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Shankar R, Welters I. Incidence and diagnosis of patients developing atrial fibrillation in intensive care. Crit Care 2007. [PMCID: PMC4095275 DOI: 10.1186/cc5381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Subrammaniyan S, Rajkumar M, Amalorpavanathan J, Shankar R, Farzana L, Manjunath S, Senthil R, Sheriff A, Dominic J, Abraham S. Autologous bone marrow stem cell therapy for an ischemic ulcer of the lower limb in a diabetic patient. J Stem Cells Regen Med 2006; 1:42-43. [PMID: 24692862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Tiwari M, Kumar S, Kumar S, Prakash, Shankar R. Solving Part-Type Selection and Operation Allocation Problems in an FMS: An Approach Using Constraints-Based Fast Simulated Annealing Algorithm. ACTA ACUST UNITED AC 2006. [DOI: 10.1109/tsmca.2006.878979] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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104
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Shankar R, Vijayaraghavan P, Narendran T. Modeling customer support performance in Indian IT hardware industry. JOURNAL OF MODELLING IN MANAGEMENT 2006. [DOI: 10.1108/17465660610715221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeCustomer support assumes strategic importance in India for branded IT‐hardware products. An authorized service center and a stream of specialized service centers undertake field services and represent a sale‐territory's support network. “Time constrained” service men have to deliver customized service meeting a promised time‐standard. The stochastic demand for support services severely mars the customer response resulting in poor service quality. A manufacturer has to address the following decisions under these conditions: what is the ideal staffing level in a territory considering restricted server availability? What will be the impact of changing the staffing levels on customer service level? This study develops an analytical model to address these decisions.Design/methodology/approachThe study identifies the variables underlying stochastic service demand through a field survey and determines the demand distribution. Applying stochastic principles the study derives relation between field staffing level and customer response considering server time constraint. Study performs statistical analysis to validate this model with real time data on variables collected from the field survey.FindingsThe outcomes of analysis reveal the following findings: this model can be applied in service systems where a time constrained server has to deliver expected level of performance (research implication); and increasing field staffing levels obscures the significant difference between the customer waiting times under very high levels of uncertain demand (practical implication).Originality/valueThe study derives relation between the staffing levels and customer waiting time considering uncertain demand with restricted working hour conditions.
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Gosain A, Muthu K, Jones S, Shankar R, Gamelli R, DiPietro L. Norepinephrine (NE) negatively modulates innate immunity in the wound. J Surg Res 2006. [DOI: 10.1016/j.jss.2005.11.339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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107
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Martins SB, Lai S, Tu S, Shankar R, Hastings SN, Hoffman BB, Dipilla N, Goldstein MK. Offline testing of the ATHENA Hypertension decision support system knowledge base to improve the accuracy of recommendations. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2006; 2006:539-43. [PMID: 17238399 PMCID: PMC1839611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
ATHENA-HTN is a clinical decision support system (CDSS) that delivers guideline-based patient-specific recommendations about hypertension management at the time of clinical decision-making. The ATHENA-HTN knowledge is stored in a knowledge-base (KB). Changes in best-practice recommendations require updates to the KB. We describe a method of offline testing to evaluate the accuracy of recommendations generated from the KB. A physician reviewed 100 test cases and made drug recommendations based on guidelines and the "Rules" (descriptions of encoded knowledge). These drug recommendations were compared to those generated by ATHENA-HTN. Nineteen drug-recommendation discrepancies were identified: ATHENA-HTN was more complete in generating recommendations (15); ambiguities in the Rules misled the physician (3); and content in the Rules was not encoded (1). Three new boundaries were identified. Three updates were made to the KB based on the results. The offline testing method was successful in identifying areas for KB improvement and led to improved accuracy of guideline-based recommendations.
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108
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Neetu S, Suresh I, Shankar R, Shankar D, Shenoi SSC, Shetye SR, Sundar D, Nagarajan B. Comment on "The great Sumatra-Andaman earthquake of 26 December 2004". Science 2005; 310:1431; author reply 1431. [PMID: 16322440 DOI: 10.1126/science.1119662] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Lay et al. (Research Articles, 20 May 2005, p. 1127) estimated a 600-km length for the tsunami source region. Adding tide-gauge data from Paradip, the northernmost of the Indian east-coast stations and therefore the most critical constraint on the northern extent of the source, we estimate that its length was greater by approximately 30%.
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Neetu S, Suresh I, Shankar R, Shankar D, Shenoi SSC, Shetye S, Sundar D, Nagarajan B. Comment on "The Great Sumatra-Andaman Earthquake of 26 December 2004". Science 2005. [DOI: 10.1126/science.1118950] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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110
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Shankar R, Gude N, Cullinane F, Brennecke S, Purcell AW, Moses EK. An emerging role for comprehensive proteome analysis in human pregnancy research. Reproduction 2005; 129:685-96. [PMID: 15923384 DOI: 10.1530/rep.1.00524] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Elucidation of underlying cellular and molecular mechanisms is pivotal to the comprehension of biological systems. The successful progression of processes such as pregnancy and parturition depends on the complex interactions between numerous biological molecules especially within the uterine microenvironment. The tissue- and stage-specific expression of these bio-molecules is intricately linked to and modulated by several endogenous and exogenous factors. Malfunctions may manifest as pregnancy disorders such as preterm labour, pre-eclampsia and fetal growth restriction that are major contributors to maternal and perinatal morbidity and mortality. Despite the immense amount of information available, our understanding of several aspects of these physiological processes remains incomplete. This translates into significant difficulties in the timely diagnosis and effective treatment of pregnancy-related complications. However, the emergence of powerful mass spectrometry-based proteomic techniques capable of identifying and characterizing multiple proteins simultaneously has added a new dimension to the field of biomedical research. Application of these high throughput methodologies with more conventional techniques in pregnancy-related research has begun to provide a novel perspective on the biochemical blueprint of pregnancy and its related disorders. Further, by enabling the identification of proteins specific to a disease process, proteomics is likely to contribute, not only to the comprehension of the underlying pathophysiologies, but also to the clinical diagnosis of multifactorial pregnancy disorders. Although the application of this technology to pregnancy research is in its infancy, characterization of the cellular proteome, unearthing of functional networks and the identification of disease biomarkers can be expected to significantly improve maternal healthcare in the future.
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Shankar R, Cullinane F, Brennecke SP, Moses EK. Applications of proteomic methodologies to human pregnancy research: A growing gestation approaching delivery? Proteomics 2004; 4:1909-17. [PMID: 15221748 DOI: 10.1002/pmic.200300790] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Maternal and perinatal morbidity and mortality rates are significantly higher in pregnancies complicated by preterm labor, pre-eclampsia and fetal growth restriction. Decades of research have not translated into a clear understanding of the underlying pathophysiologies or effective identification of women who are at high risk of developing these complications. Often the severity of these diseases does not correlate with the clinical symptoms, and current diagnostic methods are unable to accurately predict the conditions prior to clinical presentation. Though several potential markers have been proposed for each of these disorders, to date none have proven clinical utility. Emerging proteomic technology is only beginning to be employed in pregnancy research. A comprehensive analysis of gestational tissues can be expected to contribute to the elucidation of the complex molecular mechanisms of pregnancy and related complications. Comparison of the expression profiles of normal and pathogenic tissues and biofluids may also highlight novel candidate marker proteins that have so far remained undetected. More interestingly, rapidly evolving technologies using sophisticated bioinformatic tools are demonstrating their potential in disease diagnostics by using overall protein profiles to detect diseases. The clinical significance of these methodological advances is enormous. Early diagnosis together with improved understanding of underlying molecular mechanisms can enhance outcomes and increase effective management and therapeutic options.
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Bakshi D, Seth A, Narula MK, Shankar R. Ultrasonographic assessment of thyroid volume in Delhi children. J Pediatr Endocrinol Metab 2003; 16:843-9. [PMID: 12948296 DOI: 10.1515/jpem.2003.16.6.843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ultrasonographic measurement of thyroid volume is increasingly being used to assess prevalence of iodine deficiency in a community. OBJECTIVES To assess thyroid volume by ultrasonography in normal Delhi children, and compare them with the recently adopted WHO reference standards. METHODS One hundred and three children aged of 6-10 years were enrolled from the paediatric outpatient clinic in a prospective study. Thyroid volume was estimated by ultrasound, and urinary iodine levels were measured for all subjects by spot urine samples. RESULTS Goitre prevalence was 24.3% on clinical assessment. Urinary iodine levels fell in the range of mild to moderate deficiency in 61% of the children. None of the children met the WHO recommended ultrasonographic criteria for goitre (thyroid volume >97th percentile of the reference standards), when WHO age-specific norms were used for comparison. On applying body surface area (BSA)-specific norms, only two children were classified as having goitre. CONCLUSIONS The WHO standards for thyroid volume by ultrasonography tended to underestimate goitre prevalence.
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Shankar R. A response to 'Another use for capnography', White SM, Anaesthesia 2003; 58: 189-90. Anaesthesia 2003; 58:620. [PMID: 12846667 DOI: 10.1046/j.1365-2044.2003.03236_12.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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114
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Murthy G, Shankar R. Quantum dots with disorder and interactions: a solvable large-g limit. PHYSICAL REVIEW LETTERS 2003; 90:066801. [PMID: 12633315 DOI: 10.1103/physrevlett.90.066801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2002] [Indexed: 05/24/2023]
Abstract
We analyze the problem of interacting electrons on a ballistic quantum dot with chaotic boundary conditions, where the effective interactions at low energies are characterized by Landau parameters. When the dimensionless conductance g of the dot is large, the disordered interacting problem can be solved in a saddle-point approximation which becomes exact as g --> infinity (as in a large-N theory), leading to a phase transition in each Landau interaction channel. In the weak-coupling phase constant charging and exchange interactions dominate the low-energy physics, while the strong-coupling phase displays a spontaneous distortion of the Fermi surface, smeared out by disorder.
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Fantoni P, Hoffmann M, Shankar R, Davis E. On-line monitoring of instrument channel performance in nuclear power plant using PEANO. PROGRESS IN NUCLEAR ENERGY 2003. [DOI: 10.1016/s0149-1970(03)00017-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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116
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Shankar R. Measurement of systemic oxygen uptake during low-flow anaesthesia with a standard technique vs. a novel method. Anaesthesia 2002; 57:1136. [PMID: 12392461 DOI: 10.1046/j.1365-2044.2002.28763.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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117
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Shankar R. Can we be more polite? Anaesthesia 2002; 57:1044. [PMID: 12358985 DOI: 10.1046/j.1365-2044.2002.00123.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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118
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Shankar R. Somebody else's nervous system. Br J Anaesth 2002; 89:662; author reply 663. [PMID: 12393380 DOI: 10.1093/bja/aef554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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119
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Shankar R, Navapurkar VU. Blame it on the surgeons. Anaesthesia 2002; 57:88. [PMID: 11843751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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120
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Shankar R, Navapurkar VU. Blame it on the surgeons. Anaesthesia 2002. [DOI: 10.1046/j.1365-2044.2002.2412_11.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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121
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Abstract
Hematopoietic stem cells represent a long term reservoir of cells to populate blood with multiple formed cells. These hematopoietic stem cells proliferate and mature into lymphoid, erythroid, and myeloid precursor cells, with the balance of these cell populations modulated by major thermal injury, with or without sepsis. Recent studies indicate that thermal injury shifts this balance to favor the monocyte/macrophage lineage at the expense of neutrophil production. The mechanisms for these changes are now being elucidated with the results of clinical importance, because understanding the dynamics of the different precursor pools could be used to identify patients at greater risk for systemic inflammatory sequelae following major thermal injury.
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Singh S, Mariappan TT, Shankar R, Sarda N, Singh B. A critical review of the probable reasons for the poor variable bioavailability of rifampicin from anti-tubercular fixed-dose combination (FDC) products, and the likely solutions to the problem. Int J Pharm 2001; 228:5-17. [PMID: 11576764 DOI: 10.1016/s0378-5173(01)00754-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The problem of poor/variable bioavailability of rifampicin, which is shown in particular when the drugs are present in anti-tubercular fixed-dose combination (FDC) products, is a matter of serious concern. There is a potential of failure of therapy in patients with an active disease. It perhaps also is a contributory factor towards the increasing resistance to anti-tubercular drugs. Unfortunately, the origin and cause of the problem is not clearly understood, though GMP and crystalline changes in the drug are invariably cited as the principal reasons. In this write-up, various probable physical and/or chemical reasons are critically reviewed. The enhanced decomposition of rifampicin in the presence of isoniazid in stomach after ingestion is indicated to be the key factor behind the problem. Some simple solutions offered by the knowledge of the cause are discussed and it is concluded that there is a need to have a multifaceted approach to handle the problem.
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Patil UD, Ragavan A, Murthy K, Shankar R, Bastani B, Ballal SH. Helical CT angiography in evaluation of live kidney donors. Nephrol Dial Transplant 2001; 16:1900-4. [PMID: 11522876 DOI: 10.1093/ndt/16.9.1900] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Live kidney donor evaluation mandates anatomical and functional assessment of the donor kidney. Helical computed tomography (CT) with advanced 3-D techniques provides detailed description of the vascular, parenchymal, and collecting system. METHODS We compared the accuracy of helical CT angiography with intra-operative findings in the evaluation of 102 live kidney donors. RESULTS Identification of vascular anomalies was best on direct viewing of the axial images using interactive scrolling through the images and cine-loop paging. In 204 kidneys evaluated, a single renal artery was present in 74.5% and a single renal vein in 87.5%. Multiple renal arteries were more common on the left side (31%) vs the right side (20%). Early branching of the arteries was seen with equal frequency (approximately equal to 10%) on either side. Multiple renal veins were more often on the right side (20%) vs the left side (5%), and one patient was found to have double inferior vena cava. CT angiographic findings were concordant with the intra-operative findings in 97% of the cases, missing a small renal vein, an accessory artery that was visualized in retrospect, and a very early branch that was read as accessory artery. CT also revealed cortical cysts (four cases), duplex collecting system (two cases), hydronephrosis (one case), renal stone (one case), and liver haemangioma (two cases). CONCLUSION CT angiography is highly accurate for detecting vascular anomalies, and providing anatomical information. It may serve as the primary tool for donor evaluation.
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Matta B, Shankar R. Recent advances in neuroanaesthesia. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2001; 62:480-6. [PMID: 11530586 DOI: 10.12968/hosp.2001.62.8.1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In order to provide optimum intracranial operating conditions for neurosurgery, anaesthetists must have a thorough understanding of brain physiology and how this is affected by pathology and anaesthetic drugs and techniques. This article discusses the current understanding of cerebral vascular physiology and how novel neuroanaesthetic drugs and techniques affect it.
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Shankar R, Bastani B, Salinas-Madrigal L, Sudarshan B. Acute thrombosis of the renal transplant artery after a single dose of OKT3. Am J Nephrol 2001; 21:141-4. [PMID: 11359022 DOI: 10.1159/000046237] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We present the case of an 18-year-old male who 8 months after a living-related donor, one-haplotype-matched renal transplantation developed acute thrombosis of the renal allograft artery, within 10 h of the first dose of OKT3. The antibody therapy had followed five daily doses of intravenous pulse methylprednisolone for a Banff class 1B acute tubulointerstitial rejection, on a ciclosporin-based immunosuppression protocol. We briefly review the literature on the incidence of vascular thrombosis after transplantation and the procoagulant effects of OKT3, pulse methylprednisolone, and ciclosporin therapy.
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