The COVID-19 pandemic has strained economies and health systems worldwide, particularly in low- and middle-income countries, where limited resources were further stretched by the crisis. In response, innovative strategies like wastewater-based epidemiology (WBE) have emerged as cost-effective and efficient alternatives to traditional surveillance. In Breede Valley Municipality, Western Cape, South Africa, weekly monitoring of wastewater treatment plants (WWTPs) showed consistently high SARS-CoV-2 viral loads in Rawsonville, especially of the Delta variant (AY.32 and B.1.617.2), despite Omicron's dominance in other regions. Total RNAs of all samples were extracted using the Qiagen RNeasy PowerSoil Kit, from which both RT-qPCR and whole genome sequencing were performed to determine the amount of SARS-CoV-2 RNA and their variants, respectively. Rawsonville had the highest median viral load, measured in genome copies per millilitre (gc/mL) at 2211 gc/mL, compared to Worcester (1790 gc/mL), De Doorns (1438 gc/mL), and Touws River (1253 gc/mL). Neighbourhoods in Rawsonville (RV) upstream of the main WWTP, where manholes were sampled, indicated that the suburban manhole on Grey Street (RV_G, 2347 gc/mL) and the peri-urban manhole on Rugby Street (RV_R, 714 gc/mL) were the primary contributors to the SARS-CoV-2 viral load. In contrast, the manhole near public toilets (RV_P, 470 gc/mL) had the lowest viral load. Notably, sequencing data indicated that only Omicron (BA.5) was detected in upstream sites RV_G and RV_R when Deltacron was present in Rawsonville, suggesting complex transmission dynamics requiring further study. These findings underscore the importance of targeted upstream surveillance to trace variant emergence and inform public health interventions.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) non-structural protein 13 (Nsp13) helicase is a multi-functional protein that can unwind dsDNA and dsRNA in an NTP-dependent manner. Given that this viral helicase is essential for viral replication and highly conserved among coronaviruses, a thorough understanding of the helicase's unwinding and binding activity may allow for the development of more effective pan-coronavirus therapeutics. Herein, we describe the use of genetic code expansion techniques to site-specifically incorporate the non-canonical amino acid (ncAA) p-azido-l-phenylalanine (AzF) into Nsp13 for fluorescent labelling of the enzyme with a conjugated Cy5 fluorophore. This Cy5-labelled Nsp13-AzF can then be used in Förster resonance energy transfer (FRET) experiments to investigate the dynamics of enzyme translocation on its substrate during binding and unwinding. Five sites (F81, F90, Y205, Y246, and Y253) were identified for AzF incorporation in Nsp13 and assessed for fluorescent labelling efficiency. The incorporation of AzF was confirmed to not interfere with the unwinding activity of the helicase. Subsequently, FRET-based binding assays were conducted to monitor the binding of Cy5-labelled Nsp13-AzF constructs to a series of fluorescently-labelled nucleic acid substrates in a distance-dependent manner. Overall, this approach not only allows for the direct monitoring of Nsp13's binding activity on its substrate, it may also introduce a novel method to screen for compounds that can inhibit this essential enzymatic activity during viral replication.

To assess the prevalence of SARS-CoV-2 antibodies in the residents of Kibera informal settlement in Nairobi, Kenya, before vaccination became widespread, and explore demographic and health-related risk factors for infection.

A cross-sectional study.

Kibera informal settlement, Nairobi, Kenya.

Residents of Kibera informal settlement between October 2019 and August 2021, age 1 year and above who reported no current symptoms of COVID-19.

Associations were determined between SARS-CoV-2 positive tests measured with one rapid test and two ELISAs and demographic and health-related factors, using Pearson's χ2 test. Crude OR and adjusted OR were calculated to quantify the strength of associations between variables and seropositive status.

A total of 438 participants were recruited. Most (79.2%) were age 18-50 years; females (64.2%) exceeded males. More than one-third (39.1%) were unemployed; only 7.4% were in formal, full-time employment. Less than one-quarter (22.1%) self-reported any underlying health conditions. Nearly two-thirds (64.2%) reported symptoms compatible with COVID-19 in the previous 16 months; only one (0.23%) had been hospitalised with a reported negative COVID-19 test. 370 (84.5%) participants tested positive in any of the three tests. There was no significant difference in SARS-CoV-2 seropositivity across age, sex, presence of underlying health conditions, on medication or those ever tested for SARS-CoV-2. Multiple logistic regression analysis showed that COVID-19 symptoms in the previous 16 months were the only significant independent predictor of seropositivity (p=0.0085).

High SARS-CoV-2 exposure with limited morbidity was found in the residents of Kibera informal settlement. The study confirms other reports of high SARS-CoV-2 exposure with limited morbidity in slum communities. Reasons cited include the high infectious disease burden on the African continent, demographic age structure and underreporting due to limited testing and lack of access to healthcare services; genetic factors may also play a role. These factors require further investigation.

The kinase-like nidovirus RdRp-associated nucleotidyl transferase (NiRAN) domain of nsp12 in SARS-CoV-2 catalyzes the formation of the 5' RNA cap structure. This activity is required for viral replication, offering a new target for the development of antivirals. Here, we develop a high-throughput assay to screen for small molecule inhibitors targeting the SARS-CoV-2 NiRAN domain. We identified NiRAN covalent inhibitor 2 (NCI-2), a compound with a reactive chloromethyl group that covalently binds to an active site cysteine (Cys53) in the NiRAN domain, inhibiting its activity. NCI-2 can enter cells, bind to, and inactivate ectopically expressed nsp12. A cryo-EM reconstruction of the SARS-CoV-2 replication-transcription complex bound to NCI-2 offers a detailed structural blueprint for rational drug design. Although NCI-2 showed limited potency against SARS-CoV-2 replication in cells, our work lays the groundwork for developing more potent and selective inhibitors targeting the NiRAN domain. This approach presents a promising therapeutic strategy for effectively combating COVID-19 and potentially mitigating future coronavirus outbreaks.

Contact tracing is an effective method for mitigating the infectious diseases spread and it played a crucial role in reducing COVID-19 outbreak. Since the pandemic, there has been an increased concern regarding people's health in hospital and office settings, as these limited air exchange spaces provide a conductive medium for virus spread. Various technologies were used to recognize close contacts autonomously, in addition, multiple machine learning attempts were carried out to determine proximity in contact tracing. This study, however, proposes a unique concept in contact tracing: forecasting future close contact prior to occurrence in order to regulate and control it rather than tracking past occurrences. For our research, we constructed a completely new real-life dataset that was collected during the pandemic in a hospital infectious ward (Alfred Hospital, Melbourne, Australia) utilizing a Bluetooth Low Energy (BLE) Internet of Things (IoT) system. Our prediction technique considers two types of environments: single transceiver environments and multiple transceivers settings, these transceivers record the nearby tags' BLE received signal strength indicator (RSSI) values. The system employs mathematical models and supervised machine learning (ML) algorithms to solve regression and classification problems for workers' pattern recognition within the environment. The output is compared using different metrics, such as efficiency, which reached more than 80%, root mean square errors and mean absolute errors which were as low as 2.4 and 1.2 respectively in some models.

The COVID-19 pandemic has had varying impacts across different regions, necessitating localised data-driven responses. SARS-CoV-2 was first identified in a person in Wuhan, China, in December 2019 and spread globally within three months. While there were similarities in the pandemic's impact across regions, key differences motivated systematic quantitative analysis of diverse geographical data to inform responses. Malawi reported its first COVID-19 case on 2 April 2020 but had significantly less data than Global North countries to inform its response. Here, we present a modelling analysis of SARS-CoV-2 epidemiology and phylogenetics in Malawi between 2 April 2020 and 19 October 2022. We carried out this analysis using open-source tools and open data on confirmed cases, deaths, geography, demographics, and viral genomics. R was used for data visualisation, while Generalised Additive Models (GAMs) estimated incidence trends, growth rates, and doubling times. Phylogenetic analysis was conducted using IQ-TREE, TreeTime, and interactive tree of life. This analysis identifies five major COVID-19 waves in Malawi, driven by different lineages: (1) Early variants, (2) Beta, (3) Delta, (4) Omicron BA.1, and (5) Other Omicron. While the Alpha variant was present, it did not cause a major wave, likely due to competition from the more infectious Delta variant, since Alpha circulated in Malawi when Beta was phasing out and Delta emerging. Case Fatality Ratios were higher for Delta, and lower for Omicron, than for earlier lineages. Phylogeny reveals separation of the tree into major lineages as would be expected, and early emergence of Omicron, as is consistent with proximity to the likely origin of this variant. Both variant prevalence and overall rates of confirmed cases and confirmed deaths were highly geographically heterogeneous. We suggest that real-time analyses should be considered in Malawi and other countries, where similar computational and data resources are available.

From poor healthcare infrastructure to vaccine donors, India has traveled a long way. In this study, the author tried to find the investment certainty and persistence of volatility in the Indian healthcare system due to COVID-19.

Using the Generalized Autoregressive Conditional Heteroskedasticity (GARCH 1,1) model, this study quantifies the change in the conditional variance after the first case report of COVID-19. The author has used the S&P BSE HEALTHCARE index time series to analyze India's healthcare infrastructure and practices.

The author found evidence of a decrease in investment certainty in investments related to India's healthcare infrastructure and practices after the first case report of COVID-19. Furthermore, the estimation of the econometric model suggests the presence of a large degree of volatility persistence in the S&P BSE HEALTHCARE index.

This research would be the first of its kind where the return volatility of the Indian healthcare sector has been discussed. Also, this research quantifies the return volatility of the healthcare sector during the pre- and post-COVID-19 period.

The geo-inequality of COVID-19 risk has attracted a great deal of research attention. In this study, the spatial correlation between community environment and the incidence of COVID-19 cases in 30 Chinese cities is discussed. The spread of the disease is analyzed based on timing and spatial monitoring at the km2-grid level, with the use of publicly available data relating to housing prices, Gross Deomestic Product (GDP), medical facilities, consumer sites, public green spaces, and industrial sites. The results indicate substantial geographical variations in the distribution of COVID-19 communities in all 30 cities. Significant global bivariate spatial dependence was observed between the disease and housing prices (Moran's I =0.099, p<0.01, z=488.6), medical facilities (Moran's I = 0.349, p<0.01, z=1675.0), consumer sites (Moran's I =0.369, p<0.01, z=1843.4), green space (Moran's I =0.205, p<0.01, z=1037.8), and industrial sites (Moran's I =0.234, p<0.01, z=1178.6). The risk of COVID-19 under the influence of GDP is further examined for cities with per capita GDPs from high to low ranging from 1.69 to 4.62 (1.69~3.74~4.62, 95% CI). These findings provide greater detail on the interplay between the infectious disease and community environments.

This cohort study aimed to determine the effect of the COVID-19 pandemic on the prevalence of metabolic syndrome (MetS) among health care workers at a dedicated COVID-19 hospital in Taiwan.

This study recruited 397 health care workers who completed health checkups before and during the COVID-19 pandemic. The differences of MetS and its components prevalence before and during the COVID-19 pandemic were compared using the paired samples t tests for normally distributed variables, and Wilcoxon signed-rank tests for nonnormally distributed variables.

The prevalence of MetS among health care workers significantly increased from 20.9% to 28.7% during the pandemic ( P < 0.001). Central obesity and hypertension were the primary contributors to the development of MetS.

COVID-19 pandemic was associated with an increasing prevalence of MetS in health care workers, necessitating health-promoting measures to mitigate this risk.

During the Covid-19 pandemic, people with chronic conditions experienced delayed or missed care, while their carers endured social isolation, loneliness, and reduced support. Information communication technology (ICT) can be utilized to encourage continuity of care, address misinformation, and allocate support. This study aimed to identify factors associated with the ICT adaptation of South Asian carers of individuals with chronic conditions by comparing changes in ICT utilization and preferences before and during the pandemic.

416 South Asian carers reporting feelings of loneliness and isolation were identified from the Coping with Loneliness, Isolation and Covid-19 (CLIC) online survey. Descriptive statistics and multinomial regression models were utilized.

The most commonly used ICT modality was auditory, followed by written and audio-visual. Four variables identified were: social network size and relationship proximity, Covid-19-induced distress, age, and living arrangements. We identified a negative correlation between social network size and ICT frequency/intensity, reductions in communication frequency/intensity associated with Covid-19-induced distress, working-age carer (18-60) preference adaptation toward written communication during the pandemic, written and auditory ICT fluency in carers spending time alone by choice, and aversion from auditory ICT in carers who lived and were often alone involuntarily.

The findings provide insights into South Asian carers' ICT usage, preferences, and adaptation in response to the pandemic. The findings aid in the development of health and social care pathways that fulfil local caregivers' unmet support and resource needs.

The COVID-19 pandemic caused major stress, as well as changes to home and work environments, with the potential to alter smoking-related behaviors. This study examined determinants of smoking-related behaviors among patients of federally qualified health centers (FQHCs) in Georgia.

We analyzed survey data from 353 patients (mean age=50 years, 62.9% women, 54.4% Black/African American, 27.8%

RESULTS

Most study participants (85.6%) smoked daily, and 41.6% had smoke-free homes. Compared to pre-pandemic, 36.3% reported increased stress, 28.8% increased smoking, 18.8% increased in-home smoking, and 55.4% quit attempts. Regression models showed more household members who smoke (AOR=1.56; 95% CI: 1.02-2.39) and greater stress (AOR=5.52; 95% CI: 2.74-11.12) were associated with increased smoking (vs no change) since the pandemic began. Non-daily (vs daily) smoking (OR=4.79; 95% CI: 1.71-13.46) was associated with decreased smoking (vs no change). Allowing smoking in the home and greater stress were associated with both increased and decreased in-home smoking (vs no change). We found no associations with quit attempts.

CONCLUSIONS

Home environments, specifically home smoking restrictions, as well as stress, may be important intervention targets during societal stressors.

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Background/Objectives: The prevalence of mental health disorders has been rising in Saudi Arabia, which may have been exacerbated by the COVID-19 pandemic. Therefore, the aim of our study was to examine the usage patterns of various psychotropic drugs before and during the pandemic. Methods: This cross-sectional study was conducted at the psychiatric outpatient clinic of a single hospital in Saudi Arabia from 1 October 2018 to 31 March 2023. Electronic medical records were used to gather information on all adult patients who were prescribed at least one antidepressant, antipsychotic, or anxiolytic/sedative/hypnotic medication. The data were analyzed using descriptive statistics and multivariable logistic regression model. Results: In the 4846 participants in the study, the total frequently prescribed psychotropics during the pandemic were antidepressants (2119 prescriptions), then antipsychotics (1509 prescriptions), and anxiolytics/sedatives/hypnotics (780 prescriptions). The mean before and during the pandemic for olanzapine was (41.86 vs. 23.55) and risperidone was (39.00 vs. 22.18), indicating a significant difference for both medications (p = 0.0003). Psychotropic drug use during the COVID-19 pandemic was significantly higher among the female patients (OR = 1.15, 95% CI [1.06-1.26]) and those aged 18-39 years (OR = 1.65, 95% CI [1.52-1.80]). Antidepressant and antipsychotic use were significantly lower than anxiolytic/sedative/hypnotic use during the pandemic (OR = 0.74, 95% CI [0.65-0.84]; OR = 0.66, 95% CI [0.58-0.75], respectively). Conclusions: The prescription rate of anxiolytics/sedatives/hypnotics was higher than that of antidepressants and antipsychotics. Furthermore, women and individuals aged ≤40 years were at a higher risk of psychotropic medication use. To mitigate stress, anxiety, and depression in Saudi Arabia, policymakers should implement mental health screening initiatives.

The kinase-like NiRAN domain of nsp12 in SARS-CoV-2 catalyzes the formation of the 5' RNA cap structure. This activity is required for viral replication, offering a new target for the development of antivirals. Here, we develop a high-throughput assay to screen for small molecule inhibitors targeting the SARS-CoV-2 NiRAN domain. We identified NCI-2, a compound with a reactive chloromethyl group that covalently binds to an active site cysteine (Cys53) in the NiRAN domain, inhibiting its activity. NCI-2 can enter cells, bind to, and inactivate ectopically expressed nsp12. A cryo-EM reconstruction of the SARS-CoV-2 replication-transcription complex (RTC) bound to NCI-2 offers a detailed structural blueprint for rational drug design. Although NCI-2 showed limited potency against SARS-CoV-2 replication in cells, our work lays the groundwork for developing more potent and selective inhibitors targeting the NiRAN domain. This approach presents a promising therapeutic strategy for effectively combating COVID-19 and potentially mitigating future coronavirus outbreaks.

The COVID-19 pandemic had devastating health and socioeconomic effects, partly due to policy decisions to mitigate them. Little evidence exists of approaches that guided decisions in settings with limited pre-pandemic modelling capacity. We thus sought to identify knowledge translation mechanisms, enabling factors and structures needed to effectively translate modelled evidence into policy decisions.

We used convergent mixed methods in a participatory action approach, with quantitative data from a survey and qualitative data from a scoping review, in-depth interviews and workshop notes. Participants included researchers and policy actors involved in COVID-19 evidence generation and decision-making. They were mostly from lower- and middle-income countries (LMICs) in Africa, Southeast Asia and Latin America. Quantitative and qualitative data integration occurred during data analysis through triangulation and during reporting in a narrative synthesis.

We engaged 147 researchers and 57 policy actors from 28 countries. We found that the strategies required to use modelled evidence effectively include capacity building of modelling expertise and communication, improved data infrastructure, sustained funding and dedicated knowledge translation platforms. The common knowledge translation mechanisms used during the pandemic included policy briefs, face-to-face debriefings and dashboards. Some enabling factors for knowledge translation comprised solid relationships and open communication between researchers and policymakers, credibility of researchers, co-production of policy questions and embedding researchers in policymaking spaces. Barriers included competition among modellers, negative attitude of policymakers towards research, political influences and demand for quick outputs.

We provide a contextualised understanding of knowledge translation for LMICs during the COVID-19 pandemic. Furthermore, we share key lessons on how knowledge translation from mathematical modelling complements the broader learning agenda related to pandemic preparedness and long-term investments in evidence-to-policy translation. Our findings led to the co-development of a knowledge translation framework useful in various settings to guide decision-making, especially for public health emergencies.

The present work aimed to estimate the economic impact of PTSD following COVID-19 in a population of patients affected by systemic autoimmune disease (SAD) using a cost-of-illness approach and accounting for the perspective of society.

Considering data collected from SAD patients enrolled in a specialized outpatient clinic in the Tuscany region, Italy, generalized linear models and LASSO logistic regression were used to evaluate the impact of PTSD on costs and its relevance as a possible predictor of being a high-cost patient, respectively.

Considering 301 SAD patients, 161 (51.2%) of whom were diagnosed with PTSD, the overall costs were EUR 3670 [890; 40,529] per patient/year among patients with PTSD and EUR 2736.7 [283; 21,078] per patient/year among those without PTSD (p-value < 0.001), with differences mainly attributable to significantly greater direct non-healthcare and indirect costs. PTSD was estimated to increase overall costs (β = 0.296 (0.140), p-value = 0.035), direct non-healthcare (β = 1.193 (0.392), p-value = 0.002), and indirect costs (β = 3.741 (1.136), p-value = 0.001). PTSD diagnosis was also significantly associated with the likelihood of being a high-cost patient.

Findings from the present study offer a novel perspective on the economic impact of COVID-19 and provide valuable data for policymakers to better understand the demand for healthcare services and associated costs.

Vaccination against coronavirus disease 2019 (COVID-19) can mitigate the burden of health care worker (HCW) infection. We investigate the burden of HCW illness and its associated direct health care personnel costs in the setting of widespread vaccine availability and explore factors influencing these outcomes.

This multicenter prospective study followed HCWs over an 8-month period from January to August 2023. Data recorded included incident COVID-19 infection, symptom burden, workdays missed, and vaccine history. Workdays lost due to illness were used to calculate direct health care personnel costs due to COVID-19 infection. Univariate analysis and multivariable regression investigated the factors associated with workdays lost and direct health care personnel.

In total, 1218 participants were enrolled and followed for 8 months, with 266 incidents of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 1191 workdays lost, and health care personnel costs of €397 974. Multivariable regression revealed that workdays lost were associated with incomplete primary COVID-19 vaccination course. Being unvaccinated, older age, and male were associated with increased health care personnel costs.

Health care workdays lost remain a significant issue and are associated with health care system burden despite vaccine availability. These can be mitigated via targeted implementation of vaccine programs. Seasonal variation in health care workdays lost should inform workforce planning to accommodate surge periods.

The study explores the impact of Covid-19 on pets and their owners using a structured questionnaire. One hundred fifty-seven (157) respondents were recruited from six veterinary clinics at strategic points within Accra. Only a third of owners gave their pet(s) special attention out of fear of contracting Covid-19 from their pet(s). 68.2 % of the respondents were interested in learning healthy pet-keeping tips from the electronic media and evident in their willingness (75.2 %) to embrace tele-veterinary services; a potential drift from traditional in-person way of providing veterinary services in Ghana. The decrease in household income (46.5 %), loss of employment for at least one person in the household (17.2 %) and associated spike in prices of pet related commodities affected the feeding of pets in about 44 % of respondents and ability to afford veterinary pet products (17.2 %). This is reflected in a 12.7 % reduction in the ability of pet owners to afford veterinary services. The observations made could be used as a basis for future research exploring the pet culture in Ghana and its evolution as a direct consequence of the pandemic.

At the time of the emergence of COVID-19, denialist and anti-vaccine groups have also emerged and are shaking public confidence in vaccination.

A qualitative study was conducted using online focus groups. Participants had not received any doses of vaccination against the disease. A total of five focus group sessions were conducted with 28 participants. They were recruited by snowball sampling and by convenience sampling.

The two major topics mentioned by the participants were adverse effects and information. The adverse effects described were severe and included sudden death. In the case of information, participants reported: (1) consultation of websites on which scientists posted anti-vaccination content; and (2) distrust.

At a time when anti-vaccine groups pose a major challenge to public health in general, and to COVID-19 vaccination campaigns in particular, this study is a first step towards gaining deeper insight into the factors that lead to COVID-19 vaccine refusal.

The Mpox virus (MPXV) is known to cause zoonotic disease in humans. The virus belongs to the genus Orthopoxvirus, of the family Poxviridae, and was first reported in monkeys in 1959 in Denmark and in humans in 1970 in the Congo. MPXV first appeared in the U.S. in 2003, re-emerged in 2017, and spread globally within a few years. Wild African rodents are thought to be the reservoir of MPXV. The exotic trade of animals and international travel can contribute to the spread of the Mpox virus. A phylogenetic analysis of MPXV revealed two distinct clades (Central African clade and West African clade). The smallpox vaccine shows cross-protection against MPXV infections in humans. Those who have not previously been exposed to Orthopoxvirus infections are more vulnerable to MPXV infections. Clinical manifestations in humans include fever, muscle pain, headache, and vesicle formation on the skin of infected individuals. Pathognomonic lesions include ballooning degenerations with Guarnieri-like inclusions in vesicular epithelial cells. Alterations in viral genome through genetic mutations might favor the re-emergence of a version of MPXV with enhanced virulence. As of November 2023, 92,783 cases and 171 deaths have been reported in 116 countries, representing a global public health concern. Here, we provide insights on the re-emergence of MPXV in humans. This review covers the origin, emergence, re-emergence, transmission, pathology, diagnosis, control measures, and immunomodulation of the virus, as well as clinical manifestations. Concerted efforts of health professionals and scientists are needed to prevent the disease and stop its transmission in vulnerable populations.

This study aimed to evaluate the association between employment status and mental health, considering food insecurity as a mediator of this relation. A cross-sectional population-based study was conducted with adults (≥ 18 and < 60 years) during the COVID-19 outbreak in two cities from Southern Brazil. Employment status was categorized into working, not working, and lost job. The mental health outcomes evaluated were depressive symptoms, perceived stress, and sadness. Food insecurity was identified by the short-form version of the Brazilian Food Insecurity Scale. Adjusted analyses using Poisson regression were performed to assess the association between employment status and mental health. Mediation analysis was performed to investigate the direct and indirect effects of employment status on mental health outcomes. In total, 1,492 adults were analyzed. The not working status was associated with 53% and 74% higher odds of perceived stress and of sadness, respectively. Being dismissed during the pandemic increased the odds of depressive symptoms, perceived stress, and sadness by 68%, 123%, and 128%, respectively. Mediation analyses showed that food insecurity was an important mediator of the association between employment status and depressive symptoms and sadness, but not of perceived stress. The complexity of these results highlights economic and nutritional aspects involved in mental health outcomes.

Differences in control measures and response speeds between regions may be responsible for the differences in the number of infections of global infectious diseases. Therefore, this article aims to examine the decay stage of global infectious diseases. We demonstrate our method by considering the first wave of the COVID-19 epidemic in 2020.

We introduce the concept of the attenuation rate into the varying coefficient SEIR model to measure the effect of different cities on epidemic control, and make inferences through the integrated adjusted Kalman filter algorithm.

We applied the varying coefficient SEIR model to 136 cities in China where the total number of confirmed cases exceeded 20 after the implementation of control measures and analyzed the relationship between the estimated attenuation rate and local factors. Subsequent analysis and inference results show that the attenuation rate is significantly related to the local annual GDP and the longitude and latitude of a city or a region. We also apply the varying coefficient SEIR model to other regions outside China. We find that the fitting curve of the average daily number of new confirmed cases simulated by the variable coefficient SEIR model is consistent with the real data.

The results show that the cities with better economic development are able to control the epidemic more effectively to a certain extent. On the other hand, geographical location also affected the effectiveness of regional epidemic control. In addition, through the results of attenuation rate analysis, we conclude that China and South Korea have achieved good results in controlling the epidemic in 2020.

To demonstrate the utilisation of a risk assessment protocol designed to prioritise elective neurosurgical patients against the risks of COVID-19. This tool can be applied to all other surgical specialties.

Prospective case series of 166 patients.

Single-centre tertiary neurosurgical department.

All patients awaiting an elective neurosurgical procedure were included in this study. All emergency or life-threatening neurosurgical pathologies affecting patients were excluded.

The risk assessment tool identified patients with progressive neurology and stratified need for surgery against risk of harm during the COVID-19 pandemic.

Using our risk stratification tool, 6.6% patients required expedited surgery and a further 11.4% patients were removed completely from the waiting list. The majority of patients 47%, required surgery within 3 months.

This simple tool encourages surgical departments to establish contact with patients during COVID-19. The clinician acquires up-to-date information regarding patient symptomatology and subsequently determines surgical priority, a timescale required for surgery and overall uses of NHS resources efficiently. We recommend the use of this tool for all neurosurgical departments, with a wider application to other surgical specialties during the ongoing pressures of elective backlogs secondary to the persistent COVID-19 pandemic.

Many protocols for the treatment of coronavirus disease 2019 (COVID-19) have been published. In addition to an abundance of studies and meta-analyses on the treatment of COVID-19, different medications used in the intensive care unit will have a significant impact on mortality. The study attempted to highlight, compare, and quantify the impact on outcomes.

Data were collected from subjects' files, encompassing all physiological parameters, hematological profiles, and available laboratory results. In addition, all treatment modalities administered to the subjects were documented in medical files. Survival analysis was conducted using Kaplan-Meier curves and Cox proportional hazards.

The study included 120 subjects with confirmed COVID-19. Subjects treated with systemic corticosteroids (hazard Ratio [HR 0.45, 95% Confidence Interval [CI] 0.01-1.32; P = 0.01) and tocilizumab (HR 0.98, 95% CI 0.49-1.98; P = 0.05) exhibited lower mortality, while those treated with remdesivir (HR 1.13, 95% CI 0.53-2.43; P = 0.05) showed increased mortality. In patients with COVID-19, improved mortality was observed with early rather than late treatment with noninvasive mechanical ventilation (NIV) (HR 0.01 vs. 1.72, P = 0.05) and tocilizumab (HR 0.45 vs. 1.50, P = 0.05).

The early use of NIV is associated with decreased mortality compared to late use. Corticosteroids demonstrate a mortality-reducing effect. In addition, early administration of tocilizumab is associated with decreased mortality compared to late use.

Uganda has been implementing the Global Health Security Agenda (GHSA) since 2015 to build its capacity according to World Health Organization (WHO) Benchmarks on International Health Regulations Capacities. The country remains prone to outbreaks, with more than 20 disease outbreaks reported in the past five years, including Ebola virus disease, Crimean-Congo haemorrhagic fever, Marburg haemorrhagic fever, measles, yellow fever, coronavirus disease 2019 (COVID-19), and cholera. Antimicrobial resistance (AMR) is an ongoing challenge. Uganda scored capacity level 3 on infection prevention and control (IPC) and antimicrobial stewardship (AMS) in the 2017 Joint External Evaluation (JEE) assessment. Identified gaps were being addressed after a self-assessment in 2021. This paper describes the technical assistance approaches provided to Uganda by the Medicines, Technologies, and Pharmaceutical Services Program, funded by the United States (U.S.) Agency for International Development, and implemented by Management Sciences for Health. The program, through a One Health approach, supported systematic capacity strengthening based on the JEE's capacity advancement framework for global health security, specifically relating to AMR. The program's interventions impacted 32 WHO benchmark actions (7 for AMR multisectoral coordination, 16 for IPC, and 9 for AMS), contributing to Uganda's strengthened GHSA capacity. Leveraging success built on the AMR platform, the program trained 745 health workers in IPC for the Ebola virus and provided support for simulation exercises by eight district IPC teams. The program also worked with the Ministry of Health to coordinate IPC for the COVID-19 response in five health regions, covering 45 districts and reaching 5,452 health workers at 858 health facilities.

The COVID-19 pandemic has led to fear, rumours, and stigma, particularly against those infected with the virus. In Malaysia, the manufacturing industry is particularly vulnerable to COVID-19 clusters, making it critical to assess stigma attitudes among workers. To address this issue, The Workplace COVID-19 Knowledge & Stigma Scale (WoCKSS) was developed specifically for use in the manufacturing industry which served as the sample population for testing this scale. It was developed in the Malay language to ensure alignment with the local context. This study examines the content and face validity of WoCKSS, which can help assess the level of knowledge and stigma associated with COVID-19 among workers.

The WoCKSS was developed with 20 and 31 items for knowledge and stigma domains, respectively, based on an extensive review of COVID-19 literature. Content validation was conducted by four experts using a content validation form to assess the relevancy of each item to the intended construct. Content Validity Index (CVI) was calculated to measure the agreement between the experts on the relevance of each item to the intended construct. Face validation was then conducted by randomly selecting 10 respondents from the manufacturing industry, who rated the clarity and comprehension of each item using a face validation form. The Item Face Validity Index (I-FVI) was calculated to determine the clarity and comprehension of each question, and only items with an I-FVI ≥ 0.83 were retained.

The WoCKSS achieved excellent content validity in both knowledge and stigma domains. Only 19 items from the knowledge domain and 24 items from the stigma domain were retained after CVI analysis. All retained items received a CVI score of 1.00, indicating perfect agreement among the experts. FVI analysis resulted in 17 items for the knowledge domain and 22 items for the stigma domain. The knowledge domain achieved a high level of agreement among respondents, with a mean I-FVI of 0.91 and a S-FVI/UA of 0.89. The stigma domain also showed high agreement, with a mean I-FVI of 0.99 and a S-FVI/UA of 0.86.

In conclusion, the WoCKSS demonstrated high content and face validity. However, further testing on a larger sample size is required to establish its construct validity and reliability.

Containment measures slowed the spread of COVID-19 but led to a global economic crisis. We establish a reinforcement learning (RL) algorithm that balances disease control and economic activities.

To train the RL agent, we design an RL environment with 4 semi-connected regions to represent the COVID-19 epidemic in Tokyo, Osaka, Okinawa, and Hokkaido, Japan. Every region is governed by a Susceptible-Exposed-Infected-Quarantined-Removed (SEIQR) model and has a transport hub to connect with other regions. The allocation of the synthetic population and inter-regional traveling is determined by population-weighted density. The agent learns the best policy from interacting with the RL environment, which involves obtaining daily observations, performing actions on individual movement and screening, and receiving feedback from the reward function. After training, we implement the agent into RL environments describing the actual epidemic waves of the four regions to observe the agent's performance.

For all epidemic waves covered by our study, the trained agent reduces the peak number of infectious cases and shortens the epidemics (from 165 to 35 cases and 148 to 131 days for the 5th wave). The agent is generally strict on screening but easy on movement, except for Okinawa, where the agent is easy on both actions. Action timing analyses indicate that restriction on movement is elevated when the number of exposed or infectious cases remains high or infectious cases increase rapidly, and stringency on screening is eased when the number of exposed or infectious cases drops quickly or to a regional low. For Okinawa, action on screening is tightened when the number of exposed or infectious cases increases rapidly.

Our experiments exhibit the potential of the RL in assisting policy-making and how the semi-connected SEIQR models establish an interactive environment for imitating cross-regional human flows.

Fatigue, headache, problems sleeping and numerous other symptoms have been reported to be associated with long COVID. However, many of these symptoms coincide with symptoms reported by the general population, possibly exacerbated by restrictions/precautions experienced during the COVID-19 pandemic. This study examines the symptoms reported by individuals who tested positive for COVID-19 compared with those who tested negative.

Observational study.

The study was conducted on adult residents in Alberta, Canada, from October 2021 to February 2023.

We evaluated self-reported symptoms in 7623 adults with positive COVID-19 tests and 1520 adults who tested negative, using surveys adapted from the internationally standardised International Severe Acute Respiratory and emerging Infection Consortium (ISARIC)-developed COVID-19 long-term follow-up tools. These individuals had an index COVID-19 test date between 1 March 2020 and 31 December 2022 and were over 28 days post-COVID-19 testing.

The primary outcomes were to identify the symptoms associated with COVID-19 positivity and risk factors for reporting symptoms.

Fatigue was the top reported symptom (42%) among COVID-19-positive respondents, while headache was the top reported symptom (32%) in respondents who tested negative. Compared with those who tested negative, COVID-19-positive individuals reported 1.5 times more symptoms and had higher odds of experiencing 31 out of the 40 listed symptoms during the postinfectious period. These symptoms included olfactory dysfunction, menstruation changes, cardiopulmonary and neurological symptoms. Female sex, middle age (41-55 years), Indigeneity, unemployment, hospital/intensive care unit (ICU) admission at the time of testing and pre-existing health conditions independently predicted a greater number and variety of symptoms.

Our results provide evidence that COVID-19 survivors continue to experience a significant number and variety of symptoms. These findings can help inform targeted strategies for the unequally affected population. It is important to offer appropriate management for symptom relief to those who have survived the acute COVID-19 illness.

COVID-19 has serious consequences on different body systems particularly the respiratory system with its impact on pulmonary function, exercise capacities, and physical activities. This study aimed to investigate the long-term effect of COVID-19 on pulmonary function, exercise capacities, and physical activities in patients with non-severe COVID-19.

160 individuals were selected to participate in a cross-section study. Group-I: 80 male and female patients with non-severe COVID-19 at least 3 months after the recovery time. Group-II: 80 male and female matched (non-infected with COVID-19) participants. The spirometer, six-minute walk test (6MWT), and International Physical Activity Questionnaire (IPAQ) were used to assess pulmonary function, exercise capacities, and physical activities respectively. The Kolmogorov-Smirnov test was used to test normality of data. The Mann-Whitney and independent t-tests were used to compare the significant differences between both groups.

The results show significant differences in FVC & FEV 1 of the pulmonary function, exercise capacities, and physical activities of the work & transportations between both COVID-19 and matched groups p-value = (0.001 & 0.001, 0.001 and 0.005 & 0.012) respectively.

Pulmonary function, exercise capacities, and physical activities are negatively influenced by COVID-19 as long-term consequences indicating the need for extended health care, and prescription of proper rehabilitative training programs for non- severe COVID-19 patients whatever their severity degree of infection or history of hospitalization. Outcome reflections of the current results raise awareness of physical therapists to the importance of the proper rehabilitative training programs for non-severe COVID-19 patients.

The World Health Assembly (WHA), on 1st December 2021, unanimously agreed to launch a global process to draft and negotiate a convention, agreement, or other international instrument under the World Health Organization's (WHO's) constitution to strengthen pandemic prevention, preparedness, and response. We aimed to explore the role of global health diplomacy (GHD) in pandemic treaty negotiations by providing deep insight into the ongoing drafting process under the WHO leadership.

We conducted a narrative review by searching Scopus, Web of Sciences, PubMed, MEDLINE, and Google Scholar search engine using the keywords "Pandemic Treaty," OR "International Health Regulations," OR "International conventions," OR "International treaties" in the context of recent COVID-19 pandemic. Besides, we included articles recommending the need for GHD, leadership and governance mechanisms for this international treaty drafting approved by the WHA.

Amid the COVID-19 pandemic, the concept of GHD bolstered the international system and remained high on the agendas of many national, regional and global platforms. As per Article 19 of the WHO constitution, the Assembly established an intergovernmental negotiating body (INB) to draft and negotiate this convention/ agreement to protect the world from disease outbreaks of pandemic potential. Since GHD has helped to strengthen international cooperation in health systems and address inequities in achieving health-related global targets, there is a great scope for the successful drafting of this pandemic treaty.

The pandemic treaty is a defining moment in global health governance, particularly the pandemic governance reforms. However, the treaty's purpose will only be served if the equity considerations are optimized, accountability mechanisms are established, and a sense of shared responsibility is embraced. While fulfilling treaty commitments might be complex and challenging, it provides an opportunity to rethink and build resilient systems for pandemic preparedness and response in the future.

This study aimed to synthesize and compare the prioritization strategies outlined in the national vaccination plans (NVPs) against Coronavirus Disease 2019 (COVID-19) developed by countries in the Latin America and Caribbean (LAC) region.

We conducted a comparative policy analysis based on COVID-19 NVPs.

We conducted a search strategy in three stages to identify NVPs for COVID-19 across 41 countries/territories in the LAC region. Sources included official governmental repositories, complementary Google searches, and less formal documentation. We extracted key variables and conducted a comparative policy analysis based on the prioritization criteria and specific prioritization groups.

The study identified 52 NVPs for COVID-19, corresponding to 27 (65.8 %) out of 41 countries/territories in the LAC region. Official national websites yielded documents for 12 countries. All NVPs included frontline healthcare personnel in the first prioritization phase/stage, whilst some included residents of long-term healthcare facilities, adults aged 60 years or more, and people with disabilities. The decision criteria for prioritization were declared in 14 countries/territories. Ethical considerations declared in five NVPs included human welfare, equality, solidarity, equity, and social justice as values.

The early stages of vaccination rollout in LAC countries prioritized protection of the healthcare system and epidemiological risk for severe disease. Few countries included ethical considerations in their NVPs, and global inequities in vaccine access and distribution led to varied protections for vulnerable populations across LAC. This analysis highlights the need for improved emergency-response capacity, planning, and enhanced multilateral cooperation in the LAC region for future public health emergencies.

The coronavirus pandemic that began in December 2019, has had an unprecedented impact on the global economy, health systems and infrastructure, in addition to being responsible for significant mortality and morbidity worldwide. The "new normal" has brought along, unforeseen challenges for the scientific community, owing to obstructions in conducting field-based research in lieu of minimizing exposure through in-person contact. This has had greater ramifications for the LMICs, adding to the already existing concerns. As a response to COVID-19 related movement restrictions, public health researchers across countries had to switch to remote data collections methods. However, impediments like lack of awareness and skepticism among participants, dependence on paper-based prescriptions, dearth of digitized patient records, gaps in connectivity, reliance on smart phones, concerns with participant privacy at home and greater loss to follow-up act as hurdles to carrying out a research study virtually, especially in resource-limited settings. Promoting health literacy through science communication, ensuring digitization of health records in hospitals, and employing measures to encourage research participation among the general public are some steps to tackle barriers to remote research in the long term. COVID-19 may not be a health emergency anymore, but we are not immune to future pandemics. A more holistic approach to research by turning obstacles into opportunities will not just ensure a more comprehensive public health response in the coming time, but also bolster the existing infrastructure for a stronger healthcare system for countries.

The uncertain future due to the COVID-19 pandemic and the technological advancements may have altered young adults' experiences of romantic relationships. It is unclear whether individuals will continue to prefer traditional long-term romantic relationships (LTRR) or opt for short-term ones (STRR). This research describes how young adults in Malaysia perceive LTRR and STRR. Using the structured approach of the theory of social representations, data were collected from 512 participants; 238 (46.48%) male; Mage 21.75; majority were heterosexual and students, and analyzed using prototypical analysis to reveal high consensus elements. Five observations were made: (1) females prioritize "love" in both STRR and LTRR, while males prioritize "love" only in LTRR; (2) females prioritize "marriage" in LTRR, while males prioritize "trust," "comfort," and "stability." Males do not consider "marriage" as part of a LTRR; (3) both males and females view STRR positively, while LTRR are viewed more practically; (4) "sex" is a core element in STRR but is absent in LTRR; (5) males differentiate between STRR and LTRR with no overlapping elements. These findings provide insight into the social representations of romantic relationships among young adults in Malaysia and suggest future directions for research in the field.

Coronavirus has burdened considerable expenditures on the different health systems. Vaccination programs, the critical solution against pandemic diseases, are known as safe and effective interventions to prevent and control epidemics. We aimed to perform a systematic review to provide economic evidence of the value of different types of vaccines available to combat the Covid-19 to all health policymakers worldwide.

Electronic searches conducted on Medline/PubMed, Cochrane Library, Web of Science, Scopus, Embase, and other economic evaluation databases. Related and published articles searched up to March 2022 by using keywords such as "Vaccination," "Covid-19," "Cost-benefit," "Cost-utility," "Cost-effectiveness," "Economic Assessment," and "Economic evaluation." Followed by choosing the most suitable articles according to inclusion and exclusion criteria, data captured and the results extracted. The quality assessment of the articles performed by the checklist of CHEERS 2022. Finally, 13 articles included in the review.

All messenger RNA vaccines were dominant with approximately 70% coverage against no vaccination in the primary vaccination program except in one study that looked at booster effects. From a payer's perspective, a dollar invested in a vaccine would be less profitable than from a societal perspective. Therefore, primary mass vaccination can be considered a cost-effective intervention in primary vaccination to save more lives and produce more positive externalities. However, the cost-benefit ratio for all vaccines increases when statistical lifetime value and global economic and educational disadvantages are considered.

The COVID-19 primary vaccination programs in regional outbreaks, from a long-term perspective, will demonstrate substantial cost-effectiveness. It is suggested that due to the positive externalities of vaccination, primary mass vaccination, with the help of COVAX-19TM, could be considered a reliable way to combat viral epidemics compared to the loss of individual lives and economic and educational disturbances around the world.

Recent pandemics have had far-reaching effects on the world's largest economies and amplified the need to estimate the full extent and range of socioeconomic impacts of infectious diseases outbreaks on multi-sectoral industries. This systematic review aims to evaluate the socioeconomic impacts of airborne and droplet-borne infectious diseases outbreaks on industries.

A structured, systematic review was performed according to the PRISMA guidelines. Databases of PubMed, Scopus, Web of Science, IDEAS/REPEC, OSHLINE, HSELINE, and NIOSHTIC-2 were reviewed. Study quality appraisal was performed using the Table of Evidence Levels from Cincinnati Children's Hospital Medical Center, Joanna Briggs Institute tools, Mixed Methods Appraisal Tool, and Center of Evidence Based Management case study critical appraisal checklist. Quantitative analysis was not attempted due to the heterogeneity of included studies. A qualitative synthesis of primary studies examining socioeconomic impact of airborne and droplet-borne infectious diseases outbreaks in any industry was performed and a framework based on empirical findings was conceptualized.

A total of 55 studies conducted from 1984 to 2021 were included, reporting on 46,813,038 participants working in multiple industries across the globe. The quality of articles were good. On the whole, direct socioeconomic impacts of Coronavirus Disease 2019, influenza, influenza A (H1N1), Severe Acute Respiratory Syndrome, tuberculosis and norovirus outbreaks include increased morbidity, mortality, and health costs. This had then led to indirect impacts including social impacts such as employment crises and reduced workforce size as well as economic impacts such as demand shock, supply chain disruptions, increased supply and production cost, service and business disruptions, and financial and Gross Domestic Product loss, attributable to productivity losses from illnesses as well as national policy responses to contain the diseases.

Evidence suggests that airborne and droplet-borne infectious diseases have inflicted severe socioeconomic costs on regional and global industries. Further research is needed to better understand their long-term socioeconomic impacts to support improved industry preparedness and response capacity for outbreaks. Public and private stakeholders at local, national, and international levels must join forces to ensure informed systems and sector-specific cost-sharing strategies for optimal global health and economic security.

Serodiagnostic tests for antibody detection to estimate the immunoprotective status regarding SARS-CoV-2 support diagnostic management. This study aimed to investigate the performance of serological assays for COVID-19 and elaborate on test-specific characteristics. Sequential samples (n = 636) of four panels (acute COVID-19, convalescent COVID-19 (partly vaccinated post-infection), pre-pandemic, and cross-reactive) were tested for IgG by indirect immunofluorescence test (IIFT) and EUROIMMUN EUROLINE Anti-SARS-CoV-2 Profile (IgG). Neutralizing antibodies were determined by a virus neutralization test (VNT) and two surrogate neutralization tests (sVNT, GenScript cPass, and EUROIMMUN SARS-CoV-2 NeutraLISA). Analysis of the acute and convalescent panels revealed high positive (78.3% and 91.6%) and negative (91.6%) agreement between IIFT and Profile IgG. The sVNTs revealed differences in their positive (cPass: 89.4% and 97.0%, NeutraLISA: 71.5% and 72.1%) and negative agreement with VNT (cPass: 92.3% and 50.0%, NeutraLISA: 95.1% and 92.5%) at a diagnostic specificity of 100% for all tests. The cPass showed higher inhibition rates than NeutraLISA at VNT titers below 1:640. Cross-reactivities were only found by cPass (57.1%). Serodiagnostic tests, which showed substantial agreement and fast runtime, could provide alternatives for cell-based assays. The findings of this study suggest that careful interpretation of serodiagnostic results obtained at different times after SARS-CoV-2 antigen exposure is crucial to support decision-making in diagnostic management.

Although extant cross-sectional data suggest that parents have experienced numerous challenges (e.g., homeschooling, caregiver burden) and mental health consequences during the COVID-19 pandemic, longitudinal data are needed to confirm mental health changes relative to pre-pandemic levels and identify which specific pandemic-related changes most highly predict mental health during the pandemic. In two longitudinal subsamples (N = 299 and N = 175), we assessed change in anxiety, depression, and stress before and during the pandemic and whether the accumulation of pandemic-related changes predicted observed mental health changes. On average, parents reported increased depression and anxiety, but no significant changes in reported stress. Moreover, increased interpersonal conflict, difficulty managing work and caregiving responsibilities, and increased economic challenges were the types of pandemic-related changes that most strongly predicted worse mental health, highlighting that juggling caregiving responsibilities and economic concerns, along with the pandemic's impact on interpersonal family relationships are key predictors of worsening parental mental illness symptoms.

Immune checkpoint inhibitors (ICIs) are commonly used to treat lung cancer patients, but their use can lead to immune-related adverse events (irAEs), which pose a challenge for treatment strategies. The impact of irAEs on the incidence of COVID-19 pneumonia in lung cancer patients during the ongoing COVID-19 pandemic is unclear. This study aims to investigate the association between irAEs and COVID-19 pneumonia in lung cancer patients receiving ICIs.

We conducted a cross-sectional study of lung cancer patients who received ICIs and were infected with COVID-19 due to the Omicron variant between December 2022 and February 2023 in China. We collected data on irAEs and COVID-19 outcomes. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between irAEs and the incidence of COVID-19 pneumonia.

A total of 193 patients were enrolled, with 72 patients (37.30%) in the irAEs group and 121 patients (62.70%) in the non-irAEs group. Twenty-six patients (13.47%) developed COVID-19 pneumonia and 6 patients (3.11%) progressed to severe cases after COVID-19 infection. Multivariate logistic regression showed that the lung cancer patients who experienced irAEs was significantly associated with a higher incidence rate of COVID-19 pneumonia (OR = 9.56, 95%CI: 2.21-41.33; P = 0.0025).

Our study suggests that lung cancer patients receiving ICIs and experiencing irAEs may have a higher risk of developing COVID-19 pneumonia due to the Omicron variant. Therefore, close monitoring of these patients during the COVID-19 pandemic is necessary to mitigate this risk.

Workplace violence is a major issue in society, business and healthcare settings. It adversely affects both employee safety and their ability to provide healthcare services.

This study examined the association between workplace violence, emotional exhaustion, job satisfaction and turnover intention among nurses during the COVID-19 pandemic.

We collected data from 513 nurses. We conducted 'Process Macro' analysis. Firstly, we included three mediators in the model: job satisfaction, workplace violence and emotional exhaustion. Secondly, we used work hours and anxiety as moderators of the relationship between workplace violence and turnover intention.

The findings revealed statistical significance that job satisfaction and workplace violence mediated the relationship between emotional exhaustion and nurse turnover intentions. Work hours and anxiety also moderated the relationship between workplace violence and nurses' turnover intention.

Respondents indicated that they were most affected by verbal violence during this time. Workplace violence is a negative factor that affects nurses' work, affecting them physically and psychologically. This occupational risk should be considered when evaluating nurses exposed to violence, as it affects job satisfaction and turnover intentions. The main theoretical contribution of this research is the identification of the association between workplace violence, emotional exhaustion, job satisfaction and turnover intention among nurses during the COVID-19 pandemic. It is clear that the research findings will be useful for healthcare professionals. The findings may have practical implications for healthcare administrators and their staff.

Infectious diseases continue to be the leading cause of morbidity and mortality, and a formidable obstacle to the development and well-being of people worldwide. Viruses account for more than half of infectious disease outbreaks that have plagued the world. The past century (1918/19-2019/20) has witnessed some of the worst viral disease outbreaks the world has recorded, with overwhelming impact especially in low- and middle-income countries (LMIC). The frequency of viral disease outbreak appears to be increasing. Generally, although infectious diseases have afflicted the world for centuries and humankind has had opportunities to examine the nature of their emergence and mode of spread, almost every new outbreak poses a formidable challenge to humankind, beating the existing pandemic preparedness systems, if any, and causing significant losses. These underscore inadequacy in our understanding of the dynamics and preparedness against viral disease outbreaks that lead to epidemics and pandemics. Despite these challenges, the past 100 years of increasing frequencies of viral disease outbreaks have engendered significant improvements in response to epidemics and pandemics, and offered lessons to inform preparedness. Hence, the increasing frequency of emergence of viral outbreaks and the challenges these outbreaks pose to humankind, call for the continued search for effective ways to tackle viral disease outbreaks in real time. Through a PRISMA-based approach, this systematic review examines the outbreak of viral diseases in retrospect to decipher the outbreak patterns, losses inflicted on humanity and highlights lessons these offer for meaningful preparation against future viral disease outbreaks and pandemics.

Adjuvants can enhance vaccine immunogenicity, but their mechanism of action is often incompletely understood, hampering rapid applicability for pandemic vaccines. Herein, we characterized the cellular and molecular activity of adjuvant formulations available for pre-clinical evaluation, including several developed for global open access. We applied four complementary human in vitro platforms to assess individual and combined adjuvants in unformulated, oil-in-water, and liposomal delivery platforms. Liposomal co-formulation of MPLA and QS-21 was most potent in promoting dendritic cell maturation, selective production of Th1-polarizing cytokines, and activation of SARS-CoV-2 Spike-specific CD4+ and CD8+ T cells in a co-culture assay. Select formulations also significantly enhanced Spike antigen-specific humoral immunity in vivo. This study confirms the utility of the cumulative use of human in vitro tools to predict adjuvanticity potential. Thus, human in vitro modeling may advance public health by accelerating the development of affordable and scalable adjuvants for vaccines tailored to vulnerable populations.

With the surge in the number of infected individuals during the COVID-19 pandemic, there was also a surge observed in the number of publications discussing its epidemiology, characteristics, path-o-phys-i-ol-o-gy, diagnosis, prevention and treatment. This bibliometric analysis focuses on the papers published on COVID-19 in South Asia.

We searched articles in the Scopus database from December 2019 to October, 2022. After manual screening, a list of the 100 most-cited articles was obtained, which was analyzed for various factors, including the type of article, citation count, author's affiliation, country of origin, funding bodies, etc.

The majority of the top 100 articles (n=79) in South Asia were published during 2020. India was affiliated with the highest number of articles (n=68), followed by Bangladesh (n=18) and Pakistan (n=12). However, 7 articles were authored by a researcher in Bangladesh. Female authors were under represented (32.38%), with no female author in lists of authors with 4 or more articles. The average number of citations for each of the top 100 most-cited articles was 180.8. Original articles constituted the major portion of the publications (82%), followed by letters (11%) and reviews (4%). Half of the publications belonged to the field of medicine (n=49), while others were contributed by science, psychology, social sciences, and biochemistry and allied sciences (n=8). Vaccine trials were under-represented. Jahangirnagar University, Bangladesh was affiliated with the maximum number of articles. Most articles were published in Science of The Total Environment (n=8) while Indian Council of Medical Research (n=4) was the top funding body.

These findings highlight that South Asia has a great potential to conduct research addressing its challenging health problems. But lack of funds hinders conducting trials of new medications and vaccines. Thus, there is need for allocation of sufficient funds for research and clinical trials by governments and the private sector to enhance the research productivity of this region.