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This study was undertaken to explore the gene expression profile of primary central nervous system vasculitis (PCNSV).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.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.RNA sequencing confirmed PCNSV heterogeneity. ANN NEUROL 2022.

Effects of select medications on hemorrhage risk in patients with cerebral or spinal cavernous malformations (CMs) are unknown.From a single-institution prospective cohort of patients with CM (2015-2021), demographics, mode of clinical presentation, and radiographic data were collected. Follow-up was performed with electronic medical record review, in-person visits, and written surveys. Select medication use was ascertained from the time of CM diagnosis to a censor date of first prospective symptomatic hemorrhage, complete surgical excision of sporadic form CM, last follow-up, or death. Using Cox proportional hazards regression model, we assessed effects of antithrombotic agents, fish oil, selective serotonin reuptake inhibitors (SSRIs), vitamin E and D supplementation, statins, and beta blockers on prospective hemorrhage risk.The study included 364 patients with spinal or cerebral CM (58.0% female; 20.0% familial form; 42.3% presentation to medical attention owing to hemorrhage; 25.8% brainstem location). During a follow-up of 2018 patient-years, 103 prospective hemorrhages occurred. No studied medications increased the prospective CM hemorrhage risk. Antithrombotics, vitamin D supplementation, fish oil, and SSRI were associated with lower hemorrhage risk even after adjusting for age at diagnosis, hemorrhage at diagnosis, and brainstem location.Use of select medications with antithrombotic properties do not increase the risk of CM hemorrhage. Vitamin D supplementation, any antithrombotic agent, fish oil, and SSRI were associated with a lower prospective hemorrhage risk. Further studies should evaluate the mechanism of action and potential benefit of these select medications.

Background Description of cerebral and retinal infarction in patients with bicuspid aortic valve (BAV) is limited to case reports. We aimed to characterize cerebral and retinal infarction and examine outcomes in patients with BAV. Methods and Results Consecutive patients from 1975 to 2015 with BAV (n=5401) were retrospectively identified from the institutional database; those with confirmed cerebral or retinal infarction were analyzed. Infarction occurring after aortic valve replacement was not included. Patients were grouped according to infarction pathogenesis: embolism from a degenerative calcific BAV (BAVi); non‐BAV, large artery atherosclerotic or lacunar infarction (LAi); and non‐BAV, non‐large artery embolic infarction (nLAi). There were 83/5401 (1.5%) patients, mean age 54±12 years and 28% female, with confirmed cerebral or retinal infarction (LAi 23/83 [28%]; nLAi 30/83 [36%]; BAVi 26/83 [31%]; other 4/83 [5%]). Infarction was embolic in 72/83 (87%), and 35/72 (49%) were cardioembolic. CHA 2 DS 2 ‐VASc score was 1.4±1.2 in BAVi ( P =0.188 versus nLAi) and 2.3±1.2 in LAi ( P =0.005). Recurrent infarction occurred in 41% overall (50% BAVi, P =0.164 and 0.803 versus LAi and nLAi). BAVi was more commonly retinal (39% BAVi versus 13% LAi, P =0.044 versus 0% nLAi, P =0.002). Patients with BAVi and LAi were more likely to have moderate‐to‐severe aortic stenosis and undergo aortic valve replacement compared with patients with nLAi. Conclusions Cardioembolism, often from degenerative calcification of the aortic valve, is a predominant cause of cerebral and retinal infarction in patients with BAV and is frequently recurrent. Cerebral and retinal infarction should be regarded as a complication of BAV.

Whenever people spend time outdoors during hot weather, they are putting themselves in potentially stressful situations. Being able to predict whether a person is overheating can be critical in preventing heat-health issues. There is a clear relationship between body core temperature and heat health. However, measuring body core temperature is expensive. Identifying a non-invasive measure that could indicate a person’s thermal strain would be valuable. This study investigated five physiological measures as possible surrogates: finger mean skin temperature (FSKT), finger maximum skin temperature (FMSKT), skin conductance level (SCL), heart rate (HR), and heart rate variability (HRV). Furthermore, they were compared against the results of participants’ subjective thermal sensation and thermal comfort in a range of hot microclimatic conditions in a hot and humid climate. Results showed that except for SCL, each of the other four physiological measures had a positive significant relationship with thermal sensation, but a negative relationship with thermal comfort. Furthermore, through testing by cumulative link mixed models, HRV was found to be the most suitable surrogate for predicting thermal sensation and thermal comfort through a simple, non-invasive measure in outdoor environment in summer in a hot and humid area. This study highlights the method for predicting human thermal strain and contributes to improve the public health and well-being of urban dwellers in outdoor environments.

Background: Arterial dissection represents a rare but significant cause of ischemic stroke. We hypothesized that the detection rate of arterial dissections has increased in recent decades. Objective: To determine the incidence of cervical artery dissection in a defined population. Methods: We identified Olmsted County, Minnesota residents diagnosed with carotid artery or vertebral artery dissection between 2002 and 2020 using the Rochester Epidemiology Project database. Patients who had suffered major trauma, were under 18 years of age or had intracranial artery dissections were excluded. Virtually all Olmsted County residents receive their medical care within the participating health systems, leading to a high likelihood of complete case ascertainment. We assessed longitudinal trends by dividing the data into 5-year time windows, with the last being a 4-year interval. Incidence rates were adjusted for age and sex. Results: In a 19-year period from 2002 through 2020, 127 patients with a diagnosis of cervical artery dissection were identified. There were 64 females (50.4%) and 63 males (49.6%). The average age at diagnosis was 51.2 years (SD 15.7). There were 63 internal carotid artery dissections (ICAD), 60 vertebral artery dissections (VAD), and three common carotid artery dissections (CCAD) identified. One patient had ICAD and VAD at diagnosis. The overall incidence rate of detection for cervical artery dissection, adjusted for age and sex, was 4.9 per 100,000 person-years (py) (95% CI, 4.0 to 5.7). The incidence rate of ICAD was 2.5 per 100,000 py (95% CI, 1.8 to 3.1). The incidence rate of VAD was 2.3 per 100,000 py (95% CI, 1.7 to 2.9). The incidence rate of CAD gradually increased over time from 2.3 per 100,000 py (95% CI, 1.1 to 3.5) in 2002-2006 to 9.4 per 100,000 py (95% CI, 6.9 to 11.8) in 2017-2020, a 4.2-fold increase. Conclusion: The incidence of detection rate of cervical artery dissection increased over four-fold in the last 19 years. This can potentially be attributed to increased usage of non-invasive angiographic imaging.

Introduction: Cervical artery dissection (CAD) is a well-recognized cause of acute ischemic stroke, especially in young adults, accounting for up to 20-25% of all cases. Several studies reported an incidence between 2.5-5 per 100,000 in the general population. However, the actual incidence may be higher as many patients remain asymptomatic. Even though CAD is one of the leading causes of ischemic stroke, there is a lack of consensus in management. Our study surveyed practicing clinicians involved in the management of CAD to characterize current practice trends and provide a foundation for future research. Methods: An online case-based questionnaire with 11 questions regarding the management of cervical artery dissection was developed and piloted internally with 12 Mayo Clinic cerebrovascular neurologist/neurosurgeons. The survey was finalized, and initially sent to the STOP-CAD study group. We then sent the survey to practicing vascular neurologists across different academic institutions. Surveys were sent to 126 unique individuals. Results: A total of 42 clinicians completed the questionnaires. The response rate was 33% (42/126). Aspirin antiplatelet monotherapy was seen as the most appropriate therapy for asymptomatic CAD (81% [34/42]). Anticoagulation was the treatment of choice for cases with CAD and concomitant intraluminal thrombus (74% [31/42]). Most (74% [31/42]) of the participants recommended repeat imaging at three months. However, no consistent response regarding the type of antithrombotic agent for symptomatic CAD without intramural thrombus or cases with pseudoaneurysm. There was marked variability regarding the duration of antithrombotic therapy, ranging from three months to life-long treatment. Conclusion: Marked variability was seen in the management of CAD, especially regarding the choice of antithrombotic agent in symptomatic and complicated (stenosis or pseudoaneurysm) cases and the duration of such therapy, which reflects the lack of definitive clinical trial data. Ongoing research is needed to better guide the optimal management of these patients.

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.

The white paper first outlines the state of inequity in food security/sovereignty in our area of focus, taking into account historical context as well as emerging and ongoing effects of the COVID-19 pandemic and community and policy responses to it. We then discuss a food acquisition intervention, structured as a longitudinal, collaborative research, and service-learning effort known as Everybody Eats. The white paper provides detailed discussion of competing understandings of agriculture, horticulture, and the social problem of food insecurity; the preliminary data that has led to a current collaborative effort to enhance the skillset of people previously not understood as food producers and provisioners, but only as end-user consumers; and the new iteration of the project wherein specific sets of expertise from diverse disciplines are deployed both to offer a more robust intervention, and bring new methodologies to bear in assessing the ecology of a local foodshed. We propose mobilizing existing resources and expertise of the Land Grant/Cooperative Extension system to act as a regional hub for facilitating full community food security (caloric and nutritional adequacy) and food sovereignty (participatory decision-making regarding living spaces and culturally appropriate foodways). Finally, we illustrate how a nexus of faculty, working from a service-learning advocacy perspective and embedded in a participatory action framework, provides a mechanism for bringing together and sustaining a community of intellectually diverse researchers and stakeholders.

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.

Introduction: During the COVID-19 pandemic, studies reported less number of hospitalizations for acute stroke and reduction in the use of recanalization treatments. This study analyzes nationwide data on stroke admissions and management in the Czech Republic during the first wave of the COVID-19 pandemic. Methods: We compared the early COVID-19 pandemic (March–May 2020) with the pre-pandemic period (January–February 2020 and March–May 2019): (a) the National Register of Reimbursed Health Services provided volume of all admissions for subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and ischemic stroke (IS), and volume of recanalization treatments (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]); (b) Registry of Stroke Care Quality provided door-to-needle time (DNT), onset-to-door time (ODT), and stroke severity at admission (National Institutes of Health Stroke Scale, NIHSS) for IS. Results: During the pandemic (March–May 2020), the peak number of COVID-19 patients treated in Czech hospitals was 39 per million. In March–May 2020 versus March–May 2019, hospital admissions decreased as follows: stroke overall by 14% (p < 0.001), IS by 14% (p < 0.001), SAH by 15% (p = 0.07), and ICH by 7% (p = 0.17). The mean age was 74 years versus 74 years (p = 0.33), and 52% versus 51% were men (p = 0.34). The volumes of IVT and MT decreased by 14% (p = 0.001) and 19% (p = 0.01), respectively. The proportions of all IS patients receiving IVT or MT remained unchanged, with, respectively, 17% versus 17% receiving IVT (p = 0.86) and 5% versus 5% receiving MT (p = 0.48). DNT and ODT were 24 versus 25 min (p = 0.58) and 168 versus 156 min (p = 0.23), respectively. NIHSS at admission did not differ (6 vs. 6; p = 0.54). Conclusion: Even with a low burden of COVID-19 during the first wave and no change in organization and logistics of stroke services, stroke admissions and volume of recanalization treatments decreased. Public health communication campaigns should encourage people to seek emergency medical care for stroke symptoms during the COVID-19 pandemic.

Background: Multi-phenotype analysis of genetically correlated phenotypes can increase the statistical power to detect loci associated with multiple traits, leading to the discovery of novel loci. This is the first study to date to comprehensively analyze the shared genetic effects within different hemostatic traits, and between these and their associated disease outcomes. Objectives: To discover novel genetic associations by combining summary data of correlated hemostatic traits and disease events. Methods: Summary statistics from genome wide-association studies (GWAS) from seven hemostatic traits (factor VII [FVII], factor VIII [FVIII], von Willebrand factor [VWF] factor XI [FXI], fibrinogen, tissue plasminogen activator [tPA], plasminogen activator inhibitor 1 [PAI-1]) and three major cardiovascular (CV) events (venous thromboembolism [VTE], coronary artery disease [CAD], ischemic stroke [IS]), were combined in 27 multi-trait combinations using metaUSAT. Genetic correlations between phenotypes were calculated using Linkage Disequilibrium Score Regression (LDSC). Newly associated loci were investigated for colocalization. We considered a significance threshold of 1.85 × 10−9 obtained after applying Bonferroni correction for the number of multi-trait combinations performed (n = 27). Results: Across the 27 multi-trait analyses, we found 4 novel pleiotropic loci (XXYLT1, KNG1, SUGP1/MAU2, TBL2/MLXIPL) that were not significant in the original individual datasets, were not described in previous GWAS for the individual traits, and that presented a common associated variant between the studied phenotypes. Conclusions: The discovery of four novel loci contributes to the understanding of the relationship between hemostasis and CV events and elucidate common genetic factors between these traits.

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 ( $$ {\overline{T}}_{\mathrm{s}} $$ ) 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 $$ {\overline{T}}_{\mathrm{s}} $$ 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 $$ {\overline{T}}_{\mathrm{s}} $$ 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.

A 54-year-old woman presented with an enlarging, pulsatile left neck mass and a history of Takayasu arteritis. She had seven prior cervical vascular reconstructions, including a prosthetic right-to-left carotid crossover, and left vertebral and subclavian bypasses done with saphenous vein. The skin of her neck was scarred and thin. The anastomotic pseudoaneurysms were resected, the left carotid bifurcation was reconstructed with the cryopreserved femoral artery because of the concern about wound healing, and the subclavian and vertebral vein grafts were reimplanted. Intraoperative management, clamp sites and sequence, manner of shunting, choice of conduit, and wound healing were important considerations.

OBJECTIVERecent population-based and hospital cohort studies have reported a decreasing incidence of aneurysmal subarachnoid hemorrhage (aSAH) and declining aSAH-associated case-fatality rates. Principal drivers of these trends are debated, but improvements in smoking cessation and hypertension control may be critical factors.METHODSThe population-based medical records linkage system of the Rochester Epidemiological Project was used to document aSAH incidence and 30-day case fatality rates during a 20-year study period (1996–2016) in Olmsted County, Minnesota. Incidence rates in the study period were compared with data from a previous Olmsted County study concerning aSAH incidence from 1965 to 1995 and with regional trends in tobacco use.RESULTSOne hundred nineteen incident cases of aSAH were included. The median age at hemorrhage was 59 years (range 16–94 years), and 74 patients were female (62.2%). The overall average annual aSAH incidence rate was 4.2/100,000 person-years (P-Y). The aSAH incidence rate decreased from 5.7/100,000 in 1996 to 3.5/100,000 P-Y in 2011–2016. The overall aSAH-associated 30-day case-fatality rate was 21.9% and declined by approximately 0.5% annually. An accelerated decline in the fatality rate (0.9%/year) was observed from 2006–2016. Smoking among adult Olmsted County residents decreased from 20.4% in 2000 to 9.1% in 2018.CONCLUSIONSA decline in the incidence of aSAH and 30-day case-fatality rate from 1996 to 2016 was observed, as well as an accelerated decline of the fatality rate from 2006 to 2016. These findings confirm and extend the trends reported by prior studies in the same population. The decrease in aSAH in the years studied paralleled a noticeable reduction in the population smoking rates.

The distributions of many high-elevation tree species have shifted as a result of recent climate change; however, there is substantial variability in the movement of alpine treelines at local to regional scales. In this study, we derive records of tree growth and establishment from nine alpine treeline ecotones in the Canadian Rocky Mountains, characterise the influence of seasonal climate variables on four tree species (Abies lasiocarpa, Larix lyallii, Picea engelmannii, Pinus albicaulis) and estimate the degree to which treeline movement in the twentieth century has lagged or exceeded the rate predicted by recent temperature warming. The growth and establishment records revealed a widespread increase in radial growth, establishment frequency and stand density beginning in the mid-twentieth century. Coinciding with a period of warming summer temperatures and favourable moisture availability, these changes appear to have supported upslope treeline advance at all sites (range, 0.23–2.00 m/year; mean, 0.83 + 0.67 m/year). However, relationships with seasonal climate variables varied between species, and the rates of treeline movement lagged those of temperature warming in most cases. These results indicate that future climate change impacts on treelines in the region are likely to be moderated by species composition and to occur more slowly than anticipated based on temperature warming alone.

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.

The coronavirus disease 2019 pandemic has disrupted the lives of whole communities and nations. The multinational multicenter National Institute of Neurological Disorders and Stroke Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial stroke prevention trial rapidly experienced the effects of the pandemic and had to temporarily suspend new enrollments and shift patient follow-up activities from in-person clinic visits to telephone contacts. There is an ethical obligation to the patients to protect their health while taking every feasible step to ensure that the goals of the trial are successfully met. Here, we describe the effects of the pandemic on the trial and steps that are being taken to mitigate the effects of the pandemic so that trial objectives can be met.

Background: Cavernous malformations (CM) are angiographically occult vascular malformations that may be incidental or present with intracerebral or spinal hemorrhage, seizures, or nonhemorrhagic focal neurologic deficit (FND). Recently in vitro data have suggested vitamin D may play a role in stabilizing CCM2 endothelial cells. Little is known about the effect of vitamin D in human CM disease. Methods: Beginning in 2015, consecutive patients at our institution with radiologically confirmed CM were recruited to participate in a prospective clinical registry as well as 25-hydroxy-vitamin D study. A structured interview, survey, and examination were performed at baseline. Medical records and magnetic resonance imaging studies were reviewed and data collected included comorbid conditions, medication use, and location of CM. Standard definition of clinical hemorrhage, FND, and seizures was used. Univariate and multivariate logistic regression models were used, and OR, 95% CIs, and likelihood-ratio p values were calculated to determine the influence of the 25-hydroxy-vitamin D level on clinical presentation with hemorrhage. Results: Of 213 patients enrolled in the clinical registry between January 2015 and October 2018, 70 participated in the vitamin D study (median age: 38.3 years; 51.4% female). Of the 70 participants, 30 (42.9%) presented with hemorrhage. 25-Hydroxy-vitamin D levels were performed within 1 year of symptoms in 64.1% of patients. Patients presenting with hemorrhage had a lower 25-hydroxy-vitamin D level compared to those presenting with seizure without hemorrhage, FND, or as an incidental finding (median 25.5 ng/mL; range 11–59 hemorrhage vs. median 31.0; range 14–60, no hemorrhage; p = 0.04). After adjusting for age, month of blood draw, and body mass index, 25-hydroxy-vitamin D remained a significant predictor of hemorrhagic presentation. Brainstem location also predicted hemorrhage at presentation. Conclusion: Low 25-hydroxy-vitamin D level was more common in patients with CM presenting with hemorrhage. This study supports the potential role of modifiable factor in the initial clinical presentation of CM. Further study is needed to determine the role of vitamin D on prospective hemorrhage risk and whether supplementation may be beneficial.

Stroke is one of the leading causes of death and disability. Despite the high prevalence of stroke, characterizing the acute neural recovery patterns that follow stroke and predicting long-term recovery remains challenging. Objective methods to quantify and characterize neural injury are still lacking. Since neuroimaging methods have a poor temporal resolution, EEG has been used as a method for characterizing post-stroke recovery mechanisms for various deficits including motor, language, and cognition as well as predicting treatment response to experimental therapies. In addition, transcranial magnetic stimulation (TMS), a form of non-invasive brain stimulation, has been used in conjunction with EEG (TMS-EEG) to evaluate neurophysiology for a variety of indications. TMS-EEG has significant potential for exploring brain connectivity using focal TMS-evoked potentials and oscillations, which may allow for the system-specific delineation of recovery patterns after stroke. In this review, we summarize the use of EEG alone or in combination with TMS in post-stroke motor, language, cognition, and functional/global recovery. Overall, stroke leads to a reduction in higher frequency activity (≥8 Hz) and intra-hemispheric connectivity in the lesioned hemisphere, which creates an activity imbalance between non-lesioned and lesioned hemispheres. Compensatory activity in the non-lesioned hemisphere leads mostly to unfavorable outcomes and further aggravated interhemispheric imbalance. Balanced interhemispheric activity with increased intrahemispheric coherence in the lesioned networks correlates with improved post-stroke recovery. TMS-EEG studies reveal the clinical importance of cortical reactivity and functional connectivity within the sensorimotor cortex for motor recovery after stroke. Although post-stroke motor studies support the prognostic value of TMS-EEG, more studies are needed to determine its utility as a biomarker for recovery across domains including language, cognition, and hemispatial neglect. As a complement to MRI-based technologies, EEG-based technologies are accessible and valuable non-invasive clinical tools in stroke neurology.

This scoping review aimed to identify current evidence and gaps in the field of long-term space nutrition. Specifically, the review targeted critical nutritional needs during long-term manned missions in outer space in addition to the essential components of a sustainable space nutrition system for meeting these needs. The search phrase “space food and the survival of astronauts in long-term missions” was used to collect the initial 5432 articles from seven Chinese and seven English databases. From these articles, two independent reviewers screened titles and abstracts to identify 218 articles for full-text reviews based on three themes and 18 keyword combinations as eligibility criteria. The results suggest that it is possible to address short-term adverse environmental factors and nutritional deficiencies by adopting effective dietary measures, selecting the right types of foods and supplements, and engaging in specific sustainable food production and eating practices. However, to support self-sufficiency during long-term space exploration, the most optimal and sustainable space nutrition systems are likely to be supported primarily by fresh food production, natural unprocessed foods as diets, nutrient recycling of food scraps and cultivation systems, and the establishment of closed-loop biospheres or landscape-based space habitats as long-term life support systems.

Knowledge of the natural history of unruptured intracranial aneurysms and vascular malformations of the brain is important because this information can be weighed against the morbidity and death rates of intervention to decide on the most appropriate treatment of an individual patient. This chapter reviews the epidemiologic factors and natural history of common intracranial vascular abnormalities.

A 57-year-old woman had development of acute-onset, right-sided weakness and sensory change (face, arm, and leg) when at a casino. She was brought to the emergency department, and her symptoms had essentially resolved upon her arrival. Brain magnetic resonance imaging showed no acute stroke, and a transient ischemic attack was diagnosed. She was transferred to an academic medical center. Investigations showed high-grade left internal carotid artery stenosis; the same day, a stent was placed via endovascular procedure by an interventional neuroradiologist. Magnetic resonance imaging of the head showed an enhancing lesion with surrounding edema in the left frontal and parietal lobes at the cortex, also involving the nearby leptomeninges. Electroencephalography showed potentially epileptogenic discharges over the left central head region. Brain biopsy was performed, which showed abundant CD68+ macrophages, granulomatous inflammation, and necrosis associated with foreign material. The associated lymphocytic infiltrates were predominantly composed of CD3+ T cells and only sparse CD20+ B cells. The foreign material seen was lamellated, amorphous, nonpolarizable, and nonrefractile, typical of hydrophilic polymers commonly used in intravascular medical devices. The patient was diagnosed with seizures caused by multifocal, intracranial, foreign-body, granulomatous reaction to polymers that had embolized to brain parenchyma during the prior endovascular procedure. To suppress this inflammatory reaction, corticosteroids were initiated—intravenous methylprednisolone, followed by an oral prednisone course, with a plan to gradually taper. Antiseizure medication was continued at the same doses. The patient’s seizures remitted initially but relapsed upon corticosteroid dose reduction despite a very slow prednisone taper. At that point, 18 months after the initial onset of seizures, the patient had cushingoid features, depression, and chronic insomnia. During the next year, 2 steroid-sparing strategies were employed sequentially. In patients who have received neurovascular medical device therapy and have subsequent development of seizures, focal neurologic deficit, headache, or encephalopathy, central nervous system inflammation triggered by retained foreign-body material should be considered as a potential cause.

This study investigates the diurnal, seasonal, monthly and temporal variation of land surface temperature (LST) and surface urban heat island intensity (SUHII) over the Isfahan metropolitan area, Iran, during 2003–2019 using MODIS data. It also examines the driving factors of SUHII like cropland, built-up areas (BI), the urban–rural difference in enhanced vegetation index (ΔEVI), evapotranspiration (ΔET), and white sky albedo (ΔWSA). The results reveal the presence of urban cool islands during the daytime and urban heat islands at night. The maximum SUHII was observed at 22:30 p.m., while the minimum was at 10:30 a.m. The summer months (June to September) show higher SUHII compared to the winter months (February to May). The daytime SUHII demonstrates a robust positive correlation with cropland and ΔWSA, and a negative correlation with ΔET, ΔEVI, and BI. The nighttime SUHII displays a negative correlation with ΔET and ΔEVI.

Place-based structural inequalities can have critical implications for the health of vulnerable populations. Historical urban policies, such as redlining, have contributed to current inequalities in exposure to intra-urban heat. However, it is unknown whether these spatial inequalities are associated with disparities in heat-related health outcomes. The aim of this study is to determine the relationships between historical redlining, intra-urban heat conditions, and heat-related emergency department visits using data from 11 Texas cities. At the zip code level, the proportion of historical redlining was determined, and heat exposure was measured using daytime and nighttime land surface temperature (LST). Heat-related inpatient and outpatient rates were calculated based on emergency department visit data that included ten categories of heat-related diseases between 2016 and 2019. Regression or spatial error/lag models revealed significant associations between higher proportions of redlined areas in the neighborhood and higher LST (Coef. = 0.0122, 95% CI = 0.0039–0.0205). After adjusting for indicators of social vulnerability, neighborhoods with higher proportions of redlining showed significantly elevated heat-related outpatient visit rate (Coef. = 0.0036, 95% CI = 0.0007–0.0066) and inpatient admission rate (Coef. = 0.0018, 95% CI = 0.0001–0.0035). These results highlight the role of historical discriminatory policies on the disparities of heat-related illness and suggest a need for equity-based urban heat planning and management strategies.

The name Iphianassa occurs only once in Latin literature—in the proem to De Rerum Natura (= DRN). Here Lucretius illustrates the evils of religion with a description of Iphianassa's sacrifice at Aulis (1.80–101):illud in his rebus uereor, ne forte rearisimpia te rationis inire elementa uiamqueindugredi sceleris. quod contra saepius illareligio peperit scelerosa atque impia facta.Aulide quo pacto Triuiai uirginis aramIphianassai turparunt sanguine foedeductores Danaum delecti, prima uirorum.cui simul infula uirgineos circumdata comptusex utraque pari malarum parte profusast,et maestum simul ante aras adstare parentemsensit et hunc propter ferrum celare ministrosaspectuque suo lacrimas effundere ciuis,muta metu terram genibus summissa petebat.nec miserae prodesse in tali tempore quibatquod patrio princeps donarat nomine regem.nam sublata uirum manibus tremibundaque ad arasdeductast, non ut sollemni more sacrorumperfecto posset claro comitari Hymenaeo,sed casta inceste nubendi tempore in ipsohostia concideret mactatu maesta parentis,exitus ut classi felix faustusque daretur.tantum religio potuit suadere malorum.It is clear that Lucretius treats the name Iphianassa as a synonym for Iphigenia. Homer (Il. 9.145, 9.287) and Sophocles (El. 157) mention a daughter of Agamemnon called Iphianassa, but in neither author is she the daughter who was sacrificed at Aulis (and in several versions rescued at the last moment by Artemis). The first known mention of this myth was in the Cypria, where, according to the summary of Proclus, the daughter was called Iphigenia (Kinkel, EGF 19; Bernabé, PEG 1.41). Hesiod refers to it in the Catalogue of Women, where he calls the daughter Iphimede (Cat. fr. 23a.15–26 + b M-W). From the fifth century b.c.e., the extant sources, beginning with Pindar (Pyth. 11.22) and Aeschylus (Ag. 1526, 1555), call her Iphigenia. Why did Lucretius choose Iphianassa?

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.

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.

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.

Objective To describe the clinical, laboratory, and imaging features and course of patients with primary central nervous system vasculitis (PCNSV) presenting with an intracranial tumor-like mass (TLM). Methods We retrospectively studied a cohort of 191 consecutive patients with PCNSV seen at the Mayo Clinic, Rochester, MN over a 35-year period (1982–2017). 13/191 patients presented with a TLM. We compared the findings in these 13 patients with those from the 178 without this presentation. Results In 13 of 191 (6.8%) patients with TLM the diagnosis of PCNSV was established by cerebral biopsy. Granulomatous vasculitis was found in 11/13 patients, accompanied by vascular deposits of β-amyloid peptide in 7. Compared to the 178 patients without TLM, the patients with TLM were more likely to be male (p = 0.04), and less likely to have a transient ischemic attack (p = 0.023), bilateral cerebral infarcts (p = 0.018), or vasculitic lesions on angiography (p = 0.045). They were more likely to have seizures (p = 0.022), gadolinium-enhanced lesions (p = 0.007), and amyloid angiopathy (p = 0.046). All 13 patients responded to therapy and 8/13 (61.5%) had a Rankin disability score of 0 at last visit. Overall, high disability scores (Rankin scores 4–6) at last follow-up were associated with increasing age (odds ratio, OR, 1.49) and cerebral infarction (OR, 3.47), but were less likely in patients with gadolinium-enhanced lesions (OR, 0.36) and amyloid angiopathy (OR, 0.21). Conclusion In PCNSV a TLM at presentation represents a definable subgroup of patients with a favourable treatment response.

ObjectiveTo describe the prevalence of cerebral microbleeds (CMBs) and determine the association between CMBs and β-amyloid burden on PET.MethodsFrom the population-based Mayo Clinic Study of Aging, 1,215 participants (53% male) underwent 3-tesla MRI scans with T2* gradient recalled echo sequences from October 2011 to February 2017. A total of 1,123 participants (92%) underwent 11C-Pittsburgh compound B (PiB)-PET scans. The prevalence of CMBs was derived by adjusting for nonparticipation and standardizing to the Olmsted County, MN, population. The relationship between β-amyloid burden and CMB presence and location was tested using logistic regression models. Ordinal logistic models tested the relationship between CMB frequency and β-amyloid burden.ResultsTwo hundred seventy-four participants (22.6%) had at least one CMB. CMB frequency increased with age by decade (11% aged 60–69 years, 22% 70–79 years, and 39% 80 years and older). After adjusting for age, sex, and hypertension, PiB standardized uptake value ratio (SUVR) was associated with increased odds of a CMB. The association between PiB SUVR and CMBs was location-specific; PiB SUVR was associated with lobar CMBs but not deep CMBs. Age, hypertension, and PiB SUVR were associated with increasing CMB count. CMB density was greatest in parietal and occipital regions; β-amyloid burden correlated with concentration of CMBs in all lobar regions. Among participants with multiple CMBs, greater PiB uptake occurred in the pre- and postcentral gyri superiorly, the superior parietal lobe and precuneus, the angular gyrus, inferior temporal gyrus, and temporal poles.ConclusionsThe prevalence of CMBs increases with age. In this population-based sample, β-amyloid load was associated with lobar but not with deep CMBs.

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.

Medical students need to understand core neuroscience principles as a foundation for their required clinical experiences in neurology. In fact, they need a solid neuroscience foundation for their clinical experiences in all other medical disciplines also because the nervous system plays such a critical role in the function of every organ system. Because of the rapid pace of neuroscience discoveries, it is unrealistic to expect students to master the entire field. It is also unnecessary, as students can expect to have ready access to electronic reference sources no matter where they practice. In the preclerkship phase of medical school, the focus should be on providing students with the foundational knowledge to use those resources effectively and interpret them correctly. This article describes an organizational framework for teaching the essential neuroscience background needed by all physicians. This is particularly germane at a time when many medical schools are reassessing traditional practices and instituting curricular changes such as competency-based approaches, earlier clinical immersion, and increased emphasis on active learning. This article reviews factors that should be considered when developing the preclerkship neuroscience curriculum, including goals and objectives for the curriculum, the general topics to include, teaching and assessment methodology, who should direct the course, and the areas of expertise of faculty who might be enlisted as teachers or content experts. These guidelines were developed by a work group of experienced educators appointed by the Undergraduate Education Subcommittee (UES) of the American Academy of Neurology (AAN). They were then successively reviewed, edited, and approved by the entire UES, the AAN Education Committee, and the AAN Board of Directors.

Global climate change and urban heat island intensification are making many cities dangerously hot during heat waves and uncomfortably hot much of the time. Research has identified ways that urban environments can be designed to reduce the heat, but much of the information is too technical or has not been interpreted or communicated so as to be available to landscape architects. This study identifies ways that landscape architecture researchers have applied microclimate information in design to proactively create more thermally comfortable outdoor environments. A systematic review that assessed the growing recognition of microclimatic factors in design revealed four main approaches: principles and guidelines, strategies, mapping, and evaluation. The advantages and limitations of each have been noted, and a diagram has been developed that matches each approach with specific steps in the landscape architectural design process. The study also identified four areas where microclimate has potential for use in landscape architecture but that are currently not being very actively studied: education, modeling and visualization, policy, and ideation. Microclimatic design has the potential to enhance the health and well-being of the public through the design of thermally comfortable outdoor environments.

Background and Purpose: Pregnancy as a hemorrhage risk factor in women with cavernous malformations (CMs) is controversial. We describe prospective hemorrhage risk in women who become pregnant after an established CM diagnosis. Methods: Beginning in 2015, we recruited consecutive patients with radiologically confirmed CM of the brain or spinal cord to participate in a prospective registry. Participants underwent a baseline and annual medical record review, imaging review, and annual surveys to ascertain pregnancies, deliveries, and neurological complications. We collected prospective hemorrhage data on reproductive age women. We calculated prospective hemorrhage rates on childbearing age patients based on the number of hemorrhages occurring post-CM diagnosis during pregnancy and nonpregnancy, divided by the years of follow-up and censored at last follow-up, age 46, or surgery in sporadic-form CM. The hemorrhage rates were compared and the 95% CI presented with a P value of Results: Of 160 women, 90 presented with CM under the age of 46 (average age 31.6 years; 25.6% familial form; 46.7% with hemorrhage; 24.4% brain stem location). These 90 patients had 136 pregnancies before CM diagnosis; 36 pregnancies occurred at or after the diagnosis of CM. Four patients had a hemorrhage while pregnant or postpartum leading to the first CM diagnosis. During 402.6 years of follow-up while not pregnant, 42 hemorrhages occurred prospectively yielding a 10.4% per year (95% CI, 7.5–14.0) risk of hemorrhage while not pregnant. No hemorrhages occurred during 32 prospective pregnancies (26 live births including 1 twinset and 7 nonviable fetuses) after CM diagnosis during 26.9 years of pregnancy time yielding a rate of 0% per year (95% CI, 0–13.6). We found no statistical difference in the rates of hemorrhage during pregnant and nonpregnant time ( P =0.09). No hemorrhage occurred during delivery. Conclusions: Our prospective data suggest that pregnancy does not increase the risk of hemorrhage in women with a known brain or spinal cord CM and that vaginal delivery is safe in appropriate candidates.

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 ([Formula: see text]) 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 [Formula: see text] 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., ∆MRT

There is a high and growing incidence of skin cancer associated with overexposure to the sun. Most of a person&rsquo, s exposure occurs during their first eighteen years of life. While many children are taught to wear hats and sunscreen, studies indicate these are inadequate. There is a pressing need to improve the design of our landscapes to reduce exposure. Landscape architects can play a key role in driving this process, but only if they understand the factors determining sun protection behaviours among children in the landscape, and how to design for these. We introduced a systematic evidence-based teaching approach to landscape architecture students in New Zealand where the incidence of skin cancer is one of the highest in the world. In this paper, we describe the methods we used to integrate scientific information into a creative design process that included four design phases: (1) review, summary and translation of evidential theory into design guidelines, (2) inventory and analysis of existing schoolyard, (3) redesign of schoolyard, and (4) final design evaluation. We found this process was effective in developing student appreciation for the need to improve sun protection through design, for increasing their understanding of the evidential science, in addition to developing their ability to translate, often inaccessible, evidential data into its spatial form implications. Furthermore, the process led to a high degree of confidence and pride among many students as their resulting design solutions were not only supported by evidence but were often highly creative. Such evidence-based design courses are essential for preparing future landscape architects to design landscapes that significantly reduce the incidence and health effects of skin cancer.

Background and PurposeThe novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic.MethodsThis is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center.ConclusionThe proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.

Current methods for estimating heat vulnerability of young athletes use a heat index (HI) or a wet bulb globe thermometer (WBGT), neither of which fully include the environmental or physiological characteristics that can affect a person&rsquo, s heat budget, particularly where activity occurs on a synthetic surface. This study analyzed and compared the standard methods, HI and WBGT, with a novel and more comprehensive method termed COMFA-Kid (CK) which is based on an energy budget model explicitly designed for youth. The COMFA model was presented at the same time to demonstrate the difference between a child and an adult during activity. Micrometeorological measurements were taken at a synthetic-surfaced football field during mid-day in hot environmental conditions. Standard methods (HI and WBGT) indicated that conditions on the field were relatively safe for youth to engage in activities related to football practice or games, whereas the CK method indicated that conditions were dangerously hot and could lead to exertional heat illness. Estimates using the CK method also indicated that coaches and staff standing on the sidelines, and parents sitting in the stands, would not only be safe from heat but would be thermally comfortable. The difference in thermal comfort experienced by coaches and staff off the field, versus that experienced by young players on the field, could affect decision making regarding the duration and intensity of practices and time in the game. The CK method, which is easy to use and available for modification for specific conditions, would lead to more accurate estimates of heat safety on outdoor synthetic surfaces in particular, and in sports with a high prevalence of heat illness such as football, and should be considered as a complementary or alternative preventive measure against heat.