Abstract P99: Impact of the Covid-19 Pandemic on Stroke Thrombolysis Rate and Delay to Thrombolysis Treatment in a Regional Stroke Centre in London, UK

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Brian Drumm ◽  
Paul Bentley ◽  
Zoe Brown ◽  
Lucio D’Anna ◽  
Tsering Dolkar ◽  
...  
Keyword(s):  
Arrival Time ◽  
Negative Impact ◽  
Public Awareness ◽  
Stroke Severity ◽  
Time Intervals ◽  
Neurological Outcomes ◽  
Stroke Thrombolysis ◽  
Prehospital Delays ◽  
The Impact ◽  
Stroke Centre

Introduction: There are reports of changes in the numbers of stroke admissions and time intervals to receiving emergency treatments during the COVID-19 pandemic. We examined the impact of the COVID-19 pandemic on the stroke thrombolysis rate and delay to thrombolysis treatment in a regional stroke centre in London, UK. Methods: COVID-19 testing began at our hospital on 3 March 2020. Clinical data for all acute stroke admissions were routinely collected as part of a national Sentinel Stroke National Audit Programme (SSNAP) and all thrombolysis data were entered into our local thrombolysis database. We retrospectively extracted the relevant patient data for the period of March to May 2020 (COVID group) and compared to the same period in 2019 (pre-COVID group). Results: Compared with pre-COVID, there was a 17.5% fall in total stroke admissions (from 315 to 260) during COVID; but there were no significant differences in the demographics, stroke severity, proportions with known time of onset, or median onset-to-arrival time. The thrombolysis rates amongst ischemic strokes were not significantly different between the two groups (59/260=23% pre-COVID vs. 41/228=18% COVID, p=.19). For thrombolysis patients, their stroke severity and demographics were similar between the two both groups. Median onset-to-needle time was significantly longer by 22 minutes during COVID [127 (IQR 94-160) vs. 149 (IQR 110-124) minutes, p=.045]; this delay to treatment was almost entirely due to a longer median onset-to-arrival time by 16 minutes during COVID (p=.029). Favorable early neurological outcomes post-thrombolysis (defined as an improvement in NIHSS by ≥4 points at 24 hours) were similar (45% vs. 46%, p=.86). Conclusion: COVID-19 pandemic had a negative impact on prehospital delays which in turn significantly increased onset-to-needle time, but without affecting the chance of a favorable early neurological outcome. Our data highlight the need to maintain public awareness of taking immediate action when stroke symptoms occur during the COVID-19 pandemic.

scholarly journals Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia

2021 ◽  
pp. 1-9
Author(s):  
Anna Ramos-Pachón ◽  
Álvaro García-Tornel ◽  
Mònica Millán ◽  
Marc Ribó ◽  
Sergi Amaro ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Stroke Care ◽  
Care Quality ◽  
Point Of View ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Vessel Occlusion ◽  
Prehospital Delays ◽  
The Impact

<b><i>Introduction:</i></b> The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system’s bottlenecks from a territorial point of view. <b><i>Methods:</i></b> Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15–May 2, 2020) and an immediate prepandemic period (January 26–March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. <b><i>Results:</i></b> Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = −0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05–2.4], <i>p</i> 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4–0.9], <i>p</i> 0.015) during the pandemic period. <b><i>Conclusion:</i></b> During the COVID-19 pandemic, Catalonia’s stroke system’s weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system’s analysis is crucial to allocate resources appropriately.

scholarly journals Impact of COVID-19 Pandemic on a Regional Stroke Thrombectomy Service in the United Kingdom

2020 ◽  
pp. 1-7
Author(s):  
Joseph Kwan ◽  
Madison Brown ◽  
Paul Bentley ◽  
Zoe Brown ◽  
Lucio D’Anna ◽  
...  
Keyword(s):  
Negative Impact ◽  
Service Evaluation ◽  
Outcome Data ◽  
Term Outcome ◽  
Neurological Outcomes ◽  
Neurological Improvement ◽  
Patient Demographics ◽  
The United Kingdom ◽  
The Uk ◽  
The Impact

<b><i>Introduction:</i></b> We examined the impact of the coronavirus disease 2019 (COVID-19) pandemic on our regional stroke thrombectomy service in the UK. <b><i>Methods:</i></b> This was a single-center health service evaluation. We began testing for COVID-19 on 3 March and introduced a modified “COVID Stroke Thrombectomy Pathway” on 18 March. We analyzed the clinical, procedural and outcome data for 61 consecutive stroke thrombectomy patients between 1 January and 30 April. We compared the data for January and February (“pre-COVID,” <i>n</i> = 33) versus March and April (“during COVID,” <i>n</i> = 28). <b><i>Results:</i></b> Patient demographics were similar between the 2 groups (mean age 71 ± 12.8 years, 39% female). During the COVID-19 pandemic, (a) total stroke admissions fell by 17% but the thrombectomy rate was maintained at 20% of ischemic strokes; (b) successful recanalization rate was maintained at 81%; (c) early neurological outcomes (neurological improvement following thrombectomy and inpatient mortality) were not significantly different; (d) use of general anesthesia fell significantly from 85 to 32% as intended; and (e) time intervals from onset to arrival, groin puncture, and recanalization were not significantly different, whereas internal delays for external referrals significantly improved for door-to-groin puncture (48 [interquartile range (IQR) 39–57] vs. 33 [IQR 27–44] minutes, <i>p</i> = 0.013) and door-to-recanalization (82.5 [IQR 61–110] vs. 60 [IQR 55–70] minutes, <i>p</i> = 0.018). <b><i>Conclusion:</i></b> The COVID-19 pandemic has had a negative impact on the stroke admission numbers but not stroke thrombectomy rate, successful recanalization rate, or early neurological outcome. Internal delays actually improved during the COVID-19 pandemic. Further studies should examine the effects of the COVID-19 pandemic on longer term outcome.

scholarly journals One-Year Lesson: Machine Learning Prediction of COVID-19 Positive Cases with Meteorological Data and Mobility Estimate in Japan

2021 ◽  
Vol 18 (11) ◽  
pp. 5736
Author(s):  
Essam A. Rashed ◽  
Akimasa Hirata
Keyword(s):  
Network Architecture ◽  
Short Term Memory ◽  
Negative Impact ◽  
Meteorological Data ◽  
Public Awareness ◽  
The United States ◽  
Dominant Factor ◽  
Daily Routine ◽  
Proposed Model ◽  
The Impact

With the wide spread of COVID-19 and the corresponding negative impact on different life aspects, it becomes important to understand ways to deal with the pandemic as a part of daily routine. After a year of the COVID-19 pandemic, it has become obvious that different factors, including meteorological factors, influence the speed at which the disease is spread and the potential fatalities. However, the impact of each factor on the speed at which COVID-19 is spreading remains controversial. Accurate forecasting of potential positive cases may lead to better management of healthcare resources and provide guidelines for government policies in terms of the action required within an effective timeframe. Recently, Google Cloud has provided online COVID-19 forecasting data for the United States and Japan, which would help in predicting future situations on a state/prefecture scale and are updated on a day-by-day basis. In this study, we propose a deep learning architecture to predict the spread of COVID-19 considering various factors, such as meteorological data and public mobility estimates, and applied it to data collected in Japan to demonstrate its effectiveness. The proposed model was constructed using a neural network architecture based on a long short-term memory (LSTM) network. The model consists of multi-path LSTM layers that are trained using time-series meteorological data and public mobility data obtained from open-source data. The model was tested using different time frames, and the results were compared to Google Cloud forecasts. Public mobility is a dominant factor in estimating new positive cases, whereas meteorological data improve their accuracy. The average relative error of the proposed model ranged from 16.1% to 22.6% in major regions, which is a significant improvement compared with Google Cloud forecasting. This model can be used to provide public awareness regarding the morbidity risk of the COVID-19 pandemic in a feasible manner.

scholarly journals Ecological Strategies for Designing Urban River Banks\ Abu Nuwas Buffer Zone in Baghdad as a Case Study

2020 ◽  
Vol 27 (3) ◽  
pp. 72-80
Author(s):  
Safa Aubaid Khauin ◽  
Hoda A. Al-Alwan
Keyword(s):  
Negative Impact ◽  
Public Awareness ◽  
Theoretical Framework ◽  
Human Intervention ◽  
Ecological Strategies ◽  
Ecological Value ◽  
River Bank ◽  
Main Research ◽  
The Impact

The riverbank is an effective component of the city-river interconnection, and any damage that occurs to it affects its natural structure and particularly its ecological values. Most of these problems are diagnosable and observable in the riverside space, and many studies have focused on them. The emergence of these problems may appear in varying proportions in the riverbank environment depending on the type of human intervention, both in urban and non-urban spaces, which may have a negative impact on the riverbank space. In light of this, studies have been directed towards exploring different ecological strategies that should be applied on the urban riverbank space, which work in an integrated manner with many other values to restore the natural characteristics of landscape and riverbank space and reduce the impact of negative human intervention in them. The main research problem is defined in the loss of the ecological value of riverbanks in cities in general and Baghdad city in particular, and the lack of knowledge concerning the ecological strategies in riverbanks on the planning and design levels. The main objective of the research was thus to draw the theoretical framework that extracts the strategies and indicators of the landscape ecology.The theoretical framework was then applied to the edge of the Tigris River in Baghdad (as a case study), that resembles the area and park of Abu Nuwas region in Baghdad, with the aim of further diagnosing the reality of the riverbank and the extent to which ecological strategies can be applied.The results of the research in both its theoretical and practical aspects have revealed a clear approach to ecological strategies that achieve riverbank ecology and the development of specific mechanisms to provide a safe and effective river environment that accommodates various events and uses in the river bank, and enhances public awareness of its importance

scholarly journals The Impact of Gender on Food Waste at the Consumer Level

2019 ◽  
Vol 29 (4) ◽  
pp. 41-57 ◽  
Author(s):  
Ramona Cantaragiu
Keyword(s):  
Food Waste ◽  
Social Inequalities ◽  
Negative Impact ◽  
Public Awareness ◽  
Age Groups ◽  
The Public ◽  
Awareness Campaigns ◽  
The Family ◽  
Potential Factor ◽  
The Impact

Abstract Food waste is one of the main contributors to economic disparities, social inequalities and environmental pollution. Numerous studies have sought to understand the drivers of food waste at various stages in the food supply chain, including the consumption stage. Based on a quantitative analysis of 252 Romanian consumers, the present study shows that gender is an important factor that affects the individuals’ attitudes and behaviours in regard to food and a potential factor that could affect the amount of food wasted. The study found that attitudes towards food waste evolve as individuals age, and that, at each stage, women tend to be more concerned about the negative impact of food waste on social equity or the family budget than men. In addition, women were found to display behaviours in regard to food acquisition and preparation that can result in higher food waste in a larger degree than men, even though the study found no differences in the actual amount of food wasted by the two genders. The results of the study are important because they show the need to adapt the public awareness campaigns on food waste on the particularities of each gender across several age groups.

Urbanization of fauna on the example of marsh frog (Pelophylax ridibundus)

2015 ◽  
Vol 26 (3-4) ◽  
pp. 116-123
Author(s):  
A. P. Korzh ◽  
T. V. Zahovalko
Keyword(s):  
Urban Areas ◽  
Cognitive Modeling ◽  
Negative Impact ◽  
Natural Populations ◽  
Cellular Level ◽  
Anthropogenic Factors ◽  
Migration Routes ◽  
Corrective Effect ◽  
The Impact ◽  
The City

Recently, the number of published works devoted to the processes of synanthropization of fauna, is growing like an avalanche, which indicates the extreme urgency of this theme. In our view, the process of forming devices to coexist with human and the results of his life reflects the general tandency of the modern nature evolution. Urbanization is characteristic for such a specific group of animals like amphibians, the evidence of which are numerous literature data. Many researchers use this group to assess the bioindicative quality of the environment. For this aim a variety of indicators are used: from the cellular level of life of organization up to the species composition of the group in different territories. At the same time, the interpretation of the results is not always comparable for different areas and often have significantly different interpretations by experts. Urban environment, primarily due to the contamination is extremely aggressive to amphibians. As a consequence, the urban populations of amphibians may be a change in the demographic structure, affecting the reproductive ability of the population, the disappearance of the most sensitive species or individuals, resizing animals, the appearance of abnormalities in the development, etc. At the same time play an important amphibians in the ecosystems of cities, and some species in these conditions even feel relatively comfortable. Therefore, it is interesting to understand the mechanisms of self-sustaining populations of amphibians in urban environments. To assess the impact of natural and anthropogenic factors on the development of amphibian populations were used cognitive modeling using the program Vensim PLE. Cognitive map of the model for urban and suburban habitat conditions were the same. The differences concerned the strength of connections between individual factors (migration, fertility, pollution) and their orientation. In general, factors like pollution, parasites, predators had negative impact on the population, reducing its number. The birth rate, food and migration contributed to raising number of individuals. Some of the factors affected on the strength to of each other as well: the majority of the factors affected the structure of the population, had an influence on the fertility. Thanks to it the model reflects the additive effect of complex of factors on the subsequent status of the population. Proposed and analyzed four scenarios differing strength and duration of exposure. In the first scenario, a one-time contamination occurs and not subsequently repeated. The second and third scenario assumes half board contamination, 1 year (2 scenario) and two years (scenario 3). In the fourth scenario, the pollution affected the population of amphibians constantly. In accordance with the results of simulation, much weaker than the natural populations respond to pollution - have them as an intensive population growth and its disappearance at constant pollution is slow. Changes to other parameters of the model showed that this pollution is the decisive factor -only the constant action leads to a lethal outcome for the populations. All other components of the model have a corrective effect on the population dynamics, without changing its underlying trand. In urban areas due to the heavy impact of pollution maintaining the population is only possible thanks to the migration process – the constant replenishment of diminishing micropopulations of natural reserves. This confirms the assumption that the form of existence metapopulations lake frog in the city. In order to maintain the number of amphibians in urban areas at a high level it is necessary to maintain existing migration routes and the creation of new ones. Insular nature of the placement of suitable habitats in urban areas causes the metapopulation structure of the types of urbanists. Therefore, the process of urbanization is much easier for those species whicht are capable of migration in conditions of city. In the initial stages of settling the city micropopulationis formed by selective mortality of the most susceptible individuals to adverse effects. In future, maintaining the categories of individuals is provided mainly due to migration processes metapopulisation form of the species of existence is supported). It should be noted that the changes in the previous levels are always saved in future. In the case of reorganizations of individuals we of morphology can assume the existence of extremely adverse environmental conditions that threaten the extinction of the micropopulations. 

Modernisation of Higher Education – Willful Action or Wishful Thinking? The Case of Bulgaria

2020 ◽  
Vol 8 (3) ◽  
pp. 3-17
Author(s):  
Elena Blagoeva
Keyword(s):  
Higher Education ◽  
Economic Crisis ◽  
Negative Impact ◽  
National Level ◽  
Sustainable Growth ◽  
Research Approach ◽  
Case Study Methodology ◽  
The Impact ◽  
The Eu

The impact of the last global economic crisis (2008) on the European economy put a strain on higher education (HE), yet it also pushed the sector towards intensive reforms and improvements. This paper focuses on the “Strategy for the Development of Higher Education in the Republic of Bulgaria 2014-2020”. With a case study methodology, we explore the strategic endeavours of the Bulgarian government to comply with the European directions and to secure sustainable growth for the HE sector. Our research question is ‘How capable is the Bulgarian HE Strategy to overcome the economic and systemic restraints of Bulgarian higher education?’. Because the development of strategies for HE within the EU is highly contextual, a single qualitative case study was chosen as the research approach. HE institutions are not ivory towers, but subjects to a variety of external and internal forces. Within the EU, this is obviated by the fact that Universities obtain their funds from institutions such as governments, students and their families, donors, as well as EU-level programmes. Therefore, to explore how these pressures interact to affect strategic action on national level, the case method is well suited as it enabled us to study the phenomena thoroughly and deeply. The paper suggests the actions proposed within the Strategy have the potential to overcome the delay, the regional isolation and the negative impact of the economic crisis on the country. Nevertheless, the key elements on which the success or failure of this Strategy hinges are the control mechanisms and the approach to implementation. Shortcomings in these two aspects of strategic actions in HE seem to mark the difference between gaining long-term benefits and merely saving face in front of international institutions.

Effects of Quarantine Due to the COVID-19 on Sleep Duration and Quality in Algerians

2020 ◽  
Vol 60 (2) ◽  
pp. 182-193
Author(s):  
Kacem Abdelhadi ◽  
Houar Abdelatif ◽  
Zerf Mohamed ◽  
Bengoua Ali
Keyword(s):  
Statistical Analysis ◽  
Sleep Quality ◽  
Sleep Duration ◽  
Online Survey ◽  
Public Awareness ◽  
Italian Version ◽  
Sleep Timing ◽  
Algerian Population ◽  
Significant Change ◽  
The Impact

SummaryThis study tests the impact of COVID-19 on sleep of Algerian population before and during the COVID-19 quarantine by an estimated online survey, adapted from the PSQI Italian version. Including 1210 participants (age between 18-60 years old). The statistical analysis was carried out using SPSS version 22.0 software. Our results showed a significant change in sleeping quality during quarantine, the sleep timing markedly changed, we also noticed additional use of sleeping medications. Algerian scientists recommend to build public awareness and to provide necessary information regarding Algerian sleep quality, especially for Algerian adults.

Has Aid Helped in Pakistan?

1997 ◽  
Vol 36 (4II) ◽  
pp. 947-957 ◽  
Author(s):  
Shahrukh Rafi Khan
Keyword(s):  
Economic Growth ◽  
Negative Impact ◽  
Negative Association ◽  
Causal Impact ◽  
The Impact ◽  
Over Time

This paper has a two-fold objective: first, to examine the terms on which Pakistan receives aid and whether its debt situation is sustainable, and second, to examine the impact of aid and debt on economic growth. It is found that there is little encouraging that can be said about how the terms on which Pakistan has received aid over time have changed, and its current debt situation is not sustainable. Also reported is the analysis done elsewhere which shows that aid has a negative (Granger) causal impact on GDP, and aid has a robust negative impact on economic growth after controlling for supplyside shocks. We provide various reasons for this negative association.

Green Beans Cultivation Using Mice Pets Control to Improve the Quality of Bintaro Fruit Extract

2018 ◽  
Vol 1 (1) ◽  
pp. 38
Author(s):  
Ajeng Embri Legawati ◽  
Nur Azizah ◽  
Achmad Ramadhan
Keyword(s):  
Natural Resources ◽  
Negative Impact ◽  
Green Beans ◽  
Fruit Extract ◽  
Bean Plants ◽  
Cultivation Technology ◽  
Environmental Balance ◽  
The Impact ◽  
Chemical Pesticides

Green beans cultivation technology using mice pets control has been implemented in the Gluranploso village, Benjeng Gresik. The implementation of the technology performed for 2.5 months from August to October 2017. The purpose of the implementation is aimed to reduce the dependence of farmers on the use of chemical pesticides so that the farmers are aware of the negative impact of chemical pesticides. Assessing the impact of the utilization of Bintaro fruit and fruit extracts to explore ways of making Bintaro as a natural biopesticide to overcome rat attack on green bean plants in the Gluranploso village. Pest control mice can reduce the rate of loss of the crops more effectively and efficiently. Finally, with the use of those natural resources as a biopesticide material can also maintain the environmental balance

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