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

Transient Cold Flow Simulation of Fast-Fluidized Bed Air Reactor with Hematite as an Oxygen Carrier for Chemical Looping Combustion

Chemical looping combustion (CLC) is the most reliable carbon capture technology for curtailing CO2 insertion into the atmosphere. This paper presents the cold flow simulation results necessary to understand the hydrodynamic viability of the fast-fluidized bed air reactor. Hematite is selected as an oxygen carrier due to its easy availability and active nature during the reactions. The dense discrete phase model (DDPM) approach using the commercial software Ansys Fluent is applied in the simulation. An accurate and stable solution is achieved using the second-order upwind numerical scheme. A pressure difference of 150 kPa is obtained between the outlet and inlet of the selected air reactor, which is necessary for the movement of the particle. The stable circulating rate of hematite is achieved after 28 s of particle injection inside the air reactor. The results have been validated from the experimental results taken from the literature

Utilization, financial outcomes and stakeholder perspectives of a re-organized adult sickle cell program.

In 2011 Yale New Haven Hospital, in response to high utilization of acute care services and widespread patient and health care personnel dissatisfaction, set out to improve its care of adults living with sickle cell disease. Re-organization components included recruitment of additional personnel; re-locating inpatients to a single nursing unit; reducing the number of involved providers; personalized care plans for pain management; setting limits upon access to parenteral opioids; and an emphasis upon clinic visits focused upon home management of pain as well as specialty and primary care. Outcomes included dramatic reductions in inpatient days (79%), emergency department visits (63%), and hospitalizations (53%); an increase in outpatient visits (31%); and a decrease in costs (49%). Providers and nurses viewed the re-organization and outcomes positively. Most patients reported improvements in pain control and life style; many patients thought the re-organization process was unfair. Their primary complaint was a lack of shared decision-making. We attribute the contrast in these perspectives to the inherent difficulties of managing recurrent acute and chronic pain with opioids, especially within the context of the imbalance in wellness, power, and privilege between persons living with sickle cell disease, predominantly persons of color and poor socio-economic status, and health care organizations and their personnel

Rothenberg_et_al_Appendix_2 – Supplemental material for Real-Time Surveys Reveal Important Safety Risks During Interhospital Care Transitions for Neurologic Emergencies

<p>Supplemental material, Rothenberg_et_al_Appendix_2 for Real-Time Surveys Reveal Important Safety Risks During Interhospital Care Transitions for Neurologic Emergencies by John Sather, Craig Rothenberg, Emily B. Finn, Kevin N. Sheth, Charles Matouk, Laura Pham, Vivek Parwani, Andrew Ulrich and Arjun K. Venkatesh in American Journal of Medical Quality</p

Rothenberg_et_al_Appendix_1_Final_survey_instrument – Supplemental material for Real-Time Surveys Reveal Important Safety Risks During Interhospital Care Transitions for Neurologic Emergencies

<p>Supplemental material, Rothenberg_et_al_Appendix_1_Final_survey_instrument for Real-Time Surveys Reveal Important Safety Risks During Interhospital Care Transitions for Neurologic Emergencies by John Sather, Craig Rothenberg, Emily B. Finn, Kevin N. Sheth, Charles Matouk, Laura Pham, Vivek Parwani, Andrew Ulrich and Arjun K. Venkatesh in American Journal of Medical Quality</p