Background and Purpose-Acute ischemic stroke patients are infrequently treated with recombinant tissue plasminogen activator (rtPA). We present unique population-based data regarding the eligibility of ischemic stroke patients for rtPA treatment. Methods-All ischemic strokes presenting to an emergency department (ED) within a biracial population of 1.3 million were identified. The patient was considered eligible for rtPA on the basis of exclusion criteria from the National Institute of Neurological Disorders and Stroke rtPA trial. Results-Of 2308 ischemic strokes, 1849 presented to an ED. Only 22% of all ischemic strokes in the population arrived in the ED in Ͻ3 hours from symptom onset; of these, 209 (51%) were ineligible for rtPA on the basis of mild stroke severity, medical and surgical history, or blood tests. We present unique population-based data regarding the eligibility of ischemic stroke patients for rtPA treatment within a major metropolitan population of 1.3 million with a proportion of blacks and socioeconomic demographics similar to those of the US population. 3 Conclusions-In Materials and MethodsThe unique methodology of the GCNK stroke study has been previously described. 3 This study was approved by the institutional review board at all participating hospitals. The methods involved collection of all strokes in the study population between July 1, 1993, and June 30, 1994. Study nurses reviewed the medical records of all inpatients with primary or secondary stroke-related International Classification of Diseases, ninth revision, discharge diagnoses (codes 430 through 438) from the 19 acute-care hospitals in the study region.In addition to ascertaining inpatient strokes using the methodology described above, we also ascertained strokes not found by inpatient monitoring by screening all visits to 18 of the hospital's emergency departments (EDs; Cincinnati Children's Hospital was excluded), 5 county coroner's offices, 16 public health clinics, and 14 hospital-based outpatient clinics and family practice centers. In addition, monitoring was performed using a random sample of 50 of 878 primary care physicians' offices and 25 of 193 nursing homes in the greater Cincinnati metropolitan area. Events found by out-of-hospital monitoring were checked against inpatient records to prevent double counting.Once potential cases were identified, the study nurse reviewed the medical record and abstracted detailed information regarding the event in question. Specifically, information was collected on possible inclusion and exclusion criteria used in rtPA treatment decisions. An estimated retrospective National Institutes of Health Stroke Scale Score (NIHSSS) was obtained from review of the physician examination as documented in the ED evaluation. This estimation of the NIHSSS was validated by a comparison with a total of 183 charts that had a true NIHSSS documented (as performed by an NIHSSS- this correlation also held true for milder strokes, with ϭ0.76 for NIHSSS Ͻ5 (data not shown). For this analysis, we include...

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Background and Purpose-Delay in seeking medical attention after stroke symptom onset is the most important reason for low rates of thrombolytic use for ischemic stroke (IS) in the United States. This may be related to poor recognition of stroke symptoms, or to lack of awareness of time-sensitive stroke treatments. We describe public knowledge of t-PA as a treatment for IS, as well as changes over time in knowledge of stroke warning signs (WS) and risk factors (RF). Methods-Survey respondents were drawn from our biracial population of 1.3 million using random-digit dialing in 1995, 2000, and 2005 to reflect the age, race, and gender distribution of stroke patients, based on an ongoing stroke incidence study in the same region. .6% of those surveyed were able to independently name t-PA or "clot buster" when asked: "Suppose you were having a stroke. Do you know of any medication your doctor could give you into the vein to increase your chance of recovering from a stroke?"-although 19% claimed to have heard of t-PA once it was mentioned to them. Conclusion-Despite numerous national stroke public awareness campaigns, public knowledge of stroke WS and RF has not improved over the last 5 years. In addition, knowledge of t-PA as a treatment for IS is extremely poor. Public awareness messages in the future should focus on the possibility of urgent treatments, in addition to stroke WS and RF, so the public can translate their knowledge into action and present to medical attention more quickly. This may be the highest yield approach to increasing rates of treatment of IS with t-PA.

Most patients undergoing otolaryngology procedures are at low risk of VTE, indicating that guidelines for a low-risk population could be adapted to otolaryngology. Patients undergoing high-risk otolaryngology procedures should be considered as candidates for more aggressive VTE prophylaxis.

Genetic risk factors for intracranial aneurysm (IA) are not yet fully understood. Genomewide association studies have been successful at identifying common variants; however, the role of rare variation in IA susceptibility has not been fully explored. In this study, we report the use of whole exome sequencing (WES) in seven densely-affected families (45 individuals) recruited as part of the Familial Intracranial Aneurysm study. WES variants were prioritized by functional prediction, frequency, predicted pathogenicity, and segregation within families. Using these criteria, 68 variants in 68 genes were prioritized across the seven families. Of the genes that were expressed in IA tissue, one gene (TMEM132B) was differentially expressed in aneurysmal samples (n=44) as compared to control samples (n=16) (false discovery rate adjusted p-value=0.023). We demonstrate that sequencing of densely affected families permits exploration of the role of rare variants in a relatively common disease such as IA, although there are important study design considerations for applying sequencing to complex disorders. In this study, we explore methods of WES variant prioritization, including the incorporation of unaffected individuals, multipoint linkage analysis, biological pathway information, and transcriptome profiling. Further studies are needed to validate and characterize the set of variants and genes identified in this study.

The imaging and analysis approach developed based on calibrated in vitro measurements was extended to in-vivo data. Bending and tension forces were successfully evaluated in this pilot study.

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