Exploring the Interaction Between Internal Customer Satisfaction and Talent Waste: A Lean Management Perspective1

Principles of lean management have become more popular in recent years and the implementation area of Lean, spread from manufacturing environment to service sectors due to its wide applicability. Human centric structure of service sector reveals the need of lean principles which focuses on improvements related to employees. In lean thinking, elimination of wastes is one of the priority and it is essential to eliminate them for organizational enhancements. Wastes in lean were firstly defined under seven categories as overproduction, over-processing, waiting, motion, inventory, defect, transportation for manufacturing environment. However, these wastes were not found adequate, since one of the most important factor in organizations, human, was ignored. Therefore, the 8th waste of lean was presented as “talent” in order to include the human factor and it refers to underutilization of people’s talent, knowledge, skills and abilities. As eliminating talent waste has been perceived as an important concept, it should be a significant driver of increasing internal customer satisfaction. This study aims to explore the relation between talent waste and internal customer satisfaction while considering level of top management commitment. Within this context a survey was conducted with the participation of whitecollar internal customers to understand their perception of talent waste related to their jobs. At the end of the study, it is found that talent waste partially mediates the relationship between top management commitment and internal customer satisfaction

The Need for Information and Support among First-degree Relatives of Patients with Breast Cancer What Do We Know?

Objective:Since first-degree female relatives (FDFRs) of women with breast cancer (BC) also have a high risk of developing BC, providing them information and support is important and this should not be overlooked. The purpose of the study is to determine the needs of primary relatives of women with BC in Turkey for information and support. Methods:This article is a descriptive research. A total of 199 volunteer relatives of patients with BC were reached and interviewed by nurses in a university hospital’s oncology clinic. They completed the Information and Support Needs Questionnaire. Parametric, non parametric, and multiple regression tests were used in statistical analysis.Results:In the study, a statistically significant difference was observed between the information and support needs and demographics of FDFRs (p<0.05). The rate of information need was higher among those who had a risk of BC and who practiced protective behaviors regularly. And also the rate of unmet support need was higher among those who had a risk of BC and who did not practice protective behaviors (p<0.05). The need for information and support is increasing in the FDFRs of women with BC whose diagnosis time prolonged.Conclusion:This study showed that FDFRs of patients with BC needed information and psychosocial support. Nurses should have an important role in communicating with relatives of patients with BC

Turner syndrome and associated problems in turkish children: A multicenter study

Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population. Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014. Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosi) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto’s thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%. Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespan. © Journal of Clinical Research in Pediatric Endocrinology

First-line treatment of patients with HER2-positive metastatic gastric and gastroesophageal junction cancer

Fluoropyrimidine+cisplatin/oxaliplatin+trastuzumab therapy is recommended for the first-line treatment of HER2-positive metastatic gastric adenocarcinoma. However, there is no comprehensive study on which platinum-based treatment should be preferred. This study aimed to compare the treatment response and survival characteristics of patients with HER2-positive metastatic gastric or gastroesophageal junction (GEJ) cancer who received fluorouracil, oxaliplatin, and leucovorin (mFOLFOX)+trastuzumab or cisplatin and fluorouracil (CF)+trastuzumab as first-line therapy. It was a multicenter, retrospective study of the Turkish Oncology Group, which included 243 patients from 21 oncology centers. There were 113 patients in the mFOLFOX+trastuzumab arm and 130 patients in the CF+trastuzumab arm. The median age was 62 years in the mFOLFOX+trastuzumab arm and 61 years in the CF+trastuzumab arm (P = 0.495). 81.4% of patients in the mFOLFOX+trastuzumab arm and 83.1% in the CF+trastuzumab arm had gastric tumor localization (P = 0.735). The median progression-free survival (PFS) was significantly higher in the mFOLFOX+trastuzumab arm (9.4 months vs. 7.3 months, P = 0.024). The median overall survival (OS) was similar in both groups (18.4 months vs. 15.1 months, P = 0.640). Maintenance trastuzumab was continued after chemotherapy in 101 patients. In this subgroup, the median OS was 23.3 months and the median PFS was 13.3 months. In conclusion, mFOLFOX+trastuzumab is similar to CF+trastuzumab in terms of the median OS, but it is more effective in terms of the median PFS in the first-line treatment of HER2-positive metastatic gastric and GEJ cancer. The choice of treatment should be made by considering the prominent toxicity findings of the chemotherapy regimens

Temperature Effects Explain Continental Scale Distribution of Cyanobacterial Toxins

Insight into how environmental change determines the production and distribution of cyanobacterial toxins is necessary for risk assessment. Management guidelines currently focus on hepatotoxins (microcystins). Increasing attention is given to other classes, such as neurotoxins (e.g., anatoxin-a) and cytotoxins (e.g., cylindrospermopsin) due to their potency. Most studies examine the relationship between individual toxin variants and environmental factors, such as nutrients, temperature and light. In summer 2015, we collected samples across Europe to investigate the effect of nutrient and temperature gradients on the variability of toxin production at a continental scale. Direct and indirect effects of temperature were the main drivers of the spatial distribution in the toxins produced by the cyanobacterial community, the toxin concentrations and toxin quota. Generalized linear models showed that a Toxin Diversity Index (TDI) increased with latitude, while it decreased with water stability. Increases in TDI were explained through a significant increase in toxin variants such as MC-YR, anatoxin and cylindrospermopsin, accompanied by a decreasing presence of MC-LR. While global warming continues, the direct and indirect effects of increased lake temperatures will drive changes in the distribution of cyanobacterial toxins in Europe, potentially promoting selection of a few highly toxic species or strains.Peer reviewe

Data Descriptor : A European Multi Lake Survey dataset of environmental variables, phytoplankton pigments and cyanotoxins

Under ongoing climate change and increasing anthropogenic activity, which continuously challenge ecosystem resilience, an in-depth understanding of ecological processes is urgently needed. Lakes, as providers of numerous ecosystem services, face multiple stressors that threaten their functioning. Harmful cyanobacterial blooms are a persistent problem resulting from nutrient pollution and climate-change induced stressors, like poor transparency, increased water temperature and enhanced stratification. Consistency in data collection and analysis methods is necessary to achieve fully comparable datasets and for statistical validity, avoiding issues linked to disparate data sources. The European Multi Lake Survey (EMLS) in summer 2015 was an initiative among scientists from 27 countries to collect and analyse lake physical, chemical and biological variables in a fully standardized manner. This database includes in-situ lake variables along with nutrient, pigment and cyanotoxin data of 369 lakes in Europe, which were centrally analysed in dedicated laboratories. Publishing the EMLS methods and dataset might inspire similar initiatives to study across large geographic areas that will contribute to better understanding lake responses in a changing environment.Peer reviewe

Stratification strength and light climate explain variation in chlorophyll a at the continental scale in a European multilake survey in a heatwave summer

To determine the drivers of phytoplankton biomass, we collected standardized morphometric, physical, and biological data in 230 lakes across the Mediterranean, Continental, and Boreal climatic zones of the European continent. Multilinear regression models tested on this snapshot of mostly eutrophic lakes (median total phosphorus [TP] = 0.06 and total nitrogen [TN] = 0.7 mg L−1), and its subsets (2 depth types and 3 climatic zones), show that light climate and stratification strength were the most significant explanatory variables for chlorophyll a (Chl a) variance. TN was a significant predictor for phytoplankton biomass for shallow and continental lakes, while TP never appeared as an explanatory variable, suggesting that under high TP, light, which partially controls stratification strength, becomes limiting for phytoplankton development. Mediterranean lakes were the warmest yet most weakly stratified and had significantly less Chl a than Boreal lakes, where the temperature anomaly from the long-term average, during a summer heatwave was the highest (+4°C) and showed a significant, exponential relationship with stratification strength. This European survey represents a summer snapshot of phytoplankton biomass and its drivers, and lends support that light and stratification metrics, which are both affected by climate change, are better predictors for phytoplankton biomass in nutrient-rich lakes than nutrient concentrations and surface temperature

Kayısı Çekirdeğine Bağlı Akut Siyanür İntoksikasyonu: Beyin Manyetik Rezonans Görüntüleme Bulguları

Siyanür düşük dozlarda bile hızlıca dakikalar içerisinde ölüme yol açabilen güçlü bir zehirdir. Erik, kiraz, kayısı, şeftali, acı badem gibi meyvelerin çekirdeklerinde bulunan amigdalin maddesi midede hidrojen siyanüre dönüşebilmektedir. Siyanür zehirlenmeleri nadiren siyanür glikozitleri içeren gıda ürünlerinin alımını takiben gözlenir. Kayısı çekirdeği yenmesine bağlı siyanür intoksikasyonu gelişen 3,5yaşındaki erkek hastaya intoksikasyonun 9. gününde beyin manyetik rezonans görüntüleme yapıldı. Beyin Manyetik rezonans görüntülemede, bilateral lentiform nükleusta hemorajik hasar ve kaudat nükleuslarda hasar gözlemlendi. Amacımız kayısı çekirdeği yenmesinden sonra meydana gelen siyanür zehirlenmesi olgusunun beyin manyetik rezonans görüntüleme bulgularını sunmaktır.Cyanide is a strong poison which acts rapidly and which may lead to death in minutes even at low doses. The substance of amigdaline which is found in seeds of fruit including plum, cherry, apricot, peach and bitter almond can be converted into hydrogen cyanide in the stomach. Cyanide intoxications are rarely observed following the ingestion of food products that contain cyanide glycosides. Brain magnetic resonance imaging was performed 9 days after intoxication in a 3.5-year old male patient in whom cyanide poisoning developed as a result of intake of apricot seed. On brain magnetic resonance imaging, hemorrhagic damage was found in bilateral lentiform nuclei and damage was found in the caudate nuclei. Our aim was to present magnetic resonance imaging findings related to cyanide poisoning which occurred after the ingestion of apricot seed