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This is a case of a 32-year-old primigravid who developed sudden severe headache on the 7th day postpartum associated with focal neurologic deficits and altered sensorium. She had a GCS score of 6, anisocoric pupils and an NIHSS score of 31. Cranial MRI with MRA showed multifocal hyperacute to acute infarcts on the left occipital lobe, left thalamus, and midbrain which was more prominent on the right. Due to clinical deterioration, a repeat Cranial MRI with MRA was done and showed progression of infarcts involving both thalami and right pons with interval appearance of contour irregularities in the proximal anterior cerebral, posterior cerebral, basilar and internal carotid arteries. Serial transcranial Doppler showed significant distal right middle cerebral artery vasospasm. She was managed as a case of reversible cerebral vasoconstriction syndrome, associated with postpartum cerebral angiopathy. Intravenous pulse methylprednisolone was started subsequently IVIG was initiated. Intravenous immunoglobulin was given for 5 days. The patient gradually improved, underwent rehabilitation therapy, and was discharged stable after 6 weeks.

Research and applications related to Virtual Reality (VR) in the Architecture, Engineering, Construction and Facility Management (AEC/FM) industry are steadily increasing, being considered as one of the current trends in digital innovation. A convergence is currently on-going between Building Information Modelling (BIM), VR implementation and the soft landings principles, which highlight the need for a smooth transition from design to operation through the early involvement of clients and end-users. In particular, immersive virtual environments could allow stakeholders to experience the full-scale representation of a virtual facility prototype in an intuitive and engaging manner through immersion and sense of presence, promoting feedback collection during usability-focused design review meetings. On the other hand, despite the renewed interest in immersive VR, both technological and procedural challenges to its effective implementation still exist. The latter are within the scope of this study, which aims to address them in a systematic way as a comprehensive guideline for clients and design teams. This study describes the development of a VR-aided usability-focused design review session protocol for implementing immersive VR when clients and end-users are involved in design review meetings. It is the result of an inductive approach associated with qualitative research methods for data collection and data analysis. A case study has been selected as a main research method for facing the first step into the research problem. A further iteration of data collection and analysis was adopted to guarantee the validity of the research, including talks with experts and literature comparison. Finally, the session protocol has been developed in the form of a process map representing all the necessary phases and activities to consider for the effective adoption of immersive VR to evaluate design intents with clients and end-users. As a comprehensive summary, the session protocol fills a gap in the research on the adoption of virtual reality in the AEC industry, which was lacking a prescriptive and structured process to drive the effective use of this technology in collaborative meetings and decision-making processes.

Text simplification is a non-trivial task that aims at reducing the linguistic complexity of written texts. Researchers have studied the problem by proposing new methodologies for addressing the English language, but other languages, like the Italian one, are almost unexplored. In this paper, we give a contribution to the enhancement of the Automated Text Simplification research by presenting a deep learning-based system, inspired by a state of the art system for the English language, capable of simplifying Italian texts. The system has been trained and tested by leveraging the Italian version of Newsela; it has shown promising results by achieving a SARI value of 30.17.

The European goal to reach carbon neutrality in 2050 has further put the focus on the construction sector, which is responsible for great impacts on the environment, and new sustainable solutions to renovate the existing building stock are currently under development. In this paper, the AdESA (Adeguamento Energetico Sismico ed Architettonico, in Italian) system, a holistic retrofit technique for the integrated renovation of the existing buildings, is presented. The system was developed by a consortium of enterprises and universities and was applied to a pilot building. The system consists of a dry, modular and flexible shell exoskeleton technique that implements different layers depending on the building retrofit needs (cross-laminated timber (CLT) panels for the structural retrofit, thermal insulation panels for the energy efficiency amelioration, and claddings for the architectural restyling). In order to foster actual sustainability, the solution contextually targets eco-efficiency, safety and resilience. To this end, the system not only couples the structural and energy interventions to reduce the operating costs, but it is also conceived in compliance with life cycle thinking (LCT) principles to reduce impacts throughout the remaining building service life (from retrofit time to the end of its life). The system is designed to be easily mountable and demountable to allow for the reuse/recycling of its components at the end of life by adopting macro-prefabricated dry components and standardized connections, to reduce damage caused by earthquakes by reducing the allowed inter-story drift, and by amassing the possible damage into sacrificial replaceable elements. The paper describes the AdESA system from a multidisciplinary perspective and its effective application for the deep renovation of an existing gymnasium hall.

Our study aimed to determine the effects of new-onset neurological symptoms (NNS) on clinically relevant outcomes in hospitalized patients with COVID-19 infection. We conducted a nationwide, comparative, retrospective, cohort study among adult, hospitalized COVID-19 patients involving 37 hospital sites from various regions in the Philippines. We included a total of 10,881 patients with confirmed COVID-19 infection (2008 had NNS while 8873 did not have NNS). The adjusted hazard ratios (aHRs) for mortality among the mild and severe cases were significantly higher by 1.660 (95% CI 1.132–2.435) and by 1.352 (95% CI 1.042–1.752), respectively, in the NNS group compared to those in the non-NNS group. The aHRs for respiratory failure in the NNS group were significantly increased by 1.914 (95% CI 1.346–2.722), by 1.614 (95% CI 1.260–2.068), and by 1.234 (95% CI 1.089–1.398) among the mild, severe, and critical cases, respectively. The aHRs for ICU admission in the NNS group were still significantly higher by 1.973 (95% CI 1.457–2.673) and by 1.831 (95% CI 1.506–2.226) among the mild and severe cases, respectively. Patients who had NNS were not significantly associated with a longer duration of ventilator dependence (adjusted odds ratio (aOR) 0.954, 95% CI 0.772–1.179), longer ICU stay (aOR 0.983, 95% CI 0.772–1.252) and longer hospital admission (aOR 1.045, 95% CI 0.947–1.153). The presence of NNS significantly increases the risk of mortality, respiratory failure and ICU admission among COVID-19 patients. Registration and associated protocol publication: ClinicalTrials.gov website (NCT04386083); Espiritu AI, Sy MCC, Anlacan VMM, Jamora RDG. The Philippine COVID-19 Outcomes: a Retrospective study Of Neurological manifestations and Associated symptoms (The Philippine CORONA study): a protocol study. BMJ Open. 2020;10:e040944.

Background The internet has made significant contributions towards health education. Analyzing the pattern of online behavior regarding meningitis and vaccinations may be worthwhile. It is hypothesized that the online search patterns in meningitis are correlated with its number of cases and the search patterns of its related vaccines. Methods This was an infodemiological study that determined the relationship among online search interest in meningitis, its worldwide number of cases and its associated vaccines. Using Google Trends™ Search Volume Indices (SVIs), we evaluated the search queries “meningitis,” “pneumococcal vaccine,” “BCG vaccine,” “meningococcal vaccine” and “influenza vaccine” in January 2021, covering January 2008 to December 2020. Spearman rank correlation was used to determine correlations between these queries. Results The worldwide search interest in meningitis from 2008 to 2020 showed an average SVI of 46 ± 8.8. The most searched topics were symptoms, vaccines, and infectious agents with SVIs of 100, 52, and 39, respectively. The top three countries with the highest search interest were Ghana, Kazakhstan, and Kenya. There were weak, but statistically significant correlations between meningitis and the BCG (ρ = 0.369, p ρ = 0.183, p Conclusion The relationships among the Google SVIs for meningitis and its related vaccines and number of cases data were inconsistent and remained unclear. Future infodemiological studies may expand their scopes to social media, semantics, and big data for more robust conclusions.

The approach to the built environment as a container of human activities has been severely outdated with a new vision that puts the user, his/her well-being and his/her experience, at the centre, shifting from the old “building as a product” to the newer “building as a service” and the newest “building as an experience” concept. Nevertheless, the sick building syndrome, mainly documented in office buildings, is a widespread problem in many public buildings and, among these, in educational facilities. In these categories we can list school and university buildings where the users are not only workers but also students, sharing anyway the same problem: an artificial environment which is not supporting their productivity in the office or learning performance in the classrooms. Carbon dioxide concentration, due to the natural human breathing process, is a diffuse parameter strongly influencing the indoor air quality and, thus, the users’ wellbeing. An acceptance threshold of 1000 ppm in indoor spaces has been derived for this pollutant. Although allowed, the CO2 concentration in indoor space shouldn’t reach this threshold because in such a condition a 11–23% reduction of the users’ cognitive performance has been measured and, when the level increases reaching 2500 ppm, the reported drop is dramatic (44–94%). Extensive researches set the optimal threshold at 600 ppm, a level defined as fresh air. Then, how is it possible to encompass a natural process as CO2 production by humans? Basically with the correct ventilation rate, depending on room geometry, number of people and ventilation system (i.e. natural or mechanical or mixed). A modulating mechanical ventilation system could adapt the ventilation rate according to people density and changing indoor conditions nevertheless many existing buildings have outdated systems not providing this option. Sometimes their air handling units (AHUs) have few regulation options to control the parameters and tuning procedures during the building lifecycle are required. CO2 concentration is convenient to measure indoor air quality because it is easily quantifiable through a sensors network. Thus, it may be adopted as an indicator to assess suitable indoor conditions to human activities and used to trigger manual or automatic procedures to preserve wellbeing thresholds. The article presents a research work depicting the integration of indoor air quality data gathered by internet of things (IoT) sensors to activate the control of the indoor conditions according to the occupancy rate in the educational building eLUX lab, located in the Smart Campus of the University of Brescia. The challenge is to directly regulate the heating, ventilation and air conditioning (HVAC) systems and define opening/closing patterns for windows to improve the indoor air quality and protect the learning performance of users in dynamic use conditions. The embraced methodology suggests the training of an artificial neural network (ANN) with the actual monitored data and to trigger the ventilation rate control through an IoT communication protocol.

Previous studies have shown that the learning performance of students greatly increases once personal experiences are made possible. In construction education, few serious gaming environments are available to boost the students’ thirst of discovery and interaction. As of now, theoretical content like lean principles is often taught by frontal classroom style teaching. This paper describes the development and preliminary testing of a first of a kind serious gaming platform that introduces construction engineering and management students to hands-on learning. The novelty of the developed platform is that it combines the previously separate methods of Building Information Modeling (BIM), Internet of things (IoT), and Lean Construction (LC) in one (serious) game. Technical aspects of the platform and results to its evaluation in a classroom setting are presented. The added value to learning is shown as part of learning curves automatically generated from the players’ data. While such data were previously not available, some still existing limitations and an outlook present the next steps in establishing such serious games in construction education.

Huntington disease (HD) is a devastating and presently untreatable neurodegenerative disease characterized by progressively disabling motor and mental manifestations. The sigma-1 receptor (&sigma, 1R) is a protein expressed in the central nervous system, whose 3D structure has been recently determined by X-ray crystallography and whose agonists have been shown to have neuroprotective activity in neurodegenerative diseases. To identify therapeutic agents against HD, we have implemented a drug repositioning strategy consisting of: (i) Prediction of the ability of the FDA-approved drugs publicly available through the ZINC database to interact with &sigma, 1R by virtual screening, followed by computational docking and visual examination of the 20 highest scoring drugs, and (ii) Assessment of the ability of the six drugs selected by computational analyses to directly bind purified &sigma, 1R in vitro by Surface Plasmon Resonance and improve the growth of fibroblasts obtained from HD patients, which is significantly impaired with respect to control cells. All six of the selected drugs proved able to directly bind purified &sigma, 1R in vitro and improve the growth of HD cells from both or one HD patient. These results support the validity of the drug repositioning procedure implemented herein for the identification of new therapeutic tools against HD.

Energy saving is crucial for existing buildings which is present a huge potential of improvement by a strong energy retrofitting. Often, the existing envelope components are not adequately insulated and deep refurbishment is required to comply current regulations to improve energy efficiency and address Nearly Zero Energy Building (NZEB) goals. The strategies to enhance buildings energy performance involve heating and cooling demands strongly dependent by envelope quality (i.e. insulation, thermal mass, internal gain storage capacity and solar heat gains exploitation). Commonly, the suggested main retrofit interventions on envelope are glazed surfaces replacement, Solar Heat Gain Coefficient (SHGC) reduction and thermal transmittance (U value) improvement by additional insulation layers or even components replacement. However, it is worthy to note that the resulting thickness of the external envelope and the payback time of the interventions are important supports for decision-making. The environmental issue related to CO2 emissions during the operational phase of the building is encompassed into the standard energy certification of the asset and the conversion factors to define fuels’ impacts are available and updated. However, the calculation excludes the environmental impact due to energy used for materials’ production and few official information sources provide accredited values, e.g. the Environmental Product Declaration (EPC). Going towards a Zero Energy Building, which reduces its environmental impact during the running phase, embodied energy claims an increasing weight. Thus, materials and components with low embodied energy should be favoured and endorsed. For this reason, the most influential rating systems worldwide available for building sustainability assessment (e.g. LEED, BREEAM, etc.) updated their checklists including criteria related to reduced energy for extraction, production and materials transportation on the field. The technological optioneering of envelope solutions to achieve both energy efficiency and economic affordability is inevitably based on and supported by multicriteria assessment frameworks. These frameworks should include energy, environmental and economic parameters to define the technological suitability in different climate conditions identifying accurate optimization points, e.g. thickness of the insulation layer or heat storage capacity, considering energy saving and management costs in the life cycle. When actual optimization processes are required, computational parametric tools support to ease the options’ performance comparison and to compute different combinations. Nowadays some tools are available into the main authoring software on the energy simulation market. Although different tools could be adopted, the need of transparency and custom workflows is crucial. In the present research, a specific multi-criteria methodological approach enables to outline a synoptic diagram for each considered climate to compare the envelope technological solutions by aggregating LCA (Life Cycle Analysis) and LCC (Life Cycle Cost) factors. For LCA, Embodied Energy (EE) of the envelope materials and Primary Energy (EP) used during the running phase have been considered. For LCC Investment Cost (C) of the materials to enhance a baseline performance and related operational costs of the building based on Net Present Value (NPV) and Discounted Payback Period (DPP) have been adopted. The present study focuses as first on the construction coherency of different technologies used to define the external envelope of a test room, able to manage the energy flows resulting from different external conditions. Subsequently the definition of the technological basket, a parametric analysis based on reducing thermal losses and increase solar gains has been performed defining the most suitable technologies and facade configuration in three representative climate conditions at national level by calculating heating and cooling demand and related primary energy.

The current perspective about urban development expects 70% of energy consumption will be concentrated in the cities in 2050. In addition, a growing density of people in the urban context leads to the need for increased security and safety for citizens, which imply a better lighting infrastructure. Smart solutions are required to optimize the corresponding energy effort. In developing countries, the cities&rsquo, lighting is limited and the lighting world map is strongly significant about the urban density of the different areas. Nevertheless, in territories where the illumination level is particularly high, such as urban contexts, the conditions are not homogenous at the microscale level and the perceived security is affected by artificial urban lighting. As an example, 27.2% of the families living in the city of Milan, ombardy Region, Italy, consider critical the conditions of lighting in the city during the night, although the region has diffused infrastructure. The paper aims to provide a local illuminance geographic information system (GIS) mapping at the neighborhood level that can be extended to the urban context. Such an approach could unveil the need to increase lighting to enhance the perceived safety and security for the citizens and promote a higher quality of life in the smart city. Lighting mapping can be matched with car accident mapping of cities and could be extended to perceived security among pedestrians in urban roads and green areas, also related to degradation signs of the built environment. In addition, such an approach could open new scenarios to the adaptive street lighting control used to reduce the energy consumption in a smart city: the perceived security of an area could be used as an additional index to be considered during the modulation of the level of the luminosity of street lighting. An example of a measurement set-up is described and tested at the district level to define how to implement an extensive monitoring campaign based on an extended research schema.

Occupancy analyses represent a crucial topic for building performance. At present, this is even true because of the pandemic emergency due to SARS-CoV-2 and the need to support the functional analysis of building spaces in relation to social distancing rules. Moreover, the need to assess the suitability of spaces in high occupancy buildings as the educational ones, for which occupancy evaluations result pivotal to ensure the safety of the end-users in their daily activities, is a priority. The proposed paper investigates the steps that are needed to secure a safe re-opening of an educational building. A case study has been selected as a test site to analyse the re-opening steps as required by Italian protocols and regulations. This analysis supported the school director of a 2-to-10 year old school and its team in the decision-making process that led to the safe school re-opening. Available plants and elevations of the building were collected and a fast digital survey was carried out using the mobile laser scanner technology (iMMS - Indoor Mobile Mapping System) in order to acquire three-dimensional geometries and digital photographic documentation of the spaces. A crowd simulation software (i.e. Oasys MassMotion) was implemented to analyse end-users flows; the social distance parameter was set in its proximity modelling tools in order to check the compliance of spaces and circulation paths to the social distancing protocols. Contextually to the analysis of users flows, a plan of hourly air changes to maintain a high quality of the environments has been defined.

In the last few years, the technology re-evolution has deeply transformed several aspects of everyday life. For sure, one technology with a strong impact is the so-called Internet of Things (IoT). The IoT paradigm made it possible to break down the data barrier between the vertical domains on which the traditional information and communication technology (ICT) world was organized. Recently, the designers of home automation systems have begun looking to the IoT paradigm to ease the deployment of systems that are able to collect data from different plants. Such a situation has driven further evolution from the traditional automation system, where logic is defined by the programmer or by the user, to a cognitive system that is able to learn from the user&rsquo, habits regarding what should be the best configuration of plants. Several countries are funding renovations of public and private buildings for improving energy efficiency. Generally, such renovations are only focusing on the structure of the building and of its energy performance (e.g., the thermal envelope, window units, air-conditioning plants, and renewable generators) and largely ignoring the use of intelligent devices. On the contrary, scientific literature and practice have demonstrated that the wider use of IoT sensors, as well as distributed and remote intelligence, is fundamental to optimize energy consumption. This research work aimed to identify issues due the application of cognitive solutions during the renovation phase of buildings. In particular, the paper presents a cognitive architecture to support the operation and management phases of buildings, thanks to the massive digitalization of the entire supply chain of the construction sector from the single building element to the entire construction process. Such an architecture is capable of combining data from the IoT sensors and actuators of smart objects installed during the renovation phase, as well as legacy building automation systems. As an indication of the capability of the proposed solution, an intelligent window device was developed and validated. Within the Energy, Life Styled, and Seismic Innovation for Regenerated Buildings (ELISIR) project, window units are equipped with sensors to monitor indoor and outdoor condition behaviours of users. In addition, windows are able to react to changes in the environment by means of actuators that enable motorized opening and shading. Thanks to the cognitive layer designed in the project, the window is able to automatically define the best rules for opening and shading by using the local controller to satisfy user&rsquo, s habits and energy efficiency targets. The cognitive layer defines the appropriate rules for opening and shading using the decision tree algorithm applied to the data generated by the sensors in order to infer users&rsquo, preferences. For this research, two prototypes of the window units were installed in two offices of Politecnico di Milano, Italy. The accuracy of this algorithm to classify the users&rsquo, behaviour and preferences was found to be around 90%, considering an observation interval of two months.

Regeneration of existing buildings and abandoned areas is a governmental and European key objective. This research focuses on Poveglia: an abandoned island in the Venetian lagoon, Italy. The underpinning idea concerns the upgrade of Poveglia to a zero energy Cognitive University Campus, connected to other educational institutions in the lagoon. The vision aims at reusing abandoned islands combining architecture, learning environments and digital networks, to demonstrate the potential of new technologies for the transformation of abandoned areas. The case study demonstrates the effectiveness of employing improved and revised systems and tools, developed in eLUX lab at the University of Brescia, for the regeneration of the island. The inclusion of the island in a smart campus network results in triggering positive synergies both enhancing energy efficiency and the learning environment. A further development concerns the setup of strategies for historical preservation, energy efficiency and renewable energy production.

Educational buildings across Europe refer to a large amount of structures for which critical interventions are necessary. Particularly, for old buildings, comprehensive refurbishment efforts are essential, in order to enhance the indoor comfort conditions and establish the best possible settings for students and users. Evidently, the above issue is decisive to stimulate and support students with reference to the learning process and aims of the educational system (superior learning performance); this has also a positive effect on users’ interaction with the nearby environment, in terms of social adaptability and health for children and adults. In this context, the main goal is to transform entirely the design of educational building spaces with respect to the initial conditions. To this end, governments often set targets on upgrading and utilizing school infrastructure in the urban district (mostly, for school classes situated in the urban core of the social and local communities). As is well known, the improvement of a building from a building physics point of view is fundamentally related to the attainment of acceptable hygro-thermal, visual and acoustic comfort conditions. On the other hand, limiting the heat flux through the buildings’ envelope and restricting CO2 emissions, is of great importance, from an environmental point of view. However, the complexity and significance to assess educational facilities mostly relies on the use of heating in winter and the absence of cooling systems during summer. In addition, climate change, which results into growing values of the air temperature, makes it difficult to attain acceptable indoor comfort conditions with natural ventilation. To reduce this effect, especially in the southern part of Europe, shading devices, as well as ventilation and cooling systems offer rational approaches to scrutinize the indoor environment. The central points of the present investigation, with respect to the indoor comfort conditions of educational buildings in different climate zones, during the cooling season, are as follows: (a) the retrofit measures to improve the thermal performance during heat waves; (b) how to gain tolerable indoor comfort conditions with or without a cooling; (c) the implementation of adaptive thermal comfort models. A dynamic thermal simulation on three levels (envelope, classroom, school building) has been carried out in order to assess the school building stock and investigate possibilities of improvements . For three different locations several retrofit scenarios have been evaluated by considering adaptive comfort standards (for typical users, as well as for children). Furthermore, to stretch the impact of this investigation, the analysis has been extended for a real case study: the “Modulo Didattico” building in the Smart Campus of the University of Brescia. At last, the integrated workflow of the design process is presented, considering both BIM and BEM data, and demonstrating an interesting application of visualization techniques for assessment of the comfort conditions in the different thermal zones. The study is the outcome of a collaborative workplan between the University of Brescia (unibs, Italy) and the Aristotle University of Thessaloniki (A.U.Th., Greece).

Building Information Modeling (BIM) is an object-oriented design process based on the assembling of building components virtually prototyped. Both the BIM objects available in BIM authoring platforms and the ones provided by manufacturers in digital marketplaces do not include the level of information need suitable to manage each purpose and use case within a BIM environment. Considering the purpose of energy retrofitting, this study analyzes the use of a BIM library of External Thermal Insulation Composite Systems (ETICS) as provided by a global manufacturer. The set of requirements for supporting a preliminary energy analysis is evaluated. Moreover, a data spreadsheet for energy analysis, bi-directionally linked to the BIM model, has been developed as a calculation tool for the energy evaluation of design options. Finally, the outline concept of a web-based system able to support the recommended selection of the most suitable BIM object from one or more BIM libraries based on various project parameters, including the selected BIM uses, is proposed.

Considering the remarkable shift that the digitalisation is nowadays bringing about in the building sector, the paper focuses on how the great amount of data collected around assets is changing the way buildings are operated, particularly for what concerns innovation on products, processes and technologies. By establishing a connection between as-designed virtual models and as-delivered physical assets, the paper presents methods and tools based on information management and developed for assessing building behaviours in operation and for defining control strategies for satisfying user needs. The research aims to investigate how the building process could benefit from the availability of multi-faceted information collected in real time (e.g. through sensors) during the operational stages of buildings. Digitally-enabled practices and technologies have been developed and tested for improving a data-driven asset management, by enriching Building Information Models through data gathered through Building Management Systems, according to the Industry Foundation Classes schema.

In recent years, energy-savings policies have affected many aspects of everyday life. Considering a typical building, the heating, ventilation, and air conditioning (HVAC) system is the most energy-consuming system. This consideration is especially true for large public-access buildings, such as schools, and public administrations. In these cases, the energy saving of buildings depends on the capability to optimise the behaviour of the HVAC. Typically, the HVAC control system is based on static models of the building, which consider the average occupancy rate of each of the rooms. On the contrary, in this research work, a cognitive system based on an occupancy rate model that is able to take into consideration user habits and indoor air quality (IAQ) provided by IoT sensors is considered for the control of HVAC systems. This approach has been applied to the eLUX lab building of the University of Brescia, Italy. Data provided by IoT IAQ sensors (temperature, relative humidity, CO2) is used to refine the results of the occupancy rates for the models of the rooms of this building. The experimental results show, as in 22.15 % of the samples, the CO2 concentration exceeded the 1,000 ppm threshold of the perception of fresh air and good conditions.

In the last years, the energy savings policies are affecting several aspects of the everyday life, from the introduction of renewables and the use of Electric Vehicles, down to the adoption of more efficient lightening systems. Considering a typical building, one of the most energy consuming plant is the Heating, Ventilation and Air Conditioning (HV AC) system. This consideration is especially true for large public-access buildings, such as schools, universities and public administrations. In these cases, the energy saving of buildings depends on the capability to optimize the behavior of the HV AC. Typically, the HV AC control system is based on static models of the building, which consider an average occupancy rate of each of the rooms. On the contrary, in this research work, a Cognitive Building approach has been considered. The Energy Management System (EMS) is able to control and to regulate the HV AC system, considering an occupancy rate model able to take into consideration user’ habits and the indoor air quality (IAQ), provided in near real-time by IoT sensors. This approach has been applied to the eLUX lab building of the campus of the University of Brescia, Italy. Data provided by IAQ sensors (temperature, relative humidity, CO 2 ) are used to refine the results of occupancy rate models of rooms of this building. The experimental results show as in the 22.15 % of the samples, the CO 2 concentration overcame the 1000 ppm threshold of perception of fresh air and good condition.

In spite of the growing implementation of Computer-aided technologies and Building Information Modeling (BIM) in AEC industry, building activities in construction sites are ineffectively monitored even now. Current formats of reporting and communicating the construction progress (e.g., textual progress reports, progress lines, and photographs) may not properly and quickly communicate the construction progress. In the proposed research the capability to communicate progress information right away and to share an Interactive Building Model (IBModel) are identified as the key components for successful management of the site and the supply chain network. This is carried out establishing the involved actors (Owner, Site Director, Site Safety Coordinator, Construction Companies and Suppliers) and setting them several options for the information management and visualization within the BIM environment. The monitoring system comes from the integration of the building and construction site model bestowing the visualization of site conditions on a set of graphical parametric rules, such as: chromatic visualization of building components referred to objects’ completion percentage; thematic views, automatically extracted and updated, representing the real site conditions; and so forth. The monitoring system, supported by the BIM-based visualization model and managed in a Cloud computing seems to be one of the right directions for improving safety condition on one hand and site productivity and control on the other one.

Building Information Modelling is a methodology, which is able to take into account many data, both geometrical and non-geometrical, in order to evaluate at the actual condition of the asset. The project has the scope of evaluating the conditions of different school buildings, in order to develop a way to choose the best-tailored management solution to the owner. A further step is the management and planning of design solutions during the life cycle customized on monitored buildings’ conditions. The research work focuses on providing a support decisions concerning the gap between the present building state laws and the current state of the existing buildings. The process will be developed in an expanded BIM environment, using sensors, which will give back the state of the consistency of the actual conditions to enable the buildings to adapt themselves in the best way into their specific constraints and boundaries. The results of the study are (i) a complete workflow to make decision and the possibility to shape the decision process on an objective through a scientific approach, (ii) evaluate the current state of the asset and (iii) manage maintenance in the lifespan. Further development will take in consideration all the aspects related to management of big data environment generated by a smart buildings system.

The construction industry is currently facing important challenges: an imperative improvement of its productivity, higher performance targets and an increase of projects complexity. In order to overcome these challenges, a digital transition is on-going and has started with the implementation of Building Information Modelling (BIM) processes. At the same time, digitisation of the construction industry requires a paradigm shift focused on collaborative workflows and user involvement, with the Client acting as driver for innovation. The proposed paper highlights the role of the Briefing process as project management tool of the demand side of construction. Information technologies for managing the bi-directional link between as-briefed and as-designed information requirements within a BIM environment are also investigated. These approaches are then compared with the ones of other industries and particularly with Systems Engineering methods. As a major Systems Engineering tool, the use of the SysML language in the construction industry is discussed. The comparison between the various data flows suggests further researches both in the application of Systems Engineering in the construction industry and in the development of requirements management tools for managing a BIM-based construction process. Finally, recommendations for the effective implementation of innovative processes and technologies are proposed.

The paper proposes a sensorization plan for monitoring a relevant architectural case study at the University of Cagliari, in order to verify indoor thermo-hygrometric conditions and define a set of interventions which should be compatible with building preservation issue and oriented at improving its energy performance. The research aims at understanding how to organize and structure the compliance of the building, in order to anticipate users' needs and how the centrality of these requirements can influence the definition of new retrofit models. Firstly, the proposed workflow has been tested on a pilot building with the same use: the eLUX lab, e.g. the Smart Campus Demonstrator at the University of Brescia and then, an adaptation of the developed cognitive concept has been applied to the “Mandolesi Pavilion”, an icon building at the University of Cagliari Campus. This adaptation and the main features transferred to from the experience in Brescia to Cagliari are here presented. The research is ongoing and first results are discussed.

The increased awareness on sustainability matters is contributing to the evolution of energy and environmental policies for the building sector at the EU level, oriented toward resource efficiency. There exist today several possible strategies to model building performance through the life cycle. The increase of available computational capacity and of data acquisition capability is opening new scenarios for practical applications, which can contribute to the reduction of the gap usually encountered between simulated and measured energy performance. This article aims to investigate an approach for probabilistic building performance simulation to be used across life cycle phases, employing reduced-order models for performance monitoring and energy management. The workflow proposed aims to establish a continuity among design and operation phases. Design phase simulation is generally subject to relevant temporal and economic constraints and a successful workflow should incorporate elements from current design practices but should also add new features, which have to be reasonably automated to reduce additional effort. Therefore, the workflow proposed is automated and tested for robustness using Monte Carlo technique. In the design phase, the approach can be used for identifying probabilistic performance bounds suitable for risk analysis in energy efficiency investments, employing cost-optimal or life cycle cost accounting methodologies. In the operation phase, it can be used for performance monitoring and energy management based on daily energy consumption analysis, similarly to other multivariate regression-based methods at the state of the art, addressing the problem of maintaining energy consumption and related costs constantly under control.

BIM is representing a shift in the traditional process of building delivery. Its adoption in US reached 71% in 2012 rising from 17% in 2007; moreover, Europe is going to adopt BIM for public contracting as promoted by the European Union Public Procurement Directive. Meanwhile, BIM is widely diffused in UK and Northern Europe, as it includes a more accurate documentation, less rework and shorter project timelines. The use of BIM to provide data for energy performance evaluation and sustainability assessment is defined Green BIM and pioneering design organizations are adopting this approach to enable integrated design, construction and maintenance towards Net Zero Energy buildings. Green BIM includes Building Energy Modelling dealing with project energy performance to identify options optimising building energy efficiency during the life cycle. By allowing revisions during the design phase, project teams can ensure that customers’ green ambitions beyond regulation compliance can be realized, together with technical and economic requirements. Thus, BIM can provide information to support the calculation of a number of credit points to define goal levels of sustainability related to rating systems. The aim of the paper is to investigate the opportunity to include the “green dimension” in BIM considering the more diffused rating systems.

Rule-based Code Checking validates the design phase comparing Building Information Models against current codes and regulations translated into parametric rules. The proposed paper fits into a wider project for implementing design verification and validation within a BIM environment. The design of construction site layouts and safety plans is an essential part of an effective integrated process but it is traditionally carried out by means of error-prone and inefficient manual observation and, moreover, building designers and health and safety (H&S) coordinators still lack a collaborative working approach. The digitization of the construction site allows virtual inspections and information-based analysis of construction phases. Moreover, interoperable BIM tools allow the semi-automatic review of design compliance against normative texts, improving accuracy and reliability of the validation process. The research project aims to define an H&S BIM-based design and validation workflow, specifying the minimum level of requirements and mandatory informative content for the submission of construction site layouts and safety plans. The paper is focused on the translation into a parametric rule-set of the Italian construction sites’ H&S normative text (D.Lgs. 81/2008). A semantic analysis was used in order to translate it into computable parameters to be implemented into checking rules. Object tables have been created for each construction site element regulated by the D.Lgs. 81/2008. Based on those tables, meant as guideline for the design phase, a BIM library for the construction site has been created and a model checking tool has been used for creating rules to check and validate BIM objects and mutual relations. The customized rule-set includes legal references and information requirements specifications. Such an approach aims at including the design of construction safety plans within digital

Technologies for the acquisition, storage and mining of big data are increasingly affecting the Architecture, Engineering and Construction (AEC) industry, modifying the way buildings are conceived and developed. Indeed, they will be no longer designed and managed only as financial products, but also as service providers to support the needs of the occupants. This is a great challenge in the building sector, that is experiencing a period of various (r)evolution concerning products, technologies and processes. This research defines a digitally enabled framework for operating cognitive buildings, presenting a case study by which it has been possible to analyze how information collected during operations could inform end-users (i.e. administrators, owners, facility managers and occupants) about the behavior of both buildings and occupants. Focusing on building in-use stages, advantages in tracking the behavior of occupants and in satisfying the needs of users should be derived through the availability of real-time information, i.e. collected by sensors. In this way, not only the behavior of users could be taken into account, but also predicted performance could be correlated with real measurement and, consequently, the building performance gap should be estimated and filled. A connection between as-designed virtual models (resulted from a BIM — Building Information Modeling — process) and as-delivered physical assets (monitored in real-time, i.e. through BMS — Building Management Systems) could be established to explore how BIM practices and technologies could improve a data-driven asset management, by enriching building information in operation. The results should allow pointing out how data and information gathered along building life cycle could provide services to users.

Building Information Modelling (BIM) is enabling the dissemination and improvement of strategies for planned conservation. Through the implementation of BIM models in two case studies, different both in terms of size and scope of restoration and refurbishment, it was possible to assess the suitable ways for collecting and managing heterogeneous data generated by various disciplines. Furthermore, the collaboration amongst various stakeholders involved in the conservation process was investigated. Issues of integration and interoperability over the phases of the conservation process were analysed: starting from the architectural survey, carried out by laser scanning technology combined with the traditional survey, as far as the management of data as a function of future maintenance phase. Using these technologies, problems related to the building information model of the current condition of heritage buildings and the information exchange between different software environments were observed. Applying BIM workflows on restoration and refurbishment projects allowed to evaluate the potential of these technologies for different stages of the process: survey, design phase, monitoring work progress and evaluation of proposed amendments and changes. It was also possible to deal with safety management. Finally, the possibility of applying the 4D BIM technology, which combines the 3D BIM model to the construction work plan, has been analysed.

Building Information Modelling (BIM) represents a long-term investment that could allow reduction of time and cost control by optimising design and construction processes. It also ensures greater effectiveness of control systems. The paper is focused on a public procurement case study regarding the BIM-based validation and construction optimisation of an actual residential building designed in a compact urban context of Milan, in a confined construction site affected from lack of space and coordination problems. The scope is the implementation of an interoperable IFC-based process to perform advanced model and code checking and to effectively manage the construction phase through 4D modelling. Architectural, structural and MEP models were enriched with alphanumeric attributes as required for semiautomatic validation processes. Auto matching between BIM objects and construction activities was also achieved. The experimentation project showed the possibility of a rapid validation of the model and an advanced coordination between design disciplines. The construction site simulation allowed the comparison of different layout options and baseline schedules. The research also tested the joint use of model checking and 4D modelling tools to manage the percentage of completion of the construction progress and to support H&S management through the IFC export of a specific configuration of the plan of work directly from the 4D BIM software. The proposed process created an open, interoperable and multidisciplinary approach involving designers, project managers and construction companies.

We report the initial results from a phase I clinical trial for ALS. We transplanted GMP-grade, fetal human neural stem cells from natural in utero death (hNSCs) into the anterior horns of the spinal cord to test for the safety of both cells and neurosurgical procedures in these patients. The trial was approved by the Istituto Superiore di Sanita and the competent Ethics Committees and was monitored by an external Safety Board. Six non-ambulatory patients were treated. Three of them received 3 unilateral hNSCs microinjections into the lumbar cord tract, while the remaining ones received bilateral (n = 3 + 3) microinjections. None manifested severe adverse events related to the treatment, even though nearly 5 times more cells were injected in the patients receiving bilateral implants and a much milder immune-suppression regimen was used as compared to previous trials. No increase of disease progression due to the treatment was observed for up to18 months after surgery. Rather, two patients showed a transitory improvement of the subscore ambulation on the ALS-FRS-R scale (from 1 to 2). A third patient showed improvement of the MRC score for tibialis anterior, which persisted for as long as 7 months. The latter and two additional patients refused PEG and invasive ventilation and died 8 months after surgery due to the progression of respiratory failure. The autopsies confirmed that this was related to the evolution of the disease. We describe a safe cell therapy approach that will allow for the treatment of larger pools of patients for later-phase ALS clinical trials, while warranting good reproducibility. These can now be carried out under more standardized conditions, based on a more homogenous repertoire of clinical grade hNSCs. The use of brain tissue from natural miscarriages eliminates the ethical concerns that may arise from the use of fetal material. EudraCT:2009-014484-39 .

The public construction sector has recently started to put more effort into cost savings and improvement of efficiency. Therefore, public clients have started to promote new strategies, embracing innovative approaches such as Building Information Modelling (BIM) and e-Procurement. Tendering plays a key role for the success of the overall process; however, the selection of the best contractor is still a difficult task. The paper investigates how tendering can be integrated with Model Checking in order to control the compliance between the client's requirements and bidders' offers within a digital environment. The research shows that, although the BIM is still not widely adopted in tendering procedures, Model Checking tools are already available to support the jury, as well as bidders. Moreover, even though BIM can be implemented in several procurement procedures, it is more effective if a collaborative and integrated behaviour is promoted. Results can help increase public clients' awareness of the limits and potentials of an innovative approach and to set BIM requirements and guidelines. (C) 2015 The Authors. Published by Elsevier B. V.

Factor V Leiden and prothrombin G20210A are gain-offunction mutations of the corresponding coagulation factors leading to an increased risk of venous thrombosis. They are the most common causes of inherited thrombophilia, being present in their heterozygous form in 15–20% of unselected patients with venous thrombosis for factor V Leiden and in 6–15% for prothrombin G20210A. Homozygous carriers of the mutations are rare, and homozygous carriers of both mutations, expected in 1 in every 1,200,000 individuals, have never been described in the literature. The risk of venous thrombosis associated with heterozygous factor V Leiden and prothrombin G20210A is increased approximately 7– and 4-fold, respectively. The risk is increased 20-fold in double heterozygous . . .

Background. Factor V Leiden and prothrombin G20210A are gain-of-function mutations leading to an increased risk of venous thrombosis. They are the most common causes of thrombophilia, being present in their heterozygous form in 15–20% for factor V Leiden and 6–15% for prothrombin G20210A of unselected patients with venous thrombosis. The prevalence of each mutation in the Italian general population is 3%. Homozygous carriers for each mutation are rare, and double homozygous carriers, expected in 1 in 1.200.000 individuals, has never been described in the literature so far. Patient. On March 3, 2005 a 30-year-old woman was admitted to the Unit of Internal Medicine, Valduce Hospital, Como, for swell and pain in the left leg. She was pregnant at the 25th gestational week. Ultrasound examination diagnosed a deep vein thrombosis of the left external and common iliac veins. She had no symptoms of pulmonary embolism. She was given nadroparin 6000 UI b.i.d. (her weight was 63 kg), elastic stockings, and was discharged on March 9, 2005. Because of worsening of the swell in the left leg, she was re-admitted on March 12, 2005 and the ultrasound examination showed an extension of the deep vein thrombosis to the left femoral-popliteal venous system. The dose of nadroparin was increased to 7000 UI b.i.d. Thrombophilia screening revealed a double homozygosity for factor V Leiden and prothrombin G20210A. Her past personal history was negative for thrombosis, but she was never exposed to high risk situations (surgery, bone fractures, prolonged immobilization, oral contraceptive use, long-haul flights) apart from a previous pregnancy which ended in miscarriage at the 6th gestational week. On June 14, 2004 she had an uneventful vaginal delivery after two hours of labour, with the last nadroparin injection in the evening before, The newborn was a female who weighted 3500 g. Her family history was also negative for thrombosis in first- and second-degree relatives despite both parents were double heterozygotes for factor V Leiden and prothrombin G20210A and brother and sister were homozygotes for factor V Leiden and heterozygotes for prothrombin G20210A. Conclusions. The relative risk of venous thrombosis in double homozygous for factor V Leiden and prothrombin G20210A is unknown but is predicted to be extremely high. However, the patient described here had her first episode during a trigger situation, i.e., pregnancy, and severe thrombophilia seems to run an uneventful cause in her family in spite of repeated exposures to high risk situations. Hence, we shall advise the patient to stop oral anticoagulant therapy, started soon after delivery, one year after the thrombotic event.

Simulation and predictive models to verify the energy performance of new or retrofitted existing buildings strongly need tuning procedures based on energy monitoring in the operational phase, thus to avoid performance gap concerns. The value chain of an uninterrupted information for energy models based on design data (e.g. for new buildings) or on paper documents and additional surveys (e.g. for existing buildings) is crucial to perform a reliable design optioneering process. The present research applies a BIM2BEM approach to provide a public administration with a model for facility management (i.e. BIM) and a model to assess energy improvement and check the choices (i.e. BEM), as a pilot project on school buildings renovation. Schools are frequently out-of-date buildings in harsh need of structural and energy refurbishment and public administrations require consistent economic evaluations considering the payback time of the proposed solutions. Additionally, O&M (Operation & Maintenance) costs should be included in a life cycle evaluation of the buildings. Two schools with different layouts and configuration adopted as case studies to compare energy simulation to actual consumption. The workflow empowers the energy simulation results highlighting the accuracy of energy modelling in different situations and it introduces possible tuning strategies to decrease uncertainty.

Building Information Modelling (BIM) is part of a wider digital innovation that has arrived as an epochal transition in the Architecture, Engineering and Construction (AEC) Industry. Although the benefits of BIM within the supply-side of the industry have been widely explored, its impact on the value for clients and end-users has been researched in a limited manner so far. The paper reviews some of the BIM-related technologies which could effectively support client and end-user involvement in the briefing process. Four main types of information technologies are considered and grouped as (1) rule-based validation tools (i.e. briefing software; rule-based model checking) and (2) simulation-based validation tools (i.e. gamification, immersive virtual environments). Those technologies are analysed and compared in order to identify what has already been done, possible future trends, evaluate their integration in the briefing process and, finally, take into account both their advantages and disadvantages in supporting the effective involvement of the demand-side of construction in digitally-enabled processes.

The authors report the case of a 71-year-old woman presented to the Emergency Department with acute ischemic stroke. She was treated with rt-PA and interventional endovascular revascularization and developed rapidly progressing angioedema that led to emergency intubation. The standard treatment was not very effective and the swelling improved after infusion of fresh frozen plasma. Angioedema after rt-PA infusion could be a life-threatening emergency that requires quick airway management by skilled professionals. As this condition is triggered by several factors, such as unregulated histamine and bradykinin production, the traditional treatment recommended by the guidelines may not be sufficient and the use of FFP can be considered as a safe and valuable aid.

OBJECTIVES The aim of the present study was to evaluate the diagnostic accuracy of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in differentiating benign from malignant exudative pleural effusions. METHODS This is a unicentre observational study including 97 consecutive patients with exudative pleural effusions. Metalloproteinase-9, tissue inhibitor of metalloproteinase-1, lactate dehydrogenase, ferritin, carcinoembryonic antigen and carbohydrate antigen 15-3 were measured in pleural effusion and serum by enzyme-linked immunosorbent assay. The activity of metalloproteinase-9 was also evaluated by substrate zymography. The data were correlated with final diagnosis of pleural effusions to evaluate the diagnostic accuracy. RESULTS Of the 97 eligible patients, 6 were excluded. Of the 91 patients included in the study, 70 had malignant pleural effusions and 21 had benign pleural effusions. Both in sera and pleural effusions, matrix metalloproteinase-9 (P < 0.0001), tissue inhibitor of metalloproteinase-1 (P < 0.0001) and carcinoembryonic antigen (P < 0.0001) levels were higher in neoplastic patients than in benign group. Zymography analysis showed a most prominent band at a molecular weight of 92 kDa (metalloproteinase-9) whereas a less intense band was observed at 72 kDa (metalloproteinase-2). A significant correlation was found between metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 levels in pleural effusion (P < 0.0001; r = 0.8) and serum (P < 0.03; r = 0.2). Pleural effusion metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 levels showed higher value of sensitivity (97 and 91%, respectively) and specificity (90 and 95%, respectively) compared with other standard markers. Serum metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 levels showed similar results. Among 70 neoplastic patients, 29 had negative pleural cytology. Of these, 25 presented elevated levels of metalloproteinase-9 and tissue inhibitor of metalloproteinase-1, whereas 4 patients had elevated levels of one of the two markers. CONCLUSIONS Our results showed that metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 might be valuable markers in differentiating benign from malignant pleural effusions. Their levels are neither influenced by the histology and tumour origin nor by the presence of tumour cells in pleural effusions. Thus, their use in clinical practice could help in the selection of patients needing more invasive procedures, such as thoracoscopic biopsy. OBJECTIVES The aim of the present study was to evaluate the diagnostic accuracy of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in differentiating benign from malignant exudative pleural effusions. METHODS This is a unicentre observational study including 97 consecutive patients with exudative pleural effusions. Metalloproteinase-9, tissue inhibitor of metalloproteinase-1, lactate dehydrogenase, ferritin, carcinoembryonic antigen and carbohydrate antigen 15-3 were measured in pleural effusion and serum by enzyme-linked immunosorbent assay. The activity of metalloproteinase-9 was also evaluated by substrate zymography. The data were correlated with final diagnosis of pleural effusions to evaluate the diagnostic accuracy. RESULTS Of the 97 eligible patients, 6 were excluded. Of the 91 patients included in the study, 70 had malignant pleural effusions and 21 had benign pleural effusions. Both in sera and pleural effusions, matrix metalloproteinase-9 (P < 0.0001), tissue inhibitor of metalloproteinase-1 (P < 0.0001) and carcinoembryonic antigen (P < 0.0001) levels were higher in neoplastic patients than in benign group. Zymography analysis showed a most prominent band at a molecular weight of 92 kDa (metalloproteinase-9) whereas a less intense band was observed at 72 kDa (metalloproteinase-2). A significant correlation was found between metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 levels in pleural effusion (P < 0.0001; r = 0.8) and serum (P < 0.03; r = 0.2). Pleural effusion metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 levels showed higher value of sensitivity (97 and 91%, respectively) and specificity (90 and 95%, respectively) compared with other standard markers. Serum metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 levels showed similar results. Among 70 neoplastic patients, 29 had negative pleural cytology. Of these, 25 presented elevated levels of metalloproteinase-9 and tissue inhibitor of metalloproteinase-1, whereas 4 patients had elevated levels of one of the two markers. CONCLUSIONS Our results showed that metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 might be valuable markers in differentiating benign from malignant pleural effusions. Their levels are neither influenced by the histology and tumour origin nor by the presence of tumour cells in pleural effusions. Thus, their use in clinical practice could help in the selection of patients needing more invasive procedures, such as thoracoscopic biopsy.

Since a great deal of confusion surrounds the different uses made by clinicians, pathologists, and biologists of the term, this paper clarifies the concept of “early” cancer of the larynx. Clinically, this is usually a glottic neoplasm in which full cordal mobility is still present; early supraglottic cancer is infrequent, and usually a chance finding. Whatever the site, early laryngeal cancer is a minimally invasive neoplastic lesion that does not invade the muscle or cartilage, but is still capable of metastasis. Being confined to the lamina propria, it is more than a carcinoma in situ but less than a deeply infiltrating carcinoma. Superficial extending carcinoma is therefore an early cancer. Biologically, early cancer belongs to stage II.

Malignant fibrous histiocytoma (MFH) of the upper respiratory tract is rare. We report a case of laryngeal MFH in a 78-year-old man. The patient died 8 months after the first surgical treatment. The clinicopathologic features are described, and the importance of electron microscopy and immunohisto-chemical techniques in the differential diagnosis with so-called « sarcomatoid carcinoma » is stressed. The tumor has an aggressive biological behavior and tends to recur and metastasize.