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Objective: This case study examines the implementation of inpatient telemedicine in COVID-19 intensive care units (ICUs) and explores the impact of shifting forms of visibility on the management of the unit, staff collaboration, and patient care., Background: The COVID-19 crisis drove healthcare institutions to rapidly develop new models of care based on integrating digital technologies for remote care with transformations in the hospital-built environment. The Sheba Medical Center in Israel created COVID-19 ICUs in an underground structure with an open-ward layout and telemedicine control rooms to remotely supervise, communicate, and support the operations in the contaminated zones. One unit had a physical visual connection between the control room and the contaminated zone through a window, while the other had only a virtual connection with digital technologies., Methods: The findings are based on semistructured interviews with Sheba medical staff, telemedicine companies, and the architectural design team and observations at the COVID-19 units during March-August 2020., Results: The case study illustrates the implications of virtual and physical visibility on the management of the unit, staff collaboration, and patient care. It demonstrates the correlations between patterns of visibility and the users' sense of control, orientation in space, teamwork, safety, quality of care, and well-being., Conclusions: The case study demonstrates the limitations of current telemedicine technologies that were not designed for inpatient care to account for the spatial perception of the unit and the dynamic use of the space. It presents the potential of a hybrid model that balances virtual and physical forms of visibility and suggests directions for future research and development of inpatient telemedicine.

Objective: This research aimed to identify the extent to which physical features of two neurorehabilitation units appeared to support positive patient experience and recovery., Background: Neurorehabilitation inpatient facilities must be focused on safety management and efficiency of care, as well as being supportive of the patient experience. While occupational safety and risk management is paramount, the supportive nature of the physical setting for inpatient neurorehabilitation following spinal cord injury or acquired brain injury is unclear., Method: Structured observation of two physical environments using an adapted observational tool comprising 237 items across 8 area zones, and 3 major categories (patient safety, worker safety and efficiency, and holistic patient experience)., Results: Results indicated that across both neurorehabilitation settings, the built environment attended well to occupational safety, risk reduction, harm prevention and internal security (up to 87% in spinal injury unit [SIU] and 95% in brain injury unit [BIU] patient rooms), but with limited evidence of physical features to support psychosocial needs or promote positive user experiences (up to 30% in SIU and 45% in BIU patient rooms)., Conclusion: The built environments observed appeared to be an underutilized resource for supporting positive psychosocial neurorehabilitation experiences (including complex behavior support) beyond hazard management.

Background: Circumpolar nations are experiencing unprecedented environmental and public health policy challenges due to global climate change, exploitation of nonrenewable natural resources, the endangerment of myriad wildlife species, and growing sovereignty disputes. In a call to action, the Arctic states' health ministers recently signed a declaration identifying shared priorities for mutual international cooperation. Among agreed-upon collaborations, an enhancement of intercultural understanding and promotion of culturally appropriate healthcare delivery systems is to be of high priority going forward., Purpose and Aim: In far north Canada, health policies perpetuated for generations upon indigenous communities have, traditionally, often had adverse consequences for the medically underserved inhabitants of these communities. This discussion addresses the cultural disconnect between the colonial era and current indigenous, decolonialist health and healing design strategies., Method and Result: In response, two architectural design case studies are presented that synthesize ecological site planning precepts with salutogenic architectural design attributes-a behavioral health and substance abuse residential treatment center and three elderhousing prototypes for construction in Canada's Northwest Territories., Conclusion: This conceptual synthesis is practicable, transferable, and adaptable to varied, extreme climatic conditions, as reflective of best practices in the delivery of healthcare facilities that express a synthesis of ecohumanist and salutogenic values and methodologies. The discussion concludes with a call for empathic, evidence-based collaboration and research that further examines the blending together of prefabricated off-site construction with on-site construction approaches.

The 2014-2018 National Prevention Plan (NPP), in order to promote a correct relationship between health and the environment, indicated, among the central objectives, the definition of guidelines to promote the building hygiene codes in an eco-compatible way, but also to develop specific skills on the subject of confined environments and residential construction in the operators of the Regional Health Services. The CCM2015 Project has therefore set itself the goal of taking stock of the best health practices available today in terms of sustainability and eco-compatibility in the buildings' construction and renovation actions. All this in order to define updated health performance targets to be made available to the competent Authorities, to adapt the current legislation at national, regional and local level, and finally to define the contents of a continuing education (training courses) capable to support operators in risk assessment related to the built environment and in the definition of effective preventive measures.

Background: Healthcare environments are one of the most complex and demanding fields of work. Scientific, technological and research developments along with new discoveries within health promotion and prevention strategies are increasingly requiring a multidisciplinary and interdisciplinary approach. Therefore, it is likely that the current professions will need to be significantly adapted to accommodate new and more specialized roles., Objectives: To present an overview of the current educational and training courses of the emerging professions, such as hospital planner, physician-engineer, doctor-architect, nurse-architect or engineer, we review the present global training courses (BSc, MSc, specialization and PhD courses) related to healthcare design focusing on the fields of Medicine and Nursing, Architecture and Engineering sciences., Results: The paper analyses the literature review and website analysis about active teaching programs and courses. Several academic institutions offer BSc, MSc and PhD degree programs in Healthcare Design, Environmental and Building Hygiene, and Public Health. In addition, there are several professional postgraduate courses, either in classroom, hybrid-based or online., Conclusions: A considerable number of international training experiences addresses the topic of training multidisciplinary professionals. Further in-depth investigations are needed to examine the content, teaching format and impact of the courses, student outcomes and professional careers, fields of interest and the degree of collaborations with other institutions.

Healthcare facility design is a complex process that brings together diverse stakeholders and ideally aligns operational, environmental, experiential, clinical, and organizational objectives. The challenges inherent in facility design arise from the dynamic and complex nature of healthcare itself, and the growing accountability to the quadruple aims of enhancing patient experience, improving population health, reducing costs, and improving staff work life. Many healthcare systems and design practitioners are adopting an evidence-based approach to facility design, defined broadly as basing decisions about the built environment on credible and rigorous research and linking facility design to quality outcomes. Studies focused on architectural options and concepts in the evidence-based design literature have largely employed observation, surveys, post-occupancy study, space syntax analysis, or have been retrospective in nature. Fewer studies have explored layout optimization frameworks, healthcare layout modeling, applications of artificial intelligence, and layout robustness. These operations research/operations management approaches are highly valuable methods to inform healthcare facility design process in its earliest stages and measure performance in quantitative terms, yet they are currently underutilized. A primary objective of this paper is to begin to bridge this gap. This systematic review summarizes 65 evidence-based research studies related to facility layout and planning concepts published from 2008 through 2018, and categorizes them by methodology, area of focus, typology, and metrics of interest. The review identifies gaps in the existing literature and proposes solutions to advance evidence-based healthcare facility design. This work is the first of its kind to review the facility design literature across the disciplines of evidence-based healthcare design research, healthcare systems engineering, and operations research/operations management. The review suggests areas for future study that will enhance evidence-based healthcare facility designs through the integration of operations research and management science methods.

Aim: User group consultation is more effective when participants work toward commonly agreed goals and objectives. To understand how they set these goals, this research explored how "user group" participants from diverse professional discipline backgrounds define the concepts of "design quality" and "project success," and their connection on a healthcare facility design project., Background: User group consultation is often time-consuming, frustrating, and expensive. Rarely are design quality or project success clearly defined, nor is the connection between them communicated well either in the literature or by project clients., Method: Using an online survey, respondents were asked to rank frameworks of components for design quality and project success in order of importance and to indicate how they believed their project clients would assess the same items. They were asked about the connection between the terms, and how well each was achieved on their healthcare projects, both from their personal and their client's point of view., Results: Design quality and project success were personally valued highly by respondents, with a strong connection seen between the concepts. By contrast, respondents perceived their clients saw the connection as less important. Functionality was essential to all, especially clinicians, but designers and other consultants demonstrated a broader perspective on all design outcomes., Conclusions: Healthcare designers should take the lead on project teams in defining design quality and its connection to project success as part of setting clear goals and objectives for more effective user group consultation.

Background and Objective: Patients with abnormal uterine bleeding (AUB) often require hysteroscopy as part of the diagnostic workup. The purpose of this study was to improve efficiency by shortening the time to patient appointment for office hysteroscopy., Interventions: Preintervention, nurse practitioners (NPs) and gynecologists saw patients with abnormal uterine bleeding (AUB) separately. This created inefficiency for the patients, frequently requiring second visits for hysteroscopy. A new hysteroscopy clinic was designed to increase practice efficiency. A collaborative team model was created including consecutive visits with NPs and gynecologists. Each patient with AUB was first evaluated by an NP, followed immediately by a shorter visit with a gynecologist for office hysteroscopy as indicated. NPs managed other diagnostic evaluation and bleeding treatment if hysteroscopy was not warranted. Collaborative clinic staffing consisted of two NPs seeing patients with AUB paired with one gynecologist for procedural support., Measurements and Results: Electronic records of 393 patients scheduled for AUB visits from January to June 2015 were evaluated for preintervention data. Postintervention, 647 patient records were reviewed from January to June of 2016. During the preintervention period, 30% of patients had a hysteroscopy appointment scheduled within 0-13 days from the initial visit for AUB. Postintervention, the wait time for appointments decreased, with 63% of patients scheduled within 0-13 days. Clinic redesign also resulted in an increase of 57.5% in appointment slots. No-show rates and appointment fill rates were not adversely affected., Conclusions: A collaborative team-based care model using NPs and gynecologists improved efficiency and access to office hysteroscopy services.

Whilst radiopharmaceuticals have an important role to play in both imaging and treatment of patients, most notably cancer patients, nuclear medicine and radiopharmacy are currently facing challenges to create innovative new drugs. Traditional radiopharmaceutical manufacture can be considered as either a routine hospital production or a large-scale industrial production. The gap between these two practices has meant that there is an inability to supply innovative radiopharmaceuticals for use at the local level for mono- or multicentric clinical trials with satisfactory quality and safety specifications. This article highlights the regulatory requirements in aseptic pharmaceutical processing and in nuclear medicine to be able to locally produce radiopharmaceuticals. We validate the proof-of-concept for an "in-house" hospital-based radiopharmacy including an on-site cyclotron, that can fulfill the conflicting requirements between radiation safety and aseptic processing. The ARRONAX in-house radiopharmacy is currently able to provide sterile and pyrogenic-free injectable radiopharmaceutical compounds for both industrial and institutional clinical trials., Competing Interests: The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript., (Copyright © 2020 Aurelien Vidal et al.)

Background and Objective: In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency., Materials and Method: Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts. Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus., Results: The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus., Conclusions: The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units., (Copyright © 2019 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Participation has long been considered important for post-disaster recovery. Establishing what constitutes participation in post-disaster shelter projects, however, has remained elusive, and the links between different types of participation and shelter programme outcomes are not well understood. Furthermore, recent case studies suggest that misguided participation strategies may be to blame for failures. This study analysed 19 shelter projects implemented in the Philippines following Typhoon Haiyan in November 2013 to identify the forms of participation employed. Using fuzzy-set qualitative comparative analysis, it assessed how household participation in the planning, design, and construction phases of shelter reconstruction led to outcomes of household satisfaction and safe shelter design. Participation was operationalised via eight central project tasks, revealing that the involvement of households in the early planning stages of projects and in construction activities were important for satisfaction and design outcomes, whereas engagement during the design phase of projects had little impact on the selected outcomes., (© 2019 The Authors. Disasters published by John Wiley & Sons Ltd on behalf of Overseas Development Institute.)

This study presents a systematic review of the literature on layout planning in healthcare facilities. The review includes 81 articles from journals, conferences, books, and other documents. Articles were classified in two groups according to their main contents including (i) concepts and guidelines and (ii) techniques and tools to assist in layout planning in healthcare facilities. Results indicate that a great variety of concepts and tools have been used to solve layout problems in healthcare. However, healthcare environments such as hospitals can be complex, limiting the ability to obtain optimal layout solutions. Influential factors may include the flows of patients, staff, materials, and information; layout planning and implementation costs; staff and patients safety and well-being; and environmental contamination, among others. The articles reviewed discussed and often proposed solutions covering one or more factors. Results helped us to propose future research directions on the subject.

Objective: This article describes an approach to a metrics-based evaluation of public space in hospitals using cross-disciplinary qualitative and quantitative analyses. The method, Indoor Public Space Measurement (IPSM), is well suited to researchers and designers who intend to evaluate user-centered spatial solutions in hospitals and similar facilities., Background: Healthcare is transiting toward a value-based policy at all levels. Choosing the right set of qualitative and quantitative analyses to support value-based design solutions is not always an easy journey for healthcare design consultants. This article seeks to pull together the key analyses to evaluate the impact of the hospital indoor public space on the psychosocial well-being of the hospital users., Method: A step-by step guide to performing key analyses to evaluate the impact of hospital indoor public space environment on the users' psychosocial well-being is provided. A case study from the authors' research is utilized to illustrate the application of the method., Results: Interpolating the results of all the analyses, the reader can identify where in the layout most of interactions among users occur, identify their typology and evaluate the contribution to the general psychosocial well-being, and know which group of users is more exposed to a specific typology of interaction., Conclusions: The IPSM method can help design consultants to measure the impact of the built environment of hospital public space on its occupants' psychosocial well-being: factual knowledge about the users' behavioral response with respect to wayfinding and social interaction. The application of the method is not limited to healthcare settings only.

Aim: Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP., Method: This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented., Results: From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care., Perspective: This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

The primary considerations for any health care facility construction or renovation project are the design and function of the new areas, assessment of environmental risks for airborne contamination, and containment of dust and moisture created during construction activities. Disruptions created by construction inside or outside a health care facility can increase airborne organisms, such as Aspergillus, that can lead to infections; thus, infection prevention and control are integral parts of construction planning. The AORN "Guideline for design and maintenance of the surgical suite" provides guidance to perioperative team members for developing a functional program to guide the construction/renovation project, use of evidence-based design principles, measures to contain construction-related dust and debris, and maintenance of utilities after planned or emergent utility failures. Perioperative nurses should review the complete guideline for additional information and for guidance when writing and updating policies and procedures., (© AORN, Inc, 2019.)

This article describes how the increased use of energy-efficient solid-state light sources (e.g., light-emitting diode [LED]-based illumination) in hospitals, pharmacies, and at home can help alleviate concerns of photodegradation for pharmaceuticals. LED light sources, unlike fluorescent ones, do not have spurious spectral contributions <400 nm. Because photostability is primarily evaluated in the International Council of Harmonization Q1B tests with older fluorescent bulb standards (International Organization for Standardization 10977), the amount of photodegradation observed can over-predict what happens in reality, as products are increasingly being stored and used in environments fitted with LED bulbs. Because photodegradation is premised on light absorption by a compound of interest (or a photosensitizer), one can use the overlap between the spectral distribution of a light source and the absorption spectra of a given compound to estimate if photodegradation is a possibility. Based on the absorption spectra of a sample of 150 pharmaceutical compounds in development, only 15% would meet the required overlap to be a candidate to undergo direct photodegradation in the presence of LED lights, against a baseline of 55% of compounds that would, when considering regular fluorescent lights. Biological drug products such as peptides and monoclonal antibodies are also expected to benefit from the use of more efficient solid-state lighting., (Copyright © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

This cross-sectional survey has compared subjective outcomes obtained from workers in shared (2⁻5 occupants) and open-plan (+5 occupants) offices, related to irrelevant speech, which is the noise that is generated from conversations between colleagues, telephone calls and laughter. Answers from 1078 subjects (55% in shared offices and 45% in open-plan offices) have shown that irrelevant speech increases noise annoyance, decreases work performance, and increases symptoms related to mental health and well-being more in open-plan than in shared offices. Workers often use headphones with music to contrast irrelevant speech in open-plan offices, while they take a break, change their working space, close the door or work from home in shared offices. Being female, when there are more than 20 occupants, and working in southern cities without acoustic treatments in the office, make it more likely for the occupants to be annoyed by irrelevant speech noise in open-plan offices. While, working in southern cities and with acoustic treatments in the office makes it more likely that noise annoyance will be reported in shared offices. Finally, more than 70% of the interviewed in open-plan offices were willing to reduce their voice volumes when advised by a noise monitoring system with a lighting feedback.

Background: In this article, we propose a method that integrates systematic layout planning techniques to lean health care practices aided by multicriteria decision analysis that could be applied to reformulate the layout of health care facilities., Methods: We analyze a high-variety sterilization unit of a large public hospital located in Brazil. The unit is currently implementing lean practices, and layout changes are required to provide more efficient materials and information flows., Results: Traditional design of health care facilities is not aligned with lean implementation and its underlying practices and principles. We propose the integration of such approaches to enhance their benefits. To rank and select the best layout alternative, a multicriteria decision analysis method (analytic hierarchy process) is adopted., Conclusions: There are 3 contributions here: the integration of lean principles into traditional health care facility design practices, the use of multicriteria decision analysis to refine the determination of the best layout solution, and the application of our propositions in a real case study.

Aim:: We aim to gain insight into how a dementia special care unit is used and experienced by its residents and what design aspects are important therein., Background:: In Flanders, housing for people with dementia evolves toward small-scale, homelike environments. As population aging challenges the affordability of this evolution, architects and other designers are asked to design dementia special care units that offer the advantages of small scaleness within the context of large-scale residential care facilities. How these units are used and experienced is not systematically evaluated., Method:: A case study was conducted in a recently built residential care facility where a dementia special care unit was foreseen on the ground floor, yet after a few months was moved to the top floor. The case study combined architectural analysis, participant observation, and qualitative interviews with residents and care staff., Results:: Comparing the original situation on the ground floor with the new situation on the top floor highlights how enclosure (physical and visual access to outside and the rest of the facility) and spatial organization affect how residents use and experience a dementia special care unit., Conclusions:: Depending on the type and stage of dementia, residents may have different needs for space to move, sensory stimuli, and social contact. In order to meet these different needs, confining residents to a dementia special care unit to the top floor should be avoided unless it is carefully designed, providing sufficient freedom of movement and connection with the outside world.

Indoor environmental quality (IEQ) has become an important component of green building certification schemes. While green buildings are expected to provide enhanced IEQ, higher occupant satisfaction, and less risks of occupant health when compared with non-green buildings, the literature suggests inconsistent evidence due to diverse research design, small sample size, and weak statistical analysis. This study compared several outcomes pertinent to IEQ performance in green and non-green office buildings in Singapore. Adopting a cross-sectional study design, objective measurements were taken in eight green and six non-green buildings, and satisfaction and acute health symptom risks of 367 occupants were obtained. Green buildings exhibited lower concentration of PM2.5, bacteria, and fungi and maintained temperature and humidity more consistently compared to non-green counterparts. The mean ratings for satisfaction with temperature, humidity, lighting level, air quality, and indoor environment were higher in green buildings (with statistical significance P < 0.05). There was statistically significant reduction in risk of occupants having headache, unusual fatigue, and irritated skin in green buildings. Although matching of buildings and occupant characteristics, survey participation bias, and sampling duration (a 1-week snapshot) of IEQ monitoring remain as limitations, this study offered positive association of green buildings with qualitatively and quantitatively measured performance of IEQ., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

A Proton Accelerator based Boron Neutron Capture Therapy (A-BNCT) facility is under development in Korea. Neutron beams for treatment are produced from a beryllium (Be) target and an 8 mA, 10 MeV proton beam. The purpose of the research is a radiation shielding analysis and an activation analysis for the facility design satisfying the radiation safety requirements as well as obtaining an operating license for the radiation facility according to a domestic nuclear commissioning procedure. The radiation shielding analysis was performed using the MCNPX computational particle transport code. The radiation source terms in the facility were evaluated and utilized in the shielding calculations. The minimum concrete thickness satisfying the designated dose rate of 5 μSv/h for the worker's area and 0.25 μSv/h for the public area were estimated and applied to the design. For an assessment of the radiation safety inside the facility, the dose rates were evaluated at several positions, such as behind the shielding door, around the primary barriers near the radiation sources, and in the penetrations of the ducts. The dose rate distribution was mapped for verification of the radiation safety for the entire facility. An activation analysis was carried out for the concrete walls, air, target assembly, beryllium target, and cooling water using FISPACT-2010 code. Concentrations of the activation products and dose rate induced by the radionuclides after shutdown were evaluated for the purpose of safe operation of the facility. The results were reviewed with the radiation safety regulations in Korea. As a result, it was proved that the final facility design satisfies the safety requirements., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Impact Statement: This article describes the feasibility and path to establishing a current good manufacturing practice biomaterial facility in an academic medical center. It presents a solution to overcome the "Valley of Death" in bench to bedside translation of biomaterials-based medical devices. It sets a good and feasible example to those who are interested in joining the path toward clinical practice/commercialization, and helps to spur other institutions and investigators to think about how they could incorporate in-house processes and facilities to help speed up the translation of their work into first-in-human trials.

Green buildings have been viewed as one of the most effective solutions to the negative environmental impacts of construction activities. For the sustainable development of the economy and the environment, many governments in the world have launched a variety of policies to encourage the development of green buildings. However, green targets achieved during the operational stage of green buildings are far below the expectations from the design stage. In addition, the development of green buildings is unevenly distributed in different cities. To help resolve these issues, this paper identifies 28 green building influencing factors from two perspectives, the life cycle and stakeholders. Then, a social network analysis is used to analyse their interactions and identify the critical factors. Our results show that government supervision, incremental cost, property management experience, and the awareness of environmental protection in green buildings are the critical influencing factors in promoting green building development. However, some factors related to contractors, designers and suppliers are not as important as perceived. Finally, some policy recommendations are proposed to promote green buildings in China.

Objectives:: A study exploring facility-related barriers to healthcare participation (the level to which an individual is engaged or involved in their own healthcare activities from simply keeping appointments to following treatment regimens) in persons with disabilities in Appalachia from the perspectives of four stakeholder groups, (1) adults with disabilities, (2) caregivers of persons with disabilities, (3) advocates for persons with disabilities, and (4) providers who treat persons with disabilities., Background:: Persons with disabilities potentially face additional barriers to healthcare participation than those without disabilities. Understanding and addressing the barriers to participation could assist in improving healthcare outcomes among the disabled population., Methods:: A qualitative study was conducted involving scripted focus groups with four stakeholder groups with expertise/experience in disabilities. The objective was to assess perceptions of impacts of clinical design elements on healthcare participation., Results:: Participants identified and characterized six major categories of facility- and nonfacility-related barriers they felt impacted healthcare participation, with priority differences reported between each group., Conclusions:: The healthcare facility is perhaps the most visible tool the provider has at his or her disposal to deliver effective healthcare. Understanding the interactions persons with different disabilities have with the physical facility and the messages, both intentional and unintentional, the state of the facility sends can provide useful insights into delivering more effective healthcare to this population.

The purpose of this literature review is to provide a better understanding of the impact that environmental design can have on the process of cancer prevention, diagnosis, treatment, and survivorship. Cancer is considered a chronic disease in the United States, and more than 1.6 million new cases are diagnosed annually. New strategies of cancer care propose patient-centered services to achieve the best outcome, and researchers have found that environmental design can be an important part of improving this care. Searches were conducted in the PubMed and Google Scholar databases as well as in specific healthcare design journals such as Health Environments Research & Design, Environmental Psychology, and Environment and Behavior. The criteria for articles included in the review were (a) English-language articles related to facility design, which addressed (b) the topics of built environment in relation to cancer diagnosis, treatment, and survivorship, and were (c) published in peer-reviewed journals between 2000 and 2017. Finally, 10 articles were selected, and the contents were analyzed. The selected articles demonstrate that environmental design is one of the critical factors for success throughout the whole continuum of cancer care from diagnosis to end-of-treatment. Some of the specific conclusions from the review are that "neighborhood-oriented" design strategies can be beneficial (by providing accessibility to all facilities along the patient's path), that access to nature for patients, staff, and visitors alike is associated with better outcomes, and that provisions for natural lighting and noise reduction are associated with cancer patients' well-being.

Objective:: The study explored design for well-being within dementia care by investigating the adoption of well-being-focused design in real-world practice, through observing National Health Service (NHS) wards., Background:: Design for well-being is an approach that considers the psychological and physiological effects of architecture to improve health and well-being. The high psychological care requirement for dementia patients makes them a significant group to study in the evaluation of current hospital facilities., Methods:: A literature review was conducted to frame the current theoretical perception of the key characteristics of a good environment for dementia care. A framework was generated to summarize and used as an assessment tool in a series of observational visits to NHS wards. Interviews with clinical staff focused on care outcomes and practicalities of implementing well-being-focused design, considering the historical and economical context. Key findings from the observations and interviews were analyzed for recurring themes., Results:: The ward observations and interviews provided insight into the current progression of well-being-led design in NHS hospitals in England. The research highlights key areas of success and factors that inhibit further progression., Conclusions:: The case studies showed a good degree of ambition to utilize well-being-focused design, with belief among staff that the physical environment has a substantial role in the health and well-being of patients. Staff also felt that this approach is most effective for those in the less advanced stages of dementia. Despite the high level of support, the current degree of implementation appears to be varied.

Design approaches towards energy efficient hospitals often result in a deteriorated indoor environmental quality, adverse health and comfort outcomes, and is a public health concern. This research presents an advanced approach to the design of a hospital environment based on a stimulative paradigm of healing to achieve not only healthy but also comforting conditions. A hospital room for severely burn patient was considered as one of the most demanding spaces. The healing environment was designed as a multi-levelled, dynamic process including the characteristics of users, building and systems. The developed integral user-centred cyber-physical system (UCCPS) was tested in a test room and compared to the conventional system. The thermodynamic responses of burn patients, health care worker and visitor were simulated by using modified human body exergy models. In a healing environment, UCCPS enables optimal thermal balance, individually regulated according to the user specifics. For burn patient it creates optimal healing-oriented conditions with the lowest possible human body exergy consumption (hbExC), lower metabolic thermal exergy, lower sweat exhalation, evaporation, lower radiation and convection. For healthcare workers and visitors, thermally comfortable conditions are attained with minimal hbExC and neutral thermal load on their bodies. The information on this is an aid in integral hospital design, especially for future extensive renovations and environmental health actions.

With the Room Acoustical Quality Inventory (RAQI), a measuring instrument for the perceptual space of performance venues for music and speech has been developed. First, a focus group with room acoustical experts determined relevant aspects of room acoustical impression in the form of a comprehensive list of 50 uni- and bipolar items in different categories. Then, n  = 190 subjects rated their acoustical impression of 35 binaurally simulated rooms from 2 listening positions, with symphonic orchestra, solo trumpet, and dramatic speech as audio content. Subsequent explorative and confirmative factor analyses of the questionnaire data resulted in three possible solutions with four, six, and nine factors of room acoustical impression. The factor solutions, as well as the related RAQI items, were tested in terms of reliability, validity, and several types of measurement invariance, and were cross-validated by a follow-up experiment with a subsample of 46% of the original participants, which provided re-test reliabilities and stability coefficients for all RAQI constructs. The resulting psychometrically evaluated measurement instrument can be used for room quality assessment, acoustical planning, and the further development of room acoustical parameters in order to predict primary acoustical qualities of venues for music and speech.

Objectives: Determine the relative impact of 11 building wellness features on preference and on the ability to deliver/receive quality care for two groups: patients and caregivers., Background: The impact of building features that promote wellness is of increasing interest to the building owners, designers, and occupants., Methods: This study performed a postoccupancy evaluation of two user groups at a healthcare facility with specific wellness features. Seventy-six staff and 62 patients of a cancer center were polled separately to determine their preferences in 11 categories., Results: Results showed that all wellness features were viewed favorably by the two groups, with natural lighting, views of nature, and thermal comfort as top categories for both. The t-test comparisons were performed, and significant differences ( p < .05) between the two groups were found for three of the features (views of nature, art and murals, and indoor plants). Discussion of these differences and the interaction of competing design goals (thermal comfort, views of nature, natural light, and desire for privacy) are included., Conclusions: Designers and owners will want to consider the preferred use of roof gardens, art and murals, and indoor plants for patient spaces, where their relative value is greater. Access to private and quiet spaces is the top need for caregivers. Ease of movement, thermal comfort, and natural light were top needs for patients.

With the work of Wallace C. Sabine on the lecture hall of the Fogg Art Museum and concert hall of Boston Symphony Hall, a foundation for the field of architectural acoustics as a science was laid between 1895 and 1900. Prior to that, architects employed various notions in acoustic design. Previous studies by the authors have reviewed 18th and 19th century design guidelines that were based on the quantification of the perception threshold between direct sound and first order reflections, with these guidelines being followed in the design of several rooms with acoustical demands. This study reviews an alternate metric guideline, based on the directivity and propagation distance of the human voice, which was utilized in several halls also during the 18th and 19th centuries. The related acoustic experiments tested how far sound was perceivable towards the front, sides, and rear of a speaking person. These ratios were used in the acoustical design of at least five lecture halls, four theater halls, one opera hall, and one concert hall, constructed in Germany, England, and the USA. These historic designs, and comparisons to modern measures and guidelines, are reviewed.

Civilizational challenges have questioned the status quo of energy and material consumption by humans. From the built environment perspective, a response to these challenges was the creation of green buildings. Although the revolutionary capacity of the green building movement has elevated the expectations of new commercial construction, its rate of implementation has secluded the majority of the population from its benefits. Beyond reductions in energy usage and increases in market value, the main strength of green buildings may be the procurement of healthier building environments. Further pursuing the right to healthy indoor environments could help the green building movement to attain its full potential as a transformational public health tool. On the basis of 40 years of research on indoor environmental quality, we present a summary of nine environment elements that are foundational to human health. We posit the role of green buildings as a critical research platform within a novel sustainability framework based on social-environmental capital assets.

Background: Older people with an acute illness, many of whom are also frail, form a significant proportion of the acute hospital inpatient population. Attention is focusing on ways of improving the physical environment to optimize health outcomes and staff efficiency., Purpose: This article explores the effects of the physical environment in three acute care settings: acute hospital site, in-patient rehabilitation hospital, and intermediate care provision (a nursing home with some beds dedicated to intermediate care) chosen to represent different steps on the acute care pathway for older people and gain the perspectives of patients, family carers, and staff., Methods: Semi structured interviews were undertaken with 40 patient/carer dyads (where available) and three staff focus groups were conducted in each care setting with a range of staff., Results: Multiple aspects of the physical environment were reported as important by patients, family carers, and staff. For example, visitors stressed the importance of access and parking, patients valued environments where privacy and dignity were protected, storage space was poor across all sites, and security was important to patients but visitors want easy access to wards., Conclusions: The physical environment is a significant component of acute care for older people, many of whom are also frail, but often comes second to organization of care, or relationships between actors in an episode of care.

This article outlines the evolution of a rescue team in responding to adenovirus prevention with a deployable field hospital. The local governments mobilized a shelter hospital and a rescue team consisting of 59 members to assist with rescue and response efforts after an epidemic outbreak of adenovirus. We describe and evaluate the challenges of preparing for deployment, field hospital maintenance, treatment mode, and primary treatment methods. The field hospital established at the rescue scene consisted of a medical command vehicle, a computed tomography shelter, an X-ray shelter, a special laboratory shelter, an oxygen and electricity supply vehicle, and epidemic prevention and protection equipment. The rescue team comprised paramedics, physicians, X-ray technicians, respiratory therapists, and logistical personnel. In 22 days, more than 3000 patients with suspected adenovirus infection underwent initial examinations. All patients were properly treated, and no deaths occurred. After emergency measures were implemented, the spread of adenovirus was eventually controlled. An emergency involving infectious diseases in less-developed regions demands the rapid development of a field facility with specialized medical personnel when local hospital facilities are either unavailable or unusable. An appropriate and detailed prearranged action plan is important for infectious diseases prevention. (Disaster Med Public Health Preparedness. 2018;12:109-114).

Allogeneic hematopoietic cell transplantation is part of the standard of care for many hematological diseases. Over the last decades, significant advances in patient and donor selection, conditioning regimens as well as supportive care of patients undergoing allogeneic hematopoietic cell transplantation leading to improved overall survival have been made. In view of many new treatment options in cellular and molecular targeted therapies, the place of allogeneic transplantation in therapy concepts must be reviewed. Most aspects of hematopoietic cell transplantation are well standardized by national guidelines or laws as well as by certification labels such as FACT-JACIE. However, the requirements for the construction and layout of a unit treating patients during the acute phase of the transplantation procedure or at readmission for different complications are not well defined. In addition, the infrastructure of such a unit may be decisive for optimized care of these fragile patients. Here we describe the process of planning a transplant unit in order to open a discussion that could lead to more precise guidelines in the field of infrastructural requirements for hospitals caring for people with severe immunosuppression., (Copyright © 2017. Published by Elsevier Masson SAS.)

Objective: This case study explores the influence of the healthcare design studio experience on students' short-term professional goals as measured through rates of healthcare-related certification and internship/employment., Background: The value and relevance of interior design is evident in the healthcare design sector. However, interior design students may not perceive this value if it is not communicated through their design education. Students' experience in the design studio plays a crucial role in determining career choices, and students may be more committed to career goals when there is clear connection between major coursework and professional practice., Method: The authors compared healthcare-related certification and internship/employment levels between two student cohorts in a capstone undergraduate interior design healthcare design studio course. The first cohort was led by the existing curriculum. The second cohort was led by the revised curriculum that specifically aimed at encouraging students to commit to healthcare-related design practice., Results: When measured at 3 months from graduation, the second cohort, led by the revised curriculum, saw a 30% increase in Evidence-based Design Accreditation and Certification exam pass rates and a 40% increase in healthcare-related internship/employment., Conclusion: The challenge of interior design education is to instill in emerging professionals not only professional competence but also those professional attitudes that will make them better prepared to design spaces that improve quality of life, particularly in healthcare environments. The results exceeded the project goals, and so this could be considered a promising practice for courses focused on healthcare design education.

The purpose of this study was to collect the perceptions of design professionals and clinicians regarding design process success strategies and elements of interprofessional engagement and communication during healthcare design and construction projects. Additional objectives were to gather best practices to maximize clinician engagement and provide tools and techniques to improve interdisciplinary collaboration for future projects. Strategies are needed to enhance the design and construction process and create interactions that benefit not only the project but the individuals working to see its completion. Meaningful interprofessional collaboration is essential to any healthcare design project and making sure the various players communicate is a critical element. This was a qualitative study conducted via an online survey. Respondents included architects, construction managers, interior designers, and healthcare personnel who had recently been involved in a building renovation or new construction project for a healthcare facility. Responses to open-ended questions were analyzed for themes, and descriptive statistics were used to provide insight into participant demographics. Information on the impressions, perceptions, and opportunities related to clinician involvement in design projects was collected from nurses, architects, interior designers, and construction managers. Qualitative analysis revealed themes of clinician input, organizational dynamics, and a variety of communication strategies to be the most frequently mentioned elements of successful interprofessional collaboration. This study validates the need to include clinician input in the design process, to consider the importance of organizational dynamics on design team functioning, and to incorporate effective communication strategies during design and construction projects.

Mall walking has been a popular physical activity for decades. However, little is known about why mall managers support these programs or why adults choose to walk. Our study aim was to describe mall walking programs from the perspectives of walkers, managers, and leaders. Twenty-eight walkers, 16 walking program managers, and six walking program leaders from five states participated in a telephone or in-person semi-structured interview (N = 50). Interview guides were developed using a social-ecological model. Interviews were recorded, transcribed verbatim, and analyzed thematically. All informants indicated satisfaction with their program and environmental features. Differences in expectations were noted in that walkers wanted a safe, clean, and social place whereas managers and leaders felt a need to provide programmatic features. Given the favorable walking environments in malls, there is an opportunity for public health professionals, health care organizations, and providers of aging services to partner with malls to promote walking.

The layout of the structures according to the noise source is an important parameter in terms of the level of noise reaching to both open usage areas and the structure surfaces. In this paper, it is aimed to reveal the effect of mass housing settlement type on the size of suitable open usage areas in terms of noise. Comfortable open usage areas in 25 mass housing alternatives are determined for the case of being affected by three different road noises. The reliability of the simulation results is validated by on-site noise level measurements. As a result, it is seen that better results are obtained in linear, L, C, and U type alternatives than point-type blocks. Especially in alternatives consisting of point-and linear-type blocks, if the noise level is above 75 Leq (dBA), the percentage of comfortable open usage areas is very low. It is determined that the percentage of comfortable open areas increases between 50 and 100% by means of appropriately designed noise barriers.

This study determines the magnitude of the market signaling effect arising from Leadership in Energy and Environmental Design certification for green buildings and explores the mechanisms behind the signaling effect. Previous studies have shown that signaling or marketability plays an important role in the pursuit for Leadership in Energy and Environmental Design and equivalent green-building certification. By analyzing all new construction projects receiving Leadership in Energy and Environmental Design certification from 2000 to 2012 in the US, this study estimates the relative importance of 'green' signaling. This broad perspective using project-level data enables an analysis of some drivers of signaling and the pursuit of marketing benefits. The roles of local competition and market conditions, as well as municipal regulations are examined, especially as they differ between types of building owners (e.g., for-profit firms, governments, nonprofits). The results indicate that the non-building performance value-value captured by Leadership in Energy and Environmental Design signals above and beyond the specific building attributes that Leadership in Energy and Environmental Design certifies-dominates the attainment of Leadership in Energy and Environmental Design scores around certification tier thresholds. Further, strong evidence of spatial clustering of this non-building performance value for some owner types indicates that for-profit owners may be more responsive to local competition than non-profit owners. Local legislative mandates predict greater signaling intensity by government-owned buildings, as expected, but for-profit-owned projects tend to signal less, even after controls for local conditions. The results highlight the importance of local conditions, including peer effects and regulations, in driving non-building performance values across a wide range of green buildings.

Objectives: The aim of this study was to assess the implementation of partitioning and the negative pressure method in limiting the dispersion of dust to areas adjacent to renovation sites., Methods: The pressure difference between the worksites and adjacent areas and PM10 concentrations in the both zones were measured in 12 renovation sites, and the factors affecting the prevention of dispersion of dust were assessed., Results: Poor implementation of partitioning and negative pressurization found in half of the renovation sites lead difficulties in achieving a proper negative pressure, causing dispersion of dust into adjacent areas. Main problems related to flimsy partitioning walls and poor air tightness of the enclosure. Dust concentrations in adjacent areas were substantially lower when natural ventilation in the renovation site was rejected and partitioning walls and their junctions to existing structures were sealed. In case of leaky enclosures, despite the high air exchange rates, a definite negative pressure could not be maintained. Instead, negative pressure minimum of -5 Pa was found to be sufficient for limiting the dispersion of dust from renovation sites., Conclusions: Improvement on implementation of dust controls is required through revising the guidance documents, education, and efficient supervision. This study revealed that the current Finnish practice to implement the negative pressurization based on the air exchange rate achieved with the portable exhaust fans alone is not reasonable to assure adequate dust containment. Continuous negative pressure minimum of -5 Pa is suggested, and it should be monitored with alarm devices throughout the renovation processes., (© The Author 2017. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)