A Portuguese study on building renovation towards a nearly zero energy building (nZEB)

The social and environmental urgency of large-scale integrated retrofitting of the European residential building stock is widely acknowledged and supported by all Member States. However, the European building sector is currently still not able to offer an integral solution for deep renovation toward nearly Zero Energy Building (nZEB) for reasonable costs. MORE-CONNECT project aims to tackle this issue by developing cost optimal solutions to renovate buildings towards nZEB. In this project, the optimal solutions include the development of prefabricated, multifunctional renovation elements for the total building envelope (façade and roof) and installation/building services. This paper presents the first stage of the project, namely the analysis and comparison of three scenarios following the current national requirements in Portugal i) 80% reduction of the current primary energy consumption of the building, ii) cost optimal solution (nZEB) and iii) net zero energy (NZEB). The optimization of the building envelope will be the main driver for the three scenarios as well as the inclusion of renewable energy strategies. Overall, results suggest that it is possible to achieve cost-effective solutions for the renovation of Portuguese residential buildings. Moreover, the cost-optimal solution (scenario ii) matches approximately with the 80% reduction of energy scenario (scenario i).MORE-CONNECT is funded by the European Commission within the framework of the Horizon 2020 progra

Soluções de reabilitação de fachadas como contributo para assegurar os nZEB – um caso de estudo em Portugal

O sector dos edifícios é o maior consumidor de energia final na União Europeia. Isto deve-se ao facto de a maioria dos edifícios apresentar um fraco desempenho térmico da envolvente. O parque edificado da União Europeia é, na sua maioria, anterior a 1960, de uma época pautada pela ausência de regulamentos de eficiência energética e em que as questões relacionadas com o consumo de energia e as emissões de carbono não assumiam a premência que apresentam na atualidade. A reabilitação energética apresenta-se hoje como a ferramenta mais eficaz para fazer face ao desafio de melhorar o desempenho energético do parque edificado existente. Servirá não só para atingir as ambiciosas metas de redução de consumo energético até 2020 e 2050 como para garantir um ambiente construído de qualidade e sustentável. Com taxas de construção nova muito reduzidas, a reabilitação é uma solução alternativa que apresenta inúmeras vantagens e é cada vez mais reconhecida como o futuro no sector dos edifícios. A revisão da diretiva Europeia relativa ao desempenho energético dos edifícios introduziu o conceito de edifício de necessidades quase nulas de energia (nZEB) e a obrigatoriedade de todos os edifícios novos após 2020 serem nZEB. Da mesma forma, também o conceito deverá ser aplicado aos edifícios existentes, adaptando-os para nZEB, através da reabilitação energética. Estes edifícios apresentam um desempenho energético muito elevado, sendo que as reduzidas necessidades energéticas que apresentam devem ser asseguradas em grande parte por energia proveniente de fontes renováveis, produzida no local ou nas proximidades. Complementarmente, as soluções nZEB devem obedecer a critérios de racionalidade económica. Para tal, a Comissão Europeia desenvolveu um quadro metodológico aplicável a todos os Estados Membros, que permite a identificação e análise dos níveis ótimos de rentabilidade do desempenho energético dos edifícios. O presente estudo enquadra-se no âmbito do projeto Europeu More-Connect que se centra no desenvolvimento de elementos modulares prefabricados de reabilitação energética para atingir edifícios nZEB. É apresentada a análise preliminar de três cenários de reabilitação energética aplicados ao caso de estudo em Portugal e o desenvolvimento inicial de um elemento prefabricado de reabilitação de fachada.Projeto Europeu H2020-EE-2014-2015/H2020-EE-2014-1-PPP, grant agreement no 633477, “MORE-CONNECT – Development and advanced prefabrication of innovative, multifunctional building envelope elements for Modular Retrofitting and smart CONNECTions

An Interoperable Resuscitation Registry for the University Hospital of Bern.

During resuscitation, the patient is the primary focus with the documentation of actions and outcomes being secondary. In most cases, a cardiac event leads to further treatment or hospitalization, in which complex patient pathways, independent documentation systems and information loss represent the key challenges for successful quality management. Hence, the need for a system that takes all these aspects into account. Market research, system analysis and requirements engineering for such a solution were performed and a prototype was created. A complete reference architecture for a web-based electronic data capture system was developed and implemented that enables healthcare professionals to enter resuscitation-relevant data uniformly and store it centrally in compliance with human research legislation. A qualitative evaluation concerning the process flows of the as-is and the to-be situation suggests that there is potential to achieve benefits in the form of improved data quality and quantity

Nebulized Bacteriophages for Prophylaxis of Experimental Ventilator-Associated Pneumonia Due to Methicillin-Resistant Staphylococcus aureus.

OBJECTIVES There is a need for alternative strategies to combat and prevent antibiotic-resistant bacterial infections. Here, we assessed the potential for bacteriophage prophylaxis in the context of experimental ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus in rats. DESIGN Nebulized phages (aerophages) were delivered to the lungs of rats using a modified vibrating mesh aerosol drug delivery system. Animals were intubated and ventilated for 4 hours, at which point they were infected with methicillin-resistant S. aureus strain AW7 via the endotracheal tube, extubated, and then monitored for 96 hours. SETTING Ventilator-associated pneumonia. SUBJECTS Male Wistar rats. INTERVENTIONS A single application of aerophages prior to ventilation at one of two concentrations (~1010 plaque forming units/mL or ~1011 plaque forming units/mL). MEASUREMENTS AND MAIN RESULTS 1) Animal survival at 96 hours, 2) enumeration of bacteria and phages in the lungs and spleen, and 3) lung tissue histopathology. Animals that received aerophages prior to ventilation and methicillin-resistant S. aureus challenge showed a higher survival rate compared with untreated controls (60% for animals that received 3 × 10 plaque forming units; 70% for animals that received 3 × 10 plaque forming units; 0% for controls; p < 0.01 for each treatment versus untreated). Surviving animals that received aerophage prophylaxis had fewer methicillin-resistant S. aureus in the lungs compared with untreated control animals that succumbed to pneumonia (1.6 × 10 colony forming units/g vs 8.0 × 10; p < 0.01). CONCLUSIONS Prophylactically administered nebulized bacteriophages reduced lung bacterial burdens and improved survival of methicillin-resistant S. aureus infected rats, underscoring its potential in the context of ventilator-associated pneumonia

Searching for synergy: combining systemic daptomycin treatment with localised phage therapy for the treatment of experimental pneumonia due to MRSA.

OBJECTIVE Bacteriophages (or phages) are viruses which infect and lyse bacteria. The therapeutic use of phages (phage therapy) has regained attention in the last decades as an alternative strategy to treat infections caused by antimicrobial-resistant bacteria. In clinical settings it is most likely that phages are administered adjunct to antibiotics. For successful phage therapy it is therefore crucial to investigate different phage-antibiotic combinations in vivo. This study aimed to elucidate the combinatorial effects of systemic daptomycin and nebulised bacteriophages for the treatment of experimental pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). RESULTS Using a rat model of ventilator-associated pneumonia caused by MRSA, the simultaneous application of intravenous daptomycin and nebulised phages was not superior to aerophage therapy alone at improving animal survival (55% vs. 50%), or reducing bacterial burdens in the lungs, or spleen. Thus, this combination does not seem to be of benefit for use in patients with MRSA pneumonia

Effects of Hypothermia vs Normothermia on Societal Participation and Cognitive Function at 6 Months in Survivors After Out-of-Hospital Cardiac Arrest

ImportanceThe Targeted Hypothermia vs Targeted Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial reported no difference in mortality or poor functional outcome at 6 months after out-of-hospital cardiac arrest (OHCA). This predefined exploratory analysis provides more detailed estimation of brain dysfunction for the comparison of the 2 intervention regimens.ObjectivesTo investigate the effects of targeted hypothermia vs targeted normothermia on functional outcome with focus on societal participation and cognitive function in survivors 6 months after OHCA.Design, Setting, and ParticipantsThis study is a predefined analysis of an international multicenter, randomized clinical trial that took place from November 2017 to January 2020 and included participants at 61 hospitals in 14 countries. A structured follow-up for survivors performed at 6 months was by masked outcome assessors. The last follow-up took place in October 2020. Participants included 1861 adult (older than 18 years) patients with OHCA who were comatose at hospital admission. At 6 months, 939 of 1861 were alive and invited to a follow-up, of which 103 of 939 declined or were missing.InterventionsRandomization 1:1 to temperature control with targeted hypothermia at 33 °C or targeted normothermia and early treatment of fever (37.8 °C or higher).Main outcomes and measuresFunctional outcome focusing on societal participation assessed by the Glasgow Outcome Scale Extended ([GOSE] 1 to 8) and cognitive function assessed by the Montreal Cognitive Assessment ([MoCA] 0 to 30) and the Symbol Digit Modalities Test ([SDMT] z scores). Higher scores represent better outcomes.ResultsAt 6 months, 836 of 939 survivors with a mean age of 60 (SD, 13) (range, 18 to 88) years (700 of 836 male [84%]) participated in the follow-up. There were no differences between the 2 intervention groups in functional outcome focusing on societal participation (GOSE score, odds ratio, 0.91; 95% CI, 0.71-1.17; P = .46) or in cognitive function by MoCA (mean difference, 0.36; 95% CI,−0.33 to 1.05; P = .37) and SDMT (mean difference, 0.06; 95% CI,−0.16 to 0.27; P = .62). Limitations in societal participation (GOSE score less than 7) were common regardless of intervention (hypothermia, 178 of 415 [43%]; normothermia, 168 of 419 [40%]). Cognitive impairment was identified in 353 of 599 survivors (59%).ConclusionsIn this predefined analysis of comatose patients after OHCA, hypothermia did not lead to better functional outcome assessed with a focus on societal participation and cognitive function than management with normothermia. At 6 months, many survivors had not regained their pre-arrest activities and roles, and mild cognitive dysfunction was common.Trial RegistrationClinicalTrials.gov Identifier: NCT0290830

Value of the TTM risk score for early prognostication of comatose patients after out-of-hospital cardiac arrest in a Swiss university hospital.

Comatose patients admitted to the intensive care unit (ICU) after out-of-hospital cardiac arrest frequently die after withdrawal of life support. Guidelines recommend scheduling prognostication no sooner than 96 hours after cardiac arrest, and strict withdrawal criteria leave many patients waiting for improvement for days without ever reaching a favourable outcome. In clinical practice, physicians are frequently confronted with vague living wills expressed by next of kin or an imprecise advance care directive soon after cardiac arrest. Often a decision to admit a patient to an ICU or limiting ICU treatment in terms of time or intensity is made early, based on the patient&rsquo;s preferences. The Target Temperature Management (TTM) risk score is an imperfect measure that predicts outcome early, at the time of ICU admission. It was developed on a data set of 939 patients included in the TTM Trial, a study in which unconscious patients after cardiac arrest were randomised into two temperature management arms. Patient selection in that trial might impede generalisability. We aimed to validate the TTM risk score with 100 consecutive patients treated in our ICU. Although we had different survival rates, reflecting a different patient population, we were able to confirm the score&rsquo;s albeit imperfect ability to predict outcome early after cardiac arrest. The suggested cut-off values of 10 and 16 can be used as a basis for discussion with the family; in particular, a risk score value below 10 predicts a favourable outcome and might guide early discussion. As in the original study, the outcome of an individual patient cannot be predicted. (ClinicalTrials.gov Identifier: NCT02722460)

Effects of M101-an extracellular hemoglobin-applied during cardiopulmonary resuscitation: An experimental rodent study.

During and immediately after cardiac arrest, cerebral oxygen delivery is impaired mainly by microthrombi and cerebral vasoconstriction. This may narrow capillaries so much that it might impede the flow of red blood cells and thus oxygen transport. The aim of this proof-of-concept study was to evaluate the effect of M101, an extracellular hemoglobin-based oxygen carrier (Hemarina SA, Morlaix, France) derived from Arenicola marina, applied during cardiac arrest in a rodent model, on markers of brain inflammation, brain damage and regional cerebral oxygen saturation.27 Wistar rats subjected to 6 min of asystolic cardiac arrest were infused M101 (300 mg/kg) or placebo (NaCl 0.9%) concomitantly with start of cardiopulmonary resuscitation. Brain oxygenation and five biomarkers of inflammation and brain damage (from blood, cerebrospinal fluid, and homogenates from four brain regions) were measured 8 hours after return of spontaneous circulation. In these 21 different measurements, M101-treated animals were not significantly different from controls except for phospho-tau (p-tau) only in single cerebellum regions (p = 0.048; ANOVA of all brain regions: p = 0.004). Arterial blood pressure increased significantly only at 4-8 min after return of spontaneous circulation (p < 0.001) and acidosis decreased (p = 0.009).While M101 applied during cardiac arrest did not significantly change inflammation or brain oxygenation, the data suggest cerebral damage reduction due to hypoxic brain injury, measured by p-tau. Global burden of ischemia appeared reduced since acidosis was less severe. Whether post-cardiac arrest infusion of M101 improves brain oxygenation is unknown and needs to be investigated