Management des contradictions et santé au travail : exploration en pays de lean management

Atteindre des performances durables est un enjeu majeur dans un monde confronté à une complexité croissante et à des risques multiples. Dans ce contexte, la santé des travailleurs est régulièrement pointée comme étant le symptôme du caractère non durable ou non tenable de certains modèles productifs regroupés en particulier sous le terme de lean management (management au plus juste). En étudiant trois entreprises ayant adopté ce type d'organisation mais présentant des différences notables en termes de santé au travail notre propos est de comprendre en quoi certains aspects du management peuvent contribuer à corriger les effets prétendument délétères du lean management et expliquer les différences observées. Plus précisément, cette étude se focalise sur la manière dont les trois entreprises managent les problèmes et contradictions potentiellement générateurs de stress auxquels doivent faire face leurs membres. Deux angles d'étude sont privilégiés : l'équipement de l'organisation en termes d'espaces de discussion d'une part, le positionnement et les caractéristiques du management intermédiaire d'autre part.Santé ; lean management ; performance ; management intermédiaire

Medial coracoclavicular ligament revisited: an anatomic study and review of the literature

The medial coracoclavicular ligament (MCCL), up to now rarely reported in the literature, was studied in a formol-fixed cadaver by means of dissection, morphometry, and light microscopy. This entity represents a true ligament within the coracoclavicular fascia. Although longer and narrower than its lateral counterpart, the medial coracoclavicular ligament follows the same morphological pattern, including the cartilage at the level of the coracoidal attachment. Its clinical significance and implications together with a review of the literature is presente

End-to-End Personalized AAL Services for Elderly with Chronic Conditions

In the recent years, the number of the elderly living with chronic diseases (e.g., high blood pressure, diabetes, etc.) is continuously growing, potentially affecting their independence. Therefore, many efforts have been given in AAL applications for supporting the monitoring activities and, particularly, focusing to the issue of gathering continuous information at home, standardizing formats, extracting further information from raw sensors data using different techniques to reconstruct a context. One aspect that is rather important but less developed in current investigation is the design of personalized end-to-end services for classes of users of such technology being them either primary user (old people) or secondary users (medical doctors, caregiver, relatives)

Steps Toward End-to-End Personalized AAL Services

In Ambient Assisted Living research and development, a significant effort has been dedicated to issues like gathering continuous information at home, standardizing formats in order to create environments more easily, extracting further information from raw data using different techniques to reconstruct context. An aspect relatively less developed but also important is the design of personalized end-to-end services for technology users being them either primary (older people) or secondary (medical doctors, caregiver, relatives). This paper explores an effort, internal to the EU project GIRAFFPLUS, for designing such services starting from a state-of-the-art continuous data gathering infrastructure. The paper presents the general project idea, the current choices for the middleware infrastructure and the pursued direction for a set of services personalized to different classes of users

Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy

Background: The aim of this study was to ascertain the impact of injury to the superior mesenteric nerve plexus caused by right colectomy with D3 extended mesenterectomy as performed in the prospective multicenter trial: “Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-detector Computed Tomography” in which all soft tissue surrounding the superior mesenteric vessels from the level of the middle colic artery to that of the ileocolic artery was removed. Methods: Bowel function and gastrointestinal quality of life in two consecutive cohorts that underwent right colectomy with and without D3 extended mesenterectomy were compared. Main outcome measures were the Diarrhea Assessment Scale (DAS) and Gastrointestinal Quality of Life Index (GIQLI). The data were collected prospectively through telephone interviews. Results: Forty-nine patients per group, comparable for age, sex, length of bowel resected but with significantly shorter follow-up time in the experimental group, were included. There was no difference in total DAS scores, subscores or additional questions except for higher bowel frequency scores in the D3 group (p = 0.02). Comparison of total GIQLI scores and subscales showed no difference between groups. Regression analysis with correction for confounding factors showed 0.48 lower bowel frequency scores in the D2 group (p = 0.022). Within the D3 group presence of jejunal arteries cranial to the D3 dissection area showed 1.78 lower DAS scores and 0.7 lower bowel frequency scores. Conclusions: Small bowel denervation after right colectomy with D3 extended mesenterectomy leads to increased bowel frequency but does not impact gastrointestinal quality of life. Individual anatomical variants can affect postoperative bowel function differently despite standardized surgery.acceptedVersio

Arterial supply of the trigeminal ganglion, a micromorphological study

Background: In this study, we explored the specific microanatomical properties of the trigeminal ganglion (TG) blood supply and its close neurovascular relationships with the surrounding vessels. Possible clinical implications have been discussed. Materials and methods: The internal carotid and maxillary arteries of 25 adult and 4 foetal heads were injected with a 10% mixture of India ink and gelatin, and their TGs subsequently underwent microdissection, observation and morphometry under a stereoscopic microscope. Results: The number of trigeminal arteries varied between 3 and 5 (mean 3.34), originating from 2 or 3 of the following sources: the inferolateral trunk (ILT) (100%), the meningohypophyseal trunk (MHT) (100%), and from the middle meningeal artery (MMA) (92%). In total, the mean diameter of the trigeminal branches was 0.222 mm. The trigeminal branch of the ILT supplied medial and middle parts of the TG, the branch of the MHT supplied the medial part of the TG, and the branch of the MMA supplied the lateral part of the TG. Additional arteries for the TG emerged from the dural vascular plexus and the vascular network of the plexal segment of the trigeminal nerve. Uniform and specific intraganglionic dense capillary network was observed for each sensory trigeminal neuron. Conclusions: The reported features of the TG vasculature could be implied in a safer setting for surgical approach to the skull base, in relation to the surrounding structures. The morphometric data on TG vasculature provide anatomical basis for better understanding the complex TG blood supply from the internal and external carotid arteries

Map Building and Monte Carlo Localization Using Global Appearance of Omnidirectional Images

In this paper we deal with the problem of map building and localization of a mobile robot in an environment using the information provided by an omnidirectional vision sensor that is mounted on the robot. Our main objective consists of studying the feasibility of the techniques based in the global appearance of a set of omnidirectional images captured by this vision sensor to solve this problem. First, we study how to describe globally the visual information so that it represents correctly locations and the geometrical relationships between these locations. Then, we integrate this information using an approach based on a spring-mass-damper model, to create a topological map of the environment. Once the map is built, we propose the use of a Monte Carlo localization approach to estimate the most probable pose of the vision system and its trajectory within the map. We perform a comparison in terms of computational cost and error in localization. The experimental results we present have been obtained with real indoor omnidirectional images

Non-assisted versus neuro-navigated and XperCT-guided external ventricular catheter placement: a comparative cadaver study

Background and purpose: Accurate placement of an external ventricular drain (EVD) for the treatment of hydrocephalus is of paramount importance for its functionality and in order to minimize morbidity and complications. The aim of this study was to compare two different drain insertion assistance tools with the traditional free-hand anatomical landmark method, and to measure efficacy, safety and precision. Methods: Ten cadaver heads were prepared by opening large bone windows centered on Kocher's points on both sides. Nineteen physicians, divided in two groups (trainees and board certified neurosurgeons) performed EVD insertions. The target for the ventricular drain tip was the ipsilateral foramen of Monro. Each participant inserted the external ventricular catheter in three different ways: 1) free-hand by anatomical landmarks, 2) neuronavigation-assisted (NN), and 3) XperCT-guided (XCT). The number of ventricular hits and dangerous trajectories; time to proceed; radiation exposure of patients and physicians; distance of the catheter tip to target and size of deviations projected in the orthogonal plans were measured and compared. Results: Insertion using XCT increased the probability of ventricular puncture from 69.2 to 90.2% (p = 0.02). Non-assisted placements were significantly less precise (catheter tip to target distance 14.3 ± 7.4mm versus 9.6 ± 7.2mm, p = 0.0003). The insertion time to proceed increased from 3.04 ± 2.06min. to 7.3 ± 3.6min. (p < 0.001). The X-ray exposure for XCT was 32.23mSv, but could be reduced to 13.9mSv if patients were initially imaged in the hybrid-operating suite. No supplementary radiation exposure is needed for NN if patients are imaged according to a navigation protocol initially. Conclusion: This ex vivo study demonstrates a significantly improved accuracy and safety using either NN or XCT-assisted methods. Therefore, efforts should be undertaken to implement these new technologies into daily clinical practice. However, the accuracy versus urgency of an EVD placement has to be balanced, as the image-guided insertion technique will implicate a longer preparation time due to a specific image acquisition and trajectory planning