bluuebunny/crossref_metadata_2025 huggingface dataset:
An Experimental Study of Fracture Parameters of Concrete Produced With Basalt Aggregate by Peak‐Load Method
Authors: Yilmaz Cetin Senem , Celik Tahir Azad
Published: January 2025

Limestone or river aggregates have been traditionally used as aggregates in ready‐mixed concrete from the past to the present. The depletion of these natural aggregates used in ready‐mixed concrete has led the concrete industry to investigate aggregate resources and search for alternative aggregates. In this study, natural rocks defined as basalt type from Karacadağ, located within the borders of Diyarbakır, Şanlıurfa, and Mardin provinces in the Southeastern Anatolia Region of Türkiye, were used as aggregate materials. The mechanical strength of concrete produced with basalt aggregate was examined. In order to determine the physical and mechanical properties of the produced basalt aggregate concretes, unit weight, compressive strength, and splitting tensile strength experiments were carried out on hardened concretes. In addition to the physical and mechanical properties of basalts, their chemical composition properties have been investigated. In the experimental study, crushed basalt aggregates with size fractions 0–5, 5–11.2, and 11.2–22.4 mm were used. The water/cement ratio of the concrete produced in the study was 0.45, and the selected cement contents were determined as 300 kg/m3, 350, and 400 kg/m3. The fracture parameters of the produced concrete were presented with the two‐parameter fracture model (TPFM). Statistical analyses of this study show that the fracture parameters of cube samples made with basalt aggregate commonly found in the region are acceptable for use in construction sites.
Imbalance of Endogenous Opioids and Its Association With Pruritus Among Renal Transplant Recipients: A Cross‐Sectional Study
Authors: Krajewski Piotr K. , Sójka Aleksandra , Tyczyńska Kinga , Olczyk Piotr , Nowicka-Suszko Danuta , Krajewska Magdalena , Szepietowski Jacek C.
Published: January 2025

Background: Chronic pruritus (CP) is a common and distressing symptom among renal transplant recipients (RTRs), yet its pathogenesis remains poorly understood. Recent evidence suggests that dysregulation of the endogenous opioid system may contribute to pruritus in various conditions, but its role in RTRs has not been thoroughly investigated.

Objective: This study aimed to assess the concentrations of specific endogenous opioids (β‐endorphin, dynorphin A, met‐enkephalin, and leu‐enkephalin) in RTRs with and without pruritus to explore their potential role in pruritus pathogenesis.

Methods: A total of 129 RTRs and 47 healthy controls were included in the study. Serum levels of β‐endorphin, dynorphin A, met‐enkephalin, and leu‐enkephalin were measured using enzyme‐linked immunosorbent assays (ELISAs). Pruritus severity was assessed using the Worst Pruritus Numerical Rating Scale (WP‐NRS) and the 4‐Item Itch Questionnaire (4IIQ).

Results: Pruritic RTRs had significantly lower serum β‐endorphin levels compared to nonpruritic RTRs (p = 0.008). However, there were no significant differences in dynorphin A, met‐enkephalin, or leu‐enkephalin levels between pruritic and nonpruritic RTRs or between RTRs and healthy controls. The β‐endorphin to dynorphin A ratio also did not differ significantly between groups.

Conclusion: The study suggests that disturbances in the endogenous opioid system, particularly involving β‐endorphin, may play a role in the pathogenesis of pruritus in RTRs. Further research is needed to elucidate the precise mechanisms and to explore potential therapeutic interventions targeting the opioid system in this population.
A Comprehensive Review of Passive Water and Thermal Management of Air‐Breathing Proton Exchange Membrane Fuel Cell
Authors: Huang Siqi , Zhao Yinghua , Wang Xiaoyu , Shi Jingwu , Yao Shouwen
Published: January 2025

Air‐breathing proton exchange membrane fuel cells (AB‐PEMFCs) utilize ambient air for oxygen and cooling, making them suitable for small‐scale applications. However, the absence of auxiliary systems presents considerable challenges in water and thermal management, which are crucial for ensuring optimal performance and durability. Poor management can lead to issues like membrane dehydration or cathode flooding. This deficiency subsequently impacts the affordability and longevity of AB‐PEMFCs, both of which are critical considerations in the commercialization process. This review highlights the importance of water‐thermal transport processes in enhancing efficiency and durability. While much research has focused on airflow’s role in thermal regulation, internal factors such as current density have received less attention. It is recommended to prioritize the coupling of water and thermal management in future studies, employing strategies like AI‐driven optimization to accelerate the commercialization of AB‐PEMFCs.
Antifungal Potential of Sweet Orange Essential Oil on Pathogens of Two Important Cocoa Diseases in Ghana
Authors: Bukari Yahaya , Avicor Silas Wintuma , Ainooson Michael Kojo , Asare Eric Kumi , Awudzi Godfred Kweku , Amoako-Attah Ishmael
Published: January 2025

Plants are known to possess antimicrobial properties, as such, their extracts remain potential sources of eco‐friendly antimicrobial products. Extracts from sweet orange have been evaluated as potential antimicrobial sources. However, their activity against pathogens of major agricultural crops such as cocoa is unknown. In this study, the essential oil (EO) of the peel of sweet orange was evaluated against Marasmiellus scandens and Erythricium salmonicolor, the pathogens, respectively, responsible for causing white thread blight and pink disease on cocoa. Minimum Inhibitory Concentration (MIC), IC50, IC90, and IC95 against mycelial growth of the pathogens were determined by agar plate tests following 7 days of incubation. Mycelial growths of the two pathogens were completely (100%) inhibited at 10% (w/v) of the EO. The MIC, IC50, IC90, and IC95 against M. scandens were 0.1%, 0.25%, 1.23%, and 2.11% while those against E. salmonicolor were 0.01%, 0.13%, 0.75%, and 1.35%, respectively. This study shows that EO of sweet orange peel has antifungal activity against the pathogens. Determining the bioactivity of the individual compounds in the EO and field application of effective formulations in future research has potential for the biological control of these fungal diseases of cocoa.
Migratory Wave due to Conflicts: Risk of Increased Infection From Zoonotic Diseases
Authors: Salajegheh Tazerji Sina , Magalhães Duarte Phelipe , Gharieb Rasha , Szarpak Lukasz , Pruc Michal , Rahman Md. Tanvir , J. Rodriguez-Morales Alfonso , Furqan Ilyas Muhammad , Santos Ferreira Maria de Nazaré , Singh Malik Yashpal , Kalantari Roozbeh , Shahrokhabadi Ava , Jafari Niloofar , Shahabinejad Fatemeh , Maleki Yasaman , Montajeb Sina , Mehrpouya Roya , Ahmadi Hadis , Vazir Bita , Kabir Farrokhreza , Rehman Abdul , Elmi Zahra , Hajipour Pouneh , El-Seedi Hesham R. , Eisenreich Wolfgang , Shehata Awad A.
Published: January 2025

Wars have devastating effects on all the components of the One Health approach: humans, animals, and ecosystems. Wars and the resulting migratory waves massively disrupt normal animal health services and surveillance. Among other consequences, they adversely impact the early detection, prevention, and control of animal diseases. Uncontrolled movement of animals or their undisposed carcasses, the destruction of wildlife habitats, and the increased interface between humans, wildlife, and domestic animals contribute to uncontrolled transmission and spread of zoonotic pathogens from animals to humans. In the last millennium, zoonotic diseases such as the “Black Death” were triggered by devastating wars and led to the deaths of a large fraction of the human population. However, also recent and ongoing wars carry the risk of an uncontrollable increase in zoonotic diseases. The most significant zoonotic diseases reported during the recent wars are African swine fever, highly pathogenic avian influenza, rabies, leptospirosis, and brucellosis, as well as foodborne and waterborne zoonotic diseases. Indeed, alarming rates of infections by antimicrobial‐resistant pathogens such as Mycobacterium tuberculosis go along with wars, as seen in the current Ukraine–Russia conflict. Considering human migration, foodborne and waterborne zoonotic diseases are key health threats for refugees due to the consumption of unsafe food, lack of safe water, and disruption of the water supply and sanitation system. This review summarizes the potential factors and some data associated with the increased risk of zoonotic disease emergence and transmission during recent and ongoing conflicts.
Werden Serum-Biomarker bald eine Rolle in der Behandlung systemischer Sklerose-assoziierter interstitieller Lungenerkrankung spielen?
Authors: Mihai Carina
Published: January 2025

Objective: Interstitial lung disease (ILD) is the leading cause of mortality in SSc. Novel biomarkers are crucial to improve outcomes in SSc-ILD. We aimed to compare the performance of potential serum biomarkers of SSc-ILD that reflect different pathogenic processes: KL-6 and SP-D (epithelial injury), CCL18 (type 2 immune response), YKL-40 (endothelial injury and matrix remodelling) and MMP-7 (ECM remodelling). Methods: Baseline and follow-up serum samples from 225 SSc patients were analysed by ELISA. Progressive ILD was defined according to the 2022-ATS/ERS/JRS/ALAT guidelines. Linear mixed models and random forest models were used for statistical analyses. Results: Serum levels of KL-6 [MD 35.67 (95% CI 22.44–48.89, P < 0.01)], SP-D [81.13 (28.46–133.79, P < 0.01)], CCL18 [17.07 (6.36–27.77, P < 0.01)], YKL-40 [22.81 (7.19–38.44, P < 0.01)] and MMP-7 [2.84 (0.88–4.80, P < 0.01)] were independently associated with the presence of SSc-ILD. A machine-learning model including all candidates classified patients with or without ILD with an accuracy of 85%. The combination of KL-6 and SP-D was associated with the presence [0.77 (0.53–1.00, P’ <0.01)] and previous progression of SSc-ILD [OR 1.28 (1.01–1.61, P’ =0.047)]. Higher baseline levels of KL-6 [OR 3.70 (1.52–9.03, P < 0.01)] or SP-D [OR 2.00 (1.06–3.78, P = 0.03)] increased the odds of future SSc-ILD progression, independent of other conventional risk factors, and the combination of KL-6 and SP-D [1.109 (0.665–1.554, P < 0.01)] showed improved performance compared with KL-6 and SP-D alone.
Public resources on the Brazilian Food and Nutrition Security agenda from 2000 to 2022
Authors: Martins Milena Corrêa , Machado Mick Lennon , Hinnig Patrícia de Fragas , Machado Patrícia Maria de Oliveira , Gabriel Cristine Garcia
Published: January 2025

OBJETIVO: Analisar a tendencia temporal dos recursos publicos federais investidos na agenda brasileira de Seguranca Alimentar e Nutricional do periodo de 2000–2022. MÉTODOS: Realizou-se um estudo de serie temporal com dados coletados de um sistema de acesso publico sobre planejamento e orcamento do Governo Federal. Foram analisadas as acoes orcamentarias e seus recursos indicados pela Dotacao Orcamentaria e o Valor Liquidado. As acoes foram categorizadas em temas da agenda de SAN, analisadas a partir da regressao de Prais-Winsten, juntamente com o metodo de Cochrane-Orcutt. Os valores foram corrigidos pelo Indice de Precos ao Consumidor Amplo, para janeiro de 2023. RESULTADOS: O investimento na area de Seguranca Alimentar e Nutricional apresentou uma tendencia crescente em duas decadas de financiamento federal, apesar de ter demonstrado oscilacoes em determinados anos. A Dotacao Orcamentaria mostrou uma variacao anualde 10,1%, e o Valor Liquidado obteve 10,8%. No entanto, ha um desequilibrio no financiamento federal entre as areas estrategicas, com tendencia crescente na saude (37,4%), soberania alimentar (23,7%) e acesso a alimentacao (12,3%); e tendencia negativa de investimento em algumas areas, como desenvolvimento agrario (-7,0%). Constatou-se uma alocacao de recursos concentrada em acoes assistenciais para garantia do acesso a alimentacao, em media 73,4% do total de recursos executados. CONCLUSÃO: Os resultados apresentaram um comportamento crescente do investimento publico na agenda brasileira de Seguranca Alimentar e Nutricional, embora expressassem oscilacoes em determinados anos e uma concentracao de recursos em areas especificas. Apesar de 2/3 do orcamento ser exclusivamente para acoes de acesso a alimentacao, dados recentes demonstram que a fome ainda assola a realidade brasileira. Reforcando a necessidade de um investimento continuo e mais equanime entre as areas, como forma de fortalecer politicas publicas estruturantes que garantam de forma permanente a Seguranca Alimentar e Nutricional da populacao brasileira.
Ripple Effects of Early Life Stress on Vascular Health
Authors: Kellum Cailin E. , Kelly Gillian C. , Pollock Jennifer S.
Published: January 2025

The term early life stress encompasses traumatic events occurring before the age of 18 years, such as physical abuse, verbal abuse, household dysfunctions, sexual abuse, childhood neglect, child maltreatment, and adverse childhood experiences. Adverse psychological experiences in early life are linked to enduring effects on mental and physical health in adulthood. In this review, we first describe the effects and potential mechanisms of early life stress on the components of the vasculature. Next, we dive into the impact of early life stress on the vasculature across the lifespan through alterations of the epigenetic landscape. Finally, we consolidate the critical gaps in knowledge for focusing future research including the potential for resilience in combatting the impact of early life stress on vascular health.
Abstract 104: Theoretical effect of PCSK9 inhibitor use in the SAMMPRIS trial: A secondary analysis of LDL lowering
Authors: Siegler James , Badillo Goicoechea Elena , Morsi Rami , Arevalo Andrea , Smith Matthew , Kothari Sachin , Mehendale Rachel , Desai Harsh , Kellogg Caroline , Sehgal Neha , Rana Rohini , Jhaveri Aditya , Brorson James , Nguyen Thanh , Coleman Elisheva , Prabhakaran Shyam , Dunne Therese , Cameron Kamil , Chaturvedi Seemant , Ghannam Malik , Yaghi Shadi , Kass-Hout Tareq
Published: January 2025

Introduction:
The risk of recurrent atherosclerotic vascular events in patients with stroke due to intracranial atherosclerotic disease (ICAD) is high, and can be reduced with aggressive medical management. Novel lipid-lowering therapies such as proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) can dramatically lower low-density lipoprotein (LDL) and lipoprotein(a) levels, but are not presently indicated for stroke due to ICAD.

Methods:
We conducted a secondary analysis of the SAMMPRIS clinical trial to estimate the association between changes in LDL and a composite outcome of first ischemic stroke, myocardial infarction, or death. Estimates were assessed using an adjusted Cox proportional hazards model accounting for age, sex, race, Hispanic ethnicity, baseline LDL level, vascular comorbidities, and use of intracranial stenting. We applied relative LDL reduction estimates from meta-analyzed trial data evaluating the effect of PCSK9i versus placebo among statin users with atherosclerotic vascular disease to project adjusted incidence rate differences of the primary outcome observed in SAMMPRIS with an equivalent LDL reduction. Semiparametric Cox proportional hazards models estimated the annualized relative risk of primary events if PCSK9i were used with aggressive risk factor modification for stroke due to ICAD.

Results:
Of the 451 patients from SAMMPRIS, 446 had reported lipoprotein(a) and LDL levels reported at follow-up and were therefore included. The median LDL was 101 mg/dl (IQR 77-130). There was no significant change in lipoprotein(a) at the first follow-up although low-density lipoprotein (LDL) levels fell significantly (relative difference -22%, IQR -38% to 0%). In adjusted Cox proportional hazards regression, every 1% change in LDL by the time of first follow-up was associated with a 0.9% relative reduction in the composite endpoint (adjusted hazard ratio [aHR] 1.009, 95% confidence interval [CI] 1.002 - 1.015). Assuming modest, average, and high projected effects of PCSK9i (40%, 60%, and 80% reduction in LDL), with half of SAMMPRIS patients having been treated, PCSK9i use could reduce outcome events by 18.1%, 24.6%, and 30.1%. With all SAMMPRIS patients having been treated, assuming an average PCSK9i effect, the primary outcome could be reduced by 43.6%.

Conclusions:
Even with minimal gains from PCSK9i with stroke due to ICAD, atherosclerotic vascular events following stroke due to ICAD could be reduced significantly.
Abstract 105: Long-term exposure to ambient air pollution, including ultrafine particles, increases ischemic and hemorrhagic stroke risk among women in the California Teachers Study cohort
Authors: Cauble Emily , Kleeman Mike , Wang Sophia , Franklin Meredith , Epeldegui Marta , Spielfogel Emma , Benmarhnia Tarik , Yao Mandy , Lacey Holly , Wu Jingyuan , Zhao Juan , Anderson Cheryl , Elkind Mitchell
Published: January 2025

Introduction:
Ambient air pollution is linked to increased stroke risk, but it is unclear if associations apply to long-term exposures, equally to different stroke subtypes (ischemic versus hemorrhagic) and differ by pollutants. Of particular interest is exposure to ultrafine particles (PM0.1) for which there is sparse literature on its association with stroke.

Hypothesis:
Long-term exposures to particulate matter (PM0 2.5, PM10, PM0.1), ozone (O
3
), and nitrogen dioxide (NO
2
) are associated with stroke risk.

Methods:
In a prospective cohort study of 133,477 women enrolled in the California Teachers Study in 1995-96, we assessed 110,120 participants who resided in California from 2000-2018 for residential exposure to 5 air pollutants (O
3
, NO
2
, PM2.5, PM10, and PM0.1) based on a chemical transport model (4-km grid) applied to geocoded residential histories across follow-up (median follow-up=19 years). Strokes were identified with ICD-9 and ICD-10 codes via linkage of cohort participants to California state hospitalization records (Department of Health Care Access and Information). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for associations between the air pollutants (average exposure across follow-up) with total stroke (n=4,348) and stroke subtypes (ischemic stroke n=3,596; hemorrhagic stroke n=752), adjusted for stroke risk factors.

Results:
Consistent with state-wide trends, median levels of NO
2
and PM masses assessed among participants declined and plateaued in recent years (2000-2018), whereas median annual O
3
levels increased. The exposures observed among study participants also reflected that of the State; annual median PM2.5=8.23 ug/m
3
(range: 0.84-85.6). We observed increased risks for total, ischemic, and hemorrhagic strokes per ug/m3 increase of PM2.5, PM10.0, and PM0.1 (overall stroke: HR
PM0.1
=1.43, 95% CI=1.29-1.58; HR
PM2.5
=1.45, 95% CI=1.30-1.63; HR
PM10
=1.36, 95% CI=1.23-1.51); the risk magnitudes were higher for hemorrhagic stroke (HR
PM0.1
=1.57, 95% CI=1.22-2.02; HR
PM2.5
=1.84, 95% CI=1.40-2.42; HR
PM10
=1.62, 95% CI=1.27-2.08). Associations observed between NO
2
and stroke were also elevated (HR=1.12 per ppm, 95% CI=1.07-1.18).

Conclusion:
All PM masses, including ultrafine particles, were associated with overall stroke risk and for both ischemic and hemorrhagic stroke. Further delineation of independent versus combined effect of pollutants is warranted and will be presented.
Abstract 125: Factors Associated with Neuroscience Appointment Attendance in Hemorrhagic Stroke Patients and the Impact on Readmission and Functional Outcomes
Authors: Dellostretto Nicole , Pope Leslie , Hackett Chris , Heintz Rebekah , Noah Patty , Cerejo Russell
Published: January 2025

Introduction:
Managing post-acute hemorrhagic stroke care is complex and necessitates close follow-up and coordination. We aimed to identify factors contributing to neuroscience (neurology or neurosurgery) appointment attendance and the impact on readmission and 90-day function outcomes.

Methods:
Retrospective analysis of hemorrhagic stroke patients with care coordinated by a stroke nurse navigator from one of seven hospitals between January 2022 and March 2024. Patients were excluded if: discharged to a long-term care facility or hospice, expired prior to discharge or had incomplete data. Primary outcome evaluated variables contributing to attendance of a neuroscience appointment post-discharge and secondary outcome: examined 90-day all cause readmission using binomial logistic regressions. Ninety-day modified Rankin Scale (mRS) evaluated functional outcomes analyzed using a proportional odds logistic regression. Subgroup analysis compared latency to neuroscience appointment. Outcome variables were adjusted for potential confounding variables based on univariate analyses. Secondary outcomes were also adjusted for patients discharged to home.

Results:
A total of 914 patients were evaluated and after exclusions 424 were included in this study. Hemorrhagic patients were more likely to attend a clinic appointment when: had an active patient portal, Odds Ratio (OR)=2.49 [95% Confidence Interval (CI) 1.49, 4.17], p=0.001 or discharged home OR=2.11 [95%CI 1.17, 3.80], p=0.01 and less likely to attend with higher premorbid mRS OR=0.59 [95%CI 0.46, 0.74], p<0.001. Patients attending appointments were less likely to be readmitted: OR=0.50 [95%CI 0.30, 0.85], p=0.01 and more likely to shift to the next (better) mRS at 90 days: OR=4.25 [95%CI 2.70, 6.99], p<0.001. Longer delays in returning to the clinic post-discharge resulted in a greater likelihood of readmission within 90 days, OR=1.01 [95%CI 1.00, 1.02], p=0.04. Outcome data was similar for patients with intracerebral hemorrhage and subarachnoid hemorrhage all p<0.05.

Conclusion:

Prehospital mRS, post hospital disposition and mychart activation were key contributors to patient attendance at a neuroscience follow up appointment.
Abstract 127: Advanced Practice Provider Achieves Quicker Door to Needle Time than Neurology Residents
Authors: Staltari Concetta , Noah Patty , Heintz Rebekah , Hackett Chris
Published: January 2025

Introduction:
Advanced Practice Providers (APP) are being integrated into more medical sub-specialties and opportunities may exist to increase the acuity of the patients they serve. We evaluated whether utilizing an APP in the emergency room affected timing and safety of IV thrombolytic therapy.

Methods:
Single center academic hospital retrospective analysis on acute ischemic stroke patients given thrombolytic therapy in the emergency department between January 2022 and June 2024. Patients treated greater than 4.5 hours of symptom onset and those with non-disabling symptoms upon emergency room arrival were excluded. Primary outcome: door to needle (DTN) time of the APP versus neurology residents using quantile (median) regression adjusted for age, NIHSS and delays for treating hypertension. Secondary outcome evaluated symptomatic intracranial hemorrhage (sICH) post thrombolysis comparing APP versus neurology residents using Fisher’s exact test. To evaluate for potential time confounds due to the APP’s working schedule, a subgroup analysis compared patients treated by neurology residents during APP scheduled work times to APP off hours using quantile (median) regression adjusted for aforementioned cofounding variables.

Results:
There were 278 patients given thrombolytic therapy in the emergency room and after exclusions 271 patients were included in the study and all analyses. The APP had a lower median DTN time than the neurology residents, 32 minutes versus 54 minutes. After adjusting for confounding variables the APP treated patients 18.98 [95% CI 5.11, 32.85] minutes quicker than neurology residents, p=0.008. Rates of sICH were similar between the APP and neurology residents, 0(0%) versus 5(1.9%), p>0.99. Neurology resident DTN times remained consistent when covering APP shift and outside of APP scheduled hours, adjusted median difference in door to needle time, 2.50[95% CI -11.43,16.44], p=0.72.

Conclusion:
The utilization of an APP who specializes in treating ischemic stroke patients with thrombolytic therapy provides safe and fast administration. APPs may be used to respond to emergency room stroke alerts to determine eligibility and administration of thrombolytic therapy.
Abstract 128: Unbiased Detection of Infection in Children with Arterial Ischemic Stroke: Results of the VIPS II Study
Authors: Karalius Mary , Hills Nancy , Wintermark Max , Grose Charles , Dowling Michael , Wilson Jenny , Lee Sarah , Chung Melissa , Berry Megan , Ramachandran Prashanth , Wang Mary , Zia Maham , DeRisi Joseph , Wilson Michael , Fullerton Heather
Published: January 2025

Introduction:
Acute infection transiently increases risk for childhood arterial ischemic stroke (AIS). We hypothesize that this paradox of a common exposure linked to a rare outcome could be explained by either (1)
unusual infections
—uncommon pathogens or combinations of pathogens—or (2) an
unusual host response
to infection. While previous studies relied solely on clinical history and targeted laboratory testing as measures of infection, we leveraged metagenomic next-generation sequencing (mNGS) as an unbiased measure of infection to test the first hypothesis.

Methods:
The Vascular effects of Infection in Pediatric Stroke II
(
VIPS II) study is a North American and Australian prospective cohort study which enrolled children (28 days – 18 years old) with AIS at 22 sites over a 5-year period. We collected data on preceding infection via parental interview and chart abstraction at time of admission. We performed mNGS of serum and throat swabs collected within 72 hours of stroke ictus. To assess for the background spectrum of pathogens, we enrolled and performed mNGS on unmatched stroke-free well controls (WC) and ill controls (IC).

Results:
Between 2017 and 2022, VIPS II enrolled 205 cases, 95 WC, and 47 IC
(Table 1)
. Both serum and throat swab mNGS data was available for 190/205 cases, 91/95 WC, and 27/47 IC. Parents reported clinical infection in the 4 weeks prior to stroke in 47/190 (25%) cases. Chart abstraction identified hospital diagnoses of pre-stroke infection in 69/190 (35%) cases. Typical childhood viral pathogens were identified by mNGS in 26/190 (14%) cases, 9/91 WC (10%), and 9/27 (33%) IC; multiple pathogens in a single patient were rare
(Table 2).
Clinical infection (parental history or chart abstraction) was present in 18/26 (69%) cases with infection detected on mNGS. Overall, infection preceding or coincident with stroke was identified by parental interview, chart abstraction, or mNGS in 46% of cases.

Conclusions:
Almost half of cases had evidence of infection prior to or coincident with AIS, supporting prior literature. Unbiased pathogen detection with mNGS, performed for the first time in children with AIS, detected a variety of common childhood infections in both cases and controls, suggesting that the paradoxical relationship between infection and AIS is not explained by unusual or multiple pathogens. The alternative hypothesis regarding an unusual host immune response to infection in the pathogenicity in AIS should be further explored.
Abstract 137: Association Between Sociodemographic Disparities and Door to Computerized Tomography Time in Patients with Acute Ischemic Stroke Immediately Before and Through COVID-19 Pandemic in the Emergency Department: A Multi-Center Cohort Study
Authors: Khan Maha , CHOU ERIC , Hsieh Yu-Lin , Tiffany Tzeng ChingFang
Published: January 2025

Introduction:
Stroke is the fifth leading cause of death and long-term disability in the United States with an estimated prevalence of 7 million individuals affected as of 2019. Protocols for stroke management established by the American Heart Association (AHA) and American Stroke Association (ASA) include a 25-minute timeframe from door to CT time (DTCT). Adapting to challenges during the COVID-19 pandemic likely increased the DTCT in acute stroke patients from various sociodemographic backgrounds.

Methods:
We aimed to identify factors affecting the DTCT time for a cohort of over 23,000 patients between January 2018 and August 2022. The primary endpoint was DTCT ≤25 minutes upon arrival to hospital for all patients suspected of acute ischemic stroke. Race and ethnicity were self-reported.

Results:
We have identified patient race and post-COVID timing of care as two factors with statistically significant effects on DTCT time. 4,468 patients (19.1%) had DTCT times less than or equals to 25 minutes, and 16,464 patients (70.5%) had DTCT times more than 25 minutes. Patients in the pre-COVID, COVID, and post-COVID phases were 6,852 (29.3%), 13,593 (58.2%) and 2,919 (12.5%), respectively. In our cohort, Black (OR 1.35; 95% CI 1.23-1.49) and Asian patients (OR 1.33; 95% CI 1.01-1.74) were more likely to have DTCT >25 minutes compared to White patients. Hispanic patients (OR 1.20; 95% C1 1.07-1.34) were more likely to have DTCT >25 minutes compared to non-Hispanics. Patients presenting during COVID (OR 1.45; 95% CI 1.34-1.57) and post-COVID period (OR 1.46; 95% CI 1.30-1.65) were more likely to have DTCT >25 minutes compared to the pre-COVID period.

Conclusion:
Therefore, we demonstrated a discrepancy in DTCT time for acute ischemic stroke patients based on their race and ethnic population. We also observed an increase in DTCT time after the start of COVID-19 which has persisted after the pandemic. These diverse factors highlight the complex interplay of logistical, organizational, and healthcare challenges that have influenced DTCT time. Identifying disparities can help address inequities and ensure that all patients, regardless of background, receive timely care.
Abstract 138: A Real-World Pilot for Diagnostic Yield of Cardiac CTA vs Echocardiography in Acute Ischemic Stroke
Authors: Chakravarthula Nitin Ramanujam , Milani Marcus , Tessmer Megan , Staugaitis Abbey , Akimoto Kai , Markowitz Jeremy , Kalra Rajat , Nijjar Prabhjot , Streib Christopher
Published: January 2025

Introduction:
Echocardiography, the current gold standard for evaluating cardioembolic sources of acute ischemic stroke (AIS), is relatively low yield, not readily available at all hospitals, and may delay treatment and disposition. Cardiac CT angiography (CCTA) can also be used to identify cardioembolic sources of stroke. Many prior studies of CCTA in AIS have been enriched with a patient population most likely to have embolic stroke and/or large vessel occlusion. We report the preliminary results of a pilot study assessing the utility of CCTA in the routine evaluation of all AIS and TIA stroke patients.

Methods:
In 2024, we integrated CCTA into the standard of care diagnostic evaluation of patients with AIS and TIA in addition to routine echocardiography (TTE or TEE). CCTA was obtained for all AIS patients when possible, but limitations included scanner availability, cardiology availability, and CT tech training. CCTA could be integrated directly into the stroke code imaging (i.e. combined with CT Angiograms of the Head/Neck utilizing a single contrast bolus) or obtained as a standalone study. The patient’s demographics, stroke characteristics, and type of CCTA obtained (integrated vs standalone) were reported using descriptive statistics. To assess the diagnostic yield of CCTA we analyzed: 1) the number of times echocardiography changed the stroke etiology and 2) the number of times CCTA changed the stroke etiology (by TOAST criteria). In addition, we studied how often echocardiography or CCTA findings changed management. We tested statistical significance using McNemar's mid P-test.

Results:
Our study population consisted of 88 patients with the final diagnosis of AIS or TIA. The median age was 70 IQR: 65-80, female 48.9%, median NIHSS: 2.5, IQR: 0-9, AIS 70 (79.5%). (Table 1). Echocardiography changed the diagnosed stroke etiology in 1 (1.1%) of patients, CCTA changed the diagnosed stroke etiology in 6 (6.8%) of patients (p=0.07). Echocardiography changed management in 1 (1.1%) of patients, whereas CCTA changed management in 10 (11.4%) of patients (p<0.01) (see Table 2 for detailed CCTA findings).

Conclusions:
In our real-world pilot study, CCTA more commonly changed clinical management than echocardiography (11.4% vs 1.1%). Further studies of the diagnostic yield of routine CCTA in patients with AIS and TIA are warranted.
Abstract 142: Rural Disparities in Access to Mechanical Thrombectomy in the Deep South
Authors: Gropen Toby , Beasley Mark , Gazi Melissa , Kamal Shaila , Minor Michael , Floyd Alice , Ross Tabatha , Gray Jamie , Crawford William , Varner Gary , Mittman Brian , Ivankova Nataliya
Published: January 2025

Introduction:
Mechanical thrombectomy (MT) dramatically improves the outcome for patients with acute ischemic stroke due to large vessel occlusion (LVO). There are racial and socioeconomic disparities in access to MT. In addition, while thrombectomy-specific data are limited, there are clear urban-rural disparities in access to acute stroke care.

Hypothesis:
We hypothesized that in a rural state in which the Emergency Medical System (EMS) routes all suspected stroke patients to the nearest available stroke center of any level, there would be a significant association between rural LVO patient location and lower rates of MT.

Methods:
As part of an ongoing statewide stroke system implementation initiative, Stroke STAT, we prospectively collected data on patients presenting to EMS with suspected stroke due to LVO from 4/30/22 to 10/9/23. As of March, 2023, the Alabama acute stroke system included 10 centers performing thrombectomy (including Comprehensive Stroke Centers (Level 1) and Thrombectomy capable Stroke Centers (Level 2a) out of 81 hospitals in the stroke system. All thrombectomy performing hospitals are located in urban areas, as shown in the
Figure
. We collected zip and rural-urban commuting area (RUCA) codes of initial EMS contact, age, sex, ethnicity, race, initial NIHSS score, reperfusion treatment rates with thrombolysis or MT, and whether the patient was transferred from one hospital to another in the acute period (transferred). Differences were assessed using Chi-squared, t-test and the appropriate non-parametric methods at 0.05 significance.

Results:
There were 2,692 patients with suspected stroke due to LVO in the study period, including 1,921 with urban and 771 with rural point of initial EMS contact. There were 497 patients with LVO, including 293 (59%) who underwent MT. As shown in
Table 1
, there were no differences in rates of MT by age, sex, ethnicity, or race. As shown in
Table 2
, rural and urban patients had equal access to tPA, but rural patients were less likely to receive MT 80/179 (45%) vs. 213/318 (67%) (p<0.0001).

Conclusions:
In a large cohort from a rural state, we found that rural patients encountered by EMS with stroke due to large vessel occlusion have similar rates of treatment with thrombolytic therapy but significantly less access to mechanical thrombectomy compared to urban patients. Stroke systems of care need to evolve to improve rural access to mechanical thrombectomy.
Abstract 147: Telestroke Network Mapping: An Update of the World Landscape for Remote Stroke Care
Authors: Saleh Velez Faddi , Tunkl Christine , Agarwal Ayush , roushdy tamer , Ullberg Teresa , Carbonera Leonardo , Ciopleias Bogdan , Yusof Khan Abdul Hanif Khan , Heldner Mirjam , Khan Maria , Alet Matias , Matuja Sarah , ramage emily , Lagos Javier , Mosconi Maria Giulia , Katsanos Aristeidis , Li Linxin , Gerner Stefan , zuurbier susanna , Law Zhe Kang , Elkady Ahmed , Minhas Jatinder , Sampaio Gisele , Ranta Anna
Published: January 2025

Background:
Telestroke has proven efficacy in improving clinical outcomes by providing rapid access to specialized stroke care, particularly in remote areas. However, the global implementation of telestroke networks remains uneven, with limited data on their structure and coverage outside of high-income countries (HICs).

Objective:
This study aimed to provide a comprehensive overview of the global landscape of telestroke networks, highlighting disparities and underscoring the need for universal guidelines. We aimed to map the global telestroke landscape, characterize existing networks, and identify disparities in access, technological adoption, and quality monitoring practices across different regions.

Methods:
We conducted a three-tiered identification process involving engagement with national stroke experts, stroke societies, and international authorities, supplemented by extensive literature and internet searches to identify providers involved in telestroke networks worldwide. A detailed 39-question survey was distributed to the leaders of identified telestroke networks, assessing their structural characteristics, operational processes, and quality monitoring practices.

Results:
A total of 254 telestroke networks were identified across 67 countries (Figure 1), with 69% located in HICs. The response rate to our survey was 34%, with 88 networks from 31 countries providing detailed data. Our findings reveal significant disparities in the establishment and operation of telestroke networks. HICs predominantly host large, well-established networks, with robust technological infrastructures and comprehensive quality monitoring. In contrast, networks in low- and middle-income countries (LMICs) are fewer, smaller, and often lack advanced technology and standardized quality assurance measures. Notably, 87% of networks established within the last three years are located in non-HIC regions, signaling a shift toward broader global implementation.

Conclusion:
This study provides one of the most comprehensive global mappings of telestroke networks to date, uncovering significant disparities in access, resources availability (Figure 2) and quality monitoring practices. While telestroke networks are expanding into LMICs, there remains a critical need for universally applicable guidelines that can be adapted to diverse resource settings.
Abstract 2: Endovascular thrombectomy plus intravenous thrombolysis versus endovascular thrombectomy alone in patients with large core infarct
Authors: Elfil Mohamed , Abbas Abdallah , Fountain Hayes , Abdul-Hamid Ebrahem , Aladawi Mohammad , Najdawi Zaid , Elmashad Ahmed , Ghaith Hazem , Dawod Giana , Malik Amer , Al-Mufti Fawaz
Published: January 2025

Background:
For patients meeting eligibility criteria, endovascular thrombectomy (EVT) remains the gold standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). A few randomized trials have investigated EVT in AIS-LVO with large ischemic infarcts (LII). We studied the impact of intravenous thrombolysis (IVT) on the outcomes of EVT in those patients.

Methods:
We conducted a meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the Cochrane Handbook of Systematic Reviews and Interventions. We searched 4 databases (PubMed, Scopus, Web of Science, and Cochrane CENTRAL) from inception till June 11, 2024. We performed our analysis with RevMan utilizing a pooled risk ratio (RR) with a 95% confidence interval (CI).

Results:
Three studies with a total of 1,927 patients investigated EVT with and without IVT in AIS-LVO patients with LII. All 3 studies reported on modified Rankin Scale (mRS) score of 0-2 at 3 months, (831 patients in the EVT+IVT group and 1,049 patients in the EVT-only group), with a statistically significant difference favoring EVT+IVT (RR: 1.48, 95%CI: 1.27, 1.72, P< 0.00001). Two studies reported on mRS score of 0-3 (699 patients in the EVT+IVT group and 831 patients in the EVT-only group). The analysis also favored EVT+IVT (RR: 1.25, 95%CI: 1.11, 1.41, P= 0.0003). Two studies reported on early neurological improvement (ENI) after 24 and 36 hours (699 patients in the EVT+IVT group and 831 patients in the EVT-only group). The analysis revealed a statistically significant difference favoring EVT+IVT (RR: 1.16, 95%CI: 1.01, 1.34, P= 0.03). Two studies reported on successful reperfusion after EVT with no statistically significant difference between the two groups (RR: 1.01, 95%CI: 0.88, 1.16, P= 0.86). All 3 studies reported on mortality (831 patients in the EVT+IVT group and 1,049 patients in the EVT-only group), and the analysis favored EVT+IVT (RR: 0.88, 95%CI: 0.77, 1, P= 0.04). Lastly, our subgroup analysis did not favor any of the two groups across different types of intracranial hemorrhage (ICH).

Conclusion:
Our results indicate a beneficial impact of IVT on the clinical outcomes of EVT in AIS-LVO patients with LII regarding functional outcomes and early neurological improvement. IVT was also associated with a lower mortality rate but not with an increased risk of ICH. More studies of larger sample sizes are needed to corroborate such results.
Abstract 47: Rapid prehospital diagnosis of intracerebral hemorrhage in acute stroke patients by measuring GFAP on a point-of-care platform (DETECT study)
Authors: Kalra Love-Preet , Zylyftari Sabina , Blums Kristaps , Barthelmes Stephan , Baum Hannsjoerg , Meckel Stephan , Heilgeist Andreas , Luger Sebastian , Foerch Christian
Published: January 2025

Introduction:
The rapid identification of acute intracerebral hemorrhage (ICH) in patients with symptoms of acute stroke is decisive for prehospital triage and initiation of targeted therapies. Glial fibrillary acidic protein (GFAP) is a highly promising blood biomarker indicating ICH. In this study we investigated the potential of a new GFAP point-of-care test for rapidly distinguishing ICH from ischemic stroke (IS) and stroke mimics in the

prehospital phase.

Methods:
Acute stroke patients admitted within 6 hours of symptom onset were enrolled. Blood samples were collected in the prehospital phase. Plasma GFAP measurements were performed on the i-STAT Alinity® (Abbott) device (duration of analysis 15 min). The gold standard was the final diagnosis at hospital discharge categorized as ICH, IS or stroke mimics.

Results:
353 patients were enrolled (mean age 74.6 ±13.4, years). GFAP concentrations were strongly elevated in ICH patients (n=76; median 208 pg/mL [IQR 60 – 5907]) compared to IS patients (n=258; median 30 pg/mL [IQR 29-51]) and stroke mimics (n=19; median 48 pg/mL [IQR 29-97]; p<0.001). Patients with anticoagulation-associated ICH had higher GFAP values compared to non-anticoagulated patients. Cut-off points were determined allowing diagnosis of ICH across distinct age groups with high positive predictive values (90.0 to 95.5%). Vice versa, in patients with a moderate to severe neurological deficit (NIHSS > 6), GFAP values below 30 pg/mL ruled out ICH with a negative predictive value of 100.0 %.

Conclusion:
Prehospital GFAP measurements on a point-of-care platform allow a reliable identification of patients with ICH. This opens the potential for optimized triage as well as the initiation of blood pressure lowering therapy and anticoagulation reversal in earlier time frames.
Abstract 49: Genomic Profiling and Risk of Intracerebral Hemorrhage in Patients with Atrial Fibrillation on Apixaban
Authors: Clocchiatti-Tuozzo Santiago , Rivier Cyprien , Huo Shufan , Gilmore Emily , Shoamanesh Ashkan , Kamel Hooman , Murthy Santosh , Ohno-Machado Lucila , Sheth Kevin , Gill Thomas , Falcone Guido
Published: January 2025

Introduction:
Intracranial hemorrhage (ICH) is the most severe adverse effect of anticoagulation in atrial fibrillation (AF) patients. Hypertension, diabetes, hyperlipidemia, and chronic kidney disease are well-known cardiovascular risk factors for ICH. However, the relationship between the polygenic profiles (PP) of these risk factors and ICH risk in AF patients on anticoagulation remains unclear. We hypothesize that adverse PP increases the risk of ICH in AF patients on anticoagulation.

Methods:
We conducted a prospective genetic association study within
All of Us
. Participants over 50 with a history of AF treated with apixaban (the most widely used anticoagulant in this population) and no history of ischemic stroke or ICH were included. We calculated the polygenic profile (PP) by combining five standardized polygenic risk scores for systolic blood pressure, type 2 diabetes, low- and high-density lipoproteins, and glomerular filtration rate, along with
APOE
epsilon 4 and 2 genotypes. These were based on data from recent genome-wide association studies, with
APOE
genotypes determined by variants
rs429358
and
rs7412
. We categorized PP into three risk groups using a standard approach: favorable (<20%), neutral (20%-80%), and adverse (>80%). The outcome was incident ICH (new intraparenchymal, subdural, or subarachnoid hemorrhage) after apixaban initiation.

Results:
A total of 2,088 participants were included in the study (mean age 71 years, 953 [45%] female and 1,743[83%] of European ancestry). After a median follow-up of 2.9 years, 26 participants sustained an ICH (cumulative incidence:1.5%[95%CI:1.00–2.20], Figure 1). Multivariable Cox proportional hazards models showed that when compared to patients with a favorable PP, those with an adverse PP had a more than three-fold increase in the risk of ICH (HR:3.38,95%CI:1.09–10.50,
p
-trend=0.005). Polygenic information improved the discrimination of risk prediction scores for ICH (c-statistics of 0.68 and 0.75 for models without and with genomic information, respectively (
p
=0.01, Figure 2).

Conclusions:
Our results show that among AF patients on apixaban, an adverse PP for key cardiovascular risk factors significantly increases the risk of ICH compared to those with a favorable PP. Additionally, incorporating PP data enhances the predictive power of clinical prediction scores for ICH. These findings support further research into whether polygenic profiling can improve clinical decision-making in AF patients.
Abstract 64: Optimized Transient Ischemic Attack Management Workflow Improves Administrative and Cost Efficiency
Authors: Lee Eun Hye , Chaudhary Hira , Vanderhye Vanesa , urumov andrej , Demaerschalk Bart , Dumitrascu Oana
Published: January 2025

Introduction:
Previous studies have established the safety and economic benefits of outpatient Transient Ischemic Attack (TIA) management, highlighting reduced expenses for outpatient evaluation. This context underscores the potential advantages of refined outpatient TIA management, a focus of our study, through the implementation of a novel expedited outpatient TIA workflow and assessment of its economic, administrative and clinical impact.

Methods:
We implemented a novel TIA pathway including streamlined assessments by emergency department (ED) physicians, a structured expedited set of diagnostic tests and outpatient follow-up with vascular neurologists within 48-72 hours of ED presentation. We conducted a retrospective cost-efficacy analysis, contrasting two phases: pre-implementation (standard ED-to-hospital admission TIA workflow from May 1, 2020 - December 31, 2020) and post-implementation (ED-to- outpatient TIA workflow from May 1, 2021 - December 31, 2021). We also compared the clinical outcomes of patients with a final diagnosis of TIA or minor ischemic stroke syndrome from the implementation cohort (May 2021-May 2022) with those from an ABCD2-matched inpatient TIA cohort evaluated in the pre-implementation period (2017-2021).

Results:
The newly implemented outpatient TIA workflow resulted in a 7% decrease in admissions to hospital observation status, 14.8% reduction in hospital admissions, whereas ED discharge rates rose by 20.4%. Within 8 months, these changes equated to 21 fewer hospitalizations or admissions, reducing costs by approximately $103,320 (Figure1). Laboratories, diagnostic imaging, and neurology evaluations were completed faster in the inpatient pathway.

Both pathways had similar vascular risk factors and outcomes regarding final diagnosis, - diagnostic testing achieved, preventative treatments prescribed, stroke/TIA recurrences, re-admissions, TIA-related morbidity and mortality, and related ED return visits (Table 1).

Conclusion:
The deployment of an optimized outpatient TIA management workflow at Mayo Clinic Arizona had demonstrated improved administrative and cost efficiency, with similar clinical outcomes as inpatient TIA pathway. This investigation corroborates the efficacy of workflow enhancements in outpatient TIA settings and suggests a scalable model for analogous strategies in other medical centers.