Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Electromagnetic Models of Plasma Breakdown in the JET Tokamak

This paper presents the electromagnetic modeling of the plasma current breakdown phase of the JET tokamak. The first part of this paper models the presence of the JET iron core up-down asymmetry and the effects of the eddy currents in the reconstruction of the magnetic topology needed for the plasma start. The second part describes the approach used to evaluate the ionized particle connection length inside the vacuum chamber at breakdown. The results obtained are validated using JET experimental measurements

Electromagnetic Models of Plasma Breakdown in the JET Tokamak

This paper presents the electromagnetic modeling of the plasma current breakdown phase of the JET tokamak. The first part of this paper models the presence of the JET iron core up-down asymmetry and the effects of the eddy currents in the reconstruction of the magnetic topology needed for the plasma start. The second part describes the approach used to evaluate the ionized particle connection length inside the vacuum chamber at breakdown. The results obtained are validated using JET experimental measurements

Determining the fuel ion ratio for D(T)and T(D) plasmas at JET using neutron time-of-flight spectrometry

The fusion fuel ion ratio, nΤ/nD, is an important plasma parameter that needs to be tuned to maximize the power of a tokamak type fusion reactor. It is recognized as a parameter required for optimizing several ITER operating scenarios, and will likely be continuously monitored in future high-performance fusion devices such as DEMO. Tritium was recently introduced in the Joint European Torus (JET) plasma for the first time since the 1997 DTE1 and 2003 TTE campaigns, enabling the possibility to investigate fuel ion ratios. We present a method for measuring nΤ/nD using neutron time-of-flight (TOF) spectrometry. By fitting the measured neutron spectral features, the relative reaction rate intensities between different ion species can be inferred, from which the fuel ion ratio can be extracted for a corresponding modeled reactivity. Unlike previous measurements of nT/nD using neutron spectrometry, we utilize the neutron energy continuum produced in the three-body TT reaction to determine the fuel ion ratio for plasmas with large concentrations of tritium. Furthermore, the use of neutron TOF spectrometry has never previously been demonstrated for evaluating nT/nD. The method is applied to TOF spectra acquired with TOFOR (JET name KM11) and shown to be consistent with the optical JET diagnostic KT5P which uses optical spectroscopy of a modified Penning gauge plasma to measure tritium and deuterium concentrations in the divertor exhaust gas

Use of the disruption mitigation valve in closed loop for routine protection at JET

Disruptions are a major concern for next-generation tokamaks, including ITER. Heat loads, electromagnetic forces and runaway electrons generated by disruptions have to be mitigated for a reliable operation of future machines. Massive gas injection is one of the methods proposed for disruption mitigation. This article reports the first use of massive gas injection as an active disruption protection system at JET. During the 2011–2012 campaigns, 67 disruptions have been mitigated by the disruption mitigation valve (DMV) following a detection by mode lock amplitude and loop voltage changes. Most of disruptions where the valve was intended to be used were successfully mitigated by the DMV, although at different stages of the typical slow disruptions of the ITER-like wall. The fraction of magnetic and thermal energy radiated during the disruption was found to be increased by the action of the DMV. Vertical forces dispersion was also reduced. No non-sustained breakdown was observed following pulses terminated by the disruption mitigation valve

A 3D electromagnetic model of the iron core in JET

The Magnet and Power Supplies system in JET includes a ferromagnetic core able to increase the transformer effect by improving the magnetic coupling with the plasma. The iron configuration is based on an inner cylindrical core and eight returning limbs; the ferromagnetic circuit is designed in such a way that the inner column saturates during standard operations [1]. The modelling of the magnetic circuit is a critical issue because of its impact on several applications, including equilibrium and reconstruction analysis required for control applications. The most used model in present applications is based on Equivalent Currents (ECs) placed on the iron boundary together with additional specific constraints, in a 2D axisymmetric frame. The (circular) ECs are chosen, by using the available magnetic measurements, to best represent the magnetic polarization effect [1]. Due to the axisymmetric assumption such approach is not well suited to deal with significant 3D effects, e.g. arising in operations with Error Field Correction Coils (EFCC). In this paper a new methodology is proposed, based on a set of 3D-shaped ECs and able to better model the actual 3D magnetization giving rise to a linear system to be solved. According to a well assessed approach [2], the 3D shape of ECs is represented by a set of elementary sources. The methodology has been successfully validated in a number of JET dry-run experiments where 3D effects are generated by EFCC currents. The new procedure has been designed to be easily coupled with equilibrium or reconstruction codes such as EFIT/V3FIT. The proposed model resulted to be very effective in representing 3D iron magnetization, especially if compared with typical 2D models. © 2017 The Author