Functional recovery of a resilient hospital type

Four adaptation options for ‘Nightingale’-type hospital ward buildings devised with practising clinicians are presented and evaluated. The adaptations recover functionality in an archaic ward configuration by delivering care to current UK National Health Service (NHS) models whilst preserving resilience to summer overheating. The investigation builds on recent work that demonstrates the significant resilience to heatwaves enjoyed by such traditionally constructed communal dormitories, the dominant UK hospital type between the late 1850s and 1939. Nightingale wards are potentially well-ventilated naturally, with good dilution of airborne pathogens. Although condemned as outdated by health ministers in recent years, many remain in use. As financial retrenchment suggests economical, creative refurbishment of hospitals will be required rather than new-build and replacement, the authors argue for health estates’ strategies that place value on resilience in a changing climate. Proposed adaptation options are investigated to assess resulting internal airflows and patient exposure to airborne pathogens. Options are costed and payback periods calculated to the standard public sector methodology. The proposed adaptations save time and cost over new-build equivalents. Selection of the most appropriate option is dependent on the characteristics of the patient cohort and care required.Four adaptation options for ‘Nightingale’-type hospital ward buildings devised with practising clinicians are presented and evaluated. The adaptations recover functionality in an archaic ward configuration by delivering care to current UK National Health Service (NHS) models whilst preserving resilience to summer overheating. The investigation builds on recent work that demonstrates the significant resilience to heatwaves enjoyed by such traditionally constructed communal dormitories, the dominant UK hospital type between the late 1850s and 1939. Nightingale wards are potentially well-ventilated naturally, with good dilution of airborne pathogens. Although condemned as outdated by health ministers in recent years, many remain in use. As financial retrenchment suggests economical, creative refurbishment of hospitals will be required rather than new-build and replacement, the authors argue for health estates’ strategies that place value on resilience in a changing climate. Proposed adaptation options are investigated to assess resulting internal airflows and patient exposure to airborne pathogens. Options are costed and payback periods calculated to the standard public sector methodology. The proposed adaptations save time and cost over new-build equivalents. Selection of the most appropriate option is dependent on the characteristics of the patient cohort and care required.This is the final published version distributed under a Creative Commons Attribution License 2.0, which can also be viewed on the publisher's website at: http://www.tandfonline.com/doi/full/10.1080/09613218.2014.926605#.U8ZFv_ldXH

A medium-rise 1970s maternity hospital in the east of England: Resilience and adaptation to climate change

The late 1970s design for the Rosie Maternity Hospital on the Addenbrookes campus in Cambridge is a recurring type across the UK National Health Service, a framed three-storey courtyard configuration in brick masonry. It was selected as a case study project for the ‘Design and Delivery of Robust Hospitals in a Changing Climate’ project, pursuing the methodology developed for that research. Temperature data were collected in representative spaces within the hospital, over a two-year period. These revealed overheating in mild conditions relative to an observed 24℃ threshold for sleep but concealed within the customary 28℃ threshold marking the upper limit of acceptable conditions. The building was modelled using current climate data to predict 2010 conditions. The model was then calibrated against the observed 2010 data and used to predict the likely internal temperatures in current and 2030s. The results indicated an increase in peak temperatures. Four adaptive intervention schemes were subsequently developed: an ‘enlightened’ industry standard ‘Passivhaus’-type option providing superinsulation, sealed glazing and heat recovery; a lower technology-based scheme promoting natural cross-ventilation by providing greater opening glazing area, opening up the plan, sunshading and additional insulation; an enhanced natural ventilation scheme glazing over the courtyards to provide supply air winter gardens, and an advanced natural ventilation option pursuing passive downdraught cooling. All four schemes were modelled using the projected current and 2030s weather data and their performance was compared. The schemes were fully costed to yield relative ‘value for money’ guidance to National Health Service Trusts. Practical application: The Heat wave Plan for England 2014 warns National Health Service (NHS) organisations of the risks to patients, particularly the very young, the elderly and the seriously ill, from extreme summer heat events.1 The Chief Medical Officer in her introduction challenges each NHS locality to plan well in advance of hot spells, as appropriate. This paper describes the likely extent of overheating risk and a series of potential adaptation plans for a recurring NHS hospital building type. As a consequence, estates and facilities decision makers in NHS organisations and Public Health England officers charged with the mitigation of risk resulting from overheating of wards and clinical spaces will benefit directly in their necessary decision making from the findings. Policy makers in the Department of Health and policy advisors in the NHS Sustainable Development Unit and the Climate Change Committee Adaptation Sub-Committee will benefit from the evidence presented in advising the NHS and Department of Health. This work was undertaken at part of the UK Engineering and Physical Sciences Research Council project, ‘Design and Delivery of Robust Hospital Environments in a Changing Climate’ [grant number EP/G061327/1] through the ‘Adaptation and Resilience to a Changing Climate’ (ARCC) programme under the auspices of the ‘Living with Environmental Change’ (LWEC) initiative. The Project also received funding directly from the Department of Health.This is the final version. It was first published by Sage at http://bse.sagepub.com/content/early/2015/01/30/0143624414567544

Excising Infection in the Surgical Environment

A new AHRC initiative is exploring the architecture and design of operating theatres and what it could mean for AMR research

An Assessment of Recent and Future Temperature Change over the Sichuan Basin, China, using CMIP5 Climate Models

The Sichuan basin is one of the most densely populated regions of China, making the area particularly vulnerable to the adverse impacts associated with future climate change. As such, climate models are important for understanding regional and local impacts of climate change and variability, like heat stress and drought. In this study, climate models from phase 5 of the Coupled Model Intercomparison Project (CMIP5) are validated over the Sichuan basin by evaluating how well each model can capture the phase, amplitude, and variability of the regionally observed mean, maximum, and minimum temperature between 1979 and 2005. The results reveal that the majority of the models do not capture the basic spatial pattern and observed means, trends, and probability distribution functions. In particular, mean and minimum temperatures are underestimated, especially during the winter, resulting in biases exceeding −3°C. Models that reasonably represent the complex basin topography are found to generally have lower biases overall. The five most skillful climate models with respect to the regional climate of the Sichuan basin are selected to explore twenty-first-century temperature projections for the region. Under the CMIP5 high-emission future climate change scenario, representative concentration pathway 8.5 (RCP8.5), the temperatures are projected to increase by approximately 4°C (with an average warming rate of +0.72°C decade−1), with the greatest warming located over the central plains of the Sichuan basin, by 2100. Moreover, the frequency of extreme months (where mean temperature exceeds 28°C) is shown to increase in the twenty-first century at a faster rate compared to the twentieth century.Funding for this research was provided by the Engineering and Physical Sciences Research Council (EPSRC) as part of the Low Carbon Climate-Responsive Heating and Cooling of Cities (LoHCool) project (EP/N009797/1)

Excising Infection in the Surgical Environment (ExISE)

A new AHRC initiative is exploring the architecture and design of operating theatres and what it could mean for AMR research. </jats:p

Is preference for mHealth intervention delivery platform associated with delivery platform familiarity?

Published online: 22 July 2016Background: The aim of this paper was to ascertain whether greater familiarity with a smartphone or tablet was associated with participants’ preferred mobile delivery modality for eHealth interventions. Methods: Data from 1865 people who participated in the Australian Health and Social Science panel study were included into two multinomial logistic regression analyses in which preference for smartphone and tablet delivery for general or personalised eHealth interventions were regressed onto device familiarity and the covariates of sex, age and education. Results: People were more likely to prefer both general and personalised eHealth interventions presented on tablets if they reported high or moderate tablet familiarity (compared to low familiarity) and people were more likely to prefer both general and personalised eHealth interventions presented on smartphones if they reported high or moderate smartphone familiarity, were younger, and had university education (compared to completing high school or less). Conclusion: People prefer receiving eHealth interventions on the mobile devices they are most familiar with. These findings have important implications that should be considered when developing eHealth interventions, and demonstrates that eHealth interventions should be delivered using multiple platforms simultaneously to optimally cater for as many people as possible.Daniel Granger, Corneel Vandelanotte, Mitch J. Duncan, Stephanie Alley, Stephanie Schoeppe, Camille Short and Amanda Reba

A Pan-African Convection-Permitting Regional Climate Simulation with the Met Office Unified Model: CP4-Africa

This is the final version. Available on open access from the American Meteorological Society via the DOI in this recordA convection-permitting multiyear regional climate simulation using the Met Office Unified Model has been run for the first time on an Africa-wide domain. The model has been run as part of the Future Climate for Africa (FCFA) Improving Model Processes for African Climate (IMPALA) project, and its configuration, domain, and forcing data are described here in detail. The model [Pan-African Convection-Permitting Regional Climate Simulation with the Met Office UM (CP4-Africa)] uses a 4.5-km horizontal grid spacing at the equator and is run without a convection parameterization, nested within a global atmospheric model driven by observations at the sea surface, which does include a convection scheme. An additional regional simulation, with identical resolution and physical parameterizations to the global model, but with the domain, land surface, and aerosol climatologies of CP4-Africa, has been run to aid in the understanding of the differences between the CP4-Africa and global model, in particular to isolate the impact of the convection parameterization and resolution. The effect of enforcing moisture conservation in CP4-Africa is described and its impact on reducing extreme precipitation values is assessed. Preliminary results from the first five years of the CP4-Africa simulation show substantial improvements in JJA average rainfall compared to the parameterized convection models, with most notably a reduction in the persistent dry bias in West Africa, giving an indication of the benefits to be gained from running a convection-permitting simulation over the whole African continent.Natural Environment Research Council (NERC

The development and validation of measures to assess cooking skills and food skills

BACKGROUND: With the increase use of convenience food and eating outside the home environment being linked to the obesity epidemic, the need to assess and monitor individuals cooking and food skills is key to help intervene where necessary to promote the usage of these skills. Therefore, this research aimed to develop and validate a measure for cooking skills and one for food skills, that are clearly described, relatable, user-friendly, suitable for different types of studies, and applicable across all sociodemographic levels. METHODS: Two measures were developed in light of the literature and expert opinion and piloted for clarity and ease of use. Following this, four studies were undertaken across different cohorts (including a sample of students, both 'Food preparation novices' and 'Experienced food preparers', and a nationally representative sample) to assess temporal stability, psychometrics, internal consistency reliability and construct validity of both measures. Analysis included T-tests, Pearson's correlations, factor analysis, and Cronbach's alphas, with a significance level of 0.05. RESULTS: Both measures were found to have a significant level of temporal stability (P < 0.001). Factor analysis revealed three factors with eigenvalues over 1, with two items in a third factor outside the two suggested measures. The internal consistency reliability for the cooking skills confidence measure ranged from 0.78 to 0.93 across all cohorts. The food skills confidence measure's Cronbach's alpha's ranged from 0.85 to 0.94. The two measures also showed a high discriminate validity as there were significant differences (P < 0.05 for cooking skills confidence and P < 0.01 for food skills confidence) between Food preparation novices' and 'Experienced food preparers.' CONCLUSIONS: The cooking skills confidence measure and the food skills confidence measure have been shown to have a very satisfactory reliability, validity and are consistent over time. Their user-friendly applicability make both measures highly suitable for large scale cross-sectional, longitudinal and intervention studies to assess or monitor cooking and food skills levels and confidence

Nitrogen uptake and internal recycling in Zostera marina exposed to oyster farming: eelgrass potential as a natural biofilter

Oyster farming in estuaries and coastal lagoons frequently overlaps with the distribution of seagrass meadows, yet there are few studies on how this aquaculture practice affects seagrass physiology. We compared in situ nitrogen uptake and the productivity of Zostera marina shoots growing near off-bottom longlines and at a site not affected by oyster farming in San Quintin Bay, a coastal lagoon in Baja California, Mexico. We used benthic chambers to measure leaf NH4 (+) uptake capacities by pulse labeling with (NH4)-N-15 (+) and plant photosynthesis and respiration. The internal N-15 resorption/recycling was measured in shoots 2 weeks after incubations. The natural isotopic composition of eelgrass tissues and vegetative descriptors were also examined. Plants growing at the oyster farming site showed a higher leaf NH4 (+) uptake rate (33.1 mmol NH4 (+) m(-2) day(-1)) relative to those not exposed to oyster cultures (25.6 mmol NH4 (+) m(-2) day(-1)). We calculated that an eelgrass meadow of 15-16 ha (which represents only about 3-4 % of the subtidal eelgrass meadow cover in the western arm of the lagoon) can potentially incorporate the total amount of NH4 (+) excreted by oysters (similar to 5.2 x 10(6) mmol NH4 (+) day(-1)). This highlights the potential of eelgrass to act as a natural biofilter for the NH4 (+) produced by oyster farming. Shoots exposed to oysters were more efficient in re-utilizing the internal N-15 into the growth of new leaf tissues or to translocate it to belowground tissues. Photosynthetic rates were greater in shoots exposed to oysters, which is consistent with higher NH4 (+) uptake and less negative delta C-13 values. Vegetative production (shoot size, leaf growth) was also higher in these shoots. Aboveground/belowground biomass ratio was lower in eelgrass beds not directly influenced by oyster farms, likely related to the higher investment in belowground biomass to incorporate sedimentary nutrients