Academic literature on the topic '120299 Building not elsewhere classified'

The financial facility of development of machinery building in Latgale is expected in manufacturing of electrical and optical equipment and in production of metal and metal ware. At present the proportion of production of leading machinery and equipment non-classified elsewhere, as well as of production of transport means has a tendency to reduce and also they have lesser probability to manage the financial crisis.

Detailed laboratory investigations were conducted on Mae Moh fly ash from northern Thailand for the determination of its grain size distribution, mineralogy, pozzolanic activity, compaction and strength characteristics, and the collapse potential. On the basis of the experimental results, this fly ash is classified as ASTM class C, which is considered to be pozzolanic. It has good potential to be utilized as an effective fill for embankments (roads and dams), airfields, pavements, and building bricks, as well as for the stabilization of compressible or erodible foundations. Because of the fact that Mae Moh fly ash contains only a negligible amount of unburned carbon, its pozzolanic reactivity is accelerated, in comparison with the relatively inert, high-carbon fly ash produced elsewhere in Thailand and many other parts of Asia. It is also demonstrated that Mae Moh fly ash can be easily compacted to produce acceptable dry densities over a wide range of water contents. Curing with an adequate moisture supply in the presence of calcium oxide plays an important role in accelerating the pozzolanic reactions, hence improving the time-dependent-properties. This study further proposes that a curing period of 2–3 weeks is sufficient for this material to approach its maximum strength. Although the behaviour of one specific fly ash cannot generalize the wide array of other ashes, the test results obtained for Mae Moh fly ash may be applied to lignite ashes in the category of ASTM class C. Key words: fly ash, structural fill, compaction, compressive strength, shear strength, collapse potential, pozzolanic activity.

Introduction: Data on the cause of death form the cornerstone for analyzing the health situation and disease in countries, and they make a major contribution to building evidence for health policies. Aim: The aim of this study was to determine the extent to which diagnoses from the group - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), International Classification of Diseases (ICD - Revision X) were used as the main cause of death in Serbia, Croatia, North Macedonia, and Slovenia in the ten-year period, 2007 - 2016. Materials and methods: Methods of descriptive and analytical statistics were used in this research. An analysis of data on the causes of death (R00-R99 ICD - Revision X), by gender, during the ten-year period (2007 - 2016) was performed. Linear regression was also used as an analytical method to analyze the trend. Results: During the ten-year period, in Serbia, the R00-R99 diagnoses were among the five most common groups of diagnoses of death, i.e., in each year they took third place, with a percentage of 4.7%. In the observed period, in the surrounding countries, there was an increase in the death rate in Slovenia, with the highest rate in 2016 (19.9), while in Croatia there was a decrease in the death rate related to the diagnoses from group XVIII ICD - X (R00-R99). In Macedonia, the rate had a linear trend, with a slight decline in 2012 (52.3) and 2013 (58.7). In the observed period, an increase in the death rate of the population of Serbia with an unknown cause of death was observed, with particularly high rates in 2009 and 2016. Comparative analysis has shown that R00-R99 diagnoses are represented more in the mortality statistics of Serbia than in Slovenia and Croatia, and less than in Northern Macedonia. Conclusion: Urgent interventions are needed to improve the quality of mortality statistics and data on the causes of death in the described countries.

In this era of startling developments in the medical field there remains a serious worry about the hazardous potential of various by products which if not properly addressed can lead to consequences of immense public concern. Hospitals and other health care facilities generate waste products which are evidently hazardous to all those exposed to its potentially harmful effects. Need for effective legislation ensuring its safe disposal is supposed to be an integral part of any country's health related policy. This issue is of special importance in developing countries like Pakistan which in spite of framing various regulations for safeguarding public health, seem to overlook its actual implementation. The result unfortunately is the price wehave to pay not only in terms of rampant spread of crippling infections but a significant spending of health budget on combating epidemics which could easily have been avoided through effective waste disposal measures in the first place. Waste classified under the heading 'bio-hazardous' includes any infectious or potentially infectious material which can be injurious or harmful to humans and other living organisms. Amongst the many potential sources are the hospitals or other health delivery centres which are ironically supposed to be the centres of infection control and treatment. Whilst working in these setups, health care workers such as doctors, nurses, paramedical staff and sanitation workers are actually the ones most exposed and vulnerable to these challenges. Biomedical waste may broadly be classified into Infectious and toxic waste. Infectious waste includes sharps, blood, body fluids and tissues etcwhile substances such as radioactive material and by-products of certain drugs qualify as toxic waste. Furthermore health institutions also have to cater for general municipal waste such as carton boxes, paper and plastics. The World Health Organisation has its own general classification of hospital waste divided into almost eight categories of which almost 15% (10% infectious and 5% toxic) is estimated to be of a hazardous nature while the remaining 85% is general non hazardous content.1A recent study from Faisalabad, Pakistan has estimated hospital waste generation around 1 to 1.5 kg / bed /day for public sector hospitals in the region,2while figures quoted from neighbouring India are approximately 0.5 to 2 KG / hospital bed /day.3 Elsewhere in the world variable daily hospital waste production has been observed ranging from as low as 0.14 to 0.49 kg /day in Korea4 and 0.26 to 0.89 kg/day in Greece5to as high as 2.1 to 3.83 kg/day in Turkey6 and 0.84 to 5.8 kg/day in Tanzania.7Ill effects of improper management of hospital waste can manifest as nosocomial infections or occupational hazards such as needle stick injuries. Pathogens or spores can be borne either through the oro-faecal or respiratory routes in addition to direct inoculation through contact with infected needles or sharps. Environmental pollution can result from improper burning of toxic material leading to emission of dioxins, particulate matter or furans into the air. The habitat can also be affected by illegal dumping and landfills or washing up of medical waste released into the sea or river. Potential organisms implicated in diseases secondary to mismanagement of hospital waste disposal include salmonella, cholera, shigella, helminths, strep pneumonia, measles, tuberculosis, herpesvirus, anthrax, meningitis, HIV, hepatitis and candida etc. These infections can cause a considerable strain on the overall health and finances of the community or individuals affected. The basic principal of Public health management i.e 'prevention is better than cure' cannot be more stressed in this scenario as compared to any other health challenge. Health facilities must have a clear policy on hazardous waste management. To ensure a safe environment hospitals need to adopt and implement international and local systems of waste disposal. Hospital waste management plan entails policy and procedures addressing waste generation, accumulation, handling, transportation, storage, treatment and disposal. Waste needs to be collected in marked containers usually colour coded and leak proof. Segregation at source is of vital importance. The standard practice in many countries is the Basic Three Bin System ie to segregate the waste into RED bags/ boxes for sharps, YELLOW bags for biological waste and BLUE or BLACK ones for general/ municipal waste. All hospital staff needs to be trained in the concept of putting the right waste in relevant containers/ bags. They need to know that more than anything else this practice is vital for their own safety. The message can be reinforced through appropriate labelling on the bins and having posters with simple delineations to avoid mixing of different waste types. Sharps essentially should be kept in rigid, leak and puncture-resistant containers which are tightly lidded and labelled. Regular training sessions for nurses and cleaning staff can be organised as they are the personnel who are more likely to deal with waste disposition at the level of their respective departments. Next of course is transportation of waste products to the storage or disposal. Sanitary staff and janitors must be aware of the basic concepts of waste handling and should wear protective clothing, masks and gloves etc, besides ensuring regular practice of disinfection and sterilization techniques.8Special trolleys or vehicles exclusively designed and reserved for biomedical waste and operated by trained individuals should be used for transportation to the dumping or treatment site. Biomedical waste treatment whether on site or off site is a specialised entity involving use of chemicals and equipment intended for curtailing the hazardous potential of the material at hand. Thermal treatment via incinerators, not only results in combustion of organic substances but the final product in the form of non-toxicash is only 10 to 15% of the original solid mass of waste material fed to the machine. Dedicated autoclaves and microwaves can also be used for the purpose of disinfection. Chemicals such as bleach, sodium hydroxides, chlorine dioxide and sodiumhypochlorite are also effective disinfectants having specialised indications. Countries around the world have their own regulations for waste management. United Kingdom practices strict observance of Environmental protection act 1990, Waste managementlicensing regulations 1994 and Hazardous waste regulations 2005 making it one of thesafest countries in terms of hazardous waste disposal. Similar regulations specific for each state have been adopted in United States following passage of the Medical Waste tracking act 1988. In Pakistan, every hospital must comply with the Waste Management Rules 2005 (Environment Protection Act 1997), though actual compliance is far from satisfactory. It is high time that the government and responsible community organisations shape up to seriously tackle the issue of bio hazardous waste management through enforcement of effective policies and standard operating procedures for safeguarding the health and lives of the public in general and health workers in particular. Outbreaks, defined as excess cases of a particular disease or illness which outweighs the response capabilities, have the capacity to overwhelm health care facilities and need timely response and attention to details in order to avoid potentially disastrous sequelae . In this day and age when improvement in public health practices have significantly curtailed outbreak of various diseases, certain viral illnesses continue to make headlines. One of the notable vector borne infectious disease affecting significant portions of south east Asia in the early part of twenty first century is 'Dengue fever'. Dreaded as it is by those suffering from the illness, a lot of the hysteria created is secondary to a lack of education and understanding of the nature of the disease and at times a result of disinformation campaign for vested interests by certain political and media sections.'Dengue' in fact is a Spanish word, assumed to have originated from the Swahili phrase -ka dinga peppo -which describes the disease as being caused by evil spirit. 1 Over the course of time it has been called 'breakbone fever', 'bilious vomiting fever', 'break heart fever', 'dandy fever', 'la dengue' and 'Phillipine, Thai and Singapore hemorrhagic fever' Whilst the first reported case referring to dengue fever as a water poison spread by flying insects, exists in the Chinese medical encyclopedia from Jin Dynasty (265-420 AD), the disease is believed to have disseminated from Africa with the spread of the primary vector, aedes egypti, in the 15th to 19th century as a result of globalisation of slave trade 45In 80% of the patients affected by this condition the presentation is rather insidious and at best characterized by mild fever. The classical 'Dengue fever' present in about 5% of the cases is characterized by high temperature, body aches, vomiting and at times a skin rash. The disease may regresses in two to seven days. However inrare instances (<5%) it may develop into more serious conditions such as Dengue hemorrhagic fever whereby the platelet count is significantly reduced leading to bleeding tendencies and may even culminate in a more life threatening presentation i.e Dengue shock syndrome.6To understand the actual dynamics of Dengue epidemic it is important to understand the mode of its spread in affected areas. Aedes mosquito (significantly Aedes Egypti) acts a vector for this disease. Early morning and evening times7 are favoured by these mosquitos to feed on their prey. There is some evidence that the disease may be transmitted via blood products and organ donation. 8 Moreover vertical transmission (mother to child) has also been reported 9Diagnostic investigations include blood antigen detection through NS-I or nucleic acid detection via PCR. IO Cell cultures and specific serology may also be used for confirming the underlying disease. Whilst sporadic and endemic cases are part of routine medical practice and may not raise any alarm bells, outbreaks certainly need mobilization of appropriate resources for effective control. Needless to say 'prevention is better than cure' and should be the primary target of the health authorities in devising strategies for disease control.The WHO recommended 'Integrated Vector control programme', lays stress on social mobilisation and strengthening of public health bodies, coherent response of health and related departments and effective capacity building of relevant personnel and organisations as well as the community at risk. For Aedes Egypti the primary control revolves around eliminating its habitats such as open sources of water. In a local perspective in our city Peshawar, venue of the recent dengue epidemic, it may be seen in the form of incidental reservoirs such as receptacles and tyres dumped in open areas such as roof tops with rain water accumulating in them and provtdjng excellent breeding habitats, Larvicidal and insecticides may be added to more permanent sources such as watertanks and farm lands. There is not much of a role for spraying with organophosphorous agents which is at times resorted to for public consumption. Public education is the key to any effective strategy which must highlight the need for wearing clothing that fully covers the skin, avoiding unnecessary early morning and evening exposure to vector agents, application of insect repellents and use of mosquito nets. It is also important not to panic if affliction with the disease is suspected as in a vast majority of instances it is a self limiting illness without any long term harmful effects and needs simple conservative management like antipyretics and analgesics.An important consideration for responsible authorities in a dengue epidemic is to ensure that maximum management facilities for simple cases are provided at the community level through primary and secondary health care facilities and that the tertiary care hospitals are not inundated with all sort of patients demanding consultation. These later facilities should be reserved for those patients who end up with any complications or more severe manifestation of the disease.Research is underway to develop an ideal vaccine for Dengue fever. In 2016, a vaccine by the name 'Dengvaxia' was marketed in Phillipines and Indonesia. However with development of new serotypes of the virus, its efficacy has been somewhat compromised.As for treatment , there are no specific antiviral drugs. Management is symptomatic revolving mainly around oral and intravenous hydration. Paracetamol (Acetaminophen) is used for fever as compared to NSAIDS such as Ibuprophen infusion as well as blood and platelet transfusion.Data to date shows that slightly more than twenty three thousand people have been diagnosed with dengue over the past three months ie August to October there is a lower risk of bleeding with the former. Those with more severe form of the disease may need Dextran 2017, in Peshawar, Pakistan with around fourteen thousand needing admission and about sixty nine recorded deaths. The mortality is well within the acceptable international standards of less than 1% for the disease. In the backdrop of all the debate surrounding the current epidemic, one can infer that such outbreaks are best addressed with effective planningwell ahead of the time before the disease threatens to spiral out of control. Simple measures such as covering water storage facilities, using larvicidals where practical, use of insect repellents, mosquito nets and avoiding unnecessary exposure can offerthe best protection. Public health messages via print and electronic media can help educate people in affected areas and allay any anxiety building up from a fear of developing life threatening complications. Health department must mobilise all its resources to ensure local management of diagnosed patients with simple dengue fever and facilitate hospital admission only for those suffering from more severe form of the disease. Moreover the media hype into such situations needs to be addressed through constant updates and discouraging any negative politicking on the issue. To sum up Dengue fever is not really an affliction to be dreaded provided it is viewed and managed in the right perspective.

In this era of startling developments in the medical field there remains a serious worry about the hazardous potential of various by products which if not properly addressed can lead to consequences of immense public concern. Hospitals and other health care facilities generate waste products which are evidently hazardous to all those exposed to its potentially harmful effects. Need for effective legislation ensuring its safe disposal is supposed to be an integral part of any country's health related policy. This issue is of special importance in developing countries like Pakistan which in spite of framing various regulations for safeguarding public health, seem to overlook its actual implementation. The result unfortunately is the price wehave to pay not only in terms of rampant spread of crippling infections but a significant spending of health budget on combating epidemics which could easily have been avoided through effective waste disposal measures in the first place. Waste classified under the heading 'bio-hazardous' includes any infectious or potentially infectious material which can be injurious or harmful to humans and other living organisms. Amongst the many potential sources are the hospitals or other health delivery centres which are ironically supposed to be the centres of infection control and treatment. Whilst working in these setups, health care workers such as doctors, nurses, paramedical staff and sanitation workers are actually the ones most exposed and vulnerable to these challenges. Biomedical waste may broadly be classified into Infectious and toxic waste. Infectious waste includes sharps, blood, body fluids and tissues etcwhile substances such as radioactive material and by-products of certain drugs qualify as toxic waste. Furthermore health institutions also have to cater for general municipal waste such as carton boxes, paper and plastics. The World Health Organisation has its own general classification of hospital waste divided into almost eight categories of which almost 15% (10% infectious and 5% toxic) is estimated to be of a hazardous nature while the remaining 85% is general non hazardous content.1A recent study from Faisalabad, Pakistan has estimated hospital waste generation around 1 to 1.5 kg / bed /day for public sector hospitals in the region,2while figures quoted from neighbouring India are approximately 0.5 to 2 KG / hospital bed /day.3 Elsewhere in the world variable daily hospital waste production has been observed ranging from as low as 0.14 to 0.49 kg /day in Korea4 and 0.26 to 0.89 kg/day in Greece5to as high as 2.1 to 3.83 kg/day in Turkey6 and 0.84 to 5.8 kg/day in Tanzania.7Ill effects of improper management of hospital waste can manifest as nosocomial infections or occupational hazards such as needle stick injuries. Pathogens or spores can be borne either through the oro-faecal or respiratory routes in addition to direct inoculation through contact with infected needles or sharps. Environmental pollution can result from improper burning of toxic material leading to emission of dioxins, particulate matter or furans into the air. The habitat can also be affected by illegal dumping and landfills or washing up of medical waste released into the sea or river. Potential organisms implicated in diseases secondary to mismanagement of hospital waste disposal include salmonella, cholera, shigella, helminths, strep pneumonia, measles, tuberculosis, herpesvirus, anthrax, meningitis, HIV, hepatitis and candida etc. These infections can cause a considerable strain on the overall health and finances of the community or individuals affected. The basic principal of Public health management i.e 'prevention is better than cure' cannot be more stressed in this scenario as compared to any other health challenge. Health facilities must have a clear policy on hazardous waste management. To ensure a safe environment hospitals need to adopt and implement international and local systems of waste disposal. Hospital waste management plan entails policy and procedures addressing waste generation, accumulation, handling, transportation, storage, treatment and disposal. Waste needs to be collected in marked containers usually colour coded and leak proof. Segregation at source is of vital importance. The standard practice in many countries is the Basic Three Bin System ie to segregate the waste into RED bags/ boxes for sharps, YELLOW bags for biological waste and BLUE or BLACK ones for general/ municipal waste. All hospital staff needs to be trained in the concept of putting the right waste in relevant containers/ bags. They need to know that more than anything else this practice is vital for their own safety. The message can be reinforced through appropriate labelling on the bins and having posters with simple delineations to avoid mixing of different waste types. Sharps essentially should be kept in rigid, leak and puncture-resistant containers which are tightly lidded and labelled. Regular training sessions for nurses and cleaning staff can be organised as they are the personnel who are more likely to deal with waste disposition at the level of their respective departments. Next of course is transportation of waste products to the storage or disposal. Sanitary staff and janitors must be aware of the basic concepts of waste handling and should wear protective clothing, masks and gloves etc, besides ensuring regular practice of disinfection and sterilization techniques.8Special trolleys or vehicles exclusively designed and reserved for biomedical waste and operated by trained individuals should be used for transportation to the dumping or treatment site. Biomedical waste treatment whether on site or off site is a specialised entity involving use of chemicals and equipment intended for curtailing the hazardous potential of the material at hand. Thermal treatment via incinerators, not only results in combustion of organic substances but the final product in the form of non-toxicash is only 10 to 15% of the original solid mass of waste material fed to the machine. Dedicated autoclaves and microwaves can also be used for the purpose of disinfection. Chemicals such as bleach, sodium hydroxides, chlorine dioxide and sodiumhypochlorite are also effective disinfectants having specialised indications. Countries around the world have their own regulations for waste management. United Kingdom practices strict observance of Environmental protection act 1990, Waste managementlicensing regulations 1994 and Hazardous waste regulations 2005 making it one of thesafest countries in terms of hazardous waste disposal. Similar regulations specific for each state have been adopted in United States following passage of the Medical Waste tracking act 1988. In Pakistan, every hospital must comply with the Waste Management Rules 2005 (Environment Protection Act 1997), though actual compliance is far from satisfactory. It is high time that the government and responsible community organisations shape up to seriously tackle the issue of bio hazardous waste management through enforcement of effective policies and standard operating procedures for safeguarding the health and lives of the public in general and health workers in particular. Outbreaks, defined as excess cases of a particular disease or illness which outweighs the response capabilities, have the capacity to overwhelm health care facilities and need timely response and attention to details in order to avoid potentially disastrous sequelae . In this day and age when improvement in public health practices have significantly curtailed outbreak of various diseases, certain viral illnesses continue to make headlines. One of the notable vector borne infectious disease affecting significant portions of south east Asia in the early part of twenty first century is 'Dengue fever'. Dreaded as it is by those suffering from the illness, a lot of the hysteria created is secondary to a lack of education and understanding of the nature of the disease and at times a result of disinformation campaign for vested interests by certain political and media sections.'Dengue' in fact is a Spanish word, assumed to have originated from the Swahili phrase -ka dinga peppo -which describes the disease as being caused by evil spirit. 1 Over the course of time it has been called 'breakbone fever', 'bilious vomiting fever', 'break heart fever', 'dandy fever', 'la dengue' and 'Phillipine, Thai and Singapore hemorrhagic fever' Whilst the first reported case referring to dengue fever as a water poison spread by flying insects, exists in the Chinese medical encyclopedia from Jin Dynasty (265-420 AD), the disease is believed to have disseminated from Africa with the spread of the primary vector, aedes egypti, in the 15th to 19th century as a result of globalisation of slave trade 45In 80% of the patients affected by this condition the presentation is rather insidious and at best characterized by mild fever. The classical 'Dengue fever' present in about 5% of the cases is characterized by high temperature, body aches, vomiting and at times a skin rash. The disease may regresses in two to seven days. However inrare instances (<5%) it may develop into more serious conditions such as Dengue hemorrhagic fever whereby the platelet count is significantly reduced leading to bleeding tendencies and may even culminate in a more life threatening presentation i.e Dengue shock syndrome.6To understand the actual dynamics of Dengue epidemic it is important to understand the mode of its spread in affected areas. Aedes mosquito (significantly Aedes Egypti) acts a vector for this disease. Early morning and evening times7 are favoured by these mosquitos to feed on their prey. There is some evidence that the disease may be transmitted via blood products and organ donation. 8 Moreover vertical transmission (mother to child) has also been reported 9Diagnostic investigations include blood antigen detection through NS-I or nucleic acid detection via PCR. IO Cell cultures and specific serology may also be used for confirming the underlying disease. Whilst sporadic and endemic cases are part of routine medical practice and may not raise any alarm bells, outbreaks certainly need mobilization of appropriate resources for effective control. Needless to say 'prevention is better than cure' and should be the primary target of the health authorities in devising strategies for disease control.The WHO recommended 'Integrated Vector control programme', lays stress on social mobilisation and strengthening of public health bodies, coherent response of health and related departments and effective capacity building of relevant personnel and organisations as well as the community at risk. For Aedes Egypti the primary control revolves around eliminating its habitats such as open sources of water. In a local perspective in our city Peshawar, venue of the recent dengue epidemic, it may be seen in the form of incidental reservoirs such as receptacles and tyres dumped in open areas such as roof tops with rain water accumulating in them and provtdjng excellent breeding habitats, Larvicidal and insecticides may be added to more permanent sources such as watertanks and farm lands. There is not much of a role for spraying with organophosphorous agents which is at times resorted to for public consumption. Public education is the key to any effective strategy which must highlight the need for wearing clothing that fully covers the skin, avoiding unnecessary early morning and evening exposure to vector agents, application of insect repellents and use of mosquito nets. It is also important not to panic if affliction with the disease is suspected as in a vast majority of instances it is a self limiting illness without any long term harmful effects and needs simple conservative management like antipyretics and analgesics.An important consideration for responsible authorities in a dengue epidemic is to ensure that maximum management facilities for simple cases are provided at the community level through primary and secondary health care facilities and that the tertiary care hospitals are not inundated with all sort of patients demanding consultation. These later facilities should be reserved for those patients who end up with any complications or more severe manifestation of the disease.Research is underway to develop an ideal vaccine for Dengue fever. In 2016, a vaccine by the name 'Dengvaxia' was marketed in Phillipines and Indonesia. However with development of new serotypes of the virus, its efficacy has been somewhat compromised.As for treatment , there are no specific antiviral drugs. Management is symptomatic revolving mainly around oral and intravenous hydration. Paracetamol (Acetaminophen) is used for fever as compared to NSAIDS such as Ibuprophen infusion as well as blood and platelet transfusion.Data to date shows that slightly more than twenty three thousand people have been diagnosed with dengue over the past three months ie August to October there is a lower risk of bleeding with the former. Those with more severe form of the disease may need Dextran 2017, in Peshawar, Pakistan with around fourteen thousand needing admission and about sixty nine recorded deaths. The mortality is well within the acceptable international standards of less than 1% for the disease. In the backdrop of all the debate surrounding the current epidemic, one can infer that such outbreaks are best addressed with effective planningwell ahead of the time before the disease threatens to spiral out of control. Simple measures such as covering water storage facilities, using larvicidals where practical, use of insect repellents, mosquito nets and avoiding unnecessary exposure can offerthe best protection. Public health messages via print and electronic media can help educate people in affected areas and allay any anxiety building up from a fear of developing life threatening complications. Health department must mobilise all its resources to ensure local management of diagnosed patients with simple dengue fever and facilitate hospital admission only for those suffering from more severe form of the disease. Moreover the media hype into such situations needs to be addressed through constant updates and discouraging any negative politicking on the issue. To sum up Dengue fever is not really an affliction to be dreaded provided it is viewed and managed in the right perspective.

ObjectiveWe sought to measure the burden of emergency department (ED) visits associated with injection drug use (IDU), HIV infection, and homelessness; and the intersection of homelessness with IDU and HIV infection in Massachusetts via syndromic surveillance data.IntroductionIn Massachusetts, syndromic surveillance (SyS) data have been used to monitor injection drug use and acute opioid overdoses within EDs. Currently, Massachusetts Department of Public Health (MDPH) SyS captures over 90% of ED visits statewide. These real-time data contain rich free-text and coded clinical and demographic information used to categorize visits for population level public health surveillance.Other surveillance data have shown elevated rates of opioid overdose related ED visits, Emergency Medical Service incidents, and fatalities in Massachusetts from 2014-20171,2,3. Injection of illicitly consumed opioids is associated with an increased risk of infectious diseases, including HIV infection. An investigation of an HIV outbreak among persons reporting IDU identified homelessness as a social determinant for increased risk for HIV infection.MethodsTo accomplish our objectives staff used an existing MDPH SyS IDU syndrome definition4, developed a novel syndrome definition for HIV-related visits, and adapted Maricopa County's homelessness syndrome definition. Syndromes were applied to Massachusetts ED data through the CDC’s BioSense Platform. Visits meeting the HIV and homelessness syndromes were randomly selected and reviewed to assess accuracy; inclusion and exclusion criteria were then revised to increase specificity. The final versions of all three syndrome definitions incorporate free-text elements from the chief complaint and triage notes, as well as International Statistical Classification of Diseases and Related Health Problems, 9th (ICD-9) and 10th Revision (ICD-10) diagnostic codes. Syndrome categories were not mutually exclusive, and all reported visits occurring at Massachusetts EDs were included in the analysis.Syndromes CreatedFor the HIV infection syndrome definition, we incorporated the free-text term “HIV” in both the chief complaint and triage notes. Visit level review demonstrated that the following exclusions were needed to reduce misspellings, inclusion of partial words, and documentation of HIV testing results: “negative for HIV”, “HIV neg”, “negative test for HIV”, “hive”, “hivies”, and “vehivcle”. Additionally, the following diagnostic codes were incorporated: V65.44 (Human immunodeficiency virus [HIV] counseling), V08 (asymptomatic HIV infection status), V01.79 (contact with or exposure to other viral diseases), 795.71 (nonspecific serologic evidence of HIV), V73.89 (special screening examination for other specified viral diseases), 079.53 (HIV, type 2 [HIV-2]), Z20.6 (contact with and (suspected) exposure to HIV), Z71.7 (HIV counseling), B20 (HIV disease), Z21 (asymptomatic HIV infection status), R75 (inconclusive laboratory evidence of HIV), Z11.4 (encounter for screening for HIV), and B97.35 (HIV-2 as the cause of diseases classified elsewhere).Building on the Maricopa County homeless syndrome definition, we incorporated a variety of free-text inclusion and exclusion terms. To meet this definition visits had to mention: “homeless”, or “no housing”, or, “lack of housing”, or “without housing”, or “shelter” but not animal and domestic violence shelters. We also selected the following ICD-10 codes for homelessness and inadequate housing respectively, Z59.0 and Z59.1.We analyzed MDPH SyS data for visits occurring from January 1, 2016 through June 30, 2018. Rates per 10,000 ED visits categorized as IDU, HIV, or homeless were calculated. Subsequently, visits categorized as IDU, HIV, and meeting both IDU and HIV syndrome definitions (IDU+HIV) were stratified by homelessness.ResultsSyndrome Burden on EDThe MDPH SyS dataset contains 6,767,137 ED visits occurring during the study period. Of these, 82,819 (1.2%) were IDU-related, 13,017 (0.2%) were HIV-related, 580 (<0.01%) were related to IDU + HIV, and 42,255 visits (0.6%) were associated with homelessness.The annual rate of IDU-related visits increased 15% from 2016 through June of 2018 (from 113.63 to 130.57 per 10,000 visits); while rates of HIV-related and IDU + HIV-related visits remained relatively stable. The overall rate of visits associated with homelessness increased 47% (from 49.99 to 73.26 per 10,000 visits).Rates of IDU, HIV, and IDU + HIV were significantly higher among visits associated with homelessness. Among visits that met the homeless syndrome definition compared to those that did not: the rate of IDU-related visits was 816.0 versus 118.03 per 10,000 ED visits (X2= 547.12, p<0. 0001); the rate of visits matching the HIV syndrome definition was 145.54 versus 18.44 per 10,000 ED visits (X2= 99.33, p<0.0001); and the rate of visits meeting the IDU+HIV syndrome definition was 15.86 versus 0.76 per 10,000 visits (X2= 13.72, p= 0.0002).ConclusionsMassachusetts is experiencing an increasing burden of ED visits associated with both IDU and homelessness that parallels increases in opioid overdoses. Higher rates of both IDU and HIV-related visits were associated with homelessness. An understanding of the intersection between opioid overdoses, IDU, HIV, and homelessness can inform expanded prevention efforts, introduction of alternatives to ED care, and increase consideration of housing status during ED care.Continued surveillance for these syndromes, including collection and analysis of demographic and clinical characteristics, and geographic variations, is warranted. These data can be useful to providers and public health authorities for planning healthcare services.References1. Vivolo-Kantor AM, Seth P, Gladden RM, et al. Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses — United States, July 2016–September 2017. MMWR Morbidity and Mortality Weekly Report 2018; 67(9);279–285 DOI: http://dx.doi.org/10.15585/mmwr.mm6709e12. Massachusetts Department of Public Health. Chapter 55 Data Brief: An assessment of opioid-related deaths in Massachusetts, 2011-15. 2017 August. Available from: https://www.mass.gov/files/documents/2017/08/31/data-brief-chapter-55-aug-2017.pdf3. Massachusetts Department of Public Health. MA Opioid-Related EMS Incidents 2013-September 2017. 2018 Feb. Available from: https://www.mass.gov/files/documents/2018/02/14/emergency-medical-services-data-february-2018.pdf4. Bova, M. Using emergency department (ED) syndromic surveillance to measure injection-drug use as an indicator for hepatitis C risk. Powerpoint presented at: 2017 Northeast Epidemiology Conference. 2017 Oct 18 – 20; Northampton, Massachusetts, USA.

This article aims to analyse an intercultural telephone invitation given by a Chinese tutor to an Australian student, and highlight general principles of intercultural invitations. This anecdote is based on a true story that took place in a university in Australia, but the persons' names used here are fictitious for the sake of confidentiality. Below is the transcript of the actual conversation between the Chinese tutor Dr Lin Liang (L) and his student Catherine Jones (C): C: Catherine speaking. L: Hi, Catherine, this is Lin. C: Hi, Teacher Lin. L: I would like to invite you to our New Year's party to be held in my house this Saturday evening. C: This Saturday? I am afraid I won't be able to make it because I am going to my best friend's birthday party. L: You know this is the end of our school year. It would be so nice for all of our classmates to gather together. C: But I have already promised my friend. L: En... It is a pity... C: Sorry about that, but -- L: Never mind. Enjoy your party then. C: Thanks. L: That's OK, bye. C: Bye. However, the story does not end here. About two hours later, Dr Lin rang Catherine a second time, asking if it was still possible for her to consider attending the Saturday party. Late in the evening around 9.00 pm, Dr Lin rang her yet again to invite her to the party, saying it would be OK even if she stayed just for a short while. The next day, Catherine lodged a complaint with the Dean, alleging that Dr. Lin's repeated calls constituted sexual harassment. Dr. Lin was highly distressed to learn of the complaint, and explained that he just wanted to indicate sincerity and warmth as required by an invitation, and had no other intentions. This communication breakdown invites a number of questions: What are the factors underlying Catherine's interpretation that Dr. Lin's repeated calls constituted sexual harassment? What are the factors underlying Dr. Lin's contention that his actions were intended to emphasise his sincerity? What factors would need to be recognised in order to facilitate culturally competent performances on both their parts? In order to answer these questions, this article will adopt a holistic approach based on an analytic framework encompassing three theoretical dimensions. This framework is comprised as follows: Differences in intercultural exchange and politeness behaviour; Aristotle's distinction between the three orientations of persuasive/rhetorical appeal; ethos, pathos, and logos; Austin and Searle's theory of speech acts, as applied to politeness behaviour and felicity conditions in communicative interaction as applied to the act of inviting. These approaches are conceptualised as three overlapping spheres, and their relatedness can be further illustrated: Figure 1 First and foremost, the case study in question is related to an intercultural interaction between the Australian and Chinese culture, and some research findings in relevant areas may help highlight the differences in politeness behaviour between high-context and low-context cultures (Hall). According to Hall, high-context cultures such as Chinese tend to stress the use of internalised or implicit message while low-context cultures tend to emphasise the use of explicit messages. In other words, in Chinese culture, the message may have some shared implied meanings that may go beyond the linguistic forms used in the message. Kaplan's model on oriental circularity and western linearity seemed to in accordance with Hall's model. Young's exploration of the directness and indirectness of American and Chinese requests further substantiated this point. In a similar way, differences may arise in determining the criteria for appropriate behaviour relating to the use of other directives across cultures. As Gao and Ting-Toomey suggest, Chinese culture seems to pay attention to qing (reciprocity and feelings of obligation) and guanxi (relationship building), while in low-context cultures such a stress tends to be missing. This difference may also help explain the differences in communicative patterns as discussed by Kaplan and Young. Zhu found that in making a sales offer, Chinese companies often try to establish a long-term relationship with their clients ("Structural Moves"). In contrast, Australian companies seem to mainly focus on promoting products. The stress on qing in Chinese culture may also be a crucial factor that contributes to the different criteria for a polite invitation as compared to the Australian culture. The following discussion will further explore the other two parameters (see Figure 1) the two cultures differ in when making an invitation, which may have finally led to the breakdown in communication between Dr. Lin and Catherine. As shown in Figure 1, the argument underpinning this approach is that a given illocutionary act reflects culture-specific preferences for certain persuasive/rhetorical orientations, thereby affecting the socio-linguistic performance, i.e. parole as opposed to langue (Cullen) related to politeness principles. In short, the persuasive/rhetorical orientation varies between cultures, which means that the nature of ostensibly equivalent illocutionary acts also varies. Consequently, cross-cultural competence will be limited unless one is aware of the rhetorical and politeness codes implicit in the performance of certain communicative actions. Note that rhetorical orientation may also influence the politeness behaviour directly as a specification of that orientation. This in turn requires an awareness of cultural preferences toward certain persuasive/rhetorical orientations. The interconnections between them and the theoretical utility of this approach will be made explicit in the course of this discussion. Austin and Searle conceptualise the speech acts as comprising of locution (langue) and illocution (parole). What is of vital importance is the illocutionary force of an utterance which is the performance of a speech act, such as an invitation. According to Searle, an invitation is a directive used to get the addressee to do something. Invitation can be understood as a particular form of persuasive speech act. It is generally intended to produce a particular response (i.e. acceptance). As an illocutionary action, an invitation seeks to establish a relationship of social expectations between the host and invitee. This requires certain felicity conditions to be met. In other words, for the speech act to be socially significant, it must create a shared sense of meaning in regard to some perceived change or modification to existing social relations. These are often so obvious that they require little explanation. However, felicity conditions in speech-acts are culture-specific and may include rhetorical and politeness devices that are not obvious to other cultures. Politeness behaviour in invitations, related to using appropriate language forms, is an important element in competent illocutionary performance. Leech contends that polite illocutions are likely to be seen as minimising the addressee's cost and maximising his/her benefits, and the opposite is true for the addresser. Politeness behaviour can also be further explained in the light of Brown and Levinson's face-saving theory. Many actions we perform with words are potential face-threatening acts, such as requests and invitations (Brown and Levinson). The addresser is thus often confronted with negative face wants and has to address them by applying Leech's principles, in which maximising the addressee's benefits is the dominant strategy to gain politeness. However, strategies to maximise the addressee's benefits can be culture-specific. This is further connected to the persuasive/rhetorical orientation. Based on Aristotle, the appeal from ethos emphasises the persuader's (host's) character and status or other social conventions which might oblige compliance. The appeal from pathos emphasises emotion/feelings (either positive or negative) in inducing the desired response. The appeal from logos emphasises reason and the logical consistency of the proposal with the ideas and motives of the persuadee (invitee). Moran and Stripp found that western cultures tend to have a logical orientation, while others such as Japanese and Chinese tend to be characterised by emotional or dogmatic orientations. In a similar manner, Chinese scholars seem to address ethos, logos and pathos at the same time, in particular the logos and pathos. These principles remain a well-accepted principle in Chinese writing theories. Li, for example, clearly explicates the persuasive principle in writing as qing li (the combination of the emotional and logical approaches). The explicitly preferred qing (feelings/emotions) can be seen as part of the Confucian values relating to harmony, consensus and relationship building as noted by Hofstede and Bond. The different rhetorical orientations are also further explored by Campbell. This difference may suggest that the preferred rhetorical orientations are also a key aspect underpinning competent illocutionary performance. For example in Chinese invitations, a stress on the emotional approach may validate behaviours such as repeating the invitation even after initial refusal. However, a stress on the logical orientation, such as in western cultures, may negate the validity of these politeness conditions. This clearly points out the necessity of understanding the criteria for competent performance across cultures. The felicity conditions of invitation in Euro-Australian culture require, first, that the potential host be in a legitimate position to offer hospitality, and second, that the potential guest be -- at least theoretically -- able and willing to accept. Thirdly, the locutionary form of politeness requires use of conventionally appropriate terms of address and wording. The illocutionary form requires that the host symbolically offer hospitality to the invitee without the imposition of charges or other demands. Furthermore, the implied benefit to the invitee would ideally be achieved though implied cost to the host (even if the invitee is addressed as if their presence constitutes the bestowal of a favour). Fourthly, depending on the nature of the relationship between the host and invitee, certain persuasive/rhetorical orientations are preferred over others (eg. an appeal to emotion may seem out of place in formal invitation). The initial invitation meets these criteria. Dr. Lin offers and Catherine declines, citing a plausible and legitimate reason for being unavailable. From Catherine's perspective, the felicity conditions for invitation are now redundant. She has already declined in a manner which makes it clear that she is socially obliged to be elsewhere. From a persuasive/rhetorical perspective, the first invitation was primarily based on an appeal from logos/reason. i.e. Dr. Lin did not know that Catherine had already committed herself to other plans and it would be reasonable to suppose that she might appreciate being invited to a social occasion. This was backed up by a secondary appeal from pathos/emotion, whereby Dr. Lin pointed out that it would be nice for the whole class to get together. However, the priority of attending a best friend's birthday-party over-rides both these appeals. In Euro-Australian culture, close personal friends enjoy greater social priority than classmates or more distant associates. For Dr. Lin, however, the politeness criteria for invitation were still applicable. From a Chinese cultural perspective, the illocutionary performance of invitation may require repetition of the offer, even if the initial approach has been declined. According to Zhu (Business Communication), in Chinese culture repeating invitations is an accepted ritual to indicate sincerity and hospitality. Thus in Dr. Lin's view the second approach is required to perform the illocutionary act competently. The persuasive appeal, however, has become oriented toward ethos, reflecting Chinese conventions pertaining to politeness behaviour. For Dr. Lin not to repeat the invitation might suggest that Catherine's presence was of merely casual concern. Therefore the sincerity of the invitation demanded the gesture of repetition, regardless of the logical grounds cited for the initial refusal. Unfortunately, Dr. Lin and Catherine perceive the second invitation in very different ways based on the illocutionary performance criteria of their respective cultures. For Catherine, the logical basis for her initial refusal renders Dr. Lin's performance incompetent, and creates uncertainty about his apparent motives. In Euro-Australian culture, the repeated invitation makes no logical sense, since a perfectly legitimate reason for declining has already been provided. Therefore the communicative action cannot be interpreted as an invitation. If it is, then it is performed in a culturally incompetent fashion which could legitimately be construed as pestering. Repeating an invitation which has already been declined may appear to be an emotional appeal. While an illocutionary invitation based on pathos conceivably may be competent in Euro-Australian culture, the only circumstances that it would occur in is between relatively close friends. The power-relations between Catherine, as student, and Dr. Lin, as tutor, precludes felicity in this case. Thus the same locutionary action is interpreted as two quite different illocutionary actions. This depends on the interpreter's culturally specific understanding of the social significance of the locution. Since Catherine's cultural conventions would implicitly deny the validity of a repeated invitation, the communicative action must be construed as something else. Catherine may have classified the repeated invitation as a minor issue of little consequence. However, when Dr. Lin called her up to invite her a third time, she interpreted the illocutionary act as harassment. From a contemporary Euro-Australian perspective, pestering may be irritating, but harassment is political in nature. Three factors lead Catherine to this conclusion. First, after two previous declinations, the third invitation could not fulfil the illocutionary performance criteria of a legitimate invitation. In particular, the persuasive/rhetorical orientation of the repeated appeals were not oriented toward logos, as befits the formality of the lecturer-student relation. Indeed, it was Dr. Lin's apparent attempt to approach Catherine in a non-formal manner (apparently oriented toward pathos rather than logos) which led her to this interpretation. Second, the fact that Dr. Lin' social status is higher than Catherine's introduced the problem of the implicit power-relations in the discourse. For Catherine, the third invitation was intrusive and pushy, and it seemed that her explanations had been ignored. The evening call demanded that she re-engage in the discourse of day-time student-tutor power-relations. Since she is subordinate to Dr. Lin, other strategies through which she might have asserted her rights may have carried the risk of subsequent disfavour. However, she obviously resented what she perceived as an attempt to inappropriately use status to interfere with her personal affairs and sought out higher authority to rectify the situation, hence the complaint of harassment made to the Dean. Ironically, Dr. Lin's third invitation in the evening may well have been intended to reduce the social distance between himself and Catherine created by workplace space-time power-relations. For Dr. Lin, the first invitation expressed the illocutionary intent. The second call made sure that the invitee was made to feel assured of the sincerity of the invitation, and the third ring expressed the would-be host's appreciation. Establishing a host-guest relationship is a key illocutionary function in Chinese invitation. Note though, that there may also be a 'face' consideration here. Dr. Lin attempts to facilitate Catherine's attendance by pointing out that it would be acceptable to attend for a brief period. This suggests a re-emphasis on the orientation to logos, since it points out a compromise which allows Catherine to attend both parties. It also allowed Dr. Lin to save 'face' by not having his invitation totally disregarded. However, it failed as an illocutionary performance because the felicity conditions for polite invitation had already been violated as far as Catherine was concerned, even though they remained intact throughout for Dr. Lin. In conclusion, it can be seen from the above analysis of the communication breakdown that persuasive orientations and politeness principles are interrelated and culturally sensitive. Euro-Australian culture stresses the logical orientation in illocutionary performance whereas Chinese culture seems to emphasise both the logical and emotional approaches. Without a recognition of this difference, specific politeness behaviours in intercultural invitations can lead to illocutionary incompetence. This has been exemplified by Catherine's misconstrual of Dr. Lin's intended invitation-performance as harassment. Therefore in intercultural communication, one ought not to judge a speech act such as an invitation based on one's own culture's felicity conditions. First and foremost, a basic understanding of persuasive orientations between cultures is essential. With appropriate understanding of these principles one can avoid misinterpreting the intent of the addresser, thus overcoming barriers in intercultural communication. Specifically, further appreciation of the interplay between rhetorical orientation, politeness codes and felicity conditions in illocutionary performances in different cultures is required for a fuller comprehension of potential cross-cultural incompetence. With this in mind, greater tolerance can be achieved, and intercultural competence enhanced. References Aristotle. Aristotle on Rhetoric: A Theory of Civic Discourse. Trans. George A. Kennedy. New York: Oxford UP, 1991. Austin, John. L. How to Do Things with Words. New York: Oxford UP, 1962. Brown, Penelope, and Stephen C. Levinson. Politeness: Some Universals in Language Usage. Cambridge, UK: Cambridge UP, 1987. Campbell, Charles. P. "Rhetorical Ethos: A Bridge between High-Context and Low-Context Cultures? The Cultural Context in Business Communication. Eds. Susanne Niemeier, Charles P. Campbell and René Dirven. Philadelphia: John Benjamins, 1998. 31-47. Cullen, Johnathan. Saussure. 2nd ed. London: Fontana, 1985. Ge Gao, and S. Ting-Toomey. Communicating Effectively with the Chinese. Thousand Oaks: Sage, 1998. Hall, E. T. Beyond Culture. Garden City, NY: Anchor, 1977. Hofstede, G., and M. H. Bond. "The Confucius Connection: From Cultural Roots to Economic Growth." Organisational Dynamics 16.4 (1988): 4-21. Kaplan, R. B. "Cultural Thought Patterns in Inter-Cultural Education." Language Learning 16 (1966): 1-20. Leech, Geoffery. Principles of Pragmatics. New York: Longman, 1983. Li Xiaoming. "Good Writing" in Cross-Cultural Context. Albany, NY: State U of New York P, 1996. Moran, R. T., and W. G. Stripp. Successful International Business Negotiations. Houston: Gulf, 1991. Searle, John R. Speech Acts: An Essay in the Philosophy of Language. Cambridge, UK: Cambridge UP, 1969. Young, Linda Wai Ling, ed. Crosstalk and Culture in Sino-American Communication. Cambridge, UK: Cambridge UP, 1994. Zhu Yunxia. Business Communication in China. New York: Nova Science Publishers, 1999. ---. Structural Moves Reflected in English and Chinese Sales Letters. Discourse Studies (In Press). Citation reference for this article MLA style: Zhu Yunxia, Peter Thompson. "Invitation or Sexual Harassment? An Analysis of an Intercultural Communication Breakdown." M/C: A Journal of Media and Culture 3.4 (2000). [your date of access] <http://www.api-network.com/mc/0008/invitation.php>. Chicago style: Zhu Yunxia, Peter Thompson, "Invitation or Sexual Harassment? An Analysis of an Intercultural Communication Breakdown," M/C: A Journal of Media and Culture 3, no. 4 (2000), <http://www.api-network.com/mc/0008/invitation.php> ([your date of access]). APA style: Zhu Yunxia, Peter Thompson. (2000) Invitation or sexual harassment? An analysis of an intercultural communication breakdown. M/C: A Journal of Media and Culture 3(4). <http://www.api-network.com/mc/0008/invitation.php> ([your date of access]).

This thesis reports on design and performance studies of a prototype combined air source heat pump and storage system, retro fitted to heat occupied spaces subjected to high ventilation rates. The source of heat is from the air in the extract duct. Two limiting thermal conditions exist. The first is the thermal capacity of air passing over the ducted heat exchangers. The second is the dew and freezing points of the exhaust air, because of the insulating effect of ice on exchanger fins and tubes. Both are alleviated to a significant extent with high mass flow rates passing down the duct, since more heat can be extracted for a set decline in exhaust air temperatures. This study identifies reasons for ventilation and building strategies involving high ventilation rates, including the physiological and emotional needs of people and the various economic, climatic and Governmental polices (climate change levy, public health legislation) that impact upon heating and ventilation design. The study recognises the need for reduced carbon dioxide emissions and explores issues of indoor air quality and sick building syndrome and how increased ventilation rates can address them. The proposition investigated in this thesis is that air source recovery and heating by heat pump systems, combined with a heat storage system, can economically allow increases in ventilation rates to well above current standards without incurring great increases in energy use and carbon emissions; and in some circumstances reducing them. The thesis discusses in depth and detail, the advantages and disadvantages of possible alternative methods of heating a building and ventilation recovery, comparing their effectiveness and cost. A prototype system has been designed and field trials of a retrofit application have produced performance data that has subsequently been used in a long term cost comparison. The rig's design and construction are fully documented and its function over a full heating season is comprehensively explained (recording methods, types of calibration, control choices etc). A theoretical estimate of the energy requirements could have been attained using simulation and degree day information, however, a real like-for-like comparison using field trials prepared and a model was developed which allowed test data to be used to predict costs. The rig was tested over two heating seasons and compared with actual reading from alternative heating systems, degree day calculations are discussed but the reliance is on the actual live data gathered. (although summer cooling is achievable with the test rig no readings were recorded or comparison made). The work shows that heat pump heating and recovery systems and combined storage ability out-performed the other systems investigated. The crucial elements of its functionality are the high temperature of the heat source and the vast volume (and thermal capacity) of air being used, extracting at 24 °C and delivering at 35°C. The Coefficient of performance varies through the heating season but, synthesis of theory with test rig performance demonstrate that the longer term cost of the system is attractive; and its attraction shall probably grow with anticipated future trends in consumer demands for comfort and air quality coupled with fuel costs and a philanthropic social and political attitude to emissions control.

There is need for sustainable building practice in Nigeria as buildings generally show signs of poor design for ventilation, natural lighting, energy management, water management, waste management and other building services. These buildings under perform in relation to the purpose for which they have been built. Building users often complain that the buildings do not provide the required services such as functioning air-conditioning systems, effective water and energy management systems and waste management. Facilities management (FM) professionals in Nigeria have recognised the role that they can play in the practice of sustainable building as a way to proffering a solution to the above mentioned problems. Six objectives were set for the study: to identify the constituents of sustainable building with reference to literature and internationally recognised standards; to evaluate the role of FM in relation to the sustainable building at the design, the construction and operations stages of the building life-cycle; to develop a conceptual framework that shows the facilities manager’s role in sustainable buildings; to evaluate the perception of facilities managers in relation to their competence in achieving sustainable buildings; to investigate the drivers and barriers to the facilities manager’s role in achieving sustainable buildings; and finally to develop and validate a framework for sustainable building practice for FM in Nigeria. The methodology adopted for this research included a combination of extensive literature review, content analysis of relevant literature and documents, 20 interviews and a questionnaire survey of 139 members of IFMA Nigeria in order to identify sustainable building constituents and the facilities manager’s role in sustainable buildings. The findings of the research helped in developing a framework for the achievement of sustainable buildings through the facilities manager’s role at the design, construction and operations stages of the building’s life-cycle.

This dissertation argues for the value of the concept of systemic reflexivity in sense making, orientation and action in systemic practice, and in organisational practice in particular. The concept emerges as a theme through the development of two specific strands of published work from 1992 to 2013, that of Coordinated Management of Meaning Theory (CMM) and Appreciative Inquiry (AI). Both lines of inquiry highlight the moral dimension of practitioners’ conceptualisation and practice. Systemic reflexivity alerts us to the opportunities and constraints system participants make for the system in focus, facilitating exploration of a system’s coherence, through a detailed framework for systemic thinking which links patterns of communication to their narratives of influence and narrative consequences. It provides the conditions for enabling individual and collective responsibility for the ways that communication shapes our social worlds. The concept is illustrated in practice through a range of case studies within the published works.

With the availability of innumerable ‘intelligent’ building products and the dearth of inclusive evaluation tools, design teams are confronted with the quandary of choosing the apposite building control systems to suit the needs of a particular intelligent building project. The paucity of measures that represent the degree of system intelligence and indicate the desirable goal in intelligent building control systems design further inhibits the consumers from comparing numerous products from the viewpoint of intelligence. This thesis is organised respectively to develop models for facilitating the selection evaluation and the system intelligence analysis for the seven predominant building control systems in the intelligent building. To achieve these objectives, systematic research activities are conducted to first develop, test and refine the general conceptual models using consecutive surveys; then, to convert the developed conceptual frameworks to the practical models; and, finally, to evaluate the effectiveness of the practical models by means of expert validations.----- The findings of this study, on one hand, suggest that there are different sets of critical selection criteria (CSC) affecting the selection decision of the intelligent building control systems. Service life, and operating and maintenance costs are perceived as two common CSC. The survey results generally reflect that an ‘intelligent’ building control system does not necessarily need to be technologically advanced. Instead, it should be the one that can ensure efficiency and enhance user comfort and cost effectiveness. On the other hand, the findings of the research on system intelligence suggest that each building control system has a distinctive set of intelligence attributes and indicators. The research findings also indicate that operational benefits of the intelligent building exert a considerable degree of influence on the relative importance of intelligence indicators of the building control systems in the models. This research not only presents a systematic and structured approach to evaluate candidate building control systems against the CSC, but it also suggests a benchmark to measure the degree of intelligence of one control system candidate against another.

Cities are not merely inanimate objects. They are complex living environments, built over time by cultures and civilisations. This thesis argues that cities have a central place in human history and civilisation because they are imbued with meaning and meaningful activity. Thus, cities are inherently political spaces, and it may be reasonably expected that they will be important sites of social transformation in the postmodern era. In order to understand the relationship between urban space and political consciousness, this thesis traces several different interpretive paths within the marxist tradition. First, we examine the work of Henri Lefebvre, who argues for an understanding of urban space as socially produced. Next, the thesis looks at the contributions of Guy Debord, particularly at his understanding of the relation between time and the city. Both writers struggle to understand the urban in the context of the shift to what we now call postmodernity. Despite their many strengths, Debord and Lefebvre ultimately fail to theorise a social subject capable of resisting capitalist domination of the city. As a result, the thesis turns to a consideration of the work of Antonio Negri. Negri’s analysis of the fate of contemporary subjectivity has reinvigorated marxist critique with a return to the question of political change. His figure of the multitude takes leave of traditional marxism in challenging and productive ways, and helps us better understand the nature of subjectivity and resistance in a world of immaterial labour and virtuality. Nevertheless, this thesis argues that there is still work to be done before Negri’s work can be mapped out onto the contemporary metropolis.

Buildings are one of the fundamental sources of geospatial information for urban planning, population estimation, and infrastructure management. Although building extraction research has gained considerable progress through neural network methods, the labeling of training data still requires manual operations which are time-consuming and labor-intensive. Aiming to improve this process, this thesis developed an automated building extraction method based on the boundary following technique and the Mask Regional Convolutional Neural Network (Mask R-CNN) model. First, assisted by known building footprints, a boundary following method was used to automatically best label the training image datasets. In the next step, the Mask R-CNN model was trained with the labeling results and then applied to building extraction. Experiments with datasets of urban areas of Bloomington and Indianapolis with 2016 high resolution aerial images verified the effectiveness of the proposed approach. With the help of existing building footprints, the automatic labeling process took only five seconds for a 500*500 pixel image without human interaction. A 0.951 intersection over union (IoU) between the labeled mask and the ground truth was achieved due to the high quality of the automatic labeling step. In the training process, the Resnet50 network and the feature pyramid network (FPN) were adopted for feature extraction. The region proposal network (RPN) then was trained end-to-end to create region proposals. The performance of the proposed approach was evaluated in terms of building detection and mask segmentation in the two datasets. The building detection results of 40 test tiles respectively in Bloomington and Indianapolis showed that the Mask R-CNN model achieved 0.951 and 0.968 F1-scores. In addition, 84.2% of the newly built buildings in the Indianapolis dataset were successfully detected. According to the segmentation results on these two datasets, the Mask R-CNN model achieved the mean pixel accuracy (MPA) of 92% and 88%, respectively for Bloomington and Indianapolis. It was found that the performance of the mask segmentation and contour extraction became less satisfactory as the building shapes and roofs became more complex. It is expected that the method developed in this thesis can be adapted for large-scale use under varying urban setups.

A BIM-based tool for formwork management was developed using Dynamo Studio and Revit, based on practitioners preferences regarding LOD and rental option. The BIM tool is a toolset of Dynamo scripts able to create a BIM model for formwork enable with parameters that describes formwork features necessary for formwork management. The BIM model created with this toolset is able to compute quantities, cost analysis, generate a demand profile, and cerate a 4D & 5D simulation automatically.

Research on net-zero energy buildings (NZEBs) has been largely centered around improving building energy performance, while little attention has been given to indoor air quality. A critically important class of indoor air pollutants are nanoaerosols – airborne particulate matter smaller than 100 nm in size. Nanoaerosols penetrate deep into the human respiratory system and are associated with deleterious toxicological and human health outcomes. An important step towards improving indoor air quality in NZEBs is understanding how occupants, their activities, and building systems affect the emissions and fate of nanoaerosols. New developments in smart energy monitoring systems and smart thermostats offer a unique opportunity to track occupant activity patterns and the operational status of residential HVAC systems. In this study, we conducted a one-month field campaign in an occupied residential NZEB, the Purdue ReNEWW House, to explore how energy use profiles and smart thermostat data can be used to characterize indoor nanoaerosol dynamics. A Scanning Mobility Particle Sizer and Optical Particle Sizer were used to measure indoor aerosol concentrations and size distributions from 10 to 10,000 nm. AC current sensors were used to monitor electricity consumption of kitchen appliances (cooktop, oven, toaster, microwave, kitchen hood), the air handling unit (AHU), and the energy recovery ventilator (ERV). Two Ecobee smart thermostats informed the fractional amount of supply airflow directed to the basement and main floor. The nanoaerosol concentrations and energy use profiles were integrated with an aerosol physics-based material balance model to quantify nanoaerosol source and loss processes. Cooking activities were found to dominate the emissions of indoor nanoaerosols, often elevating indoor nanoaerosol concentrations beyond 10⁴ cm^-3. The emission rates for different cooking appliances varied from 10¹¹ h^-1 to 10¹⁴ h^-1. Loss rates were found to be significantly different between AHU/ERV off and on conditions, with median loss rates of 1.43 h^-1 to 3.68 h^-1, respectively. Probability density functions of the source and loss rates for different scenarios will be used in Monte Carlo simulations to predict indoor nanoaerosol concentrations in NZEBs using only energy consumption and smart thermostat data.

With dwindling water supplies and the impacts of climate change, many cities are turning to water sources previously considered unusable. One such source for inland cities is brackish groundwater. With prolonged drought throughout Texas, cities such as El Paso, Lubbock, and San Antonio are desalinating brackish groundwater to supplement existing water sources. Similar projects are under consideration elsewhere in Texas. While brackish groundwater contains fewer total dissolved solids than seawater, desalination of brackish groundwater is still an energy-intensive process. Brackish water desalination using reverse osmosis, the most common desalination membrane treatment process, consumes 20 to 40 times more energy than traditional surface water treatment using local water sources. This additional energy consumption leads to increased carbon emissions when using fossil fuel-generated electricity. As a result of concern over greenhouse gas emissions from additional energy consumption, some desalination plants are powered by wind-generated electricity. West Texas is a prime area for desalination of brackish groundwater using wind power, since both wind and brackish groundwater resources are abundant in the area. Most of the Texas Panhandle and Plains region has wind resource potential classified as Class 3 or higher. Additionally, brackish groundwater is found at depths less than 150 m in most of west Texas. This combination of wind and brackish groundwater resources presents opportunities for the production of alternative drinking water supplies without severe carbon emissions. Additionally, since membrane treatment is not required to operate continuously, desalination matches well with variable wind power. Implementing a brackish groundwater desalination project using wind-generated electricity requires economic feasibility, in addition to the geographic availability of the two resources. Using capital and operating cost data for wind turbines and desalination membranes, we conducted a thermoeconomic analysis for three parameters: 1) transmission and transport, 2) geographic proximity, and 3) aquifer volume. Our first parameter analyzes the cost effectiveness of tradeoffs between building infrastructure to transmit wind-generated electricity to the desalination facility versus pipelines to transport brackish groundwater to the wind turbines. Secondly, we estimate the maximum distance between the wind turbines and brackish groundwater at which desalination using wind power remains economically feasible. Finally, we estimate the minimum available brackish aquifer volume necessary to make such a project profitable. Our analysis illustrates a potential drinking water option for Texas (and other parts of the world with similar conditions) using renewable energy to treat previously unusable water. Harnessing these two resources in an economically efficient manner may help reduce future strain on the energy-water nexus.