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1. Coronary artery calcium scoring vs. coronary CT angiography for the assessment of occupationally significant coronary artery disease

Author

Jennifer, Holland, Leanne, Eveson, David, Holdsworth, and Edward, Nicol

Subjects
Computed Tomography Angiography, Predictive Value of Tests, Humans, Calcium, Radiology, Nuclear Medicine and imaging, Coronary Artery Disease, Coronary Angiography, Cardiology and Cardiovascular Medicine, Risk Assessment
Abstract

Existing pathways for investigating coronary artery disease (CAD) in individuals undertaking high-hazard employment are currently guided by coronary artery calcium scoring (CACS) or coronary CT angiography (CTA). The optimal pathway has not been established.To compare the diagnostic outcome and occupational recommendations from two differing investigative pathways for the investigation of CAD in a cohort of high-hazard employees.We collected CACS and coronary CTA data from three clinics across two Hospitals on 200 consecutive individuals employed in high-hazard occupations to confirm/exclude occupationally significant CAD. High-hazard occupations were grouped into civil/military pilots and aircraft controllers (n ​= ​106); non-pilot aircrew (NPA) (n ​= ​26); and ground-based (military) personnel (GBP) (n ​= ​52). Demographics, referral indications and recommended occupational outcomes between pathways were compared between groups.The CACS pathway led to more than double the number of individuals being returned to partial or full employment, compared with the coronary CTA pathway (OR 2.10, [95%CI 1.54-2.85], P ​ ​0.001). This effect was seen in all sub-groups. Of the 177 subjects that would have been returned to full employment using CACS, 21 (11.9%) would have been occupationally restricted on the basis of significant non-calcified plaque disease using coronary CTA (11.4% pilots/controllers; 19.2% non-pilot aircrew, and 7.7% ground-based personnel).Using CACS to determine the presence of occupational CAD risks returning individuals to roles with occupationally significant CAD that may lead to an unacceptably high likelihood of an incapacitating/distracting acute coronary event. Coronary CTA appears to be a more reliable, non-invasive imaging modality for confirming or excluding occupationally significant CAD in high-hazard employees.

Published
2022
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3. Enhancing linkage to HIV care in the 'Universal Test-and-Treat' era: Barriers and enablers to HIV care among adults in a high HIV burdened district in KwaZulu-Natal, South Africa

Author

Edward Nicol, Ngcwalisa Amanda Jama, Vuyelwa Mehlomakulu, Mbuzeleni Hlongwa, Desiree Pass, Wisdom Basera, and Debbie Bradshaw

Abstract

Ending AIDS by 2030 would depend on how successful health systems are in linking people living with HIV (PLHIV) into care. The World Health Organization recommended the ‘Universal Test-and-Treat’ (UTT) strategy – initiating all individuals testing positive on antiretroviral therapy (ART) irrespective of their CD4 count and clinical staging. This study aimed to explore the enablers and barriers to linkage to HIV care among adults with a new HIV diagnosis in a high-HIV prevalent rural district in South Africa. A qualitative study was undertaken to explore patients’ perceptions of enablers and barriers of linkage-to-care, using a life-story narration and dialogue approach. In-depth interviews were conducted with 38 HIV-positive participants sampled from a cohort of 1194 HIV positive patients recruited from December 2017 to June 2018. Participants were selected based on whether they had linked to care or not within 3 months of positive HIV diagnosis. Interviews were thematically analysed using a general inductive approach. Of the 38 participants, 22 (58%) linked to care within three months of HIV-positive diagnosis. Factors which facilitated or inhibited linkage-to-care were found at individual, family, community, as well as the health systems levels. Enablers included a positive HIV testing experience, and assistance from the fieldwork team. Support from family, friends, as well as prior community-based education about HIV and ART were also noted. Individual factors such as acceptance of HIV status, previous exposure to PLHIV, and fear of HIV progressing, were identified. Barriers to linkage included, denial of HIV status, dislike of taking pills, and preference for alternative medicine. Negative experience with counselling and health systems inefficiency were also noted as barriers. Perceived stigma and socio-economic factors, such as lack of food or money to visit the clinic were other barriers. Community-based and health system level interventions would need to focus on clinic readiness in providing patients with necessary and effective health services such as proper and adequate counselling. This could increase the number of patients who link to care. Finally, interventions to improve linkage-to-care should consider a holistic approach, including training health care providers, community outreach and the provision of psychological, social, and financial support.

Published
2023
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5. Return to Flying After Catheter Ablation of Arrhythmic Disorders in Military Aircrew

Author

Norbert Guettler, Edward Nicol, and Stefan Sammito

Subjects
Military Personnel, Tachycardia, Atrial Fibrillation, Catheter Ablation, Humans, Tachycardia, Atrioventricular Nodal Reentry, General Medicine
Abstract

INTRODUCTION: Catheter ablation is a widely used and effective treatment option for many tachyarrhythmic disorders. This study analyzes all ablation cases in German military aircrew over a 17-yr period. Recurrence of different arrhythmias and ablation complications were analyzed with an aim of refining specific recommendations for aircrew employment.METHODS: All cases of catheter ablations in pilots and nonpilot aircrew examined at the German Air Force Centre of Aerospace Medicine from 2004 to 2020 were analyzed for sex, age, concomitant diseases, ablated arrhythmias, complications, recurrences, time elapsed from ablation to reablation, number of ablations, and aeromedical disposition, including restrictions in case of a return to flying duties.RESULTS: There were 36 aircrew who underwent catheter ablation; 7 were ablated for 2 or more different arrhythmias; 10 underwent more than one ablation. Ablated arrhythmias included atrioventricular (AV) nodal re-entrant tachycardias, accessory pathways, focal atrial tachycardias, typical and atypical atrial flutter, atrial fibrillation, and premature atrial and ventricular complexes. Recurrence rates differed between the arrhythmias and were lowest in AV re-entrant tachycardias. Complication rates were low.CONCLUSION: In this aircrew cohort, nearly all aircrew were able to return to flying duties following ablation, albeit some with restrictions. Restrictions depended on the underlying arrhythmia, the ablation procedure, and the symptoms prior to ablation. A basic understanding of different arrhythmias, ablation techniques, and long-term success rates is essential for the AME and for the responsible licensing authority. Close cooperation with an electrophysiologist is necessary prior to and after ablation to ensure optimal management of aircrew with arrythmias.Guettler N, Nicol E, Sammito S. Return to flying after catheter ablation of arrhythmic disorders in military aircrew. Aerosp Med Hum Perform. 2022; 93(10):725–733.

Published
2022

6. Barriers and Facilitating Factors to HIV Treatment Among Men in a High-HIV-Burdened District in KwaZulu-Natal, South Africa: A Qualitative Study

Author

Mbuzeleni Hlongwa, Ngcwalisa Amanda Jama, Vuyelwa Mehlomakulu, Desiree Pass, Wisdom Basera, and Edward Nicol

Subjects
Adult, Male, South Africa, Health (social science), Anti-Retroviral Agents, Social Stigma, Public Health, Environmental and Occupational Health, Humans, HIV Infections, Qualitative Research
Abstract

Despite enormous increases in the proportion of people living with HIV accessing treatment in sub-Saharan Africa, major gender disparities persist, with men experiencing lower rates of testing, linkage to treatment, and retention in care. In this study, we investigated the barriers and facilitating factors to HIV treatment among men in uThukela, a high-HIV-burdened district in KwaZulu-Natal province, South Africa. We conducted a qualitative study including nine Black African male participants who were recruited from 18 health care facilities in uThukela District, KwaZulu-Natal province. In-depth interviews were conducted with participants who linked to care and those who did not link to care at 3-month post HIV diagnosis. We used Atlas.ti for thematic analysis. Data were coded and linked to broader themes emerging across interviews. The median age was 40 years (interquartile range [IQR]: 31–41). This study identified the following key themes which emerged as barriers to HIV treatment among men in uThukela District: lack of emotional readiness, perceived medication side effects, fear of treatment non-adherence, perceived stigma and confidentiality concerns, and poor socioeconomic factors. We identified the following enabling factors to HIV treatment among men: fear of HIV progressing, acceptance of status, disclosure, support from family and friends, positive testing experience, and accessibility of antiretroviral treatment. This study revealed barriers and enabling factors to HIV treatment among men. These factors are important to inform the design of targeted intervention strategies aimed at improving linkage and retention to HIV treatment among men.

Published
2022

7. Healthcare provider perceptions on the implementation of the Universal Test-and-Treat policy in South Africa: A qualitative inquiry

Author

Edward Nicol, Vuyelwa Mehlomakulu, Ngcwalisa Amanda Jama, Mbuzeleni Hlongwa, Wisdom Basera, Desiree Pass, and Debbie Bradshaw

Subjects
Health Policy
Abstract

Background South Africa had an estimated 7.5 million people living with HIV (PLHIV), accounting for approximately 20% of the 38.4 million PLHIV globally in 2021. In 2015, the World Health Organization recommended the universal test and treat (UTT) intervention which was implemented in South Africa in September 2016. Evidence shows that UTT implementation faces challenges in terms of human resources capacity or infrastructure. We aim to explore healthcare providers (HCPs)’ perspectives on the implementation of the UTT strategy in uThukela District Municipality in KwaZulu-Natal province. Methods A qualitative study was conducted with one hundred and sixty-one (161) healthcare providers (HCPs) within 18 healthcare facilities in three subdistricts, comprising of Managers, Nurses, and Lay workers. HCPs were interviewed using an open ended-survey questions to explore their perceptions providing HIV care under the UTT strategy. All interviews were thematically analysed using both inductive and deductive approaches. Results Of the 161 participants (142 female and 19 male), 158 (98%) worked at the facility level, of which 82 (51%) were nurses, and 20 (12.5%) were managers (facility managers and PHC manager/supervisors). Despite a general acceptance of the UTT policy implementation, HCPs expressed challenges such as increased patient defaulter rates, increased work overload, caused by the increased number of service users, and physiological and psychological impacts. The surge in the workload under conditions of inadequate systems’ capacity and human resources, gave rise to a greater burden on HCPs in this study. However, increased life expectancy, good quality of life, and immediate treatment initiation were identified as perceived positive outcomes of UTT on service users. Perceived influence of UTT on the health system included, increased number of patients initiated, decreased burden on the system, meeting the 90-90-90 targets, and financial aspects. Conclusion Health system strengthening such as providing more systems’ capacity for expected increase in workload, proper training and retraining of HCPs with new policies in the management of patient readiness for lifelong ART journey, and ensuring availability of medicines, may reduce strain on HCPs, thus improving the delivery of the comprehensive UTT services to PLHIV.

Published
2022
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8. Is the routine health information system ready to support the planned national health insurance scheme in South Africa?

Author

Wisdom Basera, Lyn A. Hanmer, Edward Nicol, Debbie Bradshaw, Andiswa Zitho, and Ferdinand C. Mukumbang

Subjects
National Health Programs, Health informatics, South Africa, Health Information Systems, Obstetrics and gynaecology, medicine, Information system, data quality, Humans, AcademicSubjects/MED00860, Medical diagnosis, Child, Reimbursement, discharge summaries, Hospitals, Public, business.industry, Health Policy, Public sector, routine health information system (RHIS), medicine.disease, insurance claims, Confidence interval, Cross-Sectional Studies, Data quality, Original Article, National Health Insurance (NHI), Medical emergency, morbidity data, business, clinical coding
Abstract

Implementation of a National Health Insurance (NHI) in South Africa requires a reliable, standardized health information system that supports Diagnosis-Related Groupers for reimbursements and resource management. We assessed the quality of inpatient health records, the availability of standard discharge summaries and coded clinical data and the congruence between inpatient health records and discharge summaries in public-sector hospitals to support the NHI implementation in terms of reimbursement and resource management. We undertook a cross-sectional health-records review from 45 representative public hospitals consisting of seven tertiary, 10 regional and 28 district hospitals in 10 NHI pilot districts representing all nine provinces. Data were abstracted from a randomly selected sample of 5795 inpatient health records from the surgical, medical, obstetrics and gynaecology, paediatrics and psychiatry departments. Quality was assessed for 10 pre-defined data elements relevant to NHI reimbursements, by comparing information in source registers, patient folders and discharge summaries for patients admitted in March and July 2015. Cohen's/Fleiss’ kappa coefficients (κ) were used to measure agreements between the sources. While 3768 (65%) of the 5795 inpatient-level records contained a discharge summary, less than 835 (15%) of diagnoses were coded using ICD-10 codes. Despite most of the records having correct patient identifiers [κ: 0.92; 95% confidence interval (CI) 0.91–0.93], significant inconsistencies were observed between the registers, patient folders and discharge summaries for some data elements: attending physician’s signature (κ: 0.71; 95% CI 0.67–0.75); results of the investigation (κ: 0.71; 95% CI 0.69–0.74); patient’s age (κ: 0.72; 95% CI 0.70–0.74); and discharge diagnosis (κ: 0.92; 95% CI 0.90–0.94). The strength of agreement for all elements was statistically significant (P-value ≤ 0.001). The absence of coded inpatient diagnoses and identified data inaccuracies indicates that existing routine health information systems in public-sector hospitals in the NHI pilot districts are not yet able to sufficiently support reimbursements and resource management. Institutional capacity is needed to undertake diagnostic coding, improve data quality and ensure that a standard discharge summary is completed for every inpatient.

Published
2021
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9. Strengthening Health System’s Capacity for Linkage to HIV Care for adolescent girls and young women and adolescent boys and young men in South Africa (SheS’Cap-Linkage): Protocol for a mixed methods study in KwaZulu-Natal, South Africa

Author

Edward Nicol, Wisdom Basera, Carl Lombard, Kim Jonas, Trisha Ramraj, Darshini Govindasamy, Mbuzeleni Hlongwa, Tracy McClinton-Appollis, Vuyelwa Mehlomakulu, Nuha Naqvi, Jason Bedford, Jennifer Drummond, Mireille Cheyip, Sibongile Dladla, Desiree Pass, Noluntu Funani, and Cathy Mathews

Subjects
Multidisciplinary
Abstract

IntroductionIn South Africa, HIV prevalence among adolescent girls and young women (AGYW) was 5.8% (15-19 years) and 15.6% (20-24 years) respectively in 2017. Amongst South African males, HIV prevalence in 2017 was 4.7% (15-19 years), 4.8% (20-24 years), 12.4% (25-29 years) and 18.4% (30-34 years). The National Department of Health adopted the universal test and treat (UTT) strategy in 2016, resulting in increases in same-day antiretroviral therapy initiations and linkage to care. Monitoring progress towards attainment of South Africa’s 95-95-95 targets amongst AGYW and adolescent boys and young men (ABYM) relies on high quality data to identify and address gaps in linkage to care. The purpose of this study is to provide evidence to guide efforts to improve linkage to, and retention in, HIV care among AGYW and ABYM in KwaZulu-Natal, in the context of the UTT strategy.Methods and analysisThis is a mixed methods study, which will be conducted in uMgungundlovu district of KwaZulu-Natal, over a 24-month period, in 22 purposively selected HIV testing and treatment service delivery points (SDPs). For the quantitative component, a sample size of 1100 participants will be recruited into the study. The qualitative component will include 30 participating patients who were successfully linked to care, 30 who were not, and 30 who have never tested for HIV. The questionnaire study population comprises of 231 healthcare providers and AGYW aged 15-24 years and ABYM aged 15-35 years old. Primary outcomes will be evaluated using a logistic regression model. A time to event analysis will also be conducted taking the study design into account. Quantitative data for outcome variables and process indicators will be summarized by domain evaluated with logistic regression to account for potential confounders. For qualitative data, manual thematic content analysis will be conducted.Ethics and disseminationThe protocol was approved by the South African Medical Research Council Health Research Ethics Committee (EC052-11/2020). Findings from the study will be communicated to the study population and results will be presented to stakeholders and at appropriate local and international conferences. Outputs will also include a policy brief, peer reviewed journal articles and research capacity building through research degrees.

Published
2022
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10. International Impact of COVID-19 on the Diagnosis of Heart Disease

Author

Einstein, A. J., Shaw, L. J., Hirschfeld, C., Williams, M. C., Villines, T. C., Better, N., Vitola, J. V., Cerci, R., Dorbala, S., Raggi, P., Choi, A. D., Lu, B., Sinitsyn, V., Sergienko, V., Kudo, T., Norgaard, B. L., Maurovich-Horvat, P., Campisi, R., Milan, E., Louw, L., Allam, A. H., Bhatia, M., Malkovskiy, E., Goebel, B., Cohen, Y., Randazzo, M., Narula, J., Pascual, T. N. B., Pynda, Y., Dondi, M., Gerd Hinterleitner, Paez D., Yao, Lu, Olga, Morozova, Zhuoran, Xu, Juan, Lopez-Mattei, Purvi, Parwani, Mohammad Nawaz Nasery, Artan, Goda, Ervina, Shirka, Rabie, Benlabgaa, Salah, Bouyoucef, Abdelkader, Medjahedi, Qais, Nailli, Mariela, Agolti, Roberto Nicolas Aguero, Maria Del Carmen Alak, Lucia Graciela Alberguina, Guillermo, Arroñada, Andrea, Astesiano, Alfredo, Astesiano, Carolina Bas Norton, Pablo, Benteo, Juan, Blanco, Juan Manuel Bonelli, Jose Javier Bustos, Raul, Cabrejas, Jorge, Cachero, Alejandro, Canderoli, Silvia, Carames, Patrícia, Carrascosa, Ricardo, Castro, Oscar, Cendoya, Luciano Martin Cognigni, Carlos, Collaud, Claudia, Cortes, Javier, Courtis, Daniel, Cragnolino, Mariana, Daicz, Alejandro De La Vega, Silvia Teresa De Maria, Horacio Del Riego, Fernando, Dettori, Alejandro, Deviggiano, Laura, Dragonetti, Mario, Embon, Ruben Emilio Enriquez, Jorge, Ensinas, Fernando, Faccio, Adolfo, Facello, Diego, Garofalo, Ricardo, Geronazzo, Natalia, Gonza, Lucas, Gutierrez, Miguel Angel Guzzo, Victor, Hasbani, Melina, Huerin, Victor, Jäger, Julio Manuel Lewkowicz, Maria Nieves, A López De Munaín, Jose Maria Lotti, Alejandra, Marquez, Osvaldo, Masoli, Edgardo, Mastrovito, Matias, Mayoraz, Graciela Eva Melado, Anibal, Mele, Maria Fernanda Merani, Alejandro Horacio Meretta, Susana, Molteni, Marcos, Montecinos, Eduardo, Noguera, Carlos, Novoa, Claudio Pereyra Sueldo, Sebastian Perez Ascani, Pablo, Pollono, Maria Paula Pujol, Alejandro, Radzinschi, Gustavo, Raimondi, Marcela, Redruello, Marina, Rodríguez, Matías, Rodríguez, Romina Lorena Romero, Arturo Romero Acuña, Federico, Rovaletti, Lucas San Miguel, Lucrecia, Solari, Bruno, Strada, Sonia, Traverso, Sonia Simona Traverzo, Maria Del Huerto Velazquez Espeche, Juan Sebastian Weihmuller, Juan, Wolcan, Susana, Zeffiro, Mari, Sakanyan, Scott, Beuzeville, Raef, Boktor, Patrick, Butler, Jennifer, Calcott, Loretta, Carr, Virgil, Chan, Charles, Chao, Woon, Chong, Mark, Dobson, D'Arne, Downie, Girish, Dwivedi, Barry, Elison, Jean, Engela, Roslyn, Francis, Anand, Gaikwad, Ashok Gangasandra Basavaraj, Bruce, Goodwin, Robert, Greenough, Christian, Hamilton-Craig, Victar, Hsieh, Subodh, Joshi, Karin, Lederer, Kenneth, Lee, Joseph, Lee, John, Magnussen, Nghi, Mai, Gordon, Mander, Fiona, Murton, Dee, Nandurkar, Johanne, Neill, Edward, O'Rourke, Patricia, O'Sullivan, George, Pandos, Kunthi, Pathmaraj, Alexander, Pitman, Rohan, Poulter, Manuja, Premaratne, David, Prior, Lloyd, Ridley, Natalie, Rutherford, Hamid, Salehi, Connor, Saunders, Luke, Scarlett, Sujith, Seneviratne, Deepa, Shetty, Ganesh, Shrestha, Jonathan, Shulman, Vijay, Solanki, Tony, Stanton, Murch, Stuart, Michael, Stubbs, Ian, Swainson, Kim, Taubman, Andrew, Taylor, Paul, Thomas, Steven, Unger, Anthony, Upton, Shankar, Vamadevan, William Van Gaal, Johan, Verjans, Demetrius, Voutnis, Victor, Wayne, Peter, Wilson, David, Wong, Kirby, Wong, John, Younger, Gudrun, Feuchtner, Siroos, Mirzaei, Konrad, Weiss, Natallia, Maroz-Vadalazhskaya, Olivier, Gheysens, Filip, Homans, Rodrigo, Moreno-Reyes, Agnès, Pasquet, Veronique, Roelants, Caroline, M Van De Heyning, Raúl Araujo Ríos, Valentina, Soldat-Stankovic, Sinisa, Stankovic, Maria Helena Albernaz Siqueira, Augusto, Almeida, Paulo Henrique Alves Togni, Jose Henrique Andrade, Luciana, Andrade, Carlos, Anselmi, Roberta, Araújo, Guilherme, Azevedo, Sabbrina, Bezerra, Rodrigo, Biancardi, Gabriel Blacher Grossman, Simone, Brandão, Diego Bromfman Pianta, Lara, Carreira, Bruno, Castro, Tien, Chang, Fernando Cunali Jr, Roberto, Cury, Roberto, Dantas, Fernando de Amorim Fernandes, Andrea De Lorenzo, Robson De Macedo Filho, Fernanda, Erthal, Fabio, Fernandes, Juliano, Fernandes, Thiago Ferreira De Souza, Wilson Furlan Alves, Bruno, Ghini, Luiz, Goncalves, Ilan, Gottlieb, Marcelo, Hadlich, Vinícius, Kameoka, Ronaldo, Lima, Adna, Lima, Rafael Willain Lopes, Ricardo Machado, E Silva, Tiago, Magalhães, Fábio Martins Silva, Luiz Eduardo Mastrocola, Fábio, Medeiros, José Claudio Meneghetti, Vania, Naue, Danilo, Naves, Roberto, Nolasco, Cesar, Nomura, Joao Bruno Oliveira, Eduardo, Paixao, Filipe Penna De Carvalho, Ibraim, Pinto, Priscila, Possetti, Mayra, Quinta, Rodrigo Rizzo Nogueira Ramos, Ricardo, Rocha, Alfredo, Rodrigues, Carlos, Rodrigues, Leila, Romantini, Adelina, Sanches, Sara, Santana, Leonardo Sara da Silva, Paulo, Schvartzman, Cristina Sebastião Matushita, Tiago, Senra, Afonso, Shiozaki, Maria Eduarda Menezes de Siqueira, Cristiano, Siqueira, Paola, Smanio, Carlos Eduardo Soares, José Soares Junior, Marcio Sommer Bittencourt, Bernardo, Spiro, Cláudio Tinoco Mesquita, Jorge, Torreao, Rafael, Torres, Marly, Uellendahl, Guilherme Urpia Monte, Otávia, Veríssimo, Estevan Vieira Cabeda, Felipe Villela Pedras, Roberto, Waltrick, Marcello, Zapparoli, Hamid, Naseer, Marina, Garcheva-Tsacheva, Irena, Kostadinova, Youdaline, Theng, Gad, Abikhzer, Rene, Barette, Benjamin, Chow, Dominique, Dabreo, Matthias, Friedrich, Ria, Garg, Mohammed Nassoh Hafez, Chris, Johnson, Marla, Kiess, Jonathon, Leipsic, Eugene, Leung, Robert, Miller, Anastasia, Oikonomou, Stephan, Probst, Idan, Roifman, Gary, Small, Vikas, Tandon, Adwait, Trivedi, James, White, Katherine, Zukotynski, Jose, Canessa, Gabriel Castro Muñoz, Carmen, Concha, Pablo, Hidalgo, Cesar, Lovera, Teresa, Massardo, Luis Salazar Vargas, Pedro, Abad, Harold, Arturo, Sandra, Ayala, Luis, Benitez, Alberto, Cadena, Carlos, Caicedo, Antonio Calderón Moncayo, Sharon, Gomez, Claudia, T Gutierrez Villamil, Claudia, Jaimes, Juan Luis Londoño Blair, Luz, Pabon, Mauricio, Pineda, Juan Carlos Rojas, Diego, Ruiz, Manuel Valencia Escobar, Andres, Vasquez, Damiana, Vergel, Alejandro, Zuluaga, Isabel Berrocal Gamboa, Gabriel, Castro, Ulises, González, Ana, Baric, Tonci, Batinic, Maja, Franceschi, Maja Hrabak Paar, Mladen, Jukic, Petar, Medakovic, Viktor, Persic, Marina, Prpic, Ante, Punda, Juan Felipe Batista, Juan Manuel Gómez Lauchy, Yamile Marcos Gutierrez, Rayner, Menéndez, Amalia, Peix, Luis, Rochela, Christoforos, Panagidis, Ioannis, Petrou, Vaclav, Engelmann, Milan, Kaminek, Vladimír, Kincl, Otto, Lang, Milan, Simanek, Jawdat, Abdulla, Morten, Bøttcher, Mette, Christensen, Lars Christian Gormsen, Philip, Hasbak, Søren, Hess, Paw, Holdgaard, Allan, Johansen, Kasper, Kyhl, Kristian Altern Øvrehus, Niels Peter Rønnow Sand, Rolf, Steffensen, Anders, Thomassen, Zerahn, Bo, Alfredo, Perez, Giovanni Alejandro Escorza Velez, Mayra Sanchez Velez, Islam Shawky Abdel Aziz, Mahasen, Abougabal, Taghreed, Ahmed, Ahmed, Asfour, Mona, Hassan, Alia, Hassan, Ahmed, Ibrahim, Sameh, Kaffas, Ahmed, Kandeel, Mohamed Mandour Ali, Ahmad, Mansy, Hany, Maurice, Sherif, Nabil, Mahmoud, Shaaban, Ana Camila Flores, Anne, Poksi, Juhani, Knuuti, Velipekka, Kokkonen, Martti, Larikka, Valtteri, Uusitalo, Matthieu, Bailly, Samuel, Burg, Jean-François, Deux, Vincent, Habouzit, Fabien, Hyafil, Olivier, Lairez, Franck, Proffit, Hamza, Regaieg, Laure, Sarda-Mantel, Vania, Tacher, Roman, P Schneider, Harold, Ayetey, George, Angelidis, Aikaterini, Archontaki, Sofia, Chatziioannou, Ioannis, Datseris, Christina, Fragkaki, Panagiotis, Georgoulias, Sophia, Koukouraki, Maria, Koutelou, Eleni, Kyrozi, Evangelos, Repasos, Petros, Stavrou, Pipitsa, Valsamaki, Carla, Gonzalez, Goleat, Gutierrez, Alejandro, Maldonado, Klara, Buga, Ildiko, Garai, Erzsébet, Schmidt, Balint, Szilveszter, Edit, Várady, Nilesh, Banthia, Jinendra Kumar Bhagat, Rishi, Bhargava, Vivek, Bhat, Partha, Choudhury, Vijay Sai Chowdekar, Aparna, Irodi, Shashank, Jain, Elizabeth, Joseph, Sukriti, Kumar, Girijanandan, Mahapatra, Deepanjan, Mitra, Bhagwant Rai Mittal, Ahmad, Ozair, Chetan, Patel, Tapan, Patel, Ravi, Patel, Shivani, Patel, Sudhir, Saxena, Shantanu, Sengupta, Santosh, Singh, Bhanupriya, Singh, Ashwani, Sood, Atul, Verma, Erwin, Affandi, Padma Savenadia Alam, Edison, Edison, Gani, Gunawan, Habusari, Hapkido, Basuki, Hidayat, Aulia, Huda, Anggoro Praja Mukti, Djoko, Prawiro, Erwin Affandi Soeriadi, Hilman, Syawaluddin, Amjed, Albadr, Majid, Assadi, Farshad, Emami, Golnaz, Houshmand, Majid, Maleki, Maryam Tajik Rostami, Seyed Rasoul Zakavi, Eed Abu Zaid, Svetlana, Agranovich, Yoav, Arnson, Rachel, Bar-Shalom, Alex, Frenkel, Galit, Knafo, Rachel, Lugassi, Israel Shlomo Maor Moalem, Maya, Mor, Noam, Muskal, Sara, Ranser, Aryeh, Shalev, Domenico, Albano, Pierpaolo, Alongi, Gaspare, Arnone, Elisa, Bagatin, Sergio, Baldari, Matteo, Bauckneht, Paolo, Bertelli, Francesco, Bianco, Rachele, Bonfiglioli, Roberto, Boni, Andrea, Bruno, Isabella, Bruno, Elena, Busnardo, Elena, Califaretti, Luca, Camoni, Aldo, Carnevale, Roberta, Casoni, Armando Ugo Cavallo, Giorgio, Cavenaghi, Franca, Chierichetti, Marcello, Chiocchi, Corrado, Cittanti, Mauro, Colletta, Umberto, Conti, Alberto, Cossu, Alberto, Cuocolo, Marco, Cuzzocrea, Maria Luisa De Rimini, Giuseppe De Vincentis, Eleonora Del Giudice, Alberico Del Torto, DELLA TOMMASINA, Veronica, Rexhep, Durmo, Erba, PAOLA ANNA, Laura, Evangelista, Riccardo, Faletti, Evelina, Faragasso, Mohsen, Farsad, Paola, Ferro, Luigia, Florimonte, Viviana, Frantellizzi, Fabio Massimo Fringuelli, Marco, Gatti, Angela, Gaudiano, Alessia, Gimelli, Raffaele, Giubbini, Francesca, Giuffrida, Salvatore, Ialuna, Riccardo, Laudicella, Lucia, Leccisotti, Lucia, Leva, Liga, Riccardo, Carlo, Liguori, Giampiero, Longo, Margherita, Maffione, Maria Elisabetta Mancini, Claudio, Marcassa, Barbara, Nardi, Sara, Pacella, Giovanna, Pepe, Gianluca, Pontone, Sabina, Pulizzi, Natale, Quartuccio, Lucia, Rampin, Fabrizio, Ricci, Pierluigi, Rossini, Giuseppe, Rubini, Vincenzo, Russo, Gian Mauro Sacchetti, Gianmario, Sambuceti, Massimo, Scarano, Roberto, Sciagrà, Massimiliano, Sperandio, Antonella, Stefanelli, Guido, Ventroni, Stefania, Zoboli, Dainia, Baugh, Duane, Chambers, Ernest, Madu, Felix, Nunura, Hiroshi, Asano, Chimura Misato Chimura, Shinichiro, Fujimoto, Koichiro, Fujisue, Tomohisa, Fukunaga, Yoshimitsu, Fukushima, Kae, Fukuyama, Jun, Hashimoto, Yasutaka, Ichikawa, 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Barneveld, Andor, Glaudemans, Jesse, Habets, Klaas Pieter Koopmans, Jeroen, Manders, Stefan, Pool, Arthur, Scholte, Asbjørn, Scholtens, Riemer, Slart, Paul, Thimister, Erik-Jan Van Asperen, Niels, Veltman, Derk, Verschure, Nils, Wagenaar, John, Edmond, Chris, Ellis, Kerryanne, Johnson, Ross, Keenan, Shaw Hua Anthony Kueh, Christopher, Occleshaw, Alexander, Sasse, Andrew, To, Niels Van Pelt, Calum, Young, Teresa, Cuadra, Hector Bladimir Roque Vanegas, Idrissa Adamou Soli, Djibrillou Moussa Issoufou, Tolulope, Ayodele, Chibuzo, Madu, Yetunde, Onimode, Elen, Efros-Monsen, Signe Helene Forsdahl, Jenni-Mari Hildre Dimmen, Arve, Jørgensen, Isabel, Krohn, Pål, Løvhaugen, Anders Tjellaug Bråten, Humoud Al Dhuhli, Faiza Al Kindi, Naeema, Al-Bulushi, Zabah, Jawa, Naima, Tag, Muhammad Shehzad Afzal, Shazia, Fatima, Muhammad Numair Younis, Musab, Riaz, Mohammad, Saadullah, Yariela, Herrera, Dora, Lenturut-Katal, Manuel Castillo Vázquez, José, Ortellado, Afroza, Akhter, Dianbo, Cao, Stephen, Cheung, Dai, Xu, Lianggeng, Gong, Dan, Han, Yang, Hou, Caiying, Li, Tao, Li, Dong, Li, Sijin, Li, Jinkang, Liu, Hui, Liu, Ming Yen Ng, Kai, Sun, Gongshun, Tang, Jian, Wang, Ximing, Wang, Zhao-Qian, Wang, Yining, Wang, Yifan, Wang, Jiang, Wu, Zhifang, Wu, Liming, Xia, Jiangxi, Xiao, Lei, Xu, Youyou, Yang, Yin, Wu, Jianqun, Yu, Yuan, Li, Tong, Zhang, Longjiang, Zhang, Yong-Gao, Zhang, Xiaoli, Zhang, Zhu, Li, Ana, Alfaro, Paz, Abrihan, Asela, Barroso, Eric, Cruz, Marie Rhiamar Gomez, Vincent Peter Magboo, John Michael Medina, Jerry, Obaldo, Davidson, Pastrana, Christian Michael Pawhay, Alvin, Quinon, Jeanelle Margareth Tang, Bettina, Tecson, Kristine Joy Uson, Mila, Uy, Magdalena, Kostkiewicz, Jolanta, Kunikowska, Nuno, Bettencourt, Guilhermina, Cantinho, Antonio, Ferreira, Ghulam, Syed, Samer, Arnous, Said, Atyani, Angela, Byrne, Tadhg, Gleeson, David, Kerins, Conor, Meehan, David, Murphy, Mark, Murphy, John, Murray, Julie, O'Brien, Ji-In, Bang, Henry, Bom, Sang-Geon, Cho, Chae Moon Hong, Su Jin Jang, Yong Hyu Jeong, Won Jun Kang, Ji-Young, Kim, Jaetae, Lee, Chang Kyeong Namgung, Young, So, Kyoung Sook Won, Venjamin, Majstorov, Marija, Vavlukis, Barbara Gužic Salobir, Monika, Štalc, Theodora, Benedek, Imre, Benedek, Raluca, Mititelu, Claudiu Adrian Stan, Alexey, Ansheles, Olga, Dariy, Olga, Drozdova, Nina, Gagarina, Vsevolod Milyevich Gulyaev, Irina, Itskovich, Anatoly, Karalkin, Alexander, Kokov, Ekaterina, Migunova, Viktor, Pospelov, Daria, Ryzhkova, Guzaliya, Saifullina, Svetlana, Sazonova, Irina, Shurupova, Tatjana, Trifonova, Wladimir Yurievich Ussov, Margarita, Vakhromeeva, Nailya, Valiullina, Konstantin, Zavadovsky, Kirill, Zhuravlev, Mirvat, Alasnag, Subhani, Okarvi, Dragana Sobic Saranovic, Felix, Keng, Jia Hao Jason See, Ramkumar, Sekar, Min Sen Yew, Andrej, Vondrak, Shereen, Bejai, George, Bennie, Ria, Bester, Gerrit, Engelbrecht, Osayande, Evbuomwan, Harlem, Gongxeka, Magritha Jv Vuuren, Mitchell, Kaplan, Purbhoo, Khushica, Hoosen, Lakhi, Nico, Malan, Katarina, Milos, Moshe, Modiselle, Stuart, More, Mathava, Naidoo, Leonie, Scholtz, Mboyo, Vangu, Santiago, Aguadé-Bruix, Isabel, Blanco, Antonio, Cabrera, Alicia, Camarero, Irene, Casáns-Tormo, Hug, Cuellar-Calabria, Albert, Flotats, Maria Eugenia Fuentes Cañamero, María Elia García, Amelia, Jimenez-Heffernan, Rubén, Leta, Javier Lopez Diaz, Luis, Lumbreras, Juan Javier Marquez-Cabeza, Francisco, Martin, Anxo Martinez de Alegria, Francisco, Medina, Maria Pedrera Canal, Virginia, Peiro, Virginia, Pubul-Nuñez, Juan Ignacio Rayo Madrid, Cristina Rodríguez Rey, Ricardo Ruano Perez, Joaquín, Ruiz, Gertrudis Sabatel Hernández, Ana, Sevilla, Nahla, Zeidán, Damayanthi, Nanayakkara, Chandraguptha, Udugama, Magnus, Simonsson, Hatem, Alkadhi, Ronny Ralf Buechel, Peter, Burger, Luca, Ceriani, Bart De Boeck, Christoph, Gräni, Alix Juillet de Saint Lager Lucas, Christel, H Kamani, Nadine, Kawel-Boehm, Robert, Manka, John, O Prior, Axel, Rominger, Jean-Paul, Vallée, Benjapa, Khiewvan, Teerapon, 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Semple, Naveen, Sharma, Peter, Strouhal, Deepak, Subedi, William, Topping, Katharine, Tweed, Jonathan, Weir-Mccall, Suhny, Abbara, Taimur, Abbasi, Brian, Abbott, Shady, Abohashem, Sandra, Abramson, Tarek, Al-Abboud, Mouaz, Al-Mallah, Omar, Almousalli, Karthikeyan, Ananthasubramaniam, Mohan Ashok Kumar, Jeffrey, Askew, Lea, Attanasio, Mallory, Balmer-Swain, Richard, R Bayer, Adam, Bernheim, Sabha, Bhatti, Erik, Bieging, Ron, Blankstein, Stephen, Bloom, Sean, Blue, David, Bluemke, Andressa, Borges, Kelley, Branch, Paco, Bravo, Jessica, Brothers, Matthew, Budoff, Renée, Bullock-Palmer, Angela, Burandt, Floyd, W Burke, Kelvin, Bush, Candace, Candela, Elizabeth, Capasso, Joao, Cavalcante, Donald, Chang, Saurav, Chatterjee, Yiannis, Chatzizisis, Michael, Cheezum, Tiffany, Chen, Jennifer, Chen, Marcus, Chen, Andrew, Choi, James, Clarcq, Ayreen, Cordero, Matthew, Crim, Sorin, Danciu, Bruce, Decter, Nimish, Dhruva, Neil, Doherty, Rami, Doukky, Anjori, Dunbar, William, Duvall, Rachael, Edwards, Kerry, Esquitin, Husam, Farah, Emilio, Fentanes, Maros, Ferencik, Daniel, Fisher, Daniel, Fitzpatrick, Cameron, Foster, Tony, Fuisz, Michael, Gannon, Lori, Gastner, Myron, Gerson, Brian, Ghoshhajra, Alan, Goldberg, Brian, Goldner, Jorge, Gonzalez, Rosco, Gore, Sandra, Gracia-López, Fadi, Hage, Agha, Haider, Sofia, Haider, Yasmin, Hamirani, Karen, Hassen, Mallory, Hatfield, Carolyn, Hawkins, Katie, Hawthorne, Nicholas, Heath, Robert, Hendel, Phillip, Hernandez, Gregory, Hill, Stephen, Horgan, Jeff, Huffman, Lynne, Hurwitz, Ami, Iskandrian, Rajesh, Janardhanan, Christine, Jellis, Scott, Jerome, Dinesh, Kalra, Summanther, Kaviratne, Fernando, Kay, Faith, Kelly, Omar, Khalique, Mona, Kinkhabwala, George Kinzfogl Iii, Jacqueline, Kircher, Rachael, Kirkbride, Michael, Kontos, Anupama, Kottam, Joseph, Krepp, Jay, Layer, Steven, H Lee, Jeffrey, Leppo, John, Lesser, Steve, Leung, Howard, Lewin, Diana, Litmanovich, Yiyan, Liu, Kathleen, Magurany, Jeremy, Markowitz, Amanda, Marn, Stephen, E Matis, Michael, Mckenna, Tony, Mcrae, Fernando, Mendoza, Michael, Merhige, David, Min, Chanan, Moffitt, Karen, Moncher, Warren, Moore, Shamil, Morayati, Michael, Morris, Mahmud, Mossa-Basha, Zorana, Mrsic, Venkatesh, Murthy, Prashant, Nagpal, Kyle, Napier, Katarina, Nelson, Prabhjot, Nijjar, Medhat, Osman, Edward, Passen, Amit, Patel, Pravin, Patil, Ryan, Paul, Lawrence, Phillips, Venkateshwar, Polsani, Rajaram, Poludasu, Brian, Pomerantz, Thomas, Porter, Ryan, Prentice, Amit, Pursnani, Mark, Rabbat, Suresh, Ramamurti, Florence, Rich, Hiram Rivera Luna, Austin, Robinson, Kim, Robles, Cesar, Rodríguez, Mark, Rorie, John, Rumberger, Raymond, Russell, Philip, Sabra, Diego, Sadler, Mary, Schemmer, U Joseph Schoepf, Samir, Shah, Nishant, Shah, Sujata, Shanbhag, Gaurav, Sharma, Steven, Shayani, Jamshid, Shirani, Pushpa, Shivaram, Steven, Sigman, Mitch, Simon, Ahmad, Slim, David, Smith, Alexandra, Smith, Prem, Soman, Aditya, Sood, Monvadi Barbara Srichai-Parsia, James, Streeter, Albert, T Ahmed Tawakol, Dustin, Thomas, Randall, Thompson, Tara, Torbet, Desiree, Trinidad, Shawn, Ullery, Samuel, Unzek, Seth, Uretsky, Srikanth, Vallurupalli, Vikas, Verma, Alfonso, Waller, Ellen, Wang, Parker, Ward, Gaby, Weissman, George, Wesbey, Kelly, White, David, Winchester, David, Wolinsky, Sandra, Yost, Michael, Zgaljardic, Omar, Alonso, Mario, Beretta, Rodolfo, Ferrando, Miguel, Kapitan, Fernando, Mut, Omoa, Djuraev, Gulnora, Rozikhodjaeva, Ha Le Ngoc, Son Hong Mai, Xuan Canh Nguyen, Einstein, A. J., Shaw, L. J., Hirschfeld, C., Williams, M. C., Villines, T. C., Better, N., Vitola, J. V., Cerci, R., Dorbala, S., Raggi, P., Choi, A. D., Lu, B., Sinitsyn, V., Sergienko, V., Kudo, T., Norgaard, B. L., Maurovich-Horvat, P., Campisi, R., Milan, E., Louw, L., Allam, A. H., Bhatia, M., Malkovskiy, E., Goebel, B., Cohen, Y., Randazzo, M., Narula, J., Pascual, T. N. B., Pynda, Y., Dondi, M., Paez, D., Cuocolo, A., Einstein, A, Shaw, L, Hirschfeld, C, Williams, M, Villines, T, Better, N, Vitola, J, Cerci, R, Dorbala, S, Raggi, P, Choi, A, Lu, B, Sinitsyn, V, Sergienko, V, Kudo, T, Norgaard, B, Maurovich-Horvat, P, Campisi, R, Milan, E, Louw, L, Allam, A, Bhatia, M, Malkovskiy, E, Goebel, B, Cohen, Y, Randazzo, M, Narula, J, Pascual, T, Pynda, Y, Dondi, M, Paez, D, Pacella, S, and Erba, P

Subjects
INCAPS COVID Investigators Group, Heart disease, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Diagnostic Techniques, Cardiovascular, coronavirus, global health, IAEA, Disease, Telehealth, Cardiorespiratory Medicine and Haematology, 030204 cardiovascular system & hematology, Cardiovascular, 0302 clinical medicine, cardiovascular disease, cardiac testing, COVID-19, diagnostic techniques, cardiovascular, health care surveys, heart diseases, humans, international agencies, Pandemic, Global health, 030212 general & internal medicine, COVID-19 Heart Disease, Cause of death, STATEMENT, Heart Disease, International Agencie, Public Health and Health Services, Biomedical Imaging, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Heart Diseases, 03 medical and health sciences, Clinical Research, medicine, Humans, Personal protective equipment, Heart Disease - Coronary Heart Disease, business.industry, International Agencies, medicine.disease, the, coronaviru, Diagnostic Techniques, Good Health and Well Being, Clinical research, Cardiovascular System & Hematology, Health Care Survey, Health Care Surveys, Emergency medicine, Global Health, business
Abstract

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. OBJECTIVES The study sought to assess COVID-19`s impact on global cardiovascular diagnostic procedural volumes and safety practices. METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. RESULTS Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoradc echocardiography decreased by 59%, transesophageat echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). hi multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower-middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and teteheatth. CONCLUSIONS COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19-related changes in care delivery is warranted. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

Published
2021
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11. High-resolution non-contrast free-breathing coronary cardiovascular magnetic resonance angiography for detection of coronary artery disease: validation against invasive coronary angiography

Author

Muhummad Sohaib Nazir, Aurélien Bustin, Reza Hajhosseiny, Momina Yazdani, Matthew Ryan, Vittoria Vergani, Radhouene Neji, Karl P. Kunze, Edward Nicol, Pier Giorgio Masci, Divaka Perera, Sven Plein, Amedeo Chiribiri, René Botnar, and Claudia Prieto

Subjects
Magnetic Resonance Spectroscopy, Radiological and Ultrasound Technology, Coronary Stenosis, Myocardial Perfusion Imaging, Coronary Artery Disease, Coronary Angiography, Sensitivity and Specificity, Coronary artery disease, Predictive Value of Tests, Humans, Female, Radiology, Nuclear Medicine and imaging, Prospective Studies, Coronary imaging, Cardiology and Cardiovascular Medicine, Cardiovascular magnetic resonance angiography, Magnetic Resonance Angiography
Abstract

Background Coronary artery disease (CAD) is the single most common cause of death worldwide. Recent technological developments with coronary cardiovascular magnetic resonance angiography (CCMRA) allow high-resolution free-breathing imaging of the coronary arteries at submillimeter resolution without contrast in a predictable scan time of ~ 10 min. The objective of this study was to determine the diagnostic accuracy of high-resolution CCMRA for CAD detection against the gold standard of invasive coronary angiography (ICA). Methods Forty-five patients (15 female, 62 ± 10 years) with suspected CAD underwent sub-millimeter-resolution (0.6 mm3) non-contrast CCMRA at 1.5T in this prospective clinical study from 2019–2020. Prior to CCMR, patients were given an intravenous beta blockers to optimize heart rate control and sublingual glyceryl trinitrate to promote coronary vasodilation. Obstructive CAD was defined by lesions with ≥ 50% stenosis by quantitative coronary angiography on ICA. Results The mean duration of image acquisition was 10.4 ± 2.1 min. On a per patient analysis, the sensitivity, specificity, positive predictive value and negative predictive value (95% confidence intervals) were 95% (75–100), 54% (36–71), 60% (42–75) and 93% (70–100), respectively. On a per vessel analysis the sensitivity, specificity, positive predictive value and negative predictive value (95% confidence intervals) were 80% (63–91), 83% (77–88), 49% (36–63) and 95% (90–98), respectively. Conclusion As an important step towards clinical translation, we demonstrated a good diagnostic accuracy for CAD detection using high-resolution CCMRA, with high sensitivity and negative predictive value. The positive predictive value is moderate, and combination with CMR stress perfusion may improve the diagnostic accuracy. Future multicenter evaluation is now required.

Published
2022
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12. Linkage to HIV care and early retention in care rates in the Universal Test-and-Treat era: a population-based prospective study in KwaZulu-Natal, South Africa

Author

Edward Nicol, Wisdom Basera, Ferdinand C Mukumbang, Mireille Cheyip, Simangele Mthethwa, Carl Lombard, Ngcwalisa Jama, Desiree Pass, Ria Laubscher, and Debbie Bradshaw

Subjects
Infectious Diseases, Social Psychology, Public Health, Environmental and Occupational Health
Abstract

Introduction: HIV care, linkage, and retention are key weaknesses in South Africa’s national antiretroviral therapy (ART) program, with the greatest loss of patients in the HIV treatment pathway occurring before ART initiation. Very few studies have investigated the proportion of people newly diagnosed with HIV linked-to and retained-in-care in the ‘Universal Test-and-Treat’ era. This study investigated linkage-to and early-retention-in-care (LTRIC) rates among adults newly diagnosed with HIV in a high-HIV prevalent rural district. Methods: We conducted an observational prospective cohort study from December 2017 to August 2019 to investigate LTRIC rates for adults with a new HIV diagnosis in uThukela district, South Africa. Patient-level survey and clinical data were collected using a one-stage-cluster design from 18 healthcare facilities and triangulated between HIV and laboratory databases and registered deaths from Department of Home Affairs. We used Chi-square tests to assess associations between categorical variables, and results were stratified by HIV status, sex, and age. Confidence intervals (CI) and p-value of £0.05 were reported to consider statistical significance. Results: Of the 5,637 participants recruited from December 2017 to June 2018, 21.2% [1,194/5,637; CI: 15.8-26.5] had confirmed HIV. Of the HIV-positive participants, 70.9% were women, and 46.5% were aged 25–34 years. Although 82.7% of participants (987/1,194) were linked-to-care within 3 months, only 46.1% (551/1,194; CI: 31.0-61.3) remained-in-care 12 months after initiating ART and 5.2% (62/1,194; CI: 4.0-6.6) were deceased. While a significantly higher proportion of men were linked-to-care at 3 months compared to women [85.1% (292/343); CI: 80.4-88.9 vs. 81.7 (695/851); CI: 75.0-86.9, p=0.03], a significantly proportion of women [49.5% (419/847); CI: 34.3-64.7] remained-in-care at 12 months than men [38.0% (132/347); CI: 24.6-53.6, p=0.01). Nearly half of the participants retained-in-care were aged 35–49 years (49.1%). Post-secondary education (p=0.05) and child support grants (p=0.03) were independently significantly associated with retention. Conclusion: We found high initial linkage-to-care rates, but less than 50% of participants remained-in-care at 12 months. Significant effort is required to retain PLHIV in care, especially during the first year after ART initiation. Our findings suggest that interventions could target women aged 18–34 years; more research is needed to understand barriers to LTRIC for men.

Published
2022
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13. Strengthening health system’s capacity for pre-exposure Prophylaxis for adolescent girls and young women and adolescent boys and young men in South Africa (SHeS’Cap – PrEP): Protocol for a mixed methods study in KwaZulu-Natal, South Africa

Author

Edward Nicol, Trisha Ramraj, Mbuzeleni Hlongwa, Wisdom Basera, Ngcwalisa Jama, Carl Lombard, Tracy McClinton-Appollis, Darshini Govindasamy, Desiree Pass, Noluntu Funani, Sarah Aheron, Ariana Paredes-Vincent, Jennifer Drummond, Mireille Cheyip, Sibongile Dladla, Jason Bedford, and Cathy Mathews

Abstract

IntroductionPre-exposure prophylaxis (PrEP) is an effective prevention intervention that can be used to control HIV incidence especially among people who are at increased risk for HIV such as adolescent girls and young women (AGYW) and adolescent boys and young men (ABYM). In South Africa, various approaches of delivering PrEP have been adopted at different service delivery points (facility-based only, school-based only, community-based only and hybrid school-facility and community-facility models) to overcome challenges associated with individual, structural, and health systems related barriers that may hinder access to and uptake of PrEP among these populations. However, little is known about how to optimize PrEP implementation and operational strategies to achieve high sustained uptake of good quality services for AGYW and ABYM. This study aims to identify effective and feasible PrEP models of care for improving PrEP uptake, continuation, and adherence among AGYW and ABYM.Methods and analysisA sequential explanatory mixed-methods study will be conducted in 22 service delivery points (SDPs) in uMgungundlovu district, KwaZulu-Natal, South Africa. We will recruit 600 HIV negative, sexually active, high risk, AGYW (aged 15-24 years) and ABYM (aged 15-35 years). Enrolled participants will be followed up at 1-, 4- and 7-months to determine continuation and adherence to PrEP. We will conduct two focus group discussions (with 8 participants in each group) across four groups (i. Initiated PrEP within 1 month, ii. Did not initiate PrEP within 1 month, iii. Continued PrEP at 4/7 months and iv. Did not continue PrEP at 4/7 months) and 48 in-depth interviews from each of the four groups (12 per group). Twelve key informant interviews with stakeholders working in HIV programs will also be conducted. Associations between demographic characteristics stratified by PrEP initiation and by various service-delivery models will be assessed using Chi-square/Fishers exact tests or t-test/Mann Whitney test. A general inductive approach will be used to analyze the qualitative data.Ethics and disseminationThe protocol was approved by the South African Medical Research Council Health Research Ethics Committee (EC051-11/2020). This project was reviewed by the U.S. Centers for Disease Control and Prevention (Atlanta, GA), Centers for Global Health Associate Director for Science in accordance with CDC human research protection procedures and was determined to be research, but CDC investigators did not interact with human subjects or have access to identifiable data or specimens for research purposes. Provincial and district level approval has been granted. Findings from the study will be communicated to the study population and results will be presented to stakeholders and at appropriate local and international conferences. Outputs will also include a policy brief, peer-reviewed journal articles and research capacity building through research degrees.

Published
2022
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14. Service delivery models that promote linkages to PrEP for adolescent girls and young women and men in sub-Saharan Africa: a scoping review

Author

Trisha Ramraj, Witness Chirinda, Kim Jonas, Darshini Govindasamy, Ngcwalisa Jama, Tracy McClinton Appollis, Babalwa Zani, Ferdinand C Mukumbang, Wisdom Basera, Mbuzeleni Hlongwa, Eunice B Turawa, Catherine Mathews, and Edward Nicol

Subjects
General Medicine
Abstract

BackgroundPre-exposure prophylaxis (PrEP) is an emerging biomedical prevention intervention. Documenting PrEP service delivery models (SDMs) that promote linkage to and continuation of PrEP will inform guidelines and maximise roll-out.ObjectivesTo synthesise and appraise the effectiveness and feasibility of PrEP SDMs designed to promote linkage to PrEP care among adolescent girls and young women (AGYW) and men in sub-Saharan Africa (SSA).Eligibility criteriaPrimary quantitative and qualitative studies published in English and conducted in SSA were included. No restrictions on the date of publication were applied.Sources of evidenceMethodology outlined in the Joanna Briggs Institute reviewers’ manual was followed. PubMed, Cochrane library, Scopus, Web of Science and online-conference abstract archives were searched.Charting methodsData on article, population, intervention characteristics and key outcomes was charted in REDCap.Results and conclusionOf the 1204 identified records, 37 (met the inclusion criteria. Health facility-based integrated models of PrEP delivery with family planning, maternal and child health or sexual and reproductive services to AGYW resulted in PrEP initiation of 16%–90%. Community-based drop-in centres (66%) was the preferred PrEP outlet for AGYW compared with public clinics (25%) and private clinics (9%). Most men preferred community-based delivery models. Among individuals who initiated PrEP, 50% were men, 62% were

Published
2023
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15. Reduced athletic performance post-COVID-19 is associated with reduced anaerobic threshold

Author

Robert M Barker-Davies, Peter Ladlow, Rebecca Chamley, Edward Nicol, and David A Holdsworth

Subjects
General Medicine
Abstract

Detailed characterisation of cardiopulmonary limitations in patients post-COVID-19 is currently limited, particularly in elite athletes. A male elite distance runner in his late 30s experienced chest pain following confirmed COVID-19. He underwent cardiopulmonary exercise testing (CPET) at 5 months postacute illness. Subjective exercise tolerance was reduced compared with normal, he described inability to ‘kick’ (rapidly accelerate). His CPET was compared with an identical protocol 15 months prior to COVID-19. While supranormal maximal oxygen uptake was maintained (155% of peak predicted V̇O2) anaerobic threshold (AT), a better predictor of endurance performance, reduced from 84% to 71% predicted peak V̇O2maximum. Likewise, fat oxidation at AT reduced by 21%, from 0.35 to 0.28 g/min. Focusing exclusively on V̇O2maximum risks missing an impairment of oxidative metabolism. Reduced AT suggests a peripheral disorder of aerobic metabolism. This finding may result from virally mediated mitochondrial dysfunction beyond normal ‘deconditioning’, associated with impaired fat oxidation.

Published
2023
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16. The year in cardiovascular medicine 2021: imaging

Author

Chiara Bucciarelli-Ducci, Nina Ajmone-Marsan, Marcelo Di Carli, and Edward Nicol

Subjects
Ischaemic heart disease, Myocardial Ischemia, COVID-19, Heart, Amyloidosis, Valvular heart disease, Magnetic Resonance Imaging, Imaging, PET, Echocardiography, Magnetic resonance, Artificial Intelligence, SPECT, Cardiac CT, Humans, CMR, Cardiology and Cardiovascular Medicine
Abstract

This article reviews the most relevant literature published in 2021 on the role of cardiovascular imaging in cardiovascular medicine. Coronavirus disease 2019 (COVID-19) continued to impact the healthcare landscape, resulting in reduced access to hospital-based cardiovascular care including reduced routine diagnostic cardiovascular testing. However, imaging has also facilitated the understanding of the presence and extent of myocardial damage caused by the coronavirus infection. What has dominated the imaging literature beyond the pandemic are novel data on valvular heart disease, the increasing use of artificial intelligence (AI) applied to imaging, and the use of advanced imaging modalities in both ischaemic heart disease and cardiac amyloidosis.

Published
2021

18. Service delivery models for enhancing linkage to and retention in HIV care services for adolescent girls and young women and adolescent boys and young men: a protocol for an overview of systematic reviews

Author

Kim Jonas, Babalwa Zani, Trisha Ramraj, Witness Chirinda, Ngcwalisa Jama, Wisdom Basera, Tracy McClinton Appollis, Desiree Pass, Darshini Govindasamy, Ferdinand C Mukumbang, Catherine Mathews, and Edward Nicol

Subjects
Male, Review Literature as Topic, South Africa, Adolescent, Humans, Female, HIV Infections, General Medicine, Biological Phenomena, Systematic Reviews as Topic
Abstract

IntroductionRecent advances in the HIV care continuum have shown that an individual diagnosed with HIV should be initiated on antiretroviral therapy as soon as possible regardless of the CD4 count levels and retained in HIV care services. Studies have reported large losses in the HIV continuum of care, before and after the era of universal test and treat. Several systematic reviews have reported on the strategies for improving linkage to and retention in HIV treatment and care. The purpose of this overview of systematic reviews is to identify HIV care interventions or service delivery models (SDMs) and synthesise evidence on the effects of these to link adolescent girls and young women (AGYW) and adolescent boys and young men (ABYM) to care and retain them in care. We also aim to highlight gaps in the evidence on interventions and SDMs to improve linkage and retention in HIV care of AGYW and ABYM.Methods and analysisAn electronic search of four online databases: PubMed, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science will be performed to identify systematic reviews on the effects of linkage to and retention in HIV care interventions or SDMs for AGYW aged 15–24 years and ABYM aged 15–35 years. Our findings on the effects of interventions and SDMs will be interpreted considering the intervention and or SDMs’ effectiveness by the time period, setting and population of interest. Two or more authors will independently screen articles for inclusion using a priori criteria.Ethics and disseminationEthics approval is not required for this study as only published secondary data will be used. Our findings will be disseminated through peer-reviewed publication, conference abstracts and through presentations to stakeholders and other community fora. The findings from this overview of systematic reviews will inform mixed-methods operations research on HIV intervention programming and delivery of HIV care services for AGYW and ABYM in South Africa.PROSPERO registration numberCRD42020177933.

Published
2022
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19. 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)

Author

Dondi, M., Milan, E., Pontone, G., Hirschfeld, C. B., Williams, M., Shaw, L. J., Pynda, Y., Raggi, P., Cerci, R., Vitola, J., Better, N., Villines, T. C., Dorbala, S., Pascual, T. N. B., Giubbini, R., Einstein, A. J., Paez, D., Italy: Domenico Albano, Pierpaolo, Alongi, Gaspare, Arnone, Elisa, Bagatin, Sergio, Baldari, Matteo, Bauckneht, Paolo, Bertelli, Francesco, Bianco, Rachele, Bonfiglioli, Roberto, Boni, Andrea, Bruno, Isabella, Bruno, Elena, Busnardo, Elena, Califaretti, Luca, Camoni, Aldo, Carnevale, Roberta, Casoni, Armando Ugo Cavallo, Giorgio, Cavenaghi, Franca, Chierichetti, Marcello, Chiocchi, Corrado, Cittanti, Mauro, Colletta, Umberto, Conti, Alberto, Cossu, Alberto, Cuocolo, Marco, Cuzzocrea, Maria Luisa De Rimini, Giuseppe De Vincentis, Eleonora Del Giudice, Alberico Del Torto, Veronica Della Tommasina, Rexhep, Durmo, Paola Anna Erba, Laura, Evangelista, Riccardo, Faletti, Evelina, Faragasso, Mohsen, Farsad, Paola, Ferro, Luigia, Florimonte, Viviana, Frantellizzi, Fabio Massimo Fringuelli, Marco, Gatti, Angela, Gaudiano, Alessia, Gimelli, Raffaele, Giubbini, Francesca, Giuffrida, Salvatore, Ialuna, Riccardo, Laudicella, Lucia, Leccisotti, Lucia, Leva, Liga, Riccardo, Carlo, Liguori, Giampiero, Longo, Margherita, Maffione, Maria Elisabetta Mancini, Claudio, Marcassa, Elisa, Milan, Barbara, Nardi, Sara, Pacella, Giovanna, Pepe, Gianluca, Pontone, Sabina, Pulizzi, Natale, Quartuccio, Lucia, Rampin, Fabrizio, Ricci, Pierluigi, Rossini, Giuseppe, Rubini, Vincenzo, Russo, Gian Mauro Sacchetti, Gianmario, Sambuceti, Massimo, Scarano, Roberto, Sciagrà, Massimiliano, Sperandio, Antonella, Stefanelli, Guido, Ventroni, Stefania Zoboli Members from Rest of the World (alphabetically by country and last name) Afghanistan: Mohammad Nawaz Nasery Albania: Artan Goda, Ervina Shirka Algeria: Rabie Benlabgaa, Salah, Bouyoucef, Abdelkader, Medjahedi, Qais Nailli Argentina: Mariela Agolti, Roberto Nicolas Aguero, Maria del Carmen Alak, Lucia Graciela Alberguina, Guillermo, Arroñada, Andrea, Astesiano, Alfredo, Astesiano, Carolina Bas Norton, Pablo, Benteo, Juan, Blanco, Juan Manuel Bonelli, Jose Javier Bustos, Raul, Cabrejas, Jorge, Cachero, Roxana, Campisi, Alejandro, Canderoli, Silvia, Carames, Patrícia, Carrascosa, Ricardo, Castro, Oscar, Cendoya, Luciano Martin Cognigni, Carlos, Collaud, Claudia, Cortes, Javier, Courtis, Daniel, Cragnolino, Mariana, Daicz, Alejandro De La Vega, Silvia Teresa De Maria, Horacio Del Riego, Fernando, Dettori, Alejandro, Deviggiano, Laura, Dragonetti, Mario, Embon, Ruben Emilio Enriquez, Jorge, Ensinas, Fernando, Faccio, Adolfo, Facello, Diego, Garofalo, Ricardo, Geronazzo, Natalia, Gonza, Lucas, Gutierrez, Miguel Angel Guzzo, Victor, Hasbani, Melina, Huerin, Victor, Jäger, Julio Manuel Lewkowicz, Maria Nieves, A López De Munaín, Jose Maria Lotti, Alejandra, Marquez, Osvaldo, Masoli, Osvaldo Horacio Masoli, Edgardo, Mastrovito, Matias, Mayoraz, Graciela Eva Melado, Anibal, Mele, Maria Fernanda Merani, Alejandro Horacio Meretta, Susana, Molteni, Marcos, Montecinos, Eduardo, Noguera, Carlos, Novoa, Claudio Pereyra Sueldo, Sebastian Perez Ascani, Pablo, Pollono, Maria Paula Pujol, Alejandro, Radzinschi, Gustavo, Raimondi, Marcela, Redruello, Marina, Rodríguez, Matías, Rodríguez, Romina Lorena Romero, Arturo Romero Acuña, Federico, Rovaletti, Lucas San Miguel, Lucrecia, Solari, Bruno, Strada, Sonia, Traverso, Sonia Simona Traverzo, Maria del Huerto Velazquez Espeche, Juan Sebastian Weihmuller, Juan, Wolcan, Susana Zeffiro Armenia: Mari Sakanyan Australia: Scott Beuzeville, Raef, Boktor, Patrick, Butler, Jennifer, Calcott, Loretta, Carr, Virgil, Chan, Charles, Chao, Woon, Chong, Mark, Dobson, D'Arne, Downie, Girish, Dwivedi, Barry, Elison, Jean, Engela, Roslyn, Francis, Anand, Gaikwad, Ashok Gangasandra Basavaraj, Bruce, Goodwin, Robert, Greenough, Christian, Hamilton-Craig, Victar, Hsieh, Subodh, Joshi, Karin, Lederer, Kenneth, Lee, Joseph, Lee, John, Magnussen, Nghi, Mai, Gordon, Mander, Fiona, Murton, Dee, Nandurkar, Johanne, Neill, Edward, O'Rourke, Patricia, O'Sullivan, George, Pandos, Kunthi, Pathmaraj, Alexander, Pitman, Rohan, Poulter, Manuja, Premaratne, David, Prior, Lloyd, Ridley, Natalie, Rutherford, Hamid, Salehi, Connor, Saunders, Luke, Scarlett, Sujith, Seneviratne, Deepa, Shetty, Ganesh, Shrestha, Jonathan, Shulman, Vijay, Solanki, Tony, Stanton, Murch, Stuart, Michael, Stubbs, Ian, Swainson, Kim, Taubman, Andrew, Taylor, Paul, Thomas, Steven, Unger, Anthony, Upton, Shankar, Vamadevan, William Van Gaal, Johan, Verjans, Demetrius, Voutnis, Victor, Wayne, Peter, Wilson, David, Wong, Kirby, Wong, John Younger Austria: Gudrun Feuchtner, Siroos, Mirzaei, Konrad Weiss Belarus: Natallia Maroz-Vadalazhskaya Belgium: Olivier Gheysens, Filip, Homans, Rodrigo, Moreno-Reyes, Agnès, Pasquet, Veronique, Roelants, Van De Heyning Bolivia: Raúl Araujo Ríos Bosnia - Herzegovina: Valentina Soldat-Stankovic, Caroline M., Sinisa Stankovic Brazil: Maria Helena Albernaz Siqueira, Augusto, Almeida, Paulo Henrique Alves Togni, Jose Henrique Andrade, Luciana, Andrade, Carlos, Anselmi, Roberta, Araújo, Guilherme, Azevedo, Sabbrina, Bezerra, Rodrigo, Biancardi, Gabriel Blacher Grossman, Simone, Brandão, Diego Bromfman Pianta, Lara, Carreira, Bruno, Castro, Tien, Chang, Fernando Cunali, Jr., Roberto, Cury, Roberto, Dantas, Fernando de Amorim Fernandes, Andrea De Lorenzo, Robson De Macedo Filho, Fernanda, Erthal, Fabio, Fernandes, Juliano, Fernandes, Thiago Ferreira De Souza, Wilson Furlan Alves, Bruno, Ghini, Luiz, Goncalves, Ilan, Gottlieb, Marcelo, Hadlich, Vinícius, Kameoka, Ronaldo, Lima, Adna, Lima, Rafael Willain Lopes, Ricardo Machado, e Silva, Tiago, Magalhães, Fábio Martins Silva, Luiz Eduardo Mastrocola, Fábio, Medeiros, José Claudio Meneghetti, Vania, Naue, Danilo, Naves, Roberto, Nolasco, Cesar, Nomura, Joao Bruno Oliveira, Eduardo, Paixao, Filipe Penna De Carvalho, Ibraim, Pinto, Priscila, Possetti, Mayra, Quinta, Rodrigo Rizzo Nogueira Ramos, Ricardo, Rocha, Alfredo, Rodrigues, Carlos, Rodrigues, Leila, Romantini, Adelina, Sanches, Sara, Santana, Leonardo Sara da Silva, Paulo, Schvartzman, Cristina Sebastião Matushita, Tiago, Senra, Afonso, Shiozaki, Maria Eduarda Menezes de Siqueira, Cristiano, Siqueira, Paola, Smanio, Carlos Eduardo Soares, José Soares Junior, Marcio Sommer Bittencourt, Bernardo, Spiro, Cláudio Tinoco Mesquita, Jorge, Torreao, Rafael, Torres, Marly, Uellendahl, Guilherme Urpia Monte, Otávia, Veríssimo, Estevan Vieira Cabeda, Felipe Villela Pedras, Roberto, Waltrick, Marcello Zapparoli Brunei Darussalam: Hamid Naseer Bulgaria: Marina Garcheva-Tsacheva, Irena Kostadinova Cambodia: Youdaline Theng Canada: Gad Abikhzer, Rene, Barette, Benjamin, Chow, Dominique, Dabreo, Matthias, Friedrich, Ria, Garg, Mohammed Nassoh Hafez, Chris, Johnson, Marla, Kiess, Jonathon, Leipsic, Eugene, Leung, Robert, Miller, Anastasia, Oikonomou, Stephan, Probst, Idan, Roifman, Gary, Small, Vikas, Tandon, Adwait, Trivedi, James, White, Katherine Zukotynski Chile: Jose Canessa, Gabriel Castro Muñoz, Carmen, Concha, Pablo, Hidalgo, Cesar, Lovera, Teresa, Massardo, Luis Salazar Vargas Colombia: Pedro Abad, Harold, Arturo, Sandra, Ayala, Luis, Benitez, Alberto, Cadena, Carlos, Caicedo, Antonio Calderón Moncayo, Sharon, Gomez, Gutierrez Villamil, Claudia T., Claudia, Jaimes, Juan, Londoño, Juan Luis Londoño Blair, Luz, Pabon, Mauricio, Pineda, Juan Carlos Rojas, Diego, Ruiz, Manuel Valencia Escobar, Andres, Vasquez, Damiana, Vergel, Alejandro Zuluaga Costa Rica: Isabel Berrocal Gamboa, Gabriel, Castro, Ulises, González, Croatia: Ana Baric, Tonci, Batinic, Maja, Franceschi, Maja Hrabak Paar, Mladen, Jukic, Petar, Medakovic, Viktor, Persic, Marina, Prpic, Ante Punda Cuba: Juan Felipe Batista, Juan Manuel Gómez Lauchy, Yamile Marcos Gutierrez, Rayner, Menéndez, Amalia, Peix, Luis Rochela Cyprus: Christoforos Panagidis, Ioannis Petrou Czech Republic: Vaclav Engelmann, Milan, Kaminek, Vladimír, Kincl, Otto, Lang, Milan Simanek Denmark: Jawdat Abdulla, Morten, Bøttcher, Mette, Christensen, Lars Christian Gormsen, Philip, Hasbak, Søren, Hess, Paw, Holdgaard, Allan, Johansen, Kasper, Kyhl, Bjarne Linde Norgaard, Kristian Altern Øvrehus, Niels Peter Rønnow Sand, Rolf, Steffensen, Anders, Thomassen, Bo Zerahn Dominican Republic: Alfredo Perez Ecuador: Giovanni Alejandro Escorza Velez, Mayra Sanchez Velez Egypt: Islam Shawky Abdel Aziz, Mahasen, Abougabal, Taghreed, Ahmed, Adel, Allam, Ahmed, Asfour, Mona, Hassan, Alia, Hassan, Ahmed, Ibrahim, Sameh, Kaffas, Ahmed, Kandeel, Mohamed Mandour Ali, Ahmad, Mansy, Hany, Maurice, Sherif, Nabil, Mahmoud Shaaban El Salvador: Ana Camila Flores Estonia: Anne Poksi Finland: Juhani Knuuti, Velipekka, Kokkonen, Martti, Larikka, Valtteri Uusitalo France: Matthieu Bailly, Samuel, Burg, Jean-François, Deux, Vincent, Habouzit, Fabien, Hyafil, Olivier, Lairez, Franck, Proffit, Hamza, Regaieg, Laure, Sarda-Mantel, Schneider Ghana: Harold Ayetey Greece: George Angelidis, Vania Tacher Germany: Roman P., Aikaterini, Archontaki, Sofia, Chatziioannou, Ioannis, Datseris, Christina, Fragkaki, Panagiotis, Georgoulias, Sophia, Koukouraki, Maria, Koutelou, Eleni, Kyrozi, Evangelos, Repasos, Petros, Stavrou, Pipitsa Valsamaki Guatemala: Carla Gonzalez, Goleat Gutierrez Honduras: Alejandro Maldonado Hungary: Klara Buga, Ildiko, Garai, Pál, Maurovich-Horvat, Erzsébet, Schmidt, Balint, Szilveszter, Edit Várady India: Nilesh Banthia, Jinendra Kumar Bhagat, Rishi, Bhargava, Vivek, Bhat, Mona, Bhatia, Partha, Choudhury, Vijay Sai Chowdekar, Aparna, Irodi, Shashank, Jain, Elizabeth, Joseph, Sukriti, Kumar, Prof Dr Girijanandan Mahapatra, Deepanjan, Mitra, Bhagwant Rai Mittal, Ahmad, Ozair, Chetan, Patel, Tapan, Patel, Ravi, Patel, Shivani, Patel, Sudhir, Saxena, Shantanu, Sengupta, Santosh, Singh, Bhanupriya, Singh, Ashwani, Sood, Atul Verma Indonesia: Erwin Affandi, Padma Savenadia Alam, Edison, Edison, Gani, Gunawan, Habusari, Hapkido, Basuki, Hidayat, Aulia, Huda, Anggoro Praja Mukti, Djoko, Prawiro, Erwin Affandi Soeriadi, Hilman Syawaluddin Iraq: Amjed Albadr Islamic Republic of Iran: Majid Assadi, Farshad, Emami, Golnaz, Houshmand, Majid, Maleki, Maryam Tajik Rostami, Seyed Rasoul Zakavi Israel: Eed Abu Zaid, Svetlana, Agranovich, Yoav, Arnson, Rachel, Bar-Shalom, Alex, Frenkel, Galit, Knafo, Rachel, Lugassi, Israel Shlomo Maor Moalem, Maya, Mor, Noam, Muskal, Sara, Ranser, Aryeh Shalev Jamaica: Dainia Baugh, Duane, Chambers, Ernest, Madu, Felix Nunura Japan: Hiroshi Asano, Chimura Misato Chimura, Shinichiro, Fujimoto, Koichiro, Fujisue, Tomohisa, Fukunaga, Yoshimitsu, Fukushima, Kae, Fukuyama, Jun, Hashimoto, Yasutaka, Ichikawa, Nobuo, Iguchi, Masamichi, Imai, Anri, Inaki, Hayato, Ishimura, Satoshi, Isobe, Toshiaki, Kadokami, Takao, Kato, Takashi, Kudo, Shinichiro, Kumita, Hirotaka, Maruno, Hiroyuki, Mataki, Masao, Miyagawa, Ryota, Morimoto, Masao, Moroi, Shigeki, Nagamachi, Kenichi, Nakajima, Tomoaki, Nakata, Ryo, Nakazato, Mamoru, Nanasato, Masanao, Naya, Takashi, Norikane, Yasutoshi, Ohta, Satoshi, Okayama, Atsutaka, Okizaki, Yoichi, Otomi, Hideki, Otsuka, Masaki, Saito, Sakata Yasushi Sakata, Masayoshi, Sarai, Daisuke, Sato, Shinya, Shiraishi, Yoshinobu, Suwa, Kentaro, Takanami, Kazuya, Takehana, Junichi, Taki, Nagara, Tamaki, Yasuyo, Taniguchi, Hiroki, Teragawa, Nobuo, Tomizawa, Kenichi, Tsujita, Kyoko, Umeji, Yasushi, Wakabayashi, Shinichiro, Yamada, Shinya, Yamazaki, Tatsuya Yoneyama Jordan: Mohammad Rawashdeh Kazakhstan: Daultai Batyrkhanov, Tairkhan Dautov Kenya: Khalid Makhdomi, Kevin Ombati Kuwait: Faridah Alkandari, Masoud Garashi Lao People's Democratic Republic: Tchoyoson Lim Coie, Sonexay Rajvong Latvia: Artem Kalinin, Marika Kalnina Lebanon: Mohamad Haidar Lithuania: Renata Komiagiene, Giedre, Kviecinskiene, Mindaugas, Mataciunas, Karim Malta: Luise Reichmuth, Donatas Vajauskas Luxembourg: Christian Picard Malaysia: Noor Khairiah A., Anthony Samuel Mauritius: Mohammad Aaftaab Allarakha, Ambedhkar Shantaram Naojee Mexico: Erick Alexanderson-Rosas, Erika, Barragan, Alejandro Becerril González-Montecinos, Manuel, Cabada, Daniel Calderon Rodriguez, Isabel, Carvajal-Juarez, Violeta, Cortés, Filiberto, Cortés, Erasmo De La Peña, Manlio, Gama-Moreno, Luis, González, Nelsy Gonzalez Ramírez, Moisés, Jiménez-Santos, Luis, Matos, Edgar, Monroy, Martha, Morelos, Mario, Ornelas, Jose Alberto Ortga Ramirez, Andrés, Preciado-Anaya, Óscar Ulises Preciado-Gutiérrez, Adriana Puente Barragan, Sandra Graciela Rosales Uvera, Sigelinda, Sandoval, Miguel Santaularia Tomas, Sierra-Galan, Lilia M., Silvia, Siu, Enrique, Vallejo, Mario Valles Monaco: Marc Faraggi Mongolia: Erdenechimeg Sereegotov Montenegro: Srdja Ilic Morocco: Nozha Ben-Rais, Nadia Ismaili Alaoui, Sara Taleb Myanmar: Khin Pa Pa Myo, Phyo Si Thu Nepal: Ram Kumar Ghimire, Bijoy Rajbanshi Netherlands: Peter Barneveld, Andor, Glaudemans, Jesse, Habets, Klaas Pieter Koopmans, Jeroen, Manders, Stefan, Pool, Arthur, Scholte, Asbjørn, Scholtens, Riemer, Slart, Paul, Thimister, Erik-Jan Van Asperen, Niels, Veltman, Derk, Verschure, Nils Wagenaar New Zealand: John Edmond, Chris, Ellis, Kerryanne, Johnson, Ross, Keenan, Shaw Hua (Anthony) Kueh, Christopher, Occleshaw, Alexander, Sasse, Andrew, To, Niels Van Pelt, Calum Young Nicaragua: Teresa Cuadra, Hector Bladimir Roque Vanegas Niger: Idrissa Adamou Soli, Djibrillou Moussa Issoufou Nigeria: Tolulope Ayodele, Chibuzo, Madu, Yetunde Onimode Norway: Elen Efros-Monsen, Signe Helene Forsdahl, Jenni-Mari Hildre Dimmen, Arve, Jørgensen, Isabel, Krohn, Pål, Løvhaugen, Anders Tjellaug Bråten Oman: Humoud Al Dhuhli, Faiza Al Kindi, Naeema, Al-Bulushi, Zabah, Jawa, Naima Tag Pakistan: Muhammad Shehzad Afzal, Shazia, Fatima, Muhammad Numair Younis, Musab, Riaz, Mohammad Saadullah Panama: Yariela Herrera Papua New Guinea: Dora Lenturut-Katal Paraguay: Manuel Castillo Vázquez, José Ortellado People's Republic of Bangladesh: Afroza Akhter People's Republic of China: Dianbo Cao, Stephen, Cheung, Dai, Xu, Lianggeng, Gong, Dan, Han, Yang, Hou, Caiying, Li, Tao, Li, Dong, Li, Sijin, Li, Jinkang, Liu, Hui, Liu, Bin, Lu, Ming Yen Ng, Kai, Sun, Gongshun, Tang, Jian, Wang, Ximing, Wang, Zhao-Qian, Wang, Yining, Wang, Yifan, Wang, Jiang, Wu, Zhifang, Wu, Liming, Xia, Jiangxi, Xiao, Lei, Xu, Youyou, Yang, Yin, Wu, Jianqun, Yu, Yuan, Li, Tong, Zhang, Longjiang, Zhang, Yong-Gao, Zhang, Xiaoli, Zhang, Li Zhu Peru: Ana Alfaro Philippines: Paz Abrihan, Asela, Barroso, Eric, Cruz, Marie Rhiamar Gomez, Vincent Peter Magboo, John Michael Medina, Jerry, Obaldo, Davidson, Pastrana, Christian Michael Pawhay, Alvin, Quinon, Jeanelle Margareth Tang, Bettina, Tecson, Kristine Joy Uson, Mila Uy Poland: Magdalena Kostkiewicz, Jolanta Kunikowska Portugal: Nuno Bettencourt, Guilhermina, Cantinho, Antonio Ferreira Qatar: Ghulam Syed Republic of Ireland: Samer Arnous, Said, Atyani, Angela, Byrne, Tadhg, Gleeson, David, Kerins, Conor, Meehan, David, Murphy, Mark, Murphy, John, Murray, Julie O'Brien Republic of Korea: Ji-In Bang, Henry, Bom, Sang-Geon, Cho, Chae Moon Hong, Su Jin Jang, Yong Hyu Jeong, Won Jun Kang, Ji-Young, Kim, Jaetae, Lee, Chang Kyeong Namgung, Young, So, Kyoung Sook Won Republic of North Macedonia: Venjamin Majstorov, Marija Vavlukis Republic of Slovenia: Barbara Gužic Salobir, Monika Štalc Romania: Theodora Benedek, Imre, Benedek, Raluca, Mititelu, Claudiu Adrian Stan Russian Federation: Alexey Ansheles, Olga, Dariy, Olga, Drozdova, Nina, Gagarina, Vsevolod Milyevich Gulyaev, Irina, Itskovich, Anatoly, Karalkin, Alexander, Kokov, Ekaterina, Migunova, Viktor, Pospelov, Daria, Ryzhkova, Guzaliya, Saifullina, Svetlana, Sazonova, Vladimir, Sergienko, Irina, Shurupova, Tatjana, Trifonova, Wladimir Yurievich Ussov, Margarita, Vakhromeeva, Nailya, Valiullina, Konstantin, Zavadovsky, Kirill Zhuravlev Saudi Arabia: Mirvat Alasnag, Subhani Okarvi Serbia: Dragana Sobic Saranovic Singapore: Felix Keng, Jia Hao Jason See, Ramkumar, Sekar, Min Sen Yew Slovak Republic: Andrej Vondrak South Africa: Shereen Bejai, George, Bennie, Ria, Bester, Gerrit, Engelbrecht, Osayande, Evbuomwan, Harlem, Gongxeka, Magritha Jv Vuuren, Mitchell, Kaplan, Purbhoo, Khushica, Hoosen, Lakhi, Lizette, Louw, Nico, Malan, Katarina, Milos, Moshe, Modiselle, Stuart, More, Mathava, Naidoo, Leonie, Scholtz, Mboyo Vangu Spain: Santiago Aguadé-Bruix, Isabel, Blanco, Antonio, Cabrera, Alicia, Camarero, Irene, Casáns-Tormo, Hug, Cuellar-Calabria, Albert, Flotats, Maria Eugenia Fuentes Cañamero, María Elia García, Amelia, Jimenez-Heffernan, Rubén, Leta, Javier Lopez Diaz, Luis, Lumbreras, Juan Javier Marquez-Cabeza, Francisco, Martin, Anxo Martinez de Alegria, Francisco, Medina, Maria Pedrera Canal, Virginia, Peiro, Virginia, Pubul-Nuñez, Juan Ignacio Rayo Madrid, Cristina Rodríguez Rey, Ricardo Ruano Perez, Joaquín, Ruiz, Gertrudis Sabatel Hernández, Ana, Sevilla, Nahla Zeidán Sri Lanka: Damayanthi Nanayakkara, Chandraguptha Udugama Sweden: Magnus Simonsson Switzerland: Hatem Alkadhi, Ronny Ralf Buechel, Peter, Burger, Luca, Ceriani, Bart De Boeck, Christoph, Gräni, Alix Juillet de Saint Lager Lucas, Kamani, Christel H., Nadine, Kawel-Boehm, Robert, Manka, Prior, John O., Axel, Rominger, Jean-Paul Vallée Thailand: Benjapa Khiewvan, Teerapon, Premprabha, Tanyaluck Thientunyakit Tunisia: Ali Sellem Turkey: Kemal Metin Kir, Haluk Sayman Uganda: Mugisha Julius Sebikali, Zerida Muyinda Ukraine: Yaroslav Kmetyuk, Pavlo, Korol, Olena, Mykhalchenko, Volodymyr, Pliatsek, Maryna Satyr United Arab Emirates: Batool Albalooshi, Mohamed Ismail Ahmed Hassan United Kingdom: Jill Anderson, Punit, Bedi, Thomas, Biggans, Anda, Bularga, Russell, Bull, Rajesh, Burgul, John-Paul, Carpenter, Duncan, Coles, David, Cusack, Aparna, Deshpande, John, Dougan, Timothy, Fairbairn, Alexia, Farrugia, Deepa, Gopalan, Alistair, Gummow, Prasad Guntur Ramkumar, Mark, Hamilton, Mark, Harbinson, Thomas, Hartley, Benjamin, Hudson, Nikhil, Joshi, Michael, Kay, Andrew, Kelion, Azhar, Khokhar, Jamie, Kitt, Ken, Lee, Chen, Low, Sze Mun Mak, Ntouskou, Marousa, Jon, Martin, Elisa, Mcalindon, Leon, Menezes, Gareth, Morgan-Hughes, Alastair, Moss, Anthony, Murray, Edward, Nicol, Dilip, Patel, Charles, Peebles, Francesca, Pugliese, Jonathan Carl Luis Rodrigues, Christopher, Rofe, Nikant, Sabharwal, Rebecca, Schofield, Thomas, Semple, Naveen, Sharma, Peter, Strouhal, Deepak, Subedi, William, Topping, Katharine, Tweed, Jonathan Weir-Mccall United States of America: Suhny Abbara, Taimur, Abbasi, Brian, Abbott, Shady, Abohashem, Sandra, Abramson, Tarek, Al-Abboud, Mouaz, Al-Mallah, Omar, Almousalli, Karthikeyan, Ananthasubramaniam, Mohan Ashok Kumar, Jeffrey, Askew, Lea, Attanasio, Mallory, Balmer-Swain, Bayer, Richard R., Adam, Bernheim, Sabha, Bhatti, Erik, Bieging, Ron, Blankstein, Stephen, Bloom, Sean, Blue, David, Bluemke, Andressa, Borges, Kelley, Branch, Paco, Bravo, Jessica, Brothers, Matthew, Budoff, Renée, Bullock-Palmer, Angela, Burandt, Burke, Floyd W., Kelvin, Bush, Candace, Candela, Elizabeth, Capasso, Joao, Cavalcante, Donald, Chang, Saurav, Chatterjee, Yiannis, Chatzizisis, Michael, Cheezum, Tiffany, Chen, Jennifer, Chen, Marcus, Chen, Andrew, Choi, James, Clarcq, Ayreen, Cordero, Matthew, Crim, Sorin, Danciu, Bruce, Decter, Nimish, Dhruva, Neil, Doherty, Rami, Doukky, Anjori, Dunbar, William, Duvall, Rachael, Edwards, Kerry, Esquitin, Husam, Farah, Emilio, Fentanes, Maros, Ferencik, Daniel, Fisher, Daniel, Fitzpatrick, Cameron, Foster, Tony, Fuisz, Michael, Gannon, Lori, Gastner, Myron, Gerson, Brian, Ghoshhajra, Alan, Goldberg, Brian, Goldner, Jorge, Gonzalez, Rosco, Gore, Sandra, Gracia-López, Fadi, Hage, Agha, Haider, Sofia, Haider, Yasmin, Hamirani, Karen, Hassen, Mallory, Hatfield, Carolyn, Hawkins, Katie, Hawthorne, Nicholas, Heath, Robert, Hendel, Phillip, Hernandez, Gregory, Hill, Stephen, Horgan, Jeff, Huffman, Lynne, Hurwitz, Ami, Iskandrian, Rajesh, Janardhanan, Christine, Jellis, Scott, Jerome, Dinesh, Kalra, Summanther, Kaviratne, Fernando, Kay, Faith, Kelly, Omar, Khalique, Mona, Kinkhabwala, George Kinzfogl Iii, Jacqueline, Kircher, Rachael, Kirkbride, Michael, Kontos, Anupama, Kottam, Joseph, Krepp, Jay, Layer, Steven, H Lee, Jeffrey, Leppo, John, Lesser, Steve, Leung, Howard, Lewin, Diana, Litmanovich, Yiyan, Liu, Juan, Lopez-Mattei, Kathleen, Magurany, Jeremy, Markowitz, Amanda, Marn, Stephen, E Matis, Michael, Mckenna, Tony, Mcrae, Fernando, Mendoza, Michael, Merhige, David, Min, Chanan, Moffitt, Karen, Moncher, Warren, Moore, Shamil, Morayati, Michael, Morris, Mahmud, Mossa-Basha, Zorana, Mrsic, Venkatesh, Murthy, Prashant, Nagpal, Kyle, Napier, Jagat, Narula, Katarina, Nelson, Prabhjot, Nijjar, Medhat, Osman, Purvi, Parwani, Edward, Passen, Amit, Patel, Pravin, Patil, Ryan, Paul, Lawrence, Phillips, Venkateshwar, Polsani, Rajaram, Poludasu, Brian, Pomerantz, Thomas, Porter, Ryan, Prentice, Amit, Pursnani, Mark, Rabbat, Suresh, Ramamurti, Florence, Rich, Hiram Rivera Luna, Austin, Robinson, Kim, Robles, Cesar, Rodríguez, Mark, Rorie, John, Rumberger, Raymond, Russell, Philip, Sabra, Diego, Sadler, Mary, Schemmer, Joseph Schoepf, U., Samir, Shah, Nishant, Shah, Sujata, Shanbhag, Gaurav, Sharma, Steven, Shayani, Jamshid, Shirani, Pushpa, Shivaram, Steven, Sigman, Mitch, Simon, Ahmad, Slim, David, Smith, Alexandra, Smith, Prem, Soman, Aditya, Sood, Monvadi Barbara Srichai-Parsia, James, Streeter, Albert, T, Ahmed, Tawakol, Dustin, Thomas, Randall, Thompson, Tara, Torbet, Desiree, Trinidad, Shawn, Ullery, Samuel, Unzek, Seth, Uretsky, Srikanth, Vallurupalli, Vikas, Verma, Alfonso, Waller, Ellen, Wang, Parker, Ward, Gaby, Weissman, George, Wesbey, Kelly, White, David, Winchester, David, Wolinsky, Sandra, Yost, Michael Zgaljardic Uruguay: Omar Alonso, Mario, Beretta, Rodolfo, Ferrando, Miguel, Kapitan, Fernando Mut Uzbekistan: Omoa Djuraev, Gulnora Rozikhodjaeva Vietnam: Ha Le Ngoc, Son Hong Mai, and Xuan Canh Nguyen

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Cardiology, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, COVID-19, Cardiac imaging, Cardiovascular disease, Article, cardiac imaging, Healthcare delivery, cardiovascular disease, Intensive care, Surveys and Questionnaires, Health care, Pandemic, medicine, Humans, Pandemics, Protocol (science), business.industry, SARS-CoV-2, Non invasive, Italy, humans, pandemics, surveys and questionnaires, cardiology, Emergency medicine, Cardiology and Cardiovascular Medicine, business
Abstract

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 < 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.

Published
2021
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20. National Trends in Coronary Artery Disease Imagingassociations with Health Care Outcomes and Costs

Author

Jonathan R. Weir-McCall, Edward Nicol, Anoop S V Shah, Michelle C. Williams, Giles Roditi, David E. Newby, and James H. F. Rudd

Subjects
History, medicine.medical_specialty, education.field_of_study, Polymers and Plastics, medicine.diagnostic_test, business.industry, Population, Disease, medicine.disease, Chest pain, Industrial and Manufacturing Engineering, Confidence interval, Coronary artery disease, Myocardial perfusion imaging, Internal medicine, medicine, Cardiology, Myocardial infarction, Business and International Management, medicine.symptom, education, business, Computed tomography angiography
Abstract

Background: We sought to determine the impact of temporal trends and the 2016 updated National Institute for Health and Care Excellence chest pain guidelines (CG95) on imaging investigations and outcomes for coronary artery disease. Methods: Investigations for coronary artery disease from 2012-2018 were extracted from the English national database of imaging procedures and linked to national hospital admission and mortality registries. Growth rates were calculated, adjusted for population size, and linked with trends in cardiovascular hospital admissions and mortality compared across tertiles of imaging growth. The impact of CG95 was assessed using an interrupted time-series analysis. Findings: From 2012-2018, 1,909,314 investigations for coronary artery disease were performed, with an annualised per capita growth rate of 4·8%. At a national level, CG95 was associated with a rise in coronary computed tomography angiography (CTA) (exp(β) 1·10 [95% confidence interval 1·03 to 1·18], p=0·006), with no change in myocardial perfusion imaging and a potential modest fall in invasive coronary angiography (exp(β) 0·997 [0·993 to 1·00], p=0·06). At a regional level, greater CTA growth was associated with reduced hospitalisations for myocardial infarction (-0·7 [-0·8 to 1·7] admissions/100,000 population/year) whereas lower growth was associated with increased hospitalisations for myocardial infarction (1·8 [0·9 to 2·7] admissions/100,000 population/year). Cardiovascular and coronary artery disease deaths fell by -2·95 [-3·11 to -2·72] and -1·66 [-1·79 to -1·51] deaths/100,000/year respectively (p

Published
2021
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21. Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa

Author

Edward Nicol, Peter Delobelle, Eveline M Kabongo, Ferdinand C. Mukumbang, and Public Health Sciences

Subjects
Program evaluation, Maternal and child health, Process management, MomConnect, Epidemiology, Computer science, media_common.quotation_subject, Health Informatics, Context (language use), Theory of change, South Africa, 03 medical and health sciences, 0302 clinical medicine, Humans, 030212 general & internal medicine, Child, Empowerment, media_common, lcsh:R5-920, Motivation, 030503 health policy & services, Knowledge acquisition, Abductive reasoning, mHealth, Thematic analysis, lcsh:Medicine (General), 0305 other medical science, Construct (philosophy), Realist evaluation, Program Evaluation, Research Article
Abstract

Background One of the Sustainable Development Goals is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. In South Africa, the flagship National Department of Health MomConnect program was launched in 2014 to strengthen the quality of maternal and child health (MCH) services and improve mortality outcomes. MomConnect was rapidly rolled out with a limited understanding of how and why the program was expected to work even though studies had shown the effectiveness of the MomConnect program in improving the uptake of MCH services. This study aimed to unearth the initial program theory of the MomConnect program based on explicit and implicit assumptions of how the program was organized and expected to work. Methods We conducted a document analysis using design- and implementation-related documents of the MomConnect program guided by the principles of Theory of Change (ToC) and Realist Evaluation (RE). Content and thematic analysis approaches were deductively applied to analyze the documents toward constructing ToC and RE-informed models. Abductive thinking and retroduction were further applied to the realist-informed approach to link program context, mechanisms, and outcomes to construct the initial program theory. Results ToC and RE-informed models illustrated how the MomConnect program was organized and expected to work. The process of constructing the ToC provided the platform for the development of the initial program theory, which identified three critical elements: (1) the central modalities of the MomConnect program; (2) the intended outcomes; and (3) the tentative causal links indicating, in a stepwise manner of, how the outcomes were intended to be achieved. The RE approach ‘enhanced’ the causal links by identifying relevant programmatic contexts and linking the postulated mechanisms of action (empowerment, encouragement, motivation, and knowledge acquisition) to program outcomes. Conclusion The application of ToC and RE provided an explicitly cumulative approach to knowledge generation in unveiling the initial program theory of MomConnect rather than delivering answers to questions of program effectiveness.

Published
2020
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22. M5 Reporting incidental coronary and cardiac calcification on thoracic CT– BSCI/BSCCT survey of radiologist opinions

Author

James Stirrup, Michelle C. Williams, Aparna Deshpande, James Shambrook, Alastair J Moss, Bobby Agrawal, Ben Holloway, Giles Roditi, Deepa Gopalan, Gareth Morgan Hughes, Matthias Schmitt, Russell Bull, J. Weir-McCall, and Edward Nicol

Subjects
Aortic valve, Aorta, medicine.medical_specialty, Thoracic aorta calcification, business.industry, medicine.disease, Coronary arteries, medicine.anatomical_structure, medicine.artery, Coronary artery calcification, Mitral valve, medicine, Thoracic ct, Radiology, business, Calcification
Abstract

Introduction Coronary and cardiac calcifications are common incidental findings on thoracic CT which are frequently not reported. This survey sought the opinions of UK radiologists regarding reporting of incidental calcification. Methods Using an online survey form UK radiologists were invited to answer questions regarding reporting of coronary, aortic valve, mitral and thoracic aorta calcification on routine non-cardiac/vascular thoracic CT. Results 210 radiologists completed the survey including 24 (11%) trainees and 186 (89%) consultants. 30% were not sub-specialists in cardiac, thoracic or vascular imaging. Calcification was not reported by 11% for the coronary arteries, 21% for the aortic valve, 25% for the mitral valve and 38% for the aorta. Age and indication for imaging were the most frequent factors influencing the reporting of calcification. For coronary calcification a per patient visual assessment was the most frequently used (66%), followed by per vessel visual assessment (14%), semi-quantitative scoring (5%) and Agatston scoring (2%). Several comments suggested that guidelines for reporting incidental coronary and cardiac calcification would be useful. Conclusion Reporting of incidental coronary and cardiac calcification varies widely and guidelines are required.

Published
2020
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23. Improving the quality and use of immunization and surveillance data: Summary report of the Working Group of the Strategic Advisory Group of Experts on Immunization

Author

Edward Nicol, Use, Ana Morice, Carolina M. Danovaro-Holliday, Noni E. MacDonald, Nargis Rahimi, Heather M. Scobie, Michael Edelstein, and Jaleela Jawad

Subjects
Research Report, Quality management, Process management, Program management, 030231 tropical medicine, 03 medical and health sciences, 0302 clinical medicine, Information system, Humans, Information systems, 030212 general & internal medicine, Programme level, Vaccine-preventable disease, Vaccination coverage, Surveillance, General Veterinary, General Immunology and Microbiology, Immunization Programs, Vaccination, Public Health, Environmental and Occupational Health, Data quality, Conference Report, Data use, Data sharing, Government Programs, Infectious Diseases, Needs assessment, Workforce, Molecular Medicine, Immunization, Business
Abstract

Highlights • Reported to SAGE on immunization and surveillance data quality & use, October 2019. • Improvements since 2011, but gaps persist in data quality (fit-for-purpose) and use. • Improving data quality and use requires better governance, people, tools, and processes. • Better use of existing data needed to continuously improve programme performance. • Report relevant for “data-guided” implementation of the Immunization Agenda 2030., Concerns about the quality and use of immunization and vaccine-preventable disease (VPD) surveillance data have been highlighted on the global agenda for over two decades. In August 2017, the Strategic Advisory Group of Experts (SAGE) established a Working Group (WG) on the Quality and Use of Global Immunization and Surveillance Data to review the current status and evidence to make recommendations, which were presented to SAGE in October 2019. The WG synthesized evidence from landscape analyses, literature reviews, country case-studies, a data triangulation analysis, as well as surveys of experts. Data quality (DQ) was defined as data that are accurate, precise, relevant, complete, and timely enough for the intended purpose (fit-for-purpose), and data use as the degree to which data are actually used for defined purposes, e.g., immunization programme management, performance monitoring, decision-making. The WG outlined roles and responsibilities for immunization and surveillance DQ and use by programme level. The WG found that while DQ is dependent on quality data collection at health facilities, many interventions have targeted national and subnational levels, or have focused on new technologies, rather than the people and enabling environments required for functional information systems. The WG concluded that sustainable improvements in immunization and surveillance DQ and use will require efforts across the health system — governance, people, tools, and processes, including use of data for continuous quality improvement (CQI) — and that the approaches need to be context-specific, country-owned and driven from the frontline up. At the country level, major efforts are needed to: (1) embed monitoring DQ and use alongside monitoring of immunization and surveillance performance, (2) increase workforce capacity and capability for DQ and use, starting at the facility level, (3) improve the accuracy of immunization programme targets (denominators), (4) enhance use of existing data for tailored programme action (e.g., immunization programme planning, management and policy-change), (5) adopt a data-driven CQI approach as part of health system strengthening, (6) strengthen governance around piloting and implementation of new information and communication technology tools, and (7) improve data sharing and knowledge management across areas and organizations for improved transparency and efficiency. Global and regional partners are requested to support countries in adopting relevant recommendations for their setting and to continue strengthening the reporting and monitoring of immunization and VPD surveillance data through processes periodic needs assessment and revision processes. This summary of the WG’s findings and recommendations can support “data-guided” implementation of the new Immunization Agenda 2030.

Published
2020

24. Strengthening health system’s capacity for pre-exposure prophylaxis for adolescent girls and young women and adolescent boys and young men in South Africa (SHeS’Cap–PrEP): Protocol for a mixed methods study in KwaZulu-Natal, South Africa

Author

Edward Nicol, Trisha Ramraj, Mbuzeleni Hlongwa, Wisdom Basera, Ngcwalisa Jama, Carl Lombard, Tracy McClinton-Appollis, Darshini Govindasamy, Desiree Pass, Noluntu Funani, Sarah Aheron, Ariana Paredes-Vincent, Jennifer Drummond, Mireille Cheyip, Sibongile Dladla, Jason Bedford, and Cathy Mathews

Subjects
Male, South Africa, Multidisciplinary, Adolescent, Anti-HIV Agents, Incidence, Black People, Humans, Female, HIV Infections, Pre-Exposure Prophylaxis
Abstract

Introduction Pre-exposure prophylaxis (PrEP) is an effective prevention intervention that can be used to control HIV incidence especially among people who are at increased risk for HIV such as adolescent girls and young women (AGYW) and adolescent boys and young men (ABYM). In South Africa, various approaches of delivering PrEP have been adopted at different service delivery points (facility-based only, school-based only, community-based only and hybrid school-facility and community-facility models) to overcome challenges associated with individual, structural, and health systems related barriers that may hinder access to and uptake of PrEP among these populations. However, little is known about how to optimize PrEP implementation and operational strategies to achieve high sustained uptake of good quality services for AGYW and ABYM. This study aims to identify effective and feasible PrEP models of care for improving PrEP uptake, continuation, and adherence among AGYW and ABYM. Methods and analysis A sequential explanatory mixed-methods study will be conducted in 22 service delivery points (SDPs) in uMgungundlovu district, KwaZulu-Natal, South Africa. We will recruit 600 HIV negative, sexually active, high risk, AGYW (aged 15–24 years) and ABYM (aged 15–35 years). Enrolled participants will be followed up at 1-, 4- and 7-months to determine continuation and adherence to PrEP. We will conduct two focus group discussions (with 8 participants in each group) across four groups (i. Initiated PrEP within 1 month, ii. Did not initiate PrEP within 1 month, iii. Continued PrEP at 4/7 months and iv. Did not continue PrEP at 4/7 months) and 48 in-depth interviews from each of the four groups (12 per group). Twelve key informant interviews with stakeholders working in HIV programs will also be conducted. Associations between demographic characteristics stratified by PrEP initiation and by various service-delivery models will be assessed using Chi-square/Fishers exact tests or t-test/Mann Whitney test. A general inductive approach will be used to analyze the qualitative data. Ethics and dissemination The protocol was approved by the South African Medical Research Council Health Research Ethics Committee (EC051-11/2020). Findings from the study will be communicated to the study population and results will be presented to stakeholders and at appropriate local and international conferences. Outputs will also include a policy brief, peer-reviewed journal articles and research capacity building through research degrees.

Published
2022
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25. Management of established coronary artery disease in aircrew with previous myocardial infarction or revascularisation

Author

Norbert Guettler, Eddie D Davenport, Joanna d’Arcy, Dennis Bron, Olivier Manen, Rienk Rienks, Edward Nicol, Gary Gray, and Thomas Syburra

Subjects
Standards, medicine.medical_specialty, Myocardial Infarction, Coronary Artery Disease, Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, aviation medicine, 0302 clinical medicine, medicine, Humans, Plaque morphology, 030212 general & internal medicine, Myocardial infarction, Cardiac risk, business.industry, Disease Management, medicine.disease, Stenosis, cardiology, Practice Guidelines as Topic, Emergency medicine, Aerospace Medicine, Aircrew, Aviation medicine, Cardiology and Cardiovascular Medicine, business
Abstract

This manuscript focuses on the broad aviation medicine considerations that are required to optimally manage aircrew with established coronary artery disease (CAD) without myocardial infarction (MI) or revascularisation (both pilots and non-pilot aviation professionals). It presents expert consensus opinion and associated recommendations and is part of a series of expert consensus documents covering all aspects of aviation cardiology.Aircrew may present with MI (both ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI)) as the initial presenting symptom of obstructive CAD requiring revascularisation. Management of these individuals should be conducted according to published guidelines, ideally with consultation between the cardiologist, surgeon and aviation medical examiner. Return to restricted flight duties is possible in the majority of aircrew; however, they must have normal cardiac function, acceptable residual disease burden and no residual ischaemia. They must also be treated with aggressive cardiac risk factor modification. Aircrew should be restricted to dual pilot operations in non-high-performance aircraft, with return to flying no sooner than 6 months after the event. At minimum, annual follow-up with routine non-invasive cardiac evaluation is recommended.

Published
2018
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26. Heart muscle disease management in aircrew

Author

Joanna d’Arcy, Dennis Bron, Olivier Manen, Norbert Guettler, Rienk Rienks, Gary Gray, Eddie D Davenport, Edward Nicol, and Thomas Syburra

Subjects
health care delivery, Standards, myocardial disease, medicine.medical_specialty, Myocarditis, Heart disease, Cardiomyopathy, heart disease, 030204 cardiovascular system & hematology, 03 medical and health sciences, Pericarditis, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, business.industry, Disease Management, medicine.disease, Family member, Military Personnel, Muscle disease, Aerospace Medicine, Electrocardiography, Ambulatory, Aircrew, Aviation medicine, Cardiomyopathies, Cardiology and Cardiovascular Medicine, business
Abstract

This manuscript focuses on the broad aviation medicine considerations that are required to optimally manage aircrew with suspected or confirmed heart muscle disease (both pilots and non-pilot aviation professionals). ECG abnormalities on aircrew periodic medical examination or presentation of a family member with a confirmed cardiomyopathy are the most common reason for investigation of heart muscle disease in aircrew. Holter monitoring and imaging, including cardiac MRI is recommended to confirm or exclude the presence of heart muscle disease and, if confirmed, management should be led by a subspecialist. Confirmed heart muscle disease often requires restriction toflying duties due to concerns regarding arrhythmia. Pericarditis and myocarditis usually require temporary restriction and return to flying duties is usually dependent on a lack of recurrent symptoms and acceptable imaging and electrophysiological investigations.

Published
2018
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27. Contemporaneous management of valvular heart disease and aortopathy in aircrew

Author

Dennis Bron, Olivier Manen, Joanna d’Arcy, Rienk Rienks, Thomas Syburra, Edward Nicol, Eddie D Davenport, Norbert Guettler, and Gary Gray

Subjects
health care delivery, Standards, medicine.medical_specialty, Cardiac output, Population, Aortic Diseases, Cardiology, Heart Valve Diseases, Disease, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Bicuspid aortic valve, Risk Factors, Internal medicine, medicine.artery, medicine, Humans, 030212 general & internal medicine, education, Cardiac imaging, education.field_of_study, Aorta, business.industry, valvular heart disease, Disease Management, medicine.disease, Military Personnel, aortic and arterial disease, Aerospace Medicine, cardiovascular system, Aircrew, Cardiology and Cardiovascular Medicine, business
Abstract

Valvular heart disease (VHD) is highly relevant in the aircrew population as it may limit appropriate augmentation of cardiac output in high-performance flying and predispose to arrhythmia. Aircrew with VHD require careful long-term follow-up to ensure that they can fly if it is safe and appropriate for them to do so. Anything greater than mild stenotic valve disease and/or moderate or greater regurgitation is usually associated with flight restrictions. Associated features of arrhythmia, systolic dysfunction, thromboembolism and chamber dilatation indicate additional risk and will usually require more stringent restrictions. The use of appropriate cardiac imaging, along with routine ambulatory cardiac monitoring, is mandatory in aircrew with VHD.Aortopathy in aircrew may be found in isolation or, more commonly, associated with bicuspid aortic valve disease. Progression rates are unpredictable, but as the diameter of the vessel increases, the associated risk of dissection also increases. Restrictions on aircrew duties, particularly in the context of high-performance or solo flying, are usually required in those with progressive dilation of the aorta.

Published
2018
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28. Congenital heart disease in aircrew

Author

Olivier Manen, Thomas Syburra, Norbert Guettler, Rienk Rienks, Dennis Bron, Gary Gray, Edward Nicol, Joanna d’Arcy, and Eddie D Davenport

Subjects
Heart Defects, Congenital, health care delivery, Standards, medicine.medical_specialty, Consensus, Heart disease, Aviation, Cardiology, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, North Atlantic Treaty, business.industry, Disease Management, Expert consensus, Civil aviation, medicine.disease, congenital heart disease, Military aviation, Military Personnel, Aerospace Medicine, Aircrew, Medical emergency, Aviation medicine, Cardiology and Cardiovascular Medicine, business
Abstract

This article focuses i on the broad aviation medicine considerations that are required to optimally manage aircrew ii with suspected or confirmed congenital heart disease (both pilots and non-pilot aviation professionals). It presents expert consensus opinion and associated recommendations and is part of a series of expert consensus documents covering all aspects of aviation cardiology. This expert opinion was born out of a 3 year collaborative working group between international military aviation cardiologists and aviation medicine specialists, as part of a North Atlantic Treaty Organization (NATO) led initiative to address the occupational ramifications of cardiovascular disease in aircrew (HFM-251) many of whom also work with and advise civil aviation authorities.

Published
2018
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30. Heart muscle disease

Author

Nicholas Green, Edward Nicol, Hutchison Ewan, and Steven Gaydos

Subjects
medicine.medical_specialty, Muscle disease, business.industry, Internal medicine, Cardiology, Medicine, business
Published
2019
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40. Medication in aircrew

Author

Nicholas Green, Steven Gaydos, Hutchison Ewan, and Edward Nicol

Subjects
business.industry, Medicine, Aircrew, Medical emergency, business, medicine.disease
Published
2019
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42. Rotary wing operations

Author

Nicholas Green, Edward Nicol, Steven Gaydos, and Hutchison Ewan

Subjects
Engineering, business.industry, Mechanical engineering, business, Rotary wing
Published
2019
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44. International regulation of medical standards

Author

Nicholas Green, Steven Gaydos, Hutchison Ewan, and Edward Nicol

Subjects
business.industry, Best practice, Interoperability, Agency (sociology), Civil aviation, Aircrew, Benchmarking, Public relations, business, Cockpit, Variety (cybernetics)
Abstract

International Civil Aviation Organization was created to promote safe and orderly development of civil aviation. It is the specialized agency of the United Nations. The Framework for regulatory activity in civil aviation develops international Standards and Recommended Practices. Military aircrew are subject to a variety of additional stressors in and out of the cockpit resulting in separate standards and regulatory systems. Personnel must be deployable in as wide a range of military roles as possible. Military medical licencing may be centralised to a medical board or delegated to military aeromedical examiners. Smaller number of military aircrew means that evidence base for best practice is much slower to accumulate than in civilian operations. Benchmarking against civilian standards and aggregating data between different services and nationalities helps with review and revision of medical standards. To facilitate interoperability, share costs, foster co-operation and evidence-based practice, allied forces have formed interoperability agreements.

Published
2019
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46. Congenital heart disease

Author

Steven Gaydos, Nicholas Green, Edward Nicol, and Hutchison Ewan

Subjects
medicine.medical_specialty, Heart disease, business.industry, Internal medicine, medicine, Cardiology, business, medicine.disease
Published
2019
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48. Valvular heart disease

Author

Hutchison Ewan, Edward Nicol, Steven Gaydos, and Nicholas Green

Subjects
medicine.medical_specialty, business.industry, Internal medicine, valvular heart disease, Cardiology, Medicine, business, medicine.disease
Published
2019
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50. High-altitude protection

Author

Edward Nicol, Hutchison Ewan, Nicholas Green, and Steven Gaydos

Subjects
Environmental science, Effects of high altitude on humans, Atmospheric sciences
Published
2019
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