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1.
Dis Esophagus ; 2024 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-38366900

RESUMO

Esophagectomy is a complex and complication laden procedure. Despite centralization, variations in perioparative strategies reflect a paucity of evidence regarding optimal routines. The use of nasogastric (NG) tubes post esophagectomy is typically associated with significant discomfort for the patients. We hypothesize that immediate postoperative removal of the NG tube is non-inferior to current routines. All Nordic Upper Gastrointestinal Cancer centers were invited to participate in this open-label pragmatic randomized controlled trial (RCT). Inclusion criteria include resection for locally advanced esophageal cancer with gastric tube reconstruction. A pretrial survey was undertaken and was the foundation for a consensus process resulting in the Kinetic trial, an RCT allocating patients to either no use of a NG tube (intervention) or 5 days of postoperative NG tube use (control) with anastomotic leakage as primary endpoint. Secondary endpoints include pulmonary complications, overall complications, length of stay, health related quality of life. A sample size of 450 patients is planned (Kinetic trial: https://www.isrctn.com/ISRCTN39935085). Thirteen Nordic centers with a combined catchment area of 17 million inhabitants have entered the trial and ethical approval was granted in Sweden, Norway, Finland, and Denmark. All centers routinely use NG tube and all but one center use total or hybrid minimally invasive-surgical approach. Inclusion began in January 2022 and the first annual safety board assessment has deemed the trial safe and recommended continuation. We have launched the first adequately powered multi-center pragmatic controlled randomized clinical trial regarding NG tube use after esophagectomy with gastric conduit reconstruction.

2.
Int J Biometeorol ; 67(12): 1927-1940, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37726553

RESUMO

Hot weather conditions can have negative impacts on the thermal comfort and physical activity of vulnerable groups such as children. The aim of this study is to analyze the effects of warm weather on 5-year-old children's thermal comfort and physical activity in a preschool yard in Gothenburg, Sweden. In situ measurements were conducted for 1-1.5 h in the early afternoon on 8 days in May, June, and August of 2022. The thermal comfort and physical activity was estimated with GPS-tracks, heart rate monitors, and step counts and compared to observed weather conditions. Results show that physical activity decreases under warmer weather conditions, depicted by a decrease in distance moved, step counts, and highest registered pulse. Moreover, on warm days, the children avoid sunlit areas. For 50% or more of the time spent in sunlit areas, the children are exposed to cautious levels of heat. In shaded areas, on the other hand, the children are less exposed, with five out of 8 days having 50% or more of the time at neutral levels. The study demonstrates the importance of access to shaded areas in preschool yards where children can continue their active play while simultaneously maintaining a safe thermal status.


Assuntos
Exercício Físico , Tempo (Meteorologia) , Humanos , Pré-Escolar , Suécia , Instituições Acadêmicas , Escolaridade
3.
Int J Biometeorol ; 67(4): 633-647, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36826592

RESUMO

A robust representation of the radiative properties in complex urban settings is important for accurate estimations of radiant load. Here, we present a new parameterization scheme in the SOlar and LongWave Environmental Irradiance Geometry (SOLWEIG) model that partitions the upper hemisphere into 153 patches. Partitioning of the upper hemisphere enables determination if longwave irradiance originates from the sky, vegetation, sunlit building surfaces, or shaded building surfaces from each patch. Furthermore, a model for anisotropic sky longwave irradiance where emissivity increases with zenith angle is included. Comparisons between observations and simulations show high correlation, with R2 and RMSE for Tmrt of 0.94 and 4.6 °C, respectively, and R2 and RMSE for longwave radiation of 0.89 and 14.1 Wm-2, respectively. Simulations show that mean radiant temperature (Tmrt) can be up to 1.5 °C higher with an anisotropic sky compared to a uniform sky as an effect of higher radiant load on the vertical of a human when sky longwave irradiance increases with zenith angle. In comparisons of simulated Tmrt with the new parameterization and old parameterization schemes, previously overestimated Tmrt under trees (high sky obstruction, sky view factor (SVF) < 0.3) can be decreased by up to 3 °C from more realistic estimations using the patches. Moreover, Tmrt close to sunlit walls (SVF ~ 0.5) is increased by up to 2-3 °C from increased exposure to sunlit surfaces. Concluding, anisotropic sky longwave radiation and directionality of longwave radiation from different sources are important in estimations of Tmrt of humans in outdoor settings.


Assuntos
Modelos Teóricos , Luz Solar , Humanos , Temperatura
4.
PLoS One ; 17(7): e0270699, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35789217

RESUMO

BACKGROUND: A glycerol throat spray containing cold-adapted cod trypsin (GCTS) deactivates common cold virus in vitro and decreases pharyngeal rhinovirus load after inoculation in humans. We relied on early self-diagnosis and evaluated two different scales to detect a treatment effect in naturally occurring common colds. METHODS: Adults were enrolled in this randomised, prospective, parallel group, single-blind study to begin treatment six times daily at first sign of a common cold or were assigned to a non-treated group. Jackson's symptom scale and the 9-item Wisconsin Upper Respiratory Symptom Survey (WURSS)-21 quality of life (QoL) domain were recorded daily by subjects and area under the curve over 12 days (AUC1-12) calculated. RESULTS: Treatment resulted in reduced symptoms with an AUC1-12 of 45.1 ± 32.5 for Jackson scores compared to 53.8 ± 35.7 in the controls (p = 0.023). AUC1-12 for the 9-item WURSS-21 QoL domain was likewise improved, 113.6 ± 107.7 and 152.7 ± 126.3 (p = 0.006), respectively. During the first four days fewer of the treated subjects (35.3%) used rescue medication than did the control group (50.4%, p = 0.014). CONCLUSIONS: Reduction in common cold symptoms was seen with treatment with a glycerol throat spray containing cold-adapted cod trypsin. This effect was best detected with the 9-item WURSS-21 QoL domain.


Assuntos
Resfriado Comum , Adulto , Resfriado Comum/diagnóstico , Resfriado Comum/tratamento farmacológico , Glicerol/uso terapêutico , Humanos , Faringe , Estudos Prospectivos , Qualidade de Vida , Rhinovirus , Índice de Gravidade de Doença , Método Simples-Cego , Tripsina
5.
J Med Virol ; 93(3): 1792-1795, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32975843

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic calls for effective and safe treatments. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19 actively replicates in the throat, unlike SARS-CoV, and shows high pharyngeal viral shedding even in patients with mild symptoms of the disease. HCoV-229E is one of four coronaviruses causing the common cold. In this study, the efficacy of ColdZyme® (CZ-MD), a medical device mouth spray, was tested against SARS-CoV-2 and HCoV-229E in vitro. The CZ-MD provides a protective glycerol barrier containing cod trypsin as an ancillary component. Combined, these ingredients can inactivate common cold viruses in the throat and mouth. The CZ-MD is believed to act on the viral surface proteins that would perturb their entry pathway into cells. The efficacy and safety of the CZ-MD have been demonstrated in clinical trials on the common cold. METHOD OF STUDY: The ability of the CZ-MD to inactivate SARS-CoV-2 and HCoV-229E was tested using an in vitro virucidal suspension test (ASTM E1052). RESULTS: CZ-MD inactivated SARS-CoV-2 by 98.3% and HCoV-229E by 99.9%. CONCLUSION: CZ-MD mouth spray can inactivate the respiratory coronaviruses SARS-CoV-2 and HCoV-229E in vitro. Although the in vitro results presented cannot be directly translated into clinical efficacy, the study indicates that CZ-MD might offer a protective barrier against SARS-CoV-2 and a decreased risk of COVID-19 transmission.


Assuntos
Antivirais/farmacologia , Coronavirus Humano 229E/efeitos dos fármacos , Glicerol/farmacologia , SARS-CoV-2/efeitos dos fármacos , Tripsina/farmacologia , Inativação de Vírus/efeitos dos fármacos , COVID-19/prevenção & controle , COVID-19/transmissão , Resfriado Comum/tratamento farmacológico , Resfriado Comum/prevenção & controle , Resfriado Comum/transmissão , Desinfetantes/farmacologia , Humanos , Proteínas Virais/efeitos dos fármacos , Tratamento Farmacológico da COVID-19
6.
Neuroendocrinology ; 111(9): 840-849, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32721955

RESUMO

BACKGROUND: Small intestinal neuroendocrine tumors (SI-NETs) are difficult to diagnose in the early stage of disease. Current blood biomarkers such as chromogranin A (CgA) and 5-hydroxyindolacetic acid have low sensitivity (SEN) and specificity (SPE). This is a first preplanned interim analysis (Nordic non-interventional, prospective, exploratory, EXPLAIN study [NCT02630654]). Its objective is to investigate if a plasma protein multi-biomarker strategy can improve diagnostic accuracy (ACC) in SI-NETs. METHODS: At the time of diagnosis, before any disease-specific treatment was initiated, blood was collected from patients with advanced SI-NETs and 92 putative cancer-related plasma proteins from 135 patients were analyzed and compared with the results of age- and sex-matched controls (n = 143), using multiplex proximity extension assay and machine learning techniques. RESULTS: Using a random forest model including 12 top ranked plasma proteins in patients with SI-NETs, the multi-biomarker strategy showed SEN and SPE of 89 and 91%, respectively, with negative predictive value (NPV) and positive predictive value (PPV) of 90 and 91%, respectively, to identify patients with regional or metastatic disease with an area under the receiver operator characteristic curve (AUROC) of 99%. In 30 patients with normal CgA concentrations, the model provided a diagnostic SPE of 98%, SEN of 56%, and NPV 90%, PPV of 90%, and AUROC 97%, regardless of proton pump inhibitor intake. CONCLUSION: This interim analysis demonstrates that a multi-biomarker/machine learning strategy improves diagnostic ACC of patients with SI-NET at the time of diagnosis, especially in patients with normal CgA levels. The results indicate that this multi-biomarker strategy can be useful for early detection of SI-NETs at presentation and conceivably detect recurrence after radical primary resection.


Assuntos
Neoplasias Duodenais/sangue , Neoplasias do Íleo/sangue , Neoplasias do Jejuno/sangue , Tumores Neuroendócrinos/sangue , Biomarcadores/sangue , Neoplasias Duodenais/diagnóstico , Humanos , Neoplasias do Íleo/diagnóstico , Neoplasias do Jejuno/diagnóstico , Aprendizado de Máquina , Tumores Neuroendócrinos/diagnóstico
7.
Br J Sports Med ; 55(15): 825-830, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32467149

RESUMO

BACKGROUND: The Wet-Bulb Globe Temperature (WBGT) index is a common tool to screen for heat stress for sporting events. However, the index has a number of limitations. Rational indices, such as the physiological equivalent temperature (PET) and Universal Thermal Climate Index (UTCI), are potential alternatives. AIM: To identify the thermal index that best predicts ambulance-required assistances and collapses during a city half marathon. METHODS: Eight years (2010-2017) of meteorological and ambulance transport data, including medical records, from Gothenburg's half-marathon were used to analyse associations between WBGT, PET and UTCI and the rates of ambulance-required assistances and collapses. All associations were evaluated by Monte-Carlo simulations and leave-one-out-cross-validation. RESULTS: The PET index showed the strongest correlation with both the rate of ambulance-required assistances (R2=0.72, p=0.008) and collapses (R2=0.71, p=0.008), followed by the UTCI (R2=0.64, p=0.017; R2=0.64, p=0.017) whereas the WBGT index showed substantially poorer correlations (R2=0.56, p=0.031; R2=0.56, p=0.033). PET stages of stress, match the rates of collapses better that the WBGT flag colour warning. Compared with the PET, the WBGT underestimates heat stress, especially at high radiant heat load. The rate of collapses increases with increasing heat stress; large increase from the day before the race seems to have an impact of the rate of collapses. CONCLUSION: We contend that the PET is a better predictor of collapses during a half marathon than the WBGT. We call for further investigation of PET as a screening tool alongside WBGT.


Assuntos
Ar , Ambulâncias/estatística & dados numéricos , Temperatura Corporal/fisiologia , Exaustão por Calor/epidemiologia , Corrida/estatística & dados numéricos , Termografia/métodos , Adolescente , Adulto , Distribuição por Idade , Idoso , Regulação da Temperatura Corporal , Intervalos de Confiança , Feminino , Exaustão por Calor/diagnóstico , Transtornos de Estresse por Calor , Resposta ao Choque Térmico , Humanos , Umidade , Modelos Lineares , Masculino , Corrida de Maratona , Pessoa de Meia-Idade , Método de Monte Carlo , Risco , Corrida/fisiologia , Distribuição por Sexo , Temperatura Cutânea/fisiologia , Luz Solar , Suécia/epidemiologia , Termografia/instrumentação , Sensação Térmica , Fatores de Tempo , Vento , Adulto Jovem
8.
Sci Rep ; 10(1): 8937, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32488077

RESUMO

Substantial palsa degradation has occurred in Fennoscandia, which is considered to be driven by global climate change. Deeper understanding of the role of different climatic drivers on palsa decay, however, is lacking. We use meteorological data and aerial photographs from 1955 to 2016 to statistically identify the most important climatic drivers affecting changes in lateral-temporal palsa decay rates in the largest coherent palsa complex in Sweden, Vissátvuopmi. We show that wetter, warmer and shorter winters are the main causes of large and rapid changes in lateral-palsa extent since the mid-1950s. By analyzing meteorological data from the 1880s to present, we show that average annual temperature conditions have been unfavourable for palsas for more than a century and average annual precipitation conditions have been unfavourable since the 1940s. The decay rates have likely been amplified over the past 50-60 years, and in particular over the most recent decades, due to the combined effect of adverse air temperature and precipitation conditions. Palsa loss is expected to continue, most likely at a higher rate than today, with serious ecological impacts as a consequence.

9.
Sports (Basel) ; 8(1)2019 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-31881684

RESUMO

Among several serious medical conditions, arrhythmia and heat stroke are two important causes of death during endurance races. Clinically, collapsing might be the first sign of these serious conditions and may mimic the more common and benign exercise-associated collapse. Several risk factors have been reported in the literature. We aimed to conduct a qualitative study to find a perceived risk profile among runners who collapsed and who were transported by ambulances to the nearest hospital during Gothenburg's half marathon (2010-2017). Collapsing runners seem to lack the ability to make a decision to withdraw from the contest despite being exhausted. They feel the pain, but are unable to put meaning to their feeling, to adjust their pacing, and to handle other influences. Consequently, they do not overcome the problem or assess the situation. These individual mental characteristics may indicate a unique profile for collapsing runners. Pre-race health control and educational initiatives aiming at mental preparedness and information before endurance races might be a necessary step to avoid life-threatening complications.

10.
Int J Sports Med ; 40(5): 312-316, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30856672

RESUMO

The aim was to analyze the influence of weather conditions on medical emergencies in a half-marathon, specifically by evaluating its relation to the number of non-finishers, ambulance-required assistances, and collapses in need of ambulance as well as looking at the location of such emergencies on the race course. Seven years of data from the world's largest half marathon were used. Meteorological data were obtained from a nearby weather station, and the Physiological Equivalent Temperature (PET) index was used as a measure of general weather conditions. Of the 315,919 race starters, 104 runners out of the 140 ambulance-required assistances needed ambulance services due to collapses. Maximum air temperature and PET significantly co-variated with ambulance-required assistances, collapses, and non-finishers (R2=0.65-0.92; p=0.001-0.03). When air temperatures vary between 15-29°C, an increase of 1°C results in an increase of 2.5 (0.008/1000) ambulance-required assistances, 2.5 (0.008/1000) collapses (needing ambulance services), and 107 (0.34/1000) non-finishers. The results also indicate that when the daily maximum PET varies between 18-35°C, an increase of 1°C PET results in an increase of 1.8 collapses (0.006/1000) needing ambulance services and 66 non-finishers (0.21/1000).


Assuntos
Emergências , Corrida , Tempo (Meteorologia) , Adolescente , Adulto , Idoso , Ambulâncias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Suécia , Temperatura , Adulto Jovem
11.
Int J Biometeorol ; 63(6): 711-722, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30519956

RESUMO

While capabilities in urban climate modeling have substantially increased in recent decades, the interdependency of changes in environmental surface properties and human (dis)comfort have only recently received attention. The open-source solar long-wave environmental irradiance geometry (SOLWEIG) model is one of the state-of-the-art models frequently used for urban (micro-)climatic studies. Here, we present updated calculation schemes for SOLWEIG allowing the improved prediction of surface temperatures (wall and ground). We illustrate that parameterizations based on measurements of global radiation on a south-facing vertical plane obtain better results compared to those based on solar elevation. Due to the limited number of ground surface temperature parameterizations in SOLWEIG, we implement the two-layer force-restore method for calculating ground temperature for various soil conditions. To characterize changes in urban canyon air temperature (Tcan), we couple the calculation method as used in the Town Energy Balance (TEB) model. Comparison of model results and observations (obtained during field campaigns) indicates a good agreement between modeled and measured Tcan, with an explained variance of R2 = 0.99. Finally, we implement an energy balance model for vertically mounted PV modules to contrast different urban surface properties. Specifically, we consider (i) an environment comprising dark asphalt and a glass facade and (ii) an environment comprising bright concrete and a PV facade. The model results show a substantially decreased Tcan (by up to - 1.65°C) for the latter case, indicating the potential of partially reducing/mitigating urban heat island effects.


Assuntos
Clima , Microclima , Cidades , Humanos , Modelos Teóricos , Temperatura
13.
Scand J Med Sci Sports ; 28(12): 2760-2766, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30218614

RESUMO

OBJECTIVES: Despite endurance races leading to a substantial number of ambulance-requiring cases (ARC), little is known regarding where they occur, meaning that knowing where to place medical teams, ambulance pick-up points, etc, is difficult. This article investigates whether the location of ARCs can be identified by race participants. METHODS: Using the world's largest half marathon (Gothenburg half marathon) as a case, 237 runners were asked, post-race, to mark on a map which geographical point of the race was most exhausting. Using the level of agreement tests, these geographical points were then compared with the GPS positions of ARCs. RESULTS: According to the level of agreement tests, the most exhausting positions (MEP), as identified by participants, seem to be highly correlated to the location of ARCs. This study can also show that ambulance-requiring cases seem to be more prevalent towards the end of the race and in uphill sections. CONCLUSIONS: By asking participants where they found the race most exhausting it seems possible to identify high-risk places for an ARC. From a practical perspective, using this method could considerably increase the safety of competitors as well as improving the cost-effectiveness of safety interventions at endurance races. Further studies are needed to understand the specific risk factors of the high-risk areas as well as characteristics of collapsed runners.


Assuntos
Ambulâncias , Fadiga/diagnóstico , Previsões , Corrida , Feminino , Geografia , Humanos , Masculino , Fatores de Risco
14.
Sci Rep ; 8(1): 11498, 2018 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-30065389

RESUMO

One important challenge facing the urbanization and global environmental change community is to understand the relation between urban form, energy use and carbon emissions. Missing from the current literature are scientific assessments that evaluate the impacts of different urban spatial units on energy fluxes; yet, this type of analysis is needed by urban planners, who recognize that local scale zoning affects energy consumption and local climate. Satellite-based estimation of urban energy fluxes at neighbourhood scale is still a challenge. Here we show the potential of the current satellite missions to retrieve urban energy budget fluxes, supported by meteorological observations and evaluated by direct flux measurements. We found an agreement within 5% between satellite and in-situ derived net all-wave radiation; and identified that wall facet fraction and urban materials type are the most important parameters for estimating heat storage of the urban canopy. The satellite approaches were found to underestimate measured turbulent heat fluxes, with sensible heat flux being most sensitive to surface temperature variation (-64.1, +69.3 W m-2 for ±2 K perturbation).  They also underestimate anthropogenic heat fluxes. However, reasonable spatial patterns are obtained for the latter allowing hot-spots to be identified, therefore supporting both urban planning and urban climate modelling.

15.
Int J Biometeorol ; 62(3): 373-385, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28612254

RESUMO

Due to the complexity of built environment, urban design patterns considerably affect the microclimate and outdoor thermal comfort in a given urban morphology. Variables such as building heights and orientations, spaces between buildings, plot coverage alter solar access, wind speed and direction at street level. To improve microclimate and comfort conditions urban design elements including vegetation and shading devices can be used. In warm-humid Dar es Salaam, the climate consideration in urban design has received little attention although the urban planning authorities try to develop the quality of planning and design. The main aim of this study is to investigate the relationship between urban design, urban microclimate, and outdoor comfort in four built-up areas with different morphologies including low-, medium-, and high-rise buildings. The study mainly concentrates on the warm season but a comparison with the thermal comfort conditions in the cool season is made for one of the areas. Air temperature, wind speed, mean radiant temperature (MRT), and the physiologically equivalent temperature (PET) are simulated using ENVI-met to highlight the strengths and weaknesses of the existing urban design. An analysis of the distribution of MRT in the areas showed that the area with low-rise buildings had the highest frequency of high MRTs and the lowest frequency of low MRTs. The study illustrates that areas with low-rise buildings lead to more stressful urban spaces than areas with high-rise buildings. It is also shown that the use of dense trees helps to enhance the thermal comfort conditions, i.e., reduce heat stress. However, vegetation might negatively affect the wind ventilation. Nevertheless, a sensitivity analysis shows that the provision of shade is a more efficient way to reduce PET than increases in wind speed, given the prevailing sun and wind conditions in Dar es Salaam. To mitigate heat stress in Dar es Salaam, a set of recommendations and guidelines on how to develop the existing situation from microclimate and thermal comfort perspectives is outlined. Such recommendations will help architects and urban designers to increase the quality of the outdoor environment and demonstrate the need to create better urban spaces in harmony with microclimate and thermal comfort.


Assuntos
Planejamento de Cidades , Microclima , Sensação Térmica , Temperatura Alta , Humanos , Umidade , Modelos Teóricos , Poaceae , Tanzânia , Árvores , Vento
16.
J Environ Manage ; 205: 274-285, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29020655

RESUMO

Ongoing urban exploitation is increasing pressure to transform urban green spaces, while there is increasing awareness that greenery provides a range of important benefits to city residents. In efforts to help resolve associated problems we have developed a framework for integrated assessments of ecosystem service (ES) benefits and values provided by urban greenery, based on the ecosystem service cascade model. The aim is to provide a method for assessing the contribution to, and valuing, multiple ES provided by urban greenery that can be readily applied in routine planning processes. The framework is unique as it recognizes that an urban greenery comprises several components and functions that can contribute to multiple ecosystem services in one or more ways via different functional traits (e.g. foliage characteristics) for which readily measured indicators have been identified. The framework consists of five steps including compilation of an inventory of indicator; application of effectivity factors to rate indicators' effectiveness; estimation of effects; estimation of benefits for each ES; estimation of the total ES value of the ecosystem. The framework was applied to assess ecosystem services provided by trees, shrubs, herbs, birds, and bees, in green areas spanning an urban gradient in Gothenburg, Sweden. Estimates of perceived values of ecosystem services were obtained from interviews with the public and workshop activities with civil servants. The framework is systematic and transparent at all stages and appears to have potential utility in the existing spatial planning processes.


Assuntos
Conservação dos Recursos Naturais , Ecossistema , Animais , Cidades , Suécia , Árvores
17.
Int J Biometeorol ; 61(9): 1531-1543, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28447175

RESUMO

Present-day and projected future changes in mean radiant temperature, T mrt in one northern, one mid-, and one southern European city (represented by Gothenburg, Frankfurt, and Porto), are presented, and the concept of hot spots is adopted. Air temperature, T a , increased in all cities by 2100, but changes in solar radiation due to changes in cloudiness counterbalanced or exacerbated the effects on T mrt. The number of days with high T mrt in Gothenburg was relatively unchanged at the end of the century (+1 day), whereas it more than doubled in Frankfurt and tripled in Porto. The use of street trees to reduce daytime radiant heat load was analyzed using hot spots to identify where trees could be most beneficial. Hot spots, although varying in intensity and frequency, were generally confined to near sunlit southeast-southwest facing walls, in northeast corner of courtyards, and in open spaces in all three cities. By adding trees in these spaces, the radiant heat load can be reduced, especially in spaces with no or few trees. A set of design principles for reducing the radiant heat load is outlined based on these findings and existing literature.


Assuntos
Planejamento de Cidades , Temperatura , Cidades , Mudança Climática , Previsões , Alemanha , Modelos Teóricos , Portugal , Luz Solar , Suécia , Árvores
18.
BMC Gastroenterol ; 17(1): 48, 2017 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-28388942

RESUMO

BACKGROUND: Health care providers need solid evidence based data on cost differences between alternative surgical procedures for common surgical disorders. We aimed to compare small-incision open cholecystectomy (SIOC) and laparoscopic cholecystectomy (LC) concerning costs and health-related quality of life using data from an expertise-based randomised controlled trial. METHODS: Patients scheduled for cholecystectomy were assigned to undergo LC or SIOC performed by surgeons in two different expert groups. Total costs were calculated in USD. Reusable instruments were assumed for the cost analysis. Quality of life was measured using the EuroQol 5-D 3-L (EQ 5-D-3L), at five postoperative time points and calculated to Area Under Curve (AUC) for 1 year postoperatively. Two hospitals participated in the trial, which included both emergency and elective surgery. RESULTS: Of 477 patients that underwent a cholecystectomy during the study period, 355 (74.9%) were randomised and 323 analysed, 172 LC and 151 SIOC patients. Both direct and total costs were less for SIOC than for LC patients. The total costs were 5429 (4293-6932) USD for LC and 4636 (3905-5746) USD for SIOC, P = 0.001. The quality of life index did not differ between the LC and SIOC groups at any time. Median values (25th and 75th percentiles (p25-p75)) for AUC at 1 year were as follows: 349 (337-351) for LC and 349 (338-350) for SIOC. CONCLUSIONS: In this expertise-based randomised controlled trial LC was a more costly procedure and quality of life did not differ after SIOC and LC. (ClinicalTrials.gov Identifier: NCT00370344, August 30, 2006).


Assuntos
Colecistectomia Laparoscópica/métodos , Doenças da Vesícula Biliar/cirurgia , Custos de Cuidados de Saúde , Laparotomia/métodos , Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistectomia/economia , Colecistectomia/métodos , Colecistectomia Laparoscópica/economia , Custos e Análise de Custo , Feminino , Humanos , Laparotomia/economia , Masculino , Pessoa de Meia-Idade , Competência Profissional , Adulto Jovem
19.
Boundary Layer Meteorol ; 164(2): 183-213, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-32025040

RESUMO

Nine methods to determine local-scale aerodynamic roughness length ( z 0 ) and zero-plane displacement ( z d ) are compared at three sites (within 60 m of each other) in London, UK. Methods include three anemometric (single-level high frequency observations), six morphometric (surface geometry) and one reference-based approach (look-up tables). A footprint model is used with the morphometric methods in an iterative procedure. The results are insensitive to the initial z d and z 0 estimates. Across the three sites, z d varies between 5 and 45 m depending upon the method used. Morphometric methods that incorporate roughness-element height variability agree better with anemometric methods, indicating z d is consistently greater than the local mean building height. Depending upon method and wind direction, z 0 varies between 0.1 and 5 m with morphometric z 0 consistently being 2-3 m larger than the anemometric z 0 . No morphometric method consistently resembles the anemometric methods. Wind-speed profiles observed with Doppler lidar provide additional data with which to assess the methods. Locally determined roughness parameters are used to extrapolate wind-speed profiles to a height roughly 200 m above the canopy. Wind-speed profiles extrapolated based on morphometric methods that account for roughness-element height variability are most similar to observations. The extent of the modelled source area for measurements varies by up to a factor of three, depending upon the morphometric method used to determine z d and z 0 .

20.
Int J Biometeorol ; 60(9): 1439-52, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26852384

RESUMO

The effect of variations in land cover on mean radiant temperature (T mrt ) is explored through a simple scheme developed within the radiation model SOLWEIG. Outgoing longwave radiation is parameterised using surface temperature observations on a grass and an asphalt surface, whereas outgoing shortwave radiation is modelled through variations in albedo for the different surfaces. The influence of ground surface materials on T mrt is small compared to the effects of shadowing. Nevertheless, altering ground surface materials could contribute to a reduction in T mrt to reduce the radiant load during heat-wave episodes in locations where shadowing is not an option. Evaluation of the new scheme suggests that despite its simplicity it can simulate the outgoing fluxes well, especially during sunny conditions. However, it underestimates at night and in shadowed locations. One grass surface used to develop the parameterisation, with very different characteristics compared to an evaluation grass site, caused T mrt to be underestimated. The implications of using high temporal resolution (e.g. 15 minutes) meteorological forcing data under partly cloudy conditions are demonstrated even for fairly proximal sites.


Assuntos
Modelos Teóricos , Luz Solar , Temperatura , Hidrocarbonetos , Londres , Poaceae , Água
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