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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Computational Revision of the Mechanism of the Thorpe Reaction

The Thorpe reaction is described as a self-condensation of nitriles in the presence of a basic catalyst producing β-enaminonitriles. We performed theoretical calculations within the Density Functional Theory (DFT) framework at the ωB97XD/def2-svpd level to explore different mechanistic proposals when propionitrile is used as a reagent and sodium ethoxide (EtONa) as a catalyst. Furthermore, the influence of different solvents, such as ethanol (EtOH), tetrahydrofuran (THF), 1,2-dimethoxyethane (DME), and propionitrile (EtCN), was assessed. Finally, we also evaluated the effect of the fluorine group (-F), compared to the methyl group (-CH3), substituted in the α position of acetonitrile (MeCN). Our theoretical findings agree with different experimental reports on the Thorpe reaction

Computational Revision of the Mechanism of the Thorpe Reaction

The Thorpe reaction is described as a self-condensation of nitriles in the presence of a basic catalyst producing &beta;-enaminonitriles. We performed theoretical calculations within the Density Functional Theory (DFT) framework at the &omega;B97XD/def2-svpd level to explore different mechanistic proposals when propionitrile is used as a reagent and sodium ethoxide (EtONa) as a catalyst. Furthermore, the influence of different solvents, such as ethanol (EtOH), tetrahydrofuran (THF), 1,2-dimethoxyethane (DME), and propionitrile (EtCN), was assessed. Finally, we also evaluated the effect of the fluorine group (-F), compared to the methyl group (-CH3), substituted in the &alpha; position of acetonitrile (MeCN). Our theoretical findings agree with different experimental reports on the Thorpe reaction

First measurement of the Z→μ+μ−Z\rightarrow \mu^+ \mu^- angular coefficients in the forward region of pppp collisions at s=13\sqrt{s}=13 TeV

The first study of the angular distribution of $\mu^+ \mu^-$ pairs produced in the forward rapidity region via the Drell-Yan reaction $pp \rightarrow \gamma^{*}/Z +X \rightarrow l^+ l^- + X$ is presented, using data collected with the LHCb detector at a centre-of-mass energy of 13TeV, corresponding to an integrated luminosity of 5.1 $\rm{fb}^{-1}$. The coefficients of the five leading terms in the angular distribution are determined as a function of the dimuon transverse momentum and rapidity. The results are compared to various theoretical predictions of the $Z$-boson production mechanism and can also be used to probe transverse-momentum-dependent parton distributions within the proton

Measurement of the charm mixing parameter yCP−yCPKπy_{CP} - y_{CP}^{K\pi} using two-body D0D^0 meson decays

A measurement of the ratios of the effective decay widths of $D^0 \to \pi^-\pi^+$ and $D^0 \to K^-K^+$ decays over that of $D^0 \to K^-\pi^+$ decays is performed with the LHCb experiment using proton-proton collisions at a centre-of-mass energy of $13 \, \mathrm{TeV}$, corresponding to an integrated luminosity of $6 \, \mathrm{fb^{-1}}$. These observables give access to the charm mixing parameters $y_{CP}^{\pi\pi} - y_{CP}^{K\pi}$ and $y_{CP}^{KK} - y_{CP}^{K\pi}$, and are measured as $y_{CP}^{\pi\pi} - y_{CP}^{K\pi} = (6.57 \pm 0.53 \pm 0.16) \times 10^{-3}$, $y_{CP}^{KK} - y_{CP}^{K\pi} = (7.08 \pm 0.30 \pm 0.14) \times 10^{-3}$, where the first uncertainties are statistical and the second systematic. The combination of the two measurements is $y_{CP} - y_{CP}^{K\pi} = (6.96 \pm 0.26 \pm 0.13) \times 10^{-3}$, which is four times more precise than the previous world average

First measurement of the Z→μ+μ−Z\rightarrow \mu^+ \mu^- angular coefficients in the forward region of pppp collisions at s=13\sqrt{s}=13 TeV

The first study of the angular distribution of $\mu^+ \mu^-$ pairs produced in the forward rapidity region via the Drell-Yan reaction $pp \rightarrow \gamma^{*}/Z +X \rightarrow l^+ l^- + X$ is presented, using data collected with the LHCb detector at a centre-of-mass energy of 13TeV, corresponding to an integrated luminosity of 5.1 $\rm{fb}^{-1}$. The coefficients of the five leading terms in the angular distribution are determined as a function of the dimuon transverse momentum and rapidity. The results are compared to various theoretical predictions of the $Z$-boson production mechanism and can also be used to probe transverse-momentum-dependent parton distributions within the proton

Precision measurement of forward ZZ boson production in proton-proton collisions at s=13\sqrt{s} = 13 TeV

A precision measurement of the $Z$ boson production cross-section at $\sqrt{s} = 13$ TeV in the forward region is presented, using $pp$ collision data collected by the LHCb detector, corresponding to an integrated luminosity of 5.1 fb$^{-1}$. The production cross-section is measured using $Z\rightarrow\mu^+\mu^-$ events within the fiducial region defined as pseudorapidity $2.020$ GeV/$c$ for both muons and dimuon invariant mass $60<M_{\mu\mu}<120$ GeV/$c^2$. The integrated cross-section is determined to be \begin{equation*} \sigma(Z\rightarrow\mu^+\mu^-) = 195.3 \pm 0.2 \pm 1.5 \pm 3.9~pb, \end{equation*} where the first uncertainty is statistical, the second is systematic, and the third is due to the luminosity determination. The measured results are in agreement with theoretical predictions, including a prediction at next-to-next-to-leading order in perturbative quantum chromodynamics and a prediction with resummation