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

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Augmenting High-Performance Mobile Cloud Computations for Big Data in AMBER

Big data is an inspirational area of research that involves best practices used in the industry and academia. Challenging and complex systems are the core requirements for the data collation and analysis of big data. Data analysis approaches and algorithms development are the necessary and essential components of the big data analytics. Big data and high-performance computing emergent nature help to solve complex and challenging problems. High-Performance Mobile Cloud Computing (HPMCC) technology contributes to the execution of the intensive computational application at any location independently on laptops using virtual machines. HPMCC technique enables executing computationally extreme scientific tasks on a cloud comprising laptops. Assisted Model Building with Energy Refinement (AMBER) with the force fields calculations for molecular dynamics is a computationally hungry task that requires high and computational hardware resources for execution. The core objective of the study is to deliver and provide researchers with a mobile cloud of laptops capable of doing the heavy processing. An innovative execution of AMBER with force field empirical formula using Message Passing Interface (MPI) infrastructure on HPMCC is proposed. It is homogeneous mobile cloud platform comprising a laptop and virtual machines as processors nodes along with dynamic parallelism. Some processes can be executed to distribute and run the task among the various computational nodes. This task-based and data-based parallelism is achieved in proposed solution by using a Message Passing Interface. Trace-based results and graphs will present the significance of the proposed method

Assessment of Communication Quality through Work Authorization between Dentists and Dental Technicians in Fixed and Removable Prosthodontics

Fabrication of a clinically successful dental prosthesis requires clear and effective communication between dentists and dental technicians. Adequate completion of work authorization by dentists provides a means for increased professional quality assurance and satisfaction in dental prosthesis. The aim of this study was to evaluate the quality of communication between dentists and dental technicians via work authorization for fixed and removable dental prosthesis in Pakistan. This cross-sectional study was conducted for a period of 6 months to assess the quality of communication between dentists and dental technicians. A well-constructed questionnaire regarding work authorization of removable and fixed prostheses was used as a tool to collect data from 453 dentists. A linear regression analysis was performed to evaluate the relationship of the independent and dependent variables. A p value of ≤0.05 was considered statistically significant. It was observed that 92.1% of the dentists leave removable partial denture design to the dental technicians. About 56.5% of the dentists indicated information about base retention of partial dentures in work authorization. The majority of the dentists (56.5%) mentioned the material to be used for the construction of casting partial dentures. Nearly 66% of the dentists indicated the design of margins, and 44.6% of the dentists did not select the shade for fixed prostheses. Nearly 43% of the dentists did not draw the design of restoration, 21.9% chose to draw the design on paper, and 32.2% of the dentists drew the design on the cast. Meanwhile, 76.8% of the participants chose to directly communicate with their dental technicians personally. Nearly 41% of the dentists were satisfied with the restoration design, and 13.5% of the participants were not satisfied with the designs. Poor communication between dentists and technicians was observed, as the majority of the design decisions were left to the dental technicians. Therefore, communication between dentists and dental technicians should be improved by conducting combined workshops for the successful construction of dental prostheses

Assessment of Golden Proportion among Natural Maxillary Anterior Teeth of Global Population: A Systematic Review

The purpose of this systematic review was to analyze studies, identify the existence of golden proportion between the perceived widths of the maxillary anterior teeth among the different geographical populations, and evaluate the range of dental proportion that exists regionally. An electronic search was conducted using PubMed, Medline, EMBASE, Scopus, Science Direct, Web of Science, and the Cochrane Library. The focused question was, &ldquo;Does golden proportion exist in natural, aesthetically pleasing smiles among different populations around the world?&rdquo; The search conducted included studies from January 2000 to September 2020, identifying articles in English with the specific combination of MeSH and other related terms. The title search yielded eight hundred and ninety-eight articles, and seventy-five articles were selected for full-text analysis. However, only fifty-two full-text articles were included in the systematic review. The mean predicted dental ratios were either larger or smaller than the successive widths of maxillary natural anterior teeth. Golden proportions were not found consistently among anterior teeth in different populations observed in the systematic review. The golden proportion is still a useful tool for the reconstruction of lost or damaged anterior tooth widths; however, it is not the only standard for restoring esthetic smiles worldwide, and anterior tooth proportions differ among populations based on their geographic, ethnic, and racial background. Moreover, consideration should also be given to an individual&rsquo;s dentofacial variations in restoring anterior teeth

Assessment of Golden Proportion among Natural Maxillary Anterior Teeth of Global Population: A Systematic Review

The purpose of this systematic review was to analyze studies, identify the existence of golden proportion between the perceived widths of the maxillary anterior teeth among the different geographical populations, and evaluate the range of dental proportion that exists regionally. An electronic search was conducted using PubMed, Medline, EMBASE, Scopus, Science Direct, Web of Science, and the Cochrane Library. The focused question was, “Does golden proportion exist in natural, aesthetically pleasing smiles among different populations around the world?” The search conducted included studies from January 2000 to September 2020, identifying articles in English with the specific combination of MeSH and other related terms. The title search yielded eight hundred and ninety-eight articles, and seventy-five articles were selected for full-text analysis. However, only fifty-two full-text articles were included in the systematic review. The mean predicted dental ratios were either larger or smaller than the successive widths of maxillary natural anterior teeth. Golden proportions were not found consistently among anterior teeth in different populations observed in the systematic review. The golden proportion is still a useful tool for the reconstruction of lost or damaged anterior tooth widths; however, it is not the only standard for restoring esthetic smiles worldwide, and anterior tooth proportions differ among populations based on their geographic, ethnic, and racial background. Moreover, consideration should also be given to an individual’s dentofacial variations in restoring anterior teeth

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or &gt;= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

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-U.S. 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 &lt; 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