PurposeDespite being a common term in the literature, there is little agreement about what the word 'adaptability' means in the context of the built environment and very little evidence regarding practitioners' understanding of adaptability. This paper therefore examines what practitioners in the building industry mean when they talk about 'adaptability'. Design/methodology/approachThis study adopted a qualitative approach, involving 82 unstructured face-to-face interviews with practitioners from a range of professional disciplines in the construction industry, including architects, engineers, facilities managers, property agents and planners. The interview transcripts were coded inductively in order to identify themes in the qualitative data. FindingsThe interview data revealed a wide range of perspectives on adaptability, particularly regarding terminology, the meanings practitioners associate with adaptability and the way in which these meanings are communicated to others in the industry. The applied meaning of adaptability varied depending on context. Practical implicationsConflicting language, and different interpretations of adaptability, is a potential barrier to the development of adaptable buildings. A clearer articulation of the meaning of adaptability (particularly by clients) during briefing and design could give rise to a more appropriate level of adaptability in the built environment. Originality/valueThis study has addressed a gap in the existing literature, by foregrounding the voices of industry practitioners and exploring their (sometimes very different) interpretations of adaptability in buildings.

This paper explores the adaptability of buildings in Japan from the perspective of three distinct practice typologies: large general contractors, large architectural design firms, and small design ateliers. The paper illustrates the cultivation of adaptability in Japan revealing a maturing of concepts into current innovations, trends, priorities, and obstacles in relation to adaptability in design. The paper contextualizes the situation by reviewing the evolution of residential development in support of building adaptability, and the ways in which these policies and concepts have shaped practice and transcended residential design. This evolution is then explored through non-residential case studies undertaken by the three practice types, and supported through a review of critical themes emerging from the interviews. The importance of particular physical characteristics are examined including storey height, location of services, planning modules and structural spacing/spans. The interviews expose the critical relationship between adaptability and different social variables - the state of the market, the role of planning regulations and other legal frameworks; as well as, the misconceptions and variations in the perceptions on the role and meaning adaptability has in practice. The paper is concluded by revealing the lessons learnt, including the unfolding of dependencies outside the ‘black box’ of adaptability (e.g. practice culture, material and, stakeholder mindsets) and the requirement of effective communication of concepts to allow an informed conversation between professionals and with clients and users. Like many other philosophical design concepts in complex processes, adaptability benefits from a mutual understanding, good relationships, communication, integration, and shared goals amongst team members.

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Our paper addresses how building design elucidates the connection between two definitions of politics: ‘Big Politics’ and micropolitics. We will seek to examine how these two versions of politics are imbricated; how, in other words, codified ideologies and political institutions circulate within the everyday practices by which new actors and sites of contestation enter the social collective. The conceptual space for this argument has already been mapped out by various authors, including Gilles Deleuze and Félix Guattari, Bruno Latour and Michel Foucault. These authors have variously proposed how powerful totalities always travel along small, fragile conduits. Or, as Deleuze and Guattari put it, ‘the boss's office is as much at the end of the hall as on top of the tower’.

Background: Respiratory syncytial virus (RSV) infection remains one of the major reasons of re-hospitalization among children with congenital heart disease (CHD). This study estimated the cost-effectiveness of palivizumab prophylaxis versus placebo, in Spain, from the societal perspective, using a novel cost-effectiveness model reflecting evidence-based clinical pathways. Methods: A decision-analytic model, combining a decision tree structure in the first year and a Markov structure in later years, was constructed to evaluate the benefits and costs associated with palivizumab versus no prophylaxis among children with CHD. In the first year of the model, children were at risk of mild (i.e. medically attended, MA-RSV) and severe (hospitalized, RSV-H) RSV infection. The impact of delayed corrective CHD surgery due to RSV infection and the consequence of performed surgery despite severe infection were considered. In later years, patients were at risk of developing asthma and allergic sensitization as sequelae of RSV infection. Input data for the model were derived from the pivotal clinical trial and systematic literature reviews. Indirect costs included parental absence from work and nosocomial infections. In agreement with Spanish guidelines, costs and effects were discounted at 3%. Results: Over a lifetime horizon, palivizumab prophylaxis yielded 0.11 and 0.07 additional quality-adjusted life years (QALYs) and life years (LYs), respectively, at additional costs of € 1,693, resulting in an ICER of € 15,748 per QALY gained and € 24,936 per LY gained. Probabilistic sensitivity analyses demonstrated that the probability of palivizumab prophylaxis being cost-effective at a € 30,000 per QALY threshold was 92.7%. The ICER remained below this threshold for most extreme scenario analyses. Conclusions: The model demonstrated that palivizumab prophylaxis results in more QALYs than no prophylaxis in children with CHD. Palivizumab prophylaxis was shown to be a cost-effective health care intervention according to the commonly accepted standards of cost-effectiveness in Spain (ICER below the threshold of € 30,000 per QALY).