Historic manufacturing enterprises based on vertically optimized companies, practices, market share, and competitiveness are giving way to enterprises that are responsive across an entire value chain to demand dynamic markets and customized product value adds; increased expectations for environmental sustainability, reduced energy usage, and zero incidents; and faster technology and product adoption. Agile innovation and manufacturing combined with radically increased productivity become engines for competitiveness and reinvestment, not simply for decreased cost. A focus on agility, productivity, energy, and environmental sustainability produces opportunities that are far beyond reducing market volatility. Agility directly impacts innovation, time-to-market, and faster, broader exploration of the trade space. These changes, the forces driving them, and new network-based information technologies offering unprecedented insights and analysis are motivating the advent of smart manufacturing and new information technology infrastructure for manufacturing.

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Objective: To assess the feasibility of measuring the health impacts of a 12-week naturopathic whole foods nutrition education course among adults with or at risk for prediabetes. Design: A pilot nonrandomized pre-post intervention design investigated physiological changes associated with participation in a 12-week structured naturopathic nutrition education course. Follow-up measures were assessed at 6 and 12 months from baseline. Settings/Location: Three community-based kitchens in Oregon. Subjects: Forty-five adults with or at risk for prediabetes. Intervention: Twelve weekly 90-min workshops emphasizing the health benefits of a naturopathic whole foods diet and including collective meal preparation and communal dining. Outcome measures: Changes in biomarkers of diabetes and cardiovascular disease risk, including highsensitivity C-reactive protein (hs-CRP), hemoglobin A1c, insulin, and lipids, and changes in dietary behaviors at baseline, postintervention (12 weeks), and 6-and 12-month follow-up. Changes in biomarkers and food consumption patterns were assessed using linear mixed models with random intercept, including data from all participants who completed the end-of-intervention assessment. Results: Pre-post intervention results for 45 participants showed decreases in blood glucose and hs-CRP. Food frequency questionnaire data showed decreases in daily servings of grain, dairy, and fat postintervention. Decreases in blood glucose, hs-CRP, triglycerides, cholesterol, low-density lipoprotein, very-low-density lipoprotein, and HbA1c from baseline were observed at 12-month follow-up. Both insulin and high-density lipoprotein were decreased from baseline and 12-week levels at the 6-month follow-up but increased from all earlier levels at 12 months (all p < 0.0001). Daily servings of meat, dairy, and fat remained decreased at 6-month follow-up. Reduced grain consumption observed at 12-week and at 6-month follow-up was not sustained, and increased at 12 months, although still decreased from baseline. Conclusions: Results suggest that this naturopathic nutrition education series may promote dietary behavior change with associated changes in clinical biomarkers. Larger controlled studies are needed to confirm these results.