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

Deliberate engagement as a strategy for promoting behavior change while enhancing well -being.

Changing behavior is difficult. Approaches which focus on educating people about the consequences of behavior or providing incentives for performance often do not fare well. This dissertation contrasts such an approach with one that helps individuals deliberately engage the mind by encouraging richer and more diverse interactions with the behavior setting. While this engagement-based approach is likely applicable to a number of behaviors, it is explored here in the context of promoting outdoor physical activity. To investigate this approach, 117 adults were randomly assigned to one of two treatment conditions-- Standard Care (schedule setting, commitment) or Engagement (awareness plans) -- and asked to take at least three, 30 minutes outdoor walks each week for two weeks. Walking behavior was measured using surveys, walking logs, and accelerometers. Survey instruments were used to investigate changes in psychological well-being and satisfaction with the walking environment. Baseline measures were collected prior to the intervention. Results show that individuals in both treatment conditions reported similar changes in walking behavior. However, only participants in the Engagement condition experienced significant improvements in multiple dimensions of psychological well-being. In addition, among participants who walked at low to moderate levels those assigned to the Engagement condition were more likely to obtain these psychological benefits. Individuals in the Engagement condition also reported being more satisfied with several distinct aspects of the walking environment. These changes in satisfaction were particularly strong for participants who walked with another person. Overall, the findings indicate that strategies designed to help individuals deliberately interact and explore a behavior setting can be useful for promoting the adoption and maintenance of outdoor walking routines. These strategies may also make it easier for individuals to achieve other important benefits, including improvement in psychological well-being and enhanced perceptions of the local environment. Because deliberate engagement is able to leverage a number of powerful but often underappreciated cognitive and motivational forces, there is reason to believe that this behavior change strategy is valuable to a wide variety of behaviors and contexts.Ph.D.Behavioral psychologyCognitive psychologyHealth and Environmental SciencesPsychologyPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/127162/2/3429473.pd

Synthesis of Stereochemically and Skeletally Diverse Fused Ring Systems from Functionalized <i>C</i>‑Glycosides

A diversity-oriented synthesis (DOS) strategy was developed for the synthesis of stereochemically diverse fused-ring systems containing a pyran moiety. Each scaffold contains an amine and methyl ester for further diversification via amine capping and amide coupling. Scaffold diversity was evaluated in comparison to previously prepared scaffolds by a shape-based principal moments of inertia (PMI) analysis

Synthesis of Stereochemically and Skeletally Diverse Fused Ring Systems from Functionalized <i>C</i>‑Glycosides

A diversity-oriented synthesis (DOS) strategy was developed for the synthesis of stereochemically diverse fused-ring systems containing a pyran moiety. Each scaffold contains an amine and methyl ester for further diversification via amine capping and amide coupling. Scaffold diversity was evaluated in comparison to previously prepared scaffolds by a shape-based principal moments of inertia (PMI) analysis

Synthesis of Stereochemically and Skeletally Diverse Fused Ring Systems from Functionalized <i>C</i>‑Glycosides

A diversity-oriented synthesis (DOS) strategy was developed for the synthesis of stereochemically diverse fused-ring systems containing a pyran moiety. Each scaffold contains an amine and methyl ester for further diversification via amine capping and amide coupling. Scaffold diversity was evaluated in comparison to previously prepared scaffolds by a shape-based principal moments of inertia (PMI) analysis

Synthesis and Profiling of a Diverse Collection of Azetidine-Based Scaffolds for the Development of CNS-Focused Lead-like Libraries

The synthesis and diversification of a densely functionalized azetidine ring system to gain access to a wide variety of fused, bridged, and spirocyclic ring systems is described. The in vitro physicochemical and pharmacokinetic properties of representative library members are measured in order to evaluate the use of these scaffolds for the generation of lead-like molecules to be used in targeting the central nervous system. The solid-phase synthesis of a 1976-membered library of spirocyclic azetidines is also described

Synthesis and Profiling of a Diverse Collection of Azetidine-Based Scaffolds for the Development of CNS-Focused Lead-like Libraries

The synthesis and diversification of a densely functionalized azetidine ring system to gain access to a wide variety of fused, bridged, and spirocyclic ring systems is described. The in vitro physicochemical and pharmacokinetic properties of representative library members are measured in order to evaluate the use of these scaffolds for the generation of lead-like molecules to be used in targeting the central nervous system. The solid-phase synthesis of a 1976-membered library of spirocyclic azetidines is also described