How Can Landscape Architecture Influence Systemic Change to Achieve Sustainable Cities and Regions

This paper presents how the ideas of landscape, design quality and drawings can influence systemic change to result in sustainable cities and regions. The research related to this paper explores project frameworks and design methods in order to reveal innovative ways and processes for creating environmentally friendly cities and regions that will have the power to adapt and mitigate climatic issues of the future. Through a series of explorations on existing landscape projects and while using a series of stakeholder engagement workshops contacted at a pan-European level the paper examines ways in which systemic change is possible and the outcomes it has in relation to the landscape. Using previously implemented and ongoing landscape projects such as the Room for the River (the Netherlands) and the West Midlands National Park (UK), the paper discusses how bold landscape-led visions influence decision making and support systemic change on a spatial scale. Drawing on experience gained during a series of stakeholder engagement workshops, where the projects of the Tame Valley Wetlands Partnership (UK) and the Urban Farming and Growing Network (UK) were selected as case studies, the research presents key findings and presents lessons learned that can build capacity and improve the understanding and management of stakeholders when it comes to spatial planning and urban design. The paper argues that a new way of thinking in design, policy or governance is not enough if these disciplines act individually. The breakthrough comes when each discipline collaborates with the aim to future proof our cities and regions. By presenting pioneering examples and models giving us tools for a systemic change, the paper aims to demonstrate that large scale developments can be brilliant examples of the new methodologies applied and lessons learnt. This research concludes that systemic change is represented across all levels, policy, decision making, governance, design and implementation if the aim is to deliver a sustainable city.

Multi-criteria Web Services Selection: Balancing the Quality of Design and Quality of Service

Web service composition allows developers to create applications via reusing available services that are interoperable to each other. The process of selecting relevant Web services for a composite service satisfying the developer requirements is commonly acknowledged to be hard and challenging, especially with the exponentially increasing number of available Web services on the Internet. The majority of existing approaches on Web Services Selection are merely based on the Quality of Service (QoS) as a basic criterion to guide the selection process. However, existing approaches tend to ignore the service design quality, which plays a crucial role in discovering, understanding, and reusing service functionalities. Indeed, poorly designed Web service interfaces result in service anti-patterns, which are symptoms of bad design and implementation practices. The existence of anti-pattern instances in Web service interfaces typically complicates their reuse in real-world service-based systems and may lead to several maintenance and evolution problems. To address this issue, we introduce a new approach based on the Multi-Objective and Optimization on the basis of Ratio Analysis method (MOORA) as a multi-criteria decision making (MCDM) method to select Web services based on a combination of their (1) QoS attributes and (2) QoS design. The proposed approach aims to help developers to maintain the soundness and quality of their service composite development processes. We conduct a quantitative and qualitative empirical study to evaluate our approach on a Quality of Web Service dataset. We compare our MOORA-based approach against four commonly used MCDM methods as well as a recent state-of-the-art Web service selection approach. The obtained results show that our approach outperforms state-of-the-art approaches by significantly improving the service selection quality of top- k selected services while providing the best trade-off between both service design quality and desired QoS values. Furthermore, we conducted a qualitative evaluation with developers. The obtained results provide evidence that our approach generates a good trade-off for what developers need regarding both QoS and quality of design. Our selection approach was evaluated as “relevant” from developers point of view, in improving the service selection task with an average score of 3.93, compared to an average of 2.62 for the traditional QoS-based approach.

Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: Qualitative Study (Preprint)

BACKGROUND Geriatric care professionals were forced to rapidly adopt the use of telemedicine technologies to ensure the continuity of care for their older patients in response to the COVID-19 pandemic. However, there is little current literature that describes how telemedicine technologies can best be employed to meet the needs of geriatric care professionals in providing care to frail older patients and their caregivers, and families. OBJECTIVE This study aimed to identify the benefits and challenges geriatric care professionals face when using telemedicine technologies with frail older patients, their caregivers, and families, and how to maximize the benefits of this method of providing care. METHODS We conducted a mixed methods study that recruited geriatric care professionals to complete an online survey regarding their personal demographics and experiences with using telemedicine and participate in a semi-structured interview. Interview responses were analyzed using the Consolidated Framework for Implementation Research (CFIR). RESULTS We obtained quantitative and qualitative data from 30 practicing geriatric care professionals (22 geriatricians, 5 geriatric psychiatrists, and 3 geriatric specialist nurses) recruited from across the Greater Toronto Area. Analysis of interview data identified 5 CFIR contextual barriers (Complexity, Design quality and packaging, Patient needs and resources, Readiness for implementation, and Culture) and 13 CFIR contextual facilitators (Relative Advantage, Adaptability, Tension for Change, Available Resources, Access to Knowledge, Network and Communications, Compatibility, Knowledge and Beliefs, Self-Efficacy, Champions, External Agents, Executing, and Reflecting and Evaluating). The CFIR concept of External Policy and Incentives was found to be a neutral construct. CONCLUSIONS This is the first known study to use the CFIR to develop a comprehensive narrative to characterize the experiences of geriatric care professionals using telemedicine technologies in providing care. Overall, telemedicine can significantly enable most of the geriatric care that is traditionally provided in person, but is less useful in providing specific aspects of geriatric care to frail older patients and their caregivers, and families.

Early fluid bolus in adults with sepsis in the emergency department: a systematic review, meta-analysis and narrative synthesis

Background Early intravenous fluids for patients with sepsis presenting with hypoperfusion or shock in the emergency department remains one of the key recommendations of the Surviving Sepsis Campaign guidelines to reduce mortality. However, compliance with the recommendation remains poor. While several interventions have been implemented to improve early fluid administration as part of sepsis protocols, the extent to which they have improved compliance with fluid resuscitation is unknown. The factors associated with the lack of compliance are also poorly understood. Methods We conducted a systematic review, meta-analysis and narrative review to investigate the effectiveness of interventions in emergency departments in improving compliance with early fluid administration and examine the non-interventional facilitators and barriers that may influence appropriate fluid administration in adults with sepsis. We searched MEDLINE Ovid/PubMed, Ovid EMBASE, CINAHL, and SCOPUS databases for studies of any design to April 2021. We synthesised results from the studies reporting effectiveness of interventions in a meta-analysis and conducted a narrative synthesis of studies reporting non-interventional factors. Results We included 31 studies out of the 825 unique articles identified in the systematic review of which 21 were included in the meta-analysis and 11 in the narrative synthesis. In meta-analysis, interventions were associated with a 47% improvement in the rate of compliance [(Random Effects (RE) Relative Risk (RR) = 1.47, 95% Confidence Interval (CI), 1.25–1.74, p-value < 0.01)]; an average 24 min reduction in the time to fluids [RE mean difference = − 24.11(95% CI − 14.09 to − 34.14 min, p value < 0.01)], and patients receiving an additional 575 mL fluids [RE mean difference = 575.40 (95% CI 202.28–1353.08, p value < 0.01)]. The compliance rate of early fluid administration reported in the studies included in the narrative synthesis is 48% [RR = 0.48 (95% CI 0.24–0.72)]. Conclusion Performance improvement interventions improve compliance and time and volume of fluids administered to patients with sepsis in the emergency department. While patient-related factors such as advanced age, co-morbidities, cryptic shock were associated with poor compliance, important organisational factors such as inexperience of clinicians, overcrowding and inter-hospital transfers were also identified. A comprehensive understanding of the facilitators and barriers to early fluid administration is essential to design quality improvement projects. PROSPERO Registration ID CRD42021225417.

Modeling of the Point Defect Migration across the AlN/GaN Interfaces—Ab Initio Study

The formation and diffusion of point defects have a detrimental impact on the functionality of devices in which a high quality AlN/GaN heterointerface is required. The present paper demonstrated the heights of the migration energy barriers of native point defects throughout the AlN/GaN heterointerface, as well as the corresponding profiles of energy bands calculated by means of density functional theory. Both neutral and charged nitrogen, gallium, and aluminium vacancies were studied, as well as their complexes with a substitutional III-group element. Three diffusion mechanisms, that is, the vacancy mediated, direct interstitial, and indirect ones, in bulk AlN and GaN crystals, as well at the AlN/GaN heterointerface, were taken into account. We showed that metal vacancies migrated across the AlN/GaN interface, overcoming a lower potential barrier than that of the nitrogen vacancy. Additionally, we demonstrated the effect of the inversion of the electric field in the presence of charged point defects VGa3− and VAl3− at the AlN/GaN heterointerface, not reported so far. Our findings contributed to the issues of structure design, quality control, and improvement of the interfacial abruptness of the AlN/GaN heterostructures.

A Systematic Characterization Approach for Vacuum Bag Only Prepregs towards an Accurate Process Design

Aerospace-grade composite parts can be manufactured using Vacuum Bag Only prepregs through an accurate process design. Quality in the desired part can be realized by following process modeling, process optimization, and validation, which strongly depend on a primary and systematic material characterization methodology of the prepreg system and material constitutive behavior. The present study introduces a systematic characterization approach of a Vacuum Bag Only prepreg by covering the relevant material properties in an integrated manner with the process mechanisms of fluid flow, consolidation, and heat transfer. The characterization recipe is practiced under the categories of (i) resin system, (ii) fiber architecture, and (iii) thermal behavior. First, empirical models are successively developed for the cure-kinetics, glass transition temperature, and viscosity for the resin system. Then, the fiber architecture of the uncured prepreg system is identified with X-ray tomography to obtain the air permeability. Finally, the thermal characteristics of the prepreg and its constituents are experimentally characterized by adopting a novel specimen preparation technique for the specific heat capacity and thermal conductivity. Thus, this systematic approach is designed to provide the material data to process modeling with the motivation of a robust and integrated Vacuum Bag Only process design.

Integrate

The projects selected for this publication show a range of approaches to making energy, carbon emissions, and their underpinning principles explicit in studio design work. We hope the selection not only inspires and stimulates, but also encourages both novice and expert in their search for future-proof architectures. Without a doubt, we are convinced that now is the time to challenge conventional norms and explore the potentials of such principles, not only to elevate design quality in building practice, but to benefit global society as a whole. Für dieses Buch wurden Arbeiten ausgewählt, die unterschiedliche Ansätze in der Umsetzung der Themen Energie, CO2-Emissionen und den dahinter liegenden Prinzipien im Entwurfsprozess thematisieren. Wir hoffen, dass die Arbeiten sowohl AnfängerInnen und ExpertInnen bei der Suche nach zukunftsfähigen Architekturen anregen und ermutigen. Zweifellos ist es an der Zeit, bestehende Ansätze zu hinterfragen und neue Prinzipien zu testen, die unter Berücksichtigung der gestalterischen Qualität das Potenzial haben, unserer Gesellschaft als Ganzes zugutezukommen.

Contextual influences on implementation of online behavioral obesity treatment in primary care: formative evaluation guided by the consolidated framework for implementation research

Online behavioral obesity treatment is a promising first-line approach to weight management in primary care. However, little is known about contextual influences on implementation. Understand qualitative contextual factors that affect the implementation process, as experienced by key primary care stakeholders implementing the program. Online behavioral obesity treatment was implemented across a 60-clinic primary care practice network. Patients were enrolled by nurse care managers (NCMs; N = 14), each serving 2–5 practices. NCMs were randomized to one of two implementation conditions—“Basic” (standard implementation) or “Enhanced” (i.e., with added patient tracking features and more implementation strategies employed). NCMs completed qualitative interviews guided by the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed and analyzed via directed content analysis. Emergent categories were summarized by implementation condition and assigned a valence according to positive/negative influence. Individuals in the Enhanced condition viewed two aspects of the intervention as more positively influencing than Basic NCMs: Design Quality & Packaging (i.e., online program aesthetics), and Cost (i.e., no-cost program, clinician time savings). In both conditions, strongly facilitating factors included: Compatibility between intervention and clinical context; Intervention Source (from a trusted local university); and Evidence Strength & Quality supporting effectiveness. Findings highlight the importance of considering stakeholders’ perspectives on the most valued types of evidence when introducing a new intervention, ensuring the program aligns with organizational priorities, and considering how training resources and feedback on patient progress can improve implementation success for online behavioral obesity treatment in primary care.

Kestävä kädenjälki käsityössä

Käsitepari kestävä käsityö on syntynyt käsityön vastaukseksi kestävän kehityksen haasteisiin. Tässä teoreettisessa kirjallisuuskatsauksessa tarkastelemme käsityötä mahdollisuutena kestävään kädenjälkeen. Ensin pohjustamme keskustelua kirjallisuuden avulla, minkä jälkeen syvennymme kestävän käsityön käsitteeseen sekä avaamme näkökulmia kestävään käsityöhön perusopetuksen käsityössä. Kestävän käsityön teoreettisessa mallissa kuvataan käsityötä toimintana, tuotteena ja aineettomana käsityönä. Kestävää käsityötä toimintana kuvataan käsityötietoa syventävänä sekä arvoja ja asenteita muokkaavana taitona. Kestävä käsityötuote puolestaan huomioi materiaalien, elinkaaren, tekniikan, designin, laadun, esteettisyyden, tarpeen ja tuotesuhteen. Aineeton käsityö nivoo kestävyyden ympäristön lisäksi kulttuuriin sekä sosiaaliseen, taloudelliseen, psykologiseen, yhteiskunnalliseen, filosofiseen ja kommunikatiiviseen näkökulmaan. Nämä elementit toimivat lomittain yhdessä muotoillen ympäristöä, konkreettisia tuotteita sekä tekoja kestäväksi ekologiseksi kädenjäljeksi, mikä tulisi olla lähtökohtana myös käsityönopetuksessa kaikilla koulutusasteilla. Ecological handprint in craft Abstract The concept of sustainable craft is crafts’ response to sustainability. This theoretical article views the craft's potential to be an ecological handprint. We first view discussion through literature, followed by opening the concept of sustainable craft and viewpoint to sustainable craft education. The theoretical model concretizes the systemic nature of sustainable craft as practice, product, and immaterial craft. Sustainable craft as practice is described as deepening craft knowledge and as a skill shaping the values and attitudes of craft. Sustainable craft products consider the materials, life cycle, technique, design, quality, aesthetics, need, and product relationship. Immaterial craft combines sustainability to the environment, cultural, social, economic, psychologic, societal, philosophical, and communicational aspects. These elements work together shaping the environment, concrete product, and actions towards sustainability with an ecological handprint that could be utilized in craft education. Keywords: Immaterial craft, sustainable development, craft product, craft skill, ecological handprint

Understanding key implementation determinants for a school-based universal prevention intervention: a qualitative study

This study examined how teachers discuss various factors as impacting their ability to execute with fidelity the Michigan Model for Health (MMH), an evidence-based health universal prevention curriculum widely adopted throughout Michigan. Researchers have found a robust relationship between fidelity and participant outcomes, including in schools. While previous studies have identified barriers that inhibit fidelity, few have focused on identifying key barriers and deepening our understanding of how these factors influence intervention fidelity. We conducted a thematic analysis using the reflexive thematic approach to identify key barriers and facilitators and deepen our understanding of how these factors influence MMH implementation. Guided by the Consolidated Framework for Implementation Research (CFIR) and the Implementation Outcomes Framework, we conducted semistructured interviews with 23 high school health teachers across Michigan. Teachers identified intervention characteristics (e.g., design quality, packaging, and program adaptability), student needs (e.g., trauma exposure, substances), and the fit between the intervention and the context as factors that contributed to acceptability. They also discussed the curriculum and its alignment with their teaching style and/or experiences as contributing to fidelity. Teachers shared how they would often go “off protocol” to improve intervention-context fit and meet students’ needs. Our results identified acceptability, a perceptual implementation outcome, as demonstrating an important role in shaping the relationship between CFIR factors and fidelity. Results provide guidance for systematically designing implementation strategies that address key barriers to improve acceptability, enhance fidelity, and ultimately achieve desired public health objectives.