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

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Relación entre estrés laboral y cultura organizacional en empleados administrativos del sector salud de la ciudad de monteria cordoba

Esta investigación tiene como finalidad encontrar la posible relación que existe entre Estrés laboral y cultura organizacional, aplicado a los empleados administrativos del sector salud en las entidades promotora de salud (EPS) e Institutos prestadores de salud (IPS) en la ciudad de Montería - Córdoba. En el estudio participaron dos (2) EPS y seis (6) IPS, donde se recolectaron 200 datos entre los dos tipos de organizaciones, para la medición de las variables se emplearon dos instrumentos, uno para medir cultura organizacional compuesto por cuatro dimensiones: Características Dominantes, Aspectos estratégicos, Liderazgo, Factores Integradores y otro instrumento para medir estrés laboral denominado Cuestionario para la evaluación de estrés de la batería de riesgo psicosocial, además se usaron cinco (5) dimensiones anexas de la Batería de Riesgo psicosocial que tenían relación con la temática. Luego de la recolección de la información se pasó a analizar la información a través del software ADANCO 2.1.1 aplicando la técnica de análisis de modelos de ecuaciones estructurales por mínimos cuadrados parciales (PLS.SEM), por medio de este se evalúan la validez y fiabilidad del modelo, así como las pruebas de bondad de ajuste, varianza, entre otras. También se graficó el tipo de cultura por dimensión y se analizaron los resultados que arrojó el estudio (relación causal). Finalmente se comprueban las hipótesis con relación al estrés, donde se afirma que cada una de las culturas explica en gran medida algunas dimensiones de estrés, como recomendaciones se deja la aplicación de medidas basadas en los Protocolos de intervención psicosocial para el sector salud en materia de seguridad y salud en el trabajo en Colombia.CAPÍTULO 1 .....................................................................................................................11. INTRODUCCIÓN ......................................................................................................1CAPÍTULO 2 .....................................................................................................................32. DESCRIPCIÓN Y FORMULACIÓN DEL PROBLEMA ...........................................32.1 Descripción del problema. ........................................................................................3• Cultura clan. ........................................................................................................ 5• Cultura ad-hoc (adhocracia). ................................................................................ 6• Cultura jerarquizada. ............................................................................................ 6• Cultura mercado. ................................................................................................. 62.2 Formulación del problema ..........................................................................................8CAPÍTULO 3 .....................................................................................................................83. JUSTIFICACIÓN .......................................................................................................8CAPÍTULO 4 ................................................................................................................... 114. OBJETIVOS ................................................................................................................. 114.1 Objetivo general. ...................................................................................................... 114.2 Objetivos específicos. ............................................................................................... 11CAPÍTULO 5 ................................................................................................................... 135. REVISIÓN DE LITERATURA ................................................................................ 135.1 Marco teórico - seguridad y salud en el trabajo. ...................................................... 135.1.1 Medicina del trabajo. ....................................................................................... 145.1.2 Higiene industrial. ...................................................................................... 145.1.2 Seguridad industrial. ........................................................................................ 155.1.3 Psicología ocupacional (PSO). .................................................................... 165.1.4 Peligros y factores de riesgos laborales. ...................................................... 165.1.5 Riesgos psicosociales ...................................................................................... 175.1.6 Estrés............................................................................................................... 185.2 Características sector salud ....................................................................................... 215.2.1 Demandas de la jornada de trabajo .............................................................. 235.2.2 Demandas de carga mental.......................................................................... 235.3 Cultura organizacional............................................................................................ 245.3.1 Marco de valores competitivos. ................................................................... 265.3.2 Tipos de cultura. ......................................................................................... 275.3.2.1 Cultura de jerarquía ................................................................................. 275.3.2.2 Cultura de mercado ................................................................................. 285.3.2.3 Cultura clan ............................................................................................. 285.3.2.4 Cultura adhocrática ................................................................................. 295.4 Modelo de ecuaciones estructurales (STRUCTURAL EQUATION MODELING, SEM)............................................................................................................................. 315.5 Marco legal. ........................................................................................................... 325.6 Estado del arte estrés laboral y cultura organizacional. ........................................... 345.7 MARCO CONCEPTUAL ...................................................................................... 38• Comportamiento. ............................................................................................... 38• Constructo. ........................................................................................................ 39• Cultura. .............................................................................................................. 39• Instrumento de medición. ................................................................................... 39• Medición. .......................................................................................................... 39• Organización. .................................................................................................... 40• Patrón. ............................................................................................................... 40• Variable. ............................................................................................................ 40• Dimensión de demandas ambientales y de esfuerzo físico. ................................. 40• Dimensión de demandas de carga mental. .......................................................... 41• Dimensión de demandas emocionales. ............................................................... 41• Dimensión de influencia del trabajo sobre el entorno extralaboral. ..................... 42• Dimensión de demandas de la jornada de trabajo. .............................................. 42• Población objeto. ............................................................................................... 42CAPÍTULO 6 ................................................................................................................... 436. HIPÓTESIS .............................................................................................................. 43CAPÍTULO 7 ................................................................................................................... 467. MATERIALES Y MÉTODOS. ................................................................................. 467.1 Metodología.............................................................................................................. 467.2 Procedimiento. .......................................................................................................... 477.3 Participantes. ............................................................................................................ 497.4 Instrumentos utilizados. ............................................................................................ 497.5 Indicadores de validez y confiabilidad cultura organizacional ................................... 50Validez de contenido ................................................................................................ 50Fiabilidad o consistencia interna ............................................................................... 51Validez convergente ................................................................................................. 51Validez discriminante ............................................................................................... 517.6 Indicadores de validez y confiabilidad estrés laboral ................................................. 527.7 Codificación y medidas utilizadas ............................................................................. 537.8 Variables. ................................................................................................................. 567.8.1 Medición de estrés. .......................................................................................... 577.8.2 Medición cultura organizacional. ..................................................................... 577.7 Método. .................................................................................................................... 597.7.1 Criterios de consistencia y ajuste de los modelos ............................................. 59CAPÍTULO 8 ................................................................................................................... 618. ANÁLISIS DE RESULTADOS. ............................................................................... 618.1 MODELO PLS- SEM ............................................................................................... 65CAPÍTULO 9 ................................................................................................................... 779. CONCLUSIONES .................................................................................................... 77CAPÍTULO 10 ................................................................................................................. 8210. LIMITACIONES Y RECOMENDACIONES ........................................................... 82CAPÍTULO 11 ................................................................................................................. 8311. BIBLIOGRAFÍA ...................................................................................................... 83PregradoIngeniero(a) Industria

Revista Temas Agrarios Volumen 26; Suplemento 1 de 2021

1st International and 2nd National Symposium of Agronomic Sciences: The rebirth of the scientific discussion space for the Colombian Agro.1 Simposio Intenacional y 2 Nacional de Ciencias Agronómicas: El renacer del espacio de discusión científica para el Agro colombiano

Surgeons' perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

Background: Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons' knowledge and perception of using AI-based tools in clinical decision-making processes. Methods: An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society's website and Twitter profile. Results: 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust. Discussion: The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI

Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions

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

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