Retrofitting Existing Buildings to Improve Energy Performance

Energy-efficient retrofits embrace enhancement of the building envelope through climate control strategies, employment of building-integrated renewable energy technologies, and insulation for a sustainable city. Building envelope improvements with insulation is a common approach, yet decision-making plays an important role in determining the most appropriate envelope retrofit strategy. In this paper, the main objective is to evaluate different retrofit strategies (RS) through a calibrated simulation approach. Based on an energy performance audit and monitoring, an existing building is evaluated on performance levels and improvement potentials with basic energy conservation measures. The considered building is experimentally monitored for a full year, and monitoring data are used in calibrating the simulation model. The validation of the base model is done by comparing the simulation analysis with the experimental investigation, and good agreement is found. Three different retrofit strategies based on Intervention of minor (RS1), Moderate (RS2), and Major (RS3) are analyzed and juxtaposed with the base model to identify the optimal strategy of minimizing energy consumption. The result shows that total energy intensity in terms of the percentage reduction index is about 16.7% for RS1, 19.87 for RS2, and 24.12% for RS3. Hence, RS3 is considered the optimal retrofit strategy and is further simulated for a reduction in carbon dioxide (CO2) emissions and payback investigation. It was found that the annual reduction in CO2 emissions of the building was 18.56%, and the payback period for the investment was 10.6 years.

Increasing labor income and real unit labor costs in Brazilian agrobusiness

This study analyzes the interactions between per worker labor income (PWLI), labor productivity, real unit labor costs, and the relationship between relevant employee (IPCA) and employers (GDP deflators) prices, specifically focusing on Brazilian agrobusiness. For that purpose, labor productivities of the entire agrobusiness sector and its segments were calculated from 2004 through 2015. We found that the gap between agrobusiness sector deflators and the IPCA did not play a preponderant role to mitigate the effect of PWLI growth of 3.81% annually on real unit labor cost (CURT), which only increased 0.21% annually. In turn, CURT was contained by productivity gains, boosted mainly by agriculture. Without this productivity growth, CURT would have increased at 3.7% annually, thus making unviable the observed simultaneous gains for employers and employees in the Brazilian agrobusiness sector. The result for the primary agrobusiness segment should be highlighted. Even with an annual increase of 4.07% in PWLI, the 7.24% annual growth in productivity implied on an average annual reduction in CURT (-2.56%); without this significant productivity growth, the same increase in PWLI would have boosted CURT by 4.7% annually.

The Penrose hypothesis in the second half of the 20th century: investigating the relationship between psychiatric bed numbers and the prison population in England between 1960 and 2018–2019

Background NHS Psychiatric beds comprise mental illness and intellectual disability beds. Penrose hypothesised that the number of psychiatric in-patients was inversely related to prison population size. Aims To ascertain whether the Penrose hypothesis held true in England between 1960 and 2018–2019. Method A time-series analysis explored the association between total prison population and NHS psychiatric beds; this was also tested for the male and female prison populations, using non-psychiatric beds as a comparator. Associations were explored with time lags of up to 20 years. Linear regression was conducted to estimate the size of the effect of bed closures. Results NHS psychiatric beds decreased 93% and the prison population increased 208%. A strong (r =−0.96) and highly significant negative correlation between these changes was found. Annual reduction in psychiatric bed numbers was associated with an increase in prison population, strongest at a lag of 10 years. The closure of mental illness and intellectual disability beds was associated with increases in female prisoners 10 years later. The only significant explanatory variable for the increase in male prison population was intellectual disability bed reduction. Conclusions The Penrose hypothesis held true between 1960 and 2018–2019 in England: psychiatric bed closures were associated with increases in prison population up to 10 years later. For every 100 psychiatric beds closed, there were 36 more prisoners 10 years later: 3 more female prisoners and 33 more male prisoners. Our results suggest that the dramatic increase in the female prison population may relate to the closure of NHS beds.

Turning green: the impact of changing to more eco-friendly respiratory healthcare. A carbon and cost analysis of Dutch prescription data.

Objectives Dry powder inhalers (DPIs) have a substantially lower global warming potential than pressurized metered-dose inhalers (MDIs). To help mitigate climate change, we assessed the potential reduction in CO2-equivalents when replacing MDIs by DPIs in the Netherlands, and estimated the associated cost. Design We performed a four-step analysis based on data from two national databases of two independent governmental bodies (Dutch National Healthcare Institute and the Dutch Healthcare Authority). First, we calculated the number of patients with Chronic Obstructive Pulmonary Disease (COPD) and asthma that were using inhalation medication (2020). Second, we calculated the number and total of daily defined doses of MDIs, DPIs, and soft mist inhalers and the number of spacers per patients, dispensed by non-hospital based pharmacies in 2020. Third, we estimated the potential reduction in CO2-equivalents (eq.) if all eligible patients (≥7 years old; COPD with ≤exacerbation per year) would switch from using MDIs to using DPIs as eco-friendly alternatives. Fourth, we performed a cost-effectiveness analysis. Results In 2020, 1.4 million patients used inhalers for COPD or asthma treatment. A total of 460 million defined daily doses (DDDs) from inhalers were dispensed, of which, after the exclusion of nebulisers, 50.4% were from MDIs. We estimated that this use could be reduced by 70% leading to annual reduction in emissions of 77 - 84 million kg CO2eq. saving at best EUR 49.8 million annually. Conclusions In the Netherlands, substitution of MDIs to DPIs for eligible patients is theoretically safe and in accordance with medical guidelines, while reducing emissions by 80 million kg.CO2eq. on average and saving at best EUR 49.8 million per year. This study confirms the potential climate and economic benefit of delivering eco-friendlier respiratory care.

Modeling Future Blood Requirements in Patients with Transfusion-Dependent β-Thalassemia in Greece

Introduction : In Greece, official data confirm that blood supply is consistently declining, primarily because of decreased voluntary blood donations. At this rate, it is unclear whether there will be sufficient red blood cell (RBC) units to meet future demand for patients with β-thalassemia. We modeled future blood demand in patients with transfusion-dependent β-thalassemia (TDT) over the next 15 years to assess whether such a demand can be met. Methods: A discrete time, stochastic, individual-based model, was developed to assess future blood needs of patients with TDT in Greece. The model adopted a cohort approach and patients enter the model shortly after birth and exit at death. The model was seeded with data from the National Registry for Hemoglobinopathies in Greece (NRHG; patient population) and data from the National Blood Centre (RBC units) (Table). To quantify the decrease in TDT incidence, a linear regression model was fitted to the incident cases as described by Voskaridou (Voskaridou E, et al. Ann Hematol 2019;98:55-66). The calculated annual reduction rate was then applied to the observed thalassemia major (TM) and thalassemia intermedia (TI) incident cases for 2012 (Voskaridou E, et al. Ann Hematol 2012;91:1451-1458). The model assumes the reduction would continue through to 2020, from which time the incidence curve would be constant. Results: The model estimates a decrease in both target population, primarily due to the implementation of the national prenatal screening program and TM related mortality, (9.2%, 18.6%, and 26.0% in 2025, 2030, and 2034, respectively) and in demand for RBC units (100,665, 89,428 and 80,565, respectively) over the next 15 years. After accounting for any blood donated, based on latest (2017) data as projected to 2020, Greece is expected to be short of 56,716 RBC units to meet needs of patients with TDT in 2020. By 2025, 2030, and 2034, cumulative required RBC units for patients with TDT are estimated to be 307,150, 501,698, and 617,074, respectively. Assuming RBC units are divided among patients ≥ 18 years and those < 18 years in line with the population mix in the NRHG, cumulative RBC units required for adult patients with TDT are estimated to be 292,837, 464,337, and 554,083 by 2025, 2030, and 2034, respectively. Conclusions: Though blood demand for patients with TDT is expected to decrease in line with a decrease in the patient population, it will remain a challenge for the healthcare system in Greece to meet the demand, primarily due to a continuing shortage of available RBC units from voluntary donations. This annual deficit is estimated to accumulate to over 600,000 units over the next 15 years. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Impact of childhood and maternal vaccination against diphtheria, tetanus, and pertussis in Colombia

Background: In Latin America, there are few studies of the impact of vaccination against diphtheria, tetanus, and pertussis. We estimate the impact of infant and maternal vaccination on the incidence of these diseases in Colombia.Design and methods: an interrupted time series study analyzing the incidence before and after of vaccination with DwPT (1975-2018) and with Tdap in pregnant women (2008-2018). A segmented regression model with negative binomial distribution estimated the change in level and trend of the predicted incidence ratio after vaccination in relation to the incidence if vaccination had not been started (IRR), using a Prais Winsten regression.Results: The pertussis IRR decreased immediately after the start of childhood vaccination (0.91, p=0.51), but this was only significant (1.01, p<0.001) along with the trend per year, after the start of maternal vaccination (0.98, p<0.001). In the absence of vaccination, the incidence would not have been reduced. Neonatal tetanus had the highest rate of change with significant reduction -1.69 - CI 95%: -2.91, -0.48). The trend after vaccination was the highest with an annual reduction of 19% (0.81, p=0.001). The change in incidence of diphtheria was significant, although slow (-0.02 - CI 95%: -0.04, -0.004). The sustained effect in the post-vaccination period was smaller (0.95, p=0.79).Conclusions: Childhood and maternal vaccination markedly reduced the incidence of pertussis and neonatal tetanus. It is necessary to maintain optimal vaccination coverage and surveillance, within an integrated elimination plan, which prevents the resurgence of these diseases.

Economic impacts of overweight and obesity: current and future estimates for eight countries

BackgroundObesity is a growing public health challenge worldwide with significant health and economic impacts. However, much of what is known about the economic impacts of obesity comes from high-income countries and studies are not readily comparable due to methodological differences. Our objective is to demonstrate a method for estimating current and future national economic impacts of obesity and apply it across a sample of heterogeneous contexts globally.MethodsWe estimated economic impacts of overweight and obesity for eight countries using a cost-of-illness approach. Direct and indirect costs of obesity from 2019 to 2060 were estimated from a societal perspective as well as the effect of two hypothetical scenarios of obesity prevalence projections. Country-specific data were sourced from published studies and global databases.ResultsIn per capita terms, costs of obesity in 2019 ranged from US$17 in India to US$940 in Australia. These economic costs are comparable to 1.8% of gross domestic product (GDP) on average across the eight countries, ranging from 0.8% of GDP in India to 2.4% in Saudi Arabia. By 2060, with no significant changes to the status quo, the economic impacts from obesity are projected to grow to 3.6% of GDP on average ranging from 2.4% of GDP in Spain to 4.9% of GDP in Thailand. Reducing obesity prevalence by 5% from projected levels or keeping it at 2019 levels will translate into an average annual reduction of 5.2% and 13.2% in economic costs, respectively, between 2020 and 2060 across the eight countries.ConclusionOur findings demonstrate that the economic impacts of obesity are substantial across countries, irrespective of economic or geographical context and will increase over time if current trends continue. These findings strongly point to the need for advocacy to increase awareness of the societal impacts of obesity, and for policy actions to address the systemic roots of obesity.

The Energy Consumption Control as Support to The Environmental and Economic Sustainability of Public Universities

Energy consumption at Universities follows specific standards related to the development of its education, research, and extension activities. For these activities’ continuity, the supply of energy must have a high level of reliability, without, however, compromising the economic sustainability of the institutions. That is because energy expenditures, in some cases, can be relevant for Universities, especially to public institutions in developing countries, which routinely deal with budget restrictions. On the other hand, energy efficiency and rational energy consumption, have a direct impact on these organizations' environmental sustainability indicators, such as their carbon footprint. In this sense, considering that the Universidade Federal do Rio Grande do Sul faces economic challenges, which often make investments in innovative technologies impossible, we compare strategies to optimize its energy consumption. These strategies should achieve better levels of emission reduction and economic costs related to this resource. Therefore, the objective of this study is to analyze how Public Universities, in developing countries, can optimize their energy consumption, even under budget restrictions. To this end, the results from three strategies adopted by the University, since 2016, to reduce the energy consumption are discussed: (i) increased individual monitoring of consumption points; (ii) optimization and detailed analysis of energy consumption data; and (iii) extensive implementation of reduced summer hours. With the adoption of these practices, it was observed an annual reduction in energy consumption of 6% and 20%, reaching 33.70% on average during the summer period. Thus, it was possible to guide the energy policies of the University, which can change consumption patterns, leading to a reduction in greenhouse gas emissions and a better economic equilibrium