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\"The same Lean principles that are helping hospitals eliminate waste and improve efficiencies are applicable to individuals working in healthcare. This book not only provides the tools to alleviate the obvious symptoms of inefficiency but also demonstrates how to find the root causes underlying that inefficiency. It presents a practical, step-by-step approach to applying Lean principles to individuals, including real-world examples that illustrate how these principles have been applied in the healthcare industry\"-- Provided by publisher.

When stretch goals seem overwhelming and unattainable, they sap employees' intrinsic motivation. The magnitude of the problem causes people to freeze up, and the extrinsic motivator of money crowds out the intrinsic motivators of learning and growth. In their book The Progress Principle, Teresa Amabile and Steven Kramer build on the same argument and clearly demonstrate how even the smallest, most mundane steps forward can motivate and inspire workers. In the early 1990s, Sears gave a sales quota of $147 per hour to its auto repair staff. Faced with this target the staff overcharged for work and performed unnecessary repairs. Sears' Chairman at the time, Ed Brennan, acknowledged that the stretch goal gave employees a powerful incentive to deceive customers. Focusing on small wins, in combination with process improvement, will drive your organisation forward, without the negative consequences of stretch goals. However, this approach requires a willingness to abandon the 'ready, fire, aim' approach to problem solving.

The central auditory system consists of a series of relay stations at which auditory information is processed in stages before reaching the auditory cortex for sound perception. However, descending projections and non-auditory inputs into the central auditory system also play a vital role in shaping neural coding along the auditory pathway. The work in this thesis seeks to investigate the organization and role of these modulatory pathways of the central auditory system, particularly to devise and improve upon existing neuromodulation strategies for treating neurological disorders related to the auditory system, including tinnitus and hyperacusis. Through animal studies, we have shown that the descending projections from primary auditory cortex to subcortical centers, particularly the central nucleus of the inferior colliculus, exhibit a precise spatial organization based on frequency coding, supporting the role of the corticofugal system for modulating specific and relevant coding features within the ascending auditory system. Further, by combining stimulation of auditory cortex with an irrelevant acoustic stimulus, we were able to suppress neural firing throughout the inferior colliculus, revealing at least one potential mechanism for gating relevant versus irrelevant sound inputs. Targeting this gating mechanism could provide a neuromodulation treatment for tinnitus and/or hyperacusis which are associated with hyperactivity across auditory centers. Finally, we introduce a new neuromodulation approach using simultaneous noninvasive stimulation of multimodal pathways, focusing initially on somatosensory and auditory inputs. We present our proof-of-concept studies showing the ability to modulate neural coding in the inferior colliculus up to auditory cortex in a systematic way depending on the stimulation parameters (e.g., interstimulus interval and body stimulation location). These invasive and noninvasive techniques for modulating the brain provide potential options for the treatment of hearing disorders as well as other neurological and neuropsychiatric conditions.

Time management classes, books, Web sites, and tools are multiplying like rabbits in a meadow -- GTD, Four-Hour Workweeks, the Pomodoro Technique, Autofocus, and more. People devote more time to training and adoption of new techniques -- and in the end, they still didn't get their work done. The fact is, time management training is stunningly ineffective. What happens is this: after learning the fundamental principles of time management, participants go back to their natural habitat with new tools, high hopes, and grand intentions. Ask any graduate of a time management course what keeps them from implementing the concepts they learned, and they'll say \"email.\" The desire to show that you're really working hard is what lies behind emails sent to large groups of people only tangentially involved with the issue at hand. Training them in basic time management principles and advanced software functions can be very helpful.

Outsourcing responsibility for this improvement to a team of Six Sigma Black Belts or external consultants, or foisting it on the leadership team is not only disrespectful to the true expert (the person doing the job), but it's also not scalable and unlikely to result in much improvement. [...]if someone did screw up, a fit leader asks why the system made it so easy for the person to make a mistake. There's ample research12 showing extrinsic rewards-such as large cash bonuses for successfully completing an improvement project-will destroy the intrinsic rewards of the project: the pride people take in doing a good job, solving tough problems, and accomplishing something meaningful to their colleagues and customers.

In the wake of a 20-inch snowfall, Manhattan streets were plowed quickly, but streets in the outer boroughs remained unplowed for days. New York City Mayor Michael Bloomberg apologized, promised a thorough post-mortem of the poor municipal response, and then demoted and reassigned three people. In New Jersey, Gov Chris Christie took heat for vacationing at Disney World instead of returning to the state to help the recovery efforts. Then there was Cory Booker, the mayor of Newark, NJ. Booker personally responded to several calls for help, showing up with a shovel to help motorists who were stuck in the snow and bringing diapers to others. What strikes the author is the fact that only one of these leaders went to gemba -- a Japanese term meaning \"the real place.\"

Edward Nanas's contention that fluency in Japanese by American executives is unimportant for business success (letter, March 3) has merit, but displays the lack of understanding of Japanese business relationships that has plagued Americans for years.

Older patients with AML face difficult treatment decisions as they can be treated either with 'intensive' chemotherapy requiring prolonged hospitalization, or 'non-intensive' chemotherapy. Although clinicians often perceive intensive chemotherapy as more burdensome, research is lacking on patients' quality of life (QOL) and psychological distress. We conducted a longitudinal study of older patients (≥60 years) newly diagnosed with AML receiving intensive (cytarabine/anthracycline combination) or non-intensive (hypomethylating agents) chemotherapy. We assessed patients' QOL [Functional-Assessment-of-Cancer-Therapy-Leukemia] and psychological distress [Hospital-Anxiety-and-Depression-Scale] at baseline and 2, 4, 8, 12, and 24 weeks after diagnosis. We enrolled 75.2% (100/133) of eligible patients within 72-hours of initiating intensive (n = 50) or non-intensive (n = 50) chemotherapy. Patient QOL improved over time (β = 0.32, P = 0.013). At baseline, 33.3% (33/100) and 30.0% (30/100) of patients reported clinically significant depression and anxiety symptoms, respectively, with no differences between groups. Patients' depression symptoms did not change over time, while their anxiety symptoms decreased over time (β = -0.08, P < 0.001). Patient-reported QOL, depression and anxiety symptoms did not differ significantly at any time point between those who received intensive versus non-intensive chemotherapy. Older patients with AML experience improvements in their QOL and anxiety while undergoing treatment. Patients receiving intensive and non-intensive chemotherapy have similar QOL and mood trajectories.

BackgroundCell therapies for solid tumors are thwarted by the hostile tumor microenvironment (TME) and by heterogeneous expression of tumor target antigens. We address both limitations with a novel class of chimeric antigen receptors based on plant lectins, which recognize the aberrant sugar residues that are a ‘hallmark’ of both malignant and associated stromal cells. We have expressed in T cells a modified lectin from banana, H84T BanLec, attached to a chimeric antigen receptor (H84T-CAR) that recognizes high-mannose (asparagine residue with five to nine mannoses). Here, we tested the efficacy of our novel H84T CAR in models of pancreatic ductal adenocarcinoma (PDAC), intractable tumors with aberrant glycosylation and characterized by desmoplastic stroma largely contributed by pancreatic stellate cells (PSCs).MethodsWe transduced human T cells with a second-generation retroviral construct expressing the H84T BanLec chimeric receptor, measured T-cell expansion, characterized T-cell phenotype, and tested their efficacy against PDAC tumor cells lines by flow cytometry quantification. In three-dimensional (3D) spheroid models, we measured H84T CAR T-cell disruption of PSC architecture, and T-cell infiltration by live imaging. We tested the activity of H84T CAR T cells against tumor xenografts derived from three PDAC cell lines. Antitumor activity was quantified by caliper measurement and bioluminescence signal and used anti-human vimentin to measure residual PSCs.ResultsH84T BanLec CAR was successfully transduced and expressed by T cells which had robust expansion and retained central memory phenotype in both CD4 and CD8 compartments. H84T CAR T cells targeted and eliminated PDAC tumor cell lines. They also disrupted PSC architecture in 3D models in vitro and reduced total tumor and stroma cells in mixed co-cultures. H84T CAR T cells exhibited improved T-cell infiltration in multicellular spheroids and had potent antitumor effects in the xenograft models. We observed no adverse effects against normal tissues.ConclusionsT cells expressing H84T CAR target malignant cells and their stroma in PDAC tumor models. The incorporation of glycan-targeting lectins within CARs thus extends their activity to include both malignant cells and their supporting stromal cells, disrupting the TME that otherwise diminishes the activity of cellular therapies against solid tumors.