Delivery Patterns Research Articles

Spatial pattern and determinants of institutional delivery in Ethiopia: Spatial and multilevel analysis using 2019 Ethiopian demographic and health survey.

In Ethiopia, despite the progress that has been made to improve maternal and child health, the proportion of births occurring at health institutions is still very low (26%), Which significantly contribute to a large number of maternal death 412 deaths/100,000 live births. Therefore, this study intended to determine spatial pattern and factors affecting institutional delivery among women who had live birth in Ethiopia within five years preceding survey. Data from 2019 Ethiopian demographic and health survey were used. Taking into account the nested structure of the data, multilevel logistic regression analysis has been employed to a nationally representative sample of 5753 women nested with in 305 communities/clusters. A significant heterogeneity was observed between clusters for institutional delivery which explains about 57% of the total variation. Individual-level variables: primary education (OR = 1.8: 95% CI: 1.44-2.26), secondary education (OR = 3.65: 95% CI: 2.19-6.1), diploma and higher (OR = 2.74: 95% CI: 1.02-7.34), women who had both Radio and Television were 4.6 times (OR = 4.6; 95% CI: 2.52, 8.45), four and above Antenatal visit (AOR = 2.72, 95% CI:2.2, 3.34), rich wealth index (OR = 2.22; 95% CI: 1.62-2.99), birth interval for 18 to 33 months (OR = 1.8; 95% CI: 1.19, 2.92), and women who space birth for 33 and above months (OR = 2.02; 95% CI: 1.3, 3.12) were associated with institutional delivery. Community level variables, community high proportion of antenatal visit (OR = 4.68; 95% CI: 4.13-5.30), and Region were associated with institutional delivery. A clustered pattern of areas with low institutional delivery was observed in Ethiopia. Both individual and community level factors found significantly associated with institutional delivery theses showed the need for community women education through health extension programs and community health workers. And the effort to promote institutional delivery should pay special attention to antenatal care, less educated women and interventions considering awareness, access, and availability of the services are vital for regions. A preprint has previously been published.

Society for Education and the Advancement of Research in Connected Health SEARCH 2022 – The National Telehealth Research Symposium Abstracts Virtual Meeting November 16–18, 2022

Society for Education and the Advancement of Research in Connected Health SEARCH 2022 – The National Telehealth Research Symposium Abstracts Virtual Meeting November 16–18, 2022

Genomic Characterization of a Vancomycin-Resistant Strain of Enterococcus faecium Harboring a rep2 Plasmid.

In China, vancomycin-resistant enterococci (VRE) was not a common occurrence, and research on the genetic context and transmission mechanism of vanA-plasmid was scarce. The aim of this study was to molecularly characterise a vancomycin-resistant Enterococcus faecium isolate from a bloodstream infection and determine the genetic environment and delivery pattern of the plasmid carrying vancomycin-resistant gene. In May 2022, a vancomycin-resistant strain of Enterococci was identified during routine screening for VRE bacteria at the First Affiliated Hospital, Zhejiang University School of Medicine. Utilizing matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), the isolate was accurately identified. Antimicrobial susceptibility and whole-genome sequencing (WGS) were employed to perform phenotypic and genomic analysis, respectively. Further bioinformatics analyses was carried out to characterize the vanA-bearing plasmid. The antimicrobial susceptibility test showed that SJ2 strain was resistant to multiple antimicrobials, including ampicillin, benzylpenicillin, ciprofloxacin, erythromycin, levofloxacin, streptomycin, and vancomycin. Whole-genome analysis revealed that SJ2 strain carries several antimicrobial resistance genes and virulence determinants. MLST analysis found that SJ2 strain belongs to an unknown ST type. Plasmid analysis confirmed that the vanA gene was located on a variant of ~50 kb rep2 plasmid. Our study found that vanA-bearing rep2 plasmid is a potential source of dissemination and outbreak, and continuous surveillance is necessary to control its spread in Hangzhou, China.

Tight control in patients with rheumatoid arthritis treated with targeted therapies across the COVID-19 pandemic era

Objectives To analyze the impact of different patterns of healthcare delivery on remission of rheumatoid arthritis (RA) patients treated with targeted therapies during the first wave (2020) and second/third waves (2021) of the pandemic compared to the pre-pandemic period (2019). Methods In this observational real-life study, data from RA patients treated with biologic or targeted synthetic drugs were extracted from a longitudinal registry. Clinical Disease Activity Index (CDAI) was analyzed in the same period from the 22nd of February to the 18th of May for three consecutive years. These three periods were characterized by different patterns of healthcare delivery: (1) before the pandemic (2019) only in-person visits, (2) during the first wave (2020) both in-person visits and telehealth, and (3) during the second/third waves (2021) only in-person visits. A generalized linear model with the binomial error was fitted to evaluate the difference in the proportion of patients in CDAI remission. Quantile regression was used to compare the median of CDAI in difficult-to-treat (D2T) patients. Results In the three periods, we included 407, 450, and 540 RA patients respectively. The percentages of patients in CDAI remission were similar in the three periods (prevalence ratio 1.07, p value 0.423 between 2020 and 2019, and 1.01, p-value 0.934 between 2021 and 2019). The CDAI remission rate was 40.55% (N = 163), 43.18% (N = 155) and 40.82% (N = 220) in 2019, 2020 and 2021, respectively. Among our cohort of D2T patients, CDAI remission was similar across the three periods (N = 30, 22.22%; N = 27, 23.68%; and N = 34, 21.52% respectively). Conclusion Although the pandemic has imposed changes in our healthcare delivery, these different strategies seem to be effective in ensuring satisfactory management of RA treated with targeted therapies. The approaches modulated in the context of the different periods have been a feasible compensation for ensuring disease control even in D2T patients.

Care Disruption During COVID-19: a National Survey of Hospital Leaders.

The COVID-19 pandemic caused massive disruption in usual care delivery patterns in hospitals across the USA, and highlighted long-standing inequities in health care delivery and outcomes. Its effect on hospital operations, and whether the magnitude of the effect differed for hospitals serving historically marginalized populations, is unknown. To investigate the perspectives of hospital leaders on the effects of COVID-19 on their facilities' operations and patient outcomes. A survey was administered via print and electronic means to hospital leaders at 588 randomly sampled acute-care hospitals participating in Medicare's Inpatient Prospective Payment System, fielded from November 2020 to June 2021. Summary statistics were tabulated, and responses were adjusted for sampling strategy and non-response. There were 203 responses to the survey (41.6%), with 20.7% of respondents representing safety-net hospitals and 19.7% representing high-minority hospitals. Over three-quarters of hospitals reported COVID testing shortages, about two-thirds reported staffing shortages, and 78.8% repurposed hospital spaces to intensive care units, with a slightly higher proportion of high-minority hospitals reporting these effects. About half of respondents felt that non-COVID inpatients received worsened quality or outcomes during peak COVID surges, and almost two-thirds reported worsened quality or outcomes for outpatient non-COVID patients as well, with few differences by hospital safety-net or minority status. Over 80% of hospitals participated in alternative payment models prior to COVID, and a third of these reported decreasing these efforts due to the pandemic, with no differences between safety-net and high-minority hospitals. COVID-19 significantly disrupted the operations of hospitals across the USA, with hospitals serving patients in poverty and racial and ethnic minorities reporting relatively similar care disruption as non-safety-net and lower-minority hospitals.

Patterns of Prenatal Care Delivery and Obstetric Outcomes before and during the COVID-19 Pandemic.

Health care providers and health systems confronted new challenges to deliver timely, high-quality prenatal care during the coronavirus disease 2019 (COVID-19) pandemic as the pandemic raised concerns that care would be delayed or substantively changed. This study describes trends in prenatal care delivery in 2020 compared with 2018 to 2019 in a large, commercially insured population and investigates changes in obstetric care processes and outcomes. This retrospective cohort study uses de-identified administrative claims for commercially insured patients. Patients whose entire pregnancy took place from March 1 to December 31 in years 2018, 2019, and 2020 were included. Trends in prenatal care, including in-person, virtual, and emergency department visits, were evaluated, as were prenatal ultrasounds. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included preterm birth and stillbirth. To determine whether COVID-19 pandemic-related changes in prenatal care had an impact on maternal outcomes, we compared the outcome rates during the pandemic period in 2020 to equivalent periods in 2018 and 2019. In total, 35,112 patients were included in the study. There was a significant increase in the prevalence of telehealth visits, from 1.1 to 1.2% prior to the pandemic to 17.2% in 2020, as well as a significant decrease in patients who had at least one emergency department visit during 2020. Overall prenatal care and ultrasound utilization were unchanged. The rate of SMM across this period was stable (2.3-2.8%) with a statistically significant decrease in the preterm birth rate in 2020 (7.4%) compared with previous years (8.2-8.6%; p < 0.05) and an unchanged stillbirth rate was observed. At a time when many fields of health care were reshaped during the pandemic, these observations reveal considerable resiliency in both the processes and outcomes of obstetric care. · Overall prenatal care and ultrasound were unchanged from 2018 to 2019 to 2020.. · There was a large increase in the prevalence of telehealth visits in 2020.. · There was no change in the rate of severe maternal morbidity or stillbirth in 2020 compared with 2018 to 2019..

A prospective and observational study on maternal and fetal outcome in antepartum hemorrhage at a tertiary care hospital

Background: Antepartum hemorrhage (APH) in our country is a frequent problem due to various reasons. This event affects maternal physical and mental health, fetal health, family health, social impact, and countries burden at large. We have conducted the study to find out the precise effect on maternal and fetal health. Aims and Objectives: The aim of the study was to find out the socio-demographic variables of study population and analyze mother and fetal outcome and complications of antepartum bleeding in Obstetrics and Gynaecology department, Midnapore Medical College and Hospital. Materials and Methods: This prospective and observational study done for 1 ½ year (April 2021–September 2022), estimated sample size of 100 fulfilling study criteria. Data collected included maternal age, parity, gestational age, delivery pattern, complications after delivery, and fetal complications. Results: In the present study, 92% of patients were booked, maximum number of women presented at 34–36+6 weeks of gestation (34%) followed by 37–39+6 weeks of gestation (28%), mean age of population was 20–24 years, commoner in multipara (66%), stillbirth occurred in 14% of cases, 51% had associated risk factors, 21% suffered from postpartum hemorrhage, 70% of patients required blood transfusion, 91% delivered by cesarean section, zero maternal death, 67% were premature, and 81% were low birth weight. Conclusion: As most of the cases presented late, already complications had occurred. Thus, APH is known to be associated with maternal and fetal morbidity and mortality. Complications can be minimized by early detection and by proper and prompt management. Proper equipped obstetric and neonatal wards with multidepartmental management facilities can improve mother and perinatal well-being. Routine antenatal visits, timely cesarean sections, timely referral, and correction of anemia with good ICU and NICU facilities can lower the maternal and fetal mortality and morbidity.

How Do Hospitals Organize Diabetes Services? A Comparative Study.

Most patients with diabetes will present to hospital for a reason not directly related to their diabetes. When a person with diabetes is not cared for properly, hospitalization can become complicated and lead to worse consequences for the patient. In fact, it is important to know how to manage a diabetic patient while in hospital. Therefore, a special organization is needed in hospitals for adaptation to chronic diseases such as diabetes. This study intends to help hospital adaptation to the special needs of diabetic patients by identifying patterns of care delivery in selected countries. This comparative study was performed in 2021. The data collection was conducted by searching in PubMed, Web of Knowledge, Scopus, Science Direct, Springer, Proquest, and also the websites of the selected countries hospitals. Based on the sampling method, three countries, Turkey, United Kingdom, and the United States, were selected from the countries with eligibility. However, during the study, according to the good practices about special diabetic care of countries such as Australia and Denmark, they were also examined. In this review study, we organized and compared the effective measures taken in selected countries in relation to the management of these patients in the hospital, focusing on the dimensions of service package, human resource, process, structure, equipment/technology, and information system required by diabetic patients.

Advances in nanoscale carrier-based approaches to reduce toxicity and enhance efficacy of podophyllotoxin

Podophyllotoxin (PPT), an aryltetralin-type lignan isolated from Podophyllum species, exhibits a wide range of biologic and pharmacologic activities, and mainly serves as an antiviral agent or antitumor drug in clinical applications. However, the therapeutic potential of PPT has been hindered due to its detrimental systemic toxicity, poor solubility, and bioavailability. Nanoparticles, which preferentially accumulate in tumors through enhanced permeability and retention effects, have become useful tools for targeted drug delivery, thus securing a niche in cancer therapies. The nano-based drug delivery platform has been introduced to PPT delivery for the purpose of improved solubility, enhanced efficacy, and reduced toxicity. For decades, extensive efforts have been dedicated to designing and developing various PPT delivery systems to mitigate undesirable toxicity and expand clinical applicability. Herein, we briefly review the latest achievements in PPT delivery patterns and pharmacodynamic concerns with the expectation of shedding light on future research and potential applications of PPT.

Causes of Reduced Revenue Generation in Federal Staff Hospital (Fsh) Laboratory; Annex 111 Federal Capital Territory, Abuja

The healthcare delivery system has been criticized for its “culture of blame” in which culpability for failure has been attributed to the human elements of the system: The Study was designed to identify and ascertain reasons for low-revenue generation in Federal staff hospital (FSH) laboratory; annex 111, Abuja and to proffer solutions, as well as deliver health care that minimizes risks and harm to service users, including avoiding preventable injuries and reducing medical errors. According to World Health Organization (WHO), a well-functioning healthcare system requires a financing mechanism, well trained and adequately paid workforce, reliable Information on which to base decisions and policies, and well-maintained health facilities to deliver quality services and technologies. Out of a total number of two hundred (200) respondents interviewed using questionnaires, hundred and sixty (160) were received using the random sampling method. 41% of the respondents believed that there are no barriers to accessing the facility, 48.0% indicated a Lack of Knowledge, and 11.0% said proximity. The year 2017/2018 to 2019 report showed a tremendous improvement. Revenue generated and the number of patients for the year 2018 was to the tune of twenty-nine million, nine hundred and seventy-six thousand, six hundred and sixty naira only (₦29,976,660.00) and twelve thousand, seven hundred and twenty-six patients (12,726) respectively. In comparing the year 2017/2018, respectively, this Study concluded that for overall improvement of the quality and performance in the healthcare environment, there is a need for the development of new inter-organizational patterns of care delivery and complex multitier governance structures. Keywords: Federal staff hospital (FSH) laboratory, Health care, Knowledge. Preventable injuries, World Health Organization (WHO).

Efficacy of the therapeutic use of video games on the depressive state of stroke patients: Protocol for systematic review and meta-analysis.

To assess the effects of virtual reality (VR) on the depressive state of patients with stroke admitted to neuro-rehabilitation units. Design: Systematic review and meta-analysis protocol. Randomized Controlled Trials (RCTs) focusing on the effects of virtual reality on depressive state as a primary outcome will be included. Grey literature and the following databases will be consulted: PubMed, Cinahl, PsycInfo, Scopus, Embase, Cochrane Library and Web of Science. The recently revised Cochrane risk of bias tool will be used to assess the quality of included studies. Data will be extracted and meta-analyses will be performed within the specific condition of the emotional state of stroke patients admitted to neurorehabilitation units. Meta-regression and subgroup analyses will be used to identify effective modes and patterns of therapy delivery. The approach of assessment, development and evaluation of recommendations will be applied to reach a convincing conclusion. An accurate, transparent and standardized review process is expected to provide recommendations on the use of VR technology in the healthcare of stroke patients. Emotional difficulties are common after stroke and have an impact on rehabilitation outcome. VR seems to have an important role in the treatment and depression in neurological patients, as it is able to improve levels of well-being, coping strategies and social relationships. The systematic review may contribute to a more convincing and specific conclusion compared to existing studies of this type. Systematic review registration: CRD42022303968.

Based on 5G network, use the unmanned aerial vehicles to live stream in VR

5G network has begun to step into people’s horizons. The character of high transmitting speed and low latency can enable some applications to do better in their fields. This article focuses on the new application of the UAV (unmanned aerial vehicles) based on the 5G network. Live streaming is a new entertaining way that is popular worldwide. In this article, the theoretical analysis of the 5G network and VR shows the development of mobile communication technology, the essential features of 5G network, which demonstrate the advantage of 5G, and the Internet requirement of VR. To reduce network bandwidth demand, a different view information transmission can distribute the transmission data of the side angle of view into the in front version. A Popularity Balance Method(PB) for UAVs in the same area layer) method based on the division of the entire search area into multiple area layers to change the pattern of message delivery to the area layer closer to the destination node. Advanced wireless systems (AWS) can make safe, effective operations. Suggestions about using Content Delivery Network (CDN) to solve the live stream problems are also given.

Pattern of cesarean deliveries among women in an urban and rural district in Egypt.

to compare patterns of delivery at an urban and a rural district in Egypt over 3 years. This retrospective study included 500 women and 50 obstetricians from each district from January, 2013 till December, 2015. Women answered a questionnaire about their deliveries. Obstetricians answered a questionnaire about their practice of CS. CS rate in the rural district was 57.2% compared to 54.8% in the urban district in 2013. In 2014 and 2015, CS rates increased to 65.3% and 69%, respectively in the rural district compared to 56% and 57.7%, respectively in the urban district. 66% of obstetricians in the rural district performed CS for more than 50% of their patients compared to 76% of obstetricians in the urban district. 52% and 4% of obstetricians in the rural and urban districts, respectively, performed CS upon maternal request. 70.3% of women in the rural district who delivered by CS preferred to deliver vaginally. 51.4% of urban women who delivered by CS preferred to deliver vaginally. Level of education was the only factor showing statistical significance. CS rates increased over time with higher rates in the rural area. Level of women's education was the only factor affecting delivery choice.

Clinical feature and predictive factor analysis for spontaneous regression of retinopathy of prematurity in a Chinese population.

To investigate the ratio of spontaneous regression of retinopathy of prematurity (ROP) and to explore the possible relevant predictive factors. A retrospective review of 405 infants who were diagnosed with ROP and mother during pregnancy were collected. Stage, zone, and duration of ROP were recorded. Statistical analysis was performed on 51 possible predictive factors. Totally 356 infants showed spontaneous regression. The incidence was 100%, 95.3%, and 22.7% in stage 1, 2, and 3, respectively. The 13.4% of the ROP with plus disease eventually resolved spontaneously. All affected eyes of aggressive posterior retinopathy of prematurity (AP-ROP) failed to spontaneously regress. The mean duration of ROP was 7.2wk in patients with spontaneous resolution of ROP. Days of mechanical ventilation (OR=0.981, 95%CI, 0.965-0.997, P=0.021), retinal hemorrhage (OR=0.173, 95%CI, 0.064-0.470, P=0.001), delivery pattern (OR=2.750, 95%CI, 1.132-6.681, P=0.025), maternal anemia in pregnancy (OR=0.142, 95%CI, 0.036-0.563, P=0.005), the stages (at initial diagnosis OR=0.183, 95%CI, 0.041-0.816, P=0.026; at final diagnosis OR=0.031, 95%CI, 0.006-0.167, P<0.001), and with plus disease or not (OR=0.005, 95%CI, 0.001-0.031, P<0.001) were independent predictive factors of the spontaneous regression of ROP. Most mild ROP can spontaneously resolve. Active treatment is still recommended for stage 3 ROP, zone I ROP, AP-ROP, and ROP with plus disease. Prolonged mechanical ventilation and concurrent retinal hemorrhage reduce the likelihood of spontaneous ROP resolution. The pattern of delivery and the mother's anemia during pregnancy can also affect the prognosis of ROP.

Association between modes of delivery and postpartum dietary patterns: A cross-sectional study in Northwest China.

Puerperae' dietary patterns (DPs) during the puerperium may be influenced by the mode of delivery, but population studies on this topic are scarce. This study aims to explore the relationship between DPs and different modes of delivery among puerperae. A cross-sectional study was conducted on 3,345 parturients in Lanzhou, China. The postpartum food intake was measured by a food frequency questionnaire (FFQ). Factor analysis was used to determine the DPs. Multiple linear regression was employed to examine the association between the mode of delivery and DP. In this study, two DPs, i.e., traditional and modern DPs, were identified. Traditional DP was characterized by high energy-adjusted intake of tubers, coarse cereals, rice, whole grains, fishery products, and eggs. Modern DP included a high intake of coffee, non-sugary drinks, wine, tea, and fishery products. Compared with participants with vaginal delivery (reference category), cesarean section had an inverse association with modern DP (β: -0.11, 95% CI: -0.36, -0.09). A significant interaction was found between education level, monthly household income, alcohol drinking, and modes of delivery. The inverse association between cesarean section and modern DP or the intake of coffee was significant among puerperae with higher or lower monthly household income. However, the inverse association between cesarean section and traditional DP was only found among puerperae with higher monthly household income. Moreover, among the participants with high education, cesarean section was positively associated with intake of vegetables. Cesarean puerperae with higher levels of education and those with lower and higher monthly household income had less unhealthy foods intake than those who had vaginal delivery. They need to be accounted for in educational programs and interventions focused on healthy diet recommendations in puerperium.

Clinician perceptions of Passport for Care, a web-based clinical decision support tool for survivorship care plan delivery.

The Children's Oncology Group Long-Term Follow-Up Guidelines provide exposure-based risks and recommendations for late effects screening of survivors of childhood cancer. Passport for Care (PFC) is a web-based clinical decision support tool for generating a personalized survivorship care plan (SCP) derived from the Guidelines and user-entered exposures. We assessed PFC clinician user practices and perceptions of PFC impact on clinic workflow, guidelines application, and survivor shared decision-making. A 35-item REDCap survey was emailed to all PFC users (n=936) in 146 current and former PFC user clinics. Anonymous responses were permitted. Results were summarized and compared with a 2012 survey. Data were available from 148 respondents representing 64 out of 146 PFC user clinics (minimum clinic response rate 44%, excluding 49 anonymous responses). Generation of a personalized SCP was the most common application of PFC, followed by determination of surveillance recommendations and use as a survivor database. Twenty-five respondents (17%) felt data entry was a significant or insurmountable barrier to PFC application. Sixty-nine percent of respondents attributed PFC with a very high/high impact on guidelines adherence in their clinical practice, compared with 40% who attributed PFC with having a significant impact on adherence in 2012 (p<.001). The survey results provide valuable insights on patterns of SCP delivery and Survivor Clinic workflow. User-perceived benefits to PFC included facilitating clinician ability to follow guidelines recommendations in clinical practice. Importantly, some barriers to resource utilization were also identified, suggesting a need for user-informed adaptations to further improve uptake.

Computation of Voxel-by-Voxel Dose Rates in Patients for Proton Pencil Beam Dose Delivery

<h3>Purpose/Objective(s)</h3> Proton beam radiotherapy is most commonly delivered using the pencil beam scanning (PBS) technique. However, the vast majority of clinical outcome data is based on patients treated with the passive scattering technique. The overall dose distributions delivered with these techniques are fairly similar, with an advantage in conformity noted for PBS. Major differences between these two modalities can be observed in the temporal dose delivery pattern. The passive scattering technique uniformly delivers dose across the cross section of the entire target simultaneously, while the dose in PBS is delivered point-by-point, resulting in a much higher local instantaneous dose rate. Recent studies have shown that ultra-high dose rate (FLASH) irradiations can change the biological response to radiation. This work presents an analytical tool to compute voxel-wise maximum dose rates for clinical PBS treatment plans. <h3>Materials/Methods</h3> The scripting environment of our treatment planning system was used to develop software to compute dose rate distributions for clinical pencil beam scanning treatment plans. The basis of the computation is an accurate model of the delivery timing properties of the accelerator and scanning system. The minimum temporal resolution supported is 1 ms. This captures the timing of single spots but excludes the beam pulse structure of our cyclotron (ns). With the timing model and a given spot map we compute the average dose rate over a time interval of interest for each voxel. The latter is an input parameter determined by the user. To validate the tool, test beams in a simple solid water geometry were generated in the treatment planning system and corresponding dose rate distributions produced. Single point measurements with custom-made diode and electronics were used to verify computations against experimentation for a range of proton energies and depths. <h3>Results</h3> For dose rate calculations recording the maximum value observed in any 1 ms time interval during the field's delivery, we observe peak values of 186 Gy/min and 273 Gy/min for 110 MeV and 150 MeV protons, respectively. On average, the agreement of calculations and measurements was -0.9% with a standard deviation of 4.1%. <h3>Conclusion</h3> The software enables accurate local instantaneous dose rate calculations for clinically deliverable treatment plans. This may be important to use as a basis to better understand clinical results. In addition to standard PBS treatments, the observed dose rates may be relevant when considering the out of field areas in FLASH treatments.

What is the Right Size for a Residential Building Parcel Locker?

Common-carrier parcel lockers present a solution for decreasing delivery times, traffic congestion, and emissions in dense urban areas through consolidation of deliveries. Multi-story residential buildings with large number of residents, and thus a high volume of online package orders, are one of the best venues for installing parcel lockers. But what is the right size for a residential building locker that would suit the residents’ and building managers’ needs? Because of the novelty of parcel lockers, there is no clear guideline for determining the right locker size and configuration for a residential building given the resident population. A small locker would result in packages exceeding capacity and being left in the lobby, increasing the building manager’s workload and confusing and inconveniencing users. On the other hand, a large locker is more expensive, more difficult to install, and unappealing to residents. To answer this question, we installed a common-carrier parcel locker in a residential building in downtown Seattle, WA, U.S.A. Through collecting detailed data on locker usage from the locker provider company, we studied and quantified carriers’ delivery patterns and residents’ online shopping and package pickup behaviors. We then used this information to model the locker delivery and pickup process, and simulated several locker configurations to find the one that best suits the delivery needs of the building. These findings could aid urban planners and building managers in choosing the right size for residential building lockers that meet delivery demand while minimizing costs and contributing to environmental benefits.

Handling of the Covid-19 Pandemic and Its Effects on Bariatric Surgical Practice: Analysis of GENEVA Study Database

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams.Materials and MethodsThe current study is a subset analysis of the GENEVA study which was an international cohort study between 01/05/2020 and 31/10/2020. Data were specifically analysed regarding the timing of BMS suspension, patterns of service recovery, and precautionary measures deployed.ResultsA total of 527 surgeons from 439 hospitals in 64 countries submitted data regarding their practices and handling of the pandemic. Smaller hospitals (with less than 200 beds) were able to restart BMS programmes more rapidly (time to BMS restart 60.8 ± 38.9 days) than larger institutions (over 2000 beds) (81.3 ± 30.5 days) (p = 0.032). There was a significant difference in the time interval between cessation/reduction and restart of bariatric services between government-funded practices (97.1 ± 76.2 days), combination practices (84.4 ± 47.9 days), and private practices (58.5 ± 38.3 days) (p < 0.001).Precautionary measures adopted included patient segregation, utilisation of personal protective equipment, and preoperative testing. Following service recovery, 40% of the surgeons operated with a reduced capacity. Twenty-two percent gave priority to long waiters, 15.4% gave priority to uncontrolled diabetics, and 7.6% prioritised patients requiring organ transplantation.ConclusionThis study provides global, real-world data regarding the recovery of BMS services following the COVID-19 pandemic.Graphical abstract

Reirradiation with Photon Radiotherapy for Recurrent or New Primary Breast Cancer after Prior Breast Irradiation

<h3>Purpose/Objective(s)</h3> Recurrent or new primary breast cancer may benefit from the local and/or regional recurrence risk reduction provided by RT, but delivery of a repeat course of RT is challenging due to risks of potential serious toxicities to organs at risk. This has led to limited use and heterogeneous practice patterns of salvage RT delivery. We hypothesize that breast cancer reirradiation (reRT) may be feasible using modern photon treatment techniques, and we present clinical outcomes and toxicities from a large single institution cohort. <h3>Materials/Methods</h3> In an IRB-approved retrospective study, all consecutive patients with recurrent or new primary non-metastatic breast cancer treated with breast or chest wall (CW) RT and photon reRT from a single institution were identified. Patient and tumor characteristics, treatment parameters, clinical outcomes and toxicities were collected. Recurrence-free survival (RFS), distant metastasis-free survival (DMFS), and overall survival (OS) were defined from reRT start to date of any recurrence, distant recurrence, and death or last follow-up and estimated using Kaplan-Meier methodology. <h3>Results</h3> In total, 126 consecutive patients treated with reRT from 2013-2020 met criteria for analysis. Median age at reRT was 65 years (range 39-88). ReRT was delivered with 3DCRT in 47.6%, VMAT in 46.0%, and static IMRT in 6.4%. Median first, second, and cumulative prescription doses were 60.0 Gy, 46.4 Gy, and 105.0 Gy, respectively. Most received whole breast (WB) (80.2%) or partial breast (PB) (8.7%) initial RT. At reRT, 30.9% were treated to the PB, 11.1% WB/CW, 37.3% WB/CW with comprehensive regional lymph nodes (LN), and 12.8% WB/CW with partial regional LN. Median time between RT courses was 95 months (range 10-361). At a median follow-up of 26.5 months, 9 patients had died. Locoregional, distant, and any recurrence developed in 15 (11.9%), 22 (17.5%), and 28 (22.2%) patients, respectively. Estimated 3-year RFS was 80.7%, DMFS was 80.9%, and OS was 93.2%. Eleven (8.7%) patients developed grade 3 (G3) toxicities (dermatitis (n=8), acute (n=1) and late (n=1) CW pain, decreased joint range of motion (ROM) (n=1)); no G4 or G5 toxicities occurred. Five (4.0%) patients developed rib fracture. Of 23 patients retreated to a reconstructed CW, 30.4% and 34.8% developed Baker G1-2 or G3-4 implant contracture, respectively. Four patients had significant brachial plexus overlap, of whom 1 developed G2 decreased joint ROM and G2 soft tissue fibrosis and 1 developed G3 decreased joint ROM. <h3>Conclusion</h3> In the largest institutional experience to date on the use of photon reRT for recurrent or new primary breast cancer, reRT is associated with low rates of severe adverse events. In this high-risk population, locoregional and distant disease control rates are high. Further prospective study is needed to define the optimal treatment volume, prescription dose selection, and cumulative dose constraints with reRT to maximize the likelihood for successful and safe salvage therapy.