Assessing the Operational Feasibility of Integrating Point-of-Care G6PD Testing into Plasmodium vivax Malaria Management in Vietnam.

Plasmodium vivax cases represent more than 50% of a diminishing malaria case load in Vietnam. Safe and effective radical cure strategies could support malaria elimination by 2030. This study investigated the operational feasibility of introducing point-of-care quantitative glucose-6-phosphate dehydrogenase (G6PD) testing into malaria case management practices. A prospective interventional study was conducted at nine district hospitals and commune health stations in Binh Phuoc and Gia Lai provinces in Vietnam over the period of October 2020 to October 2021. The STANDARD™ G6PD Test (SD Biosensor, Seoul, Republic of Korea) was incorporated to inform P. vivax case management. Case management data and patient and health care provider (HCP) perspectives, as well as detailed cost data were collected. The G6PD test results were interpreted correctly by HCP and the treatment algorithm was adhered to for the majority of patients. One HCP consistently ran the test incorrectly, which was identified during the monitoring and resulted in provision of refresher training and updating of training materials and patient retesting. There was wide acceptability of the intervention among patients and HCP albeit with opportunities to improve the counseling materials. Increasing the number of facilities to which the test was deployed and decreases in the malaria cases resulted in higher per patient cost for incorporating G6PD testing into the system. Commodity costs can be reduced by using the 10-unit kits compared to the 25 unit kits, particularly when the case loads are low. These results demonstrate intervention feasibility while also highlighting specific challenges for a country approaching malaria elimination.

A Deep Learning Powered System to Lie Detection While Online Study

Many education facilities have recently switched to online learning due to the COVID-19 pandemic. The nature of online learning makes it easier for dishonest behaviors, such as cheating or lying during lessons. We propose a new artificial intelligence - powered solution to help educators solve this rising problem for a fairer learning environment. We created a visual representation contrastive learning method with the MobileNetV2 network as the backbone to improve predictability from an unlabeled dataset which can be deployed on low power consumption devices. The experiment shows an accuracy of up to 59%, better than several previous research, proving the usability of this approach.

Systematic sequencing of imported cases leads to detection of SARS-CoV-2 B.1.1.529 (Omicron) variant in central Viet Nam.

As authorities braced for the arrival of the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), infrastructure investments and government directives prompted action in central Viet Nam to establish capacity for genomic surveillance sequencing. From 17 November 2021 to 7 January 2022, the Pasteur Institute in Nha Trang sequenced 162 specimens from 98 150 confirmed SARS-CoV-2 cases in the region collected from 8 November to 31 December 2021. Of these, all 127 domestic cases were identified as the B.1.617.2 (Delta) variant, whereas 92% (32/35) of imported cases were identified as the B.1.1.529 (Omicron) variant, all among international flight passengers. Patients were successfully isolated, enabling health-care workers to prepare for additional cases. Most (78%) of the 32 Omicron cases were fully vaccinated, suggesting continued importance of public health and social measures to control the spread of new variants.

One Health Surveillance Highlights Circulation of Viruses with Zoonotic Potential in Bats, Pigs, and Humans in Viet Nam.

A One Health cross-sectoral surveillance approach was implemented to screen biological samples from bats, pigs, and humans at high-risk interfaces for zoonotic viral spillover for five viral families with zoonotic potential in Viet Nam. Over 1600 animal and human samples from bat guano harvesting sites, natural bat roosts, and pig farming operations were tested for coronaviruses (CoVs), paramyxoviruses, influenza viruses, filoviruses and flaviviruses using consensus PCR assays. Human samples were also tested using immunoassays to detect antibodies against eight virus groups. Significant viral diversity, including CoVs closely related to ancestors of pig pathogens, was detected in bats roosting at the human-animal interfaces, illustrating the high risk for CoV spillover from bats to pigs in Viet Nam, where pig density is very high. Season and reproductive period were significantly associated with the detection of bat CoVs, with site-specific effects. Phylogeographic analysis indicated localized viral transmission among pig farms. Our limited human sampling did not detect any known zoonotic bat viruses in human communities living close to the bat cave and harvesting bat guano, but our serological assays showed possible previous exposure to Marburg virus-like (Filoviridae), Crimean-Congo hemorrhagic fever virus-like (Bunyaviridae) viruses and flaviviruses. Targeted and coordinated One Health surveillance helped uncover this viral pathogen emergence hotspot.

How has the COVID-19 epidemic affected the risk behaviors of people who inject drugs in a city with high harm reduction service coverage in Vietnam? A qualitative investigation.

INTRODUCTION: The COVID-19 outbreak disproportionally affects vulnerable populations including people who inject drugs (PWID). Social distancing and stay-at-home orders might result in a lack of access to medical and social services, poorer mental health, and financial precariousness, and thus, increases in HIV and HCV risk behaviors. This article explores how the HIV/HCV risk behaviors of PWID in Haiphong, a city with high harm reduction service coverage in Vietnam, changed during the early phase of the COVID-19 pandemic, and what shaped such changes, using the risk environment framework. METHOD: We conducted three focus group discussions with peer outreach workers in May 2020 at the very end of the first lockdown, and 30 in-depth interviews with PWID between September and October 2020, after the second wave of infection in Vietnam. Discussions and interviews centered on the impact of the COVID-19 pandemic on their lives, and how their drug use and sexual behaviors changed as a result of the pandemic. RESULTS: The national shutdown of nonessential businesses due to the COVID-19 epidemic caused substantial economic challenges to participants, who mostly were in a precarious financial situation before the start of the epidemic. Unsafe injection is no longer an issue among our sample of PWID in Haiphong thanks to a combination of different factors, including high awareness of injection-related HIV/HCV risk and the availability of methadone treatment. However, group methamphetamine use as a means to cope with the boredom and stress related to COVID-19 was common during the lockdown. Sharing of smoking equipment was a standard practice. Female sex workers, especially those who were active heroin users, suffered most from COVID-related financial pressure and may have engaged in unsafe sex. CONCLUSION: While unsafe drug injection might no longer be an issue, group methamphetamine use and unsafe sex were the two most worrisome HIV/HCV risk behaviors of PWID in Haiphong during the social distancing and lockdown periods. These elevated risks could continue beyond the enforced lockdown periods, given PWID in general, and PWID who are also sex workers in particular, have been disproportionately affected during the global crisis.

Descriptive epidemiology and spatial analysis of African swine fever epidemics in Can Tho, Vietnam, 2019.

The objectives of this study were to describe the epidemiology of African swine fever (ASF) and to identify factors that increased commune-level risk for ASF in Can Tho, a province in the Mekong River Delta of Vietnam. In 2019, a total of 2377 of the 5220 pig farms in Can Tho were ASF positive, an incidence risk of 46 (95% CI 44-47) ASF positive farms for every 100 farms at risk. Throughout the outbreak ASF resulted in either the death or culling of 59,529 pigs out of a total population size of 124,516 (just under half of the total pig population, 48%). After the first detection in Can Tho in May 2019, ASF spread quickly across all districts with an estimated dissemination ratio (EDR) of greater than one up until the end of July 2019. A mixed-effects Poisson regression model was developed to identify risk factors for ASF. One hundred unit increases in the number of pigs per square kilometre was associated with a 1.28 (95% CrI 1.05-1.55) fold increase in commune-level ASF incidence rate. One unit increases in the number of pig farms per square kilometre was associated with a 0.91 (95% CrI 0.84-0.99) decrease in commune-level ASF incidence rate. Mapping spatially contiguous communes with elevated (unaccounted-for) ASF risk provide a means for generating hypotheses for continued disease transmission. We propose that the analyses described in this paper might be run on an ongoing basis during an outbreak and disease control efforts modified in light of the information provided.

COVID-19 mortality may be reduced among fully vaccinated solid organ transplant recipients.

BACKGROUND: Solid organ transplant (SOT) recipients are at increased risk for morbidity and mortality from COVID-19 due to their immunosuppressed state and reduced immunogenicity from COVID-19 mRNA vaccines. This investigation examined the association between COVID-19 mRNA vaccination status and mortality among SOT recipients diagnosed with COVID-19. METHODS & FINDINGS: A retrospective, registry-based chart review was conducted investigating COVID-19 mortality among immunosuppressed solid organ transplant (SOT) recipients in a large metropolitan healthcare system in Houston, Texas, USA. Electronic health record data was collected from consecutive SOT recipients who received a diagnostic SARS-CoV-2 test between March 1, 2020, and October 1, 2021. The primary exposure was COVID-19 vaccination status at time of COVID-19 diagnosis. Patients were considered 'fully vaccinated' at fourteen days after completing their vaccine course. COVID-19 mortality within 60 days and intensive care unit admission within 30 days were primary and secondary endpoints, respectively. Among 646 SOT recipients who were diagnosed with COVID-19 at Houston Methodist Hospital between March 2020, and October 2021, 70 (10.8%) expired from COVID-19 within 60 days. Transplanted organs included 63 (9.8%) heart, 355 (55.0%) kidney, 108 (16.7%) liver, 70 (10.8%) lung, and 50 (7.7%) multi-organ. Increasing age was a risk factor for COVID-19 mortality, while vaccination within 180 days of COVID-19 diagnosis was protective in Cox proportional hazard models with hazard ratio 1.04 (95% CI: 1.01-1.06) and 0.31 (0.11-0.90), respectively). These findings were confirmed in the propensity score matched cohort between vaccinated and unvaccinated patients. CONCLUSIONS: This investigation found COVID-19 mortality may be significantly reduced among immunosuppressed SOT recipients within 6 months following vaccination. These findings can inform vaccination policies targeting immunosuppressed populations worldwide.

The COVID-19 Pandemic Impact and Responses in Emerging Economies: Evidence from Vietnamese Firms

A nationwide survey of 162,738 firms in Vietnam asked firms to report the impact of the COVID-19 pandemic on the health of the business, coping strategies used, and various firm and situational characteristics. More than 80% of firms reported negative impacts from the pandemic with fewer than 4% reporting positive effects;63% of the firms adopted at least one coping strategy. The coping strategies were categorized into seven groups as follows: (1) Non-adoption, (2) promoting e-commerce, (3) transforming key products/services, (4) training employees to improve professional qualifications, (5) finding new markets for input materials, (6) finding markets for products outside of the traditional market, (7) producing new products/services according to market demand during the epidemic period, and (8) other strategies. A multinomial logit regression model showed statistically significant associations between a firm's selected coping strategy and several independent variables, as follows: (1) Firm size, (2) impact of the pandemic on firm health, firm access to inputs, and firm access to domestic markets, (3) decrease in firm revenue, and (4) receipt of government support. However, many businesses have not implemented coping strategies, leading to concerns regarding their resilience to upcoming threats and uncertainties.

Mucosal immunization with a delta-inulin adjuvanted recombinant spike vaccine elicits lung-resident immune memory and protects mice against SARS-CoV-2.

Multiple SARS-CoV-2 vaccine candidates have been approved for use and have had a major impact on the COVID-19 pandemic. There remains, however, a significant need for vaccines that are safe, easily transportable and protective against infection, as well as disease. Mucosal vaccination is favored for its ability to induce immune memory at the site of infection, making it appealing for SARS-CoV-2 vaccine strategies. In this study we performed in-depth analysis of the immune responses in mice to a subunit recombinant spike protein vaccine formulated with the delta-inulin adjuvant Advax when administered intratracheally (IT), versus intramuscular delivery (IM). Both routes produced robust neutralizing antibody titers (NAb) and generated sterilizing immunity against SARS-CoV-2. IT delivery, however, produced significantly higher systemic and lung-local NAb that resisted waning up to six months post vaccination, and only IT delivery generated inducible bronchus-associated lymphoid tissue (iBALT), a site of lymphocyte antigen presentation and proliferation. This was coupled with robust and long-lasting lung tissue-resident memory CD4+ and CD8+ T cells that were not observed in IM-vaccinated mice. This study provides a detailed view of the lung-resident cellular response to IT vaccination against SARS-CoV-2 and demonstrates the importance of delivery site selection in the development of vaccine candidates.

Mucosal TLR2-activating protein-based vaccination induces potent pulmonary immunity and protection against SARS-CoV-2 in mice.

Current vaccines against SARS-CoV-2 substantially reduce mortality, but protection against infection is less effective. Enhancing immunity in the respiratory tract, via mucosal vaccination, may provide protection against infection and minimise viral spread. Here, we report testing of a subunit vaccine in mice, consisting of SARS-CoV-2 Spike protein with a TLR2-stimulating adjuvant (Pam2Cys), delivered to mice parenterally or mucosally. Both routes of vaccination induce substantial neutralising antibody (nAb) titres, however, mucosal vaccination uniquely generates anti-Spike IgA, increases nAb in the serum and airways, and increases lung CD4+ T-cell responses. TLR2 is expressed by respiratory epithelia and immune cells. Using TLR2 deficient chimeric mice, we determine that TLR2 expression in either compartment facilitates early innate responses to mucosal vaccination. By contrast, TLR2 on hematopoietic cells is essential for optimal lung-localised, antigen-specific responses. In K18-hACE2 mice, vaccination provides complete protection against disease and sterilising lung immunity against SARS-CoV-2, with a short-term non-specific protective effect from mucosal Pam2Cys alone. These data support mucosal vaccination as a strategy to improve protection in the respiratory tract against SARS-CoV-2 and other respiratory viruses.

A Comparative Study of Question Answering over Knowledge Bases (preprint)

Question answering over knowledge bases (KBQA) has become a popular approach to help users extract information from knowledge bases. Although several systems exist, choosing one suitable for a particular application scenario is difficult. In this article, we provide a comparative study of six representative KBQA systems on eight benchmark datasets. In that, we study various question types, properties, languages, and domains to provide insights on where existing systems struggle. On top of that, we propose an advanced mapping algorithm to aid existing models in achieving superior results. Moreover, we also develop a multilingual corpus COVID-KGQA, which encourages COVID-19 research and multilingualism for the diversity of future AI. Finally, we discuss the key findings and their implications as well as performance guidelines and some future improvements. Our source code is available at \url{https://github.com/tamlhp/kbqa}.

From fears to recession? Time‐frequency risk contagion among stock and credit default swap markets during the COVID pandemic

This study uses a high-dimensional time-frequency volatility spillover model to examine risk interactions across 32 global stock and credit default swap (CDS) markets during the coronavirus (COVID-19) pandemic. Our empirical results mainly show that cross-market risk spillovers between these two types of markets are rare over the whole crisis period. Adding CDS assets to the stock portfolio would significantly decrease the overall risk spillovers in the mixed portfolio. Then, the time-frequency spillover and rolling window analyses confirm this finding and provide further evidence of frequency heterogeneity of risk spillovers during the pandemic. The outbreak of the COVID pandemic only sharply increases short-term risk spillovers between the stock and sovereign CDS market but exerts insignificant impacts on the medium and long-term cross-market risk spillovers. Moreover, our results show that developed countries are net transmitters in the stock markets. In contrast, the emerging markets account for the most risk spillovers in sovereign CDS markets over the sample period, emphasizing the heterogenous adverse impacts of the pandemic across various countries and markets. Finally, we find that bailouts implemented by the US and EU central banks, though with heterogeneous impacts across frequencies, gradually enhance the confidence and resilience of investors in these markets.

Increased SARS-CoV-2 Infection, Protease, and Inflammatory Responses in Chronic Obstructive Pulmonary Disease Primary Bronchial Epithelial Cells Defined with Single-Cell RNA Sequencing.

Rationale: Patients with chronic obstructive pulmonary disease (COPD) develop more severe coronavirus disease (COVID-19); however, it is unclear whether they are more susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and what mechanisms are responsible for severe disease. Objectives: To determine whether SARS-CoV-2 inoculated primary bronchial epithelial cells (pBECs) from patients with COPD support greater infection and elucidate the effects and mechanisms involved. Methods: We performed single-cell RNA sequencing analysis on differentiated pBECs from healthy subjects and patients with COPD 7 days after SARS-CoV-2 inoculation. We correlated changes with viral titers, proinflammatory responses, and IFN production. Measurements and Main Results: Single-cell RNA sequencing revealed that COPD pBECs had 24-fold greater infection than healthy cells, which was supported by plaque assays. Club/goblet and basal cells were the predominant populations infected and expressed mRNAs involved in viral replication. Proteases involved in SARS-CoV-2 entry/infection (TMPRSS2 and CTSB) were increased, and protease inhibitors (serpins) were downregulated more so in COPD. Inflammatory cytokines linked to COPD exacerbations and severe COVID-19 were increased, whereas IFN responses were blunted. Coexpression analysis revealed a prominent population of club/goblet cells with high type 1/2 IFN responses that were important drivers of immune responses to infection in both healthy and COPD pBECs. Therapeutic inhibition of proteases and inflammatory imbalances reduced viral titers and cytokine responses, particularly in COPD pBECs. Conclusions: COPD pBECs are more susceptible to SARS-CoV-2 infection because of increases in coreceptor expression and protease imbalances and have greater inflammatory responses. A prominent cluster of IFN-responsive club/goblet cells emerges during infection, which may be important drivers of immunity. Therapeutic interventions suppress SARS-CoV-2 replication and consequent inflammation.

Exploration of chalcones as 3-chymotrypsin-like protease (3CLpro) inhibitors of SARS-CoV-2 using computational approaches.

The main protease 3CLpro is one of the potential targets against coronavirus. Inhibiting this enzyme leads to the interruption of viral replication. Chalcone and its derivatives were reported to possess the ability to bind to 3CLpro protease in the binding pocket. This study explored an in-house database of 269 chalcones as 3CLpro inhibitors using in silico screening models, including molecular docking, molecular dynamics simulation, binding free energy calculation, and ADME prediction. C264 and C235 stand out as the two most potential structures. The top hit compound C264 was with the Jamda score of -2.8329 and the MM/GBSA binding energy mean value of -28.23 ± 3.53 kcal/mol, which was lower than the reference ligand. Despite the lower mean binding energy (-22.07 ± 3.39 kcal/mol), in-depth analysis of binding interaction suggested C235 could be another potential candidate. Further, in vitro and in vivo experiments are required to confirm the inhibitory ability. Supplementary Information: The online version contains supplementary material available at 10.1007/s11224-022-02000-3.

Cold Plasmamed Beam as a Supporting Treatment of Soft Tissue Injuries in Severe Covid-19 Patients: A Preliminary Report.

Background: Cold plasma has many characteristics that allow for effective wound healing. Due to its efficacy, we have applied it in treating patients with severe Covid-19 who have soft tissue skin lesions and diseases including burns, pressure ulcers, shingles, and contact or atopic dermatitis. This study aims to assess the general characteristics of Covid-19 patients with soft tissue lesions and to conduct a fundamental evaluation of the efficacy of cold plasmamed beams in treating soft tissue wounds in patients with severe Covid-19. Methods: This prospective study was conducted on 20 severe Covid-19 patients with soft tissue lesions at the Intensive Care Center for Covid-19 of Hue Central Hospital in Ho Chi Minh City from September 25 to November 11, 2021. These patients was performed cold plasma irradiation at any stage of wound progression, including new injuries and chronic wounds. Results: Among 915 severe Covid-19 patients treated at our center, 20 patients had soft tissue lesions. Grade I, II, and III pressure ulcers accounted for 70% of the 20 cases of soft tissue lesions and 1.53% of the total patients at the time of the survey. Pressure ulcers were present in only 0.55% of patients (5/915 patients). Eleven out of 20 patients (55.0%) had lesions before admission, and 9 (45.0%) had lesions that appeared after admission. After 14 days of treatment, 14/20 patients had complete epithelialization (70%), and in 18/20 patients, wound exudation had ceased. The wounds became painless; after 3 weeks, the rashes had completely disappeared. Conclusion: The study emphasizes that irradiation with cold plasma contributes to the wound healing process.

Characteristics and Outcomes of DKA Admissions Before and During COVID-Pandemic

Background: COVID-increases risk of DKA and poor outcomes in patients with diabetes. Methods: A retrospective review was conducted of 4,959 DKA admissions from 1/1/2019-12/31/2021 at our hospital system. EHR data was collected on consecutive admissions coded with DKA for clinical characteristics, hospital outcomes of length of stay (LOS) , 30day readmission (30d RADM) and mortality. Data was analyzed for differences stratified by year 20vs. 2020 and 2021, and by COVID-infection. Results: Compared to 2019, patients in 2020 were older, more Hispanic and had CHF. Compared to 2019, patients in 2021 had less HTN and kidney disease but similar rates of CHF;Table 1. Mortality and LOS were higher for 2020 and 2021 while 30d RADM was lower;Table 2. Conclusion: Despite advancements in COVID-treatments, DKA patients have progressively poorer outcomes.

The Impact of Absorption Capability, Innovation Capability, and Branding Capability on Firm Performance—An Empirical Study on Vietnamese Retail Firms

This study aims to explore the impact of absorption capability, innovation capability, and branding capability on the performance of retailers. Using the resource-based view (RBV), this study proposes a research model on the direct impact of absorption capability, innovation capability, and branding capability on firm performance as well as the indirect impact of absorption capability on firm performance which is mediated by both innovation capability and branding capability. By surveying 201 middle and senior managers representing 201 Vietnamese retailers, PLS-SEM was used to test the hypotheses. The research results show the important role of developing innovation capability and branding capability in improving retailer performance. The findings also reveal the significant impact of absorption capability on retailers by an indirect mechanism through innovation capability and branding capability. Based on the findings, practical implications for Vietnamese retailer managers are suggested to improve their performance by strengthening and developing absorption capability, innovation capability, and branding capability.

A Novel Integrating Data Envelopment Analysis and Spherical Fuzzy MCDM Approach for Sustainable Supplier Selection in Steel Industry

Supply chain sustainability, which takes environmental, economic, and social factors into account, was recently recognized as a critical component of the supply chain (SC) management evaluation process and known as a multi-criteria decision-making problem (MCDM) that is heavily influenced by the decision-makers. While some criteria can be analyzed numerically, a large number of qualitative criteria require expert review in linguistic terms. This study proposes an integration of Data Envelopment Analysis (DEA), spherical fuzzy analytic hierarchy process (SF-AHP), and spherical fuzzy weighted aggregated sum product assessment (SF-WASPAS) to identify a sustainable supplier for the steel manufacturing industry in Vietnam. In this study, both quantitative and qualitative factors are considered through a comprehensive literature review and expert interviews. The first step employs DEA to validate high-efficiency suppliers based on a variety of quantifiable criteria. The second step evaluates these suppliers further on qualitative criteria, such as economic, environmental, and social factors. The SF-AHP was applied to obtain the criteria’s significance, whereas the SF-WASPAS was adopted to identify sustainable suppliers. The sensitivity analysis and comparative results demonstrate that the decision framework is feasible and robust. The findings of this study can assist steel industry executives in resolving the macrolevel supplier selection problem. Moreover, the proposed method can assist managers in selecting and evaluating suppliers more successfully in other industries.

Post-traumatic stress disorder, anxiety, depression and related factors among COVID-19 patients during the fourth wave of the pandemic in Vietnam.

BACKGROUND: This study investigated post-traumatic stress disorder (PTSD), anxiety, depression and their related factors among coronavirus disease 2019 (COVID-19) patients during the fourth wave of the pandemic in Vietnam. METHODS: Vietnamese-fluent confirmed COVID-19 patients for at least 3 d were recruited in this online cross-sectional study to answer a three-part questionnaire including participants' sociodemographic characteristics, PTSD (Impact of Event Scale-Revised) and anxiety and depression (Hospital Anxiety and Depression Scale). Associated factors were determined using multivariable binary logistic regression models. RESULTS: Of 1544 responses, the majority were female (53.0%), ages 18-39 y (74.8%) and were isolated and treated at field hospitals (72.2%). Family or friends were the greatest sources of mental support (68.2%), followed by healthcare providers (51.1%). The overall prevalence rates of PTSD, anxiety and depression among COVID-19 patients were 22.9%, 11.2% and 17.4%, respectively. Risk factors included older age, higher education, getting infected from the public, knowing someone who died from COVID-19 and high perception of life threat. Meanwhile, mental assistance from family or friends, a greater number of supporters, living with someone not vulnerable and higher salaries were significantly protective factors. CONCLUSIONS: The psychological responses associated with some sociodemographic details. Family or friends should be the first line of mental interventions for COVID-19 patients.

A Cross-Country European Efficiency Measurement of Maritime Transport: A Data Envelopment Analysis Approach

Maritime transport, which includes shipping and port operations, is the fundamental basis of international trade and globalization. In transportation management, efficiency is critical for verifying performance and proposing the best countermeasure to meet predetermined goals. Various efforts in this field have been made to solve this problem satisfactorily. However, the significant proportion of conventional approaches are based on long-term observations and professional expertise, with only a few exceptions based on practice-based historical data. Data Envelopment Analysis (DEA) is a non-parametric technique for analyzing various output and input variables parallelly. The efficiency of maritime transport in European countries is explored using a two-stage DEA approach based on Malmquist and Epsilon-Based Measure (EBM). First, the Malmquist model analyses countries’ total productivity growth rates and their breakdown into technical efficiency (catch-up) and technology change (frontier-shift). Second, the EBM model is used to determine the efficiency and inefficiency of the maritime transportation systems in each European country. Apart from identifying the best-performing countries in specific areas over the study period (2016–2019), the results highlight that the gap in applying the EBM method to maritime transport has been successfully closed and that the emerging paradigm, when combined with the Malmquist model, can be a sustainable and appropriate evaluation model for other research areas.