Indigenous Ecohumanist Architecture for Health in Canada's Far North.

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.

Safe and Supportive Neurorehabilitation Environments: Results of a Structured Observation of Physical Features Across Two Rehabilitation Facilities.

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.

Hyperbaric oxygen therapy for intensive care patients: position statement by the European Committee for Hyperbaric Medicine.

Many of the accepted indications for hyperbaric oxygen treatment (HBOT) may occur in critically ill patients. HBOT itself may cause a number of physiological changes which may further compromise the patient's state. Guidelines on the management of critically ill patients in a hyperbaric facility have been founded on the conclusions of the 2007 European Committee for Hyperbaric Medicine (ECHM) meeting. With regard to patient management, HBOT should be included in the overall care of ICU patients only after a risk/benefit assessment related to the specifics of both the hyperbaric centre and the patient's clinical condition and should not delay or interrupt their overall management. Neither patient monitoring nor treatment should be altered or stopped due to HBOT, and any HBOT effects must be strictly evaluated and appropriately mitigated. With regard to the hyperbaric facility itself, the hyperbaric chamber should be specifically designed for ICU patients and should be fully equipped to allow continuation of patient monitoring and treatment. The hyperbaric chamber ideally should be located in, or around the immediate vicinity of the ICU, and be run by a sufficiently large and well-trained team of physicians, nurses, chamber operators and technicians. All devices to be introduced into the chamber should be evaluated, tested and acknowledged as safe for use in a hyperbaric environment and all procedures (standard and emergency) should be tested and written before being implemented.

Hyperbaric intensive care technology and equipment.

In an emergency, life support can be provided during recompression or hyperbaric oxygen therapy using very basic equipment, provided the equipment is hyperbaric-compatible and the clinicians have appropriate experience. For hyperbaric critical care to be provided safely on a routine basis, however, a great deal of preparation and specific equipment is needed, and relatively few facilities have optimal capabilities at present. The type, size and location of the chamber are very influential factors. Although monoplace chamber critical care is possible, it involves special adaptations and inherent limitations that make it inappropriate for all but specifically experienced teams. A large, purpose-designed chamber co-located with an intensive care unit is ideal. Keeping the critically ill patient on their normal bed significantly improves quality of care where this is possible. The latest hyperbaric ventilators have resolved many of the issues normally associated with hyperbaric ventilation, but at significant cost. Multi-parameter monitoring is relatively simple with advanced portable monitors, or preferably installed units that are of the same type as used elsewhere in the hospital. Whilst end-tidal CO2 readings are changed by pressure and require interpretation, most other parameters display normally. All normal infusions can be continued, with several examples of syringe drivers and infusion pumps shown to function essentially normally at pressure. Techniques exist for continuous suction drainage and most other aspects of standard critical care. At present, the most complex life support technologies such as haemofiltration, cardiac assist devices and extra-corporeal membrane oxygenation remain incompatible with the hyperbaric environment.

A pro/con review comparing the use of mono- and multiplace hyperbaric chambers for critical care.

Hyperbaric oxygen treatment (HBOT) of critically ill patients requires special technology and appropriately trained medical team staffing for '24/7' emergency services. Regardless of the chamber system used it is essential that the attending nurse and critical care specialist understand the physics and physiology of hyperbaric oxygen for safe treatment and compression/decompression procedures. Mechanical ventilation through endotracheal tube or tracheotomy is hampered by the increased gas density and flow resistance with risks of hypoventilation, carbon dioxide retention and oxygen seizures. Ventilation should be controlled and arterial and end-tidal carbon dioxide levels monitored. Haemodynamically unstable patients require careful risk-benefit evaluation, invasive monitoring and close supervision of inotropes, vasopressors and sedative drug infusions to avoid blood pressure swings and risk of awareness. Two distinctly different chambers are used for critical care. Small cost-efficient and easy-to-install acrylic monoplace chambers require less staffing and no inside attendant. Major disadvantages include patient isolation with difficulties to maintain standard organ support and invasive monitoring. Monoplace ventilators are less advanced and require the use of muscle relaxants and excessive sedation. Intravenous lines must be changed to specially designed IV pumps located outside the chamber with chamber pass-through and risk of inaccurate drug delivery. The multiplace chamber is better suited for HBOT of critically ill patients with failing vital functions and organ systems, primarily because it permits appropriate ICU equipment to be used inside the chamber by accompanying staff. Normal 'hands-on' intensive care continues during HBOT with close attention to all aspects of critical patient care. A regional trauma hospital-based rectangular chamber system immediately bordering critical care and emergency ward facilities is the best solution for safe HBOT in the critically ill. Disadvantages include long-term commitment, larger space requirements and higher capitalization, technical and staffing costs.

A case study of ISO 11064 in control centre design in the Norwegian petroleum industry.

In 2006-2008 we performed a case study for the purpose of assessing the industrial application of the seven part Control Centre (CC) design standard ISO 11064 to identify positive and negative experiences among stakeholders in the Norwegian petroleum sector. We mainly focussed on ISO 11064 Part 1, because this was the most commonly used among the identified stakeholders. ISO 11064 is generally appreciated and applied in the industry, but we did observe a significant variance in use between the different parts of the standard. We also identified potential areas for improvements, like scope and application adaptation. Thus we suggest a more goal-based approach based on one normative part only.

Subjective assessment of listening environments in university classrooms: perceptions of students.

A questionnaire is developed to evaluate perception of the listening environment by university students. The objectives were to develop a questionnaire-based measurement tool, derive a measure of perceived classroom-listening quality, use the questionnaire to investigate factors that enhance, impair, or do not affect perceived listening quality, and consider the implications for classroom design. The questionnaire was administered to over 5700 students in 30 classrooms at one university. Physical and acoustical measurements were also performed in each classroom. The questionnaire included items that recorded aspects of student perception, as well as individual, course-, and instructor-specific factors. Responses to 19 perception items generated a perception of listening ease (PLE) score for each student and a classroom-average score. Decreased PLE was associated with women, English-second-larguage students, those with hearing impairment, students not interested in the course material, and those who found the material difficult. Increased PLE was associated with higher speech transmission index, acceptable lighting, temperature and seating, better instructor voice, increased visual-aid use, and easier course material. Results indicate that PLE is a useful measure of student perception of the classroom-listening environment, and that optimal classroom acoustical design must take into consideration "in-use" conditions, as well as classroom physical characteristics.

[Health requirements of sauna facilities in East Germany]. / Hygieneanforderungen an Saunaanlagen in der DDR.

There was a considerable increase in sauna attendance in the GDR in recent years. For excluding the risk of an infection transfer when attenting the sauna it is necessary to pay particular hygienic attention to this special type of sports and recreational facilities. The special hygienic requirements to the staff and sauna users are explained. The tasks and responsibilities of the state sanitary inspection when opening and controlling public saunas are described.

A review of the development of an ergonomically balanced chair.

Chiropractors are constantly exposed to patients with back problems partially related to prolonged periods of sitting. It has been recognized that people who spend much of their work day in a sitting position are more prone to back problems than those who alter their position throughout the day. A properly constructed chair, anthropometrically designed, is of great benefit for those whose working posture is in a sitting position. Numbers of biomechanical engineers, orthopedists, physiologists, and physical anthropologists have studied this problem. Their findings and conclusions are reviewed in this paper. May this open the door to those biomechanical specialists in the chiropractic profession to further investigate the problem and add to the existing knowledge and literature on the subject.