THE IMPACT OF INDOOR ENVIRONMENT QUALITY ON THECONSERVATION PRACTICE OF HISTORICAL BUILDINGTHECASE OF LEBANESE COASTAL ZONE

It is widely acknowledged that a multidisciplinary approach should be adopted to conserve historical buildings that include indoor environmental features. This paper discusses the effect of healthier indoor environment requirements on the conservation of historical buildings. Conservation, being an essential sustainable practice using inherited built assets to satisfy present needs, imposes limitations on the intervention that can be induced to historical buildings. Healthier indoor environment requires controlling various factors as Indoor Air Quality and Thermal Comfort, which directly affect the Heat-Air- Moisture transfer (hygrothermal behavior) of the historic building envelope and may lead to its deterioration and degradation. Focusing on the historic built fabric of the Lebanese coastal zone, this paper investigates the impact of Indoor climate control on the pathology of the historic building envelope and presents recommendations that mitigate that impact while preserving both conservation requirements and occupant comfort. A case study analysis is conducted to identify the qualitative parameters in the Indoor space of an 18th century heritage building located in the coastal zone of Lebanon and used as public building. The conclusion highlights the potential for comfort establishment in refurbished historic building through raising awareness in relation to occupant behavior and identifying scientific approaches to control hygrothermal behavior of the historic envelope, by the mean of whole building simulation software, which adds significant contribution to the conservation practice

THE IMPACT OF PLASTERING ON THE HYGROTHERMAL BEHAVIOUR OF HISTORICAL SANDSTONE LOCATED IN THE COASTAL REGION OF LEBANON

In an unusual trend in the conservation practice of built heritage in Lebanon, the external plaster layer, which protects the sandstone from weathering factors, is being removed for aesthetic reasons. These buildings are in a coastal region, hot humid climate in the summer and moderate cold weather in the winter. This paper discusses the importance of external and internal plastering of the historical sandstone bearing wall, by the mean of a computational tool that underlines the role of the plastering in the hygrothermal behaviour of the historical stone, in the aim to validate the practice of the ancestors in covering the envelope of their buildings to avoid the degradation of these natural stones. The methodology adopted in this paper is a comparative quantitative study, using a hygrothermal simulation modelling tool, named Wufi Pro, which is a standard program for evaluating moisture conditions in building envelopes developed by the Fraunhofer Institute for Building Physics (IBP) Stuttgart, Germany. The results are in the form of values for the heat and moisture fluxes through the high porosity sandstone assembly that composes the building envelope. These values represent the hygrothermal behaviour of the stone, and they are compared between two cases, one without plastering while the second has the inner and outer layers of traditional plaster. The analysis of the results is guiding to a conclusion that favours one of the two cases, taking into consideration the interstitial condensation threat avoided by the means of plastering

Quantitation in Dextrocardia on myocardial perfusion imaging: how to perform quantitative analysis using Cedars-Sinai software

Dextrocardia, although a rare cardiac abnormality, carries the same risk for cardiac events as other people. SPECT Myocardial perfusion imaging is a potentially helpful diagnostic tool in patients with dextrocardia. Because of swapping of lateral and septal walls on SPECT slices, although visual analysis is possible, quantitation is substantially limited. Here, we introduce a simple practical method to make quantitative analysis feasible and accurate.Dextrocardia, although a rare cardiac abnormality, carries the same risk for cardiac events as other people. SPECT Myocardial perfusion imaging is a potentially helpful diagnostic tool in patients with dextrocardia. Due to swapping of lateral and septal walls on SPECT slices, although visual analysis is possible, quantitation is substantially limited. Here, we introduce a simple practical method to make quantitative analysis feasible and accurate.

Bone Cement Emboli after Arthroplasty: Is It Possible? A Case Report and Literature Review

Background: Polymethylmethacrylate (PMMA) has been extensively used as bone cement in orthopedic procedures. Pulmonary cement embolisms (PCEs) are supposed to originate from cement extravasation into the basivertebral veins before draining into the inferior vena cava and eventually becoming lodged in the pulmonary capillaries. Few cases of bone cement embolism have been reported. This study reported a case of pulmonary embolism (PE) after thoracolumbar fixation and kyphoplasty and reviewed the current literature.   Case Report: We presented an 81-year-old woman who had undergone thoracolumbar vertebroplasty three months before admission and became symptomatic due to PE after total knee arthroplasty (TKA).   Conclusion: This case illustrates that clinicians must be aware of the probable occurrence of respiratory distress syndrome in patients with a history of vertebroplasty

Evaluating National Emergency Indexes in Medical and Educational Centers

In order to manage sections of emergency in an effective manner in various levels of headquarters and line, it is critical to have a tool to monitor and evaluate the performance. Thus, present research was developed aiming to evaluate national emergency indexes in medical and educational centers. The statistical society of ore sent research is all educational – medical centers of Kermanshah Medical University and we used census method. Indexes were gathered by means of forms completed in emergencies and analyzed by Spss 21 software and we used descriptive statistics including median and standard deviation. Findings indicate that the minimum rate of the percentage of patients settled during 6 hours is related to Imam Reza Hospital with 76.66 percent and also the minimum rate of the percentage of patients existing the emergency less than 12 hours was related to Mohammadi Kermanshahi Hospital equal to 85 percent. The minimum rate of unsuccessful CPR is related to Motazedi Hospital equal to zero percentage. The maximum rate of leaving with personal responsibility is related to Kermanshah’s Imam Khomeini Hospital in rate of 18.94 percent. The minimum median of triage time duration in levels one, four and five are related to Motazedi Hospital and to Taleghani Hospital in levels two and three. Considering the fact that emergency is first level of patients’ contact with the hospital, exact evaluation of emergency indexes, specially important indexes such as percentage of settled patients during 6 hours, percentage of patients leaving the emergency under 12 hours, and the triage time duration median are essential. DOI: 10.5901/mjss.2015.v6n4s2p60

Efficacy of 153Sm-EDTMP on Bone Pain Palliation in Metastatic Patients: Breast and Prostate Cancers

Purpose: This study aimed to evaluate the effect of samarium-153-EDTMP (153Sm-EDTMP) on pain relief bone metastases of Breast Cancer (BC) and Prostate Cancer (PC) patients. Materials and Methods: Thirty patients aged 40-77 years (62.6±10.2 years) with intractable metastatic bone pain were included in the current study. A checklist of patient information and a standard questionnaire for the assessment of pain and quality of life were completed before and after four and eight week’s palliative treatment with 37 MBq/kg of 153Sm-EDTMP. To analyse the data, parametric and non-parametric tests were used in SPSS software. Results: Twelve females with BC (40%) and 18 males with PC (60%) were included. Four and eight weeks after palliative treatment of 153Sm-EDTMP, the mean pain score reduction and quality of life were statistically increased compared to before the intervention (P-value 0.05). Conclusion: The injection of 153Sm-EDTMP had therapeutic efficacy for bone pain palliation in patients with diffuse bone metastases at the end of the 4th and 8th week post-infusion

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation