Beyond the performance gap: reclaiming building appraisal through archival research

Current debates about building performance evaluation often emphasise the ‘performance gap’ between how buildings perform in practice and how performance was envisaged during the design stage. While such debates continue to be dominated by energy considerations, increasing attention is directed towards the subjective experiences of building users in terms of thermal comfort and wellbeing. The latter trends are undoubtedly to be welcomed, but buildings continue to be conceptualised as fixed physical objects rather than entities that are enacted in practice. With the aim of challenging current assumptions, research is described which sought to reclaim the concept of building appraisal as practised by the pioneering architectural practice DEGW. The concept of building appraisal differs from current notions of building performance evaluation in that the point of departure was not the supposedly fixed entity of the building, but the essential fluidity of the occupying organisation and their aspirations in terms of space. Empirical data is derived from archival sources and through extensive interaction with the DEGW diaspora, many of whom remain active at the leading edge of international practice. It is concluded that the continued fixation with the ‘performance gap’ reinforces long-since discredited assumptions of environmental determinism

Embedding building performance evaluation in UK architectural practice and beyond

Despite repeated efforts to foreground Post-occupancy evaluation (POE) in many countries, few have any policy or legislation in place to mandate this process. Large scale voluntary efforts have also failed to provide successful templates through which to mainstream broader Building performance Evaluation (BPE) activity within which POE sits. This paper reviews various programmes and initiatives in the UK which have attempted to embed first POE, then BPE over the last twenty years within a global context, using a practice-based approach based on the author’s experience of working in the field over this period. Key findings are: a failure of government to systemically follow through on BPE initiatives, stakeholders operating independently of eachother, a lack of institutional engagement in the education sector as a key driver for BPE, and the potential for interdisciplinary models to embrace all members of the design team as well as the client. The paper then examines the means by which BPE has been successfully embedded into practice directly, through deep organisational learning and knowledge exchange activities. Recommendations for these models to be replicated through professional institutions, other learning organisations and regulatory frameworks in the UK are put forward in the Conclusion as a way forward

Developing, validating and testing a Ward Environment Assessment Tool: WEAT

Aims To develop, validate and test a ward environment assessment tool (WEAT) for post-occupancy evaluation of hospital wards from the perspectives of ward nurses, using Person-Environment fit theory. Background It is argued that as the needs and expectations of various user groups of healthcare facilities would vary, so would the tools to measure the suitability of the architectural design features of these healing environments for different groups of users. However, a review of relevant literature revealed that there is a dearth of assessment tools to appraise the adequacy of healthcare facilities for nursing staff. Methods Extant literature was reviewed to construct WEAT. Twenty ward nurses were interviewed to obtain user perspectives on the ward environment. Post-occupancy evaluation of three hospital wards was undertaken to validate and test WEAT. Results WEAT: A new post-occupancy evaluation tool was created. Conclusions WEAT measures the impacts of ward environment on nurses in four personal constructs; namely physical, cognitive, sensory and universal. Implications for Nursing Management WEAT is an innovative management decision-making tool for ward managers, who may use its results to argue for workspace redesign with facilities managers, explore job readjustments with occupational health nurses, and review job description with human resource managers

Intensity Modulated Radiotherapy (IMRT) and Fractionated Stereotactic Radiotherapy (FSRT) for children with head-and-neck-rhabdomyosarcoma

<p>Abstract</p> <p>Background</p> <p>The present study evaluates the outcome of 19 children with rhabdomyosarcoma of the head-and-neck region treated with Intensity Modulated Radiotherapy (IMRT) or Fractionated Stereotactic Radiotherapy (FSRT) between August 1995 and November 2005.</p> <p>Methods</p> <p>We treated 19 children with head-and-neck rhabdomyosarcoma with FSRT (n = 14) or IMRT (n = 5) as a part of multimodal therapy. Median age at the time of radiation therapy was 5 years (range 2–15 years). All children received systemic chemotherapy according to the German Soft Tissue Sarcoma Study protocols.</p> <p>Median size of treatment volume for RT was 93,4 ml. We applied a median total dose of 45 Gy (range 32 Gy – 54 Gy) using a median fractionation of 5 × 1,8 Gy/week (range 1,6 Gy – 1,8 Gy).</p> <p>The median time interval between primary diagnosis and radiation therapy was 5 months (range 3–9 months).</p> <p>Results</p> <p>After RT, the 3- and 5-year survival rate was 94%. The 3- and 5-year actuarial local control rate after RT was 89%.</p> <p>The actuarial freedom of distant metastases rate at 3- and 5-years was 89% for all patients.</p> <p>Radiotherapy was well tolerated in all children and could be completed without interruptions > 4 days. No toxicities >CTC grade 2 were observed. The median follow-up time after RT was 17 months.</p> <p>Conclusion</p> <p>IMRT and FSRT lead to excellent outcome in children with head-and-neck RMS with a low incidence of treatment-related side effects.</p

Prognostic implications of type and density of tumour-infiltrating lymphocytes in gastric cancer

The study aims to determine whether type and density of tumour-infiltrating lymphocytes (TILs) can predict the clinical course in gastric cancer. Gastric carcinomas (n=220) were immunostained for CD3, CD8, CD20, and CD45RO and evaluated for clinicopathologic characteristics. Number of TILs that immunostained positively for each marker were counted using NIH ImageJ software. Tumours were grouped into low- and high-density groups for each marker (CD3, CD8, CD45RO). The densities of CD3+, CD8+, and CD45RO+ TILs were found to be independent predictors of lymph node metastasis by multivariate analysis with odds ratios (95% CI) of 0.425 (0.204–0.885), 0.325 (0.150–0.707), and 0.402 (0.190–0.850), respectively. Kaplan–Meier survival analysis revealed that patients in the high-density groups for CD3, CD8, and C45RO had a significantly longer survival time than the patients in the corresponding low-density groups, respectively. In multivariate survival analysis, the densities of CD3+, CD8+, and CD45RO+ TILs remained independent prognostic factors with hazard ratios (95% CI) of 0.549 (0.317–0.951), 0.574 (0.347–0.949), and 0.507 (0.298–0.862), respectively. In conclusion, density of TILs was found to be independently predictive of regional lymph node metastasis and patient survival in gastric cancer