Simple decision rules to predict local surges in COVID-19 hospitalizations during the winter and spring of 2022

Low rates of vaccination, emergence of novel variants of SARS-CoV-2, and increasing transmission relating to seasonal changes leave many U.S. communities at risk for surges of COVID-19 during the winter and spring of 2022 that might strain hospital capacity, as in previous waves. The trajectories of COVID-19 hospitalizations during this period are expected to differ across communities depending on their age distributions, vaccination coverage, cumulative incidence, and adoption of risk mitigating behaviors. Yet, existing predictive models of COVID-19 hospitalizations are almost exclusively focused on national- and state-level predictions. This leaves local policymakers in urgent need of tools that can provide early warnings about the possibility that COVID-19 hospitalizations may rise to levels that exceed local capacity. In this work, we develop simple decision rules to predict whether COVID-19 hospitalization will exceed the local hospitalization capacity within a 4- or 8-week period if no additional mitigating strategies are implemented during this time. These decision rules use real-time data related to hospital occupancy and new hospitalizations associated with COVID-19, and when available, genomic surveillance of SARS-CoV-2. We showed that these decision rules present reasonable accuracy, sensitivity, and specificity (all ≥80%) in predicting local surges in hospitalizations under numerous simulated scenarios, which capture substantial uncertainties over the future trajectories of COVID-19 during the winter and spring of 2022. Our proposed decision rules are simple, visual, and straightforward to use in practice by local decision makers without the need to perform numerical computations.

‘Community’: A Q study exploring perspectives in community governance settings in Taranaki, New Zealand

<p>Attend any public meeting in Taranaki and, more often than not, one will hear the word ‘community’ used to bolster a policy proposal, or oppose it. But when that happens, what exactly is meant by ‘community’? Taking advantage of her position as an embedded participant, the author of this thesis set out to understand what ‘community’ means to those who occupy roles of influence in decision-making settings in Taranaki, Aotearoa- New Zealand. To the study’s informants and participants, a deceptively simple question was put: ‘what do you understand by ‘community’?’ The set of techniques used to elicit responses to this question was William Stephenson’s Q Methodology. Data collection began with 29 informant interviews from which 45 statements representative of what is understood by ‘community’ were extracted. Those statements were rank-ordered by 35 participants generating 47 Q sorts (the mechanism by which each viewpoint was captured). Using PQMethod 2.35, a three-factor solution generated through principal components analysis and subjected to a varimax rotation was selected for further analysis. The interpretation of the results substantiated three somewhat highly correlated, yet nuanced perspectives where ‘community’ is: ▪ ‘Everyone and we’re all in this together’ (Factor 1), ▪ ‘Well... it depends’ given the multiplicity of interests (Factor 2), and ▪ ‘It’s everything’ (Factor 3). The primacy of relationships and expectations to contribute to where one lives provide the basis for consensus. The nuance is in the scope and reach in terms of who counts, what matters and why it is important at a given point in time. The subsequent discussion noted there is still no agreement on a definition of ‘community’ and its malleability in meaning makes ‘community’ useful for furthering political interests. Its use in the community governance settings of this study reflects the pragmatism of everyday life. ‘Community’ is affirmed as a concept that frames policy discourse. This study also identifies ‘community’ as a practice and as a way of governing that frames policy responses where the basis for ‘community’ is as: ▪ A preference for face-to-face interaction and usually over a cup of tea (Factor 1), ▪ A strategy of enabling that is realistic and pragmatic (Factor 2), and ▪ An account of the integrated connections to places, with people and to events across time and space (Factor 3). The study opens up new ground as the collection, analysis and interpretation of first- person, vested responses from those ‘doing’ ‘community’ in community governance settings is missing from the scholarly and practitioner literature. This study forms a bridge in an identified gap between those who theorise in the political philosophy of ‘community’ and those who advocate in the political practice of ‘community’. Furthermore, the three perspectives identified and discussed in this study also lead to a proposition that the phrase ‘governing communities’ would be a more apt and authentic alternative to ‘community governance’. Such a development is positioned as the next step in the evolution of the theory surrounding local decision-making and local government in New Zealand and as a normative model for political practice.</p>

A Proposal of a Combined Convergence Regulatory Strategy Applied to Post-approval Changes by Latin American Countries, Reducing Workload and Allowing Continuous Improvement to Guarantee the Quality, Safety, and Efficacy of Medicines

In recent years, post-approval changes (PACs) for medicinal products have increased faster than the national regulatory agencies can attend to without causing any negative impact. This study presents a proposal for regulatory management based on our analysis of the data available from the national regulatory agencies of Latin America on the total post-approval changes evaluated, and the time spent in the process. A retrospective search on the official websites of competent national regulatory authorities (NRAs) of 14 Latin American countries (México, Guatemala, Nicaragua, Honduras, El Salvador, Panamá, Costa Rica, Venezuela, Colombia, Ecuador, Peru, Argentina, Chile and Brazil) was conducted to collect data on post-approval changes in the last 4–6 years, up to January 2021. The NRAs considered were Brazil, México, Colombia, and Costa Rica. Our analysis was focused on the post-approval changes that required approval before implementation, those that were submitted, and those that were submitted and approved for small molecules, biologics, and biotechnological products. The results indicated differences in the regulatory processes and procedures applied by the different agencies. We also found that the implementation of the PACs was directly impacted by limited resources, which puts the medication supply for chronic treatments at risk resulting in serious consequences for patients. For local decision-making, Latin American NRAs should implement regulatory pathways already made by regulatory agencies included in the World Health Organization Listed Authorities on PAC approval to optimize their resources and to ensure the continuity of medicine supply for their patients.

‘Community’: A Q study exploring perspectives in community governance settings in Taranaki, New Zealand

<p>Attend any public meeting in Taranaki and, more often than not, one will hear the word ‘community’ used to bolster a policy proposal, or oppose it. But when that happens, what exactly is meant by ‘community’? Taking advantage of her position as an embedded participant, the author of this thesis set out to understand what ‘community’ means to those who occupy roles of influence in decision-making settings in Taranaki, Aotearoa- New Zealand. To the study’s informants and participants, a deceptively simple question was put: ‘what do you understand by ‘community’?’ The set of techniques used to elicit responses to this question was William Stephenson’s Q Methodology. Data collection began with 29 informant interviews from which 45 statements representative of what is understood by ‘community’ were extracted. Those statements were rank-ordered by 35 participants generating 47 Q sorts (the mechanism by which each viewpoint was captured). Using PQMethod 2.35, a three-factor solution generated through principal components analysis and subjected to a varimax rotation was selected for further analysis. The interpretation of the results substantiated three somewhat highly correlated, yet nuanced perspectives where ‘community’ is: ▪ ‘Everyone and we’re all in this together’ (Factor 1), ▪ ‘Well... it depends’ given the multiplicity of interests (Factor 2), and ▪ ‘It’s everything’ (Factor 3). The primacy of relationships and expectations to contribute to where one lives provide the basis for consensus. The nuance is in the scope and reach in terms of who counts, what matters and why it is important at a given point in time. The subsequent discussion noted there is still no agreement on a definition of ‘community’ and its malleability in meaning makes ‘community’ useful for furthering political interests. Its use in the community governance settings of this study reflects the pragmatism of everyday life. ‘Community’ is affirmed as a concept that frames policy discourse. This study also identifies ‘community’ as a practice and as a way of governing that frames policy responses where the basis for ‘community’ is as: ▪ A preference for face-to-face interaction and usually over a cup of tea (Factor 1), ▪ A strategy of enabling that is realistic and pragmatic (Factor 2), and ▪ An account of the integrated connections to places, with people and to events across time and space (Factor 3). The study opens up new ground as the collection, analysis and interpretation of first- person, vested responses from those ‘doing’ ‘community’ in community governance settings is missing from the scholarly and practitioner literature. This study forms a bridge in an identified gap between those who theorise in the political philosophy of ‘community’ and those who advocate in the political practice of ‘community’. Furthermore, the three perspectives identified and discussed in this study also lead to a proposition that the phrase ‘governing communities’ would be a more apt and authentic alternative to ‘community governance’. Such a development is positioned as the next step in the evolution of the theory surrounding local decision-making and local government in New Zealand and as a normative model for political practice.</p>

Evaluating the Success of Decentralisation in Facilitating the Inclusion of Rwanda’s Marginalised

Decentralisation plays a key role in Rwanda’s efforts to overcome the violence and instability of the past by fostering national unity and by bringing governance closer to the people. This paper examines the impact of decentralisation on the feelings of inclusion of Rwanda’s most marginalised group, the Batwa. Drawing on a 4-year empirical project, our findings suggest that, despite impressive improvements in the living standards of the poorest and efforts to encourage participation in local decision making, many Twa do not feel included. This suggests that the government has not yet succeeded in creating downward accountability. We attribute this to two factors: continuing economic inequality and poor communication.

Borehole siting and construction in rural Malawi: A sociotechnical process?

Choosing the site for a new water well in rural southern Malawi is essentially a political process with competing priorities and stakeholders. For a new well (or borehole) to be sustainably used and maintained, the relevant stakeholders must be fully engaged in the siting process and given meaningful responsibility for the final siting decision. However, without sound technical information, a siting decision based solely on stakeholder priorities such as proximity to the headman’s compound or accessibility to the center of population, may not result in a satisfactory borehole. Instead, in addition to stakeholder interests, we used a process that includes electrical resistivity tomography (ERT) as a tool to guide and constrain the local decision-making process. Within the region of the crystalline-basement aquifer, ERT profiles indicate variations in weathering thickness, hence aquifer storage. In a lacustrine setting, the ERT profile delineated a zone of moderately large resistivity associated with a deposit of fresh-water saturated sand. This ERT-derived technical information becomes one element in a comprehensive sociotechnical approach to the location of sustainable water resources. We used this sociotechnical approach to complete boreholes for all four villages in our project and have a high confidence that the villagers will be motivated to use and maintain these resources.

Automatic energy demand and system simulation at district level

The importance of climate protection and sustainability is steadily increasing all over the world. However, there is a large potential for reducing emissions in the heating demand reduction and renewable heat supply of buildings that needs to be addressed. Therefore, a method was developed within the scope of this work that allows local decision-makers such as energy supply companies, project developers and the public sector to calculate, evaluate and compare different scenarios to make buildings and city districts more sustainable based on few and widely available input data. It includes both the determination of the heat demand and measures for its reduction as well as the selection and simulation of centralised and decentralised supply systems. A combination of different methods from the fields of geoinformatics, heuristic decision-making and object-oriented modelling is used. The latter forms a focal point in the work with the development of a data model for energy system components to enable automatic simulation. The applicability as well as the transferability of the method is shown in several case studies. Based on the simulations results, which can be related to CO2 emissions as well as costs, recommendations for the implementation of measures can be given and implemented.The paper is a summary of the dissertation with the title “Automatische Simulation von Wärmebedarf und -versorgung auf Quartiersebene” by the first author at Karlsruhe Institute for Technology.

Geographic delay characterization of railway systems

Railway systems provide pivotal support to modern societies, making their efficiency and robustness important to ensure. However, these systems are susceptible to disruptions and delays, leading to accumulating economic damage. The large spatial scale of delay spreading typically make it difficult to distinguish which regions will ultimately affected from an initial disruption, creating uncertainty for risk assessment. In this paper, we identify geographical structures that reflect how delay spreads through railway networks. We do so by proposing a graph-based, hybrid schedule and empirical-based model for delay propagation and apply spectral clustering. We apply the model to four European railway systems: the Netherlands, Germany, Switzerland and Italy. We characterize these geographical delay structures in the railway systems of these countries and interpret these regions in terms of delay severity and how dynamically disconnected they are from the rest. The method also allows us to point out important differences between these countries’ railway systems. For practitioners, such geographical characterization of railways provides natural boundaries for local decision-making structures and risk assessment.

The NIMBY problem

Nimbyism is widely thought to arise from an inherent tradeoff between localism and efficiency in government: because many development projects have spatially concentrated costs and diffuse benefits, local residents naturally oppose proposed projects. But why cannot project developers (with large potential profits) compensate local residents? We argue that local regulatory institutions effectively require developers to expend resources that cannot be used to compensate residents. Not being compensated for local costs, residents therefore oppose development. Using a formal model, we show that when these transaction costs are high, voters consistently oppose development regardless of compensation from developers. But when transaction costs are low, developers provide compensation to residents and local support for development increases. We conclude that nimbyism arises from a bargaining problem between developers and local residents, not the relationship between local decision-making and the spatial structure of costs and benefits. We suggest policy reforms implied by this theory.