Daily Deliveries Research Articles

Occupational Safety and Health of Riders Working for Digital Food Delivery Platforms in the City of Milan, Italy.

The rapid growth of the digital economy has transformed various labor markets, including the food sector. The transient nature and the peculiar work environments of food delivery workers raise concerns about occupational safety and health (OSH). This study aims to better understand these issues by conducting a comprehensive exploratory survey on OSH among food delivery riders in Milan, Italy. The study employed structured interviews based on a validated questionnaire developed through a literature review, expert interviews, and input from riders and health and safety professionals. The survey was performed from July to November 2022 by interviewing riders at their main gathering points. We interviewed 240 riders, 97% males, 81% less than 35 years old, and 83% with extra-European origin. Delivery was performed mainly by traditional bicycles (40%) and e-bikes (46%), with 44% working seven days per week and 23% working more than 8 hours daily. Road accidents were reported by 39% of riders, influenced by type of vehicle, fatigue, and number of daily deliveries. Physical and verbal assaults (12% and 28%, respectively) were reported, as well as health-related issues, particularly musculoskeletal disorders. The findings underscore food delivery riders' complex challenges, emphasizing the need for targeted interventions. The study calls for collaborative efforts between policymakers, employers, OSH professionals, and stakeholders to enhance OSH standards and promote decent working conditions, aligning with the 2030 Agenda for Sustainable Development.

Designing an information system for recapitulating goods received transactions

This research aims to design and implement an information system to recapitulate goods receipt and delivery transactions. Previously, this process used Microsoft Excel, which required manual data copying, took a long time, and required daily, weekly, and monthly printing and reporting. In addition, the application used was not stored in a database and was not integrated with the network, making data processing inefficient. In order to overcome this problem, the research developed a database programming-based information system with the waterfall method for the design stage. System modelling is done with the Unified Modeling Language (UML). This research produces a needs analysis, system design using UML, and nine tables supporting the system. Testing is done with black box testing and direct trials by users involved in data management, showing satisfactory results. Implementing the system using PHP programming and MySQL database resulted in a web-based application that accelerates the recapitulation process, stores data in the database, and is integrated with the network. This application is proven to speed up data processing. The application needs to be improved with more complex technology and compatible with various smartphones for further development. In addition, the app needs a dashboard feature to display the number of daily monthly deliveries, as well as the income of each officer. Increasing the number of human resources capable of maintaining the system is also important to ensure its sustainability and efficiency.

Exploring public sentiments towards courier services in Malaysia through Twitter: a sentiment analysis approach

This study delves into the sentiment analysis of courier services in Malaysia through the lens of tweets. With the escalating reliance on courier services for daily parcel deliveries, understanding public sentiment becomes imperative. Through a systematic methodology encompassing data gathering, preparation, alteration, analysis, modeling, and deployment, this study aims to furnish valuable insights and recommendations. A dynamic graphical representation of sentiment scores is presented for intuitive interpretation and informed decision-making. The study's significance lies in empowering Malaysians to make judicious choices regarding courier services, thereby fostering transparency in the industry. The study proposes several avenues for future enhancements, including the integration of autocorrect features, diversifying data sources and languages, incorporating deep learning techniques, and developing a user-friendly interface for enhanced visualization. This study serves as a guiding resource, illuminating sentiments surrounding courier services in Malaysia and paving the way for future advancements in sentiment analysis within this domain.

Online Shopping System

The main objective of this system is to make global shopping possible, were the customers buy things from anywhere in India. The customer will be displayed with the available products of the company, and the customer will be asked to select the items based on his choice and all information about the product like price, product id model will be given to the customer based on his requirements they make an order of the product. The modules are: Product Master, Customer Module, Purchase Module, Order Module, Billing Module. Daily, special and emergency deliveries are available. At any time during off-hours, 24 hours a day, seven days a week, we can provide your record. As days goes offline shopping has reduced and online shopping is increased. This Software will help you know the various products, product description, price range, discounts so that the customers can easily identify which product will suit best for them. The Web model that was used in the implementation of the On-Line Shopping Database Application is very simple each request from the webpage invokes a request, which then communicates with the Objectivity/DB to retrieve the requested data. The resulting data is passed by a request object to. The client-side HTML that displays the result to the user.

Cesarean delivery availability in Iowa was not constrained by anesthesia workforce limitations: Retrospective cohort study of inpatient surgery case counts

BackgroundOur goal was to assess whether anesthesia workforce limited surgical obstetrical care in the rural US state of Iowa. All Iowa hospitals with obstetrics have anesthesia practitioners (i.e., constraints would be functional, not related to having no anesthesia coverage). Our hypothesis #1 was that scheduling for cesarean delivery would functionally be separate from other inpatient operating room scheduling. Our hypothesis #2 was absence of systematic differences among hospitals in their distributions of cesarean deliveries between weekends and regular workdays. MethodsThe retrospective cohort study included all inpatient surgical cases at hospitals with cesarean births in the state of Iowa October 2015 through June 2021. There were analyzed 112 hospitals × 2100 days × 2 numbers, counts of cesarean deliveries and counts of all other surgical cases. ResultsThe incremental risk ratio between daily cesarean deliveries and other inpatient surgical cases was 1.00 per cesarean delivery (99% confidence interval 0.99 to 1.01). Thus, doing another cesarean delivery was not associated with either a proportional reduction (ratio <1) or increase (ratio >1) in other cases performed on the same day. Multiple sensitivity analyses showed the same results. In addition, there was no association in cesarean deliveries between hospitals’ percentages on weekends and overall weekly numbers (P = 0.08). Multiple sensitivity analyses showed the same results, no systematic differences between large versus small obstetrical programs in the distributions of cesareans between weekends versus workdays. Finally, among the 19/73 hospitals ending obstetrics during the study period, all continued to perform surgery. ConclusionsLimitations in the anesthesia workforce did not constrain surgical obstetrical care statewide. Similarly, cesarean births were at most negligibly causing other inpatient surgical cases to be postponed to later days.

Paving the Path towards Efficient Construction Logistics by Revealing the Current Practice and Issues

Multiple deliveries and long turnaround times on construction sites harm the environment and disturb on-site productivity and safety. The purpose of this paper is to investigate the transport patterns of construction material deliveries, including turnaround times. In order to investigate the number of transports and turnaround times, transport data for 13 Swedish construction sites, which were collected with the help of booking systems, were used. By comparing data from the cases, several patterns were observed: (i) very few projects receive deliveries at weekends, (ii) almost all projects receive 50% of their daily deliveries before 09:00, (iii) long goods, standard euro pallets and lightweight goods (less than 500 kg) are the most common deliveries, (iv) trucks and delivery vans are the most common vehicles used and (v) goods to be handled by crane and lightweight goods generate the longest turnaround time/delivery. This is one of the rare studies revealing current practice and issues associated with material deliveries, which is a necessary first step to increase efficiency of construction logistics. This study shows that it is possible to influence these issues, as some projects performed better than others regarding turnaround times and transport.

Dosimetric benefits of daily treatment plan adaptation for prostate cancer stereotactic body radiotherapy

BackgroundHypofractionation is increasingly being applied in radiotherapy for prostate cancer, requiring higher accuracy of daily treatment deliveries than in conventional image-guided radiotherapy (IGRT). Different adaptive radiotherapy (ART) strategies were evaluated with regard to dosimetric benefits.MethodsTreatments plans for 32 patients were retrospectively generated and analyzed according to the PACE-C trial treatment scheme (40 Gy in 5 fractions). Using a previously trained cycle-generative adversarial network algorithm, synthetic CT (sCT) were generated out of five daily cone-beam CT. Dose calculation on sCT was performed for four different adaptation approaches: IGRT without adaptation, adaptation via segment aperture morphing (SAM) and segment weight optimization (ART1) or additional shape optimization (ART2) as well as a full re-optimization (ART3). Dose distributions were evaluated regarding dose-volume parameters and a penalty score.ResultsCompared to the IGRT approach, the ART1, ART2 and ART3 approaches substantially reduced the V37Gy(bladder) and V36Gy(rectum) from a mean of 7.4cm3 and 2.0cm3 to (5.9cm3, 6.1cm3, 5.2cm3) as well as to (1.4cm3, 1.4cm3, 1.0cm3), respectively. Plan adaptation required on average 2.6 min for the ART1 approach and yielded doses to the rectum being insignificantly different from the ART2 approach. Based on an accumulation over the total patient collective, a penalty score revealed dosimetric violations reduced by 79.2%, 75.7% and 93.2% through adaptation.ConclusionTreatment plan adaptation was demonstrated to adequately restore relevant dose criteria on a daily basis. While for SAM adaptation approaches dosimetric benefits were realized through ensuring sufficient target coverage, a full re-optimization mainly improved OAR sparing which helps to guide the decision of when to apply which adaptation strategy.

A Decision Support System for Data-Driven Driver-Experience Augmented Vehicle Routing Problem

Logistics delivery companies typically deal with delivery problems that are strictly constrained by time while ensuring optimality of the solution to remain competitive. Often, the companies depend on intuition and experience of the planners and couriers in their daily operations. Therefore, despite the variability-characterizing daily deliveries, the number of vehicles used every day are relatively constant. This motivates us towards reducing the operational variable costs by proposing an efficient heuristic that improves on the clustering and routing phases. In this paper, a decision support system (DSS) and the corresponding clustering and routing methodology are presented, incorporating the driver’s experience, the company’s historical data and Google map’s data. The proposed heuristic performs as well as [Formula: see text]-means algorithm while having other notable advantages. The superiority of the proposed approach has been illustrated through numerical examples.

Performance of Irrigated Agriculture in the Panam Irrigation Project of Gujarat

There is large mismatch between the irrigation water supply and demand in the Panam irrigation project in Gujarat, India, arising from high spatiotemporal variation in occurrence and distribution of rainfall. Gross irrigation requirement of crops in the command area was estimated to quantify the gaps. Daily water deliveries during the crop period from 2009–2010 to 2012–2013 were analyzed and compared with the crop water demand. Monthly supply–demand ratio was found to be less than one except some peak monsoon months showing deficit water supply than the demand. Soil infiltration capacity, waterfront advance, and recession under furrow irrigation were studied to assess the irrigation system. Empirical infiltration equations were developed and waterfront advance and recession functions were formulated as empirical power equations. Depth of furrow infiltration was found to increase rapidly for a period up to about 10–15 min and then slowed down. Water distribution along the length of furrow run was found to be non-uniform as the advance and recession curves were divergent. Hence, adoption of furrow irrigation with surge flow can be beneficial for better irrigation water management.

DIURNAL ACTIVITY PATTERN OF A PAIR OF BREEDING NORTHERN PYGMY-OWLS

In 2012, we explored the activity pattern of a pair of breeding Northern Pygmy-Owls based on 15 d (and 15 nights) of video monitoring of the nest-cavity entrance during the nestling period. Video monitoring ended after all 6 owlets had left the nest. All instances of nest activity (n= 288) occurred during the daylight period from 1 h before sunrise to 1 h after sunset, so the pair was not nocturnal. Most of the activity (60%) occurred during the diurnal period (1 h after sunrise to 1 h before sunset), and the rest was in the crepuscular period (the first and last 2 h of daylight). Prey type factored heavily into the frequency of activity at certain times of day, and on certain days during the nestling period. Activity during the diurnal period was dominated by the combination of vertebrate prey deliveries (80% of diurnal activity) and enticements of young from the nest (14% of diurnal activity). In contrast, activity during the crepuscular period was dominated by insect prey deliveries (60% of crepuscular activity). Overnight nest attendance activity, arriving and departing the nest to tend young through the night, accounted for 11% of crepuscular activity. For the entire 15-d monitoring period, deliveries of vertebrate prey made up 60% of all activity. The frequency of daily vertebrate prey deliveries was relatively similar for the first 10 full days of monitoring (range 9 to 13 deliveries), then peaked 3 to 4 d prior to fledging (range 15 to 20 deliveries) before declining on the last 2 d of the period, when deliveries of moths and enticement activity increased. We concluded that the pair's activity during the nestling period was consistent with a diurnal activity pattern. We encourage other researchers to refine the meanings of the terms diurnal and crepuscular and clarify how those terms should be used to define the primary activity pattern of a species.

A discrete event simulation model for analysis of farm scale grain transportation systems

Grain transportation from the field to an on-farm storage facility is a critical component of the harvest system. A discrete event simulation model of grain transportation was developed to evaluate how truck and driver resource constraints impact material flow efficiency, resource utilization, and system throughput. Harvest rate and in-field transportation were represented as a stochastic entity generation process, and service times associated with various material handling steps were represented by a combination of deterministic times and statistical distributions. The model was applied to data collected for three distinct harvest scenarios (18 total days). Wheat and corn harvest from a large Kentucky operation was selected to evaluate the effect of different harvest rates (in wheat and corn), and corn harvest from a smaller Michigan operation was used to assess how the model handled situations where a single operator shuttled multiple trucks. The observed number of daily deliveries was within ±2 standard deviations of the simulation for 15 of the 18 input conditions examined, and on a daily basis, the median error between the simulated and observed deliveries was −4.1%. This model can be used to simulate how changes in vehicle and labor constraints impact the overall system performance. An important extension of this concept is that, given an existing equipment set and labor force, a producer can estimate how often grain transportation is the system bottleneck and simulate the impact of additional vehicles or labor on grain transportation efficiency.

Assessing Fuel Distribution in Urban Areas: Off-Hours Deliveries in the City of Rio de Janeiro

Abstract This article analyzes impact that initiatives for improving freight system performance can generate in fuel distribution in urban areas, especially in mega-cities. We propose a comprehensive methodology to identify initiatives with the most potential in terms of cost and efficiency for the fuel distribution process in urban areas, and then to assess impacts of such initiatives in terms of environmental and economic sustainability. Results indicated off-hours deliveries as having a higher potential to increase sustainability in fuel distribution within city borders. Therefore, an application of the proposed methodology is presented to assess results of a live experiment of off-hours deliveries held in a fuel-distribution process in a mega-city in comparison to daytime deliveries, which is companies’ standard practice. Several positive results were observed during off-hour deliveries, such as reduction in fuel consumption, reduction in the emission of air pollutants and greenhouse gases, reduction in travel time, increase in average operational speed as well as the possibility of carrying out two trips with the same vehicle per day leading to a reduction in expenses with drivers when there is an increase in daily truck deliveries. Although the case assessed was conducted during the Olympic Games of Rio de Janeiro, the method can be applied in any other mega-city.

Impact of Facility Delivery Intensity on the Practice of Active Management of Third Stage of Labour and Other Labour and Delivery Interventions in Tanzania

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality globally and Tanzania particularly. The World Health Organisation recommends Active Management of Third Stage of Labour (AMTSL) in preventing PPH, but its correct implementation has generally remained low. Many factors have been associated with the low practice of AMTSL, but the literature on the impact of delivery intensity is scanty. The aim was to determine the impact of facility delivery intensity on correct practice of AMTSL and provision of other labour and delivery interventions. Methods: In 2016, an analytical cross-section study was conducted in four public health facilities in Dar es Salaam. A priori criterion was set at 10 daily deliveries or more for High Delivery Intensity Facilities (HDIFs) in contrast to Low Delivery Intensity Facilities (LDIFs). All public obstetric care hospitals and health centres were ranked such that one facility with the highest deliveries and one with the lowest deliveries per category were selected. All eligible deliveries between 8.00 am and 2.00 pm were studied. An observer was assigned to each facility to time and document delivery and third stage events. Data were entered and analysed using SPSS program version 20. Pearson Chi square test was used for categorical data and Student’s t-test for comparing continuous data. Clinical relevance of the differences was evaluated by using 95% confidence intervals. Statistics with p-value The study was ethically approved by MUHAS Senate Research and Publication Committee. Results: In total, 752 normal deliveries were observed including 376 in LDIFs and 376 in HDIFs. Socio-demographic characteristics of women were comparable in both, except that women with secondary or higher education were more delivered in LDIFs (60.4%) than in HDIFs (35.1%), p Conclusions: Facility delivery intensity has remarkable impact on correct practice of AMTSL, labor and intra-partum care. Efforts to reduce maternal deaths should minimize facility delivery intensity.

Implementation of Dietary Education Within a Multidisciplinary Team Approach to Improve Treatment Accuracy and Efficiency in Prostate Cancer External Beam Radiation Therapy

Prostate cancer is the most common cancer in the Veterans Health Administration. Radiation is an important treatment option for prostate cancer patients. Imaging is done before each daily radiation treatment to ensure the radiation beam is aimed accurately. Imaging can be inaccurate due to excess gas or stool in the rectum, which alters the treatment field and leads to delays in the daily treatment schedule, increased radiation exposure due to re-imaging, repetitive staff treatment delivery interventions, and an unsatisfactory veteran experience. A quality improvement project utilizing A3.9 Box Process Improvement Methodology (problem solving template) was undertaken to address identified gastrointestinal concerns hindering daily treatment. A dietitian integrated services into the Radiation Oncology clinic by providing dietary education and counseling to avoid gas-producing foods and manage bowel regularity for prostate cancer patients. Daily images were reviewed for accuracy. For 3 months prior to intervention, we examined daily treatment images and documented any interruption in treatment delivery from gas or stool in the rectum as a nutrition-related defect. Baseline data analysis revealed that 72 of 208 (34.62%) daily treatment deliveries experienced nutrition-related defects. As a result of changing the radiation therapy process to include dietary education to patients, we experienced a 45.84% reduction rate in nutrition-related defects (from 34.62% to 18.75%). Calculated cost avoidance showed an annual savings of $21,252 with implementation of a multidisciplinary approach. An estimate of approximately 132 daily treatment visits and 99 patient treatment hours can be saved annually with this approach. This project improved overall clinic function by implementing a multidisciplinary approach to prostate cancer radiation oncology care, increased patient’s satisfaction, reduced excess radiation exposure, and improved department efficiency.

Avaliando a sustentabilidade alcançada por meio de entregas noturnas: o caso da distribuição de combustíveis na cidade do Rio de Janeiro

Este trabalho tem como objetivo analisar o impacto que a implantação de iniciativas para aumentar o desempenho do transporte de carga pode gerar na distribuição de combustíveis em áreas urbanas, em relação à sustentabilidade ambiental e econômica, bem como à eficiência da operação. Desta forma, o artigo propõe uma metodologia a ser ­ das iniciativas com maior potencial, em termos de custo e eficiência, para contribuir para o processo de distribuição de combustíveis em áreas urbanas, bem como para a avaliação do impacto de sua implantação, em termos econômicos e ambientais. O resultado apontou a entrega noturna como a prática com maior potencial de ganhos para o setor, de modo que a metodologia proposta é aplicada para avaliar os resultados de um experimento de entregas noturnas de combustíveis na zona Sul da cidade do Rio de Janeiro, em uma das maiores distribuidoras do Brasil. Os resultados do período de teste de entregas noturnas foram comparados em relação às entregas diurnas, prática padrão da empresa. Foram observados diversos resultados positivos durante o processo de entrega noturna, tais como:, 9% de redução no consumo de combustível; 66% de aumento na velocidade média operacional dos caminhões; redução média de 31% no tempo de viagem, possibilitando o aumento do número de viagens diárias por veículo com a utilização de um mesmo motorista; além da redução média de 13% na emissão de poluentes atmosféricos e gases de efeito estufa no meio ambiente.

Consistent vehicle routing problem with service level agreements: A case study in the pharmaceutical distribution sector

In this paper, a mathematical model is developed to tackle a Consistent Vehicle Routing Problem, which considers customers with multiple daily deliveries and different service level agreements such as time windows, and release dates. In order to solve this problem, an instance size reduction algorithm and a mathematical programming based decomposition approach are developed. This solution approach is benchmarked against a commercial solver. Results indicate that the method solves instances of large size, enabling its application to real-life scenarios. A case study in a pharmaceutical distribution company is analyzed. Consistent routes are planned for several warehouses, comprising hundreds of orders. A simulation model evaluates the performance of the generated route plans. Significant improvements in terms of the total distance traveled and the total travel times are obtained when compared to the company’s current planning process.

A method to reconstruct and apply 3D primary fluence for treatment delivery verification.

MotivationIn this study, a method is reported to perform IMRT and VMAT treatment delivery verification using 3D volumetric primary beam fluences reconstructed directly from planned beam parameters and treatment delivery records. The goals of this paper are to demonstrate that 1) 3D beam fluences can be reconstructed efficiently, 2) quality assurance (QA) based on the reconstructed 3D fluences is capable of detecting additional treatment delivery errors, particularly for VMAT plans, beyond those identifiable by other existing treatment delivery verification methods, and 3) QA results based on 3D fluence calculation (3DFC) are correlated with QA results based on physical phantom measurements and radiation dose recalculations.MethodsUsing beam parameters extracted from DICOM plan files and treatment delivery log files, 3D volumetric primary fluences are reconstructed by forward‐projecting the beam apertures, defined by the MLC leaf positions and modulated by beam MU values, at all gantry angles using first‐order ray tracing. Treatment delivery verifications are performed by comparing 3D fluences reconstructed using beam parameters in delivery log files against those reconstructed from treatment plans. Passing rates are then determined using both voxel intensity differences and a 3D gamma analysis. QA sensitivity to various sources of errors is defined as the observed differences in passing rates. Correlations between passing rates obtained from QA derived from both 3D fluence calculations and physical measurements are investigated prospectively using 20 clinical treatment plans with artificially introduced machine delivery errors.ResultsStudies with artificially introduced errors show that common treatment delivery problems including gantry angle errors, MU errors, jaw position errors, collimator rotation errors, and MLC leaf position errors were detectable at less than normal machine tolerances. The reported 3DFC QA method has greater sensitivity than measurement‐based QA methods. Statistical analysis‐based Spearman's correlations shows that the 3DFC QA passing rates are significantly correlated with passing rates of physical phantom measurement‐based QA methods.ConclusionAmong measurement‐less treatment delivery verification methods, the reported 3DFC method is less demanding than those based on full dose re‐calculations, and more comprehensive than those that solely checks beam parameters in treatment log files. With QA passing rates correlating to measurement‐based passing rates, the 3DFC QA results could be useful for complementing the physical phantom measurements, or verifying treatment deliveries when physical measurements are not available. For the past 4+ years, the reported method has been implemented at authors’ institution 1) as a complementary metric to physical phantom measurements for pretreatment, patient‐specific QA of IMRT and VMAT plans, and 2) as an important part of the log file‐based automated verification of daily patient treatment deliveries. It has been demonstrated to be useful in catching both treatment plan data transfer errors and treatment delivery problems.

A Novel Short-Term Wind Speed Prediction Based on MFEC

Accurate forecasting of short-term wind speed is a key technology to enable efficient and reliable operation of microgrids with wind generators. Results of wind speed prediction (WSP) methods in the current literature are subject to errors due to the random nature of wind speed and the limited generalization of forecast algorithms. In this paper, a short-term WSP method based on a model of forecast, error correction, wind power generation, support vector machines (SVMs), and prediction algorithms is proposed. In the proposed method, the error model is built to predict the errors of the original predicted wind speed. Subsequently, the predicted errors are incorporated into the original predicted sequence to produce the final forecasts. The final predicted results can be brought to the system operator step by step for use in scheduling strategies. Using SVM and back propagation (BP) prediction algorithm as examples for the basic prediction algorithm, the proposed method is applied to a day-ahead WSP with five daily deliveries and compared with the results by a single SVM or a BP prediction algorithm. The test results demonstrate significant improvement in prediction accuracy using the proposed short-term WSP based on a model of forecast error correction method, independent of the basic prediction algorithm.

Perinatal mortality among infants born during health user-fees (Cash & Carry) and the national health insurance scheme (NHIS) eras in Ghana: a cross-sectional study.

BackgroundThis research determined the rates of perinatal mortality among infants delivered under Ghana’s national health insurance scheme (NHIS) compared to infants delivered under the previous “Cash and Carry” system in Northern Region, especially as the country takes stock of its progress toward meeting the Millennium Development Goals (MDG) 4 and 5.MethodsThe labor and maternity wards delivery records of infants delivered before and after the implementation of the NHIS in Northern Region were examined. Records of available daily deliveries during the two health systems were extracted. Fisher’s exact tests of non-random association were used to examine the bivariate association between categorical independent variables and perinatal mortality.ResultsOn average, 8% of infants delivered during the health user-fee (Cash & Carry) died compared to about 4% infant deaths during the NHIS delivery fee exemption period in Northern Region, Ghana. There were no remarkable difference in the rate of infant deaths among mothers in almost all age categories in both the Cash and Carry and the NHIS periods except in mothers age 35 years and older. Infants born to multiparous mothers were significantly more likely to die than those born to first time mothers. There were more twin deaths during the Cash and Carry system (p = 0.001) compared to the NHIS system. Deliveries by caesarean section increased from an average of 14% in the “Cash and Carry” era to an average of 20% in the NHIS era.ConclusionThe overall rate of perinatal mortality declined by half (50%) in infants born during the NHIS era compared to the Cash and Carry era. However, caesarean deliveries increased during the NHIS era. These findings suggest that pregnant women in the Northern Region of Ghana were able to access the opportunity to utilize the NHIS for antenatal visits and possibly utilized skilled care at delivery at no cost or very minimal cost to them, which therefore improved Ghana’s progress towards meeting the MDG 4, (reducing under-five deaths by two-thirds).

SU‐F‐T‐205: Effectiveness of Robust Treatment Planning to Account for Inter‐ Fractional Variation in Intensity Modulated Proton Therapy for Head Neck Cancer

Purpose:To evaluate the potential benefits of robust optimization in intensity modulated proton therapy(IMPT) treatment planning to account for inter‐fractional variation for Head Neck Cancer(HNC).Methods:One patient with bilateral HNC previous treated at our institution was used in this study. Ten daily CBCTs were selected. The CT numbers of the CBCTs were corrected by mapping the CT numbers from simulation CT via Deformable Image Registration. The planning target volumes(PTVs) were defined by a 3mm expansion from clinical target volumes(CTVs). The prescription was 70Gy, 54Gy to CTV1, CTV2, and PTV1, PTV2 for robust optimized(RO) and conventionally optimized(CO) plans respectively. Both techniques were generated by RayStation with the same beam angles: two anterior oblique and two posterior oblique angles. The similar dose constraints were used to achieve 99% of CTV1 received 100% prescription dose while kept the hotspots less than 110% of the prescription. In order to evaluate the dosimetric result through the course of treatment, the contours were deformed from simulation CT to daily CBCTs, modified, and approved by a radiation oncologist. The initial plan on the simulation CT was re‐replayed on the daily CBCTs followed the bony alignment. The target coverage was evaluated using the daily doses and the cumulative dose.Results:Eight of 10 daily deliveries with using RO plan achieved at least 95% prescription dose to CTV1 and CTV2, while still kept maximum hotspot less than 112% of prescription compared with only one of 10 for the CO plan to achieve the same standards. For the cumulative doses, the target coverage for both RO and CO plans was quite similar, which was due to the compensation of cold and hot spots.Conclusion:Robust optimization can be effectively applied to compensate for target dose deficit caused by inter‐fractional target geometric variation in IMPT treatment planning.