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Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke.

Abstract The role of supine positioning after acute stroke in improving cerebral blood flow and the countervailing risk of aspiration pneumonia have led to variation in head positioning in clinical practice. We wanted to determine whether outcomes in patients with acute ischemic stroke could be improved by positioning the patient to be lying flat (i.e., fully supine with the back horizontal and the face upwards) during treatment to increase cerebral perfusion.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the new england journal of medicine
Publication Year Start




PMID- 28636854
OWN - NLM
STAT- In-Process
DA  - 20170621
LR  - 20170621
IS  - 1533-4406 (Electronic)
IS  - 0028-4793 (Linking)
VI  - 376
IP  - 25
DP  - 2017 Jun 22
TI  - Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke.
PG  - 2437-2447
LID - 10.1056/NEJMoa1615715 [doi]
AB  - BACKGROUND: The role of supine positioning after acute stroke in improving
      cerebral blood flow and the countervailing risk of aspiration pneumonia have led 
      to variation in head positioning in clinical practice. We wanted to determine
      whether outcomes in patients with acute ischemic stroke could be improved by
      positioning the patient to be lying flat (i.e., fully supine with the back
      horizontal and the face upwards) during treatment to increase cerebral perfusion.
      METHODS: In a pragmatic, cluster-randomized, crossover trial conducted in nine
      countries, we assigned 11,093 patients with acute stroke (85% of the strokes were
      ischemic) to receive care in either a lying-flat position or a sitting-up
      position with the head elevated to at least 30 degrees, according to the
      randomization assignment of the hospital to which they were admitted; the
      designated position was initiated soon after hospital admission and was
      maintained for 24 hours. The primary outcome was degree of disability at 90 days,
      as assessed with the use of the modified Rankin scale (scores range from 0 to 6, 
      with higher scores indicating greater disability and a score of 6 indicating
      death). RESULTS: The median interval between the onset of stroke symptoms and the
      initiation of the assigned position was 14 hours (interquartile range, 5 to 35). 
      Patients in the lying-flat group were less likely than patients in the sitting-up
      group to maintain the position for 24 hours (87% vs. 95%, P<0.001). In a
      proportional-odds model, there was no significant shift in the distribution of
      90-day disability outcomes on the global modified Rankin scale between patients
      in the lying-flat group and patients in the sitting-up group (unadjusted odds
      ratio for a difference in the distribution of scores on the modified Rankin scale
      in the lying-flat group, 1.01; 95% confidence interval, 0.92 to 1.10; P=0.84).
      Mortality within 90 days was 7.3% among the patients in the lying-flat group and 
      7.4% among the patients in the sitting-up group (P=0.83). There were no
      significant between-group differences in the rates of serious adverse events,
      including pneumonia. CONCLUSIONS: Disability outcomes after acute stroke did not 
      differ significantly between patients assigned to a lying-flat position for 24
      hours and patients assigned to a sitting-up position with the head elevated to at
      least 30 degrees for 24 hours. (Funded by the National Health and Medical
      Research Council of Australia; HeadPoST ClinicalTrials.gov number, NCT02162017
      .).
FAU - Anderson, Craig S
AU  - Anderson CS
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Arima, Hisatomi
AU  - Arima H
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Lavados, Pablo
AU  - Lavados P
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Billot, Laurent
AU  - Billot L
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Hackett, Maree L
AU  - Hackett ML
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Olavarria, Veronica V
AU  - Olavarria VV
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Munoz Venturelli, Paula
AU  - Munoz Venturelli P
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Brunser, Alejandro
AU  - Brunser A
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Peng, Bin
AU  - Peng B
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Cui, Liying
AU  - Cui L
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Song, Lily
AU  - Song L
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Rogers, Kris
AU  - Rogers K
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Middleton, Sandy
AU  - Middleton S
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Lim, Joyce Y
AU  - Lim JY
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Forshaw, Denise
AU  - Forshaw D
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Lightbody, C Elizabeth
AU  - Lightbody CE
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Woodward, Mark
AU  - Woodward M
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Pontes-Neto, Octavio
AU  - Pontes-Neto O
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - De Silva, H Asita
AU  - De Silva HA
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Lin, Ruey-Tay
AU  - Lin RT
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Lee, Tsong-Hai
AU  - Lee TH
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Pandian, Jeyaraj D
AU  - Pandian JD
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Mead, Gillian E
AU  - Mead GE
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Robinson, Thompson
AU  - Robinson T
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
FAU - Watkins, Caroline
AU  - Watkins C
AD  - From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., 
      K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R.,
      J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal
      Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research
      Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M.,
      C.W.) - all in Sydney; the George Institute China at Peking University Health
      Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union
      Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology,
      85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the
      Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka
      University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry,
      Clinica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina,
      Clinica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias
      Neurologicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in
      Santiago, Chile; the College of Health and Wellbeing, University of Central
      Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global
      Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences,
      University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular
      Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester
      (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins
      University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department
      of Neuroscience and Behavior, Ribeirao Preto School of Medicine, University of
      Sao Paulo, Sao Paulo (O.P.-N.); the Clinical Trials Unit, Department of
      Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
      (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana,
      India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and
      Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology,
      Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung
      University, Taoyuan (T.-H.L.) - both in Taiwan.
CN  - HeadPoST Investigators and Coordinators
LA  - eng
SI  - ClinicalTrials.gov/NCT02162017
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - N Engl J Med
JT  - The New England journal of medicine
JID - 0255562
EDAT- 2017/06/22 06:00
MHDA- 2017/06/22 06:00
CRDT- 2017/06/22 06:00
AID - 10.1056/NEJMoa1615715 [doi]
PST - ppublish
SO  - N Engl J Med. 2017 Jun 22;376(25):2437-2447. doi: 10.1056/NEJMoa1615715.

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