bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 78: Predicting Ordinal Functional Outcome at 90-Days Post Intracerebral Hemorrhage
Authors: Wing Jeffrey J , Bath Philip M , Zahuranec Darin B ,   on behalf of the VISTA collaborators
Published: January 2019

Introduction:
There is substantial variability in current estimation and communication of stroke prognosis. Existing predictive models have focused on dichotomous outcomes (e.g. functional independence or not), though other outcomes may also be of importance to patients and families. Our objective was to create an ordinal prognostic model to predict the full range of functional outcome (modified Rankin Scale (mRS)) at 90 days after intracerebral hemorrhage.

Methods:
We used anonymized data from the Virtual International Stroke Trials Archive (VISTA), comprising individuals from both clinical trials and registries. The 90-day mRS was modeled using a proportional odds model. Potential predictors were selected
a priori
from available data including age, sex, comorbidities, and initial stroke severity. The best model was chosen based on fit statistics using a stepwise selection approach, internally validated using bootstrapping procedures, and externally validated using a population-based sample of 126 ICH cases from southeast Texas.

Results:
A total of 1097 ICH cases were used in model building, with 95% from clinical trials. Cases were 63% male, with an average age of 66.7 years (SD=12.0), a median stroke severity of 13 (NIHSS) and 23% had a history of stroke. The final predictive model included 6 variables (age, sex, NIHSS, AFIB, diabetes, and prior stroke) and discriminated well between mRS scores (c-statistic=0.743), with minor optimism after bootstrap resampling (corrected c-statistic=0.740). The model yielded good discrimination in the external data set (c-statistic=0.774). Examples of model output are shown in the Figure.

Conclusions:
This calibrated, internally and externally validated ordinal prognostic model to predict the full range of 90-day functional outcome will be tested as a part of an ongoing study to develop an educational decision support tool for stroke surrogate decision makers (NCT0342764).
Abstract 82: Thrombus Migration is a Common Phenomenon With IV TPA and May Have Negative Effects on Outcome When TPA Treatment is Given Before Endovascular Thrombectomy in Proximal Occlusions
Authors: Ohara Tomoyuki , Menon Bijoy K , Al-Ajlan Fahad S , Horn MacKenzie , Al Sultan Abdulaziz S , Letteri Federica , Dey Sadanand , Evans James , Najm Mohamed , Puig Josep , Dowlatshahi Dar , Calleja Ana , Sohn Sung-Il , Ahn Seong H , Poppe Alex , Mikulik Robert , Asdaghi Negar , Field Thalia S , Jin Albert , Asil Talip , Boulanger Jean-Martin , Goyal Mayank , Hill Michael D , Almekhlafi Mohammed , Demchuk Andrew M ,   INTERRSeCT Study Investigators
Published: January 2019

Introduction:
There is interest in understanding thrombus dynamics from IV TPA prior to endovascular thrombectomy (EVT) given the possible dichotomy amongst sites of occlusion for IV TPA benefit/harm. Kaesmacher et al reported beneficial 5+% rates of early TICI
>
2a reperfusion in distal M1 or M2 MCA occlusions with IV TPA. However in more proximal occlusions this was rare; and potentially harmful worsening of perfusion seen with change of occlusion site. We aimed to examine IV TPA related thrombus dynamics including migration further across both proximal and distal occlusions in a multicenter prospective cohort study INTERRSeCT.

Methods:
Acute ischemic stroke patients with intracranial occlusion who had baseline CTA and follow-up CTA or initial run angio in INTERRSeCT and IV TPA were reviewed. We evaluated change of occlusion site (COS) and classified patients into 4 categories: Complete Recanalization (CR) of primary occlusive lesion with no remaining thrombus; definite Thrombus Migration (dTM) with primary occlusion site moved to a distal artery and occlusion site patent on baseline CTA; probable Thrombus Migration (pTM) with COS evident but initial occlusion extent not visualized; or No Change of occlusion site (NC).

Results:
A total of 462 IV TPA patients were enrolled, 41% received EVT. Median time from TPA to follow-up imaging was 133 minutes. COS was seen in 50% of cases with CR in 15% and TM in 35% (dTM 12%, pTM 23%). Distal artery occlusion and longer interval of TPA to imaging were independent predictors for COS. In 62 proximal occlusion (ICA and proximal-mid M1 MCA) patients with follow-up imaging within 60 mins after TPA (receiving EVT in 94%), any TM showed a lower rate of 90-day mRS≤2 than NC (47% vs 78%, adjusted OR 0.21, 95%CI 0.04-0.87). No CR was seen in this early group.

Conclusions:
Thrombus migration is common after IV TPA. Thrombus instability from IV TPA may worsen clinical outcome in proximal occlusions despite early EVT initiation, possibly due to migration of thrombus to distal arteries accelerating infarction or more challenging thrombectomy due to thrombus dispersion. The benefit of IV TPA prior to EVT at comprehensive stroke centers for ICA or prox-mid M1 occlusions require more study in randomized clinical trials.
Abstract 89: Effects of the Endpoint Adjudication Process on the Results of the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trial
Authors: Farrant Mary , Easton John D , Adelman Eric E , Barsan William G , Cucchiara Brett L , Elm Jordan L , Tillman Holly , Kim Anthony S , Lindblad Anne S , Palesch Yuko Y , Johnston S. C ,   POINT Investigators
Published: January 2019

Introduction:
Misclassification of outcome events can potentially lead to biased treatment effect estimates. Efforts to avoid endpoint misclassification in large-scale multicenter randomized clinical trials such as POINT have included an independent adjudication committee blinded to study treatments to standardize assessment of outcomes and reduce risk of ascertainment bias of main study endpoints. Debate continues about the scientific value of such committees and whether independent assessments improve reliability of study results, particularly when compared to the considerable time and resources consumed by the process.

Methods:
An independent adjudication committee adjudicated 467 primary and secondary efficacy outcomes and major and minor bleeding events, including the primary efficacy endpoint, a composite of new ischemic vascular events: ischemic stroke, myocardial infarction or ischemic vascular death at 90 days. The impact of the adjudicated endpoint process was studied by comparing the primary results using site-assessed endpoints versus adjudicator-assessed endpoints. Time from randomization to first endpoint of interest was calculated using the log-rank test and the hazard ratio and 95% CI were computed using a Cox proportional hazards model. Rate of agreement between site-assessed and adjudicator-assessed outcomes was also calculated. All analyses were completed according to the intention-to-treat principle.

Results:
The primary results of POINT have been published. The hazard ratios (HRs) (95% confidence interval [CI]) for clopidogrel versus aspirin therapy for the primary composite endpoint were 0.75 (0.59-0.95) for adjudicator-assessed events and 0.76 (0.60-0.95) for investigator-assessed events. Agreement between the composite endpoint for adjudicated-assessed and investigator-assessed events was 90.7%.

Conclusion:
Independent endpoint adjudication did not significantly impact estimates of the primary efficacy treatment effect in POINT compared to site-assessed endpoints. If misclassification of outcome events is infrequent, and careful site selection, study design and outcome definitions are in place, independent adjudication may have no meaningful impact on estimates of treatment effect.
Abstract TMP23: Short Term Outcomes in Patients Treated on a Mobile Stroke Unit
Authors: Kerrigan Deborah , Shimbo Daisuke , Maselli Kerri , Sheikhi Lila , Hussain M. S , Uchino Ken , Russman Andrew ,   PHAST Study Group
Published: January 2019

Introduction:
Mobile Stroke Units (MSU) allow for the administration of intravenous tissue plasminogen activator (IV tPA) to eligible patients more quickly than those treated in the emergency department (ED). We aimed to describe whether patients who received IV tPA in the MSU had better short term outcomes than those treated in the ED.

Methods:
We reviewed the medical records of patients who received IV tPA for ischemic stroke or transient ischemic attack on the MSU from 2014-2017 and in the ED from 2015-2017 at a single tertiary referral center. Outcome measures including symptom onset to treatment time, post-thrombolysis National Institute of Health Stroke Scale (NIHSS) over the first 24 hours, length of hospital stay, and disposition after discharge were compared.

Results:
Of 270 patients diagnosed with ischemic stroke or transient ischemic attack and received IV tPA, 98 were treated on the MSU and 172 were treated in the ED. Both groups had similar pre-morbid modified Rankin scores and pre-treatment NIHSS. Patients treated on the MSU received IV tPA at a median of 76 minutes from their last known well (interquartile range (IQR) 56-117), while those in the ED were treated at a median of 116.5 minutes (IQR 84.75-162) (p<0.00001). The median initial pre-treatment NIHSS of MSUtreated patients was 9.5 (IQR 6-16) while ED treated patients was 10 (IQR 5-19) (p=0.5485). The median 24 hour post-thrombolysis NIHSS for the MSU group was 4 (IQR 1-10) and that of the ED group was 5(IQR 2-13.25) (p=0.043).The median length of hospital stay for those treated in the MSU was 3 days (IQR 2-5) while that of patients treated in the ED was 5 days (IQR 3-8) (p=0.007). After discharge, 71patients treated in the MSU had a more favorable discharge disposition (home or acute rehabilitation facility vs skilled nursing facility, long term acute care facility, palliative care, or death) compared with 103 patients who received treatment in the ED (p=0.043).

Conclusion:
Patients treated with IV tPA on the MSU had a shorter symptom onset to treatment time, a shorter length of stay, were discharged with a more favorable disposition, and had a lower NIHSS 24 hours after treatment than those who received treatment in the ED indicating favorable short term outcomes.
Abstract TMP4: TICI Chronology in ARISE II: Impact of Stepwise Reperfusion in Endovascular Therapy for Acute Ischemic Stroke
Authors: Liebeskind David S , Yoo Albert J , Bozorgchami Hormozd , Ribo Marc , Jadhav Ashutosh J , Saver Jeffrey L , Mattle Heinrich P , Andersson Tommy , Zaidat Osama O ,   for the ARISE II Investigators
Published: January 2019

Background:
The severity and duration of ischemia determine the extent of injury in acute ischemic stroke (AIS). Rapid reperfusion in endovascular therapy is therefore linked with good outcomes, yet the chronology of reperfusion with subsequent device passes has not been fully explored. We tested whether the sequence of reperfusion after each interventional step or mTICI chronology, influences subsequent imaging and clinical outcomes after endovascular therapy for AIS.

Methods:
ARISE II dataset of clinical and angiography variables was analyzed to determine the relationship between sequential mTICI reperfusion scores with 90-day mRS outcomes. mTICI was scored at baseline and after each device pass. A Mantel-Haenszel chi-square p-value was calculated to measure the correlation between the total number of passes required and the mRS score at 90 days.

Results:
Core lab adjudicated mTICI scores on routine angiography injections were available in 227/227 (100%) of treated ARISE II subjects (age 68.0 ± 13.0, 54.2% women, mean baseline NIHSS 15.8 ± 5) and 90±30 day mRS scores were available for 217. The number of passes was highly correlated with mRS (p<0.001). The rate of mRS ≤ 2 at 90 days decreased with number of passes (81.3%, 71.1%, 52.1%, and 50.0% in patients with 1, 2, 3, and 4+ passes). Detailed modeling is in-process to explore the relationship between timing, number of passes, reperfusion and clinical outcome.

Conclusions:
mTICI chronology, or reperfusion at each procedural stage, varies in endovascular treatment of AIS and demonstrates an important link with outcomes.
Abstract TP1: Sex Differences in Management and Outcomes of Acute Ischemic Stroke With Large Vessel Occlusion: Sub-Analysis of RESCUE-Japan Registry 2
Authors: Uchida Kazutaka , Yoshimura Shinichi , Sakai Nobuyuki , Yamagami Hiroshi ,   RESCUE-Japan Registry 2 Investigators, Morimoto Takeshi
Published: January 2019

Background:
Several studies have shown that women have a poorer prognosis after stroke than men. However, there were scanty data on sex difference in the management and clinical outcomes of acute ischemic stroke due to large vessel occlusion.

Methods:
Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan Registry 2 in Japan registered patients with acute ischemic stroke due to large vessel occlusion who were admitted within 24 hours of onset from 2014 to 2017. We estimated the likelihood to receive endovascular therapy between the sexes. Primary outcome was good functional outcome defined by modified Rankin Scale (mRS) of 0-2 at 90 days after onset. Secondary outcome was the mortality within 90 days after onset. Adjusted odds ratio (OR) was estimated by logistic regression model accounted for potential confounders. Safety endpoints were all bleeding included intracerebral hemorrhage, recurrence of stroke within 90 days.

Results:
Among 2399 patients registered, 1087 patients were female and 1312 were male. Mean age was 80 and 73 years in female and male patients, respectively. Cardioembolic stroke consisted of 77% and 71% of female and male patients, respectively. 47.9% of female patients received the endovascular therapy compared with 57.7% in the counterparts (adjusted OR 0.69, 95%CI 0.58-0.83). Good outcome was observed in 27.3% and 44.2% the female and male patients, respectively (p<0.0001). Adjusted OR of good outcome of female relative to male was 0.79 (95%CI: 0.64-0.98). Subgroup analyses showed the female was good prognosis over 75 years old [adjusted OR 0.57 (95%CI 0.43-0.77) while not differ under 75 years old [adjusted OR 1.24 (95%CI 0.89-1.72)] (interaction p=0.0001). The mortality was 12.3% and 9.9% in female and male patients (p = 0.06), and adjusted OR was not also statistically significant.

Conclusions:
Female patients with acute cerebral large vessel occlusion has poor prognosis compared to male. Female patients were less likely to receive endovascular therapy than male but such lower utilization of endovascular therapy accounted for a part of poor prognosis in female patients. The causes of poor prognosis in female patients should be attested in addition to the improved access to endovascular therapy in female.
Abstract TP420: Clinical and Imaging Characteristics in Noac-Related Intracerebral Hemorrhage
Authors: Gerner Stefan T , Kuramatsu Joji B , Schwab Stefan , Huttner Hagen B ,   RETRACE II Study Group
Published: January 2019

Importance:
Given recent studies that provided controversial results it is intensely debated whether clinical and imaging characteristics, as well as functional outcome, differ among patients with intracerebral hemorrhage (ICH) related to vitamin K antagonists(VKA) versus non-vitamin K antagonist oral anticoagulant (NOAC) related ICH.

Methods:
This retrospective cohort study analyzed individual patient data of 1,328 patients with oral anticoagulation (OAC)-associated ICH over a 5-year-period (2011-2015) at 19 Departments of Neurology across Germany (ClinicalTrials.gov Identifier: NCT03093233). We compared baseline and hematoma characteristics as well as outcome in NOAC- versus VKA-related ICH, specifically correlating NOAC-dosing regimes. Functional outcome was assessed at 3 months using the modified Rankin scale (mRS) and multiple imputation was undertaken for missing outcome data.

Results:
Overall, 190 patients with NOAC- and 1138 with VKA-related ICH were available for analyses. Despite older age and more frequent arterial hypertension in NOAC-patients, there were no relevant differences in clinical and hematoma characteristics between NOAC- and VKA-related ICH, notably baseline hematoma volume (median(IQR): NOAC 14.7(5.1-42.3)ml vs. VKA 17.3(6.0-43.0)ml; p=0.21) rate of hematoma expansion (HE) (No.(%) NOAC 46/146(31.5%) vs. VKA 262/753(34.8%); p=0.44) and proportion of patients with favorable outcome were similar (mRS 0-3 at 3 months, No. (%): NOAC 55/190(28.9%) vs. VKA 337/1138(29.6%); p=0.86). Subanalyses of different NOAC-dosing regimes (regular dose: n=96 versus reduced dose: n=65) revealed similar NOAC-plasma levels and no differences regarding initial ICH-volume, rate of HE or functional outcome among patients with NOAC at low- and high-dosing regime.

Conclusion:
Among patients with anticoagulant-related ICH, there were no significant differences between those with NOAC-related ICH compared to those with VKA-related ICH in functional outcomes at 3 months or in frequency of HE. NOAC-dosage does not seem to influence hematoma characteristics in patients with OAC-related ICH.
Abstract TP494: A Continuous Monitoring Led by a Nurse Working Group Plays a Key Role in the Improvement of Acute Ischemic Stroke Workflow-Metrics
Authors: Boursin Perrine , Sabben Candice , Dercy Burty ,   Fondation Rothschild Stroke Team, Zuber Kevin , Mazighi Mikael , Piotin Michel , Obadia Michael
Published: January 2019

Background and Purpose:
In the workflow process for the management of acute ischemic stroke (AIS) patients, time is critical to improve functional outcome. Based on the recent 2018 AHA ASA guidelines, median door-to-imaging (DTI) time should be less than 20 minutes and median door-to-needle (DTN) time for tPA administration less than 60 minutes. Our comprehensive stroke center mostly recruits suspected AIS patients following a “mother ship” approach with systematic emergency medical services pre-notification and emergency room by-pass. Based on this specific patient’s care approach, the purpose of our study was to evaluate our capacity to get with the guidelines (GWTG) and to shorten our DTN/DTI times.

Methods:
In our stroke center, the stroke alert follows a workflow including 15 time-points from call notification to cath lab access. The stroke team work during the stroke alert was evaluated, during two periods of time (oct-to-march and april-to-august) based on its capacity to comply with DTI and DTN recommended median times. Continuous improvement of the workflow was based on prospective data collection analysis and interpretation by a working group led by nurses focusing on knowledge, organization and leadership difficulties identification.

Results:
From october 2017 to august 2018, 501 stroke alerts were identified in our comprehensive stroke center. Of these, 425 (85%) cases were analyzed. A total of 81 (19%) of the suspected AIS patients received tPA, 44 (10.3%) were treated with combined tPA infusion and thrombectomy and 44 (10.3%) with thrombectomy alone. Median DTI time was 15 min (3-62), median DTN time for tPA administration was 44 min (21-87), median door-to-cath lab time was 64 min (23-140). DTI median time improved significantly between the two time-periods (15,5 (3-62), vs 15(3-50), p= 0,01). Neither DTN time nor door-to-cath lab room time changed significantly during the studied time periods.

Conclusion:
Our comprehensive stroke center fulfilled the 2018 AHA ASA guidelines for DTI and DTN times. Under the supervision of a nurse working group, shortening of DTI times could be achieved. These findings support the key role of nurses working groups focusing on knowledge and management to improve stroke alert workflow, and finally patient care.
Abstract WP218: Obesity, Burden of Cerebral Small Vessel Disease and Outcomes After Lacunar Stroke:The Secondary Prevention of Small Subcortical Strokes(SPS3) Trial
Authors: Al Momen Ghadeer , Gomez Alejandra , Gosselin-Lefebvre Stephanie , Honig Asaf Asaf , Benavente Oscar , Field Thalia ,   SPS3 investigators
Published: January 2019

Background:
Obesity is a recognized risk factor for stroke. But, it is uncertain whether obesity is related to burden of cerebral small vessel disease (CSVD). We explored burden of CSVD, stroke recurrence and mortality in obese and non-obese patients with lacunar infarcts.

Method:
Data was from the SPS3 (Secondary Prevention of Small Subcortical Strokes) trial. Participants were according to BMI categories: normal /underweight (<24.9), overweight (25.0-29.9), and obese (>30.0). Baseline MRI findings were explored with multivariable logistic regression and outcomes using multivariable Cox proportional hazards.

Results:
Compared with participants who were normal/underweight (n=691, 23%) overweight (n=1256, 42%) and obese (n=1072, 36%) participants tended to be younger, male and with a higher prevalence of vascular risk factors. Compared to obese participants, normal/underweight had a higher burden of SVD on MRI: odds were 1.40 ( 95% CI 1.15 - 1.69) for severe burden of white matter disease, 1.23 (1.01 - 1.52) for 1+ old lacunes, and, in those 1278 participants with baseline T2*-weighted gradient echo MRI, 1.64 (1.35-2.00) times as likely to have 1+ microbleeds. During a mean follow-up of 3.3 years, overweight and obese subjects also had a lower risk of stroke recurrence (HR 0.74, 95% CI 0.5-1.0 and HR 0.71, 95% CI 0.5-1.0, respectively) and death (HR 0.71 95% CI 0.5-1.0 and HR 0.61, 95% CI 0.4-0.9, respectively).

Conclusion:
In this cohort, unexpectedly, being overweight or obese was associated with less CSVD, stroke recurrence and mortality. Further research is required to elucidate the mechanisms for this relationship.
Abstract WP256: Administration of Cilostazol Clarifies the Burden Atrial Fibrillation in Non-Cardioembolic Stroke
Authors: Aoki Junya , Kimura Kazumi , Abe Koji , Uno Masaaki , Okada Yasushi , Urabe Takao , Fujimoto Shigeru , Matsuoka Hideki , Yamagata Sen , Yamagami Hiroshi , Yamamoto Yasumasa , Yonehara Toshiro , Inoue Takeshi ,   the ADS group
Published: January 2019

Introduction:
The survey of atrial fibrillation (AF) is routinely recommended in acute stroke case, even in patients without AF on admission, because the AF leads to a sever stroke. Cilostazol is often used for stroke patients without AF in Japan; however, it has the adverse events of palpitation due to the vessels dilatation by increased nitric oxide. We hypothesized that administration of cilostazol may clarify the burden AF in stroke patients without AF.

Methods:
From our prospective randomized control study, (randomized to dual antiplatelet therapy using cilostazol and aspirin or aspirin alone targeted patients for non-cardioembolic stroke [ADS]), patients assessed the presence of AF were retrospectively analyzed. Presence of AF was detected using ECG monitoring and Holter ECG. All patients were divided into the AF group and the non-AF group and imaging and laboratory findings were compared between the 2 groups. Multivariate regression analysis was conducted to evaluate the independent factors related to new AF.

Results:
1194 patients (793 [66%] men; median age [IQR] of 69 [61-77] years, NIHSS score 2 [1-4], onset-to-admission 10.8 [4.7-20.5] hours) patients were included. AF was newly detected in 41 patients (3 by ECG, 21 by the ECG monitoring and 17 by the Holter ECG) during hospitalization. Patients randomized to the combined cilostazol and aspirin therapy frequently had the AF than those to aspirin alone (29/596 [5%] vs. 12/598 [2%], p=0.007). AF group was older than the non-AF group (76 [72-82] vs. 68 [60-77] years, p<0.001). NIHSS score was similar between AF and non-AF group (5 [3-12] vs. 4 [2-6] p=0.062). Serum brain natriuretic peptide (BNP) level was higher in AF group (65.9 [31.7-145.5] vs. 25.6 [13.1-52.5] ng/ml. p<0.001). Regarding imaging findings, cardio-thoracic ratio (CTR) was elevated (p<0.001), multiple infarcts was frequent (p=0.003) and the infarcts size was larger (>1.5cm) (p<0.001) in AF group. By multivariate regression analysis, cilostazol administration was the independent factor for new AF detection (odds ratio 2.81, 95%CI: 1.30-6.09, p=0.009) adjusting for age, infarct size and number, CTR, BNP, and NIHSS score.

Conclusion:
Administration of cilostazol increases the detectability of AF in acute non-cardioembolic stroke.
Abstract WP27: Alteration in Clinical Outcome Between Discharge and Three Months After Mechanical Thrombectomy versus Medical Management in Late-Presenting Stroke Patients
Authors: Schaafsma Joanna D , Pereira Vitor M , Zhang Yanchang , Jadhav Ashutosh P , Haussen Diogo C , Budzik Ronald F , Bonafe Alain , Yavagal Dileep R , Hanel Ricardo A , Ribo Marc , Cognard Christophe , Sila Cathy A , Hassan Ameer E , Smith Wade S , Saver Jeffrey L , Liebeskind David S , Jovin Tudor G , Nogueira Raul G ,   DAWN Investigators
Published: January 2019

Background:
Mechanical thrombectomy in late-presenting stroke patients with a limited infarct core on CTP/DWI is highly effective. We aimed to evaluate the degree of disability at discharge as an indicator for functional impairment at one and three months after mechanical thrombectomy compared to medical management in these patients.

Methods:
This study concerns a post-hoc analysis of the DAWN-trial population. Patients presenting 6-24h after symptom onset of an emergent large vessel occlusion with mismatch between symptom severity and infarct size on CTP/DWI, were randomized for medical management versus mechanical thrombectomy. We assessed the change in modified Rankin score (mRS) from discharge up to three months post-stroke for DAWN-patients treated with mechanical thrombectomy compared to those randomized to medical management. Kendall’s tau test was used to evaluate the correlation between the mRS at discharge, at 30 days, and at 90 days. Mixed models were used to explore the potential difference between treatment arms in the change of utility weighted mRS over time.

Results:
Ninety-eight of 107 patients treated with mechanical thrombectomy and 89/99 controls survived at discharge and were included in the analysis. We found a strong correlation between the mRS at discharge, at 30 days, and at 90 days for both treatment arms with a tau varying from 0.52 to 0.72 for mechanical thrombectomy and 0.56 to 0.71 for medical management. All correlation coefficients were statistically significant (p < 0.0001). The utility weighted mRS after mechanical thrombectomy was consistently superior to medical management (p < 0.0001). Although there was a trend towards a stronger dispersion of the utility weighted mRS over time after mechanical thrombectomy, there was no statistically significant interaction effect between time and treatment arm (p 0.44).

Conclusion:
The treatment effect of mechanical thrombectomy occurs early and further improvement over time is similar to that of medical management. The mRS at discharge is a robust indicator for functional status at one and three months post stroke and may therefore be used as an alternative measure for clinical outcome.
Abstract WP316: Assessing the Accuracy of a Linkage Between the Michigan Emergency Medical Services Information System and the Michigan Coverdell Acute Stroke Registry
Authors: Ibrahim Ghada , Nickles Adrienne V. , Wall Samantha R. , O’Brien Suzanne L. , Scorcia-Wilson Teri , Wahl Robert , Allen Justin , Quartermus Krystal , Reeves Mathew J. , Oostema Adam
Published: January 2019

Background:
Michigan’s Ongoing Stroke Registry to Accelerate Improvement of Care (MOSAIC) supports expansion of statewide stroke systems of care. The Michigan EMS Information System (Mi-EMSIS) is a repository for EMS data developed to standardize collection, storage, sharing and analysis of data. To provide feedback to EMS providers concerning stroke patient identification, care, and outcomes, development of statewide linkage between hospital and EMS registry data is needed.

Objectives:
Develop data linkage between MOSAIC and MiEMSIS stroke data and assess completeness and accuracy of match results.

Method:
All patients transported by EMS in 2017 with an impression of stroke (i.e. suspected stroke) were linked to patients who were discharged with confirmed stroke or TIA from 33 participating MOSAIC hospitals with successful linkage defined as suspected stroke transport having confirmed stroke upon discharge. Records were deterministically matched using four variables: receiving hospital code, hospital admission date, date of birth, and sex. Additionally, performance on EMS stroke quality measures and hospital outcomes were calculated.

Results:
197 EMS agencies transported 4,580 suspected stroke patients to MOSAIC hospitals. Of the 11,352 confirmed stroke cases discharged from MOSAIC hospitals, 4,924 (43.4%) were documented to have arrived via EMS. However, only 1,287 (26.1%) cases were successfully linked to the MiEMSIS data. Of the 4,580 suspected stroke transports 1,287 (28.1%) were confirmed as acute stroke cases at discharge.

Conclusions:
A deterministic linkage between Coverdell stroke cases and EMS suspected strokes from a state EMS registry resulted in low match rates, which may imply low rates of EMS stroke recognition or high rates of match failure. Alternative linkage methods such as probabilistic matching and inclusion of all EMS transports should be explored.
Abstract WP4: Which Characteristics Determine the Decision to Proceed With Endovascular Therapy in Acute Stroke Patients: Results From an International Multidisciplinary Study
Authors: Saposnik Gustavo , Wilson Alexis , Almekhlafi Mohammad , Kashani Nima , Kunz Wolfgang , Baxter Blaise , Pillai Silaja , Campbell Bruce , Michell Peter , Fisher Urs , Rabinstein Alejandro , Yoshimura Sishini , Heo Ji Hoe , Kim BM , Cherian Matthew , Turjman Francis , Foss Mona , Hill Michael D , Menon Bijoy , Goyal Mayank ,   On behalf of the UNMAST EVT Rsch Group
Published: January 2019

Introduction:
The current management of acute ischemic stroke has changed recently with the publication of randomized trials using endovascular therapy (EVT).

Rationale/Hypothesis:
Limited information is however available on how physicians make decisions regarding patient selection for endovascular therapy (EVT) in the real-world.

Methods:
We conducted an international web-based cross-sectional survey of stroke physicians and interventionalists to assess the decision to offer EVT. Part 1 of the survey used hierarchical Bayes’ disaggregate discrete choice modelling to analyze ten pairs of patient scenarios, randomly generated from ten key patient characteristics to have respondents choose which scenario was best suited for EVT in their practice. Part 2 of the survey used mixed effects logistic regression modelling to analyze 22 randomly chosen patient scenarios, again randomly generated from several key patient and hospital level characteristics.

Results:
607 physicians [mean age of 44 (SD 8.5) years, 83.5% men, 53.6% neurologists, 28.7% neuro-interventionists, 13.3% neurosurgeons, 4.7% other], from 38 countries participated. Using disaggregate discrete choice analysis, the most influential characteristic in deciding about EVT was the extent of ischemic change (ASPECTS)/volume of infarct core (26-28% of the choice). Patient age, premorbid status, baseline NIHSS score, and occlusion location (13-15% each) were the other relevant characteristics. Using mixed effects logistic regression, baseline stroke severity (NIHSS> 15 vs. NIHSS 0-5, OR 6.7; 95% CI 4.8-9.5), ASPECTS (5-7 vs. 0-4, OR 9.4; 95% CI7.4-11.9) and occlusion location (distal M2 vs. ICA/M1, OR 012; 95% CI 0.08-0.17) were the most relevant characteristics in deciding about EVT. Time from stroke onset, sex, comorbidities, time of day (off hours vs. day time) were all less relevant in deciding about EVT in both analyses.

Conclusion:
Severity of stroke assessed clinically, and extent of brain infarction and location of thrombus assessed on imaging are the dominant characteristics that treating physicians use in the real world when deciding about EVT for patients with an acute ischemic stroke.
Abstract WP519: Ischemic Stroke Despite Oral Anticoagulant Therapy in Patients With AF - What is the Risk of Recurrence and How to Prevent Further Events?
Authors: Seiffge David J , De Marchis Gian Marco , Koga Masatoshi , Paciaroni Maurizio , Cappellari Manuel , Cappellari Manuel , Kallmünzer Bernd , Macha Kosmas , Wilson Duncan , Engelter Stefan , Werring David J ,   RAF, RAF-NOAC, CROMIS-2, NOACISP, SAMURAI, Erlangen and Verona Registry collaborators
Published: January 2019

Background:
It is unknown whether patients with atrial fibrillation (AF) having an ischemic stroke despite preventive oral anticoagulant therapy are at increased risk for further recurrent strokes and how secondary prevention should be managed.

Methods:
We conducted a pooled individual patient data analysis of 7 prospective cohort studies recruiting patients with AF and an index event (ischemic stroke or TIA). We compared patients taking oral anticoagulants (Vitamin K antagonists [VKA] or direct oral anticoagulants [DOAC]) prior to index event (OAC
prior
) with those without prior anticoagulation (OAC
naive
). We further compared those who changed the type (i.e. from VKA or DOAC or vice versa) of anticoagulation (OAC
changed
) with those who continued the same anticoagulation as secondary prevention (OAC
unchanged
). Time-to-endpoint was analysed using multivariate cox proportional hazard regression models with frailty term for study and calculating hazard ratios (HR) with corresponding 95% confidence intervals.

Results:
We included 5413 patients (median age 78years [IQR 71-84years], 5136 [96.7%] had ischemic stroke as index event, median NIHSS-on-admission 6 [IQR 2-12]). The median CHA
2
DS
2
-Vasc score was 5 (IQR4-6) and not different (p=0.103) between
prior
OAC (n=1195) and OAC
naive
(n=4119). During follow-up of 6128 patient years, 289 patients had recurrent ischemic stroke (AIS, 4.7%/year, 95%CI 4.2-5.3%).
prior
OAC was independently associated with an increased risk of AIS (HR 1.6, 95%CI 1.1-2.1, p=0.006). OAC
changed
(n=307) was not associated with decreased risk of AIS (HR 1.3, 95%CI 0.8-2.2, p=0.326) compared to OAC
unchanged
(n=585).

Conclusion:
Patients with AF who failed oral anticoagulation once are at a higher risk for further ischemic strokes although the CHA
2
DS
2
-Vasc scores did not differ between both groups.
Symbiopsocus Li (Psocoptera: Psocidae), with a new species from China
Authors: LIU LUXI , LI FASHENG , LIU ZHIQI
Published: January 2019

The genus Symbiopsocus is reviewed and S. furcatus sp. n., is described from China. The biogeography of 10 Chinese species is discussed briefly, and a distribution map provided. An updated key to the 13 world species is presented.
Description of two new species of munnopsid isopods (Crustacea: Isopoda: Asellota) from manganese nodules area of the Clarion-Clipperton Fracture Zone, Pacific Ocean
Authors: MALYUTINA MARINA V.
Published: January 2019

Two new species of deep sea asellotes of the family Munnopsidae, Rectisura slavai sp. nov. and Storthyngura yuzhmorgeo sp. nov. are described from the manganese nodules area in the Clarion-Clipperton Fracture Zone of the Pacific Ocean. The discovery of these new species allowed re-examination of the taxonomic position of two similar species, Storthyngura ? intermedia (Beddard, 1885) from the Northeastern Basin of the Pacific Ocean and Ilyarachna defecta Menzies & George, 1972 from the Peru-Chile Trench, eastern Pacific Ocean. The species are moved to the genera Rectisura Malyutina, 2003 and Storthyngura Vanhöffen, 1914, respectively. Additional composition and distribution of the species of the genera are presented.
Six new species of Prozercon Sellnick, 1943 (Acari, Mesostigmata, Zerconidae) from Greece, with remarks on the genus
Authors: UJVÁRI ZSOLT
Published: January 2019

The taxonomic histroy of the genus Prozercon Sellnick, 1943 is summarised. A diagnosis of the genus is given, with remarks on variability of certain characters. The genus Rafas Błaszak, 1979b, which was defined earlier on the basis of its divided sternal shield, is proposed as junior synonym of Prozercon, which results in the following new combinations: P. bisternalis (Błaszak, 1979b) comb. nov. and P. blaszaki (Urhan & Ayyildiz, 1996d) comb. nov. Prozercon changbaiensis Bei et al., 2002 is transferred to Mesozercon Błaszak, 1976 as Mesozercon changbaiensis (Bei et al., 2002) comb. nov., on the basis of the presence of the adgenital gland openings and ventrianal setae ZV1. Prozercon willmanni Schweizer, 1948 was synonymised earlier with a former variety of P. kochi Sellnick, 1944, but is here regarded as a valid species since there are several important characters distinguishing the two species. Prozercon masani Moraza, 2006 is proposed as junior synonym of P. cambriensis Skorupski & Luxton, 1996 since no convincing differences exist between the two species. Six new species, P. achaeanus sp. nov., P. bulbiferus sp. nov., P. dramaensis sp. nov., P. graceus sp. nov., P. morazae sp. nov. and P. norae sp. nov., are described from Greece, and P. carpathofimbriatus and P. carsticus are recorded for the first time from the country. Detailed descriptions of the female and the previously unknown deutonymph are of P. yavuzi Urhan, 1998a also presented, as the Greek specimens differ from the Turkish ones by important characters. A key to the known species of Prozercon is provided.
Species of the genus Scirtothrips from Africa (Thysanoptera, Thripidae)
Authors: MOUND LAURENCE A. , STILLER MICHAEL
Published: January 2019

A key is provided to 14 species of Scirtothrips recorded from Africa south of the Sahara, including Cape Verde Islands. S. dodonaeae sp. n. is described from Dodonaea in South Africa, and the possibility is discussed that South African populations here referred to as S. aff. dorsalis represent a new species. Type specimens of the six Scirtothrips species described by J.C.Faure have been re-examined, and brief diagnoses are provided for all 14 species.
On the taxonomic status of the Brazilian mouse Calomys anoblepas Winge, 1887 (Mammalia, Rodentia, Cricetidae)
Authors: PARDIÑAS ULYSES F. J. , TETA PABLO
Published: January 2019

We studied the holotype and only known specimen of the rodent Calomys anoblepas Winge, 1887, an enigmatic and putatively extinct pentalophodont sigmodontine found in the limestone caves of Lagoa Santa, Minas Gerais, Brazil. Comparisons with other sigmodontines suggest that anoblepas can be allocated under the genus Juliomys González, 2000 and probably represents an extinct form within it. Cranial characters that support our generic hypothesis include the combination of an interlacrymal depression behind nasals, anterior portion of interfrontal suture with incomplete fusion, zygomatic plate nearly vertical with almost nonexistent upper free border, anterior border of the mesopterygoid fossa located at the level of third molar hypoflexus, and brachyodont molars with crested coronal topography. Juliomys includes three living species of sylvan and arboreal mice endemic of the Atlantic forests. This genus is absent in contemporaneous rodent assemblage from Lagoa Santa area, suggesting different environmental conditions during Pleistocene deposition times.
Synopsis of the genus Amphicoma Latreille (Coleoptera: Glaphyridae) of Taiwan with special reference to the male genitalia
Authors: LI CHUN-LIN , WANG CHUAN-CHAN , CHEN HOU-JAY
Published: January 2019

The three Amphicoma species, including Amphicoma lalashanensis n. sp., from Taiwan are reviewed with diagnoses, descriptions, illustrations, distributional data and natural history of each species. The analysis of new sets of characters on the genital capsule, flagellum articulating to temones and basal piece extension of the male genitalia were found to be helpful in delimitating the three Amphicoma species in addition to the previously established diagnostic paramere characters. Two other undocumented character states on median lobe of the male genitalia are also discussed.
Description of a new genus and species of whitefly from Lafoensia pacari in Brazil (Hemiptera, Aleyrodidae, Aleurodicinae)
Authors: MARTIN JON H.
Published: January 2019

Costalimada brasiliensis, gen. and sp. nov. is described from Lafoensia pacari (Lythraceae) in Minas Gerais, Brazil. Its position within the Aleurodicinae is discussed, and an amendment to a previously published key to worldwide genera of Aleurodicinae is presented.
Interdecadal Indian Ocean Basin Mode Driven by Interdecadal Pacific Oscillation: A Season-Dependent Growth Mechanism
Authors: Huang Yu , Wu Bo , Li Tim , Zhou Tianjun , Liu Bo
Published: January 2019

The interdecadal variability of basinwide sea surface temperature anomalies (SSTAs) in the tropical Indian Ocean (TIO), referred to as the interdecadal Indian Ocean basin mode (ID-IOBM), is caused by remote forcing of the interdecadal Pacific oscillation (IPO), as demonstrated by the observational datasets and tropical Pacific pacemaker experiments of the Community Earth System Model (CESM). It is noted that the growth of the ID-IOBM shows a season-dependent characteristic, with a maximum tendency of mixed layer heat anomalies occurring in early boreal winter. Three factors contribute to this maximum tendency. In response to the positive IPO forcing, the eastern TIO is covered by the descending branch of the anomalous Walker circulation. Thus, the convection over the southeastern TIO is suppressed, which increases local downward shortwave radiative fluxes. Meanwhile, the equatorial easterly anomalies to the west of the suppressed convection weaken the background mean westerly and thus decrease the upward latent heat fluxes over the equatorial Indian Ocean. Third, anomalous westward Ekman currents driven by the equatorial easterly anomalies advect climatological warm water westward and thus warm the western TIO. In summer, the TIO is out of the control of the positive IPO remote forcing. The ID-IOBM gradually decays due to the Newtonian damping effect.
Cross-Sectional Study to Characterise Nicotine Dependence in Central Vietnamese Men
Authors: Kõks Gea , Tran Ha Diep Thi , Ngo Ngoc Bich Thi , Hoang Linh Nhat Nguyen , Tran Hue Minh Thi , Ngoc Thanh Cao , Phuoc Thuoc Doan , Dung Ho Xuan , Duy Binh Ho , Lättekivi Freddy , Kõks Sulev
Published: January 2019

Tobacco is legally permitted for adults, easily available, and the prevalence of smoking is high. Tobacco use is the largest preventable risk factor for human disease. To reduce smoking, many countries have introduced public policy to restrict the distribution of tobacco. The aim of this study was to analyse tobacco smoking and nicotine dependence in Central Vietnamese men around Hue and Da Nang cities. Nicotine dependence was measured using the Fagerström Test for Nicotine Dependence (FTND) score. The cohort contained total of 1822 Central Vietnamese men from Hue and Da Nang: 1453 smokers and 369 non-smokers. Individuals completed a questionnaire and factors such as smoking initiation, quitting behaviour, and success in quitting were also recorded. In the smoking group, the average amount of time in which the individual had smoked was 26.4 years. Average FTND value was 4.02, median was 4, the first quartile was 2, and the third quartile was 6. In all, 431 smokers (30%) had an FTND score of 6 or higher; an FTND score of this value is considered to equate to an individual having high nicotine dependence. Therefore, it could be noted that high nicotine dependence is very common in Central Vietnam. High nicotine dependence was significantly correlated with years of smoking. The longer the smoking period, the higher the FTND score. A high FTND score correlated with the individual being less likely to successfully quit smoking. The results of the questionnaire demonstrate that even when there is no restriction in public policy concerning the distribution of tobacco, individuals still wish to quit smoking. This study identified a high prevalence of severe nicotine dependence in Central Vietnamese men and the majority smokers wished to quit smoking. Consequently, the results of this study highlight the acute need for a specific programme to aid smokers in Central Vietnam to quit smoking.
Characterization of Pathogenic Sepsis Etiologies and Patient Profiles: A Novel Approach to Triage and Treatment
Authors: Dolin Hallie H , Papadimos Thomas J , Chen Xiaohuan , Pan Zhixing K
Published: January 2019

Pathogenic sepsis is not a monolithic condition. Three major types of sepsis exist within this category: bacterial, viral, and fungal, each with its own mechanism of action. While similar in symptoms, the etiologies and immune mechanisms of these types differ enough that a discrete patient base can be recognized for each one. Non-specific treatment, such as broad-spectrum antibiotics, without determination of sepsis origins may worsen sepsis symptoms and leads to increased morbidity and mortality in patients. However, recognition of current and historical patterns in likely patients for each sepsis type may aid in differentiation between pathogens prior to definitive blood testing. Clinicians may ultimately be able to diagnose and treat bacterial, viral, and fungal sepsis using analysis of previous patient patterns and circumstances in addition to standard care. This method is likely to decrease incidence of multidrug-resistant organisms, organ failure due to ineffective treatment, and turnaround time to the correct treatment for each sepsis patient. Ultimately, we aim to provide classification information on these patient populations and to suggest epidemiology-based screening methods that can be integrated into critical care medicine, specifically triage and treatment of sepsis.
Judicial Politics and Sentencing Decisions
Authors: Cohen Alma , Yang Crystal S.
Published: January 2019

This paper investigates whether judge political affiliation contributes to racial and gender disparities in sentencing using data on over 500,000 federal defendants linked to sentencing judge. Exploiting random case assignment, we find that Republican-appointed judges sentence black defendants to 3.0 more months than similar nonblacks and female defendants to 2.0 fewer months than similar males compared to Democratic-appointed judges, 65 percent of the baseline racial sentence gap and 17 percent of the baseline gender sentence gap, respectively. These differences cannot be explained by other judge characteristics and grow substantially larger when judges are granted more discretion. (JEL D72, J15, J16, K41, K42)
Administering intravenous therapy in patients' homes
Authors: Payne Drew
Published: January 2019

Intravenous therapy in patients' homes is a relatively new procedure in the community nursing practice. This article looks at the practicalities of administering home IV therapy from the following aspects: hand hygiene; how to adjust IV therapy practices to the home environment; care of the IV access site including appropriate dressings; identifying and reacting to problems; maintaining a safe environment when performing IV therapy in a patient's home; anaphylaxis and how to identify and manage it; and the need for training to perform home IV therapy.