Warm Room Research Articles

Spatial and temporal access to warm spaces during the winter of 2022/2023

It is estimated that over half a million people visited one network of ‘warm rooms’ during the winter of 2022 in the UK, a figure that may rise to 2.5 million people if other networks are considered. As well as offering a means to try to limit exposure to cold temperatures and reduce household energy costs, these winter warm hubs also address wider concerns such as social isolation, loneliness and mental well-being as the cost-of-living bites. This graphic demonstrates how geospatial approaches can be used to explore access via public transport and walking to a network of warm spaces in the capital city of Cardiff, Wales. By accounting for site opening times in relation to existing bus timetables for those for whom walking may not be an option, we illustrate how such information can be included in three commonly applied access measures (floating catchment area, cumulative opportunity and shortest distance) to highlight potential spatio-temporal gaps in provision across the city.

Expanded glass sphere/lauryl alcohol composite in gypsum: Physico-mechanical properties, energy storage performance and environmental impact assessment

In recent years, thermal energy storage systems, which are a promising solution to improve the thermal comfort of buildings and reduce energy demand, are a critical issue. This study aims to develop a new shape-stable gypsum composite using expanded glass sphere (EGS) and lauryl alcohol (LA) and analyses its thermal performances. For this purpose, EGS was impregnated with LA in different mass fractions (25 and 50%) by direct impregnation technique. DSC results exposed that melting temperature and melting enthalpy of shape-stable EGS/LA composite were 20.97 °C and 83.1 J/g, respectively. FTIR investigations confirmed the existence of well chemical compatibility between EGS and LA. TGA analysis revealed that the operating temperature of EGS/LA was considerably lower than its thermal degradation temperature. While incorporation of EGS and EGS/LA composite increases water absorption and porosity; caused a decrease in compressive strength, dry unit weight and ultrasound pulse velocity properties. EGS/Gypsum composite with LA (50%) provided a warmer room temperature for more than 12 h between midnight and solar noon hours. It achieved about 2 ℃ warmer room during these hours. After solar noon hours, proposed composite attained about 3.6 ℃ cooler room center temperatures. It provided cooler indoor temperatures for more than 5 h. A warmer indoor temperature was observed for EGS/Gypsum composite with LA (50%) after 18:00 until midnight to be 2 ℃. It can provide a carbon emission saving of around 3–23.2 kg-CO2/kWh, depending on fuel type for a wall cover made of EGS/Gypsum with LA.

STUDY RECOMMENDATIONS TO ACHIEVE THERMAL COMFORT IN AN EDUCATIONAL BUILDING

This paper evaluates natural ventilation effectiveness in one fully dependent Air Conditioned-Educational Building in Depok to recommend potential passive cooling approaches toward user thermal comfort. This study involves building surveys to measure the temperature and humidity of three selected classrooms, A, B, and C, with varying configurations and capacities. Airflow simulation using Computational Fluid Dynamics (CFD) is done under two conditions: open and closed doors. A set of parameters, which are room configuration, type of window, and ventilation strategy, are set to evaluate natural ventilation aspects. The site survey indicates that only one classroom with an area of 92 sqm facing to the southside is classified as efficiently warm (Room A). The simulation demonstrates that cross-ventilation only occurs when the door is opened. The parameters indicating shape, dimension, type, and area of natural ventilation matter, show that the building’s natural ventilation is ineffective in providing thermal comfort. This study recommends that the building’s natural ventilation be placed according to the direction of the airflow, adding vertical fin elements, and increasing the openings by more than 5% area from the floor area.

Rudolf Richard Buchheim, the founder of pharmacology.

Today, the University of Tartu (earlier Dorpat) belongs among the 250 best universities of the world. Its international team of pharmacologists uses powerful confocal microscopes to study apoptosis and cell death within an international consortium. Science is working on solutions to fight Alzheimer disease, which is a torture for humankind. For this to happen today, the foundation was laid by scientists of previous centuries who deserve our great respect, all of them together and everyone separately. Johannes Piiper, a well-known professor of physiology, once told me in a conversation that articles should be published in every 10years about the men who have served as examples for the science of the present-day world and about the conditions in which their research was done. It is essential that researchers working in modern laboratories would not forget in their smugness that the laboratory has not always been a warm and well-lit room full of expensive technology, and not always have millions been allocated for research grants. Electricity came to Dorpat as late as in 1892. In the harsh Estonian winter, ice sometimes covered the inner walls of the Old Anatomical Theatre. Dorpat received railway connection in 1876. When I have made presentations in American countries, I have repeatedly been asked why the pharmacologists of the University of Tartu have not published an illustrated biography of Rudolf Richard Buchheim. As I have worked in the rooms the construction of which was directed by R. Buchheim as Dean of the Faculty of Medicine, I am trying to correct this shortcoming at least to some extent. I have written about Buchheim earlier, but then the print volume was limited. In this article, I have attempted to fill the gaps where the earlier materials have been erroneous or incomplete. So, the article will explain the formation of the large family of Buchheims. Several articles have given the impression that when Buchheim arrived in Dorpat, there were no facilities at all, and, therefore, he founded the laboratory in the basement of his dwelling house. This article will also bring clarity to that. Through O. Schmiedeberg's memories, we will see the great difficulties with which Buchheim's viewpoints broke through and were accepted. The question where Buchheim's laboratory was situated after Buchheim moved house in 1852 until the completion of the annex to the Old Anatomical Theatre in 1860 will also be answered. The article also brings some clarity about R. Buchheim's children. For the first time, it has been summed up how R. Buchheim is commemorated in different towns and countries. The article includes photos from Estonian and foreign archives; some photos have also been received from cooperation partners. Photos available on the Internet as freeware have also been used. The mid-nineteenth century brought a whole constellation of talented scientists to the German-language University of Dorpat (now Tartu in Estonia, founded 1632) on the outskirts of the Russian Empire. They did not tinker on their own but were engaged in successful cooperation. Thus, the celebrities who happened to work in Tartu simultaneously included Professor of Anatomy and Physiology Georg Friedrich Karl Heinrich Bidder; founder of physiological chemistry, chemist Carl Ernst Heinrich Schmidt; and Rudolf Richard Buchheim whom Professors E. A. Carus and F. Bidder had invited to Tartu to work as Head of the Department of Materia Medica, Dietetics and History of Medicine. Together, the three talented and hardworking scientists cleared the path to research-based medicine and wrote their names into the history of world medicine forever. By introducing chemical analysis and animal experiments, R. Buchheim laid the foundation to scientific pharmacology.

Microencapsulated phase change material incorporated light transmitting gypsum composite for thermal energy saving in buildings

The increased energy consumption for specific applications, including heating, cooling, air conditioning and lighting of residential and commercial buildings accelerate the research efforts concentrated on developing thermal energy storage capacity of buildings materials in recent years. Likewise, the development of light-transmitting building elements is a novel energy-saving technique that enhances lighting efficiency in buildings. In light of these, the current study seeks to design an untried microencapsulated phase change material (MPCM) integrated glass fiber reinforced gypsum composite with sufficient light-transmitting properties and thermal energy storage capacity. In this research, a multi-scale investigation of light-transmitting gypsum composite was conducted experimentally with physical, mechanical, chemical, microstructural, thermal, light transmittance and solar thermoregulation tests. The gypsum composite is formed from α-gypsum, water, polymer admixture, alkali-resistant glass fiber (AR-GF), several concentrations of MPCM, and plastic optical grids to allow light to transmit through the board. Although higher fractions of MPCM yielded an apparent decrease in mechanical strength test results, 5 wt% introduction of MPCM to the reference matrix reduced the compressive and flexural strength of specimens by 1 and 8 %, respectively. The results verified a reduction trend in thermal conductivity of composites with MPCM loading. DSC investigations revealed that the melting temperature and the regarding latent heat storage capacity of gypsum composite with 15 wt% of MCPM are 17.76 °C and 19.2 J/g, respectively. Light-transmitting gypsum composites showed up to ~10 % light transmittance, that can greatly increase the efficiency of lighting in buildings. The produced gypsum composites with MPCM kept the test room cooler during the highest temperature, while it provided a warmer room during the nighttime for an extended time. The study's findings are applicable to increase thermal comfort by reducing the significant temperature variations in buildings and improving artificial lighting efficiency, encouraging the design of sustainable building applications.

PD26-12 FLACCID PENILE ULTRASOUND: A NEW POTENTIAL TOOL TO PREDICT THE INDIVIDUAL 10-YEAR RISK OF CARDIOVASCULAR DISEASE

You have accessJournal of UrologyCME1 Apr 2023PD26-12 FLACCID PENILE ULTRASOUND: A NEW POTENTIAL TOOL TO PREDICT THE INDIVIDUAL 10-YEAR RISK OF CARDIOVASCULAR DISEASE Giovanni Cochetti, Giuseppe Maiolino, Michele Del Zingaro, Alessio Paladini, Graziano Felici, Giulia Manfredini, Angelica Tancredi, and Ettore Mearini Giovanni CochettiGiovanni Cochetti More articles by this author , Giuseppe MaiolinoGiuseppe Maiolino More articles by this author , Michele Del ZingaroMichele Del Zingaro More articles by this author , Alessio PaladiniAlessio Paladini More articles by this author , Graziano FeliciGraziano Felici More articles by this author , Giulia ManfrediniGiulia Manfredini More articles by this author , Angelica TancrediAngelica Tancredi More articles by this author , and Ettore MeariniEttore Mearini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003304.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cardiovascular risk has become a hot topic in evaluation of patients with vasculogenic erectile dysfunction (ED). Recently, European Society of Cardiology (ESC) designed a cardiovascular disease (CVD) Risk Calculation App to calculate individual 10-year risk of CVD for healthcare professionals based on specific population-target scores. Aim of our study is to evaluate the association between mean basal peak systolic velocity of cavernosal arteries and the 10-year risk in men with vasculogenic ED. METHODS: We prospectively evaluated all patients with vasculogenic ED who underwent penile ultrasound between September 2021 and July 2022. All patients were examined in the same setting: quiet and warm room, one expert operator, sampling of basal PSV in the first third of cavernosal artery with an angle of doppler between 40-50° and calculation of mean basal PSV (mbPSV) between right and left cavernosal artery. Exclusion criteria were: neurological disease or spinal injury, psychogenic (clinical suspicious and/or Beck Inventory Scale ≥14) erectile disfunction. For each patient we calculated 10-year risk of CVD disease using SCORE2 for patients between 40 and 69 years without history of cardiovascular disease and diabetes mellitus, SMART score for patients with a history of cardiovascular disease and ADVANCE score for patients with diabetes mellitus. All risk scores were calculated by CVD Risk Calculation App of ESC. Ethical Committee approval has been obtained. RESULTS: We enrolled 80 consecutive patients. Mean age and BMI were 57,9 years and 26,8 Kg/m2, respectively. Median IIF-5 was 13,7. Average mbPSV and 10-year risk of CVD disease resulted 13,6 cm/sec (range: 5,3 -32,4 cm/sec) and 10,8% (range: 1,9-34%), respectively. We found an inverse and significant correlation between mbPSV and 10-year risk of CVD disease (r: -0.29; p: 0,02). The correlation resulted significant in patients with a history of cardiovascular disease which were evaluated by SCORE2 (r: -0.34; p: 0,017) and a stronger significant inverse correlation was found between mbPSV and 10-year risk of CVD in patients with diabetes mellitus in which the cardiovascular risk was calculated by ADVANCE score (r: -0.61; p: 0,021). mbPSV resulted significantly correlated also with age (r: -0.28; p: 0,021). CONCLUSIONS: MbPSV is a useful screening tool in patients with vasculogenic ED to evaluate 10-year risk of cardiovascular (CVD) disease. A lower mbPSV is correlated with a higher cardiovascular risk, especially in patients with diabetes mellitus where risk is calculated by ADVANCE score. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e739 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Cochetti More articles by this author Giuseppe Maiolino More articles by this author Michele Del Zingaro More articles by this author Alessio Paladini More articles by this author Graziano Felici More articles by this author Giulia Manfredini More articles by this author Angelica Tancredi More articles by this author Ettore Mearini More articles by this author Expand All Advertisement PDF downloadLoading ...

THE EFFECT OF THERMAL COMFORT ON THE HEALTH OF OCCUPANTS AT CITRA GRAHA HOUSING

Humans mostly spend much time indoors, which is residential houses, so it is necessary to pay attention to thermal comfort because thermal comfort is closely related to health. Simple residential houses have the potential to cause thermal discomfort because simple houses are synonymous with dense settlements where building density is affected by the distance between buildings, building height, and building dimensions which will affect wind speed, temperature, and humidity. Thermal comfort is not only influenced by environmental aspects but also by one's condition. Although thermal comfort generally does not cause serious illness, it can significantly impact a person's quality of life and performance level. This study aims to analyze the thermal comfort in modest housing and the effect of thermal comfort on the health of the occupants. This research uses mixed methods, qualitative and quantitative, with data collection through direct field observation, simulation using Sefaira software and distribution questionnaires. The sample is a simple housing that is densely populated, namely Citra Graha Housing. Citra Graha Residential Housing residents feel thermal discomfort and depend on artificial ventilation in their homes. The results of this study indicate that the thermal comfort conditions of Citra Graha Housing do not meet ASHRAE 55 standards with relatively warm room conditions and tend to be hot throughout the day. Citra Graha housing already uses a type of opening that follows the Minister of Health Decree No.1077/MENKES/PER/V/2011 standard. Regarding the effect of thermal comfort on health, the variable thermal comfort partially does not affect health. Meanwhile, it simultaneously influences thermal comfort with a percentage of 54.7%

Hypothermia in clinical practice

Hypothermia or cold injury is a fairly common occurrence. The number of frostbite and cold injury varies annually in the regions of Russia and is directly related to the peculiarities of the local climate. In cities with a temperate climate, cold injury makes up no more than 1% of the total structure of injuries, while in the Far North it reaches 6-10%, being a characteristic problem for this area. The pathogenesis of frostbite is complex and diverse. Due to cold exposure, hemorheology disorders occur in the affected segments, persistent endothelial dysfunction is formed with changes in peripheral innervation in the focus of alteration and perifocally, which leads to thrombosis and necrosis of the affected limb tissues. Basic help algorithm: 1. To ensure transportation to a warm room, active outdoor warming, i.e. to cover with a heat-insulating blanket, in the absence of offer the usual. 2. Offer warm water in a small amount for hypovolemia 3. Warm infusions with isotonic solutions of crystalloids. 4. Warming should be started from the trunk, not from the limbs, to avoid collapse. 5. Hemodialysis, used only in a hospital setting

Light transmitting glass fiber reinforced cementitious composite containing microencapsulated phase change material for thermal energy saving

The energy utilization for artificial lighting, cooling, heating, and air conditioning in buildings results in the release of greenhouse gases and causes climate crises. In this regard, a novel light-transmitting cementitious composite (LTCC) was developed by substituting microencapsulated phase change material (MPCM) to reduce the building energy utilization via transmitted light through the composite and improve the solar thermal energy efficiency. The cementitious matrix is produced with cement, kaolin, silica sand, water, superplasticizer, adhesive polymer, glass fiber, different ratios of MPCM, and plastic optical grids to let inward sunlight transmittance. The current study thoroughly investigates the characteristics of light-transmitting composite, including MPCMs, via physico-mechanical, chemical, microstructural, thermal, light transmittance and solar thermoregulation tests. The thermal conductivity of the composite with 0 wt% MPCM decreased from 1.09 W/mK to 0.96 W/mK with 15 wt% MPCM addition. Incorporating 10 wt% of MPCM reduced the 28 days-compressive strength of specimens by almost 28 % due to the lower strength and density of microcapsules, as well as the voids formed by damaged MPCMs. On the other hand, the incorporation of MPCM did not dramatically affect the flexural strength of the cementitious composite. DSC analysis results revealed that the composite containing 15 wt% MPCM shows a latent heat of fusion of 14.6 J/g with a melting point of 17.65 °C. FTIR analysis disclosed that MPCM maintains its chemical structure in the composite. Composite slabs exhibited up to 12.4 % artificial light transmittance, which would translate to a considerable increase in the lighting efficiency of commercial and residential buildings. Thermoregulation performance test under ambient conditions indicates that the specimen containing 15 wt% MPCM can provide a cooler room temperature for 6.5 h when the room or surface temperatures increase above 21–23 °C, and a warmer room when the temperature decreases below these temperatures. The findings of the current study can be applied to enhance thermal energy saving and artificial lighting efficiency in buildings that inspire the design of environment-friendly constructions.

Differences Baby's Body Temperature in the Six Hours Postpartum between a Cold Room And A Warm Room

Differences Baby's Body Temperature in the Six Hours Postpartum between a Cold Room And A Warm Room

Effect of indoor temperature on the velocity fields and airborne transmission of sneeze droplets: An experimental study and transient CFD modeling

The spread of the COVID-19 pandemic through the airborne transmission of coronavirus-containing droplets emitted during coughing, sneezing, and speaking has now been well recognized. This study presented the effect of indoor temperature (T∞) on the airflow dynamics, velocity fields, size distribution, and airborne transmission of sneeze droplets in a confined space through experimental investigation and computational fluid dynamic (CFD) modeling. The CFD simulations were performed using the renormalization group k-ε turbulence model. The experimental shadowgraph imaging and CFD simulations showed the time evolution of sneeze droplet concentrations into the turbulent expanded puff, droplet cloud, and fully-dispersed droplets. Also, the predicted mean velocity of droplets was compared with the obtained experimental data to assess the accuracy of the results. In addition, the validated computational model was used to study the sneeze complex airflow behavior and airborne transmission of small, medium, and large respiratory droplets in confined spaces at different temperatures. The warm room showed more than ∼14 % increase in airborne aerosols than the room with a mild temperature. The study provides information on the effect of room temperature on the evaporation of respiratory droplets during sneezing. The findings of this fundamental study may be used in developing exposure guidelines by controlling the temperature level in indoor environments to reduce the exposure risk of COVID-19.

Air curtains: validation of results from small-scale laboratory waterbath experiments by real-scale measurements in climate chambers and numerical simulations

An air curtain is a planar turbulent air jet, which is used to separate two zones maintained at different temperatures. One of the aims of using an air curtain in the doorway of a building is to minimise the heat losses from the warm room to the cold environment and thus, to save energy. It is important to know how well an air curtain performs in a given operating scenario in order to assess its energy saving potential. In recent literature, it was proposed to use the waterbath experimental technique as a quick and inexpensive tool for testing the performance of an air curtain in a given scenario. The first central objective of the present study is to validate whether results obtained from small-scale waterbath experiments (WB) are adequate to describe the performance of a real-scale air curtain. To this end, we selected scenarios previously investigated by means of WB experiments and conducted real-scale measurements (RS) with a commercially available air curtain device (ACD) in a climate chamber, and RANS numerical simulations (NS) reproducing the configuration of the ACD in the climate chamber. These scenarios include (I) the base case of a downwards discharging air curtain when the doorway is the only connection between the two rooms, (II) the case when there is an additional top-level ventilation pathway between the rooms as well as (III) the case of a downwards blowing heated air curtain when the rooms are again joined only by the doorway. The second main goal of the present study is to verify the previously developed theoretical models for scenarios (II) and (III) by real-scale measurements and numerical simulations. As the main results, we establish that the effectiveness curves for an ACD obtained from WB experiments on the one hand as well as RS and NS measurements on the other exhibit the same general trends but also possess some minor differences for which we offer possible explanations. Furthermore, we find that RS and NS data are very well described by the previously proposed theoretical models in scenarios (II) and (III). The main finding of the present study is that the waterbath technique can be used as a reliable investigation tool to assess the general trends of the performance of an ACD in a given scenario but should be complemented by a small amount of RS or NS measurements if the finer details are important.

Occurrence of foodborne pathogens in Italian soft artisanal cheeses displaying different intra- and inter-batch variability of physicochemical and microbiological parameters.

Artisanal cheeses are produced in small-scale production plants, where the lack of full automation and control of environmental and processing parameters suggests a potential risk of microbial contamination. The aim of this study was to perform a longitudinal survey in an Italian artisanal factory producing a spreadable soft cheese with no rind to evaluate the inter- and intra-batch variability of physicochemical and microbial parameters on a total of 720 environmental and cheese samples. Specifically on cheese samples, the evaluation was additionally performed on physicochemical parameters. Cheese samples were additionally collected during 15 days of storage at constant temperatures of 2 and 8°C, as well as a dynamic profile of 2°C for 5 days and 8°C for 10 days. Furthermore, Enterobacteriaceae isolates were identified at species level to have a better knowledge of the environmental and cheese microbiota potentially harboring human pathogens. High inter-batch variability was observed for lactic acid bacteria (LAB) and total bacteria count (TBC) in cheese at the end of production but not for pH and water activity. A temperature of 8°C was associated with a significantly higher load of Enterobacteriaceae in cheeses belonging to batch 6 at the end of storage, and this temperature also corresponded with the highest increase in LAB and TBC loads over cheese shelf life. Results from generalized linear mixed models (GLMMs) indicated that drains in the warm room and the packaging area were associated with higher levels of TBC and Enterobacteriaceae in cheese. Regarding foodborne pathogens, no sample was positive for verotoxigenic Escherichia coli (VTEC) or Listeria monocytogenes, whereas six Staphylococcus aureus and one Salmonella pullorum isolates were collected in cheese samples during storage and processing, respectively. Regarding Enterobacteriaceae, 166 isolates were identified at species level from all batches, with most isolates belonging to Klebsiella oxytoca and pneumoniae, Enterobacter cloacae, Hafnia alvei, and Citrobacter freundii evidencing the need to focus on standardizing the microbial quality of cow milk and on hygienic procedures for cleaning and disinfection especially in warm and maturation rooms. Further studies should be performed to investigate the potential pathogenicity and antimicrobial resistance of the identified Enterobacteriaceae species in artisanal cheeses.

Perioperative active warming for preventing neonatal hypothermia: the Neohyp trial

Background Perioperative hypothermia for women undergoing elective caesarean section is a common comorbidity, which may result in neonatal hypothermia when at-birth skin-to-skin contact is performed. This trial compared the effectiveness of warm intravenous and room temperature fluids among women performing at birth skin-to-skin contact on perioperative neonatal and maternal heat loss. Methods A double-blind, randomised controlled trial compared warm and room temperature intravenous fluids in 150 healthy women performing at birth skin-to-skin contact while undergoing elective caesarean section. Analysis was based on intention-to-treat. Results Active warming of women significantly reduced neonatal (P=0.02) and maternal (P=0.0027) hypothermia at the end of skin-to-skin contact in the operative theatre, maternal hypothermia on post-anaesthesia care unit admission (P=0.0022) and maternal shivering (P=0.0001). Conclusions Administering warm intravenous fluids during caesarean section when skin-to-skin contact is performed at birth is a safe practice with multiple health benefits for both newborns and their mothers. Consideration should be given to incorporating this intervention into clinical practice procedures promoting skin-to-skin contact in women undergoing elective caesarean section.

Warm saline effectiveness for pain relief in office hysteroscopy: A systematic review and meta-analysis of randomized controlled trials.

To evaluate the impact of warm distension medium versus room temperature distension medium on pain control among patients undergoing office hysteroscopy. A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI web of science from inception to October 2021. We selected randomized clinical trials (RCTs) compared warmed saline distension medium in the intervention group versus room temperature distension medium in the control group among women undergoing diagnostic and/or operative office hysteroscopy. Revman software was utilized for performing our meta-analysis. Our primary outcomes were pain scores evaluated by the visual analog scale (VAS) during and after the procedure. Our secondary outcome was the patient satisfaction between both groups. Five RCTs met our inclusion criteria with a total number of 441 patients. We found warm saline was linked to a significant reduction in the VAS pain score during the procedure compared to the control group (mean difference [MD] = -1.12, 95% confidence interval [CI] [-1.80, -0.45], p = 0.001). Moreover, the VAS pain score after the procedure was significantly declined among the warm saline group (MD = -0.62, 95% CI [-0.97, -0.27], p = 0.005). Interestingly, more patients were significantly satisfied with warm saline distension medium application compared to room temperature group (odds ratio [OR] = 3.71, 95% CI [2.01, 6.86], p < 0.001). Warm saline application in office hysteroscopy is effective in reducing pain during and after the procedure as well as improvement in patient satisfaction.

587 Ambient temperatures in the burn operating room: A QI initiative

IntroductionPatients with burn injuries are particularly susceptible to perioperative hypothermia, which is associated with a range of complications, including infection, bleeding and delayed wound healing. Raising the operating room (OR) ambient temperature is an important strategy to prevent hypothermia, but we were uncertain about how strictly we do this. The purpose of this study was to determine the ambient OR temperatures during acute burn surgery as the first step of a quality improvement initiative to ensure we are maintaining a warm OR environment.MethodsBetween 1/3/2020 and 28/2/2021, ambient temperatures during surgery in the burn OR of an ABA-verified burn center were recorded every 15 minutes. Temperatures were measured using a wall-mounted smart sensor, transmitted to a mobile smartphone application via Bluetooth. All patients undergoing acute burn excision and closure procedures lasting > 2 hours were included in the study. Hypothermia was defined as a core temperature < 36°C.ResultsOf the 119 patients, the majority were male (n=86; 72.3%), the mean age was 49.8 years (range 18-89) and the mean total body surface area (TBSA) was 15.8% (range 1-62%). They underwent 261 operations (mean 2.2 cases per patient; range 1-15) with a mean duration of 211.1 minutes (range 120-468 minutes). Sixty-two patients underwent 1 surgery, and 31 had 2 surgeries. Eight patients (6.7%) died. Thirty-three patients (27.7%) were hypothermic at the end of 43 cases (16.5%).The mean ambient temperature was 24.8oC (range 18.7oC to 29.6oC). Hypothermic patients (n= 33 patients, 43 cases), did not differ significantly in age or operative duration from non- hypothermic patients (n= 86 patients, 218 cases) but did have significantly larger %TBSA burns [32.3 vs 24.8 (p= 0.02)]. Hypothermic cases experienced significantly lower ambient temperatures at the start of surgery (p=0.007), and mean temperature during surgery (p=0.009), and tended to experience a lower ambient temperature at the end of surgery (24.5 C vs 25.1 °C , p= 0.06). [Table]ConclusionsWe have identified that the ambient temperature in our burn OR is lower than desirable and that this is directly related to development of hypothermia. These results now indicate that a QI intervention (stricter attention and manoeuvers to ensuring a warm operating room at the start and during surgery) is required.

Low Ambient Temperature Exposition Impairs the Accuracy of a Non-invasive Heat-Flux Thermometer.

BackgroundIndirect core body temperature (CBT) monitoring from skin sensors is gaining attention for in-field applications thanks to non-invasivity, portability, and easy probe positioning. Among skin sensors, heat-flux devices, such as the so-called Double Sensor (DS), have demonstrated reliability under various experimental and clinical conditions. Still, their accuracy at low ambient temperatures is unknown. In this randomized cross-over trial, we tested the effects of cold temperature exposition on DS performance in tracking CBT.MethodsTwenty-one participants were exposed to a warm (23.2 ± 0.4°C) and cold (−18.7 ± 1.0°C) room condition for 10 min, following a randomized cross-over design. The accuracy of the DS to estimate CBT in both settings was assessed by quantitative comparison with esophageal (reference) and tympanic (comparator) thermometers, using Bland–Altman and correlation analyses (Pearson’s correlation coefficient, r, and Lin’s concordance correlation coefficient, CCC).ResultsIn the warm room setting, the DS showed a moderate agreement with the esophageal sensor [bias = 0.09 (−1.51; 1.69) °C, r = 0.40 (p = 0.069), CCC = 0.22 (−0.006; 0.43)] and tympanic sensor [bias = 2.74 (1.13; 4.35) °C, r = 0.54 (p < 0.05), CCC = 0.09 (0.008; 0.16)]. DS accuracy significantly deteriorated in the cold room setting, where DS temperature overestimated esophageal temperature [bias = 2.16 (−0.89; 5.22) °C, r = 0.02 (0.94), CCC = 0.002 (−0.05; 0.06)]. Previous exposition to the cold influenced temperature values measured by the DS in the warm room setting, where significant differences (p < 0.00001) in DS temperature were observed between randomization groups.ConclusionDS accuracy is influenced by environmental conditions and previous exposure to cold settings. These results suggest the present inadequacy of the DS device for in-field applications in low-temperature environments and advocate further technological advancements and proper sensor insulation to improve performance in these conditions.

The Daughter of Isis at Duke University

The Daughter of Isis at Duke University

Implementation of Bubble Continuous Positive Airway Pressure in the Delivery Room and NICU.

Implementation of Bubble Continuous Positive Airway Pressure in the Delivery Room and NICU.

Assessment of airflow and heat transfer around a thermal manikin in a premise served by DOAS and ceiling fans

Ceiling fan improves thermal comfort and reduces air-conditioning energy consumption in super low energy buildings operated at warmer room air temperature with increased air movement. This paper investigated the characteristics of airflow generated by the ceiling fans around a thermal manikin body, and the convective heat transfer caused by the airflow distribution through experiment and CFD for standing and seated postures. The standing and seated postures showed almost the same convective heat transfer for the whole-body, but the contribution of mean velocity and turbulence components were different. Turbulence intensity (median value and dispersion) of the seated posture was higher, and the dispersion range reaches between 20 and 84% despite the average velocity being relatively low compared to the standing posture when the fan speed exceeds 100 rpm. The convective heat transfer coefficient for the whole-body caused by the ceiling fan was 32–75% of the horizontal air flow cases of previous studies at inflow air speed under 1.1 m/s for both postures. On the other hand, under ceiling fan flow the heat transfer coefficient at the lower body of the manikin remains relatively low compared to horizontal flow even at increased fan speeds. This difference potentially leads to a different thermal sensation in corresponding body parts between the ceiling fan flow and the horizontal flow situations.