Foyle Bubbles: How can design reduce suicide attempts using everyday social and civic spaces?

The River Foyle and its environments, banks and bridges in Derry/Londonderry in Northern Ireland have become associated with poor mental health and emotional wellbeing. ‘Our Future Foyle’ is a collaborative research initiative looking at how health and wellbeing can be designed into the riverfront in the city as a means of suicide prevention. This paper discusses one aspect and output of the research and design process: ‘Foyle Bubbles’ In order to carry out research and engage with the community as a whole the team have been carrying out a series of architectural interventions during city scale events. Using various co-design methods, the project has sought people from across the community, in an area which is known for its past conflict. The research showed the need for shared space along the riverfront. People within the community felt that 'one side of the river gets more than the other side'. This pointed to the need for movable spaces that could respond to the needs of different areas of the waterfront without having to be located in one area. Such spaces could be occupied by a variety of organisations and individuals to create a network and reinforce that community congestion. ‘Foyle Bubbles’ are a series of satellite spaces designed to house arts, commercial, educational and well-being activities around the riverfront; these will act as suicide deterrents and increase footfall and so achieve natural surveillance of the site. These portable pods offer the opportunity for enterprise and community engagement through social and civic functions. This pilot and subsequent measurable data provide the necessary evidence for larger procurement and roll out across the local community and service users with the hope of creating a connected, engaged and positive community on the river with the needs of people in crisis at its heart

Creating an Inclusive Architectural Intervention as a research Space to Explore Community Wellbeing

Abstract: This paper outlines a two-year active design research project coordinated in collaboration with Public Health Northern Ireland and set in the city of Derry/Londonderry to explore how inclusive design methodologies can produce interventions to improve community wellbeing. The research focuses on the waterfront of the River Foyle and how an inclusive architectural intervention challenged the areas’ negative associations. In the last decade, the waterfront has become synonymous with mental health crisis and suicide. This has led to the phrase “I'm ready for the Foyle” becoming embedded within the communities’ language as a colloquial term for stress. This project seeks to extend inclusive design within the community, creating wellbeing spaces around the bridges and banks of the river, with outcomes focused on drawing people to the area as a place of celebration and life affirming activities. The project has helped to develop Inclusive Design as a means of engaging a whole city in the redesign of public spaces for improved wellbeing

The Genetics of Pneumothorax.

A genetic influence on spontaneous pneumothoraces-those occurring without a traumatic or iatrogenic cause-is supported by several lines of evidence: 1) pneumothorax can cluster in families (i.e., familial spontaneous pneumothorax), 2) mutations in the FLCN gene have been found in both familial and sporadic cases, and 3) pneumothorax is a known complication of several genetic syndromes. Herein, we review known genetic contributions to both sporadic and familial pneumothorax. We summarize the pneumothorax-associated genetic syndromes, including Birt-Hogg-Dubé syndrome, Marfan syndrome, vascular (type IV) Ehlers-Danlos syndrome, alpha-1 antitrypsin deficiency, tuberous sclerosis complex/lymphangioleiomyomatosis, Loeys-Dietz syndrome, cystic fibrosis, homocystinuria, and cutis laxa, among others. At times, pneumothorax is their herald manifestation. These syndromes have serious potential extrapulmonary complications (e.g., malignant renal tumors in Birt-Hogg-Dubé syndrome), and surveillance and/or treatment is available for most disorders; thus, establishing a diagnosis is critical. To facilitate this, we provide an algorithm to guide the clinician in discerning which cases of spontaneous pneumothorax may have a genetic or familial contribution, which cases warrant genetic testing, and which cases should prompt an evaluation by a geneticist

Soluble toll-like receptor 2 is a biomarker for sepsis in critically ill patients with multi-organ failure within 12 h of ICU admission

Soluble TLR2 levels are elevated in infective and inflammatory conditions, but its diagnostic value with sepsis-induced multi-organ failure has not been evaluated. 37 patients with a diagnosis of severe sepsis/septic shock (sepsis) and 27 patients with organ failure without infection (SIRS) were studied. Median (IQR) plasma sTLR2 levels were 2.7 ng/ml (1.4–6.1) in sepsis and 0.6 ng/ml (0.4–0.9) in SIRS p < 0.001. sTLR2 showed good diagnostic value for sepsis at cut-off of 1.0 ng/ml, AUC:0.959. We report the ability of sTLR2 levels to discriminate between sepsis and SIRS within 12 h of ICU admission in patients with multi-organ failure

Foyle Reeds: How can design reduce suicide attempts at a specific place whilst at the same time improving the experience for all?

The impact of a suicide in a public environment has a profound negative effect on those living nearby. This paper outlines a project aiming to tackle this by bringing together researchers, designers and the local community to reduce suicidal behaviour and improve well-being across a section of the Foyle riverfront in Derry Londonderry through suicide prevention interventions. This paper discusses ‘Foyle Reeds’, one element of the project, an art installation and suicide prevention barrier for one of the bridges, designed to protect and engage with the community whilst avoiding any sense of imprisonment. The team created a research space at a number of large city wide events connecting with over 5,000 people through research activities such as voting on key themes and outcomes, comment cards about activities people would like to see around the river and vox-pop interviews about focused topics. The team have conducted in-depth workshops with over 100 individuals, held site visits and observations with key stakeholders from the local statutory and community groups and engaged with people over social media through surveys, reaching over 10,000 people. In-depth interviews with suicideologists and people who have attempted suicide were carried out in parallel. Individuals highlighted several key concerns about the bridge, including the suicide stigma, the wind and the height. A multidisciplinary team of students used these insights to create a range of designs. The concepts were tested using stakeholder workshops and led to the creation of the ‘Foyle Reed’ bridge concept, inspired by the ‘common reeds’ which surround the riverfront. By day, the bridge becomes part of a sculptural trail and provides an element of shelter and safety for pedestrians. At dusk the bridge displays interactive lighting. As the project moves towards the procurement phase, the measurement of impact on the community, and the environment is under way

Protocol for intervention development to improve adolescent perinatal mental health in Kenya and Mozambique: The INSPIRE project

Introduction: Mental health interventions have traditionally been developed by clinicians and researchers without the meaningful engagement and partnership with those who would receive, deliver, and fund them. Recent progress has highlighted the importance of the co-design of interventions, through stakeholder participation, as a means of increasing the integration of mental health interventions into existing health, education, and social care systems. This protocol describes the pre-implementation phase of the INSPIRE (Innovative approaches to adolescent perinatal wellbeing) project which aims to identify challenges, and design and test interventions to promote mental wellbeing and good mental health of adolescent girls during pregnancy and the year after birth with local stakeholders in Kenya and Mozambique. Methods: A participatory approach that blends human-centred design, systems thinking, and implementation science methods will be used to engage adolescents (aged 15–19 years), their families, and other stakeholders who can influence implementation efforts, in planning and preparing interventions. First, an understanding of context, barriers, and opportunities related to adolescent perinatal mental health will be elicited through individual interviews, focus group discussions, and observations. This will be complemented by a scoping review of relevant interventions. The research team will identify contextual insights relating to adolescent and system characteristics, strengths, and challenges. These will be shared with and refined by stakeholders. Thematic analysis will be conducted to describe the experiences of adolescent girls, and barriers and enablers to maintaining good mental health. The former will be triangulated with the Context and Implementation of Complex Intervention (CICI) framework. Causal loop diagrams will be developed to illustrate the individual and system-level variables which influence adolescent perinatal mental health. Stakeholder workshops will be used to identify priorities, brainstorm potential interventions, develop a program theory, and prototype an intervention and implementation strategies. Intervention acceptability, appropriateness, and feasibility will be assessed, and a theory of change map finalized. Results: To date the study has recruited 169 participants to complete individual interviews, focus group discussions and observation activities. Conclusions: It is anticipated that the use of a participatory and systematic approach to the development of an intervention to improve mental health, will improve its perceived appropriateness, acceptability, and feasibility among key stakeholders. This may, in turn, significantly improve its availability, uptake, and sustainability

Developing the Double Diamond Process for Implementation

This paper details overarching methodological insights resulting from several Inclusive Design projects in healthcare spanning ten years. A number of lessons have emerged, both practical and methodological, and are applicable to future design work in healthcare and the implementation of innovation. The Double Diamond methodology was used in all projects, increasingly run in parallel / mixed with an agile approach and PDSA cycles, where rapid iterations of the methodology are run in series. The final phase of the Double Diamond concerns delivery. The exact form that ‘delivery’ takes is unique to each project and partnership, but merits careful examination. Implementation of innovation is notoriously difficult in healthcare (Morris et al, 2011). Typically this is seen as post-‘design’, and necessarily requires the commitment of any healthcare project partner. Whilst some of the best innovations win design awards, many award winning designs are not adopted into front line use. There may be more to be done in design terms. The practices of co-research, co-creation and co-design are well used. Co-implementation efforts should start well before the end of the ‘Discover’ phase. These efforts may involve the identification of implementation stakeholders (standard practice in much co-design), but also funding bodies, the development of business cases and the adoption of commercial constraints in the design. Adoption of innovation in healthcare takes time, and is fraught with many complicating factors. Many lauded design outputs are not in use, pointing to poor implementation strategies. The above benefits of the Double Diamond must be applied to implementation in order to help adoption. This not only means involving the relevant stakeholders and identifying the relevant funds for implementation earlier in the process, but crucially designing the output with an implementation strategy in mind. This practice of ‘co-implementation’ will improve future adoption of innovations

Familial pneumothorax: towards precision medicine.

One in 10 patients suffering from primary spontaneous pneumothoraces has a family history of the disorder. Such familial pneumothoraces can occur in isolation, but can also be the presentation of serious genetic disorders with life-threatening vascular or cancerous complications. As the pneumothorax frequently precedes the more dangerous complications by many years, it provides an opportunity to intervene in a focused manner, permitting the practice of precision medicine. In this review, we will discuss the clinical manifestations and underlying biology of the genetic causes of familial pneumothorax

TLR activation enhances C5a-induced pro-inflammatory responses by negatively modulating the second C5a receptor, C5L2

TLR and complement activation ensures efficient clearance of infection. Previous studies documented synergism between TLRs and the receptor for the pro-inflammatory complement peptide C5a (C5aR/CD88), and regulation of TLR-induced pro-inflammatory responses by C5aR, suggesting crosstalk between TLRs and C5aR. However, it is unclear whether and how TLRs modulate C5a-induced pro-inflammatory responses. We demonstrate a marked positive modulatory effect of TLR activation on cell sensitivity to C5a in vitro and ex vivo and identify an underlying mechanistic target. Pre-exposure of PBMCs and whole blood to diverse TLR ligands or bacteria enhanced C5a-induced pro-inflammatory responses. This effect was not observed in TLR4 signalling-deficient mice. TLR-induced hypersensitivity to C5a did not result from C5aR upregulation or modulation of C5a-induced Ca2+ mobilization. Rather, TLRs targeted another C5a receptor, C5L2 (acting as a negative modulator of C5aR), by reducing C5L2 activity. TLR-induced hypersensitivity to C5a was mimicked by blocking C5L2 and was not observed in C5L2KO mice. Furthermore, TLR activation inhibited C5L2 expression upon C5a stimulation. These findings identify a novel pathway of crosstalk within the innate immune system that amplifies innate host defense at the TLR-complement interface. Unravelling the mutually regulated activities of TLRs and complement may reveal new therapeutic avenues to control inflammation

Meta-analysis of genome-wide association studies of asthma in ethnically diverse North American populations.

Asthma is a common disease with a complex risk architecture including both genetic and environmental factors. We performed a meta-analysis of North American genome-wide association studies of asthma in 5,416 individuals with asthma (cases) including individuals of European American, African American or African Caribbean, and Latino ancestry, with replication in an additional 12,649 individuals from the same ethnic groups. We identified five susceptibility loci. Four were at previously reported loci on 17q21, near IL1RL1, TSLP and IL33, but we report for the first time, to our knowledge, that these loci are associated with asthma risk in three ethnic groups. In addition, we identified a new asthma susceptibility locus at PYHIN1, with the association being specific to individuals of African descent (P = 3.9 × 10(-9)). These results suggest that some asthma susceptibility loci are robust to differences in ancestry when sufficiently large samples sizes are investigated, and that ancestry-specific associations also contribute to the complex genetic architecture of asthma