bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Rasch Rating Scale Methodology to Examine a Behavioral Screener for Preschoolers At Risk
Authors: DiStefano Christine , Greer Fred W. , Kamphaus R. W. , Brown William H.
Published: February 2015

A screening instrument used to identify young children at risk for behavioral and emotional difficulties, the Behavioral and Emotional Screening System Teacher Rating Scale–Preschool was examined. The Rasch Rating Scale Method was used to provide additional information about psychometric properties of items, respondents, and the response scale. Using a representative U.S. sample of 1,485 children, the structure of the screener, performance of the rating scale, and coverage of the Maladaptive Behavior construct were investigated to identify children with emerging behavioral and emotional difficulties. Items measuring Internalizing and Externalizing Problems indicated greater efficiency for assessing at-risk behavioral and emotional problems, whereas items measuring emerging school problems or adaptive skills contributed little to the assessment of risk. Differential item functioning was examined for by age and found to be present for roughly one third of the items. Implications for scale development, screening young children, and use of screening information are discussed.
Vancomycin Loading Doses
Authors: Reardon Jillian , Lau Tim T. Y. , Ensom Mary H. H.
Published: February 2015

Objective: To systematically assess the literature to ascertain the pharmacokinetics, pharmacodynamics, and clinical efficacy and safety associated with administration of a vancomycin loading dose (LD). Data Sources: MEDLINE (1948-December 31, 2014), EMBASE (1980-December 31, 2014), Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts (1970-December 31, 2014), Google and Google Scholar, and International Clinical Trials Registry Platform were searched using the following terms: vancomycin, glycopeptides, loading dose, dose-response relationship. Study Selection and Data Extraction: Pharmacokinetic, pharmacodynamic, and clinical efficacy studies using vancomycin LDs to achieve trough concentrations of 15 to 20 mg/L were included. Nonhuman, non-English, oral vancomycin, and dialysis patient studies were excluded. Abstracts were included. Study quality was ranked using US Preventative Services Task Force 1996 classification system. Data on study design, baseline characteristics, exclusion criteria, dosing, study outcomes, and conclusions were extracted. Data Synthesis: A total of 8 studies (5 manuscripts [2 level I, 3 level II-3] and 3 abstracts) were cited. Of 6 adult studies, 4 concluded that administration of vancomycin LDs resulted in significantly more patients achieving troughs of 15 to 20 mg/L. Studies in children found that LDs did not lead to rapid attainment of vancomycin levels ≥15 mg/L. No studies assessed clinical or microbiological outcomes. Limitations included heterogeneity and inconsistent timing of concentration measurements. Conclusions: High-quality data to guide the use of vancomycin LDs are lacking. LDs may more rapidly attain vancomycin troughs of 15 to 20 mg/L in adults, but information in pediatrics, obesity, and renal impairment is limited. Further studies are required to determine benefit of LDs on clinical and microbiological outcomes.
Single-Photon-Emission Computed Tomography in Painful Total Ankle Replacements
Authors: Mason Lyndon W. , Wyatt James , Butcher Clifford , Wieshmann Hülya , Molloy Andrew P.
Published: February 2015

Background:

The use of single-photon-emission computed tomography (SPECT) in identifying unexplained pain in the foot and ankle has been described, where other imaging modalities have failed. The investigation of a painful total ankle replacement (TAR) is difficult, often not delineating a definitive cause. Our aim in this study was to investigate the use of SPECT-CT imaging in painful TARs.

Methods:

We performed a retrospective analysis of SPECT imaging performed for painful TARs in our department between October 2010 and December 2014. There were 14 patients identified who had undergone SPECT-CT imaging for a painful TAR. The mean age was 63.1 years, with a male/female sex ratio of 2:3 and a minimum time from surgery to imaging of 18 months.

Results:

Of the 14 patients, 13 were positive for increased osteoblastic activity in relation to the periprosthetic area consistent with implant loosening. The most common finding was tracer activity in relation to the talar component in 13 cases. There was additional tracer activity localized to the tibial component in 5 of these cases. In 10 of the 13 cases with prosthetic loosening/failure of bony ongrowth, there was no evidence of loosening on the plain radiographs. Infection was ruled out by using joint aspiration as clinically indicated.

Conclusion:

In our series, SPECT-CT imaging revealed a high incidence of medial sided talar prosthesis activity consistent with loosening. The finding of a high incidence of talar nonintegration illustrates the limitations of conventional radiology in follow-up of total ankle replacements, as this was not apparent on plain radiographs. We therefore conclude that there should be a high index of suspicion for talar prosthesis nonintegration in patients with otherwise unexplained ongoing medial pain in total ankle replacements.

Level of Evidence:

Level IV, retrospective case series.
Development and Validation of a Measure of Self-Critical Rumination
Authors: Smart Laura M. , Peters Jessica R. , Baer Ruth A.
Published: February 2015

Self-criticism is a form of negative self-evaluation that has strong associations with many forms of psychopathology. Rumination is a maladaptive form of repetitive thinking that is associated with many psychological disorders. Although measures of several different types of rumination (e.g., general rumination, depressive rumination, anger rumination) have been developed, none focuses specifically on self-critical rumination. An initial pool of items addressing self-critical rumination was developed by adapting items from existing rumination measures and through a writing task administered to both student and clinical samples. Following an evaluation of content validity, 24 items were administered to a large sample of undergraduates along with measures of related constructs. The final 10-item version of the Self-Critical Rumination Scale showed excellent internal consistency, a clear single-factor structure, convergent relationships with related constructs, and incremental validity over other measures of self-criticism and rumination in predicting both general distress and features of borderline personality disorder.
Machine learning for ultrafast X-ray diffraction patterns on large-scale GPU clusters
Authors: Ekeberg Tomas , Engblom Stefan , Liu Jing
Published: February 2015

The classical method of determining the atomic structure of complex molecules by analyzing diffraction patterns is currently undergoing drastic developments. Modern techniques for producing extremely bright and coherent X-ray lasers allow a beam of streaming particles to be intercepted and hit by an ultrashort high-energy X-ray beam. Through machine learning methods the data thus collected can be transformed into a three-dimensional volumetric intensity map of the particle itself. The computational complexity associated with this problem is very high such that clusters of data parallel accelerators are required. We have implemented a distributed and highly efficient algorithm for the inversion of large collections of diffraction patterns targeting clusters of hundreds of GPUs. With the expected enormous amount of diffraction data to be produced in the foreseeable future, this is the required scale to approach real-time processing of data at the beam site. Using both real and synthetic data we look at the scaling properties of the application and discuss the overall computational viability of this exciting and novel imaging technique.
Internal e-consultations in an integrated multispecialty practice: a retrospective review of use, content, and outcomes
Authors: North Frederick , Uthke Lorraine D , Tulledge-Scheitel Sidna M
Published: February 2015

E-consultations are being offered within clinic walls as an option for specialist advice without a face-to-face consultation appointment. In a six month time frame, nearly 100% of primary care internists and family medicine providers in a multispecialty practice had used an e-consultation at least once. Specialists also used e-consultations for advice from other specialists. E-consultations were often questions about interpreting images or laboratory tests, or questions about management of chronic conditions such as osteoporosis, hypertension, or headaches. Although e-consultations were offered as an alternative to face-to-face specialty consultations, 1,111 of 5,334 e-consultations eventually did receive face-to-face appointments in the same specialty. Within 30 days of the e-consultation 11.5% had a specialty face-to-face visit and 17.7% had seen a specialist face-to-face within 90 days of the e-consultation. The conversions of e-consultations to face-to-face consultations depended on the specialty providing the e-consultation (fewer for gastroenterology and infectious disease), patient distance from the clinic (fewer for international patients and those living greater than 800 kilometers from the clinic), and experience of specialist responding to the e-consultation (lower conversions for specialists providing 15 or more e-consultations).
Reflexive voicing: a communicative approach to intersectional writing
Authors: Harris Kate Lockwood
Published: February 2015

Intersectionality has increasing traction in interdisciplinary inquiry, yet questions remain about qualitative intersectional methods. In particular, scholars have yet to consider how to write qualitative research in the service of intersectionality. Drawing upon my disciplinary training in communication studies, I argue that the field’s theoretical grounding offers useful resources for advancing intersectional writing. Because communication theory posits that symbols both reflect and make reality, it resonates with an intersectional desire to simultaneously describe and transform the world through critical analysis. Using exemplars from communication scholars, I highlight how this interplay of approaches can advance identity politics and trouble identity categories. Furthermore this approach can help qualitative writers to link what some perceive to be distinct ‘levels’ of analysis. By discussing techniques for coupling reflexivity and voice, I make communication theory intelligible for intersectional writing and also invite communication studies to become more intersectional.
Towards a carnal anthropology: reflections of an ‘imperfect’ anthropologist
Authors: Vartabedian Julieta
Published: February 2015

This article offers an exploration into the ways in which the researcher’s body enters into a permanent dialogue with the practices and the discourses of the research participants, and is transformed into an essential investigative tool. Based on my ethnographic experience amongst a group of Brazilian travesti sex workers, I will show how my own ‘imperfect’ body, according to the travesti canons of feminine aesthetics, became an element that awarded me visibility and served as a bridge to interaction with them. At the same time, I was accidentally interpreted by the group as the ‘photographer’. From this corporeal interaction, and via the medium of the camera, I was able to legitimize my position amongst travestis and open a new field of theoretical enquiry, developing, therefore, Wacquant’s proposal (2004) on a ‘corporeal sociology’ in the understanding of the active role that the body takes in the research process.
Crafting resonance: Empathy and belonging in ancient Rajasthan
Authors: Rizvi Uzma Z
Published: February 2015

In this article I introduce the concept of resonance to interrogate how things and meanings are relevant beyond the cultural context within which they begin. The notion of resonance is theorized as an intangible affect that the material thing has beyond its formal physical boundaries within larger planes of perception creating dynamic relationships among humans/nonhumans and illustrating cultural decisions of material as vibrant matter. If material has vibrancy and frequency it then has the capacity to evoke an emotional and affective response to a similarity of material, style, and/or form. Such response can be coded as a sensory aesthetic empathy that links to constituting subjective belonging in the ancient world. In order to explore how resonance might be useful in an archaeological context, this article will utilize copper arrowheads documented from the 1978 to 1979 excavations at the site of Ganeshwar, in the state of Rajasthan, India.
Transforming conceptual space into a creative learning place: Crossing a threshold
Authors: Moffat Kirstine , McKim Anne
Published: February 2015

This article describes, discusses and reflects on a teaching and learning experiment in a first year BA course. Students were led out of the lecture room to a different space, the New Place Theatre. While this move out of the usual teaching space was appropriate for the text being studied, William Shakespeare’s The Tempest, the strategy aimed to develop students’ grasp of a critical concept we had identified as troublesome to students who had encountered it in the past: subjective interpretation. For us the concept of subjective interpretation shared the transformative and integrative, as well as the troublesome, characteristics of ‘threshold concepts’. According to threshold concept theory, threshold concepts are critical points where students may get ‘stuck’ before making ‘learning leaps’ as they journey towards a ‘new conceptual space and enter … a postliminal state in which both the learner and the learning are transformed’ (Land et al., 2010: ix). Students first participated in a collective exercise, creating the storm which opens the play through movement and vocalisation, and were then invited to intervene in a performance of the opening act, supporting the characters with whom they sympathised. Student feedback confirmed that this teaching strategy not only assisted them to grasp the concept of subjective interpretation, but also promoted transformative shifts in understanding through their active learning. A key factor in the resulting student engagement was movement to a different physical space, and a fresh, creative learning place.
A study of preferred colour rendering of light sources: Shop lighting
Authors: Szabó F , Kéri R , Schanda J , Csuti P , Wilm A , Baur E
Published: February 2015

This paper provides recommendations for optimum LED light spectra in shop environments. The main aspects of the research were to elaborate the optimal LED spectral power distribution for the lighting of different colour textiles, fruits and vegetables, meat and bakery products. The spectrum was tailored towards different colour quality metrics such as the colour rendering index and the colour quality scale. Small scale investigations with eye-tracker studies were carried out by Osram Opto Semiconductors at the University of Regensburg and full scale experiments were conducted at the University of Pannonia during the project in order to determine which metric correlates best to the preference of the observers. Results of the psychophysical have been evaluated with the help of analytic hierarchy process and a modified Thurstone method. As a result of the investigation, optimal spectral power distributions for shop environment are described.
Atoh7 promotes the differentiation of Müller cells-derived retinal stem cells into retinal ganglion cells in a rat model of glaucoma
Authors: Song Wei-tao , Zhang Xue-yong , Xia Xiao-bo
Published: February 2015

Glaucoma is one of the leading eye diseases resulting in blindness due to the death of retinal ganglion cells. This study aimed to develop novel protocol to promote the differentiation of retinal Müller cells into ganglion cells in vivo in a rat model of glaucoma. The stem cells dedifferentiated from rat retinal Müller cells were randomized to receive transfection with empty lentivirus PGC-FU-GFP or lentivirus PGC-FU-Atoh7-GFP, or no transfection. The stem cells were induced further to differentiate. Ocular hypertension was induced using laser photocoagulation. The eyes were injected with Atoh7 expression vector lentivirus PGC-FU-Atoh7-GFP. Eyeball frozen sections, immunohistochemistry, RT-PCR, Western bolt, and apoptosis assay were performed. We found that the proportion of ganglion cells differentiated from Atoh7-tranfected stem cells was significantly higher than that of the other two groups. The mean intraocular pressure of glaucomatous eyes was elevated significantly compared with those of contralateral eyes. Some retinal Müller cells in the inner nuclear layer entered the mitotic cell cycle in rat chronic ocular hypertension glaucoma model. Atoh7 contributes to the differentiation of retinal Müller cells into retinal ganglion cells in rat model of glaucoma. In conclusion, Atoh7 promotes the differentiation of Müller cells-derived retinal stem cells into retinal ganglion cells in a rat model of glaucoma, thus opening up a new avenue for gene therapy and optic nerve regeneration in glaucoma.
Effects ofRosmarinus officinalisextract on human primary omental preadipocytes and adipocytes
Authors: Stefanon Bruno , Pomari Elena , Colitti Monica
Published: February 2015

The prevalence of obesity is increasing all over the world. Although it has been shown that natural substances influence fat metabolism, little is known about the effect on cellular and molecular mechanisms in human. In this in vitro study, the activity of Rosmarinus officinalis (RO) standardized extract in modulating human primary visceral preadipocytes differentiation, lipolysis, and apoptosis was investigated. Moreover, gene expression of key adipogenesis modulators and microRNAs-seq were evaluated. Preadipocytes treated with RO extract significantly reduced triglyceride incorporation during maturation in a dose-dependent manner without affecting cell viability. In addition, RO extract stimulated lipolytic activity in differentiating preadipocytes and mature adipocytes in treated cells compared to controls. Differentiating preadipocytes incubated in the presence of RO extract showed a decreased expression of cell cycle genes such as cyclin D1, cyclin-dependent kinase 4, cyclin-dependent kinase inhibitor 1A (p21, Cip1) and an increased expression of GATA binding protein 3, wingless-type MMTV integration site family, member 3A mRNA levels. Recent studies have demonstrated that some phytochemicals alter the expression of specific genes and microRNAs that play a fundamental role in the pathogenesis of obesity and related diseases. Interestingly, genes modulated in RO-treated cells were found to be validated miRNAs targets, such as let-7f-1, miR-17, and miR-143. The results indicated that RO extract modulates human adipocyte differentiation and significantly interferes with adipogenesis and lipid metabolism, supporting its interest as dietary supplement.
Liraglutide prevents fast weight gain and β-cell dysfunction in male catch-up growth rats
Authors: Zheng Juan , Chen Ting , Zhu Ying , Li Hui-Qing , Deng Xiu-Ling , Wang Qing-Hua , Zhang Jiao-Yue , Chen Lu-Lu
Published: February 2015

We reported recently that after a nutritional growth retardation, rats showed significant weight gain, central fat accumulation, dyslipidemia, and β-cell dysfunction during a catch-up growth (CUG) phase. Here, we investigated whether glucagon-like peptide-1 (GLP-1) ameliorated the rapid weight gain, central fat deposition, and β-cell dysfunction during the CUG in rats. Sixty-four male Sprague Dawley rats were stratified into four groups including normal control group, CUG group, catch-up growth with liraglutide treatment group, and catch-up growth with liraglutide and exendin 9–39 treatment group. Energy intake, body weight, and body length were monitored. Fat mass percentage was analyzed by dual energy X-ray absorptiometry scan. Plasma triglyceride and non-esterified fatty acid were measured. The β-cell mass was analyzed by morphometric analysis and signaling molecules were examined by Western blot and real-time PCR. Insulin secretion capability was evaluated by hyperglycemic clamp test. Liraglutide prevented weight gain and improved lipid and glucose metabolism in rats under CUG conditions, which were associated with reduced fasting insulin levels and improved glucose-stimulated insulin secretion. Improved β-cell function is found to be associated with increased β-cell replication as determined by β-cell density and insulin-Ki67 dual staining. Furthermore, liraglutide increased islet pancreatic duodenal homeobox-1 (Pdx-1) and B-cell lymphoma-2 transcript and protein expression, and reduced Procaspase-3 transcript and Caspase-3 p11 subunit protein expression, suggesting that expression of Pdx-1 and reduction of apoptosis may be the mechanisms involved. The therapeutic effects were attenuated in rats co-administered with exendin 9–39, suggesting a GLP-1 receptor-dependent mechanism. These studies revealed that incretin therapy effectively prevented fast weight gain and β-cell dysfunction in rats under conditions of nutrition restriction followed by nutrition excess, which is in part due to enhanced functional β-cell mass and insulin secretory capacity.
Three-Dimensional Eye Tracking in a Surgical Scenario
Authors: Bogdanova Rositsa , Boulanger Pierre , Zheng Bin
Published: February 2015

Introduction. Eye tracking has been widely used in studying the eye behavior of surgeons in the past decade. Most eye-tracking data are reported in a 2-dimensional (2D) fashion, and data for describing surgeons’ behaviors on stereoperception are often missed. With the introduction of stereoscopes in laparoscopic procedures, there is an increasing need for studying the depth perception of surgeons under 3D image-guided surgery. Methods. We developed a new algorithm for the computation of convergence points in stereovision by measuring surgeons’ interpupillary distance, the distance to the view target, and the difference between gaze locations of the 2 eyes. To test the feasibility of our new algorithm, we recruited 10 individuals to watch stereograms using binocular disparity and asked them to develop stereoperception using a cross-eyed viewing technique. Participants’ eye motions were recorded by the Tobii eye tracker while they performed the trials. Convergence points between normal and stereo-viewing conditions were computed using the developed algorithm. Results. All 10 participants were able to develop stereovision after a short period of training. During stereovision, participants’ eye convergence points were 14 ± 1 cm in front of their eyes, which was significantly closer than the convergence points under the normal viewing condition (77 ± 20 cm). Conclusion. By applying our method of calculating convergence points using eye tracking, we were able to elicit the eye movement patterns of human operators between the normal and stereovision conditions. Knowledge from this study can be applied to the design of surgical visual systems, with the goal of improving surgical performance and patient safety.
A Situated Approach to the Understanding of Dynamic Situations
Authors: Chiappe Dan , Strybel Thomas Z. , Vu Kim-Phuong L.
Published: February 2015

Situation awareness (SA) is an operator’s understanding of “what is going on” as he or she manages a complex, dynamic system. In what follows, the case for a situated approach to SA is presented. It claims operators rely on interactions between internal and external representations to maintain their understanding of situations. It is argued that this approach allows researchers to capture two different types of SA—one where operators store SA information directly and one where the information is offloaded but the operator internally represents where to access it from the world and can do so quickly. This position takes a broader unit of analysis on SA than the widely cited Three-Level Model, which claims that only if information is stored internally does it count as SA. We also discuss how to assess SA in situated agents, focusing on the Situation Present Assessment Method (SPAM). We end by discussing some of the potentially fruitful research questions that arise as a result of taking a situated approach as well as implications for interface design.
Medical Complications of Intra-Hospital Patient Transports: Implications for Architectural Design and Research
Authors: Ulrich Roger S. , Zhu Xuemei
Published: February 2015

Literature on healthcare architecture and evidence-based design has rarely considered explicitly that patient outcomes may be worsened by intra-hospital transport (IHT), which is defined as transport of patients within the hospital. The article focuses on the effects of IHTs on patient complications and outcomes, and the implications of such impacts for designing safer, better hospitals. A review of 22 scientific studies indicates that IHTs are subject to a wide range of complications, many of which occur frequently and have distinctly detrimental effects on patient stability and outcomes. The research suggests that higher patient acuity and longer transport durations are associated with more frequent and serious IHT-related complications and outcome effects. It appears no rigorous research has compared different hospital designs and layouts with respect to having possibly differential effects on transport-related complications and worsened outcomes. Nonetheless, certain design implications can be extracted from the existing research literature, including the importance of minimizing transport delays due to restricted space and congestion, and creating layouts that shorten IHT times for high-acuity patients. Limited evidence raises the possibility that elevator-dependent vertical building layouts may increase susceptibility to transport delays that worsen complications. The strong evidence indicating that IHTs trigger complications and worsen outcomes suggests a powerful justification for adopting acuity-adaptable rooms and care models that substantially reduce transports. A program of studies is outlined to address gaps in knowledge.
Popeye's Chicken, Design, and Another Five Senses
Authors: Bishop Linda Porter
Published: February 2015

Many healthcare facilities strive to develop the perfect patient experience. In the process, authenticity and good design are often overlooked in favor of thematic architecture. The author presents five design considerations, or five senses, necessary to create an authentic and well-designed healthcare facility.
A Multidimensional Framework for Assessing Patient Room Configurations
Authors: Pati Debajyoti , Harvey Thomas E. , Reyers Evelyn , Evans Jennie , Waggener Laurie , Serrano Marjorie , Saucier Rachel , Nagle Tina
Published: February 2015

Purpose:

A framework for multidimensional assessment of patient room configurations is presented. Twenty-three issues are considered and categorized under six domains of assessment: (1) patient safety, (2) staff efficiency, (3) circulation, (4) infection control, (5) patient considerations, and (6) family amenities. Use of the framework to rank issues by importance and assess six alternative patient room configurations by a diverse group of experts in a symposium is described.

Background:

One of the key questions posed during inpatient room design is the location of the bathroom. What issues are affected by the variations in room configuration that arise from bathroom location? A complete articulation of the issues that potentially are affected by room configuration is not available in the literature.

Framework:

The list of issues was developed by the authors in preparation for a symposium. The symposium was organized in May 2007 and attended by 14 experts from four institutions. Six alternative room configurations were used. Variations in the configurations included: (1) three same-handed and three mirror-image rooms; (2) three outboard, two inboard, and one nested bathroom; and (3) three rooms with footwall bathrooms and three with headwall bathrooms. In a four-step process, the attendees ranked the issues, discussed them in detail, rated each room configuration against each issue on a seven-point suitability scale, and conducted an overall assessment of the six configurations.

Conclusions:

Based on the ratings and rankings provided by the symposium participants, outboard bathroom locations were found to be most suitable, followed by nested and inboard configurations. Furthermore, configurations with patient bathrooms located on the footwall were rated as more suitable than headwall locations. The authors recommend, however, that the framework be used to determine a suitable room configuration in a specific context, rather than to identify configurations that will perform well universally.
Evaluating Building Performance in Healthcare Facilities: An Organizational Perspective
Authors: Steinke Claudia , Webster Lynn , Fontaine Marie
Published: February 2015

Purpose:

Using the environment as a strategic tool is one of the most cost-effective and enduring approaches for improving public health; however, it is one that requires multiple perspectives. The purpose of this article is to highlight an innovative methodology that has been developed for conducting comprehensive performance evaluations in public sector health facilities in Canada.

Background:

The building performance evaluation methodology described in this paper is a government initiative. The project team developed a comprehensive building evaluation process for all new capital health projects that would respond to the aforementioned need for stakeholders to be more accountable and to better integrate the larger organizational strategy of facilities.

Theoretical Framework:

The Balanced Scorecard, which is a multiparadigmatic, performance-based business framework, serves as the underlying theoretical framework for this initiative. It was applied in the development of the conceptual model entitled the Building Performance Evaluation Scorecard, which provides the following benefits: (1) It illustrates a process to link facilities more effectively to the overall mission and goals of an organization; (2) It is both a measurement and a management system that has the ability to link regional facilities to measures of success and larger business goals; (3) It provides a standardized methodology that ensures consistency in assessing building performance; and (4) It is more comprehensive than traditional building evaluations.

Conclusion:

The methodology presented in this paper is both a measurement and management system that integrates the principles of evidence-based design with the practices of pre- and post-occupancy evaluation. It promotes accountability and continues throughout the life cycle of a project. The advantage of applying this framework is that it engages health organizations in clarifying a vision and strategy for their facilities and helps translate those strategies into action and measurable performance outcomes.
Directions in Healthcare Research: Pointers from Retailing and Services Marketing
Authors: Van Rompay Thomas J. L. , Tanja-Dijkstra Karin
Published: February 2015

Purpose:

Although the importance of the environment in relation to healing processes has been well established, empirical evidence for environmental effects on patient well-being and behavior is sparse. In addition, few attempts have been made to integrate insights from related fields of research such as retailing and services marketing with findings from healthcare studies. In this paper, relevant findings and insights from these domains are discussed. What insights and findings from retailing and services marketing are (potentially) of interest to the healthcare context, and how should one interpret and follow up on these results in healthcare environments?

Background:

Research in retailing and services marketing indicates that physical environmental factors (i.e., music and scent) and social environmental factors (i.e., crowded conditions) may affect consumer satisfaction and well-being. In addition, environmental effects have been shown to vary with contextual factors (e.g., the type of environment) and consumer needs (e.g., the extent to which consumers value social contact or stimulation in a specific setting). Although the evidence base for environmental factors in health environments is steadily growing, few attempts have been made to integrate findings from both domains.

Conclusions/Recommendations:

The findings presented indicate that environmental variables such as music and scent can contribute to patient well-being and overall satisfaction. In addition, findings suggest that these variables may be used to counteract the negative effects resulting from crowded conditions in different healthcare units. Taking into account recent developments in the healthcare industry, the importance of creating memorable and pleasant patient experiences is likely to grow in the years to come. Hence, the finding that subtle and relatively inexpensive manipulations may affect patient well-being in profound ways should inspire follow-up research aimed at unraveling the specifics of environmental influences in health environments.
Centralized vs. Decentralized Nursing Stations: Effects on Nurses' Functional Use of Space and Work Environment
Authors: Zborowsky Terri , Bunker-Hellmich Lou , Morelli Agneta , O'Neill Mike
Published: February 2015

Objective:

Evidence-based findings of the effects of nursing station design on nurses' work environment and work behavior are essential to improve conditions and increase retention among these fundamental members of the healthcare delivery team. The purpose of this exploratory study was to investigate how nursing station design (i.e., centralized and decentralized nursing station layouts) affected nurses' use of space, patient visibility, noise levels, and perceptions of the work environment.

Background:

Advances in information technology have enabled nurses to move away from traditional centralized paper-charting stations to smaller decentralized work stations and charting substations located closer to, or inside of, patient rooms. Improved understanding of the trade-offs presented by centralized and decentralized nursing station design has the potential to provide useful information for future nursing station layouts. This information will be critical for understanding the nurse environment “fit.”

Methods:

The study used an exploratory design with both qualitative and quantitative methods. Qualitative data regarding the effects of nursing station design on nurses' health and work environment were gathered by means of focus group interviews. Quantitative data-gathering techniques included place- and person-centered space use observations, patient visibility assessments, sound level measurements, and an online questionnaire regarding perceptions of the work environment.

Results:

Nurses on all units were observed most frequently performing telephone, computer, and administrative duties. Time spent using telephones, computers, and performing other administrative duties was significantly higher in the centralized nursing stations. Consultations with medical staff and social interactions were significantly less frequent in decentralized nursing stations. There were no indications that either centralized or decentralized nursing station designs resulted in superior visibility. Sound levels measured in all nursing stations exceeded recommended levels during all shifts. No significant differences were identified in nurses' perceptions of work control-demand-support in centralized and decentralized nursing station designs.

Conclusions:

The “hybrid” nursing design model in which decentralized nursing stations are coupled with centralized meeting rooms for consultation between staff members may strike a balance between the increase in computer duties and the ongoing need for communication and consultation that addresses the conflicting demands of technology and direct patient care.
A Framework for Evaluating Evidence in Evidence-Based Design
Authors: Pati Debajyoti
Published: February 2015

A major challenge in the evidence-based design (EBD) practice model has been in determining the degree of credibility of specific (or a body of) evidence. This challenge has remained one of the key impediments to the broader adoption of EBD. Borrowing from evidence-based medicine and evidence-based practice literatures, this paper proposes a framework for evaluating evidence in EBD. Key to the proposed framework is the separation of the evaluation of strength and quality of evidence from the evaluation of appropriateness and feasibility in a specific application context.
Evaluation of the Built Environment: Staff and Family Satisfaction Pre- and Post-Occupancy of the Children's Hospital
Authors: Kotzer Anne Marie , Zacharakis Susan Koch , Raynolds Mary , Buenning Fred
Published: February 2015

Objective:

To evaluate and compare the impact of an existing and newly built hospital environment on family and staff satisfaction related to light, noise, temperature, aesthetics, and amenities, as well as safety, security, and privacy.

Background:

The United States is engaged in an unprecedented healthcare building boom driven by the need to replace aging facilities, understand the impact of the built environment on quality and safety, incorporate rapidly emerging technologies, and enhance patient- and family-centered care. More importantly, there is heightened attention to creating optimal physical environments to achieve the best possible outcomes for patients, families, and staff.

Methods:

Using a pre-post descriptive survey design, all nursing, social work, therapy staff, and families on selected inpatient units were invited to participate. A demographic form and Family and Staff Satisfaction Surveys were developed and administered pre- and post-occupancy of the new facility.

Results:

Pre/post mean scores for staff satisfaction improved on all survey subscales with statistically significant improvement ( p < .05) in most areas. The most improvement was seen with layout of the patient room, natural light, storage and writing surfaces, and comfort and appeal. Family satisfaction demonstrated statistically significant improvement on all subscales (p ≤ .01), especially for natural light, quiet space, parking, and the child's room as a healing environment.

Conclusions:

Families and staff reported greater satisfaction with the newly built hospital environment compared to the old facility. Study results will help guide future architectural design decisions, attract and retain staff at a world-class facility, and create the most effective healing environments.
Perceived Neighborhood Environments and Leisure-Time Walking among Korean Adults: An Application of the Theory of Planned Behavior
Authors: Lee Hyung-Sook , Shepley Mardelle M.
Published: February 2015

Objective:

To examine personal, social, and perceived environmental factors related to leisure-time walking behavior among Korean adults using the framework of the Theory of Planned Behavior (TPB).

Background:

Sedentary lifestyle and physical inactivity contribute to rising obesity rates and chronic diseases among Korean adults. Understanding correlates of walking is necessary to develop effective interventions to promote regular walking. Methods: A cross-sectional survey was conducted in 2008 among 424 Korean adults. Participants completed a questionnaire on perceived neighborhood environment, the TPB constructs, and leisure-time walking behavior.

Results:

Those who participated in leisure-time walking had more positive perceptions of aesthetics and expressed greater perceived behavioral control (PBC) and intention of walking than nonwalkers. Also, walking correlated with intention and PBC, and perceived crime safety. Intentions were moderately to strongly associated with attitude, PBC, and subjective norm. Integrating TPB constructs and the perceived environment variable (crime safety) resulted in a moderate fit of the data [χ2= 2.372, df = 5; p = 0.796; NFI = 0.99; RMSEA = 0.00] with approximately 45.6% variance of intention and 19.4% of the response variance of walking explained. The model showed that perceived safety from crime was not directly related to leisure-time walking, but indirectly predicted walking through the TPB model.

Conclusions:

Perceived safety was identified as an important environmental variable among Korean adults, and the TPB offered a good prediction of walking behavior. Identifying individual, social, and neighborhood environmental correlates of walking can help develop policies to promote public health for a more active and healthier community.
How to Help Hospitals Achieve Their Mission Through Good Design
Authors: Rabner Barry S.
Published: February 2015

In 2003, Princeton HealthCare System (PHCS) completed a strategic plan that called for replacing its 220-bed acute care hospital—a decision driven by the need to serve a growing and aging population and the demand for new programs, services, technologies, and clinical strategies. As hospitals nationwide undertake similar projects to replace aging facilities, they face many of the same challenges. Various factors must be considered when designing a new hospital. Two significant obstacles to great design exist: First, hospital executives understand the economic and clinical drivers that affect hospital care and financial performance but often lack an appreciation for how design decisions can impact these critical factors. Second, CEOs often delegate oversight to others in the organization. The CEO's direct participation is necessary to ensure that the project reflects the organization's values and strategic and operational objectives. Solutions to address this dilemma include increased use of evidence-based design and strategies such as tying payment for design services to long-term facility performance indicators. Effective partnerships among healthcare planners, facility designers, and hospital executives will result in a new facility whose design promotes improved clinical outcomes, greater patient satisfaction, and financial viability.
Rethinking Efficiency in Acute Care Nursing Units: Analyzing Nursing Unit Layouts for Improved Spatial Flow
Authors: Zadeh Rana Sagha , Shepley Mardelle McCuskey , Waggener Laurie Tranchina
Published: February 2015

Objective:

This paper introduces a new design tool to increase efficiency in acute care settings. This visual tool facilitates matching spatial flow with caregivers' workflow to reduce waste and redundancies, as recommended by Lean thinking. Providing work environments that protect caregivers from fatigue, interruptions, and redundancies can contribute to quality patient care.

Methods:

By studying the Guidelines for Design and Construction of Health Care Facilities and reviewing the literature, the authors identified the main clinical spaces supporting nursing care and their important linkages. Space syntax, a diagrammatic analysis of relationships, was used to decode spatial relationships among the clinical spaces in five case studies. The movement distributions were measured and possible conflicts with focus-demanding tasks, such as noise and interruptions, were identified. The information was summarized in a visual diagram providing the “syntactic anatomy” of the most important work spaces.

Results:

The main clinical spaces were the following: (1) patient corridor; (2) nurses' station; (3) medication area; (4) clean room; (5) soiled room; (6) physicians' dictation area; (7) report room; (8) restricted nourishment area; (9) equipment storage; and (10) unrestricted nourishment area. The report room, nourishment area, and physician workspace showed strong linkages to the patient corridor and nurses' station, although such spaces were not clearly discussed in the design guidelines. The most caregiver movement occurs in the patient corridor and nurses' station. These areas pose the greatest possibility of interruptions by persons. The results were translated into a visual design efficiency checklist.

Conclusion:

Illustrating the spatial order of the support spaces—and comparing that to use patterns—enables designers to reduce the movement sequences nurses undertake when accessing resources and identify where the flow is disrupted by “displaced” functions.
Process Simulation during the Design Process Makes the Difference: Process Simulations Applied to a Traditional Design
Authors: Traversari Roberto , Goedhart Rien , Schraagen Jan Maarten
Published: February 2015

Objective:

The objective is evaluation of a traditionally designed operating room using simulation of various surgical workflows.

Background:

A literature search showed that there is no evidence for an optimal operating room layout regarding the position and size of an ultraclean ventilation (UCV) canopy with a separate preparation room for laying out instruments and in which patients are induced in the operating room itself. Neither was literature found reporting on process simulation being used for this application. Many technical guidelines and designs have mainly evolved over time, and there is no evidence on whether the proposed measures are also effective for the optimization of the layout for workflows.

Methods:

The study was conducted by applying observational techniques to simulated typical surgical procedures. Process simulations which included complete surgical teams and equipment required for the intervention were carried out for four typical interventions. Four observers used a form to record conflicts with the clean area boundaries and the height of the supply bridge. Preferences for particular layouts were discussed with the surgical team after each simulated procedure.

Results:

We established that a clean area measuring 3 × 3 m and a supply bridge height of 2.05 m was satisfactory for most situations, provided a movable operation table is used. The only cases in which conflicts with the supply bridge were observed were during the use of a surgical robot (Da Vinci) and a surgical microscope. During multiple trauma interventions, bottlenecks regarding the dimensions of the clean area will probably arise.

Conclusions:

The process simulation of four typical interventions has led to significantly different operating room layouts than were arrived at through the traditional design process.