Park på hög nivå

Världen går mot att bli allt mer urban och det i kombination med dagens förtätningsideal ställer krav på att städer planeras och utformas på ett sådant sätt så att de blir både trivsamma och hållbara. Förtätning framhålls ofta som en hållbar planeringsstrategi, men i den ligger också flera utmaningar och det är av betydelse att förtätningen sker på ett effektivt och eftertänksamt sätt. Att grönskan får vara en del i den täta staden är viktigt, både som vistelseyta och för dess positiva inverkan på klimatet. Men i konkurrens om stadsutrymmet blir det ofta trångt och risken är att grönskan får stå tillbaka till förmån för andra intressen och funktioner. Att införa gröna tak är ett tillvägagångssätt för att effektivt utnyttja stadsutrymmet, föra in grönskans värden och skapa vistelseytor i en tät stadsväv. Mot bakgrund av detta är syftet med det här arbetet att undersöka hur ett grönt tak kan utformas till en offentlig takpark inom ett av Sveriges för tillfället största stadsutvecklingsprojekt, förtätningen av Ulleråkerområdet i Uppsala. Arbetet inleddes med en förstudie som bestod av en litteraturstudie, studie av referensprojekt och intervjuer. Litteraturstudien ämnade att svara på frågorna vad ett grönt tak innebär, vilka värden de kan bidra med samt hur man kan tänka kring uppbyggnad och utformning. Syftet var att skapa en grundläggande förståelse kring gröna tak för att sedan kunna använda resultatet i gestaltningsarbetet. Referensprojekten Takparken Emporia och Takparken Sveavägen studerades utifrån idé och innehåll med syftet att finna inspiration kring gestaltningslösningar. Intervjuer med tre landskapsarkitekter utfördes för att skapa ytterligare förståelse för hur man kan tänka kring utformning av gröna tak och vilka utmaningar som följer denna typ av anläggning. Förstudien sammanfattades sedan i riktlinjer att använda i gestaltningsarbetet. Genom inventering och en SWOT-analys av området skapades en bild av platsens förutsättningar. Resultatet av de genomförda metoderna låg därefter till grund för ett program som sedan utgjorde basen för det vidare gestaltningsarbetet. I förslaget har jag fokuserat på att göra platsen till en vistelseyta med rekreativa och estetiska värden med goda möjligheter till utsikt över omgivande landskap. Jag har också eftersträvat en gestaltning som främjar biologisk mångfald. Arbetet kan ses som ett exempel på hur man som landskapsarkitekt kan arbeta med ett taklandskap för att skapa en rekreativ miljö som bidrar med positiva effekter för både människa och miljö. Arbetet avslutas med en diskussion kring metod, förslag och vidare studier. En reflektion handlar om de gröna takens roll och att det är viktigt att poängtera att de aldrig kan kompensera för ytor i marknivå, utan de måste betraktas som komplement och unika inslag i sig. Med tanke på all den takyta som städer utgörs av finns här stor potential till att möta förtätningens utmaningar och till att skapa nya, spännande och nyttiga platser som kan vara ett bidrag till att skapa mer hållbara städer.The world is becoming increasingly more urban and in combination with today's densification ideal it requires cities to be planned and designed in such a way that they become both livable and sustainable. Densification is often emphasized as a sustainable planning strategy, but there are also several challenges, and it is important that the densification process takes place in an efficient and thoughtful manner. Urban green infrastructure is an important part of the dense city and a key factor to creating the sustainable and livable cities of the future. But in the competition for the city space there can be a conflict between densification processes and the accessibility of urban public green space, and there is a risk that green space may stand back in favor of other interests and functions. Introducing green roofs is an approach to effectively utilizing the urban space, introducing greenery values and create public space in a dense urban fabric. Against this background, the purpose of this work is to investigate how a green roof can be designed into a public roof park in one of Sweden's currently largest urban development projects, the densification of the Ulleråker area in Uppsala. The work began with a pre-study consisting of a literature study, study of reference projects and interviews. The literature study meant to answer questions about what a green roof is, what values they can contribute with and how to think about the design. The purpose was to create a basic understanding of the concept of green roofs and then use the results in the design work. The reference projects Takparken Emporia and Takparken Sveavägen were studied on the basis of ideas and content with the aim of finding inspiration about design solutions. Interviews with three landscape architects were conducted to provide further understanding of how to think about the design of green roofs and the challenges that follow this type of facility. The pre-study was then summarized into guidelines for use in the design work. Through inventory and a SWOT- analysis of the area, an image of the prerequisites was created. The result of the implemented methods then formed the foundation of a program which served as the basis for the following design work. In the proposal, I have focused on making the place a public space with recreational and aesthetic values with opportunities for views of surrounding landscape. I have also sought a design that promotes biodiversity. The work can be seen as an example of how you as a landscape architect can work with a roof landscape to create a recreational environment that contributes to positive effects for both humans and the environment. The work is concluded with a discussion about method, proposals and further studies. For example, one reflection deals with the role of green roofs and that it is important to point out that they can never compensate for ground level space. They must be seen and treated as complementary and unique elements in themselves. Cities largely exists of roof surface which provide a great potential to create green and social space that can meet the challenges of the densification and become new, exciting and useful places that can contribute to creating more sustainable cities

Att gestalta utifrån Jan Gehls teori och metod

Att utforma stadens offentliga rum till inbjudande platser där människor vill vistas och kan mötas är en grundpelare i arkitekten Jan Gehls teori. Han har i närmare 50 år arbetat för en stadsplanering som sätter människan i fokus, och menar att ett socialt hållbart samhälle förutsätter människovänliga stadsrum. Fyristorg är centralt beläget i Uppsala stad och förutsättningarna för ett livligt stadstorg är många, men i dagsläget domineras torget av en parkeringsplats och platsens mänskliga aktivitet är låg. Syftet med den här uppsatsen har därför varit att, utifrån Jan Gehls teorier kring levande och människovänliga stadsrum, föreslå en övergripande omgestaltning av Fyristorg. Genom att applicera Gehls teorier och metoder i gestaltningen ämnar arbetet att svara på frågeställningen hur Fyristorg kan omformas till ett inbjudande stadsrum för människor att vistas i. Genom en litteraturstudie identifierade jag Gehls designprinciper för hur offentliga rum bör utformas för att främja aktivitet och interaktion. För att förstå torgets förutsättningar gjorde jag en inventering som sedan följdes av Gehls observationsmetoder ”mapping” och ”tracing” , där jag studerade den aktivitet och rörelse som idag sker på platsen . Torget analyserades också utifrån Gehls ”12 kvalitetskriterier”, vilket synliggjorde platsens brister och kvaliteter. Jag sammanfattade sedan platsens huvudproblem och utformade ett program med åtgärder för hur Fyristorg kan bli ett inbjudande och människovänligt stadsrum. Med utgångspunkt i programmet och med stöd i litteraturstudien gjorde jag slutligen en översiktlig gestaltning. Resultatet visar på hur ett bildominerat torg med lite plats för mänsklig aktivitet kan omformas till det motsatta och hur man som gestaltare kan tänka kring utformning och placering av funktioner för att inbjuda människor till vistelse och interaktion. I diskussionen reflekterade jag bland annat kring konflikten mellan bilar och människor i dagens täta städer och eventuella svagheter med att gestalta utifrån en specifik teori. En slutsats från arbetet är att bilens närvaro i hög grad påverkar människors rörelsefrihet och aktivitet i stadsrummet, och genom att utgå från den mänskliga dimensionen vid gestaltning skapas förutsättningar för levande och aktiva stadsrum.Designing public spaces into inviting places where people want to reside and can meet is the cornerstone of architect Jan Gehl’s theory. For nearly 50 years he has worked on promoting urban planning that puts people in focus, and he argues that a socially sustainable society requires people-friendly cities. ”Fyristorg” is centrally located in the city of Uppsala and the conditions for a lively town square are numerous, but currently the square is dominated by a car parking and the human activity of the site is low. The purpose of this paper has therefore been to, based on Gehl’s theories on lively and people-friendly urban spaces, create a schematic design proposal of Fyristorg. By applying Gehl’s theories and methods in the design process, I intend to answer the question of how Fyristorg can be transformed into an inviting urban space for people to reside. Through a literature review, I identified Gehl’s design principles for how public spaces should be designed in order to encourage activity and interaction. To understand the square’s conditions, I did an inventory which was then followed by Gehl’s observation methods Mapping and Tracing which meant a study of the human activity and movement on the site. The square was also analyzed by Gehl’s ”The 12 quality criteria” which exposed the site’s flaws and qualities. I then identified the site’s main problems and formulated a program of action for how Fyristorg can become an inviting and people-friendly public space. The result shows how a square dominated by cars and with little room for human activity can be designed to become the opposite, and how the designer can think about the design and placement of functions to invite people to stay and interact. In the discussion, I then reflected on the conflict between cars and people in today’s dense cities, and any weaknesses of a design based on one specific theory. A conclusion is that the presence of cars greatly affects people’s freedom of movement and activity in a public space, and by designing the space based on the human dimension, the conditions for a vibrant and active public space can be created

Effect of three wound dressings on infection, healing comfort, and cost in patients with sternotomy wounds - a randomized trial

Study objective: To compare three dressing types in terms of their ability to protect against infection and promote healing, patient comfort, and cost-effectiveness.Design: Prospective, randomized controlled trial.Setting: Major metropolitan, academically affiliated, tertiary referral center.Patients: Seven hundred thirty-seven patients were randomized to receive a dry absorbent dressing (n = 243) [Primapore; Smith &amp; Nephew; Sydney, NSW, Australia], a hydrocolloid dressing (n = 267) [Duoderm Thin ConvaTec; Mulgrave, VIC, Australia], or a hydroactive dressing (n = 227) [Opsite; Smith &amp; Nephew] in the operating theater on skin closure.Results: There was no difference in the rate of wound infection or wound healing between treatment groups. The Primapore dressing was the most comfortable and cost-effective dressing option for the sternotomy wound. Duoderm Thin dressings were associated with increased wound exudate (p &lt; 0.001), poor dressing integrity (p &lt; 0.001), more frequent dressing changes (p &lt; 0.001), more discomfort with removal (p &lt; 0.05), and increased cost (p &lt; 0.001).Conclusions: In the context of no additional benefit for the prevention of wound infection or the rate of wound healing for any of the three dressing products examined, dry absorbent dressings are the most comfortable and cost-effective products for sternotomy wounds following cardiac surgery.<br /

First experience with a new negative pressure incision management system on surgical incisions after cardiac surgery in high risk patients

<p>Abstract</p> <p>Background</p> <p>Sternal wound infection remains a serious potential complication after cardiac surgery. A recent development for preventing wound complications after surgery is the adjunctive treatment of closed incisions with negative pressure wound therapy. Suggested mechanisms of preventive action are improving the local blood flow, removing fluids and components in these fluids, helping keep the incision edges together, protecting the wound from external contamination and promoting incision healing. This work reports on our initial evaluation and clinical experience with the Prevena™Incision Management System, a recently introduced new negative pressure wound therapy system specifically developed for treating closed surgical incisions and helping prevent potential complications. We evaluated the new treatment on sternal surgical incisions in patients with multiple co-morbidities and consequently a high risk for wound complications.</p> <p>Methods</p> <p>The Prevena™incision management system was used in 10 patients with a mean Fowler risk score of 15.1 [Range 8-30]. The negative pressure dressing was applied immediately after surgery and left in place for 5 days with a continuous application of -125 mmHg negative pressure. Wounds and surrounding skin were inspected immediately after removal of the Prevena™ incision management system and at day 30 after surgery.</p> <p>Results</p> <p>Wounds and surrounding skin showed complete wound healing with the absence of skin lesions due to the negative pressure after removal of the Prevena™ dressing. No device-related complications were observed. No wound complications occurred in this high risk group of patients until at least 30 days after surgery.</p> <p>Conclusions</p> <p>The Prevena™system appears to be safe, easy to use and may help achieve uncomplicated wound healing in patients at risk of developing wound complications after cardiothoracic surgery.</p

Exploring cancer register data to find risk factors for recurrence of breast cancer – application of Canonical Correlation Analysis

BACKGROUND: A common approach in exploring register data is to find relationships between outcomes and predictors by using multiple regression analysis (MRA). If there is more than one outcome variable, the analysis must then be repeated, and the results combined in some arbitrary fashion. In contrast, Canonical Correlation Analysis (CCA) has the ability to analyze multiple outcomes at the same time. One essential outcome after breast cancer treatment is recurrence of the disease. It is important to understand the relationship between different predictors and recurrence, including the time interval until recurrence. This study describes the application of CCA to find important predictors for two different outcomes for breast cancer patients, loco-regional recurrence and occurrence of distant metastasis and to decrease the number of variables in the sets of predictors and outcomes without decreasing the predictive strength of the model. METHODS: Data for 637 malignant breast cancer patients admitted in the south-east region of Sweden were analyzed. By using CCA and looking at the structure coefficients (loadings), relationships between tumor specifications and the two outcomes during different time intervals were analyzed and a correlation model was built. RESULTS: The analysis successfully detected known predictors for breast cancer recurrence during the first two years and distant metastasis 2–4 years after diagnosis. Nottingham Histologic Grading (NHG) was the most important predictor, while age of the patient at the time of diagnosis was not an important predictor. CONCLUSION: In cancer registers with high dimensionality, CCA can be used for identifying the importance of risk factors for breast cancer recurrence. This technique can result in a model ready for further processing by data mining methods through reducing the number of variables to important ones

Double vs single internal thoracic artery harvesting in diabetic patients: role in perioperative infection rate

Background: The aim of this prospective study is to evaluate the role in the onset of surgical site infections of bilateral internal thoracic arteries harvesting in patients with decompensated preoperative glycemia. Methods: 81 consecutive patients with uncontrolled diabetes mellitus underwent elective CABG harvesting single or double internal thoracic arteries. Single left ITA was harvested in 41 patients (Group 1, 50.6%), BITAs were harvested in 40 (Group 2, 49.4%). The major clinical end points analyzed in this study were infection rate, type of infection, duration of infection, infection relapse rate and total hospital length of stay. Results: Five patients developed sternal SSI in the perioperative period, 2 in group 1 and 3 in group 2 without significant difference. All sternal SSIs were superficial with no sternal dehiscence. The development of infection from the time of surgery took 18.5 ± 2.1 and 7.3 ± 3.0 days for Groups 1 and 2 respectively. The infections were treated with wound irrigation and debridement, and with VAC therapy as well as with antibiotics. The VAC system was removed after a mean of 12.8 ± 5.1 days, when sterilization was achieved. The overall survival estimate at 1 year was 98.7%. Only BMI was a significant predictor of SSI using multivariate stepwise logistic regression analysis (Odds Ratio: 1.34; 95%Conficdence Interval: 1.02–1.83; p value: 0.04). In the model, the use of BITA was not an independent predictor of SSI. Conclusion: CABG with bilateral pedicled ITAs grafting could be performed safely even in diabetics with poor preoperative glycaemic control

The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients

BACKGROUND: Problematic waiting lists in public health care threaten the equity and timeliness of care provision in several countries. This study assesses different stakeholders' views on the acceptability of waiting lists in health care, their preferences for priority care of patients, and their judgements on acceptable waiting times for surgical patients. METHODS: A questionnaire survey was conducted among 257 former patients (82 with varicose veins, 86 with inguinal hernia, and 89 with gallstones), 101 surgeons, 95 occupational physicians, and 65 GPs. Judgements on acceptable waiting times were assessed using vignettes of patients with varicose veins, inguinal hernia, and gallstones. RESULTS: Participants endorsed the prioritisation of patients based on clinical need, but not on ability to benefit. The groups had significantly different opinions (p < 0.05) on the use of non-clinical priority criteria and on the need for uniformity in the prioritisation process. Acceptable waiting times ranged between 2 and 25 weeks depending on the type of disorder (p < 0.001) and the severity of physical and psychosocial problems of patients (p < 0.001). Judgements were similar between the survey groups (p = 0.3) but responses varied considerably within each group depending on the individual's attitude towards waiting lists in health care (p < 0.001). CONCLUSION: The explicit prioritisation of patients seems an accepted means for reducing the overall burden from waiting lists. The disagreement about appropriate prioritisation criteria and the need for uniformity, however, raises concern about equity when implementing prioritisation in daily practice. Single factor waiting time thresholds seem insufficient for securing timely care provision in the presence of long waiting lists as they do not account for the different consequences of waiting between patients

Potential risk factors associated with human encephalitis: application of canonical correlation analysis

<p>Abstract</p> <p>Background</p> <p>Infection of the CNS is considered to be the major cause of encephalitis and more than 100 different pathogens have been recognized as causative agents. Despite being identified worldwide as an important public health concern, studies on encephalitis are very few and often focus on particular types (with respect to causative agents) of encephalitis (e.g. West Nile, Japanese, etc.). Moreover, a number of other infectious and non-infectious conditions present with similar symptoms, and distinguishing encephalitis from other disguising conditions continues to a challenging task.</p> <p>Methods</p> <p>We used canonical correlation analysis (CCA) to assess associations between set of exposure variable and set of symptom and diagnostic variables in human encephalitis. Data consists of 208 confirmed cases of encephalitis from a prospective multicenter study conducted in the United Kingdom. We used a covariance matrix based on Gini's measure of similarity and used permutation based approaches to test significance of canonical variates.</p> <p>Results</p> <p>Results show that weak pair-wise correlation exists between the risk factor (exposure and demographic) and symptom/laboratory variables. However, the first canonical variate from CCA revealed strong multivariate correlation (ρ = 0.71, se = 0.03, p = 0.013) between the two sets. We found a moderate correlation (ρ = 0.54, se = 0.02) between the variables in the second canonical variate, however, the value is not statistically significant (p = 0.68). Our results also show that a very small amount of the variation in the symptom sets is explained by the exposure variables. This indicates that host factors, rather than environmental factors might be important towards understanding the etiology of encephalitis and facilitate early diagnosis and treatment of encephalitis patients.</p> <p>Conclusions</p> <p>There is no standard laboratory diagnostic strategy for investigation of encephalitis and even experienced physicians are often uncertain about the cause, appropriate therapy and prognosis of encephalitis. Exploration of human encephalitis data using advanced multivariate statistical modelling approaches that can capture the inherent complexity in the data is, therefore, crucial in understanding the causes of human encephalitis. Moreover, application of multivariate exploratory techniques will generate clinically important hypotheses and offer useful insight into the number and nature of variables worthy of further consideration in a confirmatory statistical analysis.</p