bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP173: Mexican Americans Less Likely to Return to Work Following Stroke
Authors: Skolarus Lesli , Wing Jeffrey J , Morgenstern Lewis B , Lisabeth Lynda D
Published: July 2021

Introduction:
Lost earnings are the largest driver of the projected $2.2 trillion in stroke costs over the next 4 decades. Mexican Americans (MA) are more likely to have a working age stroke and suffer greater post-stroke disability than non-Hispanic whites (NHW). Thus, we explored ethnic differences in post-stroke return to work and whether sociodemographics and stroke severity contribute to ethnic differences.

Methods:
Ischemic stroke patients were identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) study from August 2011-December 2013. Employment status was obtained at baseline and 90-day interviews conducted with patients or proxies. Sequential logistic regression models were built to assess ethnic difference in return to work after accounting for: 1) age (<65 vs ≥65), sex; 2) 90-day NIH stroke score, and 3) education (<high school vs. ≥high school).

Results:
Of the 729 MA and NHW stroke survivors who completed the baseline interview, 197 (27%) were working at the time of their stroke of which 125 completed the 90-day outcome interview. There were no ethnic differences in sex or the proportion over the age of 65. MAs had less education (5% vs. 24% college graduate, p<0.01) and greater median 90-day stroke severity (2 vs. 1, p=0.02) than NHWs. Forty-nine (40%) stroke survivors returned to work. MAs were less likely to return to work (OR= 0.45, 95% CI 0.22-0.94) than NHWs. This difference remained after accounting for age and sex (OR=0.45, 95% CI 0.21-0.94). The ethnic difference was attenuated and became non-significant after adjusting for stroke severity (0.59, 95%CI 0.24-1.24) and further attenuated after accounting for education (0.85, 95% CI 0.32, 2.22). In the fully adjusted model, lower stroke severity and higher education were associated with return to work.

Conclusion:
MAs are less likely to return to work after stroke than NHWs. This finding is important given that MAs are younger and poorer at the time of their stroke suggesting a crucial public health problem. Future work should consider including return to work as part of patient centered outcomes and efforts to optimize stroke recovery.
Abstract WP188: Clinical Severity and Timing of Onset for Acute Ischemic Stroke and TIA During Oral Anticoagulation Using Warfarin or Non-vitamin K Antagonist Oral Anticoagulants
Authors: Seki Kenta , Koga Masatoshi , Yamagami Hiroshi , Arihiro Shoji , Nagatsuka Kazuyuki , Minematsu Kazuo , Toyoda Kazunori
Published: July 2021

Background and Purpose:
In Japan, four non-vitamin K antagonist oral anticoagulants (NOACs) became available in clinical use for prevention of stroke in patients with non-valvular atrial fibrillation (NVAF) between 2011 through 2014. The aim of this study is to determine underlying characteristics and ischemic stroke/TIA features of patients taking NOACs or warfarin, a vitamin K antagonist (VKA) prior to stroke/TIA.

Methods:
We enrolled oral anticoagulant (OAC) users for NVAF, who were admitted to our stroke center for acute ischemic stroke/TIA between March 2011 and June 2015 (ClinicalTrials.gov Identifier: NCT02251665).

Results:
381 OAC users who developed stroke/TIA were studied. Of these, 63 patients took NOACs [23 women, 77±9 years, dabigatran in 33 (7 taking higher dosage between two official ones), rivaroxaban in 22 (5), apixaban in 8 (3), edoxaban in none] and 318 took VKA (143 women, 79±8 years). There were no significant differences between NOACs users and VKA users in sex, age, CHADS2 score (median 3[IQR 2-4] vs. 3 [2-4]), history of ischemic stroke/TIA (57% vs. 51%) and prior antiplatelet use (25% vs. 24%). Admission NIHSS score tended to be lower (3 [1-15] vs. 7 [2-20], p=0.076) and discharge NIHSS score was lower (1[0-5] vs 3[1-13], p=0.032) in NOACs users. Discharge mRS (2 [1-4] vs. 3 [1-4]) and mortality during hospitalization (5% vs. 4%) were similar between two groups. A different point was timing of stroke/TIA after initiating OAC ; 6% of NOAC users developed events within 14 days and 32% within 3 months, whereas 4% and 7% of VKA users did, respectively (p<0.001). Congestive heart failure tended to be more common in NOACs users developing events within 3 months than those developing events later (43% vs. 19%, p=0.070).

Conclusions:
NOACs users tended to show milder neurological deficits than VKA users during acute hospitalization of ischemic stroke/TIA, although discharge mRS was similar. NOACs users often developed stroke/TIA within the initial 3 months after initiating OAC, particularly between 14 days and 3 months. One would take special care of ischemic events during early months after initiating NOACs.
Abstract WP200: Post-operative Infection Does not Increase Risk of Post-operative Stroke: Analysis From a Nationwide Quality Initiative Program
Authors: Kummer Benjamin R , Hazan Rebecca , Kamel Hooman , Merkler Alexander E , Willey Joshua Z , Middlesworth William , Yaghi Shadi , Elkind Mitchell S , Boehme Amelia K
Published: July 2021

Introduction:
Infection has been described as a trigger for acute ischemic stroke, but the relationship between postoperative infection and the risk of postoperative stroke is unclear. We investigated the association between postoperative infection and stroke using the American College of Surgeons National Surgical Quality Initiative Program (NSQIP) database.

Hypothesis:
Postoperative infection is associated with an increased risk of postoperative stroke.

Methods:
We used the NSQIP database to identify all patients who underwent surgery between the years of 2000 and 2010 and developed a postoperative stroke within 30 days of surgery. The group was further stratified according to the presence of infection preceding stroke. Using a logistic regression model adjusted for age, race, sex, medical comorbidities, surgical type, and dichotomized functional status, we compared the risk of stroke in patients with and without preceding infections, and investigated the risk of infection following stroke.

Results:
729,886 surgical patients were identified, of whom 2,703 (0.3%) developed postoperative stroke. 848 (0.12%) patients developed both postoperative stroke and infection. Among patients who had postoperative stroke, 100 (3.7%) had developed an infection prior to developing a stroke. Patients with infection prior to stroke had a lower risk of stroke than patients who did not develop infection prior to stroke (adjusted odds ratio [OR] 0.25, 95%CI 0.20-0.32). 748 patients (0.1%) developed an infection after having a postoperative stroke. These patients had a higher risk of infection (incidence rate ratio 2.76, 95%CI 2.57-2.97) and a higher odds of infection (adjusted odds ratio [OR] 3.47, 95%CI 3.18-3.78) than patients who did not have a stroke.

Conclusions:
We found that the presence of a preceding infection was associated with a low risk of postoperative stroke in a large surgical inpatient sample. Although the total number of strokes may have been under-reported, these results conflict with other studies that report that infection is a trigger for ischemic stroke. Further analyses using more granular data are needed to investigate the relationship between postoperative infection and the risk of postoperative stroke.
Abstract WP258: Effective Neuroprotection After Clinically Relevant Delay Using Intra-arterial Recanalization Plus Perivascular Hypothermia: Novel Approach to an Old Problem
Authors: Lamb Jessica , Rajput Padmesh , Nezhad Mani , Kothari Shweta , Schlick Konrad , Lyden Patrick
Published: July 2021

Background:
Therapeutic hypothermia (TH) shows considerable promise in laboratory ischemic stroke models. Delayed therapy confounds trials of any neuroprotectant, as well as inadvertent inclusion of non-recanalized patients in most clinical trials. The advent of intra-arterial thrombectomy (IAT) offers the opportunity to combine neuroprotection with controlled, documented recanalization. In contrast to prior rodent models using surface cooling techniques, clinical TH often uses endovascular cooling technology. We modeled delayed recanalization and simulated endovascular cooling in a rodent model.

Method:
A perivascular catheter was implanted retroperitoneally in 8 male, 300g, Sprague Dawley rats 6 days prior to a 4h heat blunted nylon filament MCAo. At reperfusion animals were randomized by an investigator outside the laboratory to brain temperature 33°C or 37°C (n=4 per group) monitored by a temporalis muscle needle thermistor. Saline pumped through the closed loop cooling circuit convectively changed vena cava and body core temperature. After 2h the circuit was disconnected and the animals returned to cages. Bederson 3-point neuroscores were obtained 4h and 24h after occlusion. After 24 hours, rats were sacrificed for TTC exclusion.

Results:
Perivascular cooling achieved very rapid target temperature (< 15min) and maintained temperature within 0.5°C for 4 hours. Mean±SD neuroscores were 2.5±0.5 after 4h MCAo; 1.8±0.4 at 24 hours (NS between groups). TTC exclusion lesions (% ipsi hemisphere, mean±SE ) were smaller after TH: 15±3 vs 30±4 (p<0.002, t-test).

Conclusions:
A novel perivascular cooling catheter faithfully simulates endovascular cooling in a rat MCAo model. Filament removal simulates recanalization as would occur during IAT. The combination of recanalization after 4h MCAo and only 2h TH yielded highly significant neuroprotection, with a 50% treatment effect. Future clinical trials may consider combining brief, deep TH with IAT.
Abstract WP307: Social Factors That influence Follow-up in Stroke Clinic
Authors: Osteraas Nicholas , Song Sarah , Ouyang Bichun , Lee Vivien , Cherian Laurel , Conners James , Diebolt Elizabeth , Cutting Shawna
Published: July 2021

Background and Objective:
Follow-up in outpatient stroke clinic after hospitalization for ischemic stroke is an integral aspect of the management of stroke patients. This study sought to investigate predictors of risk of not following up in outpatient stroke clinic.

Methods:
We reviewed consecutive acute ischemic stroke patients admitted to an urban academic medical center from 4/2013 to 4/2014. On discharge, all stroke patients except those going to long term acute care received notice of scheduled follow-up stroke clinic appointment date; they also received a phone call 2-3 days prior to the appointment. Univariate analysis examined the relationship between race, ethnicity, marital status, insurance type, and living arrangement with stroke clinic follow up status. Multivariate analysis was performed with logistic regression controlling for significant factors found in our previous study including discharge location, previously documented diagnosis of depression and outpatient physicians at same institution.

Results:
Among 355 acute ischemic stroke patients, 49% were female and mean age was 65 years. The follow-up rate in stroke clinic was 53%. In univariate analysis, race, ethnicity, marital status, employment status, and insurance type (i.e. self-pay) were not significantly associated with compliance with stroke clinic follow-up. In logistical regression, patients who lived alone were significantly less likely to follow up in stroke clinic compared with those living with family (OR=2.18, 95% CIs=[1.18, 4.03], p=0.01) as were patients who were depressed, (OR=5.99, CIs =[1.47, 24.4], p=0.01) who did not have other doctors at the same institution, (OR=2.23 CIs = [1.31, 3.70] p=0.003] and who were discharged to a facility other than home or acute rehab (OR=4.38, CIs [1.74, 11.03], p=0.003).

Conclusions:
Institutions taking care of patients with ischemic strokes should be aware that certain patients may be less likely to follow up in clinic and merit additional efforts in order to ensure that they are not lost to follow up.
Abstract WP312: The Association of Chronic Kidney Disease (CKD) With 30-day and 1-year Post Ischemic Stroke Mortality and Rehospitalization: Get With the Guidelines (GWTG) Stroke
Authors: El Husseini Nada , Fonarow Gregg C , Smith Eric E , Ju Christine , Schwamm Lee H , Hernandez Adrian F , Schulte Phillip , Xian Ying , Goldstein Larry B
Published: July 2021

Background:
The extent to which CKD is associated with 30-day and 1-year post ischemic stroke mortality and rehospitalization rates has not been well studied.

Methods:
Data from 232,236 fee for service Medicare patients admitted with ischemic stroke to 1581 AHA GWTG-Stroke participating hospitals between January 2009 and December 2012 were analyzed. Estimated GFR in mL/min/1.73 m2 was determined based on the MDRD study equation categorized as: no CKD (GFR ≥60); stage 3a CKD (GFR 45-59); stage 3b CKD (GFR 30-44); stage 4 CKD, (GFR 15-29); stage 5 CKD (GFR <15 excluding those on dialysis). Dialysis was identified by ICD-9 codes. Multivariable Cox proportional hazards models adjusted for demographics, medical history, NIHSS, arrival hour, and hospital characteristics were used to determine the independent associations of CKD (reference group those without CKD) with mortality and readmission at 30 days and 1 year.

Results:
After adjustment, 30-days poststroke mortality was highest among those with CKD stage 5 (HR 1.94, 95%CI 1.72-2.18), even after excluding in-hospital mortality and patients discharged to hospice (HR 2.09, 95%CI 1.66-2.63). Unadjusted 1-year mortality and readmission rates were highest among patients on dialysis (Figure). After adjustment, 1-year post-stroke mortality remained highest among patients on dialysis (HR 2.19, 95%CI 2.08-2.31), even after excluding in-hospital mortality and discharge to hospice (HR 2.65, 95%CI 2.49-2.81). For those discharged alive, 30-day and 1-year rehospitalization rates were also highest among patients on dialysis (HR 2.10, 95%CI 1.95-2.26; HR 2.55, 95%CI 2.44-2.66, respectively) as was the 30-day and 1-year composite of mortality and rehospitalization (HR 2.04, 95%CI 1.90-2.18; HR 2.46, 95% CI 2.36-2.56, respectively).

Conclusion:
Among Medicare beneficiaries with acute ischemic stroke, poststroke mortality and rehospitalization varied by CKD stage and were highest among those with advanced CKD.
Abstract WP335: Incidence of Stroke Mimics and Post R-tpa Hemorrhage in the Era of Telemedicine
Authors: Lekoubou Alain , Sin Dong In , Smock Alison , Ozark Shelly
Published: July 2021

Introduction:
The use of r-tPA to treat stroke patient presenting within 4.5 hours of symptoms onset has rapidly expanded with the advent of telestroke. This expansion may further exacerbate the concerns related to treating patients with alternative diagnoses (stroke mimics).

Hypothesis:
Stroke mimics rate is higher in patient treated through telestroke and is associated with a higher rate of hemorrhagic conversion.

Methods:
This is a single center cross-sectional analysis of possible stroke patients treated with r-tPA from January 2013 to October 2014 using retrospective panel review of post-tPA negative imaging (MRI and CT) for diagnoses of stroke mimics and provision of alternative diagnoses. The frequency of stroke mimics was compared between patients treated via telestroke and on-site treated patients. Rate of hemorrhagic transformation was compared between stroke mimics and “actual stroke”.

Results:
Overall 66 (23.3%) stroke mimics were identified including 53 (27.2%) in the telestroke group and 13 (14.8%) in the In-house group (P= 0.033). There was a total 34 (12.0%) hemorrhagic transformation in the entire cohort with 2 (3.0%) occurring in stroke mimics and 32 (14.7%) in those with an established diagnosis of acute infarct (p = 0.019).

Conclusion:
In this single center cohort, the rate of stroke mimics was twice as high in participants treated via telestroke as in on-site treated participants. The rate of hemorrhagic transformation in stroke mimics was lower than in those with stroke.
Abstract WP340: Prevalence and Influence of Chronic Obstructive Pulmonary Disease on Stroke Outcomes in Hospitalized Stroke Patients
Authors: Akinboro Oladimeji , Olorunfemi Odunayo , Holstein Stanley , Pomerantz Daniel , Jesmajian Stephen , Ovbiagele Bruce
Published: July 2021

Background:
COPD recently overtook stroke as the third leading cause of death in the United States. Intriguingly, smoking is an important shared risk factor for both stroke and COPD; COPD patients have baseline cerebral hypoxia and hypercapnia that could potentially exacerbate vascular brain injury; and stroke patients with COPD are at higher risk of aspiration than those without COPD. Yet, relatively little is known about the prevalence of COPD among stroke patients or its impact on outcomes after an index stroke.

Objective:
To assess prevalence of COPD among hospitalized stroke patients in a nationally representative sample and examine the effect of COPD with risk of dying in the hospital after a stroke.

Methods:
Data were obtained for patients, 18 years and older, from the National Inpatient Sample from 2004-2009 (n=48,087,002). Primary discharge diagnoses of stroke were identified using ICD-9 diagnosis codes 430-432 and 433-436, of which a subset with comorbid COPD were defined with secondary ICD-9 diagnoses codes 490-492, 494, and 496. In-hospital mortality rates were calculated, and independent associations of COPD with in-hospital mortality following stroke were evaluated with logistic regression. All analysis were survey-weighted.

Results:
11.71% (95% CI 11.48-11.94) of all adult patients hospitalized for stroke had COPD. The crude and age-adjusted in-hospital mortality rates for these patients were 6.33% (95% CI 6.14-6.53) and 5.99% (95% CI 4.05-7.94), respectively. COPD was independently and modestly associated with overall stroke mortality (OR 1.03, 95% CI 1.01-1.06; p=0.02). However, when analyzed by subtype, greater risks of mortality were seen in those with intracerebral hemorrhage (OR 1.12, 95% CI 1.03-1.20; p<0.01), and ischemic stroke (OR 1.08; 95% CI 1.03-1.13, p<0.01), but not subarachnoid hemorrhage (OR 0.98, 95% CI 0.85-1.13; p=0.78). There were no statistically significant interactions between COPD and age, gender, or race.

Conclusion:
12% of hospitalized stroke patients have COPD. Presence of COPD is independently associated with higher odds of dying during ischemic stroke hospitalization. Prospective studies are needed to identify any modifiable risk factors contributing to this deleterious relationship.
Abstract WP362: Subarachnoid and Subdural Hemorrhages Concomitant to Acute Lobar Intracerebral Hematoma are Markers of Cerebral Amyloid Angiopathy
Authors: Viguier Alain , Cazzola Vanessa , Raposo Nicolas , Patsoura Sofia , Calviere Lionel , Albucher Jean-Francois , Ruidavets Jean-Bernard , Chollet Francois , Larrue Vincent , Cognard Christophe , Olivot Jean-Marc , Bonneville Fabrice
Published: July 2021

Background:
Convexity subarachnoid hemorrhage (cSAH) or subdural Hematoma (SDH) are occasionally described on CT or MRI in the area of acute lobar intracerebral hematoma (ICH). The prevalence and the etiologic significance of this association are not well known.

Hypothesis:
We hypothesized that cSAH and SDH were more frequent in Cerebral Amyloid Angiopathy (CCA)-related lobar ICH.

Methods:
Using our electronic database, we retrospectively reviewed the clinical and MRI characteristics of 165 consecutive patients (mean age 70 ± 13 years) admitted for acute lobar ICH. The presence of cSAH and SDH was assessed by 2 reviewers on a brain MRI performed within 10 days after ICH onset.

Results:
SDH and cSAH were present in respectively 28.5 and 54.5 % of all patients. Among patients with acute lobar ICH meeting the modified Boston criteria for probable CAA, the frequency was 37.5 % (27/72) for SDH and 73 % (53/72) for cSAH, which is significantly higher than among patients with hematoma of other causes ( 21.5 and 39.8 %; p=0.03 and p<0.001 respectively). The association remained significant considering patients meeting the modified Boston criteria for probable or possible CAA versus others causes.

Conclusions:
Using MRI for evaluation of acute lobar ICH, cSAH and SDH were very frequent and associated with CCA. This is consistent with the involvement of leptomeningeal arteries in this disease. The presence of subarachnoid or subdural hemorrhage should be systematically assessed and could be added to diagnostic criteria for CAA.
Abstract WP379: Mode of Arrival Effects tPA Timeliness: a Retrospective Review
Authors: Motz Deb , Moore Tracy , Huey Dicky , Austin Tommye
Published: July 2021

Background:
Baptist Health System (BHS) became Primary Stroke Certified in May, 2009. BHS admits approximately 2,000 stroke patients annually. Applying LEAN methodology and the AHA/ASA Target Stroke Best Practice Strategies, BHS initially obtained the Target Stroke Honor Roll status in 2010 and continues to sustain this status. With the addition of Target Stroke Elite and Elite Plus awards, we have re-focused on our Door-to-Needle (D2N) times. The purpose of this review is to evaluate the effectiveness of our D2N initiative of
<
60 minutes, whether the patient arrives by EMS or Private Vehicle (PV).

Methods:
A retrospective review was conducted of AIS patients who received IV tPA between 2008 and 2014 using GWTG data. The intent of the review was to compare annual results of the mode of arrival (EMS versus PV) and the percent of patients who received tPA with a D2N time of
<
60 minutes.

Results:
Between 2008 and 2014, BHS administered tPA to 688 AIS patients. Of these patients, an average of 84% arrived by EMS and 16% by PV annually. Data revealed that prior to stroke certification 31 patients received tPA. Only one (3.2%) of the 31 patients, who arrived by EMS, received tPA
<
60 minutes. The year BHS became stroke certified tPA was administered to 63 patients. Of those 63, two patients received tPA
<
60 minutes; one arrived by EMS (14.3%) and one arrived by PV (1.8%). Since the implementation of Target Stroke Best Practice Strategies in 2010, tPA administration ranged from 113 - 127 patients the following years. The D2N goal of
<
60 minutes was achieved an average of 53.6 % when arriving by EMS and an average of 36.3% when arriving by PV. Although arrival modes did not vary significantly, there was a noted increase in D2N time of
<
60 minutes in patients arriving by PV between 2013 at 22.7% and 2014 at 47.4%

Conclusion:
Patients arriving by EMS have historically had a faster tPA administration time than patients arriving by PV. There is a marked improvement in D2N times in patients arriving by PV with the introduction of the Target Stroke Elite and Target Stroke Elite Plus initiative and a refocus on D2N time in this hospital system.
Abstract WP397: CT Stroke Code Dramatically Reduces Door-to-needle and Door-to-groin Times for Reperfusion Therapy
Authors: Sanjuan Estela , Rubiera Marta , Santana Katherine E , Giron Pilar , Muchada Marian , Boned Sandra , Ribo Marc , Rodriguez-Luna David , Pagola Jorge , Sanchis Mireia , Juega Jesus , Flores Alan A , Molina Carlos A
Published: July 2021

Background and aim:
Shortening door-to-needle (DTN) time is one of the major goals of reperfusion therapy. Several strategies have been proposed to shortening DTN including fast track emergency room (ER) protocols, and tPA administration in the CT suit. A comprehensive Stroke Code (SC) pre-notification leading to a direct transfer of patients to the CT suit, bypassing ER, may dramatically reduce DNT. To ensure quality of care, and continuity of care in this process, the role of an expert stroke nurse may also be essential. We aimed to assess the impact of SC and direct transfer to CT (CT-SC) on DTN and door-to-groin (DTG) time and to evaluate the role of an expert stroke nurse to ensures the continuity of patient′s care from admission.

Methods:
Forty-four CT-SC patients were compared to 81 contemporary SC patients who underwent reperfusion treatment first evaluated at ER. Once CT-SC was activated, and information provided was clear, patient was directly transfer from ambulance to CT. An expert stroke unit nurse wait for the patient in the CT suit. If SC was not activated, patient unstable or information was incomplete or unclear, the patient was first transfer to the ER before CT. Clinical data and response times were evaluated. The primary outcome was the reduction of DTN time to <20minuntes, and DTG to <60min, and secondary outcome security (Symptomatic ICH and mortality) and feasibility (lack of incidents) of the CT-SC protocol.

Results:
In the CT-SC group 52.2% patients were treated in <20min vs 5.4% in the SC group (p<0.001). CS-CT protocol significantly reduces DTG times, as DTG was shorter in the CS-CT group (n=11; 64.7%) compared to CS group (n=6; 16.7%), p=0.001. Regarding security of the protocol, no differences were found between groups: SICH was present in 3 (3%) patents in CS group, and in 3 (9%) patients in CT-SC group; Seven patients (8.6%) died in CS group, and 2 patients (6,2%) in CT-SC group. Regarding feasibility no major incidents were found in the stroke unit while expert nurse was attending a CS-CT patient. Nurse mean time out of the stroke unit was 28+/-12min.

Conclusions:
CT-SC protocol markedly reduces DTN and DTG times, increasing the number of patients treated bellow <20 and <60 minutes time-window respectively. Moreover, CT-SC seems to be feasible and safe.
Abstract WP413: Recurrent Acute Ischemic Stroke in a Child on Novalung iLA® Treated Twice With Mechanical Clot Retrieval: a Case Report and Review of the Literature
Authors: Buompadre Maria C , Andres Kathleen , Slater Lee-Anne , Mohseni-Bod Hadi , Guerguerian Ann-Marie , Branson Helen , Laughlin Suzanne , Armstrong Derek , Pereira Vitor , Moharir Mahendranath , deVeber Gabrielle , Humpl Tilman , Jean-St-Michel Emilie , Ichord Rebecca , Askalan Rand , Krings Timo , Dlamini Nomazulu
Published: July 2021

Background:
The American Heart Association recently amended their acute stroke guidelines to add recommendation for mechanical thrombectomy with stent retrieval in adults with proximal arterial occlusions. These guidelines further advise that stent retrieval may be reasonable for patients under age 18.

Case:
We present the case of an 8 year old girl who demonstrated acute stroke symptoms on two occasions, 4 days apart, while therapeutically anticoagulated on Novalung iLA® . Thrombectomy was offered in both instances since the patient had a severe persistent deficit (NIHSS > 6), a clot in a proximal large artery, the procedure could be facilitated within 6 hours of symptom onset, anticoagulation precluded her from tPA administration, and CT showed uninfarcted brain tissue distal to the thrombus. On both occasions, thrombi were non-occlusive and successfully recovered with a Trevo stent retrieval device. No hemorrhagic complications were observed despite continuing anticoagulation during and between the procedures. Post-procedural assessment found respective decreases in the patient’s NIHSS score from 10 to 4 and 12 to 7.

Discussion:
Treatment indications and immediate clinical benefits in our case are consistent with other thrombectomy cases reported. However, publication bias and the heterogeneity of paediatric cases make drawing conclusions about the safety and efficacy of thrombectomy in children difficult. Anticipating that recent changes to adult stroke guidelines would likely prompt paediatric stroke care providers to consider thrombectomy for their patients, our institution developed consensus-based guidelines for thrombectomy prior to the index case. This guideline served to facilitate multidisciplinary intervention and manage foreseeable risks.

Conclusions:
Thrombectomy in our case was safely performed and resulted in improvement in immediate neurological outcomes. This case demonstrates the importance of engaging in partnerships with paediatric stroke providers and neurointerventionalists to establish consensus-based guidelines before offering thrombectomy to a child.
Abstract WP50: MRI Biomarkers in Acute Stroke: Addition of Clinical Parameters Improves the Identification of Patients Eligible for Thrombolysis
Authors: Madai Vince I , Wood Carla N , Galinovic Ivana , Grittner Ulrike , Piper Sophie K , Revankar Gajanan S , Martin Steve Z , Zaro Weber Olivier , Moeller-Hartmann Walter , von Samson-Himmelstjerna Federico C , Heiss Wolf-Dieter , Ebinger Martin , Fiebach Jochen B , Sobesky Jan
Published: July 2021

Introduction:
Patients with unknown time from stroke onset, e.g. in wake-up stroke, are not eligible for thrombolyic treatment. Relative signal intensities (rSI) of DWI and FLAIR MRI are biomarkers for eligibility for thrombolysis, but have shown heterogeneous results to date. We investigated if the addition of available clinical parameters improves the prediction of the thrombolysis time window in patients with acute stroke.

Hypothesis:
Inclusion of clinical parameters improves the prediction of the thrombolysis time window by quantitative MRI biomarkers

Methods:
Patients from two centers with proven stroke and stroke-onset <12 hours were included in a retrospective design. The DWI lesion was segmented and overlaid on ADC and FLAIR maps. rSI mean and standard deviation (std) were calculated: mean VOI value/mean value of the unaffected hemisphere. Prediction of the thrombolysis time window was evaluated by the area-under-the-curve (AUC) of receiver-operating-characteristic (ROC) curve analysis. Age, NIHSS, MRI field strength, lesion size, vessel occlusion and Wahlund-Score were included in adjusted and stratified regression models.

Results:
82 patients were included. In the unadjusted analysis, DWI-mean and -std (AUC: 0.86, 0.87) performed best. Adjustment for clinical parameters significantly improved the performance of FLAIR-mean (0.87) and DWI-std (0.91). The best performance was found for the final stratified and adjusted models of DWI-std (0.94) and FLAIR-mean (0.96). ADC-rSIs showed no clinically acceptable performance in all models.

Conclusion:
rSIs of DWI and FLAIR MRI predict eligibility for thrombolysis in acute stroke with high precision, when easily available clinical parameters are included in the prediction.
Abstract WP79: Appropriate Timing of Fluoxetine and Statin Administration Reduces the Risk of Secondary Hemorrhagic Infarct After Ischemic Stroke
Authors: Ragas Moner A , Balch Maria H , Wright Danny , Hensley Amber , Reynolds Kenny , Kerr Bryce , Corbett Adrian M
Published: July 2021

Introduction:
Ongoing clinical trials are testing the effect of fluoxetine delivered 2-15 days from the onset of an acute ischemic stroke where a majority of patients are taking statins. We hypothesized that earlier drug delivery would result in smaller infarcts.

Methods:
Endothelin-1-induced strokes were initiated in 10-12 month old Sprague-Dawley rats, targeting the forelimb motor cortex. Combined medications of 5 mg/kg fluoxetine and 1 mg/kg simvastatin were orally administered either beginning 6-12 hours or 20-26 hours after stroke induction and continued daily for 90 days. Infarct volumes were assessed at post-stroke day 91 using Nissl stained coronal brain sections. An unpaired T-test with Welch’s correction for unequal variances was used for statistical comparison of the infarct volumes.

Results:
Control animals typically had 5-13 mm3 infarct volumes. Animals that received fluoxetine and simvastatin beginning 20-26 hours after stroke induction showed a strong trend of reduced infarct volume (3 ± 0.3447 mm3 SEM, P=0.0563). Earlier drug delivery (6-12 hours after stroke) resulted in significantly larger infarct volumes (15.4 ± 4.260 mm3 SEM, P=0.0157) when the drug groups were directly compared (Fig.1). Examination of the infarct volumes showed that earlier drug delivery induced secondary hemorrhagic infarcts, while later delivery did not (P=0.0427; Fisher’s exact test).

Conclusions:
There appears to be substantial danger of developing hemorrhagic infarct if the combination of fluoxetine and statin is given within 6-12 hours of stroke induction (RR= 4.36, 95% CI = 0.64-29.5). For that reason, it is crucial to monitor stroke patients for statins and fluoxetine, and withhold the statin for at least 20 hours after stroke onset. Delivery of both drugs after 20-26 hours of stroke onset resulted in significantly reduced infarcts.
Abstract WP95: Parent Artery Curvature and Angle of Incidence of Blood Flow Affect Flow Diversion Effect of Pipeline
Authors: Obi Shinnosuke , Kulkarni Chaitanya C , Segas Raphael , Duong David , Tateshima Satoshi
Published: July 2021

Introduction:
Pipeline flow diversion stent is often placed in a tortuous anatomy. Nevertheless, effect of parent artery curvature on the flow diversion effect from Pipeline stent is poorly understood. The flow diversion effect could be enhanced or diminished depending on the curvature of Pipeline or the angle at which blood flow strikes the Pipeline (angle of incidence). These variations may explain why not all aneurysms are obliterated after Pipeline treatment despite its high efficacy. We evaluated the flow diversion effect of Pipeline in various parent artery curvatures and angle of incidence in in-vitro models.

Methods:
Four acrylic prototypes of curved tube with a side branch were constructed with circular cross section with the inner diameter of 3.8mm. The variation among the prototypes was made in terms of the radius of curvature R (R=25mm & 50mm), and the relative angle θ of the side branch (θ=60, 90, & 120). The angle θ of the side branch determines the angle of incidence. The identical Pipeline of diameter 4.75mm were placed to each prototype and the pressure loss (K) occurring in the flow through the Pipeline mesh was measured for the Reynolds numbers ranging from 100 to 800. Careful error analysis on the measured data made it possible to quantify weak change of the flow resistance due to the geometrical variations.

Results:
The parent artery curvature and angle of incidence of the blood flow clearly affect the flow diversion effect (K) of Pipeline (Fig.1). Flow diversion effect diminishes in tighter curvature. Also noted is higher angle of incidence reduces flow diversion effect.

Conclusion:
The parent artery curvature and angle of incidence are important parameters that may affect the efficacy of Pipeline.
A multifactorial analysis of differential agent marking in Herodotus
Authors: Goldstein David
Published: July 2021

Passive agents in ancient Greek exhibit a well-known alternation between dative case and prepositional phrase. It has long been recognized that grammatical aspect plays a crucial role in this alternation: dative agents preponderate among aspectually perfect predicates, prepositional phrase agents elsewhere. Although the importance of grammatical aspect is undeniable, it is not the only factor that determines the realization of passive agents. The identification of other factors has proven challenging, however, not least because previous researchers have lacked methods for assessing the relative importance of the determinants that influence the realization of agent phrases. In this paper, I use Bayesian mixed-effects logistic regression to provide a multifactorial account of differential agent marking in Herodotus, according to which the realization of passive agent phrases is conditioned by the relationship between semantic role and referential prominence (Haspelmath 2021). Dative agents are favored in clauses where semantic role and referential prominence are aligned (i.e., the agent is referentially prominent or the patient is referentially non-prominent). By contrast, prepositional phrase agents are more likely when semantic role and referential prominence are at odds (i.e., the patient is referentially prominent or the agent is referentially non-prominent).
Qualitative Liability in the Early Modern Low Countries (ca. 1425–1650)
Authors: Druwé Wouter
Published: July 2021

In his ‘Inleidinge tot de Hollantsche Rechtsgeleertheyt’, Hugo Grotius introduced the concept of wrong-by-construction-of-law (‘misdaed door wetsduidinge’), the idea that civil law could assign liability to someone who had not committed any fault, i.e. merely because of his or her ‘capacity’ or ‘quality’ as a parent, as an owner of an animal, as an inhabitant of a building, or as an employer or shipowner. This contribution situates Grotius’s views on qualitative liability within the wider Netherlandish learned juridical context of his time, and especially studies the role of fault (‘culpa’) and presumptions of fault in the learned theories on qualitative liability. Apart from printed treatises and volumes of consilia, this contribution also takes into account hitherto unstudied handwritten lecture notes of the late medieval and early modern university of Leuven.
The History of Fair Trade: Hugo Grotius, Corporations, and the Spanish Enlightenment
Authors: Corredera Edward Jones
Published: July 2021

The early Spanish Enlightenment was shaped by debates over corporations, sovereignty, and the balance of power in Europe. Spanish officials, in this context, turned to the ideas of Hugo Grotius to establish joint-stock companies that could allow the Crown to regain control over its imperial domains and establish perpetual peace in Europe. This article recovers the writings of Félix Fernando de Sotomayor, Duke of Sotomayor (1684–1767), who drew on the works of Grotius, Samuel Pufendorf, and Charles Dutot in order to show that the history of these corporations chronicled the contestation and erosion of Spanish power and the diversion of European states from their true interests. Sovereigns, not merchants, argued Sotomayor, could guarantee fair trade and the equitable distribution of wealth. The study of Sotomayor’s views on trade, natural law, and alienation challenges traditional interpretations about the Iberian engagement with Grotius, the rise of capitalist hopes in Southern and Northern Europe, and Spain’s investment in the Enlightenment.
Les formes contemporaines de mobilisation des Lumières. Un essai de définition
Authors: Schandeler Jean-Pierre
Published: July 2021

L’article propose une analyse du phénomène de mobilisation des Lumières, c’est-à-dire de la réactivation récurrente de leurs notions (liberté, tolérance, progrès …) dans des moments d’affrontements idéologiques depuis le début du XXe siècle. L’étude s’appuie notamment sur les traductions de l’Esquisse d’un tableau historique des progrès de l’esprit humain de Condorcet (1795) dans le monde. Mais elle propose aussi l’analyse d’autres modes de convocation des idéaux des Lumières, par exemple dans le contexte d’actes terroristes qui visent précisément les valeurs associées à la philosophie du XVIIIe siècle. En examinant la force mobilisatrice du « siècle de Voltaire » lors de crises aiguës, la présente contribution distingue et définit plusieurs formes de ces mobilisations.
Towards a reflexive intelligence of emerging sociology in France around 1900
Authors: Strauss Martin
Published: July 2021

Recent years have seen a proliferation of publications reconsidering the emergence of sociology in France. The present review discusses and compares three of these works: S. Mosbah-Natanson’s bibliometric study on the fashion of sociology around 1900 (2017a); Th. Hirsch’s history of the idea of social time from the Durkheimians to Les Annales (2016a); and M. Joly’s enquiry into a purported sociological revolution in France and Germany at around the same time (2017a). Pushing respectively for a sociological, a historical and an epistemological history of sociology, they represent three distinct ways of renewing the historiography of the social sciences. The article argues that qualities and limitations of these works alike suggest two challenges for the history of sociology: (1) integrating sociological, historical and epistemological competences in a comprehensive intelligence of sociological texts; and (2) accounting for the reflexivity involved in a social history of the social sciences.
Des inventaires de culture au Tableau économique. Sur les origines empiriques de l’analyse économique physiocratique
Authors: Charles Loïc , Théré Christine
Published: July 2021

Loin d’être un programme de recherche tourné uniquement vers l’abstraction, la physiocratie comporte une dimension empirique tout à fait centrale dans sa constitution et dans son développement. L’étude de cette dimension permet de mettre au jour les liens généalogiques et méthodologiques qui ont uni le mouvement physiocratique et les traditions anglaise et française de l’arithmétique politique. En outre, une attention portée à l’inventaire des différentes activités agricoles et à la mesure de leurs productions respectives témoigne d’une autre influence importante dans la construction de l’économie politique de Quesnay, à savoir l’agronomie, alors en plein renouveau sous l’impulsion de Duhamel du Monceau.
Ministerial Autonomy, Parliamentary Scrutiny and Government Reform Output in Parliamentary Democracies
Authors: Bäck Hanna , Müller Wolfgang C. , Angelova Mariyana , Strobl Daniel
Published: July 2021

One of the most important decisions coalition partners make when forming a government is the division of ministries. Ministerial portfolios provide the party in charge with considerable informational and agenda-setting advantages, which parties can use to shape policies according to their preferences. Oversight mechanisms in parliaments play a central role in mitigating ministerial policy discretion, allowing coalition partners to control each other even though power has been delegated to individual ministers. However, we know relatively little about how such mechanisms influence the agenda-setting and gatekeeping powers of ministers and how much influence minister parties have on policy output relative to the government as a whole in different institutional settings. We fill this gap by analyzing original data on over 2000 important social and economic policy reform measures adopted in nine Western European countries over 20 years, based on a coding of more than 1200 country reports issued by the Economist Intelligence Unit and the Organisation for Economic Co-operation and Development (OECD). We find that parliaments with strong oversight powers constrain the agenda-setting capacity of minister parties but have limited impact on their gatekeeping capacity. Our findings have important implications for our understanding of policy-making and democratic accountability.
On India as a Responsible Nuclear Weapon State: Does the ‘No First Use’ Doctrine Need a Review?
Authors: Desai Jay B. , Desai Bharat H.
Published: July 2021

India conducted Operation Shakti (Pokhran II) nuclear tests during 11–13 May 1998 that ushered her into the cherished nuclear weapons club. It was well calibrated decision to formally choose the nuclear path through the first peaceful nuclear explosion, Smiling Buddha (Pokhran I) that was conducted on 18 May 1974. It was significant that without joining the 1968 Nuclear Non-proliferation Treaty, India managed to gatecrash into the nuclear weapons capability. It led to articulation of the No First Use (NFU) doctrine on 4 January 2003 (Ministry of External Affairs [MEA], 2003). In the wake of 16 August 2019 pronouncement of the Indian Defence Minister on possible review of the NFU, this article seeks to probe the question: Does the NFU doctrine require any such review? It comprises the rational, the promise of NFU, counterforce strategies, NFU with respect to tactical nuclear weapons and associated problems with First Use and NFU.
The Book of Revelation: Plagues as Part of the Eschatological Human Condition
Authors: Lietaert Peerbolte Bert Jan
Published: July 2021

Although plagues and disease do not feature prominently in the book of Revelation, specific images from the book, including the four horsemen (Rev. 6) and bowls of wrath (Rev. 15–16), have been used in certain traditions in which epidemics and pandemics have been, and still are, being interpreted as part of the eschatological human condition: they are seen as inflicted on humanity, ultimately by an angry God, whose wrath will lead to a final judgment.
Believing in the American Dream Sustains Negative Attitudes toward Those in Poverty
Authors: Hoyt Crystal L. , Burnette Jeni L. , Forsyth Rachel B. , Parry Mitchell , DeShields Brenten H.
Published: July 2021

A critical lever in the fight against poverty is to improve attitudes toward those living in poverty. Attempting to understand the factors that impact these attitudes, we ask: Does believing that meritocracy exists (descriptive meritocracy) sustain negative attitudes? Using cross-sectional (N = 301) and experimental (N = 439) methods, we found that belief in the United States as a meritocracy is associated with blaming people living in poverty and predicts negative attitudes toward them. Replicating and extending these findings, we experimentally manipulated beliefs in meritocracy and blame. Weakening American Dream beliefs predicted improved attitudes toward those in poverty. Understanding the nuanced role of belief systems in attitudes toward those in poverty provides strategies for promoting more positive thoughts and feelings.
“Those Are Typical Tell-Tale Signs of a Lesbian”: LGBQ Young Peoples’ Perceptions of Parental Messaging Surrounding Gender Non-Conforming Behavior
Authors: Estes Michelle L. , Carlisle Zachary T. , Schmitz Rachel M.
Published: July 2021

Socialization surrounding gender and sexuality is prominent within the familial context. Gender and sexuality are frequently linked with the assumption that gender-expansive behavior leads to nonheterosexuality. Research has largely focused on parental perspectives, leaving queer youth experiences largely invisible. Utilizing semistructured interviews with 10 queer young adults, this project contributes to the existing discussions regarding gender and sexuality socialization while growing up. First, participants described parents’ seemingly natural ability to correctly categorize youth’s sexual orientation, which is often linked to gender nonconforming behavior. Participants reinforced essentialized ideas of gender and sexuality through their discussion of engagement in expansive gender behavior. Furthermore, women discussed more freedom to engage in diverse gender behavior, while being expected to conform to traditional gender roles. Through elevating youth’s viewpoints on gender and sexuality family dynamics, these findings can assist service providers and parents in supporting queer youth across their gender and sexual development.
Parental Migration and Children’s Exposure to Polyvictimization in Rural China
Authors: Chen Xiaojin , Wu Yuning , Qu Jia
Published: July 2021

The present study aims to investigate (1) the difference in polyvictimization rate between children left behind and those living with non-migrant parents in rural China, and (2) the social processes through which the effects of parental migration are conveyed through children’s behaviors and interaction with the immediate external environment (e.g., family, school, and peers). The research hypotheses were tested by using a probability sample consisting of 1,681 middle school students in rural areas in Guizhou province (Mean age = 13.55, SD = 1.01; 50% of the participants were boys). Findings from multivariate logistic regression models and indirect effect analyses suggest that (1) overall, left-behind children are exposed to a higher level of polyvictimization than children living with both non-migrant parents in rural China and (2) whereas all left-behind children face similar challenges in school and family settings, each type of parental migration and caretaking arrangement entails unique protective or risk factors of polyvictimization. As one of the first studies to systematically investigate the rate and etiology of polyvictimization among children left behind in rural China, this study highlights the prominent role of parental migration in reproducing and reinforcing children’s differential exposure to polyvictimization among China’s rural families.