Search Results (47,085)

Background: Tranexamic acid is an antifibrinolytic medication often used to prevent hemorrhage. The dosage and route of administration can vary depending on specialty and indication, although one of the most common routes includes intravenous application. Other possible administration modalities include intramuscular and topical applications or irrigation. Although not the most common method, more research is emerging on the topical application of the drug to prevent bleeding. Methods: Specific search terms regarding the topical administration of tranexamic acid were input into PubMed and were reviewed via Covidence. Selected studies were stratified based on specialty (ears, nose, and throat; cardiology; plastic surgery; and orthopedics), and hematologic outcomes regarding tranexamic acid use were reviewed. Results: An evaluation of the studies demonstrated the feasibility of tranexamic acid in the topical form; however, it can depend on the specialty-specific indications. Each field utilizes unique procedures or surgeries, which can play a role in the effectiveness of the medication. Conclusions: While the current literature demonstrates the feasibility of tranexamic acid, further research is needed to understand its viability in other fields, such as obstetrics. Full article

This study explores the estimation of the mean of a sensitive variable using calibration estimators under measurement error. Three randomized response techniques are evaluated: Partial Randomized Response Technique, Compulsory Randomized Response Technique, and Optional Randomized Response Technique. Theoretical properties of the proposed estimators are analyzed, and a simulation study using real COVID-19 infection data is conducted. Results indicate that the Optional Randomized Response Technique outperforms Partial Randomized Response Technique and Compulsory Randomized Response Technique in terms of efficiency, underscoring its effectiveness and practical utility for improving data quality in sensitive survey settings. Full article

In this paper we aimed to compare seasonality, clinical characteristics, and outcomes of Influenza A and COVID-19 in the context of influenza reemergence and ongoing Omicron circulation. We performed a retrospective comparative analysis at the Teaching Hospital of Infectious Diseases in Cluj-Napoca, Romania. We included adult patients hospitalized with Influenza A or COVID-19 between 1 November 2022 and 31 March 2024. Data were collected on demographics, clinical presentation, complications, and in-hospital mortality. We included 899 COVID-19 and 423 Influenza A patients. The median age was 74 years for COVID-19 and 65 for Influenza A (p < 0.001). The age-adjusted Charlson comorbidity index was higher in COVID-19 patients (5 vs. 3, p < 0.001). Despite this age gap, acute respiratory failure was more common in Influenza A (62.8% vs. 55.7%, p = 0.014), but ventilation rates did not differ significantly. Multivariate models showed Influenza A was associated with increased risk of intensive-care unit (ICU) admission or ventilation, whereas older COVID-19 patients had higher in-hospital mortality (5.67% vs. 3.3%, p = 0.064). Omicron COVID-19 disproportionately affected older patients with comorbidities, contributing to higher in-hospital mortality. However, Influenza A remained a significant driver of respiratory failure and ICU admission, underscoring the importance of preventive measures in high-risk groups. Full article

Background/Objective: Nursing and non-nursing students experience high stress levels, making them susceptible to mental health issues. This study compared stress, anxiety, and depression between these two groups after 2 years of the COVID-19 pandemic. Additionally, it explored the relationship between perceived helplessness, self-efficacy, and symptoms of mental stress and strain resulting from challenging internship conditions for nursing students. Methods: This cross-sectional study included 154 nursing students (mean age = 22.43 years) and 291 non-nursing students (mean age = 27.7 years). Data were collected using the Depression Anxiety Stress Scales (DASS-21), Perceived Stress Scale-10 (PSS-10), and a questionnaire on mental stress and strain. Results: Nursing students reported significantly higher scores in the DASS-21 subscales depression (ηp² = 0.016) and anxiety (ηp² = 0.037), and global stress (PSS-10; ηp² = 0.029) compared to non-nursing students, but no significant difference on the DASS-21 Stress subscale. The observed group differences in the present study may be partially attributed to group differences in demographic factors. Helplessness correlated strongly with nearly all scales of mental stress and strain during internships (all p’s < 0.001), while self-efficacy showed a strong negative correlation with non-occupational difficulties, health impairment, and emotional problems (all p’s < 0.001). Conclusions: Nursing students experience elevated depression, anxiety, and perceived stress levels compared to non-nursing students. Stronger feelings of helplessness and lower confidence in their ability to overcome challenges were strongly correlated with mental stress and strain during clinical training. Targeted interventions such as cognitive behavioral training and stress management should be integrated into nursing curricula to enhance resilience and coping strategies. Full article

Background/Objectives: The COVID-19 pandemic caused pronounced disorder in healthcare delivery globally, including ophthalmology. Our study explores how ophthalmologists in Puerto Rico (PR) altered their practices during the pandemic, confronting obstacles such as resource shortages, evolving public health mandates, and unique socio-economic and geographic constraints. The study aims to enhance preparedness for future public health crises. Methods: We conducted descriptive analyses on four online surveys distributed at crucial time points of the pandemic (March 2020, May 2020, August 2020, August 2021) to all practicing ophthalmologists in PR (N ≈ 200), capturing data on closures, patient volume, personal protective equipment (PPE) access, telemedicine use, and financial relief. Results: Survey responses ranged from 41% (n = 81) to 56% (n = 111). By March 2020, 22% (24/111) of respondents closed their offices. By May 2020, 20% (19/93) of respondents maintained a closed office, while 89% (64/72) of open offices reported seeing less than 25% of their usual patient volume. Access to PPE was a challenge, with 59% (65/111) reporting difficulty obtaining N95 masks in March 2020. Telemedicine usage increased initially, peaking in May 2020 and declining in July 2020. By August 2021, all respondents were fully vaccinated and most practices returned to pre-pandemic levels. Overall, 86% (70/81) of respondents found the surveys to be useful for navigating practice changes during the pandemic. Conclusions: PR ophthalmologists showed adaptability during the COVID-19 pandemic to maintain care given limited resources. Guidelines from professional organizations and real time surveys play an important role in future crisis preparedness. Full article

High-dimensional prediction problems with complex non-linear feature interactions present significant algorithmic challenges in machine learning, particularly when dealing with imbalanced datasets and multicollinearity issues. This study proposes an innovative Shapley Additive Explanations (SHAP)-enhanced machine learning framework that integrates SHAP with advanced ensemble methods for interpretable financialization prediction. The methodology simultaneously addresses high-dimensional feature selection using 40 independent variables (19 CSR-related and 21 financialization-related), multicollinearity issues, and model interpretability requirements. Using a comprehensive dataset of 25,642 observations from 3776 Chinese A-share companies (2011–2022), we implement nine optimized machine learning algorithms with hyperparameter tuning via the Hippopotamus Optimization algorithm and five-fold cross-validation. XGBoost demonstrates superior performance with 99.34% explained variance, achieving an RMSE of 0.082 and R² of 0.299. SHAP analysis reveals non-linear U-shaped relationships between key predictors and financialization outcomes, with critical thresholds at approximately 10 for CSR_SocR, 1.5 for CSR_S, and 5 for CSR_CV. SOE status, EPU, ownership concentration, firm size, and housing prices emerge as the most influential predictors. Notable shifts in factor importance occur during the COVID-19 pandemic period (2020–2022). This work contributes a scalable, interpretable machine learning architecture for high-dimensional financial prediction problems, with applications in risk assessment, portfolio optimization, and regulatory monitoring systems. Full article

The COVID-19 pandemic was a profoundly influential global occurrence in recent history, impacting daily life, economics, and healthcare systems for an extended period. The abundance of data has been essential in creating models to simulate and forecast the dissemination of infectious illnesses, aiding governments and health organizations in making educated decisions. This research primarily focuses on designing a control technique that incorporates the five most important inputs that impact the spread of COVID-19 on the Romanian territory. Quantitative analysis and data filtering are two crucial aspects to consider when developing a mathematical model. In this study the transfer function principle was used as the most accurate method for modeling the system, based on its superior fit demonstrated in a previous study. For the control strategy, a PI (Proportional-Integral) controller was designed to meet the requirements of the intended behavior. Finally, it is showed that for such complex models, the chosen control strategy, combined with fine tuning, led to very accurate results. Full article

This study estimates the prevalence of co-use of alcohol and cannabis, assesses the sociodemographic risk factors of co-use, and examines the associations between mental health and heavy episodic drinking (HED) and alcohol–cannabis co-use in Canada during the early years of the COVID-19 pandemic. Nine successive cross-sectional surveys, held from May 2020 to January 2022, of adults (aged ≥18 years) living in Canada were pooled for 9011 participants. The prevalence of co-use was calculated across sociodemographic groups. Logistic regressions were used to assess associations. Alcohol–cannabis co-use was associated with a greater likelihood of engaging in HED and experiencing symptoms of anxiety, depression, and loneliness. The prevalence of co-use of alcohol was different across sociodemographic groups. The highest prevalence was among TGD people (35.5%), followed by individuals aged 18–39 years (14.5%). Additionally, being TGD (aOR = 3.61, 95% CI 2.09–6.25), separated/divorced/widowed (aOR = 1.60, 95% CI 1.23–2.07), living in an urban area (aOR = 1.26, 95% CI 1.07–1.56), and having a high household income (aOR = 1.41, 95% CI 1.09–1.82) increased the likelihood of reporting alcohol–cannabis co-use. These findings underscore the fact that developing public health and clinical interventions for preventing and treating excessive alcohol or cannabis use must consider both alcohol and cannabis use patterns and should be tailored to the highest-risk TGD and young adults. Full article

In this study, we investigate the return propagation mechanism, hedging effectiveness, and portfolio performance across several common agricultural commodities, crude oil, and S&P 500 index, ranging from July 2000 to June 2024 by using a time-varying parameter vector autoregression (TVP-VAR) connectedness approach and three common multiple assets portfolio optimization strategies. The empirical results show that, the total connectedness peaked during the 2008 global financial crisis, followed by the European debt crisis and the COVID-19 pandemic, while it remained relatively lower at the onset of the Russia-Ukraine conflict. In the transmission mechanism, commodities and S&P 500 index exhibit distinct and dynamic characteristics as transmitters or receivers. Portfolio analysis reveals that, with exception of the COVID-19 pandemic, all three dynamic portfolios outperform the S&P 500 benchmark across major global crises. Additionally, the minimum correlation and minimum connectedness strategies are superior than transitional minimum variance method in most scenarios. Our findings have implications for policymakers in preventing systemic risk, for investors in managing portfolio risk, and for farmers and agribusiness enterprises in enhancing economic benefits. Full article

Background/Objectives: Cognitive impairment in older adults has emerged as a growing public health concern, particularly in relation to COVID-19 infection and its associated neuropsychiatric symptoms. The identification of modifiable risk factors may contribute to the development of targeted preventive strategies. This study aimed to assess predictors of cognitive impairment in older adults with and without recent SARS-CoV-2 infection. Methods: A prospective cohort study was conducted from June 2023 to March 2024 at a tertiary hospital in western Mexico. Adults aged 65 years or older with confirmed SARS-CoV-2 infection within the previous six months, along with uninfected controls, were enrolled. Cognitive function (Mini-Mental State Examination), depression (PHQ-9), anxiety (Geriatric Anxiety Inventory), insomnia (Insomnia Severity Index), functional status (Katz Index and Lawton–Brody Scale), and laboratory markers were evaluated at baseline, three months, and six months. The primary outcome was cognitive impairment at six months. Independent predictors were identified using a multivariable generalized linear mixed-effects model. Results: Among the 111 participants, 20 (18.8%) developed cognitive impairment within six months. Low serum magnesium (adjusted risk ratio [aRR] 2.73; 95% CI 1.04–7.17; p = 0.041) and depression (aRR 5.57; 95% CI 1.88–16.48; p = 0.002) were independently associated with a higher risk. A significant synergistic among COVID-19, depression, and hypomagnesemia was observed (RR 44.30; 95% CI 9.52–206.21; p < 0.001), corresponding to the group with simultaneous presence of all three factors compared to the group with none. Conclusions: Depression and hypomagnesemia appear to be independent predictors of cognitive impairment in older adults with recent COVID-19 infection. These findings suggest potential targets for prevention and support the implementation of routine neuropsychiatric and biochemical assessments in this population. Full article

The work presents a comprehensive analysis and costing of sugar beet cultivation in 2020–2022, for individual farms of the Lublin region. About 120 farms were analyzed. Based on this analysis, the criteria for a model farm were determined and adopted for the calculation of sugar beet production costs. ARIMA process modeling was performed, based on which forecasts were determined for several selected parameters. Customs tariffs introduced by the USA have a drastic impact on the economy. The effects of the COVID19 pandemic may also have a significant impact on the current market situation. Forecasting in the current geopolitical situation is very difficult because of the lack of stationarity of parameters. The financial result obtained by growers is mainly influenced by indirect costs absorbing 61.31% of total costs in 2020. In 2021 and 2022, indirect costs were 61.16% and 59.61% of production income, respectively. Among this group of costs, the largest share is accounted for by the costs of sowing services, sugar beet harvesting, and soil liming amounting from 14.27% to 15.92%. During the analyzed period, sugar beet cultivation remained profitable, with a production profitability index of 1.31 in 2020 and 2021, and 1.10 in 2022. The unit cost of production increased every year. In 2020, it was 14.27% and in 2021, it increased to 15.19%. The unit cost of production in 2022 was the highest, at 23.41%. Sugar beet cultivation is one of the profitable activities in agricultural production, but it is characterized by high production costs, which increased during the years analyzed (2020 to 2022), topping out at 90.87% of total revenue. The information and data presented in this study will be used in the development of a farmer-oriented application and will support the creation of an expert system for sugar beet growers. Cost forecasting will enable farmers to plan their production more effectively. Full article

Background: Coronavirus disease 2019 (COVID-19) has led to the expansion of the spectrum of invasive fungal infections beyond traditional immunocompromised populations. Although COVID-19-associated pulmonary aspergillosis is increasingly being recognised, COVID-19-associated mucormycosis remains rare, particularly in non-endemic regions. Concurrent COVID-19-associated invasive tracheobronchial aspergillosis and pulmonary mucormycosis with histopathological confirmation is exceedingly uncommon and poses significant diagnostic and therapeutic challenges. Case presentation: We report the case of a 57-year-old female with myelodysplastic syndrome who underwent haploidentical allogeneic haematopoietic stem cell transplantation. During post-transplant recovery, she developed COVID-19 pneumonia, complicated by respiratory deterioration and radiological findings, including a reverse halo sign. Bronchoscopy revealed multiple whitish plaques in the right main bronchus. Despite negative serum and bronchoalveolar lavage fluid galactomannan assay results, cytopathological examination revealed septate hyphae and Aspergillus fumigatus was subsequently identified. Given the patient’s risk factors and clinical features, liposomal amphotericin B therapy was initiated. Subsequent surgical resection and histopathological analysis confirmed the presence of Rhizopus microsporus. Following antifungal therapy and surgical intervention, the patient recovered and was discharged in stable condition. Conclusions: This case highlights the critical need for heightened clinical suspicion of combined invasive fungal infections in severely immunocompromised patients with COVID-19, even in non-endemic regions for mucormycosis. Early tissue-based diagnostic interventions and prompt initiation of optimal antifungal therapy are essential for obtaining ideal outcomes when co-infection is suspected. Full article

The emergence of SARS-CoV-2 variants highlights the urgent need for novel therapeutic strategies, particularly entry inhibitors that could efficiently prevent viral infection. Medicinal herbs and herbal combination formulas have long been recognized for their effects in treating infectious diseases and their antiviral properties, thus providing abundant resources for the discovery of antiviral candidates. While many candidates have been suggested to have antiviral activity against SARS-CoV-2 infection, few have been validated for their mechanisms, including possible effects on viral entry. This study aimed to identify SARS-CoV-2 entry inhibitors from medicinal herbs and herbal formulas that are known for heat-clearing and detoxifying properties and/or antiviral activities. A SARS-CoV-2 pseudoparticle (SARS-CoV-2pp) system was used to assess mechanism-specific entry inhibition. Our results showed that the methanol extract of Anemarrhena asphodeloides rhizome, as well as the water extracts of Cimicifuga foetida rhizome, Xiao Chai Hu Tang (XCHT), and Sheng Ma Ge Gen Tang (SMGGT), have substantial inhibitory effects on the entry of SARS-CoV-2pps into host cells. Given the observation that Cimicifuga foetida exhibited the most potent inhibition and is a constituent of SMGGT, we further investigated the major compounds of the herb and identified caffeic acid as a bioactive component for blocking SARS-CoV-2pp entry. Entry inhibition of Cimicifuga foetida and caffeic acid was validated on both wild-type and the currently dominant JN.1 strain SARS-CoV-2pp systems. Moreover, caffeic acid was able to both inactivate the pseudoparticles and prevent their entry into pretreated host cells. The results support the traditional use of these herbal medicines and underscore their potential as valuable resources for identifying active compounds and developing therapeutic entry inhibitors for the management of COVID-19. Full article

This study is the first to investigate the performance of ultraviolet germicidal irradiation (UVGI) in underfloor air distribution (UFAD) systems. A simplified mathematical model is developed to predict airborne pathogen transport and inactivation by upper room UVGI in UFAD spaces. The proposed model is substantiated for the SARS-CoV-2 virus as a simulated pathogen through a comprehensive computational fluid dynamics methodology validated against published experimental data of upper room UVGI and UFAD flows. Simulations show an 11% decrease in viral concentration within the upper irradiated zone when a 15 W louvered germicidal lamp is utilized. Finally, a case study on Mycobacterium tuberculosis (M. tuberculosis) bacteria is carried out using the validated simplified model to optimize the use of return air and UVGI implementation, ensuring acceptable indoor air quality and enhanced energy efficiency. Results reveal that the UFAD-UVGI system may consume up to 13.6% less energy while keeping the occupants at acceptable levels of M. tuberculosis concentration and UV irradiance when operated with 26% return air and a UVGI output of 72 W. Full article

The COVID-19 pandemic precipitated unprecedented social isolation measures, profoundly disrupting daily life, educational routines, and mental health worldwide. University students, already susceptible to psychological distress, encountered intensified challenges under remote learning and prolonged confinement. This longitudinal study examined fluctuations in anxiety and mood among 102 Brazilian university students during the pandemic, distinguishing between those solely engaged in academic pursuits and those simultaneously balancing work and study. Data collected via the Brunel Mood Scale and State-Trait Anxiety Inventory in April and July 2021 revealed that students exclusively focused on studies exhibited significant increases in depressive symptoms, anger, confusion, and anxiety, alongside diminished vigor. Conversely, participants who combined work and study reported reduced tension, fatigue, confusion, and overall mood disturbance, coupled with heightened vigor across the same period. Notably, women demonstrated greater vulnerability to anxiety and mood fluctuations, with socioeconomic disparities particularly pronounced among females managing dual roles, who reported lower family income. These findings suggest that occupational engagement may serve as a protective factor against psychological distress during crises, underscoring the urgent need for tailored mental health interventions and institutional support to mitigate the enduring impacts of pandemic-related adversities on the student population. Full article