bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP231: Nutrition And Food Insecurity Among Stroke Survivors
Authors: Ahmed Mariam , Almohamad Maha , Cohen Audrey S , Wiley Christian , Ibrahim Lamya , Uhlig-Reche Hannah , Cooksey Gabretta , Okpala Munachi N , Jones Erica , Altema-Johnson Daphene , Hernandez Daphne , Sharrief Anjail Z
Published: February 2022

Background:
Food insecurity (FI) is a social determinant of health (SDOH) that impacts access to adequate quality food, which may result in poor nutrition and increased cardiovascular risk. In chronic disease populations, FI is associated with poor nutrition and higher vascular risk. We sought to investigate FI in stroke survivors (SS) and hypothesized that FI would be associated with inadequate fruit and vegetable (FV) intake. We also evaluated relationships between FI, FV intake, and other clinical and demographic factors.

Methods:
We conducted a retrospective review of SS presenting for an initial visit to the UTHealth Stroke clinic from 1/28/21 to 7/31/21. We included SS who completed a 2-question FI screener (Hunger Vital Sign) and the Block Fruit and Vegetable (FV) Frequency screener. FI and FV scores were determined with standard techniques; FV score was dichotomized (score < 11 indicates inadequate intake - validated). Patient data were self-reported. Chi-squared, fisher’s exact, and t-tests were conducted for univariate analysis (Table).

Results:
Among 383 potentially eligible SS, we included 285 who completed the FV and FI questionnaires (X
age
=62; 50% female). Of those, 39 (13.7%) were FI and 149 (52.3%) had inadequate FV. Among demographic and clinical factors, only race/ethnicity was associated with FI. Compared to White SS, Hispanic and Black SS had higher odds of FI (OR 3.62, 95%CI 1.19-11.03 and OR 3.24, 95% CI 1.07- 9.83, respectively). FI was not associated with inadequate FV intake. Inadequate FV intake was not associated with clinical or demographic factors; however, there were trends of better FV intake among currently employed SS and those with more than high school education.

Conclusions:
We did not find associations between FI and inadequate FV intake. This suggests that there may be other SDOH that contribute to poor dietary intake in this population.
Abstract WP242: Stabilizing Mast Cell Signaling From The Gut Mitigates Neuroinflammation In The Brain Post Stroke
Authors: Blasco-Conesa Maria P , Blixt Frank , Honarpisheh Pedram , Korf Janelle , Lee Juneyoung , McCullough Louise , Banerjee Anik , Ganesh Bhanu P
Published: February 2022

Background:
Clinically, ~65% of stroke patients are left with functional impairments after stroke and 15% die shortly after their stroke. Increasing evidence suggests that peripheral inflammatory responses after stroke play an important role in determining neurological outcome. Mast cells (MCs) are one of the most rapid responders to injury. MCs release histamine (HA), a pro-inflammatory transmitter that enhances inflammation. Gut MCs are a major source of HA.

Hypothesis:
We hypothesize that aged animals stroke will lead to robust gut mucosal MC-activation and HA release, with subsequent gut disruption and inflammation. Stabilizing peripheral MCs will decrease peripheral/central inflammation, MC trafficking, and improve stroke outcomes.

Methods:
We used a reversible middle cerebral artery occlusion (MCAO) model of ischemic stroke in aged (18mo) wild-type male mice to investigate the MC role in neuroinflammation post-stroke (PS). We stroke the aged animals and treated the animals with 25 mg/kg BW of cromolyn (MC stabilizer), oral gavage. Cromolyn was administered at 3-h, 10-h, 24-h and every other day PS. Positive control group that were stroked but treated only with saline. In total, four groups stroke and sham (surgery control), out of these animals one set received cromolyn and one set received saline. We sacrificed animals at 3-h, 24 –h and 3-days after cromolyn treatment post-stroke.

Results:
We found that cromolyn administration significantly reduced MC numbers in the brain at 24-hours (P<0.0051) and 3 days (P<0.0005) PS. In association with that we found behavioral changes with improved motor activity at 3-days post-stroke animals after cromolyn treatment. We also found that gut mast cells are significantly reduced after cromolyn treatment in the 24 hours and 3-days PS groups (P<0.01). Additionally, we found significant decrease in NDS at the 3-days PS animals which was not very prominent at 24-hours (P<0.0125).

Conclusion:
Our results show that preventing MC-HA release post-stroke possess clinical value in preventing neuroinflammation PS. Future studies will focus on IgE and FcεR1 due to its cross-linking role in activating MC-HA release.
Abstract WP247: Two Novel Interferon Signaling Proteins (Ifi27l2a And Ifitm3) Regulate Microglial Inflammation With Brain Aging And Following Stroke.
Authors: Kim Gab Seok , WU TING , Andersohn Alexander , Harmon Elisabeth , Doan Andrea , Cantu Gutierrez Manuel E , Wythe Joshua D , Marrelli Sean P
Published: February 2022

Interferon signaling drives neuroinflammation in AD and stroke. Microglia (MG) play a critical role in initiating and spreading inflammation and are involved in the chronic recovery phase following stroke. We compared the MG transcriptomic response to stroke in young and aged mice by single-cell RNA sequencing (scRNAseq) to identify novel key players in inflammation.

Methods:
Permanent distal middle cerebral artery occlusion (pdMCAO) or sham surgery was performed in young and aged mice (3 & 20 months). scRNAseq was performed to define the transcriptional signature in brains at 14-days after stroke versus sham surgery. Primary MG culture was used to compare the mRNA levels of Ifi27l2a and Ifitm3 after cytokine treatment. We used qRT-PCR to validate scRNAseq findings and compare specific MG genes.

Results:
Using comprehensive scRNAseq analysis, our unbiased approach identified Ifi27l2a and Ifitm3 as the most highly up-regulated genes in aged MG following stroke. Further analysis showed a positive correlation between Ifi27l2a and Ifitm3 in MG (
R
=0.4, p<0.001) as well as in all cells. Our qRT-PCR results validated scRNAseq findings and further showed that Ifi27l2a was significantly up-regulated in the thalamus of aged brains (p=0.04; n=4 young/aged). Expression was increased in cortex, but below significance level (p=0.23). We also found upregulation of Ifitm3 in brain at PSD 3 (
p
=0.01), and trending at PSD 14 (
p
=0.08) (n=5-6 stroke vs. sham). In contrast, Ifitm1 and Ifitm2 were not changed. Interestingly, Ifitm3 was recently proposed as an activator to γ-secretase. In vitro exposure of MG to inflammatory cytokines (TNFα and IFNγ, 6 hrs) caused significant increase in Ifi27l2a (
p
=0.03, n=5-6) and Ifitm3 mRNA (p=0.02, n=5-6) compared to untreated MG. The in vitro co-expression of these genes was also well correlated (
R
=0.5).

Conclusions:
We identified Ifi27l2a and Ifitm3 as highly up-regulated and correlated genes in MG in aging and following stroke. Our findings suggest that co-expression of Ifi27l2a and Ifitm3 may contribute to neuroinflammation. Further studies will be required to identify the specific functions of these genes and to determine the therapeutic potential of targeting these proteins to regulate neuroinflammation in aging and stroke.
Abstract WP30: Zoom Or In The Room, Meeting The Stroke Education Standard
Authors: Friedrich Sherri H , Evans Cobb Cheryl
Published: February 2022

Background:
Comprehensive Stroke Center nurses are required to receive 8 hours of stroke education annually; meeting this objective has been a challenge for administrators due to staffing shortages as well as the need to social distance during the COVID pandemic prompting virtual learning as a method to meet these standards. Web based courses often lack the multiplicity of diverse learning modalities needed for success.

Purpose:
Our objective was to provide a meaningful way to provide stroke education using the six perceptual modalities needed for adult learning which included visual, aural, printed, tactile, interactive, and kinesthetic learning.

Methods:
The stroke administrative team conducted a needs analysis based on nursing requests, outcome metrics, and requirements of the Joint Commission. A hybrid approach was delivered to the staff using four hours of classroom didactics, three hours of online classes, and one hour of education at hospital skills fairs, and unit meetings. Classrooms utilized social distancing, requiring multiple classes to be offered.

Results:
Nurses were surveyed with a 12 question Likert scale about how well they were prepared to integrate learned material into clinical practice comparing both virtual and live modalities. They were also asked about individual learning modalities. Twenty-five people responded to the survey. Only 12% of virtual learner respondents felt strongly prepared to care for stroke patients compared to 76% of classroom learners. Seventy-nine percent preferred classroom learning compared to 17% virtual, with a 4% hybrid preference. Learning preferences were multifactorial for visual, aural, printed, tactile, interactive, and kinesthetic learning being 95%, 48%, 56%, 40%, 11%, and 20% respectively.

Conclusions:
Virtual learning provides solutions in difficult situations, however classroom education is the preferred method of learning for healthcare professionals delivering evidenced based care for acute stroke patients. Planning committees should at least consider a hybrid approach that offer classroom time to caregivers.
Abstract WP32: Thinking Outside The Box In Delivering Advanced Stroke Care In A Pandemic
Authors: HENDERSON Kathleen A
Published: February 2022

Background:
The challenges presented by the COVID-19 Pandemic have caused healthcare providers, hospitals, and systems of care to re-think how care is provided to other acute time-sensitive diseases, such as stroke. Stroke admissions to hospitals decreased during the initial surge of COVID-19 cases.

Purpose:
To ensure Stroke patients who are eligible for endovascular therapy (EVT) receive timely access to evaluation and treatment when healthcare systems may be too overwhelmed with lack of post-procedural ICU beds and resources.

Method:
As a Primary Stroke Center (PSC), patients with stroke symptoms are quickly evaluated for potential treatment and advanced therapy. With Rapid software imaging, CTA and CT-P are readily available and reliable tools to diagnosis Large Vessel Occlusions (LVO). When eligible for EVT, patients are transferred emergently to a Comprehensive Stroke Center. With limited resources in the region, delays in care and transfers, ED and ICU beds were not readily available. Neuro-interventionalists were available to perform EVT but limited for lack of ICU bed availability. The CSC and PSC collaborated to develop a plan to transfer eligible patients for the EVT and transfer patient back to PSC ICU for post-procedure care. This allows the patient to receive appropriate and timely stroke care despite limited access to ICU beds at the CSC.

Results:
The CSC collaborated with the PSC to put this contingency plan into place. When an EVT eligible patient is identified at the PSC, the CSC is contacted for evaluation. If the patient is a candidate, the PCS admits patient to ICU and emergently transfers to CSC for outpatient procedure. This was approved by the billing department at both facilities.

Conclusions:
Modifications to stroke algorithms and care may be necessary during a Pandemic to maintain safe, efficient, and effective care. Communication and collaboration are key between stroke centers and stroke systems of care to facilitate positive outcomes without adding more challenges to an overwhelmed healthcare system
Abstract WP35: Promoting Staff Engagement Through Recognition Of Stroke Excellence
Authors: Hartman Chelle , Duke Kimberley
Published: February 2022

Background and Purpose:
In 2019, two sister facilities identified opportunities to decrease Door to Needle (DTN) and Door in Door Out (DIDO) times. Several goals were established to decrease these times and were set to reflect recommended “Best Practice” in administering IV Alteplase and transfer to higher level of care for Endovascular Therapy (EVT). It was observed that staff engagement played a crucial role in decreasing both DTN and DIDO times at each facility. To align with the new facility DTN (less than 30 and 45 minutes) and DIDO (less than 90 minutes) goals, a staff engagement program was developed.

Methods:
To promote staff engagement, the “Recognition of Stroke Excellence” (R.O.S.E.) Award was created to encourage staff commitment in reaching the new goals. “Stroke Teams consisted of ED Providers, nursing staff, ED techs, medical imaging techs, health unit coordinators, lab techs and pre-hospital personnel. Teams that administered IV Alteplase in less than 30 and 45 minutes were presented with a lapel pin, certificate of accomplishment and recognition displayed in the “Stroke Zone”. To address challenges effecting DIDO times at each facility, individual goals were established. Facility one set a DIDO goal of less than 75 minutes while facility two set separate goals of less than 90 and 60 minutes. Stroke Teams that met these expectations were also presented with a lapel pin, certificate of accomplishment and recognition displayed in the “Stroke Zone”.

Results:
Implementation of the R.O.S.E award increased staff engagement and created friendly competition amongst team members. Staff compete to get the most R.O.S.E. Award recognition lapel pins and “bragging rights” for best DTN and DIDO times. Since the R.O.S.E. award was established, there has been an overall decrease in DTN and DIDO times at each facility. In addition, the percentage of patients receiving IV Alteplase less than 30 and 45 minutes increased across the board.

Conclusion:
Staff engagement plays a significant role in caring for the acute stroke population and has a positive impact on decreasing DTN and DIDO times. “Recognition of Stroke Excellence” helps to promote a collaborative approach by fostering teamwork and improving staff morale.
Abstract WP43: Modeling The Decay In Probability Of Receiving Endovascular Thrombectomy Based On Time From Stroke Onset
Authors: Paydarfar Daniel A , Holodinsky Jessalyn K , Kamal Noreen
Published: February 2022

Introduction:
Large-vessel occlusion (LVO) stroke patients with infarct core volumes greater than 70 mL do not meet current AHA guidelines for thrombectomy eligibility. Therefore, it is important to understand how time-dependent infarct core growth translates to a patient’s declining probability of thrombectomy eligibility. Modeling the probability that a suspected LVO patient would qualify for thrombectomy can help inform the optimal prehospital emergency transport strategy which maximizes the likelihood of an excellent patient outcome.

Methods:
We determined the time from stroke onset required for an infarct core to grow to 70 mL as a function of penumbra volume and collateral score. After applying a series of numerical interpolations, our framework outputted the probability a suspected LVO patient qualifies for thrombectomy (based on core volume threshold) as a function of time from stroke onset to imaging. We then incorporated this function into an existing model of prehospital emergency transport, which previously assumed all patients were thrombectomy-eligible, in order to assess the impact that considering treatment eligibility had on optimal transport decisions.

Results:
An exponential decay curve best fit the numerically-generated probability function. We found that after integrating this eligibility model into the emergency transport decision tool the optimal transport strategy changed from drip and ship to mothership in 8.5% of possible patient pickup locations in Alberta, Canada.

Conclusions:
This methodology provides a novel, mechanistic approach to deriving a thrombectomy eligibility curve. As a result, we are able to better optimize prehospital transport decisions to improve outcomes of suspected LVO patients.
Abstract WP5: Bundling Of Head Computed Tomography Scan And Head And Neck Computed Tomography Angiogram At Initial Telestroke Consultation Is Associated With Faster Thrombectomy Transfer And Treatment Times
Authors: Magsi Shahvaiz , Jamal Nida , Giles James A , Holder Derek
Published: February 2022

Introduction:
Telestroke has expanded access to tPA and thrombectomy for acute ischemic stroke and improved neurologic outcomes. A key step in the evaluation of acute stroke is non-contrast head CT (HCT) and head and neck CT angiogram (CTA). These imaging studies can either be bundled at presentation, or a delayed CTA may be performed after a tPA decision based on HCT alone. Bundled imaging may facilitate faster transfer and treatment times, while delaying tPA. We investigated the effect of bundled imaging on thrombectomy transfer and treatment times in our telestroke network.

Methods:
We reviewed patients in our telestroke network from 2019-2021. We included patients who had received HCT and CTA at a partner hospital prior to transfer to our comprehensive stroke center (CSC) for thrombectomy. We collected baseline clinical variables, and timing of imaging, transfer and treatment relative to time of initial HCT. Patients were divided into a bundled imaging group (simultaneous HCT and CTA) or a delayed CTA group. Wilcoxon Rank sum test was used to compare between the two groups for HCT to tPA needle time, HCT to CSC arrival time, and HCT to Groin Puncture Time

Results:
273 patients were assessed via telestroke in the study period. Of these 93 were included. 43 patients received bundled CTA, and 50 patients received a delayed CTA. 20 patients received tPA in the bundled group vs 25 in the delayed CTA group. Median CSC transfer time was lower with a bundled imaging strategy (110 min vs 160 min; p<0.001), as was median time to groin puncture (174 min vs 242 min; p<0.001). Further, there was no difference in tPA needle time (38 min vs 37 min; p=0.86).

Conclusions:
Bundled HCT and CTA at telestroke sites was associated with significantly faster transfer and groin puncture times for patients with large vessel occlusion. Further, obtaining the CTA prior to a tPA decision did not significantly prolong HCT-to-needle times.
Abstract WP52: Emergency Medical Services Documentation Of Stroke Care In The United States
Authors: Pitchford Haydon M , Dabhi Nisha , Chu Lucy , Padhi Elizabeth , Roach Necrisha , Aldridge Chad M , Chapman Sherita N
Published: February 2022

Introduction:
Emergency medical services (EMS) are often the first point of medical contact for patients suffering from acute stroke. EMS must identify and triage patients appropriately for them to receive the best care. Several prehospital stroke scales exist to assist prehospital providers in identifying acute stroke in the field, but their real-world applications are poorly characterized. Understanding prehospital stroke treatment provides the opportunity to identify areas of improvement across the stroke continuum of care.

Methods:
We retrospectively reviewed data from the 2019 National EMS Information System (NEMSIS) dataset from the United States of America. NEMSIS contains standardized information reported by states on EMS activations. Observations included were transported by ground ambulance and had an EMS provider documented stroke assessment with a primary impression of stroke or TIA. Observations excluded interfacility transfers and were limited to activations that documented pre-notification of hospital-based stroke specialty team resources.

Results:
EMS providers used a variety of stroke scales in 2019. Of 30,436 observations, the Cincinnati Prehospital Stroke Scale was the most common with 17,462 uses (57.37%). The F.A.S.T. Exam came second with 3366 (11.05%) uses and the Los Angeles Prehospital Stroke Scale with 3,146 (10.33%). EMS providers recorded “Other Stroke Scale Type” 4362 (14.33%) times. EMS providers documented either a negative or inconclusive stroke score 10,390 (34.13%) times. EMS documented stroke specialty team notifications 17,391 (57.14%) of the time. EMS did not pre-notify the stroke specialty team for 13,045 (42.86%) of patients. 3,576 (27.41%) of these patients received a negative stroke scale score, 1,745 (13.38%) inconclusive and 7,724 (59.21%) positive respectively. Among cases where EMS notified a stroke specialty team 1,590 (9.14%) received a negative, 2,479 (14.25%) an inconclusive and 13,322 (76.60%) a positive stroke scale score.

Conclusion:
US EMS stroke care documentation has substantial variability and is ripe for standardization. This fact necessitates research to understand its causes and achieve pre-hospital stroke care optimization on a national scale.
Abstract WP57: Association Between Stroke Presentation During Off-hours And Mechanical Thrombectomy
Authors: Bouslama Mehdi , Navi Babak , Mir Saad , Parikh Neal S , Liberman Ava L , Kamel Hooman
Published: February 2022

Background:
Access to mechanical thrombectomy in the US remains limited, in part due to a relative lack of trained interventionalists. Given potential staffing challenges, we hypothesized that access to thrombectomy would be worse on nights and weekends.

Methods:
We used 2016-2018 all-payer claims data from all nonfederal emergency departments and acute care hospitals across 11 US states encompassing 80 million residents. Using recorded arrival times, hospital presentation was classified as on-hours if it fell between 8:00 a.m. and 6:00 p.m. on weekdays and as off-hours otherwise. For patients who underwent interhospital transfer, we used the arrival time at the initial hospital. We examined the association between off-hours arrival and mechanical thrombectomy using multiple logistic regression adjusted for age, sex, race/ethnicity, insurance type, socioeconomic status, urban-rural location of residence, the Charlson comorbidity index, initial presentation to a thrombectomy hub, and treatment with intravenous thrombolysis. We performed a sensitivity analysis limited to patients who presented with a probable large-vessel occlusion, defined as a documented NIHSS score ≥12, to a thrombectomy hub and underwent intravenous thrombolysis.

Results:
Among 169,199 patients with ischemic strokes, the 82,784 (48.9%) who presented during off-hours had higher NIHSS scores (4 [IQR, 2-10] vs 2 [IQR, 1-9],
P
<0.001) and underwent thrombolysis more often (9.3% vs 8.5%,
P
<0.001). There were no differences between groups in rates of mechanical thrombectomy (3.4% on-hours vs 3.5% off-hours,
P
= 0.25). In adjusted models, off-hours presentation was not significantly associated with lower odds of mechanical thrombectomy (OR, 0.94; 95% CI, 0.85-1.03). Our findings were similar in a sensitivity analysis limited to patients with a probable large-vessel occlusion who initially presented to a thrombectomy hub and underwent intravenous thrombolysis (OR, 0.87; 0.69-1.09).

Conclusions:
In a large population-based sample of ischemic stroke patients across the US, the odds of mechanical thrombectomy did not vary by time of presentation.
Abstract WP63: The Effect Of Inpatient Rehabilitation Facility Treatment On 90 Day Outcomes: A Shift Analysis Of Modified Rankin Scale Score In Ischemic Stroke Patients
Authors: Venkatachalam Aardhra M , Manchi Maunica R , Atem Folefac D , Stone Suzanne , Abraham Annie M , Chavez Audrie A , Welch Babu G , Ifejika Nneka L
Published: February 2022

Introduction:
Several AHA Guidelines recommend inpatient rehabilitation facility (IRF) care to enhance post-stroke recovery. We evaluated the IRF treatment effect on modified Rankin scale (mRS) score change at 90 days in ischemic stroke (IS) patients.

Methods:
Using prospectively collected data from Get With the Guidelines-Stroke, the Uniformed Data System for Medical Rehabilitation registry and the electronic medical record, we identified IS patients with discharge disposition of home or IRF between 1/1/2018-12/31/2020. Sociodemographics, clinical variables and IS treatment rates were summarized. IRF outcomes, including length of stay (LOS), improvement in mobility and self-care scores and discharge disposition were compared in thrombectomy vs no thrombectomy groups. mRS at IRF discharge was calculated with a Cronbach interrater score of 0.88; shift analyses of mRS at hospital discharge and 90 days were completed for IS patients in the Home and IRF care groups.

Results:
Among 738 patients, 499 went home, 239 went to IRF. IRF patients were more likely to have Medicare insurance (49.2 vs 28.9%), undergo thrombectomy (16.3 vs 4.6%) have increased LOS (12.7 vs 4.8 days) and stroke severity (mean NIHSS 7.8 vs 4.8; mean mRS 3.1 vs 1.7) compared to Home (Table 1). At IRF, 39 patients previously underwent thrombectomy, 200 did not. Both groups had a IRF LOS >14 days and considerable recovery in the self-care and mobility domains (Table 2). Shift analysis of mRS at hospital discharge compared to 90 days yielded significant improvements in mRS of 0-2 and lower mortality in the IRF group compared to home group (Figure).

Conclusion:
In ischemic stroke patients with higher disease severity, IRF treatment is a catalyst for improved functional recovery.
Abstract WP67: Safety And Effects Of High-frequency Repetitive Transcranial Magnetic Stimulation In Acute Intracranial Hemorrhage Patients
Authors: Komatsu Teppei , Hada Takuya , Kida Hiroyuki , Takahashi Junichiro , Maku Takahiro , Nakada Ryoji , Kitagawa Tomomichi , Sato Takeo , Takatsu Hiroki , Sakuta Kenichi , Sakai Kenichiro , Umehara Tadashi , MURAKAMI HIDETOMO , Mitsumura Hidetaka , Abo Masahiro , Iguchi Yasuyuki
Published: February 2022

Background and Purpose:
Repetitive transcranial magnetic stimulation (rTMS) in chronic intracranial hemorrhage (ICH) is beneficial, it has been poorly investigated in rTMS for acute ICH. Our aim is to investigate safety and effects of rTMS in acute ICH.

Methods:
We prospectively performed high-frequency rTMS to consecutive patients with acute ICH within 24 hours from onset between April 2019 and March 2021. Exclusion criteria were: 1) subcortical ICH; 2) ventricular perforation; 3) history of symptomatic stroke; 4) surgical management for ICH; 5) disturbance of consciousness; 6) over 80 years old at admission; and 7) convulsion after onset. Inclusion criterion was 1) persistent paralysis with a NIHSS scale 1 of higher for at least 3 days after onset. The comparison was made with historical control group; patients who met the same criteria between April 2016 and March 2019. We evaluated incidence of epilepsy and exacerbation of NIHSS score in rTMS group. We also compared clinical background and outcome among groups.

Results:
A total of 40 patients (29 male, median age 56 years, median NIHSS score on admission 13) were enrolled. Of them, 18 patients (45%) were rTMS group. The median (IQR) time from onset to the start of rTMS is 9 (6-12) days. There were no case of epilepsy or exacerbation of NIHSS after the start of rTMS. There were no significant differences in median age (54 years vs 57 years, p=0.70), median hemorrhage volume at admission (9.3 ml vs 11.3 ml, p=0.43) or median NIHSS score on admission (13 vs 12, p=0.99) among groups. Favorable 90 days outcome (modified Rankin Scale score of 0-2) was frequently observed in rTMS group (67% vs 27%, p = 0.02).

Conclusion:
High-frequency rTMS may be safe and effective in acute intracranial hemorrhage patients.
Abstract WP8: Blood Pressure And EVT Outcomes By The Baseline Perfusion And Recanalization Timing
Authors: Kim Beom , Singh Nishita , Menon Bijoy K , Almekhlafi Mohammed A , Ryu Wi-Sun , Kang Jihoon , Baik Sung Hyun , Kim Jun Y , Lee Keon-joo , Jung Cheolkyu , Han Moon Ku K , Bae Hee-joon
Published: February 2022

Introduction:
Leptomeningeal collaterals help maintain cerebral perfusion after the large vessel occlusion (LVO), potentially regulated by systemic blood pressure (BP). We hypothesized that the association between BP and endovascular treatment (EVT) outcomes would differ by the baseline perfusions status and before and after recanalization.

Method:
From a prospective registry, we identified anterior circulation LVO patients who received EVT ≤24 hours after their onset, had baseline perfusion, and achieved post-EVT mTICI ≥2b. BPs were measured from arrival at 5-minute intervals in the ER and during the procedure. Systolic BPs (SBP) up to 24 hours after EVT were summarized as dropmax (the maximal decrement over two consecutive measurements), incmax (the maximal increment), mean, coefficient of variation, and standard deviation. Baseline perfusion images were quantified using Olea Sphere. Infarct proportion was defined as the volume of final infarct on DWI within the volume of Tmax>6 sec. Significant hemorrhage included PH2 or HBC class 3. 3-month mRS was prospectively collected.

Result:
A total of 388 LVO patients were included. Mean SBP at arrival was 153 ± 42 mm Hg; the average count of BP measurements was 47 ± 17 per patient.In the adequate baseline perfusion group, i.e., hypoperfusion intensity ratio (HIR) <0.5, SBP parameters were better associated with infarct proportion and functional outcome before the recanalization period; weaker associations were noted after recanalization. In the poor baseline perfusion group, i.e., HIR ≥0.5, SBP parameters before recanalization were partially associated with the infarct proportion but not functional status. No association between SBP parameters and significant hemorrhage was noted. (estimates in Table)

Conclusion:
Association between BP and patient outcomes differs by baseline perfusion status and before and after recanalization. BP management during the peri-EVT period may therefore need to be individualized.
Abstract WP86: Gender Disparities In Authorship Of Major Randomized Controlled Trials In Stroke Research
Authors: Kumar Prateek , Trifan Gabriela , Testai Fernando
Published: February 2022

Introduction:
Many medical specialties including vascular neurology have recently raised awareness of gender disparities among researchers. This study seeks to investigate patterns and yearly trends in authorship of randomized controlled trials (RCTs) in stroke research.

Methods:
This study included RCTs from the 2019 AHA/ASA Guidelines for the Early Management of Patients with Acute Ischemic Stroke. Studies that did not distinguish primary authors for publication and rather credited a collaborative group were excluded. Gender was determined for each author based on analysis of names with assistance of online references (institution directories, biographies, news articles, profile photos and professional social media platforms). Validated software (Genderize.io) was used to corroborate gender based on first names with a probability threshold of 60% as implemented in previous work. Chi-squared tests for observed frequencies and linear trend were performed. Differences were considered significant at p<0.05.

Results:
One hundred eighty-six RCTs were included with a total 2451 authors (78% male, 22% female) covering 46 stroke topics. Publication dates were 1994 to 2019 (median 2014, IQR 2010-2016). Number of authors for each study ranged from 1 to 56, with a mean±SD of 13±10 authors. Of the 186 included studies, 145 (78%) had male first authors and 41 (22%) had female first authors (p<0.0001). One hundred fifty-nine (85%) studies had male senior authors and 27 (15%) had female senior authors (p<0.0001). Distribution of authorship by country revealed higher prevalence of male first and senior authors for all countries except the Netherlands (n=5 RCTs), Sweden (n=1) and India (n=1). Yearly trends in authorship distribution from 1994 to 2019 did not identify any significant shift in authorship for first or senior authors based on gender (p>0.05).

Conclusions:
This study reveals that gender disparities are prevalent across the field of stroke research. Female authors are underrepresented in both roles of first and senior authors in major RCTs. This discrepancy is present across nearly all countries and has persisted over the past three decades. Continued research and targeted interventions are needed to alleviate gender disparities in stroke research.
Abstract WP89: Evaluating Age, Sex, And Racial / Ethnic Representation In Acute Ischemic Stroke Trials, 2010-2020: A Systematic Review And Meta-Analysis
Authors: Acton Emily K , Abbasi Mohammad Hossein , Kasner Scott E
Published: February 2022

Introduction:
Enrollment of populations that bear the real-world burden of ischemic strokes is critical to development of generalizable and clinically relevant randomized clinical trials (RCTs). Despite well-recognized historical patterns of underrepresentation for women, older adults, and certain racial/ethnic minorities, major knowledge gaps remain regarding representation in modern trials. We aimed to determine representativeness by age, sex, and race/ethnicity of participants in acute ischemic stroke RCTs performed in the US or Canada

Methods:
We conducted a systematic review and meta-analysis in accordance with PRISMA, and prospectively registered with PROSPERO (CRD42021247730). ClincalTrials.gov was searched for ischemic stroke RCTs with acute interventions (
<
72 hours following stroke onset) published between 2010-2020. Our search was focused on the published text and supplementary materials of phase 2 and phase 3 trials among adult populations, with ≥5 sites, ≥80% of sites located in the US or Canada, and ≥100 participants. Meta-analysis was based on a random intercept logistic regression model, and confidence intervals (CIs) were derived using the Clopper-Pearson method.

Results:
Of 548 screenings, 12 RCTs met eligibility criteria (total: 7955 participants). Age and sex were reported by all assessed trials, but race/ethnicity was only documented by 42% (5 publications). Only 33% (4 publications) provided a level of granularity beyond white/non-white for race. Relatively proportionate representation was observed by age (12 studies: heterogeneity in reporting precluded meta-analysis) and sex (12 studies: 48% female, CI 45-51%; I
2
=70%). Black and Asian participants accounted for 19% (CI 12-28%) and 2% (CI 1-4%) of reporting trials’ populations, respectively (4 studies; I
2
=96% and 45%). Hispanic participants encompassed 11% of reporting trials’ populations (CI 8-15%; 5 studies; I
2
=97%).

Conclusions:
While age and sex were routinely documented, less than half of the assessed US or Canadian acute ischemic stroke RCTs reported on race/ethnicity. We recommend further emphasis on complete and granular reporting of racial/ethnic profiles in order to facilitate ongoing assessments of representation among modern stroke trials.
Abstract WP91: Pre-notification Is Associated With Decreased Door To Groin Puncture Time But Not 90-day Modified Rankin Scale
Authors: Cole Sydni M , Fanty Lauren F , Pusso Antonia N , Osullivan Jillian N , Selim Magdy H , Lioutas Vasileios A
Published: February 2022

Background:
Time is essential in endovascular reperfusion of large vessel occlusions (LVO) in acute ischemic stroke. Improving time to reperfusion improves functional outcome for these patients and is thus an area of critical concern. We sought to determine factors that predict delays in door-to-groin puncture time in an effort to improve clinical outcomes for our patient population. We hypothesized that patients who presented without pre-notification of our interventional team would have delays in door-to-groin time and higher 90-day modified Rankin scale (mRS).

Methods:
We conducted a retrospective review of consecutive patients with LVO consented for thrombectomy between January 1, 2017, and December 31, 2020, in a comprehensive Stroke Center in a hub-and-spoke stroke care model. We collected baseline demographic data, mode of transport (ground vs air), time of the day (regular hours, 8am-5pm vs after hours, 5pm-8am) and status as transfer or direct admission to hub.

Results:
A total of 237 patients (127 [54%] female, mean age 70.2±14.7 years) were included in the analysis; 204 (86%) were transferred from other hospitals. Patients transferred from other hospitals had a significantly lower door-to-groin time than non-transfers (37 vs 86 minutes, p<0.001), as did patients with arrival pre-notification compared to without (35 vs 88 min, p<0.001). There was overlap between transfers and those with pre-notification. After adjustment for mode of transport, time of day, and transfer-from-spoke status, pre-notification remained independently associated with significantly lower door-to-groin time with an adjusted mean difference of 23.7, 95% CI (18.7-28.8) minutes, p<0.0001). In adjusted analyses, baseline mRS (p=0.005) younger age (p=0.003), fewer passes (p=0.03), higher TICI (p=0.002), and lower initial NIHSS (p<0.0001) were associated with better 90-day mRS scores. Prenotification was not associated with mRS (p=0.85).

Conclusion:
Door-to-groin puncture times are significantly shorter in stroke patients with arrival pre-notification. However, prenotification was not associated with 90-day mRS in our cohort. This highlights the need to optimize all components of thrombectomy systems-of-care to improve outcomes.
Abstract WP92: Healing Strokes: Virtually Improving Stroke Survivors And Caregivers’ Well-being Through Student-run Art Therapy Support Group
Authors: Kim Soo Hyun , Burgon Sierra M , Song Andrew J , Hernandez Gonzalez Elaine M , Xue Athena , Yip Elaina , Pike Brittany , Muccini Julie , Stroshane Lauren , Hsieh Vivian , Vora Nirali
Published: February 2022

Background:
Depression and anxiety impact recovery and quality of life in 1 in 3 stroke survivors. Caregivers also experience burnout. Creative art-based therapy boosts feelings of accomplishment, self-esteem, and neuroplasticity by stimulating diverse brain regions. Few outpatient art therapy programs exist for stroke survivors and caregivers, limited further during the COVID-19 pandemic. We aim to implement an outpatient, student-run virtual art therapy curriculum using a patient-carer team approach to foster a supportive peer community, reduce depressive symptoms in survivors, and increase relief for caregivers.

Methods:
A multidisciplinary team of stroke physician, nurse, occupational therapist, clinic managers, and undergraduate student volunteers created an evidenced-based art therapy curriculum feasible for stroke survivors. An art educator trained volunteers in empathetic communication, teaching techniques, and patient privacy. Participants pre-registered for weekly 1 hour classes held via video conference and received art materials by mail. We administered surveys at initial registration and quarterly. An institutional grant provided funding.

Results:
From September 2020 - July 2021, Healing Strokes hosted 30 classes using the curriculum (Table 1) for 71 survivors and caregivers from 9 states at a 1:5 volunteer-to-participant ratio. 20 participants (14 survivors, 6 caregivers) self-reported benefits of peer support, creative inspiration, increased sense of accomplishment, and improvement in speech and fine motor skills.

Conclusion:
Implementation of a virtual outpatient art-based therapy program for stroke survivors and caregivers is feasible with participants self-reporting benefits in functional recovery and mood. Post-stroke supportive care programs can expand to include art therapy during a pandemic. Future studies can validate the impact on peer support, function, and post-stroke depression and anxiety.
Rehabilitation of Cognitive Deficits Poststroke: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: O'Donoghue Mairead , Leahy Siobhan , Boland Pauline , Galvin Rose , McManus John , Hayes Sara
Published: February 2022

Background:

Despite the prevalence of cognitive impairment poststroke, there is uncertainty regarding interventions to improve cognitive function poststroke. This systematic review and meta-analysis evaluate the effectiveness of rehabilitation interventions across multiple domains of cognitive function.

Methods:

Five databases were searched from inception to August 2019. Eligible studies included randomized controlled trials of rehabilitation interventions for people with stroke when compared with other active interventions or standard care where cognitive function was an outcome.

Results:

Sixty-four randomized controlled trials (n=4005 participants) were included. Multiple component interventions improved general cognitive functioning (MD, 1.56 [95% CI, 0.69–2.43]) and memory (standardized MD, 0.49 [95% CI, 0.27–0.72]) compared with standard care. Physical activity interventions improved neglect (MD, 13.99 [95% CI, 12.67–15.32]) and balance (MD, 2.97 [95% CI, 0.71–5.23]) compared with active controls. Noninvasive brain stimulation impacted neglect (MD, 20.79 [95% CI, 14.53–27.04) and functional status (MD, 14.02 [95% CI, 8.41–19.62]) compared with active controls. Neither cognitive rehabilitation (MD, 0.37 [95% CI, −0.94 to 1.69]) nor occupational-based interventions (MD, 0.45 [95% CI, −1.33 to 2.23]) had a significant effect on cognitive function compared with standard care.

Conclusions:

There is some evidence to support multiple component interventions, physical activity interventions, and noninvasive brain stimulation improving cognitive function poststroke. Findings must be interpreted with caution given the overall moderate to high risk of bias, heterogeneity of interventions, and outcome measures across studies.
Contemporary Trends in the Nationwide Incidence of Primary Intracerebral Hemorrhage
Authors: Bako Abdulaziz T. , Pan Alan , Potter Thomas , Tannous Jonika , Johnson Carnayla , Baig Eman , Meeks Jennifer , Woo Daniel , Vahidy Farhaan S.
Published: February 2022

Background:

We report contemporary trends in nationwide incidence of intracerebral hemorrhage (ICH) across demographic and regional strata over a 15-year period.

Methods:

Utilizing the Nationwide Inpatient Sample (2004–2018) and US Census Bureau data, we calculated ICH incidence rates for age, race/ethnicity, sex, and hospital region sub-cohorts across 5 consecutive 3-year periods (2004–2006 to 2016–2018). We fit Poisson and log binomial regression models to evaluate demographic and regional differences in ICH incidence and trends in prevalence of hypertension and past/current anticoagulant use among hospitalized ICH patients.

Results:

Overall, the annual incidence rate (95% CI) of ICH per 100 000 was 23.15 (23.10–23.20). The 3-year incidence of ICH (per 100 000) increased from 62.79 in 2004 to 2006 to 78.86 in 2016 to 2018 (adjusted incidence rate ratio, CI: 1.11 [1.02–1.20]), coinciding with increased 3-year prevalence of hypertension and anticoagulant use among hospitalized ICH patients (adjusted risk ratio, CI: hypertension—1.16 [1.15–1.17]; anticoagulant use—2.30 [2.14–2.47]). We found a significant age-time interaction, whereby ICH incidence increased significantly faster among those aged 18 to 44 years (adjusted incidence rate ratio, CI: 1.10 [1.05–1.14]) and 45 to 64 years (adjusted incidence rate ratio, CI: 1.08 [1.03–1.13]), relative to those aged ≥75 years.

Conclusions:

Rising ICH incidence among young and middle-aged Americans warrants ICH prevention strategies targeting these economically productive age groups.
Name It, Claim It, Grab It
Authors: White Peter , Aikins Rachel Pauline
Published: February 2022

Pentecostalism being a global phenomenon has become an interesting subject in Global Christianity and academic discourses. Numerous scholars have researched and published articles on it from various perspectives. This article discusses African Pentecostalism by bringing fresh discussion on the existing literature on ‘prosperity gospel’. The article argues that Pentecostal preachers are not prosperity gospel preachers but rather preachers of a faith and hope gospel. The article conceptualises the faith and hope gospel from a Biblical perspective as well as the theological perspective of the adherents and practitioners of Pentecostal theology. Although the article acknowledges the extremist approach of some of the adherents and practitioners in their interpretation of scriptures and sometimes the abuses, the article argues that the dynamic and contextual nature of theology should be considered while the abuses are also objectively condemned. The article discusses debates on Pentecostal hermeneutics as well as the characteristics of the three perspectives of the faith and hope gospel by using the terms ‘name it, claim it, grab it’.
Baptized with the Holy Spirit
Authors: Ben Keshet Hanoch
Published: February 2022

For many, the evocative phrase ‘baptism in the Holy Spirit’ supplies ideological scaffolding for vital pneumatological concerns even though it is not found in Scripture. Achieving a more accurate understanding of the original terminology requires review of two foundational aspects of nt baptism: a) extended senses of the verb baptizein that include purify, and b) the source of John’s baptisma, argued in this article as Israel’s national purification promised in Ezek. 36.25. Working from this basis, Acts 1.5 is reconsidered as Luke’s paradigmatic guide for baptisma while composing Acts. As such, John’s purification with water is seen to continue in Acts, performed in the name of Messiah Yeshua. Most importantly, however, this article maintains that in Acts, Luke frequently uses baptizein in relation to the Holy Spirit to describe one’s initial, powerfully palpable transformation that especially signifies New Covenant purification and certainly includes actualized resurrection power.
From Giant to Lilliputians: A Reflection on Nigeria’s Afro-Centric Policy in Post-Authoritarian Era
Authors: Basiru Adeniyi S. , Osunkoya Olusesan A. , Adebayo Tajudeen I.
Published: February 2022

Central to understanding the character of countries’ foreign policies are the personality traits of individuals who preside over the affairs of countries. This is even more so in Africa where institutions responsible for foreign policy making are not only weak, but are also overshadowed by the personality traits of powerful chief executives. It is against this background that this article, based on desk analysis, examines and compares the impact of leaders’ personality traits on Nigeria’s Afro-centric policy in the post-authoritarian era. Specifically, it attempts to lay bare why Nigeria’s Afro-centric policy, in post-Obasanjo era, has not enjoyed as much dynamism and vigour as it did during Obasanjo’s administration. Comparatively, it notes that President Obasanjo’s successors, Presidents Yar Adua and Jonathan, even though did not discountenance Nigeria’s age-long Afro-centric posture, but did not bring as much dynamism and aggressiveness to bear on it as did President Obasanjo. It argues that this may be unconnected majorly to these individuals’ different personality traits.
Picturing Seeds of Poppies
Authors: Eriksen Christoffer Basse
Published: February 2022

The middle of the seventeenth century saw the emergence of a new kind of botanical observation: Microscopical observations of seeds. Previously, naturalists had made observations of seeds to complete their description of plants published in herbals, but for the first generation of Royal Society microscopists—Henry Power, Robert Hooke, and Nehemiah Grew—seeds became the centre of attention. This essay details this transition in plant knowledge by zooming in on just one kind of seeds: The poppy seed. Poppy seeds were abundant in early modern England as they were found in fields, gardens, kitchens and pharmacies. They were also excellent specimens to look at through microscopes, but for different reasons. Focusing on pictorial representation, especially, I analyse the diverse ambitions behind Power, Hooke, and Grew’s observations of poppy seeds, and how they used pictures to further these. The comparison of these three observations of the same specimen highlights the diversity of strategies for scientific representation in the early Royal Society while showing that intense, instrument-enhanced observation did not produce a stable epistemic object, but a multiplicity of epistemic images.