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A systematic literature review was conducted up to 15th February 2022 to summarize long COVID evidence and to assess prevalence and clinical presentation in children and adolescents. Articles reporting long COVID prevalence and symptoms based on original data in the paediatric population were included. Case series quality was assessed through the JBI Critical Appraisal Checklist. For observational studies, adherence to STROBE checklist was evaluated. Twenty-two articles were included: 19 observational studies (12 cohort/7 cross-sectional) and 3 case series. Nine studies provided a control group. We found a high variability in terms of prevalence (1.6–70%). The most frequently reported symptoms were fatigue (2–87%), headache (3.5–80%), arthro-myalgias (5.4–66%), chest tightness or pain (1.4–51%), and dyspnoea (2–57.1%). Five studies reported limitations in daily function due to long COVID. Alterations at brain imaging were described in one study, transient electrocardiographic abnormalities were described in a minority of children, while most authors did not evidence long-term pulmonary sequelae. Older age, female sex, and previous long-term pathological conditions were more frequently associated with persistent symptoms.Conclusion: Long COVID evidence in children is limited, heterogeneous, and based on low-quality studies. The lockdown consequences are difficult to distinguish from long COVID symptoms. High-quality studies are required: WHO definition of long COVID should be used, controlled clinical studies should be encouraged, and the impact of new variants on long COVID prevalence should be investigated to ensure an objective analysis of long COVID characteristics in children and a proper allocation of healthcare system resources. What is Known:• Children rarely develop a severe respiratory disease in the acute phase of COVID-19.• A limited number of patients develop a multisystem inflammatory condition that can lead to multiorgan failure and shock. What is New:• Persistent symptoms after SARS-CoV-2 infection are reported in children and limitations in daily function due to long COVID symptoms affect school attendance.• Functional complaints of post-acute COVID are difficult to be distinguished from those due to social restrictions.

Purpose Firms can choose from an array of approaches for reducing the detrimental financial effects caused by unfavorable fluctuations in commodity prices. The purpose of this paper is to provide guidance for effectively estimating the financial effects of mitigating commodity price risk volatility (CPV) in supply chain management decisions. Design/methodology/approach This paper adopts two prominent and complementary methodologies, namely, total cost of ownership (TCO and real options valuation (ROV), to illustrate how commodity price risk mitigation strategies can be analyzed with respect to their effect on costs and performance. The paper provides insights through a case study to demonstrate the application of these methods together and establish the benefits and challenges associated with their implementation. Findings The paper illustrates advantages and disadvantages of TCO and ROV and how these approaches can be adopted together to contribute to effective purchasing decisions. Supply chain flexibility is a key capability but requires investments. Holistically measuring the financial effects of flexibility investments is imperative for gaining executive management support in mitigating commodity price volatility. Research limitations/implications This study can provide supply chain professionals with useful guidance for measuring the costs and benefits related to developing strategies for mitigating commodity price volatility. TCO provides a focus on the costs associated with the commodity purchasing process, and ROV enables the aggregation of all the costs and benefits associated with the use of the strategy and synthesizes them into the net value estimate. Originality/value The paper provides a comparison of different but complementary approaches, specifically TCO and ROV, for analyzing the effectiveness of CPV risk mitigation decisions. In addition, these two methods allow supply chain professionals to evaluate and control the financial effects of CPV risk, particularly the impact of mitigation on firm’s cash flows.

PurposeThis paper provides a comprehensive risk management framework for buyer-supplier relationships where the buyer has the status of a preferred customer with the supplier.Design/methodology/approachEmpirical evidence is offered with a case study on a large multinational organization in the Fast Moving Consumer Goods (FMCG) industry, with some real-life perspectives on the main risks, mitigation strategies, and issues faced when applying the risk management framework.FindingsThe results show that several risks may affect buyer-supplier relationships: not only traditional supply risks but also risks linked to specific initiatives and/or relationships, as well as risks specific to buyer-supplier relationships with a preferred customer status. Customer attractiveness and supplier satisfaction are found as core drivers for the mitigation strategies, which are built to protect the relationship with the supplier, rather than the buying firm alone, knowing that being a preferred customer with preferential resources allocation may increase a firm’s competitive advantage.Originality/valueThe research brings important contributions to the academic literature and interesting insights to strategic purchasing practitioners, by enhancing the existing knowledge on supply risk management in buyer-supplier relationships with a preferred customer status, as well as providing strategic purchasing practitioners a comprehensive view of the risks, which may affect the relationships with a preferred customer status, as well as possible ways to mitigate them.

In the last years, several studies dealt with smart working (SW) and its evolution during the pandemic. Most of them discussed benefits, drawbacks and drivers for successful implementation. Few studies investigated the impact on organization performance. It is not clear to what extent SW, especially in the emergence phase of the Covid-19 pandemic, has impacted the organizations, both at macro- and micro- structure level, and whether it may result into increased productivity and better innovation performance. The paper aims at investigating whether and under which conditions companies that adopted SW during the Covid-19 pandemic improved their performance. To achieve such a goal, based on a literature review, we develop a theoretical framework to describe the impact of SW on organization performance. Then, we design and administer a survey to test it. In particular, a questionnaire to empirically test the framework is developed, administered, and validated. In the paper we present a preliminary analysis of the results of the survey, which offers some interesting insights for theory and practice. In particular, by analysing the impact of the implementation of this new work modality on the organization performance, the paper contributes to the research on SW. Also, by developing a valid and reliable questionnaire, we provide a useful tool to help investigate whether and to what extent SW allows for productivity increase and better innovation performance. The tools also help retrieving information about the workers’ perceptions regarding the implementation of smart working in their own company.

Despite the prevailing view in the studies on public private partnerships (PPPs) on the potentiality of PPP models for stimulating innovation, existing studies fail to provide a full understating o...

Acute food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by the onset of delayed repetitive and projectile vomiting accompanied by other clinical manifestations such as pallor, hypotonia, lethargy, hypothermia and/or diarrhea (1). Acute FPIES can be classified as classic or atypical based on the absence or presence of sensitization to the trigger food (2).

In this paper, a cost decision-making model that compares the healthcare costs for diverse treatment strategies is built for BRCA-mutated women with breast cancer. Moreover, this model calculates the cancer treatment costs that could potentially be prevented, if the treatment strategy with the lowest total cost, along the entire lifetime of the patient, is chosen for high-risk women with breast cancer. The benchmark of the healthcare costs for diverse treatment strategies is selected in the presence of uncertainty, i.e., considering, throughout the lifetime of the patient, the risks and complications that may arise in each strategy and, therefore, the costs associated with the management of such events. Our results reveal a clear economic advantage of adopting the cost decision-making model for benchmarking the healthcare costs for various treatment strategies for BRCA-mutated women with breast cancer. The cost savings were higher when all breast cancer patients underwent counseling and genetic testing before deciding on any diagnostic-therapeutic path, with a probability of obtaining savings of over 75%.

This paper investigates the value of the flexibility created by the transportation options in mitigating supply chain transportation risks. We accomplish this aim by developing an innovative comput...

For advertisers, media management is the downstream part of advertising: After creative content is produced, advertisers manage different distribution channels to reach the right target audiences i...

Much work has been done on applying Business Intelligence (BI) in the healthcare sector. Most of these studies were focused only on Information Technology (e.g., to improve the Information and Communication Technology architectures and data management systems) or medical (e.g., to support prognoses and diagnoses) aspects, while the usage of BI for improving the management of healthcare processes is still overlooked. This research aims at filling this gap by investigating whether a decision support system (DSS) based on the exploitation of data through BI can outperform traditional experience-driven practices for managing processes in the healthcare domain. To accomplish this objective, we develop a DSS for reducing the overall costs of a specific healthcare process in the oncology field. The DSS was developed in two versions: the first is experience-driven (i.e., based only on scientific and historical literature and physicians’ experience data), while the second is data-driven (i.e., based on additional information coming from hospital data). The results of our study demonstrate that the usage of BI for managing the healthcare processes proved to improve traditional activities and processes mostly based only on the physicians’ experience, both from a business (i.e., costs reduction) and managerial (i.e., effectiveness improving) point of view.

Many firms have an array of available approaches for reducing financial losses caused by commodity price changes. This chapter provides guidance for more accurately measuring the potential financial effects of commodity price risk mitigation approach selection. Based upon two prominent methodologies, namely total cost of ownership (TCO) and real options approach (ROA), this chapter illustrates how commodity price risk mitigation strategies can be analyzed with respect to their effect on costs and performance. A practical example is provided to illustrate how TCO and ROA can provide useful insight into measuring the costs and benefits related to mitigating the effects of commodity price volatility.

The recent development of metropolitan cities, especially in Europe, requires an effective integrated management of city services, infrastructure, and communication networks at a metropolitan level. A preliminary step towards a proper organizational and management strategy of the metropolitan city is the analysis, benchmarking and optimization of the metropolitan areas through a set of indicators coherent with the overall sustainability objective of the metropolitan city. This paper proposes the use of the Analytic Hierarchy Process multi-criteria decision making technique for application in the smart metropolitan city context, with the aim of analysing the sustainable development of energy, water and environmental systems, through a set of objective performance indicators. Specifically, the 35 indicators defined for the Sustainable Development of Energy, Water and Environment Systems Index framework are used. The application of the approach to the real case study of four metropolitan areas (Bari, Bitonto, Mola, and Molfetta) in the city of Bari (Italy) shows its usefulness for the local government in benchmarking metropolitan areas and providing decision indications on how to formulate the sustainable development strategy of the metropolitan city. Based on the Analytic Hierarchy Process characteristics, the results highlight that although one specific area (Mola in the considered case) is globally ranked at the first place, it is only ranked first with respect to some dimensions. Such a result has strong implications for the metropolitan city's manager who has the possibility to identify and implement targeted actions, which may be designed ad hoc to improve specific dimensions based on the current state of the city, thus maximizing the efficiency and effectiveness of the actions undertaken for the sustainable development of energy, water and environmental systems of the whole metropolitan city.

Purpose The purpose of this paper is to deal with the maximum interest rate guarantees (MIRGs), and develop a methodology for setting the optimal value of the interest rate cap, namely the maximum interest rate above which the private investor will obtain reimbursement from the government, which balances the interests of the parties involved in the project. Design/methodology/approach The mechanism underlying the MIRG is modeled through real options. Monte Carlo simulation is employed as the option-pricing method. The resulting real option-based model is applied to the case of the “Camionale di Bari” toll road (Southern Italy). Findings The application provides some insights for the policy maker called to define the proper forms of guarantees. Furthermore, the results support the negotiation process, allowing the different actors to structure the guarantee in a way that satisfies all the parties and fairly allocates risks between them according to different operational and financial conditions. Originality/value The novelty of the contribution is triple. First, the authors advance the state of the art on government supports by focusing on the interest rate guarantee. Second, the authors enrich the existing studies on MIRG by proposing a quantitative model to set the guarantee in compliance with the public–private win-win principle. The developed real option-based model supports the decision maker in finding the optimal value of the interest rate cap, which is able to satisfy the interests of the parties involved in the project. Third, the authors consider not only the private sponsor and the government, as traditionally made by the models developed for other guarantees, but also the lender.

Purpose The prevailing view in the studies on Public Private Partnerships (PPPs) is that PPPs can improve the quality and efficiency of infrastructure services and facilitates innovation in infrastructure developments. Although researchers highlight the potentiality of PPP models for stimulating innovation, they do not prove whether and in which conditions the PPP model is capable of developing innovative solutions. This paper aims to provide answers to the following key research questions: Which are the PPP features that favor innovation? How properly structure a PPP to foster innovation? Design/methodology/approach With this aim, drawing upon the main streams of studies on innovation, the authors develop a conceptual framework that identifies the PPP features that can influence the innovativeness. Second, they define how these PPP features have to be structured to foster innovation. Finding The authors find that a wider involvement of the private sector will increase the level of innovation. The industry structure exerts opposite forces on innovation: the dominance of large-sized firms is positively related to innovative output, whereas the market concentration negatively affects innovation. Performance-based contracts should be used in the context of PPP instead of traditional contracts. Finally, the authors find that, to fully exploit the networking effects on innovation, cooperation and trusting among partners involved in PPPs should be enhanced. Originality/value The developed framework identifies the relations existing between each PPP feature and the level of innovation and allows to define how these PPP features have to be structured to foster innovation. The authors contribute to fill the gap in the academic literature on PPP and innovation by proving whether and in which conditions the PPP model is capable of developing innovative solutions. Furthermore, they provide meaningful guidelines to those called to structure the PPP arrangements.

Government guarantees are often granted to increase the viability of the Public–Private Partnership projects, although the use of these guarantees can cause problems if they are not properl...

Total laparoscopic right hemicolectomy is a procedure that involves an intracorporeal anastomosis. This approach may reduce tissue injury resulting in a significant lower surgical stress response (SSR) compared with the same procedure performed with an extracorporeal anastomosis. The purpose of this study was to compare the SSR level between 2 groups of patients undergoing laparoscopic right hemicolectomy with intracorporeal or extracorporeal anastomosis. From June 2015 to December 2016, 60 patients were enrolled and randomized. Interleukin-6, C-reactive protein, procalcitonin, white blood cell count, cortisol, prolactin, prealbumin, albumin, triglycerides, and transferrin were analyzed preoperatively and at 1, 3, and 5 days postoperatively. Interleukin-6 and C-reactive protein levels were significantly lower in the intracorporeal group on days 1, 3, and 5 postoperatively compared with the extracorporeal group. Gastrointestinal recovery was significantly earlier in the intracorporeal group. The intracorporeal anastomosis in laparoscopic right hemicolectomy reduces SSR, which may play a role in bowel recovery.

To stimulate private sector investments and promote energy efficiency, in recent years through Public Private Partnership arrangements, the public sector uses private companies, the Energy Service Company (ESCO), to perform one or more activities related to the provision of energy services, and the contractual arrangements defining the contracting parties' obligations and rights are traditionally based on Energy Performance Contracting (EPC). Although EPC is a valuable model for delivering public energy efficiency projects, the adoption is still far from its vast potential mainly because of two unresolved issues: the dilemma of equally sharing the benefits between the public and private parties so as assuring a win-win condition, and the lack of adequate public procedures that support the selection of the most appropriate EPC schema given certain circumstances and projects' characteristics. The existing literature have analyzed the advantages of EPC mechanism for delivering energy efficiency projects and explored the critical success factors of EPC. However, it does not provide any solution to address the issues that hamper the adoption of EPCs in public sector. To fill this gap, this paper proposes a model for assessing and benchmarking the net benefits of the different EPC structures, so as choosing the EPC schema that creates a ‘win–win’ solution for both the ESCO and the government, by balancing the private sector's profitability needs and the public sector's economic interests. The assessment of the benefits of the EPC schema for contractual parties and the benchmark among the contracts are based on an economic approach, which expresses the net benefit gained by each party through the three EPC contracts in monetary terms and benchmarks the three EPC schema through the Net Present Value (NPV) method. The win-win condition is ensured by the contract that minimizes the difference between the net profits (NPV) gained by the contractual parties. This will support the public authority in the decision-making process about the EPC structure to be adopted to develop an energy efficiency project as a PPP. To demonstrate the applicability of the proposed model, we apply it to an energy efficiency project launched by the Municipality of Noci (Southern Italy).

The purpose of this paper is to assess the value of postponement as strategy for mitigating supply chain disruptions. To accomplish this objective, we develop a real option computational model that...

The study investigates whether the adoption of a risk-based approach that allows public managers to take into account the context and external not-controllable factors during goal setting may contribute to overcome unintended managerial side effects of performance management (PM) practices that hamper their success within public organizations. An explorative research is carried out on court officials of Italian public administration. The results from this study show that the adoption of a risk-based approach could enhance goal setting within the PM process and provide interesting insights to policy-makers invested of the responsibility to improve the effectiveness of current PM procedures.

This paper presents a hierarchical decision-making strategy for the energy management of a smart city. The proposed decision process supports the city energy manager and local policy makers in taking energy retrofit decisions on different urban sectors by an integrated, structured, and transparent management. To this aim, in the proposed decision strategy, a bilevel programming model integrates several local decision-making units, each focusing on the energy retrofit optimization of a specific urban subsystem, and a central decision unit. We solve the hierarchical decision problem by a game theoretic distributed algorithm. We apply the developed decision model to the case study of the city of Bari (Italy), where a smart city program has recently been launched.

Objective: Older patients with cancer value functional outcomes as much as survival, but surgical studies lack functional recovery (FR) data. The value of a standardized frailty assessment has been confirmed, yet it's infrequently utilized due to time restrictions into everyday practice. The multicenter GOSAFE study was designed to (1) evaluate the trajectory of patients' quality of life (QoL) after cancer surgery (2) assess baseline frailty indicators in unselected patients (3) clarify the most relevant tools in predicting FR and clinical outcomes. This is a report of the study design and baseline patient evaluations. Materials & Methods: GOSAFE prospectively collected a baseline multidimensional evaluation before major elective surgery in patients (≥70 years) from 26 international units. Short−/mid−/long-term surgical outcomes were recorded with QoL and FR data. Results: 1003 patients were enrolled in a 26-month span. Complete baseline data were available for 977(97.4%). Median age was 78 years (range 70–94); 52.8% males. 968(99%) lived at home, 51.6% without caregiver. 54.4% had ≥ 3 medications, 5.9% none. Patients were dependent (ADL < 5) in 7.9% of the cases. Frailty was either detected by G8 ≤ 14(68.4%), fTRST ≥ 2(37.4%), TUG > 20 s (5.2%) or ASAIII-IV (48.8%). Major comorbidities (CACI > 6) were detected in 36%; 20.9% of patients had cognitive impairment according to Mini-Cog. Conclusion: The GOSAFE showed that frailty is frequent in older patients undergoing cancer surgery. QoL and FR, for the first time, are going to be primary outcomes of a real-life observational study. The crucial role of frailty assessment is going to be addressed in the ability to predict postoperative outcomes and to correlate with QoL and FR.

Risk in global supply chains has garnered significant attention in business practice and research. However, our understanding of currency rate exchange volatility, and the resulting foreign exchange (FX) risk firms are exposed to, is currently limited from a supply chain perspective. The purpose of this chapter is to present an illustrative case of how Vortice SpA, a medium-sized Italian producer of ventilation systems for residential and industrial applications, perceives and mitigates FX risk in their firm and extended supply chains.

This paper investigates the impact of the adoption of public support on the performance of public&ndash, private partnership (PPP) projects as perceived and measured by the different actors involved. In particular, the public support investigated by this study is put-or pay contracts, which are often used in PPP projects financed through project finance to optimize risk allocation. In order to quantify the benefit gained by each party with and without the put-or-pay contract, cash flows of the project have been modeled by using the concept of real option, defined as the right without the obligation to make an action if it is convenient to do so. This concept enabled us to model and quantify the inner flexibility mechanism of put-or-pay contracts. With a put-or-pay agreement signed between the municipality, a (private) owner, and operator of a disposal facility, the owner of the facility has the faculty, without any obligation, to require the payment of penalty, if the municipality fails to meet its obligations. This means that the owner of the facility holds a series of European put options that can be exercised if it is convenient for the holder. The developed model has been used for studying the effectiveness of put-or-pay contracts for financing the treatment plant of a special dispose through project finance, i.e., the plant for disposal of marine plant posidonia.

This paper develops a multi-criteria decision making tool to support the public decision maker in optimizing energy retrofit interventions on existing public street lighting systems. The related literature analysis clearly highlights that, to date, only a few number of studies deal with the definition of optimal decision strategies complying with multiple and conflicting objectives in the planning of street lighting refurbishment. To fill this gap, we propose a decision making tool that allows deciding, in an integrated way, the optimal energy retrofit plan in order to simultaneously reduce energy consumption, maintain comfort, protect the environment, and optimize the distribution of actions in subsystems, while ensuring an efficient use of public funds. The presented tool is applied to a real street lighting system of a wide urban area in Bari, Italy. The obtained results highlight that the approach effectively supports the city energy manager in the refurbishment of the street lighting systems.

During the last years, due to the strict regulations on waste landfilling, anaerobic digestion (AD) of the organic fraction of municipal solid waste (OFMSW) is increasingly considered a sustainable alternative for waste stabilization and energy recovery. AD can reduce the volume of OFMSW going to landfill and produce, at the same time, biogas and compost, all at a profit. The uncertainty about the collected quantity of organic fraction, however, may undermine the economic-financial sustainability of such plants. While the flexibility characterizing some AD technologies may prove very valuable in uncertain contexts since it allows adapting plant capacity to changing environments, the investment required for building flexible systems is generally higher than the investment for dedicated equipment. Hence, an adequate justification of investments in these flexible systems is needed. This paper presents the results of a study aimed at investigating how different technologies may perform from technical, economic and financial standpoints, in presence of an uncertain organic fraction quantity to be treated. Focusing on two AD treatment plant configurations characterized by a technological process with different degree of flexibility, a real options-based model is developed and then applied to the case of the urban waste management system of the Metropolitan Area of Bari (Italy). Results show the importance of pricing the flexibility of treatment plants, which becomes a critical factor in presence of an uncertain organic fraction. Hence, it has to be taken into consideration in the design phase of these plants.