Nexus of thermal resilience and energy efficiency in buildings: A case study of a nursing home

Extreme weather events become more frequent and severe due to climate change. Although energy efficiency technologies can influence thermal resilience of buildings, they are traditionally studied separately, and their interconnections are rarely quantified. This study developed a methodology of modeling and analysis to provide insights into the nexus of thermal resilience and energy efficiency of buildings. We conducted a case study of a real nursing home in Florida, where 12 patients died during Hurricane Irma in 2017 due to HVAC system power loss, to understand and quantify how passive and active energy efficiency measures (EEMs) can improve thermal resilience to reduce heat-exposure risk of patients. Results show that passive measures of opening windows and doors for natural ventilation, as well as miscellaneous load reduction, are very effective in eliminating the extreme dangerous occasions. However, to maintain safe conditions, active measures such as on-site power generators and thermal storage are also needed. The nursing home was further studied by changing its location to two other cities: San Francisco (mild climate) and Chicago (cold winter and hot summer). Results revealed that the EEMs' impacts on thermal resilience vary significantly by climate and building characteristics. The study also estimated the costs of EEMs to help stakeholders prioritize the measures. Passive measures that may not save energy may greatly improve thermal resilience, and thus should be considered in building design or retrofit. Findings from this study indicate energy efficiency technologies should be evaluated not only by their energy savings performance but also by their influence on a building's resilience to extreme weather events

Fisioterapia respiratória em pacientes com fissuras labiopalatinas : rotinas do Hospital de Reabilitação de Anomalias Craniofaciais

As malformações craniofaciais apresentam-se como alterações frequentes sendo as fissuras labiopalatinas mais comumente encontradas. Essa condição leva à ocorrência de infecções de vias aéreas superiores e broncopneumonias pois a comunicação entre a cavidade oral e nasal modifica toda depuração de vias aéreas. O Setor de Fisioterapia do Hospital de Reabilitação de Anomalias Craniofaciais (HRAC/USP) atua em conjunto com a equipe multidisciplinar tanto no ambulatório quanto nas unidades de internação, onde realiza terapia respiratória para melhora do quadro clínico e condição cirúrgica desses pacientes. Diversas são as técnicas de fisioterapia respiratória utilizadas, sendo necessária uma modificação ou adaptação para melhor realização no paciente fissurado. Objetivo: Descrever e divulgar as rotinas de atendimento fisioterapêutico respiratório do Setor de Fisioterapia do HRAC/USP. Método: Baseado em um estudo descritivo da experiência clínica. Resultados: Realiza-se primeiramente uma anamnese, após verifica-se exames laboratoriais e de imagem seguindo para uma avaliação fisioterapêutica respiratória e assim são traçadas as condutas necessárias com o paciente. Na Unidade Ambulatorial foi observado que os pacientes ganham condição cirúrgica após realização de terapia respiratória pré operatória. Na Unidade de Internação a Fisioterapia auxilia na diminuição do tempo de hospitalização, orientando acompanhantes à continuidade do tratamento em casa. Conclusão: Acredita-se que o presente estudo possa contribuir para a divulgação da atuação do fisioterapeuta na assistência de pacientes com fissuras labiopalatinas

Bio-physical characteristics of gastrointestinal mucosa of celiac patients: comparison with control subjects and effect of gluten free diet-

<p>Abstract</p> <p>Background</p> <p>Intestinal mucosa is leaky in celiac disease (CD), and this alteration may involve changes in hydrophobicity of the mucus surface barrier in addition to alteration of the epithelial barrier. The aims of our study were i) to compare duodenal hydrophobicity as an index of mucus barrier integrity in CD patients studied before (n = 38) and during gluten- free diet (GFD, n = 68), and in control subjects (n = 90), and ii) to check for regional differences of hydrophobicity in the gastro-intestinal tract.</p> <p>Methods</p> <p>Hydrophobicity was assessed by measurement of contact angle (CA) (Rame Hart 100/10 goniometer) generated by a drop of water placed on intestinal mucosal biopsies.</p> <p>Results</p> <p>CA (mean ± SD) of distal duodenum was significantly lower in CD patients (56° ± 10°)) than in control subjects (69° ± 9°, p < 0.0001), and persisted abnormal in patients studied during gluten free diet (56° ± 9°; p < 0.005). CA was significantly higher (62° ± 9°) in histologically normal duodenal biopsies than in biopsies with Marsh 1-2 (58° ± 10°; p < 0.02) and Marsh 3 lesions (57° ± 10°; p < 0.02) in pooled results of all patients and controls studied. The order of hydrofobicity along the gastrointestinal tract in control subjects follows the pattern: gastric antrum > corpus > rectum > duodenum > oesophagus > ileum.</p> <p>Conclusions</p> <p>We conclude that the hydrophobicity of duodenal mucous layer is reduced in CD patients, and that the resulting decreased capacity to repel luminal contents may contribute to the increased intestinal permeability of CD. This alteration mirrors the severity of the mucosal lesions and is not completely reverted by gluten-free diet. Intestinal hydrophobicity exhibits regional differences in the human intestinal tract.</p

Natural history of SLC11 genes in vertebrates: tales from the fish world

<p>Abstract</p> <p>Background</p> <p>The <it>SLC11A1/Nramp1 </it>and <it>SLC11A2/Nramp2 </it>genes belong to the <it>SLC11/Nramp </it>family of transmembrane divalent metal transporters, with <it>SLC11A1 </it>being associated with resistance to pathogens and <it>SLC11A2 </it>involved in intestinal iron uptake and transferrin-bound iron transport. Both members of the <it>SLC11 </it>gene family have been clearly identified in tetrapods; however <it>SLC11A1 </it>has never been documented in teleost fish and is believed to have been lost in this lineage during early vertebrate evolution. In the present work we characterized the <it>SLC11 </it>genes in teleosts and evaluated if the roles attributed to mammalian <it>SLC11 </it>genes are assured by other fish specific <it>SLC11 </it>gene members.</p> <p>Results</p> <p>Two different <it>SLC11 </it>genes were isolated in the European sea bass (<it>Dicentrarchus. labrax</it>), and named <it>slc11a2-α </it>and <it>slc11a2-β</it>, since both were found to be evolutionary closer to tetrapods <it>SLC11A2</it>, through phylogenetic analysis and comparative genomics. Induction of <it>slc11a2-α </it>and <it>slc11a2-β </it>in sea bass, upon iron modulation or exposure to <it>Photobacterium damselae </it>spp. <it>piscicida</it>, was evaluated in <it>in vivo </it>or <it>in vitro </it>experimental models. Overall, <it>slc11a2-α </it>was found to respond only to iron deficiency in the intestine, whereas <it>slc11a2-β </it>was found to respond to iron overload and bacterial infection in several tissues and also in the leukocytes.</p> <p>Conclusions</p> <p>Our data suggests that despite the absence of <it>slc11a1</it>, its functions have been undertaken by one of the <it>slc11a2 </it>duplicated paralogs in teleost fish in a case of synfunctionalization, being involved in both iron metabolism and response to bacterial infection. This study provides, to our knowledge, the first example of this type of sub-functionalization in iron metabolism genes, illustrating how conserving the various functions of the SLC11 gene family is of crucial evolutionary importance.</p

Muc2 Protects against Lethal Infectious Colitis by Disassociating Pathogenic and Commensal Bacteria from the Colonic Mucosa

Despite recent advances in our understanding of the pathogenesis of attaching and effacing (A/E) Escherichia coli infections, the mechanisms by which the host defends against these microbes are unclear. The goal of this study was to determine the role of goblet cell-derived Muc2, the major intestinal secretory mucin and primary component of the mucus layer, in host protection against A/E pathogens. To assess the role of Muc2 during A/E bacterial infections, we inoculated Muc2 deficient (Muc2−/−) mice with Citrobacter rodentium, a murine A/E pathogen related to diarrheagenic A/E E. coli. Unlike wildtype (WT) mice, infected Muc2−/− mice exhibited rapid weight loss and suffered up to 90% mortality. Stool plating demonstrated 10–100 fold greater C. rodentium burdens in Muc2−/− vs. WT mice, most of which were found to be loosely adherent to the colonic mucosa. Histology of Muc2−/− mice revealed ulceration in the colon amid focal bacterial microcolonies. Metabolic labeling of secreted mucins in the large intestine demonstrated that mucin secretion was markedly increased in WT mice during infection compared to uninfected controls, suggesting that the host uses increased mucin release to flush pathogens from the mucosal surface. Muc2 also impacted host-commensal interactions during infection, as FISH analysis revealed C. rodentium microcolonies contained numerous commensal microbes, which was not observed in WT mice. Orally administered FITC-Dextran and FISH staining showed significantly worsened intestinal barrier disruption in Muc2−/− vs. WT mice, with overt pathogen and commensal translocation into the Muc2−/− colonic mucosa. Interestingly, commensal depletion enhanced C. rodentium colonization of Muc2−/− mice, although colonic pathology was not significantly altered. In conclusion, Muc2 production is critical for host protection during A/E bacterial infections, by limiting overall pathogen and commensal numbers associated with the colonic mucosal surface. Such actions limit tissue damage and translocation of pathogenic and commensal bacteria across the epithelium