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

Two Ways of Suspending Object Agreement in Puma: Between Incorporation, Antipassivization, and Optional Agreement

Although Kiranti languages generally show verb agreement with both arguments of a transitive verb, object agreement can also be suspended, resulting in the intransitive inflection of lexically transitive verbs. This paper analyzes suspended object agreement in Puma (Southern Kiranti). Suspended object agreement in this language is accompanied by either (i) the obligatory realization of a caseless object NP, or (ii), limited to human object referents, the prefixation of a morpheme kha-. Semantically, both constructions contrast with transitively inflected forms by entailing that the cardinality of object referents is unknown; they are thus generally used for non-enumerable or generic reference. The construction with an obligatory NP is similar to incorporation but differs from better known instances of incorporation by the fact that the object is an NP rather than a noun stem, that the NP keeps positional freedom, and that it can be relativized on. The construction also bears similarity to optional agreement patterns in other languages but differs from other known cases of optional agreement by the fact that the object looses core NP properties: the properties that are lost in Puma are case marking and optionality in discourse. The construction with kha- is similar to antipassivization but differs from many known instances of antipassivization by the fact that the object cannot be overtly realized, not even as an adjunct

Two ways of suspending object agreement in Puma: between incorporation, antipassivization, and optional agreement

Although Kiranti languages generally show verb agreement with both arguments of a transitive verb, object agreement can also be suspended, resulting in the intransitive inflection of lexically transitive verbs. This paper analyzes suspended object agreement in Puma (Southern Kiranti). Suspended object agreement in this language is accompanied by either (i) the obligatory realization of a caseless object NP, or (ii), limited to human object referents, the prefixation of a morpheme kha-. Semantically, both constructions contrast with transitively inflected forms by entailing that the cardinality of object referents is unknown; they are thus generally used for non-enumerable or generic reference. The construction with an obligatory NP is similar to incorporation but differs from better known instances of incorporation by the fact that the object is an NP rather than a noun stem, that the NP keeps positional freedom, and that it can be relativized on. The construction also bears similarity to optional agreement patterns in other languages but differs from other known cases of optional agreement by the fact that the object looses core NP properties: the properties that are lost in Puma are case marking and optionality in discourse. The construction with kha- is similar to antipassivization but differs from many known instances of antipassivization by the fact that the object cannot be overtly realized, not even as an adjunct

An ethnobotanical survey of medicinal plants used in the eastern highlands of Papua New Guinea

Abstract Background The Eastern Highlands area of Papua New Guinea (PNG) has a rich tradition of medicinal plant use. However, rapid modernization is resulting in the loss of independent language traditions and consequently a loss of individuals knowledgeable in medicinal plant use. This report represents a program to document and preserve traditional knowledge concerning medicinal plant use in PNG. This report documents and compares traditional plant use in the Eastern Highlands districts of Unggai-Bena, Okapa, and Obura-Wonenara, and puts these new records in context of previously documented PNG medicinal plant use. Methods This manuscript is an annotated combination of Traditional Medicines survey reports generated by UPNG trainees using a survey questionnaire titled “Information sheet on traditional herbal reparations and medicinal plants of PNG”. The Traditional Medicines survey project is supported by WHO, US NIH and PNG governmental health care initiatives and funding. Results Overall, after “poisoning” (synonymous with “magic”) the most commonly recorded ailments addressed by medicinal plant use were pain, gynecological disease, gastrointestinal maladies, anemia or malnutrition and malaria. However, the recorded indications for plant use varied widely amongst the different survey locations. Unlike many areas of PNG, mixing of ingredients was the most common mode of preparation recorded, except for two areas where the consumption of fresh plant material was more common. Throughout the Eastern Highlands oral administration was most common, with topical application second. Overall, leaves were most commonly used in the preparations of the healers interviewed, followed by bark and stems. Several new medicinal uses of plants were also documented. Conclusions Collaboration between the WHO, UPNG and the PNG Department of Health initiated Traditional Medicine survey program in order to preserve traditional knowledge concerning medicinal plant use in PNG. This effort promotes integration of effective and accessible traditional practices with Western protocols. The Traditional Medicine surveys are particularly important because, in the absence of the clinical validation, the documentation of the consistent use of a given plant for specific indication by a large number of herbalists, across a wide range of ethnic traditions, maybe considered as a positive criterion for the promulgation of said use amongst PNG’s recently formed traditional healer associations.</p

Traditional Preparations and Methanol Extracts of Medicinal Plants from Papua New Guinea Exhibit Similar Cytochrome P450 Inhibition

The hypothesis underlying this current work is that fresh juice expressed from Papua New Guinea (PNG) medicinal plants (succus) will inhibit human Cytochrome P450s (CYPs). The CYP inhibitory activity identified in fresh material was compared with inhibition in methanol extracts of dried material. Succus is the most common method of traditional medicine (TM) preparation for consumption in PNG. There is increasing concern that TMs might antagonize or complicate drug therapy. We have previously shown that methanol extracts of commonly consumed PNG medicinal plants are able to induce and/or inhibit human CYPs in vitro. In this current work plant succus was prepared from fresh plant leaves. Inhibition of three major CYPs was determined using human liver microsomes and enzyme-selective model substrates. Of 15 species tested, succus from 6/15 was found to inhibit CYP1A2, 7/15 inhibited CYP3A4, and 4/15 inhibited CYP2D6. Chi-squared tests determined differences in inhibitory activity between succus and methanol preparations. Over 80% agreement was found. Thus, fresh juice from PNG medicinal plants does exhibit the potential to complicate drug therapy in at risk populations. Further, the general reproducibility of these findings suggests that methanol extraction of dried material is a reasonable surrogate preparation method for fresh plant samples

An ethnobotanical survey of medicinal plants used in the East Sepik province of Papua New Guinea

© 2015 Koch et al. Background: Rapid modernization in the East Sepik (ES) Province of Papua New Guinea (PNG) is resulting in a decrease in individuals knowledgeable in medicinal plant use. Here we report a synthesis and comparison of traditional medicinal plant use from four ethnically distinct locations in the ES Province and furthermore compare them to two other previous reports of traditional plant use from different provinces of PNG. Methods: This manuscript is based on an annotated combination of four Traditional Medicines (TM) survey reports generated by University of Papua New Guinea (UPNG) trainees. The surveys utilized a questionnaire titled Information sheet on traditional herbal preparations and medicinal plants of PNG , administered in the context of the TM survey project which is supported by WHO, US NIH and PNG governmental health care initiatives and funding. Regional and transregional comparison of medicinal plant utilization was facilitated by using existing plant databases: the UPNG TM Database and the PNG Plant Database (PNG Plants) using Bayesian statistical analysis. Results: Medicinal plant use between four distinct dialect study areas in the ES Province of PNG showed that only a small fraction of plants had shared use in each area, however usually utilizing different plant parts, being prepared differently and to treat different medical conditions. Several instances of previously unreported medicinal plants could be located. Medicinally under- and over-utilized plants were found both in the regional reports and in a transregional analysis, thus showing that these medicinal utilization frequencies differ between provinces. Conclusions: Documentation of consistent plant use argues for efficacy and is particularly important since established and effective herbal medicinal interventions are sorely needed in the rural areas of PNG, and unfortunately clinical validation for the same is often lacking. Despite the existence of a large corpus of medical annotation of plants for PNG, previously unknown medical uses of plants can be uncovered. Furthermore, comparisons of medicinal plant utilization is possible if databases are reformatted for consistencies that allow comparisons. A concerted effort in building easily comparable databases could dramatically facilitate ethnopharmacological analysis of the existing plant diversity