Comparative Analysis of Lean and Six Sigma in Building Construction: Benefits, Obstacles and Opportunities

Lean and Six Sigma have been recognized as innovative strategies that can be used to transform a firm’s management practices to a newer level. However, there is little guidance, or evidence indicating whether Lean or Six Sigma enhance the construction process significantly. This research fills this gap by investigating major obstacles, benefits and opportunities of Lean and Six Sigma as published in journal papers. A structured literature research (SLR) was performed to identify and compare lean and Six Sigma case studies and analyzed their findings and conclusions. This SLR resulted in a matrix that identifies the obstacles, benefits and opportunities of using Six Sigma and lean practices to assist industry practitioners adopt and implement these strategies

Outcome measurement in speech and language therapy: a digital journey

Background Evidencing the impact of speech and language therapy interventions is challenging. The UK’s professional body for speech and language therapists (SLTs) is supporting a consistent approach to outcome measurement and analysis using Therapy Outcome Measures (TOMs). Objective To develop a digital solution for collecting TOMs data, evaluate the impact of therapeutic interventions and explore contributing factors to outcome variation across clinical areas. \ud Method Agile methodology was applied to software development. Organisations were recruited to provide data. Criteria were identified to exemplify outcome variability. Results A digital tool was developed. 21 organisations provided data on 16 356 individuals. Improvement in at least one domain of TOMs occurred in 77.1% of instances. Data for two clinical areas exemplify the tool’s effectiveness in highlighting the impact of speech and language therapy. Conclusion This established outcomes data set can be used to evaluate the impact of speech and language therapy, and explore variation in outcomes

Quality of care in adult patients with inflammatory bowel disease transferring between healthcare providers: multicentre audit

Background: Inflammatory bowel disease (IBD) predominantly affects young adults at critical socioeconomic periods of their lives. There are no studies examining the process of transfer of care for adult patients with IBD changing healthcare providers. Our aims were to assess the quality of referral information provided when patients with an established IBD diagnosis transfer care between heathcare providers and to assess the impact of referral quality on patient outcome. / Methods: Retrospective data pertaining to IBD transfer of care referrals were collected from 16 hospitals across London over a 2-month period. Data were collected on patient demographics, source and content of referral and cross-referenced with an established transfer of care checklist. Patient outcome within the 6 months following transfer was also documented. / Results: 154 cases were identified, over half of which transferred due to patient relocation. Details included in transfer letters were in many cases incomplete. In over 70% of cases, the letter came from primary care, including when a tertiary opinion was sought. Although referrals from primary care contained fewer patient data points, there was no association with poor patient outcomes at 6 months. / Conclusion: This is the first study examining the quality of transfer of care in adult patients with IBD. We highlighted a significant and underreported issue and found that the majority of referrals were led by primary care. Though the inclusion in the referral of fewer data points was not associated with poor outcomes, we highlighted an area where gastroenterologists might take more responsibility to provide smooth and robust transfer of care

Epigenetic and metabolic reprogramming of fibroblasts in Crohn's disease strictures reveals histone deacetylases as therapeutic targets.

BACKGROUND & AIMS: No effective therapeutic intervention exists for intestinal fibrosis in Crohn's disease [CD]. We characterised fibroblast subtypes, epigenetic and metabolic changes, and signalling pathways in CD fibrosis to inform future therapeutic strategies. METHODS: We undertook immunohistochemistry, metabolic, signalling pathway and Epigenetic [Transposase-Accessible Chromatin using sequencing] analyses associated with collagen production in CCD-18Co intestinal fibroblasts and primary fibroblasts isolated from stricturing [SCD] and non-stricturing [NSCD] CD small intestine. SCD/ NSCD fibroblasts were cultured with TGFβ and valproic acid [VPA]. RESULTS: Stricturing CD was characterised by distinct histone deacetylase [HDAC] expression profiles, particularly HDAC1, HDAC2, and HDAC7. As a proxy for HDAC activity, reduced numbers of H3K27ac+ cells were found in SCD compared to NSCD sections. Primary fibroblasts had increased extracellular lactate [increased glycolytic activity] and intracellular hydroxyproline [increased collagen production] in SCD compared to NSCD cultures. The metabolic effect of TGFβ-stimulation was reversed by the HDAC inhibitor VPA. SCD fibroblasts appear "metabolically primed" and responded more strongly to both TGFβ and VPA. Treatment with VPA revealed TGFβ-dependent and independent Collagen-I production in CCD-18Co cells and primary fibroblasts. VPA altered the epigenetic landscape with reduced chromatin accessibility at the COL1A1 and COL1A2 promoters. CONCLUSIONS: Increased HDAC expression profiles, H3K27ac hypoacetylation, a significant glycolytic phenotype, and metabolic priming, characterise SCD-derived as compared to NSCD fibroblasts. Our results reveal a novel epigenetic component to Collagen-I regulation and TGFβ-mediated CD fibrosis. HDAC inhibitor therapy may 'reset' the epigenetic changes associated with fibrosis

Small-molecule Wnt inhibitors are a potential novel therapy for intestinal fibrosis in Crohns disease

Intestinal fibrosis and stricture formation is an aggressive complication of Crohns disease (CD), linked to increased morbidity and costs. The present study investigates the contribution of Wingless-Int-1 (Wnt) signalling to intestinal fibrogenesis, considers potential cross-talk between Wnt and transforming growth factor β1 (TGFβ) signalling pathways, and assesses the therapeutic potential of small-molecule Wnt inhibitors. β-catenin expression was explored by immunohistochemistry (IHC) in formalin-fixed paraffin embedded (FFPE) tissue from patient-matched nonstrictured (NSCD) and strictured (SCD) intestine (n=6 pairs). Functional interactions between Wnt activation, TGFβ signalling, and type I collagen (Collagen-I) expression were explored in CCD-18Co cells and primary CD myofibroblast cultures established from surgical resection specimens (n=16) using small-molecule Wnt inhibitors and molecular techniques, including siRNA-mediated gene knockdown, immunofluorescence (IF), Wnt gene expression arrays, and western blotting. Fibrotic SCD tissue was marked by an increase in β-catenin-positive cells. In vitro, activation of Wnt-β-catenin signalling increased Collagen-I expression in CCD-18Co cells. Conversely, ICG-001, an inhibitor of β-catenin signalling, reduced Collagen-I expression in cell lines and primary CD myofibroblasts. TGFβ increased β-catenin protein levels but did not activate canonical Wnt signalling. Rather, TGFβ up-regulated WNT5B, a noncanonical Wnt ligand, and the Wnt receptor FZD8, which contributed directly to the up-regulation of Collagen-I through a β-catenin-independent mechanism. Treatment of CCD-18Co fibroblasts and patient-derived myofibroblasts with the FZD8 inhibitor 3235-0367 reduced extracellular matrix (ECM) expression. Our data highlight small-molecule Wnt inhibitors of both canonical and noncanonical Wnt signalling, as potential antifibrotic drugs to treat SCD intestinal fibrosis. They also highlight the importance of the cross-talk between Wnt and TGFβ signalling pathways in CD intestinal fibrosis

Government regulations on demand response

Thesis (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, 2012.Cataloged from PDF version of thesis.Includes bibliographical references (p. 42-43).A vision of distributed energy generation, storage, electric vehicles and a "smart-grid" has been the driving force of a number of regulations and policies to promote a steady evolution of the existing & future infrastructure relating to the generation, transmission, distribution and retailing of electrical energy. Demand Response (DR) is often cited for smoothing this evolution as it has the ability to shave peaks and provide flexibility in load to dynamically adapt to an increasingly variable supply from renewable energy resources. In general, there are regulations and policies which are inadvertently increasing supply volatility (e.g., wind & solar). There are regulations and policies increasing technology adoption to decrease supply volatility (e.g., storage). There are regulations and policies which are inadvertently increasing demand volatility (e.g., electric vehicles). Finally, there are regulations and policies to increase technology adoption to decrease demand volatility (e.g., demand response). While the individual regulations are well-intentioned, from a holistic point-of-view, it is unclear how the combination of these government regulations will influence the electricity industry. The approach to answer this question is the creation of a System Dynamics Model of the Electricity industry highlighting demand response, energy efficiency initiatives, electric vehicles, storage, and variable energy resources and associated regulatory levers. The model was used to analyze the impact of regulations on the medium to long term dynamics of the industry. The result is a hypothesis that there will be a need for extra government incentives to increase the adoption of distributed generation, storage and demand response to align with the forecasted adoption rate of variable energy resources and electric vehicles in order to maintain grid reliability.by Neil Kamal Gadhok.S.M

An Unexpected Airway Complication in a Male Patient with Goltz Syndrome

Goltz syndrome, also known as focal dermal hypoplasia, is a rare X-linked dominant multisystem syndrome presenting with cutaneous, skeletal, dental ocular, central nervous system and soft tissue abnormalities. This case report discusses an adult male patient with Goltz syndrome that was noted to have large, papillomatous, hypopharyngeal lesions upon induction of general anesthesia. We highlight challenges with airway management intraoperatively and postoperatively in patients with Goltz syndrome. Our aim is to increase awareness of the potential airway complications associated with this genetic disorder and to provide suggestions for optimal perioperative management for patients afflicted with Goltz syndrome

Comparative Analysis of Lean and Six Sigma in Building Construction: Benefits, Obstacles and Opportunities

Lean and Six Sigma have been recognized as innovative strategies that can be used to transform a firm’s management practices to a newer level. However, there is little guidance, or evidence indicating whether Lean or Six Sigma enhance the construction process significantly. This research fills this gap by investigating major obstacles, benefits and opportunities of Lean and Six Sigma as published in journal papers. A structured literature research (SLR) was performed to identify and compare lean and Six Sigma case studies and analyzed their findings and conclusions. This SLR resulted in a matrix that identifies the obstacles, benefits and opportunities of using Six Sigma and lean practices to assist industry practitioners adopt and implement these strategies

Ik Chota Bacha and Other Sikh Nursery Rhymes

Kikli and Ujjaldidar Singh Memorial Foundation (USMF) proudly introduce their first book and CD, Ik Chota Bacha & Other Sikh Nursery Rhymes . This CD/Book set contains 10 kavitas that are set to the tune of popular western sing-along nursery rhymes