Logistical Delays Research Articles

DIVÓRCIO NO BRASIL NO PERÍODO PRÉ E PÓS PANDEMIA DA COVID-19: UM ESTUDO ACERCA DA JUDICIALIZAÇÃO DO DIVÓRCIO NESSE PERÍODO

Divorce in Brazil reflects changes in family, social, and legal relations over time. This study explores the judicialization of divorce, highlighting its increase during and after the Covid-19 pandemic. Pandemic challenges such as mobility restrictions drove the adoption of digital solutions to facilitate legal procedures, although logistical challenges arose. The study's qualitative approach seeks to understand the factors influencing divorce and its implications, aiming to contribute to more effective policies. Research findings indicate a significant decrease in the number of divorces in Brazil in 2020, totaling 331.2 thousand cases, followed by a significant increase in 2021, reaching a record of 386.8 thousand divorces. In 2022, there was a decrease to 68,703 cases until November, reflecting fluctuations influenced by social and economic conditions during the pandemic. The transition to the virtual environment during the pandemic facilitated divorce processes, with virtual hearings and digital document signatures, overcoming logistical challenges and delays in legal procedures. The analysis reveals significant variations in the number of divorces during and after the pandemic, reflecting social and economic changes. The transition to the virtual environment facilitated legal procedures, while changes in family structures demand supportive policies. Future studies can further explore the impact of technological adaptations on the divorce process, including the effectiveness of virtual hearings and the security of online communications.

Reassessing the transition from paper to electronic bills of lading: regulatory impediments and prospective reforms in Nigeria’s maritime sector

PurposeThe purpose of this paper is to re-evaluate the legal barriers surrounding the implementation of electronic billing systems and to propose potential reforms aimed at facilitating their efficient and widespread adoption in Nigeria. Since the 16th century, bills of lading have been integral to global trade, evolving in response to the practical exigencies and technological advancements of their respective eras. Despite their historical significance, the traditional paper-based bill of lading has increasingly been recognised as a hindrance to contemporary maritime commerce. The inherent vulnerabilities of physical documents such as susceptibility to damage and the logistical delays associated with their manual transfer have underscored the inefficiencies of this conventional system. These limitations have catalysed the development of electronic bills of lading (e-bills of lading) as a digital counterpart, a transition particularly pertinent within Nigeria’s maritime sector. Nevertheless, the adoption of e-bills of lading has engendered considerable apprehension, largely due to uncertainties surrounding their legal validity and operational efficacy.Design/methodology/approachThis paper conducts a comprehensive desk-based study to examine the historical evolution and current concerns surrounding e-bills of lading as a substitute for traditional paper forms.FindingsSpecifically, the paper advocates for the enactment of clear and robust legislation that would grant e-bills of lading the same legal status as their paper counterparts.Originality/valueThis paper offers an original contribution to the academic and legal discourse on the subject, providing a novel analysis of the regulatory gaps while proposing practical recommendations for the effective adoption of e-bills of lading in Nigeria’s maritime industry.

Intensive Reinduction Chemotherapy Followed by Early Allogeneic Hematopoietic Cell Transplantation for Relapsed/Refractory High-Grade Myeloid Neoplasms

Outcomes for adults with relapsed/refractory (R/R) high-grade myeloid neoplasms remain poor, with allogeneic hematopoietic cell transplantation (HCT) the sole therapy likely to result in cure. We conducted the present study to determine the feasibility of early HCT-within 60 days of beginning reinduction chemotherapy-to see whether getting patients to HCT in an expeditious manner would expand the number of patients being offered this curative option. In this proof-of-principle feasibility study, we included adults age 18 to 75 years with R/R myeloid malignancies with ≥10% blood/marrow blasts at diagnosis who were eligible for a reduced-intensity HCT. Subjects received reinduction chemotherapy with cladribine, cytarabine, mitoxantrone, and filgrastim (CLAG-M) and proceeded to HCT with reduced-intensity conditioning (fludarabine/ melphalan). We enrolled 30 subjects, all of whom received CLAG-M reinduction, although only 9 underwent HCT within 60 days (<15, the predetermined threshold for feasibility "success"), with a median time to HCT of 48 days (range, 42 to 60 days). Eleven additional subjects received HCT beyond the target 60 days (off-study), with a median time to transplantation of 83 days (range, 53 to 367 days). Barriers to early HCT included infection, physician preference, lack of an HLA-matched donor, logistical delays, and disease progression, all of which may limit the real-world uptake of such early-to-transplantation protocols.

Fast and Convenient Human Immune Profiling of Fresh and Long-Term Stabilized Whole Blood Samples Enabled With CyTOF

Abstract Whole blood (WB) analysis within 24 hours of collection is crucial for monitoring clinical efficacy of therapies. WB collection and cytometric analysis are often performed at different sites, leading to significant delays. Fixation of WB with stabilizer reagents can overcome these challenges. However, not all antibody panels are compatible with these reagents. A high-parameter CyTOF™ panel was created to be compatible with commercial WB stabilizers to enable fast and convenient human immune profiling. The CyTOF panel contains 20 metal-tagged antibodies to identify over 30 immune cell populations in a single tube of fresh or stabilized WB. There are more than 30 open channels for additional markers. Flexibility of the panel and its workflow was shown using two methods of stabilization, in which WB is either stained followed by freeze storage or WB is first frozen then later stained. To reduce technical variability in staining and acquisition, the CyTOF panel was pooled and frozen as single-use aliquots ahead of time, and samples were barcoded and acquired as a single tube. The CyTOF panel for broad immune profiling overcomes analysis challenges caused by logistical delays as WB samples can be frozen with various workflows. Furthermore, freezing antibody cocktails is a unique feature of CyTOF flow cytometry, ensuring staining consistency. Thus, CyTOF workflows enable fast and convenient cytometry of WB samples. For Research Use Only. Not for use in diagnostic procedures.

Cryopreserved leukapheresis material can be transferred from controlled rate freezers to ultracold storage at warmer temperatures without affecting downstream CAR-T cell culture performance and in-vitro functionality

Chimeric antigen receptor (CAR) T-cell therapies are increasingly adopted as a commercially available treatment for hematologic and solid tumor cancers. As CAR-T therapies reach more patients globally, the cryopreservation and banking of patients’ leukapheresis materials is becoming imperative to accommodate intra/inter-national shipping logistical delays and provide greater manufacturing flexibility. This study aims to determine the optimal temperature range for transferring cryopreserved leukapheresis materials from two distinct types of controlled rate freezing systems, Liquid Nitrogen (LN2)-based and LN2-free Conduction Cooling-based, to the ultracold LN2 storage freezer (≤−135 °C), and its impact on CAR T-cell production and functionality. Presented findings demonstrate that there is no significant influence on CAR T-cell expansion, differentiation, or downstream in-vitro function when employing a transfer temperature range spanning from −30 °C to −80 °C for the LN2-based controlled rate freezers as well as for conduction cooling controlled rate freezers. Notably, CAR T-cells generated from cryopreserved leukapheresis materials using the conduction cooling controlled rate freezer exhibited suboptimal performance in certain donors at transfer temperatures lower than −60 °C, possibly due to the reduced cooling rate of lower than 1 °C/min and extended dwelling time needed to reach the final temperatures within these systems. This cohort of data suggests that there is a low risk to transfer cryopreserved leukapheresis materials at higher temperatures (between −30 °C and −60 °C) with good functional recovery using either controlled cooling system, and the cryopreserved materials are suitable to use as the starting material for autologous CAR T-cell therapies.

Identification and assessment of supply chain risks: The case of food hubs

AbstractThe supply chain risk management literature highlights the importance of ex‐ante identification and assessment of risks to ensure continuity of firms, in particular, and the high performance of supply chains in which they operate, in general. Supply chain disruptions are harmful and costly for firms. The risk of such disruptions can be particularly consequential for firms in emerging industries that lack resources and for which dominant organizational and supply chain designs do not yet exist. Within local and regional food supply chains, food hubs are nascent enterprises coordinating these supply chains. Building off the existing supply chain risk management literature, this study identifies and assesses the perceived supply chain risks faced by U.S. food hubs. The study employs an exploratory sequential mixed methods research design and the Failure Mode and Effect Analysis methodology for this purpose. The results show risks related to imbalances in food supply and demand, logistical delays, human resources, and infrastructure capacity limitations were perceived to be the highest priority supply chain risks for the U.S. food hubs before the COVID‐19 pandemic. The study further provides insights on association between food hub characteristics and risk, as well as association between risk preferences and risk perceptions of food hub managers [EconLit Citations: L29 Other (Firm Supply Chain Risk Management)].

Is localization better than globalization for sustainability? Evidence from the nutraceuticals industry for managing malnutrition in India

The socioeconomic consequences of the worldwide burden of malnutrition are substantial, with long-term consequences for individuals, their families, and their countries. Despite being one of the world's greatest producers of various agricultural products, India has regularly performed poorly in the Global Hunger Index. The World Food Programme provides funds to deliver a nutraceutical product (Plumpy Nut) to malnourished children in Low- and Medium-Income Countries (LMIC). The cost of obtaining these items from the international market is high, and worldwide logistics contribute to pollution. Despite these efforts, there has been insufficient food to feed nearly 40% of malnourished children in India, owing to budget constraints. This research provides a linear programming model and the Augmented ε-Constraint Method for developing a sustainable nutraceutical network. The model examines whether localizing the availability of nutraceutical items, in comparison to global sourcing, might be a viable option for improved managing malnutrition in LMIC's. The findings illustrate that localization can lead to a significant reduction in both cost (50%) and greenhouse gas emissions (90%). In addition, localization leads to feeding increased number of malnourished children in the budget constraint environment. Localization can also lead to a reduction in lead time related to due import-related logistical delays. The study offers insights into various policy interventions for stakeholders such as the government, producers, malnourished children (consumers), and others, to reduce malnutrition, while contributing towards United Nations Sustainable Development Goals of Zero Hunger and Responsible Consumption-Production by 2030. We use a case study from India to validate the model.

Static management presents a simple solution to a dynamic fishery and conservation challenge

Dynamic ocean management, which leverages near real-time data to adaptively shift management in response to changing ocean conditions, is gaining attention as an alternative to static approaches for managing dynamic fisheries challenges. While promising, dynamic management can be data-intensive, costly, and difficult to implement, and its value relative to simpler static approaches should be evaluated before being applied, especially when endangered species and economically crucial fisheries are at risk. Here, we use management strategy evaluation to compare static and dynamic management strategies for reducing humpback whale (Megaptera novaeangliae) entanglement risk in the highly lucrative California Dungeness crab (Metacarcinus magister) trap fishery. We find that simple gear reductions outperform dynamic management strategies across several measures of performance. Gear reductions maintain uninterrupted fishing seasons and high fisheries catch and effectively prevent whale entanglement risk by directly reducing the number of vertical trap lines. Furthermore, gear reductions are robust to delayed openings resulting from biotoxin contamination and low meat quality, do not depend on the availability or accuracy of entanglement risk indicators, add no new management costs or enforcement challenges, and avoid biases in geographical equity. Dynamic management strategies, which proactively or reactively respond to indicators of entanglement risk, struggle to achieve their intended benefits because they are implemented after long logistical delays and because they redistribute rather than reduce entanglement risk. Bycatch threatens protected species and valuable fisheries around the world and models like the one developed here present valuable tools for weighing solutions to complex fisheries and conservation challenges.

Rapid assessment of NCD services rollout in Health and Wellness Centres in North-Eastern Indian state: A cross- sectional study.

The creation of health and wellness centres (HWCs) to deliver comprehensive primary healthcare (CPHC) is a programmatic response to the changing demographic and epidemiological profile in India. Since the north-eastern (NE) states face distinct challenges to routine healthcare services, and it has been two years since the rollout of non-communicable disease (NCD) services through the HWCs, a rapid assessment of the rollout with respect to all components of CPHC was undertaken in the NE state of Manipur. The assessment was undertaken using a mixed methodology to assess the rollout of NCD services under CPHC based on the functionality criteria of HWCs. The districts and the facilities were sampled purposively using pre-defined criteria. Primary data were collected using adapted pre-tested semi-structured tools and an interview schedule, which were triangulated with facility-based records and field observations. The data were anonymized, analysed thematically and presented under the domains of CPHC. The assessment aided in identifying progress and challenges in the rollout of NCD services through the HWCs. Overall, the initiative was successful in generating demand and community awareness of the expanded range of services at the primary level. Yet, constraints posed by infrastructural gaps, logistical delays, training gaps, fund flow and weak community-level convergence compounded by the COVID-19 pandemic challenged seamless NCD service delivery. In as much as the attainment of universal health coverage is dependent on NCD prevention and control, the rollout of NCD services is dependent on strong institutional structures, especially at the primary level. The assessment highlights the need to strengthen the HWCs through adequate financing, human resources, logistics for medicines and technology, community participation, citizen engagement and change management.

The performance of the German chemical industry through the prism of geopolitical instability

The aggravated energy crisis caused by rising raw materials’ prices significantly reshapes the global chemical industry. The European Union is the second largest market in terms of turnover, lagging only behind the People’s Republic of China. The EU market is dominated by Germany that occupies the leading position in the industry and determines production standards for the entire European community. The industry faces new challenges as it has not yet completely recovered from COVID-19 pandemic. Growing costs for electricity and resources, disruption of supply chains, logistical delays in semi-processed and basic chemicals’ supply as well as diminishing demand lead to crises that are already traceable in the fi rst half of 2022. A fairly capital-intensive, energy-intensive and export-oriented German chemical industry significantly aff ects adjacent industries such as metallurgy, construction, automobile production, agriculture and healthcare. The given article analyses the current state of the German chemical industry and its positioning on the global markets in the context of geopolitical shifts as well as its adaptation to the rapidly changing conditions. The inability to comply with the strict norms of the European Commission within the framework of the green agenda as well as the insufficiency of energy resources are already forcing companies operating in the industry to take desperate measures and deviate from the original standards. Competition against the rapidly growing Japanese chemical industry in the recent years is forcing Germany to undertake critical measures aimed at protecting its share of the global market. Thus, there is a downward trend in production capacities that has a direct impact on the general state of the industry.

Exploring the incidence and causes of cesarean Delivery : Partially Mixed Concurrent quantitative and Qualitative analysis from a Medical College

Background: India has seen a rise in the incidence of cesarean deliveries (CD) especially in the last decade. The present national average stands at 17.2%, which if taken as a stand alone figure represents an almost ideal statistical measurement. However, the country has widespread regional variations in the CD rate, ranging from 4.4% to 35.9%. Auditing individual CD rates by each institution, and exploring reasons for high incidence remains an essential component of maternal care. Aim of the study: The present study was done to find out the incidence of CD at our facility, compare it with the national average and explore reasons for high incidence of CD. Methodology: It is a partially mixed concurrent quantitative and qualitative study including retrospective analysis of one year data and filling up of questionnaire from resident doctors. Data extraction was done from Maternity Ward, for all women who delivered during the aforementioned period in our facility, including socio-demographic profile, number of births, mode of delivery, reasons for induction of labour and any complications during childbirth. Statistical analysis was done using appropriate tests. Results: A total of 621 deliveries were studied, out of which 44.6% delivered vaginally and 55.3% had CD. Conclusion: The incidence of CD in the present study is 55.3% . The main reasons for high incidence of CD are high risk pregnancies, previous CD, fear of litigation and logistical delays in performing Category I cesarean section, prompting early decision for CD. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 284-290

Abstract TMP31: Genesis Of Malpractice Risk With Mechanical Thrombectomy

Introduction: In 1996 tPA was approved for treatment of acute ischemic stroke (AIS), leading to a higher bar for quality of care but also to many medical-legal claims. Subsequent reviews of legal databases showed most lawsuits were for failure to treat rather than for tPA-associated complications. Acute stroke care has again undergone a paradigm shift with the landmark mechanical thrombectomy (MT) trials, the AHA’s recommendation of MT for AIS, and its adoption as standard of care therapy for acute large vessel occlusions of the brain in select patients. Accordingly, lawsuits have been brought forward alleging malpractice. The aim of our study was to systematically review legal databases to better understand claims pertaining to MT. Methods: Legal databases were searched using key words “stroke” and “thrombectomy”. Cases were included if they were medical malpractice claims for AIS involving endovascular MT. Cases with and without verdicts were included and were systematically categorized based on claims and case details including vascular territory, interventions, and plaintiff/defendant arguments. Results: Search criteria revealed 313 results of which 25 cases met inclusion criteria. Cases were most frequently excluded due to duplicate result (n=126), or not being a malpractice claim for AIS (n=65). Anterior circulation strokes were the cause of complaint in 13 cases, vertebrobasilar and related strokes in 10 cases, and other/unknown in 2 cases. In 16 cases MT was not performed, leading to an alleged failure to timely diagnose and treat AIS. In the remaining 9 cases where MT was performed, 8 cases also alleged failure of timely treatment and 1 claimed complications of MT. Other frequent allegations included failure of timely consultation, performance of vascular imaging, or transfer. Specific allegations related to delay in transfer included choice of road vs. air ambulance travel, and transfer to in-network hospital vs. nearest MT-capable center. One case involved a tele-stroke neurologist. Conclusions: Similar to medical-legal claims for tPA, failure to perform (or failure to timely perform) MT was a common complaint. In addition, delays in obtaining vascular imaging and logistical delays in transfer causing potential delays in MT were commonly noted.

Mechanical Thrombectomy Access for All? Challenges in Increasing Endovascular Treatment for Acute Ischemic Stroke in the United States.

Mechanical thrombectomy (MT) is the most effective treatment for selected patients with an acute ischemic stroke due to emergent large vessel occlusions (LVOs). There is an urgent need to identify and address challenges in access to MT to maximize the numbers of patients who can benefit from this treatment. Barriers in access to MT include delays in evaluation and accurate diagnosis of LVO leading to inappropriate triage, logistical delays related to availability of facilities and trained interventionalists, and financial hurdles that affect treatment reimbursement. Collection of regional data related to these barriers is critical to better understand current access gaps and a measurable access score to thrombectomy could be useful to plan local public health intervention.

Voter Participation and Electoral Integrity in Nigeria’s 2019 General Elections

This paper examines the inclusivity and legitimacy of elections in Nigeria’s Fourth Republic amidst, concerns continually expressed over the zero-sum nature of Nigerian politics, which manifests in the rising tide of contentious elections. Issues such as logistical failures and delays, misconduct and irregularities, violence, challenges of internal party democracy, corruption and a biased judiciary, have almost become permanent features of electioneering in the country. The paper explores the value mechanisms and processes that can enable an electoral process that guarantees transparency and accountability based on Nigeria’s electoral laws and regional instruments, such as the African Charter on Human and Peoples’ Rights, provides a credible opportunity for broad based participation, enables significant roles for the judiciary, anticorruption bodies, civil society organisations, and political parties as well as provide the strategic tools to ensure the credibility and integrity of each stage of the electoral cycle. The context of the 2019 elections, which recorded the participation of only a third of the 84 million eligible voters, will provide a barometer to measure the overall health of Nigeria’s electoral democracy, drawing extensively from secondary sources.

Analisis Distribusi Logistik pada Pemilu 2019 di Kota Medan

This study aims to explore the 2019 election logistics distribution process carried out by the KPU of Medan City along with the obstacles that resulted in the late election logistics distribution process; finding a way out of the delay in the distribution process of election logistics in Medan City so that it is in accordance with the principles of being on time, effectively and efficiently; and to analyze the impact of late distribution of election logistics on the integrity of elections. This study used descriptive qualitative method. The results showed that many factors caused delays in the distribution of the 2019 election logistics, such as the DPTHP stage, fleet shortages, policies taken for distribution from PPS in urban villages to polling stations on April 17, 2019 before the start of voting, and others. as a way out of these problems: one, permanent distribution from KPU to PPS and finally to TPS; two, Using distribution centers (warehouses) in five constituencies in Medan City to break the concentration from one place in order to ease the work, be more focused, and minimize the occurrence of logistical delays and the exchange of ballots between electoral districts. Logistical delays indicate human error, lack of capacity and capability of election administrators.

Biliary cultures of patients with malignant biliary obstruction undergoing pancreaticoduodenectomy and the effect on infectious complications

Introduction: Infective complications are common after pancreaticoduodenectomy and are associated with prolonged hospital stay, delay starting adjuvant therapy and worse disease-free survival. Pre-operative biliary drainage (POBD) is associated with bactobilia and is a risk factor for post-operative infective complications. Indications for POBD include cholangits, severe hyperbilirubinaemia or poor nutritional status at presentation. It is also required to facilitate neo-adjuvant therapy and because of logistical delays to surgery. Methods: We performed a retrospective review of the prospectively maintained pancreatic resection database at an Academic Hospital in Cape Town, South Africa. All patients that had a pancreaticoduodenectomy between the 1st of October 2008 until the 31st of May 2019 were included in the study. Patients were only included if there was an intra-operative biliary culture (IOBC). Patients were divided into those with and without POBD. Perioperative variables including demographic data, microbiology data (microorganisms and antibiotic susceptibility), prophylactic antibody use, POBD, post-operative complications, and mortality, length of ICU and hospital admission. Results: 171 patients had a pancreaticoduodenectomy. 43 patients were excluded as there was no intraoperative culture and/or they had benign pathology. 128 patients were included in the analysis. 89 (69.5%) of these patients had POBD versus 39 (30.5%) without POBD. Patients without POBD were significantly more likely to have sterile intra-operative biliary cultures than patients with POBD (38.6% vs. 6.74%). In 18/45 (40%) of POBD patients and 4/21 (19%) of patients without POBD there was correlation between the IOBC and at least one of the post-operative cultures. Conclusion: This study highlights the importance of institutional specific microbiological reviews to guide appropriate institution specific antibiotic stewardship. The high correlation between IOBC and post-operative cultures favoured prolonged antibiotic therapy in patients with positive IOBC. The high incidence of positive cultures in patients without POBD was a noticeable difference to studies from other regions in the world.

A Phenotypic Screen for the Liver Stages of Plasmodium vivax

Control of malaria caused by Plasmodium vivax can be improved by the discovery and development of novel drugs against the parasite's liver stage, which includes relapse-causing hypnozoites. Several recent reports describe breakthroughs in the culture of the P. vivax liver stage in 384-well microtiter plates, with the goal of enabling a hypnozoite-focused drug screen. Herein we describe assay details, protocol developments, and different assay formats to interrogate the chemical sensitivity of the P. vivax liver stage in one such medium-throughput platform. The general assay protocol includes seeding of primary human hepatocytes which are infected with P. vivax sporozoites generated from the feeding of Anopheles dirus mosquitoes on patient isolate bloodmeals. This protocol is unique in that, after source drug plates are supplied, all culture-work steps have been optimized to preclude the need for automated liquid handling, thereby allowing the assay to be performed within resource-limited laboratories in malaria-endemic countries. Throughput is enhanced as complex culture methods, such as extracellular matrix overlays, multiple cell types in co-culture, or hepatic spheroids, are excluded as the workflow consists entirely of routine culture methods for adherent cells. Furthermore, installation of a high-content imager at the study site enables assay data to be read and transmitted with minimal logistical delays. Herein we detail distinct assay improvements which increase data quality, provide a means to limit the confounding effect of hepatic metabolism on assay data, and detect activity of compounds with a slow-clearance phenotype. Graphical abstract: Overview of P. vivax liver stage screening assay performed at the Institute Pasteur of Cambodia.

Folding a neuroscience center into streamlined COVID-19 response teams: Lessons in origami.

In response to the COVID-19 pandemic epicenter in Bronx, NY, the Montefiore Neuroscience Center required rapid and drastic changes when considering the delivery of neurologic care, health and safety of staff, and continued education and safety for house staff. Health care leaders rely on principles that can be in conflict during a disaster response such as this pandemic, with equal commitments to ensure the best care for those stricken with COVID-19, provide high-quality care and advocacy for patients and families coping with neurologic disease, and advocate for the health and safety of health care teams, particularly house staff and colleagues who are most vulnerable. In our attempt to balance these principles, over 3 weeks, we reformatted our inpatient neuroscience services by reducing from 4 wards to just 1, in the following weeks delivering care to over 600 hospitalized patients with neuro-COVID and over 1,742 total neuroscience hospital bed days. This description from members of our leadership team provides an on-the-ground account of our effort to respond nimbly to a complex and evolving surge of patients with COVID in a large urban hospital network. Our efforts were based on (1) strategies to mitigate exposure and transmission, (2) protection of the health and safety of staff, (3) alleviation of logistical delays and strains in the system, and (4) facilitating coordinated communication. Each center's experience will add to knowledge of best practices, and emerging research will help us gain insights into an evidence-based approach to neurologic care during and after the COVID-19 pandemic.

Most of the Variation in Prehospital Scene Time Is Not Related to Patient Factors, Injury Characteristics, or Geography

ObjectiveThe time spent on scene by emergency medical services remains highly variable. We sought to investigate how much of the prehospital scene time variation in penetrating trauma patients could be explained by prehospital factors. MethodsUsing the 2010 to 2016 Trauma Quality and Improvement database, all adult penetrating trauma patients were included. The prehospital scene time was defined as the time from emergency medical service scene arrival to departure. Using all Trauma Quality and Improvement database variables including patient, injury (eg, Injury Severity Score), geography, and logistical (eg, transport mode) factors, multivariable linear regression models were created to predict the prehospital scene time. The prehospital scene time was treated as a continuous variable, and the degree to which the models could explain the variation in scene time was measured using the coefficient of determination (R). ResultsA total of 45,560 patients were included. The median prehospital scene time was 6 minutes (interquartile range, 3-10 minutes). The R for factors in the multivariable regression model was 0.06, suggesting that 94% of the prehospital scene time variation cannot be explained by the wide range of prehospital factors. ConclusionMost of the variation in prehospital scene time cannot be explained by injury characteristics. The variation may be caused by logistical delays or system-related factors.

Abstract P4-17-08: Surveillance mammography after treatment for male breast cancer

Abstract Background: The clinical utility of routine annual mammogram after curative-intent treatment for male breast cancer is uncertain. There is potentially greater value after lumpectomy (as surveillance for ipsilateral recurrence) than mastectomy (as screening for a new contralateral cancer). The goal of this study was to assess real world use of mammography in men during the first year after lumpectomy or mastectomy to treat breast cancer. Methods: Administrative claims data from OptumLabs Data Warehouse (a large US database that includes privately insured patients and Medicare Advantage-insured enrollees from all 50 states and of all ages and ethnic and racial groups) were used to identify men treated with breast surgery for a new diagnosis of breast cancer between 2007 and 2017. We required continuous coverage starting at least 6 months prior to the non-metastatic breast cancer diagnosis and continuing until at least 13 months after the breast surgery. Our primary endpoint was the proportion of patients who had at least one mammogram during the year (13-month period, to allow for scheduling and other logistical delays) after lumpectomy or mastectomy. Univariate and multivariate testing were performed to identify predictors of mammography (with p&amp;lt;0.05 used as the threshold for statistical significance for both). Our secondary endpoint was the proportion with at least one mammogram within 24 months of surgery, performed in a subset who maintained their insurance coverage for at least that duration. Results: The 13-month analysis included 730 men with a median age at diagnosis of 62 years (Range: 25 to 87 years) and a median follow-up duration of 35 months (Range: 13 to 134 months). 209 (29%) of these men underwent mammography within 13 months after surgery. The characteristics of patients who underwent mammography and those who did not are shown in Table 1. Mammography was more likely after lumpectomy than mastectomy (41% vs. 27%) and after radiation therapy (41% vs. 32% in those who did not receive radiation). In a multivariate logistic regression model, more recent diagnosis (2015+) was associated with lower odds of undergoing mammography, while receipt of radiation was associated with higher odds of undergoing mammography. In the subset of patients with two or more years of post-surgery coverage (n=527), the proportion who had at least one mammogram during that 24-month period was 49% after lumpectomy and 40% after mastectomy. Conclusions: In this insured cohort, 73% of men did not undergo mammography within a year after mastectomy, and 59% did not within a year after lumpectomy. Mammography was less likely in patients diagnosed more recently (perhaps due to acknowledgment of the unique aspects of male breast cancer including a relatively low risk of contralateral second primary tumors), and more likely in those who received radiation. These variations in practice likely result from the paucity of evidence-based guidelines for male breast cancer survivorship care. More research is needed pertaining to whether or not mammograms improve clinical outcomes after curative intent treatment for male breast cancer. Table 1: Patient characteristics associated with receipt of mammogram within first 13 months after male breast cancer surgeryUnivariate AnalysisMultivariate AnalysisNo Mammogram (N=521)Mammogram (N=209)P-value, chi-square testOdds Ratio (OR) and 95% CIP-value for ORAge Group:0.1225-4966 (12.7%)32 (15.3%)Reference50-64216 (41.5%)98 (46.9%)0.99 (0.60, 1.63)0.9665-74112 (21.5%)44 (21.1%)0.87 (0.48, 1.57)0.6575+127 (24.4%)35 (16.7%)0.57 (0.30, 1.07)0.08Census Region:0.52Midwest138 (26.5%)59 (28.2%)ReferenceNortheast97 (18.6%)47 (22.5%)1.10 (0.68, 1.78)0.69South223 (42.8%)79 (37.8%)0.74 (0.49, 1.11)0.15West63 (12.1%)24 (11.5%)0.83 (0.47, 1.47)0.51Year of diagnosis:0.072007-2010126 (24.2%)65 (31.1%)Reference2011-2014199 (38.2%)82 (39.2%)0.80 (0.54, 1.20)0.292015+196 (37.6%)62 (29.7%)0.63 (0.41, 0.96)0.03Elixhauser Category:0.250148 (28.4%)69 (33.0%)Reference1-2218 (41.8%)74 (35.4%)0.85 (0.56, 1.28)0.433+155 (29.8%)66 (31.6%)1.18 (0.75, 1.87)0.47Surgery Type:0.005Lumpectomy55 (10.6%)38 (18.2%)ReferenceMastectomy466 (89.4%)171 (81.8%)1.57 (0.97, 2.55)0.07Chemotherapy:0.79No301 (57.8%)123 (58.9%)ReferenceYes220 (42.2%)86 (41.1%)0.79 (0.54, 1.16)0.23Radiation:0.02No355 (68.1%)124 (59.3%)ReferenceYes166 (31.9%)85 (40.7%)1.51 (1.03, 2.20)0.03 Citation Format: Siddhartha Yadav, Lindsey Sangaralingham, Stephanie R. Payne, Karthik V. Giridhar, Tina J. Hieken, Judy C. Boughey, Robert W. Mutter, John R. Hawse, Rafael E. Jimenez, Rachel A. Freedman, Sadia Choudhery, Fergus J. Couch, Celine M. Vachon, Nilay Shah, Roberto A. Leon-Ferre, Kathryn J. Ruddy. Surveillance mammography after treatment for male breast cancer [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 P4-17-08.