The little book of sharing in the city

This little book tells you about research that we did as part of the Liveable Cities project, looking at sharing in cities. Through a series of conversations with researchers and workshops with citizens of Lancaster and Birmingham in 2015, we conclude that: • Cities are important hubs for sharing and they always have been • Sharing is more than just giving something to someone to use- there are a lot of factors to think about when trying to understand what sharing is! • A way of classifying sharing in cities can help make sense of all the examples of sharing and allow for easy comparisons between examples • The presence of physical and digital hubs and bridges and the need to promote sharing in different ways are incredibly important to sharing in cities • There are a multitude of resources about sharing that can be useful if you want to find out more information on the topic • Well-designed and fun exercises can get people mapping their examples of sharing in cities This book therefore not only presents our current understanding of sharing, but illustrates how cities and communities can go about understanding the sharing phenomenon in their locality

Using the power of creativity to unlock social capital and economic drivers

Over the last two decades, the government has recognised the ‘problem’ of the north, and broad narratives and plans such as the Northern Powerhouse and The Northern Way have been put forward to deal with deficits and inequalities in infrastructure, economy and health outcomes etc., only to fade away, as governments and ministers change. Political agendas rise and fall, but what can we do when these fail and problems remain? Recent research suggests that the Northern region has strong, individual cities, but that collectively, they do not compare to similar regions in Europe, and overall, the productivity gap in the North is 11% below the national average. In the North of England, a person’s chances of dying earlier than those who live in the South are higher. Home ownership is also becoming increasingly problematic in the North, with lower wages and higher levels of unemployment. Numerous neighbourhoods in the North witness some of the highest levels of social deprivation in England, and on average, people report lower levels of life satisfaction and wellbeing. Despite this, the North of England has strength and depth in its capabilities and competence to understand many of these issues. The North is home to eight of the UK’s leading research intensive universities, who have secured over £1.2bn for funding in urban research. But how can the universities ensure that the knowledge and expertise they have improves conditions and leads to solutions for real world problems? We suggest that one way to do this is to embed knowledge through design as a way to empower citizens to seek creative solutions that best meet the needs of the world they inhabit. At ImaginationLancaster, based at Lancaster University, we conduct applied research into people, places and their interactions. Our projects to date have included, Beyond the Castle and Creative Exchange. The former involved working with Lancaster City Council to use collaborative, co-design methods to re-think the a major public space and an ancient monument, both subject to competing interests from residents, visitors and the local council. The latter meanwhile connects pioneering companies and academic expertise to develop digital public space to provide new contexts for the experience economy. These projects are emblematic of innovative and creative relationships that bridge academia and wider society for mutual benefit and are vibrant case studies that engage with the notions of inclusion and liveability in the North

Envisioning urban futures:from narratives to composites

Design (and design research) have a rich history of developing ways of making possible futures visible and tangible through prototypes, models, scenarios, or visualisations. Less common are platforms that gather multiple perspectives in the same space about possible futures. Thinking about diverse, rather than alternative, futures is particularly relevant in the context of cities. This paper suggests an alternative way of developing future visions for cities, moving away from coherent narratives to more pluralistic composites. Using the Liveable Cities project as a mechanism for exploration, it reflects on how participatory design methods and information visualisation techniques can engage participants in developing visions of urban futures. The paper will describe the details of the approach. It will present a summary of the findings as well as a discussion on the methods, which will include challenges and shortcomings

Lancaster as a sharing city:an interdisciplinary exploration and thought experiment

This paper presents an ongoing study that is being conducted jointly by Lancaster University, University of Birmingham, University of Southampton, and University College of London as part of the Liveable Cities programme. Liveable Cities is a five-year interdisciplinary research programme aimed at developing guidelines to implement radical solutions for low-carbon, resource-secure UK cities that prioritise societal wellbeing and aspirations. “Sharing City” is the first of a series of seven cross-disciplinary themes that bring together the research teams involved in Liveable Cities in localized “thought experiments” aimed at developing scenarios of desirable and provocative urban futures in the form of social conversations, policy recommendations, and prototypes. Although the term “Sharing Economy” has only recently grown in popularity, literature indicates sharing as an essential component of cities. The city itself is a complex product of shared creation and/or co-production. Sharing in cities was and is needed to maintain the environment, support the civic society, sustain the economy, and promote individual and community wellbeing. Despite the quality, safety, and accessibility of most essential infrastructures and services of our cities (e.g. energy and water networks, libraries, roads) depending on them being shared, we are experiencing increasing privatisation and commercialisation of many resources that were “public”. Moreover, particularly in wealthier societies, the crisis of urban commons might contribute to an increase in the social value and importance of owning goods and resources to fulfil everyday needs. We define Sharing Cities as cities where individualistic consumption of resources and ideologies are valued less than those that emphasise the collective benefit to citizens and other stakeholders. A Sharing City is more than simply a city in which models of Sharing Economy become mainstream. It is a city that needs to rethink its infrastructure, spaces, services, and governance. A number of questions need to be asked: •How can we design and engineer cities that maintain/improve/prioritise sharing? •What does a sharing city look like and how does it function? •What are the barriers to creating and maintaining such a sharing city? •How do sharing cities impact individual, community and planetary wellbeing? •Can sharing cities reduce carbon and other resource use while positively impacting wellbeing? •What gets shared in the sharing city? •Who shares (e.g., between groups, between cities)? •Is sharing equal for all parties involved? •How does sharing occur? While we can draw upon research that is being conducted in different areas of the Liveable Cities project to understand some of these issues, studies on cities are rarely complete without a contextualisation. We chose therefore to understand what would it mean for the city of Lancaster (one of the three Liveable Cities case studies) to become a Sharing City. We are also aiming to conduct a shorter comparative study for the city of Birmingham. Lancaster is a small city in the North-West of England, characterised by a rich historical and cultural heritage, its proximity to nature, and two universities. A large number of groups involved in formal and informal initiatives of sharing are active in the city. We decided to directly involve these groups early on in our research project, to learn from their expertise and day-to-day experience. To do so, we organised a one-day workshop for researchers and members of the local community involved in or with a strong interest in sharing. The aims of the workshop included mapping current initiatives of formal and informal sharing in Lancaster, discussing worst-case scenarios (worries, dangers and risks of sharing), and imagining a future city in which positive initiatives of sharing could be amplified, new forms of sharing could be created, and barriers could be destroyed. A summary report is forthcoming. One of the key-concepts of the day was the need for “building bridges”. The “Lancaster Map of Sharing” produced at the beginning of the workshop captured a rich landscape of initiatives, particularly in the areas of food and urban farming, ethical and fair trade, knowledge and skills exchange. However, there seems to be a need for better communication and understanding across the groups and with the rest of the population that is not directly involved (but might be interested). “Bridges” are also constituted by spaces and infrastructures. The ill-designed transport network in Lancaster, and the limited spaces that are available for shared use, constitute practical barriers to sharing. Finally, to design a sharing city, “bridges” between communities and the local government should be improved, by supporting models of participatory governance. However, the ultimate condition for sharing is trust. This leads to an additional research question: what are the conditions to be designed for a city that promotes trust

Extending thrombolysis to 4·5–9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data

Background: Stroke thrombolysis with alteplase is currently recommended 0–4·5 h after stroke onset. We aimed to determine whether perfusion imaging can identify patients with salvageable brain tissue with symptoms 4·5 h or more from stroke onset or with symptoms on waking who might benefit from thrombolysis. Methods: In this systematic review and meta-analysis of individual patient data, we searched PubMed for randomised trials published in English between Jan 1, 2006, and March 1, 2019. We also reviewed the reference list of a previous systematic review of thrombolysis and searched ClinicalTrials.gov for interventional studies of ischaemic stroke. Studies of alteplase versus placebo in patients (aged ≥18 years) with ischaemic stroke treated more than 4·5 h after onset, or with wake-up stroke, who were imaged with perfusion-diffusion MRI or CT perfusion were eligible for inclusion. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] score 0–1) at 3 months, adjusted for baseline age and clinical severity. Safety outcomes were death and symptomatic intracerebral haemorrhage. We calculated odds ratios, adjusted for baseline age and National Institutes of Health Stroke Scale score, using mixed-effects logistic regression models. This study is registered with PROSPERO, number CRD42019128036. Findings: We identified three trials that met eligibility criteria: EXTEND, ECASS4-EXTEND, and EPITHET. Of the 414 patients included in the three trials, 213 (51%) were assigned to receive alteplase and 201 (49%) were assigned to receive placebo. Overall, 211 patients in the alteplase group and 199 patients in the placebo group had mRS assessment data at 3 months and thus were included in the analysis of the primary outcome. 76 (36%) of 211 patients in the alteplase group and 58 (29%) of 199 patients in the placebo group had achieved excellent functional outcome at 3 months (adjusted odds ratio [OR] 1·86, 95% CI 1·15–2·99, p=0·011). Symptomatic intracerebral haemorrhage was more common in the alteplase group than the placebo group (ten [5%] of 213 patients vs one [<1%] of 201 patients in the placebo group; adjusted OR 9·7, 95% CI 1·23–76·55, p=0·031). 29 (14%) of 213 patients in the alteplase group and 18 (9%) of 201 patients in the placebo group died (adjusted OR 1·55, 0·81–2·96, p=0·66). Interpretation: Patients with ischaemic stroke 4·5–9 h from stroke onset or wake-up stroke with salvageable brain tissue who were treated with alteplase achieved better functional outcomes than did patients given placebo. The rate of symptomatic intracerebral haemorrhage was higher with alteplase, but this increase did not negate the overall net benefit of thrombolysis

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Background: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p<0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons