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Extracellular vesicles (EVs) are diverse nanoparticles with large heterogeneity in size and molecular composition. Although this heterogeneity provides high diagnostic value for liquid biopsy and confers many exploitable functions for therapeutic applications in cancer detection, wound healing and neurodegenerative and cardiovascular diseases, it has also impeded their clinical translation-hence heterogeneity acts as a double-edged sword. Here we review the impact of subpopulation heterogeneity on EV function and identify key cornerstones for addressing heterogeneity in the context of modern analytical platforms with single-particle resolution. We outline concrete steps towards the identification of key active biomolecules that determine EV mechanisms of action across different EV subtypes. We describe how such knowledge could accelerate EV-based therapies and engineering approaches for mimetic artificial nanovesicle formulations. This approach blunts one edge of the sword, leaving only a single razor-sharp edge on which EV heterogeneity can be exploited for therapeutic applications across many diseases.

BackgroundIndividuals with Down syndrome (DS) are at high risk of early-onset Alzheimer's disease (AD); yet, some 20 percent do not develop any signs of dementia until after 65 years or in their lifetime. Mosaicism could contribute to this phenotypic variation, where some disomic cells could lead to lower levels of gene products from chromosome 21.MethodsWe examined longitudinal neuropsychological and biomarker data from two large studies of DS: the Alzheimer Biomarker Consortium-Down syndrome study (ABC-DS) (n = 357); and a legacy study (n = 468). We assessed mosaicism using karyotyping or GWAS data. Participants had data on plasma AD biomarkers (Aβ40, Aβ42, tau, and NfL) and longitudinal cognitive measures. A subset had cerebrospinal fluid biomarkers (Aβ40, Aβ42, tau, ptau181, and NfL) and amyloid and tau PET data.FindingsFor both cohorts, the prevalence of mosaicism was

The First2 Network is an alliance of higher education institutions across the State of West Virginia striving to improve science, technology, engineering, or math (STEM) education by supporting rural, first-generation, and underrepresented college students pursuing STEM majors. Over the summers of 2019 and 2020, the First2 Network delivered two-week summer research immersion experiences at various institutions throughout West Virginia, including our institutions. The 2019 program was delivered on-campus at four universities while the 2020 program was redesigned to be delivered virtually, due to the COVID-19 pandemic, across nine sites. Before and after the immersion experience, students who participated in the program completed a variety of survey questionnaires for the assessment of their interests, expectations, identity, and belonging in STEM. We found that the in-person research experience in 2019 had better outcomes compared to the virtual experience, suggesting that students conducting research directly under their faculty supervisors in-person and on-site will have a more positive impact on their STEM education and career. However, participation in the virtual research format with structured group activities still resulted in an improvement in belonging and STEM identity, indicating that connecting with students remotely is still worthwhile when it is the most viable option. The student population in West Virginia/Appalachia region faces a number of academic barriers, so there is much to gain by finding new ways to reach as many students as possible with early career development programs. Our virtually delivered program using citizen science projects, group discussions, and team building activities may be a useful template for other STEM programs to search for new ways to connect with a broader population of students offsite.

The effectiveness of incorporating an audience response system (ARS) in improving the learning environment and student performance was assessed in a didactic biomedical science course at a large US dental school. Instructors and students were surveyed for their experiences of using Top Hat-based ARS in a multi-disciplinary biomedical science course. Average exam scores and grade distribution for challenging sections on immunology and developmental biology were compared before and after incorporating ARS. Pearson's chi-squared test, likelihood ratio test, Student's t-test and Fisher's exact test using beta regression model were used to assess statistical significance (p < 0.05). Student survey results with 78% (82/105) response rate, indicated that incorporating ARS improved student engagement, reinforced lecture material, and prepared them better for exams (p < 0.0001). Sixty seven percent of student respondents recommended continued integration of ARS questions in lectures (p < 0.0001). Although faculty survey data (n = 5, 100% response rate) were not statistically significant, the majority of faculty agreed that real-time feedback through ARS allowed them to appropriately pace lecture delivery and restructure forthcoming material. The average exam scores and grade distribution for challenging sections showed modest improvement after incorporation of ARS (p < 0.05). There was no significant correlation between final course grades and ARS grades for participation or correctness. Incorporating the ARS in a multi-disciplinary biomedical science course is perceived by faculty and students as an effective instructional approach that improves the learning environment, teaching strategies, and student performance.

Through yarning and storying led by Aboriginal researchers, this study explores the success factors for Indigenous PhD Graduates. Participants comprised 21 Aboriginal and/or Torres Strait Islander people who had completed their PhDs within the last 7 years. Our thematic analysis uncovered themes associated with participants' decision to enrol as a scholar and the factors and experiences that contributed to the successful completion of their PhD. We identified three overlapping yet distinct themes that represent why Aboriginal and Torres Strait Islander people choose to pursue a PhD: Telling our story in our way, My Community needs me to do this, and Practicality rules. A strong sense of Connection and Reciprocity was a crucial factor for participants' successful completion of the PhD. We present a model of our findings model that translates the three key success factors identified in this study as foundational to success for Indigenous scholars' success in their PhD journey.

BACKGROUND: Firearm secure storage is an important public health practice due to its potential impact on reducing the incidence of accidental injuries, suicides, and thefts. Yet, there is limited research on how economic conditions might shape firearm storage patterns. METHODS: This study explores the relationship between material hardship and firearm secure storage among firearm-owning households. Data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed, including responses from 7,197 firearm-owning adults in California, Minnesota, Nevada, and New Mexico. Multinomial logistic regression models assessed the relationship between levels of material hardship and storage practices, adjusting for demographic and socioeconomic factors. RESULTS: Among respondents, 14.3% reported firearms were stored, loaded and unlocked. Compared to respondents experiencing no hardships, those experiencing three or more material hardships incurred a 183% higher risk of storing firearms in an unsecured manner (Relative Risk Ratio = 2.828, 95% CI = 1.286, 6.220). CONCLUSION: This study highlights an association between greater material hardship and unsecured firearm storage. These findings emphasize the need for public health interventions that address economic barriers to safe firearm storage, potentially reducing firearm-related injuries and deaths among individuals experiencing material hardship.

By age 40 years, over 90% of adults with Down syndrome have Alzheimer's disease pathology and most progress to dementia. Despite having few systemic vascular risk factors, individuals with Down syndrome have elevated cerebrovascular disease markers that track with the clinical progression of Alzheimer's disease, suggesting a role of cerebrovascular disease that is hypothesized to be mediated by inflammatory factors. This study examined the pathways through which small vessel cerebrovascular disease contributes to Alzheimer's disease-related pathophysiology and neurodegeneration in adults with Down syndrome. One hundred eighty-five participants from the Alzheimer's Biomarkers Consortium-Down Syndrome [mean (SD) age = 45.2 (9.3) years] with available MRI and plasma biomarker data were included in this study. White matter hyperintensity (WMH) volumes were derived from T2-weighted fluid-attenuated inversion recovery MRI scans, and plasma biomarker concentrations of amyloid beta 42/40, phosphorylated tau 217, astrocytosis (glial fibrillary acidic protein) and neurodegeneration (neurofilament light chain) were measured with ultrasensitive immunoassays. We examined the bivariate relationships of WMH, amyloid beta 42/40, phosphorylated tau 217 and glial fibrillary acidic protein with age-residualized neurofilament light chain across Alzheimer's disease diagnostic groups. A series of mediation and path analyses examined statistical pathways linking WMH and Alzheimer's disease pathophysiology to promote neurodegeneration in the total sample and groups stratified by clinical diagnosis. There was a direct and indirect bidirectional effect through the glial fibrillary acidic protein of WMH on phosphorylated tau 217 concentration, which was associated with neurofilament light chain concentration in the entire sample. Amongst cognitively stable participants, WMH was directly and indirectly, through glial fibrillary acidic protein, associated with phosphorylated tau 217 concentration, and in those with mild cognitive impairment, there was a direct effect of WMH on phosphorylated tau 217 and neurofilament light chain concentrations. There were no associations of WMH with biomarker concentrations among those diagnosed with dementia. The findings from this cross-sectional study suggest that among individuals with Down syndrome, cerebrovascular disease promotes neurodegeneration by increasing astrocytosis and tau pathophysiology in the presymptomatic phases of Alzheimer's disease, but future studies will need to confirm these associations with longitudinal data. This work joins an emerging literature that implicates cerebrovascular disease and its interface with neuroinflammation as a core pathological feature of Alzheimer's disease in adults with Down syndrome.

BackgroundInfection prevention (IP) measures are designed to mitigate the transmission of pathogens in healthcare. Using large-scale viral genomic and social network analyses, we determined if IP measures used during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic were adequate in protecting healthcare workers (HCWs) and patients from acquiring SARS-CoV-2.MethodsWe performed retrospective cross-sectional analyses of viral genomics from all available SARS-CoV-2 viral samples collected at UC San Diego Health and social network analysis using the electronic medical record to derive temporospatial overlap of infections among related viromes and supplemented with contact tracing data. The outcome measure was any instance of healthcare transmission, defined as cases with closely related viral genomes and epidemiological connection within the healthcare setting during the infection window. Between November 2020 through January 2022, 12 933 viral genomes were obtained from 35 666 patients and HCWs.ResultsAmong 5112 SARS-CoV-2 viral samples sequenced from the second and third waves of SARS-CoV-2 (pre-Omicron), 291 pairs were derived from persons with a plausible healthcare overlap. Of these, 34 pairs (12%) were phylogenetically linked: 19 attributable to household and 14 to healthcare transmission. During the Omicron wave, 2106 contact pairs among 7821 sequences resulted in 120 (6%) related pairs among 32 clusters, of which 10 were consistent with healthcare transmission. Transmission was more likely to occur in shared spaces in the older hospital compared with the newer hospital (2.54 vs 0.63 transmission events per 1000 admissions, P < .001).ConclusionsIP strategies were effective at identifying and preventing healthcare SARS-CoV-2 transmission.

With the emergence of Alzheimer's disease (AD) disease-modifying therapies, identifying patients who could benefit from these treatments becomes critical. In this study, we evaluated whether a precise blood test could perform as well as established cerebrospinal fluid (CSF) tests in detecting amyloid-β (Aβ) plaques and tau tangles. Plasma %p-tau217 (ratio of phosporylated-tau217 to non-phosphorylated tau) was analyzed by mass spectrometry in the Swedish BioFINDER-2 cohort (n = 1,422) and the US Charles F. and Joanne Knight Alzheimer Disease Research Center (Knight ADRC) cohort (n = 337). Matched CSF samples were analyzed with clinically used and FDA-approved automated immunoassays for Aβ42/40 and p-tau181/Aβ42. The primary and secondary outcomes were detection of brain Aβ or tau pathology, respectively, using positron emission tomography (PET) imaging as the reference standard. Main analyses were focused on individuals with cognitive impairment (mild cognitive impairment and mild dementia), which is the target population for available disease-modifying treatments. Plasma %p-tau217 was clinically equivalent to FDA-approved CSF tests in classifying Aβ PET status, with an area under the curve (AUC) for both between 0.95 and 0.97. Plasma %p-tau217 was generally superior to CSF tests in classification of tau-PET with AUCs of 0.95-0.98. In cognitively impaired subcohorts (BioFINDER-2: n = 720; Knight ADRC: n = 50), plasma %p-tau217 had an accuracy, a positive predictive value and a negative predictive value of 89-90% for Aβ PET and 87-88% for tau PET status, which was clinically equivalent to CSF tests, further improving to 95% using a two-cutoffs approach. Blood plasma %p-tau217 demonstrated performance that was clinically equivalent or superior to clinically used FDA-approved CSF tests in the detection of AD pathology. Use of high-performance blood tests in clinical practice can improve access to accurate AD diagnosis and AD-specific treatments.

Depression is a common mental health problem that is associated with significant disability and mortality. Electroconvulsive therapy (ECT) has been demonstrated to be effective at resolving expression of suicidal intent in patients with depression. In less acute situations, patients are usually referred for ECT after several medication trials. Neuromuscular blocking agents (NMBAs) are used to block tonic-clonic motor activity and associated physical harm during the delivery of ECT. Succinylcholine (Sch), with its rapid onset of muscle relaxation, short self-terminating duration of action, and rapid subsequent return of spontaneous ventilation, is the NMBA of choice for ECT. However, the use of Sch is problematic or contraindicated is some situations. Although non-depolarizing NMBAs can be used, the variable time to onset of adequate muscle relaxation and prolonged duration of action have limited their widespread acceptance as alternatives to Sch. Recently, however, with the widespread availability of sugammadex, a chemically modified γ-cyclodextrin that rapidly and predictably reverses the effect of non-depolarizing NMBAs, the muscle relaxation achieved by rocuronium can predictably and effectively be reversed. In situations where Sch is contraindicated or otherwise problematic, rocuronium, followed by pharmacological antagonism with sugammadex, can provide a safe and effective muscle relaxation approach comparable to that of Sch in terms of duration of action. This review provides a summary of the current state of evidence for the use of sugammadex during ECT, which should lend support to further acceptance and future studies of sugammadex in the context of ECT.

Life skills development among youth in foster care is critical in helping them overcome the barriers they face when leaving care. While foster care agencies, child welfare professionals, and caregivers play important roles in life skills development, little research has examined the topic from their perspectives. This study examined the barriers and supports Florida foster care agencies, child welfare professionals, and caregivers face related to life skills development of youth in foster care. Foster care agency representatives (n = 11) completed interviews or questionnaires and identified agency-level challenges, agency-level supports, and caregiver-focused supports for life skills development. In surveys, child welfare professionals (n = 24) and caregivers (n = 23) identified the challenges and supports they experience, as well as additional supports they needed. Semi-structured interviews with three child welfare professionals and seven caregivers gathered in-depth information on the topics covered in the survey. Thematic analysis was employed to identify themes within the data. While a number of challenges (i.e., lack of youth-focused resources, staff turnover) emerged across all three groups, supports were more varied across and within groups. Notably, caregivers received minimal support from the foster care system in helping youth develop life skills. Despite this, caregivers and child welfare professionals mainly identified youth-focused resources and services as needed additional supports. More training, support, and funding are required to address the challenges identified in this study. Broader child welfare issues, such as staff retention and turnover, must also be addressed to support the youths' development of independent living skills.

Objective: Compare changes in cholesterol and lipoprotein levels occurring in septic patients with and without acute respiratory distress syndrome (ARDS) and by survivorship. Methods: We reanalyzed data from prospective sepsis studies. Cholesterol and lipoprotein levels were analyzed using univariate testing to detect changes between septic patients with or without ARDS, and among ARDS survivors compared with nonsurvivors at enrollment (first 24 h of sepsis) and 48 to 72 h later. Results: 214 patients with sepsis were included of whom 48 had ARDS and 166 did not have ARDS. Cholesterol and lipoproteins among septic ARDS versus non-ARDS showed similar enrollment levels. However, 48 to 72 h after enrollment, change in median total cholesterol (48/72 h - enrollment) was significantly different between septic ARDS (-4, interquartile range [IQR] -23.5, 6.5, n = 35) and non-ARDS (0, -10.0, 17.5, P = 0.04; n = 106). When compared by ARDS survivorship, ARDS nonsurvivors (n = 14) had lower median total cholesterol levels (75.5, IQR 68.4, 93.5) compared with ARDS survivors (113.0, IQR 84.0, 126.8, P = 0.022), and lower median enrollment low-density lipoprotein cholesterol (LDL-C) levels (27, IQR 19.5-34.5) compared with ARDS survivors (43, IQR 27-67, P = 0.013; n = 33). Apolipoprotein A-I levels were also significantly lower in ARDS nonsurvivors (n = 14) (87.6, IQR 76.45-103.64) compared with ARDS survivors (130.0, IQR 73.25-165.47, P = 0.047; n = 33). At 48 to 72 h, for ARDS nonsurvivors, median levels of low-density lipoprotein cholesterol (9.0, IQR 4.3, 18.0; n = 10), LDL-C (17.0, IQR 5.0, 29.0; n = 9), and total cholesterol (59.0, 45.3, 81.5; n = 10) were significantly lower compared with ARDS survivors (n = 25) levels of low-density lipoprotein cholesterol (20.0, IQR 12.0-39.0, P = 0.014), LDL-C (42.0, IQR 27.0-58.0, P = 0.019), and total cholesterol (105.0, IQR 91.0, 115.0, P = 0.003). Conclusions: Change in total cholesterol was different in septic ARDS versus non-ARDS. Total cholesterol, LDL-C, and apolipoprotein A-I levels were lower in ARDS nonsurvivors compared with survivors. Future studies of dysregulated cholesterol metabolism in septic ARDS patients are needed to understand biology and links to potential therapies.

Abstract Background Firearm secure storage is an important public health practice due to its potential impact on reducing the incidence of accidental injuries, suicides, and thefts. Yet, there is limited research on how economic conditions might shape firearm storage patterns. Methods This study explores the relationship between material hardship and firearm secure storage among firearm-owning households. Data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed, including responses from 7,197 firearm-owning adults in California, Minnesota, Nevada, and New Mexico. Multinomial logistic regression models assessed the relationship between levels of material hardship and storage practices, adjusting for demographic and socioeconomic factors. Results Among respondents, 14.3% reported firearms were stored, loaded and unlocked. Compared to respondents experiencing no hardships, those experiencing three or more material hardships incurred a 183% higher risk of storing firearms in an unsecured manner (Relative Risk Ratio = 2.828, 95% CI = 1.286, 6.220). Conclusion This study highlights an association between greater material hardship and unsecured firearm storage. These findings emphasize the need for public health interventions that address economic barriers to safe firearm storage, potentially reducing firearm-related injuries and deaths among individuals experiencing material hardship.

Abstract The Controls Over Mesopelagic Interior Carbon Storage (COMICS) cruise DY086 took place aboard the RRS Discovery in the South Atlantic during November and December, 2017. Physical, chemical, biogeochemical and biological data were collected during three visits to ocean observatory station P3, off the coast of South Georgia, during an austral spring bloom. A diverse range of equipment including CTD-rosette, Acoustic Doppler Current Profiler (ADCP), net deployments, marine snow catchers (MSCs), Stand Alone Pump System (SAPS) and PELAGRA Sediment Traps were used to produce a comprehensive, high-quality dataset. The data can provide excellent insight into regional biological carbon pump (BCP) processes; it is recommended for use by observational scientists and modellers to enhance understanding of ecosystem interactions relating to mesopelagic carbon storage.

Background: The Beat It program is a clinician-led, community-based group exercise intervention for adults with Type 2 Diabetes Mellitus (T2DM). While previous studies have demonstrated its effectiveness in improving physical and mental health outcomes, this study explores the perspectives of Beat It Trainers to identify key factors contributing to the program’s success and areas for improvement. Methods: Semi-structured interviews were conducted with 11 Accredited Exercise Physiologists who had delivered both in-person and online versions of the program. Interviews were thematically analyzed using inductive approaches. Results: Eight main themes emerged: customization to individual needs, capability building, outcome improvement, affordability, accessibility, sustainability, and a holistic approach delivered in a group setting. Challenges identified included managing group dynamics, maintaining participant commitment in a fully subsidized program, and providing nutrition advice within the trainers’ scope of practice. The program’s adaptability to both in-person and online delivery modes was highlighted as enhancing its accessibility and resilience. Conclusions: This study provides valuable insights into the factors contributing to the success of the Beat It program from the implementers’ perspective. The findings suggest that investing in comprehensive training for facilitators, particularly in group dynamics management, could benefit similar programs. While the program’s fully subsidized structure reduces financial barriers to entry, innovative strategies to enhance participant engagement and perceived value should be explored. The success of the online delivery mode indicates that hybrid models offering both in-person and virtual options could increase accessibility in future supervised, community-based exercise programs for T2DM management.

Abstract Adults with cancer may perceive cannabis as beneficial for managing their cancer-related symptoms, but the evidence supporting its medical use is varied and inconclusive. This study characterized associations of cannabis use with cancer-related symptom trajectories. Participants were adults undergoing cancer treatment at the Stephenson Cancer Center (SCC; n = 218) in Oklahoma; they were 71% female, 10% minoritized race, and 45% had stage III or IV cancer. Participants completed surveys at baseline and 2-, 4-, and 6-months post-baseline. Assessments queried about cannabis use behavior, physical and psychological distress via the Rotterdam Symptoms Checklist (RSCL), respiratory symptoms via the American Thoracic Society Questionnaire (ATSQ), and quality of life indices (physical and social functioning, pain interference, sleep quality, fatigue) via the Patient Reported Outcomes Measurement Information System (PROMIS-29). Cannabis use status was categorized based on self-reported past 30-day cannabis use at each assessment as non-use [no use at any assessment], occasional-use [use at 1–2 assessments], or consistent-use [use at 3–4 assessments]. Longitudinal hierarchical linear modeling evaluated associations of cannabis use status with average symptoms and symptom trajectories across all four assessments. One-third (33%) of participants reported past 30-day cannabis use at ≥ 1 assessment. Participants who reported cannabis use (occasional-use and consistent-use) had more severe symptoms overall across assessments. While most cancer symptom trajectories did not differ by cannabis use status, participants who reported consistent cannabis use uniquely showed worsening physical function over time. Cannabis use was associated with greater cancer-related symptom severity over time.

Abstract Background The Covid-19 pandemic led to a rapid increase in the use of virtual consultations across healthcare. Post-pandemic, this use is expected to continue alongside the resumption of traditional face-to-face clinics. At present, research exploring when to use different consultation formats for palliative care patients is limited. Aim To understand the benefits and limitations of a blended approach to outpatient palliative care services, to provide recommendations for future care. Methods A mixed-methods study. Component 1: an online survey of UK palliative care physicians. Component 2: a qualitative interview study exploring patients’ and caregivers’ experiences of different consultation formats. Findings from both components were integrated, and recommendations for clinical practice identified. Results We received 48 survey responses and conducted 8 qualitative interviews. Survey respondents reported that face-to-face consultations were appropriate/necessary for physical examinations (n = 48) and first consultations (n = 39). Video consultations were considered appropriate for monitoring stable symptoms (n = 37), and at the patient’s request (n = 42). Patients and caregivers felt face-to-face consultations aided communication. A blended approach increased flexibility and reduced travel burden. Conclusions A blended outpatient palliative care service was viewed positively by physicians, patients and caregivers. We identified 13 clinical practice recommendations for the use of different consultation formats.

Abstract Genetic profiling of the biodiversity in cultivated crop plants is necessary to preserve important genes and utilize them in a breeding program. Cucumber is used as a model plant to study various characteristics of Cucurbitaceae. Its adaptation to a wide range of climatic conditions suggested analyzing the landraces. The present study was conducted to evaluate the differences, at the genetic level, among landraces spanning five continents. DNA extracted from fifty-six landraces selected from USDA germplasm bank to cover a global representative sample of world cucumber landraces was used for polymerase chain reaction using twenty-eight polymorphic expressed sequence tags simple sequence repeat (EST-SSR) markers. Twenty-eight EST-SSR markers covering all seven chromosomes yielded 98 bands with an average of 3.42 bands per marker. Polymorphic information content ranged from 0.00 (EC35) to 0.74 (EC17) with an average of 0.34. Six clusters provided an appropriate summary of the variation among the landraces, with the two largest groups including 32 (Asiatic) and 17 (European and American) landraces, respectively. Four small groups, three with two members, and one with one member (PI 525155-Egypt) were dissimilar to the two main groups. Landraces from the same region were often clustered together. Genetic similarity of the landraces was revealed by marker banding patterns. The locations of genetic diversity for cucumber landraces can be identified from this study.

Introduction: Early prediction of functional outcome after rtPA helps clinicians in prognostic conversations with stroke patients and their families. Three prognostic tools have been developed in this regard: DRAGON, MRI-DRAGON, and S-TPI scales. These tools, all performing with comparable accuracy, have been internally and externally validated in tertiary care centers. However, their performance in rural areas remains uncertain. This study addresses this gap in the literature by evaluating the effectiveness of those prognostic tools in stroke patients treated in a rural area of the Midwest. Methods: We conducted a retrospective study of stroke patients treated with thrombolytics at Southern Illinois Healthcare Stroke Network from July 2017 to June 2024. Data on demographics, clinical presentations, laboratory values, neuroimaging, and stroke metrics were collected. Modified Rankin Scale (mRS) at 1 month, classified into good (mRS ≤2) and poor (mRS ≥5) outcomes were noted. DRAGON and MRI-DRAGON scores were calculated. S-TPI model was built. Area under the receiver operating characteristic curve (AUC) with its 95% confidence interval was calculated for each prognostic model. Results: A total of 279 patients were included in this study. Of those, 43% (n = 119) were male. Median age (interquartile range [IQR]) was 69 (57–80) years. NIHSS at presentation (IQR) was 7 (4–13). 12% of the cohort (n = 34) had posterior circulation stroke. At 1 month, 66% of patients (n = 185) had mRS ≤2, whereas 14% of patients (n = 39) had mRS ≥5. MRI-DRAGON showed the highest accuracy in predicting both good (AUC = 0.86, 95% CI: 0.81–0.90) and poor outcomes (AUC = 0.84, 95% CI: 0.76–0.91). DRAGON also demonstrated high accuracy for good (AUC = 0.85, 95% CI: 0.80–0.89) and poor (AUC = 0.82, 95% CI: 0.75–0.90) outcomes. Conversely, in our population, the S-TPI model had the lowest accuracy for good (AUC = 0.56, 95% CI: 0.49–0.63) and poor (AUC = 0.68, 95% CI: 0.61–0.76) outcomes. Conclusion: Among the available grading scores, MRI-DRAGON score can be considered the more accurate short-term prognostic tool for stroke patients treated with rtPA in the rural setting.