Background: Extubation failure can lead to a longer intensive care unit (ICU) stay, higher mortality rate, and higher risk of requiring tracheostomy. Chest physiotherapy (CPT) can help patients in reducing the accumulation of airway secretion, preventing collapsed lung, improving lung compliance, and reducing comorbidities. Much research has investigated the correlation between CPT and respiratory system clearance. However, few studies have investigated the correlation between CPT and failed ventilator extubation. Therefore, this study aimed to investigate the use of CPT for reducing the rate of failed removal from mechanical ventilators. Methods: This study was an intervention study with mechanical control. Subjects were divided into two groups. The control group, which received routine nursing chest care, was selected from a retrospective chart review. The intervention group was prospectively taken into the chest physiotherapy program. The chest physiotherapy treatment protocol consisted of inspiratory muscle training, manual hyperinflation, chest wall mobilization, secretion removal, cough function training, and early mobilization. Results: A total of 439 subjects were enrolled in the intervention and control groups, with a mean age of 69 years. APACHE II score (P = .09) and GCS scores (P = .54) were similar between the two groups. Compared to the control group, patients in the intervention group had a significantly lower reintubation rate (8% vs 16%; P = .01). Conclusions:The results indicate that intensive chest physiotherapy could decrease extubation failure in mechanically ventilated patients in the ICU. In addition, chest physiotherapy could also significantly improve the rapid shallow breathing index score.

Indoor air quality of the workplace is highly linked with occupants' health, comfort and satisfaction. To maintain the good indoor air quality of buildings, Post Occupancy Evaluation (POE) is often combined with environmental measurements to holistically examine existing performance conditions in relation to occupants' satisfaction. The Centre for Building Performance and Diagnostics (CPBD) at Carnegie Mellon University conducted post occupancy evaluations for over 1600 workstations in 64 buildings using the National Environment Assessment Toolkit (NEAT)-a suite of three tools for workstation IEQ measurements, Technical Attributes of Building Systems (TABS) and occupant satisfaction surveys. The rich dataset generated by NEAT was employed in this study to perform multivariate regression and multiple correlation coefficient analyses on Indoor Air Quality (IAQ). We examine the relationship between measured and perceived IAQ indices, as well as interdependencies between IAQ indices and occupant satisfaction variables of significance. Among measured IAQ indices, CO 2 and particulates are identified as critical factors for user satisfaction. In particular, the analyses revealed that the CO 2 threshold of 582 ppm is the highest occupant satisfaction in office buildings. To ensure good air quality in office buildings, our findings recommend "Operable window", "Dedicated exhaust", "Individual return air diffuser density" and "Low/medium partition height" as applicable design guidelines. Through this study, we demonstrate the effectiveness of integrating POE with environmental measurements to systematically develop a rich database leading to critical thresholds and design guidelines for highest occupant satisfaction.

No abstract

The Dou-Gong system in Asian timber structures plays an important role in resisting seismic action. Traditional carpentry in Asia uses timber pegs to connect components, which enables relative movement between components and hence provides friction to dissipate energy in an earthquake. This method, however, has some shortcomings, such as inadequate stiffness to resist a large lateral force, and, therefore, the structures tend to exhibit permanent deformation after earthquakes. This study proposes a new technique by using super-elastic alloy bars to replace conventional wooden peg connections to enhance the seismic performance of the structures. Static pushover experiments were conducted on full-scale two-tiered Dou-Gong systems, and high-strength steel and conventional wooden pegs were used as benchmarks. The ultimate stiffness of the Dou-Gong system has shown an increase when both high-strength steel and super-elastic alloy bars were used, but only super-elastic alloy can provide a consistently high damping ratio. This technique also involves pre-strain of the super-elastic alloy, and the outcomes of this series of experiments have shown that pre-strain of the super-elastic alloy can significantly increase the damping ratio in the structure, and, hence, more energy is dissipated. The results of this paper can be used in projects of timber structures using the Dou-Gong system.

Abstract. Achieving sustainability on an urban scale is an overwhelming problem. We can address this by dividing the problem into manageable proportions. Environmental impacts of urban design fall into measurable categories, for example, air quality, biodiversity, solid wastes, water and wastewater, hazardous materials, and impacts of nonrenewable energy use. Such measures are incorporated into building rating systems as a way of codifying sustainability. In this chapter, to illustrate such codification, we examine water use as well as generated wastewater according to the requirements of a specific sustainable building rating system. Conventional calculations are coupled with building information modeling to illustrate the overall effects of parametrically selecting fixtures, systems and materials to control the use of potable water. We further demonstrate how this approach of combining parametric building information modeling with measures of their environmental impacts can be employed on an urban scale, thereby, guiding the design of sustainable urban spaces.