Healthcare facilities are complex infrastructures where different features from technological, social, clinical and architectural field interact. In modern healthcare systems there is a growing ...attention to the need of quality in terms of process and outcome, while the structural (physical) aspects are not often considered. Since the Nineties the theory of the Evidence Based Design (EBD) states that there is significant relationship between built environment and health related outcome.
Aim of this paper is to investigate, in the recent scientific literature, which are the most important occupants' and organizational outcomes influenced by EBD hospital built environment qualities.
A Literature Review based on Scopus and PubMed databases has been run in order to understand the existing situation in terms of hospital quality evaluation from the physical and architectural point of view and to highlight the current trends. The results of the different reviews, empirical studies and post Occupancy Evaluations have been analyzed according to Ulrich's EBD conceptual framework.
35 peer reviewed papers from the last 2 years were included. The methodologies adopted are very different and data are mainly collected through structured interviews or observations and elaborated with qualitative (33%), quantitative (26%) or mixed (41%) methodologies. The topic is mostly investigated in USA, Australia, Canada, UK and in the Scandinavian region; few contributions come also from Italy. Built environment variables that affect user's or organizational outcomes are mainly the Visual Environment (29%), the Audio Environment (20%) and the Patient Room Design (20%).
The most recurrent outcomes found to be affected by the built environmental qualities are staff job satisfaction (n=11), patients' stress reduction (n=9), patients' satisfaction (n=6) and patients' fall reduction (n=6). Organizational outcomes are mentioned only two times. Although EBD is an old theory, the topic is both contemporary and relevant. Due to the diversity of the contributions and the limitations of the research, a deep comparison is challenging. Further investigation is necessary to deepen each of the variables identified.
This paper presents an accurate and efficient initialization strategy for modular multilevel converters (MMCs) based on the shooting method, a numerical technique aimed at deriving the periodic ...steady-state operating condition of any circuit. This technique is compatible with MMC models of different levels of detail and whose control scheme may include modulation strategies and capacitor voltage balancing algorithms. Electromagnetic transient simulations of the NORDIC32 power system modified by adding a high-voltage direct current link with 128-level MMCs prove that the proposed initialization strategy allows starting simulations close to steady-state, thereby significantly limiting initialization transients and their corresponding extra CPU time.
•We present a technique to initialize grids with modular multilevel converters (MMCs).•The proposed technique is based on the shooting method (SHM) and is purely numerical.•Initialization transients (and, thus, CPU time) are minimized by the SHM.•The approach is compatible with different MMC models and control schemes.•A benchmark grid is simulated to validate the accuracy and efficiency of the method.
Fast transient response, simple control scheme and low cost are features that distinguish constant-on-time buck converters from others. Simplicity of the control scheme is reflected in a single ...requirement for power electronics engineers: a design that ensures enough low amplitude resistive ripple component at the feedback to precisely starts the on-time pulse. There are design rules that guide the selection of the components. A well known one reported in the literature predicts if the converter suffers of the sub-harmonic oscillations undesirable phenomenon. The authors present a better simple design expression to avoid the onset of this unwanted drawback.
There have been several reports of successful deep brain stimulation (DBS) for the treatment of severe Gilles de la Tourette syndrome (GTS).
18 cases of GTS who were resistant to at least 6 months of ...standard and innovative treatments, as well as to psychobehavioural techniques, underwent DBS. DBS was placed bilaterally in the centromedian-parafascicular (CM-Pfc) and ventralis oralis complex of the thalamus. Patients were evaluated after surgery, with immediate and formal assessments at least every 3 months, including "on-off" and "sham off" in the first nine patients.
All patients responded well to DBS, although to differing degrees. The duration of follow-up assessments ranged from 3 to 18 months. The comorbid symptoms of obsessive-compulsive behaviour, obsessive-compulsive disorder, self-injurious behaviours, anxiety and premonitory sensations decreased after treatment with DBS. There were no serious permanent adverse effects.
DBS is a useful and safe treatment for severe GTS. The results of ours and previous DBS reports suggest that the CM-Pfc and ventralis oralis complex of the thalamus may be a good DBS target for GTS.
Metal–oxide interfaces play a fundamental role in determining the functional properties of artificial layered heterostructures, which are at the root of present and future technological applications. ...Magnetic exchange and magnetoelectric coupling, spin filtering, metal passivation, catalytic activity of oxide-supported nano-particles are just few examples of physical and chemical processes arising at metal–oxide hybrid systems, readily exploited in working devices. These phenomena are strictly correlated with the chemical and structural characteristics of the metal–oxide interfacial region, making a thorough understanding of the atomistic mechanisms responsible of its formation a prerequisite in order to tailor the device properties. The steep compositional gradient established upon formation of metal–oxide heterostructures drives strong chemical interactions at the interface, making the metal–oxide boundary region a complex system to treat, both from an experimental and a theoretical point of view. However, once properly mastered, interfacial chemical interactions offer a further degree of freedom for tuning the material properties. The goal of the present review is to provide a summary of the latest achievements in the understanding of metal/oxide and oxide/metal layered systems characterized by reactive interfaces. The influence of the interface composition on the structural, electronic and magnetic properties will be highlighted. Particular emphasis will be devoted to the discussion of ultra-thin epitaxial oxides stabilized on highly oxidizable metals, which have been rarely exploited as oxide supports as compared to the much more widespread noble and quasi noble metallic substrates. In this frame, an extensive discussion is devoted to the microscopic characterization of interfaces between epitaxial metal oxides and the Fe(001) substrate, regarded from the one hand as a prototypical ferromagnetic material and from the other hand as a highly oxidizable metal.
This paper introduces the 3D risk management (3DRM) concept, with particular emphasis on hydrogen installations (Hy3DRM). The 3DRM framework entails an integrated solution for risk management that ...combines a detailed site-specific 3D geometry model, a computational fluid dynamics (CFD) tool for simulating flow-related accident scenarios, methodology for frequency analysis and quantitative risk assessment (QRA), and state-of-the-art visualization techniques for risk communication and decision support. In order to reduce calculation time, and to cover escalating accident scenarios involving structural collapse and projectiles, the CFD-based consequence analysis can be complemented with empirical engineering models, reduced order models, or finite element analysis (FEA). The paper outlines the background for 3DRM and presents a proof-of-concept risk assessment for a hypothetical hydrogen filling station. The prototype focuses on dispersion, fire and explosion scenarios resulting from loss of containment of gaseous hydrogen. The approach adopted here combines consequence assessments obtained with the CFD tool FLACS-Hydrogen from Gexcon, and event frequencies estimated with the Hydrogen Risk Assessment Models (HyRAM) tool from Sandia, to generate 3D risk contours for explosion pressure and radiation loads. For a given population density and set of harm criteria, it is straightforward to extend the analysis to include personnel risk, as well as risk-based design such as detector optimization. The discussion outlines main challenges and inherent limitations of the 3DRM concept, as well as prospects for further development towards a fully integrated framework for risk management in organizations.
•Introducing the 3D risk management (3DRM) concept for hydrogen applications.•Inherent use of computational fluid dynamics (CFD) for flow-related accident scenarios.•Extending quantitative risk assessment (QRA) towards risk management.•Prototype demonstration of 3D risk assessment for hypothetical filling station.
Energy performance certificates (EPCs) 3re conventionally employed to certify the design according to different indicators. However, they 3re often used to evaluate the design outcomes, overlooking ...their potential as decision-making tools during the design process Among those, Passivhaus is currently being debated in Australia. Currently, there are only less than 30 certified cases, and all of them 3re residential buildings. Thus, the question about its suitability for commercial cases in the Australian context is still open. This paper contributes to the discussion, analysing the case study of the Woodside Building for Technolog>f and Design in Melbourne. the first University Buildmg to aim for the Passivhaus certification. The paper quantifies the impacts of the Passivhaus criteria on the facade design, benchmarking the energy demand agamst the 2016 Building Cede of Australia (BCA-2016) deemed to satisfy (DTS) design approach. Results show that the approach adopted in this C3se studs- leads to much better environmental performance when compared to the minimum performance required by the Australian standard DTS design approach. This building sets a nesv sustainability target in the Australian design culture, showing that it is necessary to change the way buildings are designed, toward a more sustainable and integrated design process.
Eighteen patients with severe and refractory Tourette syndrome (TS) underwent bilateral thalamic deep brain stimulation (DBS).
To assess the long-term outcome on tics, behavioral symptoms, and ...cognitive functions in the largest case series of thalamic DBS for TS to date.
In this prospective cohort study, 15 of the original 18 patients were evaluated before and after surgery according to a standardized protocol that included both neuropsychiatric and neuropsychological assessments.
In addition to marked reduction in tic severity (p = 0.001), 24-month follow-up ratings showed improvement in obsessive-compulsive symptoms (p = 0.009), anxiety symptoms (p = 0.001), depressive symptoms (p = 0.001), and subjective perception of social functioning/quality of life (p = 0.002) in 15 of 18 patients. There were no substantial differences on measures of cognitive functions before and after DBS.
At 24-month follow-up, tic severity was improved in patients with intractable Tourette syndrome (TS) who underwent bilateral thalamic deep brain stimulation. Available data from 15 of 18 patients also showed that neuropsychiatric symptoms were improved and cognitive performances were not disadvantaged. Controlled studies on larger cohorts with blinded protocols are needed to verify that this procedure is effective and safe for selected patients with TS.
This study provides class IV evidence that bilateral thalamic deep brain stimulation reduces global tic severity measured 24 months after implantation in patients with severe intractable Tourette syndrome.
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