Effects of virtual reality v. biophilic environments on pain and distress in oncology patients: a case-crossover pilot study.

This pilot study aimed to determine if a biophilic Green Therapy or Virtual Reality environment can decrease an oncology patient's pain and distress while receiving chemotherapy. A case-crossover pilot study was conducted in a comprehensive cancer infusion center. 33 participants with breast, gynecologic, gastrointestinal, pancreatic and prostate cancers were all included in three rooms in a random order at different cycles: control room, Green Therapy room, and Virtual Reality room to receive chemotherapy, respectively. Participants' pain, distress, heart rate, blood pressure, and saliva cortisol were measured before and after infusion in each room. No statistical significance differences were shown in the changes of heart rate, systolic, or diastolic blood pressure, saliva cortisol, pain, or distress before and after infusion between the control, Green Therapy, and Virtual Reality rooms. However, more patients reported the experience as "fun" and "enjoyable" when they were in Green Therapy or Virtual reality room as compared to in the control room. Additionally, since participating in the study, 14 patients reported spending at least 30 min or more outside in nature. In this study, we found that patients' heart rate, blood pressure, and self-reported distress levels were reduced after each biophilic intervention although results are not statistically significant. The study also suggested that biophilic interventions are safe and feasible and may complement the standard of care for oncology patients.

Neurophysiology goes wild: from exploring sensory coding in sound proof rooms to natural environments.

To perform adaptive behaviours, animals have to establish a representation of the physical "outside" world. How these representations are created by sensory systems is a central issue in sensory physiology. This review addresses the history of experimental approaches toward ideas about sensory coding, using the relatively simple auditory system of acoustic insects. I will discuss the empirical evidence in support of Barlow's "efficient coding hypothesis", which argues that the coding properties of neurons undergo specific adaptations that allow insects to detect biologically important acoustic stimuli. This hypothesis opposes the view that the sensory systems of receivers are biased as a result of their phylogeny, which finally determine whether a sound stimulus elicits a behavioural response. Acoustic signals are often transmitted over considerable distances in complex physical environments with high noise levels, resulting in degradation of the temporal pattern of stimuli, unpredictable attenuation, reduced signal-to-noise levels, and degradation of cues used for sound localisation. Thus, a more naturalistic view of sensory coding must be taken, since the signals as broadcast by signallers are rarely equivalent to the effective stimuli encoded by the sensory system of receivers. The consequences of the environmental conditions for sensory coding are discussed.

Managing COVID-19 in a Novel, Rapidly Deployable Community Isolation Quarantine Facility.

Singapore is one of the most densely populated small island-states in the world. During the coronavirus disease 2019 (COVID-19) pandemic, Singapore implemented large-scale institutional isolation units called Community Care Facilities (CCFs) to combat the outbreak in the community by housing low-risk COVID-19 patients from April to August 2020. The CCFs were created rapidly by converting existing public spaces and used a protocolized system, augmented by telemedicine to enable a low health care worker-patient ratio (98 health care workers for 3200 beds), to operate these unique facilities. In the first month, a total of 3758 patients were admitted to 4 halls, 4929 in-house medical consults occurred, 136 patients were transferred to a hospital, 1 patient died 2 weeks after discharge, and no health care workers became infected. This article shares the authors' experience in operating these massive-scale isolation facilities while prioritizing safety for all and ensuring holistic patient care in the face of a public health crisis and lean health care resources.

Observational study of anaesthesia workflow to evaluate physical workspace design and layout.

BACKGROUND: The safety and efficiency of anaesthesia care depend on the design of the physical workspace. However, little is known about the influence that workspace design has on the ability to perform complex operating theatre (OT) work. The aim of this study was to observe the relationship between task switching and physical layout, and then use the data collected to design and assess different anaesthesia workspace layouts. METHODS: In this observational study, six videos of anaesthesia providers were analysed from a single centre in the United States. A task analysis of workflow during the maintenance phase of anaesthesia was performed by categorising tasks. The data supported evaluations of alternative workspace designs. RESULTS: An anaesthesia provider's time was occupied primarily by three tasks: patient (mean: 30.0% of total maintenance duration), electronic medical record (26.6%), and visual display tasks (18.6%). The mean time between task switches was 6.39 s. With the current workspace layout, the anaesthesia provider was centred toward the patient for approximately half of the maintenance duration. Evaluating the alternative layout designs showed how equipment arrangements could improve task switching and increase the provider's focus towards the patient and visual displays. CONCLUSIONS: Our study showed that current operating theatre layouts do not fit work demands. We report a simple method that facilitates a quick layout design assessment and showed that the anaesthesia workspace can be improved to better suit workflow and patient care. Overall, this arrangement could reduce anaesthesia workload while improving task flow efficiency and potentially the safety of care.

Nursing Home Design and COVID-19: Balancing Infection Control, Quality of Life, and Resilience.

Many nursing home design models can have a negative impact on older people and these flaws have been compounded by Coronavirus Disease 2019 and related infection control failures. This article proposes that there is now an urgent need to examine these architectural design models and provide alternative and holistic models that balance infection control and quality of life at multiple spatial scales in existing and proposed settings. Moreover, this article argues that there is a convergence on many fronts between these issues and that certain design models and approaches that improve quality of life, will also benefit infection control, support greater resilience, and in turn improve overall pandemic preparedness.

Radiation Oncology in Oman: Current Status and Future Challenges.

Oman is a high-income Middle Eastern country. Over the past 50 years, the country's health care system has undergone revolutionary changes to meet the health care needs of its population, driven by high oil and gas revenues. It currently has a very efficient universal health care system. There are 2 linear accelerators in the country and 6 radiation oncologists. A new cancer research center is currently under construction. The major challenge that could affect the delivery of radiation therapy in the future is sustenance of the health care achievements in view of a growing population and the reliance on public funding for health care delivery.

VOJNA LJECILISTA NA KVARNERU U AUSTRO-UGARSKOJ MONARHIJI I BRIGA ZA UNAPREDENJE CASNICKOG ZDRAVLJA / [Military Health Resorts in Kvarner in the Austro-Hungarian Monarchy and Care for Improving Officer Health]

The health of officers (as well as the entire army) is exposed to additional risks due to the performance of various life-threatening tasks for the needs of the state. Therefore, it is not unusual for the state to take care of the health of its officers (as well as the army) through a system of Vojvodina medical care or specialised society through the construction of military or officer health resorts [Militärkurhaus / Offizierskurhaus] with the provision of medical/ health services. The subject of this paper is the relationship between architecture and the provision of military-medical services of officer/military health resorts built by the Society of the White Cross [Gesellschaft vom Weißen Kreuze] in Kvarner at the end of the 19th and the beginning of the 20th century. The research is based on data collected from Austrian architectural, medical and tourist magazines and yearbooks of Austrian Society of the White Cross. The results of the research contribute to a better understanding of the improvement of the health of officers, the development of the architecture of health buildings [Kurhaus] and the entire history of medicine and health tourism in the Croatian Adriatic.

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.

Therapeutic effect of high-flow nasal cannula on severe COVID-19 patients in a makeshift intensive-care unit: A case report.

INTRODUCTION: Several intensive-care units (ICUs) in Wuhan are nonstandard wards that were repurposed from general wards. Considering the shortage of medical resources and the need to prevent nosocomic infection, the respiratory-treatment strategy in these nonstandard ICUs is different from those in general wards and standard ICUs. High-flow nasal cannula (HFNC) plays an important role in nonstandard ICUs and is beneficial to the patients therein. PATIENT CONCERNS: In this study, we analyzed four cases of HFNC-treated patients with severe coronavirus disease 2019 (COVID-19) in a makeshift ICU and summarized our experience. DIAGNOSES: Four patients diagnosed with COVID-19 according to World Health Organization (WHO) interim guidance were admitted to the makeshift ICU. INTERVENTIONS: All patients had oxygen treatment with HFNC, as well as regular treatment of antivirals and traditional Chinese medicine. OUTCOMES: Two patients survived after treatment, while the other two died from acute respiratory distress syndrome (ARDS) and heart failure, respectively. CONCLUSION: Patients with severe and critical COVID-19 often have poor prognoses after mechanical ventilation, exhibiting corresponding complications such as ventilator-associated pneumonia and deep-vein thrombosis, which significantly prolongs length of stay in the ICU. HFNC could prevent intubation in some patients, thereby avoiding the above complications; however, this needs confirmation in further clinical studies. This treatment reduced difficulty and workloads for healthcare professionals, had good tolerability for patients, might not significantly increase the risk of infection for healthcare professionals, and do not require additional preventive measures against nosocomic infection. HFNC treatment has its advantages in providing oxygen therapy in COVID-19, but healthcare professionals should still pay close attention to changes in patients' oxygenation rates and respiratory frequency.

Complex Cancer Surgery in the Outpatient Setting: The Josie Robertson Surgery Center.

Minimally invasive operative techniques and enhanced recovery after surgery (ERAS) protocols have transformed clinical practice and made it possible to perform increasingly complex oncologic procedures in the ambulatory setting, with recovery at home after a single overnight stay. Capitalizing on these changes, Memorial Sloan Kettering Cancer Center's Josie Robertson Surgery Center (JRSC), a freestanding ambulatory surgery facility, was established to provide both outpatient procedures and several surgeries that had previously been performed in the inpatient setting, newly transitioned to this ambulatory extended recovery (AXR) model. However, the JRSC core mission goes beyond rapid recovery, aiming to be an innovation center with a focus on superlative patient experience and engagement, efficiency, and data-driven continuous improvement. Here, we describe the JRSC genesis, design, care model, and outcome tracking and quality improvement efforts to provide an example of successful, patient-centered surgical care for select patients undergoing relatively complex procedures in an ambulatory setting.

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.

A Scoping Review of the Impact on Children of the Built Environment Design Characteristics of Healing Spaces.

AIM: This article elucidates current understanding in pediatric healthcare building design via scoping review of research on the impacts on the health and well-being of children of the architectural and landscape characteristics of healing spaces. BACKGROUND: Studies indicate that patients' phenomenological experiences of the built environment characteristics of healthcare buildings can impact their healing and well-being. It follows that understanding the healing effects of landscape and architecture can inform the design of healthcare settings for increased health benefits. METHOD: This method comprises five search stages: (1) research question is formed; (2) key words, search terms, and search strategy are identified; (3) databases are searched, and papers are assessed via inclusion and exclusion criteria; (4) information of the selected articles is extracted and summarized; and (5) key findings are interpreted and reported via comparative tabulation. RESULTS: One hundred seventy-three papers were found during the first search stage. After screening and evaluating for relevance and quality, 13 articles were selected for study. Analysis indicates that the built environment characteristics of pediatric healthcare environments that have healing benefits include access to nature, music, art and natural light, reduced crowding, reduced noise, and soft, cyclical, and user-controlled artificial lighting. CONCLUSIONS: While it is important to understand the design variables that influence pediatric healthcare, it is also necessary to contextualize them and to distinguish these variables from each other and appreciate their interaction. In other words, a more rounded understanding of these variables is required via research so that their individual and combined impacts are reflected in holistic design recommendations.

Nurses' Satisfaction With Patient Room Lighting Conditions: A Study of Nurses in Four Hospitals With Differences in the Environment of Care.

PURPOSE: The present study aims to contribute to current knowledge about nurses' perceived importance of lighting in patient rooms and to compare these perceptions across different ages, work shifts, (day and night), and environments of care (traditional and contemporary). BACKGROUND: Creating an environment of care in patient rooms that successfully balances energy efficiency concerns with the holistic needs of patients, families, and caregivers poses a major challenge for future lighting systems. This study adds to a growing evidence base on the effects of lighting on nurses' job performance, job satisfaction, and overall perceptions of the environment. METHOD: Survey responses from 138 participants working in medical-surgical units in four hospitals were analyzed using a mixed-methods approach, with three of the hospitals having lighting systems characterized as providing a traditional environment of care (TEC) and the other hospital having lighting systems characterized as providing a contemporary environment of care (CEC). RESULTS: No significant differences were found based on age or work shift, but several significant differences were found between participants working in the hospital with a CEC and those working in hospitals with a TEC. Participants from the hospital with a CEC lighting system consistently reported higher lighting quality, fewer patient complaints, and less need for supplemental lighting than the participants from the three hospitals with TEC lighting systems. CONCLUSION: The results of this study provide evidence that innovative lighting approaches and technologies are worth considering as an investment by hospital administrators looking to improve perceptions of the patient room environment.

Behavioral Health Integration in a Medicaid Accountable Care Organization: Management Lessons from a Health Center.

Behavioral health integration, including as used in Medicaid Accountable Care Organizations, can improve care and decrease costs. Our model strives to integrate fully its medical, behavioral health, and substance use disorder services into one primary care clinic. Merged management has decreased wait times, improved billing, and enabled several promising innovations.

Keeping our immigrants healthy: hygienist doctrine in the Hospedaria de Imigrantes da Ilha das Flores. / Como manter saudáveis nossos imigrantes: preceitos higienistas na constituição da Hospedaria de Imigrantes da Ilha das Flores.

The Hospedaria de Imigrantes (Immigrant Lodgings) da Ilha das Flores was established in 1883 in accordance with the hygienist thinking of the time. Immigrants were isolated on the east coast of Guanabara Bay because of the epidemics of yellow fever which returned to the Imperial capital every summer since 1849-1850. Hygienists attributed the disease to the precarious health conditions in the city of Rio de Janeiro, which enabled germs to multiply and infect the atmosphere. As physicians reinterpreted the disease in light of Pasteurian theory, new procedures were adopted to receive immigrants, changing the structure and function of the facility on Ilha das Flores.

A criação da Hospedaria de Imigrantes da Ilha das Flores, em 1883, esteve de acordo com os preceitos higienistas vigentes na época. O isolamento de imigrantes na costa leste da baía de Guanabara ocorreu em virtude das epidemias de febre amarela que retornavam à capital do Império todo verão, desde 1849-1850. Higienistas atribuíam a doença à precária condição sanitária da cidade do Rio de Janeiro, que propiciava a multiplicação do germe e infeccionava a atmosfera. Na medida em que os médicos reinterpretavam a doença à luz da teoria pasteuriana, foram sendo adotados novos procedimentos para a recepção de imigrantes, alterando a estrutura e o funcionamento da Hospedaria da Ilha das Flores.

Impact of room acoustic parameters on speech and music perception among participants with cochlear implants.

OBJECTIVES: Besides numerous other factors, listening experience with cochlear implants is substantially impaired by room acoustics. Even for persons without hearing impairment, the perception of auditory scenes, for example, concerning speech intelligibility, acoustic quality or audibility, is considerably influenced by room acoustics. For CI users, complex listening environments are usually associated with heavy losses. The aim of the present study was to determine room acoustic criteria that particularly influence speech pleasantness for CI users. DESIGN: Accordingly, speech material of the Oldenburg Sentence Test (Oldenburger Satztest, OLSA) as well as basic music material (major and minor triads) were auralized using the software Auratorium which allows auralization of simulated rooms. The constructed rooms for speech stimuli were based on the standard DIN 18041:2016-03 concerning acoustic quality in rooms, the binding standard referred to by room acoustic consultants in Germany, which also includes specifications for inclusive applications in schools. For the music perception tests, two typical concert halls of different sizes were modelled. The auralized test stimuli were unilaterally presented to 10 CI users via their auxiliary input as well as to 18 participants with typical hearing via headphones (control group). Speech pleasantness was evaluated using modified MUSHRA tests. Concerning music perception, chord discrimination was tested using paired comparisons. RESULTS: A strong preference of small source to listener distances by CI users was found, but no significant preference for room acoustic attenuation which exceeded the recommended for inclusive applications in schools. The analyses of the energy-time-structures suggested that a dense concentration of early reflections makes a beneficial impact on CI listeners' pleasantness ratings. Music materials were distinguished more consistently without any room acoustic impact, while any room acoustic impact led to performance close to chance level. This effect is probably due to spectral smearing effects caused by reverberation. CONCLUSIONS: These results suggest that in terms of pleasantness of speech, for CI-users, source-to-listener distance is the more influential parameter than room attenuation which goes beyond the German standard recommendation. Reflections from which CI users can benefit seem to occur much earlier than those from which NH listeners benefit. Future studies on chord discrimination concerning room acoustics are needed.

Como manter saudáveis nossos imigrantes: preceitos higienistas na constituição da Hospedaria de Imigrantes da Ilha das Flores / Keeping our immigrants healthy: hygienist doctrine in the Hospedaria de Imigrantes da Ilha das Flores

Resumo A criação da Hospedaria de Imigrantes da Ilha das Flores, em 1883, esteve de acordo com os preceitos higienistas vigentes na época. O isolamento de imigrantes na costa leste da baía de Guanabara ocorreu em virtude das epidemias de febre amarela que retornavam à capital do Império todo verão, desde 1849-1850. Higienistas atribuíam a doença à precária condição sanitária da cidade do Rio de Janeiro, que propiciava a multiplicação do germe e infeccionava a atmosfera. Na medida em que os médicos reinterpretavam a doença à luz da teoria pasteuriana, foram sendo adotados novos procedimentos para a recepção de imigrantes, alterando a estrutura e o funcionamento da Hospedaria da Ilha das Flores.

Abstract The Hospedaria de Imigrantes (Immigrant Lodgings) da Ilha das Flores was established in 1883 in accordance with the hygienist thinking of the time. Immigrants were isolated on the east coast of Guanabara Bay because of the epidemics of yellow fever which returned to the Imperial capital every summer since 1849-1850. Hygienists attributed the disease to the precarious health conditions in the city of Rio de Janeiro, which enabled germs to multiply and infect the atmosphere. As physicians reinterpreted the disease in light of Pasteurian theory, new procedures were adopted to receive immigrants, changing the structure and function of the facility on Ilha das Flores.

Effectivity-ecosphere-economics in nZEB retrofit procedures.

Sustainable development has by now become an element deeply integrated in the everyday design. It has many shades and may be found under many names. We speak about resiliency in design and procurement of passive, ecologic, plus energy, or nZEB buildings. Nevertheless, if we look closely, we may distinguish certain characteristic ideas. First, sustainable development of societies and urbanization processes should be consistent on a deeper level than presently, and be included within design processes, organization, and planning, as well as modernization and redevelopment procedures of existing urban tissue. Secondly, urbanization should be perceived holistically, as an interaction and harmonious development of both natural and manmade environments, with solutions based on the best technical and technological standards available. Lastly, described ideas are achievable only, if we include continuous cooperation between urban planners, architects, specialist consultants, as well as energy-efficient interdisciplinary solutions to achieve high standard energy measures. One of the thresholds is economic feasibility; the other is health and well-being of the users which should always be discussed as a priority. This paper-outside a brief theoretical approach to initial procedures in design management-will dwell on transformation and modernization of an existing building belonging to the Warsaw University of Technology, one of the oldest universities in Poland, its founding dating back to the beginning of the twentieth century. In 2015, a Nordic Finance Mechanism grant dedicated to the nZEB technology transfer from Norway to Poland was awarded to a group of researchers from Warsaw University of Technology and NTNU Trondheim. The main aim of the project is implementation of nZEB knowledge in Poland, as well as preparation of two integrated concept designs for public (University) buildings as exemplary case studies which could act as the benchmarks for other public buildings.

Conceptualizing Health Promotion in Relation to Outpatient Healthcare Building Design: A Scoping Review.

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