Relationship of TQM and business performance with mediator of SPC, Lean Production and TPM

In today s highly competitive market, the demand for quality is the single most critical factor for companies to survive in the ever-expanding global marketplace. The concept of Total Quality Management (TQM) has been developed as a result of intense global competition. Most of the previous works show that TQM has significant relationship with business performance. However, the examining of moderators is less given in previous work, which mediators are known generally as general tools and techniques without specific focus on types of improvement. The purpose of this paper is to propose relationship between TQM practices and business performance with mediators of Statistical Process Control (SPC), Lean Production (LP) and Total Productive Maintenance (TPM) based on extensive review of the literature. Study on TQM, Lean Production, TPM and SPC generally investigate the practices and business performance in isolation. The main contribution of this paper is to identify the relationships among TQM, TPM, SPC and Lean Production practices as a conceptual model. This proposed conceptual model will help the academicians and industry players to have better understanding on the relationship between the practices and step by step implementation to improve business performance. The structural equation modeling (SEM) techniques are used to examine the relationships of the practices.©2012 the Authors. Published by Elsevier Ltd. Open Access under the Creative Commons Attribution–NonCommercial–NoDerivatives 4.0 International (CC BY–NC–ND 4.0) license, https://creativecommons.org/licenses/by-nc-nd/4.0/fi=vertaisarvioitu|en=peerReviewed

The incidence, prevalence and mortality of granulomatosis with polyangiitis in the UK Clinical Practice Research Datalink

Objectives: To estimate the incidence, prevalence and mortality of Granulomatosis with polyangiitis (GPA) in the United Kingdom. Methods: We conducted a historical cohort study using data from the Clinical Practice Research Datalink and Hospital Episode Statistics (CPRD-HES). We calculated incidence rate ratios, adjusted for age, gender and ethnicity, using Poisson regression. Results: We identified 462 cases diagnosed between 1997 and 2013. Our overall estimate of incidence was 11.8 (95% CI 10.7-12.9)/million person-years. Incidence in children (aged <16 years) was 0.88 (95% CI 0.40-1.96), and adults 14.0 (95% CI 12.8-15.4). The incidence was lower in females (adjusted IRR 0.68; 95% CI 0.56-0.81) and highest in the 55-69 year age-group (adjusted IRR 9.5, 95% CI 6.9-13.0; reference group 0-39 years). Incidence was not significantly different in the Black / Minority Ethnic population compared to the white population (adjusted odds ratio 0.78, 95% CI 0.53-1.13, p=0.13). The prevalence in 2013 was 134.9 (121.3-149.6) /million. Mortality was 13.6% at 1-year, and higher in HES than CPRD-identified cases (Hazard ratio 3.16, 95% CI 2.19-4.56, p<0.001). Conclusions: By combining primary and secondary care datasets we have found the incidence and mortality of granulomatosis with polyangiitis to be higher than previously reported. We predict that at present each year in the UK there will be approximately 700 new cases of whom 95 will die within 12 months

Morphometric Analysis and Prioritization of Watersheds for Soil Erosion Management in Upper Gibe Catchment

As morphometric investigation is connected to prioritization of watershed, morphometric analysis has got a significance role in light of soil and water conservation. In this study, an endeavour for the examination of point by point morphometric analyses of sub-basins was accomplished through the measurement of linear and shape parameters by using ArcGIS-9.3 software. Specifically, linear and shape morphometric parameters like stream length, stream order, drainage density, stream frequency, bifurcation ratio, Length of overland flow, basin perimeter, form factor, compactness coefficient, elongation ratio has been considered. The SRTM DEM (30 x 30 m) is processed for the delineation resulting in 61 sub-basins. The morphometric parameters which affect the soil erodibility are considered to organize the sub-basins and relegate positions on the premise of their association with erodibility to get compound parameter (Cp) esteem. Based on the value of Cp the sub-basin with the lowest Cp value was given the highest priority and then categorized the sub-basins into three classes as high, medium and low in terms of priority. Accordingly, high priority zone comprises 11 sub-basins, medium 19 and low 31 sub-basins. The sub-basins which are falling under high priority were a great deal more defenceless to soil disintegration and ought to be given high need for land preservation measures

Delayed heart perforation after blunt trauma

A 33-year-old patient was hospitalized after a blunt chest trauma with a left flail chest. Six hours after admission to the intensive care unit the patient suddenly developed hypotension and tachycardia. His left chest tube drained 1.5 l of blood within minutes. Immediate resuscitation and emergency sternotomy with left anterolateral extension was performed for pericardial tamponade secondary to left ventricular perforation due to a sharp rib fragment. Outcome was favourable and the patient was operated on for his flail chest by internal stabilization the next da

Tips and turns of bacteriophytochrome photoactivation

Phytochromes are ubiquitous photosensor proteins, which control the growth, reproduction and movement in plants, fungi and bacteria. Phytochromes switch between two photophysical states depending on the light conditions. In analogy to molecular machines, light absorption induces a series of structural changes that are transduced from the bilin chromophore, through the protein, and to the output domains. Recent progress towards understanding this structural mechanism of signal transduction has been manifold. We describe this progress with a focus on bacteriophytochromes. We describe the mechanism along three structural tiers, which are the chromophore-binding pocket, the photosensory module, and the output domains. We discuss possible interconnections between the tiers and conclude by presenting future directions and open questions. We hope that this review may serve as a compendium to guide future structural and spectroscopic studies designed to understand structural signaling in phytochromes.Peer reviewe

Re-thinking resuscitation: Leaving blood pressure cosmetics behind and moving forward to permissive hypotension and a tissue perfusion-based approach

Definitions of shock and resuscitation endpoints traditionally focus on blood pressures and cardiac output. This carries a high risk of overemphasizing systemic hemodynamics at the cost of tissue perfusion. In line with novel shock definitions and evidence of the lack of a correlation between macro- and microcirculation in shock, we recommend that macrocirculatory resuscitation endpoints, particularly arterial and central venous pressure as well as cardiac output, be reconsidered. In this viewpoint article, we propose a three-step approach of resuscitation endpoints in shock of all origins. This approach targets only a minimum individual and context-sensitive mean arterial blood pressure (for example, 45 to 50 mm Hg) to preserve heart and brain perfusion. Further resuscitation is exclusively guided by endpoints of tissue perfusion irrespectively of the presence of arterial hypotension ('permissive hypotension'). Finally, optimization of individual tissue (for example, renal) perfusion is targeted. Prospective clinical studies are necessary to confirm the postulated benefits of targeting these resuscitation endpoints

Moderating effect of asean free trade agreement between total quality management and business performance

The unprecedented pace of globalisation, trade liberalisation, and capital movement in the later years profoundly changed to pose serious challenges for Malaysian companies to compete in an open market. In today's highly competitive market, the demand for quality is important factor for companies to survive in the ever-expanding global marketplace. The concept of Total Quality Management (TQM) has been developed as a result of intense global competition. ASEAN trade liberalisation through the elimination of intraregional tariffs contributed to improving manufacturing in ASEAN countries to be more efficient and competitive in world markets. However, Asean Free Trade Agreement (AFTA) is a good news for foreign companies as they have competitive advantages, but not for local companies. The examining of AFTA as a moderator is less done in previous work. The purpose of this paper is to propose relationship between TQM practices and business performance with moderator effects of AFTA. The main contribution of this paper is to examine whether AFTA has the effect as a moderator. This proposed conceptual model will help the academicians and industry players to have better understanding on the effect of AFTA in TQM implementation in improving their business performance. The structural equation modeling (SEM) techniques are used to examine the relationships of the practices.©2014 the Authors. Published by Elsevier Ltd. Open Access under the Creative Commons Attribution–NonCommercial–NoDerivatives 4.0 International (CC BY–NC–ND 4.0) license, https://creativecommons.org/licenses/by-nc-nd/4.0/fi=vertaisarvioitu|en=peerReviewed

Influenza A(H1N1) infection and severe cardiac dysfunction in adults: A case series

Zusammenfassung: HINTERGRUND: Während die virale Myokarditis und das Herzversagen anerkannte und gefürchtete Komplikationen einer saisonalen Influenza A Infektion sind, liegen bislang nur wenig Informationen über ein durch das 2009 Influenza A(H1N1) Virus induziertes Herzversagen vor. METHODEN UND HAUPTERGEBNISSE: Diese Fallsammlung fasst den Krankheitsverlauf von vier Patienten mit 2009 Influenza A(H1N1) Infektion zusammen, welche an unserer Klinik im Zeitraum von November 2009 bis September 2010 behandelt wurden. Alle Patienten präsentierten sich mit einer schweren kardialen Funktionsstörung (akutes Herzversagen, kardiogener Schock oder Herzkreislaufstillstand im Rahmen eines Kammerflimmerns) als das führende Symptom einer Influenza A(H1N1) Infektion. Zwei Patienten waren mit hoher Wahrscheinlichkeit kardial vorerkrankt, und drei benötigten eine Katecholamintherapie, um die hämodynamische Funktion zu stabilisieren. Mit Ausnahme eines Patienten der vor der Diagnosestellung der Influenza A(H1N1) Infektion verstarb, wurden alle Patienten mit einer antiviralen Therapie mit Oseltamivir und supportiver Intensivtherapie behandelt. Ein Acute Respiratory Distress Syndrom infolge der Influenza A(H1N1) Infektion trat bei einem Patienten auf. Die Herzfunktion normalisierte sich bei zwei Patienten und war bei einem Patienten noch bei Krankenhausentlassung eingeschränkt. SCHLUSSFOLGERUNG: Eine Influenza A(H1N1) Infektion kann mit einer schweren kardialen Funktionseinschränkung assoziiert sein. Diese kann sich sogar als führendes klinisches Symptom darstellen. Während einer Influenza Pandemie kann eine genaue Anamneseerhebung Grippeähnliche Symptome hervorbringen und sollte auch bei kritisch kranken Patienten mit akutem Herzversagen eine Diagnostik auf H1N1 Infektion veranlasse

Luokanopettajien näkemyksiä yhteisopettajuudesta

Tiivistelmä. Tässä pro gradu -tutkielmassa tarkastelemme yhteisopettajuutta, sen etuja ja haasteita sekä ammatillista kasvua. Yhteisopettajuus on keino toteuttaa opetusta sekä oppilaita että opettajia hyödyttävällä tavalla. Opetusmuotona yhteisopettajuutta ei vielä tunneta kovinkaan yleisesti ja tutkimusta siitä ei Suomessa ole juuri tehty. Aiemmissa tutkimuksissa yhteisopettajuudessa toinen opettaja on erityisopettaja. Tämän vuoksi perehdyimme yhteisopettajuuteen kahden luokanopettajan välillä. Tutkielmamme tutkimuskysymyksillä pyrimme perehtymään opettajien näkemyksiin siitä, mitä yhteisopettajuus on, millaisia etuja ja haasteita siinä ilmenee sekä miten yhteisopettajuus vaikuttaa opettajien ammatilliseen kasvuun. Tutkielmamme taustalla oleva teoria määrittää yhteisopettajuuden kahden opettajan väliseksi yhteistoiminnaksi heterogeenisessä ryhmässä. Yhteisopettajuudella on monia toimintamalleja sekä erilaisia etuja ja haasteita. Yhteisopettajuus on nähty yhtenä ammatillisen kasvun keinona. Ammatillinen kasvu koostuu opettajien ammatillisesta oppimisesta ja kehityksestä. Tutkielmamme on laadullinen tutkimus, joka toteutettiin fenomenografisella tutkimusotteella teemahaastattelun avulla. Haastateltavina oli neljä yhteisopettajuutta toteuttavaa opettajaa. Haastatteluissa oli tarkoitus saada opettajien näkemyksiä yhteisopettajuuteen. Tutkimustulokset muotoutuivat aineistolähtöisen sisällönanalyysin avulla. Tutkielmassamme saimme selville opettajien näkemyksiä yhteisopettajuudesta. Opettajat määrittivät yhteisopettajuuden tärkeimmäksi olemukseksi työn jakamisen. Yhteisopettajuuden etuina nähtiin kollegiaalinen yhteistyö sekä oppilaiden saama hyöty useamman aikuisen läsnäolosta. Haasteena pidettiin suuria oppilasmääriä, jotka saattavat hankaloittaa opetusta. Yhteisopettajuudessa ammatillista kasvua nähtiin tapahtuvan toista opettajaa seuraamalla sekä opettajuudesta keskustelemalla. Tutkimustuloksistamme voidaan päätellä yhteisopettajuuden olevan laajempaa yhteistyötä, kuin miten aiempi tutkimus on sen määritellyt. Yhteisopettajuuden ei välttämättä tarvitse tapahtua samassa luokkatilassa jatkuvasti. Haastateltavamme toteuttivat yhteisopettajuutta eri tavoilla. Osa opettajista toteutti yhteisopettajuutta kokonaisvaltaisesti yhdessä ja osalla toiminta oli keskittynyt tiettyihin oppiaineisiin. Yhteisopettajuus nähtiin helpottavan opettajan työtä laajasti, koska työtä voitiin jakaa ja asioista keskustella. Mielestämme yhteisopettajuutta voidaan hyödyntää keinona vastaamaan jatkuvasti muuttuvaan koulumaailmaan

Hemodynamic variables and mortality in cardiogenic shock: a retrospective cohort study

INTRODUCTION: Despite the key role of hemodynamic goals, there are few data addressing the question as to which hemodynamic variables are associated with outcome or should be targeted in cardiogenic shock patients. The aim of this study was to investigate the association between hemodynamic variables and cardiogenic shock mortality. METHODS: Medical records and the patient data management system of a multidisciplinary intensive care unit (ICU) were reviewed for patients admitted because of cardiogenic shock. In all patients, the hourly variable time integral of hemodynamic variables during the first 24 hours after ICU admission was calculated. If hemodynamic variables were associated with 28-day mortality, the hourly variable time integral of drops below clinically relevant threshold levels was computed. Regression models and receiver operator characteristic analyses were calculated. All statistical models were adjusted for age, admission year, mean catecholamine doses and the Simplified Acute Physiology Score II (excluding hemodynamic counts) in order to account for the influence of age, changes in therapies during the observation period, the severity of cardiovascular failure and the severity of the underlying disease on 28-day mortality. RESULTS: One-hundred and nineteen patients were included. Cardiac index (CI) (P = 0.01) and cardiac power index (CPI) (P = 0.03) were the only hemodynamic variables separately associated with mortality. The hourly time integral of CI drops 0.05). The hourly time integral of CPI drops 0.05). CONCLUSIONS: During the first 24 hours after intensive care unit admission, CI and CPI are the most important hemodynamic variables separately associated with 28-day mortality in patients with cardiogenic shock. A CI of 3 L/min/m2 and a CPI of 0.8 W/m2 were most predictive of 28-day mortality. Since our results must be considered hypothesis-generating, randomized controlled trials are required to evaluate whether targeting these levels as early resuscitation endpoints can improve mortality in cardiogenic shock