Search Results (423)

Background/Objective: Frontline healthcare staff who contend diseases and mitigate their transmission were repeatedly exposed to high-risk conditions during the COVID-19 pandemic. They were at risk of mental health issues, in particular, psychological stress, depression, anxiety, financial stress, and/or burnout. This study aimed to investigate and evaluate the occupational stress of medical doctors, nurses, pharmacists, physiotherapists, and other hospital support crew during the COVID-19 pandemic in Saudi Arabia. Methods: We collected both qualitative and quantitative data from a survey given to public and private hospitals using methods like correspondence analysis, cluster analysis, and structural equation models to investigate the work-related stress (WRS) and anxiety of the staff. Since health-related factors are unclear and uncertain, a fuzzy association rule mining (FARM) method was created to address these problems and find out the levels of work-related stress (WRS) and anxiety. The statistical results and K-means clustering method were used to find the best number of fuzzy rules and the level of fuzziness in clusters to create the FARM approach and to predict the work-related stress and anxiety of healthcare staff. This innovative approach allows for a more nuanced appraisal of the factors contributing to work-related stress and anxiety, ultimately enabling healthcare organizations to implement targeted interventions. By leveraging these insights, management can foster a healthier work environment that supports staff well-being and enhances overall productivity. This study also aimed to identify the relevant health factors that are the root causes of work-related stress and anxiety to facilitate better preparation and motivation of the staff for reorganizing resources and equipment. Results: The results and findings show that when the financial burden (FIN) of healthcare staff increased, WRS and anxiety increased. Similarly, a rise in psychological stress caused an increase in WRS and anxiety. The psychological impact (PCG) ratio and financial impact (FIN) were the most influential factors for the staff’s anxiety. The FARM results and findings revealed that improving the financial situation of healthcare staff alone was not sufficient during the COVID-19 pandemic. Conclusions: This study found that while the impact of PCG was significant, its combined effect with FIN was more influential on staff’s work-related stress and anxiety. This difference was due to the mutual effects of PCG and FIN on the staff’s motivation. The findings will help healthcare managers make decisions to reduce or eliminate the WRS and anxiety experienced by healthcare staff in the future. Full article

Background/Objectives: Chronic illness after COVID-19 vaccination (longvax) lacks a therapeutic protocol anchored in pathophysiology. Persistent vaccine derived spike protein appears to trigger microvascular fibrin amyloid microclots, immune dysfunction, pathogen reactivation and multisystem injury. This article proposes an integrative approach, Vaxtherapy, to tackle these mechanisms. Methods: A narrative synthesis of peer reviewed literature from 2021 to 2025 on spike related injury and vaccine adverse events was conducted, supplemented by clinical case series and mechanistic observations from long COVID. The findings were arranged into a four stage therapeutic sequence ordered by pathophysiological precedence. Results: Stage one aims to reopen hypoperfused tissue through oral fibrinolytics that degrade fibrin amyloid resistant microclots; stage two intends to neutralise circulating or tissue bound spike via a receptor binding domain monoclonal antibody cocktail; stage three seeks to eliminate reactivated viral or microbial reservoirs with targeted antivirals or antimicrobials once perfusion is improved; and stage four aspires to support tissue repair with mitochondrial supplements and, when indicated, cell based therapies. Omitting or reordering stages may reduce efficacy or foster resistance. Conclusions: This hypothesis driven framework outlines a biologically plausible roadmap for longvax research. By matching interventions to specific mechanisms (fibrinolysis, spike neutralisation, pathogen clearance and regeneration), it aims to guide controlled trials and compassionate pilot programs directed at durable recovery rather than chronic symptom management. Full article

There are increasing expectations that we should live in a digitally and computationally literate society. For many young people, particularly girls, school is the one place that provides an opportunity to develop the necessary knowledge and skills. This environment can either perpetuate and reinforce or eliminate existing gender inequalities. In this article, we present the “PLAYING, ENGAGEMENT, CREATVITIY, CREATING” (PECC) Framework, a practical guide to supporting teachers in the design of gender-sensitive learning activities, bringing students’ own interests to the fore. Through a six-year, mixed-methods, design-based research approach, PECC—along with supporting resources and digital tools—was developed through iterative cycles of theoretical analysis, empirical data (both qualitative and quantitative), critical reflection, and case study research. Exploratory and instrumental case studies investigated the promise and limitations of the emerging framework, involving 43 teachers and 1453 students in secondary-school classrooms (including online during COVID-19) in Austria, Germany, and Switzerland. Quantitative data (e.g., surveys, usage metrics) and qualitative findings (e.g., interviews, observations, classroom artefacts) were analyzed across the case studies to inform successive refinements of the framework. The case study results are presented alongside the theoretically informed discussions and practical considerations that informed each stage of PECC. PECC has had a real-world, tangible impact at a national level. It provides an essential link between research and practice, offering a theoretically informed and empirically evidenced framework for teachers and policy makers. Full article

Background/Objectives: Extracorporeal membrane oxygenation (ECMO) is increasingly used in critically ill patients, but may significantly alter the pharmacokinetics (PK) of antifungals. Data on plasma concentrations of Isavuconazole (IsaPlasm) in ECMO patients are limited. Our objective is to evaluate Isavuconazole exposure and variability in critically ill COVID-19 patients receiving ECMO. Methods: We conducted a pharmacokinetic analysis of Isavuconazole in critically ill patients receiving Veno-Venous ECMO for respiratory support. Plasma concentrations were measured using therapeutic drug monitoring (TDM) at multiple time points, including sampling before and after the membrane oxygenator. PK parameters—Area Under Curve (AUC_0–24), Minimum Plasma Concentration (Cmin), Elimination Half-Life (T_1/2), volume of distribution (Vd), and clearance (CL)—were estimated and compared with published data in non-ECMO populations. Results: Five patients were included. The median AUC_0–24 was 227.3 µg·h/mL (IQR 182.4–311.35), higher than reported in non-ECMO patients. The median Vd was 761 L (727–832), suggesting extensive peripheral distribution and potential drug sequestration in the ECMO circuit. CL was increased (1.6 L/h, IQR 1.5–3.4). Two patients with recently replaced ECMO circuits exhibited significant drug loss across the membrane. Obesity and hypoalbuminemia were identified as factors associated with altered drug exposure. Conclusions: Isavuconazole pharmacokinetics show marked variability in critically ill ECMO patients. Increased AUC and Vd, along with reduced clearance, highlight the need for individualized dosing. Full article

Congenital Rubella Syndrome (CRS) results from maternal infection with the rubella virus during pregnancy, particularly in the first trimester, when the risk of vertical transmission and severe fetal damage is highest. CRS is characterized by a broad spectrum of congenital anomalies, including sensorineural hearing loss, congenital heart defects, cataracts, neurodevelopmental delay, and behavioral disorders. Despite the absence of specific antiviral therapies, active immunization remains the only effective strategy to prevent rubella infection and its congenital consequences. Global immunization efforts, particularly in the Americas, have led to the elimination of rubella and CRS in several countries. However, challenges persist in the post-elimination era, including declining vaccine coverage, vaccine hesitancy, and setbacks caused by the COVID-19 pandemic. Diagnosis relies on maternal serology, fetal imaging, postnatal antibody testing, and molecular techniques. Management requires long-term, multidisciplinary follow-up due to the complex and lifelong sequelae affecting sensory, motor, and cognitive development. This review highlights the clinical, epidemiological, and pathophysiological aspects of CRS, while emphasizing the urgent need to maintain high vaccination coverage and strengthen surveillance systems. Sustained public health commitment is essential to prevent the reemergence of rubella and protect future generations from this preventable syndrome. Full article

The human voice is an important medium of communication and expression of feelings or thoughts. Disruption in the regulatory systems of the human voice can be analyzed and used as a diagnostic tool, labeling voice as a potential “biomarker”. Conversational artificial intelligence is at the core of voice-powered technologies, enabling intelligent interactions between machines. Due to its richness and availability, voice can be leveraged for predictive analytics and enhanced healthcare insights. Utilizing this idea, we reviewed artificial intelligence (AI) models that have executed vocal analysis and their outcomes. Recordings undergo extraction of useful vocal features to be analyzed by neural networks and machine learning models. Studies reveal machine learning models to be superior to spectral analysis in dynamically combining the huge amount of data of vocal features. Clinical applications of a vocal biomarker exist in neurological diseases such as Parkinson’s, Alzheimer’s, psychological disorders, DM, CHF, CAD, aspiration, GERD, and pulmonary diseases, including COVID-19. The primary ethical challenge when incorporating voice as a diagnostic tool is that of privacy and security. To eliminate this, encryption methods exist to convert patient-identifiable vocal data into a more secure, private nature. Advancements in AI have expanded the capabilities and future potential of voice as a digital health solution. Full article

Background/Objectives: The World Health Organization (WHO) declared a global pandemic of COVID-19 caused by SARS-CoV-2 in March 2020. May 2023 was the month that ended the global pandemic. Pregnant females with COVID-19 are less likely to be symptomatic than non-pregnant patients, with nearly three-quarters being without symptoms. According to previous studies, even if somebody develops symptoms, they are usually mild, most commonly coughing (41%), fever (40%), and dyspnea (21%). Our study aims to search the literature systematically, especially case series and case reports published in Europe, and to summarize results about the kind of COVID-19 therapy in pregnant women and about outcomes in mothers and newborns. Methods: Our systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) with CRD42024566838. We searched PubMed/MEDLINE, Google Scholar, Web of Science, Scopus, and Serbian Citation Index (SCIndeks). In this study, case reports or case series with open, complete text that included full clinical records of the individuals identified with infection in pregnancy, thought to be caused by COVID-19, were used. Case series or case reports were eliminated if they (1) did not contain a full clinical report for every patient, or (2) included an individual who suffered from another viral infection other than COVID-19, so the clinical course and the outcome could not be precisely defined. We evaluated reporting bias and attrition bias. Results: Our study included 32 published studies (eight case series and 24 case reports) that included 56 individual cases. The oldest patient was 50 years old, and the youngest was 19 years old. The most common symptom initially was dry cough (n = 23; 41%), followed by fever (n = 21; 37%) and dyspnea (n = 10; 17%). In three patients, a lower level of thrombocytes was reported, with the lowest level of 86 × 10⁹. The most frequently used drugs in pregnant women with COVID-19 infection were azithromycin, lopinavir/ritonavir, hydroxychloroquine, as well as corticosteroids. Twenty-two patients were on mechanical ventilation. After all this reported therapy, ten women died, as well as seven newborns. Conclusions: From our results, we can conclude that mechanical ventilation correlates with cesarean section performed more frequently, as well as with a higher mortality rate of neonates. There are no significant data related to transplacental transmission of the virus. Generally, mortality in our group of patients (mothers) was 17%, which is similar to the general population death from COVID-19 infection. Full article

The COVID-19 pandemic exposed significant deficiencies in global health emergency preparedness, highlighting the critical importance of health equity. This study investigates the role of public health infrastructure in promoting health equity, utilizing data from 31 provincial regions in China. The analysis examines the mediating role of medical service utilization (hospitalization and outpatient services) and the moderating effect of health insurance. The findings indicate that public health infrastructure is significantly associated with health equity. Medical service utilization partially mediates this relationship, with health insurance further moderating the positive impact of hospitalization utilization on health equity, though not for outpatient services. Regional analysis reveals heterogeneity, with public health infrastructure exerting a significant effect on health equity in the central–western regions but not in the eastern region. This research underscores the importance of accessible public health infrastructure and comprehensive health insurance in eliminating health disparities, providing valuable insights for policymaking aimed at fostering health equity. Full article

Clostridioides difficile (CD) is a Gram-positive, spore-forming anaerobic bacterium, usually transmitted through the fecal–oral route, that can result from direct person-to-person contact, exposure to contaminated environmental surfaces, or contact with the hands of colonized healthcare personnel. An increased number of infections, especially healthcare-associated, with this etiology has been observed in most countries. As a spore-forming organism, CD is resistant to alcohol formulations and is a challenge for chemical disinfection. The solution could be the supplementation of traditional disinfection with non-touch techniques, such as UV-C radiation. The adoption of UV-C as a supplementary disinfection method in hospitals has significantly increased since the COVID-19 pandemic. However, there are no current guidelines concerning the use of UV-C disinfection in hospitals. The aim of this study was to evaluate the effectiveness of UV-C irradiation in inactivating Clostridioides difficile from different types of surfaces in hospital settings. The study was based on laboratory tests evaluating the efficacy in eliminating three different C. difficile strains on carriers made of plastic, metal and glass after 10 min exposure to UV-C (wavelength, 253.7 nm). We observed a wide range of reductions in the C. difficile suspensions depending on the density of the carrier contamination, type of carrier, strains and the location of the carrier. The percentage reductions ranged from 0 to 100%, but the best results were observed for glass, with lower initial suspension density and carrier placement on a door frame. Statistically significant differences were only seen in different suspension densities. Our experiment was a continuation of the tests done for non-sporing bacteria and C. auris, and there were some interesting differences in C. difficile reflecting its biology, especially its sensitivity to an aerobic atmosphere during the sample drying. Although the elimination of C. difficile by UV-C radiation was confirmed in our experiment, it was lower than in the case of non-spore-forming bacteria. Thus, this method may be used in healthcare settings (hospitals) for improving environmental safety and preventing C. difficile spreading. Full article

The article presents the results of research on the resilience of companies using management concepts such as Lean Management, Agile, and Six Sigma to the crises that companies have had to face in recent years: the COVID-19 pandemic, rising energy prices, and the war in Ukraine. The implementation of these management concepts should lead to process improvements and a reduction in the consumption of production resources, including energy. The aim of the study was to determine how these crises have affected the efficiency of companies and to determine whether the solutions used so far are sufficient or require modification. The authors used three research methods. Firstly, they analyzed the literature—scientific publications, studies, and expert reports. Secondly, they analyzed the financial results (net profits and share of Costs of Goods Sold in the value of Revenues) in the period before (2016–2019) and after the outbreak of the COVID-19 pandemic (2020–2023) of companies using Lean Management, Agile, and Six Sigma strategies and their combinations. To compare the effectiveness of these management methods, they also analyzed the financial results of international corporations and Polish companies. Third, they conducted a survey among Polish companies applying the Lean Management concept. The results of this research show that the crises of recent years, even if they caused a deterioration in financial performance, were short-lived as companies were able to adapt to the new conditions. Japanese companies using Lean Management increased their profits by an average of 55.56% between 2020 and 2023, and “Lean” American organizations even more (71.64%). Polish companies have been steadily increasing their profits for years (134.14% before the pandemic and 143.27% after the outbreak). The share of COGS will remain at a similar (high) level for many years to come. There are no significant increases in these costs due to crises in the companies’ environment (e.g., increase in energy prices), and, on the other hand, there is no tendency for them to decrease in a large proportion of companies. In the years 2020–2023, the largest decreases in the share of these costs occurred in companies combining Lean and Six Sigma (−11.85%). In companies that use the Agile strategy, there was an increase of 8.05%. However, these are average data, and the analysis of the results of companies from individual groups leads to the conclusion that it is not only the management concept that is important, but also how it is implemented in a given company. In addition, streamlining processes only by eliminating waste is not enough these days. It is necessary to use modern technologies (digital technologies, Industry 4.0). Increasing the efficiency of production or logistics processes leads to a reduction in energy consumption and external costs. However, new, specialized solutions are needed. The issue of energy efficiency is indeed gaining more and more importance in companies and is included in management concepts, e.g., in Lean Management. Full article

Background: COVID-19, caused by SARS-CoV-2, poses a significant threat to human health. Vaccines designed for T-cell epitopes play an important role in eliminating the virus. However, T cell epitope screening often requires the use of a large number of peripheral blood mononuclear cells (PBMCs) from infected or convalescent patients, and if MHC humanized mice can be used for epitope screening, they will not have to wait for enough PBMCs to be available to screen for epitopes, thus buying time for epitope confirmation and vaccine design. Methods: In this study, we used SARS-CoV-2 BA.5 to infect HLA-A11/DR1, C57BL/6, hACE2 mice, and detected body weight changes, viral load, and pathological changes after infection. Fourteen days after the HLA-A11/DR1 and C57BL/6 mice were immunized against inactivated viruses, IgG antibodies were detected in mouse serum using ELISA, and IFN-γ produced by peptide stimulation of splenocytes was detected by ELISpot. Results: There is no obvious pathogenic phenotype of SARS-CoV-2 infection in HLA-A11/DR1 mice. Specific IgG antibodies were detected in serum after immunization of inactivated virus in both HLA-A11/DR1 and C57BL/6 mice, but specific IFN-γ was detected in splenocytes of HLA-A11/DR1 mice. Conclusions: Although HLA-A11/DR1 mice are unable to replicate the virus effectively in vivo, they are able to generate cellular immune responses after immunization inactivated viruses. Therefore, it can be used as a tool to substitute for human PBMCs in epitope screening, thus shortening the timeliness of T cell epitope screening and obtaining the immunogenicity information of new epitopes in a timely manner. Full article

This review of the literature examines diseases and pathogen characteristics on military vessels, in order to improve the success of missions on a boat. Our aim is to understand the spread of disease, aiming to maximize biological resilience and hopefully eliminate outbreaks. Keyword research was conducted from various sources of information, including scientific publications, theses, public health organization websites, and clinical trials. A synthesis of bacterial, viral, fungal, and parasitosis characteristics was established, and a risk prioritization index was defined, based on contagiousness (basic reproduction number (R0)) and clinical severity. For instance, COVID-19 was assessed as moderately contagious, with critical severity, and Influenza A H1N1 as having a minor level of contagiousness with critical severity, resulting in a level two out of three risk prioritization index. This approach demonstrates that while diseases have numerous characteristics, a method for classifying them by isolating specific criteria and prioritizing them could be proposed. In conclusion, further work is needed to analyze onboard operator activities and develop simulation models related to pathogen characteristics. Full article

Antibiotic resistance is a global environmental and health threat. Approximately 4.95 million deaths were associated with antibiotic resistance in 2019, including 1.27 million deaths that were directly attributable to bacterial antimicrobial resistance. Hospital wastewater is one of the key sources for the spread of clinically relevant antibiotic resistance genes (ARGs) into the environment. Understanding the current situation of ARGs in hospital wastewater is of great significance. Here, we review the prevalence of ARGs and antibiotic-resistant bacteria (ARB) in hospital wastewater and wastewater from other places and the treatment methods used. We further discuss the intersection between ARGs and COVID-19 during the pandemic. This review highlights the issues associated with the dissemination of critical ARGs from hospital wastewater into the environment. It is imperative to implement more effective processes for hospital wastewater treatment to eliminate ARGs, particularly during the current long COVID-19 period. Full article

The COVID-19 pandemic has led to significant increases in morbidity, mortality, and energy consumption, primarily due to infection control measures. Hospitals, as frontline responders, are particularly vulnerable to infection risks due to dense populations and numerous viral carriers. Integrating natural ventilation to optimize air-conditioning systems is crucial for mitigating these risks while balancing energy efficiency. However, existing research has predominantly focused on mechanical ventilation upgrades, with limited attention given to the effective integration of natural ventilation. This study presents an innovative air-conditioning system that incorporates easily installable automatic window control units into existing fresh-air-handling units and fan coil unit systems. This approach allows for multi-zone simultaneous control, making it suitable for both new and retrofitted hospitals. Additionally, the study proposes an optimal multi-zone ventilation strategy aimed at reducing infection risks while enhancing energy efficiency. The performance of the proposed system and ventilation strategy is evaluated considering five common respiratory diseases, with their seasonal transmission characteristics across a wide range of climatic conditions integrated into a revised version of the traditional Wells–Riley equations. The results demonstrate that conventional systems, following China’s GB55015-2021 standard, incur high infection risks during peak-season hours for COVID-19 (1347 h), influenza (470 h), and measles (1386 h). In contrast, the proposed multi-zone ventilation strategy eliminates infection risks while only increasing energy consumption by 3–10%, utilizing outdoor wind pressure as a key resource. This solution not only enhances hospital resilience but also provides valuable technical guidance for the design and retrofitting of hospital buildings, ensuring enhanced infection control and energy efficiency across diverse climates. Full article

In this paper, the non-parametric frontier methodology (DEA) with input orientation, variable returns to scale, and the Malmquist productivity indices are used to study the level of national and regional efficiency and know the productive change of Spanish hotels in the period 2014–2021, after the health crisis caused by COVID-19. The main objective of this paper is to know if the national and regional efficiency and total productivity of this sector have changed due to this pandemic. The data were extracted from the Iberian Balance Sheet Analysis System (SABI) and the Spanish National Statistics Institute (INE). The results obtained make it possible to determine which regions are the most efficient (Asturias, Castilla-León, and Cantabria) and to know that changes in productivity have their origin in efficiency. Furthermore, in 2021, after eliminating the restrictions imposed to fight COVID-19, investments made by hotel companies led to great technical progress. Thus, contrary to what one might think, the pandemic did positively affect the productivity of these companies, thanks to great technical progress and better adjustment of their scale. Besides, it is possible that COVID-19 has shifted tourism from regions with large cities to those with more natural areas, so the most efficient regions are those where natural tourism stands out. Full article