Positioning of outdoor space in house design : an energy efficiency and thermal comfort perspective

The present thesis is primarily motivated by the will to provide help for decisionmaking on the overall layout of a house or a housing development in the very early stages of design from the point of view of energy efficiency and thermal comfort. This study contributes towards a deeper understanding of thermal interactions between a house and its adjacent enclosed open spaces. It addresses the contribution of the yard design, i.e. placement, size and type towards the development of a comfortable microclimate within the yard itself, as well as the reduction of total energy demands of the house for mechanical heating and cooling. The focus is put on the applicability of the results and findings are expressed in form of a decision-making aid. This research also makes empirical and analytical assessments on the validity of some existing methods and tools that are used for understanding the nature of microclimates in small scales and proposes methods for their improvement, particularly when used in conjunction with standard tools for the assessment of indoor climates. These methods are also demonstrated through an exemplary application in an archetypal setting and the results of the exemplary case are analysed to reach a decision on the most advisable design layouts for the buildings in the example. As a result, this work emphasises on the importance of private outdoor spaces and how their careful design can benefit occupiers, investors and the environment.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Developing a child-friendly post-occupancy assessment methodology for sustainable schools

This paper explores the development of post-occupancy evaluation (POE) methodologies for working with children and school buildings and discusses why a tailored, child-friendly method is important for both understanding and assessing the efficient use of energy. It presents work carried out in a series of workshops with pupils in 3 case study UK schools in the East and West Midlands and South Yorkshire. Whilst POE methods generally allow examination of the physical, technical and management factors influencing the actual performance of building, they can also be adapted to examine the gap between predicted and actual energy performance of a building and human behaviour is key in such investigations. Moreover, using action research-based participatory and collaborative methods in POE provides a way to explore knowledge and attitudes towards low carbon buildings influencing behaviours. Understanding why our energy use and our relationship with natural resources have to change raises complex social issues but new school environments provide a unique opportunity for feedback methods not only to improve the performance of 'sustainable' architecture, but also to examine and influence adoption of sustainable lifestyles. This paper reports our finding from PostOPE, a research project currently being run by the Civil and Building Engineering Department at Loughborough University

Reasons of Delay in the Referral for Cochlear Implantation of Pre-lingual Sensory-Neural Deaf Children

Introduction: Deafness is the most common congenital sensory disorder. Clearly, deafness has a lot of negative influence on a child’s growth, learning, and social communications. More than 90% of deafness cases are sensory-neural, which can be cured with cochlear implantation. One of the most important factors which can change the results of cochlear implantation is the child’s age at the time of implantation. In this work, the reason of delay in referring sensory-neural deaf children for cochlear implantation is studied. Methods: A questionnaire was designed to investigate the reasons of delay in regards to deaf children referred of age 3 or more. 54 children, 28 (51.9%) boys and 26 (48.1%) girls were studied. Variables such as age, sex, reason of delay, parents’ level of education, etc. were considered. Results: 36 (66.7%) cases were due to the unfortunate referrals by the Ear, Nose and Throat specialists, among which 19 (35.2%) of them were reported this to be the only reason. 20 (37%) cases reported improper services at the cochlear implantation centers as their reason. 3 (5.6%) cases were due to the unfortunate referral by the pediatricians. 21 cases reported the delay due to combined factors. In an additional study, 49 cases of children with deafness which referred for a cochlear implantation before the age of 3 were questioned of how they were informed of this treatment. 27 (56.3%) cases reported that they were referred by a physician. Conclusion: Many reasons can be concluded as to the main reasons for the delay in referring children with deafness for cochlear implantation. The most important factor can be inappropriate referral by the treatment-health system and the second reason can be considered improper services at cochlear implantation centers

Direct Electron Transfer of Hemoglobin on Manganese III Oxide-Ag Nanofibers Modified Glassy Carbon Electrode

We investigated the electrochemical behavior of hemoglobin by glassy carbon electrode modified with Mn2O3-Ag nanofibers. The Mn2O3-Ag nanofibers were used as facilitator electron transfer between Hb and glassy-carbon-modified electrode. The Mn2O3-Ag nanofibers are studied by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The hemoglobin showed a quasireversible electrochemical redox behavior with a formal potential of −49 mV (versus Ag/AgCl) in 0.1 M potassium phosphate buffer solution at pH 7.0. The designed biosensor possesses good stability and reproducibility and achieves 95% of the steady-state current in less than five seconds

Multimorbidity as an important issue among women: results of gender difference investigation in a large population-based cross-sectional study in West Asia

Objectives: To investigate the impact of gender on multimorbidity in northern Iran. Design: A cross-sectional analysis of the Golestan cohort data. Setting: Golestan Province, Iran. Study population: 49 946 residents (age 40–75 years) of Golestan Province, Iran. Main outcome measures: Researchers collected data related to multimorbidity, defined as co-existence of two or more chronic diseases in an individual, at the beginning of a representative cohort study which recruited its participants from 2004 to 2008. The researchers utilised simple and multiple Poisson regression models with robust variances to examine the simultaneous effects of multiple factors. Results: Women had a 25.0% prevalence of multimorbidity, whereas men had a 13.4% prevalence (p<0.001). Women of all age-groups had a higher prevalence of multimorbidity. Of note, multimorbidity began at a lower age (40–49 years) in women (17.3%) compared with men (8.6%) of the same age (p<0.001). This study identified significant interactions between gender as well as socioeconomic status, ethnicity, physical activity, marital status, education level and smoking (p<0.01). Conclusion: Prevention and control of multimorbidity requires health promotion programmes to increase public awareness about the modifiable risk factors, particularly among women

Exploring the use of new school buildings through post-occupancy evaluation and participatory action research

This paper presents the results of the development and testing of an integrated post-occupancy evaluation (POE) approach for teachers, staff, pupils and community members using newly constructed school buildings. It focusses on three cases of UK secondary schools, demonstrating how users can be inspired to engage with the problems of school design and energy use awareness. The cases provided new insights into the engagement of school teachers, staff and young people regarding issues of sustainability, management, functional performance and comfort. The integrative approach adopted in these cases provided a more holistic understanding of these buildings’ performance than could have been achieved by either observational or more traditional questionnaire-based methods. Moreover, the whole-school approach, involving children in POE, provided researchers with highly contextualised information about how a school is used, how to improve the quality of school experiences (both socially and educationally) and how the school community is contributing to the building's energy performance. These POE methods also provided unique opportunities for children to examine the social and cultural factors impeding the adoption of energy-conscious and sustainable behaviours

Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran):a pragmatic, cluster-randomised trial

Background: A fixed-dose combination therapy (polypill strategy) has been proposed as an approach to reduce the burden of cardiovascular disease, especially in low-income and middle-income countries (LMICs). The PolyIran study aimed to assess the effectiveness and safety of a four-component polypill including aspirin, atorvastatin, hydrochlorothiazide, and either enalapril or valsartan for primary and secondary prevention of cardiovascular disease. Methods: The PolyIran study was a two-group, pragmatic, cluster-randomised trial nested within the Golestan Cohort Study (GCS), a cohort study with 50 045 participants aged 40�75 years from the Golestan province in Iran. Clusters (villages) were randomly allocated (1:1) to either a package of non-pharmacological preventive interventions alone (minimal care group) or together with a once-daily polypill tablet (polypill group). Randomisation was stratified by three districts (Gonbad, Aq-Qala, and Kalaleh), with the village as the unit of randomisation. We used a balanced randomisation algorithm, considering block sizes of 20 and balancing for cluster size or natural log of the cluster size (depending on the skewness within strata). Randomisation was done at a fixed point in time (Jan 18, 2011) by statisticians at the University of Birmingham (Birmingham, UK), independent of the local study team. The non-pharmacological preventive interventions (including educational training about healthy lifestyle�eg, healthy diet with low salt, sugar, and fat content, exercise, weight control, and abstinence from smoking and opium) were delivered by the PolyIran field visit team at months 3 and 6, and then every 6 months thereafter. Two formulations of polypill tablet were used in this study. Participants were first prescribed polypill one (hydrochlorothiazide 12·5 mg, aspirin 81 mg, atorvastatin 20 mg, and enalapril 5 mg). Participants who developed cough during follow-up were switched by a trained study physician to polypill two, which included valsartan 40 mg instead of enalapril 5 mg. Participants were followed up for 60 months. The primary outcome�occurrence of major cardiovascular events (including hospitalisation for acute coronary syndrome, fatal myocardial infarction, sudden death, heart failure, coronary artery revascularisation procedures, and non-fatal and fatal stroke)�was centrally assessed by the GCS follow-up team, who were masked to allocation status. We did intention-to-treat analyses by including all participants who met eligibility criteria in the two study groups. The trial was registered with ClinicalTrials.gov, number NCT01271985. Findings: Between Feb 22, 2011, and April 15, 2013, we enrolled 6838 individuals into the study�3417 (in 116 clusters) in the minimal care group and 3421 (in 120 clusters) in the polypill group. 1761 (51·5) of 3421 participants in the polypill group were women, as were 1679 (49·1) of 3417 participants in the minimal care group. Median adherence to polypill tablets was 80·5 (IQR 48·5�92·2). During follow-up, 301 (8·8) of 3417 participants in the minimal care group had major cardiovascular events compared with 202 (5·9) of 3421 participants in the polypill group (adjusted hazard ratio HR 0·66, 95% CI 0·55�0·80). We found no statistically significant interaction with the presence (HR 0·61, 95% CI 0·49�0·75) or absence of pre-existing cardiovascular disease (0·80; 0·51�1·12; pinteraction=0·19). When restricted to participants in the polypill group with high adherence, the reduction in the risk of major cardiovascular events was even greater compared with the minimal care group (adjusted HR 0·43, 95% CI 0·33�0·55). The frequency of adverse events was similar between the two study groups. 21 intracranial haemorrhages were reported during the 5 years of follow-up�ten participants in the polypill group and 11 participants in the minimal care group. There were 13 physician-confirmed diagnoses of upper gastrointestinal bleeding in the polypill group and nine in the minimal care group. Interpretation: Use of polypill was effective in preventing major cardiovascular events. Medication adherence was high and adverse event numbers were low. The polypill strategy could be considered as an additional effective component in controlling cardiovascular diseases, especially in LMICs. Funding: Tehran University of Medical Sciences, Barakat Foundation, and Alborz Darou. © 2019 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved

Determinants of gastroesophageal reflux disease, including hookah smoking and opium use- a cross-sectional analysis of 50,000 individuals.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common cause of discomfort and morbidity worldwide. However, information on determinants of GERD from large-scale studies in low- to medium-income countries is limited. We investigated the factors associated with different measures of GERD symptoms, including frequency, patient-perceived severity, and onset time. METHODS: We performed a cross-sectional analysis of the baseline data from a population-based cohort study of ∼ 50,000 individuals in in Golestan Province, Iran. GERD symptoms in this study included regurgitation and/or heartburn. RESULTS: Approximately 20% of participants reported at least weekly symptoms. Daily symptoms were less commonly reported by men, those of Turkmen ethnicity, and nass chewers. On the other hand, age, body mass index, alcohol drinking, cigarette smoking, opium use, lower socioeconomic status, and lower physical activity were associated with daily symptoms. Most of these factors showed similar associations with severe symptoms. Women with higher BMI and waist to hip ratio were more likely to report frequent and severe GERD symptoms. Hookah smoking (OR 1.34, 95% CI 1.02-1.75) and opium use (OR 1.70, 95% CI 1.55-1.87) were associated with severe symptoms, whereas nass chewing had an inverse association (OR 0.87, 95% CI 0.76-0.99). After exclusion of cigarette smokers, hookah smoking was still positively associated and nass chewing was inversely associated with GERD symptoms (all frequencies combined). CONCLUSION: GERD is common in this population. The associations of hookah and opium use and inverse association of nass use with GERD symptoms are reported for the first time. Further studies are required to investigate the nature of these associations. Other determinants of GERD were mostly comparable to those reported elsewhere