Background: We aim to assess whether time of day modified the treatment effect in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion Trial), a cluster-randomized trial that did not demonstrate the benefit of direct transportation to a thrombectomy-capable center versus nearest local stroke center for patients with a suspected large vessel stroke triaged in nonurban Catalonia between March 2017 and June 2020. Methods: We performed a post hoc analysis of RACECAT to evaluate if the association between initial transport routing and functional outcome differed according to trial enrollment time: daytime (8:00 am –8:59 pm ) and nighttime (9:00 pm –7:59 am ). Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with ischemic stroke. Subgroup analyses according to stroke subtype were evaluated. Results: We included 949 patients with an ischemic stroke, of whom 258 patients(27%) were enrolled during nighttime. Among patients enrolled during nighttime, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days (adjusted common odds ratio [acOR], 1.620 [95% CI, 1.020–2.551]); no significant difference between trial groups was present during daytime (acOR, 0.890 [95% CI, 0.680–1.163]; P interaction =0.014). Influence of nighttime on the treatment effect was only evident in patients with large vessel occlusion(daytime, acOR 0.766 [95% CI, 0.548–1.072]; nighttime, acOR, 1.785 [95% CI, 1.024–3.112] ; P interaction <0.01); no heterogeneity was observed for other stroke subtypes ( P interaction >0.1 for all comparisons). We observed longer delays in alteplase administration, interhospital transfers, and mechanical thrombectomy initiation during nighttime in patients allocated to local stroke centers. Conclusions: Among patients evaluated during nighttime for a suspected acute severe stroke in non-urban areas of Catalonia, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days. This association was only evident in patients with confirmed large vessel occlusion on vascular imaging. Time delays in alteplase administration and interhospital transfers might mediate the observed differences in clinical outcome. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02795962.

Background: We aim to compare the outcome of patients from urban areas, where the referral center is able to perform thrombectomy, with patients from nonurban areas enrolled in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion). Methods: Patients with suspected large vessel occlusion stroke, as evaluated by a Rapid Arterial Occlusion Evaluation score of ≥5, from urban catchment areas of thrombectomy-capable centers during RACECAT trial enrollment period were included in the Stroke Code Registry of Catalonia. Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with an ischemic stroke. Secondary outcomes included mortality at 90 days, rate of thrombolysis and thrombectomy, time from onset to thrombolysis, and thrombectomy initiation. Propensity score matching was used to assemble a cohort of patients with similar characteristics. Results: The analysis included 1369 patients from nonurban areas and 2502 patients from urban areas. We matched 920 patients with an ischemic stroke from urban areas and nonurban areas based on their propensity scores. Patients with ischemic stroke from nonurban areas had higher degrees of disability at 90 days (median [interquartle range] modified Rankin Scale score, 3 [2–5] versus 3 [1–5], common odds ratio, 1.25 [95% CI, 1.06–1.48]); the observed average effect was only significant in patients with large vessel stroke (common odds ratio, 1.36 [95% CI, 1.08–1.65]). Mortality rate was similar between groups(odds ratio, 1.02 [95% CI, 0.81–1.28]). Patients from nonurban areas had higher odds of receiving thrombolysis (odds ratio, 1.36 [95% CI, 1.16–1.67]), lower odds of receiving thrombectomy(odds ratio, 0.61 [95% CI, 0.51–0.75]), and longer time from stroke onset to thrombolysis (mean difference 38 minutes [95% CI, 25–52]) and thrombectomy(mean difference 66 minutes [95% CI, 37–95]). Conclusions: In Catalonia, Spain, patients with large vessel occlusion stroke triaged in nonurban areas had worse neurological outcomes than patients from urban areas, where the referral center was able to perform thrombectomy. Interventions aimed at improving organizational practices and the development of thrombectomy capabilities in centers located in remote areas should be pursued. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02795962.

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PEMEX Urban Park is an urban regeneration project focused on the remediation and reclamation of PEMEX's brownfield and the adjacent natural lagoon 'Laguna La Escondida' located in the city of Reynosa, Tamaulipas, Mexico. The 65-hectare brownfield is strategically located within the urban center, one of the causes of high levels of air and water pollutants in the city. Historically, the presence of the oil refinery generated dystopic neighbourhoods, some with no access to public spaces, others with inadequate conditions for any type of sustainable community engagement. The natural lagoon, the 'Laguna La Escondida', is a 152-hectare body of water, contaminated by toxic metals and chemicals produced by the refinery and the city's uncontrolled rapid growth. Although contaminated, the lagoon is an essential resource for many local floras and migrating species of fauna. This study includes a thorough analysis of comparable precedents of industrial heritage sites, their associated values and strategies of transformation of polluted landscapes, demonstrating the needs of a broader urban-hydro-ecological approach, emerging from the desire to revive and reintegrate nature into the city. Site analysis and case studies also highlight the important role of culture, of the history embedded in the place, as well as the communities interlinked with the oil refinery. The project, implementing the transformation of PEMEX oil refinery into an urban park, will keep the refinery infrastructure untouched as a memory of the past, acting as a catalyst for eco-socio-cultural activities, providing the community with a place to reconnect as a civic society. The proposal enhances the inherent values of the site, such as history, culture and nature. While purification of water is the focus of this new urban-hydro-ecological proposal, the research suggests alternative remediation strategies that will reverse the damage without compromising future generations' wellbeing. Phytoremediation and rhizo-filtration strategies are analysed as a technique to clean the toxins and heavy metals from the contaminated soil and water. The bioremediation of the lagoon would increase water-quality and reinstate the biodiversity. PEMEX Urban Park envisions an urban eco-hydrological future of the area and re-imagine it as a social condenser in response to capitalism as a form of urbanization.

This study aims to raise a discourse on the unfolding future of a PEMEX vacant oil refinery and a natural lagoon located in the city of Reynosa, Tamaulipas. Reynosa is part of a larger geographical border defined by Mexico and the United States. The Rio Grande River is the geo-political border between both nations, and it’s the primary source of water in the region. Its landscape is composed of several bodies of water featuring the Rio Grande, human-made canals, and a natural lagoon. Reynosa’s water landscapes are interconnected as water flows from the canals to the lagoon into the Rio Grande to the Gulf of Mexico.