bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP32: A Dissection of Spinal Cord Infarction: Cases With Rare Features and Innovative Treatments
Authors: Oyer Maxwell , Chornay Christopher , Kvernland Alexandra , Zhang Cen , Khawaja Ayaz M , Chung Charlotte , Nossek Erez , Kelly Sean M
Published: February 2024

Spinal cord infarction (SCI) poses a unique set of diagnostic and therapeutic challenges to clinicians. The condition carries high risk for severe disability if not promptly addressed, yet there is no consensus on the threshold for patients to be screened with emergent MRI or receive acute interventions such as IV-thrombolysis or endovascular therapy, in large part due to limited case data and a lack of statistically powered trials or formal guidelines. Moreover, multiple distinct pathologic processes can cause SCI, and there remains limited understanding of which patient cohorts may be most susceptible to each stroke mechanism or respond favorably to the various possible treatments.

Here, we present an in-depth analysis of a series of 11 SCI cases presenting to a network of 3 hospitals at a large academic center in New York City over a 5-year period to compare presenting symptoms, etiology, acute treatment strategy, and clinical outcome. We review the results of 9 patients who were evaluated with digital subtraction angiography (DSA), including 2 patients receiving different multiple drug regimens of acute intra-arterial therapies. One patient was also found eligible and treated with IV-thrombolysis. In these data we also identify multiple patients who experienced SCI in the setting of sickle cell disease and track their functional outcomes after being treated with exchange transfusion or anticoagulation, as well as 2 young patients with apparent heritable causes of hypercoagulability leading to their ischemic events.

These preliminary data suggest that underlying conditions of hypercoagulability and arterial dissection are more predominant drivers of SCI than traditional mechanisms of cerebral ischemic stroke such as large vessel atherosclerosis or cardioembolism, and that heritable causes may be more prevalent in patients with SCI compared to other stroke patients. We propose these findings as a basis for designing a larger scale study for result confirmation.
Abstract WP55: Enhancing the Stroke Patient Education Experience: A Focus on Stroke Procedure Education
Authors: Gordos Paula , Buttrick Maureen , Brown Dena R
Published: February 2024

Background and Issue:
Providing stroke patient education is a fundamental core measure for all levels of stroke centers with a generalized focus of topics including activation of emergency medical services, need for follow up after discharge, medications prescribed at discharge, risk factors for stroke, warning signs and stroke symptoms. A gap exists in patient education focusing on advanced stroke treatment procedures such as thrombolytic administration and mechanical thrombectomy. Available educational topics in the electronic medical record are often too generic and do not address the post procedural stroke patient population.

Purpose:
The purpose of this project was to develop a standardized set of post stroke procedural education topics and design a method of documentation to enhance and augment the stroke patients’ educational experience.

Methods:
Using Lean Six-Sigma methods, a multidisciplinary workgroup reviewed current literature on education topics, examined the existing EMR post procedure topics available, and queried other stroke centers for best practices in stroke post procedural patient education. Based on the results of findings, we created new procedural education topics focusing on thrombolytic administration, mechanical thrombectomy, aneurysm repair procedures, diagnostic angiogram, and carotid procedures. We developed an automated process to pre-populate the topics, specific to the procedural order set into the EMR.

Results:
In 2021, procedural stroke patient education documentation compliance was 63% (n=191); through improvement efforts compliance increased to 77% (n=210), year to date 2023.

Conclusion:
Creating a standardized set of education topics focusing on stroke treatment procedures and embedding education into procedural order sets helps to minimize education omission, increase education documentation compliance, and enhance the stroke patient’s educational experience overall.
Abstract WP60: On vs. Off-Hours Arrival to Groin Time: Identifying Gaps in a Comprehensive Stroke Center
Authors: Schrier Chad , Palmisano Caitlin , Phipps Michael S
Published: February 2024

Introduction:
Timeliness of treatment for patients with acute ischemic stroke (AIS) directly correlates with outcomes. The most current AHA guidelines standard of care for patients having a large vessel occlusion (LVO) stroke is endovascular mechanical thrombectomy (MT). Earlier treatment is associated with better outcomes at 90 days. Parallel processing is paramount when executing an expedited transition from the emergency department (ED) to the MT suite. At a large academic comprehensive stroke center (CSC), as we receive a high volume of direct ED cases, we examined whether there was a difference in daytime vs. off-hour LVO cases.

Methods:
The MT database maintained by the CSC was queried for all cases from July 2022- July 2023. Inclusion criteria included all AIS with LVO and receiving MT that were transported by EMS directly to the CSC ED. Data was further stratified by time of day and day of the week. Cases were designated as day if they arrived Monday through Friday between 7am-5pm. Cases were considered night/weekend if they arrived 5pm-7am or anytime Saturday or Sunday. Times between groups were compared with t-test.

Results:
There were a total of 37 cases in the day group and 43 cases in the night/weekend group. Patients arriving during the day had a median arrival-to-groin time of 89 minutes and a mean of 93 minutes. The night/weekend group had a median of 116 minutes and a mean of 125 minutes, and the difference was statistically significant (p=0.0009). Upon further analysis, mean ED arrival to suite time was significantly longer for night/weekends, 105 vs. 76 minutes, p=0.008, but mean suite to groin puncture time was not significantly different, 18 vs. 16 minutes, p=0.24.

Conclusion:
There is a statistically significant difference in arrival to suite/groin times between the day and night/weekend groups, therefore putting patients with LVO arriving off hours at higher risk for poor outcomes. Historically some cardiac cath labs have utilized nursing bridge teams to help with parallel processing, and we theorize that using such a team to facilitate preparation of the patient and suite, we can reduce treatment times for off-hour’s ED MT cases and potentially improve outcomes.
Abstract WP62: Intracerebral Hemorrhage Score and Glasgow Coma Scale Are Not Accurate Predictors of Subsequent Mechanical Ventilation in Initially Non-Intubated Intracerebral Hemorrhage Patients
Authors: Spicer Alan , Dixon Crystal , Hairston Marla , Coughlin Emily , Burgin William S
Published: February 2024

Introduction:
Intracerebral hemorrhage (ICH) often requires mechanical ventilation (MV), increasing patient risks and hospital costs. Two standard tools were evaluated for their ability to predict patients needing subsequent MV. A predictive tool could reduce costs and complications from unnecessary MV and reduce risks for patients requiring non-elective intubation.

Methods:
Spontaneous ICH patients were evaluated at a comprehensive stroke center, focusing on those not intubated upon arrival or in the Emergency Department. Retrospective chart review included ICH score (ICHS), Glasgow Coma Scale (GCS), MV rates, and timing of intubation. To assess the ability of ICHS and GCS to predict subsequent MV within two weeks, we used the area under the receiver operating characteristic curve (AUC) and Youden's J statistic (range 0-1), which combines sensitivity and specificity. Higher values indicate better test performance.

Results:
Over 4 years, 700 consecutive ICH patients were evaluated, with 231 meeting analysis criteria. Of these, 20/231 (8.66%) received subsequent MV within the following two weeks. Neither the ICHS nor GCS accurately predicted subsequent MV, with AUC/Standard Error/Youden's J of 0.630/0.066/0.254 for ICHS and 0.643/0.070/0.235 for GCS. Specificity was >97% (95% Confidence Interval: 94-99%) for both an ICHS
>
4 and a GCS
<
8; however, corresponding sensitivities were low (5% and 10%, respectively).

Conclusions:
The ICHS and GCS are not accurate predictors of subsequent MV, as shown by the low AUC and Youden's J. Both scales are >97% specific when the ICHS is
>
4 or GCS is
<
8, which may identify high-risk patients but would overlook others. Development of an intubation-specific tool, further exploration of alternative existing ICH scores, and evaluation of a larger sample size are needed.
Abstract WP63: Direct Physician Call to Spoke Reduces Door to Needle Time in a Telestroke Network
Authors: Kaziz Hamza , Hackett Chris , Chandra Rahul , Malhotra Konark
Published: February 2024

Background:
Door-to-needle time (DTN) and strategies to reduce DTN are well published, but less is known about specific processes that may contribute to DTN in sites using telestroke. We aimed to reduce potential delays in connecting the telestroke physician with the spoke by eliminating the initial call by telestroke physicians to the call center.

Methods:
A retrospective analysis examined telestroke patients treated with IV thrombolysis from 06/01/2018 to 03/15/2023 in a 20 spoke network. Telestroke physicians began calling the spoke back directly (instead of calling transfer center to be connected) in July 2022. We compared data and outcomes in the two groups; Prior to Direct Phone (PDP) and After Direct Phone (ADP). Primary outcome analyzed DTN before and after direct connection. Secondary outcome was telestroke page to video times. Primary and secondary outcomes were analyzed using quantile regressions specifying the median, adjusted for confounding variables determined in preliminary analyses. A subgroup analysis was completed in patients transferred for endovascular thrombectomy (EVT) after IVT, to evaluate Door in Door out time (DIDO), using a median regression adjusted for potential confounding variables.

Results:
There were 580 patients in this study; 469 patients in the PDP group and 111 patients in the ADP group. Patients had a mean age and SD of 69.13 ±15.03 years and a median NIHSS (interquartile range) of 6 (4, 12). After adjusting for potential confounding variables, DTN in the ADP group was 9.22 minutes quicker than in the PDP group, [95% Confidence (CI), 2.07 - 16.36], p = 0.01. Adjusted telestroke page to video times were 2.60 minutes quicker in the ADP compared to the PDP group, [95%CI, 0.01 - 5.20], p = 0.05. There were 137 patients (121 in PDP; 24 in ADP) in the subgroup analysis. There were similar DIDO times in both groups; 1.06 minutes faster in the ADP group, but not statistically significant [95%CI, -14.56, 16.68], p = 0.89.

Conclusion:
Eliminating one step in the telestroke process by connecting directly to the telestroke site resulted in faster treatment times. Removing the call center from the initial phone call did not delay DIDO times but the downstream effect from removing the step was likely minimized in patients transferred for EVT.
Abstract WP64: Assessment of a Smartphone App-Sensor to Assist Patients in Identification of Neurologic and Cardiac Emergencies: The Emergency Call for Heart Attack and Stroke (ECHAS) Study
Authors: Dhand Amar , Mangipudi Rama , Varshney Anubodh , Crowe Jonathan , Kelly Michael E , Shin Min , Tate Sam , Haddad Haissam , Muller James E , Shavadia Jay S
Published: February 2024

Introduction:
While timely therapy of neurologic and cardiac emergencies can improve outcomes, patients often fail to identify acute events resulting in delays in seeking emergency care. ECHAS is a smartphone application and sensor system aimed to reduce patient-related delay. We performed a retrospective study to test ECHAS in identifying patients who required emergency assessment for possible myocardial infarction (MI) or stroke.

Methods:
We enrolled 202 patients (57 with stroke-like, 145 MI-like symptoms) who presented to the ED at a single center in Canada. Participants answered yes-no questions about their prior history, acute symptoms, and performed a finger-tapping test on an Apple iPhone with ECHAS. Answers resulted in a risk score that guided one of the three triage decisions: 1) call 911, 2) call hotline, or 3) call your primary care physician. The ground truth for the triage decision assessment was the appropriateness of the patient’s visit to the ED. Specificity could not be calculated due to low numbers of patients who did not need emergency evaluation.

Results:
The mean time to complete the acute assessment was 60 seconds for MI and 111 seconds for stroke. ECHAS output recommended 66% of patients call 911, 30% hotline, and 4% primary care follow-up. The sensitivity to identify the need for emergency evaluation was 0.98. The sensitivity to identify patients who were admitted for possible MI or stroke was 1.0. A negative correlation was found between low ECHAS score and prolonged symptom onset to hospital arrival time for MI-like symptoms (r = -0.21, p < 0.05). Patients found ECHAS to be very useable (Fig 1).

Conclusion:
The ECHAS application was highly sensitive and easily usable in guiding patients to identify medical emergencies without input by healthcare personnel. These pilot results will drive a planned 4,000-patient prospective randomized trial to evaluate whether ECHAS will reduce times from symptom onset to first medical contact for MI and stroke.
Abstract WP67: Utilization and Impact of Large Vessel Occlusion Stroke Screening Practices and Selected Target Stroke III Strategies in the Get-with-the-Guidelines Registry Hospitals
Authors: Asif Kaiz S , Xu Haolin , Messe Steven , Park Soojin , Mac Grory Brian , Zachrison Kori S , Goyal Mayank , Southerland Andrew M , Boehme Ameila , Alhanti Brooke , Smith Eric E , Jhadav Ashutosh , Ortega-Gutierrez Santiago , Hassan Ameer E , Leonard Anne D , Fargen Kyle , Panagos Peter D , Jauch Edward C , Sheth Kevin N , Schwamm Lee H , Wira Charles R , Fonarow Gregg C
Published: February 2024

Background:
The utilization and impact of pre-hospital and in-hospital large vessel occlusion (LVO) stroke screening protocols and Target: Stroke phase III (TS III) best-practice strategies on time metrics for endovascular treatment at a national level, have not been studied.

Methods:
We sent an online survey in July 2022 to hospital representatives of 2528 hospitals participating in the GWTG registry about their EMS systems, clinical and imaging protocols, and utilization of selected TS III best-practice strategies (multiple choice, 0-100 scale, and yes/no questions). We obtained Individual patient-level data from the GWTG-Stroke Registry from January 2017 to March 2022. Multivariable linear regression models were performed to investigate the associations of these strategies with door-to-puncture (DTP) in endovascular (EVT) patients.

Results:
Out of 2455 sites that met our inclusion criteria, 1455 sites completed the survey, with a response rate of 59.3%. Hospital-level baseline characteristics, utilization of selected LVO screening practices, and site-reported strategies associated with shorter DTP times are shown (Table 1). Strategies associated with shorter DTP were the performance of simultaneous vascular imaging along with non-contrast CT scan on all stroke patients within 24 hours, and the use of newer technologies for LVO detection in the field leading to a 7.1 min (CI -12.8, -1.5) decrease and a 10 min (CI -18.6, -1.3) decrease in DTP with every 25% increase in the utilization of these strategies, respectively (Table 1).

Conclusion:
The simultaneous performance of vascular imaging with non-contrast CT scan in all stroke patients presenting within 24 hours and the use of newer technologies for LVO detection in the field could lead to shorter DTP times.
Abstract WP70: Novel Weighted FANG-D Scale Scoring to Detect Large Vessel Occlusion
Authors: Crandall Suzanne , Seeberger Lauren C , Yuminaga Jun , Dunlap Sonya
Published: February 2024

Objective:
To determine if a novel weighted FANG-D scoring scale (NWFSS) increases sensitivity and specificity rates of large vessel occlusion (LVO) as compared to those reported with the original FANG-D scale scoring.

Methodology:
The present study used an observational, descriptive design to identify the important variables (field cut, aphasia, neglect, gaze preference, and dense hemiparesis) associated with the likelihood of detecting LVO. We used the FANG-D scale in patients admitted through the emergency department (ED) of a comprehensive stroke center (CSC), from December 2022 through April 2023. The NIHSS was performed and compared with the NWFSS for analysis. Each component was required to have a score ≥ 2(moderate to severe deficits) except dense hemiparesis which required a score ≥3 (significant weakness) to receive one point on the FANG-D scale. A total score of 2 or higher on FANG-D indicated a positive result suggesting LVO. If aphasia or neglect were present with a NIHSS of≥2, it was considered a positive FANG-D score.

Results:
A total of 311 patients were included in the study for analysis with a mean age of 67 ±16.4 years of whom 56.6% were female. The sensitivity and specificity rates were 85.7% (Confidence Interval (CI) =72.8%-94.1%) and 90.5% (CI= 86.2%-93.7%) respectively for positive predictive value of NWFSS to identify LVO. The sensitivity and specificity of the NIHSS has been reported as 86% and 60% respectively for LVO detection. The previous FANG-D study group used lower values in calculating the FANG-D scores and reported a sensitivity rate of 98% and specificity of 76.7%.

Conclusion:
The NWFSS has high specificity and is reliable for LVO prediction. While the NIHSS assesses eleven items sensitive for stroke diagnosis, it may take up to 10 minutes to complete and is not specific for LVO, whereas the FANG-D assesses 5items critical to LVO detection and is simple and fast with completion in <1 minute, minimizing time to intervention. Our study occurred in the ED, but this scale scoring method could be tested in the prehospital setting. The use of a scale with higher specificity for LVO could improve patient outcomes and resource utilization by faster routing of patients to CSCs capable of performing mechanical thrombectomy.
Abstract WP72: National Assessment of Trainee and Non-Vascular Neurology Acute Stroke Decision-Making at StrokeNet Regional Coordinating Centers
Authors: Mamer Lauren , Scott Phillip A
Published: February 2024

Background:
The impact of acute stroke treatment changes, including development of Vascular Neurology, advances in neuroimaging, and endovascular treatment (EVT), on stroke team trainee utilization and decision-making are unknown. For insight into high-performance teams, we surveyed StrokeNet Regional Coordinating Centers (RCCs).

Methods:
A confidential, self-administered, pilot-tested survey was distributed to the site PIs of all 27 StrokeNet RCCs. The survey assessed in-person acute stroke response staffing, involvement of trainees, decisional autonomy, and attitudes regarding decision-makers. Absent data fields excluded. Descriptive statistics presented.

Results:
18 of 27 RCCs completed the survey (gross response rate 66%). 67% (12/18) reported trainees (Resident and/or Fellow) always respond to ED and inpatient activations and 39% (7/18) that trainees always respond to EVT activations. 44% (7/16) and 27% (4/15) reported Nurse Practioner (NP) and Physician Assistant (PA) involvement in ED stroke responses, respectively. Thrombolytic decision-making authority (prior to attending staffing) rested with Fellows and Residents in 61% (11/18) and 18% (3/17), respectively. No NP or PA independent use was identified (0%). 89% (16/18) reported attending Emergency Physicians did not order thrombolytics prior to stroke team consultation. Apart from Vascular Neurology, which was universally acceptable, acceptability by attending specialty for thrombolytic ordering was: Emer Med (88%), Gen Neurology (75%), Neurosurgery (33%), Fam Med (12%), Int Med (11%) and Radiology (6%). Acceptability for EVT decisions was Neurosurgery (94%), Gen Neurology (59%), Radiology (50%), Emer Med (44%), Fam Med (12%) and Int Med (11%).

Conclusions:
At StrokeNet RCCs, acute stroke teams have significant trainee involvement in both ED and inpatient acute stroke responses and allow trainees significant autonomy. Stroke team involvement likely occurs early in the ED, as few reported attending emergency physicians ordering thrombolytics prior to consultation. Respondents varied in acceptability of different specialties as decision-makers for both thrombolytics and EVT. These findings have potential workforce, education, and training implications.
Abstract WP74: Organized System of Care Improves Door to Needle Times in Rural Montana
Authors: Guzman Joani , Davis Daniel , McNamara Mike , Oser Carrie , Armstrong Christina L , Trethewey Janet M , Myers Gary , Yang Hannah
Published: February 2024

Early reperfusion is critical to improved outcomes from acute stroke, with door-to-CT times < 25 min and door-to-needle times
<
60 min as key performance metrics. These may be difficult to achieve in critical access hospitals (CAHs) due to low volumes, longer EMS transport, delays to provider response, challenges in obtaining rapid CT, and lack of access to neurology consultation. Each of these represent appropriate targets for performance improvement efforts.

Methods:
In 2022, The Montana Stroke Initiative began a quality improvement project to improve door-to-CT and door-to-needle times for acute stroke in rural Montana (MT) with the following objectives: 1. Engage more CAHs in the stroke registry. 2. Initiate monthly clinical learning collaboratives to share stroke data and best practices in reducing door-to-CT times. 3. Create statewide stroke order-sets. 4. Involve stroke coordinators and physicians from MT’s certified stroke centers in providing education on the order-sets, NIHSS, and the importance of data abstraction for quality improvement. The Montana Department of Health and Human Services collects statewide stroke data using the Get With The Guidelines®-Stroke registry. For this analysis, all CAH acute stroke patients evaluated for thrombolytic therapy in 2021 and 2022-23 were included. These cohorts were compared to total number of patients and the primary outcome measures of door-to-CT time <25 min and door-to-needle time
<
60 min. Registry participation doubled from 12 hospitals in 2021 to 24 in 2022-23. The total number of suspected stroke patients increased from 126 patients in 2021 to 269 patients in 2022-23. Mean Door-to-CT time decreased from 56 min to 39 min (p=0.004), with Door-to-CT times 25 min increasing from 31.7% to 50.6% (p<0.001). Thrombolytic therapy was given to a total of 10 patients in 2021 and 36 patients in 2022-23. Mean Door-to-Needle time decreased from 118 min to 77 min (p=0.026), with Door-to-Needle times 60 min increasing from 10.0% to 33.3% (p=0.24).In conclusion, an organized effort to improve door-to-CT processes for suspected stroke patients, including sharing data and best practices, and providing focused education, has resulted in more patients receiving lytic therapy in the recommended time of
<
60 minutes.
Abstract WP77: Changes in Acute Stroke Management and Outcomes in Korea Between 2013-2014 and 2018
Authors: Kim Jun Yup , Kim Do Yeon , Kang Jihoon , Kim Beom Joon , Kim Seong-Eun , Park Hong-Kyun , Cho Yong-Jin , Park Jong-Moo , Lee Kyungbok , Lee Ji Sung , Lee Juneyoung , Kwon Yong Uk , Bae In Ok , Kim Gui Ok , Bae Hee-Joon
Published: February 2024

Purpose:
The quality of acute stroke care can be improved through the nationwide compulsory quality assessment. Acute stroke quality assessment (ASQA) covers most acute stroke patients treated in acute care hospitals in Korea. We evaluated the changes of acute stroke management and outcomes between 2013/2014 and 2018 in Korea.

Methods:
We compared the most recent available ASQA data from 2018 with the data from 2013/2014. Patients with ischemic stroke (IS), subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH), who were admitted via emergency rooms within 7 days of onset at hospitals treating 10 or more cases during the each 3-month (2013, 2014) and 6-month (2018) survey period were selected. We grouped 2013 and 2014 into one group and compared them with 2018.

Results:
A total of 19,599 acute stroke cases in 2013/2014 and 28,286 cases in 2018 were enrolled at 216 and 248 nationwide hospitals, respectively. Age of stroke patients increased slightly (67.1±13.5 vs 68.2±13.8,
p
<0.001), and the proportion of stroke types slightly increased ICH and decreased SAH. The proportion of severe stroke was decreased. The number of hospitals equipped with stroke units increased. Mean bed size increased, but there was no difference in the number of stroke specialists by hospital. IVT and EVT were performed in 8.7% and 5.3% among IS patients in 2013/2014, respectively. In 2018, IVT rates decreased to 6.3% (
p
<0.001), and EVT rates increased to 9.8% (
p
<0.001). In particular, IVT rates significantly decreased from 1.3% to 0.2% in those over 80 years of age, and EVT rates increased from 0.7% to 2.4%. Decompressive surgery rates in ICH patients decreased slightly from 28.0% to 25.2% (
p
=0.009). In SAH, clipping rates decreased from 34.7% to 24.3% (
p
<0.001), and coiling rates increased significantly from 39.8% to 53.0% (
p
<0.001). One-year mortality significantly decreased from 22.0% to 18.2% in all stroke patients (
p
<0.001). Mortality decreased at 1 month and 3 months, also, and decreased in all patients with IS, ICH, and SAH.

Conclusions:
This study showed that while stroke patients had improved outcomes from 2013/2104 to 2018 in Korea, there is still room for improvement, particularly in IVT rates.
Abstract WP97: Disparities in Health-Related Quality of Life Among Adults With Heart Disease, Stroke, and Both Conditions
Authors: Jacobs Molly , Evans Elizabeth , Ellis Charles
Published: February 2024

Background:
Notable racial and ethnic disparities exist in cardiovascular disease (CVD) and stroke epidemiology; however, few studies have assessed the disparate quality of life (QOL) among individuals living with CVD, stroke, or both. This study evaluated the impact of these conditions on health related QOL (HRQOL) and quantified demographic disparities.

Methods:
Using data from the 2021 National Health Interview Survey (NHIS), we calculated the Health and Activity Limitation Index (HALex)—a generic HRQOL measure comprising perceived health and activity limitations—for 29,482 adults. Stratified analysis and ordinary least-squares regressions were used to adjust for sex, age, income, education, urbanicity, marital status, household size, region of residence, and insurance status. Differences in HRQOL were estimated across racial and ethnic groups with and without CVD, stroke, or both conditions. To test the robustness of study findings, analyses were repeated using the EQ-5D.

Results:
Adjusted HRQOL was lower for Blacks (-0.014, SE=0.004) and Hispanics (-0.012, SE=0.003) compared to Whites. Compared those with neither CVD nor stroke, individuals with CVD only (-0.21, SE=0.015), stroke only (-0.29, SE=0.028), and both conditions (-0.44, SE=0.040) had 20% to 44% lower HRQOL. Even after for age, income, education, and income, diagnosis with stroke only (-0.19, SE=0.081), CVD only (-0.12, SE=0.051), or both (-0.44, SE=0.040) lowered the HRQOL more for Blacks than Whites, while other racial/ethnic groups showed no statistically significant difference HRQOL. In general, geographic location, sex, and household composition had little impact on HRQOL, but higher age, lower educational attainment, and low/middle income was associated with significant reductions in HRQOL.

Conclusion:
CVD and stroke were independently associated with significantly low HRQOL, their co-occurrence has a substantially negative impact on HRQOL for all individuals particularly Blacks who had the largest HRQOL impact in all three condition groups. Findings suggest that public health interventions should be aimed at improving HRQOL among individuals diagnosed with these conditions, especially the most vulnerable groups.
Feed supplementation with Ligilactobacillus salivarius PS21603 optimises intestinal morphology and gut microbiota composition in weaned piglets
Authors: Cuevas-Gómez I. , de Andrés J. , Cardenas N. , Espinosa-Martos I. , Jiménez E.
Published: February 2024

Post-weaning diarrhoea in piglets remains an important cause of economic losses for swine producers. Feed supplementation with probiotics is one of the alternatives to antibiotics used to reduce the impact of such gastrointestinal disease. The aim of the present study was to evaluate the effect of Ligilactobacillus salivarius PS21603 supplementation on the intestinal structure and the gut microbiota composition of weaned piglets. Safety and tolerance of L. salivarius PS21603 were previously evaluated in a 28-days study using 384 weaned piglets (28 ± 2 days old and 7.5 ± 1.5 kg) divided in three treatment groups: T1: Basal diet + L. salivarius PS21603 109 cfu/day, T2: Basal diet + L. salivarius PS21603 107 cfu/day, and T3: Basal diet (control group). For the present study, 16 piglets per treatment group were randomly selected and faecal samples were collected on day 0 (weaning) and 28 of study. At the end of study, three males and three females per treatment were euthanised. Intestinal morphometric values were measured after necropsy. Faecal counts of Escherichia coli were evaluated by culture techniques, and faecal microbiota composition was assessed by high-throughput sequencing. All data were analysed and compared between treatment groups. Supplementation with L. salivarius PS21603 caused an increase in the intestine length of piglets from T1 and in the villous height:crypt ratio of piglets from T2 (P < 0.05) compared to T3 on day 28. According to the Shannon Diversity Index, microbiota diversity increased on day 28 compared to day 0, with no significant differences observed between treatments. The main changes in the relative abundance of bacteria at the phylum, family, and genus levels were observed between different sampling time points. However, piglets from T1 and T2 had lower faecal E. coli counts than T3 on day 28 (P < 0.05). Moreover, supplementation with L. salivarius PS21603 modulated gut microbiota through a more optimal composition, reducing Escherichia and increasing Bifidobacterium relative abundance in piglets from T1 (P < 0.05) from the beginning to the end of the study. Therefore, the strain L. salivarius PS21603 has shown probiotic properties to be used as feed additive in the pig industry, along with good hygiene and farm management practices, for the prevention and/or treatment of post-weaning diarrhoea in piglets.
Measuring Innovation and Collaboration System using Big Data: A Case Study about Ho Chi Minh City
Authors: Park Han Woo
Published: February 2024

Academic, government, and industry researchers have attempted to build some theoretical and empirical ways to understanding how to innovate and interact in data- driven contexts in recent years. However, it does not appear to go above and beyond our expectations in terms of offering fresh views and resources to investigate this trend in terms of measurement. In this brief study, I show how Dimensions.ai, a new academic big data resource, can be used to assess knowledge-based innovation processes in emerging and transitional countries like Vietnam. This article investigates creativity and collaboration in Ho Chi Minh City using a “n-tuple helix” framework based on Loet Leydesdorff’s sociological theory of communication. From a social network standpoint, I argued that a city’s innovation system is inextricably linked to its position in intercity and global co-authorship networks. This shows how the helix model and applications can be utilized to discover a data-driven society.
Conversation: Potential for Inclusive Populist Masculinities
Authors: Hakola Outi , Salminen Janne , Winberg Oscar
Published: February 2024

This conversation text responds to Larry A. Swatuk’s thoughtful review of our book The Culture and Politics of Populist Masculinities (Hakola, Salminen, Turpeinen & Winberg, 2021). Swatuk inspired us to consider what inclusive populist masculinity could look like. In our conversation, we argue that Ukrainian President Volodymyr Zelenskyy offers us a case, where the evolution of Zelenskyy’s political persona from his roots in entertainment to his presidency brings forward an inclusive gender potential. Initially challenging traditional gender norms, Zelenskyy’s early presidency sought to deconstruct hierarchical political cultures and gender assumptions. However, with the onset of the Russian invasion in 2022, his gender performances evolved towards more conventional masculinity, yet leaving room for inclusive interpretations. Zelenskyy, along with other figures, has redefined masculine archetypes in intersections of popular culture and politics, which shows that any deterministic categories to understand populist masculinities downplay the cultural complexity and varied contexts of the phenomenon.
Difficult texts: the author and content of the commandment in 1 John 3.23
Authors: James Rob
Published: February 2024

Three interpretative problems with 1 John 3.23 are addressed. First, it is suggested that the subject of the verse changes halfway through, from ‘God’ to ‘Jesus Christ’. Second, belief ‘in the name’ of Jesus is taken to mean the acknowledgement of Jesus’ ultimate significance. Third, the single command both to believe and to love one another is suggested to be a way of opening up the life of the disciple to the acceptance of Jesus’ ultimate significance and a way in which such acceptance can be measured or deduced.
Polydopamine-mediated in situ synthesis of gold nanoparticles uniformly distributed on silk fibers as reusable catalysts for efficient 4-nitrophenol reduction
Authors: Zhang Zhendong , Xiao Jing , Wang Chunyou , Song Fangmiao , Sun Wei , Wang Chenhui , Lu Zhisong , Zhang Yan
Published: February 2024

Developing green fibrous materials with uniformly distributed metal nanoparticles for highly efficient and recyclable catalysis remains a major challenge. Herein, we developed a simple, effective, and green method to immobilize gold nanoparticles (AuNPs) on polydopamine (PDA)-functionalized silk fibers (SFs) for efficient catalytic reduction of 4-nitrophenol (4-NP). The density and size of AuNPs on the PDA-coated SFs can be tuned by adjusting precursor concentration and synthesis duration, respectively. The AuNPs-PDA-SFs catalysts prepared under optimized conditions could catalyze the reduction of 4-NP, 4-nitroaniline (4-NA), and 4-amino-3-nitrophenol (4-A-3-NP) at the apparent rate constants of 0.087, 0.091, and 0.063 min−1, respectively. After six rounds of flow-through reduction of 4-NP, the AuNPs-PDA-SFs could maintain a 4-NP conversion rate greater than 92%, indicating their superior reusability and consistent catalytic activity. Due to the protein properties of SFs, the AuNPs-PDA-SFs can be degraded by enzymes and alkali solutions. This work may provide new insights for designing advanced fiber-supported recyclable catalysts with high catalytic performance and reusability in wastewater treatment.
Exploring the lived experience: impact of dementia diagnosis on individuals with cognitive impairment - a qualitative study
Authors: Molvik Inger , Kjelvik Grete , Selbæk Geir , Rokstad Anne Marie Mork
Published: February 2024

Objective

Although knowledge about the experience of being diagnosed with dementia is limited, with the expected rise in dementia’s prevalence in the coming decades, such knowledge is pivotal for the people diagnosed, their families, and healthcare planners. Thus, the aim of our study was to explore the experience of living with cognitive impairment and dementia and the impact of being diagnosed with dementia.

Method

A qualitative design was applied. Participants were recruited based on age-adjusted values below ​​threshold values on the Montreal Cognitive Assessment Scale (i.e. 70–79 years, < 22; 80–89 years, < 21; 90 + years, < 20), and the sample ultimately included 15 participants: six with and nine without a documented dementia diagnosis. Qualitative content analysis was performed on the transcribed interviews in four steps to identify codes, categories, and the overall theme.

Results

Three major categories emerged from the interviews: (1) experiences with changes, (2) experiences with being diagnosed with dementia, and (3) existential experience. All participants with and most participants without a dementia diagnosis experienced changes in cognition.

Conclusion

Our findings imply that being diagnosed with dementia is a relief because it explains observed cognitive and functional decreases and reduces confusion, shame and stigma. However, it also raises concerns about an unknown future. Most participants not diagnosed with dementia reported having little or no difficulty with everyday living and leading a fulfilling life. Those findings emphasise the significance of timely versus early diagnosis.
Pulmonary function in children post -SARS-CoV-2 infection: a systematic review and meta-analysis
Authors: Bakhtiari Elham , Moazzen Nasrin
Published: February 2024

Objective

There are some concerns regarding long-term complications of COVID-19 in children. A systematic review and meta-analysis was performed evaluating the respiratory symptoms and pulmonary function, post-SARS-CoV-2 infection.

Methods

A systematic search was performed in databases up to 30 March 2023. Studies evaluating respiratory symptoms and pulmonary function after COVID-19 infection in children were selected. The major outcomes were the frequency of respiratory symptoms and the mean of spirometry parameters. A pooled mean with 95% confidence intervals (CIs) was calculated.

Results

A total of 8 articles with 386 patients were included in meta-analysis. Dyspnea, cough, exercise intolerance, and fatigue were the most common symptoms. The meta-mean of forced expiratory volume (FEV1) and forced vital capacity (FVC) was 101.72%, 95% CI= (98.72, 104.73) and 101.31%, 95% CI= (95.44, 107.18) respectively. The meta-mean of FEV1/FVC and Forced expiratory flow at 25 and 75% was 96.16%, 95% CI= (90.47, 101.85) and 105.05%, 95% CI= (101.74, 108.36) respectively. The meta-mean of diffusing capacity for carbon monoxide was 105.30%, 95%CI= (88.12, 122.49). There was no significant difference in spirometry parameters before and after bronchodilator inhalation.

Conclusions

Despite some clinical respiratory symptoms, meta-results showed no abnormality in pulmonary function in follow-up of children with SARS-CoV-2 infection. Disease severity and asthma background had not confounded this outcome.
The journey within: mental navigation as a novel framework for understanding psychotherapeutic transformation
Authors: Kabrel Mykyta , Tulver Kadi , Aru Jaan
Published: February 2024

Background

Despite the demonstrated efficacy of psychotherapy, the precise mechanisms that drive therapeutic transformations have posed a challenge and still remain unresolved. Here, we suggest a potential solution to this problem by introducing a framework based on the concept of mental navigation. It refers to our ability to navigate our cognitive space of thoughts, ideas, concepts, and memories, similar to how we navigate physical space. We start by analyzing the neural, cognitive, and experiential constituents intrinsic to mental navigation. Subsequently, we posit that the metaphoric spatial language we employ to articulate introspective experiences (e.g., “unexplored territory” or “going in circles”) serves as a robust marker of mental navigation.

Methods

Using large text corpora, we compared the utilization of spatial language between transcripts of psychotherapy sessions (≈ 12 M. words), casual everyday conversations (≈ 12 M. words), and fictional dialogues in movies (≈ 14 M. words). We also examined 110 psychotherapy transcripts qualitatively to discern patterns and dynamics associated with mental navigation.

Results

We found a notable increase in the utilization of spatial metaphors during psychotherapy compared to casual everyday dialogues (U = 192.0, p = .001, d = 0.549) and fictional conversations (U = 211, p < .001, d = 0.792). In turn, analyzing the usage of non-spatial metaphors, we did not find significant differences between the three datasets (H = 0.682, p = 0.710). The qualitative analysis highlighted specific examples of mental navigation at play.

Conclusion

Mental navigation might underlie the psychotherapy process and serve as a robust framework for understanding the transformative changes it brings about.
Implementing internet-based cognitive behavioural therapy (moodgym) for African students with symptoms of low mood during the COVID-19 pandemic: a qualitative feasibilty study
Authors: Ncheka Joyce M. , Menon J. Anitha , Davies E Bethan , Paul Ravi , Mwaba Sidney O C , Mudenda John , Wharrad Heather , Tak Harsa , Glazebrook Cris
Published: February 2024

Background

Online therapies have been shown to be effective in improving students’ mental health. They are cost-effective and therefore have particular advantages in low-income countries like Zambia where mental health resources are limited. This study aimed to explore the perceived impact of the COVID-19 pandemic and the feasibility of implementing an Internet-Based Cognitive Behavioural Therapy (iCBT) intervention (‘moodgym’) to improve resilience in vulnerable Zambian students.

Methods

The study was a qualitative interview study. Participants identifying as having symptoms of low mood and completing a baseline, online survey (n = 620) had the option to volunteer for a semi-structured interview to explore views about their experience of the pandemic and the acceptability and perceived benefits and limitations of using moodgym.

Results

A total of 50 students (n = 24 female, n = 26 male) participated in the study. One theme with 4 sub-themes, captured the severe emotional and social impact of the COVID-19 pandemic. A second, very strong theme, with 5 sub-themes, reflected the considerable negative effects of the pandemic on the students’ educational experience. This included the challenges of online learning. The third theme, with three subthemes, captured the benefits and acceptability of moodgym, particularly in terms of understanding the relationship between thoughts and feelings and improving academic performance. The fourth theme described the technical difficulties experienced by students in attempting to use moodgym.

Conclusion

COVID-19 caused fear and impacted wellbeing in vulnerable students and severely impaired the quality of students’ educational experience. The findings suggest that moodgym might be a valuable support to students in a low-income country.
Level of completion of a continuum of age-appropriate infant feeding practices and barriers among breastfeeding mothers in Ethiopia: a mixed methods study
Authors: Mohammed Shikur , Worku Alemayehu , Girma Eshetu
Published: February 2024

Background

Ethiopia has committed to ending undernutrition by implementing nutrition intervention strategies, including promoting optimal feeding and care practices. To monitor and evaluate optimal infant feeding practices, it is crucial to have reliable and quality data on infant feeding indicators. Therefore, this study aimed to evaluate the extent to which breastfeeding mothers in Ethiopia have completed the continuum of age-appropriate infant feeding practices and the barriers they face.

Methods

In this study, a sequential explanatory mixed method design was used. First, using datasets from performance monitoring for action (PMA) in Ethiopia, we estimated the level of the outcome and associated factors. In the quantitative (QUAN) analysis, 1755 mothers of infants were included to generate estimates. A generalized estimating equations logistic regression model was used to identify factors associated with the outcome by accounting for the clustering nature of the data by enumeration area. Then, a qualitative (QUAL) study was conducted with 14 mothers to explore their infant feeding practices using an in-depth interview guide and analyzed using a thematic approach. Results from both quantitative and qualitative data were integrated, described under the identified thematic areas, and interpreted concurrently.

Results

This study showed that 13.96% (95% CI: 12.4 to 15.6%) of mothers practiced a complete continuum of age-appropriate infant feeding. Over 8% of mothers did not practice any optimal feeding. Nearly 47% of mothers practiced optimal breastfeeding, and one-fifth of mothers practiced optimal complementary feeding. Results from both quantitative and qualitative data showed that mothers’ complete continuum of age-appropriate infant feeding practice was affected by their level of income, knowledge, and attitude towards optimal infant feeding, as well as by important others, including husbands, grandmothers, and health workers.

Conclusion

The level of a complete continuum of age-appropriate infant feeding practice is low among breastfeeding mothers in Ethiopia. Mothers’ optimal feeding practices in Ethiopia are affected by their level of knowledge and attitude towards infant feeding, income or access to food, and health workers or family members. Therefore, collaborative efforts are needed to strengthen mothers’ education on the health benefits of optimal infant feeding and design and promote strategies to improve household income or access to diverse food.
Factors determining the quality of life of homeless people staying in support centers for people in the crisis of homelessness. Pilot study
Authors: Konrady Jakub , Talarska Dorota
Published: February 2024

Background

The aim of the study was to discuss the issues of the homelessness crisis and to present the assessment of the quality of life of people experiencing a homelessness crisis, taking into account various aspects of life and everyday functioning.

Methods

This was a pilot cross- sectional study carried out using an anonymous survey. The author’s questionnaire, the WHOQOL-Bref scale and the Beck depression scale were used. From among the support centers for people in the homelessness crisis operating in the city of Poznań, the 2 largest centers were selected. The obtained results were based on the statistical analysis of the collected data.

Results

The study group consisted only of people in the crisis of homelessness staying at the support centers at the time of the study. The analysis included data from 114 people, including 28 (24.6%) women. The youngest participant was 21 and the oldest 76 years old. The average period of homelessness was 86 months. 55.3% of respondents showed symptoms of depression. The main cause of homelessness was their family situation (59.6%), financial problems (36.0%) and the need to leave the apartment (13.2%). Abuse of alcohol before the homelessness crisis was reported by 96 (84.2%) respondents. The WHOQOL– Bref questionnaire was used to assess the quality of life. The psychological domain was rated the highest (62.09 ± 16.94 points, the lowest somatic domain (53.25 ± 18.71 points). The quality of life of homeless people was positively related to their economic situation, depression and health status. It was shown that sex, age and education had no influence (p > 0.05) on the assessment of the quality of life of people experiencing the crisis of homelessness.

Conclusions

The economic situation is the main factor affecting the quality of life within the psychological and social domain. Health status is the main factor affecting the quality of life within the somatic and environmental domain. The biggest dream of the respondents was to have a flat and improve their financial situation.