Monday, April 10, 2017

Cardiac Pacemaker - Inventions, Developments, and Patents

In 1889, John Alexander MacWilliam reported in the British Medical Journal (BMJ) of his experiments in which application of an electrical impulse to the human heart in asystole caused a ventricular contraction and that a heart rhythm of 60–70 beats per minute could be evoked by impulses applied at spacings equal to 60–70/minute.

In 1926, Dr Mark C Lidwill of the Royal Prince Alfred Hospital of Sydney, supported by physicist Edgar H. Booth of the University of Sydney, devised a portable apparatus which "plugged into a lighting point" and in which "One pole was applied to a skin pad soaked in strong salt solution" while the other pole "consisted of a needle insulated except at its point, and was plunged into the appropriate cardiac chamber". "The pacemaker rate was variable from about 80 to 120 pulses per minute, and likewise the voltage variable from 1.5 to 120 volts". In 1928, the apparatus was used to revive a stillborn infant at Crown Street Women's Hospital, Sydney whose heart continued "to beat on its own accord", "at the end of 10 minutes" of stimulation.

In 1932, American physiologist Albert Hyman, with the help of his brother, described an electro-mechanical instrument of his own, powered by a spring-wound hand-cranked motor. Hyman himself referred to his invention as an "artificial pacemaker", the term continuing in use to this day.

An apparent hiatus in publication of research conducted between the early 1930s and World War II may be attributed to the public perception of interfering with nature by "reviving the dead". For example, "Hyman did not publish data on the use of his pacemaker in humans because of adverse publicity, both among his fellow physicians, and due to newspaper reporting at the time. Lidwell may have been aware of this and did not proceed with his experiments in humans".

In 1950, Canadian electrical engineer John Hopps designed and built the first external pacemaker based upon observations by cardio-thoracic surgeon's Wilfred Gordon Bigelow and John Callaghan at Toronto General Hospital, although the device was first tested at the University of Toronto's Banting Institute on a dog. A substantial external device using vacuum tube technology to provide transcutaneous pacing, it was somewhat crude and painful to the patient in use and, being powered from an AC wall socket, carried a potential hazard of electrocution of the patient and inducing ventricular fibrillation.

A number of innovators, including Paul Zoll, made smaller but still bulky transcutaneous pacing devices in the following years using a large rechargeable battery as the power supply.

In 1957, William L. Weirich published the results of research performed at the University of Minnesota. These studies demonstrated the restoration of heart rate, cardiac output and mean aortic pressures in animal subjects with complete heart block through the use of a myocardial electrode.[9]

In 1958 Colombian doctor Alberto Vejarano Laverde and Colombian electrical engineer Jorge Reynolds Pombo constructed an external pacemaker, similar to those of Hopps and Zoll, weighing 45 kg and powered by a 12 volt car lead acid battery, but connected to electrodes attached to the heart. This apparatus was successfully used to sustain a 70-year-old priest, Gerardo Florez.

The development of the silicon transistor and its first commercial availability in 1956 was the pivotal event which led to rapid development of practical cardiac pacemaking.

In 1958, engineer Earl Bakken of Minneapolis, Minnesota, produced the first wearable external pacemaker for a patient of C. Walton Lillehei. This transistorized pacemaker, housed in a small plastic box, had controls to permit adjustment of pacing heart rate and output voltage and was connected to electrode leads which passed through the skin of the patient to terminate in electrodes attached to the surface of the myocardium of the heart.

One of the earliest patients to receive this Lucas pacemaker device was a woman in her early 30s in an operation carried out in 1964 at the Radcliffe Infirmary in Oxford by cardiac surgeon Dr Alf Gunning from South Africa and later Professor Gunning[10][11] who was a student of Dr Christiaan Barnard. This pioneering operation was carried out under the guidance of cardiac consultant Dr Peter Sleight at the Radcliffe Infirmary in Oxford and his cardiac research team at St George's Hospital in London. Dr Sleight later became Professor of Cardiovascular Medicine at Oxford University.[12][13]


Illustration of implanted cardiac pacemaker showing locations of cardiac pacemaker leads
The first clinical implantation into a human of a fully implantable pacemaker was in 1958 at the Karolinska Institute in Solna, Sweden, using a pacemaker designed by Rune Elmqvist and surgeon Åke Senning, connected to electrodes attached to the myocardium of the heart by thoracotomy. The device failed after three hours. A second device was then implanted which lasted for two days. The world's first implantable pacemaker patient, Arne Larsson, went on to receive 26 different pacemakers during his lifetime. He died in 2001, at the age of 86, outliving the inventor as well as the surgeon.[14]

In 1959, temporary transvenous pacing was first demonstrated by Seymore Furman and John Schwedel, whereby the catheter electrode was inserted via the patient's basilic vein.[15]

In February 1960, an improved version of the Swedish Elmqvist design was implanted in Montevideo, Uruguay in the Casmu 1 Hospital by Doctors Orestes Fiandra and Roberto Rubio. That device lasted until the patient died of other ailments, nine months later. The early Swedish-designed devices used rechargeable batteries, which were charged by an induction coil from the outside. It was the first pacemaker implanted in America.

Implantable pacemakers constructed by engineer Wilson Greatbatch entered use in humans from April 1960 following extensive animal testing. The Greatbatch innovation varied from the earlier Swedish devices in using primary cells (mercury battery) as the energy source. The first patient lived for a further 18 months.

The first use of transvenous pacing in conjunction with an implanted pacemaker was by Parsonnet in the United States, Lagergren in Sweden[19][20] and Jean-Jacques Welti in France[21] in 1962–63. The transvenous, or pervenous, procedure involved incision of a vein into which was inserted the catheter electrode lead under fluoroscopic guidance, until it was lodged within the trabeculae of the right ventricle. This method was to become the method of choice by the mid-1960s.

Cardiothoracic Surgeon Leon Abrams, and Medical Engineer Ray Lightwood, developed and implanted the first patient controlled variable rate heart pacemaker in 1960 at Birmingham University. The first implant took place in March 1960, with two further implants the following month. These three patients made good recoveries and returned to a high quality of life. By 1966, 56 patients had undergone implantation with one surviving for over  5 1⁄2 years.

Adopted from

Thursday, February 16, 2017

World Class Manufacturing - Yamashina Way

On 24.10.2010, I participated in the presentations of Operations Management - On the Job Achievement Event of NITIE's IE organized event Lakshya.
There one of the jury members from FIAT India pointed out that WCM has Yamashina way. That leads to the inquiry - What is Yamashina Way?

Some sources to start with

Presentation by Fiat Executive -
The presentation refers to total industrial engineering.
(I collected some ideas on Total Industrial Engineering in Total Industrial Engineering - H. Yamashina )
Scott Garberding
Senior Vice President - Manufacturing/World Class Manufacturing, Chrysler Group LLC

“World Class Manufacturing: Agent of Cultural Change”
CAR Management Briefing Seminars
Grand Traverse Resort & Spa
Traverse City, Mich.
Aug. 2, 2010

The World Class Manufacturing has 10 pillars

1. Safety, Hygiene and Working Environment'
2. Customer service
3. Cost deployment
Cost Deployment—aims to identify problems that increase costs. It also approves improvement projects to reduce costs.

Good article on cost deployment
Cost Deployment Tool for Technological Innovation of World Class Manufacturing
Luan Carlos Santos Silva, João Luiz Kovaleski, Silvia Gaia, Manon Garcia, Pedro Paulo de Andrade Júnior
Department of Production Engineering and Technology Transfer Research Group, Federal University of Technology—Paraná (UTFPR), Ponta Grossa, Brazil
Journal of Transportation Technologies
Vol.3 No.1(2013).

4. Focused improvement
Focused Improvement—aims to develop the know how to reduce costs by using appropriate methods in problem areas identified by cost deployment investigations;

5. Quality control
6. Autonomous activity
7. Professional maintenance
8. Early products/Equipment management
9. People development/
10. Environment


Papers, Articles and Presentations by H. Yamashina

A Detailed presentation by Yamashina

Cost-optimized maintenance of the elevator – single unit case
Hajime Yamashina, Shunsuke Otani, (2001) "Cost-optimized maintenance of the elevator – single unit case", Journal of Quality in Maintenance Engineering, Vol. 7 Iss: 1, pp.49 - 70

Japanese manufacturing strategy and the role of total productive maintenance
H Yamashina - Journal of Quality in Maintenance Engineering, 1995

The service parts control problem
Engineering Costs and Production Economics
Volume 16, Issue 3, June 1989, Pages 195-208

A brochure of training program coordinated by H. Yamashina for European Managers in Japan

Related Material
Chrysler group business plan 2010-2014

Update 13 November 2016

I came across total industrial engineering once again. WCM of Yamashina is still under active implemenation and more articles are available on internet now.

New Holland Agriculture in Basildon is getting the benefit of 8% reduction in operating costs using the WCM methodology.

Cost deployment is described in more detail in the article

Cost Deployment Tool for Technological Innovation of World Class Manufacturing
Luan Carlos Santos Silva, João Luiz Kovaleski, Silvia Gaia, Manon Garcia, Pedro Paulo de Andrade Júnior
Department of Production Engineering and Technology Transfer Research Group, Federal University of Technology—Paraná (UTFPR), Ponta Grossa, Brazil
Journal of Transportation Technologies
Vol.3 No.1(2013).

Updated 19 February 2017,   13 November 2016,  23 October 2012

Originally Posted in Knol by Me

A comment on the Knol by a Fiat executive

1.s & wo (two diffrent activities&presentations during audit but one mark)
7.log & cs

By us i mean fiat europe.
Best regards
Bartosz.Dabrowski  at

World Class Manufacturing Blog by Oskar Oloffson

Wednesday, February 1, 2017

Case Study Method in Business Administration - Management

Important Points from

An Introduction to the Use of Cases

Arthur Stone Dewing
Article in Book, 1931

Cases should be used as education method in business education with the clear consciousness that the purpose of business education is not command of established precedents as in law or uncritical allegiance to experience of others, but the development of ability to think through the facts and come out with some intelligent solution. In business this solution must have adequate profit and therein lies the individual success and contribution to the economic prosperity of the country.

Teaching by case method results in the class in a combination of possibilities, probabilities and expedients. Possibilities are based on combination of intricate facts presented in the case (when coupled with various theories in diverse subjects of business management), probabilities refer to reactions of others in the class, and expedients are the various proposals and acts by the presenter to bring about the responses in other that lead to a definite end (agreement with his proposal).

Thinking happens when one is confronted with new situations and thinking prompts action. Cases provide thinking opportunity to students.

Important Points from

Because Wisdom Can't Be Told

Charles I. Gragg
Harvard Alumni Bulletin, 1940

Benefits of The Case Study System

The case study system in business administration course initiates students into ways of independent thought and responsible judgment. Case studies provide real current situations and place the student in an active role to decide the business action and to present it to a peer group of students for their accepting the same. The peer group may act various roles of superiors, peers, and even subordinates when they criticize the decision from various angles. It provides the student presenter the occasion to deal constructively with their contemporaries some of them being elders to him and may be having experience in that business. The faculty is also one critic.

Case studies force students to actually make decisions which can be implemented by them. Thus the learning becomes active. Lectures are passive learning unless they are followed by exercises. But the exercises may not provide the type of environment that case study provides wherein the student who made the decision has to present to rest of students and get their agreement or modify his decision in response to the comments and suggestions by others.

Business management is both technical and human matter. Business administrators and managers have to understand how people in various roles in the total business system - Suppliers, Producers, Sellers, Consumers, Investors, Bankers, Government agencies, Media - will react to specific business actions. Case study method provides an opportunity to the students to observe the reactions of his fellow students to the proposals that he made as a part of case presentation.

The case method also presents an opportunity to learn from others and modify thoughts. This provides a group discussion platform to agree to certain features of a proposals and to disagree with certain parts of proposals and make an effort to arrive at a consensus.

Case Provides Raw Material

Case provides the raw material with which the student develops his decision. The case class is not meant for absorption of knowledge alone but it forces the student to think independently using his accumulated knowledge up to that point in time and present it to other without any fear or shyness.

Business education has to provide the ability to see vividly the potential relationships between the facts of the situation related to both things and people and make judgment. The judgments have to be communicated to other organization members to initiate agreement and action.

Business education has to accelerate the progress of a candidate to a position of responsibility in comparison to a person who enters business without MBA. Hence the objective of business education has to be to prepare the student to occupy a position say within five years which the person without MBA may take 10 ten years.

The lecture method may also provide similar inputs. But a dynamic process wherein the student himself takes the decision and feels confident about it is much more powerful than the passive learning.

The case method may bring out some innovative solutions from the students with which all the members of the class including the faculty members may be in agreement. This calls for real appreciation of the presenter and such appreciations will make students more confident in their real life assignments. They develop the ability of creative problem solving.

Case Studies Do not Provide Real Experience with Profits and Losses - But They Provide Simulated Experience without the Risk

There are some critics who say the case does not provide the exact replica of the real situation and students do not actually implement their decisions and incur profits and losses. Gragg agrees with the criticism and states that anything except experience can be exactly like experience. But the case method provides a training period where risk is eliminated. The student gets acquainted with process of making real decisions without risk to himself. In the course of his education, he is provided the opportunity to live through a number of diverse real situations which if he has to experience in real life would take a life time. Through the case study training, he develops analytical and synthesizing experience that will provide a basis for comparison when he is asked to do a real life problem and implement it.

Important Points from

Tough-Mindedness and The Case Method

Malcolm P. McNair

From an address given on February 25, 1953 at the first meeting of participants of 23rd Advanced Management Program at the Harvard Business School

Case discussion is an exercise in decision-making. For learning through case discussions, tough-mindedness is necessary to analyse the facts and issues following logical paths of reasoning and judgment to come out with appropriate decisions and conclusions. The toughness is intellectual to persist with the learning effort till an adequate comprehension is made of the situation described. How much effort the student has to make depends on his reaching that comprehension.

The instructor's job is to see that men in the class settle down to a tough-minded analysis and do not become content with a superficial analysis.

The principal value of case method is not facts and theories accumulated. No doubt the student will accumulate them by digging the case and other materials available to him in library (and presently on internet). But value accrues in the power that they will develop in digging now for the digging they have to do in actual situations. The mastery of decision making is the purpose of the entire case based curriculum. Case method provides you the power to analyze a new situation, to formulate an actionable program for positive outcome, and carry out the program through people.

Businesses can hire many people who solve problems that have one right answer. But the pay more to people who have the capability to find the best solution appropriate to the situation when many alternatives are possible.  This requires creativity, judgment and leadership to implement the solution.

The essence of profit is managing risk and uncertainty. The human spirit must always try to do good things without shunning the risk of failure. (We say there must be expected profit in a venture not the possibility of loss. Possibility of loss is always there and we must bear the loss always psychologically as well as the ability of ours to live within reduced means.)

Updated 4 February 2017, 28 January 2017

Saturday, January 28, 2017

Business Analysis - Introduction

In Harvard case study method, it is being emphasized that cases are to be analysed and decisions have to be taken by the students based on the facts presented in the case. No doubt it implied that decisions are taken using the theories of business (successful conduct of the business). What is unique about the case study method is that students have to apply multiple theories to the facts given in the case and come out with a decision. Then they have to present their decision to other students in the class and get their concurrence for the decision taken. This exercise of presenting the decision and making efforts to convince them with the facts of the case and the analysis and synthesis made to arrive the at decision will improve people interaction skills that includes communication skills.

Hence, as part of business administration course business analysis has to be done to take decisions to solve various business problems or to take advantage of various business opportunities.

Now, we have International Institute of Business Analysis offering courses and certification in business analysis.

What is Business Analysis?

Business Analysis is the practice of enabling change in an organizational context, by defining needs and recommending solutions that deliver value to stakeholders.

Business Analysis Helps Businesses Do Business Better

Business analysis is used to identify and articulate the need for change in how organizations work, and to facilitate that change. Business analysts  identify and define the solutions that will maximize the value delivered by an organization to its stakeholders. Business analysts work across all levels of an organization and may be involved in everything from defining strategy, to creating the enterprise architecture, to taking a leadership role by defining the goals and requirements for programs and projects or supporting continuous improvement in its technology and processes.

The value of business analysis is in realization of benefits, avoidance of cost, identification of new opportunities, understanding of required capabilities and modeling the organization.

Learn more about:
Business Analysis: The Evolution of a Profession

Business Analysis: The Foundation for Business Success

Business Analysis Process

UC Berkeley Extension course in Business Analysis

Course Page

McGill Business Analysis Course

ACCA Course - Syllabus

Resources for Business Analyst - BA Times

Thursday, January 26, 2017

Design Thinking for Managers

Design Thinking can do for organic growth and innovation what TQM did for quality.

10 tools that you can combine with traditional business thinking that will enhance your ability to profitably grow your business.

10 Tools


Journey Mapping

Value Chain Analysis

Mind Mapping

Brain Storming

Concept Development

Assumption Testing

Rapid Prototyping

Customer Cocreation

Learning Launch


Ten tools to help managers to think creatively - Jeanne Liedtka

Design Thinking - Talk by Jeanne Liedtka



Designing for Growth: A Design Thinking Tool Kit for Managers

Jeanne Liedtka, Tim Ogilvie
Columbia University Press, 2011 - Business & Economics - 227 pages

Jeanne Liedtka and Tim Ogilvie educate readers in one of the hottest trends in business: "design thinking," or the ability to turn abstract ideas into practical applications for maximal business growth. Liedtka and Ogilvie cover the mind-set, techniques, and vocabulary of design thinking, unpack the mysterious connection between design and growth, and teach managers in a straightforward way how to exploit design's exciting potential.

Exemplified by Apple and the success of its elegant products and cultivated by high-profile design firms such as IDEO, design thinking unlocks creative right-brain capabilities to solve a range of problems. This approach has become a necessary component of successful business practice, helping managers turn abstract concepts into everyday tools that grow business while minimizing risk.

Google Book Link

Jeanne Liedtka, "Learning to use design thinking tools for successful innovation", Emerald 39, (2011)

Related Articles

The Highs and Lows of Design Thinking

Why design thinking doesn't work in schools

Updated 29 January 2017, 30 August 2013

Thursday, October 6, 2016

CEO's First 100 Days - 5 Myths - HBR Blogs Post

Myth 1. Find out short coming
Better alternative: harmonize with the the company

Myth 2. Do something and go for quick wins.
Better alternative: Find out what ticks in the company.

Myth 3. Establish new team by identifying the best functional specialists.
Better alternative: Focus teamability.

Myth 4. Define and communicate performance standards
Better alternative: First communicate how you want to be evaluated.

Myth 5. Show that you are the smartest man.
Better alternative: Recognize the functional specialization and expert knowledge of other. Only show ability to assess the key assumption behind the analysis.

Authors of the post
Roselinde Torres
Peter Tollman
Senior Partners, Boston Consulting Group.

CEO Talk Radio: Path to CEO




Updated 9 October 2016,  31 January 2012

Wednesday, August 31, 2016

Management Articles and Concepts Directory (Aa to Az)

 Index of concepts
  1. Aa to Az 
  2. Ba to Bz
  3. Ca to Cz
  4. Da to Dz  
  5. Ea to Ez 

  6. Fa to Fz 
  7. Ga to Gz
  8. Ha to Hz
  9. Ia to Iz
Articles by Narayana Rao

=> Articles on the Web

Advertising - Lecture notes - Alex Brown

Key Management Models and Concepts - Google Book Link