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Background: The high incidence of dysphagia after acute stroke is likely the result of cumulative effects of the stroke and pre-stroke brain health. While cerebral small vessel disease (cSVD) is recognized as a marker of compromised brain health, it’s unclear which neuroanatomical pathologies of cSVD impact post-stroke dysphagia. We assessed the relation between cSVD pathologies, i.e., brain atrophy, white matter hyperintensities (WMH), perivascular spaces, as markers for brain integrity at the time of the stroke, and acute post-stroke dysphagia measured with the Modified Barium Swallow Study (MBSS). Methods: We conducted a retrospective, observational study of 40 individuals with an acute first-ever ischemic stroke. We segmented T1-weighted images into gray matter, white matter, and cerebrospinal fluid (CSF) to derive brain atrophy estimates. We scored the presence and severity of periventricular and deep WMH using the Fazekas scale and counted perivascular spaces in the basal ganglia following standard guidelines. Swallow impairments were determined with the Modified Barium Swallow Impairment Profile (MBSImP), Penetration-Aspiration Scale, and timing measures (oral (OTT), and pharyngeal transit times (PTT)). We performed regression to assess the relation between cSVD pathologies and swallowing while controlling for the stroke overlap with the right and left corticobulbar tracts, stroke volume, and the number of days between the MRI and MBSS. Results: Worse brain atrophy and more severe periventricular WMH were related to more severe MBSImP pharyngeal total scores, and worse deep WMH were related to aspiration events. More severe perivascular spaces in the basal ganglia were related to longer OTT and PTT, with a high explanatory value (27.5% and 25.1%, respectively), even when controlling for chronological age. Conclusions: Our results suggest that several aspects of pre-stroke brain health impact dysphagia severity after acute stroke independent of the stroke site and size. These findings contribute to our understanding of mechanisms underlying the variability of post-stroke dysphagia and emphasize the importance of brain structural integrity before the stroke. Future larger studies are warranted.

AbstractBackground:There is discontent and turnover among faculty at US academic health centers because of the challenges in balancing clinical, research, teaching, and work–life responsibilities in the current healthcare environment. One potential strategy to improve faculty satisfaction and limit turnover is through faculty mentoring programs.Methods:A Mentor Leadership Council was formed to design and implement an institution-wide faculty mentoring program across all colleges at an academic health center. The authors conducted an experimental study of the impact of the mentoring program using pre-intervention (2011) and 6-year (2017) post-intervention faculty surveys that measured the long-term effectiveness of the program.Results:The percent of faculty who responded to the surveys was 45.9% (656/1428) in 2011 and 40.2% (706/1756) in 2017. For faculty below the rank of full professor, percent of faculty with a mentor (45.3% vs. 67.1%, P < 0.001), familiarity with promotion criteria (81.7% vs. 90.0%, P = 0.001), and satisfaction with department’s support of career (75.6% vs. 84.7%, P = 0.002) improved. The percent of full professors serving as mentors also increased from 50.3% in 2011 to 68.0% in 2017 (P = 0.002). However, the percent of non-retiring faculty considering leaving the institution over the next 2 years increased from 18.8% in 2011 to 24.3% in 2017 (P = 0.02).Conclusions:Implementation of an institution-wide faculty mentoring program significantly improved metrics of career development and faculty satisfaction but was not associated with a reduction in the percent of faculty considering leaving the institution. This suggests the need for additional efforts to identify and limit factors driving faculty turnover.

OBJECTIVES/GOALS: The objective of this study is to perform a systematic review and meta-analysis on the prognostic utility of electroencephalography (EEG) in stroke recovery. METHODS/STUDY POPULATION: A literature search was conducted using three electronic databases, including PubMed, Scopus, and CINAHL. Key search terms were “EEG,” “stroke,” and “rehabilitation”. Only peer-reviewed journal articles published in English that examined the relationship between EEG and a standardized clinical outcome measure(s) at a later time in stroke patients were included. Two independent raters completed data extraction and assessed methodological quality of the studies with the Downs and Black form. A linear meta-regression was performed across subsets of individual studies that utilized a common clinical outcome measure to determine the association between EEG and clinical outcome while adjusting for sample size and study quality. RESULTS/ANTICIPATED RESULTS: 56 papers met the inclusion criteria and were included in the systematic review. The prognostic value of EEG was evidenced at both the acute and chronic stages of stroke. The addition of EEG enhanced prognostic accuracy more than initial clinical assessment scores and/or lesion volume alone. In the meta-analysis, a subset of 10 papers that utilized the National Institutes of Health Stroke Scale (NIHSS) and a subset of 7 papers that utilized the Modified Rankin Scale (MRS) were included. Analysis demonstrated an association between EEG and the subsequent clinical outcome measures. DISCUSSION/SIGNIFICANCE OF IMPACT: Currently, prognosis is largely based on initial behavioral impairment level. However, post-stroke recovery outcomes are heterogeneous despite similar initial clinical presentations. Uncertain prognosis makes it difficult for clinicians to develop personalized treatment plans for patients. Improved prognosis for recovery may guide clinical management for stroke survivors by helping clinicians determine the maximally efficient course of treatment and care. This study suggests that prognostic accuracy may be enhanced using EEG.