bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract TP189: Hip Hop Stroke: Adapting a Facilitator-driven Evidence-based Multimedia Program into a Scalable Digital-only Version
Authors: Leighton-Herrmann Ellyn , Hecht Mindy , Hedmann Monique , Noble James , Williams Olajide 
Published: March 2022

A major barrier to timely care for ischemic stroke is delayed hospital arrival, often due to failure to identify symptoms as those of a stroke or serious enough to seek immediate care. We developed a facilitator-driven multimedia stroke literacy intervention - Hip Hop Stroke (HHS) - to improve knowledge of risk factors, symptoms, urgent action, treatment and prevention. HHS uses Hip Hop music and child-centric media (e.g., cartoons) to engage 4th-6th graders and their parents in high-risk minority communities. We have previously published on the efficacy of our 3-day program to improve short and long-term knowledge of children and transmission of key principles to adults. In an effort to widely disseminate HHS in an effective, cost-efficient way, we developed a pilot study to test a self-guided digital adaptation of the program.
We conducted focus groups with fifth graders to inform the modification of the existing HHS curriculum into six 20-minute, self-guided computer modules. We pilot tested the digital program with 4th and 5th graders (N=55) and assessed the effect on stroke knowledge through pre/post surveys embedded into the first and last modules. Data were analyzed using Pearson χ2 and Fisher exact tests.
Stroke knowledge improved after the program to a degree consistent with data from our facilitator-driven program. The proportion of students able to correctly identify symptoms of stroke significantly increased from pre to post-test on all symptoms. At post-test, 96% identified that a stroke occurs in the brain, compared to 44% at baseline (p<.001). Every student (100%) correctly identified slurred speech at post-test, compared to 43% at baseline (p<.001). Identification of an appropriate urgent plan for a hypothetical stroke scenario - calling 911 - also increased significantly. Importantly, students found the program enjoyable and engaging, and 84% said they shared stroke information with a family member at home.
These results show promise for computer-based stroke literacy programming for elementary school children and may serve as a conduit for health messages into the home when child mediation techniques are incorporated. This method may represent a novel strategy for broad dissemination of stroke information or other chronic diseases.
Abstract TP283: Hemorrhagic Risk Assessment of DS-1040 in a Cerebral Ischemia/reperfusion Model of Rats With Hypertension and Hyperglycemia
Authors: Edo Naoko , Noguchi Kengo , Ito Yusuke , Morishima Yoshiyuki , Yamaguchi Kyoji 
Published: March 2022

Introduction:
DS-1040 is a novel inhibitor of the activated thrombin-activatable fibrinolysis inhibitor (TAFIa) and is in clinical development for the treatment of acute ischemic stroke. The objectives of this study were to establish a tissue plasminogen activator (tPA)-sensitive cerebral hemorrhage model and to assess the hemorrhagic risk of DS-1040.

Methods:
After glucose administration (i.p.), male SHR/Izm rats were subjected to middle cerebral artery occlusion (MCAO) using an intraluminal monofilament.

Establishment of tPA-sensitive model: Rats were subjected to MCAO for 1, 2, or 3 h followed by recanalization. tPA (10 mg/kg) or saline (control) was intravenously administered by 10% bolus and 90% infusion just before recanalization. At 2.5 h after recanalization, cerebral hemorrhage was quantified by measuring the excess hemoglobin in the ischemic hemisphere compared to the contralateral side.
Hemorrhagic risk assessment: Rats were subjected to MCAO for 3 h followed by recanalization. At 135 min after MCAO, saline (control) and DS-1040 (30 mg/kg) were intravenously injected as bolus. The dosage of DS-1040 was set to achieve full inhibition of TAFIa. As a positive control, tPA (7 mg/kg) was intravenously administered by 10% bolus and 90% infusion at 5 min before recanalization. The excess hemoglobin was determined at 1 h after recanalization.

Results:
Establishment of tPA-sensitive model: Excess hemoglobin in the tPA group significantly increased in animals subjected to 2 and 3-h MCA occlusion compared to each corresponding control group.

Hemorrhagic risk assessment: In the rt-PA group, excess hemoglobin was significantly increased (63.03 ± 8.38 mg/dL, mean ± SE) compared to the control group (38.74 ± 2.10 mg/dL). In contrast, excess hemoglobin in the DS-1040 group was 33.21 ± 3.28 mg/dL.

Conclusions:
Using hypertensive rats with transient hyperglycemia, we have established a tPA-sensitive cerebral hemorrhage model. DS-1040 did not significantly increase the cerebral hemorrhage compared to the control. These data suggest DS-1040 has the potential to be a thrombolytic enhancer with low risk of cerebral hemorrhage.
Abstract TP384: Educating Staff: A Travelers Guide
Authors: Power Martha , Daignault Gabrielle L , Frye John , Gallo Michelle L , McKee Bruce L , Schaffer Angela J , Stoppe Maggie M 
Published: March 2022

Background and Issues:
The West Virginia University (WVU) Medicine Stroke EducationTeam (SET) provides innovative stroke education to Nursing and Ancillary staff. The 2015 WVU Stroke Care Fair emphasized broadening all caregivers’ knowledge of the patient experience from the community to rehabilitation. The title “A Travelers Guide through Stroke Care” was chosen to highlight the patient’s journey and transition through the phases of stroke treatment and recovery.

Purpose:
The goal of the Stroke Fair is to educate the interdisciplinary team on the various aspects of stroke recognition, care and recovery. This enhanced understanding improves transitions of care, compliance with performance measures and better patient outcomes by facilitating best practice in stroke care.

Methods:
The SET meets monthly for planning and developing stroke education. The highlight of our educational year is the annual Stroke Fair. The 2015 Stroke Fair used a transportation model to present information in a fun and engaging format. Various modes of transportation represented the stages of the journey. Each site was stationed by a SET member who escorted the participants along their leg of the journey and took on the role of the method of transportation assigned to that section. Four one-hour lectures were provided. The community and ED were represented by the helicopter team. The ICU took on the role of mountain climbers. The in-hospital care was symbolized by a train ride. Participants then sailed to the rehabilitation journey.

Results:
One hundred twelve staff members from Nursing, Pharmacy, Care Management, Rehabilitation Services, and Health Information Management participated. Evaluation comments included: “Provided a view of the big picture”

“Learned more about appropriate hand-off of care”
“I learned how to utilize CPG”
“Stroke Fair is awesome as usual”
“Great props and costumes”
“This is always so fun; appreciate the creativity and enthusiasm from the whole group”

Conclusions:
The WVU SET believes providing quality stroke education contributes to our continued best practice as evidenced by receipt of the Gold Plus GWTG award, Target Stroke Honor Roll Elite award and our Magnet Hospital status.
Abstract TP398: Telestroke: Expanding the Utilization of Endovascular Treatment
Authors: Guzik Amy , Johnson Rayetta 
Published: March 2022

Background:
The Comprehensive Stroke Center at Wake Forest Baptist Medical Center in Winston-Salem, N.C. implemented a telestroke network system in January of 2010 to provide 24/7 access to one of their board certified vascular neurologists. There are presently fourteen hospitals in the network with over 1900 consults and a tPA administration rate of 42%.

In early 2015, positive results from four stroke interventional trials showed that recanalization rates were much higher after stent retrieval compared with tPA alone. It was shown that these devices can safely and effectively remove a blood clot that is causing a stroke, with improved clinical outcomes over IV tPA alone. Wake Forest Baptist has made the commitment to expand the use of intraarterial therapy to give every telestroke patient with a large vessel occlusion an opportunity to experience the outstanding clinical outcomes that have been seen in stroke patients treated at their medical center.
The following guidelines were developed to assist the network physician in determining when to consider interventional treatment:
- The time from onset is less than 6 hrs. (up to 12 hrs. in a suspected basilar artery stroke)
- A NIHSS score equal to or greater than 10 (indicating large vessel occlusion)

Method:
Education was provided regarding the new interventional treatment guidelines and for quick reference, the protocol was placed on the screen of the telestroke robot/cart in each of the network hospitals and a cell phone number was provided that gave 24/7 access to communicate with the neurointerventionalist on call. A retrospective study was performed to determine if there had been an increase in patient transfers for an interventional procedure.

Results:
In FY'14, 14 of 139 patients (10%) transferred received an IR procedure and in FY'15, 26 of 146 (17%) patients received an IR procedure. An increase of 7% was identified in telestroke patients that were transferred and underwent an interventional treatment. A combination of providing guidelines regarding when to consider interventional treatment as well as 24/7 access to a neurointerventionalist has significantly increased number of telestroke patients receiving interventional treatment.
Abstract TP47: Inverse PWI/DWI Mismatch is a Typical Feature of Acute Subcortical Ischemic Stroke
Authors: Villringer Kersten , Khalil Ahmed A , Brunecker Peter , Nolte Christian , Villringer Arno , Fiebach Jochen 
Published: March 2022

Introduction / Hypothesis:
Diffusion/perfusion mismatch (MM) is commonly used to assess tissue at risk in stroke patients. In small subcortical infarcts (SSI) the reverse pattern i.e. “inverse mismatch” (IM) has been shown [1]. We aimed to evaluate the frequency and characteristics of IM in a larger cohort using two different perfusion diffusion analysis approaches.

Methods:
We enrolled 129 patients with SSI within 24 hours of symptom onset (1000+ study, NCT00715533) comprising 44 infarcts of the thalamus, 9 located juxtacortically, 58 in the anterior choroidal artery, 18 in the lenticulostriate territory. Lesion volumes were assessed on DWI images using AnToNIa software. To evaluate perfusion maps a time-shift insensitive technique using a block-circulant matrix for deconvolution (oSVD) [2] was employed. Perfusion lesions were evaluated on MTT and Tmax (delay >2s and >6s) maps. A perfusion/diffusion ratio of 0.7 was used to define IM and 1.3 to define mismatch (MM).

Results:
Results are summarized in table1. For all types of data analysis and all time points, IM was the by far most frequent pathophysiological pattern. Obviously, IM was seen most often at Tmax>6s, but it was still clearly observed with looser thresholds (Tmax>2s, MTT). At earlier time of onset IM occurred less often, but was still the most frequent pattern (p=0.0026). No significant association between infarct location and perfusion pattern was observed

Conclusion:
IM is the most common pathophysiological constellation in SSI. We hypothesize that this is due to a lack of collateral circulation in these “endstream infarcts” and that the diffusion changes in areas without perfusion deficit reflect cytotoxic mechanisms.

1. Doege CA et al. AJNR 2003;24:1355-63
2. Wu O et al. Magn Reson Med 2003;50:164-174
Abstract WP109: Repairing the Brain by Hematopoietic Stem Cell Factors 6 Months Post-experimental Stroke: a Causal Link Between Functional Improvement and Neurovascular Remodeling in the Peri-infarct Cavity Cortex
Authors: Zhao Li-Ru , Cui Lili , Wang Dandan 
Published: March 2022

Stroke, a leading cause of adult disability in the world, is a severe medical condition with limited treatment. Chronic stroke represents the phase beyond 3 months after stroke onset. Physical therapy, the only treatment available for stroke rehabilitation, appears to be effective within 6 months post-stroke. Here we have mechanistically determined the efficacy of combined two hematopoietic growth factors, stem cell factor (SCF) and granulocyte-colony stimulating factor (G-CSF) (SCF+G-CSF) in brain repair 6 months after cortical infarct induction in the transgenic mice carrying yellow fluorescent protein in layer V pyramidal neurons (Thy1-YFP-H). Using a combination of live brain imaging, whole brain imaging, molecular manipulation, synaptic and vascular assessments, and motor function examination, we found that SCF+G-CSF promoted mushroom spine formation, enlarged postsynaptic membrane size, and increased postsynaptic PSD-95 accumulation and blood vessel density in the peri-infarct cavity cortex through NF-κB. Once the SCF+G-CSF-enhanced synaptogenesis and angiogenesis in the peri-infarct cavity cortex were blocked by an NF-κB inhibitor, the SCF+G-CSF-induced motor function improvement was eliminated. These data suggest that a stroke-damaged brain is repairable by SCF+G-CSF even 6 months after the lesion occurs. This study provides novel insights into the development of new restorative strategies for stroke recovery.
This work was supported by the National Institutes of Health, National Institute of Neurological Disorders and Stroke (NINDS)(R01 NS060911) in the United States.
Abstract WP324: Integrated Systems Enhance Equitable and High-Quality Stroke Prevention Clinic Care
Authors: Gocan Sophia , Bourgoin Aline , Hall Ruth , Khan Ferhana , Zhou Limei , Stotts Grant 
Published: March 2022

Stroke prevention clinics were established in Ontario to provide comprehensive, equitable, evidence-based care for patients at high risk of stroke. However, depending on where patients present with their stroke symptoms there are differences in access to diagnostic services. Patients presenting to a primary care office or small hospital, have limited or no access to diagnostic services compared to those presenting to large academic hospitals. To overcome this inequitable access to stroke expertise and diagnostics, we developed a standard referral protocol, a centralized approach to triage and dedicated diagnostic imaging services in regional stroke prevention clinics. The objective of our research was to evaluate the degree to which these system supports have resulted in comprehensive stroke prevention best practice care.
Retrospective data analysis was completed using the FY 2011/12 Ontario Stroke Audit of Secondary Stroke Prevention Clinics database. We examined differences in secondary stroke prevention best practices across the five stroke prevention clinics and if there were differences in practice by referral source (Emergency vs. Primary Care).
A total of 1853 patients were seen at the five Champlain stroke prevention clinics in 2011/12. The majority of referrals were initiated from Emergency Departments 58.7%, followed by primary care 29.2%, specialists 9.2% and inpatient units 2.8%. Overall, high rates of neuroimaging (97.6%), and vascular imaging (97.6 %) were achieved with little variation across stroke prevention clinics. There was no variation in imaging rates by referral source. The stroke prevention clinics facilitated neuroimaging and vascular imaging for almost 30% of patients, as they did not have these tests completed at the site of initial presentation.
Implementing a centralized stroke prevention clinic referral and triage system has enabled equitable access to essential diagnostic testing in the Champlain region. Rapid diagnostic imaging plays a vital role of in identifying stroke etiology, and influences patient prioritization, treatments and management in the stroke prevention clinic setting. Future research should include evaluation of patient outcomes relative to the timing of diagnostic testing.
Abstract WP386: Swallowing Assessment of Nurses and Speech-Therapists
Authors: Stolzenburg Joanna , Ott Anja , Bulut Cem , Ringleb Peter A 
Published: March 2022

Background:
A relevant number of stroke patients have swallowing disabilities; assessment of swallowing ability is an important procedure on a stroke unit to reduce complications. There is still doubt whether or not a trained nurse has a similar efficacy in the assessment of swallowing difficulties as does a specialized speech therapist (ST).

Methods:
Our ST has trained any stroke unit nurse (SN) in assessment of swallowing function. A test using first thickened flavored water (custard consistency) and 5 ml water is done.

For a pilot study, during 6 weeks all stroke unit patients with cerebral ischemia were included. Patients with TIA, non-stroke diagnoses or altered consciousness (score 2-3 for item 1a of the NIHSS) were excluded. Swallowing function was evaluated independently by the patient’s SN and latest on the next working day by the ST. A 5 step scale was used, measuring from no food, to 2 different texture-modified diets, to normal food.
Cohen’s kappa statistic was calculated to evaluate congruence of the assessments. Univariate statistics were done to analyze difference between cohorts with equivalent and different grading.

Results:
Overall 90 patients were included (53% male, 93% ischemic stroke, mean age 71 years). In 72 (80%) of the SN and ST scored identical (10% no food allowed, 11% special food preparation, 79% no problem). In 11 (12%) SN were more careful than the ST, and in 7 (8%) the SN assessed less swallowing-problems than the ST. Cohens’s kappa was 0.6067. In four of those patients the ST found relevant swallowing problems, which could have led to feeding abstention (2 patients) or special food preparation (2 patients). Comparing those 18 patients with differences in the assessments and those 72 without, presence of dysarthria was the only different parameter and was more present in the patients with varying rating (Mann Whitney U, p=0.0019)

Conclusion:

In this unselected cohort of ischemic stroke patients, swallowing problems were detected in 32%, when using the ST’s assessment as gold standard. Inter-rater agreement with a trained SN was good. In a small percentage (8%) nurses had overseen swallowing problems and in 4% this was relevant. Presence of dysarthria was the only factor, which was different between equal and unequal graded patients.
Abstract WP73: No Influence of Dabigatran or its Specific Reversal Agent, Idarucizumab, on rTPA-induced Thrombolysis of Clots in Human Plasma: an
in vitro
Study
Authors: van Ryn Joanne , Schurer Johanna , Fischer Davina 
Published: March 2022

Oral anticoagulation reduces the elevated incidence of stroke in patients with atrial fibrillation. Though stroke risk is reduced, it is not entirely prevented. When patients present with ischemic stroke and are also being treated with newer oral anticoagulants, such as dabigatran, this can complicate therapy. Currently a specific reversal agent to dabigatran, idarucizumab, is in development and was shown to immediately reverse the anticoagulant effect of dabigatran in volunteers and patients.
However, it is unknown if administration of idarucizumab to reverse dabigatran results in any nonspecific effects on the action of rtPA. Thus this study was performed to determine the effect of dabigatran and its reversal with idarucizumab on rtPA-induced thrombolysis of a clot in human plasma in vitro.
Blood was obtained from volunteers after written informed consent. Clots were produced by adding thromboplastin and 200mM CaCl2 to platelet rich plasma containing 594Alexa-labelled fibrinogen at 37°C for 60 min. Clots were then removed, washed and added to plasma from the same subject containing 150 IU/mL rtPA ± dabigatran (150 ng/mL) for 1 hr. Idarucizumab (3 mg/mL) was added after 60 min and incubated for a further 60 min at 37°C, all under continuous stirring. Lysis was measured as fluorescence released into plasma from the clot. Data shown as mean ± SD, n=5, were compared with ANOVA, p<0.05 was significant.
Initial clot weight was similar (18±6 mg) across groups. Clots added to plasma containing only dabigatran or idarucizumab underwent no lysis. Incubation with rtPA resulted in 28±17, 34±18 and 61±18% lysis after 60, 65 and 120 min, respectively (p<0.001 vs control). Addition of dabigatran or idarucizumab alone did not significantly affect lysis in the presence of rtPA. Addition of dabigatran (at t=0) followed by idarucizumab (at t=60 min) to plasma resulted in similar rtPA-induced thrombolysis, 30±16, 34±14 and 55±17%, as compared to incubation with rtPA alone. Clot weight after 2 hrs was 6.3±2.2 mg with no difference across groups.
These data show there are no non-specific interactions of idarucizumab with rtPA-induced thrombolysis in this in vitro model. It reinforces the specificity of idarucizumab for only dabigatran and its lack of binding to other substrates.
Competing Narratives
Authors: Kanagarathinam D. V. 
Published: March 2022

Abstract
This article traces the trajectories of the historical narratives of Tamil medicine from the mid-nineteenth century to the mid-twentieth century in the Madras presidency. It examines how different actors promoted different historical narratives that were influenced by contemporary political, social, and cultural factors. Marking out pre- siddha (up to 1921) and siddha (after 1921) eras of Tamil medicine, it traces the work of Ayothidoss Pandithar, the split after 1921 between ayurveda and siddha traditions, and how particular narratives became dominant through the participation of key actors in powerful political and cultural movements and colonial institutions. It offers a corrective to the dominant upper-caste non-Brahmin Tamil siddha narrative by drawing attention to the marginalization of Dalit physicians and bringing into focus hitherto unrecognized critical voices such as Pandit Narayana Iyengar and S. R. V. Das.
Dimensions of Authenticity in Siddha Medical and Clinical Research
Authors: Hausman Gary J. 
Published: March 2022

Abstract
The article discusses three methods of combining biomedicine with traditional medicine in pre-Independence Madras State in India, with comparative examples drawn from ethnographic studies in South India in the 1990s. In the mid to late 1920s, two officers of modern medicine from the Madras presidency were delegated to be trained in the Calcutta School of Tropical Medicine to investigate the properties of the indigenous drugs of India using laboratory and physiological techniques. In the 1930s, Srinivasamurti, the first principal of the Government School of Indian Medicine in Madras, trialed a collaborative approach between clinical practitioners of ayurveda, siddha, and unani, and allopathic medical registrars with the ideal of developing a universal and synthetic textbook encompassing all medical systems on an equal setting. In the 1940s, a traditional practitioner was permitted to practice bone setting in the Government Hospital of Indian Medicine in Madras. These examples illustrate various dimensions of asymmetric relations between traditional and modern medicine in twentieth- and twenty-first-century India.