A study on the effects of inter-organizational factors on the supply chain performance

In the current competitive environment, managers do their best to convert organizations under their supervision into competitive and responsive through creating capability of timely delivery of quality products and services. In the other word, they try to create value for their customers, which yield more profitability for stakeholders. In line with this, determining of inter-organizational factors and the relationships among these variables and supply chain performance plays an important role in achieving these objectives. The relationship modeling is a type of multiple criteria decision-making (MCDM) problem, which requires applying experts to determine the relationships. The Decision Making Trial and Evaluation Laboratory (DEMATEL) is an MCDM tool, which not only can convert the relationships among cause and effect criteria into a visual structural framework, but also it can be used as a technique to handle the inner dependences within a set of criteria. This paper proposes an effective solution based on DEMATEL approach to help managers evaluate the relationships between inter-organizational factors and supply chain performance

Infallibility (Poka-Yoke) Fundamentals for Improving Production Processes, Case Study: An Automotive Parts Manufacturing Company

In production processes, quality is defined in terms of defects and sigma level wastes. In order to achieve zero level wastes, it is required that production processes’ sigma levels be increased through improvements in the processes. Utilizing Infallibility Strategy (Poka-Yoke) increases the sigma level of production processes and thus leads the process towards producing parts without fault and with zero defects. In the present study, the researcher has implemented the Infallibility Strategy (Poka-Yoke) in an automotive parts manufacturing company. In order to achieve the objectives of the study, the researcher, using a map, first determined the areas in which defects occurred in the production process, then the significance of defects with regard to their frequency of occurrence and their scope were determined, and the proper anti-error system was chosen. Given the number of defects and the annual production capacity, the PPM and the manufacturing process sigma level were calculated. Obtained results demonstrated the significant increase in the manufacturing process sigma level, which in turn implied the successful implementation of the Infallibility Strategy (Poka-Yoke) in the studied company

Infallibility (Poka-Yoke) Fundamentals for Improving Production Processes, Case Study: An Automotive Parts Manufacturing Company

In production processes, quality is defined in terms of defects and sigma level wastes. In order to achieve zero level wastes, it is required that production processes’ sigma levels be increased through improvements in the processes. Utilizing Infallibility Strategy (Poka-Yoke) increases the sigma level of production processes and thus leads the process towards producing parts without fault and with zero defects. In the present study, the researcher has implemented the Infallibility Strategy (Poka-Yoke) in an automotive parts manufacturing company. In order to achieve the objectives of the study, the researcher, using a map, first determined the areas in which defects occurred in the production process, then the significance of defects with regard to their frequency of occurrence and their scope were determined, and the proper anti-error system was chosen. Given the number of defects and the annual production capacity, the PPM and the manufacturing process sigma level were calculated. Obtained results demonstrated the significant increase in the manufacturing process sigma level, which in turn implied the successful implementation of the Infallibility Strategy (Poka-Yoke) in the studied company

Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality among Patients with COVID-19 Admitted to the Intensive Care Unit: The INSPIRATION Randomized Clinical Trial

Importance: Thrombotic events are commonly reported in critically ill patients with COVID-19. Limited data exist to guide the intensity of antithrombotic prophylaxis. Objective: To evaluate the effects of intermediate-dose vs standard-dose prophylactic anticoagulation among patients with COVID-19 admitted to the intensive care unit (ICU). Design, Setting, and Participants: Multicenter randomized trial with a 2 � 2 factorial design performed in 10 academic centers in Iran comparing intermediate-dose vs standard-dose prophylactic anticoagulation (first hypothesis) and statin therapy vs matching placebo (second hypothesis; not reported in this article) among adult patients admitted to the ICU with COVID-19. Patients were recruited between July 29, 2020, and November 19, 2020. The final follow-up date for the 30-day primary outcome was December 19, 2020. Interventions: Intermediate-dose (enoxaparin, 1 mg/kg daily) (n = 276) vs standard prophylactic anticoagulation (enoxaparin, 40 mg daily) (n = 286), with modification according to body weight and creatinine clearance. The assigned treatments were planned to be continued until completion of 30-day follow-up. Main Outcomes and Measures: The primary efficacy outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, assessed in randomized patients who met the eligibility criteria and received at least 1 dose of the assigned treatment. Prespecified safety outcomes included major bleeding according to the Bleeding Academic Research Consortium (type 3 or 5 definition), powered for noninferiority (a noninferiority margin of 1.8 based on odds ratio), and severe thrombocytopenia (platelet count <20 �103/µL). All outcomes were blindly adjudicated. Results: Among 600 randomized patients, 562 (93.7) were included in the primary analysis (median interquartile range age, 62 50-71 years; 237 42.2% women). The primary efficacy outcome occurred in 126 patients (45.7%) in the intermediate-dose group and 126 patients (44.1%) in the standard-dose prophylaxis group (absolute risk difference, 1.5% 95% CI,-6.6% to 9.8%; odds ratio, 1.06 95% CI, 0.76-1.48; P =.70). Major bleeding occurred in 7 patients (2.5%) in the intermediate-dose group and 4 patients (1.4%) in the standard-dose prophylaxis group (risk difference, 1.1% 1-sided 97.5% CI,-� to 3.4%; odds ratio, 1.83 1-sided 97.5% CI, 0.00-5.93), not meeting the noninferiority criteria (P for noninferiority >.99). Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (6 vs 0 patients; risk difference, 2.2% 95% CI, 0.4%-3.8%; P =.01). Conclusions and Relevance: Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days. These results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in unselected patients admitted to the ICU with COVID-19. Trial Registration: ClinicalTrials.gov Identifier: NCT04486508. © 2021 American Medical Association. All rights reserved

Intermediate versus standard-dose prophylactic anticoagulation and statin therapy versus placebo in critically-ill patients with COVID-19:Rationale and design of the INSPIRATION/INSPIRATION-S studies

Background: Microvascular and macrovascular thrombotic events are among the hallmarks of coronavirus disease 2019 (COVID-19). Furthermore, the exuberant immune response is considered an important driver of pulmonary and extrapulmonary manifestations of COVID-19. The optimal management strategy to prevent thrombosis in critically-ill patients with COVID-19 remains unknown. Methods: The Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) and INSPIRATION-statin (INSPIRATION-S) studies test two independent hypotheses within a randomized controlled trial with 2 � 2 factorial design. Hospitalized critically-ill patients with reverse transcription polymerase chain reaction confirmed COVID-19 will be randomized to intermediate-dose versus standard dose prophylactic anticoagulation. The 600 patients undergoing this randomization will be screened and if meeting the eligibility criteria, will undergo an additional double-blind stratified randomization to atorvastatin 20 mg daily versus matching placebo. The primary endpoint, for both hypotheses will be tested for superiority and includes a composite of adjudicated acute arterial thrombosis, venous thromboembolism (VTE), use of extracorporeal membrane oxygenation, or all-cause death within 30 days from enrollment. Key secondary endpoints include all-cause mortality, adjudicated VTE, and ventilator-free days. Key safety endpoints include major bleeding according to the Bleeding Academic Research Consortium definition and severe thrombocytopenia (platelet count 3 times upper normal limit and clinically-diagnosed myopathy. The primary analyses will be performed in the modified intention-to-treat population. Results will be tested in exploratory analyses across key subgroups and in the intention-to-treat and per-protocol cohorts. Conclusions: INSPIRATION and INSPIRATON-S studies will help address clinically-relevant questions for antithrombotic therapy and thromboinflammatory therapy in critically-ill patients with COVID-19. © 2020 Elsevier Lt