FC 135A STEP TOWARD GREEN NEPHROLOGY: APPLYING THE PASSIVE HOUSE CONCEPT TO THE CONSTRUCTION OF DIALYSIS FACILITIES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Christophe Mariat ◽  
Jocelyne Rey ◽  
Annie Olivier ◽  
Perrine Jullien
Keyword(s):  
Health Care ◽  
Environmental Impact ◽  
Energy Savings ◽  
The Body ◽  
Sustainable Construction ◽  
Passive House ◽  
Pump System ◽  
Dialysis Facility ◽  
Dialysis Facilities ◽  
House Standard

Abstract Background and Aims The environmental impact of dialysis is now being largely recognized. It requires from the nephrology community to actively explore novel environmentally responsible health-care practices. Among them, conception of energy-efficient facilities may be an important prerequisite for improving the environmental impact of dialysis. The Passive House concept is an internationally recognised, performance-based energy standard in construction which so far has been rarely applied to medical facilities and never to dialysis centres. We report our experience with the first passive-house certified dialysis facility in Europe. Method The Passive House concept is a sustainable construction standard for nearly zero energy buildings (the Resolution of the European Parliament of 31/01/2008 has called for its implementation by all member states by 2021). Principles and design tools of the Passive House concept are freely available for all architects. The concept combines a particularly high level of insulation with a specific system of ventilation. Geothermal energy and energy from inside the building such as the body heat from the residents or solar heat entering the building are the main energy sources. Passive House buildings allow for heating and cooling related energy savings of up to 90% compared with typical building stock and over 75% compared with average new buildings. Results The François Berthoux Center (www.artic42.fr) is a 4 400 m2 dialysis facility operated by 40 health care agents and providing care to 135 patients. It was designed following the Passive-House standard, applied for the first time to such a medical building. Several adjustments specific to the dialysis activity were necessary. The most unexpected aspect was the importance of hemodialysis machines as an energy source. Thorough thermal evaluation showed that the heat provided by different type of hemodialysis machines was systematically superior to the energy mandatory during the coldest day of the year (>10 W/m2). In practice, the center turned out to be fully operational with no external source of heating. The downside was that the geothermal pump system was not sufficient to fully regulate temperatures during the warmest period of the year. Optimal cooling was achieved by the addition of conventional AC systems in the hemodialysis rooms. Overall, as compared to a similar center, energy savings provided by the The François Berthoux Center were substantially less than what is expected from a conventional Passive House building but were over 50%. The extra-cost of the construction was estimated to 3 to 5%. Conclusion In conclusion, the concept of eco-friendly building should extend to dialysis facilities. Application of the Passive House Standard in the context of hemodialysis requires to take into account some specificities that can impact the global environmental performance of the building. However, the net result is clearly in favor of such a construction, which is both affordable and sustainable.

scholarly journals Are the energy savings of the passive house standard reliable? A review of the as-built thermal and space heating performance of passive house dwellings from 1990 to 2018

2020 ◽  
Vol 13 (8) ◽  
pp. 1605-1631
Author(s):  
David Johnston ◽  
Mark Siddall ◽  
Oliver Ottinger ◽  
Soeren Peper ◽  
Wolfgang Feist
Keyword(s):  
Energy Savings ◽  
Space Heating ◽  
Passive House ◽  
Heating Performance ◽  
House Standard

scholarly journals Binary Linear Programming as a Tool of Cost Optimization for a Water Supply Operator

2021 ◽  
Vol 13 (6) ◽  
pp. 3470
Author(s):  
Przemysław Kowalik ◽  
Magdalena Rzemieniak
Keyword(s):  
Linear Programming ◽  
Water Supply ◽  
Electric Power ◽  
Energy Savings ◽  
Cost Optimization ◽  
Production Optimization ◽  
Production Costs ◽  
Pump System ◽  
Power Cost ◽  
Binary Linear Programming

The problem of scheduling pumps is widely discussed in the literature in the context of improving energy efficiency, production costs, emissions, and reliability. In some studies, the authors analyze the available case studies and compare the results; others present their own computational methods. In the paper, a problem of pump scheduling in regular everyday operations of a water supply operator is considered. The issues of water production optimization and energy savings are part of the topic of sustainable development. The objective of the article is the minimization of the cost of electric power used by the pumps supplying water. It is achieved thanks to the variability of both the demand for water and the price of electric power during the day combined with the possibility of storing water. The formulation of an existing electric power cost optimization problem as a binary linear programming problem was improved. An essential extension of the above mathematical model, which enables more flexible management of the pump system, was also proposed. An example containing real-world input data was successfully solved using Microsoft Excel with a free OpenSolver add-in.

Perceived Oral Health Literacy, Behaviors, and Oral Health Care among Caregivers to the Homebound Population

2021 ◽  
pp. 108482232110084
Author(s):  
Agata Wilk ◽  
Lisa LaSpina ◽  
Linda D. Boyd ◽  
Jared Vineyard
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Literacy ◽  
Oral Care ◽  
Oral Health Care ◽  
The Body ◽  
Current Evidence ◽  
Oral Health Literacy ◽  
Cross Sectional Survey ◽  
Cross Sectional

This study aimed to explore the level of perceived oral health literacy (OHL) among caregivers of the homebound population in the Chicago metropolitan area and how caregivers’ OHL impacts their oral care to the homebound population. The relationships between demographic characteristics, perceived OHL levels, personal oral health behaviors, and oral health care to clients were also assessed. This cross-sectional survey research examined 69 caregivers of the homebound population employed by home health agencies. The OHL was determined by the validated Health Literacy in Dentistry Scale (HeLD-14). Independent t-tests, chi-square tests set at p < .05 significance level, and logistic regressions were used for analysis. The mean age of participants was 43. The HeLD-14 scores indicated a high perceived OHL among this group. Caregivers came from diverse groups, and the majority spoke a second language at home. About 93% performed oral self-care the recommended amount of time or more, while only 57% did it for their clients. Those who cleaned clients’ mouth twice a day had a higher OHL score ( M = 23 compared to M = 19). About 43% did not check for sores in the client’s mouth, and those who checked had a higher OHL score ( M = 25 compared to M = 19). Controlling for OHL, age was a good predictor of oral care frequency to clients. These findings provide current evidence and add to the body of knowledge on OHL among homebound individuals. The results provide insights for designing a preventive approach in oral health care to the homebound population.

scholarly journals ‘Ilāj bi’l-Tadbīr (regimenal therapy): a core mode of Unani treatment

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Athar Parvez Ansari
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Holistic Approach ◽  
The Body ◽  
Core Mode ◽  
Unani Medicine ◽  
Therapeutic Applications ◽  
Leech Therapy ◽  
Care System

AbstractSince antiquity, the Unani system of medicine has been participating in health care system. Usually, four modes of treatment viz. regimenal therapy, dietotherapy, pharmacotherapy and surgery are applied for the treatment of diseases. Regimenal therapy is an important mode in which the morbid matter present in the body is either dispersed/excreted or its unnecessary production is blocked or its flow is restricted and the diseases are cured by natural healer of the body, consequently bring back the humoural stability. Nearly 30 regimens have been mentioned in classical Unani literature. Commonest regimenal procedures such as fasd (venesection/phlebotomy), hijāma (cupping), ta‘līq al-‘alaq (hirudotherapy/leech therapy), ishāl (purgation), qay’ (emesis), idrār-i-bawl (diuresis), huqna (enema), ta’rīq (diaphoresis), riyādat (exercise), dalk (massage), hammām (bathing), tadhīn (oiling), natūl (irrigation), sakūb (douching/spraying), inkibāb (steam/vapour application), takmīd (fomentation) etc. are usually applied for the management of various ailments. These regimenal procedures are completely based on holistic approach and are potential but needs to be explored scientifically. This review outlines the therapeutic applications of various regimens of regimenal therapy used in Unani medicine.

Underlying factors for successful project management to construct sustainable built assets

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Marios Stanitsas ◽  
Konstantinos Kirytopoulos
Keyword(s):  
Project Management ◽  
Construction Projects ◽  
Sustainability Indicators ◽  
The Body ◽  
Senior Management ◽  
Sustainable Construction ◽  
Online Questionnaire ◽  
Content Type ◽  
Theoretical Contribution ◽  
Sustainable Economic Growth

PurposeThis study aims to investigate the underlying factors that give rise to the set of sustainability indicators which are used for the implementation of sustainable construction projects and eventually the production of sustainable built assets.Design/methodology/approachTo accomplish the purpose of this research, an online questionnaire survey was administered to a sample of 200 experts. By employing the statistical method of exploratory factor analysis (EFA), five distinct dimensions (factors) of stakeholders' attitudes were revealed.FindingsThe findings indicate that the sustainability indicators are based on five underlying factors, namely (1) sustainable competitiveness; (2) stakeholder engagement; (3) sustainable economic growth; (4) social sustainability; and (5) resource conservation and environmental policy.Research limitations/implicationsMore studies would be welcome to verify the underlying factors revealed in this paper.Practical implicationsThe knowledge of the underlying factors enables senior management to maintain a balance of choices during the project management (PM) phase in order to implement and deliver sustainable construction projects. Furthermore, the findings deepen the understanding toward sustainable PM practices by providing insights on its core attributes.Originality/valueAs a theoretical contribution to knowledge, this study enhances the body of knowledge by revealing the underlying factors that give rise to the predefined set of the 82 sustainability indicators which are used to enable sustainable construction projects. In practice, the findings aid senior management in adopting strategies that enhance the delivery of sustainable construction projects.

scholarly journals Medicare’s New Prospective Payment System on Facility Provision of Peritoneal Dialysis

2018 ◽  
Vol 13 (12) ◽  
pp. 1833-1841 ◽  
Author(s):  
Virginia Wang ◽  
Cynthia J. Coffman ◽  
Linda L. Sanders ◽  
Shoou-Yih D. Lee ◽  
Richard A. Hirth ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Confidence Interval ◽  
Market Competition ◽  
Prospective Payment System ◽  
Payment System ◽  
Prospective Payment ◽  
System Effect ◽  
Number Of Patients ◽  
Dialysis Facility ◽  
Dialysis Facilities

Background and objectivesPeritoneal dialysis is a self-administered, home-based treatment for ESKD associated with equivalent mortality, higher quality of life, and lower costs compared with hemodialysis. In 2011, Medicare implemented a comprehensive prospective payment system that makes a single payment for all dialysis, medication, and ancillary services. We examined whether the prospective payment system increased dialysis facility provision of peritoneal dialysis services and whether changes in peritoneal dialysis provision were more common among dialysis facilities that are chain affiliated, located in nonurban areas, and in regions with high dialysis market competition.Design, setting, participants, & measurementsWe conducted a longitudinal retrospective cohort study of n=6433 United States nonfederal dialysis facilities before (2006–2010) and after (2011–2013) the prospective payment system using data from the US Renal Data System, Medicare, and Area Health Resource Files. The outcomes of interest were a dichotomous indicator of peritoneal dialysis service availability and a discrete count variable of dialysis facility peritoneal dialysis program size defined as the annual number of patients on peritoneal dialysis in a facility. We used general estimating equation models to examine changes in peritoneal dialysis service offerings and peritoneal dialysis program size by a pre– versus post-prospective payment system effect and whether changes differed by chain affiliation, urban location, facility size, or market competition, adjusting for 1-year lagged facility–, patient with ESKD–, and region-level demographic characteristics.ResultsWe found a modest increase in observed facility provision of peritoneal dialysis and peritoneal dialysis program size after the prospective payment system (36% and 5.7 patients in 2006 to 42% and 6.9 patients in 2013, respectively). There was a positive association of the prospective payment system with peritoneal dialysis provision (odds ratio, 1.20; 95% confidence interval, 1.13 to 1.18) and PD program size (incidence rate ratio, 1.27; 95% confidence interval, 1.22 to 1.33). Post-prospective payment system change in peritoneal dialysis provision was greater among nonurban (P<0.001), chain-affiliated (P=0.002), and larger-sized facilities (P<0.001), and there were higher rates of peritoneal dialysis program size growth in nonurban facilities (P<0.001).ConclusionsMedicare’s 2011 prospective payment system was associated with more facilities’ availability of peritoneal dialysis and modest growth in facility peritoneal dialysis program size.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_11_19_CJASNPodcast_18_12_.mp3

The relationships between obesity-increasing risk factors for public health, environmental impacts, and health expenditures worldwide

2018 ◽  
Vol 29 (1) ◽  
pp. 131-147 ◽  
Author(s):  
Eduardo Botti Abbade
Keyword(s):  
Public Health ◽  
Health Care ◽  
Environmental Impact ◽  
Environmental Impacts ◽  
Health Care Cost ◽  
Health Care Systems ◽  
Health Expenditures ◽  
Health Care Expenditures ◽  
Public Health Care ◽  
Content Type

Purpose The purpose of this paper is to investigate the associations between obesogenic severity, the public health situation, environmental impacts, and health care expenditures in populations worldwide. Design/methodology/approach This ecological study is based on official data available for approximately 140 countries worldwide. This study defines four main variables: obesogenic severity, environmental impact, public health implications (PHI), and health expenditures, all measured through specific indicators. Data were obtained mainly from the WHO, World Bank, and IDF. The indicators were reduced to the main variables through factorial reduction and multiple regression analyses were used to test the main hypotheses. Findings Obesogenic severity strongly and positively affects environmental impacts (β=0.6578; p<0.001), PHI-1 (cardiovascular risk factor) (β=0.3137; p<0.001) and PHI-2 (blood glucose and diabetes diagnoses) (β=0.3170; p<0.001). Additionally, environmental impacts strongly and positively affect PHI-1 (β=0.4978; p<0.001) but not PHI-2. Thus, results suggest that environmental impact, PHI-1, and PHI-2 strongly affect health expenditures (β=0.3154; p<0.001, β=0.5745; p<0.001, and β=−0.4843; p<0.001, respectively), with PHI-2 negatively affecting the health expenditures. Practical implications This study presents evidence that can aid in decision making regarding public and private efforts to better align budgets and resources as well as predict the needs and expenditures of public health care systems. Originality/value This investigation finds that the main variables addressed are strongly associated at the worldwide level. Thus, these analytical procedures can be used to predict public health and health care cost scenarios at the global level.

scholarly journals THE REDESIGN STRATEGY AT REGION GENERAL HOSPITAL TYPE B IN MAGELANG CITY

Arsitektura ◽  
2018 ◽  
Vol 16 (1) ◽  
pp. 15
Author(s):  
Prananda Fadhlul Husna ◽  
Sri Yuliani ◽  
Ahmad Farkhan
Keyword(s):  
Health Care ◽  
General Hospital ◽  
Research Method ◽  
The Body ◽  
Type B ◽  
Hospital Type ◽  
Analysis Study ◽  
Planning And Design ◽  
Hospital Building ◽  
Medical Equipments

<p class="Abstract"><em></em><em><em>Health is the prosperous state of the body, soul and social that must always be maintained by way of periodic checks to the hospital. The hospital is health care institutions that provides patient care with medical personsl, specialized nurses and medical equipments that need to be accredited to improve public services. The purpose of this redesain strategy is to formulate the concept of planning and design of Tidar Hospital of Magelang City that meet the criteria of the future. Redesign of RSUD Tidar in Magelang was conducted based on Hospital Building Technical Guidelines in 2012. </em><em>The research method is divided into three levels, programming, planning and design. Based on the results of the analysis study in field, the redesign has been obtained from the application of the Hospital Building Technical Guidelines. It should be designed on the outpatient installation can make the waiting area wider and the circulation of patients with the officers can be separated. The parking area is placed on the basement area so it is wider. For Emergency Installation is placed close to the main door so that the patient can go directly to this area and the circulation separate from the syringe to the inpatient and service area. Most of room programmes are designed based on universal accessibity.</em></em></p><p class="Abstract"><em>                                               </em></p>

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