Urban Green Development and Resilient Cities: A First Insight into Urban Forest Planning in Italy

The research proposes an application of a modification of the 3–30–300 rule to identify areas that require Urban Forestry implementation in small and medium-sized Roman and/or medieval urban areas. The selected case study is that of Asti in Piedmont, Italy. An open source, cross-platform desktop geographic information system is used to process geospatial datasets via qualitative analyses of electoral sections (or wards). An analysis of the number and distribution of trees around each building is performed, in addition to the calculation of tree canopy cover and distance between buildings and green spaces. Findings reveal that 64 out of 70 wards have an average of at least three trees per building and sufficient green areas of at least 0.5 hectares within 300 m of the buildings. Additionally, the tree canopy cover ranges from approximately 0.6% (lowest) to about 55% (highest) for the electoral sections. Lastly, findings suggest that the highly built-up urban fabric in these areas may significantly affect the availability and quality of green spaces. In conclusion, the case study proves the benefits of applying the 3–30–300 rule to small and medium-sized urban areas using an integrated assessment approach based on nature-based solutions and ecosystem services

Spatializing Urban Forests as Nature-based Solutions: a methodological proposal

The Fifth Session of the UNEA-5 defines Nature-based Solutions (NbS) as “actions to protect, conserve, restore, sustainably use and manage natural or modified terrestrial, freshwater, coastal and marine ecosystems, which address social, economic and environmental challenges effectively and adaptively, while simultaneously providing human well-being, ecosystem services and resilience and biodiversity benefits”. A large number of the EU HORIZON 2020 research program projects include the implementation of NbS in urban settings. The proGIreg project implemented several NbS for urban regeneration with and for citizens in its Living Lab in the city of Turin (Italy), among others. Focusing on the NbS of urban forestry, this paper addresses the following question: where can NbS be implemented within the city, in order to maximize their social impact? To achieve this goal, by identifying neighborhoods in need of NbS implementation, the 3–30-300 rule proposed by the International Union for Conservation of Nature (IUCN) was adopted and implemented, taking greater account of environmental and social characteristics. The paper also proposes an index to identify neighborhoods of the city that could have precedence in the implementation of NbS. The results highlight 10 neighborhoods where there is a high need of NbS implementation

Short-term rail rolling stock rostering and maintenance scheduling

This paper describes an optimization framework for railway rolling stock rostering and maintenance scheduling. A key problem in railway rostering planning requires covering a given set of services and maintenance works with limited rolling stock units. The problem is solved via a two-step approach that combines the scheduling tasks related to train services, short-term maintenance operations and empty runs. A commercial MIP solver is used for the development of a real-time decision support tool. A campaign of experiments on real world scenarios from Trenitalia (Italian train operating company) illustrates the improvement achievable by the approach when compared to the practical solution

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Rolling stock rostering and maintenance scheduling optimization

This thesis addresses identification and analysis of frameworks for optimizing medium-term maintenance planning and rolling stock rostering. Rolling Stock Management (RSM) is the main cost factor for Rail Undertakings. For example, for high-speed trains, more than 30% of the lifecycle costs is spent for maintenance operations. In order to reduce the costs due to railway operations, every company should address the joint problem of rolling stock rostering and maintenance scheduling since they are strongly related parts of the same problem. Maintenance optimization can be a key factor to increase the productivity of railway companies. At the same time, in a competitive globalized and multimodal market, RSM is one of the competitiveness key factors because services quality level depends on it. The strategic relevance of RSM, in particular of maintenance scheduling, is thus due to the reduction of needs (such as platforms and human resources) and to the enhancement of quality standards (such as vehicle reliability and cleaning). From our point of view the literature is focused on manufacturing setting in order to reduce the occurrence of a failure while unfortunately the coordination of maintenance and rolling stock scheduling is still underinvestigated. A key problem in railway planning process requires to cover a given set of services and maintenance works with a minimum amount of rolling stock units. Additional objectives are to minimize the number of empty runs and to maximize the kilometres travelled by each train between two maintenance operations of the same type. First,the rostering and maintenance optimization problems are formulated by graph theoretical approaches that involve medium-term maintenance operations, the scheduling tasks related to train services and empty rides. The constraints of the maintenance optimization problem require that the different types of maintenance operations must be carried out for each train periodically. The various maintenance tasks can only be done at a limited number of dedicated sites. Starting from the solutions of the rostering and maintenance optimization problems, we developed another graph theoretical approach to optimize workshop management and in particular to minimize the number of drivers involved and to verify the feasibility of the maintenance plan at each site. For a set of timetables and rolling stock categories, we compare flexible versus rigid plans regarding the number of empty rides and maintenance kilometres. For different feasible frameworks and different kinds of timetables, we provide new mixed-integer linear-programming formulations for train rostering and maintenance scheduling problems and we also show how the proposed scheduling formulations could be used as effective tools to absorb real-time timetable perturbations while respecting the agreed level of service. The specific objective of our research is to related to the following questions: “How can the timetable be executed by an efficient use of resources such that the overall railway company costs are reduced? Which is the maximal improvement that can be achieved? At which cost?". In this thesis, we give an answer to these questions by performing an assessment of key performance indicators. The computational evaluation presents the efficiency of the new solutions compared to the practical solutions. Experimental results on real-world scenarios from Trenitalia show that these integrated approaches can reduce significantly the number of trains and empty rides when compared with the current plan. We use a commercial MIP solver for developing a decision support tool that computes efficient solutions in a short time