Objective:The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods.Methods:We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases.Results:There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI, -11.7 to - 11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI, -13.8 to -12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI, -13.7 to -10.3, p=0.001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions.Conclusions:The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

Depressive disorders affect approximately 5% of the population in any given year. Antidepressants may require several weeks to produce their clinical effects. Despite progress being made in this area there is still room and a need to explore additional therapeutic modes to increase treatment effectiveness and responsiveness. Herein, we examined a new method for intervention in depressive states based on deep brain stimulation of the ventral tegmental area (VTA) as a source of incentive motivation and hedonia, in comparison to chemical antidepressants. The pattern of stimulation was fashioned to mimic the firing pattern of VTA neurons in the normal rat. Behavioral manifestations of depression were then monitored weekly using a battery of behavioral tests. The results suggest that treatment with programmed acute electrical stimulation of the VTA substantially alleviates depressive behavior, as compared to chemical antidepressants or electroconvulsive therapy, both in onset time and longitudinal effect. These results were also highly correlated with increases in brainderived neurotrophic factor mRNA levels in the prefrontal cortex.

No abstract

Background: Intravenous tPA has a limited efficacy in large vessel occlusion strokes (LVOS). Thus LVOS patients may be better served by direct transfer to endovascular capable centers. We aimed to develop a field scale to identify LVOS. Methods: The FAST-ED scale was designed based on items of the NIHSS with higher predictive value for LVOS: Facial Palsy (scored 0-1), Arm Weakness (0-2), Speech Changes (0-2), Eye Deviation (0-2), and Denial/Neglect (0-2). The scale was tested in the STOPStroke cohort, a prospective study of patients who underwent CT angiography (CTA) within the first 24 hours of stroke onset. LVOS were defined by total occlusions involving the ICA-T, MCA-M1, MCA-2, or basilar arteries. Patients with partial, bi-hemispheric, and/or anterior + posterior circulation occlusions were excluded. Receiver operating characteristic (ROC) curve, sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of FAST-ED were compared with the Rapid Arterial oCclusion Evaluation (RACE) scale and Cincinnati Prehospital Stroke Severity Scale (CPSSS). Results: LVO was detected in 240 out of the 727 qualifying patients (33%). FAST-ED had a strong correlation with NIHSS (r=0.92; P<0.001). FAST-ED had comparable accuracy to predict LVO to the more complex NIHSS and higher accuracy than RACE and CPSS (area under the ROC curve: 0.81, 0.80, 0.77 and 0.75 respectively). Better performance of FAST-ED could be shown at two distinct thresholds depending on the desired sensitivity/specificity trade-offs with scores ≥3 and ≥4 having sensitivity for LVO of 0.71 and 0.60, specificity 0.78 and 0.89, PPV 0.62 and 0.72, and NPV 0.84 and 0.82 versus RACE ≥5 of 0.55, 0.87, 0.68, 0.79 and CPSS ≥2 of 0.56, 0.85, 0.65, 0.78, respectively. Conclusions: FAST-ED is a simpler field scale that can be used by medical emergency professionals to accurately identify LVOS in the pre-hospital setting enabling rapid triage of patients to primary vs. endovascular capable stroke centers.

Background/Aims: This paper describes the design and collection of a comprehensive spoken language dataset from speakers with motor speech disorders in Atlanta, Ga., USA. This collaborative project aimed to gather a spoken database consisting of nonmainstream American English speakers residing in the Southeastern US in order to provide a more diverse perspective of motor speech disorders. Methods: Ninety-nine adults with an acquired neurogenic disorder resulting in a motor speech disorder were recruited. Stimuli include isolated vowels, single words, sentences with contrastive focus, sentences with emotional content and prosody, sentences with acoustic and perceptual sensitivity to motor speech disorders, as well as ‘The Caterpillar' and ‘The Grandfather' passages. Results: Utility of this data in understanding the potential interplay of dialect and dysarthria was demonstrated with a subset of the speech samples existing in the database. Conclusion: The Atlanta Motor Speech Disorders Corpus will enrich our understanding of motor speech disorders through the examination of speech from a diverse group of speakers.