Search results for: hospital building

Authors: Tess Howard, Lily Owens, Maneesha De Silva, Russell Hodgson

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Purpose: This study aims to evaluate the cost-effectiveness of laparoscopic common bile duct exploration (CBDE) compared to endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy for the emergency management of common bile duct (CBD) stones. Methodology: A retrospective case note review was conducted on consecutive patients undergoing emergency management of CBD stones using either CBDE, or ERCP and cholecystectomy at a single centre between January 2014-October 2014. Data on admission and procedural costs, length of hospital stay, postoperative complications and further stone related interventions were analysed. Results: A total of 350 patients were analysed. Among them, 299 patients underwent CBDE at the time of cholecystectomy, while the remaining 51 underwent ERCP either pre-, intra- or post cholecystectomy. CBDE was associated with lower overall costs compared to ERCP with an average hospital stay cost of $13,093 vs $22,930 respectively. This was largely attributed to shorter hospital stays (6.5 vs 10.3 days), decreased need for intensive care unit admission and fewer postoperative interventions within the CBDE group. Notably, single procedure laparoscopic cholecystectomy with CBDE demonstrated decreased operative costs compared to laparoscopic cholecystectomy combined with ERCP pre-/intra- or post-operatively ($3,747 vs. $4,641). Conclusion: Emergent CBDE is a cost-effective alternative to ERCP for managing CBD stones when combined with cholecystectomy. The upfront investment in equipment for CBDE and increased cholecystectomy procedural time is counterbalanced by reduced hospital stay, fewer procedures and subsequent cost savings. Economic considerations, in conjunction with clinical outcomes, should inform the selection of the optimal approach for CBD stone management in emergency settings.

Keywords: choledocolithiasis, management, cost-effectiveness, endoscopic retrograde cholangiopancreatography, ERCP, CBDE, common bile duct exploration

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Authors: Tzong-Ying Hao, Mohammad T. Rahmani

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The Torre Central building is a 9-story shear wall structure located in Santiago, Chile, and has been instrumented since 2009. Events of different intensity (ambient vibrations, weak and strong earthquake motions) have been recorded, and thus the building can serve as a full-scale benchmark to evaluate the structural health monitoring method developed. The first part of this article presents an analysis of inter-story drifts, and of changes in the first system frequencies (estimated from the relative displacement response of the 8th-floor with respect to the basement from recorded data) as baseline indicators of the occurrence of damage. During 2010 Chile earthquake the system frequencies were detected decreasing approximately 24% in the EW and 27% in NS motions. Near the end of shaking, an increase of about 17% in the EW motion was detected. The structural health monitoring (SHM) method based on changes in wave traveling time (wave method) within a layered shear beam model of structure is presented in the second part of this article. If structural damage occurs the velocity of wave propagated through the structure changes. The wave method measures the velocities of shear wave propagation from the impulse responses generated by recorded data at various locations inside the building. Our analysis and results show that the detected changes in wave velocities are consistent with the observed damages. On this basis, the wave method is proven for actual implementation in structural health monitoring systems.

Keywords: Chile earthquake, damage detection, earthquake response, impulse response, layered shear beam, structural health monitoring, Torre Central building, wave method, wave travel time

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Authors: T. Valdbjørn Rasmussen

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Design criteria for achieving an acceptable indoor radon concentration are presented in this paper. The paper suggests three design criteria. These criteria have to be considered at the early stage of the building design phase to meet the latest recommendations from the World Health Organization in most countries. The three design criteria are; first, establishing a radon barrier facing the ground; second, lowering the air pressure in the lower zone of the slab on ground facing downwards; third, diluting the indoor air with outdoor air. The first two criteria can prevent radon from infiltrating from the ground, and the third criteria can dilute the indoor air. By combining these three criteria, the indoor radon concentration can be lowered achieving an acceptable level. In addition, a cheap and reliable method for measuring the radon concentration in the indoor air is described. The provision on radon in the Danish Building Regulations complies with the latest recommendations from the World Health Organization. Radon can cause lung cancer and it is not known whether there is a lower limit for when it is not harmful to human beings. Therefore, it is important to reduce the radon concentration as much as possible in buildings. Airtightness is an important factor when dealing with buildings. It is important to avoid air leakages in the building envelope both facing the atmosphere, e.g. in compliance with energy requirements, but also facing the ground, to meet the requirements to ensure and control the indoor environment. Infiltration of air from the ground underneath a building is the main providing source of radon to the indoor air.

Keywords: radon, natural radiation, barrier, pressure lowering, ventilation

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Authors: Deepika Biswas

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Acinetobacter baumannii, a hospital-acquired pathogen, causes nosocomial infections including pneumonia, urinary tract infection, and secondary meningitis. Carbapenem is most effective antibiotics against it. Its increased resistance to carbapenems has been a rising global concern. Antibiotics such as carbapenem are unable to use on hospital setups to eradicate A. baumannii, hence different concentrations of disinfectants including phenol; sodium hypochlorite and ethanol are increasingly being used. The objective of the present study is to find an effective concentration of above disinfectants against carbapenem-resistant strain RS307 of A. baumannii. Growth kinetics of RS307 has been determined using UV-Vis spectrophotometer in the presence and absence of disinfectants in triplicate and its standard deviation has also been calculated which make the results more reliable. Differential growth curves were plotted, which showed the effective concentration among all the concentrations of phenol, sodium hypochlorite and ethanol. On disc diffusion assay, antimicrobial effect was observed by comparing all the concentrations of disinfectants to check its synergy with imipenem, most effective carbapenem. All the results collectively revealed that 0.5% phenol, 0.5% sodium hypochlorite, and 70% ethanol could preferably be used as disinfectant for hospital setup against the carbapenem-resistant strain of A. baumannii. SDS PAGE analysis showed differential expression in the protein profile of A. baumannii after treatment. The present study highlighted that few disinfectants even in low concentration had shown better antimicrobial activity hence may be recommended for regular use in the hospitals, which will be cost effective and less harmful.

Keywords: Acenatobacter bomunii, phenol, sodium hypoclirite, ethanol, carbapenem resistance, disinfectant

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Authors: Helia Moayedi, Mahdi Moaidi

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Nowadays, the managing and planning of hospitals is facing many problems. Failure to recognize the main criteria for strategic management to ensure long-term hospital performance can lead to many health problems. To achieve this goal, a qualitative-quantitate method titled Delphi-Fuzzy has been applied. This strategy makes it possible for experts to screen among the most important criteria in strategic management. To conduct this operation, a statistical society consisting of 20 experts in Ahwaz hospitals has been questioned. The final model confirms the key criterions after three stages of Delphi. This model provides the possibility to focus on the basic criteria and can determine the organization’s main orientation.

Keywords: Delphi-fuzzy method, hospital management, long-term planning, qualitative-quantitate method, screening of strategic criteria, strategic planning

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Authors: Emma S. Bowers

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Perturbations in global environments and temperatures have heightened the urgency of creating cost-efficient, energy-neutral building techniques. Structural responses to this thermal crisis have included designs (including those of the building standard PassivHaus) with airtightness, window placement, insulation, solar orientation, shading, and heat-exchange ventilators as potential solutions or interventions. Limitations in the predictability of the circulation of cooled air through the ambient temperature gradients throughout a structure are one of the major obstacles facing these enhanced building methods. A diverse range of air-cooling devices utilizing varying technologies is implemented around the world. Many of them worsen the problem of climate change by consuming energy. Using natural ventilation principles of air buoyancy and density to circulate fresh air throughout a building with no energy input can combat these obstacles. A unique prototype of an energy-neutral air-circulation system was constructed in order to investigate potential temperature and pressure gradients related to the stack effect (updraft of air through a building due to changes in air pressure). The stack effect principle maintains that since warmer air rises, it will leave an area of low pressure that cooler air will rush in to fill. The result is that warmer air will be expelled from the top of the building as cooler air is directed through the bottom, creating an updraft. Stack effect can be amplified by cooling the air near the bottom of a building and heating the air near the top. Using readily available, mostly recyclable or biodegradable materials, an insulated building module was constructed. A tri-part construction model was utilized: a subterranean earth-tube heat exchanger constructed of PVC pipe and placed in a horizontally oriented trench, an insulated, airtight cube aboveground to represent a building, and a solar chimney (painted black to increase heat in the out-going air). Pressure and temperature sensors were placed at four different heights within the module as well as outside, and data was collected for a period of 21 days. The air pressures and temperatures over the course of the experiment were compared and averaged. The promise of this design is that it represents a novel approach which directly addresses the obstacles of air flow and expense, using the physical principle of stack effect to draw a continuous supply of fresh air through the structure, using low-cost and readily available materials (and zero manufactured energy). This design serves as a model for novel approaches to creating temperature controlled buildings using zero energy and opens the door for future research into the effects of increasing module scale, increasing length and depth of the earth tube, and shading the building. (Model can be provided).

Keywords: air circulation, PassivHaus, stack effect, thermal gradient

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Authors: Mustahsan Mir, Ahmed Hassanin, Mohammed A. Al-Saleh

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The layout optimization of building blocks of unequal areas has applications in many disciplines including VLSI floorplanning, macrocell placement, unequal-area facilities layout optimization, and plant or machine layout design. A number of heuristics and some analytical and hybrid techniques have been published to solve this problem. This paper presents an efficient high-quality building-block layout design technique especially suited for solving large-size problems. The higher efficiency and improved quality of optimized solutions are made possible by introducing the concept of Promising Infant Clusters in a constructive placement procedure. The results presented in the paper demonstrate the improved performance of the presented technique for benchmark problems in comparison with published heuristic, analytic, and hybrid techniques.

Keywords: block layout problem, building-block layout design, CAD, optimization, search techniques

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Authors: Hadis Pouyafar, D. Matin Alaghmandan

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Gallium arsenide (GaAs) solar cells are widely used in applications like spacecraft and satellites because they have a high absorption coefficient and efficiency and can withstand high-energy particles such as electrons and protons. With the energy crisis, there's a growing need for efficiency and cost-effective solar cells. GaAs cells, with their 46% efficiency compared to silicon cells 23% can be utilized in buildings to achieve nearly zero emissions. This way, we can use irradiation and convert more solar energy into electricity. III V semiconductors used in these cells offer performance compared to other technologies available. However, despite these advantages, Si cells dominate the market due to their prices. In our study, we took an approach by using software from the start to gather all information. By doing so, we aimed to design the optimal building that harnesses the full potential of solar energy. Our modeling results reveal a future; for GaAs cells, we utilized the Grasshopper plugin for modeling and optimization purposes. To assess radiation, weather data, solar energy levels and other factors, we relied on the Ladybug and Honeybee plugins. We have shown that silicon solar cells may not always be the choice for meeting electricity demands, particularly when higher power output is required. Therefore, when it comes to power consumption and the available surface area for photovoltaic (PV) installation, it may be necessary to consider efficient solar cell options, like GaAs solar cells. By considering the building requirements and utilizing GaAs technology, we were able to optimize the PV surface area.

Keywords: gallium arsenide (GaAs), optimization, sustainable building, GaAs solar cells

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Authors: Behzad Sinaei, Shahryar Sane, Behzad Kazemi Haki

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Children with different malignancies usually experience potential neurologic complications when treated with radiation therapy, especially if under frequent anesthesia. The aim of this study was to evaluate the neurologic problems associated with anesthesia in pediatrics treated with radiotherapy under anesthesia. The study was a cross-sectional experiment that consisted of 133 pediatric patients with different malignancies who needed anesthesia for performing radiotherapy and were referred to Omid Charity Hospital and Imam Khomeini University Hospital from 2014 to 2020 by the census. P-values less than 0.05 were considered statistically significant (P-value < 0.05). Anesthesia complications in this study were slight and insignificant. Some were due to the effects of the tumor on other important organs or either previous radiation therapy or chemotherapy. For safe anesthesia, considering the effects of tumors on body organs and the neurological complications they cause can greatly help reduce anesthesia complications in pediatrics under radiation therapy.

Keywords: anesthesia, neurologic complications, pediatrics, radiotherapy

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Authors: Kim Young-Jin, Kim Byung-Kon

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Although more efforts to expand the application of BIM (Building Information Modeling) technologies have be pursued in recent years than ever, it’s true that there have been various challenges in doing so, including a lack or absence of relevant institutions, lots of costs required to build BIM-related infrastructure, incompatible processes, etc. This, in turn, has led to a more prolonged delay in the expansion of their application than expected at an early stage. Especially, attempts to save costs for building BIM-related infrastructure and provide various BIM services compatible with domestic processes include studies to link between BIM and cloud computing technologies. Also in this study, the author attempted to develop a cloud BIM service operation model through analyzing the level of BIM applications for the construction sector and deriving relevant service areas, and find how to link BIM services to the cloud operation model, as through archiving BIM data and creating a revenue structure so that the BIM services may grow spontaneously, considering a demand for cloud resources.

Keywords: construction IT, BIM (building information modeling), cloud computing, BIM service based cloud computing

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Authors: Kim H. K. Choy, Oliva H. K. Chu, W. Y. Keung, B. Lim, Winnie P. Y. Tang

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Background: Health care providers have been identified as an at-risk group for obesity. Mobile health technology can be used to motivate lifestyle behavioral changes. The aim of this study was to investigate hospital-based health care providers’ perceptions of mHealth Workplace Nutrition Wellness Program. Methods: This qualitative study was conducted at a regional hospital in Hong Kong. Ten health care providers were purposively selected for the study. Qualitative data was collected by individual face-to-face semi-structured interviews which were audio-taped, transcribed verbatim and analyzed by thematic analysis. Results: Four themes were identified: (1) mobile health technology motivates lifestyle changes, (2) self-perceived body weight initiates health behavioral changes, (3) organizational support promotes healthy behavior, (4) lack of self-confidence hinders lifestyle modification. The health care providers’ perceptions of mobile health technology, barriers, and facilitators to participation in the mHealth Workplace Nutrition Wellness Program were discussed in the study. Conclusions: Barriers, facilitators, self-perceived body weight and experiences of mobile health technology were associated with intention of participation in mHealth Workplace Nutrition Wellness Program. The knowledge generated from the study could be used to guide the design and implementation of effective interventions, strategies and policies of workplace wellness programs to promote participation for hospital’s employees.

Keywords: workplace wellness program, mobile health, barriers, facilitators, qualitative

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Authors: Cheryl Forchuk, Sandra Fisman, Steve Cordes, Dan Catunto, Katherine Krakowski, Melissa Jeffrey, John D’Oria

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The discharge of youth aged 16-25 from hospital into homelessness is a prevalent issue despite research indicating social, safety, health and economic detriments on both the individual and community. Lack of stable housing for youth discharged into homelessness results in long-term consequences, including exacerbation of health problems and costly health care service use and hospital readmission. People experiencing homelessness are four times more likely to be readmitted within one month of discharge and hospitals must spend $2,559 more per client. Finding safe housing for these individuals is imperative to their recovery and transition back to the community. People discharged from hospital to homelessness experience challenges, including poor health outcomes and increased hospital readmissions. Youth are the fastest-growing subgroup of people experiencing homelessness in Canada. The needs of youth are unique and include supports related to education, employment opportunities, and age-related service barriers. This study aims to identify the needs of youth at risk of homelessness by evaluating the efficacy of the “Preventing Discharge to No Fixed Address – Youth” (NFA-Y) program, which aims to prevent youth from being discharged from hospital into homelessness. The program connects youth aged 16-25 who are inpatients at London Health Sciences Centre and St. Joseph’s Health Care London to housing and financial support. Supports are offered through collaboration with community partners: Youth Opportunities Unlimited, Canadian Mental Health Association Elgin Middlesex, City of London Coordinated Access, Ontario Works, and Salvation Army’s Housing Stability Bank. This study was reviewed and approved by Western University’s Research Ethics Board. A series of interviews are being conducted with approximately ninety-three youth participants at three time points: baseline (pre-discharge), six, and twelve months post-discharge. Focus groups with participants, health care providers, and community partners are being conducted at three-time points. In addition, administrative data from service providers will be collected and analyzed. Since homelessness has a detrimental effect on recovery, client and community safety, and healthcare expenditure, locating safe housing for psychiatric patients has had a positive impact on treatment, rehabilitation, and the system as a whole. If successful, the findings of this project will offer safe policy alternatives for the prevention of homelessness for at-risk youth, help set them up for success in their future years, and mitigate the rise of the homeless youth population in Canada.

Keywords: youth homelessness, no-fixed address, mental health, homelessness prevention, hospital discharge

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Authors: Choo Hong Ang

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The most popular approach to save energy for large commercial buildings in Malaysia is to replace the existing chiller plant of high kW/ton to one of lower kW/ton. This approach, however, entails large capital outlay with a long payment period of up to 7 years. This paper shows that by using multiple approaches, other than replacing the existing chiller plant, an energy saving of up to 20 %, is possible. The main methodology adopted was to identify and then plugged all heat ingress paths into a building, including putting up glass structures to prevent mixing of internal air-conditioned air with the ambient environment, and replacing air curtains with glass doors. This methodology could save up to 10 % energy bill. Another methodology was to change fixed speed motors of air handling units (AHU) to variable speed drive (VSD) and changing escalators to motion-sensor type. Other methodologies included reducing heat load by blocking air supply to non-occupied parcels, rescheduling chiller plant operation, changing of fluorescent lights to LED lights, and conversion from tariff B to C1. A case example of Komtar, the tallest building in Penang, is given here. The total energy bill for Komtar was USD2,303,341 in 2016 but was reduced to USD 1,842,927.39 in 2018, a significant saving of USD460,413.86 or 20 %. In terms of kWh, there was a reduction from 18, 302,204.00 kWh in 2016 to 14,877,105.00 kWh in 2018, a reduction of 3,425,099.00 kWh or 18.71 %. These methodologies used were relatively low cost and the payback period was merely 24 months. With this achievement, the Komtar building was awarded champion of the Malaysian National Energy Award 2019 and second runner up of the Asean Energy Award. This experience shows that a strong commitment to energy saving is the key to effective energy saving.

Keywords: chiller plant, energy saving measures, heat ingress, large building

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Authors: Jorn Fricke, Frans Melissen

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Citizens in urban areas are prone to increased levels of stress due to urbanization, inadequate and overburdened infrastructure and services, and environmental degradation. Moreover, communities are fragile and subject to shocks and stresses through various social and political processes. A loss of (a sense of) community is often seen as related to increasing political and civic disintegration. Feelings of community can manifest themselves in various ways but underlying all these manifestations is the need for trust between people. One of the main drivers of trust between individuals is (shared) experiences. It is these shared experiences that may play an important role in building resilience, i.e., the ability of a community and its members to adapt to and deal with stresses, as well as ensure the ongoing development of a community. So far, experience design, as a discipline and academic field, has mainly focused on designing products or services. However, people-to-people experiences are the ones that play a pivotal role in building inclusiveness, safety, and resilience in communities. These experiences represent challenging objects of design as they develop in an interactive space of spontaneity, serendipity, and uniqueness that is based on intuition, freedom of expression, and interaction. Therefore, there is a need for research to identify which elements are required in designing the social and physical environment (or ‘experience scape’) to increase the chance for people-to-people experiences to be successful and what elements are required for these experiences to help in building resilience in urban communities that can resist shocks and stresses. By means of a comparative case study approach in urban areas in Germany and the Netherlands, using a range of qualitative research methods such as in-depth interviews, focus groups, participant observation, storytelling techniques, and life stories, this research identifies relevant actors and their roles in creating building blocks of optimal experience scrapes for building resilience in communities.

Keywords: community development, experiences, experience scapes, resilience

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Authors: Jamaludin Tarkim, Yoga Teguh Guntara, Maftuhah

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Islamic leadership style is model of leadership style applied by the Prophet Muhammad SAW. Islamic leadership style is applied, namely Syura (deliberation), ‘Adl bil qisth (justice, with equality), and Hurriyyah al-kalam (freedom of expression) and along with the values of Islam in the Islamic leadership style. This research aims to gain an overview of the experience of Head Nurse in the implementation of Islamic leadership style. This research is a qualitative one with descriptive phenomenology design through in-depth interviews. Participants were occupied as Head Nurse at the Hospital room Syarif Hidayatullah, set directly (purposive) with the principle of suitability (appropriateness) and sufficiency (adequacy). Retrieval of data and research conducted during the month of June 2014. Data collected in the form of recording in-depth interviews and analysis with Collazi method. This research identified four themes Syura (deliberation);‘Adl bil qisth (justice, with equality); Hurriyyah al-kalam (freedom of expression) and along with the values of Islam in the Islamic leadership style. The results of this research can provide a review of the Head Room experience in the application of Islamic leadership style at Syarif Hidayatullah Hospital already skilled leadership during the process, but the application is still not maximized. Required further research on in-depth exploration of how to get more comprehensive results from room Head Nurse experience in the application of Islamic leadership style, as well as subsequent researchers can choose a wider scope and complex so get more complete data.

Keywords: experience, Islamic leadership style, head nurse, nursing management

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Authors: Arindam Chowdhury, Andres Tremante, Mohammadtaghi Moravej, Bodhisatta Hajra, Ioannis Zisis, Peter Irwin

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Extreme wind events, such as hurricanes, have caused significant damage to buildings, resulting in losses worth millions of dollars. The roof of a building is most vulnerable to wind-induced damage due to the high suctions experienced by the roof in extreme wind conditions. Wind turbines fitted to buildings can help generate energy, but to our knowledge, their application to wind load mitigation is not well known. This paper presents results from an experimental study to assess the effect of small wind turbines (developed and patented by the first and second authors) on the wind loads on a low rise building roof. The tests were carried out for an open terrain at the Wall of Wind (WOW) experimental facility at Florida International University (FIU), Miami, Florida, USA, for three cases – bare roof, roof fitted with wind turbines placed closer to the roof edges, and roof with wind turbines placed away from the roof edges. Results clearly indicate that the presence of the wind turbines reduced the mean and peak pressure coefficients (less suction) on the roof when compared to the bare deck case. Furthermore, the peak pressure coefficients were found to be lower (less suction) when the wind turbines were placed closer to the roof, than away from the roof. Flow visualization studies using smoke and gravel clearly showed that the presence of the turbines disrupted the formation of vortices formed by cornering winds, thereby reducing roof suctions and preventing lift off of roof coverings. This study shows that the wind turbines besides generating wind energy, can be used for mitigating wind induced damage to the building roof. Future research must be directed towards understanding the effect of these wind turbines on other roof geometries (e.g. hip/gable) in different terrain conditions.

Keywords: wall of wind, wind loads, wind turbine, building

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Authors: Priya Pawar, Rithika Susan Thomas, Emmanuel Blonkowski

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Due to the solar geometry of Singapore, which lay within the geographical classification of equatorial tropics, there is a great deal of thermal energy transfer to the inside of the buildings. With changing face of economic development of cities like Singapore, more and more buildings are designed to be lightweight using transparent construction materials such as glass. Increased demand for energy efficiency and reduced cooling load demands make it important for building designer and operators to adopt new and non-invasive technologies to achieve building energy efficiency targets. A real time performance evaluation study was undertaken at School of Art Design and Media (SADM), Singapore, to determine the efficiency potential of a new generation solar insulation film. The building has a window to wall ratio (WWR) of 100% and is fitted with high performance (low emissivity) double glazed units. The empirical data collected was then used to calibrate a computerized simulation model to understand the annual energy consumption based on existing conditions (baseline performance). It was found that the correlations of various parameters such as solar irradiance, solar heat flux, and outdoor air-temperatures quantification are significantly important to determine the cooling load during a particular period of testing.

Keywords: solar insulation film, building energy efficiency, tropics, cooling load

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Authors: Avadhoot Bhosale, Robin Davis P., Pradip Sarkar

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The seismic performance of buildings with irregular distribution of mass, stiffness and strength along the height may be significantly different from that of regular buildings with masonry infill. Masonry infilled reinforced concrete (RC) frames are very common structural forms used for multi-storey building construction. These structures are found to perform better in past earthquakes owing to additional strength, stiffness and energy dissipation in the infill walls. The seismic performance of a building depends on the variation of material, structural and geometrical properties. The sensitivity of these properties affects the seismic response of the building. The main objective of the sensitivity analysis is to found out the most sensitive parameter that affects the response of the building. This paper presents a sensitivity analysis by considering 5% and 95% probability value of random variable in the infills characteristics, trying to obtain a reasonable range of results representing a wide number of possible situations that can be met in practice by using pushover analysis. The results show that the strength-related variation values of concrete and masonry, with the exception of tensile strength of the concrete, have shown a significant effect on the structural performance and that this effect increases with the progress of damage condition for the concrete. The seismic risk assessments of the selected frames are expressed in terms of reliability index.

Keywords: fragility curve, sensitivity analysis, reliability index, RC frames

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Authors: Erika Duggan

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A Major Hospital had identified that there was no standard process for handling a patient’s medication that they brought with them to the hospital. It was also identified that each floor was handling the patient’s medication differently and storing it in multiple locations. Based on this disconnect many patients were leaving the hospital without their medication. The project team was tasked with creating a cohesive process to send a patient’s unneeded medication home on admission, storing any of the patient’s medication that could not be sent home, storing any of the patient’s medication for inpatient administration, and sending all of the patient’s medication home on discharge. The project team consisted of pharmacists, RNs, LPNs, members from nursing informatics and a project engineer and followed a DMAIC framework. Working together observations were performed to identify what was working and not working on the different floors which resulted in process maps. Using the multidisciplinary team, brainstorming, including affinity diagramming and other lean six sigma techniques, the best process for receiving, storing, and returning the medication was created. It was highlighted that being able to track the medication throughout the patient’s stay would be beneficial and would help make sure the medication left with the patient on discharge. Using an automated medications dispensing system would help store, and track patient’s medications. Also, the use of a specific order that would show up on the discharge instructions would assist the front line staff in retrieving the medication from a set location and sending it home with the patient. This new process will effectively streamline the admission and discharge process for patients who brought their medication with them as well as effectively tracking the medication during the patient’s stay. As well as increasing patient safety as it relates to medication administration.

Keywords: lean six sigma, medication dispensing, process improvement, process mapping

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Authors: Tian Yi Du, Guan Rong Fan, Dong Dong Zou, Di Xue

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Background: The patient satisfaction survey is becoming of increasing importance for hospitals or other providers to get more reimbursement and/or more governmental subsidies. However, when the results of patient satisfaction survey are compared among medical institutions, there are some concerns. The primary objectives of this study were to evaluate patient satisfaction in tertiary hospitals of Shanghai and to compare the satisfaction rating on physician services between patients and observers. Methods: Two hundred outpatients were randomly selected for patient satisfaction survey in each of 28 public tertiary hospitals of Shanghai. Four or five volunteers were selected to observe 5 physicians’ practice in each of above hospitals and rated observed physicians’ practice. The outpatients that the volunteers observed their physician practice also filled in the satisfaction questionnaires. The rating scale for outpatient survey and volunteers’ observation was: 1 (very dissatisfied) to 6 (very satisfied). If the rating was equal to or greater than 5, we considered the outpatients and volunteers were satisfied with the services. The validity and reliability of the measure were assessed. Multivariate regressions for each of the 4 dimensions and overall of patient satisfaction were used in analyses. Paired t tests were applied to analyze the rating agreement on physician services between outpatients and volunteers. Results: Overall, 90% of surveyed outpatients were satisfied with outpatient care in the tertiary public hospitals of Shanghai. The lowest three satisfaction rates were seen in the items of ‘Restrooms were sanitary and not crowded’ (81%), ‘It was convenient for the patient to pay medical bills’ (82%), and ‘Medical cost in the hospital was reasonable’ (84%). After adjusting the characteristics of patients, the patient satisfaction in general hospitals was higher than that in specialty hospitals. In addition, after controlling the patient characteristics and number of hospital visits, the hospitals with higher outpatient cost per visit had lower patient satisfaction. Paired t tests showed that the rating on 6 items in the dimension of physician services (total 14 items) was significantly different between outpatients and observers, in which 5 were rated lower by the observers than by the outpatients. Conclusions: The hospital managers and physicians should use patient satisfaction and observers’ evaluation to detect the room for improvement in areas such as social skills cost control, and medical ethics.

Keywords: patient satisfaction, observation, quality, hospital

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Authors: Bakr Gomaa

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Wind driven Cross ventilation is achieved when air moves indoors due to the pressure difference on the building envelope. This is especially important in breezy moderate to humid settings in which fast air flow can promote thermal comfort. Studies have shown that the use of simple building forms or ignoring the urban context when studying natural ventilation can lead to inaccurate results. In this paper, the impact of the urban form of a regular array of buildings is investigated to define the impact of this urban setting on cross ventilation potential. The objective of this paper is to provide the necessary tools to achieve natural ventilation for cooling purposes in an array of building blocks context. The array urban form has been studied before for natural ventilation purposes yet to the best of our knowledge no study has considered the relationship between the urban form and the pressure patterns that develop on the buildings envelope for cross ventilation. For this we use detailed weather data for a case study city of Alexandria (Egypt), as well as a validated CFD simulations to investigate the cross ventilation potential in terms of pressure patterns in waterfront as well as in-city wind flows perpendicular to the buildings array. it was found that for both waterfront and in-city wind speeds the windows needed for cross ventilation in rear raws of the array are significantly larger than those needed for front raw.

Keywords: Alexandria, CFD, cross ventilation, pressure coefficient

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Authors: Saba Baienat, Ivanka Iordanova, Bechara Helal

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Incorporating the principles of Design for Adaptability (DfAd) and Circular Economy (CE) into the service life planning of buildings and construction engineering projects can significantly enhance sustainable development. By employing DfAd, both the service life and design process can be optimized, gradually postponing the building’s End of Life (EoL) and extending the service life of buildings, thereby closing material cycles and making them more circular. This paper presents a comprehensive framework that addresses adaptability strategies and considerations to objectively assess the role of DfAd in circularity. The framework aims to provide a streamlined approach for accessing DfAd strategies and identifying the most effective ones for enhancing a project's adaptability. Key strategies include anticipating changes in requirements, enabling adaptations and transformations of the building for better use and reuse, preparing for future lives of the building and its components, and contributing to the circular material life cycle. Furthermore, the framework seeks to enhance the awareness of stakeholders about the subject of Design for Adaptability through the lens of the Circular Economy. Additionally, this paper integrates Life Cycle Assessment (LCA) methodologies to evaluate the environmental impacts of implementing DfAd strategies within the context of the Circular Economy. By utilizing LCA, the framework provides a quantitative basis for assessing the sustainability benefits of adaptable building designs, offering insights into how these strategies can minimize resource consumption, reduce emissions, and enhance overall environmental performance. This holistic approach underscores the critical role of LCA in bridging DfAd and CE, ultimately fostering more resilient and sustainable construction practices.

Keywords: circular economy (CE), design for adaptability (DfAd), life cycle assessment (LCA), sustainable development

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Authors: Nirand Anunthanakul

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This paper is to investigate a 54-story reinforced concrete residential tall building structures—238.8 meters high. Shear walls, core walls, and columns are the primary vertical components. Other special lateral components—core-outrigger and belt trusses—are studied and combined with the structural system in order to increase the structural stability during severe lateral load events, particularly, wind loads. The wind tunnel tests are conducted using the force balance technique. The overall wind loads and dynamics response of the building are also measured for 360 degrees of azimuth—basis for 10-degree intervals. The results from numerical analysis indicate that an outrigger and belt truss system clearly engages perimeter columns to efficiently reduce acceleration index and lateral deformations at the top level so that the building structures achieve lateral stability, and meet standard provision values.

Keywords: outrigger, belt truss, tall buildings, wind loadings

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Authors: Carolyne Ndungu, Wesley Too, Diana Kassaman

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Diabetes is a global public health problem with an increasing morbidity and mortality rate across the globe. It is reported that 422 million people worldwide have diabetes with type 2 diabetes more common in people of African descent. Whilst prevalence of diabetes is four times more than it was in the last three decades, making it the world's ninth greatest cause of mortality, treatment of complications resulting from poor glycemic control is still high, contributing to poverty level in sub-Saharan. Poor treatment adherence has also been identified as a major contributing factor poor glycemic control among diabetic patients and still remains a significant challenge especially among patients living in rural Kenya. This study therefore seeks to identify gaps, barriers and challenges towards medication non-adherence among diabetic patients on follow-up at Kiambu County Referral Hospital, Kenya. Methods: A cross- sectional descriptive study was carried out at Gatundu Level five Hospital in Kiambu County. The study population consisted of adult patients with type two diabetes mellitus (T2DM) on follow up, at the Diabetes clinic between the month of June to July 2022. Systematic sampling of 200 participants was carried out. Ethical approvals from relevant authorities were done and ethical aspects of the study were also observed. Data analysis is ongoing using logistic regression analysis. Results, recommendations -contribution of this study will be highlighted within the next one month.

Keywords: adherence, diabetes, medication, Kenya

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Authors: Riadh Habash, Kristina Djukic, Gandhi Habash

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Sustainable design is one of the emerging milestones in building construction. This concept is defined as buildings that on a yearly average consume as much energy as they generate using renewable energy sources. Realization of sustainable buildings requires a wide range of technologies, systems and solutions with varying degrees of complexity and sophistication, depending upon the location and surrounding environmental conditions. This paper will address not only the role of the above technologies and solutions but will provide solutions to reduce the electromagnetic fields (EMFs) in the building as much as possible so that the occupiers can recover from electro-hyper-sensitivity, if any. The objective is to maximize energy efficiency, optimize occupant comfort, reduce dependency on the grid and provide safer and healthier EMF environment especially for hypersensitive people. Creative architectural and engineering solutions that capitalize on the design of energy efficient technologies; combined cooling, heating and power (CCHP) microgrid (MG); and EMF mitigation will be presented.

Keywords: sustainable buildings, energy efficiency, thermal simulation, electromagnetic environment

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Authors: Calassandra Nwokoro

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Introduction: The nursing profession requires a lot of commitment, effort, and time to efficiently manage patients and provide them quality healthcare services, this work load may eventually cause the nurses to become burned out and experience psychological distress. This study assessed the prevalence of burnout, risk factors, and the coping strategies among nurses working in Lagos University Teaching Hospital (LUTH), Lagos state, Nigeria. Methodology: A descriptive cross-sectional study design was conducted among 308 nurses working in LUTH. Simple random sampling was used in selection of study respondents. The questionnaire comprised three parts; the sociodemographic characteristics of the respondents, the extent of burnout syndrome using the Maslach Burnout Inventory, and the coping strategies used among the respondents using the BRIEF-COPE Inventory. Results: This study revealed relatively high levels of burnout among the nurses in LUTH with a prevalence of 16.9%, 31.2% and 20.1% for high emotional exhaustion, high depersonalization and reduced professional accomplishment respectively. It also showed that burnout was significantly associated with long working hours. Religion was found to be the most commonly used coping strategy overall, while emotional support was the most frequently used coping strategy among nurses who had burnout. Conclusion: This study has revealed a relatively high prevalence of burnout among the nurses in Lagos University Teaching Hospital. In order to minimize the negative health impacts of burnout, the government should collaborate with psychologists and psychiatrists to implement regular stress management and stress inoculation programs for nurses and other health professionals in the country.

Keywords: burnout, nurses, coping strategies, healthcare

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Authors: Meena Kumari, Ajitha Sharma, Mohan Babu Amberkar, Hasitha Manohar, Joseph Thomas, K. L. Bairy

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Aim: To evaluate the pattern of occurrence of adverse drug reactions (ADRs) with platinum compounds in cancer chemotherapy at a tertiary care hospital. Methods: It was a retrospective, descriptive case record study done on patients admitted to the medical oncology ward of Kasturba Hospital, Manipal from July to November 2012. Inclusion criteria comprised of patients of both sexes and all ages diagnosed with cancer and were on platinum compounds, who developed at least one adverse drug reaction during or after the treatment period. CDSCO proforma was used for reporting ADRs. Causality was assessed using Naranjo Algorithm. Results: A total of 65 patients was included in the study. Females comprised of 67.69% and rest males. Around 49.23% of the ADRs were seen in the age group of 41-60 years, followed by 20 % in 21-40 years, 18.46% in patients over 60 years and 12.31% in 1-20 years age group. The anticancer agents which caused adverse drug reactions in our study were carboplatin (41.54%), cisplatin (36.92%) and oxaliplatin (21.54%). Most common adverse drug reactions observed were oral candidiasis (21.53%), vomiting (16.92%), anaemia (12.3%), diarrhoea (12.3%) and febrile neutropenia (0.08%). The results of the causality assessment of most of the cases were probable. Conclusion: The adverse effect of chemotherapeutic agents is a matter of concern in the pharmacological management of cancer as it affects the quality of life of patients. This information would be useful in identifying and minimizing preventable adverse drug reactions while generally enhancing the knowledge of the prescribers to deal with these adverse drug reactions more efficiently.

Keywords: adverse drug reactions, platinum compounds, cancer, chemotherapy

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Authors: Agnieszka Zalejska-Jonsson

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The Swedish Green Building Council (SGBC) was established in 2009. Since then, over 1000 buildings have been certified, of which approximately 600 are newly produced and 340 are residential buildings. During that time, approximately 2000 apartment buildings have been built in Sweden. This means that over a five- year period 17% of residential buildings have been certified according to the environmental building scheme. The certification of the building is not a guarantee of environmental progress but it gives us an indication of the extent of the progress. The overarching aim of this study is to investigate the factors behind the relatively slow evolution of the green residential housing market in Sweden. The intention is to examine stated willingness to pay (WTP) for green and low energy apartments, and to explore which factors have a significant effect on stated WTP among apartment owners. A green building was defined as a building certified according to the environmental scheme and a low energy building as a building designed and constructed with high energy efficiency goals. Data for this study were collected through a survey conducted among occupants of comparable apartment buildings: two green and one conventional. The total number of received responses was 429: green A (N=160), response rate 42%; green B (N=138) response rate 35%, and conventional (N=131) response rate 43%. The study applied a quasi-experimental method. Survey responses regarding factors affecting purchase of apartment, stated WTP and environmental literacy have been analysed using descriptive statistics, the Mann–Whitney (rank sum) test and logistic models. Comments received from respondents have been used for further interpretation of results. Results indicate that environmental education has a significant effect on stated WTP. Occupants who declared higher WTP showed a higher level of environmental literacy and indicated that energy efficiency was one of the important factors that affected their decision to buy an apartment. Generally, the respondents were more likely to pay more for low energy buildings than for green buildings. This is to a great extent a consequence of rational customer behaviour and difficulty in apprehending the meaning of green building certification. The analysis shows that people living in green buildings indicate higher WTP for both green and low energy buildings, the difference being statistically significant. It is concluded that growth in the green housing market in Sweden might be achieved if policymakers and developers engage in active education in the environmental labelling system. The demand for green buildings is more likely to increase when the difference between green and conventional buildings is easily understood and information is not only delivered by the estate agent, but is part of an environmental education programme.

Keywords: consumer, environmental education, housing market, stated WTP, Sweden

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Authors: A. Kaddour, S. M. A. Bekkouche

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Limiting heat losses during ventilation of indoor building spaces has become a basic aim for architects. Much experience has been gained in terms of ventilation of indoor spaces. Nevertheless, due to the complex applications, attempts to create a theoretical base for solving the problems related to the issue are limited, especially determining the minimum ventilation period required within a designated space. In this paper we have approached this matter, both theoretically and computationally. The conclusion we reached was that controlled ventilation of spaces through vent holes that successively open and close at regular time intervals can limit the excessive circulation of air masses, which in turn limits heat losses. Air change rates through open and tilted windows in rooms of residential buildings driven by atmospheric motions are investigated to evaluate natural ventilation concepts. Model of thermal building simulations is used. A separated sample storey and a sample single room in larger scales were used to measure air transport through window openings under the influence of the external pressure distribution.

Keywords: natural ventilation, temperature factor, air change rates, air circulation

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Authors: Songul Cinaroglu

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Regional planning in health has gained speed for developing countries in recent years. In Turkey, 89 different Public Hospital Unions (PHUs) were conducted based on provincial levels. In this study technical efficiencies of 89 PHUs were examined by using Data Envelopment Analysis (DEA) and machine learning techniques by dividing them into two clusters in terms of similarities of input and output indicators. Number of beds, physicians and nurses determined as input variables and number of outpatients, inpatients and surgical operations determined as output indicators. Before performing DEA, PHUs were grouped into two clusters. It is seen that the first cluster represents PHUs which have higher population, demand and service density than the others. The difference between clusters was statistically significant in terms of all study variables (p ˂ 0.001). After clustering, DEA was performed for general and for two clusters separately. It was found that 11% of PHUs were efficient in general, additionally 21% and 17% of them were efficient for the first and second clusters respectively. It is seen that PHUs, which are representing urban parts of the country and have higher population and service density, are more efficient than others. Random forest decision tree graph shows that number of inpatients is a determinative factor of efficiency of PHUs, which is a measure of service density. It is advisable for public health policy makers to use statistical learning methods in resource planning decisions to improve efficiency in health care.

Keywords: public hospital unions, efficiency, data envelopment analysis, random forest

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