Search

Objective Plication of the diaphragm is a life-changing procedure for patients affected by diaphragm paralysis. Traditionally, this procedure is performed through a thoracotomy. Access to the diaphragm via this incision is poor and the indications for surgery are limited to patients who can actually sustain such an invasive approach and associated morbidities. A minimally invasive approach was developed to improve the surgical management of diaphragm paralysis. Methods Patients underwent minimally invasive diaphragm plication either by video-assisted or robotic surgery through a 3-port technique with CO2 insufflation. Patients were followed at the routine 6-week clinic and also by telephone consultation 6 to 12 months postoperatively. Data were collected on postoperative complications, postoperative pain or numbness, symptomatic improvement, and change to quality of life following surgery. Results Forty-eight patients underwent 49 minimally invasive diaphragm plication. Median postoperative length of hospital stay was 4 days (range: 2 to 34 days) and there were no cases of mortality. Mean reduction in Medical Research Council dyspnea score per patient was 2.2 points (mode: 3 points). Twenty-eight patients (77.8%) reported a significant symptomatic improvement enabling improvements in quality of life, and 97.2% ( n = 35) were satisfied with the surgical outcome. Conclusions Minimally invasive diaphragm plication is a safe procedure associated with prompt postoperative recovery. It is effective at reducing debilitating dyspnea and improving quality of life.

The utility of computed tomography (CT) for forensic autopsy is being defined. Small studies have indicated potential areas of use. Systematic studies are few. Evidence of the utility of CT as an autopsy substitute in fatal trauma cases has been inconsistent. Some studies show that there are injuries seen by CT that aren't detected by autopsy indicating that CT, at least, is likely useful as an autopsy adjunct. Research has been limited by small study populations, variation in postmortem interval, differences in protocols including CT slice thickness, who interpreted the scans (radiologists vs. pathologists), and how injuries were scored. Challenges exist to implement and use advanced imaging technology for the forensic autopsy. It is important to determine how to arrange these technologies into a coherent approach to postmortem diagnosis while not encumbering forensic pathologists. Forensic pathologists and radiologists require training in interpreting the unique aspects of postmortem CT scans. Some forensic pathologists might perceive imaging technology as a threat and express concern that it will make the autopsy obsolete. If CT is found to supplant or supplement autopsy in valuable ways, more comprehensive diagnostic information can be provided. If CT can supplant the use of autopsy in certain situations and significantly decrease autopsy numbers it will allow offices to achieve an annual cost savings and divert these resources to other needs. If CT becomes widely available and can supplant autopsy, it could make up some of the gap between the numbers of forensic pathologists available and the numbers needed nationally.

Revelation has always presented major challenges for study, interpretation and application. Over the last twenty years there have been some significant developments in a number of areas, including greater understanding of Revelation's first-century setting, some settling of debate about the nature of its language, engagement with questions of the complexity of its structure, and a growing awareness of the impact of its rhetoric, both in its original contexts and in the history of interpretation. Yet there still remains a substantial gap between much scholarly insight and its appropriation at a more popular level.

This study explores the interaction between perceived and calculated thermal comfort in Iranian office buildings. To achieve this, a questionnaire survey in six office buildings in Tehran (Iran) is conducted in conjunction with physical measurements. The study results reveal that there is a good agreement between perceived thermal sensation and calculated predicted mean vote (PMV) from the measurements for the majority of the offices (four out of six). This finding implies that the calculation of PMV is valid for the Iranian cultural situation in air conditioned and HVAC office buildings. The results also show that more than half of the studied offices are not in good compliance with the comfort levels suggested in ASHRAE Standard 55 and ISO Standard 7730.

With the EU Energy Performance in Buildings Directive imminent in 2006, attention is focusing on how to reduce carbon emissions from buildings in practice. This research was undertaken to try to establish some ‘real’ buildingbased figures for the energy performance of air-conditioning systems in UK office buildings. One of the major questions to be answered is whether chilled beam and ceiling systems really are more efficient than traditional air-conditioning systems when used in the real world.1,2 This paper presents findings of a two-year field monitoring study investigating the energy performance of airconditioning (AC) systems in UK office buildings. The findings shown in this paper include: 1) the cooling power demand for the various air-conditioning systems monitored; 2) comparison of national energy consumption and carbon emissions bench-marks to the monitored systems; 3) comparison of the energy consumption and carbon emissions of reverse-cycle AC systems with traditional heating-only systems. The results show that chilled ceiling systems typically consume significantly less energy than the other generic AC types in the heating and cooling of office buildings. However, all the generic AC system types studied appeared capable of meeting current ‘good practice’ standards for energy use in the UK. Practical application: The work provides an insight into the energy performance achieved by real AC systems as operated in UK Offices. When the EC Energy Performance in Buildings Directive becomes law in January 2006 the practically achievable energy and emissions performance of building services will fall more sharply into focus for designers. It is hoped that this paper will provide information useful to both designers and operators of AC systems in the UK as they attempt to reduce the impact of AC systems on the environment.

In 1991 the UK Audit Commission produced energy performance indicators for hospitals based on the type of care provided. However, an analysis of over 100 hospitals throughout the United Kingdom has found the type of care provided to have relatively little effect on the energy performance of hospitals. Although other factors influenced energy use to some degree, the major factor affecting performance was found to be the plan of the hospital, as this influenced the amount of mechanical ventilation required. Modem mechanically ventilated hospitals were found to typically use 40% of their total electricity consumption in fan power, equating to 80 kWh m-2 purely due to fans. This paper presents a suggested set of new performance indicators based on the percentage of floor area which is ventilated mechanically.

The results of a series of measurements into the electrical energy savings achieved by PIR and photocell control of individual fluorescent luminaires are presented. Two versions of the PIR/photocell control system (referred to as ‘intelligent’ luminaires from here on) were tested. The results are compared with estimates of the performance of switchstart and ‘standard’ high frequency fluorescent luminaires. The results show that the original ‘intelligent’ control system installed achieved electrical savings of around 10% when compared to ‘standard’ high frequency fittings. An improved version of the ‘intelligent’ system achieved energy savings averaging around 80% when compared to ‘standard’ high frequency fittings. This latter result is in line with the savings predicted by BRE Digest 272 (1) for photoelectric dimming control. The study also showed that these fittings need proper commissioning to return their full potential savings.

The market for combined heat and power (CHP) in the UK is being significantly restricted by the lack of a reliable sizing procedure for CHP in new buildings. This paper describes the approach taken to produce such a procedure for new build hospitals. The procedure is based around energy use profiles for existing hospital buildings and a requirement to minimise the input necessary to obtain a reliable sizing estimate. A computer program has been written which automates the procedure, and means that an initial sizing estimate can usually be reached within 20 minutes. The only aspect of the work not yet fully completed is an analysis of the error limits associated with the new technique. These are currently being assessed. Initial findings suggest that the procedure is at least as accurate as sizing techniques used for the installation of CHP in existing hospital buildings.

A 20-month old energy monitoring scheme has achieved a 14% reduction in gas energy consumption and costs at Cardiff University. This paper reviews the implementation of the energy monitoring scheme, briefly noting the main details including the data gathering techniques used and the main obstacles encountered. It also notes the total energy and cost benefits achieved to date along with measures proposed to maintain and improve the savings achieved.