Evidence-based practice guidelines for prescribing home modifications for clients with bariatric care needs.

BACKGROUND/AIM: Home modifications maintain people's functional independence and safety. No literature exists to guide the prescription of home modifications for clients with bariatric care needs. With Australia's increasing obesity rate, more evidence is needed to support home modification prescribers. This study aimed to map Australian home modification prescribing practices for clients with bariatric care needs and to establish and evaluate a clinical resource for this prescription process. METHODS: The study included two phases. Phase 1 conducted a cross-sectional survey of therapists practicing in Australia, and Australian industry partners who prescribe or install home modifications for clients with bariatric care needs. Phase 2 included design, implementation and evaluation of a clinical resource. Data were analysed with means and frequencies; multivariable regression analysis was used to explore prescribing habits. RESULTS: Therapists surveyed (n = 347) reported 11 different bariatric weight definitions. Less than 3% constantly or regularly prescribed home modifications for these clients; rails were most commonly prescribed. Many therapists (n = 171, 58%) 'never' or 'rarely' knew rail load capacity. Therapists' knowledge of rail load capacity was associated with previous experience prescribing home modifications (P = 0.009); rail manufacturer's advice (P = 0.016) and not using advice from builders (P = 0.001). Clinical resources were used by 11% (n = 26) of therapists to support their prescription, and industry sporadically relied on therapists to specify modification design requirements (n = 5, 45%). Post-implementation of a clinical resource increased consensus regarding understanding of the term bariatric and increased consultation with builders and manufacturers. CONCLUSION: There was a lack of consistency in bariatric terminology, uncertainty of rail load capacities and minimal use of clinical practice guidelines. Additional resources will assist with consistency in prescribing practices to maximise occupational performance for clients with bariatric care needs.

Feng shui And Emotional Response in the Critical care Environment (FARCE) study.

The aim of this study was to investigate the relationship between nursing staff emotions and their surrounding environment, using the ancient system of feng shui. Two orientations of critical care bed spaces (wind and water groups, respectively) were mapped using a western bagua. Energy or 'chi' scores for nine emotions were calculated based on the positive or negative flow of chi in each of the two groups. During a two-week period, nursing staff were allocated to work in a bed space in either the wind or water groups; nursing staff who were not allocated to a study bed space acted as a control group. Participating nursing staff completed a questionnaire, ranking nine emotional states and their overall inner harmony, using a 11-point chi scale. In total, 108 questionnaires were completed. Critical bed space orientation according to feng shui principles was not related to nurse-reported chi scores or inner harmony (p > 0.05 for all measurements). There was also poor correlation between the bagua-predicted and reported chi scores for both the wind and water groups (R2  = 0.338 and 0.093, respectively). The use of feng shui to guide the layout of critical care bed spaces does not improve the emotional well-being of nursing staff.

Wellbeing-enhancing occupation and organizational and environmental contributors in long-term dementia care facilities: an explorative study.

BACKGROUND: Occupation remains an unmet need in long-term dementia care. To increase residents' occupation, knowledge of types of occupation related to wellbeing, and organizational and environmental characteristics encouraging involvement in these types of occupation, is indispensable. METHODS: In this explorative study, Dementia Care Mapping was used to study involvement in different types of occupation and wellbeing among 57 residents of 10 dementia care facilities. For each type of occupation, mean experienced wellbeing was studied. Occupation types with high mean wellbeing scores were classified as "wellbeing-enhancing occupation." Care facilities were ranked according to the mean time residents spent in types of wellbeing-enhancing occupation. Using information on staff-to-resident ratio, individual space, and items of the Physical Environment Evaluation Component of Dementia Care Mapping, organizational and environmental characteristics of the facilities were compared to study their relationship with wellbeing-enhancing occupation. RESULTS: Reminiscence, leisure, expression, and vocational occupation had greatest potential to enhance wellbeing, but these types were seldom offered. Much variation existed in the extent to which wellbeing-enhancing occupation was provided. Long-term care facilities that did so more frequently generally had a more homelike atmosphere, supported social interaction through the environment, and had no central activity program. CONCLUSIONS: This study suggests that it is possible to engage residents in wellbeing-enhancing occupation, within current means of budget and staff. The physical environment and care organization might play a role, but the key factor seems to equip staff with skills to integrate wellbeing-enhancing occupation into care practice.

Integrating energy and environmental management in wood furniture industry.

As energy costs continue to rise, industrial plants (even those of energy nonintensive industries such as furniture industry) need effective way to reduce the amount of energy they consume. Besides, there are a number of economic and environmental reasons why a company should consider environmental management initiatives. This paper provides a detailed guideline for implementing joint energy and environmental management system in wood furniture industrial company. It covers in detail all essential aspects of the system: initial system assessment, organization, policy development, energy and environmental auditing, action plan development, system promotion, checking system performance, and management review.

Critical thinking: optimal outcomes through end user involvement in the design of critical care areas.

Including end users in evidence-based design is vital to outcomes. The physical environment impacts caregiver efficiencies, safety, satisfaction, and quality of patient outcomes. End users are more than members of the organization: patients should have representation as well. Patients bring value by offering insight from a different perspective. Timing is key; therefore, it is critical in obtaining desired outcomes, to include end users as early as possible, gaining the most insight into the design of the build. Consideration should also be given to best practice standards, regulatory compliance, progressive sciences, and technologies. Another vital factor is education of the end users on their role and expectations for participation in a design team. When end users are educated and understand the significance of input, the design team will be able to conceive a critical care unit that will meet needs for today and be able to adapt to needs for the future.

Relational sustainability: environments for long-term critical care patients.

Patients undergoing bone marrow transplant, using spinal cord services, and with traumatic brain injury represent a relatively new patient type, requiring both intense care and long-term care in the same facility. As medical advances allow these patients the opportunity to recover from their critical illnesses or injuries, designers and caregivers must give increased attention to the long-term critical care environment. Designing for this type of care requires an understanding of new technologies and the potential for the built environment to address the wide range of physical, sensory, and psychological issues long-term inpatients face. Recent work by SmithGroupJJR has provided valuable insights into the ways in which lighting, patient room and unit layouts, spatial volumes, and other design elements can contribute to the recovery of patients who must spend weeks or months in a critical care environment. This knowledge was gained through an approach that allows design professionals to immerse themselves in a health care institution's values, culture, and work processes. By mapping both operational flow and patients' experiences, project teams can develop design solutions that sustain the well-being of higher-acuity patients and their family members and caregivers.

Design for safety in the critical care environment: an evidence-based approach: considering the caregiver-patient-family experiences.

Research supporting the impact of the built environment, while still in its infancy, has exerted strong influence on design teams as they seek solutions to maximize operational efficiency, address the reduction of errors, and create environments that are supportive for patients, families, and staff. This article will explore various solutions to addressing the most impactful issues from each perspective and will compare solutions against measures of effectiveness.

Earthquake in Turkey: The Triangle of Life and Disaster Kits Saves Lives.

OBJECTIVE: Precautions taken before an earthquake are of vital importance. When buildings collapse, the weight of the ceiling crushes objects such as furniture, leaving a space or void within the rubble. This area is called the "triangle of life." The larger and stronger the object, the more it will maintain its volume; the more the object maintains its volume, the larger the void will be, and the less likely it is that the person who uses this void will be injured. METHODS: Durable, solid furniture such as beds and tables that can be tipped over during an earthquake in appropriate areas in the building can form a living triangle. Creating and using the triangle of life is the method of protection in an earthquake that produces the highest probability of survival. RESULTS: Two earthquakes with magnitudes of 7.8 and 7.5 occurred in Kahramanmaras, Turkey, on February 6, 2023. This report presents the case of a 43-y-old female victim of these earthquakes who used the triangle of life to survive; she was removed from the rubble 164 h after the earthquake. CONCLUSIONS: The case provides evidence that predetermining areas in which the triangle of life can be formed and storing supplies necessary for survival can decrease morbidity and mortality in an earthquake.

Designing for competence: spaces that enhance collaboration readiness in healthcare.

Many universities in the United States are investing in classrooms and campuses designed to increase collaboration and teamwork among the health professions. To date, we know little about whether these learning spaces are having the intended impact on student performance. Recent advances in the identification of interprofessional teamwork competencies provide a much-needed step toward a defined outcome metric. Rigorous study of the relationship between design and student competence in collaboration also requires clear specification of design concepts and development of testable frameworks. Such theory-based evaluation is crucial for design to become an integral part of interprofessional education strategies and initiatives. Current classroom and campus designs were analyzed for common themes and features in collaborative spaces as a starting place for specification of design concepts and model development. Four major themes were identified: flexibility, visual transparency/proximity, technology and environmental infrastructure. Potential models linking this preliminary set of design concepts to student competencies are proposed and used to generate hypotheses for future study of the impact of collaborative design spaces on student outcomes.

Prevalence of dry methods in granite countertop fabrication in Oklahoma.

Granite countertop fabricators are at risk of exposure to respirable crystalline silica, which may cause silicosis and other lung conditions. The purpose of this study was to estimate the prevalence of exposure control methods, especially wet methods, in granite countertop fabrication in Oklahoma to assess how many workers might be at risk of overexposure to crystalline silica in this industry. Granite fabrication shops in the three largest metropolitan areas in Oklahoma were enumerated, and 47 of the 52 shops participated in a survey on fabrication methods. Countertop shops were small businesses with average work forces of fewer than 10 employees. Ten shops (21%) reported using exclusively wet methods during all fabrication steps. Thirty-five shops (74%) employing a total of about 200 workers reported using dry methods all or most of the time in at least one fabrication step. The tasks most often performed dry were edge profiling (17% of shops), cutting of grooves for reinforcing rods (62% of shops), and cutting of sink openings (45% of shops). All shops reported providing either half-face or full-face respirators for use during fabrication, but none reported doing respirator fit testing. Few shops reported using any kind of dust collection system. These findings suggest that current consumer demand for granite countertops is giving rise to a new wave of workers at risk of silicosis due to potential overexposure to granite dust.

Ergonomics in healthcare facility design, part 2: support areas.

There are many factors to consider during design including a balance between patient-centered features and ergonomic considerations that can prevent workplace injuries. This facility design department aims to expand nurse leaders' knowledge and competencies in health facility design and enables them to take leadership roles in design efforts. Part 1 in this 2-part series focused on ergonomic designs for patient care areas to enhance patient and nurse safety. The focus of part 2 is ergonomic designs for nursing stations and support areas that can prevent worker injury.

Ergonomics in healthcare facility design, part 1: patient care areas.

There are many ergonomic considerations during design that can enhance nurse and other provider safety in the built healthcare environment. This facility design department aims to expand nurse leaders' knowledge and competencies in health facility design and enables them to take leadership roles in design efforts. Part 1 in this 2-part series focuses on ergonomic designs for patient care areas to enhance patient and nurse safety. Part 2 discusses ergonomic designs for centralized and decentralized nursing stations.

Can modifications to the bedroom environment improve the sleep of new parents? Two randomized controlled trials.

Postpartum sleep disruption is common among new parents. In this randomized controlled trial we evaluated a modified sleep hygiene intervention for new parents (infant proximity, noise masking, and dim lighting) in anticipation of night-time infant care. Two samples of new mothers (n = 118 and 122) were randomized to the experimental intervention or attention control, and sleep was assessed in late pregnancy and first 3 months postpartum using actigraphy and the General Sleep Disturbance Scale. The sleep hygiene strategies evaluated did not benefit the more socioeconomically advantaged women or their partners in Sample 1, but did improve postpartum sleep among the less advantaged women of Sample 2. Simple changes to the bedroom environment can improve sleep for new mothers with few resources.

Magnetic fields of green.

By incorporating even the basic elements of a more environmentally friendly, "green"construction and design in an MRI setting can create a safer, more pleasant space for the patients and staff, better images, and operational cost savings. Using building systems that have reduced amounts of steel can decrease construction time, increase thermal insulation, and reduce the weight of the structure meaning less energy required to transport and install. HVAC systems and lighting design can also play a major role in creating a "green"MRI suite. LEED certification places a focus on quality of the built environment, life cycle cost, and a productive indoor environment, as well as impact on the exterior environment. An LEED certified building considers costs and benefits for the lifetime of the building.

Improved privacy preserving method for periodical SRS publishing.

Spontaneous reporting systems (SRSs) are used to collect adverse drug events (ADEs) for their evaluation and analysis. Periodical SRS data publication gives rise to a problem where sensitive, private data can be discovered through various attacks. The existing SRS data publishing methods are vulnerable to Medicine Discontinuation Attack(MD-attack) and Substantial symptoms-attack(SS-attack). To remedy this problem, an improved periodical SRS data publishing-PPMS(k, θ, ɑ)-bounding is proposed. This new method can recognize MD-attack by ensuring that each equivalence group contains at least k new medicine discontinuation records. The SS-attack can be thwarted using a heuristic algorithm. Theoretical analysis indicates that PPMS(k, θ, ɑ)-bounding can thwart the above-mentioned attacks. The experimental results also demonstrate that PPMS(k, θ, ɑ)-bounding can provide much better protection for privacy than the existing method and the new method dose not increase the information loss. PPMS(k, θ, ɑ)-bounding can improve the privacy, guaranteeing the information usability of the released tables.

Production planning of a furniture manufacturing company with random demand and production capacity using stochastic programming.

In this article two multi-stage stochastic linear programming models are developed, one applying the stochastic programming solver integrated by Lingo 17.0 optimization software that utilizes an approximation using an identical conditional sampling and Latin-hyper-square techniques to reduce the sample variance, associating the probability distributions to normal distributions with defined mean and standard deviation; and a second proposed model with a discrete distribution with 3 values and their respective probabilities of occurrence. In both cases, a scenario tree is generated. The models developed are applied to an aggregate production plan (APP) for a furniture manufacturing company located in the state of Hidalgo, Mexico, which has important clients throughout the country. Production capacity and demand are defined as random variables of the model. The main purpose of this research is to determine a feasible solution to the aggregate production plan in a reasonable computational time. The developed models were compared and analyzed. Moreover, this work was complemented with a sensitivity analysis; varying the percentage of service level, also, varying the stochastic parameters (mean and standard deviation) to test how these variations impact in the solution and decision variables.

Effect of two different house screening interventions on exposure to malaria vectors and on anaemia in children in The Gambia: a randomised controlled trial.

BACKGROUND: House screening should protect people against malaria. We assessed whether two types of house screening--full screening of windows, doors, and closing eaves, or installation of screened ceilings--could reduce house entry of malaria vectors and frequency of anaemia in children in an area of seasonal malaria transmission. METHODS: During 2006 and 2007, 500 occupied houses in and near Farafenni town in The Gambia, an area with low use of insecticide-treated bednets, were randomly assigned to receive full screening, screened ceilings, or no screening (control). Randomisation was done by computer-generated list, in permuted blocks of five houses in the ratio 2:2:1. Screening was not treated with insecticide. Exposure to mosquitoes indoors was assessed by fortnightly light trap collections during the transmission season. Primary endpoints included the number of female Anopheles gambiae sensu lato mosquitoes collected per trap per night. Secondary endpoints included frequency of anaemia (haemoglobin concentration <80 g/L) and parasitaemia at the end of the transmission season in children (aged 6 months to 10 years) who were living in the study houses. Analysis was by modified intention to treat (ITT), including all randomised houses for which there were some outcome data and all children from those houses who were sampled for haemoglobin and parasitaemia. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN51184253. FINDINGS: 462 houses were included in the modified ITT analysis (full screening, n=188; screened ceilings, n=178; control, n=96). The mean number of A gambiae caught in houses without screening was 37.5 per trap per night (95% CI 31.6-43.3), compared with 15.2 (12.9-17.4) in houses with full screening (ratio of means 0.41, 95% CI 0.31-0.54; p<0.0001) and 19.1 (16.1-22.1) in houses with screened ceilings (ratio 0.53, 0.40-0.70; p<0.0001). 755 children completed the study, of whom 731 had complete clinical and covariate data and were used in the analysis of clinical outcomes. 30 (19%) of 158 children from control houses had anaemia, compared with 38 (12%) of 309 from houses with full screening (adjusted odds ratio [OR] 0.53, 95% CI 0.29-0.97; p=0.04), and 31 (12%) of 264 from houses with screened ceilings (OR 0.51, 0.27-0.96; p=0.04). Frequency of parasitaemia did not differ between intervention and control groups. INTERPRETATION: House screening substantially reduced the number of mosquitoes inside houses and could contribute to prevention of anaemia in children. FUNDING: Medical Research Council.

Objective and subjective evaluation of a redesigned corridor environment in a psychiatric hospital.

This study examined the impact of redesigning a corridor space within a psychiatric hospital on the behaviour of patients with dementia. In addition, patient and staff perceptions of the redesigned corridor were assessed. Data were collected through an observational tool (behavioural mapping) and a specifically design questionnaire. The findings suggest a positive impact of the redesigned corridor on patient behaviour and that patients and staff perceived the change to the environment differentially. These results are discussed in relation to theoretical explanations of the importance of the health care environment and design for dementia.