Net Zero Hospital

1. “Net Zero Hospitals”
Frank Mills
Chartered Engineer
ASHRAE Distinguished
lecturer, member TC 9.6
Healthcare, TC 9.8 Large
buildings, 9.7 Education, TC
2.8 sustainability, PEAC,
Nominating Committee
DL Presentation
Jaipur 16th November 2019

2. • EUROPEAN ENGINEER, MEMBER OF FEANI
• FELLOW CHARTERED INSTITUTE OF BUILDING
SERVICES ENGINEERS
• MEMBER INSTITUTION OF MECHANICAL ENGINEERS
• MEMBER AMERICAN SOCIETY HEATING
REFRIGERATION, AIR CONDITIONING ENGINEERS
• MEMBER INSTITUTE OF ENERGY
CIBSE Guide section A8 Health issues in buildings
UK rep ASHRAE IAQ 2010 conference planning panel
Chair and member of drafting committee for ASHRAE
Healthcare design manuals - first published 2004 and
republished in 2012
ALI (ASHRAE Learning Institute) course presenter for
hospital HVAC
ALI course presenter for Net Zero Energy Buildings
• Member of Dept of Health Engineering Knowledge
Network Group, EKNG, industry representative and
liaison to professional bodies. Dept of Health
representative at expert panel meeting for Hospital
energy code EnCode, December London 2014
• Member of advisory steering group on Energy in
Hospitals, EnCode , HTM 07-02
• ASHRAE TC 9.6 Healthcare
• ASHRAE SPC170 Ventilation in Hospitals
• ASHRAE SPC 170 subgroup on Natural Ventilation in
Hospitals
• Member of Low Energy Hospital study team 1981
• Member of research team studying low energy
cooling and ventilation for hospitals 2008-2012
• Past and current Chair CIBSE Healthcare group
• Chair IMechE Healthcare Engineering conference
Oct 2002
• Chair IMechE Hospital Ventilation 2012
Frank Mills, Chair, IMechE Construction and Building Services Division,
Chair of CIBSE Healthcare Group, ASHRAE DL, TC 9.6 Healthcare

3. Overview
• Why net zero ?
• What does net zero mean ?
• What is UK doing to get to net
zero ? The NHS ?
• What are options/strategies ?
• What should be done and when ?
• Technologies
• ASHRAE Design guidance
• Targets for net zero

4. Workshop 3 - Realizing nZEB
Hospital Buildings
Together
Wim Maassen
Date: 23rd May 2016
Time: 10.30-12.00
Location: Columbinesalen
Inspiration & Enthusiasm
Wubbo Ockels (1946-2014)

5. Drivers for change
• Financial targets v increasing costs
• Increasing healthcare demands – growing and elderly
population and new and better cures
• New legislation
• Government performance targets
• Climate change agenda
• Heat and Energy saving strategies
• National Health Service (NHS) sustainability targets
• Commitment to improve the patient experience
5

6. Determinantsof PatientSatisfaction
6
• Recovery
• Comfort – noise, drafts, temperature, humidity, lighting
• Views and daylight
• No Hospital Acquired Infections
• Food, parking, visitors, etc.
• Happy attentive staff – staff comfort and efficiency important
• Affordable / value received
• Safety
• HCAHPS – Hospital Consumer Assessment of Healthcare Providers
and Systems
• CQC - Care Quality Commission - UK

7. • We are applications
engineers
• Codes of practice
• Proven technologies
• Innovation
• Drivers for change –
the carbon challenge
Hospital HVAC Applications
7

8. Changing drivers – UK CO2 reduction target by
2050 was 80% – but now 100% !
8

9. Building Regulations (Part L) – energy strategy new
build - 2006 and beyond
2010 25% reduction on 2006
2013 44% reduction
2016 Net Zero Carbon Residential
2019 Net Zero Carbon Buildings including Hospitals
2006CO2
9

10. But ..
New buildings
are not yet NZ
• UK government has stalled
on Part L targets
• Drive for modern attractive
design outweighs NZ
• Developers keen on
architecture (and letting
rates) – not so much on NZ

11. Defining NZEB’s
What is ‘Net Zero’ ?
Define by the Performance Metric
• Net Zero Site Energy Building
• Produces as much energy as it consumes annually - when measured at the site
• Net Zero Source Energy Building
• Produces as much energy annually as it uses - compared to the energy content at the
source
• Net Zero Energy Cost Building
• Uses energy efficiency and renewable energy strategies so that annual energy cost is zero
• Net Zero Energy Emissions Building
• Annual carbon emissions by the energy needs of the building are zero – by using
renewable energy systems or other means
11

12. Zero Energy Target—UK Schools
• UK—Target all new schools zero carbon
by 2016
• Public engagement – energy and carbon
• Develop knowledge and skills
• Feedback on performance
• Low and zero carbon energy supplies
• Investment and improvement
• Living labs – visual impact
• Students monitor targets – and learn
about Net Zero energy
12

13. Manchester City, UK
Vision 2050 – now 2040
Manchester is playing its full part in limiting the impacts of climate
change, locally and globally.
It is a thriving, zero carbon, zero waste, climate resilient city where
all our residents, public, private and third sector organisations are
actively contributing to and benefiting from the city’s success.
http://www.manchesterclimate.com/sites/default/files/MCCS%20Launch_5th%20De
c_ppt.pdf.

14. Manchester’s plan …….

15. Cities like Manchester setting the agenda
for NZ ahead of UK government
<#>
15

16. Green Summit March 2019
• Mayor brings 2015 target of
NZ city forward to 2038
• Requires citizens and
companies to pledge
support
• Manchester’s Tyndall
Centre leads Climate change
research
<#>
16

17. London’s Action Plan
The mayor aims for London to be a
zero carbon city by 2050, with energy-
efficient buildings, clean transport,
and clean energy.
Make sure that all new developments
are zero carbon from 2019, with clean
supplies of energy and high energy
efficiency designed in from the start
<#>
17

18. How do we achieve Net zero carbon London ?

19. • Grenfell Tower disaster
• BREXIT confusion
• UK engineers NOT registered
• CPD not mandatory – yet !
• Certification of contractors limited and ineffective
• Building services courses closing
• Industry leadership and management issues as companies argue, collapse
or fail to deliver – such as Carrillion collapse
• Poor care of historic buildings as fires destroy irreplaceable landmarks –
Littlewoods, Mackintosh library, Bank buildings Belfast
However – UK Construction is in crisis.
How can the UK achieve NZ hospitals ?

20. Hackitt Enquiry - Building a safer future
Government enquiry into the Grenfell Tower disaster………
Independent Review of Building Regulations and Fire Safety - 17th May 2018
Report Executive summary lists the following specific areas …
1. Roles and responsibilities of those procuring, designing, constructing and
maintaining buildings are unclear. This includes engineers who should have a
controlling and supervisory role but lack status. Often overruled by others.
2. Package of regulations and guidance (in the form of Approved Documents) can
be ambiguous and inconsistent;
3. Processes that drive compliance with building safety requirements are weak
and complex with poor record keeping and poor change control
4. Competence across the system is patchy
5. Product testing, labelling and marketing regime is opaque and insufficient
6. Voices of residents (occupants and users) often go unheard, even when safety
issues are identified. Same applies to energy usage where occupants have to
pay the bill whatever it is.
7. Integrated design and construction approach is not the norm

21. Hackitt review ongoing …
• Big Changes are coming ………
• Regulation
• Registration – such as PE
• Certification - of trades and designers
• Can these help us in our quest for Net Zero too….

22. The task ahead ..
Hospitals use a lot of energy – lots of equipment, 24 / 365 usage, specialist environments

23. Large electricity usage and back up needed
too !

24. Actually - UK hospitals use too much.
They use more than US hospitals…..
• Even though UK climate is temperate - less extreme summer and winter
• Median UK performance is 68.8 GJ/100m3
• Only 65% meet the mandatory target of 65 GJ/100m3 for existing build
• Only 45% meet the mandatory target of 55 GJ/100m3 for new build and
major refurb
• Only 17% are less than the US average of 40-45 GJ/100m3
• Conclusion - UK hospitals use a lot more energy than necessary
• So what chance zero energy ?

25. UK v US general acute hospital energy usage
• UK average
= 68.8
GJ/100m3
• US average
= 45
GJ/100m3

26. Energy Comparisons:
UK vs. North America
26

27. Hospitals CAN be net zero
• Big size is not an issue
• Long hours of usage can be a benefit if heat
energy is recovered and stored
• Hospital resilience needs electricity back up –
so more on site generation = more net zero
heat energy – and cooling (absorption chillers) –
is available

28. Big NZ example - La Jolla Commons II, Cailfornia
• 13-story La Jolla
Commons II office
University Town Centre
• Largest "net-zero" energy
building in U.S.
• 415,000 ft2
• Biogas and onsite fuel
cells
• Methane to electricity,
tapping methane in
landfills and wastewater
plants.

29. Big example - DEWA to build the tallest zero energy
building
• Dubai Electricity and Water
Authority’s (DEWA) new
headquarters (HQ) will be the tallest,
largest, and smartest net zero energy
building (ZEB) in the world once it’s
completed in 2019.
• Total renewable energy generated by
the building will be over 5,400
megawatt hours (MWh) annually.
• Al-Sheraa’s design was inspired by
the traditional houses in the UAE,
where enclosed spaces overlook an
open courtyard.

30. Initial strategy for Net Zero Hospitals
• New build and existing
• Traditional approach based on 3
steps
• Reduce demand
• Reduce waste
• Install renewable energy systems
• Reduce use of fossil fuels –
ultimately avoid fossil fuels –
decarbonise
3
Use fossil
energy
efficiently
1
Reduce
energy
demand
2
Apply sustainable energy
sources
Trias Energetica method

31. Strategy for Net Zero energy hospitals
3
Use fossil
energy
efficiently
1
Reduce
energy
demand
2
Apply
sustainable
energy sources
5
Use fossil energy
efficiently
1
User demand & behaviour
2
Reduce energy demand
3
Apply sustainable energy sources
4
Energy exchange
and storage systems
Trias Energetica
method
Five step method
5 step approach developed by
REHVA
Presented at CLIMA 2016 Aalburg
1. Behavioural change
2. Reduce demand
3. Renewables
4. No waste – store and use
when needed
5. Use any fossil fuel efficiently -
CHP

32. 32
Step Measures
1. User demand &
Behaviour
Lower internal heat loads (more use of stand by mode), zoning, smart and
individual control systems (human in the loop, SR ventilation), low flow fume
hoods, low energy consuming MRI, Combining processes/equipment/test set ups
2. Reduce Energy
Demand
Insulation, envelope airtightness, heat recovery ventilation/hot tapwater, daylight,
thermal mass, demand control ventilation, LED lighting, Less heating and cooling
(change standards – adaptive environmental controls), energy efficient appliances,
less or no humidification, occupancy detection,
3. Apply Sustainable
Energy Sources
Photovoltaic solar cells, biomass, waste to energy, wind energy, adiabatic cooling,
natural ventilation, water source
4. Energy Exchange &
Storage
Long term energy storage in the soil/acquifer (LTES), short term energy storage
(buffers, Phase Change Materials), Concrete Core Activation (TABS), Exchange
energy between internal/external functions and storage till needed
5. Efficient use of fossil
energy
High efficient boilers, chillers, heat pumps, cogeneration of heat and power, variable
speed pumps, plug fans in a multiple fan wall,
nZEB approach (5-step) - Measures

33. Energy4Health
SUMMARY -Demand-Side Policy Roadmap - Stakeholder Consultations
Energy4Health project is 1 of 6 being carried out in support of the
EU Demand-Side Action Plan2.
• Commenced in January 2014, concluded in March 2015.
• Aim - to develop policy roadmap to influence the demand for innovative energy
solutions in the healthcare sector.
This is being implemented through four main activities:
• 1. Generate baseline scenarios to 2020
• 2. Create policy action roadmaps for more favourable scenarios
• 3. Engage with influential stakeholders
• 4. Develop implementation strategy

34. Energy4Healthcare VISION 2025
• The European healthcare sector has become a
global leader in energy efficiency and
community renewable energy systems.
• Many are becoming both carbon and cost
neutral.
• The average cost of energy is less than 1% of
healthcare budgets (currently near 20% UK)
• The sector is well on its way towards reducing
its 2050 carbon footprint to less than 20% of
1990 levels.

35. Energy4Health – Key issues

36. How to do more with less, by making better
use of space
Headline benefit: A Study by Conclude UK
• For a typical hospital in Sweden every 1
square metre of space saved translates into
200 -250 kWh energy saving.
• In the United Kingdom the saving translates
into 400-450 kWh.
• How much space do we actually need ?

37. How to do more with less, by making better
use of space
Actions to achieve a target less
than 200 kWh/m2
www.conclude.org.uk
Energy analysis demonstrated that ‘right-
sizing’ space and HVAC plant
infrastructure (using Occupancy
Analytics™ data), overall plant sizing could
be reduced by an average of 24%, and
energy consumption reduced to between
100 – 150 kWh/m2.

38. 3
Use fossil
energy
efficiently
1
Reduce
energy
demand
2
Apply sustainable
energy sources
5
Use fossil energy
efficiently
1
User demand & behaviour
2
Reduce energy demand
3
Apply sustainable energy sources
4
Energy exchange
and storage systems
Trias Energetica method
Five step method
nZEB approach (5-step)
38

39. ACCELERATED PATIENT RECOVERY
• Research in USA in 1984
• - patient recovery rates improve
• - if they can view trees from
their hospital window
• Ulrich, R.S.,1984. View through a
window may influence recovery
from GP practice.Science 224,
420-421

40. Trees and health
• Evidence that the NHS Forest
will help sites to realise….
• Health
• Social
• Environmental
• Financial benefits

41. 17 November, 2019
Joselyn Art Museum
Omaha

42. Internal trees - Guys hospital atriums
17 November 2019 FRANK MILLS, LCDC 42
• 4 atriums with trees
• Help patients – particularly
elderly - get familiar with
‘external’ landscapes - street
styles and surfaces
• Natural Ventilation
• Daylight

43. Internal trees – atriums
St Stephens hospital, Chelsea –
Art - but no trees !

44. Atrium building with
Green wall –
hydroponic plant
growth – for air
cleaning and
occupant satisfaction
17 November, 2019
Carleton University
Ottawa

45. 17 November, 2019

46. Artwork and planting – and good external landscape views too
17 November, 2019

47. 1. Performance – Infection Control, Comfort, Patient Outcome
2. Equipment operation – Scanners, Radio therapy……
3. Safety – Fire, falls, injuries – Employees, visitors, patients
4. Reliability, Resilience – Lost Revenue, down-time ?
5. Maintenance Cost
6. Energy Cost
7. Adaptability
Elements of HPHCHVACSystems
47

48. Using Nature-Inspired Design to Foster Workplace Wellness
Wellness & Biophilia

49. Erasmus hospital atrium,
Rotterdam
Central street
Ventilation pathway
17 November, 2019

50. 17 November, 2019

51. “A good hospital engineer takes an
integrated and holistic approach to
ventilation in hospitals.”
Element#1–InfectionControl,
Comfort,Outcome
51

52. • Kills around 75,000 people per year in the US (200 per day)
• Average of 15 deaths per hospital per year
• But even more non fatal infections - 722,000 non-lethal infections per
year
• 1 out of 25 patients admitted to a hospital got HAI (2011)
• Estimated 5% are airborne (~ 35,000 incidents)
• ~ 150 HAI per year in every hospital in US
• Surgical Site Infection in 1 out of 50 operations
• Major push by North American Healthcare providers and associations
HospitalAssociatedInfections(HAI) -
NosocomialInfections
52
Magill, S.S. et. al, “Survey of Health Care – Associate Infections,” The New England Journal of Medicine, 3/27/14

53. • HAI ~$30-$45 Billion per year, ~ 2 M cases
 Top 5 HAIs in US……
o Pneumonia: ~ $28,000 per case
o Bloodstream (central line): ~$29,000 per case
o Surgical site: ~$35,000 per case
o Gastrointestinal (C. difficile & MRSA): ~$9,000
o Urinary Tract: ~$1000 per case
• Average cost of a HAI: ~$26,000
• ~$500 Million per year are airborne
Cost of Hospital Associated Infections – $
53
Scott, R.D., II. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits
of Prevention. U.S. Centers for Disease Control and Prevention, Mar. 2009.

54. How People Get Infected
54
• Inhalation
• Deposition of particles
in air, esp. on skin
• Contact w/ surfaces
and other people
• Insects
• “Contact” exposure
(< 2m) to sneezes and
coughs, as per CDC

55. UK Dept of Health – The HTMs
55

56. HTM 03 HVAC
56

57. • Patient, staff, visitors
• Sneezes and Coughs
• Outside air - infiltration
• Propagating spores
• Disturbance especially during construction
• Linens, towels, cleaning clothes
• Movement of “dirty” air within the hospital
• Aerosolization, including toilets, cooling towers, air exhausts and laying
water
How Do Micro-organisms Get Into The
Air?
57

58. Deposition: Thermal Plume Theory
58
Memarzadeh & Jiang
Limit velocity at
laminar diffuser
Buoyancy driven, natural convection from the patient

59. ASHRAE Standard 170 – The Bible?
59Excerpt: ASHRAE Standard 170-2013
Function of Space
Pressure
Relationship
to Adjacent
Areas (n)
Minimum
Outdoor
ACH
Minimum
Total
ACH
All Room Air
Exhausted
Directly to
Outdoors (j)
Air
Recirculated by
Means of Room
Units (a)
Design Relative
Humidity (k),
%
Design
Temperature (l),
°F/°C
SURGERY AND CRITICAL CARE
Operating room (Class B and C) (m),
(n), (o)
Positive 4 20 NR No 20-60 68-75/20-24
Operating/surgical cystoscopic rooms,
(m), (n) (o)
Positive 4 20 NR No 20-60 68-75/20-24
Delivery room (Caesarean) (m), (n), (o) Positive 4 20 NR No 20-60 68-75/20-24
Substerile service area NR 2 6 NR No NR NR
Recovery room NR 2 6 NR No 20-60 70-75/21-24
Critical and intensive care NR 2 6 NR No 30-60 70-75/21-24
Intermediate care (s) NR 2 6 NR NR max 60 70-75/21-24
Wound intensive care (burn unit) NR 2 6 NR No 40-60 70-75/21-24
Newborn intensive care Positive 2 6 NR No 30-60 70-75/21-24
Treatment room (p) NR 2 6 NR NR 20-60 70-75/21-24
Patient Room NR 2 4 NR NR 30-60 70-75/21-24

60. But HTM 03
Differs…
And so do others:
• Germany - DIN
• Spain
• France
• …………..

61. Definitions
• Ventilation = Outside Air
• Air Change = Filtered Supply Air Only
• Recirculated = Filtration
ASHRAE 170
• Air Change = Any supply air including recirculated in
“non-critical” areas
Key Definitions
61

62. • ACH rate
• ACH filtered?
• Diffuser velocity in OR
• HEPA grade filters
• UV air sterilisation
• OA rate (Std 62.1 vs. 170)
• Full fresh air vs. Recirculation
• Temperature
• Humidity: Recent study indicates >40%;(1) Recent revisions to Std 170
• Scientific evidence is needed, esp Dose/Response
• Monitoring “requirements”
(1)Noti, JD, High Humidity….PLOS|one 2/27/13
(2)Memarzadeh, F., ASHE 2013 Lit Review: Room Ventilation & Airborne Disease Transmission
Controversial Issues
62

63. UK Hospital practices are wasteful ………
Ventilation systems use full fresh air
Example of UK Operating theatre schematic - from HTM 03

64. Recycling air can be done – like it is in US
Case Study – Northern Cancer Care Centre,
Newcastle
• Install packaged AHU (HTM
compliant)
• HEPA 14 filter
• 10 ACH recirculation
• 4 to 6 fresh air changes/hour
from AHU with F7 filter

65. Ventilation Upgrade
• Major refurbishment project
• Ventilation approved by Public
Health England
• Treatment rooms are now
amongst ‘cleanest in UK’

66. Ventilation Upgrade
• Patient environment priority
• But also machines which operate
between strict limits
• Air flows critical

67. But HVAC systems still running at full capacity 24/7

68. Health Technical
Memorandum 07-02:
EnCO2de 2015 – making
energy work in
healthcare – fits with
policies

69. Low Energy District Hospital – Romford,UK
• Over 50% naturally ventilated
• Energy reduced from 101 to 58
GJ/100m3/annum
• Lighting controls
• Heat recovery
• Daylighting with controls
• Control of glare and summer
heat gains
Queens Hospital, Romford
17 November 2019 FRANK MILLS, LCDC 69

70. Romford Hospital heating
• Gas fired CHP provides electricity
and heat cost effectively
• 4 medium pressure hot water
boilers installed – but low heating
load and high performance fabric
= no heat demand
• Actually no need for any boilers
• ‘Sometimes 1 is used’ on low heat
• Money wasted – again !

71. Natural Ventilation – ideal for hospitals
• Major energy savings
• Major Capital cost savings
• Major operational savings
• Improved infection control
• Improved indoor air quality
• Increased patient and staff comfort
17 November 2019 FRANK MILLS, LCDC 71

72. Dept of Health study – low energy cooling and Ventilation
GROUND FLOOR LAYOUT

73. Dept of Health study – low energy cooling and
Ventilation
FIRST FLOOR LAYOUT

74. HOSPITAL PLAN FOR NAT VENT – UPPER FLOORS
17 November 2019 FRANK MILLS, LCDC 74

75. VENTILATION CROSS
SECTION

76. VENTILATION STRATEGIES BY FLOOR AREAS

77. Guys hospital atrium – London Bridge area
• Designed in 1991
• Natural Ventilation
• Daylight
• Plant lighting strategy
17 November 2019 FRANK MILLS, LCDC 77

78. 17 November 2019 FRANK MILLS, LCDC 78

79. Guidance
Dept of Health HTMs

80. Combined Heat and Power CHP)
• Low Carbon energy – but waste heat seen as ‘renewable’ because it displaces power
station waste
• Low carbon ‘clean’ fuel = gas
• On site generation of both heat and electrical energy
• Two types
• Heat led - most common, satisfy base heat load, top up electricity from grid
• Power led - satisfy base power load, dump heat in summer
• Decentralised energy over 50% more efficient than grid
• Payback varies with technology but for high utilisation can be as low as 4 years
• Can be used to provide absorption cooling – called Tri-generation
• More information: www.chpa.co.uk
CHP and district energy systems

81. 15%
50%
Most power stations
convert only 30% to
35% of the input
energy into
electricity.
Combined Heat
and Power

82. Biomass Systems
Renewable Energy
Bio
Fuel CHP

83. Geothermal Systems
Renewable Energy - Geothermal
83

84. Toronto – zero carbon cooling from Lake Ontario
<#>
84

85. DEEP LAKE WATER COOLING SYSTEM
<#>
85
The major renewable energy, Net Zero cooling system in Toronto cools the city
using NZ energy.
The City of Toronto and Enwave Energy Corp.
ACCIONA
General Contractor, responsible for procurement; construction of intake
pipelines, heat exchange plant, heat exchangers and valve chambers, equipment
installation, testing and commissioning of the project
Infrastructure
Enwave’s Deep Lake Water Cooling system
Completion date
2004

86. Abandoned collieries could heat UK hospitals (and
homes) – 9th April 2018
<#>
86
© Getty Images A coal delivery to the Gorbals tenements in
Glasgow, circa 1960. Future heat for the city’s homes could be
piped from colliery tunnels below.

87. Flooded coal mines in UK
1. UK coal industry closed down
2. All mines are disused and flooded.
3. vast reservoir of warm water fills a labyrinth of
disused mines and porous rock layers underneath
Glasgow
4. this subterranean store of naturally heated water
could be used to warm hospitals and homes.
5. Such ‘warm ‘ water renewable energy could be
exploited in other cities and towns across Britain’s
coal communities
<#>
87

88. Guidance on low and NZ energy
ASHRAE LOW CARBON GUIDES
• Ongoing publications
• Retail 50% guide now out
• Others in production
• Information on HVAC and R and
Electrical systems
<#>
88

89. ASHRAE 50% and NZ SCHOOLS GUIDES
<#>
89

90. ASHRAE HOSPITAL 50% GUIDE
• Hospital guide
available
<#>
90

91. ASHRAE and REHVA NZ Hospitals guide in
development
• ASHRAE TC 9.6 oversight
• REHVA initiative
• Dutch engineers taking the
lead
• Supports EU and UK
aspirations
• Applies worldwide
• Contact Frank Mills for
information
<#>
91

92. Achieving NZ in practice -
Design Standards ASHRAE Beq
• Design and energy modelling for
NZ – but what happens in
practice
• Actual performance needed
• UK has the EPC and DEC
approach
• ASHRAE has the Beq approach
• ‘Avoid’ the gap !!!
<#>
92

93. Q&A
Contact details...
Frank Mills
famills@hotmail.co.uk