bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP49: Clinical Performance Measures For Emergency Department Care For Adults With Nontraumatic Intracranial Hemorrhage
Authors: Zachrison Kori S , Goldstein Joshua N , Jauch Edward C , Radecki Ryan , Madsen Tracy , Adeoye Opeolu M , Oostema John A , Feeser Ramana , Ganti Latha , Lo Bruce M , Meurer William J , Garvin Rachel , Corral Mitra , Rothenberg Craig , Mendez-Hernandez Cindy , Finch Melissa , Goyal Pawan , Venkatesh Arjun
Published: February 2023

Study Objective:
Though select inpatient-based performance measures exist for the care of patients with nontraumatic intracranial hemorrhage (ICH), Emergency Departments (EDs) lack measurement instruments designed to support and improve care processes in the hyperacute phase. To address this, we propose a set of measures applying a syndromic (rather than diagnosis-based) approach informed by performance data from a national sample of community EDs participating in the Emergency Quality Network Stroke Initiative (E-QUAL).

Methods:
We convened a workgroup of experts in acute neurologic emergencies. The group considered the appropriate use case for each proposed measure (internal quality improvement [QI], benchmarking, or accountability) and examined data from E-QUAL-participating EDs to consider the validity and feasibility of proposed measures. The initially conceived set included 14 measure concepts of which 7 were selected for inclusion in the measure set after review of data and further deliberation. To inform the process, we collected data from E-QUAL participating EDs. EDs used a web-based portal to submit data from chart reviews on patients with ICH during 2020-2021. Descriptive statistics characterize performance and identify variation.

Results:
Proposed measures include 2 for QI, benchmarking, and accountability, 3 for QI and benchmarking and 2 for QI only (Table). Of the E-QUAL participating EDs, 35 had sufficient case volume (≥25) and were included for review of preliminary performance data. Median annual ED volume was 44,000 (IQR 31,337-67,000) and 16 (48%) reported typically transferring patients with ICH. The Table includes available performance data.

Conclusion:
Application of these measures may identify opportunities for improvement and focus QI resources on evidence-based targets. The proposed measures warrant further development and validation to support broader implementation and advance national healthcare quality goals.
Abstract WP55: Development Of Comprehensive Post-Acute Stroke Program Standards
Authors: Stein Joel , Downs Alyson , Lutz Barbara J , Hoffnung Deborah , Pietrzak Janna , Volkman Kathleen G , Weissling Kristy , Picou Kylie , Kovic Mark , Zorowitz Richard D , Bierner Samuel , Dentel Steve , Pugh Sue B , Duncan Pamela W
Published: February 2023

Introduction:
Evidence-based rehabilitation and secondary prevention interventions improve post-stroke functional recovery and reduce secondary complications. However, stroke rehabilitation expertise, processes of care, and educational resources vary among sites where post-acute care (PAC) is delivered.

Purpose:
The American Heart Association (AHA) developed quality standards based on the AHA 2016 Guidelines for Adult Stroke Rehabilitation and Recovery to address these gaps.

Methods:
An interdisciplinary PAC standards writing committee identified key areas for PAC: quality improvement, medical management, care coordination, patient/caregiver and personnel education, and program management. Subgroups developed draft standards, combining results from a national landscape survey of PAC sites with clinical practice guidelines. The committee then refined the draft standards using a consensus-based process. AHA staff and PAC sites in Montana (MT) convened a learning collaborative to gather feedback and provide gap analyses of the standards relative to current practices. Qualitative input from beta testing in MT, and quantitative results from the nationwide survey and MT sites were analyzed and used to refine the standards further.

Results:
The national landscape survey demonstrated that most sites do not meet the proposed standards: stroke program oversight structure (78% fall short), stroke rehabilitation leadership (70%), stroke-specific order sets/protocols (61%), and policies requiring staff stroke education (66%). Regarding MT findings, 41% of the PAC sites have no mechanisms to identify areas of quality improvement specific to their stroke rehabilitation programs, and 59% do not use standardized tools to ensure performance improvement initiatives are followed. However, with adequate support and resources, most MT sites stated they would be able to meet the proposed standards.

Conclusions:
The Stroke PAC Program Standards are applicable in diverse PAC settings and provide a pathway to improving access to high-quality care for stroke survivors. Outcome studies are needed to confirm anticipated improvements in medical and functional outcomes.
Abstract WP62: Skilled Nursing Facilities As A Bridge For Acute Rehabilitation In Acute Stroke Patients Who Are Not Immediate Candidates For Intensive Therapy
Authors: Dong Henry , Firestone Lisa , Shen Victor , Field Heather , Gaffney Denise , Cheng Pamela , Taleb Shayandokht , Ajani Zahra , Sangha Navdeep S
Published: February 2023

Background:
Rehabilitation after hospital discharge is an essential component of stroke recovery. However, many stroke patients are not immediately ready for an Inpatient Rehabilitation Facility (IRF) after hospital discharge because of poor endurance, weakness, cognitive status, or medical condition. The purpose of this study is to demonstrate the efficacy of skilled nursing facilities (SNF) as a bridge to improve the number of post-stroke IRF admissions, and better understand the factors that allow transfer from a SNF to IRF by assessing differences between patients who are discharged from a SNF with vs. without an IRF referral.

Methods:
We included subjects with a primary diagnosis of ischemic stroke, subarachnoid hemorrhage, or intracerebral hemorrhage who were admitted to an urban CSC and discharged to a SNF from 1/2015 to 12/2021. Baseline demographics including gender, race, age, and risk factors were abstracted. Data were retrieved from both our EMR and Get With the Guidelines Stroke Database. Wilcoxon rank sum tests and chi square tests were used to analyze the data.

Results:
1120 patients with a stroke diagnosis were discharged to a SNF, of which 173 (15%) received an IRF referral after SNF discharge. Nine to 19% (mean=15, SD=3) of SNF patients received an IRF referral between 2015 and 2021. Patients with an IRF referral were younger (mean age: 61.90, SD=14.05 vs 73.09, SD=12.12; p < 0.0001). There were no statistically significant differences in length of stay, discharge mRS, and prevalence of hypertension, diabetes mellitus, coronary artery disease, dyslipidemia, heart failure, and smoking. Men more frequently received an IRF referral (20% vs 11%, p < 0.0001). Racial differences in referral patterns were not significant (p = 0.19).

Conclusions:
SNFs are an effective bridge between the hospital and IRF settings, given that 15% of all stroke patients discharged to a SNF were ultimately referred to an IRF. SNFs should be considered as an alternate route for post-stroke patients who are not immediately ready for IRFs after hospital discharge but may still benefit from IRF therapy.
Abstract WP67: Determining The Dosage Of BCI-FES Intervention For Optimal Motor Recovery Of Stroke Survivors
Authors: Remsik Alexander B , Hosseini Thomas K , Little Oliver , Adluru Nagesh , Caldera Kristin , Nair Veena A , Prabhakaran Vivek
Published: February 2023

Brain-computer interface (BCI)-mediated functional electrical stimulation (FES) of stroke impaired upper extremity motor function has been shown to improve motor capacity but accurate dosing of BCI-FES has not been determined. This analysis seeks to determine whether participants with a greater number of FES runs realized greater change in the Stroke Impact Scale-Hand Function subdomain (SIS-hf) as a result of intervention. Participants (n = 14, 8 females, mean age = 61.3 ± 11.5 yr) in an ongoing study completed up to 30 hours of BCI-FES intervention. These participants were grouped
post hoc
into two groups, high (greater than 184 runs) and low (less than 184 runs) dosages of BCI-FES intervention. All participants underwent a series of behavioral tests at baseline and completion which included the Stroke Impact Scale-hand function (SIS-hf) domain. Group mean change in SIS-hf scores were compared using an independent samples t-test. Participants who completed 15 intervention sessions with fewer than 184 BCI-FES runs (n = 7) had a greater mean increase in SIS-hf scores (group mean difference = 2.29 ± 4.65) compared to those who completed more than 184 runs with paired FES (n = 7, group mean difference = 0.86 ± 1.68). These group mean differences as a result of intervention were not statistically significant
t
(7.54) = 0.77,
p
= 0.47. As expected, SIShf scores increased in both low-dose and high-dose groups of participants; however, the present results suggest that increasing the dose (i.e., number of runs) of BCI-FES intervention may not necessarily result in greater motor recovery in stroke participants.
Abstract WP69: Days Alive And Out Of Hospital As A Measure Of Stroke Outcome In Patients Receiving Hyperacute Stroke Intervention
Authors: Donnelly Joseph , Hong Jae Beom , Boyle Luke , Yong Vivien T , Diprose William , Campbell Douglas , Barber P A
Published: February 2023

Background:
Patient outcome after stroke is frequently assessed with the modified Rankin Scale score (mRS), which is a 7-level ordinal scale from 0 - no disability, to 6- dead that is usually obtained by in-person or telephone interviews. The mRS can be prone to bias and can have significant inter-rater variability. Days alive and out of hospital at 90 days (DAOH-90) is an objective, readily available outcome measure that accounts for survival, time spent in hospital or rehabilitation settings, re-admission, and institutionalization. We aimed to assess the criterion, construct and face validity of DAOH.

Methods:
Consecutive ischemic stroke patients treated with thrombolysis or endovascular thrombectomy were used in this analysis. DAOH-90 was calculated from the national minimum dataset, an administrative nationwide database. mRS at 90 days was assessed with in-person or telephone interviews. Simple descriptive statistics were applied (median [IQR]). The ability of DAOH-90 to distinguish between the commonly applied cut-points of mRS-90 was assessed using the area under the receiver operating curve (AUROC). The associations of DAOH-90 with commonly used stroke prognostic variables were assessed with Spearman’s correlation.

Results:
1067 ischemic stroke patients (481 male, median age 69 [58-78], median NIHSS 16 [11-20] were included in this study. Overall, median DAOH-90 was 68 [25-82] and median mRS-90 was 2 [1-4]. There was a strong association between mRS-90 and DAOH-90 (Spearman's rho correlation 0.79, p<0.001). AUROC (95% CI) for predicting mRS>0, mRS>1, mRS>2 were 0.85 (0.83-0.88), AUC 0.88 (0.86-0.90), AUC 0.90 (0.88-0.92) respectively. DAOH-90 was significantly correlated with age (spearman rho -0.37, p=0.002), admission NIHSS (spearman rho -0.37, p<0.001), Alberta stroke programme early CT score (spearman rho 0.23, p<0.001), and admission blood glucose concentration (spearman rho -0.24, p<0.001).

Conclusion:
DAOH is statistically valid outcome measure in ischemic stroke that strongly relates to mRS at 90 days. DAOH is an objective, patient-centric outcome measure that can be determined from large datasets and therefore its place in stroke research warrants further study.
Abstract WP71: Endovascular Thrombectomy With Or Without Bridging Thrombolysis In Patients With Acute Ischemic Stroke: A Cost-utility Analysis
Authors: Morsi Rami Z. , Zhang Yuan , Zhu Meng , Xie Shitong , Carrión-Penagos Julián , Desai Harsh , Tannous Elie , Kothari Sachin A , Khamis Assem , Tarabichi Ammar , Bastin Reena , Hneiny Layal , Thind Sonam , Coleman Elisheva , Brorson James R , Mendelson Scott J , Mansour Ali , Prabhakaran Shyam , Kass-Hout Tareq
Published: February 2023

Introduction:
There is clinical equipoise behind bridging intravenous thrombolysis (BT) with endovascular thrombectomy (EVT). We performed a cost-effectiveness analysis comparing BT versus EVT alone.

Methods:
We conducted a model-based cost-utility analysis comparing the cost-effectiveness of BT vs EVT only for patients with acute ischemic stroke. We used a decision tree to examine the short-term costs and outcomes at 90 days after the index stroke, and developed a Markov state transition model to assess the costs and outcomes over 1-year, 5-year, and 20-year time horizons. Clinical outcome inputs were derived from our systematic review. We considered the impact of disability and recurrent stroke on mortality risk, health-related quality of life, and costs. We estimated total and incremental cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Probabilistic analysis was used to calculate the reference case estimates.

Results:
The average costs per patient were estimated to be $55,503, $57,814, $68,183, and $84,946 for EVT only strategy, and $47,311, $49,556, $59,625, and $75,898 for BT over 90-day, 1-year, 5-year, and 20-year, respectively. The cost saving of EVT only strategy was driven by the avoided medication costs of IVT (ranging from $8,193 to $9,048). The additional thrombolytics led to slight decrease in QALY estimate during the 90-day time horizon (loss of 0.0016 QALY), but a small gain over 1-year, 5-year, and 20-year time horizons (0.0108, 0.0638, and 0.1481 QALY). With similar outcomes and less cost, the EVT only strategy was cost-effective compared with BT. Analyses with longer time horizon show lower probabilities of EVT only strategy being cost-effective. At a fixed willingness to pay threshold of $50,000, the probabilities of EVT only to be cost-effective were 100%, 100%, 99.0%, and 65.9% over 90-day, 1-year, 5-year, and 20-year time horizons. At the willingness to pay thresholds of $100,000 per QALY, the probabilities of EVT only strategy being cost-effective was 22.8% over the 20-year time horizon.

Conclusions:
Our cost-effectiveness model suggested that bridging with thrombolytics may not be cost-effective for patients with acute ischemic stroke secondary to large vessel occlusion.
Abstract WP74: Predictors Of Acute Ischemic Stroke In Young Adults With Cannabis Use Disorder: An Artificial Neural Network Analysis Using A Nationwide Cohort (2019)
Authors: Desai Rupak , Meka Gautham Gosh , Lavu Venkat Srikar , Ashfaque Mariam , Gowda Supreeth , Brereton Brian J , Chauhan Sukhjinder , Samala Venkata Vikramaditya , Puli Srikanth , Rupareliya Chintan
Published: February 2023

Background:
An increase in cannabis use disorder (CUD) has been associated with a rise in adverse cerebrovascular events in the United States. However, large-scale data on risk stratification of acute ischemic stroke (AIS) among young patients with CUD remains limited. We aim to determine predictors of AIS in the young CUD cohort using the Artificial Neural Network (ANN) model in a national cohort.

Methods:
We identified hospitalizations of young adults (18-44 years) with CUD (unweighted n=101094, weighted n=539125) using the National Inpatient Sample (2019). Later we grouped them into AIS and non-AIS cohorts. The neural network’s predictive factors were selected for AIS in CUD cohort. CUD admissions were randomly split between training (80%, n=80754) & testing datasets (20%, n=20340). Training data was used to calibrate ANN, while testing data was used to evaluate the algorithm's accuracy. We compared the frequency of incorrect prediction between training and testing data and measured the area under the curve (AUC) to determine ANN’s efficacy in predicting AIS with CUD.

Results:
The 2019 cohort consisted of a total of 539125 admissions (56.1% male, 52.9% white, 28.7% blacks, 12.4% Hispanic, 6.0% Asian or Pacific Islander) in young adults with CUD with a median age of 30 (IQR 24-36) years. The rate of AIS admissions in young CUD cohort was 0.5% (n=2535). Training data showed improved predictions with a significantly low error rate (0.5%), thereby depicting better accuracy. The normalized importance of independent predictors of AIS in the CUD cohort is displayed in
Fig. 1a
. History of PVD, prior stroke/TIA, hypertension and hyperlipidemia had the highest normalized importance. The AUC was 0.811
(Fig. 1b)
which shows an excellent ANN model for the prediction of AIS in young CUD cohort.

Conclusion:
The ANN model successfully revealed the order of prevalent independent predictors of AIS that can be utilized to screen high-risk young adults with CUD and improve outcomes.
Abstract WP75: Association Between Sleep-disordered Breathing And Post-stroke Fatigue
Authors: Becker Christopher J , Lisabeth Lynda D , Kwicklis Madeline , Shi Xu , Chervin Ronald , CASE Erin , Brown Devin
Published: February 2023

Background:
Post-stroke fatigue (PSF) is a common and often disabling symptom, the etiology of which is poorly understood. Sleep-disordered breathing (SDB) is also highly prevalent among stroke survivors. We explored the relationship between SDB and PSF over time in a bi-ethnic cohort.

Methods:
Ischemic stroke (IS) patients within the Brain Attack Surveillance in Corpus Christi (BASIC) project were identified through active and passive surveillance, and were offered home SDB screening with a well-validated cardiopulmonary sleep apnea testing device, the ApneaLink Plus. The primary exposure was the respiratory event index (REI). The primary outcome was PSF as measured by the SF-36 vitality scale (lower scores reflect greater fatigue). SDB and PSF were measured at baseline, 3, 6, and 12 months post-stroke. A linear regression model, using GEE to account for repeated measures, was used to examine the associations between REI and PSF at each time point adjusting for sociodemographics, stroke severity, depressive symptoms, pre-stroke fatigue, and comorbidities.

Results:
SDB screening and at least one PSF assessment were completed by 462 IS patients, who were 44% female, 61% Mexican American (MA), 26% non-Hispanic white, 7% Black, and 5% other race/ethnicity. Median NIHSS was 2 (IQR: 1-4). Multivariable regression model results are presented in the Table. Higher REI at 3 months was associated with greater PSF at 3 months (β= -1.87, 95%CI -3.47, -0.27), but there was no association between REI and PSF at 6 or 12 months. Across timepoints, female sex, depressive symptoms at time of assessment, pre-stroke medication for depression, higher levels of pre-stroke fatigue, and vascular risk factor burden were associated with greater PSF, whereas MA ethnicity was associated with less PSF.

Conclusions:
Higher REI was associated with greater PSF in the early post-stroke period, but no association was observed at 6 months and beyond. MA ethnicity seems to be protective against PSF.
Abstract WP76: Death Rate And Risk Factors For Stroke Patients
Authors: Taneja Kamil , Patel Karan , Diaz Michael , Ladehoff Lauren , Batchu Sai , Zhang Alex
Published: February 2023

Introduction:
Stroke is a major contributor to emergency department (ED) cases and human mortality in the US. However, the annual trend in death rate and death risk factors in stroke has not been rigorously studied.

Methods:
We conducted a retrospective analysis of the Nationwide Emergency Department sample (NEDS). We analyzed incidence and death rate of stroke patients from 2006 to 2019. We used a multivariate logistic regression that included patient characteristics (e.g. age, Charlson Comorbidity Index, medication use) as covariates to identify death risk factors.

Results:
In this study time-period, 2,998,237 patients presented to the ED with a primary stroke. Stroke incidence increased by 39% from 1358 ± 56 to 1883 ± 69 per million US population (p<0.001) (Figure 1A). Total death rate decreased from 8.8% to 5.5% (p<0.001) (Figure 1B). This trend was mirrored in the admitted patients (9.7% to 6.8%, p<0.001) and non-admitted patients (1.71% to 0.65%, p<0.001) (Figure 1B). Death risk factors are displayed in Figure 2. Interestingly, being from the highest income quartile (OR: 1.15 ± 0.03, p<0.001) and a female (OR: 1.08 ± 0.02, p<0.001) are related to a higher risk of death. Interestingly, paying with private insurance is related with a lower risk of death (OR: 0.81 ± 0.03, p<0.001).

Conclusion:
In contrast to the increasing rise in stroke incidence, death rate is decreasing in both admitted and non-admitted patients. Furthermore, age, sex, and insurance status are related to a higher risk of death.
Abstract WP79: Addition Of Multidisciplinary Novel Processes Reduces The Door-to-Needle Time In Acute Ischemic Stroke
Authors: Paolucci Gino , Harmon Melissa , Madsen Tracy , Jayaraman Mahesh , Furie Karen L , Thornsbury Alyssa , Sarafin Jo-Ann M , Yaghi Shadi
Published: February 2023

Introduction:
It is well established that reduced door-to-needle (DTN) time leads to improved outcomes in acute ischemic stroke. Rhode Island Hospital is a Comprehensive Stroke Center focused on improving outcomes by seeking novel methods to improve the DTN to below the institutional goal of a median of < 30 minutes.

Methods:
We sought to reduce DTN time by the following methods: 1) Addition of an electronic DTN Timer appearing in the Electronic Medical Record (EMR) to improve situational awareness of elapsed time in Code Strokes in real time (Figure). 2) Creation of a multidisciplinary Thrombolysis Focus Group to analyze data and improve processes. 3) Increased awareness of metric exclusion criteria and ease of processes for providers to document exclusions. 4) Concurrent review of each thrombolysis case with direct provider feedback and opportunity to appropriately document and clarify delays. 5) Creation of a thrombolysis Time-Out process.

Results:
The median DTN for the pre-implementation period of January 2020 to August 2021 was 40.3 minutes compared to 35.8 min for the post-implantation period of September 2021 to June 2022. Additionally, the percent of thrombolysis cases meeting the institutional goal of under 30 minutes improved from 22.6% to 29.8% percent (Figure) and when exclusions were applied, this percentage improved from 29.8% to 49.4% (Figure).

Conclusion:
Novel measures to reduce the DTN time in acute stroke thrombolysis can positively impact both the door-to-needle time and percent of cases under the institutional DTN time goal.

Figure 1.
Abstract WP82: Racial Disparities Affecting Hospitalization For Acute Ischemic Stroke: A National Inpatient Sample Analysis
Authors: Nanavaty Dhairya , Sanghvi Ankushi , Thakre Anuj , Singh Sohrab , Devarakonda Pradeep Kumar , Manoharan Suganya , Bhavsar dishang , Ayala- Rodriguez Cesar , Reddy Sarath
Published: February 2023

Introduction:
Stroke affects more than 795000 individuals annually, of which 87% are ischemic. We aimed to determine the socioeconomic and racial disparities in this prevalent cerebrovascular disease.

Methodology:
The Nationwide Inpatient Sample was queried for 2017 to identify patients with a primary or secondary diagnosis of acute ischemic stroke. Demographics were analyzed after stratifying the population by race. Multivariate regression analysis was performed taking disposition, total hospital charges and length of stay (LOS) as outcomes of interest.

Results:
A total of 519904 ischemic stroke patients were included in the study of which 66.3% were white, 16.8% black, 7.9% hispanic and 8.9% in the other race category. Blacks (50.39%) and hispanics (43.43%) were significantly younger (<65 years) compared to whites (27.74%). Blacks (54.9%) and hispanics (38.4%) were significantly present in the lowest national household income quartile compared to whites (25.2%). In adjusted analysis, blacks (aOR-1.37; p<0.001), hispanics (aOR-1.20; p<0.001) and others (aOR-1.26; p<0.001) had a higher odds of increased LOS (>7days) as compared to whites. Hispanics had 9% (p<0.001) lower odds whereas blacks had 30% higher odds (p<0.001) of being discharged to short-term hospital/skilled nursing facility (SNF) compared to their white counterparts. Blacks, hispanics and others were found to have considerably higher hospital charges compared to whites(table 2).

Conclusion:
Increased LOS, greater distribution in lowest quartile of income and higher total charges for blacks and hispanics compared to whites indicates continued prevalence of racial and socioeconomic disparities.
Abstract WP84: Optimizing Longitudinal Follow Up For Outcomes Research Among Patients With Intracerebral Hemorrhage
Authors: Kelly Hannah , Johnson Carnayla , Baig Eman , Jefferson Imory , Adegbindin Sofiat , Khan Osman , Nair Rejani R , Britz Gavin W , Vahidy Farhaan , Tannous Jonika
Published: February 2023

Intro:
To address gaps in intracerebral hemorrhage (ICH) outcomes, acquisition of long-term data is necessary and resource intensive. We present our experience from follow-up of ICH patients across a 7-hospital certified stroke healthcare system.

Methods:
From 01/21 to 07/22, follow-up calls were made to adult non-traumatic ICH patients at 30, 90, 180, and 365-day timepoints (TP) post discharge. Consent was obtained at first successful contact, followed by collection of functional, cognitive, and quality of life outcomes. Trained research staff made multiple attempts (calls per patient) to complete assessment at each TP. An attempt was deemed successful if contact was made with a patient/proxy. We report overall and TP-specific rates of successful contact, consent, and completion using logistic regression. We also report the association of individual call success with attempt number and day of week.

Results:
Overall, 2,214 call attempts were made for 375 patients, of whom 246 (70.7%) were successfully contacted at least once. Of contacted, 173 (70.3%) consented, and 147 consented patients (85.0%) completed all assessments at one or more TPs (Fig A). Proportion of successful contact at 365-day (60.7%) was significantly higher compared to other TPs (Fig B). Consent rate was non-significantly higher for 30 and 90-day TPs (74.4%) compared to 180 and 365-day (68.1%). Conversely, patients were significantly less likely to complete assessments at the first three TPs compared to 365-day. For individual call attempts, first attempts were 1.5-2.4 times more likely to be successful than subsequent attempts, and calls made on Thursdays were 42-52% more likely to be successful.

Conclusion:
We demonstrate the need to consent patients early in their recovery when they are likely most motivated. As completion rates were lower at early vs. late TPs, we recommend curtailing laborious assessments at early TPs to decrease patient burden and continuing longitudinal follow-up.
Abstract WP85: Stroke Prevalence In Arkansas's Delta
Authors: Brown Aliza T , Savage Brittany , Wells Erin , Berry Lori , Joiner Renee , Porter Austin , Onteddu Sanjeeva Reddy , Nalleballe krishna
Published: February 2023

Background:
Telestroke hospitals in the southern Arkansas Delta participating in the American Heart Associations (AHA) Get With the Guidelines® (GWTG) are challenged with medically disadvantaged, vulnerable patient populations. The Delta is largely rural with a poverty rate higher than the US National average and residents suffer a 10 year lower life expectancy of when compared to neighboring northern counties. To determine the Delta’s influence on stroke recognition and outcomes, we examined 3-digit zip code, age at stroke occurrence, race, transport mode to diagnosing hospital, patient disposition at discharge, and stroke type in calendar years (CY) 2019 to 2021.

Methods:
We retrospectively reviewed the AHA GWTG Stroke data for the University of Arkansas for Medical Sciences (UAMS) Institute for Digital Health & Innovation (IDHI) - Telestroke Program 2019 to 2021, from 47 of the Programs 58 participating hospital sites. Transport mode included transfers from other hospitals, emergency medical services (EMS) transport, or privately owned vehicle/taxi (POV). Patient age significance was determined using ANOVA and categorical differences with chi square analysis.

Results:
Data totals were 13,721 entries with 4,571, 4,478 and 4,672 entries by CY. Ages at stroke onset were among the lowest in the zip codes from Delta areas with a median age of 66 compared to the median age of 69 for Arkansas as a whole. Percentages of stroke among Black or African Americans were the highest in Delta areas in all CYs p=0.002, p<0.0001 and p<0.0001, respectively. Patient disposition at discharge with increased discharges home vs. hospice was significant by race at all CY’s p=0.01; =0.017; =0.012, respectively. Black or African Americans had an increased %death vs. Whites in 2021, 3.7% vs. 2.8%, respectively. Transport mode was significant in 2021 with increased percentages of EMS transport of ischemic and hemorrhagic strokes and increased POV transport of transient ischemic attacks (< 24 hours) TIAs X
2
=535; p<0.0001. Delta regions experienced a higher percentage of TIAs and ischemic strokes X
2
=836; p<0.0001.

Conclusions:
Delta areas remain at risk for increased stroke mortality for Black or African Americans and younger populations.
Abstract WP93: Academic Vascular Neurology - Lingering Effect Of Gender Inequity On Compensation, Career And Burnout
Authors: Grewal Parneet , Lindstrom Sasha Alick , He Annie , Zheng Cynthia , Patel Sima , Nobleza Christa O
Published: February 2023

Introduction:
Despite rising numbers of women physicians in medical schools and the workforce, gender inequity persist. This cumulates in disempowerment, burnout, limited career advancement and devaluation of women. The aim of this study was to explore the disparity among academic vascular neurologists in terms of compensation, career development and burn-out.

Methods:
A total of 19 academic neurology departments in the United States were sent a survey in 2021-2022 on demographics, career, compensation, equity, and burnout. There were 425 academic neurology faculty members who responded. This study analyzed the cohort of academic vascular neurology (AVN) faculty.

Results:
A total 47 AVN faculty were included, of which 62% (29) were women. Majority of the respondents were Caucasian (68%, n=32) and were instructors or assistant professors (55%, n=26). Among the AVN faculty, only 51% (n=24) were satisfied with their current compensation. Majority of those who were satisfied were men (54%, n=13). Majority of those who were dissatisfied were women (75%, n=15). The most common reason for dissatisfaction was compensation being below national benchmark or compared to colleagues. 59.5% of AVN faculty members, majority of whom are females, perceived lack of gender equity in pay. Implicit gender bias was reported to have a negative effect on career development by 23% of AVN faculty. Moderate to severe burn out was reported by 26% (n=12) AVN faculty, among which majority (75%, n=9) were females. Those who reported burnout have been AVN faculty for 5.9±3.3 years. Half of those who reported burn out was dissatisfied with compensation and have felt that gender bias affected their careers, while 67% indicated absence of career sponsorship and 42% had no mentorship.

Conclusions:
This study described specific disparities in compensation, burn-out and career development among academic vascular neurology faculty. This information offers preliminary information for academic vascular neurology programs to explore areas of improvement when it comes to AVN faculty pipeline development, recruitment and retention as it aligns with DEI efforts. Future studies should be done to explore how interventions can improve the disparities noted.
Abstract WP99: Impact Of Venous Delay Evaluated Before And After Mechanical Thrombectomy On Stroke Outcome
Authors: Zangana Lara , Valls Adrian , Munuera Josep , Werner Mariano , Remollo Sebastiàn , Dorado Laura , Serena Joaquin , Puig Josep , Perez de la Ossa Natalia , Gomis Meritxell , Bustamante Alejandro , Pina Belen F. , Castaño Carlos , Muñoz Lucia , Palomeras Ernest , Massuet Anna , Terceño Mikel , Davalos Antonio , Millan Monica , Hernandez-Perez Maria
Published: February 2023

Introduction:
We aimed to evaluate venous delay before and after treatment as a marker of radiological and clinical outcome in stroke patients receiving endovascular treatment (EVT).

Methods:
Prospective cohort of patients with anterior intracranial occlusion undergoing EVT. Brain MRI was performed on arrival (pre-EVT), <2h after EVT (post-EVT), and 5 days after stroke. Final infarct volume was segmented on DWI at 5 days. We evaluated the veins of Labbé, Trolard and the superficial middle cerebral vein at both hemispheres on the dynamic MR angiography (dmRA) pre-EVT and post-EVT. For each vein we calculated a standardized venous delay measure:[(time to maximum venous contrast filling in the healthy hemisphere-time to maximum venous contrast filling in the affected hemisphere)/time to maximum venous contrast filling in the healthy hemisphere]x100. We defined venous delay as the value of the most delayed vein in each patient. We assessed the association between venous delay pre-EVT and post-EVT and final infarct volume and modified Rankin Scale (mRS) at 90 days, using multivariable regressions adjusted by successful reperfusion (mTICI≥2b) and other relevant variables.

Results:
From 98 included patients (median NIHSS 17, final mTICI≥2b 86%), 89 pre-EVT dMRIs and 88 post-EVT dMRIs were evaluable. The median venous delay pre-EVT and post-EVT were -31.9[-58.1;-16.7]% and -13.5[-34.5;-7.5]%, respectively. Venous delay pre-EVT was not related to infarct volume or clinical outcome. When final mTICI≥2B, venous asymmetry decreased but still persisted. For each 10% of increment in venous delay post-EVT, there was an adjusted increase of 0.12[0.05-0.19]ml in the final infarct volume. Venous delay post-EVT was independently associated with mRS at 90 days (cOR 1.013 [95%CI 1.001-1.0256]).

Conclusion:
Cortical vein delay assessed after but not before EVT, is associated with a larger final infarct volume and with a worse clinical outcome.
False positive result of human chorionic gonadotropin caused by human anti-mouse antibodies
Authors: Šolcová Marie , Trefil Ladislav , Rajdl Daniel , Potočová Ivana , Racek Jaroslav
Published: February 2023

Immunochemical reactions are fast, can be automated, and generally do not require pretreatment of biological material. Based on these advantages, they are widely used. On the other hand, they are susceptible to analytical interference that can lead to inaccurate results. These factors include the presence of anti-mouse antibodies, causing false positive (or sometimes false negative) results. Although the anti-mouse antibodies over many decades have been repeatedly identified to be the causative source but due to the rarity of such encounters they remain insufficiently considered. Here we show a case, a 45 year-old female who was mis-diagnosed with pregnancy due to falsely elevated human chorionic gonadotropin (hCG) due to anti-mouse antibodies. This led to the patient undergoing two ultrasound examinations and laparoscopy before the hCG was repeated on alternative assays which showed negative results, preventing the patient from methotrexate treatment. Here we describe the details of the case, outline the assay principal, supporting the finding from literature and outlining a process on how to identify such interferences in timely manner.
Dynamic Computer-Aided Orchestration in Practice with Orchidea
Authors: Cella Carmine-Emanuele , Ghisi Daniele , Maresz Yan , Petrolati Alessandro , Teiller Alexandre , Esling Philippe
Published: February 2023

The problem of target-based computer-aided orchestration is a recurring topic in the contemporary music community. Because of its complexity, computer-aided orchestration remains a partially unsolved problem and several systems have been developed in the last twenty years. This article presents a practical overview of the recently introduced Orchidea framework for dynamic computer-aided target-based orchestration. Orchidea continues the line of tools dedicated to the subject (the so-called Orchid* family) originally developed at the Institut de Recherche et Coordination Acoustique/Musique in Paris. Unlike its predecessors, Orchidea uses a combination of optimization techniques that include stochastic matching pursuit, long short-term memory neural networks, and monoobjective evolutionary optimization, with a specifically designed cost function. Symbolic constraints can be integrated in the cost function, and temporally evolving sounds are handled by segmenting them into a set of static targets optimized jointly and then connected. Orchidea is deployed in three different ways: a standalone application, designed to streamline a simplified compositional workflow; a Max package, targeted at composers willing to connect target-based orchestration to the more general area of computer-aided composition; and a set of command-line tools, mostly intended for research purposes and batch processing. The main aim of this article is to present an overview of such software systems and show several instances of the Orchidea framework's application in recent musical productions, tracing the path for future research on the subject.
WHAT ARE KIDS DOING ONLINE? EVIDENCE FROM STUDIES ON ADOLESCENTS’ DIGITAL PRACTICES
Authors: Sysoeva Tatiana A. , Yaroshevskaya Svetlana V.
Published: February 2023

Background. Th e use of digital devices and the Internet is an integral feature of modern everyday life, making children’s developmental situation “digitalized”. Th ere are not many papers on the specifi cs, types and content of digital practices of schoolchildren, and questions about what and why children do online are oft en replaced by questions about how this “something” is related to diff erent characteristics of well-being or cognitive and personality traits. Objective. To review recent studies that focus on the practices of schoolchildren in diff erent digital environments and to analyze them in terms of both results and approaches. Methods. Review of the literature on the varieties of digital practices of modern-day schoolchildren. Articles on schoolchildren’ digital and online practices were selected from Scopus database using publication date range (2016 — 2021) and keywords, such as “digital/online behaviour/practices”, “schoolchildren/ adolescents” etc. Th e initial selection was complemented by articles from key psychology and education journals in Russian from the same time span and also by relevant articles cited in the selected literature. Results. When considering the ratio of online and offl ine activities in the life of modern schoolchildren, two main ideas stand out: combining online and offl ine environments into a single hybrid environment, or considering them as complementary and having their own specifi cs. Th e idea of hybridity changes the formulation of the question of the well-being of schoolchildren and the possibility of it being negatively impacted by digital technologies: constant involvement in online contexts ceases to be pathologized and can be viewed as primarily associated with “offl ine needs” and satisfying them in new ways. Methods for characterizing digital practices of schoolchildren are described: based on the kinds of behavior, the type of interaction with the content, the goals of interaction, as well as various ways of managing digital behavior on the part of the school and parents, which can become the basis for the emergence of new forms of digital inequality. Research shows that online environments are well suited to meet the age-related needs of adolescents. Conclusion. Research in recent years has allowed to rethink a number of questions and to demonstrate the irrelevance of some attitudes regarding the use of digital technologies by children, which emphasizes the importance of conducting empirical research aimed at revealing the meaning and content of digital practices, and not limited to quantitative measurements.
RUSSIAN ADAPTATION OF «THE MULTI-DIMENSIONAL ASSESSMENT OF INTERCEPTIVE AWARENESS» (MAIA-R)
Authors: Popova Rezeda R. , Lopukhova Olga G.
Published: February 2023

Background of the study is related to the problem on the lack of psychodiagnostic tools allowing to operationalize the concept of “interoceptive awareness”. Th e interoceptive awareness is an aspect of body awareness, focused on sensory bodily processes associated with the state of the internal environment of the body, and plays an important role in the regulation of emotional states. Objective. To operationalize this concept, the Russian-language version of Th e Multidimensional Assessment of Interoceptive Awareness questionnaire (MAIA) (Mehling et al., 2012) was validated. Th e purpose of the study is to test the psychometric characteristics of MAIA-R and standardize it. Methods. Th e study was conducted on a sample of 1100 people aged 16 to 66 years (M=26.9; SD=10.4); 19.3% men, 80.7% women. To assess the criterion validity, following contrasting groups with diff erent levels of interoceptive awareness were identifi ed: 1) psychotherapists (N=50), 2) professional athletes (N=103), 3) respondents with experience in bodily practices as a hobby (N=81), 4) with no experience in bodily practices (N=123). Processing of the received data was carried out by the methods of mathematical statistics (t-Student, factor analysis, one-factor analysis of variance, correlation analysis, Cronbach’s alpha). Results. Th e cultural specifi city of the MAIA questionnaire was confi rmed; the content of the factors, diff erent from the original, is refl ected in the titles: «Noticing», «Not-distracting», «Not-worrying», «Attention Regulation», «Awareness of a Negative Emotional State», «Self-regulation Based on Active “Listening” to the Body», «Trusting» and «Awareness of a Positive Emotional State». Th e orthogonal nature of the structural components of interoceptive awareness and their independence from the gender factor have been established. High rates of internal consistency and retest reliability were obtained. Conclusion. Th e questionnaire can be used in psychotherapeutic research and practice, as well as in the work of sports psychologists to assess the level of awareness of bodily processes and the dynamics of self-regulation of athletes.
Nanomaterial-assisted diagnosis of bone infections: A view on current challenges and updates
Authors: Wu Xia , Gopinath Subash C.B. , Chen Yeng , Wang Hui
Published: February 2023

Orthopedic infections affect the joins or bones and sometimes affects both simultaneously. More often, orthopedic infections occur during and after the surgery, particularly with joint replacement surgeries of hip bone and knee bone. Most infections are arised by the bacteria Streptococcus,
Staphylococcus, and Pseudomonas. On the other hand, nanomaterials have been used for implanting and bacteria are able to attach on implanted materials and damaged tissue to cause the infection. Monitoring the infection in patients during surgery is mandatory for the successful
treatment and avoid further damage to the treated bones and joins. In general, diagnosis of infections is by radiological and clinical findings. Serum inflammatory biomarkers are helpful to monitoring the follow-up for orthopedic infection. Various biosensors were demonstrated well with the
involvement of nanomaterials (gold, graphene, silica, metallic oxides) and biomarkers are effectively applied for monitoring orthopedic infections. This review is discussed on orthopedic infection, biofilm formation, recent development of nanomaterial-assisted biosensing technologies, and
nursing for orthopedic infection.
Refractive shift prediction of DNA supramolecular hydrogels as artificial vitreous substitutes
Authors: Song Sijia , Jin Yu , Li Yujie , Lu Yao , Zhang Chun
Published: February 2023

Vitreous substitutes are sufficient for tamponade after pars plana vitrectomy. However, these substitutes (silicone oil and gas) are weak in the refractive aspect. DNA supramolecular hydrogel, a novel vitreous substitute, exhibits good biocompatibility. This study calculated the theoretical
refractive shifts after the DNA supramolecular hydrogels were tamponed in the vitreous cavity in schematic eyes. Navarro and Liou–Brennan schematic eyes with relaxed accommodation were modeled using ZEMAX software. The refractive index representing the vitreous contents was changed to
simulate a DNA supramolecular hydrogel tamponade in the vitreous cavity. The results of the theoretical refraction and power of the required spectacles to correct refractive error were output by the software. The same procedures were performed for other commonly used vitreous substitutes.
The theoretical refractions of DNA supramolecular hydrogels were 60.368 and 60.189 D in Navarro and Liou–Brennan schematic eyes, which were only 0.229 and 0.154 D lower than that of the natural vitreous body, respectively. The power of the corresponding spectacles was less than 0.25
D. The refractive property of DNA supramolecular hydrogels was confirmed to be similar to that of a natural vitreous body. Hence, it is considered a promising vitreous substitute.
Preparation of chitosan modified poly(lactic-co-glycolic acid) nanoparticles containing hawthorn proanthocyanidins: SCC25 cell cycle arrest, antiproliferation, and apoptosis studies
Authors: Yongle Qiu , Kunshan Li , Feifei Lv , Na Li , Xuewei Yuan , Liru Zhang , Shuangling Zhao , Yueting Lu
Published: February 2023

The present study aims at the preparation of a chitosan-PLGA-based proanthocyanidin from hawthorn fruit loaded nano-system (CS-PLGA-PHL) and investigate its inhibitory effect on SCC-25 cells and the related mechanisms. Methods: CS-PLGA-PHL nanocomposites were constructed by emulsion-solvent
evaporation. The effect of CS-PLGA-PHL on the proliferation of human normal squamous epithelial hNOK cells were detected. The antitumor activity of CS-PLGA-PHL on SCC-25 cells were studied by cytotoxicity test, cell cycle and apoptosis analysis. The apoptotic protein and gene expression in
SCC-25 cells was detected by western blotting and q-PCR. Results: The particle size distribution of CS-PLGA-PHL was narrow with an average of 177.60±41.00 nm. CS-PLGA-PHL did not show significant cytotoxicity to hNOK cells (IC50 > 50 μg/mL), with strong cytotoxicity
to SCC-25 cells (IC50 = 1.21 μg/mL), which could block the G0/G1 phase of SCC-25 cells and increase the distribution of G2/M phase. Meanwhile, the apoptosis induction of CS-PLGA-PHL was higher than that of free PHL and PLGA-PHL group (P <0.05). The cell cycle inhibition
and apoptosis induction may be due to the up regulation of apoptosis-associated proteins and genes. Conclusion: CS-PLGA-PHL nanocomposites can inhibit the cell cycle and promote apoptosis of SCC-25 cells by up regulating the expression of apoptosis-associated proteins and genes, suggesting
that it has potential as a chemotherapeutic drug for the treatment of oral squamous cell carcinoma.