129 research outputs found

    Human factors in the design of sustainable built environments

    Get PDF
    Scientific research provides convincing evidence that climate change is having significant impacts on many aspects of life. In the built-environment domain, regulatory requirements are pushing the challenges of environmental, economic, and social sustainability at the core of the professional agenda, although the aims of carbon reduction and energy conservation are frequently given a priority over occupants' comfort, well-being, and satisfaction. While most practitioners declare to embrace sustainability as a driver of their professional approach, a general lack of integrated creative and technical skills hinders the design of buildings centred on articulate and comprehensive sustainability goals, encompassing, other than energy criteria, also human-centred and ethical values founded on competent and informed consideration of the requirements of the site, the programme, and the occupants. Built environments are designed by humans to host a range of human activities. In response, this article aims to endorse a sustainable approach to design founded on the knowledge arising from scholarly and evidence-based research, exploring principles and criteria for the creation and operation of human habitats that can respond to energy and legislative demands, mitigate their environmental impacts, and adapt to new climate scenarios, while elevating the quality of experience and delight to those occupying them

    Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

    Get PDF
    Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme
    corecore