Today's Opinion Page editorial cartoon
SARS-CoV-2, the virus that causes COVID-19, affects various organs and systems in the body, including the cardiovascular system. What do we currently know about its impact on the heart? This feature looks at the latest research and reveals what cardiologists have observed in the hospital setting.
SARS-CoV-2 has exhibited the ability to impact more than the respiratory system. Since its emergence, people who have had COVID-19 also report symptoms affecting the brain, gastrointestinal system, and heart.
Observational and research data suggest that COVID-19 impacts the heart in hospitalized patients, those with mild cases of the disease, and people with no prior heart-related conditions. These heart-related issues may remain long after the illness has passed, regardless of whether the individual experienced a severe or mild case of COVID-19.
Doctors still do not fully understand how SARS-CoV-2 causes heart problems, the extent of these issues, or whether this aspect of the virus should cause extreme concern.
In this feature, we sift through the latest research to understand the impact COVID-19 has on the heart. We also spoke with one cardiologist from a hospital intensive care unit that has experienced a heavy influx of patients with COVID-19.
COVID-19-related heart complications
Although many viruses, such as influenza, can cause heart-related issues, SARS-CoV-2 seems to impact the cardiovascular system more frequently.
According to an article published in Science, of the family of seven human coronaviruses, scientists know that most affect the lungs but not the heart. SARS-CoV-2 is different because it may have a propensity to cause cardiac-related issues, such as inflammation of the heart, heart attack-like symptoms, and heart rhythm irregularities.
However, other, rather alarming data indicates that approximately 25% of people hospitalized with COVID-19 have cardiovascular complications, contributing to about 40% of all COVID-19-related deaths.
Interestingly, people with severe cases of the disease might not be the only individuals at risk for heart complications. Additional research published in JAMA Cardiology suggests that people who have had COVID-19 may experience cardiac involvement even with mild illness.
In the study, researchers used cardiac magnetic resonance imaging to examine the hearts of 100 German people who had recovered from COVID-19. Of these participants, 78 had cardiac involvement, and 60 showed ongoing heart muscle tissue inflammation. These findings were independent of the length of time after the original diagnosis, pre-existing conditions, and the severity and overall course of COVID-19.
Even young adults may be at risk of COVID-19-related heart complications.
Recent research, also published in JAMA Cardiology, found that out of 26 college-aged competitive athletes who previously tested positive for COVID-19, four (15%) had cardiovascular magnetic resonance (CMR) findings that suggested myocarditis.
Eight additional athletes (30.8%) exhibited late gadolinium enhancement (LGE) without T2 elevation, which suggests prior heart muscle injury.
Both LGE and T2 are techniques doctors use to characterize the myocardium (cardiac muscle) and determine any damaged areas.
Because of a limited number of study participants, the relationship between COVID-19 and myocardial injury in athletes needs more extensive studies, including control populations.
Doctors’ observations in hospital settings
To understand the scope of COVID-19-related heart complications observed in the clinical setting, Medical News Today spoke with Joshua I. Goldhaber MD, Cardiologist and Associate Director of the Coronary Intensive Care Unit, Smidt Heart Institute at Cedars Sinai, in Los Angeles, California.
Cedars-Sinai Medical Center in Los Angeles is one of several hundred hospitals in the US that have reported full intensive care units due to COVID-19 as of January 28.
Dr. Goldhaber told MNT that at the Smidt Heart Institute at Cedars-Sinai, most of the patients who experience COVID-19-related heart complications are people who already have an underlying cardiac condition, such as heart failure or coronary disease.
In patients with COVID-19 and underlying cardiac conditions, the illness tended to exacerbate their heart issues, which increases the likelihood that these patients would need intubation in the intensive care unit (ICU).
Early in the pandemic, Dr. Goldhaber and his colleagues were concerned there was going to be an increased rate of cardiac findings related to COVID-19.
Dr. Goldhaber said, “we were surprised — and we continue to be surprised — that we have not seen that to the extent that we believed [we would], based on data that had been coming out of China early on in the pandemic.”
Dr. Goldhaber also noted that his team has not seen many new cardiac problems they could directly relate to COVID-19 disease.
Events over the past year have put a lens on finance and the need for faster insights and guidance amid change. That means CFOs and finance leaders need a broader set of skills, writes Workday’s Steve Dunne
The post-pandemic world, when it arrives, will transform many aspects of business as usual. Workforces have shifted and many will stay remote. Supply chains disrupted by the pandemic have found new footing. Companies have rejiggered budgets and strategies to exist in a more digital-first world. And CFOs have played a key role in guiding these changes.
In this new world, companies have to continue to pivot to seize new opportunities and meet challenges. Key to that ability will be CFOs and finance teams that can deliver analytics and insights to support strategy and decision making.
Already, the COVID-19 pandemic placed the CFO role at the heart of companies as they rushed to ensure liquidity given rapid market changes and then re-forecasted as required. Almost 60% of finance executives and CEOs say the pandemic has changed the CFO role, and 72% say the role was increasing or significantly increasing. This finding comes from a June survey of more than 1,100 global executives that accompanies The CFO of the Future, a report from the Association of Chartered Certified Accountants (ACCA) and the Institute of Management Accountants (IMA).
Indeed, once considered a numbers-only role, finance is now balancing traditional responsibilities with growing demand for data-driven analysis and insights, risk management and other key business functions. As the roles of CFOs and other finance leaders are being redefined, so, too, will be skill sets that CEOs seek in finance leaders.
As the finance function changes, so do skills
The direction of this changing skills trend is clear from data in a CFO study from organizational consulting firm Korn Ferry. It finds that, at the 1,000 largest U.S. public companies, the portion of CFOs who are certified public accountants fell to about 36% last year, down from nearly 50% in 2014. The same study also finds that almost half (45%) of the CFOs surveyed say the two capabilities most critical to the future of the finance function are operational information (such as reporting and analytics) and strategy enablement — both beating out more specialized finance skills.
Against that backdrop, here are five skills — some emerging, others more traditional — that finance needs in order to become the strategic guide the C-suite requires:
Access to data and actionable insights are now fundamental to business success and helping companies identify new market opportunities, improve customer experiences, drive business planning, and support change and innovation. As a result, CEOs will turn to finance leaders who not only have accounting experience, but also wider operational backgrounds and a broader mix of business experience. CEOs have not turned their backs on candidates from accounting backgrounds when choosing finance leaders — they just require a broader range of capabilities.
"The person in that position just needs to have an evolving skill set, regardless of their initial training," says Bob Ryan, an executive adviser at Shields Meneley Partners, a career-transition firm that advises executives, speaking to the Wall Street Journal.
2. Data science familiarity
CFOs and finance teams will need to understand how to harness data — beyond the numbers — to explain why strategies are the right ones, and to explain the reasons and context behind those decisions. Ilya Strebulaev, professor of finance at Stanford University, told Finance Director Europe:
We now live in a sea of data and have the technology to evaluate that data and make decisions about consumers, competitors, markets, and much more. CFOs must understand how to use all of this data — not just financial data — to understand the business and drive decisions. The companies that don't won't survive.
3. Technology understanding
Technology will play an important role in the ability to make data timely, accessible, and relevant. New cloud-based financial management systems, in-memory databases, visualization, and mobility are enabling finance leaders to move beyond just analyzing historical financial data to accessing real-time insights about business performance. Even better, it's making it easier to deliver these insights to other business leaders, further strengthening those partnerships.
Looking ahead, finance teams will increasingly use advanced analytics to run predictive models and develop better forecasts. Understanding technology and systems — and whether they are capable of enabling greater efficiencies, agility, and insights — will be critical.
4. Better collaboration with CIOs
Finance's journey to become a more strategic function will depend a great deal on its ability to find the skills to allow it to embrace digital technologies, such as artificial intelligence and machine learning. That requires a shift to more technical skills and better links with IT leaders to bring together the two functions more effectively.
The importance of CFO partnerships with the CIO is clear from ACCA's and PwC's 2020 report Finance Insights — Reimagined that calls out the importance of collaboration between finance leaders and those with the remit for information management and the technology that underpins it. The report states:
Clearly, the CFO has a significant role to play in the management of data across the entity. The relationship between the CFO and those responsible for data and information technology is key. This is certainly an area that is evolving but one that CFOs of the future ignore at their peril.
Stanford University's Strebulaev emphasizes the importance of the CFO-CIO partnership in creating a more data-driven organization, but says it will require learning how to better understand each other. Working more closely together, they can also evaluate what technologies and financial systems are required to support CFOs and their teams' expanded responsibilities. He explains:
CFOs need to partner closely with CIOs on this data-driven revolution and help them understand what kind of data they need. The challenge in the past has been that they often speak different languages, so improving that communication channel will be important.
In a survey of more than 670 global finance leaders, 68% say that effective collaboration between CIOs and CFOs is limited by the fact that IT and finance don't speak the same language — meaning terminology and jargon specific to a particular functional domain — while 66% say that IT executives are reluctant to collaborate with their finance peers. This data is from Workday's global Finance Redefined: Workday Global Finance Leader Survey, conducted by Longitude.
5. Ethics and trust
The ability to apply an ethical lens is a strong attribute of the CFO, and the finance community, indicates The CFO of the Future. In the report, CFO Gwen van Berne, of RIPE NCC in Amsterdam, comments that:
Ethical standards are important and will become more and more prominent for the CFO as it is an important element in the storytelling. You need to be able to defend how you are making money and what kind of key performance drivers you are using to drive your business.
This school of thought is backed up by Gina Mastantuono, CFO, ServiceNow, who wrote in Forbes:
Financial and business expertise are table stakes. It's interpersonal skills, such as empathy, curiosity, courage, and creativity combined with business acumen, that takes a finance organization from an essential function to a strategic business partner.
Threats and opportunities
Given the pace of change and level of disruption experienced, a failure to develop appropriate skills poses a serious threat to finance teams. In PwC's Finance Insights — Reimagined study, more than half (55%) of survey respondents said their role could be obsolete within five years without appropriate skills development. Fortunately, reskilling and addressing such gaps are becoming a priority for the function. PwC's research found that 17% said it's an issue they're actively working on now, with a further 15% planning to do so.
The past year has been socially, politically, and economically transformational. Businesses have never before faced complete shutdowns that forced them to change where and how they operate.
Yet, every challenge brings with it opportunity. It could be argued that there has never been a more opportune time for the office of finance to have an impact, with CEOs increasingly looking to the finance function to help shape business direction and strategy.
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