The human performance impact on oee in the adoption of new production technologies

Featured Application This research work proposes a framework for the evaluation of the initial adoption phase of new production technologies and its application to the introduction of a semi-automatic packaging machine in a relevant logistics company. The case study allowed the assessment of the machine ramp-up phase and provided valuable insights for reducing the length of this period by achieving a stable target production output. Moreover, it shows how the framework can be adopted, applied and interpreted for obtaining useful insights. Manufacturing systems in digital and interconnected industrial settings where human worker activity is required represents further potential applications of this paper. The initial adoption phase of new production technologies is the period between the first production run or technology reconfiguration and the achievement of a stable target output. This time frame is generally characterized by productivity unsteadiness, quality performance variability, and unexpected machine failures together with increasing production volumes due to the process setup and instability, which inevitably affects production output. In this context, human performance represents an additional source of variability and process instability that is dependent on the workers' productivity, learning curve and related training activities. Hence, to effectively assess the ramp-up phase of new production technologies, an appropriate evaluation of human performance is required. This paper proposes a comprehensive framework and criteria to perform a consistent assessment of the initial adoption phase of new production technologies by introducing two OEE measurement methodologies that distinguish between human performance, process configuration and technical features of the production technology. The proposed framework is then applied to and validated by a case study concerning the introduction of a semi-automatic packaging machine in a primary multinational company in the logistics industry. This case study shows the difference between the two OEE measures, along with the values interpretation and useful insights for achieving a stable production output

On the relationship between human factor and overall equipment effectiveness (OEE): An analysis through the adoption of analytic hierarchy process and ISO 22400

In the industrial field, one of the most widespread KPIs is represented by the Overall Equipment Effectiveness (OEE), first introduced by Seiichi Nakajima within the Total Productive Maintenance (TPM) theory and aimed at identifying the inefficiencies of industrial assets. While OEE has been objective of several studies, the relationship between the Overall Equipment Effectiveness and the role of the human factor in achieving its high levels of values has not been extensively investigated. In recent years few scientific studies have investigated the relationship, showing that there is a link between OEE and human factors, even significant, but not clearly identified yet. In order to examine this relationship, our study proposes a framework to clarify the links between human factors, OEE parameters, the industrial sector, and the degree of automation. This framework is then validated through the application of the Analytic Hierarchy Process (AHP) methodology. As a result, 13 aspects related to the human factor were identified. Finally, the study provides practical guidance and implications for maximizing the outcomes of the investigation, with the goal of improving an organization’s overall manufacturing performance. By understanding the impact of the human factor on OEE, organizations can make informed decisions to optimize their operations and achieve higher levels of productivity

Phenotypic classification and biochemical profile of obesity for cardiovascular prevention

Obesity is one of the major cardiovascular risk factors. The combination of obesity with other cardiovascular risk factors causes a systemic inflammation that increases the progression of cardiovascular disease. Ectopic fat plays a key role in inflammation and in the production of cytokines. There are various types of obesity and each phenotype has a different cardiometabolic risk. The clinical biochemistry laboratory is extremely relevant in the correct characterization of obesity phenotypes thanks to cardiometabolic markers. In fact, these markers quantify the metabolically active adipose tissue, which is responsible for atherosclerosis and cardiovascular diseases. On the other hand, monitoring obesity patients through the activity of those markers can be of fundamental help in the follow-up of diet therapies and in the pharmacological approach. Patients with same weight and body mass index (BMI) may have different levels of biochemical markers and body composition, and therefore different profiles of cardiovascular risk. The aim of this paper is to characterize the biochemical markers of ectopic fat and any obesity phenotype for a correct cardiovascular prevention

Every minute counts: in-hospital changes of left ventricular regional and global function in patients with ST-segment elevation myocardial infarction

Aims The aim of our study was to assess the effects of an early percutaneous coronary intervention on changes of in-hospital left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) in patients with ST-segment elevation myocardial infarction. Methods The study population consisted of 324 consecutive patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention, divided into two groups, according to the first medical contact (FMC)-to-reperfusion time, respectively, 90 min or less (n = 173) and more than 90 min (n = 151). Moreover, we performed a sub-analysis in the group of patients who showed at discharge an improvement in the LVEF of at least 10%. Results In both groups at baseline, patients suffered from a moderately reduced LVEF (40.88 +/- 8.38% in <= 90 min group vs. 40.70 +/- 8.98% in >90 min group; P = 0.858). A WMSI of more than 1 was recorded uniformly: 1.71 +/- 0.37 in patients with FMC-to-reperfusion 90 min or less and 1.72 +/- 0.38 in patients more than 90 min (P = 0.810). At the time of discharge, a significant improvement in LVEF (43.82 +/- 8.38%, P = 0.001) and WMSI (1.60 +/- 0.41, P = 0.009) exclusively emerged in the 90 min or less group. Furthermore, we identified 105 patients who experienced an improvement in the LVEF of at least 10% compared with baseline values. In these patients FMC-to-reperfusion and total ischemic time resulted as significantly shorter, when compared with patients with LVEF improvement of less than 10%. Conclusion Our study confirms and reinforces the concept that reducing the duration of the time between FMC and reperfusion, as well as the total ischemic time influences a positive recovery of left ventricular global and regional function during in-hospital stay

Meta-analysis of the impact on early and late mortality of TAVI compared to surgical aortic valve replacement in high and low-intermediate surgical risk patients

OBJECTIVE: We studied the impact of transcatheter aortic valve implantation (TAVI) compared to the surgical aortic valve replacement (SAVR) on 30-day and one-year mortality from randomized controlled trials (RCTs) in patients with severe aortic stenosis at high or low-intermediate surgical risk.MATERIALS AND METHODS: All RCTs were retrieved through PubMed computerized database and the site https://www.clinicaltrials.gov from January 2010 until March 31st, 2019. The absolute risk reduction (RD) with the 95% confidence interval (CI) was used to assess the effectiveness of the intervention under comparison. We evaluated overall mortality rates at 30-day and one-year follow-up in the comparison between TAVI vs. SAVR. We also evaluated the role played by the site access for TAVI performed through the femoral or subclavian artery (TV-TAVI) vs. SAVR, or transapically (TA-TA-VI) vs. SAVR.RESULTS: In the "as-treated population" the overall 30-day mortality was significantly lower in TAVI (p=0.03) with respect to SAVR. However, the analysis for TAVI subgroups showed that 30-day mortality was (1) significantly lower in TV-TAVI vs. SAVR (p=0.006), (2) increased, not significantly, in TA-TAVI vs. SAVR (p=0.62). No significant differences were found between TAVI vs. SAVR at one-year follow-up.CONCLUSIONS: The results of our meta-analysis suggest that TV-TAVI is a powerful tool in the treatment of severe aortic stenosis at high or low-intermediate surgical risk, with a significant lower mortality with respect to SAVR. On the contrary, SAVR seems to provide better results than TA-TAVI

Meta-analysis of the impact on early and late mortality of TAVI compared to surgical aortic valve replacement in high and low-intermediate surgical risk patients

OBJECTIVE: We studied the impact of transcatheter aortic valve implantation (TAVI) compared to the surgical aortic valve replacement (SAVR) on 30-day and one-year mortality from randomized controlled trials (RCTs) in patients with severe aortic stenosis at high or low-intermediate surgical risk. MATERIALS AND METHODS: All RCTs were retrieved through PubMed computerized database and the site https://www.clinicaltrials.gov from January 2010 until March 31st, 2019. The absolute risk reduction (RD) with the 95% confidence interval (CI) was used to assess the effectiveness of the intervention under comparison. We evaluated overall mortality rates at 30-day and one-year follow-up in the comparison between TAVI vs. SAVR. We also evaluated the role played by the site access for TAVI performed through the femoral or subclavian artery (TV-TAVI) vs. SAVR, or transapically (TA-TAVI) vs. SAVR. RESULTS: In the "as-treated population" the overall 30-day mortality was significantly lower in TAVI (p=0.03) with respect to SAVR. However, the analysis for TAVI subgroups showed that 30-day mortality was (1) significantly lower in TV-TAVI vs. SAVR (p=0.006), (2) increased, not significantly, in TA-TAVI vs. SAVR (p=0.62). No significant differences were found between TAVI vs. SAVR at one-year follow-up. CONCLUSIONS: The results of our meta-analysis suggest that TV-TAVI is a powerful tool in the treatment of severe aortic stenosis at high or low-intermediate surgical risk, with a significant lower mortality with respect to SAVR. On the contrary, SAVR seems to provide better results than TA-TAVI

Who Has Seen Patients With ST-Segment-Elevation Myocardial Infarction? First Results From Italian Real-World Coronavirus Disease 2019

Background After the coronavirus disease 2019 outbreak, social isolation measures were introduced to contain infection. Although there is currently a slowing down of the infection, a reduction of hospitalizations, especially for myocardial infarction, was observed. The aim of our study is to evaluate the impact of the infectious disease on ST-segment-elevation myocardial infarction (STEMI) care during the coronavirus disease 2019 pandemic, through the analysis of recent cases of patients who underwent percutaneous coronary intervention. Methods and Results Consecutive patients affected by STEMI from March 1 to 31, 2020, during social restrictions of Italian government, were collected and compared with patients with STEMI treated during March 2019. During March 2020, we observed a 63% reduction of patients with STEMI who were admitted to our catheterization laboratory, when compared with the same period of 2019 (13 versus 35 patients). Changes in all time components of STEMI care were notably observed, particularly for longer median time in symptom-to-first medical contact, spoke-to-hub, and the cumulative symptom-to-wire delay. Procedural data and in-hospital outcomes were similar between the 2 groups, whereas the length of hospitalization was longer in patients of 2020. In this group, we also observed higher levels of cardiac biomarkers and a worse left ventricular ejection fraction at baseline and discharge. Conclusions The coronavirus disease 2019 outbreak induced a reduction of hospital access for STEMI with an increase in treatment delay, longer hospitalization, higher levels of cardiac biomarkers, and worse left ventricular function

Target-controlled infusion during MitraClip procedures in deep-sedation with spontaneous breathing

- OBJECTIVE: Percutaneous mi-tral valve repair with the MitraClip system is an alternative procedure for high-risk patients not suitable for conventional surgery. The Mi-traClip can be safely performed under gener-al anesthesia (GA) or deep sedation (DS) with spontaneous breathing using a combination of propofol and remifentanil. This study aimed to evaluate the benefits of target-controlled infu-sion (TCI) of remifentanil and administration of propofol during DS compared with manual ad-ministration of total intravenous anesthesia (TI -VA) medication during GA in patients undergo-ing MitraClip. We assessed the impact of these procedures in terms of remifentanil dose, he-modynamic profile, adverse events, and days of hospital stay after the process.PATIENTS AND METHODS: From March 2013 to June 2015 (mean age 73.5 +/- 9,54), pa-tients underwent transcatheter MitraClip repair, 27 received DS via TCI and 27 GA with TIVA.RESULTS: Acute procedural success was 100%. DS-TCI group, in addition to a significant reduction of remifentanil dose administrated (249 mu g vs. 2865, p < 0.01), resulted in a decrease in vasopressor drugs requirement for hemodynam-ic adjustments (29.6% vs. 63%, p = 0.03) during the procedure and a reduction of hypotension (p = 0.08). The duration of postoperative hospital-ization did not differ between the two groups (5.4 days vs. 5.8 days, p = 0.4).CONCLUSIONS: Administration of remifen-tanil by TCI for DS in spontaneously breathing patients offers stable anesthesia conditions, with a lower amount of drugs, higher hemody-namic stability, and decreased side effects