The impact of economic and supply chain trends on British warehousing

Purpose: Warehouses are key nodes in many supply chains and typically represent over 20% of logistics costs. However, other than property market studies, there has been relatively little research on warehousing, particularly as regards how trends in warehouses may relate to changes in such parameters as wider economic and supply chain factors. The purpose of this paper is to examine this area in order to explore how trends in warehousing may relate to existing warehousing and supply chain theory so as to facilitate further research into the relationship between warehousing and "smarter" logistics strategies and efficient supply chain performance. Research approach: The paper is based on a longitudinal study examining the take-up (i.e. occupation) of new large warehouses in Great Britain over the past 16 years covering some 700 records. For the purposes of this study, large warehouses are classified as those over 100,000 square feet (9,290 square metres) in area. These trends, together with those of total warehouse stock, are then related to national statistics, warehouse surveys, supply chain changes and other relevant data over that period. Findings and Originality: This is a rare longitudinal study of this subject. It is found that, until the recent recession, the total warehouse stock, as well as the take-up of large warehouses, has been increasing and this can be associated with such factors as economic growth, retail spending and globalisation. Both the footprint and height of large warehouses has been rising and this may be due to such factors as network economies and warehouse technology. The locations of warehouses are becoming more dispersed, possibly due to the growth in e-commerce and port-centric logistics. In addition, it was found that large warehouses have been increasingly taken up by retailers and manufacturers rather than logistics companies. Research impact: This paper examines the possible influence of economic and supply chain trends on warehousing in Great Britain. As well as testing existing theories, the data provides a sound foundation for future research. For example, there have been conflicting evidence in previous research regarding economies and diseconomies of scale and this discussion can now be set against trends in warehouse footprint and height. Practical impact: The paper provides a better understanding and basis for decision making by planners, developers, funding corporations, operators and end users. For example, topics such as size and height of buildings are examined, as well as trends in port-centric logistics, rail connections and e-fulfilment. The changing nature of warehouse designs in terms of wider economic and supply chain trends is particularly important for practitioners as warehousing costs are to a large extent determined at the design phase and have a major impact on the effectiveness of the overall supply chain of which they are a part

COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

BACKGROUND: Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. METHODS: In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. FINDINGS: Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. INTERPRETATION: Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. FUNDING: British Heart Foundation Data Science Centre, led by Health Data Research UK

Integration of oncology and palliative care : a Lancet Oncology Commission

Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care