Potential Delay Research Articles

Diagnostic workup for esophageal cancer patients can be improved with checklists and clearer protocols; a comparative study between two tertiary centers in Europe

BackgroundRapid and complete workup of newly diagnosed esophageal cancer is vital for a timely, individual and high-quality treatment strategy. The aim of this study was to uncover potential delay, inefficiencies and non-contributing investigations in the diagnostic process in two tertiary referral centers. MethodsThis retrospective cohort study included all newly diagnosed esophageal cancer patients referred to or diagnosed in the Amsterdam UMC and Karolinska University Hospital between July 2020 and July 2021. Radiology, pathological assessment and multidisciplinary team meeting reports were reviewed. To assess time interval from diagnosis to treatment, dates of diagnosis, admittance to referral hospital, MDT meeting and start of treatment were collected. ResultsIn total, 252 esophageal cancer patients were included, 187 were treated with curative intent. Curatively treated patients had a mean age of 66 years, were predominantly male (74.9 %) with an adenocarcinoma (71.1 %). Curatively treated patients had a median time from diagnosis to referral of seven days (IQR:0–11) and of 35 days (IQR:28–45) between diagnosis and start of treatment. Main reasons for the significant (P < 0.001) differences in time between diagnosis and treatment between centers, Amsterdam UMC (39 days) vs Karolinska (27 days), were need for additional diagnostics (47.8 %) and differences in referral routine. Gastroscopy was repeated in 32.2 % of patients, mainly for further anatomical mapping. ConclusionSignificant time differences between centers in the path from diagnosis to start treatment can be explained by differences in workup approach, referral routines and MDT meeting regulations. Repeat of gastroscopy can be prevented with clearer endoscopy guidelines.

Prenatal exposures to organophosphate ester metabolites and early motor development in the MADRES cohort

Organophosphate esters (OPEs) are increasingly considered neurotoxicants which may impact gross and fine motor development. We evaluated associations between prenatal OPE exposures and infant motor development. Third trimester urinary concentrations of nine OPE metabolites were measured in 329 mother-infant dyads participating in the Maternal And Developmental Risks from Environmental and Social Stressors (MADRES) cohort. Child gross and fine motor development at 6, 9, 12, and 18-months were assessed with the Ages and Stages Questionnaire-3 (ASQ-3) and operationalized in models using dichotomous instrument-specific cutoffs for typical motor development. Five OPE metabolites with >60% detection were specific-gravity-adjusted, natural log-transformed, and modeled continuously, while four metabolites with <60% detection were modeled dichotomously (detected/not-detected). We fit mixed effects logistic regression between OPE metabolites and fine/gross motor development and assessed sex-specific effects using a statistical interaction term and sex-stratified models. Among children, 31% and 23% had gross and fine motor scores, respectively, below the ASQ-3 at-risk cutoffs at least once across infancy. A doubling in prenatal diphenyl phosphate (DPHP) exposure was associated with 26% increased odds of potential fine motor delays (ORfine = 1.26, 95% CI: 1.02, 1.57, p = 0.04). We also observed significant interactions by infant sex for associations of detected dipropyl phosphate (DPRP) with gross motor development (pinteraction = 0.048) and detected bis(1-chloro-2-propyl) phosphate (BCIPP) with fine motor development (pinteraction = 0.02). Females had greater odds of potential motor delays for both detected DPRP (females vs males ORgross (95% CI) = 1.48 (0.71, 3.09), p = 0.30 vs 0.27 (0.06, 1.29), p = 0.10) and detected BCIPP (females vs males ORfine (95% CI) = 2.72 (1.27, 5.85), p = 0.01 vs 0.76 (0.31, 1.90), p = 0.56). There were no other significant associations between other metabolites and motor development, despite similar patterns. We found evidence of adverse effects of prenatal OPE exposures on infant motor development with greater adverse effects among female infants with some OPE metabolites.

Abstract A061: Understanding health-seeking delays for post-menopausal bleeding among Haitian women

Abstract Introduction: Black women have the highest risk of Endometrial cancer (EC) among any racial group in the US. When disaggregated, Haitian women specifically have been shown to have a higher incidence of high-grade EC, present at more advanced stages, and have lower overall survival compared to US-born Blacks. There is no screening test for EC, and women are diagnosed when they develop symptoms. The most common symptom of EC is postmenopausal bleeding (PMB). Little data exist about understanding/perception of PMB and subsequent care-seeking delays in this population of at-risk women. Utilizing the Safer and Anderson model of total patient delay, our objective was to qualitatively evaluate perceptions of PMB and how these may guide care-seeking behaviors among a healthy population of at-risk postmenopausal Haitian women. Methods: Nineteen women were included. Participants were 1) Haitian Black women; 2) ≥ 50 years of age; 3) living in South Florida; and 4) without a personal or family history of breast or gynecologic cancer. Participants were recruited through a mix of purposive and snowball sampling strategies via multiple channels (community outreach, radio advertisements, social media). Women participated in focus group discussions, conducted in Creole, and guided by a semi-structured interview guide designed to capture perceptions about PMB. Sessions were audio recorded, transcribed, and coded by a team of 5 raters. Dedoose software was used for content analyses and identification of emerging themes. Results: Three key themes that aligned primarily within the Safer and Andersen constructs of appraisal delay and illness delays were identified: 1) There was a significant lack of knowledge about the meaning of PMB. Resumption of fertility, PMB as a normal part of aging, and interpreting the symptom as reflective of a benign disease (e.g., food poisoning) were common. Cancer was not a primary concern in the setting of PMB, and there was consistent low perceived severity of the symptom. In fact, there was a conveyed sense of invulnerability to cancer purely due to the nature of being Haitian. 2) Women would preferentially use cultural-specific coping strategies in lieu of seeking immediate medical care. Such strategies included use of home remedies such as teas, and prayer/reliance on God. 3) Appraisal of PMB and discussion of severity involves consultation with spiritual leaders and others in the community for guidance. There was a perception that community members may dissuade the pursuit of traditional medical care. The use of the Internet as a facilitator for care was not considered primary. Conclusion: This study underscores the complexity of factors impacting potential help-seeking delays among Haitian women experiencing PMB. Our findings highlight the need for culturally-tailored, comprehensive educational interventions to increase awareness of the meaning of PMB and its health relevance to improve earlier care-seeking and timely diagnosis of EC. Citation Format: Maurice J. Chery, Vanessa Morales, Lashae Rolle, Alejandra Casas, Diana Zapata, Sophia H.L. George, Matthew P. Schlumbrecht. Understanding health-seeking delays for post-menopausal bleeding among Haitian women [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A061.

Composite Index of Anthropometric Failure and Early Childhood Cognitive Development Based on the 2018 Indonesian Basic Health Research Data

Delays in early childhood cognitive development may have profound long-term implications on health and life expectancy. Optimal nutrition supports early life development, including a child's cognitive development. This study aimed to determine the association between the Composite Index of Anthropometric Failure and early childhood cognitive development among children aged 36-59 months in Indonesia. This cross-sectional study utilized data from the 2018 Indonesian Basic Health Research that involved 18,027 participants aged 36-59 months. This study outcome demonstrated that children who were stunted-underweight were potentially susceptible to delayed cognitive development compared to those with normal nutritional status (aOR = 1.30; 95% CI 1.12-1.51) after controlling for child’s age, sex, vitamin A supplementation, antenatal care visits, gestational age, access to drinking water and sanitation (combined risk), maternal education and mental health (combined risk), maternal occupation and number of household members (combined risk). In summary, malnourished children are vulnerable to impaired physical growth and potential delays inearly cognitive development.

Communicating the Crisis: Navigating the Challenges of Chemotherapeutic Drug Shortages with a Patient-Centered Ethical Dialogue Framework

Introduction: The United States finds itself gripped by debilitating drug shortages, thrusting thousands of patients nationwide into a precarious limbo and making the potential delay or cancellation of essential chemotherapy treatments a reality. In June 2023, the situation escalated to encompass a staggering 309 active drug shortages, including twenty-five chemotherapeutics, two of which are carboplatin and cisplatin. Communicating the nuances of a chemotherapy drug shortage to those affected transforms into a multifaceted and delicate endeavor that demands deep-seated empathy, preparation, and understanding. Mastering strategic, patient-centered communication becomes an ethical imperative and valuable skill for all physicians, amplifying the human connection at the heart of medicine. Our multidisciplinary team of specialists developed an ethical communication framework to guide physicians in navigating and discussing the complexities of modern drug shortages with patients. This framework promotes empathetic and informative dialogue with patients, empowering them to understand the situation and actively participate in their care decisions. Through this approach, we aim to foster a partnership between physicians and patients, mitigating anxieties and ensuring patients feel heard and supported throughout this trying period. Method: A multidisciplinary team of specialists convened, including physicians, advanced practice providers from hematology and oncology, and bioethicists. We developed an ethical and theoretical communication framework that will prove beneficial for both physicians and patients. Our framework facilitates compassionate and informed exchanges between healthcare professionals and their patients. Special care was given to consider the patient's background, perspectives, and beliefs. Results: The ethical communication framework for addressing chemotherapeutic shortages demonstrated promising potential for enhancing patient-provider interactions during times of crisis. The framework emphasizes open and transparent communication, facilitating patient understanding of the drug shortage situation and empowering patients to participate in their treatment actively. Conclusion: The developed ethical communication framework offers a patient-centered approach to addressing this crisis, aiming to empower patients with knowledge and understanding while fostering a collaborative decision-making process during crisis communication. By prioritizing empathy, transparency, and patient autonomy, the framework serves as a valuable tool for navigating the complexities of drug shortages and mitigating patient fears when discussing the drug shortage crisis. As the framework continues to be integrated into healthcare systems, ongoing evaluation and tracking of patient outcomes will provide valuable insights into its effectiveness and potential areas for improvement in communicating the crisis. Through strategic and empathetic patient-centered communication, physicians can play a crucial role in supporting patients during the national drug shortage crisis, ensuring that patients' voices are heard and their needs are addressed with compassion and understanding when communicating the crisis.

In vivo evaluation of the antiretroviral activity of Melia azedarach against small ruminant lentiviruses in goat colostrum and milk.

This study aimed to evaluate in vivo the use of the extract from the leaves of Melia azedarach in the ethyl acetate fraction at a concentration of 150µg/mL as an antiretroviral treatment against small ruminant lentiviruses (SRLV) in goat colostrum, and milk with a 90-min action. Two groups of six kids were treated with the extract. One group received three supplies of colostrum from does naturally positive for SRLV, treated with the ethyl acetate fraction of M. azedarach (EAF-MA) for three days, while the other group consumed milk from does also carrying the virus with the respective extract twice a day for five days. After undergoing treatment, all animals began to receive thermized milk until weaning (60days) and were monitored for six months using nested polymerase chain reaction (nPCR) and western blot (WB) tests. The study revealed cumulative percentages of positive animals in WB or nPCR in the milk group of 66.66% on the seventh day, 83.33% in the following week, and 100% at 120days, while the colostrum group showed values of 66.66% at 14days, 83.33% at 90days, and 100% at 120days. Variation and intermittency were observed in viral detection, but all animals tested positive in WB or nPCR at some point. A potential delay in infection was observed, which was more significant in the colostrum group. The need for the combination of serological and molecular tests for a more efficient detection of the disease is also emphasized.

576. Comparison of Three Blood Culture Testing Models at a Tertiary Care Hospital: Does Laboratory Centralization Work?

Abstract Background Centralization of laboratory testing has become increasingly common in US hospital systems. One criticism of centralization is increased test turnaround time leading to potential delays in care. Methods In this study, we analyzed three microbiology laboratory testing models for blood cultures at a tertiary care hospital. These models were: 1) full workup in a hospital-based microbiology laboratory; 2) incubation, Gram stain (GS), and molecular blood culture identification (BCID) in a hospital-based microbiology laboratory followed by subculture identification and susceptibility testing (AST) at a centralized core laboratory; and 3) full workup in the centralized microbiology laboratory. Blood culture samples were transported 33 miles from the hospital to the core laboratory. We evaluated these three models for time from collection to positivity, time from collection to GS result, time from collection to BCID result, time from collection to organism identification, time from collection to AST, and patient length of hospital stay. Results We observed no statistical difference in time to blood culture positivity, time to GS result, or time to BCID result. There were shifts in the median time to AST between Model 1 (53.6h) and Model 2 (73.9h) and Model 2 and Model 3 (63.8h), but these were not statistically significant. Of note, time to AST and time to final result in Model 3 were more uniform, with fewer outliers than in the other two models. This is likely a result of the greater degree of laboratory automation in place at the core laboratory and reduced time spent in transit before culture workup. Finally, there was no difference in length of hospital stay between the hospital and decentralized models, though the hybrid approach (Model 2) resulted in increased length of hospital stay compared to either of the other models. Conclusion Our results suggest centralization of blood culture testing does not significantly impact timely reporting of laboratory results and has no impact on length of patient hospital stay. Interestingly, these data demonstrate potential delays when blood culture workups are split between hospital and centralized laboratories. Additional work is needed to fully understand the role of centralization of laboratory testing on treatment decisions and patient outcomes. Disclosures All Authors: No reported disclosures

A chemical reaction network implementation of a Maxwell demon.

We study an autonomous model of a Maxwell demon that works by rectifying thermal fluctuations of chemical reactions. It constitutes the chemical analog of a recently studied electronic demon. We characterize its scaling behavior in the macroscopic limit, its performances, and the impact of potential internal delays. We obtain analytical expressions for all quantities of interest: the generated reverse chemical current, the output power, the transduction efficiency, and correlation between the number of molecules. Due to a bound on the nonequilibrium response of its chemical reaction network, we find that, contrary to the electronic case, there is no way for the Maxwell demon to generate a finite output in the macroscopic limit. Finally, we analyze the information thermodynamics of the Maxwell demon from a bipartite perspective. In the limit of a fast demon, the information flow is obtained, its pattern in the state space is discussed, and the behavior of partial efficiencies related to the measurement and feedback processes is examined.

Planning of prescriptive maintenance types for generator with fuzzy logic-based genetic algorithm in a hydroelectric power plant

The move to predictive and prescriptive maintenance underlines the need for cost-effective methods to monitoring degradation and predicting failures. It is in hydroelectric power plants (HPPs) where the most powerful and unique techniques of this evolution were observed. The final premise of this transition is the need to improve the decision-making process for planning activities in the Prescriptive Maintenance Planning (MP). This encourages the use of fuzzy set theory in process management. Although there are many studies on MP in the literature, these studies do not fully reflect the real life as they ignore potential schedule delays and the indirect impact of sustainable strategy on revenues. Therefore, in the first stage of this study, it is aimed to weight the maintenance types (MTs) on a plant basis for the generator, which is the most critical system of the pumped storage HPP, and in the second stage, it is aimed to create MPs that minimize delays due to system shutdowns with weighted MTs. For this purpose, in the first stage, the MTs for the HPP were weighted by AHP-TOPSIS combination augmented with Pythagorean fuzzy numbers, and in the second stage, a Genetic Algorithm model was designed for the problem of coordinating maintenance durations and deadlines in addition to these weights. Averaged over 50 iterations, the average number of delayed MPs is 142.55, indicating that the algorithm is successful in reducing delayed MPs, while the average weighted delay value is 172.85, indicating that more work is needed in terms of weighted delay.

OGC P35 A clinical audit looking at how efficient the current pathways are for detecting upper oesophageal cancer

Abstract Background Dysphagia is a red flag symptom of possible oesophageal cancer. Patients are referred to gastroenterology, Upper GI Surgery or Otolaryngology. The referral pathway is determined by whether the symptoms are thought to be oropharyngeal or oesophageal in nature. Often, correlation between patient’s perception of the level of dysphagia and the anatomical location of the underlying cause is unreliable. This can result in a number of patients receiving either a delayed complete examination of the oesophagus or not receiving one at all. Our aim was to identify potential delays in the diagnostic pathway of patients with suspected upper oesophageal malignancy. Methods A retrospective analysis of 348 patients with a confirmed histological diagnosis of oesophageal cancer between January 2021 – March 2023 was performed. Only patients with cervical oesophageal cancer up to 20cm were included. The time between GP referral and commencement of treatment was compared against NHS England standards. The initial investigation ordered for those patients after being referred to the specialist was reviewed in order to identify any diagnostic delays. According to NICE guidelines, all patients with dysphagia should be referred for oesophago-gastro-duodenoscopy (OGD) urgently. Barium swallow should not be the first line investigation for suspected oesophageal cancer. Results 14 cervical oesophageal cancer cases were identified. 5 cases discussed at UGI Multidisciplinary meeting with incidental diagnosis were excluded. All remaining 9 cases were discussed at both Head and Neck and UGI MDMs. 6/9 patients were first referred to ENT with dysphagia. The remaining 3/9 were referred to either Gastroenterology or UGI. 4/9 patients had OGD whereas 5/9 had barium swallow and 7/9 rigid oesophagoscopy organized by ENT. Interestingly, 4/5 barium swallow tests were the first line investigation. Median interval from GP referral till start of treatment was 108 days which is almost double compared to the standards (62 days). Conclusions This study highlights significant delays in the diagnostic pathway of patients referred from GP with dysphagia and suspected cervical oesophageal cancer. It appears that this group of patients enters a pathway without a clear diagnostic consensus. Patients with red flag dysphagia symptoms for suspected malignancy should have direct visualisation of the oesophagus irrespective of whether the initial assessment occurs within head and neck or upper gastrointestinal suspected cancer pathways.

OGC P65 Diagnostic workup for esophageal cancer patients can be improved with checklists and clearer protocols; a comparative study between two tertiary centers in Europe

Abstract Background Rapid and complete workup of newly diagnosed esophageal cancer is vital for a timely, individual and high-quality treatment strategy. The aim of this study was to uncover potential delay, inefficiencies and non-contributing investigations in the diagnostic process. Methods This retrospective cohort study included all newly diagnosed esophageal cancer patients referred to or diagnosed in the Amsterdam UMC and Karolinska University Hospital between July 2020 and July 2021. Radiology, pathological assessment and multidisciplinary team meeting reports were reviewed. To assess time interval from diagnosis to treatment, dates of diagnosis, admittance to referral hospital, MDT meeting and start of treatment were collected. Results In total, 252 esophageal cancer patients were included, of which 187 were treated with curative intent. Curatively treated patients had a mean age of 66 years, were predominantly male (74.9%) with an adenocarcinoma (71.4%). Curatively treated patients had a median time from diagnosis to referral of seven days (IQR:0-11) and a median of 35 days (IQR:28-45) between diagnosis and start treatment. 69 patients had a prolonged time, defined as 40 days or more, between diagnosis and treatment. Main reasons for differences in time between diagnosis and treatment between centers, Amsterdam UMC (39 days) vs Karolinska (27 days), were additional diagnostics (47.8%) and differences in referral routine. For 27 out of 67 patients (40.3%) only logistical reasons were found for prolonged time between diagnosis and treatment. Conclusions Time between diagnosis and treatment can be improved, possibly with alterations in workup protocol, referral routines, MDT meeting regulations and workup checklists.

Risk factors for delayed termination of pregnancy following increased nuchal translucency.

Termination of pregnancy after increased nuchal translucency (NT) is a common occurrence. This study aimed to identify characteristics of a cohort with a NT ≥3.0mm who underwent a pregnancy termination ≥15weeks compared with those who terminated <15weeks. All NT ≥3.0mm identified within our department over an 11-year period (2010-2021) (n=689) were retrospectively examined and characteristics of the cohort of increased NTs ending in termination were further categorized. There were 221 (32.1%) individuals with an increased NT (≥3mm) who underwent a termination of pregnancy within our study period (2010-2021). Pregnancy termination occurred at a gestational age <15weeks in 162 (73.3%) and ≥15weeks in 59 individuals. Pregnant individuals without positive NIPT for aneuploidy were at a higher risk for a ≥15-week termination (p=0.004). In 29% (17/59) of late terminations, there were additional imaging findings after the NT scan (ultrasound, echocardiogram, magnetic resonance imaging) that ultimately triggered the decision to pursue termination. As the options for workup of an increased NT expand, potential delays in decision-making surrounding termination increase. This study identifies multiple reasons for delayed termination and proposes several approaches to care aimed at maximizing diagnostic information by imaging and diagnostic testing in an expedited manner.

The supply of convenience stores: Challenges of short-distance routing within the constraints of working time regulations

Convenience stores are small shops typically located in dense urban areas. They are an important element in modern retailing considering growing urbanization. The layout of convenience stores usually differs significantly for individual stores depending on the local conditions and the types of store (e.g., grocery stores, kiosks, gas stations). Convenience stores have specific delivery requirements that differ significantly due to their variety. In this context, retailers have to cope with small order sizes and frequent deliveries that need to occur within opening hours or predetermined time windows. In addition to these requirements, working hour regulations for the drivers, i.e., the consideration of break times and tour duration restrictions, have to be respected. These regulations have so far been neglected within short-distance routing but significantly impact the planning in practice. The supply of convenience stores is thus a major challenge for retailers.This article addresses the supply of convenience stores as it takes place at a major European retailer. We develop a mathematical model that integrates existing working time regulations and actual requirements in retail practice. The resulting routing problem is solved using an adaptive large neighborhood search. We demonstrate the impact of the requirements imposed on the routing problem and corresponding delivery solutions in numerical studies. Our experiments show that ignoring break times within route planning when strict time windows are given leads to non-feasible solutions and a potential delay in deliveries of more than 18 h for a single planning week.

The dual lens: bilingualism's influence on cognitive, social, and emotional aspects of child well-being in a globalised world

This research investigated the cognitive, emotional, and social implications of bilingualism on children aged 6-12 years from 20 diverse families, divided equally into bilingual and monolingual households. Utilising a mixed-methods design, the study employed cognitive tests, self-report questionnaires, and semi-structured interviews to gauge the multifaceted impacts of bilingual upbringing. Results, aligned with prior studies, underscored cognitive advantages in bilingual children. However, potential language delays and the necessity for adaptive educational strategies were highlighted. While bilingualism fostered heightened resilience and empathy, emotional strains were identified. The research emphasises the need for longitudinal studies, highlighting the intricate relationship between bilingualism and child well-being.

Real-World Characteristics, Treatment Utilization, and Transfusion Burden in Patients with β-Thalassemia Initiating Luspatercept: A US Cohort Study

Introduction: β-thalassemia is a β-globin gene disorder resulting in decreased production of hemoglobin A and chronic anemia. Disease severity ranges from asymptomatic, mild anemia to life-long red blood cell transfusion dependence. Luspatercept is an erythroid maturation agent that reduces transfusion burden in patients with transfusion-dependent β-thalassemia. We describe real-world baseline demographics and clinical characteristics alongside treatment utilization patterns in US patients with β-thalassemia treated with luspatercept. Methods: This retrospective, observational, cohort study used Komodo Health's Healthcare Map, a large administrative claims database in the USA. Patients with a diagnosis of β-thalassemia (ICD-10 code: D56.1) who initiated luspatercept treatment between January 1, 2020 and September 30, 2021 were included; the full study period was July 1, 2019 to September 30, 2022. The index date was defined as the first documented administration of luspatercept during the identification period. Patients were adults (≥ 18 years of age on index date) continuously enrolled for 6 months before (baseline) and 12 months after (follow-up) the index date. Discontinuation was defined as no medication claim for ≥ 90 days (assuming a 3-week schedule while taking into account potential dose delays). Descriptive statistics were used to analyze and report baseline demographics and clinical characteristics. Time-to-event variables were assessed using Kaplan-Meier methods. Results: The 101 patients included had a mean (standard deviation [SD]) age of 37.7 (14.9) years, with a broad geographical spread throughout the USA (Midwest n = 17, 16.8%; Northeast n = 24, 23.8%; South n = 28, 27.7%; West n = 32, 31.7%). Approximately half (52.5%) were female, and mainly commercially insured (56.4%). Patients were in relatively good health (mean [SD] Charlson Comorbidity Index: 0.8 [1.7]). Bone deformities (n = 16, 15.8%), hepatosplenomegaly (n = 13, 12.9%), and thrombotic events (n = 10, 9.9%) were the most common β-thalassemia-related comorbidities observed in the baseline period. Median (interquartile range) baseline transfusion frequency during the 6-month baseline period was 4.0 (8.0), and 55.0% of the patients were transfusion dependent (≥ 4 transfusions in the 6-month baseline period). Over 40% of patients remained on luspatercept after 1 year of treatment with a median time to discontinuation of 96.5 days (Figure). Approximately one fifth (19.0%) of patients who discontinued luspatercept reinitiated treatment (Figure). Among those who were transfusion-dependent who stayed on luspatercept at 6 months, 31.3% (10/32) experienced a reduction in the frequency of transfusions, with a median decrease of 2 visits in the 6-month follow-up period from baseline, and 28.1% (9/32) observed a decrease in the units of blood transfused, with a median decrease of 5 units in the 6-month follow-up period from baseline (Table). Similarly, among patients who were transfusion-dependent who stayed on luspatercept for 12 months, 32.0% (8/25) experienced a reduction in the frequency of transfusions, with a median decrease of 2.5 visits in the follow-up period from baseline, and 48.0% (12/25) observed a decrease in the units of blood transfused, with a median decrease of 3.7 units in the 12 month follow-up period from baseline (Table). Conclusion: This study shows that patients with β-thalassemia treated with luspatercept saw a substantial reduction in transfusion burden, in both the frequency of blood transfusion and units of blood used. As those who remained on luspatercept longer, through 12 months, saw an increased reduction in transfusion burden from baseline, these findings suggest the clinical and real-world benefit of longer-term luspatercept treatment.

1 Early Development of Adaptive Skills in Young Children with Agenesis of the Corpus Callosum: A Comparison to Monogenetic and Neurodevelopmental Conditions

Objective:Differences in adaptive functioning present early in development for many children with monogenic (Down Syndrome, Fragile X) and neurodevelopmental disorders. At this time, it is unclear whether children with ACC present with early adaptive delays, or if difficulties emerge later as functional tasks become more complex. While potential delays in motor development are frequently reported, other domains such as communication, social and daily living skills are rarely described. We used a prospective, longitudinal design to examine adaptive behavior from 6-24 months in children with ACC and compared their trajectories to those with monogenic and neurodevelopmental conditions.Participants and Methods:Our sample included children with primary ACC (n= 27-47 depending on time point) whose caregivers completed the Vineland Adaptive Behavior Scales-Interview 3rd Edition, via phone at 6, 12, 18 and 24 months. Comparison samples (using the Vineland-2) included children with Down Syndrome (DS; n = 15-56), Fragile X (FX; n = 15-20), children at high familial likelihood for autism (HL-; n=192-280), and low likelihood (LL; no family history of autism and no developmental/behavioral diagnosis; n = 111196). A subset of the HL children received an autism diagnosis (HL+; n = 48-74). The DS group did not have an 18-month Vineland.Results:A series of linear mixed model analyses (using maximum likelihood) for repeated measures was used to compare groups on three Vineland domains at 6, 12, 18 and 24 month timepoints). All fixed factors (diagnostic group, timepoint, and group X timepoint interaction) accounted for significant variance on all Vineland domains (p &lt; .001). Post hoc comparisons with Bonferroni-correction examined ACC Vineland scores compared to the other diagnostic groups at each timepoint. At 6 months, parent-ratings indicated the ACC group had significantly weaker skills than the LL group in Communication and Motor domains. At 12, 18 and 24 months, ratings revealed weaker Communication, Daily Living and Motor skills in the ACC group compared to both the LL and HL- groups. Compared to the other clinical groups, the ACC group had stronger Socialization and Motor skills than Fragile X at 6 months, and at 24 months had stronger Communication and Socialization skills than both the DS and FX groups, as well as stronger Socialization than the HL+ group.Conclusions:Compared to children with low likelihood of ASD, children with primary ACC reportedly have weaker Communication and Motor skills from 6 to 24 months, with weakness in Daily Living Skills appearing at 12 months and all differences increase with age. Compared to Fragile X, the ACC exhibited relative strengths in socialization and motor skills starting at 6 months. By 24 months, the ACC group was outperforming the monogenic groups on Socialization and Communication. In general, the ACC scores were consistent with the HL+ sample, except the ACC group had stronger Social skills at 18 and 24 months. The results clearly inform the need for early intervention in the domains of motor and language skills. Additionally, as we know that children with ACC are at increased risk for social difficulties, research is needed both using more fine-grained social-communication tools, and following children from infancy through middle childhood.

Abstract 058: General anesthesia versus conscious sedation during endovascular thrombectomy for distal vessel occlusions

Introduction Choice of anesthesia for endovascular thrombectomy in large vessel occlusion of the anterior circulation has been well studied, although practice patterns may still be variable. Anesthesia choice for distal vessel occlusions (DVO) presents unique challenges, however. General anesthesia (GA) may offer advantages over conscious sedation (CS) due to reduced patient movement facilitating catheter navigation, but concerns persist about potential delays and hypotension impacting collateral circulation. In our study, we aim to explore this question further. Methods In our prospectively maintained stroke registry from December 2014 to July 2023, we identified patients with DMVO defined as M2, M3, M4 occlusion, ACA occlusion, and PCA occlusion, who underwent MT for AIS. We compared patients who received CS to those who GA. Our primary outcome measures were length of procedure defined as time from entering angiography suite until final recanalization, access time to recanalization, CS to GA conversion rate, number of passes to reach TICI2b or better and first pass effect. Our secondary outcomes were length of stay, and modified Rankin Scale (mRS) at 5 days, 30 days, and 90 days. Results Total of 290 patients with DVO were identified, the median age was 73 (IQR 19). Of these, 86 patients (29.7%) underwent GA, and 200 (69.0%) received CS. CS to GA conversion was required in 36 patients (12.4%). Females accounted for 47.5% of the CS group and 38.4% of the GA group. No significant differences were found between the two groups in the racial and gender composition (p&gt;0.1). The mean admission NIHSS was significantly higher in the GA group (16.86) compared to the CS group (12.44) as was the rate of IV thrombolysis in the CS (36.2%) group compared to GA (31.4%) group (p&lt;0.01). The type of anesthesia used was not influenced by the laterality of the stroke in the middle cerebral artery territory (left vs right) (χ²=0.39, p=0.53). After adjusting for age, sex, IV thrombolysis, and admission NIHSS, CS usage did not result in an increase in procedural time (β=1.3, p=0.83). Furthermore, CS had no significant effect on the total number of passes (β=‐0.15, p=0.53), nor did it influence the likelihood of achieving first‐pass recanalization (β=0.28, p=0.48). No associations were found between CS use and the modified Rankin Scale (mRS) at 5 days (β=0.17, p=0.65), 30 days (β=0.22, p=0.75), or 90 days (β=0.15, p=0.67). Likewise, the length of stay in the hospital (β=1.71, p=0.77) was not significantly affected by the use of CS. Conclusion In our analysis of DMVO, the use of CS during thrombectomy appeared to be safe and feasible and comparable to GA with regards to procedural length, number of passes, and rate of first pass recanalization. Similarly, the type of anesthesia did not have an impact on clinical outcome. Further studies are needed to build on these findings and inform optimal management strategies.

Abstract 065: Advancing Stroke Care Services through Collaborative Efforts: Mission Thrombectomy Surveys of Slovenia

Introduction Acute stroke care must always be improved because stroke is still a leading cause of mortality and adult‐onset disability. The Mission Thrombectomy Slovenia Regional Committee (RC) has established a forward‐thinking initiative to improve stroke treatment services in response to this challenge. With a focus on showcasing the complete picture of stroke systems and identifying areas for improvement to achieve better patient outcomes and increase accessibility to mechanical thrombectomy (MT) treatments in Slovenia, this partnership aims to conduct extensive surveys, analyses, and propose a roadmap to overcome obstacles and optimize the stroke care ecosystem. The SVIN Mission Thrombectomy Slovenia Regional committee (RC) comprises distinguished experts, including Zoran Miloševič as Neurointerventional co‐chair, and Senta Frol and Janja Pretnar Oblak as stroke co‐chairs, respectively, and Igor Rigler as ER co‐chair, whose expertise and collaborative efforts form the backbone of this initiative. Methods As an initial step, we have commenced surveys with UMC Ljubljana, Slovenia. UMC Ljubljana, as a Mechanical Thrombectomy Center, has demonstrated consistent growth in the number of procedures conducted. There is a projection of 180 procedures in 2023, an increase from 135 in 2021 and 109 in 2022. The increased projected procedure volume indicates the hospital's proactive approach in delivering cutting‐edge stroke treatments. A pivotal aspect of UMC Ljubljana's stroke care model lies in its advanced imaging capabilities, including CTA/CTP and MRI/MRP, enabling precise and swift diagnoses, fostering better treatment planning, and optimizing patient outcomes. Furthermore, the presence of a well‐equipped Angio suite, staffed with competent MT operators, ensures seamless execution of interventional procedures. Results The collaboration's future vision involves conducting surveys and analyzing data to identify barriers to MT access, streamlining the patient journey, and improving overall stroke care efficiency. The ongoing efforts of building a Stroke Registry at UMC Ljubljana will enable in‐depth analysis, fostering continuous evolution in stroke care practices. Additionally, investments in Intermediate/Step down care and Telemetry beds will play a vital role in strengthening the continuum of care, enabling smooth patient transitions, and reducing potential delays in treatment. Healthcare practitioners' awareness for stroke triage and Physician Training emerge as the most impactful Thrombectomy Patient Health Initiatives. By prioritizing these initiatives, UMC Ljubljana and Mission Thrombectomy aim to foster early recognition, prompt treatment, and streamlined care for stroke patients. Conclusion In conclusion, the collaborative efforts of UMC Ljubljana and Mission Thrombectomy Slovenia RC are poised to elevate stroke care and MT services through data‐driven analysis and the proposed roadmap. By incorporating future surveys and continuous improvement strategies, the collaboration aims to create a paradigm shift in stroke care, ensuring accessible, efficient, and optimized services to patients in need. Moving forward, we will continue to conduct surveys within the current EVT and stroke centers examining the calculated MT Operator availability (MTOA), MT Center availability (MTCA), and MT Access Rate (MTAR) scores to identify the current barriers to increase access to mechanical thrombectomy.

Rapid care transition: Implementation of an undiagnosed cancer clinic.

80 Background: There is a critical need to address potential delays in care for patients (pts) with new, undiagnosed cancer in academic medical centers that operate on a subspecialty clinic model. To bridge this gap, we established an Undiagnosed Cancer Clinic (UCC) staffed by oncology physicians and advanced practice providers (APP) to provide rapid access to specialty-led diagnostic work-up, symptom management, and disease education with the transition to subspecialists at a final diagnosis. Methods: A referral process was created, and specified provider template allocation (2 slots/week increased to 5) with a goal of referral to visit time &lt;3 business days. A nurse navigator facilitates diagnostic procedures and helps overcome barriers to care. We collected data on time from referral to UCC visit, demographics, diagnosis, and symptoms managed. Results: Prior to the UCC, median wait time for undiagnosed pts at our institution was 17 days (range 7-49) over a 4-month historical cohort (n=14). In the first 9 months of the UCC, 52 patients were seen, with a decrease in median wait time to 5 business days (range 1-21); when excluding 13 pts who requested delays or were hospitalized, wait time was 3 business days (range 1-7). Referrals increased over time from 1 to 8 per month, most from primary care providers (PCP) (31%) and emergency department (ED) (25%). Demographics include race: 65% White, 25% Black/African American, 10% Other; ethnicity: 13% Hispanic; language: 90% English, 8% Spanish, and 2% Other. The most common cancers diagnosed were gastrointestinal (35%), lymphoma (12%), genitourinary (8%), and breast (8%); 79% of solid tumor pts had metastatic disease. No cancer was identified in 15%. 58% had at least one ED visit before UCC visit, and 8% between UCC visit and establishing care with a subspecialty team. Symptoms requiring intervention were present in 63% at the time of visit, including pain, nausea, vomiting, diarrhea, and constipation. 8% of those diagnosed were referred to hospice. Conclusions: The UCC is a high-value means of specialty-led care to work up a presumed cancer diagnosis while offering symptom management and patient-centered goals of care. A team of oncology providers and clinical navigation team decreased wait time and increased access in an outpatient setting, had a low rate of ED visits following UCC-established care, and provided support and coordination of care with the ability to address barriers for marginalized communities. We are actively partnering with EDs and PCPs to expand the reach of our UCC to a broader population.

USER PERCEPTIONS BASED LEVEL OF SERVICE FOR UNCONTROLLED MID-BLOCK CROSSINGS USING TRAFFIC SURVEYS AND ITS REGRESSION ANALYSIS

The exponential growth of urban populations has led to a substantial increase in traffic on urban roads, prompting extensive research into optimizing road networks for vehicular traffic. However, there has been a noticeable lack of attention given to the safety and well-being of pedestrians. One particularly perilous scenario for pedestrians occurs at mid-block crossing locations where well-designed crosswalks are absent. In such areas, pedestrians are forced to identify safe crossing points, often with limited safety measures in place. Ensuring the safety, convenience, comfort, and minimal delay for pedestrians in these situations is imperative. To address this gap, a comprehensive evaluation of the quality of service at mid-block crosswalks is necessary. This research study focused on assessing the quality of service at non-signalized mid-block pedestrian crossings from the perspective of consumers. The analysis employed regression techniques and gathered data from four distinct mid-block crossing locations in different areas of Visakhapatnam. Data collection involved video image surveillance to obtain data on pedestrian quantities, volume-based characteristics, walking speeds, capacity, and gap sizes, complemented by questionnaires to capture real-time experiences and opinions of pedestrians. The questionnaire encompassed various variables affecting crossing quality, including demographic information and pedestrian perceptions of safety and comfort. Pedestrians rated these attributes on a scale of one to six, with their scores serving as variables for subsequent analysis. This approach seeks to ensure that pedestrians have the safest, most comfortable, and efficient means to cross the street while minimizing potential delays. Keywords:Pedestrian safety,Mid-block crossing,Quality of service,Urban road traffic,Crosswalk design, Consumer perspective,Data collection, ,Questionnaires,Perception,Safety measures,Comfort, Demographic information,,Efficiency,Delay mitigation,Regression analysis,Vehicular traffic optimization,Urbanization impact.