Threat appraisal for harm from falls: Insights for development of education-based intervention

Objective: This study aims to describe how patients perceive the threat of falls in hospitals, to identify patient characteristics that are associated with greater or lesser perceptions of the threat of falls, and to examine whether there is a discord between the risk that patients perceive in general and the risk that they perceive for themselves personally. Method: A cross-sectional survey amongst geriatric rehabilitation inpatients in Brisbane, Australia, was implemented. The first component of the survey dealt with the ‘general’ nature of in-hospital falls and falls related risks while the second component of the survey was directed at identifying whether the patient held the same belief for themselves. Results: A total of 21 out of 125 participants (17%) indicated that they felt that they were at risk of falling during their hospitalisation and 28 (22%) felt that they would injure themselves if they were to fall. Self-perceived risk of falls was associated with decreasing age and lower cognitive function (Functional Independence Measure Cognitive score). A majority of patients felt that falls most commonly occur in the bathroom [n=67 (54%)] and that if they were to fall, they would fall in the bathroom [n=56 (45%)]. Discussion: Patients generally do not think they are at risk of falling while in hospital and this may contribute to poor adherence to falls prevention strategies. It is possible that raising patient perception of the risk of falls and injury from falls in hospitals may help improve adherence to falls prevention strategies in this setting.

Birth outcomes after spontaneous or assisted conception among infertile Australian women aged 28 to 36 years: A prospective, population-based study

Objective To examine the extent to which the odds of birth, pregnancy, or adverse birth outcomes are higher among women aged 28 to 36 years who use fertility treatment compared with untreated women. Design Prospective, population-based. Setting Not applicable. Patient(s) Participants in the ALSWH born in 1973 to 1978 who reported on their infertility and use of in vitro fertilization (IVF) or ovulation induction (OI). Intervention(s) Postal survey questionnaires administered as part of ALSWH. Main Outcome Measure(s) Among women treated with IVF or OI and untreated women, the odds of birth outcomes estimated by use of adjusted logistic regression modeling. Result(s) Among 7,280 women, 18.6% (n = 1,376) reported infertility. Half (53.0%) of the treated women gave birth compared with 43.8% of untreated women. Women with prior parity were less likely to use IVF compared with nulliparous women. Women using IVF or OI, respectively, were more likely to have given birth after treatment or be pregnant compared with untreated women. Women using IVF or OI were as likely to have ectopic pregnancies, stillbirths, or premature or low birthweight babies as untreated women. Conclusion(s) More than 40% of women aged 28–36 years reporting a history of infertility can achieve births without using treatment, indicating they are subfertile rather than infertile.

Investigating the deployment of project management : a new perspective based on the concept of certification

Purpose – The purpose of this paper is to provide a summary description of the doctoral thesis investigating the field of project management (PM) deployment. Researchers will be informed of the current contributions within this topic and of the possible further investigations and researches. The decision makers and practitioners will be aware of a set of tools addressing the PM deployment with new perspectives. Design/methodology/approach – Research undertaken with the thesis is based on quantitative methods using time series statistics (time distance analysis) and comparative and correlation analysis aimed to better define and understand the PM deployment within and between countries or groups. Findings – The results suggest a project management deployment index (PMDI) to objectively measure the PM deployment based on the concept of certification. A proposed framework to empirically benchmark the PM deployment between countries by integrating the PMDI time series with the two dimensional comparative analysis of Sicherl. The correlation analysis within Hoftsede cultural framework shows the impact of the national culture dimensions on the PM deployment. The forecasting model shows a general continual growth trend of the PM deployment, with continual increase in the time distance between the countries. Research limitations/implications – The PM researchers are offered an empirical quantification on which they can construct further investigations and understanding of this phenomenon. The number of possible units that can be studied offers wide possibilities to replicate the thesis work. New researches can be undertaken to investigate further the contribution of other social or economical indicators, or to refine and enrich the definition of the PMDI indicator. Practical implications – These results have important implications on the PM deployment approaches. The PMDI measurements and time series comparisons facilitate considerably the measurement and benchmarking between the units (e.g. countries) and against targets, while the readiness setting of the studied unit (in terms of development and cultural levels) impacts the PM deployment within this country. Originality/value – This paper provides a summary of cutting-edge research work in the studied field of PM deployment and a link to the published works that researchers can use to help them understand the thesis research as well as how it can be extended.

Travel context : development of a model to measure destination brand performance across different travel situations

Purpose: There is a lack of theory relating to destination brand performance measurement in the destination branding literature, which emerged in the late 1990s (see for example Dosen, Vransevic, & Prebezac, 1998). Additionally, there is a lack of research about the importance of travel context in consumers’ destination decision making (Hu & Ritchie, 1993). This study develops a structural model to measure destination brand performance across different travel situations. The theory of planned behaviour (TpB) was utilised as a framework to underpin the consumer-based brand equity (CBBE) hierarchy to develop a model of destination brand performance. Research approach: A proposed model of destination brand performance was developed through a review of the literature. The first study was used to identify destination image attributes (the core construct) using an analysis of the literature, a document analysis, and personal interviews using the Repertory Test qualitative technique. Underpinned by Personal Construct Theory (PCT), the Repertory Test enables the elicitation of attributes consumers use to evaluate destinations when considering travel. Data was examined in the first study to i) identify any attribute differences in travel contexts and ii) create a scale for use in a questionnaire. A second study was conducted to test the proposed model using a questionnaire with eight groups of participants to assess four destinations across two travel contexts. The model was tested utilising structural equation modelling. Findings: The first study resulted in a list of 29 destination image attributes for use in a scale index. Attributes were assessed across travel contexts and few differences were identified. The second study assessed the congruence of destination brand identity (the destination marketing organisation’s desired image) and destination brand image (the actual perceptions held by consumers) using importance-performance analyses. Finally, the proposed model of destination brand performance was tested. Overall the data supported the model of destination brand performance across travel contexts and destinations. Additionally, this was compared to consumers’ decision sets, further supporting the model. Value: This research provides a contribution to the destination marketing literature through the development of a measurement of destination brand performance underpinned by TpB. Practically; it will provide destination marketing organisations with a tool to track destination brand performance, relative to key competing places, over time. This is important given the development of a destination brand is a long term endeavour.

A home-based progressive resistance exercise programme for patients with venous leg ulcers : a feasibility study

This study aimed to assess the feasibility of a home-based exercise program and examine the effects on the healing rates of venous leg ulcers. A 12 –week randomised controlled trial was conducted investigating the effects of an exercise intervention compared to a usual care group. Participants in both groups (n = 13) had active venous ulceration and were treated in a metropolitan hospital outpatients clinic in Australia. Data were collected on recruitment from medical records, clinical assessment and questionnaires. Follow-up data on progress in healing and treatments were collected fortnightly for 12 weeks. Calf muscle pump function data were collected at baseline and 12 weeks from recruitment. Range of ankle motion data were collected at baseline, 6 and 12 weeks from recruitment. This pilot study indicated that the intervention was feasible. Clinical significance was observed in the intervention group with a 32% greater decrease in ulcer size (p=0.34) than the control group, and a 10% (p=0.74) improvement in the number of participants healed in the intervention group compared to the control group. Significant differences between groups over time were observed in calf muscle pump function parameters; (ejection fraction [p = 0.05]; residual volume fraction [p = 0.04]) and range of ankle motion (p = 0.01). This pilot study is one of the first studies to examine and measure clinical healing rates for participants involved in a home-based progressive resistance exercise program. Further research is warranted with a larger multi-site study.

Probabilistic cable rating based on cable thermal environment studying

This paper describes a new approach to establish the probabilistic cable rating based on cable thermal environment studies. Knowledge of cable parameters has been well established. However the environment in which the cables are buried is not so well understood. Research in Queensland University of Technology has been aimed at obtaining and analysing actual daily field values of thermal resistivity and diffusivity of the soil around power cables. On-line monitoring systems have been developed and installed with a data logger system and buried spheres that use an improved technique to measure thermal resistivity and diffusivity over a short period. Based on the long-term continuous field data for more than 4 years, a probabilistic approach is developed to establish the correlation between the measured field thermal resistivity values and rainfall data from weather bureau records. Hence, a probabilistic cable rating can be established based on monthly probabilistic distribution of thermal resistivity

Why we need a population-based approach to clinical indicators for cancer: a case study using microscopic confirmation of lung cancer in Queensland

An important function of clinical cancer registries is to provide feedback to clinicians on various performance measures. To date, most clinical cancer registries in Australia are located in tertiary academic hospitals, where adherence to guidelines is probably already high. Microscopic confirmation is an important process measure for lung cancer care. We found that the proportion of patients with lung cancer without microscopic confirmation was much higher in regional public hospitals (27.1%) than in tertiary hospitals (7.5%), and this disparity remained after adjusting for age, sex and comorbidities. The percentage was also higher in the private than in the public sector. This case study shows that we need a population-based approach to measuring clinical indicators that includes regional public hospitals as a matter of priority and should ideally include the private sector.

Investigation of sensitivity based load ranking with composite load model in power system

Load modeling plays an important role in power system dynamic stability assessment. One of the widely used methods in assessing load model impact on system dynamic response is through parametric sensitivity analysis. Load ranking provides an effective measure of such impact. Traditionally, load ranking is based on either static or dynamic load model alone. In this paper, composite load model based load ranking framework is proposed. It enables comprehensive investigation into load modeling impacts on system stability considering the dynamic interactions between load and system dynamics. The impact of load composition on the overall sensitivity and therefore on ranking of the load is also investigated. Dynamic simulations are performed to further elucidate the results obtained through sensitivity based load ranking approach.

Continuous and non-intrusive identity verification in real-time environments based on free-text keystroke dynamics

Internet services are important part of daily activities for most of us. These services come with sophisticated authentication requirements which may not be handled by average Internet users. The management of secure passwords for example creates an extra overhead which is often neglected due to usability reasons. Furthermore, password-based approaches are applicable only for initial logins and do not protect against unlocked workstation attacks. In this paper, we provide a non-intrusive identity verification scheme based on behavior biometrics where keystroke dynamics based-on free-text is used continuously for verifying the identity of a user in real-time. We improved existing keystroke dynamics based verification schemes in four aspects. First, we improve the scalability where we use a constant number of users instead of whole user space to verify the identity of target user. Second, we provide an adaptive user model which enables our solution to take the change of user behavior into consideration in verification decision. Next, we identify a new distance measure which enables us to verify identity of a user with shorter text. Fourth, we decrease the number of false results. Our solution is evaluated on a data set which we have collected from users while they were interacting with their mail-boxes during their daily activities.

Investigation into the noise map based on traffic flow prediction in the citywide road network

As one of the measures for decreasing road traffic noise in a city, the control of the traffic flow and the physical distribution is considered. To conduct the measure effectively, the model for predicting the traffic flow in the citywide road network is necessary. In this study, the existing model named AVENUE was used as a traffic flow prediction model. The traffic flow model was integrated with the road vehicles' sound power model and the sound propagation model, and the new road traffic noise prediction model was established. As a case study, the prediction model was applied to the road network of Tsukuba city in Japan and the noise map of the city was made. To examine the calculation accuracy of the noise map, the calculated values of the noise at the main roads were compared with the measured values. As a result, it was found that there was a possibility that the high accuracy noise map of the city could be made by using the noise prediction model developed in this study.

The individual and interactive relationship between long chain omega-3 polyunsaturated fatty acids and physical activity as predictors of cognition in cognitively impaired and non-impaired older adults

Alterations in cognitive function are characteristic of the aging process in humans and other animals. However, the nature of these age related changes in cognition is complex and is likely to be influenced by interactions between genetic predispositions and environmental factors resulting in dynamic fluctuations within and between individuals. These inter and intra-individual fluctuations are evident in both so-called normal cognitive aging and at the onset of cognitive pathology. Mild Cognitive Impairment (MCI), thought to be a prodromal phase of dementia, represents perhaps the final opportunity to mitigate cognitive declines that may lead to terminal conditions such as dementia. The prognosis for people with MCI is mixed with the evidence suggesting that many will remain stable within 10-years of diagnosis, many will improve, and many will transition to dementia. If the characteristics of people who do not progress to dementia from MCI can be identified and replicated in others it may be possible to reduce or delay dementia onset, thus reducing a growing personal and public health burden. Furthermore, if MCI onset can be prevented or delayed, the burden of cognitive decline in aging populations worldwide may be reduced. A cognitive domain that is sensitive to the effects of advancing age, and declines in which have been shown to presage the onset of dementia in MCI patients, is executive function. Moreover, environmental factors such as diet and physical activity have been shown to affect performance on tests of executive function. For example, improvements in executive function have been demonstrated as a result of increased aerobic and anaerobic physical activity and, although the evidence is not as strong, findings from dietary interventions suggest certain nutrients may preserve or improve executive functions in old age. These encouraging findings have been demonstrated in older adults with MCI and their non-impaired peers. However, there are some gaps in the literature that need to be addressed. For example, little is known about the effect on cognition of an interaction between diet and physical activity. Both are important contributors to health and wellbeing, and a growing body of evidence attests to their importance in mental and cognitive health in aging individuals. Yet physical activity and diet are rarely considered together in the context of cognitive function. There is also little known about potential underlying biological mechanisms that might explain the physical activity/diet/cognition relationship. The first aim of this program of research was to examine the individual and interactive role of physical activity and diet, specifically long chain polyunsaturated fatty acid consumption(LCn3) as predictors of MCI status. The second aim is to examine executive function in MCI in the context of the individual and interactive effects of physical activity and LCn3.. A third aim was to explore the role of immune and endocrine system biomarkers as possible mediators in the relationship between LCn3, physical activity and cognition. Study 1a was a cross-sectional analysis of MCI status as a function of erythrocyte proportions of an interaction between physical activity and LCn3. The marine based LCn3s eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have both received support in the literature as having cognitive benefits, although comparisons of the relative benefits of EPA or DHA, particularly in relation to the aetiology of MCI, are rare. Furthermore, a limited amount of research has examined the cognitive benefits of physical activity in terms of MCI onset. No studies have examined the potential interactive benefits of physical activity and either EPA or DHA. Eighty-four male and female adults aged 65 to 87 years, 50 with MCI and 34 without, participated in Study 1a. A logistic binary regression was conducted with MCI status as a dependent variable, and the individual and interactive relationships between physical activity and either EPA or DHA as predictors. Physical activity was measured using a questionnaire and specific physical activity categories were weighted according to the metabolic equivalents (METs) of each activity to create a physical activity intensity index (PAI). A significant relationship was identified between MCI outcome and the interaction between the PAI and EPA; participants with a higher PAI and higher erythrocyte proportions of EPA were more likely to be classified as non-MCI than their less active peers with less EPA. Study 1b was a randomised control trial using the participants from Study 1a who were identified with MCI. Given the importance of executive function as a determinant of progression to more severe forms of cognitive impairment and dementia, Study 1b aimed to examine the individual and interactive effect of physical activity and supplementation with either EPA or DHA on executive function in a sample of older adults with MCI. Fifty male and female participants were randomly allocated to supplementation groups to receive 6-months of supplementation with EPA, or DHA, or linoleic acid (LA), a long chain polyunsaturated omega-6 fatty acid not known for its cognitive enhancing properties. Physical activity was measured using the PAI from Study 1a at baseline and follow-up. Executive function was measured using five tests thought to measure different executive function domains. Erythrocyte proportions of EPA and DHA were higher at follow-up; however, PAI was not significantly different. There was also a significant improvement in three of the five executive function tests at follow-up. However, regression analyses revealed that none of the variance in executive function at follow-up was predicted by EPA, DHA, PAI, the EPA by PAI interaction, or the DHA by PAI interaction. The absence of an effect may be due to a small sample resulting in limited power to find an effect, the lack of change in physical activity over time in terms of volume and/or intensity, or a combination of both reduced power and no change in physical activity. Study 2a was a cross-sectional study using cognitively unimpaired older adults to examine the individual and interactive effects of LCn3 and PAI on executive function. Several possible explanations for the absence of an effect were identified. From this consideration of alternative explanations it was hypothesised that post-onset interventions with LCn3 either alone or in interation with self-reported physical activity may not be beneficial in MCI. Thus executive function responses to the individual and interactive effects of physical activity and LCn3 were examined in a sample of older male and female adults without cognitive impairment (n = 50). A further aim of study 2a was to operationalise executive function using principal components analysis (PCA) of several executive function tests. This approach was used firstly as a data reduction technique to overcome the task impurity problem, and secondly to examine the executive function structure of the sample for evidence of de-differentiation. Two executive function components were identified as a result of the PCA (EF 1 and EF 2). However, EPA, DHA, the PAI, or the EPA by PAI or DHA by PAI interactions did not account for any variance in the executive function components in subsequent hierarchical multiple regressions. Study 2b was an exploratory correlational study designed to explore the possibility that immune and endocrine system biomarkers may act as mediators of the relationship between LCn3, PAI, the interaction between LCn3 and PAI, and executive functions. Insulin-like growth factor-1 (IGF-1), an endocrine system growth hormone, and interleukin-6 (IL-6) an immune system cytokine involved in the acute inflammatory response, have both been shown to affect cognition including executive functions. Moreover, IGF-1 and IL-6 have been shown to be antithetical in so far as chronically increased IL-6 has been associated with reduced IGF-1 levels, a relationship that has been linked to age related morbidity. Further, physical activity and LCn3 have been shown to modulate levels of both IGF-1 and IL-6. Thus, it is possible that the cognitive enhancing effects of LCn3, physical activity or their interaction are mediated by changes in the balance between IL-6 and IGF-1. Partial and non-parametric correlations were conducted in a subsample of participants from Study 2a (n = 13) to explore these relationships. Correlations of interest did not reach significance; however, the coefficients were quite large for several relationships suggesting studies with larger samples may be warranted. In summary, the current program of research found some evidence supporting an interaction between EPA, not DHA, and higher energy expenditure via physical activity in differentiating between older adults with and without MCI. However, a RCT examining executive function in older adults with MCI found no support for increasing EPA or DHA while maintaining current levels of energy expenditure. Furthermore, a cross-sectional study examining executive function in older adults without MCI found no support for better executive function performance as a function of increased EPA or DHA consumption, greater energy expenditure via physical activity or an interaction between physical activity and either EPA or DHA. Finally, an examination of endocrine and immune system biomarkers revealed promising relationships in terms of executive function in non-MCI older adults particularly with respect to LCn3 and physical activity. Taken together, these findings demonstrate a potential benefit of increasing physical activity and LCn3 consumption, particularly EPA, in mitigating the risk of developing MCI. In contrast, no support was found for a benefit to executive function as a result of increased physical activity, LCn3 consumption or an interaction between physical activity and LCn3, in participants with and without MCI. These results are discussed with reference to previous findings in the literature including possible limitations and opportunities for future research.

Monte Carlo-based diode design for correction-less small field dosimetry

Due to their small collecting volume diodes are commonly used in small field dosimetry. However the relative sensitivity of a diode increases with decreasing small field size. Conversely, small air gaps have been shown to cause a significant decrease in the sensitivity of a detector as the field size is decreased. Therefore this study uses Monte Carlo simulations to look at introducing air upstream to diodes such that they measure with a constant sensitivity across all field sizes in small field dosimetry. Varying thicknesses of air were introduced onto the upstream end of two commercial diodes (PTW 60016 photon diode and PTW 60017 electron diode), as well as a theoretical unenclosed silicon chip using field sizes as small as 5 mm × 5 mm . The metric D_(w,Q)/D_(Det,Q) used in this study represents the ratio of the dose to a point of water to the dose to the diode active volume, for a particular field size and location. The optimal thickness of air required to provide a constant sensitivity across all small field sizes was found by plotting D_(w,Q)/D_(Det,Q) as a function of introduced air gap size for various field sizes, and finding the intersection point of these plots. That is, the point at which D_(w,Q)/D_(Det,Q) was constant for all field sizes was found. The optimal thickness of air was calculated to be 3.3 mm, 1.15 mm and 0.10 mm for the photon diode, electron diode and unenclosed silicon chip respectively. The variation in these results was due to the different design of each detector. When calculated with the new diode design incorporating the upstream air gap, k_(Q_clin 〖,Q〗_msr)^(f_clin 〖,f〗_msr ) was equal to unity to within statistical uncertainty (0.5 %) for all three diodes. Cross-axis profile measurements were also improved with the new detector design. The upstream air gap could be implanted on the commercial diodes via a cap consisting of the air cavity surrounded by water equivalent material. The results for the unclosed silicon chip show that an ideal small field dosimetry diode could be created by using a silicon chip with a small amount of air above it.

Cardiac parasympathetic reactivation following exercise : implications for training prescription

The objective of exercise training is to initiate desirable physiological adaptations that ultimately enhance physical work capacity. Optimal training prescription requires an individualized approach, with an appropriate balance of training stimulus and recovery and optimal periodization. Recovery from exercise involves integrated physiological responses. The cardiovascular system plays a fundamental role in facilitating many of these responses, including thermoregulation and delivery/removal of nutrients and waste products. As a marker of cardiovascular recovery, cardiac parasympathetic reactivation following a training session is highly individualized. It appears to parallel the acute/intermediate recovery of the thermoregulatory and vascular systems, as described by the supercompensation theory. The physiological mechanisms underlying cardiac parasympathetic reactivation are not completely understood. However, changes in cardiac autonomic activity may provide a proxy measure of the changes in autonomic input into organs and (by default) the blood flow requirements to restore homeostasis. Metaboreflex stimulation (e.g. muscle and blood acidosis) is likely a key determinant of parasympathetic reactivation in the short term (0–90 min post-exercise), whereas baroreflex stimulation (e.g. exercise-induced changes in plasma volume) probably mediates parasympathetic reactivation in the intermediate term (1–48 h post-exercise). Cardiac parasympathetic reactivation does not appear to coincide with the recovery of all physiological systems (e.g. energy stores or the neuromuscular system). However, this may reflect the limited data currently available on parasympathetic reactivation following strength/resistance-based exercise of variable intensity. In this review, we quantitatively analyse post-exercise cardiac parasympathetic reactivation in athletes and healthy individuals following aerobic exercise, with respect to exercise intensity and duration, and fitness/training status. Our results demonstrate that the time required for complete cardiac autonomic recovery after a single aerobic-based training session is up to 24 h following low-intensity exercise, 24–48 h following threshold-intensity exercise and at least 48 h following high-intensity exercise. Based on limited data, exercise duration is unlikely to be the greatest determinant of cardiac parasympathetic reactivation. Cardiac autonomic recovery occurs more rapidly in individuals with greater aerobic fitness. Our data lend support to the concept that in conjunction with daily training logs, data on cardiac parasympathetic activity are useful for individualizing training programmes. In the final sections of this review, we provide recommendations for structuring training microcycles with reference to cardiac parasympathetic recovery kinetics. Ultimately, coaches should structure training programmes tailored to the unique recovery kinetics of each individual.

On organisational legitimacy practices in developing economies : a profit and readability based approach

In this study, we investigate whether organisations in developing markets legitimise their use of societal resources. We concur that organisations’ existence in developing markets is also part of a social contract. Within this implied contract, organisations are to leverage resources in an equitable manner, allowing fair distribution of benefits to society and themselves. In this setting, we propose that the level of profit is the best indicator of the outcome of use of resources, and is subject to numerous societal emotions in developing economies. We also propose that readability of narratives relating to a level of profit is the best measure of organisations’ immediate legitimacy activities. Five-year data on profitability and readability of sections of corporate annual reports from 30 organisations reveals that organisations with higher profits present more readable narrative disclosures in their annual reports. This relationship is more evident in larger companies and with the public enterprises. These outcomes imply that organisations communicate their profit-related information in ways to manage an appropriate impression and legitimize a level of profit. The study’s outcomes also imply that authorities need to monitor organisations rights to protected existence continuously, as their legitimacy efforts suggest that higher levels of profit may be an outcome of potential misuse of resources.

A fuzzy TOPSIS based multi criteria performance measurement model for lean supply chain

Increasing global competition, rapid technological changes, advances in manufacturing and information technology and discerning customers are forcing supply chains to adopt improvement practices that enable them to deliver high quality products at a lower cost and in a shorter period of time. A lean initiative is one of the most effective approaches toward achieving this goal. In the lean improvement process, it is critical to measure current and desired performance level in order to clearly evaluate the lean implementation efforts. Many attempts have tried to measure supply chain performance incorporating both quantitative and qualitative measures but failed to provide an effective method of measuring improvements in performances for dynamic lean supply chain situations. Therefore, the necessity of appropriate measurement of lean supply chain performance has become imperative. There are many lean tools available for supply chains; however, effectiveness of a lean tool depends on the type of the product and supply chain. One tool may be highly effective for a supply chain involved in high volume products but may not be effective for low volume products. There is currently no systematic methodology available for selecting appropriate lean strategies based on the type of supply chain and market strategy This thesis develops an effective method to measure the performance of supply chain consisting of both quantitative and qualitative metrics and investigates the effects of product types and lean tool selection on the supply chain performance Supply chain performance matrices and the effects of various lean tools over performance metrics mentioned in the SCOR framework have been investigated. A lean supply chain model based on the SCOR metric framework is then developed where non- lean and lean as well as quantitative and qualitative metrics are incorporated in appropriate metrics. The values of appropriate metrics are converted into triangular fuzzy numbers using similarity rules and heuristic methods. Data have been collected from an apparel manufacturing company for multiple supply chain products and then a fuzzy based method is applied to measure the performance improvements in supply chains. Using the fuzzy TOPSIS method, which chooses an optimum alternative to maximise similarities with positive ideal solutions and to minimise similarities with negative ideal solutions, the performances of lean and non- lean supply chain situations for three different apparel products have been evaluated. To address the research questions related to effective performance evaluation method and the effects of lean tools over different types of supply chains; a conceptual framework and two hypotheses are investigated. Empirical results show that implementation of lean tools have significant effects over performance improvements in terms of time, quality and flexibility. Fuzzy TOPSIS based method developed is able to integrate multiple supply chain matrices onto a single performance measure while lean supply chain model incorporates qualitative and quantitative metrics. It can therefore effectively measure the improvements for supply chain after implementing lean tools. It is demonstrated that product types involved in the supply chain and ability to select right lean tools have significant effect on lean supply chain performance. Future study can conduct multiple case studies in different contexts.