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Heat waves are increasing in severity, duration, and frequency. The Multi-Scenario Extreme Weather Simulator (MEWS) models this using historical data, climate model outputs, and heat wave multipliers. In this study, MEWS is applied for planning of a community resilience hub in Hau'ula, Hawaii. The hub will have normal operations and resilience operations modes. Both these modes were modeled using EnergyPlus. The resilience operations mode includes cutting off air conditioning for many spaces to decrease power requirements during emergencies. Results were simulated for 300 future weather files generated by MEWS for 2020, 2040, 2060, and 2080. Shared socioeconomic pathways 2–4.5, 3–7.0 and 5–8.5 were used. The resilience operations mode results show two to six times increase of hours of exceedance beyond 32.2 °C from present conditions, depending on climate scenario and future year. The resulting decrease in thermal resilience enables an average decrease of energy use intensity of 26% with little sensitivity to climate change. The decreased thermal resilience predicted in the future is undesirable, but was not severe enough to require a more energy-intensive resilience mode. Instead, planning is needed to assure vulnerable individuals are given prioritized access to air-conditioned parts of the hub if worst-case heat waves occur. [ABSTRACT FROM AUTHOR]

Emergency medical services (EMS) clinicians are expected to provide expert care to all patients, but face obstacles in maintaining skillsets required in the care of critically ill or injured children. The objectives of this study were to describe and assess the effectiveness of a pediatric-focused, simulation-based, procedural training program for EMS clinicians, delivered on-site by a pediatric simulation education team. We also describe a novel, remote, asynchronous performance outcome measurement system using first-person-view video review. This was a prospective study of simulation-based training and procedural outcomes. The study population involved EMS clinicians at three fire-based EMS agencies stratified as urban, suburban, and rural sites. The primary outcome was performance of intraosseous catheterization (IO), bag-valve-mask ventilation (BVM), and supraglottic device placement (SGD), measured across three time points. Secondary outcomes were identification of differences across EMS agencies and participant survey responses. We obtained video data from 122 clinicians, totaling 561 videos, with survey response rates of 89.0–91.3%. Pre-intervention scores were high: least-square means (95% confident-intervals) 9.5 (8.9, 10.2) for IO; 9.6 (9.3, 9.9) for BVM; and 11.6 (10.9, 12.2) for SGD. There was significant improvement post-intervention: 11.5 (10.7, 12.3) for IO; 11.0 (10.7, 11.4) for BVM; and 13.6 (12.8, 14.4) for SGD. Improvement was maintained at follow-up after a median of 9.5 months: 10.5 (9.8, 11.2) for IO; 10.2 (9.9, 10.6) for BVM; and 12.4 (11.7, 13.1) for SGD. There were no statistical differences between sites. Of survey respondents, half had not cared for a critically ill or injured child in at least a year, the vast majority had not had hands-on pediatric training in over 6 months, and the majority felt that training should occur at least every 6 months. Our pediatric-focused, simulation-based procedural training program was associated with improvement and maintenance of high-baseline procedural performance for EMS clinicians over the study period. Findings were consistent across sites. Remote assessment was feasible. Participant surveys emphasized a desire for more pediatric-focused training and highlighted the low frequency of clinical exposure to procedures potentially needed in the care of critically ill or injured pediatric patients. [ABSTRACT FROM AUTHOR]

Systemic sclerosis (SSc) is a heterogeneous autoimmune disease characterized by dysregulation of fibroblast function, which often involves the lungs. Interstitial lung disease (ILD) associated with SSc (SSc-ILD) is a major cause of death among patients with SSc. Our study aimed to identify risk factors for mortality and compare the clinical characteristics of patients with SSc-ILD. Patients were retrospectively enrolled between 2010 and 2018 in a tertiary hospital in Korea. Patients with SSc-ILD were classified depending on the first pulmonary function test or radiologic findings: extensive (n = 46, >20% disease extent on computed tomography (CT) or forced vital capacity [FVC] < 70% in indeterminate cases) and limited (n = 60, <20% disease extent on CT or FVC ≥70% in indeterminate cases). Patients in the extensive group were younger (mean age ± SD 49.3 ± 11.5) than those in the limited group (53.9 ± 12.5, p =.067) at diagnosis. The extensive group showed frequent pulmonary hypertension (43.5% vs. 16.7%, p =.009) and higher erythrocyte sedimentation rate (61.3 ± 33.7 vs. 42.1 ± 26.0, p =.003) and mortality (32.6%, mean duration of follow-up, 100.0 ± 44.7 months vs. 10.0%, 86.0 ± 53.4 months, p =.011). ILD was detected within five years from the first visit (median years 3.5 (1.0, 6.0) vs. 4.5 (0.6, 9.0), survivors vs. non-survivors), and mortality occurred in 19.8% of all patients during a 15-year follow-up. Older age, lower FVC, and initial disease stage (limited or extensive) were associated with mortality, but FVC decline was similar in the limited and extensive groups, such as 15–20% in the first year and 8–10% in the next year, regardless of the initial extent of the disease. Approximately 10% of patients with SSc-ILD in the limited and extensive group showed progression. ILD was detected at a median of less than five years from the first visit; therefore, it is necessary to carefully monitor patients' symptoms and signs from an early stage. Long-term surveillance is also required. Patients with systemic sclerosis-interstitial lung disease manifested a heterogeneous disease course. Approximately 10% of the patients in the limited group showed progression, which was similar to the proportion of patients in the extensive group. Interstitial lung disease was detected at a median of less than five years from the first visit. [ABSTRACT FROM AUTHOR]

Over half of commercial building floor area in the US is served by packaged rooftop units (RTUs). With a typical useful life in the 10-20 years range, RTU replacement is a periodic necessity in commercial buildings and an opportunity for upgrading to higher-efficiency units. We designed a package of energy efficiency measures that can be used in conjunction with an RTU replacement, including advanced controls, high-efficiency low pressure-drop air filters, energy monitoring and, optionally, window films and cool-roofs to reduce loads and size of the replacement RTUs. We conducted side-by-side laboratory testing of the package to evaluate energy savings and thermal comfort relative to an existing building baseline. Daily HVAC energy savings for the RTU replacement package averaged 61% across all seasons. The test data showed that the ASHRAE Guideline 36 controls significantly reduced thermal loads and this was a key contributor to the savings, in addition to the higher efficiency of the RTU itself. The laboratory testing also revealed some challenges with installation and commissioning of Guideline 36. Overall, the results demonstrate that significant savings can be realized in existing office buildings by incorporating relatively low-risk, proven measures in conjunction with an RTU replacement. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the effects of a foot drop stimulator (FDS) and ankle-foot orthosis (AFO) on the gait ability of patients with hemiplegia after stroke. This study recruited 10 patients with hemiplegia after stroke. All patients performed gait under two conditions (AFO and FDS gait). Gait parameters were measured with the GAITRite® system to analyze the spatial and temporal parameters of the patients' gaits. No significant differences in cadence, velocity, swing time, stance time, or step length of the affected or less-affected limbs were found between the two conditions (all, p >.05). These findings demonstrate that AFO and FDS have a similar effect on the gait ability of patients with hemiplegia after stroke. [ABSTRACT FROM AUTHOR]