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

Expertise in business process management

As organizations attempt to become more business process-oriented, existing role descriptions are revised and entire new business process-related roles emerge. A lot of attention is often being paid to the technological aspect of Business Process Management (BPM), but relatively little work has been done concerning the people factor of BPM and the specification of BPM expertise in particular. This study tries to close this gap by proposing a comprehensive BPM expertise model, which consolidates existing theories and related work. This model describes the key attributes characterizing “BPM expertise” and outlines their structure, dynamics, and interrelationships. Understanding BPM expertise is a predecessor to being able to develop and apply it effectively. This is the cornerstone of human capital and talent management in BPM

“Just Existing Is Activism” : Transgender Experiences in Martial Arts

This study focuses on transgender experiences in martial arts. Interviews with three Finnish and two British transgender martial artists were thematically analyzed, and findings were interpreted through the lens of queer theory. Two themes were identified related to the ways that transgender martial artists experience their sporting contexts, namely martial arts as an empowering and inclusive context and the challenges related to being transgender in martial arts. Two themes were also identified when it comes to participants’ strategies for coping with cis-/heteronormativity in martial arts. Whenever possible, participants employed social change strategies, whereas other times, they drew on self-care strategies. Following this, we suggest a need for context-specific, protective policies; nonbinary means of organizing sport; and gender diversity education for instructors to better cater for the specific needs of transgender people in sport.peerReviewe

Multiplex cytokine analyses in patients with rheumatoid arthritis require use of agents blocking heterophilic antibody activity

Objectives: Heterophilic antibodies, such as rheumatoid factor (RF), are known to interfere with enzyme-linked immunosorbent assays (ELISAs). Treatment of rheumatoid arthritis (RA) with tumour necrosis factor (TNF)-α blockers is well established. The aims of this study were to develop a protocol for blocking the interaction of present heterophilic antibodies and to validate this procedure by evaluating the effect on correlations of cytokine levels to clinical response in RA patients treated with adalimumab. Method: Fourteen patients with active RA were evaluated at baseline and 3 months after starting adalimumab treatment. Cytokines were analysed with a commercial 12-plex bead ELISA. To block interference by RF, a commercial blocker (HeteroBlock) was used. To determine the optimal concentration of HeteroBlock, patient sera were analysed with different concentrations of HeteroBlock. Subsequently, baseline and follow-up sera from the 14 patients were analysed and correlated with clinical outcome. Results: Measured cytokine levels were reduced in the majority of samples when adding the blocker. The optimal concentration of HeteroBlock was 1600 μg/mL of serum. Sera with high RF levels were more prone to produce false positive values, although some RF-negative sera also demonstrated evidence of interference. HeteroBlock did not interfere with the analysis. In RA patients treated with adalimumab, changes in interleukin (IL)-6 levels between baseline and follow-up correlated with changes in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in sera with added HeteroBlock. Conclusions: When analysing sera from patients with RA with multiplex bead ELISA, the assay should be evaluated for interference by heterophilic antibodies, and if present corrected with, for example, HeteroBlock

Combined angiotensin and endothelin receptor blockade attenuates adverse cardiac remodeling post-myocardial infarction in the rat: possible role of transforming growth factor beta(1)

A. Tzanidis, S. Lim, R. D. Hannan, F. See, A. M. Ugoni and H. Krum. Combined Angiotensin and Endothelin Receptor Blockade Attenuates Adverse Cardiac Remodeling Post-Myocardial Infarction in the Rat: Possible Role of Transforming Growth Factor beta(1). Journal of Molecular and Cellular Cardiology (2001) 33, 969-981. Myocardial infarction (MI) is associated with activation of the vasoconstrictor peptides, angiotensin II (AngII) and endothelin-1 (ET-1), which are thought to contribute to adverse cardiac remodeling and dysfunction. The present study sought to determine whether combined AngII and ET receptor blockade improves cardiac remodeling over individual treatments in an experimental model of left ventricular myocardial infarction (LVMI) in the rat. Groups of eight female Sprague-Dawley rats were randomized at 24 h post-LVMI to 1 week treatment with either vehicle, an ET(A/B)receptor antagonist (bosentan), an AT(1)receptor antagonist (valsartan), or combined treatment. Vehicle-treated animals developed LV dysfunction with extensive accumulation of collagen type I and increased alpha(1)(I) procollagen mRNA compared to sham controls. Whilst individual receptor blockade with either bosentan or valsartan reduced LVEDP towards sham control levels, there were no significant changes to myocardial collagen deposition in comparison to vehicle. In contrast, improved ventricular function by combined treatment was associated with reduced type I collagen deposition within left ventricular non-infarct regions, as well as reduced peptide distribution and cardiac gene expression of the profibrogenic peptide, transforming growth factor beta(1)(TGF beta(1)). These data demonstrate that combined AngII and ET receptor blockade has beneficial effects on myocardial fibrogenesis over individual treatments during adverse cardiac remodeling early post-MI