Evidence Based Design

The term ‘salutogenic’ is widely used in healthcare architecture, even though very few healthcare architects have much of a handle on what the term means. Here, we clarify the key concepts of salutogenesis, demonstrate how they work and show how they have been designed into healthcare facilities to yield exemplary results. The central idea is that there are three resources that combine to provide a Sense of Coherence—a forward thrust that resists the entropic forces of illness and infirmity. The sense of coherence is made up of resources that improve manageability—the capacity to maintain homeostasis and physical function; resources that improve comprehensibility—an ability to negotiate circumstances in order to maximise their benefit; and resources that enrich a sense of meaningfulness—the desires, causes and concerns that give us the need to resist illness in the first place.

Evidence-based design (EBD) takes information from credible research and case evaluations into account for design-related decision-making. Despite a wealth of studies in healthcare buildings, EBD has so far considered hospital layouts and their effects only marginally. Therefore, this study contributes to the EBD of hospitals by studying configurational issues. It focuses on how a building layout can affect communication between people that is crucial for good healthcare provision. Two types of interface created between users in outpatient clinics are analysed: caregivers- patients and caregivers-caregivers by comparing spatial layouts across two very differently organised hospitals. The two settings are compared using ‘Space Syntax’ as a methodology; this is brought together with findings from a staff survey identifying communication networks and direct observations on everyday activities of caregivers.

Results suggest that by providing shared facilities and bringing caregivers together, communication is more frequent. Creating a clear spatial separation of staff and patient areas facilitates good communication, both among caregivers and between caregivers and patients. However, space is not the only factor affecting communication, since other aspects such as workflow or culture also have an effect on interaction patterns between users. In summary, configurational issues matter and should be studied further by researchers in the field. The paper adds to the existing body of evidence in the field of healthcare and thus enhances the current understanding and knowledge of practitioners on the influence of the built environment on people. Implications for architects and designers in healthcare are discussed briefly.

Review Soft tissue changes following extraction vs. nonextraction orthodontic fixed appliance treatment: a systematic review and meta-analysis Konstantonis D, Vasileiou D, Papageorgiou SN, Eliades T. Soft tissue changes following extraction vs. nonextraction orthodontic fixed appliance treatment: a systematic review and meta-analysis. Eur J Oral Sci 2018; 00: 1–13. © 2018 Eur J Oral Sci The aim of this systematic review was to assess the effect of systematic extraction protocols during orthodontic fixed appliance treatment on the soft tissue profile of human patients. Nine databases were searched until December 2016 for controlled clinical studies including premolar extraction or nonextraction treatment. After elimination of duplicate studies, data extraction, and risk-of-bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MD) or standardized mean differences (SMD) and their 95% CIs were performed, followed by subgroup, meta-regression, and sensitivity analyses. Extraction treatment was associated with increased lower lip retraction (24 studies; 1,456 patients; MD = 1.96 mm), upper lip retraction (21 studies; 1,149 patients; MD = 1.26 mm), nasolabial angle (21 studies; 1,089 patients; MD = 4.21°), soft-tissue profile convex-ity (six studies; 408 patients; MD = 1.24°), and profile pleasantness (three studies; 249 patients; SMD = 0.41). Patient age, extraction protocol, and amount of upper incisor retraction during treatment were significantly associated with the observed extraction effects, while the quality of evidence was very low in all cases due to risk of bias, baseline confounding, inconsistency, and imprecision. Although tooth extractions seem to affect patient profile, existing studies are heterogenous and no consistent predictions of profile response can be made.

Abstract
Purpose Although several prescriptions and techniques exist for comprehensive fixed appliance treatment, their treatment effects have not yet been adequately assessed in an evidence-based manner. The aim of this systematic review was to assess the therapeutic and adverse effects of various prescriptions or techniques for orthodontic appliances from randomized clinical trials on human patients.
Methods Eight databases were searched up to July 2016 for randomized trials assessing any orthodontic prescriptions or techniques in human patients. After elimination of duplicate studies, data extraction, and risk of bias assessment according to the Cochrane guidelines, random effects meta-analyses with mean differences (MD) and their 95% confidence intervals (CIs) were performed.
Results Compared to Roth preadjusted appliances, both Begg and modified Begg appliances were associated with statistically significantly worse occlusal outcome assessed with Peer Assessment Review (PAR) scores (1 trial, MD 3.1 points, 95% CI 1.9–4.3 points and 1 trial, MD 2.4 points, 95% CI 1.2–3.6 points, respectively) with low quality of evidence, due to bias and imprecision. Compared to a partially programmed fixed orthodontic appliance, a fully programmed appliance was associated with a statistically significant, but clinically irrelevant increase in treatment duration (1 trial, MD 2.4 months, 95% CI 0.6–4.2 months), supported by high quality of evidence. However, caution is needed in the interpretation of these results as only a limited number of small trials with methodological issues were available.
Conclusions Based on existing trials, there is limited evidence to support any robust clinical recommendation
regarding the prescriptions or techniques for fixed orthodontic appliances.
Registration: PROSPERO (CRD42016042727).
Funding: None.

The built environment may and should be utilized to address the extraordinary problems afflicting contemporary civilization. This speculation follows a fourfold logic. First, humanity is facing an unprecedented crisis in speed and scale. Second, a serious response demands a worldview depending on and advancing spirituality. Third, traditional faiths cannot effect the necessary spiritual shift at the pace or degree required. More intense and successful spiritual practices extracted from religions and scientifically validated offer better chances for wide deployment and therefore impact. Fourth, the built environment is well suited to induce and reinforce some of these ‘new’ spiritual practices given (a) its shaping role in cultural affairs; (2) humanity being an urban phenomenon, and (3) the huge population growth of the next half century. The paper ends offering initial guidelines for a spiritual urbanism.

Evidence about the benefits and harms of health care interventions has the potential to improve quality of care. Syntheses of the best available evidence - systematic reviews - can provide valuable information for health care clinicians and policy makers, but these publications are often too lengthy to be useful for decision makers in time-pressed contexts. Condensed summaries of reviews may help, but there is little research about how to design such summaries (what content to include and how to present it), how they will be experienced by users, and their effect. Earlier research to create summaries of Cochrane Reviews has also shown that condensing complex data can be challenging and lead to misrepresentation.

This thesis builds on a series of studies examining these issues from several perspectives, with the designed artifact as the main focal point. An underlying assumption for all of this work is that the design of artifacts in which evidence is embedded may shape or influence users’ experiences of this evidence. Given that these artifacts are, in effect, mediating between the domains of evidence production and evidence use (by policymakers, clinicians or the public), they warrant far more attention that they appear to have received to date.

Multiple methods are employed, including a framework from design practice domain. The first study is a set of user tests, examining health professionals’ user experience of the Cochrane Library (where Cochrane Reviews are published). The second study involves exploring user and stakeholder feedback to inform iterations of a Summary of Findings Table for Cochrane Reviews. The third study is an evaluation of the effect of including a Summary of Findings Table in a Cochrane Review (compared to a Review with no table) on user satisfaction, understanding and time spent to find key messages. The fourth study explores user and stakeholder feedback to inform the development of a template for short summaries of systematic reviews that are tailored for health policy makers in low and middle-income countries.
Findings from the user feedback uncovered many comprehension problems, for instance:
• Health professionals and policy makers may not know what a systematic review is or may confuse it with another type of report (e.g. single trial). This can lead to unrealistic expectations or critical misunderstanding of content.
• Unfamiliar language (both foreign language and jargon, abbreviations and unfamiliar terms) may lead to frustration and alienation, or cause critical barriers while reading and searching. Non-native English speakers are at an extra disadvantage.
• Outcome effects may be misunderstood when presented as absolute differences in a table; the use of absolute risks can solve this problem.
• Outcome effects presented as continuous outcomes are often difficult to understand when the scales that are used are unfamiliar.

However, in two small trials we demonstrated that correct comprehension of the main results in a Cochrane Review were improved by including a Summary of Findings Table (in comparison to a review with no table). These trials also showed that key findings were quicker to find in a review with a table.

User studies also helped us understand how summaries of evidence from reviews could be made more useful:
• The layering of the information, through use of a graded entry format, is well-received by policy makers
• Making summaries useful for policy makers also includes broadening the scope of information, such as adding author’s comments about applicability or a wider range of references, as well as information about the information.
• Making summaries useful for clinicians includes better descriptions of interventions and risk groups.

One of the main challenges we encountered in development work was resolving the tension between stakeholders’ concern for precision in data presentation and users’ needs for simplicity. This can be reframed in light of fuzzy traces theory, where people are seen to process information along a gist-verbatim continuum, with a gist preference. Artifacts presenting evidence should be designed with the aim of enabling easy gist extraction.

Drawing on findings across the studies, I evaluated the suitability of the user experience framework we employed and present a revised version. I suggest that user experience frameworks may need to be tailored for specific use contexts and product types.

At the end of the thesis I reflect on my experiences as a designer participating in this work. I discuss, among other things, the challenges to designer role and identity – such as when design-related tasks are increasingly shared with non-designers or when the product disappears out of sight. The results of design processes of complex digital information may not be strikingly visible, but rather subtle, hard to freeze in time and claim ownership to. I propose a move towards redefining design as more than a “reflective conversation with the materials”, and discuss how legitimate output from design should not be limited to the “things” that we make, but also include knowledge gained underway.

Corporate cultures' prevailing attitudes towards design have begun to shift. Financial companies and management consultancies now have design teams, and include “design” in their service portfolios. Large corporations are bolstering their in-house design capabilities, and appointing designers to executive roles. Venture capitalist firms and startups increasingly recognize the value of including designers in the early stages of business development. Even global organizations and international foundations now list design on their agendas. A paradigm shift is taking place in the field of design. This study examines some of the latest corporate investments in design, and reflects on what this phenomenon means for the wider field of design. The focus of this study is on the key trend indicators that are defining the current landscape of design, and its changing role in business and society.

Within the context of contemporary neuroscience and clinical research in meditation, this pilot study uses fMRI scans to gauge and compare the neurophenomenological response that contemplative and ordinary buildings elicit from 12 subjects. The result indicates not only that there are clearly different reactions to the two types of built environments but also, and more significantly, that the phenomenological and neural correlates of the architecturally-induced contemplation share many similarities with internally-generated meditation while displaying important differences that have more in common with peak/flow/aesthetic psychosomatic states than with meditative conditions

Root cause analysis is perhaps the most widely used tool in healthcare risk management, but does it actually lead to successful risk control? Are there categories of risk control that are more likely to be effective? And do healthcare risk managers have the tools they need to support the risk control process? This systematic review examines how the healthcare sector translates risk analysis to risk control action plans and examines how to do better. It suggests that the hierarchy of risk controls should inform risk control action planning and that new tools should be developed to improve the risk control process.

The study focues on the evidence based design of "patient rooms" as one of the most important therapeutic elements of the environment inside a healthcare building. It examines the degree of care environment for patients, the feedback through the patient satisfaction and orientation towards the future of patient rooms where care environment will continue as always with possible changes depending on many factors. The research aims at Evidence-Based Design (EBD) Features of inpatient Rooms in Healthcare Buildings. Some of the world proposal designs for patient rooms in the future were studied as "Future's Patient Room". Factors associated with the room design were taken into consedration to gain access to a range of features for evidence-based design for maximum safety and optimility. An analytical study was carried out for some of patients rooms globally such as in Soin medical Center in Ohio, USA, where the most important room features were concluded and clarified. Then, the field study of certain patient rooms in Mansoura University hospitals were undertaken such as the University Hospital and the Urology and Nephrology Center, the most important reasons and justifications for choosing the case studies were reviewed, while analyzing some of the patient rooms with examples, proposals illustrated, and the most important features of each room explained through clarifying aspects of the evidence-based design.

OBJECTIVE: This article discusses the use of positive distraction, an evidence-based design approach, in rehabilitation hospitals in Brazil through the work of João Filgueiras Lima (“Lelé”).

BACKGROUND: In many parts of the world architects may not formally incorporate theories of positive distraction and evidence-based design, but there are multiple international examples of health facility architects and designers that use nature, daylighting, art, and social interaction to enhance the healing experience. The work of the Brazilian architect João Filgueiras Lima is a particularly salient example. Lima has been a dominant figure in 20th and 21st century Brazilian architecture and the architect of several rehabilitation facilities.

METHODS: First positive distraction is defined as it relates to nature and art, and in the context of rehabilitation hospitals. Second, rehabilitation facilities are defined. The discussion then focuses on awareness of evidence-based design in Latin America. Next, Brazilian healthcare architecture is discussed along with the history of the Brazilian Sarah rehabilitation hospitals designed by Lelé and Lelé's role in the history of Brazilian architecture. Last we look at Lelé's use of positive distraction.

RESULTS: Despite Lelé's recognition in Brazil, his work has not gained much international exposure. Lelé played a critical role in the design of the Sarah facilities and served on the board of directors for the Technological Center of the Sarah Network (CTRS) in Brazil from 1992 to 2009. Based on our review of his work it was clear that Lelé used positive distraction as a tool for creating healing environments.

CONCLUSIONS: In spite of the lack of formal integration of evidence-based design in healthcare architecture in Latin America, many of its basic tenets have been incorporated in Brazilian rehabilitation hospitals. Lelé's projects are a clear example of this phenomenon and demonstrate an alignment between research and practitioner objectives. The presence of nature, art, and natural light in his rehabilitation hospitals serves as a model for evidence-based design in facilities throughout the world and presents an opportunity to measure the benefits of positive distraction on rehabilitation patient outcomes.

The purpose of this research is to expand the knowledge of sacred architecture by bridging the gap between the “subjective” phenomenology of human experience and architecture’s “objective” built conditions. The research employs mixed methods of quantitative and qualitative analysis of survey data as well as graphical analysis of specific case studies. The analyses from these methods demonstrate the importance, relevance, and compatibility of Lindsay Jones’ conceptual model or “morphology of ritual-architectural priorities” when (re)designing sacred spaces during the evidence-based design process.
Design professionals and religious specialists can improve the experience of sacred architecture by incorporating Jones’ conceptual model within the evidence-based design process. A preliminary survey tool, designed using Jones’ categories, was tested against a non-probability sample of respondents (N=112). In general, the survey can be replicated case by case to identify which categories of sacred space are important for different user groups – an essential part of programming and pre-design. As top design priorities are identified and converted into research questions, information and evidence are collected. Evidence of people’s actual (i.e., real, lived) “subjective” experiences that occur within specific cases of Catholic sacred architecture are derived from Julio Bermudez’s large survey database (N=2,872) of “extraordinary architectural experiences.” In addition, graphical analysis and interpretation of the “objective” built conditions are conducted for the Pantheon, Chartres Cathedral, and the chapel at Ronchamp.  The empirical data for both “subjective” and “objective” conditions are then compared in order to test Jones’ conceptual model. For example, does a sacred space built with “XYZ” category actually result in “XYZ” experience? 
The study concludes that built environments possessing a higher presence and quality of Jones’ “morphology of ritual-architectural priorities” in the “objective” built conditions are more likely to be perceived as sacred, produce extraordinary experiences, and transform human understanding. Meanwhile, the opposite is also plausible. Evidence-based design for sacred architecture and transformative human experience demand more attention from scholarly inquiry.

In this this essay, I discuss what I see as central to the advancement of Environmental and Architectural Phenomenology in the next quarter century: developing a sophisticated, robust phenomenological dialogue with analytic science. This dialogue is necessary because it is increasingly difficult, if not impossible (theoretically and practically), to ad-vance insights, observations, or allegations without offering empirical evidence.

The state of the graphic design industry has made some practitioners apprehensive. By employing widely available design software and online tutorials, self-taught lay people are able to perform the work of professional graphic designers, often faster and more cheaply. Many companies do not consider professional design to be a necessity. Clients who do not value good design do not understand the interrelatedness of aesthetics and effective communication, and it is difficult for designers to demonstrate the latter. Thus, designers are left making empty claims about design successes, which are often based on arbitrary and unreliable criteria.

When stakes are high, clients expect the professionals with whom they consult to be confident that proffered recommendations will achieve desired outcomes. Such confidence is strengthened when founded in evidence, not intuition alone (Dawes, Faust, & Meehl, 1989). As Becker (1999) writes, “Scientists don’t make decisions without checking the research data. Physicians don’t prescribe penicillin because they like the color pink” (p. 57). Designers, then, should not propose solutions without being able to anticipate and measure the effects of those solutions with confidence.

Because of this increased demand for certainty in design, there has been a growing interest in the adoption of evidence-based design (EBD), the practice of grounding design solutions and decisions in a researched and documented knowledge base that includes the analysis and interpretation of research (Stewart-Pollack & Menconi, 2005). This paper will provide an overview of the history of the evidence-based approach, weigh the costs and benefits of its implementation in design, identify facets of the industry that could benefit from evidence-based design, and demonstrate how an evidence-based approach might be implemented in those contexts.

THE PURPOSE OF THIS FRAMEWORK DOCUMENT

This is a Framework Document on evidence-based reintegration programme design, prepared by the United Nations Institute for Disarmament Research (UNIDIR) for the Inter-agency Working Group(IAWG) on Disarmament, Demobilization and Reintegration (DDR). The purpose of this Framework Document is to develop and introduce a Conceptual Framework for working with evidence in the design of reintegration programmes to support efforts towards greater local impact at the field level. This is critical to achieving strategic goals at both the national and the international levels.

The general task of a Conceptual Framework is to lay out the central concern to be addressed, provide a way of thinking about that concern (in the sense of a theoretical orientation), and identify ways of treating, engaging or addressing that concern (in the sense of both practical and methodological requirements). A Conceptual Framework sets up the foundations for a shared vocabulary and orientation to complex phenomena and provides direction and focus to practices developed in response.

Taking direction from both the Integrated Disarmament, Demobilization and Reintegration Standards (IDDRS) and the IAWG’s strategic priority areas as established for 2012–2014,1 this framework is designed to support locally effective implementation of existing (and developing) policy on reintegration programming by directing attention to the operational needs of reintegration practitioners involved with programme design and strategic planning. As such, it is a highly pragmatic endeavour to advance the means by which policy is implemented.

Because these tasks inherently involve negotiating the complex space between local realities on the one hand, and the strategic objectives set out by high-level political actors on the other (such as national governments, existing peace treaties, United Nations Security Council resolutions, United Nations Development Assistance Frameworks, Poverty Reduction Strategy Papers etc.) the framework developed here treats evidence-based programme design as both a diagnostic and a design process.

It is a diagnostic process in that it is used for identifying and learning about local reintegration contexts, and that learning can directly contribute to crafting locally effective programming activities that serve strategic goals, but which are not always known a priori or are identified by predetermined assessments. It is a design process in that it facilitates both adaptation and innovation in programming through the use of evidence as a way of addressing problem-solving tasks.

The primary audience for this document is practitioners of the IAWG’s member organizations. This is a diverse group of organizations and professionals. Therefore, the framework developed here is intended to provide broadly applicable and practical assistance relevant to tasks and requirements involved in programme design at various levels and junctures.
A secondary audience is the wider community of peace, security and development professionals concerned with how to better move knowledge to action in order to achieve greater success in their efforts.
A key objective in this Framework Document is to create an approach to evidence-based programme design that is responsive to the central challenge of negotiating field-level realities with strategic objectives (in the form of policies etc.) in a manner that is pragmatic, practical and productive.

In addressing this goal, the Framework Document focuses on two procedural steps central to evidence-based programme design, namely the identification of evidence, and the application of evidence to the design of activities that serve strategic goals in a local context.

Objective: The aim of this systematic review was to assess the occlusal outcome and duration of fixed orthodontic therapy from clinical trials in humans with the Objective Grading System (OGS) proposed by the American Board of Orthodontics. Methods: Nine databases were searched up to October 2016 for prospective/ retrospective clinical trials assessing the outcomes of orthodontic therapy with fixed appliances. After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of the mean OGS score and treatment duration were performed and 95% confidence intervals (CIs) were calculated. Results: A total of 34 relevant clinical trials including 6,207 patients (40% male, 60% female; average age, 18.4 years) were identified. The average OGS score after treatment was 27.9 points (95% CI, 25.3–30.6 points), while the average treatment duration was 24.9 months (95% CI, 24.6–25.1 months). There was no significant association between occlusal outcome and treatment duration, while considerable heterogeneity was identified. In addition, orthodontic treatment involving extraction of four premolars appeared to have an important effect on both outcomes and duration of treatment. Finally, only 10 (39%) of the identified studies matched compared groups by initial malocclusion severity, although meta-epidemiological evidence suggested that matching may have significantly influenced their results. Conclusions: The findings from this systematic review suggest that the occlusal outcomes of fixed appliance treatment vary considerably, with no significant association between treatment outcomes and duration. Prospective matched clinical studies that use the OGS tool are needed to compare the effectiveness of orthodontic appliances. [Korean J Orthod 2017;47(6):401-413]

The conservation community is increasingly focusing on the monitoring and evaluation of management, governance, ecological, and social considerations as part of a broader move toward adaptive management and evidence-based conservation. Evidence is any information that can be used to come to a conclusion and support a judgment or, in this case, to make decisions that will improve conservation policies, actions, and outcomes. Perceptions are one type of information that is often dismissed as anecdotal by those arguing for evidence-based conservation. In this paper, I clarify the contributions of research on perceptions of conservation to improving adaptive and evidence-based conservation. Studies of the perceptions of local people can provide important insights into observations, understandings and interpretations of the social impacts, and ecological outcomes of conservation; the legitimacy of conservation governance; and the social acceptability of environmental management. Perceptions of these factors contribute to positive or negative local evaluations of conservation initiatives. It is positive perceptions, not just objective scientific evidence of effectiveness, that ultimately ensure the support of local constituents thus enabling the long-term success of conservation. Research on perceptions can inform courses of action to improve conservation and governance at scales ranging from individual initiatives to national and international policies. Better incorporation of evidence from across the social and natural sciences and integration of a plurality of methods into monitoring and evaluation will provide a more complete picture on which to base conservation decisions and environmental management.

This is an introduction to UNIDIR’s new prototype of the Evidence-Based Programme Design Tool. It was developed in response to the goal of the United Nation’s Inter-Agency Working Group (IAWG) on Disarmament, Demobilization and Reintegration, to create an evidence-based approach to achieving more positive results in reintegration programming.

Towards that end, UNIDIR and its project partner The Policy Lab launched a three-phase, multi-year research and development initiative. Our overarching goal is to assist United Nations field staff and their operational partners to achieve greater impact by design.

The EBD prototype is the product of two years of research, development, and testing and meets all three “solution criteria” established in the 2011 Framework Document. Namely, the prototype:

• will contribute to the creation of more effective programming (i.e. social impact) in local contexts;
• may facilitate results-based management processes for the benefit of greater accountability, transparency, and effectiveness; and
• can provide a new basis from which to build and facilitate interagency cooperation on shared strategic goals.

The IAWG’s member organizations are the primary audience for this document. A key secondary audience is the national governments and partner organizations that are concerned with:

• maximizing political opportunities for local and national impact through better designed interventions;
• increasing value for money;
• creating new systems for the progressive improvement of professional conduct in post-conflict stabilization; and
• working to build internal mechanisms to collaborate on strategic goals across (or among) different bureaus (i.e. departments, sections, thematic areas, etc.).

This paper presents results of two large surveys (in English and Spanish) conducted from April 2007 to April 2008. The objective was to gather empirical information about Extraordinary Architectural Experiences (EAEs). The survey produced the largest number of personal testimonies of EAEs ever collected (2,872).  This paper presents 14 responses that cover the process, nature, and effects characterizing such extreme atmospheres. The findings show a phenomenology of sudden and surprising arousal, spontaneous unfolding, intense/profound/vivid perceptions, high state of consciousness, no talking and silent/introspective manners, strong bodily reactions, and remarkable levels of recall. EAEs were overwhelmingly reported to be emotional, sensual/physical/perceptual, timeless, and pleasurable.

Environmental velocity has emerged as an important concept but remains theoretically underdeveloped, particularly with respect to its multidimensionality. In response, we develop a framework that examines the variations in velocity across multiple dimensions of the environment (homology) and the causal linkages between those velocities (coupling). We then propose four velocity regimes based on different patterns of homology and coupling and argue that the conditions of each regime have important implications for organizations.

In the preceding essay, mathematician and probability theorist William Dembski notes that human beings often detect the prior activity of rational agents in the effects they leave behind. Archaeologists assume, for example, that rational agents produced the inscriptions on the Rosetta Stone; insurance fraud investigators detect certain ‘‘cheating patterns’’ that suggest intentional manipulation of circumstances rather than ‘‘natural’’ disasters; and cryptographers distinguish between random signals and those that carry encoded messages.

In this paper, we examine the environmental scanning strategy of manufacturing companies in southwestern Nigeria against the background that manufacturing companies in Nigeria exist in a challenging environment characterised by high import dependency, inappropriate policies, lack of transparent governance and weak industrial capabilities. Empirical data was collected with a questionnaire from a sample of 84 manufacturing firms in southwestern Nigeria. It was observed that generally companies in the industry actively engage in systematic gathering, analyses and assimilation of information about the business environment as strategic input into planning. The main objective of firms’ search was to obtain information required to initiate or support strategies for competing in the domestic market. Central among the factors determining the companies’ level of intrusiveness into the environment are companies’ capacity to interpret changes in the environment, available channels of information and quality of information.

A growing body of research suggests that aging and decline are two separate processes. A reframing also has been moving through the medical, psychological, and specialized sensory research communities in studies of the relationship between sensory and cognitive activity and decline. We now know the extent of sensory decline in aging, yet companies are building and renovating facilities that don't employ either the research on perceptual decline or formal standards for improving the perceptual aspects of facility design. Over the past four years, Orfield Laboratories and the Architectural Research Consortium have instituted a research program in aging perception and performance that has developed building performance standards for seniors housing architecture and design. Intuitive attempts by the design community to understand the knowledge base and experience of aging perception have been unsuccessful. By adding a research-based design program to the design process, these definitional problems can be overcome. The result is generally a far better performing building constructed for the same total cost, with design focused more on the user than on the façade.

Introduction: Aim of this study was to assess the registration of orthodontic systematic reviews in PROSPERO. Method: Seven databases were searched for orthodontic systematic reviews published in 2012-2016. After duplicate study selection and data extraction, descriptive statistics, followed by chi-square/Fisher exact tests were calculated. Finally, bivariable/multivariable regression with relative risks (RR) and 95% confidence intervals (CIs) was used. Results: A total of 182 orthodontic systematic reviews were identified, 37 (20.3%) of which were registered in PROSPERO, with registration rates ranging from 4.3% in 2012 to 37.0% in 2016. Differences in review registration were found according to publication year, geographic origin, multicentre status, funding, and journal category. After controlling for confounders, each additional year was associated with increased registration probability (RR = 1.51; 95% CI = 1.19– 1.93). Reviews from South America were more likely to be registered than reviews from Europe (RR = 1.49; 95% CI = 1.06–2.11). Finally, reviews published in orthodontic specialty journals were more likely to be registered than reviews in general dentistry journals (RR = 1.87; 95% CI = 1.02– 3.49). Conclusions: A small percentage of orthodontic systematic reviews was registered a priori, although improvement signs have been seen since the initiation of PROSPERO.

The study reported here adopts an interdisciplinary focus to elicit children's views about hospital environments. Based at the Hospital for Sick Children (SickKids), Toronto, the research explores the ways in which designers and patients understand and use the eight-storey lobby, The Atrium, a monumental addition constructed in 1993. It is a public place that never closes; hundreds of children pass through the namesake atrium every day. Combining methodological approaches from architectural history and health sociology, the intentions and uses of central features of the hospital atrium are examined. Data were collected from observations, focused interviews, and textual and visual documents. We locate the contemporary atrium in a historical context of building typologies rarely connected to hospital design, such as shopping malls, hotels and airports. We link the design of these multi-storey, glass-roofed spaces to other urban experiences especially consumption as normalizing forces in the everyday lives of Canadian children.

Seeking to uncover children's self-identified, self-articulated place within contemporary pediatric hospitals, we assess how the atrium—by providing important, but difficult-to-measure functions such as comfort, socialization, interface, wayfinding, contact with nature and diurnal rhythms, and respite from adjacent medicalized spaces—contributes to the well-being of young patients. We used theoretical underpinnings from architecture and humanistic geography, and participatory methods advocated by child researchers and theorists. Our findings begin to address the significant gap in understanding about the relationship between the perceptions of children and the settings where their healthcare occurs. The study also underlines children's potential to serve as agents of architectural knowledge, reporting on and recording their observations of hospital architecture with remarkable sophistication.

When we look at the world population survey; 60 years and older population was reported as 962 million in 2017 (World Population Prospects: The 2017 Revision). Again, according to the data from 2017 World Population Research this number will increase more than double to 2.1 billion by 2050 and in the year 2100 it is estimated to rise up to 3.1 billion.
With the increasing elderly population both in developed and developing countries, the disease of dementia especially the most common diagnosis of alzheimer cases become the major problem. It is estimated that 46.8 million people around the world lived with dementia in 2015. It is also predicted that this number will be doubled to almost 74.7 million in 2030 and will reach 131.5 million in 2050 (Alzheimer’s Disease International, 2015).
Alzheimer is a disease that emerges together with medical, social and psychological problems. Begining with forgetfulness, progresses with the patient’s personality changes, while leading the patient to lost its verbal and motor skills. As the disease progresses, the patients unfortunately can not perform their daily needs and therefore oblige care at the end.
Large numbers of researches have been carried out until today. Although the number is increasing everyday, scientists and assesments were proved that physical environment and social care environments could improve the quality of life for the patients with dementia, and may reduce the negative affects of the disease. Therapeutic effects of the design of physical environment in which they live in are accepted in order to increase the quality of life and performance of dementia patients. In other words, design of physical environment paves the way for enhancing the quality of life and encouraging the functionality of people with dementia. In this respet, the design of physical environments of the patients with dementia is also a very important tast for designers.
In this thesis, it is aimed to draw a guide line for designing the physical environments of the patinets with dementia. This, gathering information on the basis of an existing research to reflect the importance of the physical environment, in the care of alzheimer’s patients; to analyze their daily needs; to suggest design criteria related enhancing the life quality of alzheimer’s patients in the light of find outs from the analysis are all the essential aim of this thesis study.
The scope of the study is initially to assess and enhance the present care policy in Turkey for the patients with Alzheimer’s disease while observing and examing the care centers for people with alzheimer’s disease. During the study, after a
Today, the average human life span has been prolonged as a result of the progress in comprehensive literature review, an extensive field research is performed in order to collective data sets from selected alzheimer centers: Eskişehir Alzheimer’s Long-term Guest House, Konya Alzheimer Day Care Center, Mersin Elderly Care Life Center. These spots were selected in accordance with Alzheimer Association and detailed observations were made on users and space. Medical staff and care givers were interviewed in order to reveal the impact of physical environment design on the behavior and attitudes of patients, related with the organisation of space, interior comfort conditions and space equipment.
After the observations on site and the interviwes, as well as the content analysis of the qualitative research and the reflection of the quantative data, necessary inputs were obtained and refined for the study. Related to all these researches and findings, spatial and physical design criteria are developped as a design guideline which could serve for the prospect care centers for people with alzheimer’ disease.

Bad practices in psychological research have affected the scientific status of knowledge in Psychology
and the Behavioral Sciences. This paper aims to show some mechanisms that could improve both
the research process and professional practice. The paper is divided into three sections: first,
Psychology as scientific activity in opposition to pseudoscience, that examines and suggests actions
to maintain this scientific principle; second, some recommendations on the research process and
its replication; and third, the process of publishing research as a methodological and theoretical
mechanism for self-correction. In general, there is constant discussion, beyond the scope of
epistemological questions, concerning the review of principles and practices supporting research
findings, and on the other hand, the vision of integrating technological tools to overcome barriers to
accessing consumption, production and dissemination of psychological knowledge.

This article presents a methodology for evaluating microclimatic summer conditions across an entire city, focusing on the provision of outdoor shade as a primary comfort indicator. Based on high-resolution 2.5D and 3D mapping of buildings, ground, and tree canopies in Tel Aviv-Yafo, a city of hot-summer Mediterranean climate, we employed a detailed calculation of solar exposure of streets and open spaces (public and private) using commonly available GIS algorithms. The raw results of these calculations were used for calculating summer Shade Index values for every street segment and neighbourhood of the city, which were then plotted to a comprehensive 'shade maps' reflecting the city's spatial hierarchy of shade. The shade maps, combined with analysis of tree canopy cover on similar scales, enabled to relate building and tree morphologies to outdoor shade conditions. For prioritizing intervention of local planning authorities in improving poor shade conditions or conserving highly-shaded locations, we related the climatic analysis to space-syntax classification of streets according to their potential to attract pedestrian movement, and produced a city-wide map that highlighted streets that have high pedestrian movement potential while requiring high level of shade intensification or conservation.

Our ageing population is a looming problem for economies worldwide. One of the most important aspects to this unprecedented demographic shift is the need to adapt existing built environments for those with declining mobility, visual acuity and mental capacity. As a result the healthcare sector will need to develop new modes of service delivery, while care providers and funding agencies will need to find new sources of revenue. Increasingly, larger cohorts of the population will require new, integrated forms of care that operate across scales, agencies and places.

This high-level prognosis indicates a complex set of problems and a rich vein of research questions that need to be addressed in order to solve them. Inter-disciplinarity, mixed research methods and collaborative engagement among a broad base of stakeholders offer the opportunity for new insights. Design, with its capacity for innovation and integration, can address this complex set of problems involving multiple stakeholders. This paper explores the initial stages for a new program of design research for aged care that integrates three large academic disciplines: design (strategic, industrial and spatial), health (psychology and community) and business. The researchers will collaborate with relevant partners in government, community and private sectors.

Central to the research program will be a series of four design studios that will act as vehicles to present a range of possible solutions to the problems.” Each studio will explore specific design for better care in Residential Aged Care Facilities (RACFs), single family homes, apartments and hospitals. The varied disciplinary perspectives will interact with the design process through informing, briefing, critiquing and appraising. Importantly for the research design, the studios will run consecutively over two years, to progressively review, refine and adapt inputs, processes to capture and make the most of emergent findings and new questions that arise.

Architecture is losing sense of senses. Despite exceptions, architecture has become merely a shelter. There is no longer exceptional effort being put into the common building.
How can space be rethought and turned into an active character, promoting human interaction, instead of existing as a passive container? We have lost touch with it because we have lost touch with our ability to recognize it. Once reanimated, by reexamining the senses, it will become apparent that space has the ability to biologically, psychologically, and physiologically play an active role.
To understand aspect, within space, that is being reacted to, the root of human reactions will be examined, and through that, the trigger of the bodily reaction will also be explored.
Through manipulation of space, interaction will be instigated as a healing vehicle. The combination of the findings will establish an ideal testing method.

Objectives: To compare the failure pattern of four different bracket types and to assess its effect on treatment duration. Materials and Methods: A total of 78 white patients (28 male, 50 female) with a mean age of 12.6 years were included in this retrospective cohort study and treated for a mean period of 30.6 months. The patients were treated in a private practice with stainless steel conventionally ligated brackets, ceramic conventionally ligated brackets, stainless steel self-ligating brackets, or nickel-free self-ligating brackets. The loss of at least one bracket during the course of treatment was analyzed with Cox proportional hazards survival analyses and generalized linear regression. Results: The overall bracket failure rate at the tooth level was 14.1% (217 brackets), with significant differences according to tooth type (between 8.0%–23.4%) and bracket type (between 11.2%–20.0%). After taking confounders into account, patients treated with ceramic brackets lost more brackets (hazard ratio ¼ 1.62; 95% confidence interval ¼ 1.14–2.29; P ¼ .007) than patients with stainless steel brackets. On average, treatment time increased by 0.6 months (95% confidence interval ¼ 0.21–1.05; P ¼ .004) for each additional failed bracket. Conclusions: Bracket failure was more often observed with ceramic brackets and was associated with increased treatment duration. (Angle Orthod. 0000;00:000–000.)

Evaluating the quality of a learning environment is a key component for understanding the value of architectural design and its functional performance on educational outcomes. Surveys are one means to address this challenge. The following study investigates how the quality of an elementary school learning environment can be evaluated through a post-occupancy evaluation (POE) survey.
In order to assess how the learning environment was performing from the building users’ perspective at Odyssey Elementary School, a POE survey was conducted during the Spring of 2015. The short one-month survey gathered a total of 275 responses that were comprised of students, teachers, administrators, maintenance personnel, and parents. The survey was designed to capture several different aspects of environmental quality. The present study focuses on four main areas of the survey and includes:
1) Student perspectives of the learning experience
2) Teacher perspectives of the instructional experience
3) Student and teacher perspectives of the classroom environment
4) Parental perspectives of their child’s academic performance
Major findings from the survey suggest that a flexible classroom environment has a positive and direct impact on the perceptions of students, teachers, and parents.
• The survey revealed that the overall student learning experience was enhanced. Students also felt the layout of the school and classrooms fostered collaboration and made it easy to work in groups. Students largely believed the open and flexible layout improved student-teacher interactions. The design also helped students to pay more attention in class.
• Teachers had similar responses. They felt student attention span increased and student-teacher interactions were improved. The design also enhanced their instructional experience and facilitated different teaching techniques. A large majority of teachers were not only satisfied with the design of the building, but they felt it provided quality learning experiences for their students.
• Parents equally had positive responses.  A majority of parents felt the school was preparing their child for the next academic year, and many had witnessed improvements in their child’s academic performance.  Parents also reported that the design of the school was enhancing their child’s ability to learn. Nearly half of parents felt that the classroom design in particular was a key factor affecting their child’s learning experience and academic performance.
In the end, this study illustrates some of the impacts the classroom environment has on human perceptions to learn or teach. The results of the survey are relevant for designers, architects, educators, administrators, and policy makers who are concerned with improving academic performance through better educational design.

All Rights Reserved, 2020 ! ii ! iii "Death is not the opposite of life, but a part of it." -Haruki Murakami ! iv ACKNOWLEDGEMENTS Endless thanks and gratitude go to my advisor Gillian Darley for the fascinating conversations and invaluable guidance over these past months; to Phil Crew for inspiring me to look for elements of architecture that tell stories and bring a spark of joy to the everyday; to my sister Chelsea and to Shannen Eikerman and Brynne Blanchflower for keeping my spirits afloat; to my parents Cheryl and D'Arcy and to Michael Blanchflower for their motivation and support; to Tweedledee and Tweedledum for the infinite laughter over this past year, even when no one felt like laughing; and in loving memory of Pat Flavin who continually brought so much life and laughter to all in her presence, and who always knew what was truly important. Your spirit is tremendously missed.

In recent years, health care institutions around the world, has been a transformation. Hospital designs, not only aimed at meeting the physical requirements will be given. Social, psychological and physical factors are taken into consideration. These factors, the patient's healing process was investigated. Obtained according to the criteria, the hospital design is made.

Previous research has assessed whether the typographic layout of reading examinations affects performance. To complement this under-researched aspect of assessment, an experimental study sought to find out whether such an effect is limited to types of question that require more location than comprehension processes; or whether it is also found with types of question that require comprehension processes to a greater extent. The results showed that participants read a text and answered questions on it faster with a text layout conforming to legibility guidelines. This is true for both types of question, regardless of the reading processes required.

The EVICURES project developed a new user-friendly design model for intensive and intermediate care facilities. In this model staff, management, patients and their families, and corporate, hospital district and other cooperation partners jointly participated in the design work from day one. EVICURES is the fi rst project to study evidence-based design (EBD) activities in Finland. It draws on research information on EBD, users' views, and an extensive multidisciplinary network. In addition, the design of operations seeked to improve the quality and effectiveness of intensive care and increase patient and staff satisfaction.

Green Areas in the Accessible City. Parks and Therapeutic Gardens. This paper presents the topic of universal design of urban public green spaces. Universal design facilitates use of therapeutic qualities of landscape, i.e. mental and physical regeneration, promotion of physical activity and social contacts of all users, regardless of their mental or physical disabilities. The first part of this paper presents a literature review. The definition of a therapeutic garden is provided and the spatial needs of people with various degrees of disabilities are examined. Additionally, the advantages of gardening and hortitherapy are discussed. The second part of this paper presents the universal pattern for designing parks with therapeutic qualities. This pattern was developed as a tool for public parks designers. Finally, the best practices from selected therapeutic gardens and urban parks in Poland and France are presented. Wstęp. Terapeutyczne właściwości terenów zieleni w mieście Tereny zieleni w mieście dostępnym mogą pełnić ważną funkcję terapeutyczną. Badaniem terapeutycznego wpływu kontaktu z naturą na człowieka zajmuje się wiele dyscyplin naukowych, dziedziny projektowe – architektura krajobrazu, architektura i urbanistyka, nauki medyczne, nauki społeczne – psychologia, socjologia oraz inne nauki pokrewne. Opublikowano wiele badań i teorii związanych z wpływem terenów zieleni publicznej w mieście na promocję zdrowia. Ten wpływ można podzielić na trzy sfery oddziaływania: regenerację psychiczną i fizyczną, czyli oddziaływanie bierne oraz promocję aktywności fizycznej i kontaktów społecznych, czyli oddziaływania wymagające aktywnego zaangażowania się użytkownika. Na początku przyjrzymy się teoriom i badaniom wyjaśniającym terapeutyczne właściwości natury według tych obszarów oddziaływania. W drugiej części artykułu zapoznamy się z wzorcem parku o właściwościach terapeutycznych i z przykładami dobrych praktyk.

¿Qué es el paisaje? ¿Cómo lo percibimos? ¿Cómo se relaciona con nuestra salud? En este breve ensayo se abordan algunos elementos teóricos sobre el concepto de paisaje, que provienen de la filosofía, la psicología y la arquitectura, y que nos permiten evidenciar la conexión entre paisaje y los espacios de la medicina y del cuidado.

History suggests that departures from accepted design practice can contribute to positive change in the delivery of mental healthcare; the daily experience of hospitalised patients; and public perceptions of mental illness. The question of how architecture can support the therapeutic journey of patients remains a critical one. The availability of evidence-based design literature to guide architects cannot keep pace with growing global demand for new forensic mental hospital facilities. This article reports a global survey of current design practice to speculate on the potential of three new hospitals to positively improve the patient experience. A desktop survey was conducted of 31 mental hospitals (24 forensic, 7 non-forensic) constructed, or scheduled for completion, between 2006 and 2022. This was supplemented by advisory panel sessions with clinical/facilities staff, alongside architectural knowledge obtained through workshops with architects from the United Kingdom and the United States, and the inclusion of Australian architects on the research team. Data analysis draws on knowledge from architectural practice, architectural history and environmental psychology, arguing that there is a responsibility to integrate knowledge from across these disciplines in respect of such a pressing and important problem.

We report on a diary study of the activities of information workers aimed at characterizing how people interleave multiple tasks amidst interruptions. The week-long study revealed the type and complexity of activities performed, the nature of the interruptions experienced, and the difficulty of shifting among numerous tasks. We present key findings from the diary study and discuss implications of the findings. Finally, we describe promising directions in the design of software tools for task management, motivated by the findings.

Through advances in production and treatment technologies, transparent glass has become an increasingly versatile material and a global hallmark of modern architecture. In the shape of invisible barriers, it defines spaces while simultaneously shaping their lighting, noise, and climate conditions. Despite these unique architectural qualities, little is known regarding the human experience with glass barriers. Is a material that has been described as being simultaneously there and not there from an architectural perspective, actually there and/or not there from perceptual, behavioral, and social points of view? In this article, we review systematic observations and experimental studies that explore the impact of transparent barriers on human cognition and action. In doing so, the importance of empirical and multidisciplinary approaches to inform the use of glass in contemporary architecture is highlighted and key questions for future inquiry are identified.