Secondary Risk Theory: Validation of a Novel Model of Protection Motivation.

Protection motivation theory states individuals conduct threat and coping appraisals when deciding how to respond to perceived risks. However, that model does not adequately explain today's risk culture, where engaging in recommended behaviors may create a separate set of real or perceived secondary risks. We argue for and then demonstrate the need for a new model accounting for a secondary threat appraisal, which we call secondary risk theory. In an online experiment, 1,246 participants indicated their intention to take a vaccine after reading about the likelihood and severity of side effects. We manipulated likelihood and severity in a 2 × 2 between-subjects design and examined how well secondary risk theory predicts vaccination intention compared to protection motivation theory. Protection motivation theory performed better when the likelihood and severity of side effects were both low (R2 = 0.30) versus high (R2 = 0.15). In contrast, secondary risk theory performed similarly when the likelihood and severity of side effects were both low (R2 = 0.42) or high (R2 = 0.45). But the latter figure is a large improvement over protection motivation theory, suggesting the usefulness of secondary risk theory when individuals perceive a high secondary threat.

"Influenza" versus "Flu": Do Different Medical Terms Affect Vaccination Intention?

Confusion about disease terminology contributes to lower risk perceptions that may lead to lesser engagement in protective measures. Communication campaigns promoting influenza vaccination have become commonplace around the world. Such campaigns vary widely in their terminology used from depicting the disease and response formally as an "influenza vaccination" to more colloquial terms like "flu shot." This study gathered responses from 896 Singapore residents through an online experiment and employed a Chi-square test to assess if different medical terms describing the same preventive measure ("influenza vaccine" and "flu shot") influence vaccination intentions. Results indicate that the formal term "influenza vaccine" prompts significantly greater vaccination intention than the abbreviated colloquial term "flu shot," even when no further information about the disease or vaccine is provided. This finding suggests that the proclivity to use the less formal term "flu shot" in widespread campaigns is less advantageous in prompting intentions to vaccinate against the disease. This may be the result of an activated availability bias brought on by the distinct semantic frames. We conclude that in this instance the medical terms should not be used interchangeably and that "influenza vaccine" may be more advantageous in future communication to encourage adoption of advised health behavior.

Collateral flow and brain changes on computed tomography angiography predict infarct volume on early diffusion-weighted imaging.

BACKGROUND: We investigated whether a computed tomography (CT)-based score could predict a large infarct (≥ 80 mL) on early diffusion-weighted magnetic resonance imaging (DWI). METHODS: Acute stroke patients considered for endovascular therapy within 8 hours of the onset of symptoms were included. The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was determined on noncontrast CT and computed tomography angiography source images (CTA-SI). Limited collateral flow was defined as less than 50% collateral filling on CTA-SI. RESULTS: Fifty-six patients were analyzed. National Institutes of Health Stroke Scale score was 20 (15-24) in the large infarct group and 16 (11-20) in the small infarct group (P = .049). ASPECTS on noncontrast CT and CTA-SI was 5 (3-8) and 3 (2-6) in the large infarct group and 9 (8-10) and 8 (7-9) in the small infarct group (both P < .001), respectively. Limited collateral flow was frequent in the large infarct group than in the small infarct group (92% vs. 11%, P < .001). Multivariate analysis found that CTA-SI ASPECTS less than or equal to 5 (odds ratio [OR], 40.55; 95% confidence interval [CI], 1.10-1493.44; P = .044) and limited collateral flow (OR, 114.64; 95% CI, 1.93-6812.79; P = .023) were associated with a large infarct. Absence of ASPECTS less than or equal to 5 and limited collateral flow on CTA-SI predicted absence of a large infarct with a sensitivity of .89, specificity of 1.00, positive predictive value of 1.00, and negative predictive value of .71. CONCLUSIONS: Assessment of ASPECTS and collateral flow on CTA-SI may be able to exclude a patient with large infarct on early DWI.

Exposure to climate change information predicts public support for solar geoengineering in Singapore and the United States.

Solar geoengineering is a controversial climate policy measure that could lower global temperature by increasing the amount of light reflected by the Earth. As scientists and policymakers increasingly consider this idea, an understanding of the level and drivers of public support for its research and potential deployment will be key. This study focuses on the role of climate change information in public support for research and deployment of stratospheric aerosol injection (SAI) in Singapore (n = 503) and the United States (n = 505). Findings were consistent with the idea that exposure to information underlies support for research and deployment. That finding was stronger in the United States, where climate change is a more contentious issue, than in Singapore. Cost concern was negatively related to support for funding and perceived risk was negatively related to support for deployment. Perceived government efficacy was a more positive predictor of support for funding in Singapore than in the United States. Additionally, relatively low support for local deployment was consistent with a NIMBY mindset. This was the first study to quantify the role of climate change information in SAI policy support, which has practical implications for using the media and interpersonal channels to communicate about SAI policy measures.

The worsening divergence of biotechnology: the importance of risk culture.

In the last 20 years, the field of biotechnology has made significant progress and attracted substantial investments, leading to different paths of technological modernization among nations. As a result, there is now an international divide in the commercial and intellectual capabilities of biotechnology, and the implications of this divergence are not well understood. This raises important questions about why global actors are motivated to participate in biotechnology modernization, the challenges they face in achieving their goals, and the possible future direction of global biotechnology development. Using the framework of prospect theory, this paper explores the role of risk culture as a fundamental factor contributing to this divergence. It aims to assess the risks and benefits associated with the early adoption of biotechnology and the regulatory frameworks that shape the development and acceptance of biotechnological innovations. By doing so, it provides valuable insights into the future of biotechnology development and its potential impact on the global landscape.

Parameters, practices, and preferences for regulatory review of emerging biotechnology products in food and agriculture.

This paper evaluates the U.S. regulatory review of three emerging biotechnology products according to parameters, practices, and endpoints of assessments that are important to stakeholders and publics. First, we present a summary of the literature on variables that are important to non-expert publics in governing biotech products, including ethical, social, policy process, and risk and benefit parameters. Second, we draw from our USDA-funded project results that surveyed stakeholders with subject matter expertise about their attitudes towards important risk, benefit, sustainability, and societal impact parameters for assessing novel agrifood technologies, including biotech. Third, we evaluate the regulatory assessments of three food and agricultural biotechnology case studies that have been reviewed under U.S. regulatory agencies and laws of the Coordinated Framework for the Regulation of Biotechnology, including gene-edited soybeans, beef cattle, and mustard greens. Evaluation of the regulatory review process was based on parameters identified in steps 1 and 2 which were deemed important to both publics and stakeholders. Based on this review, we then propose several policy options for U.S. federal agencies to strengthen their oversight processes to better align with a broader range of parameters to support sustainable agrifood products that rely on novel technologies. These policy options include 1) those that would not require new institutions or legal foundations (such as conducting Environmental Impact Statements and/or requiring a minimal level of safety data), 2) those that would require a novel institutional or cross-institutional framework (such as developing a publicly-available website and/or performing holistic sustainability assessments), and 3) those that would require the agencies to have additional legal authorities (such as requiring agencies to review biotech products according to a minimal set of health, environmental, and socio-economic parameters). Overall, the results of this analysis will be important for guiding policy practice and formulation in the regulatory assessment of emerging biotechnology products that challenge existing legal and institutional frameworks.

Balancing climate resilience and adaptation for Caribbean Small Island Developing States (SIDS): Building institutional capacity.

Although the Caribbean's Small Island Developing States (SIDS) minimally contribute to global greenhouse gas emissions, they face disproportionate climate risks and are particularly susceptible to systemic economic threats posed by climate change and subsequent increases in climate variability. Historically, strategic programs and investments have sought to develop more robust and adaptive engineered systems to absorb climate threats. However, such initiatives are limited and under-resourced in the SIDS' context. This article reviews existing climate strategies in the Caribbean and then critically examines current gaps and barriers relating to climate impact knowledge, needs, and implementation. This examination can assist Caribbean SIDS leadership to identify opportunities to transition from a vulnerability-reducing mindset to one of resilience and transformative adaptation to improve long-term economic outlooks, social welfare, and environmental stewardship despite recurring and escalating climate risks. Integr Environ Assess Manag 2023;00:1-19. © 2023 SETAC.

Informing environmental health and risk priorities through local outreach and extension.

Our society is currently facing an unprecedented number of environmental and societal challenges. Stakeholder and community engagement can help identify priority issues and needs at local levels. One approach to engage stakeholders and communities in the contexts of environmental, health, and societal challenges is to leverage outreach and extension programs. Within this context, and to help identify priority issues to focus subsequent research and extension programs in North Carolina (NC), a survey was conducted with extension agents to identify priority issues as they relate to environmental health and risks and related needs. Based on responses from 66 study participants that represented half of the 100 NC counties, we found that Water pollution, Flooding, Natural resources management, and Engaging stakeholders were top priority issues across all environmental health and risk topics. Participants also identified that practices of Engaging stakeholders as well as Assessing, Managing, and Communicating risks were increasingly important. Participants indicated they needed a moderate-to-significant amount of guidance across a range of areas related to assessing, managing, communicating, and making decisions regarding environmental health and risk topics, as well as engaging with local communities. Outcomes from this work can not only help inform subsequent research and outreach efforts at local scales, but this work demonstrates a simple, low-cost approach to elicit perspectives and priorities can be leveraged in other states and regions with established stakeholder and community outreach programs more broadly. Supplementary Information: The online version contains supplementary material available at 10.1007/s10669-022-09864-0.

Influence of rapid COVID-19 vaccine development on vaccine hesitancy.

INTRODUCTION: In the race to deploy vaccines to prevent COVID-19, there is a need to understand factors influencing vaccine hesitancy. Secondary risk theory is a useful framework to explain this, accounting for concerns about vaccine efficacy and safety. METHODS: During the first week of July, 2020, participants (N = 216) evaluated one of three different hypothetical vaccine scenarios describing an FDA-approved vaccine becoming available "next week," "in one year," or "in two years." Dependent variables were perceived vaccine efficacy, self-efficacy, perceived vaccine risk, and vaccination willingness. Covariates included vaccine conspiracy beliefs, science pessimism, media dependency, and perceived COVID-19 risk. Data analysis employed multiple analysis of covariance (MANCOVA). RESULTS: Perceived vaccine efficacy was lowest for the next-week vaccine (η2p = .045). Self-efficacy was higher for the two-year vaccine than the next-week vaccine (η2p = .029). Perceived vaccine risk was higher for the next-week vaccine than for the one-year vaccine (η2p = .032). Vaccination willingness did not differ among experimental treatments. In addition, vaccine conspiracy beliefs were negatively related to perceived vaccine efficacy (η2p = .142), self-efficacy (η2p = .031), and vaccination willingness (η2p = .143) and positively related to perceived vaccine risk (η2p = .216). CONCLUSIONS: The rapid development of the COVID-19 vaccine may have heightened public concerns over efficacy, availability, and safety. However, the current findings showed a general willingness to take even the most rapidly developed vaccine. Nonetheless, there remains a need to communicate publicly and transparently about vaccine efficacy and safety and work to reduce vaccine conspiracy beliefs.

COVID-19: how a self-monitoring checklist can empower early intervention and slow disease progression.

The SARS-CoV-2 novel coronavirus pandemic has revealed many scientific, social, and institutional challenges required to improve the health and wellbeing of individuals stricken by this disease. While organizations and governing institutions have risen to the task to concurrently prepare for and respond to this pandemic under conditions of high uncertainty and extreme pressure, another important aspect of this viral infection deserves attention and is not being fully considered, that is early intervention strategies and structured tools for individuals who test positive for the virus and begin developing symptoms. For those whose infection is progressing, we describe the potential benefits of a self-monitoring tool for use in combination with physician directed early medical interventions to slow COVID-19 progression.

Barriers to responsible innovation of nanotechnology applications in food and agriculture: A study of US experts and developers.

The use of nanotechnology and engineered nanomaterials in food and agriculture (nano-agrifood) sectors is intended to provide several potential benefits to consumers and society, such as the provision of more nutritious processed foods, edible food coatings to extend shelf lives of fresh cut produce, and more sustainable alternatives to traditional agrochemicals. The responsible innovation of nano-agrifoods may be particularly important to pursue given previous case studies involving other agrifood technologies that experienced significant public consternation. Here, we define responsible innovation following Stilgoej et al. (2013) that establishes processes to iteratively review and reflect upon one's innovation, engage stakeholders in dialogue, and to be open and transparent throughout innovation stages - processes that go beyond primary focuses of understanding environmental, health, and safety impacts of nano-enabled products and implementing safe-by-design principles. Despite calls for responsible nano-innovation across diverse sectors, it has not yet been clear what types of barriers are faced by nano-agrifood researchers and innovators in particular. This study therefore identifies and builds the first typology of barriers to responsible innovation as perceived by researchers and product developers working in nano-agrifood sectors in the United States. Our findings report 5 key barriers to responsible innovation of nano-agrifoods: Lack of Data (reported by 70% of all interview participants, and represented 34.6% of all barrier-related excerpts), Lack of Product Oversight (reported by 60% of participants, and represented 28.7% of excerpts), Need for Ensuring Marketability & Use (reported by 70% of participants, and represented 21.3% of all barrier-related excerpts), Need for Increased Collaboration (reported by 40% of participants, and represented 10.3% of excerpts), and finally Lack of Adequate Training & Workforce (reported by 30% of participants, and represented by 5.1% of excerpts). We also relate these key barriers across three main nano-innovation phases, including 1) Scientific and Technical R&D, 2) Product Oversight, and 3) Post-commercialization Marketability & Use, and discuss how these barriers may impact stakeholders as well as present opportunities to align with principles of responsible innovation. Overall, these findings may help illuminate challenges that researchers and innovators face in the pursuit of responsible innovation relevant for the field of nanotechnology with relevancy for other emerging food and agricultural technologies more broadly.

Responsible innovation of nano-agrifoods: Insights and views from U.S. stakeholders.

To date, there has been little published work that has elicited diverse stakeholder views of nano-agrifoods and of how nano-agrifoods align with the goals of responsible innovation. This paper aims to fill this research gap by investigating views of nano-agrifoods, how well their development adheres to principles of responsible innovation, and potential challenges for achieving responsible nano-agrifood innovation. Using an online engagement platform, we find that U.S. stakeholder views of responsible innovation were dominated by environmental, health, and safety (EHS) contexts, considerations of societal impacts, opportunities for stakeholder engagement, and responding to societal needs. These views overlap with scholarly definitions of responsible innovation, albeit stakeholders were more focused on impacts of products, while the field of responsible innovation strives for more "upstream" considerations of the process of innovation. We also find that views of nano-agrifoods differed across applications with dietary supplements and improved whitening of infant formula viewed least favorably, and environmental health or food safety applications viewed most favorably. These findings align with the larger body of literature, whereby stakeholders are expected to be more supportive of nanotechnology used in agricultural applications compared to directly within food and food supplements. Overall, participants indicated they held relatively neutral views on research and innovation for nano-agrifoods being conducted responsibly, and they identified key challenges to ensuring their responsible innovation that were related to uncertainties in EHS studies, the need for public understanding and acceptance, and adequate regulation. In light of these results, we recommend future research efforts on EHS impacts and risk-benefit frameworks for nano-agrifoods, better understanding stakeholder views on what constitutes effective regulation, and addressing challenges with effective regulation and responsible innovation practices.

Can Comorbidity Data Explain Cross-State and Cross-National Difference in COVID-19 Death Rates?

Many efforts to predict the impact of COVID-19 on hospitalization, intensive care unit (ICU) utilization, and mortality rely on age and comorbidities. These predictions are foundational to learning, policymaking, and planning for the pandemic, and therefore understanding the relationship between age, comorbidities, and health outcomes is critical to assessing and managing public health risks. From a US government database of 1.4 million patient records collected in May 2020, we extracted the relationships between age and number of comorbidities at the individual level to predict the likelihood of hospitalization, admission to intensive care, and death. We then applied the relationships to each US state and a selection of different countries in order to see whether they predicted observed outcome rates. We found that age and comorbidity data within these geographical regions do not explain much of the international or within-country variation in hospitalization, ICU admission, or death. Identifying alternative explanations for the limited predictive power of comorbidities and age at the population level should be considered for future research.

A typology of beliefs and misperceptions about the influenza disease and vaccine among older adults in Singapore.

Access to the influenza vaccine pose little barriers in developed countries such as Singapore and vaccination against influenza is highly recommended for at-risk populations including older adults. However, vaccination rates are much lower than recommended despite the significant morbidity and mortality associated with the disease among this vulnerable population. Given timely goals to increase vaccine acceptance and uptake, we explored Singaporean older adults' misperceptions about influenza disease and vaccine. Qualitative semi-structured interviews were conducted among 76 Singaporean adults aged 65 and above with no focus on a specific area in Singapore. Data were analyzed with grounded theory methods to understand participants' attitudes, perceptions, and knowledge. We developed in vivo codes that reflect the verbiage used by participants and exhaustively catalogued themes through a constant comparison coding method. Focusing specifically on older adults' misperceptions, seven main themes about influenza disease or vaccine emerged from our data analysis: familiarity with influenza, misperceptions about influenza, personal susceptibility to influenza, familiarity with the influenza vaccine, misperceptions about the influenza vaccine, misperceptions about influenza vaccine usage, and opinions about and barriers to influenza vaccine uptake. Notably, there is a lack of adequate knowledge and motivation in vaccinating against influenza among older adults in Singapore. Health communication needs to be more tailored toward older adults' message processing systems and engage health professionals' involvement in addressing the influenza disease and vaccine misperceptions identified in this study.

Herpesvirus Infections of the Nervous System.

PURPOSE OF REVIEW: This article reviews the spectrum of neurologic disease associated with human herpesvirus infections. RECENT FINDINGS: As more patients are becoming therapeutically immunosuppressed, human herpesvirus infections are increasingly common. Historically, infections with human herpesviruses were described as temporal lobe encephalitis caused by herpes simplex virus type 1 or type 2. More recently, however, additional pathogens, such as varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6 have been identified to cause serious neurologic infections. As literature emerges, clinical presentations of herpesvirus infections have taken on many new forms, becoming heterogeneous and involving nearly every location along the neuraxis. Advanced diagnostic methods are now available for each specific pathogen in the herpesvirus family. As data emerge on viral resistance to conventional therapies, newer antiviral medications must be considered. SUMMARY: Infections from the herpesvirus family can have devastating neurologic outcomes without prompt and appropriate treatment. Clinical recognition of symptoms and appropriate advanced testing are necessary to correctly identify the infectious etiology. Knowledge of secondary neurologic complications of disease is equally important to prevent additional morbidity and mortality. This article discusses infections of the central and peripheral nervous systems caused by herpes simplex virus type 1 and type 2, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6. The pathophysiology, epidemiology, clinical presentations of disease, diagnostic investigations, imaging characteristics, and treatment for each infectious etiology are discussed in detail.

Genetic susceptibility to cerebrovascular disease: A systematic review.

Investigation of genetic susceptibility to cerebrovascular disease has been of growing interest. A systematic review of human studies assessing neurogenomic aspects of cerebrovascular disease was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Any association study exploring genetic variants located in the exome associated with one of the major cerebrovascular diseases with at least 500 subjects was eligible for inclusion. Of 6874 manuscripts identified, 35 studies met the inclusion criteria. Most studies of interest focused on ischemic stroke and cerebrovascular occlusive disease. Large cohort genetic association studies on hemorrhagic cerebrovascular disease were less common. In addition to rare, well-established monogenic conditions with significant risk for cerebrovascular disease, a number of genetic variants are also relevant to cerebrovascular pathogenesis as part of a multifactorial process. The 45 polymorphisms identified were located in genes involved in processes related to endothelial and vascular health (15 (33.4%) variants), plasma lipid metabolism (10 (22.2%) variants), inflammation (9 (20%) variants), coagulation (3 (6.7%) variants), and blood pressure modulation (2 (4.4%) variants), and other (6 (13.3%) variants). This work represents a comprehensive overview of genetic variants in the exome relevant to ischemic and hemorrhagic stroke pathophysiology.

Societal Risk Evaluation Scheme (SRES): Scenario-Based Multi-Criteria Evaluation of Synthetic Biology Applications.

Synthetic biology (SB) applies engineering principles to biology for the construction of novel biological systems designed for useful purposes. From an oversight perspective, SB products come with significant uncertainty. Yet there is a need to anticipate and prepare for SB applications before deployment. This study develops a Societal Risk Evaluation Scheme (SRES) in order to advance methods for anticipatory governance of emerging technologies such as SB. The SRES is based upon societal risk factors that were identified as important through a policy Delphi study. These factors range from those associated with traditional risk assessment, such as health and environmental consequences, to broader features of risk such as those associated with reversibility, manageability, anticipated levels of public concern, and uncertainty. A multi-disciplinary panel with diverse perspectives and affiliations assessed four case studies of SB using the SRES. Rankings of the SRES components are compared within and across the case studies. From these comparisons, we found levels of controllability and familiarity associated with the cases to be important for overall SRES rankings. From a theoretical standpoint, this study illustrates the applicability of the psychometric paradigm to evaluating SB cases. In addition, our paper describes how the SRES can be incorporated into anticipatory governance models as a screening tool to prioritize research, information collection, and dialogue in the face of the limited capacity of governance systems. To our knowledge, this is the first study to elicit data on specific cases of SB with the goal of developing theory and tools for risk governance.

Diffusion-weighted imaging volume as the best predictor of the diffusion-perfusion mismatch in acute stroke patients within 8 hours of onset.

BACKGROUND: Diagnostic accuracies of standard NCCT, CTA, CTA-SI, FLAIR, and DWI to detect the diffusion-perfusion mismatch (DPM) were compared. METHODS: Stroke patients considered for endovascular therapy within 8 hours of onset were enrolled. DPM was defined as at least 160% mismatch between DWI and PWI volume. RESULTS: DPM was seen in 35 (71%) of 49 patients. ASPECTS on NCCT, CTA-SI, and DWI was 9 (8-9), 8 (6-9), and 7 (5-9) in mismatch group, and 6 (4-9), 6 (2-7), 5 (2-6) in nonmismatch group, respectively (P = .027, .006, and .001). Ischemic volume on CTA-SI and DWI was 4.6 (.2-13.0) cm(3) and 21.5 (9.7-44.0) cm(3) in mismatch group, and 61.5 (6.6-101.1) cm(3) and 94.9 (45.7-139.8) cm(3) in nonmismatch group (P = .003 and <.001). Significant collateralization on CTA-SI and FLAIR was seen in 80% and 88% in mismatch group, and 42% and 58% in nonmismatch group (P = .026 and .039). Odds ratios (95% CI) of DWI volume of ≤ 70 cm(3) to predict the mismatch was 30.17 (2.06-442.41) after adjusting for ASPECTSs on NCCT, CTA-SI, and DWI, 44.90 (2.75-732.73) for ischemic volume on CTA-SI, and 42.80 (3.05-601.41) for significant collateralization on CTA-SI and FLAIR (P = .013, .008, and .005). CONCLUSIONS: DWI volume was the best predictor of DPM.

Properties of engineered vascular constructs made from collagen, fibrin, and collagen-fibrin mixtures.

Vascular constructs were formed by embedding rat aortic smooth muscle cells in three-dimensional matrices of Type I collagen, fibrin, or a mixture of collagen and fibrin in a 1:1 ratio, at total matrix protein concentrations of 2 and 4 mg/ml. Morphological and mechanical properties were evaluated after 6 days in culture, and the effect of cyclic mechanical strain on collagen-fibrin mixture constructs was also studied. Constructs made with the lower protein concentration compacted to the greatest degree, and fibrin was found to enhance gel compaction. Each matrix type exhibited a characteristic stress-strain profile. Pure collagen had the highest linear modulus and pure fibrin had the lowest. The ultimate tensile stress was strongly dependent on the degree of gel compaction, and collagen-fibrin mixtures at 2mg/ml total protein content exhibited the highest values. Application of cyclic mechanical strain to collagen-fibrin mixture constructs caused a significant increase in gel compaction and a decrease in cell proliferation. The linear modulus, ultimate tensile stress and toughness of the constructs were all augmented by mechanical strain. These results demonstrate that the properties of engineered vascular tissues can be modulated by the combination of selected extracellular matrix components, and the application of mechanical stimulation.

Centenarian middle cerebral artery occlusion treated with intra-arterial mechanical embolectomy.

Advanced age, arbitrarily defined as over 80 years, has been an exclusion criterion in many clinical trials for the treatment of acute ischemic stroke. The oldest person, to our knowledge, treated for acute ischemic stroke with intra-arterial therapy is presented and, importantly, this patient was excluded from intravenous tissue plasminogen activator due to an advanced age of 100 years and arrival in our emergency department within the 3-4.5 h time window. Utilizing an MRI based protocol to assess the risk-benefit ratio, treatment by intra-arterial mechanical embolectomy was commenced resulting in middle cerebral artery recanalization at 6 h 30 min. The patient improved, and ultimately returned to a baseline modified Rankin Scale score of 3. With careful selection, elderly patients may benefit from acute stroke therapies and may be considered on a case by case basis.