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

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A novel technique for validating diagnosed respiratory noises in infants and children

The goal of this paper is to develop a novel technique to validate diagnosed respiratory noises in infants and children with high accuracy and reduced time consumption. A large number of recorded lung sounds are acquired with varied cases of normal and abnormal respiratory sounds. Wavelet-based Dynamic Time Warping technique is utilized in the proposed approach and the recognition accuracy was found to be above 88% in average. All the sounds represent infants and children below 13 years old and collected from AUCH-Alexandria, Egypt. Keywords: Dynamic time warping, Discrete wavelet transform, Respiratory noise

Detecting defects in software requirements specification

AbstractThis research is concerned with detecting defects in software requirements specification. Motivated by both the problem of producing reliable requirements and the limitations of existing taxonomies to provide a satisfactory level of information about defects in the requirements phase, we focus on providing a better tool for requirements analysts. Only few attempts have been made to classify defects and defect detection techniques. Scattered knowledge about defects and defect detection techniques needs compilation and re-evaluation in order to enhance the ability to discover defects in the requirements phase. Toward this end, this work presents a taxonomy of requirements defects and the causes of their occurrences. The purpose is to reach a comprehensive understanding of both the sources of the problem and the solutions of possible defects and defect detection techniques. The taxonomy’s design is based on the analysis of each defect and its sources. In addition, this paper proposes a combined-reading technique for defects in requirements. The proposed technique avoids the shortcomings of other reading techniques. The result of applying the recommendations of this work specifically improves the quality of the requirements specification and generally software quality

The role of MRI and MRS in the diagnosis of non hydrocephalic macrocrania in infancy and early childhood

The aim of this study was to determine the key MRI findings in different disease causing macrocrania in early childhood that will help in early detection and diagnosis. Patients and methods: This study was conducted on 20 patients (their age ranged from 3.5 months to 5 years) referred to the radiodiagnosis department in the period between February 2013 and June 2014. All patients were subjected to conventional MRI. MRS was done in 8 cases using PRESS 3D multi-voxel chemical shift imaging. Results: The patients subdivided into 7 groups. Glutaric aciduria type 1 (40%) MRI showed wide operculum sign; MRS done in 4 patients showed elevated choline with preserved NAA peak. Benign macrocrania of infancy (15%), and MRI showed enlarged cranio-cortical and inter-hemispheric subarachnoid spaces beyond 5 mm, mildly dilated ventricles. Van der Knaap disease (15%) showed bilateral symmetrical confluent white matter dysmyelination with bilateral fronto-temporal subcortical cystic changes .MRS done in 2 patients showed increase in Cho/NAA ratios. Mucopolysaccharidosis (10%) showed dilated Virchow Robin spaces. MRS done in one patient showed decreased NAA, and increased choline/creatine ratio. Canavan disease (10%) MRI showed bilateral symmetrical extensive white matter dysmyelination. MRS showed markedly elevated NAA. Alexander disease (5%) showed bilateral symmetrical white matter dysmyelination with frontal predilection. MRS revealed increased NAA/Cr, increased myo-inositol/Cr, and lactate doublet. Gangliosidosis (5%) MRI showed bilateral symmetrical T2 and FLAIR hyperintense putamen. CT showed bilateral symmetric thalamic hyperdensities. Conclusion: MRI can diagnose different causes of non hydrocephalic macrocrania. MRS is helpful in differentiating benign macrocrania of infancy from dysmyelinating diseases and is specific in Canavan Disease

Role of brain magnetic resonance spectroscopy in the evaluation of suspected mitochondrial diseases in children: Experience in 30 pediatric cases

Introduction: Mitochondrial diseases are a group of inherited disorders caused by derangement of mitochondrial respiration. MR spectroscopy (MRS) has been shown to detect abnormal accumulation of lactate in brain parenchyma and CSF in patients with mitochondrial disorders, but the frequency of detection is largely unknown. Aim of the work: To evaluate the role of brain MR spectroscopy in the assessment of suspected mitochondrial diseases in the pediatric age group. Patients and methods: Thirty children with suspected mitochondrial diseases were examined by MRS. Examination was done using multisection technique and multiple echo times mainly short (35 ms) and intermediate (144 ms). Mitochondrial disease criteria scoring system was used to confirm the suspected diagnosis. Results: All patients showed elevated lactate peak with the CSF being the most sensitive (100%). Among the 30 patients, 26 (86.7%) had elevated levels of blood lactate/pyruvate ratio. Conventional MRI showed highly suggestive features in 15 patients while non specific findings were detected in 11 patients and 4 showed normal appearing brain. Conclusions: MRS provides a noninvasive tool for the diagnosis of mitochondrial diseases, especially in children with non specific findings on MRI, normal appearing MRI or a normal blood lactate/pyruvate ratio

Growth, carcass traits, immunity and oxidative status of broilers exposed to continuous or intermittent lighting programs

Objective: An experiment was conducted to investigate the continuous and intermittent lighting program effects on terms of the productive performance, carcass traits, blood biochemical parameters, innate immune and oxidative status in broiler chicks. Methods: A total of 600 Cobb-500 one day old chicks were randomly allocated into six equal groups (100 chicks per treated group with five replicates of 20 chicks each) based on lighting program; 22 continuous lighting (22 C), 11 h lighting+1 darkness twice daily (11 L/1 D), 20 h continuous lighting (20 C), 5 h lighting+1 darkness four times daily (5 L/1 D), 18 h continuous lighting (18 C) and the final group subjected for 3 h lighting+1 h darkness six times daily (3 L/1 D). The experimental period lasted 42 days. Results: Compared with those under the intermittent light program, broiler chicks exposed to continuous lighting for 22 h had significant improvement in live body weight and carcass (dressing and breast percentage) measured traits. Though reducing lighting hours significantly reduced feed intake and feed conversion ratio values. Different lighting programs revealed no significant effect on all blood biochemical parameters. Oxidative stress and innate immunity parameters significantly enhance by reducing lighting hours (3L/1D). Conclusion: The findings suggest that reducing lighting hours up to 3L/1D would be more useful in enhancing feed efficiency, innate immunity, and oxidative status compared with continuous lighting programs on broilers

Evaluation of the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease

Abstract Background Dexmedetomidine infusion improves oxygenation and lung mechanics in patients with chronic obstructive lung disease; however, its effect in patients with restrictive lung disease has not been thoroughly investigated yet. The aim of this work was to evaluate the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease. Methods Forty-two morbidly obese patients scheduled for bariatric surgery were included in the study. Patients were randomized to receive either dexmedetomidine infusion at a bolus dose of 1mcg/Kg followed by infusion at 1 mcg/Kg/hour for 90 min (Dexmedetomidine group), or normal saline infusion (Control group). Both groups were compared with regard to: oxygenation {P/F ratio: PaO2/fraction of inspired oxygen (FiO2)}, lung compliance, dead space, plateau pressure, blood pressure, and heart rate. Results Dexmedetomidine group showed significant improvement of the PaO2/FiO2 ratio, and higher lung compliance compared to control group by the end of drug infusion. Dexmedetomidine group demonstrated decreased dead space, plateau pressure, blood pressure, and heart rate compared to control group by the end of drug infusion. Conclusion A 90-min dexmedetomidine infusion resulted in moderate improvement in oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease. Trial registration clinicaltrials.gov: NCT02843698 on 20 July 2016

Managing Gut Microbiota through In Ovo Nutrition Influences Early-Life Programming in Broiler Chickens

The chicken gut is the habitat to trillions of microorganisms that affect physiological functions and immune status through metabolic activities and host interaction. Gut microbiota research previously focused on inflammation; however, it is now clear that these microbial communities play an essential role in maintaining normal homeostatic conditions by regulating the immune system. In addition, the microbiota helps reduce and prevent pathogen colonization of the gut via the mechanism of competitive exclusion and the synthesis of bactericidal molecules. Under commercial conditions, newly hatched chicks have access to feed after 36&ndash;72 h of hatching due to the hatch window and routine hatchery practices. This delay adversely affects the potential inoculation of the healthy microbiota and impairs the development and maturation of muscle, the immune system, and the gastrointestinal tract (GIT). Modulating the gut microbiota has been proposed as a potential strategy for improving host health and productivity and avoiding undesirable effects on gut health and the immune system. Using early-life programming via in ovo stimulation with probiotics and prebiotics, it may be possible to avoid selected metabolic disorders, poor immunity, and pathogen resistance, which the broiler industry now faces due to commercial hatching and selection pressures imposed by an increasingly demanding market