Nonalcoholic fatty liver disease in lean subjects:Prognosis,outcomes and management

Nonalcoholic fatty liver disease(NAFLD)accounts for most cases of chronic liver disease worldwide,with an estimated global prevalence of approximately 25%and ranges from simple steatosis to nonalcoholic steatohepatitis and cirrhosis.NAFLD is strongly connected to metabolic syndrome,and for many years,fatty liver was considered to be an exclusive feature of obese patients.However,recent studies have highlighted the presence of NAFLD in non-obese subjects,with or without increased visceral fat or even in lean subjects without increased waist circumference.“Lean NAFLD”is a relatively new concept and there is significant scientific interest in understanding the differences in pathophysiology,prognosis and management compared with NAFLD in overweight/obese patients.In the present editorial,we discuss the clinical and metabolic profiles and outcomes of lean NAFLD compared with both obese NAFLD and lean healthy individuals from Asian and Western countries.Moreover,we shed light to the challenging topic of management of NAFLD in lean subjects since there are no specific guidelines for this population.Finally,we discuss open questions and issues to be addressed in the future in order to categorize NAFLD patients into lean and nonlean cohorts.

Lean Management in Obstetrics and Gynecology: Application in the Ambulatory Clinic Pre- and Post-Kaizen

OBJECTIVE: The ambulatory clinic was an important departmental problem. Providers hated working there and patients complained about the wait times there. It seemed there were equal numbers of patients and provider complaints. In the spirit of solving the problem, data was gathered, a LEAN intervention was planned, and data was collected. METHODS: We defined the service families in the clinic as registration, vital signs, provider or ultrasound visit, nursing visit, and registration for the return visit. We walked the Gemba engaging all the staff in the process. Many observations pointed to long waits between and among the five stations. In order to study the current state, time data was collected by attaching a sheet of paper to a folder that the patient would carry themselves to all the clinical steps. On the sheet of paper each station logged the time that patient appeared and the time the patient left their sight. Data was gathered each day and every day from October 2016 to the summer of 2017. The data was analyzed. Leadership met and identified value and waste in the process. A Kaizen event was scheduled after the first set of measurements engaging all the staff. After the data was thoroughly analyzed and digested, brainstorming occurred. Together we determined our future state. We created a vision and strategic goals to reach our future state. RESULTS: The data pre-Kaizen event showed that the process of arrival to leaving took 124 minutes. We discovered that not every patient passed through each station. We learned the patients were on time or early for their visit most of the time. The providers were late most of the time by 1 - 1.5 hours. We learned how long each station took from the patient’s point of view. There were no statistically significant differences between ultrasound and provider visits;there were no statistically significant differences between midwife and physician visits. Each day of the week was similar. The arrival rate was higher in the morning because of the template. After the event, the total time in clinic did not change however the variability in time between and among each station decreased in variance. We informed the staff of these findings so that they could take responsibility for their part in the process. The atmosphere in clinic changed dramatically and the complaints from both providers and patients stopped. CONCLUSION: LEAN management was used to improve the clinic. It yielded important results, got the staff engaged in the process, and provided a way for the patients to see the efforts made by staff to improve.

Update in lean metabolic dysfunction-associated steatotic liver disease

BACKGROUND A new nomenclature consensus has emerged for liver diseases that were previously known as non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated fatty liver disease(MAFLD).They are now defined as metabolic dysfunction-associated steatotic liver disease(MASLD),which includes cardiometabolic criteria in adults.This condition,extensively studied in obese or overweight patients,constitutes around 30%of the population,with a steady increase worldwide.Lean patients account for approximately 10%-15%of the MASLD population.However,the pathogenesis is complex and is not well understood.AIM To systematically review the literature on the diagnosis,pathogenesis,characteristics,and prognosis in lean MASLD patients and provide an interpretation of these new criteria.METHODS We conducted a comprehensive database search on PubMed and Google Scholar between January 2012 and September 2023,specifically focusing on lean NAFLD,MAFLD,or MASLD patients.We include original articles with patients aged 18 years or older,with a lean body mass index categorized according to the World Health Organization criteria,using a cutoff of 25 kg/m2 for the general population and 23 kg/m2 for the Asian population.RESULTS We include 85 studies in our analysis.Our findings revealed that,for lean NAFLD patients,the prevalence rate varied widely,ranging from 3.8%to 34.1%.The precise pathogenesis mechanism remained elusive,with associations found in genetic variants,epigenetic modifications,and adaptative metabolic response.Common risk factors included metabolic syndrome,hypertension,and type 2 diabetes mellitus,but their prevalence varied based on the comparison group involving lean patients.Regarding non-invasive tools,Fibrosis-4 index outperformed the NAFLD fibrosis score in lean patients.Lifestyle modifications aided in reducing hepatic steatosis and improving cardiometabolic profiles,with some medications showing efficacy to a lesser extent.However,lean NAFLD patients exhibited a worse prognosis compared to the obese or overweight counterpart.CONCLUSION MASLD is a complex disease comprising epigenetic,genetic,and metabolic factors in its pathogenesis.Results vary across populations,gender,and age.Limited data exists on clinical practice guidelines for lean patients.Future studies employing this new nomenclature can contribute to standardizing and generalizing results among lean patients with steatotic liver disease.

Study on Tobacco Leave Lean Production Management System

In recent years, tobacco lean production infrastructure is almost full-fledged through development, and professional service scope expands accordingly. Hence, the developing emphasis has transformed from hardware facilities improvement to software updating of lean management and precise work. With related documents released by China Tobacco and Guizhou Tobacco, the achievement of comprehen- sive lean management probably becomes one of the key goals for the future devel- opment of tobacco business. The construction goal of tobacco leaves lean produc- tion management system is to internalize technology, information, human resources, material and other production elements into value stream of flue-cured tobacco pro- duction, and strict control value stream of input costs and output benefits, and then create management profit, promote enterprise, core competitiveness. The lean pro- duction management is both extension and expansion of modern tobacco agriculture, closely related to agricultural standardization and GAP management, which is based on professional service training and production machinery upgrading, with team management and station working as carriers, and information feedback, key quality monitoring and benefit evaluation as assessment references.

The Practical Application of Lean Management Model to the Production and Operation of China＇s Small and Medium- sized Apparel Enterprises

In this paper, the prospect and advantages of applying prospect and advantages to the production and operation of China＇ s small and medimn-sized apparel enterprises, the main waste parts in the apparel production and operation process are systematically analyzed, an efficient production, management, and operation model meeting the characteristics of the small and medium-sized apparel enterprises is explored according to the solutions in lean management, and also the technical transformation in the key positions is fully implemented, so that the production efficiency of the sewing workshop is improved, the bottlenecks of the backward production management way to restrict the development of enterprises are broken, the vitality of the enterprises is restored, and also significant economic and social benefits are achieved.

Lean Management Based Sustainable Transport System for Surat Metropolitan Area in the Context of Industrial Development

Surat city is continuously expanding with industrial development. Despite several flyovers, traffic congestion continues in the heart of city. Therefore, fresh transportation planning is at anvil. Simultaneously, further expansion plan is under consideration to create yet another, the 10th industrial zone. Purpose of this paper is to explore lean management based sustainable transport system for meeting the increasing needs of people and supply-chain. The research examines different mode of transportation like; vehicles on road, rail on the land, and steamers through the sea route to provide connectivity. This study may support the planners of the smart city. The study intends to find how lean management can be integrated to sustainable transport system meeting objectives of lean and sustainability both. Lean management system claims to be capable of eliminating all type of wastes including those associated with transport system. On the other hand, sustainable transport claims to meet the needs of people in personal economic lives, importantly respecting the need of future generations. Therefore, this applied research aims to find a lean and sustainable transport solution. This research work can be seen as descriptive type as it includes survey of location and fact finding enquiries.

LMS及其在我国森林经营中的应用

LMS具有单木、林分、场景3个尺度的建模与可视化,具有经营管理、景观规划、辅助设计等功能,该系统能够满足林业科学研究人员和林业经营管理者等用户需求,但该系统要在我国进行应用,还有很多方面需要改进和完善。本文在简要介绍LMS主要功能模块(FVS、SVS和EnVi-sion)基础上,从林分生长模型、植物个体形态参数设计、软件汉化等方面讨论了该软件在我国应用的改进,最后介绍了LMS在林分空间格局可视化以及经营效果模拟方面应用的一个实例。

基于LMS AMESim的车用燃料电池-锂离子动力电池混合动力系统能量管理仿真

基于20kW燃料电池电堆及燃料电池测试系统,获得燃料电池极化曲线及氢气消耗量曲线;基于锂离子动力电池充放电系统,获得锂离子动力电池输出电压曲线.将试验所得数据导入到LMS AMESim软件中,分别构建燃料电池及锂离子动力电池模块,同时,构建仿真平台其他所需模块并搭建DC/DC变换器模型,建立燃料电池-锂离子动力电池混合的动力系统仿真平台.依据不同动力源的各自特点,引入能量控制策略,对该混合动力系统进行模拟仿真.在所选定新欧洲驾驶循环(new European driving cycle,NEDC)工况下仿真结果表明,该混合动力系统可以满足车辆在所选定工况下的动力需求.DC/DC变换器可提升并稳定燃料电池输出电压跟随母线电压,并通过对电流的分配进行功率在不同动力源之间的分配;燃料电池输出功率在合理范围之内,并取消燃料电池在低功率下的工况,从而保护燃料电池,延长其使用寿命;锂离子动力电池荷电状态(state of charge,SOC)始终保持在合理范围内,未出现过充或过放情况.研究结果可为搭建混合动力试验平台及整车搭载匹配提供理论依据及参考.

我国医院精益管理研究现状与热点分析

目的:探索精益管理在医院管理的研究现状和热点,为其进一步实践和研究提供参考借鉴。方法:在中国生物医学文献数据库、中国知网和万方数据库中检索关于精益管理相关文献,从相关概念、文献来源、文献时间和空间分布、关键词分布进行统计和可视化分析,揭示相关研究主题和热点。结果:共纳入669篇文献,发表于208种期刊,432个第一研究机构,991个关键词,研究主题分为8个类。结论:精益管理在医院管理研究广泛、应用创新发展不均衡和理论研究有待进一步升华。

Progress and key challenges in catalytic combustion of lean methane

As a primary type of clean energy,methane is also the second most important greenhouse gas after CO_(2)due to the high global warming potential.Large quantities of lean methane(0.1–1.0 vol%)are emitted into the atmosphere without any treatment during coal mine,oil,and natural gas production,thus leading to energy loss and greenhouse effect.In general,it is challenging to utilize lean methane due to its low concentration and flow instability,while catalytic combustion is a vital pathway to realize an efficient utilization of lean methane owing to the reduced emissions of polluting gases(e.g.,NOxand CO)during the reaction.In particular,to efficiently convert lean methane,it necessitates both the designs of highly active and stable heterogeneous catalysts that accelerate lean methane combustion at low temperatures and smart reactors that enable autothermal operation by optimizing heat management.In this review,we discuss the in-depth development,challenges,and prospects of catalytic lean methane combustion technology in various configurations,with particular emphasis on heat management from the point of view of material design combined with reactor configuration.The target is to describe a framework that can correlate the guiding principles among catalyst design,device innovation and system optimization,inspiring the development of groundbreaking combustion technology for the efficient utilization of lean methane.

基于VisiLean的工程项目施工协同管理系统研究

针对现有研究将BIM用于施工协同管理的不足,引入VisiLean系统;围绕组织、信息、流程三大施工协同管理要素构建基于VisiLean的施工协同管理系统架构;进一步阐述基于VisiLean的施工协同管理系统的运行过程,构建基于VisiLean的施工协同管理模型,为推进工程项目整个施工过程的集成化、精细化、信息化、协同化管理提供参考。

Lean Product Development Process with Design Verification Stages in the Value Stream of Automotive Industry

In the automotive industry, lean projects and innovation creation come to life by being updated under the control of systematic interdisciplinary process flows. The lean product development process that changes the shell, defined under the light of the variables created by the competitive conditions, is today measured by the value flow efficiency and the global market spread of the final product. Consequently, the lean product development approach, which aims to identify and purify all the wastes that do none value or create value to the system or cause burdens in the new product development process, is shaped by step-by-step approvals in the flow. In the main automotive industry company practices within the scope of the research (3 national, 3 international), the beginning of the concept of lean in design is to define and optimize the steps in the product development process under the value stream map. Therefore, the product function for which the customer has paid for, the function of the new product or the physical structure used to meet the needs in question, the comfort, life, experience, innovations of the scope that constitute the new product concept are planned and verified and implemented in the simplified automotive design stages at the beginning of the lean product development process. In this research, initial automotive design objectives and stages are at the focal point of the innovation and added value creation brought by the concept of “lean” approach. The research is modelled on the determination of steps that do not create added value together with the points where the flow circuits’ or stems, the process is devalued, the interdisciplinary holistic studies intensify, the information and delay begin and end in the sequential and simultaneous design validation step transition stages, which are examined under the lean approach. As a visual and virtual tool that enables the elaboration of nominal values such as the total duration of the design verification stages and the influence of interdisciplinary stakeholders or the test level of the product design with the new product added, it reveals the value flow or losses. Hence research;from innovation creation and new product design steps, which constitute the initial stages of the lean product development process, to design verification analysis, the efficiency of the automotive company processes within the scope of the research has been measured by comparing using lean automotive design techniques, methods and concepts.

Real-time and dynamic schedule optimization of construction projects on the basis of lean construction

Lean construction has been newly applied to construction industry. The best performance of a project can be achieved through the precise definition of construction product, rational work break structure, lean supply chain, decrease of resources waste, objective control and so forth. Referring to the characteristics of schedule planning of construction projects and lean construction philosophy, we proposed optimizing methodology of real-time and dynamic schedule of construction projects based on lean construction. The basis of the methodology is process reorganization and lean supply in construction enterprises. The traditional estimating method of the activity duration is fuzzy and random;however, a newly proposed lean forecasting method employs multi-components linear-regression, back-propagation artificial neural networks and learning curve. Taking account of the limited resources and the fixed duration of a project, the optimizing method of the real-time and dynamic schedule adopts the concept of resource driving. To optimize the schedule of a construction project timely and effectively, an intellectualized schedule management system was developed. It can work out the initial schedule, optimize the real-time and dynamic schedule, and display the schedule with the Gant Chart, the net-work graph and the space-time line chart. A case study was also presented to explain the proposed method.

浅谈Lean Construction在工程质量管理中应用

我国建设工程的质量问题诸多,仅仅依靠传统的质量管理方法,很难从根本上改善工程的质量。因此,从其它行业引进新的方法是解决问题的一个新的思路。文章对工程质量管理的现状和问题进行了分析。从精益建设(Lean Construction)的产生、原则、定义、理论体系的角度研究了这一新的管理理念,以及如何将精益建设的方法运用到工程质量的控制当中。

LMS精益物流评价指标体系在汽车制造企业中的应用研究

LMS Scorecard是汽车制造企业生产物流领域非常有价值的精益物流指标评价体系,它的评价指标全部聚焦于生产物流微观运行层面,通过对LMS Scorecard的应用进行研究,有助于分析制造企业精益物流在通用全球汽车工厂中所处的水平和潜在的问题,为企业管理决策提供依据。

The Effectiveness of Blackboard System, Uses and Limitations in Information Management

This paper presents a review of the literature on the effectiveness of Blackboard system, its uses and limitations in information management and highlights the ongoing debate of it. A critical evaluation of Blackboard system literature reveals a good number of academic views, studies, theories, models and experiences regarding the virtual learning environment. The extant literature shows that the world of information management is always in flux as it is being impacted on by the learning technology such as blackboard system. Blackboard system now has a recognised presence in the information management of the education system. Now the question is: how effective is this Blackboard system? The article will explore, in part, how blackboard is designed as suitable learning models in terms of learner cognitive engagement and constructivist perspective, resulting in the effective Blackboard system. It will further cover to review the effectiveness of Blackboard as an aid to pedagogy. Finally, the article will also present a comparison between Blackboard and other LMS such as Moodle to explore the effectiveness and limitations of the Blackboard for better academic information management.

基于Lean管理理念的门诊医疗服务质量提升研究

目的分析在Lean管理理念基础上实施门诊护理管理对门诊医疗服务质量提升的影响。方法选取2021年1月—2022年12月在南京医科大学附属逸夫医院门诊工作的34名护理人员作为研究对象,2021年1—12月实施常规管理(实施前组),2022年1—12月实施Lean管理理念(实施后组)。比较实施前后护理质量、不良事件发生率及交接班质量评分。结果实施后组护理质量评分高于实施前组,差异有统计学意义(P<0.05)。实施后组护理差错、缺陷、纠纷发生率均低于实施前组,差异有统计学意义(P均<0.05)。实施后组护理人员交接班质量评分高于实施后组,差异有统计学意义(P<0.05)。结论Lean管理理念在门诊护理管理中的应用能有效提升护理质量,降低护理差错发生率,减少护患纠纷和投诉发生率,对提升门诊医疗服务质量具有积极意义。

Improving Information Technology Infrastructure Library Service Delivery Using an Integrated Lean Six Sigma Framework: A Case Study in a Software Application Support Scenario

Increasing competition in service businesses (eg: Information Technology, Healthcare, Education, Logistics, Distribution, Hospitality Financial and other services) is compelling corporates to adopt business improvement philosophies and methodologies for addressing customer demands for better quality service and organizational demands for improving the profit margins through cost reduction. Many companies around the world have already implemented Information Technology Infrastructure Library (ITIL) as a way to manage and control their Information Technology (IT) Departments more effectively. These companies are now willing to improve their ITIL processes in order to become even more efficient. Lean Six Sigma is a methodology that has been suggested as a means to resolve these problems, reducing costs and improving quality. Its application in the IT Services area is becoming increasingly popular among researchers and academicians and can be used to conduct these improvements. Despite the application of lean six sigma approaches to different contexts in the service sector, the application of Lean Six Sigma approaches in service delivery specific to Information Technology Service Management (ITSM) remains largely untested. The purpose of this paper is to implement Integrated Lean Six Sigma for Software application support services and evaluate the benefits of continual service improvement over ITIL.

The Impact of Lean Transformation on the Organizational Performance: The Case of Public Utilities in Greece

Purpose: Lean Management concerns a strategy or philosophy aiming at saving resource practices and curtailment of public expenses, with ultimate objective of the enhancement of the organizational performance. By extension, the successful integration of the Lean Management leads to positive organizational results, such as higher quality, along with improved financial, environmental and business market performance. Although a lot of studies related to the effect of Lean production on the organizational performance have been conducted, empirical findings that examine the case of the public sector are absent. Additionally, there is no precise mechanism through which the Lean Management determines the organizational performance of the public utility companies. The above mentioned research gap is examined with this research, given that it investigates the influence of the Successful Lean Management on the Organizational Performance (Environmental Performance, Financial Performance, Business Performance) in public utilities in Greece. Research Methodology: The research method combines bibliographic research and empirical—with quantitative method—through a case study. More specifically, via quantitative approach, which was based on sample research with standardized questionnaire, performed in two of the biggest and most important public utilities in Greece, the Public Power Corporation S.A. (PPC S.A.) and the Athens Water Supply and Sewerage Company (EYDAP S.A). Findings: Quantitative findings from this illustrated that the successful transformation towards the Lean principles/saving resources affects positively the Business Market Performance, the Environmental and the Financial Performance. Limitations: Main restrictions of the current study are the capitalization of random sample and the strict focus on Greek public utilities that function under conditions of competition. Consequently, whichever generalizations for the whole Public Sector as well as for businesses of the private sector it would be better to be avoided, as they differ concerning their structural and functional features and their organizational culture.

Autonomous Vehicle Design in Lean Product Development Processes for Value Stream Map

The global automotive industry is giving a difficult and common test in order to create advanced life models in the near future plans or scenarios that include current autonomous vehicle technologies. Therefore, the main purpose of the research is to comparatively evaluate the impact of autonomous vehicle technologies, which are newly included in the automotive manufacturing industry under sustainable competition, on lean product development processes, value acquisition and preservation, in different organizational structures in the approach. Although mergers or brand acquisitions in the global automotive industry create joint R & D (Research Development) or joint new P & D (Product Development) process structures for the development of autonomous vehicle technologies, heavy competition continues in the market. These new processes create different needs for the merger and partnership of the renewed traffic infrastructures under national and international regulations, and for the implementation of the new autonomous life model. Firm and brand marriages, mergers or acquisitions in today’s automotive industry have ensured the high diffusion of lean product development processes under the stream of value creation or preservation carried out specific to the company under competition. Brand mergers in automotive industry companies struggling to survive under high competition create new work disciplines, professions, and engineering flow steps in lean product development processes. However, lean product development processes driven by technological innovation under simplification have resulted in the integration of parts and systems within the autonomous vehicle design structure, as well as creating new interdisciplinary value streams or different stakeholders. Therefore, the research revealed the significant effects of lean product development processes on the value stream in the automotive industry, on the mixed and lean product development process structure formed by new or existing vehicle systems (conventional vehicle) under the penetration of each existing and new discipline. This research compares the efficient operation steps of the process stakeholders in the autonomous vehicle design parts or systems containing innovation and new technology together with the value stream in the lean product development process, and the new process stakeholder’s business-oriented global and local automotive industry companies. New autonomous vehicle technologies, together with their unique software, hardware and development analysis, have been involved in the lean product development process with their interdisciplinary studies or expertise. Therefore, the study firstly focused on the technologies in environmental use together with the new basic features of autonomous vehicles, and then examined in depth the new or existing disciplines and interdisciplinary basic structure that these innovations affect under the value stream in the lean product development process. In addition, micro-level results and recommendations were shared, shedding light on how autonomous vehicle levels will create changes in the new product development process.