Pneumomediastinum as a complication of SARS-CoV-2 pneumonia

The incidence of pneumomediastinum in hospitalised patients diagnosed with SARS-CoV-2 pneumonia is by no means negligible, much higher compared to the general population. The pathophysiology of pneumomediastinum in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is explained by the increase in alveolar-interstitial pressure gradient (dry coughing spells, respiratory work, barotrauma from ventilatory support) in the context of particularly "fragile" lungs due to diffuse alveolar-interstitial damage from infectious-inflammatory origin, all of which significantly increases the risk of alveolar wall rupture. The more severe the SARS-CoV-2 pneumonia, the more likely it is that pneumomediastinum will occur. The development of pneumomediastinum in patients with SARS-CoV-2 pneumonia is associated with higher frequencies of death, intensive care unit (ICU) admission and tracheostomy and longer hospital and ICU lengths of stay. In most cases, pneumomediastinum in SARS-CoV-2 pneumonia is a benign and self-limiting process that resolves with conservative treatment. © 2022 Sociedad Madrinela de Neumologia y Cirugia Toracica. All rights reserved.

Assessing the robustness of COVID-19 vaccine efficacy trials: systematic review and meta-analysis, January 2023.

BackgroundVaccines play a crucial role in the response to COVID-19 and their efficacy is thus of great importance.AimTo assess the robustness of COVID-19 vaccine efficacy (VE) trial results using the fragility index (FI) and fragility quotient (FQ) methodology.MethodsWe conducted a Cochrane and PRISMA-compliant systematic review and meta-analysis of COVID-19 VE trials published worldwide until 22 January 2023. We calculated the FI and FQ for all included studies and assessed their associations with selected trial characteristics using Wilcoxon rank sum tests and Kruskal-Wallis H tests. Spearman correlation coefficients and scatter plots were used to quantify the strength of correlation of FIs and FQs with trial characteristics.ResultsOf 6,032 screened records, we included 40 trials with 54 primary outcomes, comprising 909,404 participants with a median sample size per outcome of 13,993 (interquartile range (IQR): 8,534-25,519). The median FI and FQ was 62 (IQR: 22-123) and 0.50% (IQR: 0.24-0.92), respectively. FIs were positively associated with sample size (p < 0.001), and FQs were positively associated with type of blinding (p = 0.023). The Spearman correlation coefficient for FI with sample size was moderately strong (0.607), and weakly positive for FI and FQ with VE (0.138 and 0.161, respectively).ConclusionsThis was the largest study on trial robustness to date. Robustness of COVID-19 VE trials increased with sample size and varied considerably across several other important trial characteristics. The FI and FQ are valuable complementary parameters for the interpretation of trial results and should be reported alongside established trial outcome measures.

Revisiting Poverty Trends and the Role of Social Protection Systems in Africa during the COVID-19 Pandemic

Quantifying the impact of the COVID-19 pandemic on poverty in Africa has been as difficult as predicting the path of the pandemic, mainly due to data limitations. The advent of new data sources, including national accounts and phone survey data, provides an opportunity for a thorough reassessment of the impact of the pandemic and the subsequent expansion of social protection systems on the evolution of poverty in Africa. In this paper, we combine per capita GDP growth from national accounts with data from High-Frequency Phone Surveys for several countries to estimate the net impact of the pandemic on poverty. We find that the pandemic has increased poverty in Africa by 1.5 to 1.7 percentage points in 2020, relatively smaller than early estimates and projections. We also find that countries affected by Fragility, Conflict and Violence experienced the greatest increases in poverty, about 2.1 percentage points in 2020. Furthermore, we assess and synthesize empirical evidence on the role that social protection systems played in mitigating the adverse impact of the COVID-19 crisis in Africa. We review social protection responses in various African countries, mainly focusing on the impact of these programs and effectiveness of targeting systems. Although the evidence base on the protective role of social protection programs during the pandemic remains scarce, we highlight important findings on the impacts of these programs while also uncovering some vulnerabilities in social protection programming in Africa. We finally draw important lessons related to the delivery, targeting and impact of various social protection programs launched in Africa in response to the pandemic.

Quality Improvement Project: Improving Osteoporosis Treatment for Patients with a Neck of Femur Fracture

Background/Aims The Fracture Liaison Service (FLS) identifies patients >50 who have sustained a fragility fracture (FF). These patients need prompt assessment and decision on appropriate treatment for osteoporosis in order to reduce their risk of sustaining further FFs. Without treatment, 1/5 patients can go on to have a further FFs which carry significant risk to mortality and morbidity. Zoledronate is a bone agent that halves the risk of another FF. Patients with a neck of femur fracture (#NOF) present as one of the most at-risk groups for a further FF. These patients are generally elderly and frail and attendance to outpatient hospital appointments are difficult. Therefore, transforming the FLS from an out-patient-based service, to one that is streamlined to systematically identify and opportunistically treat patients whilst they are still in hospital means delivering timely, effective and efficient patient-centred care. Methods We used various Plan-Do-Study-Act cycles to aim to deliver Zoledronate to>=90% of appropriately assessed in-patients >60 who have had a #NOF within a year of commencing QIP. Results PDSA cycle 1-Involvement of ortho-geriatrician: P-Improve working relationship with ortho-geriatrician with an interest in bone health over a 6-month period;D-Regular meetings with wider MDT;S-Priority of bone health assessments made greater through ward round documentation;A-Expand knowledge throughout the wider ortho-geriatrician team. PDSA cycle 2-Timing of Zoledronate delivery: P-Literature review regarding delivery of Zoledronate timing;D-Discuss as MDT;SNo evidence to suggest delay in fracture healing if given on day 7;AAdopted process and communicated. PDSA cycle 3-FLS team on the wards as a result of PDSA cycle 2 not improving treatment outcomes: P-FLS nurses to join ortho-geriatrician ward round twice-weekly for 3- month trial period;D-Bank holidays and spike in Covid cases presented a challenge. Solution: Improvement of MDT relationships;S-At the end of the trial period an increase in patients who received treatment was shown and proved our prediction;A-Adaptation to documentation in FLS to streamline and reduce duplication. Conclusion The ability to deliver Zoledronate to>=90% of appropriate patients with a #NOF as an inpatient was reached after 8 months of initiating QIP. Furthermore, maintaining this was consistently achieved throughout the following year and beyond. A few of the main reasons for this included earlier drug delivery, having a dedicated ortho-geriatrician as part of the FLS, and the FLS team attending the wards. A prompt bone health assessment of patients has enabled appropriate treatment to be delivered efficiently. The delivery of Zoledronate as an in-patient has meant that a significantly greater proportion of patients receive treatment, and sooner, in comparison to awaiting an outpatient assessment (that they may not attend). Therefore, this QIP has demonstrated time- and cost-effective management of patients with #NOF requiring Zoledronate.

Determinants of individuals' objective and subjective financial fragility during the COVID-19 pandemic.

We examine determinants of the objective and subjective financial fragility of 2100 individuals across Australia, France, Germany, and South Africa during the COVID-19 pandemic. Objective financial fragility reflects individuals' (in)ability to deal with unexpected expenses, while subjective financial fragility reflects their emotional response to financial demands. Controlling for an extensive set of socio-demographics, we find that negative personal experiences during the pandemic (i.e., reduced or lost employment; COVID-19 infection) are associated with higher objective and subjective financial fragility. However, individuals' cognitive (i.e., financial literacy) as well as non-cognitive abilities (i.e., internal locus of control; psychological resilience) help to counteract this higher financial fragility. Finally, we examine the role of government financial support (i.e., income support; debt relief) and find that it is negatively related to financial fragility only for the economically weakest households. Our results have implications for public policymakers, providing levers for reducing individuals' objective and subjective financial fragility.

Myanmar's path to democracy from 2016-2021: Progress, limitations and disruptions

While the NLD's landslide election victory in November 2020 had strengthened the hopes of the people of Myanmar and the international community that the process of democratization would continue, yet another majority bagged by the NLD was a threat to the military institution and its affiliates. On February 1, 2021, the Myanmar military staged a coup: the promising chapter of Myanmar's democratic and economic transition, albeit limited in duration and reach, has come to an end, as has the Union's ongoing reintegration into the international order after roughly sixty years of isolation. Despite the coup, this chapter argues that the democratic transition much lauded in 2015 had yet to fully occur;the future of it happening remains distant, although not impossible. This chapter also highlights reflections from the periphery and the challenges faced in 2020, namely, the general election and the Covid-19 pandemic. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.

Role of faith-based organisations and individuals in provision of health services in Zimbabwe

This article reflects on the increasing roles of faith-based organisations (FBOs) and individual followers in the provision of health services in Zimbabwe within the context of declining capabilities of state-funded and state-owned health facilities. In colonial and post-colonial Africa in general and Zimbabwe in particular, FBOs have consistently contributed to the provision of public services and social security. We contend that state fragilities in the Zimbabwean political landscape result in severe public service delivery deficits that are often filled by FBOs and individual followers. The implications for FBOs and individual followers are twofold. Firstly, the increased involvement of FBOs in the production and provision of public services such as education and health services afford FBOs with opportunities and spaces to evangelise. Secondly, and on the downward side, the provision of health services can often be expensive and diverts attention from the core business of these religious organisations. The article reveals that in the context of economic and governance crises, FBOs play an increasingly momentous role in providing health care services in Zimbabwe. The article focuses on Zimbabwe during the crisis periods of 2007–2009 and 2018 up to the current (2022) socio-economic and political declines, poor governance, and the subsequent fragilities in the state. Contribution: Faith-based organisations assume increasing roles in the provision of health services in place of failing states. Those increased roles provide FBOs opportunities to evangelise. However, FBOs are not a sustainable replacement because they become afflicted with the same financial challenges that bedevil the state.

Financial capability and households' financial vulnerability: evidence for the Spanish case

PurposeThe present study examines the potential relationship between financial capability and household financial vulnerability for a sample of Spanish individuals.Design/methodology/approachThe methodology combines a literature review deepening on the two concepts addressed in this paper – financial vulnerability and financial capability – and an empirical analysis. Based on a sample of 7,811 Spanish individuals taken from the Survey of Financial Competences, different probit regression models are used to test the relationship of key independent variables (namely, financial literacy, financial inclusion, and financial capability) with household financial vulnerability.FindingsEmpirical evidence points to the existence of a negative relationship between financial capability and household financial vulnerability. Besides, the variable on financial capability demonstrates, per se, a greater explanatory power than its two components (i.e. objective financial literacy and financial inclusion) separately, particularly in the case of financial literacy.Originality/valueThis paper contributes to the research on household finances along three main dimensions. Firstly, it enhances the research on financial capability by analysing how it relates to consumers' financial vulnerability;an association barely explored by the extant literature. Secondly, it gets closer to the multifaceted concept of financial vulnerability through a wide set of objective and subjective proxy variables. And thirdly, the empirical evidence found leads to proposing some recommendations aimed at improving households' financial capability.

The fragile city

The COVID-19 pandemic brought cities around the world to a halt, causing massive disruption and suffering for hundreds of millions of people. This chapter assesses the sources of fragility rooted in our cities and explores approaches that could help cities develop more resilient urban systems, enabling them to function, and even thrive, in times of crisis. The COVID crisis has clearly exposed how unequal cities can be, with migrants, the poor, women, racial minorities, and isolated older people being hardest hit. The pandemic saw hundreds of thousands of people flee urban coronavirus hotspots for rural areas. The digital divide is one of the many inequalities exposed by the pandemic. Focused investments that help address the digital divide will also help address social inequalities, particularly in a world where schools, businesses, and government services have gone digital. © 2022 John Wiley & Sons Ltd. All rights reserved.

Does financial fragility affect consumer well-being? Evidence from COVID-19 and the United States

Financial fragility is of considerable concern for consumer well-being. Besides unleashing a public health crisis, COVID-19 also ignited a financial crisis and thus represents a natural event from the field to study financial well-being. We maintain that well-being is a corollary to one's financial situation. We investigate the linkage between financial fragility and well-being and the moderating role of financial literacy and personality using US data. We find that financial fragility is negatively associated with well-being. This pervasive phenomenon during a financial crisis has harmful consequences. We also find evidence of a differential impact of financial fragility on well-being based on Agreeableness, Conscientiousness, and Neuroticism, supporting our argument that personality has varying degrees of explanatory and predictive power in terms of well-being. Surprisingly, financial literacy does not modify this relationship, possibly due to the well-being affecting an individual's cognition and emotions rather than financial knowledge. Our findings could aid policy makers and financial educators in devising timely strategies to deal with post-crisis complications. © 2023 The Authors. Global Business and Organizational Excellence published by Wiley Periodicals LLC.

A Reflection on the Nexus between South African Land Reform Struggles and the Unresolved National Question

The post-apartheid South African government continues to struggle with its transformation posture, including the quest to redress the racially based land inequalities that have plagued the country since its colonial past. The Covid-19 pandemic, the 2015 #RhodesMustFall and #FeesMustFall movements, and the July 2021 #FreeZuma violence have highlighted both the fragility and the resilience of South African political institutions. Since the formation of the Economic Freedom Fighters (EFF), a left-leaning and militant political party, in 2013, the South African land question has become more vociferously contested within government purview and in the public domain. Unresolved land issues have exposed the failure of the state to resolve one of its most sensitive national questions. We interrogate the land conflict and locate it within the broader national questions that have continued to haunt post-apartheid South Africa. Indeed, the South African land question must be understood holistically, and not solely as an agrarian question. Although the ANC-led government has implemented a land reform scheme under four pillars—land restitution, land redistribution, tenure security, and land development—there are still compelling cases of land hunger and conflict, as well as widespread confusion about the proposed land expropriation without compensation. Despite the rhetoric by government officials, we hold that the land debacle is a manifestation of a failing national question, state fragility, and an incomplete decolonisation process wherein the so-called "political power" held by the majority has not transformed into economic power and the effective redistribution of land to meet the targets of successive administrations. [ABSTRACT FROM AUTHOR] Copyright of International Journal of African Renaissance Studies is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Short-term Outcomes of Patients with Fragility Hip Fractures Infected with SARS-CoV-2 Managed in a COVID-19 Referral Hospital with an Orthogeriatric Team

Objectives. Presence of COVID-19 infection in patients with acute fragility hip fracture complicates the decisionmaking process in the management of these patients. This study aims to describe outcomes of patients with coexisting fragility hip fracture and COVID-19 infection who underwent surgery. Methods. In this retrospective study, the patient database of a university hospital designated as a COVID-19 referral center with an orthogeriatric team was reviewed to determine the mortality and morbidity rates, and short-term functional outcomes of patients with coexisting COVID-19 and acute fragility hip fracture who underwent surgery. Results. A total of 18 patients were admitted with COVID-19 infection and acute fragility hip fracture - 12 had surgery. Mean injury-to-admission and admission-to-surgery intervals were 6.5 and 4.8 days, respectively. Most patients (91.7%) had an incidental finding of SARS-CoV-2 infection. Mean ASA score was 2.9. Arthroplasty was done in all patients with a mean operative time of 155.8 minutes and an average blood loss of 366.7 mL. Thirty-day mortality and morbidity rates were 16.7% and 33.3%, respectively. Mean EuroQoL overall health score was 79.3. Conclusion. A multidisciplinary team approach is recommended to expedite timely surgery prior to the onset of clinical deterioration. Asymptomatic and mildly symptomatic patients with acute fragility hip fracture are candidates for urgent surgical intervention even in the presence of COVID-19 infection. © 2022 University of the Philippines Manila. All rights reserved.

Impact of COVID-19 Pandemic on Treatment and Outcome of Fragility Hip Fractures In Non-COVID Patients: Comparison Between the Lockdown Period, a Historical Series and the "Pandemic Normality" in a Single Institution.

Introduction: The COVID-19 pandemic has affected and is still deeply affecting all aspects of public life. World governments have been forced to enact restrictive measures to stem the contagion which have led to a decrease in the movement of people within national territory and to a redirection of health care resources with a suspension of non-urgent procedures. In Italy, a lockdown was imposed from March 9th to May 3rd, 2020. As a result, a significant reduction in the overall operative volume of orthopedic trauma was expected, but it was not possible to predict a similar trend regarding fragility fractures of the proximal femur in the elderly. Methods: The aim of this paper was to examine the impact of COVID-19 on the operating volume for trauma surgeries and to determine how the pandemic affected the management of fragility hip fractures (FHFs) in non-COVID patients at a single Institution. Results: The first result was a statistically significant reduction in the overall operative volume of orthopedic trauma during the period of the first lockdown and an increase in the mean age of patients undergoing surgery, as expected. As regard to the second aim, the incidence of FHFs remained almost unchanged during the periods analysed. The population examined were superimposable in terms of demographics, comorbidities, type of fracture, peri-operative complications, percentage of operations performed within 48 hours from hospitalization and 1-year outcome. Discussion: Our results are in line with those already present in the Literature. Conclusions: Our study revealed a significant impact of the restrictive anti-contagion measures on the overall orthopedic surgical volume, but, at the same time, we could affirm that the pandemic did not affect the management of FHFs in non-COVID patients, and their results.

Mortality and outcome in fragility hip fracture care during COVID-19 pandemic in Police General Hospital, Thailand.

Objectives: The objective of this study is to assess outcomes and patient's mortality of Police General Hospital's fracture liaison service (PGH's FLS) during Coronavirus disease 2019 (COVID-19) outbreak comparing to the former period. Methods: Retrospective cohort study was performed in patients aged 50 or older who were admitted with fragility hip fracture in Police General Hospital, Bangkok, between January 1, 2018 to December 31, 2019 (before pandemic) comparing to January 1, 2020 to December 31, 2021 (pandemic) using the electronic database. The outcomes were mortality and other outcomes in one-year follow up. Results: A total of 139 fragility hip fractures were recorded in 2018-2019 (before pandemic) compared with 125 in 2020-2021 (pandemic). The 30-day mortality in hip fracture numerically increased from 0% to 2.4% during the pandemic. One-year mortality was significantly escalated from 2 cases (1.4%) to 5 cases (4%) (P = 0.033). However, the cause of mortality was not related with COVID-19 infection. We also found a significantly shorter time to surgery but longer wait time for bone mineral density (BMD) testing and initiation of osteoporosis medication in pandemic period. Conclusions: The results of this study in COVID-19 pandemic period, 1-year mortality rate was significantly higher but they were not related with COVID-19 infection. We also found longer time to initial BMD testing and anti-osteoporotic medication and more loss of follow up, causing lower anti-osteoporotic medication taking. In contrast, the time to surgery became shorter during the pandemic.

Bone fragility during the COVID-19 pandemic: the role of macro- and micronutrients.

Bone fragility is the susceptibility to fracture due to poor bone strength. This condition is usually associated with aging, comorbidities, disability, poor quality of life, and increased mortality. International guidelines for the management of patients with bone fragility include a nutritional approach, mainly aiming at optimal protein, calcium, and vitamin D intakes. Several biomechanical features of the skeleton, such as bone mineral density (BMD), trabecular and cortical microarchitecture, seem to be positively influenced by micro- and macronutrient intake. Patients with major fragility fractures are usually poor consumers of dairy products, fruit, and vegetables as well as of nutrients modulating gut microbiota. The COVID-19 pandemic has further aggravated the health status of patients with skeletal fragility, also in terms of unhealthy dietary patterns that might adversely affect bone health. In this narrative review, we discuss the role of macro- and micronutrients in patients with bone fragility during the COVID-19 pandemic.

Political Trust, Mental Health, and the Coronavirus Pandemic: A Cross-National Study.

OBJECTIVES: We investigate whether older adults who place greater trust in their political leadership fare better in terms of mental wellbeing during the COVID-19 pandemic. We also test if and how the trust-wellbeing relationship varies across individual- and country-level moderators. METHODS: Based on cross-national data consisting of over 13,000 older adults in 66 countries, we estimate a series of multilevel models. RESULTS: Within countries, political trust is significantly negatively associated with depressive symptoms. And this association is stronger for those who are subjectively less healthy. Between countries, the trust-depression link at the individual level is stronger in more "fragile" states. These findings are robust to a host of confounders including the experienced level of anxiety stemming from COVID-19. DISCUSSION: During the novel coronavirus pandemic, political trust provides a significant mental health buffer for older adults. This protective role varies partly as a function of individual and contextual vulnerability.

Fragility of FDI flows in sub-Saharan Africa region: does the paradox persist?

The circumstances of the SSA region regarding the inflow of foreign direct investment (FDI) present a puzzle. In spite of the high rate of return on investment, the inflow of foreign investments keeps eluding the region, and the COVID-19 pandemic even perplexes the flow fragility the more. What factors then determine FDI flows aside from return on investment? Could there be more persuasive relative cost complexes? The study aimed at testing the effects of determining factors that influence FDI flows and their impact on economic development, considering the COVID-19 period. The study used cross-country pooled data from 30 SSA countries collected between 2001 and 2020. The study utilized five panel estimation techniques, namely Pooled Regression, Fixed Effect (FE), Random Effect (RE), Panel Two-Stage Least Square and Differenced Generalized Moments of Method (DGMM). The study found that the inflow of FDI has significant positive impact on economic development in the sub-Saharan African region. It is also ascertained that the outflow of FDI, and political stability has an inverse relationship with economic development. The study recommends that governments of host economies should hence ensure an enabling framework for their economies, so as to improve infrastructure, political stability, and institutional quality, in order to sufficiently encourage the inflow of FDI into the SSA region and make the environment inviting, sustainable, and beneficial for foreign investors and host economies alike.

IMPACT of COVID-19 on hip fracture services: A global survey by the International Multicentre Project Auditing COVID-19 in Trauma & Orthopaedics.

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic resulted in major disruption to hip fracture services. This frail patient group requires specialist care, and disruption to services is likely to result in increases in morbidity, mortality and long-term healthcare costs. AIMS: To assess disruption to hip fracture services during the COVID-19 pandemic. METHODS: A questionnaire was designed for completion by a senior clinician or service manager in each participating unit between April-September 2020. The survey was incorporated into existing national-level audits in Germany (n = 71), Scotland (n = 16), and Ireland (n = 16). Responses from a further 82 units in 11 nations were obtained via an online survey. RESULTS: There were 185 units from 14 countries that returned the survey. 102/160 (63.7%) units reported a worsening of overall service quality, which was attributed predominantly to staff redistribution, reallocation of inpatient areas, and reduced access to surgical facilities. There was a high rate of redeployment of staff to other services: two thirds lost specialist orthopaedic nurses, a third lost orthogeriatrics services, and a quarter lost physiotherapists. Reallocation of inpatient areas resulted in patients being managed by non-specialised teams in generic wards, which increased transit of patients and staff between clinical areas. There was reduced operating department access, with 74/160 (46.2%) centres reporting a >50% reduction. Reduced theatre efficiency was reported by 135/160 (84.4%) and was attributed to staff and resource redistribution, longer anaesthetic and transfer times, and delays for preoperative COVID-19 testing and using personal protective equipment (PPE). CONCLUSION: Hip fracture services were disrupted during the COVID-19 pandemic and this may have a sustained impact on health and social care. Protection of hip fracture services is essential to ensure satisfactory outcomes for this vulnerable patient group.

New Parking Lot Selection Approach Based on the Multi-Criteria Decision Making (MCDM) Methods: Health Criteria

To find a parking space, valet parking drivers have to travel a lot, which leads to carbon dioxide (CO2) emissions. In order to reduce these emissions, it is essential to understand a user's needs and criteria when searching for a parking space. Several selection criteria are considered when allocating a parking space. Recent research on parking space management mentions several parameters that have an impact on the choice of a parking space: namely, the traffic situation, the availability of each parking lot in question, and the cost of parking, etc. In this article, we discuss a new criterion: the physical condition of the driver in the management of parking spaces;the identification of the driver's bodily fragility. We also propose MCDM as a parking space allocation model that best meets the cost–benefit convention. This reflection leads us to evaluate MCDM methods in the field of intelligent parking management. Therefore, we conducted a comparison between the most recent multi-criteria decision making methods used by researchers, namely, CODA, EDAS, TOPSIS, and WASPAS. The CRITIC method was used in this paper to objectively determine the weight of each criterion. A new approach is proposed to evaluate and select the best MCDM method. Indeed, we propose a method that computes the "average inter-item correlation SW”, a combination of the "average inter-item correlation” and the SW coefficient. This approach allows us to efficiently compute the correlation between a method and the set of methods while favoring the cells with the best ranking. A case study is presented to illustrate the MCDM approach to parking space allocation and evaluation. The proposed system provides drivers with services such as intelligent parking decisions, taking into account the human aspect while reducing energy consumption, driving time, and traffic congestion caused by searching for available parking spaces.

Robustness of Significant Dichotomous Outcomes in Randomized Controlled Trials in the Treatment of Patients with COVID-19: A Systematic Analysis.

Purpose: Significant results of randomized controlled trials (RCTs) should be properly weighed. This study adopted fragility index (FI) to evaluate the robustness of significant dichotomous outcomes from RCTs on coronavirus disease 2019 (COVID-19) treatment. Materials and methods: ClinicalTrials.gov and PubMed were searched from inception to July 31, 2021. FIs were calculated and their distribution was depicted. FI's categorical influential factors were analyzed. Spearman correlation coefficient (r s) was reported for the relationship between FI and the continuous characteristics of RCTs. Results: Fifty RCTs with 120 outcomes in 7869 patients were included. The FI distribution was abnormal with median 3 (interquartile range 1-7, P = 0.0001). The FIs and robustness were affected by the outcomes of interest, various patient populations, and interventions (T = 18.215,16.667, 23.107; P = 0.02,0.0001, 0.001, respectively). A cubic relationship between the FIs and absolute difference of events between groups with R square of 0.848 (T = 215.828, P = 0.0001, R square = 0.865) was observed. A strong negative logarithmic relationship existed between FI and the P value with R square = - 0.834. Conclusion: The robustness of significant dichotomous outcomes of COVID-19 treatments was fragile and affected by the outcomes of interest, patients, interventions, P value, and absolute difference of events between the groups. FI was an useful quantitative metric for the binary significant outcomes on COVID-19 treatments. Registration: PROSPERO (CRD42021272455). Supplementary Information: The online version contains supplementary material available at 10.1007/s44231-022-00027-y.