SIX SIGMA AND LEAN APPROACH FOR ENHANCED PROCESS VALUE CHAIN

Abstract This research highlight the different aspects of implementing lean and six-sigma approach, their contrasting features and integration in manufacturing organizations. Qualitative research method has been used to conduct this research as the defined period of time for the research was limited. This method was pertinent for the deep analysis of literature and case studies of concerned approaches. It helped to conduct the research in a subjective manner. The use of secondary data saved time from preparing the questionnaires or surveys also the ethical approval from the University of the West of Scotland was not required. Descriptive feature of qualitative research was germane to gather substantial information of related topic from different legitimate resources. For the collected data analysis, Deductive scientific approach has been applied. This research does not make use of any statistical tools for data analysis. Literature studies reveal that Lean Six Sigma has been mostly frequently used in service organization in comparison of manufacturing industries. It has been observed that the Implementation of Lean Six Sigma gave an amalgam of advantages of both approaches when deployed together in terms of cutting down the cost of production, decreasing process variations, lower process waste and effective resource management. This research was limited by few factors as the time-frame was not enough to cover up every aspect of the selected topic. Moreover, six case studies were found not to be enough to generalize the model for Lean Six Sigma implementation because there is a possibility of a manufacturing organization of different nature that may not be covered in the research. Furthermore, the concluded concepts shall be applicable only for manufacturing organizations. Adding to this, the research methodology was not enough to add up to the data collection skills of the researcher. For future studies there is a need to fill the research gap by using quantitative research method to analyze the impact of Lean and Six Sigma integration on process value chain. Future researchers can also take up the service organizations as a subject matter for an extensive research. Keywords Lean; Six Sigma; Integration; Manufacturing Industrie

FREQUENCY OF PULMONARY HYPERTENSION IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA (OSA).

Background; Obstructive sleep apnea (OSA) is commonly complicated by left heart disease and is associated with pulmonary hypertension (PH). This study was done to determine the frequency of pulmonary hypertension in OSA to ascertain current magnitude of the problem. Material and methods: This cross-sectional study was done at Department of Medicine, Nishtar Hospital Multan. A total of 95 patients with OSA were included in this study. Once registered in the study, all the relevant baseline investigations were done like echocargiography to diagnose Pulmonary Hypertension. History was taken like diabetes, hypertension, smoking  and other sociodemographic factors was inquired and statistical analysis was performed by entering all the data in SPSS version 20. Results; Of these 95 study cases, 60 (63.25) were male patients and 35 (26.8%) were female patients. Mean age of our study cases was 36.57 ± 6.06 years. Of these 95 study cases, 20 (21.1%) had diabetes and hypertension was noted in 42 (44.2%) of our study cases. Mean height of our study cases was 156.39 ± 12.92 centimeters while mean weight of our study cases was 74.59 ± 17.27 kilograms. Mean body mass index (BMI) of our study cases was 27.33 ± 4.07 kg/m2 and obesity was present in 40 (42.1%) of our study cases. Mean disease duration was 26.32 ± 10.97 months and history of smoking was present in 21 (22.1%). Pulmonary hypertension was present in 43 (45.3%) of our study cases. Conclusion; Very high frequency of pulmonary hypertension was observed in our study among patients with obstructive sleep apnea. Pulmonary hypertension was significantly associated with diabetes, disease duration, smoking and obesity. All clinicians treating such patients should investigate for pulmonary hypertension for early diagnosis and management which will decrease morbidity and improve quality of life of these patients. Keywords; Obstructive sleep apnea, Pulmonary hypertension, Arterial hypertension

Radiographic Evaluation of Knee Joint in Patients with Knee pain and its correlation with Osteoarthritis and Gender

Background: Osteoarthritis (OA) is the most rampant reason of knee discomfort and pain. Knee osteoarthritis accounts for 83 percent of the overall Osteoarthritis burden. Knee osteoarthritis (KOA) is projected to grow more frequent as age progresses, and it is more common in women and overweight individuals. The Kellgren and Lawrence scoring criteria is usually employed to estimate the severity of disease. To evaluate the Radiographic findings associated with knee joint pain and to assess the prevalence of osteoarthritis in individuals with knee joint discomfort, as well as its correlation with gender.Methods: From August to December 2021, cross-sectional research was undertaken at the Department of Radiology, Amin Medical Complex, Sialkot. This research comprised participants of both gender having knee discomfort, ranging in age from forty to eighty yrs. SPSS version 24 was employed to record the data and analyze the information.Results: Total 100 Patients (M=45, F=55) were enrolled in this study. Out of 100 participants with knee pain 45(45%) patients had abnormal knee radiographic findings. Osteoarthritis of the knee accounted for 35% of all abnormal radiographic findings in this study, with synovial effusion accounting for 8% of the total, and erosion only contributing for 2%. Knee osteoarthritis was found to be more prevalent in females than in males (24% vs. 11%), demonstrating that gender is a significant predictor for knee osteoarthritic disease. Findings corroborate the implementation of the Kellgren-Lawrence marking scheme to characterize Knee osteoarthritis in population research.Conclusion: The findings suggest that radiographic aspects of knee Osteoarthritis are substantially linked to knee discomfort, and that it is more frequent in people over the age of 55. Knee osteoarthritis is substantially linked with gender, with females suffering from it at a higher rate. The findings authenticate the implementation of the Kellgren-Lawrence grading scheme to characterize Knee osteoarthritis in population research

Knowledge, attitude and practices towards consumption of caffeine containing drinks among the student population of Ras al-Khaimah medical and health sciences university, UAE

Background: Caffeine, world’s most widely consumed and legally accepted psychoactive substance which is commonly found ingredient in many drinks like coffee, tea, carbonated drinks and energy drinks. The objective was to explore how much dependent are the teenagers and young adults on caffeine containing drinks, reasons and circumstances for the consumption and to know the knowledge and attitude of the consumers about the health effects of the caffeine containing drinks.Methods: A validated questionnaire was administered randomly to about 298 students from MBBS, BDS, B Pharma and Nursing programmes of RAK Medical and Health Sciences University (RAKMHSU).Results: Out of 298 students in the study, 97% (n=290) of them drink caffeinated beverages in the form of coffee (53%), tea (43%), energy drinks (17%), carbonated drinks (18%) and all of the above (11%). The major reasons for consuming varied, where more than half of them gave the reason as to keep them awake for study purpose (53%), to get refreshed (51%), taste and flavour (49%). About 56% were of an opinion that they do experience different symptoms if they don’t consume their daily caffeine intake. 54% students admitted their caffeine consumption has been increased after joining the university. When knowledge and attitude were questioned, 63% of them think caffeine addiction is a health issue and majority of them were aware of the ingredients of these drinks but not the safest amount.Conclusions: Drinking caffeine containing drinks by the students are variable from different sources, so monitoring is necessary for the daily intake and there is need for educational programmes about the health effects related to high consumption of caffeine.

COMBUSTION CHARACTERISTICS OF REACTIVE NANOMATERIALS

The combustion ofmetallic particlesis analogous to the combustion of hydrocarbon particles andthe particleburn time can be related to its diametric length. The relationship is called ‘d’ law and represented astb=d2. From the physics aspect, many deviations from the established laws at the bulk scale have been reported. As the ignition temperature of energetic nanomaterials is more sensitive to the passivation layer and the external heating conditions, and the burning time of nanomaterials is deviated from the conventional d2 law. Due to the variation of certain parameters such as the particles size distribution, agglomeration, morphology, level of contamination and initial particle size,thecorrect and precise value of the exponentisdifficult to find.Consequently, there’s no universal law for the burn time and a variant of the dn law is always proposed whose exponent is less than 2 (~ 1.3-1.7).In this research, combustion experiments are performed using a Bunsen burner in a particle-laden methane stream and the relationship of particle burning time with particle diameter is found to betb ~ d1.2. The combustion process of the various particles is captured using a high speed video camera.The average values of extinction time for Si (720 nm) and Si (1000 nm) are 11.4 ms and 17.2 ms, respectively. It is also observed that the nanoparticles are more reactive than the microsized particles. The average velocity flow fields of the silicon, iron and aluminum particles are also investigatedusing PIV technique.Before and after the experiments, the particles are characterised using dynamic light scattering (DLS), scanning electron microscopy (SEM), Energy-dispersive X-ray spectroscopy (EDS) and transmission electron microscopy (TEM

Neuropharmacological Potential of Diterpenoid Alkaloids

This study provides a narrative review of diterpenoid alkaloids (DAs), a family of extremely important natural products found predominantly in some species of Aconitum and Delphinium (Ranunculaceae). DAs have long been a focus of research attention due to their numerous intricate structures and diverse biological activities, especially in the central nervous system (CNS). These alkaloids originate through the amination reaction of tetra or pentacyclic diterpenoids, which are classified into three categories and 46 types based on the number of carbon atoms in the backbone structure and structural differences. The main chemical characteristics of DAs are their heterocyclic systems containing β-aminoethanol, methylamine, or ethylamine functionality. Although the role of tertiary nitrogen in ring A and the polycyclic complex structure are of great importance in drug-receptor affinity, in silico studies have emphasized the role of certain sidechains in C13, C14, and C8. DAs showed antiepileptic effects in preclinical studies mostly through Na+ channels. Aconitine (1) and 3-acetyl aconitine (2) can desensitize Na+ channels after persistent activation. Lappaconitine (3), N-deacetyllapaconitine (4), 6-benzoylheteratisine (5), and 1-benzoylnapelline (6) deactivate these channels. Methyllycaconitine (16), mainly found in Delphinium species, possesses an extreme affinity for the binding sites of α7 nicotinic acetylcholine receptors (nAChR) and contributes to a wide range of neurologic functions and the release of neurotransmitters. Several DAs such as bulleyaconitine A (17), (3), and mesaconitine (8) from Aconitum species have a drastic analgesic effect. Among them, compound 17 has been used in China for decades. Their effect is explained by increasing the release of dynorphin A, activating the inhibitory noradrenergic neurons in the β-adrenergic system, and preventing the transmission of pain messages by inactivating the Na+ channels that have been stressed. Acetylcholinesterase inhibitory, neuroprotective, antidepressant, and anxiolytic activities are other CNS effects that have been investigated for certain DAs. However, despite various CNS effects, recent advances in developing new drugs from DAs were insignificant due to their neurotoxicity

Critical failure factors for Quality 4.0 : an exploratory qualitative study

Purpose. This study aims to investigate the adoption of Quality 4.0 (Q4.0) and assess the critical failure factors (CFFs) for its implementation and how its failure is measured. Design/methodology/approach. A qualitative study based on in-depth interviews with quality managers and executives was conducted to establish the CFFs for Q4.0. Findings. The significant CFFs highlighted were resistance to change and a lack of understanding of the concept of Q4.0. There was also a complete lack of access to or availability of training around Q4.0. Research limitations/implications. The study enhances the body of literature on Q4.0 and is one of the first research studies to provide insight into the CFFs of Q4.0. Practical implications. Based on the discussions with experts in the area of quality in various large and small organizations, one can understand the types of Q4.0 initiatives and the CFFs of Q4.0. By identifying the CFFs, one can establish the steps for improvements for organizations worldwide if they want to implement Q4.0 in the future on the competitive global stage. Originality/value. The concept of Q4.0 is at the very nascent stage, and thus, the CFFs have not been found in the extant literature. As a result, the article aids businesses in understanding possible problems that might derail their Q4.0 activities

Making prescriptions “talk” to stroke and heart attack survivors to improve adherence: Results of a randomized clinical trial (The Talking Rx Study)

Background: We developed and tested the effectiveness of a tailored health information technology driven intervention: TalkingPrescriptions (Talking Rx) to improve medication adherence in a resource challenged environment.Methods: We conducted a parallel, randomized, controlled, assessor-blinded trial at the Aga Khan University (AKU), Karachi, Pakistan. Adults with diagnosis of cerebrovascular accident (CVA) or coronary artery disease (CAD) diagnosed least one month before enrollment, on anti-platelets and statins, with access to a mobile phone were enrolled. The intervention group received a) Daily Interactive Voice Response (IVR) call services regarding specific statin and antiplatelet b) Daily tailored medication reminders for statin and antiplatelet and c) Weekly lifestyle modification messages for a period of 3 months. We assessed Medication adherence to statin and antiplatelets by a validated version of the 8-item Morisky Medication Adherence scale 8 (MMAS-8) at 3 months by a blinded assessment officer. Analysis was conducted by intention-to-treat principle (ITT).Results: Between April 2015 and December 2015, 197 participants (99 in intervention and 98 in the usual care group) enrolled in the Talking Rx Study. The dropout rate was 9.6%. Baseline group characteristics were similar. At baseline, the mean MMAS-8 was 6.68 (SD = 1.28) in the intervention group and 6.77 (SD = 1.36) in usual care group. At end of follow-up, the mean MMAS-8 increased to 7.41(0.78) in the intervention group compared with 7.38 (0.99) in usual care group with mean difference of 0.03 (S.D 0.13) (95% C.I [-0.23, 0.29]), which was not statistically significant. (P-Value = 0.40) CVA patients showed a relatively greater magnitude of adherence via the MMAS-8 at the end of follow up where the mean MMAS-8 increased to 7.29 (S.D 0.82) in the intervention group as compared to 7.07(S.D 1.24) in usual care group with mean difference of 0.22 (SD = 0.22) 95% C.I (-0.20, 0.65) with (P-value = 0.15). Around 84% of those on intervention arm used the service, calling at least 3 times and listening to their prescriptions for an average of 8 minutes. No user was excluded due to technologic reasons.Conclusion: The use of a phone based medication adherence program was feasible in LMIC settings with high volume clinics and low patient literacy. In this early study, with limited follow up, the program did not achieve any statistically significant differences in adherencebehavior as self-reported by the MMAS-8 Scale

Effect of 5-minute movies shown via a mobile phone app on risk factors and mortality after stroke in a low- to middle-income country: Randomized controlled trial for the stroke caregiver dyad education intervention (Movies4Stroke)

Background: Pakistan is the sixth most populous nation in the world and has an estimated 4 million stroke survivors. Most survivors are taken care of by community-based caregivers, and there are no inpatient rehabilitation facilities.Objective: The objective of this study was to evaluate the effectiveness and safety of locally designed 5-min movies rolled out in order of relevance that are thematically delivered in a 3-month program to deliver poststroke education to stroke survivor and caregiver dyads returning to the community.Methods: This study was a randomized controlled, outcome assessor–blinded, parallel group, single-center superiority trial in which participants (stroke survivor-caregiver dyads) with first-ever stroke (both ischemic and hemorrhagic) incidence were randomized within 48 hours of their stroke into either the video-based education intervention group or the control group. The video-based education intervention group had health education delivered through short videos that were shown to the participants and their caregivers at the time of admission, before discharge, and the first and third months of follow-up after discharge. The control group had standardized care including predischarge education and counseling according to defined protocols. All participants enrolled in the video education intervention and control groups were followed for 12 months after discharge for outcome assessment in the outpatient stroke clinics. The primary outcome measures were the proportion of participants achieving control of blood pressure, blood sugar, and blood cholesterol in the video intervention versus the control group. Several predefined secondary outcomes were included in this study, of which we report the mortality and functional disability in this paper. Analysis was by performed using the intention-to-treat principle.Results: A total of 310 stroke survivors and their caregiver dyads (participant dyads) were recruited over a duration of 6 months. In total, 155 participant dyads were randomized into the intervention and control groups, each. The primary outcome of control of three major risk factors revealed that at 12 months, there was a greater percentage of participants with a systolic BP(18/54, 33% vs 11/52, 21%; P=.16), diastolic BP(44/54, 81% vs 37/52, 71%; P=.21), HbA1c levelP=.32), and low-density lipoprotein level/dL (36/51, 70% vs 30/45, 67%; P=.68) in the intervention group than in the control group. The secondary outcome reported is the mortality among the stroke survivors because the number of stroke-related complications was higher in the control group than in the intervention group (13/155, 8.4% vs 2/155, 1.3%), and this difference was statistically significant (P\u3c.001).Conclusions: The Movies4Stroke trial failed to achieve its primary specified outcome. However, secondary outcomes that directly related to survival skills of stroke survivors demonstrated the effectiveness of the video-based intervention on improving stroke-related mortality and survival without disability

The Impact of the COVID-19 Pandemic on Pregnant Women with Perinatal Anxiety Symptoms in Pakistan: A Qualitative Study

The impact of coronavirus disease 2019 (COVID-19) on people with existing mental health conditions is likely to be high. We explored the consequences of the pandemic on women of lower socioeconomic status with prenatal anxiety symptoms living in urban Rawalpindi, Pakistan. This qualitative study was embedded within an ongoing randomized controlled trial of psychosocial intervention for prenatal anxiety at a public hospital in Rawalpindi. The participants were women with symptoms of anxiety who had received or were receiving the intervention. In total, 27 interviews were conducted; 13 women were in their third trimester of pregnancy, and 14 were in their postnatal period. The data were collected through in-depth interviews and analyzed using framework analysis. Key findings were that during the pandemic, women experienced increased perinatal anxiety that was linked to greater financial problems, uncertainties over availability of appropriate obstetric healthcare, and a lack of trust in health professionals. Women experienced increased levels of fear for their own and their baby’s health and safety, especially due to fear of infection. COVID-19 appears to have contributed to symptoms of anxiety in women already predisposed to anxiety in the prenatal period. Efforts to address women’s heightened anxiety due to the pandemic are likely to have public health benefits.</jats:p