In the March 1942 issue of the journal Modern Hospital, Charles F. Neergaard, a prominent New York City hospital design consultant, published a layout for a hospital inpatient department that was so innovative he copyrighted it. The plan held two nursing units—groups of patient rooms overseen by a single nursing staff—in a single building wing. For each unit, a corridor provided access to a row of small patient rooms along a long exterior wall and to a shared service area between the two corridors.
The feature that made his plan so innovative—and therefore risky? It included rooms that had no windows.
A windowless room hardly seems daringly innovative nowadays, but in the 1940s it was a shocking proposal for a patient wing. It violated a long-lived understanding of what, exactly, the role of the hospital building should be in terms of promoting health.
For nearly two centuries, hospital designers had based their layouts on a fundamental assumption: In order to remain disease-free and health-giving, hospital spaces required direct access to sunlight and fresh air. This rule was the product of a centuries-old belief that disease could be spread by, or perhaps even directly caused by, dark, stagnant spaces where bad air—smelly, vitiated, stagnant, particulate-laden air—accumulated.
In the late 18th century, this correlation was statistically certain. Epidemics always hit the tenants of crowded, impoverished urban districts harder than the inhabitants of airier, wealthier neighborhoods. Patients in large urban hospitals suffered cross-infections and secondary infections far more frequently than patients in rural or small-town hospitals. It was common knowledge that if windowless rooms didn’t directly breed disease, they bred the conditions that led to disease.
Given this correlation, before the 20th century, every single room within a hospital typically had access to the outdoors. Corridors had windows. Linen closets had windows. In some hospitals even the ventilation ducts and enclosures for plumbing pipes and risers had windows. Windows in patient rooms and operating rooms were so large that the glare caused problems—keeping patients awake and causing momentary blindness in surgeons during operations.
Late 19th-century and early 20th-century advances in medical theories and practices altered, but did not erase, a faith in windows. With the development of germ theory, sunlight and fresh air had new purposes. Experiments proved that ultraviolet light was germicidal. So windows of clear glass, or even of special “vita-glass” that did not block the UV rays, were a means of surface decontamination.
Similarly, tuberculosis sanatoria records proved that simple exposure to fresh air could be curative. The hospital building itself was a form of therapy. In a 1940 issue of the architectural journal Pencil Points, Talbot F. Hamlin confidently noted that “the quality of the surroundings of the sick person may be as important in the cure as the specific therapeutic measures themselves.”
But surroundings were important, partly, because of who went to hospitals in the first place. Indeed, until the late 19th century, medical treatment was not the reason to go to a hospital—poverty was. The vast majority of 19th-century hospital patients were charity cases—sick people who could not afford a doctor’s house call, had no family to care for them, and had no place else to go. A patient would occupy the same bed in a hospital ward—which housed anywhere from half a dozen to 30 patients—for weeks, sometimes even months. The doctor made rounds once a day. Nurses provided food, changed bandages, cleaned, and changed linens—but provided very little in terms of hands-on treatment. The hospital’s scrupulously clean, bright, airy rooms were an environmental antidote to the tenement surroundings from which impoverished patients came.
But the population of hospitals changed in the first decades of the 20th century. Medical advances, urban growth, and philanthropic transformations turned hospitals into a new kind of institution—where persons of all classes went to get cutting-edge treatment. Anesthesia and asepsis made hospital surgeries not only safer but also more bearable. New equipment like x-ray machines, ophthalmoscopes, and cardiographs improved diagnostic and therapeutic options. Bacteriological lab technicians could identify pathogens with a certainty undreamed of during the preceding era of symptomatic diagnosis. By the early 20th century, what happened in hospitals was increasingly about medical procedures and efficient workflow, not the ostensible healthiness of the environment in itself.
These changes made the limitations of the earlier “therapeutic” hospital designs glaringly apparent. In order to provide a window in every room, buildings could not be wider than two rooms deep; this inevitably required multiple long narrow wings. Such rambling structures were expensive to build, prohibitively expensive to heat, light, and supply with water, and inefficient and labor-intensive to operate. Food reached the patients cold after being trucked from a distant central kitchen; patients requiring operations were wheeled through numerous buildings to the surgical suite.
Hospital designers thus began to arrange practitioners, spaces, and equipment into a more effective layout. Catchwords changed from “light” and “air” to “efficiency” and “flexibility.” An emphasis on efficiency rapidly took over the utilitarian areas of the hospital; time and motion studies determined layouts and locations of kitchens, laundry, and central sterile supplies. Diagnostic and treatment spaces were re-designed to establish efficient, but aseptically safe, paths for the movement of patients, nurses, technicians, and supplies.
But, initially, it left the design of inpatient departments unaltered.
Hospital designers and practitioners worried that patient areas designed for efficiency, not healthiness, would prolong treatment, impede recovery, or even cause deaths. In a 1942 issue of Modern Hospital, Lt. Wilber C. McLin considered it “unthinkable even to consider the possibilities of applying time and motion studies to the methods of direct patient care.” Inpatient departments remained sacrosanct temples of light and air.
By the 1940s, therefore, most hospital buildings were odd mixtures of efficiently arranged medical treatment spaces and inefficiently arranged nursing units. Nurses trudged up and down long, open wards that held 20 or more patients, or long, double-loaded corridors that connected smaller (six-, four- or two-bed) wards and private rooms. Service areas were at the far end of that walk; getting even basic supplies was a long hike. Pedometers proved that the daily distance was best counted in miles; some nurses averaged 8-10 per shift. In 1939, prominent Philadelphia doctor Joseph C. Doane drily observed that “some hospitals are apparently planned on the erroneous theory that nurses wing their way from distant service rooms to far off beds without incurring fatigue.”
This was the design dilemma that confronted Neergaard, an iconoclastic rising star in the brand-new profession of “hospital consultant” (doctors who advised building committees and architects on best practices). He proposed streamlining nursing unit design, keeping windows in the inviolable patient rooms, but prioritizing efficiency over direct access to sunlight and fresh air in the adjacent service rooms. His plan allowed two different nursing units (groups of patients overseen by one head nurse) to share the same windowless central service rooms, reducing spatial redundancy.
Neergaard calculated that this “double pavilion plan” required only two-thirds of the floor area of a traditional nursing unit layout. It also moved the service rooms closer to the patient rooms, drastically reducing a nurse’s daily travels. His design was a first foray into treating the hospital as if it were any other building. The structure was a tool, facilitating the delivery of medical care, not a therapy in itself.
Neergaard knew his ideas would be contentious. In 1937, his presentation at an American Hospital Association convention prompted the prominent hospital architects Carl A. Erickson and Edward F. Stevens to resign from a committee rather than be seen as supporting Neergaard’s proposals. One prominent hospital architect called the double pavilion plan “essentially a slum.”
Neergaard’s ideas, however, won out. Rising costs and decreasing revenue sources made reduction of hospital construction and operational budgets a fiscal imperative. Centralized design reduced the amount of expensive exterior wall construction, facilitated centralization of services, and minimized nurse staffing requirements by reducing travel distances. By the 1950s, with the advent of antibiotics and improved aseptic practices, the medical establishment also believed that patient healthiness could be maintained regardless of room design. Some doctors even preferred the total environmental control offered by air conditioning, central heating, and electric lighting. Windows were no longer necessary to healthy hospitals, and by the 1960s and 1970s even windowless patient rooms appeared.
The efficient, inhuman, and monotonous buildings of the second half of the 20th century bear witness to the extent to which hospital design became a tool to facilitate medicine rather than a therapy in itself. Today, a stay in a hospital room is endured, not enjoyed.
The pendulum, however, is still swinging. In 1984, hospital architect Roger Ulrich published an article that had one clear and influential finding: Patients in hospital rooms with windows improved at a faster rate and in greater percentage than did patients in windowless rooms.
It seems as if this year’s long, widespread flu season should be coming to an end, but parents—especially those with younger children—should stay diligent when it comes to spotting influenza symptoms. There could be a second wave of the flu, according to the Centers for Disease Control and Prevention (CDC).
In the CDC’s most recent weekly report, the organization says that though the overall percentage of influenza activity is decreasing, the proportion of influenza B viruses is increasing, and there were more reports of the influenza B than influenza A during week 11 of this year. For the majority of the flu season, which began in October 2017, most cases reported were influenza A, but in the past week, 59 percent of all confirmed cases were influenza B.
What does all that mean? Parents should be aware that even if their kids were diagnosed with influenza A, they could still get sick with the influenza B virus. “We know that illness associated with influenza B can be just as severe as illness associated with influenza A,” CDC spokeswoman Kristen Nordlund told CNN. “We also know that influenza B tends to be more severe for younger children.”
The possibility of another round of the flu isn’t good news, but it’s also not that surprising. “We often see a wave of influenza B during seasons when influenza A H3N2 was the predominant virus earlier in the season,” Nordlund told the network. “Unfortunately, we don’t know what the influenza B wave will look like.”
The CDC reports that there have been 133 pediatric deaths as a result of this year’s flu season, with five deaths reported in the past week alone. Young children—as well as older adults and pregnant women—are at a higher risk for contracting the flu. According to the CDC’s website, annual vaccinations are the best way to prevent the flu and the “potentially severe complications” the virus causes in children.
Is Formaldehyde in your wood flooring?
Lumber Liquidators violated California’s air-quality controls by importing wood with formaldehyde
Beleaguered flooring retailer Lumber Liquidators is paying $2.5 million to settle allegations that some of its products violated California’s air-safety standards.
The penalty announced Tuesday was the latest that Lumber Liquidators has absorbed for formerly selling laminate flooring made in China.
In this case, Lumber Liquidators faced allegations that the imported flooring contained high levels of the carcinogen formaldehyde that violated California’s air-quality controls. The flooring was sold at Lumber Liquidators’ California stores from September 2013 until May 2015 when the retailer suspended sales of the products made in China.
Lumber Liquidators currently operates 40 of its 375 stores in California.
Last year, Lumber Liquidators paid $13.2 million in fines and pleaded guilty to environmental crimes for importing China-made flooring that contained timber illegally logged in eastern Russia.
Lumber Liquidators still faces a variety of class-action lawsuits revolving around the formaldehyde levels of the China-made flooring.
Read More: CDC Revises Lumber Liquidators Flooring Cancer Risk
The legal fallout so far has been less costly to Lumber Liquidators than the damage done to its stock since investigation shown slightly more than a year ago “60 Minutes” raised questions about whether the retailer was selling potentially hazardous flooring.
Shares of Lumber Liquidators Holdings Inc. have plunged more than 70 percent since the TV program aired, a downturn that has wiped out more than $1 billion in stockholder wealth. The shares rallied Tuesday, gaining $1.74 to $13.76 in afternoon trading.
What is formaldehyde?
Formaldehyde is a colorless, flammable, strong-smelling chemical that is used in building materials and to produce many household products. It is used in pressed-wood products, such as particleboard, plywood, and fiberboard; glues and adhesives; permanent-press fabrics; paper product coatings; and certain insulation materials. In addition, formaldehyde is commonly used as an industrial fungicide, germicide, and disinfectant, and as a preservative in mortuaries and medical laboratories. Formaldehyde also occurs naturally in the environment. It is produced in small amounts by most living organisms as part of normal metabolic processes.
How is the general population exposed to formaldehyde?
According to a 1997 report by the U.S. Consumer Product Safety Commission, formaldehyde is normally present in both indoor and outdoor air at low levels, usually less than 0.03 parts of formaldehyde per million parts of air (ppm). Materials containing formaldehyde can release formaldehyde gas or vapor into the air. One source of formaldehyde exposure in the air is automobile tailpipe emissions.
During the 1970s, urea-formaldehyde foam insulation (UFFI) was used in many homes. However, few homes are now insulated with UFFI. Homes in which UFFI was installed many years ago are not likely to have high formaldehyde levels now. Pressed-wood products containing formaldehyde resins are often a significant source of formaldehyde in homes. Other potential indoor sources of formaldehyde include cigarette smoke and the use of unvented fuel-burning appliances, such as gas stoves, wood-burning stoves, and kerosene heaters.
Industrial workers who produce formaldehyde or formaldehyde-containing products, laboratory technicians, certain health care professionals, and mortuary employees may be exposed to higher levels of formaldehyde than the general public. Exposure occurs primarily by inhaling formaldehyde gas or vapor from the air or by absorbing liquids containing formaldehyde through the skin.
A sippy cup company is under fire.
Two moms from Montreal shared unnerving photos of Tommee Tippee sippy cups on Facebook, Buzzfeed reports.
These photos show moldy sippy cups. Worse, the women allege that people can’t get rid of the mold when they try washing the cups.
Unsurprisingly, the moms are not happy about this.
According to Marie-Pier S. L’Hostie’s post (translated from French), her friend was wondering why his son had gotten sick, so he called Tommee Tipee. He got an unfortunate response.
“My friend Simon O’kanada wondered why his son was always sick. He broke the anti-spill top of his ‘Tommee Tippee’ bottle and discovered mold inside the mouthpiece. It doesn’t wash and can’t be seen unless it is broken open. He called the company, and the lady on the phone laughed out out loud. Several moms on other groups have also discovered mold after my post in another Facebook group, so I’m sharing you. If you please, those who have these cups, pay attention! Being washed by hand or in the dishwasher, the mold will stay there!”
Her friend Penny Powell shared the story (and nasty photos) as well, and said that the unsettling mold could only be seen if it the anti-spill top was broken open. She wrote that other mothers in a Facebook group complained about the issue.
She encouraged parents to share the issue and to complain to the company.
The photos that the women shared tell the story — there’s tons of mold right below where the mouthpiece is.
Tommee Tippee responded in a Facebook post to the angry parents, apologizing and claiming to be “actively working on the subject.”
The company pointed to an FAQ section on its site describing how to pope-rly use the cups, but also said that the company could not find “any trace of the conversation with [the original friend who discussed the issue], however we ask him to contact us by private message so that we can answer him directly.”
In a statement to Buzzfeed, the company advised consumers to use the cups with “recommended liquids” which include “cold, light fluids including water and non-pulp juice” and to clean the cups according to the instructions. ” Difficulties have arisen though when liquids that are not recommended for use in the cups have been used, like thick formula milk, pulpy juice and warm liquids. We also recommend that cups are not left for long periods before being cleaned,” the company added.
Tommee Tippee did say in the statement that “we understand that the well being of little ones is paramount and we can reassure all parents that we have extensively tested the valves,” and again, encouraged troubled. consumers to reach out ot them.
You can view the original Facebook complaints in full below.
These recent fungi, mold, and mushrooms were observed on the inside of a home. Fungi grow for numerous reasons in buildings and structures, including the presence of water damage or moisture intrusion.
Some fungi and mushrooms are able to import moisture from other source outside the home and continue growing even if the moisture source is eradicated. This complex rooting system allows the fungi and molds to grow in the absence of moisture leak or water damage.
Although this is not probably not a indoor air quality problem, it is a problem for the building or structure. With continuing growth of this fungi, the organism digests the cellulose within the wood, drywall, and other building components of the structure.
Experts familiar with this type of mold growth should be called to help diagnose the extent of contamination and present a pragmatic solution to eradicate the problem.
Read More > > > http://funguyinspections.com/poria-incrassata-problems-in-los-angeles/