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Emergency medical services (EMS) are an important part of the modern healthcare system that tries to provide timely medical care and transportation to patients to reduce morbidity and mortality. Performance evaluation of such EMS systems to determine measures such as mean service rates, dispatch probabilities, busy probabilities, and on-scene times is necessary to design effective and efficient systems. In this paper, we consider an urban EMS system that employs three types of emergency vehicles, including advanced life support (ALS), basic life support (BLS) and first responder vehicle (FRV). We consider two types of patients: type A requires ALS to be dispatched, while type B patients are expected to be served by BLS ambulances. We also consider co-located servers so ambulances of different types can be co-located at the same station. The presence of different types of servers (ambulances) and the patients with different dispatch policies, along with co-located servers, makes it applicable to a more realistic system. We first discuss a modification of the hypercube queueing model for the proposed system and then present an approximate approach for application in large EMS systems. These approaches are compared against a simulation-based model by computing server utilization, service times and on-scene time of ambulances. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to model dynamic feedback effects and complex interactions among risks affecting foodgrains transportation using a system dynamics approach. The risk scenario is simulated using a system dynamics model considering risk index values. It has been observed that there is a significant increase in inventory level from 8.39% to 28.4% and vehicle capacity from 8.99% to 28.4% with a change in risk value by 30%. This can help managers to develop inventory and transportation policies. It will, therefore, help to generate risk reduction scenarios for better availability of foodgrains through integrated risk control and mitigation in a supply chain. The key findings drawn for transportation and inventory management of foodgrains will help policy-makers to improve the efficiency of foodgrains supply chain. This research uniquely analyses the dynamic implication of inventory-transportation policies on foodgrains transportation system using system dynamics modelling approach. [ABSTRACT FROM AUTHOR]

In this paper, we study a vendor-buyer integrated supply chain with uncertain demand and random defect rate under carbon cap-and-trade policy. We assume that the lot sent by the vendor to the buyer in each shipment contains a random fraction of defective item, and a fraction of defective items can be repaired. The defective items get screened at the buyer and sent back to the vendor, and the vendor sorts out the repairable items. At the end of each production cycle, the accumulated repairable items at the vendor are repaired in a single lot. We have taken into account the carbon emissions from all the major sources, i.e. production, inventory, transportation, repairing, and scrapping. Shortages at the buyer are partially backordered. A mathematical model is formulated to minimize the total expected cost of the supply chain by optimizing the order quantity, reorder point, and the number of shipments between the vendor and buyer under carbon cap-and-trade policy. An algorithm is proposed to solve the model. A numerical example and sensitivity analysis are presented to get some managerial insights. [ABSTRACT FROM AUTHOR]

Purpose -- National Food Security Act 2013 (NFSA) is a unique step taken by Indian government to fight against hunger and protect right of the people for food. With its peculiarities like the life cycle approach, women empowerment, consideration of vulnerable sections in society and proposed reforms in public distribution system (PDS), NFSA is a promising effort for food security in India. The purpose of this paper is to put forth various aspects of NFSA and to identify issues and challenges for its implementation in the light of Indian PDS. Design/methodology/approach -- Understanding the implications of NFSA, mapping the existing system of foodgrains distribution in India and analysing existing literature and secondary data available from assorted sources are the steps followed in this endeavour. Findings -- Limited resources and exponentially increasing population, lack of infrastructure, operational inefficiencies and poor performance of the PDS are the major hurdles in successful implementation of the proposed act. This study gives emphasis on the need of major reforms in procurement, storage, movement and distribution of foodgrains strategies. Research limitations/implications -- This paper focusses mainly on the operational and strategic aspects of PDS and its implications on NFSA. There is a wide scope for future research on sustainability of the act through agricultural and biotechnological innovations, financial analysis and strategic aspects. Originality/value -- This study is an unique attempt of mapping and auditing of the entire complex value chain of the Indian PDS for implementation of NFSA. As NFSA is going to redefine the food security aspects, this pioneering work will be useful for researchers and policy makers working in this field in India and other developing countries. [ABSTRACT FROM AUTHOR]

BRCA1 gene expression in familial breast cancer is mainly focused on mutational analysis. However in sporadic cancers BRCA1 protein expression is the main area of interest because somatic inactivation of one allele of the gene is likely to occur during the oestrogen mediated proliferation at puberty and subsequent tumourigenic events take place in the same cell. Standard immunohistochemical analysis was used to assess BRCA1 and oestrogen/progesterone receptor (ER/PR) status in familial and sporadic breast cancer patients and correlation of BRCA1 protein expression with histopathological features ER/PR status was studied in these tumours. One hundred and seventy-seven sporadic tumours (group A) and 28 familial tumours (patients with history of breast cancer in first or second degree relative ie, group B) were studied. In group A, 61 tumours had absent/reduced BRCA 1 protein expression; 30 (49%) out of these were negative for ER/PR receptors. In group B, 18 patients had absent/reduced BRCA1 protein expression, and 10 (55.6%) out of these, were ER/PR negative. Overall in 2 groups, 82 tumours were of grade 1, 61 tumours of grade 2 and 62 tumours were of grade 3 differentiation. Test of proportion showed that percentage of ER/PR negativity is significantly higher than ER/PR positivity in sporadic as well as in familial tumours with absent/ reduced BRCA 1 protein expression (p < 0.05). Sporadic tumours with deranged BRCA1 protein expression like familial tumours have more unfavourable histopathological characteristics and are likely to be of higher grade and oestrogen receptor negative

Background: Hepatitis B virus (HBV) DNA detection and quantification are now playing an increasing role in the assessment of disease activity and response to therapy. However, viraemia levels which define various stages of HBV infection have not yet been established., Aim: To define viraemia levels which describe various stages of chronic hepatitis B virus infection., Methods: In a retrospective study, stored sera samples of chronic hepatitis B virus (CHB) infected patients registered at AIIMS liver clinic, from January 1996 to June 2005 were subjected to competitive, quantitative PCR analysis., Results: The median HBV DNA load was lowest among carriers and highest among patients with chronic hepatitis B [0 (0-8) vs. 7 (0-12) log10 copies/ml, respectively; p<0.05]. As compared to chronic hepatitis patients the DNA load was also lower among cirrhotics [7 (0-12) vs. 4.5 (0-8) log10 copies/ml, respectively; p<0.05] and hepatocellular cancer patients [ 7(0-12) vs. 0 (0-8) log10 copies/ml, respectively; p<0.05]. Patients with carriers had a DNA load which was significantly lower than e antigen negative CHB [0 (0-8) vs. 6 (0-10) log10 copies/ml; p<0.05] or e antigen positive CHB [0 (0-8) vs 8 (0-12) log10 copies/ml; p<0.05]. A threshold of 3.5 log10 copies/ml had sensitivity and specificity of 83% and 58% respectively in differentiating carriers from e antigen negative CHB. There was a strong positive correlation of HBV DNA load with inflammatory grade (R=0.334; p=0.0001), fibrosis stage (R=0.276; p=0.001) and ALT levels (R=0.378; p=0.0001). 82% (9/11) of those who lost e antigen had a decline in HBV DNA levels to <5 log10 copies/ml, whereas only 12.5% (1/8) of those who did not lose e antigen had a decline in DNA load below this level., Conclusions: HBV DNA viraemia levels correlate positively with the inflammatory grade, fibrosis stage and ALT levels. Most patients who loose e antigen have a decline in DNA load to below 5 log10 copies/ml. Further prospective studies employing repeated measurements are required to define a threshold to differentiate between HBV carriers and e antigen negative CHB.

A cDNA of fatty acyl-acyl carrier protein (ACP) thioesterase (Fat) from developing seed of Madhuca butyracea has been cloned. The deduced amino acid sequence of the cDNA corresponding to the mature polypeptide showed 30-40% and 60-75% identity to the reported FatA and FatB class of plant thioesterases, respectively. This gene, MbFatB, is present as a single copy in M. butyracea genome and the MbFatB protein was detected clearly in seed tissues of this plant but not in that of Indian mustard (Brassica juncea). Heterologous expression of the MbFatB gene driven by different promoters in E. coli wild type and fatty acid beta-oxidation mutant (fadD88) strains resulted production of the recombinant protein with various fusion tags either as biologically inactive (insoluble) or functionally active forms. Expression of functionally active recombinant MbFatB in E. coli affected bacterial growth and cell morphology as well as changed the fatty acid profiles of the membrane lipid and the culture supernatant. Alteration of the fatty acid composition was directed predominantly towards palmitate and to a lesser extent myristate and oleate due to acyl chain termination activity of plant thioesterase in bacteria. Thus, this new MbFatB gene isolated from a non-traditional oil-seed tree can be used in future for transgenic development of oil-seed Brassica, a widely cultivated crop that expresses predominantly oleoyl-ACP thioesterase (FatA) in its seed tissue and has high amount of unwanted erucic acid in edible oil in order to alter the fatty acid profile in a desirable way.