Search Results (977)

The COVID-19 pandemic triggered unprecedented economic disruptions, raising critical questions about the resilience and adaptability of macroeconomic productivity across countries. This study examines the impact of COVID-19 on macroeconomic efficiency and productivity dynamics in 37 OECD countries using quarterly data from 2018Q1 to 2024Q4. By employing a Slack-Based Measure Data Envelopment Analysis (SBM-DEA) and the Malmquist Productivity Index (MPI), we decompose total factor productivity (TFP) into efficiency change (EC) and technological change (TC) across three periods: pre-pandemic, during-pandemic, and post-pandemic. Our framework incorporates both desirable (GDP) and undesirable outputs (inflation, unemployment, housing price inflation, and interest rate distortions), offering a multidimensional view of macroeconomic efficiency. Results show broad but uneven productivity gains, with technological progress proving more resilient than efficiency during the pandemic. Post-COVID recovery trajectories diverged, reflecting differences in structural adaptability and innovation capacity. Regression analysis reveals that stringent lockdowns in 2020 were associated with lower productivity in 2023–2024, while more adaptive policies in 2021 supported long-term technological gains. These findings highlight the importance of aligning crisis response with forward-looking economic strategies and demonstrate the value of DEA-based methods for evaluating macroeconomic performance beyond GDP. Full article

Hand hygiene (HH) is essential for preventing disease transmission, particularly in schools where children are in close contact with other children. This study evaluated a school-based intervention on observed HH practices and hand cleanliness in six primary schools in Guatemala. Hand cleanliness was measured using the Quantitative Personal Hygiene Assessment Tool. The intervention included (1) HH behavior change promotion through Handwashing Festivals, and (2) increased access to HH materials at HH stations. Handwashing Festivals were day-long events featuring creative student presentations on HH topics. Schools were provided with soap and alcohol-based hand rub throughout the project to support HH practices. Appropriate HH practices declined from 51.2% pre-intervention to 33.1% post-intervention, despite an improvement in median Quantitative Personal Hygiene Assessment Tool scores from 6 to 8, indicating cleaner hands. Logistic regression showed higher odds of proper HH when an assistant was present. The decline in HH adherence was likely influenced by fewer assistants and changes in COVID-19 policies, while improvements in hand cleanliness may reflect observational bias. These findings emphasize the importance of sustained behavior change strategies, reliable HH material access, and targeted interventions to address gaps in HH practices, guiding school health policy and resource allocation. Full article

Background and Objectives: The COVID-19 pandemic disrupted cancer care, prompting adaptations to reduce patient exposure while preserving treatment efficacy. This retrospective observational study compared a weekly cisplatin and 5-fluorouracil (5-FU) regimen to the standard monthly regimen for neoadjuvant chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma. Materials and Methods: This single-center retrospective study included 91 patients, divided into two cohorts: weekly chemotherapy (n = 30) and standard chemotherapy (n = 61). Treatment assignment was based on hospital policy changes during the pandemic, with weekly outpatient chemotherapy implemented after November 2022 to conserve inpatient resources. All patients received radiotherapy at 50 Gy in 25 fractions. The weekly regimen consisted of cisplatin 20 mg/m² and 5-FU 800 mg/m², administered over 1–2 h weekly, while the standard regimen administered the same doses over four consecutive days on weeks 1 and 5. Primary endpoints were pathologic complete response (pCR), progression-free survival (PFS), and overall survival (OS). Results: The response rates were similar between groups (weekly: 86.7% vs. standard: 90.2%; p = 0.724). The weekly regimen group showed a higher pCR (40.0% vs. 26.2%; p = 0.181) and significantly lower recurrence (26.7% vs. 52.5%; p = 0.020). Mortality was also reduced in the weekly group (6.7% vs. 34.4%; p = 0.004), though the follow-up duration was shorter (10.6 vs. 22.8 months; p < 0.001). Conclusions: In this retrospective observational study, weekly cisplatin and 5-FU demonstrated comparable efficacy to the standard regimen, with potential advantages in reducing recurrence and mortality. This modified approach may be a viable alternative for maintaining oncologic outcomes while minimizing the burden on healthcare systems during pandemic conditions, although prospective validation is needed. Full article

The contagious COVID-19 disease not only brought about a global health crisis but also a disruption in the global economy. The uncertainty levels regarding the impact of the disease increased volatility. This study analyses stock market volatility and Economic Policy Uncertainty (EPU) of South Africa (SA) with that of the United States of America (USA) and Brazil, Russia, India, and China (BRIC) during the COVID-19 pandemic. The study aims to analyse volatility spillovers from a developed market (USA) to emerging markets (BRIC countries) and also to examine the causality between EPU and stock returns during the COVID-19 pandemic. By employing the GARCH-in-Mean model from a sample of daily returns of national equity market indices from 1 January 2020 to 31 March 2022, SA and China are shown to be the most volatile during the pandemic. By using the diagonal Baba, Engle, Kraft, and Kroner (BEKK) model to analyse spillover effects, evidence of spillover effects from the US to the emerging countries is small but statistically significant, with SA showing the strongest impact from US market shocks. From the Granger causality test, Brazil’s and India’s equity markets are shown to be highly sensitive to changes in EPU relative to the other countries. Full article

This study aimed to longitudinally analyze changes in body mass index (BMI) among Korean middle and high school students before and after the COVID-19 pandemic. Data were obtained from the national-level Physical Activity Promotion System (PAPS), collected between 2018 and 2024. A total of 171,705 adolescents aged 13 to 18 were included in the analysis (86,542 males and 85,163 females), with a mean age of 15.2 years (SD = 1.68). Time-series analysis and two-way analysis of variance (ANOVA) were conducted to examine differences in BMI by year, sex, region (capital vs. non-capital), and urban–rural classification. The results indicated a significant increase in BMI during the pandemic period (2020–2022), peaking in 2022, followed by a gradual decline thereafter. Notably, male students and those living in rural or non-capital areas consistently exhibited higher BMI levels, suggesting structural disparities in access to physical activity opportunities and health resources. This study employed the Socio-Ecological Model and the Health Equity Framework as theoretical lenses to interpret BMI changes not merely as individual behavioral outcomes but as consequences shaped by environmental and policy-level determinants. The findings underscore the need for equity-based interventions in physical education and health policy to mitigate adolescent health inequalities during future public health crises. Full article

Cities house more than half of the world’s population and are responsible for more than 70% of the world anthropogenic CO₂ emissions. Therefore, quantifications of emissions from major cities, which are only less than a hundred intense emitting spots across the globe, should allow us to monitor changes in global fossil fuel CO₂ emissions in an independent, objective way. The study adopted a high-spatiotemporal-resolution regional assimilation method using satellite observation data and atmospheric transport model WRF-Chem/DART to assimilate CO₂ concentration and fluxes in Lisbon, a major city in Portugal. It is based on Zhang’s assimilation method, combined OCO-2 XCO₂ retrieval data, ODIAC 1 km anthropogenic CO₂ emissions and Ensemble Adjustment Kalman Filter Assimilation. By employing three two-way nested domains in WRF-Chem, we refined the spatial resolution of the CO₂ concentrations and fluxes over Lisbon to 3 km. The spatiotemporal distribution characteristics and main driving factors of CO₂ concentrations and fluxes in Lisbon and its surrounding cities and countries were analyzed in March 2020, during the period affected by COVID-19 pandemic. The results showed that the monthly average CO₂ and XCO₂ concentrations in Lisbon were 420.66 ppm and 413.88 ppm, respectively, and the total flux was 0.50 Tg CO₂. From a wider perspective, the findings provide a scientific foundation for urban carbon emission management and policy-making. Full article

Driven by climate change and stringent ecological conservation policies, arid and semi-arid pastoral areas face acute grassland degradation and forage–livestock imbalances. In Sunan County (Gansu Province, China), herders have increasingly turned to off-site grazing—leasing crop fields in adjacent oases during autumn and winter—to alleviate local grassland pressure and adapt their livelihoods. However, the interplay between the evolving land use system (L) and this emergent borrowed pasture system (B) remains under-explored. This study introduces a coupled analytical framework linking L and B. We employ multi-temporal remote sensing imagery (2018–2023) and official statistical data to derive land use dynamic degree (LUDD) metrics and 14 indicators for the borrowed pasture system. Through entropy weighting and a coupling coordination degree model (CCDM), we quantify subsystem performance, interaction intensity, and coordination over time. The results show that 2017 was a turning point in grassland–bare land dynamics: grassland trends shifted from positive to negative, whereas bare land trends turned from negative to positive; strong coupling but low early coordination (C > 0.95; D < 0.54) were present due to institutional lags, infrastructural gaps, and rising rental costs; resilient grassroots networks bolstered coordination during COVID-19 (D ≈ 0.78 in 2023); and institutional voids limited scalability, highlighting the need for integrated subsidy, insurance, and management frameworks. In addition, among those interviewed, 75% (15/20) observed significant grassland degradation before adopting off-site grazing, and 40% (8/20) perceived improvements afterward, indicating its potential role in ecological regulation under climate stress. By fusing remote sensing quantification with local stakeholder insights, this study advances social–ecological coupling theory and offers actionable guidance for optimizing cross-regional forage allocation and adaptive governance in arid pastoral zones. Full article

To develop interventions and policies to promote healthy and sustainable diets during times of crisis, it is important to understand how populations respond to such situations based on real-life examples. Using the recent COVID-19 pandemic as a case study to identify risk and protective factors for such situations, we implemented the first longitudinal mixed-methods approach of this topic to date. Data were collected from a sample of UK parents (stratified for gender and socioeconomic status) through two surveys and a set of focus groups during the pandemic. The focus groups identified multifaceted drivers of change linked to capability (e.g., shielding), opportunity (e.g., time, food access and availability), and motivation (e.g., reflective motivation, stress and mental health challenges) barriers. High levels of COVID-19 stress were linked with less healthy and sustainable diets in the survey results, while higher social cohesion, reflective motivation to consume healthy foods, and positive coping scores were protective, and linked to healthier and more sustainable diets. A range of coping strategies were identified, including home cooking and meal planning, which could provide a basis for future intervention development to reduce stress, maintain wellbeing, and improve dietary outcomes in future crisis situations. Full article

Background/Objectives: Maintaining high childhood vaccination coverage is essential to prevent outbreaks of vaccine-preventable diseases. In Italy, Law No. 119/2017 introduced mandatory childhood immunizations, leading to significant improvements. However, the COVID-19 pandemic disrupted routine services, potentially jeopardizing these gains. This study aimed to evaluate national and regional trends in vaccine coverage across three phases: post-mandate (2015–2016 vs. 2017–2019), pandemic (2017–2019 vs. 2020–2021), and post-pandemic recovery (2020–2021 vs. 2022–2023). Methods: National and regional administrative data on vaccination coverage at 24 months of age were obtained from the Italian Ministry of Health. Temporal trends were analyzed using Joinpoint regression to estimate annual percent changes (APCs), and absolute changes in coverage (Δ) were calculated across defined periods. Pearson correlation coefficients were used to assess associations between baseline coverage and subsequent changes. Results: After the 2017 mandate, coverage increased significantly for varicella (APC = +28.6%), MenB (+22.6%), and measles (+3.4%). Regionally, varicella coverage rose by up to +58.4% in Emilia-Romagna and measles by +11.1% in Campania. During the pandemic, coverage declined for polio (−2.4% in the South) and measles (−6.2% in Abruzzo), while MenB increased in regions with lower initial uptake (r = −0.918, p < 0.001). Post-pandemic, coverage rebounded, with varicella improving by +20.1% in central regions and measles by +13.9% in Abruzzo. A strong inverse correlation between baseline coverage and improvement was observed for varicella across all periods (r from −0.877 to −0.915). Conclusions: Mandatory vaccination policies led to substantial coverage improvements, and despite the disruption caused by the pandemic, recovery trends were observed for most vaccines. The consistent association between low baseline coverage and stronger gains highlights the resilience of the system, but also the ongoing need for regionally tailored strategies to reduce geographic disparities and ensure equitable immunization across Italy. Full article

The global crude oil market, known for its pronounced volatility and nonlinear dynamics, plays a pivotal role in shaping economic stability and informing investment strategies. Contrary to traditional research focused on price forecasting, this study emphasizes the more investor-centric task of predicting returns for West Texas Intermediate (WTI) crude oil. By spotlighting returns, it directly addresses critical investor concerns such as asset allocation and risk management. This study applies advanced machine learning models, including XGBoost, random forest, and neural networks to predict crude oil return, and for the first time, incorporates sustainability and external risk variables, which are shown to enhance predictive performance in capturing the non-stationarity and complexity of financial time-series data. To enhance predictive accuracy, we integrate 55 variables across five dimensions: macroeconomic indicators, financial and futures markets, energy markets, momentum factors, and sustainability and external risk. Among these, the rate of change stands out as the most influential predictor. Notably, XGBoost demonstrates a superior performance, surpassing competing models with an impressive 76% accuracy in direction forecasting. The analysis highlights how the significance of various predictors shifted during the COVID-19 pandemic. This underscores the dynamic and adaptive character of crude oil markets under substantial external disruptions. In addition, by incorporating sustainability factors, the study provides deeper insights into the drivers of market behavior, supporting more informed portfolio adjustments, risk management strategies, and policy development aimed at fostering resilience and advancing sustainable energy transitions. Full article

Portfolio optimisation is a crucial decision-making task. Traditionally static, this problem is more realistically addressed as dynamic, reflecting frequent trading within financial markets. The dynamic nature of the portfolio optimisation problem makes it susceptible to rapid market changes or financial contagions, which may cause drifts in historical data. While reinforcement learning (RL) offers a framework that allows for the formulation of portfolio optimisation as a dynamic problem, existing RL approaches lack the ability to adapt to rapid market changes, such as pandemics, and fail to capture the resulting concept drift. This study introduces a recurrent proximal policy optimisation (PPO) algorithm, leveraging recurrent neural networks (RNNs), specifically the long short-term memory network (LSTM) for pattern recognition. Initial results conclusively demonstrate the recurrent PPO’s efficacy in generating quality portfolios. However, its performance declined during the COVID-19 pandemic, highlighting susceptibility to rapid market changes. To address this, an incremental recurrent PPO is developed, leveraging incremental learning to adapt to concept drift triggered by the pandemic. This enhanced algorithm not only learns from ongoing market data but also consistently identifies optimal portfolios despite significant market volatility, offering a robust tool for real-time financial decision-making. Full article

Decreases in animal mortality due to wildlife–vehicle collisions have been consistently documented as an environmental effect of human mobility restrictions aimed at containing the spread of the COVID-19 pandemic. In this study, we investigate this phenomenon on the mid-sized Mediterranean island of Lesvos, considering a multi-species group of mammals over a five-year systematic recording of animal casualties. We developed a method to analyze the relationship between actual casualties and risk, drawing inspiration from Markowitz’s theory on multi-asset optimization in economics. Additionally, we treated this phenomenon as a Poisson probabilistic process. Our main finding indicates that the lockdown year diverged markedly in modeled return–risk space, exhibiting a displacement on the order of 10² compared to the multi-year baseline—an outcome that reflects structural changes in risk dynamics, not a literal 100-fold decrease in observed counts. This modeled shift is significantly larger compared to published evidence regarding individual species. The results concerning the vulnerability of specific mammals, analyzed as a Poisson process, underscore the importance of singular events that can overshadow the overall systemic nature of the issue. We conclude that a promising strategy for addressing this problem is for conservationists to integrate animal-friendly measures into general human road safety policies. Full article

This study examines six decades (1964–2023) of changes in motor skills and body dimensions among Japanese 13-year-old students, analyzing grip strength, handball throwing, 50 m dash, endurance running, and composite scores. National Physical Fitness and Motor Skills Survey data were analyzed alongside School Health Examination Survey measurements to identify trends and correlations between performance metrics and anthropometric variables. The results revealed distinct developmental patterns, with motor skills peaking in the 1980s for both genders, followed by decline until 2000, after which boys experienced stagnation while girls showed improvement until 2019. Both genders demonstrated marked decreases following 2020, coinciding with the COVID-19 pandemic. Notably, while height increased significantly over the study period, only boys’ 50 m dash performance showed strong positive correlations with height (r = 0.779) and BMI (r = 0.854). This longitudinal analysis demonstrates how interdisciplinary factors—including educational policy shifts, reduced physical education curriculum hours, changes in urban park design, diminished outdoor play opportunities, and increased sedentary behaviors—collectively impact children’s motor development. These findings hold significant implications for public health initiatives and sports education strategies aimed at reversing concerning trends in youth physical capabilities and addressing the substantial post-pandemic decline in motor performance. Full article

The COVID-19 pandemic may have disproportionately affected forcibly displaced people due to parallel uncertainties such as visa insecurity and family separation. This study explicitly examined whether different sources of uncertainty contributed in specific ways to increased psychological symptoms for refugees during the pandemic. A large cohort of 733 refugees and asylum seekers settled in Australia completed a mental health survey in June 2020 (T1) and 12 months later in June 2021 (T2). Using cross-lagged panel modelling, we tested changes in post-traumatic stress (PTS), depression and anxiety symptoms, visa status, family separation and COVID-19 uncertainty stress, and the contribution of intolerance of uncertainty (trait prospective and inhibitory), controlling for age, sex, trauma exposure, language, and time in Australia. Visa status and family separation stress at T1 predicted increased depression (bidirectional pathways) and PTS symptoms at T2 (unidirectional pathways), respectively. Visa status uncertainty at T1 was also associated with increases in COVID-19 and family separation stress at T2. Intolerance of uncertainty showed limited associations with symptoms and stressors. Findings demonstrate that different forms of refugee uncertainty had specific impacts on psychopathology during the first year of the COVID-19 pandemic. Refugees facing diverse kinds of stress may benefit from individual, community, and policy level support targeted to their specific circumstances and mental health needs during future crises. Full article

Background/Objectives: This study introduces the Multi Group Cost Malmquist Index ($CM{g}_m$), a novel tool for comparing and ranking the cost efficiency of multiple groups of similar decision-making units operating in different contexts. It was applied to Greek public hospitals to assess productivity change between 2009 and 2021, covering the period before the economic recession and after the second lockdown during the COVID-19 pandemic. The study aimed to determine the impact of these external shocks on hospital efficiency and to identify differences in cost productivity based on hospital size and regional location. Methods: Data envelopment analysis was employed to compute the Malmquist indices for productivity change and ranking. Overall, 109 Greek public hospitals were analysed using three models: as a single group, classified by bed capacity, and classified by regional health authority (RHA). Cost productivity was decomposed into its core measures. Results: During the economic crisis, hospitals improved their cost productivity by 13.2%, whereas during the pandemic, it declined by 32.1%, primarily due to cost frontier deterioration resulting from increased healthcare demand and strained resources. Medium-sized hospitals exhibited higher cost efficiency than small and large hospitals. Regional disparities were also observed, with hospitals in the 5^th and 7^th RHAs outperforming those in 1^st and 2^nd RHAs. Conclusions: The findings highlight the pandemic’s disruptive impact on hospital cost productivity compared to the efficiency gains during the economic crisis. It is encouraging, though, that hospitals are recovering again after the lifting of strict lockdown measures. The $CM{g}_m$ is a valuable tool for policymakers, offering insights into hospital performance across multiple groups. Future healthcare policies should prioritise resource optimisation and address regional disparities to enhance system-wide efficiency and resilience in times of crisis. Full article