bluuebunny/crossref_metadata_2025 huggingface dataset:
Erythroderma and Skin Desquamation in Paederus Dermatitis
Authors: Kitisin Thitinan , Sukphopetch Passanesh
Published: December 2021

Exfoliative erythroderma is rare but serious condition, which requires close supervision. We report a rare case of 28-year-old man with kissing lesions of Paederus dermatitis at his right side of neck. The rash caused by Paederus beetle was improved after treatments. However, the patient developed generalized erythema with desquamation and scaling. The patient was successfully treated topically with moisturizing liquid soap and topical moisturizer with emollients and humectants, and triamcinolone lotion was applied on the bright red lesion. The patient was also treated with oral replacement solution and tropical azelaic cream was applied on the hyperpigmented kissing lesion. This case report shows the importance of a diagnostic practice with follow-up examination.
Analysis of Volleyball Video Intelligent Description Technology Based on Computer Memory Network and Attention Mechanism
Authors: Zhang Zhongzi
Published: December 2021

There are some problems in the process of video intelligent description and analysis of volleyball, such as poor effective information extraction rate and poor dynamic tracking effect. Based on this, combined with long‐term and short‐term memory network and attention mechanism, this paper designs an intelligent description model of volleyball video based on deep learning algorithm and studies how to improve the extraction rate of volleyball video information through intelligent detection hardware and image recognition technology. This paper first introduces the application of image recognition technology and deep learning algorithm in the intelligent description of volleyball video, then designs the volleyball video and image recognition model based on deep learning algorithm according to the requirements of volleyball video intelligent description, and selects three correlation factors related to the impact indicators of volleyball skills. This study selects three characteristic parameters associated with volleyball video analysis indexes, namely, take‐off, bounce, and hand movement, combined with image sensing hardware assisted sensor network to realize real‐time monitoring of action state in volleyball video analysis system. The experimental results show that, compared with the current mainstream sports video intelligent analysis and image recognition methods with data analysis as the core, the intelligent volleyball sports video intelligent description and image recognition system based on the integration of deep learning algorithm and sensor hardware assistance has the advantages of good detection effect, high data effectiveness, low cost, and high efficiency of volleyball sports video analysis. It can effectively improve the efficiency of volleyball video intelligent description.
[Retracted] Software Systems Security Vulnerabilities Management by Exploring the Capabilities of Language Models Using NLP
Authors: Althar Raghavendra Rao , Samanta Debabrata , Kaur Manjit , Alnuaim Abeer Ali , Aljaffan Nouf , Aman Ullah Mohammad
Published: December 2021

Security of the software system is a prime focus area for software development teams. This paper explores some data science methods to build a knowledge management system that can assist the software development team to ensure a secure software system is being developed. Various approaches in this context are explored using data of insurance domain‐based software development. These approaches will facilitate an easy understanding of the practical challenges associated with actual‐world implementation. This paper also discusses the capabilities of language modeling and its role in the knowledge system. The source code is modeled to build a deep software security analysis model. The proposed model can help software engineers build secure software by assessing the software security during software development time. Extensive experiments show that the proposed models can efficiently explore the software language modeling capabilities to classify software systems’ security vulnerabilities.
Abdominal Enhanced Computed Tomography Image by Artificial Intelligence Algorithm in the Diagnosis of Abdominal Aortic Aneurysm
Authors: Zheng Tao , Shao Guofeng , Zhou Qingyun , Wang Qinning , Ye Mengmeng
Published: December 2021

The purpose of this study was to investigate the clinical value of CT angiography (CTA) images processed by the segmentation denoising technique based on deep convolution neural network algorithm in the diagnosis of abdominal aortic aneurysm (AAA) and the detection of disease changes. A total of 98 patients with ruptured AAA were retrospectively selected as the study subjects. Patients were grouped according to whether the CTA images were optimized, the images receiving artificial intelligence segmentation and denoising were set as the observation group, and the CTA images without optimization were set as the control group. The detection and diagnosis effects of CTA images before and after the treatment were compared. The surgical results were used as the standard to analyze the diagnostic effect, and the maximum diameter measurement results of AAA and the proportion results of intraluminal thrombus (ILT) were compared. Although the sensitivity and accuracy of diagnosis in the observation group (97.73% and 94.9%) were higher than those in the control group (95.45% and 92.86%), there was no significant statistical significance (

P
>
0.05

). When the diameter of AAA was no less than 5 cm, all results showed that the coverage percentage of intraluminal thrombus (ILT) was over 50%. When the diameter of AAA was less than 5 cm, only 55.56% of the results showed that the percentage of ILT coverage was over 50%, with considerable differences (

P
>
0.05

). According to the results of the study, it was found that there was a certain relationship between the thrombus coverage of the abdominal aortic wall and the growth rate of AAA. The deep convolution neural network algorithm had a certain effect on the treatment of CTA, but it is not obvious. However, CTA had a better clinical diagnostic effect on AAA.
An Interesting Case of Nonlupus Full-House Nephropathy
Authors: Sathi Satyanand , Sharma Alok , Garg Anil Kumar , Saini Virendra Singh , Singh Manoj Kumar , Vohra Devinder , Trivedi Arvind
Published: December 2021

Full-house immunofluorescence and endothelial tubuloreticular inclusions are known as characteristic features of lupus nephritis. However, both features are not pathognomonic for lupus nephritis. A kidney biopsy specimen showing full-house immunofluorescence pattern in the absence of autoantibodies and classical clinical features of Systemic Lupus Erythematosus (SLE) is now considered as nonlupus full-house nephropathy (FHN). Nonlupus FHN may be idiopathic or due to other disease processes known as secondary nonlupus FHN. Here, we report the case of a 36-year-old female who presented with nephrotic proteinuria with bland urine sediment. Additional analyses revealed normal serum antinuclear antibody (ANA), normal anti-double-stranded DNA (anti-dsDNA) antibodies, and normal serum C3 and C4 levels. A renal biopsy showed a normal-appearing glomerulus without any proliferation or capillary wall thickening and widespread glomerular immune deposits (full-house effect; IgA, IgG, IgM, C3, and C1Q) on direct immunofluorescence. Renal electron microscopy showed diffuse effacement of visceral epithelial cell foot processes and mesangial electron dense deposits. The patient was diagnosed as nonlupus FHN. There is a controversial role of steroids and other immunosuppressive drugs in the treatment of nonlupus FHN patients, but our case patient responded favourably to steroid therapy. The term nonlupus FHN can be used as an umbrella term for patients who do not satisfy the clinical and serological criteria of SLE.
Safety and Efficacy of Cryoballoon Ablation of Atrial Fibrillation in relation to the Patients’ Age: Results from a Large Real-World Multicenter Observational Project
Authors: Sciarra Luigi , Iacopino Saverio , Arena Giuseppe , Tondo Claudio , Pieragnoli Paolo , Molon Giulio , Manfrin Massimiliano , Curnis Antonio , Russo Antonio Dello , Rovaris Giovanni , Stabile Giuseppe , Calò Leonardo , Boscolo Gabriele , Verlato Roberto
Published: December 2021

Background. The real-world efficacy and safety of atrial fibrillation (AF) ablation in particularly young and elderly patients are still under debate. The aim of the analysis was to investigate the effect of age on the efficacy and safety of cryoballoon ablation (CBA). Methods. 2,534 patients underwent pulmonary vein isolation (PVI) by way of CBA for paroxysmal or persistent drug-resistant and symptomatic AF. The population was divided into age quartiles for evaluation, including (1) <53 years, (2) ≥53 and <61 years, (3) ≥61 and <67 years, and (4) ≥67 years. Furthermore, outcomes were analyzed in patients <41 years, ≥41 and ≤74, and >74 years old. Procedural data and complications were collected, and atrial fibrillation recurrences were evaluated during follow-up. Results. Procedural-related complications (4.1%) were similar in the four subgroups according to age. At the 12-month follow-up, freedom from AF recurrence was 79.2%, 77.4%, 76.8%, and 75.2% (

p
=
0.21

), respectively (with increasing age). At 24-month follow-up, similar incidences of AF recurrence were observed in the four subgroups. When the sample was arbitrarily divided into the three age groups, a higher rate of recurrence was observed in older patients with regard to long-term follow-up (freedom from AF recurrence was 71.8% and 40.9%, respectively, at 12 and 24-month follow-up). In the univariate and multivariate analysis, age did not result in a significant predictor of AF recurrence during follow-up; however, a trend toward higher AF recurrences rates in patients ≥67 years was observed. Conclusion. The data demonstrated a high degree of safety during CBA across all patient ages. Procedural performance and complications were similar between different ages; AF recurrences seem to be more frequent in patients over 74 years.
Subthreshold Laser Treatment for Serous Retinal Detachment Associated with Tilted Disc Syndrome
Authors: Minowa Yuko , Ohkoshi Kishiko , Ozawa Yoko
Published: December 2021

Persistent serous retinal detachment (SRD) is a common complication of tilted disc syndrome (TDS). The purpose of this study is to evaluate the efficacy of subthreshold laser photocoagulation for SRD associated with TDS. This retrospective, single-center study included 5 eyes of 5 patients with TDS-associated SRD treated by subthreshold laser treatment. SRD was completely absorbed in 4 eyes within 4 months after initial treatment. However, it recurred in 2 eyes; one required additional laser treatment and one showed spontaneous resolution. Eventually, all 4 eyes showed complete SRD resorption. The mean visual acuities at enrollment and 1 and 3 months showed no significant differences. The mean central macular thickness showed a significant decrease at 3 months. Two eyes showed changes in fundus autofluorescence findings at the laser ablation site. However, there were no instances of laser scotoma and no laser-induced retinal scarring on color fundus photography performed at the end of treatment. In conclusion, subthreshold laser photocoagulation is an effective treatment for SRD associated with TDS. Thus, the clinical indications of subthreshold laser photocoagulation may be extended to SRD in patients with TDS.
Associations of Gait Disorders and Recurrent Falls in Older People: A Prospective Population-Based Study
Authors: Marini Kathrin , Mahlknecht Philipp , Schorr Oliver , Baumgartner Melanie , De Marzi Roberto , Raccagni Cecilia , Kiechl Stefan , Rungger Gregorio , Stockner Heike , Willeit Peter , Willeit Johann , Poewe Werner , Seppi Klaus
Published: December 2021

Background: Recurrent falls represent a major source of serious adverse health outcomes in the general older population. Gait impairment has been linked to recurrent falls, but there are only limited long-term data on this association. Objectives: The objective of the study was to investigate the association of gait disorders (GDs) and gait tests with future falls in an existing longitudinal population-based cohort. Method: The study was performed in participants of the Bruneck Study cohort 2010 aged 60–97 years, with prospective 5-year follow-up. At baseline, participants underwent a clinical gait assessment (to determine neurological and non-neurological GDs according to an established classification) and were also evaluated by quantitative and semiquantitative gait tests (Hauser Index, Tinetti balance and gait test, and gait speed). Logistic regression analysis adjusted for age and sex was used to determine the relationship of baseline variables with incident recurrent falls at 5-year follow-up. Results: Of 328 included participants, 22 (6.7%) reported recurrent falls at follow-up. Baseline presence of GDs was associated with recurrent falls at follow-up (odds ratio [OR] 4.2; 95% confidence interval [CI] 1.6–11.1; p = 0.004), and this effect was largely driven by neurological GDs (OR 5.5; 95% CI 1.7–17.4; p = 0.004). All 3 simple gait tests were predictive for incident falls (Hauser Index, p = 0.002; Tinetti test, p = 0.006; and gait speed, p < 0.001). Conclusions: Clinical assessment of GDs and gait tests both had independent significant predictive value for recurrent falls over a 5-year follow-up period. This highlights the potential of such assessments for early fall risk screening and timely implementation of fall-preventive measures.
Papillary Craniopharyngioma: A Type of Tumor Primarily Impairing the Hypothalamus – A Comprehensive Anatomo-Clinical Characterization of 350 Well-Described Cases
Authors: Prieto Ruth , Barrios Laura , Pascual José M.
Published: December 2021

Objective: Papillary craniopharyngiomas (PCPs) represent a rare histological type of craniopharyngiomas (CPs) usually involving the hypothalamus. This study systematically analyzes the clinical-anatomical correlation between tumor topography and symptoms related to hypothalamic dysfunction in the largest series of PCPs ever gathered. Methods: From 5,346 CP reports published from 1856 to 2021, we selected 350 well-described cases of the squamous-papillary type. Clinical presentation, tumor topography, severity of hypothalamic adhesion, patient outcome, and tumor recurrence were thoroughly analyzed. Results: PCPs predominantly occur in adult (96.3%), male (61.7%) patients presenting with headache (63.4%), visual alterations (56.2%), and psychiatric disturbances (50.4%). Most PCPs are solid (50%), round (72%) lesions that occupy the third ventricle (3V, 94.8%) and show low-risk severity adhesions to the hypothalamus (66.8%). Two major topographical categories can be found: strictly 3V (57.5%), growing above an intact 3V floor, and not-strictly or infundibulo-tuberal (32.9%), expanding at the infundibulum and/or tuber cinereum. The hypothalamic syndrome predominated among strictly 3V PCPs (p < 0.001). Psychiatric symptoms (p < 0.001) and high-risk hypothalamic attachments (p = 0.031) related to unfavorable postoperative outcomes among patients treated from 2006 onwards. The not-strictly 3V topography was identified as the major predictor of high-risk hypothalamic attachments (71.2% correctly predicted), which, along with incomplete tumor removal (p = 0.018), underlies the higher tumor recurrence of this topography (p = 0.001). Conclusions: This systematic review evidences that PCP topography is a major determinant of hypothalamic-related symptoms, type of hypothalamic attachments, and tumor recurrence rate. Accurate preoperative definition of PCP-hypothalamus relationships is essential for the judicious, safe management of these complex lesions.
САМОВРЯДУВАННЯ В СИСТЕМІ ОХОРОНИ ЗДОРОВʼЯ УКРАЇНИ
Authors: Литвинова О. Н. , Запорожан Л. П. , Юріїв К. Є. , Феш М. С.
Published: December 2021

Мета: проаналізувати засади самоврядування в системі охорони здоровʼя для можливостей його імплементації в Україні.

Матеріали і методи. Використовуючи методи системного аналізу, показано стан функціонування самоврядних професійних організацій в охороні здоровʼя та можливості його запровадження в Україні.

Результати. Показано причини появи необхідності запровадження лікарського самоврядування в ряді європейських країн. Розглянуто позитивні та проблемні сторони лікарського самоврядування, шляхи його запровадження в Україні.

У більшості розвинених країн світу працюють самоврядні організації в системі медичної допомоги, і про те, що вони є гарантом високої якості медичної допомоги, говорять їх управлінські органи. Вони здійснюють це право і мають здатність реально регламентувати значну частину державних справ та управляти діяльністю в системі медичної допомоги, діючи в рамках закону, під свою відповідальність і в інтересах місцевого населення.

У лікарській практиці багатьох країн світу існує певна дилема: з одного боку, це клінічні протоколи, яким лікар у більшості випадків має слідувати, а з іншого – лікарське самоврядування, яке допускає свободу його дій.

В Україні запровадження в медицині принципів самоврядування полягало у створенні громадських організацій на кшталт Лікарського товариства, Асоціації лікарів тощо. Але слабкою їх стороною було те, що вони мали право лише дорадчого голосу.

Висновки. Виходячи із аналізу діяльності органів лікарського самоврядування та реалій української медичної спільноти, можемо зробити висновок про назрівання необхідності запровадження професійного медичного самоврядування в Україні. Імплементація медичного самоврядування в Україні потребує адекватної нормативної бази, узгодження положень про самоврядування з існуючою нормативною базою.
ОСОБЛИВОСТІ РОЗВИТКУ СТОМАТОЛОГІЧНОЇ ДОПОМОГИ У РОЗВИНЕНИХ КРАЇНАХ ЗАХІДНОЇ ЄВРОПИ ТА ПІВНІЧНОЇ АМЕРИКИ
Authors: Лебедик С. В. , Коноваленко С. О.
Published: December 2021

У статті розглянуто основні напрямки розвитку стоматологічної допомоги у розвинених країнах Західної Європи та Північної Америки.
Allele and genotype frequency for milk beta-casein in dairy cattle in the northern region of Tocantins State, Brazil
Authors: Oliveira Rodolfo Olinto Rotoli Garcia , Carvalho Minos Esperandio de , Rodrigues Matheus Henrique Dias , Poleti Mirele Daiana , Ferraz José Bento Sterman , Souza Ana Beatriz Bezerra , Minharro Silvia , Santos Helcileia Dias , Ferreira Jorge Luís
Published: December 2021

At present, there is a concern about the quality of milk and diseases related to its consumption, as it can generate discomfort and allergic reactions in some individuals due to its protein components. Thus, the present study was developed to identify the allele and genotype frequencies of genes for β casein, A1 and A2, in dairy herds in the region of Araguaína-TO, Brazil. Genetic material from 421 animals (crossbred dairy cattle in lactation) was used. All animals were numbered for identification, and DNA samples were extracted from hair bulbs. Samples for two markers from the polymorphic regions were characterized and confirmed by real time PCR using the ABI Prism® 7500 Sequence Detection System (Applied Biosystems). Allele and genotype frequencies were determined using the TaqMan™ detection system, where the primer and probe release different fluorescence signals for each allele of the polymorphism. The sampled herd showed frequencies of 28.27% for the A1 allele and 71.73% for the A2 allele. Genotype frequencies were 52.96% (223/421) for A2A2; 37.53% (158/421) for the A1A2 genotype; and 9.50% (40/421) for the A1A1 genotype. The frequency of the A1 allele for β-casein in dairy herds from the northern region of Tocantins was low and is per the results of previous studies. Although the A2A2 genotype of β-casein had a high relative frequency, the A1A2 genotype is still rather frequent, warranting greater selection pressure.
Role of Echocardiography for Assessment of Cardiac Remodeling in Congenitally Corrected Transposition of Great Arteries
Authors: Egbe Alexander C. , Miranda William R. , Connolly Heidi M.
Published: December 2021

Background:

The purpose of this study was to assess the role of echocardiography for a comprehensive assessment of cardiac remodeling, and the relationship between indices of cardiac remodeling and cardiovascular events (defined as the composite end point of heart failure hospitalization, heart transplant, or cardiovascular death) in adults with congenitally corrected transposition of great arteries (cc-TGA).

Methods:

This is a retrospective study of adults with cc-TGA who underwent echocardiogram (2003–2020). Offline image analysis was performed in all patients. Chamber (atrial and ventricular) function and size were assessed by strain imaging and 2-dimensional echocardiography.

Results:

Of 233 patients with cc-TGA (40±15 years), 123 (55%) had at least one cardiac procedure before baseline echocardiogram. Of 233 patients, 76% and 61% had left atrial dysfunction and systemic right ventricular dysfunction, respectively; while 43% and 11% had right atrial dysfunction and left ventricular dysfunction, respectively. During a median follow-up of 8.9 years, 114 (49%) underwent additional cardiac procedures, and 66 (28%) had cardiovascular events. Left atrial reservoir strain, right ventricular global longitudinal strain, right atrial reservoir strain, left ventricular systolic pressure, and left ventricular global longitudinal strain were independently associated with cardiovascular events.

Conclusions:

In addition to the clinical importance of right ventricular systolic dysfunction in cc-TGA that is already well described, the current study demonstrated, for the first time, that biatrial dysfunction was common and was associated with clinical outcomes. Since there are currently no effective therapies for atrial and ventricular dysfunction in patients with cc-TGA, there is a need for research to identify novel strategies to prevent atrial and ventricular dysfunction in this population.
Abstract 102: Major Adverse Cardiovascular Events in U.S. Coronary Heart Disease and Acute Coronary Syndrome Patients
Authors: Ariely Rinat , Korsnes Jennifer S , Mitra Debanjali , Davis Keith L , Bell Christopher
Published: December 2021

Background:
Healthcare resource utilization and costs associated with cardiovascular events among patients with coronary heart disease (CHD) and acute coronary syndrome (ACS) are needed to assess the value of treatments.

Methods:
A retrospective analysis of a large US administrative claims database (1/1/2006-12/31/2011) was conducted to describe episodes of major adverse cardiovascular events (MACE: hospitalization for stroke, myocardial infarction (MI), or cardiac arrest) in adults with CHD and ACS, respectively. The CHD cohort (n=245,185) had either a diagnosis of MI, a percutaneous coronary intervention (PCI) procedure or coronary artery bypass graft (CABG), or both, a CHD diagnosis and a multiple vessel coronary procedure, at a minimum. The ACS cohort (N= 75,231, not mutually exclusive with CHD) had ≥1 ACS-related hospitalization. The index date was the first observed cohort-specific disease claim and the 30-day period following the service date of the index episode or discharge date (for hospitalizations). Patients were required to have continuous health plan enrollment for 12 months +/- the index episode. HF, MI, and cardiac arrest diagnoses did not specify whether they were fatal or not.

Results:
Mean age in both cohorts was ~65 years and ~66% were male. The overall MI rate during the 12-month follow-up period was 15.6 and 26.4 per 1,000 person years for CHD and ACS patient, respectively. Among patients with at least one MACE, 286 CHD patients (4.8% of those with an event) and 137 ACS patients (5.5% of those with an event) experienced a second event during the 12-month follow-up period. Mean (SD) total episode-related costs per patient were $19,230 ($34,983) for CHD patients and $23,490 ($36,749) for ACS patients. Inpatient hospitalization represented the highest proportion of costs at 86.9% of CHD and 95.0% of ACS episode-related costs, while CVD-related pharmacotherapy mean costs (SD) were only $226 ($293) and $228 ($294) per patient for CHD and ACS, respectively.

Conclusions:
CHD and ACS are resource intensive diseases in the first year after index episode, with most costs related to hospitalizations. Outpatient cardiovascular drug costs make up a small proportion of the total costs.
Abstract 109: In-Hospital Worsening Heart Failure is Associated With Poor Patient Outcomes and Increased Health Care Utilization
Authors: DeVore Adam D , Hammill Bradley G , Sharma Puza P , Qualls Laura G , Mentz Robert J , Waltman Johnson Katherine , Fonarow Gregg C , Curtis Lesley H , Hernandez Adrian F
Published: December 2021

Background:
A subset of patients hospitalized with acute heart failure (AHF) experiences worsening clinical status while hospitalized and require escalation of therapy. This phenomenon, termed in-hospital worsening heart failure (WHF), is an endpoint for many clinical trials but limited data exist on the prevalence of WHF in clinical practice and associated outcomes.

Methods:
We analyzed inpatient data from Acute Decompensated Heart Failure National
Registry
(ADHERE) linked to Medicare claims data to describe outcomes and health care utilization of patients that developed WHF. In-hospital WHF was defined by any of the following: use of inotropes or intravenous vasodilators >12 hours after admission; initiation of mechanical circulatory support, hemodialysis, or ventilation after the first inpatient day; or transfer to the ICU after initial admission to a regular hospital ward. Patients with WHF were compared to those with an uncomplicated hospital course and those that had a complicated hospital presentation, defined as requiring the above advanced therapies on arrival.

Results:
The study population consisted of 63,727 patients hospitalized between 01/2001 and 12/2004. Of these, WHF developed in 7032 (11%), 15,361 (24%) presented with a complicated presentation and 41,334 (65%) with an uncomplicated hospital course. Observed mean length of stay was longest in the WHF cohort (10.0 days) followed by complicated presentation (6.3 days) and uncomplicated course (4.8 days). Patients with WHF also had higher observed rates of mortality and all-cause readmission at 30 days and 1 year after discharge (P<0.001; Figure). The adjusted hazard ratio for 30-day mortality was 2.56 (99% CI 2.34-2.80) for WHF compared to an uncomplicated hospital course and 1.29 (1.17-1.42) compared to a complicated presentation. Medicare payments were also higher for patients with WHF with an adjusted cost ratio at 30 days of 1.35 (99% CI 1.24-1.46) for WHF compared to an uncomplicated hospital course and 1.11 (1.02-1.22) compared to a complicated presentation.

Conclusion:
In a large, multicenter registry, in-hospital WHF was common and associated with higher rates of mortality, all-cause readmission, and Medicare payments. Preventing and treating WHF represents an important therapeutic target among patients hospitalized with AHF.
Abstract 11: Temporal Changes in NIHSS Documentation and Stroke Severity among Patients Treated with Thrombolysis in the Massachusetts Coverdell Registry
Authors: Schwamm Lee , Parkinson Gabrielle , Coe Laura
Published: December 2021

Intro:
IV tPA use has increased since the 2009 US guidelines recommended extending the window to 4.5 hr. The most common reasons for nontreatment are rapid improvement of stroke symptoms (RISS) and stroke “Too Mild”. We evaluated the NIHSS profile and outcomes over time in Massachusetts Coverdell patients receiving IV tPA, or not treated due to RISS and Too Mild.

Methods:
All adults >18 yr arriving at a MA Coverdell hospital < 4.5 hr from time last known well with a diagnosis of ischemic stroke or TIA (with persistent symptoms) were included (n=10,433). We compared rates of NIHSS documentation, median NIHSS, and discharge home between 11/09-10/10 (Year 1, n=2,573) vs. 11/12-10/13 (Year 4, n=2,658) among All, IV tPA, RISS, and Too Mild patients. Ordinal variables were analyzed by Kruskal-Wallis and proportions by Chi square, and odds ratio of discharge home was adjusted for NIHSS, age, and gender. NIHSS was missing in 20% of cases.

Results:
The two cohorts were similar by gender and vascular risk factors, except for age, HTN and dyslipidemia. IV tPA use within 4.5 hr of onset increased (19% vs. 25%, p<.0001) as did the documentation of an NIHSS among All patients (68% vs. 87%, p<.0001), IV tPA (86% vs. 97%, p<.0001), RISS (70% vs. 89%, p<.0001) and Too Mild (75% vs. 92%, p<.0001). Rates of RISS (27% vs. 26%) and Too Mild (19 vs. 22%) did not decrease but median NIHSS decreased over time among the IV tPA and Too Mild (Figure). Unadjusted rates of discharge home increased for IV tPA (25% vs. 31%, p=0.004), and for All (36% vs. 45%), RISS (51% vs. 63%), and Too Mild (52% vs. 67%; all comparisons, p<.0001). In multivariate analysis, discharge home increased among All (OR 1.9; 95%CI 1.6-2.2); RISS (2.2; 1.7-2.9) and Too Mild (2.4; 1.8-3.4) but not IV tPA (1.1, 0.8-1.6).

Discussion:
IV tPA use in MA Coverdell patients is increasing and now reaches 25% of all early arriving subjects. NIHSS documentation is increasing as well, especially among subjects with lower NIHSS scores. The median NIHSS in RISS or Too Mild patients is reassuringly low, and decreased significantly among Too Mild patients. These data, coupled with the fact that unadjusted rates of discharge home among IV tPA patients are increasing while severity-adjusted rates are not, suggests that more patients previously felt to be Too Mild are now receiving IV tPA. Further efforts are still warranted.
Abstract 110: Long-Term Health Status Outcomes in Young Women with Acute Myocardial Infarction: Results from the VIRGO Study
Authors: Dreyer Rachel P , Strait Kelly M , Lichtman Judith H , Lorenze Nancy , D'Onofrio Gail , Bueno Hector , Spertus John A , Krumholz Harlan M
Published: December 2021

Background:
Despite the excess risk of mortality in young women following acute myocardial infarction (AMI), little effort has been made to describe their long-term outcomes, particularly with respect to their health status (symptoms, function and quality of life). Accordingly, we assessed gender differences in 1-year health status outcomes after AMI.

Methods:
Data was used from the VIRGO study, an observational cohort of patients aged ≤55 years with AMI in the US and Spain (n=3,501, 67% women). Clinical data was abstracted from medical records and health status was obtained through patient interviews at the time of hospitalization and at 1-year later [Short Form 12 (SF-12) and the Seattle Angina Questionnaire (SAQ)]. Patient scores were categorized as “bad” if they had below average scores on the SF-12 components, had a score below 100 on the SAQ physical limitations (PL) or the SAQ angina frequency (AF), or had a score below 75 on the SAQ quality of life (QOL) at either baseline or 1-year. Patients were classified as having a “poor” outcome for a measure if they had a “bad” score at both baseline and 1-year or had a “bad” score at 1-year. Logistic regression models were used to assess factors associated with having a “poor” outcome for each scale.

Results:
The median age was 48 years (IQR: 44, 52). Women were more likely to present with diabetes (39% vs. 27%), obesity (51% vs. 45%), stroke (5% vs. 2%), heart failure (5% vs. 2%), lung disease (13% vs. 5%), and depression (48% vs. 24%, all P values <0.0001). Women were more likely to have “poor outcomes” compared with men (SF-12 PCS 46% vs. 30%; SF-12 MCS 47% vs. 30%; SAQ AF 32% vs. 25%; SAQ PL 29% vs. 20%; SAQ QOL 42% vs. 28%, all p-values <0.001). Female gender, prior AMI/percutaneous coronary intervention/coronary artery bypass grafting, and smoking within 30 days were independent predictors of having a “poor” outcome for all health status measures. Specifically, women had an increased odds of having a “poor” outcome on the SF-12 PCS (OR=2.05; 95% CI 1.69, 2.48), MCS (OR=1.98; 95% CI 1.65, 2.39), SAQ AF (OR=1.39; 95% CI 1.15, 1.67), SAQ PL (OR=1.62; 95% CI 1.32, 1.99) and the SAQ QOL scale (OR=1.84; 95% CI 1.53, 2.22), as compared with men.

Conclusion:
Compared with men, young women are more likely to have “poor” health status outcomes after AMI. This information is critically important in developing targets for gender-specific interventions to improve young women’s recovery post AMI.
Abstract 115: Predictors Of A Positive Stress Test Among Patient Presenting To The Emergency Department With Chest Pain
Authors: Gadiraju Taraka V , Sagi Jahnavi , Basu Dev , Penumetsa Srikanth , Rothberg Michael
Published: December 2021

Objectives:
Patients frequently present to the hospital with chest pain. Once myocardial infarction is ruled out based on EKG and cardiac enzymes, most patients undergo stress testing, but only few patients have a positive test. In ambulatory practice, age, sex and symptomatology can establish pretest probability of the coronary disease. However, there are no studies evaluating the predictors of a positive stress test in the emergency department (ED). We assessed predictors for a positive stress test in patients presenting to our hospital with chest pain.

Methods:
This is a case-control study conducted on a subset of patients admitted to our tertiary care center with chest pain between 2007 and 2009, and who had an inpatient stress test (n=1474). Using chart review, we identified 87 patients, whose stress tests were positive (abnormals), defined as presence of ischemia on EKG and/or imaging modalities. We then used a pseudorandom number generator to select 194 patients whose stress test results were normal (normals) for comparison. Clinical features of chest pain and CAD risk factors were abstracted from the medical record for comparison.

A bivariable screening process was used to identify characteristics for inclusion in a multivariable predictive model. Sex and age were maintained in the model for face validity, and remaining covariates were removed in ascending order of their z-statistics until only those with a two-sided p-value of <0.10 remained. Stata 12.1 (Copyright 2011, StataCorp LP) was used for all analyses.

Results:
Patients with an abnormal stress test were older and more likely to be male and to have a history of vascular disease. Although patients with abnormal stress test were more likely to have history of hypertension, hyperlipidemia and current or ex-smoking, this difference was not statistically significant. Over half of the patients presented with non-cardiac chest pain and there was no significant difference in the chest pain characteristics between patients who had a normal and an abnormal stress test result.

In the final multivariable model, when compared to the normals, abnormals were four times as likely to have a history of revascularization (OR 4.13, 95% CI 2.11, 8.09) and twice as likely to have a history of hyperlipidemia (OR 2.1, 95% CI 1.18, 3.79). They were also more likely to have an EKG suggestive of ischemia at presentation (OR 1.90, 95% CI 1.03, 3.53). Specificity of the model was 89%; sensitivity was 43%, and the c-statistic for the final multivariable model was 0.76, suggesting fair to good discrimination.

Conclusions:
Among patients presenting to the ED with chest pain, a past history of revascularization and hyperlipidemia and an EKG suggestive of ischemia may independently predict the likelihood of an abnormal stress test. Further validation of this model on an external dataset is necessary.
Abstract 120: Outcomes of Out-of-Hospital Cardiac Arrest in Children
Authors: Jayaram Natalie , McNally Bryan , Tang Fengming , Chan Paul S
Published: December 2021

Background:
As pediatric out-of-hospital cardiac arrest (OHCA) occurs infrequently, little is known about survival outcomes in children. We examined whether OHCA survival in children differed by patients’ age, sex, and race, as well as recent survival trends.

Methods:
Within the Cardiac Arrest Registry to Enhance Survival (CARES), a prospective U.S. OHCA registry encompassing 64 million residents, we identified patients less than 18 years of age with an OHCA from October, 2005 to December, 2012. We examined whether survival differed by patients’ age (≤1 year, 1-8 years, >8 years), sex, race, and initial cardiac arrest rhythm, using modified Poisson regression, adjusted for patient characteristics. Similarly, we examined trends in survival, with years 2005-7 as the reference.

Results:
A total of 1,412 patients with an OHCA were identified, of which 67 (4.7%) were infants, 918 (65.0%) were younger children, and 427 (30.2%) older children. Sixty percent of the study population was male and 33.4% were black. The vast majority of arrests involved a non-shockable rhythm, with only 9.2% of patients having a first documented rhythm of ventricular tachycardia (VT) or ventricular fibrillation (VF). Overall, 103 (7.3%) patients survived to hospital discharge. Of those with non-shockable rhythms (asystole, pulseless electrical activity, and unknown, non-shockable rhythms), 4.4% survived to discharge compared with a survival of 36.2% in those with VT or VF (P<0.001). After adjustment for patient characteristics, children 1-8 years of age were less likely to survive to hospital discharge compared with children >8 years of age (rate ratio [RR]: 0.52; 95% confidence interval [CI]: 0.34, 0.82). In addition, OHCAs due to VT or VF were associated with improved survival (RR 6.67; 95% CI 4.35, 10.23). In contrast, there were no differences in survival by sex or race. Additionally, no temporal trends in survival were observed (p=0.47).

Conclusion:
In a large, national registry of pediatric OHCA, we found no disparities in survival by patients’ sex, race, or year of arrest, although survival was lower in young children and those with non-shockable cardiac arrest rhythms.
Abstract 102: Adding Computed Tomography Angiography (CTA) to the Acute Stroke Evaluation: A Single-center Experience
Authors: Ehrlich Matthew E , Turner Heather L , Currie Lillian J , Wintermark Max , Worrall Bradford B , Southerland Andrew M
Published: December 2021

Objective:
To evaluate the safety and utility of CTA acquisition during initial acute stroke evaluation. We hypothesized CTA would not increase risk of renal injury or delay therapy.

Design/Methods:
We performed a pilot study of CTA acquisition in the acute stroke evaluation at the University of Virginia Medical Center in the first three quarters of 2014. We extracted data from Acute Stroke Team Leader consultations with additional chart review. We collected door-to-CT read times, door-to-needle times, baseline creatinine (Cr) values on presentation, and Cr values 24-48 hours after stroke alert evaluation. Differences in means of these variables were compared between those receiving CTA versus non-contrasted head CT (NCHCT) only. Additionally, we captured CTA results immediately relevant to treatment decisions.

Results:
Of 289 patients, 157 had CTA completed while 132 had only NCHCT. In the CTA group, 18 patients (11.5%) were treated with IV tissue plasminogen activator (tPA) compared to 11 (8.3%) in the NCHCT group, with no significant difference between groups (p=0.377). There was no difference between mean door-to-CT-read times between the NCHCT (43.07 minutes) and CTA (41.46 minutes) groups (p=0.70). Likewise, there was no significant difference in mean door-to-needle times between the NCHCT (81.36 minutes) and CTA (68.11 minutes) groups (p=0.577). There was a difference between mean Cr values on presentation (1.39mg/dL NCHCT, 1.06mg/dL CTA; p=0.004), but there was no difference between the groups at 24-48 hours (p=0.059) and no difference between the mean change in Cr values (p=0.489). No patients developed a new requirement for hemodialysis. CTA imaging revealed 14 patients with vascular anomalies, and 53 patients with severe stenosis or occlusion of a major cervical or intracranial vessel. One patient in the CTA group and none in the NCHCT group had intravascular intervention.

Conclusions:
Overall, CTA during acute stroke evaluations were safe and may offer clinical utility, without delaying evaluation or therapy delivery. Additional cost of acute CTA acquisition is negligible given it replaces MRA typically performed later, following admission, as standard vessel imaging. Further prospective study is required.
Abstract 106: Defining an International Standard Set of Patient-centered Outcome Measures After Stroke
Authors: Salinas Joel ,   ICHOM Stroke Measure Group
Published: December 2021

Background:
Value-based healthcare delivery is a strategy to align patients, providers, and payers toward improving outcomes while reducing costs. We sought to define an international standard set of patient-centered, stroke health outcomes.

Methods:
We assembled an international expert panel representing patients, advocates, and physician experts in stroke outcomes, stroke registries, global health, epidemiology, and rehabilitation. A modified Delphi process was used to reach consensus recommendations for a Standard Set of outcome measures, baseline risk adjustment variables, and included populations for use in both low and high income countries.

Results:
Patients presenting to a hospital with ischemic stroke or intracerebral hemorrhage evaluated with brain imaging were selected as the required included population, with optional inclusion of transient ischemic attacks. Because of differences in ascertainment and imaging modalities, duration of symptoms and type of imaging are collected to allow for comparisons of homogeneous groups across various countries and practice settings. Basic functional status is assessed at prestroke baseline, index admission, discharge, 90 days, and 1 year thereafter. Co-morbidities and stroke severity are collected for risk adjustment. Symptomatic intracerebral hemorrhage after thrombolysis is the only complication captured, and many measures reflect patient-reported quality of life outcomes and priorities captured in the Patient Reported Outcomes Measurement Information System 10-question short form (PROMIS-10) and elements from existing registries.

Conclusions:
The stroke measure Standard Set is proposed for implementation to permit meaningful comparisons and increase value of stroke care worldwide using a simple, pragmatic strategy.
Abstract 107: Decade Long Trends (1999 - 2009) in Pre-hospital Delay and Short-term Mortality in Patients Hospitalized for Acute Myocardial Infarction - The Worcester Heart Attack Study
Authors: Erskine Nathaniel , Yarzebski Jorge , Lessard Darleen M , Gore Joel M , Goldberg Robert J
Published: December 2021

Objective:
Patients experiencing signs and symptoms of an acute myocardial infarction (AMI) require prompt evaluation and treatment. There are little contemporary data, however, available on how the extent of delay between the onset of acute coronary symptoms and hospital presentation may impact short-term mortality. The purpose of this population-based study was to examine the relationship between extent of pre-hospital delay with hospital case-fatality rates (HCFRs) and 30-day post-admission mortality rates (PAMRs) among patients hospitalized with validated AMI in all central Massachusetts medical centers, and trends over time therein.

Methods:
We examined the medical records of residents of the Worcester, MA, metropolitan area hospitalized with a confirmed AMI at all 11 central MA medical centers on a biennial basis between 1999 and 2009 (n = 6,017). Information on patient’s demographic, medical history, clinical characteristics, and time of acute symptom onset and hospital arrival was abstracted.

Results:
Hospital medical record data on pre-hospital delay were available for 2,913 (48%) subjects of whom their mean age was 68 years, 38% were female, and 90% were Caucasian. The mean and median pre-hospital delay times were 4.0 hours and 2.0 hours, respectively, with little change noted in these times between 1999 and 2009. Patients who reported pre-hospital delay times greater than two hours were more likely to be older, female, and have a history of heart failure or diabetes mellitus as compared with patients who delayed seeking medical care by less than 2 hours. The overall HCFR was 6.6% and 30-day PAMR was 9.4%. The average HCFRs and 30-day PAMRs varied slightly between those with delay times of less than 2 hours (6.5%, 9.2%), 2 to 4 hours (6.3%, 8.6%), and greater than 4 hours (7.0%, 10.6%). No statistically significant changes in HCFRs and 30-day PAMRs were observed as pre-hospital delay times increased. Analyses of our principal study outcomes according to type of AMI (e.g., STEMI and NSTEMI) are ongoing and will be presented subsequently.

Conclusions:
This population-based study of residents of central MA hospitalized with AMI in all metropolitan Worcester medical centers showed little change in average and median pre-hospital delays between 1999 and 2009. Both the HCFRs and 30-day PAMRs were not significantly increased with greater durations of pre-hospital delay possibly due to potential confounders such as symptom severity. Our preliminary results suggest the need to further investigate trends in pre-hospital delay and short-term mortality, including patients who die in the community before receiving acute medical care.
Mbembe’s Matrix and the Matri-Archive
Authors: Grillo Laura S.
Published: December 2021

Achille Mbembe shows how the West’s denigrating projections on Africa as a chaotic void perpetrated a founding epistemic violence. The matrix of Black Reason, Blackness, and The Black worked systematically to justify colonialism and undermine African subjectivity. By maintaining its grip over the psyche, the postcolonial commandement effortlessly and indefinitely sustained subjugation. This is its ‘little secret’. Mbembe suggests that liberation may be possible by appealing to an archive from the ‘underside’ of African history to retrieve a self that is not constituted by toxic colonial projections. Drawing on my work An Intimate Rebuke: Female Genital Power in Ritual and Politics in West Africa, I argue that the traditional appeal by postmenopausal women to their ‘bottom power’ is just such a living matrix – a ‘matri-archive’. Performing this ritual in the context of public protest, the ‘Mothers’ deploy their own ‘little secret’ with the capacity to break the hold of the postcolony’s spell.