Step-by-step implementation of BIM-LCA: A case study analysis associating defined construction phases with their respective environmental impacts

Building Information Modelling (BIM) supports construction processes by dealing with the variety and complexity of design in a single virtual model. The model may also be complemented by the static and energy performance of buildings. Facing the growing demand of sustainability strategies in the construction sector, the consideration of environmental information within the planning process influences the decision making of planners and stakeholders. Nevertheless, the life cycle assessment of buildings has been so far excluded in BIM, due to the high variety of accurate information and time required. In this paper, a systematic framework is presented and applied to a case study. BIM-LCA assists actors along the planning and designing phase, from the building conception as a whole, up to the elements\u27 details and materials\u27 definition. BIM and LCA intertwine in an application scheme of seven phases for integral planning and four levels of structural composition of a building. With respect to these, involved actors examine potential solutions through a tool which exploits alternative specifications in order to assess the environmental impacts. The goal of this paper is to demonstrate the application of a BIM-LCA model regarding decision making for reliable values of environmental impact in a given structural level of the building. The main findings of this framework are due to the multitude of actors and information orchestrated, namely to uncertainties which characterize the whole planning process and data handling. Through BIMLCA, actors are assisted by ensuring flexibility of models and consistency of results throughout planning and designing

The BIM2LCA approach: An industry foundation classes (IFC)-based interface to integrate life cycle assessment in integral planning

An increasing degree of digitalization in construction planning offers significant potential for building life cycle assessment (LCA) to reduce access barriers, as well as the assessment effort itself. To realize the widespread application of LCA tools and their potential to effectively minimize life cycle impacts, an open approach is required that allows for flexible application of comprehensive LCA studies and early integration in planning processes. The authors present an approach for LCA integration in all phases of digital planning which aims at a DGNB (Deutsche Gesellschaft für nachhaltiges Bauen) certification based on the open Building Information Modeling (BIM) standard Industry Foundation Classes (IFC). The approach takes into account varying levels of development and resulting data availability during integral planning phases, as well as resulting LCA application contexts. It goes beyond existing strategies and allows one to consider both BIM and LCA software through a workflow based on a single data format. The assessment framework is operationalized through standardized interface development and technical realization following the information delivery manual (IDM) process standardized for IFC interfaces. The Extensible Markup Language (XML) schema, as a specific implementation for certification, provides the target system for LCA data requirements and is generalized to a planning phase specific IDM base table. The technical realization based on respective model view definitions and distributed data suggests a pathway to the standardization of LCA-IFC integration based on an open approach. The overall approach exemplarily applies to the “LERNZENTRUM” at the Karlsruhe Institute of Technology (KIT) campus. We conclude that an open BIM approach for LCA integration in model-based planning is feasible, but requires several adjustments in IFC, LCA, and planning practice. Adding a lifecycle element to the IFC to connect BIM and LCA provides comprehensive feedback for informed decision making based on environmental impact

Recurrent autoimmune myocarditis in a young woman during the coronavirus disease 2019 pandemic

We report a unique case of a young woman with recurrent immune-mediated (virus-negative) lymphocytic fulminant myocarditis during the coronavirus disease 2019 pandemic. At the first endomyocardial biopsy (EMB)-proven episode, she had concomitant pneumonia, and a temporary biventricular assist device implant was followed by complete and long-lasting cardiac recovery. Five years later, she was re-admitted for relapsing cardiogenic shock with a recent history of pneumonia. She was treated with extracorporeal life support with apical venting for left ventricular unloading, and full recovery was achieved. Despite negative seriate nasopharyngeal swabs and EMB during hospitalization, an antibody positivity for severe acute respiratory syndrome coronavirus 2 was discovered after 4\ua0weeks from discharge. This is the first report of an EMB-proven, immune-mediated (virus-negative) recurrence of fulminant myocarditis. We hypothesize that in patients with a predisposing immunogenetic background, autoimmune disease may be triggered or reactivated by major infections, for example, pneumonia, that may act as adjuvants leading to an immune-mediated hyper-response

Coronavirus disease 2019 (COVID-19) in the heart transplant population: a single-centre experience

OBJECTIVES: Few anecdotal cases have been reported in the literature regarding heart transplant recipients and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report our experience with 6 patients hospitalized in Northern Italy during the outbreak. METHODS: Of the 396 living heart transplant recipients from 1985 to 2020 included in the study, 6 patients developed the novel 2019 coronavirus disease. Risk factors, last follow-up characteristics, onset presentation, in-hospital course of disease and blood examinations data were collected for these patients. RESULTS: All patients were symptomatic and had positive results from a nasopharyngeal swab test for SARS-CoV-2. Of the 6 patients, 5 were hospitalized and 1 remained self-quarantined at home. Two patients died and 3 were discharged home. Two patients were admittted to the intensive care unit . Immunosuppressive therapy was modified with a median reduction comprising doses that were 50% cyclosporine and 50% mycophenolate. All patients received a medium-dose of corticosteroids as a bolus medication in addition to their therapy. All hospitalized patients received hydroxychloroquine; 2 patients received ritonavir/lopinavir. Broad-spectrum antibiotics for prophylaxis were administered to all. One patient had an ischaemic stroke and died of sepsis. CONCLUSIONS: In the absence of any strong evidence regarding the treatment of heart transplant recipients infected with SARS-CoV-2, we faced a new challenge in managing viral infection in an immunosuppressed population. Because immunomodulation interaction with the infection seems to be crucial for developing severe forms of the disease, we managed to reduce immunosuppressive therapy by adding medium doses of corticosteroids. Despite the limited number of affected patients, this report suggests that special considerations should be given to treating coronavirus disease in the heart transplant recipient population

Impact of Continuous Flow Left Ventricular Assist Device on Heart Transplant Candidates: A Multi-State Survival Analysis

(1) Objectives: The aim of this study was to investigate the impact of the prolonged use of continuous-flow left ventricular assist devices (LVADs) on heart transplant (HTx) candidates. (2) Methods: Between January 2012 and December 2019, we included all consecutive patients diag-nosed with end-stage heart failure considered for HTx at our institution, who were also eligible for LVAD therapy as a bridge to transplant (BTT). Patients were divided into two groups: those who received an LVAD as BTT (LVAD group) and those who were listed without durable support (No-LVAD group). (3) Results: A total of 250 patients were analyzed. Of these, 70 patients (28%) were directly implanted with an LVAD as BTT, 11 (4.4%) received delayed LVAD implantation, and 169 (67%) were never assisted with an implantable device. The mean follow-up time was 36 ± 29 months. In the multivariate analysis of survival before HTx, LVAD implantation showed a protective effect: LVAD vs. No-LVAD HR 0.01 (p < 0.01) and LVAD vs. LVAD delayed HR 0.13 (p = 0.02). Mortality and adverse events after HTx were similar between LVAD and No-LVAD (p = 0.65 and p = 0.39, respectively). The multi-state survival analysis showed a significantly higher probability of death for No-LVAD vs. LVAD patients with (p = 0.03) or without (p = 0.04) HTx. (4) Conclusions: The use of LVAD as a bridge to transplant was associated with an overall survival benefit, compared to patients listed without LVAD support

COVID-19 in Heart Transplant Recipients: A Multicenter Analysis of the Northern Italian Outbreak

Objectives: The aim of this study was to assess the clinical course and outcomes of all heart transplant recipients affected by coronavirus disease-2019 (COVID-19) who were followed at the leading heart transplant centers of Northern Italy. Background: The worldwide severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic has created unprecedented challenges for public health, demanding exceptional efforts for the successful management and treatment of affected patients. Heart transplant patients represent a unique cohort of chronically immunosuppressed subjects in which SARS-CoV-2 may stimulate an unpredictable clinical course of infection. Methods: Since February 2020, we enrolled all 47 cases (79% male) in a first cohort of patients, with a mean age of 61.8 \ub1 14.5 years, who tested positive for SARS-CoV-2, out of 2,676 heart transplant recipients alive before the onset of the COVID-19 pandemic at 7 heart transplant centers in Northern Italy. Results: To date, 38 patients required hospitalization while 9 remained self-home quarantined and 14 died. Compared to the general population, prevalence (18 vs. 7 cases per 1,000) and related case fatality rate (29.7% vs. 15.4%) in heart transplant recipients were doubled. Univariable analysis showed older age (p = 0.002), diabetes mellitus (p = 0.040), extracardiac arteriopathy (p = 0.040), previous PCI (p = 0.040), CAV score (p = 0.039), lower GFR (p = 0.004), and higher NYHA functional classes (p = 0.023) were all significantly associated with in-hospital mortality. During the follow-up two patients died and a third patient has prolonged viral-shedding alternating positive and negative swabs. Since July 1st, 2020, we had 6 new patients who tested positive for SARS-CoV-2, 5 patients asymptomatic were self-quarantined, while 1 is still hospitalized for pneumonia. A standard therapy was maintained for all, except for the hospitalized patient. Conclusions: The prevalence and mortality of SARS-CoV-2 should spur clinicians to immediately refer heart transplant recipients suspected as having SARS-CoV2 infection to centers specializing in the care of this vulnerable population