Hvor planlegging og design møtes : transformasjon av bystruktur som et resultat av fortettingspolitikken : eksempel Oslo

Over the past few decades, urban planning has been distancing itself from architecture and engineering, becoming increasingly dominated by strategic approaches and goals for sustainability. This shift of focus has created a gap, which is also possible to observe in the Norwegian planning context. Despite this gap, built structures and physical urban form still represent a significant part of the outcomes of urban planning. This empirically based PhD thesis aims to explore the physical outcomes of the current planning for densification in Norway, using Oslo as the case. The study includes two main analytical aspects: spatial and procedural. The main research question posed in the thesis is, “What are the morphological characteristics of the physical outcomes of densification in Oslo, and what spatially related concerns have influenced the design of those outcomes?” Six sub-questions address spatial and procedural components of the analysis in further detail. The field of urban morphology offers theoretical lenses for an integrative analysis of both the spatial and procedural aspects. In the spatial part of the analysis, the main concepts applied are urban tissue, constituted tissue, urban block, and architectural type. The spatial analysis covers the intermediate spatial scale (between a building and several urban blocks). The procedural part of the analysis encompasses three components – planning, actors, and design. The main concepts in this step are planning instrument, strategic and project plans, actors, and the articulation of physical form and architectural functions. The study is designed as an embedded case study, with Oslo (its built-up area) as the main case and 71 multi-family residential buildings as sub-cases. In addressing each research sub-question, specific methods have been used: site visits, analysis of maps and aerial photos, document analysis and interviews. The results expose a large variety of types of previously existing urban tissue that have undergone densification, a considerable variety of physical outputs of densification, and strong interrelations between the pre-existing urban tissue and the new structures. Among the analysed sub-cases, context-dependence appears both in terms of built form and the distribution of architectural functions. Regarding the spatially related concerns that arose in the planning processes, a number of considerations are common in the analysed cases (e.g. building heights and density), while a greater number of the considerations are site-specific, indicating that the design in densification places great attention on the immediate spatial context. Considering the principles of the addition of new built masses at the intermediate spatial scale, the new structures have been added in numerous ways. A fairly surprising finding was that the morphological element of urban block continues to play a significant role in the design of new multi-family residential buildings. Entirely new urban blocks occur both in the pre-existing urban tissue dating from pre-modernist era and in the land-use transformation areas. The new developments also relate to pre-existing urban blocks as additions (infills), thus contributing to a further consolidation of the pre-existing urban blocks. The study also identifies that densification in Oslo produces a particular architectural type, namely the “podium type”, and exposes its varieties relative to the topographic features of the sites. The planning instruments at the municipal planning level (i.e., identified among the analysed cases) partially provided the inputs for the design at the intermediate spatial scale. The analysis exposes a locally adopted planning instrument in Oslo – guiding plan for public spaces (Veiledende plan for offentlige rom [VPOR]), which has been devised with the aim to provide guidelines for design of more coherent urban areas, beyond the extent of particular, individual architectural projects. This instrument indicates the need for planning practice to re-establish connections between planning and design.I løpet av de siste tiårene er byplanleggingen i økende grad blitt dominert av overordnet strategisk tenking og mål for bærekraft, og har distansert seg fra arkitektur og prosjektering. Denne endringen av fokus har skapt en kløft som også er mulig å observere i norsk planleggingssammenheng. Til tross for denne kløften, representerer bygde strukturer og fysisk byform fortsatt en betydelig del av resultatene fra byplanlegging. Denne empiribaserte PhD-avhandlingen tar sikte på å utforske de fysiske resultatene av nåværende planlegging for fortetting i Norge og bruker Oslo som case. Studien omfatter to analytiske aspekter: romlig og prosessuell analyse. Det overordnede forskningsspørsmålet som stilles i oppgaven er: “Hva er de morfologiske egenskapene til de fysiske resultatene av fortetting i Oslo, og hvilke romlige hensyn har påvirket utformingen av disse resultatene?” Seks underspørsmål tar for seg de romlige og prosessuelle komponentene av de to analytiske aspektene. Bymorfologi tilbyr et teoretisk perspektiv for å analysere både de romlige og prosessuelle aspekter på en integrert måte. I den romlige analysen er følgende hovedbegrep benyttet: byvev, konstituert byvev (byvev før fortetting), kvartal og bygningstype. Den romlige analysen dekker den romlige skalaen på mellomliggende nivå (mellom en bygning og flere kvartaler). Den prosessuelle delen av analysen omfatter tre komponenter: planlegging, aktører og design. Denne delen av analysen undersøker planleggingsinstrumenter, aktører og artikulering av fysisk form og arkitektoniske funksjoner. Studien bygger på en integrert (“embedded”) casestudie med Oslo (det bebygde området) som case og 71 flerfamilieboliger som under-case. For å belyse hvert enkelt underspørsmål er følgende metoder brukt: feltstudier, analyse av kart og flyfoto, dokumentanalyse og intervjuer. Resultatene avdekker at fortettingen i Oslo har foregått i mange forskjellige varianter av eksisterende byvev og har resultert i en stor variasjon av fortettingsformer (f.eks. infill, transformasjon, etc.). Klaresammenhenger mellom den eksisterende byveven og de nye strukturene er også identifisert. Blant de analyserte under-casene vises tegn på kontekstavhengighet både når det gjelder bygd form og fordelingen av arkitektoniske funksjoner. Analysen av casene avdekket også at noen av de romlig relaterte hensynene som ble diskutert i planprosessene, var felles (f.eks. byggehøyder og tetthet), mens flere av hensynene var stedsspesifikke. Dette indikerer at utformingen i tilknytning til fortettingsprosesser i stor grad tar hensyn til den nære romlige konteksten. På den mellomliggende (“intermediate”) romlige skalaen, er den nye bebyggelsen innpasset på mange måter. Et noe overraskende funn var at det morfologiske elementet kvartal fortsetter å spille en betydelig rolle i utformingen av nye flerfamilieboliger. Helt nye kvartaler forekommer både i den eksisterende byveven som stammer fra førmodernistisk tid og i transformasjonsområder. De nye boligprosjektene kan også være en utvidelse av eksisterende kvartaler (såkalte “infills”), og bidrar dermed til å konsolidere kvartalsformen ytterligere. Studien har videre identifisert at fortetting i Oslo resulterer i en bestemt bygningstype, nemlig “podiumtype”, og viser varianter av denne typen tilpasset områdets topografiske trekk. Planleggingsinstrumentene som ble identifisert på kommunalt plannivå i de analyserte casene ga delvis innspill til prosjekteringen på mellomliggende romlig skala. Analysen avdekket bruk av et lokalt vedtatt planleggingsinstrument i Oslo – Veiledende plan for offentlige rom (Veiledende plan for offentlige rom [VPOR]). VPOR er i hovedsak utarbeidet for å gi retningslinjer for utforming av mer sammenhengende byområder, men gir noen prinsipper for de individuelle arkitektoniske prosjektene. Dette indikerer at det var et behov i (praktisk) planlegging for å gjenopprette forbindelsen mellom planlegging og design og bidro muligens til at Plan- og bygningsloven av 2008 introduserte områderegulering som et nytt planleggingsinstrument

Malaria outpatient management in government health facilities in Kenya : an evaluation of current practice

Background: Effective case management is a key element of malaria control. Health workers’ performance of assessment, diagnosis, treatment and counseling tasks in accordance with evidence-based standards is critical to ensure adequate quality of malaria case management. Methods: In children below 5 years, the quality of outpatient case management in accordance with national guidelines and factors influencing treatment practices were measured. In older children and adults, the quality of clinical assessment, the accuracy of diagnosis and the ability of clinical signs and symptoms to predict malaria were evaluated. The effects of routine microscopy on malaria case management were described across all-age groups. Data were collected from government facilities in 4 Kenyan districts, in a series of age-specific surveys using a full range of quality of care assessment tools. Results: The majority (89%) of children with malaria were diagnosed in line with national recommendations; however, only 55% of children with uncomplicated malaria had recommended treatment prescribed. The assessment and counselling components were the weakest parts of the case management. Associations between several programmatic interventions (i.e. training, guidelines, wall charts...) and higher quality of treatment were demonstrated. In older children and adults, the performance of clinical assessment tasks was sub-optimal and massive overdiagnosis (80%) of malaria was apparent. Clinical signs and symptoms showed little promise of being able to improve health worker’s ability to predict malaria. While routine microscopy might overcome the problem it was characterised by inaccuracy (SEN = 67%; SPE = 61%; PPV = 23%; NPV = 92%) and an extremely common practice of ignoring negative results across all age groups (67-78%). Conclusions: As we embark upon a new era of more expensive and more complex to use antimalarial treatments, improvement in clinical practice and careful consideration of malaria diagnostic strategies are urgently needed. This thesis highlighted the problems, suggests some solutions and provides some support for the view that programmatic approaches might improve health workers performance if implemented effectively at scale

Effects of revised diagnostic recommendations on malaria treatment practices across age groups in Kenya

OBJECTIVE. The recent change of treatment policy for uncomplicated malaria from sulfadoxine-pyrime-thamine to artemether-lumefantrine (AL) in Kenya was accompanied by revised malaria diagnosis recommendations promoting presumptive antimalarial treatment in young children and parasitological diagnosis in patients 5 years and older. We evaluated the impact of these age-specific recommendations on routine malaria treatment practices 4-6 months after AL treatment was implemented. METHODS. Cross-sectional, cluster sample survey using quality-of-care assessment methods in all government facilities in four Kenyan districts. Analysis was restricted to the 64 facilities with malaria diagnostics and AL available on the survey day. Main outcome measures were antimalarial treatment practices for febrile patients stratified by age, use of malaria diagnostic tests, and test result. RESULTS. Treatment practices for 706 febrile patients (401 young children and 305 patients =5 years) were evaluated. 43.0% of patients =5 years and 25.9% of children underwent parasitological malaria testing (87% by microscopy). AL was prescribed for 79.7% of patients =5 years with positive test results, for 9.7% with negative results and for 10.9% without a test. 84.6% of children with positive tests, 19.2% with negative tests, and 21.6% without tests were treated with AL. At least one antimalarial drug was prescribed for 75.0% of children and for 61.3% of patients =5 years with a negative test result. CONCLUSIONS. Despite different recommendations for patients below and above 5 years of age, malaria diagnosis and treatment practices were similar in the two age groups. Parasitological diagnosis was under-used in older children and adults, and young children were still tested. Use of AL was low overall and alternative antimalarials were commonly prescribed; but AL prescribing largely followed the results of malaria tests. Malaria diagnosis recommendations differing between age groups appear complex to implement; further strengthening of diagnosis and treatment practices under AL policy is required.The Wellcome Trust; the Kenya Medical Research Institute; Novartis Pharm

Translation of artemether–lumefantrine treatment policy into paediatric clinical practice: an early experience from Kenya

OBJECTIVE: To describe the quality of outpatient paediatric malaria case-management approximately 4-6 months after artemether-lumefantrine (AL) replaced sulfadoxine-pyrimethamine (SP) as the nationally recommended first-line therapy in Kenya. METHODS: Cross-sectional survey at all government facilities in four Kenyan districts. Main outcome measures were health facility and health worker readiness to implement AL policy; quality of antimalarial prescribing, counselling and drug dispensing in comparison with national guidelines; and factors influencing AL prescribing for treatment of uncomplicated malaria in under-fives. RESULTS: We evaluated 193 facilities, 227 health workers and 1533 sick-child consultations. Health facility and health worker readiness was variable: 89% of facilities stocked AL, 55% of health workers had access to guidelines, 46% received in-service training on AL and only 1% of facilities had AL wall charts. Of 940 children who needed AL treatment, AL was prescribed for 26%, amodiaquine for 39%, SP for 4%, various other antimalarials for 8% and 23% of children left the facility without any antimalarial prescribed. When AL was prescribed, 92% of children were prescribed correct weight-specific dose. AL dispensing and counselling tasks were variably performed. Higher health worker's cadre, in-service training including AL use, positive malaria test, main complaint of fever and high temperature were associated with better prescribing. CONCLUSIONS: Changes in clinical practices at the point of care might take longer than anticipated. Delivery of successful interventions and their scaling up to increase coverage are important during this process; however, this should be accompanied by rigorous research evaluations, corrective actions on existing interventions and testing cost-effectiveness of novel interventions capable of improving and maintaining health worker performance and health systems to deliver artemisinin-based combination therapy in Africa

Health worker performance in the management of paediatric fevers following in-service training and exposure to job aids in Kenya

BACKGROUND: Improving the way artemether-lumefantrine (AL) is provided to patients attending clinics is critical to maximize the benefit of this new medicine. In 2007, a new initiative was launched in one part of Kenya to improve malaria case-management through enhanced in-service training and provision of job aids. METHODS: An evaluation of the intervention using pre- and post-intervention cross sectional health facility surveys was conducted in Bondo district. The surveys included: audit of government health facilities, health worker structured interviews and exit interviews with caretakers of sick children below five years of age. The outcome indicators were the proportions of febrile children who had AL prescribed, AL dispensed, and four different dispensing and counseling tasks performed. RESULTS: At baseline 33 government health facilities, 48 health workers and 386 febrile child consultations were evaluated. At follow-up the same health facilities were surveyed and 36 health workers and 390 febrile child consultations evaluated. The findings show: 1) no health facility or health worker was exposed to all components of the intervention; 2) the proportion of health workers who received the enhanced in-service training was 67%; 3) the proportion of febrile children with uncomplicated malaria treated with the first-line anti-malarial drug, artemether-lumefantrine (AL), at health facilities where AL was in stock increased from 76.9% (95%CI: 69.4, 83.1) to 87.6% (95% CI: 82.5, 91.5); 4) there were modest but non-significant improvements in dispensing and counseling practices; and 5) when the analyses were restricted to health workers who received the enhanced in-service training and/or had received new guidelines and job aids, no significant improvements in reported case-management tasks were observed compared to baseline. CONCLUSION: In-service training and provision of job aids alone may not be adequate to improve the prescribing, dispensing and counseling tasks necessary to change malaria case-management practices and the inclusion of supervision and post-training follow-up should be considered in future clinical practice change initiatives

Below the Radar: Private Groups, Locked Platforms, and Ephemeral Content—Introduction to the Special Issue

none3noopenBoccia Artieri, Giovanni; Brilli, Stefano; Zurovac, ElisabettaBoccia Artieri, Giovanni; Brilli, Stefano; Zurovac, Elisabett

Facebook digital traces for survey research: Assessing the efficiency and effectiveness of a Facebook ad–based procedure for recruiting online survey respondents in niche and difficult-to-reach populations

Survey-based studies are increasingly experimenting with strategies that employ digital footprints left by users on social media as entry points for recruiting participants and complementary data sources. In this perspective, the Facebook advertising platform provides unique opportunities and challenges through its marketing tools that target advertisements based on users’ demographics, behaviors, and interests. This article presents a procedure that employed the most recent developments in Facebook marketing tools to evaluate the efficiency and effectiveness of an innovative method for recruiting niche and traditionally hard-to-reach respondents. Although the multiple innovations introduced in the method hinder a proper comparison with previous studies, the survey provides evidence concerning the efficacy of the procedure and offers scholars a set of implementations to design future comparable Facebook ad–based surveys. Challenges, opportunities, and results for effectiveness are discussed in light of a previous survey on Italian adults carried out with a panel-based computer-assisted web interviewing method

Quality of malaria case management at outpatient health facilities in Angola

<p>Abstract</p> <p>Background</p> <p>Angola's malaria case-management policy recommends treatment with artemether-lumefantrine (AL). In 2006, AL implementation began in Huambo Province, which involved training health workers (HWs), supervision, delivering AL to health facilities, and improving malaria testing with microscopy and rapid diagnostic tests (RDTs). Implementation was complicated by a policy that was sometimes ambiguous.</p> <p>Methods</p> <p>Fourteen months after implementation began, a cross-sectional survey was conducted in 33 outpatient facilities in Huambo Province to assess their readiness to manage malaria and the quality of malaria case-management for patients of all ages. Consultations were observed, patients were interviewed and re-examined, and HWs were interviewed.</p> <p>Results</p> <p>Ninety-three HWs and 177 consultations were evaluated, although many sampled consultations were missed. All facilities had AL in-stock and at least one HW trained to use AL and RDTs. However, anti-malarial stock-outs in the previous three months were common, clinical supervision was infrequent, and HWs had important knowledge gaps. Except for fever history, clinical assessments were often incomplete. Although testing was recommended for all patients with suspected malaria, only 30.7% of such patients were tested. Correct testing was significantly associated with caseloads < 25 patients/day (odds ratio: 18.4; p < 0.0001) and elevated patient temperature (odds ratio: 2.5 per 1°C increase; p = 0.007). Testing was more common among AL-trained HWs, but the association was borderline significant (p = 0.072). When the malaria test was negative, HWs often diagnosed patients with malaria (57.8%) and prescribed anti-malarials (60.0%). Sixty-six percent of malaria-related diagnoses were correct, 20.1% were minor errors, and 13.9% were major (potentially life-threatening) errors. Only 49.0% of malaria treatments were correct, 5.4% were minor errors, and 45.6% were major errors. HWs almost always dosed AL correctly and gave accurate dosing instructions to patients; however, other aspects of counseling needed improvement.</p> <p>Conclusion</p> <p>By late-2007, substantial progress had been made to implement the malaria case-management policy in a setting with weak infrastructure. However, policy ambiguities, under-use of malaria testing, and distrust of negative test results led to many incorrect malaria diagnoses and treatments. In 2009, Angola published a policy that clarified many issues. As problems identified in this survey are not unique to Angola, better strategies for improving HW performance are urgently needed.</p