Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Temporal and spatial variation of limnological variables and biomass of different macrophyte species in a Neotropical reservoir (São Paulo - Brazil)

AIM: This study reports an investigation of limnological characteristics and aquatic macrophyte occurrence in a neotropical reservoir in order to assess the spatio-temporal variation of water and sediment variables and their influence on plant distribution. METHODS: Macrophytes, water and sediment samples were collected from a Brazilian reservoir in different seasons from four main arms of the reservoir. In total sixteen water-sediment variables were analyzed including N:P ratio and Trophic State Index. The plants were collected using a quadrat sampling procedure and the dry weight per sample was measured. MANOVA was performed to evaluate spatial and temporal variation of environmental variables as well as seasonal biomass differences. To assess the relationship among environmental variables and macrophytes an ordination analysis (using Canonical Correspondence Analysis: CCA) was carried out. RESULTS: The spatial and temporal variation of limnological variables generated a heterogeneous system which supports the presence of different species of macrophyte. pH, dissolved oxygen and sediment composition were important predictors of Polygonum lapathifolium occurrence while nutrients were associated with Eichhornia crassipes and Pistia stratiotes. Inorganic substances were related to biomass variation of Eichhornia azurea and Myriophyllum aquaticum. CONCLUSIONS: The spatial variation of the environmental variables has caused heterogeneity in the reservoir and it may support the occurrence of different species of macrophyte. Limnological variables highlighted in CCA are important to predict the species occurrence and their control in the study area