Using lean methodologies for economically and environmentally sustainable foundries

Lean manufacturing is often seen as a set of tools that reduce the total cost and improve the quality of manufactured products. The lean management philosophy is one which targets waste reduction in every facet of the manufacturing business; however, only recently have studies linked lean management philosophies with improving environmental sustainability. These studies suggest that lean manufacturing is more than a set of lean tools that can optimize manufacturing efficiencies; it is a process and mindset that needs to be integrated into daily manufacturing systems to achieve sustainability. The foundry industry, as well as manufacturing in general, has significant challenges in the current regulatory and political climate with developing an economically and environmentally sustainable business model. Lean manufacturing has proven itself as a model for both economic sustainability and environmental stewardship. Several recent studies have shown that both lean and green techniques and “zero-waste” policies also lead to reductions in overall cost. While these strategies have been examined for general manufacturing, they have not been investigated in detail for the foundry industry. This paper will review the current literature and describe how lean and green can provide a relevant framework for environmentally and economically sustainable foundries. Examples of lean and green technologies and techniques which can be applied to foundries in a global context will be described

A preoperative package of care for osteoarthritis, consisting of weight loss, orthotics, rehabilitation, topical and oral analgesia (OPPORTUNITY): A two centre open label randomised controlled feasibility trial

Background Osteoarthritis of the knee is a major cause of disability worldwide. Non-operative treatments can reduce the morbidity but adherence is poor. We hypothesised that adherence could be optimised if behavioural change was established in the preoperative period. Therefore, we aimed to assess feasibility, acceptability, and recruitment and retention rates of a preoperative package of non-operative care in patients awaiting knee replacement surgery. Methods We did an open-label, randomised controlled, feasibility trial in two secondary care centres in the UK. Eligible participants were aged 15–85 years, on the waiting list for a knee arthroplasty for osteoarthritis, and met at least one of the thresholds for one of the four components of the preoperative package of non-operative care intervention (ie, weight loss, exercise therapy, use of insoles, and analgesia adjustment). Participants were randomly assigned (2:1) to either the intervention group or the standard of care (ie, control) group. All four aspects of the intervention were delivered weekly over 12 weeks. Participants in the intervention group were reviewed regularly to assess adherence. The primary outcome was acceptability and feasibility of delivering the intervention, as measured by recruitment rate, retention rate at follow-up review after planned surgery, health-related quality of life, joint-specific scores, and adherence (weight change and qualitative interviews). This study is registered with ISRCTN, ISRCTN96684272. Findings Between Sept 3 2018, and Aug 30, 2019, we screened 233 patients, of whom 163 (73%) were excluded and 60 (27%) were randomly assigned to either the intervention group (n=40) or the control group (n=20). 34 (57%) of 60 participants were women, 26 (43%) were men, and the mean age was 66·8 years (SD 8·6). Uptake of the specific intervention components varied: 31 (78%) of 40 had exercise therapy, 28 (70%) weight loss, 22 (55%) analgesia adjustment, and insoles (18 [45%]). Overall median adherence was 94% (IQR 79·5–100). At the final review, the intervention group lost a mean of 11·2 kg (SD 5·6) compared with 1·3 kg (3·8) in the control group (estimated difference –9·8 kg [95% CI –13·4 to –6·3]). A clinically significant improvement in health-related quality o life (mean change 0·078 [SD 0·195]) were reported, and joint-specific scores showed greater improvement in the intervention group than in the control group. No adverse events attributable to the intervention occurred. Interpretation Participants adhered well to the non-operative interventions and their health-related quality of life improved. Participant and health professional feedback were extremely positive. These findings support progression to a full-scale effectiveness trial

A preoperative package of care for osteoarthritis, consisting of weight loss, orthotics, rehabilitation, topical and oral analgesia (OPPORTUNITY): a two centre open label randomised controlled feasibility trial

BackgroundOsteoarthritis of the knee is a major cause of disability that non-operative treatments can reduce but, adherence is poor. We hypothesised adherence could be optimised if behavioural change was established in the pre-operative period. Thus, the aim was to assess feasibility, acceptability and recruitment/retention rates of a pre-operative package of non-operative care.MethodsA multicentre randomised controlled open label feasibility trial in secondary care of patients awaiting arthroplasty: Participants were randomised (2:1) to the intervention, (consisting of weight-loss, exercise therapy, analgesia advice and/or insoles), or usual care. The primary outcome was acceptability and feasibility of delivering the intervention. Recruitment, retention, adherence, weight change, EQ-5D, joint specific scores and qualitative interviews were obtained.FindingsOf 233 patients screened, the majority (n=138,62%) were eligible and 43% (60/138) participated (mean age 66.8years [range 48-85], 57% [n=34] female). Uptake of the specific interventions varied: physical activity (n=31,78%), weight loss (n=28,70%), analgesia (n=22,55%) and insoles (n=18,45%). Overall median adherence was 94% (interquartile range 79.5%-100%). The intervention group lost a mean of 11.2kg vs 1.3kg in controls (estimated difference -9.8 kg, 95% CI -13.4 to -6.3 kg). Five (8%) participants cancelled their surgery; 4 (10%) were in the intervention arm. There was a clinically significant improvement in EQ-5D (mean change 0.078) and joint specific scores demonstrated greater improvement in the intervention group. No AEs were encountered. Participant and health professional feedback was extremely positive. InterpretationParticipants adhered well to it, and their health-related quality of life (HRQoL) improved. The findings are particularly timely, as the intervention could empower patients to optimise their health while awaiting surgery and prevent the deterioration in HRQoL and even improve it. Progression to a full-scale effectiveness trial is supported. Further, as some patients cancelled their surgery the intervention could help address the waiting list crisis