Life course building epidemiology: An alternative approach to the collection and analysis of carbon emission data

Developing policy for the reduction of the carbon emissions due to buildings requires models for energy usage that incorporate social, behavioural, and environmental factors in addition to the physical properties and technical specifications of the buildings. Marked parallels exist with some of the more intractable public health issues, such as rising levels of obesity. Recently, health researchers have recognized the importance of taking a broader life-course approach to epidemiology in order to examine the degree that long-term health outcomes are set in early life and the extent that these may be mediated or mitigated by subsequent growth and development, as well as by intervention strategies. Life course epidemiology as applied in building science, where energy usage is treated as analogous to poor health outcomes, provides an alternative approach for the construction of causal models that allow for complex interactions between social and technical factors as well as long term effects. It can provide a useful framework for the successful management and analysis of longitudinal studies and may prove particularly effective in identifying the type, timing, and targeting of intervention strategies to produce optimal outcomes in terms of absolute reductions of carbon emissions and resilience of building performance to external stresses, such as those imposed by climate change. An example based on a study in Milton Keynes (London), which is currently in progress, is used to illustrate the way causal models may help elucidate the complex interactions between factors that influence energy usage

Milton Keynes Park Revisited: changes in internal temperatures

27-30 April 2006 The Carbon Reduction in Buildings project has undertaken a pilot longitudinal survey based on a study of 160 ‘low-energy’ homes in 1989 in Milton Keynes Energy Park. In that study, a sub-sample of 29 dwellings was monitored on an hourly basis for internal temperature for the living room and main bedroom over 2 years. The follow up study has been in progress since 2005 and consists of 15 dwellings from the original detailed survey. Findings include that under an average daily external temperature of 5 ºC, internal temperatures were predicted from regression analysis to be 20.1ºC (95%CI:19.7, 20.5) for the living room in 2005 and 19.5 ºC (95 %CI:19.1, 19.9) for the bedroom. This was not significantly different from the 1990 baseline study, except for main bedroom evening temperatures (6pm-11pm) which were found to have decreased by -1.3°C (95%CI -2.4, 0.08; p-value 0.04). This may be indicative of higher ventilation rates since almost all participants in 2005 reported opening bedroom windows through winter

Three-Dimensional High-Resolution Urban Thermal & Mechanical Large Eddy Simulation Interactive Physics Between Buildings, Land Cover And Trees

This paper describes the development of a 3D model of the non-domestic building stock of England and Wales. The model’s purpose is to assess energy use in the stock, and study conservation options. Previous stock models have used data on floor area by activities, and have not represented building geometry. The present model by contrast combines digital maps and property taxation data to build a 3D representation in which separate premises are located within buildings, with floor areas on each level. Sub-activities per floor are also represented in 2D. A case study of the London Borough of Camden is presented

Energy efficiency uptake and energy savings in English houses: A cohort study

The UK Government estimates that approximately 22 TWh of energy can be saved from English dwellings by 2020 from a range of fabric and heating energy efficiency retrofits. Yet the rate of retrofit uptake has been less than is needed to meet government targets and the retrofits impact on energy demand has been less than predicted. Two questions that must be addressed are: who have (and have not) taken up retrofits and what household factors affect this; and, what impact have these retrofits had on energy use and how does this differ among households. The purpose of this study is to provide a better understanding of the uptake of energy efficiency retrofits and the resulting change in energy demand. A cohort of 168,998 dwellings gas-heated English dwellings was used to examine retrofit uptake from 2002 to 2007 and the change in gas use from 2005 to 2007. The findings show that retrofits do have an attributable impact on reducing energy demand and that combining retrofits displays a dose-response like effect, after controlling for household and dwelling factors. Energy savings play a central role in meeting UK climate change mitigation targets and therefore understanding the take up of energy efficiency retrofits and their impact on energy demand and variations in these retrofits across the population is vital to understand their potential

Pyoderma gangrenosum after caesarean section: a case report

BACKGROUND: Pyoderma gangrenosum is a rare ulcerative skin disease. The diagnosis is based on clinical features and excluding other causes of skin ulcers, as it does not have characteristic histopathology or laboratory findings. The etiology is poorly understood. Lesions can develop spontaneously, after surgery or after trauma. CASE PRESENTATION: We present the case of a 32-year-old woman with ulcerative wound defect after caesarean section. The wound was not healing despite standard wound care and antibiotic treatment. Pyoderma gangrenosum was diagnosed and after high dose corticosteroids wound healing started. CONCLUSION: Early diagnosis and subsequent treatment of pyoderma gangrenosum are crucial for limiting scar tissue. Diagnosis of pyoderma gangrenosum could easily be missed since gynaecologists are rarely confronted with this disorder

The intertropical convergence zone modulates intense hurricane strikes on the western North Atlantic margin

© The Author(s), 2016. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Scientific Reports 6 (2016): 21728, doi:10.1038/srep21728Most Atlantic hurricanes form in the Main Development Region between 9°N to 20°N along the northern edge of the Intertropical Convergence Zone (ITCZ). Previous research has suggested that meridional shifts in the ITCZ position on geologic timescales can modulate hurricane activity, but continuous and long-term storm records are needed from multiple sites to assess this hypothesis. Here we present a 3000 year record of intense hurricane strikes in the northern Bahamas (Abaco Island) based on overwash deposits in a coastal sinkhole, which indicates that the ITCZ has likely helped modulate intense hurricane strikes on the western North Atlantic margin on millennial to centennial-scales. The new reconstruction closely matches a previous reconstruction from Puerto Rico, and documents a period of elevated intense hurricane activity on the western North Atlantic margin from 2500 to 1000 years ago when paleo precipitation proxies suggest that the ITCZ occupied a more northern position. Considering that anthropogenic warming is predicted to be focused in the northern hemisphere in the coming century, these results provide a prehistoric analog that an attendant northern ITCZ shift in the future may again return the western North Atlantic margin to an active hurricane interval.This research was supported by NSF Awards: OCE-1519578, OCE-1356708, BCS-1118340

Medial collateral ligament injuries of the knee: current treatment concepts

The medial collateral ligament is one of the most commonly injured ligaments of the knee. Most injuries result from a valgus force on the knee. The increased participation in football, ice hockey, and skiing has all contributed to the increased frequency of MCL injuries. Prophylactic knee bracing in contact sports may prevent injury; however, performance may suffer. The majority of patients who sustain an MCL injury will achieve their pre-injury activity level with non-operative treatment alone; however, those with combined ligamentous injuries may require acute operative care. Accurate characterization of each aspect of the injury will help to determine the optimum treatment plan

Cardiovascular MR evaluation of symptomatic severe aortic stenosis: association of circumferential myocardial strain and mortality

Background It is unknown whether circumferential strain is associated with prognosis after treatment of aortic stenosis (AS). We aimed to characterise strain in severe AS, using myocardial tagging cardiovascular magnetic resonance (CMR), prior to and following Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR), and determine whether abnormalities in strain were associated with outcome. Methods CMR was performed pre- and 6 m post-intervention in 98 patients (52 TAVI, 46 SAVR; 77 ± 8 years) with severe AS. TAVI patients were older (80.9 ± 6.4 vs. 73.0 ± 7.0 years, p  −18.7% was associated with significantly reduced survival. Conclusion TAVI and SAVR procedures are associated with comparable declines in rotational LV mechanics at 6 m, with largely unchanged strain and strain rates. Pre-operative peak mid LV circumferential strain is associated with post-operative mortality

Spontaneous hyaline cartilage regeneration can be induced in an osteochondral defect created in the femoral condyle using a novel double-network hydrogel

<p>Abstract</p> <p>Background</p> <p>Functional repair of articular osteochondral defects remains a major challenge not only in the field of knee surgery but also in tissue regeneration medicine. The purpose is to clarify whether the spontaneous hyaline cartilage regeneration can be induced in a large osteochondral defect created in the femoral condyle by means of implanting a novel double-network (DN) gel at the bottom of the defect.</p> <p>Methods</p> <p>Twenty-five mature rabbits were used in this study. In the bilateral knees of each animal, we created an osteochondral defect having a diameter of 2.4-mm in the medial condyle. Then, in 21 rabbits, we implanted a DN gel plug into a right knee defect so that a vacant space of 1.5-mm depth (in Group I), 2.5-mm depth (in Group II), or 3.5-mm depth (in Group III) was left. In the left knee, we did not apply any treatment to the defect to obtain the control data. All the rabbits were sacrificed at 4 weeks, and the gross and histological evaluations were performed. The remaining 4 rabbits underwent the same treatment as used in Group II, and real-time PCR analysis was performed at 4 weeks.</p> <p>Results</p> <p>The defect in Group II was filled with a sufficient volume of the hyaline cartilage tissue rich in proteoglycan and type-2 collagen. The Wayne's gross appearance and histology scores showed that Group II was significantly greater than Group I, III, and Control (p < 0.012). The relative expression level of type-2 collagen, aggrecan, and SOX9 mRNAs was significantly greater in Group II than in the control group (p < 0.023).</p> <p>Conclusions</p> <p>This study demonstrated that spontaneous hyaline cartilage regeneration can be induced <it>in vivo </it>in an osteochondral defect created in the femoral condyle by means of implanting the DN gel plug at the bottom of the defect so that an approximately 2-mm deep vacant space was intentionally left in the defect. This fact has prompted us to propose an innovative strategy without cell culture to repair osteochondral lesions in the femoral condyle.</p

A Novel Approach to Determining Violence Risk in Schizophrenia: Developing a Stepped Strategy in 13,806 Discharged Patients

Clinical guidelines recommend that violence risk be assessed in schizophrenia. Current approaches are resource-intensive as they employ detailed clinical assessments of dangerousness for most patients. An alternative approach would be to first screen out patients at very low risk of future violence prior to more costly and time-consuming assessments. In order to implement such a stepped strategy, we developed a simple tool to screen out individuals with schizophrenia at very low risk of violent offending. We merged high quality Swedish national registers containing information on psychiatric diagnoses, socio-demographic factors, and violent crime. A cohort of 13,806 individuals with hospital discharge diagnoses of schizophrenia was identified and followed for up to 33 years for violent crime. Cox regression was used to determine risk factors for violent crime and construct the screening tool, the predictive validity of which was measured using four outcome statistics. The instrument was calibrated on 6,903 participants and cross-validated using three independent replication samples of 2,301 participants each. Regression analyses resulted in a tool composed of five items: male sex, previous criminal conviction, young age at assessment, comorbid alcohol abuse, and comorbid drug abuse. At 5 years after discharge, the instrument had a negative predictive value of 0.99 (95% CI = 0.98–0.99), meaning that very few individuals who the tool screened out (n = 2,359 out of original sample of 6,903) were subsequently convicted of a violent offence. Screening out patients who are at very low risk of violence prior to more detailed clinical assessment may assist the risk assessment process in schizophrenia