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

Sistemas de medição remota de energia na agência Nabón CENTROSUR: análise da viabilidade e dos benefícios.

La Agencia Nabón de la Empresa Eléctrica Regional Centro Sur C.A. (CENTROSUR) enfrenta desafíos logísticos y climáticos al llevar a cabo lecturas presenciales de medidores de energía eléctrica en la parroquia El Progreso del cantón Nabón. Este estudio de investigación se enfoca en la viabilidad y los beneficios de implementar sistemas de medición remota de energía eléctrica en la Agencia Nabón de CENTROSUR. La gestión eficiente de la energía eléctrica es esencial tanto entornos urbanos como rurales, y la adopción de tecnologías de medición remota puede desempeñar un papel crucial en la optimización de su uso. Esta iniciativa tiene como objetivo optimizar recursos, reducir costos y mejorar la calidad del servicio eléctrico al proporcionar datos precisos y en tiempo real sobre el consumo de energía. El estudio se basa en un análisis exhaustivo que combina métodos cuantitativos, descriptivos, explicativo – causal, de corte transversal y no experimental, incluyendo revisión de literatura y evaluación de datos específicos de la Agencia Nabón de CENTROSUR. Se viabiliza la aplicación de la investigación al obtener resultados positivos en los índices financieros PIR de 78.84 meses y VAN 11.115,84, además destaca la necesidad de modernizar la infraestructura de los sistemas de medición que cumplieron su vida útil. En conclusión, dentro de la parroquia El Progreso se requiere una modernización de los sistemas de medición, aunque demanda una inversión inicial considerable, promete beneficios a largo plazo como facturación precisa, gestión eficiente del consumo y mayor satisfacción del cliente, respaldada por análisis económicos positivos.The Nabón Agency of the Regional Electricity Company Centro Sur C.A. (CENTROSUR) faces logistical and climatic challenges in conducting meter readings in situ in the parish of El Progreso in the canton of Nabón. This research study focuses on the feasibility and benefits of implementing remote power metering systems at CENTROSUR’s Nabón Agency. Efficient electricity management is essential in urban and rural environments, and the adoption of remote measurement technologies can play a crucial role in optimizing their use. This initiative aims to optimize resources, reduce costs and improve the quality of electrical service by providing accurate, real-time data on energy consumption. The study is based on a comprehensive analysis that combines quantitative, descriptive, explanatory - causal, cross-sectional and non-experimental methods, including literature review and evaluation of specific data from the Nabón Agency of CENTROSUR. The application of the research is made possible by obtaining positive results in the financial indices PIR of 78.84 months and VAN 11.115,84, also highlights the need to modernize the infrastructure of the measurement systems that met their useful life. In conclusion, within the parish El Progreso a modernization of measurement systems is required, although it demands a considerable initial investment, promises long-term benefits such as accurate billing, efficient management of consumption and greater customer satisfaction, supported by positive economic analyses.A Agência Nabón da Empresa Eléctrica Regional Centro Sur C.A. (CENTROSUR) enfrenta desafios logísticos e climáticos para realizar leituras de medidores de eletricidade no local, na paróquia de El Progreso, no cantão de Nabón. Este estudo de pesquisa concentra-se na viabilidade e nos benefícios da implementação de sistemas de medição remota de energia na Agência Nabón da CENTROSUR. O gerenciamento eficiente da eletricidade é essencial em ambientes urbanos e rurais, e a adoção de tecnologias de medição remota pode desempenhar um papel crucial na otimização de seu uso. Essa iniciativa visa otimizar recursos, reduzir custos e melhorar a qualidade do serviço de eletricidade, fornecendo dados precisos e em tempo real sobre o consumo de energia. O estudo baseia-se em uma análise abrangente que combina métodos quantitativos, descritivos, explicativos-causais, transversais e não experimentais, incluindo revisão da literatura e avaliação de dados específicos da Agência Nabon da CENTROSUR. A aplicação da pesquisa é viabilizada pela obtenção de resultados positivos nos índices financeiros PIR de 78,84 meses e VPL 11.115,84, além de evidenciar a necessidade de modernização da infraestrutura dos sistemas de medição que atingiram sua vida útil. Concluindo, na paróquia de El Progreso, é necessária uma modernização dos sistemas de medição que, embora exija um investimento inicial considerável, promete benefícios a longo prazo, como faturamento preciso, gerenciamento eficiente do consumo e maior satisfação do cliente, respaldados por uma análise econômica positiva

Search for supersymmetry with a compressed mass spectrum in the vector boson fusion topology with 1-lepton and 0-lepton final states in proton-proton collisions at s=\sqrt{s}= 13 TeV

A search for supersymmetric particles produced in the vector boson fusion topology in proton-proton collisions is presented. The search targets final states with one or zero leptons, large missing transverse momentum, and two jets with a large separation in rapidity. The data sample corresponds to an integrated luminosity of 35.9 fb$^{-1}$ of proton-proton collisions at $\sqrt{s}=$ 13 TeV collected in 2016 with the CMS detector at the LHC. The observed dijet invariant mass and lepton-neutrino transverse mass spectra are found to be consistent with the standard model predictions. Upper limits are set on the cross sections for chargino ($\widetilde\chi_1^\pm$) and neutralino ($\widetilde\chi_2^0$) production with two associated jets. For a compressed mass spectrum scenario in which the $\widetilde\chi_1^\pm$ and $\widetilde\chi_2^0$ decays proceed via a light slepton and the mass difference between the lightest neutralino $\widetilde\chi_1^0$ and the mass-degenerate particles $\widetilde\chi_1^\pm$ and $\widetilde\chi_2^0$ is 1 (30) GeV, the most stringent lower limit to date of 112 (215) GeV is set on the mass of these latter two particles

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

Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2: 1). Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding

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

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

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

Objective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies