Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study\u27s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p\u3c0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p\u3c0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction

Aplicação das técnicas de planejamento e análise de experimentos no processo de injeção plástica Application design of experiments in the injection molding process

Experimentos industriais são realizados pelas empresas com o intuito de melhorar o desempenho dos produtos e os processos de fabricação. Nesse sentido, este trabalho tem por objetivo estudar e aplicar as técnicas de planejamento e análise de experimentos na melhoria da qualidade industrial. Especificamente são aplicadas as técnicas de planejamento Fatorial Fracionado 2k-p, Metodologia de Superfície de Resposta e Análise de Variância, em um processo de moldagem por injeção plástica. Com essa pesquisa experimental foi possível identificar os níveis ótimos de regulagem e os parâmetros mais importantes da injeção plástica: temperatura da máquina e pressão de injeção. Para finalizar é avaliado o procedimento de implementação das técnicas de experimentação e as dificuldades práticas encontradas na empresa.<br>Industrial experiments are made by companies in order to improve the quality characteristics of products and production processes. In this sense, the objective of this paper is to study and apply the design of experiments in the industrial quality improvement. In addition, as a part of the objective, an application of the techniques of design Fractional Factorial 2k-p, Analysis of Variance and Response Surface Methodology is done. It is focused in an injection molding process applied by a company, that makes and trades plastic products for the civil construction. Using this experimental study, the most important parameters of plastic injection are identified: machine temperature and injection pressure. At the same time, the optimal levels of adjustment of these parameters are determined. From this study, it is evaluated both the implantation procedures of the designs of experiments as well as the difficulties faced. Also, this study tries to contribute to the university-company relationship

Utilização do planejamento experimental em rede simplex no estudo de resíduo de rocha ornamental como filler para obtenção de máxima compacidade Use of simplex lattice experimental design in the study of ornamental rock waste as filler to obtain maximum compaction

A utilização de agregados industrializados vem crescendo ao longo dos anos para atender a grande demanda da construção civil devido ao crescimento econômico do país. O objetivo deste trabalho foi utilizar o planejamento experimental em Rede Simplex para avaliar o efeito da adição do resíduo de rocha ornamental como filler na composição de misturas ternárias (brita 0, pó de pedra e resíduo), que levem a máxima compacidade (densidade seca aparente máxima). Foram tomados dezesseis pontos experimentais, cujos teores dos materiais utilizados variaram de 0 a 100%. O modelo em rede simplex cúbico completo apresentou melhor ajuste aos resultados experimentais, o qual resulta em respostas estatisticamente mais adequadas para as composições estudadas. A superfície de resposta gerada indicou que a densidade seca aparente máxima de 2,0 g/cm³ foi obtida para a composição ternária: 63% de brita 0/17% de pó de pedra/20% de resíduo de rocha ornamental. Portanto, o uso de resíduo de rocha ornamental como filler em agregados para a construção civil pode ser uma alternativa viável para deposição final deste abundante resíduo de forma ambientalmente correta.<br>The use of industrial aggregates has grown over the years to meet the great demand of the civil construction due to the country's economical growth. The aim of this work was to use the experimental design in Simplex Lattice to evaluate the effect of the addition of ornamental rock waste as filler in the composition of ternary mixtures (crushed rock 0, stone powder, rock waste), leading to maximum compaction (maximum apparent dry density). Sixteen experimental points were taken, whose contents of the used materials ranged from 0 to 100%. The complete cubic simplex model showed to best fit to the experimental results, which results in more statistically appropriated responses to the studied compositions. The response surface generated indicated that the maximum apparent dry density (2.0 g/cm³) was obtained for the ternary composition: 63% crushed rock 0/ 17% stone powder/ 20% ornamental rock waste. Therefore, the use of ornamental rock waste as filler in aggregates for civil construction can be a viable alternative for final deposition in an environmental correct way

Increased risk of hospitalization and death in Mexican children and adolescents with COVID-19 and comorbidities

Background: Although COVID-19 (coronavirus disease 2019) in children is usually mild, they need hospitalization and intensive care in exceptional cases. Adverse outcomes have been observed mainly among children with comorbidities, justifying their vaccination. This study aimed to assess the risk of hospitalization and death in Mexican children and adolescents with COVID-19 and comorbidities. Methods: A cross-sectional study was performed on 366,542 confirmed COVID-19 cases under 18 years, reported by the Mexican Ministry of Health up to July 9, 2022. Logistic regression models were performed. Results: The mean age was 10.98 years, 50.6% were male, and 7.3% reported at least one comorbidity. The percentage of hospitalization and death in COVID-19 patients with and without comorbidities was 3.52%, and 0.20%, respectively; children with comorbidities presented a higher percentage of hospitalization (14.0%) and death (1.9%). The probability of hospitalization was 5.6 times greater in pediatric patients with COVID-19 and comorbidities, and the comorbidities that showed the greatest risk were immunosuppression (odds ratio (OR) 22.06), chronic kidney disease (CKD) (11.36), and cardiovascular diseases (5.66). The probability of death in patients with comorbidities was 11.01 times higher than in those without diseases, and the highest risk was observed in those with CKD (OR 12.57), cardiovascular diseases (6.87), and diabetes (5.83). Conclusions: Pediatric patients with comorbidities presented a higher risk of severe COVID-19. It is suggested that vaccination should be promoted with greater emphasis on pediatric patients with comorbidities

Proposta de um sistema de avaliação do desempenho para arranjos produtivos locais Purpose of a performance measurement system for an industrial cluster

Os Arranjos Produtivos Locais (APLs) são sistemas que podem ser utilizados para promover a cooperação empresarial, a inovação contínua e o desenvolvimento sustentável das Pequenas e Médias Empresas (PMEs). O processo de gestão de desempenho do APL é construído a partir do planejamento estratégico e com a implantação de ações coletivas de melhoria contínua. Também é necessário construir uma infraestrutura local e um ambiente que estimule a confiança e a cooperação dos membros do APL. A avaliação de desempenho é uma prática que fortalecerá a coordenação e execução das atividades de melhoria contínua do APL. Assim, o objetivo deste trabalho é propor um Sistema de Medição do Desempenho (SMD) que dê suporte ao processo de gestão de desempenho do APL. A proposta foi construída a partir das pesquisas de campo realizadas nos APLs de Ibitinga e Jaú. Os resultados demonstram que a medição de desempenho integrada a um processo sistemático de melhoria contínua promove a gestão colaborativa, aprimora o processo de tomada de decisão ou coordenação das ações planejadas pelas instituições, empresas e outros órgãos que fazem parte dos APLs. É um instrumento que pode ajudar a monitorar o desempenho das PMEs inseridas em uma rede de cooperação empresarial e direcionar as iniciativas coletivas ou ações de melhoria para as principais necessidades do APL.<br>Industrial clusters or cooperation network is an interesting alternative in promoting the sustainable development of Small and Medium Enterprises (SME's). The fundamental characteristics for managing the performance of clusters are the identification of the stakeholders, definitions of common strategies and objectives, development of collaborative improvement actions, design of a performance management system, organization of a support infrastructure, and promotion of social capital. The concepts of a performance management system can be of great value in managing collective efficiency and performance improvement of the companies of the cluster. The purpose of this article is to describe a model for the performance measurement and management of a cluster. In order to develop this study, a field research was carried out in two industrial clusters: Ibitinga, a textile industry cluster and Jau, a Lady's footwear cluster. The results show the applicability of performance measurement systems for the performance management of a cluster. It also helps to integrate the objectives of performance establishing actions, evaluating results promoting cooperation to improve the collective efficiency of a cluster