Comparative Simulations of an Electrochromic Glazing and a Roller Blind as Controlled by Seven Different Algorithms

The use of roller blind as a surrogate for a switchable glazing in a dynamic building environmental simulation is investigated. Seven different control algorithms were applied to simulations of both operations of the blind and of the switchable glazing. The configurations compared were an electrochromic glazing and a roller blind, the controllers used were rule-based, proportional-integral-derivative (PID), anti-windup PID (a PID) and a model predictive controller (MPC). Particular case studies were examined in the weather conditions of Dublin, Ireland to make comparisons of simulated energy savings and occupancy daylight comfort from the use of electrochromic glazing or a roller blind with those for a double-glazed window. The results suggest that previous studies that simulated electrochromic window as an integrated roller blind in a heating-dominated climate would have overestimated building energy loads, and depending on the controller used, overestimated occupancy daylight comfort

Deployment and control of adaptive building facades for energy generation, thermal insulation, ventilation and daylighting: A review

A major objective in the design and operation of buildings is to maintain occupant comfort without incurring significant energy use. Particularly in narrower-plan buildings, the thermophysical properties and behaviour of their façades are often an important determinant of internal conditions. Building facades have been, and are being, developed to adapt their heat and mass transfer characteristics to changes in weather conditions, number of occupants and occupant’s requirements and preferences. Both the wall and window elements of a facade can be engineered to (i) harness solar energy for photovoltaic electricity generation, heating, inducing ventilation and daylighting (ii) provide varying levels of thermal insulation and (iii) store energy. As an adaptive façade may need to provide each attribute to differing extents at particular times, achieving their optimal performance requires effective control. This paper reviews key aspects of current and emerging adaptive façade technologies. These include (i) mechanisms and technologies used to regulate heat and mass transfer flows, daylight, electricity and heat generation (ii) effectiveness and responsiveness of adaptive façades, (iii) appropriate control algorithms for adaptive facades and (iv) sensor information required for façade adaptations to maintain desired occupants’ comfort levels while minimising the energy use

Optimal temperature-actuated control of a thermally-insulated roller blind

By altering the thermal equilibria between internal and ambient environments, dynamic insulation can minimize heating and cooling building energy requirements. The performance of a thermally-insulated roller blind was evaluated both experimentally and via simulation studies. The variation of blind position was optimized to minimize building energy consumption, maintain thermal comfort, and minimize daylight discomfort for a particular system, location and conditions. The roller blind was adjusted between four positions, from fully-open to fully-closed, optimal indoor temperature switching thresholds found for moving to these blind positions were 15 °C, 18.4 °C, 19.4 °C and 21.4 °C, respectively. Using these resulted in a 15.3% energy savings and a 7% reduction in occupancy daylight discomfort compared with no blind

Comparison of control parameters for roller blinds

Roller blinds can reduce the heating and cooling building energy consumption required to maintain thermal comfort. The effectiveness of roller blinds is influenced by the strategies and input parameters for their control. This study is the first to identify the most effective of seven alternative control parameters to control roller blinds. It further defines the benefits from using paired control parameters to maximise energy savings and optimise occupants’ comfort. For the particular case studies and conditions examined, it is concluded that operating roller blinds using indoor air temperature as a single control parameter with rule-based controller provided, 16 %, 19 % and 45 % in heating, cooling and lighting energy savings in Dublin, Berlin and Madrid respectively compared to a window without roller blinds, with an average 51 % daylight discomfort reduction. Using both internal temperature and outdoor ambient temperature to control the roller blinds had little effect on energy need, with only a further 0.6 %, 0.5 % and 0.3 % energy savings and an average of 2 % reduction in daylight discomfort achieved compared to using solely indoor temperature as the control parameter

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

Background 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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Influence of Social Marketing Drives on Brand Loyalty via the Customer Satisfaction as a Mediating Factor in Travel and Tourism Offices

This study analyzed the impact of various aspects of social media marketing (beneficial promotions, relevant content, popular content, and presence on multiple platforms) on brand loyalty through the mediating factor of customer satisfaction in travel and tourism offices in Jordan. The study’s sample consisted of 350 followers of at least one travel and tourism office on social media, with a response rate of 86% obtained via a self-administered questionnaire. The results supported the significance of social media marketing drives on brand loyalty, with customer satisfaction playing a crucial mediating role. All the factors that engage customers in social media marketing (i.e., beneficial promotions, relevant content, popular content, and presence on multiple platforms) were found to have a simultaneous impact on brand loyalty. This study is the first of its kind in the Jordanian business setting to examine the effect of social media marketing on brand loyalty through customer satisfaction. Most prior research in this field has been conducted in Western countries

Economic Evaluation of Talimogene Laherparepvec Plus Ipilimumab Combination Therapy vs Ipilimumab Monotherapy in Patients With Advanced Unresectable Melanoma

IMPORTANCE. A phase 2 trial comparing talimogene laherparepvec plus ipilimumab vs ipilimumab monotherapy in patients with advanced unresectable melanoma found no differential benefit in progression-free survival (PFS) but noted objective response rates (ORRs) of 38.8% (38 of 98 patients) vs 18.0% (18 of 100 patients), respectively. OBJECTIVE To perform an economic evaluation of talimogene laherparepvec plus ipilimumab combination therapy vs ipilimumab monotherapy. DESIGN, SETTING, AND PARTICIPANTS For PFS, cost-effectiveness and cost-utility analyses using a 2-state Markov model (PFS vs progression or death) was performed. For ORRs, cost-effectiveness analysis of the incremental cost of 1 additional patient achieving objective response was performed. In this setting based on a US payer perspective (2017 US dollars), participants were patients with advanced unresectable melanoma. MAIN OUTCOMES AND MEASURES The PFS life-years and PF5 quality-adjusted life-years were determined, and the associated incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs) were estimated. Also estimated was the ICER per 1 additional patient (out of 100 treated patients) achieving objective response. Base-case analyses were validated by sensitivity analyses. RESULTS In PFS analyses, the cost of talimogene laherparepvec plus ipilimumab ($494 983) exceeded the cost of ipilimumab monotherapy ($132 950) by $362 033. The ICER was$2 129 606 per PFS life-years, and the ICUR was $2 262 706 per PFS quality-adjusted life-year gained. Probabilistic sensitivity analyses yielded an ICER of$1 481 208 per PFS life-year gained and an ICUR of $1 683 191 per PFS quality-adjusted life-year gained. In 1-way sensitivity analyses, the PFS hazard ratio and the utility of response were the most influential parameters. Talimogene laherparepvec plus ipilimumab has a 50$1 683 191 per PFS quality-adjusted life-year gained. In ORR analyses, talimogene laherparepvec plus ipilimumab ($474 904) vs ipilimumab alone ($132 810), a $342 094 difference, yielded an ICER of$1 629 019 per additional patient achieving objective response. In subgroup analyses by disease stage and BRAF(V600E) mutation status, ICERs ranged from $1 069 044 to$17 104 700 per 1 additional patient achieving objective response. CONCLUSIONS AND RELEVANCE The cost to gain 1 additional progression-free quality-adjusted life-year, 1 additional progression-free life-year, or to have 1 additional patient attain objective response is about $1.6 million. This amount may be beyond what payers typically are willing to pay. Combination therapy of talimogene laherparepvec plus ipilimumab does not offer an economically beneficial treatment option relative to ipilimumab monotherapy at the population level. This should not preclude treatment for individual patients for whom this regimen may be indicated.12 month embargo; published online: 21 November 2018This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Spinal Cord Infarction With Prolonged Femoral Venoarterial Extracorporeal Membrane Oxygenation

OBJECTIVES: There have been sporadic reports of ischemic spinal cord injury (SCI) during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. The authors observed a troubling pattern of this catastrophic complication and evaluated the potential mechanisms of SCI related to ECMO. DESIGN: This study was a case series. SETTING: This study was performed at a single institution in a University setting. PARTICIPANTS: Patients requiring prolonged VA-ECMO were included. INTERVENTIONS: No interventions were done. This was an observational study. MEASUREMENTS AND MAIN RESULTS: Four hypotheses of etiology were considered: (1) hypercoagulable state/thromboembolism, (2) regional hypoxia/hypocarbia, (3) hyperperfusion and spinal cord edema, and (4) mechanical coverage of spinal arteries. The SCI involved the lower thoracic (T7-T12 level) spinal cord to the cauda equina in all patients. Seven out of 132 (5.3%) patients with prolonged VA-ECMO support developed SCI. The median time from ECMO cannulation to SCI was 7 (range: 6-17) days.There was no evidence of embolic SCI or extended regional hypoxia or hypocarbia. A unilateral, internal iliac artery was covered by the arterial cannula in 6/7 86%) patients, but flow into the internal iliac was demonstrated on imaging in all available patients. The median total flow (ECMO + intrinsic cardiac output) was 8.5 L/min (LPM), and indexed flow was 4.1 LPM/m. The median central venous oxygen saturation was 88%, and intracranial pressure was measured at 30 mmHg in one patient, suggestive of hyperperfusion and spinal cord edema. CONCLUSIONS: An SCI is a serious complication of extended peripheral VA-ECMO support. Its etiology remains uncertain, but the authors\u27 preliminary data suggested that spinal cord edema from hyperperfusion or venous congestion could contribute