Exploring Challenges and Opportunities of Biophilic Urban Design: Evidence from Research and Experimentation

Global health emergencies such as Covid-19 have highlighted the importance of access to nature and open spaces in our cities for social, physical, and mental health. However, there continues to be a disconnect between our need for nature and our daily lived experience. Recent research indicates that our connectedness and relationship with nature, and in particular biophilic design, may be key for improving both health and quality of life. Rather than relying on abstract universal ideas of “nature”, using evidence-based biophilic design and policy at a building, neighborhood, and city scale, to link our daily lives with biodiversity, may encourage sense of place and make environmental action more meaningful. Then, improving our natural capital in the urban built environment might help address the current climate and disease crisis, as well as improving our physical and mental health. Drawing from emerging research and innovative practice, the paper describes key research and design paradigms that influence the way we understand the benefits of nature for different environments, including the workplace, neighborhood, and city, and explains where biophilic design theory sits in this field. Examples from recent research carried out in London and Chicago are provided, aiming at demonstrating what kind of research can be functional to what context, followed by a detailed analysis of its application supporting both human and ecological health. The study concludes indicating key policy and design lessons learned around regenerative design and biophilia as well as new directions for action, particularly with regard to climate change, sense of place, and well-being

Assessing employee engagement in a post-COVID-19 work-place ecosystem

This article has aimed to better understand employee engagement in a post-COVID-19 workplace ecosystem. We have identified a knowledge gap in the relationship between employee engage-ment and the physical workplace environment through an interdisciplinary literature review. We subsequently have tested this gap by comparing employee engagement metrics proposed by leading academics in the field of organisational psychology with a sample of commonly used real estate industry approaches to monitoring workplace design/management. With a specific focus on industry-projected post-COVID-19 workplace ecosystem scenarios, the results suggest that traditional employee engagement metrics and industry approaches to monitoring workplace de-sign and management do not fully reflect the recent shift to hybrid work patterns. We shed light on the implications that this can have on our existing knowledge of “sustainable” property markets in a wider city context

TCF7L2 Regulates Late Events in Insulin Secretion From Pancreatic Islet β-Cells

OBJECTIVE: Polymorphisms in the human TCF7L2 gene are associated with reduced insulin secretion and an increased risk of type 2 diabetes. However, the mechanisms by which TCF7L2 affect insulin secretion are still unclear. We define the effects of TCF7L2 expression level on mature beta-cell function and suggest a potential mechanism for its actions. RESEARCH DESIGN AND METHODS: TCF7L2 expression in rodent islets and beta-cell lines was altered using RNAi or adenoviral transduction. Beta-cell gene profiles were measured by quantitative real-time PCR and the effects on intracellular signaling and exocytosis by live cell imaging, electron microscopy, and patch clamp electrophysiology. RESULTS: Reducing TCF7L2 expression levels by RNAi decreased glucose- but not KCl-induced insulin secretion. The glucose-induced increments in both ATP/ADP ratio and cytosolic free Ca2+ concentration ([Ca2+]i) were increased compared with controls. Overexpression of TCF7L2 exerted minor inhibitory effects on glucose-regulated changes in [Ca2+]i and insulin release. Gene expression profiling in TCF7L2-silenced cells revealed increased levels of mRNA encoding syntaxin 1A but decreased Munc18–1 and ZnT8 mRNA. Whereas the number of morphologically docked vesicles was unchanged by TCF7L2 suppression, secretory granule movement increased and capacitance changes decreased, indicative of defective vesicle fusion. CONCLUSION: TCF7L2 is involved in maintaining expression of beta-cell genes regulating secretory granule fusion. Defective insulin exocytosis may thus underlie increased diabetes incidence in carriers of the at-risk TCF7L2 alleles.</p

Ten Questions Concerning Well-Being in the Built Environment

Well-being in the built environment is a topic that features frequently in building standards and certification schemes, in scholarly articles and in the general press. However, despite this surge in attention, there are still many questions on how to effectively design, measure, and nurture well-being in the built environment. Bringing together experts from academia and the building industry, this paper aims to demonstrate that the promotion of well-being requires a departure from conventional agendas. The ten questions and answers have been arranged to offer a range of perspectives on the principles and strategies that can better sustain the consideration of well-being in the design and operation of the built environment. Placing a specific focus on some of the key physical factors (e.g., light, temperature, sound, and air quality) of indoor environmental quality (IEQ) that strongly influence occupant perception of built spaces, attention is also given to the value of multi-sensory variability, to how to monitor and communicate well-being outcomes in support of organizational and operational strategies, and to future research needs and their translation into building practice and standards. Seen as a whole, a new framework emerges, accentuating the integration of diverse new competencies required to support the design and operation of built environments that respond to the multifaceted physical, physiological, and psychological needs of their occupants

Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study

In the emergency setting, non-traumatic headache is a benign symptom in 80% of cases, but serious underlying conditions need to be ruled out. Copeptin improves risk stratification in several acute diseases. Herein, we investigated the value of copeptin to discriminate between serious secondary headache and benign headache forms in the emergency setting.; Patients presenting with acute non-traumatic headache were prospectively enrolled into an observational cohort study. Copeptin was measured upon presentation to the emergency department. Primary endpoint was serious secondary headache defined by a neurologic cause requiring immediate treatment of the underlying disease. Secondary endpoint was the combination of mortality and hospitalization within 3 months. Two board-certified neurologist blinded to copeptin levels verified the endpoints after a structured 3-month-telephone interview.; Of the 391 patients included, 75 (19%) had a serious secondary headache. Copeptin was associated with serious secondary headache (OR 2.03, 95%CI 1.52-2.70, p &lt; 0.0001). Area under the curve (AUC) for copeptin to identify the primary endpoint was 0.70 (0.63-0.76). After adjusting for age &gt; 50, focal-neurological abnormalities, and thunderclap onset of symptoms, copeptin remained an independent predictive factor for serious secondary headache (OR 1.74, 95%CI 1.26-2.39, p = 0.001). Moreover, copeptin improved the AUC of the multivariate logistic clinical model (p-LR-test &lt; 0.001). Even though copeptin values were higher in patients reaching the secondary endpoint, this association was not significant in multivariate logistic regression.; Copeptin was independently associated with serious secondary headache as compared to benign headaches forms. Copeptin may be a promising novel blood biomarker that should be further validated to rule out serious secondary headache in the emergency department.; Study Registration on 08/02/2010 as NCT01174901 at clinicaltrials.gov

How do marine and coastal citizen science experiences foster environmental engagement?

Citizen science programs enable community involvement in scientific research. In addition to fostering greater science literacy, some citizen science programs aim to foster engagement in environmental issues. However, few data are available to indicate whether and how citizen science programs can achieve greater environmental engagement. We survey individuals choosing to attend one of seventeen reef citizen science events and examine the extent to which attendees reported three indicators of greater environmental engagement: (i) willingness to share information, (ii) increased support for marine conservation and citizen science, and (iii) intentions to adopt a new behavior. Most participants reported being willing to share information about reef conservation (91%) and described increased support for marine science and conservation (87%). Half of participants (51%) reported intentions to adopt a new conservation behavior. We found that key elements of the citizen science experience associated with these outcomes were learning about actions to protect reefs and coasts (procedural learning), experiencing surprise, and experiencing negative emotions about environmental problems. Excitement was also associated with positive outcomes, but only in participants who were less likely to see themselves as environmental, or were less frequent visitors to reefs and coasts. Importantly, the association between factual learning and environmental engagement outcomes was limited or negative. These findings suggest that the way citizen science experiences make people feel, may be more important for fostering future environmental engagement than factual-based learning. When designing citizen science programs for community members, these findings provide a reminder to not focus on provision of factual information alone, but to highlight environmental impacts while providing meaningful experiences and building environmental skills

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Greening the City: Exploring Health, Well-being, Green Roofs, and the Perception of Nature in the Workplace

This five-paper thesis explores office workers perceptions of green roofs and how this influences their health/well-being in Toronto and Chicago. Paper 1 examines the underlying paradigms and world-views of major research programs that look at the human relationship to nature and health/well-being, showing that despite some convergence between their methods and integration of different paradigms, continued differences and lack of clarity on the normative assumptions underlying each approach leads to confusion in the specification of ‘nature’ in health/well-being and place research. Paper 2 is a comparative analysis of the implementation of green roof policies in Toronto and Chicago. Paper 2 demonstrates the importance of ‘selling’ green roofs by linking them to larger environmental programs and of the municipal power structure that influences how and if environmental programs are implemented. Paper 3 examines the awareness, attitudes, and feelings towards green roofs by office workers with access to them (visual or physical) from their workplace in Toronto and Chicago. Using a phenomenological analysis of semi-structured interviews (n=55), Paper 3 shows that the hinterland, expectations of different kinds of ‘nature’ and aesthetics in the city, and access all influence perceptions of green roofs and sense of place. Paper 4 explores office workers awareness of and attitudes towards green roofs and the possible influence on their well-being in Toronto and Chicago from a large survey (n = 903). Participants showed a high literacy on the environmental benefits of green roofs. Chi-square analysis showed mixed results for health, but a significant association between visual access to a green roof and improved concentration. Paper 5 tests whether the relationship found in Paper 4, improved concentration with visual access, was still significant when other confounding variables were added to the model. Using a logistic regression on the same survey population (subset n =505), results found that concentration was no longer significant but that there was a trend towards improved concentration.Ph