FENA(%) = {U Na / Pl Na x 100} / {U Cr * 1000 / Pl Cr}

All concentrations in mmol/L except plasma creatinine in umol/L.

Interpretation:
In pre-renal renal failure FENA is generally <1%.

FENa can be useful in the evaluation of acute renal failure and oliguria. Low fractional excretion indicate sodium retention by the kidney, suggesting pathophysiology extrinsic to the urinary system such as volume depletion. Higher values can suggest sodium wasting due to acute tubular necrosis or other causes of intrinsic renal failure. The FENa may be affected or invalidated by diuretic use, since many diuretics act by altering the kidney’s handling of sodium. Wikepdia

Calculate the fractional excretion of sodium given the serum and urine sodium, and the serum and urine creatinine.

_______________________________________________________________________

To accurately interpret FENa, patients should not have recently received diuretics. FENa is greater than 1% and usually greater than 3% with acute tubular necrosis and severe obstruction of the urinary drainage of both kidneys. It is generally less than 1% in patients with acute glomerulonephritis, hepatorenal syndrome, and states of prerenal azotemia such as congestive heart failure or dehydration. FENa may also be less than 1% with acute partial urinary tract obstruction.

– Stein JH, ed. Internal Medicine, 4th edition. Mosby-Year Book. 1994.

The equation is:

New age construction and renovation strategies are reflective of these trends and the intense scrutiny they are subject to. It maybe through thermal insulation, better moisture control, or cutting edge technologies like better air infiltration regulation, active facades which come with automated shading and venting. Alternatively it could be the use of innovative enclosure types, like for instance double walls.

The construction of energy efficient buildings requires, what is called a systems design approach. This is an amalgam of design, technology, equipment, materials and the knowhow to put together a home that serves the occupant, structure and environment equally well. The key to doing this is the use of only environmentally friendly and energy efficient materials.

A home has to be durable, secure and easy to live in while at the same time not consume huge amounts of energy. The elements will impact on the house both internally and externally. These comprise of humidity, rain, heat, wind, and dust. In order for a building to be able to successfully withstand all these pressures, each and every home should be built with materials and technologically that have been specifically researched and tested. The environment, the location of the building, and other factors need to synergise with the environment control system that is in place inside the house. It is a fact that no two homes are alike. That explains the necessity of having whole home energy standards. This is all about using an energy efficient approach and customising it to the specific needs of the house under consideration. Energy efficient construction is all set to create new paradigms for a home building strategy.

For instance there is the all new welded steel form tie. It offers sufficient strength, better flow of concrete, and a bigger more secure attachment stud. As the concept of eco friendly buildings begins to find even greater acceptance, there has been a huge spurt in the demand for eco-friendly products. One of the leading eco friendly products in the market is eco roofing. Another interesting material is solar panels. That has become quite a hit with a lot many builders because of their unique ability to not only recover their cost but substantially lower the energy costs incurred by a building or house over its entire life-cycle. There is no reason upon the face of this earth to be consuming traditional, energy guzzling  construction products when there is a range of innovative, relatively inexpensive and most importantly environment friendly new age construction materials available in the market.

It is not really necessary that only modern technology is the way to achieve efficient and energy sustaining projects. Many of the traditional and primitive societies of the world have evolved perfectly sustainable and environmentally friendly methods of construction. We may not regard these people as modern, or their dwellings as very comfortable, but the fact of the matter is that post the industrial revolution, while there has undoubtedly been progress we have ravaged the resources of the world to the point, where continuing in the same vein will lead to annihilation of the human race. We need to re-look our priorities and think of the earth as the abode of mankind, and apportion and utilise the resources in a manner that there is no disparity. This is the information age and there is no doubt that we will find out a way to achieve our goals. But in order for us to realize what those goals are and how we shall go about achieving them, we require to pause and introspect. The blind march of technology will get us nowhere. We need to think up technology with a human heart. Perhaps we should learn from the classical Greeks, who advocated moderation- in their lifestyle, in their professional life and indeed in their homes. That is perhaps the reason why the democracy which the Greeks preached is the prevalent doctrine in the world. The grandiose Roman Empire will find no takers in the post colonial world, and indeed the post modern world order.

In the end it is all about marrying technologies to smart and innovative thinking. The enormous amount of intellectual capability that the information age fosters makes achieving any objective in the realm of possibility. Ushering in a sustainable and eco friendly construction industry should not be that difficult.

One reason for this problem is of course the unsustainable land use practices in urban areas. However it is the building sector that has to initiate the major steps to reduce carbon emissions. According to estimates of the International Panel on Climate Changes emissions by buildings in the commercials and residential sectors can be brought down by a whopping 29% by 2020. In no other sector is such a major gain possible. Most of the costs emanating from pollution caused by buildings can be eliminated by professional renovation and new construction following new age markers. Green buildings therefore carry in themselves the solution both to environmental as well as economic challenges. Not only do green buildings reduce the overall environmental footprint, they also cause overall cost reductions during the entire life cycle of the building. That apart, using these technologies presents new economic opportunities, increases industrial output, enhances social welfare, as well as the comfort and health of the occupants of the buildings. A real win win situation, if there were any.

There are several techniques which are put into use to make buildings come up the green way. One of these is the extensive use of steel frames, which reduces the building time frame, saves costs and improves thermal qualities. Steel happens to be fully recyclable and one can build a house on a raised platform, which negates any bad impact on the environment, It is far better to transport a semi-complete house on a truck than have heavily laden trucks lumber up and down the road. Houses erected with help of lightweight steel framework systems are better than conventional brick and mortar constructions in as much as they provide better insulation during the winter and keep the building cool in the winter. The use of CAD (Computer Aided Design) software makes it possible to customise the design to the specifications desired by the client.

In this type of construction the first step is to erect the framework, after which the walls are typically clad with OSB board and Vermont plank and internally fortified with gypsum board. The insulation in the wall cavity takes care of the temperature issues. The usual time frame for complete such a construction is only a few months. The concept of green building has slowly but surely gained a fair amount of momentum, the world over. If one were to define green buildings one could say that these are buildings which consume minimal and optimal quantities of water, power and energy during construction, operation and eventual demolition.

We can take care that our future and upcoming buildings follow the green code. But what about the existing buildings that are not green? What do we do about them? Well we retrofit them so as to make them comply with green specifications. The economic potential of this is colossal. The total size of the retrofitting market is nearly $400 billion in the commercial building sector. Right now the market is small but by some estimates should grow to the size of $6.6 billion by 2013. In the U.S. the total commercial buildings market at a size of 70 billion square feet of space offers an incredible opportunity to effect energy savings, reduce carbon emissions, and increase property values.

Though direct energy savings is an important factor in the decision to retrofit commercial buildings the more significant factors have to do with the desire for lower carbon footprint, higher employee output and escalation in property value. Why even the rentals of green buildings are higher. We can see that green buildings are here to stay not because of legislation and coercive policies of governments because regular business houses have realised that the old markers of development were no longer economically viable and continuing in the same vein would be disastrous, both for the environment and the businesses. The sensible way, in fact the only way forward was to follow the route of holistic development that is in sync and indeed partnership with the environment, and green buildings are a major outcome of this organic perspective of growth.

Most Americans receive their health coverage through some type of group health insurance. Although large corporations with hundreds or even thousands of employees have the bargaining power to negotiate with medical insurance companies for custom health plans for their workers, the small business owner must still research options and compare prices from multiple providers. Since small business health insurance offers guaranteed coverage to all employees in a given company, it can be difficult and time consuming for a small business owner to find the best policy. Our group health insurance resources help cut down on the time it takes to get medical insurance quotes, making the processing quicker and simpler.