MIC chemotherapy prolongs survival in unresectable NSCLC without compromising QOL.

PurposeThe cold chain has become an integral part of the supply chain of perishable items. Recent studies have shown a critical absence of a strong and dependable cold chain in developing economies. The purpose of this paper is to set out to identify and inter‐relate the inhibitors that significantly influence the efficiency of a cold chain in developing economies like India.Design/methodology/approachThe synthesis and prioritization of inhibitors are done on the basis of an extensive literature review as well as consultation with academicians and industrial professionals. Using semi‐structured interviews and Fuzzy Interpretive Structure Modeling (FISM) approach, the research presents a hierarchy‐based model.FindingsThe end result is a model that establishes the relationships among the identified inhibitors with their respective dominance. The research shows that there exists a group of inhibitors having a high driving power and low dependence with strategic importance and requiring maximum attention and another group includes inhibitors that have high dependence and the consequential actions.Research limitations/implicationsAt the time when cold chain is the key domain for the food sector, these findings will be immensely helpful for industry professionals, Government, non‐government, academia and the community in developing strategies and impounding the root causes responsible for the inefficient and weak cold chain in India. The Indian situation echoes to the situation in most of the developing economies and similar solutions can apply there also. These findings will be truly useful for organizations that are planning to operate food chains in developing nations.Orignality/valuePresentation of inhibitors in hierarchy and their classification into driver and dependent categories with their respective dominance on the system is a unique effort in the area of cold chain management. This would help decision makers to better utilize the limited resources.

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In a distributed heterogeneous computing system, the resources have different capabilities and tasks have different requirements. To maximize the performance of the system, it is essential to assign the resources to tasks (match) and order the execution of tasks on each resource (schedule) to exploit the heterogeneity of the resources and tasks. Dynamic mapping (defined as matching and scheduling) is performed when the arrival of tasks is not known a priori. In the heterogeneous environment considered in this study, tasks arrive randomly, tasks are independent (i.e., no inter-task communication), and tasks have priorities and multiple soft deadlines. The value of a task is calculated based on the priority of the task and the completion time of the task with respect to its deadlines. The goal of a dynamic mapping heuristic in this research is to maximize the value accrued of completed tasks in a given interval of time. This research proposes, evaluates, and compares eight dynamic mapping heuristics. Two static mapping schemes (all arrival information of tasks are known) are designed also for comparison. The performance of the best heuristics is 84% of a calculated upper bound for the scenarios considered.

Summary Mitomycin, ifosfamide and cis-platin are three of the most active single agents in the chemotherapy of non-small cell lung cancer. We have combined them for a phase 2 study in patients with inoperable non-small cell lung cancer. The regimen ('MIC') comprised: mitomycin 6mg m -2, ifosfamide 3gm-2 and cis-platin 50mgm-2, with routine use of lorazepam, dexamethasone and high dose metoclopramide for anti-emesis. Seventy-four ambulatory patients with untreated, limited (LD) or extensive (ED) disease have entered this study, and 66 are evaluable for response. Thirty patients (45%) have achieved partial remission and 7 (11%) complete remission, as assessed radiologically. The overall response rate is thus 56% (95% confidence interval 44%-68%). There have been 29/43 responses in LD (67%, 95% CI 53%-81%) and 8/23 in ED (35%, 95% CI 15%-55%). The median response duration, measured from the start of treatment is 8.75 months. The median survival for the whole group is 9.2 months. The principal toxicity was nausea and vomiting which was severe or prolonged (>48h) for one or more courses, in 9% of patients. Performance status (PS) and weight were assessed before, and 3 weeks after the last course of chemotherapy. Fifteen (of 31 evaluable) responders improved their PS and only 1 responder deteriorated. Twenty-one of the 28 evaluable non-responders had no change in PS. The difference in PS change between responders and non-responders is highly significant (P=0.002). Thirty evaluable responders experienced a mean increase in weight of 2.9% with treatment, whereas 24 evaluable non-responders had a mean weight loss of 3.8%. This change is also highly significant (P=0.0013). MIC is clearly a well tolerated regime and among the most active combinations in non-small cell lung cancer. It will now be tested in a randomized trial against no chemotherapy.Non-small cell lung cancer (NSCLC) is the commonest malignant disease in the western world and is among the most chemoresistant. There are only 5 drugs (ifosfamide, mitomycin, cis-platin, vinblastine and vindesine) which, when tested as single agents in large numbers, produce major responses in 15% or more of cases (Kris et al., 1985). Mitomycin, ifosfamide and cis-platin have been associated with response rates of 20%, 26% and 20% respectively and are the 3 most active agents (Bakowski et al., 1983). We have combined ifosfamide with mitomycin in a recent phase 2 study in NSCLC (Chetiyawardana et al., 1985). Thirty patients were assessable for response to chemotherapy -8 achieving partial remission (PR) and 5 complete remission (CR). The overall response rate to chemotherapy was thus 43%. Cis-platin and ifosfamide have demonstrated synergism in experimental models (Goldin, 1982). Although both agents are associated with severe nausea and vomiting, a trial of anti-emetic therapy in our unit suggested that the combination of high dose metoclopramide infusion, lorazepam and dexamethasone would allow these drugs to be combined with acceptable subjective toxicity (O'Brien et al., 1987...

This study attempted to evaluate the relative roles of vessel distensibility and vessel recruitment in the changes in pulmonary blood volume induced by changes in pulmonary intravascular pressure. Pulmonary blood volume was determined by a double-injection indicator-dilution technique in eight anesthetized open-chest dogs with a right and left ventricular bypass which allowed independent control of pulmonary artery and left atrial pressures. In three dogs, measurements were also taken during reverse perfusion (from the left atrium to the pulmonary artery). During forward perfusion, when left atrial pressure was increased from 7 to 26 cm H 2 O, and, by reducing flow from 3.4 to 1.2 liters'/min, pulmonary artery pressure was maintained at 30 cm H 2 O so that recruitment could be considered constant, pulmonary blood volume did not change but remained at about 260 ml. Pulmonary blood volume also did not change during reverse perfusion when pulmonary artery pressure was increased from 8 to 27 cm H 2 O at a constant left atrial pressure (inflow pressure). By contrast, when pulmonary artery pressure was raised by increasing flow, so that vessel recruitment could occur, pulmonary blood volume increased 12 ml for each 1-cm H 2 O increase in pulmonary artery pressure at a constant left atrial pressure of 5 cm H 2 O, and pulmonary blood volume increased 7 ml for each 1-cm H 2 O increase in pulmonary artery pressure at a constant left atrial pressure of 33 cm H 2 O. Therefore, in the range of pressures that we explored, the role of large-vessel distensibility in the changes in pulmonary blood volume observed when intravascular pressures were raised was small.