Search Results (2,941)

Background/Objectives: The COVID-19 pandemic has significantly intensified global concerns surrounding antimicrobial resistance (AMR), particularly in relation to tuberculosis (TB). In the European Union (EU), the reallocation of healthcare resources towards managing COVID-19 led to a de-prioritization of TB surveillance and control. This shift contributed to delays in TB diagnosis and treatment, creating conditions favorable for the emergence and spread of drug-resistant TB strains. This meta-analysis aims to assess epidemiological trends of drug-resistant TB across EU countries before, during, and after the pandemic and quantify the impact of COVID-19 on Mycobacterium tuberculosis resistance patterns. Methods: Data were obtained from the European Centre for Disease Prevention and Control (ECDC) covering 2015 to 2022. Following the TB incidence, the multidrug-resistant TB (MDR-TB) and rifampicin-resistant/MDR-TB (RR/MDR-TB) cases, as well as treatment success rates over 12- and 24-month periods, were analyzed. The analysis included 31 EU countries across three-time frames: pre-pandemic (2015–2019), pandemic onset (2020), and post-pandemic transition (2020–2022). Results: The pandemic was associated with a decrease in reported TB cases but a simultaneous increase in the proportion of MDR and RR/MDR cases. Treatment success rates showed a modest rise for 24-month regimens, while outcomes declined for 12-month therapies. Conclusions: These findings underscore the pandemic’s disruptive impact on TB control and highlight the need for renewed investment in diagnostic capacity, treatment access, and antimicrobial stewardship, in order to reduce antimicrobial resistance occurrence. Continued monitoring beyond 2022 is essential to fully understand long-term effects and inform future public health strategies. Full article

This study examines the key factors influencing the quality of distance learning in higher education during the COVID-19 pandemic, a period when online learning became the dominant mode of education. Using a descriptive method and a 26-item questionnaire, data were collected from a representative sample of 360 students in Vojvodina, Serbia. The factors analyzed include computer literacy and technology access (Ph1), students’ ability to balance life obligations with study demands (Ph2), and their motivation for distance learning (Ph3). The results show that 89% of students had adequate IT access, 47% were able to reconcile study and personal obligations, and 70% reported strong motivation. Correlation analysis confirmed a statistically significant positive relationship between all three factors and students’ perceptions of well-organized distance learning, thus supporting the main research hypothesis. Beyond these findings, this study interprets digital literacy as adaptability, time management as resilience, and motivation as value orientation and future thinking—core dimensions of sustainability competences outlined in the European GreenComp framework. Distance learning is therefore positioned not only as an emergency response but also as a transformative pedagogy that integrates brain (knowledge), hands (skills), heart (values), and spirit (purpose), contributing to sustainable and resilient higher education. Full article

Housing markets worldwide have undergone major disruptions during the COVID-19 period, raising questions about how systemic shocks reshape housing preferences and spatial structures. This study develops an integrated spatial framework to examine multi-dimensional housing market restructuring, combining global and local modelling with network-based submarket delineation. Using Shanghai as a case study, we compare pre- and post-pandemic conditions (2019 and 2023) to explore fluctuations in housing prices, shifts in attribute effects, and reconfiguration of submarkets. The results reveal highly differentiated market responses across space. A dual restructuring is observed: decentralisation within the urban core and reinforced integration of outer-peripheral areas into the metropolitan centre, suggesting a gradual transition from a monocentric system towards a more polycentric and context-dependent housing landscape. Methodologically, the study proposes a transferable framework for analysing spatial restructuring under systemic shocks. Empirically, it provides fine-grained evidence of housing market reconfiguration across spatial scales, offering practical insights for spatially informed urban planning and housing market management. Full article

This study investigates the causal impact of board governance structures on firm profitability. We develop the Board Structure Influence (BSI) index, a composite metric that captures board independence, diversity, and role distribution—which we conceptualize as three structural pillars of Separation, Variety, and Disparity—to provide a comprehensive measure of governance effectiveness. Using a Difference-in-Differences (DiD) framework centered on the COVID-19 pandemic as an exogenous shock, we identify firms with strong governance and top BSI quartiles and compare their financial performance—measured by net profit margin—against firms with weaker board structures. Our results demonstrate that firms with higher BSI scores experience a statistically significant increase in profitability post-COVID-19. A Causal Forest analysis further reveals that this positive effect is heterogeneous, with the largest firms benefiting most significantly from strong board governance. Robustness checks—including placebo tests, parallel trends validation, and a SUTVA test—affirm the credibility of our findings. This research highlights the strategic importance of board structure for firm resilience during crises. It provides management insights for corporate leaders, investors, and policymakers aiming to align governance reform with financial profitability. Full article

Background: Pediatric asthma is a multifactorial condition influenced by environmental, biological, and social determinants. The COVID-19 pandemic introduced new variables that may have affected the severity and management of asthma in children and adolescents, particularly through changes in healthcare access, treatment adherence, and exposure to environmental risk factors. Objective: To evaluate the association between asthma severity and various factors including nutritional status, corticosteroid use, COVID-19 vaccination, and pollutant exposure before and during the COVID-19 pandemic in a pediatric population. Methods: A retrospective analysis was conducted using 307 medical records of patients aged 3 to 17 years. Data collected included sociodemographic characteristics, nutritional indicators, history of corticosteroid use, vaccination status against COVID-19, and exposure to environmental pollutants. Asthma severity was assessed using the pulmonary score, and multiple statistical analyses, including logistic regression using the Bayesian Logistic Regression Model (BLRM), were employed to identify significant associations. Results: The analysis revealed a statistically significant impact of the pandemic on hospitalization rates (p = 0.0187) and the use of corticosteroids (p = 0.009), indicating changes in asthma management during this period. Notable differences were observed in the geographic distribution of mild versus severe asthma cases prior to the pandemic, associated with nutritional status and gender (p = 0.018). During the pandemic, breastfeeding history, body weight, and hospitalization emerged as significant predictors of asthma severity (p < 0.05). In addition, breastfeeding in young children (aged 3 to 6 years) and hospitalization were strongly associated with pulmonary scores, with significance values of 0.022 and 0.012, respectively, as identified by the BLRM. Conclusions: These findings suggest that the pandemic context influenced both the clinical course and management of pediatric asthma. Preventive strategies should consider individual and environmental factors such as nutrition, early-life health practices (e.g., breastfeeding), and equitable access to appropriate asthma care and vaccination. Tailoring pediatric asthma management to these variables may improve outcomes and reduce disparities in disease severity. Full article

Sectoral vulnerability to distinct crisis types in small, open, and geopolitically exposed markets—such as Jordan—remains insufficiently quantified, constraining targeted policy design and portfolio allocation. This study’s primary purpose is to establish a transparent, comparable metric of sector-level market resilience that reveals how crisis typology reorders vulnerabilities and shapes recovery speed. Applying this framework, we assess Jordan’s equity market across three archetypal episodes—the Global Financial Crisis, the Arab Spring, and COVID-19—to clarify how shock channels reconfigure sectoral risk. Using daily Amman Stock Exchange sector indices (2001–2025), we estimate $GARCH\left(\mathrm{1,1}\right)$ models for each sector–crisis window and summarize volatility dynamics by persistence $(\alpha +\beta )$, interpreted as an inverse proxy for resilience; complementary diagnostics include maximum drawdown and days-to-recovery, with nonparametric (Kruskal–Wallis) and rank-based (Spearman, Friedman) tests to evaluate within-crisis differences and cross-crisis reordering. Results show pronounced heterogeneity in every crisis and shifting sectoral rankings: financials—especially banking—display the highest persistence during the GFC; tourism and transportation dominate during COVID-19; and tourism/electric-related industries are most persistent around the Arab Spring. Meanwhile, food & beverages, pharmaceuticals/medical, and education recurrently exhibit lower persistence. Higher persistence aligns with slower post-shock normalization. We conclude that resilience is sector-specific and contingent on crisis characteristics, implying targeted policy and portfolio responses; regulators should prioritize liquidity backstops, timely disclosure, and contingency planning for fragile sectors, while investors can mitigate crisis risk via dynamic sector allocation and volatility-aware risk management in emerging markets. Full article

Office is one of the core sectors within the buildings sector, attracting tens of billions of dollars in global real estate investment flows. Most of these are achieved through non-listed investments, where office real estate represents one of the major sectoral investment exposures for many global institutional real estate investors and investment managers. The rising interest rates in recent years have been a significant concern, impacting the global real estate markets significantly. Based on these premises and by using quarterly total returns of non-listed office real estate across the US, UK, Germany, Canada, and Australia from June 2008 to June 2024, this research assesses the risk-adjusted performance and portfolio diversification benefits of non-listed office real estate across the five markets over both interest rate cut and interest rate hike cycles. The results empirically validate the added-value role of non-listed office real estate in institutional multi-asset portfolios across the UK, Germany, Canada, and Australia during the interest rate hike cycle preceding the COVID recession. In the 10% capped real estate allocation, the average allocation was 0.7% in the UK, 0.4% in Germany, 0.7% in Canada, and 9.1% in Australia. Over the interest rate hike cycle after the COVID recession, Australian non-listed office real estate offered enhanced benefits as part of the multi-asset portfolio, constituting an average of 0.8% in the capped real estate allocation. In the global non-listed office real estate portfolio, the US dominated the portfolio across varying interest rate cycles, with an average allocation of approximately 65%. The average allocation to Australia was 24.2% over the interest rate hike cycles, while the average allocation to Germany was 32.0% over the interest rate cut cycles. These findings offer institutional real estate investors and investment managers critical and practical insights into how the investment performance and portfolio construction strategy of office assets—an essential component of the buildings sector and a major non-listed real estate investment exposure for global institutional real estate investors—respond to macro-financial and interest rate cycles. The investment implications of the findings are also discussed. Full article

Background: Spontaneous retroperitoneal hematomas constitute a rare clinical entity, yet their incidence has markedly increased during the SARS-CoV-2 pandemic. The pathophysiological substrate is incompletely elucidated, being influenced by anticoagulant therapy, vascular inflammatory alterations induced by SARS-CoV-2 infection, and comorbidities in critically ill patients that exacerbate hemorrhagic risk. Methods: We performed a comprehensive literature review of published case reports and case series on spontaneous retroperitoneal hematomas in COVID-19 patients, complemented by our institutional experience, in order to synthesize current diagnostic and therapeutic approaches. Results: Available evidence indicates that most cases occur in anticoagulated patients, with clinical manifestations often limited to nonspecific abdominal or lumbar pain. Diagnosis relies primarily on contrast-enhanced CT imaging. Reported therapeutic strategies include conservative management, endovascular embolization, and surgical intervention, with outcomes ranging from complete recovery to fatal progression, particularly in elderly and comorbid individuals. Conclusions: Spontaneous retroperitoneal hematomas in the setting of SARS-CoV-2 infection represent a diagnostic and therapeutic challenge associated with considerable morbidity and mortality. Early recognition, prompt imaging, and individualized multidisciplinary management are essential, while further research is needed to clarify incidence, risk factors, and preventive strategies. Full article

This study is designed to investigate the dynamic risk transmission processes between clean energy ETFs and ESG indices in the BRICS countries—Brazil, India, China, and South Africa—while excluding Russia due to the lack of consistent data availability during the study period, which coincides with the Russia–Ukraine conflict. The analysis is conducted on daily data obtained from DataStream, spanning from 27 October 2021 to 5 January 2024. By applying a time-varying parameter vector autoregression (TVP-VAR) modeling framework, we considered examining the global market conditions and economic shocks’ effects on these indices’ interconnectedness, including COVID-19 and geopolitical tensions. In this context, clean energy ETFs turned out to stand as net shock transmitters throughout volatile market spans, while ESG indices proved to act as net receivers. Moreover, we undertook to estimate both of the minimum variance and minimum connectedness portfolios’ hedging efficiency and performance. The findings highlight that introducing clean energy indices into investment strategies helps boost financial outcomes while maintaining sustainability goals. Indeed, the minimum connectedness portfolio consistently delivers superior risk-adjusted returns across varying market circumstances. In this respect, the present study provides investors, regulators, and policymakers with practical insights. Investors may optimize their portfolios by integrating clean energy and ESG indexes, useful for achieving financial and sustainability aims. Similarly, regulators might apply the findings to establish reliable green investment norms and strategies. Thus, this work underscores the crucial role of dynamic portfolio management in optimizing risk and return in the globally evolving green economy. Full article

Background/Objectives: The COVID-19 pandemic disrupted healthcare systems globally, with dental services significantly limited due to infection control measures. This study investigates the impact of the pandemic on the clinical presentation, management, and outcomes of odontogenic abscesses over three distinct periods. Methods: A retrospective study was conducted at University Clinical Hospital (Poznan, Poland), which included adult patients hospitalised for odontogenic infections between March 2019 and February 2022. The cohort comprised 101 patients (median age: 33 years; 59.41% male), with admissions distributed across pre-pandemic (37.62%), pandemic (19.80%), and post-pandemic (42.57%) periods. Clinical, biochemical, and radiographic data were analysed. Results: No statistically significant differences were found between periods for abscess severity, hospitalisation length, or inflammatory marker levels. Elevated procalcitonin (Rs = 0.289, p = 0.005), C-reactive protein (Rs = 0.385, p < 0.001), and body mass index (Rs = 0.253, p = 0.011) independently predicted longer hospital stays. In regression modelling, procalcitonin (β = 0.464, p = 0.001) and prior outpatient antibiotic use (β = 0.281, p = 0.038) were mainly associated with larger abscess volumes, while comorbidities (β = 0.262, p = 0.025), longer hospitalisation (β = 0.594, p = 0.001) and abscess volume (β = −0.294, p = 0.040) increased the risk of reoperation. Conclusions: The study highlights clinically important findings linked to delayed dental care and increased systemic inflammation related to the pandemic. Elevated procalcitonin and CRP levels provide prognostic information that can guide early triage, risk stratification, and decisions regarding surgical versus outpatient management. These findings emphasise the importance of maintaining essential dental services, implementing preventive strategies, and optimising management protocols to reduce the risk of severe infections and improve patient outcomes during healthcare disruptions. Full article

Background/Objectives: Home healthcare assistants (HHCAs) play a vital role in supporting older adults to remain in their homes. Yet, this work is often performed under conditions of emotional strain, limited resources, and systemic undervaluation. This study answers the question, how do HHCAs cope with work-related stress? Methods: Undertaken during the COVID-19 pandemic, a period of heightened stress and mandated social distancing, online interviews were conducted with HHCAs (n = 10). Data were inductively analyzed and themes were identified. Results: It was found that amid experiences of fear, caregiver stress, grief, and exhaustion, HHCAs coped with resource, communication, and care challenges by relying on informal peer-managed communication systems with colleagues. Leveraging existing peer-support coping strategies, HHCAs negotiated caring for others while taking care of themselves alongside a care ecosystem under unprecedented strain. Conclusions: HHCAs are increasingly vital to front-line home health care amid global aging and a shift toward community-based services. Urgent organizational reform is needed to support their well-being, prevent stress, and avoid burnout. Research-informed sector-wide planning must ensure adequate resources to maintain high-quality home care in the face of rising demand and anticipated future health crises. Full article

Background/Objectives: The COVID-19 (Coronavirus Disease, 2019) pandemic affected all countries in a variety of ways, and forced policymakers to adapt national health infrastructure. In this context, the strategic adaptation and policy evolution of small island states are understudied. Therefore, the objective of this study was to quantitatively analyse the relationship between confirmed COVID-19 cases and health policy decisions in Northern Cyprus. We also examined the shifting management strategies employed during the pandemic using a replicable statistical analysis framework. Methods: In this mixed-methods study, we used systematic thematic analysis to categorise official policy decisions from March 2020 to December 2022. Yearly linear regression models using SPSS and Python correlated the monthly number of decisions with the number of confirmed COVID-19 cases. The analyses included R² values, p-values, and visualisations with 95% confidence intervals. Results: The findings of this study highlight a three-phase strategic period. In 2020, the results (R² = 0.03, p = 0.63) showed no significant relationship, indicating initial uncertainty. The results (R² = 0.60, p = 0.003) indicate a strong negative correlation in 2021, which reflects the consistency of the proactive suppression strategies adopted. Conversely, for 2022, the results (R² = 0.79, p < 0.001) show a strong positive correlation representing the shift to a reactive mitigation strategy, in which the government responded based on case peaks. Conclusions: This study’s primary finding is that strategic agility was key to managing the pandemic. For small island states in particular, the effectiveness of geographic advantages like border control depends on a coherent strategy that transcends initial uncertainty. Our data-driven framework provides a tool for analysing this strategic evolution and guiding responses to future pandemics. Full article

Background: Currently available immunological tests for SARS-CoV-2 assess only antibody responses. Despite the growing evidence that T cells play a crucial role in protection, especially against emerging viral variants, no routine test is available to determine T cell immunity. The prognostic value of SARS-CoV-2-specific antibodies for determining whether individuals are immune and protected against disease remains uncertain. This is in part due to the following: (a) specificity and limitations such as the sensitivity of antibody tests, and (b) the lack of correlation between antibody titers (quantity) and the antiviral function of antibodies (quality). Approximately a quarter of SARS-CoV-2-infected patients with symptoms fail to show seroconversion in serological assays. Methods: The current report describes the development and application of a whole-blood-based assay to detect previous exposure to SARS-CoV-2. Whole blood is stimulated with SARS-CoV-2-derived peptides identified during assay development and stimulation-induced cytokines quantified using a multiplex testing platform. The resulting cytokine profiles are generated using computational tools to identify previous exposure to the virus. Results: The application of the assay revealed a lack of self-awareness of individuals’ COVID-19 infection history and demonstrated the value of this new assay to assess the prevalence of SARS-CoV-2 exposure history and immunity in populations. Conclusions: Positive responses in this assay can facilitate the identification of underlying causes of unexplained symptoms and provide clinically actionable insights for healthcare applications, including in the continued conundrum of post-acute sequela of SARS-CoV-2 infection (PASC or “long COVID”), for which both diagnosis and management remain challenging. Full article

Background and Clinical Significance: Advanced pelvic organ prolapse (POP) associated with perineal herniation of pelvic and abdominal organs is a sporadic occurrence in gynaecological practice. Generally, POP affects up to 50% of multiparous women at some point during their lives. Advanced forms (grade III or IV) represent less than 10% of all cases, with severe grade IV prolapse occurring in fewer than 2% of patients. Case Presentation: We report the case of a 48-year-old nulliparous woman with no prior surgical history and no known medical conditions at presentation. The patient presented with severe grade IV POP (Baden–Walker Classification), characterised by abdominal pain, vaginal bleeding and significant urinary incontinence. A computed tomography scan was performed, revealing an extremely large perineal hernia, containing the uterus, urinary bladder, and small bowel loops—a rare finding with only isolated cases reported in the medical literature. Surgical treatment involved a total intracapsular hysterectomy with right-sided adnexectomy and colpoperineorrhaphy. After the surgery, the overall status of the patient was good. However, less than two months later, she returned, complaining of a recurrence of the initial pathology, and was diagnosed with grade II/III POP recurrence despite having no connective tissue disorders or other classical predisposing factors such as pregnancies, pelvic surgery history or obstetric trauma. The case was further complicated by a femoral neck fracture, stage V chronic kidney disease, COVID-19 pneumonia, and a Clostridium difficile infection. All these complications led to the postponement of the gynaecological reintervention procedure. Conclusions: We emphasise the significant challenges in managing this kind of perineal hernia, under unusual conditions and without common risk factors. A personalised, multidisciplinary approach is required, including careful follow-up to prevent early recurrence. Full article

This study examines the dynamic relationship between the gold markets of India and the United States from 2005 to 2025. Recognising gold’s role as a hedge and safe-haven during market uncertainty, we employ the Autoregressive Distributed Lag (ARDL) model to assess long-term co-integration and apply the Toda–Yamamoto causality test to evaluate directional influences. Additionally, the Generalised Autoregressive Conditional Heteroskedasticity (GARCH) (1, 1) model is applied to examine volatility spillovers. Results reveal no long-term co-integration between the two markets, suggesting they function independently over time. However, unidirectional causality is observed from the U.S. to the Indian gold market, and the GARCH model confirms bidirectional volatility transmission, indicating interconnected short-run dynamics. These findings imply that gold market shocks in one country may affect short-term pricing in the other, but not long-term trends. From a portfolio diversification and risk management perspective, investors may benefit from allocating assets across both markets. This study contributes a novel empirical framework by integrating ARDL, Toda–Yamamoto Granger causality, and GARCH(1, 1) models over a two-decade period (2005–2025), incorporating post-COVID market dynamics. The combination of these methods, applied to both an emerging (India) and developed (U.S.) economy, provides a comprehensive understanding of gold market interdependence. In doing this, the paper offers valuable insights into causality, volatility transmission, and diversification potential. The econometric rigour of the study is enhanced through residual diagnostic tests, including tests of normality, autocorrelation, and other heteroscedasticity tests, as well as VAR stability tests. These ensure strong inference and model validity; more specifically, they are pertinent to the analysis of financial time series. Full article