Embracing variations in patterns of use, pre and post design phase, to improve tenant energy performance

This paper elaborates a new energy performance benchmarking method to support green tenancy agreements and other energy performance contracts. The existing national energy reporting method does not categorise systemic variations in patterns of use. Results of a case study monitoring operational data of a multi-tenanted office building are presented. The data reveals the actual designed spectrum of occupant density accounts for a 44% increase in tenant energy demand per square meter and a 112% increase in tenant energy demand per full time employees [FTE], dramatically affecting the buildings internal gains, heating and cooling requirements. The study highlights how low levels of occupancy and extended operational hours can give a false representation of energy efficiency

Patterns of Drinking Among the Deaf

Thirty-nine White deaf persons functioning normally within the general hearing community were surveyed on a variety of factors concerning their use of alcohol, and compared to the data from two comparable hearing samples reported previously in the literature. No significant differences were found between the deaf and heharing samples on patterns of drinking or other parameters of alcohol use. Heavier alcohol use among the deaf correlated significantly with reported frequency of driving after having drunk too much, age of having had first drink, ever having been drunk, feeling guilt over drinking too much, and others criticizing the respondent for drinking behavior. Heavier use also tended to be correlated with attendance at an all-deaf school. Implications of the findings of similar drinking patterns for the deaf and the hearing are discussed in terms of the lack of specific rehabilitation facilities for the deaf, along with possible reasons for the lack of use by deaf clients of alcohol rehabilitation agencies in the community

A critical assessment of the quality of community home-based care

Volunteer home-based caregivers are critical role players in South Africa‘s health care system and in the South African government‘s strategy to fight HIV and AIDS. In order to achieve the aims that the government seeks to attain, it is important that the care and treatment provided to patients receiving community home-based care (CHBC) be of a high quality. While the need for quality care is supported by government and civil society, research indicates that it is not clear whether quality care is indeed being provided and therefore there is a need for research into the quality of CHBC. The research aimed to undertake a critical assessment of CHBC programmes to determine the quality of care provided by volunteer caregivers using social capital theory as a theoretical framework. The study examined the quality of CHBC by analysing the context of CHBC, by investigating the support that volunteer caregivers and their clients receive and by discussing the support that volunteer caregivers and their clients still need. The study used one-on-one in-depth interviews and focus groups to obtain relevant data. The participants included volunteer caregivers, clients and supervisors who took part in the one-on-one interviews. The focus groups consisted of key informants and supervisors respectively. The quantitative data consisted of descriptive statistics which helped describe the participants. The qualitative data was coded and themes and sub-themes were developed. The data was also analysed by an independent coder. The results showed that poverty, and the related problems of poor living conditions and a lack of food security affects the quality CHBC. In addition, unemployment and the problem of stipends also affect quality CHBC. Certain socio-economic factors were also found to lead people to choose to become volunteer caregivers and unemployment was found to be an important driving force behind the choice to undertake volunteer caregiving. Furthermore, the volunteer caregivers in the sample received organisational support from their supervisors and their fellow caregivers or peers. They also received social support from their families and their communities. Regarding the clients of the volunteer caregivers, it was found that they received a number of types of support including psycho- iv social counselling, spiritual counselling and care of a holistic nature. In addition, the study found that there is a need for standardised quality training of volunteer caregivers, which will equip them with multiple skills. It was also found that volunteer caregivers require mentoring and quality supervision in order to be able to provide quality CHBC to their clients. Government has the ability to put the necessary systems and structures in place, such as a scope of practice for volunteers, standardised training and monitoring and evaluation, to enable CHBC and its relevant role players to operate at optimum levels. It also has the authority to make the changes and to enforce rules. Furthermore, it has the ability to unite CHBC organisations and can create the necessary conditions that can lead to increased social capital. Furthermore, the study recommends that two additional dimensions of quality care be added to existing dimensions of quality in health care. The first is the holistic approach to caregiving and the second is social support systems, namely supervisor/mentor and peer support and family and community support. This second dimension is also closely linked to social capital and the networks that make up CHBC

A critical assessment of the quality of community home-based care

Volunteer home-based caregivers are critical role players in South Africa‘s health care system and in the South African government‘s strategy to fight HIV and AIDS. In order to achieve the aims that the government seeks to attain, it is important that the care and treatment provided to patients receiving community home-based care (CHBC) be of a high quality. While the need for quality care is supported by government and civil society, research indicates that it is not clear whether quality care is indeed being provided and therefore there is a need for research into the quality of CHBC. The research aimed to undertake a critical assessment of CHBC programmes to determine the quality of care provided by volunteer caregivers using social capital theory as a theoretical framework. The study examined the quality of CHBC by analysing the context of CHBC, by investigating the support that volunteer caregivers and their clients receive and by discussing the support that volunteer caregivers and their clients still need. The study used one-on-one in-depth interviews and focus groups to obtain relevant data. The participants included volunteer caregivers, clients and supervisors who took part in the one-on-one interviews. The focus groups consisted of key informants and supervisors respectively. The quantitative data consisted of descriptive statistics which helped describe the participants. The qualitative data was coded and themes and sub-themes were developed. The data was also analysed by an independent coder. The results showed that poverty, and the related problems of poor living conditions and a lack of food security affects the quality CHBC. In addition, unemployment and the problem of stipends also affect quality CHBC. Certain socio-economic factors were also found to lead people to choose to become volunteer caregivers and unemployment was found to be an important driving force behind the choice to undertake volunteer caregiving. Furthermore, the volunteer caregivers in the sample received organisational support from their supervisors and their fellow caregivers or peers. They also received social support from their families and their communities. Regarding the clients of the volunteer caregivers, it was found that they received a number of types of support including psycho- iv social counselling, spiritual counselling and care of a holistic nature. In addition, the study found that there is a need for standardised quality training of volunteer caregivers, which will equip them with multiple skills. It was also found that volunteer caregivers require mentoring and quality supervision in order to be able to provide quality CHBC to their clients. Government has the ability to put the necessary systems and structures in place, such as a scope of practice for volunteers, standardised training and monitoring and evaluation, to enable CHBC and its relevant role players to operate at optimum levels. It also has the authority to make the changes and to enforce rules. Furthermore, it has the ability to unite CHBC organisations and can create the necessary conditions that can lead to increased social capital. Furthermore, the study recommends that two additional dimensions of quality care be added to existing dimensions of quality in health care. The first is the holistic approach to caregiving and the second is social support systems, namely supervisor/mentor and peer support and family and community support. This second dimension is also closely linked to social capital and the networks that make up CHBC

Deficiency of the bone mineralization inhibitor NPP1 protects against obesity and diabetes

The emergence of bone as an endocrine regulator has prompted a re-evaluation of the role of bone mineralization factors in the development of metabolic disease. Ectonucleotide pyrophosphatase/phosphodiesterase-1 (NPP1) controls bone mineralization through the generation of pyrophosphate, and levels of NPP1 are elevated both in dermal fibroblast cultures and muscle of individuals with insulin resistance. We investigated the metabolic phenotype associated with impaired bone metabolism in mice lacking the gene that encodes NPP1 (Enpp1−/− mice). Enpp1−/− mice exhibited mildly improved glucose homeostasis on a normal diet but showed a pronounced resistance to obesity and insulin resistance in response to chronic high-fat feeding. Enpp1−/− mice had increased levels of the insulin-sensitizing bone-derived hormone osteocalcin but unchanged insulin signalling within osteoblasts. A fuller understanding of the pathways of NPP1 could inform the development of novel therapeutic strategies for treating insulin resistance

Late toxicity and biochemical recurrence after external-beam radiotherapy combined with permanent-source prostate brachytherapy

BACKGROUND The combination of external-beam radiotherapy and brachytherapy is used commonly to treat men with prostate cancer. In this analysis, the authors examined the rate of biochemical recurrence (BR) and late grade ≥3 genitourinary (GU) and gastrointestinal (GI) toxicity after treatment with external-beam radiotherapy and brachytherapy in a multiinstitutional, cooperative group setting. METHODS All eligible patients received external-beam radiotherapy (45 Gray [Gy] in 25 fractions) followed 2 to 6 weeks later by an interstitial implant using iodine-125 to deliver an additional 108 Gy. BR was defined in 2 ways: according to the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus Definition (ACD) and according to the Phoenix definition (PD) (prostate-specific antigen nadir +2 ng/mL). The Radiation Therapy Oncology Group(RTOG)/European Organization for Research and Treatment of Cancer late radiation morbidity scoring system was used to grade all toxicity. RESULTS One hundred thirty-eight patients were enrolled, and 130 were eligible for the current analysis. The median follow-up for surviving patients was 49 months (range, 20–60 months). The 48-month estimate of late grade ≥3 GU/GI toxicity was 15% (95% confidence interval [95% CI], 8–21%), and the 48-month estimate of BR was 19% (95% CI, 12–26%) and 14% (95% CI, 8–20%) according to the ACD and PD, respectively. CONCLUSIONS The morbidity observed in this multiinstitutional, cooperative group study was slightly higher than that reported in recent RTOG studies using brachytherapy alone or high-dose external-beam radiotherapy. The BR rate observed in this report was similar to that observed with high-dose external-beam radiotherapy alone in similar patients. Cancer 2007. © 2007 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55987/1/22560_ftp.pd

Assessing the role of EO in biodiversity monitoring: options for integrating in-situ observations with EO within the context of the EBONE concept

The European Biodiversity Observation Network (EBONE) is a European contribution on terrestrial monitoring to GEO BON, the Group on Earth Observations Biodiversity Observation Network. EBONE’s aims are to develop a system of biodiversity observation at regional, national and European levels by assessing existing approaches in terms of their validity and applicability starting in Europe, then expanding to regions in Africa. The objective of EBONE is to deliver: 1. A sound scientific basis for the production of statistical estimates of stock and change of key indicators; 2. The development of a system for estimating past changes and forecasting and testing policy options and management strategies for threatened ecosystems and species; 3. A proposal for a cost-effective biodiversity monitoring system. There is a consensus that Earth Observation (EO) has a role to play in monitoring biodiversity. With its capacity to observe detailed spatial patterns and variability across large areas at regular intervals, our instinct suggests that EO could deliver the type of spatial and temporal coverage that is beyond reach with in-situ efforts. Furthermore, when considering the emerging networks of in-situ observations, the prospect of enhancing the quality of the information whilst reducing cost through integration is compelling. This report gives a realistic assessment of the role of EO in biodiversity monitoring and the options for integrating in-situ observations with EO within the context of the EBONE concept (cfr. EBONE-ID1.4). The assessment is mainly based on a set of targeted pilot studies. Building on this assessment, the report then presents a series of recommendations on the best options for using EO in an effective, consistent and sustainable biodiversity monitoring scheme. The issues that we faced were many: 1. Integration can be interpreted in different ways. One possible interpretation is: the combined use of independent data sets to deliver a different but improved data set; another is: the use of one data set to complement another dataset. 2. The targeted improvement will vary with stakeholder group: some will seek for more efficiency, others for more reliable estimates (accuracy and/or precision); others for more detail in space and/or time or more of everything. 3. Integration requires a link between the datasets (EO and in-situ). The strength of the link between reflected electromagnetic radiation and the habitats and their biodiversity observed in-situ is function of many variables, for example: the spatial scale of the observations; timing of the observations; the adopted nomenclature for classification; the complexity of the landscape in terms of composition, spatial structure and the physical environment; the habitat and land cover types under consideration. 4. The type of the EO data available varies (function of e.g. budget, size and location of region, cloudiness, national and/or international investment in airborne campaigns or space technology) which determines its capability to deliver the required output. EO and in-situ could be combined in different ways, depending on the type of integration we wanted to achieve and the targeted improvement. We aimed for an improvement in accuracy (i.e. the reduction in error of our indicator estimate calculated for an environmental zone). Furthermore, EO would also provide the spatial patterns for correlated in-situ data. EBONE in its initial development, focused on three main indicators covering: (i) the extent and change of habitats of European interest in the context of a general habitat assessment; (ii) abundance and distribution of selected species (birds, butterflies and plants); and (iii) fragmentation of natural and semi-natural areas. For habitat extent, we decided that it did not matter how in-situ was integrated with EO as long as we could demonstrate that acceptable accuracies could be achieved and the precision could consistently be improved. The nomenclature used to map habitats in-situ was the General Habitat Classification. We considered the following options where the EO and in-situ play different roles: using in-situ samples to re-calibrate a habitat map independently derived from EO; improving the accuracy of in-situ sampled habitat statistics, by post-stratification with correlated EO data; and using in-situ samples to train the classification of EO data into habitat types where the EO data delivers full coverage or a larger number of samples. For some of the above cases we also considered the impact that the sampling strategy employed to deliver the samples would have on the accuracy and precision achieved. Restricted access to European wide species data prevented work on the indicator ‘abundance and distribution of species’. With respect to the indicator ‘fragmentation’, we investigated ways of delivering EO derived measures of habitat patterns that are meaningful to sampled in-situ observations

Osteoblast-specific deficiency of ectonucleotide pyrophosphatase or phosphodiesterase-1 engenders insulin resistance in high-fat diet fed mice

Supraphysiological levels of the osteoblast‐enriched mineralization regulator ectonucleotide pyrophosphatase or phosphodiesterase‐1 (NPP1) is associated with type 2 diabetes mellitus. We determined the impact of osteoblast‐specific Enpp1 ablation on skeletal structure and metabolic phenotype in mice. Female, but not male, 6‐week‐old mice lacking osteoblast NPP1 expression (osteoblast‐specific knockout [KO]) exhibited increased femoral bone volume or total volume (17.50% vs. 11.67%; p < .01), and reduced trabecular spacing (0.187 vs. 0.157 mm; p < .01) compared with floxed (control) mice. Furthermore, an enhanced ability of isolated osteoblasts from the osteoblast‐specific KO to calcify their matrix in vitro compared to fl/fl osteoblasts was observed (p < .05). Male osteoblast‐specific KO and fl/fl mice showed comparable glucose and insulin tolerance despite increased levels of insulin–sensitizing under‐carboxylated osteocalcin (195% increase; p < .05). However, following high‐fat‐diet challenge, osteoblast‐specific KO mice showed impaired glucose and insulin tolerance compared with fl/fl mice. These data highlight a crucial local role for osteoblast NPP1 in skeletal development and a secondary metabolic impact that predominantly maintains insulin sensitivity