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Understanding the relationship of COVID-19 to stroke is important. We compare characteristics of pre-pandemic stroke (PPS), cases in acute COVID infection (CS) and in patients who have recovered from COVID-19 infection (RCS). We interrogated the Qatar stroke database for all stroke admissions between Jan 2020 and Feb 2021 (PPS) to CS and RCS to determine how COVID-19 affected ischemic stroke sub-types, clinical course, and outcomes prior to, during and post-pandemic peak. There were 3264 cases admitted (pre-pandemic: 3111, stroke in COVID-19: 60 and recovered COVID-19 stroke: 93). Patients with CS were significantly younger, had more severe symptoms, fever on presentation, more ICU admissions and poor stroke recovery at discharge when compared to PPS and RCS. Large vessel disease and cardioembolic disease was significantly higher in CS compared to PPS or RCS. There was a significant decline in stroke mimics in CS. Stroke in RCS has characteristics similar to PPS with no evidence of lasting effects of the virus on the short-term. However, CS is a more serious disease and tends to be more severe and have a poor prognosis.Other Information Published in: Journal of Thrombosis and Thrombolysis License: https://creativecommons.org/licenses/by/4.0See article on publisher's website: http://dx.doi.org/10.1007/s11239-021-02581-6

Satellite and aerial image data are becoming more widely available, and analysis techniques based on supervised learning are advancing their use in a wide variety of remote sensing contexts. However, supervised learning requires training datasets which are not always available or easy to construct. In this respect, unsupervised machine learning techniques present important advantages. This work presents a novel pipeline to demonstrate how available aerial imagery can be used to better the provision of services related to the built environment, using the case study of road traffic collisions (RTCs) across three cities in the UK. In this paper, we show how aerial imagery can be leveraged to extract latent features of the built environment from the purely visual representation of top-down images. Through the clustering of hazardous road segments with these latent image features, this work demonstrates how aerial images and machine learning can provide a data-driven aid for road safety experts to enhance their nuanced understanding of how and where different types of RTCs occur.

Background and purposeGuidelines recommend patients with high-risk TIAs and minor stroke presenting within 1-3 days from onset be offered dual antiplatelet therapy (DAPT). There is little data on real-world adherence to these recommendations. We evaluated the appropriateness of DAPT use in TIA and stroke patients in a prospective Database.MethodsThe Qatar Stroke Database began enrollment of patients with TIAs and acute stroke in 2014 and currently has ∼ 16,000 patients. For this study we evaluated the rates of guideline-adherent use of antiplatelet treatment at the time of discharge in patients with TIAs and stroke. TIAs were considered high-risk with ABCD2 score of ⍰ 4 and minor stroke was defined as NIHSS ⍰ 3. Patient demographics, clinical features, risk factors, previous medications, imaging and laboratory investigations, final diagnosis, discharge medications, and discharge and 90-day modified Rankin Scale (mRS) were analyzed.ResultsAfter excluding patients with ICH, mimics and rare secondary causes, 8082 patients available for final analysis (TIAs: 1357;stroke 6725). In high-risk TIAs, 282 of 666 (42.3%) patients were discharged on DAPT. In patients with minor stroke, 1207 of 3572 (33.8%) patients were discharged on DAPT. DAPT was inappropriately offered to 238 of 691 (34.4%) of low-risk TIAs and 809 of 3153 (25.7%) of non-minor stroke patients.ConclusionsThis large database of prospectively collected patients with TIAs and stroke shows that, unfortunately, despite several guidelines, a large majority of patients with TIAs and stroke are receiving inappropriate antiplatelet treatment at discharge from hospital. This requires urgent attention and further investigation.

Hypothesis: Hypertriglyceridemia (HT) may increase the risk of stroke. Limited studies have shown that stroke severity and infarction size are smaller with HT. We explored the relationship between triglyceride and stroke risk factors, severity and outcome in a large prospective database. Methods: We interrogated the Qatar Stroke Database in all patients admitted between 2014-2022 with acute ischemic stroke and evaluated the relationship between vascular risk factors, stroke severity (measured on NIHSS), stroke type (TOAST classification) and the short- (mRS at 90 days) and long-term outcomes (MACE at 1 year) in patients with and without HT. Results: 6558 patients with ischemic stroke [mean age 54.6 ± 12. 9; male 82.1%) with normal (1.7 mmol/l - 4.4 ±4.6; p Conclusion: Onset of stroke occurs earlier in HT. The lower severity of symptoms and better prognosis evident with HT may in part be related to higher rates of lacunar stroke. Long-term MACE are however more frequently seen in HT subjects.

Oversight mechanisms, whereby the functioning and behaviour of AI systems are controlled to ensure that they are tuned to public benefit, are a core aspect of human-centered AI. They are especially important in public sector AI applications, where decisions on core public services such as education, benefits, and child welfare have significant impacts. Much current thinking on oversight mechanisms revolves around the idea of human decision makers being present ‘in the loop’ of decision making, such that they can insert expert judgment at critical moments and thus rein in the functioning of the machine. While welcome, we believe that the theory of human in the loop oversight has yet to fully engage with the idea that decision making, especially in high-stakes contexts, is often currently made by hierarchical teams rather than one individual. This raises the question of how such hierarchical structures can effectively engage with an AI system that is either supporting or making decisions. In this position paper, we outline some of the key contemporary elements of hierarchical decision making in contemporary public services and show how they relate to current thinking about AI oversight, thus sketching out future research directions for the field. Accepted and presented as poster at NeurIPS HCAI Workshop 2022 https://hcai-at-neurips.github.io/site/program.html.

As artificial intelligence (AI) becomes increasingly embedded in government operations, retaining democratic control over these technologies is becoming ever more crucial for mitigating potential biases or lack of transparency. However, while much has been written about the need to involve citizens in AI deployment in public administration, little is known about how democratic control of these technologies works in practice.This chapter proposes to address this gap through participatory governance, a subset of governance theory that emphasises democratic engagement, in particular through deliberative practices. We begin by introducing the opportunities and challenges the AI use in government poses. Next, we outline the dimensions of participatory governance and introduce an exploratory framework which can be adopted in the AI implementation process. Finally, we explore how these considerations can be applied to AI governance in public bureaucracies. We conclude by outlining future directions in the study of AI systems governance in government.

Summary Background Salmonella spp are a major cause of food-borne outbreaks in Europe. We investigated a large multi-country outbreak of Salmonella enterica serotype Enteritidis in the EU and European Economic Area (EEA). Methods A confirmed case was defined as a laboratory-confirmed infection with the outbreak strains of S Enteritidis based on whole-genome sequencing (WGS), occurring between May 1, 2015, and Oct 31, 2018. A probable case was defined as laboratory-confirmed infection with S Enteritidis with the multiple-locus variable-number tandem repeat analysis outbreak profile. Multi-country epidemiological, trace-back, trace-forward, and environmental investigations were done. We did a case-control study including confirmed and probable cases and controls randomly sampled from the population registry (frequency matched by age, sex, and postal code). Odds ratios (ORs) for exposure rates between cases and controls were calculated with unmatched univariable and multivariable logistic regression. Findings 18 EU and EEA countries reported 838 confirmed and 371 probable cases. 509 (42%) cases were reported in 2016, after which the number of cases steadily increased. The case-control study results showed that cases more often ate in food establishments than did controls (OR 3·4 [95% CI 1·6–7·3]), but no specific food item was identified. Recipe-based food trace-back investigations among cases who ate in food establishments identified eggs from Poland as the vehicle of infection in October, 2016. Phylogenetic analysis identified two strains of S Enteritidis in human cases that were subsequently identified in salmonella-positive eggs and primary production premises in Poland, confirming the source of the outbreak. After control measures were implemented, the number of cases decreased, but increased again in March, 2017, and the increase continued into 2018. Interpretation This outbreak highlights the public health value of multi-country sharing of epidemiological, trace-back, and microbiological data. The re-emergence of cases suggests that outbreak strains have continued to enter the food chain, although changes in strain population dynamics and fewer cases indicate that control measures had some effect. Routine use of WGS in salmonella surveillance and outbreak response promises to identify and stop outbreaks in the future. Funding European Centre for Disease Prevention and Control; Directorate General for Health and Food Safety, European Commission; and National Public Health and Food Safety Institutes of the authors' countries (see Acknowledgments for full list).

Background and Purpose: Nocturnal non-dipping blood pressure and heart rate are associated with an increased risk of cardiovascular disease. The effects of such variance on cerebrovascular disease have not been well studied.Methods: The 24-h ambulatory blood pressure (ABPM) and heart rate were monitored with B-pro in patients with acute stroke within the initial week of hospital admission. The risk factor profiles, clinical presentation, imaging, and short-term prognosis were compared in nocturnal dippers and non-dippers (more than 10% nocturnal decrease) of blood pressure and heart rate.Results: We enrolled 234 patients in whom ABPM and MRI data were available. Heart rate data were available in 180 patients. Lacunar sub-cortical stroke was the most common acute lesion (58.9%), while hypertension (74%) and diabetes (41.5%) were the most common associated risk factors. ABPM revealed non-dipping in 69% of patients. On univariate analysis, Small Vessel Disease (SVD) was significantly more frequent in non-dippers vs. dippers (BP: 56.8 vs. 40.3% p = 0.02; heart rate: 57.9 vs. 40.7% p = 0.03). Silent strokes were also more frequent in non-dippers vs. dippers (BP: 40.7 vs. 26.4% p = 0.35; heart rate: 44.6 vs. 25.4% p = 0.01). Multivariate analysis revealed SVD to be significantly related to age, hypertension, blood pressure non-dipping, and severity of symptoms at index event.Conclusions: The presence of nocturnal non-dipping of blood pressure and heart rate are associated with an increased risk of silent stroke and SVD. Increased use of ABPM may allow for improved diagnosis of non-dippers.

Background: Sex differences may determine presentation, utility of treatment, rehabilitation, and occurrences of major adverse cardiovascular events (MACEs) in acute stroke (AS). Objective:The purpose of the study was to evaluate the short-term prognosis and long-term outcomes in MACEs in Qatari nationals admitted with AS. Methods: All AS patients admitted between January 2014 and February 2019 were included. We evaluated the preadmission modified Rankin scale (mRS) score, etiology and severity of symptoms, complications, and functional recovery at discharge and 90 days. MACEs were recorded for 5 years. Results: There were 891 admissions for AS (mean age 64.0 ± 14.2 years) (male, n = 519 [mean age ± SD 62.9 ± 14.1 years]; female, n = 372 [mean age ± SD 65.6 ± 14.2 years] p = 0.005). There were no differences in the preadmission mRS and severity of symptoms as measured on National Institute of Stroke Scale. At discharge, the outcome was better (mRS 0–2) in men (57.8 vs. 46.0%), p = 0.0001. This difference persisted at the 90-day follow-up (mRS 0–2, male 69.4% vs. female 53.2%, p = 0.0001). At the 90-day follow-up, more women died (total deaths 70; women 38 [10.2%] versus men 32 [6.2%], p = 0.03). MACEs occurred in 25.6% (133/519) males and 30.9% (115/372) females over the 5-year follow-up period (odds ratio 0.77, 95% confidence interval 0.57–1.0, p = 0.83). Conclusions: Female patients have a poor short-term outcome following an AS when corrected for age and comorbidities. While our study cannot explain the reasons for the discrepancies, higher poststroke depression and social isolation in women may be important contributory factors, and requires further studies are required to confirm these findings.

BackgroundDelays in transfer of patients from emergency department (ED) to stroke ward increases medical complications. We evaluate if a new risk-score ‘DHOW2’ (dysphagia, hemiplegia, observation-required, wet (incontinence) and weight) will identify high-risk patients and whether expedited admission of ‘high-DHOW2’ score patients to SW will result in fewer complications.MethodsThe DHOW2 score was designed to determine risk of complications following acute stroke. Phase I (279 patients) tested rates of complications with increasing DHOW2. Phase II (1091 patients), evaluated if early admission to the SW of high-DHOW2 patients will lead to fewer complications. Phase III (1257 patients) monitored implementation of the DHOW2 following completion of the study.FindingsMedical complications increased with higher-DHOW2 scores during all three phases; 0%–0.8% with DHOW2 of ≤3, 3.1%–6.5% with DHOW2 of 4–5 and 10.9%–14.1% with DHOW2 of ≥6 (p=InterpretationsThe DHOW2 score detects patients at risk of AS related medical complications. It is easy to implement in busy EDs where nurses can use the score to identify such patients. The risk stratification by DHOW2 and early transfer of high-scoring patients to SW is associated with significantly fewer complications.

Background Several reports document a decrease in the rates of stroke hospital admissions during the covid-19 pandemic. There is very little information whether the admission rates will change as the infection is controlled. We report on our rates of admissions before, during and following the peak of covid-19 infections in a prospective database from Qatar. Methods and results The stroke admissions in the six months prior to COVID-19 pandemic averaged 229/month. There was a decrease to 157/month in March-June during the peak of the pandemic. In the 6 months following the peak, as covid-19 numbers began to decrease, the average numbers increased back to 192/month. There was an increase in severe ischemic strokes and decreased in functional recovery. The decreased admissions were mainly driven by fewer stroke mimics. Patients presenting with ischemic stroke or cerebral hemorrhage remained unchanged. Conclusions Fewer stroke mimics presenting to the hospital can explain the fewer admissions and poor outcome at the height of the covid-19 pandemic. The continued decrease in the number of ischemic stroke and stroke mimic admissions following the pandemic peak requires more study.

Drawing on interdisciplinary, cross-national perspectives, this open access book contributes to the development of a coherent scientific discourse on social exclusion of older people. The book considers five domains of exclusion (services; economic; social relations; civic and socio-cultural; and community and spatial domains), with three chapters dedicated to analysing different dimensions of each exclusion domain. The book also examines the interrelationships between different forms of exclusion, and how outcomes and processes of different kinds of exclusion can be related to one another. In doing so, major cross-cutting themes, such as rights and identity, inclusive service infrastructures, and displacement of marginalised older adult groups, are considered. Finally, in a series of chapters written by international policy stakeholders and policy researchers, the book analyses key policies relevant to social exclusion and older people, including debates linked to sustainable development, EU policy and social rights, welfare and pensions systems, and planning and development. The book’s approach helps to illuminate the comprehensive multidimensionality of social exclusion, and provides insight into the relative nature of disadvantage in later life. With 77 contributors working across 28 nations, the book presents a forward-looking research agenda for social exclusion amongst older people, and will be an important resource for students, researchers and policy stakeholders working on ageing.

IntroductionThe COVID-19 pandemic has resulted in a dramatic unexplained decline in hospital admissions due to acute coronary syndromes and stroke. Several theories have emerged aiming to explain this decline, mostly revolving around the fear of contracting the disease and thus avoiding hospital visits.AimsIn this study, we aim to examine the impact of the COVID-19 pandemic on stroke admissions to a tertiary care centre in Qatar.MethodsThe Hamad General Hospital stroke database was interrogated for stroke admissions between September 2019 and May 2020. The number of stroke admissions, stroke subtypes and short-term outcomes was compared between the ‘pre-COVID-19’ period (September 2019 to February 2020) and the COVID-19 pandemic period (March to May 2020).ResultsWe observed a significant decline in monthly admissions in March (157), April (128) and May (135) compared with the pre-COVID-19 6-month average (229) (p=0.024). The reduction in admissions was most evident in functional stroke mimics. The average admissions decreased from 87 to 34 per month (p=0.0001). Although there were no significant differences in admissions due to ischaemic stroke (IS), intracranial haemorrhage or transient ischaemic attacks between the two periods, we noted a relative decrease in IS due to small vessel disease and an increase in those due to large vessel atherosclerosis in March to May 2020.ConclusionsThe decline in overall stroke admissions during the COVID-19 pandemic is most likely related to concerns of contracting the infection, evidenced mainly by a decline in admissions of stroke mimics. However, a relative increase in large vessel occlusions raises suspicion of pathophysiological effects of the virus, and requires further investigation.

Background: Stroke in diabetics may delay recovery and increases the risk of early recurrence of stroke. We compared the outcomes of patients (with and without diabetes) admitted with an acute ischemic stroke (AIS) in the state of Qatar. Patients and methods: We prospectively compared the clinical presentation, complications, discharge outcome, and stroke recurrence at 90 days in patients with and without diabetes. Results: Five thousand two hundred twenty-eight stroke patients were admitted between January 2014 and December 2017. Two thousand nine hundred sixty-one had confirmed AIS, 1695 (57.2%) had diabetes, 429 (14.5%) had prediabetes and 873 (29.5%) had no diabetes. Comparing diabetic patients to prediabetic and nondiabetics, they were significantly older (58.5 ± 11.9 versus 54.0 ± 12.9 versus 49.5 ± 13.8, P = .0001), had higher rates of hypertension (80.8% versus 67.4% versus 59.2%), previous stroke (18.0% versus 5.4% versus 6.2%), and coronary artery disease (12.9% versus 5.6% versus 5.0%; P = .001 for all). The percentage of patients with modified Rankin scale 3-6 at discharge (39.7% versus 32.6% versus 30.2%; P = .0001) and 90 days (26.7% versus 18.8% versus 21.4%, P = .001); 90-day mortality (6.2% versus 2.2% versus 5.2%; P = .03) and stroke recurrence (4.2% versus .7% versus 2.2%; P = .005) was significantly higher in diabetic patients. Conclusions: Patients with diabetes and AIS have more in-hospital complications, worse discharge outcomes, higher mortality and stroke recurrence at 90 days, compared to prediabetes and no diabetes.

Background Atrial fibrillation is an important risk factor for stroke but there are limited data on atrial fibrillation-related stroke from the Middle East. Methods We interrogated the Qatar Stroke Database to establish the occurrence, clinical features, and outcomes of atrial fibrillation-related stroke at Hamad General Hospital, the sole provider of acute stroke care in Qatar. Results A total of 4079 patients (81.4% male, mean age 55.4 ± 13.3 years) were enrolled in the stroke database between January 2014 and 21 October 2017. Atrial fibrillation was present in 260 (6.4%) patients, of whom 106 (2.6%) had newly diagnosed atrial fibrillation. The National Institute of Health Stroke Scale (NIHSS) was significantly higher (7.9 + 7.0 (median 6; IQR 11) vs. 5.9 + 6.4 (median 4; IQR 6), P Conclusion We demonstrate a low rate of atrial fibrillation and stroke in Qatar, perhaps reflecting the relatively young age of these patients. Atrial fibrillation-related strokes had higher admission NIHSS, greater disability, and higher mortality at 90 days when compared to non-atrial fibrillation strokes.

Aim and objective: Atrial fibrillation (AF), a major cause of thromboembolic stroke, is under-detected. Our aim was to compare the established pathway of AF detection, reporting to point-of-treatment decision, with a pilot pathway coordinated by the clinical nurse specialists (CNS) for stroke in Qatar. Methods: The established system uses traditional holter monitors, attached by a technician. The report is sent to cardio-electrophysiology physicians, and then uploaded onto electronic records. The piloted stroke system used a cardiac monitoring device capable of prolonged recording. The device is calibrated, downloaded, reviewed and uploaded onto electronic records by the CNS. Results: 319 holters were requested during the 6-month pilot period, 217 via the stroke cardiac monitor service (SCMS) and 102 via the hospital holter monitor service (HHMS). Sixty-two percent of the SCMS reports were attached within 24 hours of admission compared to 31% of the HHMS reports. The reports were available within 48 hours in 2% of patients in the HHMS as compared to 76% with SCMS. The time from detachment to the consultant's decision was 2.6 days in SCMS versus 18.4 days in the HHMS. Conclusion: Utilising the skills of the CNS team for the application, interpretation and reporting provided a more efficient service with improved initiation of anticoagulation treatment for patients.

Mimics comprise a third of patients presenting with an acute stroke. There is limited information on their natural history.We evaluate long term major cardiovascular events (MACE) in stroke mimics in a prospective database from Qatar.Between Feb 2014 and Jan 2019, 481 patients (male: 238; female: 243) mean age 57.5 years (±18.0), with 399 (83%) medical mimics and 82 (17%) functional mimics were evaluated. Imaging revealed previous old stroke in 26.6% and small vessel disease in 5%. MACE occurred in 57 (11.9%) and there were 31 deaths (6.4%) with majority of deaths (5.6%) from cardiovascular causes. MACE was significantly higher in patients with previous stroke, p 0.0001), coronary artery disease, p = 0.002), diabetic, p = 0.01), and hypertensive on admission, p 0.0001. MACE were also significantly higher in patients where imaging showed a previous stroke, p = 0.006).The occurrence of MACE during follow-up suggests that patients with existing vascular disease require aggressive management of vascular risk factors.

Limestone sourced from Salisbury Cathedral and Bath Abbey (UK) was treated with commercially available nanolime of concentration 25 g/l. The response of the stones to the treatment was studied using a variety of analysis techniques including optical microscopy, electron microscopy, drilling resistance measurement and mercury intrusion porosimetry. Weathered and non-weathered surfaces of both types of stones were compared. All the specimens were characterised before and after the treatment to determine any changes in their properties caused by their weathering and by the treatment itself. Results show that the degradation processes of the stones strongly affect their interaction with nanolime consolidation treatments. Drilling resistance measurements of treated and untreated samples were compared. After 20 days significant increases in sub-surface drilling resistance was observed in the non-weathered Bath stone and a small increase in the weathered Bath stone after 6 months was also noted. Both weathered and non-weathered Chilmark stone showed an increase in drilling resistance after 6 months, however at 20 days this was most evident in the samples treated with nanolime in isopropanol as opposed to ethanol.

Introduction Perinatal depression is well recognised as a mental health condition but