Practical Approaches to the Management of Cardiorenal Disease beyond Congestion.

BACKGROUND: The coexistence of heart and kidney diseases, also called cardiorenal syndrome, is very common, leads to increased morbidity and mortality, and poses diagnostic and therapeutic difficulties. There is a risk-treatment paradox, such that patients with the highest risk are treated with lesser disease-modifying medical therapies. SUMMARY: In this document, different scientific societies propose a practical approach to address and optimize cardiorenal therapies and related comorbidities systematically in chronic cardiorenal disease beyond congestion. Cardiorenal programs have emerged as novel models that may assist in delivering coordinated and holistic management for these patients. KEY MESSAGES: (1) Cardiorenal disease is a ubiquitous entity in clinical practice and is associated with numerous barriers that limit medical treatment. (2) The present article focuses on the practical approaches to managing chronic cardiorenal disease beyond congestion to overcome some of these barriers and improve the treatment of this high-risk population.

A comparative approach to evaluate the toxicity of building materials through life cycle assessment.

BACKGROUND: This paper addresses the lack of research that compares the toxicity of commonly used construction materials. The toxicity of construction materials has received less attention, despite its importance within the Life Cycle Assessment methodology. All aspects, including toxicity, need to be analysed throughout the life cycle of the material to understand its true behaviour. AIM: The purpose of this study is to propose a methodology to compare the toxicity of different construction materials and highlight the need to consider toxicity criteria in the selection of materials during the design phase. The study seeks to fill the gap in the existing literature by providing information on the comparative toxicity of the most common building materials. METHODOLOGY: The study follows Life Cycle Assessment methodology as established by the ISO 14040:2006 and ISO 14044:2006 standards. For this study, statistics were consulted to identify the most used materials in the construction sector; then, from this group of materials, those available in the Ecoinvent 3.7.1 database were selected. For comparison, these materials were categorised into material families and a functional unit was established to compare them. Finally, all materials were compared with each other, using 1 kg as the functional unit. RESULTS: When we conduct a comparative analysis of various materials and categorise them into groups, it becomes readily apparent which materials demonstrate a less favourable performance with respect to their toxic properties. This approach allows us to discern and pinpoint those materials that present a more concerning level of toxicity relative to others, facilitating informed decision-making in terms of construction material selection and design. CONCLUSIONS: By comparing all materials with each other using 1 kg as the functional unit, we can conclude that some materials have a greater impact than others, both in absolute and relative terms, for example, steel and polyurethane foam.

Prognostic Impact of the UMIPIC Program in the Follow Up in Patients with Heart Failure and Cardiorenal Syndrome.

BACKGROUND: Individuals suffering from heart failure (HF) and cardiorenal syndrome (CRS) represent a special group of patients considering their age, multiple health issues, and treatment challenges. These factors make them more susceptible to frequent hospital stays and a higher mortality rate. UMIPIC is a multidisciplinary care model program for patients with heart failure follow up provided by internists and nurses who are experts in this entity. Our study delved into the effectiveness of this specialized care program (UMIPIC) in mitigating these risks for HF and CRS patients. METHODS: We analyzed the medical records of 3255 patients diagnosed with HF and CRS types 2 and 4, sourced from the RICA registry. These patients were divided into two distinct groups: those enrolled in the UMIPIC program (1205 patients) and those under standard care (2050 patients). Using propensity score matching, we ensured that both groups were comparable. The study focused on tracking hospital admissions and mortality rates for one year after an HF-related hospital stay. RESULTS: Patients in the UMIPIC group experienced fewer hospital readmissions due to HF compared to their counterparts (20% vs. 32%; Hazard Ratio [HR] = 0.48; 95% Confidence Interval [95% CI]: 0.40-0.57; p < 0.001). They also showed a lower mortality rate (24% vs. 36%; HR = 0.64; 95% CI: 0.54-0.75; p < 0.001). Furthermore, the UMIPIC group had fewer total hospital admissions (36% vs. 47%; HR = 0.58; 95% CI: 0.51-0.66; p < 0.001). CONCLUSIONS: The UMIPIC program, centered on holistic and ongoing care, effectively reduces both hospital admissions and mortality rates for HF and CRS patients after a one-year follow-up period.

Can Grapevine Leaf Water Potential Be Modelled from Physiological and Meteorological Variables? A Machine Learning Approach.

Climate change is affecting global viticulture, increasing heatwaves and drought. Precision irrigation, supported by robust water status indicators (WSIs), is inevitable in most of the Mediterranean basin. One of the most reliable WSIs is the leaf water potential (Ψleaf), which is determined via an intrusive and time-consuming method. The aim of this work is to discern the most effective variables that are correlated with plants' water status and identify the variables that better predict Ψleaf. Five grapevine varieties grown in the Alentejo region (Portugal) were selected and subjected to three irrigation treatments, starting in 2018: full irrigation (FI), deficit irrigation (DI), and no irrigation (NI). Plant monitoring was performed in 2023. Measurements included stomatal conductance (gs), predawn water potential Ψpd, stem water potential (Ψstem), thermal imaging, and meteorological data. The WSIs, namely Ψpd and gs, responded differently according to the irrigation treatment. Ψstem measured at mid-morning (MM) and mid-day (MD) proved unable to discern between treatments. MM measurements presented the best correlations between WSIs. gs showed the best correlations between the other WSIs, and consequently the best predictive capability to estimate Ψpd. Machine learning regression models were trained on meteorological, thermal, and gs data to predict Ψpd, with ensemble models showing a great performance (ExtraTrees: R2=0.833, MAE=0.072; Gradient Boosting: R2=0.830; MAE=0.073).

Application of Silica-Aerogel-Fibre-Based Thermal Renders for Retrofits in Building Walls: A Comparative Assessment with Benchmark Solutions.

The current climate change context raises the demand for reducing energy and environmental impacts while keeping an economic balance and building users' comfort. Thermal insulation solutions are potential allies in ensuring the adequacy of existing buildings for challenging sustainability requirements. In this scenario, silica-aerogel-fibre-based thermal renders are innovative solutions for which integrated approaches still lack information, and they should be compared with benchmark multilayer solutions, such as those based on expanded polystyrene (EPS), extruded polystyrene (XPS), mineral wool (MW), and insulated corkboard (ICB), to evidence their prospective economic, environmental, and energy benefits. This paper quantifies the optimum insulation thicknesses, life cycle savings, payback periods, and environmental impacts of innovative thermal renders compared to conventional thermal insulation materials when applied as a retrofit in existing facade walls. The results show that cost-optimised thermal renders with sisal fibres led to the best overall performance. Higher heating needs led to higher optimum render thicknesses and life cycle savings. With a 0.02 m thickness, aerogel-fibre-based thermal renders outperformed other materials in terms of heating-degree days (HDD) from 1000 °C·day onwards; they can save approximately EUR 60∙m-2, 1000 MJ∙m-2, and 100 kg CO2 eq∙m-2 while presenting a U-value 13% lower throughout their 30-year lifetime when compared with the second-best multilayer solution with XPS.

Integrated Performance Evaluation of Aerogel-Based Fibre-Enhanced Thermal Renders Applied on Building Walls.

In this work, aerogel renders were enhanced with fibres for use in new building walls, emphasising a Mediterranean climate. The main novelty of the study relies on an integrated evaluation of the aerogel-based fibre-enhanced thermal renders from environmental, energy and economic approaches. Therefore, optimum insulation thicknesses, life cycle savings, payback periods, abiotic depletion potential from fossil fuels (ADP-ff) and global warming potential (GWP) impacts were quantified as a function of the energy consumption. The cost optimisation of aerogel-based renders enabled a reduction from 2477.4 to 1021.7 EUR∙m-3 for the reference formulation, and the sisal-optimised render led to the best-integrated performance. A higher DD* (degree-days equivalent) led to higher optimum thicknesses (the Azores required 0.02 m and 0.01 m and Bragança 0.06 m and 0.03 m for cost-optimised and non-optimised thermal renders with sisal fibre, respectively). The optimum thickness related to the ADP-ff and GWP impacts was higher, 0.04 m for the Azores and 0.09 m for Bragança. A steeper decrease in the annual energy consumption occurred for thermal renders up to 0.02 m in the Azores and 0.04 m in Bragança. Aerogel-based fibre-enhanced thermal renders had benefits, mainly from 600 DD* onwards.

First Approach to the Aroma Characterization of Monovarietal Red Wines Produced from Varieties Better Adapted to Abiotic Stresses.

Adaptation strategies in the wine sector consist of the use of cultural techniques to limit damages caused by climate change, using, among other resources, varieties better adapted to the scenarios of abiotic stress exacerbation, namely water and thermal stress, as well as those more tolerant to heatwaves. With the intention to determine the aromatic characterization of ten monovarietal wines produced from cultivars with high productive performance in a global warming scenario ('Petit Verdot', 'Marselan', 'Merlot', 'Touriga Franca', 'Syrah', 'Vinhão', 'Bobal', 'Preto Martinho', 'Trincadeira', and 'Alicante Bouschet'), grown in Esporão vineyard (Alentejo, Portugal) and submitted to deficit irrigation (Ks ± 0.5), their aromatic character has been analyzed. Each grape variety was vinified at a small scale, in duplicate, and the wines were evaluated by a sensory panel, which rated several sensory attributes (visual, olfactory, and gustatory). Sensory analysis revealed a discrete appreciation for the monovarietal wines tasted, showing a differentiation at the olfactory level that was not too marked, although present, between the samples. The free volatile compounds were analysed using gas chromatography-olfactometry (GC-O), identified using a gas chromatography-mass spectrometry (GC-MS) technique and semi-quantified using the gas chromatography-flame ionization detector (GC-FID) technique. Based on the interpolation of the results of the various statistical analyses carried out, 49 probable odor active compounds (pOACs) were identified and based on the odor activity values (OAVs), 24 of them were recognized as odor active compounds (OACs) originated mainly during the fermentation processes. An aromatic characterization of the varieties has been proposed.

Benefits of dapagliflozin in the whole spectrum of heart failure in clinical practice: the RICA registry.

Aims: To determine the projected benefits of dapagliflozin after an acute heart failure (HF) event in Spain. Methods: A multicenter and prospective study that included subjects aged 50 years or older consecutively admitted with HF to internal medicine departments in Spain. The projected clinical benefits of dapagliflozin were calculated via pooled analysis of the DAPA-HF and DELIVER trials. Results: A total of 5644 subjects were analyzed, of whom 79.2% were eligible for dapagliflozin, according to criteria of the DAPA-HF and DELIVER trials. Full implementation of dapagliflozin would imply a 1-year absolute risk reduction of 2.3% for death (number needed to treat = 43) and 5.7% (number needed to treat = 17) for HF rehospitalization. Conclusion: Treatment with dapagliflozin could significantly reduce HF burden in clinical practice.

Heart failure is a severe condition that is associated with a high risk of complications. This means that it is important to start using new therapies that have demonstrated a clinical benefit. Clinical trials have shown that dapagliflozin reduces the risk of developing these complications in patients with heart failure. However, it is important to find out whether the results of clinical trials are also seen in real-life populations. We estimated the potential benefits of dapagliflozin in people admitted to hospital more than once with heart failure. The study took place in Spain. Our data suggest that treatment with dapagliflozin could reduce the complications associated with heart failure in real-life patients.

Combining loop with thiazide diuretics for decompensated heart failure: the CLOROTIC trial.

AIMS: To evaluate whether the addition of hydrochlorothiazide (HCTZ) to intravenous furosemide is a safe and effective strategy for improving diuretic response in acute heart failure (AHF). METHODS AND RESULTS: A prospective, double-blind, placebo-controlled trial, including patients with AHF randomized to receive HCTZ or placebo in addition to an intravenous furosemide regimen. The coprimary endpoints were changes in body weight and patient-reported dyspnoea 72 h after randomization. Secondary outcomes included metrics of diuretic response and mortality/rehospitalizations at 30 and 90 days. Safety outcomes (changes in renal function and/or electrolytes) were also assessed. Two hundred and thirty patients (48 women, 83 years) were randomized. Patients assigned to HCTZ were more likely to lose weight at 72 h than those assigned to placebo [2.3 vs. 1.5 kg; adjusted estimated difference (notionally 95 confidence interval) 1.14 (1.84 to 0.42); P 0.002], but there were no significant differences in patient-reported dyspnoea (area under the curve for visual analogue scale: 960 vs. 720; P 0.497). These results were similar 96 h after randomization. Patients allocated to HCTZ showed greater 24 h diuresis (1775 vs. 1400 mL; P 0.05) and weight loss for each 40 mg of furosemide (at 72 and at 96 h) (P 0.001). Patients assigned to HCTZ more frequently presented impaired renal function (increase in creatinine 26.5 moL/L or decrease in eGFR 50; 46.5 vs. 17.2; P 0.001), but hypokalaemia and hypokalaemia were similar between groups. There were no differences in mortality or rehospitalizations. CONCLUSION: The addition of HCTZ to loop diuretic therapy improved diuretic response in patients with AHF.

Learning curve for performing laparoscopic common bile duct exploration in biliary surgery 2.0 era.

BACKGROUND: Recent trials and metanalysis have demonstrated the favorable results of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) for the treatment of cholecysto-choledocholithiasis. The aim of this study was to evaluate the LC + LCBDE learning curve including transcystic and transductal approaches and its effect on the outcomes. METHODS: We identified all unselected patients who underwent LC + LCBDE by a single surgeon between May 2017 and July 2021. Pre-, intra-, and postoperative data were analyzed using the cumulative sum (CUSUM) analysis to evaluate the learning curve. RESULTS: A total of 110 patients were included. Total postoperative complications rate was 12.7%, including bile leakage in six (5.5%) patients. Mean length of hospital stay was 2.7 (1-14) days. No patient had conversion to open surgery. The CUSUM graph divided the learning curve into three distinct phases: (1) Learning (1-38), (2) Competence (39-61) and (3) Proficiency (62-110). There was a significant increase in the transcystic approach rate with each phase (44.7% vs 73.9% vs 98%; P < .001). A significant decrease in the operative time (150.9 vs 117.6 vs 99.9 min; P < .001) and complication rate (21.1% vs 21.7% vs 2%; P = .01) were observed across the three phases. CONCLUSION: Our data suggest that the learning curve for complete competence in LC + LCBDE is approximately 60 cases, provided that proper training is available. The initial learning phase can be carried out safely and efficiently with acceptable results.

Effectiveness of sacubitril-varsartan versus angiotensin converting enzyme inhibitors in patients hospitalized for acute heart failure: a retrospective cohort study of the RICA registry.

BACKGROUND: Sacubitril-valsartan has been shown to reduce hospitalizations and mortality in patients with heart failure (HF) and reduced ejection fraction. The PIONEER-HF trial demonstrated that initiation of the drug during acute HF hospitalization reduced NT-proBNP levels and a post-hoc analysis of the trial found a reduction in HF hospitalizations and deaths. Real-life studies in the elderly population are scarce. The aim of our study was to assess the effectiveness of sacubitril-valsartan versus angiotensin converting enzyme inhibitors (ACEI) in elderly patients who initiate this treatment during hospitalization for acute HF. METHODS: We conducted a retrospective cohort study using the Spanish acute heart failure registry (RICA) comparing rehospitalizations and deaths at 3 months and 1 year among patients aged 70 years or older who had initiated treatment with sacubitril-valsartan during hospitalization for acute HF versus those treated with ACEI. RESULTS: One hundred and ninety-nine patients hospitalized between October 2016 and November 2020 were included, with a median age of 82 years and high rate of comorbidity. Of these, 107 were treated with sacubitril-valsartan and 92 with ACEI. The adjusted OR for readmission for HF at 3 months was 0.906 (95% CI: 0.241-3.404) and for the combined variable readmission for HF or death at 3 months was 0.696 (95% CI: 0.224-2.167). The adjusted OR for HF readmission at one year was 0.696 (95% CI: 0.224 -2.167). and for the combined variable HF readmission or death at one year 0.724 (95% CI: 0.325-1.612). CONCLUSION: Treatment with sacubitril-valsartan initiated early in hospitalization for HF in elderly patients with high comorbidity was associated with a trend towards a reduction in readmissions and death due to HF compared to treatment with ACEI, which did not reach statistical significance either at 3 months or 1 year of follow-up.

More extensive land loss expected on coastal deltas due to rivers jumping course during sea-level rise.

River deltas are home to hundreds of millions of people worldwide and are in danger of sinking due to anthropogenic sea-level rise, land subsidence, and reduced sediment supply. Land loss is commonly forecast by averaging river sediment supply across the entire delta plain to assess whether deposition can keep pace with sea-level rise. However, land loss and deposition vary across the landscape because rivers periodically jump course, rerouting sediment to distinct subregions called delta lobes. Here, we developed a model to forecast land loss that resolves delta lobes and tested the model against a scaled laboratory experiment. Both the model and the experiment show that rivers build land on the active lobe, but the delta incurs gradual land loss on inactive lobes that are cut off from sediment after the river abandons course. The result is a band of terrain along the coast that is usually drowned but is nonetheless a sink for sediment when the lobe is active, leaving less of the total sediment supply available to maintain persistent dry land. Land loss is expected to be more extensive than predicted by classical delta-plain-averaged models. Estimates for eight large deltas worldwide suggest that roughly half of the riverine sediment supply is delivered to terrain that undergoes long periods of submergence. These results draw the sustainability of deltas further into question and provide a framework to plan engineered diversions at a pace that will mitigate land loss in the face of rising sea levels.

Ecotoxicity of Recycled Aggregates: Application of a Prediction Methodology.

Due to environmental concerns, the search for sustainable construction solutions has been increasing over the years. This global concern is creating a trend in the use of recycled aggregates resulting from construction and demolition wastes from different sources. In addition to their physical and mechanical properties, it is important to analyse their ecotoxicological risk to determine whether their leachates might be an issue. To assess ecotoxicity, biological tests should be performed for different trophic levels. This type of test is expensive and needs a high level of expertise, which leads to a lack of studies on recycled aggregates including ecotoxicity analysis. This paper presents a set of predictive ecotoxicity results based on the published studies on recycled aggregates. These results are the outcome of applying an innovative methodology previously developed and validated by the authors aiming to foresee the ecotoxicological fate of building materials' constituents and products. The application of this methodology enables the classification of a recycled aggregate product as safe or unsafe in terms of ecotoxicity risk, while keeping biological testing to a minimum.

Where rivers jump course.

Rivers can abruptly shift pathways in rare events called avulsions, which cause devastating floods. The controls on avulsion locations are poorly understood as a result of sparse data on such features. We analyzed nearly 50 years of satellite imagery and documented 113 avulsions across the globe that indicate three distinct controls on avulsion location. Avulsions on fans coincide with valley-confinement change, whereas avulsions on deltas are primarily clustered within the backwater zone, indicating a control by spatial flow deceleration or acceleration during floods. However, 38% of avulsions on deltas occurred upstream of backwater effects. These events occurred in steep, sediment-rich rivers in tropical and desert environments. Our results indicate that avulsion location on deltas is set by the upstream extent of flood-driven erosion, which is typically limited to the backwater zone but can extend far upstream in steep, sediment-laden rivers. Our findings elucidate how avulsion hazards might respond to land use and climate change.

Environmental and Economic Life Cycle Assessment of Recycled Coarse Aggregates: A Portuguese Case Study.

The incorporation of recycled aggregates in concrete not only reduces the extraction of natural resources, but also decreases landfill disposal of construction and demolition waste. Hence, environmental impacts and costs are reduced, promoting the use of recycled aggregates and circular economy. However, the impacts of transport depend on the distance between facilities and longer distances may result in recycled aggregates being more costly and having larger environmental impact than natural aggregates. This paper discusses this topic, presents a review on the use of life cycle assessment methodology on natural and recycled aggregates for concrete, and applies this methodology in a real context pertaining the procurement of coarse aggregates to ready-mix concrete plants. A case study of two Portuguese regions, Coimbra and Lisbon, is presented. For each region, a quarry, a construction and demolition waste plant, and a ready-mix concrete plant are chosen and a comparative life cycle assessment is made. Different scenarios for the supply of natural and recycled aggregates are studied and the scenarios for recycled aggregates procurement include different hypotheses for the installation (construction and demolition waste plant or quarry) processing the construction and demolition waste into recycled aggregates. For this case study and both regions, it was found that the supply of recycled aggregates produced at the construction and demolition waste plant has lower environmental impact and cost than all other scenarios, including the provision of natural aggregates, except when it is assumed that the quarry is licensed and equipped for receiving unsorted construction and demolition waste and processing it into recycled aggregates. The paper shows that transport distance is a determining factor in the comparison of the impacts of the procurement of natural and recycled aggregates. Moreover, in the Portuguese context, the environmental impacts of the procurement of recycled aggregates may be smaller than those of natural aggregates, but cost may be larger for recycled aggregates, preventing that the most sustainable option is chosen.

Chemical composition and sensory properties of Albariño wine: Fertigation effects.

Interannual climate variability and management practices, including fertigation, can alter volatile compound concentrations in wines from a given grapevine cultivar. These compounds are highly relevant for wine aroma. The current study aimed to assess the effect of two levels of fertigation on the volatile composition and sensory properties of wines from Albariño grown in two vineyards in NW Spain over three years. Treatments were fertigation to 60% (F-60) and 100% (F-100) of crop needs since budbreak, and a rain-fed control (F-0). Volatile compounds were determined through gas chromatography and mass spectrometry (GC-MS) and wine sensory evaluation was performed by nine experts using quantitative descriptive analysis. General chemical parameters of wines were similar among treatments; however, F-60 and F-0 slightly reduced volatile total concentrations in both vineyards. Wines from the fertigation treatments had greater concentrations of volatile fatty acids, ethyl esters, acetates and C6 compounds. However, terpene concentrations slightly decreased when fertigation was applied. Higher alcohols showed a different behavior between vineyards, mainly related with grapevine water status during the growing season. Seven sensory descriptors differed significantly between vineyards. This study indicates that fertigation could be a tool for modulating wine chemical and sensory characteristics.

Biot-Granier Sensor: A Novel Strategy to Measuring Sap Flow in Trees.

The Biot-Granier (Gbt) is a new thermal dissipation-based sap flow measurement methodology, comprising sensors, data management and automatic data processing. It relies on the conventional Granier (Gcv) methodology upgraded with a modified Granier sensor set, as well as on an algorithm to measure the absolute temperatures in the two observation points and perform the Biot number approach. The work described herein addresses the construction details of the Gbt sensors and the characterization of the overall performance of the Gbt method after comparison with a commercial sap flow sensor and independent data (i.e., volumetric water content, vapor pressure deficit and eddy covariance technique). Its performance was evaluated in three trials: potted olive trees in a greenhouse and two vineyards. The trial with olive trees in a greenhouse showed that the transpiration measures provided by the Gbt sensors showed better agreement with the gravimetric approach, compared to those provided by the Gcv sensors. These tended to overestimate sap flow rates as much as 4 times, while Gbt sensors overestimated gravimetric values 1.5 times. The adjustments based on the Biot equations obtained with Gbt sensors contribute to reduce the overestimates yielded by the conventional approach. On the other hand, the heating capacity of the Gbt sensor provided a minimum of around 7 °C and maximum about 9 °C, contrasting with a minimum around 6 °C and a maximum of 12 °C given by the Gcv sensors. The positioning of the temperature sensor on the tip of the sap flow needle proposed in the Gbt sensors, closer to the sap measurement spot, allow to capture sap induced temperature variations more accurately. This explains the higher resolution and sensitivity of the Gbt sensor. Overall, the alternative Biot approach showed a significant improvement in sap flow estimations, contributing to adjust the Granier sap flow index, a vulnerability of that methodology.

Environmental Life Cycle Assessment of Thermal Insulation Tiles for Flat Roofs.

Envelope insulation and protection is an important technical solution to reduce energy consumption, exterior damage, and environmental impacts in buildings. Thermal insulation tiles are used simultaneously as thermal insulation of the building envelope and protection material of under layers in flat roofs systems. The purpose of this research is to assess the environmental impacts of the life cycle of thermal insulation tiles for flat roofs. This research presents the up-to-date "cradle to gate" environmental performance of thermal insulation tiles for the environmental categories and life-cycle stages defined in European standards on environmental evaluation of building. The results presented in this research were based on site-specific data from a Portuguese factory and resulted from a consistent methodology that is here fully described, including the raw materials extraction and production, and the modelling of energy and transport processes at the production stage of thermal insulation tiles. These results reflect the weight of the raw-materials within the production process of thermal insulation tiles in all environmental categories and show that some life cycle stages, such as transportation of raw materials (A2) and packaging and packaging waste (A3.1 and A3.3, respectively), may not be discarded in a cradle to gate study of a construction material because they can make a significant contribution to some environmental categories. Moreover, complementary results regarding the economic, environmental, and energy performance Life Cycle Assessment (LCA) of flat roofs solutions incorporating the thermal insulation tiles studied showed that the influence of the economic costs on the total aggregated costs of these solutions is much higher than that of the environmental costs due to the lower environmental costs of the thermal insulation tiles at the product stage (A1-A3). These costs influenced the corresponding percentage of the environmental costs (between 14% and 18%) and the percentage of the economic costs (between 70% and 75%) in the total aggregated (environmental, economic, and energy) net present value (NPV). Finally, a complementary "cradle to cradle" environmental LCA discussion is presented including the following additional life cycle stages: maintenance and replacement (B2-B4), operational energy use (B6), and end-of-life stage and benefits and loads beyond the system boundary (C1-C4 and D).

Dynamic Assessment of Construction Materials in Urban Building Stocks: A Critical Review.

There is a lack of understanding on the different types of dynamics of building stocks, in real life and in models. Moreover, there is now a particular interest in the embodied impacts of construction materials, since with the increasing efficiency of buildings operation, embodied impacts gain more importance in the overall building life cycle. This critical review wants to advance the understanding of the type of dynamics, methods, and tools used. The well-known IPAT equation is adapted for building stocks and three dynamics are defined: spatial, evolutionary temporal, and spatial-cohort dynamic. A framework is defined that can help researchers choose a method, tool, and dynamics of input parameters depending on their research goal, case study, and data. Moreover, generally valid conclusions are drawn, including MFA is useful to model spatially dynamic material flows; GIS is needed to include spatial dynamics. Retrofit, compared to construction and demolition, is understudied and usually analyzed through top-down methods. Material intensity and emission intensity are rarely modeled in a dynamic way. Overall, scholars seem to perform increasingly data intensive and complex studies tailored to a specific case study. However, there are big differences in the quality depending on the dynamic of input parameters.

Influence of potassium levels on one-year outcomes in elderly patients with acute heart failure.

BACKGROUND: Abnormal serum potassium levels (K+) in patients with heart failure (HF) relate to worse prognosis. We evaluated whether admission K+ levels predict 1-year outcomes in elderly patients admitted for acute HF. METHODS: We evaluated 2865 patients aged >74 years from the RICA Spanish Heart Failure Registry, classified according to admission serum K+ levels: hyperkalemia (>5.5 mmol/L), normokalemia (3.5-5.5 mmol/L) and hypokalemia (<3.5 mmol/L). We explored whether K+ levels were significantly associated with one-year all-cause mortality or hospital readmission and their combination. RESULTS: Mean admission K+ value was 4.3 ±â€¯0.6 mmol/L; 97 patients (3.38%) presented with hyperkalemia and 174 (6.06%) with hypokalemia. Overall, 43% of the patients died or were readmitted for HF during the follow-up period; the risk was higher for those with hyperkalemia (59% vs 41% in hypokalemic patients). The HR for one-year mortality was 1.43 (p = .073) and 1.67 for readmissions (p = .007) when K+ was >5.5 mmol/L and 1.08 (p = .618) and 0.90 (p = .533) respectively for K+ < 3.5 mmol/L. The HR for the combined outcome was 1.59 (1.19-2.13); p = .002 in hyperkalemic patients and 0.96 (0.75-1.23); p = .751in hypokalemic patients. Multivariate analysis showed a significant association of admission K+ values >5.5 mmol/L with the combined outcome of mortality and readmission (HR 1.15 [95% CI 1.04-1.27], p = .008). CONCLUSION: In patients hospitalized for decompensated HF, admission hyperkalemia predicts a higher mid-term risk for HF readmission and mortality, probably related to the significant higher risk of readmission.