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.

Telemedicine Implementation in COVID-19 ICU: Balancing Physical and Virtual Forms of Visibility.

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

Field testing an "acoustic lighthouse": Combined acoustic and visual cues provide a multimodal solution that reduces avian collision risk with tall human-made structures.

Billions of birds fatally collide with human-made structures each year. These mortalities have consequences for population viability and conservation of endangered species. This source of human-wildlife conflict also places constraints on various industries. Furthermore, with continued increases in urbanization, the incidence of collisions continues to increase. Efforts to reduce collisions have largely focused on making structures more visible to birds through visual stimuli but have shown limited success. We investigated the efficacy of a multimodal combination of acoustic signals with visual cues to reduce avian collisions with tall structures in open airspace. Previous work has demonstrated that a combination of acoustic and visual cues can decrease collision risk of birds in captive flight trials. Extending to field tests, we predicted that novel acoustic signals would combine with the visual cues of tall communication towers to reduce collision risk for birds. We broadcast two audible frequency ranges (4 to 6 and 6 to 8 kHz) in front of tall communication towers at locations in the Atlantic migratory flyway of Virginia during annual migration and observed birds' flight trajectories around the towers. We recorded an overall 12-16% lower rate of general bird activity surrounding towers during sound treatment conditions, compared with control (no broadcast sound) conditions. Furthermore, in 145 tracked "at-risk" flights, birds reduced flight velocity and deflected flight trajectories to a greater extent when exposed to the acoustic stimuli near the towers. In particular, the 4 to 6 kHz stimulus produced the greater effect sizes, with birds altering flight direction earlier in their trajectories and at larger distances from the towers, perhaps indicating that frequency range is more clearly audible to flying birds. This "acoustic lighthouse" concept reduces the risk of collision for birds in the field and could be applied to reduce collision risk associated with many human-made structures, such as wind turbines and tall buildings.

Challenges in the establishment of a biosafety testing laboratory for COVID-19 in Bangladesh.

At the beginning of the coronavirus disease 2019 (COVID-19) pandemic in Bangladesh, there was a scarcity of ideal biocontainment facilities to detect the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a risk group of 3 organisms. Molecular detection of SARS-CoV-2 must be performed in a BSL-2 laboratory with BSL-3-equivalent infection prevention and control practices. Establishing these facilities within a short timeframe proved to be an enormous challenge, including locating a remote space distant from the university campus to establish a laboratory, motivating the laboratory staff to work with a novel pathogen without any prior experience, allocation of funds for essential equipment and accessories, and arrangement of a safe waste management system for environmental hazard reduction. This report also highlights several limitations, such as the facility's architectural design that did not follow the biosafety guidelines, lack of continuous flow of funds, and an inadequate number of laboratory personnel. This article describes various efforts taken to overcome the challenges during the establishment of this facility that may be adopted to create similar facilities in other regions of the country. Establishing a BSL-2 laboratory with BSL-3-equivalent infection prevention and control practices will aid in the early detection of a large number of cases, thereby isolating persons with COVID-19, limiting the transmission of SARS-CoV-2, and promoting a robust public health response to contain the pandemic.

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.

Evaluation of airflow pattern and thermal behavior of the arched greenhouses with designed roof ventilation scenarios using CFD simulation.

Natural ventilation is an effective energy-saving strategy conducive to promoting sustainable agricultural production. A comprehensive numerical simulation is performed to predict the airflow pattern and thermal behavior in different arched greenhouses. The defined arc chord angle and position angle are employed to examine the natural ventilation process and corresponding roof vent scenarios. The numerical simulation is compared with the experimental data and good agreements are observed. Various configurations of ventilated structures, wind conditions and ventilation layouts are simulated on a high-resolution polyhedral grid based on a grid sensitivity analysis, which is beneficial to the optimization of greenhouse cooling combined with the water circulation heat collection system. The cooling effect in summer is analyzed by estimating the ventilation flow rate and microclimate inhomogeneity. The results demonstrate that the position angle of 85° of the arched greenhouses is an optimum ventilation direction and its impact on the microclimate is marginally affected by the change of the ventilation structure. The designed ventilation scheme has perfect air exchange capacity and cooling effect because the average air temperature can be reduced by 1.5°C more than the existing greenhouse in 10 minutes of ventilation. Likewise, the results show that the temperature and velocity inhomogeneities are approximately decreased by 33.3% and 11.89%, respectively. The practical value of the research is expected to provide basic quantitative conclusions for evaluating the natural ventilation performance.

A study of the layout planning of plant facility based on the timed Petri net and systematic layout planning.

The purpose of this research is to solve the problems of unreasonable layout of the production plant, disorder of the logistics process, and unbalanced production line in discrete manufacturing plants. By analyzing the production process and characteristics, the timed Petri net model is constructed according to the function and connection of each production unit, which is then used to generate a FlexSim simulation model of the production plant logistics system with a simulation software. Therewith the FlexSim simulation model is used to simulate the original layout of the plant, and to analyse the simulation data synthetically to put forward an improvement strategy. Combined with the use of the systematic layout planning method to analyze the overall layout of the plant and logistics relations, we infer the relevant drawings between the production units and determine the improved layout of the facilities. Finally, by comparing the before and after improvement simulation results, it is verified that the combination of timed Petri nets and systematic layout planning is effective to ameliorate the layout of the plant facilities and the logistics system. This method makes up for the factors that traditional methods have not considered, achieves the goal of reducing the cross circuitous route of the plant and the idle rate of equipment, and improving the efficiency of production.

Maintaining Operations and Staff Morale amid Redevelopment and Construction.

The purpose of this article is to share how one Canadian hospital is using a blend of project management and change management strategies as well as operational readiness best practices to help maintain operations and staff morale in a large urban emergency department as it redevelops its current space (to approximately double the current size) over a four-year period. Crucial to its ongoing success is robust support of senior and program leadership, project and change management resources and clinical leads working collaboratively to address and plan for the impacts of construction.

Practice-Based Research Methods and Tools: Introducing the Design Diagnostic.

OBJECTIVE: To introduce a composite tool called Design Diagnostic that allows a rapid but triangulated insight into key areas of a facility combining the methods of shadowing, behavior mapping, surveys, interviews, photo-essays, and parametric analysis to determine key challenges and opportunities for improvement, identify future design drivers, and recommend simple "do-now" changes. BACKGROUND: Research-based practice relies on agile and nimble methods to investigate, evaluate, and apply research in project work. This requires the ability to scale methodologies, so they can provide actionable insights in often constrained time lines. Surveys, observations, space analytics, and lit reviews often need to be done in extremely short periods of time. In this article, we share how these processes can be condensed to meet time constraints of project time lines, with the critical reminder not to generalize contextually derived insights. CONCLUSION: Combining field research (shadowing and behavior mapping) with user engagement (interviews), user feedback (surveys), and analytics of the plan itself allows designers and owners to understand the relationship between design intent and operational outcome and be resource effective in capital planning projects. Scaling these methods to fit the time and resource availability, and ensuring that results are always reviewed and applied in context, is critical.

Design of the Academic Emergency Department.

This article introduces a clinical audience to the process of emergency department (ED) design, particularly relating to academic EDs. It explains some of the major terms, processes, and key decisions that clinical staff will experience as participants in the design process. Topics covered include an overview of the planning and design process, issues related to determining needed patient capacity, the impact of patient flow models on design, and a description of several common ED design types and their advantages and disadvantages.

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.

Using Immersive Virtual Environments (IVEs) to Conduct Environmental Design Research: A Primer and Decision Framework.

PURPOSE: We propose a methodological framework to use immersive virtual environments (IVEs) in head-mounted displays for environmental design research. BACKGROUND: IVEs offer researchers with experimental control and realistic representations of environments with high levels of ecological validity. IVEs are also increasingly being used to visualize proposed designs. Despite these tremendous benefits, IVEs are underutilized in environmental design research. We are unaware of preexisting frameworks that synthesize the methodological decisions related to the use of IVEs to conduct environmental design research. METHODS/RESULTS: We define the concepts necessary to conduct IVE research (virtual reality [VR], IVEs, ecological validity, visual realism, behavioral realism, and contextual realism). We also summarize the available study designs (correlational studies, experimental studies, and performance evaluations) and software systems used to create IVEs. We conclude with a conceptual framework that describes how research questions and study designs inform IVE selection and ecological validity. This framework is accompanied by a workflow that operationalizes the creation and use of IVEs in research. CONCLUSIONS: VR provides a robust and innovative research strategy for environmental design research because of its high degree of experimental control, rich data collection options, and opportunities for systematic evaluation of alternative design configurations.

Advancing evidence-based healthcare facility design: a systematic literature review.

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

Keeping a 2009 Design Award-Winning Intensive Care Unit Current: A 13-Year Case Study.

In a complex medical center environment, the occupants of newly built or renovated spaces expect everything to "function almost perfectly" immediately upon occupancy and for years to come. However, the reality is usually quite different. The need to remediate initial design deficiencies or problems not noted with simulated workflows may occur. In our intensive care unit (ICU), we were very committed to both short-term and long-term enhancements to improve the built and technological environments in order to correct design flaws and modernize the space to extend its operational life way beyond a decade. In this case study, we present all the improvements and their background in our 20-bed, adult medical-surgical ICU. This ICU was the recipient of the Society of Critical Care Medicine's 2009 ICU Design Award Citation. Our discussion addresses redesign and repurposing of ICU and support spaces to accommodate expanding clinical or entirely new programs, new regulations and mandates; upgrading of new technologies and informatics platforms; introducing new design initiatives; and addressing wear and tear and gaps in security and disaster management. These initiatives were all implemented while our ICU remained fully operational. Proposals that could not be implemented are also discussed. We believe this case study describing our experiences and real-life approaches to analyzing and solving challenges in a dynamic environment may offer great value to architects, designers, critical care providers, and hospital administrators whether they are involved in initial ICU design or participate in long-term ICU redesign or modernization.

Effect of internal surface structure of the north wall on Chinese solar greenhouse thermal microclimate based on computational fluid dynamics.

Chinese solar greenhouses are unique facility agriculture buildings and widely used in northeastern China, providing a favorable requirement for crop growth. The north wall configurations play an essential role in heat storage and thermal insulation and directly affect the management of the internal environment. This research is devoted to further improve the thermal performance of the greenhouse and explore the potential of the north wall. A mathematical model was designed to investigate the concave-convex wall configurations based on computational fluid dynamics. Four passive heat-storage north walls were analyzed by using the same constituent materials, including a plane wall, a vertical wall, a horizontal wall and an alveolate wall. The numerical model was validated by experimental measurements. The temperature distributions of the north walls were examined and a comparative analysis of the heat storage-release capabilities was carried out. The results showed that the heat-storage capacity of the north wall is affected by the surface structure. Moreover, the critical factor influencing the air temperature is the sum of the heat load released by the wall and the energy increment of greenhouse air. The results suggested that the alveolate wall has preferable thermal accumulation capacity. The concave-convex wall configurations have a wider range of heat transfer performance along the thickness direction, while the plane wall has a superior thermal environment. This study provides a basic theoretical reference to rationally design the internal surface structures of the north wall.