Reimagine the ICU: Healthcare Professionals' Perspectives on How Environments (Can) Promote Patient Well-Being.

OBJECTIVE: This study aims (1) to understand the needs and challenges of the current intensive care unit (ICU) environments in supporting patient well-being from the perspective of healthcare professionals (HCPs) and (2) to explore the new potential of ICU environments enabled by technology. BACKGROUND: Evidence-based design has yielded how the design of environments can advocate for patient well-being, and digital technology offers new possibilities for indoor environments. However, the role of technology in facilitating ICU patient well-being has been unexplored. METHOD: This study was conducted in two phases. First, a mixed-method study was conducted with ICU HCPs from four Dutch hospitals. The study investigated the current environmental support for care activities, as well as the factors that positively and negatively contribute to patient experience. Next, a co-creation session was held involving HCPs and health technology experts to explore opportunities for technology to support ICU patient well-being. RESULTS: The mixed-method study revealed nine negative and eight positive patient experience factors. HCPs perceived patient emotional care as most challenging due to the ICU workload and a lack of environmental support in fulfilling patient emotional needs. The co-creation session yielded nine technology-enabled solutions to address identified challenges. Finally, drawing from insights from both studies, four strategies were introduced that guide toward creating technology to provide holistic and personalized care for patients. CONCLUSION: Patient experience factors are intertwined, necessitating a multifactorial approach to support patient well-being. Viewing the ICU environment as a holistic unit, our findings provide guidance on creating healing environments using technology.

Influence of Sit-Stand Tables in Classrooms on Children's Sedentary Behavior and Teacher's Acceptance and Feasibility: A Mixed-Methods Study.

Children spend over 70% of their school day sitting, most of the time in the classroom. Even when meeting physical activity guidelines but sitting for long uninterrupted periods, children are at risk of poorer health outcomes. With an approach to create an active learning environment through the implementation of sit-stand tables, this exploratory mixed-methods study aims to evaluate a holistic concept for reducing sedentary time in schools by implementing sit-stand tables as well as to examine the feasibility and didactic usability in classroom settings. Children from eight German schools aged 7 to 10 in primary schools and 11 to 13 in secondary schools (n = 211), allocated into control and intervention groups, were included in the study, as well as teachers (n = 13). An accelerometer was used as a quantitative measure to assess sitting and standing times and sport motoric tests were taken. Qualitative interviews were performed with teachers regarding feasibility and acceptance of the sit-stand tables. Independent t-test analysis adjusted for age, sex and school type found that sitting times of children in the intervention group could be reduced (by 30.54 min per school day of 6 h, p < 0.001) within all school and age levels. Overall, implementing sit-stand tables in classrooms serves as a feasible and effective opportunity to reduce sedentary behaviour and create an active learning environment.

Global research into the relationship between electronic waste and health over the last 10 years: A scientometric analysis.

Introduction: The aims of this research were to conduct the first holistic and deep scientometric analysis of electronic waste and health and provide with the prediction of research trends and hot topics. Method: A comprehensive literature search was conducted via the Web of Science Core collection databases on 26 August 2022 to identify all articles related to electronic waste and health. A total of 652 records have been extracted from the Web of Science after applying inclusion and exclusion criteria and were analyzed using bibliometrix software of R-package, VOSviewer, and CiteSpace, visualized by tables and diagrams. Result: The number of publications and total citations had shown a general growth trend from 2012 to 2021, with an average annual growth rate of 23.74%. Mainland China was the significant nation with the greatest number of publications, citations, and international links. The journal publishing the most was "Science of the Total Environment" (n = 56). Huo X and Hu XJ were the top two author contributing to this field with the highest h-index (23). Over time, the focus in this field shifted to exposure to heavy metal, polychlorinated biphenyls, polybrominated biphenyl ethers, and poly- and perfluorinated alkyl substances from electronic waste, and managements, such as hydrometallurgy. Discussion: By this scientometric analysis, we found that the most active country, journal, organization and author contributing to this filed, as well as high impact documents and references and research hotspots. Also, we found that the hotspots might be exposure to toxic substances from electronic waste procession, its impact on human health and relevant managements. And evironmentally friendly materials to replace heavy metal mate rials, and environmentally friendly and effective recycling methods of electronic waste need to be further studied.

Federated Learning via Augmented Knowledge Distillation for Heterogenous Deep Human Activity Recognition Systems.

Deep learning-based Human Activity Recognition (HAR) systems received a lot of interest for health monitoring and activity tracking on wearable devices. The availability of large and representative datasets is often a requirement for training accurate deep learning models. To keep private data on users' devices while utilizing them to train deep learning models on huge datasets, Federated Learning (FL) was introduced as an inherently private distributed training paradigm. However, standard FL (FedAvg) lacks the capability to train heterogeneous model architectures. In this paper, we propose Federated Learning via Augmented Knowledge Distillation (FedAKD) for distributed training of heterogeneous models. FedAKD is evaluated on two HAR datasets: A waist-mounted tabular HAR dataset and a wrist-mounted time-series HAR dataset. FedAKD is more flexible than standard federated learning (FedAvg) as it enables collaborative heterogeneous deep learning models with various learning capacities. In the considered FL experiments, the communication overhead under FedAKD is 200X less compared with FL methods that communicate models' gradients/weights. Relative to other model-agnostic FL methods, results show that FedAKD boosts performance gains of clients by up to 20 percent. Furthermore, FedAKD is shown to be relatively more robust under statistical heterogeneous scenarios.

Mouse with your arm™: Facilitating forearm support using the chair armrest to prevent and mitigate musculoskeletal disorders.

BACKGROUND: Musculoskeletal disorders (MSDs) can be prevented by avoiding trauma caused by poor posture, compression, force, and repetition. Neutral postures are recommended to avoid MSDs. OBJECTIVE: This study introduces Mouse With Your Arm™ (MWYA) methodology which promotes sitting back in a chair, using the chair's armrest for forearm support at relaxed elbow height, matching surface and armrest height, and keeping the mouse on the surface edge. This position allows optimal task chair use, facilitates movement and neutral postures, avoids compression and contact stress, and is effective in mitigating MSDs. METHOD: MWYA was applied and measured in the field for more 23 years providing over 3,500 individualized assessments to integrate a participant's unique characteristics, reported health concerns, tasks, tools, and environment to achieve and sustain whole-body neutral and comfortable working postures. RESULTS: Previous research has consistently recommended use of forearm support by a desk, apparatus, or wrist rest, and resulted in non-neutral, static postures and measured health consequences. By using armrests for support, MWYA avoids the potential of MSDs as can be caused by these previously endorsed postures. CONCLUSION: By applying the five MWYA principles, computer users comprehend neutral posture and put forth the effort essential to creating healthy human computer relationships.

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.

Current phototherapy practice on Java, Indonesia.

BACKGROUND: In Indonesia, the burden of severe hyperbilirubinemia is higher compared to other countries. Whether this is related to ineffective phototherapy (PT) is unknown. The aim of this study is to investigate the performance of phototherapy devices in hospitals on Java, Indonesia. METHODS: In 17 hospitals we measured 77 combinations of 20 different phototherapy devices, with and without curtains drawn around the incubator/crib. With a model to mimic the silhouette of an infant, we measured the irradiance levels with an Ohmeda BiliBlanket Meter II, recorded the distance between device and model, and compared these to manufacturers' specifications. RESULTS: In nine hospitals the irradiance levels were less than required for standard PT: < 10 µW/cm2/nm and in eight hospitals irradiance failed to reach the levels for intensive phototherapy: 30 µW/cm2/nm. Three hospitals provided very high irradiance levels: > 50 µW/cm2/nm. Half of the distances between device and model were greater than recommended. Distance was inversely correlated with irradiance levels (R2 = 0.1838; P < 0.05). The effect of curtains on irradiance levels was highly variable, ranging from - 6.15 to + 15.4 µW/cm2/nm, with a mean difference (SD) of 1.82 (3.81) µW/cm2/nm (P = 0.486). CONCLUSIONS: In half of the hospitals that we studied on Java the levels of irradiance are too low and, in some cases, too high. Given the risks of insufficient phototherapy or adverse effects, we recommend that manufacturers provide radiometers so hospitals can optimize the performance of their phototherapy devices.

Current and ceased users of sit stand workstations: a qualitative evaluation of ergonomics, safety and health factors within a workplace setting.

BACKGROUND: Many workplaces have implemented sit-stand workstations (SSW), which enable a worker to transition between sitting and standing as they perform their work activities. The factors which determine the initial adoption, sustainability or cessation of use for a SSW, remain largely unexamined. This study investigates the experiences of workers who had previously used or were currently using a SSW. METHODS: The study setting was within an Australian university. Participants who were current or past SSW users, as well as workplace key informants, were interviewed for the study. All interviews were recorded, transcribed and analysed. Transcripts were coded by two researchers for concepts and themes regarding uptake and sustainability of SSW. Discussion and validation of themes was undertaken by the team of three researchers. RESULTS: A total of 24 interviews were conducted. Twenty-two interviews were with ceased and current users (16 current and six ceased users) and two interviews were with workplace key informants. Analysis of the interviews with current and ceased users identified three main themes: Personal considerations for use/sustainability; Posture; and Usability. Analysis of the interviews with key informants identified two themes: Considerations and concerns and Policies and procedures. Little information was provided to workers when first using a SSW. Workers who were able to adopt their working style to the new workstations were able to sustain ongoing use of a SSW. Key informants were concerned that employees believed using a SSW would provide a health benefit in its own right without an understanding of the possible risks that might be associated with use. CONCLUSIONS: Sustainable usage of this type of SSW is achievable, however, it requires some element of adaptation at the individual worker level. Participants spoke about how the use of the SSW in a standing position was typically associated with the time of day, specific task selection and musculoskeletal comfort or fatigue factors. The provision of education to new SSW users with relevant supporting information by a subject matter expert should enable the worker to obtain a more holistic understanding of the safety and health risks and benefits embedded in the use of a SSW.

Released Volatile Organic Compounds in Southern Yellow Pine before and after Heat Treatment.

As the main material in indoor furniture, southern yellow pine (Pinus spp.) releases volatile organic compounds (VOCs) into the environment during use. To better understand variations in the contents of VOCs in southern yellow pine before and after heat treatment, this study conducts dry heat treatment on southern yellow pine at 140 °C and 220 °C. Headspace solid phase micro-extraction was used to extract VOCs from southern yellow pine. The VOCs of southern yellow pine before and after heat treatment were identified via gas chromatography-mass spectrometry, and chemical component differences were characterized via Fourier transform infrared spectroscopy. Results reveal 86 VOCs in pure southern yellow pine, including alcohols, aromatics, acids, aldehydes, alkanes, alkenes, and some trace compounds (e.g., furans, ketones, phenols, and esters). With an increase in heat-treatment temperature, the contents of alkanes increased, whereas those of alcohols and alkenes decreased. The contents of aromatics, acids, and aldehydes were highest when heat treated at 140 °C. At 220 °C, the total contents of key VOCs in southern yellow pine were lowest.

How to Design and Equip a Mentalization-Based Play Therapy Room.

Designing and equipping a play therapy room as a differentiated tool in a psychodynamic approach to child psychotherapy is seldom discussed. This article sketches out the equipment and furnishing of a play therapy room to be used for mentalization-based psychodynamic psychotherapy and gives examples of the use of such a room in practice.

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.

"Artificial But Better Than Nothing".

OBJECTIVE: To investigate patient, staff, and carer responses to an environmental intervention in an oncology clinic waiting room and evaluate the acceptability of artificial plant materials. Design Postintervention: Cross-sectional survey study. SETTING: Oncology outpatient clinic waiting room located in a metropolitan comprehensive cancer center in Australia. MAIN OUTCOME MEASURE: Observer ratings of perceived qualities and effects of lifelike (fake) plants while spending time in the waiting room. PARTICIPANTS: Convenience sample ( N = 143) consisted of 73 cancer patients, 13 staff, 52 carers, and 5 "others" aged between 24 and 89 years ( M = 56, SD = 14.5). INTERVENTION: Artificial plant arrangements, hanging installations, two movable green walls, and one rock garden on wheels placed throughout the outpatients' clinic waiting room. RESULTS: Eighty-one percent (115/142) of respondents noticed the green features when first entering the waiting room and 67% (90/134) noticed they were artificial. Eighty-one percent (115/142) indicated "like/like a lot" when reporting their first reaction to the green features. Forty-eight percent (68/143) were positively affected and 23% (33/143) were very positively affected. Eighty-one percent (110/135) agreed/strongly agreed that "The greenery brightens the waiting room," 62% (80/130) agreed/strongly agreed that they "prefer living plants," and 76% (101/133) agreed/strongly agreed that "'lifelike' plants are better than no plants." Comments included mostly positive appraisals and occasional adverse reactions to artificial plants. No significant differences were found between patients', staff, and carers' reactions. CONCLUSIONS: The environmental intervention positively impacted patients', staff, and carers' perceptions of the oncology waiting room environment. Patients, staff, and carers mostly accepted artificial plants as an alternative design solution to real plants.

Interior effects on comfort in healthcare waiting areas.

BACKGROUND: This study compared the effects of pre-experience and expectations on participant comfort upon waking, arrival to, and after an appointment, as well as the assessment of properly placed Feng Shui elements in three healthcare waiting rooms. METHODS: Participants assessed comfort levels using self-report surveys. The researcher conducted 'intention interviews' with each doctor to assess the goals of each waiting area design, and conducted a Feng Shui assessment of each waiting area for properly placed Feng Shui elements. RESULTS: The waiting area designed by the Feng Shui expert rated 'most comfortable', followed by the waiting area design by a doctor, and the lowest comfort rating for the conventional waiting room design. Results show a sufficiently strong effect to warrant further research. CONCLUSIONS: Awareness of the external environment, paired with pre-experience and expectation, influences comfort for people over time. Fostering and encouraging a holistic approach to comfort utilizing eastern and western concepts and ergonomic principles creates a sense of "placeness" and balance in the design for comfort in built environments. This is new research information on the influences of the comfort experience over time, to include pre-experience, expectations and the placement of elements in the external environment.

Rapid methodology to screen flame retardants in upholstered furniture for compliance with new California labeling law (SB 1019).

In response to concerns regarding the widespread use of flame retardants, the California Legislature passed a law (SB1019) requiring labels on furniture products to indicate whether they do or do not contain flame retardants. To support the enforcement of the new law, our laboratory developed a step-wise, screening approach to test for brominated (BFR) and phosphorus-based flame retardants (OPFRs) in several types of furniture components (foam, fabric, batting, plumage, etc.). We used X-Ray Fluorescence (XRF) to screen for the presence of Br (and other elements) and Inductively Coupled Plasma - Optical Emission Spectrometry (ICP-OES) to identify and measure the concentration of P (and other elements). The same samples were also extracted by dichloromethane using sonication and analyzed by a single injection into a Gas Chromatograph - Tandem Mass Spectrometer to obtain concentrations of specific BFRs and OPFRs. Our approach showed excellent screening potential for Br and Sb by XRF and for P by ICP-OES, with both tests having predictive values of a negative equal to 1. To explore and screen for flame retardants in products not included in our current list of target chemicals, we used Liquid Chromatography/Time-of-Flight Mass Spectrometry operated with electrospray ionization, to identify additional flame retardants to be incorporated in quantitative methods. We are making all our methodologies public to facilitate simple and low cost methods that can help manufacturers and suppliers have their products tested and correctly labeled, ultimately benefitting the consumer.

Contact allergy to finished woods in furniture and furnishings: a small allergic contact dermatitis epidemic to western red cedar in sauna interior decoration.

BACKGROUND: Allergic contact dermatitis caused by wood dust remains uncommon and most cases are occupational. Contact allergy to finished wooden products is even more rare and only few cases of contact dermatitis to wooden furnishings and furniture are described. OBJECTIVE: During 2012-2014 surprisingly many patients with dermatitis associated to sauna baths were referred to our clinic. METHODS: We report three novel cases with allergic contact dermatitis to western red cedar due to exposure during sauna baths. RESULTS: Three cases of non-occupational contact dermatitis to western red cedar were confirmed by patch testing. CONCLUSION: Allergic contact dermatitis to interior decoration or furniture is a rarity, but can be induced by novel exposures, like western red cedar in sauna interior decoration.

The Colour Treatment: A Convergence of Art and Medicine at the Red Cross Russell Lea Nerve Home.

When the Red Cross opened its new convalescent home at Russell Lea in Sydney in 1919, it contained a coloured room designed for treating 'nerve cases'. This room was painted by Roy de Maistre, a young artist, and was modelled on the Kemp Prossor colour scheme trialled at the McCaul Convalescent Hospital in London for the treatment of shell shock. Dubbed the 'colour cure' by the popular press, this unconventional treatment was ignored by the Australian medical profession. The story of de Maistre's colour experiment is not widely known outside the specialist field of Australian art history. Focusing on the colour room as a point of convergence between art and medicine in the context of the First World War, this article investigates Red Cross activities and the care of soldiers suffering from nervous conditions.

Patients' recovery experiences of indoor plants and viewsof nature in a rehabilitation center.

BACKGROUND: There is an increasing interest in the possible healing factors connected to the presence of nature elements in health institutions. OBJECTIVE: The aim of the present study is to get a deeper understanding of how residents in a residential rehabilitation center experience the views through windows and the indoor plants, and whether and how the view and the plants can impact their recovery process. METHODS: In-depth individual and group interviews were conducted among 16 residents at a rehabilitation center in Norway. RESULTS: The participants said that the indoor plants and the view of nature were pleasant to look at and elicited feelings of relaxation and positive emotions which contributed to opportunities for reflection and contemplation. They expressed a feeling of connectedness to nature: a feeling of wholeness and spirituality elicited by the nature elements. They also expressed that the presence of nature elements contributed to a sense of being taken care of. CONCLUSIONS: The nature elements, such as a view of nature or indoor plants, seem to enhance opportunities for reflection, feelings of meaningfulness and sense of being taken care of which may strengthen their feeling of well-being and make them more resilient to the stressors in life.

Rethinking design parameters in the search for optimal dynamic seating.

Dynamic seating design purports to lessen damage incurred during sedentary occupations by increasing sitter movement while modifying muscle activity. Dynamic sitting is currently defined by O'Sullivan et al. ( 2013a) as relating to 'the increased motion in sitting which is facilitated by the use of specific chairs or equipment' (p. 628). Yet the evidence is conflicting that dynamic seating creates variation in the sitter's lumbar posture or muscle activity with the overall consensus being that current dynamic seating design fails to fulfill its goals. Research is needed to determine if a new generation of chairs requiring active sitter involvement fulfills the goals of dynamic seating and aids cardio/metabolic health. This paper summarises the pursuit of knowledge regarding optimal seated spinal posture and seating design. Four new forms of dynamic seating encouraging active sitting are discussed. These are 1) The Core-flex with a split seatpan to facilitate a walking action while seated 2) the Duo balans requiring body action to create rocking 3) the Back App and 4) Locus pedestal stools both using the sitter's legs to drive movement. Unsubstantiated claims made by the designers of these new forms of dynamic seating are outlined. Avenues of research are suggested to validate designer claims and investigate whether these designs fulfill the goals of dynamic seating and assist cardio/metabolic health. Should these claims be efficacious then a new definition of dynamic sitting is suggested; 'Sitting in which the action is provided by the sitter, while the dynamic mechanism of the chair accommodates that action'.