Search Results (113)

Background/Objectives: In Italy, Ministerial Decree 77/2022 provides the regulatory framework for reorganizing community-based care around community health centers and hub-and-spoke territorial networks. However, translating territorial allocation into specialist working-hour requirements remains a key operational challenge, particularly in low-density and mountainous areas. This study developed an activity-based workload model to translate observed outpatient cardiology activity into estimated specialist working-hour requirements within the hub-and-spoke community health center network of local health authority (ASL 1) Avezzano-Sulmona-L’Aquila, Abruzzo, Italy. Methods: A second-stage workforce planning analysis was conducted using the baseline 30 min territorial configuration from a previously defined allocation framework. Municipal-level outpatient cardiology administrative data for 2019 were linked to standardized procedure scheduling durations and aggregated across the catchments of three hub centers and eight spoke centers according to predefined municipality-to-node assignments. Procedure volumes were converted into annual and weekly workload hours and then into nominal 36 h weekly specialist-schedule equivalents. The resulting estimates represent a pre-pandemic, utilization-based workload scenario derived from observed activity; they should not be interpreted as direct measures of underlying population demand, epidemiological need, or unmet need, nor as validated staffing requirements. Results: The reference network covered 286,832 residents and included 44,039 outpatient cardiology procedures, corresponding to 12,719.8 annual workload hours. These volumes generated 244.6 weekly workload hours, equivalent to 6.79 nominal 36 h weekly specialist-schedule equivalents. Workload was unevenly distributed across the network: the L’Aquila and Sulmona hubs accounted for the largest annual workloads, with 3014.9 and 2894.3 h, respectively, whereas Trasacco was the spoke center with the highest observed workload, with 1775.5 h. Population-standardized indicators showed substantial variation in workload intensity across the catchments, indicating that catchment population size alone did not adequately capture the observed workload differences. Conclusions: Activity-based workload estimation adds an operational workforce layer to hub-and-spoke territorial planning. By translating observed outpatient service-use volumes into specialist working-hour requirements, the model provides a transparent and potentially transferable framework to support the operational planning of community health centers in geographically complex settings. The approach is adaptable to other specialties, territories, and service configurations where comparable activity data, standardized scheduling durations, and territorial assignment inputs are available. Full article

Background: Chronic subdural haematoma (cSDH) is one of the most common neurocranial conditions in older adults and is increasing in incidence. Conservatively managed patients are typically older, frailer, and more comorbid than surgical candidates, yet specialist geriatrician input into their management is rarely formalised. Potential for geographic inequity in hub-and-spoke neurosurgical networks within the UK compounds this challenge. We describe a service evaluation of a novel regional geriatric trauma advice service providing specialist trauma geriatrician input into cSDH management alongside the neurosurgical team, across a single UK Neurosurgical Network. To the authors’ knowledge, this is the first of its kind in the UK. Prior to this service ‘normal’ care within our region was no routine specialist medical input. Methods: A service evaluation of all referrals received by the North Bristol National Health Service (NHS) Trust geriatric trauma team between July 2024 and March 2026 was performed by the authors. Referrals were discussed within a multidisciplinary team including geriatric trauma, interventional neuroradiology and neurosurgery. Individuals’ demographic data, advice types, management enhancement, intervention outcomes and mortality were recorded and analysed descriptively. Management enhancement was defined as a definitive management decision that resulted in either an action or an active decision not to act. Results: Ninety referrals were included. Median age was 83 years (IQR 77–88) and median Clinical Frailty Scale (CFS) score was 4, with 50% classified as frail (CFS 4–8). Referrals were received from five satellite NHS trusts and the community. Three-quarters (75.6%) required multiple concurrent advice types; Middle Meningeal Artery Embolisation (MMAE) suitability (93.3%) and antithrombotic management (51.1%) were the most frequent. Specialist geriatrician input enhanced management in 97.8% of cases. Forty percent of conservatively managed patients were converted to active intervention, most commonly standalone MMAE (50%). Of district general hospital patient referrals, 40.3% were conveyed to the neurosurgical centre following geriatric trauma review. Mortality was comparatively lower at multiple time points when compared to existing UK data for conservatively managed patients. Conclusions: A regional virtual geriatric trauma advice service for older adults with cSDH is feasible and is associated with enhanced management of this cohort, potentially improving access to treatment. Combining neurosurgical, neurointerventional and geriatrician expertise through a structured multi-disciplinary team (MDT) approach addresses the clinical complexity of this patient group and the potential geographic inequity of hub-and-spoke networks. Further research is needed to investigate the impact of routine geriatrician input into cSDH care. Full article

The development of suspension systems for urban micro-mobility vehicles, such as bicycles and e-bikes, requires balancing effective road filtering with structural simplicity. Traditional solutions, such as telescopic forks and rear shock absorbers, face significant challenges related to weight, bulk, and mechanical complexity, which increase production and maintenance costs. The integration of in-wheel motors into wheel hubs further complicates the design by increasing unsprung mass and vertical vibrations, negatively affecting ride comfort. The In-Wheel Suspension (IWS) system offers an innovative solution by incorporating elastic and damping elements directly into the wheel rim, eliminating the need for frame modifications and reducing overall weight. This study proposes an integrated approach to optimising the internal geometries of IWS elastic elements, using structural analyses with LS-Dyna and dynamic simulations in the Simulink environment for comfort assessment. Results demonstrate that optimising the geometry of spokes and rims significantly reduces stiffness variations and self-induced vibrations, with enhancements in ride comfort and resistance to fatigue. The optimized IWS design minimises discomfort peaks at critical speeds and improves vibration attenuation. However, the high average stiffness limits filtering performance at speeds above 10 km/h. While IWS systems represent a promising alternative to traditional suspensions due to their advantages in weight reduction, compactness, and construction simplicity, further improvements—such as the use of composite materials and alternative geometries—are necessary to further increase comfort and to ensure structural resistance to variable loads. Full article

In 2025, Rome hosted the Catholic Jubilee, recording over 33 million cumulative pilgrim attendances while simultaneously facing the death of Pope Francis, the election of Pope Leo XIV, and a regional West Nile Virus (WNV) outbreak. This commentary describes the Lazio Region’s preparedness strategy, based on adapting an existing Hub-and-Spoke infectious diseases network integrating surveillance with Regional Service for Epidemiology, Surveillance and Control of Infectious Diseases (SERESMI) laboratory support, telemedicine, and clinical management. Preparatory measures included an additional Hub, updated syndromic pathways, multidisciplinary coordination, and enhanced surveillance. Emergency department visits increased by 14.8%, while the proportion of infectious syndromes remained stable. This experience highlights the potential value of strengthening existing healthcare networks for mass gathering preparedness. Full article

Background: Inequitable access to clinical trials persists in blood cancers despite ongoing equity, diversity, and inclusion (EDI) efforts. Despite the critical role of clinical trials in improving survival and outcomes, recruitment remains suboptimal, limiting patient access to potentially life-saving therapies. Practical and scalable approaches are therefore needed to address the non-medical barriers that hinder patient readiness upstream of enrolment. Methods: Myeloma Canada led a national, multi-phase initiative using human-centred design (HCD) to operationalize EDI in clinical trials. Following an initial systems level workshop, the two-day Phase 0 workshop used a HCD approach that convened a purposively selected multidisciplinary group of stakeholders to co-design operational solutions for non-medical barriers affecting trial participation for patients. Given the use of purposive sampling, the results should be interpreted as reflecting a balanced range of diverse, informed perspectives across the Canadian clinical trial ecosystem. Results: Participants identified persistent cultural, logistical, financial, and linguistic barriers, along with fragmented awareness of available supports. Across diverse personas and care settings, all groups independently converged on a human-centred, equity-focused pre-trial navigation model supported by simple digital tools, including AI-enabled infrastructure drawing on curated resources from validated sources with appropriate governance, privacy, and oversight. Digital tools were proposed to support, rather than replace, human support and to align with existing health system realities. Conclusions: This hypothesis-generating work proposes a feasible, sustainable, and scalable equity-embedded, protocol-agnostic navigation framework. Its external hub-and-spoke structure can reduce non-medical barriers, strengthen trial access and accrual, and enhance representativeness. Pilot implementation that assesses feasibility, uptake, workflow impact, equity effects, and implementation burden is warranted. Full article

Acute infectious gastroenteritis (AIG) is caused by diverse bacterial and viral enteric pathogens with overlapping clinical presentations, limiting conventional pathogen-directed workflows. This retrospective before–after study evaluated the diagnostic, microbiological, operational, and economic impact of multiplex molecular syndromic testing for AIG within a regional hub-and-spoke laboratory network in Italy. Two 19-month periods were compared: a pre-implementation period based on conventional diagnostics and a post-implementation period using multiplex syndromic panels as first-line tests. Diagnostic investigations totalled 25,574 before and 24,509 after implementation. Overall test positivity increased from 5.43% to 11.59% (p < 0.001), with significant increases for bacterial and viral targets. Pathogen detection events increased from 1388 to 2839, including broader detection of Campylobacter spp., Shigella spp./enteroinvasive Escherichia coli (EIEC), Yersinia enterocolitica, Aeromonas spp., Astrovirus, Sapovirus, and Norovirus genogroups. Mean turnaround time decreased from 63 to 47 h from sample collection and from 56 to 41 h from laboratory check-in. Although direct diagnostic costs increased moderately, total laboratory costs decreased when personnel costs were included, and cost per diagnostic detection declined from €233.80 to €120.86. Multiplex syndromic testing improved microbiological detection, diagnostic efficiency, turnaround time, and laboratory organisation in routine AIG diagnosis. Full article

Background/Objectives: A structured follow-up after out-of-hospital cardiac arrest (OHCA) is recommended, but implementation across regional networks remains challenging. REVIVE introduced a hub-and-spoke survivorship pathway in Lombardy. This 12-month formative implementation evaluation aimed to describe staged pathway progression, operational reach, attrition points, centre-level variation, and documented barriers to assessment completion. Methods: Adult OHCA survivors with Cerebral Performance Category (CPC) 1–2 or Modified Rankin Scale (mRS) ≤ 3 were considered eligible. The evaluation was structured using Proctor et al.’s implementation outcomes framework. Implementation outcomes were operationalised using prospectively collected pathway indicators: eligibility ascertainment, successful contact, T0 assessment completion, completion of planned assessment components, timeliness where available, and documented reasons for non-progression. Analyses were descriptive and used chi-square or Fisher’s exact tests for unadjusted centre-level comparisons. Results: Of the 1663 patients hospitalised, 1458 (87.7%) were recorded as deceased or having an unfavourable neurological outcome and were therefore outside the intended REVIVE target population. Among the remaining 205 patients, eligibility could not be determined for 78 (4.7% of the total cohort), and 127 (7.6%) met eligibility criteria. Of eligible survivors, 96 (75.6%) were contacted and 64 completed the T0 assessment (66.7% of contacted; 50.4% of eligible). Pavia showed higher observed rates of eligibility ascertainment, contact, and assessment completion than spoke centres, but these differences were unadjusted and should be interpreted as centre-level implementation variation rather than evidence of causal superiority. Conclusions: REVIVE initiated a structured regional pathway for post-OHCA follow-up, but first-year implementation was partial rather than definitive. The 50.4% T0 completion rate among eligible survivors should be interpreted as an initial internal implementation indicator, not as evidence of established feasibility, effectiveness, or regional benchmarking. Priorities for further optimisation include eligibility ascertainment, transfer of contact information, patient engagement, and spoke-site support for assessment delivery. Full article

Higher technical and professional education is increasingly discussed in relation to workforce readiness, innovation, and societal inclusion. In Italy, the PNRR-funded Rome Technopole operates as a multi-institutional ecosystem in which universities, research organizations, industry, and public bodies interact through a Hub & Spoke model to support training and innovation activities. Among its components, Spoke 4 addresses professional higher technical education through the co-development of modular learning initiatives involving multiple stakeholders. This commentary examines the role and activities of the Italian National Institute of Health (ISS) within this context, with particular reference to the development of two pilot modules: one on Artificial Intelligence and Algorethics, and one on Accessibility and Assistive Technologies, including applications supported by AI. The paper combines a conceptual discussion of the approach with selected empirical insights derived from pilot implementation, including stakeholder engagement processes, structured evaluations, and thematic prioritization exercises. The findings suggest the perceived relevance of multi-stakeholder co-design, the use of flexible and modular learning formats, and the integration of technical and ethical dimensions in higher technical education. At the same time, they point to challenges related to coordination, scalability, and alignment across institutional actors. Rather than proposing a definitive model, the Spoke 4 experience is discussed as a context-specific case that may offer insights contributing to ongoing debates on the design and implementation of higher technical education in complex, multi-institutional settings. Full article

Advancing environmental monitoring through coordinated autonomous systems is central to sustainable smart region governance and data-driven territorial management. The article presents an engineering-oriented architecture and deployment methodology for an integrated wildfire monitoring and response system that combines unmanned aerial vehicles (UAVs), unmanned ground vehicles (UGVs), and stationary sensor networks (SNs). We formalise hub-and-spoke infrastructure placement as a mixed-integer optimisation problem that accounts for platform types, endurance, travel times and logistical constraints, and propose a practical pre-processing pipeline (confidence scoring, resampling, Kalman/median filtering, strategy fusion) for heterogeneous telemetry and imagery. The system couples multimodal neural network processing (image backbones, clustering and time-series models) with online resource-allocation and mission-planning mechanisms to prioritise UAV/UGV sorties and dynamically select launch sites. The article describes scenario-driven operational modes (early warning, alarm verification, autonomous local extinguishing, post-fire recovery, sensor-gap compensation, and inter-hub reinforcement), defines validation protocols (synthetic experiments, precision/recall/F1, and hardware-in-the-loop testing), and proposes KPIs to assess environmental, social, and economic impacts for smart regions. The contribution is a reproducible, deployment-focused blueprint that bridges conceptual UAV–UGV–SN research and practical implementation, highlighting trade-offs in reliability, communication redundancy, and sustainability, and outlining directions for simulation, field pilots and algorithmic refinement. Full article

Research on hub-and-spoke logistics networks can effectively advance the construction of the Northeast China Sea–Land Grand Corridor. In the context of regional synergistic development, this study investigates the optimization of the logistics network for the Northeast China Land–Sea Grand Corridor. Focusing on 43 prefecture-level cities across Liaoning, Jilin, Heilongjiang, and Inner Mongolia, a hub-and-spoke logistics network optimization model is developed. The model aims to minimize total network costs while satisfying specific network resilience thresholds. It integrates multi-modal transport and incorporates considerations such as economies of scale, node heterogeneity in resilience evaluation, and route redundancy. Based on this, the study employs the entropy weight method to establish a comprehensive evaluation system for regional logistics and economic development levels and applies an improved coupling coordination degree model to assess the synergistic relationship between these two systems. A modified gravity model, with the coupling coordination degree as a moderating coefficient, is constructed to quantify the strength of logistics–economic linkages between cities. Furthermore, social network analysis and a logistics affiliation model are used to identify key hub cities. The results demonstrate that the optimized network significantly enhances transport efficiency, achieves substantial economies of scale and strikes a balance between cost efficiency and system resilience. This research provides a quantitative foundation and practical reference for node layout planning and multi-modal transport organization along the Northeast China Sea–Land Grand Corridor, and its methodological framework can inform logistics network planning in similar regions. Full article

Background: Geographic and demographic disparities strongly influence access to community-based healthcare, especially in rural and mountainous areas. In Italy, Ministerial Decree 77/2022 promotes a territorial reorganization based on networked care models, but practical tools for translating policy standards into operational catchment areas remain limited. Methods: We developed a transparent, data-driven allocation framework combining travel-time accessibility and population-based capacity constraints. A case study was conducted in the Province of L’Aquila, within Local Health Authority ASL 1 Avezzano–Sulmona–L’Aquila, a low-density mountainous area including 65 municipalities. Using official ISTAT data, including the 2021 national origin–destination road travel-time matrix, municipalities were allocated to 3 hub nodes and 8 spoke nodes. Population caps of 50,000 residents per hub and 40,000 per spoke were applied. Scenario analyses were performed under 20, 30, and 40 min travel-time thresholds. Results: Under the 30 min scenario, all municipalities were allocated, but the L’Aquila hub exceeded the capacity cap. A cap-compliant 30 min allocation eliminated this violation at the cost of longer upper-tail travel times. Under the 20 min scenario, only 54 municipalities were allocated, leaving 11 mountainous municipalities outside the threshold. Under the 40 min scenario, all municipalities were allocated without capacity violations. Conclusions: The proposed framework provides a reproducible approach for territorial healthcare planning and makes explicit the trade-off between accessibility and capacity compliance in hub-and-spoke network design, particularly in geographically complex mountain settings. Full article

The South African Government prioritises Small, Micro-, and Medium Enterprises (SMMEs) as catalysts for employment creation, in alignment with Sustainable Development Goal 8 (SDG 8), Decent Work and Economic Growth, which advocates for sustained, inclusive, and sustainable economic growth. However, the extent to which agro-processing SMMEs translate this policy ambition into measurable socio-economic gains remains contested due to persistent structural, financial, and operational constraints. This study develops a comprehensive, data-driven business support framework tailored to agro-processing SMMEs in the Free State province of South Africa. Employing a mixed-methods approach, survey data from 88 agro-processing SMMEs were analysed across 18 business performance dimensions. Average agreement scores and performance gaps were utilised to diagnose strengths and vulnerabilities within the sector. While overall performance was relatively strong (average agreement score: 86.7%), a critical weakness emerged in operational cost management (76.1%), revealing a 14.2% gap relative to the highest-performing dimension, equipment selection (90.3%). Based on these empirical insights, the study proposes a three-tiered business support architecture: (i) maintaining and leveraging high-performing dimensions (≥85% agreement), (ii) targeted enhancement for moderate-performing areas (80–84.9%), and (iii) crisis intervention for critical weaknesses (<80%). The framework integrates cross-cutting support services, including financing, regulatory guidance, and technology access, delivered through a phased implementation strategy comprising crisis intervention, system establishment, and optimisation and scaling. A multi-channel delivery mechanism, combining a hub-and-spoke model, mobile support units, and a digital platform, ensures provincial accessibility. By translating performance diagnostics into differentiated policy action, the framework promotes efficient resource allocation, supports both high-potential and vulnerable agro-processing SMMEs, and embeds a robust monitoring and evaluation system to track key performance indicators. The study contributes to the SMME development literature by demonstrating how structured, tiered, and context-specific support models can strengthen resilience, competitiveness, and sustainable agro-industrial growth in developing-country settings. Full article

Background: Liquefied natural gas (LNG) distribution in archipelagic regions involves complex trade-offs between transportation, infrastructure investment, and contractual arrangements. While most optimisation studies focus on seller-managed Delivery Ex-Ship (DES) schemes, limited research addresses buyer-managed Free on Board (FOB) frameworks that extend decision responsibility upstream. Methods: This study develops a two-stage integrated optimisation model for long-term LNG supply chain planning under an FOB contractual scheme with time-dependent deterministic demand. Stage 1 determines hub selection, port clustering, vessel sizing, fleet configuration, and endogenous infrastructure capacities using a genetic algorithm, while Stage 2 optimises cluster-level routing sequences. Robustness is assessed through multiple independent runs and sensitivity analysis. Results: A case study of the Nusa Tenggara region identifies Sumbawa as the optimal hub. The upstream segment consistently selects a 65,000 m³ vessel under terminal service capacity constraints, while downstream clusters are served by 3500 m³ and 10,000 m³ vessels depending on distance and demand aggregation. Infrastructure requirements are derived from peak-demand conditions, and the resulting levelised logistic cost is 4.66 USD/MMBtu. Conclusions: The findings demonstrate that FOB arrangements fundamentally reshape network configuration, fleet segmentation, and infrastructure sizing, providing a robust strategic planning framework for buyer-managed LNG supply chains in archipelagic contexts. Full article

Truck platooning enabled by V2X and cooperative driving can reduce aerodynamic drag and consequently decrease fuel consumption and CO₂ emissions. Meanwhile, hub-and-spoke courier networks require strategic decisions on hub locations, allocation, and line-haul routing. This paper introduces an integrated Hub Location-Platoon Routing Problem (HLPRP) that jointly optimizes (i) hub selection and single allocation of spokes; (ii) the departure hubs where platoons are formed; (iii) line-haul (inter-hub) service design and route selection; and (iv) demand routing, while internalizing monetized carbon benefits from platooning. A variable neighborhood search-based simulated annealing solution framework is developed to eliminate duplicated hub pair representations induced by network symmetry. Computational experiments on benchmark and large-scale North China instances demonstrate that the proposed approach consistently produces high-quality solutions within practical runtimes. The results indicate that the optimal network structure is primarily driven by transportation cost trade-offs and is further shaped by platoon-enabling investment and the associated carbon benefit, which concentrates on a subset of high-volume inter-hub corridors. Overall, the proposed framework provides a decision support approach for designing low-carbon courier line-haul networks. Full article

Background: Rare cancers combine low incidence with high biological heterogeneity and multi-institutional care trajectories. These features make single-center learning structurally incomplete and render pathway fragmentation a dominant driver of preventable harm, variability, and waste. In this context, care quality is best understood as a property of pathway integrity across routing, diagnostics (imaging/biopsy planning), multidisciplinary intent-setting, definitive treatment, and surveillance—rather than as a department-level attribute. Objective: To define a pragmatic, transferable operating blueprint for a rare-cancer Learning Health System (LHS) that turns routine care into continuous, auditable learning under explicit governance, while maintaining claims discipline and protecting measurement validity. Approach: We synthesize an implementation-oriented operating model using the Swiss Sarcoma Network (SSN) as an exemplar. The blueprint couples clinical governance (Integrated Practice Unit logic, hub-and-spoke routing, auditable multidisciplinary team decision systems) with an interoperable real-world-time data backbone designed for benchmarking, pathway mapping, and feedback. The operating logic is expressed as a closed-loop control cycle: capture → harmonize → benchmark → learn → implement → re-measure, with explicit owners, minimum requirements, and failure modes. Results/Blueprint: (i) The model specifies a minimal set of data primitives—time-stamped and traceable decision points covering baseline and tumor characteristics, pathway timing, treatment exposure, outcomes and complications, and feasible longitudinal PROMs and PREMs; (ii) a VBHC-ready, multi-domain measurement backbone spanning outcomes, harms, timeliness, function, process fidelity, and resource stewardship; and (iii) two non-negotiable validity guardrails: explicit applicability (“N/A”) rules and mandatory case-mix/complexity stratification. Implementation is treated as a governed step with defined workflow levers, fidelity criteria, balancing measures, and escalation thresholds to prevent “dashboard medicine” and surrogate-driven optimization. Conclusions: This perspective contributes an operating model—not a platform or single intervention—that enables credible improvement science and establishes prerequisites for downstream causal learning and minimum viable digital twins. By distinguishing enabling infrastructure from the governed clinical system as the primary intervention, the blueprint supports scalable, learnable excellence in rare-cancer care while protecting against gaming, inequity, and inference drift. Distinct from generic LHS or VBHC frameworks, this blueprint specifies validity gates required for rare-cancer benchmarking—explicit applicability (“N/A”) rules, denominator integrity/capture completeness disclosure, anti-gaming safeguards, and escalation governance. These elements are critical in rare cancers because small denominators, high heterogeneity, and multi-institutional pathways otherwise make benchmarking prone to artifacts and unsafe inferences. Full article