Laparoscopic Swenson procedure - An optimal approach for both primary and secondary pull-through for Hirschsprung's disease

Background/Purpose: Several pull-through procedures are available for the surgical management of Hirschsprung's disease (HD) in children. The authors have adopted a laparoscopic approach since 1995, including laparoscopic Swenson procedure (LSw), both for one-stage primary and 2-stage secondary procedures. The aim of this study was to examine the role of LSw in children with HD in both primary and secondary procedures. Methods: From January 1995 to December 2001, 42 children with biopsy-proven HD underwent laparoscopic pull-through procedure for HD. This group included 29 children who underwent LSw, a detailed analysis of which forms the basis of this report. Results: Sixteen children underwent a single-stage neonatal LSw; the median weight of this group at the time of surgery was 3.2 kg and the median age was 5 days. Secondary LSw was performed in the remaining 13 children, which included 3 children with total colonic HD who underwent laparoscopic total colectomy and LSw. The median operating time was 105 minutes (range, 66 to 175 minutes). The median time to commence full diet was 48 hours (range, 24 to 86 hours), and median time to return to normal play and activity was 72 hours (range, 48 hours to 5 days). There was no difference in operating time between primary and secondary pull-through procedures. There were no intraoperative complications, and no patient required open conversion. Postoperative ileus was noted in 3 children and enterocolitis in 2. The median hospital stay was 4 days (range, 2 to 6 days). Follow-up was between 6 months to 7 years with a median follow-up of 2.2 years. At follow-up, 2 children required laparoscopic antegrade continence enema procedure. A satisfactory continence was noted in 15 of the 19 children who were older than 3 years at the time of last follow-up. Conclusions: LSw seems to be a suitable procedure for laparoscopic management of HD in children. LSw is safe and effective, both for primary and secondary type of pull-through procedures, with good short-term results.

Criteria for quantum coherent transfer of excitations between chromophores in a polar solvent

We show that the quantum decoherence of Forster resonant energy transfer between two optically active molecules can be described by a spin-boson model. This allows us to give quantitative criteria that are necessary for coherent quantum oscillations of excitations between the chromophores. Experimental tests of our results should be possible with flourescent resonant energy transfer (FRET) spectroscopy. Although we focus on the case of protein-pigment complexes our results are also relevant to quantum dots and organic molecules in a dielectric medium. (c) 2006 Elsevier B.V. All rights reserved.

Quantum yield calculations for strongly absorbing chromophores

This article demonstrates that a commonly-made assumption in quantum yield calculations may produce errors of up to 25% in extreme cases and can be corrected by a simple modification to the analysis.

Knowledge management systems:finding a way with technology

Purpose - To consider the role of technology in knowledge management in organizations, both actual and desired. Design/methodology/approach - Facilitated, computer-supported group workshops were conducted with 78 people from ten different organizations. The objective of each workshop was to review the current state of knowledge management in that organization and develop an action plan for the future. Findings - Only three organizations had adopted a strongly technology-based "solution" to knowledge management problems, and these followed three substantially different routes. There was a clear emphasis on the use of general information technology tools to support knowledge management activities, rather than the use of tools specific to knowledge management. Research limitations/implications - Further research is needed to help organizations make best use of generally available software such as intranets and e-mail for knowledge management. Many issues, especially human, relate to the implementation of any technology. Participation was restricted to organizations that wished to produce an action plan for knowledge management. The findings may therefore represent only "average" organizations, not the very best practice. Practical implications - Each organization must resolve four tensions: Between the quantity and quality of information/knowledge, between centralized and decentralized organization, between head office and organizational knowledge, and between "push" and "pull" processes. Originality/value - Although it is the group rather than an individual that determines what counts as knowledge, hardly any previous studies of knowledge management have collected data in a group context.

Evaluating the motives of informal entrepreneurs: some lessons from Ukraine

To understand entrepreneurs' motivations, it has become increasingly common to distinguish between those driven by necessity (or pushed) and those driven by opportunity (or pulled) into entrepreneurship. Until now, entrepreneurs operating wholly or partially in the informal economy have been widely assumed to be necessity-driven, pushed into this enterprise as a survival strategy in the absence of alternatives. To evaluate whether this is indeed the case, this paper reports one of the first surveys of informal entrepreneurs' motives. Reporting face-to-face interviews conducted in Ukraine during 2005–06 with 298 informal entrepreneurs, the finding is although most identified themselves as necessity entrepreneurs when initially asked whether they were either pushed or pulled, subsequent questions reveal in the vast majority of cases, there were not only both push and pull factors driving their original decision to start-up informal enterprises, but also a clear shift among these entrepreneurs as their business became established away from necessity-oriented motivations and toward more opportunity-oriented motivations. The outcome is a call for a transcendence of a static either/or approach and the adoption of a dynamic both/and approach that recognizes the coexistence of necessity- and opportunity-drivers as well as the fluidity of entrepreneurs' motivations.

The development of heat recovery equipment from conception to commercialisation

A comprehensive survey of industrial sites and heat recovery products revealed gaps between equipment that was required and that which was available. Two heat recovery products were developed to fill those gaps: a gas-to-gas modular heat recovery unit; a gas-to-liquid exhaust gas heat exchanger. The former provided an entire heat recovery system in one unit. It was specifically designed to overcome the problems associated with existing component system of large design commitment, extensive installation and incompatibility between parts. The unit was intended to recover heat from multiple waste gas sources and, in particular, from baking ovens. A survey of the baking industry defined typical waste gas temperatures and flow rates, around which the unit was designed. The second unit was designed to recover heat from the exhaust gases of small diesel engines. The developed unit differed from existing designs by having a negligible effect on engine performance. In marketing terms these products are conceptual opposites. The first, a 'product-push' product generated from site and product surveys, required marketing following design. The second, a 'market-pull' product, resulted from a specific user need; this had a captive market and did not require marketing. Here marketing was replaced by commercial aspects including the protection of ideas, contracting, tendering and insurance requirements. These two product development routes are compared and contrasted. As a general conclusion this work suggests that it can be beneficial for small companies (as was the sponsor of this project) to undertake projects of the market-pull type. Generally they have a higher probability of success and are less capital intensive than their product-push counterparts. Development revealed shortcomings in three other fields: British Standards governing heat exchangers; financial assessment of energy saving schemes; degree day procedure of calculating energy savings. Methods are proposed to overcome these shortcomings.

The antimicrobial efficacy of copper alloy furnishing in the clinical environment:a crossover study

Objective. To determine whether copper incorporated into hospital ward furnishings and equipment can reduce their surface microbial load. Design. A crossover study. Setting. Acute care medical ward with 19 beds at a large university hospital. Methods. Fourteen types of frequent-touch items made of copper alloy were installed in various locations on an acute care medical ward. These included door handles and push plates, toilet seats and flush handles, grab rails, light switches and pull cord toggles, sockets, overbed tables, dressing trolleys, commodes, taps, and sink fittings. Their surfaces and those of equivalent standard items on the same ward were sampled once weekly for 24 weeks. The copper and standard items were switched over after 12 weeks of sampling to reduce bias in usage patterns. The total aerobic microbial counts and the presence of indicator microorganisms were determined. Results. Eight of the 14 copper item types had microbial counts on their surfaces that were significantly lower than counts on standard materials. The other 6 copper item types had reduced microbial numbers on their surfaces, compared with microbial counts on standard items, but the reduction did not reach statistical significance. Indicator microorganisms were recovered from both types of surfaces; however, significantly fewer copper surfaces were contaminated with vancomycin-resistant enterococci, methicillin-susceptible Staphylococcus aureus, and coliforms, compared with standard surfaces. Conclusions. Copper alloys (greater than or equal to 58% copper), when incorporated into various hospital furnishings and fittings, reduce the surface microorganisms. The use of copper in combination with optimal infection-prevention strategies may therefore further reduce the risk that patients will acquire infection in healthcare environments.

Pragmatic development of service based real-time change data capture

This thesis makes a contribution to the Change Data Capture (CDC) field by providing an empirical evaluation on the performance of CDC architectures in the context of realtime data warehousing. CDC is a mechanism for providing data warehouse architectures with fresh data from Online Transaction Processing (OLTP) databases. There are two types of CDC architectures, pull architectures and push architectures. There is exiguous data on the performance of CDC architectures in a real-time environment. Performance data is required to determine the real-time viability of the two architectures. We propose that push CDC architectures are optimal for real-time CDC. However, push CDC architectures are seldom implemented because they are highly intrusive towards existing systems and arduous to maintain. As part of our contribution, we pragmatically develop a service based push CDC solution, which addresses the issues of intrusiveness and maintainability. Our solution uses Data Access Services (DAS) to decouple CDC logic from the applications. A requirement for the DAS is to place minimal overhead on a transaction in an OLTP environment. We synthesize DAS literature and pragmatically develop DAS that eciently execute transactions in an OLTP environment. Essentially we develop effeicient RESTful DAS, which expose Transactions As A Resource (TAAR). We evaluate the TAAR solution and three pull CDC mechanisms in a real-time environment, using the industry recognised TPC-C benchmark. The optimal CDC mechanism in a real-time environment, will capture change data with minimal latency and will have a negligible affect on the database's transactional throughput. Capture latency is the time it takes a CDC mechanism to capture a data change that has been applied to an OLTP database. A standard definition for capture latency and how to measure it does not exist in the field. We create this definition and extend the TPC-C benchmark to make the capture latency measurement. The results from our evaluation show that pull CDC is capable of real-time CDC at low levels of user concurrency. However, as the level of user concurrency scales upwards, pull CDC has a significant impact on the database's transaction rate, which affirms the theory that pull CDC architectures are not viable in a real-time architecture. TAAR CDC on the other hand is capable of real-time CDC, and places a minimal overhead on the transaction rate, although this performance is at the expense of CPU resources.

Competitive edge through operations management

A view has emerged within manufacturing and service organizations that the operations management function can hold the key to achieving competitive edge. This has recently been emphasized by the demands for greater variety and higher quality which must be set against a background of increasing cost of resources. As nations' trade barriers are progressively lowered and removed, so producers of goods and service products are becoming more exposed to competition that may come from virtually anywhere around the world. To simply survive in this climate many organizations have found it necessary to improve their manufacturing or service delivery systems. To become real ''winners'' some have adopted a strategic approach to operations and completely reviewed and restructured their approach to production system design and operations planning and control. The articles in this issue of the International journal of Operations & Production Management have been selected to illustrate current thinking and practice in relation to this situation. They are all based on papers presented to the Sixth International Conference of the Operations Management Association-UK which was held at Aston University in June 1991. The theme of the conference was "Achieving Competitive Edge" and authors from 15 countries around the world contributed to more than 80 presented papers. Within this special issue five topic areas are addressed with two articles relating to each. The topics are: strategic management of operations; managing change; production system design; production control; and service operations. Under strategic management of operations De Toni, Filippini and Forza propose a conceptual model which considers the performance of an operating system as a source of competitive advantage through the ''operation value chain'' of design, purchasing, production and distribution. Their model is set within the context of the tendency towards globalization. New's article is somewhat in contrast to the more fashionable literature on operations strategy. It challenges the validity of the current idea of ''world-class manufacturing'' and, instead, urges a reconsideration of the view that strategic ''trade-offs'' are necessary to achieve a competitive edge. The importance of managing change has for some time been recognized within the field of organization studies but its relevance in operations management is now being realized. Berger considers the use of "organization design", ''sociotechnical systems'' and change strategies and contrasts these with the more recent idea of the ''dialogue perspective''. A tentative model is suggested to improve the analysis of different strategies in a situation specific context. Neely and Wilson look at an essential prerequisite if change is to be effected in an efficient way, namely product goal congruence. Using a case study as its basis, their article suggests a method of measuring goal congruence as a means of identifying the extent to which key performance criteria relating to quality, time, cost and flexibility are understood within an organization. The two articles on production systems design represent important contributions to the debate on flexible production organization and autonomous group working. Rosander uses the results from cases to test the applicability of ''flow groups'' as the optimal way of organizing batch production. Schuring also examines cases to determine the reasons behind the adoption of ''autonomous work groups'' in The Netherlands and Sweden. Both these contributions help to provide a greater understanding of the production philosophies which have emerged as alternatives to more conventional systems -------for intermittent and continuous production. The production control articles are both concerned with the concepts of ''push'' and ''pull'' which are the two broad approaches to material planning and control. Hirakawa, Hoshino and Katayama have developed a hybrid model, suitable for multistage manufacturing processes, which combines the benefits of both systems. They discuss the theoretical arguments in support of the system and illustrate its performance with numerical studies. Slack and Correa's concern is with the flexibility characteristics of push and pull material planning and control systems. They use the case of two plants using the different systems to compare their performance within a number of predefined flexibility types. The two final contributions on service operations are complementary. The article by Voss really relates to manufacturing but examines the application of service industry concepts within the UK manufacturing sector. His studies in a number of companies support the idea of the ''service factory'' and offer a new perspective for manufacturing. Harvey's contribution by contrast, is concerned with the application of operations management principles in the delivery of professional services. Using the case of social-service provision in Canada, it demonstrates how concepts such as ''just-in-time'' can be used to improve service performance. The ten articles in this special issue of the journal address a wide range of issues and situations. Their common aspect is that, together, they demonstrate the extent to which competitiveness can be improved via the application of operations management concepts and techniques.

Understanding supply chain disruption risk with the aid of social networks and information flows analysis

Supply Chain Risk Management (SCRM) has become a popular area of research and study in recent years. This can be highlighted by the number of peer reviewed articles that have appeared in academic literature. This coupled with the realisation by companies that SCRM strategies are required to mitigate the risks that they face, makes for challenging research questions in the field of risk management. The challenge that companies face today is not only to identify the types of risks that they face, but also to assess the indicators of risk that face them. This will allow them to mitigate that risk before any disruption to the supply chain occurs. The use of social network theory can aid in the identification of disruption risk. This thesis proposes the combination of social networks, behavioural risk indicators and information management, to uniquely identify disruption risk. The propositions that were developed from the literature review and exploratory case study in the aerospace OEM, in this thesis are:- By improving information flows, through the use of social networks, we can identify supply chain disruption risk. - The management of information to identify supply chain disruption risk can be explored using push and pull concepts. The propositions were further explored through four focus group sessions, two within the OEM and two within an academic setting. The literature review conducted by the researcher did not find any studies that have evaluated supply chain disruption risk management in terms of social network analysis or information management studies. The evaluation of SCRM using these methods is thought to be a unique way of understanding the issues in SCRM that practitioners face today in the aerospace industry.

Making Sense of Home and Homeland: Former-Soviet Greeks' Motivations and Strategies for a Transnational Migrant Circuit

Focusing on former-Soviet Greeks' experiences of cross-border movement to Greece, this paper sheds light on the impact of this migration on the social identities of Russian Greeks as a transnational community. It draws on informants’ narratives and ethnographic observations recorded among Greek migrants in their home communities in southern Russia, and shows how their motivation, in their transnational movement, is determined by the ‘push-and-pull’ forces of socio-economic and political transformations in post-Soviet space. In these conditions, Greek identity becomes a resource which facilitates the organisation of transnational migration. The cultural, social and economic differences between the former-Soviet Greek migrants and the native-born population of Greece result in the emergence of a Pontic-Greek cultural identity which emphasises migrants’ connections with the former USSR. The difficulties of economic and cultural adaptation for migrants to Greece are examined in relation to the Russian Greeks' economic strategies within their home communities and their perception of the ‘homeland’ as a constantly contested and relocated social construct.

Enhanced process verification through re-engineering the manufacturing procedure

In today’s modern manufacturing industry there is an increasing need to improve internal processes to meet diverse client needs. Process re-engineering is an important activity that is well understood by industry but its rate of application within small to medium size enterprises (SME) is less developed. Business pressures shift the focus of SMEs toward winning new projects and contracts rather than developing long-term, sustainable manufacturing processes. Variations in manufacturing processes are inevitable, but the amount of non-conformity often exceeds the acceptable levels. This paper is focused on the re-engineering of the manufacturing and verification procedure for discrete parts production with the aim of enhancing process control and product verification. The ideologies of the ‘Push’ and ‘Pull’ approaches to manufacturing are useful in the context of process re-engineering for data improvement. Currently information is pulled from the market and prominent customers, and manufacturing companies always try to make the right product, by following customer procedures that attempt to verify against specifications. This approach can result in significant quality control challenges. The aim of this paper is to highlight the importance of process re-engineering in product verification in SMEs. Leadership, culture, ownership and process management are among the main attributes required for the successful deployment of process re-engineering. This paper presents the findings from a case study showcasing the application of a modified re-engingeering method for the manufacturing and verification process. The findings from the case study indicate there are several advantages to implementing the re-engineering method outlined in this paper.

Randomized Push-Out Mechanisms in Priority Queuing and their Probability Characteristics

2002 Mathematics Subject Classification: 60K25.

Crack tip stress study for elastic-perfectly plastic materials with some applications

The problems of plasticity and non-linear fracture mechanics have been generally recognized as the most difficult problems of solid mechanics. The present dissertation is devoted to some problems on the intersection of both plasticity and non-linear fracture mechanics. The crack tip is responsible for the crack growth and therefore is the focus of fracture science. The problem of crack has been studied by an army of outstanding scholars and engineers in this century, but has not, as yet, been solved for many important practical situations. The aim of this investigation is to provide an analytical solution to the problem of plasticity at the crack tip for elastic-perfectly plastic materials and to apply the solution to a classical problem of the mechanics of composite materials.^ In this work, the stresses inside the plastic region near the crack tip in a composite material made of two different elastic-perfectly plastic materials are studied. The problems of an interface crack, a crack impinging an interface at the right angle and at arbitrary angles are examined. The constituent materials are assumed to obey the Huber-Mises yielding condition criterion. The theory of slip lines for plane strain is utilized. For the particular homogeneous case these problems have two solutions: the continuous solution found earlier by Prandtl and modified by Hill and Sokolovsky, and the discontinuous solution found later by Cherepanov. The same type of solutions were discovered in the inhomogeneous problems of the present study. Some reasons to prefer the discontinuous solution are provided. The method is also applied to the analysis of a contact problem and a push-in/pull-out problem to determine the critical load for plasticity in these classical problems of the mechanics of composite materials.^ The results of this dissertation published in three journal articles (two of which are under revision) will also be presented in the Invited Lecture at the 7$\rm\sp{th}$ International Conference on Plasticity (Cancun, Mexico, January 1999). ^