A5060902667- Acute Ischemic Stroke Management
- Stroke Rehabilitation and Recovery
- Cerebrovascular and Carotid Artery Diseases
- Cardiovascular Health and Risk Factors
- Traumatic Brain Injury and Neurovascular Disturbances
- Healthcare Systems and Public Health
- Venous Thromboembolism Diagnosis and Management
- Neurological Disorders and Treatments
- Long-Term Effects of COVID-19
- Intracerebral and Subarachnoid Hemorrhage Research
- Healthcare Systems and Practices
- Advanced MRI Techniques and Applications
- Peripheral Artery Disease Management
- Atrial Fibrillation Management and Outcomes
- Clinical practice guidelines implementation
- COVID-19 Clinical Research Studies
- Cardiovascular and Diving-Related Complications
- Dysphagia Assessment and Management
- COVID-19 and healthcare impacts
- Esophageal and GI Pathology
- Retinal and Optic Conditions
- Intracranial Aneurysms: Treatment and Complications
- Neurological Disease Mechanisms and Treatments
- Cardiovascular Disease and Adiposity
- Health Systems, Economic Evaluations, Quality of Life
Yale University
2019-2025
Yale Cancer Center
2025
Cincinnati Children's Hospital Medical Center
2020-2024
Brown University
2024
University of Cincinnati
2017-2024
University of Cincinnati Medical Center
2023-2024
United Nations Economic and Social Commission for Asia and the Pacific
2021-2024
University of Virginia
2024
University of Alabama at Birmingham
2017-2024
Lahey Medical Center
2024
Brain imaging is essential to the clinical management of patients with ischemic stroke. Timely and accessible neuroimaging, however, can be limited in stroke pathways. Here, portable magnetic resonance (pMRI) acquired at very low field strength (0.064 T) used obtain actionable bedside neuroimaging for 50 confirmed Low-field pMRI detected infarcts 45 (90%) across cortical, subcortical, cerebellar structures. Lesions as small 4 mm were captured. Infarcts appeared hyperintense regions on...
<h3>Objective</h3> To determine the sensitivity of T2*-weighted gradient-echo (T2*GRE) and inversion recovery turbo-field-echo (TFE) sequences for cortical multiple sclerosis lesions at 7 T. <h3>Design, Setting, Participants</h3> Autopsied brain tissue from individuals with was scanned 3-dimensional T2*GRE white matter–attenuated TFE Cortical visible either sequence were scored each anatomical lesion type. Imaged then processed immunohistochemical analysis, identified by labeling antibody...
Background and Purpose- Sex differences in stroke incidence over time were previously reported from the GCNKSS (Greater Cincinnati/Northern Kentucky Stroke Study). We aimed to determine whether these continued through 2015 they driven by particular age groups. Methods- Within population of 1.3 million, incident (first ever) strokes among residents ≥20 years ascertained at all local hospitals during 5 periods: July 1993 June 1994 calendar 1999, 2005, 2010, 2015. Out-of-hospital cases sampled....
Background and Purpose— Stroke mortality is 30% higher in the rural United States. This could be because of either incidence or case fatality from stroke areas. Methods— The urban–rural status 23 280 stroke-free participants recruited between 2003 2007 REGARDS study (Reasons for Geographic Racial Differences Stroke) was classified using Rural–Urban Commuting Area scheme as residing urban, large town/city, small town isolated risk incident assessed proportional hazards analysis, (death within...
Background: Anecdotal reports suggest fewer patients with stroke symptoms are presenting to hospitals during the coronavirus disease 2019 (COVID-19) pandemic. We quantify trends in code calls and treatments at 3 Connecticut local emergence of COVID-19 examine patient characteristics process measures a Comprehensive Stroke Center (CSC) before Methods: activity was analyzed from January 1 April 28, 2020, corresponding dates 2019. Piecewise linear regression spline models identified when codes...
Background and Purpose— Loss of cerebral autoregulation in the acute phase ischemic stroke leaves patients vulnerable to blood pressure (BP) changes. Effective BP management after endovascular thrombectomy may protect brain from hypoperfusion or hyperperfusion. In this observational study, we compared personalized, autoregulation-based targets static systolic thresholds. Methods— We prospectively enrolled 90 undergoing for stroke. Autoregulatory function was continuously measured by...
Intravenous thrombolysis is a standard treatment of acute ischemic stroke. The efficacy and safety combining intravenous with argatroban (an anticoagulant agent) or eptifibatide antiplatelet are unclear.
Background and Purpose— We aimed to compare functional procedural outcomes of patients with acute ischemic stroke none-to-minimal (modified Rankin Scale [mRS] score, 0–1) moderate (mRS 2–3) prestroke disability treated mechanical thrombectomy. Methods— Consecutive adult undergoing thrombectomy for an anterior circulation were prospectively identified at 2 comprehensive centers from 2012 2018. Procedural 90-day compared among mRS scores 0 1 3 using χ , logistic, linear regression tests....
Background and Purpose: Reports indicate an increased risk of ischemic stroke during coronavirus disease 2019 (COVID-19) infection. We aimed to identify patients with COVID-19 explore markers inflammation, hypercoagulability, endotheliopathy, a structural functional disturbance the vascular endothelium due stressor. Methods: This was retrospective, observational cohort study comparing acute without across 3 hospitals. Timing onset course endothelial activation were evaluated by status cause....
Undergraduate ultrasound education is becoming increasingly important to medical student development; as a result, innovative training methods are being designed and implemented. The Ultrasound Challenge was created help students learn core techniques apply them in friendly competition where they showcase their abilities. consisted of 6 events: focused assessment with sonography for trauma, cardiac ultrasound, aortic pelvic vascular access, musculoskeletal ultrasound. Thirty-three from all 4...
Get With The Guidelines-Stroke (GWTG-Stroke) is an American Heart Association/American Stroke Association stroke-care quality-improvement program; however, to our knowledge, there has not been a direct comparison of the quality care between patients hospitalized at participating hospitals and those nonparticipating hospitals.To contrast stroke measures for admitted in GWTG-Stroke.Subpopulation 546 participants with ischemic occurring during 9-year follow-up Reasons Geographic Racial...
The magnitude and drivers of excess cerebrovascular-specific mortality during the coronavirus disease 2019 (COVID-19) pandemic are unknown. We aim to quantify stroke-related deaths characterize its association with social distancing behavior COVID-19-related vascular pathology.United States state-level cerebrovascular from January May 2020 were quantified using National Center for Health Statistic data Poisson regression models. Excess analyzed as a function time-varying emergency medical...
There are significant racial disparities in stroke the United States, with Black individuals having a higher risk of incident even when adjusted for traditional factors. It is unknown whether also at recurrent stroke.Over an 18-month period spanning 2014-2015, we ascertained index cases within Greater Cincinnati/Northern Kentucky population 1.3 million. We then followed up all patients 3 years and determined recurrence. Multivariable survival analysis was performed to determine effect race...
Delivery of acute ischemic stroke (AIS) therapies is contingent on the duration from last known well (LKW) to emergency department arrival time (EDAT). One reason for treatment ineligibility delay in presentation hospital. We evaluate patient and neighborhood characteristics associated with LKW EDAT.
Abnormal restricted diffusion on magnetic resonance imaging is often associated with ischemic stroke or anoxic injury, but other conditions can present similarly. We six cases of an unusual consistent pattern in bilateral hippocampi and cerebellar cortices. This injury distinct from typical findings ischemic, anoxic, toxic suggesting it may represent under-recognized clinicoradiographic syndrome. Despite initial presentation stupor coma the context obstructive hydrocephalus, patients have...
Introduction: Acute treatment for stroke often requires emergent interhospital transfer access to advanced therapies not available at the initial hospital. Prolonged times have been associated with worse outcomes. Door-in-door-out time (DIDO: amount of a patient spends in transferring emergency department [ED]) is an important quality metric acute care, current recommendations DIDO ≤ 120 minutes. We sought characterize trends and predictors transfers using Greater Cincinnati Northern...
Background: Understanding the trends of stroke incidence and how those strokes are distributed across race is a critical step to implement trials programs decrease burden caused by nationally. In 2015, we reported that decreasing in both Black White adults. We investigated continued 2020. Methods: this population-based surveillance study, all cases within 5-county population surrounding Cincinnati adults aged ≥20 years were ascertained during full year every 5 from 1993 Cases abstracted...
Introduction: Recurrent stroke accounts for approximately 1/4 of all strokes and is associated with high morbidity mortality. Glucagon-like peptide-1 receptor agonists (GLP-1), while originally developed to treat diabetes, have demonstrated efficacy in preventing cardiovascular events overweight or obese (BMI>27) patients without diabetes. It unknown whether these agents could also be useful recurrence non-diabetic patients. To guide potential trial planning, we sought characterize the...
Background: Prior literature has reported patterns of racial differences in percutaneous endoscopic gastrostomy (PEG) placement for patients with post-stroke dysphagia. Reasons this disproportion are not well understood, but critical clinical decision making. Long-term implications PEG considerable, given complication rates and that reducing oral intake can significantly impact recovery swallow function. In population-based study, we evaluated the influence patient-related factors stroke...
Background: Ongoing surveillance of stroke incidence over time by demographic groups is critical to understand trends in disease burden and effective interventions. Our objective was examine changes sex age 27 years. Methods: In a population-based study covering 5-county region southern Ohio northern Kentucky, hospital cases were ascertained adjudicated trained physicians during six 1-year periods (07/1993–06/1994, 1999, 2005, 2010, 2015, 2020). Temporal evaluated sex, age, subtype (ischemic...
Introduction: Time from stroke symptom onset to emergency department (ED) arrival (OTA) is an important driver of acute functional outcomes and mortality for both ischemic (AIS) intracerebral hemorrhage (ICH). Acute therapies AIS are time-sensitive, there several recently published time-dependent therapeutic trials ICH, yet little known about the patterns ED presentation over time. We sought analyze trends predictors times ICH within Greater Cincinnati/Northern Kentucky Stroke Study....
Understanding the current status of and temporal trends stroke epidemiology by age, race, subtype is critical to evaluate past prevention efforts plan future interventions eliminate existing inequities. We investigated in incidence case fatality over a 22-year time period.
Background Dysphagia after stroke is common and can impact morbidity death. The purpose of this population‐based study was to determine specific epidemiological health risk factors that development dysphagia acute stroke. Methods Results Ischemic hemorrhagic cases from 2010 2015 were identified via chart review the GCNKSS (Greater Cincinnati Northern Kentucky Stroke Study), a representative sample ≈1.3 million adults southwestern Ohio northern Kentucky. status determined on basis clinical...
Poverty is associated with greater stroke incidence. The relationship between poverty and recurrence less clear.