A Supply chain performance measurement system: A Case study in automotive industry

Today's fierce market conditions drive companies to effectively evaluate their overall supply chain performance and identify improvement areas for gaining competitive advantages. In the last few decades, organizations have improved their internal processes by using initatives such as JIT, Kanban, Kaizen, and TQM. At the same time new methods and initiatives in the area of Supply Chain Management have forced organizations to improve not only their internal processes but also the supply chain to which they belong. While companies have transformed their supply chain to Integrated Supply Chain, they have in need of a tool which will show the combined performance of the supply chain, the final outcome of the efforts of all integrated members, new improvement areas through the supply chain, and whether the supply chain is improved or not. This needed tool is a supply chain performance measurement system. In this thesis, a new performance measurement framework is proposed. In this framework, in addition to Customer Satisfaction Perspective and Financial Perspective a new perspective with respect to new trends in Supply Chain Management is defined. This new perspective is Supply Chain Collaboration Perspective. Furthermore, the necessary steps to be followed during the implementation of a performance measurement in automotive industry are identified. The supply chain performance measurement in a leading automotive manufacturer in Turkey is also discussed within this framework

In Vitro Cytotoxicity of GuttaFlow Bioseal, GuttaFlow 2, AH-Plus and MTA Fillapex

Introduction: The aim of the present in vitro study was to evaluate the cytotoxicity of different sealers including GuttaFlow Bioseal, GuttaFlow 2, AH-Plus and MTA Fillapex on L929 murine fibroblasts. Methods and Materials: Samples of GuttaFlow Bioseal, GuttaFlow 2, AH-Plus and MTA Fillapex were fabricated in Teflon disks of 5 mm diameter and 3 mm thickness. L929 fibroblasts were exposed to the extracts of these materials for 3, 24, 72 and 168 h at 37°C with 5% CO2. Cell viability was evaluated by the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Apoptosis was evaluated by the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay. The data were analysed by ANOVA. Results: GuttaFlow Bioseal was nontoxic at all experimental time points (P>0.05), whereas MTA Fillapex and AH-Plus were toxic (P<0.001). At 7 days, there were more viable cells in the GuttaFlow 2 group than in the control group, and MTA Fillapex was more cytotoxic than AH-Plus. There were more apoptotic cells in the MTA Fillapex and AH-Plus groups than in the other groups at 3 h (P<0.001). Conclusion: GuttaFlow sealers are less cytotoxic than MTA Fillapex and AH-Plus. At all experimental time points, there was no significant difference in the cell viability between the GuttaFlow Bioseal group and the control group.Keywords: AH-Plus; Cytotoxicity; GuttaFlow Bioseal; GuttaFlow 2; MTA Fillapex; MTT Assay; TUNEL Assa

Single-Visit Pulp Revascularization of a Nonvital Immature Permanent Tooth Using Biodentine

An 11-year-old female patient was referred with a chief complaint of pain in the right mandibular second premolar. Clinical and radiographic examinations showed secondary caries under an old composite restoration, a negative response to a pulp test and an immature root with an open apex. After root canal cleaning and shaping, bleeding was invoked in the canal up to 2 mm short of the cemento-enamel junction (CEJ). After 10 min to allow clotting at this level, a plug of Biodentine was placed over the blood clot and the tooth was temporized with glass ionomer cement. At the next visit, the tooth was free of symptoms and a permanent filling was placed. Clinical and radiographic examinations during a two-year follow-up showed complete root maturation and intact supporting soft tissues without sinus tract, pain or swelling. Conclusion: The use of Biodentine in a single-visit apexification protocol to treat an immature permanent tooth with necrotic pulp can create a suitable environment for revascularization, resulting in the completion of root maturation.Key Words:Biodentine; Immature Apex; Pulp Revascularization

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Coordination of inventory and transportation decisions in a two-stage supply chain

In today\u27s competitive business world, companies face the crucial task of delivering goods on time. In order to benefit from high volumes, distributors (suppliers) try to consolidate deliveries while maintaining a high percentage of on time delivery. Increasing delivery frequencies typically increases suppliers\u27 performance, but it also increases the transportation costs. Finding a suitable middle ground is a challenge confronting many companies throughout various supply chains. This dissertation is a study about the coordination of inventory and transportation decisions in a two-stage supply chain