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See detailEducation therapeutique et mesure continue de la glycemie chez le patient diabetique insulino-traite.
Thielen, Vinciane ULg; Radermecker, Régis ULg; Renard, Eric et al

in Revue Médicale Suisse (2010), 6(260), 1596-600

L’efficacité d’un programme éducationnel fondé sur l’utilisation d’une mesure continue du glucose avec un affichage en temps réel a été évaluée chez des patients diabétiques de type 1 (système couplé à ... [more ▼]

L’efficacité d’un programme éducationnel fondé sur l’utilisation d’une mesure continue du glucose avec un affichage en temps réel a été évaluée chez des patients diabétiques de type 1 (système couplé à une pompe à insuline externe - Paradigm Real Time®) et chez des patients diabétiques de type 2 mal contrôlés sous insuline (système Guardian RT® une semaine par mois pendant 3 mois versus automesure classique). Ces deux essais pilote montrent une diminution du taux d’hémoglobine glyquée (HbA1c) avec le « glucose sensor », avec moins d’hypoglycémies symptomatiques. Malgré certaines difficultés techniques (surtout chez les diabétiques de type 2), l’approche représente un outil intéressant d’éducation thérapeutique. Ces résultats prometteurs plaident pour des études de plus grande envergure chez des patients diabétiques bien sélectionnés. [less ▲]

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See detailA propos de l'inertie et de la non-observance therapeutiques.
Scheen, André ULg

in Revue Médicale Suisse (2010), 6(260), 1571-2

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See detailPatient coronarien avec co-morbidites: integrer indications et contre-indications dans le raisonnement pharmaco-therapeutique.
Scheen, André ULg

in Revue Médicale de Liège (2010), 65(7-8), 476-81

A patient with abdominal obesity, type 2 diabetes, arterial hypertension and dyslipidaemia is exposed to a high risk of coronary artery disease, congestive heart failure and/or renal insufficiency. The ... [more ▼]

A patient with abdominal obesity, type 2 diabetes, arterial hypertension and dyslipidaemia is exposed to a high risk of coronary artery disease, congestive heart failure and/or renal insufficiency. The management of such a patient requires different medications, which should be prescribed by taking into account both (relative and absolute) indications and contra-indications to improve overall prognosis. The present clinical case report illustrates the therapeutic reasoning leading to an appropriate pharmacological polytherapy, combined with life-style changes. [less ▲]

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See detailLe medicament du mois. Saxagliptine (ONGLYZA): nouvel inhibiteur de la dipeptidylpeptidase-4 pour le traitement oral du diabete de type 2.
Scheen, André ULg

in Revue Médicale de Liège (2010), 65(9), 527-32

Saxagliptin (Onglyza) is a specific and reversible inhibitor of dipeptidylpeptidase-4 (DPP-4), which inhibits the activity of the enzyme for at least 24 hours after one single oral administration. It ... [more ▼]

Saxagliptin (Onglyza) is a specific and reversible inhibitor of dipeptidylpeptidase-4 (DPP-4), which inhibits the activity of the enzyme for at least 24 hours after one single oral administration. It increases the circulating levels of incretin hormones (GLP-1, GIP), which contributes to amplify the insulin secretory response to meals and to reduce postprandial hyperglycaemia and, subsequently, fasting glycaemia. Saxagliptin, 5 mg once daily, has been shown to be effective in patients with type 2 diabetes treated with diet alone, metformin, sulfonylurea or glitazone, with a favourable tolerance profile. Reduction in glycated haemoglobin (HbA(1c)) averaged 0.6-0.8%, without increasing the risk of hypoglycaemia or promoting weight gain. The only indication of saxagliptin that is currently reimbursed in Belgium is the treatment of patients not controlled with metformin, the oral antidiabetic agent that is recommended as first line therapy in the management of type 2 diabetes. [less ▲]

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See detailLe medicament du moi. Dabigatran etexilate (Pradaxa): anticoagulant oral, inhibiteur direct selectif de la thrombine
Lancellotti, Patrizio ULg; Scheen, André ULg

in Revue Médicale de Liège (2010), 65(10), 588-92

Dabigatran (Pradaxa) is a new oral, direct, selective and reversible thrombin inhibitor (factor IIa) acting as anticoagulant. Pradaxa does not require monitoring or dose adjustment, except in cases of ... [more ▼]

Dabigatran (Pradaxa) is a new oral, direct, selective and reversible thrombin inhibitor (factor IIa) acting as anticoagulant. Pradaxa does not require monitoring or dose adjustment, except in cases of moderate renal insufficiency or in elderly patients (>75 years old). It is currently indicated for prophylaxis against venous thromboembolism after total hip or knee replacement surgery. Pradaxa has been shown to be as effective as enoxaparin in reducing the risk of venous thromboembolism after total hip or knee replacement surgery, with a similar safety profile. The recommended dose of 220 mg is administered once-daily, starting with a half-dose 1-4 h after surgery. The total duration of treatment is 10 days for knee surgery and 28-35 days in case of hip replacement. Contrary to enoxaparin, with Pradaxa there is no risk of drug-related thrombocytopenia. Of note, this promising new anticoagulant has also shown to be more effective than warfarin for stroke prevention in patients with non-valvular atrial fibrillation and as effective as warfarin for the treatment of acute venous thromboembolism (indications not recognized yet). [less ▲]

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See detailUn cavigliere "al femminile" di parmigianinesca leziosità: la cetera D.MR.R.434 del Musée de la Musique di Parigi
Bugini, Mariaelena ULg

in Santarelli, Cristina (Ed.) Ut musica pictura (2010)

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See detailCommunication financière : Un outil pour améliorer la liquidité des entreprises françaises
Ajina, Aymen ULg; Sougné, Danielle

in Revue Banque = Banque Magazine (2010), 724

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See detailEfficacy and safety of saxagliptin in combination with metformin compared with sitagliptin in combination with metformin in adult patients with type 2 diabetes mellitus.
Scheen, André ULg; Charpentier, Guillaume; Ostgren, Carl Johan et al

in Diabetes/Metabolism Research & Reviews (2010), 26(7), 540-9

BACKGROUND: Dipeptidyl peptidase-4 inhibitors improve glycaemic control in patients with type 2 diabetes mellitus when used as monotherapy or in combination with other anti-diabetic drugs (metformin ... [more ▼]

BACKGROUND: Dipeptidyl peptidase-4 inhibitors improve glycaemic control in patients with type 2 diabetes mellitus when used as monotherapy or in combination with other anti-diabetic drugs (metformin, sulphonylurea, or thiazolidinedione). This 18-week, phase 3b, multicentre, double-blind, noninferiority trial compared the efficacy and safety of two dipeptidyl peptidase-4 inhibitors, saxagliptin and sitagliptin, in patients whose glycaemia was inadequately controlled with metformin. METHODS: Adult type 2 diabetes mellitus patients (N = 801) with glycated haemoglobin (HbA(1c)) 6.5-10% on stable metformin doses (1500-3000 mg/day) were randomized 1 : 1 to add-on 5 mg saxagliptin or 100 mg sitagliptin once daily for 18 weeks. The primary efficacy analysis was a comparison of the change from baseline HbA(1c) at week 18 in per-protocol patients. Noninferiority was concluded if the upper limit of the two-sided 95% confidence interval of the HbA(1c) difference between treatments was < 0.3%. RESULTS: The adjusted mean changes in HbA(1c) following the addition of saxagliptin or sitagliptin to stable metformin therapy were - 0.52 and - 0.62%, respectively. The between-group difference was 0.09% (95% confidence interval, - 0.01 to 0.20%), demonstrating noninferiority. Both treatments were generally well tolerated; incidence and types of adverse events were comparable between groups. Hypoglycaemic events, mostly mild, were reported in approximately 3% of patients in each treatment group. Body weight declined by a mean of 0.4 kg in both groups. CONCLUSIONS: Saxagliptin added to metformin therapy was effective in improving glycaemic control in patients with type 2 diabetes mellitus inadequately controlled by metformin alone; saxagliptin plus metformin was noninferior to sitagliptin plus metformin, and was generally well tolerated. [less ▲]

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See detailCentral nervous system: a conductor orchestrating metabolic regulations harmed by both hyperglycaemia and hypoglycaemia.
Scheen, André ULg

in Diabètes & Métabolism (2010), 36S3

Recent evidence suggests that the brain has a key role in the control of energy metabolism, body fat content and glucose metabolism. Neuronal systems, which regulate energy intake, energy expenditure, and ... [more ▼]

Recent evidence suggests that the brain has a key role in the control of energy metabolism, body fat content and glucose metabolism. Neuronal systems, which regulate energy intake, energy expenditure, and endogenous glucose production, sense and respond to input from hormonal and nutrient-related signals that convey information regarding both body energy stores and current energy availability. In response to this input, adaptive changes occur that promote energy homeostasis and the maintenance of blood glucose levels in the normal range. Defects in this control system are implicated in the link between obesity and type 2 diabetes mellitus. The central nervous system may be considered the conductor of an orchestra involving many peripheral organs involved in these homeostatic processes. However, the brain is mainly a glucose-dependent organ, which can be damaged by both hypoglycaemia and hyperglycaemia. Hypoglycaemia unawareness is a major problem in clinical practice and is associated with an increased risk of coma. Stroke is another acute complication associated with diabetes mellitus, especially in elderly people, and the control of glucose level in this emergency situation remains challenging. The prognosis of stroke is worse in diabetic patients and both its prevention and management in at-risk patients should be improved. Finally, chronic diabetic encephalopathies, which may lead to cognitive dysfunction and even dementia, are also recognized. They may result from recurrent hypoglycaemia and/or from chronic hyperglycaemia leading to cerebral vascular damage. Functional imaging is of interest for exploring diabetes-associated cerebral abnormalities. Thus, the intimate relationship between the brain and diabetes is increasingly acknowledged in both research and clinical practice. [less ▲]

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See detailHomme de lettres, écrivain, auteur. Déclinaison sociale d'une fonction symbolique
Durand, Pascal ULg

in Luneau, Marie-Pier; Vincent, Josée (Eds.) La Fabrication de l'Auteur (2010)

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See detailApproche multirisque du patient diabetique de type 2: desaccord sur les valeurs cibles suite a l'etude ACCORD.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue Médicale Suisse (2010), 6(260), 1582-7

The ACCORD trial investigated the effects of intensifying the global management of 10,251 type 2 diabetic patients, with established cardiovascular disease or at least two other cardiovascular risk ... [more ▼]

The ACCORD trial investigated the effects of intensifying the global management of 10,251 type 2 diabetic patients, with established cardiovascular disease or at least two other cardiovascular risk factors, on a composite endpoint (non fatal myocardial infarction, stroke and cardiovascular death). The attempt to reduce HbA1c level below 6% was associated with an increased cardiovascular mortality (despite a reduction in non fatal myocardial infarcts); lowering systolic blood pressure below 120 mmHg instead of 140 mmHg did not provide any additional benefit; finally, the control of atherogenic dyslipidaemia, with fenofibrate added to a statin, did not modify the composite endpoint (despite a positive effect in the subgroup of patients with high triglycerides and low HDL cholesterol). These rather disappointing results should be interpreted to provide practical guidelines. [less ▲]

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See detailL’hyperglycémie provoquée par voie orale (HGPO) revisitée 1re partie : Tolérance au glucose, diabète gestationnel et hypoglycémie réactive
Scheen, André ULg; Luyckx, Françoise ULg

in Médecine des Maladies Métaboliques (2010), 4(5), 569-574

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes, impaired glucose tolerance or reactive hypoglycemia. Since almost 10 years, however ... [more ▼]

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes, impaired glucose tolerance or reactive hypoglycemia. Since almost 10 years, however, it has been proposed to limit the use of this dynamic test, favoring instead the measurement of either fasting plasma glucose or glycated hemoglobin. Nevertheless, almost all recent important studies used OGTT as reference test. In this first article, we will consider the potential interest of OGTT as diagnostic or prognostic test able to evaluate glucose regulation. In a second article, we will describe how to use OGTT to derive indices that quantitatively evaluate insulin secretion and/or insulin sensitivity. [less ▲]

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See detailCardiovascular risk-benefit profile of sibutramine.
Scheen, André ULg

in American Journal of Cardiovascular Drugs : Drugs, Devices, & Other Interventions (2010), 10(5), 321-34

Sibutramine is a combined norepinephrine and serotonin reuptake inhibitor used as an antiobesity agent to reduce appetite and promote weight loss in combination with diet and exercise. At a daily dose of ... [more ▼]

Sibutramine is a combined norepinephrine and serotonin reuptake inhibitor used as an antiobesity agent to reduce appetite and promote weight loss in combination with diet and exercise. At a daily dose of 10-20 mg, it was initially considered to have a good safety profile, as it does not induce primary pulmonary hypertension or adverse effects on cardiac valves, in contrast to previous reports relating to some other antiobesity agents. However, it exerts disparate effects on cardiovascular risk factors. On the one hand, sibutramine may have antiatherogenic activities, as it improves insulin resistance, glucose metabolism, dyslipidemia, and inflammatory markers, with most of these effects resulting from weight loss rather than from an intrinsic effect of the drug. On the other hand, because of its specific mode of action, sibutramine exerts a peripheral sympathomimetic effect, which induces a moderate increase in heart rate and attenuates the reduction in BP attributable to weight loss or even slightly increases BP. It may also prolong the QT interval, an effect that could induce arrhythmias. Because of these complex effects, it is difficult to conclude what the final impact of sibutramine on cardiovascular outcomes might be. Sibutramine has been shown to exert favorable effects on some surrogate cardiovascular endpoints such as reduction of left ventricular hypertrophy and improvement of endothelial dysfunction. A good cardiovascular safety profile was demonstrated in numerous 1- to 2-year controlled trials, in both diabetic and nondiabetic well selected patients, as well as in several observational studies. However, since 2002, several cardiovascular adverse events (hypertension, tachycardia, arrhythmias, and myocardial infarction) have been reported in sibutramine-treated patients. This led to a contraindication of the use of this antiobesity agent in patients with established coronary heart disease, previous stroke, heart failure, or cardiac arrhythmias. SCOUT (Sibutramine Cardiovascular and Diabetes Outcome Study) was designed to prospectively evaluate the efficacy/safety ratio of sibutramine in a high-risk population. The efficacy/safety results of the first 6-week lead-in open period of treatment with sibutramine 10 mg/day were reassuring in 10 742 overweight/obese high-risk subjects (97% had cardiovascular disease, 88% had hypertension, and 84% had type 2 diabetes mellitus). However, the final results of SCOUT showed that long-term (5 years') treatment with sibutramine (10-15 mg/day) exposed subjects with pre-existing cardiovascular disease to a significantly increased risk for nonfatal myocardial infarction and nonfatal stroke, but not cardiovascular death or all-cause mortality. Because the benefit of sibutramine as a weight-loss aid seems not to outweigh the cardiovascular risks, the European Medicines Agency recommended the suspension of marketing authorizations for sibutramine across the EU. The US FDA stated that the drug should carry a 'black box' warning due to an increased risk of stroke and heart attack in patients with a history of cardiovascular disease. In conclusion, concern still persists about the safety profile of sibutramine regarding cardiovascular outcomes, and the drug should not be prescribed for overweight/obese patients with a high cardiovascular risk profile. [less ▲]

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See detailAptitude physique versus adiposité : aspects physiopathologiques et impacts cardio-métaboliques chez le sujet adulte non diabétique
Esser, Nathalie ULg; Paquot, Nicolas ULg; Scheen, André ULg

in Médecine des Maladies Métaboliques (2010), 4

L’excès de masse grasse (adiposité), surtout abdominale, induit des effets cardio-métaboliques néfastes, alors que l’exercice musculaire et une bonne aptitude physique exercent globalement une influence ... [more ▼]

L’excès de masse grasse (adiposité), surtout abdominale, induit des effets cardio-métaboliques néfastes, alors que l’exercice musculaire et une bonne aptitude physique exercent globalement une influence favorable. Les effets délétères d’un excès de masse grasse (fatness) pourraient donc être contrecarrés par la pratique régulière d’exercices aboutissant à une bonne forme physique (fitness). Cet article analyse d’abord les différents mécanismes physiopathologiques par lesquels l’exercice physique produit des effets bénéfiques chez la personne avec excès pondéral et fait le distinguo entre la pratique d’une activité physique (exercice musculaire) stricto sensu et aptitude physique (fitness). Ensuite, il décrit les études les plus importantes ayant analysé les relations entre le niveau d’aptitude physique et le degré d’adiposité chez le sujet adulte en surpoids ou obèse non diabétique et leurs influences respectives sur le risque de survenue de troubles métaboliques (syndrome métabolique) et sur la mortalité, en particulier cardiovasculaire. [less ▲]

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See detailEtude de la filière industrielle des énergirs renouvelables
Scheuren, Claude; Andre, Philippe ULg; Germani, David et al

Report (2010)

Rapport final du projet Firewal2, réalisé en collaboration avec l'asbl Energy Factor 4

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See detailActivite anticancereuse de la metformine: nouvelles perspectives pour une vieille molecule.
Beck, Emmanuel ULg; Scheen, André ULg

in Revue Médicale Suisse (2010), 6(260), 1601-7

Le diabète de type 2 est associé à un risque accru de cancer, d’autant plus évident qu’on maîtrise mieux la mortalité cardio-vasculaire. Tous les traitements antidiabétiques n’ont pas le même impact sur ... [more ▼]

Le diabète de type 2 est associé à un risque accru de cancer, d’autant plus évident qu’on maîtrise mieux la mortalité cardio-vasculaire. Tous les traitements antidiabétiques n’ont pas le même impact sur le cancer : le risque est accru avec les sulfonylurées et diminué avec la metformine (et les glitazones). De nombreuses études épidémiologiques observationnelles et cas-témoins récentes révèlent qu’un traitement par metformine est associé à une nette réduction de l’incidence de néoplasies et de la mortalité par cancer. Il existe une relation doseréponse et une relation entre la durée préalable du traitement par metformine et l’effet protecteur observé. Les mécanismes invoqués sont l’activation de l’enzyme AMPK et l’inhibition de la voie mTOR. Des études avec la metformine sont en cours en oncologie, notamment dans le cancer du sein. [less ▲]

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See detailDifferences in carbohydrate composition of barley varieties influence Salmonella transmission among pen mate weaned piglets
Bindelle, Jérôme ULg; Pieper, Robert; Marshall, Jason et al

in Journal of Animal Science (2010), 88(E2), 284

Indigestible carbohydrate (CHO) composition can vary markedly between barley varieties. They induce changes in intestinal ecophysiology and enhance growth of health-promoting bacteria. An experiment was ... [more ▼]

Indigestible carbohydrate (CHO) composition can vary markedly between barley varieties. They induce changes in intestinal ecophysiology and enhance growth of health-promoting bacteria. An experiment was undertaken to assess whether these changes could influence Salmonella typhimurium (ST) infection in pigs and transmission between penmates. A challenge study was undertaken using 84 recently weaned piglets divided in 12 pens, and fed one of the 4 experimental diets (3 pens/diet), according to the barley variety. Three hullless and one hulled varieties were chosen according to their differing CHO composition (amylose/amylopectin, β-glucan, and insoluble non-starch polysaccharides). After 14 d of adaptation, 2 pigs per pen (Trojan pigs, TrojP) were orally infected (8.0 log cfu/animal) with a low virulent, nalidixic acid and novobiocin resistant ST strain. The other animals were considered as Contact pigs (ConP) to assess ST transmission. Over 5 d following inoculation, pigs were monitored for detection of ST in the feces using plate counts. On d 6, 2 TrojP and 2 ConP per group were killed and intestinal samples as well as organ samples (liver, spleen, and lymph nodes) were analyzed for ST. The results showed that in TrojP, the cereal variety had no influence on ST fecal shedding over time and gastrointestinal tract (GIT) colonization. All pigs were positively tested for ST. Translocation of ST to lymph nodes was observed frequently but not to other organs. In ConP, compared with hulled barley, hulless barleys reduced the number of animals shedding ST (P < 0.05 for d 2) and the number of ST (cfu/g) in cecum on d 6 (P < 0.01). Although hulless barleys did not protect against colonization when directly challenged at a high oral dose, these barleys may be useful to reduce natural ST transmission among penmates. [less ▲]

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See detailHand position on the bunch and source-sink ratio influence the banana fruit susceptibility to crown rot disease
Lassois, Ludivine ULg; Bastiaanse, H.; Chillet, M. et al

in Annals of Applied Biology (2010), 156

The postharvest development of crown rot of bananas depends notably on the fruit susceptibility to this disease at harvest. It has been shown that fruit susceptibility to crown rot is variable and it was ... [more ▼]

The postharvest development of crown rot of bananas depends notably on the fruit susceptibility to this disease at harvest. It has been shown that fruit susceptibility to crown rot is variable and it was suggested that this depends on environmental preharvest factors. However, little is known about the preharvest factors influencing this susceptibility. The aim of this work was to evaluate the extent to which fruit filling characteristics during growth and the fruit development stage influence the banana susceptibility to crown rot. This involved evaluating the influence of (a) the fruit position at different levels of the banana bunch (hands) and (b) changing the source–sink ratio (So–Si ratio), on the fruit susceptibility to crown rot. The fruit susceptibility was determined by measuring the internal necrotic surface (INS) after artificial inoculation of Colletotrichum musae. A linear correlation (r = −0.95) was found between the hand position on the bunch and the INS. The So–Si ratio was found to influence the pomological characteristics of the fruits and their susceptibility to crown rot. Fruits of bunches from which six hands were removed (two hands remaining on the bunch) proved to be significantly less susceptible to crown rot (INS = 138.3 mm2) than those from bunches with eight hands (INS = 237.9 mm2). The banana susceptibility to crown rot is thus likely to be influenced by the fruit development stage and filling characteristics. The present results highlight the importance of standardising hand sampling on a bunch when testing fruit susceptibility to crown rot. They also show that hand removal in the field has advantages in the context of integrated pest management, making it possible to reduce fruit susceptibility to crown rot while increasing fruit size. [less ▲]

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See detailAssessing wind comfort in urban planning
Reiter, Sigrid ULg

in Environment & Planning B : Planning & Design (2010), 37(5), 857-873

There are increasing concerns regarding the quality of urban public spaces. Wind is one important environmental factor that influences pedestrians’ comfort and safety. In modern cities, there are more and ... [more ▼]

There are increasing concerns regarding the quality of urban public spaces. Wind is one important environmental factor that influences pedestrians’ comfort and safety. In modern cities, there are more and more high constructions and complex forms which can involve significant problems of wind discomfort around these buildings. Today, architects and town planners need guidelines and simple design tools to take account of wind in their projects. This paper addresses the progress made towards computational fluid dynamics (CFD) simulations for assessing wind comfort in urban planning. We validated Fluent software for wind studies in urban environments by comparing our simulations results with wind tunnel tests. This validation shows that wind mean velocities around buildings can be simulated numerically with a very high degree of accuracy. Based on the results of a great number of CFD simulations, we developed a methodology and simple graphical tools to quantify critical wind speeds around buildings. This article should thus help in practice architects and town planners to design our built environment. Moreover, this paper shows how numerical modeling is now a high-performance tool to work out useful guidelines and simple design tools for urban planners. [less ▲]

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