A state of the art review of the impact of Vertical Greenery Systems (VGS) on the energy performance of buildings in temperate climates

Rapid urbanization and climate change concerns have led to a growing drive to integrate nature into the built environment. It is expected that London will face increasing risks of flooding, overheating and drought, through hotter drier summers and warmer wetter winters. In response, the Mayor of London adopted new policies for encouraging the use of living roofs and green walls. Greenery systems are considered as promising solutions for improving energy and thermal efficiency of buildings as well as reducing pollution, encouraging biodiversity and water runoff, reducing Urban Heat Island (UHI) effects and improving the microclimate overall. The research aims to review the current state-of-the-art literature concerning the potentials and limitations of vertical greenery systems on energy and thermal performance of buildings in temperate climates. This review paper synthesises and summarizes the literature with regards to vertical green systems (VGS) when used as a passive design strategy to enhance energy savings in buildings. From the review of the literature, some key aspects to consider when designing VGS are outlined, such as climate influence, the plant species grown and the different operating mechanisms as associated such as shade, evapotranspiration, insulation and wind barrier. The results achieved from the literature review clearly indicate that green walls may be considered as key solutions to mitigate operational energy consumption of buildings as well as provide thermally comfortable indoor and outdoor environments. The results of this research will prove useful to builders, architects, engineers and policy makers as it will provide an in-depth understanding of the potential of VGS to mitigate building related energy consumption in a renewable, sustainable, energy-efficient and cost-effective way

The influence of urban green systems on the Urban Heat Island effect in London

Urban areas are typically warmer than rural ones. This is mainly due to denser configuration dominated by impermeable surfaces such as buildings and roads, compared to rural areas which are less densely built and mainly dominated by open spaces. Rapid urban expansion in dense cities bares direct impact on surface and air temperature patterns within street canyons; a phenomena which is known as the Urban Heat Island (UHI) effect. Thus, several UK city councils such as Birmingham, Manchester, and London have started to develop strategies aiming at enhancing urban green systems (UGS) through trees, green walls and green roofs. Some of those strategies include considering the green space factor, and increasing green areas within the cities to improve street canyon microclimate and reduce UHI. The Mayor of London has adopted a strategy for London 2050 aspiring to transform it to be the greenest city in the world by increasing the green areas up to 50%. This paper investigates the influence of increasing the UGS percentage which is considered as a key solution to mitigate UHI effect which will, in turn, provide thermally comfortable outdoor environments for pedestrians. The investigation is undertaken by comparing the morphology of precincts and streets in relation to air temperature, mean radiant temperature and surface temperature within Oxford Street canyons in London city centre; being one of the world’s busiest streets. The results from this research demonstrate that different UGS interventions with varying percentage are required depending on particular canyon orientations and geometries. The study found that, in general, more trees would have significant thermal comfort effect followed by living façade, while high albedo pavement (HAP) came last. However, HAP had high influence on improving thermal comfort in North-South orientated streets with minor variance to trees and living facades which, changing their percentage levels was insignificant

Pattern of Strabismus in Children and Adolescents in Hail, KSA

Background: Strabismus (Squint), abnormal ocular alignment could occur constantly or intermittently. Double vision, poor vision or abnormal head positioning may accompany it. A child with squint may stop using the affected eye. This can lead to visual loss, which can become permanent unless treated early in childhood. Objective: to estimate the prevalence of squint, types and treatment characteristics in the studied children and adolescents in Hail city, Saudi Arabia. Methods: A cross-sectional study conducted in Hail city, Saudi Arabia. The study included 299 participants; 148 male and 151 female children and adolescents from 6 months to 19 years. The study period was from 1 January to 30 May 2018. Data collected by personal interview using a pre-designed questionnaire, which distributed among mothers of children and adolescents to be self-reported. Results: Squint found in 17.1% of the studied sample. Squint was right sided in 37.3% of the cases, left sided in also 37.3% and in both eyes in 25.5% of the studied cases. About half (47.1%) of cases had inward squint (esotropia) and 15.7% outward squint (exsotropia), 21.6% of the cases had Intermittent squint and 52.2% had permanent squint. In most (70.7%) of cases, squint affected the visual acuity. As regards treatment, 45.1% received medical treatment and 13.7% received surgical treatment. Only 19.6% of cases completely cured and 39.2% had recurrence. There was insignificant relation with sex, squint in parents, other hereditary diseases and consanguinity between parents (P>0.05). Conclusion: in this study, the prevalence of squint in the studied children and adolescents in Hail city, Saudi Arabia was 17.1%. No significant difference between males and females. After treatment, only 19.6% of cases completely cured and 39.2% had recurrence. Health education of the public about importance of early treatment is mandatory. Keywords: Squint; strabismus; prevalence; types; Hail; Saudi Arabia

The Prevalence of Nocturnal Enuresis among Patients with Vesicoureteral Reflux

Background: To identify the prevalence and other associated factors of nocturnal enuresis in children with vesicoureteral reflux undergoing surgical interventions.Methods: This is a cross-sectional study were the medical records of 40 children with confirmed vesicoureteral reflux were reviewed. Additionally, parents were asked to fill out a questionnaire inquiring about presence, onset & course of nocturnal enuresis as has been defined according to ICD-10.Results: Among the 40 children, 22 children (55%) had nocturnal enuresis before any surgical intervention. However; gender, family history of bedwetting, renal hydronephrosis on ultrasound, positive urine culture, and pre-op creatinine level were found to have statistically insignificant association with nocturnal enuresis. After surgical management only 13 (32.5%) children experienced nocturnal enuresis.Conclusion: This study can conclude that there is a weak correlation between NE and VUR in patients undergoing surgical intervention. Also, the surgical management of VUR did not significantly affect the prevalence of NE. However, it is an essential problem for both families and children in Jordan for which specific guidelines should be developed

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The window to wall ratio for high-rise office buildings in a temperate climate : assessing façade embodied energy and building operative energy (life cycle energy) in London

Building energy demand starts from its construction stage to its demolition stage. A significant factor in the life cycle of buildings is the embodied energy (EE) as it directly relates to the overall sustainability of the built environment (Treloar, 1994). It is desirable to identify aspects, which consume significant amounts of energyand develop appropriate strategies to reduce it. In office buildings, life cycle energy (LCE) range between 250-550 kwh/m2 per year at which the EE represents between 10 to 20 % of the total LCE consumption, while operative energy OE represents the outstanding 80-90% (Ramesha, et al ., 2010). Each building is a compound combination of a variety of processed materials, which contribute towards the EE of the buildings and the overall building CO2 emissions (Langdon, 2008). This study proposes a feasible approach to minimise EE and OE with a main purpose to reduce the building life cycle energy by investigating the ideal window to wall ratio in high-rise office building typology. The aim of this study is to determine the significance of optimising window to wall ratio for high-rise office buildings in a temperate climate through assessing the building envelope EE as well as calculating the BOE (life cycle energy)

Building an educational design based on interactive electronic activities and measuring its impact on the reflective thinking of fourth-grade students in physics

The aim of this research is to identify (the effect of an educational design based on interactive electronic activities on the contemplative thinking of fourth-grade students in physics), where the research followed the experimental method, and the research sample consisted of two groups, one of which was a control group that was taught in the usual way, and the other experimental, which was studied according to The educational design, and the number of the sample was (86) female students distributed into two control groups (43) students and an experimental group (43) female students. By building a reflective thinking scale, and the results of the research showed that there was a significant difference between the mean scores of the control group that was studied using the usual and experimental method, which was taught by educational design based on interactive electronic activities for the benefit of the experimental group, and on the basis of the results that appeared, the researcher made a set of recommendations