Urban logistics solutions and financing mechanisms: a scenario assessment analysis

T his paper presents the main issues related to the financing of urban logistics solutions , m ore precise ly to the contribution of economic analysis on strategic decision support related for urban logistics financing , focusing on cost benefit analysis. First we present the main funding strategies in urban economics, mainly in the field of urban logistics . Second we address the contribution of cost benefit analysis by recalling the main methodology and adapting it to urban logistics. Third we apply the method to the example of deploying a delivery spac e booking network, and illustrate the application via a set of three examples containing different situations and scenarios, which are presented , assessed and discussed . From the different simulations, it is observed that the way the system is financed has strong impacts on both its individual cost (for potential users) and its attractiveness

Food hub as an efficient alternative to sustainably feed the cities

La tarea de alimentar las ciudades es un reto al que hoy se enfrentan todos los gobiernos e implica una coordinación de múltiples productores, distribuidores, operadores logísticos y comerciantes de alimentos perecederos. Este artículo pretende analizar los Food hubs en el sistema de distribución urbano de alimentos, de manera crítica y sistemática desde la literatura. Se presenta en primera instancia un estado del arte sobre el concepto de Food hub, luego se presenta una propuesta de tipificación de Food hubs de acuerdo a unos criterios, concentrándose en actores implicados en el proceso de distribución de alimentos, estructura jurídica y sus funciones. También se describen los impactos sociales, económicos y medioambientales que traería consigo la implementación de un Food hub. Finalmente, se presentan las principales oportunidades para la expansión de Food hubs urbanos y se exponen cuatro ejemplos latinoamericanos, relacionándolos con la tipología propuesta. The task of feeding cities is a challenge that nowadays all governments face, it involves the coordination of multiple producers, distributors, logistics operators and traders of perishable foods. This paper analyzes the Food hubs concept and its impact on urban development in a critical perception from the literature review. The state of the art on the concept of Food Hub is presented at first instance. Then a classification of different types of Food hub is done by focusing on the actors involved in the food system distribution process, structure and functions. After that, an analysis of the prospects of the implementation of Food hubs is performed, evaluating its economic, social and environmental impacts. Finally, the main opportunities for the deployment of urban Food hubs are presented, and four Latin-American cases are introduced, linked them with the proposed typology.

'Incidental' and 'non-incidental' thyroid papillary microcarcinomas are two different entities

Papillary thyroid microcarcinomas (microPTC) may be 'incidental' (Inc-microPTC), occasionally found at histology after surgery for benign disease or 'non-incidental' (Non-Inc-microPTC), diagnosed on clinical grounds. It is unclear whether these different microPTC reflect the same disease. The aim of the study was to compare Inc-microPTC and Non-Inc-microPTC for clinical and histological features as well as for serum TSH, a known factor involved in PTC development

Les effets de la vente en ligne sur les inégalités territoriales d'accès au commerce. Vers un nivellement des disparités urbain-périurbain ?

L’accessibilité géographique des populations aux biens est différenciée selon les espaces. Les populations des centres-villes peuvent accéder à pieds, à proximité de leur domicile à des magasins offrant un large choix de biens, alors que les populations périurbaines doivent parcourir plusieurs kilomètres en voiture pour accéder au premier magasin de proximité. Depuis les années 1990, le commerce à destination des particuliers (business-to-consumer) connaît de fortes évolutions, avec le développement d‘Internet et de la vente en ligne. Cette « électronisation » offre la possibilité d’une séparation croissante des fonctions du commerce, notamment la vente en elle-même et la logistique de distribution . Ainsi, la livraison à domicile et celle dans des relais-livraison se sont affirmées comme des modes de distribution alternatifs aux magasins, bouleversant les cadres de l’analyse de l’accessibilité des populations aux commerces, notamment dans les espaces périurbains. L’accessibilité est entendue ici comme l’ensemble des contraintes spatiales, temporelles et modales pesant sur les déplacements nécessaires pour accéder à un bien.Les principales formes de distribution de la vente en ligne, les livraisons à domicile et en relais-livraison, proposent une redéfinition de l’accessibilité à un large éventail de biens matériels, en offrant ces biens à domicile et/ou dans des commerces de proximité plutôt que, pour certains biens, dans un magasin du centre-ville. Les disparités d’accessibilités aux commerces, parfois fortes selon le type de bien recherché, marquées par un gradient urbain-périurbain et par une hétérogénéité des territoires périurbains, devraient s’en trouver significativement nivelées par une multiplication attendue des points de distribution, notamment dans des territoires qui n’en disposaient pas. Cependant cela nécessite, d’une part, que les habitants des territoires concernés adoptent largement le commerce électronique et tirent parti des options de livraison. D’autre part, le développement de la vente en ligne entraîne une transformation de l’offre commerciale existante par la concurrence qu’elle opère. Certaines localisations commerciales existantes s’en trouvent fragilisées ou remises en cause, tout autant que l’accessibilité et les pratiques d’achat des populations résidant dans ces territoires.Les trois parties du rapport fournissent des réponses et des éclairages différenciés sur ces interrogations, plus précisément sur celle formulée en titre. La première partie sera focalisée sur l'accès aux produits alimentaires et de consommation courante via l'analyse des zones de dessertes des cybermarchés. La seconde partie s'intéressera à un acteur émergent du e-commerce: les points relais. Enfin la dernière partie essaiera de saisir plus finement les usages et pratiques des ménages en termes de ventes en ligne

Baseline Tumor Size as Prognostic Index in Patients With Advanced Solid Tumors Receiving Experimental Targeted Agents

Abstract Background Baseline tumor size (BTS) has been associated with outcomes in patients with cancer treated with immunotherapy. However, the prognostic impact of BTS on patients receiving targeted therapies (TTs) remains undetermined. Methods We reviewed data of patients with advanced solid tumors consecutively treated within early-phase clinical trials at our institution from 01/2014 to 04/2021. Treatments were categorized as immunotherapy-based or TT-based (biomarker-matched or not). BTS was calculated as the sum of RECIST1.1 baseline target lesions. Results A total of 444 patients were eligible; the median BTS was 69 mm (IQR 40-100). OS was significantly longer for patients with BTS lower versus higher than the median (16.6 vs. 8.2 months, P < .001), including among those receiving immunotherapy (12 vs. 7.5 months, P = .005). Among patients receiving TT, lower BTS was associated with longer PFS (4.7 vs. 3.1 months, P = .002) and OS (20.5 vs. 9.9 months, P < .001) as compared to high BTS. However, such association was only significant among patients receiving biomarker-matched TT, with longer PFS (6.2 vs. 3.3 months, P < .001) and OS (21.2 vs. 6.7 months, P < .001) in the low-BTS subgroup, despite a similar ORR (28% vs. 22%, P = .57). BTS was not prognostic among patients receiving unmatched TT, with similar PFS (3.7 vs. 4.4 months, P = .30), OS (19.3 vs. 11.8 months, P = .20), and ORR (33% vs. 28%, P = .78) in the 2 BTS groups. Multivariate analysis confirmed that BTS was independently associated with PFS (P = .03) and OS (P < .001) but not with ORR (P = .11). Conclusions Higher BTS is associated with worse survival outcomes among patients receiving biomarker-matched, but not biomarker-unmatched TT

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

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

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