The "performance gap" in the United Kingdom construction industry is a persistent problem as new building development projects underperform more often than not. The "performance gap" is partially attributed to the number of stages involved in building project development and the coordination difficulties of partners with different incentives. The project outcome is important for energy consumption, carbon emissions and occupant well-being. Thus, it is important to study the project management process in terms of the standard time, cost and quality parameters, but also in terms of project partner incentives and coordination, and the subsequent energy performance and resultant indoor environmental conditions. A system dynamics model of project management processes is developed to explore the implications of partner coordination for building quality. The system dynamics model is coupled to a building performance simulation model to explore building energy consumption and Indoor Environmental Quality, and apply this on a recent building project case study. Results show that greater project partner alignment can reduce annual energy consumption up to 12% and CO2 emissions up to 37%, with greater emphasis in the design stage of the project subject to resource availability. The trade-offs involved on value appropriation are considered and discussion of results points to possible ways for improvement.

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There is a policy-driven focus, at present, on improving the energy performance of buildings. However, energy-related issues alone do not capture the full impact of buildings on occupants and the wider environment. The performance of a building also includes occupant wellbeing and indoor environmental quality. Specifically, in schools, indoor environmental quality (thermal comfort, indoor air quality, lighting and acoustics) is an important aspect. Additionally, the issue of the ‘performance gap’, generally focused on energy, also affects indoor environmental quality parameters and needs to be addressed holistically. This paper reports on a holistic building performance evaluation covering aspects of energy, thermal comfort, indoor air quality, lighting and acoustics. It assesses the performance issues and inter-relationships between energy and indoor environmental quality in a recently built school campus in London. Based on the evidence collated from this case study and supplementary literature, the endemic issues and constraints within the construction industry are explored, such as inappropriate design calculations and resistance to new low-carbon technologies. Further, lessons for improved performance in the design, operation and maintenance of schools are highlighted such as factoring in the changing building use trends during design and the significance of optimal operations and maintenance of building systems for better energy and indoor environmental quality performance. This study shows that if the building design focus primarily remains on energy, unintended consequence of indoor environmental quality underperformance may occur where there are conflicts between energy and indoor environmental quality objectives. An integrated approach to building performance can help address this issue. Practical application: There are often conflicts between energy efficiency and indoor environmental quality (IEQ) objectives in building design and operation. Most building performance evaluations are primarily focused on one set of these performance criteria. This building performance evaluation was done with an integrated energy and IEQ perspective. The study identifies the causes of underperformance in energy and IEQ in a recently built school in London. Some of the findings from this study provide lessons that are relevant across the industry for the delivery of low-carbon and healthy buildings. These lessons include methods to further strengthen the policy frameworks and design protocols along with overall improvements in the processes followed during design, construction and operation of schools and other non-domestic buildings. The paper can also inform building designers, contractors and facility managers about the ways to reduce the performance gap and achieve energy targets without unintended consequences for indoor environment.

Hospitals are controlled yet complex ecosystems which provide a therapeutic environment that promotes healing, wellbeing and work efficiency for patients and staff. As these buildings accommodate the sick and vulnerable, occupant wellbeing and good indoor environmental quality (IEQ) that deals with indoor air quality (IAQ), thermal comfort, lighting and acoustics are important objectives. As the specialist nature of hospital function demands highly controlled indoor environments, this makes them energy intensive buildings due to the complex and varying specifications for their functions and operations. This paper reports on a holistic building performance evaluation covering aspects of indoor air quality, thermal comfort, lighting, acoustics, and energy use. It assesses the performance issues and inter-relationships between IEQ and energy in a new building on a hospital campus in the city of Bristol, United Kingdom. The empirical evidence collated from this case study and the feedback received from the hospital staff help identify the endemic issues and constraints related to hospital buildings, such as the need for robust ventilation strategies in hospitals in urban areas that mitigate the effect of indoor and outdoor air pollution and ensuring the use of planned new low-carbon technologies. Whilst the existing guidelines for building design provide useful instructions for the protection of hospital buildings against ingress of particulate matter from outdoors, more advanced filtration strategies may be required to enact chemical reactions required to control the concentration levels of pollutants such as nitrogen dioxide and benzene. Further lessons for improved performance in operation and maintenance of hospitals are highlighted. These include ensuring that the increasingly available metering and monitoring data in new buildings, through building management systems, is used for efficient and optimal building operations for better IEQ and energy management. Overall, the study highlights the need for an integrated and holistic approach to building performance to ensure that healthy environments are provided while energy efficiency targets are met.

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Introduction. To confirm the efficacy and safety of substituting teneligliptin with hydroxychloroquine in inadequately control type 2 diabetes patients (T2DM) despite treatment with teneligliptin, metformin and glimepiride with or without other antidiabetic therapy. Material and methods. This is a multicentre observational, retrospective, 24 week clinical study performed in type 2 diabetes patients with HbA 1c in the range of 7.5% to 9.5%. This patients were on teneligliptin 20 mg in addition of metformin and glimepiride with or without other antidiabetic therapy. Teneligliptin 20 mg treatment was replaced by hydroxychloroquine 400 mg. The primary endpoint was change in fasting blood glucose (FBG), postprandial blood glucose (PPBG) and HbA 1c from baseline to week 24. The secondary outcome of the study was the proportion of patients who achieved good glycaemic control (HbA 1c < 7%) and change in estimated glomerular filtration rate (eGFR), blood urea, serum creatinine and lipid profile levels by the end of the study. Data was taken from patients medical records of the Hospital and Private clinic. Results. Total of 500 patients' data was analysed and after 24 week of follow up these patients presented with significant decrease in HbA 1c (-1.1 ± 0.17%; p = 0.000); FBG (-29.87 ± 8.9 mg/dl), PPBG (-56.89 ± 9.2 mg/dl) with 52% of patients had achieved HbA 1c levels < 7% at the end of the study which confirmed superiority of switching to hydroxychloroquine from teneligliptin. It has also been observed that after the switch from teneligliptin to hydroxychloroquine there was no change in serum creatinine and eGFR and further statistically significant change in total cholesterol,

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