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Nurses are an integral part of the multidisciplinary team caring for a patient eligible for endovascular thrombectomy. Their care includes obtaining health history, performing clinical assessments, using critical thinking to anticipate the care path, and communicating findings to other team members. The prehospital and emergency department nurses utilize stroke severity scales to identify a possible thrombectomy candidate and help expedite intervention. In the interventional laboratory, nursing collaborates with radiology technologists and interventionalists to ensure patient safety and monitor for intraprocedural complications. Post-procedure, the intensive care nurse delivers complex care to ensure optimal neurological outcome and assess for postprocedural complications. Nursing is essential in every phase of care along with collaboration with other disciplines.

Background: We sought to determine and validate a pre-reperfusion blood pressure threshold for MCA occlusions patients with better thrombectomy outcomes. Methods: We reviewed patients from 2013 to 2015 treated with thrombectomy for a MCA M1 occlusion at our center. Blood pressure measurements from available records at the time of EMS activation to the time of reperfusion were used to calculate an averaged pre-reperfusion mean arterial pressure (MAP). All patients in our analysis had successful reperfusion. Our endpoint was a mRS ≤2 at 90 days. The averaged MAP was grouped as follows: ≥85mmHg, ≥90mmHg, ≥95mmHg, ≥100mmHg, ≥110 mmHg and ≥115mmHg. We considered hourly epochs from symptom onset to reperfusion, pre-treatment ASPECTS, thrombolytics, and collateral status. Significant parameters from a univariate analysis were included into a multivariate logistic regression to determine independent predictors of outcome. The multivariate findings were then validated with a prospective set of similar patients evaluated with our mobile stroke treatment unit. Results: We reviewed 52 patients. Mean age was 70; NIHSS was 16±6; 40% (21) received t-PA; median ASPECTS score was 10; TICI 3 score was achieved in 63% (33), and 67% (35) had a good outcome. The number of patients having a mean arterial blood pressure threshold were as follows: ≥85mmHg (96%), ≥90mmHg (83%), ≥95mmHg (73%), ≥100mmHg (58%), ≥110mmHg (31%) and ≥115mmHg (15%). Reperfusion occurred as follows: ≤3hrs (4%), ≤4hrs (21%), ≤5hrs (39%), ≤6hrs (52%), ≤7hrs (67%), ≤8hrs (79%), ≤9hrs (87%), and ≤12hrs (90%). Our multivariate logistic regression model identified an average pre-reperfusion MAP ≥95mmHg as the sole factor statistically associated with a better outcome post successful thrombectomy [OR 15.1, CI 1.3-170.1,p=0.02]. Good clinical outcome in those patients with an averaged MAP ≥95mmHg was 76% and 43% in those below the threshold [OR 5.2, p=0.02]. Our validation cohort consisted of 32 patients, and a pre-reperfusion averaged MAP ≥ 95 mmHg had a sensitivity of of 93% for a good outcome. Conclusion: Our analysis suggests with validation that a pre-reperfusion averaged MAP ≥ 95mmHg results in better outcomes with successful thrombectomy and may be used as a therapeutic target in the pre-hospital setting.

Title: Effect of hypertension on clinical recovery after stroke thrombectomy Objective: Our goal was to identify what vascular risk factors for stroke affect outcomes after mechanical thrombectomy. Methods: We retrospectively reviewed stroke thrombectomy patients at our comprehensive stroke center from June 2013 to August 2016. Patients were determined to have atrial fibrillation, hypertension, diabetes, or hyperlipidemia based on historical information pre-treatment or based on hospital records during their index hospitalization. All patients in our series achieved recanalization after thrombectomy defined as a Thrombolysis in cerebral infarction (TICI) score of 2b or higher. Our endpoint was mild to moderate disability at 90 days defined by the modified Rankin Scale (mRS) score of 2 or less. We performed a univariate analysis on the above covariates affecting clinical outcome and studies all variables with a p-value of < 0.2 in a multivariate analysis to determine which independent variables affected outcome. Multi-variate analyses were performed separately for males and females. Results: We reviewed 288 stroke patients that underwent thrombectomy. The mean age was 69±15; NIHSS was 17±6; 36% (104 of 288) received t-PA and 42% (121 of 288) had a modified Rankin Score of < 2. 42.7% (123 of 288) were females. From the entire group, 47.5% (137 of 288) had atrial fibrillation, 29% (83 of 288) had diabetes mellitus 68% (197 of 288) had hypertension, 38.5% (111 of 288) had hyperlipidemia and 16% (47 of 288) had a history of tobacco smoking. After considering positive univariates from above, our multivariate logistic regression model identified that not having hypertension [ OR 2.32, CI 1.01-5.41, p=0.05 ] predicted better outcome post thrombectomy procedure for males after a successful recanalization. Conclusion: Our analysis suggests that, for males, the odds of a positive outcome after a successful thrombectomy procedure is positively influenced when the patient is not hypertensive. No traditional risk factor appeared to influence the outcome in females. Further prospective study is required to validate these findings.

This paper presents the cyclic deformation behaviour and fatigue properties of a wire + arc additive manufactured Ti-6Al-4V alloy in the as built condition under strain-controlled test condition. Higher local energy input used to build the material has resulted in a coarser primary columnar β grain structure along with a coarser α microstructure compared to Ti-6Al-4V alloys produced by other additive manufacture processes. Test specimens were manufactured in horizontal and vertical orientations with respect to the deposited layers. Isotropic fatigue property was observed at lower applied strain values. When the strain amplitude was above 0.6%, the vertical samples, where the loading axis was parallel with the primary columnar β grains, showed marginally higher fatigue life owing to the material being more ductile in this direction. Moreover, higher cyclic softening rate by a factor of two was measured in the vertical samples. No porosity defects were found in the material. Cracks were initiated from either the α laths or α/β interface due to cyclic slip localisation.

Kidney failure is frequently observed during and after COVID-19, but it remains elusive whether this is a direct effect of the virus. Here, we report that SARS-CoV-2 directly infects kidney cells and is associated with increased tubule-interstitial kidney fibrosis in patient autopsy samples. To study direct effects of the virus on the kidney independent of systemic effects of COVID-19, we infected human induced pluripotent stem cell-derived kidney organoids with SARS-CoV-2. Single cell RNA-sequencing indicated injury and dedifferentiation of infected cells with activation of pro-fibrotic signaling pathways. Importantly, SARS-CoV-2 infection also led to increased collagen 1 protein expression in organoids. A SARS-CoV-2 protease inhibitor was able to ameliorate the infection of kidney cells by SARS-CoV-2. Our results suggest that SARS-CoV-2 can directly infect kidney cells and induce cell injury with subsequent fibrosis. These data could explain both acute kidney injury in COVID-19 patients and the development of chronic kidney disease in Long-COVID., Graphical Abstract, Jansen, Reimer, Nagai et al report that SARS-CoV-2 infects kidney cells and is associated with kidney fibrosis in patients. Using single cell transcriptomics of infected kidney organoids, they show that SARS-CoV-2 causes kidney injury and stimulates pro-fibrotic signaling. Viral infection in organoids was inhibited by a recently developed protease blocker.

This ethnographic case study explored how children build and use working theories in play (Hill, 2015), specifically theories about existential matters of life, death and dying, human nature, and the social, physical and natural world. The concepts of funds of knowledge and interests are integrated to theorise children's agency and competence in how they collectively build working theories. This conceptualisation reflects contemporary socio-cultural theories in which peer cultures, relationships and interactions are central to play and learning, with interaction conceived as multimodal, encompassing artefacts, embodiment and affect. Data is presented from research conducted with children age 4–6 (Hill, 2015), using videotaped episodes of their ‘Dead Forever’ play, and post-video discussions with children and parents. Findings indicate that children's interests and working theories are sources of knowledge in peer-led learning, as evidenced in the social, cognitive, cultural and affective content of their play. We propose a complex understanding of play and learning within child-led Zones for Proximal Development. The extent to which children's interests and working theories are understood by teachers to connect with curriculum goals is problematized in the context of contemporary ECE frameworks.

The field of neurointerventional radiology (NIR) therapy, including acute ischemic stroke intervention, endovascular intracranial aneurysm management, and treatment of intra- and extracranial large-vessel disease, has evolved over the past 18 years. To support this specialized advanced care requires nursing standards of care for staff to provide direct patient care in NIR suites and intensive management of this high-risk patient population. The intent of this paper is to provide a complementary document for the Stroke Interventional Laboratory Consensus (SILC) statement that will specifically address the nursing standards of care for patients in an NIR suite.

Targeted temperature management (TTM) is often used in neurocritical care to minimize secondary neurologic injury and improve outcomes. TTM encompasses therapeutic hypothermia, controlled normothermia, and treatment of fever. TTM is best supported by evidence from neonatal hypoxic-ischemic encephalopathy and out-of-hospital cardiac arrest, although it has also been explored in ischemic stroke, traumatic brain injury, and intracranial hemorrhage patients. Critical care clinicians using TTM must select appropriate cooling techniques, provide a reasonable rate of cooling, manage shivering, and ensure adequate patient monitoring among other challenges. The Neurocritical Care Society recruited experts in neurocritical care, nursing, and pharmacotherapy to form a writing Committee in 2015. The group generated a set of 16 clinical questions relevant to TTM using the PICO format. With the assistance of a research librarian, the Committee undertook a comprehensive literature search with no back date through November 2016 with additional references up to March 2017. The Committee utilized GRADE methodology to adjudicate the quality of evidence as high, moderate, low, or very low based on their confidence that the estimate of effect approximated the true effect. They generated recommendations regarding the implementation of TTM based on this systematic review only after considering the quality of evidence, relative risks and benefits, patient values and preferences, and resource allocation. This guideline is intended for neurocritical care clinicians who have chosen to use TTM in patient care; it is not meant to provide guidance regarding the clinical indications for TTM itself. While there are areas of TTM practice where clear evidence guides strong recommendations, many of the recommendations are conditional, and must be contextualized to individual patient and system needs.

The pupillary light reflex (PLR) describes the response when light hits the retina and sends a signal (cranial nerve II) to the Edinger-Westphal Nucleus which via cranial nerve III results in pupillary constriction. The Neurological Pupil indexTM (NPi) and pupil constriction velocity (CV) are two distinct variables that can be observed and measured using a pupillometer. We examine NPi and CV in 27,462 pupil readings (1,617 subjects). NPi values

Este documento propone herramientas para profesoras/es de la educación superior interesadas/os en realizar la transversalización de género desde una perspectiva interseccional. Planteamos que las y los educadores deben empezar su camino hacia una pedagogía no discriminatoria analizando sus propias prácticas y presuposiciones - en la clase y fuera de ella - para poder evaluar y transformar sus creencias y pedagogías, con el objetivo de encontrar una forma de aprender y de enseñar más crítica, política, personal y democrática; que avance en el objetivo de eliminar desigualdades basadas en género y otras diferencias. Este artículo incluye herramientas y estrategias para los ámbitos educativos, institucionales y personales, con la idea que deben ser trabajados de manera integral para generar cambios reales

Aim Correct identification of the protein that is causing amyloidosis is crucial for clinical management. Current standard laboratory methods have limited ability to detect the full range of amyloid forming proteins. We assessed the diagnostic value of LCM-MS/MS, which combines specific sampling of amyloid deposits by LCM with protein identification by MS/MS. Methods Biopsy specimens were referred to the Princess Alexandra Hospital Amyloidosis Centre. For all specimens, 10µm sections of formalin-fixed paraffin embedded tissue were stained with Congo Red using a standard technique. LCM was performed using an Arcturus XT instrument with an infrared capture laser. Proteins were extracted with FFPE Protein Extraction Solution (Agilent Technologies), digested with trypsin and peptides were analysed by nano-liquid chromatography-coupled MS/MS using an Agilent Chip CUBE-QTOF. Database searching was performed using Spectrum Mill (Agilent) with the NCBInr human protein database. Results Biopsies were received on 136 patients: there was insufficient tissue in the block in 7, repeat LCM was required in15 cases and no amyloid forming protein was identified in 8. In 121/136 (89%) an amyloid forming protein was identified. Proteins identified included immunoglobulin light chain (localised amyloid n=25, systemic AL n=45), immunoglobulin heavy chain (AH n=6), transthyretin (senile amyloid n=25, hereditary ATTR n=6), serum amyloid A (AA n=7), fibrinogen alpha chain (AFib n=2), LECT2 (ALect2 n=2), TGFb (corneal lattice amyloid n=1) and semenogelin (seminal vesicle amyloid n=2). It was not infrequent, particularly in cases of localised amyloidosis (>80% of cases), for smaller amounts of other amyloid forming proteins to be present especially immunoglobulins, transthyretin and ApoA1 (Table 1). This suggests that these inherently amyloidogenic proteins are capable of integrating within the amyloid deposit. An amyloid proteomic signature as previously defined by the Mayo Clinic (at least two of SAP, ApoE and ApoA4; Haematologica 2014;99(7):1239) was present in 76% of cases and was more likely to be found if larger amounts of amyloid could be dissected (p=0.0001). In terms of clinical impact, amyloid typing by immunohistochemical stains had been attempted in 87 cases and reported as diagnostic in 39. Five of these were subsequently revealed by proteomic analysis to be incorrect. Overall, the clinical diagnosis of amyloid subtype was altered by proteomic analysis in 24% of cases. Conclusion. LCMMS/MS identifies an amyloid forming protein in ~90% of clinical biopsy samples. Amyloid deposits often contain small amounts of other amyloid forming proteins which may reflect not just contamination but co-deposition of fibrils due to a shared beta pleated sheet conformation. Because of this, results need to be interpreted in the context of full clinical information to enable correct diagnosis of amyloid subtype. Table 1. LCM-MS/MS results Amyloidosis subtype AL-lambda AL-kappa AH Localised lambda Localised kappa ATTRwt ATTRmut AA Number of subtype cases 32 13 5 16 9 25 6 7 Amyloid forming proteins Lambda light chain 32 16 1 2 Kappa light chain 4 13 2 5 9 4 1 Ig heavy chain 8 5 6 6 4 1 3 Transthyretin 1 3 3 25 6 ApoA1 2 3 7 3 SAA 7 Fibrinogen alpha chain 2 1 2 1 Lysozyme 1 1 1 Cases with low levels of 2nd amyloid forming protein 34% 46% 40% 81% 89% 20% 17% 57% Amyloid associated proteins ApoE 21 12 2 16 7 19 6 5 SAP 16 8 13 6 24 6 4 ApoA4 23 10 1 16 8 22 6 2 Amyloid proteomic signature 63% 77% 0% 100% 78% 92% 100% 57% Disclosures Mollee: Onyx: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau.

Using industry leading methods and software products, this article explores the potential for health risk adjustment in the Department of Defense (DoD) Military Health System. From an epidemiologic perspective, the study assesses whether DoD populations enrolled to and served by different provider groups exhibit sufficient variation in risk to justify changes in resource allocation, such as staffing, services, and facility modification. In addition, the study investigates whether systematic differences in risk exist between TRICARE enrollees and commercially insured enrollees. Given the interest of the DoD in managed care, risk prediction tools are shown to project future risk for individuals with sufficient accuracy to justify development of disease management programs for patients with chronic conditions. Analyses demonstrate that Military Health System data support industry requirements to perform risk grouping among a random sample of 200,000 enrollees selected from 495,941 eligible enrollees.

Este documento propone herramientas para profesoras/es de la educación superior interesadas/os en realizar la transversalización de género desde una perspectiva interseccional. Planteamos que las y los educadores deben empezar su camino hacia una pedagogía no discriminatoria analizando sus propias prácticas y presuposiciones - en la clase y fuera de ella - para poder evaluar y transformar sus creencias y pedagogías, con el objetivo de encontrar una forma de aprender y de enseñar más crítica, política, personal y democrática; que avance en el objetivo de eliminar desigualdades basadas en género y otras diferencias. Este artículo incluye herramientas y estrategias para los ámbitos educativos, institucionales y personales, con la idea que deben ser trabajados de manera integral para generar cambios reales.