Evaluation of Various Inspiratory Times and Inflation Pressures During Airway Pressure Release Ventilation

There are few recommendations on how best to apply certain modes of mechanical ventilation. The application of Airway Pressure Release Ventilation (APRV) includes strategic implementation of specific inspiratory times (I-times) and particular mean airway pressures (MAWP) neither of which is standardized. This study utilized a retrospective analysis of archived electronic health record data to evaluate the clinical outcomes of adult patients that had been placed on APRV for at least 8 hours. 68 adult subjects were evaluated as part of a convenient purposive sample. All outcomes of interest (surrogates) for short-term clinical outcomes to include the PaO2/FiO2 (P/F) ratio, Oxygen Index and Oxygen Saturation Index (OI; OSI), and Modified Sequential Organ Failure Assessment (MSOFA) scores showed improvement after at least 8 hours on APRV. Most notably, there was significant improvement in P/F ratio (p = .012) and OSI (p = .000). Results of regression analysis showed P low as a statistically significant negative predictor of pre-APRV P/F ratio with a higher initial P low coinciding with a lower P/F ratio. The regression analysis also showed MAWP as a significant positive predictor of post-APRV OSI and P high and P low as significant negative predictors of post-APRV MSOFA scores. In summary, it was found that settings for P high, Plow, and T low in addition to overall MAWP and Body Mass Index (BMI) had significant correlation to impact at least one of the short-term clinical outcomes measured

Green healthcare facilities: assessing the impacts of indoor environmental quality on the working environment from the perspective of health care workers

The primary aim of this study is to investigate the impacts of indoor environment on the nursing staff of public hospitals in the tropics. The research was conducted in three Singaporean public hospitals. Of the three study hospitals, one had just been completed and awarded with the highest certification level for Green Mark Assessment Tool (GMAT). The second hospital had undergone remodelling and classified as an existing green hospital with the second highest level of GMAT certification. The last hospital, selected as control, had never undergone GMAT certification. Several peer reviewed studies have shown that healthcare workers are often dissatisfied with the indoor environment and environmental design features of hospital wards. However, the perceptions and wellbeing of healthcare workers towards the indoor environment within green hospitals is little known to date. This study investigates whether the nurses of green hospitals perceived the indoor environmental quality (IEQ) of their work place to have a positive effect on their wellbeing and perception as compared to the convention. The secondary aim is to comment on the role of GMAT in promoting sustainability in Singapore. This study has two parts. In the first part, the quantitative measurements of IEQ parameters were taken in the context of air conditioned and naturally ventilated hospital wards. In the second part of this investigation, a survey instrument was designed to evaluate the nurses wellbeing and perceptions of their working environment. The two studies, when combined, would reveal the overall nursing staff s perception and attitude towards green hospital facilities and the indoor environment of public hospital wards in the Tropics. Results showed that GMAT certification, as a measure of successful green building design, did not influence the perception and satisfaction of the nurses. Furthermore, it was found that although the green hospitals achieved high GMAT certification, healthcare workers often complained about various IEQ parameters. In short, the results from this study need to be further substantiated by long term research and a larger sample size of test subjects. In addition, more research needs to be conducted to optimize GMAT standards for the benefits of occupants within healthcare facilities

Proceedings of the COST Action TU1403 : Adaptive Facades Network Final Conference

info:eu-repo/semantics/publishedVersio

Natural ventilation : an evaluation of strategies for improving indoor air quality in hospitals located in semi-arid climates

PhD ThesisThis thesis is an investigation into improving natural ventilation in low rise hospital wards in Northern Nigeria. The climate of this region is semi-arid, during the dry season, sub-Saharan fine dust (Harmattan dust) is blown into the region from the North East and during the wet season, Mosquitos are prevalent. The energy infrastructure in the whole of Nigeria is under resourced; hence ventilation strategies’ based on mechanical extraction are not possible. Five wards within low rise hospital buildings were studied; these were purpose designed hospital buildings, not converted buildings. Questionnaire surveys of health care workers in the hospitals was conducted and revealed dissatisfaction with the buildings’ ventilation and Indoor Air Quality. The questionnaires were then followed up by Tracer Gas measurements and during the period of measurement there was only one occasion when a ward achieved an air change rate of 6-ach-1, the ASHREA Standard requirement for hospital buildings. To investigate methods of improving natural ventilation in these wards, a CFD model was developed of a representative ward, the model was validated against the Tracer Gas measurements; with an acceptable agreement of ≤ 15%. Using the CFD model, achievable ventilation strategies within the context of the location, were investigated, and a combination of cross ventilation utilizing windows on the windward and leeward sides of the ward together with a roof ventilator on the leeward side proved the most successful. All openings were screened to prevent the entry of mosquitos. This best case was further investigated with the wind direction at an oblique angle to the ward side. The oblique angle of wind attack reduced the air change rates but improved air circulation/mixing within the ward. With the exception when the wind direction was parallel to the ward side. To reduce the ingress of Harmattan Dust, was problematic given the energy restrictions, a low energy solution of introducing screened plenums on both the windward and leeward sides of the building proved successful. Larger dust particles were detained within the windward plenum and the smaller dust particles were exhausted into the leeward plenum. With the mosquito screens located on the large surface area of the plenum, the window screens were removed resulting in higher air change rates. Thus, it is recommended that, openings should be provided on the windward and leeward walls and on the roof toward the leeward side for efficient ventilation and airflow circulation at the occupancy level. The longer sides of the wards should be oriented toward the North-South to capture the North-East trade winds and South-West monsoon winds with oblique angle of attack. Plenums should be incorporated to the windward and leeward facades and Insect screen should be installed on the plenums instead of the wards’ openings to increase ventilation rates while excluding mosquitoes and decreasing dust particle concentration in the hospital wards. Openings should be at the middle of the windward and leeward walls and on the roof toward the leeward to avoid airflow short-circuiting. It is recommended to use insect screen with the porosity of 0.2 and when the outdoor local wind speed is ≤ 1.26 m/s (2 m/s: airport value), the ventilation should be supplemented with fan.Ramat Polytechnic Maiduguri, Borno State Government and Tertiary Education Trust Fund (TETFUND

Recent Advances in Volatile Organic Compound Analysis as Diagnostic Biomarkers

Volatile organic compounds (VOCs) are a diverse group of carbon-based molecules that are volatile at ambient temperatures and are emitted by an organism as a result of metabolic processes of cells and associated microbiome. The qualitative and quantitative profile of VOCs in biological fluids can vary depending on the physiological changes. Therefore, the pattern of volatile metabolites may reflect the presence of several diseases. This has been intensively investigated in the last few decades, resulting in an increasing number of studies focused on new volatile biomarker discovery.This reprint aimed to summarize the recent findings related to VOCs detected in various biological fluids such as breath, urine and feces for biomedical applications. The content covers various topics, including but not limited to biomedical/medical application of VOC analysis, biomarker discovery, and novel approaches for sampling and analyzing VOCs