Impact of Capacity of Mobile Units on Blood Supply Chain Performance: Results From a Robust Analysis

Methods: This work is an extension of our previously introduced stochastic blood supply chain model, which was developed based on the robust optimization concept. The aim of this model is to determine the optimal number and service areas of the blood facilities under different disaster scenarios using mixed integer linear programming. While in our previous model, the capacity of blood facility center was assumed to be constant, in the present work, it is considered as an integer variable varying within a defined interval. The present model, hence, allows exploring the influence of capacity of temporary facilities on the total costs of blood supply chain. Findings: Changing the capacity of mobile units from 80 to 120 resulted in roughly 10% reduction in the costs, 20% reduction in the optimal number of fixed blood facilities, and 25% reduction in the optimal number of the required mobile blood facilities. Conclusions: While the results of model analysis predict a marginal impact of the capacity of mobile units on the total cost, the capacity of these units is anticipated to considerably influence the optimal number of both permanent and temporary facilities. Abstract Background and Objectives The availability blood supply often becomes limited in emergency situations due to a sudden jump in blood demand betides. Governments may face extreme dif- ficulties in managing blood supply during and after disaster. For instance, during the Bam earthquake in 2003 in the east of Iran, only 23% of the nationally donated blood was used for the plagued people. 1 Abstract Background and Objectives: Endometrial hyperplasia (EH) is an abnormal overgrowth of endometrium that may lead to endometrial cancer, especially when accompanied by atypia. The treatment of EH is challenging, and previous studies report conflicting results. Metformin (dimethyl biguanide) is an anti-diabetic and insulin sensitizer agent, which is supposed to have antiproliferative and anticancer effects and the potential to decrease cell growth in endometrium. While some studies have evaluated the anticancer effect of metformin, studies on its potential effect on endometrial hyperplasia are rare. To address this gap, in this comparative trial study, we evaluate the effect of additive metformin to progesterone in patients with EH. Methods: In this clinical trial, 64 women with EH were randomized in two groups. The progesterone-alone group received progesterone 20 mg daily (14 days/month, from the 14 th menstrual day) based on the type of hyperplasia, and the progesterone-metformin group received metformin 1000 mg/day for 3 months in addition to progesterone. Duration of bleeding, hyperplasia, body mass index (BMI), and blood sugar (BS) of the patients were then com- pared between the two groups. Findings: NA mean age of 44.5 years, mean BMI of 29 kg/m 2 and mean duration of bleeding of 8 days were calcu- lated for the study sample. There was no significant difference in age, BMI, gravidity, bleeding duration, and duration of disease at baseline between the two groups. While all patients in the progesterone-metformin group showed bleeding and hyperplasia improvement, only 69% of the progesterone-alone patients showed such an improvement, with the difference between the two groups being significant (P = 0.001). Although the difference between two groups in the post treatment endometrial thickness was not significant (P = 0.55), post treatment BMI in the progesterone-metformin group was significantly lower than in the progesterone-alone group (P = 0.01). In addition, the BS reduction in the progesterone-metformin group was significantly larger than that in the progesterone-alone group (P = 0.001). Conclusions: Our results indicated that administration of progesterone 20 mg/day plus metformin 1000 mg/day can significantly decrease bleeding duration, hyperplasia, BMI and BS in women with EH.