Processes and Skills Manufacturing Organizational Leaders Use to Implement Corporate Restructuring

Corporate restructuring implementation failure has the potential for adverse business outcomes. Business owners are concerned with corporate restructuring implementation failure, as it is the number one predictor of the collapse of businesses. Grounded in transformational leadership theory and business process reengineering model, the purpose of this qualitative multiple case study was to explore the processes and skills business owners use to minimize corporate restructuring implementation failure. The participants comprised 10 business owners of the manufacturing sector who minimized corporate restructuring implementation failure. Data were collected using semistructured interviews and a review of the organization’s corporate restructuring information on social media platforms. Through the modified Van Kaam method of analysis 10 themes were identified: continuous improvement, restructuring proactiveness, stakeholder engagement, capacity building, communication, transparency, diverse leadership skills, leadership self-leading, monitoring and evaluation, and coaching. A key recommendation is for business leaders to have a proactive mindset in corporate restructuring implementation through the recognition, continuous engagement, and influence of all stakeholders to implement daily, weekly, monthly, and continuous improvement systems. The implications for positive social change include the potential to sustain businesses, maintain employees, create jobs, support employees’ families, and the economic development of their communities

Reasons for discontinuation of novel oral anticoagulant therapy in patients with atrial fibrillation

Aims: We sought to investigate the reasons for, and rates of, novel oral anticoagulant (DOAC) therapy discontinuation.Methods: This was an observational cohort study of patients with atrial fibrillation (AF) referred to a regional DOAC outpatient clinic between February 2013 and October 2017. The study population consisted of 875 consecutive patients with AF who visited the DOAC outpatient unit to initiate treatment with apixaban (N = 303), dabigatran (N = 267) or rivaroxaban (N = 305) for long-term ischemic stroke prophylaxis. All the patients came from the Leeuwarden Medical Center cardiology outpatient clinic, which offers a well structured and nurse-run DOAC unit in cooperation with the hospital's thrombosis service. This clinic operates according to the Dutch nationwide guidelines on integration of anticoagulation services.Results: Overall rate of discontinuation was 11.9 per 100 patient-years of follow-up. Discontinuation rates for apixaban, dabigatran and rivaroxaban were 8.1, 16.6 and 11.5 per 100 patient-years of follow-up.Apixaban had the lowest rate of discontinuation during the 36 month follow-up period. Dabigatran and rivaroxaban had high discontinuation rates during the 3-6 month period following DOAC therapy initiation. The main reasons for discontinuation of DOAC therapy were adverse side effects, patient-initiated discontinuation and any bleed.Limitation: This was a retrospective and non-randomized study, and our results should be interpreted in light of these observations.Conclusion: DOAC discontinuation rates varied significantly and appeared related to drug-specific side effects, patient-initiated discontinuation and bleeding. We observed longer-term administration of apixaban, suggesting that this drug is better tolerated than dabigatran or rivaroxaban

Minor bleeding in patients with atrial fibrillation using a non-vitamin K antagonist oral anticoagulant

Aims: We sought to investigate the magnitude of minor bleeding and identify risk factors for minor bleeds during non-vitamin K antagonist oral anticoagulant (NOAC) therapy.Methods: This was an observational cohort study of patients with atrial fibrillation (AF) referred to a regional NOAC outpatient clinic between February 2013 and October 2017. The study population consisted of 875 consecutive patients with AF who visited the NOAC outpatient unit to initiate treatment with apixaban (N = 303), dabigatran (N = 267) or rivaroxaban (N = 305) for long-term ischemic stroke prophylaxis. Minor bleed was defined as every overt bleeding that does not fulfil the criteria of major or non-major clinically relevant bleeding according to the International Society on Thrombosis and Haemostasis.Results: Overall rate of minor bleeds was 19.2 per 100 patient years of follow up. Bleeding rates for apixaban, dabigatran and rivaroxaban were 26, 8.3 and 23 per 100 patient-years of follow-up. Next to the type of NOAC, the main risk indicators for minor bleedings during NOAC therapy were a HAS-BLED score of 3 or higher and novel anticoagulant use (no history of vitamin K antagonist use).Limitation: This was a retrospective observational study evaluating NOAC treatment in a non-randomized setting.Conclusion: Our data showed that minor bleeds are common in novel NOAC users, especially when using apixaban and rivaroxaban. In the latter two NOACs, hematoma (bruises) and nose bleeds were more frequently observed and accounted for the difference with dabigatran. Besides type of NOAC, a higher HAS-BLED score and novel anticoagulant drug use were associated with an increased risk of minor bleeding

Comparação de cortes transversais do nervo massetérico de cadáveres humanos processados por duas diferentes técnicas histológicas

Em cadáveres humanos o estudo histológico de nervos espinais e cranianos tem sido complementar à descrição do seu trajeto anatômico, norteando assim procedimentos cirúrgicos e de bloqueio. O objetivo deste trabalho foi descrever a localização anatômica do nervo massetérico e identificar qual técnica histológica mais indicada para analisar morfometricamente as fibras nervosas mielinizadas de cadáveres fixados pós-congelamento do acervo do Laboratório de Anatomia Humana da UFRGS. Foram utilizados 4 cadáveres caucasianos do gênero feminino com faces íntegras, totalizando 8 hemifaces estudadas. Dois cadáveres foram recém-retirados das cubas de formol e os outros dois já estavam em mesas de estudo há 1 ano e banhados com solução de preservação. O posicionamento do nervo massetérico e da artéria massetérica em relação ao tragus e ao arco zigomático foram registrados através do uso de um paquímetro digital. Em cada hemiface, após o registro de medidas foi coletado um segmento do nervo, antes da sua ramificação, o qual foi dividido em duas partes iguais. Cada parte foi utilizada para uma técnica específica: RA - inclusão em resina acrílica com coloração em Azul de Toluidina e PHE - inclusão em parafina com coloração em Hematoxilina-Eosina. Para análises histológicas e morfométricas, as imagens dos cortes transversais dos nervos do lado direito de dois cadáveres, sendo um da cuba de formol e um da mesa de estudo foram capturadas e digitalizadas com um microscópio Nikon Eclipse E-600 (Japan) acoplado a uma câmera de alta performance CCD. Para análise das imagens foi usado o Software ZEN 2.3 (Zeiss). Foram realizadas medidas da área de secção transversa do nervo e da densidade de fibras nervosas mielinizadas e mensuráveis. De acordo com os resultados o nervo esteve localizado na profundidade do músculo masseter a 32,3±2,6 mm de distância do tragus e a 8,2±0,9 mm de distância do arco zigomático. A artéria massetérica apresentou-se imediatamente posterior e inferior ao nervo em todos os cadáveres. Ambos estavam posicionados a 10,1±0,9 mm da superfície. O cadáver oriundo da cuba apresentou a melhor preservação microscópica do nervo massetérico, quando comparado com o da mesa, e isso ficou melhor evidenciado pelo processamento histológico RA em relação ao PHE. Os axônios do nervo oriundo do cadáver da cuba, processado com a técnica RA, apresentaram-se com aspecto circular bem definido, as bainhas de mielina bem coradas e homogêneas em meio a tecido conjuntivo sem rupturas. Este mesmo nervo no processamento em PHE apresentou-se com retração axonal, má definição das fibras nervosas e com a presença de espaçamentos endoneurais. A área de secção transversa do nervo deste cadáver foi menor que a dos outros e ele também apresentou uma densidade maior de fibras nervosas mielinizadas e identificáveis. Em conclusão, o nervo massetérico esteve localizado a cerca de 3,2 cm anteriormente ao tragus, 0,8 cm inferiormente ao arco zigomático e a cerca de 1 cm de profundidade. A melhor técnica histológica para analisar morfometricamente as fibras nervosas mielinizadas de cadáveres fixados pós-congelamento do acervo do Laboratório de Anatomia Humana da UFRGS foi a RA. Adicionalmente, o corpo oriundo da cuba de formol mostrou ter melhor preservação estrutural do nervo massetérico em comparação com cadáver oriundo das mesas de estudo.The histological study of spinal and cranial nerves in human cadavers has been complementary to the description of its anatomical path, guiding surgical procedures. The objective of this work was to describe the anatomical location of the masseteric nerve and identify the most efficient histological technique for the morphometric analyses of the myelinated nerve fibers of post-freezing fixed cadavers from the Laboratory of Human Anatomy of UFRGS. Four caucasian female cadavers with intact faces were used, totaling 8 hemifaces studied. Two corpses were freshly removed from the formaldehyde vats and the other two were already on study tables for 1 year and bathed with preservation solution. The positioning of the masseteric nerve and the masseteric artery in relation to the tragus and the zygomatic arch were measured by using a digital caliper. In each hemiface, a nerve segment was collected after measurement immediately before its branching, and was divided into two equal parts. Each part was used for a specific technique: RA - inclusion in acrylic resin with Toluidine Blue staining and PHE - inclusion in paraffin with Hematoxylin-Eosin staining. For the histological and morphometric analyses, the images of the cross-sectional sections of the nerve segments on the right side of two cadavers, one from the formaldehyde vat and one from the study table, were captured and digitized with a Nikon Eclipse E-600 (Japan) microscope coupled to a High performance CCD camera. The software ZEN 2.3 (Zeiss) was used to analyze the images. The cross-sectional area of the nerve and the density of the measurable myelinated nerve fibers were measured. According to the results, the nerve was located at the depth of the masseter muscle at 32.3 ± 2.6 mm from the tragus and at 8.2 ± 0.9 mm from the zygomatic arch. The masseteric artery was immediately posterior and inferior to the nerve in all corpses. Both were positioned at 10.1 ± 0.9 mm from the surface. The cadaver from the vat presented the best microscopic preservation of the massetric nerve when compared to the nerves of the cadaver from the laboratory table. This was further bought to evidence by the RA histological processing in relation to the PHE. The axons of the nerve from the cadaver of the vat processed with the RA technique presented well-defined circular appearance, well-stained and homogeneous myelin sheaths in the middle of connective tissue without ruptures. This same nerve in the PHE processing presented with axonal retraction, poor definition of nerve fibers and with the presence of endoneurial spaces. The cross-sectional area of the nerve from the vat was smaller than that of the others and presented a higher density for myelinated and identifiable nerve fibers. In conclusion, the masseteric nerve was located about 3.2 cm anterior to the tragus, 0.8 cm inferior to the zygomatic arch and about 1 cm deep. The best histological technique for the morphometric analyses of the myelinated nerve fibers of the fixed post-freezing cadavers from the Laboratory of Human Anatomy of UFRGS was RA. Additionally, the cadaver from the formaldehyde vat showed to have better preservation of the massetric nerve in comparison with cadaver from the study tables

Costs of minor bleeds in atrial fibrillation patients using a non-vitamin K antagonist oral anticoagulant

BACKGROUND: A very common side effect of non-vitamin K antagonist oral anticoagulant (NOAC) is (minor) bleeding. Data about impact and costs of minor bleeds in NOAC therapy is still limited or not present in current literature. In this patient orientated study, we aim to provide an estimate of the costs of minor bleeds in patients with atrial fibrillation (AF) treated with a NOAC. METHODS: A retrospective observational cohort study was conducted. Patients with AF and on NOAC therapy were included. Data was obtained by questionnaires and information from electronic patient records. Reference prices were used to calculate the costs per patient. Furthermore, cost of minor bleeds per patient is compared with literature-based costs of minor and major bleeding. RESULTS: 139 patients were included. A total of 94 minor bleed were reported by 71 patients. The sum of minor bleeding costs from societal perspective were €9,851.49, or on average €70,87 (95% CI €54,37 - €85,68) per patient with AF. The biggest cost drivers were rectal and vaginal bleeds, epistaxis was most commonly reported. CONCLUSION: Total costs of minor bleeds from a societal perspective, in AF patients using NOACs, are non trivial and exceed the costs presented in existing literature

Effect of tree age on fruit characteristics, seed emergence and seedling growth in Rambutan (Nephelium lappaceum L.)

Rambutan (Nephelium lappaceum L.) is an important exotic fruit from Asia, which is gaining popularity due to its nutritional benefits. The objective of the study was to evaluate the effect of tree age on fruit characteristics, seed emergence and seedling growth of rambutan. The study was conducted at the CSIR-Plant Genetic Resources Research Institute, Bunso, Ghana. Fruits of rambutan were harvested from 8, 10, 25 and 40 years old trees at different locations of the field genebank. For each tree age, three trees were used as replicates. Fruits harvested from trees of different ages were assessed for total fruit weight, pulp weight, pericarp weight, seed weight, percentage seed emergence, seedling plant height and number of leaves at monthly intervals. Fruits harvested from 8, 10, 25 and 40 years old trees did not show significant difference in fruit characteristics and seed emergence. Significant (p<0.05) differences were observed in plant height and number of leaves at 5 and 6 months after emergence, respectively

EfficientPPS: Part-aware Panoptic Segmentation of Transparent Objects for Robotic Manipulation

The use of autonomous robots for assistance tasks in hospitals has the potential to free up qualified staff and im-prove patient care. However, the ubiquity of deformable and transparent objects in hospital settings poses signif-icant challenges to vision-based perception systems. We present EfficientPPS, a neural architecture for part-aware panoptic segmentation that provides robots with semantically rich visual information for grasping and ma-nipulation tasks. We also present an unsupervised data collection and labelling method to reduce the need for human involvement in the training process. EfficientPPS is evaluated on a dataset containing real-world hospital objects and demonstrated to be robust and efficient in grasping transparent transfusion bags with a collaborative robot arm

Adherence to protocols for the use of reversal agents in patients treated with direct oral anticoagulants

OBJECTIVES: This study aimed to evaluate the adherence to protocols for the use of reversal agents in direct oral anticoagulant (DOAC) users in Dutch hospitals.METHODS: A retrospective cohort study was conducted in seven hospitals in the Netherlands. Treatment protocols for bleeding and (urgent) procedures in patients on DOAC were collected from each hospital. All patient data on the use of reversal agents were retrospectively collected from September 2021 to April 2022 and compared to the protocols. The degree of per-protocol adherence (compliance score) was categorized into four levels as follows: poor (&lt;45%), moderate (45-79%), high (80-89%), and full (&gt; 90%) adherence rates.RESULTS: A total of 290 patients were included in our study. In patients with bleeding under DOAC, the protocol adherence for prothrombin complex concentrate (PCC) was "moderate" (61%). In the remaining cases (39%), non-adherence was mainly caused by underdosing (68%), overdosing (12%), and a lack of indication (14%). Furthermore, idarucizumab was administered for bleeding with "full" adherence (96%). For andexanet alfa, adherence to the hospital bleeding protocol was "moderate" (67%), with a lack of indication being the only reason for non-adherence. In case of reversal for an urgent procedure, the protocol adherence for PCC was "low" (45%), with underdosing, a lack of indication, and missing lab data being the main reasons for non-adherence. Missing lab data on dabigatran plasma concentration before reversal was the main reason for "low" adherence (26%) in idarucizumab. The adherence for andexanet alfa was also "low" (0%).CONCLUSION: In case of reversal for bleeding under DOAC, overall adherence to the protocol was "moderate"; however, in patients needing an urgent procedure, it was "low." The major reasons for non-adherence were underdosing, off-label use, and a lack of specific lab testing. The results of this study can assist in improving the implementation of hospital protocols.</p

Significance of Ear Wax Impaction in School Children: A Case of Winneba West Circuit, Ghana

Cerumen or earwax is a mixture of secretions that is sebum together with secretions from modified apocrine glands and sloughed epithelial cells present in the external auditory canals of humans. Earwax impaction is one of the most common reasons patients seek medical care for ear-related problems such as blockage and conductive hearing impairment. However, in Ghana there is virtually no literature on earwax impaction among school children. The aim of the study was to determine the prevalence of school children with wax impaction in Government assisted basic schools in the Winneba West circuit of the Effutu Municipal. This cross-sectional study included 4407 children between the ages of 5 to 16 years from 11 government assisted basic schools in the Winneba West circuit, of the Effutu municipal, Ghana. The instruments used were otoscopy and interview of randomly selected children on the use of cotton-tipped ear swabs for cleaning their ears. Out of the 4407 children, earwax impaction was found in 988 (22.4%). There was a marginal difference in the prevalence of earwax impaction in females compared to males; that is, of the 988 with earwax impaction 522 (53%) were females and 466 (47%) were males. However, the use of cotton-tipped swab could not be directly associated with earwax impaction. Earwax impaction and its attendant challenges is a problem amongst Ghanaian basic school children. The high prevalence of earwax impaction among basic school children in Winneba (Ghana) can lead to conductive hearing impairment which can affect the academic performance of the children negatively. Regular hearing screening involving processes such as otoscopy at the entry point and at regular intervals is being recommended for early identification and remediation. Keywords: Ear wax (cerumen) impaction, Cotton-tipped swa