governance and the stakeholders engagement in city logistics the sulpiter methodology and the bologna application

Abstract Many actors are involved in the urban freight delivery system. They hold different visions, perceptions, goals. However, city logistics affects a well-defined set of subjects: their acceptance of (and even positive contribution to) policy can be enhanced by continuing consultation. This evidence stresses the need for the stakeholders' engagement as a strategic factor of any decision-making process. The paper presents the guidelines of the EU-funded project SULPiTER (Interreg Central Europe Programme) for the stakeholders' involvement (both public and private) in the definition of city logistics policies. In particular, the FQP (Freight Quality Partnership) tool is analyzed and discussed. After an overview of the institutional references and the implemented experiences, a methodological approach is presented, describing the steps for an effective FQP implementation. The case of the Metropolitan city of Bologna is presented as the local application of the SULPiTER methodology, considering two aspects: the way of defining the governance for combining horizontally different public authorities, and the tool for e ngaging the private stakeholders in the definition of Sustainable Urban Logistics Plans (SULPs)

on road measurement of co2 vehicle emissions under alternative forms of intersection control

Abstract The environmental impact of road intersection operations, and in particular of alternative types of traffic control, has received increasing attention in recent years as a factor to be considered in addition to efficiency and safety. The purpose of this study is to provide experimental evidence about this issue based on direct measurement of CO2 emissions produced by a vehicle under traffic signal versus roundabout control. Carbon Dioxide was chosen as specific target of the analysis because of its important contribution to the "greenhouse effect". Using data collected with a Portable Emission Measurement System (PEMS) installed on a test car, a before-and-after analysis was conducted on an intersection where a roundabout has replaced a traffic signal. A total of 396 trips were carried out by two drivers in different traffic conditions and in opposite directions along a designated route. Using statistical methods, the existence of significant differences in CO2 emissions in relation to the type of intersection control was investigated based on the collected data, also considering the effect of other explanatory variables and focusing in particular on peak traffic conditions. More precisely, the effect of the type of control has been characterized using descriptive statistics and permutation tests applied to the entire data set, while an analysis based on binary logistic regression has been performed with specific reference to trips carried out under peak traffic conditions. The results of these analyses support the conclusion that converting a signal-controlled intersection to a roundabout may lead to a decrease in CO2 emissions

The space density of z>4 blazars

High redshift blazars are an important class of Active Galactic Nuclei (AGN) that can provide an independent estimate of the supermassive black-hole mass function in high redshift radio-loud AGN without the bias due to absorption along the line-of-sight. Using the Cosmic Lens All Sky Survey (CLASS) we built a complete radio flux-limited sample of high redshift (z>4) blazars suitable for statistical studies. By combining dedicated optical observations and the SDSS spectroscopic database, we obtained a sample of 26 blazar candidates with a spectroscopic redshift above 4. On the basis of their radio spectrum we distinguish between blazars and QSO with a Gigahertz Peaked Spectrum (GPS) like spectrum. Out of the 18 confirmed blazars 14 constitute a completely identified, flux-limited sample down to a magnitude of 21 (AB). Using this complete sample we derive a space density of blazars with 4<z<5.5 of rho=0.13 (+0.05,-0.03) Gpc^-3. This is the first actual estimate of the blazar space density in this range of redshift. This value is in good agreement with the extrapolation of the luminosity function and cosmological evolution based on a sample of flat-spectrum radio quasars selected at lower redshifts and it is consistent with a cosmological evolution peaking at z$\sim$2 similar to radio-quiet QSO. We do not confirm, instead, the presence of a peak at z~4 in the space density evolution, recently suggested using an X-ray selected sample of blazars. It is possible that this extreme peak of the evolution is present only among the most luminous blazars.Comment: 14 pages, accepted for publication on MNRAS (https://doi.org/10.1093/mnras/sty3526

Single-Center-Single-Blinded Clinical Trial to Evaluate the Efficacy of a Nutraceutical Containing Boswellia Serrata, Bromelain, Zinc, Magnesium, Honey, Tyndallized Lactobacillus Acidophilus and Casei to Fight Upper Respiratory Tract Infection and Otitis Media

Some nutraceuticals have been studied as supportive treatment for fighting upper respiratory tract infection and middle ear disease. Our study aims at evaluating the effect of a specific oral supplementation in the treatment of pediatric otits media. The subjects were randomly assigned by the physician (single-blinded study) to one of three groups: Control Group (CG), Treatment Group 1 (TG1), or Treatment Group 2 (TG2). Both TG were treated with Flogostop Duo (for 20 days—TG1 or 30 days—TG2) in combination with the standard treatment, while CG underwent standard treatment only. The standard treatment was nasal aerosol with Fluticasone and Mucolytic, and nasal washing with hypertonic solution. All patients were analyzed by otoscopy, impedance, fibroscopy, and pure auditory test at the baseline (T0), after 20 days (T1) and 35 days (T2). 120 children were included in the study, 40 in the CG, 40 in the TG1, and 40 in the TG2. Both TG1 and TG2 presented statistically significant differences with respect to controls in otoscopy, impedance, fibroscopy, and PTA at T2. The otoscopy improved at T2 with statistically significant value only in TG2. The impedance and fibroscopy improved at T1 both in TG1 and TG2 compared to CG. A statistically significant improvement was observed in TG2 at T2 in comparison to both CG and TG1. Statistically significant differences were observed in PTA at T2 only compared with controls. This study confirmed the efficacy of nutraceutical as supporting therapy in the upper respiratory tract infection in children. In particular, the supplement containing Boswellia serrata and Bromelain, which are molecules with strong anti-inflammatory and pain-control capacities, could add the benefit without the adverse effects which are related to NSAID us

Nociplastic Pain in Gynecology: Understanding This Painful Experience in Women

The term “nociplastic pain” was introduced in 2017 by the International Association for the Study of Pain (IASP) to describe pain that results from impaired nociception despite no clear evidence of actual or potential tissue damage causing activation of peripheral nociceptors or evidence of disease or lesion of the somatosensory system causing the pain. It is a definition born from the need to recognize early the presence of central sensitization of the nervous system in patients with chronic pain; we can find ourselves in the co-presence of nociceptive or neuropathic pain and nociplastic pain. In gynecological pathology, nociplastic pain plays an important role characterizing some important pathologies that can be associated with chronic pelvic pain in women. It is essential to understand the mechanisms of pathogenesis and maintenance of nociplastic pain in order to undertake a multidisciplinary path for the treatment of these patients

Quantitative Microbial Risk Assessment as support for bathing waters profiling

Profiling bathing waters supported by Quantitative Microbial Risk Assessment (QMRA) is key to the WHO's recommendations for the 2020/2021 revision of the European Bathing Water Directive. We developed an areaspecific QMRA model on four pathogens, using fecal indicator concentrations (E. coil, enterococci) for calculating pathogen loads. The predominance of illness was found to be attributable to Human Adenovirus, followed by Salmonella, Vibrio, and Norovirus. Overall, the cumulative illness risk showed a median of around 1 case/10000 exposures. The risk estimates were strongly influenced by the indicators that were used, suggesting the need for a more detailed investigation of the different sources of fecal contamination. Area-specific threshold values for fecal indicators were estimated on a risk-basis by modelling the cumulative risk against E. coll. and enterococci concentrations. To improve bathing waters assessment, we suggest considering source apportionment locally estimating of pathogen/indicator ratios, and calculating site-specific indicators thresholds based on risk assessment

Structured reporting for fibrosing lung disease: a model shared by radiologist and pulmonologist

Objectives: To apply the Delphi exercise with iterative involvement of radiologists and pulmonologists with the aim of defining a structured reporting template for high-resolution computed tomography (HRCT) of patients with fibrosing lung disease (FLD). Methods: The writing committee selected the HRCT criteria\ue2\u80\u94the Delphi items\ue2\u80\u94for rating from both radiology panelists (RP) and pulmonology panelists (PP). The Delphi items were first rated by RPs as \ue2\u80\u9cessential\ue2\u80\u9d, \ue2\u80\u9coptional\ue2\u80\u9d, or \ue2\u80\u9cnot relevant\ue2\u80\u9d. The items rated \ue2\u80\u9cessential\ue2\u80\u9d by &lt; 80% of the RP were selected for the PP rating. The format of reporting was rated by both RP and PP. Results: A total of 42 RPs and 12 PPs participated to the survey. In both Delphi round 1 and 2, 10/27 (37.7%) items were rated \ue2\u80\u9cessential\ue2\u80\u9d by more than 80% of RP. The remaining 17/27 (63.3%) items were rated by the PP in round 3, with 2/17 items (11.7%) rated \ue2\u80\u9cessential\ue2\u80\u9d by the PP. PP proposed additional items for conclusion domain, which were rated by RPs in the fourth round. Poor consensus was observed for the format of reporting. Conclusions: This study provides a template for structured report of FLD that features essential items as agreed by expert thoracic radiologists and pulmonologists

Safety of extended interval dosing immune checkpoint inhibitors:a multicenter cohort study

BACKGROUND: Real-life spectrum and survival implications of immune-related adverse events (irAEs) in patients treated with extended interval dosing (ED) immune checkpoint inhibitors (ICIs) are unknown. METHODS: Characteristics of 812 consecutive solid cancer patients who received at least 1 cycle of ED monotherapy (pembrolizumab 400 mg Q6W or nivolumab 480 mg Q4W) after switching from canonical interval dosing (CD; pembrolizumab 200 mg Q3W or nivolumab 240 mg Q2W) or treated upfront with ED were retrieved. The primary objective was to compare irAEs patterns within the same population (before and after switch to ED). irAEs spectrum in patients treated upfront with ED and association between irAEs and overall survival were also described. RESULTS: A total of 550 (68%) patients started ICIs with CD and switched to ED. During CD, 225 (41%) patients developed any grade and 17 (3%) G3 or G4 irAEs; after switching to ED, any grade and G3 or G4 irAEs were experienced by 155 (36%) and 20 (5%) patients. Switching to ED was associated with a lower probability of any grade irAEs (adjusted odds ratio [aOR] = 0.83, 95% confidence interval [CI] = 0.64 to 0.99; P = .047), whereas no difference for G3 or G4 events was noted (aOR = 1.55, 95% CI = 0.81 to 2.94; P = .18). Among patients who started upfront with ED (n = 232, 32%), 107 (41%) developed any grade and 14 (5%) G3 or G4 irAEs during ED. Patients with irAEs during ED had improved overall survival (adjusted hazard ratio [aHR] = 0.53, 95% CI = 0.34 to 0.82; P = .004 after switching; aHR = 0.57, 95% CI = 0.35 to 0.93; P = .025 upfront). CONCLUSIONS: Switching ICI treatment from CD and ED did not increase the incidence of irAEs and represents a safe option also outside clinical trials.</p

Diagnosis and Treatment of Chronic Neuropathic and Mixed Pain in Children and Adolescents: Results of a Survey Study amongst Practitioners

Validated diagnostic tools to diagnose chronic neuropathic and mixed pain in children are missing. Therapeutic options are often derived from therapeutics for adults. To investigate the international practice amongst practitioners for the diagnosis and treatment of chronic, neuropathic pain in children and adolescents, we performed a survey study among members of learned societies or groups whose members are known to treat pediatric pain. The survey included questions concerning practitioners and practice characteristics, assessment and diagnosis, treatment and medication. We analyzed 117 returned questionnaires, of which 41 (35%) were fully completed and 76 (65%) were partially completed. Most respondents based the diagnosis of neuropathic pain on physical examination (68 (58.1%)), patient history (67 (57.3%)), and underlying disease (59 (50.4%)) combined. Gabapentin, amitriptyline, and pregabalin were the first-choice treatments for moderate neuropathic pain. Tramadol, ibuprofen, amitriptyline, and paracetamol were the first-choice treatments for moderate mixed pain. Consensus on the diagnostic process of neuropathic pain in children and adolescents is lacking. Drug treatment varies widely for moderate, severe neuropathic, and mixed pain. Hence, diagnostic tools and therapy need to be harmonized and validated for use in children

Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

Objective: This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS). Methods: We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results. Results: Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18-4.74, p = 0.015) with increased risk of severe COVID-19. Recent use (&lt;1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20-12.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses. Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists