PurposeThe paper aims to identify key human and operational focused barriers to the implementation of Total Quality Management (TQM). It develops a comprehensive structural relationship between various barriers to successfully implement TQM for sustainability in Indian organizations.Design/methodology/approachWith the help of expert opinions and extant literature review, we identified the case of TQM failure companies and barriers to implement TQM effectively. Interpretive Structural Modeling (ISM) and fuzzy MICMAC techniques are employed to develop a structural model and the identified barriers are categorized based on their dependence and driving power in the various categories.FindingsFrom the intensive case analysis, we identify fourteen barriers that constrain the successful implementation of TQM. The findings also provide a hierarchy of barriers in which the absence of top management involvement and ineffective leadership are the human barriers having the highest dependence.Research limitations/implicationsThe critical inputs show the implementation of TQM in the firms being more proactive and well prepared in the selected five companies. The study's emphasis on barriers will help organizations in implementing TQM for better sustainability in an organizational context.Originality/valueIn the successful implementation of TQM, barriers need to be identified because failure has often eliminated the organizations from the market. Thus, TQM is the source of strength to achieve higher productivity, profitability, and sustainable business performance. The barriers must be identified to improve organizational performance to contribute to sustainable development.

We reviewed a single-center experience of pediatric lung resections for various congenital and acquired benign lung conditions. Thirty-five children underwent lung resections between 1998 and 2006, their age ranging from 8 days to 12 years (mean 3 years), with a male:female ratio of 4:1. Twelve patients were neonates. Antenatal diagnosis was available in only one patient. The presenting symptoms were respiratory distress and respiratory tract infections. Imaging with chest X-ray with/without a CT scan picked up the lesion in all cases. Preoperative ventilation was required for five patients. One patient had pneumothorax at presentation; however, ten patients had inadvertent intercostal tube insertion before surgical referral. The surgical procedures performed included lobectomy (28), segmentectomy (3), and pneumonectomy in 4 cases. Twenty-one patients underwent emergency surgery. Six patients required postoperative ventilation. The histopathological diagnosis was congenital lobar emphysema (CLE) (9), congenital cystic adenomatoid malformation (CCAM) (9), bronchiectasis (9), sequestration (3), atelectasis (1), lung abscess (1), unilobar tuberculosis (1), hydatid cyst (1), and foreign body with collapse (1). There was considerable discrepancy between the preoperative diagnosis based on imaging and the postoperative histopathological diagnosis. Postoperative complications included atelectasis (2), pneumothorax (2) and fluid collection (4 cases). Three patients died, one from compromised cardiac function, one from overwhelming sepsis and one from respiratory failure due to severe bilateral CCAM; the rest of the patients made a satisfactory recovery. At short-term follow-up all patients were doing well. Pulmonary resections are necessary for various congenital and acquired lung lesions in children and can be done safely in a pediatric hospital setup. Proper preoperative diagnosis can avoid inadvertent intercostal tube insertion in patients with congenital cystic lung lesions. The histopathological diagnosis often differs from the radiological diagnosis. Emergency lobectomies for acute respiratory distress, even in neonates, result in a satisfactory outcome.

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The CTA showed high sensitivity (93%) and specificity (92.7%) for overall assessment of degree of stenosis in a vascular segment in cases of aortic and lower limb occlusive disease. The assessment of lesions of infrapopliteal segment was comparatively inferior (sensitivity 91.6%, accuracy 73.3%, and positive predictive value 78.5%), more so in the presence of significant calcification. The advantages of CTA were its noninvasive nature, ability to image large area of body, almost no adverse effects to the patients, and better assessment of vessel wall disease. However, the CTA assessment of collaterals was inferior with a sensitivity of only 62.7% as compared to DSA. Overall, 256-slice CTA provides fast and accurate imaging of vascular tree which can restrict DSA only in few selected cases as a problem-solving tool where clinico-radiological mismatch is present.