Search Results (29,450)

Background and Clinical Significance: The COVID-19 pandemic led to the rapid development of effective vaccination strategies. Although COVID-19 vaccines are generally safe, rare hematological adverse events have been reported, most prominently vaccine-induced immune thrombotic thrombocytopenia (VITT). Isolated cases of autoimmune cytopenias and bone marrow failure syndromes following COVID-19 vaccination have also been described. Case Presentation: We report the case of an 80-year-old male who developed subacute-onset severe normocytic anemia with reticulocytopenia and mild leukopenia following heterologous COVID-19 vaccination with ChAdOx1 nCoV-19 (AstraZeneca) and BNT162b2 (Pfizer–BioNTech). Seven days after the second vaccination, mild anemia was detected, progressing over the following weeks to symptomatic anemia requiring hospitalization. Extensive diagnostic evaluation revealed no evidence of hemolysis, nutritional deficiency, autoimmune disease, or viral infection, including SARS-CoV-2 and Parvovirus B19. Bone marrow examination demonstrated an erythroid maturation arrest at the proerythroblast stage, resembling a pure red cell aplasia (PRCA)-like pattern. Cytogenetic and molecular analyses excluded myelodysplastic syndromes. Treatment with erythropoietin resulted in complete hematologic recovery. Conclusions: This case suggests that, in rare instances, COVID-19 vaccination may be temporally associated with transient suppression of erythropoiesis. Further studies are required to elucidate underlying mechanisms and to guide diagnosis and management. Full article

COVID-19, caused by the SARS-CoV-2 coronavirus, emerged as a global pandemic in 2020, with profound impacts on public health and a substantial burden on intensive care units (ICUs). Because critically ill patients are at increased risk of rapid clinical deterioration and death, there is a need for reliable early prognostic biomarkers to support risk stratification and optimize clinical management. Therefore, this study investigated whether clinical and laboratory parameters obtained at hospital admission could serve as prognostic biomarkers for endotracheal intubation and mortality in critically ill patients with COVID-19 admitted to ICUs. A retrospective analytical study was conducted using the medical records of 107 critically ill patients with confirmed COVID-19 admitted to ICUs. Patients were classified according to clinical outcome as survivors (n = 22) or non-survivors (n = 85). Clinical characteristics and laboratory biomarkers obtained at hospital admission were analyzed. D-dimer, lactate dehydrogenase (LDH), red cell distribution width (RDW), the AST/ALT ratio, and age were independently associated with mortality. In addition, D-dimer and LDH demonstrated moderate discriminatory performance for predicting the need for endotracheal intubation. These findings suggest that routinely available clinical and laboratory parameters obtained at hospital admission may serve as complementary prognostic biomarkers to support early risk stratification and clinical decision-making in critically ill patients with COVID-19. Nevertheless, prospective multicenter studies are warranted to externally validate these findings and further establish their clinical applicability. Full article

This study examines the impact of the Russian–Ukrainian war on global financial stability, focusing on currency crises, exchange-rate dynamics, and economic vulnerability during 2003–2024 with an outlook for subsequent years. The objective is to assess how geopolitical shocks, combined with global monetary tightening, influenced the frequency and intensity of currency crises across developed and emerging economies. The study applies a quantitative comparative methodology based on a modified Exchange Market Pressure Index (EMPI) using monthly IMF data on exchange rates, reserves, interest rates, and depreciation dynamics. Currency crises are identified through threshold-based criteria, enabling cross-country and temporal comparison. A conceptual framework explains how geopolitical risk affects currency markets, financial stability, and macroeconomic performance. The findings show that crisis episodes were more frequently concentrated around the Great Recession, the COVID-19 pandemic, and the Russian–Ukrainian war. Emerging economies were more vulnerable, experiencing stronger capital outflows, sharper currency depreciation, and more frequent crises, while developed economies were affected mainly through inflation and energy price shocks. The war intensified financial fragmentation, increased safe-haven flows toward the US dollar, gold, and Swiss franc, and raised systemic risks in debt, banking, and corporate sectors. The study concludes that differentiated macroeconomic strategies, stronger external buffers, and enhanced international financial coordination are necessary to reduce risks and preserve currency stability. Full article

Small and medium-sized enterprises (SMEs) represent the majority of EU businesses and a disproportionate share of its environmental impact, yet longitudinal evidence on their resource efficiency behaviour remains scarce. This study examines whether SME adoption of resource efficiency practices increased between 2017 and 2024 and whether the size gradient changed across a period spanning several major and concurrent institutional and economic events: the European Green Deal (2019), the Circular Economy Action Plan (2020), the COVID-19 pandemic and its economic aftermath (2020–2021), the energy price shock that intensified in 2021 and was amplified by the Russia–Ukraine conflict in 2022, and the early implementation phase of the Corporate Sustainability Reporting Directive (2022–2024). These events overlapped substantially in time and cannot be disentangled with the present empirical design. Using microdata from three Flash Eurobarometer waves (N = 38,165; EU27), we construct a harmonised eight-item adoption index and estimate a weighted Poisson regression with cluster-robust standard errors and wave × firm-size interactions. Adoption increased substantially: SMEs reporting no resource efficiency action fell from 10.5% to 4.2%, and renewable energy use more than doubled (+15.3 pp). More substantively, the population-level gap in resource efficiency adoption between medium-sized enterprises (50–249 employees) and microenterprises (1–9 employees) narrowed by 81%, from +0.89 practices in 2017 (out of a maximum of 8) to a statistically non-significant +0.13 and +0.17 practices in 2021 and 2024 respectively (interaction IRR ≈ 0.81–0.82, p < 0.001 in both waves), robust to nine checks. The size gradient in environmental behaviour appears not to be structural but a dynamic feature of the institutional landscape, one that narrowed substantially over a period coinciding with intensifying regulatory ambition and energy price shock—though the present repeated cross-sectional design cannot establish which mechanisms drove this compression. Full article

The aim of the study was to analyse the epidemiological characteristics of confirmed COVID-19 cases in the Tumbes region between March 2020 and December 2022. Method: An ecological design with a descriptive approach was used for the study population, which consisted of 51,421 confirmed cases of COVID-19 residing in the provinces of Contralmirante Villar, Tumbes, and Zarumilla in the department of Tumbes. Confirmed cases of COVID-19 reported in SISOVID by the Ministry of Health and the registry of confirmed cases of COVID-19 in all age groups were recorded. The sociodemographic data collected was supplemented with information available on the web platform of the National Institute of Statistics and Informatics (INEI). The data were organized into databases and analyzed using software such RStudio (versión 2024.12.1), applying epidemiological indicators (incidence, prevalence, mortality, and lethality). The epidemiological data were organized and analyzed in a database prepared in Microsoft Excel to consolidate the information through data filtering and organization. Results: Among the main findings, a decrease in incidence was observed between 2021 (7840/100,000 inhabitants) and 2022 (5721/100,000 inhabitants), although the cumulative case rate increased from 15% to 20%. The mortality rate fell significantly from 2.57 per 1000 inhabitants in 2021 to 0.33 in 2022. The highest fatality rates were concentrated among people over 60 years of age with comorbidities, especially men. Conclusion: The pandemic was unevenly distributed, affecting adults between 30 and 59 years of age, populations with pre- existing conditions, and densely populated urban areas the most. The geographic distribution of cases helped identify areas warranting priority for improving the health response. It is recommended to strengthen epidemiological surveillance, improve access to health services in densely populated areas, and prioritise care for vulnerable groups such as older adults and indigenous peoples. Full article

Tele-oncology expanded rapidly during the COVID-19 pandemic and remains central to cancer care, yet evidence on guideline adherence in tele-oncology is limited, particularly in Latin America. In Chile, the Explicit Health Guarantees (GES) program mandates oncology care standards but provides no process model for monitoring adherence. We evaluated the conformance and temporal performance of telemedicine-based oncology pathways against a guideline-derived reference model using process mining, based on event logs from 182 patients treated in 2020–2023 in a Chilean hospital network. Conformance was computed using PM4Py with token-based replay and alignment-based fitness, complemented by cohort, abstraction-level and robustness analyses with bootstrap confidence intervals and multiple-comparison-adjusted testing. Overall conformance was low (4.95% of cases fully conforming; mean alignment fitness 0.19, 95% CI 0.16–0.22) against a highly precise reference model (precision 0.90). Censoring-aware analyses showed that low conformance was driven predominantly by genuine structural deviations rather than incomplete observation alone. Event-level cohort signatures were observed, but patient-level analyses suggested that these patterns should be interpreted as exploratory. Crude differences in care duration by out-of-model activity status were largely explained by differential observation time after exposure adjustment. Process-mining conformance checking provides reproducible indicators for governing tele-oncology pathways when metrics are interpreted alongside methodological caveats. Full article

Chad Hartigan’s science fiction romantic drama Little Fish was released in 2020, soon after the start of the COVID-19 pandemic. However, the disease plaguing communities in Little Fish is not affecting people’s bodies but their minds—those who have contracted Neuroinflammatory Affliction (NIA) are losing their memories. The story centres upon the experiences of one young couple as they anxiously witness the disease take hold of their community, loved ones, and eventually one another. The film explores relationships between memory and identity, and poses questions about the ways these processes interact with those of love and loss. Who are we once we begin to lose memories of our histories and ourselves? Who do we then become to our loved ones, with whom we have shared these memories and selves? What binds us together? The paper examines the film using concepts from memory studies, in particular psychoanalysis and philosophy, to argue that after conscious memory is gone, aspects of memory and identity remain through the body, the unconscious, and love. Full article

Since the onset of the COVID-19 pandemic, children and adolescents across Europe have experienced a significant rise in mental health challenges, including anxiety, depression, and behavioural disorders. Schools have observed a marked shift in social behaviour, with increased emotional instability, social withdrawal, and attention-related issues. Simultaneously, educational systems face a growing shortage of skilled professionals, particularly in psychological support roles. While digital technologies offer partial relief, their effectiveness is limited by concerns such as screen fatigue and a lack of embodied interaction. This paper conceptualises the use of social robots as a novel intervention tool in education, grounded in the 4E cognition framework—embodied, embedded, enacted, and extended—and informed by interdisciplinary research. Using design thinking and insights from empirical and practical work, we developed five use cases for integrating robots into the Swiss MindMatters mental health promotion programme. These five use cases demonstrate how robots can facilitate emotional learning, simulate social interactions, support conflict mediation, and reduce teacher workload. By combining physical presence with adaptive behaviour, social robots, which will serve as digital twins of pedagogical partners, offer a promising, ethically sensitive extension of classroom environments, fostering deeper engagement, social competence, and cognitive development in ways traditional technologies cannot fully replicate. Full article

The COVID-19 pandemic caused uneven employment losses and recovery across tourism economies. Using county-level Quarterly Census of Employment and Wages data for 2010–2023, we estimate a 2020 third-quarter decline index and recovery indexes for 2021–2023, each benchmarked against national leisure and hospitality (L&H) employment change. In the full sample, a one-percentage-point higher 2019 L&H employment share was associated with a 0.0127 lower 2020 decline index and a 0.0495 lower 2021 recovery index. Pollution and population density were also negatively associated with both outcomes, whereas the share of second homes was positively associated with 2021 recovery. Natural amenities were positively associated with 2021 recovery. Social capital was not significant in the 2020 decline or 2021 recovery full sample but was negatively associated with decline and recovery in metro counties. The findings show that regional tourism employment resilience is shaped by economic dependence, environmental quality, settlement patterns, and amenity-based tourism resources. These are sustainability-relevant regional conditions, although the employment indexes do not directly measure sustainability outcomes. Policies should combine economic diversification with environmental protection and place-specific urban and rural resilience strategies. Full article

The adversity-activated development reflection tool (AART) has been used therapeutically to capture personal growth arising during adversity. Our mixed-methods study used this tool to assess adversity-activated growth in 854 mental and community healthcare workers during the COVID-19 pandemic. Participants used the tool to describe the positive and negative effects of the COVID-19 pandemic in different life domains (self, family, work, and community). Through an ideal-type analysis of 133 purposively subsampled AARTs, we derived three levels of adversity-activated development (AAD): none, minimal, and deep. Higher levels of AAD were associated with spending more time connecting with friends and family (OR = 1.83, 95% CI 1.23 to 2.75, p < 0.01) and skill development in mental health care (OR = 1.63, 95% CI 1.16 to 2.28, p < 0.01). Deep development was characterised by changes in life priorities, changes in coping, realising strengths and capabilities, and making stronger connections with others. The AART can usefully assess both positive and negative growth, enabling respondents to convey the complexities of their experiences in their own words, whilst allowing the levels of overall self-development to be distilled. Our findings reinforce the value of promoting social connectedness and skill development to facilitate employee growth during collective occupational stress. Full article

During the COVID-19 pandemic, healthcare systems experienced significant disruption, increasing the risk of multidrug-resistant (MDR) pathogen transmission. Acinetobacter baumannii, a critical-priority MDR pathogen, is known for its ability to persist in hospital environments and rapidly acquire resistance. To investigate the genomic characteristics, antimicrobial resistance determinants, and phylogenetic relationships of outbreak-associated Acinetobacter baumannii isolates, whole-genome sequencing (WGS) and comparative genomic analyses on 24 clinical and environmental strains collected during the COVID-19 period were performed. Twenty-four A. baumannii isolates collected between August 2020 and February 2021 from clinical and environmental samples were analyzed by WGS. All isolates displayed an MDR phenotype, with uniform resistance to carbapenems and aminoglycosides, and preserved colistin susceptibility. One environmental strain showed extreme drug resistance. WGS confirmed medium-quality genome assemblies and the clonal spread of a single A. baumannii lineage. Most resistance genes, including OXA-23, ADC-type β-lactamases, and ade efflux pumps, were chromosomally encoded and shared across all isolates. Plasmid-mediated resistance genes were variably distributed. This outbreak of MDR A. baumannii was driven by the clonal dissemination of a genomically stable lineage. Combined genomic and epidemiological analyses underscore the importance of integrated surveillance and environmental decontamination to prevent the spread of MDR pathogens. Full article

The COVID-19 pandemic created a unique natural experiment to evaluate the impact of reduced human activity on urban air quality. This study assessed the effects of lockdown measures on major air pollutants across three Georgian cities with contrasting emission profiles: traffic-dominated Tbilisi, coastal Batumi, and industrial Rustavi. Daily concentrations of NO₂, SO₂, PM_2.5, PM₁₀, and O₃ were obtained from the National Environmental Agency’s automated monitoring network for March–June 2019–2022. Following systematic missing value imputation, meteorologically adjusted interrupted time-series (segmented regression) models, incorporating daily temperature and wind speed as covariates, were used as the primary analysis; Mann–Kendall trend analysis was retained as a secondary, descriptive measure. Results were evaluated against WHO 2021 Air Quality Guidelines. Tbilisi showed the strongest lockdown response: NO₂ declined by 47.9% in 2020 (vs. 2019), before rebounding fully in 2022. PM_2.5 and PM₁₀ showed attenuated reductions, reflecting continued heating combustion and dust sources. Ground-level O₃ increased in Tbilisi in 2020 (+25.0% vs. 2019). Rustavi exhibited no NO₂ response and an O₃ decrease of 43.2% in 2020, with partial recovery in 2021–2022. Batumi showed intermediate responses, with PM_2.5 and PM₁₀ increases in 2020. Meteorologically adjusted interrupted time-series models confirmed 11 of 30 city–pollutant effect estimates after false discovery rate correction, most robustly for NO₂; several borderline ozone and SO₂ findings did not survive correction and are reported as suggestive only. Lockdown measures were associated with source-specific and temporary air quality improvements, after accounting for meteorological conditions. Sustained reductions require structural interventions targeting traffic, residential combustion, and industrial emissions simultaneously. Full article

Background/Objectives: Burnout among healthcare professionals has emerged as a major occupational and organizational challenge with important implications for workforce sustainability, patient safety, and healthcare system performance. Although the scientific literature on burnout has expanded substantially, an integrated understanding of its global development, research structure, and scientific impact remains limited. This study aimed to examine the evolution, thematic development, and citation dynamics of burnout research among healthcare professionals through an integrated bibliometric approach combining science mapping, multilevel citation modelling, and critical literature synthesis. Methods: A bibliometric analysis was conducted using publications indexed in the Web of Science Core Collection between 1987 and 2024. Science mapping techniques were applied using Bibliometrix and VOSviewer to evaluate publication trends, collaboration networks, thematic development, and citation patterns. In addition, a multilevel negative binomial regression model was used to identify publication characteristics associated with citation impact. Results: A total of 1232 publications were included in the analysis. Scientific production increased markedly after 2020, temporally coinciding with the COVID-19 pandemic and growing scientific interest in healthcare workforce wellbeing. Research output was concentrated in high-income countries, particularly the United States, China, the United Kingdom, Canada, and Australia. Physicians and nurses dominated the literature, while non-clinical healthcare workers remained underrepresented. The thematic analysis indicated an increasing emphasis on organizational and system-level determinants of burnout alongside the continued presence of individual-centered perspectives. The multilevel negative binomial model identified longer title length and a greater number of author-provided keywords as being associated with lower expected citation counts, whereas a greater number of Keywords Plus terms was associated with higher expected citation counts. Conclusions: Burnout research has evolved into a rapidly expanding and increasingly interdisciplinary field. However, important gaps persist regarding geographic representation, workforce diversity, methodological standardization, and organizational intervention research. Future studies should move beyond descriptive approaches and further evaluate organizational interventions and workforce-related strategies to strengthen the evidence base that may inform healthcare policy and organizational practice. Full article

This study examines behavior among mutual funds across five sectors, including energy, utilities, real estate, technology, and healthcare, over a 27-year period (1999–2025). For each year, using daily NAV returns, each fund is regressed against the S&P 500 to separate fund-specific performance from broader market movements. All the resulting residual vectors for each year and fund are clustered together. These annual cluster assignments are then linked across time to construct each fund’s trajectory, showing how its relative performance position shifts from year to year. These trajectories capture long-term behavioral divergence and provide a simple, intuitive visualization. To identify and characterize fund trajectory and distinctiveness, we apply methods based on residual magnitudes, quantile migration patterns, and Hamming distance measures of (cluster, time) fund trajectories. These trajectories reveal how certain funds consistently diverge from market behavior, thereby contributing to portfolio diversity in terms of trajectory separation. We introduce a portfolio Hamming diversification index that measures separation between trajectories. Using trajectories and Hamming distances, we examine how fund behavior changes during major market disruptions, including the dot-com crash (2001), the financial crisis (2009), and the COVID-19 pandemic (2020–2021), and identify sector-specific differences in how fund trajectories respond to these events. The proposed methodology is intended as an exploratory descriptive methodology for studying long-term behavioral trajectories rather than as a replacement for traditional asset-pricing or performance-evaluation models. Full article

The COVID-19 pandemic presented a unique opportunity for researchers to use pragmatic methods to obtain information about the virus and promptly disseminate the findings for healthcare providers to utilize them. One such approach to studying patients who presented with COVID-19 and ST-Elevation Myocardial Infarction (STEMI) was the development of the North American COVID-19 STEMI (NACMI) registry. By leveraging social media and communication platforms such as WhatsApp, cardiologists across North America initiated the development of the NACMI registry within 14 days—an accomplishment which was unfathomable pre-pandemic. This was followed by ethics approval through a centralized Institutional Review Board, which led to patient consent being waived, and the use of a single coordinating center (Minneapolis Heart Institute Foundation) responsible for sites, database, and analysis. The NACMI findings were published rapidly across various media, including high-profile cardiovascular journals. Early results demonstrated an elevated mortality rate, disproportionality based on race, and angiographic differences showing unique mechanistic differences in the etiology of STEMI due to COVID-19. Additionally, NACMI provided early evidence that vaccination for COVID-19 reduced the risk of mortality in those with COVID-19 and STEMI. NACMI provided a framework for informing cardiologists early on regarding the optimal treatment of STEMI in patients with COVID-19. The lessons learned may be valuable for developing policy in future pandemics to treat patients using real-world application and routinely collected variables. Full article