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

Patent ductus arteriosus as rare cause of sudden death. Case report of a 4-day-old infant

Ein persistierender Ductus arteriosus (Ductus Botalli) ist seit Jahren als Ursache eines plötzlichen und unerwarteten Neugeborenentods und pulmonaler Hämorrhagien identifiziert. Insbesondere Frühgeborene weisen ein erhöhtes Risiko zur Entwicklung eines hämodynamisch signifikanten persistierenden Ductus arteriosus auf. Vorgestellt wird der plötzliche und unerwartete Todesfall eines 4 Tage alt gewordenen Säuglings, der 2 Wochen vor dem errechneten Termin geboren worden war. Bei der Obduktion zeigte sich ein sehr muskelkräftiger arterieller Gefäßkurzschluss zwischen der A. pulmonalis und dem Aortenbogen mit einem Durchmesser knapp unter dem der A. pulmonalis. Als Folge der pulmonalen Hyperperfusion fanden sich eine massive akute Blutstauung und kongestives Herzversagen infolge des „shunting“ von der systemischen in die pulmonale Zirkulation.A persistent patent ductus arteriosus as a cause of sudden and unexpected death in neonates and of pulmonary hemorrhage has been known for many years. Especially preterm neonates have an increased risk of developing a patent ductus arteriosus. The case of a 4-day-old neonate is presented who was born 2 weeks preterm and died suddenly. At autopsy a very muscular arterial vascular bypass was visible between the pulmonary artery and the aortic arch with a diameter nearly equal to the pulmonary artery. As a result of pulmonary hyperperfusion there was massive pulmonary congestion and congestive heart failure as a result of shunting from the systemic to the pulmonary circulation

Situational factors shape moral judgments in the trolley dilemma in Eastern, Southern, and Western countries in a culturally diverse sample

The study of moral judgements often centers on moral dilemmas in which options consistent with deontological perspectives (i.e., emphasizing rules, individual rights, and duties) are in conflict with options consistent with utilitarian judgements (i.e., following the greater good based on consequences). Greene et al. (2009) showed that psychological and situational factors (e.g., the intent of the agent or the presence of physical contact between the agent and the victim) can play an important role in moral dilemma judgements (e.g., trolley problem). Our knowledge is limited concerning both the universality of these effects outside the United States and the impact of culture on the situational and psychological factors of moral judgements. Thus, we empirically tested the universality of the effects of intent and personal force on moral dilemma judgements by replicating the experiments of Greene et al. in 45 countries from all inhabited continents. We found that personal force and its interaction with intention, exert influence on moral judgements in the US and Western cultural clusters, replicating and expanding the original findings. Moreover, the personal force effect was present in all cultural clusters, suggesting it is culturally universal. The evidence for the cultural universality of the interaction effect was inconclusive in the Eastern and Southern cultural clusters (depending on exclusion criteria). We found no strong association between collectivism/individualism and moral dilemma judgements

Situational factors shape moral judgements in the trolley dilemma in Eastern, Southern and Western countries in a culturally diverse sample

The study of moral judgements often centres on moral dilemmas in which options consistent with deontological perspectives (that is, emphasizing rules, individual rights and duties) are in conflict with options consistent with utilitarian judgements (that is, following the greater good based on consequences). Greene et al. (2009) showed that psychological and situational factors (for example, the intent of the agent or the presence of physical contact between the agent and the victim) can play an important role in moral dilemma judgements (for example, the trolley problem). Our knowledge is limited concerning both the universality of these effects outside the United States and the impact of culture on the situational and psychological factors affecting moral judgements. Thus, we empirically tested the universality of the effects of intent and personal force on moral dilemma judgements by replicating the experiments of Greene et al. in 45 countries from all inhabited continents. We found that personal force and its interaction with intention exert influence on moral judgements in the US and Western cultural clusters, replicating and expanding the original findings. Moreover, the personal force effect was present in all cultural clusters, suggesting it is culturally universal. The evidence for the cultural universality of the interaction effect was inconclusive in the Eastern and Southern cultural clusters (depending on exclusion criteria). We found no strong association between collectivism/individualism and moral dilemma judgements. © 2022, The Author(s), under exclusive licence to Springer Nature Limited

Situational factors shape moral judgements in the trolley dilemma in Eastern, Southern and Western countries in a culturally diverse sample

The study of moral judgements often centres on moral dilemmas in which options consistent with deontological perspectives (that is, emphasizing rules, individual rights and duties) are in conflict with options consistent with utilitarian judgements (that is, following the greater good based on consequences). Greene et al. (2009) showed that psychological and situational factors (for example, the intent of the agent or the presence of physical contact between the agent and the victim) can play an important role in moral dilemma judgements (for example, the trolley problem). Our knowledge is limited concerning both the universality of these effects outside the United States and the impact of culture on the situational and psychological factors affecting moral judgements. Thus, we empirically tested the universality of the effects of intent and personal force on moral dilemma judgements by replicating the experiments of Greene et al. in 45 countries from all inhabited continents. We found that personal force and its interaction with intention exert influence on moral judgements in the US and Western cultural clusters, replicating and expanding the original findings. Moreover, the personal force effect was present in all cultural clusters, suggesting it is culturally universal. The evidence for the cultural universality of the interaction effect was inconclusive in the Eastern and Southern cultural clusters (depending on exclusion criteria). We found no strong association between collectivism/individualism and moral dilemma judgements

Situational factors shape moral judgments in the trolley dilemma in Eastern, Southern, and Western countries in a culturally diverse sample

Much research on moral judgment is centered on moral dilemmas in which deontological perspectives (i.e., emphasizing rules, individual rights and duties) are in conflict with utilitarian judgements (i.e., following the greater good defined through consequences). A central finding of this field Greene et al. showed that psychological and situational factors (e.g., the intent of the agent, or physical contact between the agent and the victim) play an important role in people’s use of deontological versus utilitarian considerations when making moral decisions. As their study was conducted with US samples, our knowledge is limited concerning the universality of this effect, in general, and the impact of culture on the situational and psychological factors of moral judgments, in particular. Here, we empirically test the universality of deontological and utilitarian judgments by replicating Greene et al.’s experiments on a large (N = X,XXX) and diverse (WEIRD and non-WEIRD) sample across the world to explore the influence of culture on moral judgment. The relevance of this exploration to a broad range of policy-making problems is discussed

Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia: The IAEA INCAPS-COVID Study

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted