Field Evaluation of a Near Zero Energy Home in Oklahoma

The authors evaluated a zero energy home built by Ideal Homes in Edmond, Oklahoma, that included an extensive package of energy-efficient technologies and a photovoltaic array for site electricity generation. The home was part of a Building America research project in partnership with the Building Science Consortium to exhibit high efficiency technologies while keeping costs within the reach of average home buyers

Test Protocol for Room-to-Room Distribution of Outside Air by Residential Ventilation Systems

This test and analysis protocol has been developed as a practical approach for measuring outside air distribution in homes. It has been used successfully in field tests and has led to significant insights on ventilation design issues. Performance advantages of more sophisticated ventilation systems over simpler, less-costly designs have been verified, and specific problems, such as airflow short-circuiting, have been identified

Advanced Energy Retrofit Guide (AERG): Practical Ways to Improve Energy Performance; Healthcare Facilities (Book)

The Advanced Energy Retrofit Guide for Healthcare Facilities is part of a series of retrofit guides commissioned by the U.S. Department of Energy. By presenting general project planning guidance as well as detailed descriptions and financial payback metrics for the most important and relevant energy efficiency measures (EEMs), the guides provide a practical roadmap for effectively planning and implementing performance improvements in existing buildings. The Advanced Energy Retrofit Guides (AERGs) are intended to address key segments of the U.S. commercial building stock: retail stores, office buildings, K-12 schools, grocery stores, and healthcare facilities. The guides' general project planning considerations are applicable nationwide; the energy and cost savings estimates for recommended EEMs were developed based on energy simulations and cost estimates for an example hospital tailored to five distinct climate regions. These results can be extrapolated to other U.S. climate zones. Analysis is presented for individual EEMs, and for packages of recommended EEMs for two project types: existing building commissioning projects that apply low-cost and no-cost measures, and whole-building retrofits involving more capital-intensive measures

Evaluation of a High-Performance Solar Home in Loveland, Colorado: Preprint

Building America (BA) partner McStain Neighborhoods built the Discovery House in Loveland, Colorado, with an extensive package of energy-efficient features, including a high-performance envelope, efficient mechanical systems, a solar water heater integrated with the space-heating system, a heat-recovery ventilator (HRV), and ENERGY STAR appliances. The National Renewable Energy Laboratory (NREL) and Building Science Consortium (BSC) conducted short-term field-testing and building energy simulations to evaluate the performance of the house. These evaluations are utilized by BA to improve future prototype designs and to identify critical research needs. The Discovery House building envelope and ducts were very tight under normal operating conditions. The HRV provided fresh air at a rate of about 35 l/s (75 cfm), consistent with the recommendations of ASHRAE Standard 62.2. The solar hot water system is expected to meet the bulk of the domestic hot water (DHW) load (>83%), but only about 12% of the space-heating load. DOE-2.2 simulations predict whole-house source energy savings of 54% compared to the BA Benchmark. The largest contributors to energy savings beyond McStain's standard practice are the solar water heater, HRV, improved air distribution, high-efficiency boiler, and compact fluorescent lighting package

Evaluation of a High-Performance Solar Home in Loveland, Colorado

Building America (BA) partner McStain Neighborhoods built the Discovery House in Loveland, Colorado, with an extensive package of energy-efficient features, including a high-performance envelope, efficient mechanical systems, a solar water heater integrated with the space-heating system, a heat-recovery ventilator (HRV), and ENERGY STAR? appliances. The National Renewable Energy Laboratory (NREL) and Building Science Consortium (BSC) conducted short-term field-testing and building energy simulations to evaluate the performance of the house. These evaluations are utilized by BA to improve future prototype designs and to identify critical research needs. The Discovery House building envelope and ducts were very tight under normal operating conditions. The HRV provided fresh air at a rate of about 75 cfm (35 l/s), consistent with the recommendations of ASHRAE Standard 62.2. The solar hot water system is expected to meet the bulk of the domestic hot water (DHW) load (>83%), but only about 12% of the space-heating load. DOE-2.2 simulations predict whole-house source energy savings of 54% compared to the BA Benchmark [1]. The largest contributors to energy savings beyond McStain's standard practice are the solar water heater, HRV, improved air distribution, high-efficiency boiler, and compact fluorescent lighting package

Field Test of Room-to-Room Distribution of Outside Air with Two Residential Ventilation Systems

Uniform distribution of outside air is one way to ensure that residential dilution ventilation systems will provide a known amount of fresh air to all rooms

Patient-reported Quality of Life outcomes in patients treated for muscle-invasive bladder cancer with radiotherapy ± chemotherapy in the BC2001 Phase III Randomised Controlled Trial

BC2001, the largest randomised trial of bladder-sparing treatment for muscle-invasive bladder cancer, demonstrated improvement of local control and bladder cancer-specific survival from the addition of concomitant 5-fluorouracil and mitomycin C to radiotherapy.This article is available via Open Access. Click on the Publisher URL to access the full-text

TUXEDO: a phase I/II trial of cetuximab with chemoradiotherapy in muscle-invasive bladder cancer

Objective: To assess the feasibility and preliminary efficacy of adding cetuximab to standard chemoradiotherapy for muscle-invasive bladder cancer. Patients and Methods: TUXEDO was a prospective, single-arm, open-label, phase I/II trial conducted in six UK hospitals. Cetuximab was administered with an initial loading dose of 400 mg/m2 on Day 1 of Week −1, and then seven weekly doses of 250 mg/m2. The radiotherapy schedule was 64 Gy/32F with Day 1 mitomycin C (12 g/m2) and 5-fluorouracil (500 mg/m2/day) over Days 1–5 and Days 22–26. Patients with T2-4aN0M0 urothelial cancer and a performance status of 0–1 were eligible. Prior neoadjuvant therapy was permitted. The Phase I primary outcome was impact on radiotherapy treatment completion and toxicity experienced during treatment. The Phase II primary outcome was local control at 3 months post treatment. Results: Between September 2012 and October 2016, 33 patients were recruited; seven in Phase I, 26 in Phase II. Three patients in Phase II were subsequently deemed ineligible and received no trial therapy. Eight patients discontinued cetuximab due to adverse effects. The patients’ median (range) age was 70.1 (60.6–75.1) years, 20 had a performance status of 0, 27 were male and 26 had already received neoadjuvant chemotherapy. In Phase I, all patients completed planned radiotherapy, with no delays or dose reductions. Of the 30 evaluable patients in Phase II, 25 had confirmed local control 3 months after treatment (77%, 95% confidence interval 58–90). During the trial there were 18 serious adverse events. The study was halted due to slow accrual. Conclusion: Phase I data demonstrate it is feasible and safe to add cetuximab to chemoradiotherapy. Exploratory analysis of Phase II data provides evidence to consider further clinical evaluation of cetuximab in this setting

Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury

Background: Individuals with acute-onset central nervous system (CNS) injury, including stroke, motor incomplete spinal cord injury, or traumatic brain injury, often experience lasting locomotor deficits, as quantified by decreases in gait speed and distance walked over a specific duration (timed distance). The goal of the present clinical practice guideline was to delineate the relative efficacy of various interventions to improve walking speed and timed distance in ambulatory individuals greater than 6 months following these specific diagnoses. Methods: A systematic review of the literature published between 1995 and 2016 was performed in 4 databases for randomized controlled clinical trials focused on these specific patient populations, at least 6 months postinjury and with specific outcomes of walking speed and timed distance. For all studies, specific parameters of training interventions including frequency, intensity, time, and type were detailed as possible. Recommendations were determined on the basis of the strength of the evidence and the potential harm, risks, or costs of providing a specific training paradigm, particularly when another intervention may be available and can provide greater benefit. Results: Strong evidence indicates that clinicians should offer walking training at moderate to high intensities or virtual reality–based training to ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. In contrast, weak evidence suggests that strength training, circuit (ie, combined) training or cycling training at moderate to high intensities, and virtual reality–based balance training may improve walking speed and distance in these patient groups. Finally, strong evidence suggests that body weight–supported treadmill training, robotic-assisted training, or sitting/standing balance training without virtual reality should not be performed to improve walking speed or distance in ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. Discussion: The collective findings suggest that large amounts of task-specific (ie, locomotor) practice may be critical for improvements in walking function, although only at higher cardiovascular intensities or with augmented feedback to increase patient's engagement. Lower-intensity walking interventions or impairment-based training strategies demonstrated equivocal or limited efficacy. Limitations: As walking speed and distance were primary outcomes, the research participants included in the studies walked without substantial physical assistance. This guideline may not apply to patients with limited ambulatory function, where provision of walking training may require substantial physical assistance. Summary: The guideline suggests that task-specific walking training should be performed to improve walking speed and distance in those with acute-onset CNS injury although only at higher intensities or with augmented feedback. Future studies should clarify the potential utility of specific training parameters that lead to improved walking speed and distance in these populations in both chronic and subacute stages following injury. Disclaimer: These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for persons with chronic stroke, incomplete spinal cord injury, and traumatic brain injury to improve walking speed and distance

Developing a prototype digital risk mitigation pathway for children and young people admitted to acute paediatric NHS care in mental health crisis: Protocol of the Safety Assessment in Paediatric healthcare Environments (SAPhE) pathway study

Background: Globally, there are increasing numbers of Children and young people (CYPs) experiencing a mental health crisis requiring admission to acute paediatric inpatient care. These CYPs can often experience fluctuating emotional states accompanied by urges to self-harm or attempt to end their life, leading to reduced safety and poorer experiences. Currently, in the UK National Health Service (NHS) there are no standardised, evidence-based interventions in acute paediatric care to mitigate or minimise immediate risk of self-harm and suicide in CYP admitted with mental health crisis. Objective: To outline the protocol for the SAPhE Pathway study which aims to: 1) identify and prioritise risk mitigation strategies to include in the digital prototype, 2) understand the feasibility of implementing a novel digital risk mitigation pathway in differing NHS contexts, and 3) co-create a prototype digital risk mitigation pathway. Methods: This is a multi-centre study uses a mixed-methods design. A systematic review and exploratory methods (interviews, surveys, and focus groups) will be used to identify the content and feasibility of implementing a digital risk mitigation pathway. Participants will include healthcare professionals, digital experts and CYP with experience of mental health conditions. Data will be collected between January 2022 and March 2023 and analysed using content and thematic analysis, case study, cross-case analysis for qualitative data and descriptive statistics for quantitative data. Findings will inform the experience-based co-design workshops. Ethics and Dissemination: The study received full ethical approval from NHS REC [Ref: 22/SC/0237 and 22/WM/0167]. Findings will be made available to all stakeholders using multiple approaches