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The definition of user behavior in computer simulations for building thermal performance analysis is a challenging and complex task. People behave differently depending on their ...routine and culture, among many other factors. Thus, in this study, mixed-mode climatization for cooling and heating (air conditioning and natural ventilation) was analyzed considering different thermal performance indicators, construction systems and climates in Brazil. The typology analyzed was a single-family dwelling. The results showed not only how different cooling strategies can change the dwelling thermal performance, but also how this performance may be perceived differently based on the indicator. Depending on the indicator, distinct envelopes would be recommended. Also, the study demonstrated that for public policies, the stakeholders need to understand the behavior and occupancy patterns of residents who are representative of a country in order to identify, with more accuracy, the most appropriate envelope for each case. In the case of the indicators, metrics that are most easily adapted to considerer resilient according to climate changing are recommended for inclusion in standards and regulations.
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•Building policies must be rooted in a good understanding of the targeted population.•Building performance standards may benefit from creating databases of weather files.•A thermal ...performance analysis should consider multiple key performance indicators.•Building performance policies should address the thermal resilience of buildings.
This paper presents the main challenges faced and lessons learned when developing a new method to assess the thermal performance of residential buildings for the recently updated Brazilian building performance standard, NBR 15575–1:2021. It touches on subjects related to the representation of occupant behavior, climate, and thermal acceptability in building performance simulation, as well as the use of reference models, key performance indicators, and performance levels in policies. NBR15575 provides a thorough procedure to analyze thermal performance, allowing buildings to be assessed while in passive operation mode and also accounting for energy needs when active operation is necessary. Multiple key performance indicators are introduced to provide a comprehensive evaluation. The main difficulty found was dealing with diversity. Given the vast scale of Brazil’s territory, a high variation in culture, climate and construction techniques is expected, thus requiring a compromise between detail and scalability. There are still many opportunities for improvement, especially regarding the representation of occupants, and adjustments of the characteristics of reference models to promote high thermal performance, considering the diverse climates, regional practices, and economic needs. This paper might help researchers and other stakeholders to develop and improve other local standards and protocols, especially for warm climates.
Chronic pain is an issue that affects over 100 million Americans daily. Acceptance and Commitment Therapy (ACT) has been found to be beneficial for patients with chronic pain by focusing provider ...efforts on teaching coping mechanisms for pain instead of eliminating the pain entirely. Current studies demonstrate that ACT significantly improves post-operative chronic pain scores and outcomes.
The 200 patients chosen via random generator were collected and presented to (institution) orthopedic spine surgeons along with additional information such as the patients’ history of present illness, Visual Analog Scale (VAS) scores, PROMIS-CAT Pain Interference scores, and status of opiate usage. Surgeons were blinded to the PCS cutoff scores. The (institution) orthopedic spine surgeons then identified which patients they would indicate for ACT and their reasoning. Pre-determined PCS score cut-offs were separately used to determine if a patient was indicated for ACT.
The effectiveness of this screening tool was based on the frequency at which the surgeons and PCS scores were complimentary. A department epidemiologist assisted in the analysis of the data with the use of a ROC curve. ROC Curve demonstrated an area under the curve of 0.7784 with a Sensitivity of 0.68 and a Specificity of 0.79. The cut point according to Youden's index is 35. The data showed that the PCS is moderately accurate in its ability to distinguish coinciding patients that the institution orthopedic spine surgeons referred for ACT. The adjusted cut-point indicates that patients above a PCS of 35 would be referred to ACT by the orthopedic spine surgeons while those below a PCS score of 35 would not be referred.
Using the PCS, a referral with the department pain psychologist would occur by institution orthopedic spinal surgeons for patients that are deemed at-risk with a score of at least 35. The goal following this study is to perform future investigations regarding PCS and ACT with patients regarding chronic opioid use and postoperative outcomes. Patients who would be referred for help with chronic pain would be compared to PCS-referred patients and non-referred patients. Pre-operative ACT would be compared to patient outcomes post-operatively. The future aim is to use the cut-offs established in this study for experimental design to evaluate if PCS-referred patients have better pain management post-operatively as compared to the control and previously referred patients.
Level III diagnostic study.
Environmental infection control considerations for Ebola Lowe, John J., PhD; Olinger, Patricia L., BS, RBP; Gibbs, Shawn G., PhD, CIH ...
American journal of infection control,
07/2015, Letnik:
43, Številka:
7
Journal Article
Recenzirano
The growing Ebola virus outbreak in West Africa, coupled with the transport of patients to the United States for treatment and the first US Ebola case identified September 30, 2014, in Texas, have ...driven hospitals throughout the United States to be prepared to provide care for patients with Ebola virus disease (EVD). US hospital preparations are widely focused on the provision of supportive critical care and managing risks to health care workers (HCWs) with infection prevention and control measures recommended by the Centers for Disease Control and Prevention.
The kidney-specific gene
encodes for uromodulin, the most abundant protein excreted in normal urine. Rare large-effect variants in
cause autosomal dominant tubulointerstitial kidney disease (ADTKD), ...while common low-impact variants strongly associate with kidney function and the risk of chronic kidney disease (CKD) in the general population. It is unknown whether intermediate-effect variants in
contribute to CKD. Here, candidate intermediate-effect
variants were identified using large-population and ADTKD cohorts. Biological and phenotypical effects were investigated using cell models, in silico simulations, patient samples, and international databases and biobanks. Eight
missense variants reported in ADTKD are present in the Genome Aggregation Database (gnomAD), with minor allele frequency (MAF) ranging from 10
to 10
. Among them, the missense variant p.Thr62Pro is detected in ∼1/1,000 individuals of European ancestry, shows incomplete penetrance but a high genetic load in familial clusters of CKD, and is associated with kidney failure in the 100,000 Genomes Project (odds ratio OR = 3.99 1.84 to 8.98) and the UK Biobank (OR = 4.12 1.32 to 12.85). Compared with canonical ADTKD mutations, the p.Thr62Pro carriers displayed reduced disease severity, with slower progression of CKD and an intermediate reduction of urinary uromodulin levels, in line with an intermediate trafficking defect in vitro and modest induction of endoplasmic reticulum (ER) stress. Identification of an intermediate-effect
variant completes the spectrum of
-associated kidney diseases and provides insights into the mechanisms of ADTKD and the genetic architecture of CKD.
Abstract Objective This report describes the development and validation of a technology-based system that integrates data on food choice, nutrition, and plate waste to generate feedback reports ...summarizing students' dietary intake at school meals. Methods Cafeteria staff used the system to document the school lunch choices of seventh-graders (n = 37) in an urban charter school for 5 months. Plate waste was assessed by research staff using a visual estimation method that was validated against directly weighed plate waste. Results Most food choices (97.1%) were correctly recorded through the system. Visual estimates of plate waste had excellent interrater reliability ( r 's ≥ .94) and agreement with direct measurements (ρ's ≥ .75). Plate waste assessment required approximately 10 s/tray. Fifty-four percent of parents received feedback reports consistently. Conclusions and Implications The technology-based system enabled staff to monitor dietary intake accurately at school meals. The system could potentially inform lunch menu modifications aimed at reducing plate waste.
To evaluate the effect of GABA(B) receptor in drug-kindled seizures, the gene expression of GABA(B) receptor in cocaine- and lidocaine-kindled rats was examined in this study. Rats were injected ...(i.p.) daily with cocaine (55 mg/kg) or lidocaine (65 mg/kg) until they experienced a motor seizure (kindling). After kindling, rats received a 1-day, 10-day, or 30-day drug washout period. The rats in the 1-day washout group were killed after the washout. Those in the 10-day and 30-day groups were challenged either with drug or saline, and killed 24 h later. Control rats were injected and challenged with saline. GABA(B)R1a, 1b and R2 mRNAs in discrete regions of brain were detected by in situ hybridization; GABA(B)R1a protein level was measured by Western blotting. Ninety percent of the cocaine-treated rats and 100% of the lidocaine-treated rats were kindled by day 12. Those rats responded to the challenge cocaine or lidocaine with a motor seizure after the 10-day and 30-day washout. GABA(B) receptor mRNA and protein levels in the hippocampus were significantly increased after the 1-day and 10-day washout, but not the 30-day washout. In addition, the levels in drug-treated and drug-challenged rats were significantly greater than those in drug-treated and saline-challenged rats after the 10-day washout. Those data suggest that changes of GABA(B) receptor gene expression could be a factor underlying the development of drug-kindled seizure, but not a necessary component for the maintenance of this phenomenon.
Outbreaks of emerging infections present health professionals with the unique challenge of trying to select appropriate pharmacologic treatments in the clinic with little time available for drug ...testing and development. Typically, clinicians are left with general supportive care and often untested convalescent-phase plasma as available treatment options. Repurposing of approved pharmaceutical drugs for new indications presents an attractive alternative to clinicians, researchers, public health agencies, drug developers, and funding agencies. Given the development times and manufacturing requirements for new products, repurposing of existing drugs is likely the only solution for outbreaks due to emerging viruses. In the studies described here, a library of 290 compounds was screened for antiviral activity against Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV). Selection of compounds for inclusion in the library was dependent on current or previous FDA approval or advanced clinical development. Some drugs that had a well-defined cellular pathway as target were included. In total, 27 compounds with activity against both MERS-CoV and SARS-CoV were identified. The compounds belong to 13 different classes of pharmaceuticals, including inhibitors of estrogen receptors used for cancer treatment and inhibitors of dopamine receptor used as antipsychotics. The drugs identified in these screens provide new targets for in vivo studies as well as incorporation into ongoing clinical studies.
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