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Building Information Modeling (BIM) is a powerful process for creating and managing data throughout the life cycle of a building. Traditionally, measuring the well-being of building occupants has been addressed solely through objective physical variables such as temperature or relative air humidity. However, recent studies indicate that the built environment influences subjective aspects of human well-being. This article presents a scoping review to find information related to the use of BIM in the assessment of the mental and emotional state of inhabitants. A scoping review has been undertaken following the PRISMA-ScR guidelines by searching in Scopus, ACM, IEEE Xplore and PsycINFO databases. Fourteen articles meeting the inclusion criteria were found after the screening process, all of them published in the last decade, twelve in the last five years. Two ways of using BIM have been identified in relation to the subject matter of this review: (i) for visualization and monitoring of occupant well-being and (ii) for showing building design alternatives to future occupants. The included papers show that BIM has potential for assessing the mental and emotional state of building occupants. However, the results of these studies are still limited and much research in this area remains pending. [ABSTRACT FROM AUTHOR]

Diverting organic waste from landfills provides significant emissions benefits in addition to preserving landfill capacity and creating value-added energy and compost products. Dry anaerobic digestion (AD) is particularly attractive for managing the organic fraction of municipal solid waste because of its high-solids composition and minimal water requirements. This study utilizes empirical data from operational facilities in California in order to explore the key drivers of dry AD facility profitability, impacts of market forces, and the efficacy of policy incentives. The study finds that dry AD facilities can achieve meaningful economies of scale with organic waste intake amounts larger than 75,000 tonnes per year. Materials handling costs, including the disposal of inorganic residuals from contaminated waste streams and post-digester mass (digestate) management, are both the largest and the most uncertain facility costs. Facilities that utilize the biogas for vehicle fueling and earn associated fuel credits collect revenues that are 4-6x greater than those of facilities generating and selling electricity and 10-12x greater than facilities selling natural gas at market prices. The results suggest important facility design elements and enabling policies to support an increased scale of organic waste handling infrastructure.

Building ventilation systems must get much better

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The major science and technology infrastructure in the field of life science is an indispensable and important content in the large-science facility landscape. It encompasses cutting-edge, strategic, and fundamental aspects. This field differs from traditional facilities such as particle physics, astronomy and nuclear energy. Moreover, it represents a relatively underdeveloped area in China's facility landscape. Unique characteristics are observed in terms of capital investment, physical form, facility lifespan, digitization degree, organizational structure, project risk, and development effect when compared to traditional facilities. Despite its importance, challenges persist in project establishment, investment, management, and construction. Therefore, it is necessary to strengthen the condensing mechanism for addressing major scientific issues in the life science field, improve the strategic investment layout, facilitate the localization of technical equipment based on original scientific ideas, and strengthen the differentiated management capacity of life science facilities.

Patients with suspected or confirmed high-consequence infectious diseases (HCIDs) may present for care at any acute care facility. However, there are limited data to inform recommendations for the design, maintenance, and operation of isolation spaces for patients with suspected or confirmed HCIDs. To address this gap, we developed consensus statements by convening a group of 29 subject matter experts to participate in a modified Delphi process facilitated by a validated tool (the RAND-developed ExpertLens system). The subject matter experts participated in 3 consensus rounds, providing feedback and rating the appropriateness of 36 draft consensus statements. These draft statements were then revised based on their feedback. As a result, we developed 36 consensus statements addressing 5 domains: (1) patient room physical space, (2) doors and windows, (3) air handling, (4) electrical and plumbing, and (5) soiled utility rooms and waste management. These statements could inform the approaches of frontline acute care facilities when building new spaces or modifying existing spaces to enable appropriate HCID patient isolation and care.

Background: The built environment is a key component of dementia-specific care. Little is known about the characteristics of dementia-sensitive environmental elements in living units of nursing homes in Germany. The German Environmental Audit Tool (G-EAT) is a systematic assessment tool for describing these elements in detail., Aim of the Study: To describe the extent of dementia-sensitive design principles and environmental elements in a regionally limited sample of living units in Germany., Methods: The built environment was assessed using G-EAT and analysed quantitatively and descriptively. Definitions of living units were developed based on site visits and analysed using qualitative content analysis., Results: The 42 participating living units were heterogeneous in terms of space and composition. Dementia-sensitive design principles varied greatly in their implementation in the built environment; on average, 87.7% of the environmental elements were oriented towards a familiar environment. In contrast, visual accessibility was much less frequently enabled by the built environment (mean 37.3%)., Conclusions: The characteristics of various dementia-sensitive environmental elements need to be further investigated against the background of the nursing home care concept and the homogeneity of the resident group to enable the initiation of tailored environmental adaptation that can be implemented by interdisciplinary teams in nursing homes. This also requires a follow-up study with a larger sample of living units to identify the factors that promote and inhibit the development of a dementia-sensitive environment., Competing Interests: The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Aim: To determine the relationship between working conditions, especially room acoustics, with voice symptoms and voice-related quality of life among Colombian school and college teachers during online classes in times of COVID-19 pandemic., Method: Exploratory cross-sectional study. Participants were thirty-two primary, secondary and university Colombian teachers, who were invited to fill in an online survey about working conditions and voice symptoms during online classes in times of COVID-19 pandemic. In the statistical analysis, four dependent variables and eight independent variables were defined. We used Generalized Linear Model with a Gamma distribution and Binary Logistic Regression to determine the association between voice with working conditions., Results: High reverberation time and stress during online classes in times of the COVID-19 pandemic reduced slightly the VRQOL scores. For Factor 3 of the VFI, high reverberation time and months teaching online classes were associated at the multivariate analysis. Stress and years of experience were statistically associated with an increased odds of reporting hoarseness., Conclusion: Similar to pre-COVID-19, teachers with online classes during the COVID-19 pandemic are affected by two work-related factors namely high reverberation time and stress. These two factors are increasing their likelihood of reporting hoarseness and having lower voice-related quality of life, which may confirm the relationship between reverberation, stress, and voice also during online classes. This highlights the need of implementing workplace vocal and mental health programs to decrease the occurrence of voice problems among teachers in times of and post-COVID-19 pandemic., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

The Black Hills State University Underground Campus (BHUC) houses a low background counting facility on the 4850' level of the Sanford Underground Research Facility. There are currently four ultra-low background, high-purity germanium detectors installed in the BHUC and it is anticipated four more detectors will be installed within a year. In total, the BHUC will be able to accommodate up to twelve detectors with space inside a class 1000 cleanroom, an automated liquid nitrogen fill system, on-site personnel assistance and other required utilities.

BackgroundRepeat HIV testing in late pregnancy has the potential to decrease rates of mother-to-child transmission of HIV by identifying mothers who seroconvert after having tested negative for HIV in early pregnancy. Despite being national policy in Kenya, the available data suggest that implementation rates are low.MethodsWe conducted 20 in-depth semi-structured interviews with healthcare providers and managers to explore barriers and enablers to implementation of repeat HIV testing guidelines for pregnant women. Participants were from the Nyanza region of Kenya and were purposively selected to provide variation in socio-demographics and job characteristics. Interview transcripts were coded and analyzed in Dedoose software using a thematic analysis approach. Four themes were identified a priori using Ferlie and Shortell's Framework for Change and additional themes were allowed to emerge from the data.ResultsParticipants identified barriers and enablers at the client, provider, facility, and health system levels. Key barriers at the client level from the perspective of providers included late initial presentation to antenatal care and low proportions of women completing the recommended four antenatal visits. Barriers to offering repeat HIV testing for providers included heavy workloads, time limitations, and failing to remember to check for retest eligibility. At the facility level, inconsistent volume of clients and lack of space required for confidential HIV retesting were cited as barriers. Finally, at the health system level, there were challenges relating to the HIV test kit supply chain and the design of nationally standardized antenatal patient registers. Enablers to improving the implementation of repeat HIV testing included client dissemination of the benefits of antenatal care through word-of-mouth, provider cooperation and task shifting, and it was suggested that use of an electronic health record system could provide automatic reminders for retest eligibility.ConclusionsThis study highlights some important barriers to improving HIV retesting rates among pregnant women who attend antenatal clinics in the Nyanza region of Kenya at the client, provider, facility, and health system levels. To successfully implement Kenya's national repeat HIV testing guidelines during pregnancy, it is essential that these barriers be addressed and enablers capitalized on through a multi-faceted intervention program.

In an extreme heat event, people can go to air-conditioned public facilities if residential air-conditioning is not available. Residences that heat slowly may also mitigate health effects, particularly in neighborhoods with social vulnerability. We explored the contributions of social vulnerability and these infrastructures to heat mortality in Maricopa County and whether these relationships are sensitive to temperature. Using Poisson regression modeling with heat-related mortality as the outcome, we assessed the interaction of increasing temperature with social vulnerability, access to publicly available air conditioned space, home air conditioning and the thermal properties of residences. As temperatures increase, mortality from heat-related illness increases less in census tracts with more publicly accessible cooled spaces. Mortality from all internal causes of death did not have this association. Building thermal protection was not associated with mortality. Social vulnerability was still associated with mortality after adjusting for the infrastructure variables. To reduce heat-related mortality, the use of public cooled spaces might be expanded to target the most vulnerable.

Projects and construction management in healthcare facilities are usually assigned to architectural firms and engineering companies with previous experience. However, there is no evaluation system to ensure their level of competence in the healthcare sector. In the past, this was also the case for clinicians when they were self-appointed specialists without any supervision. Currently, the Specialised Health Training (SHT) programme in Spain is the only official specialisation pathway and consists of a period that combines training and paid healthcare practice. Similarly, but from Argentina, hospital residencies in architecture have been carried out for specialised postgraduate training. The aim of this article was to show the experience in Argentina and to propose the extension of the SHT in Spain. Our proposal consists of a programme of residencies in architecture and engineering to be developed in healthcare centres. We believe that this initiative has great potential to address health from its multiple disciplines and to reinforce the maturity of a National Health System in constant change., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Haemodialysis facilities have a large environmental impact due to high energy, water and consumable usage by haemodialysis equipment. As climate change and natural resource scarcity escalate, all the while the number of people requiring dialysis increases, there is an urgent need for dialysis facilities that meet care needs while minimising environmental impact. To address this, the Australian and New Zealand Society of Nephrology engaged an environmental sustainability consulting practise to develop a best practise guide for the environmentally sustainable design and operation of haemodialysis facilities. Four opportunity areas were considered, namely energy, water, waste and resource recovery, and additional sustainability. A total of 28 environmental improvement initiatives were identified. The majority (n = 23) were general measures that could be applied across all healthcare settings, while five were specific to haemodialysis facilities. Recommendations were made regarding specific measures that should be undertaken and/or standards that must be met to achieve the intent of each initiative. These were stratified to enable their application to both existing dialysis facilities and new builds. The lifecycle stage of a haemodialysis facility to which each initiative applied was highlighted, as was its potential impact. This guide provides a tailored and comprehensive resource for the kidney care community to enable the integration of best practise sustainability considerations into both existing and new facilities. If broadly implemented, it has the potential to markedly improve the environmental impact of haemodialysis provision., (© 2024 Asian Pacific Society of Nephrology.)

Objective: This study aims to review and synthesize what design factors are associated with the physiological and psychological health of occupants in underground spaces., Background: The development of underground spaces offers options to global challenges, such as traffic congestion, urban overcrowding, the revitalization of dormant underground areas, disaster mitigation, and adaptation to extreme environments. Despite these advantages, concerns persist about potential adverse effects on human health in these environments. This situation underlines the necessity of systematically identifying concerns and perceptions related to health in underground spaces., Methods: A narrative literature review was conducted to examine the relationship between design factors and health factors across 21 empirical studies. Based on the review of the identified literature, a relationship diagram was developed to depict the interconnections between the identified design and health factors., Results: The analysis identified design factors related to the air, sound, light, nature, transport, and spatial context of underground spaces, each of which exerted relationships with occupants' physiological and psychological health factors. The relationship diagram indicated that the psychological factor "feeling of confinement" was mentioned most frequently, suggesting that it is one of the most extensively researched factors in this context., Conclusions: The relationship diagram aims to bridge the existing knowledge gap and set the stage for future research endeavors. The ultimate goal is to refine urban living standards by leveraging the potential of underground spaces while ensuring health and well-being., 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.

Purpose: This work aims at reviewing challenges and pitfalls in proton facility design related to equipment upgrade or replacement. Proton therapy was initially developed at research institutions in the 1950s which ushered in the use of hospital-based machines in 1990s. We are approaching an era where older commercial machines are reaching the end of their life and require replacement. The future widespread application of proton therapy depends on cost reduction; customized building design and installation are significant expenses., Methods and Materials: We take this opportunity to discuss how commercial proton machines have been installed and how buildings housing the equipment have been designed., Results: Data on dimensions and weights of the larger components of proton systems (cyclotron main magnet and gantries) are presented and innovative, non-gantry-based, patient positioning systems are discussed., Conclusions: We argue that careful consideration of the building design to include larger elevators, hoistways from above, wide corridors and access slopes to below grade installations, generic vault and treatment room layouts to accommodate multiple vendor's equipment, and modular system design can provide specific benefits during planning, installation, maintenance, and replacement phases of the project. Room temperature magnet coils can be constructed in a more modular manner: a potential configuration is presented. There is scope for constructing gantries and magnet yokes from smaller modular sub-units. These considerations would allow a hospital to replace a commercial machine at its end of life in a manner similar to a linac., Competing Interests: Disclosures Dr Maughan reports consulting activity with Proton Therapy Partners, Inc for a purpose unrelated to the submitted work. The authors have no other relationships to report that could be construed as a conflict of interest., (Copyright © 2023 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)

BackgroundMany internal medicine (IM) programs have reorganized their resident continuity clinics to improve trainees' ambulatory experience. Downstream effects on continuity of care and other clinical and educational metrics are unclear.MethodsThis multi-institutional, cross-sectional study included 713 IM residents from 12 programs. Continuity was measured using the usual provider of care method (UPC) and the continuity for physician method (PHY). Three clinic models (traditional, block, and combination) were compared using analysis of covariance. Multivariable linear regression analysis was used to analyze the effect of practice metrics and clinic model on continuity.ResultsUPC, reflecting continuity from the patient perspective, was significantly different, and was highest in the block model, midrange in combination model, and lowest in the traditional model programs. PHY, reflecting continuity from the perspective of the resident provider, was significantly lower in the block model than in combination and traditional programs. Panel size, ambulatory workload, utilization, number of clinics attended in the study period, and clinic model together accounted for 62% of the variation found in UPC and 26% of the variation found in PHY.ConclusionsClinic model appeared to have a significant effect on continuity measured from both the patient and resident perspectives. Continuity requires balance between provider availability and demand for services. Optimizing this balance to maximize resident education, and the health of the population served, will require consideration of relevant local factors and priorities in addition to the clinic model.

Historically, safety in the gastrointestinal (GI) endoscopy unit has focused on infection control, particularly around the reprocessing of endoscopes. Two highly publicized outbreaks where the transmission of infectious agents were related to GI endoscopy have highlighted the need to address potential gaps along the endoscopy care continuum that could impact patient safety.

Background: Consultation room design varies from country to country. The layout of a general practitioner’s (GP’s) consulting room may influence the physician’s or patient’s experience. The aim of this study is to explore and investigate the layout of GP’s consulting rooms around the world and to describe any significant differences. Methods: Between 3rd July and 2nd August 2018, an internet-based questionnaire on Google Docs was distributed by email, social media and WhatsApp platforms to several worldwide rural medicine groups. Analysis of an internet-based questionnaire to explore possible layouts of consultation rooms within practices was performed. The questionnaire was designed with three distinct sections: first, a GP demographic profile including gender, year of graduation from medical school, country of graduation, and type of practice (private or public); second, questions relating to the office layout; third, a section for questionnaire feedback. Results: 502 responses to the questionnaire were received; 65.3% women and 34.7% men. The most common layout in Europe and America was where the physician and the patient were separated by a desk. The layout where the physician and the patient had a 90º angle facing each other was the most commonly used layout in Asia-Pacific and Africa. For GPs who graduated before 1990 and between 1990-2010, the layout where the table was between the patient and physician was preferred. However, physicians graduating after 2010 preferred a layout with the physician and the patient with a 90º angle facing each other. Conclusion: The position of the GP’s desk differs between and within countries as well as the gender of the physician and year of graduation. Next steps should focus on gathering an even greater breadth of GP input, as well as comparing and contrasting those to the preferences of our patients and communities.

With a growing need for long-term care facilities in general, and for specialized dementia units in particular, it is important to ensure that the architectural layouts of such facilities support the well-being of both the residents and the unit caregivers. This study aimed to investigate correlations between the support provided by the architectural layout of long-term care units for enhancing residents' well-being and for decreasing unit caregivers' burnout and increasing their resilience-as layouts may impact each party differently. The Psycho Spatial Evaluation Tool was utilized to assess the support provided by the layouts of seventeen long-term care units (ten regular nursing units and seven specialized dementia units) for the residents' physical and social well-being (five dimensions); a questionnaire was used to measure the unit caregivers' burnout and resilience. When analyzing layouts' support for residents' physical and social well-being, inconsistencies emerged regarding correlations with caregivers' burnout and resilience across the two types of long-term care units. Supporting residents' physical well-being was correlated with increased caregiver resilience in dementia units, and with increased burnout and decreased resilience in regular nursing units. Layouts supporting social well-being showed inconsistent correlations with caregivers' resilience indexes in dementia units, and with burnout and resilience indexes in regular nursing units. The findings underscore the role of the architectural layout of long-term care units in enhancing residents' well-being; the results also highlight the possible unintentional yet negative impact of the layout on the caregivers' burnout and resilience. This study emphasizes the need to identify and rectify design shortcomings as a means of enhancing residents' well-being, while increasing the unit caregivers' resilience and decreasing their burnout. These insights should be addressed when developing strategies and interventions for ensuring optimal care environments for all parties involved.

Objectives: Mental health inpatient facilities are increasingly focusing on creating therapeutic, person-centred care environments. However, research shows that this focus may have unintended consequences for healthcare staff. Designs that do not pay attention to staff needs may risk contributing to stress, burnout, job dissatisfaction and mental exhaustion in the work environment. This systematic review aims to identify and synthesise current research on the design factors of adult mental health inpatient facilities that impact healthcare staff., Design: A mixed method systematic review was conducted to search for empirical, peer-reviewed studies using the databases CINAHL, Embase, PsycINFO, PubMed and Web of Science from their inception up to 5 September 2023. The Joanna Briggs Institute's critical appraisal checklists were used to assess the methodological quality of the eligible studies. Data were extracted and grouped based on the facility design factors., Results: In our review, we included 29 peer-reviewed empirical studies that identified crucial design factors impacting healthcare staff in adult mental health inpatient facilities. Key factors included layouts providing optimal visibility, designated work and respite areas, and centrally located nursing stations. Notably, mixed perceptions regarding the benefits and challenges of open and glass-enclosed nursing stations suggest areas requiring further research. Facilities in geographically remote locations also emerged as a factor influencing staff dynamics. Additionally, although only supported by a limited number of studies, the significance of artwork, sensory rooms for respite, appropriate furniture and equipment, and access to alarms was acknowledged as contributory factors., Conclusion: Through the synthesis of existing research, this review identified that the design of mental health facilities significantly impacts staff well-being, satisfaction, performance and perception of safety. Concluding that, in order to create a well-designed therapeutic environment, it is essential to account for both service users and staff user needs., Prospero Registration Number: CRD42022368155., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Partner Notification Service is among the strategies used to conduct targeted Human Immunodeficiency Virus Testing Service by obtaining information about sexual contacts of index clients to refer for testing. But most people living with Human Immunodeficiency Virus are still unaware of their status, including Ethiopia. Limited studies are available on the magnitude of partner notification service utilization and associated factors in Ethiopia., Objective: The aim of this study was to assess the magnitude of partner notification service utilization and associated factors among people living with Human Immunodeficiency Virus attending anti-retroviral therapy clinics of public health facilities in Gimbi town, West Ethiopia., Methods: A facility-based mixed-method cross-sectional study design was used. Total of 455 study participants were selected by systematic random sampling for quantitative data and health workers were purposively selected for qualitative data until saturation of ideas was reached. The study was conducted from December 1, 2022 to January 30, 2023. Structured questionnaires and key informant interview guides were used for data collection. Quantitative data were analyzed using Statistical Package for Social Science version 25. Open code 4.02 software was used for qualitative data analysis. Frequencies and proportions were used to summarize descriptive statistics. Bivariable and multivariable logistic regression was used to identify associated factors then variables with a p value < 0.05 were declared to have an association with the dependent variable., Result: Exactly 298 (65.5%) of the study participants were notified their HIV status to their sexual partners. Factors associated with Partner Notification Service Utilization were depression AOR: 0.12 (95% CI: 0.07, 0.20), urban settlers AOR: 2.21 (95% CI: 1.2, 3.83), fear of support loss AOR: 0.24 (95% CI: 0.14, 0.40) and intimate partner violence AOR: 0.55 (95% CI: 0.31, 0.97). From qualitative part of this study, factors associated to Partner Notification service utilization were fear of stigma, discrimination and fear of divorce., Conclusion: Two-third of the study participants were utilized partner notification service, and efforts are important to prevent depression and intimate partner violence. Local government bodies and stakeholders should implement economic strengthening and strategies to address the rural community for HIV/AIDS prevention. Promotion of supportive and inclusive environment for PLHIV should also considered as way to increase PNS utilization., (© 2024. The Author(s).)

Background and Objective: People with disabilities are one of the groups that usually frequent healthcare centers, so it is essential to attend to their specific needs, especially from the point of view of universal accessibility, safety and healthcare quality. The aim of the study is to summarize the available evidence on the needs of groups of patients with some type of disability in access, navigation and stay during the reception of healthcare in various health centers and to identify successful solutions., Materials and Methods: A scoping review had been designed, based on a literature review without time limit in three databases (PubMed, WOS, and Embase)., Results: Of the 2562 articles identified, 11 were included. Recommendations for improvement in the design of healthcare services focused on the following aspects: improving access to primary care centers; navigation, signage, and orientation in the hospital environment; elevator design; hospital room bathroom design; meeting the needs of wheelchair users; importance of the participation of the patient with a disability; involvement of stakeholders in the design process; and the need for appropriate policies to ensure accessibility to buildings., Conclusions: The promotion of artistic programs in healthcare settings and the participation of people with disabilities in the design process of healthcare settings could provide beneficial solutions. More studies are needed, given the scarcity of evidence found, to ensure that care for this group is based on criteria of patient safety, universal accessibility, healthcare quality and humanization., (Copyright © 2024 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Résumé: La confidentialité est une obligation légale et déontologique pour tout médecin. Elle permet d'établir une relation de confiance avec son patient. Plusieurs études montrent qu'elle n'est pas toujours respectée dans les cabinets des médecins généralistes. Le but de notre étude était d'en comprendre les raisons. Les médecins généralistes ont conscience que le respect de la confidentialité n'est pas optimal dans leur cabinet ; ils identifient une origine plurifactorielle à sa rupture ne se limitant pas à un aménagement inadéquat des locaux. Confidentiality is a legal and ethical obligation for all doctors. It allows you to establish a relationship of trust with your patient. Several studies show that it is not always respected in the offices of general practitioners. The purpose of our study was to understand the reasons for this. General practitioners are aware that respecting confidentiality is not optimal in their practice; they identify a multifactorial origin to its rupture, not limiting it to an inadequate layout of the premises. [ABSTRACT FROM AUTHOR]

Policy decisions regarding the quality of the physical school environment-both, school siting and school facility planning policies-are often considered through the lens of environmental planning, public health, or education policy, but rarely through all three. Environmental planners consider environmental justice issues on a local level and/or consider the regional impact of a school. Public health professionals focus on toxic exposures and populations particularly vulnerable to negative health outcomes. Educators and education policymakers emphasize investing in human capital of both students and staff. By understanding these respective angles and combining these efforts around the common goals of achieving adequacy and excellence, we can work toward a regulatory system for school facilities that recognizes children as a uniquely vulnerable population and seeks to create healthier school environments in which children can learn and adults can work.

Work-related stress is common within the nursing profession, especially in the ED. Studies have shown that interventions to improve hospital working environments positively impact retention and help prevent burnout. This nursing practice innovation project describes the development, implementation, and evaluation of a restorative space (the "Serenity Room") in a busy regional ED. The evaluation of this project focused on the effectiveness of the room at reducing stress and the value ED staff place on having access to a restorative space. Data were gathered through preand postimplementation surveys. [ABSTRACT FROM AUTHOR]

Clinician teamwork is effective at improving many health care outcomes, and the physical environment is an important part of a system that facilitates teamwork. This review critically evaluates and synthesizes the empirical evidence on the impacts of the physical environment and surrounding ecosystem on clinician teamwork in health care facilities using a systems-based lens. The systematic search yielded 2,323 titles and abstracts between 2007 and 2017, which were reviewed and resulted in 34 articles examining physical environment's impact on clinician teamwork. The Systems Engineering for Patient Safety (SEIPS) framework is utilized to thematically structure findings to examine the interdependent nature of built and nonbuilt factors that have a documented impact on clinician teamwork. This study found consistent evidence of the interdependence of these systems factors in facilitating or hampering teamwork, as defined by Salas and colleagues' "Big Five." The review identifies current gaps in the literature and suggests where future research is needed. [ABSTRACT FROM AUTHOR]

The physical layout of the emergency department affects the way in which patients and providers move within the space and can cause substantial changes in workflow and, therefore, affect communication patterns between providers. There is no 1 ED design that enables the best patient care, and quantitative studies looking at ED design are limited. The goal of this study was to examine how different ED designs, centralized and decentralized, are associated with communication patterns among health care professionals. A task performance, direct observation time study was used. By developing a novel tablet-based digital mapping tool using a cloud-based mapping platform (ArcGIS), data on provider actions and interactions were collected and mapped to a precise location within the emergency department throughout an entire nursing shift. The difference in the duration of nurse-physician interactions between the 2 ED designs was statistically significant. Within the centralized design, nurse-physician interactions totaled 14 minutes and 38 seconds compared with 30 minutes and 11 seconds in the decentralized design (t = 2.31, P = 0.02). More conversations between nurses and physicians occurred inside the patient's room in the decentralized design. Our findings suggest that the ED design affects communication patterns among health care providers and that the design has the potential to affect the quality of patient care. [ABSTRACT FROM AUTHOR]

ObjectivesTo report an outbreak of respiratory synctyial virus (RSV) in a long-term care facility (LTCF) during ongoing routine respiratory illness surveillance.DesignRapid antigen testing, viral culture, direct fluorescent antibody (DFA) testing, and reverse transcriptase polymerase chain reaction (RT-PCR) testing for up to 15 viruses in symptomatic residents and chart review.SettingA 120-bed LTCF.MeasurementsComparison of rapid antigen testing, respiratory viral cultures, and DFA testing and RT-PCR in residents with symptoms of a respiratory tract infection.ResultsTwenty-two of 52 residents developed symptoms of a respiratory tract infection between January 29, 2008, and February 26, 2008. RSV was detected using RT-PCR in seven (32%) of the 22 cases. None of the seven cases had positive RSV rapid antigen testing, and only two had positive culture or DFA results. This outbreak occurred during a time when state wide RSV rates were rapidly declining. One patient was admitted to the hospital during the infection and subsequently died.ConclusionRSV may cause outbreaks in LTCFs that traditional diagnostic methods do not detect. RT-PCR can provide a more timely and accurate diagnosis of outbreaks, which allows for early symptomatic treatment, rational use of antibiotics, and improved infection control.

Background: Health clinic design varies from country to country. The layout of a general practitioner’s (GP’s) consulting room may influence the physician’s or patient’s experience. The aim of this study is to explore and investigate the layout of GP’s consulting rooms around the world and to describe any significant differences. Methods: Between 3rd July and 2nd August 2018, an internet-based questionnaire on Google Docs was distributed by email, social media and WhatsApp platforms to several worldwide rural medicine groups. Analysis of an internet-based questionnaire to explore possible layouts of consultation rooms within practices was performed. The questionnaire was designed with three distinct sections: first, a GP demographic profile including gender, year of graduation from medical school, country of graduation, and type of practice (private or public); second, questions relating to the office layout; third, a section for questionnaire feedback. Results: 502 responses to the questionnaire were received; 65.3% women and 34.7% men. The most common layout in Europe and America was where the physician and the patient were separated by a desk. The layout where the physician and the patient had a 90º angle facing each other was the most commonly used layout in Asia-Australia and Africa. For GPs who graduated before 1990 and between 1990-2010, the layout where the table was between the patient and physician was preferred. However, physicians graduating after 2010 preferred a layout with the physician and the patient with a 90º angle facing each other. Conclusion: The position of the GP’s desk differs between and within countries as well as the gender of the physician and year of graduation. Next steps should focus on gathering an even greater breadth of GP input, as well as comparing and contrasting those to the preferences of our patients and communities.

Objective: This study aimed to identify latent conditions in a pediatric intensive care unit (PICU) by analyzing characteristics of flow disruptions (FD) during a simulation of a three-phased scenario., Background: The built environment of healthcare facilities contributes to FD that can lead to clinical errors and patient harm. In the facility design process, there is an opportunity to identify built environment features that cause FD and pose safety risks. Simulation-based evaluation of proposed designs may help in identifying and mitigating safety concerns before construction and occupancy., Methodology: During design development for a new 400-bed children's hospital, a series of simulations were conducted using physical mock-ups in a large warehouse. A three-phased scenario, (1) admission and intubation, (2) cardiac arrest, and (3) bedside surgery involving a cannulation to extracorporeal membrane oxygenation, was conducted in a PICU room mock-up. Each scenario was video recorded from four angles. The videos were systematically coded to identify FD., Results: Analysis identified FDs in three ICU zones: respiratory therapists (RT) zone, nurse zone, and head of the patient. Challenges in these zones were related to spatial constraints in the RT zone and head of the bed, equipment positioning in the RT zone and nurse zone, and impeded visibility related to the location of the boom monitor in the nurse zone., Conclusion: Simulation-based evaluation of prototypes of patient care spaces can help identify characteristics of minor and major FD related to the built environment and can provide valuable information to inform the iterative design process., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To develop an objective, structured observational tool to enable identification and measurement of hazards in the built environment when applied to audiovisual recordings of simulations by trained raters., Background: Simulation-based facility design testing is increasingly used to optimize safety of healthcare environments, often relying on participant debriefing or direct observation by human factors experts., Methods: Hazard categories were defined through participant debriefing and detailed review of pediatric intensive care unit in situ simulation videos. Categories were refined and operational definitions developed through iterative coding and review. Hazard detection was optimized through the use of structured coding protocols and optimized camera angles., Results: Six hazard categories were defined: (1) slip/trip/fall/injury risk, impaired access to (2) patient or (3) equipment, (4) obstructed path, (5) poor visibility, and (6) infection risk. Analysis of paired and individual coding demonstrated strong overall reliability (0.89 and 0.85, Gwet's AC 1 ). Reliability coefficients for each hazard category were >0.8 for all except obstructed path (0.76) for paired raters. Among individual raters, reliability coefficients were >0.8, except for slip/trip/fall/injury risk (0.68) and impaired access to equipment (0.77)., Conclusions: Hazard Assessment and Remediation Tool (HART) provides a framework to identify and quantify hazards in the built environment. The tool is highly reliable when applied to direct video review of simulations by either paired raters or trained single clinical raters. Subsequent work will (1) assess the tool's ability to discriminate between rooms with different physical attributes, (2) develop strategies to apply HART to improve facility design, and (3) assess transferability to non-ICU acute care environments., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

In the context of an aging population, the concept of peaceful end-of-life care has gained increasing significance as an essential component of individuals' fundamental well-being. This underscores the importance of researching and developing hospice care facilities and service systems dedicated to providing a tranquil resting environment. This study focuses on selected hospice care buildings, examining their service model evolution and architectural design. Through case analyses, it explores contemporary hospice care architecture, identifying various types and spatial design features that cater to the end-of-life needs of individuals. The findings guide the design of hospice care buildings in China, emphasizing patient-living areas, medical care zones, and auxiliary functional spaces. This comprehensive approach aims to enhance terminally ill patients' comfort, serenity, and dignity. Moreover, it aims to provide emotional and post-funeral support to terminally ill patients' families., 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.

Green roofs can reduce stormwater runoff in urban areas by capturing rainfall. The extent of this capture is partially influenced by vegetation type and cover, which can be manipulated to optimise run-off reduction. However, in the absence of routine maintenance, planted green roof vegetation is often replaced by 'weedy' spontaneous species with unknown rainfall retention qualities. To better understand the role of spontaneous vegetation in green roof stormwater mitigation, we undertook a 100-day rainfall simulation involving 14 plant species that occur spontaneously on green roofs in Mediterranean-type climates. Green roof modules were filled with either 7 cm (shallow) or 14 cm (deep) substrate. The substrate was either left bare or sown with the spontaneous species community, which established approximately 100 % cover prior to the beginning of the rainfall simulation. During the simulation, modules were subjected to a "dry" and then a "wet" rainfall phase, each based on historical climate records from Melbourne, Australia. The "dry" treatment replicated the timing and depth of the driest rainfall period on record, while the "wet" treatment applied rainfall depths randomly selected from the 90th, 95th, and 99th percentiles of recorded rainfall. Rainfall retention, evapotranspiration, time to initiation of runoff and soil water content was measured for 17 rainfall events. Spontaneous vegetation cover and both species and functional diversity were measured at the end of each rainfall phase, and biomass was measured at the end of the wet phase. During the dry phase, modules with spontaneous vegetation cover retained 88 % of applied rainfall regardless of substrate depth and had 6 % greater retention than bare substrate. During the wet phase, deep substrate modules with spontaneous vegetation cover had 30 % greater retention than other treatment combinations. At the end of the wet phase, spontaneous vegetation in deep substrate had 42 % greater biomass, 19 % greater coverage and more than twofold greater functional richness than in shallow substrate. These findings demonstrate that spontaneous vegetation can increase stormwater retention on green roofs relative to bare substrate and have similar retention performance to commonly utilised species. However, the extent to which stormwater mitigation on green roofs is enhanced by spontaneous vegetation is dependent on factors that are more important for rainfall retention, such as substrate depth and rainfall patterns., Competing Interests: Declaration of competing interest 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., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Physical design of the emergency department (ED) has an important effect on its role and function. To date, no guidelines have been introduced to set the standards for the construction of EDs in Iran. In this study we aim to devise an easy-to-use tool based on the available literature and expert opinion for the quick and effective assessment of EDs in regards to their physical design. For this purpose, based on current literature on emergency design, a comprehensive checklist was developed. Then, this checklist was analyzed by a panel consisting of heads of three major EDs and contradicting items were decided. Overall 178 crude items were derived from available literature. The Items were categorized in to three major domains of Physical space, Equipment, and Accessibility. The final checklist approved by the panel consisted of 163 items categorized into six domains. Each item was phrased as a “Yes or No†question for ease of analysis, meaning that the criterion is either met or not. Â

Awareness of the impact of the built environment on health care outcomes and experiences has led to efforts to redesign birthing environments. The Birth Unit Design Spatial Evaluation Tool was developed to inform such improvements, but it has only been validated with caseload midwives and women birthing in caseload models of care. To assess the content validity of the tool with four new participant groups: Birth unit midwives, Aboriginal or Torres Strait Islander women; women who had anticipated a vaginal birth after a caesarean; and women from refugee or culturally and linguistically diverse backgrounds. Participants completed a Likert-scale survey to rate the relevance of The Birth Unit Design Spatial Evaluation Tool's 69 items. Item-level content validity and Survey-level validity indices were calculated, with the achievement of validity set at >0.78 and >0.9 respectively. Item-level content validity was achieved on 37 items for birth unit midwives (n = 10); 35 items for Aboriginal or Torres Strait Islander women (n = 6); 33 items for women who had anticipated a vaginal birth after a caesarean (n = 6); and 28 items for women from refugee or culturally and linguistically diverse backgrounds (n = 20). Survey-level content validity was not demonstrated in any group. Birth environment design remains significant to women and midwives, but the Birth Unit Design Spatial Evaluation Tool was not validated for these participant groups. Further research is needed, using innovative methodologies to address the subconscious level on which environment may influence experience and to disentangle the influence of confounding factors. [ABSTRACT FROM AUTHOR]

Introduction. In 1907, the City Council of Novi Sad authorized the building of a new city hospital. The complex of hospital buildings was planned as a modern pavilion-style hospital with a 300 bed capacity. Foundation. The Pavilion 1 was intended for Admitting Department, Management and Administrative Departments. The facade of this building was decorated with a monumental mosaic of two angels. The Pavilion 2 was built for Departments of Surgery and Gynecology, whereas the Pavilion 3 included departments for patients with internal diseases, patients with skin and venereal diseases and maternity ward, but occasionally some infectious and neurological patients were treated there as well. In 1912, two new buildings were built: the first was the Antitrachoma Department and the other for patients with tuberculosis. During the First World War, the City Hospital was turned into a military hospital for the wounded, and also for those suffering from abdominal and typhoid fever, as well as from Spanish fever. Period between the two world wars. Since 1921, the founder of the hospital and its name have changed, and it has become the General State Hospital. After young physicians, educated at famous European medical centers, were employed, the Novi Sad State Hospital experienced a great advancement, especially in the field of surgery. In 1922, a new building was built, where the Bacteriological Station and the Pasteur Institute were established. The problems that the City Hospital was facing transferred to the General State Hospital, and were mostly financial. Before the Second World War, the State Hospital had a 455 bed capacity. After the Hungarian armed forces occupied Novi Sad in May 1941, the hospital director and all the ward physicians were replaced by Hungarian military doctors who worked there until September 1944. [ABSTRACT FROM AUTHOR]

Purpose: Evaluate the incremental impact of environmental stairwell enhancements on stair usage in addition to prompts.Design: Phased, nonrandomized, quasi-experimental intervention.Setting: Two 6-story and one 8-story municipal government office buildings-each with 2 stairwells.Participants: Approximately 2800 municipal employees and 1000 daily visitors.Intervention: All stairwells received door wraps and point-of-decision and wayfinding prompts. Environmental enhancements were installed in 1 stairwell in each of the 2 buildings: wall paint, upgraded stair treads and handrails, artwork, light-emitting diode (LED) lighting, fire-rated glass doors, and removal of security locks on at least the ground floor.Measures: Staff surveys and focus groups, electronic and direct measures of stair and elevator use occurred at baseline and over 3 years of phased implementation and follow-up.Analysis: Change in the proportion of vertical movement by stairs using χ2 analysis.Results: The prompts were associated with a significant increase in stair use (odds ratio [OR] = 1.36; 95% confidence interval [CI]: 1.31-1.41), with an average absolute increase of 3.2%. Environmental enhancements were associated with an additional significant increase in stair use (OR = 1.31; 95% CI: 1.25-1.37) beyond prompts alone with an average absolute increase of a further 3.5% that was sustained for 1 year. The initial increases in stair use with prompts alone were not sustained.Conclusion: Implementing environmental stairwell enhancements in office buildings increased stair usage in a sustained manner beyond that achieved by prompts alone. [ABSTRACT FROM AUTHOR]

Objective: Focusing on Hong Kong Care and Attention homes which provide residential care, meals, personal care and limited nursing care for older people, this study aimed to understand the impact of floor plans' legibility (layout and complexity) on residents' wayfinding satisfaction and self‐reported health status. Methods: A questionnaire survey was conducted in nine Care and Attention homes. Space syntax, a well‐established method, was used to evaluate the legibility of their floor plans via calculating the integration value. Results: Familiarity with Care and Attention homes did not influence the residents' satisfaction with wayfinding. The integration value had a significant impact on residents' satisfaction with wayfinding. No relationship was observed between integration value and self‐reported health status. Conclusion: Increasing complexity in floor plans appears to negatively affect residents' wayfinding satisfaction. These data suggest that circulation patterns should be improved for better wayfinding. [ABSTRACT FROM AUTHOR]

ObjectivesThe study examined the usefulness of a three-perspective model for determining the quality of evaluations in psychiatric emergency services. The model was used to evaluate the hypothesis that the provision of high-quality care in emergency services is primarily influenced by service objectives related to patients' clinical characteristics rather than by institutional constraints, such as workload or physical facilities, or by social biases, such as clinicians' attitudes toward patients or perceptions of community expectations.MethodsThe evaluation of 683 persons assessed in nine California public facilities were independently observed. Multivariate techniques were used to test the relative importance of patients' clinical characteristics, possible sources of social bias among clinicians, and institutional constraints in influencing three quality-of-care dimensions: technical quality, the art of patient care, and optimum investment of time.ResultsThe findings generally confirmed the hypothesis that patients' clinical characteristics have more influence on the quality of care provided than institutional constraints or social biases. However, one institutional constraint--increased workload demands--led to reduced technical quality and to less than optimal use of time. Further, social biases reflected in the clinician's like for and preconceptions about the patient also influenced the quality of their evaluations.ConclusionsThe model is a useful tool for examining quality of care in the psychiatric emergency service. Increasing workload pressures negatively affect quality of care.

The hazard of vehicle emissions mainly come from the four wheel positioning, drum test and vehicle emissions test sections in automobile assembly workshop, which can lead to abnormal hemoglobin and hepatic insufficiency in workers. We researched on preventing toxic gases technologies for the vehicle emissions generated by these three sections, designed the ventilation facilities, and then detected and evaluated the operation effect, thereby improving the working environment, ensuring the occupational health of workers, and providing scientific basis for the control of vehicle emissions hazards.

Objective: The following research paper seeks to explore how post-occupancy evaluations (POEs) are undertaken in the nine health jurisdictions across Australia and Aotearoa New Zealand and investigate if the process can be strengthened to better inform healthcare design and investment., Background: Healthcare expenditure in both nations is increasing, and the rigorous evaluation of healthcare facilities can provide evidence to improve their return on investment. A POE is a research method used to undertake this analysis, usually 12 months after a facility has been occupied. There is limited information available about how POEs are undertaken in each jurisdiction, and there has never been research conducted to understand these processes across the region., Methods: Focus groups were conducted with participants from the government health organization in each jurisdiction to collect qualitative data regarding various aspects of POE processes and barriers to undertaking POEs., Results: Only five of the nine jurisdictions undertake POEs on healthcare facilities (with varied frequencies), and there is no standardized framework in use. However, every jurisdiction does undertake a "benefits realization" process. There is limited involvement of external consultants in POEs or benefits realization processes. POE benchmarks should be established at project commencement, and POE results should then inform future projects. Top-down support is required for POEs to occur., Conclusions: The primary conclusion is that strengthening any evaluation process requires a nuanced approach in each jurisdiction to account for their unique context and challenges. Regular rigorous evaluations are required to feed results into the Australasian Health Facility Guidelines and encourage innovative facility design., 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.

Background: Meatpacking plants were major sources of COVID-19 outbreaks, posing unprecedented risks to employees, family members, and local communities. The effect on food availability during outbreaks was immediate and staggering: within 2 months, the price of beef increased by almost 7% with documented evidence of significant meat shortages. Meatpacking plant designs, in general, optimize on production; this design approach constrains the ability to enhance worker respiratory protection without reducing output., Methods: Using agent-based modeling, we simulate the spread of COVID-19 within a typical meatpacking plant design under varying levels of mitigation measures, including combinations of social distancing and masking interventions., Results: Simulations show an average infection rate of close to 99% with no mitigation, 99% with the policies that US companies ultimately adopted, 81% infected with the combination of surgical masks and distancing policies, and 71% infected with N95 masks and distancing. Estimated infection rates were high, reflecting the duration and exertion of the processing activities and lack of fresh airflow in an enclosed space., Conclusion: Our results are consistent with anecdotal findings in a recent congressional report, and are much higher than US industry has reported. Our results suggest current processing plant designs made rapid transmission of the virus during the pandemic's early days almost inevitable, and implemented worker protections during COVID-19 did not significantly affect the spread of the virus. We argue current federal policies and regulations are insufficient to ensure the health and safety of workers, creating a justice issue, and jeopardizing food availability in a future pandemic., (© 2023 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals LLC.)