According to the , more than 750,000 people in the U.S. will have a stroke each year. In Kentucky, strokes are the fifth leading cause of death, underscoring their significant impact both locally and nationally.

Recognizing the urgent need for improved therapies, and the University of Louisville are actively participating in a pivotal clinical trial known as the . This study focuses on patients who come to the emergency department 4.5 to 24 hours after the onset of an ischemic stroke and who are not candidates for standard treatment methods, such as previously approved clot-dissolving medications or mechanical interventions.

Upon arrival, patients undergo a comprehensive evaluation and advanced imaging to determine eligibility. If they meet all criteria, they may be enrolled in the study and randomly assigned to receive one of five doses of the investigational drug TS23, a type of clot-dissolving drug, or a placebo. The treatment is delivered through a single 20-minute infusion, followed by close monitoring and imaging at 30 hours post-treatment, with additional follow-up evaluations at 30 and 90 days to assess outcomes and recovery.

a neurosurgeon with , a part of , and associate professor in the Department of Neurological Surgery at the , leads the study at the Louisville site.

“By bringing this trial here, we are creating an opportunity for patients in town to get access to cutting-edge therapies that they otherwise could not access and at time windows during a stroke that typically prohibit them from getting a treatment drug. That is exciting,” Abecassis said.

Through innovative research initiatives like the SISTER trial, and UofL School of Medicine are working to enhance recovery, reduce long-term neurological damage and expand access to advanced stroke care. These efforts create opportunities for more personalized treatment, offering hope to patients and their families facing the life-altering effects of stroke.

Recognizing the signs and symptoms of a stroke is crucial. The acronym BE FAST can help you remember the most common warning signs:

• Balance lost – sudden loss of balance or coordination
• Eyes blur – sudden trouble seeing or blurred vision in one or both eyes
• Face drooping – one side of the face droops or is numb
• Arm weakness – sudden weakness or numbness of an arm or leg, especially on one side of the body
• Speech difficulty – sudden confusion, trouble speaking, or difficulty understanding speech
• Time – note the time the symptoms started and call 911 immediately

If you or someone around you experiences any of these symptoms, seek emergency medical care right away. Quick action can make a significant difference in treatment and recovery.

By Allison Dulin, UofL Health

The three-year grant will allow the coordination��and expansion of��existing��efforts to improve stroke-related health outcomes. Kentucky health care��systems��and community providers will work together to��implement��comprehensive stroke systems for��those��at��high��risk for stroke and��those who have had a��stroke.��

“This program will allow expansion of our statewide efforts to serve rural and underserved citizens of the Commonwealth, to reduce disparities and monitor our progress,” said Kerri S. Remmel, chair of the��, director of and co-chair of the KHDSP Task Force. “T��� program will facilitate continuous quality improvement in the full continuum of care from the moment a patient has a stroke through their emergency services, hospitalization and rehabilitation to their outpatient preventive care. We are extremely enthusiastic about collaborating with our partners in the Coverdell Program to improve stroke systems of care in Kentucky.”

“This award validates the voluntary efforts of stroke center personnel, EMS representatives, community partners, KHDSP staff and colleagues in public health, as well as all other stakeholders who have worked tirelessly across geopolitical boundaries in a collaborative effort to advance stroke systems of care in our state,” said Kari Moore, chair of the ��(SEQIP) and project co-investigator. “We are excited to continue to build upon these efforts supported by the Coverdell award.”

KHDSP and SEQIP have made significant strides over the last 10 years improving stroke systems of care in the Commonwealth and growing access to stroke care by increasing the number of certified stroke centers in the state, increasing delivery of acute stroke treatments that can reverse or minimize stroke deficits and sharing best practices to help facilitate care delivery during hospitalization and after discharge.

This grant will coordinate and expand existing efforts in Kentucky to improve stroke-related health outcomes by working with Kentucky health care systems and community providers to implement comprehensive stroke systems for those at high risk for stroke and those who have had a stroke.��

The Coverdell award also will allow the group to target areas of the Commonwealth that are disproportionately affected by stroke, such as the Appalachian counties. The mortality rate due to stroke in that region is 14% higher than the national average and 8% higher than the rest of the state.

“This award could not come at a better time, because Kentucky has among the highest rates of stroke-related deaths in the country,” said��, chairman of the����and principal investigator on the project. “Over 2,000 Kentuckians die from stroke or stroke-related complications each year. Health behaviors and conditions that contribute to stroke are present at high rates in Kentucky with contributions from smoking, obesity, diabetes, hypertension, excessive alcohol use and physical inactivity. Although there are several existing stroke programs in Kentucky, we are excited that this project will coordinate and expand upon these efforts to improve stroke outcomes for Kentuckians.”

As part of the Coverdell initiative, the Kentucky Stroke Improvement Cooperative (KSIC) will be created to provide��leadership��for��improving��the quality of stroke care��in the Commonwealth.��Building from the KHDSP Taskforce and��SEQIP, the UK and UofL Stroke Programs and the SCN, this group will lead the collaborative effort to transform Kentucky’s stroke care and outcomes by improving health approaches and practices.

Since its inception in 2005, The Coverdell Program has funded programs to ensure that all Americans receive the highest quality stroke care, a leading cause of death and long-term disability, by supporting coordinated stroke systems of care.

Joining nine other states currently funded by the Paul Coverdell National Acute Stroke Program, Kentucky’s program will:

• Increase access and participation in the statewide Kentucky Heart Disease and Stroke Prevention Task Force from the current 38 hospitals to help close the gap in stroke care for high burden populations. In addition to focusing on hospitals, the project will expand participation to encompass the community, primary care clinics, EMS, rehabilitation centers and long-term care facilities.
• Expand coordination between existing programs including the Kentucky SEQIP, the statewide UK/Norton Healthcare Stroke Care Network, and the 36 certified stroke centers in Kentucky.
• Increase access, understanding, utilization, and compliance with evidence-based performance measures of the��.
• Expand existing systems of care to coordinate and extend access to rural and underserved populations.
• Increase the dissemination of evidence-based guidelines for improvement of hypertension, obesity and diabetes control, which are the leading risk factors for stroke disproportionately affecting high-burden populations.
• Reduce stroke disparities and deaths over the long term and improve outcomes throughout Kentucky with a focus on Appalachia and underserved communities at highest risk.

earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients.��Before discharge, patients should also receive education on managing their health, get a follow-up visit scheduled, as well as other care transition interventions.

“T��� is dedicated to improving the quality of care for our stroke patients by implementing the American Heart Association’s Get With The Guidelines-Stroke initiative,” said Kerri Remmel, MD, PhD, medical director of the UofL Hospital – Comprehensive Stroke Center. “T��� tools and resources provided help us track and measure our success in meeting evidenced-based clinical guidelines developed to improve patient outcomes.”

UofL Hospital additionally received the association’s Target: Stroke��Elite Plus award. To qualify for this recognition, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or, the only drug approved by the U.S. Food and Drug Administration to treat .

“We are pleased to recognize UofL Hospital for their commitment to stroke care,” said Lee H. Schwamm, MD, national chairperson of the Quality Oversight Committee and Executive Vice Chair of Neurology, Director of Acute Stroke Services, Massachusetts General Hospital, Boston. “Research has shown that hospitals adhering to clinical measures through the Get With The Guidelines quality improvement initiative can often see fewer readmissions and lower mortality rates.”

According to the American Heart Association/American Stroke Association, stroke is the No. 5 cause of death and a leading cause of adult disability in the United States. On average, someone in the U.S. suffers a stroke every 40 seconds and nearly 795,000 people suffer a new or recurrent stroke each year.

In this study, the first of its kind, researchers from the University of Louisville investigated the impact of neighborhood greenspaces on individual-level markers of stress and cardiovascular disease risk.

Over five years, blood and urine samples were collected from 408 people of varying ages, ethnicities and socioeconomic levels, then assessed for biomarkers of blood vessel injury and the risk of having cardiovascular disease. The participants were recruited from the and were largely at elevated risk for developing cardiovascular diseases.

The density of the greenspaces near the participants’ residences were measured using the Normalized Difference Vegetation Index (NDVI), a tool that indicates levels of vegetation density created from satellite imagery collected by NASA and USGS. Air pollution levels also were assessed using particulate matter from the EPA and roadway exposure measurements.

Researchers found living in areas with more green vegetation was associated with:

• Lower urinary levels of epinephrine, indicating lower levels of stress;
• Lower urinary levels of F2-isoprostane, indicating better health (less oxidative stress);
• Higher capacity to repair blood vessels.

They also found that associations with epinephrine were stronger among women, study participants not taking beta-blockers – which reduce the heart’s workload and lower blood pressure – and people who had not previously had a heart attack.

“Our study shows that living in a neighborhood dense with trees, bushes and other green vegetation may be good for the health of your heart and blood vessels,” said Aruni Bhatnagar, PhD, lead study author and professor of medicine and director of the UofL and the . “Indeed, increasing the amount of vegetation in a neighborhood may be an unrecognized environmental influence on cardiovascular health and a potentially significant public health intervention.”

The findings were independent of age, sex, ethnicity, smoking status, neighborhood deprivation, use of statin medications and roadway exposure.

Previous studies also have suggested that neighborhood greenspaces are associated with positive effects on overall physical and psychosocial health and well-being, as well as reduced rates of death from cardiovascular and respiratory diseases and improved rates of stroke survival, according to Bhatnagar. However, these reports are largely limited by their reliance on self-reported questionnaires and area-level records and evaluations, Bhatnagar said.

Co-authors of this study are Ray Yeager, Ph.D.; Daniel W. Riggs, M.S.; Natasha DeJarnett, Ph.D.; David J. Tollerud, Ph.D.; Jeffrey Wilson, Ph.D.; Daniel J. Conklin, Ph.D.; Timothy E. O’Toole, Ph.D.; James McCracken, Ph.D.; Pawel Lorkiewicz, Ph.D.; Xie Zhengzhi, Ph.D.; Nagma Zafar, M.D., Ph.D.; Sathya S. Krishnasamy, M.D.; Sanjay Srivastava, Ph.D.; Jordan Finch, M.S.; Rachel J. Keith, Ph.D.; Andrew DeFilippis, M.D.; ��Shesh N. Rai, Ph.D. and Gilbert Liu, M.D. Author disclosures are on the manuscript.

The WellPoint Foundation and the National Institute of Environmental Health Sciences of the National Institutes of Health supported the study. View the manuscript .

Some services require that participants meet certain criteria; staff in the booth can provide information.

Daily services

University of Louisville health care providers will be on-site in the Health Horizons Pavilion at the Kentucky State Fair, and three programs will be offering services each day:

• Mammogram screenings: Providers affiliated with the UofL James Graham Brown Cancer Center and Kentucky Cancer Program will provide mammograms. All screenings will take place in the privacy of the Horses and Hope Cancer Screening Van. Mammogram screenings will be billed to insurance, so participants should have their health insurance verification and photo identification handy. Yearly mammograms are covered by Medicare and most private insurance providers for women over 40. Special discounted rates are available to those without insurance.
• Vascular screenings, including carotid artery screen and ankle brachial index, will be provided daily at the fair, Aug. 17-27. A carotid artery screen is ideal for anyone with dizziness, ringing in the ears or anyone with a family history of carotid artery disease. It also is indicated for smokers and people with high blood pressure, high cholesterol or diabetes or for anyone who is over the age of 50. The test is administered by a registered technologist and uses ultrasound technology.��
• ����ֱ��, prevention and survivorship information from the Kentucky Cancer Program: The Kentucky Cancer Program is a statewide cancer prevention and control program, bringing together local organizations, providers and other partners in planning, implementing and evaluating cancer prevention and control efforts. The KCP staff and volunteers will be on-site providing information and giveaways to fair-goers with the goal of reducing cancer incidence and cancer death in Kentucky.

Women’s health

Staff from UofL Hospital’s��Center for Women & Infants��and��UofL Physicians-Ob/Gyn & Women’s Health��will be on hand at the fair to help women of all ages. The Center for Women & Infants specializes in both high-risk obstetrics and general maternity services and gives expectant families their choice of care from board-certified obstetricians and certified nurse midwives who practice with UofL Physicians-Ob/Gyn & Women’s Health.

At the fair, staff will be on hand to discuss urogynecology with providers from the Female Pelvic Medicine & Reconstructive Surgery practices, fertility specialists in reproductive endocrinology and infertility, the certified nurse midwifery program, family planning services, and our newest offering – Centering Prenatal Care.��

Emergency care, training

The UofL Hospital Level I Trauma Center and the Burn Unit will also both provide a variety of services at the fair.

The��Trauma Center��is the region’s only Level I trauma unit. Staff will train fair-goers to “Stop the Bleed” on Aug. 18. This innovative program uses a lifelike replica of the human thigh – complete with faux blood – to train participants in handling bleeds from wounds at the scene where they occur. On Aug. 22, the Trauma Center will participate in Senior Day at the Fair, and feature a walk-through demonstration to help older adults identify potential hazards, help prevent falls and improve balance. The Trauma Center staff will return on Aug. 26, with more trauma prevention activities.

The UofL��Burn Unit��is the region’s only dedicated adult burn unit and will provide safety information and activities for the entire family. Burn Unit personnel will be at the fair on Aug. 23.

Senior Day

Senior Day at the Fair will feature two programs that will only be available to fair-goers on that date, Tuesday, Aug. 22:

• UofL Hospital Pharmacists��will share information of interest to older adults, including diabetes, vaccinations, pharmacy services at UofL facilities and more. They also will be available to answer questions one-on-one with fair-goers about their medications and treatments.
• UofL Hospital Volunteers��will be at the fair to provide information on how fair-goers can serve others as a hospital volunteer. A wide array of service opportunities are available each year, from greeting guests to clerical service and more.

Also on Senior Day, the UofL booth will provide mammogram screenings, vascular screenings, colon cancer screenings, blood pressure checks, stroke assessments, women’s health information and a walk-through demonstration for older adults to help them avoid falls.

Specialty screenings

Several specialty services will be provided by UofL staff at the fair:

• UofL Physicians-Pediatrics��will be at the fair Aug. 19, offering vision and blood pressure screenings and a child safety demonstration.��
• UofL Physicians-Diabetes & Obesity Center��will be at the fair Aug. 23, providing screenings for prediabetes and diabetes. The screening requires a finger stick and the participant does not have to be fasting.
• UofL Hospital Infection Control��will be at the fair Aug. 24, with information on the importance of hand hygiene in preventing the spread of disease. The staff also will show fair-goers the benefits of getting annual flu vaccinations and provide information on when antibiotics should be used and when they should not.
• Carbon monoxide screening��will be available during the final four days of the fair, Aug. 24 through Aug 27. The carbon monoxide breath test shows the amount of carbon monoxide in the lungs and blood in an indirect, non-invasive manner. Breath carbon monoxide also is an indicator of the levels of approximately 7,000 toxic substances present in cigarette smoke, 69 of which are known to cause cancer. Participants will blow into a small handheld device for several seconds.

Cancer screenings and more��

Staff with UofL’s James Graham Brown Cancer Center, the Kentucky Cancer Program and the UofL School of Dentistry will be on hand to provide information, screenings and more. In addition to the aforementioned mammogram and vascular screenings:

• Head and neck cancer screenings: Provided Aug. 19 and 20, Aug. 22, Aug. 26 and Aug. 27, the UofL School of Dentistry and the Kentucky Cancer Program will observe the 25^th��anniversary of their collaboration in providing head and neck assessments at the fair. Dental students and faculty have conducted more than 3,800 screenings since the collaboration began. This oral head and neck exam is painless and quick, and open to everyone. Participants wearing dentures will be asked to remove them during the 10-minute exam.
• Prostate cancer screenings: Provided Aug. 19 and Aug. 20. Prostate screenings are recommended for men with average risk starting at age 50. African-American men and anyone with a brother, father or son who had prostate cancer before age 65 should begin getting screened for prostate cancer at age 45. Testing will involve a prostate specific antigen (PSA) blood test that involves taking a small amount of blood. A digital rectal exam also will be performed in the privacy of the Horses and Hope Cancer Screening Van to feel for any lumps, bumps or other abnormalities. The results of the PSA will be mailed about two weeks after the fair ends. The entire testing process takes approximately 20 minutes.
• Colon cancer screenings: Provided Aug. 21 through Aug. 27. Colon cancer screenings with FIT kits are available to anyone over 50 who has not had a colonoscopy within the past 10 years or a stool test in the past year. A free take-home kit will be available for men and women 50 and older and to younger participants who are cancer survivors or have a history of cancer in close relatives. The participant will complete stool collection at home and then mail it to UofL Hospital in special packaging provided.
• Cancer resources and Reiki demonstration from the M. Krista Loyd Resource Center��at the Brown Cancer Center: Provided Aug. 24. The Krista Loyd Center provides a peaceful environment for patients with cancer to learn, relax and heal emotionally. One service provided is the Japanese technique of Reiki for stress reduction and healing promotion. Personnel from the Loyd Center will demonstrate the technique.
• Stroke risk assessments and blood pressure screening:��Provided Aug. 22 and Aug. 26. The UofL Hospital Comprehensive Stroke Center was the first certified stroke center in Kentucky. Staff will provide free stroke risk assessment and blood pressure checks to fair-goers.

The award recognizes the hospital’s commitment to providing the most appropriate stroke treatment according to nationally-recognized, research-based guidelines based on the latest scientific evidence.

Hospitals must achieve 85 percent or higher adherence to all Get With The Guidelines-Stroke achievement indicators for two or more consecutive 12-month periods and achieve 75 percent or higher compliance with five of eight Get With The Guidelines-Stroke Quality measures to receive the Gold Plus Quality Achievement Award.

To qualify for the Target: Stroke Honor Roll Elite or Elite Plus, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the Food and Drug Administration to treat ischemic stroke. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability.

These quality measures are designed to help hospital teams follow the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients.

“University of Louisville Hospital has been recognized with the Stroke Elite Plus award again as we continue to strive for excellence in the acute treatment of stroke patients,” said Kerri Remmel, MD, PhD, chair of UofL’s Department of Neurology and director of the UofL Hospital Stroke Center. “This recognition further reinforces the UofL stroke team’s hard work and commitment to caring for patients with stroke.”

UofL Hospital now has received the Get with the Guidelines��Stroke Gold Plus Award for the past 12 years. In 2004, UofL Hospital became Kentucky’s first Joint Commission-certified Primary Stroke Center and in 2012, the hospital became Kentucky’s first Joint Commission-certified Comprehensive Stroke Center, the 20th in the nation.

“Stroke is 80-percent preventable. High blood pressure, diabetes, cigarette smoking, high cholesterol, atrial fibrillation and sedentary lifestyle are treatable and modifiable risk factors. If we could give the community one message for the prevention of stroke, it would be to know your own risk factors and be aggressive about controlling them,” Remmel said.

At the 2^nd Annual Knock Out Stroke event, medical experts from the University of Louisville Stroke Program, the state’s first Certified Comprehensive Stroke Center, will share tips on how to manage high blood pressure and other risk factors related to heart disease and stroke. Guests will learn how to monitor their blood pressure, the importance of physical activity and how to incorporate it into their daily routine, recognizing the symptoms of stroke and understanding the latest treatment options. Plus, WAVE 3’s Dawne Gee will share her personal experience in suffering a stroke.

Knock out Stroke is May 12, 2017 from 10:30 a.m. to 2 p.m. at the Muhammed Ali Center, 144 N. Sixth St. The event is free and open to the public and includes lunch, door prizes and the opportunity to tour the Muhammad Ali Center museum at your leisure. Attendees are asked to . ��

Family Health Centers and the UofL Department of Neurology host the program in conjunction with Stroke Awareness Month. Additional partners include the Kentucky Department of Public Health Heart Disease and Stroke Prevention Program, Louisville Department of Health and Wellness, UofL School of Medicine, and UofL Signature Partnership Health & Quality of Life division.

The UofL Stroke Program is a collaboration of University of Louisville Hospital, a part of KentuckyOne Health, UofL Physicians and the UofL School of Medicine.

“T���se findings suggest that living in a polluted environment could promote the development of high blood pressure, heart disease and stroke more pervasively and at an earlier stage than previously thought,” said Aruni Bhatnagar, PhD, study co-author and the at the University of Louisville. “Although we have known for some time that air pollution can trigger heart attacks or strokes in susceptible, high-risk individuals, the finding that it could also affect even seemingly healthy individuals suggests that increased levels of air pollution are of concern to all of us, not just the sick or the elderly.”

“T���se results substantially expand our understanding about how air pollution contributes to cardiovascular disease by showing that exposure is associated with a cascade of adverse effects,” said C. Arden Pope, PhD, study lead author and Mary Lou Fulton Professor of Economics at Brigham Young University in Provo, Utah.

is known to contribute to cardiovascular disease and related deaths. In 2004, the American Heart Association released a , updated in 2010, warning of the risk and recommending that people talk to their doctor about avoiding exposure to air pollution specific to their area. What remained unclear, however, was how air pollution actually affects the blood vessels to increase the risk of disease.

For this study, investigators analyzed the component of air pollution known as fine particulate matter — the tiny pieces of solid or liquid pollution emitted from motor vehicles, factories, power plants, fires and smoking. They found that periodic exposure to fine particulate matter was associated with several abnormal changes in the blood that are markers for cardiovascular disease. As air pollution rose, they found:

• Small, micro-particles indicating cell injury and death significantly increased in number;
• Levels of proteins that inhibit blood vessel growth increased; and
• Proteins that signify blood-vessel inflammation also showed significant increases.

Study participants included 72 healthy, nonsmoking adults in Provo, Utah. Their average age was 23, most were white and more than half were male. During the winters of 2013, 2014 and 2015, participants provided blood samples, which researchers then tested for markers of cardiovascular disease. Due to the unique weather and geographical features of Provo, they were able to evaluate these informative blood markers with various levels of air pollution.

However, researchers noted that the third study year, 2015, was relatively unpolluted, which could have affected the results.

The other co-authors from the study were also from UofL and include:��James P. McCracken, PhD; Wesley Abplanalp, PhD; Daniel J. Conklin, PhD; and Timothy O’Toole, PhD. The National Institutes of Health funded the study.