bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P843: Stroke Patient Monitoring Used in Adult Emergency Department During Covid-19 Acting Both Rapidly and Safely
Authors: Pasci-Sepulveda Alsacia , Perdomo Crismely , Lizardo Kyra , Willey Joshua Z
Published: March 2021

Introduction:
The healthcare system was facing two challenges: acute patients presenting to the adult emergency department diagnosed with Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)/ COVID-19 and how to treat life-threating emergencies. Emergency, neurovascular and multidisciplinary teams, therefore, had to be ready to treat these emergencies rapidly and safely. The goals were to balance substantial needs and preserve resources during this extraordinary time for incoming acutely ill patients.

Background:
The World Health Organization (WHO) defined COVID-19 as a pandemic. New York City was the epicenter for the 2019-2020 COVID -19 pandemic. There were 30,000 confirmed cases resulting in over 2,500 hospitalizations as of March 30, 2020. Hence, it was vital to develop new monitoring protocols, based upon the expert opinion of the stroke and multidisciplinary leadership at New York Presbyterian Hospital that required minimum monitoring and criteria for admission necessary to safely care for complex stroke patients.

Purpose:
This quality improvement project evaluated patient outcomes after the implementation of the modified stroke protocol.

Methods:
Retrospective data review was conducted for patients who presented via the Emergency Department with stroke symptoms, and were treated with intravenous thrombolysis (IVT) between 3/30 and 6/30/2020, with a focus on whether patients required a higher level of care or developed hemorrhagic transformation post IVT.

Results:
The sample consisted of 10 patients (60% female), median age 54 (range 37-73). Length of stay ranged from 2 to 12 days. Two patients (20%) were SARS-CoV-2 positive. None (0%) of the patients developed hemorrhagic transformation. None (0%) of the patients admitted to non-ICU units required critical care transfer or interventions within 24 hours of receiving IVT. Six (60%) patients were discharged to home.

Conclusions:
Using the modified patient monitoring protocol post IVT none of the patients developed symptomatic hemorrhagic transformation and did not require transfer to higher level of care within 24 hours. If there is another wave of the COVID-19 pandemic, this protocol could be adopted and its effectiveness and safety can continue to be evaluated.
Abstract P849: Effects of Standardized Stroke Protocols on Nursing Confidence and Knowledge in Low Volume Telestroke Emergency Departments
Authors: Provencher Michelle , Figueroa Stephen A , Novakovic Robin , Hynan Linda , Olson Daiwai M , Stutzman Sonja , Goldberg Mark P
Published: March 2021

Introduction:
Nurses and staff in Emergency Departments (ED) with low monthly case volumes have few opportunities to build confidence and solidify skills in acute stroke management. The Nursing-driven Acute Stroke Care (NAS-Care) study tested a workflow model with empowerment of ED bedside nurses, clear role assignments for team members, and standardized protocols including a predefined run sheet.

Methods:
Seven Texas hospitals participated in this prospective, multisite, baseline-controlled study as part of the Lone Star Stroke Research Consortium. After three months of blinded baseline data collection, the following interventions were implemented: NIHSS certification, nursing education including mock stroke codes, and a standardized flowsheet for code organization and documentation (run sheet). Participating nurses were surveyed before and after implementation of this process.

Results:
The study was completed at 6 hospitals, with 180 patients in the pre-intervention group and 267 in the post-intervention group. The study intervention was found to improve Door-to-ED provider and Door-to-CT metrics but not physician-dependent metrics, Door-to-Needle or Door-to-Provider times (Provencher et al, ISC 2020). Completed surveys were returned by 97 nurses (pre-intervention) and 57 nurses (post-intervention). There were significant increases in the following questions (10 point scale, p<.001): “I understand goals and processes of stroke code activation”, “stroke codes at my institution are completed efficiently”, and “stroke codes are nursing-driven.” In the post-intervention surveys, nurses reported that the NAS-Care protocol improved understanding (mean score 8.0 +/- 2.4 SD/10) and efficiency (8.2 +/- 2.4/10), and reported that they would recommend NAS-Care to be adopted at other institutions (8.8 +/- 2.1/10).

Conclusion:
Standardized nurse-driven stroke protocols improved self-assessed knowledge and confidence for nurses in EDs utilizing telestroke, in addition to gains in staff-dependent stroke metrics.
Abstract P855: Importance of Compliance in Dysphagia Screening in Acute Stroke Care
Authors: Noah Patty , Henderson Melanie , Heintz Rebekah , Cerejo Russell , Hackett Christopher T , Tayal Ashis H
Published: March 2021

Introduction:
Dysphagia occurs in up to two thirds of stroke patients and can lead to serious complications such as aspiration pneumonia, which is also linked to increased morbidity and mortality. Evidence-based guidelines recommend a bedside dysphagia assessment before oral intake in stroke patients regardless of initial stroke severity. Several studies have described registered nurses’ competency in terms of knowledge and skills regarding dysphagia screening. We aimed to examine the rate of aspiration pneumonia compared to the rate of dysphagia screening.

Methods:
A retrospective analysis of prospectively collected data at a single tertiary stroke center was carried out between January 2017 and June 2020. Data comparison was completed utilizing ICD-10 diagnosis codes to identify aspiration pneumonia in ischemic and hemorrhagic stroke patients. The data was reviewed to compare the compliance of a completed dysphagia screen prior to any oral intake to rate of aspiration pneumonia. Chi square tests were used to assess proportion differences in completed dysphagia screen and proportion of aspiration pneumonia diagnosis in the ischemic and hemorrhagic stroke patients.

Results:
We identified 3320 patient that met inclusion criteria. 67% were ischemic strokes, 22% were intracerebral hemorrhages and 11% were subarachnoid hemorrhages. Compliance with dysphagia screening decreased from 94.2% (n=1555/1650) in 2017-2018 to 74.0% (n=1236/1670) in 2019-2020, OR=0.17 (95%CI 0.14 - 0.22), p < 0.0001. Aspiration pneumonias increased from 58 (3.5%) in 2017-2018 to 77 (4.6%) in 2019-2020, but this difference was not statistically significant, OR=0.75 (95%CI 0.53 - 1.07), p = 0.11.

Conclusion:
We noted that the decrease in compliance with completing a dysphagia screen in patients with acute stroke prior to any oral intake was associated with a higher trend of aspiration pneumonia.
Abstract P858: The Impact of a Dedicated Stroke Program Quality Coordinator Registered Nurse on the Volume of Performance Improvement Projects
Authors: Gaffney Denise , Punsalang Lorina , Mkrtumyan Alvina , Dhanji Raeesa , McCartney David L , Ajani Zahra , Le Duy , Cline Trevor E , Sangha Navdeep S
Published: March 2021

Background:
Performance Improvement (PI) enhances processes, services, and outcomes. The Joint Commission (TJC) standards require a comprehensive approach to PI. This can be challenging due to variability of staffing within a stroke program. The stroke coordinator is often left to manage PI projects, which can be arduous due to the multiple demands of their role. A dedicated Stroke Quality Coordinator RN (SQCRN) manages quality improvement activities solely for the stroke program. It is a unique position that requires clinical knowledge of stroke, neuro-interventional and neurosurgical procedures, as well as, comprehension of regulatory requirements, PI and data analysis.

Purpose:
To determine if having an SQCRN dedicated to a stroke program results in an increased number of PI Projects implemented.

Methods:
The SQCRN initiative was implemented in 2020 with the objective of determining the impact of having a dedicated SQCRN on the number of projects completed. A survey was created consisting of 5 questions and sent to 328 individuals via email utilizing an anonymous Microsoft Forms Link. The survey was emailed to the Los Angeles Stroke Coordinator Network and National Stroke Coordinator group. Fifty-eight (17.6%) responded. Survey results were compared for stroke programs with a Dedicated SQCRN to those without. Data were analyzed using T-Test.

Results:
In stroke programs with a dedicated SQCRN, there were more respondents who reported 6 or greater PI projects than stroke programs who did not have a dedicated SQCRN. This was statistically significant when compared to both 2 or less (p=0.001) or 4 or less projects p=0.035.

Conclusion:
A dedicated SQCRN improves the number of PI projects that a stroke program can implement. PI initiatives help to improve the safety, treatments, services and quality of care in order to improve patient outcomes.
Abstract P860: Is Now the Time to Wake Up?
Authors: Beland Dawn K , Panza Gregory
Published: March 2021

Thrombolytic treatment for patients who wake with acute ischemic stroke based on MRI DWI-FLAIR mismatch was added to AHA’s 2019 stroke guidelines. While changes were implemented to facilitate care in 2019, it was determined that managing each patient on a case-by-case basis would best use system resources. The spring of 2020 brought new challenges in delay to hospital arrival due to COVID-19.

Purpose:
Evaluate the current process of managing potential wake up treatment eligible patients.

Methods:
All ischemic stroke discharges during CT’s rise and peak of the pandemic were reviewed, January 1 - May 31, 2020. Records were reviewed to determine time of arrival, onset or last seen well, time found, NIHSS, treatment or hyperacute MRI done, and any contraindication based on wake up criteria. A chi-square of proportions or Fisher’s Exact test was used to examine the association between month of discharge and patient characteristics for categorical variables. A Kruskal-Wallis H test was used for the continuous NIHSS variable.

Results:
Since the first COVID-19 patients were admitted in early March, results from January and February were combined (Group 1 n=122) and compared to March, April and May (Group 2 n=143). There was a non-significant (p=0.48) increase from group 1 (62.3%) to group 2 (66.4%) in the percentage arriving more than 4.5 hours from onset or LSW. In addition, group 1 had higher NIHSSs than group 2 (median, IQR=6, 9 vs 3, 10, respectively), but this was not significant (p=0.27, H=1.21). This did however translate into fewer meeting wake up criteria for treatment during the rise and peak period (Group 1=6.6%, Group 2=2.8%; p=0.15). Use of hyperacute MRI was significantly higher in group 1 than group 2 (5.7% vs 0%, p=0.004) since no patients received a hyperacute MRI during peak pandemic.

Conclusions:
While more patients were expected to be eligible for acute thrombolytics using the wake up criteria due to delay in hospital arrival, this was not observed. Instead, patients arriving during the peak of the pandemic were less severe. Although a hyperacute MRI was still possible without confirmation of COVID-19 negative status, none were done. Enhancements to facilitate obtaining a hyperacute MRI are still needed regardless of reason for patient delay to hospital arrival.
Abstract P861: The Perception of Missed Nursing Care in Patients With Acute Stroke
Authors: Zrelak Patricia A
Published: March 2021

Background:
“
Missed nursing care”
is a unique type of error known as
medical underuse.
These errors of omission are related to events, such as patient falls, nosocomial infections, and pressure injuries, associated with increased stroke mortality and morbidity. This study aimed to measure the phenomena of missed care in patients with stroke from the perspective of staff RNs working on a stroke unit and neuro intensive care unit at a Comprehensive Stroke Center.

Methods:
A Missed Care Survey was developed. Building on the work by Kalisch, the new Missed Care Survey focused entirely on nurse-sensitive measures and related evidence-based bundle steps. Two versions of the 25- question ordinal survey were developed, differing only in how the responses were worded. One asked how often care was missed [never missed (5), rarely missed (4), occasionally missed (3), frequently missed (2), always missed (1)]. and the other how frequently care was completed [always completed (5),usually completed (4), etc.).Descriptive statistics were used to evaluate results. Staff volunteered to take the survey during an annual stroke review class, rating their perception of care over the last 30-days. The IRB determined that the human subject regulation did not apply.

Results:
Completion rate was 93% (n=140). Differences between the two surveys were minimal with the overall summary score being the same (4.1; range 3.5-4.5). Individual scores ranged from 2.6 to 5. Items most frequently described as never missed included timely administration of pre-operative antibiotics and use of barrier precautions with central venous access device insertion. Care most missed included bathing and peri-care (with/without indwelling catheter), mobility, incentive spirometry, and the prevention of loops in urinary drainage catheter tubing. There were minor changes in rankings between the two survey versions.

Conclusions:
Scores reflect that known interventions to prevent iatrogenic complications are frequently or occasionally missed (or only usually and occasionally completed). Next steps include validation with real time observations. When missed care is not addressed, it can become routine, known as normalization of deviance, negatively impacting patient outcomes and the quality of care.
Abstract P878: Racial and Ethnic Disparities in Early Hypertension Control After Intracerebral Hemorrhage
Authors: Castello Juan Pablo , Teo Kay Cheong , Abramson Jessica R , Leung Ian Y , Leung William Chun-yin , Wang Yujie , Kourkoulis Christina , Myserlis Evangelos Pavlos , Warren Andrew , Henry Jonathan , Chan Koon Ho H , Cheung Raymond , Ho Shu Leong , Anderson Christopher D , Gurol Edip M , Viswanathan Anand , Greenberg Steven M , Lau Kui Kai , Rosand Jonathan , Biffi Alessandro
Published: March 2021

Introduction:
Survivors of Intracerebral Hemorrhage (ICH) are at high risk of recurrent stroke. This risk is inversely proportional to average Blood Pressure (BP) after ICH. Racial/ethnic minority ICH survivors in the US demonstrate greater hypertension severity after ICH and are at higher risk of recurrent cerebral bleeding. Since most recurrent strokes occur within 12-18 months of index ICH, rapidly achieving BP control is likely to be crucial. We investigated the frequency, prognostic impact, and racial/ethnic disparities in uncontrolled short-term hypertension (HTN) after ICH.

Methods:
We analyzed data from prospective ICH cohort studies at Massachusetts General Hospital (MGH-ICH, n=1305) and the University of Hong Kong (HK-ICH, n=523). We classified HTN as controlled, uncontrolled or treatment-resistant and determined: 1) risk factors for uncontrolled and treatment-resistant HTN; and 2) whether HTN control at 3 months is associated with long-term BP control, stroke recurrence and mortality across self-reported race/ethnicity groups.

Results:
We followed 1828 ICH survivors (1128 White, 565 Asian, 59 Hispanic, 49 Black, 27 other) for a median of 46.2 months. Only 9 of 172 (5%) recurrent strokes occurred before 3 months after ICH. At 3 months, 713 participants (39%) had controlled HTN, 755 (41%) had undertreated HTN, and 360 (20%) had treatment-resistant HTN. BP measurements at 3 months were highly correlated with measurements during follow-up (p<0.001). Black, Hispanic and Asian race/ethnicity were associated with higher prevalence of uncontrolled HTN at 3 months (all p<0.05). Both undertreated and uncontrolled HTN at 3 months were associated with increased risk of recurrent stroke and mortality during follow-up (all p<0.05).

Conclusions:
Most ICH survivors have inadequate HTN control 3 months after ICH, with under-treatment accounting for the majority of cases. Three-month BP measurements are associated with inadequate long-term HTN control, higher recurrent stroke risk and mortality. ICH survivors self-reporting as Black, Hispanic or Asian appear to be at highest risk for uncontrolled HTN. Optimizing HTN control at 3 months is a unique opportunity to address racial/ethnic disparities in quality of care among survivors of primary ICH.
Abstract P881: Geospatial Analysis of Community and Patient Risk Factors for Poor Functional Outcome in Stroke
Authors: Jones Erica , Leong Man Chong , Tootoo Joshua , Osgood Claire , Wewior Natalia , Miranda Marie Lynn , Savitz Sean I , Sharrief Anjail Z
Published: March 2021

Introduction:
Low neighborhood socioeconomic status has been associated with increased stroke risk, but it is not clear if this association is independent of individual socioeconomic status and clinical risk. Neighborhood racial segregation as defined by a racial isolation index (RI) has been shown to be associated with increased risk of stroke mortality. Using geospatial mapping techniques, we sought to determine the impact of neighborhood socioeconomic status and racial isolation on post-stroke functional outcome.

Methods:
Using our center’s prospective stroke registry, we matched charts for ischemic stroke patients seen between 1/1/2008 and 12/31/2018 with address data obtained from our hospital EMR for geospatial mapping. Racial Isolation (RI) and Neighborhood Deprivation Index (NDI) were calculated using census data. To assess the relationship between neighborhood factors and functional outcome, we used geographically weighted regression models. We fitted univariate and multivariate multinomial logistic regression models for functional outcome, and linear regression models for the percentage of poor functional outcome (defined as mRS 4-6). Significance was determined to be p < 0.05.

Results:
We included 5204 patients across 786 county census tracts. NDI (range -1.75 to 3.79) and RI (range 0 to 1) both appear to correlate visually with stroke rates of our patients across individual census tracts (Figure 1). Hypertension, diabetes, and dyslipidemia rates at individual and census tract level were significantly associated with poor functional outcome. NDI was not (OR 1.00 95% CI 0.99 - 1.00), but RI trended significant (OR 1.04 95% CI (0.99 - 1.09). Overall explanatory power was limited, warranting further investigation.

Conclusions:
Patient’s individual risk factors increased likelihood of poor functional outcome, but community segregation and socioeconomic deprivation indices are not predictors of poor functional outcome.
Abstract P882: A Multi-Level Exploration of the Social Determinants of Health in Florida: Initial Findings From the Transitions of Care Stroke Disparities Study
Authors: Bustillo Antonio , Gardener Hannah , Wang Kefeng , Dong Chuanhui , Rodriguez Anny , Campo-Bustillo Iszet , Gutierrez Carolina M , Marulanda-londono Erika T , Rundek Tatjana , Sacco Ralph L , Romano Jose G , Zeki Al Hazzouri Adina
Published: March 2021

Introduction:
Social determinants of health (SDH) are major contributors to stroke incidence and disparities, yet their relationship with severity and disability is relatively unexplored. The purpose of this study is to provide preliminary findings on SDH measures at the individual- and ZIP code-level across outcomes of stroke severity and disability.

Methods:
We used data from 344 stroke patients from the ongoing Transitions of Care Stroke Disparities Study (TCSDS) enrolled 2018-2020 from sites throughout Florida. TCSDS aims to identify disparities in hospital-to-home transition of stroke care. Individual-level SDH were collected by a trained interviewer at discharge; ZIP-level SDH data were obtained from a contracted data company. Outcomes included stroke severity at admission measured by the NIH Stroke Scale (NIHSS; Mild: 0-4; Moderate: 5-14; Severe: ≥15) and obtained from the AHA Get with the Guidelines-Stroke program; and disability at discharge measured by the modified Rankin Scale (mRS; 0-1; 2-5). Non-parametric statistical tests were used to compare individual- and ZIP-level SDH by NIHSS and mRS scores.

Results:
Most patients were older (median age 62 years, IQR: 19), male (58%), non-Hispanic White (39%) or Hispanic (35%) and suffered mild strokes (median NIHSS, IQR: 2, 4) with mild disability (median mRS: 1, 4). Those living with children (LWC) had more moderate strokes, while those living with a spouse/partner (LWP) had more severe strokes (p=0.004). Less than high school (HS)-, HS-, and college-educated patients had more moderate, mild, and severe strokes, respectively (p=0.02). ZIP-level unemployment rate was positively associated with NIHSS (p=0.031). Higher mRS was seen among Spanish and Haitian Creole speakers (p=0.005); HS- and less than HS-educated patients (p=0.005); and those with lower levels of social support (p=0.019). LWC had higher mRS scores, while the opposite was true for LWP (p=0.001).

Conclusions:
Despite the intersectional nature of SDH, these findings highlight possible mechanisms by which education, economic conditions and psychosocial factors may influence stroke severity and disability after stroke. More data are necessary to determine whether these SDH influence long term stroke outcomes post-discharge.
Abstract P885: Sex-Based Differences of Cerebral Venous Sinus Thrombosis Patients in the Appalachian Region
Authors: WALSH BLACKMORE Seth , Dobbs Michael , Hall Jason , Fraser Justin
Published: March 2021

Introduction:
The majority of data describing Cerebral Venous Sinus Thrombosis (CVST) patients has been collected outside the United States (U.S.). Females are reported at higher incidence with more favorable outcomes. Available U.S. data have poor representation of the Appalachian region, which has a higher burden of chronic disease and lower socioeconomic level. The objective of this study was to examine the sex-based characteristics of an Appalachian CVST cohort.

Methods:
Data were collected in a retrospective cohort using the Kentucky Appalachian Stroke Registry (KApSR), from admissions in a comprehensive stroke center serving 554,300 from the Appalachian region. Patients 18 years and older diagnosed with CVST from 2010-2018 were retrieved via International Classification of Diseases 9 and 10 codes. Secondary analysis by review of patient records was performed to screen for inclusion criteria and acquire additional data points.

Results:
Fifty-eight patients met inclusion criteria and 35(60%) were female. Twenty-three (40%) (15F 8M) had Kentucky Medicaid as primary insurance. At least one comorbidity was documented in 44(76%) (26F 18M) and 32(55%) (17F 13M) had 2 or more comorbidities. Headache was the most common presenting complaint, present in 33(56%) (19F 14M) with 8 (5F 3M) absent symptoms other than headache. Those with headache were more likely to have multi-sinus involvement OR 7.9 (1.9-32.7). Abnormal neurological exam was documented at admission in 36(64%) (20F 16M). Infarct was present in 19(32%) (11F 8M) hemorrhage in 3(1F 2M). Those with infarct were more likely to have superior sagittal involvement OR 3.6 (1.1 - 12.0). The National Institutes of Health Stroke Scale (NIHSS) was administered to 43(25F 18M) patients. Median NIHSS was 2.0 at admission, 0.5 at discharge and 19 (13F 6M) recorded an NIHSS >2 at admission. Median length of stay was 6 days. Thirty-nine patients (67%) (20F 19M) were routinely discharged to home vs hospice, skilled nursing facility, long term care or death. Female patients were less likely to be discharged to home OR 0.3 (0.1-0.9).

Conclusion:
The results suggest a high burden of comorbid disease among CVST patients in the Appalachian region. This may explain the worse prognosis of female patients in this cohort.
Abstract P888: Is There a Racial/Ethnic Disparity Among Stroke Patients With Covid-19?
Authors: Lekoubou Alain , Pelton Matthew , Ssentogo Paddy
Published: March 2021

Background and Purpose:
Cerebrovascular prevalence is high in patients with coronavirus disease 2019 (COVID-19). However, racial disparities have not been systematically explored in this population.

Methods:
We performed a retrospective, observational study of stroke prevalence in all patients with COVID-19 who visited emergency department (ED) up to August 13, 2020 in the United States. We used multivariable logistic regression to compare the odds of stroke in black patients with COVID-19 compared to their non-black counterpart while adjusting for the major confounders.

Results:
Among 8815 patients with ED visits with COVID-19, 77 (0.87 %) had ischemic stroke. The median age of patients with stroke was 64 years (SD: 2 years); 28 (43%) were men, 55 (71%) had hypertension, and 29 (50%) were black. After adjustment for age, sex, hypertension, diabetes, obesity, drinking and smoking, the likelihood of stroke was higher in black than non-black patients (adjusted odds ratio, 2.76; 95% CI, 1.13-7.15, p=0.03).

Conclusions:
Racial disparities in the prevalence of stroke among patients with COVID-19 exist, with blacks carrying greatest burden.
Abstract P93: The Effects of Covid-19 on Telestroke Care Delivery
Authors: Morton Johanna L , Didwania Suraj , Anderson Eric , Hallock Jason
Published: March 2021

Background:
Telestroke is increasingly being utilized to deliver acute stroke care to patients without in-person access to stroke expertise. After the U.S. emergence of the COVID-19 pandemic in March of 2020, reports of its effects on acute stroke care surfaced. This review examines the effect of the COVID-19 pandemic on telestroke care delivery in a large telestroke network, spanning 36 states and 340 hospitals throughout the nation.

Methods:
For this retrospective observational study, data was reported from the internal medical record platform from three separate time periods - a year before the pandemic (March 2019 - May 2019), the three months immediately prior to the pandemic (December 2019 - February 2020), and the height of the COVID-19 pandemic in the U.S. (March 2020 - May 2020). Two groups were studied, those seen in the emergency department (ED) with a suspected stroke diagnosis, and those who received alteplase in the ED.

Results:
The analysis revealed a decrease in patient volumes in both groups during the pandemic. The presentation time did not significantly vary between any of the stroke or alteplase groups. There was no significant difference in door-to-consult request times in the pandemic vs prior to the pandemic. The door-to-video time was shorter in the pandemic in alteplase patients compared to immediately prior (
P
=0.04), but not compared to 2019 (
P
=0.35). There was no significant difference in door-to-decision times or door-to-needle times in all of the groups. There was no difference in stroke severity in the alteplase group during the pandemic, but in the stroke group, stroke severity was higher during the pandemic (
P
<0.01). Rates of thrombolysis did not decrease during the pandemic.

Conclusion:
COVID-19 has strained the U.S. emergency medical system and created unique challenges to treating patients with acute ischemic stroke. Likely due to the size and heterogeneity of the patient population, minimal adverse effects on telestroke process metrics were seen in this particular large teleneurology practice during the COVID-19 pandemic. This review highlights the resilience of our nation’s stroke system of care to withstand the stressor of a worldwide pandemic.
Abstract P97: Changes in Stroke Patient’s Health-Seeking Behavior by Covid-19 Epidemic Regions: Data From Korean Stroke Registry
Authors: Jeong Han-yeong , Lee Eung-Jun , Kang Min Kyoung , Nam Ki-woong , Bae Jeonghoon , Jeon Kipyoung , Kim Tae Jung , Jung Keun-hwa , Ko Sang-bae , Oh Mi Sun , Lee Ji Sung , Bae Hee-joon , Yoon Byung-Woo , Park Jong-moo
Published: March 2021

Background and purpose:
With the wide spread of coronavirus disease 2019 (COVID-19) around the world, not only patients with COVID-19, but also patients with other disease such as stroke have undergone many changes in their health-seeking behavior. Between late February and March 2020, COVID-19 was epidemic in the community of Daegu city and Gyeongsangbuk-do region (D-G region) in Korea. We aimed to clarify the changes in the health-seeking behaviors of stroke patients and stroke care services by region in Korea through analysis of data from Korean Stroke Registry (KSR).

Methods:
We retrospectively reviewed the data with acute stroke and transient ischemic attack (TIA) patients between 2019 and 2020. We compared the stroke onset to hospital arrival (onset-to-door) time of these patients in the D-G region and other regions in Korea during the epidemic period in 2020 (post-COVID-19: February 18-March 31, 2020) and the same period in 2019 (Pre-COVID-19). In addition, we investigated the in-hospital stroke pathways with the patients.

Results:
1,792 patients in pre-COVID-19 and 1,555 patients in post-COVID-19 who visited KSR-registered hospitals were analyzed. Compared to pre-COVID-19, the number of patients registered in KSR decreased in most regions in post-COVID-19. In the D-G region, the number of registered patients decreased by two thirds, and the proportion of patients with TIA decreased significantly. (9.97% to 2.91%). Unlike other regions, the median onset-to-door time increased significantly in the D-G region (361 versus 526.5 minutes, p=0.0084). The proportion of patients with onset-to-door time within 3 hours also decreased significantly (36.45% versus 28.16%, p=0.0485). Patients in their 60s and 70s and mild symptoms (NIHSS score 0 to 3) came to the hospital later. As a result, the patients who underwent thrombectomy also decreased, but the treatment time did not differ between the two periods.

Conclusion:
During the epidemic of COVID-19, the patients residing in the epicenter showed distinct changes in health-seeking behavior. Appropriate public education about stroke is needed during the COVID-19 pandemic.
Health-Related Quality of Life Among Patients With Acute Ischemic Stroke and Large Vessel Occlusion in the ESCAPE Trial
Authors: Joundi Raed A. , Rebchuk Alexander D. , Field Thalia S. , Smith Eric E. , Goyal Mayank , Demchuk Andrew M. , Dowlatshahi Dar , Poppe Alexandre Y. , Williams David J. , Mandzia Jennifer L. , Buck Brian H. , Jadhav Ashutosh P. , Pikula Aleksandra , Menon Bijoy K. , Hill Michael D.
Published: March 2021

Background and Purpose:

Endovascular thrombectomy (EVT) reduces 90-day disability in patients following acute ischemic stroke due to large vessel occlusion. Patient-reported outcome measures after EVT, such as health-related quality of life and specific functional domains, are less well described.

Methods:

We report outcomes on the EuroQol-5D (EQ-5D) from the ESCAPE (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) randomized controlled trial at 90 days after stroke. Death was assigned an index value of 0 for EQ-5D. We used quantile regression to evaluate the association between EVT and EQ-5D index scores and logistic regression for the association between EVT and symptom-free status among 90-day survivors for each EQ-5D dimension (self-care, usual activities, mobility, pain/discomfort, and anxiety/depression), assessing for modification by age or sex and adjusting for baseline factors including stroke severity, affected hemisphere, and receipt of alteplase. Lastly, the association between severe disability at 90 days and EQ-5D was evaluated with assessment for modification by EVT, age, and sex.

Results:

There were 165 patients randomized to EVT and 150 patients randomized to control. Median EQ-5D was significantly higher for those who received EVT compared with best medical management (0.80 versus 0.60;
P
<0.001). After accounting for the greater number of deaths in the elderly, there was evidence of modification of treatment effect by age, with older age associated with a larger effect size difference in EQ-5D with EVT. Those receiving EVT had higher odds of symptom-free status in self-care, usual activities, mobility for those aged 60 to 79 years, and pain/discomfort for women, but there was no association with anxiety/depression. Severe disability at 90 days was associated with lower EQ-5D in older compared with younger individuals, and the association was not modified by EVT.

Conclusions:

Patients treated with EVT report substantially improved health-related quality of life, with relatively greater impact in older individuals and observed benefit across multiple dimensions.
Exploring the Collateral Damage of the COVID-19 Pandemic on Stroke Care
Authors: Balucani Clotilde , Carhuapoma J. Ricardo , Canner Joseph K. , Faigle Roland , Johnson Brenda , Aycock Anna , Phipps Michael S. , Schrier Chad , Yarbrough Karen , Toral Linda , Groman Susan , Lawrence Erin , Aldrich Eric , Goldszmidt Adrian , Marsh Elizabeth , Urrutia Victor C.
Published: March 2021

Background and Purpose:

During the coronavirus disease 2019 (COVID-19) pandemic, the various emergency measures implemented to contain the spread of the virus and to overcome the volume of affected patients presenting to hospitals may have had unintended consequences. Several studies reported a decrease in the number of stroke admissions. There are no data on the impact of the COVID-19 pandemic on stroke admissions and stroke care in Maryland.

Methods:

A retrospective analysis of quality improvement data reported by stroke centers in the State of Maryland. The number of admissions for stroke, overall and by stroke subtype, between March 1 and September 30, 2020 (pandemic) were compared with the same time period in 2019 (prepandemic). Median last known well to hospital arrival time, the number of intravenous thrombolysis and thrombectomy were also compared.

Results:

During the initial 7 months of the pandemic, there were 6529 total admissions for stroke and transient ischemic attack, monthly mean 938 (95% CI, 837.1–1038.9) versus prepandemic 8003, monthly mean 1156.3 (CI, 1121.3–1191.2),
P
<0.001. A significant decrease was observed in intravenous thrombolysis treatments, pandemic 617, monthly mean 88.1 (80.7–95.6) versus prepandemic 805, monthly mean 115 (CI, 104.3–125.6),
P
<0.001; there was no significant decrease for thrombectomies. The pandemic decreased the probability of admissions for stroke and transient ischemic attack by 19%, for acute ischemic stroke by 20%, for the number of intravenous thrombolysis performed by 23%. There was no difference in the number of admissions for subarachnoid hemorrhage, pandemic 199, monthly mean 28.4 (CI, 22.5–34.3) versus prepandemic 217, monthly mean 31 (CI, 23.9–38.1), respectively,
P
=0.507.

Conclusions:

Our findings suggest that the COVID-19 pandemic adversely affected the acute care of unrelated cerebrovascular emergencies.
Can God Deliver His Servants? Two Theological Problems in the Daniel Narratives (Dan 1:9; 3:17–18)
Authors: Golan Naama , Gordin Shai
Published: March 2021

This article addresses two cases from the narratives in Daniel in which a similar theological question arises concerning the uncertainty of God’s ability to deliver his servants: (1) The chief officer’s denial of Daniels’ request (Dan 1:10) despite the fact that God granted Daniel grace and compassion from the chief officer, and (2) the speech of Shadrach, Meshach, and Abednego (Dan 3:17–18), in which they entertain the possibility that God will not, or perhaps cannot, save them. Commentators and translators throughout the generations have struggled with these theological problems, and we can identify a clear trend seeking to read the relevant verses in a way that removes the uncertainty, replacing it with certain faith in God’s deliverance.

In this article, we demonstrate how this interpretive trend surprisingly continues even with modern biblical scholars. Based on a literary analysis, we suggest that reading the MT version without altering it to conform with certain theological preconceptions may shed new light on the Daniel narratives, thereby exposing their deep and complex message.
Of Conflict and Collapse: Rethinking State Formation in Post-Gaddafi Libya
Authors: Badi Emadeddin
Published: March 2021

This paper explores the relationships between the Libyan state and society, and the ways in which these dynamics affected the subsequent civil wars in 2011 and onwards. Beyond the commonly-studied impact of oil and state rentierism, this paper demonstrates that the enduring centralization of the state, Gaddafi’s dystopian governance system, the socio-economic and political cultures pre-2011, and the interplay between local systems of legitimacy and central authority have played an underappreciated role in the contemporary Libyan landscape. The continuities and discontinuities of order that defined and characterized the Libyan state before and after 2011 are thus dissected. An exploration of the appositeness of Eurocentric theories of statehood to the Libyan landscape unveils the pillars of legitimacy that defined Libyan statehood pre-Gaddafi. This sheds light both on how the Gaddafi regime sought to control society by often manipulating these pillars and on the ways in which Libyan society either directly and indirectly resisted his rule or rested in complacency. This covert resistance, which turned overt, widespread, and violent in 2011, paved the way for a discursive mutation of “tribalism.” This notion morphed from one of a group behavioral binding mechanism tied to blood lineage into one underpinned by notions of solidarity that override kinship. This analysis in turn elucidates the precarity of the Libyan state and explains the subsequent turmoil in the country post-2011, characterized notably by the emergence of armed non-state actors. A key discontinuity identified is in the realm of foreign influencers that have exploited long-standing domestic grievances and weaponized Libya’s traditional pillars of legitimacy, thus tearing at its society’s social fabric.
A new genus and new species of the leafhopper tribe Idiocerini (Hemiptera: Cicadellidae: Eurymelinae)
Authors: WANG XIAN-YI , WANG JIA-JIA , DAI REN-HUAI
Published: March 2021

A new genus of the leafhopper tribe Idiocerini (Hemiptera: Cicadellidae: Eurymelinae) Longiaedeagus gen. nov. with type species Longiaedeagus flavofasciatus sp. nov. from China is described and illustrated. This new genus can be distinguished from other leafhopper genera by the broad style with truncate apex, and aedeagus with a long, unpaired retrorse preapical process.
Investigation of Correlation Between Fracture Toughness and Charpy Impact Energy of Cryogenic Steel Welds
Authors: An Gyubaek , Hong Seunglae , Park Jeongung , Han Ilwook
Published: March 2021

The high manganese steel was developed to improve the fracture toughness and safety at cryogenic temperatures, the austenite structure was formed by increasing the manganese (Mn) content. The developed weld high manganese steel was alloyed with austenite stabilizing elements (e.g.,
C, Mn, and Ni) for cryogenic toughness and fluxes contained less than 10% of acidic slag formers such as rutile (TiO2) and silica (SiO2). This paper describes the work carried out to enhance the fracture toughness of Mn contents in an economical way by means of increase
of manganese up to 23% instead of using nickel (Ni) which has unique element to improve fracture toughness especially at cryogenic steel. The new cryogenic steels should be carefully evaluated in terms of safety for application in real structures including LNG ships. In this study, the fracture
toughness performance was evaluated for recently developed cryogenic steels (high-Mn steels), especially the crack tip opening displacement (CTOD) parameter was evaluated using the prediction formula proposed by conventional equation. The CTOD value was investigated the effect of microstructure
and mechanical properties of Fe–C–Mn and Fe–C–Mn–Ni high manganese steel, it was revealed that the e-martesnsite phase formed in high manganese steel of 0.2C–20Mn and 0.4C–20Mn as a result of a low stability of austenite upon strain-induced phase transformation.
Doping Mo on Tungsten Oxide Thin Film and Photoelectrochemical Measurement
Authors: Yoon Sang-Hyeok , Kim Kyo-Seon
Published: March 2021

Tungsten oxide (WO3) is semiconductor material which can be used for various applications. Especially, one-dimensional (1-D) nanostructured WO3 shows the high photoelectrochemical (PEC) performance due to high surface area and short transport route of electron–hole
pair. The flame vapor deposition (FVD) process is an efficient and economical method for preparation of the 1-D nanos-tructured WO3 thin film. Molybdenum doping is a well-known method to improve the PEC performance of WO3 by reducing band gap and increasing electrical
property. In this study, we prepared the 1-D WO3 nanostructures doped with Mo by FVD single step process. We confirmed that Mo was successfully doped on WO3 without changing significantly the original nanostructure, crystal structure and chemical bonding state of WO3
thin film. As a result of PEC measurement, the pho-tocurrent densities of WO3 thin film with Mo doping were higher by about 1.4 to 2 times (for applied voltage above 0.7 V vs. SCE) than those without Mo doping.
Formation of Heterogeneous Microstructure in AA1050/AA5052/AA6061/AA1050 Layered Sheet Processed by Cold Roll-Bonding and Subsequent Annealing
Authors: Jo Sang-Hyeon , Lee Seong-Hee
Published: March 2021

A cold roll-bonding process was applied to fabricate an AA1050/AA6061/AA5052/AA1050 four-layer clad sheet and subsequently annealed. Three types of aluminum alloy sheets such as AA1050, AA6061 and AA5052 with 2 mm thickness, 40 mm width and 300 mm length were stacked up each other after
such surface treatment as degreasing and wire brushing, then reduced to a thickness of 2 mm by multi-pass cold rolling. The rolling was performed at ambient temperature without lubricant using a 2-high mill with a roll diameter of 400 mm at rolling speed of 6.0 m/sec. The roll bonded AA1050/AA6061/AA5052/AA1050
clad sheet was then annealed for 0.5 h at 200~400 °C. Microstructures of the as-roll bonded and subsequently annealed aluminum sheets are investigated by electron back scatter diffraction (EBSD) measurement. After rolling, the roll-bonded AA1050/AA5052/AA6061/AA1050 sheet showed a typical
deformation structure that the grains are largely elongated to the rolling direction. However, after annealing, it exhibits a very heterogeneous structure consisting of both deformation structure and recrystallization structure containing nanometer order grains. The formation of this heterogeneous
structure and texture with annealing is investigated in detail through EBSD analysis.
Optical Properties from a Single GaAs Quantum Dot Structure
Authors: Kim Heedae
Published: March 2021

We observed exciton and biexciton states in a single GaAs quantum dot at 4 K using micro pho-toluminescence system and investigated power dependent photoluminescence measurements to identify both exciton and biexciton states. The biexciton and exciton states showed quadratic (a~2.2)
and linear (a~0.95) increasing power factor, respectively. The large energy difference (~0.2 meV) from exciton states for the perpendicular polarization was observed.
A Study on Focused Ion Beam (FIB) Milling Machining and Fabrication Technology of Nano-Scale Diamond Tool for Machining Fine-Patterns in a Free-Form Surfaces
Authors: Jung Sung-Taek , Kim Hyun-Jeong , Wi Eun-Chan , Kong Jung-Shik , Lee Joo-Hyung , Song Ki-Hyeong , Choi Young-Jae , Park Jeong-Woo , Kim Tae-Wan , Kim Kyung-Mok , Baek Seung-Yub
Published: March 2021

Recently, the technology of the industry has been increasing for diffractive optical elements, holograms, optical components, and next-generation display components. The advanced high value-added industry is designing fine patterns on ultra-precision optical components and applying
them to various industries. In the case of the ultra-fine pattern, a contact-type machining technique is required because it requires a precise pattern in nano-scale units. In this paper, the fabrication technology of ultra-precision diamond which is essential in the ultra-precision processing
technology was suggested. The material used in the experiment was a single-crystal diamond tool (SCD), and the equipment for machining the SCD used a focused ion beam (FEI COMPANY, system Nova 600) equipment. The back fire method was applied without metal coating in order to carry out the
process study and the focused beam of 30 keV Ga+ ions were carried out processing for various fabrication of diamond cutting tools. As a result of applying the backfire method through the process experiment, the cutting edge width of the ultra-precision diamond tool was verified
275 nm.
Effect of Gd3+ Doping on Sol–Gel Prepared Y2O3 Films as Gate Insulators for Oxide Thin Film Transistors
Authors: Park Byung-Yoon , Choi Sungho , Ahn Taek
Published: March 2021

The relationships between the microstructure and the dielectric properties of sol–gel prepared Y2O3 films with various Gd3+ doping were systematically investigated. Robust solution processed lanthanide films, (Y1−xGdx)2O3
(0 < x ≤ 0.5), are demonstrated as high-k gate insulators for low voltage-driven oxide thin film transistors and their optimized composition is presented. With the proper amount of Gd3+ doping, the corresponding thin film insulators exhibit low leakage current with
increased dielectric constant. The resultant Zn–Sn–O/(Y, Gd)2O3 TFT exhibits enhanced performance, by a factor of 10.7 compared with TFTs using a SiO2 insulator, with a field-effect mobility of ~3.15 cm2V−1s−1 and
an exceptionally low operating voltage <15 V.
Improvement of Electrochemical Properties of Poly(3,4-ethylene dioxythiophene) (PEDOT) Thin Film by UV Irradiation
Authors: Lim Kyung Bin , Choi Myong Soo , Kim Sung Hee , Lee Jun Young
Published: March 2021

Electrochemical redox supercapcitor is one of promising rechargeable power sources for portable electronic, display or telecommunication devices since it has a large energy density, very fast charge/discharge time and long life cycle. In this study, poly(3,4-ethylene dioxythiophene)
(PEDOT) thin film as the electrode of electrochemical supercapacitor was deposited on a metal current collector by in-situ polymerization method. Symmetrical electrochemical capacitor was then assembled using PEDOT films as working and counter electrodes, where 0.1 M lithium perchlorate
(LiClO4) solution in acetonitrile was used as the electrolyte solution. Typical specific discharge capacitance of the capacitor was about 70 F/g and showed little decrease after 1,000 charge/discharge cycles. We also found that UV irradiation improved the electrochemical properties
of redox capacitor by formation of hydrophilic polar groups on PEDOT film surface. After UV irradiation on the surface of PEDOT film for 2 hours with the intensity of 30 mW/cm2, the specific discharge capacitance increased by about 10% compared to capacitance of pristine PEDOT film.
Preparation and Catalytic Activity of Platinum Supported on Amine-Functionalized MIL-101 (Fe)/Nitrogen-Doped Carbon Nanotube Composite for Fuel Cells
Authors: Yoo Pyeong Kang , Park Soo-Jin , Kim Seok
Published: March 2021

Pt-supported on amine functionalized MIL-101 (Fe) and nitrogen doped multi-walled carbon nanotube (CNT) composites were synthesized by hydrothermal synthesis and pyrolysis process. Electrochemical properties were measured by cyclic voltammetry (CV), chronoamperometry (CA) and structural
analysis was done by field emission scanning electron microscopy (FE-SEM) and Fourier transform infrared spectroscopy (FT-IR). As a result, higher electrochemical surface area (ECSA) and methanol oxidation reactions were obtained, and the electrochemical properties of Pt-c(NH2-MIL-101)@NCNT
are better than pristine Pt-c(NH2-MIL-101). The enhanced activity related with the synergy effect from the higher conductivity of N-doped CNT and the better porous nanostructure of carbonized NH2-MIL-101(Fe).