Shear bands lie at the root of fracture initiation in bulk metallic glasses and amorphous polymers. For silicate glasses, in contrast, studies have largely emphasized permanent volumetric strain, commonly referred to as densification. Here, we systematically investigate indentation-induced fracture in two distinct families of aluminoborosilicate glasses. The results demonstrate that plastic shear flow plays a decisive role in governing fracture initiation. In addition, molecular dynamics simulations reveal a pronounced composition dependence of softening associated with plastic shear flow, closely mirroring the experimentally observed propensity for strain localization. We conclude that silicate glasses conform to a universal pattern of rupture initiation governed by the localization of shear-deformation, aligning with a broad range of amorphous materials, including bulk metallic glasses and glassy polymers.
Background: Functional outcome measurement using the modified Rankin Scale (mRS) is widely used in post-stroke quality assessments in clinical trials. Abbreviated versions such as the Simplified mRS Questionnaire (smRSq) may improve time efficiency and scalability. This study evaluates agreement between smRSq and traditional mRS. Methods: We retrospectively reviewed follow-up mRS calls placed 75–105 days post-discharge among ischemic stroke patients treated with IV thrombolysis and/or thrombectomy at a comprehensive stroke center (CSC). A total of 147 patients were called: 57 by a remote centralized group of trained regional LVNs (smRSq) and 113 by administered by the local CSC stroke coordinator RNs (traditional mRS). Among these, 54 patients were reached and assessed by both the remote LVN and the local CSC RN. Score agreement was analyzed using frequency distributions, percent agreement, and Cohen’s kappa. Results: Of the 147 patients called, 54 (36.7%) completed both simplified and traditional mRS assessments. This subgroup had a mean age of 69.2 ±11.3 years, 44.4% were female, and 44.4% were Hispanic. Graph 1 A and B depicts the distribution of patients in each category and the score differences between them. SmRSq had a higher mean score than trmRS (1.89± 1.63 vs 1.74± 1.82). Simple agreement was seen in 70.4% (38 of 54) with kappa 0.617 (Z = 8.36, p < .001), indicating substantial inter-method agreement (Table 1). Category-specific kappa ranged from 0.53 to 0.72; highest in mRS 0 (κ = 0.72) and lowest in mRS 1 (κ = 0.53). Agreement could not be calculated for mRS 2 due to low frequency. Conclusion: The simplified mRS demonstrated substantial agreement with traditional mRS assessments. Given the demonstrated agreement between the remote LVN and the local CSC RN, systems may consider using a remote LVN team to capture the 90 day mRS which may help to mitigate costs. These findings support the simplified tool as a valid, scalable method for post-stroke functional outcomes in healthcare systems with limited resources.
Introduction: Cerebral venous sinus thrombosis (CVST) in pediatric populations presents a diagnostic and therapeutic challenge. While anticoagulation remains the mainstay of treatment, mechanical thrombectomy (MT) is increasingly considered in severe or refractory cases. This study aims to identify clinical, radiographic, and outcome-related factors associated with the decision to pursue MT in children with CVST. Methods: A retrospective cohort analysis was conducted on pediatric patients diagnosed with CVST. Patients were stratified on whether they underwent MT. Demographic data, premorbid conditions, presenting symptoms, imaging findings, treatments, and outcomes were compared between groups using appropriate statistical tests. Results: A total of 37 pediatric CVST cases were analyzed, of which 9 (24.3%) underwent MT. Patients in the MT group were significantly older (mean age 11.78 vs. 6.86 years, p = 0.03) and more likely to have a hypercoagulable state (55.6% vs. 0%, p = 0.0002), autoimmune disease (33.3% vs. 0%, p = 0.01), and focal neurological deficits on presentation (66.7% vs. 14.3%, p = 0.0081). Imaging revealed higher involvement of the deep venous system in the MT group (44.4% vs. 10.7%, p = 0.07) (Table 1). All 9 patients achieved partial recanalization. There were no catheter-related complications or new intracerebral hemorrhages. One patient experienced worsening ICH and one had seizures. Hospital length of stay was not significantly different between groups. No patients in the MT group developed epilepsy or worsened developmental delay. In the MT group ,7 of the thrombectomies were performed with the AngioJet™ device, 1 with the 3MAX™ thromboaspiration catheter alongside intracavernous sinus thrombolysis, and 1 with the pRESET™ stentretriever. In the MT group 6 of 9 (66.7%) patients had thrombi in more than 3 venous locations vs 7 of 28 (25.0%) in the medical management group (p = 0.02). Conclusion: MT in pediatric CVST is more likely to be pursued in older children with more widespread venous system involvement, underlying hypercoagulable states, autoimmune conditions, and focal neurological deficits. Despite the severity of presentation, MT was associated with favorable safety outcomes and may be considered in select cases.
