Search Results (50,461)

Background: Missed nursing care related to infection prevention and control compromises patient safety and reflects clinical practice gaps and organizational constraints. The COVID-19 pandemic intensified awareness of infection-control practices; however, whether this translated into sustained reductions remains unclear. Aim: To compare missed infection-control nursing care between the pre-/early-pandemic period (2019–2020) and the post-pandemic period (2026) and identify persistent omissions with implications for healthcare policy and management. Methods: A descriptive study was conducted among 1570 nurses, including 774 participants in Group A (2019–2020) and 796 in Group B (2026). Data were collected online using the Missed Infection Control Nursing Care Questionnaire, tested for reliability and validity in Greek. Data were analyzed using SPSS 25.0, with statistical significance set at α = 0.05. Results: Item-level analysis showed lower mean omission scores in 34/37 infection-control nursing care practices, with 26 statistically significant reductions. The largest decreases were observed for glove use during antibiotic preparation/administration (1.493 to 1.070), hand hygiene before medication administration (1.340 to 0.962), multidrug-resistant organism (MDRO) admission screening (1.849 to 1.481), and intravenous access hub disinfection (1.978 to 1.668). In 2026, key residual omissions involved urinary catheter care (31.2%), hub disinfection (33.2%), oral hygiene (30.9%), and environmental hygiene before meals (29.1%). Conclusions: Missed infection-control nursing care declined in the post-pandemic period, but system-dependent omissions persisted, highlighting the need for staffing adequacy, balanced workload allocation, environmental support, and routine integration of infection-prevention practices. Full article

Biosafety Level 3 (BSL-3) laboratories are essential for handling high-risk pathogens and strengthening global health security. This study presents a patent landscape analysis of BSL-3-related technologies using the Derwent World Patents Index (DWPI) to identify technological trends, geographic distribution, patent classifications, and temporal evolution. Patent documents associated with laboratory infrastructure, ventilation systems, containment devices, and biosafety procedures were screened and analyzed. A total of 58 patent documents filed between 2009 and 2024 met the inclusion criteria. The results showed that China and the United States are the leading contributors to BSL-3 patent development, reflecting continued investments in biosafety and biosecurity infrastructure. The most frequent International Patent Classification (IPC) categories were C12M (microbiological devices), E04H (specialized construction infrastructure), and F24F (ventilation and air control systems), highlighting the multidisciplinary nature of innovations in laboratory containment and safety. The temporal trends revealed increases in patent activity following major public health emergencies, including SARS, Ebola, and particularly the COVID-19 pandemic. Furthermore, a significant increase in patent expirations is expected by 2029, creating opportunities for technology transfer, open innovation, and broader access to critical biosafety technologies. These findings emphasize the strategic importance of continued investment in BSL-3 technologies, especially in developing countries with growing biosafety demands. Full article

The study investigates whether cultivated land abandonment (CLA) reflects structural transformation or an intensifying crisis. CLA is defined as land that has remained uncultivated for a minimum of two consecutive years, with the exclusion of land that is subject to deliberate programs such as the “Grain-for-Green” initiative. Utilizing the China Land Cover Dataset and a moving-window approach, we conducted a comprehensive analysis of spatiotemporal patterns across 2847 Chinese counties from 1992 to 2022. The research employed OLS, Tobit, high-dimensional fixed effects and instrumental variable regressions. The findings of the present study indicate an annual average abandonment rate of 2.3995%, with 12.3649% of cropland abandoned at least once and 9.2028% reclaimed, suggesting a fragile equilibrium. The Huang-Huai-Hai region and Northeast China’s plains emerged as low-abandonment clusters. Cropland fragmentation was found to trigger abandonment, while a higher ecological land ratio significantly exacerbates CLA. Rural labor migration and urbanization drive cumulative abandonment, worsened by the COVID-19 pandemic. Effective governance requires context-specific interventions that address key constraints and integrate land reuse into sustainable rural development frameworks. The research methods and theoretical mechanisms presented offer a reference for balancing food security, rural revitalization, and ecological sustainability worldwide. Full article

Background/Objectives: Several risk factors have been identified as being involved in the progression of COVID-19 over time. Among these, age, comorbidities, and various laboratory parameters have been reported. Diabetes mellitus is one of the most common comorbidities found among patients diagnosed with SARS-CoV-2 infection. Glucose metabolism dysfunction can exacerbate pre-existing diabetes or even induce diabetes mellitus. The purpose of this study is to assess the accuracy of the CURB-65, PSI, MuLBSTA severity scores and laboratory parameters in patients with diabetes mellitus diagnosed with COVID-19. Methods: We conducted a retrospective study involving patients with diabetes mellitus diagnosed with SARS-CoV-2 infection, performed between June 2023 and December 2024. Results: We analyzed 73 patients with pre-existing diabetes who were diagnosed with COVID-19. There were 56.16% men, living mostly in urban areas, with a median hospital stay of 9.38 days. Elevated levels of LDH (367.50, p = 0.002), CRP (133.90, p = 0.012), ferritin (724.25, p = 0.012), ESR (55.00, p = 0.014), D-dimers (2455.04, p = 0.004), white blood cells (12.76, p = 0.007) and the neutrophil-to-lymphocyte ratio (15.86, p = 0.021) were recorded in the group of deceased patients. Significantly elevated values were recorded for all three severity scores, the AUC for CURB-65 was 0.69, PSI 0.81 and MuLBSTA 0.86. Conclusions: Severity scores showed robust prognostic value in predicting mortality among patients with diabetes mellitus and COVID-19, emphasizing their relevance as clinically applicable tools for risk stratification and outcome assessment. Full article

This study examines financial contagion between ten SEE stock markets and two benchmarks across three crisis episodes: the Global Financial Crisis (2007–2009), COVID-19 (2020–2021), and the Russia–Ukraine war (2022–2023). Using daily data from January 2007 to September 2025, we apply MODWT wavelet coherence across six investment horizons (2–128 days), complemented by a nonlinear Breitung and Candelon causality test on wavelet decomposition coefficients. Results are validated by DCC-GARCH(1,1) and formally dated by the Bai and Perron structural break test. Three principal contributions were obtained: (1) a systematic EU member versus accession SEE market comparison in contagion research, not previously undertaken in the literature; (2) a multi-crisis comparative analysis showing fast-transmission contagion for the GFC and COVID-19 versus slow-transmission for the Ukraine war; and (3) EU member markets show wavelet coherence 15–24 percentage points higher than accession markets, with predominantly unidirectional causality from benchmarks to SEE markets. Findings have direct implications for portfolio diversification, macroprudential policy calibration, and the EU accession financial integration strategy. Full article

The paper examines the multifractal and asymmetric behavior of oil, freight and exchange rate markets in the global trade system with the help of the Asymmetric Multifractal Detrended Fluctuation Analysis (AMF-DFA) technique. Based on daily data of West Texas Intermediate (WTI) crude oil, the Baltic Dry Index (BDI), and the exchange rate between the RMB/USD over the period of post-COVID-19 (2021–2024), the analysis focuses on whether efficiency in the markets varies across time scales and directional regimes. The findings show that there is strong evidence of multifractality in all markets, which implies that the scaling behavior is heterogeneous, and that it is long-range-dependent. Notable directional persistence is found between up and down movements with oil and exchange rate markets showing stronger directional persistence, especially at longer horizons with the freight markets displaying relatively weaker directional persistence. Additional results imply that temporal dependence and nonlinearity are the main drivers of multifractality in oil and exchange rate markets, and short-term fluctuations are prevalent factors in the dynamics of the freight market. These findings not only refute the classical Efficient Market Hypothesis but also provide empirical evidence in support of the Adaptive Market Hypothesis, and how efficiency is dynamic, dependent on scale, and directionally asymmetric. The study contributes by examining asymmetric multifractal efficiency across three trading markets during the post-COVID period, while recognizing that formal cross-market spillover analysis remains a direction for future research. Full article

Objectives: Coronavirus disease 2019 (COVID-19) poses a significant threat to kidney transplant recipients (KTRs) due to chronic immunosuppression. While Azvudine has demonstrated antiviral efficacy, its long-term impact on allograft function in KTRs remains unknown. This single-arm retrospective study provides a comprehensive evaluation of the outcomes. Methods: This single-center, retrospective study consecutively enrolled 20 KTRs diagnosed with COVID-19 during the Omicron surge (December 2022–January 2023), all treated with an Azvudine-centered regimen. Clinical data, treatment responses, and serial renal function parameters were analyzed. Long-term follow-up extended to a median of 39 months. Results: The median time to COVID-19 nucleic acid negativity was 13.22 days. Renal function improved significantly during treatment: estimated glomerular filtration rate increased by a mean of 27.29 mL/min/1.73 m², and serum creatinine decreased by 57.72 µmol/L (both p < 0.01). Common complications included electrolyte imbalances and co-infections (50% of patients). Crucially, at a median follow-up of 39 months, 75% (15/20) of patients maintained normal allograft function. No Azvudine-related adverse events or drug interactions with immunosuppressants were observed. Conclusions: While acknowledging the inherent limitations of a non-comparative design, this study provides preliminary evidence suggesting that an Azvudine-centered regimen may be associated with promising efficacy, a favorable safety profile without interference with immunosuppressive therapy, and—most importantly—durable renal allograft survival in KTRs with COVID-19. Our data suggest that this regimen could contribute to mitigating the long-term risk of allograft dysfunction, potentially bringing outcomes closer to the expected baseline for stable recipients. Coupled with its low risk of drug–drug interactions, potential immunomodulatory benefits, and superior cost-effectiveness, Azvudine could be considered a valuable therapeutic option for this high-risk population in the post-pandemic era, although these findings warrant cautious interpretation. Controlled trials are ultimately needed to confirm these observations. Full article

As Artificial Intelligence (AI) evolves from passive tools into proactive actors within socio-technical systems, traditional social network theories face fundamental limitations in explaining AI’s structural power. Drawing on the Network Capabilities framework, this study investigates the mechanism of AI power generation within homogeneous communities from a structural hole perspective. This study analyzes a COVID-19 vaccine interaction network (N = 9314) on X via social network analysis, Propensity Score Matching (PSM), counterfactual simulations, and weighted Independent Cascade Model (ICM) dynamics. The results reveal that bot-like agents do not rely on traditional brokerage to acquire power; instead, they execute a Tight Integration strategy by filling micro-structural holes. After isolating the confounding effects of connection scale via rigorous Propensity Score Matching, it creates an anomalous high-density, high-constraint configuration, with these algorithmic agents exhibiting significantly higher network constraint (0.514) than comparable human users (0.453). Counterfactual removal experiments demonstrate a profound structural dependence of the social system on AI: their removal triggers a systemic cascade collapse, decreasing the largest connected component (LCC) size by a factor of 82.9 and topologically isolating 79.7% of human users. Furthermore, transitioning from static structural analysis to dynamic simulations, ICM simulations confirm AI’s topological redundancy translates into substantial information diffusion dominance (Cohen’s d = 1.081). Revealing AI’s power generation mechanism provides essential governance insights and strategic approaches for mitigating AI-driven information cocoons and group polarization. Full article

Background: Influenza viruses can cause mild to severe illnesses. The burden of disease varies widely depending on multiple factors, including the type and subtype of circulating viruses, timing of the season, flu vaccine efficacy and vaccination rates. Influenza viruses are also highly prone to genetic change and rapid spread due to modern human movement patterns, making influenza surveillance vital for public health awareness, guidance, policy, disease mitigation, and annual recommendations on vaccine composition. Methods: A network of three National Influenza Reference Centers (NIRCs) was established in the United States more than 10 years ago to support the Centers for Disease Control and Prevention’s (CDC) Influenza Division with its national influenza surveillance efforts. Located in California, New York, and Wisconsin, they are funded by CDC via a collaborative agreement with the Association of Public Health Laboratories (APHL). The role of the NIRCs is critical to national and global influenza surveillance, providing rapid information on circulating influenza strains from three arms of laboratory testing: (1) the virus isolation project (VIP), (2) next-generation sequencing (NGS), and (3) anti-viral drug resistance testing. Results: Here, we review the data generated in the VIP lab of the New York State (NYS) NIRC before, during, and after the COVID-19 pandemic and discuss its utility in an understanding of disease dynamics and viral evolution, as well as public health policy and decision making during this historic period in health care. Conclusion: Continued preparedness and surveillance are critical to mitigating the impact of evolving influenza viruses. Full article

Background/Objectives: Child social vulnerability is a multidimensional phenomenon influenced by poverty, material deprivation, inequality, and institutional protection. This study analysed child and adolescent social vulnerability in Europe between 2017 and 2023 and developed a Child Social Vulnerability Index (CSVI). Methods: A longitudinal ecological study was conducted using Eurostat country-year data from European countries. Indicators included severe child poverty, severe material deprivation, income inequality (Gini index), preventive healthcare expenditure, and social protection expenditure. Descriptive, longitudinal, principal component, and cluster analyses were performed. Results: The findings revealed substantial differences in child social vulnerability across European countries. Poverty, material deprivation, and inequality were strongly associated, supporting the multidimensional nature of vulnerability. Principal Component Analysis supported the internal structure of the child Social Vulnerability Index (CSVI), identifying two components that explained 76.35% of the variance. The CSVI showed a very high correlation with the first principal component (r = 0.97, p < 0.001) confirming its structural consistency. Longitudinal analyses revealed a significant decline in child social vulnerability between 2017 and 2023 with an additional reduction during the COVID-19/post-COVID period. Cluster analysis identified three distinct European vulnerability profiles based on the CSVI and institutional protection dimension. Conclusions: Child social vulnerability in Europe is shaped by the interaction of socioeconomic inequalities and institutional protection mechanisms. The CSVI provides a useful tool for monitoring vulnerability and informing policies to reduce inequalities and promote child and adolescent well-being. Full article

Background: Long-term symptoms after SARS-CoV-2 infection such as fatigue, shortness of breath and cognitive impairment represent a major burden on society. Risk factors include female sex, smoking, comorbidities and socioeconomic deprivation. Physical activity (PA) has been suggested as a potential protective factor, although all population groups, including athletes, were affected. Therefore, this study aimed to investigate the influence of PA duration and intensity on the odds of the presence of long-term symptoms. Methods: This cross-sectional study included 5413 individuals following acute COVID-19 within the CoCo-Fakt online monitoring study. The type, duration and intensity of exercise in the four weeks before quarantine were recorded, and the odds of the presence of long-term symptoms beyond 12 weeks after infection were determined, adjusted for demographics, health status and acute COVID-19 outcomes. Results: Among participants, 561 (10.4%) reported long-term symptoms. Those with long-term symptoms reported a longer duration (p = 0.019, d = −0.61) of exercise in the four weeks before quarantine compared to those without long-term symptoms. Adjusted for demographics, health status and acute COVID-19 outcomes, higher exercise intensity (MET/day) was associated with 16.7% increased odds of long-term symptoms (Nagelkerke R² = 18.0%). After the Bonferroni–Holm correction, this association did not remain significant. Conclusions: Current data suggests that PA has a protective effect on post-COVID-19 condition when performed at a moderate level. In our study, however, neither PA intensity nor duration emerged as a predictor of long-term symptoms. Future studies must clarify which intensities and types of exercise can help to maintain overall physical and mental health and to prevent or improve the long-term outcomes following SARS-CoV-2 infection, considering individual circumstances. Full article

Agritourism is increasingly intersecting with digital technologies to foster rural resilience, economic growth, and sustainable development. This study conducts a comprehensive systematic bibliometric review to map the intellectual structure, thematic evolution, and collaborative networks characterizing the digitalization of agritourism from 2010 to 2025. Guided by the PRISMA framework, data from the Scopus database were analyzed using scientific mapping techniques, including keyword co-occurrence, thematic evolution tracking, and spatial collaboration analysis. The findings reveal a paradigm shift categorized into three evolutionary phases: an incubation period of basic web adoption (2011–2017), a disruptive phase catalyzed by the COVID-19 pandemic (2018–2022), and an exponential maturation phase driven by Industry 4.0 technologies such as Artificial Intelligence (AI), Big Data, and Virtual Reality (2023–2025). Four primary thematic clusters emerged: digital marketing and connectivity, smart tourism and advanced analytics, immersive technologies for heritage preservation, and macro-level sustainability policies. Geopolitically, research is driven by two distinct networks: an Asian-centric hub led by China focusing on state-sponsored smart villages, and a Western hub anchored by the USA and Italy emphasizing entrepreneurial diversification. The study concludes that digitalization has transitioned from a reactive survival mechanism to a proactive strategic necessity. It highlights the critical need to bridge the digital divide through human capital investment and provides a future research agenda focusing on the ethical application of AI, the circular economy, and the preservation of rural authenticity in emerging ’phygital’ environments. Full article

The Philippines achieved World Health Organization (WHO) certification for the elimination of leprosy as a public health problem in 1998. Despite this milestone, new cases continue to be reported each year, highlighting the need for sustained surveillance and interventions to achieve zero transmission. This paper provides an update on the country’s progress toward interruption of leprosy transmission using national surveillance data and programmatic reports from 2020–2024. Quantitative data were obtained from the Department of Health (DOH) Field Health Services Information System (FHSIS), while policy and programmatic information were drawn from national reports, WHO guidance, and implementation reviews. Descriptive analyses were conducted to examine trends in prevalence, case detection rates (CDRs), and age-sex distribution patterns to identify high-risk groups. Leprosy prevalence declined from 0.41 per 10,000 population in 2020 to 0.11 in 2024, remaining below the WHO elimination threshold. The CDR increased from 0.45 in 2022 to 1.17 per 100,000 in 2024, indicating recovery of active surveillance after COVID-19-related disruptions. Most newly detected cases occurred among adults aged 20–59 years (72%), although continued detection among children aged 0–14 years (6–7%) suggests ongoing transmission in selected endemic areas. Key program strengths include policy integration and WHO-supported surveillance initiatives, while major barriers include stigma, uneven local implementation, and limited access to rehabilitation. The Philippines has maintained low national prevalence while strengthening efforts toward transmission interruption. Continued investment in surveillance, contact tracing, stigma reduction, and integrated neglected tropical disease (NTD) services will be essential to achieving zero transmission, zero disability, and zero discrimination by 2030. Full article

Background and Objectives: Courier-operated motorcycles and mopeds have become increasingly visible in urban traffic, raising concerns about injuries among both couriers and pedestrians struck by courier-operated vehicles. The study period coincided with the COVID-19 pandemic; however, this study was not designed to evaluate the effect of the pandemic on courier-related injuries. This multicenter retrospective study aimed to describe hospital-based injury patterns, injury severity, treatment requirements, complications, and mortality among selected courier-related casualties, including motorcycle couriers and pedestrians struck by courier-operated motorcycles or mopeds. Materials and Methods: This retrospective multicenter observational study included courier-related traffic casualties identified between 1 March 2020, and 1 June 2022, through nine hospitals in İstanbul and Ankara and, for fatal courier cases, linked emergency medical service and hospital records. The primary clinical cohort consisted of injured couriers and pedestrians evaluated or treated at participating hospitals. Linked prehospital and early fatal courier cases were analyzed separately for mortality-related and mechanism-specific fatality analyses. Injury severity was assessed using the New Injury Severity Score. Treatment was classified as conservative or surgical, including both fracture fixation and soft-tissue procedures. Results: A total of 857 courier-related traffic casualties were identified, including 491 couriers and 366 pedestrians. Among couriers, 111 fatal cases were verified through linked records. Clinical treatment and follow-up analyses were restricted to 380 hospital-treated surviving couriers and 366 pedestrians with available clinical records. In this selected hospital-treated courier cohort, multiple fractures, open fractures, higher injury severity scores, surgical treatment, and complications were more frequent than among pedestrians. All hospital-treated surviving couriers included in the orthopedic trauma cohort underwent surgery, reflecting the orthopedic trauma-based case-identification process, whereas most pedestrians were treated conservatively. Conclusions: Among this selected hospital-based cohort, courier casualties identified through hospital, trauma referral, emergency, forensic, and linked fatal-event records showed a more severe clinical profile than pedestrians evaluated after being struck by courier-operated motorcycles or mopeds. These findings should be interpreted as hospital-based injury-severity patterns rather than population-level estimates of accident incidence, relative injury risk, or public health burden. Full article

This paper examines the association between two Financial Technology (FinTech)-related policy windows and the profitability of Qatari commercial banks over a twenty-year horizon (2005–2024). The analysis is anchored by two structural breaks: in 2017, the Qatar Central Bank (QCB) established its FinTech task force and lifted restrictions on the implementation of a regulatory sandbox and centralised electronic know your customer (e-KYC) framework; and during the digital-acceleration period in 2020 in response to the COVID-19 pandemic and the issuance of digital banking licences. FinTech adoption is not measured directly at the bank level; the two policy windows are used as intent-to-treat proxies. Using return on assets (ROA) and return on equity (ROE), bank performance is measured and influenced by bank size (log of total assets), bank age and type (Islamic and conventional). Multiple diagnostics of Hausman and Breusch–Pagan support the use of fixed-effects (FE) panel regressions with cluster-robust standard errors on an unbalanced panel of 125 bank–year observations. The results show a positive coefficient on the post-2017 dummy in the ROE model (β = 0.0306, p = 0.054, cluster-robust) and no detectable change in ROA (β = −0.00058, p = 0.868). For the post-2020 phase, both coefficients are positive but do not reach conventional significance (ROA: β = 0.00218, p = 0.539; ROE: β = 0.0224, p = 0.150). There is no systematic difference between Islamic and conventional banks that is offered by the interaction terms in either phase. Given the small sample (nine banks, eight effective clusters after the FE singleton drop; 125 observations) and the use of policy-window proxies rather than direct bank-level FinTech measures, the design cannot isolate the effect of the FinTech-related reforms from concurrent macroeconomic, sectorial or pandemic-related developments, and the cluster-robust p-values should be read as approximate. The results are therefore presented as preliminary and indicative. Read in light of these design constraints, the results are consistent with incremental rather than transformative change around the FinTech-related policy windows in Qatar, with results influenced more by timing, scale economies, and regulatory saturation than by bank type. The country-specific empirical findings can help restore context to the literature on the Gulf Cooperation Council (GCC) average, and provide measured guidance for bank managers and regulators working toward the Qatar National Vision 2030 digital aspiration. Full article