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Special Envoy for Syria Staffan de Mistura, attending the Astana talks, said the three powers were closing in on a final statement that would reaffirm and strengthen the current cessation of hostilities between the warring parties. "We're not far from a final declaration," he told reporters. Diplomats said there was a nuance in the language being used, with the Syrian government opposed to the use of the word ceasefire as opposed to cessation of hostilities, which suggests more short-term arrangements. "There are pledges from the Russian side to reinforce the ceasefire in areas where there are continued violations, but we're waiting for more than just statements," senior opposition negotiator Osama Abu Zaid told reporters. A rebel source said they were discussing a draft of the final text with their Turkish backers. A Syrian government source said consultations were ongoing to break obstacles presented by Turkey, which he said was trying to introduce elements beyond the Astana framework. The draft statement from Monday includes a paragraph suggesting the powers would either consider or establish "a trilateral mechanism to observe and ensure full compliance with the ceasefire, prevent any provocation and determine all modalities." Turkey's state-run Anadolu Agency reported on Tuesday that this had now been agreed between the three. [ID:nI7N1F600Q] Some observers said the meeting could jump-start U.N.-led negotiations which de Mistura hopes to reconvene next month after suspending them nine months ago. FIGHT NEAR DAMASCUS However, diplomats said there were still differences among the powers especially on the wording, including on how to resume peace talks under the umbrella of a United Nations resolution which calls for a transition of power. It was also unclear whether Russia would be able to put pressure on Iran to force its militias on the front lines to abide by the terms of any ceasefire mechanism in areas on the outskirts of Damascus, where heavy fighting is ongoing. "We'd like to think that the Russians are putting pressure on the Iranians, who are not very warm to the idea of a ceasefire or a political transition," said a senior Western diplomat.

Isaac explained that he was very lucky to not have much convincing to do as everyone was on board to design the addition in a Lean manner right from the see this site start. Once the decision was made to build, we were involved after that in the project four or five years ago, working with the architects, working with staff from across the hospital, everyone that was affected by the change. I was in there, with the meetings with the architects through each design phase of the process and going through it. It was a great opportunity. Isaac said. One phase of the design work, the schematic design, included a full-scale mock-up of the interior space uncovered many details that might have been overlooked in a traditional design process. We called it cardboard city, where we started with the architects from Shepley Bulfinch and built individual rooms for each area out of cardboard. They printed out pictures of monitors, power outlets, all the things that you could possibly need in a room, Isaac said. We found some great catches with this work. One catch was not having power outlets beside family couches and chairs to charge devices. Another much larger catch in the design, caught early, was how the column grid was laid out in the perioperative services surgery area. Eleven rooms were, at first, destined to have columns in the center of the headwall, which would have limited space for beds and limited staff movement. I think it does take a unique firm to be able to accommodate this approach to focusing and working together to come up with the final design of the product, Isaac said.

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