Subsidized ridesourcing for the first/last mile: how valuable for whom?

The first/last mile is a long known deterrent to public transportation use, yet difficult to solve with fixed route transit. Many transit agencies are exploring partnerships with ridesourcing companies to offer subsidized feeder services. Ridership, however, has been surprisingly low. We explore two conceptual explanations. First, ridesourcing fares are found to exceed travel time savings for all distances below 1 mile and annual household incomes below USD 30,000 (i.e., the majority of US bus-using households). Subsidies are thus necessary, yet common schemes (flat fees, flat value or percentage discounts) are inequitable as they particularly benefit high-income households (thus miss their main target group). Second, the disutility of the additional transfer (‘transfer penalty’) and wait times exceed travel time savings assuming modest values for all distances below 0.45 miles. Subsidized ridesourcing for the first/last mile is thus not the panacea often portrayed, particularly not for short first/last miles. Where first/last miles are longer, investments in first/last mile services only might miss their purpose as the private car often remains the faster, more convenient and cheaper option. A much more holistic set of policy changes is hence required. Where transit agencies decide to proceed with first/last mile subsidies, they are advised to integrate them into existing fares (offering first/last mile rides for free) as this is the most equitable approach

MKID development for SuperSpec: an on-chip, mm-wave, filter-bank spectrometer

SuperSpec is an ultra-compact spectrometer-on-a-chip for millimeter and submillimeter wavelength astronomy. Its very small size, wide spectral bandwidth, and highly multiplexed readout will enable construction of powerful multibeam spectrometers for high-redshift observations. The spectrometer consists of a horn-coupled microstrip feedline, a bank of narrow-band superconducting resonator filters that provide spectral selectivity, and Kinetic Inductance Detectors (KIDs) that detect the power admitted by each filter resonator. The design is realized using thin-film lithographic structures on a silicon wafer. The mm-wave microstrip feedline and spectral filters of the first prototype are designed to operate in the band from 195-310 GHz and are fabricated from niobium with at Tc of 9.2K. The KIDs are designed to operate at hundreds of MHz and are fabricated from titanium nitride with a Tc of 2K. Radiation incident on the horn travels along the mm-wave microstrip, passes through the frequency-selective filter, and is finally absorbed by the corresponding KID where it causes a measurable shift in the resonant frequency. In this proceedings, we present the design of the KIDs employed in SuperSpec and the results of initial laboratory testing of a prototype device. We will also briefly describe the ongoing development of a demonstration instrument that will consist of two 500-channel, R=700 spectrometers, one operating in the 1-mm atmospheric window and the other covering the 650 and 850 micron bands.Comment: As submitted, except that "in prep" references have been update

nab-paclitaxel plus durvalumab in patients with previously treated advanced stage non-small cell lung cancer (ABOUND.2L+)

Background: The standard therapy for advanced stage non-small cell lung cancer (NSCLC) with no actionable gene alterations is a platinum-based chemotherapy doublet and immune checkpoint blocker (ICB), either concurrently or sequentially, followed by docetaxel at the time of tumor progression. However, more effective treatments are needed. We evaluated the nab-paclitaxel and durvalumab combination in patients with previously treated advanced stage NSCLC. Methods: Patients with advanced stage NSCLC previously treated with one line of platinum-based doublet with or without an ICB and no activating EGFR mutations or ALK translocations received nab-paclitaxel 100 mg/m2 (days 1 and 8) plus durvalumab 1,125 mg (day 15) every 21 days. The primary endpoint was progression-free survival (PFS). Key secondary endpoints included overall survival (OS) and safety. Results: Between February 2016 and December 2016, 79 patients were enrolled. The median age was 63 years. Most patients were males (68.4%), had non-squamous histology (69.6%), and had no prior ICB treatment (88.6%). The median PFS was 4.5 months; median OS was 10.1 months. A post hoc analysis of survival by prior ICB treatment revealed a median PFS and OS of 4.4 and 9.9 months, respectively, in ICB-naive patients and 6.9 months and not estimable, respectively, in patients previously treated with ICB. The most common treatment-emergent adverse events were asthenia (46.2%) and diarrhea (34.6%); four treatment-related deaths (5.1%) occurred. Conclusions: The nab-paclitaxel and durvalumab combination is feasible and demonstrated antitumor activity without new safety signals. Additional studies using taxanes and ICB in patients with previously treated NSCLC are warranted. Clinical Trial Registration: ClinicalTrials.gov registration (NCT02250326). EudraCT number: 2014-001105-41.This work was supported by Bristol Myers Squibb Company, Princeton, New Jersey. The sponsor was involved in the design of the study as well as in the collection, analysis, and interpretation of the data. The sponsor agreed to the decision to submit the article for publication.Ye

Impact on Patient Care of a Multidisciplinary Center Specializing in Colorectal and Pelvic Reconstruction

Aim of the study: Many patients with an anorectal malformation (ARM) or pelvic anomaly have associated urologic or gynecologic problems. We hypothesized that our multidisciplinary center, which integrates pediatric colorectal, urologic, gynecologic and GI motility services, could impact a patient's anesthetic exposures and hospital visits.Methods: We tabulated during 2015 anesthetic/surgical events, endotracheal intubations, and clinic/hospital visits for all patients having a combined procedure.Main results: Eighty two patients underwent 132 combined procedures (Table 1). The median age at intervention was 3 years [0.2-17], and length of follow up was 25 months [7-31]. The number of procedures in patients who underwent combined surgery was lower as compared to if they had been done independently [1(1-5) vs. 3(2-7) (p < 0.001)]. Intubations were also lower [1[1-3] vs. 2[1-6]; p < 0.001]. Hospital length of stay was significantly lower for the combined procedures vs. the theoretical individual procedures [8 days [3-20] vs. 10 days [4-16]] p < 0.05. Post-operative clinic visits were fewer when combined visits were coordinated as compared to the theoretical individual clinic visits (urology, gynecology, and colorectal) [1[1-4] vs. 2[1-6]; p = < 0.001].Conclusions: Patients with anorectal and pelvic malformations are likely to have many medical or surgical interventions during their lifetime. A multidisciplinary approach can reduce surgical interventions, anesthetic procedures, endotracheal intubations, and hospital/outpatient visits

Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

Purpose: Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods: A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results: Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10-1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00-16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26-46.75, vs 18 days, IQR 16-46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6-15.5) for non-IMV and 49.5 days (IQR 36.8-82.5) for IMV patients. Conclusions: Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19

MaaS Bundle Design

Mobility service bundling has received a lot of attention from researchers and practitioners due to its centrality to Mobility as a Service (MaaS) business models and potential to foster sustainable travel behavior. Stated choice studies have to date been used to explore the willingness to pay for MaaS bundles and their components. Despite an increasing number of academic studies and commercial trials, there is a surprising dearth of research on how to design MaaS bundles in the first place. Comparative learning is further limited as the designs of choice experiments and studied bundles differ widely. What are the underlying design dimensions and how can we separate differences in outcome from differences in design? We address this gap by extending the Design of Designs literature to distinguish between two categories of design dimensions for stated choice experiments: statistical and behavioral. We argue that not only statistical design (how many alternatives, attributes and levels) but also behavioral design (i.e., which attributes and levels) influences outcome. Behavioral ‘master designs’ are seldomly made explicit, yet precisely this situation leads to seemingly disjointed landscapes of stated choice studies in specific areas of application, limiting scientific advances, relevant policy-making and commercial realization. We demonstrate the practical value of our conceptual contribution by developing a behavioral master design for MaaS bundles. We show that every MaaS bundle is a permutation along ten design dimensions and every stated choice study is a permutation in a statistical and behavioral master design. Using the resulting grid, researchers can systematically compare studies, identify empirical research gaps and design new experiments accordingly and practitioners can obtain practical guidance for the design of new bundles

Mobility as a Service and private car use: evidence from the Sydney MaaS trial

Australia’s first Mobility as a Service (MaaS) trial commenced in April 2019 in Sydney, running for two years. The objective of the trial is at least twofold – to assess interest in various MaaS subscription plans through bundling public transport, rideshare, car share and car rental with varying financial discounts and monthly subscription fees, in contrast to pay as you go (PAYG); and to assess the extent to which the use of the private car might change following a subscription to a monthly mobility bundle. This paper assesses the second objective by investigating the potential for changes in monthly car use in the presence of a MaaS program. The paper develops a joint discrete-continuous model system to explain the choice between monthly bundles and PAYG, and subsequently, the total monthly car kilometres. Controlling for monthly differences due to other influences such as seasonal travel activity, the findings suggest that the offered bundles do have an encouraging impact on private car use. Within the limits of what was tested under the Sydney MaaS trial, indicative evidence suggests that MaaS has the potential to change travel behaviour in a way aligned with sustainability objectives, although this evidence should not be taken as suggesting that MaaS is a commercially viable mobility strategy

Multimodal Transportation Plans: Empirical Evidence on Uptake, Usage and Behavioural Implications from the Augsburg MaaS Trial

The integration of shared mobility modes with public transportation to provide ‘mobility as a service’ (MaaS) in a sustainable way has received substantial attention from transportation scholars, practitioners and policymakers. In fully integrated systems, customers are offered a choice between ‘pay-as-you-go’ and monthly subscription plans. While there has been considerable research into the configuration, willingness to pay and resulting market potential of such plans using stated preference methods, only few trials have been conducted to validate previous results and evaluate their potential to foster sustainable travel behavior. To this end, we report on the first MaaS trial in Germany. Between November 2018 and June 2020, 341 customers bought bundles including monthly public transportation, carsharing and bikesharing allowances. While uptake has been substantial, first indications of market saturation suggest that the (currently offered) MaaS bundles including these modes might be more of a niche product than a ‘game changer’ in urban mobility. Analyzing longitudinal panel data on bundle uptake and carsharing usage, we find that a substantial number of customers underutilize their carsharing allowances. Still, consumer gain is substantially higher than producer gain due to bundle discounts, dampening providers’ hopes of a new business model. We further find that carsharing allowances in bundles increase carsharing usage of subscribers