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Two key goals for sustainable spatial planning are to promote low-carbon travel in daily life and to enhance human wellbeing through diverse human-environment interactions. Yet, the integration of these goals has been underexplored. This study investigates the potential for experiential diversity via active travel in different residential contexts within the Gävle city-region, Sweden. Over 15 months, we collected spatiotemporal data from 165 participants, analyzing 4,362 reported experiences and 13,192 GPS-derived travel trajectories. Our analysis uncovered a significant spatial discrepancy: while the travelled distances to locations of positive experiences typically ranged from 1.5 km to 5 km, active travel predominated only within 1.5 km. This discrepancy persisted across urban, suburban, and peripheral contexts. Although residents in different contexts reported the same types of experiences, urban dwellers travelled about 50 % farther for nature experiences compared with other positive experiences, whereas peripheral dwellers travelled twice the distance for urbanicity experiences compared with other positive experiences. Consequently, urban residents mostly relied on active travel for urbanicity experiences and motorised travel for nature experiences, with the reverse trend observed among peripheral dwellers. These results illustrate the importance of spatial scale for promoting diverse positive experiences via active travel, regardless of residential context. Effective planning strategies may include enhancing environmental diversity near homes and developing infrastructure that favours active over motorised travel for short to moderate distances.

As climate change and urbanization affect current water management systems, new solutions and approaches rooted in public acceptance are needed to ensure future water supply. In this study, we examine public attitudes to reuse of recycled water and associated worldviews, values, and perceptions in a site without historical water issues. A survey of 143 randomly sampled residents in the municipality of the growing Swedish town Knivsta revealed that 81.4% of the respondents had a positive attitude towards using recycled water in general. The results did not indicate any differences in attitudes between those living in and outside the municipality's urban areas. Perceived benefits and risks were found to be significantly related to both attitudes towards using recycled water in general and to the extreme case of using it for drinking purposes. Additionally, trust in public authorities was highly predictive of attitudes towards drinking recycled water. Furthermore, attitudes were found to be related to an environmental worldview and underlying biospheric, altruistic, and hedonic values. This indicates a need to consider the intended purpose as well as engaging with underlying values as part of the technology legitimation process for improving the chances of successful implementation of water recycling technologies. HIGHLIGHTS Examining public attitudes to water reuse in a site without historical water issues.; More than 80% had a positive attitude towards using recycled water in general.; Nuanced relationships uncovered between public attitudes and perceptions.; Attitudes also related to alignment with an environmental worldview and values.; Tailoring approaches and engaging with values is key in the technology legitimation.;

Introduction: Cerebral pulsation is a vital aspect of cerebral hemodynamics. Changes in arterial pressure in response to cardiac pulsation cause cerebral pulsation, which is related to cerebrovascular compliance and cerebral blood perfusion. Cerebrovascular compliance and blood perfusion influence the mechanical properties of the brain, causing pulsation-induced changes in cerebral stiffness. However, there is currently no imaging technique available that can directly quantify the pulsation of brain stiffness in real time.Methods: Therefore, we developed non-invasive ultrasound time-harmonic elastography (THE) technique for the real-time detection of brain stiffness pulsation. We used state-of-the-art plane-wave imaging for interleaved acquisitions of shear waves at a frequency of 60 Hz to measure stiffness and color flow imaging to measure cerebral blood flow within the middle cerebral artery. In the second experiment, we used cost-effective lineby-line B-mode imaging to measure the same mechanical parameters without flow imaging to facilitate future translation to the clinic.Results: In 10 healthy volunteers, stiffness increased during the passage of the arterial pulse wave from 4.8% ± 1.8% in the temporal parenchyma to 11% ± 5% in the basal cisterns and 13% ± 9% in the brain stem. Brain stiffness peaked in synchrony with cerebral blood flow at approximately 180 ± 30 ms after the cardiac R-wave. Line-by-line THE provided the same stiffness values with similar time resolution as high-end plane-wave THE, demonstrating the robustness of brain stiffness pulsation as an imaging marker.Discussion: Overall, this study sets the background and provides reference values for time-resolved THE in the human brain as a cost-efficient and easy-touse mechanical biomarker associated with cerebrovascular compliance.

Fume hoods in laboratories consume the energy equivalent of up to four American households per hood; however, closing a modern hood’s sash completely can save up to 75% of that energy. Past efforts have attempted to harness this potential energy reduction by reminding users to close the sash when a hood is not in use. In this work, we developed a device to measure the efficacy of these energy-saving methods. The device records the position of the sash and detects motion to determine whether a user is present, and, when fitted with a piezoelectric buzzer, can audibly alert users to close the sash when not in use. We installed this device in laboratories to quantify the energy and cost savings resulting from real-time audible feedback and found that the alarm reduced wasted energy by 87 to 98%. In addition, the platform demonstrated here can be used to quantitatively test other energy-saving methods that rely on user behavioral change in future work. Keywords: Energy savings, Behavioral modification, Active feedback, Motion detection

Abstract Background Clinical teachers in medical schools are faced with the challenging task of delivering high-quality patient care, producing high-impact research and contributing to undergraduate medical education all at the same time. Little is known on the gap between an ‘ideal’ environment supporting clinical teachers to provide high quality teaching for their students and the reality of clinical teaching during worktime in the clinical environment. Most quantitative research published so far was done in a wide range of medical educators and did not consider individual academic qualifications. In this study, we wanted to survey clinical teachers in particular and assess the potential impact of individual academic qualification on their perceptions. Methods Based on qualitative data of focus group discussions, we developed a questionnaire which was piloted among 189 clinical teachers. The final web-based questionnaire was completed by clinical teachers at nine German medical schools. Results A total of 833 clinical teachers (569 junior physicians, 264 assistant professors) participated in the online survey. According to participants, the most important indicator of high quality teaching was “sustained student learning outcome” followed by “stimulation of interest in the subject matter”. Lack of time was the main factor impeding effective teaching (78%). Among the factors facilitating high-quality teaching, protected preparation time during working hours (48%) and more recognition of high-quality teaching within medical schools (21%) were perceived as most helpful. Three out of four teachers (76%) were interested in faculty development programmes directed at teaching skills, but 60% stated they had no time to engage in such activities. With regard to evaluation, teachers preferred individual feedback (75%) over global ratings (21%). Differences between assistant professors and junior physicians were found in that the latter group perceived their teaching conditions as more difficult. Conclusions Lack of time is a major barrier against planning and delivering good clinical teaching in medical schools. According to our findings, the situation at German medical schools is particularly challenging for junior physicians. Creating an institutional culture in which teaching is regarded as highly as patient care and research is a prerequisite for overcoming the barriers identified in this study.

Background: With continued increase in the use of mechanical circulatory support, the incidence of device thrombus remains a challenge. This study is a retrospective analysis of data at a single center to assess the safety and efficacy of thrombolytic use in durable mechanical assist devices. Methods: Data was analyzed retrospectively from 154 patients who underwent left ventricular assist device (LVAD) implantation from 1/1/2005 to 6/30/2014. The HMII device was implanted in 131 patients while 23 received the HVAD. LVAD thrombus was diagnosed when lactate dehydrogenase levels exceeded 1000 units/l accompanied by clinical signs of hemolysis and heart failure, echocardiographic data and surges in pump power. TPA (tissue plasminogen activator) protocol consisted of a 5 mg intravenous bolus followed by 3 mg/h infusion in normal saline for 10 h. If symptoms persisted another cycle of TPA at 1 mg/h was continued up to 48 h. Results: The TPA group had a 70% success rate. Success was defined as complete resolution of hemolysis and clinical symptoms with no requirement for LVAD exchange at 30 days. 95% survival was noted at 30 days and 90% were free of a hemorrhagic stroke in the TPA group. The rates of hemorrhagic strokes in the TPA group and the control group were not different (OR = 0.92). Conclusion: The TPA protocol described here was successful consistently. Though this study is limited by its size and retrospective nature it leads the way for larger studies to generate more robust comparisons between different types of mechanical assist devices as well as the tailored use of thrombolytics in this patient population.

Despite much attention in the literature, knowledge about the dynamics surrounding urban densification and urban greening is still in dire need for architects, urban planners and scientists that strive to design, develop, and regenerate sustainable and resilient urban environments. Here, we investigate countrywide patterns of changes in residential density and residential nature at high spatial resolution over a time period of >20 years (1995–2016), combining a dataset of address-level population data covering all of Denmark (>2 million address points) with satellite image-derived normalised difference vegetation index (NDVI) data. Our results show that many residential environments across Denmark have witnessed simultaneous densification and greening since the mid-1990s. In fact, the most common change within 500 m neighbourhoods around individual address points is of joint increases in population and NDVI (28%), followed by increasing NDVI with stable population figures (21%). In contrast, only 8% of neighbourhoods around address points have seen a decline in either population or NDVI. Results were similar in low- middle- and high-density environments, suggesting that trends were driven by climate change but also to some degree enabled by urban planning policies that seek to increase rather than decrease nature in the cities.

Background: Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, has been studied as an adjunctive therapeutic agent for alcohol dependence. In a previous study, we showed that five consecutive sessions of tDCS applied bilaterally over the dorsolateral prefrontal cortex (dlPFC) reduced relapse to the use of alcohol in alcohol use disorder (AUD) outpatients. However, no changes on craving scores were observed. In the present study, we investigated if an extended number of sessions of the same intervention would reduce craving and relapses for alcohol use in AUD inpatients.Methods: Thus, a randomized, double-blind, sham-controlled, clinical trial with parallel arms was conducted (https://clinicaltrials.gov/ct2/show/NCT02091284). AUD patients from two private and one public clinics for treatment of drug dependence were randomly allocated to two groups: real tDCS (5 × 7 cm2, 2 mA, for 20 min, cathodal over the left dlPFC, and anodal over the right dlPFC) and sham-tDCS. Real or sham-tDCS was applied once a day, every other day, in a total of 10 sessions. Craving was monitored by a 5-item obsessive compulsive drinking scale once a week (one time before, three times during and once after brain stimulation) over about 5 weeks.Results: Craving scores progressively decreased over five measurements in both groups but were significantly reduced only in the real tDCS group after treatment. Corrected Hedges' within-group (initial and final) effect sizes of craving scores were of 0.3 for the sham-tDCS and of 1.1 for the real tDCS group. Effect size was 3-fold larger in the real tDCS group. In addition, the between-group analysis on craving score difference was nearly significant, and the effect size was 0.58, in favor for a larger effect in the real tDCS group when compared to sham-tDCS. Furthermore, in a 3-months follow-up after intervention, 72.2% of sham-tDCS group relapsed to the alcohol use whereas 72.7% of tDCS group were abstinent.Conclusions: Multiple sessions of bilateral prefrontal tDCS were well tolerated with no significant adverse events. Thus, extended repetitive bilateral tDCS over the dlPFC is a promising adjunctive clinical tool that could be used to reduce alcohol craving and relapses and facilitate alcoholism cessation.