Applying architecture simulation tools to assess building sustainable design: Adapting the Egyptian residential energy code for climate change

In Egypt, residential and commercial buildings energy consumption has been increasing to more than 44% of the total energy consumption, partly due to Egypt’s rapid increase in population, which led to the aggravation of the energy crisis. Building energy codes have recently become an effective technique to enhance energy efficiency in buildings, as regulating the buildings' energy performance ? via energy standards ? can be regarded as an effective means to reduce energy consumption. This research focuses on improving the energy performance of the building envelope, using the principles of environmental design, in the hot-arid climatic context of Egypt, aiming to reduce the energy consumption in the residential sector. This will reflect on reducing the use of HVAC systems, subsequently reducing the energy running costs and the corresponding CO2 emissions. This is carried out through studying the building envelope section in the Egyptian Residential Energy Code (EREC). The work focuses on the residential sector, as in almost every country this is the major energy consumer, and more specifically, the large housing projects. In order to identify the validity of EREC under future climate change, the research aims to study the different design solutions and construction methods recommended by the code or commonly used in the building industry sector in Egypt and evaluate them under the different climate change scenarios to identify the climate change effects on the indoor thermal comfort, the energy consumption and the financial implications (investment vs. running costs). The Buildings' thermal performance simulations (BPS), was adopted as the major technique in the research. The BPS tool "EnergyPlus" and its architectural friendly interface "DesignBuilder" were used to simulate the buildings thermal behaviour in the different climatic periods, in order to assess and modify EREC to adapt to the future climate change effects. The future weather data files, which represent the climate change conditions, were generated via the morphing technique, using the Climate Change World Weather File Generator tool (CCWorldWeatherGen). Moreover, a long term financial analysis method was employed to relate the theoretical study to the real world, based on the financial theory of Discounted Cash Flow (DCF) and its practical formula Net Present Value (NPV), to produce an accurate estimation of the financial efficiency of the projects. The research outcomes are considered as an attempt to highlight current limitations of the residential energy code, especially in its behaviour against climate change. The results focus on energy consumption reductions for the residential units, along with financial benefits on the long term, while maintaining the indoor thermal comfort conditions using active and passive techniques. Through the results analysis, it was found it is not necessary to use the most expensive materials and techniques in order to achieve the most effective thermal insulation, as there are some cheaper materials and techniques in the Egyptian market, more beneficial and cost effective over the long term (under future climate change scenarios). The results have proven that, only two parts of the code's recommendations are compatible with the predicted climate changes on the long term (fenestration and shading devices), and they can mitigate the associated temperatures increase and could continue to be used efficiently through the prescriptive approach in the code. While the code's recommendations for the external walls' specifications, was found to be inadequate and inefficient over the long term. Thus, the study recommends not to use the code's prescriptive approach to determine the external walls' thermal specifications, and to use the code's overall performance path instead. In addition, the research has provided what seems to be the optimum and the most cost-effective combination of specifications to be used (in three different climatic zones), in order to achieve the best levels of performance in terms of indoor thermal comfort levels and energy consumption reduction for the project over the long term. The results are likely to be of interest to a wide range of designers, architects and to support both policy and decision makers taking steps forward towards energy efficiency obligations, particularly in Egypt

Investigation of the Ameliorating Effect of Copper Albumin Complex on Lysyl oxidase in monosodium iodoacetate -Induced Knee Osteoarthritis in Rats

Knee osteoarthritis (KOA) is a common type of joint degeneration which causes progressive damage of the joint structure and has less therapeutic options. It has been found that oral consumption of Copper Albumin Complex as anti-inflammatory drug has a positive effect on the treatment of joint deterioration. The present study aimed to investigate the effect of oral administration of Copper Albumin Complex (cu-albumin complex) on Lysyl oxidase (LOX) which acts as a protective factor in KOA. Fifty adult albino rats were divided into 3 groups: negative control (10 normal rats); positive control (20 rats with KOA which left without induction treatment); and treated group (20 rats with KOA which treated with administration of copper albumin complex). Treated and untreated arthritic groups were subdivided equally into mild and severe groups (10 rats for each) according to the severity of clinical signs. KOA was induced by intra-articular injection of monosodium iodoacetate (MIA). At the experimental end, the joints were examined histopathologically and immunohistochemically after cervical dislocation of rats. It was observed that the treatment with CU- was effective in reducing disease severity and in improvement of Lysyl oxidase KOA. It was concluded that Copper albumin complex has a positive effect in the improvement of LOX of Knee joint cartilages of rats affected by osteoarthritis (OA)

In Vivo Investigation of the Ameliorating Effect of Copper Albumin Complex on chondroitin sulfate in Monosodium iodoacetate -Induced Knee Osteoarthritis

Osteoarthritis (OA) is a condition that manifests as cartilage deterioration and subchondral bone sclerosis in the joint tissues. The weight-bearing joint is most severely impacted by OA. According to some research, consuming foods high in copper albumin complex (cu-albumin complex) can help with OA-related joint degeneration and pain relief. The current study's objective to determine how oral administration of the cu-albumin complex as an anti-inflammatory medication affected the development of rat knee osteoarthritis (KOA). Fifty adult albino rats were divided into three groups: negative control untreated (n= 10, no KOA induction); positive untreated control (n= 20, KOA induction); and treated group (n= 20, KOA induction with administration of cu-albumin complex). According to the severity of the clinical symptoms, treated and untreated arthritic groups were equally divided into mild and severe groups (n=10). Monosodium iodoacetate (MIA) was used as intra-articular injection for osteoarthritis induction. Rats were euthanized after a month of the beginning of the experiment, and the joints were examined histopathologically and immunohistochemically. It was indicated that the treatment was effective in reducing KOA severity and in improvement of chondroitin sulfate of the affected cartilages. In conclusion, the structure of the chondroitin sulphate in the knee joint cartilages of KOA-affected rats was modified by the cu-albumin complex

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

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Microbial colonization of sacral nerve stimulators pseudo-capsule: A single institution experience

Purpose: To evaluate the incidence and type of microbial colonization of the pseudo-capsule (PC) that forms around sacral nerve stimulators (SNS) and consequently the significance of surgical excision of this PC at time of SNS revision or removal. Materials and Methods: A cohort of 31 patients who underwent SNS revision or removal from January 2018 to June 2021 were retrospectively reviewed. The baseline demographics, rate and type of PC microbial colonization and development of SNS insertion site infection were reported. Results: A cohort of 31 patients who underwent “InterStim device (Medtronic)” revision or removal were included. The majority were females (93.5%). The most common indication for SNS insertion was refractory overactive bladder (67.7%). Nine patients (29.0%) underwent SNS revision due to malfunctional device, and 9 patients had SNS removal for the need of MRI procedures. Four patients (12.9%) had positive tissue culture growing Coryneform bacillus (50.0%), Cutibacterium acnes (25.0%) and Pseudomonas aeruginosa (25.0%). Conclusions: PC colonization was uncommon at the time of SNS explant. However, more research is needed to better understand the role of PC-positive culture in increasing the risk of SNS device infections if strict adherence to sterile techniques is adopted