Perspectives on outcome following hand and wrist injury in non-osteoporotic patients

Young patients without osteoporosis have high demands of the function of their hand and wrist following injury, because of an active working life. We reported on several outcome measures following hand and wrist injuries in this patient population. Following wrist fractures, presence of posttraumatic arthritis was high and seemed to worsen over time. Posttraumatic arthritis was associated with diminished movement of the wrist, but not with diminished grip strength. All motion measurements of the injured wrist were diminished compared to the uninjured wrist. An incongruency of the joint surface following injury was associated with diminished range of motion and diminished scores on patient reported outcome captured in questionnaires answered by patients regarding daily tasks with their hand and wrist. Diminished movement of the wrist was also associated with worse scores on the questionnaires. Of these specific patient reported outcome questionnaires for hand and wrist injuries, we validated two in the Dutch translated version: the DASH-DLV and the DF-PROMIS-UE v2.0 questionnaires. The latter uses a computer algorithm to reduce the number of questions that need to be answered to minimize the burden for patients. Hand and wrist injuries can evolve in major life events for young patients, due to possible impairment as we reported. For clinical practice, we advise a ‘lean’ core set of outcome measures with known thresholds to find changes in function that a patient actually notices in daily life, known as minimal important change. This will improve the interpretation of clinical relevant outcome following hand and wrist injuries

Recreational boating interferes with the behaviour of Atlantic cod (Gadus morhua): a study about the effects of noise pollution from small, recreational vessels on the movement patterns and vocalizations of cod in a fjord on the Norwegian Skagerrak coast

There is a growing concern about the impact of anthropogenic noise pollution on the marine environment. The problem is fed by a lack of knowledge, in which the effect of small recreational boats is especially underestimated. However, small recreational boats are the most abundant in vulnerable and important coastal habitats. This study addresses the issue by looking at the impact of noise on a coastal population of Atlantic cod(Gadus morhua). The results of this study indicate that vocalizations and movement patterns of cod are affected by small boat noise.. An increase in noise leads to a reduction of home range size and an increase in depth. Furthermore, the vocalization length and amount of pulses decrease during periods with high amounts of noise, while vocal fatigue increases. This impact of boat noise on cod may negatively impact courtship success due to the importance of sound during courtship interactions. Additionally, the change in depth might negatively affect cod metabolism due to changes in temperature. This may have implications for the health of cod populations residing in areas with high amounts of ambient noise. Negative impacts of noise have been previously described for other species. The negative impact on cod suggests that marine noise pollution may have economic consequences. Therefore, regulations regarding noise pollution should be urgently addressed

The service concept – a missing link in lean for services

This paper aims to contribute to the empirical literature on lean implementation for services by examining how the relation between lean implementation and operational performance improvement is moderated by the degree of service concept diffusion. The effect of explicit service concept diffusion on the outcome of lean implementation processes is tested by a sample of 153 respondents from Dutch service organizations. By means of hierarchical regression analysis this research shows that lean implementation in service organizations with an explicit and widely disseminated service concept positively affects organizational performance. Additionally, it is found that the moderating influence of service concept diffusion on performance improvement is especially apparent in case of explicit presence and a clearly disseminated service concept or an explicitly absent and unclear service concept. These results are corroborated by the finding that lean implementation in service environments without the moderating influence of service concept diffusion does not result in enhanced organizational performance. Finally, the positive sole effect of a disseminated service concept on organizational performance is empirically corroborated. These findings show the importance of clarity on what is expected of employee- and improvement specialist’s involvement in terms of goals, roles, responsibilities and activities with respect to the service concept in service-based organizations. Having such clarity enhances their ability to make a meaningful contribution to improvement initiatives in lean implementations. Thereby, this research is the first to provide empirical evidence for explaining how employee involvement in service-based organizations can yield better lean implementation results.<br/

'PARAMEDIC-2:Big study, small result'

The PARAMEDIC-2 trial demonstrated that the use of adrenaline compared with placebo in out-of-hospital cardiac arrest (OHCA) resulted in asmall increase in 30-day survival, but was associated with ahigher number of survivors with severe neurological impairment. These findings received alot of attention, and generated awidespread discussion about the role of adrenaline in cardiac arrest. In this point of view, we aim to place the PARAMEDIC-2 results in the right perspective by comparing the relative effect of adrenaline to other determinants of cerebral blood flow

The implementation of Lean Six Sigma for operational excellence in digital emerging technology companies

Purpose: The purpose of this research is to develop a better understanding of the hurdles in implementing Lean Six Sigma (LSS) for operational excellence in digital emerging technology companies. Design: We have conducted case studies of LSS implementations in six United States based companies in the digital emerging technology industry. Findings: Critical success factors (CSF) for LSS implementations in digital emerging technology companies are: (1) organizational leadership that is engaged to the implementation, (2) LSS methodology that is rebranded to fit existing shared values in the organization, (3) restructuring of the traditional LSS training program to include a more incremental, prioritized, on-the-job training approach, and (4) a modified LSS project execution methodology that includes (a) condensing the phases and tools applied in LSS projects, and (b) adopting more iterative project management methods compared to the standard phased LSS project approach. Implications: Implications comprise the awareness and knowledge of critical success factors and LSS methodology modifications specifically relevant for digital emerging technology companies or companies that share similarities in terms of focus on product development, innovation and growth, such as R&D departments in high-tech manufacturing companies. Limitations: The qualitative nature of our analysis and the geographic coverage of our sample limits the generalizability of our findings. Originality: Research on industry specific enablers for successful LSS implementation in the digital emerging technology industry is virtually absent. Our research informs practitioners on how to implement LSS in this and alike industries, and points to aspects of such implementations that are worthy of further attention from the academic community