Energy or carbon? Exploring the relative size of universal zero carbon and zero energy design spaces

One aim of zero carbon, or zero energy, buildings is to help slow climate change. However, regulatory definitions frequently miss substantial emissions, for example ones associated with the materials the building is constructed from, thereby compromising this goal. Unfortunately, including such emissions might restrict the design space, reduce architectural freedom or greatly increase costs. This work presents a new framework for examining the problem. The zero carbon/energy design and regulatory space forms a sub-space of the hyper-volume enclosing all possible designs and regulatory frameworks. A new mathematical/software environment was developed which allows the size and shape of this sub-space to be investigated for the first time. Twenty-four million building design/regulatory standard combinations were modelled and assessed using a tree classification approach. It was found that a worldwide zero standard that includes embodied emissions is possible and is easier to achieve if a carbon rather than an energy metric is adopted, with the design space twice the size for a carbon metric. This result is important for the development of more encompassing regulations, and the novel methods developed applicable to other aspects of construction controlled by regulation where there is the desire to examine the impact of new regulations prior to legislation

Energy or carbon? Exploring the relative size of universal zero carbon and zero energy design spaces

One aim of zero carbon, or zero energy, buildings is to help slow climate change. However, regulatory definitions frequently miss substantial emissions, for example ones associated with the materials the building is constructed from, thereby compromising this goal. Unfortunately, including such emissions might restrict the design space, reduce architectural freedom or greatly increase costs. This work presents a new framework for examining the problem. The zero carbon/energy design and regulatory space forms a sub-space of the hyper-volume enclosing all possible designs and regulatory frameworks. A new mathematical/software environment was developed which allows the size and shape of this sub-space to be investigated for the first time. Twenty-four million building design/regulatory standard combinations were modelled and assessed using a tree classification approach. It was found that a worldwide zero standard that includes embodied emissions is possible and is easier to achieve if a carbon rather than an energy metric is adopted, with the design space twice the size for a carbon metric. This result is important for the development of more encompassing regulations, and the novel methods developed applicable to other aspects of construction controlled by regulation where there is the desire to examine the impact of new regulations prior to legislation

Pricing of in-patent pharmaceuticals in the Middle East and North Africa: is external reference pricing implemented optimally?

In this paper we outline and compare pharmaceutical pricing policies for in-patent prescription pharma- ceuticals with emphasis on external reference pricing (ERP) in eleven countries across the Middle East and North Africa (MENA) region and explore possible improvements in their pricing systems. Primary and secondary evidence was used to inform our analysis. Comparative analysis of ERP systems across countries followed an analytical framework distilling ERP into twelve salient features, while ERP system performance was benchmarked against a framework of best practice principles across (a) objectives and scope, (b) administration and operations, (c) methods used, and (d) implementation. Results suggest that ERP is the dominant pricing method for in-patent pharmaceuticals. Although several good practice cases were identified, none of the eleven countries satisfy all best practice principles. ERP basket sizes vary sig- nificantly and are commonly composed using geographical proximity and low-price countries as criteria. Nine countries do not use the mean or median prices, but resort to using the lowest. Exchange rate fluc- tuations are routinely used to arrive at price reductions in local currency. Significant opportunities exist for MENA countries to develop their ERP regimes to achieve greater compliance with best practice princi- ples. Over the short-term, incremental changes could be implemented to several ERP salient features and can be achieved relatively easily, thereby enhancing the functionality and performance of national ERP systems. Countries in the region can also focus on the development of explicit value assessment systems, and minimize their dependence on ERP over the longer-term

Consistency and accuracy of diagnostic cancer codes generated by automated registration: comparison with manual registration

BACKGROUND: Automated procedures are increasingly used in cancer registration, and it is important that the data produced are systematically checked for consistency and accuracy. We evaluated an automated procedure for cancer registration adopted by the Lombardy Cancer Registry in 1997, comparing automatically-generated diagnostic codes with those produced manually over one year (1997). METHODS: The automatically generated cancer cases were produced by Open Registry algorithms. For manual registration, trained staff consulted clinical records, pathology reports and death certificates. The social security code, present and checked in both databases in all cases, was used to match the files in the automatic and manual databases. The cancer cases generated by the two methods were compared by manual revision. RESULTS: The automated procedure generated 5027 cases: 2959 (59%) were accepted automatically and 2068 (41%) were flagged for manual checking. Among the cases accepted automatically, discrepancies in data items (surname, first name, sex and date of birth) constituted 8.5% of cases, and discrepancies in the first three digits of the ICD-9 code constituted 1.6%. Among flagged cases, cancers of female genital tract, hematopoietic system, metastatic and ill-defined sites, and oropharynx predominated. The usual reasons were use of specific vs. generic codes, presence of multiple primaries, and use of extranodal vs. nodal codes for lymphomas. The percentage of automatically accepted cases ranged from 83% for breast and thyroid cancers to 13% for metastatic and ill-defined cancer sites. CONCLUSION: Since 59% of cases were accepted automatically and contained relatively few, mostly trivial discrepancies, the automatic procedure is efficient for routine case generation effectively cutting the workload required for routine case checking by this amount. Among cases not accepted automatically, discrepancies were mainly due to variations in coding practice

Less is more:a review of low energy standards and the urgent need for an international universal zero energy standard

There are in excess of 70 low or zero energy/carbon building definitions/standards in circulation around the world. However there are few zero energy or zero carbon buildings. This suggests that despite, or possibly because of, a continuing debate over definitions, aspiration has not been met by reality. In this paper the most important 35 standards are reviewed and a correlation between activity in standard generation and completed buildings is presented. Combining this with the requirement for an 80% cut in carbon emissions, a consideration of the proportion of humanity that live in countries without any standards and the ratio of new-build activity vs. pre-existing stock, leads to a conclusion that there is an urgent need for a binding international zero (rather than low) energy/carbon standard that can be adopted world-wide. It is argued this is only possible if carbon is ignored in favour of energy, and many lifecycle issues put to one side. In part this is because of changing national carbon intensities within the energy supply chain, but it is also due to unresolved issues in carbon and energy accountancy. It is hence suggested that such issues are left to optional additional local standards

The structure of everyday narrative in a city market: An ethnopoetics approach

This paper considers the value of Hymesian ethnopoetics as a means of analysing everyday narrative in conditions of mobility and change. The paper offers an account of the development of ethnopoetics as a means to make visible and valorize narrative in the Native American oral tradition, and as a method of revealing culturally specific relations of form and meaning. Hymes' ethnopoetic approach viewed narrative structure as a reflection of a cultural tradition of meaning‐making. Hymes' analysis proposed that traditional narrative was a culturally shaped way of speaking, and analysis of narrative structure could reveal and recreate culture. His orientation rested on an assumption that the culture of a group was more or less stable and fixed. This paper adopts an approach to analysis based on ethnopoetics, representing everyday narrative dramatically, organized not only as lines and verses, but also as scenes and acts. Representation in scenes and acts makes visible the dynamic nature of the narrative. The paper asks whether Hymes' ground‐breaking work on ethnopoetics still has currency and purchase in 21st‐century conditions of mobility, change, and unpredictability. Analysis of everyday narrative in a city market concludes that, notwithstanding the complexity of notions of 'culture' and 'language' in such conditions, ethnopoetics can be productively applied to everyday contexts for the analysis of narrative

Impact of HIV-1 viral subtype on disease progression and response to antiretroviral therapy

<p>Abstract</p> <p>Background</p> <p>Our intention was to compare the rate of immunological progression prior to antiretroviral therapy (ART) and the virological response to ART in patients infected with subtype B and four non-B HIV-1 subtypes (A, C, D and the circulating recombinant form, CRF02-AG) in an ethnically diverse population of HIV-1-infected patients in south London.</p> <p>Methods</p> <p>A random sample of 861 HIV-1-infected patients attending HIV clinics at King's and St Thomas' hospitals' were subtyped using an in-house enzyme-linked immunoassay and <it>env </it>sequencing. Subtypes were compared on the rate of CD4 cell decline using a multi-level random effects model. Virological response to ART was compared using the time to virological suppression (< 400 copies/ml) and rate of virological rebound (> 400 copies/ml) following initial suppression.</p> <p>Results</p> <p>Complete subtype and epidemiological data were available for 679 patients, of whom 357 (52.6%) were white and 230 (33.9%) were black African. Subtype B (n = 394) accounted for the majority of infections, followed by subtypes C (n = 125), A (n = 84), D (n = 51) and CRF02-AG (n = 25). There were no significant differences in rate of CD4 cell decline, initial response to highly active antiretroviral therapy and subsequent rate of virological rebound for subtypes B, A, C and CRF02-AG. However, a statistically significant four-fold faster rate of CD4 decline (after adjustment for gender, ethnicity and baseline CD4 count) was observed for subtype D. In addition, subtype D infections showed a higher rate of virological rebound at six months (70%) compared with subtypes B (45%, p = 0.02), A (35%, p = 0.004) and C (34%, p = 0.01)</p> <p>Conclusions</p> <p>This is the first study from an industrialized country to show a faster CD4 cell decline and higher rate of subsequent virological failure with subtype D infection. Further studies are needed to identify the molecular mechanisms responsible for the greater virulence of subtype D.</p