An Examination of MPCS and Their Relationship to Competitive Advantage

Manufacturing organizations are renovating their factories to become increasingly competitive in global markets. With this renovation they are focusing their attention on innovative programs. Since managerial time is limited, the increase in attention to these programs means less emphasis on traditional manufacturing planning and control systems. The research question asked by this study is: How effective are traditional manufacturing planning and control systems for increasing factory competitiveness

Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock – a systematic review and meta-analysis

INTRODUCTION: Procalcitonin (PCT) algorithms for antibiotic treatment decisions have been studied in adult patients from primary care, emergency department, and intensive care unit (ICU) settings, suggesting that procalcitonin-guided therapy may reduce antibiotic exposure without increasing the mortality rate. However, information on the efficacy and safety of this approach in the most vulnerable population of critically ill patients with severe sepsis and septic shock is missing. METHOD: Two reviewers independently performed a systematic search in PubMed, Embase, ISI Web of Knowledge, BioMed Central, ScienceDirect, Cochrane Central Register of Controlled Trials, http://www.ClinicalTrials.gov and http://www.ISRCTN.org. Eligible studies had to be randomized controlled clinical trials or cohort studies which compare procalcitonin-guided therapy with standard care in severe sepsis patients and report at least one of the following outcomes: hospital mortality, 28-day mortality, duration of antimicrobial therapy, length of stay in the intensive care unit or length of hospital stay. Disagreements about inclusion of studies and judgment of bias were solved by consensus. RESULTS: Finally seven studies comprising a total of 1,075 patients with severe sepsis or septic shock were included in the meta-analysis. Both hospital mortality (RR [relative risk]: 0.91, 95%CI [confidence interval]: 0.61; 1.36) and 28-day mortality (RR: 1.02, 95%CI: 0.85; 1.23) were not different between procalcitonin-guided therapy and standard treatment groups. Duration of antimicrobial therapy was significantly reduced in favor of procalcitonin-guided therapy (HR [hazard ratio]: 1.27, 95%CI: 1.01; 1.53). Combined estimates of the length of stay in the ICU and in hospital did not differ between groups. CONCLUSION: Procalcitonin-guided therapy is a helpful approach to guide antibiotic therapy and surgical interventions without a beneficial effect on mortality. The major benefit of PCT-guided therapy consists of a shorter duration of antibiotic treatment compared to standard care. Trials are needed to investigate the effect of PCT-guided therapy on mortality, length of ICU and in-hospital stay in severe sepsis patients

Diagnostic Confidence of Run-Off CT-Angiography as the Primary Diagnostic Imaging Modality in Patients Presenting with Acute or Chronic Peripheral Arterial Disease

Objectives To investigate the reliability of CT-angiography of the lower extremities (run-off CTA) to derive a treatment decision in patients with acute and chronic peripheral artery disease (PAD). Materials and Methods 314 patients referred for run-off CTA were includ-ed in this retrospective study. First, diagnostic confidence of run-off CTA to derive a treat-ment decision was assessed in an interdisciplinary vascular conference using a 2 point scale (sufficient or not sufficient diagnostic confidence) and compared with the image quality eval-uated by two readers in consensus in four different levels (abdominopelvic, thigh, calf, foot arteries). Second, reliability of treatment decision was verified in all patients undergoing re-vascularization therapy. Results Diagnostic confidence of run-off CTA to derive a treatment deci-sion was sufficient in all patients with acute and in 97% of patients (215/221) with chronic PAD, whereas the rate of run-off CTA with non-diagnostic image quality was considerably higher in the calf and foot level (acute vs. chronic; calf: 28% vs.17%; foot: 52% vs. 20%). Reliability of treatment decision was superior for patients with chronic (123/133 = 92%) than for patients with acute PAD (64/78 = 82%, P = 0.02). Conclusion Run-off CTA is a reliable imaging modality for primary diag-nostic work-up of patients with acute and chronic PAD

Same or Not the Same? Comparison Between Employees Prone to Overplacement, Overestimation, and Overprecision in Information Security

Overconfidence has been shown to have a detrimental effect on information security in enterprises. However, research on this systematic misperception of one’s abilities and skills is fragmented, and evidence on who is at risk of overconfidence is scarce. Using a cluster analysis in conjunction with a large-scale survey of 2,867 employees of a pharmaceutical company, we examine information security overconfidence and identify commonalities between risk groups. Our findings help raise awareness and understanding of this widespread phenomenon and can help design appropriate interventions

Evaluation of neutral oral contrast agents for assessment of the small bowel at abdominal staging CT.

BACKGROUND:Although neutral oral contrast agents are widely in use, a consensus regarding a standardized protocol in abdominal staging CT does not exist. PURPOSE:To test the null hypothesis that there is no quantitative or qualitative difference between water and mannitol for evaluation of the small bowel at abdominal staging CT. MATERIAL AND METHODS:180 patients prospectively underwent abdominal staging CT with oral administration of either 1 liter mannitol solution (n = 88) or water (n = 92). Intestinal distension was measured in 6 different segments of the small intestine. In addition, two radiologists separately evaluated diagnostic image quality with regards to luminal distension (three-point scale) in each segment and the possibility to rule out a possible underlying pathology. Quantitative and qualitative results were compared (Mann-Whitney test). RESULTS:Quantitatively, intestinal distension was comparable in all segments (p>0.05), except for the horizontal duodenum (p = 0.019). The mean luminal diameter over all intestinal segments was 19.0 mm (18.1-19.9 mm) for the water group and 18.4 mm (17.5-19.2 mm) for the mannitol group, respectively. Qualitatively, ratings were comparable for the first three segments, while distal segments were rated better using mannitol. Side effects were only observed using mannitol (n = 26; 29.5%). CONCLUSIONS:Orally administered water and mannitol solution for evaluation of the small bowel at abdominal staging CT in clinical routine resulted in comparable results for the quantitative, but not for the qualitative analysis. Looking more differentiated at the overall performance, water has advantages in terms of patient comfort, side effects and costs, and can therefore be regarded as noninferior to mannitol in this specific patient group

Lung tumour growth kinetics in SPC-c-Raf-1-BB transgenic mice assessed by longitudinal in-vivo micro-CT quantification

<p>Abstract</p> <p>Background</p> <p>SPC-c-Raf-1-BxB transgenic mice develop genetically induced disseminated lung adenocarcinoma allowing examination of carcinogenesis and evaluation of novel treatment strategies. We report on assessment of lung tumour growth kinetics using a semiautomated region growing segmentation algorithm.</p> <p>Methods</p> <p>156 non contrast-enhanced respiratory gated micro-CT of the lungs were obtained in 12 SPC-raf transgenic (n = 9) and normal (n = 3) mice at different time points. Region-growing segmentation of the aerated lung areas was obtained as an inverse surrogate for tumour burden. Time course of segmentation volumes was assessed to demonstrate the potential of the method for follow-up studies.</p> <p>Results</p> <p>Micro-CT allowed assessment of tumour growth kinetics and semiautomated region growing enabled quantitative analysis. Significant changes of the segmented lung volumes over time could be shown (<it>p </it>= 0.009). Significant group differences could be detected between transgenic and normal animals for time points 8 to 13 months (<it>p </it>= 0.043), when marked tumour progression occurred.</p> <p>Conclusion</p> <p>The presented region-growing segmentation algorithm allows in-vivo quantification of multifocal lung adenocarcinoma in SPC-raf transgenic mice. This enables the assessment of tumour load and progress for the study of carcinogenesis and the evaluation of novel treatment strategies.</p