914 resultados para Using Lean tools


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OBJECTIVE: To assess the effect of using different risk calculation tools on how general practitioners and practice nurses evaluate the risk of coronary heart disease with clinical data routinely available in patients' records. DESIGN: Subjective estimates of the risk of coronary heart disease and results of four different methods of calculation of risk were compared with each other and a reference standard that had been calculated with the Framingham equation; calculations were based on a sample of patients' records, randomly selected from groups at risk of coronary heart disease. SETTING: General practices in central England. PARTICIPANTS: 18 general practitioners and 18 practice nurses. MAIN OUTCOME MEASURES: Agreement of results of risk estimation and risk calculation with reference calculation; agreement of general practitioners with practice nurses; sensitivity and specificity of the different methods of risk calculation to detect patients at high or low risk of coronary heart disease. RESULTS: Only a minority of patients' records contained all of the risk factors required for the formal calculation of the risk of coronary heart disease (concentrations of high density lipoprotein (HDL) cholesterol were present in only 21%). Agreement of risk calculations with the reference standard was moderate (kappa=0.33-0.65 for practice nurses and 0.33 to 0.65 for general practitioners, depending on calculation tool), showing a trend for underestimation of risk. Moderate agreement was seen between the risks calculated by general practitioners and practice nurses for the same patients (kappa=0.47 to 0.58). The British charts gave the most sensitive results for risk of coronary heart disease (practice nurses 79%, general practitioners 80%), and it also gave the most specific results for practice nurses (100%), whereas the Sheffield table was the most specific method for general practitioners (89%). CONCLUSIONS: Routine calculation of the risk of coronary heart disease in primary care is hampered by poor availability of data on risk factors. General practitioners and practice nurses are able to evaluate the risk of coronary heart disease with only moderate accuracy. Data about risk factors need to be collected systematically, to allow the use of the most appropriate calculation tools.

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Purpose – The purpose of this paper is to investigate the effectiveness of quality management training by reviewing commonly used critical success factors and tools rather than the overall methodological approach. Design/methodology/approach – The methodology used a web-based questionnaire. It consisted of 238 questions covering 77 tools and 30 critical success factors selected from leading academic and practitioner sources. The survey had 79 usable responses and the data were analysed using relevant statistical quality management tools. The results were validated in a series of structured workshops with quality management experts. Findings – Findings show that in general most of the critical success factor statements for quality management are agreed with, although not all are implemented well. The findings also show that many quality tools are not known or understood well; and that training has an important role in raising their awareness and making sure they are used correctly. Research limitations/implications – Generalisations are limited by the UK-centric nature of the sample. Practical implications – The practical implications are discussed for organisations implementing quality management initiatives, training organisations revising their quality management syllabi and academic institutions teaching quality management. Originality/value – Most recent surveys have been aimed at methodological levels (i.e. “lean”, “Six Sigma”, “total quality management” etc.); this research proposes that this has limited value as many of the tools and critical success factors are common to most of the methodologies. Therefore, quite uniquely, this research focuses on the tools and critical success factors. Additionally, other recent comparable surveys have been less comprehensive and not focused on training issues.

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Microfluidics has recently emerged as a new method of manufacturing liposomes, which allows for reproducible mixing in miliseconds on the nanoliter scale. Here we investigate microfluidics-based manufacturing of liposomes. The aim of these studies was to assess the parameters in a microfluidic process by varying the total flow rate (TFR) and the flow rate ratio (FRR) of the solvent and aqueous phases. Design of experiment and multivariate data analysis were used for increased process understanding and development of predictive and correlative models. High FRR lead to the bottom-up synthesis of liposomes, with a strong correlation with vesicle size, demonstrating the ability to in-process control liposomes size; the resulting liposome size correlated with the FRR in the microfluidics process, with liposomes of 50 nm being reproducibly manufactured. Furthermore, we demonstrate the potential of a high throughput manufacturing of liposomes using microfluidics with a four-fold increase in the volumetric flow rate, maintaining liposome characteristics. The efficacy of these liposomes was demonstrated in transfection studies and was modelled using predictive modeling. Mathematical modelling identified FRR as the key variable in the microfluidic process, with the highest impact on liposome size, polydispersity and transfection efficiency. This study demonstrates microfluidics as a robust and high-throughput method for the scalable and highly reproducible manufacture of size-controlled liposomes. Furthermore, the application of statistically based process control increases understanding and allows for the generation of a design-space for controlled particle characteristics.

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This paper is devoted to the learning of event programming by using Visual C# in specialized training in Informatics in high schools. Some basic tools and technologies for the implementation of graphics and animation in C# are discussed. Two example problems are proposed.

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Open source software (OSS) popularity is growing steadily and many OSS systems could be used to preserve cultural heritage objects. Such solutions give the opportunity to organizations to afford the development of a digital collection. This paper focuses on reviewing two OSS tools, CollectionSpace and the Open Video Digital Library Toolkit and discuss on how these could be used for organizing digital replicas of cultural objects. The features of the software are presented and some examples are given.

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Grade three students used tablet computers with a pre-selected series of applications over a seven-month period at school and through a community afterschool program. The study determined that these students benefited from differentiated learning in the school environment and online collaborative play in the afterschool centre. Benefits of the exposure to digital tools included: intergenerational learning as children assisted both parents and teachers with digital applications; problem-solving; and enhanced collaborative play for students across environments. Although this study makes a contribution to the field of digital literacy and young learners, the researchers conclude further investigation is warranted, in regards to the inter-relationships between home, school and community as spaces for the learning and teaching of digital technologies.

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Idag är det vanligt att företagen konkurrerar med produkter som innefattar en fysisk vara som har utvidgats med olika tjänster för att kunna tillfredsställa kundens behov. I takt med detta ökar produkternas komplexitet och högre krav ställs på leverantörerna. Denna utveckling har lett till att många företag som tillverkar produkter med hög variation måste arbeta helt kundorderstyrt för att kunna tillgodose kundernas ökande krav. Företagen som tillverkar dessa komplexa produkter har en tillverkning som karaktäriseras av hög variation och låg volym vilket benämns med förkortningen HVLV. Utmaningen för dessa HVLV-företag ligger i att ha en hög produktmixflexibilitet med så låg resursanvändning som möjligt. För att effektivisera verksamheten har många företag därför intresserat sig för Lean production som har visat sig vara ett framgångsrikt koncept för tillverkande företag runt om i världen som effektiviserat sin produktion. Ett flertal artiklar har uppmärksammat begränsningar vid implementeringen av Lean production i HVLV-miljöer. Artiklar pekar vidare på behovet av ytterligare forskning kring Lean productions applicerbarhet i HVLV-miljöer och detta var uppkomsten till examensarbetets bakgrund och syfte. En fallstudie har genomförts på Tibrokök som är ett företag med en helt kundorderstyrd produktion som kännetecknas av HVLV. Med hjälp av fallstudien syftar examensarbetet till att undersöka om verktygen processkartläggning inkl. tidsstudier och layoutflödesdiagram kan bidra till att skapa förutsättningar för implementering av Lean production i en enskild tillverkningsprocess i en HVLV-miljö. Trots att verktygen har behövt anpassas något så anses de ha varit användbara och bidragande till skapandet av förutsättningar för implementering av Lean production i denna HVLV-miljö. Detta eftersom vi kunde identifiera många orsaker till slöseri samt ta fram ett förslag som skapar effektiviseringar av Tibroköks ytbehandlingsprocess i det framtida läget.