SMEs and the internet drivers of and barriers to e-engagement.

For many years, the internet and its associated technologies have been heralded as the new frontier for SMEs and, inherently, “a good thing”. Despite this having been a common theme for at least the last fifteen years, still many SMEs are not “e-engaged. Despite significant amounts of public money being invested in promoting the Internet to SMEs, estimates for the UK range from 20 to 40 percent non- e-engagement, and substantially more in other jurisdictions. This thesis examines the barriers and drivers to e-engagement by SMEs and challenges the conventional wisdom that the Internet is a positive force for all. In particular, the research looks at the micro end of the SME spectrum, (the μSME), and identifies a number of hitherto un-examined areas of their operation and business models. Following a comprehensive review of the relevant canon of literature, a conceptual framework is derived, developed and presented. This provides the skeleton upon which the research strategy sits. The empirical data set consists of seventeen in depth case studies from a range of SMEs involved in the b2b, b2c and professional services fields. A cross case analysis was then undertaken, leading to the finalised framework. One of the key contributions of this research is the development of the conceptual model and associated framework. This allows for the identification and analysis of barriers, drivers and key determinants of the decision by SMEs and specifically of μSMEs with regard to their engagement, or not, with the Internet. Some commentators have noted that the literature on SME Internet engagement is fragmented and incoherent and that there is a need for framework development and research at the conceptual level to provide more focused research. This thesis accepts that challenge. It takes a comparative approach to both engaged and non-engaged companies, where possible in the same industry, to allow for key determinants and principle impact factors to be identified. The research provides detailed examples of the business models operated by the case companies and the factors affecting their implementation and operation. The variables affecting each SME are codified and mapped against the determinants and principle drivers. This enables the analysis to identify the barriers that filter, and in some cases entirely block, engagement with the Internet

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

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