ABSTRACT
Energy building design today aims to ensure thermal comfort and indoor air quality;this concern has been increased, given the recent SARS-CoV-2 pandemic. The proposed work investigates the effect of increased natural ventilation on energy requirements, ensuring low CO2 levels and acceptable Indoor Air Quality (IAQ) in general. The case of hospitals was chosen because of the stringent IAQ requirements they raise as a result of the burdened (physical, chemical, biological) indoor environment, as well as the vulnerable health of the patients. The current energy analysis was carried out in patient wards, waiting rooms, and operating rooms. The proposed correlation between IAQ and energy is infrequent in the relevant literature, especially for the case of hospitals. Different scenarios regarding the ventilation mode are examined, including pure natural ventilation, natural ventilation combined with air cleaners, as well as mechanical ventilation. According to the results, improvement of the air quality leads to higher energy demand;this is the case of mechanical ventilation, noting that not properly designed natural ventilation techniques may lead to high energy consumption, without ensuring acceptable IAQ. Air cleaners can contribute towards better environment, potentially decreasing ventilation requirements;the issue of fresh air adequacy has to be examined though. The demonstrated methodological analysis and results can help the designer to investigate the efficiency of different ventilation modes, involving the effect of thermal envelope, geometrical and operation parameters, towards the energy requirements minimization and IAQ quality maximization.
ABSTRACT
BACKGROUND: Obesity underlies much chronic disease. Digitalization of obesity management provides an opportunity to innovate our traditional model of health care delivery within this setting, and to transform its scalability potentially to the population level. OBJECTIVE: The objective was to assess the feasibility and effectiveness of the Low Carb Program app for weight loss, applied within our hospital-based (tier 3) obesity service. Due to the disrupting effects of the COVID-19 pandemic on our obesity service, we compared the clinical outcomes from the Low Carb Program app applied in the context of remote patient appointments over the telephone with the prepandemic traditional standard of care. METHODS: We invited patients who attended our hospital-based obesity service to engage with the Low Carb Program smartphone app. We combined this approach with remote delivery (over the telephone) of obesity management from medical and psychology members of our obesity team during the COVID-19 pandemic. Outcome variables included changes in body weight and changes in HbA1c as a marker of glycemic control. We compared data from the Low Carb Program group with a retrospective control group (n=126) that had received traditional face-to-face obesity management from our team without concomitant use of the Low Carb Program app in the pre-COVID-19 era. T test comparisons were employed, with P<.05 considered significant. RESULTS: The mean weight of participants (n=105) was 130.2 kg, with 59% (n=62) females and a mean age of 48.8 years. Most participants (90/105, 86%) completed the Low Carb Program app registration process and engaged with the Low Carb Program app program; at follow-up, most participants (88/105, 84%) had actively engaged with the Low Carb Program app within the prior 30 days. The majority of participants (58/105, 55%) self-reported outcomes within the app. Mean duration of clinical follow-up for recruited participants who received the app was 7.4 months. Paired data were available for 48 participants for body weight and 41 participants for HbA1c. Paired sample t test analysis revealed a statistically significant mean loss of body weight of 2.7 kg (P=.001) and improvement in HbA1c of 3.3 mmol/mol (P=.01). The mean weight of control group patients (n=126) was 137.1 kg, with 74% (93/126) females and a mean age of 44.4 years. The mean follow-up for this group was 6 months. Data comparisons between the app user group and the pre-COVID-19 retrospective control group revealed equivalence for loss of body weight and change in HbA1c between the two groups. CONCLUSIONS: We provide evidence to support the feasibility of implementing the Low Carb Program app combined with remote management; this is the first proof of concept for digitalized management within a hospital-based (tier 3) obesity service. We demonstrate the potential clinical efficacy of the approach in terms of improvements in body weight and glycemic control.