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Managing the design of products and the efficient execution of the manufacturing processes needed to produce them is an endeavor fraught with all manner of risks for manufacturing enterprises large and small. In certain industries, such as the food manufacturing industry, the problems and risks can be even greater. This is because the processes necessary for a food product's manufacture must be designed not only to meet quality, cost, and efficiency targets, but also to have an innate flexibility to cope with the unavoidable variability in the characteristics of the ingredients used to produce the desired product. In the food manufacturing industry and in related industries such as pharmaceutical manufacturing, the problem of identifying vendor sources for ingredients that have acceptable characteristics, managing the acquisition of those ingredients, and then modifying the manufacturing process to cope with the inherent variability in ingredients acquired at different times is an ongoing concern that can expose a company to severe risks. In this paper, a case study will be presented that illustrates how smart manufacturing (SM) approaches can be applied to reduce the risks due to ingredient variability to, and increase the efficiency of, a food production network. Smart manufacturing integrates best-of-breed solutions from manufacturing and non-manufacturing arenas to solve manufacturing problems and offers great hope for manufacturers. The SM solution described in this paper is built upon what is called the Smart Manufacturing Platform, a software and services platform being developed by the Smart Manufacturing Leadership Coalition.

The Ochsner institutions and their physicians have figured in nonmedical works of nonfiction. A listing of these, with a description of each work, is provided.

OCHSNER AND ITS PHYSICIANS HAVE FIGURED IN WORKS OF FICTION: novels, plays, and music. A listing of these works, along with a description of each work, is provided.

Increasing numbers of people are seeking genetic testing and uncovering information that directly concerns their biological relatives as well as themselves. This familial quality of genetic information raises ethical quandaries for physicians, particularly related to their duty of confidentiality. In this article, the American Medical Association's Council on Ethical and Judicial Affairs examines the informed consent process in the specific context of genetic testing, giving particular consideration to the handling of information that has consequences for biological relatives. Furthermore, it addresses the question of whether physicians' obligation to warn biological relatives ever should override the obligation to protect patient confidentiality.

Objective: To set ethical guidelines on the use of surgical placebo controls in the design of surgical trials., Background Data: Ethical concerns recently arose from surgical trials where subjects in the control arm underwent surgical procedures that had the appearance of a therapeutic intervention, but during which the essential therapeutic maneuver was omitted. Although there are ethical guidelines on the use of a placebo in drug trials, little attention has been paid to the use of a surgical placebo control in surgical trials., Methods: The Council on Ethical and Judicial Affairs developed ethical guidelines based on a wide literature search and consultation with experts., Results: Surgical placebo controls should be limited to studies of new surgical procedures aimed at treating diseases that are not amenable to other surgical therapies, and are reasonably anticipated to be susceptible to substantial placebo effects. If the standard nonsurgical treatment is efficacious and acceptable to the patient, then it must be offered as part of the study design., Conclusions: Surgical placebo controls should be used only when no other trial design will yield the requisite data and should always be accompanied by a rigorous informed consent process and a careful consideration of the related risks and benefits. The recommended ethical guidelines were adopted as AMA ethics policy and are now incorporated in the AMA's Code of Medical Ethics.

The interaction between medical research and for-profit corporations is not new, but it has expanded considerably in recent years. Some of the recent trends may accelerate the research process, particularly when large clinical trials are required. However, a renewed commitment to the application of high ethical standards is essential to ensure that societal trust in research is not eroded, subjects enrolled in trials do not become merely a means to an end, and medical research is efficiently translated into clinical advances that will benefit future patients. This article focuses on the analysis of conflicts of interest in the conduct of clinical trials in both academic and community-based settings. Specifically, it discusses how the roles of research scientists and clinical practitioners differ and the importance of ensuring that participants' consent to enroll in clinical trials is not the result of confusion about the goals of an experimental treatment that may resemble clinical care. The article also discusses the potential conflicts of interest that can arise when clinicians stand to gain from enrolling their own patients as subjects in clinical trials and examines various instances in which disclosure of information regarding funding and compensation may serve to minimize such conflicts. This article emphasizes that to preserve the integrity of research and to protect the welfare of human subjects who enroll in trials, physicians should have adequate training in the conduct of research and be familiar with the ethics of research. When a physician has treated or continues to treat a patient who is eligible to enroll as a subject in a clinical trial conducted by the same physician, someone other than the treating physician should obtain the participant's informed consent. Finally, the article addresses disclosure of financial incentives and related funding issues.