A process view on managing quality during the creation of technical innovations : lessons from field research.

Quality Management (QM) principles have left their marks on business practice for more than a decade. Amongst the many business functions that have faced the widespread introduction of QM standards and methodologies, the R&D function has been amongst the last to undergo their pervasive influence. The uncertain and ambiguous nature of the technical innovation not to introduce 'traditional' QM approaches in R&D settings. These arguments are often based on a rather rigid and mechanistic view on QM. As recent insights show, this need not to be the case. QM can offer an avenue to fundamentally scrutinise and re-think-functional interaction strategies in innovative contexts. Therefore, the process of introducing QM principles is an R&D environment deserves close attention. This paper offers a field-based insight into these fundamental organisational and managerial issues.Innovations; Knowledge;

Prevalence of Exposure to Complex Trauma and Community Violence and Their Associations With Internalizing and Externalizing Symptoms

Studies about trauma often tend to focus on abuse and neglect. However important, these studies may neglect the importance of the broader community context that is often associated with trauma, and complex trauma (CT) in particular. This study aimed to investigate the effects of CT (defined in terms of experiencing abuse and/or neglect occurring in the context of relationships with caregivers), and of broader environmental adversity (i.e., exposure to community violence), in a sample of adolescents ( N = 218) from a severely disadvantaged district of Lima, Peru. The study had two aims: (a) to assess the prevalence of CT and its associations with internalizing and externalizing symptoms in these adolescents and (b) to investigate the associations between community violence and both internalizing and externalizing symptoms over and above the effects of CT. In total, 39.4% of the adolescents reported at least one type of moderate to severe trauma. There was a clear association between CT and both internalizing and externalizing symptoms. Ordinal logistic regressions showed that children who were exposed to one or more traumatic experiences were more likely to score within a higher range of internalizing and externalizing symptoms than children with no history of trauma. Finally, exposure to community violence was an important predictor of symptomatology beyond the effects of CT

Six Months of Balloon Treatment does Not Predict the Success of Gastric Banding

BACKGROUND: We studied whether weight loss by intragastric balloon would predict the outcome of subsequent gastric banding with regard to weight loss and BMI reduction. METHODS: A prospective cohort of patients with a body mass index (BMI)>40 kg/m(2) received an intragastric balloon for 6 months followed by laparoscopic adjustable gastric banding (LAGB). Successful balloon-induced weight loss was defined as > or =10% weight loss after 6 months. Successful surgical weight loss was defined as an additional 15% weight loss in the following 12 months. Patients were divided in group A, losing > or =10% of their initial weight with 6 months' balloon treatment, and group B, losing <10% of their initial weight. RESULTS: In 40 patients (32 female, 8 male; age 36.6 yr, range 26-54), the mean BMI decreased from 46.5 to 40.5 kg/m(2) (P <0.001) after 6 months of balloon treatment and to 35.2 kg/m(2) (P <0.001) 12 months after LAGB. Group A (25 patients) and group B (15 patients) had a significant difference in BMI decrease, 12.4 vs 9.0 kg/m(2) (P <0.05), after the total study duration of 18 months. However, there was no difference in BMI reduction (4.7 kg/m(2) vs 5.8 kg/m(2)) in the 12 months after LAGB. 6 patients in group A lost > or =10% of their starting weight during 6 months balloon treatment as well as > or =15% 12 months following LAGB. 6 patients in group B lost <10% of their starting weight after 6 months of BIB, but also lost > or =15% 12 months following LAGB. CONCLUSION: Intragastric balloon did not predict the success of subsequent LAG

Appointment scheduling with unscheduled arrivals and reprioritization

Inspired by the real life problem of a radiology department in a Dutch hospital, we study the problem of scheduling appointments, taking into account unscheduled arrivals and reprioritization. The radiology department offers CT diagnostics to both scheduled and unscheduled patients. Of these unscheduled patients, some must be seen immediately, while others may wait for some time. Herein a trade-off is sought between acceptable waiting times for appointment patients and unscheduled patients’ lateness. In this paper we use a discrete event simulation model to determine the performance of a given appointment schedule in terms of waiting time and lateness. Also we propose a constructive and local search heuristic that embeds this model and optimizes the schedule. For smaller instances, we verify the simulation model as well as compare our search heuristics’ performance with optimal schedules obtained using a Markov reward process. In addition we present computational results from the case study in the Dutch hospital. These results show that a considerable decrease of waiting time is possible for scheduled patients, while still treating unscheduled patients on time

Enteral Nutrition and Acute Pancreatitis: A Review

Introduction. In patients with acute pancreatitis (AP), nutritional support is required if normal food cannot be tolerated within several days. Enteral nutrition is preferred over parenteral nutrition. We reviewed the literature about enteral nutrition in AP. Methods. A MEDLINE search of the English language literature between 1999–2009. Results. Nasogastric tube feeding appears to be safe and well tolerated in the majority of patients with severe AP, rendering the concept of pancreatic rest less probable. Enteral nutrition has a beneficial influence on the outcome of AP and should probably be initiated as early as possible (within 48 hours). Supplementation of enteral formulas with glutamine or prebiotics and probiotics cannot routinely be recommended. Conclusions. Nutrition therapy in patients with AP emerged from supportive adjunctive therapy to a proactive primary intervention. Large multicentre studies are needed to confirm the safety and effectiveness of nasogastric feeding and to investigate the role of early nutrition support

The influence of body composition on therapeutic hypothermia: a prospective observational study of patients after cardiac arrest

Introduction Patients after out-of-hospital cardiac arrest (OHCA) benefit from therapeutic hypothermia for 24 hours. The time needed to reach hypothermia (target temperature of 32 degrees C to 34 degrees C) varies widely. In this study, we explore the relation between measures of body composition and the time needed to reach target temperature with hypothermia. Method We conducted a prospective observational study in patients treated with hypothermia after OHCA. Data collected included weight and height, body composition by anthropometric measures and by single-frequency body impedance, and waist-to-hip ratio. Analysis of concordance between impedance and anthropometric measures and hazard ratios of achieving target temperature (event) corrected for different body composition measures. Results Twenty-seven patients were included. The median (interquartile range) time to reach target temperature after admission to the intensive care unit was 191 (105 to 382) minutes. Intraclass correlation for total body fat (TBF) measures was 0.94 (95% confidence interval [CI] 0.89 to 0.97). Only TBF percentage (anthropometrics by the Durnin's table) appeared to be associated with time to reach target temperature: 0.93 (95% CI 0.87 to 0.99; P = 0.03). Conclusion The body composition measures from single-frequency impedance and anthropometrics appear to be very concordant. Only TBF percentage (anthropometrics) showed a significant but clinically irrelevant influence on time needed to achieve target temperature with hypothermia. We conclude that there are no indications to adjust current cooling practice toward the body composition of patient

Personalisation of breast cancer follow-up: a time-dependent prognostic nomogram for the estimation of annual risk of locoregional recurrence in early breast cancer patients

The objective of this study was to develop and validate a time-dependent logistic regression model for prediction of locoregional recurrence (LRR) of breast cancer and a web-based nomogram for clinical decision support. Women first diagnosed with early breast cancer between 2003 and 2006 in all Dutch hospitals were selected from the Netherlands Cancer Registry (n = 37,230). In the first 5 years following primary breast cancer treatment, 950 (2.6 %) patients developed a LRR as first event. Risk factors were determined using logistic regression and the risks were calculated per year, conditional on not being diagnosed with recurrence in the previous year. Discrimination and calibration were assessed. Bootstrapping was used for internal validation. Data on primary tumours diagnosed between 2007 and 2008 in 43 Dutch hospitals were used for external validation of the performance of the nomogram (n = 12,308). The final model included the variables grade, size, multifocality, and nodal involvement of the primary tumour, and whether patients were treated with radio-, chemo- or hormone therapy. The index cohort showed an area under the ROC curve of 0.84, 0.77, 0.70, 0.73 and 0.62, respectively, per subsequent year after primary treatment. Model predictions were well calibrated. Estimates in the validation cohort did not differ significantly from the index cohort. The results were incorporated in a web-based nomogram (http://​www.​utwente.​nl/​mira/​influence). This validated nomogram can be used as an instrument to identify patients with a low or high risk of LRR who might benefit from a less or more intensive follow-up after breast cancer and to aid clinical decision making for personalised follow-up

Efficient utilization of DSPs and BRAMs revisited : new AES-GCM recipes on FPGAs

In 2008, Drimer et al. proposed different AES implementations on a Xilinx Virtex-5 FPGA, making efficient use of the DSP slices and BRAM tiles available on the device. Inspired by their work, we evaluate the feasibility of extending AES with the popular GCM mode of operation, still concentrating on the optimal use of DSP slices and BRAM tiles. We make use of a Xilinx Zynq UltraScale+ MPSoC FPGA with improved DSP features. For the AES part, we implement Drimer's round-based and unrolled pipelined architectures differently, still using DSPs and BRAMs efficiently based on the AES Tbox approach. On top of AES, we append the GCM mode of operation, where we use DSP slices to support the GCM finite field multiplication. This allows us to implement AES-GCM with a small amount of FFs and LUTs. We propose two implementations: A relatively compact round-based design and a faster unrolled design