This special issue gathers together a selection of short articles reflecting on the historical construction of inequality and race in the histories of archaeology. The articles also suggest ways in which the discipline might grapple with the-often obvious, sometimes subtle-consequences of that historical process. Solicited via an open call for papers in the summer of 2020 (one made with the aim of speedy publication), the breadth of the topics discussed in the articles reflect how inequality and race have become more prominent research themes within the histories of archaeology in the previous five-to-ten years. At the same time, the pieces show how research can-and should-be connected to attempts to promote social justice and an end to racial discrimination within archaeological practice, the archaeological profession, and the wider worlds with which the discipline interacts. Published at a time when a pandemic has not only swept the world, but also exposed such inequalities further, the special issue represents a positive intervention in what continues to be a contentious issue.

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Introduction: Recent studies have shown patients with coronavirus disease 2019 (COVID-19) develop significant coagulopathy with thromboembolic complications including ischemic stroke. However, data are sparse regarding the clinical characteristics, stroke mechanism, and patient outcomes. Methods: We conducted a retrospective cohort study of consecutive patients with ischemic stroke who were hospitalized between March 2020 and June 2021, within at a Regional Medical Center serving three large counties in South Carolina. We further investigated clinical and demographic characteristics, stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS), and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with COVID-19 who also suffered from an acute ischemic stroke. Results: During the study period, out of 1087 hospitalized patients with a diagnosis of COVID-19 infection, 18 patients (1.6%) had an imaging-proven ischemic stroke. Of these 18 patients, 10 (56%) were men, 16 were African-Americans (89%), 2 (11.1%) patients were <55 years of age. All patients had at least one known vascular risk factor. Cryptogenic stroke was more common in patients with COVID-19 (83%). The median time (days) from COVID-19 symptom onset to stroke symptom onset was 11 (IQR 10-28), while the median time from being tested positive for COVID-19 to stroke diagnosis was 10 (IQR 2-24). Our study sample had a median admission NIHSS score of 5 (IQR 3-11) and a median peak D-dimer level of 2101 (IQR 1349 - 3213). Interestingly, 38% of these patients were already on therapeutic anticoagulation before the diagnosis of stroke. Patients with COVID-19 and stroke had an inpatient mortality rate of 11%. None of these patients met the criteria for IV-tPA treatment or thrombectomy. Conclusion: We observed a modest rate of ischemic stroke in hospitalized patients with COVID-19. Most strokes were cryptogenic, possibly secondary to coagulopathy associated with COVID-19 infection. Further studies are needed to guide management for stroke prevention in patients with COVID-19.

Background: Telestroke has significantly improved acute stroke care in intensive care and inpatient settings, but post discharge care has been lacking and fragmented resulting in poor secondary stroke prevention, post-stroke complications, and inadequate patient education. Immediate need for stroke follow up ignited the development of telemedicine outpatient stroke clinics led and managed by nurses and nurse practitioners. Nurses identified these gaps and advocated for telestroke clinics in rural areas. Purpose: The purpose of this program was to develop a nurse led telemedicine outpatient stroke clinic and improve access to expert neuro consults. Methods: Through affiliate relations with healthcare facilities and nurse advocacy, the continuity of stroke care in local communities was expanded to 2 telemedicine outpatient clinics. A specialized nurse practitioner was credentialed, privileged, and trained to conduct telemedicine appointments. Telehealth nurse coordinators trained clinics on the neurological assessment and telepresenter role. Data was analyzed assessing appointment compliance rates, miles saved, and cost of travel. Results: Between October 2017 and August 2018, 48 patients were seen at nursing led telestroke outpatient clinics. Data showed a decrease in no show appointments from fiscal year 2016 (16.29%) to 2018 (15.3%). On average, patients saved 5896 miles round trip (122.8 miles per patient) and saw a cost savings of $655.11 in gas (at $2.50/gallon). Community facilities received downstream revenue from ancillary studies; however, coordinating pre appointment scans initially exhibited interruptions in patient care. Further challenges included training clinicians on technology platforms, while simultaneously assisting remote neuro specialists with hands on patient assessments. Conclusion: Nursing advocacy for the development of telestroke outpatient clinics has shown promising improvements in no show appointment rates, increased access to specialty care, and reduction in travel burdens. Further growth and expansion of telemedicine outpatient clinics by nurses is essential in providing a holistic approach for specialized patient care and empowering nurses to be an advocate in the continuum of stroke care.