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.

Diabetic peripheral neuropathic pain is a stronger predictor of depression than other diabetic complications and comorbidities.

Aims: To investigate the independent effect on depression of painless diabetic polyneuropathy, painful diabetic polyneuropathy, and general and diabetes-related comorbidities. Methods: In 181 patients, the presence of painless diabetic polyneuropathy, painful diabetic polyneuropathy, comorbidities and depression was assessed using the Michigan Neuropathy Screening Instrument Questionnaire, the Michigan Diabetic Neuropathy Score, nerve conduction studies, the Douleur Neuropathique en 4 Questions, the Charlson Comorbidity Index and the Beck Depression Inventory-II. Results: In all, 46 patients met the criteria of confirmed painless diabetic polyneuropathy and 25 of painful diabetic polyneuropathy. Beck Depression Inventory-II scores indicative of mild-moderate-severe depression were reached in 36 patients (19.7%). In a multiple logistic regression analysis (including age, sex, body mass index, being unemployed, duration, haemoglobin A1c, insulin treatment, systolic blood pressure, nephropathy, retinopathy, Charlson Comorbidity Index and painful diabetic polyneuropathy), female sex (odds ratio: 5.9, p = 0.005) and painful diabetic polyneuropathy (odds ratio: 4.6, p = 0.038) were the only independent predictors of depression. Multiple regression analysis, including Douleur Neuropathique en 4 Questions and Michigan Diabetic Neuropathy Score instead of painful diabetic polyneuropathy, showed that Douleur Neuropathique en 4 Questions, in addition to female sex, was a significant predictor of depressive symptoms severity (p =0.005). Conclusion: Painful diabetic polyneuropathy is a greater determinant of depression than other diabetes-related complications and comorbidities. Painful symptoms enhance depression severity more than objective insensitivity

Care pathways models and clinical outcomes in disorders of consciousness

Objective: Patients with Disorders of consciousness, are persons with extremely low functioning levels and represent a challenge for health care systems due to their high needs of facilitating environmental factors. Despite a common Italian health care path-way for these patients, no studies have analyzed information on how each region have implemented it in its welfare system correlating data with patients’ clinical outcomes. Materials and Methods: A multicenter observational pilot study was realized. Clinicians collected data on the care pathways of patients with Disorder of consciousness by ask-ing 90 patients’ caregivers to complete an ad hoc questionnaire through a structured phone interview. Questionnaire consisted of three sections: sociodemographic data, description of the care pathway done by the patient, and caregiver evaluation of health services and information received.Results: Seventy- three patients were analyzed. Length of hospital stay was different across the health care models and it was associated with improvement in clinical diag-nosis. In long- term care units, the diagnosis at admission and the number of caregivers available for each patient (median value=3) showed an indirect relationship with worsening probability in clinical outcome. Caregivers reported that communication with professionals (42%) and the answer to the need of information were the most critical points in the acute phase, whereas presence of Non- Governmental Organizations (25%) and availability of psychologists for caregivers (21%) were often missing during long-term care. The 65% of caregivers reported they did not know the UN Convention on the Rights of Persons with Disabilities. Conclusion: This study highlights relevant differences in analyzed models, despite a recommended national pathway of care. Future public health considerations and ac-tions are needed to guarantee equity and standardization of the care process in all European countries

An accurate low-redshift measurement of the cosmic neutral hydrogen density

Using a spectral stacking technique, we measure the neutral hydrogen (HI) properties of a sample of galaxies at $z < 0.11$ across 35 pointings of the Westerbork Synthesis Radio Telescope (WSRT). The radio data contains 1,895 galaxies with redshifts and positions known from the Sloan Digital Sky Survey (SDSS). We carefully quantified the effects of sample bias, aperture used to extract spectra, sidelobes and weighting technique and use our data to provide a new estimate for the cosmic HI mass density. We find a cosmic HI mass density of $\Omega_{\rm HI} = (4.02 \pm 0.26)\times 10^{-4} h_{70}^{-1}$ at $\langle z\rangle = 0.066$, consistent with measurements from blind HI surveys and other HI stacking experiments at low redshifts. The combination of the small interferometer beam size and the large survey volume makes our result highly robust against systematic effects due to confusion at small scales and cosmic variance at large scales. Splitting into three sub-samples with $\langle z\rangle$ = 0.038, 0.067 and 0.093 shows no significant evolution of the HI gas content at low redshift.Comment: 17 pages, 24 figure

Weak Reprocessed Features in the Broad Line Radio Galaxy 3C382

We present a detailed X-ray study of the Broad Line Radio Galaxy 3C382, observed with the BeppoSAX satellite in a very bright state. The continuum emission is well modeled with a power law that steepens at high energies, with an e-folding energy of about 120 keV. At soft energies a clear excess of emission is detected, which can not be explained solely by the extended thermal halo seen in a ROSAT HRI image. A second, more intense soft X-ray component, possibly related to an accretion disk, is required by the data. Both a reflection component (R=0.3) and an iron line (EW \sim 50) are detected, at levels much weaker than in Seyfert galaxies, suggesting a common origin. Combining our measurements with results from the literature we find that the iron line has remained approximately constant over 9 years while the continuum varied by a factor of 5. Thus the fluorescent gas does not respond promptly to the variations of the X-ray primary source, suggesting that the reprocessing site is located away, likely at parsec distances. While the continuum shape indicates that X-rays derive from a thermal Comptonization process, the weakness of other spectral features implies that either the upper layers of the optically thick accretion disk are completely ionized or the corona above the disk is outflowing with mildly relativistic velocity.Comment: 11 pages, 4 figures. Accepted for publication in the Astrophysical Journa

Improving total body irradiation with a dedicated couch and 3D-printed patient-specific lung blocks: A feasibility study

Introduction: Total body irradiation (TBI) is an important component of the conditioning regimen in patients undergoing hematopoietic stem cell transplants. TBI is used in very few patients and therefore it is generally delivered with standard linear accelerators (LINACs) and not with dedicated devices. Severe pulmonary toxicity is the most common adverse effect after TBI, and patient-specific lead blocks are used to reduce mean lung dose. In this context, online treatment setup is crucial to achieve precise positioning of the lung blocks. Therefore, in this study we aim to report our experience at generating 3D-printed patient-specific lung blocks and coupling a dedicated couch (with an integrated onboard image device) with a modern LINAC for TBI treatment. Material and methods: TBI was planned and delivered (2Gy/fraction given twice a day, over 3 days) to 15 patients. Online images, to be compared with planned digitally reconstructed radiographies, were acquired with the couch-dedicated Electronic Portal Imaging Device (EPID) panel and imported in the iView software using a homemade Graphical User Interface (GUI). In vivo dosimetry, using Metal-Oxide Field-Effect Transistors (MOSFETs), was used to assess the setup reproducibility in both supine and prone positions. Results: 3D printing of lung blocks was feasible for all planned patients using a stereolithography 3D printer with a build volume of 14.5×14.5×17.5 cm3. The number of required pre-TBI EPID-images generally decreases after the first fraction. In patient-specific quality assurance, the difference between measured and calculated dose was generally&lt;2%. The MOSFET measurements reproducibility along each treatment and patient was 2.7%, in average. Conclusion: The TBI technique was successfully implemented, demonstrating that our approach is feasible, flexible, and cost-effective. The use of 3D-printed patient-specific lung blocks have the potential to personalize TBI treatment and to refine the shape of the blocks before delivery, making them extremely versatile

EGFR-TKI plus anti-angiogenic drugs in EGFR-mutated NSCLC: a meta-analysis of randomized clinical trials

Abstract Background Results of several RCTs testing the combination of an EGFR-TKI plus an anti-angiogenic drug in advanced EGFR-mutated NSCLC were reported. Methods We first report a systematic-review and meta-analysis of all RCTs, to estimate effectiveness and toxicity of such new therapeutic approach as compared with first-generation EGFR-TKIs monotherapy. Subsequently, we present a network meta-analysis (NMA) comparing the combination of an EGFR-TKI plus an anti-angiogenic drug with other two new treatment-options: combination of an EGFR-TKI plus chemotherapy or new EGFR-TKIs of second or third generation as monotherapy. Results Five RCTs were included in the first meta-analysis. The PFS was statistically significantly larger in patients treated with an EGFR-TKI plus an anti-angiogenic drug as compared with EGFR-TKI monotherapy: the pooled PFS-HR was 0.59 (95% CI = 0.51 to 0.69). The pooled median-PFS was 17.8 months (95% CI = 16.5 to 19.3) for the combination versus 11.7 months (95% CI = 11.1 to 12.7) for EGFR-TKI as monotherapy. No statistically significant differences between the two treatment-arms were observed in terms of both OS and ORR. The rate of grade equal or higher than 3 AEs was statistically significantly higher in patients treated with EGFR-TKI plus an anti-angiogenic drug: the pooled-Relative Risk was 1.72 (95% CI = 1.43 to 2.06). Ten RCTs were included in the NMA. All the three experimental treatments were associated with a statistically significant improvement of PFS as compared with first-generation EGFR-TKIs. When compared to each other, none of the three experimental treatments was statistically significantly associated with larger PFS or lower rate of grade ≥3AEs. Conclusion Patients with EGFR-mutated NSCLC derived clinically meaningful larger PFS-benefit from the addition of an anti-angiogenic drug to a first-generation EGFR-TKI, at the cost of an increase of toxicitie

Klebsiella pneumoniae carrying multiple alleles of antigen 43-encoding gene of Escherichia coli associated with biofilm formation

A clinical strain of Klebsiella pneumoniae typed as sequence type 307 carrying three different alleles of the flu gene encoding the Escherichia coli virulence factor antigen 43 associated with biofilm formation was detected and characterized. The flu alleles are located in the chromosome inside putative integrative conjugative elements. The strain displays the phenotypes associated with Ag43, i.e. bi-phasic colony morphology and enhanced biofilm production. Furthermore, the strain produces low amount of capsule known to affect Ag43 function. Analysis of 1431 worldwide deposited genomes revealed that 3.7% Klebsiella pneumoniae carry one or two flu alleles