bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP314: Post-Stroke Regulation of α-Synuclein by microRNA miR-7 and Circular RNA CDR1as
Authors: Vemuganti Raghu , Mehta Suresh L , Arruri Vijay K , Chokkalla Anil K , Bathula Saivenkateshkomal , Chelluboina Bharath
Published: February 2024

α-Synuclein (α-Syn) induced after stroke is a known mediator of ischemic brain damage. We currently evaluated the molecular mechanisms that regulate α-Syn expression in the post-ischemic brain. The miR-7 is an abundantly expressed miRNA in brain that targets α-Syn mRNA with high energy. In adult mice subjected to transient middle cerebral artery occlusion (MCAO), miR-7 levels were down-regulated in the cerebral cortex as early as 3h and late as 3 days of reperfusion which leads to derepression of α-Syn mRNA that facilitates α-Syn protein translation. Treating mice after transient MCAO with a miR-7 mimic significantly curtailed ischemic brain damage and promoted better motor function recovery. However, the pri-miR-7a and -7b levels were unaltered indicating that the post-ischemic reduction in miR-7 levels are not due to reduced expression of miR-7 gene. With bioinformatics, we observed that the circRNA CDR1as contains >70 binding sites with good affinity for miR-7. CDR1as is thought to sequester miR-7 to protect it from degradation and/or to transport it to the sites of its necessity. Transient MCAO also led to down-regulation of CDR1as expression between 3h and 3 days of reperfusion. When CDR1as levels were replenished in the post-ischemic mice with a CDR1as AAV9 vector, the miR-7 levels as well as binding of CDR1as to Ago2/miR-7 increased and α-Syn protein levels decreased significantly in the peri-infarct cortex. Furthermore, the CDR1as AAV9 treated mice showed decreased markers of inflammation and apoptosis, better motor function recovery and smaller infarcts. Our studies thus indicate that α-Syn in the post-ischemic brain is controlled by the mutual interaction of a miRNA (miR-7) and a circRNA (CDR1as). Thus, understanding noncoding RNA interactions and mechanisms might help to design better therapies to alleviate post-stroke neuronal damage.
Abstract WP317: Phagocytic Potentials of Purinergic Receptor P2x4 Blockade After Ischemic Stroke
Authors: Gamiotea Turro Daylin , Cronin Chunxia , Liang Bruce T , Verma Rajkumar
Published: February 2024

Backgrounds:
We previously showed that genetic deletion as well as short term pharmacological inhibition of P2X4R, a purinergic receptor for adenosine triphosphate ATP, provides neuroprotection by reducing acute excessive inflammation and thus can be potential drug targets to treat ischemic stroke. However, the mechanism how P2X4R blockade provide long term benefits are not known. Here we hypothesize that P2X4R blockade increase phagocytic uptake of damaged or dead tissue and facilitate swift recovery.

Methods:
We used both 1μm size fluorescent phagocytic bead (Polyscience Inc) and pHrodo Red zymosan A Bioparticles conjugate (Thermofisher) to study in vitro and ex-vivo phagocytic uptake by
LPS
(200 μg/ml for 2 hours) primed Bone Marrow Derived Macrophages (BMDMs) from P2X4R KO and littermate WT mice. We also used flow sorted Ly6C hi and low monocytes for phagocytic uptake study obtained from perilesional ipsilateral mouse brain tissue of P2X4R KO and littermate WT mice after 3 or 7 days of stroke. The later mice were subjected to 60 mins of transient middle cerebral artery occlusion.

Results:
Both phagocytic beads and pHrodo bioparticle uptake study suggest significantly higher uptake (1.5 and 2-fold P<0.05 vs WT student t test n=4 mice/group x 2 technical replication) by BMDMs obtained from P2X4R KO mice. FACS sorted infiltrated Ly6Chi inflammatory monocytes from global P2X4R KO mice brain after 3 days of stroke show significantly (*P>0.05 vs WT) high phagocytic bead uptake as compared to WT control. Further these monocytes also showed elevated expression of CD36, a marker for scavenger receptor at 7 days after stroke.

Conclusions:
This study suggest that P2X4R blockade provide swift and sustained neuroprotection by increasing phagocytic uptake of damage tissue after ischemic stroke.
Abstract WP321: Novel Therapeutic Potential of Intestinal Organoids Secretomes for Cerebrovascular Stroke
Authors: Mani Kathiresh Kumar , Pickle Kaylin , Wertz Anna , Miller Kate , Obhari Akruti , Paz Mariana , Sohrabji Farida
Published: February 2024

Background:
Our recent studies show that transplants of intestine epithelial stem cells (IESCs) promote acute and long term recovery after stroke in middle-aged rats. To improve the translational potential of this therapy, we investigated whether injections of the IESC conditioned media (CM) would be similarly effective in improving acute and chronic stroke outcomes.

Methods:
Conditioned media was collected intestinal organoids culture from young animals and processed for proteomic and tropic factors analysis. CM efficacy was tested in middle-aged male and female rats assigned to the following groups: Control (sham), stroke+vehicle injection, or stroke+IESC-CM treatment. Middle cerebral artery occlusion (MCAo) was induced by Endothelin-1 (vasoconstrictor). Conditioned media was injected ip (CMip) 4h/24h/48h after stroke. In the acute phase, infarct volume, sensorimotor function and serum levels of the gut permeability markers were measured 4d post stroke. Long term (4 weeks after stroke) depressive-like behavior was assessed by the Social Interaction test, and cognitive performance by the Novel object Recognition test and Barnes maze test.

Results:
Proteomic analysis of CM showed elevated levels of small peptide growth factors ad large matrix molecules. IESC-CMip treatment significantly improved acute stroke outcomes and reduced gut permeability in middle-aged hosts of either sex. In long term study, vehicle-treated MCAo animals showed depressive-like behaviors compared to their pre-stroke behaviors. In contrast, stroke animals that received IESC secretome were no different from their pre stroke performance and were similar sham (no-stroke) animals. In cognition assesments. MCAo+vehicle animals showed poor ability to discriminate the novel object and displayed impaired learning and recall on the Barnes maze. MCAo animals that received IESC secretome did not show significant improved during the Barnes learning trials, but retrieval (memory recall) performance was improved and significantly different from the vehicle group.

Conclusion:
Overall, these data show that IESC secretome derived from a healthy young animal can significantly improve acute stroke outcomes and specific aspects of cognitive performance.
Abstract WP33: Impact of Early Mobilization on Length of Stay in Acute Ischemic Stroke
Authors: Comer Kathryn , O'Connor Kevin , Lee Jessica D
Published: February 2024

Background:
IV rt-tPA is standard of care in patients presenting within 4.5 hours of acute ischemic stroke (AIS) symptom onset. Despite its short half-life, concerns regarding the safety of early mobilization remain, which may delay patients’ time to rehabilitation evaluation. We previously demonstrated the safety of early mobilization, using stratification based on stroke severity. This study aims to compare time from mobility order to PT/OT evaluation and total length of stay between patients whose mobility orders were congruent with institutional guidelines to those with incongruent orders.

Methods:
This is a retrospective case-cohort study of AIS patients who received IV tPA and/or mechanical thrombectomy (MT), admitted to our center April 2018 to December 2019. Prior to this, a 24 hour bedrest protocol post-rtPA was in place. In April of 2018, a new mobility protocol was established stratifying bedrest time following tPA and/or MT to 1, 6, or 8 hours, based on NIHSS and clinical stability. All patients in this cohort (N=524) should have been assigned the new mobility protocol. For patients receiving both tPA and MT, the mobility assignment for thrombectomy was assessed. 37 patients were excluded from analysis due to missing data points.

Results:
A total of 384 patients received tPA only, with 89% (n=354) receiving congruent orderset. 59 patients received tPA and MT, and 74 received MT only. Mean LOS days for tPA only with congruent orderset was 5.33 + 5.76 (n=350) vs. 6.45 + 6.06 (n=55) with incongruent orders. Mean LOS days for MT only with congruent orders was 10.03 + 6.42 (n=58) vs. 10.28 + 7.64 (n=57) with incongruent orders. Mean time in hours from PT/OT order to evaluation for tPA only with congruent orders was 17.72 + 13.01 (n=341) vs. 32.63 + 29.45 (n=41) with incongruent orders. For MT only patients with a congruent orderset, mean hours from PT/OT order to evaluation was 33.74 + 16.91 (n=54), and 50.7 + 34.12 (n=47) for incongruent orders.

Conclusions:
There was an increase in both PT/OT order to evaluation time and total LOS for patients with incorrect orders. Following the early mobilization protocol leads to an earlier PT/OT evaluation and disposition.
Abstract WP35: Elevated Risk of 1-month Post-Traumatic Stress Disorder Among Stroke Mimics Relative to Patients With Stroke
Authors: Chang Melinda , Willey Joshua Z , Birk Jeffrey , Schwartz Joseph E , Jurado Ammie , Chang Bernard P , Shechter Ari , Naqvi Imama A , Edmondson Donald , Kronish Ian M
Published: February 2024

Introduction:
A life-threatening medical event such as stroke can trigger symptoms of post-traumatic stress disorder (PTSD). Less is known about the risk of PTSD among individuals who present with stroke-like symptoms but are ultimately diagnosed with a stroke mimic.

Aim:
To examine the association between final diagnosis of stroke mimic, stroke, or TIA and risk of developing PTSD 1 month after the index event.

Methods:
We enrolled patients with suspected stroke or TIA from an urban academic medical center. The PTSD Checklist 5 for DSM-5 (PCL-5) was administered at enrollment to assess pre-existing PTSD, and at 1-month after discharge to assess PTSD related to the index event. The index event was adjudicated via chart review as a stroke, TIA, stroke mimic, or equivocal by a neurologist blinded to PTSD status. Logistic regression was used to determine odds of developing clinically significant PTSD (PCL-5 &ge 33) for stroke mimics compared to stroke or TIA at 1 month after adjusting for age, gender, ethnicity, initial NIH Stroke Scale, discharge modified Rankin Score, and prior PTSD. Multiple imputation was used to account for missingness in data. Equivocal cases were excluded.

Results:
In our sample of suspected stroke (
n
= 1,000, 51% female, age = 62 ± 15 y), 596 (59.6%) had a stroke, 79 (7.9%) had a TIA, 274 (27.4%) had a stroke mimic, and 51 (5.1%) were equivocal or missing. PTSD prevalence numbers (rates) at 1 month for stroke mimic, stroke, and TIA, respectively, were 30 (15.1%), 27 (6.3%), and 3 (5.5%). In the fully adjusted model, the odds of 1-month PTSD were higher for stroke mimics vs. patients with stroke, OR = 2.99, 95% CI [1.45, 6.18],
p
< .01, but not for stroke mimics vs. TIA, OR = 1.67,
p
= .45. Pre-existing PTSD was associated with increased odds of 1-month PTSD, OR = 10.32, 95% CI [5.30, 20.10],
p
< .01. No other covariates were associated with PTSD.

Conclusion:
Experiencing a stroke mimic compared to a stroke was associated with increased risk of having PTSD 1 month after the event. Clinicians should consider the risk of psychological distress particularly among individuals presenting with sudden stroke-like symptoms diagnosed as stroke mimics.
Abstract WP43: Improving Nurse Retention Through Orientation Restructuring, Planned Professional Development, and Leadership-Employee Support: One Unit’s Journey
Authors: Fazzino Kirsten , Thresher Catherine , Hewitt Jocelyn , Wlider Shailyn
Published: February 2024

Introduction:
Increasing RN turnover rates are a noteworthy and nuanced problem for many nurse leaders. It is a particular challenge within specialty units, resulting in the loss of specialty nursing knowledge, assessment, and critical thinking skills relevant to specific patient populations. RN turnover rates increased over a two-year period on a stroke unit in a large teaching hospital that provides specialty care as part of a Comprehensive Stroke Center. Many of the RNs leaving the unit pursued critical care roles, and their knowledge was lost with their attrition. This prompted the nurse leadership to re-examine the orientation process, professional development plan, and leadership-employee support methods that were being utilized.

Methods:
Using the PDSA model, orientation was reorganized allowing new RNs to be trained solely on the stroke unit for 10-12 weeks then working independently on that unit for 6 months prior to training on the epilepsy monitoring unit, as opposed to training and working on both units from the start of their employment. Professional development plans that included one-on-one resource nurse training with the Assistant Nurse Manager and cross-training to the neuroscience stepdown unit after one year of employment were created for each RN. Each staff member was supported with mentorship check-ins by an assigned Clinical Leader and with bi-monthly check-ins with the Nurse Manager. Quarterly staff meetings were held to promote staff engagement and provide staff members with an opportunity to cascade information on their individual projects, councils, or initiatives to their peers.

Results:
These changes, including the training of 10 RNs to the stepdown unit, resulted in an 82% decrease in the number of RNs who left their job on the stroke unit in the first year.

Conclusion:
This process improvement plan demonstrated that thoughtful modifications to the orientation process, a structured professional development plan, and an organized leadership-employee support method can decrease RN turnover. It allowed the preservation of specialty stroke knowledge, thus ensuring that stroke patients continue to receive high-quality, specialized care and that specialty knowledge is transmitted to new staff as they start their careers.
Abstract WP50: Analyzing Post Discharge Follow-Up of a Disparate Population Utilizing Mobile Integrated Health
Authors: Bluma Dot , Bowser John , Forlenza Leah , Miller Gregory , Belott Jonathan
Published: February 2024

Introduction:
Transition of care (TOC) to home for many stroke patients is suboptimal. Recent studies estimate 30-day all-cause readmission of stroke patients at 17.4%. The Wisconsin (WI) Coverdell Stroke Program partnered with the Milwaukee Fire Department- Mobile Integrated Health Program (MFD-MIH) and Milwaukee County hospitals three times since January 2019. The aim of our MIH focused partnership was to improve follow up care and care coordination after an acute stroke hospitalization to a vulnerable urban population.

Methods:
A charter, project algorithm, and referral forms were created to guide our work. Patient referral forms and MFD-MIH home visit summaries were sent via secure email. Upon receiving a home visit referral from the hospital MFD-MIH attempted to engage the patient within two business days. After a completed visit, MFD-MIH sent a summary form to the referring hospital mimicking post-discharge data metrics in Get With The Guidelines® (GWTG). Upon receiving the summary form, hospital abstractors entered the data into GWTG. The data was then analyzed by the Coverdell team.

Results:
As of May 2023, 73 stroke patients have received a home visit from MIH-MFD with data entry in GWTG. Analysis of the third iteration of the program will occur after it ends in April 2024. We compared our first two MIH projects to all Wisconsin hospitals entering into the GWTG Post-Discharge tab. Our results showed:

• Coverdell MIH hospitals outperform WI hospitals in
Blood Pressure Monitoring by Patient
and
Appointment Scheduled Prior to Discharge

• Coverdell MIH hospitals underperform WI hospitals in
ED Visits
,
Falls Reported by Patient
,
Medication Stoppage
and
Tobacco Use

Conclusions:
Many factors influenced our data. First, the population in the Coverdell MIH program was from an urban environment with more proximate post-discharge resources. All WI hospitals do not share this setting. Secondly, MIH data collection involves an in-person home visit. Conversely, WI hospitals data collection occurred via a phone call or chart review. The Coverdell MIH method facilitates a collegial environment where more truthful disclosures may result.
Abstract WP54: Design and Preliminary Results on an Educational Intervention to Foster Stroke Coordinator Engagement, Knowledge, and Job Satisfaction
Authors: Shoemaker Camella , OWENS JACQUELYN , Tilley Megan , Gazi Melissa , Kamal Shaila , Bakradze Ekaterina , Lyerly Michael J , Gropen Toby I
Published: February 2024

Background:
Stroke Coordinators (SC) are instrumental in overseeing the development, evaluation, and sustainability of processes that drive the Stroke Care System. However, there are many practice barriers that impact the SC role including time management, mentorship, education, and training. The aim of this study s to train SC throughout Alabama’s six EMS regions and evaluate whether training in certification in Stroke Nursing increases overall job satisfaction.

Methods:
This part of StrokeSTAT, a larger observational trial designed to evaluate the implementation of severity-based stroke triage across Alabama’s six EMS regions. Key elements of the intervention include partnerships with the Alabama Department of Public Health and the State’s professional multi-disciplinary association of health care professionals involved in the care of stroke patients (Alabama Stroke Alliance of Professionals, ASAP), bringing stroke symposia to each EMS region; providing SCs with a Stroke Certified Registered Nurse (SCRN) review course to encourage and inspire nurses caring for patients with acute stroke to sit for the exam; and reimbursement for successful certification.

Results:
At present, two regional courses have been offered with 27 Registered Nurses in attendance from 33 Stroke Centers. Evaluations (n=20) indicated that before the course, SCs were “slightly comfortable” (5%), “somewhat comfortable” (20%), “for the most part comfortable” (75%) with exam content. In the post-course evaluation, 100% of attendees responded, “the information in this activity will help me do my job.”

Conclusions:
Stroke care continues to rapidly evolve, and SC are often untrained for the role. The partnership with key stakeholder organizations, bringing the symposia to each region, and focusing on improving knowledge and preparation to sit for the SCRN exam were highly effective in engaging the Alabama SCs in the two EMS regions thus far. The symposia provided specialized knowledge for the practice of Stroke Nursing, and uniformly increased participant’s perception of their ability to perform their duties. Evaluation of impact of the different elements of this complex health intervention on stroke coordinator perception is ongoing.
Abstract WP56: Neuroscience Nurse Navigator a New Compass in Continuation of Care Among Stroke Populations
Authors: Adams Ronald , Campbell Margie L , Lee Jessica D , Perkins Leah
Published: February 2024

Background and Purpose:
Due to continued growth in our neurosciences program, of more than 1,400 discharged stroke patients per year, we saw a need for the creation of a Neuroscience Nurse Navigator (NNN) position, with initial efforts specifically focused in the stroke program. This role was developed as a means to meet and fulfill Joint Commission recommendations, along with the Comprehensive Stroke Certification (CSC) standards. Prior to the NNN role, compliance for attempted patient callbacks (a CSC requirement for those discharged home) was only 70%. Resources to support patient needs post-discharge were limited.

Method:
The process in creating this role began in 2020 and came to fruition in 2022. As a means to address patient call back compliance, those patients who have been identified as having a stroke, are visited as a point of introduction, also allowing time for unanswered questions. All stroke patients are called within a seven-day window, including those on our Neurosurgery service line. Patients are asked a series of 12 pre-set questions with calls varying from 6-10 minutes. To address the issue of post-discharge resources, the NNN aids in facilitating and arranging follow up appointments and is available to assist with patient questions prior to follow up appointments. The development of the stroke support group was initiated as well. Working with marketing and IT, the NNN created the Brain Matters stroke support group, which includes an informational postcard with QR code provided to stroke patients at time of discharge, and a separate email account. Patients can use this email to ask for a registration form for Brain Matters and allows the facilitator to communicate to the group as a whole.

Results:
Since implementing the NNN, attempted call-back rate among the 7-day calls have reached 100%, and completed call-backs (patient or family reached) increased from 70% to 85%. In relation to post-discharge resources, the creation of the Brain Matters stroke support group has been implemented and data is currently ongoing.

Conclusion:
The future plan is to further develop the NNN role as a necessary resource for all patients within the entire Neuroscience service line, including General Neurology, Epilepsy and Neurosurgery, as they navigate toward recovery.
Abstract WP57: Who Needs to Compete When You Can Collaborate? Celebrating 25 Years of Successful Stroke Care
Authors: Stenuf Chaeli , Langston Sarah J , Persondek Leighann M , Kaub Lenzi , Henderson Kathleen , Modin Tom , Saathoff Kayli , Waggoner Erin , Braklow Jana , Gooding Courtney
Published: February 2024

Background:
In 2004, Kansas City nurses partnered with the American Stroke Association to provide stroke education to health care providers and the community. Over time, the goal shifted to stroke systems of care. Today this group is known as the Bistate Stroke Consortium, comprised of 34 hospitals and rehab facilities. The group continues to work together to facilitate their mission in a spirit of collegiality and collaboration throughout two states. The communities have also benefited as evidenced by an increase in Primary and Comprehensive Stroke Centers in the region.

Methods:
In 2021, this Consortium formed a community outreach and stroke leader development sub-committee. Multiple innovative projects were created for both community outreach and stroke leader development to help with educating our region about strokes, celebrating successes, and highlighting best practices from our group. The purpose of this research is to evaluate the effectiveness of these projects.

Results:
This group placed an emphasis on community and leader education. The group distributed over 10,000 resources in the region and gained substantial community viewership. The group members of the Bistate group provide over 130 hours of education each year including best practices and benchmarked data from GWTG. Notably, during this same period, these two states experienced improvements in stroke related mortality and hospitalizations. The increasing number of patients with stroke symptoms arriving at the hospital via EMS indicates a clear preference for calling 911 and the impact of community education. While the precise factors contributing to these improvements are multifaceted, it is likely that the efforts of this group have played a pivotal role in influencing these positive outcomes.

Conclusion:
The Bistate Stroke Consortium collaborates to improve patient care, community education, and supports Stroke Coordinators. Stroke mortality and hospitalizations are decreasing in the Consortium's region. Timely stroke recognition by non-healthcare providers and presentation to appropriate healthcare systems are essential to improve outcomes. Continued focus on community outreach and program development is crucial to the Consortium's success.
Abstract WP59: Impact of Advanced Practice Nursing in Comprehensive Stroke Care
Authors: Rush Nancy , Heater Abbi
Published: February 2024

Background and Issue:
Delivering efficient comprehensive stroke care can be challenging as there are various interdisciplinary team members and factors impacting the outcome of each stroke patient. The issue identified was the lack of advanced practice nursing (APN) on the stroke team. A disease specific nurse case manager (NCM) begins the discharge process at the time of admission and proactively identifies the multiple barriers to discharge. These barriers may include payer and/or placement issues, availability of post acute services, medication costs, post discharge support, social determinants, and daily communication with internal and external entities. The role of the stroke nurse practitioner (NP) includes direct patient care, research, education of patient, family and staff and ensuring that accurate documentation is captured on every patient, including stroke metrics.

Purpose:
To incorporate APN into the comprehensive stroke team aimed at consistently delivering quality care to every stroke patient. We accomplished this by adding a dedicated disease specific NCM and stroke NP to champion the optimal utilization of resources with the end result of efficient patient throughput.

Methods:
This quality improvement initiative was to compare length of stay (LOS) and case mix index (CMI) data from 2014 to 2023 for ischemic stroke patients that includes four years prior to the addition of APNs in comparison to five years post addition.

Results:
Prior to the addition of disease specific NCM and stroke NP to the stroke team, the average LOS for an ischemic stroke patient was 5.39 days and CMI was 2.0. Each year after the addition, LOS declined by 44% and CMI increased by 24%.

Conclusion:
The combination of a disease specific NCM and stroke NP working in tandem on the stroke team enhanced stroke care at many different levels resulting in benefits to the patient and provided a positive financial impact to the institution. The results demonstrate the value of APNs in comprehensive stroke care.
Abstract WP73: Temporal Effects on Mobile Stroke “Hot” Zones Using a Geo-Spatial Software Analysis
Authors: Vora Shivam , Hake Joshua , Willis Corbin , Hall Maelee , Jennings Nate , Katz Brian S , Rai Vivek , Loochtan Aaron , Hicks William J , Crow Dan
Published: February 2024

Background:
We sought to identify variations of mobile stroke unit (MSU) hotspot activity based on time of day by using a geospatial analysis software.

Methods:
The Mobile Stroke Treatment Unit of metropolitan Columbus, Ohio, provides emergency stroke care coverage for 325 square miles which spans 47 zip codes. Our MSU is operational from 0700-1900 and is dispatched for all 911 calls designated as probable or possible strokes. We retrospectively reviewed all MSU calls from May 2019 to June 2022. The calls were organized into zip codes and 3 time epochs (0700-1100, 1101-1500, 1501-1900). Our endpoint was to determine hotspots of MSU activity during these epochs using the ESRI/ArcGIS Online geospatial analysis software. Statistically significant hotspots are qualitatively defined as clustered regions with high activity and quantitatively defined as having a Gi Bin score > 2, which correlates to statistical confidence > 95%.

Results:
We received 5198 calls during our study period; 1535 from 0700-1100; 2002 from 1101-1500; 1661 from 1501-1900. All hotspots had an average separation of 6.2 miles. From 0700-1100, 5 zip codes (12.9% of calls) were considered hotpots (Figure-Top). From 1101-1500, 15 zip codes (44.7% of calls) were considered hotspots (Figure-Middle). From 1501-1900, 9 zip codes (34.1% of calls) were considered hotspots (Figure-Bottom). Five zip codes were statistical hotspots during the entire coverage period. Four additional zip codes also showed hotspot activity and overlapped 1101-1900 time epochs.

Conclusions:
Our study showed that hotspot activity can vary throughout the day and must be considered for strategic MSU deployment. Prospective validation is needed to determine if such strategic deployment is feasible and can improve clinical outcomes.
Abstract WP85: Evaluating the Strengths and Limitations to Patient-Reported Modified Rankin Scale Studies: A Systematic Review
Authors: Nair Shuait , Hurly Jordyn , Saylor Deanna
Published: February 2024

Background:
Studies evaluating patient-reported modified Rankin scales (mRS) in patients with stroke in different cultural and language settings have not been aggregated to determine validity of these adapted assessments.

Objectives:
To systematically review all patient-reported mRS studies performed outside of the United States (US).

Methods:
We searched PubMed and Web of Science for non-US based studies that evaluated patient-reported mRS against in-person clinician mRS among patients with stroke. Studies were analyzed for country of investigation, mRS self-assessment modality, care setting (inpatient vs outpatient), study limitations, and concordance between patient-reported and in-person mRS scores.

Results:
We identified 13 patient-reported mRS evaluation studies across all continents except Africa. The most common self-reported mRS assessment was the telephone mRS questionnaire. Average time between in-person and self-reported mRS assessments was ~14 days. The weighted kappa agreement between patient-reported and in-person mRS scores ranged from moderate to very good (K

w

range: 0.56 to 0.90), though unweighted kappa scores were significantly lower (K range: 0.27 to 0.68). Discrepancies between patient-reported and clinician-evaluated mRS scores tended to result from patients at the scale extremes. Patients with good mRS outcomes (mRS
<
2) tended to rate themselves better than their clinicians while those with poor outcomes (mRS
>
3) tended to rate themselves worse than their clinicians did. Major limitations across studies included sampling bias in the in-patient setting, time delays between in-person and self-reported mRS assessments, and differences in the structure of the clinician-led vs patient-reported mRS assessments.

Conclusion:
While patient-reported mRS validation studies to date have generally displayed good agreement with clinician-reported outcomes, significant scoring discrepancies exist for patients with very poor and very good outcomes. Future studies should consider limiting time between mRS assessments and understanding reasons for differences in patient and clinician assessments. Further, data on validity of self-report mRS tools are lacking from much of the world, especially Africa.
Abstract WP88: Can Machine Learning Assist With Large Scale Medical Literature Review?
Authors: Cheng Roger , Zhang Pengfei
Published: February 2024

Introduction:
The pace of emerging scientific literature far outstrips that of guideline updates, yet clinical practice may require early implementation after careful review. Recently developed large language model (LLM) based machine learning systems are potential assistive tools to identify novel clinical practice or research avenues as they emerge. Here we use GPT3.5, a LLM developed by OpenAI, to evaluate 3 interventions for aneurysmal subarachnoid hemorrhage (aSAH), with comparison to conclusions from a systematic review, the 2023 AHA Guideline on Management of aSAH.

Methods:
A list of articles and the associated abstracts were identified for each of the terms “nimodipine” (N), “magnesium” (M), and “induced hypertension” (IH) via PubMed search, with results topic filtered using the MeSH term “Subarachnoid Hemorrhage.” Review articles and meta-analyses were excluded. Using custom code via the GPT3.5 programming interface, the LLM was asked to read each abstract, decide if the intervention was discussed, and if so, rate it as effective, neutral, or ineffective, corresponding to scores of 1, 0, or -1.

Results:
Mean efficacy scores for N, M, and IH were 0.67, 0.32, and 0.15 after automated review of 136, 47, and 33 abstracts, respectively. Corresponding guidelines report strong benefit/class 1 (N), no benefit/class 3 (M), weak/Class 2b for therapeutic use of IH, and harm (class 3) for prophylactic use. While N had consistently positive automated scores, manual review of these abstracts showed that it was often used as a standard of care comparator (possible confirmation bias). Though M had consistently poor clinical trial scores, the mostly positive case and retrospective reports raised the score (possible publication bias). IH combined all aspects, with case reports of harm, mixed trial scores, yet also widespread use as standard of care.

Conclusion:
Though GPT3.5 results roughly parallel human curated ones, this method is not meant to replace the rigorous process of systematic review, but potentially assist as a “first pass” evaluator of new literature in a real-time, continuous manner to improve efficiency. Optimization of LLM prompts may help with specificity, and weighting articles by type or perceived quality may improve accuracy.
Abstract WP90: Participants With Complex Impairment Profiles Are Systematically Excluded From Stroke Psychosocial Support Research: A Scoping Review
Authors: Lin Nancy X
Published: February 2024

Introduction:
Disability after stroke often requires mental health treatment, but contradictorily, also restricts access to it. People with cognitive, motor, language, and perceptual impairments have been excluded from research on psychosocial supports like psychotherapy, support groups, and meaningful life activities. This exclusion adds to the inequitable distribution of benefits, including fewer treatment options and less knowledgeable providers. Very little is known about
who
is excluded from stroke psychosocial support research,
why
they are excluded, and
how
exclusion occurs.

Methods:
Exclusionary practices were investigated using a Johanna Briggs Institute-method scoping review. Independent reviewers screened searches of CINAHL, Embase, MEDLINE, and PsychInfo, resulting in 101 included studies. Content analysis was used to analyze studies following an
a priori
coding framework, which included: Design, inclusion/exclusion criteria, stroke impairment, psychiatric comorbidity, and psychosocial support type.

Results:
Samples were commonly limited to mild cognitive impairment, with other subpopulations under-represented. Moderate-to-severe cognitive and language impairments were systematically excluded from psychotherapy studies. In contrast, support group and meaningful life activity studies more often included a range of impairments, but also more often excluded psychiatric comorbidity. Studies with rigorous designs rarely included complex impairment profiles. Reasons for exclusion were seldom provided, and participant characteristics were routinely underreported.

Conclusion:
By including only people with mild and uncomplicated impairment profiles, the field risks neglecting the complex realities of others who arguably have even greater need for support. This scoping review offers recommendations for stroke research and practice, including: The inclusion of a range of stroke impairments in research samples, adapting procedures using compensatory strategies to facilitate inclusion, and greater cross-pollination between mental health and rehabilitation disciplines. This review serves as a call to action to make psychosocial supports equitable and accessible for all people, regardless of ability.
Abstract WP96: Impact of Stroke Severity and Social Determinants of Health on Arrival to Last Known Well Time
Authors: Law Susan W , Huang Anna , Soh James , Kang Derrek , Shaheen Yanal , Reyes Rivera Arsenio , Kelesoglou Christopher
Published: February 2024

Introduction:
Timely administration of thrombolytic therapy remains the cornerstone of ischemic stroke management and is associated with better functional outcomes. The population served by our hospital is notable for a large socioeconomic range of patients. We examined arrival times for ischemic strokes and the timeliness of intervention with our goal to better understand our population and develop methods for improved community outreach and education.

Methods:
This retrospective study looked at ischemic stroke patients discharged between January-May 2023. Patient characteristics and demographics were mined from the Get With The Guidelines™-Stroke database from NYC Health+Hospitals/Kings County. A total of 284 patients were reviewed. Covariates included in this study: age, sex, ethnicity, initial NIHSS score, payment source, and history of previous stroke. Adjusted linear regressions were used to analyze data at alpha = 0.05.

Results:
The median time of arrival to hospital from last known well time (LKWT) is 296min; 37.32% of patients arrived within the 4.5hr window. The average NIHSS score on arrival for patients within the 4.5 hours window is 7.3; patients outside of the 4.5hr window (or unknown LKWT) have an average NIHSS of 5.17. (See distribution of NIHSS score by LKWT category in Fig. 1 below.) Out of the 284 patients, a noted association was seen between severity of NIHSS and LKWT reported: the LKWT was lower by 16.47min (23.68-9.24, p > 0.02) for every increase in NIHSS point. Additionally, compared to patients with no health insurance, those with private insurance have a decrease in LKWT of 1506.04min (1878.6-1133.5, p < 0.0001), and those with Medicare/Medicaid have a decrease in time of 1291.83min (1652.1-931.5, p > 0.0004).

Conclusion:
Review of patients in early 2023 showed a relationship between LKWT reporting and stroke severity as well as insurance status. These findings will help direct future projects in community education and outreach.
Management of Incomplete Microcirculatory Reperfusion After Endovascular Thrombectomy: Focus on Inhibition of the Glycoprotein IIb/IIIa Receptor Pathway
Authors: Krothapalli Neeharika , Ortel Thomas , McBride Devin , de Havenon Adam , Sansing Lauren H. , Hasan David , Mac Grory Brian
Published: February 2024

Endovascular thrombectomy (EVT) is one of the most effective therapies for acute ischemic stroke attributable to large‐vessel occlusion but, despite successful treatment, there remains a significant number of patients with disability. The phenomenon of incomplete microcirculatory reperfusion or no reflow is thought to underlie a substantial proportion of cases with unfavorable outcome. This phenomenon likely arises from platelet aggregation and endothelial edema impacting the cerebral microvasculature, vessels that are below the resolution of digital subtraction angiography. Although incomplete microcirculatory reperfusion prevents tissue recovery and poses a significant clinical challenge, there are multiple therapeutic options administered early after recanalization that have been shown to be promising. In this review, we discuss incomplete microcirculatory reperfusion after EVT and highlight various treatment approaches with a particular focus on antiplatelet therapy, including inhibition of the glycoprotein IIb/IIIa receptor pathway. We also review the rigor of previous studies exploring the use of intravenous and intraarterial administration of tirofiban in neurologic disease before EVT, during EVT, after EVT, or as rescue therapy to determine its effect on clinical outcomes.
The Art of Communicative Grammar
Authors: Christenson David
Published: February 2024

This review article of the Oxford Latin Syntax (Vols. I-II, 2015 and 2021) demonstrates how the communicative approach of Harm Pinkster’s monumental grammar complements recent revivals of oral, aural, and active Latin pedagogical methods. I conclude with examples of how Pinkster’s analysis of discourse may be applied to select passages (from Plautus’ Rudens, as a productive means of explicating dramaturgical and narratological matters there) in order to illustrate the OLS’s manifold potential for exploring discursive strategies of Latin texts generally.
Revision of the genus Cyrtolabulus van der Vecht in Madagascar (Hymenoptera: Vespidae: Eumeninae)
Authors: SELIS MARCO
Published: February 2024

The species of the genus Cyrtolabulus van der Vecht, 1969 occurring in Madagascar are revised, with the description of three new species: Cyrtolabulus flavorufus sp. nov., Cyrtolabulus parvulus sp. nov. and Cyrtolabulus scrobalis sp. nov. Pseudonortonia madacassa Gusenleitner, 2012 is synonymized under Cyrtolabulus suboscurus (Giordani Soika, 1941) syn. nov., and a neotype is designated for Labus bekilyensis Giordani Soika, 1941. A comparison with the closely related genus Cyrteumenes Giordani Soika, 1991 and a key to the species are provided.
Performance Improvement Program Review of Institutional Massive Transfusion Protocol Adherence: An Opportunity for Improvement
Authors: Easterday Thomas , Byerly Saskya , Magnotti Louis , Fischer Peter , Shah Kinjal , Croce Martin , Kerwin Andrew , Howley Isaac
Published: February 2024

Background

Given the acuity of patients who receive MTPs and the resources they require, MTPs are a compelling target for performance improvement. This study evaluated adherence with our MTP’s plasma:red blood cell ratio (FFPR) of 1:2 and platelet:red blood cell ratio (PLTR) of 1:12, to test the hypothesis that ratio adherence is associated with lower inpatient mortality.

Materials and Methods

The registry of an urban level I trauma center was queried for adult patients who received at least 6 units of packed red blood cells within 4 hours of presentation. Patients were excluded for interfacility transfer, cardiac arrest during the prehospital phase or within one hour of arrival, or for head AIS ≥5. Univariate analysis and multiple logistic regressions were performed to identify variables associated with early transfusion protocol noncompliance and the effect on inpatient mortality.

Results

Three hundred and eighty-three patients were included, with mean ISS of 25.9 ± 13.3 and inpatient mortality of 28.5%. Increasing age, ISS, INR, and total units of blood product transfused were associated with increased odds of mortality, while an increase in revised trauma score was associated with a decreased odds ratio of mortality. Achieving our goal ratios were protective against mortality, with OR of .451 ( P = .013) and .402 ( P=.003), respectively.

Discussion

Large proportions of critically injured patients were transfused fewer units of plasma and platelets than our MTP dictated; failure to achieve intended ratios at 4 hours was strongly associated with inpatient mortality. MTP processes and outcomes should be critically assessed on a regular basis as part of a mature performance improvement program to ensure protocol adherence and optimal patient outcome.
Civil war mediation in the shadow of IGOs: The path to comprehensive peace agreements
Authors: Karreth Johannes , Tir Jaroslav , Quinn Jason , Joshi Madhav
Published: February 2024

Recent research shows that comprehensive peace agreements (CPAs) are effective in ending civil wars and improving post-conflict conditions, but CPAs emerge in only a fraction of civil wars. This study provides systematic evidence about the origins of CPAs and the role of international actors in facilitating their signing. We argue that mediation is more likely to be successful and that CPAs are more likely to emerge in those civil war countries that are members in a higher number of IGOs with high economic leverage. Using their financial and institutional leverage, these IGOs can help the combatants overcome the credible commitment problems associated with entering into mediation, and with making sufficient concessions and compromises to reach and sign a CPA. Analyzing all intrastate armed conflicts from 1989 to 2011, we find that a conflict country’s memberships in IGOs with high economic leverage increase the odds of (1) mediation occurring and (2) mediation subsequently leading to the signing of CPAs. This finding is robust to common sources of spurious relationships between international institutions and the behavior of conflict parties. Participating in IGOs with high economic leverage carries important positive consequences for civil war management and enhances the impact of mediation on getting conflict parties to sign CPAs.
Effect of surface modification of metal powders (by aluminum stearate) on the properties of metal injection molding feedstock
Authors: Ma Haihong , Fang Shuncheng , Zhou Zhengfa , Ren Fengmei , Xu Weibing , Chen Guoming
Published: February 2024

Metal injection molding (MIM) is a net-forming technology for manufacturing miniature metal parts, which can improve the manufacturing accuracy of complex-shaped parts. In this study, aluminum stearate was used to modify the 17-4PH stainless steel powder, the binder was composed of (PMMA) and (PEG) with the volume ratio of 7:3. The effects of aluminum stearate surfactant amount on the feedstock viscosity, water debinding rate and thermal debinding shape were studied. The results showed that the coating of aluminum stearate breaks the agglomeration between the powders and decreases the viscosity of the feedstock. When the addition of aluminum stearate was 0.6wt% of the powder mass, the melt index, density and flexural modulus of the feedstock were 81.5 g/10 min, 5.44 g/cm3, and 1643Mpa, respectively, and the thermal debinding shape retention was the best of all debinded parts. However, too much aluminum stearate makes the feedstocks thicker and the green part weaker.
Effect of crossing warp architecture on tear strength of 3D orthogonal woven T-shaped reinforcements
Authors: Wei Ziyue , Chen Xiaogang
Published: February 2024

T-shaped textile composites reinforced by two-dimensional laminates and simple forms of three-dimensional reinforcements are susceptible to tear failure and delamination at the junction. To address these issues and enhance the tear resistance of composite T-joints, 10 types of crossing warp architecture based on three-dimensional woven orthogonal structures were designed, manufactured and characterized with the aim of optimizing the reinforcement architecture. The assessment of the in-plane mechanical behavior was carried out by a tensile tear load applied to the two flanges of the T-shaped reinforcements. The employment of crossing warp architecture effectively enhanced stiffness, tensile strength, and failure strain. Resistance to the failure of the reinforcement was increased as more crossing warp yarns were employed. To further optimize the crossing warp architecture for reinforcement development, the internal and external crossing arrangements were compared. The new finding was regardless of the crossing warp proportions, the external crossing warp led to a higher resistance to the tear force for the reinforcement than the internal crossing warp. The stiffness and tensile strength of the external crossing warp reinforcements exhibited notable improvement, with a maximum increase of 49.1% and 31.1% respectively, compared with that of the internal warp crossing counterparts. The findings in this research will be useful in manufacturing composite T-joints to tailor the reinforcement architecture with different crossing proportions and arrangements for meeting the required mechanical properties.
‘Faith working through love’: a new food law for a new world
Authors: Newall Marcello
Published: February 2024

In this article, I argue that in regard to dietary choices, the New Testament, while moving beyond the ritual purity found in the Mosaic dispensation, does not replace it with a libertarian freedom – a kind of antinomian indifference – or even a harsh asceticism, but with what the Apostle Paul calls ‘faith working through love’ (Gal. 5.6). The faith talked of is based on the death and resurrection of Christ and hopes in his coming. Moreover, this faith is inserted within the framework of the initial Genesis ideal of peace and the entire story of Israel, as well as the expectation for the final renewal of the cosmos beyond sin and death (Isa. 11.6–9; Matt. 19.28; Rom. 8.19–21).
The role of religious experience: a review article
Authors: Astley Jeff
Published: February 2024

A review article of two contrasting books on the role of religious experience within New Testament studies and practical theology respectively.