Urban morphology in support of disaster risk reduction : toward theory and methods for a spatial approach to tackling urban vulnerability to earthquakes

Among the most recent directions of urban morphology research is its integration with disaster studies, in support of disaster risk reduction (DRR) efforts at the urban scale. Yet, the built and unbuilt components of urban form are still disproportionately investigated for DRR purposes, with predominant approaches centred on buildings leaving the DRR potential of the urban spatial network relatively under-investigated. This paper, at the intersection of urban morphology and disaster studies, is the first of a series looking at the spatial component of urban form through the lens of risk, with a focus on urban vulnerability to earthquakes. After discussing how the interplay of configuration, governance, and use of space impact urban disaster risk in earthquake-prone settlements, the paper introduces a method for the exposure assessment of urban spatial layout. The method, applied on the configurational analysis of four settlements hit by the 2016 Central Italy Earthquakes, associates disaster risk variables to the urban spatial network’s core elements. It develops (i) a theoretical re-definition of the significant disaster risk variables in relation to configurational measures; and (ii) an integrated spatial analysis workflow for visualisation and classification of street segments and routes based on their degree of exposure, to inform both ordinary and emergency planning. In (i), the spatial-configurational dimensions of disaster concepts (hazard, exposure) are identified to unfold the spatial potential in DRR. In (ii), the spatial analysis workflow builds upon the recently developed applications of space syntax angular segment analysis on OSM RCL network, by combining Volunteered Geographic Information (VGI) with land use and disaster-related datasets, to generate hybrid exposure segment maps within the ArcGIS environment. The paper provides a twofold contribution : recontextualization and incorporation of space syntax theoretical knowledge into DRR, and innovative employ of existing applications for multidisciplinary and comprehensive approach to urban vulnerability assessment

Overcoming fears: a pathway to publishing for early career researchers

Purpose – The purpose of this paper is to present reflections of five early career researchers on the challenges of journal publishing and how to tackle them. Design/methodology/approach – The authors attended a participatory workshop on demystifying academic publications. Working individually and in groups the authors shared, discussed, analysed, visualised and ranked perceived challenges and opportunities concerning academic publishing. The authors then delved into the existing literature on the subject. Following their enhanced understanding of the area, the authors reflected on the experience and learnings. Findings – Personal confidence relating to the development of a scholarly identity was found to be a critical factor in the attitude towards journal publishing. Supervisory and peer support, accessibility to journal editors, as well as opportunities to reflect on the writing, publishing and peer review processes through participatory workshops and writing groups, were deemed more effective than formal and conventional guidance schemes. Research limitations/implications – This work adds to the available literature regarding the issue of academic publishing for PhD students and early career researchers. Originality/value – The paper contributes to a deeper understanding of issues surrounding publishing apprehension, by laying out thoughts that are seldom expressed

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Urban form and disaster risk: The role of urban public open spaces in vulnerability of earthquake-prone settlements

This thesis, at the intersection of urban and disaster studies, looks at the spatial component of urban form through the lens of risk, with a focus on urban vulnerability to earthquakes, reframing the existing knowledge on both the domains to redefine the concept of spatial vulnerability

Building synergies for cultural heritage: insights from theory and practice

The multifaceted character of Cultural Heritage and the efforts towards its protection from the impact of disaster, conflict, and urbanisation, require a synergic and multidisciplinary approach to counteract the range of threats and minimise trade-offs of single interventions. In heritage studies, synergies as a way to engage with, and incorporate, external knowledge are auspicated to critically revise the fundamentals of the discipline in terms of scope, methods, and epistemologies, and to broaden and advance contemporary enquiry (Waterton & Watson 2017). Yet on the operational level, the cooperation of different expertise, although increasingly common, is still a prevalently top-down practice based on horizontal knowledge exchange among experts and informed by methods developed and consolidated within the established (western) paradigms. This chapter focuses on multidisciplinary and multi-stakeholder synergies in the integrated approach to cultural heritage protection and DRR practice, providing examples from the field, and discussing the most common obstacles and catalysts recorded from the ground that could inform future cross-disciplinary action. The chapter ends with a critical reflection on the state of the art, appraising current directions and suggesting ways forward to building upon virtuous examples.</p

Disaster conversations: intersecting perspectives on cross-cultural disaster research

Purpose This paper aims to demonstrate the importance of conversation among disaster studies researchers who may be positioned at times and to varying degrees as both insiders and outsiders in relation to the contexts in which they work. Three key questions are explored: how we identify with and relate to people in our study areas, who we do research for and what this means for knowledge creation and research practice. Design Prompted by the Power Prestige and Forgotten Values manifesto (2019), the authors conversed with one another by email and video call, asking questions that triggered reflection. The emerging themes informed the key questions and the structure of the paper. We write with three individual voices to highlight the element of dialogue and our different experiences. Findings Sharing in depth with other researchers from different cultural and disciplinary backgrounds created space to both listen and find a voice. Emerging themes were positionality, how knowledge is used and implications for research practice. Researchers are part of a living system with the potential to serve, exploit or damage. Knowledge is generated at multiple scales and we can act as a bridge between people and policy makers, using networks. Practical implications We remain open and unbiased to ‘new’ local/contextual knowledge, adopting the attitude of a learner. Knowledge creation should focus on pragmatic outcomes such as informing emergency planning. Value We use a novel dialogical approach to demonstrate the value of conversation among researchers from different backgrounds that enables them to question and challenge each other in a supportive environment. This leads to deeper understanding of our role as cross-cultural researchers and reveals unifying questions and implications for research practice

The Role of the Spatial Network in Urban Disaster Risk Variations: Reimagining the Notion of Spatial Vulnerability at the Urban Scale

The notion of “spatial vulnerability” is present in most disaster studies with a strong geographical connotation and accordingly is adopted at all scales, including the urban. While enabling mapping and visualizing risk patterns at macroscales, this geocentric foundation fails to capture disaster risk dynamics associated with the urban spatial network—an element that plays a significant role in the everyday and emergency functioning of cities, enabling users’ movement and interaction. Yet, urban vulnerability assessment overlooks this aspect and thus leaves urban disaster risk mechanisms partially unexplored. This study investigated the role of the network of urban public open spaces (UPOS) in the creation and progression of urban disaster risk in earthquake-prone settlements. Through a multimethod approach that integrates quantitative and qualitative methods and explores spatial configuration, planning policies, and practices of use of UPOS in everyday and emergency scenarios, our study demonstrated that UPOS configuration plays an active role in urban disaster risk. Urban public open spaces impact risk by influencing the exposure of pedestrians and their capacity for self-protection. The study further reconceptualized spatial vulnerability at the urban scale, as the fraction of vulnerability associated to the spatial network, highlighting the interplay of planning policies and spatial practices in its production and progression. Our findings make the notion of spatial vulnerability less ambiguous at the urban scale, by viewing the variable as an imbalance in capacities and exposure that generates spatially unsafe conditions. This refined conceptualization of spatial vulnerability becomes a lens for a more granular approach to urban disaster risk reduction and city planning by identifying and integrating sociospatial considerations.</p

'Effing Awful!’: developing audio representation as a medium for conveying people's experiences of flooded homes

Although the concept of loss of home is well documented in disaster research, discussions of people’s experiences and vulnerabilities are normally presented in written or visual form, often adhering to established practices. This paper aims to reposition this bias by engaging participants in the creation of an audio-based representation of their experiences of the 2019 flooding in Doncaster, UK. It is based on data from a residential area situated next to the river Don. Drawing on theories of home, disaster literature, sound design, musical composition and music psychology, the research explores the minutiae of the spoken word and the characteristic ambient sounds from each of the flooded locations. By using contemporary recording and editing technology, the work presents the individual narratives as a series of thematic audio vignettes. In this setting, multiple facets of speech are manipulated alongside melodic and ambient sonic materials, deployed to engage the listener and to promote empathy and understanding. The study uses text-based thematic analysis in parallel with audio analysis of voice, timbre, sound and the prosodic elements of speech to provide an additional data set. It highlights how the participants’ experiences are reflected in their relationships with state responders, the local community, landlords within the post-disaster rebuilding experience, both physically and psychologically. It also exposes some of the factors that affect vulnerability and resilience, along with the importance of community spirit. It draws an intricate audio web that represents the complexity and intersectionality of the experience of flooding. The study is imbricated with the life experiences and local knowledge of the lead researcher, a long-time resident of the area. It analyses and represents the findings from a unique, subtle and unintrusive perspective. The audio output from the research – a soundscape composition – is designed to push the boundaries of representation and to evidence the researcher’s use of Creative Analytic Practice. It is not aimed solely for the cognoscenti: its academic qualities lie in its design, development, rationale and in its evaluation as an alternative form of representation. Its uses, however, go beyond this realm, reaching back within the communities whence it came and embodying participant feedback which is aligned with the researcher’s creative compositional contribution.</p