Effects of Fixed and Motorized Window Louvers on the Daylighting and Thermal Performance of Open-Plan Office Buildings

This study investigates the daylighting and thermal performance of open-plan office buildings with two scenarios of daylight louvers – fixed and motorized ones. Both types are for facade window applications. They redirect transmitted daylight to eliminate glare on occupants and increase daylight levels deeper in the interior space, but have significantly different daylight transmitting characteristics. In addition to daylighting, these louvers also affect solar heat gain. The tilt angle of slats in motorized louvers can be adjusted to control solar heat gain and daylight. In this study, an existing energy-efficient office building with fixed louvers is used. A combined thermal and daylighting model for a typical section of the building is developed using a simplified approach, and validated with measured data. The option of motorized louvers is then added to this model. The daylighting and thermal performance for different designs and seasons are assessed using the model. Results show that motorized louvers can effectively enhance useful solar heat gain and/or daylighting. The effect of building depth is also investigated

A Comparative Analysis of Passive and Active Daylight Redirecting Blinds in Support of the Schematic Design Process

Daylight redirecting blinds are a class of sun control device that are designed specifically to increase daylighting levels in buildings in addition to preventing unwanted solar gain and glare. Because they rely on many parameters such as complex geometry and may require automated controls to achieve their high illuminance performance, their angle-dependent optical characteristics cannot be represented or simulated accurately using the simple tools that are normally used at the beginning of the design process when rapid assessments are needed. Instead they require time- and resource-intensive simulation methods that are difficult to integrate into existing building design workflows at such an early stage of design. Therefore design guidance for these daylight redirecting blinds is needed in support of design decisions at the beginning of the schematic design phase – to assist in answering questions such as: How deep can a floor plate be for the entire floor area in an open-plan office to be considered sufficiently daylit? The daylighting illuminance performance of two classes of blinds, passive and active, are investigated to generalize this design guidance. A representative model of each class of blind is used. Through the use of a high-performance multi-storey open-plan double-perimeter zone office building in Golden, USA (40°N, 105°W) as a case study, a simplified simulation model using the radiosity method is validated. The simulation model is used to examine the effect of different parameters such as blind type, location, glazing properties, building depth, façade orientation, window to wall ratio, and window head height on daylighting illuminance in the office space. Simple correlations between building geometry and interior daylight illuminance sufficiency are sought that can be used as design guidance in early schematic design in lieu of simulations. Based on the results, the conclusion is that for most combinations tested active blinds will perform as well as or better than passive blinds. While a passive blind may be acceptable for mild, temperate climates, it may cause excessive overheating in climates with high cooling loads. In this respect, the greatest flexibility is offered by the class of active blinds which can control when daylight or solar heat is desired in the interior. Using the sDA300/50 metric from the IES LM-83-12 standard, the study found that the maximum building depth for South-oriented open-plan space that provides ‘nominally acceptable’ daylight illuminance is 14.5 m for Golden (actual building depth is 18 m). This calculated maximum building depth is between 11.5 m (Vancouver) and 15 m (Montreal) for different locations. This variation is due to the different total annual sunshine hours and visible transmittance of the glazing and blind at different solar incidence angles at each location. A correlation is made between window head height and maximum building depth for an open-plan office space

Governance capacity and collaborative action in Hong Kong : the structure and dynamics of district level community building

published_or_final_versionPolitics and Public AdministrationMasterMaster of Public Administratio

Knowledge, practices, compliance and beliefs of university nursing students’ toward hand hygiene: A cross-sectional survey

Nursing students can contribute to healthcareassociated infections if having inadequate knowledge and noncompliance of hand hygiene. Effective hand hygiene is considered the most effective measure for preventing healthcare-associated infections. This study investigated the knowledge, practices, compliance, and beliefs of university nursing students toward hand hygiene. By using a well-validated, self-report hand hygiene questionnaire, a cross-sectional survey was performed. In the convenience sampling, 421 out of 506 questionnaires were returned (83.2%). There were 169 (40.14%), 170 (40.38%) and 82 (19.48%) nursing students from Years 1, 2 and 3, respectively. The respondents’ overall mean score for hand hygiene knowledge was 7.33/10 (SD = 1.52) with an increasing trend of knowledge performance along study year was observed. The hand hygiene practice inventory was 4.76/5 (SD = 0.303). The mean scores for respondents from Years 1, 2 and 3 were 4.75 (SD = 0.367), 4.82 (SD = 0.20) and 4.69 (SD = 0.290), respectively. The self-reported hand hygiene compliance rate was 88.17% (SD = 11.922) and the mean score on the health beliefs scale was 4.03/5 (SD = 0.34). The university nursing students demonstrated moderate knowledge, good practices, a high compliance rate and positive beliefs toward hand hygiene. More effort on educating healthcare professionals about alcohol-based hand rubs and the promotion of hand cream usage to prevent hand-hygiene-induced skin irritations are suggested. Regular training workshops or seminars could be arranged to maintain knowledge levels and cultivate a positive attitude toward hand hygiene

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Mesoscale engineering of photonic glass for tunable luminescence

The control of optical behavior of active materials through manipulation of microstructure has led to the development of high-performance photonic devices with enhanced integration density, improved quantum efficiencies and controllable colour output. However, the achievement of robust light-harvesting materials with tunable, broadband and flatten emission remains a long-standing goal, owing to the limited inhomogeneous broadening in ordinary hosts. Here, we describe an effective strategy for management of photon emission by manipulation of mesoscale heterogeneities in optically active materials. Importantly, this unique approach enables control of dopant-dopant and dopant-host interactions at the extended mesoscale. This allows generating intriguing optical phenomena such as high activation ratio of dopant (close to 100 %), dramatically inhomogeneous broadening (up to 480 nm), notable emission enhancement, and moreover, simultaneously extending emission bandwidth and flattening spectral shape in glass and fiber. Our results highlight that the findings connect the understanding and manipulation at the mesoscale realm to functional behavior at the macroscale, and the approach to managing the dopants based on mesoscale engineering may provide new opportunity for construction of robust fiber light source.National Natural Science Foundation of China (Grant IDs: 11474102, 51202180), the Chinese Program for New Century Excellent Talents in University (Grant ID: NCET-13-0221), Guangdong Natural Science Funds for Distinguished Young Scholar (Grant ID: S2013050014549), Fundamental Research Funds for the Central University, Scientific Research Foundation for the Returned Overseas Chinese Scholars, State Education Ministry, World Premier International Research Center Initiative (WPI), MEXT, JapanThis is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Nature Publishing Group

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations