A Global Building Occupant Behavior Database.

This paper introduces a database of 34 field-measured building occupant behavior datasets collected from 15 countries and 39 institutions across 10 climatic zones covering various building types in both commercial and residential sectors. This is a comprehensive global database about building occupant behavior. The database includes occupancy patterns (i.e., presence and people count) and occupant behaviors (i.e., interactions with devices, equipment, and technical systems in buildings). Brick schema models were developed to represent sensor and room metadata information. The database is publicly available, and a website was created for the public to access, query, and download specific datasets or the whole database interactively. The database can help to advance the knowledge and understanding of realistic occupancy patterns and human-building interactions with building systems (e.g., light switching, set-point changes on thermostats, fans on/off, etc.) and envelopes (e.g., window opening/closing). With these more realistic inputs of occupants' schedules and their interactions with buildings and systems, building designers, energy modelers, and consultants can improve the accuracy of building energy simulation and building load forecasting.

Can CO2 sensors in the ventilation system of a pool facility help reduce the variability in the trihalomethane concentration observed in indoor air?

Volatile and hazardous compounds are formed during the chlorination of pool water. Monitoring components in the air, such as the four trihalomethanes; chloroform, dichlorobromomethane, dibromochloromethane and bromoform (tTHM), is challenging. Carbon dioxide (CO2) sensors are used for controlling air quality in different buildings and can be installed in ventilation systems for continuous surveillance and monitoring purposes. However, such sensors are not used in indoor swimming facilities. In this study, samples of tTHM and CO2 were collected and analysed, along with other air and water quality parameters such as combined chlorine, to evaluate whether CO2 sensors could be used to explain the observed variability in the tTHM concentration in an indoor swimming facility and thereby reduce the exposure of individuals utilising the pool to tTHM. Random intercept models were built for the tTHM and CO2 concentrations, respectively, and the results show that the relationships between combined chlorine in the water, CO2 in the air and number of occupants explain 52% of the variability in tTHM. The correlation between occupancy and CO2 concentration (ρ = 0.65, p ≤ 0.01) suggests that CO2 sensors should be used so that the air supply corresponds to the demand of the users.

MRI and intraoperative pathology to predict nipple-areola complex (NAC) involvement in patients undergoing NAC-sparing mastectomy.

BACKGROUND: Nipple-areola sparing mastectomy (NSM) with immediate implant reconstruction is an option for patients with non-locally advanced breast cancer. The prediction of occult tumour involvement of the nipple-areola complex (NAC) may help select candidates to NSM. PATIENTS AND METHODS: We prospectively recorded clinical and pathological data, magnetic resonance imaging (MRI) results and intraoperative pathological assessments of the subareolar (SD) and proximal nipple ducts (ND) of 112 consecutive breast cancer patients scheduled for NSM. All parameters were correlated with final pathological NAC assessment by univariate and multivariate analysis. RESULTS: Thirty-one patients (27.7%) had tumour involvement of the NAC. At univariate analysis, age (p=0.001), post-menopausal status (0.003), tumour central location (p=0.03), tumour-NAC distance measured by MRI (p=0.000) and intraoperative pathologic assessment (SD+ND) (p=0.000) were significantly correlated with NAC involvement. At multivariate analysis, only MRI tumour-NAC distance (p=0.008) and menopausal status (p=0.039) among all preoperative variables retained statistical significance. The sensitivity and specificity of MRI tumour-NAC distance were 32.2% and 88.6% and those of intraoperative pathologic assessment were 46.7% and 100%, respectively. Sensitivity, specificity and accuracy of the double assessment (MRI plus intraoperative pathology) were 50.0%, 96.2% and 84.1%, respectively. CONCLUSION: Intraoperative pathologic assessment and tumour-NAC distance measured by MRI are the most important predictors of occult NAC involvement in breast cancer patients. A negative pathological assessment and a tumour-NAC distance ⩾ 5 mm allow optimal discrimination between NAC positive and NAC negative cases and may serve as a guide for the optimal planning of oncological and reconstructive surgery.

Role of systematic scalp expansion before cranioplasty in patients with craniectomy defects.

PURPOSE: Scalp management is challenging in all types of cranioplasties, particularly following decompression or in case of resorption of a repositioned bone flap. In these cases, reduction of brain volume is constantly associated with tightening of the skin cover. MATERIAL AND METHODS: A retrospective analysis of 36 cranioplasties was performed. All patients showed cranial decompression or a large craniectomy. In all cases, cranioplasty was preceded by a preliminary scalp expansion. RESULTS: Two patients had expander exposure. One of them underwent re-intervention, to reposition the implant. Complications of the cranioplasty phase were one case of extradural hematoma, five cases of swelling due to liquorrea, four cases of temporary forehead edema, and one case of temporal bulging due to the implant. Cranial decompression and other craniectomy procedures often produce a tightening of the scalp, which makes the cranioplasty problematic. The preliminary systematic scalp expansion performed in all patients resulted in a convenient skin excess that allowed a tension-less closure, preventing the scalp suture from falling right on the edge of the cranioplasty implant. CONCLUSION: A systematic preliminary scalp expansion allows one to minimize cranioplasty complications in patients with craniectomies, to anticipate possible necrotic scalp complications in the expansion phase rather than in the cranioplasty phase, and thereby avoid implant loss.

Surgical management of digital calcinosis in CREST syndrome.

As a limited form of sclerodermy, CREST syndrome is characterized by calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia, which determine the acronym CREST. Calcinosis is a particularly difficult entity to treat given the paucity of effective options described in the literature. Treatment of finger calcinosis has a wide range of possibilities depending on the extent of calcifications and the involvement of deep structures. From a surgical point of view, whereas simple removal is adequate in minor outpatient cases, a radical debridement in the major and more painful cases seems required. A cover flap is needed particularly in the thumb due to its great functional importance, also if the fingertip is not involved. The authors recommend the kite flap for the dimensions, the tissue quality, and the possibility of giving sensation to the reconstructed area. With this surgical option, the transferred skin is soft, sensate, and the right fit. Usually, no further operations are needed for flap remodeling. The time required for sensory integration is about 2 years, often related to the age of the patient. Debridement and flap reconstruction usually give total resolution of pain, with complete recovery of thumb motion and the thumb-index finger grip.

Combination of two long-pedicled myocutaneous flaps for closure of a complex contralateral dorsal defect.

A large and deep oncological defect has been filled up using a very long-pedicled latissimus dorsi myocutaneous flap, together with a trapezius myocutaneous flap, both harvested contralaterally to the lesion. Despite the distance of the defect from the area from which the flaps have been harvested, use of long-pedicled flaps warranted a better flap rotation with less tension and greater availability of bulky tissues. Both flaps were viable, and the recipient site healed uneventfully. The two donor sites were closed directly and healed rapidly. Therefore, a challenging complex thoracic defect was covered immediately after oncological resection through a combination of two myocutaneous flaps contralaterally harvested, which seemed safe and reliable.

Selective breast reduction: a personal approach with a central-superior pedicle.

BACKGROUND: Breast reduction shows a greater risk of complications in peculiar cases such as those with gigantomastia, a high degree of ptosis, obesity, smoking, cardiovascular diseases, or metabolic disorders. The authors feel that a reduction in the complication rate can be achieved by safeguarding the vascular and nervous structures of the breast as much as possible. METHODS: The authors propose a breast reduction method based on a double central-superior pedicle that was used in 91 patients with a more or less elevated degree of obesity. This technique aims to remove excess tissue, preserving the noble structures of the breast. Beginning from preoperative drawings similar to the ones of Lejour, deepithelialization and wide medial and lateral skin undermining are performed. Next, the excess tissue is removed from the caudal, medial, and lateral portions of the breast and from the deep cranial portion, sparing the horizontal septum that supplies vessels and nerves to the nipple. A "handle" composed of the superior and central pedicles is obtained. After fixing the central pedicle to the thoracic wall, redundant skin is removed, and a vertical or J-shaped suture is made. RESULTS: The authors obtained good breast shape, short scars, and optimal viability of the nipple-areola complex. The results are stable and durable, and the complication rate seems to be very low. CONCLUSIONS: The authors believe that this technique may be a valid alternative to traditional methods, especially in vast tissue resections and in cases of considerable nipple-areola complex lift. It is mainly indicated in obese and partial weight loss patients.

Reconstruction of the retroauricular fold by 'nonpedicled' superficial mastoid fascia: details of anatomy and surgical technique.

During ear reconstruction, it is often difficult to achieve a good projection of the new ear. This is due to the retraction of retroauricular tissues, and the use of a cartilage wedge and superficial temporal fascia is frequently needed to elevate the ear framework. The aim of this article is to identify, by cadaver dissection, the anatomical structures of the retroauricular and mastoid regions and also to demonstrate the possibility of increasing the size of the superficial mastoid fascia by defibrating and cutting up its structure. The cartilage wedge is then inserted into a three-dimensional fascial environment. This allows reconstruction of the retroauricular fold with 'nonpedicled' fascia and to have a firm, stable ear elevation without sacrificing the temporal fascia. Nine ear reconstructions were performed using this technique and no major complications occurred; however, one procedure was complicated by a limited necrosis of the skin graft. In all cases we obtained a good and persistent elevation of the ear, as well as a well-defined fold, with the possibility of wearing glasses. Symmetry was satisfactory and aesthetic results were pleasant for all treated patients. This simple procedure allows one to obtain a good projection of the ear without involving the use of the superficial temporal fascia, which in addition is very useful in case of eventual complications such as cartilage extrusion.

Launois-Bensaude Syndrome: an unusual localization of obesity disease.

BACKGROUND: Launois-Bensaude syndrome is a rare pathology consisting of adipose masses symmetrically distributed mainly in the superior part of the body. Men are especially affected between age of 30 and 60 as well as chronic alcohol abusers. Etiopathogenesis is attributable to mutations or deletions of mitochondrial DNA, and alcohol is a possible cofactor. METHODS: The current treatment of the disease is described based on the authors' experience. Four cases treated in our department are retrospectively reviewed regarding comorbidities and type of surgery performed. RESULTS: A relevant and long-lasting reduction of fat bulges has been obtained in all cases with no major complications except for a mild anemia. CONCLUSION: Launois-Bensaude syndrome causes a functional rather than esthetic concern due to the peculiar localization of fat bulges. Currently, the only effective therapy is surgery, through lipectomy or liposuction of adipose bulges.

Distally based fasciocutaneous sural flap for foot reconstruction: a retrospective review of 10 years experience.

BACKGROUND: The treatment of soft tissue defects of the foot is a problem mainly connected to the thickness of the coverage tissues, to the poor circulation, and to the frequent involvement of muscle, tendon, and bone. The authors present their experience with the sural flap, also in some particular cases. MATERIALS AND METHODS: The authors treated 33 patients for small- and medium-size defects of the foot, caused by work, home, and road accidents, and by venous or diabetic ulcers. In all cases, the flap was cut in its fasciocutaneous variant; an extension of the sole portion of fascia was added in 5 patients. The flap was transferred under a subcutaneous tunnel in 10 cases, with an open incision in 20 cases, and in 3 cases the pedicle was kept external for 4 weeks, then resected. RESULTS: One patient showed a complete necrosis of the flap and another showed a superficial necrosis preserving the deep fascia; in the remaining 31 cases, the flap incorporated without any major complication. The flap provided proper coverage of the defects from both an aesthetic and functional point of view as evidenced clinically and through a baropedographic test. CONCLUSION: The advantages of this flap include: dissection is fast and easy, it is not necessary to sacrifice important arterial pedicle or muscular units as it can be used in traumatized limbs without further damage to main arteries, and a wide rotation arc is possible. Disadvantages include the sacrifice of the sural nerve and the covering of the donor region with skin grafts.