Co-designing cities: Designers as enablers of community-driven change by participatory means in the urban context

In the 21st century, design has expanded in scope and become applied as an approach to developing more human-centered and sustainable solutions, environments and strategies in the urban context, with multidisciplinary collaboration recognized as a precondition for addressing complex societal issues. Simultaneously, the progress of technology and emergence of social media have enabled citizens to become central actors, who collectively and proactively contribute to the development of cities through self-organized action. In the thesis, this transition is examined from the point of view of a designer, with the aim to explore and discover the potential roles that a designer might adopt to catalyze sustainable change in the urban context by means of co-design. With sustainability as the newly adopted, ultimate goal in all design activity, it is proposed that harnessing citizens as a resource in co-developing solutions and environments in cities by means of participation can induce broad positive impact that extends beyond improving the quality of design outcomes. The thesis topic is approached through two distinct sections: a theoretical study and a case study. A literature review and expert interviews are conducted to first establish a comprehensive understanding on three subject matters: design in contemporary society and cities; participation in design; and citizen participation in the urban context. In the case study, observations obtained through a fieldwork period in 2017-2018 on Konepaja are elaborated and analyzed. Located in a rapidly transforming industrial milieu in Vallila, Helsinki, Konepaja is a former train carriage workshop that operated for a century before the operations were shut down in 2003. In the recent years, the neglected site has become known for distinctive urban culture stemming from the grass root level. The community members of Konepaja are identified as key actors in developing the area through a bottom-up directed process, that can amplify the existing assets and potential of the site. The focus is on exploring how the shared future vision of Konepaja could potentially be achieved by means of co-design, and what roles a designer can adopt in the process. The aim is to propose how conditions might be established for the community to mobilize and sustain a bottom-up directed development process autonomously, and thus contribute to developing Konepaja into a socially sustainable and vibrant urban area. Through the study, it is discovered that high quality participation can induce various positive implications, with the most notable benefits being social. Enabling participation throughout the development process can lead to a transformation within individuals and communities themselves, including empowerment, increase in social capital, a stronger sense of community, and commitment to change. By approaching a development process with a participatory mindset, the process can become a platform for the community to assemble, collaborate, and mobilize to take concrete, collective action. Thus, by facilitating and enabling a participatory process, a designer can enable harnessing the community as an invaluable resource and a transformative force, potentially catalyzing broader positive change within the community, urban area and even in the city scale.2000-luvun yhteiskunnallisessa muutoksessa muotoilun kenttä on muuttunut ja laajentunut voimakkaasti. Yksi uusista sovelluskohteista on kaupungit, joissa muotoilun lähestymistapaa on alettu soveltamaan kestävien ja ihmislähtöisten ratkaisujen, ympäristöjen ja kauaskantoisten strategioiden suunnittelemiseksi, ja joissa monialainen yhteistyö on tunnistettu edellytykseksi monimutkaisten ongelmien ratkaisemiseksi. Samalla teknologian kehitys ja sosiaalinen media ovat mahdollistaneet kaupunkilaisten ja yhteisöjen aktivoitumisen keskeisinä toimijoina kaupunkien kehityksessä itseorganisoitumisen keinoin. Opinnäytetyön tavoitteina on tarkastella tätä muutosta muotoilijan näkökulmasta sekä tutkia niitä mahdollisia rooleja, joita muotoilija voi omaksua kaupunkiympäristöjen kehittämisessä yhteissuunnittelun menetelmiä hyödyntäen. Keskeisin muotoilun tehtävä nyky-yhteiskunnassa on edistää kestävää kehitystä ja suunnitella siten myös sosiaalisesti kestäviä ratkaisuja, minkä mahdollistamisessa yhteissuunnittelu sekä kaupunkilaisten osallistaminen ja valjastaminen muutosvoimana ovat avainasemassa. Muotoilijan rooli nähdään kaupunkilaisten osallistamisen ja kaupunkien kestävän yhteissuunnittelun mahdollistajana, sekä mahdollisena katalyyttina laajemmille vaikutuksille, joita osallistamisen keinoin voidaan saavuttaa. Opinnäytetyössä aihetta käsitellään teoreettisen tutkimuksen sekä tapausesimerkin kautta. Kirjallisuuskatsauksen ja ammattilaishaastattelujen keinoin luodaan ensin kokonaisvaltainen ymmärrys kolmesta eri aihealueesta: muotoilu nyky-yhteiskunnassa ja kaupunkikontekstissa, osallistaminen muotoilussa, sekä kaupunkilaisten osallistaminen kaupungeissa. Tapaustutkimuksessa tarkastellaan Konepajaa, Helsingin Vallilassa sijaitsevaa entistä Valtionrautateiden vaunukonepajaa, vuosien 2017-2018 aikana toteutetun kenttätutkimuksen avulla kerättyjä havaintoja analysoimalla. Alkuperäisen toiminnan päätyttyä vuonna 2003 pitkään tyhjillään olleisiin rakennuksiin on viime vuosina kehkeytynyt ruohonjuuritason toimintaa, jonka avulla alueelle on virinnyt uusia kaupunkikulttuuria ja omaleimaista paikkaidentiteettiä kehittäviä toimintoja ja väliaikaiskäyttöjä. Kenttätutkimuksessa Konepajan yhteisön jäsenet tunnistetaan merkittävinä toimijoina alueen tulevaisuuden käyttöjen ja kehitysprosessin suunnan määrittämisessä sekä sosiaalisesti kestävän, alhaalta ylöspäin suuntautuvan kehitysprosessin vetureina. Analyysiosiossa tarkastellaan, miten Konepajan tulevaisuuden kehitystä voisi lähestyä yhteissuunnittelun menetelmin ja miten muotoilija voisi osaamisellaan myötävaikuttaa alueen kestävään ja olemassa olevia vahvuuksia voimistavaan tulevaisuuskehitykseen. Pääpaino tarkastelussa on alueen toimijoiden roolissa muutosprosessin alullepanijoina ja ylläpitäjinä, joiden avulla Konepajasta voidaan kehittää yhteisiä tulevaisuusvisioita vastaava, elinvoimainen kaupunkikulttuurin keskus. Opinnäytetyön tutkimuksen kautta osoitetaan, että korkeatasoisella osallistamisella ja yhteissuunnittelulla voidaan synnyttää laajojakin kokonaisvaikutuksia sekä ympäristössä että yhteisöjen sisäisesti, joista huomattavimmat ovat sosiaalisia. Mahdollistamalla kaupunkilaisten korkeatasoisen ja jatkuvan osallistamisen koko kehitysprosessin ajan yhteisön jäsenet voidaan sitouttaa muutosprosesseihin voimaannuttamalla, yhteisöllisyyttä voidaan parantaa sekä yhteisön toimijoiden välisiä suhteita vahvistaa. Lähestymällä kehitysprosessia osallistavasta näkökulmasta yhteissuunnitteluprosessi voi toimia alustana yhteisön järjestäytymiselle, yhteistyölle ja konkreettisen toiminnan mobilisoinnille. Muotoilijan rooli yhteissuunnittelun fasilitoijana ja mahdollistajana voi johtaa yhteisön valjastamiseen resurssina ja muutosvoimana kaupungeissa. Tämä voi puolestaan mahdollistaa kestävän muutoksen ja kehityksen niin yhteisön sisäisesti, kaupunkiympäristössä kuin mahdollisesti myös koko kaupungin mittakaavassa

Radial Frequency Analysis of Contour Shapes in the Visual Cortex

Cumulative psychophysical evidence suggests that the shape of closed contours is analysed by means of their radial frequency components (RFC). However, neurophysiological evidence for RFC-based representations is still missing. We investigated the representation of radial frequency in the human visual cortex with functional magnetic resonance imaging. We parametrically varied the radial frequency, amplitude and local curvature of contour shapes. The stimuli evoked clear responses across visual areas in the univariate analysis, but the response magnitude did not depend on radial frequency or local curvature. Searchlight-based, multivariate representational similarity analysis revealed RFC specific response patterns in areas V2d, V3d, V3AB, and IPS0. Interestingly, RFC-specific representations were not found in hV4 or LO, traditionally associated with visual shape analysis. The modulation amplitude of the shapes did not affect the responses in any visual area. Local curvature, SF-spectrum and contrast energy related representations were found across visual areas but without similar specificity for visual area that was found for RFC. The results suggest that the radial frequency of a closed contour is one of the cortical shape analysis dimensions, represented in the early and mid-level visual areas.Peer reviewe

Treatment of de novo femoro-popliteal lesions with a new Drug Coated Balloon: early experience of a single Center in the first 50 patients

Angioplasty with drug-coated balloon (DCB) is an emerging and reliable method for the treatment of femoro-popliteal lesions. We report our experience with the Stellarex™ DCB in the first 50 patients. Methods - From July 2015 to November 2017, 50 patients (41 M, 9F), medium age (64 ± 7.4 year) were subject to 33 angioplasties (PTAs) for femoro-popliteal lesions with a paclitaxel-coated balloon (Stellarex™). Based upon clinical data sixteen patients had severe claudication (56% - Rutherford class 3); ten patients suffered from ischemic rest pain (34% - Rutherford class 4); and five presented minor tissue loss (10% - Rutherford class 5). 42% of patients showed femoro-popliteal lesion TASC-II B, and 58% presented lesions pertaining to TASC-II C. Results - Immediate technical success was 100% without perioperative complications. Primary patency rate was 94% at twelve months. In three cases restenosis (6%) was detected within a year from procedure, and a further PTA DCB was performed with primary assisted patency rates of 100% at twelve months. Two patients underwent major lower limb amputation. Three patients died during follow-up and one patient was lost at follow-up. Conclusion - DCB angioplasty with Stellarex™ is a viable alternative to traditional endovascular procedures proving satisfactory primary patency rates at twelve months. Based on our experience, treatment with DCB is a first choice technique for non-complex de novo lesions of the femoro – popliteal tract

Retinotopic Maps, Spatial Tuning, and Locations of Human Visual Areas in Surface Coordinates Characterized with Multifocal and Blocked fMRI Designs

The localization of visual areas in the human cortex is typically based on mapping the retinotopic organization with functional magnetic resonance imaging (fMRI). The most common approach is to encode the response phase for a slowly moving visual stimulus and to present the result on an individual's reconstructed cortical surface. The main aims of this study were to develop complementary general linear model (GLM)-based retinotopic mapping methods and to characterize the inter-individual variability of the visual area positions on the cortical surface. We studied 15 subjects with two methods: a 24-region multifocal checkerboard stimulus and a blocked presentation of object stimuli at different visual field locations. The retinotopic maps were based on weighted averaging of the GLM parameter estimates for the stimulus regions. In addition to localizing visual areas, both methods could be used to localize multiple retinotopic regions-of-interest. The two methods yielded consistent retinotopic maps in the visual areas V1, V2, V3, hV4, and V3AB. In the higher-level areas IPS0, VO1, LO1, LO2, TO1, and TO2, retinotopy could only be mapped with the blocked stimulus presentation. The gradual widening of spatial tuning and an increase in the responses to stimuli in the ipsilateral visual field along the hierarchy of visual areas likely reflected the increase in the average receptive field size. Finally, after registration to Freesurfer's surface-based atlas of the human cerebral cortex, we calculated the mean and variability of the visual area positions in the spherical surface-based coordinate system and generated probability maps of the visual areas on the average cortical surface. The inter-individual variability in the area locations decreased when the midpoints were calculated along the spherical cortical surface compared with volumetric coordinates. These results can facilitate both analysis of individual functional anatomy and comparisons of visual cortex topology across studies

ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Variation in neurosurgical management of traumatic brain injury: A survey in 68 centers participating in the CENTER-TBI study

Background Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. Methods A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP). Results The survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30 min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25 mmHg, 18% 30 mmHg, and 17% 20 mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions. Conclusion Despite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care

Variation in neurosurgical management of traumatic brain injury

Background: Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. Methods: A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP). Results: The survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30 min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25 mmHg, 18% 30 mmHg, and 17% 20 mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions. Conclusion: Despite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Työympäristö luovuuden kenttänä : luovuutta tukeva toimistotilakonsepti Y-sukupolven tarpeisiin

Opinnäytetyö käsittelee työkulttuurissa tapahtuneita muutoksia ja mahdollisia muutossuuntauksia työympäristösuunnittelun kannalta työelämään siirtymässä olevan Y-sukupolven näkökulmasta. Työssä tarkastellaan työpaikan korostunutta roolia yksilöiden ja ryhmien luovan tietotyön tekemisen ja erilaisten kohtaamisten alustana sekä niitä tilallisia ratkaisuja, joiden avulla vuorovaikutusta, luovia prosesseja ja Y-sukupolven työn tekemisen tapoja voidaan tukea toimistosuunnittelun viitekehyksessä. Kolmiosainen tietopohjaosuus kiteyttää kirjallisuuden, digitaalisen aineiston, haastattelujen ja tila-analyysien kautta kerätyn tiedon ja havainnot sekä tarjoaa yhden näkökulman työkulttuurin ja työympäristöjen kehitysnäkymiin. Tietopohjaosuuden pohjalta luodaan konseptitasoinen toimistotilasuunnitelma, jonka tarkoituksena on ilmentää kirjallisessa osiossa tehtyjä päätelmiä ja jonka suunnitteluperiaatteet on sovellettavissa myös toiseen vastaavaan tilaan. Lopullinen tilakonsepti on Y-sukupolven työntekijöiden tarpeisiin suunniteltu käyttäjälähtöinen luovan alan yrityksen toimistotilakonsepti, jossa sovelletaan monitilatoimiston suunnitteluperiaatteita ja jonka toiminnallisten ja visuaalisten ratkaisujen suunnittelussa on keskitytty vuorovaikutuksen, hiljaisen tiedon välittymisen, työviihtyvyyden sekä luovien ryhmätyöprosessien tukemiseen.This thesis deals with changes in the work culture that are due to generational transition in the work force and the possibilities that the transition of generations will provide in terms of spatial design. The work will discuss the emphasized role of an office as a meeting place and as a platform for creative knowledge based work of both teams and individual employees. It provides a point of view for how the physical spatial design of a work place can support the divergent ways of thinking and working of Generation Y in relation to the past generations. The written part of the thesis concludes the information, points of view and perceptions gathered from a range of literary and electronic sources and is supported by interviews, benchmarking and spatial analysis. It will provide a perspective for the possible directions of change in work culture that will affect the spatial design of work environments. Based on this information and personal observations and conclusions, a conceptual spatial plan for a creative work agency will be designed to demonstrate the applied principles of a hybrid office design to meet the user-centered needs and support the novel ways of working introduced by Generation Y. The concept is not limited to a certain physical space and may instead be applied to other spaces as well. The functional and aesthetical solutions of the design will focus on creating a work space that supports social interaction, transition of tacit knowledge, work satisfaction and creative team work