Moving on - design for the 21st Century

This was the keynote presentation at a research conference sponsored by Fiat, Ford and Volkswagen. Harrow argued the need for the automotive industries to evolve to meet the challenges of the 21st century. He explored the new roles of ‘car design’ through analysis of its history, processes, methods and ideologies, and considered how changing social, technical and use patterns will affect cars and the wider mobile society in the future. Harrow invited conference participants to consider what new approaches will become standard and the fit with other design professions and ways of working. On subsequent days he contributed a lecture on automotive design research practice, with particular emphasis on the role of innovation in emerging industrial nations, and was one of three leading figures in a debate on design identity in emerging markets. Related dissemination included the opening keynote lecture at the ‘10th International Symposium on Automotive Lighting’, Technische Universität Darmstadt (2013). Harrow was a speaker and panel member at the ‘Battle of Ideas 2010’ and contributed to the Cheltenham Science Festival ‘Future Cars’ (2008). In 2010, he contributed ‘Italian design on the road’ to a Design Museum lecture series and has made many other presentations on these themes internationally. Harrow’s interactions with the automotive world are two-way, advising international leaders while simultaneously augmenting his own knowledge. These leaders include graduates of the programme Harrow has headed for 20 years, who are directors at Ford, Audi, Mercedes, Škoda, GM, Rolls Royce, Jaguar, Kia, Volvo and Aston Martin. Other interactions have been with leaders at Tata, Bentley, Nissan, Hyundai, McLaren, Citroën, Mini, Finmeccanica and Hitachi. There have been approximately 60 such meetings 2008-onwards, including in Korea 2008, Detroit 2010, 2011, Shanghai and Beijing 2010, Turkey 2010, 2012, Geneva 2011, Aalto 2011, Brazil 2011

Ambulance Treatment Space Ergonomic Layout

This is the first time a multidisciplinary team has employed an iterative co-design method to determine the ergonomic layout of an emergency ambulance treatment space. This process allowed the research team to understand how treatment protocols were performed and developed analytical tools to reach an optimum configuration towards ambulance design standardisation. Fusari conducted participatory observations during 12-hour shifts with front-line ambulance clinicians, hospital staff and patients to understand the details of their working environments whilst on response to urgent and emergency calls. A simple yet accurate 1:1 mock-up of the existing ambulance was built for detailed analysis of these procedures through simulations. Paramedics were called in to participate in interviews and role-playing inside the model to recreate tasks, how they are performed, the equipment used and to understand the limitations of the current ambulance. The use of Link Analysis distilled 5 modes of use. In parallel, an exhaustive audit of all equipment and consumables used in ambulances was performed (logging and photography) to define space use. These developed 12 layout options for refinement and CAD modelling and presented back to paramedics. The preferred options and features were then developed into a full size test rig and appearance model. Two key studies informed the process. The 2005 National Patient Safety Agency funded study “Future Ambulances” outlined 9 design challenges for future standardisation of emergency vehicles and equipment. Secondly, the 2007 EPSRC funded “Smart Pods” project investigated a new system of mobile urgent and emergency medicine to treat patients in the community. A full-size mobile demonstrator unit featuring the evidence-based ergonomic layout was built for clinical tests through simulated emergency scenarios. Results from clinical trials clearly show that the new layout improves infection control, speeds up treatment, and makes it easier for ambulance crews to follow correct clinical protocols

Process matters: From car owner experiences to automotive design proposals

Collecting and analysing user experiences, communicating discovered patterns, translating information into design proposals and materialising designed features is central to design driven research. This process immerses design teams into all aspects of users’ experiences, helping them empathise with and scrutinise every detail until designers own the experiences and produce design proposals addressing end users’ needs in unique ways leading to disruptive innovation. Design practice’s strength is crystallising solutions into visualised and interactive proposals, presenting in-depth details of the look, feel and emotions they stimulate, and assisting decision making in product, service and business innovations. Existing research focusses on early stage collection of lived user experiences and final visualisation of the design proposal, yet seems to miss detailed discussion of the core bridging of user experiences and precise design proposals. We describe optimising a process supporting designers continuously switching between gathering user experiences and industry/market contexts when generating automotive design proposals

Understanding how attitudes towards autonomous vehicles can shape the design of cities

Understanding public attitudes towards autonomous vehicles is an important starting point when designing and engineering future cities, both to ensure acceptance and to deliver social benefits. The GATEway project is a consortium of industry and academic organisations that are establishing a test bed for driverless vehicle technology within public streets in Greenwich, London. Each partner is using public trials to explore the potential for autonomous technology within a city transport network. The Royal College of Art (RCA) is exploring how public attitudes can be used to enhance social benefit. This paper shares the first findings from a series of workshops including people with additional needs, non-drivers, drivers, technology enthusiasts and professional stakeholders. The workshops delved into people's hopes and fears for driverless technologies and used co-design methods to explore how designers can respond when designing autonomous vehicles, the services they provide and the wider urban environment

Defining Ritualistic Driver and Passenger Behaviour to Inform In-Vehicle Experiences

By discovering unconscious ritualistic actions in everyday driving such as preparing for the morning commute, we seek design opportunities to help people achieve critical emotional transitions such as moving from an anxious state to relief. We have gathered and analysed data from workshops and phone interviews from a variety of vehicle and public transport users to capture these key ritualistic scenarios and map their emotional transitions. Design ideation is used to generate concepts for improving the in-vehicle user experience through redesign of vehicle layout, environment and analogue and digital interfaces. We report a set of human-centred design approaches that allow us to study the details of action, objects, people, emotions and meaning for typical car users which are indispensable for designing driving experiences and are often overlooked by the car design process

Imagining an inclusive future for shared autonomous vehicle interiors: A participatory design workshop study

The introduction of shared autonomous vehicles (SAVs) has the potential to provide better transport to people groups who currently experience transport exclusion. In this paper we describe a series of four workshops carried out with members of a range of transport excluded people groups- older people (65+), women, disabled people, neurodivergent people, and people with mental health conditions (N=11). Workshops explored existing experiences of transport with a journey mapping activity and participants generated inclusive design solutions for SAVs through a participatory design activity. Through thematic analysis of workshop data, we identified 3 main areas where design intervention in the interiors of SAVs could create more inclusive SAV journey experiences. These areas were adaptability, safety & security, and navigability & familiarity

Designing for driver's emotional transitions and rituals

Emotions are a topic of increasing interest in vehicle design and research as they have a substantive impact on people's behaviour, affecting driving performance and being a source of safety issues particularly on long journeys. However, emotions do not usually occur distinctly and individually and frequently transition and transform between states. It can be challenging to obtain information about the exact emotions drivers experience, especially when subtle. We present design-led research focusing on identifying scenarios that contain normally unarticulated emotions and mental reminders that drivers use to make a journey safer and develop concepts for in-vehicle interactions that assist with these rituals. As results of the research, we designed and user tested in-vehicle interactions for two emotional transition scenarios - pre-journey preparation (‘Ready... Steady … Relax’) and checking the progress of a journey (‘Driving Whisper’)

Driverless futures: Design for acceptance and adoption in urban environments

The driverless or autonomous car offers a range of challenges and opportunities – technical, economic and social – to the UK and the world. Harrow led the academic research for GATEway, an £8M Innovate UK project led for industry by the Transport Research Laboratory in which the RCA was the principal university. It created a world-leading test-bed for driverless cars that enabled automotive and software industries, local authorities, planners, insurers, Government ministers, policy makers and others to evaluate new vehicles and new technologies applied to existing vehicles, and to understand the human behaviours and attitudes emerging around these new forms of transport. The work is crucial to the future of mobility and to future cities, the connected digital economy, and future manufacturing. Harrow focused on design research, comprising stakeholder engagement, codesign with user groups, scenario building, studies of users through observation and interview, attitude discovery through traditional and digital means, and dissemination through multiple media. A key motivation was to use autonomous vehicles for social benefit especially for groups ill-served by current transport. The research led to new knowledge about vehicles, systems and behaviours, much of which was distilled into the RCA GATEway report. Additional dissemination included: peer-reviewed journal article in Municipal Engineer (2018); paper at 6th International Conference for Universal Design, Nagoya, Japan (2016); feature in exhibition and book NEW OLD: Designing for Our Future Selves, Design Museum, London (2017); book chapter for Institute of Civil Engineering Publishing (in press); keynote for Seoul Smart Mobility (29 September 2016) as a central part of Seoul Design Week

Genome-wide associations for birth weight and correlations with adult disease

Birth weight (BW) has been shown to be influenced by both fetal and maternal factors and in observational studies is reproducibly associated with future risk of adult metabolic diseases including type 2 diabetes (T2D) and cardiovascular disease. These life-course associations have often been attributed to the impact of an adverse early life environment. Here, we performed a multi-ancestry genome-wide association study (GWAS) meta-analysis of BW in 153,781 individuals, identifying 60 loci where fetal genotype was associated with BW ($\textit{P}$  < 5 × 10$^{-8}$). Overall, approximately 15% of variance in BW was captured by assays of fetal genetic variation. Using genetic association alone, we found strong inverse genetic correlations between BW and systolic blood pressure ($\textit{R}$ $_{g}$ = -0.22, $\textit{P}$  = 5.5 × 10$^{-13}$), T2D ($\textit{R}$ $_{g}$ = -0.27, $\textit{P}$  = 1.1 × 10$^{-6}$) and coronary artery disease ($\textit{R}$ $_{g}$ = -0.30, $\textit{P}$  = 6.5 × 10$^{-9}$). In addition, using large -cohort datasets, we demonstrated that genetic factors were the major contributor to the negative covariance between BW and future cardiometabolic risk. Pathway analyses indicated that the protein products of genes within BW-associated regions were enriched for diverse processes including insulin signalling, glucose homeostasis, glycogen biosynthesis and chromatin remodelling. There was also enrichment of associations with BW in known imprinted regions ($\textit{P}$ = 1.9 × 10$^{-4}$). We demonstrate that life-course associations between early growth phenotypes and adult cardiometabolic disease are in part the result of shared genetic effects and identify some of the pathways through which these causal genetic effects are mediated.For a full list of the funders pelase visit the publisher's website and look at the supplemetary material provided. Some of the funders are: British Heart Foundation, Cancer Research UK, Medical Research Council, National Institutes of Health, Royal Society and Wellcome Trust

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570