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

Non-Invasive Monitoring of the Thermal and Morphometric Characteristics of Lettuce Grown in an Aeroponic System through Multispectral Image System

Aeroponics is a soilless cultivation technology integrating plant nutrition, physiology, ecological environment, agricultural automation and horticulture. One of the soilless advantages is that a non-invasive observation of the root system growth development is possible. This paper presents a vegetative growth evaluation of lettuce plants in an aeroponic chamber, where root and leaf development parameters were measured in three lettuce crops through plant images captured in the visible (VIS), near infrared (NIR) and far infrared (IR) spectra. A total of ninety lettuce plants was transplanted for this research, thirty for each experimental crop. The three lettuce crops were grown for thirty days in an aeroponic growth plant chamber inside a greenhouse under favorable conditions. The morphometric and thermal parameters of the lettuce roots (perimeter, area, length and average temperature) and leaves (perimeter, area and average temperature) were evaluated for each crop along ten image-capturing sessions through an implemented multispectral vision system. The average values of the root and leaf morphometric parameters obtained with the implemented imaging system along the lettuce growing period were statistically analyzed with Tukey testing. The obtained analysis results show no significant difference for a value of p ≤ 0.05 in 86.67%. Hence, the morphometric parameters can be used to characterize the vegetative lettuce growth in aeroponic crops. On the other hand, a correlation analysis was conducted between the thermal parameters computed with the root and leaf thermal image processing and the measured ambient temperature. The results were: R = 0.945 for correlation between ambient and leaf temperature, R = 0.963 for correlation between ambient and root temperature and R = 0.977 for leaf and root temperature. According to these results, the plant temperature is highly correlated with the ambient temperature in an aeroponic crop. The obtained study results suggest that multispectral image processing is a useful non-invasive tool to estimate the vegetative root and leaf growth parameters of aeroponic lettuce plants in a greenhouse

IoT-Based Monitoring System Applied to Aeroponics Greenhouse

The inclusion of the Internet of Things (IoT) in greenhouses has become a fundamental tool for improving cultivation systems, offering information relevant to the greenhouse manager for decision making in search of optimum yield. This article presents a monitoring system applied to an aeroponic greenhouse based on an IoT architecture that provides user information on the status of the climatic variables and the appearance of the crop in addition to managing the irrigation timing and the frequency of visual inspection using an application developed for Android mobile devices called Aeroponics Monitor. The proposed IoT architecture consists of four layers: a device layer, fog layer, cloud layer and application layer. Once the information about the monitored variables is obtained by the sensors of the device layer, the fog layer processes it and transfers it to the Thingspeak and Firebase servers. In the cloud layer, Thingspeak analyzes the information from the variables monitored in the greenhouse through its IoT analytic tools to generate historical data and visualizations of their behavior, as well as an analysis of the system&rsquo;s operating status. Firebase, on the other hand, is used as a database to store the results of the processing of the images taken in the fog layer for the supervision of the leaves and roots. The results of the analysis of the information of the monitored variables and of the processing of the images are presented in the developed app, with the objective of visualizing the state of the crop and to know the function of the monitoring system in the event of a possible lack of electricity or a service line failure in the fog layer and to avoid the loss of information. With the information about the temperature of the plant leaf and the relative humidity inside the greenhouse, the vapor pressure deficit (VPD) in the cloud layer is calculated; the VPD values are available on the Thingspeak server and in the developed app. Additionally, an analysis of the VPD is presented that demonstrates a water deficiency from the transplanting of the seedling to the cultivation chamber. The IoT architecture presented in this paper represents a potential tool for the study of aeroponic farming systems through IoT-assisted monitoring

Quantitative evaluation of binary digital region asymmetry with application to skin lesion detection

Abstract Background The performance of Computer Aided Diagnosis Systems for early melanoma detection relies mainly on quantitative evaluation of the geometric features corresponding to skin lesions. In these systems, diagnosis is carried out by analyzing four geometric characteristics: asymmetry (A), border (B), color (C) and dimension (D). The main objective of this study is to establish an algorithm for the measurement of asymmetry in biological entities. Methods Binary digital images corresponding to lesions are divided into 8 segments from their centroid. For each segment, the discrete compactness value is calculated using Normalized E-Factor (NEF). The asymmetry value is obtained from the sum of the square difference of each NEF value and corresponding value of its opposite by the vertex. Two public skin cancer databases were used. 1) Lee’s database with 40 digital regions evaluated by fourteen dermatologists. 2) The PH2 database which consists of 200 images in an 8-bit RGB format. This database provides a pre-classification of asymmetry carried out by experts, and it also indicates if the lesion is a melanoma. Results The measure was applied using two skin lesion image databases. 1) In Lee’s database, Spearman test provided a value of 0.82 between diagnosis of dermatologists and asymmetry values. For the 12 binary images most likely to be melanoma, the correlation between the measurement and dermatologists was 0.98. 2) In the PH2 database a label is provided for each binary image where the type of asymmetry is indicated. Class 0–1 corresponds to symmetry and one axis of symmetry shapes, the completely asymmetrical were assigned to Class 2, the values of sensitivity and specificity were 59.62 and 85.8% respectively between the asymmetry measured by a group of dermatologists and the proposed algorithm. Conclusions Simple image digital features such as compactness can be used to quantify the asymmetry of a skin lesion using its digital binary image representation. This measure is stable taking into account translations, rotations, scale changes and can be applied to non-convex regions, including areas with holes

I do it for myself : A study on motivational differences between contracted and permanent employees in Sweden

Over the past decades outsourcing decades outsourcing has become an increasing trend.Firms decide to outsource in order to increase their profits or flexibility and many differentfunctions of the firm may be outsourced, one of them being the Human Resource (HR)function. When it comes to HR outsourcing, recruitment and selection are among the morecommon functions to be outsourced (Ordanini &amp; Silvestri, 2008:373). The motivation foroutsourcing of HR is to reduce cost and increase efficiency (Elmuti, Grunewald and Abebe,2010:177). Outsourcing of HR functions like recruitment can also have negative aspect, forexample lack of loyalty and high turnover (Fisher et al, 2008:202). Previous research hasinvestigated how commitment and loyalty is affected by HR outsourcing (Connelly &amp;Gallagher, 2004:963) and one aspect that has been touched upon but not dealt withexclusively is motivation and therefore this paper will explore it further. Using the following research question: How does motivation vary between individuals working at a company butare hired through a staffing firm versus hired directly by the company? This paper tries to both evaluate the existing literature and provide practicalimplications for managers. In order to explore this question and abductive research approachhas been used where the data and theory are intertwined and played of each other to achievethe purpose (Alvesson &amp; Sköldberg, 2009:4). The data collection consists of eight semistructuredinterviews, four with people hired directly by the company and four that are orhave previously been hired through a staffing company. The study found that the theoretical framework does for the most part explain themotivational behavior of both groups studied, and that the two groups are not alwaysmotivated in the same way. Those hired directly by the company are more interested inreceiving praise, relationships at work, and receiving small tokens of appreciation. The grouphired by staffing companies was more often motivated by an internal drive to satisfythemselves and did not value work relationships to the same extent. The research also showedthat the individual rather than the form of employment plays a big role when it comes to howpeople are motivated. It was also made apparent that education and work situation wereimportant factors influencing the respondent’s motivation

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

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