bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP371: Characteristics of Fever in Intracerebral Hemorrhage
Authors: Gillow Sabreena J , John Sayona , Lee Vivien H , Ouyang Bichun
Published: July 2021

Introduction:
Fever in intracerebral hemorrhage (ICH) patients can be due to infectious or noninfectious etiology, including central mechanisms. We sought to compare patients with ICH and infectious fever to those with noninfectious fever.

Methods:
Among 351 consecutive primary ICH patients admitted to our institution from April 2009 to March 2010, 136 (39%) developed fever. Fever was defined as temperature > 100.9°F during hospitalization. Cases were reviewed to determine if the patient had fever due to infectious versus noninfectious etiology. The diagnosis of infection was based on results of microbial cultures and National Healthcare Safety Network criteria. Other data collected included age, sex, maximum temperature (Tmax), medical history, ICH location, intraventricular hemorrhage (IVH), ICH volume as measured by standard ABC/2 bedside calculation, external ventricular drain (EVD) placement, surgical evacuation, length of stay (LOS), and inpatient mortality. Univariate analysis and multivariable logistic regression model were used to determine characteristics associated with infection status.

Results:
Among the 136 ICH patients with fever, 96 (71%) had noninfectious fever and 40 (29%) had infectious fever. In the univariate analysis, patients with infectious fever did not differ from patients with noninfectious fever with respect to age (61.3 vs 60.1 years, p 0.6), female sex (40% vs 48%, p 0.8), Tmax (102.2 vs 102.2°F, p 0.96), IVH (60% vs 71%, p 0.23), ICH volume (42 vs 40 cc, p 0.8), EVD placement (48% vs 51%, p 0.85), or surgical evacuation (30% vs 29%, p 1.0). Infectious fever was significantly associated with higher LOS (18.2 vs 11.1 days, p <0.001), and this remained significant in survivors (18.6 vs 14.2 days, p 0.01). Noninfectious fever was associated with significantly higher inpatient mortality (35% vs 8%, p 0.0006). In multivariate analysis, infectious fever significantly correlated with prolonged LOS in survivors when dichotomized using a median of 15 days (OR 5.37, p 0.003).

Conclusions:
Patients with ICH who develop fever associated with an infectious etiology have longer LOS but lower in-hospital mortality. Further studies are warranted to understand fever in ICH patients.
Abstract WP378: Improving Data Quality for Stroke Performance Measures: a Comprehensive and Systematic Approach to Inter Rater Reliability in Ohio
Authors: Liskay Alice , Katzan Irene ,   Ohio Coverdell Leadership Team and Hosps
Published: July 2021

Background:
Ohio has been funded from the Centers for Disease Control and Prevention for the Paul Coverdell National Acute Stroke Prevention Program for over ten years. This data driven program focuses on reducing stroke mortality and morbidity with emphasis on stroke systems of care throughout the continuum. Inter rater reliability is required to confirm reliability and inform quality initiatives. The objective of this study is to determine the annual inter-rater reliability, utilizing Item Specific Percent Agreement (ISPA),after comprehensive abstractor training, in 45 Ohio Coverdell hospitals.

Methods:
We developed a comprehensive abstraction training program which included: in-person, all-day training for abstractors and reabstractors; reference binders; Question and Answer webinars; abstraction updates at statewide tri-annual Coverdell meetings and easy access, prompt, technical assistance communications for specific questions. Results are shared with individual hospital identifying specific areas for improvement. We examined 395 randomly selected charts from 45 hospitals to determine the overall state and individual hospital ISPA during 2014 to 2015. Up to 67 national stroke performance measure and Coverdell data elements were reviewed for agreement according to eligibility. Charts were abstracted and reabstracted by hospitals using Get With the Guidelines®-Stroke and securely transmitted for analysis. The number of charts provided by hospitals was determined by the previous year’s stroke volume. The statistical package “Rstudio” was used for analysis.

Results:
A total of 13,528 elements were reviewed. The overall state ISPA was 94.9%, compared to 94% during 2013 to 2014. Hospital agreement scores ranged from 78.2% to 99.6%, compared to the previous 83.1% to 99% in the previous year.

Conclusion:
The comprehensive abstraction training program developed by Ohio Coverdell has resulted in excellent inter rater reliability scores. ISPA is a feasible method of performing inter-rater reliability.
Abstract WP388: Clinically Focused Stroke Coordinator: How to Successfully Contact All Patients Post Hospitalization at the Highest Target
Authors: Weilbacher Georgia , Hammond-Heaton Sharon
Published: July 2021

Background:
Stroke coordinator roles often involve quality data collection and compliance with standards to maintain certification, yet have limited clinical patient contact. Implementing a Clinical Stroke Coordinator Role, with a focus on the patient, assists with care continuity and improves the success rate of follow-up phone calls to acute ischemic stroke patients.

Purpose:
To evaluate the impact of implementing a Clinical Stroke Coordinator on the percentage of successful patient follow-up phone calls to all acute ischemic stroke patients discharged from the hospital.

Methods:
Our hospital, a high volume academic medical center, implemented the role of Clinical Stroke Coordinator in October 2014. The Coordinator met with each acute ischemic stroke patient prior to discharge to personalize patient education and stroke risk assessments, and to establish an appropriate contact person and phone number for discharge follow-up phone calls. All patients (or their designee) were called by the nurse Clinical Stroke Coordinator within seven days of hospital discharge to home, rehabilitation or inpatient nursing facility. The percentage of patients reached from February 2015 through July 2015 was compared to data from the preceding year, when calls were made by Unit Managers.

Results:
Compared with the pre-implementation period, when the average success rate was 49% for 209 patients, implementation of the Clinical Stroke Coordinator led to an average success rate of 86% for 240 patients, most recently reaching 100% of patients discharged. Overall there was a 102% increase in successful patient discharge phone calls for this patient population (Figure).

Conclusion:
The Clinical Stroke Coordinator role is essential to improved discharge phone call success rates, reaching >95% of acute stroke patients in the most recent three months. Further research is warranted into the impact of follow up phone calls on patient medication compliance and life-style modification.
Abstract WP393: Cervical Arterial Fibromuscular Dysplasia in a Bi-ethnic Population: a Retrospective Study in U.S.-Mexican Border
Authors: Qureshi Ihtesham A , Maud Alberto , Chacon Tatiana , Cruz-Flores Salvador , J Rodriguez Gustavo
Published: July 2021

Background:
There have been studies trying to characterize Fibromuscular Dysplasia (FMD), however most of them are based in mainly non-Hispanic samples. The objective of this study is to describe the epidemiology, clinical characteristics, angiographic findings, and associated vascular conditions of cervical arterial fibromuscular dysplasia in Hispanics in the US-Mexican border.

Methods:
We retrospectively reviewed the cerebral angiograms performed in our center in a period of 3.5 years under different indications (cervical and intracranial steno-occlusive arterial disease, intracranial vascular malformation, cranial and facial tumor embolization, and subarachnoid hemorrhage) looking for angiographic patterns of FMD involving the cervical (internal carotid and vertebral) arteries. Exclusion criteria included subjects younger than 18 years old. Patients were subdivided by their self-reported ethnicity in Hispanics and non Hispanics. Of those patients found to have FMD, we looked for the association with the demographics, co-morbidities and related supra-aortic vascular abnormalities.

Results:
We analyzed 467 angiograms among patients >18 years of 323 (69.1%) were Hispanics and 144 (30.8%) were non-Hispanics. We found that 27 (8.3%) Hispanics patients with FMD involving the cervical arteries (internal carotid, vertebral artery isolated and in different combinations), while 20 (13.8%) cases of FMD among the non-Hispanics. There was no significant difference between the two groups regarding the frequency of FMD. In the Hispanic FMD group the mean age was 57.5 ± 15.76 years and 77.7% were females (p-value=0.007). The most common intracranial and cervical arterial conditions associated with FMD in the Hispanic group were aneurysms and arterial dissections that account for 60% and 25.9% respectively. There was a significant association between Hispanic with Female FMD and intracranial aneurysm (p=0.03).

Conclusion:
Our study suggests that FMD might follow the same demographic and clinical characteristics in Hispanics and non Hispanic populations in North-America. FMD in Hispanics has a clear predilection for women and intracranial aneurysm and supra-aortic arterial dissection are most commonly associated conditions.
Abstract WP401: Code Fast: a Quality Improvement Initiated to Reduce Door to Needle Times
Authors: Busby Leslie N , Owada Kumiko , Dhungana Samish , Coppola VIctoria , Ruban Rebecca , Horn Christopher , Rochestie Dustin , Zimmermann Susan , Khaldi Ahmad , Hormes Joseph , Gupta Rishi
Published: July 2021

Introduction:
Rapid delivery of intravenous t-PA in qualifying patients leads to better clinical outcomes. The American Heart Association has reduced target door to needle (DTN) times from 60 to 45 minutes in the hopes of continued process improvements across institutions. We thus started a quality improvement project called CODE FAST in order to reduce DTN times at our institution. These results were recently reported and published.

Materials and Methods:
We retrospectively reviewed data from our internally maintained database of patients treated with intravenous t-PA prior to and after implementation of the CODE FAST protocol. We assessed demographic information, time of day and times of arrival to first image and delivery of t-PA in patients from February 2014- February 2015. Outcomes were assessed based on discharge to home. Univariate analysis was performed to assess for improvement in DTN times prior to and after implementation of the protocol. We will present the latest data from February 2014- January 2016.

Results:
We previously reported 93 patients (41 pre-CODE FAST and 52 post-CODE FAST) received IV t-PA during the study period. We showed a substantial reduction in door to imaging time from a median of 16 to 8 minutes (p<0.0001) and DTN time with a reduction in the median from 62 to 25 minutes (p<0.0001). In logistic regression modelling, there was a trend towards more discharges to home in patients treated during the CODE FAST era. From March 2015-July 2015 an additional 57 patients have received t-PA under the CODE FAST protocol. The median door DTN remains 27 minutes. We will report further analysis comparing day and night time analysis and further strategies to further reduce DTN times.

Conclusions:
We present a quality improvement project that continues to be an overwhelmingly success in reducing DTN to less than 30 minutes. Further opportunies exist to reduce time further and improve discharge outcomes.
Abstract WP430: Long Chain Polyunsaturated Fatty Acids, Cerebral Small Vessel Disease and Incident Dementia
Authors: Miwa Kaori , Okazaki Shuhei , Sakaguchi Manabu , Mochizuki Hideki , Kitagawa Kazuo
Published: July 2021

Objective:
Long-chain omega-3 polyunsaturated fatty acids (PUFAs) have been identified as a potential protective factor for vascular events and cognitive impairment. However, few prospective studies have so far explored the impact of PUFAs on dementia while simultaneously controlling for MRI-findings, such as cerebral small-vessel disease (SVD) and brain atrophy.

Methods:
Within a cohort of Japanese participants with vascular risk factors and free of dementia, we evaluated the association between PUFAs levels, MRI-findings at baseline, and incident all-cause dementia. Circulating plasma levels of omega-3 (ie, eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA]) and omega-6 (ie, dihomo-γ-linolenic acid [DGLA], arachidonic acid [AA]) PUFAs were measured at baseline. Baseline brain MRI was used to determine SVD (lacunas, white matter hyperintensities and cerebral microbleeds) and atrophy (medial-temporal lobe atrophy and bicaudate ratio). Logistic regression analyses were used to estimate the cross-sectional association between tertile of each PUFAs and MRI-findings. Cox proportional hazards analyses were performed to estimate the longitudinal association between PUFAs and dementia, adjusting for age, sex, APOEε4, educational level, vascular risk factors, cerebrovascular events, estimated glomerular filtration rate, and MRI-findings.

Results:
In the 613 subjects (age: 67.3 ± 8.4 years, male: 59%), multivariable analyses adjusted for potential confounders showed that any PUFAs was not significantly associated with each of SVD. During the mean 7.5-year follow-up (range: 3-13), 48 subjects were diagnosed with dementia (Alzheimer’s disease:24; vascular dementia:18; mixed-type:4; other: 2). In multivariable Cox models adjusted for confounders, the relative risk of all-cause dementia was 0.42 (95%CI, 0.17-0.96, p=0.040) in the highest versus lowest tertile of DHA levels. However, no significant associations with dementia were observed for circulating EPA, EPA/AA ratio, or omega-6 PUFAs.

Conclusions:
Our results provide additional evidence of DHA may be associated with lower risk of dementia.
Abstract WP439: Who Benefits From CT-Angiography Previous Intravenous Thrombolysis?
Authors: Cardona Pedro , Quesada Helena , Lara Blanca , Cayuela Nuria , Mora Paloma , Barranco Roger , M. Angeles De Miquel , Escrig Anna , Ustrell Xavier , Garces Moises , Catena Ester , Moral Alfons , Bernal Teresa , Rubio Francisco
Published: July 2021

Background:
Endovascular treatment (EVT) is an effective treatment in strokes with persistent large artery occlusion despite previous intravenous thrombolisis (IVT) as rescue treatment. Performing computer tomography angiography (CTA) before IVT could allow early activation of neurointerventional teams; however routine CTA could delay unnecessary door-to-needle time of IVT and may be infeasible.

Methods:
We reviewed stroke code activations between May 2011 and June 2015 in our comprehensive stroke center and divided into groups based on NIHSS and patency of arterial occlusion according to non-enhanced CT on admission (dense artery sign or dot sign) and baseline CTA. We assessed patients treated with IVT and selected to EVT according to results in CTA post-IVT. We analyze percentage of recanalization or migration of thrombus after IVT alone and variables associated to successful treatment.

Results:
Of 2856 stroke codes registered during the study period 1810 were diagnosis of ischemic strokes. We treated 520 patients with IVT, 202 had a radiological evidence of large artery occlusion (55%M1, 32% M2, 5%TICA, 5%ICA, 3% basilar). Thirty-two percent of patients showed changes in CTA carried out after IVT(17% successfully recanalized, 15% distal migration of thrombus) so they were not selected to endovascular treatment. There were significant difference between M1 and M2 occlusion regarding changes in CTA after IVT (23% vs 70%; p<0.001). In multivariate logistic regression a baseline score NIH<10 was associated with higher percentage of recanalization with rtPA despite signs of large vessel occlusion (78% vs 32%; p:0.001). In receiver operating characteristic analysis higher baseline NIH was associated with persistent occlusion after IVT (area under curve=0.79;95% CI, 0.6-0.9; P:0.001) with optima threshold of 10 ( Sensivity 84%, Specificity 74%).

Conclusions:
We consider defer CTA angiography until after IVT in stroke code patients with moderate clinical impairment (NIH<10) or M2-segment occlusion, because they achieve a high percentage of arterial recanalization. CTA previous IVT could be unnecessary, provide unreliable information and delay IVT in that clinical group but could be useful to plan EVT in patients with higher NIH scores.
Abstract WP44: NIHSS Score Components Predict Infarct Volume in Minor Ischemic Stroke Patients
Authors: Yaghi Shadi , Herber Charlotte , Boehme Amelia K , Andrews Howard , Willey Joshua Z , Khan Muhib , Marshall Randolph S , Lazar Ronald M , Boden-Albala Bernadette
Published: July 2021

Background:
Prior studies have shown a correlation between the National Institutes of Health Stroke Scale (NIHSS) score and infarct volume on diffusion weighted imaging (DWI); however data are limited in patients with minor stroke whose treatment is controversial. Our aim is to determine the association between DWI lesion(s) volume and the (1) total NIHSS score and (2) NIHSS components in a population of patients with minor ischemic stroke.

Methods:
We included all patients with minor stroke (NIHSS 0-5) who were enrolled in the prospective Stroke Warning Information and Faster Treatment (SWIFT) study. All patients were admitted to the hospital with a final diagnosis of stroke. We calculated lesion(s) volume (cm
3
) on DWI sequence using Medical Image Processing, Analysis, and Visualization (MIPAV, NIH, Version 7.1.1). Based on the distribution of lesion volume, we summarized the explanatory value into median cm
3
. We used non-parametric tests to study the association between the primary outcome, DWI lesion(s) volume, and the predictors (NIHSS score and its components).

Results:
894 patients had a discharge diagnosis of ischemic stroke; 709 underwent MRI and 510 were DWI positive. There was a weak graded relationship between NIHSS score and median DWI lesion volume in cm
3
: (NIHSS 0: 7.1, NIHSS 1: 8.0, NIHSS 2: 17.1, NIHSS 3: 11.6, NIHSS 4: 19.0, NIHSS 5: 23.6). We also noted highly significant relationships between lesion volume and certain NIHSS components. Compared to patients without the deficit, the median lesion volume was significantly higher in patients with neglect (105.6 vs. 12.5,p=0.025), language disorder (34.6 vs. 11.9,p<0.001), and visual field deficits (185.6 vs. 11.6,p<0.001). Other components of the NIHSS were not associated with lesion volume.

Conclusion:
In patients with minor stroke, the nature of the neurological deficit improves prediction of infarct volume when added to the total NIHSS score. This may lead to clinical and therapeutic implications.
Abstract WP5: Outcomes Are Not Different Between Patients With Intermediate and High Dwi-aspects After Stent-retriever Thrombectomy
Authors: Yoon Woong , Kim Seul Kee , Heo Tae Wook , Baek Byung Hyun , Park Jaechan
Published: July 2021

Introduction:
Few studies have investigated the association between pretreatment DWI-ASPECTS and functional outcome after stent-retriever thrombectomy in patients with acute anterior circulation stroke.

Hypothesis:
Patients with acute stroke and DWI-ASPECTS <7 might have a similar chance of a good outcome compared to those with a higher DWI-ASPECTS, if they are treated with a stent-retriever thrombectomy in a short time window. However, this hypothesis has not been tested. Thus, this study aimed to investigate the impact of DWI-ASPECTS on functional outcome in patients with acute anterior circulation stroke who received a stent-retriever thrombectomy.

Methods:
We retrospectively analyzed the clinical and DWI data from 171 patients with acute anterior circulation stroke who were treated with stent-retriever thrombectomy within 6 hours of symptom onset. The DWI-ASPECTS was assessed by two readers. A good outcome was defined as a modified Rankin Scale score of 0-2 at 3 months.

Results:
The median DWI-ASPECTS was 7 (interquartile range, 6-8). Receiver operating characteristics analysis revealed an ASPECTS ≥ 7 was the optimal cut-off to predict a good outcome at 3 months (area under the curve=0.57; sensitivity, 75.3%; specificity, 34.4%). The rates of good outcome, symptomatic hemorrhage, and mortality were not different between high DWI-ASPECTS (scores of 7-10) and intermediate (scores of 4-6) groups. In patients with an intermediate DWI-ASPECTS, good outcome was achieved in 46.5% (20/43) of patients with successful revascularization (modified TICI 2b or 3), whereas no patients without successful revascularization had a good outcome (
P
=0.016). In multivariate logistic regression analysis, independent predictors of good outcome were age and successful revascularization.

Conclusions:
Our study suggested that treatment outcomes were not different between patients with a high DWI-ASPECTS and those with an intermediate DWI-ASPECTS who underwent stent-retriever thrombectomy for acute anterior circulation stroke. Thus, patients with an intermediate DWI-ASPECTS otherwise eligible for endovascular therapy should not be excluded for stent-retriever thrombectomy or stroke trials.
Abstract WP55: Predicting Malignant Edema in MCA Infarct Using MRI and MR Perfusion Parameters
Authors: Peng Shin-Lei , Pinho Marco , Lu Hanzhang , Magadan Alejandro , Hasan Rashedul , Warach Steven , Luby Marie , Cheng Bastian , Thomalla Gotz , Shang Ty ,   On behalf of the STIR and VISTA Imaging investigators
Published: July 2021

Introduction:
Malignant edema in large MCA infarct (MMI) is known for high rate of mortality and morbidity. Hemicraniectomy was showed to decrease mortality but not improve functional outcome. Further studies are required for better patient selection for surgery. Among several clinical biomarkers, DWI lesion volume > 82 ml within 6 hours from symptoms onset is the most used predictor for MMI. There is also evidence suggesting brain edema is correspond with severity of tissue ischemia, which could be measured by semiquantitative cerebral blood volume (CBV) and cerebral blood flow (CBF) on MRP map. We hypothesized that DWI volume combining with MRP parameters could provide more predictive value.

Methods:
Patients in MMI-MRI study (a prospective, multicenter, observational MRI/MRP study of MCA ischemic stroke within 6 hours of symptom onset) and STIR (Stroke Imaging Repository) were included if they met the inclusion criteria: age ≥ 18, MCA infarct with NIHSS ≥ 15, and MRI/MRP study within 12 hours from symptoms onset. Patients underwent thrombectomy, with poor quality images or without follow up images, with bilateral strokes, or developed hemorrhagic transformation were excluded. MMI was defined as NIHSS score >18 with suppressed level of consciousness, and at least 2/3 of the MCA territory infarct on follow-up MRI or CT.

Results:
Of 89 patients included, 17 (19.1%) developed MMI. A malignant edema predicting score (MEPS) of maximum three points was developed: one point for DWI lesion volume > 82 ml, one point for more than 40% of DWI volume with CBV < 40% of contralateral normal side, and one point for more than 50% DWI volume with CBF < 30% of contralateral normal side. The threshold of a DWI lesion volume > 82 ml predicted malignant edema with sensitivity (0.65, 95% CI 0.39-0.85), specificity (0.86, 95% CI 0.75-0.93), positive predictive value (0.52, 95% CI 0.30-0.74), and negative predictive value (0.91, 95% CI 0.81-0.96). MEPS ≥ 2 predicted malignant edema with sensitivity (0.65, 95% CI 0.39-0.85), specificity (0.98, 95% CI 0.91-1.00), PPV (0.92, 95% CI 0.60-1.00), and NPV (0.92, 95% CI 0.83-0.97).

Conclusions:
DWI volume is reliable in predicting MMI. The addition of information on tissue ischemia in a multivariate score improves the prediction of MMI over DWI alone.
Abstract WP61: A Novel Application of Four-dimensional Magnetic Resonance Angiography Using Arterial Spin Labeling for Assessment of Postoperative Cerebral Hemodynamic Changes in Moyamoya Disease
Authors: Uchino Haruto , Ito Masaki , Kazumata Ken , Houkin Kiyohiro
Published: July 2021

Introduction:
Recently, four-dimensional magnetic resonance angiography without contrast enhancement using arterial spin labeling (ASL-4D MRA) has become available to visualize the intracranial arteries. However, few reports are available about the efficacy of ASL-4D MRA in moyamoya disease (MMD).

Hypothesis:
We hypothesized that postoperative hemodynamic changes in MMD patients could be evaluated using ASL-4D MRA.

Methods:
This study included 26 hemispheres of 21 patients who underwent combined direct and indirect revascularization for MMD. ASL-4D MRA was serially performed before and after surgery. We assessed the time phases where signals of the arteries were detected on ASL-4D MRA in order to analyze perioperative changes in cerebral hemodynamics.

Results:
The signals of the anastomosed arteries on ASL-4D MRA were detected and disappeared at significantly earlier time phase after surgery than before. This change in acute period was moderated in chronic period after surgery. Postoperative hyperperfusion was observed in 12 of 26 hemispheres within 7 days after surgery. The signals of the arteries were detected significantly earlier in hemispheres with hyperperfusion than those without. In cases with hyperperfusion, ASL-4D MRA demonstrated high intensity of peripheral middle cerebral artery (MCA) around anastomosed region in early time phase (Figure). This “early hyperintensity of MCA” was observed in all cases with hyperperfusion and corresponded to the timing of the occurrence of hyperperfusion. Furthermore, this hyperperfusion-specific sign could not be detected by routine TOF MRA.

Conclusions:
Noninvasive ASL-4D MRA successfully evaluated perioperative dynamic changes of cerebral blood flow and the effect of surgical revascularization in MMD. This next generation modality could also visualize cerebral hemodynamics in cases with postoperative hyperperfusion and would be quite useful for appropriate postoperative management.
Abstract WP84: Thrombolysis is Safe in the Nonagenarians With Acute Ischemic Stroke
Authors: Abrol Tapan , Hussain Zeeshan , Chaubal Varun , Dighe Gaurav , Bilal Muhammad F , Wise Elizabeth , Moore Kari , Jerde Ann , Bystrek Laura , Wilder Michael J , Shah Jignesh J , Remmel Kerri , Liu Wei
Published: July 2021

Introduction:
People aged 90 years or older are the fastest growing group in North America. This group was excluded from traditional clinical trials of intravenous tissue plasminogen activator (iv tPA) thrombolysis. IV tPA is the most beneficial emergent therapy in acute ischemic stroke (AIS). We have compassionately treated AIS patients in this age group with iv tPA in recent years.

Hypothesis:
Our aim is to evaluate the safety and outcome of iv tPA use in nonagenarian patients with AIS

Methods:
Consecutively iv tPA-treated AIS patients who were older than 90 years and were admitted at our institution from January 2004-June 2015 were included. The administration of iv tPA was within 3 hours after the stroke onset. We reviewed the clinical features of the patients at presentation, complications, and outcomes. Outcome measures at discharge included improvement of NIHSS, mRS, symptomatic intracranial hemorrhage (sICH), and discharge disposition. We also assessed the rate of complications of iv tPA. Multiple logistic regression analysis was used to evaluate association between the outcome versus the severity of stroke, or versus pre-stroke dependence.

Results:
A total of 35 AIS patients who were 90 years or older (female 80%; and median age 93 years old) were treated with iv tPA. At baseline twenty-two patients (62.9%) had a history of atrial fibrillation without anticoagulation, and more than half (20/35) patients needed assistance for gait instability, but they were otherwise functional. Median NIHSS on admission was 16 (IQR 9-22). Two patients (5.7%) had symptomatic intracerebral hemorrhage. At discharge the median NIHSS was 10 (IQR 1-19). Ten patients (28.6%) had favorable outcome (mRS ≤ 2) while sixteen patients (45.7%) had good outcome (mRS ≤ 3). Four patients were discharged home and 16 patients went to rehabilitation facility. Fifteen patients (42.9%) succumbed to cardio-pulmonary failure or were discharged to hospice. Mild AIS patients (NIHSS <7) had better outcomes (p < 0.05). The pre-existing dependence (mRS ≥3) did not predict poor outcome.

Conclusion:
It is safe to administer iv tPA to AIS patients who are 90 years or older although the benefits are less robust compared to younger patients. Patients with milder deficits had more favorable outcomes.
Abstract WP86: Treatment Patterns and Outcomes for Ruptured and Unruptured Intracranial Aneurysms in Patients With Polycystic Kidney Disease
Authors: Saeed Fahad , Riaz Ahmed , Afzal Mohammad R , Chaudhry Saqib A , Qureshi Adnan I
Published: July 2021

Background:
Patients with polycystic kidney disease (PKD) have a high incidence of intracranial aneurysms. Patterns of surgical and endovascular treatments and their associated outcomes are largely unknown in this patient population.

Methods:
We used the National Inpatient Sample (NIS, years 2002-2012) to compare the in-hospital outcomes of aneurysm treatments between PKD and non PKD patients. In our cohort, we included all adult patients (18 years or older) with the primary discharge diagnoses of ruptured and unruptured aneurysms with or without a secondary diagnosis of PKD. We analyzed the following comparative outcomes of PKD patients: 1) rates of endovascular and surgical treatments; 2) in-hospital complications; 3) length of hospital stay; 4) moderate-to severe-disability; and 5) mortality.

Results:
Of all the admitted patients (n=182,012) for aneurysmal treatment, 1105 (0.61%) patients had PKD. Rates of surgical treatment were higher in the PKD cohort (64.23 % versus 51.63 %, p= 0.0008) while fewer of the PKD patients underwent endovascular treatment (35.7 % versus 48.3 %, p= 0.0008). Lower rates of in-hospital complications such as: myocardial infarction, pneumonia, deep venous thrombosis, hyponatremia, cerebral vasospasm, hydrocephalus, were seen in the PKD group PKD patients were also less likely to receive intubation, mechanical ventilation, ventriculostomy, gastrostomy and ventriculoperitoneal shunt as compared to patients with no PKD. There was no significant difference in the mean length of hospital stay (9.4 versus 10.7 days, p=0.0873) between the two groups. Mean hospital charges in the US dollars (118209 versus 140003, p=0.0179) were also lower in the PKD group. Rates of moderate-to-severe disability and in-hospital mortality were also significantly lower in the PKD cohort- 17.2 % versus 23.2 %; P= 0.0442 and 3.5% versus 6.3%; P=0.0276 respectively.

Conclusions:
In patients admitted for treatment of ruptured or unruptured intracranial aneurysms, PKD status is associated with significantly lower rates of certain in-hospital complications, moderate-to-severe disability and mortality in comparison with non-PKD patients.
Abstract WP87: Coronary Artery Disease and Intracranial Aneurysm; Identical Risk Factors but Different Vascular Responses
Authors: Kim Bum Joon , Kang Hyun Goo , Ahn Jae Sung , Kwon Beyong Deok , Lee Deok Hee , Kang Dong-Wha , Kim Jong S. , Kwon Sun U.
Published: July 2021

Background:
Intracranial aneurysm (IA) is a vascular disease with localized abnormal outpouching in cerebral vessels. We have hypothesized that though the risk factors are similar between atherosclerosis and IA, the response of the vessel may be different.

Methods:
Subjects who received a routine health examination (health examination group) or coronary artery bypass graft surgery (CABG group) during the study period were enrolled. The incidence of IA was compared between the two groups. The incidence of valvular insufficiency was compared between patients with and without IA in the CABG group. The tortuosities of intracranial arteries were compared between patients with IA and age- and sex-matched control from the health examination group.

Results:
Finally, 367 of 18,954 health examination group and 49 of 2,734 patients of CABG group demonstrated IA. After adjusting for age and sex, the prevalence of IA was higher in the health examination group than the CABG group (1.81% vs.0.71%; p<0.001). The proportion of patients with mitral or aortic insufficiency was higher in patients with IA than those without in the CABG group (p=0.001 and p=0.003. respectively). Female sex (OR=2.25; p=0.01), smoking OR=3.94 p<0.001)and the presence of valvular insufficiency (mild:OR=2.57; p=0.003, Severe OR=4.11; p=0.01)was independently associated with IA. The tortuosity of basilar artery was higher in patients with IA than those without (p<0.001). Hypertension (OR=2.13; p<0.001), smoking (OR=1.59; p=0.03), coronary artery disease (OR=0.32; p<0.001) and the tortuosity of basilar artery (OR=1.065; p<0.001) were independently associated with IA.

Conclusions:
Patients with IA seems to have a weaker vascular structure which easily dilates or twine to tensile strength causing valvular insufficiency or high vascular tortuosity.
Life Course Statuses and Sibling Relationship Quality during Emerging Adulthood
Authors: Aldrich Lindsey , Nomaguchi Kei , Fettro Marshal Neal
Published: July 2021

Using the National Longitudinal Study of Adolescent to Adult Health ( N = 1,366), we examine how major life course statuses are related to sibling relationships during emerging adulthood with attention to similarities and differences in these statuses between sibling dyads. We find that full-time employment, marriage/cohabitation, and parenthood are related to more distant sibling relationships, whereas college education is related to closer sibling relationships. Similarities in employment between the siblings are related to closer relationships, but differences in education, marriage/cohabitation, and parenthood are related to closer relationships, in that respondents report more help-seeking and emotional closeness with their siblings who have higher education than theirs; unpartnered respondents report more calls and fewer fights with their partnered siblings; and childless respondents report more visits and emotional closeness with their parenting siblings. Examining both one’s and one’s sibling’s life course statuses is important in understanding life course variations in sibling relationships.
Keeping the Flame Alive: Describing Marriage and Divorce Among Professional Firefighters
Authors: Pennington Michelle L. , Coe Elizabeth , Dobani Fatima , Kruse Marc I. , Sanford Keith , Meyer Eric C. , Gulliver Suzy B.
Published: July 2021

There is a common belief, but little empirical evidence, that firefighters are uniquely vulnerable to divorce. The present study aimed to examine key demographic and occupational factors related to divorce among firefighters. Online survey data (relationship status, relationship history, demographics, and occupational history) were collected from 163 firefighters in an urban city of the Southern United States. Divorced firefighters were older, in fire service longer, and younger at the age of their first marriage compared to non-divorced firefighters. Firefighters who married before joining fire service were more likely to experience divorce than firefighters who married after joining fire service; however, after controlling for age and age at first marriage, this effect became nonsignificant. Divorce was reported by firefighters at greater rates than the general population, and most divorces occurred after entry into fire service. However, non-occupational factors may better explain this trend.
Quality of Life, Family Climate, and Sense of Family Coherence During the COVID-19 Pandemic: Modeling of Triple-Serial Mediators
Authors: Neyişci Nilay , Erçetin Şefika Ş. , Açıkalın Şuay N. , Koçtürk Nilüfer , Potas Nihan
Published: July 2021

This study explored the association of quality of life (QOL) during the pandemic with family climate and family integrity. Participants were 1085 parents from Turkey. According to the findings, the participants’ QOL, which demonstrated their judgments regarding their physical health, mental well-being, social relations, and general happiness, was greatly influenced by the COVID-19 pandemic. Women were seen to have lower perceptions in relatedness in the family and cognitive cohesion than male participants. While there was a positive, but low, association between the variables, there were positive and high correlations between cognitive cohesion and relatedness in the family. When the mediation analyses were evaluated, it was concluded that QOL predicted the sense of family coherence alone, while intergenerational authority influenced other variables. The results highlighted the importance of family climate–based prevention and intervention targeting the promotion of family coherence.
Development and Validation of Teachers’ Sense of Calling Scale
Authors: Jain Puja , Kaur Jasleen
Published: July 2021

Sense of calling is an emerging construct in the field of psychology and organizational behaviour. There are a lot of studies, which have been conducted in Western countries, but there are still many parts of the globe where not many studies have been conducted. One probable reason for the deficient research in other parts of the globe could be attributed to the wording of existing scales. There is a need to develop new tools for measuring calling, which are subject specific. Calling is connected to a particular career domain. Therefore, studying the construct in a particular career domain like teaching can facilitate the research on sense of calling. But teachers’ sense of calling has received less research attention. This motivated us to develop a scale specifically for measuring teachers’ sense of calling. The scale is a 10-item, three-dimensional scale. Finally, implications and limitations of the study with some suggestions for future research are discussed.
Examining the Relationship between the Lethality Assessment/Domestic Violence High-risk Team Monitoring (LAP/DVHRT) Program and Prosecution Outcomes
Authors: Anderson Kristin L. , Bryan Hannah , Martinez Alexis , Huston Brandon
Published: July 2021

Lethality assessment (LAP) and team monitoring of high-risk offenders (DVHRT) are recent U.S. policy innovations designed to identify domestic violence offenders who are at high risk for perpetrating serious or lethal violence against their intimate partners. One goal of LAP/DVHRT is to increase offenders’ accountability for domestic violence within the legal system. This study examines associations between LAP/DVHRT and prosecution and sentencing outcomes using data on domestic violence offenses ( n = 88) involving 37 offenders monitored by a DVHRT and 51 nonmonitored comparison offenders who were identified as high risk on the LAP. We use logistic and OLS regression to estimate models of six prosecution and sentencing outcomes for the full sample and for a sample matched using the coarsened exact matching technique ( n = 73). Multivariate results indicate that when the treatment and comparison samples are matched and control variables are included in regression models, the LAP/DVHRT program is not associated with prosecution or conviction rates, number of charges, or bail amount. DVHRT monitoring is positively associated with sentence length in multivariate analysis and in models using the matched sample. Findings suggest that the LAP/DVHRT program increases offender accountability in the form of incapacitation at the sentencing stages.
Modeling and validation of crankshaft speed fluctuations of a single-cylinder four-stroke diesel engine
Authors: Babagiray Mustafa , Solmaz Hamit , İpci Duygu , Aksoy Fatih
Published: July 2021

In this study, a dynamic model of a single-cylinder four-stroke diesel engine has been created, and the crankshaft speed fluctuations have been simulated and validated. The dynamic model of the engine consists of the motion equations of the piston, conrod, and crankshaft. Conrod motion was modeled by two translational and one angular motion equations, by considering the kinetic energy resulted from the mass moment of inertia and conrod mass. Motion equations involve in-cylinder gas pressure forces, hydrodynamic and dry friction, mass inertia moments of moving parts, starter moment, and external load moment. The In-cylinder pressure profile used in the model was obtained experimentally to increase the accuracy of the model. Pressure profiles were expressed mathematically using the Fourier series. The motion equations were solved by using the Taylor series method. The solution of the mathematical model was performed by coding in the MATLAB interface. Cyclic speed fluctuations obtained from the model were compared with experimental results and found compitable. A validated model was used to analyze the effects of in-cylinder pressure, mass moment of inertia of crankshaft and connecting rod, friction, and piston mass. In experiments for 1500, 1800, 2400, and 2700 rpm engine speeds, crankshaft speed fluctuations were observed as 12.84%, 8.04%, 5.02%, and 4.44%, respectively. In simulations performed for the same speeds, crankshaft speed fluctuations were calculated as 10.45%, 7.56%, 4.49%, and 3.65%. Besides, it was observed that the speed fluctuations decreased as the average crankshaft speed value increased. In the simulation for 157.07, 188.49, 219.91, 251.32, and 282.74 rad/s crankshaft speeds, crankshaft speed fluctuations occurred at rates of 10.45%, 7.56%, 5.84%, 4.49%, and 3.65%, respectively. The effective engine power was achieved as 5.25 kW at an average crankshaft angular speed of 219.91 rad/s. The power of friction loss in the engine was determined as 0.68 kW.
The different faces of international posting: Why do companies use posting of workers?
Authors: Lens Dries , Mussche Ninke , Marx Ive
Published: July 2021

The importance of the posting of workers across EU borders has grown considerably in the past decade, causing concern regarding its impact on labour standards in Europe. This article asks why posting has taken such a flight. Building on quantitative analysis and in-depth interviews set against other sources, we shed light on employer motives for deploying posted workers. We develop a typology of posting which shows that while cost minimization is a crucial motive, especially in sectors where labour cost is an important competitive concern, a much wider set of motives are at play. Skill shortages across all levels of the skills spectrum play a crucial role in every sector. In addition, companies use sub-contracting for highly specialized temporary work as well as for routine tasks. Posting is also used for career development, especially of high potentials. Based on the wide array of employer motives for the use of posting, our typology distinguishes between ‘competition posting’, ‘specialisation posting’ and ‘expert posting’. The article discusses some implications for EU policy vis-a-vis posted work.
Academic Satisfaction of International Students at Irish Higher Education Institutions: The Role of Region of Origin and Cultural Distance in the Context of Marketization
Authors: Finn Mairéad , Mihut Georgiana , Darmody Merike
Published: July 2021

Internationalization of higher education has increased the diversity of the student body at higher education institutions. There is evidence that the experiences of international students vary according to their region of origin, but trends on a larger scale remain underexamined. Drawing on Eurostudent VI data from the Republic of Ireland, this article investigates how academic satisfaction varies between students from different global regions of origin and from national settings with distinct cultural distance characteristics. Results suggest that international students have higher levels of academic satisfaction than Irish students, but that differences between students from diverse regions of origin persist. In addition, international students originating from a national context with high power distance, irrespective of levels of individualism, have higher levels of academic satisfaction compared with Irish students. Furthermore, self-perception of being a detached customer rather than an equal partner in education has the strongest association with academic satisfaction, suggesting that commercialization trends affect both international and domestic students.
The Agony of Choice: Acceptance, Efficiency, and Psychometric Properties of Questionnaires With Different Numbers of Response Options
Authors: Müssig Markus , Kubiak Jeanette , Egloff Boris
Published: July 2021

Questionnaires are one of the most important tools in psychological assessment, yet the impact of different numbers of response options on psychometric properties of questionnaires is limited. This study extends existing research by analyzing respondents’ acceptance of and the efficiency of different numbers of response options and replicate findings on reliability and validity. We studied these questions in 540 respondents who filled out the Big Five Inventory–2 and the Emotion Regulation Questionnaire. Two response options, 11 response options and the visual analog scale showed disadvantages in acceptance compared with the original number of response options. The completion time increased by 1.7s per item when moving from 2 to 11 response options. Cronbach’s alpha (but not ordinal alpha based on polychoric covariance) was lowest for two response options. Validity was unaffected. Overall, compared with the typical choice of five or seven response options, fewer or more response options resulted in disadvantages.
Optic neuritis classification in 2021
Authors: Ducloyer Jean-Baptiste , Marignier Romain , Wiertlewski Sandrine , Lebranchu Pierre
Published: July 2021

Optic neuritis (ON) can be associated with inflammatory disease of the central nervous system or can be isolated, with or without relapse. It can also be associated with infectious or systemic disease. These multiple associations based on a variety of clinical, radiological, and biological criteria that have changed over time have led to overlapping phenotypes: a single ON case can be classified in several ways simultaneously or over time. As early, intensive treatment is often required, its diagnosis should be rapid and precise. In this review, we present the current state of knowledge about diagnostic criteria for ON aetiologies in adults and children, we discuss overlapping phenotypes, and we propose a homogeneous classification scheme. Even if distinctions between typical and atypical ON are relevant, their phenotypes are largely overlapping, and clinical criteria are neither sensitive enough, nor specific enough, to assure a diagnosis. For initial cases of ON, clinicians should perform contrast enhanced MRI of the brain and orbits, cerebral spinal fluid analysis, and biological analyses to exclude secondary infectious or inflammatory ON. Systematic screening for MOG-IgG and AQP4-IgG IgG is recommended in children but is still a matter of debate in adults. Early recognition of neuromyelitis optica spectrum disorder, MOG-IgG-associated disorder, and chronic relapsing idiopathic optic neuritis is required, as these diagnoses require therapies for relapse prevention that are different from those used to treat multiple sclerosis.
Punctate inner choroidopathy reactivation following COVID-19: A case report
Authors: Nicolai Michele , Carpenè Maria Jolanda , Lassandro Nicola Vito , Pelliccioni Paolo , Pirani Vittorio , Franceschi Alessandro , Mariotti Cesare
Published: July 2021

Purpose:

The purpose of this study is to report our experience with a case of punctate inner choroidopathy (PIC) reactivation following COVID-19.

Case report:

A 29-year-old caucasian woman with past ophthalmological history of bilateral PIC reported sudden visual acuity decrease in her right eye (RE) 3 weeks after SARS-CoV-2 infection. Her best-corrected visual acuity (BCVA) was 20/32 in RE; fundus examination and multimodal imaging (including indocyanine-green angiography, fundus autofluorescence, and optical coherence tomography) was consistent with unilateral PIC reactivation. The active choroidal lesions responded to high-dose corticosteroids, with functional improvement.

Conclusion:

Sars-CoV-2 infection could induce autoimmune and autoinflammatory dysregulation in genetically predisposed subjects. We report a case of PIC reactivation following COVID-19.