ABSTRACT
In this paper, the authors aim to design a decision support system (DSS) based on machine learning (ML) to assist institutions in implementing targeted countermeasures to combat and prevent emergencies such as the COVID -19 pandemic. The DSS relies on an ensemble of several ML models that combine heterogeneous data to predict risk levels at the micro and macro levels. Some preliminary analyses have already been conducted showing the correlation between nitrogen dioxide (NO2), mobility-related parameters, and COVID -19 data. However, given the complexity of the virus spread mechanism, which is related to many different factors, these preliminary studies confirmed the need to perform more in-depth analyses on the one hand and to use ML algorithms on the other hand to capture the hidden relationships between the huge amounts of data that need to be processed.
ABSTRACT
Co-production was vital to support public services provision during the first wave of COVID-19 pandemic, and one of the main challenges for service providers is to make co-production sustainable. There are few empirical studies on the sustainability of co-production from a long-term perspective. This study aims to contribute to this topic by exploring the micro-level foundations of co-production persistence through a longitudinal qualitative study in three public service organizations providing developmental services for youth with disabilities. Co-production is analyzed along the service provision process before, during and after the first COVID-19 lockdown, with specific attention on exploring how the conditions for sustainable co-production – mutual commitment, complementarities and institutional arrangements – occur and reinforce one another after an external shock. The findings suggest that the persistence of co-production is a result of a process in which experimentation with new complementarities can enhance previous co-production experiences and generate a context of mutual commitment that facilitates future co-production initiatives and their institutionalization.Points for practitioners: This article suggests how service providers can activate a potential virtuous cycle of co-production by increasing the opportunities that foster and sustain users and families' self-efficacy and reciprocal trust, and the contributions from wider social support networks of the most vulnerable people.
ABSTRACT
Introduction: Among all western countries, Italy was the first to be strongly affected by COVID-19 pandemic, and one of the first to apply the “hard” lockdown. In order to limit the in-hospital infections and to re-distribute the healthcare professionals, all healthcare elective activities were reduced or cancelled, and among them, cardiac percutaneous interventions in Pediatric and Adult Congenital Heart Disease (ACHD) patients were limited to urgent or emergent ones. The aim of this paper is to describe the impact of COVID-19 pandemic on Pediatric and ACHD cath lab activity during the so called “hard lockdown” in Italy. Methods: On behalf of the interventional working group of the Italian Society of Pediatric Cardiology, 11 out of 12 Italian Institutions with a dedicated Invasive Cardiology Unit in Congenital Heart Disease actively participated to the survey. The institutions were distributed over all the national territory, 5 in the northern regions, 3 in the central and 3 in the southern ones. The data from each center were collected using a self-completion questionnaire containing 41 multiple choices questions. Results: Most of the hospitals were affected by the COVID-19 pandemic, either actively, with direct management of infected patients, or passively due to decrease of routinely clinical activities. The majority of institutions stated a change in the cath lab usual workflow plan and accessibility. Most of the centers had to cease at least temporarily the Cath lab practice, and the overall reduction of procedures number ranged between 50% and 75%. This reduction was more pronounced for teenagers and ACHD compared to neonates and children. Interestingly, there was an evident discrepancy in the management of the lock-down, irrespective of the number of COVID-19 positive cases registered, with higher reduction in Southern Italy compared to the most affected Regions Conclusions: COVID-19 pandemic has significantly affected the activity of 11 different pediatric cardiology and ACHD units all over Italy. Cath lab services were deeply impacted due to decline in outpatient clinic consultations and referrals from local hospitals. ACHD cath lab procedures suffered the biggest drop. However, overall activity reduction was not consistent with the severity of outbreak in the different Italian regions.