bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP260: The Response Of Annexin A1 In Astrocyte Activation And White Matter Injury- A New Target For Stroke In Sickle Cell Disease
Authors: Hazra Rimi , Ghosh Samit
Published: February 2022

Introduction:
Ischemic stroke is common in sickle cell disease (SCD). White matter injuries, incorporated into silent cerebral infarcts, are major risk factors of stroke in SCD. The pathogenesis of cerebral infarction in SCD is not known. Induced thrombogenesis may cause impaired astrocyte that stimulates demyelination leading to white matter injury. Annexin A1 (Anxa1) can regulate astrocyte function by inhibiting intracellular phospholipase A2 (PLA2). We hypothesized that astrocyte activation during thrombogenic events promotes white matter injury in SCD. We tested astrocyte dysfunction and white matter injury in a clinically relevant mouse model of SCD.

Methods:
Cerebral Infarctions induced by de novo thrombogenesis were identified by TTC staining in transgenic sickle (SS) and control (AA) mice with human sickle and normal hemoglobin respectively. Cerebral microvessels and astrocytes were isolated from SS and AA mice. Elisa assays were used to measure thrombin, PLA2 and Anxa1. Immunofluorescence staining was performed to determine astrocyte activation and demyelination.

Results:
Thrombogenesis within cerebral microvessels was elevated by ~2-fold (n=5, p<0.05), and cerebral infarction became prevalent in SS mice compared to AA mice (n=7, p<0.001). The infarcted brain tissue from SS mice showed neuronal cell death, whereas the brain tissue from the AA mice appeared normal. The SS mice had increased glial fibrillary acid protein positive (GFAP
+
) activated astrocytes with significant increase in PLA2 accumulation. Relative abundance of non-phosphorylated neurofilament H (SMI32) and myelin basic protein (MBP) (SMI32/MBP), indicating white matter injury, was substantially induced in the SS compared to the AA. Expression of Anxa1 reduced significantly in plasma as well as within astrocytes’ end feet attached to the isolated cerebral microvessels of the SS mice. Recombinant Anxa1 prophylaxis to SS mice reduced the GFAP
+
astrocytes, PLA2 accumulation, demyelination and infarct score (n=6, p<0.01) compared to SS mice treated with vehicle.

Conclusion:
White matter injury in SS mice is associated with astrocyte dysfunction and lack of Anxa1, which may be developed as potential therapeutic targets to prevent and/or treat stroke in SCD.
Abstract WP3: Early Sustained Hyperchloremia Independently Reduces The Rates Of Favorable Outcomes In Acute Ischemic Stroke Patients: A Post Hoc Analysis Of Alias Part 1 And 2 Trials.
Authors: Gomez Francisco E , Huang Wei , Bains Navpreet , ISHFAQ Muhammad , French Brandi R , Siddiq Farhan , Malhotra Kunal , Gomez Camilo r , Qureshi Adnan I
Published: February 2022

Objective:
To investigate the effect of early hyperchloremia on 90-day outcomes in acute ischemic stroke

Methods:
We analyzed data from Albumin in Acute Ischemic Stroke (ALIAS) Part 1 and 2 trials which recruited patients with acute ischemic stroke within 5 hours of onset. Patients with hyperchloremia (defined as 110 mmol/L or greater) at baseline, 24, or 48 hours after randomization were identified. We trichotomized patients into 3 groups; no instances, one instance, and two or more instances of measured hyperchloremia within the first 48 hours. Serum creatinine levels at baseline, 24, and 48 hours were used to identify acute kidney injury (AKI) via the Acute Kidney Injury Network (AKIN) classification. Logistic regressions were performed to determine the effects of hyperchloremia on outcomes defined by modified Rankin scales or National Institutes of Health Stroke Scale scores at 90 days and mortality at 90 days.

Results:
Among the total of 1275 patients analyzed, zero, one and two or more occurrence of hyperchloremia within 48 hours were observed in 976, 191 and 108 patients respectively. Compared with patients without hyperchloremia, patients with two or more occurrences of hyperchloremia at significantly higher odds of non-favorable outcomes within 90 days after adjustment for age, NIHSS score, initial systolic blood pressure, and ALIAS treatment group (albumin or placebo) (OR 3.0, 95%, CI 1.8-5.0). Patients with two or more occurrences of hyperchloremia also presented higher odds of death within 90 days vs the non-hyperchloremia group. Patients with one occurrence of hyperchloremia were not at higher odds for non-favorable outcomes at 90 days. There was no association between occurrence of two or more occurrence of hyperchloremia and AKI (OR 0.8, 95% CI 0.3-1.9).

Conclusions:
The independent association between sustained hyperchloremia and non-favorable outcomes at 90 days suggest that avoidance of hyperchloremia may increase the rate of favorable outcomes in patients with acute ischemic stroke.
Abstract WP34: Bed Ahead Process Avoids The Thrombectomy Patient Boarding In Emergency Department
Authors: MONTGOMERY Kelly M , Fussner Julie M , Vlad Chase , Grosso Riley , SILA Cathy A
Published: February 2022

Background:
University Hospitals Comprehensive Stroke Center (UH CSC) is an academic medical center with a dedicated 19 bed Neuroscience Intensive Care unit (NSU). As the only comprehensive stroke center in a 22 hospital system, the majority of ischemic stroke patients requiring a mechanical thrombectomy procedure are transferred to the UH CSC. A post thrombectomy patient requires intensive monitoring to assess for complications and is best cared for by highly trained neuro nurses in an intensive care environment. Lack of available NSU beds often resulted in these patients returning to the high volume emergency department with less than ideal staffing. The request for a NSU bed was not initiated until the thrombectomy procedure began delaying the chain of events that lead to an available NSU bed.

Hypothesis:
A proactive process that would initiate obtaining a NSU bed sooner would avoid these patients from boarding in the emergency department.

Methods:
Key stake holders from the stroke program, neurocritical care, emergency medicine, neuro interventional and the transfer center met in early 2019 to review data and quality concerns. An algorithm was developed and shared with all staff. Once the stroke faculty accepts a transfer of a potential thrombectomy patient, the new process includes notifying the NSU fellow and charge nurse to initiate making an open bed before the patient arrives to UH CSC.

Results:
In 2018, 48% of patients that underwent a mechanical thrombectomy returned to the emergency department. After the implementation of the new process the percentage of patients returning to the emergency department declined to 28% in 2019. In 2020 only 8% returned to the emergency department. The number of quality concerns significantly decreased.

Conclusion:
The bed ahead process initiated before a thrombectomy patient arrives at the comprehensive stroke center has been successful in avoiding returns to the emergency department and meeting our goal to achieve high quality patient outcomes and improve care efficiency.
Abstract WP37: Dismantling Timely Transition Delays: Effects Of A Discharge Navigation On Stroke Patient Length Of Stay
Authors: Rhew Denise , Free Courtlanda , Upham Jason
Published: February 2022

Background:
Patient care management and throughput are directly affected by the effectiveness of interdisciplinary communication. Discharge navigation begins at in-patient (IP) admission and continues until discharge. Therefore, the healthcare team is focused on appropriately mitigating barriers to promote safe and timely discharge. The motivation for an efficient discharge process has been a top priority amongst the U.S. COVID-19 epidemic.

Purpose:
Utilizing an interdisciplinary approach to care management proves to reduce the length of stay (LOS) (Patel et al., 2019). Thus, given the rise in acute IP admissions, our team established goals focused on early identification and management of barriers commonly encountered by stroke patients.

Methods:
Stakeholders included leadership, providers, nurses, ancillary staff, and Discharge Navigator implementation. The aim is for discharge navigation to use a best-practice approach to “bridge the gap” and increase interdisciplinary communication through multidisciplinary progression rounds, interdisciplinary bedside rounding, and digital formats. The process of initiating discharge conversations on admission and intermittently throughout the day has resulted in expedited throughput transition.

Results:
Improved readiness for discharge played an essential role in decreasing stroke patient LOS and increasing patient satisfaction. Patient satisfaction (PS) data indicates that we are below the benchmark for several indices. From (2020 to 2021) average satisfaction scores for nurse and doctor communication increased from 70.1 to72.3% and 72.5 to 77%, respectively. Satisfaction with discharge information increased from 86.3 to 88.4%. In addition, LOS data indicated decreased LOS for stroke patients with minimal complications, including DRGs 069, 063, and 061. The average LOS decreased from 2.7 to 2.1, 2.9 to 1.8, and 8.8 to 8.1 days, respectively (April-July 2020) to (April-July 2021).

Conclusions:
Quality improvement initiatives, including a throughput-focused team to “drill down” on discharge barriers, has shown decreased LOS, increased PS, and accountability to stroke patients.
Abstract WP39: Improving Hospitals Documentation Of Time Last Known Well
Authors: Bluma Dot , Bowser John , Randall Kristin N
Published: February 2022

Background and Purpose:
Correctly identifying a patient’s time of last known well (LKW) is critical for determining eligibility for time-sensitive acute ischemic stroke thrombolytic treatments. Accurately abstracting LKW can be very difficult, given complexities in documentation and coding instructions. The Wisconsin Coverdell Stroke Program (Coverdell) monitors data quality through quarterly re-abstraction of five patient records from participating hospitals to assess agreement between initial and re-abstracted records. The concordance of LKW for Q4 2018-Q4 2019 was 74%-83%. This necessitated a Coverdell performance improvement project of hospitals’ LKW documentation. The project goal was set at 85% to be achieved by Q1 2021.

Methods:
Coverdell hospitals quarterly meet as a collaborative. In March and June of 2020 best practices of high performing hospitals in LKW concordance were shared with a consensus on best practices: communication between providers when documenting LKW, developing a source of truth in the EHR where LKW is documented and resourced, and providing feedback to providers when mismatches occur. These practices and scenarios were included in a document published to the Coverdell website in October 2020,
Abstracting an Accurate Last Known Well.
A second document was created, S
teps to take for Accurate Documentation of Last Known Well
which graphically summarizes in a flow chart the actions an abstractor or stroke coordinator can take when LKW documentation needs improvement. It was published May 2021. The collaborative continues to review de-identified cases where LKW was not easily recognized.

Findings:
Q1 2021 concordance for LKW was 79%. This falls short of the originally established project goal.

Conclusion:
During this PI project there was a 20% turnover rate in abstractors and re-abstractors which may have contributed to the results. The goal of 85% concordance will remain an active benchmark. We are hopeful future radiographic technology will assist stroke teams in identification of LKW, and modifications of coding instructions in the data registry will occur. Many hospitals find variances in LKW documentation between providers which could potentially lead to false ineligibility for receipt of thrombolytic therapy.
Abstract WP47: An Investigation On First Author Gender Disparities In Stroke-related Randomized Controlled Trials
Authors: Rawlley Bharat , Marchina Sarah , Cappucci Stefanie P , KUMAR Sandeep
Published: February 2022

Introduction:
While the number of women in medicine and neurology is increasing, there remains a significant gender gap in academic neurology, especially, in the subspecialty of vascular neurology. This study aims to quantify gender differences and examine trends in primary authorship of stroke randomized controlled trials (RCTs) published over the last decade as a proxy for academic leadership.

Methods:
The PubMed database was searched using pre-defined keywords relevant to ischemic and hemorrhagic stroke filtered by title and article type RCT from 2011 to 2020. EasyPubMed package in R was used for the search. The gender of first authors was determined using the gender package in R, which identifies gender using historical data. Only predictions with an accuracy of ≥ 0.8 for the associated gender were considered, remaining genders were determined by manual search.

Results:
The query identified 657 RCTs published from 2011 to 2020. Amongst these, we were able to identify the gender of primary authors of 587 (89%) RCTs. Of the 587 RCTs, 205 (35%) had females as primary authors of which 184 (90%) had unique first names. Amongst the 382 male authors, 330 (86%) had unique first names. The mean (SD) percentage of female and male first authors was 31.05 (5.91) and 58.05 (7.21), respectively. Figure 1 demonstrates the annual proportions of both genders over the past decade. The Cox and Stuart trend test did not show any trend in the percentage of female or male authors over the course of 10 years [p values (2-tailed) = 0.36, 0.85, respectively].

Conclusions:
Our results highlight the persistence of the gender gap in primary authorship of Stroke RCTs. Despite increased calls for greater representation of women in leadership roles, our data shows a lack of favorable trend towards gender parity in primary authorship. This emphasizes the need for further scrutiny of barriers contributing to this disparity and efforts to promote women as leaders in academic neurology.
Abstract WP50: Implementation Of The AHA/ASA Western States Quality Task Force Door In Door Out Best Practice Strategies Results In Quicker Transfer Times
Authors: Sangha Navdeep S , Bosson Nichole E , Whittington Mary , Taqi M A , Tirschwell David L , Liable Deborah A , Lehrfeld David , Taillac Peter , Arcangel ReaAnne , Wallace Jessica , Loomis Ron , Goudarzi Shawni , Cheng Pamela , Rho Howard J , Hemmen Thomas M
Published: February 2022

Background:
Rapid Door in Door Out (DIDO) times at primary stroke centers (PSCs) continue to be a challenge. The AHA/ASA Western States Quality Task Force met between 2018-2020 to establish strategies that could be employed at most PSCs to decrease their DIDO times. We assessed the impact of these strategies on DIDO times in a health system with 13 PSCs.

Methods:
The committee met at regularly scheduled intervals and reviewed the available literature on DIDO to help establish the document. The key strategies include: 1)Target DIDO of ≤ 90 mins, 2) Rapid administration of IV thrombolysis (follow Target: Stroke key best practice strategies), 3) Rapid initiation of a transfer process with consideration of initiation based on examination, 4) Participate in a regional system of care, 5) Integration of telemedicine into the transfer process, 6) Rapid acquisition, interpretation and transmission of neuro imaging, 7) Expedited transport handoff, 8) Mock code strokes which include the external staff who are involved in the transfer process, 9) Prompt data collection, feedback and quality improvement. The key strategies were implemented in April 2021. We compared DIDO in the first three months pre-and post-implementation using the Student’s t-test. DIDO time intervals were also assessed.

Results:
Thirty-two patients were transferred in the pre-implementation phase vs. 29 in the post-implementation phase. There were no differences in median age (pre 65 vs. post 74), gender (pre 47% female vs. post 52% female), or median NIHSS (11 both pre and post). The DIDO decreased from 120 mins (IQR 95-152) to 79 mins (IQR 63-132) p=0.009. Patient arrival to transfer center call time non-significantly changed from a median of 55 mins (IQR 35-91) to 38 mins (IQR 29-79). Time from transfer center call time to outside hospital physician acceptance had a trend toward improvement from 17 mins (IQR 10-26 mins) to 13 mins (IQR 9-18) p=0.09. Ambulance arrival to ambulance departure non-significantly decreased from 24 mins (IQR 20-34) to 20 mins (IQR 16-25).

Conclusion:
Implementation of the AHA/ASA Western States Quality Task Force DIDO Best Practice Strategies can decrease overall DIDO times. These strategies can be easily employed at PSCs to improve patient outcomes.
Abstract WP59: Sex And Age Specific Differences In Rehabilitation Attendance Between Rural And Urban Stroke Patients In The United States
Authors: Tran Phoebe , Zhu Cenjing , Dreyer Rachel P , Lichtman Judith H
Published: February 2022

Background:
Stroke rehabilitation (SR) has been outlined in ASA/AHA guidelines as a critical component of post-acute care. US studies from the 2000s have found associations between rural residence and lower SR attendance, but contemporary information about SR attendance across geographic areas and patient subgroups is limited.

Methods:
Using the most recent 2011, 2013, 2015, and 2017 self-reported Behavioral Risk Factor Surveillance System (BRFSS) Surveys with SR data, we identified US adult stroke patients in 20 states. Rural/urban residence was classified by the Metropolitan Statistical Area codes. We compared SR attendance (Yes/No) among rural and urban stroke patients by sex and age groups (18-44y, 45-64y, 65+y). Logistic regression was used to examine the association between rural/urban residence and SR while controlling for key sociodemographic factors. Survey weighting was applied to all analyses.

Results:
Among 7878 stroke patients (40.8% rural, 62.2% women), slightly less rural residents attended SR compared to urban ones (30.8% vs 32.6%, p=0.357) (
Figure
). Rural/urban residence was not associated with SR prior to and after adjustment for sex, age, race, education, income, insurance status, and having a personal doctor (OR: 0.96, 95% CI: 0.80-1.15). In stratified analyses, women, patients 18-44y, and 45-64y who live in rural areas were less likely to attend SR than their urban counterparts. Women also had lower SR than men, irrespective of rural/urban residence.

Conclusions:
On average, a third of US stroke patients went to SR with no association found between rural/urban residence and SR attendance. However, a pattern of lower SR rates was observed across some sex and age subgroups in rural areas and in women regardless of residence status. Targeted interventions are needed to address rural/urban disparities and optimize secondary stroke prevention utilization, especially among women and young to middle aged patients in US rural areas.
Abstract WP62: Safety Of Submaximal Aerobic Exercise Testing For People With Subacute Stroke And Comorbidity: A Scoping Review
Authors: Legasto Jean Michelle , Thompson Alexandra N , Chandran Nivetha , Inness Elizabeth , Mathur Sunita , Salbach Nancy M
Published: February 2022

Introduction:
Despite aerobic exercise (AE) testing being a key recommendation for stroke rehabilitation, less than half of physical therapists working with individuals post-stroke perform this practice. Concern for adverse cardiovascular events and inadequate guidance on how to conduct AE testing for individuals with stroke and comorbidity are key barriers. This review aims to describe submaximal AE testing protocols with evidence of safety, defined as less than 11% occurrence of serious adverse events, for people with subacute stroke and comorbidity.

Methods:
MEDLINE, EMBASE, PsycINFO, CINAHL and SPORTDiscus were searched from inception to October 29, 2020. Published studies that involved submaximal AE testing with individuals with subacute stroke and reported on adverse events during testing were included. Two reviewers independently conducted title and abstract, and full-text screening. One reviewer conducted data extraction, verified by a second reviewer.

Results:
Sixteen studies involving 595 participants were included. Hypertension (35%), cardiovascular disease (14%) and atrial fibrillation (8%) were the most common cardiovascular comorbidities, while, diabetes (25%), dyslipidemia (23%) and smoking history (11%) were the most common general comorbidities affecting participants with stroke. Evidence of safety for individuals with stroke and comorbidity was found for incremental bicycle (n=5), recumbent stepper (n=3), body weight support treadmill (n=1) and upper extremity ergometer (n=1) protocols; constant load bicycle (n=1) and body weight support treadmill (n=1) protocols; and field (n=10) protocols. Heart rate (95%), blood pressure (82%) and oxygen consumption (72%) monitoring were most frequently done. Test termination criteria based on volition/fatigue (59%) and heart rate (55%) were most commonly reported.

Conclusion:
A range of submaximal AE testing protocols utilizing diverse exercise modalities can be safely conducted on people with subacute stroke and comorbid conditions that are perceived to increase the risk for serious adverse events. These protocols can be used to guide the development of more specific clinical practice guidelines for conducting AE testing on individuals with stroke and comorbidity.
Abstract WP72: Telemedicine Access, Care, And Outcomes For TIA And Minor Stroke
Authors: Penn Jeremy , Austin Peter , Lee Douglas , Porter Joan , Fang Jiming , Redelmeier Donald A , Kapral Moira K , Yu Amy Y
Published: February 2022

Introduction:
Telemedicine is increasingly used, but its effectiveness for stroke prevention after minor stroke or TIA is not known. We compared the care and outcomes in patients discharged from an emergency department (ED) with TIA or stroke before and after the implementation of telemedicine stroke prevention clinics in Ontario, Canada. We hypothesized that care and outcomes will remain similar.

Methods:
We used linked administrative data to identify community-dwelling adults discharged from the ED with TIA or ischemic stroke from April 2015 to March 2020 (pre-telemedicine) and April 2020 to March 2021 (post-telemedicine). We compared access to outpatient physician visits within 90 days, neuroimaging or vascular imaging within 14 days, and echocardiogram within 90 days using standardized differences (SD <0.1 indicates negligeable difference). We used Cox proportional hazard models to compare the adjusted Hazard Ratio (aHR) and 95% confidence intervals of death within 90 days pre- and post-telemedicine and cause-specific hazard models for stroke readmission with adjustment for comorbidities.

Results:
We identified 47,869 patients (n=40,099 pre- and n=7,770 post-telemedicine), median age 73 years [62, 82], 49% female. Baseline characteristics were similar. There was a rapid uptake in telemedicine use (Figure 1). Physician visits (92.9% vs 93.1%, SD 0.01), neuroimaging (81.3% vs 80.5%, SD 0.02), and echocardiogram use (52.5% vs 53.9% SD 0.03) were similar, but use of vascular imaging increased (74.8% vs 84.3% SD 0.24). Readmission for stroke was stable (3.9% vs 4.0%, aHR 1.00 [0.89, 1.13]), but 90-day death was higher post- compared to pre-telemedicine (2.8% vs 3.6%, aHR 1.19 [1.05, 1.36]).

Conclusion:
Telemedicine is a promising tool to support routine stroke prevention care. The higher mortality must be interpreted in the context of the COVID19 pandemic. Ongoing monitoring of stroke outcomes is needed.
Abstract WP73: Impact Of Patient Age On Sex Disparities In Intravenous Alteplase Administration For Acute Ischemic Stroke
Authors: de Havenon Adam H , Yaghi Shadi , Wong Ka-ho , Arkin Cameron , Johnston Karen C
Published: February 2022

Background:
Prior research with the National Inpatient Sample (NIS) has shown that women are less likely than men to receive to receive intravenous Alteplase (tPA) for acute ischemic stroke, but more recent analyses have found conflicting results and patient age has not been taken into account, nor has stroke severity.

Methods:
We included patients in the NIS from 2016-18 with a primary discharge diagnosis of ischemic stroke and who had an admission NIH Stroke Scale (NIHSS). The primary outcome was receipt of tPA and the exposure was patient sex. After survey weighting, we fit logistic regression models adjusted for age, race/ethnicity, NIHSS, patient income by ZIP code, hospital teaching status, hospital Census region, and hospital location according to the NCHS Urban-Rural Classification. We included interactions between our covariates and the exposure of sex.

Results:
After weighting, we included 384,700 patients, of which 15.1% received tPA and 49.1% were female. The rate of tPA was identical (15.1%) between male and female patients (p=0.880). In the multivariable logistic regression model, female sex had an odds ratio for tPA of 0.97 (95% CI 0.93, 1.01, p=0.163). The only covariate that had a significant interaction with sex was age (p<0.001 for interaction). After stratification, female patients aged ≥75 were 1.5% (95% CI -2.3, -0.7, p<0.001) less likely than men to receive tPA (Figure 1).

Conclusion:
In the most recent sample of the NIS, women with acute ischemic stroke are no longer less likely than men to receive tPA. We show this holds true after adjustment for stroke severity, although there is still a disparity in older patients aged ≥75, with women being 1.5% less likely than men to receive tPA.
Abstract WP78: National Institutes Of Health Stroke Scale Correlates Well With Initial Intracerebral Hemorrhage Volume
Authors: Farooq Salman , Shkirkova Kristina , Villablanca Pablo , Sanossian Nerses , Liebeskind David S , Starkman Sidney , Avila Gilda , Sharma Latisha K , Kim-Tenser May A , Eckstein Marc , Krasuski Richard A , Hamilton Scott , Saver Jeffrey L
Published: February 2022

Introduction:
The US Centers for Medicare and Medicaid Services (CMS) currently publicly reports hospital-quality, risk-adjusted mortality measure for ischemic stroke but not intracerebral hemorrhage (ICH). The NIHSS, which is captured in CMS administrative claims data, is a candidate metric for use in ICH risk adjustment and has been shown to predict clinical outcome with accuracy similar to the ICH Score. Correlation between early NIHSS and initial ICH volume would further support use of the NIHSS for ICH risk adjustment.

Methods:
Among consecutive ICH patients enrolled in a large multicenter trial (FAST-MAG), the relation between early NIHSS and early ICH volume was assessed with correlation and linear trend analysis, in all patients and separately in; left vs right; IVH-positive vs IVH-negative, hyperacute (≤60min) vs acute (61-120min) imaging; men vs women; and younger (<65y) vs older (≥65y).

Results:
Among 372 patients with ICH, age was 65y (SD 13), 67% were men, early NIHSS was 16 (IQR 9-25) and initial ICH volume was 14.9 cc (IQR 6.1-36.4). Overall, there was substantial correlation between NIHSS and ICH volume, r=0.77 (p<0.001), and for every 10cc increase in ICH the NIHSS increased by 4.5 points. Correlations remained substantial and similar in all subgroups (Table), but magnitude of NIHSS change with ICH volume alteration varied, including greater NIHSS change with ICH unit volume increase in left than right hemisphere, absence of IVH, earlier (≤60min) than later presentation (61-120min), men than women, and younger than older patients (Table).

Conclusion:
Early NIHSS deficit severity values correlate strongly with initial ICH hematoma volume. As with ischemic stroke, lesion volume increases produce greater NIHSS changes in the left than right hemisphere, reflecting greater NIHSS sensitivity to left hemisphere function. These findings provide further support for the use of the NIHSS in risk-adjusted mortality measures for intracerebral hemorrhage.
Abstract WP82: Early Readmissions After Hospitalization For Posterior Reversible Encephalopathy Syndrome
Authors: Garg Aayushi
Published: February 2022

Background:
While most patients with posterior reversible encephalopathy syndrome (PRES) have clinical and radiological reversibility, a significant proportion can have residual neurologic sequelae and longstanding morbidity. The aim of the study was to evaluate the rate, etiologies, and risk factors for 90-day readmissions following hospitalization for PRES.

Methods:
Data were obtained from the Nationwide Readmissions Database 2016-2018. Hospitalizations with primary diagnosis of PRES, survival to discharge, and known discharge disposition were included in the study. Primary outcome was non-elective readmission within 90 days of discharge. Survival analysis was performed, and independent predictors of readmission were analyzed using multivariable Cox proportional hazards regression. P<0.01 was considered significant.

Results:
There were 6,155 hospitalizations that met the study inclusion criteria (mean±SD age: 55.9±17.3 years, female: 71.0%). Non-elective readmission within 90 days of discharge occurred in 1,922 (31.2%) patients. The most common reasons for readmissions were infections (20.0%), hypertensive disorders (12.4%), fluid/electrolyte imbalance or renal problems (8.8%), gastrointestinal problems (7.2%), continued/recurrent symptoms related to PRES (6.3%), cardiac problems (5.5%), seizures (4.6%), and acute cerebrovascular events (4.4%). Age was inversely associated with risk of readmissions [hazards ratio (HR): 0.91 for every 10 years increase in age, 95% confidence interval (CI): 0.87-0.95,
P
<0.001]. Patients with chronic kidney disease (HR: 1.24, 95% CI: 1.06-1.46,
P
0.009) and higher Charlson comorbidity index score (HR: 1.10, 95% CI: 1.07-1.14,
P
<0.001) were more likely to be readmitted. Further, patients with longer length of stay (HR: 1.01, 95% CI: 1.00-1.02,
P
0.002) and those not discharged to home (HR: 1.35, 95% CI: 1.16-1.58,
P
<0.001) during the index hospitalizations were also at a higher risk for readmission.

Conclusions:
Nearly one-third of patients with PRES get readmitted within 90 days of discharge. While most of the readmissions are due to non-neurologic etiologies, ongoing symptoms related to PRES, seizures, and acute cerebrovascular events contribute to about 15% of all readmissions.
Abstract WP83: The Challenges Of Stroke Prevention Following Intracerebral Haemorrhage; A Qualitative Study Exploring Physicians’ Decision Making.
Authors: Ivany Elena , Lotto Robyn R , Lip Gregory Y , Lane Deirdre A ,   on behalf of the PRESTIGE-AF consortium.
Published: February 2022

Introduction:
Initiating long-term oral anticoagulation (OAC) therapy in intracerebral haemorrhage (ICH) survivors who have atrial fibrillation (AF) has clinical equipoise for stroke physicians internationally, given the lack of clinical trial evidence. Understanding how physicians make decisions about stroke prevention in these patients will support and improve current decision-making practice and inform future guidelines.

Aim:
To explore physicians’ decision-making around prescription of long-term OAC for stroke prevention in patients with AF following an ICH.

Methods:
Qualitative sub-study of the PREvention of STroke in Intracerebral haemorrhaGE survivors with Atrial Fibrillation (PRESTIGE-AF) trial [NCT NCT03996772]. Semi-structured interviews with data analysed using Framework analysis.

Results:
Twenty stroke physicians (women n = 6 (30%), consultant in stroke medicine n =10, head of stroke department n = 6, geriatrician working in stroke n = 2, residents in neurology n = 2) across five European countries (Spain, France, Germany, Austria, UK) participated. The overarching theme ‘Managing Uncertainty’ highlights the difficulties faced by physicians. It draws together three sub-themes: ‘Computing the risks’, focusing on how physicians weigh-up the risks and benefits of long-term OAC; ‘The patient perspective’, which considers patients’ experiences and preferences; ‘Making the decision together’, which focuses on issues of communication between physicians and patients.

Conclusion:
The need to balance risks/benefits in the absence of data from randomised controlled trials and the uncertainty surrounding long-term outcomes of OAC were key challenges for physicians. Physicians rely on past personal clinical experience and collegiate advice to aid decision making. Physicians strive to ensure that patients understand the decision-making process. Future practice should support physicians in communicating clinical uncertainty to patients and encourage patients and physicians to work together to understand individual patients’ needs.
Funding:
This project has received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 754517.
Abstract WP85: Provider Perspectives On Stroke Treatment In Nebraska: Urban Vs. Rural Disparities
Authors: Jones Olivia N , Malina Beth L , Myers Gary , BOBENHOUSE James A , BELDIN HANNE , Thorell William E , Gonzalez Castellon Marco , SIMMONS JENNIFER , Hook Mary Ellen , Stout Pamela , Marquiss Courtney , Wharton Michael , Palmer Pamela , Cooks Nichole A , Franco David , Gregath Trevor , Hubbard Rebecca , Orr Chastity , Bene Elizabeth , Hammond Jen
Published: February 2022

Introduction:
Mission: Lifeline Stroke Nebraska (NE) is a four-year project which aims to improve stroke systems of care within the state through various interventions, including education of healthcare providers. Timely in-hospital treatment of stroke patients is key to reducing death and disability in stroke patients.

Methods:
An anonymous survey was administered to physicians and advanced practice providers that work in the ED at NE hospitals to assess the comfort/confidence level in administering IV thrombolytics and to learn more about the reasons for giving (and not giving) IV thrombolytics in various scenarios, including when an ischemic stroke is mild (NIHSS <4). A total of 110 providers completed the survey between February and April of 2021.

Results:
Critical Access Hospital (CAH) providers represented 70% of respondents. Only 50% of providers at certified centers and 29% at CAHs feel comfortable/confident in giving IV thrombolytics to ischemic stroke patients before consulting another provider. After consulting another clinician, this percentage increases to 89.7% in CAH providers but does not change in certified center providers. Overall, only 26.5% of certified center providers and 21.8% of CAH providers stated they are likely to give IV thrombolytic to a mild ischemic stroke patient. Certified center providers indicated that improved feedback on patient outcomes post IV thrombolytic therapy (41.2%) is the top item that would increase their comfort/confidence with administering IV thrombolytic. Qualitative feedback from certified center providers also shows there is hesitancy in administering IV thrombolytics to stroke patients and a desire to see more research showing the benefits. CAH providers identified access to telestroke (78.2%) and annual stroke education including updated guidelines on IV thrombolytic administration (66.7%) as the top items that would increase their comfort/confidence.

Conclusions:
These results indicate there is hesitancy to use IV thrombolytics to treat mild ischemic stroke patients and a need for more telestroke/neurology consultation options for providers in CAHs. From these conclusions, Mission: Lifeline is catering educational opportunities to the needs of rural and urban providers in NE
Abstract WP9: Iv Tpa For Acute Ischemic Stroke In The Setting Of Intracranial Tumor: A Systematic Review
Authors: Moran Caitlin E , Rubin Mark N
Published: February 2022

Objective:
Intracranial tumor is considered a contraindication to IV tPA for presumed acute ischemic stroke (AIS), though evidence differentiating rate of intracranial hemorrhage (ICH) in benign versus malignant neoplasm is lacking. A systematic review of published cases of standard-dose IV tPA for AIS within 4.5 hours of symptom onset and intracranial tumor was performed.

Methods:
PubMed, Embase, and Cochrane were used to identify articles for inclusion. Case reports, letters to the editor, conference proceedings, cohort studies, case series, literature reviews, and case-control studies that included patients given standard dose IV tPA for presumed AIS within 4.5 hours of symptom onset, who were found to have an intracranial tumor, were included. The primary outcome measure was the rate of ICH.

Results:
Twenty-three studies met inclusion criteria, involving 495 patient cases. One of the included case-control studies presented data only in the form of an odds ratio (OR), with OR 0.72 (p=0.16) for risk of ICH out of 297 benign brain tumors as compared to controls. They found an OR for ICH of 2.33 (p value <0.001) in 119 malignant brain tumors as compared to controls. The remaining 22 sources included a total of 79 cases, 49 of which were classified as benign, 16 malignant, and 14 “not otherwise specified.” Of these 79 cases, ICH occurred in 4, one of which was an asymptomatic parenchymal hematoma (5.1% total ICH, 3.8% symptomatic ICH). ICH only occurred in cases of malignant or metastatic intracranial tumors. There were no reports of ICH following IV tPA in patients with a benign intracranial tumor. Meta-analysis could not be performed due to substantial heterogeneity in study design and reported patient data in included sources.

Conclusion:
There were no reports of ICH in the setting of benign intracranial tumor, and the reported rate of ICH with standard-dose IV tPA in the setting of any brain tumor appears similar to the general AIS population. There is significant heterogeneity of sources and risk of selection bias with the included studies, such that these findings are not confirmatory. Further research is needed to assess the rate of ICH with IV tPA for AIS in the setting of brain tumor.
Chinese Governance Export in Central Asia
Authors: Yau Niva
Published: February 2022

The People’s Republic of China has been actively promoting its governance styles abroad. In Central Asia, these programs have increased rapidly both in terms of their frequency and scope. This paper documents 59 in-China training programs for Central Asian officials from 2007 to 2020, the majority of which concerned security management and involved Chinese technology and equipment transfers. It is evident that Central Asian governments are adopting surveillance practices that are based on Chinese security ideology. As Central Asian states absorb these governance models, a new set of security and human rights issues is emerging.
The osce in Central Asia: Engagement, Presence, Problems
Authors: Dunay Pál
Published: February 2022

Central Asia is a region where the osce has been engaged for more than two decades, including with missions and field presences in all five participating states. This engagement reflects the hope that these countries will gradually align themselves with the values, principles and norms of the organization. The region, however, presents the following challenges. First, Central Asian states strictly adhere to state sovereignty and want to constrain the osce’s involvement in domestic affairs. Second, these states prioritize the organization’s economic and ecological dimension, and want to reduce the importance of its human rights dimension. Finally, the activity programmes of the remaining osce field presences in the region are subject to the approval of host governments.
A Sindhi Bhagat Song Associated with Kanvar Ram
Authors: Garin Jyoti
Published: February 2022

This article presents a translation from the Sindhi oral tradition of bhagat. It originates in Sindh, Pakistan. Today it is practiced by Hindu narrators in post-Partition India. The song translated in this paper focuses upon Bhagat Kanvar Ram, who contemporary bhagat narrators mention frequently. This essay exemplifies his influence on the bhagat tradition in the areas of inspiration, authority, and performance style. It offers a glimpse of the dynamics of the live performances of oral texts.
A new record and new species of Procloeon (Procloeon) Bengtsson, 1915 (Ephemeroptera: Baetidae) from the Western Ghats, peninsular India
Authors: MUTHUKATTURAJA MARIMUTHU , BALASUBRAMANIAN CHELLAIAH
Published: February 2022

A new species Procloeon (Procloeon) kottagudiensis sp. nov. is described based on larva and adult characters from a submontane stream of the Western Ghats, peninsular India. Diagnostic characters, distribution and habitat ecology of the described species are provided. Keys for the known larvae and male imagos of Oriental Procloeon (Procloeon) are provided.
A new species of Arachnopsita (Orthoptera: Grylloidea: Phalangopsidae) from caves in Guatemala
Authors: JUNTA VITOR GABRIEL PEREIRA , CASTRO-SOUZA RODRIGO ANTÔNIO , FERREIRA RODRIGO LOPES
Published: February 2022

The current work presents the description of a new species for the genus Arachnopsita Desutter-Grandcolas & Hubbell, 1993 from caves in the municipality of Raxruhá, Alta Verapaz, Guatemala. The morphology of the phallic complex was used as the main criterion for distinguishing the species. In addition, we present the additional description for Arachnopsita cavicola (Saussure, 1897) and Arachnopsita uncinata Desutter-Grandcolas, 1997 from a new analyzed material. Finally, we present some ecological remarks for all the studied species as well as a brief discussion on troglomorphic traits for the genus.
The genus Pseudocleobis Pocock, 1900 (Solifugae: Ammotrechidae) in transitional Patagonia-Monte deserts, with descriptions of two new species
Authors: IURI HERNÁN A. , IGLESIAS MÓNICA S.
Published: February 2022

Two new solifuge species of the genus Pseudocleobis (Solifugae, Arachnida) from northern Patagonia and southern Monte desert biogeographical regions are described: P. mauryi sp. nov. and P. profanus sp. nov. New records of P. huinca Maury, 1976, P. bardensis Maury, 1976 and P. solitarius Maury, 1976 are provided. The female of P. solitarius is described based on specimens from the type locality. SEM photographs, schemes of diagnostic characters, and maps of the known distributional records are provided for the five species treated here. Pseudocleobis profanus sp. nov. is closely related to P. huinca and P. bardensis, and the three species may form a species group characterized by the peculiar morphology of the male movable finger mucron and the flagellum. Ctenidia on male sternite III and IV are reported for the five species.
Influence of Rudder Deflection Angle on Airfoil Lift Characteristics Under the Effect of Synthetic Jet Actuator
Authors: Zhao Yong-Juan , Zhou Yi , Ji Kai-Xing , Zhao Xin-Yu , Shao Xuan , Chang Jian-Long
Published: February 2022

Numerical simulations of the synthetic jet actuator adopted are carried out for analyzing the influence of rudder deflection angle on airfoil lift characteristics in detail, under 3°~20° rudder deflection angles, one and two synthetic jet actuators. By comparing the lift performance
corresponding to the synthetic jet actuator and the cases without synthetic jet actuator, within the scope of this study, the application of synthetic jet actuator can improve the lift coefficient. For a single synthetic jet actuator, effectively improvement of the lift coefficient occurs,
but the lift coefficient curve fluctuates with time. When two actuators are used, different combinations of synthetic jet actuators have different promotion effects on the lift coefficient. When the phase difference of two synthetic jet actuators is 0 or π/2, the fluctuation range
of the lift coefficient behave a certain degree of reduction. Due to the controllability of the synthetic jet actuator, the synthetic jet actuator is more advisable in certain conditions to achieve better lift characteristics.
Performance Analysis of Clock Gated Coordinate Rotation Digital Computer Based Least Mean Square Filter Design for Video Processing Applications
Authors: Rachel N. Agnes Shiny , Rajakumar G.
Published: February 2022

Design of a low power FIR filter has always been an area of intense research concern. Application of Co-ordinate Rotation digital computer (CORDIC) algorithm for designing a low power FIR filter is presented in this paper. CORDIC algorithm helps in the computation of complex trigonometric
functions by using shift and adds mechanisms avoiding the need for a separate processor in hardware implementation. The challenge of noise interruption in real time video signal capturing is rejected greatly by using CORDIC LMS filter architecture. Also the area, power, and delay of the LMS
filter are reduced to a good extent because of CORDIC multipliers. When compared to the previously discussed filter techniques in various works, the proposed technique shows 21.13% reduction in delay and 90.28% decrease in leakage power. Further improvement in dynamic power savings is obtained
through clock gating technique applied to the sequential elements in the circuit, which reduces dynamic power dissipation by 70% from the previous works. The comparative study of benchmark filters with their specifications is presented with a detailed analysis of area, delay, leakage, and
dynamic power. The video processing using CORDIC LMS filter is verified with MATLAB R 2021A software. The hardware implementation of the proposed architecture is done on a SPARTAN 3E FPGA kit with Xilinx ISE design suite interface. The design is also verified for delay, area, leakage, and
dynamic power using CADENCE with GPDK 180 nm library.
Surface Modification and Carbonation Curing of Iron Tailing Based on Granulation
Authors: Meng Haining , Lu Xiaojun , Hussain Shahid , Jin Qing , Pan Ganghua , Liu Guiwu
Published: February 2022

To improve the utilization rates of iron tailing in staple building materials, we modified the surface of iron tailing on basis of the granulation technology, and studied the effects of compositions on the performance indices of recycled aggregates. Thereby, the effects of standard
curing, steam curing, and carbonation curing were studied. The iron tailing recycled aggregates after carbonation curing had compact structures, relatively low proportions of pores and microfractures, and the smallest water absorption rate. When the mass ratio of cement to iron tailing sands
was 3:4 and the pre-curing time was 28 d, the crushing index and water absorption rate of recycled coarse aggregates after 7 d of carbonation curing were 3.0% and 4.5% respectively.
Design of Fabricated Building Wall Under Nano-Magnetic Fly Ash and Its Prevention and Effect on Heavy Metal Pollution
Authors: Xiao Yanwu
Published: February 2022

This research aims to analyse the design of fabricated building wall based on nano-magnetic fly ash (N-M fly ash) and its prevention and control effect on heavy metal pollution. The fly ash is added to ferric tetrachloride reaction solution to react for different periods after pre-treated
with sodium hydroxide, and made into spherical particles. The spherical particles are magnetized with a strong magnetic field to prepare magnetic fly ash particles, and the N-M fly ash is prepared by mechanical crushing. Then, it is applied to the frame column material of the fabricated building
wall, and the heavy metal ion adsorption test is performed. Infrared characterization results show that the absorption peak of N-M fly ash at 3000 cm−1 is greater than that at 3500 cm−1. However, there is no obvious stretching vibration peak at 2000 cm−1.
The adsorption test reveals that when the reaction time is less than 60 min, the adsorption efficiency of heavy metal ions rises fast. When the reaction time is longer than 120 min, the accelerated rate of adsorption efficiency gradually decreases. The normal pressure heat capacities of fly
ash before and after magnetization and N-M fly ash are 1150 J/(Kg*k), 950 J/(Kg*k), and 800 J/(Kg*k), respectively. The coefficients of thermal expansion are 6(e−6)1/K, 15(e−6)1/K, and 9(e−6)1/K, respectively. In short, the optimal reaction time and reaction temperature for
the preparation are 120 min and 60 °C, respectively. The heat transfer effect of N-M fly ash is slow and uniform, the material foams uniformly, and it has good thermal insulation performance. Moreover, N-M fly ash has good adsorption performance for heavy metal ions, and the adsorption
performance is best when the solution pH = 5.