Transport Time Research Articles

An Analysis of 24-Hour Survival Based on Arrival by Atypical Ground Transport Versus Ground Emergency Medical Services

Objectives Studies comparing police, privately owned vehicle (POV), and ground Emergency Medical Services (GEMS) trauma transports reveal mixed results. It remains unclear whether using nonstandard transport methods may be beneficial in the setting of certain injuries. We sought to determine 24-h survival after transport by police or POV when compared to GEMS. Methods We analyzed data from the Trauma Quality Improvement Program datasets from 2020 to 2022 for patients arriving from scene by POV, police, or GEMS. The primary outcome was 24-h survival. Multivariable logistic regression models were used to adjust for confounders. Further stratification was performed by mechanism. We used abbreviated Injury Severity Score (ISS) by body region to assess those with and without penetrating torso trauma. Results Patients arriving by POV had a lower median age than those arriving by GEMS and a higher proportion of pediatric patients. This group exhibited a lower incidence of blunt trauma but a higher incidence of penetrating trauma, along with fewer serious injuries across all body regions. Across all adjusted models, arrival by POV was associated with higher odds of 24-h survival, except for cases of penetrating torso trauma among pediatric patients. Patients arriving by police also had a lower median age but a reduced proportion of pediatric patients. This group showed a higher proportion of penetrating trauma and serious injuries to the thorax and abdomen. Police arrivals with blunt trauma had higher odds of 24-h survival, while those with penetrating trauma had lower odds of 24-h survival, a pattern consistent when stratifying by ISS greater than 15. Conclusions This study highlights a survival advantage for trauma patients transported by POV compared to GEMS. Limitations include a lack of prehospital transport time and intervention data. While police transport showed improved survival for blunt trauma, it was associated with worse outcomes for penetrating trauma. These findings suggest that nontraditional transport methods may be beneficial in certain scenarios. Future research should aim to refine transport protocols, investigate the impact of nontraditional methods on transport time, and better understand the impact of prehospital interventions on patient outcomes.

Optimizing integrated distributed flexible job-shop scheduling and customer order delivery

ABSTRACT This study addresses the Distributed Flexible Job-Shop Scheduling Problem (DFJSP) while considering the delivery of customer orders and transportation time. To tackle the problem, a mathematical model is presented, and a novel variant of the Genetic Algorithm (GA), called Time-Travel GA (TTGA), is developed. The optimization objectives include minimizing the total orders’ delivery time to the related customers, reducing transportation and production costs, reducing manufacturing pollution, and maximizing the quality of completed orders. The performance of TTGA is tested by implementing it in a real-life manufacturing setting. Additionally, TTGA results are compared with those of four other algorithms over a set of test problems. Furthermore, the solutions obtained by TTGA are compared with the optimal solutions obtained by a commercial solver for small-size problems. The results of these comparisons collectively demonstrate the promising performance of TTGA in addressing the DFJSP.

Travel Time Estimation for Optimal Planning in Internal Transportation

Optimal planning depends on precise and exact estimation of the operation costs of mobile robots. Unfortunately, determining the current and future state of a vehicle implies identifying all the parameters in its model. Rather than broadening the number of factors, in this work we adopt the approach of using a higher-level abstraction model to identify only a few cost parameters. Based on the observation that arc travel times accurately reflect the effect of physical states, this work proposes using them as the key parameters to compute accurate path traversal costs in the context of indoor transportation. This approach eliminates the need to model all factors in order to derive the cost for every robot. The resulting model organizes those parameters in a bilinear state-space form and includes the evolution of actual travel times with changing states. We show that the proposed model accurately estimates arc travel times with respect to actual observations gathered from real robots traversing a few arcs of a traffic network until battery exhaustion. We experimentally obtained minimum-cost paths from random origin and destination nodes when using heuristics and the “closer-to-reality” (bilinear-state version of our model) path costs, finding that it can save an average of 15% in transportation time compared to conventional methods.

Modeling of fresh paddy aeration on transporting barges in Mekong Delta, Vietnam

The Mekong Delta is regarded as the granary of Vietnam, with an annual production of 24.1 million tons (2023). Currently, fresh paddy is transported directly from farmers’ fields to drying facilities or rice mills. Given the extensive river and canal system in the Mekong Delta, the majority of paddy (up to 92%) is transported by barges. While barge transportation is more costeffective (91,000 VND/ton for a 100 km distance) compared to truck transportation (269,000 VND/ton), it has significant drawbacks, such as a longer transportation time of 3 to 5 days. Moreover, because the paddy is wet during transport, it is prone to discoloration (yellowing), which reduces its quality. To address this issue, this research developed an experimental paddy aeration model as a foundation for implementing aeration on barges during transportation. The model was tested with 1.4 tons of fresh paddy, specifically the DT80 variety, in Cai Lay, Tien Giang province. Key parameters monitored and analyzed included paddy temperature, moisture content, ambient conditions, and grain quality. The model was tested with a specific airflow rate of 129 ± 23 m3/h per ton. The paddy temperature in the aeration model was maintained at 28.8°C, similar to the ambient temperature of 28.3°C. As a result, the whiteness of the aerated paddy was preserved at 3.6% after three days, whereas it decreased from 3.6% to 3.2% in paddy transported without aeration. The application of aeration helped reduce quality losses, particularly discoloration, caused by the high temperatures of fresh paddy during transportation.

Robust location-allocation decision considering casualty prioritization in multi-echelon humanitarian logistics network

Timeliness of medical service delivery has become an important purpose of post-disaster relief, while its realization highly depends on an effective design of multi-echelon humanitarian logistics network (HLN). What complicates the design of HLN are multiple uncertainties in the decision-making process, especially casualty number and transportation time. This paper proposes a novel robust optimization model for designing a four-echelon HLN including disaster sites, temporary medical centers (TPCs) in affected areas and two-tier hospitals, thereby optimizing medical facilities location, medical resources allocation and casualty evacuation. In this model, we consider casualty prioritization by incorporating deprivation cost and casualty triage. After conducting extensive computational experiments and sensitivity analysis by case studies based on the Luding Earthquake, the main results obtained are as follows: (i) the proposed model performs good effectiveness and robustness; (ii) considering deprivation cost in HLN can effectively reduce both the suffering of casualty and social cost; (iii) compared to the uncertainty of transportation time, more attention needs to be paid to the risks caused by uncertain casualty number, especially the mild injured with a large number.

Geographic Access to High-Volume Mechanical Thrombectomy Centers in Florida, 2019.

Mechanical thrombectomy (MT) improves outcomes for acute ischemic stroke (AIS) due to large vessel occlusion, but is time sensitive and requires specialized infrastructure. Professional organizations and certification bodies have promulgated minimum procedural volume standards for centers and for individual proceduralists but it is unclear whether enforcing these requirements would decrease geographic access to MT. Therefore, we sought to evaluate the potential impact of applying a minimum procedural volume threshold on geographic access to MT. We identified all hospital discharges for stroke where an MT procedure was performed at any nonfederal hospital in Florida in 2019 using statewide hospital discharge data. We then generated geographic service area maps based on prespecified ground transport distances for the subset of hospitals that performed at least 1 MT and for those that performed at least 15 MTs that year, the minimum volume threshold required for thrombectomy capable and comprehensive stroke centers by the Joint Commission. Then, using zip code centroids and patient-level discharge hospital data, we computed the proportion of patients with AIS who lived within each of the generated service areas. A total of 105 of 297 hospitals performed MT; of those, 51 (17%) were low-volume centers (1-14 MTs/year) and 54 (18%) were high-volume centers (≥15 MTs/year). High-volume centers accounted for nearly 95% of all MTs performed in the state. Most patients hospitalized with AIS (87%) lived within 20 miles (or an estimated as a 1-hour driving time) of a hospital that performed at least 1 MT, and all (100%) lived within 115 miles (or estimated as 3-hour driving time). Setting a minimum MT volume threshold of 15 would decrease the proportion of stroke patients living within 1-hour driving time of an MT center from 87% to 77%. In 2019, most Florida stroke patients lived within a 1-hour ground transport time to a center that performed at least 1 MT and all lived within 3-hour driving time of an MT center, irrespective of whether a minimum procedural volume threshold of 15 cases per year was applied or not.

Strategic approaches to crisis management: The global challenges of the pandemic on the Turkish container shipping industry

The Covid-19 pandemic has posed significant challenges to the sector, and Türkiye’s strategic location plays a crucial role in crisis management. This study aims to explore the repercussions of the pandemic on the sector and propose appropriate solutions. To identify the most effective solutions for prioritizing the challenges posed by Covid-19, 53 sector experts participated in the study. The Stepwise Weight Assessment Ratio Analysis method was used to weigh the criteria representing these challenges. The solutions were ranked using the Weighted Aggregated Sum Product Assessment and Combined Compromise Solution methods. The results indicate that the primary challenge is the increased shipping cost, followed by the prolongation of the transport time, global-scale impacts, and port congestion. The most appropriate solution identified was alternative vessel loading, followed by mixed-mode transportation usage, reservation guarantees, long-term contracts with shipping operators, integrated logistics services, container purchases, and technological integration

Characteristics of radon transport and optimization of ventilation parameters in large-scale underground cavern

Radon penetrates into the underground caverns through the pores/fissures of the surrounding rock, resulting in high radon concentration area and endangering the health of construction personnel. The on-site monitoring of radon concentration in the underground powerhouse of Tuoba Hydropower Station is conducted in order to study the radon concentration level. The radon transport during the construction period of underground powerhouse under forced ventilation is established by Computational Fluid Dynamics (CFD) numerical simulation method. Furthermore, the distribution characteristics and long-term evolution law of radon concentration in underground powerhouse are revealed, and reasonable ventilation optimization measures are put forward and the results show that: (1) Blasting promotes the increase of radon concentration, while forced ventilation accelerates radon transport. (2) The airflow field along the axis is divided into a vortex distribution zone, a vortex influence zone and stable regions. (3) The radon transport includes both migration and diffusion processes based on forced ventilation. (4) The radon concentration decreases with the increase of height, while exhibits low concentration in the middle and high concentration on both sides at the same height. (5) Compared with forced ventilation, the combined ventilation can improve the ventilation efficiency and shorten the radon transport time. The research results can provide a scientific basis for the safety analysis and evaluation of deep engineering environment.

Analytical Solution of Rate Equations Including Frequency Chirp of Modulated Quantum-Well Laser with Carrier Transport Processes

When used as light sources in modern fiber communication systems, the modulation bandwidth and chirp are crucial characteristics of high-speed quantum well (QW) lasers. These parameters are primarily constrained by two factors; namely, the transport of charge carriers in the separate confinement heterojunction (SCH) layer and their escape processes in the QW. To analyze the frequency chirp theoretically, a fourth rate equation is added to the existing system of three coupled rate equations, which describe the photon number in the QW and carrier numbers in both the QW and SCH layers. This study employs small-signal analysis to linearize these coupled equations and derives analytical expressions for both the intensity modulation (IM) response and its associated frequency chirp. The chirp is quantified using two metrics, first the chirp per modulated current (CCR), and second the chirp per modulated power (CPR). These analytical expressions are presented in a generalized form, making them applicable to any nonlinear gain mathematical formulation found in the literature. Through numerical calculations applied to high-speed QW lasers, we investigate the individual effects of transport and escape times on the frequency chirp. Our findings demonstrate that CCR reaches its minimum under two specific conditions: when the transport process is relaxed with a relatively long transport time, and when carrier escape in the QW occurs rapidly with a very short escape time. Notably, we found that CPR remains independent of the transport processes.

Rural Road Assessment Method for Sustainable Territorial Development

In Latin America, initiatives have been advocated for developing rural roads that facilitate optimal conditions free from dust, mud, and noise. The criteria for assessing public investment do not align with the requirements of rural infrastructure. Indeed, in rural areas, the territorial conditions such as openness to rural–urban markets, access to education and health, environmental protection, culture, and identity are more important than transportation times or traffic volume. Hence, a multicriteria evaluation method is proposed to prioritize the rural road improvements and maximize their contribution to sustainable territorial development. The roads with the highest sustainable contribution are optimized using a multi-objective decision-making analysis and prioritized based on a Manhattan distance. In addition, a fuzzy cognitive map analyzes the dynamic behavior of the optimal roads. Based on this proposal, a case study is applied where fifteen roads are selected from a sample of 101 in the Araucanía Region, Chile. For this, 16 evaluation criteria, 27 indicators, and sustainability’s social, environmental, technical, and economic dimensions are considered. The results detect reduced one-dimensional contributions despite identifying 15 optimal roads that collectively enhance sustainability. Two roads stand out for their long-term sustainability contribution, which are influenced by economic criteria of zonal productivity, tourism, and road maintenance. Thus, this method can help public agencies rank the roads that must be the subject of development projects.

Prehospital telemedicine support for urban stroke care: Analysis of current state of care and conceptualization

BackgroundThe reduction of processing times in the treatment of acute ischemic stroke is of outstanding importance. Our objective is to analyze the acute stroke care chain from onset to treatment in a city in Germany comprising three stroke units. Additionally, we discuss solutions for detected treatment delays.MethodsWe conducted an in-depth analysis of acute stroke care processing times across three local stroke centers in Düsseldorf among all emergency services transportations for suspected stroke. Isochrone mapping was performed to identify areas with prolonged transportation times.ResultsAmong the 1,714 transportations, 943 patients had confirmed strokes. Prehospital care constituted 58% of total emergency care time until imaging. Patients with confirmed stroke had reduced in-hospital times while patients receiving treatment experienced faster in-hospital times. Isochrone mapping revealed disparities in transportation times within the city.ConclusionsIn conclusion, we identified confirmation of stroke symptoms as pre- and in-hospital and treatment eligibility as in-hospital process accelerators in stroke care. We propose the introduction of an in-ambulance video consulting model to accelerate contact to stroke-experts and accelerate processing times for patients eligible for treatment. Furthermore, we discuss the combination of in-ambulance video consulting with imaging and starting treatment outside traditional stroke centers, followed by transportation to a stroke center during thrombolysis, which might further accelerate treatment in specific cases.

A linear model to estimate modal split in international freight transport, based on revealed preferences about cost and time saving

We present a new model for estimating the distribution of international freight transport over transport modes that is directly applicable to aggregated data, allows estimations and predictions also when some modes are infeasible on some routes, and requires few processing time and memory space. It builds on the assumption that demand for transport by a given mode is driven by trading firms’ and consumers’ preferences about saving transport costs and time. In contrast to conventional mode-choice models, it is linear and grounded on consumer demand theory. Applying the model to international freight transport as recorded in the latest upgrade of UN Comtrade reveals an average cost elasticity of transport demand of − 0.32 and an average time elasticity of − 0.18. In addition, we find significant independent mode-specific effects. Cost and time elasticities are highly dependent on the type of commodity transported. The cost elasticity ranges from zero to − 1.9 and the time elasticity from zero to − 3.3 across commodity groups defined at the four-digit level of the Harmonized System classification. These findings suggest that policy measures, exogenous shocks or other events that change the relative transport costs and transit times across modes can cause modal shifts—for some commodities more than for others—thereby mitigating the loss in welfare.

Influence of different kinematics on shaping ability and accumulated hard tissue debris: an ex vivo study.

To determine the shaping ability, the amount of accumulated hard tissue debris (AHTD) and untouched area is generated by different kinematics through micro-CT. Thirty-two mesial roots of mandibular molars with Vertucci type IV were pre-scanned through micro-CT evaluation and randomized to one of the four experimental groups according to the kinematics tested: Continuous Rotation (CR), Reciprocation (REC), Optimum Torque Reverse (OTR) and Jeni motion. The root canal preparation was performed with HyFlex EDM (Coltène/Whaledent AG) up to OneFile. After each file used, irrigation was performed with 2mL 5.25% NaOCl for 1min. The final rinse was performed with 1ml of 5.25% NaOCl followed by a 1ml of 17% EDTA and, 1ml of distilled water. Then, the samples were scanned and the images, before and after preparation, were superimposed and analyzed to determine the AHTD, untouched areas, canal transportation, centering ability, and shaping time. Data were statistically analyzed using Kruskal-Wallis test and Dunn post hoc with p < 0.05. No significant differences were detected among the tested kinematics in terms of untouched areas, AHTD, canal transportation and shaping time (p > 0.05). Significantly more untouched areas were detected in the coronal third compared to the middle (p = 0.0301) and apical ones (p = 0.0399) under continuous rotation. Moreover, a significantly higher centering ratio in the middle third compared to the apical was observed for Jeni motion (p = 0.0207). The tested kinematics showed similar untouched areas, AHTD, shaping ability and shaping time. All motions determined an appropriate mechanical preparation; yet, none of them was able to prepare all canal walls and keep the root canals completely free from hard tissue debris.

Diagnostic and prognostic value of time to positivity in blood cultures. An opinion paper

Time to positivity (TTP) refers to the duration required for a microbiological culture test to indicate a positive result, marking the onset of detectable bacterial or fungal growth in the sample. Numerous variables, including patient characteristics, infection source, former antimicrobial therapy, blood sample volume, and sample transportation time can influence the value of TTP. Several studies have been conducted on bloodstream infections, whereas studies on the clinical significance of yeast TTP are quite limited in the literature. Furthermore, many studies are retrospective and have a small sample size. In this opinion paper, we have formulated some questions and attempted to provide answers based on the available literature and our perspective. The objective of this opinion paper is to summarise current knowledge based on the literature, aiming to offer a critical perspective, particularly on aspects with weaker evidence, which could guide future studies in this area. We believe that TTP of blood cultures appears to exhibit considerable potential and may prove to be a valuable tool in clinical practice for estimating patient mortality risk and guiding antimicrobial therapy choices. Topics discussed include the diagnostic and prognostic role of TTP in Gram-positive and Gram-negative bacteremias and in candidemias, and the significance of differential time to positivity (DTTP). In summary, our opinion is that, based on the available literature, it is not possible to determine whether TTP provides prognostic information, particularly concerning candidemia. Therefore, clinical decisions cannot be systematically based on this parameter.

Clinical Evaluation of the NaviNetics Stereotactic System Using Intraoperative Portable Surgical Imaging System in DBS Surgery

BACKGROUND AND OBJECTIVES: A typical workflow for deep brain stimulation (DBS) surgery consists of head frame placement, followed by stereotactic computed tomography (CT) or MRI before surgical implantation of the hardware. At some institutions, this workflow is prolonged when the imaging scanner is located far away from the operating room, thereby increasing workflow times by the addition of transport times. Recently, the intraoperative O-arm has been shown to provide accurate image fusion with preoperative CT or MR imaging, suggesting the possibility of obtaining an intraoperative localization scan and postoperative confirmation. In this article, we aim to evaluate the compatibility of the stereotactic frame system with the intraoperative O-arm system regarding lead accuracy and surgical flow. METHODS: A total of 17 patients undergoing DBS surgery for movement disorders were evaluated. One patient underwent both the stereotactic CT and O-arm localization, while 16 patients underwent only intraoperative O-arm localization. Following lead placement, intraoperative O-arm imaging was obtained to evaluate the accuracy of the lead placement. Accuracy was defined as the error measured as the distance from the center of the planned trajectory to the cannula. RESULTS: Less than 0.1 mm difference was found between the O-arm imaging technique and CT image localization of the NaviNetics stereotactic head frame in DBS surgery. Of the 16 patients who underwent the intraoperative O-arm imaging alone, the targets included bilateral ventral intermediate nucleus (16 leads), bilateral globus pallidus internus (4 leads), and subthalamic nucleus (12 leads). The mean ± SD radial error in the probe's eye view was 0.71 ± 0.33 mm for n = 32 leads. No tract hemorrhage was observed. CONCLUSION: Intraoperative O-arm imaging can be used safely and effectively for stereotactic registration and lead placement confirmation with the stereotactic system in both awake and asleep DBS surgery.

A multi-site passive approach to studying the emissions and evolution of smoke from prescribed fires

Abstract. We conducted a 2-year study utilizing a network of fixed sites with sampling throughout an extended prescribed burning period to characterize the emissions and evolution of smoke from silvicultural prescribed burning at a military base in the southeastern USA. The measurement approach and an assessment of the instrument performance are described. Smoke sources, including those within and off the base, are identified, and plume ages are determined to quantify emissions and study the evolution of smoke PM2.5 (particulate matter with aerodynamic diameters 2.5 µm or smaller) mass, black carbon (BC), and brown carbon (BrC). Over the 2021 and 2022 prescribed burning seasons (nominally January to May), we identified 64 smoke events based on high levels of PM2.5 mass, BC, BrC, and carbon monoxide (CO), of which 61 were linked to a specific burning area. Smoke transport times were estimated in two ways: using the mean wind speed and the distance between the fire and the measurement site, and from Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) back-trajectories. PM2.5 emission ratios based on ΔPM2.5 mass / ΔCO for fresh smoke (age ≤ 1 h) ranged between 0.04 and 0.18 µg m−3 ppb−1 with a mean of 0.117 µg m−3 ppb−1 (median of 0.121 µg m−3 ppb−1). Both the mean emission ratio and the variability were similar to findings from other prescribed fire studies but were lower than those from wildfires. The mean emission ratios of BC and BrC were 0.014 µg m−3 ppb−1 and 0.442 Mm−1 ppb−1, respectively. Ozone enhancements (ΔO3) were always observed in plumes detected in the afternoon. ΔPM2.5 mass / ΔCO was observed to increase with plume age in all of the ozone-enhanced plumes, suggesting photochemical secondary aerosol formation. In contrast, ΔBrC/ΔCO was not found to vary with plume ages less than 8 h during photochemically active periods.

Emergency neurosurgery for traumatic brain injury by general surgeons at local hospitals in Sweden: a viable option when time is brain

BackgroundTiming of surgical evacuation of mass lesions in traumatic brain injury (TBI) is crucial. However, due to geographical variations, transportation time to the nearest neurosurgical department may be long. To save time, general surgeons at a local hospital may perform the operation, despite more limited experience in neurosurgical techniques. This study aimed to determine whether patient outcomes differed between those who had undergone emergency neurosurgery at local hospitals by general surgeons vs. at university hospitals by neurosurgeons.MethodsA nationwide observational study was performed using data from the Swedish Trauma Registry (SweTrau) between 2018 and 2022. A total of 565 TBI patients (local hospitals, n = 21; university hospitals, n = 544) who underwent intracranial hematoma evacuation within 8 h after arrival at the hospital were included. Data on demography, admission variables, traumatic injuries, and outcome (Glasgow Outcome Scale [GOS]) at discharge were evaluated. Favourable vs. unfavourable outcomes were defined as GOS scores of 4–5 vs. 1–3.ResultsCompared with those treated at university hospitals, patients treated with intracranial hematoma evacuation at local hospitals had lower median Glasgow Coma Scale (GCS) scores (8 vs. 12, p < 0.001), higher rate of acute subdural hematomas (86% vs. 77%, p < 0.001), and lower rate of contusions (14% vs. 53%, p = 0.01). Being operated on at a local hospital was independently associated with higher mortality (p = 0.03) but with a similar rate of favourable outcome (p = 0.74) in multiple logistic regressions after adjustment for demographic and injury-related variables.ConclusionsAlthough a slightly greater proportion of patients who underwent emergency neurosurgery at local hospitals died, there was no difference in the rate of favourable outcome. Thus, in patients with impending brain herniation, when time is of the essence, evacuation of traumatic intracranial bleeding by general surgeons at local hospitals remains a highly viable option.

On the relation between urban road network and distribution centre location strategy of Franchise retail firms

Franchise retailers such as supermarkets and convenience stores have achieved greater efficiency in delivering products to their chain stores by locating distribution centres (DCs) within or near cities. In this study, we propose that the reduction of product transportation time due to the construction of intra-urban roads facilitates the location of distribution centres. To this end, we model the inventory management behaviour of franchise retailers and show that distribution centres have two functions: (1) consolidating the inventory holding risk faced by individual chain stores and (2) achieving larger lot sizes when purchasing goods from outside the city. We then analyse the effects of facilitating logistics by improving intra-city roads on reorganizing the location patterns of chain stores and distribution centres in the city and on improving the convenience of shopping for consumers.

Multiobjective Route Optimization for Multimodal Cold Chain Networks Considering Carbon Emissions and Food Waste

The cold chain logistics industry faces significant challenges in terms of transportation costs and carbon emissions. It is imperative to plan multimodal transportation routes efficiently to address these issues, minimize food waste, and reduce carbon emissions. This paper focuses on four key optimization objectives for multimodal cold chain transport: minimizing total transportation time, costs, carbon emissions, and food waste. To tackle these objectives, we propose a high-dimensional multiobjective route optimization model for multimodal cold chain networks. Our approach involves the development of a multiobjective evolutionary algorithm, utilizing Monte Carlo simulation and a one-by-one selection strategy. We evaluate the proposed algorithm’s performance by analyzing various convergence and distribution indicators. The average values for the minimum total transportation time, transportation cost, carbon emission cost, and cargo loss rate derived from the proposed algorithm ultimately converge to 6721.7, 5184.4, 301.5, and 0.21, respectively, demonstrating the effectiveness of the algorithmic solution. Additionally, we benchmark our algorithm against the existing literature to showcase its efficiency in solving high-dimensional multi-objective route optimization problems. Furthermore, we investigate the impact of different parameters, such as carbon tax rates, temperature, and cargo activation energy, on carbon emissions, and food waste. Moreover, we conduct a real-world case study to apply our approach to solving a practical business problem related to multimodal cold chain transportation. The insights gained from this research offer valuable decision-making support for multimodal carriers in developing low-carbon and environmentally friendly transportation strategies to efficiently transport perishable goods.

Abstract Su605: Return of Spontaneous Circulation after Transport with Ongoing Cardiopulmonary Resuscitation: Is Transport Always Futile?

Introduction: Despite validated Termination of Resuscitation (TOR) rules for Out of Hospital Cardiac Arrest (OHCA) some OHCA patients are transported prior to Return of Spontaneous Circulation (ROSC), sometimes with long transport times. There are certain therapies unavailable in the prehospital setting which could make transport prior to ROSC beneficial for some OHCA patients. Hypothesis: We hypothesized that longer transport times for patients with ongoing Cardiopulmonary Resuscitation (CPR) would be associated with progressively lower probability of achieving ROSC. Aims: To determine if there is a transport time interval beyond which ROSC becomes so unlikely that transport time could be determinant factor for TOR. Methods: We performed a retrospective study of the 2020-2022 NEMSIS national prehospital dataset. We included adult OHCA patients that did not have ROSC prehospital, were transported to the hospital, and had outcome and timestamp data available. We calculated transport time for each encounter and stratified encounters into 5-minute transport time intervals. We defined our outcome as ROSC after transport. We used multivariable logistic regression evaluating the association between 5-minute increases in transport time and ROSC. We performed a secondary analysis of patients that met termination of resuscitation (TOR) criteria (unwitnessed OHCA with no CPR or AED placement prior to EMS arrival). Results: Of 1,409,692 OHCAs, we included 137,957 OHCAs that were transported without prehospital ROSC. The median transport time was 8.9 minutes (IQR 5.4-13.8), and 17,957 (13.1%) had ROSC after hospital arrival. In 5-minute intervals from 0-30 minutes, ROSC rates were 13.5%, 13.1%, 12.0%, 11.1%, 12.1%, and 13.9%. Odds of ROSC per 5-minute increase in transport time was 1.00 (95% CI 1.00-1.00). For patients that met field TOR criteria, rates of ROSC for each 5-minute interval from 0-30 minutes were 9.2%, 8.7%, 7.6%, 5.9%, 6.1%, 4.2%, 7.5%. Odds of ROSC per 5-minute increase in transport time was 0.93 (95% CI 0.88-0.98). Conclusion: In this dataset we were unable to identify a transport time interval up to 30 mins beyond which transport is futile, even in patients who were transported despite meeting the universal TOR rule. Decision to transport based on case-by-case OHCA characteristics could have influenced results. Further research is needed to identify the subset of patient in whom transport prior to ROSC may be beneficial.