Who is willing-to-pay for sustainable last mile innovations?

The COVID-19 pandemic is accelerating the growth of e-commerce. As a result, urban freight transport volume is increasing, leading to traffic congestion and negative environmental impacts, while service quality is deteriorating. These challenges can be addressed through radical innovation of urban last mile logistics with environmental-friendly transportation modes (e. g., cargo bikes), consolidation points (e. g., micro hubs) and new digital service models (e. g., time window alignments). However, sustainability improvements lead to higher costs and will not be realized - beyond pilot studies - until they become economically viable. Therefore, willingness-to-pay (WTP) for sustainable last mile innovations (LMI) is one of the most important success factors. In our work, we aim to investigate the WTP for the additional costs of sustainable LMI. While various stakeholders such as online retailers, logistics service providers or city administrations could benefit from sustainable LMI, in our study we focus on the group that is likely to benefit the most: urban inhabitants. Therefore, we investigated consumers' WTP for sustainable LMI by conducting a questionnaire survey in Germany in September and October 2020 (n = 1,071) and analyzing the data using multivariate statistics. The results show four consumer segments, their characteristics, and their WTP for LMI. Based on the results, implications for stakeholders (especially online retailers) are derived to address the behavior of each consumer segment towards more sustainability in urban last mile logistics. Further research would be interesting to evaluate allocation scenarios for the additional costs among all last mile stakeholders empirically. © 2023 The Authors. Published by ELSEVIER B.V.

Training in vascular trauma surgery for non-vascular surgeons: Vascular trauma surgery skills course.

Background: The experience of general and trauma surgeons in vascular trauma management has decreased with sub-specialization of surgery and working hours restrictions. We introduce a vascular trauma surgery skills course established to train German military surgeons prior to their deployment to conflict areas. Methods: The intention and implementation of the vascular trauma course for non-vascular surgeons is described in detail. Results: In hands-on courses, participants learn and train basic vascular surgical techniques on more realistic extremity, neck, and abdominal models with pulsatile vessels. A fundamental and an advanced course each provide military as well as civilian surgeons from different non-vascular specialties with a surgical skill set including direct vessel sutures, patch angioplasty, anastomosis, thrombectomy, and resuscitative endovascular balloon occlusion of the aorta (REBOA) in order to render them capable of managing major vascular injuries. Conclusion: The experiences of this vascular trauma surgical skills course, initially established for military surgeons, can also be of use to all civilian general, visceral, and trauma surgeons occasionally facing traumatic or iatrogenic vascular injuries. Thus, the introduced vascular trauma course is valuable for all surgeons working in trauma centers.

Who is willing-to-pay for sustainable last mile innovations?

The COVID-19 pandemic is accelerating the growth of e-commerce. As a result, urban freight transport volume is increasing, leading to traffic congestion and negative environmental impacts, while service quality is deteriorating. These challenges can be addressed through radical innovation of urban last mile logistics with environmental-friendly transportation modes (e. g., cargo bikes), consolidation points (e. g., micro hubs) and new digital service models (e. g., time window alignments). However, sustainability improvements lead to higher costs and will not be realized - beyond pilot studies - until they become economically viable. Therefore, willingness-to-pay (WTP) for sustainable last mile innovations (LMI) is one of the most important success factors. In our work, we aim to investigate the WTP for the additional costs of sustainable LMI. While various stakeholders such as online retailers, logistics service providers or city administrations could benefit from sustainable LMI, in our study we focus on the group that is likely to benefit the most: urban inhabitants. Therefore, we investigated consumers' WTP for sustainable LMI by conducting a questionnaire survey in Germany in September and October 2020 (n = 1,071) and analyzing the data using multivariate statistics. The results show four consumer segments, their characteristics, and their WTP for LMI. Based on the results, implications for stakeholders (especially online retailers) are derived to address the behavior of each consumer segment towards more sustainability in urban last mile logistics. Further research would be interesting to evaluate allocation scenarios for the additional costs among all last mile stakeholders empirically. © 2023 The Authors. Published by ELSEVIER B.V.

Back and neck problems as well as disadvantageous ergonomic behavior patterns in university students: Concomitants of the pandemic?

Background: As a part of the coronavirus disease 2019 (COVID-19) lockdown measures, universities converted courses to digital formats, leading to remote studying. It is unclear how these measures affect university students in terms of musculoskeletal problems (i.e., neck and back pain), e.g., by non-ergonomically equipped home offices or reduced physical activity. Material(s) and Method(s): Students from Osnabruck University weresurveyed via fully standardized online questionnaires from early March to mid-April 2022 (6 weeks) about neck and back problems, movement behavior in home offices, and personal information. Result(s): Of 447 students who clicked on the link, 378 students (80.4% female, mean age: 24.1 +/- 4.2 years) answered the questionnaire (response rate: 84.6%). 299 (79.1%) students suffered from neck pain and 294 (77.8%) from back pain during the pandemic. 206 (54.4%) students generally used ergonomic furniture, 83 (22.0%) used ergonomic sitting furniture, 57 (15.1%) used a standing desk, and 212 (56.1%) used aids for a more comfortable use of laptops in home office. 203 (53.7%) students took movement breaks in home office, 207 (54.8%) worked out regularly, and 65 (17.2%) moved regularly in the fresh air. Conclusion(s): The present study found a high rate of neck and back pain amongst university students. Measures are needed to prevent neck and back pain in this group, considering that increased physical activity and enhanced home office equipment might be beneficial.Copyright © 2022 Elsevier GmbH

Adverse skin reactions caused by masks in healthcare workers during the COVID-19 pandemic: an empirical investigation in a Lower Saxonian maximum-care hospital

Introduction: In order to contain the coronavirus disease 2019 (COVID-19) pandemic, strict hygiene measures have been introduced for healthcare workers (HCW). An increase in the occurrence of skin changes in the facial area due to the wearing of masks has already been shown for the private sector. For professional collectives, there is a lack of data. This paper aims at evaluating and quantifying the occurrence of skin changes in the facial area associated with wearing a mask in HCW. Methods: In November 2021, a written survey was conducted in HCW working in a Lower Saxonian maximum-care hospital using fully standardized questionnaires. Results: 192 HCW participated. The average daily wearing time of a mask in the collective (n = 192) adds up to 0.6 +/- 1.7 hours before the pandemic and to 9.0 +/- 1.9 hours during the pandemic. 10.9% of the 192 participants stated that they had suffered from skin changes in the facial area before the introduction of the COVID-19-associated hygiene measures and 80.7% of the 192 participants stated that they had suffered from skin changes in the facial area - which can be attributed to wearing a mask according to self-assessment - since the introduction of the COVID-19-associated hygiene measures. Discussion: Not only a surge in the daily mask wearing time, but also a substantial increase in the occurrence of skin changes in the facial area that are associated with wearing a mask in HCW can be traced back to COVID-19-associated hygiene measures. The need for information about preventive measures indicates that the increased occurrence of skin changes in the facial area is perceived as burdensome by HCW. Conclusion: Since no decline of COVID-19-associated hygiene measures is to be expected in the foreseeable future, HCW should be provided with information on the prevention of skin changes in the facial area. In (occupational) dermatological practice, the use of adequate, individualized skin cleansing and skin care concepts is advisable. Comprehensive primary preventive content can be included in health education training measures - also in the sense of an e-learning/e-health concept.

Geriatric oncological patients in the pandemic: What are we currently doing differently in practice as compared to the past?

Patients with multiple myeloma (MM), monoclonal gammopathies (MGUS/SMM) and other hemato-oncological (hem-onc) diseases frequently present with disease- and treatment related immunosuppression and bear an increased risk for infections and infection-related mortality. Measures to reduce the infection risk, such as antibiotic and antiviral prophylaxis as well as vaccinations are important elements in the management of these pts. During the COVID-19 pandemic many hem-onc pts have been infected with the SARS-CoV-2 virus, and a large proportion had to be hospitalized. Many required intensive care treatment. Mortality rates were higher compared to those of the general population, highlighting the need to boost pts' immune system against SARS-CoV-2. Although millions of people have already been vaccinated with one of the several COVID-19 vaccines, data on the immune response in MM and other hem-onc pts are limited. First reports indicate suboptimal antispike protein or neutralizing antibody response, leaving several pts potentially unprotected. Yet, the immunological correlates of protection are incompletely understood. Factors associated with poor humoral immune response to the vaccine against SARS-CoV-2 were active or relapsing/progressive disease as well as concomitant therapy. A diminished antibody response in MM pts treated with daratumumab or lymphoma patients undergoing treatment with CD20-antibody or BTK-/bcl2-inhibitors was shown. These data mandate monitoring of humoral and cellular immune response to SARS-Cov-2-vaccination in our pts in order to define the correlates of protection in this pt population. Eventually, it is necessary to assure sufficient protection or to consider additional measures such as discontinuation of MM/lymphoma therapy, if possible, and/or additional doses with the same or other COVID-19 vaccines. In those failing to respond, prophylactic treatment with neutralizing monoclonal antibody cocktails, which is not yet approved, may be considered. However, pts lacking adequate immune response to SARS-CoV-2 will be required to adhere to measures for infection risk reduction until the end of the pandemic is reached. At this meeting, we will report our experiences with COVID-19 in hemonc pts at our center and data on the immune response of pts with certain hem-onc diseases after vaccination against SARS-CoV-2. Furthermore, we will discuss current recommendations regarding this vulnerable pt population during the COVID-19 pandemic.

Safety and Efficacy of Isavuconazole in Patients Aged 65 Years or Older with Invasive Fungal Disease: A Post-Hoc Analysis from the VITAL and Secure Studies

Background: Invasive fungal diseases (IFDs), such as invasive mucormycosis (IM) and invasive aspergillosis (IA), are life-threatening infections that remain a major cause of morbidity and mortality in a wide range of immunocompromised patients, including older individuals. During the COVID-19 pandemic, a rise in the proportion of older patients with IFDs was observed. Isavuconazole is a broad-spectrum triazole, approved for the treatment of IM and IA in adults. Here, we conducted a post-hoc analysis of two phase 3 studies to evaluate the safety and efficacy of isavuconazole specifically in patients ≥65 years with IFDs. Methods: Data from two prospective clinical trials, VITAL (NCT00634049) and SECURE (NCT00412893), were included. VITAL was a single-arm, open-label study evaluating isavuconazole for rare IFDs (mainly IM) and IA in renally-impaired patients. SECURE was a randomized, double-blind, non-inferiority study comparing isavuconazole with voriconazole for IA. Safety (adverse events [AEs] by system organ class) and efficacy (all-cause mortality through day 42 and overall responses at end of treatment [EOT]) were assessed for the ≥65 and <65 years subgroups. Results: At enrollment, 116/146 patients were <65 years and 30/146 patients were ≥65 years in VITAL, and 391/516 patients were <65 years and 125/516 patients were ≥65 years in SECURE. Baseline characteristics were mostly comparable for both subgroups across both studies and between the isavuconazole and voriconazole treatment arms in SECURE (Table 1). Safety In VITAL, AEs were reported in similar proportions in both subgroups (≥65 years: 100.0%;<65 years: 94.0%);with infections and infestations (≥65 years: 63.3%;<65 years: 62.1%) being the most common. Serious AEs (SAEs) were higher in the ≥65 years (76.7%) compared to the <65 years (56.9%) subgroup, although drug-related AEs had a reverse trend (≥65 years: 33.3%, <65 years: 43.1%). The most common drug-related AEs were gastrointestinal disorders (≥65 years: 13.3%;<65 years: 16.4%). In SECURE, a similar proportion of AEs was reported in both subgroups of the isavuconazole arm (≥65 years: 98.4%;<65 years: 95.4%), with gastrointestinal disorders (≥65 years: 73.0% <65 years: 66.0%) being the most common. SAEs were reported at higher rates (61.9% vs 49.0%) in the ≥65 years than the <65 years subgroup in the isavuconazole arm. Drug-related AEs were reported more frequently in both subgroups of the voriconazole arm (≥65 years: 54.8%;<65 years: 61.4%) than the isavuconazole arm (≥65 years: 44.4%;<65 years: 41.8%). Additionally, in the ≥65 years subgroup, a higher proportion of patients (cut-off difference: ≥5%) experienced drug-related cardiac disorders (isavuconazole: 6.3%;voriconazole: 0) and general disorders and administrative site conditions (9.5% vs 1.6%) in the isavuconazole arm;and drug-related psychiatric disorders (isavuconazole: 3.2%;voriconazole: 21.0%), eye disorders (3.2% vs 19.4%), and investigation abnormalities (7.9% vs 14.5%) in the voriconazole arm. In the <65 years subgroup, higher proportions of patients (cut-off difference: ≥5%) with drug-related AEs were observed only in the voriconazole arm: investigation abnormalities (isavuconazole: 10.3%;voriconazole: 19.3%), hepatobiliary disorders (2.6% vs 11.7%), psychiatric disorders (2.1% vs 8.1%), and eye disorders (3.1% vs 8.1%). Efficacy In VITAL, all-cause mortality through day 42 was higher (30.0% vs 13.8%) and the overall response at EOT was lower (27.6% vs 46.8%) in the ≥65 years than the <65 years subgroup (Table 2). In SECURE, all-cause mortality through day 42 was similar between both subgroups and both the isavuconazole (20.6% vs 17.9%) and voriconazole (22.6% vs 19.4%) treatment arms. Overall response at EOT was lower in the ≥65 years subgroup of the isavuconazole arm (23.7% vs 39.0%) as compared to the voriconazole arm (32.0% vs 37.5%) (Table 2). Conclusions: As expected, overall, the safety and efficacy outcomes were more favorable in the <65 years compared to the ≥65 years subgroup in both studies, although, the number of patients was relatively low in the ≥65 years subgroup. In SECURE, all-cause mortality through day 42 was similar between both subgroups and treatment arms, and the safety profile favored isavuconazole in both age subgroups. [Formula presented] Disclosures: Hamed: Basilea Pharmaceutica International Ltd.: Consultancy. Engelhardt: Basilea Pharmaceutica International Ltd.: Current Employment. Kovanda: Astellas Pharma Global Development, Inc.: Current Employment. Huang: Pfizer Inc: Current Employment, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company. Yan: Pfizer Inc: Current Employment, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company. Aram: Pfizer Inc: Current Employment, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company.

Recommendations for vaccination given to patients with multiple myeloma in real-world clinical practice and patients compliance with them

Background: Infections are the second leading cause of death in multiple myeloma (MM). All available measures to curb this complication should be exploited, including vaccination against several bacteria and viruses. Aims: In this study, we examined the recommendations for vaccination given to patients (pts) with MM in real-world clinical practice and pts' compliance with them. We also analyzed the incidence of infections before and after diagnosis, and pts' willingness to be vaccinated against COVID-19. Methods: 335 pts with MM from Germany, Switzerland, and Austria participated in this survey. A questionnaire was designed in cooperation with pts groups to assess the vaccination recommendations given to them from their treating physicians, to evaluate their compliance with the advice received, to capture the infection rate of pts in the year before and the first six months after start of therapy, and to assess pts' willingness to be vaccinated against COVID-19. The invitation to participate in this electronic survey was distributed by 31 participating myeloma support groups. In addition, 500 hardcopy questionnaires were mailed directly to pts, reaching out to approximately 2,000 pts. Results: Pts' median age was 65 years;23.0% had 1, 34.8% 2-3, and 42.3% ≥ 4 lines of prior treatment. Pts' responses were similar between respondents to the online and printed version of the questionnaire. The number of pts who received recommendations for the various vaccinations and the proportion of pts who actually received the vaccine is shown in Figure 1. Influenza was the most frequently recommended vaccine (77.0%), followed by pneumococci (65.4%). Pts' compliance with their physicians' advice varied between 67% and 90%. At least one infectious period in the year preceding the diagnosis of MM was reported by 51.9% of the 322 responding pts, and by 42.4% of the 314 responding pts during the first six months after initiation of firstline therapy. Eighty-three percent of pts declared their willingness to be vaccinated against COVID-19, while 17% stated that they objected to it. Reasons for refusing SARS-CoV-2 vaccination were lack of long-term experience (76.6%), concerns regarding late effects (60.9%), insufficient confidence in the pharmaceutical industry (26.7%), and concerns that the vaccine will not be protective (15.6%). Summary/Conclusion: The vaccination recommendations varied widely depending on the type of vaccine, but compliance with these recommendations was remarkably high (>80%) for influenza, pneumococci, hepatitis B, and DTP. The high rates of recommendations for influenza and pneumococci seem to reflect the high prevalence of upper and lower respiratory tract infections in MM. Of note, 51.9% of pts reported a least one infectious episode in the year before, and 42.4% during the first six months after initiation of treatment. As 75.4% of pts did receive prior ASCT, vaccinations with DTP and MMR were recommended to substantial pt numbers. In contrast, fewer than expected pts were advised to get vaccinated against VZV (28%) and against Haemophilus influenzae (12.8%). Tick borne encephalitis is endemic in the some areas of the participating countries, which possibly explains the high compliance rate (78.8%) in the 26.8% of pts who were advised to be vaccinated. The high readiness of MM pts to get vaccinated with a SARS-CoV-2 vaccine (83%) seems remarkable and much higher than that of the general population. A possible explanation for this proactive attitude is the preferential participation of well-informed pts in this study.