Multidisciplinary team developed and implemented protocols to assist mechanical ventilation weaning : a systematic review of literature

Aim: The aim of this review was to determine if ventilation-weaning protocols developed and implemented by multidisciplinary teams (MDTs) reduced the duration of mechanical ventilation in adult intensive care patients compared to usual care.

Method: A systematic review was conducted to review published research studies from January 1999 to June 2009 to identify and analyse the best available evidence on MDT-based weaning protocols in adult intensive care patients. All relevant studies based on electronic searches of MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Registry and the Cochrane Database of Systematic Reviews were included. Where possible data were pooled and a meta-analysis performed. A narrative synthesis of data was conducted to provide a critical appraisal of nonrandomised controlled trials included in the review.

Results: Three pre- and postinterventional studies were identified for inclusion in this review. Results show equivocal support for weaning protocols developed and implemented by MDTs for reducing duration of mechanical ventilation.

Conclusion: Communication and organizational processes must be addressed for multidisciplinary protocols to be effective. Due to methodological limitations of included studies, large randomised controlled trials are required to provide high-level evidence of the effects of MDT-based protocols on duration of mechanical ventilation.

A review of occupant control on natural ventilation

According to IPCC (Intergovernmental Panel on Climate Change), the largest use of energy in commercial buildings is space heating in colder climates and air conditioning in hot climates. In Europe, the Directive on the energy performance of buildings EPBD (European Energy Performance of Buildings Directive) [1] provides a framework for national building performance regulations and calculation procedures. However, there are often large discrepancies between calculated and measured energy performance of buildings. One main reason is the behaviour of occupants, which is often not reflected in calculation models.

Thermal and ventilation performance of a multifunctional sports hall within an aquatic centre

There has been an increasing demand for sports facilities in urban areas recently. As a result of this, more attention is drawn towards not only the energy performance of these building typologies, but also creating a healthy indoor environment for the users. This Study investigates the thermal and ventilation performance of a sports hall within an aquatic centre using computational fluid dynamics (CFD) simulations. IES Virtual Environment software was used to perform the simulations. A number of scenarios were tested by changing the position of extract fans as well as by incorporating natural ventilation strategies. A high level of discomfort was observed in the space. Better comfort condition was achieved by changing the location of exhaust fans ad openings. The results help to recommend some guidelines to inform the proposed refurbishment plans of the site.

“The hope – the one hope – is that your generation will prove wiser and more responsible than mine.” Constructions of guilt in a selection of disaster texts for young adults

This paper explores a range of definitions of guilt, and argues that fiction for young adults which is set after a major disaster that has been caused by humans has surprisingly little emphasis on guilt. Focusing on Brother in the Land by Robert Swindells, Nuclear War Diary by James E. Sanford (Jr), The Last Children by Gudrun Pausewang, The Carbon Diaries 2015 by Saci Lloyd and its sequel, The Carbon Diaries 2017, and Days Like This by Alison Stewart, the paper argues that in post-nuclear texts for young adults the emphasis tends to be on the perceived responsibility of the young adult reader's generation to work towards preventing the disaster from becoming reality, rather than on the guilt of the adult generation that caused the disaster. However, in texts dealing with environmental disaster, the young adult reader's generation can be seen to have some measure of culpability, and so the issues of guilt and responsibility become more complex

Measurement and solutions to thermal comfort, CO2 and ventilation rates in schools

An Australian research facility, conducted a study on several different school classrooms in regards to their thermal comfort, CO2 levels, air temperature stratification and ventilation rates in a selection of Victorian (Melbourne, Australia) schools during a winter season. A brief literature review reveals similar IAQ problems elsewhere (outside Australia) and suggests several HVAC concepts that provide potential solutions. Our intention is to highlight particular IAQ discrepancies in existing school classroom design resulting from these case study measurements, suggesting construction and mechanical operational conditioning improvements.In particular this research confirms the urgency and necessity of addressing IAQ problems in schools, world wide. Our results of the Australian school classroom measurements are similar to other parts of the world, indicating that CO2 levels, ventilation rates and air temperatures are non-compliant with the standards.

The functional significance of ventilation frequency, and its relationship to oxygen demand in the resting brown long-eared bat, Plecotus auritus

Mean oxygen consumption and simultaneous ventilation frequency of nine non-reproductive brown long-eared bats (body mass 8.53–13.33 g) were measured on 159 occasions. Ambient (chamber) temperature at which the measurements were made ranged from 10.8 to 41.1°C. Apneic ventilation occurred in 22 of the 59 measurements made when mean oxygen consumption was less than 0.5 ml·min-1. No records of apneic ventilation were obtained when it was over 0.5 ml·min-1. The relationship between ventilation frequency and mean oxygen consumption depended on whether ventilation was apneic or non-apneic. When ventilation was non-apneic the relationship was positive and log-linear. When ventilation was apneic the relationship was log-log. Within the thermoneutral zone ventilation frequency was not significantly different from that predicted from allometric equations for a terrestrial mammal of equivalent body mass, but was significantly greater than that predicted for a bird. A reduction in the amount of oxygen consumed per breath occurred at ambient temperatures above the upper critical temperature (39°C).