A DMAIC Framework to Improve Quality and Sustainability in Additive Manufacturing—A Case Study

Additive manufacturing as a key Industry 4.0 technology brings radical changes to how we execute production and services operations. However, this innovative technology has not reached maturity and research and development are still in progress to unleash its full sustainability potential. This paper aims to provide operational guidance to decision makers to jointly improve quality and sustainability performance of additive manufacturing processes. We propose a framework based on the DMAIC (Define/Measure/Analyze/Improve/Control) methodology and comprehensive pool of targeted key performance indicators (KPIs) and illustrate this framework through a single case study. The paper evidences the feasibility of extending DMAIC to the growing additive manufacturing domain to achieve quality and sustainability objectives. The case study uncovered some challenges, e.g., the need for customization to a company/industry context, which must be addressed in order to widely apply the proposed framework successfully.

Preprocedural fasting for contrast-enhanced CT: when experience meets evidence

Traditional preparatory fasting policy prior to iodinated contrast media (ICM) assisted contrast-enhanced CT (CECT) examinations lacks methodologically acceptable evidence. Considering the possible negative effects of preprocedural fasting, the latest European Society of Urogenital Radiology guidelines V10.0 and American Committee of Radiology 2021 guidelines clearly state that preprocedural fasting is not recommended prior to routine intravenous ICM administration. This comprehensive and detailed Review presents the current global dietary preparation policies, potential harm of excessive fasting, and a systematical and well-bedded description of practice advancements of dietary preparation. The evidences revealed that there has been no single instance of vomiting-associated aspiration pneumonia due to the undemanding implementation of preparatory fasting prior to CECT yet. Non-fasting would not increase the incidence of emetic symptoms and the risk of aspiration pneumonia. Not every patient should undergo all CECT examinations without preparatory fasting. There is still much more refinement to be done on the preparatory fasting policy. Changes in traditional preparatory fasting policy will make positive and significant implications on clinical practice. This Review aims to provide operational guidance and suggestions for practitioners and policymakers, motivate efficient, reasonable, safe and normative ICM usage, and achieve optimal patient clinical benefits and high-quality radiological care practices.

Governance frameworks for COVID-19 research ethics review and oversight in Latin America: an exploratory study

Background Research has been an essential part of the COVID-19 pandemic response, including in Latin American (LA) countries. However, implementing research in emergency settings poses the challenge of producing valuable knowledge rapidly while upholding research ethical standards. Research ethics committees (RECs) therefore must conduct timely and rigorous ethics reviews and oversight of COVID-19 research. In the LA region, there is limited knowledge on how countries have responded to this need. To address this gap, the objective of our project is to explore if LA countries developed policies to streamline ethics review and oversight of research in response to the pandemic while ensuring its adherence to ethical standards, and to analyze to what extent these governance frameworks are in accordance with international guidance. Methods We conducted a descriptive and exploratory study assessing the COVID-19 research ethics governance frameworks of 19 LA countries, considering 4 dimensions based on international COVID-19 ethics guidance documents: (i) ethics review organizational model adopted, (ii) measures to coordinate between RECs and other research stakeholders, (iii) operational guidance for RECs, and (iv) key ethical issues for review and oversight of COVID-19 research. Results 10 out of 19 LA countries have some policy to streamline ethics review of COVID-19 research. Of these countries only 6 issued comprehensive documents following international guidance that contemplate strategies with recommendations for concrete actions for a timely and rigorous review. Conclusion LA countries adopted partial strategies and operational guidance that may demonstrate a lack of a comprehensive view of research ethics for the review and oversight of COVID-19 research. Continuing efforts should be directed to strengthen LA countries' research capacity to respond timely and ethically to future health emergencies. Past lessons and the ones from this pandemic should be the basis to develop international standards and operational guidelines for ethics review and oversight of any research for public health emergencies.

Decision Making Within and Outside Standard Operating Procedures: Paradoxical Use of Operational Discretion in Firefighters

Objective To understand how firefighters’ use of rules (i.e., standard operating procedures [SOPs]) and deliberative decision making (i.e., operational discretion [OD]) interacts with acute stress. Background Current operational guidance for UK firefighters combines the provision of SOPs, for routine incidents, with the use of OD, under prescribed conditions (e.g., when there is a risk to human life). However, our understanding of the use of SOPs and OD is limited. Methods Incident commanders (ICs; n = 43) responded to simulated emergency incidents, which either licensed the use of OD or required use of a SOP. Video footage of IC behavior was used to code their response as involving a SOP or OD, while levels of acute stress were assessed using a blood-based measure and self-report. Results ICs were less likely to use OD selectively in the simulated emergency incident that licensed its use than in the one for which use of an SOP was appropriate; IC command level did not affect this pattern of results; and the incident that licensed OD resulted in more acute stress than the incident that required use of a SOP. Conclusion SOPs and OD were not used in the manner prescribed by current operational guidance in simulated emergency incidents. Application These results suggest that firefighter training in SOPs and OD should be augmented alongside personal resilience training, given the impact of stress on health and wellbeing, but also to improve the deployment of SOPs and OD under stress.

Vibrotactile-Based Operational Guidance System for Space Science Experiments

On-orbit astronauts and scientists on the ground need to cooperate closely, to complete space science experiments efficiently. However, for the increasingly diverse space science experiments, scientists are unable to train astronauts on the ground about the details of each experiment. The traditional interaction of visual and auditory channels is not enough for scientists to directly guide astronauts to experimentalize. An intuitive and transparent interaction interface between scientists and astronauts has to be built to meet the requirements of space science experiments. Therefore, this paper proposed a vibrotactile guidance system for cooperation between scientists and astronauts. We utilized Kinect V2 sensors to track the movements of the participants of space science experiments, process data in the virtual experimental environment developed by Unity 3D, and provide astronauts with different guidance instructions using the wearable vibrotactile device. Compared with other schemes using only visual and auditory channels, our approach provides more direct and more efficient guidance information that astronauts perceive is what they need to perform different tasks. Three virtual space science experiment tasks verified the feasibility of the vibrotactile operational guidance system. Participants were able to complete the experimental task with a short period of training, and the experimental results show that the method has an application prospect.

Donor Love Will Tear Us Apart: How Complexity and Learning Marginalize Accountability in Peacebuilding Interventions

Complexity theory and systems thinking are increasingly popular in both academic and practitioner discourses to “improve” peacebuilding. Recently, they have also been considered to make peacebuilding interventions more bottom-up and less exclusive. Contributing to the debate in international political sociology on the role of (professional) knowledge in shaping interventions, I examine this claim with an analysis of professional peacebuilding discourse. Drawing on an extensive corpus of operational guidance, policy documents, and interview material, I situate the emerging uses of concepts of complexity in peacebuilding against the backdrop of the power struggles of its actors and institutions. Against the introduction of measures of managerial control, professional peacebuilding discourse has cast its interventions as exceptional and in need of different methods. Thus, learning replaces donors’ standardized measures of accountability. However, the peculiar conflation of accountability as learning that emerges from these struggles legitimizes self-referential expert rule and learning, and marginalizes debates on peacebuilders’ accountability. Rather than “de-colonizing” or making peacebuilding more inclusive, the way complexity concepts have emerged in peacebuilding discourse reproduces—rather than questions—the power structures of international interventions, and denies the people targeted by interventions the status of subjects to be accountable to.

Governance Frameworks for COVID-19 Research Ethics Review and Oversight in Latin America: An Exploratory Study

Background Research has been an essential part of the COVID-19 pandemic response, including in Latin American (LA) countries. However, implementing research in emergency settings poses the challenge of producing valuable knowledge rapidly while upholding research ethical standards. Research ethics committees (RECs) therefore must conduct timely and rigorous ethics reviews and oversight of COVID-19 research. In the LA region, there is limited knowledge on how countries have responded to this need. To address this gap, the objective of our project is to explore if LA countries developed policies to streamline ethics review and oversight of research in response to the pandemic while ensuring its adherence to ethical standards, and to analyze to what extent these governance frameworks are in accordance with international guidance.Methods We conducted a descriptive and exploratory study assessing the COVID-19 research ethics governance frameworks of 19 LA countries, considering 4 dimensions based on international COVID-19 ethics guidance documents: (i) ethics review organizational model adopted, (ii) measures to coordinate between RECs and other research stakeholders, (iii) operational guidance for RECs, and (iv) key ethical issues for review and oversight of COVID-19 research.Results 10 out of 19 LA countries have some policy to streamline ethics review of COVID-19 research. Of these countries only 6 issued comprehensive documents following international guidance that contemplated strategies with recommendations for concrete actions for a timely and rigorous review.ConclusionLA countries adopted partial strategies and operational guidance that may demonstrate a lack of a comprehensive view of research ethics for the review and oversight of COVID-19 research. Continuing efforts should be directed to strengthen LA countries' research capacity to respond timely and ethically to future health emergencies. Past lessons and the ones from this pandemic should be the basis to develop international standards and operational guidelines for ethics review and oversight of any research for public health emergencies of international concern.

Why and how to open intensive care units to family visits during the pandemic

Since the lockdown because of the pandemic, family members have been prohibited from visiting their loved ones in hospital. While it is clearly complicated to implement protocols for the admission of family members, we believe precise strategic goals are essential and operational guidance is needed on how to achieve them. Even during the pandemic, we consider it a priority to share strategies adapted to every local setting to allow family members to enter intensive care units and all the other hospital wards.

Metals in the drinking water of First Nations across Canada

Objectives The First Nations Food, Nutrition and Environment Study (FNFNES), a community-based participatory research project, measured the levels of metals of health concern and the levels of metals that have operational guidance (OG) and aesthetic objectives (AO) in drinking water of First Nations (FN) south of the 60th parallel. Methods Both stagnant (first draw) and flushed tap water samples were collected from participating households in 91 FN representing 11 ecozones. The concentrations of metals were quantified and compared to Health Canada’s Guidelines for Canadian Drinking Water Quality (GCDWQ). Results In total, 1516 FN households participated in this study component. Exceedances of the 2019 GCDWQ for the health-based maximum acceptable concentration (MAC) were found for five metals: lead 8.4% of households (first draw), manganese 4.0%, uranium 1.6%, aluminum 1.3%, and copper 0.2% (flushed). Flushing taps resulted in a decrease to 0.7% of households exceeding the lead MAC. Exceedances of the current OG for aluminum were found in 14.2% and the exceedances of the proposed OG were found in 18.1% of households (flushed). Exceedances of the AO (flushed) were as follows: manganese 12.8%, sodium 5.1%, iron 3.5%, and copper 0.4%. Results of the study were compared to provincial surveys where the data were available. Taste and colour were reported to be the main reasons for limiting the use of tap water. Conclusion Overall, the quality of drinking water with respect to trace metals of human health concern is satisfactory. However, elevated lead levels were found in some FN communities. Until appropriate action can take place, it was recommended to flush the water before use to reduce the lead levels.