Objective Rheumatoid arthritis (RA) disease activity assessment is critical for treatment decisions and treat to target (T2T) outcomes. Utilization of the electronic medical record (EMR) and techniques to improve the routine capture of disease activity measures in clinical practice are not well described. We leveraged a Lean Six Sigma (LSS) approach, a data‐driven five‐step process improvement and problem‐solving methodology, coupled with EMR modifications to evaluate improvement in disease activity documentation and patient outcomes. Methods A RA registry was established, and structured fields for Routine Assessment of Patient Index Data (RAPID3) and Clinical Disease Activity Index (CDAI) were built in the EMR, along with a dashboard to display provider performance rates. An initial rapid‐cycle improvement intervention was launched, and subsequent LSS improvement cycles helped in standardization of clinic workflow, modifying provider behaviors, and motivating better documentation practices. Trends related to CDAI score categories were compared over time using run charts. Results Our project included 1322 patients with RA and 10 241 encounters between April 2016 and December 2019. Initially, RAPID3 completion rates increased from 16% to 50%, and CDAI from 15% to 44% from the RCI intervention. Post LSS intervention, the RAPID3 rate increased to more than 90% (sustained at 85%), and CDAI rate increased to more than 80% (sustained at 72%). The patients in the low disease/remission category increased from 54% to 66% (p < 0.001), and those in the high disease category decreased from 15% to 7% (p < 0.001), demonstrating improved T2T outcomes. Conclusion Combining EMR modifications with systems redesign utilizing LSS approach led to impressive and sustained improvement in disease activity documentation and T2T outcomes.
In this work, the crash behavior of a hybrid aluminum front-end structure was studied. From the test results, it was shown that overall the structure absorbed the required impact energy. An initial CAE model, which was created prior to the test, predicted the initial portion of the impact pulse. However, beyond the point where weld and joint failure initiated the model over predicted the results. Since the model did not simulate the weld failures, a more detailed model of the front-end structure was created to account for these failures. Unlike steel, the Heat-Effected-Zone (HAZ) around the welds in heat-treatable aluminum alloys exhibit significantly lower yield and ultimate stress than the base material. However, the degree to which the properties are reduced and size of the HAZ vary as a function of welding speed, heat input, weld alloy, etc. A series of analysis using a range of the properties around the HAZ showed a corresponding variation in the crash pulse. The range of properties used was based on coupon level tests of the yield and ultimate strength variation around the HAZ. To better understand the effect of the HAZ and other variations within the structure, a stochastic analysis methodology is proposed. This type of analysis will point to significant source(s) within the structure or components that affect the variations in the crash pulse. It is hoped that this information can be used to improve the manufacturing process or aid in the redesign of the structure to lessen the effect of variations.
Due to geometrical, and material property variations, response of any structural member varies from the nominal design value. Typically the geometrical and material variations are the resultant of manufacturing variations. In this paper, the effect of these variations about the nominal values on structural response is studied using stochastic or probabilistic methods. Circular aluminum cross-sections are becoming popular in structural energy management applications. Also, significant research has been done to estimate the mean crush load for a circular section using empirical relations. An empirical relation, which is a function of thickness, outer radius, elastic modulus and yield strength, was used to estimate the mean crush load. Based on the measured thickness, outer radius and yield strength, the mean crush load is calculated using the empirical relation. Also, using the empirical relation, the variation in the mean crush load is estimated using linear statistical approach and Monte-Carlo simulation. In both the stochastic methods, actual mean and standard deviations of thickness, outer radius and yield strength are used. Also, using the extreme variations of these factors, mean crush load is predicted using an implicit Finite Element Analysis (FEA) code. The FEA prediction is in good agreement with the results of the testing. However, the designed mean crush load based on the empirical relation overestimates the crush loads by about 11%. The results of the study showed that the tube thickness and yield strength variations significantly affect the crush loads. Based on the Monte-Carlo simulation and FEA values using the extreme values for the geometrical and mechanical properties, one can design crash structures that take into account the inherent variability of components.
A frontal impact test was performed on a front-end module consisting of 6xxx series aluminum extrusions, and some 5xxx series aluminum stampings as reinforcements. The front end structure consists mainly of a bumper, cross member, radiator support, front and backup lower rails, upper rails, and shock tower support. In addition to the main structure, a subframe containing the engine was also attached to the back-up rails. The front-end module was mounted on a sled at the upper and lower A-pillar points as well as at the back-up rail. In addition to measuring the barrier forces, load cells were located behind the main structural members to determine load transfer. The results of the tests showed progressive folding of the crush rails, and adequate absorption of the impact energy. To aid in the design, a CAE model of the front-end was created to determine the crash behavior of the structure during frontal impact. The final model, which took into account, the material properties of the weld joints showed good agreement with test results.
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