Data on carotid intima-media thickness and lipoprotein subclasses in type 1 diabetes from the Diabetes Control and Complications Trial and the Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC)

Type 1 diabetes (T1DM) is associated with increased risk of macrovascular complications. We examined longitudinal associations of serum conventional lipids and nuclear magnetic resonance (NMR)-determined lipoprotein subclasses with carotid intima-media thickness (IMT) in adults with T1DM (n=455) enrolled in the Diabetes Control and Complications Trial (DCCT). Data on serum lipids and lipoproteins were collected at DCCT baseline (1983-89) and were correlated with common and internal carotid IMT determined by ultrasonography during the observational follow-up of the DCCT, the Epidemiology of Diabetes Interventions and Complications (EDIC) study, at EDIC 'Year 1' (199-1996) and EDIC 'Year 6' (1998-2000). This article contains data on the associations of DCCT baseline lipoprotein profiles (NMR-based VLDL & chylomicrons, IDL/LDL and HDL subclasses and 'conventional' total, LDL-, HDL-, non-HDL-cholesterol and triglycerides) with carotid IMT at EDIC Years 1 and 6, stratified by gender. The data are supplemental to our original research article describing detailed associations of DCCT baseline lipids and lipoprotein profiles with EDIC Year 12 carotid IMT (Basu et al. in press) [1].

Issues in the epidemiology and population-based screening of primary angle-closure glaucoma

Among Caucasians, it is well known that 75-95% of primary glaucoma is due to open-angle glaucoma (POAG), with angle-closure (PACG) comprising only a very small minority of cases. These figures are reversed among other groups such as Asians and Eskimos, where PACG makes up 80-90% of primary glaucoma. Among Eskimos, the prevalence of PACG has been reported as 2-8%, as compared to 0.1% among Caucasians. It appears that a population tendency toward shallow anterior chambers may explain the excess burden of PACG morbidity. Among Asians, the prevalence of PACG is intermediate between Caucasians and Eskimos. Existing biometrical data do not show a clear tendency toward shallower anterior chambers among Asians. PACG may be screened for on a population basis by means of various techniques that estimate axial or limbal anterior chamber depth, measure intraocular pressure, or evaluate the optic disc or visual fields. Demographic information and medical and family history will also be of great importance in screening for PACG in large populations. Groups at increased risk for the disease include women, individuals over 50, first-degree relatives of PACG probands, and hyperopes.

Compositonal Analysis of Potentially harmful Elements in Soils: Implications for Epidemiology and Kidney Disease

A substantial proportion of aetiological risks for many cancers and chronic diseases remain unexplained. Using geochemical soil and stream water samples collected as part of the Tellus Project studies, current research is investigating naturally occurring background levels of potentially toxic elements (PTEs) in soils and stream sediments and their possible relationship with progressive chronic kidney disease (CKD). The Tellus geological mapping project, Geological Survey Northern Ireland, collected soil sediment and stream water samples on a grid of one sample site every 2 km2 across the rural areas of Northern Ireland resulting in an excess of 6800 soil sampling locations and more than 5800 locations for stream water sampling. Accumulation of several PTEs including arsenic, cadmium, chromium, lead and mercury have been linked with human health and implicated in renal function decline. The hypothesis is that long-term exposure will result in cumulative exposure to PTEs and act as risk factor(s) for cancer and diabetes related CKD and its progression. The ‘bioavailable’ fraction of total PTE soil concentration depends on the ‘bioaccessible’ proportion through an exposure pathway. Recent work has explored this bioaccessible fraction for a range of PTEs across Northern Ireland. In this study the compositional nature of the multivariate geochemical PTE variables and bioaccessible data is explored to augment the investigation into the potential relationship between PTEs, bioaccessibility and disease data.

Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries

Importance Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS).

Objectives To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts—for example prone positioning—in routine clinical practice for patients fulfilling the ARDS Berlin Definition.

Design, Setting, and Participants The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents.

Exposures Acute respiratory distress syndrome.

Main Outcomes and Measures The primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS.

Results Of 29 144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS.

Conclusions and Relevance Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS.

Epidemiology of painful procedures performed in neonates: A systematic review of observational studies

Procedural pain in neonates has been a concern in the last two decades. The purpose of this review was to provide a critical appraisal and a synthesis of the published epidemiological studies about procedural pain in neonates admitted to intensive care units. The aims were to determine the frequency of painful procedures and pain management interventions as well as to identify their predictors. Academic Search, CINAHL, LILACS, Medic Latina, MEDLINE and SciELO databases were searched for observational studies on procedural pain in neonates admitted to intensive care units. Studies in which neonatal data could not be extracted from the paediatric population were excluded. Eighteen studies were included in the review. Six studies with the same study duration, the first 14 days of the neonate life or admission in the unit of care, identified 6832 to 42,413 invasive procedures, with an average of 7.5-17.3 per neonate per day. The most frequent procedures were heel lance, suctioning, venepuncture and insertion of peripheral venous catheter. Pharmacological and nonpharmacological approaches were inconsistently applied. Predictors of the frequency of procedures and analgesic use included the neonate's clinical condition, day of unit stay, type of procedure, parental presence and pain assessment. The existence of pain protocols was not a predictor of analgesia. Painful procedures were performed frequently and often with inadequate pain management. Unlike neonate clinical factors, organizational factors may be modified to promote a context of care more favourable to pain management. © 2015 European Pain Federation - EFIC®

Avaliação da iluminação UV-C como sistema de desinfeção eco-inovador em laranja minimamente processada

Dissertação de mest., Engenharia Biológica, Faculdade de Ciências e Tecnologia, Univ. do Algarve, 2011

Eco ventilação: desenvolvimento de uma ventilação mais ecológica

Neste trabalho é desenvolvido um estudo comparativo de vários sistemas de ventilação, baseados em jactos localizados. Foram avaliados, para cada um deles, o nível da qualidade do ar interior, conforto térmico, desconforto térmico local (risco de resfriamento) a que os ocupantes estão sujeitos e o índice ADI (Air Distribution Index). O estudo foi efectuado numericamente, a partir de dois softwares acoplados, e experimentalmente, a partir de uma sala de aula desenvolvida a escala real. Nesta sala de aulas, equipada com 6 ou 12 ocupantes e com 6 secretárias, foram analisados sistemas de ventilação com jactos verticais descendentes, localizados em cima (mais afastado e mais próximo do nível da cabeça dos ocupantes) e à frente dos ocupantes, e com jactos horizontais, localizados em frente dos ocupantes, em cima e em baixo da secretária. O estudo numérico, da interacção do escoamento com os ocupantes, foi efectuado a partir do acoplamento de um software que simula a resposta térmica dos ocupantes (Human Thermal Comfort) e um que simula o escoamento tridimensional em espaços ocupados (Virtual Air Flow - 3D), utilizando o modelo de turbulência RNG. Foi utilizada uma malha não uniforme, com um maior refinamento junto dos obstáculos e nas entradas e saídas de ar. No estudo do projecto do sistema de ventilação baseado em jactos verticais descendentes localizados em cima e mais afastado do nível da cabeça dos ocupantes, foram efectuadas medições experimentais de forma a validar os softwares acoplados e um modelo desenvolvido para calcular o escoamento unidireccional no interior de condutas. Neste estudo foi ainda utilizado um modelo de cálculo das temperaturas das superfícies. Por fim foi realizada uma simulação num contexto mais real, com 6 ocupantes sentados e um ocupante em pé, simulando 6 alunos e um professor, onde foi utilizado o acoplamento dos modelos Human Thermal Comfort e Virtual Air Flow - 3D, o modelo numérico de escoamentos unidireccionais no interior de condutas e o modelo de cálculo das temperaturas das superfícies. São ainda feitas sugestões para a partir deste trabalho, se efectuarem estudos em geometrias mais complexas.

The "Eco" and "Low-carbon" promise: a critical review of China's experience

The scale and speed of China’s urbanization translate into major challenges for sustainability. Could the ‘eco-city’ and ‘low-carbon’ agendas, and the promotion of related pilot cities drive Chinese urban practice towards more environmentally sustainable solutions? We explore this question through a critical review of experience in China, identifying problems relating to the development of space, the treatment of scale and the pursuit of efficiency (the ‘space-scale-efficiency nexus’). China seeks sustainable solutions through eco and low-carbon agendas, but our review finds that current efforts fall short of expectations, and problematic patterns are repeated. We propose that a geo-administrative notion of functional regions could provide a strategic framework to address the range of design, physical and administrative planning problems, ensuring that eco-city and low-carbon city pilots result in comprehensive solutions that can be effectively replicated.

Eco city development in China: addressing the policy implementation challenge

Over the last few decades, China has seen a steep rise in diverse eco city and low carbon city policies. Recently, attention has begun to focus on the perceived shortcomings in the practical delivery of related initiatives, with several publications suggesting a gap between ambitious policy goals and the emerging realities of the newly built environment. To probe this further, in this article we examine – based on the policy network approach – how the gap between high-level national policies and local practice implementation can be explained in the current Chinese context. We develop a four-pronged typology of eco city projects based on differential involvement of key (policy) actor groups, followed by a mapping of what are salient policy network relations among these actors in each type. Our analysis suggests that, within the overall framework of national policy, a core axis in the network relations is that between local government and land developers. In some cases, central government agencies– often with buy-in from international architecture, engineering and consulting firms – seek to influence local government planning through various incentives aimed at rendering sustainability a serious consideration. However, this is mostly done in a top-down manner, which overemphasizes a rational, technocratic planning mode while underemphasizing interrelationships among actors. This makes the emergence of a substantial implementation gap in eco city practice an almost predictable outcome. Consequently, we argue that special attention be paid in particular to the close interdependency between the interests of local government actors and those of land and real estate developers. Factoring in this aspect of the policy network is essential if eco city implementation is to gain proper traction on the ground.

Eco-cities: technological showcases or public spaces?

A growing body of critical literature seeks to identify conceptual and practical problems accompanying the realisation of mainstream ‘eco-city’ initiatives around the world. However, little attention has been paid to the status of the ‘city’ itself within the broader discourse. If eco-cities are to be more than experimental ‘technological showcases’, and aim to transform urban life more generally, the question of what types of ‘cityness’ will ensue is of considerable importance. To effect a more significant sustainability transition, eco-city plans and policies may need somehow to encompass a more nuanced conceptualisation of cities as complex, unpredictable, and emergent spaces. The incompatibility of such a conceptualisation with liberal-modernist modes of planning means that radically innovative new approaches to eco-city development may need to be found. This thesis considers whether the eco-city, theorised as a multiple process of real-world experimentation, may shed some light on how ‘cityness’ might better be planned for in future. To do so, it conceptualises cityness through the lens of ‘publicness’. It makes an original contribution to knowledge by developing a new theoretical model of publicness as an ‘assemblage’ of space and behaviour, with an ‘emergent’ and ‘civic’ modality. It thereby extends recent debates over the idea of ‘urban assemblage’, and makes innovative links between theories of planning and of the public. This model informs the analysis of original empirical research, investigating the conceptualisation of the public in an international sample of official eco-city documents, and exploring the publicness of two implemented initiatives, in Portland, Oregon (US) and newly built Sejong City (South Korea). The research finds that publicness tends to be poorly articulated in mainstream eco-city plans and policies, with potentially negative implications for sustainability in the ‘urban age’. However, it also argues that state institution-led planning – even when experimental ‘governance’ approaches are adopted – may inevitably be limited in its ability to encompass the emergent public life of the city. The thesis concludes by considering the prospects for overcoming or more productively acknowledging these limits in future.

ECO-betão com adição de resíduo da indústria petrolífera

Dissertação de natureza Científica para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização em Edificações

Molecular epidemiology of Aspergillus collected from cystic fibrosis patients

Background - Aspergillus respiratory infection is a common complication in cystic fibrosis (CF) and is associated with loss of pulmonary function and allergic disease. Methods - Fifty-three Aspergillus isolates recovered from CF patients were identified to species by Internal Transcribed Spacer Region (ITS), β-tubulin, and calmodulin sequencing. Results - Three species complexes (Terrei, Nigri, and Fumigati) were found. Identification to species level gave a single Aspergillus terreus sensu stricto, one Aspergillus niger sensu stricto and 51 Aspergillus fumigatus sensu stricto isolates. No cryptic species were found. Conclusions - To our knowledge, this is the first prospective study of Aspergillus species in CF using molecular methods. The paucity of non-A. fumigatus and of cryptic species of A. fumigatus suggests a special association of A. fumigatus sensu stricto with CF airways, indicating it likely displays unique characteristics making it suitable for chronic residence in that milieu. These findings could refine an epidemiologic and therapeutic approach geared to this pathogen.

A case study on the eco-efficiency performance of a composite processing industry: evaluation and quantification of potential improvements

In this study, an attempt was made in order to measure and evaluate the eco-efficiency performance of a pultruded composite processing company. For this purpose the recommendations of World Business Council for Sustainable Development (WCSD) and the directives of ISO 14301 standard were followed and applied. The main general indicators of eco-efficiency, as well as the specific indicators, were defined and determined. With basis on indicators’ figures, the value profile, the environmental profile, and the pertinent eco-efficiency ratios were established and analyzed. In order to evaluate potential improvements on company eco-performance, new indicators values and eco-efficiency ratios were estimated taking into account the implementation of new proceedings and procedures, at both upstream and downstream of the production process, namely: i) Adoption of a new heating system for pultrusion die-tool in the manufacturing process, more effective and with minor heat losses; ii) Recycling approach, with partial waste reuse of scrap material derived from manufacturing, cutting and assembly processes of GFRP profiles. These features lead to significant improvements on the sequent assessed eco-efficiency ratios of the present case study, yielding to a more sustainable product and manufacturing process of pultruded GFRP profiles.

Assessing the eco-efficiency of a composite processing industry: evaluation and quantification of potential improvements’

In this study, an attempt was made in order to measure and evaluate the eco-efficiency performance of a pultruded composite processing company. For this purpose the recommendations of World Business Council for Sustainable Development (WCSD) and the directives of ISO 14301 standard were followed and applied. The main general indicators of eco-efficiency, as well as the specific indicators, were defined and determined. With basis on indicators’ figures, the value profile, the environmental profile, and the pertinent ecoefficiency’s ratios were established and analyzed. In order to evaluate potential improvements on company eco-performance, new indicators values and eco-efficiency ratios were estimated taking into account the implementation of new proceedings and procedures, both in upstream and downstream of the production process, namely: a) Adoption of new heating system for pultrusion die in the manufacturing process, more effective and with minor heat losses; c) Recycling approach, with partial waste reuse of scrap material derived from manufacturing, cutting and assembly processes of GFRP profiles. These features lead to significant improvements on the sequent assessed eco-efficiency ratios of the present case study, yielding to a more sustainable product and manufacturing process of pultruded GFRP profiles.