Estudo de viabilidade de desenvolvimento de um demonstrador de Realidade Virtual para as operações de servicing sobre a aeronave A-29B Super Tucano

Since the birth of aviation, the industry has experienced changes on how an airline operator must perform maintenance operations and how new technicians are trained to perform them to ensure the airworthiness of the aircraft, where the reduction of human errors resulting from non-compliance to the stipulated regulations are one of the main concerns. With the surge of new Virtual Reality technologies, EASA Part-147 approved organizations are enabled to incorporate and direct this new knowledge to the training of new EASA Part-66 approved technicians. However, Virtual Reality technologies must only be used and thought of as a complementary training tool, as it does not provide competencies to perform manual actions as welding, drilling, screwing, among others. Virtual Reality allows the trainee to test his theoretical knowledge at any given time without being limited by the availability of real equipment/components necessary to continue his training, without creating the risk of causing any material damage. All the training performed while resorting to the use of Virtual Reality technologies aims to improve knowledge retention, resulting in better approval rates. In this dissertation, a feasibility study and development of a Virtual Reality demonstrator directed to maintenance training for fuel servicing operations over an A-29B Super Tucano aeroplane must be performed, with the reduction of incidents/accidents reports resulting from wrongly performed procedures set as the main goal. The Virtual Reality application was built on a game engine called Unity, where the user can choose from VR hardware currently available or a mouse and keyboard to perform a fueling procedure. For each procedure, there are three modes available, guided, unguided and VR versions. The guided procedure will provide the user with an oriented experience, where no deviation from the maintenance manual for the fuel servicing action chosen can be performed. Each task will be highlighted in the correct order, providing a visual indication of the task to be executed. An exact copy of the Embraer maintenance manual for the designated procedure will also be provided to be used as a checklist. The unguided procedure allows deviation from the maintenance manual and wrong actions are allowed to be performed. However, a score will be given at the end of the procedure to evaluate how accurately the manual was followed. Embraer maintenance manual will be also provided, but with no checklist. Lastly, the VR version will follow the same fundamentals as the guided version. However, the input and output devices used on the previous 2 versions are replaced by an HMD and two handheld controllers.Desde o seu nascimento, a indústria aeronáutica tem vindo a vivenciar mudanças relativamente a como um operador aéreo realiza as suas atividades de manutenção e como treina os seus técnicos de modo a manter a aeronavegabilidade da sua frota, sendo que a ocorrência de incidentes/acidentes que resultem do incumprimento das regulações/procedimentos impostos pela operadora aérea sejam um foco de melhoria. Com a evolução e surgimento de tecnologias de Realidade Virtual, foi possível a entidades formadoras aprovadas segundo a regulação EASA Part-147, incorporar e direcionar este conhecimento para o treino de técnicos de manutenção. No entanto as mesmas apenas devem ser usadas como uma ferramenta complementar ao treino prático, pois não permitem que se adquira aptidões práticas para realizar tarefas manuais como soldadura, furação, aparafusamento, entre outros. Estas tecnologias permitem que o instruendo tenha a possibilidade de testar os seus conhecimentos teóricos a qualquer momento sem estar limitado pela disponibilidade de componentes reais para dar continuidade à sua formação. Todo este processo de treino com auxílio a aplicações de Realidade Virtual pretende melhorar a retenção de conhecimento, que necessariamente levará a um aumento nas taxas de aprovação dos instruendos. Neste trabalho pretende-se realizar o estudo de viabilidade e desenvolvimento de um demonstrador de Realidade Virtual direcionado ao treino de manutenção, para operações de fuel servicing para a aeronave A29B Super Tucano, com o objetivo de reduzir o número de relatos de incidentes/acidentes resultantes de um procedimento mal-executado. A aplicação de Realidade Virtual desenvolvida no decorrer de este trabalho de investigação, teve por base o motor de jogo Unity, em que o utilizador pode recorrer ao hardware VR atualmente disponível, ou a rato e teclado para realizar o procedimento de fuel servicing. A utilização em simultâneo das opções anteriormente referidas não é possível. Para cada procedimento, três modos de realização da tarefa são possíveis, a versão guiada, não-guiada e RV. A versão guiada fornece ao utilizador uma experiência orientada, onde qualquer desvio do manual de manutenção para o procedimento de reabastecimento escolhido não é permitido. Cada tarefa, segundo a ordem tal como surgem no manual estará destacada, de modo a fornecer uma indicação visual da tarefa a ser executada. Uma cópia exata do manual da Embraer para o procedimento escolhido é também fornecida para ser usado como um checklist. A versão não-guiada permite desvios aos procedimentos do manual de manutenção, assim como a realização de ações erradas do procedimento. No entanto, no final do treino são fornecidos elementos para quantificar os eventuais desvios do manual que tenham ocorrido durante o procedimento. Neste caso, o manual é igualmente fornecido, mas sem checklist. Por fim, na versão de Realidade Virtual, tal como acontece na versão guiada, os fundamentos são iguais, no entanto, a diferença que merece maior destaque é o facto de os aparelhos de input e output deixem de ser o rato, teclado e monitor e passamos a usar um HMD e handheld controllers

Scalable production of human mesenchymal stromal cell-derived extracellular vesicles under serum-/xeno-free conditions in a microcarrier-based bioreactor culture system

Copyright © 2020 de Almeida Fuzeta, Bernardes, Oliveira, Costa, Fernandes-Platzgummer, Farinha, Rodrigues, Jung, Tseng, Milligan, Lee, Castanho, Gaspar, Cabral and da Silva. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Mesenchymal stromal cells (MSC) hold great promise for tissue engineering and cell-based therapies due to their multilineage differentiation potential and intrinsic immunomodulatory and trophic activities. Over the past years, increasing evidence has proposed extracellular vesicles (EVs) as mediators of many of the MSC-associated therapeutic features. EVs have emerged as mediators of intercellular communication, being associated with multiple physiological processes, but also in the pathogenesis of several diseases. EVs are derived from cell membranes, allowing high biocompatibility to target cells, while their small size makes them ideal candidates to cross biological barriers. Despite the promising potential of EVs for therapeutic applications, robust manufacturing processes that would increase the consistency and scalability of EV production are still lacking. In this work, EVs were produced by MSC isolated from different human tissue sources [bone marrow (BM), adipose tissue (AT), and umbilical cord matrix (UCM)]. A serum-/xeno-free microcarrier-based culture system was implemented in a Vertical-WheelTM bioreactor (VWBR), employing a human platelet lysate culture supplement (UltraGROTM-PURE), toward the scalable production of MSC-derived EVs (MSC-EVs). The morphology and structure of the manufactured EVs were assessed by atomic force microscopy, while EV protein markers were successfully identified in EVs by Western blot, and EV surface charge was maintained relatively constant (between −15.5 ± 1.6 mV and −19.4 ± 1.4 mV), as determined by zeta potential measurements. When compared to traditional culture systems under static conditions (T-flasks), the VWBR system allowed the production of EVs at higher concentration (i.e., EV concentration in the conditioned medium) (5.7-fold increase overall) and productivity (i.e., amount of EVs generated per cell) (3-fold increase overall). BM, AT and UCM MSC cultured in the VWBR system yielded an average of 2.8 ± 0.1 × 1011, 3.1 ± 1.3 × 1011, and 4.1 ± 1.7 × 1011 EV particles (n = 3), respectively, in a 60 mL final volume. This bioreactor system also allowed to obtain a more robust MSC-EV production, regarding their purity, compared to static culture. Overall, we demonstrate that this scalable culture system can robustly manufacture EVs from MSC derived from different tissue sources, toward the development of novel therapeutic products.unding received by iBB-Institute for Bioengineering and Biosciences from the Portuguese Foundation for Science and Technology (FCT) (UID/BIO/04565/2020) and through the projects PTDC/EQU-EQU/31651/2017, PTDC/BBB-BQB/1693/2014, and PTDC/BTM-SAL/31057/2017 is acknowledged. Funding received from POR de Lisboa 2020 through the project PRECISE – Accelerating progress toward the new era of precision medicine (Project N. 16394) is also acknowledged. MAF (PD/BD/128328/2017) and FO (PD/BD/135046/2017) acknowledge FCT for the Ph.D. fellowships and DG (SFRH/BPD/109010/2015) for the Post-Doctoral fellowship.info:eu-repo/semantics/publishedVersio

Comparative Effectiveness and Safety of Monoclonal Antibodies (Bevacizumab, Cetuximab, and Panitumumab) in Combination with Chemotherapy for Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis

Background: The last decade has seen the increasing use of biological medicines in combination with chemotherapy containing 5- Fluorouracil/oxaliplatin or irinotecan for the treatment of metastatic colorectal cancer (mCRC). These combinations have resulted in increased progression-free survival (PFS) in patients with mCRC; however, there are remaining concerns over the extent of their effect on overall survival (OS). Published studies to date suggest no major differences between the three currently available monoclonal antibodies (MoAbs); however, there are differences in costs. In addition, there is rising litigation in Brazil in order to access these medicines as they are currently not reimbursed. Objective: To compare the effectiveness and safety of three MoAbs (bevacizumab, cetuximab and panitumumab) associated with fluoropyrimidine-based chemotherapy regimens or compared to fluoropyrimidine-based chemotherapy alone in patients with mCRC through an updated systematic review and meta-analysis with concurrent or non concurrent observational cohort studies to guide the authorities and judiciary. Method: A systematic review and meta-analysis was performed based on cohort studies published in databases up to November 2017. Effectiveness measures include OS, PFS, post-progression survival (PPS), RECIST (Response Evaluation Criteria In Solid Tumors), response rate, metastasectomy and safety. The methodological quality of the studies was also evaluated. Results: 21 observational cohort studies were included. There were statistically significant and clinically relevant benefits in patients treated with bevacizumab versus no bevacizumab mainly around OS, PFS, PPS and the metastasectomy rate, but not for the disease control rates. However, there was an increase in treatment-related toxicities, and concerns with the heterogeneity of the studies. Conclusion: The results pointed to an advantage in favor of bevacizumab for OS, PFS, PPS, and metastasectomy. Although this advantage may be considered clinically modest, bevacizumab represents a hope for increased survival and a chance of metastasectomy for patients with mCRC. However, there are serious adverse events associated with its use, especially severe hypertension and gastrointestinal perforation that need to be considered

Comparative effectiveness and safety of monoclonal antibodies for mCRC

Introduction: Biological medicines are increasingly used in combination with chemotherapy for patients with metastatic colorectal cancer (mCRC), resulting in increased progression-free survival (PFS). However, concerns remain over the extent of their effect on overall survival (OS) given the high costs of these monoclonal antibodies (MoAbs) (bevacizumab, cetuximab and panitumumab) and their safety. Published studies suggest no major differences in effectiveness and safety between the MoAbs; however, differences in costs with cetuximab more expensive than bevacizumab by 127% in Brazil and more expensive than panitumumab by 112%, with panitumumab more expensive than bevacizumab by 6%. Since there is rising litigation in Brazil in order to access these 3 MoAbs as they are not currently reimbursed, we wanted to compare their effectiveness and safety associated with chemotherapy or chemotherapy alone in patients with mCRC to provide future guidance to the judiciary and the healthcare system. Method: A systematic review and meta-analysis based on cohort studies published in databases up to November 2017. Effectiveness measures include PFS, post-progression survival (PPS), RECIST (Response Evaluation Criteria In Solid Tumors), response rates, metastasectomy rates, OS and safety. We also evaluated the methodological quality of the studies. Results: Overall, 21 observational cohort studies were included in the review. There were statistically significant and clinically relevant benefits in patients treated with bevacizumab versus those not treated with bevacizumab (no bevacizumab arm) mainly around PFS, PPS, metastasectomy rates and OS, but not for disease control rates. However, bevacizumab increased toxicities and there were concerns with the heterogeneity of the studies. Conclusion: The results suggested an advantage in favour of bevacizumab for a number of outcome measures and costs in patients with mCRC. However, this advantage may be only clinically modest for bevacizumab. This though has to be weighed against the serious adverse events associated with bevacizumab, especially severe hypertension and gastrointestinal perforation

FARMACOTERAPIA APLICADA ÀS REAÇÕES IMUNOLÓGICAS DA HANSENÍASE

Leprosy Leprosy is a chronic infectious disease caused by Mycobacterium leprae, or Hansen's bacillus, which is a resistant gram-positive bacterium that can infect peripheral nerves. Thus, leprosy is considered a disease with a high infectious power and low pathogenic level, and therefore, associated with 95% immunity in most populations of occurrence In this context, the most effective model to be adopted for the control of leprosy it is based on the complementarity of actions; starting with early diagnosis, specialized and continuous treatment of diagnosed cases, prevention of disabilities, surveillance of the patient's home contacts, until discharge for cure. However, some patients may have a type 1 leprosy reaction, a reaction that often occurs soon after the start of treatment, with granulomatous inflammatory reactions and tissue necrosis concomitant with possible symptomatic neurological impairment. On the other hand, some patients may have a type 2 leprosy reaction, a reaction that usually occurs during and after treatment and is determined by the manifestation of sudden-appearing skin nodules. Thus, the treatment of leprosy is multidrug, outpatient and uses standardized therapeutic regimens, recommended by the World Health Organization. It is worth remembering that leprosy is a curable, controllable and treatment-free disease.La lepra es una patología infecciosa crónica causada por Mycobacterium leprae, o bacilo de Hansen, que es una bacteria grampositiva resistente que puede infectar los nervios periféricos. Por lo tanto, la lepra se considera una enfermedad con un alto poder infeccioso y bajo nivel patogénico, y por lo tanto se asocia con una inmunidad del 95% en la mayoría de las poblaciones de ocurrencia. En este contexto, el modelo más eficaz que debe adoptarse para el control de la lepra se basa en la complementariedad de las acciones; con inicio de diagnóstico precoz, tratamiento especializado y continuo de los casos diagnosticados, prevención de discapacidades, vigilancia de los contactos domiciliarios del paciente, hasta el alta por curación. Sin embargo, algunos pacientes pueden presentar una reacción de lepra tipo 1, una reacción que a menudo ocurre poco después del inicio del tratamiento, presentando reacciones inflamatorias granulomatosas y necrosis tisular concomitante con posible deterioro neurológico sintomático. Por otro lado, algunos pacientes pueden presentar la reacción de lepra tipo 2, una reacción que generalmente ocurre durante y después del tratamiento y está determinada por la manifestación de nódulos en la piel de aparición repentina. Por lo tanto, el tratamiento de la lepra es poliquimioterapéutico, ambulatorio y utiliza regímenes terapéuticos estandarizados recomendados por la Organización Mundial de la Salud. Vale la pena recordar que la lepra es una enfermedad curable, controlable y de tratamiento gratuito.A hanseníase é uma patologia infecciosa crônica, causada pelo Mycobacterium leprae, ou bacilo de Hansen, ao qual é uma bactéria gram-positiva resistente e que pode infectar os nervos periféricos. Sendo assim, a hanseníase é considerada uma doença com um alto poder infeccioso e baixo nível patogênico, e por isso, associada a 95% de imunidade na maioria das populações de ocorrência. Nesse contexto, o modelo mais eficaz a ser adotado para o controle da hanseníase baseia-se na complementariedade das ações; com início no diagnóstico precoce, tratamento especializado e contínuo dos casos diagnosticados, prevenção de incapacidades, vigilância aos contatos domiciliares do paciente, até a alta por cura. Contudo, alguns pacientes podem apresentar reação hansênica tipo 1, reação essa que ocorre frequentemente logo após o início do tratamento, apresentando reações inflamatória granulomatosa e necrose tecidual concomitante ao possível comprometimento neurológico sintomático. Em contrapartida alguns pacientes podem apresentar a reação hansênica tipo 2, reação essa que ocorre geralmente durante e após o tratamento e é determinado pela manifestação de nódulos na pele de aparecimento súbito. Assim, o tratamento da hanseníase é poliquimioterápico, ambulatorial e utiliza esquemas terapêuticos padronizados, preconizados pela Organização Mundial da Saúde. Valendo lembrar que a hanseníase é uma doença curável, controlável e de tratamento gratuito. &nbsp

FARMACOTERAPIA APLICADA ÀS REAÇÕES IMUNOLÓGICAS DA HANSENÍASE

Leprosy Leprosy is a chronic infectious disease caused by Mycobacterium leprae, or Hansen's bacillus, which is a resistant gram-positive bacterium that can infect peripheral nerves. Thus, leprosy is considered a disease with a high infectious power and low pathogenic level, and therefore, associated with 95% immunity in most populations of occurrence In this context, the most effective model to be adopted for the control of leprosy it is based on the complementarity of actions; starting with early diagnosis, specialized and continuous treatment of diagnosed cases, prevention of disabilities, surveillance of the patient's home contacts, until discharge for cure. However, some patients may have a type 1 leprosy reaction, a reaction that often occurs soon after the start of treatment, with granulomatous inflammatory reactions and tissue necrosis concomitant with possible symptomatic neurological impairment. On the other hand, some patients may have a type 2 leprosy reaction, a reaction that usually occurs during and after treatment and is determined by the manifestation of sudden-appearing skin nodules. Thus, the treatment of leprosy is multidrug, outpatient and uses standardized therapeutic regimens, recommended by the World Health Organization. It is worth remembering that leprosy is a curable, controllable and treatment-free disease.La lepra es una patología infecciosa crónica causada por Mycobacterium leprae, o bacilo de Hansen, que es una bacteria grampositiva resistente que puede infectar los nervios periféricos. Por lo tanto, la lepra se considera una enfermedad con un alto poder infeccioso y bajo nivel patogénico, y por lo tanto se asocia con una inmunidad del 95% en la mayoría de las poblaciones de ocurrencia. En este contexto, el modelo más eficaz que debe adoptarse para el control de la lepra se basa en la complementariedad de las acciones; con inicio de diagnóstico precoz, tratamiento especializado y continuo de los casos diagnosticados, prevención de discapacidades, vigilancia de los contactos domiciliarios del paciente, hasta el alta por curación. Sin embargo, algunos pacientes pueden presentar una reacción de lepra tipo 1, una reacción que a menudo ocurre poco después del inicio del tratamiento, presentando reacciones inflamatorias granulomatosas y necrosis tisular concomitante con posible deterioro neurológico sintomático. Por otro lado, algunos pacientes pueden presentar la reacción de lepra tipo 2, una reacción que generalmente ocurre durante y después del tratamiento y está determinada por la manifestación de nódulos en la piel de aparición repentina. Por lo tanto, el tratamiento de la lepra es poliquimioterapéutico, ambulatorio y utiliza regímenes terapéuticos estandarizados recomendados por la Organización Mundial de la Salud. Vale la pena recordar que la lepra es una enfermedad curable, controlable y de tratamiento gratuito.A hanseníase é uma patologia infecciosa crônica, causada pelo Mycobacterium leprae, ou bacilo de Hansen, ao qual é uma bactéria gram-positiva resistente e que pode infectar os nervos periféricos. Sendo assim, a hanseníase é considerada uma doença com um alto poder infeccioso e baixo nível patogênico, e por isso, associada a 95% de imunidade na maioria das populações de ocorrência. Nesse contexto, o modelo mais eficaz a ser adotado para o controle da hanseníase baseia-se na complementariedade das ações; com início no diagnóstico precoce, tratamento especializado e contínuo dos casos diagnosticados, prevenção de incapacidades, vigilância aos contatos domiciliares do paciente, até a alta por cura. Contudo, alguns pacientes podem apresentar reação hansênica tipo 1, reação essa que ocorre frequentemente logo após o início do tratamento, apresentando reações inflamatória granulomatosa e necrose tecidual concomitante ao possível comprometimento neurológico sintomático. Em contrapartida alguns pacientes podem apresentar a reação hansênica tipo 2, reação essa que ocorre geralmente durante e após o tratamento e é determinado pela manifestação de nódulos na pele de aparecimento súbito. Assim, o tratamento da hanseníase é poliquimioterápico, ambulatorial e utiliza esquemas terapêuticos padronizados, preconizados pela Organização Mundial da Saúde. Valendo lembrar que a hanseníase é uma doença curável, controlável e de tratamento gratuito. &nbsp

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

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