ST-segment elevation myocardial infarction: Management and association with prognosis during the COVID-19 pandemic in France

BACKGROUND

Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown.

AIM

To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019.

METHODS

In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction.

RESULTS

A total of 6306 patients were included. During the pandemic peak, a 13.9±6.6% (P=0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150-705] vs 245 [140-646]min; P=0.013), driven by the increase in time from symptom onset to first medical contact (121 [60-360] vs 150 [62-420]min; P=0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%; P=0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020; P=0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock.

CONCLUSIONS

During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms.

DSM-flux: A new technology for reliable Combined Sewer Overflow discharge monitoring with low uncertainties

In the past ten years, governments from the European Union have been encouraged to collect volume and quality data for all the effluent overflows from separated stormwater and combined sewer systems that result in a significant environmental impact on receiving water bodies. Methods to monitor and control these flows require improvements, particularly for complex Combined Sewer Overflow (CSO) structures. The DSM-flux (Device for Stormwater and combined sewer flows Monitoring and the control of pollutant fluxes) is a new pre-designed and pre-calibrated channel that provides appropriate hydraulic conditions suitable for measurement of overflow rates and volumes by means of one water level gauge. In this paper, a stage-discharge relation for the DSM-flux is obtained experimentally and validated for multiple inflow hydraulic configurations. Uncertainties in CSO discharges and volumes are estimated within the Guide to the expression of Uncertainty in Measurement (GUM) framework. Whatever the upstream hydraulic conditions are, relative uncertainties are lower than 15% and 2% for the investigated discharges and volumes, respectively.

Urban domestic wastewater: how to reduce individual injection?

The present paper aims to identify ways to reduce pollution injected by residents in the urban wastewater network system. Two approaches are considered. The first one uses flow and pollutant calculation to test whether a polluter can easily be identified in a neighborhood. The second approach uses a survey to examine what incentive would be most effective to influence residents' behavior. Hydrodynamic simulation results show that concentration profiles at the network outlet corresponding to all possible polluters are similar and thus do not point out specific resident source of pollution. Household-level survey results show that most socio-economic and public-good-related characteristics do not play a significant role in explaining choices to discard in the home wastewater network. Apart from the nature of the waste itself, by far the belief that the respondent has about neighbors' and relatives' discarding behavior is the main driver of the choice.

Experiments and 3D simulations of flow structures in junctions and their influence on location of flowmeters

Open-channel junctions are common occurrences in sewer networks and flow rate measurement often occurs near these singularities. Local flow structures are 3D, impact on the representativeness of the local flow measurements and thus lead to deviations in the flow rate estimation. The present study aims (i) to measure and simulate the flow pattern in a junction flow, (ii) to analyse the impact of the junction on the velocity distribution according to the distance from the junction and thus (iii) to evaluate the typical error derived from the computation of the flow rate close to the junction.

Urban flooding: one-dimensional modelling of the distribution of the discharges through cross-road intersections accounting for energy losses

Many investigations have been carried out in order to develop models which allow the understanding of complex physical processes involved in urban flooding. The modelling of the interactions between overland flows on streets and flooding flows from rivers and sewer networks is one of the main objectives of recent and current research programs in hydraulics and urban hydrology. However, the modelling of the discharge distribution in the street network with crossroad needs further research due to the complexity of the flow through junctions. This paper outlines the ability of the improved one-dimensional CANOE software to simulate the street flows through the virtual network (developed under the Hy(2)Ville French National project framework) with several cross-roads. The improvements are done by adding in CANOE the energy losses coefficients deriving from the calibration phase based on the experimental study of the flow through small scale physical model of cross-road channels. Comparisons between 1D and 2D simulated distribution of discharges through the virtual network show a good agreement for the global distribution. However, large differences are observed focusing on the individual cross-road intersections in the virtual network.

One-dimensional modelling of the interactions between heavy rainfall-runoff in an urban area and flooding flows from sewer networks and rivers

Many investigations have been carried out in order to develop models which allow the linking of complex physical processes involved in urban flooding. The modelling of the interactions between overland flows on streets and flooding flows from rivers and sewer networks is one of the main objectives of recent and current research programs in hydraulics and urban hydrology. This paper outlines the original one-dimensional linking of heavy rainfall-runoff in urban areas and flooding flows from rivers and sewer networks under the RIVES project framework (Estimation of Scenario and Risks of Urban Floods). The first part of the paper highlights the capacity of Canoe software to simulate the street flows. In the second part, we show the original method of connection which enables the modelling of interactions between processes in urban flooding. Comparisons between simulated results and the results of Despotovic et al. or Gomez & Mur show a good agreement for the calibrated one-dimensional connection model. The connection operates likes a manhole with the orifice/weir coefficients used as calibration parameters. The influence of flooding flows from river was taken into account as a variable water depth boundary condition.

Phenotypic plasticity in response to mechanical stress: hydrodynamic performance and fitness of four aquatic plant species

Plastic responses of plants exposed to mechanical stress can lead to modified, performance-enhancing, morphologies, sometimes accompanied by costs to reproduction. The capacity to present short-term plastic responses to current stress, the resulting performance (expected lower mechanical forces), and the costs of such responses to reproduction were tested for four aquatic plant species. Two ramets of the same genet were submitted to running vs standing water treatment. Traits describing the morphology, hydrodynamic performance and reproduction (sexual and vegetative) were measured. For one species, plastic responses led to reduced hydrodynamic forces, without apparent costs to reproduction, indicating that the plastic response could be beneficial for plant maintenance in stressful habitats. For two species, plastic responses were not associated with variations in performance and reproduction, possibly because of the low hydrodynamic forces experienced, even for morphologies produced under standing conditions. For one species, plastic responses were associated with a sharp decrease in sexual reproduction, without variations in performance, revealing the negative impact of currents over a short time scale. Species maintenance is linked to the capacity of individuals to tolerate mechanical forces. The contrasting responses to currents may be a key element for predicting community dynamics.

Flooding flows in city crossroads: experiments and 1-D modelling

This study focuses on the discharge distribution in an intersection of four channels, similar to a city crossroad. The channels and the intersection are all horizontal. Flow enters through two of the channels, and leaves through the other two. The flow is subcritical everywhere, and flow depths are controlled by vertical weirs at the exits of the outlet channels. The main variables that are measured are the flow rates in the four channels. When the weir heights in the outlet channels are the same, the ratio of flow rates in the outlet channels depends only on the ratio of flow rates in the inlet channels; if the outlet conditions are different, other parameters, such as the total flow rate also become important. The flow has also been simulated numerically using a solution of the 1-D Saint Venant equations, with a simple model to predict flow distribution in the intersection. A comparison with the experimental data shows that this model works well for the limited range of experimental conditions studied here. However, further work is needed on a wider range of conditions, closer to real conditions, before the model can be considered valid for practical applications.