Just-in-time for supply chains in turbulent times

The Covid-19 pandemic and other recent disruptions in the early 2020s led to sections in the business press blaming just-in-time (JIT) practices for operational failings. Consequently, there are calls for moving away from JIT toward holding more inventory as preparation against future disruptions, which is referred to as just-in-case. The academic community is also divided. Some scholars argue that JIT is not resilient, while others maintain that JIT can continue providing superior performance even with disruptions. Motivated by this debate, we discuss various misconceptions about JIT that underlie this debate. Furthermore, we present different ways to adapt JIT for turbulent environments and argue that companies can improve their supply chain performance if JIT supply chain segments are chosen fittingly—even more so—during disruptions. © 2023 The Authors. Production and Operations Management published by Wiley Periodicals LLC on behalf of Production and Operations Management Society.

Customer satisfaction and sale performance in New York State brewery tasting rooms

The US craft brewery industry has grown steadily in recent years before the 2020 COVID-19 pandemic. The majority of small, independently owned craft breweries rely on tasting rooms for revenues and profits. Using data collected from a survey of tasting room visitors from 21 craft breweries in New York, this research investigates factors influencing visitors' customer satisfaction (CS) and the link between brewery tasting room CS and sales performance. The results show that brewery interior ambience, beer tasting execution, and friendliness and knowledge of servers are the main factors influencing CS in tasting rooms. Furthermore, results suggest that higher CS levels increase visitors' purchase likelihood and beer purchase amounts (by volume and value). These findings indicate that breweries should focus on such factors as strengthening staff training, enhancing tasting room ambience, and improving beer tasting execution that have the highest positive influence on CS to increase sales. This study has implications for the rapidly growing craft brewery industry in the USA. © The Author(s), 2023. Published by Cambridge University Press on behalf of the Northeastern Agricultural and Resource Economics Association.

A Organizacao De Uma Jornada Multidisciplinar Sobre Hemoterapia E Hematologia: Um Relato De Experiencia De Uma Liga Academica

Objetivo: A hemoterapia engloba diversos profissionais da area da saude envolvidos desde a captacao de doadores de sangue ate os processos laboratoriais e disponibilizacao das unidades para transfusao de hemocomponentes. Nesse contexto, surge a necessidade de um evento multidisciplinar que visa promover a integracao entre os profissionais da area e qualificar academicos que atuarao na area. O presente trabalho tem por objetivo relatar a experiencia de organizar a "V Jornada da Liga do Sangue" em formato online, permitindo a continuidade do evento no periodo da pandemia. Materiais e Metodos: A "V Jornada da Liga do Sangue" foi realizada de modo virtual, sendo exibida em formato de Live, atraves do canal do YouTube da Liga Academica do Sangue da Universidade Federal de Ciencias da Saude de Porto Alegre (LiSan-UFCSPA). O evento ocorreu em 2 dias, com carga horaria total de 7 horas. As inscricoes foram gratuitas e com certificacao. O primeiro dia de evento contou com palestras que abordaram o ciclo do sangue e controle de qualidade dos hemocomponentes, imunofenotipagem e genotipagem no Banco de Sangue. No segundo dia foi abordada a caracterizacao de leucemias, diagnostico e manejo clinico. Resultados: O evento foi planejado visando a participacao em tempo real e acesso universal durante as palestras, com o nivel de complexidade dos assuntos ocorrendo de forma escalonada. No primeiro e segundo dia de evento, o numero de participantes foi de 501 e 322, respectivamente. No final do evento, foi elaborado um formulario para computar a presenca dos participantes, para disponibilizacao dos certificados, e tambem duas perguntas para medir a organizacao e relevancia do evento para o aprendizado, sendo elas: "Como voce avaliaria o conteudo das palestras ministradas na data de hoje?" e "Como voce avaliaria a organizacao do evento?". Na avaliacao haviam as opcoes "otimo", "bom", "regular", "ruim"ou "pessimo". Tambem foi disponibilizado um espaco para comentarios. Dos 229 formularios respondidos, para a pergunta "Como voce avaliaria a organizacao do evento?";93,01% das respostas dos dias 1 e 2 do evento foram avaliadas como "otimas", seguidas de 6,55% avaliadas como "bom" e 0,44% como "regular". Para a pergunta "Como voce avaliaria o conteudo das palestras ministradas na data de hoje?", tambem para os dois dias avaliados;95,20% classificaram como "otimo" e 4,80% como "bom". Nao houveram marcacoes nas categorias "ruim" ou "pessimo". Discussao: Em decorrencia da pandemia da COVID-19, utilizou-se a internet para realizacao do evento, permitindo a adaptacao do formato presencial, utilizado nas edicoes anteriores, para o formato online. Foi possivel proporcionar um ambiente de divulgacao cientifica e conexao entre diferentes assuntos que englobam o sangue, alem de engajar profissionais e estudantes na construcao de um aprendizado na area. Conclusao: O evento atingiu mais de 800 pessoas e proporcionou troca de saberes e aprendizagem para o publico. Os palestrantes buscaram usar uma linguagem acessivel para falar sobre os assuntos. Dessa forma, o evento ajudou a salientar a importancia do dialogo entre os diferentes profissionais da saude e a comunidade, principalmente sobre a captacao de doadores e sendo uma fonte segura de informacoes. Copyright © 2022

Divulgacao Cientifica Em Hematologia E Hemoterapia Atraves Das Redes Sociais De Uma Liga Academica De Porto Alegre

Objetivo: As ligas academicas tem o objetivo de reunir estudantes com interesses em areas em comum e promover discussoes e diversas atividades voltadas ao tripe da extensao universitaria: ensino, pesquisa e extensao. Para acessar a comunidade, a Liga do Sangue (LiSan) da UFCSPA produz conteudos de divulgacao cientifica sobre os nichos de hematologia, hemoterapia e incentivo a doacao de sangue na rede social Instagram e, atraves de suas metricas, e possivel documentar seu alcance diante dos seguidores do perfil. O presente estudo teve como objetivo produzir e divulgar conteudo cientifico acessivel ao publico tanto da comunidade interna quanto externa a Universidade. Materiais e Metodos: Ao longo do periodo de 12 meses, foram produzidos conteudos informativos pelas comissoes: cientifica, responsavel pelas pesquisas bibliograficas, e de marketing, responsavel pela identidade visual da LiSan. As artes sao elaboradas atraves da ferramenta Canva, com linguagem acessivel, na forma de posts e stories da plataforma Instagram no perfil (@ligadosangue). Alem disso, a fim de promover mais acessibilidade e inclusao, a comissao responsavel pelas redes sociais da LiSan disponibiliza em cada postagem legendas e descricoes com a hashtag #PraCegoVer. Os conteudos abordados sao desde o formato de curiosidades breves relacionadas a doacao de sangue e outros aspectos referentes ao tecido hematopoietico, como o quadro "Voce Sabia?", ate publicacoes abordando conceitos de doencas hematologicas e sua ligacao com a transfusao de sangue. Tambem sao elaborados stories com conceitos comuns na hematologia, como os tipos de hemocomponentes, para facilitar o entendimento do publico leigo que tem acesso a esses conceitos nas publicacoes. Ademais, a ferramenta reels, videos da plataforma, foi usada para confeccao de um tutorial mostrando as etapas da doacao em um banco de sangue. Resultados: Neste periodo de 1 ano foram produzidos e publicados 24 posts, 5 stories e 1 reels, os quais tiveram um alcance de, em media 621 contas, sendo o post com melhor alcance foi o "Voce Sabia? Homens que fazem Sexo com Homens (HSH) podem doar sangue", com 1353 contas atingidas. Discussao: Nos ultimos 2 anos, com a pandemia causada pelo COVID-19, foi evidenciada a importancia das redes sociais na divulgacao cientifica com informacoes confiaveis e de qualidade. Como Liga Academica de uma Universidade Federal, a LiSan tem como um dos seus pilares a extensao e portanto, faz da divulgacao cientifica uma de suas prioridades e utiliza as redes sociais como ferramenta para impulsionar os conhecimentos para fora dos limites fisicos da Universidade. Conclusao: As redes sociais sao, atualmente, uma forma alternativa de promover o dialogo entre a universidade e a populacao, de forma que se torna uma ferramenta essencial e pratica para a divulgacao cientifica. A conta do Instagram da LiSan tem, ate o momento, 1849 seguidores e atinge mais de 600 pessoas por publicacao, evidenciando o seu papel social de propagacao de conhecimentos e informacoes em ciencia de qualidade e confiavel com acesso facilitado. Copyright © 2022

Building Resilient Post-pandemic Supply Chains Through Digital Transformation

The COVID-19 pandemic has created a challenging environment for firms on a global scale. Due to policies aiming to contain the spread of the virus, firms across all industries are forced to quickly adapt to highly dynamic changes in supply and demand, while simultaneously managing internal production disruptions. Most companies experience severe financial consequences during the supply chain disruptions. Digital technologies can be used to create more resilient supply chains that are able to better cope with future large-scale disruptions. In this chapter, we present current industry best practices, related to blockchain, digital platforms, analytics, and digital twins, to provide actionable insights for decision makers. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Impact of the COVID-19 pandemic on early career dementia researchers: A global online survey.

INTRODUCTION: The World Health Organization recognizes dementia as a public health priority and highlights research as an action to respond to the consequences, with early career dementia researchers (ECDRs) representing the key driving force. Due to the COVID-19 pandemic, however, biomedical and psychosocial dementia research was strained worldwide. The aim of this study was to understand the impact of the pandemic on ECDRs. METHODS: In autumn 2021, the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) Professional Interest Area to Elevate Early Career Researchers (PEERs) and University College London conducted an online survey querying ECDRs' experiences during the COVID-19 pandemic. The survey was shared through the ISTAART network, social media, podcasts, and emailing lists. Data were analyzed using descriptive and inferential statistics. RESULTS: Survey data from n = 321 ECDRs from 34 countries were analyzed (67.6% women; 78.8% working in academia). Overall, 77.8% of ECDRs surveyed indicated research delays, 53.9% made project adjustments, 37.9% required additional or extended funding, and 41.8% reported a negative impact on career progression. Moreover, 19.9% felt unsupported by their institutions and employers (33% felt well supported, 42.7% somewhat supported). ECDR's conference attendance remained the same (26.5%) or increased (More: 28.6%; a lot more: 5.6%) since the start of the pandemic. Continental differences were visible, while the impact of the pandemic did not differ greatly based on ECDRs' sociodemographic characteristics. CONCLUSIONS: The COVID-19 pandemic had a substantial impact on ECDRs worldwide and institutions, employers, and funding bodies are urged to consider the implications and lessons-learned when working with, managing, and promoting ECDRs. Strategies related to the pandemic and general career support to improve ECDRs career progression are discussed, including social media training, digital networking, and benefits of hybrid events. Global resources specific for ECDRs are highlighted.

Determinants of non-attendance in synchronous teleophthalmology clinics

Purpose : The COVID-19 pandemic has accelerated the introduction and dissemination of telemedicine into ophthalmic secondary care. Yet this pivot to telemedicine-dominated care could exacerbate the differential in health outcomes for certain groups. This study seeks to quantify and characterise factors associated with non-attendance within a population of patients attending synchronous tele-ophthalmic hospital outpatient appointments. Methods : A retrospective cohort study at a tertiary-level ophthalmic institution comprising a principal central site, four district hubs and five satellite clinics in London, UK between January 1st 2019 and October 31st 2021. Multivariable logistic regression modeled attendance status against sociodemographic, clinical and operational exposure variables for all new patient registrations. Results : Between January 1st 2019 and October 31st 2021, a total of 6843 eligible patients (mean age of 45 +/- 32, 58.0% female) were newly registered to attend synchronous teleophthalmology clinics. Self-reported ethnicity identified 3.4% as South Asian, 1.4% Black, 25.3% Other Ethnic Group and 7.6% White. 62.3% did not report their ethnicity. Most appointments were in general ophthalmology (59.9%, n=4096), followed by cataract (20.2%, n=1379), adnexal (19.1%, n=1310), medica retina (0.1%,n=55) and glaucoma (0.0%,n=3). Increased rates of non-attendance were associated with male sex (adjusted OR 0.74, CI 0.62-0.88), greater levels of deprivation (adjusted OR 0.88, CI 0.84-0.92), incompletion of self-reported ethnicity (adjusted odds ratio 0.3, CI 0.17-0.54) and a previously cancelled appointment (adjusted OR 0.65, CI 0.5-0.83) (all p<0.001). Individuals identifying as Asian or Black ethnicity had worse attendance in synchronous clinics with adjusted odds ratios of 0.42 (CI 0.20-0.90, p = 0.02) and 0.28 (CI 0.12-0.65, p=0.0025) respectively. Patients with diabetes were more likely to attend with an adjusted odds ratio of 1.03 (CI 0.3-3.55, p = 0.9). Conclusions : With regards to synchronous teleophthalmology clinics, poorer attendance is associated with male sex, greater socioeconomic deprivation and self-reported Asian and Black ethnicities. Further study is warranted to evaluate whether enhanced surveillance of these cohorts could improve their non-attendance rates.

Determinants of non-attendance in asynchronous telemedicine ophthalmology clinics

Purpose : Ophthalmic services are facing unprecedented pressures. Telemedicine has emerged as a potential solution to increase healthcare accessibility to a greater number of patients. This has been particularly emphasised by the COVID-19 pandemic, where digital health facilitated the provision of ophthalmic services in the face of strained resources, widespread service cancellations and social distancing restrictions. Thus, telemedicine has proven itself to be an invaluable resource. However, greater reliance on digital technology may further exacerbate healthcare inequalities faced by certain populations. The purpose of our study was to determine factors associated with nonattendance at asynchronous tele-ophthalmic clinics. Methods : This was a retrospective cohort study that reviewed all patients newly referred to Moorfields Eye Hospital (MEH) in London, United Kingdom, between January 1st 2019 and October 31st 2021. Electronic healthcare records were used to extract sociodemographic information, clinical variables and appointment details. The primary outcome measure was attendance at asynchronous clinics. 'Asynchronous' is the approach in which the patient attends for in-person assessment and/or imaging by technician with subsequent review of results by a clinician. Multivariable logistic regression modelling was used to examine attendance status against sociodemographic, clinical and operational exposure variables. Results : A total of 8878 eligible patients (median age 57±20 years, 52% female) attended asynchronous clinics across all MEH sites in the defined time period. Non-attendance was 11.7%. All asynchronous clinics were either medical retina (n=2740) or glaucoma (n=6138). Medical retina patients had 61% less odds (p<0.001) of attending their appointment compared to those attending the glaucoma service. Patients with diabetes (adjusted OR 2.16, CI 1.70-2.75) and registered sight impairment (OR 1.53, CI 0.35-6.60) were more likely to attend. Male sex (OR 0.78, CI 0.68-0.89) and greater levels of socioeconomic deprivation (OR 0.92, CI 0.90-0.95) were associated with increased rates of non-attendance. Conclusions : Male sex and socioeconomic deprivation are associated with greater rates of non-attendance at asynchronous teleophthalmic clinics. Further study into the identified factors associated with poor attendance may determine potential solutions and improve healthcare provision in these populations.

Determinants of Non-Attendance in Face-to-Face Ophthalmic Clinics Pre- and During the Coronavirus Pandemic

Purpose : Previous evidence suggests serial 'non-attenders' to clinic appointments are more likely to be socially disadvantaged, afflicted by poor health, and have higher use of emergency healthcare. This report seeks to quantify and characterise factors associated with non-attendance within a population of patients for face-to-face (F2F) outpatient appointments, pre-and during the COVID-19 pandemic. Methods : This was a retrospective cohort study of all National Health Service (NHS) patients, aged 18 and over, who were newly referred to Moorfields Eye Hospital NHS Foundation Trust, a tertiary ophthalmic institution consisting of a principal central site, four district hubs and five satellite clinics in London between January 1st 2019 and November 1st 2021. We included patients referred to the adnexal, cataract, general ophthalmology, glaucoma and medical retina services. Only the patient's first encounter (attendance or non-attendance) with MEH was included. Results : A total of 70,328 of first appointments were F2F (mean age pre-pandemic: 54 and pandemic: 56-IQR: 30 for both cohorts). The non-attendance rates for face-to-face pre-pandemic were 9.0% and face-to-face pandemic were 10.5%. Male sex (adjusted odds ratio pre-pandemic: 0.85, 0.80-0.91 and pandemic: 0.89, 0.82-0.97), greater levels of deprivation (adjusted odds ratio pre-pandemic: 0.89, 0.88-0.91 and pandemic: 0.91, 0.90- 0.93), incompletion of self-reported ethnicity and a previously cancelled appointment (whether instigated by the hospital or patient) were strongly associated with non-attendance within this mode of care delivery (p<0.01). Conclusions : Overall, male sex and greater socioeconomic deprivation are associated with poorer attendance. More specifically, non-attendance was higher amongst patients with self-reported Black ethnicity and early morning appointment times. Older patients, self-reported Caucasian ethnicity, those with diabetes and later appointment times were associated with higher levels of attendance. Further study is warranted to evaluate whether enhanced surveillance of certain cohorts could improve non-attendance rates in these groups.

Gasdermin-D activation by SARS-CoV-2 triggers NET and mediate COVID-19 immunopathology.

BACKGROUND: The release of neutrophil extracellular traps (NETs) is associated with inflammation, coagulopathy, and organ damage found in severe cases of COVID-19. However, the molecular mechanisms underlying the release of NETs in COVID-19 remain unclear. OBJECTIVES: We aim to investigate the role of the Gasdermin-D (GSDMD) pathway on NETs release and the development of organ damage during COVID-19. METHODS: We performed a single-cell transcriptome analysis in public data of bronchoalveolar lavage. Then, we enrolled 63 hospitalized patients with moderate and severe COVID-19. We analyze in blood and lung tissue samples the expression of GSDMD, presence of NETs, and signaling pathways upstreaming. Furthermore, we analyzed the treatment with disulfiram in a mouse model of SARS-CoV-2 infection. RESULTS: We found that the SARS-CoV-2 virus directly activates the pore-forming protein GSDMD that triggers NET production and organ damage in COVID-19. Single-cell transcriptome analysis revealed that the expression of GSDMD and inflammasome-related genes were increased in COVID-19 patients. High expression of active GSDMD associated with NETs structures was found in the lung tissue of COVID-19 patients. Furthermore, we showed that activation of GSDMD in neutrophils requires active caspase1/4 and live SARS-CoV-2, which infects neutrophils. In a mouse model of SARS-CoV-2 infection, the treatment with disulfiram inhibited NETs release and reduced organ damage. CONCLUSION: These results demonstrated that GSDMD-dependent NETosis plays a critical role in COVID-19 immunopathology and suggests GSDMD as a novel potential target for improving the COVID-19 therapeutic strategy.

Risk-reducing Salpingo-oophorectomy consults and practices during the COVID-19 pandemic.

Objective: Investigate the impact of the COVID-19 pandemic on risk-reducing salpingo-oophorectomies (RRSO) consults. Methods: Survey sent out to 1,127 full members of the Society of Gynecologic Oncology in August 2021. Survey data included physician characteristics, practice location, and self-reported subjective and objective data about their RRSO consults. Results: We received 70 responses; half of the respondents were female; the mean age of respondents was 46 (range 35-65). 86% of providers transitioned RRSO consults to telehealth. There was no correlation between uptake of telemedicine by age (R2 = 0.09) or gender (p = 0.80), but there was increased use in the West Coast region (p < 0.01). There was a small decrease in average time spent discussing sexual function over telehealth (35 s). Most providers felt comfortable discussing sexual health and function via telehealth. Conclusions: Overall, telemedicine is now commonly used for RRSO consults and physicians noted very few barriers to its uptake. Discussion of sexual function was similar between modalities, the loss of the pelvic exam or private setting did not affect the time providers spent discussing sexual health, however sexual health topics discussed were limited.

HumOSCM for pandemic response

Purpose Humanitarian organizations have faced the unprecedented consequences of the coronavirus disease 2019 (COVID-19) pandemic. In this article, the authors therefore discuss how epidemics and pandemics, specifically Ebola and COVID-19, have affected humanitarian operations and supply chain management (HumOSCM), and how HumOSCM has contributed to preparedness for and response to epidemics and pandemics. The authors present lessons learned from responses to Ebola and COVID-19. Design/methodology/approach For this study, the authors review the scholarly HumOSCM literature, use documentary evidence from practitioner literature and apply a theory synthesis approach to derive recommendations on how HumOSCM could strengthen future responses to epidemics and pandemics. Findings The conceptualizations highlight the importance of strengthening collaboration, capability and capacity for the response to epidemics and pandemics. Furthermore, the components that can enhance the degree of collaboration, and hence, response formation, are discussed. Research limitations/implications As a non-empirical article, it suffers from the limitations of conceptual research. Hence, empirical testing of the proposed framework is recommended. The framework and propositions can serve as a basis for future studies. Practical implications The conceptual framework can help humanitarian organizations and other actors in the humanitarian sector to better understand how to prepare for future responses to epidemics and pandemics, in particular by considering the components that enhance the degree of collaboration, as well as through capability development and capacity building. Originality/value This article begins a discussion of how HumOSCM should evolve to better respond to future epidemics and pandemics.

MI Diaries: ethical and practical challenges

The Michigan Diaries (MI Diaries) project was developed from late March to early April of 2020, in the early days of the COVID-19 pandemic. MI Diaries is a longitudinal sociolinguistic project, collecting "audio diaries" from participants throughout the pandemic and beyond. As a research project designed to obtain personal narratives from a time of deep anxiety and pain, and during a time where face-to-face data collection was not feasible, MI Diaries was confronted from the outset with a substantial set of both ethical and practical considerations. In this paper, we describe some of these challenges, and our false starts and eventual solutions in response. Throughout, we highlight decisions and methods that may be applicable for future researchers conducting remote fieldwork, navigating a speech community during a disaster, or both.

Financially distressed suppliers: exit, neglect, voice or loyalty?

Purpose: Major crises such as the global financial crisis 2007–08 or the COVID-19 crisis increase the level and likelihood of supplier financial distress. This research expands the understanding of how cooperatively, respectively, uncooperatively buying firms might respond to suppliers who suffer from financial distress in the course of major crises. Design/methodology/approach: The authors build on a collaborative project with a German automotive OEM, analyze OEM internal “financial quick check data”, questionnaire data and longitudinal supplier financial data and apply regression, mediation and difference-in-difference estimation analyses. Findings: The results show that the stronger the dependence on the distressed supplier, the more cooperative the buying firm's response. Furthermore, a more cooperative response of the buying firm has a strong positive influence on the suppliers' financial performance and hence recovery from the distress situation. Insights from supplier financial distress in the course of the financial crisis 2007–2008 can serve as learnings for the COVID-19 crisis. Research limitations/implications: The study fills a gap in the scholarly literature on “response to risk incidents” and response formation. Resource dependence theory and resource dependence dynamics offer a strong rationale for the type of response buying firms are likely to choose. Practical implications: Besides offering the first menu of response options, this study can help practitioners in figuring out the most appropriate response to distressed suppliers. The findings can assist buying firms in their decisions how to deal with suppliers during major economic and financial crises. Originality/value: This research is the first to conceptualize buying firms' response options to financially distressed suppliers, to investigate the influence of dependence on buying firm's response and to reveal the consequences of the buying firm's response for the supplier's financial recovery. © 2021, Emerald Publishing Limited.

Gasdermin D inhibition prevents multiple organ dysfunction during sepsis by blocking NET formation.

Multiple organ dysfunction is the most severe outcome of sepsis progression and is highly correlated with a worse prognosis. Excessive neutrophil extracellular traps (NETs) are critical players in the development of organ failure during sepsis. Therefore, interventions targeting NET release would likely effectively prevent NET-based organ injury associated with this disease. Herein, we demonstrate that the pore-forming protein gasdermin D (GSDMD) is active in neutrophils from septic humans and mice and plays a crucial role in NET release. Inhibition of GSDMD with disulfiram or genic deletion abrogated NET formation, reducing multiple organ dysfunction and sepsis lethality. Mechanistically, we demonstrate that during sepsis, activation of the caspase-11/GSDMD pathway controls NET release by neutrophils during sepsis. In summary, our findings uncover a novel therapeutic use for disulfiram and suggest that GSDMD is a therapeutic target to improve sepsis treatment.

Patient perspectives on chemotherapy de-escalation: “Don't de-escalate! I don't want to die!”

Introduction: Given excellent survival outcomes in breast cancer and new methods to predict treatment response, oncologists are interested in de-escalating the amount of chemotherapy delivered to patients. This is particularly important in the setting of COVID-19, where patient perspectives of de-escalation may be altered by perception of COVID-19 risk.Methods: This concurrent mixed methods study included (1) semi-structured interview data from patients with breast cancer treated at the University of Alabama at Birmingham and patient advocates from nationally representative advocacy organizations (10/2019-5/2020) and (2) cross-sectional survey data from a nationwide sample of women with breast cancer (11/19-12/2019). Questions evaluated interest in de-escalation study participation, perceived barriers/facilitators to participation, and language describing de-escalation. Participant perspectives surrounding COVID-19 impact on de-escalation were elicited in interviews post 3/2020.Results: Quantitative and qualitative findings were synergistic. Interviews were conducted with 40 female participants (24 patients, 16 patient advocates). Participant ages ranged from 33-79 years old;30% were minorities;35% didn't have a college degree. Common barriers to acceptance of de-escalation included fear of recurrence, worry about decision regret, lack of clinical trial interest, and dislike for the focus on less treatment. Fear of recurrence was the most commonly expressed barrier, with one participant stating, “I'm just afraid it wouldn't get it all”. Common facilitators included trust in the physician, toxicity avoidance, monitoring with the option of increasing treatment intensity, perception of good prognosis, and impact on daily life. Participants interviewed during the COVID-19 pandemic (n=16) expressed substantial virus-related fear, including fear of exposure, fear of infecting their personal contactsor health care team, fear of cancer-related complications, and fear about their immunocompromised state. Thesefears contributed to participants perspective on de-escalation, as highlighted by participants stating, “I wouldn'tworry about getting the chemo as much as I would worry about getting the virus” and “Less is more for me rightnow”.Of 91 survey respondents (69% response rate), median age was 58 years (interquartile range [IQR] 48-69),86% had early stage breast cancer. Many (43%) patients were not interested in participation in a study testing lowerdoses of chemotherapy than standard of care. Patients not interested in participating were more often unmarried(55% vs. 32%, V=.23), disabled (56% vs. 40%, V=.17), or diagnosed with early stage cancer (45% vs. 22%, V=.14).Barriers to participation included fear of cancer recurrence (85%) and regret about the decision to receive lesschemotherapy if the cancer were to recur (79%). Few patients (19%) considered clinical trials themselves as abarrier. Patients were interested in participation due to lessened physical side effects of treatment (82%), lessenedlong-term problems related to treatment (76%), and lessened impact on daily life (72%). The most popularterminology describing chemotherapy de-escalation was “lowest effective chemotherapy dose” (53%);no patientspreferred the term “de-escalation.” Conclusion: Fear of recurrence is a common barrier to de-escalation clinical trial participation in patients withbreast cancer. Fears may be altered for patients considering treatment during the COVID-19 pandemic. Trust in thephysician and use of patient-generated language, such as “customized” instead of “de-escalation”, are potentialareas for future interventions engaging patients in trials.

City and County Governments in the Time of COVID-19 and the Recession: The Long and Winding Road

The unprecedented double blow of the COVID-19 pandemic and ensuing steep recession challenges local governments in profound ways, from managing public health responses, ensuring the safety of workers, and balancing budgets in the midst of extreme uncertainty. How are local governments in the U.S. navigating these turbulent times? What impacts on revenues and services are they seeing? How does all of this impact their relationships with federal and state levels of government? Through in-depth interviews with thirty top local leaders (mayors or city/county managers), this article provides an insightful snapshot that begins to answer these questions. © The Author(s) 2020.