bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract WP110: Direct Helicopter EMS to CSC Transport of Suspected LVO Strokes Improves Timeliness of Thrombectomy vs EMS Patients Transported to a PSC and transferred
Authors: Ciechanowski Mary , Rosenbaum Robert , Sivapatham Thinesh , Gannon Kimberly , Eisenman Justin , Dworkin Mollee 
Published: January 2025

Introduction:
Delaware (DE) is comprised of 3 counties, with 7 hospitals within the stroke system. The state’s only CSC located in the northernmost county receives transfers from 1 PSC midway in the state and 3 PSCs in the southernmost county (figure 1). Historically PSC door time to CSC skin puncture time by interfacility transport can range from 3.5 to >5 hours from the furthest DE PSC. Utilizing ground EMS and Delaware State Police (DSP) helicopter EMS (HEMS) transport, DE developed a process to identify potential acute LVO patients and transport directly to the CSC to reduce time to mechanical thrombectomy (MT).

Methods:
In November 2022, DE EMS Standing Orders changed the pre-hospital stroke evaluation tool from RACE to the Visual, Aphasia, Neglect (VAN) assessment. DE EMS identified patients who were VAN+ and utilized HEMS for direct transport to the CSC statewide.

If EMS identified a VAN+ patient in Kent or Sussex counties, the local PSC medical control approved for direct CSC transport while considering thrombolytic timing.
DSP met the ground EMS crews at a pre-designated landing zone to receive the patient.
Ground EMS notified the CSC to prepare for the standard stroke alert evaluation.

Results:
From January 2023 to June 2024, 183 patients were flown by DSP HEMS directly to the CSC bypassing a PSC.

Of those, 59% had a final diagnosis of stroke (AIS and nontraumatic ICH/SAH)
Of those with AIS, 60% were positive for an LVO
Of those patients with LVO, MT was completed on 71%, compared to rate of 52% in prior years
Kent County: EMS arrival to skin puncture median time was 2.00 hours compared to 3.75 hours for interfacility transfer from the PSC.
Sussex County: EMS arrival to skin puncture median time was 2.5 hours compared to 4.00 hours for interfacility transfer time from the 2 Sussex PSCs combined (figure 2).
Statewide the median time for EMS arrival to skin puncture for patients who were MT candidates was 2.25 hours vs 3.88 hours, 1.6 hours faster than PSC to CSC transferred patients.
CSC time includes obtaining imaging which may already have been completed at the PSC for interfacility transfers.

Conclusion:
Early LVO patient identification and pre-hospital helicopter EMS transport directly to the CSC reduced the time from EMS arrival to skin puncture for MT patients in Delaware by 1.6 hours. This was 41% faster compared to those arriving at the CSC via interfacility transfer from PSC, and increased the rate of thrombectomy on eligible patients by 19%.
Abstract WP153: Identifying the Experiences and Longitudinal Needs of Stroke Survivors and Caregivers from Bedside to Community
Authors: Fernbach Madalyn , Cooke Lily , Fiorentino Arianna , Sawyer Abbey , Putrino David 
Published: January 2025

Introduction:
Despite the high incidence rate of post-stroke anxiety and mood changes, there is limited evidence for the integration of emotional and mental health support resources into acute care and long-term recovery. In this international survey-based study, we seek to better understand the emotional and mental health needs of survivors and caregivers.

Methods:
Participants were recruited via online advertising and advocacy groups. Eligibility included: ≥18 years, fluent in English, and identified as a brain injury survivor, caregiver, or healthcare worker. This analysis focuses on the stroke subgroup. Descriptive statistics were used for quantitative data and thematic analysis for qualitative responses.

Results:
410 individuals completed the survey (stroke: n=200). Most of them (n=158, 79%) were youth stroke survivors (aged <50 years). Both ischemic (n=59, 29%) and hemorrhagic stroke (n=141, 71%) survivors experienced an average of 3 impairments: fatigue was most common (n=150, 75%).

Surveyors reported a lack of overall emotional (n=152, 76%) and mental health support (n=139, 70%), insufficient communication about anticipated recovery (n=145, 73%), and a desire for more discussion on rehabilitation options (n=108, 54%). Table 1 presents a thematic analysis of recovery.
Most experienced a high level of anxiety ( ≥6.5/10) about long-term recovery (M =6.6, SD =2.6), emerging symptoms (M =6.7, SD =2.7), uncertainty about the future (M= 6.9, SD=2.7) and financial and return to work concerns (M=6.5, SD=3.1).
Many were unfamiliar with brain injury before their diagnosis (n=152, 76%) and reported that no information about emotional or mental support was shared at discharge (n=136, 68%). Searching the internet was utilized most for seeking information (n=144, 72%).
A majority had no contacts who had lived brain injury experience (n=150, 75%) but desired someone to talk to in their transition from bedside to community; with a preference for in-person peer support. Qualitative analyses outline the ideal supporter as empathetic, resourceful, knowledgeable about recovery, and honest.

Conclusion:
The survey indicates a lack of and need for early integration of emotional and mental health support services and comprehensive informational resources into longitudinal recovery plans. This data could guide future peer support programs and inform other research studies by emphasizing the importance of continuous dialogue with community partners and people with lived experience.
Abstract WP230: Neuroinflammation Biomarker in the Course and Prognosis of Hemorrhagic Strokes
Authors: Kuranbaeva Satima , Rakhimbaeva Gulnara , USMANOVA GULCHEKHRA 
Published: January 2025

Hemorrhagic strokes (HS) are increasingly significant causes of disability and mortality worldwide, making the use of blood biomarkers for their diagnosis and prognosis critical. Inflammatory markers in peripheral blood reflect the body's response to acute cerebrovascular incidents, and monitoring these during the acute phase of HS can provide valuable insights into disease progression and potential deterioration.
This prospective observational study, conducted without medical intervention, involved 130 patients with clinically and instrumentally verified hemorrhagic strokes in the acute phase, all with hypertension, and a control group of 30 individuals without stroke, average age 60 years. Upon admission, patients were assessed for consciousness and neurological status using the FOUR and NIHSS scales. Blood samples for Glial Fibrillary Acidic Protein (GFAP), a marker of astroglial damage, were collected within the first 24-30 hours after onset and analyzed using ELISA. All patients also underwent CT and MRI brain scans.
Statistical analysis was performed using multivariate linear regression and ROC analysis. The study found that GFAP levels were significantly higher in HS patients, particularly among those with fatal outcomes. Survivors had GFAP levels of 1.35 ng/mL, while deceased patients had levels of 1.94 ng/mL (p<0.05), suggesting the utility of GFAP in assessing HS severity and prognosis. GFAP levels were also significantly elevated in patients with an initial hematoma volume > 50 mL. These findings were used to develop multivariate binary logistic regression models for predicting HS outcomes during the acute phase.
The prognostic model, incorporating GFAP levels, FOUR and NIHSS scores, hematoma volume, perifocal edema, and midline structure shift, demonstrated a 95% sensitivity in determining fatal outcomes. GFAP, synthesized by astrocytes, plays a critical role in astrocyte differentiation, neuronal energy supply, blood-brain barrier formation, and reparative processes post-hemorrhage. Given its role as a marker of cellular damage and its regulatory function in brain repair, GFAP and other biomarkers should be employed to assess patient condition severity and guide the development of new therapeutic strategies for hemorrhagic strokes.
Abstract WP265: Stroke Subtypes Drive Distinct Neurological, Cognitive, and Mortality Outcomes in UK Biobank Cohort
Authors: Grover Ambika , Patel Chirag 
Published: January 2025

Although the pathophysiological differences between stroke subtypes are well-documented, much remains to be understood about how these variations contribute to long-term neurological and cognitive complications. In a UK Biobank cohort study of ~14,000 individuals with prior history of stroke, we investigated subtypes of stroke based on encoded ICD-10 categories of acute ischemic stroke (AIS), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and other nontraumatic intracranial hemorrhage (ONIH).
We computed the absolute risks of neurological complications, including mortality, dementia, and parkinsonism, in post-stroke patients. We assessed post-stroke cognitive outcomes via cognitive testing data administered on touchscreens at UKB sites. Adjusted for age and lifestyle factors, cognitive scores were compared with the no-stroke UKB population (n=500k) using ANOVA and Tukey tests. Further, we investigated the relationship between UKB image-derived phenotypes and stroke subtypes, including gray and white matter and white matter hyperintensities (WMH). We used a Cox Proportional Hazards (PH) model to calculate the mortality risk hazard ratios (HR) by stroke type.
In the post-stroke follow-up period, individuals with ONIH, followed by individuals with ICH, had the highest absolute risk of developing dementia (6.02% 95%CI: [5.99%, 6.7%]). Patients with ONIH have nearly double the risk (2.97%; 95 CI:[2.96,3.01]) of parkinsonism compared to AIS and ICH patients. In cognitive testing, AIS patients had worse cognitive scores relative to those without stroke. Cognitive reaction times were consistently longer, with ICH and AIS patients showing the largest delays, followed by SAH patients. ICH patients had white matter hyperintensities 6 SD above the no-stroke population, while AIS patients are 4 SD above the no-stroke population. ICH had the highest HR and absolute risk death (HR 3.12 95% CI: [3.00, 3.24], abs. risk 45.03%), followed closely by ONIH (HR 2.94, 95% CI:[2.78, 3.11], abs. risk 35.96%) and SAH (HR 2.89, 95% CI: [2.75, 3.07], abs. risk 19.34%). Cox PH values for AIS were lower than the nearest hemorrhagic type (HR 1.90 95%CI:[1.77,1.85], abs. risk 25.88%). When examining the role of age, sex, and clinical factors in stroke prediction, age was prominently featured, while other factors were heterogeneous. Our findings highlight outcome-level stroke heterogeneity and suggest treatment design and clinical surveillance tailored to stroke subtype.
Abstract WP328: Higher Artificial Intelligence (AI)-ECG Atrial Fibrillation Prediction Model Output and Delta Age Computed from AI-ECG are Associated with Adverse Vascular Outcomes in Patients with Migraine
Authors: Chiang Chia-Chun , Chao Chieh-Ju , Yang Ping-Hao , Lopez-Jimenez Francisco , Mangold Kathryn , Attia Zachi , Friedman Paul , Noseworthy Peter , Zhang Nan 
Published: January 2025

Migraine with aura(MwA) is associated with an increased risk of stroke and adverse vascular outcomes compared to those with migraine without aura (MwoA). AI-ECG prediction models developed at our institution can evaluate the probability of atrial fibrillation (AF) and estimate a patient’s age based on a normal sinus rhythm (NSR) ECG. Delta age, AI-ECG estimated age minus chronological age, indicates endothelial dysfunction and is associated with cardiovascular mortality. We aim to assess how AI-ECG prediction model outputs, specifically the AF probability and delta age, are associated with adverse vascular outcomes in patients with migraine.
Adult patients diagnosed with MwA and MwoA from 2000-2020 with at least one digital, standard 12-lead ECG were identified. The first ECG that showed NSR is used as the index ECG. Patients with any adverse vascular outcomes before the index ECG were excluded. Adverse vascular outcomes used as endpoints include acute ischemic stroke, acute myocardial infarction, deep vein thrombosis/pulmonary embolism, AF, and carotid artery dissection.
A total of 31301 patients (13783 MwA, 17518 MwoA) were included in our analysis. The mean age at the time of the index ECG was 44.3 (14.5), and the average follow-up time was 71.6 (69.8) months. Based on the index ECG, the mean AF probability was significantly higher in MwA compared to MwoA (2.39 vs 2.06, p< 0.001), while the delta age was lower in MwA compared to MwoA (3.7 vs 4.2, p <.001). The prevalences of all vascular outcomes are summarized in Table 1. Multivariate Cox regression models showed that a higher AF prediction model output (every 10% increase), as well as a higher delta age (every 10-year increase), are associated with an increased risk of composite vascular outcomes (HR1.20, 95%CI 1.17-1.23, p<.001, and HR1.19, 95%CI 1.14-1.23, p < .001) [Table 2]. The Kaplan-Meier curve of adverse vascular outcome-free survival by AF prediction model output, using 1% as the cutoff (HR 1.49, 95% CI 1.41, 1.57, p<.001), and by delta age, using 2-year as the cutoff (HR 1.14, 95% CI 1.08, 1.21, p <. 001) are presented in Figure 1. Having aura, older age, male, coronary artery disease, congestive heart failure, diabetes, hypertension, and tobacco use were also associated with a higher risk of adverse vascular outcomes.
Our results demonstrated the potential of using AI-ECG AF prediction model output and delta age to identify migraine patients at risk for adverse vascular outcomes.
Abstract WP346: Pharmacological Inhibition of Transforming Growth Factor Beta Receptor Improves Breathing Function and Cognition in Mice Models of Dementia
Authors: El Hamamy Ahmad , IQBAL ZAHID , Ranjan Arya , Zhang Yuxing , Sumani Destiny , McCullough Louise , Li Jun 
Published: January 2025

Dementia is associated with respiratory dysfunction. In mice models of dementia, there is increased astrogliosis in the brain stem retro-trapezoid nucleus (RTN), which is crucial for breathing control. Our previous work using a genetic approach suggested that increased transforming growth factor beta receptor (TGFβR) signaling may be responsible for RTN astrogliosis and contribute to respiratory and cognitive dysfunctions. Here we tested our hypothesis that pharmacological inhibition of TGFβR2 in mice models of dementia may reduce RTN gliosis, breathing disorder and cognitive impairment.
We used male 16-month-old Tg-2576 and Tg-SwDI mice that model Alzheimer’s Disease (AD) and Cerebral Amyloid Angiopathy (CAA), respectively with WT controls. LY2109761, a selective TGF-β receptor inhibitor, was administered orally every day for 6 weeks at a 50 mg/kg dose. Barnes Maze and Novel Object Recognition Test (NORT) were used to measure cognitive strength, and plethysmography was used to measure respiratory metrics such as apnea rate after the 6 weeks of treatment. Immunofluorescence was used to quantify gliosis (GFAP) at RTN. All data is presented as Mean±SEM.
Tg-2576 mice performed significantly worse than the WTs in the Barnes Maze (escape latency 184±20.99 vs. 119.4±12, p=.039, n=8-9/group), in the NORT (percentage time with the novel object 48.3±2.061 vs. 63.3±2.071, p=.0003, n=8-9/group), and showed increased apneas per minute (9±.9 vs 4.33±.81, p=.001, n=8-9/group). Similarly, Tg-SwDI mice showed impaired breathing and cognition function. In Tg-2576 mice, TGFβR2 inhibition improved performances in Barnes Maze (112±18.6 vs. 184±20.9, p= .02 n=8-9/group) and NORT (57.7±2.54 vs. 48.3±2.06, p=.023, n=8-9/group), and reduced apneas per minute (4.88±.058 vs. 9.0±.98, p=.004, n=8-9/group) compared with vehicle treatment. In Tg-SwDI mice, TGFβR2 inhibition also improved performance in Barnes Maze (43.8±2.72 vs. 58.2±5.16, p=.03 n=7/group) and NORT (59.1±3.28 vs. 46.6±3.32, p=.02, n=7/group), and reduced apneas per minute (5±1.06 vs. 9.71±1.71, p=.038 n=7/group) compared with vehicle group. TGFβR2 pharmacological inhibition additionally reduced astrogliosis in the RTN of Tg-2576 mice (drug 53.62±4.8 vs. vehicle 70.9±3.38, p=.018, n= 4/group).
In conclusion, pharmacological inhibition of TGFβR2 improved cognition in AD and CAA mice. Improving breathing control via reducing gliosis at breathing center RTN may be the underlying mechanisms of the improvement.
Abstract WP53: Genetics of Cerebral White Matter Hyperintensities in Diverse Hispanic/Latino Adults
Authors: Fornage Myriam , Sofer Tamar , Isasi Carmen , Lipton Richard , Stickel Ariana , Tarraf Wassim , Gonzalez Hector , DeCarli Charles 
Published: January 2025

Cerebral white matter hyperintensities (WMH) on magnetic resonance imaging are part of the spectrum of brain vascular injury accompanying aging and are associated with an increased risk of stroke and dementia. WMH burden is greater among Hispanic than non-Hispanics white (NHW) adults. WMH is highly heritable and genome-wide association studies (GWAS) in older community-dwelling NHW and African American (AA) individuals have identified several genetic loci. However, the genetic architecture of WMH in Hispanic/Latino adults remains largely unknown.
We conducted GWAS and admixture mapping analyses of WMH volume in a sample of 2159 diverse Hispanic/Latino adults (mean age: 62.4 years; 66% women).

The proportion of variance in WMH volume attributable to common and low frequency variants in our sample was 28.9%, similar to a previous estimate in NHW individuals (29%). No association reached genome-wide significance. The strongest association was for rs60690281 (P=9.3x10
-8
). Accounting for population differences in linkage disequilibrium, we found evidence of transferability of 14 of the 27 known WMH loci. Interestingly, while there was no association of the chr10p14 locus, previously identified in AA, in our total sample, there was a suggestive association (P=0.08) in the Caribbean subgroup. Due to power limitations, we could not exclude transferability of the remaining loci. Multi-ancestry meta-analysis combining our GWAS results with those from GWAS of WMH in NHW and AA populations identified an additional locus on chr12q22 (P=1.8x10
-8
) tagged by rs10859915, an expression QTL of
AMDHD1
. Admixture mapping identified a novel locus on chr14q13.2, where counts of European ancestry at that locus were significantly associated with WMH volume (P=4.9x10
-7
). This locus spans an 800 kb region containing
RALGAPA1,
with known impact on neuronal function and brain development; and
INSM2,
encoding a transcriptional repressor influencing glucose metabolism.

Our study suggests that WMH loci previously identified in NHW and AA individuals are relevant to Hispanic/Latino adults. It demonstrates the power of the diverse Hispanic/Latino population to discover novel WMH loci and haplotypes, adding to our understanding of WMH genetic architecture.
Abstract WP7: To study the impact of presenting blood pressure on outcomes in acute ischemic stroke patients. Can permissive hypertension be re-defined with a range?
Authors: Srinivas Meghana , Marginean Horia , Stuchiner Tamela 
Published: January 2025

Introduction:
Blood pressure is a simple physiologic parameter that is always measured, can be modulated, and may affect the outcome. In the hyperacute window, the therapeutic priorities are aimed at preserving penumbral tissue prior to reperfusion with the aim to optimize the chances of improved outcomes.

Blood pressure fluctuations early in the stroke can be a predictor of morbidity and mortality, and both high and low systolic blood pressures can negatively affect neurological outcome.

Objectives:
Investigate the effects of admission systolic blood pressure (aSBP) on outcomes in patients with acute ischemic stroke (AIS), with or without large vessel occlusion (LVO).

Methods:
This was a retrospective analysis of AIS patient data from a health system’s stroke registry for patients discharged between January 2018 and March 2024.

Adult (18+ yo) AIS patients with recorded aSBP to Thrombectomy Capable, Primary Stroke Plus or Comprehensive Stroke Center certified sites were included.
Discharge disposition (DD) was dichotomized as poor DD (Hospice, Expired) and favorable DD (Home, SNF/LTC, IRF) while the 90-day modified Rankin Scale (mRS) dichotomized as good outcome (0-2) and unfavorable outcome (3-6).
The relationship between the aSsBP , DD and 90-day mRS was analyzed using restricted cubic splines through multivariable mixed-effect models, adjusting for age, sex, race/ethnicity, NIHSS, treatment modalities, and medical history.

Results:
Data from 21,759 AIS patients were included, 72% aged ≥65 years, 49% female, 68% white, had median aSBP at admission 152 mmHg [interquartile range (IQR) 135, 172]; 3,016 (14%) had LVO.

Low aSBP is independently associated with reduced probability of good clinical outcomes (favorable DD and good 90-day mRS) overall and if LVO. (Table 1) The higher probability of good clinical outcome was found from approximately 150 mmHg, when it plateaus, to 180 mmHg.

Conclusions:
The term permissive hypertension is unique to each patient and needs to be optimized accordingly to achieve the best clinical outcome. This data will be beneficial in educating medical staff and making sure to optimize blood pressure especially during transfer to a certified stroke center.
The Unbearable Lightness of Free-Thinking
Authors: Pomata Gianna 
Published: January 2025

Abstract
My contribution focuses on a hitherto unnoticed aspect of early modern epistemic culture: the fact that the term “capriccio” was used in seventeenth-century natural philosophy and medicine to indicate conjecture, hypothesis, or theory. The term conveyed, in this context, a negative view of theory as mere opinion or “fancy.” Right at the same time, in contrast, “capriccio” was acquiring a positive currency in the arts. It appears that a “capricious” style became fashionable in the arts right when it was being frowned upon in the sciences. What was the meaning of these parallel and contrasting trends? I will argue that the negative meaning of “capriccio” in the sciences indicated: (1) the changing relationship of theory and observation in the seventeenth century, which privileged observation over theory; (2) the beginning of a divergence between acceptable styles of thinking in scientific and artistic cultures, which would more fully develop in later periods.
Navigating Power and Identity
Authors: Sharabi Asaf 
Published: January 2025

Abstract
This article explores the fluid gender identity of a local deity in the Western Himalayas, contextualized within both divine and human societal structures from the 19th century to the present. Based on fieldwork in Himachal Pradesh, India, the study examines the transformation of the deity’s gender identity from a goddess to a male deity in the 19th century—a shift that locals strategically employed to support political and territorial claims. In contrast, the deity is now primarily emphasized as the goddess Durga, reflecting cultural and social changes within the community, as well as evolving perceptions of divine hierarchies between gods and goddesses. The article argues that this renewed focus on the deity’s feminine identity serves as a symbolic resource for the local community. Thus, while in the 19th century, divine hierarchy was seen as existing between gods and goddesses, in the 21st century, it is perceived as between the principal divinities of the pan-Hindu pantheon and the local gods of human origin. The article demonstrates how widely held beliefs in South Asia regarding the fluid identities of gods and goddesses are adapted and rationalized by human communities to interpret and legitimize divine roles across historical contexts, yielding both political and symbolic benefits.