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Objective In India, cervical cancer accounts for almost 14% of all female cancer cases. Although poverty continues to cast a wide net over the Indian subcontinent, the preceding three decades have borne witness to improvements in nutrition and sanitation for many citizens. However, due to an absence of a national immunization program to cover human papillomavirus (HPV) vaccination and lack of accessible cervical cancer screening, the disease is characterized by late detection, lack of access to affordable and quality health care, and high mortality rates. Treatment of cervical cancer is stage-specific and depends on the patient’s age, desire to preserve fertility, overall health, the clinician’s expertise, and accessibility to resources. There is a paucity of uniform treatment protocols for various stages of cervical cancer in India. Considering all these parameters, a need to optimize treatment paradigms for the Indian population emerged. Methods/materials Three expert panel meetings were held in different regions of India from 2016 to 2017. They were comprised of 15 experts from across the country, and included surgical oncologists, radiation oncologists, and medical oncologists. The panel members reviewed the literature from both national and global sources, discussed their clinical experience and local practices and evaluated current therapeutic options and management gaps for women diagnosed with cervical cancer. Results This article summarizes the expert opinion from these meetings. It discusses the available resources and highlights the current therapeutic options available for different cervical cancer stages: early stage disease, locally advanced tumors, recurrent/persistent/metastatic cancer. An Indian consensus governing treatment options emerged, including guidelines for use of the only approved targeted therapy in this disease, the anti-angiogenesis drug, bevacizumab. Conclusions The panel concluded that given the availability of state-of-the-art imaging modalities, surgical devices, radiotherapeutics, and novel agents in several population-dense urban centers, a uniform, multi-disciplinary treatment approach across patient care centers is ideal but not realistic due to cost and a paucity of third party payors for most Indian citizens. Preventative strategies including visual inspection with acetic acid to screen for precursor lesions (i.e., cervical intraepithelial neoplasia) with immediate referral for cervical cryotherapy and possible large-scale roll-out of the HPV vaccine in the near future can be expected to reduce mortality rates significantly in this country.

Human epidermal growth factor receptor 2 (HER2)-positive breast cancer is a more aggressive subtype of breast cancer and targeting the HER2 receptor has proven effective in improving the prognosis of these patients. Pertuzumab, a recombinant humanized monoclonal antibody and the first in a class of HER2 dimerization inhibitors approved for treating HER2+ breast cancer. It blocks ligand-dependent heterodimerization and ligand-independent homodimerization of HER2 with other HER members. When used in combination with trastuzumab and taxane, pertuzumab complements the action of trastuzumab and results in a comprehensive blockade of HER2 signaling pathway. This review article traces the development of pertuzumab from concept to its current use in HER2+ breast cancer treatment. A search of Medical Literature Published since 2007 was performed in PubMed using the keywords “pertuzumab,” “HER2+ breast cancer,” “HER2 targeted therapy,” “metastatic breast cancer,” and in search engines for ongoing trials with pertuzumab and incidence of cancer and breast cancer in India. A total of 35 publications and abstracts from the American Society of Clinical Oncology were selected for this review. Pertuzumab is approved in combination with trastuzumab and docetaxel for the treatment of patients with HER2+ metastatic BC, who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease. The dual HER2 blockade of pertuzumab and trastuzumab is now accepted worldwide as a standard of care by various guidelines.

1098Background: There is a higher burden (29.2%-46%) of TNBC patients in India. This single arm, phase II trial evaluated the efficacy and safety of bevacizumab in combination with gemcitabine and ...

During the last few decades, a number of quality improvement methodologies have been used by organizations. This article provides a brief review of the quality improvement literature related to academia and a case study using Six Sigma methodology to analyze students' performance in a standardized examination. We found Six Sigma to be an effective tool for curriculum improvement and team building. The challenges and benefits of using Six Sigma are discussed.

The inventory system considered in this work is single echelon, N-location and continuous review in which complete pooling of stock is permitted among the locations. A model is developed for slow moving, expensive items that are common to two or more locations. The model developed focuses on parts that have a lumpy demand pattern; that is, the number of units demanded at each demand occasion is a random variable. The motivating case for this research has been a real-life situation presented by a large utility company having 29 power generating plants in five southeastern states. Data analysis from the company reveals that there are a substantial number of parts that have low usage, are expensive, and have a lumpy demand pattern. At present, each location operates independently and maintains enough stock to meet its own requirements. Transshipments take place between locations whenever there is an emergency requirement for a part, but no explicit consideration is given to this effect while deciding on the inventory control policies at different locations. A model, using analytical and simulation techniques, is developed for this situation. Limited experimentation, performed on a set of problems, shows an average savings of about 31% as a result of pooling.

This research shows that organizations with a number of “sister” plants, warehouses, or other stocking points can profit from the concept of proactive use of transshipments as an element of their inventory control policy. For certain types of parts, employing transshipments can significantly reduce the total inventory needed throughout the entire collection of stocking points. The study is motivated by a real-life situation involving a large utility company having 29 power-generating plants in five Southeastern states where there are thousands of parts that are commonly used at multiple plants. At present, each plant operates independently and maintains enough stock to meet its own requirements. Transshipments take place between plants whenever there is an emergency requirement for a part, but no explicit consideration is given to this effect while deciding on stocking levels at different plants. In the case we examined, by setting stocking levels to explicitly take account of transshipments, total system cost could be reduced by about 70% over the company's decentralized policy. In general, this work considers a single-echelon, N-location, continuous-review inventory system in which complete pooling of stock is permitted among the locations. A model is developed for slow-moving, expensive, and consumable parts that are common to two or more locations. A one-for-one ordering policy and queueing theory allow development and solution of a system of equations for the probability distribution of net inventory at each location. A heuristic procedure is also developed to determine cost-effective stocking levels. Actual data from the utility company are used to demonstrate the applicability of the model. Savings achieved as a result of pooling are reported.