Mathematical modelling of patient risks in a hospital environment, using multiple regression analysis

The aim of this research work was primarily to examine the relevance of patient parameters, ward structures, procedures and practices, in respect of the potential hazards of wound cross-infection and nasal colonisation with multiple resistant strains of Staphylococcus aureus, which it is thought might provide a useful indication of a patient's general susceptibility to wound infection. Information from a large cross-sectional survey involving 12,000 patients from some 41 hospitals and 375 wards was collected over a five-year period from 1967-72, and its validity checked before any subsequent analysis was carried out. Many environmental factors and procedures which had previously been thought (but never conclusively proved) to have an influence on wound infection or nasal colonisation rates, were assessed, and subsequently dismissed as not being significant, provided that the standard of the current range of practices and procedures is maintained and not allowed to deteriorate. Retrospective analysis revealed that the probability of wound infection was influenced by the patient's age, duration of pre-operative hospitalisation, sex, type of wound, presence and type of drain, number of patients in ward, and other special risk factors, whilst nasal colonisation was found to be influenced by the patient's age, total duration of hospitalisation, sex, antibiotics, proportion of occupied beds in the ward, average distance between bed centres and special risk factors. A multi-variate regression analysis technique was used to develop statistical models, consisting of variable patient and environmental factors which were found to have a significant influence on the risks pertaining to wound infection and nasal colonisation. A relationship between wound infection and nasal colonisation was then established and this led to the development of a more advanced model for predicting wound infections, taking advantage of the additional knowledge of the patient's state of nasal colonisation prior to operation.

The mathematical modelling of the environmental performance of buildings as an aid in the design process

This thesis is a theoretical study of the accuracy and usability of models that attempt to represent the environmental control system of buildings in order to improve environmental design. These models have evolved from crude representations of a building and its environment through to an accurate representation of the dynamic characteristics of the environmental stimuli on buildings. Each generation of models has had its own particular influence on built form. This thesis analyses the theory, structure and data of such models in terms of their accuracy of simulation and therefore their validity in influencing built form. The models are also analysed in terms of their compatability with the design process and hence their ability to aid designers. The conclusions are that such models are unlikely to improve environmental performance since: a the models can only be applied to a limited number of building types, b they can only be applied to a restricted number of the characteristics of a design, c they can only be employed after many major environmental decisions have been made, d the data used in models is inadequate and unrepresentative, e models do not account for occupant interaction in environmental control. It is argued that further improvements in the accuracy of simulation of environmental control will not significantly improve environmental design. This is based on the premise that strategic environmental decisions are made at the conceptual stages of design whereas models influence the detailed stages of design. It is hypothesised that if models are to improve environmental design it must be through the analysis of building typologies which provides a method of feedback between models and the conceptual stages of design. Field studies are presented to describe a method by which typologies can be analysed and a theoretical framework is described which provides a basis for further research into the implications of the morphology of buildings on environmental design.