Outdoor thermal comfort and airflow in relation to urban form in Amman, Jordan: A residential setting analysis

Rapid urbanisation and economic growth have put a significant pressure on urban planners to create layouts and buildings’ forms that are sustainable, healthy, and thermally comfortable for urban occupants. In the context of semi-arid climate, the built environment is often afflicted with high pedestrian comfort levels due to the increase in phenomena such as urban heat islands (UHI). The main aim of this research is to identify the key elements for enhancing the outdoor thermal comfort and airflow for pedestrians in a residential setting in the semi-arid climate of Amman in Jordan, through studying the urban geometrical parameters and their effects on the urban microclimate. The study followed an optimisation process that allowed a different variation of the designed proposals to be tested and simulated in terms of airflow and thermal comfort. The process analysed the urban elements on three different levels, the mesoscale (street grid layout), the microscale (compound layout) and the urban canyon scale. ENVI-met is a computational fluid dynamics (CFD) model that assesses the effect of meteorological parameters (e.g., air temperature, wind speed and relative humidity) on the built environment, in which it is used to simulate and evaluate proposed scenarios to find out the best configuration in terms of thermal comfort and airflow. A validation study was performed on ENVI-met using Amman configurations to test the model’s sensitivity and accuracy in predicting the microclimatic parameters change in the urban environment. The research proposed five different common street layouts to test out the geometrical aspect of the street grid. The results showed that wind speed values were found to change greatly for different orientations. However, Physiological Equivalent Temperature (PET) levels were more sensitive to the different grid geometries rather than their orientation. The research also proposed two grid designs for an empty plot in Amman based on the findings of the street grid analysis which comprised of a layout with streets oriented in the wind direction and an adjusted version of the wind flow proposal with perpendicular intersections for better land distribution. The results showed that the adjusted layout produced better PET values due to better shading geometry. Wind direction analysis showed that PET levels across the plot increased when the approaching wind angle was parallel to the streets and showed a significant decrease when directed at 45°. Compound design proposals showed that compound 1’s design with the wind flow transition produced higher PET levels when compared to strips of buildings design that allowed for better ventilation and controlled shading. The urban canyon scale analysis showed that increasing the buildings height enhanced the PET and airflow, while orienting the design in the (West-East) direction showed lower PET values when compared to the (North-South) orientation. The vegetation analysis showed airflow is enhanced with lower Leaf Area Density (LAD) values, due to less resistance from trees’ foliage

A Comparison of Students’ Thermal Comfort and Perceived Learning Performance between Two Types of University Halls:Architecture Design Studios and Ordinary Lecture Rooms during the Heating Season

In classrooms, several variables may affect students’ thermal comfort, and hence health, well-being, and learning performance. In particular, the type of learning activity may play a role in students’ thermal comfort. However, most of the previous research has mainly investigated the thermal comfort of students in ordinary classrooms, while less attention has been paid to students’ thermal comfort in classrooms with particular learning activities, such as architecture design studios, where students spend a long time and perform learning activities with high metabolic rates. For this purpose, we compared the thermal comfort and perceived learning performance of students majoring in architecture (n = 173) between two types of university halls, namely, design studios and typical lecture rooms (N = 15). We applied the classroom–comfort–data method, which included collecting physical, physiological, and psychological data from students and classrooms. Data were collected during the heating season (November 2021–January 2022) in a university building in Jordan. We conducted continuous monitoring combined with periodic measures for indoor temperature, relative humidity, mean radiant temperature, and air speed. Questionnaires, focus groups, and observations were also used to collect subjective data from students. The results showed statistically significant differences (Δμ = 3.1 °C, p d = 0.61) in indoor temperature between design studios and lecture rooms. Only 58% of students’ votes were within the ASHRAE 55-2107 recommended comfort zone. In design studios, 53% of students felt warm compared to 58.8% of students who had a cold sensation in lecture rooms. Students perceived themselves as more productive when they felt cooler. Our research’s significance lies in its injunction that there must be a special thermal comfort guide for educational buildings that are adapted to the local environment and functions of the spaces, cooperatively

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Rethinking Outdoor Courtyard Spaces on University Campuses to Enhance Health and Wellbeing: The Anti-Virus Built Environment

Responding to the events surrounding the COVID-19 pandemic, this study explores how to improve health and wellbeing and reduce infections in outdoor open spaces on university campuses to maximize their potential as a response to future crises. The study identifies the relationship between human behavior (social) and the various physical and environmental elements of these spaces. A case study and mixed-methods approach were undertaken, comprising four modes of inspection: user analysis layer using questionnaires and observations to survey students’ needs and behavior; context analysis layer using space syntax and CFD to examine the space’s physical and environmental conditions; design solutions reflecting an understanding of virus transmission; and a performance analysis layer to test the performance of ‘anti-virus’ courtyards. The findings demonstrated that students are willing to use the open spaces that they used before the pandemic, at the same frequency. This indicates a need to redesign the current spaces to prevent the spread of viruses. The study highlights the social, physical, and environmental implications to be considered in designs for outdoor anti-virus spaces. It provides a comprehensive process for transforming outdoor spaces on university campuses into anti-virus spaces that meet users’ needs. These findings have implications for the designing and retrofitting of open spaces to reduce infection

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research