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The purpose of this paper is to illustrate delirium as a possible consequence of the application of symptom-triggered therapy for alcohol withdrawal and to explore alternative treatment modalities. In the management of alcohol withdrawal syndrome, symptom-triggered therapy directs nursing staff to regularly assess patients using standardized instruments, such as the Clinical Institute for Withdrawal Assessment of Alcohol, Revised (CIWA-Ar), and administer benzodiazepines at symptom severity thresholds. Symptom-triggered therapy has been shown to lower total benzodiazepine dosage and treatment duration relative to fixed dosage tapers (Daeppen et al., 2002). However, CIWA-Ar has important limitations. Because of its reliance on patient reporting, it is inappropriate for nonverbal patients, non-English speakers (in the absence of readily available translators) and patients in confusional states including delirium and psychosis. Importantly, it also relies on the appropriate selection of patients and considering alternate etiologies for signs and symptoms also associated with alcohol withdrawal.

The authors report a case of a 47-year-old male admitted for cardiac arrest because of benzodiazepine and alcohol overdose who developed worsening delirium on CIWA-Ar protocol.

While symptom-triggered therapy through instruments such as the CIWA-Ar protocol has shown to lower total benzodiazepine dosage and treatment duration in patients in alcohol withdrawal, over-reliance on such tools may also lead providers to overlook other causes of delirium.

This case illustrates the necessity for providers to consider using other available assessment and treatment options including objective alcohol withdrawal scales, fixed benzodiazepine dosage tapers and even antiepileptic medications in select patients.

The aim of the study is to provide a comprehensive understanding of interrelations of structural systems and main planning considerations in supertall buildings (≥300 m).

Data were collected from 140 contemporary supertall towers using the case study method to analyze structural systems in the light of the key design considerations to contribute to the creation of more viable supertall building projects.

Central core typology, outriggered frame system, composite material and tapered prismatic and free forms were the most preferred features in supertall building design. Shear walled frame and tube systems occurred mostly in the 300–400 m height range, while outriggered frame systems were in the range of 300–600 m in height. Asia, the Middle East and North America mainly preferred outriggered frame systems, followed by tube systems. Considering the building function and form, the most preferred structural system in each of these groups was outriggered frame system, while mixed-use function stood out in all structural systems except in shear walled frame system.

To date, there has been no comprehensive study in the literature of the interrelations of structural systems and important planning considerations in the design of contemporary supertall towers through a large set of study samples. This critical issue was multidimensionally explored in this paper in light of 140 detailed case studies of supertall buildings around the world.

Supertall towers (300 m+) offer a viable solution to the increasing demand for housing and commercial space caused by rapid urban growth, migration from rural to urban areas and economic expansion in Asia. In this particular context, the efficient utilization of space becomes a crucial factor in the design process for Asian skyscrapers as they seek to address the changing socioeconomic landscape. This study will provide valuable guidance, especially to architectural and structural designers in the pursuit of sustainable development for Asian skyscrapers by analyzing space efficiency.

The methodology employed in this paper involved a case study approach to gather data on 75 Asian supertall towers in order to examine space efficiency.

Findings of the research can be summarized as follows: (1) the average space efficiency of these towers was 67.5%, ranging from a minimum of 55% to a maximum of 82%; (2) the average proportion of the core area to the gross floor area (GFA) was 29.5%, with values ranging from 14% to 38%; (3) the majority of Asian skyscrapers exhibited a tapered form and adopted a central core typology, which catered to mixed-use and office purposes; (4) the most frequently utilized structural system was a combination of composite and outriggered frames; (5) space efficiency tended to decrease as the height of the tower increased; and (6) there was no noteworthy difference in the impact of various load-bearing systems and building forms on space efficiency.

There is a noticeable lack of extensive research into space efficiency in supertall towers in Asia, which serves as a hub for skyscrapers. This study seeks to fill this substantial gap in the current scientific literature.

We study the contemporaneous effects of US monetary policy normalization on African stock market using panel data from six African countries.

Daily data from May 1, 2013 to December 31, 2018 were used in order to accommodate the announcement effects since the US monetary policy normalization announcement was made in May 2013, while the rate hike was in December 2015. The study used the FE, RE and PMG models.

The results revealed that US 10-year bond yield and Treasury bill rate shocks negatively affect stock prices in Africa. S$P500 shock positively affects African stock prices.The result revealed that the integration of African financial market to the global financial market is a major source of vulnerability. The finding that US Treasury bill rate is a major depressant of the African stock prices reveals the short-termism of foreign polio inflows into African economies.

We provide inexorably insight into the interplay of financial systems globally. It can be useful for the purposes of generalization in developing economies in the shape of African countries. More so, this study could be replicated in another economic bloc or region with the aim of further exposing the far-reaching spillover effects of the US monetary policy normalization.

There is a considerable disparity between clinical practice and recommendations based on meta-analyses of antipsychotic polypharmacy in clozapine resistant schizophrenia. For this reason, we investigated the clinical response to reducing the use olanzapine that had been previously added on clozapine treatment among seriously ill hospitalized patients. In a randomized controlled trial with crossover design, we studied volunteer patients (N=15) who had olanzapine added on to clozapine in a state mental hospital. Clozapine monotherapy was just as effective as clozapine-olanzapine therapy, according to results from Clinical Global Impression Scale and Global Assessment of Functioning as primary outcome measures. Polypharmacy is widely used in treating schizophrenia, and usually, add-on medications are started because of worsening of the clinical state. A major confounding feature of these add-ons is whether observed improvements are caused by the medication or explained by the natural fluctuating course of the disorder. The present study, in spite of its small size, indicates the necessity of reconsidering the value of polypharmacy in treating schizophrenia.

Many countries around the world are facing great challenges from their ageing population with shrinking workforce, this will put more pressure on their financial system and will increase the public spending on care costs provided to older people. Egypt is in the phase of establishing a new law for older people care's rights, a law that will organise how older people in need for care would benefit from access to government financial support and how will families support their older relatives financially and how the care costs will be shared between the older people, their families and the government.

The paper examines the suitability two cost-sharing methods and applying them to assess the effect on the individuals and families' income strain.

The preferred approach can be used for sharing costs as it applies a gradual funding withdrawal by the government and provide more fairness and flexibility for application in different regions. Besides, the parameters of this approach can be used by policy makers to control the levels of funding.

The paper will be the first to discuss the intergenerational fairness from a financial perspective in Egypt to avoid forcing older people into poverty or resorting to poverty trade-off.

Optimisation of daylight admission through window is crucial for alleviating glare while maintaining useful daylight levels in order to enhance occupants' health, visual comfort and moderating lighting energy consumption. Amongst various solutions, fixed external shade is an affordable solution for housing spaces that need to be sophisticatedly designed, especially during the period of increasing home spaces as working environments. In the humid subtropical region, daylight control plays an important role in indoor comfort, particularly with areas with a high window to wall ratio (WWR). Due to the insufficient amount of such study on non-office spaces in Australia, shading-related standards are not addressed in Australian building codes.

The chosen methodology for the research is a quantitative data collection and analysis through field measurement and simulation simultaneously. The first step is a multi-objective optimisation of shading elements through a non-dominated sorting genetic algorithm (NSGA-II) on parametric modelling via Rhino3D CAD and simulation engines (DIVA and ClimateStudio). In the second phase, the Pareto front solutions are validated by experimental measurements within a room with a single north-facing window (the most probable for the daytime glare in Sydney) for the seven most common local window configurations.

Through the simulation of ten genes, 1,560 values and 2.4 × 1,019 of search space, this study found an optimum shade for each local common window layout, resulted in +22% in (UDI) and −16% in views with discomfort glare on average. Moreover, an all-purpose polygonal shade showed an average of 4.6% increase in UDI and a 5.83% decrease in the percentage of views with discomfort glare.

The findings are subject to the room dimensions, window dimensions and layouts, and orientation of windows for selected residential buildings in Sydney.

The study contributes to the development of highly accurate fixed external shading systems with rectangular and tapered-form external shapes. A real-time measurement by luminance-metre sensors and HQ cameras located at six eye levels is conducted to corroborate simulation results of the visual comfort.

The purpose of this paper is to analyze and compare the performances of novel roadable personal air vehicle (PAV) concepts that meet established operational requirements with different types of engines.

The vehicle configuration was devised considering the dimensions and operational restrictions of the roads, runways and parking lots in South Korea. A folding wing design was adopted for road operations and parking. The propulsion designs considered herein use gasoline, diesel and hybrid architectures for longer-range missions. The sizing point of the roadable PAV that minimizes the wing area was selected, and the rate of climb, ground roll distance, cruise speed and service ceiling requirements were met. For various engine types and mission profiles, the performances of differently sized PAVs were compared with respect to the MTOW, wing area, wing span, thrust-to-weight ratio, wing loading, power-to-weight ratio, brake horsepower and fuel efficiency.

Unlike automobiles, the weight penalty of the hybrid system because of the additional electrical components reduced the fuel efficiency considerably. When the four engine types were compared, matching the total engine system weight, the internal combustion (IC) engine PAVs had better fuel efficiency rates than the hybrid powered PAVs. Finally, a gasoline-powered PAV configuration was selected as the final design because it had the lowest MTOW, despite its slightly worse fuel efficiency compared to that of the diesel-powered engine.

Although an electric aircraft powered only by batteries most capitalizes on the operating cost, noise and emissions benefits of electric propulsion, it also is most hampered by range limitations. Air traffic integration or any safety, and noise issues were not accounted in this study.

Aircraft sizing is a critical aspect of a system-level study because it is a prerequisite for most design and analysis activities, including those related to the internal layout as well as cost and system effectiveness analyses. The results of this study can be implemented to design a PAV.

This study can contribute to the establishment of innovative PAV concepts that can alleviate today’s transportation problems.

This study compared the sizing results of PAVs with hybrid engines with those having IC engines.