A critical examination of perceptual and cognitive effects attributed to full-spectrum fluorescent lighting

Two Different Mismatches: Integrating the Developmental and the Evolutionary-Mismatch Hypothesis

Evolutionary psychology aims to understand the origins of the human mind, including disease. Several theories about the origins of disease have been proposed. One concerns a developmental mismatch—a mismatch might occur at the individual level between the environment experienced during childhood and the environment the adult finds herself in, possibly resulting in disease. A second theory concerns the idea of an evolutionary mismatch—humans are adapted to ancestral conditions so they might now experience a mismatch with their modern environment, possibly resulting in disease. A third theory—differential susceptibility—outlines how genetic and epigenetic differences influence the extent to which humans are susceptible to rearing, including positive and negative experiences. Because of these differences, some individuals are more prone to develop disease than others. We review empirical studies that substantiate these theories and argue that an overarching theory that integrates these three lines into one provides a more accurate understanding of disease from an evolutionary perspective.

Are classroom thermal conditions, lighting, and acoustics related to teacher health symptoms?

Over half of schools surveyed in the United States reported one environmental problem affecting Indoor Air Quality. This study investigated environmental concerns in schools, teacher-reported symptoms, and performance in relation to thermal environment, lighting, and noise conditions in New York State classrooms. This cross-sectional study consisted of telephone surveys among teachers from 428 NYS public schools. Survey contents included teacher demographics, employment characteristics, and environmental factors. Unconditional logistic regression analyses were used to estimate odds ratios (OR) of health symptoms for classroom conditions including thermal environment, lighting, and acoustics. Although too dry, too hot, or cold were major thermal concerns, 78% of the teachers reported that they cannot control temperature through thermostat. Over 50% of NYS teachers reported almost all health symptoms worsening during workdays. We found the top five most common health symptoms reported by NYS teachers are all allergy-related symptoms. Additionally, all extreme thermal factors were significantly associated with work-related symptoms in teachers. "Too dry" had the highest risk for allergic symptoms (OR: 2.49, 95% CI: 2.01-3.10), and then followed by any noise (OR: 2.46, 95% CI: 1.80-3.36) associated with voice-related health, and "lighting too dim" (OR: 2.38, 95% CI: 1.77-3.19). Future studies are needed to confirm these findings.

Betwixt and between: a surgical post-acute treatment unit (SPA) for the optimal care of elderly patients with isolated hip fractures

BACKGROUND

A performance improved project identified elderly trauma patients to have a disproportionate incidence of complications.

AIMS

The purpose of this study was to assess the efficacy of a small specialty care unit to decrease complications in patients who no longer warrant care in an intensive care unit (ICU).

METHODS

A surgical post-acute treatment unit (SPA) was developed with focused attention to cognition, nutrition, respiration, and mobilization needs of patients who no longer had physiologic need for an intensive care unit environment, but were still in need of increased attention at the bedside.

RESULTS

While ICU and hospital lengths of stay were unchanged, patients placed in the SPA experienced less complications and required less unplanned ICU re-admissions.

DISCUSSION

Geriatric patients, especially the elderly, are not simply old adults. They have unique needs as a consequence of the aging process, which can be encompassed by four pillars of intercession: cognition, nutrition, respiration, and mobilization.

CONCLUSIONS

By adapting a physical environment supported by bedside attention to address the interwoven needs of geriatric and elderly patients who no longer care in an ICU, complications and unplanned return admissions to the ICU can be decreased.

LEVEL OF EVIDENCE

III.

Does Gallery Lighting Really Have an Impact on Appreciation of Art? An Ecologically Valid Study of Lighting Changes and the Assessment and Emotional Experience With Representational and Abstract Paintings

We report two studies considering the potential for gallery lighting conditions to modulate appraisals and emotional experience with works of visual art. As recently documented in a number of papers, art appreciation represents a complex blend of formal artwork factors, personalities and backgrounds of viewers, and multiple aspects of context regarding where and how art is experienced. Among the latter, lighting would be expected to play a fundamental role. However, surprisingly, this has received little empirical assessment, with almost no ecologically valid gallery analyses and no between-participant designs which would minimize awareness of lighting changes themselves. Here, we employed a controlled paradigm using a spontaneous art viewing context, a gallery-like setting, and a proprietary lighting system which allowed the minute adjustment of lighting intensity/temperature (CCT). Participants viewed a selection of original representational and abstract art under three different CCT conditions (Study 1), modulated between participants, and then reported on their artwork appraisal and emotional experience. The selected lighting temperatures were chosen based on an initial investigation of existing art museums within the Vienna area, addressing how these institutions themselves light their art—a question which, also somewhat surprisingly, has not often been considered. We also allowed the same participants to set the light temperature themselves in order to test hypotheses regarding what might be an ‘ideal’ lighting condition for art. In Study 2, we explored the question of whether artworks made by an artist to match specific lighting conditions show a resulting connection to the ratings of viewers when shown in the same or different light. Results showed almost no effects from lighting changes in both studies. Viewers’ self-set light temperature (mean = 3777 K) did roughly coincide with the suggested most enjoyable conditions for everyday living and some past research on art viewing, but again showed wide interpersonal variance. Results, and a general review of lighting factors are considered in order to provide art researchers and curators with a tool for conducting future study.

Fluorescent Light Incites a Conserved Immune and Inflammatory Genetic Response within Vertebrate Organs (Danio Rerio, Oryzias Latipes and Mus Musculus)

Fluorescent light (FL) has been utilized for ≈60 years and has become a common artificial light source under which animals, including humans, spend increasing amounts of time. Although the solar spectrum is quite dissimilar in both wavelengths and intensities, the genetic consequences of FL exposure have not been investigated. Herein, we present comparative RNA-Seq results that establish expression patterns within skin, brain, and liver for Danio rerio, Oryzias latipes, and the hairless mouse (Mus musculus) after exposure to FL. These animals represent diurnal and nocturnal lifestyles, and ≈450 million years of evolutionary divergence. In all three organisms, FL induced transcriptional changes of the acute phase response signaling pathway and modulated inflammation and innate immune responses. Our pathway and gene clustering analyses suggest cellular perception of oxidative stress is promoting induction of primary up-stream regulators IL1B and TNF. The skin and brain of the three animals as well as the liver of both fish models all exhibit increased inflammation and immune responses; however, the mouse liver suppressed the same pathways. Overall, the conserved nature of the genetic responses observed after FL exposure, among fishes and a mammal, suggest the presence of light responsive genetic circuitry deeply embedded in the vertebrate genome.

The transcriptional response of skin to fluorescent light exposure in viviparous (Xiphophorus) and oviparous (Danio, Oryzias) fishes

Differences in light sources are common in animal facilities and potentially can impact experimental results. Here, the potential impact of lighting differences on skin transcriptomes has been tested in three aquatic animal models commonly utilized in biomedical research, (Xiphophorus maculatus (platyfish), Oryzias latipes (medaka) and Danio rerio (zebrafish). Analysis of replicate comparative RNA-Seq data showed the transcriptional response to commonly utilized 4100K or "cool white" fluorescent light (FL) is much greater in platyfish and medaka than in zebrafish. FL induces genes associated with inflammatory and immune responses in both medaka and zebrafish; however, the platyfish exhibit suppression of genes involved with immune/inflammation, as well as genes associated with cell cycle progression. Furthermore, comparative analyses of gene expression data from platyfish UVB exposures, with medaka and zebrafish after exposure to 4100K FL, show comparable effects on the same stress pathways. We suggest the response to light is conserved, but that long-term adaptation to species specific environmental niches has resulted in a shifting of the wavelengths required to incite similar "genetic" responses in skin. We forward the hypothesis that the "genetic perception" of light may have evolved differently than ocular perception and suggest that light type (i.e., wavelengths emitted) is an important parameter to consider in experimental design.

LED Lights With Hidden Intensity-Modulated Blue Channels Aiming for Enhanced Subconscious Visual Responses

A new form of light-emitting diode (LED) light suitable for general illumination is proposed to enhance subconscious, nonimage-forming visual responses, which are essential to our well-being. Pulsing light has been shown to reduce photoreceptor adaptation and elicit stronger subconscious visual responses at an indoor illumination level. Using the silent substitution technique, a melanopsin-selective flicker can be added into white light. A linear optimization algorithm was developed to suppress any perceivable fluctuation of light intensity and colors of illuminated objects. Two examples of lights are given to illustrate the potential applications of the proposed multi-LED light for general illumination and therapeutic purposes.

Levels of Visual Stress in Proficient Readers: Effects of Spectral Filtering of Fluorescent Lighting on Reading Discomfort

Visual stress (VS) affects reading in 5-12% of the general population and 31-36% of children with reading disorders. Symptoms include print distortions and visual discomfort when reading, and are exacerbated by fluorescent lighting. Prior research has indicated that VS can also affect proficient readers. We therefore examined levels of visual discomfort in a group of expert readers (n = 24) under both standard and spectrally-filtered fluorescent lighting. Participants rated their awareness of six symptoms of VS under each lighting condition. Under the standard condition, 4(16.7%) of the group recorded moderate to high levels of VS. Differences in symptom levels and reading speed between conditions were analysed using the Wilcoxon Signed Rank Test. Under the filter condition, the group reported less discomfort regarding all six symptoms of VS surveyed. The differences were significant with respect to three of the symptoms (p = .029 - p < .001), with a medium effect size in all of them (r = .31 - r = .46) and total score (p = .007; r = .39). Variations in reading proficiency included significantly fewer self-corrections (p = .019) and total errors (p = .004). Here we present evidence that VS-type symptoms of reading discomfort are not confined to populations with reading difficulties and may also occur in proficient readers, and that simple adaptations to fluorescent lighting may alleviate such symptoms.

The supporting effects of high luminous conditions on grade 3 oral reading fluency scores

The universality of the impact of daylight is a common thread that defines humanity. Day light affects us in a variety of ways -visually, psychologically and biologically. Artificial lighting research has explored ways in which artificial lighting may substitute for daylight and enhance human health and wellbeing. Recently, a study by Mott et al. 2011 found that the usage of high intensity, yet glare free lighting, (referred to as Focus light setting) during reading instruction increased grade 3 students' oral reading fluency (ORF) scores, a key index of reading comprehension. The current study further explored the effect of Focus lighting during literacy instruction with at-risk grade 3 students (n = 172). Over the course of an academic year, the Focus lighting students increased their ORF scores at a greater rate than did the Normal lighting students. These findings, in combination with earlier lighting research, suggest that artificial lighting plays a key role in helping to create an effective learning environment to ensure children reach their full potential. More systematic research, however, is needed to understand the mechanisms by which artificial lighting may contribute to the learning environment: visually, biologically and/or psychologically.

Comparing colour discrimination and proofreading performance under compact fluorescent and halogen lamp lighting

Legislation in many countries has banned inefficient household lighting. Consequently, classic incandescent lamps have to be replaced by more efficient alternatives such as halogen and compact fluorescent lamps (CFL). Alternatives differ in their spectral power distributions, implying colour-rendering differences. Participants performed a colour discrimination task - the Farnsworth-Munsell 100 Hue Test--and a proofreading task under CFL or halogen lighting of comparable correlated colour temperatures at low (70 lx) or high (800 lx) illuminance. Illuminance positively affected colour discrimination and proofreading performance, whereas the light source was only relevant for colour discrimination. Discrimination was impaired with CFL lighting. There were no differences between light sources in terms of self-reported physical discomfort and mood state, but the majority of the participants correctly judged halogen lighting to be more appropriate for discriminating colours. The findings hint at the colour-rendering deficiencies associated with energy-efficient CFLs.

PRACTITIONER SUMMARY

In order to compare performance under energy-efficient alternatives of classic incandescent lighting, colour discrimination and proofreading performance was compared under CFL and halogen lighting. Colour discrimination was impaired under CFLs, which hints at the practical drawbacks associated with the reduced colour-rendering properties of energy-efficient CFLs.

Evolution in the Office: How Evolutionary Psychology Can Increase Employee Health, Happiness, and Productivity

We review the empirical literature that has implemented aspects of our ancestral environment into the workplace and discuss the positive influence these factors have had on employees' physical and psychological health. We focus upon several components of our ancestral environment, including sunlight, greenery, sleep, physical movement, and social interaction with fellow humans as well as animals (specifically, dogs). Employers who are willing to adopt an evolutionary psychological approach to organizing their workplaces may drastically improve their workers' overall physical and psychological health as well as their overall productivity. This will, in turn, decrease employer costs related to medical care, absenteeism, and lack of productivity. Suggestions regarding how to implement these evolutionary psychological methods to the workplace are also discussed.

Using Clinical Simulation Centers to Test Design Interventions: A Pilot Study of Lighting and Color Modifications

Objective:

The aim of this pilot study was to test design interventions such as lighting, color, and spatial color patterning on nurses' stress, alertness, and satisfaction, and to provide an example of how clinical simulation centers can be used to conduct research.

Background:

The application of evidence-based design research in healthcare settings requires a transdisciplinary approach. Integrating approaches from multiple fields in real-life settings often proves time consuming and experimentally difficult. However, forums for collaboration such as clinical simulation centers may offer a solution. In these settings, identical operating and patient rooms are used to deliver simulated patient care scenarios using automated mannequins.

Methods:

Two identical rooms were modified in the clinical simulation center. Nurses spent 30 minutes in each room performing simulated cardiac resuscitation. Subjective measures of nurses' stress, alertness, and satisfaction were collected and compared between settings and across time using matched-pair t-test analysis.

Results:

Nurses reported feeling less stressed after exposure to the experimental room than nurses who were exposed to the control room (2.22, p = .03). Scores post-session indicated a significant reduction in stress and an increase in alertness after exposure to the experimental room as compared to the control room, with significance levels below .10. (Change in stress scores: 3.44, p = .069); (change in alertness scores: 3.6, p = .071).

Conclusion:

This study reinforces the use of validated survey tools to measure stress, alertness, and satisfaction. Results support human-centered design approaches by evaluating the effect on nurses in an experimental setting.

Sensory environment on health-related outcomes of hospital patients

BACKGROUND

Hospital environments have recently received renewed interest, with considerable investments into building and renovating healthcare estates. Understanding the effectiveness of environmental interventions is important for resource utilisation and providing quality care.

OBJECTIVES

To assess the effect of hospital environments on adult patient health-related outcomes.

SEARCH METHODS

We searched: the Cochrane Central Register of Controlled Trials (last searched January 2006); MEDLINE (1902 to December 2006); EMBASE (January 1980 to February 2006); 14 other databases covering health, psychology, and the built environment; reference lists; and organisation websites. This review is currently being updated (MEDLINE last search October 2010), see Studies awaiting classification.

SELECTION CRITERIA

Randomised and non-randomised controlled trials, controlled before-and-after studies, and interrupted times series of environmental interventions in adult hospital patients reporting health-related outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors independently undertook data extraction and 'Risk of bias' assessment. We contacted authors to obtain missing information. For continuous variables, we calculated a mean difference (MD) or standardized mean difference (SMD), and 95% confidence intervals (CI) for each study. For dichotomous variables, we calculated a risk ratio (RR) with 95% confidence intervals (95% CI). When appropriate, we used a random-effects model of meta-analysis. Heterogeneity was explored qualitatively and quantitatively based on risk of bias, case mix, hospital visit characteristics, and country of study.

MAIN RESULTS

Overall, 102 studies have been included in this review. Interventions explored were: 'positive distracters', to include aromas (two studies), audiovisual distractions (five studies), decoration (one study), and music (85 studies); interventions to reduce environmental stressors through physical changes, to include air quality (three studies), bedroom type (one study), flooring (two studies), furniture and furnishings (one study), lighting (one study), and temperature (one study); and multifaceted interventions (two studies). We did not find any studies meeting the inclusion criteria to evaluate: art, access to nature for example, through hospital gardens, atriums, flowers, and plants, ceilings, interventions to reduce hospital noise, patient controls, technologies, way-finding aids, or the provision of windows. Overall, it appears that music may improve patient-reported outcomes such as anxiety; however, the benefit for physiological outcomes, and medication consumption has less support. There are few studies to support or refute the implementation of physical changes, and except for air quality, the included studies demonstrated that physical changes to the hospital environment at least did no harm.

AUTHORS' CONCLUSIONS

Music may improve patient-reported outcomes in certain circumstances, so support for this relatively inexpensive intervention may be justified. For some environmental interventions, well designed research studies have yet to take place.

Applicability and efficacy of variable light in schools

There is a range of reliable, empirical data on the effects of special lighting techniques on the performance of adults in the work environment in the literature. However, these studies have not adequately addressed the effects of lighting on school children in the classroom environment. In the present study, the effect of variable lighting (VL) i.e., lighting that is variable in illuminance and color temperature, was studied in the classroom using a variety of student performance and attitude measures. Two classrooms each in two separate schools were studied over a period of nine months; one class in each school served as an intervention group, and a parallel class in each school served as a control group. The effects of the individual VL programs were assessed using standardized test modules. The overall effect was measured using standardized surveys of students and teachers given at the beginning and the end of the project. The results showed that the students made fewer errors, particularly fewer errors of omission, on a standardized test of attention under the VL "Concentrate" program. Reading speed, as measured using standardized reading tests, rose significantly. Reading comprehension also improved, but this improvement was not statistically significant. In contrast, the achievement motivation of the students and the classroom atmosphere did not change over the nine-month period. Overall, the students and teachers rated VL positively and found it useful during lessons. These results are in line with previous research findings. Thus, VL represents an environmental factor that can be useful to optimize general learning conditions in schools in the future.

Light enhances learned fear

The ability to learn, remember, and respond to emotional events is a powerful survival strategy. However, dysregulated behavioral and physiological responses to these memories are maladaptive. To fully understand learned fear and the pathologies that arise during response malfunction we must reveal the environmental variables that influence learned fear responses. Light, a ubiquitous environmental feature, modulates cognition and anxiety. We hypothesized that light modulates responses to learned fear. Using tone-cued fear conditioning, we found that light enhances behavioral responses to learned fear in C57BL/6J mice. Mice in light freeze more in response to a conditioned cue than mice in darkness. The absence of significant freezing during a 2-wk habituation period and during intertrial intervals indicated that light specifically modulates freezing to the learned acoustic cue rather than the context of the experimental chamber. Repeating our assay in two photoreceptor mutant models, Pde6b(rd1/rd1) and Opn4(-/-) mice, revealed that light-dependent enhancement of conditioned fear is driven primarily by the rods and/or cones. By repeating our protocol with an altered lighting regimen, we found that lighting conditions acutely modulate responses when altered between conditioning and testing. This is manifested either as an enhancement of freezing when light is added during testing or as a depression of freezing when light is removed during testing. Acute enhancement, but not depression, requires both rod/cone- and melanopsin-dependent photoreception. Our results demonstrate a modulation by light of behavioral responses to learned fear.

Ill-lighting syndrome: prevalence in shift-work personnel in the anaesthesiology and intensive care department of three Italian hospitals

Background

Light is one of the most important factors in our interaction with the environment; it is indispensable to visual function and neuroendocrine regulation, and is essential to our emotional perception and evaluation of the environment. Previous studies have focussed on the effects of prolonged anomalous exposure to artificial light and, in the field of work-related illness. Studies have been carried out on shift-work personnel, who are obliged to experience alterations in the physiological alternation of day and night, with anomalous exposure to light stimuli in hours normally reserved for sleep. In order to identify any signs and symptoms of the so-called ill-lighting syndrome, we carried out a study on a sample of anaesthesiologists and nurses employed in the operating theatres and Intensive Care Departments of three Italian hospitals. We measured the subjective emotional discomfort (stress) experienced by these subjects, and its correlation with environmental discomfort factors, in particular the level of lighting, in their workplace.

Methods

We used a questionnaire developed by the Scandinavian teams who investigated Sick-Building Syndrome, that was self-administered on one day in the environments where the degree of illumination was measured according to UNIEN12464-1 regulations.

Results

Upon comparison of the types of exposure with the horizontal luminance values (lux) measured (< 700 lux, between 1000–1500 lux, > 1500 lux) and the degree of stress reported, (Intensive Care: mean stress = 55.8%, high stress = 34.6%; Operating Theatres: mean stress = 51.5%, high stress = 33.8%), it can be observed that the percentage of high stress was reduced as the exposure to luminance was increased, although this finding was not statistically significant.

Conclusion

We cannot share other authors' enthusiasm regarding the effects on workers well-being correlated to the use of fluorescent lighting. The stress level of our workers was found to be more heavily influenced by their familial and working conditions, irrespective of the ambient light stimulus.

The impact of light and colour on psychological mood: a cross-cultural study of indoor work environments

The aim of the study was to determine whether indoor lighting and colour would have any systematic impact on the mood of people working indoors. Earlier studies have mostly focused either on light, colour or windows in laboratory settings. The present study was carried out in real work environments at different seasons and in countries with different latitudes. A total of 988 persons completed all parts of the study. In the countries situated far north of the equator there was a significant variation in psychological mood over the year that did not occur in the countries closer to the equator. When all four countries were considered together, it became evident that the light and colour of the workplace itself also had an influence on the mood of persons working there. The workers' mood was at its lowest when the lighting was experienced as much too dark. The mood then improved and reached its highest level when the lighting was experienced as just right, but when it became too bright the mood declined again. On the other hand, the illuminance as measured in objective terms, showed no significant impact on mood at any time of the year. The relationship between mood and the distance to the nearest window was bimodal. The results also indicate that the use of good colour design might contribute to a more positive mood. It is suggested that in future research light and colour should be studied as parts of the more complex system making up a healthy building.

Ten simple strategies to prevent chemotherapy errors

Safety experts currently recommend using technology to prevent medication errors. Computerized prescriber order entry, automated medication-dispensing machines, and bar coding are a few of the technologies being advocated to promote safety. Simple, easily implemented safety strategies to prevent chemotherapy errors should not be overlooked and include consistent use of a reliable method to verify patient identity, metric measurement, and workplace illumination and organization. Other strategies are elimination of abbreviations and acronyms, provision of up-to-date information at the point of care, and partnering with patients for safety. These strategies can be customized for use in a variety of practice settings. Oncology nurses are at the forefront of chemotherapy error-prevention initiatives and play a key role in implementing safety measures.