A mechanical ventilation system is a big support for breathing complications, in which an external solution is quite necessary to keep oxygen compensation in the patients. Its knowledge is well widespread and different equipment has been developed. However, they are very expensive and their quantity in medical centers is not sufficient, especially in Peru. Hence, it has been required to develop new methods to provide oxygen by a low cost equipment; Protofy, a research group from Spain, designed one of the first low cost mechanical ventilation systems which was medically validated by its government. In this sense, a redesign of the mechanical ventilation system was carried out according to the local requirements and available technology, a different airbag resuscitator with different properties and geometry, but maintaining its working concept based on a cam compression mechanism. Sensors and a display were added to improve the performance with a control algorithm for the rotation frequency and to show the ventilation curves over time to the medical staff. It was necessary to develop a mathematical model to relate the behavior between ventilation curves for a patient and physical variables of the design, especially in the epidemic COVID 19, that many countries are dealing with at the time research is being conducted. The mechanical ventilation system was redesigned, fabricated, and tested measuring its ventilation curves over time. Results indicate that this redesign provides a sturdy equipment able to work during a longer lifetime than the original. The replicability of the ventilation curves behavior is assured, while the mechanism dimensions are adapted for a particular airbag resuscitator. The mathematical model of the whole system can predict satisfactorily the ventilation curves over time and was used to provide the air pressure, volume, and flow as a function of the rotation angle measured by sensors.

This paper presents a methodology for determining the sensitivity of the main air flow directions in ventilation subnetworks to changes of aerodynamic resistance and of air density in mine workings. Formulae for determination of the sensitivity of the main subnetwork air flows by establishing the degree of dependency of the air volume stream in a given working on the variations in resistance or air density of other workings of the network have been developed. They have been implemented in the VentGraph mine ventilation network simulator. This software, widely used in Polish collieries provides an extended possibility to predict the process of ventilation, air distribution and, in the case of underground fire, also the spread of combustion gasses. The new method facilitates assessment by mine ventilation services of the stability of ventilation systems in exploitation areas and determine of the sensitivity of the main subnetwork air flow directions to changes of aerodynamic resistance and air density. Recently in some Polish collieries new longwalls are developed in seams located deeper then the bottom of the intake shaft. Such solution is called “exploitation below the level of access” or “sublevel”. The new approach may be applied to such developments to assess the potential of changes of direction and air flow rates. In addition, interpretation of the developed sensitivity indicator is presented. While analyzing air distributions for sublevel exploitation, application of current numerical models for calculations of the distribution results in tangible benefits, such as the evaluation of the safety or risk levels for such exploitation. Application of the VentGraph computer program, and particularly the module POŻAR (fire) with the newly developed options, enables an additional approach to the sensitivity indicator in evaluating air flow safety levels for the risks present during exploitation below the level of the intake shaft. The analyses performed and examples presented enabled useful conclusions in mining practice to be drawn.

The data from the extended system was recorded on-going basis in the archives of the monitoring system, and the multipoint system was directly stored in the methane-anemometers, which allows one to perform a comparative analysis of the obtained records from many methane detectors. An important element of the analyses was the simultaneous registration of the methane concentration in the longwall, together with information on operating time, direction of shearer operation and type of work: mining/cleaning. Mining practice shows that in methane coal mines, methane is often the basic limitation for modern and high-efficiency longwall complexes. The paper reports on selected observations and tests carried out in the Cw-4 longwall in seam 364/2 of the Budryk mine belonging to JSW SA. In observation of the methane level in the Cw-4 longwall, additional sensors installed in the end part of the longwall from the side of the gobs and registration of air velocity and methane concentration in the multipoint system built in the selected longwall cross-section were used, regardless of the air parameters recorded in the monitoring system.

This paper, we examined the technology to maximize the use of renewable energy. The passive ventilation system is expected to reduce the energy consumption of the fan power and the maintenance burden. In addition, the wall-mounted solar air heater can supply thermal energy without using any energy at all. Therefore, we propose a "passive ventilation system with a solar air heater" that combines a passive ventilation system with solar air heater to preheat the air supply and reduce the ventilation load. To evaluate the solar air heater performance in a real environment, we developed a simulation for calculating the heat collection capacity of the solar air heater, and then implemented the system in a real building for verification. Based on the measurement results, the effects of heating load reduction and prediction methods are presented.

A humidity-sensitive demand-controlled ventilation system is known for many years. It has been developed and commonly applied in regions with an oceanic climate. Some attempts were made to introduce this solution in Poland in a much severe continental climate. The article evaluates this system's performance and energy consumption applied in an 8-floor multi-unit residential building, virtual reference building described by the National Energy Conservation Agency NAPE, Poland. The simulations using the computer program CONTAM were performed for the whole hating season for Warsaw's climate. Besides passive stack ventilation that worked as a reference, two versions of humidity-sensitive demand-controlled ventilation were checked. The difference between them lies in applying the additional roof fans that convert the system to hybrid. The study confirmed that the application of demand-controlled ventilation in multi-unit residential buildings in a continental climate with warm summer (Dfb) leads to significant energy savings. However, the efforts to ensure acceptable indoor air quality require hybrid ventilation, which reduces the energy benefits. It is especially visible when primary energy use is analyzed.

The UK Government is committed to reducing greenhouse gas (GHG) emissions by 80% by 2050. Buildings are responsible for 37% of the total GHG emissions in the UK and the need to reduce their emissions has resulted in more stringent building regulations in the recent past. The regulations, energy rating systems and voluntary guidelines — all are primarily aimed at reducing the need for heating and associated energy use by increasing insulation and air-tightness. However, future climates are projected to be warmer than the present day. Internal gains dominated non-domestic buildings will likely overheat, the adaptation to which will require energy-intensive cooling solutions, thus defeating the purpose of heating-focused regulations. This research investigated the effects of warming climate on overheating, and energy use and resulting emissions in representative urban office spaces in London in the present-day and future climates using hourly dynamic thermal simulations. Findings suggest that more airtight and highly—insulated office buildings designed for heating—dominated temperate UK climate will overheat in the 2050s. Heating demand reduces but electricity consumption increases by 121% when hybrid cooling is adopted to ameliorate overheating. Despite the rise, adopting a mixed-mode ventilation strategy was one of the ways of achieving overall energy efficiency while meeting benchmark overheating and carbon emissions target in present and future climatic contradictions. Current heating-focused legislations need to be urgently re-evaluated to account for the effects of climatic variability and overheating risks.

This paper describes a case study of ventilation as well as measured and perceived indoor air quality (IAQ) in a Finnish comprehensive school with a hybrid ventilation system and reported IAQ problems. An operational error was found when investigating the ventilation system that prevented air from coming into classrooms, except for short periods of high carbon dioxide (CO₂) concentrations. However, results indicated that hybrid ventilation system was able to provide adequate ventilation and sufficient IAQ once properly designed and maintained. After ventilation operation was improved, occupants reported less unpleasant odors and stuffy air. The amount of total volatile organic compounds (TVOC) and some single volatile organic compounds (VOCs) decreased. Indoor mycobiota was observed in settled dust in the classrooms, from which ventilation improvement eliminated the dominant, opportunistic human pathogen species Trichoderma citrinoviride found before improvement.

Ventilation in cities is crucial for the well being of their inhabitants. Therefore, local governments require air ventilation assessments (AVAs) prior to the construction of new buildings. In a standard AVA, however, only neutral stratification is considered, although diabatic and particularly unstable conditions may be observed more frequently in nature. The results presented here indicate significant changes in ventilation within most of the area of Kowloon City, Hong Kong, included in the study. A new definition for calculating ventilation was introduced, and used to compare the influence of buildings on ventilation under conditions of neutral and unstable stratification. The overall ventilation increased due to enhanced vertical mixing. In the vicinity of exposed buildings, however, ventilation was weaker for unstable stratification than for neutral stratification. The influence on ventilation by building parameters, such as the plan area index, was altered when unstable stratification was considered. Consequently, differences in stratification were shown to have marked effects on ventilation estimates, which should be taken into consideration in future AVAs.

After the arrival of a new airborne virus to the world, science is aiming to develop solutions to withstand the spread and contagion of the SARS-CoV-2 coronavirus. The most severe among the adopted measures is to remain in home isolation for a significant number of hours per day, in order to avoid the spreading of the infection in an uncontrolled way through public spaces. Recent literature showed that the major route of transmission is via aerosols produced especially in poorly ventilated inner spaces. With regard to contagion rates, accumulated incidence or number of hospitalizations due to COVID-19, Spain has reached very high levels, therefore this article develops a quantitative and qualitative analysis of the requirements established in Spain with respect to the European framework in reference to ventilation parameters indoors. For this, a case study has been analyzed, representing a common residence in current Spanish residential developments. Results show that the criteria established in the applicable regulations are not sufficient to ensure health as well as to avoid contagion by aerosols indoors.

Objective: This study aims to identify the impact of nutritional factors on mechanical ventilation duration for critical patients. Patients and Methods: The current study was a single-center, prospective observational design which enrolled one-hundred critically ill patients who were admitted to an intensive care unit (ICU). It demonstrates purposive sampling and also performs the descriptive nutritional factors influencing the mechanical ventilation duration. Daily calories target requirement scale (DCRS), subjective global assessment form (SGA), dyspnea assessment form, and APACHE II have been used as methods in the study along with time to initial enteral nutrition (EN) after 24-hour admission and daily calories target requirement over 7 days to assess patients. Data is analyzed using the multiple regressions. Results: As a result, nutritional status monitoring, time to initial EN, calories and target requirements are statistically positive significance associated with the mechanical ventilation duration respectively (R = 0.54, R = 0.30, R= 0.40, p < 0.05). However, age, illness severity, and dyspnea scales are not associated with the mechanical ventilation duration (p> 0.05). Therefore, the nutritional status, malnutrition scores and calorie target requirements can be used to significantly predict the mechanical ventilation duration. The predictive power is 58 and 28.0% of variance. The most proper influencer to predict the mechanical ventilation duration is nutritional status or malnutrition scores. Conclusion: The research findings show that the nutritional status, time to initial EN, and calorie target requirement within 7 days of admission are associated with the mechanical ventilation duration in the critical patients. Therefore, it can be used to develop guidelines reducing the mechanical ventilation duration and to promote the ventilator halting for critical patients.

In the past two decades, acoustic metamaterials have garnered much attention owing to their unique functional characteristics, which is difficult to be found in naturally available materials. The acoustic metamaterials have demonstrated to exhibit excellent acoustical characteristics that paved a new pathway for researchers to develop effective solutions for a wide variety of multifunctional applications such as low-frequency sound attenuation, sound wave manipulation, energy harvesting, acoustic focusing, acoustic cloaking, biomedical acoustics, and topological acoustics. This review provides an update on the acoustic metamaterials' recent progress for simultaneous sound attenuation and air ventilation performances. Several variants of acoustic metamaterials, such as locally resonant structures, space-coiling, holey and labyrinthine metamaterials, and Fano resonant materials, are discussed briefly. Finally, the current challenges and future outlook in this emerging field is discussed as well.

With the emergence of COVID-19 we are confronted with a new clinical picture of acute respiratory distress syndrome in the intensive care unit. In the majority of patients, the respiratory mechanics are very different from the “normal” ARDS patient. We measured transpulmonary pressure and dead space ventilation to assess the effects of high and low PEEP levels on lung compliance and ventilation-perfusion mismatching. Advanced respiratory mechanics were assessed in 14 patients. Compared to ARDS patients, lung compliance was relatively high (61 ± 5 mL/cmH₂O). COVID-19 patients had high dead space ventilation and gas exchange impairment (Bohr 52 ± 3%; Enghoff modification 67 ± 2%; ventilatory ratio 2.24 ± 0.23). we show that higher PEEP levels decrease lung compliance and in most cases increase dead space ventilation, indicating that high PEEP levels probably cause hyperinflation in patients with COVID-19. We suggest using prone position for an extended period of time, and apply lower PEEP levels as much as possible.

In recent years, excessive heat in the urban texture has become the main problem in the humid and calm wind city of Babolsar with high density, especially in high-rise areas. Therefore, in order to create comfort in this region, it is necessary to establish and continue the wind circulation in space with an environmentally compatible and optimal configuration. The study applies combination of literature, field measurement, experimental validation of CFD simulation output, and comparative analysis. After field measurement and validation of FLOW-3D simulation software (V11.2.2), the relationship between these parameters (height, the width of passages, enclosure between buildings, and buildings' orientation) will be studied which affects the wind’s velocity and direction. The factors of the buildings' orientation and enclosure based on the passages' width have opposite reactions in the direction of the prevailing wind especially from perpendicular side. In this study, two effective factors are on wind velocity: 1- The orientation of the buildings towards the wind flow by creating permeability 2- Reducing the enclosure by increasing the width of the passage's perpendicular to the wind flow (w '= 3w, E' = 0.33E). According to the theoretical and practical study, first, the creation of permeability in the body of the block and the separation of buildings instead of aggregation has been studied, and then reducing the confinement of streets perpendicular to the wind flow has been discussed as effective solutions to improve the wind velocity and circulation between the urban environment.

Aim: The aim of this study was to estimate the number of nurses who independently care for pa-tients with severe respiratory failure receiving mechanical ventilation (MV) or veno-venous ex-tracorporeal membrane oxygenation (VV-ECMO). Additionally, the study analyzed the actual role of nurses in the treatment of patients with MV and VV-ECMO. Methods: We conducted a cross-sectional study using postal surveys. The study included 725 Japanese intensive care units (ICUs). Descriptive statistics were conducted. Results: Among the 725 ICUs, we obtained 302 re-sponses (41.7%) and analyzed 282 responses. The median number of nurses per bed was 3.25. The median proportion of nurses who independently cared for patients with MV was 60% [IQR: 42.3-77.3]. The median proportion of nurses who independently cared for patients with VV-ECMO was 46.9 (35.7-63.3%) in the ICU experiencing VV-ECMO use. Concerning task-sharing, 33.8% of ICUs and nurses did not facilitate weaning from MV. Nurses always ti-trated sedatives in 44.5% of ICUs. Conclusion: Nurse staffing might be inadequate in all ICUs, es-pecially for severe respiratory failure. The proportion of competent nurses for caring for severe respiratory failure in ICUs should be considered when determining the work force of nurses.

We investigated effects of molecular hydrogen (H2) supplementation on acid-base status, pulmonary gas exchange responses, and local muscle oxygenation during incremental exercise. Eighteen healthy, trained subjects in a randomized, double-blind, crossover design received H2-rich calcium powder (HCP) (1500 mg/day, containing 2.544 µg/day of H2) or H2-depleted placebo (1500 mg/day) for 3 consecutive days. They performed cycling incremental exercise starting at 20-watts work rate, increasing by 20 watts/2 min until exhaustion. Breath-by-breath pulmonary ventilation (VE) and CO2 output (VCO2) were measured and muscle deoxygenation (deoxy[Hb + Mb]) was determined via time-resolved-NIRS in the vastus lateralis (VL) and rectus femoris (RF). Blood gases' pH, lactate, and HCO3− concentrations were measured at rest and 120-, 200-, and 240-watt work rates. At rest, the HCP group had significantly lower VE, VCO2, and higher HCO3−, PCO2 versus placebo. During exercise, a significant pH decrease and greater HCO3− continued until 240-watts work rate in HCP. The VE was significantly lower in HCP versus placebo, but HCP did not affect the gas exchange status of VCO2 or oxygen uptake (VO2). HCP increased absolute values of deoxy[Hb + Mb] at the RF but not VL. Thus, HCP-induced hypoventilation would lead to lower pH and secondarily impaired balance between O2 delivery and utilization in the local RF during exercise, suggesting that HCP supplementation, which increases the at-rest antioxidant potential, affects the lower ventilation and pH status during incremental exercise. HPC induced a significantly lower O2 delivery/utilization ratio in the RF but not the VL, which may be because these regions possess inherently different vascular/metabolic control properties, perhaps related to fiber-type composition.

Due to poor ventilation conditions in the tunnel, if gas pipeline leaks, the consequence of the accident will be more serious. Therefore, before the emergency repair, gas in the tunnel needs to be excharged so as not to explode during the repair process. Therefore, it is necessary to study the ventilation of gas in the tunnel. Based on the computational fluid dynamics (CFD) theory and taking the Yanyingshan tunnel section of China-Myanmar pipeline as an example, this paper uses Fluent software to establish the leakage model of the gas pipeline and fan model in the tunnel and analyzes the influence of different fan locations and number of fans on gas concentration. It can be concluded that: (1) the use of press-in method makes it more efficient to discharge gas out of the tunnel. (2) In order to make ventilation efficient, the fan should be arranged in a higher position and needs to be at a distance from the top of the tunnel. (3) Parallel use of two fans has better ventilation effect than single fan.

The different waves of the COVID-19 pandemic caused dramatic issues regarding the organiza-tion of care. In this context innovative solutions have to be developed in a timely manner to adapted the organization of the care. The establishment of middle care (MC) units is a bright example of such an adaptation. A multidisciplinary MC team, including expert and non-expert respiratory nurses, physicians, physiotherapists, psychologists, nutritionists and social workers, was built and trained to work in the COVID-19 MC unit. Important educational resources were set up to ensure rapid and effective training of the MC team, limiting the admission or delaying transfers to ICU and ensuring optimal management of palliative care. We conducted a retrospec-tive analysis of patient data in the MC unit during the second COVID-19 wave. Fifty-two COVID-19 ‘step-up’ patients admitted to the MC unit were included in the study. Thirty-four (65%) patients worsened, of which 12 (23%) were not eligible for ICU access. In total, 42% of the ICU-eligible patients were managed in the MC unit to avoid the ICU. Among the 22 patients transferred to the ICU, 15 were intubated. The establishment of an MC unit during a pandemic, mixing expert and non-expert respiratory team members, is feasible and needed. MC units possi-bly relieve the pressure exerted on ICUs. A highly trained multidisciplinary team is key to ensur-ing the success of an MC unit during a pandemic.

Rationale: Examining trends in patient characteristics, processes of care and outcomes, across an epidemic, provides important opportunities for learning. Objectives: To report and explore changes in admission rates, patient characteristics, processes of care and outcomes for all patients with COVID-19 admitted to intensive care units (ICUs) in England, Wales and Northern Ireland. Methods: Population cohort of 10,287 patients with COVID-19 in the Case Mix Programme national clinical audit from 1 February to 2 July, 2020. Analyses were stratified by time period (pre-peak, peak, post-peak) and geographical region. Multivariable logistic regression was used to estimate differences in 28-day mortality, adjusting for patient characteristics over time. Main results: Admissions to ICU peaked simultaneously across regions on 1 April, with ongoing admissions peaking ten days later. Compared with pre- and post-peak periods, patients admitted during the peak were slightly younger but had greater respiratory and renal dysfunction. Use of invasive ventilation and renal replacement reduced over time. Twenty-eight-day mortality reduced from 43.5% (95% CI 41.6% to 45.5%) pre-peak to 34.3% (95% CI 32.3% to 36.2%) post-peak; a difference of −8.8% (95% CI: −5.2%, −12.3%) after adjusting for patient characteristics. London experienced the highest admission rate and had higher mortality during the peak period but a greater reduction in post-peak mortality. Conclusion: This study highlights changes in patient characteristics, processes of care and outcomes, during the UK COVID-19 epidemic. After adjusting for the changes in patient characteristics and first 24-hour physiology, there was substantial improvement in 28-day mortality over the course of the epidemic.

The rapidly evolving understanding of Coronavirus Disease 2019 (COVID-19) respiratory failure pathogenesis, limited disease-specific evidence and demand-resource imbalances have posed significant challenges for intensive care clinicians. In this single-centre retrospective cohort study we describe the outcomes of COVID-19 patients admitted to Guy’s and St. Thomas’ NHS Foundation Trust (GSTT) critical care service. Patients were managed according to a local respiratory failure management pathway that was predicated on timely invasive ventilation when indicated and tailored ventilatory strategies according to pulmonary mechanics. Between 2nd March and 25th May 2020 GSTT critical care service admitted 316 patients with confirmed COVID-19. Of the 201 patients admitted directly through the Emergency Department with a completed critical care outcome, 71.1% survived to critical care discharge. These favourable outcomes may serve to inform the wider debate on the optimal ventilatory management in COVID-19.

Turbine generator operates with complex cooling system due to the challenge in controlling the peak temperature of the stator bar caused by ohm loss, which is unavoidable. Therefore, it is important to characterise and quantifies the thermal performance of the cooling system. The focus of the present research is to investigate the heat transfer and pressure loss characteristics of typical cooling system, so-called stator ventilation duct. A real scale model was built at its operating conditions for the present study. The direction of cooling air is varied to consider its operation condition, so that there are (1) outward flow and (2) inward flow cases. In addition, the effect of (3) cross flow (inward with cross flow case) is also studied. The transient heat transfer method using thermochromic liquid crystals is implemented to measure full surface heat transfer distribution. A series of Computational Fluid Dynamics analysis is also conducted to support the observation from the experiment. For the inward flow case, the results suggest that the average Nusselt number of the 2nd duct is about 30% higher than the 3rd duct. The trend is similar with the effect of cross flow. The CFD results are in good agreement with the experimental data.

A proper transmission of the orientation between surface and underground workings, by means of vertical shafts, is an important challenge in the mining industry, especially when the mine exceeds 200 meters deep. In fact, this study is developed in a mine located to 700 meters deep. Likewise, this paper assesses the accuracy of this operation, in a case study, using the two shafts plumbing and gyroscope methods in order to compare and analyse the planimetric displacement of the base line due to different source of errors in each one. Upsides and downsides of both methods are analysed in the paper. Some disadvantages in each method have been reduced thanks to the technological progress, especially in the two shaft plumbing method. The different sources of error that affect the measures are thoroughly analysed in the study with the aim to compensate them and achieve the required precision for an underground infrastructure. Mine ventilation has been found as one of the most important sources of error in the plumbing method due to intake and return airflow. In this direction, the paper unfolds some measures to reduce the ventilation influence and details a compensation method to reduce ventilation errors.

This paper evaluates an architectural design using an Energy Consumption consideration of Natural Ventilation in a hot dry climate (Khartoum State), at dwellings design applied. Method was used analysis of Autodesk IEVS software natural ventilation and energy consumption simulation. It resulted that to cooling, by natural ventilation in dwelling design used to get indoor temperature at the comfortable level during the summer. The Best-Case Situation of natural ventilation with consider of energy saving Based on the CFD simulation analysis, the performance of internal air velocity is approximately 0.7m/s. The wind velocity starts to slow down towards the rear of the apartment spaces. Approximately 95% of the internal areas have average air velocity between 0.43 m/s to 0.9 m/s. Internal Air flow pattern single floor house plan at Khartoum (Alazhari City); showing the internal air velocity of 0.7m/s near the window opening positions with the wind directions in the details and pressure of the air as worst-case situation, with velocity and temperature of the air with average 22o as a best-case situation. during a year. Architectural design process in the urban area of Alazhari City for dwelling towards to saving energy was applied and determined into an urban planning neighbourhood at Khartoum.

Background. It is well established that human milk feeding contributes in limiting lung disease among vulnerable neonates. The primary aim of this research was to compare the need for mechanical ventilation of human milk-fed sick neonates with that of formula-fed sick neonates. Methods. All late preterm and full term infants from a single center with findings of sepsis, from 2002 to 2017, were identified. Data regarding infant feeding during hospital admission were recorded. Multivariate logistic regression analyses were performed to assess the impact of the type of milk on ventilation support and main neonatal morbidities. Results. The total number of participants was 322 (human milk group = 260, exclusive formula group = 62). On bivariate analysis, 72% of human milk-fed neonates did not need oxygen therapy nor respiratory support versus 55% of their formula-fed counterparts (P<0.0001). Accordingly, invasive mechanical ventilation was required by 9.2% of human milk-fed infants versus 32% of their formula-fed counterparts (P=0.0085). These results hold true in multivariate analysis, indeed human milk-fed neonates were more likely to require less respiratory support (OR=0.44; 95% CI: 0.22, 0.89) when compared to those who were exclusively formula-fed. Conclusion. Human milk feeding might minimize exposure to mechanical ventilation.

The formulation and analytic solution of a new mathematical model with constitutive curvature for analysis of tunnel ventilation shaft wall is proposed. Based on the Mindlin-Reissner theory for thick shells, this model also takes into account the shell constitutive curvature and considers an expression of the shear correction factor variable (αn) in terms of the thickness (h) and the radius of curvature (R). The main advantage of the proposed model is that it has the possibility to analyze thin, medium and thick tunnel ventilation shafts. As a result, two comparisons were made: the first one, between the new model and the Mindlin-Reissner model without constitutive curvature with the shear correction factor (α_n=6/5) as a constant, and the other, between the new model and the tridimensional numerical models (solids and shells) obtained by finite element method for different slenderness ratios (h/R). The limitation of the proposed model is that it is to be formulated for a general linear-elastic and axial-symmetrical state with continuous distribution of the mass.

The Coronavirus Disease 2019 (COVID-19) pandemic has resulted in a significant surge of critically ill patients and an unprecedented demand on intensive care services. The rapidly evolving understanding of pathogenesis, limited disease specific evidence and demand-resource imbalances have posed significant challenges for intensive care clinicians. COVID-19 is a complex multisystem inflammatory vasculopathy with a significant mortality implication for those admitted to intensive care. Institutional strategic preparation and meticulous intensive care support are essential to maximising outcomes during the pandemic. The significant mortality variation observed between institutions and internationally, despite a single aetiology and uniform presentation, highlights the potential influence of management strategies on outcome. Given that optimal organ support and adjunctive therapies for COVID-19 have not yet been well defined by trial-based outcomes, strategies are predicated on existing literature and experiential learning. This review outlines the relevant pathophysiology and management strategies for critically ill patients with COVID-19, and shares some of the collective learning accumulated in a high volume Severe Respiratory Failure centre in London.

Reliable prediction of sustainable energy consumption is the key to designing environmental friend buildings. In this study, two novel hybrid intelligent methods, namely grasshopper optimization algorithm (GOA), wind-driven optimization (WDO), and biogeography-based optimization (BBO) is employed to optimize the multitarget prediction of heating loads (HLs) and cooling loads (CLs) in heating ventilation and air conditioning (HVAC) systems. Concerning the optimization of applied hybrid algorithms, a series of swarm-based iteration is performed, and the best structure for the abovementioned methods are proposed. Besides, through sensitivity analyzing the relationship between the HLs and CLs and influential factors are highlighted. In other words, the GOA, WDO, and BBO algorithm are mixed with a class of feedforward artificial neural networks (ANN), which called MLP (multi-layer perceptron) to predict the HLs and CLs. According to the provided sensitivity analysis, the WDO with swarm size = 500 proposes the most proper-fitted terms after it has been combined with optimized MLP. The proposed WDO-MLP (training (R2 correlation=0.977 and RMSE error=0.183) and testing (R2 correlation=0.973 and RMSE error=0.190)) provided accurate prediction in the heating load and (training (R2 correlation=0.99 and RMSE error=0.147) and testing (R2 correlation=0.99 and RMSE error=0.148)) presents the most-fit prediction in the cooling load.

This case study investigates the effects of ventilation intervention on measured and perceived indoor air quality (IAQ) in a repaired school where occupants reported IAQ problems. Occupants´ symptoms were suspected to be related to the impurities leaked indoors through the building envelope. The study’s aim was to determine whether a positive pressure of 5-7 Pa prevents the infiltration of harmful chemical and microbiological agents from structures, thus decreasing symptoms and discomfort. Ventilation intervention was conducted in a building section comprising 12 classrooms and was completed with IAQ measurements and occupants´ questionnaires. After intervention, the concentration of total volatile organic compounds (TVOC) and fine particulate matter (PM_2.5) decreased, and occupants´ negative perceptions became more moderate compared to those for other parts of the building. The indoor mycobiota differed in species composition from the outdoor mycobiota, and changed remarkably with the intervention, indicating that some species may have emanated from an indoor source before the intervention.

Over the last two months, as oncology specialists, we have frequently been contacted for estimating prognosis for cancer patients affected by COVID-19 infection. Until now, there have been no clear markers to guide decision making regarding the appropriateness of invasive ventilation in cancer patients affected by COVID-19 infection. Therefore, we developed a practical tool encompassing a prognostic score. We aimed at identifying a subgroup of patients likely to have a better outcome and therefore may be potential candidates for invasive ventilation, "The Milano Policlinico ONCOVID-ICU score". The score is composed by three groups of variables: patient’s characteristics such as sex, age, BMI and comorbidities; oncological variables (treatment intent, life expectancy, on or off-treatment status) and clinical parameters in association with laboratory values (SOFA score and D-dimer). The SOFA score includes six different clinical parameters and during the first few days of ICU admissions has an important prognostic role. The oncological history should never represent, per se, a contraindication to intensive care and must be considered together with other variables, such as laboratory values, clinical parameters and patient characteristics, in order to make the hardest but best possible choice. The Milano Policlinico ONCOVID-ICU score, to our knowledge, is the first prognostic score proposed in this setting of patients and may be a useful tool to assess the prognosis of cancer patients being in this critical condition.

The thoracic surgery has increased drastically in recent years, especially in the light of the severe outbreak of 2019 novel coronavirus disease (COVID-19). Routine “passive” chest computed tomography (CT) screening of inpatients detects some pulmonary diseases requiring thoracic surgeries timely. As an essential device for thoracic anesthesia, the double-lumen tube (DLT) is particularly important for anesthesia and surgery. With the continuous upgrading of the DLTs and the widespread use of the fiberoptic bronchoscopy (FOB), the position of DLT in thoracic surgery is gradually becoming more stable and easier to observe or adjust. However, the DLT malposition still occurs during transferring patients from supine to lateral position in thoracic surgery, which leads to lung isolation failure and hypoxemia during one-lung ventilation (OLV). Recently some innovative DLTs or improved intervention methods have shown good results in reducing the incidence of DLT malposition. This review aims to summarize the recent studies of the incidence of left-sided DLT malposition, the reasons and effects of malposition, and summarize current methods for reducing DLT malposition and prospects for possible approaches. Meanwhile, we use bibliometric analysis to summarize the research trends and hot spots of the DLT research.

Nowadays, energy saving is considered a key issue worldwide, as it brings a variety of benefits: reducing greenhouse gas emissions, reducing demand for energy imports, and lowering costs on a household and economy-wide level. Researchers and building designers are looking to optimize building efficiency by means of new energy technologies. Changes in existing buildings can also be made to reduce energy consumption and costs. These may include the usage of new heat transfer fluids based on nanofluids. In this work, an extended experimental campaign (from February 2020 to March 2021) has been carried out on an educational building in the Campus of University of Salento, Lecce – Italy, in order to evaluate the increase in performance of the HVAC system, due to the usage of a nanofluid. The results show that, under optimal operating conditions, plant performance improves more than 10%, with average daily peaks of about 15%.

What proportions should a thermally massive building have? How should the thermal mass be distributed? Should the "massing" change with the choice of material? This paper shows how to optimize the physical proportions of a building so that it synchronizes ambient heat exchanges in a natural feedback cycle. The internal mass is thermally coupled with buoyancy ventilation; the cycle is driven by the daily swing of outdoor temperature. Tripling up functions in this way—so that structural materials can reliably cool and power the ventilation for buildings—could help decarbonize the construction industry and provide an effective strategy for adapting to life-threatening heatwaves. Based on harmonic analysis, the method allows designers to thermally tune the form and mass of a building to meet chosen targets for temperature and ventilation in free-running mode. Once the optimal balance of exchange rates is known, design teams can proportionally vary the building height and ventilation openings against the surface area and thickness of an internal thermal mass. The possible permutations are infinite but parametrically constrained, allowing teams to fairly compare the functional and environmental credentials of different construction materials while they produce and evaluate preliminary options for organizing the exterior form and interior spaces of a building. An example study suggests that thin-shell structures of minimum weight, and even timber buildings, may be optimally tuned to produce ample ventilation and temperature attenuation.

Objectives: There are limited data regarding the efficacy of methylprednisolone in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation. We aimed to determine whether methylprednisolone increases the number of ventilator-free days (VFDs) among these patients. Design: Retrospective single-center study Setting: Intensive care unit Patients: All patients with ARDS due to confirmed SARS-CoV-2 infection and requiring invasive mechanical ventilation between 1 March and 29 May 2020 were included Interventions: None Measurements and Main Results: The primary outcome was ventilator-free days (VFDs) during the first 28 days, defined as being alive and free from mechanical ventilation. The primary outcome was analyzed with competing-risks regression based on Fine and Gray’s proportional subhazards model. Death before day 28 was considered to be the competing event. A total of 77 patients met the inclusion criteria. Thirty-two patients (41.6%) received methylprednisolone. The median dose was 1 mg.kg-1 (IQR: 1-1.3 mg.kg-1) and median duration of 5 days (IQR:5-7 days). Patients who received methylprednisolone had a mean 18.8 VFDs (95% CI, 16.6-20.9) during the first 28 days vs. 14.2 VFDs (95% CI, 12.6-16.7) in patients who did not receive methylprednisolone (difference, 4.61; 95% CI, 1.10-8.12; P = 0.001). In the multivariable competing-risks regression analysis and after adjusting for potential confounders (ventilator settings, prone position, organ failure support, severity of the disease, tocilizumab, and inflammatory markers), methylprednisolone was independently associated with a higher number of VFDs (subhazards ratio: 0.10, 95%CI: 0.02-0.45; p=0.003). Hospital mortality did not differ between the two groups (31.2% vs. 28.9%, p=0.82). Hospital length of stay was significantly shorter in the methylprednisolone group (24 days [IQR:15-41 days] vs. 37 days [IQR:23-52 days], p=0.046). The incidence of positive blood cultures was higher in patients who received methylprednisolone (37.5% vs. 17.8%, p=0.052). However, 91% of patients who received methylprednisolone also received tocilizumab. The number of days with hyperglycemia was similar in the two groups. Conclusions: Methylprednisolone was independently associated with increased VFDs and shortened hospital length of stay. The combination of methylprednisolone and tocilizumab was associated with a higher rate of positive blood cultures. Further trials are needed to evaluate the benefits and safety of methylprednisolone in moderate or severe COVID-19 ARDS.

Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus SARS-CoV-2, has been confirmed in over 10,000,000 individuals worldwide and has resulted in more than 500,000 deaths in a few months since it first surfaced. With such a rapid spread it is no surprise that there has been a massive effort around the world to collectively elucidate the mechanism by which the virus is transmitted. Despite this, there is still no definitive consensus regarding droplet versus airborne transmission of SARS-CoV-2. Public health officials around the world have introduced guidelines within the scope of droplet transmission. However, increasing evidence and comparative analysis with similar coronaviruses, such as severe acute respiratory syndrome (SARS-CoV-1) and middle eastern respiratory syndrome (MERS), suggest that airborne transmission of SARS-CoV-2 cannot be effectively ruled out. As the data supporting COVID-19 airborne transmission grows, there needs to be an increased effort in terms of technical and policy measures to mitigate the spread of viral aerosols. These measures can be in the form of broader social distancing and facial covering guidelines, exploration of thermal inactivation in clinical settings, low-dose UV-C light implementation, and greater attention to ventilation and airflow control systems. This review summarizes the current evidence available about airborne transmission of SARS-CoV-2, available literature about airborne transmission of similar viruses, and finally the methods that are already available or can be easily adapted to deal with a virus capable of airborne transmission.

The COVID-19 pandemic has great adverse impacts on personal life, the U.S. economy, and the world economy. Freezing all human activities is not a sustainable measure. Thus we want to develop a public intervention framework that allows people to resume personal and economic activities. In this article, we examined transmission routes, disease severity, personal vulnerability, available treatments, and person-person interactions to establish a general public intervention framework. We divide people into risk groups, non-risk group and group that may serve as viral transmitters, explore interactions between individual persons within each group and between different groups, and propose interaction behavior modifications to mitigate viral exposures. For the non-risk groups, we identified preventive measures that can help them avoid the most serious exposures and infections that pose higher death risks. The invention measures for the vulnerable groups include prior-exposure measures, heightened protective measures, interaction behavior changes, post-exposure remedial measures, and multiple factors treatments to reduce death and disability risks. The multiple interventions and two-ways defensive behavior modifications are expected to result in reduced rate of detectable infections and lowered disease severity for the vulnerable groups. In this framework, most human activities and economic activities can continue as normal. With time passing, the population acquires population immunity against the COVID-19 virus. Implementation of this intervention framework requires considerable resources and governmental effects while the multiple factors treatment protocol requires the support of health care professionals.

Every day around 93% of children under the age of 15 (1.8 billion children) breathe outdoor air that is so polluted it puts their health and development at serious risk. Due to the pandemic, however, ventilation of buildings using outdoor air has become an important safety technique to prevent the spread of COVID-19. With the mounting ev-idence suggesting that air pollution is impactful to human health and educational out-comes, this contradictory guidance may be problematic in schools with higher air pol-lution levels, but keeping kids COVID-19 free and in school to receive their education is now more pressing than ever. To understand if all schools in an urban area are ex-posed to similar outdoor air quality and if school infrastructure protects children equally indoors, we installed research grade sensors to observe PM2.5 concentrations in indoor and outdoor settings to understand how unequal exposure to indoor and out-door air pollution impacts indoor air quality among high- and low-income schools in Salt Lake City, Utah. Based on this approach, we found that during atmospheric inver-sions and dust events, there was a lag ranging between 35 to 73 minutes for the out-door PM2.5 concentrations to follow a similar temporal pattern as the indoor PM2.5. This lag has policy and health implications and may help to explain the rising concerns re-garding reduced educational outcomes related to air pollution in urban areas. These data and resulting analysis show that poor air quality may impact school settings, and the potential implications with respect to environmental inequality.

The provision requirement of 10% openings of the total floor area stated in the Uniform Building by Law 1984 Malaysia has been practiced by designers for building plan submission approval. However, the effectiveness of thermal performance in landed residential buildings, despite the imposition by the by-law, has never been empirically measured and proven. Although terraced houses in Malaysia have dominated 40.9% of the total property transaction in 2019, such mass production with typical designs hardly provides its occupants with thermal comfort due to the static outdoor air condition and lack of external windows, where the conventional ventilation technique does not work well, even for houses with an air well system. Consequently, the occupants need to rely on mechanical cooling, which is a high energy-consuming component contributing to outdoor heat dissipation and therefore urban heat island effect. Thus, encouraging more effective natural ventilation to eliminate excessive heat from the indoor environment is critical. Since most of the research focuses on simulation modelling lacking sufficient empirical validation, this paper drawing on field measurement investigates natural ventilation performance in terraced housing with an air well system. More importantly, the key concern as to what extent the current air well system serving as a ventilator is effective to provide better thermal performance in the single storey terraced house is to be addressed. By adopting an existing single storey air welled terrace house, the existing indoor environmental conditions and thermal performance were monitored and measured using scientific equipment, namely HOBO U12 air temperature and air humidity, the HOBO U12 anemometer and the Delta Ohm HD32.3 Wet Bulb Globe Temperature meter for a six-month duration. The findings show that the air temperature of the air well ranged from 27.48°C to 30.92°C, while the mean relative humidity were from 72.67% to 79.25%. The mean air temperature for a test room (single sided ventilation room) ranged from 28.04°C to 30.92°C with a relative humidity of 70.16% to 76%. These empirical findings are of importance, offering novel policy insights and suggestions to potentially revising the existing building code standard and by laws; since the minimum provision of 10% openings has been revealed to be less effective to provide a desired thermal performance and comfort, mandatory compliance with, and the necessity for, the bylaw requirement should be revisited and further studied.

(1) Background: Benefits and timing of percutaneous dilatational tracheostomy (PDT) in Intensive Care Unit (ICU) COVID-19 patients are still controversial. PDT is considered a high risk procedure for transmission of SARS CoV-2 to health care workers (HCWs). The present study analyzed optimal timing of PDT, clinical outcomes of patients undergoing PDT and safety of HCWs performing PDT. (2) Methods: 133 COVID-19 patients underwent PDT in our ICU from April 1, 2020 to March 31, 2021, 23 patients were excluded and 110 patients were enrolled. A trained medical team was dedicated to the PDT procedure. Demographic, clinical history and outcome data were collected. Patients who underwent PDT were stratified into two groups: early group, PDT ≤ 12 days from orotracheal-intubation (OTI) and late group, &gt;12 days from OTI; HCW surveillance program was performed. (3) Results: Early group included 57 patients and late group included 53 patients. Early group patients showed shorter ICU length of stay and fewer days of mechanical ventilation than the late group (p&lt;0.001). At day 7 after tracheostomy, early group patients required fewer intravenous anesthetic drugs and experienced an improvement of ventilation parameters, PaO2/FiO2-Ratio, PEEP and FiO2 (p&lt;0.001). No difference in case fatality ratio between the two groups was reported. No SARS-CoV-2 infection was reported in HCWs performing PDT. (4) Conclusions: PDT was safe and effective for COVID-19 patients, since it improved respiratory support parameters, reduced ICU length of stay and duration of mechanical ventilation, and optimized the weaning process. The procedure was safe for all HCWs involved in the dedicated medical team. The development of standardized early PDT protocols should be implemented and PDT procedure could be considered as first line approach in ICU COVID-19 requiring prolonged mechanical ventilation.

The article discusses determinants of living environment in Central and Eastern Europe. As an example, the city of Radzionkow was chosen, with 16 thousand inhabitants, located in the Silesia agglomeration in southern Poland, in the area where hard coal has been mined for almost two hundred years, which largely serves as a source of heating for houses and flats. 360 buildings in 6 groups of 60 buildings were examined in the selected city, which allowed to distinguish 3 different areas in terms of the quality of the living environment depending on the technical condition of buildings, the method of heating and location. To a large extent, determinants are the existing spatial and geophysical conditions of a given location. Many research and reports on the living environment do not take into account the factors mentioned, focusing only on the statistical data of pollution, excluding spatial factors. In the research presented, the author, taking into account location variables, shows differences in the measurements of air pollution in relation to the designated location zones depending on the morphological structure of the building, the degree of its modernization and the types of heating used in buildings.

This study describes the development of an automated bag valve mask (BVM) compression system, which, during acute shortages and supply chain disruptions can serve as a temporary emergency ventilator. The resuscitation system is based on the Arduino controller with a real-time operating system installed on a largely RepRap 3-D printable parametric component-based structure. The cost of the system is under $170, which makes it affordable for replication by makers around the world. The device provides a controlled breathing mode with tidal volumes from 100 to 800 milliliters, breathing rates from 5 to 40 breaths/minute, and inspiratory-to-expiratory ratio from 1:1 to 1:4. The system is designed for reliability and scalability of measurement circuits through the use of the serial peripheral interface and has the ability to connect additional hardware due to the object-oriented algorithmic approach. Experimental results demonstrate repeatability and accuracy exceeding human capabilities in BVM-based manual ventilation. Future work is necessary to further develop and test the system to make it acceptable for deployment outside of emergencies in clinical environments, however, the nature of the design is such that desired features are relatively easy to add with the test using protocols and parametric design files provided.