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Observation tools are increasingly important in healthcare building design research. They enable us to understand how the design of healthcare buildings affects users' health and organisational outcomes. Observations are used in case studies and pre- and post-occupancy evaluations. However, these case studies often struggle to pinpoint the specific design features responsible for observed outcomes. Additionally, harnessing collective knowledge from multiple cases can be challenging. This underscores the need for structured observations. The paper describes the lessons learnt from using three spatial observation tools as part of a study to assess a hospital ward design. Its goal is to reflect on the purpose, usability, advantages, disadvantages, and future improvements of these tools and to offer insights into their potential to support research on hospital ward design. The first tool, by the Centre for Health Design, utilizes a checklist-style matrix to evaluate the design of patient rooms, assessing 17 Evidence Based Design goals, including patient safety, worker safety and effectiveness, quality of care, patient experience, and organizational performance. The second tool is a one-time observation tool, a structured spatial inventory aimed at documenting design features throughout the entire hospital ward, covering elements such as room size, access to daylight, natural elements, furniture, safety measures, and more. It can be combined with the third tool; the recurring observation tool, which focuses on monitoring usage, users, their activities, and behaviour across various types of environments, including patient, staff, care, and supportive spaces. The last two observation tools were developed for the research project, adapting the Smart Sustainable Offices method for healthcare environments. This paper emphasizes the importance of selecting suitable observation tools for specific research objectives, providing guidance for working with observations and conducting pre-and post-studies. While not aimed at validating observation tools, it offers reflections to aid in development and use of observation tools. Finally, documenting spatial contexts enhances understanding of study findings, and reusing observation tools enables cross-study comparisons, with future potential for leveraging artificial intelligence.

Objective: This study utilized the evidence-gap map method and critically examined the scope, methodologies, and focus of the studies that investigated the influence of the built environment on inpatient healthcare settings over a decade (2010-2021)., Methods: We conducted a systematic review per the preferred reporting items for systematic reviews and meta-analyses guidelines and surveyed 406 articles, primarily from North America and Europe., Results: Our findings revealed a dominant focus on architectural features (73%), such as room design and ward layout. Comparatively, there was less emphasis on interior-, ambient-, social-, and nature-related features. Most previous studies explored multiple environmental features, which indicated the intricacy of this field. Research outcomes were diverse, with person-centered care (PCC) being the most frequently investigated, followed by safe care, emotional well-being, activity, and behavior. Furthermore, research methods varied considerably based on the study's outcomes and features. Clinical outcomes and safe care favored quantitative methods, activity and behavior favored mixed methods, and PCC favored qualitative research., Conclusion: This review provides an in-depth overview of the existing studies on healthcare design research and sheds light on the current trends and methodological choices. The insights garnered can guide future research, policy-making, and the development of healthcare facilities., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Housing and the ageing population are issues that pose challenges for social, health and economic policies. Therefore, there is a need for more knowledge on how to design housing and public infrastructure to improve the social engagement and well-being of older adults who age in place. This project aims to provide an overview of the existing literature on design features that support socially sustainable living environments for older adults., Methods and Analysis: A systematic scoping methodology was used to identify and summarise the findings. Four databases were searched (CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, Medline and Embase) to identify the articles. Articles were included if published in English in the last 15 years (eg, from January 2008 to June 2023) without restricting the study location or country. Articles were included if they were based on empirical qualitative, quantitative and mixed-method data. The results of the review will be discussed with a panel of 15 stakeholders (n=15) from Canada, Sweden and the Netherlands (five per country). The interdisciplinary stakeholders will have expertise in housing, architecture, engineering and social and health services. The consultations will provide content expertise to the literature findings and an opportunity to build evidence-based solutions that support the design of socially sustainable living environments for older persons., Ethics and Dissemination: Ethical clearance for this project has been granted by the Swedish Ethical Review Authority for Dalarna University (dnr 2023-01543-01) and the Natural Sciences and Engineering Sciences (NES) Ethics Committee at the University of Twente in the Netherlands (dnr 230407) has approved this project. Stakeholders will be asked to provide signed consent to participate in the study. The results of this project will be disseminated through web seminars, community advisory groups, peer-reviewed journals and policy documents to support the development of housing and public health policy., Trial Registration Number: OSF, https://doi.org/10.17605/OSF.IO/PR2NC., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The Health Promoting Hospitals (HPH) networks, founded by the World Health Organisation, support the introduction of health promotion in healthcare. This development involves the creation of a health promoting built environment. However, few studies have explored the HPH in relation to the built environments, and it is unclear how HPH-networks incorporate the built environment in their work. The study therefore examined the Swedish HPH-Network in relation to the built environment. The mixed-method study included data from (i) key online material from the Swedish network, (ii) a survey with open-ended questions of representatives of the networks' workgroups and (iii) semi-structured interviews with the built environment workgroup. The study showed that the built environment is unevenly and incoherently incorporated in the network. Moreover, there is more attention for healing and healthy rather than health-promotive strategies, indicating a knowledge gap. Descriptions of the health promoting built environment are diverse, and address design features, design strategies or indicate places for health promotion interventions. The descriptions of the built environment are combined with various HPH goals and population groups. To utilize the built environment as a resource for HPHs, the networks should consider incorporating the built environment in documents and action plans at all organizational levels., (© The Author(s) 2021. Published by Oxford University Press.)

This study investigated the current design circumstances of an office as well as employees' perceptions of the office environment in relation to their perceived health, drawing on sense of coherence theory (comprehensibility, manageability, and meaningfulness). Previous studies have related the physical office environment to employee health. However, most studies have focused on alleviating negative effects, while health-promoting potential, including employee sense of coherence, has been overlooked. This study adopted a mixed method case study approach, combining semi-structured interviews with employees, structured observations, and analysis of architectural drawings. The results indicated that employees' perceptions did not always align with the ideas behind the architectural design and that employees understood the environment differently. The study also highlighted the interrelations (and contradictions) among the different components of sense of coherence. The findings imply that organizations may need to prioritize which components of coherence should be supported most by the office environment. It also suggests that case-specific design aspects should play a more central role in studying and conceptualizing healthy office design and that design solutions should be continuously modified during the use phase, while ensuring employees' participation. The study concluded that an 'ideal' office environment should not be the goal. Instead, office design should provide an environment in which employees are able to cope with challenges in comprehensible, manageable and meaningful ways.

The COVID-19 epidemic provides yet another reason to prioritize inclusive development. Current response strategies of the global community and countries expose a low level of solidarity with poorer nations and poorer people in all nations. Against this background, this paper addresses the question: What are the development challenges that the COVID-19 pandemic lays bare and what lessons can be learnt for the way recovery processes are designed? Using an inclusive development and DPSIR lens to assess the literature, our study finds that, first, the current response prioritises the 'state' and 'impact' concerns of wealthier classes at the expense of the remainder of the world population. Second, responses have ignored underlying 'drivers' and 'pressures', instead aiming at a quick recovery of the economy. Third, a return to business-as-usual using government funding will lead to a vicious cycle of further ecological degradation, socio-economic inequality and domestic abuse that assist in exacerbating the drivers of the pandemic. We argue instead for an inclusive development approach that leads to a virtuous cycle by emphasizing human health, well-being and ecosystem regeneration. We conclude that the lost years for development did not commence in 2020 with the onset of COVID-19; the downward trend has actually been waxing over the past three decades. From this perspective, COVID-19 may be the shock needed to put the last first and transform vicious into virtuous cycles of inclusive development., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

The Sustainable Development Goals (SDGs) lay the foundations for supporting global health and international development work for the next 15 years. Thirty years ago, the Ottawa Charter defined health promotion and outlined key principles for global action on health, including the importance of advocating, enabling and mediating for health equity. Advocacy underscores a human right to health and suggests political action to support its attainment. Enabling speaks to health promotion's focus on the empowerment of people and communities to take control over their health and aspirations. Mediation draws attention to the critical intersectoral partnerships required to address health and social inequities. Underpinned by this approach, the aim of this paper is to consider how key health promotion principles, namely, rights, empowerment and partnership feature (and are framed) within the SDGs and to consider how these framings may shape future directions for health promotion. To that end, a critical frame analysis of the Transforming Our World document was conducted. The analysis interrogated varying uses and meanings of partnerships, empowerment and rights (and their connections) within the SDGs. The analysis here presents three framings from the SDGs: (1) a moral code for global action on (in)equity; (2) a future orientation to address global issues yet devoid of history; and (3) a reductionist framing of health as the absence of disease. These framings raise important questions about the underpinning values of the SDGs and pathways to health equity - offering both challenges and opportunities for defining the nature and scope of health promotion., (© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective:: This review explored different conceptualizations of health promotion in the context of, and in relation to, outpatient building design., Background:: Today's healthcare organizations are implementing holistic healthcare approaches such as health promotion, while simultaneously increasing their outpatient services. These health promotion approaches, focused on empowering people to take control of their health, are expected to have implications for the outpatient healthcare building design. Yet there is limited knowledge what these may be. A review of the literature on the current state of the art is thus needed to enable and support dialog on future healthcare building design., Method:: A scoping review of 4,506 papers, collected from four databases and three scientific journals in 2015, resulted in 14 papers relating health promotion to building design and outpatient healthcare. From the subsequent content analysis, multiple common themes and subthemes emerged., Results:: The review reveals diverse range of health promotion interpretations, three health promotion perspectives (health behavior, health equity, and sense of coherence), associated design approaches, design objectives, health-related outcomes, building features, and solutions., Conclusions:: While diverse health promotion perspectives might merely represent variations in focus, these differences become problematic when relating to building design. To support further dialogs on development of health promotion in, and in relation to, the build environment, there is a need to strengthen the health promotion vocabulary. Further research is needed to compare different design approaches and how these can be combined to minimize contradicting implications for building design.

Background: Pregnancy amongst adolescent girls is common in many parts of the world. The dominant discourse in public health unquestioningly paints this as a problem; it does not pay sufficient attention to girls' views., Objectives: This paper presents a critical account of adolescent South Sudanese girls' reasons for and explanations of childbearing. It discusses their experiences and views on childbearing and attempts to explain their reproductive choices and actions, in context., Methods: The study draws upon 24 interviews with adolescent boys, girls and parents from Wau, South Sudan. Data was analysed using the framework analysis approach., Results: Three interacting themes within which adolescent girls framed their views and decisions about childbearing are identified. The local society places high value on motherhood - adolescent girls' desires to become mothers is a reproduction of this social norm. Girls linked having a child to the possibility of making one's 'own home'; in the difficult and uncertain context they lived in, for many girls, having a child (and making a home) appeared as one of the few means to be happy. In making the decision to bear a child, the girls navigated multiple dilemmas and trade-offs between an unpromising present and an uncertain future. Bearing a child and making one's 'own home' was seen as a way to exit into the world of adults, and as a strategy towards achieving security and stability., Conclusions: Instead of simplistically problematizing adolescent pregnancy in South Sudan, it is important to take into account the experiences and standpoints of adolescent girls, and to recognize that in choosing to become mothers, they are in many ways exercising agency despite being severely constrained by complex, insecure and unfair social circumstances. We argue that such an approach will allow the development of more appropriate, realistic and inclusive health and social policies and programs.

To determine whether Charcot-Marie-Tooth (CMT) with pyramidal features is genetically distinct from other dominantly inherited axonal neuropathies, the authors examined all chromosomal loci and genes for axonal CMT. Two families were identified with an axonal CMT phenotype with distal wasting, weakness, pes cavus, sensory loss, and mild pyramidal signs (including extensor plantar responses, mild increase in tone, and preserved or increased reflexes but no spastic gait). Linkage studies excluded CMT2A, 2B, 2D, 2E, and 2F; ALS4; and HMN2. There were no mutations in the PMP22, MPZ/Po, or EGR2 genes.

Two cases of chylous ascites secondary to lymph node dissection for testicular tumors are reported. Non-surgical management failed to control the ascites in either patient. The use of the LeVeen shunt promptly and permanently controlled the ascites in 1 patient.

Microscopic tumor embolization is an uncommon cause of respiratory insufficiency. This finding has been reported previously in only 2 patients with carcinoma of the prostate. The diagnosis should be suspected in a patient with cancer of the prostate who was unexplained dyspnea or respiratory failure. Treatment consists of either bilateral orchiectomy or hormonal therapy. A case is reported of adenocarcinoma of the prostate with widespread microscopic pulmonary embolization causing respiratory failure.

Ethanolamine is readily metabolized by oat, pea, wheat, apple and carrot tissue preparations. Ethanolamine-1,2 (14)C was incorporated into the lipid fraction, and (14)C activity was distributed in the organic acid, sugar, acid volatile, carbon dioxide and insoluble residue fractions. The distribution varied with the particular tissue. Incorporation into the lipid fraction occurred in tissue homogenates in the absence of ATP by a Ca(++) activated system similar to that reported for animal preparations. The initial step in ethanolamine oxidation involves an amine oxidase. Glycolaldehyde and glyoxylic acid are metabolic intermediates, the former in the conversion of ethanolamine to carbon dioxide. No evidence was obtained for the operation of an ethanolamine transaminase or for the involvement of phosphorylated intermediates in the conversion of ethanolamine to carbon dioxide.

Dense populations containing 129 x 10(6) Jensen sarcoma, 134 x 10(6) DON Chinese hamster, 28.9 x 10(6) WI-38 human diploid, 61.8 x 10(6) HEp-2 human carcinoma, and 67.4 x 10(6) WISH human amnion cells were produced from dilute inocula, 0.85 to 5.33 x 10(6), in 7 to 8 days in a perfusion system using replicate T-60 flasks. Perfusion rates as high as 560 ml medium/day/T-60 were required to maintain pH (to ca +/-0.1 unit) and adequate nutrient supplies. The cell densities encountered are described by the term "monolayer equivalents" (M.E.), defined as number of cells per culture divided by number of cells in a monolayer. The M.E.'s for T-60 cultures containing unusually dense populations of 40 x 10(6) WI-38 and 250 x 10(6) DON cells (9-day perfusion) were 5 and 17, respectively, and numbers of cells in illustrations of stained cross-sections of membranes from these cultures were in excellent agreement. Threshold M.E.'s exist below which proliferation is the chief cellular activity and above which one or more cell functions may predominate even though proliferation persists. Cellular nutrition and metabolism may change with changes in M.E., as illustrated in different patterns of glutamic acid, proline, and glycine utilization or production in dense vs. dilute WI-38 cell populations. The results indicated that the role of contact inhibition phenomena in arresting cellular proliferation was diminished in perfusion system environments.

Cell types in addition to those previously described (Kruse et al. 1963. J. Nat. Cancer Inst. 31:109; Kruse and Miedema. 1965. J. Cell Biol. 27:273) were found to form multiple-layered cultures by perfusion-culture technique. Dense populations containing 43 x 10(6) embryonic rat muscle (NF-ER) cells, 23 x 10(6) diploid human tonsillar (NF-JAM) cells, 77 x 10(6) human pleural effusion isolate (RPMI 2650) cells, 35 x 10(6) embryonic diploid human lung (Flow 2000) cells, 21 x 10(6) bovine lung (FB4BM) cells, 108 x 10(6) bat lung (Tb1Lu) cells, and 81 x 10(6) SV-40 virus-transformed embryonic diploid human lung (WI-38VA13A) cells were obtained in 6-14 days from dilute inocula in T-60 or T-75 flasks; these were equivalent to about 4, 3, 3, 4, 2, 4, and eight monolayers, respectively. Perfusion of an NF-ER culture for 6 wk with medium plus 10% whole calf serum yielded a cell density equivalent to 12 monolayers (140 x 10(6) cells per T-75 flask). This culture exhibited random labeling of nuclei from bottom to top after pulsing for 90 min with thymidine-(3)H. Medium plus 0.1% serum maintained NF-JAM cultures at constant viable cell numbers with virtual absence of thymidine-(3)H labeling. Similar results were obtained with WI-38 cultures, but WI-38VA13A cells continued active DNA synthesis and mitosis in medium with 0.1% serum to form 16-20 layers of cells (191-239 x 10(6) cells per T-75 flask) in 27 days. WI-38VA13A cells ceased proliferation and became nonviable rapidly in serumless medium.