Set Of Facilities Research Articles

Recent development and mass production of high Je 2G-HTS tapes by using thin hastelloy substrate at Shanghai Superconductor Technology

Over the past few years, emerging applications such as high current conductors for magnets in compact fusion systems and ultra-high field insert magnets require higher engineering current density (Je) of the second generation high temperature superconductor (2G-HTS) tapes. In this paper, the state-of-art of 2G-HTS tapes with 30 μm Hastelloy substrate at Shanghai Superconductor Technology (SST) are presented. RE1Ba2Cu3O7 (REBCO, RE = rare earth) films with strong artificial pinning centers (APCs) are deposited on 30 μm thick Hastelloy substrate. Compared to those with 50 μm thick substrate, higher average critical current (Ic), better Ic homogeneity and better Ic linearity with film thickness increase are also achieved at 77 K self-field for tapes with 30 μm substrate, where piece lengths are up to 1 km. For a 4 mm wide tape with a total thickness of 35 μm, Ic and non-copper Je values reach 600 A and 450 kA cm−2 at 4.2 K, 10 T (B//c), respectively. Transmission electron microscopy observation reveals formation of mixed landscape defects mainly including high density of splayed nanoroads and stacking faults in the REBCO film thickness direction, which is attributed to the extremely high REBCO growth rate of over 50 nm s−1. The pinning force density (Fp) at 4.2 K, 12 T (B//c) reaches over 800 GN m−3, and the lift factors (defined as the ratio of Ic at 4.2 K, 10 T to Ic at 77 K, self-field) of tapes with large Ic range (100 to 500 A cm−1-w at 77 K, self-field) also show good consistency. The annual production of 10 mm wide tapes with such pinning centers can exceed 200 km for a single set of facility at SST. No significant Ic reduction is observed at bending diameter of 3 mm and the proof strength (Rp0.2_0) is 812 MPa, both measured at liquid nitrogen temperature.

MpUFLP: Universal facility location problem in the p-th power of metric space

We propose and study the MpUFLP (universal facility location problem in the p-th power of metric space) in this paper, where the universal facility location problem (UFLP) extends several classical facility location problems like the uncapacitated facility location, hard-capacitated facility location, soft-capacitated facility location, incremental-cost facility location, concave-cost facility location, etc. In UFLP, a set of facilities, a set of clients, as well as the distances between them are given. Each facility has its specific cost function w.r.t. the amount of clients assigned to that facility. The goal is to assign the clients to facilities such that the sum of facility cost and service cost is minimized. In traditional facility location problems, the unit service cost is proportional to the distance between the client and its assigned facility and thus metric. However, in our work, this assumption is removed and a generalized version of universal facility location problem is proposed, which is the so-called MnUFLP. When p=2, it is also known as l22 measure considered by Jain and Vazirani [J. ACM'01] and Fernandes et al. [Math. Program.'15]. Particularly in this case, we extend their work to include the aforementioned variants of facility location and a local search based (11.18+ε)-approximation algorithm is proposed. Furthermore, the reanalysis of the proposed algorithm gives a p-related performance guarantee for general p.

Evaluation of antecedent behaviors of dementia-related wandering in community and facility settings.

Aim: To understand antecedent behaviors to criticalwandering among persons living with dementia in or outside of a facility. Materials & methods: Caregivers were asked to write down the type and number of antecedent behaviors they observed in persons with dementia that were about to critically wander for 2-4weeks. Observations were made through a developed questionnaire. Results: Six antecedent behaviors were observed: stating intent to leave, door lingering/tampering, preparing to go outside, packing up belongings, calling to be picked up anddraw to outside stimuli. Conclusion: Information from this study can be used in the education of wander-management strategy adoption among caregivers of persons with dementia at risk of getting lost.

Quality antenatal care services delivery at health facilities of Ethiopia, assessment of the structure/input of care setting

BackgroundAccording to the Donabedian model, the assessment for the quality of care includes three dimensions. These are structure, process, and outcome. Therefore, the present study aimed at assessing the structural quality of Antenatal care (ANC) service provision in Ethiopian health facilities.MethodsData were obtained from the 2018 Ethiopian Service Availability and Readiness Assessment (SARA) survey. The SARA was a cross-sectional facility-based assessment conducted to capture health facility service availability and readiness in Ethiopia. A total of 764 health facilities were sampled in the 9 regions and 2 city administrations of the country. The availability of equipment, supplies, medicine, health worker’s training and availability of guidelines were assessed. Data were collected from October–December 2017. We run a multiple linear regression model to identify predictors of health facility readiness for Antenatal care service. The level of significance was determined at a p-value < 0.05.ResultAmong the selected health facilities, 80.5% of them offered Antenatal care service. However, the availability of specific services was very low. The availability of tetanus toxoid vaccination, folic acid, iron supplementation, and monitoring of hypertension disorder was, 67.7, 65.6, 68.6, and 75.1%, respectively. The overall mean availability among the ten tracer items that are necessary to provide quality Antenatal care services was 50%. In the multiple linear regression model, health centers, health posts and clinics scored lower Antenatal care service readiness compared to hospitals. The overall readiness index score was lower for private health facilities (β = − 0.047, 95% CI: (− 0.1, − 0.004). The readiness score had no association with the facility settings (Urban/Rural) (p-value > 0.05). Facilities in six regions except Dire Dawa had (β = 0.067, 95% CI: (0.004, 0.129) lower readiness score than facilities in Tigray region (p-value < 0.015).ConclusionThis analysis provides evidence of the gaps in structural readiness of health facilities to provide quality Antenatal care services. Key and essential supplies for quality Antenatal care service provision were missed in many of the health facilities. Guaranteeing properly equipped and staffed facilities shall be a target to improve the quality of Antenatal care services provision.

Initial data from an experiment to implement a safe procedure to perform PA erect chest radiographs for COVID-19 patients with a mobile radiographic system in a “clean” zone of the hospital ward

IntroductionWith the current Covid-19 pandemic, general wards have been converted into cohort wards for Covid-19 patients who are stable and ambulant. A 2-radiographer mobile radiography team is required to perform bedside Chest X-rays (CXR) for these patients. Hospital guidelines require both radiographers to be in full Personal Protective Equipment (PPE) throughout the image acquisition process and the mobile radiographic unit needs to be disinfected twice after each case. This affects the efficiency of the procedure and an increase usage of limited PPE resources. This study aims to explore the feasibility of performing mobile chest radiography with the mobile radiographic unit in a “clean” zone of the hospital ward. MethodsAn anthropomorphic body phantom was used during the test. With the mobile radiographic unit placed in a “clean” zone, the phantom and the mobile radiographic unit was segregated by the room door with a clear glass panel. The test was carried out with the room door open and closed. Integrated radiation level and patient dose were measured. A consultant radiologist was invited to review and score all the images acquired using a Barco Medical Grade workstation. The Absolute Visual Grading Analysis (VGA) scoring system was used to score these images. ResultsA VGA score of 4 was given to all the 40 test images, suggesting that there is no significant differences in the image quality of the images acquired using the 2 different methods. Radiation exposure received by the patient at the highest kV setting through the glass is comparable to the regular CXR on patient without glass panel at 90 kV, suggesting that there is no significant increase in patient dose. ConclusionThe result suggests that acquiring CXR with the X-ray beam attenuating through a glass panel is a safe and feasible way of performing CXR for COVID-19 patients in the newly converted COVID wards. This will allow the mobile radiographic unit as well as one radiographer to be completely segregated from the patient. Implications for practiceThis new method of acquiring CXR in an isolation facility set up requires a 2-Radiographer mobile radiography team, and is applicable only for patients who are generally well and not presented with any mobility issues. It is also important to note that a clear glass panel must be present in the barriers set up for segregation between the “clean” zone and patient zone in order to use this new method of acquiring CXR.

Clinical presentation and need for treatment of a cohort of subjects accessing to a mental illness prevention service.

Outreaching activities decrease prognostic accuracy of at-risk mental state defining tools, over-attracting subjects who are not at increased risk of mental illness. The setting was a mental illness primary indicated prevention outpatients service embedded within the Psychiatry Unit of Padua University Hospital, Italy. Help-seeking patients accessing the service between January 2018 and December 2018 were evaluated with validated tools assessing functioning, at-risk mental state, schizotypal personality features, depressive and anxious symptoms, together with medical and family history collection. The primary outcome was the prevalence of drop in functioning at presentation according to the Social and Occupational Functioning Assessment Scale (SOFAS). Secondary outcomes were diagnoses according to DSM-5 criteria and meeting criteria for at-risk mental state. Fifty-nine patients accessed the service, mean age was 18.8 (2.12) years old, 54.2% were females. Virtually all subjects (97.7%) had a drop in functioning. Baseline primary diagnoses were depressive episode in 33%, anxiety disorder in 21%, personality disorder in 17%, adjustment disorder 9%, conduct disorder 7%, schizophrenia spectrum disorder 5%, bipolar disorder 5%, eating disorder in 1.7%, dissociative disorder 1.7%. Overall, 59.1% met at-risk mental state criteria. Lower functioning was associated with anxious symptoms (p=0.031), a family history of mental illness (p=0.045) and of suicide (p=0.042), and schizotypal personality traits (p=0.036). Subjects accessing a prevention service embedded within the mental health department already present a trans-diagnostic drop in functioning, mainly due to a non-psychotic mental disorder, with at-risk mental state in one patient out of two, and schizophrenia or bipolar disorder already present in only 10% of subjects. Prevention service within mental health facility setting appears to properly detect subjects in need of treatment with a drop in functioning, at risk of developing severe mental illness, without any outreaching activity in the general population.

Extent of resection, molecular signature, and survival in 1p19q-codeleted gliomas.

Genomic analysis in neurooncology has underscored the importance of understanding the patterns of survival in different molecular subtypes within gliomas and their responses to treatment. In particular, diffuse gliomas are now principally characterized by their mutation status (IDH1 and 1p/19q codeletion), yet there remains a paucity of information regarding the prognostic value of molecular markers and extent of resection (EOR) on survival. Furthermore, given the modern emphasis on molecular rather than histological diagnosis, it is important to examine the effect of maximal resection on survival in all gliomas with 1p/q19 codeletions, as these will now be classified as oligodendrogliomas under the new WHO guidelines. The objectives of the present study were twofold: 1) to assess the association between EOR and survival for patients with oligodendrogliomas in the National Cancer Database (NCDB), which includes information on mutation status, and 2) to demonstrate the same effect for all patients with 1p/19q codeleted gliomas in the NCDB. The NCDB was queried for all cases of oligodendroglioma between 2004 and 2014, with follow-up dates through 2016. The authors found 2514 cases of histologically confirmed oligodendrogliomas for the final analysis of the effect of EOR on survival. Upon further query, 1067 1p/19q-codeleted tumors were identified in the NCDB. Patients who received subtotal resection (STR) or gross-total resection (GTR) were compared to those who received no tumor debulking surgery. Univariable and multivariable analyses of both overall survival and cause-specific survival were performed. EOR was associated with increased overall survival for both histologically confirmed oligodendrogliomas and all 1p/19q-codeleted-defined tumors (p < 0.001 and p = 0.002, respectively). Tumor grade, location, and size covaried predictably with EOR. When evaluating tumors by each classification system for predictors of overall survival, facility setting, age, comorbidity index, grade, location, chemotherapy, and radiation therapy were all shown to be significantly associated with overall survival. STR and GTR were independent predictors of improved survival in historically classified oligodendrogliomas (HR 0.83, p = 0.18; HR 0.69, p = 0.01, respectively) and in 1p/19q-codeleted tumors (HR 0.49, p < 0.01; HR 0.43, p < 0.01, respectively). By using the NCDB, the authors have demonstrated a side-by-side comparison of the survival benefits of greater EOR in 1p/19q-codeleted gliomas.

'Building on shaky ground'-challenges to and solutions for primary care guideline implementation in four provinces in South Africa: a qualitative study.

ObjectivesClinical guidelines support evidence-informed quality patient care. Our study explored perspectives of South African subnational health managers regarding barriers to and enablers for implementation for all available primary care guidelines.DesignWe used qualitative research methods, including semistructured, individual interviews and an interpretative perspective. Thematic content analysis was used to develop data categories and themes.SettingWe conducted research in four of nine South African provinces with diverse geographic, economic and health system arrangements (Eastern Cape, Western Cape, KwaZulu-Natal, Limpopo). South Africa is a middle-income country with high levels of inequality. The settings represented public sector rural and peri-urban health facilities.ParticipantsTwenty-two participants with provincial and district health management roles, that comprised implementation and/or training on primary care guidelines, were included.ResultsParticipants recommended urgent consideration of health system challenges, particularly financial constraints, impacting on access to the guidelines themselves and to medical equipment and supplies necessary to adhere to guidelines. They suggested that overcoming service delivery gaps requires strengthening of leadership, clarification of roles and enhanced accountability. Participants suggested that inadequate numbers of skilled clinical staff hampered guideline use and, ultimately, patient care. Quality assurance of training programmes for clinicians—particularly nurses—interdisciplinary training, and strengthening post-training mentorship were recommended. Furthermore, fit-for-purpose guideline implementation necessitates considering the unique settings of facilities, including local culture and geography. This requires guideline development to include guideline end users.ConclusionsGuidelines are one of the policy tools to achieve evidence-informed, cost-effective and universal healthcare. But, if not effectively implemented, they have no impact. Subnational health managers in poorly resourced settings suggested that shortcomings in the health system, along with poor consultation with end users, affect implementation. Short-term improvements are possible through increasing access to and training on guidelines. However, health system strengthening and recognition of socio-cultural–geographic diversity are prerequisites for context-appropriate evidence-informed practice.

Kv-scaling analysis to support the validation of Atucha-II Best Estimate Evaluation Model

In the frame of the licensing process of the Atucha-II PHWR (Pressurized Heavy Water Reactor) the BEPU (Best Estimate Plus Uncertainty) approach has been selected for issuing the Chapter 15 of FSAR (Final Safety Analysis Report) dealing with accident analysis. Approaches based on Best Estimate Plus Uncertainties (BEPU) to perform accident analysis of a Nuclear Power Plant (NPP) for licensing purposes request the availability of validated tools and specific procedures suitable for the analysis of accident conditions envisaged in the concerned NPP. This implies the necessity to adopt and to prove an adequate quality of the so-called Evaluation Model (EM), i.e. the ensemble of data, assumptions, codes and nodalizations developed and validated to be used for carrying out the safety analysis. The purpose of the present paper is to outline key aspects and results of one of the steps of the BEPU process concerning the qualification of the Atucha-II PHWR Evaluation Model for the licensing process. A special procedure, named “Kv-Scaled Analysis + Countepart Test Calculations” have been developed to take into account the specificities of Atucha-II NPP (CNA-2) and the fact that Atucha-II has not a prototype integral test facility. The proposed procedure uses a set of facilities which share some similar geometrical features and ranges of variations of relevant physical quantities for some subsystems or components of CNA-2, taking into account the different kind of accidents addressed in the Chapter 15 of the Final Safety Analysis Report (FSAR) of Atucha-II NPP. The final goal of the procedure is to qualify separately systems/sub-systems of the nodalization of the Atucha-II NPP while keeping the features of a full system analysis involving the whole NPP nodalization. A total of nine tests performed in six different scaled facilities have been considered and analyzed.

The Hitchhiker's Guide to Hydrogen Peroxide Fumigation, Part 1: Introduction to Hydrogen Peroxide Fumigation.

When working with pathogens in laboratories, animal or production facilities, and even hospitals, the potential need for room fumigation for decontamination purposes must be taken into consideration. Questions regarding the choice of fumigant, technical aspects of the room, its ventilation, the fumigation system to be used, and other issues will arise and will have to be addressed. This article is based on literature searches and was compiled using the authors' long-time personal experience in room and filter fumigation using various fumigation systems. The article can be used as a guide to establish an effective fumigation system in a laboratory or an animal facility setting and may be adapted for use in hospitals. Different systems for hydrogen peroxide fumigation on the market are presented. Also, technical aspects are discussed. Hydrogen peroxide is used in various forms for fumigation of rooms, equipment, and filters. Regardless of the individual limitations of these forms, hydrogen peroxide is a versatile fumigation method. However, it is important to consider numerous technical requirements when planning to implement hydrogen peroxide fumigation at an institution. Subsequent to the present overview of different fumigation systems based on hydrogen peroxide on the market and their technical requirements, part 2 of this article will focus on validation and verification of hydrogen peroxide fumigation while considering the entire fumigation process. The two parts together will serve users as a guide to establishing hydrogen peroxide fumigations at their facilities.

Coronavirus Disease 2019 in Geriatrics and Long-Term Care: The ABCDs of COVID-19.

The pandemic of coronavirus disease of 2019 (COVID-19) is having a global impact unseen since the 1918 worldwide influenza epidemic. All aspects of life have changed dramatically for now. The group most susceptible to COVID-19 are older adults and those with chronic underlying medical disorders. The population residing in long-term care facilities generally are those who are both old and have multiple comorbidities. In this article we provide information, insights, and recommended approaches to COVID-19 in the long-term facility setting. Because the situation is fluid and changing rapidly, readers are encouraged to access frequently the resources cited in this article. J Am Geriatr Soc 68:912-917, 2020.

Smart Railway Operation Aid System for Facilities With Low-Safety Requirements

Rail traffic control systems are undergoing an important transformation. ERMTS/ECTS, CBTC, PTC and other train control systems based on radio communication are being deployed in different countries. These systems meet the high safety requirements for passenger traffic, and cover from congested urban areas to high-speed trains. However, there is a set of facilities, such as ports, dry ports, facilities for the repair and maintenance of trains, logistic centers, mines, etc., whose trains, that only carry freight, circulate in a controlled environment at a low speed. These facilities have low safety requirements. For them, present commercial systems become too expensive, so that, in most cases, railway traffic is still handled manually. This paper presents a system to aid in the exploitation of rail traffic for this type of facilities, called SFPS (Seville Ferro-Port System). SFPS presents many of the features of the most advanced traffic control systems, but incorporates innovations based on Information and Communications Technologies to reduce costs. To this end, train location is based on a satellite global positioning system, physical signs are replaced by virtual ones, displayed in an On-Board Unit, and communication is almost entirely wireless. SFPS has been in a trial phase since March 2016, covering part of the railway facilities of the Port Authority of Seville, with satisfactory results.

The cost-effectiveness of sub-epidermal moisture scanning to assess pressure injury risk in U.S. health systems

ObjectiveHospital-acquired pressure injuries harm over 2.5 million patients at a U.S. cost of $26.8 billion. Sub-epidermal moisture scanning technology supports clinicians to anatomically identify locations at-risk of developing hospital-acquired pressure injuries. Our objective was to evaluate the cost-effectiveness of adopting sub-epidermal moisture scanners in comparison to existing hospital-acquired pressure injury prevention guidelines structured around subjective risk assessments.MethodsA Markov cohort model was developed to analyze the cost-effectiveness of sub-epidermal moisture scanners in comparison to existing prevention guidelines, based on current clinical trial data from the U.S. health care sector perspective in the acute, acute rehabilitation and skilled nursing facility settings. A hypothetical cohort was simulated over a time horizon of one year. An incremental cost-effectiveness ratio was measured using U.S. dollars per quality-adjusted life year at a willingness-to-pay threshold of $100,000/quality-adjusted life year, and uncertainty was tested using probabilistic sensitivity analysis.ResultsIntegration of sub-epidermal moisture scanners yielded cost-savings of $4054 and 0.35 quality-adjusted life years gained per acute care admission, suggesting that sub-epidermal moisture scanners are a dominant strategy compared to standard care and producing a net monetary benefit of $39,335. For every 1000 admissions in high-risk acute care, sub-epidermal moisture scanners could avert around seven hospital-acquired pressure injury-related deaths and decrease hospital-acquired pressure injury-related re-hospitalization by approximately 206 bed-days.ConclusionsAcute care, acute rehabilitation and skilled nursing settings that adopt sub-epidermal moisture technology could achieve a return on investment in less than one year. Providers may want to consider these types of technology that aid clinical judgment with objective measures of risk in quality improvement bundles.

How the Implementation of a Battlefield Clinical Practice Guideline Affects Documentation Practice and Informs Future Research Initiatives: Spinal Injuries and Cervical Collars

In 2010, the Joint Trauma System published a clinical practice guideline (CPG) for providing care to patients with suspicion of spinal cord injury. The CPG advocated for liberal use of cervical collars and adequate documentation of the practice. This performance improvement project examined C-spine CPG adherence in both the prehospital and military treatment facility (MTF) settings. Understanding challenges in CPG adherence facilitates evaluation of future CPGs and their success at implantation of the clinical guidance. The Department of Defense Trauma Registry was used to identify US Military casualties meeting the criteria for cervical collar placement between January 1, 2007 and December 31, 2018. Criteria for cervical collar placement were defined as any patient who experienced a mechanism of injury relating to an explosion, fall, or motor-vehicle-related injury. Any patients with an AIS severity score greater than 1 to the head or having any ICD injury codes related to either upper spinal cord or head injury were also considered for inclusion. Adherence of cervical collar placement was defined by documented ICD codes or prehospital documentation of cervical collar placement as captured in the registry. A total of 14,837 patients were identified for possible cervical collar placement and 3,317 had verifiable documentation of having a C-collar placed. Documented C-collar placement was higher after the publication of the clinical practice guideline in 2010 (29% vs. 15%, p<0.0001). CPG publication was associated with cervical collar application (odds ratio: 2.50, 95% CI: 2.29-2.72). Application of cervical collars has increased significantly, since the initial publication of the spine injury CPG. Current gaps include valid and reliable identification of patients warranting specific clinical interventions and documentation of patient care. Currently, lack of documentation is reported as nonadherence, but it remains unknown if these missing clinical data accurately portray nonadherence or adherence with lack of documentation. Future research and resources would benefit and expand the results collected in this paper, and cement the importance of CPG publication and adherence.

Spatiotemporal modelling of pregabalin prescribing in England with effect of deprivation

ObjectiveThis paper aims to understand spatial and temporal trends in pregabalin prescribing and the relationship with deprivation across England at both general practice and clinical commissioning group (CCG) levels.DesignA set...

Implementation of an Evidence-Based, Nurse-Driven Sepsis Protocol to Reduce Acute Care Transfer Readmissions in the Inpatient Rehabilitation Facility Setting.

Implementation of an Evidence-Based, Nurse-Driven Sepsis Protocol to Reduce Acute Care Transfer Readmissions in the Inpatient Rehabilitation Facility Setting.

HELICOURTS INTEGRATION IN THE CITY ARCHITECTURAL ENVIRONMENT

The article investigates the construction of an air network of a set of structures to service the passengers of air transport along the high right coast of Dnieper. The topic research methodology consists of a set of practical, theoretical, empirical, retrospective, and factor analysis techniques. In this article, the theoretical method of development is considered based on the example of Kyiv. The problem of transport communication in Kyiv is outlined: the city features an incompatibility between the urban planning structure and the need for transport support. It is proposed to introduce the progressive transportation methods, i.e. to organize the air traffic within the city. A new type of structural superstructure for air transport service, i.e. helicourts, is defined. The notion of Helicourt is defined based on the Greek "βιδωτό", a "screw", and the English "court". Helicourt is a set of facilities to service the passengers of air transport, which is located only on the part crowning a residential house or a public building, or is located on the platform of the transport hub and has an equipped platform designed for take-off and landing of helicopters or rescue crews. The latest research is analyzed in order to create a harmonious architectural environment for helicourts. The environment of the high right bank of the Dnieper, having an architectural and artistic expression, which should be maintained in the full range of natural, planning, and architectural components of Kyiv is analyzed. The examples of constructing the air network of a set of structures for air transport passenger servicing along the Dnieper River are given. It is proposed to preserve the unique appearance of the right bank of the Dnieper River with harmonious inclusion of helicourts in this architectural environment.

Abstract P5-12-03: Socio-demographic differences in utilization of genomic testing and receipt of endocrine therapy in the National Cancer Database

Abstract Background &amp; Objectives Breast cancer outcome disparities for racial and ethnic minorities continues to be a problem in the United States. Genomic testing in early stage hormone positive breast cancer is the current standard of care given the useful predictive and prognostic value of testing. However, chemotherapy treatment decisions based on genomic testing results are predicated on the assumption that patient adhere to adjuvant endocrine treatment. Factors that could contribute to ongoing disparities for racial and ethnic minorities include both the utilization of genomic testing and adherence to hormonal therapy. Understanding these patterns of care across the United States with a large dataset has not yet been done. Methods We analyzed a cohort from the National Cancer Database (NCDB) of 387,008 female patients diagnosed with Stage I-II, ER+ breast cancer between 2010 and 2014. Demographic variables included age, race, ethnicity, insurance status, income, education, Charlson-Deyo comorbidity score. Clinicopathologic and treatment variables included tumor grade, histology, receptor status, facility type, delivery of treatment at &amp;gt;1 facility and receipt of genomic testing. Descriptive statistics using chi-square testing were computed to describe patient, tumor and treatment characteristics. Logistic regression analysis was used to calculate odds of genomic testing and receipt of hormone therapy among patients who did or did not receive genomic testing. Results Among a total sample size of 387,008, median age was 63 years old, majority white (87%), non-Hispanic (95.4%), without co-morbidities (88%). A total of 147,863 (38.2%) patients underwent genomic testing. Compared to patients with ages 18-&amp;lt;50, older age (≥70 years) was associated with a lower adjusted odds of genomic testing (OR=0.33; 95% CI=0.32-0.34, p=&amp;lt;0.0001). Blacks had a lower odds of receiving genomic testing on multivariate analysis compared to whites (OR=0.82; 95% CI=0.80-0.85, p=&amp;lt;0.0001). Hispanic ethnicity, non-private insurance, increasing percentage of no high school degree in area of residence, CDS score of 2 or more, stage II disease, community or comprehensive community facility setting, and borderline HER2 status were also factors associated with a lower odds of receiving a genomic test. Odds of getting genomic testing improved over the years with patients diagnosed in 2014 reporting an odds ratio of 1.57 (95% CI=1.53-1.60, p=&amp;lt;0.0001) compared to those diagnosed in 2010. Compared to whites, blacks had a lower odds of receiving hormone therapy irrespective of genomic testing status (OR=0.86; 95% CI=0.83-0.88, p=&amp;lt;0.0001). Age ≥70 (OR=0.53; 95% CI=0.51-0.55, p=&amp;lt;0.0001), Hispanic ethnicity (OR=0.89; 95% CI=0.85-0.93, p=&amp;lt;0.0001), non-private insurance and non-academic treatment facilities were associated with lower odds of getting hormone therapy. Among patients undergoing a genomic test, age ≥70, black race, and non-academic treatment facilities had lower odds of receiving hormone therapy. Conclusion In a national cohort of breast cancer patients, Black women consistently were less likely to get genomic testing and less likely to receive hormonal therapy. Ensuring that all women with early stage ER+ breast cancer eligible for genomic testing and hormone therapy receive appropriate testing and hormonal treatment is a priority to addressing breast cancer disparities. Citation Format: Naomi Y Ko, Mustafa Q Muhammad, Michael R Cassidy, Lauren Oshry, Ariel E Hirsch. Socio-demographic differences in utilization of genomic testing and receipt of endocrine therapy in the National Cancer Database [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-12-03.

The elderly centre location problem

Increased human life expectancy combined with declining birth rates around the globe has led to ageing populations, particularly in the developed world. This phenomenon brings about increased dependency ratios and calls for setting new policies for the elderly citizens. This comprises provision of a set of life-enhancing services in an accessible and equitable way. In this paper, we consider the multi-period problem of locating senior centres offering these services to the elderly population with budget constraints and capacity limitations. Both consistent and inconsistent versions of the problem are considered, aiming at identifying the set of facilities to operate in each region at each period, the service type(s) to be offered and the allocation of budget in each period to location and operation of facilities. A mixed integer mathematical programming model is presented, an efficient iterated local search procedure is proposed and managerial insights are provided.

GIS applied to location of bioenergy plants in tropical agricultural areas

This study aimed to develop an optimal set and size model of bioenergy facilities using a GIS framework. Data from sugarcane plantations were used to create case scenarios. Spatial analysis was accomplished by applying a two-phase approach: identification of suitable zones to locate bioenergy facilities and identification of ideal areas. These analyses led to a location-allocation model, using Maximize Capacitated Coverage option, in order to assign sugarcane supply areas to potential bioenergy facilities. Nine themes, as well their respective weights, generated by AHP, were used to create a visual depiction of potential sites. This layer was reclassified into five categories, using Natural Breaks (Jenks) method. Various scenarios of bioenergy plants installation were simulated. Around 50% of the area is unsuitable for bioenergy plants. A total of 1,737 potential sites were detected for implanting bioenergy plants. The best regions to locate bioenergy plants were peripheral areas. Cumulative biomass transportation distances dramatically reduce as the number of facilities increases. There is a reduction of 31% in total and average distances when comparing a 4-plant scenario with a single plant scenario. Proposed scenarios can support decision making with different numbers of bioenergy plants. Proposed methodology can be adapted to areas of other countries.