bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 152: Bridging the Gap in Stroke Care: Enhancing Early Detection of Cognitive Impairments Through Standardized Screening Improves Therapy Referrals
Authors: Phillips Taylor , Vnenchak Leslie , Sloane Kelly 
Published: January 2025

Cognitive and speech impairments are common after stroke, contributing to greater functional dependence and a diminished quality of life. Despite this, during acute stroke hospitalization, screening for these impairments using validated tools is rarely conducted beyond routine bedside examinations by medical providers.
This quality improvement project aimed to enhance the early detection of speech and cognitive impairments in stroke patients. We hypothesized that there would be low concordance between provider perceptions of cognitive impairments and objective measures and that the referral rate for outpatient speech therapy would increase following the intervention.
From 07/01/24 to 08/31/24, stroke patients were screened for cognitive and language function using Saint Louis University Mental Status (SLUMS) and Quick Aphasia Battery (QAB), respectively. Providers were also surveyed on their perceptions of the patients' cognitive and language impairments and their intent to refer them for outpatient rehabilitation.

Analysis revealed a significant association between QAB score and providers’ beliefs, χ
2
(2, N = 19) = 6.97, p = 0.031, suggesting that providers are more likely to recognize impairments as severity increases. Linear regression comparing provider scores and SLUMS scores showed R
2
= 0.13, indicating that provider ratings were unreliable. A significant difference was found in referral rates before and after the intervention compared to the same period in 2023, χ
2
(1, N = 77) = 4.52, p = 0.034.

These findings indicate that mild and moderate cognitive impairments are frequently overlooked in acute stroke care. The discrepancy between provider assessments and standardized screening highlights the inadequacy of current bedside evaluations. Moreover, the significant increase in referrals following the implementation of validated screenings supports the effectiveness of this approach in promoting timely intervention for stroke survivors.
Abstract 84: Impact of DOAC plasma levels on Hematoma Expansion in DOAC-associated intracerebral hemorrhage
Authors: Schoene Daniela , Tiebel Oliver , Siepmann Timo , Puetz Volker , Barlinn Kristian 
Published: January 2025

Background:
Direct oral anticoagulants (DOAC) are associated with an increased risk of

hematoma expansion (HE) in spontaneous intracerebral hemorrhage (ICH). However, the
critical DOAC level influencing this risk remains unclear. This study investigates the impact of DOAC levels on the risk of HE in patients with DOAC-associated ICH.

Methods:
We conducted a retrospective analysis of patients with DOAC-associated ICH who had DOAC-calibrated anti-Xa or -IIa activity levels measured upon admission. Patients were categorized based on a clinically established cutoff for subtherapeutic DOAC levels (<30 ng/ml). Hematoma expansion was defined as a ≥35% increase in hematoma volume between admission and 24-72 hour follow-up CT scans, with symptomatic HE defined as a concurrent ≥4-point increase in the National Institutes of Health Stroke Scale (NIHSS). Multivariable logistic regression models were used to assess the association between DOAC levels and HE, adjusting for baseline ICH volume, onset-to-imaging time, systolic blood pressure, and the use of reversal agents.

Results:
Among 2147 ICH patients admitted between January 2012 and November 2023, 88 had DOAC-associated ICH with available DOAC levels (apixaban, n=36; rivaroxaban, n=30; edoxaban, n=17; dabigatran, n=4). No significant differences were observed in baseline (24.3±27.5 vs. 19.5±16.6 ml; p=0.6) or follow-up ICH volumes (30.6±36.4 vs. 36.4±14.6 ml; p=0.6) between patients with high versus low DOAC levels. Rates of HE (15.4% vs. 22.2%; p=0.6) and symptomatic HE (7.7% vs. 11.1%; p=0.5) were also similar across groups. DOAC levels below the cutoff did not predict HE (adjusted OR 0.7, 95% CI 0.1-4.5; p=0.7). These findings remained consistent when applying a <50 ng/ml DOAC cutoff and in the subgroup of patients not receiving reversal therapy.

Conclusions:
Our study suggests that DOAC levels, as defined by the current cutoffs, do not significantly predict hematoma expansion in patients with DOAC-associated ICH. Further research in multicenter cohorts is necessary to better delineate the relationship between specific DOAC levels and the risk of HE.
Abstract 91: Lipid Accumulation in Leukocytes Post-Stroke: A Contributor to Impaired Immune Function?
Authors: Do Trang , Couture Lucy , Guzman Gary , Delevati Colpo Gabriela , Khan Romeesa , West Bryce , Devlin Patrick , Cahuiche Ana , Denis Anna , Roh Solji , Venna Venugopal , McCullough Louise , Ritzel Rodney 
Published: January 2025

The acute phase of ischemic stroke triggers a complex cascade of cellular responses in the brain and the immune system. Previous studies show that ischemic stroke induces microglial lipid accumulation from 3d to 7d after stroke, linked to pro-inflammatory activation. However, little is known about cellular lipid alterations in peripheral immunity acutely after stroke. We hypothesized that acute ischemic stroke would increase neutral lipid content (lipid droplets) in peripheral myeloid cells and promote immunosuppression phenotypes.
To assess neutral lipid levels during the first week of stroke, we used the BODIPY493/503 dye probe and performed flow cytometry on human PBMCs of healthy volunteers (N=31), and ischemic stroke patients at 3d (N=43) and 7d (N=52). In time course experiments on C57BL/6 mice (1d, 3d and 7d post-MCAO), the same technique was performed using Staph A pHrodo bioparticles, BODIPY, LipiM and Bodipy-cholesterol probes to explore changes in neutral lipid level, lipid uptake, and phagocytic activity of leukocytes. We collected white adipose tissue (WAT)-conditioned PBS from sham and 1d post-MCAO mice to stimulate naive spleen cells and examine whether factors released from WAT alter lipid content and phagocytosis.
In human PBMCs, we found a significant increase in neutral lipids across innate and adaptive cells for up to 7d post-stroke (p<0.01). Consistently, we observed similar results in mice after MCAO (p<0.01). Peripheral monocytes exhibited higher uptake C12 fatty acids and cholesterol and had persistently decreased phagocytic ability up to day 7 post-MCAO (p < 0.05). The impairment in bacterial engulfment was more severe in BODIPY-Hi versus BODIPY-Lo monocytes at both day 1 and day 3 after MCAO, suggesting that higher lipid loads are associated with greater impairment in bacterial phagocytosis (p<0.05). Secretory factors from WAT juice profoundly affected splenic cells of naive mice. We observed an increasing trend in monocyte lipid levels (p = 0.07) after stimulation with stroke (versus sham) WAT-derived supernatant. Immune functions were also impacted, as evidenced by reduced CD68 and MHCII expression, and decreased phagocytosis in dendritic cells.
To conclude, our study provides evidence for lipid accumulation in circulating leukocytes after stroke in humans and mice, which was shown to impair phagocytic engulfment of bacteria. Our findings suggest a novel mechanism of post-stroke immune suppression implicating the brain-fat axis.
Abstract HUP10: Dissociation Between Perceived Racial Discrimination and SDOH Among Black and Hispanic Stroke Patients
Authors: Valdes Eduard , Corkrum Michelle , Cadena Tejada Angel , Harris Jennifer , Naqvi Imama , Marshall Randolph , Williams Olajide 
Published: January 2025

Stroke disparities are well-documented, with Black and Hispanic populations experiencing worse outcomes compared to White patients. Beyond traditional medical risk factors, social determinants of health (SDOH) and perceived racial discrimination (PRD) have been implicated in these disparities. However, the interplay between SDOH and PRD among these groups remains unclear. This study explores the relationship between SDOH and PRD among stroke survivors across racial groups. We hypothesized that PRD scores would differ across racial groups, potentially independent of the burden of SDOH.
We conducted a cross-sectional analysis of 67 stroke survivors, categorized as Black (N=38), Hispanic (N=17), or White (N=12), from an urban tertiary care center. Perceived discrimination was assessed using an adapted PhenX tool, and SDOH were evaluated using a modified PhenX survey covering five domains: education, economic stability, healthcare access, neighborhood, and social support. Statistical analyses included ANOVA and multivariable linear regression models adjusting for age, sex, stroke severity, and neighborhood disadvantage.
Significant differences in PRD were observed among racial groups (P = 0.0118). Black participants reported the highest discrimination scores (mean 10.4, SD 10.00), compared to Hispanic (mean 4.4, SD 7.01) and White participants (mean 3.3, SD 4.38). Despite this, the prevalence of ≥3 SDOH barriers was similar between Black and Hispanic participants and lower in White participants. Multivariable analysis revealed that Black individuals had significantly higher PRD scores than both Hispanic (Beta estimate -6.90, 95% CI: -12.38 to -1.42, P = 0.0144) and White individuals (Beta estimate -7.72, 95% CI: -13.43 to -1.42, P = 0.0089). No significant differences in other SDOH domains were found except for neighborhood disadvantage, which was more prevalent among Hispanic participants (P = 0.0202).
The findings reveal a dissociation between PRD and SDOH burden among stroke survivors. Black stroke survivors report higher perceived discrimination despite similar SDOH burdens as Hispanic participants. These results underscore the importance of addressing perceived discrimination independently of SDOH in interventions aimed at reducing racial disparities in stroke outcomes. Further research is needed to explore the mechanisms driving these differences and to develop targeted strategies for mitigating their impact.
Abstract TP17: Discovery and development of sovateltide, an endothelin-B receptor agonist to treat cerebral stroke patients
Authors: Gulati Anil 
Published: January 2025

Sovateltide is a synthetic analog of ET-1 and has very high selectivity for ET-B receptors, which are in high concentration in the CNS. Sovateltide induces ET-B receptor-mediated signaling to produce significant anti-oxidative activity, antiapoptosis, mitochondrial fusion and biogenesis, angiogenesis, tissue re-perfusion, neuronal differentiation, tissue regeneration, and repair in the CNS, and a significant recovery in neurological and motor functions and a reduction in the infarct volumes. Studies in mice, rats, and dog models indicate that sovateltide is well tolerated and has a good safety margin.
Clinical studies were conducted to determine human safety and efficacy. Standard of care was provided to all the patients. The study drug was administered in three doses as an intravenous injection over 1 minute at an interval of 3±1 hours on days 1, 3, and 6. Patients received either saline or sovateltide (0.3 µg/kg) within 24 hours of the stroke onset.
In the phase I clinical trial, conducted in healthy individuals, sovateltide had a short half-life of about 5 minutes and was safe and well tolerated. A phase II study was conducted on 40 patients with acute ischemic stroke. An improvement of ≥2 points on the mRS from baseline was observed in 60% and 40% of patients in the sovateltide and saline groups, respectively (p=0.0519; odds ratio 5.25). Phase III study was conducted in 158 acute ischemic stroke patients, of which 78 were in control, and 80 were in the sovateltide group. The data not available (6.4%) were assessed as "missing values" and were imputed using “MICE” by creating multiple imputations. The number of patients with mRS of 0-2 at 90 days was 53.58% in control and 76.25% in the sovateltide groups (p=0.0031). The number of patients with NIHSS of 0-5 at 90 days was 67.95% in control and 85.00% in the sovateltide groups (p=0.0114). The ordinal shift in mRS from 0-1 showed an absolute increase of 8% in the favorable outcome of sovateltide compared to the control group, while a shift in mRS from 0-2 showed an absolute increase of 22% in the favorable outcome of sovateltide compared to the control group.
Pharmacologically targeting ET-B receptors with sovateltide is safe and effective in improving neurological outcomes in cerebral ischemic stroke patients.
Abstract TP28: Digital Clock Drawing and Recall Enables Rapid Cognitive Screening in Acute Ischemic Stroke Care
Authors: Fedorov Alex , Saurman Jessica , Ro Jennifer , Ammar Abdulraheem Ahmed Jumah , Edwards Paula , Loring David , Hu Xiao , Nahab Fadi 
Published: January 2025

Cognitive impairment following acute stroke significantly impacts patient outcomes and rehabilitation. Early detection is crucial, yet comprehensive assessments are often impractical in acute settings. Digital clock drawing and recall (DCR) offers a rapid 5-minute cognitive screening by assessing clock drawing and three-word recall. While previously shown effective in early Alzheimer's detection, its utility in stroke patients has been underexplored. This study investigates the feasibility and validity of DCR compared to the Montreal Cognitive Assessment (MoCA) in stroke patients.
The study involved 80 acute ischemic stroke patients who completed both DCR and MoCA during hospitalization. DCR was implemented on the Linus Health platform. DCR data included DCR scores, battery duration, demographic variables, and recorded NIH Stroke Scale scores. Cognitive impairment was defined using a MoCA threshold of ≤24. Leave-One-Out Cross-Validation and XGBoost were used for analysis. Optuna-optimized hyperparameters and model performance were evaluated via AUC, accuracy, F1-score, sensitivity, and specificity. SHAP analysis provided insights into feature importance.
The median time from stroke to cognitive screening was 3 days [1.0, 2.0]. The impaired group (MoCA ≤ 24) was older (mean 63.2 vs. 53.2 years, p = 0.271), had lower education levels (mean 13.4 vs. 15.8 years, p = 0.005), longer battery durations (median 288.0 vs. 232.0 seconds, p = 0.017), and lower DCR scores (median 1.0 vs. 3.0, p < 0.001). NIHSS scores were higher but not statistically significant (median 4.0 vs. 2.0, p = 1.). Gender, race, and ethnicity were insignificant predictors excluded from the final model.
The XGBoost model demonstrated strong predictive performance, with an AUC of 0.8114, an F1-score of 0.8916, and an accuracy of 0.9. At the threshold of 0.5656 (Youden’s J statistic), the model achieved high sensitivity 0.9841 and moderate specificity 0.5882. SHAP analysis identified DCR score, education level, and battery duration as the most important features.
DCR screening proves to be an effective, rapid cognitive screening tool in acute ischemic stroke care. It demonstrates high sensitivity in detecting subtle cognitive impairments and correlates well with MoCA scores. While further validation is needed, this tool offers a rapid and reliable method for cognitive assessment in acute settings, potentially enhancing personalized treatment approaches and improving patient outcomes in stroke care.
Abstract TP63: Combining Stress First Aid And The 4-As Models To Improve Resiliency
Authors: Beels Suzanne , McCaffrey Sara , Evans Troy 
Published: January 2025

Background and Issues:
A neurovascular intensive care unit (ICU) had a large volume of employee turnover associated with burnout and moral distress. Literature suggested nurses caring for stroke patients experienced significant moral distress and secondary traumatic stress injuries. ICU leadership implemented a combined approach of Schwartz Center Rounds (SCR) Stress First Aid (SFA) and American Association of Critical-Care Nurses (AACN) 4-As methodology to support and improve staff resiliency.

Purpose:
Would employees experience decreased moral distress, improved sense of resiliency, decreased burnout, and decreased turnover through a combined implementation of the SCR SFA and AACN 4-A’s process?

Methods:
SFA and 4-As models were selected because they both aligned with project goals. They guided support for and educated on how to support one another. Models were launched one month apart via computerized learning modules. All employees were educated, but the measures focused on nursing. Techniques used for ongoing educational support included:

-Monthly newsletters
-Self-care and stress reduction tactics
-Awareness of hospital resources, including crisis resources
-Quarterly Mobile Town Hall: Unit rounding with therapy dogs, education, snacks, senior directors, chaplaincy, and employee assistance program director

Results:
The annual employee engagement survey used a numeric rating scale of 0-5. The statement specific to this project was “This facility helps me deal with stress and burnout”. In fiscal year (FY)2021, the ICU scored 2.43. In FY2022, the score improved to 2.53. Unfortunately, the survey question changed in 2023 to “The amount of job stress I feel is reasonable”, so an equal comparison could not be made. The score for FY2023 was 3.06.

Turnover rates decreased from a high of 32.76% to a low of 26.87% one year following implementation.

Conclusions:
Implementation of SFA and 4-As skills improved resiliency and the unit benefited in decreased turnover. Lessons learned included implementing both programs during the onboarding process and leadership role-modeling to support enculturation.

Initially, staff felt awkward approaching one another. Use of case studies would have improved confidence and comfort in approaching peers about their stress level.
A comprehensive list of hospital resources was essential.
Senior Directors played a valuable role in modeling new behaviors, increasing frontline visibility, budgeting, and supporting efforts.
Abstract TP82: Streamlining Stroke Transfers: Implementing RACE Score for Efficient Door in Door out in Primary to Comprehensive Stroke Centers
Authors: Leibowitz Amanda , Hollender Kimberly , Franke Emerson , Barden Michael , Kakadia Bhavika 
Published: January 2025

The Rapid Arterial Occlusion Evaluation (RACE) score is a new and valuable tool that prehospital providers have to utilize for assessing patients for large cerebral arterial occlusions (LVOs). The RACE scale evaluates five clinical features: facial palsy, arm/leg paralysis, head/gaze deviation, and aphasia/agnosia. A score of 5 or higher suggests a potential LVO, with studies showing 85% sensitivity and 68% specificity[1] [1]. In May 2024, Community Medical Center, a primary stroke center in New Jersey, introduced a protocol to place critical care transport vehicles and/or a helicopter on standby when p[2] hysicians and paramedics identified a patient with stroke symptoms, an NIHSS >6 and a RACE score of >5. This initiative aimed to reduce door-in and door-out (DIDO) times for transfer to a comprehensive stroke center [2]. Pre-activation benefits have been noted in myocardial infarction cases, indicating potential advantages for stroke care [3].
A retrospective chart review was conducted using the EPIC electronic medical record for patients arriving to the ED and identified by the physician to meet the above criteria. We analyzed RACE scores and DIDO times for stroke patients transferred between January 1, 2023, and April 30, 2024, before the RACE implementation, and compared these to DIDO times from May 1, 2024, to July 31, 2024, after implementation.
Before the protocol, the mean DIDO for transferred stroke patients was 136.6 minutes. After the protocol's introduction, the mean DIDO for patients with a RACE score of 5 or greater decreased to 102.8 minutes, with a p-value of 0.0042.
While the project is still in its preliminary stages, the initial data suggests that early activation of transport resources for patients suspected of having an LVO is beneficial in decreasing time to transfer. Utilization of the RACE score by providers to decrease DIDO times can be advantageous, particularly in areas with significant distance to a comprehensive stroke center. Moving forward, we plan to collect more data on DIDO times to further evaluate and refine this protocol.
Abstract WMP46: FLAIR Hyperintense Vessels in the Right MCA Parietal Region Predict Left Viewer-Centered Neglect in Acute Right Hemisphere Stroke Patients
Authors: Raman Ashley , Hillis Argye 
Published: January 2025

Both left hemisphere (LH) and right hemisphere (RH) stroke can cause contralesional viewer-centered neglect (VCN) or stimulus-centered neglect (SCN). Studies using perfusion imaging have shown that in acute stroke, hypoperfusion beyond the infarct contributes to deficits, including neglect. However, perfusion imaging is not always available. FLAIR hyperintense vessel (FHV; Fig. 1) number and site estimate the volume and site of hypoperfusion. We hypothesized that FHV rating in the right parietal cortex would contribute to VCN.
A series of 256 consenting acute stroke patients (82 LH and 174 RH) completed a neglect task with 30 ovals – 10 full, 10 with a gap on the left, and 10 with a gap on the right. Patients were asked to circle full ovals and cross out ovals with a gap on either side. We defined VCN as >10% of ovals unmarked after the most extreme mark (Fig. 2), and SCN as neglecting or incorrectly marking >10% of contralesional gaps (Fig. 3). On FLAIR sequences, we identified FHVs in 4 MCA regions: frontal, temporal, parietal, and insular, as well as ACA and PCA territories. Each region was scored from 0 to 2: 0 = no FHVs; 1 = 1-2 FHVs on 1-2 slices; 2 = 3 or more vessels on 1 slice or 3 or more slices with at least 1 FHV (total=0-12). Infarct volume was calculated after manual tracing of lesions on DWI. We used multivariable logistic regression, with the presence of VCN or SCN as the dependent variable, and FHV ratings in each territory, infarct volume, and age as independent variables. We used chi squared tests to test associations between dichotomous variables.

In LH stroke, SCN was more common than VCN (21% vs. 5%; X
2
= 9.3; p=0.002). VCN was more common in RH than LH stroke (13% vs 5%; X
2
= 4.1; p=0.04). In RH stroke, left VCN was independently predicted by age (p=0.005), volume of infarct (p<0.0001), and FHV score in the right parietal cortex (p=0.03). Together, these accounted for 40% of the variance in left VCN (pseudo r
2
= 40.2; p<0.00001). In LH stroke, right VCN was not
independently
predicted by any variable. However, together, age, infarct volume, and FHV in each region accounted for 52% of the variance in right VCN (pseudo r
2
= 51.8; p=0.008). SCN was not predicted by these variables.

In conclusion, we showed that left VCN in acute RH stroke can be predicted by age, infarct volume, and FHV score in the right parietal cortex. These results illustrate the usefulness of FHV in specific locations for estimating clinically significant hypoperfusion.