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Urban climatic challenges can motivate urban planners and designers to implement urban climate-responsive design strategies. But does this process occur sufficiently, and if not, why? This study explores the implementation of urban climate-responsive design strategies, potential functional and aesthetic conflicts, availability of policy instruments that support implementation, strengths and weaknesses, and missed opportunities for integrating agendas. Semi-structured interviews were conducted with experts familiar with urban climate-responsive design. The results suggest that greening measures are most often implemented, strategies tend to compete with other land-uses, designers face aesthetic conflicts, and strategies are predominantly mainstreamed within existing policy instruments. [ABSTRACT FROM AUTHOR]

This study examined the role and importance of various green and blue infrastructure elements in improving the deteriorating urban thermal environment from a post-occupancy evaluation perspective of residential neighborhood development. The results showed that the influential variables in this study were the tree canopy coverage ratio (TCR), tree species, yard area, and distance to a waterbody. In addition, a house with a large yard area increases the amount of direct exposure to solar radiation, so the comfort of the outdoor thermal environment was low. Furthermore, the distance to a waterbody parameter did not have a positive impact on the outdoor thermal comfort level because the dominant wind direction within the study area during the day was opposite to the blue infrastructure. Lastly, geographically weighted regression (GWR) analysis was adopted to identify an improvement to compensate for the relatively low explanatory nature of the ordinary least squares (OLS) models due to spatial correlation. [ABSTRACT FROM AUTHOR]

Background and Purpose: During the coronavirus disease 2019 (COVID‐19) pandemic many countries reported a decline in stroke volumes. The aim of this study was to analyze if the decline was related to the intensity of the COVID‐19 pandemic. Methods: The first pandemic year (1 March 2020 to 28 February 2021) overall and during the three COVID‐19 waves were compared with the preceding year. Volumes of acute ischaemic stroke (AIS), subarachnoid hemorrhage, intracerebral hemorrhage and recanalization treatments (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]) were obtained from the National Register of Reimbursed Health Services. Door‐to‐needle time, onset‐to‐door time and National Institutes of Health Stroke Scale at admission were obtained from the Registry of Stroke Care Quality. Results: During the pandemic year compared to the preceding year there were 26,453 versus 28,771 stroke admissions, representing an 8.8% decline (p < 0.001). The declines (−10%, −11%, −19%) appeared in COVID‐19 waves (spring 2020, autumn 2020, winter 2021) except for an increase (2%) during summer 2020. Admissions for AIS declined by 10.2% (p < 0.001), whilst hemorrhagic stroke volumes were minimally decreased. The absolute volumes of IVT and MT decreased by 9.4% (p < 0.001) and 5.7% (p = 0.16), respectively. However, the proportions of ischaemic stroke patients receiving IVT (18% vs. 18%; p = 0.72) and MT (6% vs. 6%; p = 0.28) remained unchanged. Conclusions: There was a decline in stroke admissions, but such decline was not related to COVID‐19 incidence. The frequency of use of recanalization procedures (IVT, MT) and times (onset‐to‐door time, door‐to‐needle time) in AIS were preserved in the Czech Republic during the first year of the pandemic. [ABSTRACT FROM AUTHOR]

The rapidly advancing knowledge of the interactions between people and their environment provides opportunities for designers to practice evidence-based landscape architecture (EBLA) in designing outdoor spaces. Recent studies have proposed some characteristics of successful EBLA projects, including the following: amicable skepticism; the questioning of assumptions; the verification of information; the application of evidence to the problem at hand; and data that is openly reported and replicable. These five steps were the basis for a framework that was developed and tested through the redesign of a downtown area in a hot-climate city, El Paso, Texas. The process started with the collection of base information, including local climate conditions and evidence on heat-related illness. Case studies and a search of the literature led to the questioning of some assumptions, including the expectation that the air temperature on the site could be substantially modified through design. On-site microclimate measurements were used to confirm this insight, and were used to validate computer models. The validated models were used to assess the thermal comfort conditions across the site. A human energy budget model was used to identify the key atmospheric elements that both strongly affect a person's heat health, and that can also be readily modified through landscape architectural design. These led to the development of guidelines, which were developed as a 'tool kit' and applied to the design. Amicable skepticism was practiced throughout the process to confirm that the decisions were made based on evidence, not opinions or preconceived notions. The resulting design was tested using computer models to check whether the goal of thermally comfortable conditions was met. The quantitative results illustrated the amount of improvement to the thermal comfort of site visitors. This process is universal and can be applied to any landscape. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to explore the gene expression profile of primary central nervous system vasculitis (PCNSV). Methods: Brain specimens of 4 patients with granulomatous vasculitis (GV), 5 with lymphocytic vasculitis (LV), 4 with amyloid β‐related angiitis (ABRA), and 4 normal controls were studied. RNA‐sequencing was performed using the Illumina Hiseq‐4,000 platform and the Illumina TruSeq Total‐RNA library. Student t test and false discovery rate tests were performed for each of the differentially expressed transcripts. Ingenuity Pathway Analysis was used for the pathway expression analysis. CIBERSORT was used to estimate the abundances of different immune cell subsets in the tissues based on gene expression data. Results: Transcripts differentially expressed between PCNSV and normal brain indicated that endosomal, mitochondrial, and ribosome dysfunction, alterations in protein synthesis, and noncoding RNAs might be involved in PCNSV. Pathway analysis revealed the activation of dendritic cell maturation and antigen processing as well as neuroinflammation in PCNSV versus normal brain, whereas oxidative phosphorylation was inhibited. CIBERSORT estimation of immune cell subsets suggested that activated NK cells, M1 macrophages, memory B cells, and follicular helper T cells were likely to be more prevalent in PCNSV samples. Naïve CD4 T cells and monocytes were mainly estimated to be present in GV and ABRA. Plasma cell and γδ T‐cell signatures were mainly found in LV and normal brain. GV showed higher levels of genes associated with macrophage activities and T cells. ABRA showed higher levels of long noncoding RNAs and miR‐616. LV showed higher levels of genes encoding immunoglobulins. Interpretation: RNA sequencing confirmed PCNSV heterogeneity. ANN NEUROL 2023;93:120–130 [ABSTRACT FROM AUTHOR]

The excessive use of energy in buildings due to increased populations and economic development leads to more greenhouse gas emissions, which affect climate change and global warming. Changes in prevailing outdoor weather conditions significantly affect the energy systems of buildings through increased cooling and decreased heating. In this paper, 30 years of data of dry and wet bulb temperatures (1990–2020) with a time interval of 3 h were considered in order to estimate the climatic outdoor design conditions in the cities of Dallas–Fort Worth, Houston, and San Antonio in the state of Texas. The results suggest that the dry bulb temperature (DBT) had significantly higher increases in Dallas–Fort Worth (2.37 °C) than the wet bulb temperature (WBT) in Houston (4.1 °C) during the study period. Furthermore, this study analyzed the effects of climate change on cooling degree hours (CDH) and heating degree hours (HDH) and the results suggest the most significant drop in HDH in Dallas–Fort Worth with a maximum CDH fluctuation as compared to other two cities. The effect of climate change on the performance of cooling systems is also investigated in this study via direct evaporative coolers (DECs) and direct-indirect evaporative coolers (IDEC), which do not perform well in the selected cities. In contrast, absorption system (Abs) and vapor compression (VC) systems show an increase in the number of additional loads. The second part of this study is related to the future projection using the ARIMA model, which suggests that DBT would rise significantly in Houston (from 37.18 °C to 37.56 °C) and Dallas–Fort Worth (39.1 °C to 39.57 °C) while diminishing in San Antonio (from 34.81 °C to 33.95 °C) from 2020 to 2030. In contrast, WBT will experience an upward trend in Houston (from 36.06 °C to 37.71 °C) and Dallas–Fort Worth (from 31.32 °C to 31.38 °C) and a downward trend in San Antonio (from 32.43 °C to 31.97 °C) during 2020–2030. Additionally, the future performance prediction of Abs and VC systems is also performed, which reveals that the amount of additional load required is significantly higher in 2030 compared to 2020 and is more prominent in Houston. Conversely, amount of additional load required for cooling systems in San Antonio shows a decreasing trend in 2030. [ABSTRACT FROM AUTHOR]

Climate change and anthropogenic activities are affecting the entire earth, where urban areas are not an exception, being affected by extreme weather conditions and environmental disturbances. Urban expansion and industrial development have negatively affected the local climatic condition due to green space deficiency, soil moisture loss, soil erosion, land subsidence, high runoff, and low infiltration rate. Megacities are needed proper management and awareness for healthy ecosystem. The study investigated the properties of land alteration on the urban heat island (UHI) in the city of Seville, Spain. Earth observational Landsat 5 TM and 8 OLI/TIRS remote sensing datasets were used for generating the urban expansion and related land alteration. The study results indicate that built-up land increased by 139.2 Km2 while agricultural land decreased by 104.07 Km2. Open space and plantation areas also decreased by 62.33 Km2 and 30.76 Km2, respectively. The average temperature increase was around 0.13 °C per year between 1991 and 2021. Megacities need appropriate development, design, and supervision for sustainable urban development to avoid further UHI intensification. UHI map indicates that thermal variation increased from 2.21 °C (1991) to 3.42 °C (2021). The ecological disturbances also identified using UTFVI and the maps denoted that UTFVI values increased by 0.005 from 1991 to 2021. The present study outcomes are obliging for planners, researchers, and other participants for future evidence-based disaster planning and management. [ABSTRACT FROM AUTHOR]

The article focuses on Ares dual role as both god of war and lover of Aphrodite goes back to Homer. Topics include examines the first line of the epigram evokes the Iliad, where Ares fights on the battlefield; the second line, the Odyssey, in which Odysseus hears the story of how Hephaestus, the husband of Aphrodite, entrapped Ares in bed with his wife.

Background and Objective: Short- and long-term mortality following ischemic stroke (IS) and their predictors have not been defined in the Czech population, and studies on long-term mortality are largely missing for the populations of Central Europe. Methods: Using the National Register of Hospitalized Patients and the Czech National Mortality Registry, we analyzed data on 1-month, 1-year, and 3-year all-cause mortality for patients admitted with IS to any of the 4 hospitals with a certified stroke unit in Brno, Czech Republic, in 2011. We reviewed discharge summaries and recorded potential factors impacting mortality after the index stroke event. Using univariate and multivariable analyses, we identified predictors of mortality at all 3 time points. Results: In our multivariable model, statin use (odds ratio [OR] 0.095, p < 0.0001), age at stroke (OR 1.03, p = 0.0445), and admission National Institutes of Health Stroke Scale (NIHSS) score (OR 1.16, p < 0.0001) predicted 1-month mortality, while statin use (OR 0.43, p = 0.0004), history of cardiac failure (OR 2.17, p = 0.0137), age at stroke (OR 1.07, p < 0.0001), and admission NIHSS score (OR 1.14, p < 0.0001) predicted 1-year mortality. Statin use (OR 0.54, p = 0.0051), history of cardiac failure (OR 2.13, p = 0.0206), age at stroke (OR 1.07, p < 0.0001), and admission NIHSS score (OR 1.11, p < 0.0001) also predicted 3-year mortality. Conclusions: Our study is the first to report data on short- and long-term mortality rates and their predictors in patients hospitalized with IS in the Czech population. Our results indicate that mortality rates and predictors of mortality are consistent with those reported in studies from other populations throughout the world. [ABSTRACT FROM AUTHOR]

Excess heat in urban environments is an increasing threat to human health and well-being. Furthermore, the increasingly important phenomenon of the Urban Heat Island (UHI) is exacerbating problems of livability in urban centers. Hence, there should be an increasing effort to assess the impact of heat mitigation strategies (HMSs) on outdoor thermal comfort in cities. This research has investigated how urban areas in steppe climate zones can be more thermally comfortable due to the effects of water bodies and trees, and how this might help to mitigate heat waves. Numerical simulations using the ENVI-met microclimate model have been performed for an urban park in Tabriz, Iran. In-situ measurements of air temperature (Ta) and mean radiant temperature (MRT) have been carried out in the study site and the collected data was used to validate the model (RMSE value 0.98 °C for Ta and 5.85 °C for MRT). Results show that water body evaporation without trees may decrease the air temperature, but on the other hand also increases the humidity, which reduces the positive impact on thermal comfort. However, the combination of water body with trees represents a better performance in the regulation of urban microclimate and thermal comfort. [ABSTRACT FROM AUTHOR]

Global climate change and urban heat island intensification are making many cities dangerously hot during heat waves. There is a need for a clear process for applying microclimate information in urban design to create cooler cities. A recent paper points out the gaps in research methodology and suggests the need for implementation-oriented research. It suggests action steps to take research from theory to practice. The framework has five steps, and in our paper, we have addressed four of those steps: (1) understanding the needs of designers; (2) integrated research on urban microclimate factors; (3) development of guidance methods for better design; and (4) developing user-friendly tools. To address the first step, a group of Chinese landscape architects was given a questionnaire and it was found that they perceived principles and guidelines as being the most useful microclimatic design methods. The second step was addressed through a case study with on-site measurements and modeling. In step 3, microclimate information was used to redesign the site. The process that followed addressed the fourth step by illustrating user-friendly tools. [ABSTRACT FROM AUTHOR]

Thermal comfort research has utilized various sensors and models to estimate the mean radiant temperature (MRT) experienced by a human, including the standard black globe thermometer (SGT), acrylic globe thermometers (AGT), and cylindrical radiation thermometers (CRT). Rather than directly measuring radiation, a temperature is measured in the center of these low-cost sensors that can be related to MRT after theoretically accounting for convection. However, these sensors have not been systematically tested under long-term hot and clear conditions. Further, under variable weather conditions, many issues can arise due to slow response times, shape, inaccuracies in material properties and assumptions, and color (albedo, emissivity) inconsistencies. Here, we assess the performance of MRT produced by various heat transfer models, with and without new average surface temperature ( T ¯ s ) correction factors, using five instruments—the SGT (15 cm, black), tan and black CRTs, gray and black 38 mm AGTs—compared to 3D integral radiation measurements. Measurements were taken on an unobscured roof throughout summer-to-early-fall months in Tempe, Arizona, examining 58 full-sun days. Deviations without correcting for asymmetrical surface heating—found to be the main cause of errors—reached ± 15–20 °C MRT. By accounting for asymmetric heating through T ¯ s calculations, new corrective algorithms were derived for the low-cost sensor models. Results show significant improvements in the estimated MRT error for each sensor (i.e., ∆MRTmodel − IRM) when applying the T ¯ s corrections. The tan MRTCRT improved from 1.9 ± 6.2 to −0.1 ± 4.4 °C, while the gray AGT and SGT showed improvements from −1.6 ± 7.2 to −0.4 ± 6.3 °C and − 6.6 ± 6.4 to − 0.03 ± 5.7 °C, respectively. The new corrections also eliminated dependence on other meteorological factors (zenith, wind speed). From these results, we provide three simple equations for CRT, AGT, and SGT correction for future research use under warm-hot and clear conditions. This study is the most comprehensive empirical assessment of various low-cost instruments with broad applicability in urban climate and biometeorological research. [ABSTRACT FROM AUTHOR]

The article focuses on Thomas Birch had written up the noble endeavours and famous deeds of men. Topics include examines the divine Protectress of Truth surveyed him with sharp eyes, and spoke at length with a calm expression as just persevere, and after death there will one day be a second Birch to record the praises that deserve.

Background: There are few contemporary epidemiological data on stroke for Central Europe. We performed a population-based study evaluating the incidence of stroke, stroke types, and ischemic stroke (IS) subtypes in Brno, the second biggest city in the Czech Republic (CR). Methods: Using the National Registry of Hospitalized Patients, and hospital databases, we identified all patients hospitalized with a stroke diagnosis in Brno hospitals in 2011. For Brno residents with validated stroke diagnosis, we calculated (a) the overall incidence of hospitalized stroke, (b) incidence rates for IS, subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), and (c) incidence rates for IS subtypes. We calculated the average annual age- and sex-standardized incidence (European Standard Population and World Health Organization), to compare our results with other studies. Results: The overall crude incidence of stroke in Brno was 213/100,000 population. The incidence of stroke for stroke types were as follows: SAH, 6.9; ICH, 26.4; and IS, 180 cases per 100,000 population, respectively. The WHO-standardized annual stroke incidence was 107 for all strokes and 88 for IS, 14.4 for ICH, and 5 for SAH. For IS subtypes, the WHO-standardized incidence was large artery atherosclerosis 25.8, cardioembolism 27.8, lacunar 21.6, other determined etiology 6.2, and undetermined etiology 6.5 cases per 100,000 population. Conclusions: The stroke incidence is lower than that previously reported for the CR and Eastern Europe probably reflecting socioeconomic changes in post-communistic countries in the region. These findings could contribute to stroke prevention strategies and influence health policies. [ABSTRACT FROM AUTHOR]

Background: The National Institute of Neurological Disorders and Stroke (NINDS) Common Data Elements (CDEs) have been generated to standardize and define terms used by the scientific community. The widespread use of these CDEs promotes harmonized data collection in clinical research. The aim of the NINDS Unruptured Intracranial Aneurysms (UIA) and Subarachnoid Hemorrhage (SAH), and Subject Characteristics working group (WG) was to identify, define, and classify CDEs describing the characteristics of patients diagnosed with an UIA and SAH. Thus, "Participant/Subject characteristics" is a set of factors defining a population of selected individuals and allowing comparisons with a reference population and overtime.Methods: Based on standard terms defined by the United States' Census Bureau, CDEs previously defined by several (Stroke, Epilepsy and Traumatic Brain Injury) NINDS CDE working groups literature and expert opinion of the WG, the "Participant/Subject characteristics" domain has been defined.Results: A set of 192 CDEs divided in 7 subsections: demographics (8 CDEs), social status (8 CDEs), behavioral status (22 CDEs), family and medical history (144 CDEs), pregnancy and perinatal history (8 CDEs), history data source reliability (3 CDEs), and prior functional status (3 CDEs) was defined. SAH is characterized by 6 core elements, all classified in the "Participant/Subject characteristics" domain. Four exploratory elements out of the 39 for SAH overall are in the "Participant/Subject characteristics" domain, and all remaining 182 CDEs in the "Participant/Subject characteristics" domain are classified as Supplemental-Highly Recommended elements.Conclusions: These CDEs would allow the development of best practice guidelines to standardize the assessment and reporting of observations concerning UIA and SAH. [ABSTRACT FROM AUTHOR]

Objectives: The goal for this project was to develop a comprehensive set of common data elements (CDEs), data definitions, case report forms and guidelines for use in unruptured intracranial aneurysm (UIA) and subarachnoid hemorrhage (SAH) clinical research, as part of a new joint effort between the National Institute of Neurological Disorders and Stroke (NINDS) and the National Library of Medicine of the US National Institutes of Health. These UIA and SAH CDEs will join several other neurological disease-specific CDEs that have already been developed and are available for use by research investigators.Methods: A Working Group (WG) divided into eight sub-groups and a Steering Committee comprised of international UIA and SAH experts reviewed existing NINDS CDEs and instruments, created new elements when needed and provided recommendations for UIA and SAH clinical research. The recommendations were compiled, internally reviewed by the entire UIA and SAH WG and posted online for 6 weeks for external public comments. The UIA and SAH WG and the NINDS CDE team reviewed the final version before posting the SAH Version 1.0 CDE recommendations.Results: The NINDS UIA and SAH CDEs and supporting documents are publicly available on the NINDS CDE ( https://www.commondataelements.ninds.nih.gov/#page=Default ) and NIH Repository ( https://cde.nlm.nih.gov/home ) websites. The recommendations are organized into domains including Participant Characteristics and Outcomes and Endpoints.Conclusion: Dissemination and widespread use of CDEs can facilitate UIA and SAH clinical research and clinical trial design, data sharing, and analyses of observational retrospective and prospective data. It is vital to maintain an international and multidisciplinary collaboration to ensure that these CDEs are implemented and updated when new information becomes available. [ABSTRACT FROM AUTHOR]

Trees are considered to be an effective tool for improving human thermal comfort in hot climates and have been widely used in landscape architecture. However, it is not always clear how trees affect human-environment energy fluxes. In this study, an in-depth analysis of four common tree species was undertaken based on comprehensive field measurements, in terms of how each tree and its characteristics affected the energy fluxes of a person in a humid subtropical climate region. Results showed that the largest effect of trees was on radiation fluxes, with a much smaller effect on the convective and evaporative fluxes. For a person standing in shade, a tree can reduce approximately 25% of the absorbed radiation compared with an open reference point. Moreover, the cooling effect on radiation components was found to be greater in the solar radiation domain than in the terrestrial radiation domain. Solar radiation and ground surface temperature had the largest effect on a human energy budget, which was affected by characteristics of the trees and the thermophysical properties of ground surfaces. The effect from relative humidity and wind speed was quite minimal. For the four common tree species in this study, Ficus microcarpa had the best thermal performance by reducing the most absorbed solar radiation flux. This study shows a detailed empirical research about the thermal effects of trees on a person, providing recommendations for tree species selection in urban design. [ABSTRACT FROM AUTHOR]

Many children growing up in cities are spending less time outdoors to escape the heat. This is contributing to childhood obesity and the prospect of a range of diseases in adulthood. When landscape architects and urban designers use a human thermal comfort model to test their designs for children's comfort, they would have to use a model essentially designed to simulate healthy adults. Yet there are many differences between the body of a child and an adult. The aim of this paper was to modify the thermal comfort model COMFA into a children's energy budget model through the consideration of the heat exchange of a child. The energy budget of a child can be up to 21 W/m2 higher than adults in hot summertime conditions, and 26 W/m2 lower in cold conditions. The model was validated through field studies of 65 children (32 boys and 33 girls) aged from 7-12 years old in 9 days from March to June in 2019, in 68 different microclimates ranging from cool to hot. A 5-point thermal comfort scale of energy budget for children was created using multinomial logistic regression, which revealed that children have a different range of thermal acceptability than adults. The frequency distribution of the actual thermal sensation and the predicted thermal comfort was improved using the new scale. The actual thermal sensation responses from children and the predicted thermal sensation using the model was determined to be positively significantly related. The accuracy of the model was 93.26%. This study has provided an effective children's energy budget model to predict children's thermal comfort. Its application can contribute to the design of thermally comfortable children's outdoor play areas by landscape architects and urban designers. [ABSTRACT FROM AUTHOR]

Notes of Terry's phenomenal career: Terry received his B.Sc. in Physics from the University of British Columbia in 1962 and his M.A. in Meteorology from the University of Toronto. Dr. Terry Gillespie, an emeritus professor at the University of Guelph, passed away suddenly on December 2, 2018, following a brief illness. B Bob, Terry, and University of Guelph Chancellor Martha Billes in 2018 where Bob received University Professor Emeritus. [Extracted from the article]

The behavioral repertoire and environmental feature needs for thermoregulatory comfort have not been reported in the literature for large captive exotics. An observational study was done to investigate the behavioral repertoire of tigers via continuous observation, while focusing on thermoregulatory behavior, in order to examine behavioral and thermoregulatory needs of these animals, and inform microclimatic landscape design for thermal comfort. Nine Bengal tigers (n = 6 females, n = 3 males) were observed in June 2012, and behavior data were recorded every minute, while thermal images of each individual, wind speed, ambient temperature, and relative humidity were recorded every 15 min. Descriptive statistics were used to analyze the data due to the observatory nature of the study. All tigers spent on average over 45% of the time lying down, less than 19% of the time in direct sunlight and over 20% of their time in the shade. Males did more panting (25.6%) than females (15.1%). There was more individual variation in water and cave usage, compared with shade use and lying behaviors, which could be related to social pressures or basic individual preferences. In summary, shade is a very valuable thermoregulatory resource for tigers. Adding more shade structures to increase thermal comfort and increase activity in these cats (around 10% on average active behaviors) by adding to the space available in the shaded areas. [ABSTRACT FROM AUTHOR]

Although white matter hyperintensities have traditionally been viewed as a marker of vascular disease, recent pathology studies have found an association between white matter hyperintensities and Alzheimer's disease pathologies. The objectives of this study were to investigate the topographic patterns of white matter hyperintensities associated with Alzheimer's disease biomarkers measured using PET. From the population-based Mayo Clinic Study of Aging, 434 participants without dementia (55% male) with FLAIR and gradient recall echo MRI, tau-PET (AV-1451) and amyloid-PET scans were identified. A subset had cerebral microbleeds detected on T2* gradient recall echo scans. White matter hyperintensities were semi-automatically segmented using FLAIR MRI in participant space and normalized to a custom template. We used statistical parametric mapping 12-based, voxel-wise, multiple-regression analyses to detect white matter hyperintense regions associated with Alzheimer's biomarkers (global amyloid from amyloid-PET and meta-regions of interest tau uptake from tau-PET) after adjusting for age, sex and hypertension. For amyloid associations, we additionally adjusted for tau and vice versa. Topographic patterns of amyloid-associated white matter hyperintensities included periventricular white matter hyperintensities (frontal and parietal lobes). White matter hyperintense volumes in the detected topographic pattern correlated strongly with lobar cerebral microbleeds (P < 0.001, age and sex adjusted Cohen's d = 0.703). In contrast, there were no white matter hyperintense regions significantly associated with increased tau burden using voxel-based analysis or region-specific analysis. Among non-demented elderly, amyloid load correlated with a topographic pattern of white matter hyperintensities. Further, the amyloid-associated, white matter hyperintense regions strongly correlated with lobar cerebral microbleeds suggesting that cerebral amyloid angiopathy contributes to the relationship between amyloid and white matter hyperintensities. The study did not support an association between increased tau burden and white matter hyperintense burden. [ABSTRACT FROM AUTHOR]

Landscape architecture is a young discipline relative to other design-based fields, such as engineering or architecture. The unique knowledge, processes, and capacities of landscape architects--central requirements of a recognizable profession--are currently broad and largely undefined. The profession needs to have clearly defined knowledge domains recognized by other disciplines and the public. This study used four sources of evidence to identify core landscape architecture knowledge domains: (1) a census of land design and development professionals from the 1970s; (2) a sample of U.S. landscape architects in the early 2000s; (3) two systematic reviews of articles published in Landscape Journal over a 25-year period; and, (4) courses offered in accredited first-professional Master of Landscape Architecture (MLA) programs across North America. Ten knowledge domains were identified, none of which were unique to landscape architecture. Two domains, design and natural, were identified by all data sources to be core to landscape architecture. However, the connections between knowledge domains, rather than the domains themselves, and a focus on conceptualizing appropriate change to the landscape, might more appropriately define the core domains of landscape architecture. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and outcomes of intracranial aneurysm (IA) in patients with bicuspid aortic valve (BAV).Methods: Retrospective review of patients with BAV who underwent brain MR angiography at the Mayo Clinic from 1994 to 2013.Results: There were 678 patients included in this study-mean age 57±13 years, men 480 (71%), mean follow-up 10±3 years (5913 patient-years). Coarctation of aorta (COA) was present in 154 (23%) patients.There were 59 IAs identified in 52 of 678 patients (7.7%). IA was present in 20/154 patients (12.9%) with COA and 32/524 patients (5.7%) without COA (p<0.001). For the patients without COA, female gender and right-left cusp fusion were risks factors for IA in women after adjustment for all potential variables (HR 1.76, CI 1.31 to 2.68, p=0.03). There was no significant trend in the risk for IA across age tertiles: age ≤40 years versus 41-60 years (HR 1.19, p=0.34), and age 41-60 years versus 61-80 years (HR 1.06, p=0.56).Among the 52 patients with IA, enlargement occurred in three patients (6%), rupture in two patients (4%) and four patients (8%) underwent coil embolisation. For the 626 patients without IA at baseline, no patient developed IA over 7±2 years of imaging follow-up.Conclusions: BAV is associated with a higher prevalence of IA compared to the general population, and this risk is higher in patients with COA, right-left cusp fusion and female gender. [ABSTRACT FROM AUTHOR]

Background: Providing the correct level of care for patients with intracerebral hemorrhage (ICH) is crucial, but the level of care needed at initial presentation may not be clear. This study evaluated factors associated with admission to intensive care unit (ICU) level of care.Methods: This is an observational study of all adult patients admitted to our institution with non-traumatic supratentorial ICH presenting within 72 h of symptom onset between 2009-2012 (derivation cohort) and 2005-2008 (validation cohort). Factors associated with neuroscience ICU admission were identified via logistic regression analysis, from which a triage model was derived, refined, and retrospectively validated.Results: For the derivation cohort, 229 patients were included, of whom 70 patients (31 %) required ICU care. Predictors of neuroscience ICU admission were: younger age [odds ratio (OR) 0.94, 95 % CI 0.91-0.97; p = 0.0004], lower Full Outline of UnResponsiveness (FOUR) score (0.39, 0.28-0.54; p < 0.0001) or Glasgow Coma Scale (GCS) score (0.55, 0.45-0.67; p < 0.0001), and larger ICH volume (1.04, 1.03-1.06; p < 0.0001). The model was further refined with clinician input and the addition of intraventricular hemorrhage (IVH). GCS was chosen for the model rather than the FOUR score as it is more widely used. The proposed triage ICH model utilizes three variables: ICH volume ≥30 cc, GCS score <13, and IVH. The triage ICH model predicted the need for ICU admission with a sensitivity of 94.3 % in the derivation cohort [area under the curve (AUC) = 0.88; p < 0.001] and 97.8 % (AUC = 0.88) in the validation cohort.Conclusions: Presented are the derivation, refinement, and validation of the triage ICH model. This model requires prospective validation, but may be a useful tool to aid clinicians in determining the appropriate level of care at the time of initial presentation for a patient with a supratentorial ICH. [ABSTRACT FROM AUTHOR]

In the course of his attack on romantic love, Lucretius asserts that even the most beautiful woman shares the failings of an ugly one, such as making bad smells. The source of this smell is controversial, with suggestions including perfume, cosmetics, defecation, menstruation, flatulence and gynecological fumigation. The article lays down four criteria for a convincing interpretation and tests the different theories against these. It concludes that the reference is scatological and illustrates the influence of the passage on certain poems of Jonathan Swift. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to test the hypothesis that high levels of preoperative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are associated with an increased risk of systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL). Materials and Methods: This is a retrospective study of patients who underwent PCNL at our institution between October 2012 and October 2013 when ESR and CRP levels were part of our standard preoperative order set. The primary endpoint was development of SIRS. Receiver operating characteristic curves were used to evaluate the discriminative ability of the test. Results: Among the 107 PCNLs performed during the study period, 35 (33%) patients had evidence of SIRS during the postoperative stay. Patients who experienced SIRS had a longer operative time (99 min vs. 85 min, p = 0.016), were more likely to have been transferred to the intensive care unit (ICU) (15% vs. 0%, p = 0.002), and experienced a longer length of stay (2 days vs. 1 day, p < 0.001). On multivariable analysis controlling for operative time and positive urine culture, ESR (odds ratio [OR] 1.32, 95% confidence interval [CI]: 1.01-1.72, p = 0.04) and CRP (OR 1.59; 95% CI: 1.07-2.37, p = 0.02) were associated with development of SIRS. Among patients without a positive urine culture, an ESR >6.5 mm/hr (AUC 0.62; 95% CI: 0.52-0.78) had sensitivity, specificity, and negative predictive value (NPV) of 70.4%, 61.5%, and 80.0%, respectively, for development of SIRS. Among all patients, a CRP >0.65 mg/dL (AUC 0.63; 95% CI: 0.51-0.74) had sensitivity, specificity, and NPV of 51.4%, 69.4%, and 74.6%. Conclusions: A preoperative blood test for ESR and CRP was predictive for the development of SIRS after PCNL. This knowledge could be used to risk stratify patients and guide duration of antibiotic prophylaxis before PCNL, particularly among those without a positive urine culture. [ABSTRACT FROM AUTHOR]

Objective: To determine post-stroke 30-d readmission rate, its predictors, its impact on mortality and to identify potentially preventable causes of post-stroke 30-d readmission in a population-based study.Patients and methods: We identified all acute ischemic strokes (AIS) using the International Classification of Diseases 9th revision codes (433.x1, 434.xx and 436) via the Rochester Epidemiology Project (REP) between January 2007 and December 2011. Acute stroke care in Olmsted County is provided by two medical centers, Saint Marys Hospital and Olmsted Medical Center Hospital. All readmissions to these two hospitals were accounted for this study. Thirty-day readmission data was abstracted through manual chart review. The REP linkage database was used to identify the status (living/dead) of all patients at last follow up.Results: Forty-one (7.6%, 95% CI 5.7%–10.2%) of total 537 AIS patients were readmitted 30-d post-stroke. In a multivariable logistic regression model, discharge to nursing home following index stroke (OR: 0.29, 95% CI 0.08–0.84) was an independent negative predictor of unplanned 30-d readmission. In a subgroup of patients with dementia, being married at time of index stroke was found to be a negative predictor of readmission (OR: 0.10, 95% CI 0.005–0.58). Only 2.8% of the patients had potentially preventable readmissions. Hospital readmission had no significant impact on patient's short-term (three months) or long-term (one or two years) mortality (p> 0.05).Conclusion: Post-stroke 30-d readmission rate is low in AIS patients from Olmsted County. Further research is needed in regarding discharge checklists, protocols and stroke transitional programs to reduce potentially preventable readmissions. [ABSTRACT FROM PUBLISHER]

Background and Purpose: Cardiac myxomas can present with a myriad of neurological complications including stroke, cerebral aneurysm formation and metastatic disease. Our study had two objectives: (1) to describe the neuroimaging findings of patients with cardiac myxomas and (2) to examine the relationship between a history of embolic complications secondary to myxoma and intracranial aneurysm formation, hemorrhage and metastatic disease. We hypothesized that patients who present with embolic complications related to myxoma would be more likely to have such complications. Materials and Methods: We searched our institutional database for all patients with pathologically proven cardiac myxomas from 1995 to 2014 who received neuroimaging. Neuroimaging findings were categorized as acute ischemic stroke, intracerebral hemorrhage, oncotic aneurysm, and cerebral metastasis. Cardiac myxoma patients were divided into those presenting with embolic complications (i.e. lower extremity emboli or cerebral emboli) and those presenting with non-embolic complications prior to surgical resection of the myxoma. The prevalence of intracranial hemorrhage, myxomatous aneurysm formation, and cerebral metastases was compared in myxoma patients presenting with and without embolic complications using a Chi-squared test. Results: Forty-seven consecutive patients were included in this study. Sixteen patients (34.0%) had imaging evidence of acute ischemic stroke. Of these, 13 had acute ischemic strokes directly attributed to the cardiac myxoma (27.7%) and 3 had acute ischemic strokes secondary to causes other than myxoma (6.4%). Seven patients (14.9%) had aneurysms. Two patients (4.3%) had parenchymal metastatic disease on long-term imaging. Fourteen patients (29.8%) presented with ischemic symptoms that were attributed to cardiac myxoma (1 with lower extremity ischemia, 1 with lower extremity ischemia and ischemic stroke, and 12 with ischemic stroke). Patients presenting with embolic complications related to the myxoma (ischemic stroke or lower extremity ischemia) were more likely to have imaging evidence of intracranial hemorrhage (21.4 vs. 3.0%, p = 0.09), oncotic aneurysm (35.7 vs. 6.1%, p = 0.03), and cerebral metastasis (14.3 vs. 0.0%, p = 0.07) on follow-up imaging. Conclusions: Ischemic stroke and intracranial oncotic aneurysm were found in a substantial proportion of cardiac myxoma patients undergoing neuroimaging. Patients presenting with embolic complications of cardiac myxoma are more likely to have intracranial hemorrhage, intracranial oncotic aneurysms, and cerebral metastatic disease. [ABSTRACT FROM AUTHOR]

Objective To describe the treatment and outcomes of patients with primary central nervous system (CNS) vasculitis. Methods We retrospectively studied a cohort of 163 consecutive patients with primary CNS vasculitis who were seen at the Mayo Clinic over a 29-year period. We analyzed treatments, treatment responses, and factors predictive of outcomes. Results A favorable response was observed in 85% of patients treated with prednisone alone and in 80% of patients treated with prednisone and cyclophosphamide. Relapses were observed in 27% of patients, and 25% of patients had discontinued therapy by the time of the last followup visit. Treatment with prednisone alone was associated with more frequent relapses (odds ratio [OR] 2.90), while large vessel involvement (OR 6.14) and cerebral infarcts at the time of diagnosis (OR 3.32) were associated with a poor response to treatment. Prominent gadolinium-enhanced cerebral lesions or meninges were linked with continued treatment at the last followup encounter (OR 2.28). Higher disability scores at the last followup visit were associated with increasing age at the time of diagnosis (OR 1.44) and cerebral infarctions (OR 3.74), while lower disability scores were associated with gadolinium-enhanced cerebral lesions or meninges (OR 0.35) and cerebral amyloid angiopathy (OR 0.24). Increased mortality was associated with increasing age at diagnosis (hazard ratio [HR] 1.39), diagnosis by angiography (HR 3.28), cerebral infarction (HR 4.44), and large vessel involvement (HR 4.98), while reduced mortality was associated with gadolinium-enhanced cerebral lesions or meninges (HR 0.20). Conclusion The majority of patients with primary CNS vasculitis responded to treatment. Recognition of findings at diagnosis that predict the course or outcome may aid in decision-making regarding therapy. [ABSTRACT FROM AUTHOR]