Home Delivery Research Articles

Resource Scheduling Optimization of Fresh Food Delivery Porters Considering Ambient Temperature Variations

In the context of an evolving socio-economic landscape and rising living standards, the online market for fresh products, encompassing fruits, vegetables, meats, dairy, and eggs, has seen substantial growth, necessitating sophisticated logistics for e-commerce home delivery. This study tackles the distinct challenges of fresh product delivery, which demand rigorous adherence to climate conditions and product mix during transport, significantly influencing the operational strategies and scheduling of delivery platforms. To address these challenges, a comprehensive mathematical model was developed to optimize fresh food home delivery scheduling, focusing on reducing spoilage rates and accommodating the dynamic impact of environmental temperature changes. The model posits assumptions of a consistent and ample supply of fresh goods, standard initial quality loss, and efficient porter assignment for multi-category order combinations. It introduces three objective functions, targeting the minimization of fresh food loss, maximization of customer satisfaction, and reduction of distributor costs. The efficacy of the model and its genetic-algorithm-based solution method was assessed through numerical analysis and case studies, illustrating that the model enhances delivery efficiency and service quality across varying temperature conditions. This substantiates the critical role of environmental temperature management in optimizing fresh food delivery, offering a robust framework for advancing logistical operations in the perishable goods sector and ensuring quality and efficiency in fresh food e-commerce delivery.

No Patient Left Behind: A Novel Paradigm to Fulfill Hepatitis C Virus Treatment for Rural Patients.

This study evaluates a novel multidisciplinary program providing expanded access to hepatitis C virus (HCV) treatment for rural Appalachian patients in South Carolina. This program identified patients via an opt-out emergency department screening program, and it aimed to achieve HCV cure by using community paramedics (CPs) to link and monitor patients from treatment initiation through 12-week sustained virologic response (SVR). Patients aged ≥18 years who were HCV RNA positive were eligible for enrollment if they failed to appear for a scheduled HCV appointment or reported barriers to accessing office-based treatment. CPs provided home visits (initial and 4, 12, and 24 weeks) using a mobile Wi-Fi hotspot to support telemedicine appointments (compliant with the Health Insurance Portability and Accountability Act) and perform focused physical assessments, venipuncture, and coordinated home delivery of medications. Statistics described participant characteristics, prevalence of SVR, and patient satisfaction results at 12 weeks posttreatment. Thirty-four patients were eligible for SVR laboratory tests by 31 August 2023; the majority were male (61.7%) and White (64.7%) with an average age of 56 years (SD, 11.7). Twenty-eight (82.4%) completed treatment and achieved 12-week SVR. Six (17.6%) were lost to follow-up. Two-thirds strongly agreed that they were satisfied with the overall care that they received, and half strongly agreed that their overall health had improved. This CP-augmented treatment program demonstrated success curing HCV for rural patients who lacked access to office-based treatment. Other health care systems may consider this novel delivery model to treat hard-to-reach individuals who are HCV positive.

P067 Support Programme for Patients Receiving Imraldi or Benepali Therapy for Immune-Mediated Inflammatory Disorders: 12-Month Persistence

Abstract Background/Aims Low persistence to long-term therapy for chronic disease is a recognised problem. Evidence suggests that increasing patients’ ability to manage their own health condition may positively impact adherence and persistence, leading to improved clinical outcomes. In 2019, Biogen initiated a patient support programme (PSP), in addition to the pre-existing medication home delivery (‘homecare’) service, to improve the knowledge, skills and confidence of patients self-administering Imraldi (adalimumab ADL) and Benepali (etanercept ETN). Methods This real-world, retrospective, database study includes patients enrolled into the PSP within 12 months of ADL/ETN initiation. At first ADL/ETN administration all patients receive a face-to-face nurse training visit, followed by a second nurse training visit or follow-up call to coincide with the second injection. Following this, patients consenting to enrol in the PSP receive nurse coaching calls at Weeks 3, 10, 22 and 34, whilst non-PSP patients self-manage thereafter. The analysis presented here excludes patients who were enrolled into the PSP more than 12 months after ADL/ETN initiation. Data including demographics and type/duration of ADL/ETN therapy was captured by the homecare provider for the PSP cohort from November 2019 to February 2022, and for the non-PSP cohort between February 2016 (ETN) or November 2018 (ADL) and February 2022. Persistence at 12 months post-initiation was estimated using Kaplan-Meier (KM) techniques, overall and by subgroup including indication (rheumatology, dermatology, gastroenterology) and whether biologic naïve or switched from another biologic. Results Persistence at 12 months for patients enrolled in the PSP was 77.5% and in the non-PSP cohort was 73.6%. Lowest persistence by prior biologic exposure was 70.9% in the non-PSP biologic naïve cohort. By therapeutic area, the greatest differential between PSP vs non-PSP group (75.7% vs 67.6%) was in the gastroenterology cohort, which also had the lowest non-PSP persistence of any subgroup. (Table) Conclusion Compared to the non-PSP cohort, patients enrolled in the PSP had higher persistence at 12 months after initiation, across all indications and regardless of prior biologic exposure. This real-world evidence indicates the benefits of a PSP to patients with chronic diseases, and that particular attention should be paid to biologic-naïve patients. Disclosure A. Clark: Corporate appointments; AC is an employee of Biogen Idec Ltd. T. Shering: Corporate appointments; TS is an employee of Biogen Idec Ltd. J. Addison: Corporate appointments; JA is an employee of Biogen Idec Ltd.

Online grocery shopping adoption versus non-adoption among the over-50s in Germany

Online grocery shopping (OGS) has significantly risen due to accelerated retail digitization and reshaped consumer shopping behaviors over the last years. Despite this trend, the German online grocery market lags behind its international counterparts. Notably, with almost half of the German population aged over 50 and the 55–64 age group emerging as the largest user segment in e-commerce, the over-50 demographic presents an attractive yet relatively overlooked audience for the expansion of the online grocery market. However, research on OGS behavior among German over-50s is scarce. This study addresses this gap, empirically investigating OGS adoption factors within this demographic through an online survey with 179 respondents. Our findings reveal that over a third of the over-50 demographic has embraced OGS, indicating a growing receptivity for OGS among the over-50s. Notably, home delivery, product variety, convenience, and curiosity emerged as primary drivers for OGS adoption among this demographic. Surprisingly, most adopters did not increase online grocery orders since 2020 and a not inconsiderable proportion have even stopped buying groceries online again. For potential OGS adopters, regional product availability turned out as a motivator, signaling substantial growth potential and providing online grocers with strategic opportunities to target this demographic. In light of our research, we offer practical suggestions to online grocery retailers, aiming to overcome barriers and capitalize on key drivers identified in our study for sustained growth in the over-50 market segment.

Breast problems and associated factors among lactating women in Northeast Ethiopia, 2022

Breastfeeding is the cornerstone of child and maternal health. However, maternal breast problems during breastfeeding have been frequently reported as one of the reasons for early discontinuation of breastfeeding. Despite the importance of having knowledge on breast problems magnitude and its associated factors in the clinical practices and designing effective interventions, there is limited data on this topic. Therefore, this study aimed to assess the prevalence and associated factors of breast problem among postnatal lactating women in Legambo district, south wollo zone, North East Ethiopia, in 2022. A community-based cross sectional study was conducted among 610 lactating mothers in Legambo district. Multi-stage sampling was employed to select study participants. Interviewer administered, WHO B-R-E-A-S-T-Feeding, observational checklist and maternal self-reported breast problem questionnaires were used to collect the data. Epi-Data version 3.1 was used for data entry and export to SPSS version 25.0 for analysis. Descriptive statistics and bi-variable and multivariable analysis was carried out. On the multivariable logistic regression, variables with p-value < 0.5 were considered as they had statistically significant association with breast problem. The overall prevalence of breast problems among postnatal lactating women was 54.3% (95%, CI 49.3–59.3%). Primipara (AOR = 5.09; 95% CI 3.40–7.62), preterm infant (AOR = 2.12; 95% CI 1.22–3.66), home delivery (AOR = 3.67; 95% CI 1.62–8.30), ineffective breastfeeding techniques (AOR = 2.45; 95%CI 1.61–3.74), caesarean section delivery (AOR = 2.05;95%CI :1.15–3.64) and mixed type of feeding (AOR = 1.97:95%CI 1.34–2.89) were factors showed significant association. The prevalence of breast problems was 54.3%. Relevant factors related to an increase risks are being primipara, cesarean section delivery, home delivery, preterm birth, ineffective breastfeeding techniques and mixed type of feeding.

Narrowing inequity gap: ERAS home delivery kit

ObjectiveTo enhance adherence to Enhanced Recovery After Surgery (ERAS) protocols and address pre-operative preparation equity gaps, a system was developed to automatically mail chlorhexidine (CHG) and nutritional carbohydrate supplements (ERAS Kits) to surgical patients. BackgroundThis retrospective observational study focused on adult patients undergoing abdominal surgeries at a large academic hospital, using a pre-post design. MethodsThe study compared adherence to pre-operative ERAS pathways, involving nutritional supplements and chlorhexidine soap usage, before (September 2021-March 2022) and after (September 2022-March 2023) implementing automatic ERAS Kits mailing. A Chi square test analyzed adherence rates. ResultsPost-implementation, adherence to preoperative nutrition rose from 49.6 % to 57.7 % (P = 0.006), and surgical site preparation from 73.8 % to 78.7 % (P = 0.06). Notable improvements were seen among Black patients, Medicaid recipients, and those from lower-income neighborhoods in nutrition adherence, and among younger patients and Medicaid recipients in site preparation. ConclusionMailing ERAS Kits directly to patients significantly enhanced compliance with preoperative protocols, demonstrating an effective strategy to improve care accessibility and reduce disparities for vulnerable groups.

Time to death and its predictors among neonates admitted with sepsis in neonatal intensive care unit at comprehensive specialized hospitals in Northeast Ethiopia.

In impoverished nations like Ethiopia, neonatal sepsis contributes significantly to neonatal mortality. Despite variations in the specific timing of death and predictors of neonatal mortality associated with sepsis across different settings, there's limited documented information in the Neonatal Intensive Care Units of northeastern Ethiopia. Consequently, the aim of this study was to determine time to death and its predictors among neonates with sepsis admitted to Neonatal Intensive Care Units in comprehensive specialized hospitals in northeastern Ethiopia. A prospective cohort study conducted at the institution level involved 306 neonates diagnosed with sepsis. Data collection utilized face-to-face interviews and chart reviews. Subsequently, the data were inputted into Epi-data version 4.6 and later analyzed using STATA version 17. The median time to death was determined, and both the Kaplan-Meier curve and log-rank test were applied. Furthermore, a Cox proportional hazard regression model was utilized to identify predictors of neonatal mortality associated with sepsis. The cumulative incidence of mortality among neonates admitted with sepsis was 34% (95% CI: 28.9%-39.5%). The neonatal mortality rate stood at 51 (95% CI: 42.1, 62) per 1,000 neonates admitted to the intensive care units with sepsis over a total of 1,854 person-days of observation. Additionally, the median time to death was 13 days (IQR = 5-23 days). Tachypnea [AHR 6.2 (95% CI: 1.5-9.7)], respiratory distress syndrome [AHR 2.1 (95% CI: 1.3-3.5)], lethargy [AHR 1.8 (95% CI: 1.2-2.6)], preterm birth [AHR 1.8 (95% CI: 1.2-2.7)], continuous positive airway pressure use [AHR 2.1 (95% CI: 1.3-3.4)], home delivery [AHR 2.63 (95% CI: 1.1-6.4)], Subgalea hemorrhage [AHR 1.8 (95% CI: 1.1-3.9)], and low platelet count [AHR 5.9 (95% CI: 2.3-8.6)] were found to be predictors of time to death in neonates with sepsis. The study revealed an alarmingly high neonatal mortality rate among septic neonates, underscoring the urgency for intervention. Enhancing the quality of care in neonatal intensive care units, bolstering infection prevention during procedures such as continuous positive airway pressure, exercising caution with locally made accessories, and reinforcing a culture of institutional delivery are critical in curbing neonatal sepsis-related mortalities.

Online shopping behaviour in the Northern and Southern Great Plain Regions

The aim of our study is to reveal the attitude of consumers related to online shopping, the advantages and disadvantages of online purchasing, the regional characteristics of purchasing food online. The literature review was carried out by a comparative analysis of the publications of the factors influencing the purchase decision, the advantages and disadvantages of using online channels as a priority. The secondary research, in addition to the changes in global and then Hungarian online retail, the FMCG sector and customer behavior. Primary research the survey was conducted using a standardized, structured, online questionnaire with the participation of students from the University of Debrecen and the Sándor Wekerle College of Business. The socio-demographic characteristics of the respondents (623) were measured according to the defining characteristics of online shopping. The rate of online shopping by residents living in the Great Plains region is 6 percentage points lower than the national average, poor result in the online purchase of food. The advantages of online shopping, the importance of convenience and saving time is rated equally, while other factors, e.g. the assessment of home delivery was different. Diadvantages are the terms of payment and data security. The future intention to buy online is uncertain and they imagine it within limits, and the potential purchase can only be linked to durable foods. Region-specific and product-specific (food) analysis of online shopping. Attitudes towards online shopping, based on regional characteristics, justify the fact that it would be more appropriate for store chains to use a differentiated marketing strategy, which may primarily affect marketing communication and sales organization.

Impacts of Behavioral, Organizational, and Spatial Factors on the Carbon Footprint of Traditional Retail and E-commerce in the Paris Region.

Carbon footprint assessment of retail is necessary to optimize procurement strategies and adopt sustainable shopping habits. However, estimating carbon footprints is a complex task, given the diversity of existing distribution channels. Average values for carbon emissions of "conventional" retail (i.e., purchasing and receiving the product directly at the physical point of sale) found in most studies mask a heterogeneous reality: different retail strategies entail diverse shopping behavior for consumers, as well as varied procurement processes for outlets. In this paper, we propose a methodology to assess greenhouse gas (GHG) impacts of different distribution systems related to the consumption of goods in the Paris Region by coupling traditional transport modeling with a life-cycle assessment (LCA) approach. We model and compare six distribution systems, including five traditional retail formats (hypermarkets, supermarkets, small generalist retail, small food retail, and small nonfood retail) and E-commerce home deliveries. Our model includes warehouse activity, shop and home delivery, shop energy consumption, consumer mobility, and goods packaging. Overall, we conclude that E-commerce emits fewer GHG emissions than retail outlets per kilogram of product purchased. This result is in line with the existing literature on the topic. However, the carbon footprint varies greatly within the case study depending on the characteristics of the logistics procurement processes of outlets, the behavior of shoppers, and spatial characteristics.

Where do high-risk drinking occasions occur more often? A cross-sectional, cross-country study.

The current paper examines the proportion of drinking occasions and total alcohol consumed that takes place at off-premise locations. Comparisons are made between high-income countries: Australia, New Zealand, England and Scotland, and across drinker-types: high-risk and lower-risk. Data were taken from the International Alcohol Control study in Australia (N = 1789), New Zealand (N = 1979), England (N = 2844) and Scotland (N = 1864). The cross-national survey measures location and beverage-specific alcohol consumption. The number of drinking occasions and mean consumption across on- and off-premise locations and the proportion of drinking occasions that high- and lower-risk drinkers had at on- and off-premise locations was estimated for each country. The majority of drinking occasions among high-risk drinkers occurred at off-premise locations across all four countries; Australia 80.1%, New Zealand 72.0%, England 61.7% and Scotland 60.7%. High-risk drinkers in Australia had significantly larger proportions of drinking occasions occurring at off-premise locations compared to England and Scotland. Across all countries, high-risk drinkers and lower-risk drinkers consumed significantly larger quantities of alcohol per occasion at off-premise locations compared to on-premises locations. Finally, the majority of total alcohol consumed occurred at off-premise locations across all countries for high- and lower-risk drinkers. As the accessibility to alcohol outside of licensed premises continues to increase, particularly with the expansion of home delivery services, it is important to be mindful of the high proportion of heavy drinking occasions that occur off-premise.

How Do Women Vote: What Women Post About Home Birth Versus Hospital Birth on Popular Social Media Platforms.

The rates of home birth have been increasing; reliance on social media as a source of medical advice and support for patients has also been increasing. This is the first study that directly evaluates birthing people's perceptions, attitudes, and advice about planned home births expressed in public posts and comments on two popular social media platforms - Reddit and TikTok. Posts on each platform were searched from January 2017 through July 2022 using the terms "home birth" and "home vs. hospital birth". Included posts were from the United States written in English, with at least 10 comments and 10 upvotes or likes. Up to five themes were collected per post or comment and were categorized as supportive, opposing, or neutral. The Institutional Review Board (IRB) determined that the project did not include human subjects. Collectively, 777 posts and 47,452 comments wereevaluated for inclusion; 257 posts and 2,408 comments met the inclusion criteria for analysis. In posts, 69% supported, 20% opposed, and 11% were neutral toward home birth (n = 257). Similarly, in comments, 53% supported, 28% opposed, and 19% were neutral (n = 2,408). Supportive themes included concerns about the safety of hospital delivery and reassurance about home birth safety, enhanced patient control with home deliveries, positive personal stories reinforcing home birth, concerns about excessive interventions in hospital birth, and advice about preparing for home birth. Opposing themes included concerns about risks of home birth, negligence of those attempting it, reassurance that hospital birth does offer women control, greater financial costs of home birth and that medical interventions can be lifesaving. These results can help physicians recognize some of the women's concerns about hospital births and what information they may find on social media guiding them as they formulate their birth plans. Overall, this information helps with the goal of balancing patient safety with the need to respect patient autonomy.

IJCM_20A: Understanding determinants of increased home deliveries in accessing antenatal care in the two blocks of the Chamba, Himachal Pradesh

Background: Maternal mortality has been declining over the years in India. Despite India achieving a maternal mortality ratio below 100 per 100,000 live births by 2020, Chamba, an aspirational district of Himachal Pradesh, still faces challenges. In Chamba, access to antenatal care (ANC) and postnatal care (PNC) remains suboptimal. Objective: To understand the perspectives of key stakeholders on barriers and facilitators for accessing ANC/PNC and institutional delivery services in the Chamba district. Methodology: The qualitative study was conducted in May and June 2023 in two blocks of the Chamba district. Around 5-6 villages were purposively selected in each block. The study encompassed 19 in-depth interviews and 7 focus group discussions involving lactating and pregnant women, family members, medical officers, and frontline healthcare workers. Additionally, the assessment of 2 labour rooms at the health facility was conducted using DAKSHATA standards. Results: The study revealed multifaceted barriers in Chamba, including challenging road conditions worsened by weather impeding timely health facility access. Women’s heavy workloads and limited awareness resulted in delayed ANC, PNC, and registration. Cultural preferences and myths hindered institutional deliveries. Transportation challenges, ambulance limitations, hospital overload, and health facility constraints amplified the difficulties. The DAKSHATA assessment indicated a mean score of 22 out of 30, stressing the need for improvements to enhance ANC, PNC, and institutional delivery access. Conclusion: The findings emphasize the critical need for interventions that enhance awareness among women, counteract cultural preferences for home deliveries and dispel prevalent myths and misconceptions. Furthermore, addressing transportation limitations, ambulance constraints, and hospital overload is crucial.

Predictors of late initiation of breastfeeding practice in Ethiopia: a multilevel mixed-effects analysis of recent evidence from EDHS 2019

ObjectivesTo identify the predictors of late initiation of breastfeeding practice in Ethiopia.DesignCross-sectional study design.SettingEthiopia.ParticipantsA total of 1982 weighted samples of mothers with children aged under 24 months were included.Outcome measureLate...

Incidence and predictors of mortality among neonates admitted with birth asphyxia to neonatal intensive care unit of West Shewa Zone Public Hospitals, Central Ethiopia

BackgroundBirth asphyxia is still one of the primary causes of newborn mortality worldwide. Similarly, the risk of newborn asphyxia in Ethiopia remains unacceptably high. Thus, studies on the incidence and...

Incorporating social determinants of health into patient care workflows within a health-system specialty pharmacy

BackgroundThe influence of adverse factors on social determinants of health (SDOH) and their impact on patient outcomes is widely recognized. Pharmacists, as accessible healthcare professionals, can play a pivotal role in identifying and addressing SDOH concerns. Health-system specialty pharmacies have consistently assisted patients in accessing expensive specialty medications and ensuring adherence to therapy. As such, they are uniquely positioned to address SDOH concerns of patients. ObjectiveTo assess the effectiveness of incorporating standardized SDOH screening and referral methods into the patient care workflows of a health-system specialty pharmacy. Practice descriptionThe University of North Carolina Health Care (UNC Health) Specialty and Home Delivery Pharmacy is a health-system owned specialty pharmacy serving patients in North Carolina, South Carolina, and Virginia. It holds accreditations from the Utilization Review Accreditation Commission and Accreditation Commission for Health Care. Practice innovationA standardized SDOH screening and referral method were integrated into patient care workflows of a health-system specialty pharmacy. If SDOH concerns were identified upon screening by a specialty pharmacist, patients were referred to an entity within the health-system responsible for connecting patients to local community resources to address their SDOH concerns. Evaluation methodsThe types of SDOH concerns, frequency of SDOH referrals, referral turnaround time, outcomes of the referrals, and patient demographics were evaluated to determine the impact of this project. Descriptive statistics were used to analyze results. ResultsSixty-nine patients were included (female: n = 38, 55.1%; age (mean±SD: 48.9 ± 16.3). Eighty-seven SDOH concerns were reported, 54 patients (78.3%) were connected to local resources upon referral, and the average turnaround time of referrals was 2.2 business days. ConclusionThe findings of this pilot study highlight the effectiveness of incorporating SDOH screening and referral methods into specialty pharmacy workflows. Specialty pharmacies can successfully identify and address nonmedical factors impacting patients.

Community Health Profile of Selected Area of Birgunj Metropolitan City, Parsa

Background: Community assessment is the basic foundation for promoting and improving the health of community populations. The objective of this survey is to appraise the health profile of the community and assist in promoting community health. Methodology: A descriptive cross-sectional survey was carried out from August 14, 2019, to September 21, 2019. The population of the study was residents of ward number 1, Chhapkaiya of Birgunj Metropolitan City, a Slum area of the ward selected purposively, where there were 200 houses and a total population was 1364. Data were collected using the interview technique. Descriptive statistics were used to analyse data. Results: The majority (79.0%) of respondents threw waste in an open field. Only 19.0% of respondents had used latrines. Most women (80.25%) became mothers at the age of fewer than 20 years. More than half (57.31%) of pregnant women had done an ANC visit up to the fourth time, among them, 90.0% of respondents had delivered in a government hospital 86.0% of the mothers had colostrum feeding practiced as well and 90.12% had done exclusive breastfeeding up to 6 months. Female sterilisation (38%) were more common in the society. Above sixty percent (62.86%) of families, had done diarrheal management in the home of under 5 children. Conclusion: The health profile of the Chhapkaiya community is satisfactory. All populations used safe water but open field defecation is prevalent and most of the population threw waste in the open field. The majority of the women became mothers below 20 years of age and home delivery is still practiced in this community. Int. J. Appl. Sci. Biotechnol. Vol 12(1): 39-45.

Strategies that enabled access to chronic care during the COVID-19 pandemic and beyond in South Africa.

The COVID-19 epidemic has revealed disturbing information about how chronic diseases are treated globally. Healthcare providers and coronavirus response teams have primarily reported on how individuals with chronic conditions sought care and treatment. However, individuals' experiences of patients are yet unknown. This study aimed to explore those strategies that enabled patients with chronic diseases access to chronic care and treatment during and beyond the COVID-19 pandemic. The study was conducted in the predominantly rural district of the Northwest Province, South Africa. An explorative qualitative research design was followed. Information-rich participants were chosen using a purposive sampling technique. Individual face-to-face interviews were used to gather data. Data saturation was achieved after interviewing n = 28 people in total. The six steps of Braun and Clarke thematic data analysis were used to analyse the data. The study revealed three themes, which includes improved healthcare structural systems, shift from traditional chronic care to digital care services and medication refill and buddy system. The findings of this study revealed a range of effective and noteworthy approaches that facilitated access to treatment and continuity of care. As a result, enhancing telemedicine as well as structural systems such as appointment scheduling, decanting choices, mobile and medication home delivery can improve access to care and treatment. The burden of disease and avoidable death will be eventually addressed by maximising the use of telemedicine and sustaining the new norm of ongoing care through digital and remote care and decanting strategies.

Optimizing care for children with difficult-to-treat and severe asthma through specialist paediatric asthma centres: expert practical experience and advice

Severe asthma in children carries an unacceptable treatment burden, yet its rarity means clinical experience in treating it is limited, even among specialists. Practical guidance is needed to support clinical decision-making to optimize treatment for children with this condition.This modified Delphi convened 16 paediatric pulmonologists and allergologists from northern Europe, all experienced in treating children with severe asthma. Informed by interviews with stakeholders involved in the care of children with severe asthma (including paediatricians, nurses and carers), and an analysis of European guidelines, the experts built a consensus focused on the gaps in existing guidance. Explored were considerations for optimizing care for patients needing biologic treatment, and for selecting home or hospital delivery of biologics. This consensus is aimed at clinicians in specialist centres, as well as general paediatricians, paediatric allergologists and paediatric pulmonologists who refer children with the most severe asthma to specialist care. Consensus is based on expert opinion and is intended for use alongside published guidelines.Our discussions revealed three key facets to optimizing care. Firstly, early asthma detection in children presenting with wheezing and/or dyspnoea is vital, with a low threshold for referral from primary to specialist care. Secondly, children who may need biologics should be referred to and managed by specialist paediatric asthma centres; we define principles for the specialist team members, tests, and expertise necessary at such centres, as well as guidance on when homecare biologics delivery is and is not appropriate. Thirdly, shared decision-making is essential at all stages of the patient’s journey: clear, concise treatment plans are vital for patient/carer self-management, and structured processes for transition from paediatric to adult services are valuable. The experts identified the potential for specialist paediatric asthma nurses to play a significant role in facilitating multidisciplinary working.Through this project is agreed a framework of practical advice to optimize the care of children with severe asthma. We encourage clinicians and policymakers to implement this practical advice to enhance patient care.

Addressing the challenges of using autonomous robots for last-mile delivery

The importance of last-mile delivery (LMD) in today's logistics networks has increased recently due to the rising popularity of e-commerce and home delivery. Various LMD modes, such as drones and autonomous vehicles, have emerged to solve the problems encountered during LMD activities and to reduce human intervention in the process. The purpose of this paper is to determine the challenges that arise when using autonomous delivery robots (ADRs) in LMD. Throughout the research, the challenges have been revealed, categorized into six titles and their significance has been calculated via the intuitionistic fuzzy (IF) pivot pairwise relative criteria importance assessment (PIPRECIA) method in conjunction with PESTEL Analysis. IF-PIPRECIA is employed for the first time in the literature with PESTEL Analysis to evaluate the challenges for the implementation of ADRs in LMD. According to the proposed methodology results, challenges related to “Energy consumption,” “Battery life and energy management,” “Cybersecurity,” “Air pollution,” and “Uncertain return on investment” are the most critical factors to consider when implementing ADRs in LMD.

Grocery Shop Application

The grocery shop app is a user-friendly mobile application designed to streamline the grocery shopping experience. With a clean and intuitive interface, users can easily browse a wide selection of products, add items to their virtual cart, and conveniently place orders for home delivery or in-store pickup. The app features personalized recommendations based on past purchases, real-time inventory updates, and a robust search function for efficient product discovery. Users can create and manage shopping lists, take advantage of exclusive deals and discounts, and enjoy a seamless checkout process with various payment options. The app aims to enhance the overall convenience and efficiency of grocery shopping, providing users with a modern and hassle-free way to meet their daily food and household needs. KEYWORDS - Fresh,Convenient, Variety, Quality, Affordable, Fresh produce, Organic options,Dairy products, Household essentials