The impact of the design on the interactions in a playground : a comparison of children’s and parents’ social interactions in a prefabricated playground and a natural playground

En lekplats utgör ofta en viktig mötesplats för såväl barn som vuxna. Liksom för alla offentliga miljöer, påverkar utformningen hur dess besökare interagerar och samspelar med varandra. På vilket sätt och i vilken utsträckning är dock förhållandevis oklart, då de befintliga kunskaperna i ämnet är begränsade. Syftet med uppsatsen är att påvisa hur sociala interaktioner bland barn och föräldrar skiljer sig åt mellan en naturlekplats och en syntetiskt utformad, prefabricerad lekplats. Detta för att öka kunskaperna, dels om hur karaktären på en lekplats påverkar dess besökare, och dels om hur lekplatser bör utformas för att utgöra goda mötesplatser. Undersökningen har utförts med hjälp av strukturerade observationer på två kontrasterande lekplatser, vartefter de respektive resultaten har sammanställts och analyserats. Resultatet har, efter jämförelse av den relativa förekomsten av interaktioner på lekplatserna, visat på två framträdande skillnader mellan lekplatsernas respektive potential som mötesplats. Den ena är att den prefabricerade lekplatsen utgör en bättre mötesplats än naturlekplatsen, för interaktioner föräldrar emellan. Den andra är att naturlekplatsen istället utgör en bättre mötesplats än den prefabricerade, för interaktioner där barn och föräldrar möts. Båda lekplatserna har visat sig fungera väl som mötesplatser för interaktioner barn emellan.A playground often provides an important venue for children as well as adults. Like all public environments, its design influences how its visitors interact with each other. In what way and to what extent, however, is relatively unclear, as the existing knowledge in the subject is limited. The purpose of this essay is to demonstrate how social interactions amongst children and parents differ between a natural playground and a synthetically designed, prefabricated playground. This has been done in order to increase the knowledge, partly of how the character of a playground affects its visitors, and partly of how playgrounds should be designed to make good venues. The study has been accomplished using structured observations at two contrasting playgrounds, after which the respective results have been compiled and analyzed. After comparison of the relative occurrences of interactions in the playgrounds, the result has shown two distinct differences between the respective potential of the playgrounds as a meeting place. One is that the prefabricated playground is a better venue in quantity than the natural playground, when it comes to interactions between parents. The other is that the natural playground instead represents a better venue in quantity than the prefabricated one, when it comes to interactions between children and parents. Both playgrounds have proven to serve well as meeting places, when it comes to interactions between children

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Respite care for caregivers and people with severe mental illness: literature review

Aim: The aim of this study was to review research literature over the past 10 years on respite care for people affected by severe mental illness; and identify key implications for nursing practice in provision of respite care for family caregivers of people with severe mental illness. Background: Family caregivers play an important role in health care, but need regular breaks to maintain their own health and well-being. Respite care is one of the few services available with a primary focus on supporting family caregivers. In most developed countries the notion of respite care as an extension of the health care service has been embraced, evidenced by a growing body of literature in health and health-related disciplines. Methods: An initial literature search was undertaken using the key words 'respite', 'short-term care', 'shared care' and 'day care' in major electronic databases for nursing, psychiatry, psychology and sociology literature between 1967 and 2002, identifying 704 articles. Closer examination of the literature from 1993 to 2002 on gaps and trends in respite care for people affected by severe mental illness was conducted. This is discussed in the context of the broader literature, particularly on dementia, where the mainstream research on respite care is found. Results: The majority of family caregiving studies identified a need for greater quality, quantity, variety and flexibility in respite provision, and the literature has remained largely silent in relation to those affected by severe mental illness. There are contradictory findings on outcomes of respite care services and a lack of controlled empirical studies and evaluative research on effectiveness. Conclusions: Respite care is beneficial for caregivers, there is significant unmet need in provision of services for the mentally ill, and greater flexibility and the needs of caregivers should be recognised and addressed