bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP37: Way Beyond the Call: An Extended Collaborative Feedback Project With EMS
Authors: Steiner Nili E , Jack Caroline , Stokes Sean , Figueroa Sonia , Paletz Laurie B
Published: February 2024

Background/Purpose:
Emergency Medical Services (EMS) providers assess, treat and transport patients to destinations that provide the most appropriate emergency care. EMS provides the first crucial link in the chain of survival for patients suffering from life-threatening conditions. Stroke is a time-sensitive emergent condition which requires urgent evaluation, treatment, and expeditious transport to stroke-specialty centers. We noticed that EMS was not providing us with important information that could impact our initial stroke care. Our 21-month collaborative feedback project was created to provide EMS personnel who frequent our Emergency Department (ED) the tools necessary to administer high-quality, expeditious care. Our goal was to improve information provided to the stroke team and ED upon patient arrival by improving and sustaining three metrics by 20% within a 21-month period, by providing feedback to EMS, which include last known well time (LKWT), caregiver contact information (CCI), and mLAPSS documented (mLAPSS).

Methods/Implementation:
We collaborated with the Beverly Hills Fire Department (BHFD) educators from July of 2021 through March of 2023, providing a continual feedback loop for all EMS runs with an adjudication of stroke and TIA. Our feedback tool included quality metrics with benchmarks determined by the Los Angeles County EMS Agency, in conjunction with the BHFD educators and our team. We performed chart reviews and extracted data pertinent to each run. We summarized the hospital course and disposition for each patient and the feedback tool was distributed to the EMS providers for review. Data was collected and analyzed over seven quarters (Q3 and Q4 of 2021, Q1-Q4 of 2022, and Q1 of 2023, respectively).

Results/Conclusions:
Sustained improvements were noted in documentation. We achieved 20% improvement in LKWT (from 78% in Q3-Q4 2021, 98% in Q1-4 2022, 98% in Q1 2023), CCI collected (from 29% in Q3-Q4 2021, 75% in Q1-4 2022, 100% in Q1 2023), and mLAPSS completion was 8% improvement (from 89% in Q3-Q4 2021, 97% in Q1-4 2022, 100% in Q1 2023). An unanticipated result of this project was a halo effect of improved destination decisions from EMS. We will continue to track and trend these metrics and work closely with our colleagues in EMS.
Abstract WP45: A Collaborative Approach to Improving Inpatient Stroke Code Time Target Metrics
Authors: Rosenberg Antonieta A , Wankmuller Gabriela , Suri-Finn Jillian , froehlich anne , Anderson Marret , Kabacinski Andrea A
Published: February 2024

Much effort and education has been placed on pre-hospital and emergency departments to recognize signs and symptoms of acute stroke and time metrics such as door-to-CT, door-to-needle, and door-to-device. For admitted patients with acute onset of stroke symptoms, our data analysis identified a gap in the timeliness of stroke code activation upon symptoms discovery and subsequent delays in CT initiation and treatment. We evaluated our current process and implemented action plans to enhance the current inpatient stroke code process through focused education and training of staff to improve their recognition of acute stroke, timely activation of stroke code and improved CT initiation and treatment times. In 2021, several cardiology pilot units were selected and neuroscience nurse specialists conducted staff education which focused on recognition of stroke signs and symptoms, code activation criteria and response time targets. A resource binder and checklist were created to guide staff in putting together pertinent elements for communication and documentation. Data was collected on stroke code response times and individual feedback was provided. The group meets quarterly to evaluate progress, discuss opportunities for improvement and highlight best practices and outcomes. The checklist was a useful tool in reminding staff of pertinent information to communicate to the stroke team although form completion is not consistent. In 2021-2022, 54% of stroke codes were called within 10 minutes of symptoms discovery. CTH initiation time within 25 minutes of symptoms discovery was achieved in 16.2% of patients. Data analysis showed an opportunity to improve documentation of symptoms discovery time which were missing in 13.8% of cases. This collaborative approach with the pilot units has increased awareness and focus to the inpatient stroke code process. Opportunities exist to improve time target achievements in CTH initiation, treatment, and documentation of symptoms discovery time. Communication between the stroke team and the patient’s primary team has been identified as an essential factor for continued improvement along with on-going staff education.
Abstract WP48: Prescription Rate for Antihyperglycemic Medication With Proven Cardiovascular Benefit at Discharge in Stroke Patients Not Equal Among Payer Sources
Authors: Abelt Susan , Bluma Dot , Ebert Lisa
Published: February 2024

Background:
Mortality doubles in stroke patients when Diabetes Mellitus (DM) is present. Target: Type 2 Diabetes
SM
(TT2DM) is an American Heart Association® (AHA) initiative focused on providing evidence-based guideline (EBG) resources to mitigate risk in hospitalized stroke patients with DM. Participating Get With The Guidelines® (GWTG)-Stroke hospitals track EBG data to improve outcomes. TT2DM initiative has10 EBG data elements related to stroke and the DM subpopulation. The measure 
Antihyperglycemic Medication with Proven Cardiovascular (CVD) Benefit at Discharge in Stroke Patients with DM
(AMPB) has low compliance. Further data analysis was needed.

Methods:
GWTG®-Stroke DM reports specific to AMPB were reviewed from Jan.1, 2020-Dec. 21, 2022, from 51 Wisconsin Coverdell Stroke hospitals. Analysis comprised of 5,045 patients with a primary diagnosis of stroke and history of DM or newly identified DM in the denominator. The numerator was satisfied when patients were prescribed a GLP-1 Receptor Agonist or SGLT-2 Inhibitor at discharge. Measure compliance was further delineated according to payment source. Payer sources were identified as: self-pay, Medicaid, Medicare, and Private/HMO. Findings: In the specified timeframe, 11.7% of patients received AMPB. Compliance variation exists across payer source. Only 2.3% identified as self-pay were prescribed AMPB at discharge. Differences in compliance rates were 10% for Medicare, 13.5% Medicaid, and 15.3% with private insurance/HMO.

Conclusions:
Discharge prescription rate for AMPB has low compliance, further variation exists among patient payer sources. Items for consideration are higher cost of medication and thus payer status are driving factors in prescribing rates. Additional barriers may exist as discharge clinicians may not feel DM management is their responsibility, along with existing medication knowledge gaps. Providing EBC requires shared decision making to ensure proper follow up. Engaging a multidisciplinary approach at discharge to verify insurance coverage, alternate cost options, and follow-up needs may enhance compliance. Future considerations are to assess race “within” payer source to gauge if there is disparate care.
Abstract WP5: Outcomes of Pre-Stroke Use of Metformin in Acute Ischemic Stroke Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis
Authors: Tolba Hatem , Ghozy Sherief , Pakkam Madona , Rabinstein Alejandro A , Kallmes David F
Published: February 2024

Background:
Diabetes mellitus (DM) is one of the risk factors for acute ischemic stroke, usually leading to poor prognosis. While DM can reduce the effect of intravenous thrombolysis, metformin can have a positive outcome on AIS patients. The outcomes of stroke in diabetic patients receiving metformin is largely unexplored. In the present study we performed a systematic review to assess the effect of metformin on AIS outcomes in diabetic patients.

Methods:
A systematic review of literature was performed following PRISMA guideline. PubMed, Embase, Scopus and Web of science were used for the literature search. Study outcomes such as modified Rankin Scale (mRS 0-2) at discharge, symptomatic intracranial hemorrhage (sICH) and 90-day mortality were extracted from the full text and analysis were performed to calculate 95% confidence intervals with pooled odds ratio for all the outcomes.

Results:
Total of six studies were included in the analysis with a total of 5390 patients taking metformin and 6039 patients without metformin. Favorable mRS of 0-2 was significantly higher among patients taking metformin (OR 1.52, 95% CI 1.21:1.93). The mortality rate was significantly lower in metformin group (OR 0.51, 95% CI 0.42:0.61). These results favor the beneficial effect of taking metformin among DM patients with AIS.

Conclusion:
Overall, chronic use of metformin seems to be beneficial in AIS patients with DM. There is a trend of favorable outcomes of mRS and Mortality, with a non-statistical significance increase of sICH.
Abstract WP51: Bridging the Gap - Impact of Advanced Practice Nurse in the Community Hospital in Singapore
Authors: Tan Il Fan , Ng Wai May
Published: February 2024

Background:
Stroke is a debilitating condition and patients with acute stroke usually stays about a week in the acute hospital. Those patients with impaired physical function may be transferred to a Community Hospital (CH) for further rehabilitation to optimize their function. In this pilot project, we aimed to incorporate the Stroke Advanced Practice Nurses (APNs) in one of the Community Hospital (OCH) so that stroke care gaps can be identified and to optimize stroke care.

Methodology:
The Stroke APN obtained their clinical privileges to work in CH. The APN would identify stroke patients admitting to CH for further rehabilitation. APN performed a weekly consultation round to review stroke patients identified in CH. During the consultation round, the APN assessed stroke patients’ neurological function and stroke complications. She also reviewed patient’s vital signs, fluid balances, pending blood results, medications and management. With the information, the APN would recommend change in management accordingly after communicating with the neurology team from the original transferring acute hospital.

Results:
There were total of 51 issues identified from Aug 2020 to Aug 2021 from 125 patients were reviewed by the Stroke APNs. The Stroke APNs identified 27.5% (n= 14) medical related issues e.g. change in stroke etiology, lack of deep vein thrombosis prophylaxis. There were pharmacological changes in 21.5% (n= 11) of the patients reviewed. Drug changes were usually anti-hypertensives or anti-thrombotics. Post-stroke psychological issue was common and 21.5% (n= 11) of patients developed low mood. To empower patients with their own health, the Stroke APN had to reinforce stroke education in 13.7% (n= 7) of the patients and 7.8% (n= 4) required reinforcement of driving advice. 7 patients (13.7%) requested Information about community resources for them to transit back into the community. Outpatient appointments were streamlined and 7.8% (n= 4) had their appointment has been amended or cancelled.

Conclusion:
There were high incidence of issues detected during the Stroke APN visiting consultation. The Stroke APN played an important role to manage post-stroke patients appropriately in the CH.
Abstract WP52: Evaluation of Post Stroke Telehealth Services in Texas (Vast-1)
Authors: Anderson Jane , Kimmel Barbara , Walder Annette , Ovalle Anette , Yanes Ruth S , Silos Christin , Olson Daiwai M , Goldberg Mark P , Warach Steven J , Cruz-Flores Salvador , Venkatasubba Chethan P , Savitz Sean I
Published: February 2024

Background:
Shortly after AHA/ASA released an updated policy on stroke care systems, COVID-19 disrupted these systems. Lockdowns and social distancing were considered critical to mitigate COVID-19 transmission but altered public perceptions about stroke medical care. As a result, telehealth expanded rapidly across Texas. However, little is known how to optimally integrate telehealth services into the continuum of stroke care.

Methods:
To identify barriers and facilitators of post-acute stroke telehealth services among stroke survivors’ facilities of the Lone Star Stroke Consortium (LSSC) Research Consortium, we conducted semi-structured interviews with stroke providers and focus groups with patients. Audiotapes were transcribed, and files prepared for analysis. Using a grounded theory approach, we performed data analysis to allow theory to emerge from data. Two independent reviewers read transcripts, developed coding using an iterative consensus building, verified codes, developed concepts, and created categories. Constant comparison process found emerging themes within each category.

Results:
We enrolled 23 providers and 34 patients. Access, telemedicine encounter and technology were revealed as major categories of post-acute stroke telehealth among providers and patients. Facilitators of access included increased accessibility and elimination of barriers. Reliable internet connection and technological skills were barriers for both groups. Patients and providers identified virtual visits as good. However, full medical exam, including cognitive evaluation, was a barrier for patients and providers. Technology increased ability to communicate with patients and providers. Barriers included constrains of internet services, lack of documentation for virtual visits, and lack of telemedicine platform.

Conclusion:
Our study will contribute to future telehealth services integration into continuum of stroke care.
Abstract WP6: Safety Outcomes of Intravenous Tenecteplase in Tandem Occlusions Undergoing Mechanical Thrombectomy With Acute Stenting
Authors: Ahmad Mohammad Jamil , Doheim Mohamed F , Starr Matthew , Rocha Marcelo , Al-Bayati Alhamza , Nogueira Raul G , Bhatt Nirav
Published: February 2024

Background:
Studies have demonstrated that the addition of alteplase for patients with tandem lesions who underwent mechanical thrombectomy and acute stenting was safe with improved outcomes. We aimed to assess the safety and efficacy of Intravenous Tenecteplase (IV TNK) for patients with tandem lesions who undergo mechanical thrombectomy (MT) and acute stenting.

Methods:
Using a prospectively collected registry of stroke patients seen at our institution we identified patients who underwent mechanical thrombectomy and acute carotid stenting between January 2021 and May 2023. Primary outcomes included symptomatic intracranial hemorrhage (sICH) and parenchymal hematoma type 2 (PH-2). Secondary outcomes included favorable functional outcome (90-day modified Ranking score 0-2), 90-day mortality, successful reperfusion (modified Thrombolysis in Cerebral Infarction [TICI] score 2b-3) and median number of passes used. Outcomes were adjusted for age, NIHSS, ASPECTS, and last known well (LKW) time to arrival time.

Results:
A total of 86 patients were included of which 14 received IV TNK + MT with carotid stenting and 72 MT with carotid stenting alone. Patients who received IV TNK had lower median LKW to arrival time in minutes (133 [IQR 81-193] vs 575 [IQR 313-925], P<0.001), and had higher ASPECTS median score (9 [9-10] vs 8 [7-9], P=0.03). There was 0% sICH vs 13.3% (p=0.36), and 0% PH-2 vs 4.2% (p>0.999) in the IV TNK and the MT alone group, respectively. All patients who received tnk received intraprocedural eptifibatide loading dose and dual antiplatelets within 24 hours. Favorable functional outcomes were seen in 80.0% of IV TNK vs 58.2% of MT with carotid stenting alone (aOR 6.92 [0.45-105.7], p=0.16). Both groups had similar 90-day mortality rates 10% vs 9.1% (aOR 0.59 [0.01-34.9], p=0.8), number of passes 1 [1-2] vs 2 [1-3], (P=0.09), and successful reperfusion (TICI score 2b-3) 100% vs 98.6% (p>0.999).

Conclusion:
Our study shows that the combination of IV TNK and MT with acute stenting for tandem lesions did not increase the risk of sICH or PH-2. IV TNK group did not have statistically significant differences in our secondary outcomes as well. However, the sample size was low, and this patient population needs to be studied in a larger group.
Abstract WP61: Effective Utilization of Stroke Survey QR Code Leads to Improved Completion of Stroke Survey
Authors: Guo Haiyi , Taleb Shayandokht , Natividad Paul , Fabellar-Sia Sharon R , Gaffney Denise , Mkrtumyan Alvina , Punsalang Lorina , Ajani Zahra , Sangha Navdeep S , Santosa Rhendyanno
Published: February 2024

Background:
The CSC Advanced Disease-Specific Certification program requires hospitals to provide stroke education to patients and family members. A stroke survey before discharge helps evaluates patients’ perception of care and understanding of their disease process. Universally, survey response rates vary widely. Therefore, a strategy for successful survey completion is necessary.

Method:
Data were compared from the pre 1/2022-6/2022 and post intervention 7/2022-12/2022. A QR code was placed in the patient’s stroke education folder and displayed prominently in visible areas. Stroke education was provided during both day and night shifts. Nursing staff introduced the stroke education survey on admission, implemented a stroke checklist, and assisted patients with QR code access and completion by day 3 of hospitalization.

Results:
We had total of 621 patients, 305 patients pre and 316 patients post intervention. There was no difference in baseline demographics (Table 1a). With QR code implementation and promotion, the stroke education survey response rate increased from 72(23%) to 184(60%) (p=0.001). There was no change in the patient’s perception of care received and understanding of stroke risk factors (Table 1b).

Conclusion:
The implementation of a QR code survey and continuous stroke education during hospitalization improves patients’ participation in a survey. To sustain these positive results, continual effort should be made to maintain high levels of patient and family survey participation. Thus, improving compliance of a CSC Advanced Disease-Specific Certification standard.
Abstract WP71: Early Stroke Alert and Telestroke Notification Reduces Door to Needle Time
Authors: Agostoni Nolan , Kaziz Hamza , Singh Romil , Chandra Rahul , Cerejo Russell , Malhotra Konark , Rana Sandeep , Quezada Timothy , Williamson Richard , Hackett Chris
Published: February 2024

Background:
Door to telestroke request times (DTSR) contribute to door to needle time (DTN) in telestroke networks, however, data is limited on the relationship between DTSR, DTN and other contributing factors. We aimed to evaluate the relationship between processes at the spoke, by EMS and how these contributed to DTN in telestroke spokes.

Methods:
This is a multi-center retrospective analysis of telestroke patients treated with IV thrombolysis from a hub and spoke telestroke network from June 2018 to March 2023. Patients were excluded from this study due to missing data. The Primary outcome was to examine the relationship between DTSR, DTN and other contributing variables. Multiple regression analyses evaluated which factors contributed to DTSR and DTN. A simple mediation model with covariates NIHSS and average telestroke volume was used to determine if DTSR mediates the relationship between door to stroke alert and DTN. A subgroup analysis examined which variables contributed to DTSR in patients arriving by EMS. A hierarchical multivariable regression analysis entering potential confounding variables as identified in preliminary analyses then variables of interest was used in the subgroup analysis.

Results:
There were 582 telestroke patients treated with IV thrombolysis and after exclusions, 471 (80.9%) patients were included in the study. The mean age ± SD of the patients was 69.50 ± 15.11 and 238 (50.5%) were female. Door to telestroke request partially mediated the relationship between door to stroke alert and DTN as door to stroke alert was significantly associated with DTN after adjustment for DTSR, B = 0.25 [95% Confidence Interval (CI), 0.10 - 0.41], p < 0.001. In the adjusted model, DTSR explained 29% [95%CI, 22% - 35%] of the variance in DTN. Prehospital stroke alert by EMS reduced DTSR by 6.99 minutes [95%CI, 3.31 - 10.68], p < 0.001, after adjustment of confounding variables. In patients with prehospital stroke alert, earlier ED physician evaluation was associated with quicker DTSR, B = 0.48 [95%CI, 0.01 - 0.95], p = 0.045.

Conclusion:
Early notification of the local stroke alert team and telestroke physician is associated with quicker DTN. Prehospital stroke alerts by EMS allow for quicker evaluation by ED physician which results in reduced DTSR.
Abstract WP92: Application of a Horizontal Communication Process in Combination With Artificial Intelligence (AI) to Improve Stroke Care in Patients With Large Vessel Occlusion (LVO)
Authors: Kashyap Bhavani , Herrmann Amanda A , Droegemueller Carol J , Gustafson Sally K , Malek Abigail M , Nyamao Tiffan M , Seth Srishti , Sathe Mihika M , Isberg Anna E , Hatton Sarah J , Podgorski Bo B , Sabayan Behnam
Published: February 2024

Introduction:
Timely acute stroke care in patients with large vessel occlusion (LVO) requires both early detection of LVO and efficient multidisciplinary communication. In this study, we aimed to evaluate the impact of using AI and a horizontal communication system within the RapidAI application platform on acute stroke quality metrics in patients with LVO.

Methods:
On April 2022, the RapidAI application was launched at our center, which allowed for use of AI as a screening measure for LVO detection with immediate notification to neurology, neuroradiology, and neuro-interventional teams. The various teams used instant messaging within the application to communicate clinical data, imaging findings and shared clinical decision making. In this single center study, we retrospectively evaluated stroke care quality metrics for 167 consecutive patients (mean age: 71.6, 49.1% male) who underwent mechanical thrombectomy (MT) from January 2021 to May 2023. Data were compiled from multiple resources including Get-With-The-Guidelines®, chart abstraction, and internal healthcare databases. The groups were compared using appropriate statistical tests and significance was determined using a two-sided alpha of 0.05.

Results:
85 patients underwent MT before implementation of the new system, and 82 patients underwent MT after. Demographic features (age, sex, race), cerebrovascular risk factors (hypertension, diabetes, hyperlipidemia, smoking, BMI) and stroke severity were similar between the two groups (p>0.05). Average door to groin puncture (pre: 97 minutes, post: 82 minutes, p=0.10) and discharge disposition (p=0.02) were significantly different between the two groups. In an adjusted analysis of door to groin puncture time, the difference between pre-RapidAI and post-RapidAI was an average reduction of 19 minutes trending towards significance (p = 0.06).

Conclusion:
Application of a horizontal communication platform in combination with RapidAI was associated with significant improvements in time to intervention in patients with LVO and a significant improvement in the number of patients discharged home.
Abstract WP93: Providing Stroke Reports to Emergency Medical Services (EMS) Agencies Improves Data Quality in Michigan's Statewide EMS Data Repository
Authors: Allen Justin , Nickles Adrienne , Ibrahim Ghada , Anderson Beth , Quartermus Krystal , Oostema John A
Published: February 2024

Intro:
The Michigan Stroke Program (MiSP) monitors statewide EMS stroke care performance and data quality. Starting in 2018, quarterly performance and outcome benchmark data were shared with EMS agency partners to support prehospital quality improvement (QI) for stroke patients.

Objective:
To improve EMS data quality and prehospital stroke care performance.

Methods:
This is a retrospective before and after study of the impact of tailored QI interventions to improve EMS compliance with three prehospital stroke quality metrics selected by MiSP EMS partners: (prehospital stroke scale documentation, last known well documentation, and prehospital notification). Five MiSP EMS partners participated in the intervention which consisted of provision of quarterly performance reports generated from linked data from Michigan’s EMS Information System and the Michigan Stroke Registry. The MiSP team reviewed agency performance with EMS leadership to select the target measures for intervention and then assisted in development of a QI plan to improve agency performance. Measure compliance was compared from three months prior to and six months after data quality solutions were implemented.

Results:
Through data sharing and communication with EMS agencies and EMS software data vendors, common themes were identified related to poor data quality beginning in January 2020. A sample of agencies and resolutions to address these issues are displayed in the Table. Compliance with the targeted metric improved significantly at each agency at three and six months following intervention.

Conclusions:
Analysis of EMS data and sharing performance data directly with EMS agency partners identified correctable data quality issues negatively impacting EMS quality measures. Correcting these issues led to dramatic and sustained improvement in EMS quality metric compliance. This approach may serve as a model for improving the accuracy of EMS performance data in state-level EMS registries.
Microglial TLR4 Mediates White Matter Injury in a Combined Model of Diesel Exhaust Exposure and Cerebral Hypoperfusion
Authors: Shkirkova Kristina , Demetriou Alexandra N. , Sizdahkhani Saman , Lamorie-Foote Krista , Zhang Hongqiao , Morales Manuel , Chen Selena , Zhao Lifu , Diaz Arnold , Godoy-Lugo Jose A. , Zhou Beryl , Zhang Nathan , Li Andrew , Mack Wendy J. , Sioutas Constantinos , Thorwald Max A. , Finch Caleb E. , Pike Christian , Mack William J.
Published: February 2024

BACKGROUND:

Air pollution particulate matter exposure and chronic cerebral hypoperfusion (CCH) contribute to white matter toxicity through shared mechanisms of neuroinflammation, oxidative stress, and myelin breakdown. Prior studies showed that exposure of mice to joint particulate matter and CCH caused supra-additive injury to corpus callosum white matter. This study examines the role of TLR4 (toll-like receptor 4) signaling in mediating neurotoxicity and myelin damage observed in joint particulate matter and CCH exposures.

METHODS:

Experiments utilized a novel murine model of inducible monocyte/microglia-specific TLR4 knockout (i-mTLR4-ko). Bilateral carotid artery stenosis (BCAS) was induced surgically to model CCH. TLR4-intact (control) and i-mTLR4-ko mice were exposed to 8 weeks of either aerosolized diesel exhaust particulate (DEP) or filtered air (FA) in 8 experimental groups: (1) control/FA (n=10), (2) control/DEP (n=10), (3) control/FA+BCAS (n=9), (4) control/DEP+BCAS (n=10), (5) i-mTLR4-ko/FA (n=9), (6) i-mTLR4-ko/DEP (n=8), (7) i-mTLR4-ko/FA+BCAS (n=8), and (8) i-mTLR4-ko/DEP+BCAS (n=10). Corpus callosum levels of 4-hydroxynonenal, 8-Oxo-2’-deoxyguanosine, Iba-1 (ionized calcium-binding adapter molecule 1), and dMBP (degraded myelin basic protein) were assayed via immunofluorescence to measure oxidative stress, neuroinflammation, and myelin breakdown, respectively.

RESULTS:

Compared with control/FA mice, control/DEP+BCAS mice exhibited increased dMBP (41%;
P
<0.01), Iba-1 (51%;
P
<0.0001), 4-hydroxynonenal (100%;
P
<0.0001), and 8-Oxo-2’-deoxyguanosine (65%;
P
<0.05). I-mTLR4 knockout attenuated responses to DEP/BCAS for all markers.

CONCLUSIONS:

i-mTLR4-ko markedly reduced neuroinflammation and oxidative stress and attenuated white matter degradation following DEP and CCH exposures. This suggests a potential role for targeting TLR4 signaling in individuals with vascular cognitive impairment, particularly those exposed to substantial ambient air pollution.
Metamodernism as the Pedagogy of Revolution
Authors: Storm Jason Ānanda Josephson
Published: February 2024

This article is a response to reviews of Metamodernism: The Future of Theory. It examines the intersection of Metamodernism and pedagogy, drawing inspiration from Paulo Freire’s Pedagogy of the Oppressed and other works. It explores how educational practices can contribute to societal transformation, emphasizing the role of humility, understanding the social world (especially process social kinds), compassion, hope, and critical consciousness in fostering revolutionary change. The paper advocates for a pedagogy that not only challenges existing power structures but also promotes the flourishing of diverse species, extending its concern beyond human-centric perspectives.
Astragalus quettensis (Galegeae—Fabaceae), a new species of section Pendulina from Pakistan
Authors: KHAN AMJAD , SULTAN AMIR , MAASSOUMI ASGHAR , MUMTAZ ABDUL SAMAD
Published: February 2024

Astragalus quettensis is described and illustrated as a new species from Hazarganji-Chiltan National Park, near Quetta, Balochistan. The new species is related to Astragalus mirabilis and is characterized by 5–31 mm long tomentose, canescent, linear-lanceolate, folded leaflets in 9–13 pairs with basal leaflets opposite and distal alternate, densely racemose inflorescence or subcapitate with 2–3 flowers lying at the same level, 1–3 cm long, densely covered with off-white spreading hairs, 3.5–5.5 mm long, linear-lanceolate, acuminate, greyish, pilose bracts, 5–13 mm long densely pubescent pedicel with ca. 0.2 mm long, spreading hairs, 9.5–15 mm long densely pubescent calyx with 7.5–12 mm funnel-shaped cup and 2–3 mm long teeth, white and yellowish-green corolla, vexillum 16–23 × 8–12 mm, broadly elliptic, wing 17–21 mm long, keel 18–21 mm long, short-stipitate pubescent legume, 22–26 × 13–18 mm and 3–4 mm long stipe. With regard to the conservation status of the new species, Astragalus quettensis is provisionally assessed as Critically Endangered (CR).
Dung beetle fauna from Mount Mabu, Mozambique. Part 3: A new species of Proagoderus van Lansberge, 1883 with an annotated checklist of the Proagoderus dives (Harold, 1877) species-group (Coleoptera: Scarabaeidae: Scarabaeinae)
Authors: DANIEL GIMO M. , JOSSO JEAN-FRANÇOIS , NGANHANE ISILDO DE N. , STRÜMPHER WERNER P.
Published: February 2024

A new species of dung beetle, Proagoderus mabuensis Daniel, Josso, Nganhane & Strümpher, new species from Mount Mabu, northern Mozambique, is described, diagnosed, and illustrated. We provide a morphological comparison between the new species and a similar species from Mount Namuli, Mozambique, Proagoderus camiadei Josso, 2014. Both species belong to the Proagoderus dives (Harold, 1877) species-group. Furthermore, we provide an updated checklist of all known members of the dives species-group.
Revision of the Afrotropical genus Zetheumenidion Bequaert (Hymenoptera: Vespidae: Eumeninae)
Authors: SELIS MARCO
Published: February 2024

A taxonomic revision of the Afrotropical genus Zetheumenidion Bequaert, 1926 is presented. Four new species (Zetheumenidion abruptum sp. nov., Zetheumenidion concinnoide sp. nov., Zetheumenidion latum sp. nov. and Zetheumenidion minimum sp. nov.) are described; Zetheumenidion paeneplanum (Bequaert, 1926) stat. rev. is resurrected from synonymy with Z. pulchripenne (Cameron, 1910); Zetheumenidion femoratum flavissimum Giordani Soika, 1987 is raised to species level (Zetheumenidion flavissimum stat. nov.). A key to all known species is provided and the taxonomic placement of the genus is discussed.
Fast Enhancement of the Stratification in the Indian Ocean over the Past 20 Years
Authors: Peng Suqi , Wang Qiang
Published: February 2024

Indian Ocean (IO) stratification has important effects on the air–sea interaction, ocean dynamics, and ecology. It is, therefore, of significance to investigate the changes in IO stratification. In this study, we use ensemble empirical mode decomposition (EEMD) to extract the nonlinear long-term trend in the upper IO stratification quantified by potential energy anomalies. The results show that the strengthening of the stratification is spatially and temporally nonuniform. Specifically, the trend of stratification intensified gradually before 1996, but accelerated rapidly after 1996. Temperature and salinity changes play a crucial role in the fast enhancement of stratification and its regional differences. Temperature variations dominate the stratification trend in ∼90% of the IO area, while the contributions of salinity changes are mainly in the southeast Indian Ocean (SEIO). Vertically, the rapid enhancement of stratification is caused by the trend of temperature and salt in the upper 400 m. We further perform temperature budget analysis and find that the warming trend in the upper 400 m south of the IO is mainly modulated by vertical advection and meridional advection, while the warming in the north of the IO is mainly induced by air–sea heat fluxes. Salinity budget analysis shows that ocean advection has played a primary role in modulating SEIO salinity over the past 20 years.
Deep-Learning-Enabled High-Fidelity Absorbance Spectra from Distorted Dual-Comb Absorption Spectroscopy for Gas Quantification Analysis
Authors: Huang Chao , Zhang Tianyou , Kong Xiangchen , Li Yan , Wei Haoyun
Published: February 2024

Dual-comb absorption spectroscopy has been a promising technique in laser spectroscopy due to its intrinsic advantages over broad spectral coverage, high resolution, high acquisition speed, and frequency accuracy. However, two primary challenges, including etalon effects and complex baseline extraction, still severely hinder its implementation in recovering absorbance spectra and subsequent quantification analysis. In this paper, we propose a deep learning enabled processing framework containing etalon removal and baseline extraction modules to obtain absorbance spectra from distorted dual-comb absorption spectroscopy. The etalon removal module utilizes a typical U-net model, and the baseline extraction module consists of a modified U-net model with physical constraint and an adaptive iteratively reweighted penalized least squares method serving as refinement. The training datasets combine experimental baselines and simulated gas absorption with different concentrations, fully exploiting prior information on gas absorption features from the HITRAN database. In the simulated and experimental test, the CO2 absorbance spectrum covering 25 cm–1 shows high consistency with the HITRAN database, of which the mean absolute error is less than 1% of the maximum absorbance value, and the retrieved concentration has a relative error under 2%, outperforming traditional approaches and indicating the potential practicality of our data processing framework. Hopefully, with a larger network volume and proper datasets, this processing framework can be extended to precise quantification analysis in more comprehensive applications such as atmospheric measurement and industrial monitoring.
The Italian Scapigliatura in New York
Authors: Carli Alberto
Published: February 2024

In 1884, Dario Papa and Ferdinando Fontana, both well known in the milieu of Scapigliatura, published a reportage that is a kind of written photograph of New York at the time. Papa had travelled to America with Fontana to discover the secrets of modern journalism. Another well-known writer of the Scapigliatura, Giuseppe Giacosa, friend of Arrigo Boito and Emilio Praga, travelled to the USA a few years later. Giacosa also wrote a series of interesting travel notes later collected in Impressioni d’America, but here are especially mentioned some articles dedicated to him in the local press and preserved at the New York Public Library.
The Influence of Contextual and Theoretical Expertise on Generic and Occupation-Specific Lifting Strategy
Authors: Armstrong Daniel P. , Beach Tyson A. C. , Fischer Steven L.
Published: February 2024

Objective

To determine whether (i) low back loads and/or (ii) kinematic coordination patterns differed across theoretical expert, contextual expert and novice groups when completing both generic and occupation-specific lifts.

Background

Experience has been proposed as a factor that could reduce biomechanical exposures in lifting, but the literature reports mixed effects. The inconsistent relationship between experience and exposures may be partially attributable to the broad classification of experience and experimental lifting protocols not replicating the environment where experience was gained.

Methods

Purposive sampling was used to recruit 72 participants including theoretical experts (formal training on lifting mechanics), contextual experts (paramedics), and novices. Participants performed 10 barbell and crate (generic) lifts, as well as backboard and stretcher (occupation-specific) lifts while whole-body kinematics and ground reaction forces were collected. Peak low back compression and anteroposterior shear loads normalized to body mass, as well as kinematic coordination patterns, were calculated as dependent variables.

Results

No significant differences in low back loads were observed across expertise groups. However, significant differences were seen in kinematic coordination patterns across expertise groups in occupation-specific lifts, but not in generic lifts.

Conclusion

Increasing expertise is unlikely to minimize low back loads in lifting. However, contextual expertise did influence lifting kinematics, but only when performing occupationally specific lifts.

Application

Contextual expertise may help lifters adopt lifting kinematics that enhance the tolerance of their musculoskeletal system to withstand applied loads, but does not seem to reduce the applied low back loads relative to noncontextual expert groups.
An examination of service user satisfaction in forensic mental health settings
Authors: Khan Al Adiya , Stirrup Victoria , MacInnes Douglas
Published: February 2024

High levels of service user satisfaction are viewed as a reliable indicator of a service providing good care and treatment. There has been limited research looking into levels of satisfaction in forensic mental health settings with most work focused on staff satisfaction in these settings. This study examined service users’ levels of satisfaction with a forensic mental health service in the United Kingdom. The service covered two sites; one a purpose-built secure unit and the other based in an old cottage hospital. Thirty-nine in-patients completed a 60-item validated forensic satisfaction scale. The scale measured seven domains of satisfaction as well as reporting an overall satisfaction score. The results indicated the service users were reasonably satisfied with the care and treatment they received. The domains of rehabilitation, safety, staff interaction and overall care showed the highest level of satisfaction. The high rehabilitation satisfaction score demonstrated the importance of meaningful activities for users accessing forensic services and may have been influenced by the security measures on the wards. The high safety domain score indicated respondents felt safe and secure within the wards and were likely to be influenced by positive interpersonal interactions. Good staff interaction was also an important factor in helping service users feel safe on the wards. These interactions are likely to be associated with longer periods of admission in secure services allowing therapeutic relationships to develop. Financial advice/support was the one domain that recorded negative satisfaction levels. Financial literacy training may help develop money management skills.
Employment Practices, Cost Minimization, and Their Implications for Food Provisions and Seafarers’ Wellbeing on board Ships – A Qualitative Analysis
Authors: Baum-Talmor Polina , Şahin Çağatay Edgücan
Published: February 2024

The global shipping industry, responsible for delivering over 70% of the world’s goods (in volume), has increasingly adopted cost minimization policies, contributing to precarious employment practices that adversely affect seafarers’ wellbeing. This study focuses on the intricate relationship between employment precarity and food provision on cargo ships. By presenting seafarers’ perspectives, we aim to understand how precarious employment practices and cost minimization in the industry influence power dynamics related to food and impact seafarers’ wellbeing. Drawing on empirical data collected through shipboard observations and interviews with seafarers, this study examines the often-overlooked experiences and perspectives of seafarers. The research sheds light on the precarity of employment in shipping and its inherent impact on the provision of food on board and its implications for seafarers’ physical and emotional health, including the availability of nutritious and sufficient food and its impact on their daily lives. Through in-depth interviews, seafarers’ insights into their experiences of food including the quality, availability, and cultural appropriateness of food on board are explored, as well as the standard of training for cooks. Through this research, we found substandard conditions on some of the ships, cost-focused decision-making, and lack of standardized food preparation practices on board. These findings underline the need for improved regulations, better training opportunities, and increased consideration for seafarers’ wellbeing. These changes are essential to ensure the provision of adequate and nutritious meals that promote the physical and mental health of seafarers on board ships. Specifically, the research underscores the need for policy and advocacy initiatives to improve seafarers’ lives and promote fair working conditions in the global shipping industry. By amplifying the voices of seafarers and providing evidence-based insights, this study contributes to the larger discourse on workers’ rights and the importance of decent working conditions. It calls for greater attention to the provision of adequate, nutritious, and culturally appropriate food on board cargo ships, recognizing its significance for seafarers’ physical and mental wellbeing, as well as a call for standardized training for ship’s cooks.
Tumor necrosis factor-α inhibitor for successful treatment of toxic epidermal necrolysis with severe infection: a case series
Authors: Peng Yu-Ting , Xiong Jian-Xia , Wei Bin , Li Hui , Xu Jing , Chen Ai-Jun , Wang Ping
Published: February 2024

Toxic epidermal necrolysis (TEN) is a rare severe cutaneous adverse reaction that involves more than 30% of the body surface area. TEN can be accompanied by a series of systemic symptoms and has a high risk of death. Tumor necrosis factor (TNF)-α inhibitors such as adalimumab and etanercept have been shown to be safe and effective for the treatment of TEN in some cases. However, clinical data on the use of TNF-α inhibitors to treat TEN with severe systemic infection are scarce. In the present study, three adult patients who developed TEN with serious active infection were successfully treated with etanercept. One of the three patients had active open pulmonary tuberculosis, and the other two had septicemia and/or fungal sepsis. All patients’ skin lesions significantly improved after several days, and none of the patients developed emerging or re-emerging infectious diseases, adverse reactions, or a similar rash during follow-up. TNF-α inhibitors may be an effective treatment choice for TEN with severe systemic infection. However, further studies with large samples are still required for validation because clinical experience is limited.
The first and second laws of thermodynamics are logically equivalent
Authors: Kaufman Richard
Published: February 2024

In the September 2022 issue of The Physics Teacher ( TPT), Richard Kaufman and Harvey Leff showed the interdependence of the first and second laws of thermodynamics. Here, I go further and use the facts that the first law implies the second law, and that the second law implies the first law. This two-way implication establishes the logical equivalence of the first and second laws. Although the laws are logically equivalent (when one is true, then the other must be true), this does not mean that they are the same. The equivalence provides for a deeper and richer understanding of the laws of thermodynamics for students, teachers, and physicists. Surely, if we can know that the first and second laws are equivalent, then we should know.
Don’t Beat Around the Bush! The Relationship Between Forensic Vigilance and Communication Style
Authors: Clercx Maartje , van Pinxteren Lisanne
Published: February 2024

The field of forensic mental healthcare is unique in several ways. Forensic vigilance is a specialty needed by forensic mental health professionals, consisting of professional forensic psychiatric knowledge, knowledge of individual patients, environmental observations, and clinical judgment. Though communication seems to play an important role in forensic vigilance, it is still unknown which communication styles are related to forensic vigilance, if any. In the current study, we examined if certain communication styles are related to forensic vigilance by means of an online survey among forensic mental health professionals. In total 138 Dutch forensic psychiatric professionals participated in the survey. The expressive and precise communication styles positively predict forensic vigilance, while the emotional and manipulative communication styles show a negative relationship with forensic vigilance. Findings of the present study further the understanding of the construct of forensic vigilance. The findings presented here may give rise to attention for specific manners of communication in supervision and training programs. The current study represents the first effort to study the relationship between communication styles and forensic vigilance.