bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 219: Determining the Proportion of Patients with Poor Premorbid mRS presenting with Large Volume Stroke
Authors: Siddiqi Madheea 
Published: March 2024

Introduction
Several lines of evidence demonstrate the effectiveness of endovascular treatment (EVT) for large volume stroke (LVS) as defined by Alberta Stroke Program Early CT Score (ASPECTS) of <6 in decreasing severe disability and death. However EVT cannot improve the degree of disability as measured by modified Rankin Scale to be better than premorbid levels. Despite this limitation, patients with severe disabilities are transferred to acute care facilities for consideration of EVT and are hospitalized resulting in over‐medicalization during a terminal event. We aim to determine the proportion of patients with LVS who have poor premorbid mRS (4‐5) and the number of days this subset spent in hospital prior to palliation/death.

Methods
2485 CT angiograms of head and neck and CT Head examinations performed between 2018‐2021 were obtained from the picture archiving and communication system (PACS). Cases presenting with ASPECTS<6 as assigned by a neuroradiologist were identified. Functional outcome data, as defined by mRS, was obtained prior to the acute presenting event (premorbid mRS) and on discharge (outcome mRS). All patients with a documented outcome mRS were included in the analysis. Patients were excluded if presenting ASPECTS was >=6, if stroke symptoms were attributable to etiology other than large vessel or tandem occlusion, or if the studies had been duplicated. Number of days spent hospitalized was calculated based on admission date and discharge date. Further subgroup analysis was performed to compare the cost of hospitalization with return to long term care (LTC) based on the Canadian national average of $7803 for hospitalization and $2406 for long term care as provided by Canadian Institute of Health Information and Ministry of long term care of Ontario.

Results
From the 2485 examinations, 62 had a baseline ASPECTS<6 and 22 cases met exclusion criteria. 40 cases were available for analysis [premorbid mRS (n): 0=(18), 1=(5), 3=(6), 4=(7), 5=(2), ?=(2); age range: 28‐93; 19 male, 21 female]. 23% (9/40) of patients had premorbid mRS of 4‐5, and of these, 78% (7/9) were from LTC or a retirement home. On average, 5.9 days were spent hospitalized [range 4‐9 days]and $5397/person was spent per hospitalization.

Conclusion
LVS secondary to a LVO can be an acutely terminal illness. 23% of patients presenting with LVS had a poor premorbid mRS. 78% of these patients resided in long term care centers and spent an average of 5.9 days ($5397/person) being hospitalized prior to their demise/palliation.
Abstract 223: Pre‐Thrombectomy Diagnosis of Large Vessel Occlusion with Underlying Intracranial Atherosclerotic Disease
Authors: Tarek Mohamed A. , Damiani Mateus , Mohammaden Mahmoud H. , Rangaraju Srikant , Martins Pedro N. , Dolia Jay N. , Pabaney Aqueel A. , Grossberg Jonathan R. , Nahhas Michael , Nogueira Alhamza R. , Haussen Raul G. 
Published: March 2024

Introduction
Intracranial atherosclerotic disease (ICAD) is one of the leading causes of ischemic stroke. We sought to identify variables associated with ICAD underlying large vessel occlusion strokes (LVOS) to facilitate pre‐procedural diagnosis.

Methods
Retrospective analysis of a prospectively collected thrombectomy single comprehensive stroke center database. Inclusion criteria: anterior circulation occlusion involving the intracranial ICA, MCA‐M1/M2/M3 or ACA(A1‐A2‐A3). ICAD cases were matched for age and sex in a 1:1 ratio to non‐ICAD controls.

Results
A total of 348 patients were included in the analysis. Patients with ICAD more frequently presented with vascular risk factors. ICAD LVOS showed less frequent atrial fibrillation(AF)(4%vs31%,P=0.001), and lower baseline NIHSS(14vs17,P=0.002) compared to the non‐ICAD group. The ICAD group less frequently showed hyperdense vessel sign and territorial cortical infarcts, but presented more frequently borderzone, deep subcortical and bilateral infarcts on CT compared to the non‐ICAD group. ICAD strokes had higher ASPECTS, and more frequently had calcifications at the carotid siphon as well as multifocal intracranial stenosis on CTA. CTA collaterals scores were comparable between groups. The ICAD group had lower median infarct core volume (1vs12 ml;P>0.001), Tmax>4s (249vs276 ml;P>0.003), and Tmax>6s (97vs140 ml;P<0.003) and higher Tmax>4:6 s ratio (2vs1;P=0.007) on CTP compared to non‐ICAD group. On multivariable analysis, absence of AF, absence of cortical infarcts, presence calcium at ipsilateral carotid siphon, cerebrovascular stroke risk factors burden (DM‐HTN‐Hyperlipidemia‐smoking), borderzone infarcts either (superficial cortical or Internal deep border zone), and multifocal intracranial stenosis were independent factors associated with ICAD. The model (table 1) by AUC for the whole model had sensitivity of 88% [P=<0.001,95%CI(0.84‐0.91)].

Conclusion
In patients with anterior circulation LVO strokes, our study suggests that presence of CVS risk factors burden, calcium at carotid siphon, borderzone infract pattern, absence of territorial cortical infarct pattern, multifocal intracranial stenosis, and absence of AF were predictors for ICAD. Additional validation is warranted
Abstract 237: Thrombectomy is the Leading Treatment Modality for Symptomatic Sub‐Occlusive Lesions: a Nationwide StrokeNet Survey
Authors: Harker Pablo , Ayala Felipe , Ades Laura , Khatri Pooja , Aziz Yazmin 
Published: March 2024

Introduction
Approximately 3% of all acute ischemic stroke are caused by sub‐occlusive thrombi in the proximal intracranial vasculature. There is a paucity of evidence regarding optimal treatment of this stroke etiology, with most evidence derived from retrospective case series preceding the advent of mechanical thrombectomy. We sought to survey the National Institute of Health StrokeNet to determine real‐world treatment patterns in experienced stroke centers. We hypothesized that most providers would choose mechanical thrombectomy (MT) over medical management (MM).

Methods
We conducted an email survey of all StrokeNet regional coordinating centers (RCCs). Each RCC principal investigator (PI) was asked to provide a name of a local stroke endovascular specialist most aligned with their region’s typical practice pattern. A subsequent survey was sent to each if the StrokeNet RCC PIs and their nominated interventionalists. Questions were based on a clinical vignette accompanied by CT angiogram displaying a sub‐occlusive lesion in the left middle cerebral artery (MCA) (Figure 1a). Subsequent questions kept the same basic vignette, changing only one historical, clinical, or radiographic variable at a time. Participants were asked to describe initial management for each scenario. If more than one initial treatment was selected, or if no treatment option was selected, applicants were asked to please explain. Results were gathered from each participant using Google Forms.

Results
Among 27 StrokeNet RCCs, 25 (93%) provided at least one response; responses were received from 43 of 54 (80%) physicians surveyed, including 26 stroke interventionalists. A total of 4 sites selected an alternate responder of the appropriate specialty if their PI or chosen representative was unable to respond. The majority (71.4%) of respondents treated patients with acute sub‐occlusive thrombus with MT (Figure 1b). MT alone, or MT with additional MM, comprised the majority of responses to clinical vignette variation questions[Moderate core (ASPECTS 6): 71.4% MT, 76.2% MT with MM; Last Known Normal 12‐hours prior with Favorable Advanced Imaging: 73.8% MT, 83% MT with MM; Last Known Normal 12‐hours prior without Advanced Imaging: 54.8% MT, 64.3% MT with MM; Severe hypertension (210/110mmHg): 50% MT, 69% MT with MM; Poor Collaterals: 71.4% MT, 78.6% MT with MM]. Only two scenarios, low baseline National Institutes of Health Stroke Score (NIHSS) and history of ipsilateral stenosis, led respondents to favor non‐thrombectomy approaches (Low NIHSS (3): 9.5% MT; History of Ipsilateral Stenosis: 30.9% MT, 47.6 MT with MM) (Figure1c‐d).

Conclusion
Despite limited evidence to support MT versus other treatment strategies, the majority of StrokeNet Regional Coordinating Center sites would use MT to treat acute strokes due to intracranial sub‐occlusive thrombi.
Abstract 251: Characterizing coma in patients presenting with large vessel occlusion stroke
Authors: Young Michael J. , Awad Amine , Andreev Alexander , Bonkhoff Anna K. , Schirmer Markus , Dmytriw Adam A. , Vranic Justin E. , Rabinov James D. , Doron Omer , Stapleton Christopher J. , Das Alvin J. S. , Singhal Aneesh B. , Rost Natalia S. , Patel Aman B. , Regenhardt Robert W. 
Published: March 2024

Introduction
Coma is an unresponsive state of disordered consciousness characterized by impaired arousal and awareness. The epidemiology and pathophysiology of coma in ischemic stroke has been underexplored. We sought to characterize the incidence and clinical features of coma as a presentation of large vessel occlusion (LVO) stroke.

Methods
Individuals who presented with LVO were retrospectively identified from July 2018 to December 2020. Coma was defined as an unresponsive state of impaired arousal and awareness, operationalized as a score of 3 on NIH Stroke Scale (NIHSS) item 1a.

Results
A total of 28/637 (4.4%) patients with LVO stroke were identified as presenting with coma. The median NIHSS was 32 (IQR 29‐34) for those with coma versus 11 (5‐18) for those without (p<0.0001). In coma, occlusion locations included basilar (13), vertebral (2), internal carotid (5), and middle cerebral (9) arteries. 8/28 were treated with endovascular thrombectomy (EVT), and 20/28 died during the admission. 65% of patients not treated with EVT had delayed presentations or large established infarcts. In models accounting for pre‐stroke modified Rankin Scale (mRS) score, basilar artery occlusion location, intravenous thrombolysis, and EVT, coma independently increased the odds of transitioning to comfort care during the admission (aOR 6.75; 95%CI 2.87,15.84; p <0.001) and decreased the odds of 90‐day mRS 0‐2 (aOR 0.12; 95%CI 0.03,0.55; p=0.007).

Conclusion
It is not uncommon for patients with LVO to present with coma, and delayed recognition of LVO can lead to poor outcomes, emphasizing the need for maintaining a high index of suspicion. While more commonly thought to result from posterior LVO, coma in our cohort was similarly likely to result from anterior LVO. Efforts to improve early diagnosis and care of patients with LVO presenting with coma are crucial, given the poor outcomes.
Abstract 268: Validation of an automated method to assess 24‐hour infarct volume in stroke patients
Authors: Jablonska Magda , Sousa João André , Molina Marc , Canals Pere , Garcia‐Tornel Alvaro , Rodrigo‐Gisbert Marc , Rizzo Federica , Olivé‐Gadea Marta , Requena Manuel , Rodriguez‐Luna David , Rodriguez‐Villatoro Noelia , Juega Jesús M. , Muchada Marián , Pagola Jorge , Rubiera Marta , Tomasello Alejandro , Molina Carlos A. , Tanzi Leonardo , Salvia Victor , Marti Cristian , Ribo Marc 
Published: March 2024

Introduction
In stroke patients, accurate infarct volume assessment at 24 hours typically requires manual segmentation of lesions that often are not well defined. We aimed to validate an automated machine learning algorithm (MethinksFIV) specifically trained to automatically segment and measure subacute infarcts on non‐contrast CT (NCCT) scans.

Methods
We retrospectively studied stroke patients with a large vessel occlusion prospectively admitted to a comprehensive stroke center. The final infarct volume was segmented on the 24h NCCT manually (man‐FIV) and with the automated method (auto‐FIV). Both measurements were correlated with clinical outcomes.

Results
We included 346 patients. On 24h‐NCCT median auto‐FIV was lower than man‐FIV (8.6 ml [2.3‐40.7] vs. 16.9 ml [1.1‐70.8], p<0.001). Auto‐FIV and man‐FIV were highly correlated (r=0.8; p<0.001; mean dice coefficient of 0.61). The Auto‐FIV correlated better than man‐FIV with 24h (r=0.54 vs. r=0.51, both p<0.001) and discharge NIHSS (r=0.59 vs r=0.54, both p<0.001). An increase of 1 ml in auto‐FIV was associated with an increase in the odds of higher ordinal mRS at three months (OR=1.01 95%CI 1.01‐1.02, p<0.001). Auto‐FIV was a better predictor of mRS>2 at three months (OR: 1.02 95%CI 1.01‐1.13, p=0.002) than manual segmentation (OR=1.01, 95%CI 1.00‐1.01, p=0.01). In a multivariable analysis, only auto‐FIV remained a significant predictor of mRS>2 at three months (aOR: 1.03 95% CI 1.01‐1.05, p=0.004).

Conclusion
An automated method to measure subacute infarct volumes in stroke patients is accurate and correlates well with further clinical outcomes. The method appears to outperform manual segmentation and may be used to facilitate infarct characterization in large clinical trials.
Abstract 281: The RACE scale for Large Vessel Stroke Diversion to Comprehensive Center by Helicopter Air Ambulance
Authors: Krebs William 
Published: March 2024

Introduction
Acute ischemic stroke caused by large vessel occlusion (LVO) occurs frequently and benefits from endovascular therapies available at comprehensive stroke centers (CSC) {Goyal 2016} {Lakomkin, 2019}. Real world evidence shows that endovascular therapy is effective and better than tPA in cases of LVO {Noguria 2016}. Comprehensive stroke centers are also faster at administering tPA and have better tPA metrics for patients with LVO compared to transfers from non CSCs{Shumei M, 2018}{Seker 2020}. Evidence shows that direct transport to an interventional center may provide benefit even if they are not the closest hospital {Benoit J, 2018} {Venema 2020}. Prehospital stroke severity tools such as the RACE scale and others have been devised to detect LVO with reasonable sensitivity and specificity {Krebs 2018} {Dickson 2020}. Helicopter Air Ambulances (HAA) can limit the time to comprehensive stroke care for rural communities {Liera 2016}. Following the recommendations of the American Stroke Society (ASA), regional EMS protocol allow for direct transfer for potential LVO cases within 24 hours by HAA.{NWOEMS consortium protocol}{Powers WJ 2019}. For this reason HAA can enhance access to comprehensive stroke centers into rural communities.

Methods
A retrospective assessment of RACE scales of 5 or greater performed by prehospital providers was used in order to activate HAA. Descriptive statistics were obtained for patients transported with primary goal of determining the positive predictive values of the RACE Scale for LVO occlusions. Secondary outcomes were if patients had other conditions requiring a comprehensive stroke center.

Results
Data from 148 subjects were in the research dataset. Twelve of these were eliminated due to not meeting inclusion criteria, death prior to imaging, and transport to another facility where records were not available. This resulted in analyses from 136 subjects. Of the 136, 53 (39.0%) were true LVO cases as defined by CT, CTA imaging or MRI. There were 83 (61%) falsely positive (no LVO on imaging). Mechanical thrombectomy occurred in 30 cases (22.1%) with 63 (46.4%) requiring a neurologic intervention.

Conclusion
When the RACE scale is used in real world EMS practice to triage rural stroke cases, it has a high positive predictive for HAA activation with delivery to a comprehensive stroke center in suspected stroke cases. Even false positive activations required care at a comprehensive stroke center in most case.
Measures of the coupling between fluctuating brain network organization and heartbeat dynamics
Authors: Candia-Rivera Diego , Chavez Mario , De Vico Fallani Fabrizio 
Published: March 2024

Abstract
In recent years, there has been an increasing interest in studying brain–heart interactions. Methodological advancements have been proposed to investigate how the brain and the heart communicate, leading to new insights into some neural functions. However, most frameworks look at the interaction of only one brain region with heartbeat dynamics, overlooking that the brain has functional networks that change dynamically in response to internal and external demands. We propose a new framework for assessing the functional interplay between cortical networks and cardiac dynamics from noninvasive electrophysiological recordings. We focused on fluctuating network metrics obtained from connectivity matrices of EEG data. Specifically, we quantified the coupling between cardiac sympathetic–vagal activity and brain network metrics of clustering, efficiency, assortativity, and modularity. We validate our proposal using open-source datasets: one that involves emotion elicitation in healthy individuals, and another with resting-state data from patients with Parkinson’s disease. Our results suggest that the connection between cortical network segregation and cardiac dynamics may offer valuable insights into the affective state of healthy participants, and alterations in the network physiology of Parkinson’s disease. By considering multiple network properties, this framework may offer a more comprehensive understanding of brain–heart interactions. Our findings hold promise in the development of biomarkers for diagnostic and cognitive/motor function evaluation.
The Relationships Between Law-Breaking and Law-Abiding Ideological Animal Rights Activists and Their Parents and Spouses
Authors: Inbar-Frohlich Tali , Bensimon Moshe , Ronel Natti 
Published: March 2024

Abstract
This phenomenological research examined family relationships among ideological nonhuman-animal rights activists, while distinguishing between law-breaking and law-abiding activists. Analysis of semi-structured interviews with 30 activists highlighted two phases within the familial dynamics. During the joining phase, conflicts arose between the participants’ identities as activists and their identities as family members, creating a crisis in their relations with their parents and spouses. During the establishing phase, however, different familial dynamics developed among each group. The law-breaking activists were able to balance family life with their activism, ensuring the preservation of the relationship. By contrast, to try and maintain peaceful relations, the law-abiding activists kept their activism from their family, leading to a deterioration in the relationship. The findings are interpreted through literature dealing with the family dynamics of social activists in general, and animal rights activists in particular.
Pneumatological Self-Confidence, Scriptural Interpretation, and the Making of Scripture in the Letter to the Hebrews
Authors: Heidel Andreas-Christian 
Published: March 2024

Abstract
The Letter to the Hebrews has long been overlooked in discussions regarding New Testament pneumatology or even considered ‘inferior’ compared to other New Testament traditions. However, this is a mistake, as the unknown author of this letter demonstrates a remarkable awareness of pneumatology, which plays a key role in the transmission of early Christian traditions and significantly shapes the formation of the New Testament canon. Hebrews presupposes the presence of the Spirit and explicitly associates it with the revelation of God throughout history. Furthermore, the author identifies his own theological and literary work with the Spirit’s function of actualizing scripture, granting him a remarkable position among New Testament and early Christian authors.
Farmed cricket (Acheta domesticus, Gryllus assimilis, and Gryllodes sigillatus; Orthoptera) welfare considerations: recommendations for improving global practice
Authors: Rowe E. , Robles López K.Y. , Robinson K.M. , Baudier K.M. , Barrett M. 
Published: March 2024

Abstract
Orthoptera, such as crickets, is currently the most reared group of hemimetabolous insects in the insects as food and feed industry, with over 370 billion individuals slaughtered and/or sold live annually. The most-farmed cricket species is Acheta domesticus, however there is growing interest in farming at least two additional species, Gryllus assimilis and Gryllodes sigillatus. Crickets are largely being explored for use as human protein, and exotic animal or pet feed – as well as, to a lesser extent, livestock and fish feed. Insect welfare is of growing interest to consumers who are considering incorporating insect protein into their diets, as well as to many producers. However, no studies have considered the welfare concerns of farmed crickets under current industry conditions. Using an established model for assessing farmed insect welfare, we assess potential welfare concerns for the three most-farmed cricket species, including: interspecific interactions (including parasites and pathogens), temperature and humidity, light cycles, electrical shocks, atmospheric gas levels, nutrition and hydration, environmental pollutants, injury and crowding, density, handling-associated stress, genetics and selection, enrichments, transport-related challenges, and stunning, anesthesia, and slaughter/depopulation methods. From our assessment of these factors, we make recommendations for improving cricket welfare now and as the industry continues to grow; in addition, we identify research directions that will improve our understanding of cricket welfare. We conclude by broadly discussing the importance of addressing the welfare challenges presented by the insects as food and feed industry for the animals and for the growth and health of the industry itself.
Coastal Ecology and The Christian Fisherfolk of South Asia
Authors: Mathew P.T. 
Published: March 2024

Abstract
This article studies a Christian fishing community on the southwest coast of the Indian peninsula and explores how it negotiates the deteriorating marine ecosystem. In this process, we get an insight into the inner world of this community whose life, occupation, and faith are deeply intertwined with the ocean and its changes. The fisherfolk’s indigenous wisdom, skill, and religious heritage help them face the threats around them. The article argues that the coastal worldview has much to offer the contemporary world amidst the threat of environmental crisis. The issues raised can offer new perspectives on Christian faith life and show the direction for a rich theology of the ocean.