Uncovering Design: Translating the Past Can Enhance the Design Process

Throughout the late 20th century, urban buildings around the world have repeatedly lost their unique reason for being. The phenomenon of diminished value, while tragic at the time, provides extraordinary opportunities for future use, by offering an authentic narrative to build upon, and overcoming the "blank slate" approach of traditional design thinking. A current generation of designers is recognizing the potential value in these deteriorated and neglected structures and districts. However, we should look critically and creatively at the past to understand the causes of displacement, before attempting to design for the future. War, deindustrialization, tourism, gentrification, white-flight, and economic instability are some of the principal forces responsible for the emptying our downtown communities. By establishing proper analytical and imaginative lenses through which to examine unique developments around the world, we can better see how to reconstitute value in these derelict buildings, thus achieving a more sustainable future. This thesis applies a framework for interjecting creativity and considerations into the regeneration process. I will use a district of abandoned building in the Portland neighborhood of downtown Louisville, Kentucky, to depict these ideas at a variety of scales. This process will develop and utilize appropriate design principles and proposals, to illustrate how architecture can revitalize and reoccupy abandoned buildings, while bringing neighborhoods and communities back to life. In utilizing neglected but rediscovered space, urban infrastructure and buildings within the urban fabric, opportunities are created through the understanding and appreciation of existing contexts, combined with the integration of innovative approaches. The process of uncovering and providing alternative interventions strategies is not linear and blurs the edge between re-search and design. This thesis reveals how architects, by uncovering the past, can fuel a creative process and lead the transformation of a lost community

Performance of the PEdiatric Logistic Organ Dysfunction-2 score in critically ill children requiring plasma transfusions

BackgroundOrgan dysfunction scores, based on physiological parameters, have been created to describe organ failure. In a general pediatric intensive care unit (PICU) population, the PEdiatric Logistic Organ Dysfunction-2 score (PELOD-2) score had both a good discrimination and calibration, allowing to describe the clinical outcome of critically ill children throughout their stay. This score is increasingly used in clinical trials in specific subpopulation. Our objective was to assess the performance of the PELOD-2 score in a subpopulation of critically ill children requiring plasma transfusions.MethodsThis was an ancillary study of a prospective observational study on plasma transfusions over a 6-week period, in 101 PICUs in 21 countries. All critically ill children who received at least one plasma transfusion during the observation period were included. PELOD-2 scores were measured on days 1, 2, 5, 8, and 12 after plasma transfusion. Performance of the score was assessed by the determination of the discrimination (area under the ROC curve: AUC) and the calibration (Hosmer–Lemeshow test).ResultsFour hundred and forty-three patients were enrolled in the study (median age and weight: 1 year and 9.1 kg, respectively). Observed mortality rate was 26.9 % (119/443). For PELOD-2 on day 1, the AUC was 0.76 (95 % CI 0.71–0.81) and the Hosmer–Lemeshow test was p = 0.76. The serial evaluation of the changes in the daily PELOD-2 scores from day 1 demonstrated a significant association with death, adjusted for the PELOD-2 score on day 1.ConclusionsIn a subpopulation of critically ill children requiring plasma transfusion, the PELOD-2 score has a lower but acceptable discrimination than in an entire population. This score should therefore be used cautiously in this specific subpopulation.</p

Factors influencing plasma transfusion practices in paediatric intensive care units around the world

Background and Objectives Plasma transfusions are a frequent treatment worldwide, but many studies have reported a wide variation in the indications to transfuse. Recently, an international paediatric study also showed wide variation in frequency in the use of plasma transfusions: 25% of the centres transfused plasma to >5% of their patients, whereas another 25% transfused plasma to <1% of their patients. The objective of this study was to explore the factors associated with different plasma transfusion practices in these centres. Materials and Methods Online survey sent to the local investigators of the 101 participating centres, in February 2016. Four areas were explored: beliefs regarding plasma transfusion, patients’ case‐mix in each unit, unit's characteristics, and local blood product transfusion policies and processes. Results The response rate was 82% (83/101). 43% of the respondents believed that plasma transfusions can arrest bleeding, whereas 27% believe that plasma transfusion can prevent bleeding. Centres with the highest plasma transfusion rate were more likely to think that hypovolaemia and mildly abnormal coagulation tests are appropriate indications for plasma transfusions (P = 0·02 and P = 0·04, respectively). Case‐mix, centre characteristics or local transfusion services were not identified as significant relevant factors. Conclusion Factors influencing plasma transfusion practices reflect beliefs about indications and the efficacy of transfusion in the prevention and management of bleeding as well as effects on coagulation tests. Educational and other initiatives to target these beliefs should be the focus of research