Periods Of Shortage Research Articles

Irrigation Management in Times of Shortage, Contraints, Strategies and Adaptive Measures for Irrigators in Falki and Gadouram (Mirriah-Zinder-Niger)

Abstract : Climate change in Niger in general and in the study area in particular has led to a socio-environmental change. The main consequence of this situation was a drop in yields in a context where food needs are increased. Today, we are increasingly seeing the promotion of irrigated agriculture which increasingly makes up for the deficits recorded by rain-fed production. The present study conducted in the rural commune of Mirriah aims to carry out an investigation into the analysis of irrigation management in periods of shortage, strategies and local adaptive measures used by farmers at the market gardening sites of Falki and Gadouram. The methodology consisted of visiting these sites to speak with producers in order to get to grips with the problem relating to irrigation water in times of shortage. Thus, a survey was conducted among 230 producers from the 2 study sites, or 13.2% of all irrigators. The results of the study show that the mode of access to land is among others: 67.91% inheritance, 25.5% purchase, 5.3% loans and 1.25% rental. The chi-square test showed that the strategies and adaptive measures used by irrigators to deal with multiple and untimely shortages do not vary significantly depending on the market gardening sites (P=0.464). The results of this study reveal a range of strategies developed and measures taken by operators. The strategies include: the construction of traditional cesspools (23%); the use of connected motor pumps (24.8%); irrigation during the night or very early in the morning (27%); the cleaning and deepening of wells or sumps (7.8%); the choice of early or resistant varieties, the reduction in cultivated area and 6% of producers took no adaptation measures, due to a lack of technical and financial resources. In order to increase water retention capacity and improve irrigation management, the State must build irrigation canals in concrete or reinforced concrete from the Timballa dam to the Falki pond in order to reduce ...

Efficacy of 0.25% Lidocaine Versus 0.5% Lidocaine in Dermatologic Surgery: A Double-Blind, Randomized Controlled Trial.

Although lidocaine is widely used in dermatologic surgery, no formal standard concentration is established. Previous research indicates that more dilute concentrations may offer equally effective anesthesia while potentially reducing toxicity risks. In addition, diluting commercially available lidocaine conserves supplies-a significant benefit during periods of lidocaine shortage. To evaluate the efficacy of 0.25% lidocaine compared with that of 0.5% lidocaine in achieving anesthesia in cutaneous surgery. A prospective, double-blind study with 100 patients undergoing cutaneous surgery (Mohs surgery or excision) randomized to receive either 0.25% or 0.5% lidocaine for their percutaneous anesthesia. Patients completed a postoperative survey assessing pain level, satisfaction, and willingness to undergo future dermatologic surgery. This study revealed no statistically significant differences between the 0.25% and 0.5% lidocaine groups regarding pain scores, patient satisfaction, total lidocaine volume, rescue lidocaine volume, or willingness to undergo the procedure again. 0.25% lidocaine is a safe and effective option for achieving anesthesia during Mohs surgery and standard excisions. The results suggest that 0.25% lidocaine can be used to optimize high-value care and enhance patient safety in dermatologic surgery.

Consumption of wild edible plants in the Kofale and Heban-Arsi districts, West Arsi Zone, Oromia Regional State, Ethiopia

BackgroundWild edible plants (WEPs) are neglected and have received little attention despite their significant contributions to the sustenance and livelihoods of rural communities. This study was conducted in the Kofale and Heban-Arsi districts of the Oromia Regional State, Ethiopia, to document the diversity, to assess the most preferred WEPs, their utilization, and threats they face.MethodsThe study was conducted in the Kofale and Heban-Arsi districts of the West Arsi Zone of the Oromia Regional State, Ethiopia. Data collection took place from February to September 2022 in Kofale and from November 2022 to April 2023 in Heban-Arsi district. To gather ethnobotanical information, the research employed semi-structured interviews, field observations, focus group discussions, and guided field walks. The interviews involved 290 informants who were selected via snowball sampling and systemic random sampling methods. Preference ranking values, direct matrix rankings, and use values (UVs) of documented species were computed.ResultsA total of 62 WEPs species belonging to 38 families and 56 genera were identified. The Moraceae family includes 7 species, followed by Fabaceae and Rubiaceae (each 4 species), and Lamiaceae (3 species). Shrub was the dominant growth form (32 species), followed by herbs (13 species). The largest number (24 species) of WEPs was collected from grazing lands/fields, followed by forest habitats (17 species). The most widely used edible plant part was fruit (40 species) and leaf (11 species). Most WEPs were collected for consumption from March to May (30 species), and the majority of the species (48, 77.4%) were utilized in their raw state. A large number of WEP (41 species) were consumed only during periods of food shortage, and the remaining (21 species) were used as staple food supplements. Multiple other uses of WEPs in the study area also reported. Fifty-two species mentioned for medicinal use, and the species that had the highest use value was Cordia africana Lam. (0.9). The direct matrix ranking results indicated that agricultural expansion was a principal threat to the WEPs in the study area.ConclusionThis study indicated that WEPs are widely used during food shortages in the study area, but many WEP species are under threat due to growing pressure from various anthropogenic factors. Thus, public awareness and community-based management need to be encouraged at all levels to conserve and sustainably use these resources to address food insecurity.

Degradation of Edible Woody Species Consumed during Periods of Food Shortage and Their Preferences among the Local Population in the Sudano-Sahelian Zones of Niger, West Africa Sahel

Degradation of Edible Woody Species Consumed during Periods of Food Shortage and Their Preferences among the Local Population in the Sudano-Sahelian Zones of Niger, West Africa Sahel

Summary of the National Institute of Allergy and Infectious Diseases workshop on Alternative Therapies to Penicillin for the Treatment of Syphilis.

The dramatic increase in syphilis cases in the United States in recent years is a serious public health concern. Periodic shortages of benzathine penicillin (BPG), the mainstay of syphilis treatment, create challenges for management of syphilis in the U.S. and worldwide. The National Institute of Allergy and Infectious Diseases (NIAID) convened working groups of experts to assess the landscape of syphilis treatments for uncomplicated adult syphilis, syphilis in pregnant persons, congenital syphilis, and neurosyphilis. The working groups came together at a workshop entitled "Alternative Therapies to Penicillin for the Treatment of Syphilis" on February 13-14, 2024, to share their findings regarding promising alternative treatments, research gaps, and challenges. Discussions focused on utilizing existing antibiotics, with a preference for those with favorable safety profiles and demonstrated success against syphilis or other infectious diseases. Clinical research on alternative treatments is complicated by the high effectiveness of penicillin and by differences in clinical, physiological, cultural, and socioeconomic considerations across different patient populations and geographic settings. In addition, current diagnostic tests and tests-of-cure create challenges for clinical trial design. Various potential trial designs were discussed, focusing on subjects with different types and stages of disease. This summary of the workshop is presented to inform plans for future research, including clinical trials on alternatives to penicillin for the treatment of syphilis.

Genomic Data Support the Revision of Provenance Regions Delimitation for Scots Pine.

Scots pine is a crucial component of ecosystems in Europe and Asia and a major utility species that comprises more than 60% of total forest production in Poland. Despite its importance, the genetic relationships between key conservation and the commercial value of Scots pine ecotypes in Poland remain unclear. To address this problem, we analyzed 27 populations (841 trees) of the most valuable Polish Scots pine ecotypes, including the oldest natural stands in all 24 regions of provenance established for the species in the country. By examining maternally inherited mitochondrial markers, nuclear microsatellite loci, and thousands of SNP markers from a genotyping array, we evaluated the genetic structure between and within them. These multilevel genomic data revealed high genetic similarity and a homogeneous structure in most populations, suggesting a common historical origin and admixture of populations after the postglacial recolonization of Central Europe. This research presents novel data on existing genomic resources among local ecotypes defined within strictly managed Polish regions of provenance, challenging their validity. Formal tests of the progeny of seed stands are needed to check whether the diversity in adaptation and quantitative traits still supports the delineation of provenance regions. In parallel, the health status of selected populations and the viability of seeds from these regions should be monitored to detect early-stage symptoms of their environmental stress. It seems reasonable that periodic shortages of forest reproductive material (FRM) in a given region of provenance could be supplemented with the one from other regions that match their climatic envelope. Together, our results have important implications for the management of native Scots pine stands, particularly elite breeding populations, as they contribute to the discussion of the boundaries of provenance regions and the transfers of FRM that face increasing climate change.

Variability of agricultural income for empowerment: Case of cucumber and potato leaves producers in Goréké (San Pedro – Côte d’Ivoire)

Female entrepreneurship in rural areas in French-speaking Africa is more related to rural, processing and marketing activities. The objective of this study is to present the variability of agricultural income of female producers for their empowerment. To this end, fifty female producers from the village of Goréké were interviewed. The areas, poultry droppings + sawdust, NPK 12 22 22, masses and incomes were observed. A Principal Component Analysis showed that on a hectare of cucumber, reasonable amounts of NPK 12 22 22 (80 kg) and organic residue (6,000 kg) provided the best mass (16,000 kg). At the level of potato leaves, 1,600 kg of organic residue and 20 kg of NPK provided the best mass (1,600 kg). Furthermore, the potato leaf producer had an average income during the shortage period of 2226,642 ± 1602,093 CFA francs compared to that of cucumber which is 584,714 ± 296,718 CFA francs. On the other hand, during the abundance period, the average incomes are respectively 713,793 ± 536,983 for potato leaves and 467,771 ± 237,374 CFA francs for cucumber. This difference is explained by the higher selling price per kilogram of potato leaves. In conclusion, the potato leaf producer would be more financially independent. In perspective, training will be provided to market gardeners to optimize the masses produced by rationalizing the masses of fertilizer used for an improvement in income.

Prescription predicament: Unveiling the financial fallout of drug shortages.

1 Background: Managing drug shortages has become a part of care delivery in oncology. Shortages have been reported to result in missed/delayed treatment, substitution of alternative therapy, increased costs, and significant administrative burden. A national shortage of cisplatin caused by manufacturing disruptions was reported by the Food and Drug Administration in the United States from February until August 2023 (shortage period). We assessed the effects of cisplatin shortage on the treatment of head and neck cancer (HNC) at practices in The US Oncology Network (The Network). Methods: Using drug administration data from medical records and claims for 26 practices in The Network prior to (July 2022 to January 2023), during, and after (September 2023 to March 2024) the shortage period, we assessed the utilization trends and financial impact (using Medicare average sale price (ASP)) of cisplatin and other anti-cancer drugs for HNC patients. Results: During the shortage period, cisplatin utilization for HNC decreased by 15% compared to pre-shortage levels. The lowest utilization occurred in June and July 2023, with a 60% decrease. Practices initially obtained supplies through an allocation model and fair-share utilization guidance from The Network Pharmacy & Therapeutics Committee. During the shortage period, alternative chemotherapy drugs for HNC saw increased use: carboplatin by 40%, paclitaxel by 24%, 5-fluorouracil by 5.3%, and cetuximab by 15%. The increased use of alternative drugs corresponded to the decrease in cisplatin usage, with new starts shifting to carboplatin (with or without paclitaxel), cetuximab and 5-fluorouracil. Ten percent of existing cisplatin recipients were shifted to an alternative drug during the shortage period. Interestingly, 5-fluorouracil was also in short supply, albeit less acutely than cisplatin. After the shortage, cisplatin volumes rebounded by 8% of pre-shortage use, while carboplatin use dropped below pre-shortage levels. Cetuximab use remained consistently 12% higher. The average cost per administration was $18 for cisplatin, $14 for carboplatin, $16 for paclitaxel, $22 for 5-fluorouracil, and $2,607 for cetuximab, based on the ASP. The increased use of cetuximab instead of cisplatin resulted in a 16% total cost increase, leading to a 144-fold increase in costs at the administration level, impacting payer costs and patient cost-sharing amounts. Conclusions: Cisplatin shortage led to a shift in utilization to alternative therapies for HNC, resulting in significant cost increases for both payers and patients. These consequences may not be limited to specific cancer types or drugs and may have other undesirable effects. Even temporary shortages of drugs can lead to lasting utilization changes and have long-term financial implications. The impacts of drug shortages on treatment decisions, guideline concordance, costs, and patient outcomes are apt for further investigation.

Untangling poikilohydry and desiccation tolerance: evolutionary and macroecological drivers in ferns.

Poikilohydry describes the inability of plants to internally regulate their water content (hydroregulation), whereas desiccation tolerance (DT) refers to plants ability to restore normal metabolic functions upon rehydration. The failure to clearly separate these two adaptations has impeded a comprehensive understanding of their unique evolutionary and ecological drivers. Unlike bryophytes and angiosperms, these adaptations in ferns are sometimes uncorrelated, offering a unique opportunity to navigate their intricate interplay. We classified ferns into two syndromes: the Hymenophyllum-type (H-type), encompassing species with filmy leaves lacking stomata that experience extreme poikilohydry and varying degrees of DT, and the Pleopeltis-type (P-type), consisting of resurrection plants with variable hydroregulation but high DT. The H-type evolved during globally cool Icehouse periods, as an adaptation to low light levels in damp, shady habitats, and currently prevails in wet environments. Conversely, the P-type evolved predominantly under Greenhouse periods as an adaptation to periodic water shortage, with most extant species thriving in warm, seasonally dry habitats. Out study underscores the fundamental differences between poikilohydry and DT, emphasizing the imperative to meticulously differentiate and qualify the strength of each strategy as well as their interactions, as a basis for understanding the genetic and evolutionary background of these ecologically crucial adaptations.

Optimal ordering strategy for deteriorating items with maximum lifetime using trade credit financing under imprecise environments

In many business scenarios, a retailer is permitted specific credit period to pay back for the products bought earlier. This facility enables retailers to continue their business operations even when they are unable to raise funds or secure a business loan. To boost the market's demand, promotional effort is a very effective business strategy to the retailer for maximizing the profit. On the other hand, a sudden and significant rise in customer demand for an inventory leads to shortages. Moreover, inventory relevant unit cost coefficients become imprecise due to insufficient data, human error etc. Nowadays, neutrosophic set quantifies the impreciseness more realistically. Considering these facts, an imprecise EOQ model for deteriorating items with maximum lifetime is formulated under trade credit facility. In addition, this article allows shortages, which are linearly time-dependent partially back-logged. Here, the unit cost coefficients are expressed as single-valued trapezoidal neutrosophic numbers. Furthermore, particular models are derived under different environments - intuitionistic, fuzzy, and crisp. Step-by-step solution procedures are suggested for all models to obtain optimal solutions. Models are numerically illustrated with real-life data, and some sensitivity analyses are performed. Managerial insights demonstrate that depletion time always depends on demand. Again, the present study suggests to reduce demand by halting the promotional activities during the shortage period and choose products with a larger lifetime.

The impact of urbanization on growth patterns of non‐adults in medieval England

AbstractIncreasing urbanization seen during the medieval period (7th to 16th centuries) is associated with adverse living conditions that may have negatively impacted childhood growth via the influence of infectious diseases and nutritional deficiencies due to increasing population density and periodic food shortages. This study aims to compare the growth of non‐adults (less than 12 years of age) from urban, proto‐urban, and rural environments from medieval England to determine whether settlement type influenced child health, and by proxy overall population health, during this period. Tibial and femoral maximum diaphyseal lengths and dental age of non‐adults (0–12 years) from urban St. Gregory's Priory (n = 60), urban York Barbican (n = 16), proto‐urban Black Gate (n = 38), and rural Raunds (n = 30) were examined using z‐scores. The results reveal that non‐adults < 2 years from St. Gregory's Priory had the lowest growth values followed by Raunds, Black Gate, and York Barbican with the highest growth values. Further, non‐adults 2–12 years from York Barbican had the lowest growth values followed by Raunds, Black Gate, and St. Gregory's Priory with the higher growth values. The femoral and tibial diaphyseal growth values are explored within the context of breastfeeding and weaning practices, stability of economies, and environmental conditions.

Going it alone: observations of solitary roosting in two Australian flying-foxes (Pteropus alecto and P. poliocephalus)

Unlike some flying-fox species that exhibit solitary roosting, all flying-fox species of the Australian mainland are strongly colonial, though some extent of solitary roosting in these species is anecdotally known. This note reports on five accounts of solitary roosting in black flying-foxes (Pteropus alecto) and grey-headed flying-foxes (Pteropus poliocephalus), herein referred to as 'singletons'. These accounts are potentially the first published detailed observations of singletons in Australian flying-foxes outside of visible periods of food shortages. In particular, one account involved solitary roosting recorded over multiple days. The frequency and extent of singletons in Australian flying-foxes remain completely unknown. In terms of deriving population sizes in these species from counts at communal roosts, these individuals represent an addition to those estimates.

Measuring the Dunkelflaute: how (not) to analyze variable renewable energy shortage

Abstract As variable renewable energy (VRE) sources increasingly gain importance in global energy systems, there is a growing interest in understanding periods of VRE shortage (‘Dunkelflauten’). Defining, quantifying, and comparing such shortage events across different renewable generation technologies and locations presents a surprisingly intricate challenge. Various methodological approaches exist in different bodies of literature, which have been applied to single technologies in specific locations or technology portfolios across multiple regions. We provide an overview of various methods for quantifying VRE shortage, focusing either on supply from variable renewables or its mismatch with electricity demand. We explain and critically discuss the merits and challenges of different approaches for defining and identifying shortage events and propose further methodological improvements for more accurate shortage determination. Additionally, we elaborate on comparability requirements for multi-technological and multi-regional energy shortage analysis. In doing so, we aim to contribute to unifying disparate methodologies, harmonizing terminologies, and providing guidance for future research.

Climate change does not impact the water flow of barley at the vegetative stage, ameliorates at anthesis and worsens after subsequent drought episodes

Climate change will bring the interaction of stresses such as increased temperature and drought under high [CO2] conditions. This is likely to impact on crop growth and productivity. This study aimed to (i) determine the response of barley water relations to vegetative and anthesis drought periods under triple interaction conditions, (ii) test the possibility to prime barley plants for drought, and (iii) analyse the involvement of aquaporins in (i) and (ii). The water status of barley was not affected by drought at the vegetative stage, regardless of the environmental conditions. At the anthesis stage, when the water shortage period was more severe, barley plants growing under combined elevated CO2 and temperature conditions were able to maintain a better water status compared with plants grown under current conditions. Elevated CO2 and temperature conditions reduced the stomatal conductance and slowed down the plant water flow through a root-leaf hydraulic conductivity coordination. Leaf HvPIP2;1 and HvTIP1;1 aquaporins seemed to play a key role regulating barley's water flow, while leaf and root HvPIP2;5 provided basic level of water flow. At anthesis drought and under future combined conditions, plants showed a reduced cell dehydration and decrease in leaf relative water content compared with plants grown under current conditions. Exposure to a previous drought did not prime the water status of barley plants to a subsequent drought, but instead worsened the response under future conditions. This was due to an imbalance between the roots versus shoot development.

Drought Dynamics and Drought Hazard Assessment in Southwest Bulgaria

Awareness of the potential threat posed by drought necessitates the implementation of appropriate procedures to enable effective and systematic actions aimed at mitigating, or at least partially limiting, the impacts of drought events. This paper seeks to analyze the spatial and temporal changes of atmospheric drought in the period 1961–2020 and assesses drought hazards in southwest Bulgaria, which is a region susceptible to periodic water shortages. In this study, the standardized precipitation evaporation index (SPEI), accounting for both precipitation and temperature changes, was used to analyze drought characteristics. The analysis reveals significant temporal changes and spatial differences in drought patterns across southwest Bulgaria. The northeastern part of the region, including the Sofia district, exhibits the lowest risk of drought, while the central part of the region shows a tendency toward moderate and occasional low drought events. Some stations, particularly in the southern part of the region, consistently experienced more severe drought conditions (Blagoevgrad and Sandanski), as indicated by negative SPEI values in different time scales (3, 6, and 12 months). Results indicate an increased frequency of droughts during 1990–2020 compared to 1961–1990, which was driven by climate change and human activities. Across all stations and in both SPEI time scales, the period from the early to mid-1990s was characterized by significant droughts. The study of drought hazards using short-term and long-term SPEI analysis reveals different levels of drought risk and increased hazard from the northern to southern parts of the study area. The share of areas with a high drought hazard exceeds 40% of the territory in the areas with a transitional and continental-Mediterranean climate. Based on the results, the paper highlights the need to integrate drought risk assessments with regional planning to improve agricultural resilience and water resource management in response to anticipated droughts, especially in drought-prone areas such as southwest Bulgaria.

Accounting for differences between serum and plasma: An indirect approach to derive reference intervals for total protein, albumin, and globulin

BackgroundObservable quantitative variations exist between plasma and serum in routine protein measurements, often not reflected in standard reference intervals. In this study, we describe an indirect approach for estimating a combined reference interval (RI) (i.e., serum and plasma), for commonly ordered protein measurands: total protein, albumin, and globulin. MethodsWe applied an indirect reference interval estimation for protein measurements in serum and plasma using data from July 2018 to February 2024. The data were divided into three Epochs based on a period of plasma separator tube shortage during the COVID-19 pandemic. Bootstrap resampling was used to calculate RIs and corresponding 95% confidence intervals for each month. ResultsOur results demonstrate notable changes in RI limits for total protein, albumin, and globulin between Epochs, reflecting the influence of changing sample matrix. A combined RI was identified for all components and verified using plasma and serum samples from 20 healthy individuals and retrospective analysis of flagging rates on our outpatient population using new and historical RIs. ConclusionThe study demonstrates notable differences in the RIs for total protein, albumin, and globulin when container type changes. In addition, the results demonstrate the effectiveness of big data analytics in deriving RIs and highlights the necessity of continuous RI assessment and adjustment based on the patient population and acceptable specimen types.

One Thousand Years of Mediterranean Silver Trade to the Levant: A Review and Synthesis of Analytical Studies

AbstractSilver exchanged by weight for its intrinsic value was the most important measure of value and means of payment in the southern Levant, starting from the Middle Bronze Age II–III through the Iron Age (~1700/1650‒600 BC). Since silver is not available locally in the Levant, its ongoing use as currency in the region triggered long-distance trade initiatives, and its availability or lack thereof had a direct impact on the economy. The continued use is evidenced in 40 silver hoards found in various sites across the region. A comprehensive study of lead isotopes and chemical analyses of samples obtained from 19 hoards enabled us to trace the origin of silver in the millennium during which it was extensively used as currency in the southern Levant and to identify constantly changing silver sources and concomitant trade routes. The results indicate that silver originated initially in Anatolia and Greece (~1700/1650–1600 BC) and shortly after from an unknown location in the Aegean/Carpathian/Anatolian sphere (~1600–1200 BC). After the collapse of Late Bronze Age Mediterranean trade routes, during Iron Age I (~1200–950 BC), there was a period of shortage. Silver trade was revived by the Phoenicians, who brought silver to the Levant from Sardinia and Anatolia (~950–900 BC), and later from Iberia (~900–630 BC). Further change occurred after the Assyrian retreat from the Levant, when silver was shipped from the Aegean (~630–600 BC). Following the devastation caused by the expanding Babylonian empire, silver consumption in the Levant practically ended for a century. Considering the isotopic results, combined with a detailed study of the context, chronology, and chemical composition, we demonstrate that all these factors are essential for the reconstruction of developments in the supply of silver in the southern Levant, and more generally. The changes in trade routes closely follow political and social transformations for over a millennium; exchange in this case was not only, not even mainly preconditioned by the environmental/geographic circumstances, as has often been argued for the Mediterranean. From an analytical point of view, we offer a protocol for the provenance of silver in general.

A Two-Stage Operation Strategy for Energy Storage under Extreme-Heat-with-Low-Wind-Speed Scenarios of a Power System

Changes in weather conditions directly impact the output of wind power, photovoltaic systems, and other forms of uncontrollable power generation. During extreme weather events, the output from wind and photovoltaic sources is typically reduced. In light of this, this paper proposes a two-stage operational strategy for energy storage, under scenarios of extreme-heat-with-low-wind-speed, in power systems. Firstly, historical data on wind and solar power, along with weather characteristics, are collected to analyze the power output during multi-day periods of extreme heat and low wind speed. Then, Monte Carlo simulations are employed to generate multi-day load curves with inherent uncertainties, based on regional load characteristics of the power system. Finally, a two-stage operation strategy for energy storage charging and discharging is established. In the first stage, normal operations are conducted to identify periods of power shortage across various types of loads. In the second stage, based on the identified moments of power shortage from the first stage, charging and discharging constraints are applied to the energy storage systems. The feasibility and effectiveness of this two-stage operational strategy are then validated through simulations, using historical data to generate scenarios of multi-day extreme-heat-and-low-wind-speed conditions.

Community perception of climate events as a security issue: the case of Hatiya Island, Bangladesh

This study delves into the multifaceted dynamics linking climate change and conflict on Hatiya Island, Bangladesh. Examining perceptions and responses to climate-induced stress, insecurity and potential conflicts, our research draws insights from literature reviews and focus group discussions. Despite the heightened stress resulting from unpredictable climate events, islanders perceive recent improvements in food security. They continue to struggle with periodic shortages and inaccessible health care and education. Many are entrapped in a cycle of poverty, debt and political marginalisation, further compounded by exploitative economic relations, power dynamics and government policies that intensify grievances. Climate change impacts are not perceived locally as an (immediate) threat: other issues seem to have more priority. Our findings emphasise the importance of prioritising social and political dynamics, alongside structural constraints, in understanding the climate–conflict nexus. This should not be taken to mean that climate change is irrelevant, though, as it has an impact on the bedrock of long-term poverty and distress. This article was published open access under a CC BY licence: https://creativecommons.org/licences/by/4.0 .

Impact of carboplatin and cisplatin shortages on treatment patterns in patients with metastatic solid tumors.

11149 Background: The United States experienced cisplatin (CP) and carboplatin (CB) shortages in 2023, leading to potential rationing or switching to alternative therapies in multiple cancers. Using a US nationwide, real-world oncology dataset, we assessed changes in the use of CP and CB in 7 cancers during the shortage period. Methods: All patients (pts) from the Flatiron Health electronic health record-derived de-identified database (~280 cancer clinics, ~800 sites of care) with a machine learning-extracted metastatic (met) diagnosis of a cancer of interest between March 2022 and June 2023 and evidence of first-line (1L) therapy, were selected. Pts with multiple primaries were excluded. Platinum of interest was identified based on frequency of pre-period 1L use for a given cancer. The pre-period was June 2022 through first month of reported shortage (February 2023 for CP; April 2023 for CB); data cutoff was June 2023. Clinical characteristics of platinum-treated pts stratified by pre- vs post-period by disease were assessed. 1L platinum utilization rates (UR), calculated as the proportion of 1L-treated pts initiating CB/CP within 30 days of met diagnosis, were plotted by month. Cohort-level impact was evaluated with an interrupted time series analysis—overall and stratified by practice type, practice size, and socioeconomic status (SES). Multiple testing was controlled using the Benjamini-Hochberg procedure. Results: 10,983 pts received 1L therapy in the study period. Monthly platinum UR were stable across diseases in the pre-period. However, there was a significant post-period decrease in CB usage for non-small cell lung (NSCLC) and endometrial cancers (EC), and a decreasing trend in UR for CB in bladder (BC), ovarian (OC), and small cell lung cancers (SCLC). We also observed a decreasing trend in CP usage for cholangiocarcinoma (CC). Post-period monthly UR were stable for CB and CP in head and neck cancer (HNC), and for CP in BC. Odds ratios (OR) representing the month-over-month change in the odds of receiving platinum therapy during both pre- and post-periods are shown (table). OR trends varied by practice type and disease; no notable trends were seen by practice size or SES. UR with additional follow-up times will be presented. Conclusions: We observed decreased platinum use across multiple cancers during the shortage period, most notably for met NSCLC and EC, suggesting shortages led oncologists to seek alternatives to standard 1L platinum-based regimens. Further study of how treatment changes due to platinum shortages impacted pt outcomes is warranted. [Table: see text]