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Race/ethnic minorities face significant inequities in stroke incidence, prevalence, care, and outcomes. The Health Equity and Actionable Disparities in Stroke: Understanding and Problem-solving symposium, a collaborative initiative of the American Heart Association and National Institute of Neurological Disorders and Stroke, was the first-ever annual multidisciplinary scientific forum focused on race/ethnic inequities in cerebrovascular disease, with the overarching goal of reducing inequities in stroke and accelerating the translation of research findings to improve outcomes for race/ethnic minorities. The symposium featured esteemed invited plenary speakers, lecturing on determinants of race/ethnic inequities in stroke and interventions aimed at redressing the inequities. The Edgar J. Kenton III Award recognized Ralph Sacco, MD, MS, for his lifetime contributions to investigation, management, mentorship, and community service in the field of stroke inequities. Early career investigators were provided with travel awards to attend the symposium; presented their research at moderated poster and Think Tank sessions; received career development advice at the Building Momentum session; and networked with experienced stroke inequities researchers. Future conferences—The Health Equity and Actionable Disparities in Stroke: Understanding and Problem-solving 2021 to 2024—will broaden the focus to include 5 major persistent inequities (race/ethnic, sex, geographic, socioeconomic, and global). Each year will focus on a different theme (community and stakeholder engagement; clinical trials; implementation science; and policy and dissemination). By fostering a community of stroke inequities researchers, we hope to highlight promising work, illuminate research gaps, facilitate networking, inform policy makers, recognize achievement, inspire greater interest among junior investigators to pursue careers in this field, and provide networking opportunities for underrepresented minority scientists.

This study modelled and optimized the oxidative desulfurization of gas condensate with ozone, as a gaseous oxidant. Experiments in this study were non-catalytic, and sulfone extraction was done by acetone. Response surface methodology was applied for the experimental design, mathematical modeling, and optimization using Design-Expert® software. The influence of effective variables and their interaction on the response was also investigated. For the first time, non-catalytic ozonation of this feed was performed on the oxidative desulfurization process. The developed model properly fitted the experimental results. The accuracy of the model was confirmed, while this model predicted 95% desulfurization would result in the optimized conditions, and the actual value of desulfurization obtained was 95.8%. Further, the results indicated interaction between the superficial gas velocity of ozone and coefficient of oxidant-to-sulfur molar ratio. GC-SCD revealed that DBT was the most refractory component in comparison with the other sulfur components in the gas condensate. It was also found that 84.3% desulfurization occurred just with oxidation and sedimentation of sulfones and without solvent extraction.

Background and Purpose:The rural-urban life-expectancy gap is widening, but underlying causes are incompletely understood. Prior studies suggest stroke care may be worse for individuals in more rural areas, and technological advancements in stroke care may disproportionately impact individuals in more rural areas. We sought to examine differences and 5-year trends in the care and outcomes of patients hospitalized for stroke across rural-urban strata.Methods:Retrospective cohort study using National Inpatient Sample data from 2012 to 2017. Rurality was classified by county of residence according to the 6-strata National Center for Health Statistics classification scheme.Results:There were 792 054 hospitalizations for acute stroke in our sample. Rural patients were more often white (78% versus 49%), older than 75 (44% versus 40%), and in the lowest quartile of income (59% versus 32%) compared with urban patients. Among patients with acute ischemic stroke, intravenous thrombolysis and endovascular therapy use were lower for rural compared with urban patients (intravenous thrombolysis: 4.2% versus 9.2%, adjusted odds ratio, 0.55 [95% CI, 0.51–0.59],PPPP=0.086; large towns, 1.05 [1.01–1.09],P=0.009; small towns, 1.10 [1.06–1.15],PPPPPConclusions:Rural patients with stroke were less likely to receive intravenous thrombolysis or endovascular therapy and had higher in-hospital mortality than their urban counterparts. These gaps did not improve over time. Enhancing access to evidence-based stroke care may be a target for reducing rural-urban disparities.

Rothmund–Kornfeld selectivity coefficient (KRK) and regular solution model are rarely used to describe soil exchange data but it seems to be able to satisfactorily predict the true thermodynamic eq...

Vanadium oxide supported on TiO2(P25) catalysts were synthesized via atomic layer deposition (ALD) of vanadyl acetylacetonate (VO(acac)2). Comprehensive investigations were performed to evaluate the ALD temperature window and the saturation deposition period of VO(acac)2, which were found to be 140–210 °C and 120 min, respectively. The synthesized catalysts were compared to their corresponding impregnation ones for the oxidative dehydrogenation of propane reaction (ODH-P). The ODH-P results indicated the superior performance of the ALD catalysts for the low temperature ODH-P (

Separation of carbon dioxide in flue gases from the combustion equipment is one of the most serious concerns for industries and especially for the power plants which are the main producers of this pollutant gas. From the various separation methods, vacuum pressure swing adsorption (VPSA) process is attracted interest due to its lower energy consumption and high efficiency. A VPSA process was studied for the separation of a mixture of CO2/N2 (80% N2 and 20% CO2). Experiments were performed in an eight-step, four-bed setup using zeolite 13X and carbon molecular sieve (CMS) as adsorbents. Experimental measurements by the bench-scale system have been obtained in a pressure range of 2.7–4.7 bar, cycle times of 360–600 s, the product flow rate of 1–3 (lit/min), and temperature 30 °C. The effects of pressure, cycle time, and product flow rate were investigated. With using 560 s for a cycle time at 3.7 bar, the maximum purity of 97.6% was obtained for zeolite 13X adsorbent.

SAPO-34 catalysts were synthesized through the seeding approach under different seed conditions. The different seed synthesis times (6 h, 12 h, and 24 h) and three types of seeds were evaluated: the dried seed, the calcined seed, and the mother liquor from an unseeded synthesis, called the solution seed. Pure SAPO-34 was obtained using 12 h and 24 h solution seeds, in which a 40% reduction of template consumption was achieved simultaneously. All seeding induced samples represented higher catalytic performance in the MTO process than conventional SAPO-34 due to the smaller crystallite/particle sizes and larger external surface areas and mesopore volume. Furthermore, the changes in the acidity of samples affect their performance. The maximum olefin selectivity under industrial feed conditions (72 wt% methanol in water) was 91.79% for the sample prepared from the 12 h solution seed, which was 14.43% higher than the unseeded sample. Although this sample did not have the longest lifetime, it showed a 330 min lifespan, which was at least twice more than that of the conventional one (150 min). The sample prepared from the 6 h solution seed showed the longest lifetime of more than 500 min among all catalysts, although it was contaminated with a little SAPO-5.

There is a paucity of literature comparing the postoperative outcomes of males and females with breast cancer who undergo mastectomy. The aim of this study is to evaluate the comorbidities and 30-day post-mastectomy complication rates among males and females.We performed a retrospective analysis of breast cancer patients who underwent mastectomy from 2014 to 2016 using the American College of Surgeon's National Surgical Quality Improvement Project database. Data including patient demographics, comorbidities, and 30-day surgical and medical complications were collected. Statistical analysis included Chi-square and Fisher's exact tests for categorical variables and Student T-tests for continuous variables. Statistical significance was defined as p 0.05.A total of 15,167 patients were identified. There were 497 males (3.3%) and 14,670 females (96.7%). Age was significantly higher in females compared to males (63.5 vs. 57.6 years, p 0.001). Body mass index (BMI) at time of surgery was also higher in males (30.0 vs. 29.3 kg/mOur findings suggest that differences in age, BMI, and comorbidities between males and females do not significantly impact 30-day medical or surgical complications following total mastectomy for breast cancer. Further research is warranted to identify perioperative risk factors that influence post-mastectomy complication rates.3 (Retrospective cohort study).

Significance Memory-like NK cells (NKG2C + CD57 + FcεRIγ – ) are established during CMV infection. Here, mass cytometry tracked the in vivo kinetics of CMV-induced memory NK cells generation and identified a unique subset of NKG2C + CD57 + FcεRIγ low–dim as potentially prememory-like NK cells in CMV-infected kidney transplant patients. The study demonstrated that prememory-like NK cells with a high cytotoxic profile proliferate along with accumulation of new memory-like NK cells, whereas preexisting memory-like NK cells decreased in the peripheral blood after transplantation. Moreover, NKG2C + CD8 + T cells and cytotoxic γδ T cells also expand during CMV infection. This interplay of three different cytotoxic lymphocytes demonstrates a combinatorial immune response against CMV infection, which may contribute to preventing CMV-associated complication in organ transplantation.

Digital Health has long been championed as a means to expanding access to health care. Now that the Coronavirus-19 disease (COVID-19) pandemic accelerated many health systems’ integration of digital tools for care, digital health may provide a path towards more accessible stroke prevention and treatment, particularly for historically disadvantaged patient populations. Stroke management is composed of multiple timepoints where digital health innovations have the potential to augment health access and treatment: from primary prevention, to the time-sensitive detection of ischemic stroke, administration of thrombolytic agents and consideration for endovascular interventions, to appropriate post-acute care, rehabilitation, and lifelong secondary stroke prevention — stroke care relies on a multidisciplinary and standardized approach. However, as we discuss pointedly in this Focused Update, underrepresented individuals face multilevel digital health disparities that potentially diminish the benefits of these digital advances. As such, these multilevel needs must be discussed and accounted for as health systems seek to integrate innovative and equitable digital health solutions towards stroke care.

Background: Measurement of allostatic load, quantified by the allostatic load index (ALI), is often utilized to evaluate the physiologic response to stress. Our objective was to assess whether allostatic load is associated with mortality after stroke or with stroke-specific mortality in the general population. Methods: Using data from the third National Health and Nutritional Examination Survey (NHANES III, 1988-1994) and the 2015 Linked Mortality File (National Death Index), we selected adults aged ≥ 25 years. Stroke was self-reported. We computed the weighted prevalence of each allostatic load index (ALI) category to obtain nationally representative estimates with higher ALI corresponding to higher stress burden. We evaluated the relationship between ALI category and mortality outcomes using the Cox proportional hazard model considering the survey design variables, adjusting for age, sex, education, marital status, and income. Results: Of 15,567 individuals included in the study, there were 48.3% ALI ≤ 1, 21.7% ALI = 2, and 30% ALI ≥ 3. Of 414 individuals with reported history of stroke there were 11.8% ALI ≤ 1, 22.1% ALI = 2, and 66.1% ALI ≥3. Higher ALI correlated with male sex, older age, lower education, married or widowed status, and lower income. In the population with history of prior stroke, those with ALI ≥ 3 had 2.7 times higher all-cause mortality and 4.5 times higher cardiovascular mortality compared to those with ALI ≤ 1 (Table). In the general population, the ALI ≥ 3 group had 1.8 times higher adjusted stroke mortality. Discussion: Baseline higher allostatic load predicts greater all-cause and cardiovascular mortality risk in stroke survivors and greater stroke mortality risk in the general population. A global approach towards addressing the modifiable indicators in the ALI may improve survival in these populations.

Background: Around 50 million people in the US have inadequate access to nutritious food. Food insecurity is linked with chronic conditions and worse overall health. Research has shown that living in a lower SES neighborhood is linked to increased post-stroke mortality, but little is known about the effect of food insecurity on mortality. Methods: This study used the National Health and Nutrition Examination Survey (NHANES) dataset 1999/2000-2013/2014 with linked mortality files through 2015. Participants included those ≥ 20 years with a complete survey, physical examination, and mortality information. Stroke was self-reported. Food security was characterized as food secure (full, marginal) or food insecure (low, very low). We evaluated the relationship between food insecurity and all-cause, cardiovascular (CV) and stroke mortality in the general and stroke population using Cox proportional hazards regression models, adjusting for sociodemographic factors and comorbidities. Results: From 1999 to 2014, 40,777 people participated in NHANES and 1,530 reported a history of stroke. Prevalence of food insecurity was 11.6% in the general population and 15.5% in the stroke subset. Among the general population, there were 5394 deaths due to all-causes, 1152 CV deaths, and 216 stroke deaths. Among the stroke population, there were 650 deaths due to all-causes, 176 CV deaths, and 41 stroke deaths. In the general population, food insecure individuals had higher adjusted all-cause mortality (aHR 1.15, CI 1.01-1.32) and a trend towards higher CV (aHR 1.14, 0.85-1.52) and stroke mortality (aHR 1.23, 0.65-2.34). In participants with prior stroke, food insecurity had no impact on all-cause, CV or stroke mortality. Discussion: Although prior studies have demonstrated that living in a low SES neighborhood results in worse post-stroke mortality, this data suggests the effect is not directly linked with food insecurity. A potential explanation is that individuals may receive greater access to food resources after a stroke. There is also the possibility that the low frequency of deaths among stroke survivors limited the ability to detect an effect. Further study is needed to explore the underpinnings of worse post-stroke outcomes in lower SES neighborhoods.

Background: Previous data from NHANES 1999-2004 showed that women aged 45-54 years were more than twice as likely as men to report a prior stroke. Little is known about recent sex-specific trends in midlife stroke prevalence and risk factors for stroke. Methods: We assessed age- and sex- specific trends in stroke prevalence among individuals aged 35-64 years (n= 23,936; weighted n= 349,074,769) participating in NHANES across epochs in 6-year intervals (1999-2004, 2005-2010, 2011-2016) using survey weighted counts and proportions to reflect US national estimates. Stroke was self-reported. Survey adjusted logistic regression models compared odds of prior stroke by sex across time for each midlife decade adjusting for sociodemographic and clinical variables. Trends in prevalence of vascular risk factors were assessed over time. Results: In 1999-2004, women aged 45-54 years were over twice as likely as men to report prior stroke (OR 2.4, 95% CI 1.4-4.2, p=0.002). In 2005-2010 and 2011-2016, the differences were no longer significant (OR 1.5, 0.9-2.5, p=0.15 and OR 0.9, 0.5-1.6, p=0.71). There were no sex differences in stroke prevalence for those aged 35-44 and 55-64 years (Table). Among those aged 45-54 years, mean systolic blood pressure (SBP) were comparable between women and men in 1999-2004 (124, SE 0.7 mmHg vs 125, SE 0.6 mmHg, p= 0.27), but women’s mean SBP decreased to 121, SE 0.6 mmHg in 2011-2016, while men’s remained stable at 124, SE 0.6 mmHg. Diabetes prevalence increased in both men (9% to 13%) and women (8% to 10%). Obesity prevalence increased from 31% to 38% in men and 37% to 42% in women. Conclusion: A decade later the midlife stroke prevalence surge among women (vs. men) in the US has abated. However, it is unclear whether this change is due to shifts in incidence or case fatality and opportunities remain to address cardiometabolic risk factors for both sexes.

Introduction: Black individuals are disproportionally affected by stroke, yet little is known about the effect of region of origin and acculturation on stroke mortality. We examined associations between nativity and stroke outcomes among Black individuals in the US. Methods: Using the National Health Interview Service 2000-2014 data and mortality linked files through 2015, we identified participants aged 25-74 years who self-identified as Black (n=64,717). We categorized Black race by birth region, i.e. foreign-born (Caribbean, South and Central American, and African) vs. US-born. Stroke was determined by self-report. Using Cox regression, we examined the association between nativity and all-cause, cardiovascular (CV), and stroke mortality, adjusting for age, sex, education, income, smoking, and body mass index, overall and by time since migration. Results: Overall, 4329 deaths (including 205 stroke and 932 CV deaths) were recorded during the study period. Weighted cumulative incidence of all-cause, CV, and stroke mortality at 10 years follow up were 12.62%, 2.76%, and 0.59% for those born in the US; 6.12%, 1.58%, and 0.45% for those born in the Caribbean, South and Central America; and 3.15%, 0.54%, and 0.08% for those born in Africa. In the model adjusted for demographic factors, compared to US-born Black individuals, rates of all cause and CV mortality were lower among Black individuals born in the Caribbean, South and Central America [all-cause mortality: aHR (95%CI): 0.46 (0.38-0.55); CV mortality [0.60 (0.40-0.89)], but rates of stroke mortality were similar [1.00 (0.55-1.99)]. African-born Black individuals had lower all-cause mortality rates [0.50 (0.32-0.80)] and trended toward having lower CV [0.47 (0.20-1.13)] mortality rates compared to those born in the US. The above findings remained similar after adjusting for smoking and BMI. Time since migration did not significantly affect mortality outcomes among foreign born Blacks. Conclusion: Foreign-born Black individuals generally have lower all cause and CV mortality regardless of time since migration. These findings highlight the need for more granular information regarding region of origin and acculturation to understand and target racial disparities.

Background: Blood pressure (BP) control is crucial for secondary stroke prevention. Previous studies have shown that one in five stroke survivors have unrecognized hypertension and one in three have poorly controlled BP. Little is known regarding recent trends in BP awareness, treatment, and control among stroke survivors in the U.S. Methods: Among adults (age>=18 years) with self-reported stroke who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, we assessed temporal trends in BP awareness, treatment and control by age group, sex, race/ethnicity, education, and poverty income ratio (PIR). BP control was defined as Systolic Blood Pressure (SBP) Results: Among individuals with self-reported stroke (n=1,883), the age-adjusted proportion of individuals with BP awareness increased from 87% (82-91%) in 1999-2002 to 96% (93-98%) in 2007-2010, then decreased to 92% (88-95%) in 2015-2018 ( P =0.005, quadratic trend). For those with hypertension, antihypertensive use increased from 87% (76-93%) in 1999-2002 to 97% (93-98%) in 2007-2010 and 96% (93-98%) in 2015-2018 ( P =0.013, quadratic trend). BP control significantly increased from 40% (29-52%) in 1999-2002 to 63% (65-81%) in 2007-2010, then decreased to 58% (50-66%) in 2015-2018 ( P =0.014, quadratic trend). Factors associated with poorly controlled BP in 2011-2018 were age 75+ years (vs. 18-44) [PR 0.60 (0.44-0.82), P ≤0.01], female sex [PR 0.79 (0.66-0.94), P ≤0.01], Black race (vs. Non-Hispanic White race) [PR 0.79, P =0.01], and lack of health insurance (vs. Medicare) [PR 0.53 (0.33-0.86), P =0.01]. Conclusion: While BP awareness, treatment, and control among stroke survivors increased from 1999 to 2010, the trend reversed in 2011-2018. Future work could help identify reasons for the worrisome trends and target vulnerable stroke survivors for sustained optimal BP control.

Introduction: Social determinants of health have a substantial impact on stroke. Food insecurity (FI) - lack of consistent access to food due to poor financial resources – is a barrier to a healthy diet, a cornerstone for stroke prevention. The prevalence and predictors of FI among stroke survivors are unknown. Methods: Using NHANES data from 1999-2015, we assessed prevalence, predictors, and temporal trends in FI in adults >=20 years with and without prior stroke. FI was based on response to the Food Security Survey Module. Full/marginal food security were considered food secure, while low/very low food security were considered food insecure. Stroke history was self-reported. Prevalence of FI among persons with/without stroke across time was adjusted for age. Factors associated with FI among persons with stroke were determined using multivariable logistic models, adjusting for year and sociodemographic factors. Results: Among 48,242 participants, 1,877 reported history of stroke. FI was more prevalent among persons with prior stroke (17%) vs. those without prior stroke (12%), p Conclusions: One in three stroke survivors have FI, nearly double the prevalence in those without stroke. Addressing the fundamental drivers of FI (e.g. socioeconomic status) and targeting vulnerable demographic groups may have a profound influence on stroke prevalence. To our knowledge, this is the first study of FI among stroke survivors in the U.S.

Introduction. Less than 1% of all breast cancers are diagnosed in males. In females, postmastectomy breast reconstruction is associated with increased patient satisfaction. However, there is a paucity of literature describing reconstructive options for postmastectomy deformity in the male chest. The purpose of this systematic review was to evaluate postmastectomy reconstruction outcomes in males with breast cancer. Methods. A systematic review was performed in accordance with PRISMA guidelines. Ovid MEDLINE, Embase, Cochrane, and Web of Science were queried for records pertaining to the study question using medical subject heading (MeSH) terms such as “male breast cancer,” “mastectomy,” and “reconstruction.” No limitations were placed on the year of publication, country of origin, or study size. Study characteristics and patient demographics were collected. Primary outcomes of interest included postoperative complications, recurrence rate, and mortality rate. Results. A total of 11 articles examining 29 male patients with breast cancer who underwent postmastectomy reconstruction were included for analysis. Literature was most commonly available in the form of case reports. The average age was 59.6 +/−11.4 years. Reconstruction methods included fat grafting (n = 1, 3.4%), silicone implants (n = 1, 3.4%), and autologous chest wall reconstruction with local flaps (n = 26, 89.7%). Postoperative complications occurred in two patients (6.8%), including partial nipple necrosis (n = 1) and hypertrophic scarring (n = 1). Of the studies reporting patient satisfaction, all patients were pleased with the aesthetic appearance of their chest. Conclusion. This systematic review revealed the limited availability of research regarding postmastectomy chest reconstruction in males with breast cancer. Nevertheless, the evidence available suggests that reconstruction can restore a patient’s body image and, thus, should be regularly considered and discussed with male patients. Larger studies are warranted to further shed light on this population.

Background Improving stroke services is critical for reducing the global stroke burden. The World Stroke Organization–World Health Organization– Lancet Neurology Commission on Stroke conducted a survey of the status of stroke services in low and middle-income countries (LMICs) compared to high-income countries. Methods Using a validated World Stroke Organization comprehensive questionnaire, we collected and compared data on stroke services along four pillars of the stroke quadrangle (surveillance, prevention, acute stroke, and rehabilitation) in 84 countries across World Health Organization regions and economic strata. The World Health Organization also conducted a survey of non-communicable diseases in 194 countries in 2019. Results Fewer surveillance activities (including presence of registries, presence of recent risk factors surveys, and participation in research) were reported in low-income countries than high-income countries. The overall global score for prevention was 40.2%. Stroke units were present in 91% of high-income countries in contrast to 18% of low-income countries (p Conclusions There is an urgent need to improve access to stroke units and services globally especially in LMICs. Countries with less stroke services can adapt strategies from those with better services. This could include establishment of a framework for regular monitoring of stroke burden and services, implementation of integrated prevention activities and essential acute stroke care services, and provision of interdisciplinary care for stroke rehabilitation.