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Introduction Research has provided novel insights into how light stimulates circadian rhythms through specialised retinal ganglion cells to the suprachiasmatic nucleus. In addition, there has been a revolution in light-emitting diode (LED) technology, leading to tunable LED light sources and lighting systems, enabling 24-hour dynamic light scenarios with bright blue-enriched short wavelength light during the day and dim evening light, stimulating the circadian system. These dynamic LED lighting systems are now being implemented at hospitals without adequate understanding of how it may affect the health and well-being of patients and staff. Methods and analysis An optimised dynamic LED lighting scenario is investigated at a newly built psychiatric hospital in Copenhagen. In the 12 months baseline period, a standard lighting scenario with dynamic colour temperature and fixed light intensity is investigated. In the following 12-month intervention period, a new DEL scenario is investigated, having dynamic colour temperature as well as dynamic light intensity with a higher daytime and lower evening-time melanopic daylight equivalent illuminance. This setting is furthermore adjusted for geographical orientation to compensate for differences in sunlight access in wintertime. The study uses a quasiexperimental design comparing patients admitted in the two study periods. Prior to each of the study periods, daylight and the contribution from the LED-lighting scenarios was measured. Patient sociodemographic and mental health data will be retrieved retrospectively from electronic medical records and by questionnaires administered in the two periods, evaluating lighting, noise, sleep quality and quality of life. Primary outcome is the proportion of patients receiving pro re nata medications. Secondary outcomes are the length of stay, sleep onset latency, sleep quality and quality of life. Ethics and dissemination No ethical issues are expec, INTRODUCTION: Research has provided novel insights into how light stimulates circadian rhythms through specialised retinal ganglion cells to the suprachiasmatic nucleus. In addition, there has been a revolution in light-emitting diode (LED) technology, leading to tunable LED light sources and lighting systems, enabling 24-hour dynamic light scenarios with bright blue-enriched short wavelength light during the day and dim evening light, stimulating the circadian system. These dynamic LED lighting systems are now being implemented at hospitals without adequate understanding of how it may affect the health and well-being of patients and staff. METHODS AND ANALYSIS: An optimised dynamic LED lighting scenario is investigated at a newly built psychiatric hospital in Copenhagen. In the 12 months baseline period, a standard lighting scenario with dynamic colour temperature and fixed light intensity is investigated. In the following 12-month intervention period, a new DEL scenario is investigated, having dynamic colour temperature as well as dynamic light intensity with a higher daytime and lower evening-time melanopic daylight equivalent illuminance. This setting is furthermore adjusted for geographical orientation to compensate for differences in sunlight access in wintertime. The study uses a quasiexperimental design comparing patients admitted in the two study periods. Prior to each of the study periods, daylight and the contribution from the LED-lighting scenarios was measured. Patient sociodemographic and mental health data will be retrieved retrospectively from electronic medical records and by questionnaires administered in the two periods, evaluating lighting, noise, sleep quality and quality of life. Primary outcome is the proportion of patients receiving pro re nata medications. Secondary outcomes are the length of stay, sleep onset latency, sleep quality and quality of life. ETHICS AND DISSEMINATION: No ethical issues are expected. The results will be dissemin

Introduction: Seasonality in depressive and bipolar disorders, are recognized in the ICD-10/11 and DSM-5 diagnostic systems. The existence of a seasonal pattern of hospital diagnosis of major depression, bipolar disorder and prescription of antidepressant medications has not been evaluated in the Danish population. Methods: We retrieved date and year for all first-time hospital contacts with depression or bipolar disorder between 1999 and 2019, registered in the Danish National Patient Registry. Depression was defined using the ICD-10 F32-F33 codes, and for bipolar disorder the F30 or F31 codes. Date and year of all first-time purchases of antidepressant medications with ATC codes (N06A) between 1999 and 2021 were retrieved from the Danish National Prescription Registry, containing information on all prescribed drugs dispensed at pharmacies since 1995. Data on sunlight hours from 2012 to 2021 were retrieved from the Danish Metrological Institute. Results: Incidences of hospital diagnoses as well as purchases of medication varied with month and season. The monthly variations were larger for antidepressant medication and smallest for bipolar disorder. The multiple linear regression analysis showed that number of first-time diagnoses of depression or bipolar disorder did not correlate with season. For antidepressant medication the number of first-time prescriptions was significantly lower in summer compared to the winter season. Conclusion: This study found a seasonal variation of first-time prescriptions of antidepressant medication. We did not find a seasonal variation in first-time hospital diagnoses. Further research looking into depression severity, polarity of bipolar illness episodes, lag-time for sunlight exposure, and specific parts of the yearly photoperiods should be conducted.

Research has provided novel insights into how light stimulates circadian rhythms through specialised retinal ganglion cells to the suprachiasmatic nucleus. In addition, there has been a revolution in light-emitting diode (LED) technology, leading to tunable LED light sources and lighting systems, enabling 24-hour dynamic light scenarios with bright blue-enriched short wavelength light during the day and dim evening light, stimulating the circadian system. These dynamic LED lighting systems are now being implemented at hospitals without adequate understanding of how it may affect the health and well-being of patients and staff. An optimised dynamic LED lighting scenario is investigated at a newly built psychiatric hospital in Copenhagen. In the 12 months baseline period, a standard lighting scenario with dynamic colour temperature and fixed light intensity is investigated. In the following 12-month intervention period, a new DEL scenario is investigated, having dynamic colour temperature as well as dynamic light intensity with a higher daytime and lower evening-time melanopic daylight equivalent illuminance. This setting is furthermore adjusted for geographical orientation to compensate for differences in sunlight access in wintertime. The study uses a quasiexperimental design comparing patients admitted in the two study periods. Prior to each of the study periods, daylight and the contribution from the LED-lighting scenarios was measured. Patient sociodemographic and mental health data will be retrieved retrospectively from electronic medical records and by questionnaires administered in the two periods, evaluating lighting, noise, sleep quality and quality of life. Primary outcome is the proportion of patients receiving pro re nata medications. Secondary outcomes are the length of stay, sleep onset latency, sleep quality and quality of life. No ethical issues are expected. The results will be disseminated through peer-reviewed international journal, lectures, poste

Daylight is essential for ecosystems and for the physical and mental well-being of people. In densely populated cities, only a small proportion of total daylight is available to support urban greenery and most people have little daily exposure to natural daylight. Despite this, many cities have followed a strategy of densification as a way of preventing urban sprawl and reducing energy consumption. In this article, we review the biological importance of daylight and show that urban densification leads to a reduction in the daylight available for both people and nature. We conclude that daylight in cities should be treated as a limiting resource that needs to be planned and managed carefully, much like water or energy. We suggest elements for a policy framework aimed at optimizing urban daylight, including how to determine daylight needs, how to determine the maximum viable urban density, and policy options for built and unbuilt areas.

Artificial light has been used as a treatment for depression since the 1980s. The indications have since broadened from seasonal depression to non-seasonal depression including bipolar, geriatric, and chronic depression. Light acts through retinohypothalamic connections from specialised retinal neurons to central nuclei involved in circadian and emotional regulation. This review illuminates the current strategies directed towards utilising natural daylight or electric lighting mimicking the dynamic spectrum and intensity of daylight to improve treatment in modern hospital settings.

This paper presents preliminary results of analyzes of the indoor environmental quality (IEQ) in a full scale rotatable 1:1 mockup of a patient room. As initial part of the planning of the indoor environment at a new mental hospital, the project seeks to uncover the natural differences and limitations of the building, caused by the geographical orientation. Examining the outdoor diurnal variations and their effect on the indoor environment, in order to create a balance between on the one hand, daylight and artificial lighting and on the other hand the demand for passive cooling, using natural ventilation. The analysis discuss potential health aspects of daylight and fresh air and proposes a new strategy for dynamic artificial lighting, including natural ventilation to supplement mechanical ventilation. In this article we uncover daylight conditions based on two main parameters; 1) the geographic orientation (N, S, E and W) and 2) the season (summer and winter). Based on the preliminary data and the regional daylight conditions, the article proposes a new way to plan the indoor environmental quality called Lattitude and Orientation Compensated Architectural Lighting (LOCAL).

Beskriver indgreb og elementer, som implementeres i det nye byggeri af Ny Psykiatri Bispebjerg, heriblandt dynamisk lysstyring i forhold til de fire verdenshjørner og naturlig ventilation

Projektet udvikler og etablerer en fuldskala drejbar 1: 1 mockup af en patient sengestue på det kom-mende Ny Bispebjerg Psykiatri Hospital (NBP). Igennem registreringer og analyser af dagslys og tempera-turer og naturlig ventilation i sengestuen, søger projektet at afdække, hvordan naturlige forskelle, forår-saget af den geografiske orientering og udendørs døgnvariationer påvirker indeklimaet, med henblik på, at skabe en balance mellem på den en side dagslys og behov for dynamisk LED-belysning og på den anden side kravet om aktiv og passiv køling ved hjælp af mekanisk og naturlig ventilation. Analysen ser i den for-bindelse også på de potentielle sundhedsmæssige aspekter af dagslys og frisk luft og foreslår en ny stra-tegi for dynamisk kunstig belysning og dynamisk ventilation, kaldet Geographical Orientation Compensa-ted Architectural Planning, GOCAP. En strategi, som inddeler dagen i henholdsvis et morgenscenarie og et aftenscenarie, med henblik på, at reducere bygningens samlede energiforbrug. Rapporten afdækker i den forbindelse indeklimaet og dagslysforholdene baseret på to hovedparametre: 1) Den geografiske orientering (N, S, Ø og V) 2) Årstiden (sommer og vinter)., Projektet udvikler og etablerer en fuldskala drejbar 1:1 mockup af en patient sengestue på det kommende Ny Bispebjerg Hospital. Igennem registreringer af dagslys og temperaturer i patient sengestuen, søger projektet, at afdække de naturlige forskelle og begrænsninger, forårsaget af den geografiske orientering og undersøge de udendørs døgnvariationer og deres indvirkning på indeklimaet, med henblik på, at skabe en balance mellem på den ene side dagslys og behov for dynamisk LED-belysning og på den anden side kravet om aktiv og passiv køling ved hjælp af mekanisk og naturlig ventilation. Analysen ser i den forbindelse også på de potentielle sundhedsmæssige aspekter af dagslys og frisk luft og foreslår en ny strategi for dynamisk kunstig belysning og dynamisk mekanisk ventilation, kaldet Geographical Orientation Compensated Architectural Planning, GOCAP. En strategi, som inddeler dagen i henholdsvis en morgenperiode og et aftenperiode, med henblik på, at reducere bygningens samlede energiforbrug. Rapporten analyserer i den forbindelsemuligheden for, at udnytte naturligt lys og naturlig ventilation, baseret på to hovedparametre.

Introduction Retrospective studies conducted in psychiatric inpatient wards have shown a relation between the intensity of daylight in patient rooms and the length of stay, pointing to an antidepressant effect of ambient lighting conditions. Light therapy has shown a promising antidepressant effect when administered from a light box. The emergence of light-emitting diode (LED) technology has made it possible to build luminaires into rooms and to dynamically mimic the spectral and temporal distribution of daylight. The objective of this study is to investigate the antidepressant efficacy of a newly developed dynamic LED-lighting system installed in an inpatient ward. Methods and analysis In all, 150 inpatients with a major depressive episode, as part of either a major depressive disorder or as part of a bipolar disorder, will be included. The design is a two-arm 1:1 randomised study with a dynamic LED-lighting arm and a static LED-lighting arm, both as add-on to usual treatment in an inpatient psychiatric ward. The primary outcome is the baseline adjusted score on the 6-item Hamilton Depression Rating Scale at week 3. The secondary outcomes are the mean score on the Suicidal Ideation Attributes Scale at week 3, the mean score on the 17-item Hamilton Depression Rating Scale at week 3 and the mean score on the World Health Organisation Quality of Life-BREF (WHOQOL-BREF) at week 3. The spectral distribution of daylight and LED-light, with a specific focus on light mediated through the intrinsically photosensitive retinal ganglion cells, will be measured. Use of light luminaires will be logged. Assessors of Hamilton Depression Rating Scale scores and data analysts will be blinded for treatment allocation. The study was initiated in May 2019 and will end in December 2021. Ethics and dissemination No ethical issues are expected. Results will be published in peer-reviewed journals, disseminated electronically and in print and presented at symposia. Trial registration num

Background: Retrospective studies conducted in psychiatric wards have indicated a shorter duration of stay for depressed inpatients in bright compared to dim daylight-exposed rooms, pointing to a possible antidepressant effect of daylight conditions. Dynamic LED lighting, aiming to mimic daylight conditions, are currently been installed in several hospitals, but their feasibility is poorly investigated. Methods: To investigate the feasibility of these systems, we developed and installed a LED-lighting system in four rooms in a psychiatric inpatient ward. The system could function statically or dynamically regarding light intensity and colour temperature. The system consisted of (A) a large LED luminaire built into the window jamb mimicking sunlight reflections, (B) two LED light luminaires in the ceiling and (C) a LED reading luminaire. In the static mode, the systems provided constant light from A and B. In the dynamic mode, the system changed light intensity and colour temperature using A, B and C. Patients with unipolar or bipolar depression were randomised to dynamic or static LED lighting for 4 weeks, in addition to standard treatment. Primary outcome was the rate of patients discontinuing the trial due to discomfort from the lighting condition. Secondary outcomes were recruitment and dropout rates, visual comfort, depressive symptoms and suicidal ideation. Results: No participants discontinued due to discomfort from the LED lighting. Recruitment rate was 39.8%, dropout from treatment rates were 56.3% in the dynamic group and 33.3% in the static group. 78.1% in the dynamic group were satisfied with the lighting compared with 71.8% in the static group. Discomfort from the light (glare) was reported by 11.5% in the dynamic group compared to 5.1% in the static group. Endpoint suicidal scores were 16.8 (10.4) in the dynamic and 16.3 (14.9) in the static group. The lighting system was 100% functional. The light sensor system proved unstable. Conclusion: Dropout f

Circadian and seasonal rhythm disturbances are prominent in patients with psychiatric disorders. Properly timed and dosed light of specific spectral composition stabilises mood and sleep through serotonergic mechanisms and through input to the master circadian clock in the hypothalamus. Correctly administered, light can be used as an effective treatment for seasonal and non-seasonal depression and for stabilising the sleep-wake cycle. Blocking blue light in the evening may provide a non-pharmacological anti-manic tool. Current developments use dynamic lighting built into somatic and psychiatric hospitals to maximise the beneficial effects of light.

We present a spectrometric instrumentation to monitor and log the spectral characteristics of the light in hospital rooms over long term periods during a trial of the effect of controlled lighting on patients. Each room has been equipped with a dynamic lighting system enabling change of correlated colour temperature of the light over the day. The objective is to estimate and document the available light exposure to the patient including the daylight through the window. The calibrated spectral measurements allows for evaluating the stimulus intensities for all five photopigments in relation to both visual and non-visual effects of the light in the rooms.

Background and Aim: Improvement in patients admitted to inpatient wards with severe depression is slow, and such patients are often discharged with residual symptoms which put them at risk for relapse. New treatments that can speed up recovery are highly desired. This naturalistic follow-up study in a specialized affective disorders unit investigated the impact of daylight on the length of hospital stay and improvement of depression. Methods: For a period of 1 year, we collected data on sociodemographics, length of stay, vitamin D, and depression severity for patients in an inpatient affective disorders unit. The ward is located with one facade that faces southeast (SE); the opposite one faces northwest (NW) and receives far less light and no direct sunlight during winter. Results: SE-facing rooms received far more daylight than NW-facing rooms. The length of stay was significantly lower in the SE rooms, i.e., 29.2 (±26.8) versus 58.8 (±42.0) days in the NW rooms (p = 0.01). There was a statistically nonsignificant greater reduction of 52.2% in depression severity for the patients staying in the SE rooms compared to 42.2% in the NW rooms, which may nevertheless be clinically relevant. Conclusion: Due to the study design, no causality for the observed difference in length of stay can be given, but the results support findings in previous studies of the importance of architectural orientation providing natural daylight as a factor for improvement.

Light seems to be a very changeable size in our build environment. Being an immaterial building stone, light takes a very liquid shape in our design-vocabulary. It consists of an invisible material – photons – and therefore it takes no specific form in itself but is only articulated through the meeting with form. Therefore, since form has been the major theme for the aesthetics up until now, giving form to light is a complex and challenging task and reducing it to Lux and measurable numbers only an escape from facing what is actually perceived. In this way light seems to suffer from what can be called the dichotomy between the aesthetics of the objects and the aesthetics of the perception – as stated by Boehme. To improve practice this article conducts a study of our perception, focusing more on the effects of light and less on the physical light (lux). By doing so the article tries to give a better understanding of the differences of the regional lighting cultures and the influences creating the differences. The article tries to establish a link between the regional daylight and the use of artificial lighting, showing that daylight, as a background, along with our perception, are determinant factors for how the artificial lighting and the brightness of the room is perceived. The articlehereby suggests that light is not an absolute factor. This means the end of the dichotomy between daylight and artificial light – often expressed by artificial light replacing daylight – instead this article tries to establish a dialogue between the daylight and the artificial lighting. The article describes how light – this intangible building block – can become a more workable size in the aesthetic and architectural practice of today. &nbsp