Comportamento térmico de soluções construtivas com estrutura em madeira

Dissertação de Mestrado em Engenharia Civil Área de Especialização Perfil ConstruçõesAs soluções construtivas com estrutura em madeira são amplamente utilizadas no mercado internacional, nomeadamente nos países nórdicos onde as temperaturas atingem valores negativos. Em Portugal o uso deste tipo de soluções construtivas tem vindo a aumentar justificando-se o estudo do comportamento térmico deste tipo de soluções. Para o efeito, neste trabalho recorre-se à previsão e análise do desempenho térmico de soluções frequentemente utilizadas no mercado nacional e internacional, através da caracterização em laboratório de quatro soluções construtivas. Três das soluções avaliadas são constituídas por troncos de madeira sendo a quarta formada por uma estrutura leve de madeira revestida com aglomerado de madeira e preenchida com lã-de-rocha. O objetivo central é o de aumentar o conhecimento técnico e científico relativo ao comportamento térmico das mesmas ao colmatar a ausência de valores referentes ao coeficiente de transmissão térmico à disposição de técnicos e investigadores. Assim, pretendese verificar se estas soluções construtivas cumprem com as exigências relativas ao coeficiente de transmissão térmica definido na regulamentação térmica atual e comparar o desempenho térmico destas soluções construtivas com as soluções mais comuns na construção em Portugal. Os ensaios foram realizados no Laboratório de Física e Tecnologia das Construções do Departamento de Engenharia Civil da Universidade do Minho e em colaboração com a empresa Rusticasa. A análise dos resultados obtidos permitiu verificar que os coeficientes de transmissão térmica destas soluções cumprem os requisitos mínimos definidos na regulamentação térmica atual, sendo a solução com estrutura leve de madeira revestida com aglomerados e preenchida com lã-de-rocha, a que apresenta melhor desempenho. Comparativamente com os sistemas construtivos mais comuns de paredes de alvenaria, e soluções construtivas em Light Steel Framing, tendo por base os dados apresentados no ITE50 de 2006, as soluções construtivas integralmente em madeira (estrutura e revestimento) apresentam um comportamento térmico superior.The constructive solutions in wooden structure are widely used in the international market, particularly in the Nordic countries where temperatures reach negative values in a almost daily basis. In Portugal the use of this type of constructive solutions has increased significantly, justifying the study of the thermal behavior of such solutions. Based on the analysis and prediction of thermal performance solutions often used in domestic and international markets, through laboratory characterization of four constructive solutions. Three of the evaluated solutions consist of wooden trunks and fourth being formed of a lightweight coated wood chipboard and filled with rock wool. The principal objective off this studie is to increase the scientific and technical knowledge about the thermal behavior of such kind off constructive solutions, to cope with the absence of values, concerning the heat transfer coefficient, of the disposal of researchers and technicians. Thus, is intended to verify whether these constructive solutions meet the requirements for the heat transfer coefficient defined in current thermal regulation and compare the thermal performance of these constructive solutions to the most common solutions in construction in Portugal. All the tests were performed in the Laboratory of Physics and Technology of Buildings Department of Civil Engineering, University of Minho within an integrated master's thesis in collaboration with the company Rusticasa. The results obtained showed that the heat transfer coefficients of these solutions meet the minimum requirements defined in the current thermal regulation, with the constructive solution with a lightweight interior frame in wood filled with 10 cm off rock wool showing better thermal performance. Comparing the results with the most common construction systems in masonry walls, and Light Steel Framing construction solutions, based on the data presented in ITE50 2006, full wood constructive solutions (interior frame and interior and exterior lining) have superior thermal behavior

Avaliação em laboratório do comportamento térmico de soluções construtivas em madeira

O presente trabalho apresenta a avaliação do comportamento térmico de quatro soluções construtivas integralmente em madeira, recorrendo à previsão e análise experimental do seu desempenho térmico. Foram avaliadas quatro soluções construtivas representativas do mercado, três delas tendo por base troncos de madeira e uma outra do tipo entramado de madeira. As principais tipologias de habitações que se encontram no mercado são, essencialmente casas em painel e em troncos de madeira tratada. As casas de troncos possuem um aspeto mais rústico sendo usualmente utilizadas em ambientes de montanha, estas recorrem a ligações metálicas entre troncos e entre paredes, podendo ou não utilizar isolamento térmico colocado no interior da parede. As casas em painel são, geralmente, do tipo modular, o que permite uma rápida execução e posterior expansão. Aliadas a uma arquitetura moderna e cuidada, são difíceis de distinguir das casas em alvenaria. O objetivo central do trabalho foi o de aumentar o conhecimento científico e técnico relativo ao comportamento térmico das soluções construtivas em madeira, colmatando a ausência de valores relativos ao coeficiente de transmissão térmica à disposição de técnicos e investigadores. Foi analisado o desempenho térmico destas soluções construtivas segundo a regulamentação térmica atual (RCCTE) [1], posteriormente estes resultados foram comparados com as soluções de construções mais comuns em Portugal. A análise dos resultados experimentais obtidos permitiu verificar que os coeficientes de transmissão térmica destas soluções cumprem os requisitos mínimos. Sendo a solução com estrutura leve de madeira revestida com aglomerados e preenchida com lã-de-rocha a que apresenta melhor desempenho. Comparativamente com os sistemas construtivos mais comuns de paredes de alvenaria as soluções construtivas com estrutura de madeira apresentam um comportamento térmico superiorRusticas

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research