Beyond sustainable buildings: eco-efficiency to eco-effectiveness through cradle-to-cradle design

Sustainable building development focuses on achieving buildings that meet performance and functionality requirements with minimum adverse impact on the environment. Such eco-efficiency strategies are however not feasible for achieving long-term economic and environmental objectives as they only result in damage reduction without addressing design flaws of contemporary industry. The cradle-to-cradle (C2C) design philosophy which has been described as a paradigm changing innovative platform for achieving ecologically intelligent and environmentally restorative buildings appears to offer an alternative vision which, if embraced, could lead to eco-effectiveness and the achievement of long-term environmental objectives. Adoption of C2C principles in the built environment has however been hindered by several factors especially in a sector where change has always been a very slow process. From a review of extant literature, it is argued that the promotion of current sustainable and/or gree n building strategies - which in themselves are not coherent enough due to their pluralistic meanings and sometimes differing solutions - are a major barrier to the promotion of C2C principles in the built environment. To overcome this barrier to C2C implementation, it is recommended that research should focus on developing clearly defined and measurable C2C targets that can be incorporated into project briefs from the inception of development projects. These targets could enable control, monitoring and comparison of C2C design outcomes with eco-efficient measures as well as serve as a guide for project stakeholders to achieve eco-effective “nutrient” management from the project conceptualization phase to the end of life of the building

The valuation tool user guide: monetizing Cradle to Cradle®

This User Guide outlines the object, scope and expected deliverables from the Valuation Tool component of the Cradle to Cradle ® C2C BIZZ project. It describes the compendium of subtools that have been developed comprising: i) overview of funding tools; ii) C2C investment appraisal tool; and iii) C2C value indexing tool. The underpinning methodologies, as well as their inherent strengths and limitations are also described. The C2C BIZZ project as a whole aims specifically to promote and enhance the implementation of C2C methods in business site development within North Western Europe (NWE) (PAD, p.14). It is intended to infuse C2C notions into conventional site development, restructuring and management. The primary focus of the project is on planning, building and managing of business sites with C2C credentials (PAD, p.18) using sites in Lille Metropole (La Lainiere), London (London Sustainable Industries Park) and Luxemburg (Ecoparc Windhof) as experimental fields. C2C BIZZ is not concerned with the internal operations and activities of occupiers or users of the developed site. Accordingly, the scope of the valuation tool is confined to the planning, building and management of C2C sites. The deliverable from this component is a compendium of subtools (see Figure 1 below) that may be used to analyse the financial performance of C2C credentials in business sites to aid the making of a business case for such developments and evaluating the financial incentives for particular C2C site development projects. This entire work is premised on the argument that the wider adoption of C2C principles within the built environment depends on the rate of uptake by the private sector. The private sector, being profit driven, are likely to engage in C2C site development if they are convinced of its capacity to contribute to their business goals which ultimately is a return on their investment. The tool development described in this document attempts to provide a framework for collating an evidence base that can assist in articulating the business case for C2C in business site developments

Resting electrocardiographic and echocardiographic findings in an urban community in the Gambia

The presence of Left Ventricular Hypertrophy (LVH) in a patient with systemic hypertension deserves serious attention and makes its clinical diagnosis a priority. Over the years various criteriahave been proposed for the electrographic (ECG) diagnosis of LVH and the sensitivity and specificity of these criteria have been extensively studied in Caucasians. Recent evidence indicates that they areinapplicable to people of African descent. Unlike echocardiography (ECHO), the ECG is generally available, cheap but has a lower sensitivity in detecting LVH compared to echocardiography. Thisstudy was conducted to evaluate ECG criteria against 2-dimensional (2-D) guided M-mode echocardiography in the diagnosis of LVH in adult Gambians. Secondly, to determine the ECG criteria usingthe Minnesota, Araoye, Sokolow and Lyon or Wolff criteria with the overall best accuracy for the diagnosis of LVH. Two hundred and eight (208) consecutive patients with systemic hypertension (BP.140/90mmHg) with or without treatment and an age matched group of 108 non-hypertensive patients were enrolled from outpatient clinics. A questionnaire was filled. All patients were investigated with 2-D guided M-mode echocardiography and a standard 12-1ead ECG. Anthropometric measurements were also taken. The gold standard was the Penn formula to determine the left ventricular mass index (of 125 g/m2 in males and 110 g/m2 in females as the cut-off for LVH). Using this gold standard the prevalence of echocardiographic LVH was 47.5% and 27.8 % in the hypertensives and non-hypertensives respectively (P 0.05). Sokolow and Lyon criterion had overall best accuracy for the electrocardiographic diagnosis of left ventricular hypertrophyin hypertensives and is further recommended for use as such. But for non-hypertensives, the Wolff criterion had overall best accuracy

Effectiveness And Safety Assessment Of Mist tonica, A Herbal Haematinic

Anaemia is a widespread public health problem, and in Ghana it is the fourth leading cause of hospital admissions and the second factor contributing to death. Mist Tonica, an herbal haematinic produced by the Centre for Scientific Research into Plant Medicine (CSRPM), Ghana, was assessed for its effectiveness and safety in humans after Ethics Committee approval. Clinically established anaemic-patients aged, 13 years and above, with haemoglobin levels less than 11.5 g/dl and 13.5g/dl for females and males respectively were treated with Mist tonica, 8.96 g/ 40 mls three times daily for two weeks . The mean haemoglobin rise per week caused by Mist Tonica was 1.92 (0.76) g/dl, range (1.66 - 2.55) g/dl/week and over 88 % of the patients on Mist Tonica had their appetite for food improved. Haematological profile, liver and kidney functions were not adversely affected by Mist tonica. Results of the study suggest that Mist Tonica is an effective and safe herbal haematinic. Keywords: Anaemia, haemoglobin, herbal, haematinic, safety, effectivenessAfr. Jnl of Trad Comp Alt medicine Vol. 5 (2) 2008: pp. 115-11

ResearchFlow: Understanding the Knowledge Flow between Academia and Industry

Understanding, monitoring, and predicting the flow of knowledge between academia and industry is of critical importance for a variety of stakeholders, including governments, funding bodies, researchers, investors, and companies. To this purpose, we introduce ResearchFlow, an approach that integrates semantic technologies and machine learning to quantifying the diachronic behaviour of research topics across academia and industry. ResearchFlow exploits the novel Academia/Industry DynAmics (AIDA) Knowledge Graph in order to characterize each topic according to the frequency in time of the related i) publications from academia, ii) publications from industry, iii) patents from academia, and iv) patents from industry. This representation is then used to produce several analytics regarding the academia/industry knowledge flow and to forecast the impact of research topics on industry. We applied ResearchFlow to a dataset of 3.5M papers and 2M patents in Computer Science and highlighted several interesting patterns. We found that 89.8% of the topics first emerge in academic publications, which typically precede industrial publications by about 5.6 years and industrial patents by about 6.6 years. However this does not mean that academia always dictates the research agenda. In fact, our analysis also shows that industrial trends tend to influence academia more than academic trends affect industry. We evaluated ResearchFlow on the task of forecasting the impact of research topics on the industrial sector and found that its granular characterization of topics improves significantly the performance with respect to alternative solutions

A review on a deep learning perspective in brain cancer classification

AWorld Health Organization (WHO) Feb 2018 report has recently shown that mortality rate due to brain or central nervous system (CNS) cancer is the highest in the Asian continent. It is of critical importance that cancer be detected earlier so that many of these lives can be saved. Cancer grading is an important aspect for targeted therapy. As cancer diagnosis is highly invasive, time consuming and expensive, there is an immediate requirement to develop a non-invasive, cost-effective and efficient tools for brain cancer characterization and grade estimation. Brain scans using magnetic resonance imaging (MRI), computed tomography (CT), as well as other imaging modalities, are fast and safer methods for tumor detection. In this paper, we tried to summarize the pathophysiology of brain cancer, imaging modalities of brain cancer and automatic computer assisted methods for brain cancer characterization in a machine and deep learning paradigm. Another objective of this paper is to find the current issues in existing engineering methods and also project a future paradigm. Further, we have highlighted the relationship between brain cancer and other brain disorders like stroke, Alzheimer’s, Parkinson’s, andWilson’s disease, leukoriaosis, and other neurological disorders in the context of machine learning and the deep learning paradigm

EFFECTIVENES AND SAFETY ASSESSMENT OF MIST TONICA, A HERBAL HAEMATINIC

Anaemia is a widespread public health problem, and in Ghana it is the fourth leading cause of hospital admissions and the second factor contributing to death. Mist Tonica, an herbal haematinic produced by the Centre for Scientific Research into Plant Medicine (CSRPM), Ghana, was assessed for its effectiveness and safety in humans after Ethics Committee approval. Clinically established anaemic-patients aged, 13 years and above, with haemoglobin levels less than 11.5 g/dl and 13.5g/dl for females and males respectively were treated with Mist Tonica, 8.96 g/ 40 mls three times daily for two weeks . The mean haemoglobin rise per week caused by Mist Tonica was 1.92 (0.76) g/dl, range (1.66 - 2.55) g/dl/week and over 88 % of the patients on Mist Tonica had their appetite for food improved. Haematological profile, liver and kidney functions were not adversely affected by Mist Tonica. Results of the study suggest that Mist Tonica is an effective and safe herbal haematinic

Antibiotic Prescribing Patterns in Ghana, Uganda, Zambia and Tanzania Hospitals: Results from the Global Point Prevalence Survey (G-PPS) on Antimicrobial Use and Stewardship Interventions Implemented

Antimicrobial resistance (AMR) remains an important global public health issue with antimicrobial misuse and overuse being one of the main drivers. The Global Point Prevalence Survey (G-PPS) of Antimicrobial Consumption and Resistance assesses the prevalence and the quality of antimicrobial prescriptions across hospitals globally. G-PPS was carried out at 17 hospitals across Ghana, Uganda, Zambia and Tanzania. The overall prevalence of antimicrobial use was 50% (30–57%), with most antibiotics prescribed belonging to the WHO ‘Access’ and ‘Watch’ categories. No ‘Reserve’ category of antibiotics was prescribed across the study sites while antimicrobials belonging to the ‘Not Recommended’ group were prescribed infrequently. Antimicrobials were most often prescribed for prophylaxis for obstetric or gynaecological surgery, making up between 12 and 18% of total prescriptions across all countries. The most prescribed therapeutic subgroup of antimicrobials was ‘Antibacterials for systemic use’. As a result of the programme, PPS data are now readily available for the first time in the hospitals, strengthening the global commitment to improved antimicrobial surveillance. Antimicrobial stewardship interventions developed included the formation of AMS committees, the provision of training and the preparation of new AMS guidelines. Other common interventions included the presentation of findings to clinicians for increased awareness, and the promotion of a multi-disciplinary approach to successful AMS programmes. Repeat PPS would be necessary to continually monitor the impact of interventions implemented. Broader participation is also encouraged to strengthen the evidence base

Baricitinib in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial and updated meta-analysis

Background: We aimed to evaluate the use of baricitinib, a Janus kinase (JAK) 1–2 inhibitor, for the treatment of patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple possible treatments in patients hospitalised with COVID-19 in the UK. Eligible and consenting patients were randomly allocated (1:1) to either usual standard of care alone (usual care group) or usual care plus baricitinib 4 mg once daily by mouth for 10 days or until discharge if sooner (baricitinib group). The primary outcome was 28-day mortality assessed in the intention-to-treat population. A meta-analysis was done, which included the results from the RECOVERY trial and all previous randomised controlled trials of baricitinib or other JAK inhibitor in patients hospitalised with COVID-19. The RECOVERY trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936) and is ongoing. Findings: Between Feb 2 and Dec 29, 2021, from 10 852 enrolled, 8156 patients were randomly allocated to receive usual care plus baricitinib versus usual care alone. At randomisation, 95% of patients were receiving corticosteroids and 23% were receiving tocilizumab (with planned use within the next 24 h recorded for a further 9%). Overall, 514 (12%) of 4148 patients allocated to baricitinib versus 546 (14%) of 4008 patients allocated to usual care died within 28 days (age-adjusted rate ratio 0·87; 95% CI 0·77–0·99; p=0·028). This 13% proportional reduction in mortality was somewhat smaller than that seen in a meta-analysis of eight previous trials of a JAK inhibitor (involving 3732 patients and 425 deaths), in which allocation to a JAK inhibitor was associated with a 43% proportional reduction in mortality (rate ratio 0·57; 95% CI 0·45–0·72). Including the results from RECOVERY in an updated meta-analysis of all nine completed trials (involving 11 888 randomly assigned patients and 1485 deaths) allocation to baricitinib or another JAK inhibitor was associated with a 20% proportional reduction in mortality (rate ratio 0·80; 95% CI 0·72–0·89; p<0·0001). In RECOVERY, there was no significant excess in death or infection due to non-COVID-19 causes and no significant excess of thrombosis, or other safety outcomes. Interpretation: In patients hospitalised with COVID-19, baricitinib significantly reduced the risk of death but the size of benefit was somewhat smaller than that suggested by previous trials. The total randomised evidence to date suggests that JAK inhibitors (chiefly baricitinib) reduce mortality in patients hospitalised for COVID-19 by about one-fifth. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Higher dose corticosteroids in patients admitted to hospital with COVID-19 who are hypoxic but not requiring ventilatory support (RECOVERY): a randomised, controlled, open-label, platform trial

BACKGROUND: Low-dose corticosteroids have been shown to reduce mortality for patients with COVID-19 requiring oxygen or ventilatory support (non-invasive mechanical ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation). We evaluated the use of a higher dose of corticosteroids in this patient group. METHODS: This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing multiple possible treatments in patients hospitalised for COVID-19. Eligible and consenting adult patients with clinical evidence of hypoxia (ie, receiving oxygen or with oxygen saturation <92% on room air) were randomly allocated (1:1) to either usual care with higher dose corticosteroids (dexamethasone 20 mg once daily for 5 days followed by 10 mg dexamethasone once daily for 5 days or until discharge if sooner) or usual standard of care alone (which included dexamethasone 6 mg once daily for 10 days or until discharge if sooner). The primary outcome was 28-day mortality among all randomised participants. On May 11, 2022, the independent data monitoring committee recommended stopping recruitment of patients receiving no oxygen or simple oxygen only due to safety concerns. We report the results for these participants only. Recruitment of patients receiving ventilatory support is ongoing. The RECOVERY trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). FINDINGS: Between May 25, 2021, and May 13, 2022, 1272 patients with COVID-19 and hypoxia receiving no oxygen (eight [1%]) or simple oxygen only (1264 [99%]) were randomly allocated to receive usual care plus higher dose corticosteroids (659 patients) versus usual care alone (613 patients, of whom 87% received low-dose corticosteroids during the follow-up period). Of those randomly assigned, 745 (59%) were in Asia, 512 (40%) in the UK, and 15 (1%) in Africa. 248 (19%) had diabetes and 769 (60%) were male. Overall, 123 (19%) of 659 patients allocated to higher dose corticosteroids versus 75 (12%) of 613 patients allocated to usual care died within 28 days (rate ratio 1·59 [95% CI 1·20–2·10]; p=0·0012). There was also an excess of pneumonia reported to be due to non-COVID infection (64 cases [10%] vs 37 cases [6%]; absolute difference 3·7% [95% CI 0·7–6·6]) and an increase in hyperglycaemia requiring increased insulin dose (142 [22%] vs 87 [14%]; absolute difference 7·4% [95% CI 3·2–11·5]). INTERPRETATION: In patients hospitalised for COVID-19 with clinical hypoxia who required either no oxygen or simple oxygen only, higher dose corticosteroids significantly increased the risk of death compared with usual care, which included low-dose corticosteroids. The RECOVERY trial continues to assess the effects of higher dose corticosteroids in patients hospitalised with COVID-19 who require non-invasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation. FUNDING: UK Research and Innovation (Medical Research Council), National Institute of Health and Care Research, and Wellcome Trust