How Can Design Features and other Factors Affect the Indoor Air Quality in Inpatient Rooms? Check-Lists for the Design Phase, Daily Procedures and Maintenance Activities for Reducing the Air Concentrations of Chemical Pollution

Indoor Air Quality (IAQ) is one of main topics of Public Health on which international institutions and countries are taking action. With regards to healing architectures, several studies have reported data analysis and case studies to improve users’ health (patients, and medical and administrative staffs), but there are not enough regarding volatile organic compounds (VOCs). Regarding chemical pollution of indoor air, the Scientific Community has highlighted that there are several factors that affect the IAQ, in particular the design and management, and energetic efficiency, of inpatient wards. Several stakeholders, from the designers to the managers, are responsible for the indoor air in healing environments. Supported by analysis of the State of the Art and the main factors that influence the heterogeneous scenario of inpatient wards, the paper presents three check-lists, designed for supporting the stakeholders during the design phase, or for the daily procedures and maintenance activities, for pre-assessment of factors that affect chemical pollution, and for the definition of strategies to be applied. In fact, in such environments IAQ assumes a particular meaning and importance, both for the vulnerability of the patients and for the long time spent by the sanitary staff. The multidisciplinary approach emphasizes the continuous need for interdisciplinary knowledge and skills aimed at finding solutions able to protect users’ health status (including patients, workers and visitors), especially in the field of the indoor air issue

Architectures for paediatric palliative care: how to improve quality of life and environmental well-being

Introduction. The influence of the environment on wellness, not only for patients themselves but for all care-givers as well, refers to the humanisation principles of spaces of care. Commencing with an analysis of existing paediatric hospices, the paper examines design suggestions for prosthetic environments, considered as a fundamental component in the healing process. Methodology. A prosthetic environment can be created only through a specific knowledge of the real needs of users. Therefore, some scholars have conducted research work for defining the best practices for healing environments, supported by an assessment and comparison of case studies. The methodology is based on two phases: the first is based on interviews with experts in hospice design and management and the second, through the application of a questionnaire to several users. Discussion and Results. The output of the work is the achievement of a logical, sequential and participatory broad-spectrum process in the design of health facilities in order to cause a sustainable awareness in paediatric hospices. Conclusion. Starting from the research work, it is necessary to define a scientific method for implementing knowledge on health, psychological, perceptual and behavioural needs to contribute towards proper planning for meeting the real requirements of users

Healthcare for all in emerging countries: a preliminary investigation of facilities in Kolkata, India

Introduction. India is one of the five countries with the lowest public health spending levels: the private medical services are one of the most developed fields, meanwhile public health ones are totally inadequate with the most number of health facilities concentrated in cities, where only the 25% of the population lives. Public facilities are mainly made up of primary level and not well distributed on the territories, so they do not guarantee accessibility to a wide sample of population, who live in rural areas of India. Methodology. Starting from the analysis of three different health care levels in the Indian context, the research team developed a meta-project that considers all the current criticisms and the Indian customs through a flexible layout that responds to the healthcare needs of population. Result and Discussion. The research work is aimed to develop a meta-project that considers all the current criticisms and the Indian customs through flexible layouts that responds to the healthcare needs of population. Conclusion. The innovation of the research work is to develop the hygienic aspects, the layout and the distribution, the sub-division of the medical functions through the Indian culture and the needs of the country. The choice of lowly technologies permits to promote the usage of local materials, their maintenance and skills for creating a virtuous economic system

Open building and flexibility in healthcare: strategies for shaping spaces for social aspects

Introduction. The fast development of technology and medicine influences the functioning of healthcare facilities as health promoter for the society, making the flexibility a fundamental requirement. Among the many ways to ensure adaptability, one that allows change without increasing the building’s overall size is the Open Building approach. Methodology. Starting from the analysis of the State-of-the-Art and many case-studies, eight parameters of evaluation were defined, appraising their relative importance through a weighting system defined with several experts. The resulting evaluation tool establishes in what measure healthcare facilities follow the Open Building principles. Results and discussion. The tool is tested to ten case-studies, chosen for their flexible features, in order to determine his effectiveness and to identify projects’ weaknesses and strengths. Conclusions. The results suggest that many Open Building’s principles are already in use but, only through a good design thinking, it will be possible to guarantee architectures for health adaptable for future social challenges

Bridging therapeutic landscapes to architecture. International experience-based design strategies for healthcare infrastructures

Background and aim: in Italy, many cases studies of therapeutic green spaces are built into healthcare infrastructures, but only some of these follow the principles of healing gardens. Scientific literature and international case studies offer many contributions of evidence relating to how therapeutic green spaces can support traditional treatments. The paper analyze the relationship between indoor and outdoor spaces and healing gardens' features; the main research questions were: "Can we synthetize experience-based design strategies for therapeutic green spaces and healing gardens? How can we prioritize the most relevant ones for the healthcare infrastructures?" Methods: Research Method is divided into three different steps: 1st case studies' selection; 2nd case studies' analysis, and 3rd quali-quantitative comparative matrix. Results: ten case studies were identifiedfour of them have the therapeutic green space on the ground floor,despite of the other six having the healing garden on the rooftop.The best experience-based design strategies for the therapeutic green spaces or healing gardens development were identified from the previous comparison matrix, and divided into A.Safety, Security and Privacy; B.Accessibility; C.Physical and Emotional Comfort; D.Positive distraction; E.Engagement with Nature; F.Maintenance and Aesthetics; and G.Sustainability. Conclusions: The results obtained from the comparative matrix are qualitative and quantitative design elements in terms of type of element / space, percentage, perimeter, area, number, materiality, shape, color, among others. The quali-quantitative matrix is a useful and practical tool that allows the designer to have a base of design guidelines that can be later applied to the proposal of new therapeutic gardens

The Enhancement of Special-Use Real Estate Properties: The Case of Hospital Facilities

In the Italian context, public investments for the redevelopment and securing of the National Health Service’s real estate assets are a crucial topic in the context of the National Recovery and Resilience Plan (NRRP) within the Next Generation Italian strategy. The paper proposes the evaluation of alternative scenarios for accessing financing under the NRRP with respect to the criterion of the technically efficient solution, i.e., the solution that minimizes investment costs while respecting time obligations. The methodology proposed refers to the Cost approach with specific reference to the Depreciated Replacement Cost Method (DRC) in order to estimate the market value in different scenarios. The approach is applied to a case study located in the Piedmont Region, where alternatives are compared with respect to both budget constraints and the timeframe for accessing financing. Given the growing concern for urban regeneration and “public city” rearrangement as an answer to the ongoing global changes, making investments in special-use real estate properties has become a central and challenging issue both in the public and private decision domains

Does the energy-environmental Kuznets curve hypothesis sustain in the Asia-Pacific region?

As mitigating the effects of energy consumption on the environment is a crucial issue for the Asia-Pacific region, this study investigates the energy-environmental Kuznets curve (EEKC) hypothesis among the 19 Asia-Pacific regions. The study also test the hypothesis for the low-, middle-, and high-income groups of the region. The panel regression and cointegration models are used for this purpose. Both models suggest that the EEKC hypothesis does sustain for the whole Asia-Pacific region. However, the test performed on the income groups revealed that the hypothesis only holds for the high-income group and the low- and middle-income groups do not satisfy the hypothesis. This is likely indicating that the transition in the energy consumption along the EEKC is only occurring in the developed countries of the Asia-Pacific region

Architetture per la salute nelle situazioni di emergenza

Emergenza e infrastrutture sanitarie Sono molte le condizioni di emergenza che, nel panorama globale attuale, ci si trova ad affrontare. Da definizione, lo “stato di emergenza” è una misura adottata per affrontare casi di pericolo e/o minaccia imminente, e solitamente viene dichiarato quando si verifica un disastro naturale, oppure la presenza di disordini civili o a seguito di una dichiarazione di guerra. Caratteri differenti e molteplici distinguono l’ampia casistica delle situazioni di emergenza e altrettante criticità si presentano nel momento in cui l’uomo cerca di porvi rimedio con risposte differenti per temporaneità, efficacia ed impatto dell’intervento sul territorio. Negli ultimi anni si sono registrati numerosi eventi che hanno determinato situazioni di emergenza a livello sanitario-epidemico, ambientale e socio-politico, a scala globale o locale. Seppur dovuti da differenti cause, l’aspetto che accomuna questi diversi stati di emergenza è la necessità di garantire strutture socio sanitarie e abitative che possano supportare le operazioni di primo soccorso. In tale contesto, pertanto, è di fondamentale importanza la risposta delle strutture sanitarie esistenti e/o l’allestimento di strutture socio-sanitarie e abitative in grado di assicurare un ricovero a coloro che hanno dovuto abbandonare la propria abitazione. Tale tema risulta essere estremamente attuale e di fondamentale importanza all’interno del quadro sociale globale perché tale condizione implica necessariamente una diffusione capillare della conoscenza delle suddette tematiche, in modo tale da implementare e migliorare la risposta all’emergenza. Casi esemplificativi a scala nazionale e internazionale Attualmente, in diversi contesti sociopolitici piuttosto critici per la presenza di conflitti bellici, le architetture per la salute si sono adattate per rispondere a diverse esigenze di emergenza: per esempio nell’Assuta Hospital in Israele i piani parcheggi interrati sono stati concepiti come dei veri e propri bunker e sono stati pertanto progettati per poter trasformarsi in aree sanitarie e rispondere alla necessità emergenziale di garantire il servizio sanitario anche in caso di attacco aereo. La flessibilità degli spazi e delle organizzazioni risulta essere quindi un requisito fondamentale per far fronte a diverse situazioni emergenziali siano esse temporanee o prolungate nel tempo. Sul territorio nazionale, invece, si può osservare come nell’area del Pronto Soccorso (Dipartimento Emergenza e Accettazione) degli ospedali italiani è possibile trovare aree dedicate ad affrontare similari situazioni, anche se meno consuete. È il caso dell’area “Bioterrorismo – decontaminazione” e l’area polifunzionale “Catastrofi – Emergenze”, composta da spazi “polmone” adatti ad ospitare un numero elevato di utenti al sopraggiungere di specifiche situazioni di emergenza. Tali locali non afferiscono a quegli spazi obbligatori che la normativa nazionale prescrive sotto forma di requisiti strutturali, tecnologici ed organizzativi minimi per l’esercizio delle attività sanitarie da parte delle strutture pubbliche e private per Decreto del Presidente della Repubblica del 14/01/1997. L’analisi approfondita di alcune aree di Pronto Soccorso di recente realizzazione in Italia, ha evidenziato che in 4 casi su 16 (25%) è possibile riscontrare la presenza di aree “Bioterrorismo – decontaminazione”, mentre in un solo caso (6%) si è rilevata la presenza dell’area polifunzionale “Catastrofi – Emergenze”. Questi dati evidenziano una grande criticità e carenza di spazi per la gestione straordinaria delle emergenze attraverso le strutture ospedaliere italiane, anche alla luce di recenti stime che propendono per una crescita sempre maggiore di emergenze per cause naturali e non, già in continuo aumento. Criticità delle strutture sanitarie italiane La carenza di spazi dedicati all’interno delle aree di Pronto Soccorso per rispondere alle grandi emergenze, la mancanza di una cultura diffusa sul tema e l’obsolescenza della maggior parte delle strutture sanitarie italiane (oltre il 70% è stato realizzato prima del 1970), porta ad individuare nell’allestimento di campi di emergenza temporanei la soluzione più ottimale e strategica. Attraverso la raccolta di informazioni riguardo la tematica delle strutture socio-sanitarie e abitative per l’emergenza, però emerge una mancanza di competenze adeguate da parte di volontari e operatori che per le prime volte si sono trovati a lavorare nell’ambito della realizzazione di tali allestimenti. Obiettivo della ricerca Pertanto, emerge la necessità di proporre strategie organizzative e indicazioni progettuali sulla realizzazione e sul funzionamento dei campi di primo soccorso e di tutte le strutture adibite alla cura in situazioni di emergenza che possono anche configurarsi come tendopoli. L’obiettivo è quello di rispondere alle necessità di diffondere e rendere facilmente accessibili la conoscenza delle principali procedure attuabili in condizioni di emergenza di vario genere. Metodologia Supportati da un ampio campione di casi studio, si sono distinti gli stessi in tre grandi macro-gruppi, caratterizzanti le tre principali tipologie di emergenze, ovvero: • legate ad una componente epidemica; • generate da un evento naturale o climatico disastroso; • dovute a problematiche sociali e politiche, quali le guerre e migrazioni. Per la raccolta dei materiali utili, è seguita una prima fase di analisi di casi studio, basata sulla tipologia di struttura relazionata alle dimensioni, il numero di pazienti ospitabili e il numero di operatori necessari per gestirla; il tutto è quindi stato posto in relazione alla tipologia di emergenza che la tendopoli o la struttura sanitaria si trovavano a dover affrontare. Una matrice di analisi basata su dati quantitativi (quali l’estensione, la capacità ricettiva e la permanenza) e qualitativi (come l’organizzazione logistica delle funzioni interne) ha permesso di confrontare diversi casi studio internazionali. L’obiettivo di tale analisi è la comprensione delle modalità di pianificazione e allestimento delle diverse tipologie di strutture per l’urgenza. A partire dalla matrice di confronto, i casi studio sono stati sottoposti ad un’analisi critica che ha permesso di analizzare le differenti funzioni al loro interno, la loro organizzazione e le relazioni spaziali e funzionali in essere tra le diverse aree. Questa analisi ha permesso così di sviluppare una coscienza critica riguardo alle corrette modalità di realizzazione delle strutture in questione e una maggior consapevolezza riguardo gli accorgimenti da mettere in atto nelle fasi di progettazione e allestimento delle stesse. Risultati e sviluppi della ricerca Il risultato finale si traduce in una proposta meta-progettuale di layout funzionali, rispettivamente per ogni macro-area, e la definizione delle principali raccomandazioni che costituiscono un supporto alla realizzazione e all’allestimento del soccorso sanitario per le vittime colpite da calamità naturali, problematiche socio-politiche o emergenza di carattere epidemico. Tali considerazioni, suddivise in base alle diverse tipologiche di evento catastrofico, possono supportare i decisori nella scelta delle strategie ottimali da attuare quali l’individuazione dell’area, la programmazione delle fasi di soccorso e di insediamento, e l’applicazione delle relazioni funzionali e spaziali più adeguate ed efficaci. Il lavoro di ricerca si pone dunque come punto di partenza per un più approfondito studio riguardante le modalità che meglio si adattano ad ogni contesto di rischio, per effettuare scelte consapevoli, efficaci e coerenti rispetto alla tipologia di emergenza che ci si trova ad affrontare

Humanisation and soft qualities in emergency rooms

Scenario. Currently, there are few evaluation methods that analyse social aspects in healthcare issues, especially humanisation and well-being, as perceived by users in emergency departments which are places in which patients’ psycho-physical well-being is decisive. For this reason, research was conducted to create a tool to improve the quality of these areas. Methodology. In order to conduct the research, the work was structured in three phases: the first, based on the analysis of State-of-the-Art and the current studies on the interactions established between the physical and emotional conditions of the structure and the users; the second, through the definition of a questionnaire which explores humanisation and comfort aspects; the third, through the application of the instrument. Results. The paper presents and analyses data collected from the application on a case study in Milan, analysing the responses and proposing design suggestions for increasing the quality of emergency environments. Conclusions. In anticipation of future works, the application of such a tool can provide the opportunity to improve and enhance quality and staff efficiency in emergency department spaces

Geothermal resources within carbonate reservoirs in western Sicily (Italy): A review

Abstract Low-to-medium temperature fluid reservoirs hosted in carbonate rocks are some of the most promising and unknown geothermal systems. Western Sicily is considered a key exploration area. This paper illustrate a multidisciplinary and integrated review of the existing geological, geochemical and geophysical data, mainly acquired during oil and gas explorations since the 1950s, specifically re-analyzed for geothermal purposes, has led to understanding the western Sicily geothermal system as a whole, and to reconstructing the modalities and particular features of the deep fluid circulation within the regional reservoir. The data review suggests the presence of wide groundwater flow systems in the reservoir beneath impervious cap rocks. We identified the main recharge areas, reconstructed the temperature distribution at depth, recognized zones of convective geothermal flow, and depicted the main geothermal fluid flow paths within the reservoir. We believe that our reconstruction of geothermal fluid circulation is an example of the general behavior of low-to-medium enthalpy geothermal systems hosted in carbonate units on a regional scale. Due to the recent technological developments of binary plants, these systems have become more profitable, not only for geothermal direct uses but also for power production