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Low energy buildings are key to reduce global energy use. However, achieving low energy use and good daylight levels simultaneously in dense cities is challenging. This article reviews relevant studies dealing with energy use and daylighting in dense residential urban blocks located in Nordic climates. The literature review combines a systematic and a ‘snowball’ search approach. Findings indicate that previous research relies heavily on parametric design as a tool. Few density metrics were found particularly relevant to describe the interplay between density, daylight, and energy use. However, the limited body of research achieved so far in the Nordic climate makes it difficult to draw a clear conclusion, suggesting that additional research is required.

Resume A ce jour, plus de 50 % des evenements critiques perioperatoires de l’enfant sont d’origine respiratoire. La bonne gestion des voies aeriennes de l’enfant lors d’une anesthesie generale fait partie des preoccupations majeures des anesthesistes-reanimateurs. Les objectifs de ces recommandations formalisees d’experts etaient d’apporter une modification ou amelioration des pratiques cliniques repondant aux evolutions techniques dans la gestion des voies aeriennes superieures de tout enfant, mais egalement de valider au niveau national des connaissances reconnues dans la litterature ou aupres de societes savantes internationales. Par ailleurs, un point particulier a aborde la gestion des VAS de l’enfant enrhume, potentiel facteur de risque en anesthesie pediatrique. Parmi les recommandations, les experts recommandent l’utilisation preferentielle des dispositifs supraglottiques lors des interventions superficielles de courte duree avec monitorage de la pression du coussinet si possible. L’utilisation de sonde a ballonnet est preferable lors de l’intubation tracheale avec monitorage de la pression du ballonnet. L’intubation doit etre systematique pour une chirurgie d’amygdalectomie chez l’enfant. La place des videolaryngoscopes est precisee lors de l’intubation difficile. L’utilisation des curares est redefinie que ce soit durant l’induction a sequence rapide ou lors d’une anesthesie classique avec intubation orotracheale. Pour l’enfant enrhume, les experts recommandent l’utilisation preferentielle, si possible, du masque facial compare a la sonde d’intubation ou dispositif supraglottique et, pour l’enfant de moins de 6 ans, la nebulisation de salbutamol avant l’anesthesie generale. Le but final de ces recommandations est d’envisager une diminution de la morbi-mortalite respiratoire de l’anesthesie des enfants par une amelioration des pratiques cliniques quotidiennes.

This research investigates the daylight regulation compliance of existing multi-family housing developments located primarily in Stockholm (Lat.: 59,33 °N), Sweden. A representative sample of 54 buildings consisting of 10.888 individual rooms was modelled according to archived documentation drawings and evaluated by use of Radiance simulations, to test their compliance with the current Swedish daylight regulation. The studied buildings were selected according to their relevance to major architectural typologies of Swedish urban planning history (1926–1991). The assessment was based on a point Daylight Factor scheme (DFP), which stipulates that a specific point in a room should achieve a Daylight Factor DFP ≥ 1%, for the room to be sufficiently daylit. Results indicate that specific architectural typologies consistently yield poor DFP levels compared to other ones. A moderate correlation was found between the density of surroundings and the percentage of compliant rooms per housing development. Finally, the results indicate the existence of distinct periods during Swedish urban planning history, when daylight performance of multi-family houses was affected by different planning practices. Future investigations are under development to evaluate the occupants’ perception of daylight in their apartments, to help define new daylight performance indicators and benchmarks for Swedish households, taking into consideration the limitations of the daylight indicator embedded in the current regulation.

This paper investigates the effectiveness of lighting control systems (LCSs) in 57 individual office rooms of an educational building located in Lund, Sweden. The study uses simulations based on actual occupancy data. The simulations, performed with Daysim via the Honeybee interface, focus on the portion of standby energy use on total lighting energy use considering different combinations of LCSs and lighting power density (LPD). The results show that standby energy use accounts for about 30% of the total lighting energy use, but it can raise up to 55% in extreme cases. The portion of standby energy use increases with lower occupancy rates and lower LPD. As a conclusion, a complete switch-off of systems during unoccupied hours is fundamental to preserve savings from LCSs. In addition, the article argues that, when standby energy use cannot be minimized or eliminated, daylight design and very efficient light sources may reduce the need for complex LCSs in individual office rooms or the like.

Objective To provide French guidelines about "Airway management during paediatric anaesthesia". Design A consensus committee of 17 experts from the French Society of Anaesthesia and Intensive Care Medicine (Societe Francaise d’Anesthesie-Reanimation, SFAR) and the Association of French speaking paediatric anaesthesiologists and intensivists (Association Des Anesthesistes Reanimateurs Pediatriques d’Expression Francophone, ADARPEF) was convened. The entire process was conducted independently of any industry funding. The authors followed the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to assess the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations were not graded. Methods The panel focused on 7 questions: 1) Supraglottic Airway devices 2) Cuffed endotracheal tubes 3) Videolaryngoscopes 4) Neuromuscular blocking agents 5) Rapid sequence induction 6) Airway device removal 7) Airway management in the child with recent or ongoing upper respiratory tract infection. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the redaction of the recommendations were then conducted according to the GRADE® methodology. Results The SFAR Guideline panel provides 17 statements on “airway management during paediatric anaesthesia”. After two rounds of discussion and various amendments, a strong agreement was reached for 100% of the recommendations. Of these recommendations, 6 have a high level of evidence (Grade 1 ± ), 6 have a low level of evidence (Grade 2 ± ) and 5 are experts’ opinions. No recommendation could be provided for 3 questions. Conclusions Substantial agreement exists among experts regarding many strong recommendations for paediatric airway management.

With the introduction of new demands targeting net-zero energy and net zero-carbon buildings and neighbourhoods on a national level in Sweden and internationally, balancing the requirements of daylight and energy is becoming more important in the design process. In order to succeed, an effective strategy needs to be defined for utilising the right digital tools and metrics for the two factors at different times in the process, and in an integrated way. This paper presents the workflow used whilst developing the concept for a new school in Enköping, Sweden (59.633°N, 17.086°E). The analyses performed during the design process included vertical sky component, daylight factor and early-stage energy calculations. Implementing photovoltaic (PV) cells and energy-efficient lighting design were also included as part of a strategy for reducing primary energy consumption. It was found that daylight and energy can be effectively balanced if an integrated strategy is followed during early stages of the design process. National regulations can also be met, and the time required for running simulations can be reduced by a factor of three by having an effective process.

This paper presents a holistic approach to perform energy renovations of office buildings. A real case study is used to demonstrate how different software can be used to facilitate the work of architects and engineers during different design stages. Initially, the moisture safety of the building is coupled to its energy performance to define the optimum insulation level. The new interior layout is based on an initial daylight study, rather than on architectural intuition. On a second stage, shading and natural ventilation are studied to eradicate any cooling demand, while the interdependence between heating energy and daylight is assessed for the use of light-wells. To demonstrate the trade-offs between visual control and electrical lighting, different shading systems are examined for a cellular office. Finally, two alternate HVAC systems are analyzed to investigate whether passive standards can be achieved with an all-air system and/or a hydronic system.

In the field of lighting and daylighting, standard monitoring procedures to assess the overall performance of retrofit projects are scarce. Nevertheless, access to monitored data is crucial in assessing whether daylighting or electric lighting systems deliver the expected performance in terms of cost-effectiveness, energy efficiency and lighting quality. In order to bridge this gap, a lighting retrofit evaluation toolbox was developed as a part of the International Energy Agency-Solar Heating and Cooling Programme (IEA-SHC) Task 50: “Advanced Lighting Solutions for Retrofitting Buildings”. The evaluation toolbox focuses on non-residential buildings and covers four key aspects: energy efficiency, costs, quality of the lighting environment and user satisfaction. This article presents the main features of this evaluation toolbox, along with some lessons learned from its application in selected case studies.

Light pipes offer a passive way to bring daylight inside deep buildings, such as agricultural buildings. However, the lack of reliable performance predictability methods for light pipes represents a major obstacle preventing their widespread use. This paper evaluates a simulation approach for performance prediction and identifies key light pipe design parameters affecting their daylight transmission performance. The study was carried out through continuous monitoring of daylight in two full-scale, identical pig stables fitted with two light pipe systems, Solatube® and Velux®. The experiment included three continuously measuring sensors in each stable and an outdoor sensor during 2013 and 2014. A forward raytracing tool, TracePro®, was used for illuminance prediction and parametric simulations. The simulation results for overcast skies indicated discrepancies between the simulated and average measurement results below 30% in all cases. The discrepancies for clear skies were somewhat higher, i.e., below 30% for 67% of the cases. The higher discrepancies with clear skies were due to the overestimation of absolute sunlight levels and absence of an advanced and detailed optical characterization of the dome collector’s surface. The parametric results have shown that light pipes’ performance is better during summer time, in sunny climates, at low to mid-latitudes, which provides higher solar altitudes than during winter and cloudy climates at high latitudes. Methods to improve the luminous transmittance for low solar altitudes occurring in Scandinavia include: bending or tilting the pipe, increasing the aspect ratio, improving the pipe specular reflectance, tilting the collector to the south, and using optical redirecting system in the collector. (Less)

An efficient lighting control systems (LCS) should take advantage of the natural light available, but this presents some technical challenges as well as user related issues. So far, the assessment of lighting energy consumption of LCS has been based on technical features rather than the occupants’ acceptance. This article presents the results of a monitoring study in a real life setting. It provides some recommendations based on the human and technical aspects of LCS in small scale applications. Four identical peripheral office rooms located in Lund, Sweden, were equipped with four different LCS: manual switch at the door, presence detector, daylight dimming with absence detector and LED task lamp. Each occupant performed ordinary office tasks for two weeks in each room in April–May 2013. A subjective evaluation concerning the general lighting experience and the appreciation of the LCS was carried out. The results indicate that the manual switch with absence detector was greatly appreciated and it accomplished good energy performances (75% savings compared to the presence detector). The daylight-linked LCS achieved only slightly higher savings (79%), due to relatively high standby losses. The desk lamp achieved 97% savings, but the lighting conditions were considered unacceptable by the office workers. In general, the participants in this study perceived all automatic controls as stressful.

The Swedish animal production sector has potential for saving electric lighting of €4-9 million per year using efficient daylight utilisation. To demonstrate this, two light pipe systems, Velux® (house 1) and Solatube® (house 2), are installed in two identical pig houses to determine if the required light intensity, daylight autonomy (DA), and reduced electricity use for illumination can be achieved. In each house, three light sensors continuously measure the indoor daylight relative to an outdoor sensor. If the horizontal illuminance at pig height decreases below 40 lux between 08.00 and 16.00 hours, an automatic control system activates the lights, and electricity use is measured.. The daylight factor (DF) and DA are determined for each house, based on annual climate data. The mean annual DA of 48% and 55% is achieved for house 1 and house 2, respectively. Light pipes in house 2 have delivered significantly more DA than those in house 1. The most common illuminance range between 0 and 160 lux is recorded in both houses, corresponding to approximately 82% and 83% of daylight time for house 1 and house 2, respectively. Further, the daylighting system for house 2 has produced a uniform DF distribution between 0.05 and 0.59. The results demonstrate that considerable electric energy savings can be achieved in the animal production sector using light pipes. Saving 50% of electric lighting would correspond to 36 GWh or 2520 t CO2 per year for Sweden, but currently the energy savings are not making the investment profitable. (Less)

In the field of lighting and daylighting, standard monitoring procedures to assess the overall performance of retrofit projects are scarce. Nevertheless the access to monitored data is crucial to assess whether daylighting or electric lighting systems deliver the expected performance in terms of cost-effectiveness and energy efficiency. In order to bridge this gap, a monitoring protocol is under development as part of the International Energy Agency – Solar Heating and Cooling Programme (IEA-SHC) Task 50 ‘Advanced Lighting Solutions for Retrofitting Buildings’. The protocol focuses on lighting and/or daylighting (façade or roof) retrofit in the non-residential building stock. It covers four key aspects: energy efficiency, costs, quality of the lighting environment and user satisfaction. The main features of this protocol are presented in this paper, along with some lessons learned from the ongoing application on selected case studies.

This paper evaluates the effect of room function and orientation on daytime electric lighting use in dwellings, and the confounding role of room design aspects. A questionnaire survey was conducted in six multi-dwelling buildings including 75 apartments located in Malmo, Sweden (Latitude: 55.6 °N). Occupants were asked how often they use electric lighting during daylight hours, in three rooms of different functions, namely the kitchen, the living room and the bedroom. In a preliminary step, the behavior of occupants regarding electric lighting use was evaluated, to test whether design and orientation can affect switch-on behavior or whether it is random and unpredictable. In the next step, statistical analysis was performed to verify whether there is a relation between daytime electric lighting and room function, room orientation or both. Results indicate that electric lighting use did not vary significantly among occupants living in rooms of similar geometry, especially when living in West-oriented rooms. With respect to room function, overall it was shown that daytime electric lighting use was more frequent in kitchens. However, the study showed that electric lighting use in kitchens is associated with specific design features and not with room function per se. With respect to orientation, a consistent finding was that West-facing rooms use electric lighting less frequently compared to rooms of other orientations, and significantly less frequently compared to East-facing rooms, which can be explained by diurnal occupancy patterns characterizing residential spaces. The implications of the findings on daylight design criteria for residences are discussed.

Atria are implemented in buildings to increase daylight, foster interaction and provide ventilation. However, their implementation can be complex if good daylight is to be achieved. This research proposed an investigation about the atrium parameters that affect daylight conditions in a case study. This evaluation concentrated in the atrium geometry and the wall reflectance values. Overall, the outcomes demonstrated that shifting the atrium from an enclosed to a semi-enclosed one can double the daylight in the atrium adjacent rooms. Moreover, it is possible to achieve better daylight in the adjacent rooms by keeping the same floor area of the building.

Focusing on subjective evaluations of daylight conditions, the present paper explores the relation between room geometric characteristics and perceived brightness and daylight distribution in residential spaces. The study was conducted in 35 apartments consisting of 105 different rooms in the city of Malmo, and selected with respect to typical Swedish architectural building typologies. Questionnaires were distributed by mail to participants, and apartments were surveyed to deduct key geometric characteristics. Results include a reliability analysis of the utilized questionnaire and a correlation study that showed the prevalence of both window size and number as key factors relating to perceived daylight conditions.

This paper presents a literature review about energy-efficient retrofit of electric lighting and daylighting systems in buildings. The review, which covers around 160 research articles, addresses the following themes: 1) retrofitting electric lighting in buildings, 2) electric lighting energy use and saving potential and 3) lighting retrofit strategies. The retrofit strategies covered in the review are: replacement of lamp, ballast or luminaire; use of task-ambient lighting design; improvement in maintenance; reduction of maintained illuminance levels; improvement in spectral quality of light sources; improvement in occupant behavior; use of control systems; and use of daylighting systems. The review indicates that existing general knowledge about lighting retrofit is currently very limited and that there is a significant lack of information concerning the actual energy performance of lighting systems installed in the existing building stock. The resulting key directions for future research highlights issues for which a better understanding is required for the spread and development of lighting retrofit. (Less)

Planning energy-efficient buildings which produce on-site renewable energy in an urban context is a challenge for all involved actors in the planning process. The primary objective of this study was to develop a façade assessment and design tool for solar energy (FASSADES) providing the necessary information for all stakeholders in the design process. The secondary objective was to demonstrate the tool by performing an assessment analysis of a building block. The FASSADES tool is a DIVA4Rhino script, combining Radiance/Daysim and EnergyPlus for simulating the annual production of solar thermal and photovoltaic systems on facades, the cost-effectiveness of the solar energy system, and the payback time. Different output methods are available; graphically within the 3D drawing environment and numerically within post-processing software. The tool was tested to analyse a building block within a city under Swedish conditions. Output of the developed tool showed that shading from nearby buildings greatly affects the feasibility of photovoltaic and solar thermal systems on facades.

Architects have a key role to play when it comes to the design of future low-energy (solar) buildings. Proper design tools and working methods could help architects in the design process. In order to identify barriers of existing tools and methods for solar design, needs of architects for improved tools, and to gain an insight into architects’ methods of working during the design process, an international survey was carried out within the framework of IEA-SHC Task 41-Solar Energy and Architecture, combined with semi-structured interviews. This paper presents an overview of main results of this study. Both the survey and interviews strongly indicate the need for further development of design tools for solar architecture, focusing on a user-friendly, visual tool that is easily interoperable within current modelling software packages, and which generates clear and meaningful results that are compatible with the existing work flow of the architect. Furthermore, the survey and interviews also indicated a strong awareness about solar aspects among respondents. However, this was combined with a limited use and knowledge of solar energy technologies, suggesting the need for further skill development amongst architects and tool development to accelerate the implementation of these technologies in future buildings and urban fabric.

in Undetermined An efficient lighting control systems (LCS) should take advantage of the natural light available, but this presents some technical challenges as well as user related issues. So far, the assessment of lighting energy consumption of LCS has been based on technical features rather than the occupants’ acceptance. This article presents the results of a monitoring study providing some recommendations based on the human and technical aspects of LCS in small scale applications. Four identical peripheral office rooms located in Lund, Sweden, were equipped with four different LCS: manual switch at the door, presence detector, daylight dimming with absence detector and LED task lamp. Each occupant performed ordinary office tasks for two weeks in each room in April-May 2013. A subjective evaluation concerning the general lighting experience and the appreciation of the LCS was carried out. The results indicate that the manual switch was greatly appreciated and it accomplished good energy performances (75% savings compared to the presence detector). The daylight-linked LCS achieved only slightly higher savings (79%), due to relatively high parasitic losses, but did not guarantee an optimal light environment. The desk lamp achieved 97% savings, but the lighting conditions were considered unacceptable by the office workers. In general, the participants in this study perceived all automatic controls as stressful. (Less)

There is an urgent need to start generating energy within cities in order to pave the way for a more sustainable and resilient society. Renewable energy by means of active solar energy systems (solar thermal, ST and/or photovoltaics, PV) can be generated using roofs and facades of buildings. In this study, the annual solar energy potential of typical Swedish city blocks was analysed in order to develop guidelines for urban planners and architects. The results show that the design of the city blocks has a significant effect (up to 50%) on the total annual solar energy production. The study also shows that the contribution from active solar energy can be significant even in the urban environment, but shading by adjacent buildings may greatly limit the total amount of energy produced.

Architects can play a key role in future solar-integrated architecture as they are involved in the building process from the beginning. Solar-integrated architecture takes both passive and active use of solar energy into account. The aim of this research was to gain insight into the actual design processes of solar-integrated buildings. Therefore, semi-structured interviews were conducted with Swedish architects who designed such buildings. Results showed that teamwork was experienced as crucial and building performance simulation tools were hardly used by the architects themselves. Results from these interviews serve as input for the development of new architectural guidelines for designing solar-integrated architecture as part of IEA-SHC Task 41: Solar Energy & Architecture.

A study is presented about the effects of three glazing colour types (blue, neutral, bronze) on daylight quality, arousal and switch-on patterns for electric lights. This study was carried out using a scale model (1:4) of an office room, where subjective evaluations of the luminous conditions were performed by 36 participants (mean age 23.8 years) with their upper bodies immersed in the model. The evaluations were achieved using questionnaires designed to assess five light quality factors: 1) visual comfort; 2) naturality; 3) pleasantness; 4) precision (of details and textures) and 5) light level. Mixed model analyses of the questions revealed significant higher scores for pleasantness (p = 0.003) comfort (p = 0.015) and light level (p = 0.044) for the bronze glazing type compared to the blue and neutral glazing, confirming results of earlier studies. Results from a paired t-test on the Karolinska Sleepiness Scale (KSS) scores indicated that the level of self-reported arousal decreased in presence of the blue glazing. However, the analysis did not reveal significant results regarding switch-on patterns of electric lights. Overall, the study shows that there is a preference for daylight filtered through bronze window glazing and that the glazing colour type may have a significant effect on arousal level of office workers. (C) 2012 Elsevier Ltd. All rights reserved. (Less)

Despite the wide diversity of available solar technologies, solar energy systems are still not considered as main stream technologies in building practice. This may be attributed to several factors such as lack of awareness and knowledge among architects, lack of tools supporting the design process, and lack of solar products designed for building integration. In order to address these issues, the IEA SHC Task 41 "Solar Energy and Architecture" was carried out during 2009 to 2012. The main aim was to promote the use of solar energy systems within high quality architecture. The main expected outcome is an increased use of solar energy in buildings, reducing the non-renewable energy use and GHG emissions. Fourteen countries participated. The work was organized in three subtasks: A) integration criteria and guidelines, B) tools and methods for architects, and C) case studies and communication guidelines. This article presents an overview of the Task's activities and results. The results include an inventory of computer tools, a literature review, a survey on solar systems perception and use by architects, a survey on needs regarding tools for solar design, recommendations for computer tool developers and different guidelines for solar product developers and architects. Finally an extensive collection of more than 250 case studies with integration of solar systems was evaluated and resulting in the online publication of around 65 selected cases demonstrating inspiring solar architecture. The results of Task 41 are also currently being disseminated through seminars and workshops for building professionals. (C) 2012 The Authors. Published by Elsevier Ltd. (Less)

This article presents key energy use figures and explores the energy saving potential for electric lighting in office buildings based on a review of relevant literature, with special emphasis on a North European context. The review reveals that theoretical calculations, measurements in full-scale rooms and simulations with validated lighting programs indicate that an energy intensity of around 10 kWh/m(2) yr is a realistic target for office electric lighting in future low energy office buildings. This target would yield a significant reduction in energy intensity of at least 50% compared to the actual average electricity use for lighting (21 kWh/m(2) yr in Sweden). Strategies for reducing energy use for electric lighting are presented and discussed, which include: improvements in lamp, ballast and luminaire technology, use of task/ambient lighting, improvement in maintenance and utilization factor, reduction of maintained illuminance levels and total switch-on time, use of manual dimming and switch-off occupancy sensors. Strategies based on daylight harvesting are also presented and the relevant design aspects such as effects of window characteristics, properties of shading devices, reflectance of inner surfaces, ceiling and partition height are discussed. (C) 2011 Elsevier B.V. All rights reserved. (Less)

BACKGROUND The RTS,S/AS01(E) candidate malaria vaccine is being developed for immunisation of infants in Africa through the expanded programme on immunisation (EPI). 8 month follow-up data have been reported for safety and immunogenicity of RTS,S/AS01(E) when integrated into the EPI. We report extended follow-up to 19 months, including efficacy results. METHODS We did a randomised, open-label, phase 2 trial of safety and efficacy of the RTS,S/AS01(E) candidate malaria vaccine given with EPI vaccines between April 30, 2007, and Oct 7, 2009, in Ghana, Tanzania, and Gabon. Eligible children were 6-10 weeks of age at first vaccination, without serious acute or chronic illness. All children received the EPI diphtheria, tetanus, pertussis (inactivated whole-cell), and hepatitis-B vaccines, Haemophilus influenzae type b vaccine, and oral polio vaccine at study months 0, 1, and 2, and measles vaccine and yellow fever vaccines at study month 7. Participants were randomly assigned (1:1:1) to receive three doses of RTS,S/AS01(E) at 6, 10, and 14 weeks (0, 1, 2 month schedule) or at 6 weeks, 10 weeks, and 9 months (0, 2, 7 month schedule) or placebo. Randomisation was according to a predefined block list with a computer-generated randomisation code. Detection of serious adverse events and malaria was by passive case detection. Antibodies against Plasmodium falciparum circumsporozoite protein and HBsAg were monitored for 19 months. This study is registered with ClinicalTrials.gov, number NCT00436007. FINDINGS 511 children were enrolled. Serious adverse events occurred in 57 participants in the RTS,S/AS01(E) 0, 1, 2 month group (34%, 95% CI 27-41), 47 in the 0, 1, 7 month group (28%, 21-35), and 49 (29%, 22-36) in the control group; none were judged to be related to study vaccination. At month 19, anticircumsporozoite immune responses were significantly higher in the RTS,S/AS01(E) groups than in the control group. Vaccine efficacy for the 0, 1, 2 month schedule (2 weeks after dose three to month 19, site-adjusted according-to-protocol analysis) was 53% (95% CI 26-70; p=0·0012) against first malaria episodes and 59% (36-74; p=0·0001) against all malaria episodes. For the entire study period, (total vaccinated cohort) vaccine efficacy against all malaria episodes was higher with the 0, 1, 2 month schedule (57%, 95% CI 33-73; p=0·0002) than with the 0, 1, 7 month schedule (32% CI 16-45; p=0·0003). 1 year after dose three, vaccine efficacy against first malaria episodes was similar for both schedules (0, 1, 2 month group, 61·6% [95% CI 35·6-77·1], p

A method is presented for assessing daylighting quality based on metrics related to illuminance, distribution, glare and directivity. The calculations are done using the programs RADIANCE and DAYSIM for a south-west and a north-west oriented offices in the CDP building in Montreal (latitude 45° 30'N). The results indicate that the following set of metrics is the most useful for assessing the daylighting quality of architectural spaces: Useful Daylight Illuminance (UDI), Daylight Glare Probability and Vector/Scalar illuminance ratio. The results also suggest that the daylight factor should be replaced by the UDI and that more empirical research is needed to establish appropriate criteria for acceptable luminance ratios in the case of well daylit buildings.

Summary Background RTS,S/AS01E is the lead candidate malaria vaccine. We recently showed efficacy against clinical falciparum malaria in 5–17 month old children, during an average of 8 months follow-up. We aimed to assess the efficacy of RTS,S/AS01E during 15 months of follow-up. Methods Between March, 2007, and October, 2008, we enrolled healthy children aged 5–17 months in Kilifi, Kenya, and Korogwe, Tanzania. Computer-generated block randomisation was used to randomly assign participants (1:1) to receive three doses (at month 0, 1, and 2) of either RTS,S/AS01E or human diploid-cell rabies vaccine. The primary endpoint was time to first clinical malaria episode, defined as the presence of fever (temperature ≥37·5°C) and a Plasmodium falciparum density of 2500/μL or more. Follow-up was 12 months for children from Korogwe and 15 months for children from Kilifi. Primary analysis was per protocol. In a post-hoc modelling analysis we characterised the associations between anti-circumsporozoite antibodies and protection against clinical malaria episodes. This study is registered with ClinicalTrials.gov, number NCT00380393. Findings 894 children were assigned, 447 in each treatment group. In the per-protocol analysis, 82 of 415 children in the RTS,S/AS01E group and 125 of 420 in the rabies vaccine group had first or only clinical malaria episode by 12 months, vaccine efficacy 39·2% (95% CI 19·5–54·1, p=0·0005). At 15 months follow-up, 58 of 209 children in the RTS,S/AS01E group and 85 of 206 in the rabies vaccine group had first or only clinical malaria episode, vaccine efficacy 45·8% (24·1–61·3, p=0·0004). At 12 months after the third dose, anti-circumsporozoite antibody titre data were available for 390 children in the RTS,S/AS01E group and 391 in the rabies group. A mean of 15 months (range 12–18 months) data were available for 172 children in the RTS,S/AS01E group and 155 in the rabies group. These titres at 1 month after the third dose were not associated with protection, but titres at 6·5 months were. The level of protection increased abruptly over a narrow range of antibody concentrations. The most common adverse events were pneumonia, febrile convulsion, gastroenteritis, and P falciparum malaria. Interpretation RTS,S/AS01E confers sustained efficacy for at least 15 months and shows promise as a potential public health intervention against childhood malaria in malaria endemic countries. Funding PATH Malaria Vaccine Initiative (MVI), GlaxoSmithKline.

Plasmodium falciparum Liver Stage Antigen 1 (LSA-1) is a pre-erythrocytic stage antigen. Our LSA-1 vaccine candidate is a recombinant protein with full-length C- and N-terminal flanking domains and two of the 17 amino acid repeats from the central repeat region termed "LSA-NRC." We describe the first Phase I/II study of this recombinant LSA-NRC protein formulated with either the AS01 or AS02 adjuvant system. We conducted an open-label Phase I/II study. Thirty-six healthy malaria-naïve adults received one of four formulations by intra-deltoid injection on a 0 and 1 month schedule; low dose (LD) LSA-NRC/AS01:10microg LSA-NRC/0.5ml AS01 (n=5), high dose (HD) LSA-NRC/AS01: 50microg LSA-NRC/0.5ml AS01 (n=13); LD LSA-NRC/AS02: 10microg LSA-NRC/0.5ml AS02 (n=5) and HD LSA-NRC/AS02: 50microg LSA-NRC/0.5ml AS02 (n=13). Two weeks post-second immunization, the high dose vaccinees and 6 non-immunized infectivity controls underwent experimental malaria sporozoite challenge. The vaccines showed a reassuring safety profile but were moderately reactogenic. There were no serious adverse events. All subjects seroconverted after the first immunization. Following the second immunization, LSA-1-specific CD4+ T cells producing two cytokines (IL-2 and IFN-gamma) were found by intra-cellular staining in all subjects in the LD LSA-NRC/AS01B group and in 3 of 5 subjects in the LD LSA-NRC/AS02 group. In contrast, the HD LSA-NRC/AS01 and HD LSA-NRC/AS02 group subjects had fewer LSA-1-specific CD4+ T cells, and minimal to no IFN-gamma responses. There was no increase in LSA-1-specific CD8+ T cells found in any group. Per protocol, 22 high dose vaccinees, but no low dose vaccinees, underwent P. falciparum homologous malaria challenge (3D7 clone). All vaccinees became parasitemic and there was no delay in their pre-patent period versus controls (p=0.95). LSA-NRC/AS01 and LSA-NRC/AS02 elicited antigen-specific antibody and CD4+ T cell responses, but elicited no protective immunity. Although the optimal antigen dose of LSA-NRC may not have been selected for the challenge portion of the protocol, further vaccine development based upon LSA-1 should not be excluded and should include alternative vaccine platforms able to elicit additional effector mechanisms such as CD8+ T cells.

In an effort to broaden the immune response induced by the RTS,S/AS02(A),vaccine, we have evaluated the immunogenicity of the RTS,S antigen when combined with MSP1(42) and with AMA1, antigens derived from the asexual blood stage. The objectives of this study were (i) to determine whether MSP1(42) and AMA1 vaccines formulated with the AS02(A) Adjuvant System were safe and immunogenic in the rhesus monkey model; (ii) to investigate whether MSP1(42) or AMA1 induced immune interference to each other, or to RTS,S, when added singly or in combinations at a single injection site; (iii) in the event of immune interference, to determine if this could be reduced when antigens were administered at separate sites. We found that MSP1(42) and AMA1 were safe and immunogenic, eliciting antibodies, and Th1 and Th2 responses using IFN-gamma and IL-5 as markers. When malaria antigens were delivered together in one formulation, MSP1(42) and RTS,S reduced AMA1-specific antibody responses as measured by ELISA however, only MSP1(42) lowered parasite growth inhibitory activity of anti-AMA1 antibodies as measured by in vitro growth inhibition assay. Unlike RTS,S, MSP1(42) significantly reduced AMA1 IFN-gamma and IL-5 responses. MSP1(42) suppression of AMA1 IFN-gamma responses was not seen in animals receiving RTS,S+AMA1+MSP1(42) suggesting that RTS,S restored IFN-gamma responses. Conversely, AMA1 had no effect on MSP1(42) antibody and IFN-gamma and IL-5 responses. Neither AMA1 alone or combined with MSP1(42) affected RTS,S antibody or IFN-gamma and IL-5 responses. Immune interference by MSP1(42) on AMA1 antibody responses was also evident when AMA1, MSP1(42) and RTS,S were administered concurrently at separate sites. These results suggest that immune interference may be complex and should be considered for the design of multi-antigen, multi-stage vaccines against malaria.

BACKGROUND We previously reported that the RTS,S/AS02A vaccine had an acceptable safety profile, was immunogenic, and demonstrated efficacy against Plasmodium falciparum malaria disease for 21 months. METHODS We conducted a randomized, controlled, phase 2b trial of RTS,S/AS02A in 2022 Mozambican children aged 1-4 years. We now report safety results for all randomized subjects and vaccine efficacy (VE) findings for children in the Manhica area over the 45-month surveillance period. RESULTS During the surveillance period, the VE((2.5-45)) (VE over months 2.5-45 of surveillance) against a first or only episode of clinical malaria disease was 30.5% (95% confidence interval [CI], 18.9%-40.4%; P < .001), and the VE((2.5-45)) against all episodes was 25.6% (95% CI, 11.9%-37.1%; P < .001). When the same period was considered, the VE((2.5-45)) for subjects protected against severe malaria was 38.3% (95% CI, 3.4%-61.3%; P = .045). At study month 45, the prevalence of P. falciparum was 34% lower in the RTS,S/AS02A group than in the control group (66 [12.2%] of 541 patients vs 101 [18.5%] of 547 patients) (P = .004). CONCLUSION These results show evidence that RTS,S/AS02A maintained protection during the 45-month surveillance period, and they highlight the feasibility of developing an effective vaccine against malaria. In combination with other malaria-control measures, such a vaccine could greatly contribute to reducing the intolerable global burden of this disease. Trial registration. ClinicalTrials.gov identifiers NCT00197041 and NCT00323622 .

The development of a vaccine for tuberculosis requires a combination of antigens and adjuvants capable of inducing appropriate and long-lasting T cell immunity. We evaluated Mtb72F formulated in AS02A in the cynomolgus monkey model. The vaccine was immunogenic and caused no adverse reactions. When monkeys were immunized with bacillus Calmette–Guérin (BCG) and then boosted with Mtb72F in AS02A, protection superior to that afforded by using BCG alone was achieved, as measured by clinical parameters, pathology, and survival. We observed long-term survival and evidence of reversal of disease progression in monkeys immunized with the prime-boost regimen. Antigen-specific responses from protected monkeys receiving BCG and Mtb72F/AS02A had a distinctive cytokine profile characterized by an increased ratio between 3 Th1 cytokines, IFN-γ, TNF, and IL-2 and an innate cytokine, IL-6. To our knowledge, this is an initial report of a vaccine capable of inducing long-term protection against tuberculosis in a nonhuman primate model, as determined by protection against severe disease and death, and by other clinical and histopathological parameters.

This article presents the results of a study where the effect of five window glazing types on daylight quality was investigated using a scale model (1:6) of a room with a single, south east-oriented window exposed to the natural sky. The space studied simulated a typical, fully furnished living room. A total of 30 research subjects took part in the experiment, observed the room and filled questionnaires, which covered seven factors related to daylight quality: light level, glare (comfort), naturalness, beauty and pleasantness, precision, light distribution and shadows. This study repeated some results from previous investigations although a different experimental design was used (within-subject, random-order, no comparison to reference). The results of the statistical analysis (ANOVA) indicated that the glazing type had a statistically significant effect on the perception of light level, naturalness, beauty/pleasantness and precision. The visual transmittance of the glazing type was positively cor...

Falciparum malaria vaccine candidates have been developed using recombinant, replication-deficient serotype 5 and 35 adenoviruses (Ad5, Ad35) encoding the Plasmodium falciparum circumsporozoite surface protein (CSP) (Ad5.CS, Ad35.CS) (Crucell Holland BV, Leiden, The Netherlands). To evaluate the immunogenicity of these constructs, BALB/cJ mice were immunized twice with either Ad5.CS, Ad35.CS, empty Ad5-vector (eAd5), empty Ad35 vector (eAd35), or saline. Another group received the CSP-based RTS,S malaria vaccine formulated in the proprietary Adjuvant System AS01B (GlaxoSmithKline Biologicals, Rixensart, Belgium). Here we report that Ad5.CS, Ad35.CS, and RTS,S/AS01B, elicited both cellular and serologic CSP antigen-specific responses in mice. These adenoviral vectors induce strong malaria-specific immunity and warrant further evaluation.

Summary Background Malaria remains a leading global health problem that requires the improved use of existing interventions and the accelerated development of new control methods. We aimed to assess the safety, immunogenicity, and initial efficacy of the malaria vaccine RTS,S/AS02D in infants in Africa. Methods We did a phase I/IIb double-blind randomised trial of 214 infants in Mozambique. Infants were randomly assigned to receive three doses either of RTS,S/AS02D or the hepatitis B vaccine Engerix-B at ages 10 weeks, 14 weeks, and 18 weeks of age, as well as routine immunisation vaccines given at 8, 12, and 16 weeks of age. The primary endpoint was safety of the RTS,S/AS02D during the first 6 months of the study, and analysis was by intention to treat. Secondary endpoints included immunogenicity and analysis of new Plasmodium falciparum infections during a 3-month follow up after the third dose. Time to new infections in the per-protocol cohort were compared between groups using Cox regression models. This study is registered with ClinicalTrials.gov, number NCT00197028. Findings There were 17 children (15.9%; 95% CI 9.5–24.2) with serious adverse events in each group. In the follow-up which ended on March 6, 2007, there were 31 serious adverse events in the RTS,S/AS02D group and 30 serious adverse events in the Engerix-B group, none of which were reported as related to vaccination. There were four deaths during this same follow-up period; all of them after the active detection of infection period had finished at study month 6 (two in RTSS/AS02D group and two in the Engerix-B group). RTS,S/AS02D induced high titres of anti-circumsporozoite antibodies. 68 first or only P falciparum infections were documented: 22 in the RTS,S/AS02D group and 46 in the control group. The adjusted vaccine efficacy was 65.9% (95% CI 42.6–79.8%, p Interpretation The RTS,S/AS02D malaria vaccine was safe, well tolerated, and immunogenic in young infants. These findings set the stage for expanded phase III efficacy studies to confirm vaccine efficacy against clinical malaria disease.

A pilot study for investigating the effect of six coated glazing materials on visual perception of the interior and of the view out in scaled rooms is presented. The study, which involved 18 subjects, is carried out in Hørsholm (Denmark, lat. 55.4°N), under overcast skies and a north orientation. The methodology involves subjective ratings using a questionnaire and seven grade bipolar scales. The results of the statistical analysis (ANOVA) show that despite significant amplitude in daylight transmittance (50%—79%), the glazing type did not have any statistically significant effect on the perception of the sharpness of shadows in the room. It is also found that higher transmittance glazing (77%—79%) resulted in views that are more glaring compared with the views obtained with the other glazing types. In terms of light level, the reference glazing (which contained an iron-free pane) results in statistically significant differences in the ratings (brighter room) compared with the ratings from all glazing types, including glazing types of similar transmittance. Finally, it is found that higher transmittance glazing types result in more positive ratings for factors, such as naturalness, beauty, and pleasantness and sharpness.

The RTS,S/AS02A protein-based vaccine consistently demonstrates significant protection against infection with Plasmodium falciparum malaria and also against clinical malaria and severe disease in children in areas of endemicity. Here we demonstrate with rhesus macaques that priming with a replication-defective human adenovirus serotype 35 (Ad35) vector encoding circumsporozoite protein (CS) (Ad35.CS), followed by boosting with RTS,S in an improved MPL- and QS21-based adjuvant formulation, AS01B, maintains antibody responses and dramatically increases levels of T cells producing gamma interferon and other Th1 cytokines in response to CS peptides. The increased T-cell responses induced by the combination of Ad35.CS and RTS,S/AS01B are sustained for at least 6 months postvaccination and may translate to improved and more durable protection against P. falciparum infection in humans.

We report the first safety and immunogenicity trial of the Plasmodium falciparum vaccine candidate FMP2.1/AS02A, a recombinant E. coli-expressed protein based upon the apical membrane antigen-1 (AMA-1) of the 3D7 clone formulated with the AS02A adjuvant. We conducted an open-label, staggered-start, dose-escalating Phase I trial in 23 malaria-naive volunteers who received 8, 20 or 40 μg of FMP2.1 in a fixed volume of 0.5 mL of AS02A on a 0, 1, and 2 month schedule. Nineteen of 23 volunteers received all three scheduled immunizations. The most frequent solicited local and systemic adverse events associated with immunization were injection site pain (68%) and headache (29%). There were no significant laboratory abnormalities or vaccine-related serious adverse events. All volunteers seroconverted after second immunization as determined by ELISA. Immune sera recognized sporozoites and merozoites by immunofluorescence assay (IFA), and exhibited both growth inhibition and processing inhibition activity against homologous (3D7) asexual stage parasites. Post-immunization, peripheral blood mononuculear cells exhibited FMP2.1-specific lymphoproliferation and IFN-γ and IL-5 ELISPOT assay responses. This is the first PfAMA-1-based vaccine shown to elicit both potent humoral and cellular immunity in humans. Encouraged by the potential of FMP1/AS02A to target host immunity against PfAMA-1 that is known to be expressed by sporozoite, hepatic and erythrocytic stages, we have initiated field trials of FMP2.1/AS02A in an endemic population in the Republic of Mali.