bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP252: Tamoxifen Treatment Worsens Astrocyte Activation And Mitochondrial Stress From Oxygen Glucose Deprivation
Authors: Zardeneta Macy E , Branyan Taylor , Sohrabji Farida
Published: February 2022

Introduction:
Tamoxifen (TAM), a selective estrogen receptor modifier, is a first-line treatment option for hormone receptor positive breast cancer. TAM inhibits the downstream estrogen receptor signaling in tumor cells. Stroke risk is increased in women with low estrogen levels, such as early-onset menopause, and doubles in women after the age of 55, which corresponds with the average age of menopause. Women with breast cancer who were treated with tamoxifen had an increased risk for ischemic stroke (82%). Since stroke severity is associated with increased blood brain barrier (BBB) damage, we investigated the effects of tamoxifen on activation and mitochondrial stress in astrocytes, which is a cellular component of the BBB.

Methods:
Cultured female human astrocytes were treated with tamoxifen (1uM), 17ß-estradiol (10nM), or vehicle (DMSO) for 24 hours. Cells were separated into two groups: normoxic (21% O2, 25mM glucose) or oxygen and glucose deprivation (OGD) conditions 6 hours before analysis. ROS production was measured using the Cellular ROS Assay Kit (Red) and aquaporin-4 levels were visualized via immunocytochemistry. Mitochondrial function was assessed by using a Seahorse XFe96 Analyzer.

Results:
Tamoxifen treatment increased Aquaporin-4 protein levels (p <0.0001) in cultured astrocytes after OGD compared to both vehicle (DMSO) and 17ß-estradiol treatment. While there was no significant effect, tamoxifen treated cells showed a trend toward (p =0.0732) increased ROS production after OGD compared to vehicle. Additionally, tamoxifen reduced oxygen consumption rate (p =0.0197) and basal respiration under normoxic conditions in astrocytes when compared with DMSO or 17ß-estradiol treatment.

Conclusions:
Tamoxifen treatment altered the expression of a water channel protein and decreased the ability to respond to oxidative stress in astrocytes. Aquaporin-4, when localized to the astrocytic end feet, facilitates edema after stroke, and ischemic stroke by definition puts brain tissue under oxidative stress. Our findings suggest tamoxifen may increase edema, which is known to impair stroke recovery. These data suggest a mechanism by which breast cancer treatment may increase the risk for severe ischemic stroke. Supported by RFAG042189 to FS
Abstract WP258: Post-stroke Microvascular No-reflow Demonstrates Spatiotemporal Heterogeneity Using Visible-Light Optical Coherence Tomography
Authors: Nadkarni Neil A , Fang Raymond , Muller William A , Sullivan David , Zhang Hao F
Published: February 2022

Introduction:
The spatiotemporal pattern of microvascular reperfusion in vivo after large vessel recanalization is poorly understood. Combining chronic cranial window with embedded microprism (CCW-MP) and visible-light optical coherence tomography angiography (Vis-OCTA) enables the study of mouse cortical cerebrovasculature up to 60 days post-stroke. Vis-OCTA/CCW-MP can identify the presence or absence of microvascular flow, without labelling, up to 1 mm in cortical depth of the mouse brain at 1.3 micron resolution. We sought to build on these findings to understand the pattern of microvascular no-reflow in a mouse model of stroke that simulates large vessel occlusion and reperfusion.

Hypothesis:
Different regions of the cortex have striking variation in flow characteristics after macrovascular reperfusion.

Methods:
All mice studied were 3-4 mo old, C57/Bl6 background, and subject to IMPROVE guideline. Control mice (n=3) were studied to confirm absence of cortical or vascular changes induced by CCW-MP surgery. Test mice (n =6) underwent CCW-MP as previously published. After 2 weeks to allow for healing post-surgery, mice were subject to transient middle cerebral artery occlusion (tMCAO) to model large vessel occlusion and reperfusion. Vis-OCTA measured cortical flow at baseline, 24 hours post-stroke, and 72 hours post-stroke. Cortical mouse vascular regions were divided into layers 1-3: layer 4 : layer 5-6 from top to bottom.

Results:
Control mice showed no neuronal death, astrogliosis, microgliosis, or neutrophil recruitment induced by CCW-MP implantation. There was no significant difference between vascular density for prism-adjacent cortex and prism-remote cortex. We also determined that the CCW-MP images cortical vascular territory supplied by the middle cerebral artery. For the test mice, all six mice survived combined surgery. Vis-OCTA showed four of six mice had reduction of microvascular flow > 20% from baseline by 72h post-stroke at layer 5-6.

Conclusions:
Microvascular reperfusion post large vessel recanalization can be incomplete up to 72 hours post-stroke, especially at deeper cortical levels. Further studies should define associated changes in inflammatory cells as well as oxygenation of vessels.
Abstract WP259: Acute Stroke Neuroprotection With Intravenous Rns60 In The Cynomolgus Macaque
Authors: Nashed Joseph , Harrison Kathleen A , Chen Yining , Ghosh Supurna , Kalmes Andreas , Cook Douglas J
Published: February 2022

Introduction:
RNS60 is an experimental therapy comprised of stable oxygenated nanobubbles in a sodium chloride solution with an oxygen content of 55+/-5 ppm. Phase I/II clinical trials established a safety profile for RNS60 in patients with ALS and MS. In-vitro assays in neurons have demonstrated mitochondrial biogenesis with RNS60. Therefore, we hypothesized that RNS60 would protect the ischemic penumbra and delay stroke evolution. In this study, we assessed RNS60 in a cynomolgus macaque (CM) model of transient middle cerebral artery occlusion (MCAO).

Methods:
Experimenters were blinded and CMs randomly allocated to treatment. In the first experiment, 22 male CMs (2.6+/-0.55 kg) were anesthetized with physiologic monitoring and MCAO followed by immediate MRI imaging to define perfusion deficit. RNS60 (5cc/kg/h IV over 1h followed by 2.5cc/kg/h for 48h) or drug vehicle were administered starting 1h following MCAO. MCA was reperfused 90min after MCAO. CMs underwent MRI diffusion-weighted (DWI) and T2 imaging at 48h and 30d after MCAO. Serial Non-Human Primate Stroke Scale (NHPSS) assessments were collected over 30 days following MCAO. In the second experiment, 10 male CMs (4.95+/-0.18 kg) underwent permanent MCAO. RNS60 or drug vehicle were infused starting 5 minutes after MCAO (5cc/kg/h IV for 1 hour followed by 2.5cc/kg/h until sacrifice). Perfusion and DWI MRI images were obtained serially over 6 hours to measure the evolution of the penumbra. CMs were sacrificed at the completion of the experiment.

Results:
DWI stroke volume was significantly reduced 4.3+/-1.1mL vs. 9.1+/-0.92mL (P=0.0036) at 48 hours post MCAO in RNS60 vs. placebo treated CMs. This result was conserved on T2 imaging at 30 days where stroke volume was 3.5+/-0.86mL vs. 7.3+/-0.79mL (P=0.004). RNS60 significantly improved NHPSS scores over 30 days compared to controls after removing three outlier CMs (2 mortalities and one non-reperfused MCA). The results of the second experiment demonstrated a 6h DWI volume of 5.9cc in RNS60 treated CMs compared to 10.6cc in controls.

Conclusion:
RNS60 administered during acute ischemic stroke significantly reduces stroke volume and improves functional outcomes in male CMs. The evolution of penumbra to stroke is slowed following RNS60 administration.
Abstract WP262: Three-dimensional Characterization Of Cerebral Microvasculature And Microhemorrhages
Authors: Xie Danny F , CROUZET Christian , Fang Chuo , Liu Jihua , Liu Han , Lau Wei Ling , Cribbs David H , Fisher Mark , Choi Bernard
Published: February 2022

Introduction:
Cerebral microhemorrhages (CMH) are the pathologic substrate of MRI-demonstrable cerebral microbleeds, and are thought to occur when integrity of cerebral microvessels is compromised, leading to deposits of hemosiderin/iron accumulating within brain tissue. The presence of CMH is associated with cognitive decline and ischemic and hemorrhagic stroke. Hypertension (HTN) is a major risk factor for cerebral microbleeds and has been linked to a more significant microbleed burden in patients. Despite the clinical significance of HTN and cerebral microbleeds, our understanding of HTN-induced microbleed formation remains limited, and the vascular origin of CMH remains obscure.

Methods:
We used a perfusion-based vascular label with tissue clearing to enable three-dimensional visualization of CMH with the surrounding microvascular network. Adult (18-month-old) C57BL/6J mice were administered angiotensin II to induce HTN (n=10) or PBS (n=10). Lectin-DyLight-649 was injected retro-orbitally to bind to the endothelial walls of all blood vessels in a mouse. Brains were cut into 1-mm thick sections, stained with Prussian blue to label CMH, cleared using iDISCO, and imaged via confocal microscopy. MATLAB and neuTube were used to quantify vessel diameters.

Results:
Using this methodology, we were able to collect three-dimensional transmission images of CMH that were colocalized with three-dimensional fluorescence images of the surrounding microvasculature. The average vessel diameter of the 5 nearest vessels to 17 different CMH was found to be 4.22±0.81 μm, which corresponds to capillary-size vessels.

Conclusions:
These data support a capillary origin for cerebral microhemorrhages in this mouse model. The capillary origin implies a role for the blood-brain barrier in the development of CMH and cerebral microbleeds in this model of HTN and aging. Three-dimensional imaging has substantial utility for improved understanding of CMH origin.
Abstract WP36: Patient Acuity In The Neuro Intensive Care Unit, A New Tool For Evaluating Provider Staffing
Authors: Wedzina Nicole , Chichelli Trevor , Woodard Kara , Coleman Amanda , Babu Arun N , Alnaji Raed , Babu Krishnan , Guterman Lee
Published: February 2022

Patient volume alone is not an accurate measurement to determine the workload per provider in the NICU. Provider workload varies greatly from patient to patient based on the severity of illness and medical comorbidities. We have not found any models that assess provider workload based on patient acuity and number. It was our intention to use this data to govern a dynamic provider staffing paradigm. We have developed a simple acuity score sheet that was used to evaluate each patient in the NICU at Mercy hospital, for 30 days consecutively (fig 1). We monitored 79 patients, for a total of 403 acuity measurements. The acuity scores were collected, average acuity for the day was calculated. In fig 2 acuity and census are depicted. In fig 3 the total daily acuity is divided by the number of providers. We found the acuity scale was easy to apply. Normalized acuity vs NICU volume is depicted in figure 2. Total acuity per provider is depicted in figure 3 . When acuity approaches 10 even low patient volumes may require additional staffing. At night acuity per provider almost doubles as the number of providers decreases. Future studies are needed to correlate this data with provider satisfaction to better understand the effects of patient workload. Our goal is to alter NICU provider staffing based this model.
Abstract WP38: Can I Eat? The Next Chapter Of Improving The Stroke Swallow Screen Process For Previously Lethargic Patients
Authors: Schaefer Karen , Harmon Melissa
Published: February 2022

For stroke patients the swallow screen is one of the initial assessments completed by the RN that is typically completed in the Emergency Department. Our hospital system consist of a Primary Stroke Center (PSC) and a Comprehensive Stroke Center (CSC). At the PSC the swallow screen process was changed to allow the RN to repeat the swallow screen for patients that had an improvement in their mental status only if the patient initially failed due to lethargy. If this patient were to fail the repeated screen, they would remain NPO until evaluated by Speech Language Pathology (SLP). This change was made as a result of RNs noticing that some of these patients who failed due to lethargy would arrive to the stroke unit no longer lethargic and requesting something to eat or drink, however, due to the prior policy would be NPO. At times, these patients were admitted in the late evening/overnight and remained NPO until morning which was causing patients to be frustrated and agitated. A year after the policy change, we looked at patients that remained at the PSC and found that this was a positive change for both patients and staff. Now that a few years have passed, we wanted to look at not only the patients that stayed at the PSC but those that were transferred to the CSC. Data was gathered from a random sample of patients seen at the PSC as well as those transferred to the CSC. Of patients who stayed at the PSC and had a swallow screen repeated, 86% passed the repeated swallow screen, those who failed were referred to SLP. Of the patients transferred to the CSC, 55% passed the initial swallow screen after failing for lethargy at the PSC, 27% remained lethargic and the swallow screen was unable to be completed by the RN. 7 of the patients (36%) transferred to the CSC expired. None of the patients at either facility were readmitted with aspiration pneumonia.
Abstract WP42: FAST Implementation Of An Urban County Severity-based Stroke Triage Protocol: Impact And Outcomes On A Comprehensive Stroke Center
Authors: Mohamed Ghada A , RANGARAJU Srikant , Carr Micheal , Jones Andrew , Peczka Mathew , Contreras Israel , Brasher Cynthia , Sutherly-Bhadsavle Loretta , Danaie Elham I , Cawley C.Micheal , Nahab Fadi B
Published: February 2022

Background:
Severity scales are recommended to assist field-based triage of acute stroke patients to designated stroke centers however require additional EMS education and performance. The Cincinnati prehospital stroke scale (CPSS) is a commonly used pre-hospital stroke screen and has been validated as a severity scale to identify large vessel occlusion (LVO). This study objective is to determine the impact of a county-based implementation of CPSS as a stroke severity scale to directly triage selected patients to a comprehensive stroke center (CSC).

Methods:
Dekalb County, Georgia in Atlanta implemented a CPSS-based triage protocol with a score of 3 and last seen normal (LSN) time < 24 hours mandating transfer to the nearest CSC if added time was <15 minutes. We compared patients presenting by EMS to the CSC six months before and after the protocol change (November 1, 2020) including frequencies of stroke alerts, diagnoses, LVO, IV tPA use, thrombectomy treatment and LSN time to treatment.

Results:
During the study period, 802 suspected acute stroke patients presented to the CSC by EMS including 95 (12%) with a FAST score of 3. There was a significant increase in monthly EMS stroke alerts with the protocol implementation (Pre- 43 ± 5.6, Post- 54 ± 5.9; p=0.005). Overall, 325 (41%) patients had a final diagnosis of stroke or TIA, including 228 (28%) with ischemic stroke. There was a significant increase in ischemic stroke patients presenting with LVO (Pre- 26%, Post- 36%; p=0.01) and the monthly rate of mechanical thrombectomy (Pre- 2.0 ± 2.0, Post- 5.5 ± 2.4; p= 0.005) but no difference in tPA administration rate. LSN to tPA median times were similar (Pre- 2.8 ± 1.1, Post- 2.6 ± 0.87 hours; p=0.66) though LSN to groin puncture median times increased (Pre- 3.2, Post- 7.1 hours; p=0.04). CPSS score of 3 was associated with the final diagnosis of ischemic stroke, IV tPA administration and presence of LVO (p=<0.001).

Conclusion:
County-based implementation of a CPSS score of 3 is a quick, easy and effective approach to triage suspected stroke patients to a thrombectomy-capable center that identifies stroke patients with LVO and increases thrombectomy treatment rates without delays in tPA treatment.
Abstract WP44: Sex Differences In The Delivery Of Stroke Care Via Telemedicine In A Large National Telestroke Practice
Authors: Morton Johanna L , Boyd Kristina L , Anderson Eric , Hallock Jason
Published: February 2022

Background:
Sex differences are encountered in many aspects of ischemic stroke, including risk factors, presenting symptoms, stroke mechanism, acute interventions and functional outcomes. As telestroke services continue to expand, many patients utilize telestroke for the evaluation and treatment of suspected stroke symptoms. To date, the existence of such differences between sexes has not been identified in the telestroke patient population.

Methods:
A retrospective observational study of the experience of a single teleneurology practice serving 340 hospitals from April 2018 to June 2021 was performed. Patients with a confirmed or suspected diagnosis of ischemic stroke were included. Data from the stroke encounter was abstracted from the medical record platform.

Results:
Within the queried period, there were 76,905 male and 90,243 female patients identified as having received a telestroke evaluation for suspected or confirmed stroke. No difference was seen in age, but females had a higher initial NIHSS score (
P
=0.03). There were no differences in percentage of consults deemed emergent between males and females. Females were received thrombolysis at lower rates than males (4.86 vs 5.99%,
P
<0.01). Females refused thrombolysis at higher rates than males (3.44 vs 2.78%,
P
<0.01), while males were more likely to present outside the therapeutic window (46.72% vs 45.43%,
P
<0.01). Males and females did not receive thrombolysis due to symptom resolution/improvement at similar rates. Males were more likely to be on therapeutic anticoagulation precluding thrombolysis, (
P
<0.01), while females were more likely to have a nondisabling deficit (
P
<0.01). In the emergency consults subgroup, there were no differences between TLSW-to-arrival times, arrival-to-call times, and video start-to-thrombolysis decision times between the sexes. There were no differences in consult length times or door-to-needle times between the sexes.

Conclusion:
This review of a national heterogeneous telestroke patient population is indicative of sex differences in multiple aspects of acute ischemic stroke, most notably in thrombolysis rates and reasons thrombolysis not given. Further investigation is warranted into the disparities between the sexes in telestroke care.
Abstract WP48: How To Optimize Population Access To Acute Stroke Expertise
Authors: Zachrison Kori S , Richard Jessica V , Schwamm Lee H , Wilcock Andrew , Uscher-Pines Lori , Majersik Jennifer J , Mehrotra Ateev
Published: February 2022

Objective:
Many U.S. emergency departments (EDs) lack access to stroke neurologists to support decision-making for thrombolytics and identification of thrombectomy-eligible patients. We outline a strategy to identify hospitals where telestroke might improve access and estimate potential gains in both the number of patients receiving reperfusion treatment and lives saved.

Methods:
We identified all EDs that provided ischemic stroke care for a Medicare beneficiary during 2018. We then excluded those with clear stroke expertise or with another ED with stroke expertise within 20 miles. At these EDs, we used annual ischemic stroke volumes and previously-derived risk ratios to quantify estimated marginal benefits (additional patients receiving reperfusion and additional lives saved) with the introduction of telestroke.

Results:
Among 4657 US EDs that provided stroke care in 2018, 1057 had limited stroke capabilities in their ED or within 20 miles. Of these 1057 EDs, 83.1% were in rural communities, and they cared for a median of 6 ischemic stroke patients per year. We estimate telestroke introduction to all 1057 would lead to 164 (95% CI 93-247) additional patients receiving reperfusion treatment and 90 (95% CI 2-180) additional lives saved annually (Figure). If only 263 EDs in the the top quartile of marginal benefit were targeted, this would capture over half of the estimated benefits.

Conclusions:
We estimate that approximately a quarter of U.S. EDs, primarily small rural EDs, would benefit most from new telestroke capacity. Our strategy may be used to improve stroke systems of care and maximize specialist access for the U.S. population.
Abstract WP55: Stroke Center Accessibility Study In The U.s. Using Geospatial Analysis And Machine Learning
Authors: Edgell Randall C , Sagan Vasit , Ali Ahsan
Published: February 2022

Background:
Several accrediting bodies certify the level of stroke care hospitals provide. The Joint Commission on Hospital Accreditation (JC) is the largest accrediting body in the United States. There is no open source Geographic Information Systems (GIS) dataset showing the distribution of JC accredited centers by ZIP code.

Objective:
to create a stroke center accessibility and stroke center desert system using geospatial analysis and machine learning which provides real-time assessment of stroke center availability, distribution and access to care.

Method:
Geospatial data layers of JC accredited stroke centers were compiled using data sources including U.S. Census Bureau and CDC. Map layers corresponding to the levels of JC accredited stroke hospitals geolocated using ZIP code were created as follows: 1) Acute Stroke Ready 2) Primary 3) Thrombectomy Capable 4) Comprehensive Stroke Center. A GIS dataset displaying stroke mortality by region was obtained from the ArcGIS Living Atlas. Stroke center deserts are analyzed using a 4.5 hour drive map along with population and diversity. Machine learning models were implemented to estimate stroke mortality as a function of distance to care centers and capability levels of the stroke centers.

Results:
Stroke centers are highly concentrated within large urban centers. There are geographic regions that have poor access to stroke centers. Such regions include the Gulf Coast States of Louisiana, Mississippi, and Alabama that have large areas with poor stroke center acces while having some of the highest stroke mortality in the country. (Figure 1)

Conclusion:
There are regional variations in stroke center availability. There are certain regions with high stroke mortality with very little stroke center access. Geospatial AI tools can be utilized to improve stroke systems of care.
Abstract WP56: 2021 Comparison Of International Stroke Guidelines For Acute Ischemic Stroke
Authors: Ayele Nohamin , Schneck Michael
Published: February 2022

Background:
Many countries/regions have formal Acute Ischemic Stroke (AIS) management guidelines. Variations between guidelines may showcase differences in demographic epidemiology and practice that correspond to the regional or national priorities.

Methods:
We systemically searched for guideline recommendations on AIS management published between January 1, 2004, and August 20, 2021. With only the latest guideline for each country selected, 11 guidelines from countries/regions of the world were identified and reviewed: United States (2018), Japan (2013), Europe (2018), Australia (2012), Brazil (2012), China (2019), Korea (2019), Canada (2018), India (2011), South Africa (2010), and Malaysia (2006).

Results:
Urgent imaging guidelines, such as CT or MRI, for initial evaluation are similar across countries; nevertheless, initial intravascular imaging guidelines greatly differ. Of the eleven countries reviewed, the majority recommend a standard tPA dose of 0.9mg/kg, while Japan and China recommend a lower tPA dose of 0.6mg/kg in select patients. While time to initiation of aspirin (ASA) post IV thrombolysis is widely accepted, consensus on the appropriate ASA dose, and possible addition of other antiplatelet therapies does not exist. Mechanical thrombectomy is overall endorsed within 6 hours or between 6-16 hours of symptom onset with causative occlusion, but countries such China and Canada have found validity extending the timeframe to 24hrs and beyond, using imaging modality recommendations. Inpatient management of nutrition, DVT prophylaxis, and rehabilitation differ between the various guidelines.

Conclusion:
Variations between guidelines exist that highlights those components with a lack of an evidence-based consensus. With further international collaboration, reconciliation of guidelines between countries or regions may be achievable.
Abstract WP60: Better Sleep Is Associated With Improvement In Functional Mobility During Inpatient Rehabilitation After Stroke
Authors: Fulk George , Zaccarini Christina G , Overend Kristin , Conese Nicole , Wheeler-Vickery Danielle , Valastro Dan , Brown Amanda , Lyter Emily , Hyland Frank , DUNCAN Pamela W , Klingman Karen
Published: February 2022

Introduction/Purpose:
Sleep is critical for health and plays a role in motor learning, which is an important component of post stroke rehabilitation. There is limited research on the impact of sleep on functional outcomes during the early stages of rehabilitation after stroke. The purpose of this study was to explore the associations between sleep parameters and functional recovery during inpatient rehabilitation in people with stroke.

Methods:
13 participants undergoing inpatient rehabilitation after stroke were recruited to participate. Function was measured at admission and discharge using GG Self Care and Mobility scales. Sleep parameters; sleep efficiency and wake after sleep onset (WASO); were determined from an ActiGraph wGT3X-BT activity monitor (AGAM), which participants wore for 5 days continuously upon admission. Associations between sleep parameters and function were determined using Pearson correlation coefficients.

Results:
Mean time since stroke was 15.5 (9.0) days, mean National Institutes of Stroke Scale score was 6.2 (4.1), mean age was 65.1 (12.1) years old, and 54% were women. There was a moderate association between sleep efficiency and change in GG mobility score; r=0.67 (p=0.012); and a moderate inverse association between WASO and change in GG mobility scores: r=-0.66 (p=0.013). There was not a significant association between change in GG self-care score and sleep parameters (p>=0.05).

Discussion:
Quality of sleep is associated with improvement in functional mobility during inpatient rehabilitation after stroke. Participants with better sleep efficiency and less time awake during the night after falling asleep during the first 5 days of their inpatient rehabilitation stay had greater improvement in functional mobility at discharge. Further research is needed to examine the complex relationships between sleep and recovery after stroke and to investigate possible interventions to promote better sleep during inpatient rehabilitation after stroke.
Abstract WP61: Enhancing Stroke Trial Efficiency Using Nihss Scores To Predict Persistence Of Treatable Deficits
Authors: Braun Robynne , Heitsch Laura , Sunmonu N A , Cole John W , Lindgren Arne , de Havenon Adam , Lohse Keith , Cramer Steven C , Worrall Bradford B
Published: February 2022

Introduction:
A persistent challenge in stroke clinical trials is predicting which patients will respond optimally to treatment. Negative trials may result when patients’ severity of deficits contributes to a floor effect, or paucity of deficits leaves no room for the treatment to exert a benefit. A further challenge arises from the fact that impairments in distinct neurological domains are known to respond differently to treatments such as recanalization.

Methods:
Here we present a secondary analysis of 624 ischemic stroke patients enrolled in the NINDS TPA trial. Patients who were dead at 90 days or had missing data at any time point were excluded. Our analysis in the remaining 487 cases summarizes relevant differences in the proportions of patients with persistent deficits at 90 days when stratified according to their baseline scores.

Results:
For arm motor impairments (see Figure), 75% of patients with a baseline score of 2 recovered to a score of 0 at 90 days. Patients with this recovery profile could contribute to a ceiling effect if enrolled in restorative trials to treat motor deficits. Our analysis demonstrates contrasting patterns in other domains including sensory, language and perceptual deficits.

Conclusions:
Evaluating these patterns can help to predict whether patients being enrolled in a restorative trial will retain a treatable deficit in the domain that the study treatment targets. Commonly collected data from the NIHSS can guide the selection of patients with deficits in relevant recovery domains to promote more economical and efficient study operations for clinical stroke trials.
Abstract WP79: Predictive Swallowing Score Performance At A United States Comprehensive Stroke Center
Authors: Weiss Martin , Park Christine , Inamullah Ovais , Feng Wuwei
Published: February 2022

Introduction:
Predicting swallow recovery after an acute ischemic stroke can be helpful for enteral nutrition decision making. Currently, there are limited models to guide post-stroke dysphagia therapeutic decision-making. The Predictive Swallowing Score (PRESS) was derived and validated in Switzerland for predicting the risk of persistent impaired oral intake at 7-day and 30-day post-ischemic stroke. To date, this model has not been validated in the Unites States (US). The aim of this study was to assess the performance of the PRESS model at predicting 7-day post-stroke swallow recovery at a US comprehensive stroke center.

Methods:
We performed a single-institution, retrospective study at a US comprehensive stroke center between January 1
st
and December 31, 2019. We included individuals admitted with an acute ischemic stroke resulting in impaired oral intake defined as Function Oral Intake Score (FOIS) < 5. Inclusion and exclusion criteria aimed to match that of the PRESS study. We calculated the area under the receiver operating curve (AUROC) to assess the PRESS model discrimination at 7-day post-stroke and the Hosmer-Lemoshow test to assess the agreement between the PRESS predicted and observed risks of persistent impaired oral intake at day 7.

Results:
A total of 80 individuals met the inclusion criteria, of which 46 individuals (58%) had persistent impaired oral intake at 7-day post-stroke. The PRESS model applied to our data yielded an AUROC of 0.68 (95% CI: 0.57-0.80) and the Hosmer-Lemoshow test failed to show a good fit.

Conclusion:
The PRESS model applied to retrospective data collected from individuals at our comprehensive stroke center in the US did not yield good predictive performance for swallow recovery at 7-day post-ischemic stroke. The PRESS model should be used with caution in the US until it is further validated with larger prospective studies.
Abstract WP81: The Association Between Health-related Locus Of Control And Post-stroke Disability, Quality Of Life, And Depression
Authors: Gutierrez Desiree , Wing Jeffrey J , Drum Emily , Boden-Albala Bernadette
Published: February 2022

Introduction:
Beliefs regarding ones’ control over their health can lie internally, influenced by their own actions, or externally, controlled by others or due to chance.

Objective:
To examine the association between health-related locus of control (HRLC) type and post-stroke disability, quality of life, and depression.

Methods:
This study utilized data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial (n=552). Participants were categorized into three groups based on their highest Multidimensional Health Locus of Control (MHLC) score. The Stroke Impact Scale (SIS) was used to assess post-stroke disability and quality of life. Linear regression was used to identify differences in each SIS domain score between the three groups while adjusting for the intervention. Depression was defined as a Center for Epidemiological Studies Depression (CESD) score ≥16. Logistic regression was used to examine differences in depression between the three groups while adjusting for the intervention.

Results:
Of the 529 participants who completed the MHLC questionnaire at baseline, 179 (33.3%) were categorized into the
internal
group
,
163 (30.8%) into the
powerful others
group, and 190 (35.9%) into the
chance
group. Of the 297 participants who completed the CESD questionnaires at 12 months, 163 (54.8%) scored ≥ 16. Participant’s mean scores for each SIS domain are reported in Table 1. For the SIS communication domain, the
chance
group’s mean score was 3.03 points lower than the
powerful others
group’s score (SE=1.39, p=.029). There were no statistically significant differences in scores for the other seven SIS domains or for depression between groups (Table 1).

Discussion:
External HRLC based on chance may be a predictor of communication difficulties in patients post-stroke. However, mean communication scores are skewed. Control beliefs are important in post-stroke recovery. More research is needed to validate these findings.
Abstract WP84: (VISIION): Viz.ai Implementation Of Stroke Augmented Intelligence And Communications Platform To Improve Indicators And Outcomes For A Comprehensive Stroke Center And Network
Authors: Figurelle Morgan E , Meyer Dawn M , Perrinez Emily , Rubenstein Stephanie , Pannell Jeffrey S , Santiago-Dieppa David , Khalessi Alexander A , Bolar Divya , Bykowski Julie , Meyer Brett C
Published: February 2022

Background:
Comprehensive Stroke Centers (CSCs) strive to narrow rt-PA and “Door To Groin” (DTG) neurointerventional (NIR) times. Process improvement workflows have been put in place for rt-PA. While similar processes have been implemented to streamline workflows for hyperacute NIR cases, complex pathways, disparate imaging locations, and fragmented communications all highlight a need for continued improvements.

Methods:
This quality improvement initiative (IRB #210525) was implemented to assess our transition to the Viz.ai platform for immediate image review and centralized communication and its effect on key performance indicators (KPIs) in an already robust CSC. We compared 6 month periods prior to and following deployment. Sequential stroke NIR patients were included. Both Direct Arriving LVO (DALVO) and telemedicine transfer LVO (BEMI) cases were assessed. We assessed subgroups of DALVO-OnHours, DALVO-OffHours, BEMI-OnHours, and BEMI-OffHours. Mann-Whitney U was utilized.

Results:
Eighty-two NIR cases were analyzed pre v. post Viz.ai implementation (DALVO-OnHours 7 v. 7, DALVO-OffHours 10 v. 5, BEMI-OnHours 13 v. 6, BEMI-OffHours 17 v. 17). DALVO-OnHours improved 19% (97min, 79min; p=0.201) in median DTG times. DALVO-OffHours had a significant 39% reduction (157min, 95min; p=0.009). DALVO-“All” showed a significant 32% reduction (127min, 86 min; p=0.006). BEMI-OnHours improved 18% (37min, 31min; p=0.337). BEMI-OffHours improved 38% (45min, 28min; p=0.077). BEMI-“All” significantly improved 33% (42min, 28min; p=0.036). Overall, there was a 22% reduction (50min, 39min; p=0.066) after Viz.ai implementation.

Conclusions:
There was an immediate KPI improvement following Viz.ai implementation for both direct arrival and telemedicine transfer NIR cases (32% and 33% respectively). In the greatest opportunity subset (direct arriving cases requiring team mobilization off hours without benefit of telemedicine transfer lead time) we noted a 39% improvement. With Viz.ai, we noted immediate access to images and streamlined group communications, even in an already well-functioning CSC. These results have implications for future care processes and can be a model for centers striving to optimize workflow and improve NIR timeliness.
Selective Serotonin Reuptake Inhibitors and Risk of Noncardioembolic Ischemic Stroke: A Nested Case-Control Study
Authors: Alqdwah-Fattouh Rasha , Rodríguez-Martín Sara , Barreira-Hernández Diana , Izquierdo-Esteban Laura , Gil Miguel , González-Bermejo Diana , Fernández-Antón Encarnación , Rodríguez-Miguel Antonio , García-Lledó Alberto , Bolúmar Francisco , de Abajo Francisco J.
Published: February 2022

Background:

Multiple studies have reported that the use of selective serotonin reuptake inhibitors (SSRIs) is associated with an increased risk of ischemic stroke; however, this finding may be the result of a confounding by indication. We examined the association using different approaches to minimize such potential bias.

Methods:

A nested case-control study was carried out in a Spanish primary health-care database over the study period 2001 to 2015. Cases were patients sustaining an ischemic stroke with no sign of cardioembolic or unusual cause. For each case, up to 5 matched controls (for exact age, sex, and index date) were randomly selected. Antidepressants were divided in 6 pharmacological subgroups according to their mechanism of action. The current use of SSRIs (use within a 30-day window before index date) was compared with nonuse, past use (beyond 365 days) and current use of other antidepressants through a conditional logistic regression model to obtain adjusted odds ratios and 95% CI. Only initiators of SSRIs and other antidepressants were considered.

Results:

A total of 8296 cases and 37 272 matched controls were included. Of them, 255 (3.07%) were current users of SSRIs among cases and 834 (2.24%) among controls, yielding an adjusted odds ratio of 1.14 (95% CI, 0.97–1.34) as compared with nonusers, 0.94 (95% CI, 0.77–1.13) as compared with past-users and 0.74 (95% CI, 0.58–0.93) as compared with current users of other antidepressants. No relevant differences were found by duration (≤1, >1 year), sex, age (<70, ≥70 years old) and background vascular risk.

Conclusions:

The use of SSRIs was not associated with an increased risk of noncardioembolic ischemic stroke. On the contrary, as compared with other antidepressants, SSRIs appeared to be protective.
Description of Scutylenchus quercinus n. sp. (Nematoda: Tylenchomorpha) from Asalem forests, north Iran
Authors: Sheikhzadeh Souzan , Mobasseri Mahyar , Valizadeh Ahmad , Pedram Majid
Published: February 2022

A new species of Scutylenchus was recovered from soil collected in the rhizosphere of forest trees in natural Asalem forests, Gilan province, north Iran. The new species is described and illustrated based upon morphological and molecular data. Scutylenchus quercinus n. sp. is mainly characterised by having four lines in the lateral fields, thus delimiting it from currently known species of the genus, which have six lines. It is further characterised by 605-709 μm long females having a slightly offset cephalic region with five or six annuli, stylet 19-21 μm long with conus ca 50% of its total length and three slightly posteriorly sloping knobs, vulva in a cavity, with epiptygma, vagina vera squarish in lateral view, female tail subcylindrical with smooth end, and males with 26-30 μm long spicules. The new species was morphologically compared with eight similar species. The molecular phylogenetic relationships of the new species with other relevant species and genera were reconstructed using partial small, large subunit and internal transcribed spacer ribosomal DNA (SSU, LSU D2-D3 and ITS1 rDNA) sequences and the resulting topologies were discussed.
Prayer as Seeing
Authors: Kamenicky Michael Austin
Published: February 2022

This article provides a theological framework whereby the practices of silent contemplative prayer and tongues speech can be understood as mutually conditioning prayer practices that form the one who prays to perceive both beauty and the beautiful. It does so through an examination of the implicit metaphysical assumptions of the respective practices. The first section examines the implicit relationship between contemplative prayer and divine impassibility. The second section examines the relationship between glossolalia and divine relationality. The third section presents the practices of contemplation and glossolalia as mutually informative in dialogue with Gregory Palamas’ distinction between divine essence and energies. The article will therefore conclude that a comprehensive prayer practice that unites the experiences of impassibility and relationality can overcome the aesthetic divide between the mystical and the artistic by uniting the one who prays with a God who is both transcendent and relational.
Structural, Optical and Magnetic Properties of (Al, Ni) Co-Doped ZnO Nanoparticles
Authors: El Ghoul J. , Abdel All N. , Khouqeer G. , Alshammari M. S.
Published: February 2022

In the present work, the synthesis of Zn0.9_xNi0.1AlxO (x = 0.01, 0.015, 0.02 and 0.025) nanoparticles by sol–gel and theirs structural, optical and magnetic properties were investigated. In our approach, we performed
a drying under supercritical conditions of ethyl alcohol. An esterification reaction was established to release water slowly. The powder obtained underwent a heat treatment in air at 500 °C in 2 hours. The results obtained by X-rays diffraction (XRD) and transmission electronic microscopy
(TEM) showed that the structure is wurtzite with a crystallite size ranging from 25 nm to 40 nm, and a second phase was detected, linked to the NiO phase. Ultraviolet-visible (UV-Vis) spectroscopy shows a decrease in bandgap values with increasing of Al concentration. Photoluminescence (PL)
results indicate the effects of oxygen vacancies on emission spectra. Magnetic measurements at 300 K and 10 K showed a paramagnetic with an improve of ferromagnetic at low temperature.
Design and Application of Waveguide Microwave Electron Synthesis Power Amplifier Using Er3+−Yb3+ Co-Doped Nanocrystalline
Authors: Zhou Qiaoyi , Cui Fuyi , Zhang Zhiliang
Published: February 2022

The solid-state power device has the advantages of small size, light weight and low working voltage, but the output power of the device is limited and cannot meet the engineering needs of power synthesis. Based on the characteristics of erbium (Er3+)-doped optical waveguide amplifier (EDWA), Er3+-ytterbium (YB3+) nanocrystalline were introduced into the design of solid-state power devices, and then nanoelectronic devices were designed to improve the output power of the device. First, NaYF4: 8%Er3+, 16%Yb3+nanocrystalline were prepared. SU-8 UV glue was used to prepare NaYF4: Er3+. Yb3+nanocrystalline doped polymer waveguide amplifier was designed and used to observe the waveguide morphology and its performance was tested. Then, the power synthesis amplification technology was studied, and the power distribution-synthesis network based on waveguide E–T junction was designed. The waveguide-microstrip transition structure adopted ridge waveguide transition. On this basis, the 4-stage waveguide E-plane stepped structure was introduced and its structure was simulated. In the design of the power synthesis amplifier, the signal gain of the synthesis amplifier was tested by using the nanocrystal-doped polymer waveguide amplifier as the power unit device. The experimental results show that the output signal light of the nanocrystal-doped polymer waveguide amplifier can be received by an infrared detector. When the pump light power at 980 nm is 200 mW and the signal light power is only 0.1 mW, the maximum relative gain is 4.7 dB in a 1.2 cm long waveguide. The saturated output power of the power unit device is 19.3 dB~19.8 dB, which is close to the saturated output power required by the chip manual. The gain curve of the power synthesis amplifier is relatively flat, that is, the use of nanocrystal-doped polymer waveguide electronic devices effectively improves the synthetic signal gain and reduces the adverse impact of power distribution-synthetic passive network loss.
Nanosheets Assembled Co3O4 Nanoflowers for Supercapacitor Applications
Authors: Shaheen A. , Hussain Shahid , Qiao G. J. , Mahmoud Mohamed H. , Fouad Hassan , Akhtar M. S.
Published: February 2022

The energy storage has become universal concern with increasing global economy and population. Therefore, it becomes a great challenge to develop renewable energy sources to meet the increasing energy demand. We have successfully synthesized Co3O4 nanoflowers by
a simple hydrothermal method for supercapacitor applications. The morphology and structure were analyzed by SEM/TEM and XRD. The electrochemical properties of the Co3O4 nanoflowers of the Co3O4 nanoflowers were measured by CV, GCD, and EIS. The resulting
material exhibited a specific capacitance of 3491 mF/cm2 at a current density of 20 mA/cm2 with good cyclic stability in 6 M KOH solution. Furthermore, the asymmetric supercapacitor assembled with Co3O4 nanoflowers as a positive electrode and activated
carbon as a negative electrode showed high energy storage capacity (2102 mF/cm2) and good cyclic stability. Therefore, this work shows great potential of Co3O4 nanoflowers as a supercapacitor cathode material.
Effect of TiO2 Nano-Photocatalyst on Cataract and Lens Epithelial Cells
Authors: Zeng Qiang , Li Li , Fu Xiaojin , Luo Yiting , Fang Junxu
Published: February 2022

Cataract seriously threatens the visual function integrity of patients, having a major impact on quality of life. As conventional cataract surgery has significant limitations in extracapsular cataract extraction, it is important to develop new, effective treatment schemes for better
clinical outcome of cataract. The advancing maturity of nanotechnology may provide a new direction for cataract treatment. In this study, we established a mouse model of cataract, and explored the properties and effects of titanium dioxide (TiO2) nano-photocatalyst on mouse lens
epithelial cells (LECs) toward new potential applications for future clinical cataract treatment. Following the generation of mice with cataract and preparation of TiO2 nano-photocatalyst and light source, we investigated the effects of TiO2 nano-photocatalyst on the
proliferation, apoptosis, and expression of apoptotic proteins of cultured mouse LECs by MTT assay, flow cytometry, and Western blot. Using electron microscopy, it was determined that TiO2 on treated glass slides were dense, aggregated, and spherical with uniform size. In addition,
the apoptosis rate, oxidative stress response and hypoxia inducible factor-1 α (HIF-1α) protein expression of lens epithelial cells treated with TiO2 were lower than those of untreated group (P < 0.05), whereas the rate of multiplication ability
increased (P < 0.05). Further, After 30 min was irradiated by UVA, the cell survival rate of TiO2 treated group was higher than that of untreated group (P < 0.05). Based on these findings, TiO2 effectively decreased apoptosis of LECs and reduce oxidative
stress injury, findings which demonstrate considerable potential in the treatment of cataract.
Treatment and Nursing Activities of Cu(II)-Based Coordination Polymers on Obstructive Jaundice in Liver Cancer by Regulating Farnesoid X Receptor and Wingless Int1–Catenin Activity
Authors: Li Yang , Li Yan , Liu Shi , Hao Liguo , Li Yuanyuan
Published: February 2022

Two novel coordination polymers, namely, [Cu3(qptc)2(H2O)3]·3.5H2O·3Me2NH (1) together with [Cu3(qptc)2(H2O)4]·5H2O (2) (H4qptc is
1,1′:4′,1″:4″,1‴-quaterphenyl-2,4,2″,4″-tetracarboxylic acid), were produced under a hydrothermally condition using the rigid aromatic multicarboxylic acid ligand. Structural analysis results indicated that compound 1 exists in a triclinic
space group of P-1 and displays a 4,8-linked 3-D open structure containing the trinuclear nickel Cu3 secondary building units (SBUs), which exists in scu topology with (44 · 62) and (416 · 612) point symbols.
And the complex 2 exists in a monoclinic space group of C2/c and displays a 3-D structure involving Cu3 SBUs, which exists in flu topology with (46) and (412 · 612 · 84) point symbols. Moreover, the novel
complexes’ bio-activities against obstructive jaundice in liver cancer was investigated, and the specific mechanism was discussed. The expression of the bile acid receptor, farnesoid X receptor, on liver cancer cells was tested by Western blot analysis. Wnt–catenin activity activation
in liver cancer cells was tested through exploiting RT-PCR.