Effect of the Coronavirus Disease 2019 Pandemic on the Quality of Stroke Care in Stroke Units and Alternative Wards: A National Comparative Analysis / 대한뇌졸중학회지

Background@#and Purpose Changes to hospital systems were implemented from March 2020 in Australia in response to the coronavirus disease 2019 pandemic, including decreased resources allocated to stroke units. We investigate changes in the quality of acute care for patients with stroke or transient ischemic attack during the pandemic according to patients’ treatment setting (stroke unit or alternate ward). @*Methods@#We conducted a retrospective cohort study of patients admitted with stroke or transient ischemic attack between January 2019 and June 2020 in the Australian Stroke Clinical Registry (AuSCR). The AuSCR monitors patients’ treatment setting, provision of allied health and nursing interventions, prescription of secondary prevention medications, and discharge destination. Weekly trends in the quality of care before and during the pandemic period were assessed using interrupted time series analyses. @*Results@#In total, 18,662 patients in 2019 and 8,850 patients in 2020 were included. Overall, 75% were treated in stroke units. Before the pandemic, treatment in a stroke unit was superior to alternate wards for the provision of all evidence-based therapies assessed. During the pandemic period, the proportion of patients receiving a swallow screen or assessment, being discharged to rehabilitation, and being prescribed secondary prevention medications decreased by 0.58% to 1.08% per week in patients treated in other ward settings relative to patients treated in stroke units. This change represented a 9% to 17% increase in the care gap between these treatment settings during the period of the pandemic that was evaluated (16 weeks). @*Conclusions@#During the first 6 months of the pandemic, widening care disparities between stroke units and alternate wards have occurred.

SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group

BackgroundStroke is reported as a consequence of SARS-CoV-2 infection. However, there is a lack of regarding comprehensive stroke phenotype and characteristics MethodsWe conducted a multinational observational study on features of consecutive acute ischemic stroke (AIS), intracranial hemorrhage (ICH), and cerebral venous or sinus thrombosis (CVST) among SARS-CoV-2 infected patients. We further investigated the association of demographics, clinical data, geographical regions, and countries health expenditure among AIS patients with the risk of large vessel occlusion (LVO), stroke severity as measured by National Institute of Health stroke scale (NIHSS), and stroke subtype as measured by the TOAST criteria. Additionally, we applied unsupervised machine learning algorithms to uncover possible similarities among stroke patients. ResultsAmong the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least one eligible stroke patient. Out of 432 patients included, 323(74.8%) had AIS, 91(21.1%) ICH, and 18(4.2%) CVST. Among 23 patients with subarachnoid hemorrhage, 16(69.5%) had no evidence of aneurysm. A total of 183(42.4%) patients were women, 104(24.1%) patients were younger than 55 years, and 105(24.4%) patients had no identifiable vascular risk factors. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144(37.8%) presented to the hospital with chief complaints of stroke-related symptoms, with asymptomatic or undiagnosed SARS-CoV-2 infection. Among AIS patients 44.5% had LVO; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median NIHSS (8[3-17], versus 11 [5-17]; p=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; p<0.001) in countries with middle to high-health expenditure when compared to countries with lower health expenditure. The unsupervised machine learning identified 4 subgroups, with a relatively large group with no or limited comorbidities. ConclusionsWe observed a relatively high number of young, and asymptomatic SARS-CoV-2 infections among stroke patients. Traditional vascular risk factors were absent among a relatively large cohort of patients. Among hospitalized patients, the stroke severity was lower and rate of mechanical thrombectomy was higher among countries with middle to high-health expenditure.

Diversity and distribution of Odonata (Insecta) larvae along an altitudinal gradient in Coalcomán mountains, Michoacán, Mexico

Evaluating components of landscape diversity is essential for the implementation of efficient conservation strategies. We evaluated the diversity of Odonata larval assemblages from the Coalcomán mountains (CM), Michoacán, Mexico, and related it to local (site-level) habitat variables. Larvae were collected from shores, riffles and pools in five streams, counted and identified to species, twice per season during 2005. The Shannon Diversity Index (H’), Margalef’s Richness Index (R), Simpson’s Index as a dominance measure (D) and Pielou’s Equitability (J) were used to describe the assemblages, and Renyi’s Diversity Profiles were used to order diversity. A Bray-Curtis Similarity Index (BC) was used to evaluate beta diversity. Theoretical richness was estimated using non-parametric and parametric methods. A Canonical Correspondence Analysis (CCA) was applied to explore the relationships of species with site-level environmental variables. A total of 12 245 larvae from 75 species, 28 genera and 8 families were recorded. Over all sites, the dominant species were Erpetogomphus elaps, Macrothemis pseudimitans and Argia pulla. The number of species per locality ranged from 18 to 36, and a high number of species (76%) occurred with relative abundances lower than 1%. A differential distribution of species and abundance in streams, time and strata was observed. Renyi’s diversity profiles showed diversity was higher in spring and on shores. Most BC similarity values were smaller than 25%, indicating a high turnover rate in the CM. The high turnover rate reflects a differential distribution of the species along the altitudinal gradient, supporting the hypothesis of Mexico as a betadiverse country. According to the slope of Clench’s curve, a reliable list of species was gathered. The CM larval assemblage is currently the largest reported for Mexico, and our results support previous proposals of the CM as a species-rich area for conservation. Rev. Biol. Trop. 59 (4): 1559-1577. Epub 2011 December 01.

Evaluar los componentes de la diversidad de paisaje es una tarea esencial para implementar estrategias eficientes de conservación. En este estudio se describe la variación geográfica, temporal y por hábitats de la diversidad de larvas de odonatos en un gradiente altitudinal en la sierra de Coalcomán, Michoacán, México, y se explora su relación con variables fisicoquímicas locales. Presentamos diferentes índices de diversidad y gráficos de perfiles de diversidad de Renyi, así como la riqueza teórica por métodos paramétricos y no paramétricos, el recambio de especies en la sierra y, mediante análisis canónico de correspondencias (ACC) la relación de las especies con las variables fisicoquímicas. Recolectamos un total 12 245 larvas de 75 especies, 28 géneros y 8 familias. En todos los hábitats un alto número de especies presentó una abundancia inferior al 1%. El número de especies en los arroyos varió entre 18 y 36, existe además un alto recambio en la sierra. La diversidad beta es un componente importante de la diversidad del paisaje; se apreció una alternancia en la dominancia estacional entre anisópteros y zygópteros y nuestros datos concuerdan con la hipótesis del Mexico betadiverso y también apoya propuestas previas de conservación de la sierra.