Absolute quantification of human tear lactoferrin using multiple reaction monitoring technique with stable-isotopic labeling

The mass spectrometry technique of multiple reaction monitoring (MRM) was used to quantify and compare the expression level of lactoferrin in tear films among control, prostate cancer (CaP), and benign prostate hyperplasia (BPH) groups. Tear samples from 14 men with CaP, 15 men with BPH, and 14 controls were analyzed in the study. Collected tears (2 μl) of each sample were digested with trypsin overnight at 37 °C without any pretreatment, and tear lactoferrin was quantified using a lactoferrin-specific peptide, VPSHAVVAR, both using natural/light and isotopic-labeled/heavy peptides with MRM. The average tear lactoferrin concentration was 1.01 ± 0.07 μg/μl in control samples, 0.96 ± 0.07 μg/μl in the BPH group, and 0.98 ± 0.07 μg/μl in the CaP group. Our study is the first to quantify tear proteins using a total of 43 individual (non-pooled) tear samples and showed that direct digestion of tear samples is suitable for MRM studies. The calculated average lactoferrin concentration in the control group matched that in the published range of human tear lactoferrin concentration measured by enzyme-linked immunosorbent assay (ELISA). Moreover, the lactoferrin was stably expressed across all of the samples, with no significant differences being observed among the control, BPH, and CaP groups.

Evidence-based practice

This chapter traces the history of evidence-based practice (EBP) from its roots in evidence-based medicine to contemporary thinking about its usefulness to public health practice. It defines EBP and differentiates it from ‘evidence-based medicine’, ‘evidence-based policy’ and ‘evidence-based healthcare’. As it is important to understand the subjective nature of knowledge and the research process, this chapter describes the nature and production of knowledge. This chapter considers the necessary skills for EBP, and the processes of attaining the necessary evidence. We examine the barriers and facilitators to identifying and implementing ‘best practice’, and when EBP is appropriate to use. There is a discussion about the limitations of EBP and the use of other information sources to guide practice, and concluding information about the application of evidence to guide policy and practice.

Disease control and management

Globally, the main contributors to morbidity and mortality are chronic conditions, including cardiovascular disease and diabetes. Chronic disease is costly and partially avoidable, with around 60% of deaths and nearly 50% of the global disease burden attributable to these conditions. By 2020, chronic illnesses will likely be the leading cause of disability worldwide. Existing healthcare systems that focus on acute episodic health conditions, both national and international, cannot address the worldwide transition to chronic illness; nor are they appropriate for the ongoing care and management of those already dealing with chronic diseases. As such, chronic disease management requires integrated approaches that incorporate interventions targeted at both individuals and populations, and emphasise the shared risk factors of different conditions. International and Australian strategic planning documents articulate similar elements to manage chronic disease, including the need for aligning sectoral policies for health, forming partnerships, and engaging communities in decision-making. Infectious diseases are also a common and significant contributor to ill health throughout the world. In many countries, this impact has been minimised by the combined efforts of preventative health measures and improved treatment methods. However, in low-income countries, infectious diseases remain the dominant cause of death and disability. The World Health Organization (WHO) estimates that infectious diseases (including respiratory infections) still account for around 23% (or around 14 million) of all deaths each year, and result in over 4.6 billion episodes of diarrhoeal disease and 243 million cases of malaria each year (Lozano et al. 2012, WHO 2009). In addition to the high level of mortality, infectious diseases disable many hundreds of millions of people each year, mainly in developing countries, with the global burden of disease from infectious diseases estimated to be around 300 million DALYs (disability-adjusted life years) (WHO 2012). The aim of this chapter is to outline the impact that infectious diseases and chronic diseases have on the health of the community, describe the public health strategies used to reduce the burden of those diseases, and discuss the historic and emerging disease risks to public health. This chapter examines the comprehensive approaches implemented to prevent both chronic and infectious diseases, and to manage and care for communities with these conditions.

Transient natural ventilation of a space with localised heating

The natural ventilation of a well-mixed, pre-heated room with a point source of heating, and openings at the base and roof is investigated. The transient draining associated with the room being warmer than the exterior combined with the convective ow produced by the point source of heat leads to a fascinating series of transient ow regimes as the system evolves to the two-layer steady-state regime described by Linden, Lane-Ser_ and Smeed [1]. As the room begins to ventilate, a turbulent plume rises from the point source of heat to the ceiling, and typically forms a deepening layer of hot air. However, with a weak heat source, then at some point the ascending plume will intrude beneath the layer of original uid. Otherwise, the ascending plume always reaches the top of the room as the system evolves to a steady state. We develop a simpli_ed model of the transient evolution and test this with some new laboratory experiments. We conclude with a discussion of the implications of our results for real buildings.

A comparison of winter pre-heating requirements for natural displacement and natural mixing ventilation

In winter, natural ventilation can be achieved either through mixing ventilation or upward displacement ventilation (P.F. Linden, The fluid mechanics of natural ventilation, Annual Review of Fluid Mechanics 31 (1999) pp. 201-238). We show there is a significant energy saving possible by using mixing ventilation, in the case that the internal heat gains are significant, and illustrate these savings using an idealized model, which predicts that with internal heat gains of order 0.1 kW per person, mixing ventilation uses of a fraction of order 0.2-0.4 of the heat load of displacement ventilation assuming a well-insulated building. We then describe a strategy for such mixing natural ventilation in an atrium style building in which the rooms surrounding the atrium are able to vent directly to the exterior and also through the atrium to the exterior. The results are motivated by the desire to reduce the energy burden in large public buildings such as hospitals, schools or office buildings centred on atria. We illustrate a strategy for the natural mixing ventilation in order that the rooms surrounding the atrium receive both pre-heated but also sufficiently fresh air, while the central atrium zone remains warm. We test the principles with some laboratory experiments in which a model air chamber is ventilated using both mixing and displacement ventilation, and compare the energy loads in each case. We conclude with a discussion of the potential applications of the approach within the context of open plan atria type office buildings.

The influence of stacks on flow patterns and stratification associated with natural ventilation

We investigate the steady state natural ventilation of an enclosed space in which vent A, located at height hA above the floor, is connected to a vertical stack with a termination at height H, while the second vent, B, at height hB above the floor, connects directly to the exterior. We first examine the flow regimes which develop with a distributed source of heating at the base of the space. If hBhB>hA, then two different flow regimes may develop. Either (i) there is inflow through vent B and outflow through vent A, or (ii) the flow reverses, with inflow down the stack into vent A and outflow through vent B. With inflow through vent A, the internal temperature and ventilation rate depend on the relative height of the two vents, A and B, while with inflow through vent B, they depend on the height of vent B relative to the height of the termination of the stack H. With a point source of heating, a similar transition occurs, with a unique flow regime when vent B is lower than vent A, and two possible regimes with vent B higher than vent A. In general, with a point source of buoyancy, each steady state is characterised by a two-layer density stratification. Depending on the relative heights of the two vents, in the case of outflow through vent A connected to the stack, the interface between these layers may lie above, at the same level as or below vent A, leading to discharge of either pure upper layer, a mixture of upper and lower layer, or pure lower layer fluid. In the case of inflow through vent A connected to the stack, the interface always lies below the outflow vent B. Also, in this case, if the inflow vent A lies above the interface, then the lower layer becomes of intermediate density between the upper layer and the external fluid, whereas if the interface lies above the inflow vent A, then the lower layer is composed purely of external fluid. We develop expressions to predict the transitions between these flow regimes, in terms of the heights and areas of the two vents and the stack, and we successfully test these with new laboratory experiments. We conclude with a discussion of the implications of our results for real buildings.

Transient Ventilation Dynamics Following a Change in Strength of a Point Source of Heat

We investigate the transient ventilation flow within a confined ventilated space, with high- and low-level openings, when the strength of a low-level point source of heat is changed instantaneously. The steady-flow regime in the space involves a turbulent buoyant plume, which rises from the point source to a well-mixed warm upper layer. The steady-state height of the interface between this layer and the lower layer of exterior fluid is independent of the heat flux, but the upper layer becomes progressively warmer with heat flux. New analogue laboratory experiments of the transient adjustment between steady states identify that if the heat flux is increased, the continuing plume propagates to the top of the room forming a new, warmer layer. This layer gradually deepens, and as the turbulent plume entrains fluid from the original warm layer, the original layer is gradually depleted and disappears, and a new steady state is established. In contrast, if the source buoyancy flux is decreased, the continuing plume is cooler than the original plume, so that on reaching the interface it is of intermediate density between the original warm layer and the external fluid. The plume supplies a new intermediate layer, which gradually deepens with the continuing flow. In turn, the original upper layer becomes depleted, both as a result of being vented through the upper opening of the space, but also due to some penetrative entrainment of this layer by the plume, as the plume overshoots the interface before falling back to supply the new intermediate layer. We develop quantitative models which are in good accord with our experimental data, by combining classical plume theory with models of the penetrative entrainment for the case of a decrease in heating. Typically, we find that the effect of penetrative entrainment on the density of the intruding layer is relatively weak, provided the change in source strength is sufficiently large. However, penetrative entrainment measurably increases the rate at which the depth of the draining layer decreases. We conclude with a discussion of the importance of these results for the control of naturally ventilated spaces.

Transient Natural Ventilation of a Room with a Distributed Heat Source

We report on an experimental and theoretical study of the transient flows which develop as a naturally ventilated room adjusts from one temperature to another. We focus on a room heated from below by a uniform heat source, with both high- and low-level ventilation openings. Depending on the initial temperature of the room relative to (i) the final equilibrium temperature and (ii) the exterior temperature, three different modes of ventilation may develop. First, if the room temperature lies between the exterior and the equilibrium temperature, the interior remains well-mixed and gradually heats up to the equilibrium temperature. Secondly, if the room is initially warmer than the equilibrium temperature, then a thermal stratification develops in which the upper layer of originally hot air is displaced upwards by a lower layer of relatively cool inflowing air. At the interface, some mixing occurs owing to the effects of penetrative convection. Thirdly, if the room is initially cooler than the exterior, then on opening the vents, the original air is displaced downwards and a layer of ambient air deepens from above. As this lower layer drains, it is eventually heated to the ambient temperature, and is then able to mix into the overlying layer of external air, and the room becomes well-mixed. For each case, we present new laboratory experiments and compare these with some new quantitative models of the transient flows. We conclude by considering the implications of our work for natural ventilation of large auditoria.

Mixing ventilation can reduce energy costs

The article provides information on a study on the potential of mixing ventilation in reducing energy costs in buildings such as theaters and schools. The study found that neither Manchester’s Contact Theatre and the Garrick Theatre in Lichfield in England is operating according to the displacement-ventilation principle upon which they were designed. Hybrid mixing ventilation has an important impact on both the ventilation rate and the thermal comfort of the theatres.