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

Multisystemic Inflammatory Syndrome in Children, A Disease with Too Many Faces: A Single-Center Experience

Background and aim: Multisystemic inflammatory syndrome in children (MIS-C) is a rare and severe condition associated with Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) infection in children with onset approximately 4–6 weeks after infection. To date, the precise mechanism that causes MIS-C is not known and there are many questions related to the etiology, risk factors, and evolution of this syndrome. We aimed to describe the clinical manifestations, treatment methods, and disease evolution and analyze the main risk factors for MIS-C in children hospitalized in our clinic. Material and methods: We performed a retrospective study including children with MIS-C followed-up in the 2nd Pediatric Clinic of the Emergency Clinical Hospital for Children Cluj-Napoca, Romania, for 13 months (November 2020–December 2021). Results: We included in our cohort 34 children (mean age 6.8 ± 4.6 years) who met MIS-C criteria: high and prolonged fever associated with organ dysfunction (heart, lungs, kidneys, brain, skin, eyes, bone marrow or gastrointestinal organs), and autoantibodies and/or polymerase chain reaction positives for SARS-CoV-2. Nineteen patients (55.88%) had a severe form of the disease, with multiorgan failure and shock, and myocardial or respiratory failure. The number of organs affected in the severe forms was significantly higher (more than 6 in 73.70%) than in mild forms (2–3 in 60%). Cardiac dysfunction, hypoalbuminemia, hypertriglyceridemia and hyponatremia were more important in severe forms of MIS-C. These patients required respiratory support, resuscitation with fluid boluses, vasoactive drugs, or aggressive therapy. All patients with mild forms had fully recovered compared to 63.16% in severe forms. The others with severe forms developed long-term complications (dilation of the coronary arteries, premature ventricular contraction, or myocardial fibrosis). Two patients had an extremely severe evolution. One is still waiting for a heart transplant, and the other died (hemophagocytic lymphohistiocytosis syndrome with multiorgan failure). Conclusions: From mild to severe forms with multiorgan failure, shock, and many other complications, MIS-C represents a difficult challenge for pediatricians, who must be aware of the correct diagnosis and unpredictable, possibly severe evolution

Automated versus Manual Mapping of Gravel Pit Lakes from South-Eastern Romania for Detailed Morphometry and Vegetation

In recent years, the accelerated development of the remote sensing domain and the improvement of the resolution and frequency of satellite images allowed the increase in the accuracy of the evaluation of morphometric characteristics and the spatiotemporal distribution of pit lakes, including the small ones. Our study quantitatively analyzes small-scale pit lakes in the piedmont and subsidence plains from contact with the Getic and Curvature Subcarpathians from Romania using the normalized difference water index (NDWI) and data series, with different resolutions, from Landsat 8, Google Earth, and Sentinel 2A. The problems encountered in extracting the contours of the gravel pit lakes were determined by the different resolution of the images, the uneven quality of the images exported from Google Earth, and an additional challenge was given by the diversity of the analyzed land surfaces, the land use, and the optical properties of the lakes. A comparison of the obtained NDWI values using data series from Sentinel 2A and Landsat 8 highlighted the importance of resolution and also showed a larger spectral difference between the identified water bodies and the surrounding land in favor of Sentinel 2A. Regarding the vegetation-derived indices, superior leaf area index (1.8&ndash;3) was recorded in low-lying plains and mixed areas (tall shrubs, wetlands, etc.) because the river banks have increased moisture that supports taller species with denser foliage and the sparsely vegetated areas are located in agricultural crops and in/near villages. Changes in vegetation richness and abundance can be spatiotemporally monitored using indices derived from the spectral bands of satellite imagery

PUBLIC ADMINISTRATION IN THE BALKANS from Weberian Bureaucracy to New Public Management

The current volume reproduces papers presented in the Workshop which was organized in Athens, in February 2010 by the European Public Law Organization (EPLO) and the Faculty of Public Administration – National School of Political Studies and Public Administration (NSPSPA), Bucharest. The workshop entitled “Public Administration in the Balkans – from Weberian bureaucracy to New Public Management” has aimed to reveal relevant aspects on the developments of national public administrations in some Balkan states related to the traditional or actual models of the administrative organization. The organizers have proposed to approach theoretical and practical aspects focusing on Weberian bureaucracy and New Public Management (NPM). In this context, the general framework of debates was based both on specificity of public administration in the Balkan states and the European integration process, particularly the enlargement of the European Administrative Space to the Balkan area. As shown by a profound analysis in the papers, the characteristics of the public administrations are moreover diverse and get closer to the developments of the public administrations in Europe, such as the Mediterranean ones (Greece, Cyprus etc.) or those of the states in transition (Bulgaria, Romania, Croatia, Serbia etc.). The interactions with different intensities between Weberianism and New Public Management emphasise, generally, the characteristics of “a new Weberian state” (NWS) for the Balkan states (Pollitt and Bouckaert, 2004, Meneguzzo et al, 2010), revealing a higher NPM impact (Cyprus, Greece, Croatia etc.) or a lower one (Bulgaria, Romania, Serbia, Slovenia etc.). NWS represents a metaphor describing a model that co-opts the passive elements of NPM, but on a Weberian foundation (Pollitt and Bouckaert, 2004, Brown, 1978). The fact that the Balkan states belong more or less explicit to NWS triggers their position in post-NPM era, thus the state remaining an important actor, able to facilitate the public-private dialogue and to sustain the processes for enhancing the effectiveness of public services and administration. The public administration reforms in the Balkan states have targeted one or several European models of national administrations. Even if the concepts on reform comprise visible differences, the tradition, geo-political specificity, human and material resources have determined similarities and common characteristics, which could be emphasized in the development and actual status of administration in the Balkan states. At the same time, the administrative reforms have already introduced elements that enable the administrations in the Balkan states to get closer to the features of “public governance”. Herewith we refer mainly to participating in decision-making, introducing the elements of “neo-corporatism” governance etc. The capacity of adaptation and openness represent a valuable feature of the Balkan administrations, most of them holding systemic connections of low intensity, thus being far away from what we call “strong administration”, found especially in the European developed states. Recent studies support the above ideas, referring to “main drivers of public administration modernization”, placing most Balkan states in the “very low” or “medium” area (Demmke et al., 2006). When referring to open government or ethics, the same studies place the Balkan states under the heading “very high influence”. Based on the above assertions, the papers emphasize concrete issues that could be synthesized in some large categories: - Balkan public administrations between tradition and modernity; - National experiences on the impact of the administrative reforms in Balkan states; - Myth or reality in considering “a Balkan model of public administration”; - Administrative convergence and dynamics as support of the evolution towards a certain model; - Assessing relevant case studies on enforcing NPM in local governance. It is also worth to mention that the approach of the participants in the workshop has been marked by the institutional innovations and trends in European governance, the debates concerning the model and characteristics of the European administration etc. The workshop was organized within the framework of Jean Monnet project “South-Eastern European developments on the administrative convergence and enlargement of the European Administrative Space in Balkan states” with the financial support of the European Community

PARSEME Corpus Release 1.3

We present version 1.3 of the PARSEME multilingual corpus annotated with verbal multiword expressions. Since the previous version, new languages have joined the undertaking of creating such a resource, some of the already existing corpora have been enriched with new annotated texts, while others have been enhanced in various ways. The PARSEME multilingual corpus represents 26 languages now. All monolingual corpora therein use Universal Dependencies v.2 tagset. They are (re-)split observing the PARSEME v.1.2 standard, which puts impact on unseen VMWEs. With the current iteration, the corpus release process has been detached from shared tasks; instead, a process for continuous improvement and systematic releases has been introduced

PARSEME Corpus Release 1.3

We present version 1.3 of the PARSEME multilingual corpus annotated with verbal multiword expressions. Since the previous version, new languages have joined the undertaking of creating such a resource, some of the already existing corpora have been enriched with new annotated texts, while others have been enhanced in various ways. The PARSEME multilingual corpus represents 26 languages now. All monolingual corpora therein use Universal Dependencies v.2 tagset. They are (re-)split observing the PARSEME v.1.2 standard, which puts impact on unseen VMWEs. With the current iteration, the corpus release process has been detached from shared tasks; instead, a process for continuous improvement and systematic releases has been introduced

PARSEME corpora annotated for verbal multiword expressions (version 1.3)

This multilingual resource contains corpora in which verbal MWEs have been manually annotated. VMWEs include idioms (let the cat out of the bag), light-verb constructions (make a decision), verb-particle constructions (give up), inherently reflexive verbs (help oneself), and multi-verb constructions (make do). This is the first release of the corpora without an associated shared task. Previous version (1.2) was associated with the PARSEME Shared Task on semi-supervised Identification of Verbal MWEs (2020). The data covers 26 languages corresponding to the combination of the corpora for all previous three editions (1.0, 1.1 and 1.2) of the corpora. VMWEs were annotated according to the universal guidelines. The corpora are provided in the cupt format, inspired by the CONLL-U format. Morphological and syntactic information, ­­­­including parts of speech, lemmas, morphological features and/or syntactic dependencies, are also provided. Depending on the language, the information comes from treebanks (e.g., Universal Dependencies) or from automatic parsers trained on treebanks (e.g., UDPipe). All corpora are split into training, development and test data, following the splitting strategy adopted for the PARSEME Shared Task 1.2. The annotation guidelines are available online: https://parsemefr.lis-lab.fr/parseme-st-guidelines/1.3 The .cupt format is detailed here: https://multiword.sourceforge.net/cupt-format

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted