Effect of Building Morphology on Energy and Structural Performance of High-Rise Office Buildings

The civil engineering and architectural communities are highly focused, these days, on designing buildings that maximize utilization of energy available from natural resources. This dissertation presents a quantitative study of the effect of high-rise office building morphology on energy and structural performances for the major climates. The parameters of the building morphologies are varied - the building footprint shape, the placement of the structural core/walls, and the building orientation. The energy analysis is performed using Autodesk Ecotect Analysis 2011; while using SAP2000 for the structure analysis and design. The key observations are: 1) the building morphology has a significant effect on the annual energy consumption, 2) placement of the structural core/walls in the east and west sides significantly improve the energy performance, 3) the tradeoff in the cost of placing the structural core/walls to maximize operating energy efficiency is too great, 4) for built to code buildings the energy demand may be considered marginally sensitive to changes in aspect ratio, and 5) high quality thermal properties of code-built envelope systems offer more flexibility to designers with regard to the building site planning without creating negative impacts on total energy demand

Haploidentical vs. sibling, unrelated, or cord blood hematopoietic cell transplantation for acute lymphoblastic leukemia

The role of haploidentical hematopoietic cell transplantation (HCT) using posttransplant cyclophosphamide (PTCy) for acute lymphoblastic leukemia (ALL) is being defined. We performed a retrospective, multivariable analysis comparing outcomes of HCT approaches by donor for adults with ALL in remission. The primary objective was to compare overall survival (OS) among haploidentical HCTs using PTCy and HLA-matched sibling donor (MSD), 8/8 HLAmatched unrelated donor (MUD), 7 /8 HLA-MUD, or umbilical cord blood (UCB) HCT. Comparing haploidentical HCT to MSD HCT, we found that OS, leukemia-free survival (LFS), nonrelapse mortality (NRM), relapse, and acute graft-versus-host disease (aGVHD) were not different but chronic GVHD (cGVHD) was higher in MSD HCT. Compared with MUD HCT, OS, LFS, and relapse were not different, but MUD HCT had increased NRM (hazard ratio [HR], 1.42; P = .02), grade 3 to 4 aGVHD (HR, 1.59; P = .005), and cGVHD. Compared with 7/8 UD HCT, LFS and relapse were not different, but 7/8 UD HCT had worse OS (HR, 1.38; P = .01) and increased NRM (HR, 2.13; P <_ .001), grade 3 to 4 aGVHD (HR, 1.86; P = .003), and cGVHD (HR, 1.72; P <_ .001). Compared with UCB HCT, late OS, late LFS, relapse, and cGVHD were not different but UCB HCT had worse early OS (<_18 months; HR, 1.93; P < .001), worse early LFS (HR, 1.40; P = .007) and increased incidences of NRM (HR, 2.08; P < .001) and grade 3 to 4 aGVHD (HR, 1.97; P < .001). Haploidentical HCT using PTCy showed no difference in survival but less GVHD compared with traditional MSD and MUD HCT and is the preferred alternative donor HCT option for adults with ALL in complete remission

Donor Types and Outcomes of Transplantation in Myelofibrosis: a CIBMTR Study

We evaluate the impact of donor types on outcomes of hematopoietic cell transplantation (HCT) in myelofibrosis, using the Center for International Blood and Marrow Transplant Research registry data for HCTs done between 2013 and 2019. In all 1597 patients, the use of haploidentical donors increased from 3% in 2013 to 19% in 2019. In study-eligible 1032 patients who received peripheral blood grafts for chronic-phase myelofibrosis, 38% of recipients of haploidentical HCT were non-White/Caucasian. Matched sibling donor (MSD)-HCTs were associated with superior overall survival (OS) in the first 3 months (haploidentical hazard ratio [HR], 5.80 [95% confidence interval (CI), 2.52-13.35]; matched unrelated (MUD) HR, 4.50 [95% CI, 2.24-9.03]; mismatched unrelated HR, 5.13 [95% CI, 1.44-18.31]; P \u3c .001). This difference in OS aligns with lower graft failure with MSD (haploidentical HR, 6.11 [95% CI, 2.98-12.54]; matched unrelated HR, 2.33 [95% CI, 1.20-4.51]; mismatched unrelated HR, 1.82 [95% CI, 0.58-5.72]). There was no significant difference in OS among haploidentical, MUD, and mismatched unrelated donor HCTs in the first 3 months. Donor type was not associated with differences in OS beyond 3 months after HCT, relapse, disease-free survival, or OS among patients who underwent HCT within 24 months of diagnosis. Patients who experienced graft failure had more advanced disease and commonly used nonmyeloablative conditioning. Although MSD-HCTs were superior, there is no significant difference in HCT outcomes from haploidentical and MUDs. These results establish haploidentical HCT with posttransplantation cyclophosphamide as a viable option in myelofibrosis, especially for ethnic minorities underrepresented in the donor registries

Allogeneic Hematopoietic Cell Transplantation for Blastic Plasmacytoid Dendritic Cell Neoplasm: A CIBMTR Analysis

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy with a poor prognosis and considered incurable with conventional chemotherapy. Small observational studies reported allogeneic hematopoietic cell transplantation (allo-HCT) offers durable remissions in patients with BPDCN. We report an analysis of patients with BPDCN who received an allo-HCT, using data reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). We identified 164 patients with BPDCN from 78 centers who underwent allo-HCT between 2007 and 2018. The 5-year overall survival (OS), disease-free survival (DFS), relapse, and nonrelapse mortality (NRM) rates were 51.2% (95% confidence interval [CI], 42.5-59.8), 44.4% (95% CI, 36.2-52.8), 32.2% (95% CI, 24.7-40.3), and 23.3% (95% CI, 16.9-30.4), respectively. Disease relapse was the most common cause of death. On multivariate analyses, age of ≥60 years was predictive for inferior OS (hazard ratio [HR], 2.16; 95% CI, 1.35-3.46; P = .001), and higher NRM (HR, 2.19; 95% CI, 1.13-4.22; P = .02). Remission status at time of allo-HCT (CR2/primary induction failure/relapse vs CR1) was predictive of inferior OS (HR, 1.87; 95% CI, 1.14-3.06; P = .01) and DFS (HR, 1.75; 95% CI, 1.11-2.76; P = .02). Use of myeloablative conditioning with total body irradiation (MAC-TBI) was predictive of improved DFS and reduced relapse risk. Allo-HCT is effective in providing durable remissions and long-term survival in BPDCN. Younger age and allo-HCT in CR1 predicted for improved survival, whereas MAC-TBI predicted for less relapse and improved DFS. Novel strategies incorporating allo-HCT are needed to further improve outcomes

Effect of Building Morphology on Energy and Structural Performance of High-Rise Office Buildings

The civil engineering and architectural communities are highly focused, these days, on designing buildings that maximize utilization of energy available from natural resources. This dissertation presents a quantitative study of the effect of high-rise office building morphology on energy and structural performances for the major climates. The parameters of the building morphologies are varied—the building footprint shape, the placement of the structural core/walls, and the building orientation. The energy analysis is performed using Autodesk Ecotect Analysis 2011; while using SAP2000 for the structure analysis and design. The key observations are: (1) the building morphology has a significant effect on the annual energy consumption, (2) placement of the structural core/walls in the east and west sides significantly improve the energy performance, (3) the tradeoff in the cost of placing the structural core/walls to maximize operating energy efficiency is too great, (4) for built to code buildings the energy demand may be considered marginally sensitive to changes in aspect ratio, and (5) high quality thermal properties of code-built envelope systems offer more flexibility to designers with regard to the building site planning without creating negative impacts on total energy demand

Site layout planning and Sensitivity of Energy Performance

Buildings account for almost 40% of all U.S. energy use (REF). This has an impact on national energy security, the economic crisis, and the global environment. Provisions for local, state, and national building energy standards/codes exist to promote energy efficiency, making such codes a central part of the sustainable building movement. These efforts are advanced further by the building design and construction industry through passive design strategies, advanced construction techniques, and the application of renewable energy sources. This paper analyzes the sensitivity of energy use to variations in footprint aspect ratio and building orientation for high-rise office buildings. The energy analysis is performed using Autodesk Ecotect Analysis 2011 for four high-rise office buildings that have been modeled according to International Energy Conservation Code (IECC 2009). The outcome suggest that buildings built to current energy codes were barely sensitive to variations in footprint aspect ratio and building orientation (which is some of the passive design strategies) for high-rise office buildings

Adapting the HCT-CI Definitions for Children, Adolescents, and Young Adults with Hematologic Malignancies Undergoing Allogeneic Hematopoietic Cell Transplantation

Allogeneic hematopoietic cell transplantation is a curative procedure for hematologic malignancies but is associated with a significant risk of non-relapse mortality (NRM). The Hematopoietic Cell Transplantation–Comorbidity Index (HCT-CI) is a prognostic tool that discriminates this risk in all age groups. A recent survey of transplant physicians demonstrated that 79% of pediatric providers used the HCT-CI infrequently, and most reported concerns about its applicability in the younger population. We conducted a retrospective study using the Center for International Blood and Marrow Transplant Research database to examine the impact of expanded HCT-CI definitions on NRM in pediatric and young adult patients with hematologic malignancies. We included 5790 patients <40 years old receiving allogeneic transplants between 2008 and 2017 to examine broader definitions of comorbidities in the HCT-CI, including history of mechanical ventilation and fungal infection, estimated glomerular filtration rate, and body mass index (BMI) percentiles. Multivariable Fine-Gray models were created to determine the effect of each HCT-CI defining comorbidity and its modification on NRM and were used to develop 2 novel risk scores. We next developed the expanded HCT-CI for children and young adults (youth with malignancies; expanded ymHCT-CI), where 23% patients had an increased comorbidity score, compared to the HCT-CI. Comorbidities with hazard ratio < 1.2 were then removed to create the simplified HCT-CI for children and young adults (youth with malignancies; simplified ymHCT-CI), which demonstrated higher scores corresponded to a greater risk of NRM (P < .001). These novel comorbidity indexes with broader definitions are more relevant to pediatric and young adult patients, and prospective studies are needed to validate these in the younger patient population. It remains to be seen whether the development of these pediatric-specific and practical risk indexes increases their use by the pediatric transplant community

Age no bar : a CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma

BACKGROUND: Upfront autologous hematopoietic cell transplantation (AHCT) remains an important therapy in managing multiple myeloma (MM), a disease of older adults. METHODS: We investigated the outcomes of AHCT in MM in patients aged 70 years and older (≥70). The CIBMTR database registered 15,999 U.S. MM patients within 12 months of diagnosis during 2013–2017; 2,092 patients were ≥70. Non-relapse mortality (NRM), relapse/progression (REL), progression-free and overall survival (PFS, OS) were modeled using Cox proportional hazards with age at transplant as the main effect. Because of the large sample size, a p-value of <0.01 was considered significant a priori. RESULTS: An increase in AHCT was noted in 2017 (28%) compared to 2013 (15%) in ≥70. While 82% patients received melphalan (Mel) 200 mg/m(2) overall, 58% of the patients ≥70 received Mel 140 mg/m(2). On multivariate analysis, patients ≥70 had no difference in NRM (hazard ratio (HR) 1.3, 99% confidence interval (CI) 1, 1.7, p 0.06), REL (HR 1.03, 99% CI 0.9–1.1, p 0.6), PFS (HR 1.06, 99% CI 1–1.2, p 0.2), and OS (HR 1.2, 99% CI 1–1.4, p 0.02) compared to the reference group (60–69 years). In patients ≥70, Mel 140 mg/m(2) was associated with worse outcomes compared to Mel 200 mg/m(2) including day-100 NRM 1 (1–2)% vs 0 (0–1)%, p 0.003, 2-year PFS 64 (60–67)% vs 69 (66–73)%, p 0.003, and 2-year OS 85 (82–87)% vs 89 (86–91)%, p 0.01, respectively, likely representing frailty. CONCLUSION: We conclude that AHCT remains an effective consolidation therapy across all MM age groups

Noninfectious Pulmonary Toxicity after Allogeneic Hematopoietic Cell Transplantation

•Noninfectious pulmonary toxicity (NPT) is a significant complication of allogeneic hematopoietic cell transplantation (HCT) with a 1-year cumulative incidence of 8.1% (95% confidence interval, 7.7% to 8.5%).•Severe pulmonary comorbidity, mismatched unrelated donor and cord blood transplantation, HCT Comorbidity Index score ≥1, and grade II-IV acute graft-versus-host disease significantly increase the risk of NPT, whereas non-total body irradiation (TBI)- and TBI-based nonmyeloablative conditioning and platelet recovery are associated with decreased risk of NPT.•NPT is associated with an increased risk of overall mortality. Noninfectious pulmonary toxicity (NPT), a significant complication of allogeneic hematopoietic cell transplantation (alloHCT), includes idiopathic pneumonia syndrome (IPS), diffuse alveolar hemorrhage (DAH), and cryptogenic organizing pneumonia (COP), with an overall incidence ranging from 1% to 15% in different case series and a variable mortality rate. A registry study of the epidemiology and outcomes of NPT after alloHCT has not been conducted to date. The primary objective of the present study was to assess the incidence of and risk factors for IPS, DAH, and COP; the secondary objective was to assess overall survival (OS) in patients developing NPT. This retrospective study included adult patients who underwent alloHCT between 2008 and 2017 and reported to the Center for International Blood and Marrow Transplant Research. Multivariable Cox proportional hazards regression models were developed to identify the risk factors for development of NPT and for OS, by including pretransplantation clinical variables and time-dependent variables of neutrophil and platelet recovery, and acute graft-versus-host disease (GVHD) post-transplantation. This study included 21,574 adult patients, with a median age of 55 years. According to the HCT Comorbidity Index (HCT-CI), 24% of the patients had moderate pulmonary comorbidity and 15% had severe pulmonary comorbidity. The cumulative incidence of NPT at 1 year was 8.1% (95% confidence interval [CI], 7.7% to 8.5%). Individually, the 1-year cumulative incidences of IPS, DAH, and COP were 4.9% (95% CI, 4.7% to 5.2%), 2.1% (95% CI, 1.9% to 2.3%), and .7% (95% CI, .6% to .8%), respectively. Multivariable analysis showed that severe pulmonary comorbidity, grade II-IV acute GVHD, mismatched unrelated donor and cord blood transplantation, and HCT-CI score ≥1 significantly increased the risk of NPT. In contrast, alloHCT performed in 2014 or later, non-total body irradiation (TBI)- and TBI-based nonmyeloablative conditioning and platelet recovery were associated with a decreased risk. In a landmark analysis at day+100 post-transplantation, the risk of DAH was significantly lower in patients who had platelet recovery by day +100. Multivariable analysis for OS demonstrated that NPT significantly increased the mortality risk (hazard ratio, 4.2; P < .0001)