Search Results (3,778)

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

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

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: The social importance of health literacy (HL) is widely understood, and its measurement is the subject of various studies. Due to the recent pandemic, several instruments for measuring HL about COVID-19 have been proposed in different countries, including the HLS-COVID-Q22 questionnaire. The diversity of cultures and languages necessitates the cross-cultural adaptation of this instrument. Thus, the present study translates, adapts, and validates the psychometric properties of the HLS-COVID-Q22 questionnaire to provide its cross-cultural adaptation from English to Spanish (Peru). Methods: As part of ensuring that the final questionnaire accommodates the cultural nuances and idiosyncrasies of the target language, the following activities were carried out: (a) a survey of 40 respondents; and (b) a focus group with 10 participants, followed by expert approval. In addition, the validity and reliability of the health instrument have been ascertained through a further pilot test administered to 490 people in the city of Tacna in southern Peru. Results: The resulting questionnaire helps measure HL in Peru, aiding better-informed decision-making for individual health choices. Conclusions: The presence of such a tool is advantageous in case of similar global health emergencies, when the questionnaire can be made readily available to support a promotion of strategies towards better self-care. Moreover, it encourages other Latin American stakeholders to adjust the instrument to their own cultural, language, and socio-economic contexts, thus invigorating the regional and global expansion of the HL study network. Full article

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

This study examines whether regional infrastructure can predict economic resilience in European regions, focusing on resistance, recovery, and reorientation during the COVID-19 crisis. While infrastructure is widely recognized as a key factor influencing regional resilience, its explicit role has been underexplored in the European context. Using a comprehensive literature review and spatial econometric models applied to NUTS-2 level data from 2017 to 2024, we investigate the direct and spatial spillover effects of various infrastructure types—transportation, healthcare, tourism, education, and digital access—on regional resilience outcomes. We apply OLS and four spatial models (SEM, SLX, SDEM, SDM) under 29 spatial weighting matrices to account for spatial autocorrelation. Results show that motorway density, early school leaving, and healthcare infrastructure in neighbouring regions significantly affect resistance. For recovery, railway density and GDP per capita emerge as key predictors, with notable spatial spillovers. Reorientation is shaped by population structure, railway density, and tourism infrastructure, with both positive and negative spatial dynamics observed. The findings underscore the importance of infrastructure not only in isolation but also within regional systems, revealing complex interdependencies. We conclude that policymakers must consider spatial externalities and coordinate infrastructure investments to enhance regional economic resilience across interconnected Europe. Full article

Achieving sustainable development goals remains a core issue in global development. In response, China has proposed the development of new quality productive forces (NQPFs) through innovative thinking, emphasizing that fostering NQPFs is both an intrinsic requirement and a pivotal focus for advancing high-quality development. Concurrently, the intelligent transformation of the manufacturing sector serves as a critical direction for China’s economic restructuring and upgrading. This paper places “new quality productive forces” and “intelligent transformation of manufacturing” within the same analytical framework. Starting from the logical chain of “new quality productive forces—three major mechanisms—intelligent transformation of manufacturing,” it concretizes the value implications of new quality productive forces into a systematic conceptual framework driven by the synergistic interaction of three major mechanisms: the mechanism of revolutionary technological breakthroughs, the mechanism of innovative allocation of production factors, and the mechanism of deep industrial transformation and upgrading. This study constructs a “3322” evaluation index system for NQPFs, based on three formative processes, three driving forces, two supporting systems, and two-dimensional characteristics. Simultaneously, it builds an evaluation index system for the intelligent transformation of manufacturing, encompassing intelligent technology, intelligent applications, and intelligent benefits. Using national time-series data from 2012 to 2023, this study assesses the development levels of both NQPFs and the intelligent transformation of manufacturing during this period. The study further analyzes the impact of NQPFs on the intelligent transformation of the manufacturing sector. The research results indicate the following: (1) NQPFs drive the intelligent transformation of the manufacturing industry through the three mechanisms of innovative allocation of production factors, revolutionary breakthroughs in technology, and deep transformation and upgrading of industries. (2) The development of NQPFs exhibits a slow upward trend; however, the outbreak of the pandemic and Sino-US trade frictions have caused significant disruptions to the development of new-type productive forces. (3) The level of intelligent manufacturing continues to improve; however, from 2020 to 2023, due to the impact of the COVID-19 pandemic and Sino-US trade conflicts, the level of intelligent benefits has slightly declined. (4) NQPFs exert a powerful driving force on the intelligent transformation of manufacturing, exerting a significant positive impact on intelligent technology, intelligent applications, and intelligent efficiency levels. Full article

This study evaluates the risk-adjusted performance of Hospitality REITs using multi-factor asset pricing models and downside risk measures with the aim of assessing their diversification potential and crisis sensitivity. Unlike prior studies that examine REITs in aggregate, this study isolates Hospitality REITs to explore their unique cyclical and macroeconomic sensitivities. This study looks at the risk-adjusted performance of Hospitality Real Estate Investment Trusts (REITs) in relation to more general REIT indexes and the S&P 500 Index. The study reveals that monthly returns of Hospitality REITs increasingly move in tandem with the stock markets during financial crises, which reduces their historical function as portfolio diversifiers. Investing in Hospitality REITs exposes one to the hospitality sector; however, these investments carry notable risks and provide little protection, particularly during economic upheavals. Furthermore, the study reveals that Hospitality REITs underperform on a risk-adjusted basis relative to benchmark indexes. The monthly returns of REITs show significant volatility during the post-COVID-19 era, which causes return-to-risk ratios to be below those of benchmark indexes. Estimates from multi-factor models indicate negative alpha values across conditional models, indicating that macroeconomic variables cause unremunerated risks. This industry shows great sensitivity to market beta and size and value determinants. Hospitality REITs’ susceptibility comes from their showing the most possibility for exceptional losses across asset classes under Value at Risk (VaR) and Conditional Value at Risk (CvaR) downside risk assessments. The findings have implications for investors and portfolio managers, suggesting that Hospitality REITs may not offer consistent diversification benefits during downturns but can serve a tactical role in procyclical investment strategies. Full article

This study examines the impact of free trade zone (FTZ) establishment on regional economic resilience (RER) in China, using provincial-level panel data spanning from 2010 to 2022 and a multi-period difference-in-differences (DID) approach. The empirical results indicate that FTZ implementation significantly enhances regional economic resilience by 3.46%, with the development of green finance acting as a key moderating mechanism that amplifies this positive effect. Heterogeneity analysis uncovers notable disparities across policy cohorts and geographical regions: the first wave of FTZs demonstrates the most pronounced resilience-enhancing impact, whereas later cohorts exhibit weaker or even adverse effects. Coastal regions experience substantial benefits from FTZ policies, in contrast to statistically insignificant outcomes observed in inland areas. These findings suggest that strategically expanding the FTZ network, when paired with tailored implementation mechanisms and the integration of green finance, could serve as a powerful policy tool for post-COVID economic recovery. Importantly, by strengthening economic resilience through institutional openness and green investment, this study offers valuable insights into balancing economic growth with environmental sustainability. It provides empirical evidence to support the optimization of FTZ spatial governance and institutional innovation pathways, thereby contributing to the pursuit of sustainable regional development. Full article

Background/Objectives: Access to health services is often limited due to socio-economic and organizational determinants of health systems, which lead to increased unmet healthcare needs. This study aimed to identify access barriers for the general population in Greece, including those that may have emerged following the COVID-19 pandemic. Methods: This was a cross-sectional survey of 1002 Greek citizens. A questionnaire regarding socio-demographics, healthcare utilization, and access to health services was used. Interviews took place between October and November 2022. Results: Of 837 participants who used health services in 2022, 82.6% had a medical consultation, 80.6% took diagnostic tests, and 63.6% visited a pharmacy for pharmaceuticals. Of those having a medical consultation, 33.1% did so at an NHS health unit, while 75% of the participants taking diagnostic tests visited a contracted private laboratory. Out of the 135 participants requiring hospitalization, 62% were hospitalized in a public hospital, while 85% of the participants requiring pharmaceuticals visited a private pharmacy. Access barriers in the past year were reported by 48% of the participants requiring a medical consultation, 34% of the participants requiring diagnostic tests, and 40% of the participants requiring hospitalization. The most common barriers were long waiting times and financial constraints. The main barrier to accessing pharmaceuticals was the availability and administration of the product. Conclusions: The identified healthcare access barriers highlight the vulnerabilities of the current health system in Greece, which were further exposed during the COVID-19 pandemic crisis. Addressing socioeconomic factors that are considered key access indicators should be the focus of future health policy initiatives. Full article

Background/Objectives: In late 2019, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) caused a pandemic called the ‘coronavirus disease 2019’ (COVID-19). After the acute SARS-CoV-2 infection, many individuals (up to 33%) complained of unexplained symptoms involving multiple organ systems and were diagnosed as having Long COVID-19 (LC-19). Currently, LC-19 is inadequately defined, requiring the formation of consistent diagnostic parameters to provide a foundation for ongoing and future studies of epidemiology, risk factors, clinical characteristics, and therapy. LC-19 represents a significant burden on multiple levels. The reduced ability of workers to return to work or compromised work efficiency has led to consequences at national, economic, and societal levels by increasing dependence on community services. On a personal scale, the isolation and helplessness caused by the disease and its subsequent impact on the patient’s mental health and quality of life are incalculable. Methods: In this paper, we used Walker and Avants’ eight-step approach to perform a concept analysis of the term “Long COVID-19” and define its impact across these parameters. Results: Using this methodology, we provide an improved definition of LC-19 by connecting the clinical symptomology with previously under-addressed factors, such as mental, psychological, economic, and social effects. This definition of LC-19 features can help improve diagnostic procedures and help plan relevant healthcare services. Conclusions: LC-19 represents a complex and pressing public health challenge with diverse symptomology, an unpredictable timeline, and complex pathophysiology. This concept analysis serves as a tool for improving LC-19 definition, but it remains a dynamic disease with evolving diagnostic and therapeutic approaches, requiring deeper investigation and understanding of its long-term effects. Full article

People living with HIV (PLWH) faced diverse challenges during the COVID-19 pandemic, including disruptions to care, housing instability, emotional distress, and economic hardship. This study used graph-based clustering methods to analyze pandemic-era experiences of PLWH in a national sample from the NIH’s All of Us dataset (n = 242). Across three graph configurations we identified consistent subgroups shaped by social connectedness, housing stability, emotional well-being, and engagement with preventive behaviors. Comparison with an earlier local study of PLWH in Illinois confirmed recurring patterns of vulnerability and resilience while also revealing additional national-level subgroups not observed in the smaller sample. Subgroups with strong social or institutional ties were associated with greater emotional stability and proactive engagement with COVID-19 preventive behaviors, while those facing isolation and structural hardship exhibited elevated distress and limited engagement with COVID-19 preventive measures. These findings underscore the importance of precision public health strategies that reflect the heterogeneity of PLWH and suggest that strengthening social support networks, promoting housing stability, and leveraging institutional connections may enhance pandemic preparedness and HIV care in future public health crises. Full article

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has posed substantial health threats and triggered widespread global economic disruption. The nucleocapsid (N) protein of SARS-CoV-2 is not only a key structural protein but also instrumental in mediating the host immune response, contributing significantly to inflammation and viral pathogenesis. Due to its immunogenic properties, SARS-CoV-2 N protein also interacts with host factors associated with various pre-existing inflammatory conditions and may possibly contribute to the long-term symptoms suffered by some COVID-19 patients after recovery—known as long COVID. This review provides a comprehensive overview of recent advances in elucidating the biological functions of the N protein. In particular, it highlights the mechanisms by which the N protein contributes to host inflammatory responses and elaborates on its association with long COVID and pre-existing inflammatory disorders. Full article

The COVID-19 pandemic fundamentally disrupted assumptions about entrepreneurship, career planning, and professional development. This study explored how the pandemic influenced the entrepreneurial intentions of undergraduate business students in the United States. Using a qualitative methodology based on in-depth interviews with 31 students at a public Midwestern university, the research interpreted student narratives through the lenses of effectuation theory, resilience theory, and the theory of planned behavior. Findings revealed that many participants reframed entrepreneurship as a strategy for navigating economic uncertainty and enhancing personal agency. Students reported valuing adaptability, resourcefulness, and opportunity recognition, often experimenting with side hustles during the pandemic as a means of resilience. Their entrepreneurial thinking shifted from purely economic motivations toward aspirations for flexibility, self-fulfillment, and purposeful work. The study highlights the formative role of crisis contexts in shaping entrepreneurial identity among emerging professionals. It suggests that entrepreneurship education should move beyond traditional models, fostering skills for navigating complexity and building resilience. In doing so, the findings contribute to broader conversations about youth entrepreneurship, post-pandemic career development, and the evolving demands of the labor market in times of disruption. Full article

Economically, all countries seek sustained growth driven by domestic demand, investment, and exports; however, COVID-19 revealed the vulnerability of interconnected economic systems and a sharp contraction in global trade. The objective of this research is to analyze through an econometric model the effect of traditional exports on Peru’s economic growth during the 2012–2023 period. The study employed a quantitative approach with a non-experimental, longitudinal design, using quarterly data from the Central Reserve Bank of Peru and the National Bureau of Statistics of China, which were transformed into natural logarithms. Unit root tests, the ordinary least squares (OLS) method and a two-stage least squares (2SLS) model were applied to correct for endogeneity. The results show that mining accounts for 81.7% of total traditional exports from Peru. The model indicated that a 1% increase in traditional exports leads to a 0.29% increase in GDP, confirming a positive impact. However, the high dependence of the mining sector exposes the economy to external risks. Therefore, a productive diversification strategy, alongside the modernization of the mining sector, is recommended to strengthen Peru’s economic resilience in the face of global crises and external fluctuations. Full article