Therme Vals-zumthor
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热玛吉原理及作用
热玛吉原理又称热学热力学第三定律,是热力学的基本定律之一,是
由比利时物理学家热玛吉(Ludwig Eduard Boltzmann)于1896年提出的,它称微观世界中热力学熵与微观状态运动定律分别可以满足热力学第二定
律和它的数学表达形式:S=k·lnW,S为系统的熵,k为玻尔兹曼常数,W
为系统的可能状态。
热玛吉原理表明,热运动是分子运动的复杂总和,并且它的统计性质
可以用熵的概念来描述,从而解释了热力学的三大定律,其活用非常广泛,常应用于化学反应熵的计算、热力学状态函数的计算以及复杂分子热力学
性质的预测。
专利名称:用于热疗的可注射的超顺磁性纳米粒子及其形成热疗植入剂的用途
专利类型:发明专利
发明人:D·吕费纳赫特,E·德尔克,O·约尔丹,M·沙特兰,A·彼得里-芬克,H·霍夫曼
申请号:CN200580049862.2
申请日:20050523
公开号:CN101227925A
公开日:
20080723
专利内容由知识产权出版社提供
摘要:用于热疗的注射型制剂包含液体载体和产热的超顺磁氧化铁纳米粒子,其平均直径不超过20nm。
所述注射型制剂能在接触体液或组织后形成原位热固体或半固体植入剂。
所述热固体或半固体植入剂可通过高热治疗肿瘤或腰椎间盘退变性疾病。
申请人:日内瓦大学,洛桑聚合联合学院,日内瓦大学医院
地址:瑞士日内瓦
国籍:CH
代理机构:中国国际贸易促进委员会专利商标事务所
代理人:唐晓峰
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褪黑素与特发性脊柱侧凸南京鼓楼医院脊柱外科朱泽章邱勇朱丽华王斌吕锦瑜俞杨特发性脊柱侧凸最早是19世纪中叶由Bauer[1]提出,1909年Nathan[2]正式使用这一名称,直到1922年才由Whitman[3]给出明确定义,随后被国际脊柱侧凸研究会[4]推广。
特发性脊柱侧凸在临床最为常见,约占全部脊柱侧凸的80%,好发于青少年。
随着对特发性脊柱侧凸生物力学特征的进一步认识及内固定技术的完善,其外科治疗取得了飞快的发展和满意的疗效。
但是特发性脊柱侧凸的发病机理仍然未明,文献报道其发生与遗传、生长发育不对称、结缔组织发育异常、神经--平衡系统功能障碍、内分泌系统异常有关。
近年来,一些学者提出血清褪黑素(Melatonin)水平降低可能是发生特发性脊柱侧凸的重要始动因素,并与侧凸曲线的进展密切相关。
一、褪黑素的分泌节律松果体是从第三脑室后顶部突出的小体,含有大量分泌细胞,一般都认为它是一种内分泌腺。
1958年Lerner首先从松果体中提炼出褪黑素,该激素能使两栖动物皮肤内黑色素细胞颗粒聚集,从而使皮肤颜色变浅,故被命名。
褪黑素化学结构为N-乙酰-5-甲羟色胺,是由色氨酸经4种酶催化后发生一系列反应所合成,具体合成途径为:色氨酸→5-羟色胺酸→5-羟色胺→N-乙酰-5-甲羟色胺→褪色素,其中5-羟色胺是一个重要的中介物质。
在人类生命周期中褪黑素的分泌随年龄增长波动明显:出生后头三个月内,夜间血清褪黑素水平很低,因而24小时内几乎没有波动变化,此后夜间分泌逐渐增加,2岁前达到峰值,然后褪黑素水平稳步下降,成年时褪黑素分泌下降约80%[5]。
每日褪黑素的分泌存在昼低夜高的规律,入睡后6-7小时为分泌高峰,这是因为5-羟色胺-N-乙酰转移酶和5-羟基吲哚-甲基转移酶是褪黑素合成所必须,而这两种酶在无光照时活性最高[6]。
夜间褪黑素分泌可被强光抑制,人类对强度超过150-200lux的光敏感[7]。
大约70%的褪黑素在肝脏代谢为6-羟褪黑素硫酸盐后从尿中排泄。
中国急性缺血性脑卒中诊治指南2014•中华医学会神经病学分会•中华医学会神经病学分会脑血管病学组中华神经科杂志, 2015,48(04): 246-257. DOI: 10.3760/cma.j.issn.1006-7876.2015.04.002急性缺血性脑卒中(急性脑梗死)是最常见的卒中类型,约占全部脑卒中的60%~80%。
急性期的时间划分尚不统一,一般指发病后2周内。
近年研究显示我国住院急性脑梗死患者发病后1个月时病死率约为3.3%~5.2%[1,2],3个月时病死率9%~9.6%[2,3],死亡/残疾率为34.5%~37.1%[2,3],1年病死率11.4%~15.4%,死亡/残疾率33.4%~44.6%[2,3,4]。
急性缺血性脑卒中的处理应强调早期诊断、早期治疗、早期康复和早期预防再发。
中华医学会神经病学分会脑血管病学组于2002年底开始组织制定中国脑血管病防治指南,2005年初经卫生部批准在全国推广,2007年初由人民卫生出版社正式出版[5]。
2010年2月中华神经科杂志发表了急性缺血性脑卒中诊治指南2010版[6]。
上述工作为规范国内脑血管病诊治起到了积极作用。
由于近年不断有新研究证据发表,2010版指南在使用过程中也收集到很好的改进建议。
因此在2014年,由中华医学会神经病学分会及脑血管病学组对2010版指南进行了更新修订。
撰写人员通过全面查询、分析和评价相关研究证据、征求各方意见并充分讨论达成共识后形成推荐,旨在帮助临床医生为脑卒中患者选择当前相对较好的诊治方法。
在临床实践中,医师应参考本指南原则并结合患者具体病情进行个体化处理。
1.在循证医学原则指导下,参考世界卒中组织指南制定方法[7],结合国情、可操作性、前两版指南使用经验和新研究证据进行更新修订。
推荐强度和证据等级标准参考了国际指南[8,9]和常用标准,并结合国情和可行性制定(表1)。
2.对每项治疗措施或临床问题,先进行当前研究证据的查询(文献检索至2014年7月)、归纳和分析评价,然后根据证据等级结合专家共识给出推荐意见。
132城市建筑Urbanism and Architecture / 2022.08身,专注细部的推敲,他不太喜欢接商业的大单,但对接手的每个设计委托均倾注极大的心血,他的作品数量虽然不多但都工艺精致,呈现出“一种朴素的精致”。
他的作品大多,包含地域化的表达,但又不仅仅局限在当地的元素,他被认为是建筑现象学和极少主义的代表,抓住了建筑的本质。
彼得·卒姆托的作品塑造着真实,塑造着空间中环境的氛围,塑造着那些点燃人们知觉的东西[1]。
他寻找到了建筑之本,使空间富有诗意,使作品永恒。
2 彼得·卒姆托的极少主义建筑理念彼得·卒姆托是执着而特别的,在复杂多变的建筑时代中,他始终恪守本心,坚持自己的原则。
曾经在接受采访时彼得·卒姆托这样说道:“如果我发现我的名字被用于营销,我不会感兴趣。
我没有为雨果·博斯(Hugo Boss)的后人建造别墅,也没有为一个富有的艺术爱好者建造一座豪宅来收藏他的收藏品。
我拒绝了在世界各地为奥迪建造展厅的邀请,还拒绝了为乔治·阿玛尼(Giorgio Armani)在米兰建造一座服装天桥的委托。
以上的项目都没有说服我。
”[2]可以看出彼得·卒姆托承接项目并不是以利益为出发点,而是凭借对这个项目本身的喜爱来综合评判。
彼得·卒姆托虽然走的不是明星建筑师的道路,但是凭借他作品那质朴的内涵和直击人内心的能力,依然收获了大批的粉丝。
彼得·卒姆托的作品亦如他处世的态度,并不会为形式上的美而妥协他的极少与纯粹。
他主张建筑的美应来自建筑自身,而不是通过复杂混乱的形式来达到美的目的,建筑的情感应该自然地流露,能够被使用者的知觉感受到,而不是通过建筑师来讲述,所以他坚持用简约的形式来表达丰富的内涵。
极少主义来源于密斯(Luduing Mies van der Rche),他提出的“less is more”让建筑朝着单纯简洁的方向发展。
加拿大老师发明的放松冥想
呼吸:将肺放空后,用完整的瑜伽呼吸的方式来呼吸,除了在某些地方外﹙后面会描述﹚,都用鼻孔呼吸。
让空气先进入你的腹腔,然后进入横隔膜,最后进入胸腔。
这是同一个过程,不要分为三个。
呼气时可以hold住胸腔,缓慢释放腹腔的空气;或者反过来hold 住腹腔,缓慢释放胸腔的空气。
最重要的一点是,要有节奏地呼吸,吸气与呼气的时间相同。
首先用七秒吸气和七秒呼气,西藏人就是用这种方法。
随着你对这种冥想越来越熟悉,你可以找到自己的呼吸节奏,但时间不应该短于五秒,除非你身体无法忍受。
通过鼻孔,稳定地吸气。
首先填满肺的下部分,横膈膜温和地往下压,腹部往前推;然后填满肺的中部分,往外推肋骨、胸骨和胸部;最后填满肺的上部分,突出胸部上部分,因此提升胸部,包括上面的六到七对肋骨。
刚开始的时候,这个呼吸似乎是由三个运动组成,但是,通过你的练习,你要克服这种划分,不要有突然的加快,要让呼吸变得稳固、平滑、持续、统一。
这个吸入过程在几秒钟内完成。
十分缓慢地呼气,保持胸部在一个稳定的位置,随着空气离开肺部,稍微地收腹、并缓慢地向上抬升。
当空气完全呼出后,放松胸部和腹部。
通过一定的练习后,上述过程都会自动发生。
2021世界閱讀日主題展「百年文化記憶,回溯瑞士風采:狄倫馬特紀念特展」瑞士建築主題圖書影片清單淡江大學覺生紀念圖書館◎2021.4月整理Le corbusier = ル.コルビュジエDVD NA 1053.J4C67 2006v.1歐洲電視台於1987年誕辰100週年製作的錄像分為三部分,介紹了勒·柯布西耶(LeCorbusier)隨時間流逝留下的許多著名建築,以及他的採訪音頻。
Le corbusier = ル.コルビュジエDVD NA 1053.J4C67 2006 v.2Le corbusier = ル.コルビュジエDVD NA 1053.J4C67 2006 v.3Le Corbusier, moderne absolumentmoderneDVD NA 1053.J4A4 2014科比意 = Le Corbusier : MorceauxChoisis, 1912-1965923.42 /8352 /8445科比意 : 廿世紀的建築傳奇人物柯布 =Le Corbusier923.42 /8445Mario Botta Mario Botta : architectural poetics NA 1353.B67S35 2000 Multi-use buildings NA 680.C66 n.12Mario Botta architetti : leadingarchitectsNA 1353.B67A4 2017Mario Botta : light and gravity :architecture, 1993-2003NA 1353.B67M375 2004 Mario Botta : public buildings1990-1998NA 1353.B67A4 1998 Mario Botta NA 1353.B67P58 1997Mario Botta NA 1353.B65A4 1979Mario Botta NA 1353.B67P59 1998Mario Botta : Centre DürrenmattNeuchâtelNA 1353.B57A63 2000Herzog & De Meuron Herzog & de Meuron : thecomplete works.NA 1353.H47A4 2009 Herzog & de Meuron NA 1353.H47A4 2002 Herzog & de Meuron : 2013-2017NA1353.H47A4 2017b Herzog & de Meuron : 1978-2002NA1353.H47A4 2019 Herzog & de Meuron : 2003-2019NA1353.H47A4 2019bPeter Zumthor Peter Zumthor, 1985-2013 :buildings and projectsNA 1353.Z86A4 2014 v.1。
肾动脉阻力指数新认识张晓东;李建初【摘要】肾动脉阻力指数是肾动脉多普勒频谱分析中最常用的参数之一,近年来对肾动脉阻力指数的影响因素如肾血管阻力、血管顺应性等方面有了较全面的认识,同时对其在临床方面的应用有了更新的认识,如在慢性肾脏疾病、肾动脉狭窄、移植肾等方面的应用,本文就目前对肾动脉阻力指数的影响因素和在临床中的应用进展做一综述.【期刊名称】《中国继续医学教育》【年(卷),期】2017(009)022【总页数】3页(P86-88)【关键词】阻力指数;多普勒;肾动脉【作者】张晓东;李建初【作者单位】厦门大学附属第一医院超声科,福建厦门 361004;北京协和医院超声医学科,北京 100003【正文语种】中文【中图分类】R445多普勒超声是肾血管病变的筛查工具,近来对肾动脉阻力指数(resistive index,RI)的研究有了许多新的见解,本文旨在通过分析肾动脉RI的影响因素、研究进展,以促进对肾动脉RI的认识并将之更好地应用于临床。
肾动脉主干在近肾门处分为前后两支,进入肾脏后再分为段动脉、叶间动脉、弓状动脉、小叶间动脉,从主干到小叶间动脉RI值呈现递减趋势[1]。
研究证实在慢性肾病时,RI变化最显著的不是主肾动脉而是分支较细的叶间动脉。
研究发现,肾动脉RI与年龄具有相关性,初生儿的RI较高,随着年龄的增长逐渐降低,Murat A等[2]报道六岁以上儿童与成人肾脏RI值无差异。
但在成年以后,肾脏RI值和年龄又呈正相关,正常成年人肾脏RI通常以0.7为上界阈值,而在老年人由于血管顺应性改变或肾脏细小血管老化而肾脏RI往往会超过0.7[3]。
超声检查时,尤其是在检查移植肾时,探头的压力作用也会引起舒张末期流速减低,从而导致RI升高。
这也是造成不同检查者间测值差异的一个原因。
这是影响肾脏RI值的一个主要因素,肾脏血管阻力的变化直接引起RI值的改变,在很多的研究中,肾动脉RI和肾血管阻力这两个名词代表相同的意义。
- 35 -①仪征市人民医院 江苏 仪征 211400重组人脑利钠肽联合尼可地尔治疗急性心力衰竭的效果及安全性陈丹丹① 王娟①【摘要】 目的:观察重组人脑利钠肽联合尼可地尔治疗急性心力衰竭的效果及安全性。
方法:选择2021年3月—2022年10月于仪征市人民医院就诊的100例急性心力衰竭患者,以随机数表法分为病例组、对照组,各50例。
对照组采用重组人脑利钠肽治疗,病例组在对照组的基础上加用尼可地尔治疗。
比较两组临床疗效、治疗前后左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、N-末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、C 反应蛋白(CRP)水平,记录两组不良反应发生率。
结果:病例组总有效率为94.00%,高于对照组的80.00%,差异有统计学意义(P <0.05)。
治疗前,两组血清NT-proBNP、cTnI、CRP 比较,差异无统计学意义(P >0.05);治疗后,两组血清NT-proBNP、cTnI、CRP 均低于治疗前,且病例组低于对照组,差异有统计学意义(P <0.05)。
治疗前,两组LVEF、LVEDD 比较,差异无统计学意义(P >0.05);治疗后,两组LVEF、LVEDD 均优于治疗前,且病例组优于对照组,差异有统计学意义(P <0.05)。
两组不良反应总发生率比较,差异无统计学意义(P >0.05)。
结论:重组人脑利钠肽联合尼可地尔治疗急性心力衰竭患者的效果显著,可降低急性心力衰竭患者血清cTnI、NT-proBNP、CRP 水平,改善患者的心功能,且安全可靠。
【关键词】 尼可地尔 重组人脑利钠肽 急性心力衰竭 安全性 左心室舒张末期内径 左心室射血分数 血清N-末端脑钠肽前体 心肌肌钙蛋白I doi:10.14033/ki.cfmr.2024.01.009 文献标识码 B 文章编号 1674-6805(2024)01-0035-04 Efficacy and Safety of Recombinant Human Brain Natriuretic Peptide Combined with Nicorandil in the Treatment of Acute Heart Failure/CHEN Dandan, WANG Juan. //Chinese and Foreign Medical Research, 2024, 22(1): 35-38 [Abstract] Objective: To observe the efficacy and safety of Recombinant Human Brain Natriuretic Peptide combined with Nicorandil in the treatment of acute heart failure. Method: A total of 100 patients with acute heart failure treated in Yizheng People's Hospital from March 2021 to October 2022 were selected and divided into case group and control group by random number table method, with 50 patients in each group. The control group was treated with Recombinant Human Brain Natriuretic Peptide, and the case group was treated with Nicorandil on the basis of the control group. The clinical efficacy, left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI) and C-reactive protein (CRP) levels before and after treatment were compared between the two groups, and the incidence of adverse reactions was recorded. Result: The total effective rate of the case group was 94.00%, which was higher than 80.00% of the control group, and the difference was statistically significant (P <0.05). Before treatment, there were no significant differences in serum NT-proBNP, cTnI and CRP between the two groups (P >0.05). After treatment, serum NT-proBNP, cTnI and CRP in two groups were lower than those before treatment, and which in the case group were lower than those in the control group, the differences were statistically significant (P <0.05). Before treatment, there were no significant differences in LVEF and LVEDD between the two groups (P >0.05). After treatment, LVEF and LVEDD in both groups were better than those before treatment, and which in the case group were better than those in the control group, the differences were statistically significant (P <0.05). There was no significant difference in the total incidence of adverse reactions between the two groups (P >0.05). Conclusion: Recombinant Human Brain Natriuretic Peptide combined with Nicorandil has a significant effect in the treatment of patients with acute heart failure, which can reduce the levels of serum cTnI, NT-proBNP and CRP in patients with acute heart failure, improve the cardiac function of patients with acute heart failure, and is safe and reliable. [Key words] Nicorandil Recombinant Human Brain Natriuretic Peptide Acute heart failure Security Left ventricular end-diastolic diameter Left ventricular ejection fraction Serum N-terminal pro-brain natriuretic peptide Cardiac troponin I First-author's address: Yizheng People's Hospital, Yizheng 211400, China 心力衰竭是心脏疾病导致心功能不全,对患者的日常生活产生了严重的影响[1-2]。
骨再生的研究进展刘守应;王继芳;蔡谞【期刊名称】《中华保健医学杂志》【年(卷),期】2014(016)001【总页数】4页(P67-70)【关键词】骨;再生;移植;组织工程【作者】刘守应;王继芳;蔡谞【作者单位】100853北京,解放军总医院骨科;100853北京,解放军总医院骨科;100853北京,解放军总医院骨科【正文语种】中文【中图分类】R68骨骼是一种高度血管化并受神经支配的结缔组织,处于一种连续不断的更新及重建过程中,其独特的再生能力属损伤修复反应的一部分[1]。
骨再生由一系列协调的骨传导和骨诱导的生物过程所组成,新形成的骨与周围正常的骨骼没有区别[2]。
在临床中,常见的骨再生形式是骨折愈合,创伤、肿瘤切除、感染、骨骼发育异常、缺血性骨坏死及关节置换翻修等造成的骨缺损[3]。
临床应用自体骨移植、同种异体骨移植和牵张成骨促进或加强骨再生,新的方法有组织工程和基因治疗,系统性增加骨修复的方法[4]。
以及增强骨形成的辅助物理治疗手段,如低频脉冲超声(low-intensity pulsed ultrasound,LIPUS)、脉冲电磁场(pulsed electromagnetic fields,PEMF)等。
1 骨移植骨移植是最常用的促进骨再生的方法,包括自体骨移植、同种异体骨移植和异种骨移植等。
1.1 自体骨移植自体骨移植是临床常用的、成功率最高的修复骨缺损的方法。
自体骨是最理想的骨移植材料,具有骨移植所要求的骨诱导性、成骨性和骨传导性,同时组织相容性好且无免疫原性。
自体骨可取三面皮质骨作为结构支撑,或作为吻合血管移植物来修复巨大骨缺损以及缺血性坏死[5]。
全身多个部位均可作为移植骨的取材部位,如髂骨、胫骨、肋骨和腓骨等;另外,还可以在邻近手术区局部取骨,如应用梨状肌筋膜骨瓣治疗股骨颈骨折。
最近,有人利用钻吸系统(reamer-irrigator-aspirator,RIA)将髓腔作为一个取骨部位,以提供大量自体骨[6]。
两种功能性动作筛查测试对新兵军事训练伤的评估分析与预防研究韩康; 冯敏敏; 张红侠; 谭树森; 荣辉; 张学三; 单群群; 王平山【期刊名称】《《解放军医药杂志》》【年(卷),期】2019(031)010【总页数】6页(P97-102)【关键词】军事训练伤; 功能动作筛查; 功能动作训练; 评估【作者】韩康; 冯敏敏; 张红侠; 谭树森; 荣辉; 张学三; 单群群; 王平山【作者单位】250000 济南中国人民解放军联勤保障部队第九六〇医院脊髓修复科【正文语种】中文【中图分类】R681.53军事训练伤(Military training, MTI)是指由于军事训练导致参训人员机体各器官组织的损伤、功能障碍及相关的病理性改变;可给部队的正常训练及训练质量造成影响,甚至可出现官兵的残疾和死亡[1-3]。
美军每年因MTI进行的伤残补偿费用高达7.5亿美元[4]。
MTI与训练强度、方法、持续时间及战士心理状态,适应能力等密切相关[5]。
新兵入伍后持续3个月的基础训练时期,MTI发生率可达50%[6],过劳性损伤及训练计划不合理是导致MTI发生的重要因素[7]。
目前,各国军队科研机构一直致力于纠正和调整训新兵练计划、方式的研究,旨在有效降低MTI发生。
Fogle 等[8]认为,新兵入伍前2.4英里的成绩与其入伍后的MTI发生相关;美军发现在第3周时取消大运动量训练可降低MTI的发生[9]。
文献报道,根据新兵不同的情况,将训练计划进行针对性的调整,可预防MTI的发生[10]。
目前我国新兵训练缺少科学、简便、可行性高的训练保障模式[11]。
本研究将功能性动作筛查测试应用于战士训练的评测中;以期为部队军事科学训练引入新的保障机制,通过科学的量化指标针对性的纠正军事训练中的问题,旨在强调军事训练中的个性化和科学化,切实减少和预防MTI的发生。
现报告如下。
1 资料和方法1.1 一般资料选取2018年某信息保障部队战士322名为研究对象,均为男性,年龄18~21(19.3±1.1岁)。
Therme Vals and the Concealment of Complexity Dimitrios Karaiskakis K0313861ARM 909 Research Contexts in ArchitectureIntroductionWidely exalted for its intimate atmosphere, its strong rela-tionship to local topography, and its celebration of the act of bathing, Peter Zumthor’s Therme Vals is regarded as an DUFKLWHFWXUDO PDVWHUZRUN LQ ZKLFK SRHWLF QDUUDWLYH ¿QGV LWV embodiment through an evidently profound understanding of the materials and processes by which to realise the en-visioned end. Conceived metaphorically as a quarry at the side of the mountain, Zumthor begins the development of the baths by likening them to a rectangular stone mass half submerged in the hillside. Through a process of voiding and hollowing, the building’s interior structure is provided, be-ing treated as a massive porous stone in which an underlying network of caverns and submerged water gullies serve as the GH¿QLQJ HOHPHQWV RI WKH LQWHULRU 1. This allegorical treatment of the building serves as the point of departure from which the celebrated interior atmosphere emerges, an atmosphere which sets the sensuous and intimate tone of the encounter of water, stone , skin and subtle light. The effect that ensues from the poetic use of materials and the strategy of dimly lit enclosures makes for an atmosphere of intimate serenity which adds a mystical dimension to the act of bathing, an aspect which attracts the most interest from users, as it is the sensuous nature of the baths that make their experience so unique.The building, fragmented in nature but monolithic in appear-ance endeavours to assert itself as a singular block of stone, a condition which is expressed through the inventive use of thin stone slabs and reinforced concrete, which aids the as-sertion of the poetic metaphor, at least in the visible parts of the building. Its monolithic appearance however, is a result of the stone course-layering scheme, a system of interchange-DEOH OD\HULQJ RI WKLQ VODEV RI VWRQH GHYHORSHG VSHFL¿FDOO\ IRU the project with the intention of creating a continuous and visually diverse pattern. This continuity, a crucial factor in the provision of a state of visual calm, depends heavily on WKH DEVHQFH RI YLVXDOO\ VXSHUÀXRXV HOHPHQWV WKDW PLJKW XQ -balance the composition or otherwise disrupt the perceptionof the whole.Figure 1: Sketch illustrating the building’s appearance in the early design stages.Figure 2: Sketch illustrating the experimentation with mass and void.The absence of all and any inessential features stands as a testament to the sensitivity Peter Zumthor expresses relat-ing to the “perception of the whole (not being) distracted by inessential detail”2. This statement acquires a more profound meaning when one considers the amount of detail which is absent from the laconic interior. Moreover, the elements that would seek to disrupt the continuity of the stone course-lay-ering scheme such as water channels, window openings and other “chinks in sealed objects”3, as the architect refers to them, are masterfully integrated into the mass of the building, the presence of technical complexity only being betrayed inUDUH FDVHV E\ GLVFUHWH ¿VVXUHV DQG RSHQLQJV )DU IURP ÀDXQW -ing technical ingenuity in construction for its own sake, the FRQFHDOPHQW RI FRPSOH[LW\ LV FDUULHG RXW ZLWK WKH VSHFL¿F intention of imbuing the building, and more importantly the spaces it encloses, with the meditative state of calm which is so integral to Peter Zumthor’s architecture. Ultimately, the power of the poetic metaphor and the sense of tranquil stasis that Therme Vals exhumes rely on the quality of the execu-tion of a number of key aspects of the design which deal with the integration of technical infrastructure into the massof stone.Figure 3 (left) and Figure 4 (below): Photographs of the indoor pool.Construction OverviewThe realisation of a poetic metaphor in Therme Vals begins with the use of stone as the primary building material along the interior of the building with the explicit aim of creating a cavernous interior setting. This characteristic is especially pronounced in the earlier stages of the building’s concep-tion, during which it was the architect’s intention to excavate singular blocks of stone which would subsequently be hol-lowed, in order to form the pillars for the roof slabs 4. Due to the technical unfeasibility of this conception however, an alternative system of layered stone slabs was used to achieve the desired visual effect.Compositionally, these blocks are placed orthogonally in DOWHUQDWLQJ SLQ ZKHHO DUUDQJHPHQWV ZKLFK GH¿QH WKH VSDWLDO sequences of the building, as well as the shape of the interior and exterior pools. In the centre of each of these blocks lies what Peter Zumthor refers to as a “concrete core”5, which functions as the platform for the subsequent mounting of the remaining building components. Cast as free-standing mono-OLWKLF FRQFUHWH ER[HV WKHVH FRUHV ZHUH WKH ¿UVW WR EH HUHFWHG during the construction and enclose certain secondary bath-ing programmes and, on occasion, their surface is also left exposed in the interior. The sides of the cores that form an external wall are subsequently clad in thermal insulation, forming an insulating perimeter along the building’s exter-nal walls, and are further reinforced by a steel lattice placed against the existing wall. This assembly forms the base onto which the compound masonry of slabs of Vals Gneiss (the lo-cal stone, excavated a kilometre away from the site) and re-inforced concrete are set, thus integrating the insulation into the structural core of the building 6. Subsequently, the slabs of gneiss are placed at a small distance from the inner wall, WKH JDS EHWZHHQ ZKLFK LV ¿OOHG ZLWK FRQFUHWH 7KH HQG UHVXOW is a compound wall construction, known as Vals Compound masonry, in which the exposed surface of the walls is load-bearing and is adjoined to the inner structure 7.Figure 5: Plan illustrating the baths as experienced by bathers. 1 : 400Figure 6: Plan illustrating the concrete cores. 1 : 400Figure 7: Plan illustrating the layer of peripheral insulation. 1 : 4005m 05mFigure 8: Plan illustrating the layers of construction at the bath level. 1 : 2005m10m20mEssential to the embodiment of the allegory behind the build-ing is its monolithic appearance, a characteristic which is key in the provision of a visually, as well as physically, calming experience of bathing. Working towards a consistent visual appearance, the architect employs the use of a system of ar-rangement of stone slabs of varying sizes which seeks to scatter the butt joints between the slabs with the objective of creating a non-repetitive pattern which permeates the en-tirety of the building’s visible surfaces. This system, known as the stone-course-layering scheme is a precise schematic LQ ZKLFK WKH SRVLWLRQ RI HYHU\ VODE RI VWRQH LV VSHFL¿HG DF -cording to the position of joints in the layers beneath it. The layers themselves are of varying thicknesses consisting of 63 mm, 47mm, and 31mm thick slabs which are laid inter-changeably, while a minimum distance of 30cm is allowed between joints of adjacent layers. The objective behind the VSHFL¿FDWLRQ RI WKHVH WKLFNQHVVHV IRU WKH KRUL]RQWDO OD\HUV RI stone is the formation of a module which, combined with a 3mm thick layer of mortar between the stones, add up to a total thickness of 15cm; this horizontal modular system is subsequently used throughout the entirety of the building’s stairs and steps 8.Figure 9 (Below): Photograph of the layered stone walls.Figure 10 (Right): Photograph of stair case leading to the rest area.What the use of this scheme achieves is a seamless visual continuity of surfaces in which spaces seem to recede into one another, maintaining the appearance that each protrud-ing volume or recess has been carved out of the same block of stone. Essential to this is the lack of a recognisable pat-tern of construction on the wall, a factor which is emulated by the construction of the corner joints. Their assembly is laid out precisely in the stone-course-layering scheme and relies on the alternating placement of cross-laminated slabs of stone of variable width and length to provide an interwoven joint system which serves as the origin for the offsetting of the bond joints. The slabs of stone are cut DQG ¿QLVKHG WR VSHFL¿F GLPHQVLRQV ZKLFK ZKHQ ODLG LQ alternating directions, continue the irregular pattern of the walls and strengthen the continuous impression of the wall construction without compromising the sense of wholenessthat characterises the baths.Figure 14 (Above): Drawing illustrating the assembly of the corner joints.Figure 11 and Figure 12: Photographs of corner joints.Figure 13 (Below): 3UR¿OH GUDZLQJ RI D FRUQHU MRLQWIn terms of appearance, the stone-course-layering scheme plays a central role in the creation of a setting for bathing which expresses a poetic metaphor; however it also serves a more important function in relation to the technicalities of the building’s embodiment and the mundane demands of its setting. The layered construction of the walls as well as the expansive network of technical infrastructure required for the provision of comfortable conditions for the programme are in direct contrast with what is expressed in the areas ex-perienced by bathers, which are characterised by a minimal, seemingly simple and unassuming aesthetic. Moreover, what is apparent in Therme Vals is a recurring motif of conceal-ment in which the architect very purposefully employs the use of systems which are subsequently hidden from the view of the bathers9.This aspect of the scheme’s role in the construction is best illustrated in a series of key moments, most notably in the assembly of the external walls of the building, the relation-ship between the inner concrete cores and its accompany-LQJ OD\HUV DQG WKH ¿WWLQJ RI WKH WKHUPDOO\ LQVXODWHG ZLQGRZ frames. In keeping with the technique of perimeter insulation outlined previously, a thin layer of insulation is applied on the exterior perimeter of the building which cuts the con-FUHWH ÀRRU VODEV LQWR WZR SLHFHV ZKLFK UHVW RQ WKH VDPH SLO-lar. This layer extends upwards and meets the horizontal in-sulation layer of the roof slab, thus providing a continuous insulating perimeter. The same technique is used in the side ¿WWLQJV RI WKH ZLQGRZ IUDPHV ZKLFK DUH KHOG LQ SODFH E\ T-shaped insulation members adjoined to the primary insu-lating layer. The windows are subsequently placed directly RQWR WKHVH WKHUPDOO\ LQVXODWLQJ ¿WWLQJV SUHYHQWLQJ DQ\ KHDW loss through the contact of the window frames with the cold exterior concrete and stone compound masonry10. The effect of the compound masonry surface however is never disrupt-ed by the underlying complexity; on the contrary it binds it and conceals it, thus maintaining the continuous appearance of the stone layers.Detail Study of ConcealmentFigure 15 (Left): 'UDZLQJ LOOXVWUDWLQJ WKH PRXQWLQJ RI WKH WKHUPDOO\ LQVXODWHG ZLQGRZV DQG WKH ÀXHV RI WKHXQGHUÀRRU KHDWLQJ V\VWHP SODFHG LQ IURQW RI WKH ZLQGRZ1 : 10Figure 16 (Above): Photograph of the rest area.Figure 17: Section illustrating the concealedinfrastructure and its effect on the interior.1RWH WKH FRQFHDOHG XQGHUÀRRU KHDWLQJ V\V-tem and the multiple layers of construction inthe roofs, as well as the compound masonryand its continuous visual effect.0.5 mWhat is revealed in published drawings of the building is the presence of thick mass on certain ends of the concrete blocks that comprise the building’s body. In the majority of cases, the layers combine to form a double-leaf load bearing pillar which supports the soaring cantilevering roof slabs. Due to structural requirements, the walls on the cantilever-ing side of the roof are thicker than the others; however, what is revealed through the study of the layered principle in the construction of the walls is the presence of gaps between the layers of concrete and compound masonry. Drawn as black PDVVHV RQ SDSHU WKHVH KRXVH D VLJQL¿FDQW DPRXQW RI WKH technical infrastructure of the baths, most importantly the drainage system from the green roofs as well as plumbing and electrical installations. The roof slabs themselves consist of 480mm members of prestressed reinforced concrete, with added layers of thermal and vapour insulation beneath the JUDVV URRI ¿QLVKLQJ 11. In order to aid water collection and drainage, the underlying layers of the green roof including the concrete are given a concave shape which concentrates the water and channels it through the concealed system ofdrains mentioned previously.Figure 18 (Above): Horizontal section layers of construction and its effect on the interior.1 : 50Figure 19 (Left): Detail section illustrating the joining and concealment of the building elements .1: 10Figure 20 (Right): Photograph of the rest space contained in the concrete core.0.5 m 2 mAlso subject to this motif of concealment is the treatment of the building’s heating system. Making use of a concealed system of hypocausts 12 WKH XQGHU ÀRRU KHDWLQJ V\VWHP SHU -meates the entirety of the building’s interior, however its ex-istence is only visible in the form of air vents in front of the double height thermally insulated windows. The underlying QHWZRUN RI WXELQJ DQG SLSHV LV SODFHG XQGHUQHDWK WKH ÀRRU slabs of stone of the primary circulation spaces, and thus meanders and branches off into various directions accord-LQJO\ ,Q D VLPLODU IDVKLRQ WR WKH XQGHU ÀRRU KHDWLQJ V\VWHP WKH FKDQQHOOLQJ RI RYHUÀRZLQJ ZDWHU LV DOVR FRQFHDOHG EH -QHDWK WKH ÀRRU KRZHYHU LW DVVXPHV D PRUH SRHWLF H[LVWHQFH through its masterful integration into the stone-course-layer-ing scheme. This integration is best seen in the water over-ÀRZV FRQVWUXFWHG DW WKH HQG RI WKH VWHSV RI HDFK RI WKH SRROV 7KH ¿UVW VWHS OHDGLQJ LQWR HDFK RI WKH SRROV LV ORZHUHG E\ RQH thickness of stone according to the layer designated by the VWRQH FRXUVH OD\HULQJ VFKHPH RYHU ZKLFK ÀRZV D WKLQ OD\HU RI ZDWHU 7KLV VWHS KRZHYHU LV RIIVHW IURP WKH DGMDFHQW ÀRRU VODE UHYHDOLQJ D JDS ZKLFK GLUHFWV WKH RYHUÀRZLQJ ZDWHU LQWR D FRQFHDOHG FKDQQHO 7KH RYHUÀRZV RI DOO RI WKH SRROV DUH subsequently interconnected and form a discrete network of water channels which is only revealed through the presence RI ¿VVXUHV RU IDXOW OLQHV DORQJ WKH ÀRRU GHVLJQHG WR UHPRYH any excess water which might be carried by bathers. This network of water channels ultimately concentrates waste wa-ter in the water treatment gullies underneath the indoor and outdoor pools 13.Figure 21 (Left): 'HWDLO VHFWLRQ LOOXVWUDWLQJ WKH LQWHJUDWLRQ RI WKH ZDWHU RYHUÀRZV DQG FKDQ -nels into the stone course layering scheme.1 : 10Figure 22 (Top Left): Photograph of the circulation space between the ramp and the indoor pool.Figure 23 (Above): Section illustrating the relationship between the concealed infrastruc-ture and the space between the ramp and the indoor pool.0.5 m 1 m2 mWhat is apparent in the Therme Vals is an approach to ar-chitecture that addresses issues of experience and of sense WKURXJK D VLQFHUH VHQVLWLYLW\ WKDW UHODWHV WR UHÀHFWLRQV UHJDUG -ing the building’s programme, place and poetic narrative. In-deed, the allegorical treatment of the building as a series of partly submerged caves in which unions of light, water, stone and skin may take place provides a setting for bathing which goes beyond the immediate sensory experience, and begins to captivate the visitor’s imagination. What is less apparent however is the way in which the design, and especially con-FHDOPHQW RI LQHVVHQWLDO GHWDLOV UHÀHFW 3HWHU =XPWKRU¶V VHQVL -tivities regarding place and the way it informs the building’s presence, and how the architect achieves a convincing em-bodiment of an artistic metaphor.In the opening passage to his architectural thesis “Thinking Architecture”, entitled A Way of Looking at Things, ZumthorH[SUHVVHV D VLQFHUH VHULHV RI UHÀHFWLRQV RQ WKH QDWXUH RI DU -chitecture, in which he deals with, among other things, the poetic potential of the meaningful use of materials and relates it to his admiration for craft and craftsmanship, to which he attributes the emergence of a meaningful whole. This understanding reveals an interdependence between the meaning of what is to be constructed and the material body WKDW FDUULHV LW ZKLFK LQ WKH 7KHUPH 9DOV ¿QGV LWV LWHUDWLRQ in the use of stone, with the intention of evoking a sense of FDYHUQRXV PRQROLWKLF SK\VLFDO SUHVHQFH )XUWKHUPRUH WKH use of stone also creates a physical link between the building and the topography which, due to the conceptual handling of the project as a rectangular monolith, becomes the medium through which the poetic potential of stone is realised.ConclusionFigure 24 (Left): Pho tograph of the ramp descending to the bath level.Figure 25 (Below): 3KRWRJUDSK RI WKH )LUH %DWKIn this respect, the sensuous atmosphere and tactile experi-ence of bathing that Therme Vals is renowned for is inextri-cable from the poetic metaphor, a quality which is expressed equally well in the way that the architect deals with the tech-nical aspects of the building. Displaying his aforementioned sensitivity towards craft, the stone-course-layering scheme envelopes the entirety of the building and adjoins its het-erogeneous elements to create the cavernous spatial narra-tive. More importantly however it also integrates technical complexity into the mass of the building, concealing it from the eyes of the bather, whose imagination is unobstructed by visually distracting features. What the architect strives to achieve through the concealment of complexity in the mass of the building is best expressed in his own words:“When we look at objects or buildings that seem to be at peace within themselves, our perception becomes calm and dulled. The objects we perceive have no message for us; they are simply there... Here, in this perceptual vacuum a memory may surface...14”What is alluded to here through the reference of the emer-gence of memory is a state of poetic dwelling in which the inhabited landscape, or the place, is made present through the building. The verity of this lies in the fact that the building, “...(built) into the mountain, (built) out of the mountain...15”, discloses those things which constitute the place in the im-mediate presence of the earth and sky, and makes the place “appear”16. To an extent, this disclosure is apparent in the use RI VWRQH DQG WKH JUDVV URRI RI WKH EXLOGLQJ ZKLFK UHÀHFW TXLWH literally, the presence of the mountain in relation to the soft green hillsides. What makes all this “appear” however, is the state of perpetual visual calm that characterises the interior and exterior of the building. As such, in an indirect but also inextricable way, the concealment of “inessential detail” and the ingenuity displayed in doing so strengthens the build-ing’s relationship to the landscape, and makes the state of poetic dwelling alluded to by Zumthor’s writings possible.1. Hauser, S. , Zumthor, P. Peter Zumthor Therme Vals, Scheidegger & Speiss, 2007, pp. 23-272. Zumthor, P. Thinking Architecture 6HFRQG ([SDQGHG (GLWLRQ %LUNKDXVHU %DVHO S3. Zumthor, P. Thinking Architecture 6HFRQG ([SDQGHG (GLWLRQ %LUNKDXVHU %DVHO S4. Hauser, S. , Zumthor, P. Peter Zumthor Therme Vals, Scheidegger & Speiss, 2007, pp. 385. Hauser, S. , Zumthor, P. Peter Zumthor Therme Vals, Scheidegger & Speiss, 2007, pp. 95-976. Hauser, S. , Zumthor, P. Peter Zumthor Therme Vals, Scheidegger & Speiss, 2007, pp. 104-1057. Hauser, S. , Zumthor, P. , Peter Zumthor Therme Vals, Scheidegger & Speiss, 2007, pp. 95-988. Hauser, S. , Zumthor, P. Peter Zumthor Therme Vals, Scheidegger & Speiss, 2007, pp. 95-1089. Hauser, S. , Zumthor, P. Peter Zumthor Therme Vals, Scheidegger & Speiss, 2007, pp. 104-10510. Hauser, S. , Zumthor, P. Peter Zumthor Therme Vals, Scheidegger & Speiss, 2007, pp. 95-10811. Hauser, S. , Zumthor, P. Peter Zumthor Therme Vals, Scheidegger & Speiss, 2007, pp. 106-10712. Hauser, S. , Zumthor, P. , Peter Zumthor Therme Vals, Scheidegger & Speiss, 2007, pp. 7813. Hauser, S. , Zumthor, P. Peter Zumthor Therme Vals, Scheidegger & Speiss, 2007, pp. 95-10814. Zumthor, P., Thinking Architecture 6HFRQG ([SDQGHG (GLWLRQ %LUNKDXVHU %DVHO S15. Zumthor, P., Thermal Baths at Vals, Architectural Association Exemplary Projects 1, Architectural Association, London,1996, p. 1016. Norberg-Schultz, C., “Heidegger’s Thinking as an Architect” in Architecture: Meaning and Place, Selected Essays, Rizzoli International Publications, New York, 1988 pp. 39-48References:Bibliography:Hauser, S. , Zumthor, P. Peter Zumthor Therme Vals, Scheidegger & Speiss, 2007Zumthor, P. Thermal Baths at Vals, Architectural Association Exemplary Projects 1, Architectural Association, London1996Zumthor, P. 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