Modelling Engineering Change Management in a New Product Development Supply Chain

The changes within a new product development (NPD) process are handled differently depending on the stage of the project. The changes during the initial stages of the project are addressed by design iterations, while the changes after the product design is complete are addressed using a formal engineering change management (ECM) process. The ECM process is a complex process, especially under a collaborative environment, where various independent entities work together for a common cause of product development. The interactions between the NPD and ECM processes have rarely been investigated in the research community. In this paper, we attempt to study the interactions between the various NPD and ECM process parameters by modelling the processes and simulated the model to understand the parameter interactions. The organisations in a supply chain have been characterised based on their interactions with the original equipment manufacturer (OEM) during the NPD process. The organisation process templates representing the NPD and ECM processes of each type of organisation in the supply chain have been modelled. The templates have been used to develop a simulation model representing the NPD and ECM processes for a supply chain. The process variables, such as processing rates, resources, resource composition, resource allocation priority, processing quality and phase overlap, have been included in the model. The results indicate that most of the variables and interactions among the variables have a significant influence on the NPD lead time. By identifying the status of the NPD process, the decision-makers can use these results to develop appropriate management policies to govern their product development projects

Comparative study of uterine repair during caesarean section: exteriorization repair versus in-situ repair

Background: Cesarean section is one of the most common major obstetrical operation performed worldwide and the rates of cesarean section are increasing. It is associated with both intra-operative and post-operative complications. Many variations in surgical methods have been devised to decrease the adverse effects and morbidity. One such method is technique of uterine repair after delivery of the fetus and placenta by exteriorizing the uterus or in-situ repair.Methods: A prospective comparative study was conducted in the department of Obstetrics and Gynecology at MGMCRI Pondicherry over 18 months from March 2015 to August 2016. Two hundred women undergoing caesarean section were assigned to 2 groups. Group 1 (Exteriorization) 100 women and Group 2 (In-situ repair) 100 women. Intra-op and post-operative complications were assessed in both groups and compared.Results: There was no significant difference between the two groups with regard to age, parity, gestational age and type of cesarean section. There was no significant difference between two groups with regard to fall in Hb, operating time, mean drop in pulse rate and blood pressure, nausea, vomiting and intra-op pain. There was significant difference in blood loss during surgery in in-situ repair, P value was <0.001 highly significant and also statistically significant increase in transfusion rates in in-situ group with a p value of 0.038. Postoperative complications like febrile morbidity was significantly more in in-situ repair P=0.046. There was no significant difference in other variables like urinary tract infection, surgical site infection, endometritis and hospital stay.Conclusions: Both techniques are accepted methods of uterine repair. Technique of repair depends on surgeon’s choice and clinical situation. Exteriorization repair is a valid option with no significant increase in morbidity compared to In-situ repair especially in cases where exposure of lower uterine segment is difficult, there is extension of incision and difficulty in achieving hemostasis

Traditional phyto-antidotes used for snakebite by Bagata tribe of Eastern Ghats of Visakhapatnam district, Andhra Pradesh

The present study highlights the medicinal plants used for treating snakebite by Bagata tribe in Visakhapatnam district, Andhra Pradesh. This paper enumerates the traditional uses of 38 plant species belonging to 36 genera under 27 families that act as antidotes against snakebite. Eleven new practices were also reported

Leading twin in breech presentation, is routine caesarean section necessary?

Background: Multiple gestations and Caesarean delivery are both showing a rising trend worldwide. One major cause for Caesarean section in twin gestations is leading twin in breech presentation. This study is to find out whether vaginal delivery is an option in such cases.Methods: Out of 66 twin deliveries, 27 cases were studied with one twin in breech presentation after excluding the previous LSCS cases. Maternal parameter studied was section rates in primi and multi gravida respectively. Neonatal parameters studied were birth weight and Apgar scores of breech twins and after weight wise distribution of babies into 4 groups the morbidity of those born vaginally were compared to those delivered by Caesarean section.Results: Twin deliveries constituted 2.7 % of total deliveries in one year and combinations of breech with 2nd foetus in breech, cephalic and transverse presentations were 16.8, 9 and 3% respectively. Out of 19 first breech twins, 11 were in primigravida who underwent LSCS and 5 in multigravida of which 60 % underwent LSCS. So 40.6% of primary LSCS were due to first twin in breech. Out of 19 2nd breech twins, 6 delivered vaginally. Irrespective of mode of delivery, morbidity was influenced by birth weight, where babies 2.5kg required NICU care in 100, 64, 20 and 0 % cases in the LSCS group compared to 100, 66.7,0 and0% cases in the vaginal delivery group.Conclusions: Vaginal delivery can be considered as an option for first twin breech specially in multigravida

Maternal factors associated with large for gestational age babies and its outcome when compared with those of appropriate for gestational age

Background: Large for gestational age (LGA) babies are known to have a higher incidence of birth trauma, difficult delivery and Caesarean sections. Knowledge about maternal factors associated with this can help in prediction and prevention of complications.Methods: Maternal factors in 112 cases of LGA babies was studied along with its outcome and compared with an equal number of controls.Results: 0.05% deliveries resulted in LGA babies. Age and parity were not significantly different in the two groups and so were the associated medical disorders of hypothyroidism and gestational hypertension. Significant association was found with post-dated pregnancies (p=0.04) and gestational diabetes mellitus (p=0.05). Also, higher number of primary Caesarean sections resulted in the case group.Conclusions: Post dated pregnancies and gestational diabetes were maternal factors associated with LGA babies and higher number of primary Caesarean sections resulted in these cases

Gestational diabetes mellitus: does treatment modality predict the obstetric and neonatal outcome?

Background: Gestational diabetes mellitus (GDM) may be controlled with dietary modifications alone or may require insulin treatment. This study aims to find out the impact of these two treatment modalities on the maternal and neonatal outcomes.Methods: This retrospective observational study divided the GDM patients into two groups, A and B, treated with diet and insulin therapy respectively and the maternal and neonatal outcome parameters were compared.Results: 299 (6.7%) GDM patients over a period of two years were divided into group A (n=222) and group B (n=77). Need for induction of labour was significantly higher in group B (p=0.02). More number of history of previous abortions were seen in group A (p=0.1) and higher number of emergency Caesarean sections were observed in group B (p=0.1). Previous history of intrauterine deaths, gestational hypertension and hypothyroidism in the present pregnancy, meconium stained liquor, large for gestational age babies and need for neonatal intensive care were comparable in the two groups.Conclusions: There are no significant differences in the pregnancy outcomes of GDM treated with diet therapy alone or insulin except for a higher number of induced labours in the insulin treated group

Outcome of clinical hypothyroidism in pregnancy: a case control study

Background: Hypothyroidism in pregnancy is generally associated with various adverse outcomes. Also worldwide, there is an increased awareness about morbidity caused by this endocrinological disorder in pregnancy .This study is undertaken to evaluate the outcome of this condition in pregnancy.Methods: 144 newly diagnosed clinical hypothyroid pregnant women were taken as the case group and 145 age and parity matched euthyroid pregnant women were taken as controls. The outcome compared in between these two groups were pregnancy complications like gestational diabetes and hypertension , oligohydramnios, intrauterine growth restriction , intrauterine demise, Caesarean section rates and it’s indication as well as neonatal outcome like birth weight and need for neonatal intensive care.Results: Clinical hypothyroidism in pregnancy constituted 6.1% of the total number of deliveries. There was a significantly higher number of gestational diabetes in the case group (p=0.0001). Caesarean sections done for the indication of foetal distress was significantly higher when compared with the control group (p=0.00002). Large for gestational age babies were more common in case group.Conclusions: Clinical hypothyroidism in pregnancy even when treated adequately might lead to complications

Myomectomy in pregnancy: feasibility and safety

Prevalence of myoma in pregnancy is increasing due to advances in imaging technology. Majority are asymptomatic. Symptomatic myomas are usually large, increase in size during pregnancy and give rise to various obstetrical complications. Myomectomy during pregnancy is controversial. The management of fibroids encountered during pregnancy and caesarean section is a therapeutic dilemma. Myomectomy during pregnancy and caesarean section is discouraged traditionally due to fear of miscarriage, uncontrolled bleeding, failure to obliterate the cavity, and ending in hysterectomy. Recent literature suggests myomectomy during pregnancy and caesarean section is safe in well selected cases with experienced obstetrician in a tertiary care center

Low doses of cisplatin or gemcitabine plus Photofrin/photodynamic therapy: Disjointed cell cycle phase-related activity accounts for synergistic outcome in metastatic non-small cell lung cancer cells (H1299).

We compared the effects of monotherapy (photodynamic therapy or chemotherapy) versus combination therapy (photodynamic therapy plus a specific drug) on the non-small cell lung cancer cell line H1299. Our aim was to evaluate whether the additive/synergistic effects of combination treatment were such that the cytostatic dose could be reduced without affecting treatment efficacy. Photodynamic therapy was done by irradiating Photofrin-preloaded H1299 p53/p16-null cells with a halogen lamp equipped with a bandpass filter. The cytotoxic drugs used were cis-diammine-dichloroplatinum [II] (CDDP or cisplatin) and 2',2'-difluoro-2'-deoxycytidine (gemcitabine). Various treatment combinations yielded therapeutic effects (trypan blue dye exclusion test) ranging from additive to clearly synergistic, the most effective being a combination of photodynamic therapy and CDDP. To gain insight into the cellular response mechanisms underlying favorable outcomes, we analyzed the H1299 cell cycle profiles and the expression patterns of several key proteins after monotherapy. In our conditions, we found that photodynamic therapy with Photofrin targeted G0-G1 cells, thereby causing cells to accumulate in S phase. In contrast, low-dose CDDP killed cells in S phase, thereby causing an accumulation of G0-G1 cells (and increased p21 expression). Like photodynamic therapy, low-dose gemcitabine targeted G0-G1 cells, which caused a massive accumulation of cells in S phase (and increased cyclin A expression). Although we observed therapeutic reinforcement with both drugs and photodynamic therapy, reinforcement was more pronounced when the drug (CDDP) and photodynamic therapy exert disjointed phase-related cytotoxic activity. Thus, if photodynamic therapy is appropriately tuned, the dose of the cytostatic drug can be reduced without compromising the therapeutic response

Multiple prebiotic metals mediate translation.

Today, Mg2+ is an essential cofactor with diverse structural and functional roles in life's oldest macromolecular machine, the translation system. We tested whether ancient Earth conditions (low O2, high Fe2+, and high Mn2+) can revert the ribosome to a functional ancestral state. First, SHAPE (selective 2'-hydroxyl acylation analyzed by primer extension) was used to compare the effect of Mg2+, Fe2+, and Mn2+ on the tertiary structure of rRNA. Then, we used in vitro translation reactions to test whether Fe2+ or Mn2+ could mediate protein production, and quantified ribosomal metal content. We found that (i) Mg2+, Fe2+, and Mn2+ had strikingly similar effects on rRNA folding; (ii) Fe2+ and Mn2+ can replace Mg2+ as the dominant divalent cation during translation of mRNA to functional protein; and (iii) Fe and Mn associate extensively with the ribosome. Given that the translation system originated and matured when Fe2+ and Mn2+ were abundant, these findings suggest that Fe2+ and Mn2+ played a role in early ribosomal evolution