Managing People In A Lean Environment: The Power Of Informal Controls And Effective Management Of Company Culture

This short case at a high tech company in the Midwest, illustrates some important principles for managing people focusing more on informal, rather than formal controls.  Lean Thinking advocates reducing waste, and continuously improving (Womack & Jones, 2003).  When a company shifts paradigms from traditional management to Lean management, the culture of the company transforms in many ways.  Traditional, formal methods of controlling employee behavior often involve a lot of non-value-add labor and cost, at the same time, they are not effective.  They are seemingly based on the attitude that employees are unprofessional, cannot develop internalized standards of behavior or understand the “big picture” of why it is in their own best interests to maintain high standards.  Analysis of this incident is useful for students of Lean management, in helping them see the power of informal controls embedded in the company culture

The Journey Toward Lean Manufacturing: Applying The Kaizen Blitz Method To Improving Operations

The authors researched an interesting example of the application of the Kaizen Blitz method to improving operations in a clean-room plant located in a suburb of Minneapolis, MN, USA, which is part of a division of a large, international medical products manufacturing company.  Heart-lung devices used in open heart surgery are manufactured in the plant.  Under pressure to reduce medical costs and having benchmark data from competitors, it was clear that operations involved in manufacturing the heart-lung devices had lead times that were too long, required far too much inventory, were too labor-intensive in spite of using several expensive automated procedures, and had comparatively low yield rates, resulting in far too much waste. The information and data gathered by the authors were organized into a case study that is suitable for teaching process improvement methods in a university course as well as for industry training.  The case details the context in which the Kaizen Blitz method was used, how it was applied, documents before and after conditions with key performance statistics, as well as provides background information on the Kaizen Blitz method.  Selected references and sources are also provided

Inhibition of cyclo-oxygenase 2 reduces tumor metastasis and inflammatory signaling during blockade of vascular endothelial growth factor

Vascular endothelial growth factor (VEGF) blockade is an effective therapy for human cancer, yet virtually all neoplasms resume primary tumor growth or metastasize during therapy. Mechanisms of progression have been proposed to include genes that control vascular remodeling and are elicited by hypoperfusion, such as the inducible enzyme cyclooxygenase-2 (COX-2). We have previously shown that COX-2 inhibition by the celecoxib analog SC236 attenuates perivascular stromal cell recruitment and tumor growth. We therefore examined the effect of combined SC236 and VEGF blockade, using the metastasizing orthotopic SKNEP1 model of pediatric cancer. Combined treatment perturbed tumor vessel remodeling and macrophage recruitment, but did not further limit primary tumor growth as compared to VEGF blockade alone. However, combining SC236 and VEGF inhibition significantly reduced the incidence of lung metastasis, suggesting a distinct effect on prometastatic mechanisms. We found that SC236 limited tumor cell viability and migration in vitro, with effects enhanced by hypoxia, but did not change tumor proliferation or matrix metalloproteinase expression in vivo. Gene set expression analysis (GSEA) indicated that the addition of SC236 to VEGF inhibition significantly reduced expression of gene sets linked to macrophage mobilization. Perivascular recruitment of macrophages induced by VEGF blockade was disrupted in tumors treated with combined VEGF- and COX-2-inhibition. Collectively, these findings suggest that during VEGF blockade COX-2 may restrict metastasis by limiting both prometastatic behaviors in individual tumor cells and mobilization of macrophages to the tumor vasculature

Posttraumatic Stress Disorder Prevalence and Risk of Recurrence in Acute Coronary Syndrome Patients: A Meta-analytic Review

BACKGROUND:Acute coronary syndromes (ACS; myocardial infarction or unstable angina) can induce posttraumatic stress disorder (PTSD), and ACS-induced PTSD may increase patients' risk for subsequent cardiac events and mortality. OBJECTIVE:To determine the prevalence of PTSD induced by ACS and to quantify the association between ACS-induced PTSD and adverse clinical outcomes using systematic review and meta-analysis. DATA SOURCES:Articles were identified by searching Ovid MEDLINE, PsycINFO, and Scopus, and through manual search of reference lists. METHODOLOGY/PRINCIPAL FINDINGS:Observational cohort studies that assessed PTSD with specific reference to an ACS event at least 1 month prior. We extracted estimates of the prevalence of ACS-induced PTSD and associations with clinical outcomes, as well as study characteristics. We identified 56 potentially relevant articles, 24 of which met our criteria (N = 2383). Meta-analysis yielded an aggregated prevalence estimate of 12% (95% confidence interval [CI], 9%-16%) for clinically significant symptoms of ACS-induced PTSD in a random effects model. Individual study prevalence estimates varied widely (0%-32%), with significant heterogeneity in estimates explained by the use of a screening instrument (prevalence estimate was 16% [95% CI, 13%-20%] in 16 studies) vs a clinical diagnostic interview (prevalence estimate was 4% [95% CI, 3%-5%] in 8 studies). The aggregated point estimate for the magnitude of the relationship between ACS-induced PTSD and clinical outcomes (ie, mortality and/or ACS recurrence) across the 3 studies that met our criteria (N = 609) suggested a doubling of risk (risk ratio, 2.00; 95% CI, 1.69-2.37) in ACS patients with clinically significant PTSD symptoms relative to patients without PTSD symptoms. CONCLUSIONS/SIGNIFICANCE:This meta-analysis suggests that clinically significant PTSD symptoms induced by ACS are moderately prevalent and are associated with increased risk for recurrent cardiac events and mortality. Further tests of the association of ACS-induced PTSD and clinical outcomes are needed

Child and adolescent development

xviii, 520 p.; 25 cm