Integrated Building Life cycle Carbon and Cost Analysis Embedding Multiple Optimisation Levels

Because the optimisation of various building components and structural systems is often performed in isolation, this study developed an integrated approach for the optimisation of building life cycle carbon emissions and costs embedding multiple analysis levels. The functionalities of the proposed approach were tested in a realistic building scenario. Results demonstrated significant variations in the lifecycle carbon performance (more than 50%) and minor variations in the cost performance (10%) between the optimised building solutions. It was suggested that project teams could effectively use the proposed approach to understand the relationships between high-performing building configurations during the early design stages

Solid-wall U-values: heat flux measurements compared with standard assumptions

The assumed U-values of solid walls represent a significant source of uncertainty when estimating the energy performance of dwellings. The typical U-value for UK solid walls used for stock-level energy demand estimates and energy certification is 2.1 Wm−2 K−1. A re-analysis (based on 40 brick solid walls and 18 stone walls) using a lumped thermal mass and inverse parameter estimation technique gives a mean value of 1.3 ± 0.4 Wm−2 K−1 for both solid wall types. Among the many implications for policy, this suggests that standard UK solid-wall U-values may be inappropriate for energy certification or for evaluating the investment economics of solid-wall insulation. For stock-level energy modelling, changing the assumed U-value for solid walls reduces the estimated mean annual space heating demand by 16%, and causes a proportion of the stock to change Energy Performance Certification (EPC) band. The analysis shows that the diversity of energy use in domestic buildings may be as much influenced by heterogeneity in the physical characteristics of individual building components as it is by variation in occupant behaviour. Policy assessment and guidance material needs to acknowledge and account for this variation in physical building characteristics through regular grounding in empirical field data

Lipid rafts are essential for release of phosphatidylserine-exposing extracellular vesicles from platelets.

Platelets protect the vascular system during damage or inflammation, but platelet activation can result in pathological thrombosis. Activated platelets release a variety of extracellular vesicles (EVs). EVs shed from the plasma membrane often expose phosphatidylserine (PS). These EVs are pro-thrombotic and increased in number in many cardiovascular and metabolic diseases. The mechanisms by which PS-exposing EVs are shed from activated platelets are not well characterised. Cholesterol-rich lipid rafts provide a platform for coordinating signalling through receptors and Ca2+ channels in platelets. We show that cholesterol depletion with methyl-β-cyclodextrin or sequestration with filipin prevented the Ca2+-triggered release of PS-exposing EVs. Although calpain activity was required for release of PS-exposing, calpain-dependent cleavage of talin was not affected by cholesterol depletion. P2Y12 and TPα, receptors for ADP and thromboxane A2, respectively, have been reported to be in platelet lipid rafts. However, the P2Y12 antagonist, AR-C69931MX, or the cyclooxygenase inhibitor, aspirin, had no effect on A23187-induced release of PS-exposing EVs. Together, these data show that lipid rafts are required for release of PS-exposing EVs from platelets.Isaac Newton Trust/ Wellcome Trust ISSF/University of Cambridge Joint Research Grant British Heart Foundation grant SP/15/7/3156

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic