Pramipexole 0.18 mg taken at bedtime, a dopaminergic agent and Level A recommended drug for Restless Legs Syndrome) an excellent response and immediate elimination of symptoms was achieved. Restless Legs Syndrome may present with a variety of symptoms (with the most prominent shortly being reported with the acronym URGE: Urge to move the legs usually associated with unpleasant leg sensations, Rest induces symptoms, Getting active brings relief, Evening and night deteriorate symptoms); given the fact that Restless Legs Syndrome presents with a great variety and heterogeneity of symptoms (mostly pain, dysesthesia and paresthesia), which may occur in several other diseases (the so called "RLS mimics"), proper diagnosis of Restless Legs Syndrome usually fails. Restless Legs Syndrome misinterpreted as S1 radiculopathy, to the best of our knowledge, has not been reported yet in the literature. Here, case history, clinical course and common RLS mimics are presented. Different forms of Restless Legs Syndrome manifestations, which are commonly -as in this case- misinterpreted due to their

  13. Simulation of lean premixed turbulent combustion

    OpenAIRE

    Bell, John B.; Day, Marcus S.; Almgren, Ann S.; Lijewski, Michael J.; Rendleman, Charles A.; Cheng, Robert K.; Shepherd, Ian G.

    2008-01-01

    There is considerable technological interest in developing new fuel-flexible combustion systems that can burn fuels such as hydrogenor 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 m...

  14. Beyond Lean and the Working Environment

    OpenAIRE

    Gonçalves, José Miguel Guerreiro

    2017-01-01

    Lean Production System (LPS) has become very popular among manufacturing industries, services and large commercial areas over the years due to its production increase abilities. However, LPS practices can have both negative and positive impacts in worker’s psychosocial factors like motivation, satisfaction and commitment and physical and psychological health factor like musculoskeletal disorders (MSD) and stress. Since LPS is a very broad term, there is no simple relation between LPS imple...

  15. 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.

  16. Regional variations in nocturnal fluctuations in subcutaneous blood flow rate in the lower leg of man

    DEFF Research Database (Denmark)

    Sindrup, J H; Kastrup, J; Jørgensen, B

    1991-01-01

    The purpose of the study was to investigate possible regional variations in recently discovered nocturnal fluctuations in subcutaneous blood flow rates. Approximately 90 min after going to sleep, a 100% blood flow rate increment, lasting about 100 min, has been demonstrated in the distal and medial...... aspect of the right lower leg of normal human subjects. In the present study subcutaneous adipose tissue blood flow rates were measured simultaneously in the right and left lower legs of 16 normal human subjects over 12-20 h ambulatory conditions. The 133Xe wash-out technique, portable CdTe(Cl) detectors...... and a portable data storage unit were used. The tracer depots were applied on the medial aspects of the right lower leg and on the medial (series 1) and lateral (series 2) aspect of the left lower leg 10 cm proximal to the malleolar level by means of the epicutaneous, atraumatic labelling technique. A nocturnal...

  17. Postprandial triacylglycerol uptake in the legs is increased during exercise and post-exercise recovery

    DEFF Research Database (Denmark)

    Enevoldsen, L H; Simonsen, L; Bülow, J

    2005-01-01

    Six young, healthy male subjects were each studied in two experiments: (1) during resting conditions before and for 360 min after a meal (54% of energy as carbohydrate, 30% of energy as lipid, and 16% of energy as protein) comprising 25% of their total daily energy intake (M-->R); and (2) while...... exercising on a cycle ergometer for 60 min at 50% of the peak oxygen consumption commencing 60 min after the meal (M-->E) and then for another 240 min. Regional metabolism was measured by Fick's Principle in a leg and in the splanchnic tissue. The combination of food intake and exercise led to increased...... plasma triacylglycerol (TAG) uptake and clearance in the exercising legs immediately and for at least 4 h post-exercise, while food intake per se did not change leg plasma TAG uptake or clearance for up to 6 h. It is hypothesized that the effect of exercise on leg plasma TAG metabolism is a result...

  18. Lean Production Practices to Enhance Organisational Performance

    Directory of Open Access Journals (Sweden)

    Shah Satya

    2017-01-01

    Full Text Available Service sector organisations are constantly overcoming the challenges facing the over-production and waste reduction within their environments. Industries are also becoming very competitive thus forcing them to seek suitable production organisation strategies with the aim towards enhancing their competitiveness and efficiency. The aim of this research study is to investigate the impact of lean production practices on the performance of service based businesses through the case study of a local baked goods supplier. The research framework adopted consists of questionnaire survey method implemented with different end users, thus covering the overall production – retail – customer cycle. The research results and analysis justify the objective of the research that lean production practices enhance the performance of the supplier company and the common tool identified were JIT (Just in Time, Value Steam Mapping (VSP and the 5S methods. The results also suggest that JIT method has a higher impact towards improvement on performance relating to quality, speed, dependability, flexibility and cost of the supplier. However, the research study also identifies that one of the major challenges faced by the organisation while adopting lean practices was the lack of commitment from top management, continuous training and employee engagement measures.

  19. Pramipexole alters thermoregulation in restless legs syndrome.

    Science.gov (United States)

    Salminen, Aaro V; Rimpilä, Ville; Polo, Olli

    2014-12-15

    Previous studies have associated restless legs syndrome (RLS) with peripheral hypoxia and impaired thermoregulation in the lower extremities. We performed long-term monitoring of skin temperatures in order to investigate whether these findings could be explained by reduced blood flow to the peripheral tissues. 96-hour continuous measurements of skin temperature were performed both in the distal and proximal parts of the body of 15 patients with RLS and 14 healthy controls. During the recording, the patients participated in suggested immobilization tests both with and without pramipexole medication. We found no baseline differences in distal or proximal skin temperature between patients and controls in daytime or during immobilization. However, pramipexole significantly increased distal skin temperature in the patient group during immobilization (31.1°C vs. 32.9°C, p thermoregulation and the previous studies might have been biased by medication. Dopaminergic medication is a major confounding factor when assessing peripheral phenomena in RLS and should be controlled for in the future studies. © 2014 American Academy of Sleep Medicine.

  20. Intensive treatment of leg lymphedema

    Directory of Open Access Journals (Sweden)

    Pereira de Godoy Jose

    2010-01-01

    Full Text Available Background: Despite of all the problems caused by lymphedema, this disease continues to affect millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is necessary. Aim: The aim of this study was to evaluate a novel intensive outpatient treatment for leg lymphedema. Methods: Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The inclusion criteria were patients with Grade II and III lymphedema, where the difference, measured by volumetry, between the affected limb below the knee and the healthy limb was greater than 1.5 kg. Intensive treatment was carried out for 6- to 8-h sessions in the outpatient clinic. Analysis of variance was utilized for statistical analysis with an alpha error of 5% (P-value < 0.05 being considered significant. Results: All limbs had significant reductions in size with the final mean loss being 81.1% of the volume of edema. The greatest losses occurred in the first week (P-value < 0.001. Losses of more than 90% of the lymphedema occurred in 9 (39.13% patients; losses of more than 80% in 13 (56.52%, losses of more than 70% in 17 (73.91% and losses of more than 50% were recorded for 95.65% of the patients; only 1 patient lost less than 50% (37.9% of the edema. Conclusion: The intensive treatment of lymphedema in the outpatient clinic can produce significant reductions in the volume of edema over a short period of time and can be recommended for any grade of lymphedema, in particular the more advanced degrees.

  1. Myocutaneous revascularization following graded ischemia in lean and obese mice

    Directory of Open Access Journals (Sweden)

    Clark RM

    2016-09-01

    Full Text Available Ross M Clark,1 Brittany Coffman,2 Paul G McGuire,3 Thomas R Howdieshell1,3 1Department of Surgery, 2Department of Pathology, 3Department of Cell Biology and Vascular Physiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA Background: Murine models of diabetes and obesity have provided insight into the pathogenesis of impaired epithelialization of excisional skin wounds. However, knowledge of postischemic myocutaneous revascularization in these models is limited. Materials and methods: A myocutaneous flap was created on the dorsum of wild type (C57BL/6, genetically obese and diabetic (ob/ob, db/db, complementary heterozygous (ob+/ob− , db+/db−, and diet-induced obese (DIO mice (n=48 total; five operative mice per strain and three unoperated mice per strain as controls. Flap perfusion was documented by laser speckle contrast imaging. Local gene expression in control and postoperative flap tissue specimens was determined by quantitative reverse transcription polymerase chain reaction (RT-PCR. Image analysis of immunochemically stained histologic sections confirmed microvascular density and macrophage presence. Results: Day 10 planimetric analysis revealed mean flap surface area necrosis values of 10.8%, 12.9%, 9.9%, 0.4%, 1.4%, and 23.0% for wild type, db+/db−, ob+/ob−, db/db, ob/ob, and DIO flaps, respectively. Over 10 days, laser speckle imaging documented increased perfusion at all time points with revascularization to supranormal perfusion in db/db and ob/ob flaps. In contrast, wild type, heterozygous, and DIO flaps displayed expected graded ischemia with failure of perfusion to return to baseline values. RT-PCR demonstrated statistically significant differences in angiogenic gene expression between lean and obese mice at baseline (unoperated and at day 10. Conclusion: Unexpected increased baseline skin perfusion and augmented myocutaneous revascularization accompanied by a control proangiogenic transcriptional

  2. Leg blood flow during static exercise.

    Science.gov (United States)

    Kilbom, A; Persson, J

    1982-01-01

    Leg blood flow was studied with the constant infusion dye technique during static exercise of the thigh muscles (quadriceps) and during hand-grips at 15 and 25-30% of MVC. Blood flow and oxygen uptake in the leg increased in quadriceps exercise and reached their highest values (around 1.21/min and 165 ml/min respectively) at 25-30% of MVC, whereas leg vascular resistance decreased. Regional circulatory adaptations and the oxygen uptake - leg blood flow relationship were in close agreement with the responses found in dynamic leg exercise. In view of the marked rise in intramuscular pressure previously observed during quadriceps contractions, a restriction of blood flow and an increased vascular resistance had been expected. Involuntary activation of leg muscles other than the quadriceps may explain the finding. Contractions of the contralateral quadriceps induced a slight increase in leg blood flow, whereas hand-grips had no influence on blood flow or vascular resistance in the leg. The distribution of the cardiac output during static contractions is discussed, and it is concluded that during hand-grips the increase in blood flow is predominantly distributed to the upper part of the body.

  3. Børns leg og eksperimenterende virksomhed

    DEFF Research Database (Denmark)

    Damgaard Warrer, Sarah; Broström, Stig

    Børns leg og eksperimenterende virksomhed er et rigt felt med mange perspektiver, indgangsvinkler og nuancer. I denne bog kædes leg og det eksperimenterende og skabende sammen som to gensidigt forbundne fænomener og belyses i pædagogisk og didaktisk perspektiv. Desuden beskrives potentialet i båd...

  4. 3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot.

    Directory of Open Access Journals (Sweden)

    Suzanne L Duce

    Full Text Available BACKGROUND: Idiopathic congenital talipes equinovarus (CTEV is the commonest form of clubfoot. Its exact cause is unknown, although it is related to limb development. The aim of this study was to quantify the anatomy of the muscle, subcutaneous fat, tibia, fibula and arteries in the lower legs of teenagers and young adults with CTEV using 3D magnetic resonance imaging (MRI, and thus to investigate the anatomical differences between CTEV participants and controls. METHODOLOGY/PRINCIPAL FINDINGS: The lower legs of six CTEV (2 bilateral, 4 unilateral and five control young adults (age 12-28 were imaged using a 3T MRI Philips scanner. 5 of the CTEV participants had undergone soft-tissue and capsular release surgery. 3D T1-weighted and 3D magnetic resonance angiography (MRA images were acquired. Segmentation software was used for volumetric, anatomical and image analysis. Kolmogorov-Smirnov tests were performed. The volumes of the lower affected leg, muscle, tibia and fibula in unilateral CTEV participants were consistently smaller compared to their contralateral unaffected leg, this was most pronounced in muscle. The proportion of muscle in affected CTEV legs was significantly reduced compared with control and unaffected CTEV legs, whilst proportion of muscular fat increased. No spatial abnormalities in the location or branching of arteries were detected, but hypoplastic anomalies were observed. CONCLUSIONS/SIGNIFICANCE: Combining 3D MRI and MRA is effective for quantitatively characterizing CTEV anatomy. Reduction in leg muscle volume appears to be a sensitive marker. Since 5/6 CTEV cases had soft-tissue surgery, further work is required to confirm that the treatment did not affect the MRI features observed. We propose that the proportion of muscle and intra-muscular fat within the lower leg could provide a valuable addition to current clinical CTEV classification. These measures could be useful for clinical care and guiding treatment pathways, as

  5. 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.

  6. Active and Inactive Leg Hemodynamics during Sequential Single-Leg Interval Cycling.

    Science.gov (United States)

    Gordon, Nicole; Abbiss, Chris R; Ihsan, Mohammed; Maiorana, Andrew J; Peiffer, Jeremiah J

    2018-01-11

    Leg order during sequential single-leg cycling (i.e. exercising both legs independently within a single session) may affect local muscular responses potentially influencing adaptations. This study examined the cardiovascular and skeletal muscle hemodynamic responses during double-leg and sequential single-leg cycling. Ten young healthy adults (28 ± 6 y) completed six 1-min double-leg intervals interspersed with one minute of passive recovery and, on a separate occasion, 12 (six with one leg followed by six with the other leg) 1-min single-leg intervals interspersed with one minute of passive recovery. Oxygen consumption, heart rate, blood pressure, muscle oxygenation, muscle blood volume and power output were measured throughout each session. Oxygen consumption, heart rate and power output were not different between sets of single-leg intervals but the average of both sets was lower than the double-leg intervals. Mean arterial pressure was higher during double-leg compared with sequential single-leg intervals (115 ± 9 mmHg vs. 104 ± 9 mmHg; p<0.05) and higher during the initial compared with second set of single-leg intervals (108 ± 10 mmHg vs. 101 ± 10 mmHg; p<0.05). The increase in muscle blood volume from baseline was similar between the active single-leg and double-leg (267 ± 150 μM[BULLET OPERATOR]cm vs. 214 ± 169 μM[BULLET OPERATOR]cm; p=0.26). The pattern of change in muscle blood volume from the initial to second set of intervals was significantly different (p<0.05) when the leg was active in the initial (-52.3 ± 111.6%) compared with second set (65.1 ± 152.9%). These data indicate that the order in which each leg performs sequential single-leg cycling influences the local hemodynamic responses, with the inactive muscle influencing the stimulus experienced by the contralateral leg.

  7. Body composition analysis by leg-to-leg bioelectrical impedance and dual-energy X-ray absorptiometry in non-obese and obese individuals.

    Science.gov (United States)

    Boneva-Asiova, Z; Boyanov, M A

    2008-11-01

    The aim of this study is to compare total weight, % body fat (% BF), fat mass (FM) and fat-free mass (FFM) measured by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA). This cross-sectional study included 159 women (mean age: 49.1 +/- 10.0 years) and 124 men (mean age: 51.4 +/- 8.0 years) subdivided according to sex and body mass index (BMI): BMI or = 35 kg/m(2) (40 women and 30 men). Bioelectrical impedance was performed in the fasting state on a Tanita TBF-215 leg-to-leg analyser (Tanita, Tokyo, Japan). Whole-body DXA scans were performed on a Hologic QDR 4500 A bone densitometer (Hologic, Bedford, MA, USA). Total weight, % BF, FM and FFM were tested for intermethod differences. Linear regression and correlation analysis was performed. Limits of agreement and Bland-Altman plots were built. DXA-derived body composition parameters were not significantly different from BIA estimates and were highly correlated (e.g. for FFM, r = 0.82-0.95). In lean individuals, BIA tended to produce lower values for FM and % BF and higher ones for FFM in comparison with DXA. This trend was reversed at BMI > 35 kg/m(2). The correlations decreased with increasing BMI. The limits of agreement were much better in men than in women and increased with increasing BMI in both sexes. Compared with DXA, the leg-to-leg Tanita TBF-215 analyser accurately assessed body composition in a heterogeneous group of both sexes. In the very obese women (BMI > 35 kg/m(2)), BIA measurements should be viewed with caution.

  8. Lean body mass is a major determinant of levothyroxine dosage in the treatment of thyroid diseases.

    Science.gov (United States)

    Santini, Ferruccio; Pinchera, Aldo; Marsili, Alessandro; Ceccarini, Giovanni; Castagna, Maria Grazia; Valeriano, Rocco; Giannetti, Monica; Taddei, Donatella; Centoni, Roberta; Scartabelli, Giovanna; Rago, Teresa; Mammoli, Claudia; Elisei, Rossella; Vitti, Paolo

    2005-01-01

    Total body weight is usually employed to calculate the amount of l-T(4) to be administered in patients with thyroid diseases. The aim of this study was to evaluate the effect of body composition on l-T(4) requirements. Body composition was assessed by dual energy x-ray absorptiometry in 75 patients on TSH-suppressive l-T(4) therapy after conventional thyroid ablation for differentiated cancer. The mean daily dose of l-T(4) was lower in normal-weight (127.5 +/- 21.3 mug/d) vs. overweight (139.4 +/- 24.5) and obese (151.3 +/- 29.1) subjects. There was a much stronger association between the l-T(4) dosage and lean body mass (P < 0.001, r = 0.667) compared with fat mass (P = 0.023, r = 0.26). Measurement of regional tissue composition showed peripheral lean mass as the best correlate with the dose of l-T(4) (r = 0.679, P < 0.001) whereas no correlation was observed with peripheral fat mass. In conclusion, individual l-T(4) requirements are dependent on lean body mass. Age- and gender-related differences in l-T(4) needs reflect different proportions of lean mass over the total body weight. An estimate of lean mass may be helpful to shorten the time required to attain a stable dose of l-T(4), particularly in subjects with high body mass index values that may be due either to increased muscular mass or to obesity.

  9. Effect of leg length on ROM, VJ and leg dexterity in dance.

    Science.gov (United States)

    Wyon, M A; Nevill, A M; Dekker, K; Brown, D D; Clarke, F; Pelly, J; Koutedakis, Y

    2010-09-01

    We investigated the associations between leg length and specific ballet movements in different skill groups. Volunteers were from an undergraduate dance programme (n=18), a pre-professional school (n=43) and from an elite classical ballet company (n=45). Individual data were collected for anthropometry, vertical jump, leg dexterity, and leg active and passive ROM. ANCOVA identified both main effects as significant with regard to vertical jump (gender Peffects with gender, skill or leg length. Active and passive range of motion noted gender (P=0.001) and skill (Peffects of leg length on fundamental ballet skills. The longer legs that benefit vertical jump have a negative influence on range of motion and leg dexterity except for highly skilled dancers, who through skill, seem to have overcome the effects of some of these dichotomies. Georg Thieme Verlag KG Stuttgart . New York.

  10. 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.

  11. 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

  12. 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.

  13. Uterine Diverticulum With Fetal Leg Entrapment: A Case Report.

    Science.gov (United States)

    Chandrasekaran, Nirmala; Yudin, Mark H; Berger, Howard

    2017-10-01

    Uterine anomalies causing fetal complications are very rarely encountered in obstetric practice and thus pose a diagnostic dilemma. A multigravid patient attended the clinic for an ultrasound examination in the third trimester following a recent hospital admission for abdominal pain. Ultrasound imaging revealed a large uterine diverticulum in the right cornu of the uterus with evidence of fetal leg entrapment. Because of concerns of increased soft tissue edema in the entrapped leg, the patient was delivered at 35 weeks' gestation by elective CS. The CS was complicated by uterine rupture at the diverticular portion. The neonatal course was complicated by compartment syndrome of the leg, and the infant underwent surgery on post-delivery day one with good outcome. Uterine diverticula are rare anomalies, and once they are diagnosed, the possibility of entrapment of fetal parts or placenta in pregnancy should be considered. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  14. 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.......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...

  15. 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...

  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

    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......, likewise, Lean manufacturing affects employee’s mindsets. The extent of which such a transformation can occur is constrained in time as it requires employees and management to unlearn old principles and practices before new ones can be fine-tuned and put fruitfully into use. This study investigates...... the relationship between Lean manufacturing, management accounting practices, Lean thinking and firm performance. Using survey data from 368 different manufacturing facilities, we construct a structural equation model and we develop hypotheses predicting relationships between Lean manufacturing, management...

  17. Lean and the working environment: a review of the literature

    DEFF Research Database (Denmark)

    Hasle, Peter; Bojesen, Anders; Jensen, Per Langaa

    2012-01-01

    of manufacturing industry. The literature reflects, only to a limited extent, on the significance of implementation strategy and production context. Practical implications - Organizations working with lean should make efforts to avoid an impaired working environment for manual employees. Involvement of employees......Purpose - The effects of lean on employees have been debated ever since the concept was introduced. The purpose of this paper is to review the scientific literature on the effects of lean on the working environment and employee health and well-being. Design/methodology/approach - Relevant databases...... were searched for studies of lean and the working environment. In total, 11 studies with quantitative effects of lean are included in this review. The methodology and results are analysed to extract information about lean and the effects on working environment. Findings - There is strong evidence...

  18. 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.

  19. Steerable Hopping Six-Legged Robot

    Science.gov (United States)

    Younse, Paulo; Aghazarian, Hrand

    2010-01-01

    The figure depicts selected aspects of a six-legged robot that moves by hopping and that can be steered in the sense that it can be launched into a hop in a controllable direction. This is a prototype of hopping robots being developed for use in scientific exploration of rough terrain on remote planets that have surface gravitation less than that of Earth. Hopping robots could also be used on Earth, albeit at diminished hopping distances associated with the greater Earth gravitation. The upper end of each leg is connected through two universal joints to an upper and a lower hexagonal frame, such that the tilt of the leg depends on the relative position of the two frames. Two non-back-driveable worm-gear motor drives are used to control the relative position of the two frames along two axes 120 apart, thereby controlling the common tilt of all six legs and thereby, further, controlling the direction of hopping. Each leg includes an upper and a lower aluminum frame segment with a joint between them. A fiberglass spring, connected via hinges to both segments, is used to store hopping energy prior to launch into a hop and to cushion the landing at the end of the hop. A cable for loading the spring is run into each leg through the center of the universal joints and then down along the center lines of the segments to the lower end of the leg. A central spool actuated by a motor with a harmonic drive and an electromagnetic clutch winds in all six cables to compress all six springs (thereby also flexing all six legs) simultaneously. To ensure that all the legs push off and land in the same direction, timing- belt pulley drives are attached to the leg segments, restricting the flexing and extension of all six legs to a common linear motion. In preparation for a hop, the spool can be driven to load the spring legs by an amount corresponding to a desired hop distance within range. The amount of compression can be computed from the reading of a shaft-angle encoder that

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

    OpenAIRE

    Alisson Christian Scheller; Paulo A. Cauchick Miguel

    2014-01-01

    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 l...

  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. 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.

  3. Lean and Green Paradigms in Logistics: Review of Published Research

    Directory of Open Access Journals (Sweden)

    Vaska Pejić

    2016-12-01

    Although key findings indicate that over the last couple of years research on all three topics has increased, a research gap regarding the studies of lean and green logistics when combined, has been identified. For all three topics the domination in research typology has been extracted. The findings indicate that most papers examined on the topic of lean logistics come from the manufacturing industries, whereas for the topic green logistics and a combination of green and lean topics no specific sector was identified.

  4. Lean healthcare across cultures: state-of-the-art

    OpenAIRE

    Guimarães, M.; Crespo de Carvalho, J.

    2012-01-01

    Lean thinking “translation” from manufacturing to services settings is a topic of growing interest among academics and practitioners. Healthcare organizations have been one of the latest services settings adopting Lean principles, tools and techniques feeding a crescent stream of literature. However, despite of the important contribution of some review articles, the Lean embeddeness in different national Healthcare systems lack cultural appraisal and updating. Through a systematic literature ...

  5. Lean thinking in healthcare services: learning from case studies

    OpenAIRE

    Guimarães, Maria Cristina Geraldes Malheiro Machado

    2013-01-01

    Tese de doutoramento em Gestão Geral, Estratégia Desenvolvimento Organizacional/ JEL: D22, I12 Healthcare organisations, especially in public sector, have been adopting Lean management practices with increasing outcomes’ evidences in several parts of the world, since the beginning of this century. However, Lean deployment in Healthcare services has been addressed in the literature in a surgical way by an array of case reports addressing the “hard” side of Lean depl...

  6. Application of AHP for Lean Implementation Analysis in 6 MSMEs

    OpenAIRE

    Ravikumar M.M; Marimuthu K; H. Abdul Zubar

    2014-01-01

    An attempt made to create an awareness about the benefits of lean manufacturing in some Micro, Small and Medium scale industries situated in the southern parts of India, and also to find out the extent up to which companies have implemented lean in their premises. The basic need for lean manufacturing is to help customers, by providing them quality products at the lowest cost and contribute to the better enhancement of the environment. In order to enforce the concept, AHP techniques have been...

  7. Is there a lean future for global startups?

    DEFF Research Database (Denmark)

    Tanev, Stoyan

    2017-01-01

    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....

  8. ED becomes 'lean' and cuts LBTC, LOS times.

    Science.gov (United States)

    2008-04-01

    Lean manufacturing techniques, first developed by Toyota, can be successfully adapted to help improve processes in your ED. St. Luke's Episcopal Hospital in Houston, has used Lean to reduce median length of stay, frequency of diversions, and the percentage of patients who left before treatment was complete (LBTC). Here's why "Lean" can help improve the performance of your ED: It enables you and your staff to see things from the patient's point of view. Lean tools enable you to view the status of your department in real-time and to compare that status with your performance goals. Exercises help identify areas where your processes break down and determine the most likely solutions.

  9. 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.

  10. 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. 

  11. 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....

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. Change management lessons learned for Lean IT implementations

    Directory of Open Access Journals (Sweden)

    Jörn Kobus

    2017-01-01

    Full Text Available Lean Management is a standard production mode that has been familiar to production organizations for several decades. To date, however, academic literature has presented surprisingly little information about the application of Lean Management in Information Technology (IT organizations, or what is called Lean IT. Drawing upon an empirical qualitative case study of the IT departments of two multinational companies, in this paper we identify change management lessons learned for Lean IT implementations, as well as seven characteristics of a corresponding change management approach. As an extension of our work, researchers should validate and expand our initial findings, preferably in a quantitative setting.

  17. Can lean contribute to work intensification in healthcare?

    Science.gov (United States)

    Rees, Gareth H; Gauld, Robin

    2017-05-15

    Purpose The purpose of this paper is to review and discuss the effects of the introduction of lean into healthcare workplaces, phenomena that have not been widely investigated. Design/methodology/approach The paper draws on discussions and findings from the literature. It seeks to bring the few geographically dispersed experiences and case studies together to draw some conclusions regarding lean's negative effects. Findings Two recurring themes emerge. The first is there is little evidence of Lean's impact on work and the people who perform it. The literature therefore suggests that we understand very little about how work conditions are changed and how Lean's negative effects arise and may be managed in healthcare workplaces. A second observation is that Lean's effects are ambiguous. For some Lean seems to intensify work, while for others it leads to improved job satisfaction and productivity. Given this variety, the paper suggests a research emphasis on Lean's socio-cultural side and to derive more data on how work and its processes change, particularly in the context of healthcare team-working. Originality/value The paper concludes that without improved understanding of social contexts of Lean interventions its value for healthcare improvement may be limited. Future research should also include a focus on how the work is changed and whether high-performance work system practices may be used to offset Lean's negative effects.

  18. 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.

  19. Hot Leg Piping Materials Issues

    International Nuclear Information System (INIS)

    V. Munne

    2006-01-01

    With Naval Reactors (NR) approval of the Naval Reactors Prime Contractor Team (NRPCT) recommendation to develop a gas cooled reactor directly coupled to a Brayton power conversion system as the space nuclear power plant (SNPP) for Project Prometheus (References a and b) the reactor outlet piping was recognized to require a design that utilizes internal insulation (Reference c). The initial pipe design suggested ceramic fiber blanket as the insulation material based on requirements associated with service temperature capability within the expected range, very low thermal conductivity, and low density. Nevertheless, it was not considered to be well suited for internal insulation use because its very high surface area and proclivity for holding adsorbed gases, especially water, would make outgassing a source of contaminant gases in the He-Xe working fluid. Additionally, ceramic fiber blanket insulating materials become very friable after relatively short service periods at working temperatures and small pieces of fiber could be dislodged and contaminate the system. Consequently, alternative insulation materials were sought that would have comparable thermal properties and density but superior structural integrity and greatly reduced outgassing. This letter provides technical information regarding insulation and materials issues for the Hot Leg Piping preconceptual design developed for the Project Prometheus space nuclear power plant (SNPP)

  20. "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.

  1. Lean Architecture for Agile Software Development

    CERN Document Server

    Coplien, James O

    2010-01-01

    More and more Agile projects are seeking architectural roots as they struggle with complexity and scale - and they're seeking lightweight ways to do it: Still seeking? In this book the authors help you to find your own path; Taking cues from Lean development, they can help steer your project toward practices with longstanding track records; Up-front architecture? Sure. You can deliver an architecture as code that compiles and that concretely guides development without bogging it down in a mass of documents and guesses about the implementation; Documentation? Even a whiteboard diagram, or a CRC

  2. DESIGNER LEAN PRODUCTION PROCESSES AND 5S

    OpenAIRE

    Amalia Venera Todorut; Doru Cîrnu

    2010-01-01

    One of the challenges faced by businesses today is the combined pressure to reduce price and to provide an increased a variety of options at lower volumes. This paper will present what we call 5S method as part of the Lean philosophy. It will explain how to introduce this concept and how can it be adapted in our institutions. 5 S is a Japanese concept. It is a methodical approach for eliminating time and material waste. The reality is that a crowded and unorganized workplace is filled with wa...

  3. Implementing LEAN in the Supply Chain

    DEFF Research Database (Denmark)

    Bilberg, Arne

    through a multi faced role called a waterspider function assisted by an adjusted ERP system to obtain a user-friendly and simple IT environment. The methods applied to redesign were based on LEAN principles to eliminate waste and to enhance flow. The project involved the end to end supply chain....... The challenge was to get commitment in the organization as well as to find a technical solution. A lot of effort was put into training the employees, which in the final run has demonstrated remarkable results....

  4. Giant recurrent infantile myofi bromatosis of the leg in a 3 year-old ...

    African Journals Online (AJOL)

    Infantile myofi bromatosis is a rare mesenchymal disorder of infancy and childhood characterised by the formation of tumours in the soft tissues, muscles, bones and viscera. Only 61 cases have been reported in the literature. This paper describes the management of a 3 year-old boy with extensive IMF of the right leg.

  5. Effect of collagen turnover and matrix metalloproteinase activity on healing of venous leg ulcers

    NARCIS (Netherlands)

    Meyer, F.J.; Burnand, K.G.; Abisi, S.; TeKoppele, J.M.; Els, B. van; Smith, A.

    2008-01-01

    Background: The presence of fibrous tissue in poorly healing venous leg ulcers suggests abnormal collagen metabolism. The aim was to determine whether there were differences in collagen turnover and matrix metalloproteinase (MMP) activity between ulcers that healed, those that did not heal and

  6. Lean Construction Implementation in the Saudi Arabian Construction Industry

    Directory of Open Access Journals (Sweden)

    Jamil Ghazi Sarhan

    2017-03-01

    Full Text Available The Kingdom of Saudi Arabia (KSA has witnessed a huge increase in construction during the last two decades. However, many projects experienced time delays, cost overruns and the generation of massive amounts of waste. To address these challenges, lean construction has been introduced into the Saudi construction industry; however, it is still in its infancy. This study therefore investigates the current state of lean construction implementation in the construction industry in the KSA. The objectives are to identify: the types of construction waste, level of use of tools that support the implementation of lean construction, stages of application of lean methods, and the benefits of lean construction. To achieve these objectives, a structured questionnaire survey of 282 construction professionals was carried out. After the analysis of the collected data using mean score and Anova test, the following conclusions were made.  In the construction industry in the KSA, waiting is the most common type of waste, while Computer Aided Design (CAD is the conventional tool supporting the implementation of lean construction. Furthermore, the data suggests that lean construction is most commonly used in the construction stage of projects while customer satisfaction is the main benefit derived from lean construction practices. This study concludes that the level of implementation of lean construction in the KSA construction industry is increasing. The results will help benchmark the current state of lean construction implementation, which will enable the construction industry to identify strategies to implement lean construction in Saudi Arabia in accordance with their needs and project goals, to achieve better productivity.

  7. Impact of leg lengthening on viscoelastic properties of the deep fascia

    Science.gov (United States)

    Wang, Hai-Qiang; Wei, Yi-Yong; Wu, Zi-Xiang; Luo, Zhuo-Jing

    2009-01-01

    Background Despite the morphological alterations of the deep fascia subjected to leg lengthening have been investigated in cellular and extracellular aspects, the impact of leg lengthening on viscoelastic properties of the deep fascia remains largely unknown. This study aimed to address the changes of viscoelastic properties of the deep fascia during leg lengthening using uniaxial tensile test. Methods Animal model of leg lengthening was established in New Zealand white rabbits. Distraction was initiated at a rate of 1 mm/day and 2 mm/day in two steps, and preceded until increases of 10% and 20% in the initial length of tibia had been achieved. The deep fascia specimens of 30 mm × 10 mm were clamped with the Instron 1122 tensile tester at room temperature with a constant tensile rate of 5 mm/min. After 5 load-download tensile tests had been performed, the specimens were elongated until rupture. The load-displacement curves were automatically generated. Results The normal deep fascia showed typical viscoelastic rule of collagenous tissues. Each experimental group of the deep fascia after leg lengthening kept the properties. The curves of the deep fascia at a rate of 1 mm/day with 20% increase in tibia length were the closest to those of normal deep fascia. The ultimate tension strength and the strain at rupture on average of normal deep fascia were 2.69 N (8.97 mN/mm2) and 14.11%, respectively. The increases in ultimate tension strength and strain at rupture of the deep fascia after leg lengthening were statistically significant. Conclusion The deep fascia subjected to leg lengthening exhibits viscoelastic properties as collagenous tissues without lengthening other than increased strain and strength. Notwithstanding different lengthening schemes result in varied viscoelastic properties changes, the most comparable viscoelastic properties to be demonstrated are under the scheme of a distraction rate of 1 mm/day and 20% increase in tibia length. PMID:19698092

  8. Leg pain (Osgood-Schlatter) (image)

    Science.gov (United States)

    Leg pain in older children or young adolescents can occur for many reasons. An Osgood-Schlatter lesion results from continued trauma to the anterior tibial bone and causes a visible lump below the knee.

  9. Support Leg Loading in Punt Kicking

    Science.gov (United States)

    Kermond, John; Konz, Stephen

    1978-01-01

    Maximum distance in football punt kicking is associated with a maximum force transfer to the ball rather than a maximum force transfer through the ground via the support leg. For maximum distance, tred lightly. (Author)

  10. Sturge-Weber syndrome - legs (image)

    Science.gov (United States)

    ... nervous system (neurocutaneous) and is associated with Port Wine Stain, red vascular markings on the face and other parts of the body (shown here on the legs). This is an unusual case, due to the large size of the lesion ( ...

  11. Leg or foot amputation - dressing change

    Science.gov (United States)

    ... patientinstructions/000018.htm Leg or foot amputation - dressing change To use the sharing features on this page, please enable JavaScript. You will need to change the dressing on your limb. This will help ...

  12. Invasive Candida krusei infection and Candida vasculitis of a leg ulcer in an immunocompetent patient: A case report

    Directory of Open Access Journals (Sweden)

    Philipp Jud

    2017-02-01

    Full Text Available A 71 year old female Caucasian farmer without any known immunosuppression presented with a painful ulcer of her right lower leg after a trauma caused by a wood billet. There was no response to empirical antibacterial treatment. An ulcer biopsy showed an invasive Candida infection of the soft tissue and leucocytoclastic vasculitis. Voriconazole treatment was followed by wound healing. Invasive Candida infection and localized Candida vasculitis represent a rare cause of persisting leg ulcers. The similar clinical picture of chronic venous leg ulcers might blur the true cause and refractory cases should therefore promptly be processed by histopathological diagnostics.

  13. Invasive Candida krusei infection and Candida vasculitis of a leg ulcer in an immunocompetent patient: A case report.

    Science.gov (United States)

    Jud, Philipp; Valentin, Thomas; Regauer, Sigrid; Gary, Thomas; Hackl, Gerald; Rief, Peter; Brodmann, Marianne; Hafner, Franz

    2017-02-01

    A 71year old female Caucasian farmer without any known immunosuppression presented with a painful ulcer of her right lower leg after a trauma caused by a wood billet. There was no response to empirical antibacterial treatment. An ulcer biopsy showed an invasive Candida infection of the soft tissue and leucocytoclastic vasculitis. Voriconazole treatment was followed by wound healing. Invasive Candida infection and localized Candida vasculitis represent a rare cause of persisting leg ulcers. The similar clinical picture of chronic venous leg ulcers might blur the true cause and refractory cases should therefore promptly be processed by histopathological diagnostics. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  14. Conjoined legs: Sirenomelia or caudal regression syndrome?

    OpenAIRE

    Das, Sakti Prasad; Ojha, Niranjan; Ganesh, G Shankar; Mohanty, Ram Narayan

    2013-01-01

    Presence of single umbilical persistent vitelline artery distinguishes sirenomelia from caudal regression syndrome. We report a case of a12-year-old boy who had bilateral umbilical arteries presented with fusion of both legs in the lower one third of leg. Both feet were rudimentary. The right foot had a valgus rocker-bottom deformity. All toes were present but rudimentary. The left foot showed absence of all toes. Physical examination showed left tibia vara. The chest evaluation in sitting re...

  15. Efficiency and Speed in Legged Robots

    Science.gov (United States)

    2011-03-22

    which we substitute into (4.42) : ( -mv s J O=-km+ mvc -k __ c __ V v 2 c c 46 (4.43) (4.44) (4.45) (4.46) to fInd the switching curve m 3 s...Legged Mechanisms. IVSS. Traverse City, MI Muench, P., Alexander, J., Quinn, R., & Aschenbeck, K. (2005) Pneumatic Spring for Legged Walker. SPIE

  16. Flexural characteristics of a stack leg

    International Nuclear Information System (INIS)

    Cook, J.

    1979-06-01

    A 30 MV tandem Van de Graaff accelerator is at present under construction at Daresbury Laboratory. The insulating stack of the machine is of modular construction, each module being 860 mm in length. Each live section stack module contains 8 insulating legs mounted between bulkhead rings. The design, fabrication (from glass discs bonded to stainless steel discs using an epoxy film adhesive) and testing of the stack legs is described. (U.K.)

  17. Severe Pelvic Obliquity Affects Femoral Offset in Patients with Total Hip Arthroplasty but Not Leg-Length Inequality

    OpenAIRE

    Zhou, Xiaoxiao; Wang, Qi; Zhang, Xianlong; Chen, Yunsu; Peng, Xiaochun; Mao, Yuanqing; Yang, Yang; Fu, Beigang; Wang, Xiuhui; Tang, Tingting

    2015-01-01

    Leg-length inequality is an extensively studied complication of total hip arthroplasty in normal patients. However, few studies have focused on the pelvic obliquity of coronal pelvic malrotation. We hypothesized that pelvic obliquity with a fixed abduction/adduction contracture deformity of the hip may intraoperatively affect the release of soft tissues, ultimately resulting in a leg-length inequality. This study also investigated whether the femoral and vertical offsets of total hip arthropl...

  18. 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

  19. 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...

  20. A review of designing machine tool for leanness

    Indian Academy of Sciences (India)

    There has been a gradual evolution of the leanness over the years from the shop floor level of a manufacturing (automobile) organization to almost every operational and management aspect now. The Leanness has undergone and still is undergoing a process of continuous and never-ending evolution due to its inherently ...

  1. 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 ...

  2. A review of designing machine tool for leanness

    Indian Academy of Sciences (India)

    lean production system design (LPSD) model developed here could be applied to any variety of production system .... strategy and not as a long term philosophical journey, which require at least 3 to 5 years to show any results. ... titioners, thus hindering efforts to correctly practice Lean management and improve business.

  3. Lang vej endnu før bilindustrien er Lean

    DEFF Research Database (Denmark)

    Christiansen, Thomas Bøhm

    2005-01-01

    Anmeldelse og diskussion af bogen "The Second Century: Reconnecting Customer and Value Chain through Build-to-order - Moving beyond Mass and Lean Production in the Auto Industry......Anmeldelse og diskussion af bogen "The Second Century: Reconnecting Customer and Value Chain through Build-to-order - Moving beyond Mass and Lean Production in the Auto Industry...

  4. 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.

  5. 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...

  6. Benchmarking performance measurement and lean manufacturing in the rough mill

    Science.gov (United States)

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

    2006-01-01

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

  7. 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…

  8. 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.

  9. Peak bone mineral density, lean body mass and fractures

    NARCIS (Netherlands)

    Boot, Annemieke M.; de Ridder, Maria A. J.; van der Sluis, Inge M.; van Slobbe, Ingrid; Krenning, Eric P.; Keizer-Schrama, Sabine M. P. F. de Muinck

    Background: During childhood and adolescence, bone mass and lean body mass (LBM) increase till a plateau is reached. In this longitudinal and cross-sectional study, the age of reaching the plateau was evaluated for lumbar spine and total body bone mass measurements and lean body mass. The

  10. An application of Lean Six Sigma in a hospital

    NARCIS (Netherlands)

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

    2007-01-01

    Abstract Healthcare today faces major challenges. Patients demand quality of care to be improved continuously. Insurance companies demand the lowest possible prices. Lean Six Sigma is a tool that can help healthcare providers to achieve these at least partly conflicting goals. Lean Six Sigma is an

  11. Logistics services and Lean Six Sigma implementation: a case study

    NARCIS (Netherlands)

    Gutierrez Gutierrez, L.; de Leeuw, S.L.J.M.; Dubbers, R.

    2016-01-01

    Purpose: This paper aims to analyze the application of Lean Six Sigma (LSS) framework for supporting continuous improvement (CI) in logistics services. Both the lean philosophy and the Six Sigma methodology have become two of the most important initiatives for CI in organizations. The combination of

  12. 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...... framework reveals the potential of Lean Enablers being applied in change programs. Incorporating the knowledge gained in the case study, the second part shows the development of a framework for the implementation of Lean Enablers....

  13. 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.

  14. 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.

  15. 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."

  16. Integrating Work Environment Considerations Into Lean and Value Stream Mapping

    DEFF Research Database (Denmark)

    Edwards, Kasper

    (Spear & Bowen, 1999; Womack & Jones, 1996) and is based on standardisation, levelling, and optimisation of work flows through value stream mapping (VSM) (Rother & Shook, 2009) and eliminating waste. Lean is essentially a rationalization approach that will reduce waste and increase productivity thereby...... causing work intensification (Westgaard & Winkel, 2011) with negative impact on work environment. To compensate for the negative effects of lean a work environment complement (ErgoVSM) has been developed in Sweden (Jarebrandt et al. 2010). EgoVSM integrate work environment considerations into VSM......, e) mental porosity and f) variation in contents. However, lean management and the VSM analysis focus on waste to identify workflow problems and develop an improved workflow. The lean mindset and waste analysis is taught to work shop participants by a lean coach. The focus and mindset of reducing...

  17. 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.

  18. 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

  19. 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.

  20. A longitudinal study of lean and fat areas at the arm.

    Science.gov (United States)

    Gasser, T; Ziegler, P; Largo, R H; Molinari, L; Prader, A

    1994-01-01

    Using biceps and triceps skinfolds and upper arm circumference, areas of fat and lean tissue at the arm can be approximately determined based on a cylindrical assumption. Based on the first Zürich growth study a longitudinal analysis of estimated fat and lean areas is undertaken. Area may often be a more meaningful parameter than width in development, due to the increasing width of the limbs stretching the layer of fat. When comparing these quantities with the body mass index, correlations in boys were higher for lean area than for fat area, and about equally high for both measures in girls (around 0.8 beyond age 10). The primary goal of this investigation was to quantify the development of lean and fat arm areas from birth to adulthood, and to assess sex differences in this respect. The comparison with results obtained earlier from radiographic data is of particular interest, since such data can rarely be obtained any more, and overall this comparison can be considered encouraging. Lean area develops slowly until the onset of puberty, girls showing a slightly smaller value than boys. The pubertal spurt is very impressive in boys and moderate in girls, timed to age of peak height velocity in both sexes. Fat area changes only minimally in boys older than 16 months, and increases steadily in girls until age 16. The respective velocity curve shows a systematic up and down until age 5, when a gradual increase to a prepubertal fat spurt starts. It is interrupted by a trough in velocity--much more accentuated in boys--at puberty, and followed by a postpubertal fat spurt. When studying subgroups of subjects with a relatively high or relatively low adult body mass index, the heavy group differed relatively more in terms of fat area than lean area. Girls heavy as adults increase their fat area consistently more from about 5 years onwards. Boys later heavy show a qualitatively different pattern in puberty, with accentuated pre- and postpubertal fat spurts, but also a strong

  1. Angioleiomyoma of the Lower Leg.

    Science.gov (United States)

    Sprinkle, Robert L B; Sangueza, Omar P; Wells, Ashleigh E

    2017-05-01

    Angioleiomyomas are benign tumefactions that originate from smooth muscle in vascular structures and are difficult to definitively diagnose preoperatively. Although these lesions are rarely encountered in the foot, the lower extremity is the most common site of occurrence. An angioleiomyoma typically manifests as a small, painful, solitary, mobile lesion. This case report describes a lateral retromalleolar para-Achilles tendon insertional location for a moderately sized immobile solid tumefaction in the subcutaneous tissues. The lesion was nonpainful and progressively enlarged over 5 years. An excisional biopsy was performed, and the nodular lesion was subsequently diagnosed histopathologically as an angioleiomyoma. Owing to the ambiguous nature of the clinical findings, angioleiomyoma should be included in the differential diagnosis of lower-extremity soft-tissue manifestations.

  2. Impaired aerobic capacity and physical functional performance in older heart failure patients with preserved ejection fraction: role of lean body mass.

    Science.gov (United States)

    Haykowsky, Mark J; Brubaker, Peter H; Morgan, Timothy M; Kritchevsky, Stephen; Eggebeen, Joel; Kitzman, Dalane W

    2013-08-01

    Exercise intolerance is the primary chronic symptom in patients with heart failure and preserved ejection fraction (HFPEF), the most common form of heart failure in older persons, and can result from abnormalities in cardiac, vascular, and skeletal muscle, which can be further worsened by physical deconditioning. However, it is unknown whether skeletal muscle abnormalities contribute to exercise intolerance in HFPEF patients. This study evaluated lean body mass, peak exercise oxygen consumption (VO2), and the short physical performance battery in 60 older (69 ± 7 years) HFPEF patients and 40 age-matched healthy controls. In HFPEF versus healthy controls, peak percent total lean mass (60.1 ± 0.8% vs. 66.6 ± 1.0%, p physical performance battery was reduced (9.9 ± 1.4 vs. 11.3 ± 0.8) and correlated with peak VO2 and total and leg lean mass (all p physical functional performance compared with healthy controls. The markedly decreased peak VO2 indexed to lean body mass in HFPEF versus healthy controls suggests that abnormalities in skeletal muscle perfusion and/or metabolism contribute to the severe exercise intolerance in older HFPEF patients.

  3. Tbc1d1 mutation in lean mouse strain confers leanness and protects from diet-induced obesity

    DEFF Research Database (Denmark)

    Chadt, Alexandra; Leicht, Katja; Deshmukh, Atul

    2008-01-01

    We previously identified Nob1 as a quantitative trait locus for high-fat diet-induced obesity and diabetes in genome-wide scans of outcross populations of obese and lean mouse strains. Additional crossbreeding experiments indicated that Nob1 represents an obesity suppressor from the lean Swiss Jim...

  4. 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

  5. The pathophysiology of restless legs syndrome

    International Nuclear Information System (INIS)

    Miyamoto, Masayuki; Miyamoto, Tomoyuki; Iwanami, Masaoki; Suzuki, Keisuke; Hirata, Koichi

    2009-01-01

    Restless legs syndrome (RLS) is a sensorimotor disorder that is frequently associated with periodic leg movements (PLMS). RLS is generally considered to be a central nervous system (CNS)-related disorder although no specific lesion has been found to be associated with the syndrome. Reduced intracortical inhibition has been demonstrated in RLS by transcranial magnetic stimulation. Some MRI studies have revealed the presence of morphologic changes in the somatosensory cortex, motor cortex and thalamic gray matter. The results of single photon emission computed tomography (SPECT) and positron emission tomography (PET) studies showed that the limbic and opioid systems also play important roles in the pathophysiology of RLS. A functional MRI study revealed abnormal bilateral cerebellar and thalamic activation during the manifestation of sensory symptoms, with additional red nucleus and reticular formation activity during PLMS. PLMS is likely to occur in patients with spinal cord lesions, and some patients with sensory polyneuropathy may exhibit RLS symptoms. RLS symptoms seem to depend on abnormal spinal sensorimotor integration at the spinal cord level and abnormal central somatosensory processing. PLMS appears to depend on increased excitability of the spinal cord and a decreased supraspinal inhibitory mechanism from the A11 diencephalic dopaminergic system. RLS symptoms respond very dramatically to dopaminergic therapy. The results of analysis by PET and SPECT studies of striatal D2 receptor binding in humans are inconclusive. However, studies in animal models suggest that the participation of the A11 dopaminergic system and the D3 receptor in RLS symptoms. The symptoms of RLS are aggravated in those with iron deficiency, and iron treatment ameliorates the symptoms in some patients. Neuroimaging studies, analysis of the cerebrospinal fluid, and studies on postmortem tissue and use of animal models have indicated that low brain iron concentrations and dysfunction of

  6. GLUT4 protein expression in obese and lean 12-month-old rats: insights from different types of data analysis

    Directory of Open Access Journals (Sweden)

    P.M. Seraphim

    2001-10-01

    Full Text Available GLUT4 protein expression in white adipose tissue (WAT and skeletal muscle (SM was investigated in 2-month-old, 12-month-old spontaneously obese or 12-month-old calorie-restricted lean Wistar rats, by considering different parameters of analysis, such as tissue and body weight, and total protein yield of the tissue. In WAT, a ~70% decrease was observed in plasma membrane and microsomal GLUT4 protein, expressed as µg protein or g tissue, in both 12-month-old obese and 12-month-old lean rats compared to 2-month-old rats. However, when plasma membrane and microsomal GLUT4 tissue contents were expressed as g body weight, they were the same. In SM, GLUT4 protein content, expressed as µg protein, was similar in 2-month-old and 12-month-old obese rats, whereas it was reduced in 12-month-old obese rats, when expressed as g tissue or g body weight, which may play an important role in insulin resistance. Weight loss did not change the SM GLUT4 content. These results show that altered insulin sensitivity is accompanied by modulation of GLUT4 protein expression. However, the true role of WAT and SM GLUT4 contents in whole-body or tissue insulin sensitivity should be determined considering not only GLUT4 protein expression, but also the strong morphostructural changes in these tissues, which require different types of data analysis.

  7. Lean construction management the Toyota way

    CERN Document Server

    Gao, Shang

    2014-01-01

    The book presents a mixed research method adopted to assess and present the Toyota Way practices within construction firms in general and for firms in China specifically. The results of an extensive structured questionnaire survey based on the Toyota Way-styled attributes identified were developed, and data collected from building professionals working in construction firms is presented. The quantitative data presented in the book explains the status quo of the Toyota Way-styled practices implemented in the construction industry, as well as the extent to which these attributes were perceived for lean construction management. The book highlights all the actionable attributes derived from the Toyota Way model appreciated by the building professionals, but alerts the readers that some attributes felled short of implementation. Further findings from in-depth interviews and case studies are also presented in the book to provide to readers an understanding how these Toyota Way practices can be implemented in real-l...

  8. 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

  9. 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

  10. 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

    The purpose of this study was to estimate the genetic correlations among claw and leg health and potential indicator traits. Claw health was defined as absence of heel horn erosion, interdigital dermatitis, interdigital phlegmon, interdigital hyperplasia, laminitis, and sole ulcer. Leg health...

  11. Ratio of Trunk to Leg Volume as a New Body Shape Metric for Diabetes and Mortality

    Science.gov (United States)

    Wilson, Joseph P.; Kanaya, Alka M.; Fan, Bo; Shepherd, John A.

    2013-01-01

    Background Body shape is a known risk factor for diabetes and mortality, but the methods estimating body shape, BMI and waist circumference are crude. We determined whether a novel body shape measure, trunk to leg volume ratio, was independently associated with diabetes and mortality. Methods Data from the National Health and Nutritional Examination Survey 1999–2004, a study representative of the US population, were used to generate dual-energy X-ray absorptiometry-derived trunk to leg volume ratio and determine its associations to diabetes, metabolic covariates, and mortality by BMI category, gender, and race/ethnicity group. Results The prevalence of pre-diabetes and diabetes increased with age, BMI, triglycerides, blood pressure, and decreased HDL level. After adjusting for covariates, the corresponding fourth to first quartile trunk to leg volume ratio odds ratios (OR) were 6.8 (95% confidence interval [CI], 4.9–9.6) for diabetes, 3.9 (95% CI, 3.0–5.2) for high triglycerides, 1.8 (95% CI, 1.6–2.1) for high blood pressure, 3.0 (95% CI, 2.4–3.8) for low HDL, 3.6 (95% CI, 2.8–4.7) for metabolic syndrome, and 1.76 (95% CI, 1.20–2.60) for mortality. Additionally, trunk to leg volume ratio was the strongest independent measure associated with diabetes (Pleg volume ratio had a higher likelihood of death (5.5%) than those in the lowest quartile (0.2%). Overall, trunk to leg volume ratio is driven by competing mechanisms of changing adiposity and lean mass. Conclusions A high ratio of trunk to leg volume showed a strong association to diabetes and mortality that was independent of total and regional fat distributions. This novel body shape measure provides additional information regarding central adiposity and appendicular wasting to better stratify individuals at risk for diabetes and mortality, even among those with normal BMI. PMID:23874736

  12. Effects of 8 weeks of Xpand® 2X pre workout supplementation on skeletal muscle hypertrophy, lean body mass, and strength in resistance trained males.

    Science.gov (United States)

    Lowery, Ryan P; Joy, Jordan M; Dudeck, Joshua E; Oliveira de Souza, Eduardo; McCleary, Sean A; Wells, Shawn; Wildman, Robert; Wilson, Jacob M

    2013-10-09

    Xpand® 2X is a proprietary blend comprised of branched chain amino acids, creatine monohydrate, beta-alanine (CarnoSyn®), quercetin, coenzymated B-vitamins, alanyl-glutamine (Sustamine®), and natural nitrate sources from pomegranate and beet root extracts purported to enhance the neuromuscular adaptations of resistance training. However to date, no long-term studies have been conducted with this supplement. The purpose of this study was to investigate the effects of a multi-ingredient performance supplement (MIPS) on skeletal muscle hypertrophy, lean body mass and lower body strength in resistance-trained males. Twenty resistance-trained males (21.3 ± 1.9 years) were randomly assigned to consume a MIPS or a placebo of equal weight and volume (food-grade orange flavors and sweeteners) in a double-blind manner, 30 minutes prior to exercise. All subjects participated in an 8-week, 3-day per week, periodized, resistance-training program that was split-focused on multi-joint movements such as leg press, bench press, and bent-over rows. Ultrasonography measured muscle thickness of the quadriceps, dual-energy X-ray absorptiometry (DEXA) determined lean body mass, and strength of the bench press and leg press were determined at weeks 0, 4, and 8 of the study. Data were analyzed with a 2 × 3 repeated measures ANOVA with LSD post hoc tests utilized to locate differences. There was a significant group-by-time interaction in which the MIPS supplementation resulted in a significant (p supplementation nor the placebo in leg press strength (p = .08). MIPS supplementation also resulted in a significant increase in lean body mass (7.8% vs. 3.6%) and quadriceps muscle thickness (11.8% vs. 4.5%) compared with placebo (group*time, p hypertrophy in resistance-trained men.

  13. One-legged endurance training: leg blood flow and oxygen extraction during cycling exercise

    DEFF Research Database (Denmark)

    Rud, B; Foss, O; Krustrup, Peter

    2012-01-01

    Aim: As a consequence of enhanced local vascular conductance, perfusion of muscles increases with exercise intensity to suffice the oxygen demand. However, when maximal oxygen uptake (VO(2) max) and cardiac output are approached, the increase in conductance is blunted. Endurance training increases...... muscle metabolic capacity, but to what extent that affects the regulation of muscle vascular conductance during exercise is unknown. Methods: Seven weeks of one-legged endurance training was carried out by twelve subjects. Pulmonary VO(2) during cycling and one-legged cycling was tested before and after...... training, while VO(2) of the trained leg (TL) and control leg (CL) during cycling was determined after training. Results: VO(2) max for cycling was unaffected by training, although one-legged VO(2) max became 6.7 (2.3)% (mean ± SE) larger with TL than with CL. Also TL citrate synthase activity was higher...

  14. 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.

  15. 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...

  16. 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...... and an effectiveness point of view. Keywords Lean Thinking, Effective product development, The Toyota Product Development System, Lean Product Development, Flow, Waste, Value......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...

  17. 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.

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

    Science.gov (United States)

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

    2018-02-13

    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. © The Author(s) 2018. 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

  19. Lean thinking in healthcare: a realist review of the literature.

    Science.gov (United States)

    Mazzocato, Pamela; Savage, Carl; Brommels, Mats; Aronsson, Håkan; Thor, Johan

    2010-10-01

    To understand how lean thinking has been put into practice in healthcare and how it has worked. A realist literature review. Data sources The authors systematically searched for articles in PubMed, Web of Science and Business Source Premier (January 1998 to February 2008) and then added articles through a snowball approach. The authors included empirical studies of lean thinking applications in healthcare and excluded those articles that did not influence patient care, or reported hybrid approaches. The authors conducted a thematic analysis based on data collected using an original abstraction form. Based on this, they articulated interactions between context, lean interventions, mechanisms and outcomes. The authors reviewed 33 articles and found a wide range of lean applications. The articles describe initial implementation stages and emphasise technical aspects. All articles report positive results. The authors found common contextual aspects which interact with different components of the lean interventions and trigger four different change mechanisms: understand processes to generate shared understanding; organise and design for effectiveness and efficiency; improve error detection to increase awareness and process reliability; and collaborate to systematically solve problems to enhance continual improvement. Lean thinking has been applied successfully in a wide variety of healthcare settings. While lean theory emphasises a holistic view, most cases report narrower technical applications with limited organisational reach. To better realise the potential benefits, healthcare organisations need to directly involve senior management, work across functional divides, pursue value creation for patients and other customers, and nurture a long-term view of continual improvement.

  20. Analysis of the body mass index and leg profiles of Asian women after total leg sculpture.

    Science.gov (United States)

    Tsai, Feng-Chou; Chen, Chien-Hao; Lin, Chan-Yi; Ho, Li-Yung

    2009-08-01

    In addition to the conventional methods used to improve leg contours, total leg sculpture, including liposuction, selective neurectomy, and transilluminated powered phlebectomy, provides a one-time solution of leg contour problems, which is a major aesthetic concern among Asian women. The authors present the postoperative results of total leg sculpture and determine any significance and correlation between the leg variables and body mass index by statistical analysis. Thirty female patients who underwent total leg sculpture between 2005 and 2008 were included in the study, and prospective analysis of the patients' data was performed during a follow-up period of 1 year. Local measurement variables and body mass index were recorded, and the correlation between them was determined by Pearson's correlation and regression analysis. A paired t test was used to compare the postoperative outcomes. Subjectively, all patient results were satisfactory. There were significant differences between preoperative and postoperative measurements for all variables for total leg sculpture. Body mass index was strongly correlated with all leg indexes, and there was a significant positive correlation between the index and variables related to the buttocks and upper thigh. The satisfactory postoperative leg variables were buttocks circumference (87.85 cm), thigh circumference (T60, 44.20 cm), maximal calf circumference (32.24 cm), and calf ratio (0.78). Each preoperative body mass index increment represents a 0.3 percent circumference improvement around the buttocks after surgery. No obvious morbidities or long-term hospital stays were noted. Total leg sculpture provides a combined aesthetic solution for improving limb contours with minimal morbidity. Patients with larger body mass index values exhibit better aesthetic improvement than those with smaller values.

  1. 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

  2. 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.

  3. 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.

  4. Lean Manufacturing Implementation: an Approach to Reduce Production Cost

    Directory of Open Access Journals (Sweden)

    Iraswari

    2012-04-01

    Full Text Available Abstract: Lean Manufacturing Implementation: An Approach To Reduce Production Cost. Opportunities to improve production processes and reduce production cost through the implementation of lean manufacturing in small medium garment manufacturing are presented in this research. This research shows that there is a possibility of decrease in production cost and increase in return on sales. Lean manufacturing implementation can eliminate waste in the production process. This is a set of techniques for identification and elimination of waste gathered from The Ford Production, Statistical Process Control and other techniques. Improvement of quality could be carried out while time and cost of production are being reduced.

  5. 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.

  6. Therapeutic advances in restless legs syndrome (RLS).

    Science.gov (United States)

    Högl, Birgit; Comella, Cynthia

    2015-09-15

    Levodopa and dopamine agonists have been the main treatment for restless legs syndrome during the past decades. Although their efficacy has been well documented over the short term, long-term dopaminergic treatment is often complicated by augmentation, loss of efficacy, and other side effects. Recent large randomized controlled trials provide new evidence for the efficacy of high-potency opioids and α2δ ligands, and several post hoc analyses, meta-analyses, algorithms, and guidelines have been published, often with a specific focus, for example, on augmentation, or on management of restless legs syndrome during pregnancy. Several new contributions to understanding the pathophysiology of restless legs syndrome have been published, but at this time, whether they will have an impact on treatment possibilities in the future cannot be estimated. © 2015 International Parkinson and Movement Disorder Society.

  7. Conjoined legs: Sirenomelia or caudal regression syndrome?

    Directory of Open Access Journals (Sweden)

    Sakti Prasad Das

    2013-01-01

    Full Text Available Presence of single umbilical persistent vitelline artery distinguishes sirenomelia from caudal regression syndrome. We report a case of a12-year-old boy who had bilateral umbilical arteries presented with fusion of both legs in the lower one third of leg. Both feet were rudimentary. The right foot had a valgus rocker-bottom deformity. All toes were present but rudimentary. The left foot showed absence of all toes. Physical examination showed left tibia vara. The chest evaluation in sitting revealed pigeon chest and elevated right shoulder. Posterior examination of the trunk showed thoracic scoliosis with convexity to right. The patient was operated and at 1 year followup the boy had two separate legs with a good aesthetic and functional results.

  8. Leg Spasticity and Ambulation in Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Swathi Balantrapu

    2014-01-01

    Full Text Available Background. Spasticity of the legs is common in multiple sclerosis (MS, but there has been limited research examining its association with ambulatory outcomes. Objective. This study examined spasticity of the legs and its association with multiple measures of ambulation in persons with MS. Methods. The sample included 84 patients with MS. Spasticity of the legs was measured using a 5-point rating scale ranging between 0 (normal and 4 (contracted. Patients completed the 6-minute walk (6 MW, timed 25 foot walk (T25FW, and timed up-and-go (TUG, and O2 cost of walking was measured during the 6 MW. The patients undertook two walking trials on a GAITRite (CIR systems, Inc. for measuring spatial and temporal parameters of gait. The patients completed the Multiple Sclerosis Walking Scale-12 (MSWS-12 and wore an accelerometer over a seven-day period. Results. 52% (n=44 of the sample presented with spasticity of the legs. Those with leg spasticity had significantly worse ambulation as measured by 6 MW (P=0.0001, d=-0.86, T25FW (P=0.003,d=0.72, TUG (P=0.001, d=0.84, MSWS-12 (P=0.0001,d=1.09, O2 cost of walking (P=0.001, d=0.75, average steps/day (P<0.05, d=-0.45, and walking velocity (P<0.05, d=-0.53 and cadence (P<0.05, d=-0.46. Conclusion. Leg spasticity was associated with impairments in ambulation, including alterations in spatiotemporal parameters and free-living walking.

  9. The Molecular Genetics of Restless Legs Syndrome.

    Science.gov (United States)

    Rye, David B

    2015-09-01

    Restless legs syndrome (RLS) is a common sensorimotor trait defined by symptoms that interfere with sleep onset and maintenance in a clinically meaningful way. Nonvolitional myoclonus while awake and asleep is a sign of the disorder and an informative endophenotype. The genetic contributions to RLS/periodic leg movements are substantial, are among the most robust defined to date for a common disease, and account for much of the variance in disease expressivity. The disorder is polygenic, as revealed by recent genome-wide association studies. Experimental studies are revealing mechanistic details of how these common variants might influence RLS expressivity. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Nocturnal leg cramps in older people

    Science.gov (United States)

    Butler, J; Mulkerrin, E; O'Keeffe, S

    2002-01-01

    Nocturnal leg cramps are common in older people. Such cramps are associated with many common diseases and medications. Physiological methods may be useful for preventing cramps in some people, but there have been no controlled trials of these approaches. Quinine is moderately effective in preventing nocturnal leg cramps. However, there are concerns about the risk/benefit ratio with this drug. In patients with severe symptoms, a trial of 4–6 weeks' treatment with quinine is probably still justified, but the efficacy of treatment should be monitored, for example using a sleep and cramp diary. PMID:12415081

  11. Symptom Severity of Restless Legs Syndrome Predicts Its Clinical Course.

    Science.gov (United States)

    Lee, Chung Suk; Kim, Tae; Lee, Sumin; Jeon, Hong Jun; Bang, Young Rong; Yoon, In-Young

    2016-04-01

    This study examines the clinical course of restless legs syndrome according to its severity and factors associated with the remission of restless legs syndrome symptoms. The remission or persistence of restless legs syndrome symptoms was investigated by considering patients with restless legs syndrome at the sleep clinic of Seoul National University Bundang Hospital. All subjects were observed for at least 18 months, and an incidence of remission was defined as having no restless legs syndrome symptoms for at least 1 year. Restless legs syndrome severity was evaluated by the International Restless Legs Syndrome Study Group Rating Scale. A total of 306 patients participated in this study. Over the observation periods of 4.1 ± 1.6 years, the cumulative incidence of remission is 32.5% (95% confidence interval [CI], 27.0-38.0) and decreased with baseline restless legs syndrome severity (P restless legs syndrome cases, respectively. Most cases of remission (82/96) were observed within 1 year, and the remission occurred sooner for mild restless legs syndrome. The hazard ratios of remission by Cox proportional hazards model were lower for moderate (0.556; 95% CI, 0.340-0.909) and severe to very severe (0.193; 95% CI, 0.108-0.343) restless legs syndrome than for mild restless legs syndrome. The remission incidence was lower for those patients who had a family history of restless legs syndrome and were older at restless legs syndrome diagnosis. Mild restless legs syndrome severity, no family history, and young age at restless legs syndrome diagnosis were significant predictors of restless legs syndrome remission. More than 80% of patients with severe restless legs syndrome showed a chronic clinical course. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. 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.

  13. Mesenchymal stem cell in venous leg ulcer: An intoxicating therapy.

    Science.gov (United States)

    Athanerey, Anjali; Patra, Pradeep Kumar; Kumar, Awanish

    2017-08-01

    Venous leg ulcers (VLU) are a prevalent and reoccurring type of complicated wound, turning as a considerable public healthcare issue, with critical social and economic concern. There are both medical and surgical therapies to treat venous leg ulcers; however, a cure does not yet exist. Mesenchymal stem cells (MSC) are capable and proved of accelerating wound healing in vivo and their study with human chronic wounds is currently awaited. MSCs are a promising source of adult progenitor cells for cellular therapy and have been demonstrated to differentiate into various mesenchymal cell lineages. They have a crucial and integral role in native wound healing by regulating immune response and inflammation. Improved understanding of the cellular and molecular mechanisms at work in delayed wound healing compels to the development of cellular therapy in VLU. This review focuses on the current treatment option of VLU and further emphasizing the role of MSCs in accelerating the healing process. With further understanding of the mechanism of action of these cells in wound improvement and, the involvement of cytokines can also be revealed that could be used for the therapeutic purpose for VLU healing. Clinical uses of MSCs have been started already, and induced MSCs are surely a promising tool or compelling therapy for VLU. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  14. Clinical characteristics of leg restlessness in Parkinson's disease compared with idiopathic Restless Legs Syndrome.

    Science.gov (United States)

    Zhu, Xiao-Ying; Liu, Ye; Zhang, Xiao-Jin; Yang, Wen-Hao; Feng, Ya; Ondo, William G; Tan, Eng-King; Wu, Yun-Cheng

    2015-10-15

    There is limited data on motor restlessness in Parkinson's disease (PD). Here we evaluate for clinical differences between cohorts of idiopathic Restless Legs Syndrome (iRLS), PD patients with leg restlessness, and PD with RLS. We examined 276 consecutive PD patients for leg restlessness symptoms, we compared clinical features of PD patients with RLS, PD patients with leg restlessness but not meeting RLS criteria, PD patient without RLS and iRLS. A total of 262 PD patients who satisfied the inclusion criteria were analyzed. After excluding 23 possible secondary RLS or mimics, 28 were diagnosed with RLS and 18 with leg motor restlessness (LMR). Compared with iRLS patients, PD patients with RLS or LMR had older age of RLS/LMR onset, shorter duration of leg restlessness, less positive family history, different seasonal trends and more unilaterality of leg restlessness symptom (Pleg restlessness. PD with LMR had less severe Parkinsonism (Pleg restlessness (P<0.01) symptoms than PD with RLS. Clinical characteristics of PD patients with RLS and LMR were different from iRLS, differentiating these various subtypes can facilitate optimal treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. 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.

  16. Lean, green and resilient practices influence on supply chain performance

    DEFF Research Database (Denmark)

    Govindan, K.; Azevedo, S. G.; Carvalho, H.

    2015-01-01

    of the lean, green and resilient practices is expected to be of great value for their effective implementation by the automotive companies. The interpretive structural modeling approach is used as a useful methodology to identify inter-relationships among lean, green and resilient practices and supply chain......Nowadays, companies are struggling to find an appropriate supply chain strategy to achieve competitiveness. Among the available strategies lean, green and resilient are considered as a new management strategies for the supply chain management to achieve competitiveness. The major issues with theses...... strategies are the integration and identification of critical issues related to the strategies. This paper aims to identify the critical lean, green and resilient practices on which top management should focus in order to improve the performance of automotive supply chains. The systematic analysis...

  17. 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.

  18. Implications of Lean Manufacturing for Human Resource Strategy.

    Science.gov (United States)

    Forrester, Rosalind

    1995-01-01

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

  19. 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.

  20. 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.

  1. Multi-Element Lean Direct Injection Combustor Module, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — We propose to develop a Multi-Element Lean Direct Injection, ME-LDI, Combustion concept with the following innovative features: 1. Independent, mini burning zones...

  2. Lean six sigma case studies in the healthcare enterprise

    CERN Document Server

    Furterer, Sandra L

    2014-01-01

    This book provides a detailed description of how to apply Lean Six Sigma in the health care industry, with a special emphasis on process improvement and operations management in hospitals.  The book begins with a description of the Enterprise Performance Excellence (EPE) improvement methodology developed by the author that links several methodologies including systems thinking, theory of constraints, Lean and Six Sigma to provide an enterprise-wide prioritization and value-chain view of health care. The EPE methodology helps to improve flow at the macro or value-chain level, and then identifies Lean Six Sigma detailed improvements that can further improve processes within the value-chain.  The book also provides real-world health care applications of the EPE and Lean Six Sigma methodologies that showed significant results on throughput, capacity, operational and financial performance. The Enterprise Performance Excellence methodology is described, and also the Six Sigma DMAIC (Define-Measure-Analyze-Improve...

  3. 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.

  4. 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.

  5. 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.

  6. Thermal Radiation Properties of Turbulent Lean Premixed Methane Air Flames

    National Research Council Canada - National Science Library

    Ji, Jun; Sivathanu, Y. R; Gore, J. P

    2000-01-01

    ... of turbulent premixed flames. Reduced cooling airflows in lean premixed combustors, miniaturization of combustors, and the possible use of radiation sensors in combustion control schemes are some of the practical reasons...

  7. 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.

  8. Operations Strategy and –Innovation? -A Contractor Implementing Lean

    DEFF Research Database (Denmark)

    Koch, Christian; Simonsen, Rolf

    2006-01-01

    Traditional strategic management and operations strategy wants us to believe that the implementation of management concepts is a simple strategic choice made by top managers. In this paper we introduce the story of Lean Construction entering into the organisation of a Danish contractor. Lean...... actors/brokers and coalitions. Lean Construction is shaped in the process of emergence in the organisation, where also explicit corporate strategies and other initiatives of the organization interact with the concept and the actors and coalitions surrounding it. It is analysed how Lean Construction...... Construction is viewed as a management concept and the journey into the construction company witness not only that top management is very little involved, but also that the concept is negotiated and promoted by a number of actors and coalitions competing for attention and resources with a number of other...

  9. [The influence of the leg load and the support mobility under leg on the anticipatory postural adjustment].

    Science.gov (United States)

    Kazennikov, O V; Kireeva, T B; Shlykov, V Iu

    2015-01-01

    Anticipatory postural adjustment is an essential part of equilibrium maintainance during standing in human. So changes in stance condition could affect both control of equilibrium and anticipatory adjustment. Anticipatory changes in the stabilogram of each leg were studied in standing subject during the early stage of quick right arm lifting while legs were on two separated supports. The center of pressure (CP) movement was analyzed in three variants of experiment: both legs on immovable support, with only right leg on the movable support and with only left leg on the moveable support. In each standing condition subject stood with symmetrical load on two legs or with the load voluntary transferred to one leg. The anticipatory CP shift depended on the mobility of the support under the leg and on loading of the leg. While standing on unmovable supports with symmetrical load on the legs before lifting of the right arm CP of right leg shifted backward and CP of left leg--forward. While standing with one leg on movable support the anticipatory CP shift of this leg was small and did not depend on the load on the leg. However the shift of CP of the leg that was placed on the unmovable support depended on the load in the same way as in the case when both legs were on unmovable supports. Results suggested that since on movable support the support and proprioceptive afferent flow from distal part of the leg that was did not supply unambiguous information about body position, the role of distal joints in posture control is reduced.

  10. 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

  11. Study and application on lean resin converting in uranium mill

    International Nuclear Information System (INIS)

    Zhao Shaoxi; Huang Qijin; Zhu Shuguang; Yi Faqing; Du Wenjie

    2012-01-01

    The field test about sulphuric acid used to convert lean resin was finished. The results indicated sulphuric acid could replace chlorin in lean resin and could be reclaimed to desorption procedure. The consumption of NaCl decreased, the chlorin concentration of tailing decreased too. Both of uranium loss and waste water volume were reduced. The uranium concentration of tailing decreased and energy saving and emission reduction can be achieved. (authors)

  12. 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....

  13. Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

    Science.gov (United States)

    Kane, Marlena; Chui, Kristen; Rimicci, Janet; Callagy, Patrice; Hereford, James; Shen, Sam; Norris, Robert; Pickham, David

    2015-09-01

    A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities.

  14. Agile and Lean Systems Engineering: Kanban in Systems Engineering

    Science.gov (United States)

    2011-12-31

    major changes in the way work is accomplished or imply specific organizational structures like other agile methods (e.g. Scrum ). Such systems can be...Contract Number: H98230-08-D-0171 DO1, TTO2, RT 035 Report No. SERC-2011-TR-022 December 31, 2011 UNCLASSIFIED Agile and Lean Systems Engineering...3. DATES COVERED 4. TITLE AND SUBTITLE Agile and Lean Systems Engineering: Kanban in Systems Engineering 5a. CONTRACT NUMBER H98230-08-D

  15. Does Lean & Agile Project Management Help Coping with Project Complexity?

    OpenAIRE

    Jalali Sohi, A.; Hertogh, M.J.C.M.; Bosch-Rekveldt, M.G.C.; Blom, R.; Serpell, A.; Ferrada, X.

    2016-01-01

    Still, projects in the construction sector are delivered with time delays and cost overruns. One of the reasons for poor performance was assigned to project complexity. A combination of lean construction and agile project management are hypothesized as a possible solution to cope with project complexity. In this paper we aim to understand if the implicit usage of lean and agile help coping with complexity. The research was done by means of correlation analysis on data gathered from a structur...

  16. 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.

  17. Automation from lean perspective-potentials and challenges

    OpenAIRE

    Zafarzadeh, Masoud; Jackson, Mats

    2013-01-01

    The competitive climate of production and high labour cost, motivate western companies to use technologies like automation as a mean to increase manufacturing competitiveness. On the other hand companies are aware about cost reductive policies like lean production which has shown noticeable achievement, consequently some manufacturers tend to follow such system. In this situation, in order to have lean enterprise, it is vital to find a clear picture of challenges and potentials of implementin...

  18. Aplikace lean managementu ve vybrané firmě

    OpenAIRE

    Zeman, Tomáš

    2014-01-01

    Abstract: The bachelor thesis is about approaches of lean management in operational ma-nagement. This way of thinking is based on Japanese methods of lean management and continuous improvement kaizen. These methods aim to eliminate all types of wasteing, shorten lead time and increase quality of output. The bachelor thesis is divided into two parts. In the theoretical part will be described theoretical knowledge and practical part, which will include direct practical solutions to problems in ...

  19. A Lean Approach to Scheduling Systems Engineering Resources

    Science.gov (United States)

    2013-05-01

    application in SE. We have defined a general Kanban -based Scheduling System (KSS) that we believe captures the essence of lean flow management visibility...finally delivered to the user Lean approaches strive to maximize flow through a process— often by using on-demand ( Kanban ) scheduling techniques...Technical Report,” Systems Engineering Research Center, SERC-2010-TR004, December 2009. 8. Anderson, David. (2010). Kanban : Successful Evolutionary

  20. 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.