Impact of risk sharing on competitive bidding in truckload transportation

Thesis (M. Eng. in Logistics)--Massachusetts Institute of Technology, Engineering Systems Division, 2012.Cataloged from PDF version of thesis.The purpose of this research was to evaluate whether a shipper's fuel surcharge (FSC) program affected its per-load transportation costs in the United States full-truckload (TL) transportation industry. In this study, we restricted transportation costs to line-haul charges and fuel surcharge premiums. Using ordinary least squares (OLS) regression, we examined the effect of a shipper's FSC program on its line-haul charges. We controlled for well-established transportation cost drivers, including distance and geography. We found that carriers discounted their line-haul rates according to a shipper's FSC program. The more a shipper paid in FSC premiums, the less it paid in line-haul charges. For fuel prices above $2.08 per gallon, however, the fuel surcharge premiums dwarfed the line-haul discount. This effect was most pronounced for shippers with low efficiency values. Shippers with lower efficiency values paid higher per-load transportation costs than shippers with higher efficiency values.by Molly Abramson and Ajit Sawant.M.Eng.in Logistic

Endoscopic removal of intrauterine contraceptive device embedded into detrusor muscle of urinary bladder: our experience of two cases

Migration of intrauterine contraceptive device (IUD) into urinary bladder is a rare event, presenting as irritative lower urinary tract symptoms; we present two cases of migrated IUD into urinary bladder and embedded inside the detrusor muscle of bladder. Both patients were assessed by ultrasonography and computed tomography. Both patients were successfully treated by endoscopic approach via per urethral route. One patient was having embedded vertical arm of IUD which was pulled using forceps and second patient was having embedded horizontal arm of IUD in detrusor muscle which was treated by taking mucosal incision with help of Collin’s knife followed by pulling IUD with help of forceps. There was no evidence of fistula or any other complication. We would like to conclude that endoscopic removal of IUD embedded into detrusor muscle is safe, feasible alternative to open surgery without any further risk of fistula formation

Investigations on microbiome of the used clinical device revealed many uncultivable newer bacterial species associated with persistent chronic infections

Introduction. Chronic persistent device-related infections (DRIs) often give culture-negative results in a microbiological investigation. In such cases, investigations on the device metagenome might have a diagnostic value. Materials and Methods. The 16SrRNA gene sequence analysis and next-generation sequencing (NGS) of clinical metagenome were performed to detect bacterial diversity on invasive medical devices possibly involved in culture-negative DRIs. Device samples were first subjected to microbiological investigation followed by metagenome analysis. Environmental DNA (e-DNA) isolated from device samples was subjected to 16SrRNA gene amplification followed by Sanger sequencing (n=14). In addition, NGS of the device metagenome was also performed (n=12). Five samples were only common in both methods. Results. Microbial growth was observed in only nine cases; among these, five cases were considered significant growth, and in the remaining four cases, growth was considered either insignificant or contaminated. Culture and sequencing analysis yielded identical results only in six cases. In culture-negative cases, Sanger sequencing of 16SrRNA gene and NGS of 16SrDNA microbiome was able to identify the presence of rarely described human pathogens, namely Streptococcus infantis, Gemella haemolysans, Meiothermus silvanus, Schlegelella aquatica, Rothia mucilaginosa, Serratia nematodiphila, and Enterobacter asburiae, along with some known common nosocomial pathogens. Bacterial species such as M. silvanus and S. nematodiphila that are never reported in human infection were also identified. Conclusions. Results of a small number of diverse samples of this pilot study might lead to a path to study a large number of device samples that may validate the diversity witnessed. The study shows that a culture free, a holistic metagenomic approach using NGS could help identify the pathogens in culture-negative chronic DRIs

A REVIEW ON DISINTEGRATION CONTROL MATRIX TABLETS

A number of sustained release formulations are available in the market which successfully sustained the drug release over a prolonged period of time by different mechanisms. The new approach for sustaining the drug release is disintegration control matrix tablet which sustained the drug release up to 24hrs by controlling the disintegration rate of tablet. Disintegration control matrix tablet (DCMT) mainly forms the granules containing drug and disintegrating agent such as low substituted hydroxyl propyl cellulose by various methods such as solid dispersion technique. The sustained release of drug is maintained by increasing the wax coating or decreasing the amount of disintegrants. The release of drug from tablet is uniform throughout till all the drug releases from tablet as it involves drug release by diffusion, dissolution and surface erosion mechanism. DCMT increases the solubility of drug and improves the bioavailability without disturbing gastrointestinal transit. BCS Class II, III, IV drugs are the best candidate for DCMT formulations. Keywords: Disintegration control matrix tablet (DCMT), Wax, Disintegrating agent, Solid dispersion

Mitrofanoff urinary diversion in a patient with cerebral palsy

Cerebral palsy is the most common motor disability in childhood which result in huge socioeconomic costs. This children have a significant incidence of lower urinary tract symptoms. Clean intermittent self-catheterization is needed to avoid deterioration of renal function. But significant spasticity and resulting contractures of the adductors can interfere with the caretakers’ ability to provide perineal hygiene. Surgery in cerebral palsy affected child is challenging due to multiple associated comorbidities. The aim of this report is to describe quality of life and renal function for a mentally retarded child with cerebral palsy before and after Mitrofanoff diversion without bladder augmentation

Subcapsular renal hematoma after ureterorenoscopy: An unknown complication of a known procedure

Renal subcapsular hematoma is not an uncommon complication after extracorporeal short wave lithotripsy, trauma, renal angiographic procedures and spontaneously in patients of malignancy and in patients on anticoagulation. We present a patient who developed renal subcapsular hematoma after ureterorenoscopy, which has not been mentioned in literature ever. Clinical spectrum varies from spontaneous resolution through acute renal failure to Page kidney. Page kidney is the external compression of a kidney usually caused by a subcapsular hematoma associated with high blood pressure and occasional renal failure. It is named after Dr. Irvin Page who first demonstrated in 1939 that wrapping cellophane tightly around animal kidneys could cause hypertension. Various management options are mentioned in literature and depend upon the severity of hematoma. Percutaneous drainage is a successful option for the management of subcapsular hematoma in hemodynamic stable patients

Cyanoacrylate injection in management of recurrent vesicovaginal fistula: Our experience

Treating recurrent vesicovaginal fistula (VVF) is a major clinical problem. We present a technique and special precautions taken during treatment of a small recurrent VVF with the help of combined cystoscopic and/or transvaginal injection of cyanoacrylate in two patients. Except for frequency of micturition in the first patient, postoperative follow-up was uneventful. Endoscopic management with cyanoacrylate is a simple and effective alternative to major reconstructive surgery

Spontaneous large renal pelvis hematoma in ureteropelvic junction obstruction presenting as an acute abdomen: Rare case report

Patients with ureteropelvic junction (UPJ) obstruction can present with flank pain or hematuria. We present 20-year-old male presenting with acute pain in lumbar and right fossa with tenderness and guarding, this case was clinically mimicking general surgical emergency. On computed tomography with urography and angiography, there was 15 cm × 11 cm × 10 cm size non-enhancing hyperdense lesion (average Hounsfield units - +64) in right renal pelvis suggestive of hematoma. Patient's diethylenetriaminepentaacetic acid diuretic renography was suggestive of right kidney glomerular function rate of 48.4 ml/min with the relative function of 43%, Peak to half peak was not achieved. The patient was managed by retrograde ureteropyelography and double J stenting. After 1 month, clot size decreased to 4 cm × 3 cm × 2 cm. The patient had undergone open reduction Anderson hynes dismembered pyeloplasty with the removal of pelvis clot after 6 weeks. We report the first case of UPJ obstruction presenting as an acute abdomen and spontaneous hematuria with large pelvis clot without rupture of the renal pelvis

Early metastasis to anterior abdominal wall following radical cystectomy: A rare presentation

Abdominal wall metastasis from urothelial cancer is extremely rare and very few such cases have been reported in the literature. As such the treatment protocols are not so well defined. We present an interesting case of a 65-year-old male patient, known case of chronic kidney disease, who presented with a large, fungating infraumbilical mass 8 months postradical cystectomy. The mass involved full thickness anterior abdominal wall and small bowel including the ileal conduit. Wide excision of the mass along with adhered bowel loops and partial excision of the ileal conduit with right ureteric reimplant was performed. The large defect in the anterior abdominal wall was closed using a mesh (permanent with a bioresorbable coating inside) and myocutaneous thigh flap. The histopathological examination of the excised mass was consistent with secondary from the urothelial tumor

Subcapsular renal hematoma after ureterorenoscopy: An unknown complication of a known procedure

Renal subcapsular hematoma is not an uncommon complication after extracorporeal short wave lithotripsy, trauma, renal angiographic procedures and spontaneously in patients of malignancy and in patients on anticoagulation. We present a patient who developed renal subcapsular hematoma after ureterorenoscopy, which has not been mentioned in literature ever. Clinical spectrum varies from spontaneous resolution through acute renal failure to Page kidney. Page kidney is the external compression of a kidney usually caused by a subcapsular hematoma associated with high blood pressure and occasional renal failure. It is named after Dr. Irvin Page who first demonstrated in 1939 that wrapping cellophane tightly around animal kidneys could cause hypertension. Various management options are mentioned in literature and depend upon the severity of hematoma. Percutaneous drainage is a successful option for the management of subcapsular hematoma in hemodynamic stable patients