Breaking the mould:Achieving high volume production output with additive manufacturing

Purpose The study aims to examine a discrepant industrial case that demonstrates how to achieve economies of scale with additive manufacturing (AM), thereby expanding the scope of AM beyond high-variety, customised production contexts. Design/methodology/approach Abductive reasoning is applied to analyse a case of using AM to compete with conventional production, winning a contract to supply 7,700,000 products. Comparing this case to existing theories and contemporary practices reveals new research directions and practical insights. Findings Economies of scale were realised through a combination of technological innovation and the adoption of operations management practices atypical of AM shops (e.g. design for volume, low-cost resource deployment and material flow optimisation). The former improved AM process parameters in terms of time, cost and dependability; the latter improved the entire manufacturing system, including non-AM operations/resources. This system-wide improvement has been largely overlooked in the literature, where AM is typically viewed as a disruptive technology that simplifies manufacturing processes and shortens supply chains. Originality/value It is empirically shown that an AM shop can achieve economies of scale and compete with conventional manufacturing in high-volume, standardised production contexts

Computed Tomography Screening for Lung Cancer: Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules

To compare long-term survival rates of patients with first, primary, clinical stage IA nonsmall cell lung cancer from a large cohort undergoing computed tomography screening with and without mediastinal lymph node resection (MLNR) under an Institutional Review Board-approved common protocol from 1992 to 2014. Assessing survival differences of patients with and without MLNR manifesting as solid and subsolid nodules. Long-term Kaplan-Meier (K-M) survival rates for those with and without MLNR were compared and Cox regression analyses were used to adjust for demographic, computed tomography, and surgical covariates. The long-term K-M rates for 462 with and 145 without MLNR was 92% versus 96% (P = 0.19), respectively. For 203 patients with a subsolid nodule, 151 with and 52 without MLNR, the rate was 100%. For the 404 patients with a solid nodule, 311 with and 93 without MLNR, the rate was 87% versus 94% (P = 0.24) and Cox regression showed no statistically significant difference (P = 0.28) when adjusted for all covariates. Risk of dying increased significantly with increasing decades of age (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.4-3.8), centrally located tumor (HR 2.5, 95% CI 1.2-5.2), tumor size 21 to 30 mm (HR 2.7, 95% CI 1.2-6.0), and invasion beyond the lung stroma (HR 3.0, 95% CI 1.4-6.1). For the 346 patients with MLNR, tumor size was 20 mm or less; K-M rates for the 269 patients with and 169 patients without MLNR were also not significantly different (HR 2.1, P = 0.24). It is not mandatory to perform MLNR when screen-diagnosed nonsmall cell lung cancer manifests as a subsolid nodule

The importance of low-dose CT screening to identify emphysema in asymptomatic participants with and without a prior diagnosis of COPD

Chronic Obstructive Pulmonary Disease (COPD) includes chronic bronchitis, small airways disease, and emphysema. Diagnosis of COPD requires spirometric evidence and may be normal even when small airways disease or emphysema is present. Emphysema increases the risk of exacerbations, and is associated with all-cause mortality and increased risk of lung cancer. We evaluated the prevalence of emphysema in participants with and without a prior history of COPD. We reviewed a prospective cohort of 52,726 subjects who underwent baseline low dose CT screening for lung cancer from 2003 to 2016 in the International Early Lung Cancer Action Program. Of 52,726 participants, 23.8%(12,542) had CT evidence of emphysema. Of these 12,542 participants with emphysema, 76.5%(9595/12,542) had no prior COPD diagnosis even though 23.6% (2258/9595) had moderate or severe emphysema. Among 12,542 participants, significant predictors of no prior COPD diagnosis were: male (OR = 1.47, p < 0.0001), younger age (ORage10 = 0.72, p < 0.0001), lower pack-years of smoking (OR10pack-years = 0.90, p < 0.0001), completed college or higher (OR = 1.54, p < 0.0001), no family history of lung cancer (OR = 1.12, p = 0.04), no self-reported cardiac disease (OR = 0.76, p = 0.0003) or hypertension (OR = 0.74, p < 0.0001). The severity of emphysema was significantly lower among the 9595 participants with no prior COPD diagnosis, the OR for moderate emphysema was ORmoderate = 0.58(p = 0.0007) and for severe emphysema, it was ORsevere = 0.23(p < 0.0001). Emphysema was identified in 23.8% participants undergoing LDCT and was unsuspected in 76.5%. LDCT provides an opportunity to identify emphysema, and recommend smoking cessation. •Emphysema was identified in 23.8% participants and was unsuspected in 76.5%.•23.6% of participants with unsuspected COPD had moderate or severe emphysema on LDCT.•COPD is underdiagnosed in patients undergoing LDCT.•LDCT provides an opportunity to identify emphysema, reduce morbidity and mortality