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

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

Specification of standard experiments, models and interfaces for supporting to the production planning in the sugar cane industry, through simulation

Este trabalho propõe a especificação e a criação de experimentos, modelos e interfaces padrões para o apoio ao processo de planejamento da produção de um sistema produtivo sucroalcooleiro, via simulação. Os modelos abrangem os setores agrícola e industrial das usinas sucroalcooleiras, da colheita da matéria-prima até a fabricação do açúcar e do álcool. A modelagem do sistema, utilizando softwares comerciais de simulação com flexibilidade de recursos para customização, visa a geração de um ambiente de simulação para análises de desempenho e sensibilidade. Os modelos padrões que compõem este ambiente de simulação permitem que sejam realizadas simulações em 3 diferentes escopos, desde a usina, passando pelos setores agrícola e industrial, e chegando ao nível dos processos de corte/carregamento, recepção de matéria-prima, extração, tratamento de caldo, fabricação de açúcar, fabricação de álcool e geração de vapor. A interação do usuário com o ambiente, por meio de interfaces amigáveis, tem como função fornecer ao planejador uma opção de ferramenta de trabalho simples e de fácil aplicação, que possibilita a obtenção de informações úteis sobre o comportamento e das inter-relações entre as principais variáveis que influenciam o desempenho do sistema, permitindo a escolha das opções mais adequadas na busca de melhorias.This work proposes the specification and generation of standard experiments, models and interfaces for supporting to the process of production planning in the sugar cane industry, through simulation. Models embrace the agricultural and industrial sections of sugar cane plants, since the cane harvesting until the sugar and alcohol production. The system modelling, using commercial simulation softwares with flexibility of customization resources, seeks the generation of a simulation environment for performance and sensibility analyses. Standard models that compose this simulation environment allow simulations to be accomplished in 3 different scopes, from the plant, passing by the agricultural and industrial sections, and arriving at the level of the processes: cutting/loading, raw material reception, extraction, juice treatment, sugar production, alcohol production and stream generation. The user\'s interaction with the simulation environment through friendly interfaces, has the function of supplying the planner with an ease-to-use tool option, that makes possible the obtaining of useful information about the behavior and the interrelations among the principal variables that influence the system performance, allowing the choice of the most appropriate options in the search of improvements

Application of modeling and Petri net concepts in the productive process of the sugarcane industry

A modelagem, como meio de análise de processos do agronegócio, bem como de cadeias produtivas, atende à demanda por métodos apropriados. O presente trabalho objetivou avaliar a aderência dos conceitos de modelagem e de rede de Petri aplicados ao complexo agroindustrial da cana-de-açúcar. Utilizou-se uma empresa real para a aquisição das informações. Os modelos das cadeias de atividades foram validados com o uso da rede de Petri, por meio de um método de análise em que são simulados todos os caminhos possíveis e os estados que o sistema modelado pode atingir. O estudo resultou em 14 conjuntos de etapas de produção, englobando todas as operações unitárias das cadeias produtivas do açúcar e do álcool, desde o plantio da cana até o armazenamento do açúcar e do álcool.The modeling, as a tool of analysis of agribusiness processes as well as of productive chains, supplies the demand for appropriated methodological tools. The present work aimed to evaluate the adherence of modeling and Petri net concepts applied to the sugarcane agroindustrial complex. A real company was used for the acquisition of the information. Models of the chains of activities were validated with the Petri net tool, through an analysis method where all possible paths and all states that the modeled system can reach are simulated. The study resulted in 14 groups of production stages, including all unitary operations of the sugar and alcohol productive chains, from the planting of the cane to the storage of the sugar and alcohol

Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes)

International audienc