Introduction: Telestroke is an effective strategy to increase appropriate stroke treatments among patients in resource-limited environments. Despite the well-documented benefits of telestroke, there is limited literature regarding its utilization. The purposes of this study are: (1) determine the percentage of potential stroke patients who generate a telestroke consult in rural critical access hospitals (CAHs) and (2) validate an electronic medical record (EMR)-derived report as a stroke screen. Methods: This retrospective chart review analyzed patients presenting between September 1, 2020 and February 1, 2021 to three CAHs. Visits with triage complaints suggesting acute ischemic stroke (AIS)/transient ischemic attack (TIA) were pooled for analysis using an EMR-derived report. Patients with confirmed AIS/TIA at discharge over this period were used to validate the EMR tool. Results: The EMR report pooled 252 possible AIS/TIA visits out of 12,685 emergency department visits for analysis. It had a specificity of 98.78% and sensitivity of 58.06%. Of the 252 visits, 12.7% met telestroke criteria and 38.89% received telestroke evaluation. Among these, a definite diagnosis of AIS/TIA was made in 92.86%. Of the remaining population who met criteria but didn't undergo consultation, 61.11% were diagnosed with AIS/TIA at discharge. Conclusion: This study provides novel characterization of stroke presentations and telestroke in rural CAHs. The EMR-derived report is a reasonable tool to concentrate potential AIS/TIA cases for review and resource allocation but is not sensitive enough to detect stroke as a stand-alone tool. The majority (56%) of eligible patients did not undergo telestroke consultation. Future studies are critical to further understand reasons contributing to this.

We are analyzing the effects of Roundup and its components on the pond snail, Lymnaea palustris. Roundup is a commonly used herbicide composed of the chemicals Glyphosate, POEA (a surfactant), and Diquat Dibromide (DD). By testing the effects of Roundup and its components on a hermaphroditic organism such as L. palustris, one can observe significant alterations in reproductive output as well as shifts in hormone levels or steroidogenic pathway components following exposure to these chemicals. Preliminary results from our laboratory showed chronic Roundup treatment yielded significantly decreased testosterone levels as well as altered estradiol and progesterone levels. Additionally, chronic treatments reduced expression of StAR enzyme, especially within the ovotestis. In the current study, snails (N=60) were chronically treated in solutions of pond water supplemented with RoundUp, DD, POEA, or Glyphosate. During the treatment period, snail fecundity and mortality were noted on a biweekly basis for each treatment group. After the treatment period, the kidney, gonadodigestive complex, and brain were harvested from each snail to analyze the expression of StAR, and p450AROM enzymes via Western blotting. Standardized amounts of protein from control and treated animals were compared during the analysis for each organ. In a concurrent study, testosterone, cortisol, and estradiol levels were tested at the three and six week marks by enzyme immunoassay. A significant decrease in fecundity was observed in snails in all treatment groups. Shifts were observed in both hormone and protein levels when comparing the results of the treatment groups to the control group.

Roundup, a commonly used herbicide, has been shown to have adverse effects on different non-target organisms, particularly on reproduction and development. Roundup has been demonstrated to affect the steroidogenic pathway, specifically the rate-limiting step in steroidogenesis, steroid acute regulatory protein (StAR). Previous research in snails demonstrated significant reduction in fecundity and increase in developmental abnormalities as a result of exposure to Roundup; preliminary results also suggested that Roundup impacted the production of steroid hormones derived from cholesterol, including the sex hormones. The present study aimed to determine a possible target in this pathway in order to understand the mechanism of disruption by the chemicals. This was done by treating Lymnaea palustris, an aquatic snail, with Roundup or its constituents (POEA, glyphosate, and diquat dibromide) for six weeks. Cortisol, testosterone and estradiol levels in the hemolymph were analyzed using enzyme-linked immunosorbent assay (ELISA) kits.Throughout the six-week treatment period there was a significant decrease in reproduction among the snails in all treatment groups. The snails treated with complete Roundup and diquat dibromide showed significant decreases in both testosterone and estradiol levels. These could be related to the decrease in StAR activity (leading to less overall material for steroid hormone production), or possibly a disruption in aromatase activity. Snails treated with glyphosate exhibited a significant decrease in testosterone, significant increase in cortisol, and a notable increase in estradiol; these results suggest a shift in the steroidogenic pathway to produce more stress hormone at the expense of steroid sex hormones.

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