Search Results (1,766)

The global rise in multidrug-resistant (MDR) fungal pathogens has positioned Candida auris and Candida glabrata as major threats to public health. In recent years, these pathogens have increasingly been reported beyond traditional hospital settings, including neonatal intensive care units, long-term care facilities, oncology wards, and post-pandemic critical care environments. International surveillance bodies, including the Centers for Disease Control and Prevention (CDC), European Centre for Disease Prevention and Control (ECDC), World Health Organization (WHO), and regional monitoring networks, have documented escalating antifungal resistance, complex outbreak dynamics, and persistent gaps in infection control implementation. C. auris has emerged as a major etiological agent of healthcare-associated outbreaks, particularly in intensive care and neonatal units. Surveillance data indicate that a high proportion of C. auris isolates exhibit resistance to azoles, often exceeding 80% in some regions, while echinocandin resistance remains variable. Resistance patterns have evolved from predominantly azole resistance to broader multidrug-resistant phenotypes, including treatment-emergent echinocandin resistance. Six genetically distinct clades (I–VI) have been identified, with Clades I, III, and IV associated with large-scale outbreaks, whereas available data suggests that Clades II, V, and VI are more geographically restricted, although evidence for the recently described clades remains limited. C. glabrata is increasingly recognized as a major cause of invasive candidiasis, with rising resistance reported across multiple regions. While reduced azole susceptibility was historically predominant, emerging evidence highlights rising dual azole–echinocandin resistance, adaptive microevolution during antifungal therapy, and biofilm-associated tolerance mechanisms. Despite these advances, significant gaps persist in global resistance surveillance and in the mechanistic understanding of virulence and antifungal adaptation. Current mitigation strategies include antifungal stewardship programs, expanded resistance testing, and strengthened surveillance systems. Advances in rapid diagnostic technologies such as matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) mass spectrometry, polymerase chain reaction (PCR)-based assays, and genomic surveillance have improved pathogen identification and outbreak detection, although accessibility remains limited in resource-constrained settings. This review examines emerging epidemiological, genomic, and antifungal resistance trends in C. auris and C. glabrata and highlights key priorities for improving diagnosis, surveillance, stewardship, and management of multidrug-resistant Candida infections. Full article

Highly pathogenic avian influenza (HPAI) is a lethal disease of poultry that has recently spilled over into mammals, including dairy cattle and humans, heightening concerns for livestock health, food security, and pandemic emergence. While vaccines that induce neutralizing antibodies against hemagglutinin and neuraminidase provide strain-specific protection, durable cross-subtype immunity requires T-cell responses targeting conserved internal antigens such as nucleoprotein (NP). To leverage these conserved targets, we utilized a previously engineered mosaic nucleoprotein (MNP) incorporating T-cell epitopes from thousands of influenza A virus (IAV) strains, conferring broad protection against epidemic (H3N2) and pandemic (H1N1) IAV in mice. Here, we tested whether precision adjuvancy could differentially imprint adaptive immunity to MNP in cattle. Combination formulations paired the carbomer-based nano-emulsion Adjuplex (ADJ) with either a STING agonist (cyclic dinucleotides; CdN) or a TLR4 agonist (glucopyranosyl lipid A; GLA) to program distinct inflammatory milieus. Both formulations elicited circulating IFN-γ–producing T cell responses and NP-specific antibodies in serum and milk. However, STING activation via CdN generated more potent and consistent cellular and humoral immunity than TLR4 engagement. These data demonstrate that selective activation of innate sensing pathways functionally imprints adaptive immune magnitude and quality in a large animal host. By advancing a broadly protective, T-cell-focused vaccine strategy in cattle, this work supports a One Health framework to mitigate H5N1 transmission risk at the human–animal interface. Full article

Zoonoses account for the majority of recognized mammalian viral spillover events, primarily originating from bats, rodents, and primates. Human activities have significantly accelerated these transmissions. This narrative review synthesizes the evolutionary, ecological, pathogen-related, and anthropogenic drivers of viral zoonotic spillover to identify critical leverage points for pandemic prevention. A narrative literature review was conducted. The analysis focused on factors enabling animal pathogens to transform into human pathogens, examining host species, pathogen traits, human–animal interactions, and environmental impacts. Pathogen transformation depends on host traits, contact frequency, and viral characteristics. Anthropogenic drivers—including livestock expansion, the bushmeat trade, wet markets, and the exotic pet industry—significantly elevate spillover risks. Effective pandemic prevention requires targeted interventions at the wildlife–livestock–human interfaces. A holistic, multidisciplinary collaboration between national governments and international organizations is essential to mitigate future risks. Full article

This study examines how energy market uncertainty affects corporate financial stability and whether environmental, social, and governance (ESG) performance mitigates this relationship. Using a panel of 168 non-financial Australian firms from 2011 to 2023, we employ a two-step system generalized method of moments (GMM) with extensive robustness checks. The results reveal three central findings. First, energy market uncertainty exerts a statistically significant and economically meaningful negative effect on corporate financial stability, indicating that heightened energy price volatility amplifies firms’ financial fragility. Second, ESG performance is positively associated with financial stability, suggesting that sustainability-oriented firms exhibit superior risk management and resilience. Third, ESG performance significantly attenuates the adverse impact of energy market uncertainty, providing strong evidence that ESG functions as an effective shock-absorbing mechanism. These findings are robust to alternative measures of financial stability and energy uncertainty, different lag structures, alternative estimation methods, and a wide range of subsample analyses. Further analyses show that the moderating role of ESG is not driven by a single pillar; rather, environmental, social, and governance dimensions jointly enhance firms’ capacity to withstand energy-related shocks. The buffering effect of ESG is stronger among high-ESG firms, in knowledge- and technology-intensive sectors, and during periods of heightened systemic stress such as the COVID-19 pandemic. Overall, the study provides novel firm-level evidence that ESG performance enhances corporate resilience to energy market uncertainty. The findings have important implications for policymakers, investors, and corporate managers seeking to strengthen financial stability in an era of elevated energy volatility and accelerating sustainability transitions. Full article

The COVID-19 pandemic exposed critical limitations in conventional screening protocols, particularly in high-traffic environments where rapid, accurate, and contactless health assessment became essential to mitigate transmission risks. In response, this study presents the development of an Artificial Intelligence-Enhanced Contactless Screening Kiosk (AICS-K) that integrates multimodal sensing, embedded systems engineering, and machine learning into a unified workflow. Utilizing a Raspberry Pi platform with computer vision, thermal sensing, QR-based contact tracing, and intelligent control logic, the system enables efficient real-time screening while minimizing human intervention. The proposed architecture demonstrates the potential of extensible, affordable AI-driven solutions for early signs detection and institutional health resilience. Full article

Background: Epidemiological alerts about the possible spread of different pathogens have highlighted the risk of international travelers contracting infectious diseases when visiting endemic areas. The role of travelers in disease transmission underscores the importance of pre-travel consultations, which provide critical information on health risks, vaccinations, and preventive measures. Understanding travelers’ risk perceptions and behaviors is essential for enhancing global health security in the post-pandemic era. Methods: A cross-sectional study (June 2023–January 2024) was conducted by administering an anonymous questionnaire at the Rome-Fiumicino Airport International Prophylaxis Clinic (USMAF-SASN). The questionnaire explored demographics, travel patterns, risk perceptions, vaccination behaviors, and sources of health information. Descriptive statistics and a multivariable logistic regression analysis were performed to identify low-risk perception predictors. Results: Among 217 participants, 89.8% were Italian, with a balanced representation of genders. The primary purpose of travel was tourism (61.6%), followed by work-related trip (23.1%). While 77.1% rated preventive measures as effective, 23.2% evaluated infection risk as low. Being male (aOR 3.63, 95% CI 1.37–9.61), and being a hotel user (aOR 6.27, 95% CI 2.43–16.15), was significantly associated with a lower risk perception. As expected, healthcare professionals and individuals using institutional healthcare sources showed a higher risk awareness. Vaccination uptake at the Airport Clinic was motivated by self-protection, vaccine confidence, and poor time flexibility to access local vaccination services, and last-minute plans, making the airport a more convenient option. Conclusions: Travelers’ risk perception is influenced by gender, profession, accommodation type, and information sources. Public health strategies should enhance health literacy, promote pre-travel consultations, and improve access to preventive services. Strengthening collaborations between health authorities, educational institutions, and the travel sector is key to mitigating health risks and ensuring global health security. Future interventions should address structural vaccination barriers and improve outreach to under-informed travelers. Full article

Quiet quitting is reported to be on the increase in the post-COVID pandemic workplace, especially among early-career Generation Z (Gen Z) employees. This trend poses serious challenges and could negatively affect organisational productivity, performance, and profitability. The purpose of this study is to evaluate the effects of mentoring and coaching on quiet quitting among graduate interns. This study also seeks to assess whether work engagement mediates this relationship and job insecurity moderates the mediated relationship between mentoring and coaching and quiet quitting via work engagement. Purposive and snowball sampling were used to recruit participants. Data were collected from 264 graduate interns employed in fixed-term internship programmes in South African organisations. The data was analysed using the SPSS PROCESS macro and SPSS Amos 30 graphics. The results showed that mentoring and coaching was significantly and negatively related to quiet quitting behaviours among graduate interns, and this negative relationship was partially mediated by work engagement. Furthermore, job insecurity moderated the mediated effect of mentoring and coaching on quiet quitting behaviours via work engagement. This study advances our understanding of how organisations can mitigate quiet quitting among graduate interns by integrating the social exchange theory and Job Demands–Resources model (JD-R). The practical implication for organisations is to capacitate line managers with technical, professional, and interpersonal skills to mentor and coach early-career Gen Z employees. Line manager mentoring and coaching will increase early-career Gen Z employees’ work engagement and subdue quiet quitting, which is reported to be on the rise among this generation. Full article

Why do pandemics keep emerging despite decades of surveillance and response? Paleopathology, the study of disease traces in ancient remains, has been revolutionized by ancient DNA (aDNA) analysis and next-generation sequencing (NGS). Reconstructing pathogen genomes from archaeological material enables the identification of extinct lineages, the refinement of disease chronologies, and the characterization of long-term host-pathogen co-evolution. This provides context for public health challenges, including the emergence of pandemics and antimicrobial resistance (AMR). Infectious diseases are increasingly understood as complex phenomena arising from biological, ecological, and sociopolitical forces. Integrating paleopathology, aDNA, and paleomicrobiology supports a deep-time syndemic framework, revealing how recurring biosocial drivers have structured infectious disease risk throughout history. Ancient resistome studies demonstrate that AMR predates modern antibiotic use, reframing resistance as an intrinsic ecological feature rather than solely a modern phenomenon. Coronavirus disease 2019 (COVID-19) reaffirmed how infection intersects with chronic disease, health system fragility, and social inequities. This review highlights how integrating evolutionary perspectives into One Health shifts surveillance from a reactive approach to upstream risk mitigation and spillover prevention. Full article

Objectives: The association between osteonecrosis (ON) and Coronavirus Disease of 2019 (COVID-19) was reported early during the pandemic. ON of the femoral head (ONFH) is particularly problematic, as it may destroy the joint and lead to arthroplasty, although early diagnosis and treatment might mitigate its progression. The aim of the present study was to quantify the prevalence of symptomatic and asymptomatic ONFH in patients with severe COVID-19 treated with high doses of corticosteroids during the first pandemic wave. Methods: For this prospective, observational, monocentric cohort study, patients were selected according to the risk factors described for severe acute respiratory syndrome coronavirus in 2002–2004 (SARS-1): young males (<61 years old), high cumulative cortisone doses (≥2 g), severe disease, and followed up clinically and with magnetic resonance imaging. ONFH was classified with the ARCO classification. Results: Out of 1944 patients admitted for COVID-19 from 23 February to 21 May 2020, 856 of 1944 were treated in ICU; 30/1944 were selected according to the inclusion criteria and 27 of 30 were enrolled. The mean age at admission was 54 years (range, 42–60). The mean dose of cumulative cortisone was 6.25 g (range, 2–16). A total of 4/27 (15%) patients had ONFH; only 2 of 4 (50%) were symptomatic, including 1 with multiple ON of major joints. Conclusions: A high-risk cohort of patients with COVID-19 and high doses of corticosteroids had a 15% rate of ONFH, and 2 years after the event, 50% of them were asymptomatic. For those patients, relying solely on clinical evaluation would risk underestimating ONFH, potentially influencing treatment and outcomes. Moreover, other joints might develop ON. The data collected in the present study can be considered for the management of long-COVID. The association between severe COVID-19, high doses of corticosteroids and ONFH suggests the need for focused clinical and magnetic resonance imaging, considering the high rate of asymptomatic patients. Full article

During the 2020–2021 period, increasingly complex models have been developed to understand the impact of containment measures, to predict pandemic trends, and then to optimally allocate the few vaccines available. The objective of this study is to demonstrate the application of a time-varying age-dependent SIRD model for developing a vaccination strategy and for better allocating resources. We used a time-varying age-dependent SIRD model to identify the best vaccination strategy considering the percentages of each age group to be vaccinated. Italian public data were used to estimate the model and perform simulations. Simulations were carried out every 15 days from 27 December 2020 to 27 June 2021. Our projections suggest vaccinating those over 89 before other age groups, following a decreasing pattern, to minimise deaths. The cost function of infected individuals returns more unstable results. In general, to minimise infected individuals, it is necessary to assign vaccines to the over-89 and under-30 age groups. Optimal allocation of the limited available vaccine dose is useful to mitigate transmission and to reduce the mortality associated with it. The application of the mathematical model can be very useful at the beginning of an epidemic caused by a new pathogen, a time when it is important to make optimal use of scarce resources, such as vaccines, to best limit the epidemic by using a standardised approach. Full article

Increasing opiate use and mental health problems among younger and older Latinos in urban US contexts prompted this investigation into the organizational resources that facilitate help-seeking efforts of Latinos in New York State (NYS). Guided by a Vulnerability Model and a framework of organizational enabling resources, this study used complementary longitudinal and cross-sectional designs. The longitudinal component examined changes in levels of organizational facilitators for Latino substance use disorder (SUD) help-seeking in Downstate NYS across three time periods, while the cross-sectional component compared post-pandemic facilitator levels across service types and regions. A convenience sample of 241 SUD clinicians participated in the longitudinal analysis. A sample of 150 clinicians whose practice information varied by location and service type participated in the post-pandemic cross-sectional comparisons. The findings revealed that the proportion of clinicians reporting organizational facilitation of Latino SUD help-seeking in Downstate NYS has diminished significantly from pre-pandemic levels, with little recovery. Cross-sectional analyses revealed no significant differences in clinician estimation of post-pandemic organizational resources by region or service type. The findings suggest that the organizational bulwarks against SUD and mental health problems are not sufficient to mitigate public health risk for NYS Latinos in the post-pandemic period. Recommendations informed by provider perspectives are discussed. Full article

At the global level, as well as in Lithuania, the risks associated with climate change and other emerging threats—such as war, radiation, and pandemics—are increasing, and adequate preparedness is necessary to avoid their negative consequences. Despite international and other strategic efforts to assess emerging threats, preparedness to adapt to them and to mitigate their impacts remains insufficient. Considering the insufficient level of preparedness of the country’s cities to cope with these threats, this article introduces a new, sustainable element of urban structure—a comprehensive territorial structural unit capable of functioning under adverse and hazardous conditions. The formation of this new urban complex is based on three core sustainability principles—social, ecological, and economic—alongside international and national urban planning experience. The newly proposed sustainable urban structural complex consists of a group of blocks with diverse building types bounded perimetrically by urban public transport streets connecting the complex with other urban areas. For the functionality of the complex, a structural element—a green core—is envisaged in its central part, intended to serve residents through recreation, social interaction, civil security, and other functions. Due to its functional characteristics, structure, autonomy, capacity to integrate with other urban structures, and other properties, this urban complex closely resembles a biological cell; thus, for semantic clarity, it is termed an urbocell (urban cell). This urbocell is integrated into the urban fabric of residential districts and the entire city, forming a sustainable spatial and urban structure suitable for safe living, working, and recreation. The article models potential structural elements of the urbocell—namely, selected urban block morphotypes—using the computational tool Autodesk Forma, the results of which may support more informed urban planning decisions for developing a more sustainable and climate-resilient urban environment. Full article

Globalization refers to the increasing density of economic, social, and technological interconnections on a global scale. In the healthcare industry, it simultaneously accelerates innovation and increases systemic vulnerabilities. This study aims to review and conceptually synthesise the main channels of impact: (1) pharmaceuticals, clinical development, and regulation; (2) supply chains and resilience; (3) service mobility (health tourism); (4) human resources and competencies; (5) digitalization, artificial intelligence (AI), and data governance; (6) ethics, law, and public policy; and (7) sustainability and climate change. The COVID-19 pandemic highlighted the risks associated with global interdependencies, particularly in supply chains, while also demonstrating the innovation-accelerating effects of knowledge sharing and international cooperation. Particular attention is given to artificial intelligence and digital health, which open up new potential for efficiency and quality improvement from research and development through diagnostics to healthcare organization, while simultaneously intensifying concerns related to data protection, cyber security, and liability. Telemedicine, platform-based systems, and real-world data may contribute to addressing the care needs of ageing societies, but only when supported by appropriate competencies and sound data governance. As global data flows intensify, the importance of data protection, bias mitigation, transparency, and accountability correspondingly increases. Through the cultural channels of globalization, health-conscious lifestyles and complementary approaches are also spreading, which we address in a brief, separate subsection. The guidelines of international organizations foster standardization; however, due to differences in local capacities and institutional environments, the effects are not homogeneous. In conclusion, the study emphasises the dual nature of globalization; it expands access and accelerates innovation, while at the same time creating new vulnerabilities—in supply chains, labour mobility, and data security—and, together with climate-related risks, generating complex adaptive pressures for the healthcare industry. Full article

Background: Older adults (aged 65 and older) faced a disproportionate burden of mortality during the COVID-19 pandemic, yet substantial geographical and sociodemographic disparities in vaccine uptake persisted within this vulnerable population. Objective: To examine the temporal dynamics of COVID-19 vaccination rates among older adults and investigate the association between vaccination uptake and neighborhood-level social determinants of health (SDOHs), including disability and poverty. Methods: COVID-19 vaccination data for older adult residents in Jefferson County, Kentucky, were obtained from the Kentucky Immunization Registry (KYIR). ZIP-code-level vaccination rates were calculated at three time points: 28 February 2021 (Q1), 31 May 2021 (Q2), and 31 May 2022 (Q6). The rates were linked to 2021 American Community Survey (ACS) ZIP code-level estimates of disability, poverty, and household composition. Two-dose COVID-19 vaccination rates stratified by race, ethnicity, and geographic region were used as outcome measures. Pearson correlation coefficients, bivariate, and multivariate linear models were used to estimate the association between COVID-19 vaccination rates and the SDOHs at the ZIP code level. Results: Among the estimated 139,222 older adults, overall two-dose vaccination rates rose from 22.4% in Q1 to 77.5% by Q6. Significant regional disparities were observed early in the campaign, with Q1 rates ranging from 12.6% in the Southwest to 35.4% in the Inner East county regions. Bivariate analyses showed ZIP-code-level disability and poverty rates were negatively associated with ZIP-code-level vaccination uptake in Q1 (disability slope: −0.38; 95% CI, −0.63 to −0.13; poverty slope: −0.36; 95% CI, −0.65 to −0.07). By Q6, the negative association between disability and vaccination had weakened significantly and was no longer statistically significant, while the negative association between poverty rate and vaccination rate remained persistent across all time points. Conclusions: The disability-associated gaps in older adults’ vaccination rates were dynamic and narrowed over time, whereas the poverty-associated gaps remained persistent and static. The low uptake observed among Black and Hispanic older adults in historically underserved areas suggests that understanding the specific factors that most negatively associate with vaccination rates in these populations, such as specific disabilities, may mitigate structural barriers. Future public health interventions should prioritize socioeconomically disadvantaged neighborhoods and account for the evolving association of functional impairments and healthcare access. Full article

Vietnam’s exports expanded dramatically from $14.5 billion in 2000 to $405 billion in 2024, elevating the country to the world’s 22nd largest exporter despite persistent global shocks. This paper introduces the application of the Causal Machine Learning Approach to Resilience Estimation (CLARE) to industry-level trade analysis, utilizing a comprehensive panel of 97 HS2 sectors from 2000 to 2024 (2425 observations) drawn from UN COMTRADE and WITS databases. We implement Double Machine Learning to estimate causal effects of the Global Financial Crisis (2008–2009) and COVID-19 pandemic (2020–2021) on export growth. Results reveal stark industry disparities: electrical machinery (HS85) exhibits exceptional resilience, fueled by 72% high-technology content and low product concentration, while knitted apparel (HS61) proves highly vulnerable. Fixed effect regressions substantiate core hypotheses: a 10-percentage-point increase in high-tech share elevates the resilience index by 0.031 points (approximately 4.1% relative to the sample mean); a one-standard-deviation reduction in product HHI (0.14 units) yields a 0.026-point gain (3.6% relative); and each additional FTA contributes 0.047 points (approximately 6.2% relative), with all estimates significant at conventional levels. Robustness encompassing alternative learners, detrended outcomes, and synthetic controls upholds findings. Policy recommendations center on accelerating high-tech global value chain integration—targeting semiconductors and electric vehicles—while optimizing CPTPP and EVFTA utilization (currently 35%) and mitigating US–China market concentration (45% of exports). These insights chart pathways for Vietnam’s Vision 2045 high-income ambition amid intensifying geopolitical and climate risks, providing a replicable framework for other export-reliant emerging economies. Full article