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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jenvman.2007.01.063 Byline: Raffaele Lafortezza (a), Robert C. Corry (b), Giovanni Sanesi (a), Robert D. Brown (b) Keywords: Alternative landscapes; Visual preferences; Cost-surface modeling; Urban forests; Brownfield sites Abstract: This paper describes an integrative method for quantifying, analyzing, and comparing the effects of alternative rehabilitation approaches with visual preference. The method was applied to a portion of a major industrial area located in southern Italy. Four alternative approaches to rehabilitation (alternative designs) were developed and analyzed. The scenarios consisted of the cleanup of the brownfields plus: (1) the addition of ground cover species; (2) the addition of ground cover species and a few trees randomly distributed; (3) the addition of ground cover species and a few trees in small groups; and (4) the addition of ground cover species and several trees in large groups. The approaches were analyzed and compared to the baseline condition through the use of cost-surface modeling (CSM) and visual preference assessment (VPA). Statistical results showed that alternatives that were more ecologically functional for forest bird species dispersal were also more visually preferable. Some differences were identified based on user groups and location of residence. The results of the study are used to identify implications for enhancing both ecological attributes and visual preferences of rehabilitating landscapes through planning and design. Author Affiliation: (a) greenLab, Department of Scienze delle Produzioni Vegetali, University of Bari, Via Amendola 165/A, 70126 Bari, Italy (b) School of Environmental Design & Rural Development, University of Guelph, Guelph, Ontario, Canada Article History: Received 16 December 2005; Revised 17 October 2006; Accepted 9 January 2007

• Unruptured intracranial aneurysm (UIA) is a rare manifestation of primary cental nervous system vasculitis (PCNSV) occurring in 5.5 % of patients. • PCNSV patients with UIA are characterized by a favorable response to immunosuppressive therapy with low disability. • Immunosuppressive treatment may play a role in preventing aneurysm rupture and the development of new aneurysms. Unruptured intracranial aneurysms (UIAs) are rarely reported in primary central nervous system vasculitis (PCNSV). In this study we described the clinical findings, response to therapy, and outcomes of UIA in a large cohort of PCNSV patients. We retrospectively studied 216 consecutive patients with PCNSV, selected by predetermined diagnostic criteria, who were seen during a 40-year period. UIAs were identified on cerebral angiography. The clinical, laboratory, radiologic and pathologic findings, management, and outcomes of patients with UIA were described and compared with those without UIA. 12/216 (5.5 %) PCNSV patients had at least one UIA. Two patients underwent biopsies; one yielded negative results, while the other showed necrotizing vasculitis. Eleven patients had evidence of UIA on angiogram at diagnosis. One patient developed an aneurysm during the follow-up associated with a worsening of vasculitic radiological findings. The most common presenting symptom for PCNSV in the setting of UIA was headache (67 %), followed by persistent neurologic deficit or stroke (50 %). Most patients with UIA presented with multiple cerebral infarcts on MRI (67 %), one patient had subarachnoid hemorrhage, and one left parieto-occipital intracerebral hematoma, both unrelated to the aneurysm. Black blood imaging was performed in 4 patients and 2 showed segmental circumferential mural enhancement involving multiple vessels. Two patients had 2 UIAs, while the other 10 had 1. The most frequent UIA location was internal carotid artery (50 %), followed by anterior cerebral artery (21 %). Ten of the UIAs were < 5 mm in diameter, and 3 were 5–7 mm in diameter; the size was not available for one. All UIAs were unchanged in size and configuration during follow-up (median: 18.5 months; range 1–151 months) and no new aneurysms were detected. Compared to the 204 patients with PCNSV without a UIA, no significant clinical differences were observed, except for a reduced disability at last follow-up (p = 0.038). UIAs uncommonly occur in PCNSV. [ABSTRACT FROM AUTHOR]

Walking enhances health and supports urban sustainability. Outdoor thermal comfort significantly influences people's enthusiasm for walking and the quality of their outdoor activities. When walking in urban streets, pedestrians encounter a series of unstable microclimate environments. However, current models for assessing outdoor thermal comfort typically focus on specific locations and times, failing to fully account for the varied conditions along the entire path. To meet pedestrians' actual walking needs, this study investigates pedestrian thermal comfort through a whole-trip perspective, conducted within a controlled laboratory setting. A series of experiments were carried out in a climate chamber, creating varied dynamic thermal radiation exposure scenarios to analyze their effects on pedestrians' perceptions throughout the trip segments they have completed. Findings indicate that for pedestrians experiencing dynamic environmental changes, whole-trip thermal sensation is neither equivalent to instantaneous thermal sensation nor to the weighted average of past thermal sensations at different time periods. Current instantaneous thermal sensation, mean skin temperature, and the surplus Joules received by the human body compared to the neutral thermal state can better characterize the whole-trip thermal sensation of pedestrians. The results of this study will help to deepen the understanding of human thermal perception patterns in dynamic environments and provide a theoretical basis for outdoor microclimate design and pedestrian thermal comfort evaluation. [Display omitted] • Study explores pedestrian thermal comfort from a whole-trip perspective. • Experiments in a climate chamber simulate dynamic thermal radiation exposure on pedestrian perceptions. • The whole-trip thermal sensation differs from instantaneous or past thermal sensation averages. • Pedestrian memory thermal sensation can be characterized by skin temperature and surplus Joules. • Appropriate dynamic sunlight-shade experiences may better mitigate TSV w than the full-shade one. [ABSTRACT FROM AUTHOR]

A Critical Urban Stream Temperature (CrUSTe) model, a combination of stream temperature and three component models, was presented. The component models were the riparian vegetation removal model, the stream morphology model and the base flow model. The CrUSTe model allows the prediction of stream temperature change as a result of amount, type and location of urbanization within a watershed, making it a potential valuable tool for environmental managers.

Walking promotes human health and well-being. However, increasing temperatures due to global climate change and urban heat islands challenge urban walkability. While people navigate urban settings, they encounter asymmetrical environmental conditions not captured by most thermal comfort models. Critically, these models predominantly factor in the Mean Radiant Temperature (MRT) but tend to neglect the effects of non-uniform solar radiation on human comfort. This study delves into the thermal impacts of solar radiation on walking individuals, utilizing a controlled environment with solar simulators. 28 subjects walked on a treadmill, simulating the walking state of pedestrians, under asymmetrical radiation conditions with the source being overhead, in front, behind, and to the side. Participants responded to queries concerning their overall thermal comfort, thermal sensation, and thermal acceptability. In addition, they provided feedback on directional and segmental thermal sensations across various body parts. Our findings revealed that the thermal sensation varied depending on the direction of radiation, and their responses regarding their forearms were most closely related to their whole body. These results provide information that can be valuable in the design of outdoor environments that will be thermally comfortable and will encourage people to walk during hot weather. • Pedestrian thermal responses under simulated solar radiation studied. • Directional body areas exposed to solar radiation contribute differently to TSV o. • Predicting TSV o using T sk,m or T sk,seg, s requires considering the direction of solar radiation exposure. [ABSTRACT FROM AUTHOR]

Abstract In the wake of major earthquakes public open spaces become hubs for both short-term disaster response efforts and support longer-term recovery needs. At present, few open spaces are actually designed to support these intermittent but critical uses. Currently, there is no consolidated body of knowledge or resource for landscape architects designing for areas of high seismic risk. This research identifies ways in which landscape architects and professionals within allied design disciplines can proactively plan and design open space to support seismic resilience. A systematic review of both grey literature and peer-reviewed academic papers was conducted. The results of the systematic review identified six key themes: Multifunctionality; networks; site location and suitability; size and function; site elements; and, social resilience. These themes contribute to developing a foundation for design disciplines to better incorporate seismic resilience into planning and design of public open spaces. Highlights • Need for open space design to support earthquake response/recovery is increasing. • Design disciplines must assume a larger role in seismic resilience. • Open space should be designed to meet basic human needs (water, food, sanitation). • Programming, education and community engagement are critical components of design. • Design for seismic resilience enhances the overall quality of the urban environment. [ABSTRACT FROM AUTHOR]

The urban thermal environment has a direct impact on the outdoor thermal comfort of city dwellers and pedestrians, which can have negative effects on their health and overall quality of life. Therefore, it is crucial to estimate the influence of the thermal environment in micro-scale urban spaces. Previous studies have used estimation models that only consider a limited number of meteorological elements and urban geometry. This study developed a new model that incorporates the concept of micro-scale heat islands (MHIs) using field measurements to estimate the micro-scale thermal environment in urban spaces. The study found that factors such as sky view factor (SVF), floor area ratio (FAR), and building coverage ratio (BCR) have a significant impact on the thermal environment of urban street canyons. Based on these results, an MHI model was developed and tested. In this process, the aspect ratio (H/W) concept was extended to a three-dimensional perspective and used to calculate the amount of heat contained in the air volume in a street canyon. This study applied a method of maximizing the use of data collected in the study area using a mobile weather station. SVF, air temperature, and surface temperature were reflected in calculating the net radiation and sensible heat flux. The MHI model showed 86.19% explanatory power in estimating the thermal environment of urban canyons. The model would benefit from further refinement by incorporating data from various cities and reflecting the characteristics of different climatic regions and urban forms. • This study found that SVF, FAR and BCR urban geometry influence micro-scale thermal environments in urban street canyons. • This study developed an MHI model to accurately estimate micro-scale thermal environments. • The MHI model has 86.19% explanatory power in estimating the thermal environment of urban canyons. • More diversified urban-scale heat island models are needed. [ABSTRACT FROM AUTHOR]

Data on safety of thrombolysis for acute ischemic stroke (AIS) in patients with hematologic malignancy is not well established. We report our single institution experience with thrombolysis in this patient population. We identified patients with pathology-confirmed hematologic malignancy from 2000-2022. Primary exposure was presence of AIS and receipt of intravenous (IV) thrombolysis. Primary outcome was safety of IV thrombolysis in this patient population. Safety was measured through imaging review for hemorrhagic transformation, post-stroke mortality, and modified Rankin Scale (mRS) at 90 days. Among 45,894 patients with hematologic malignancy, 1,099 (2.4%) were identified as having a suspected AIS. Twenty (1.8%) received IV tissue plasminogen activator (tPA) for AIS, three underwent endovascular intervention, and 17 had AIS confirmed on MRI. Two patients with confirmed AIS experienced hemorrhagic transformation, one of which was symptomatic. Most patients (n=10, 59%) were functionally independent (mRS 0-2) at 90 days post-stroke, including all patients with active hematologic malignancy at the time of stroke (n=3). Four patients died within 90 days of AIS. None of these deaths were patients with active hematologic malignancy at the time of stroke. Without other contraindications, IV alteplase should be considered for management of AIS in patients with hematologic malignancy. The safety profile of tPA administration in this patient population may be similar to the general population, whether underlying hematologic malignancy is active or in remission. [ABSTRACT FROM AUTHOR]

Background: Contemporary stroke incidence data are not available in some countries and regions, including in Eastern Europe. Based on previous validation of the accuracy of the National Registry of Hospitalized Patients (NRHOSP), we report the incidence of hospitalized stroke in the Czech Republic (CR) using the NRHOSP.Methods: The results of the prior validation study assessing the accuracy of coding of stroke diagnoses in the NRHOSP were applied, and we calculated (1) the overall incidence of hospitalized stroke and (2) the incidence rates of hospitalized stroke for the three main stroke types: cerebral infarction (International Classification of Diseases Tenth Revision, CI I63), subarachnoid hemorrhage (SAH I60), and intracerebral hemorrhage (ICH I61). We calculated the average annual age- and sex-standardized incidence.Results: The overall incidence of hospitalized stroke was 241 out of 100,000 individuals. The incidence of hospitalized stroke for the main stroke types was 8.2 cases in SAH, 29.5 in ICH, and 211 in CI per 100,000 individuals. The standardized annual stroke incidence adjusted to the 2000 World Health Organization population for overall stroke incidence of hospitalized stroke was 131 per 100,000 individuals. Standardized stroke incidence for stroke subtypes was 5.7 cases in SAH, 16.7 in ICH, and 113 in CI per 100,000 individuals.Conclusions: These studies provide an initial assessment of the burden of stroke in this part of the world. The estimates of hospitalized stroke in the CR and Eastern Europe suggest that ICH is about three times more common than SAH, and hemorrhagic stroke makes up about 18% of strokes. [ABSTRACT FROM AUTHOR]

As human beings live in an environment where various factors interact and integrate, it seems vital to examine the effects of these factors on environmental perceptions. Outdoor thermal and acoustic environments are the main factors affecting the overall comfort of urban spaces. This research uses measurements and questionnaire surveys to explore the effects of outdoor thermal comfort dimensions on acoustic comfort, emphasizing the plant community in a city park (the El Goli Park of Tabriz, Iran). In this regard, the general comfort of the psychological equivalent temperature (PET) under different conditions of the thermal-acoustic environment has been evaluated and predicted. The results showed that a higher thermal sensation vote (TSV) and PET result in a significant decrease in soundscape quality (SQ), overall impression (OI), and the percentage of reported natural dominant sound (%RNDS), while an inverse trend has been reported in thermal comfort vote (TCV). On the other hand, by increasing TSV and PET, reported loudness (RL) has recorded an upward trend. However, this process was completely reversed in TCV. Furthermore, the analyzes showed that PET has a lower effectiveness compared to TSV and TCV and, it should be stated that the three indicators of thermal comfort did not show any significant relationship with landscape quality (LQ) and sound pressure level (SPL). These findings are important for managing and improving outdoor acoustic comfort and soundscapes, and it is expected that future studies will consider the acquired results in various green urban environments and provide a practical framework for landscape architects and urban planners. • Explore the effect of thermal comfort on acoustic comfort in urban parks with an emphasis on plant communities. • Data from many questionnaires were collected and compared to experimental results. • TSV and PET are negatively associated with SQ, %RNDS, and OI and positively with RL. • TCV is positively associated with SQ, %RNDS, and OI and negatively with RL. • No significant difference was detected between thermal comfort indices and RL and SPL. [ABSTRACT FROM AUTHOR]

Residents of public or subsidized housing experience social and environmental disadvantages and are therefore particularly vulnerable to disasters. Although research has highlighted risks associated with common disasters, such as floods and heatwaves, to date little is known about the impacts of infrequent disasters, such as a winter storm in a subtropical climate with mild winter weather. Even less is known about factors related to disaster preparation by and coping strategies of these disadvantaged residents. The present study aimed to examine the impacts of the 2021 Winter Storm Uri on subsided housing residents and the factors that enabled or hindered their effective adaptation. We conducted semi-structured interviews two to four months post-disaster with residents from eleven subsidized housing sites in College Station, Texas. A total of 33 participants aged between 24 and 90 completed the interviews. Guided by relevant theories such as the Protective Motivation Theory (PMT), a combination of inductive and deductive coding was carried out using MaxQDA qualitative data analysis software, and codes, themes, and categories were identified reiteratively. The results demonstrated the process involving cognitive appraisal, preparation intention, and behavioral adaptation and the roles played by environmental stressors and infrastructural modifiers in subsidized housing. Specifically, we found: 1) insufficient risk communication and the digital divide hindered formation of accurate hazard appraisal, 2) high perceived costs of preparation contributed to low coping appraisal, 3) Differences in physical infrastructure conditions were linked to varying adaptation capacities and behaviors, and 4) overall social isolation was partly remedied by clustered social ties formed within neighborhoods that were homophily. The implications for future disaster policy and planning are discussed. [ABSTRACT FROM AUTHOR]

Two thirds of Canadians reside in urban areas and 85% of recent population growth occurs in these areas. The intensity and duration of extreme hot weather events are predicted to increase in Canadian cities and in cities globally. It is well established that human suffering due to extreme heat is exacerbated in urban as compared to rural environments. Understanding the characteristics of urban landscapes that play the greatest roles in exacerbating the human health impact of extreme heat is thus imperative. This study explores the relationship between the amount of canopy cover from trees and the incidence of heat-related morbidity during extreme heat events in 544 neighbourhoods of Toronto, Ontario, Canada. Four extreme heat events from three years were studied. Heat-related ambulance calls were found to be 12.3% higher during the heat events than in the preceding or the following week. The number of heat-related ambulance calls was negatively correlated to canopy cover (Spearman Rank rho = −0.094, p = 0.029) and positively correlated to hard surface cover (Spearman Rank rho = 0.150, p < 0.001). Toronto neighbourhoods, as defined by Census Tracts, with less than 5% canopy cover had approximately five times as many heat-related calls as those with greater than 5% tree canopy cover, and nearly fifteen times as many heat-related calls as Census Tracts with greater than 70% tree canopy cover. These data suggest that even a marginal increase in the tree canopy cover from <5% to >5% could reduce heat-related ambulance calls by approximately 80%. These results have important implications for human health during heat events, particularly in the context of global climate change and urban heat islands, both of which are trending toward hotter urban environments in future. [ABSTRACT FROM AUTHOR]

Background and Purpose: Administration of evidence-based pharmacotherapy improves stroke outcome while the use of non-evidence-based medications may not be of benefit and leads to unnecessary patient care costs. The aim of our study was to determine the frequency of guideline-approved and guideline-disapproved pharmacotherapy use in acute stroke management in the Czech Republic (CR).Methods: Using the ICD-10 codes, 500 stroke and transient ischemic attack (TIA) patients were randomly selected (random selection of 10 hospitals and then 50 patients from each hospital) from the National Registry of Hospitalized Patients for strokes occurring in 2011. Discharge summaries were reviewed for medications prescribed during hospitalization and at discharge.Results: Of the 500 requested discharge summaries, 484 were available for review (response rate 97%). Up to 479 (96%) summaries were sufficient for evaluation and of these, 393 were confirmed to have a stroke or TIA diagnosis. Brain imaging (computed tomography or magnetic resonance imaging) was performed in 97% of the 393 cases. Intravenous thrombolysis was administered to 7% of patients with ischemic stroke (rate was 0%-25% in different hospitals). Up to 97% of patients with ischemic events (TIA or ischemic stroke) were treated with antiplatelets or anticoagulants. At least 1 non-evidence-based medication was administered to 28% of the 393 patients (rate was 5%-89% in different hospitals).Conclusions: Guideline-disapproved pharmacotherapy is common in stroke and TIA patients in the CR and processes should be put into place to lessen the frequency of their use. The use of guideline-approved medications is also high and should be further promoted. [ABSTRACT FROM AUTHOR]

• The landscape spatial patterns were significantly associated with the estimated outdoor thermal comfort. The cooling effects of greenery was improved when they were in a more aggregated, less fragmented, and less complex shape. • The landscape metrics of fragmentation (PD), shape (LSI), and proximity (PLADJ) had a positive relationship with the estimated thermal comfort values, whereas composition and connectivity had a negative one. • The urban geometry of sky view factors (SVFs) and floor area ratio (FAR) had a relatively larger cooling capacity to reduce human thermal stress while showing approximately 15% explanatory power in the estimated thermal comfort values. • Interaction effects of landscape metrics with urban geometry and geographical features were identified. Fragmentation (PD) and shape (LSI) metrics had a non-liner relationship with the estimated thermal comfort, which was affected by the proximity to Tokyo Bay, floor area ratio, and building coverage ratio. Rapid urbanization and high-density development are major drivers of global warming. The associations of spatial landscape patterns with urban thermal environments have been extensively investigated. Meanwhile, quantifying the cooling effects of landscape patterns on street-level outdoor thermal comfort has been less attempted. This study examined the relationship between the spatial heterogeneity of landscape patterns and urban residents' outdoor thermal comfort in Tokyo, Japan. The cooling effects of the greenery pattern – configurations and compositions – on thermal comfort were explored while considering the interaction effects of greenery patterns with water bodies and urban densities. Our study findings indicated that spatial landscape patterns have a statistically significant impact on outdoor thermal comfort, showing 69% of explanatory power (Adj-r2) in the spatial error model. The cooling effects of greenery were improved when their spatial patterns were in a more aggregated, less fragmented, and less complex shape. Furthermore, outdoor thermal stress was relatively lower when there was simple shape greenery in low-density areas or complex shapes but in high-density areas while indicating synergies between them. Our findings would provide microclimatic urban planning and design implications of how to spatially configure urban greenery to improve outdoor thermal comfort. [ABSTRACT FROM AUTHOR]

Background and Purpose: Seizures are a known complication of ischemic stroke (IS). This study assesses the long-term incidence and characteristics of poststroke seizures in a well-defined population.Methods: Using the Rochester Epidemiology Project medical records-linkage system, we identified all incident cases of IS among Rochester, Minnesota, residents from 1990 to 1994 and followed the patients in the comprehensive medical record through March 2014. All patients with poststroke seizures were identified, and data regarding incident IS, seizures, and status at last follow-up were analyzed.Results: We identified 489 patients with first IS. Mean follow-up was 6.5 (standard deviation 6.3) years. New onset seizures occurred in 35 patients (7.2%). Patients with poststroke seizure did not differ from those without in terms of IS etiologic subtype (P = .44) or IS risk factors (P > .05). Early seizures (within 14 days of index stroke) developed in 14 patients (40%), the majority within the first 24 hours (n = 9, 64.3%). The median time of seizure onset for the remaining 21 patients was 13.8 months. Functional outcome, as measured by modified Rankin Scale (mRS), was worse following development of poststroke seizures (mean mRS score 2.9 after IS, 3.3 following index seizure; P = .005), and mortality was higher as well, even after adjusting for IS etiologic subtype (HR 1.52, 95% confidence interval 1.07-2.16, P = .02).Conclusion: Development of poststroke seizures is an infrequent but significant complication of IS, portending a worse short-term functional outcome and a higher long-term mortality rate. Seizure occurrence did not differ based on IS etiologic subtype or stroke risk factors. [ABSTRACT FROM AUTHOR]

To tackle urban overheating induced by the combined effect of global warming and intensive urbanization, researchers have recommended assimilating microclimate-related strategies into urban design practices. Field measurements, playing a central role in urban climatology, have been widely applied worldwide. Reviewing the last five years' field measurement studies and existing guidelines and standards from WMO (World Meteorological Organization) and ISO (International Organization for Standardization), this study identified a gap between available guidelines and researchers' practical needs to ascertain the collection of high caliber data. Therefore, dedicated guidelines are required to explain the crucial conceptual and application issues and refine systematic field measurement methods. This demand is particularly acute for microscale and urban environments. This study proposed and explained integrated and comprehensive guidelines for systematic microclimate field measurements. The suggested workflow included four main steps: formulating field measurement plan, preparing for field measurements, sustaining measurement quality, and curating data. The complex and heterogeneous environment in urban areas was carefully evaluated to hone the data acquisition campaign and ascertain data quality. Relevant concepts and practices learned from existing guidelines and standards, experiences from actual field studies, and professional recommendations were distilled and incorporated into the guidelines. The significance of a complete report with full metadata was emphasized. Detailed hints, precautions, recommendations, examples, and a metadata checklist were provided as a helpful and actionable package of research procedures. [ABSTRACT FROM AUTHOR]

Urban valleys as a primary element of the urban environment have played an undeniable role in the intensification of urban heat islands as climate change has increased in the past century. However, appropriate solutions can help improve outdoor thermal comfort (OTC) in these areas. In the present study, parameters related to thermal comfort outdoors such as air temperature (Ta), wind speed (Ws), sky view factor (SVF), mean radiant temperature (MRT) and physiological equivalent temperature (PET) in an urban street were analyzed using ENVI-met simulation. Furthermore, the influence of tree species and street orientation in the study area was also examined to improve thermal comfort conditions. Similarly, with field measurements on site, a questionnaire was used to determine the OTC range of visitors to the urban valley. The study also integrates with ENVI-met microclimatic modeling to improve thermal comfort in the urban street canyon, which was used to simulate the current situation and validated with field measurements, showing a good correlation. The results have revealed that, although SVF has been extensively used in previous studies, it is not an exact indicator to determine the amount of radiation and OTC conditions. The simulation study expressed that orientations' effect on thermal comfort is less prominent than tree cover. However, significant changes in orientation have a remarkable effect on improving OTC in the urban valley. • This article studied outdoor thermal comfort (OTC) conditions in an urban canyon in the hot, dry climate of Isfahan, Iran. • The acceptable range of OTC of users on this site was found to be between 24.5 °C and 29.8 °C PET. • The streets with a 150° orientation experienced better OTC conditions than other orientations in the Isfahan climate. • Trees with high trunks and wide, overlapping crowns were found to be the most suitable forms of greenery to reduce PET levels during the day. [ABSTRACT FROM AUTHOR]

Objective: To evaluate regional differences in adaptation of best practice recommendations for extracorporeal shock wave lithotripsy (SWL) across 4 distinct geographic regions. Methods: A retrospective study was performed using a prospective database maintained by a mobile lithotripsy provider (ForTec Medical, Streetsboro, OH). SWL cases performed in Ohio, Northern Illinois/Southern Wisconsin, Florida, and New York were included. Treatment parameters evaluated included treatment rate, use of a power ramp-up protocol, use of a pretreatment pause after the initial 100 shocks, ancillary procedures, and need for retreatment. Regional and physician-specific patterns were examined. Statistical analyses using chi-square and analysis of variance were performed with a significance of P <.05. Results: Data from 2240 SWL procedures were included in the study. Overall adaptation of power ramp-up protocols and treatment rates were high (93% and 93%), whereas use of pause was lower (75%, P <.001). Retreatment rates were low (4.3%), although ancillary procedures were performed in 34% of patients, and 8.3% of patients received stents for stones <1 cm. Regional differences were present in all parameters: Florida physicians used power ramp-up less (83%, P <.001) but had good use of pretreatment pause (98%, P <.001), both Wisconsin/Illinois and New York were less likely to use slow rate (87% and 84%, respectively, P <.001). Conclusion: The recommendations for slower shock wave rates and power ramp protocols have reached high penetration in urologic practices; however, the more recent recommendation for a pause after the initial 100 shocks has been less uniformly implemented. Inconsistencies in regional adaptation of best practices may identify opportunities for further education. [Copyright &y& Elsevier]

Summary: Intracranial saccular or berry aneurysms are common, occurring in about 1–2% of the population. Unruptured intracranial aneurysms are increasingly being detected as cross-sectional imaging techniques are used more frequently in clinical practice. Once an unruptured intracranial aneurysm is detected, decisions regarding optimum management are made on the basis of careful comparison of the short-term and long-term risks of aneurysmal rupture with the risk associated with the intervention, whether that be surgical clipping or endovascular management. Several factors need to be carefully considered, including aneurysm size and location, the patient's family history and medical history, and the availability of an interventional option that has an acceptable risk. The patient's knowledge that they have an unruptured intracranial aneurysm can lead to substantial stress and anxiety, and their perspective regarding treatment, after hearing an unbiased appraisal of the rupture risks and the risk of interventional treatment, is of the utmost importance. Controversy remains regarding optimum management, and thorough assessments of the risks and benefits of contemporary management options, specific to aneurysm size, location, and many other aneurysm and patient factors, are needed. [Copyright &y& Elsevier]

Abstract: There is compelling evidence that Earth's climate is changing, in most cases becoming warmer. This effect is exacerbated in urban environments by the growth of urban heat islands. These two processes can have far-reaching effects on human thermal comfort and health. Landscape architecture is well positioned to ameliorate these effects through planning and site design, but only if the designer understands how an urban environment creates microclimates. In order to prepare our students for the climate challenges they will face in future urban planning and design practice, we have introduced climate-responsive design classes into the curricula of two schools of landscape architecture, one in Wageningen, The Netherlands and the other in Guelph, Canada. In this article we describe the methods that we used to teach climate-responsive design by integrating scientific information into the creative design process. The method consisted of three main steps. First students accumulated and summarized climate knowledge at the appropriate scales. This information was used to analyze a study site and identify climate-related problems. The final step was to use this knowledge as a basis for generating design solutions and testing them for their climate-appropriateness. These courses prepare future professionals to ameliorate the effects of climate change and urban heat island intensification and create living environments that are thermally comfortable and healthy. [Copyright &y& Elsevier]

Global climate change has increased the risks of extreme weather-related disasters, leading to severe public health burdens. In February 2021, Winter Storm Uri brought severe cold to southern United States and caused unprecedented health and safety concerns. Residents in subsidized rental housing were among the most vulnerable to cold stress during such a cold storm. However, existing research on the assessment and mitigation of cold stress in underserved neighborhoods in warmer climate zones is limited, which results in the negligence of cold event preparedness and mitigation policies. Therefore, this study aims to assess the micrometeorological conditions and human cold stress in subsidized housing neighborhoods during the 2021 Winter Storm and determine the extent to which cold mitigation windbreak designs are effective in reducing cold stress. Field measurements, ENVI-met simulations, and biometeorological calculations were conducted to reconstruct the microclimate conditions and cold stress during the storm, and three cold-mitigation windbreak designs with varying foliage densities were evaluated. Results showed that the conditions were categorized as "extreme cold stress" for the majority of the day, but especially during nighttime. Areas close to the buildings were generally warmer, and the wind-blocking effects of a building decreased as the distance to the building increased. A moderately dense-foliage windbreak was the most effective in reducing wind speed and improving thermal comfort. Intentional environmental modifications to alter wind velocity and disaster relief programs that provide emergency clothing supplies during power outage may be beneficial to these underserved communities. • Extreme cold conditions in a hot climate were assessed for effect on residents of subsidized housing. • An innovative approach to identifying effective design interventions was introduced using energy flux comparisons. • Design interventions were simulated and the effect on the thermal experience of residents was identified. [ABSTRACT FROM AUTHOR]

Background: It is not known if the presence of unruptured intracranial aneurysms can increase the risk of hemorrhage after thrombolysis for acute ischemic stroke. The goal of our study was to evaluate the risk of hemorrhage after intravenous tissue plasminogen activator in acute stroke patients with intracranial aneurysms. Methods: This is a retrospective analysis of consecutive cases of patients with acute ischemic stroke who were treated with intravenous tissue plasminogen activator at Mayo Clinic between March 2002 and June 2011 and who were evaluated with invasive or noninvasive intracranial angiography. Univariate analyses were performed with the t, Chi-square, and Fisher exact tests where appropriate. Results: Intracranial angiograms were performed in105 patients (85 magnetic resonance angiography, 19 computed tomography angiography, and 1 catheter arteriography). The mean age of the patients was 69 ± 14 years. The mean National Institutes of Health Stroke Scale score at admission was 8 ± 5. A total of 12 incidental saccular aneurysms were found in 10 (9.5%) patients, and all 10 of these patients were white. There were no subarachnoid hemorrhages during the hospital stay in any patient with or without intracranial aneurysm. The rates of symptomatic intracranial hemorrhage and 3-month clinical outcomes were similar in patients with or without intracranial aneurysms. Conclusions: Intravenous thrombolysis was safe among our patients with acute ischemic stroke and incidental intracranial saccular aneurysm. [Copyright &y& Elsevier]