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finding niwa: semi-public open space in contemporary Japanese housing
Get PDFMany architects in Tokyo today are responding to a yearning for a sense of connectedness such as that afforded by the streetscapes of the interwar and post-war Japanese city; spaces that facilitate incidental and informal encounters and that contribute to a sense of being part of the collective organisation of the city. This longing for connectivity with each other and with the city, which was heightened by the bereft experience of COVID, is evident in the appearance of open semi-public spaces in recent architect designed housing projects in Tokyo. Their appearance marks a shift away from the long-standing fascination in Japanese architecture with the autonomous architect-designed house, a fascination that has been traced by scholars to Kazuo Shinohara,1 who in an article in 1964 encouraged architects to consider the ‘small’ house as an ‘art-form’ and ‘to ignore the city in favour of creating inner utopias’ for individuals and nuclear family units.2 The legacy of such an approach, an urban landscape delivering isolation and disconnection, is being addressed by the current generation of architects who are concerned with the urban condition and who are incorporating a variety of interstitial spaces in housing projects for people who choose to live together. For insight into spaces delivering connectivity these architects have looked no further than the urban morphology of Tokyo itself, a city of predominantly individual dwellings on increasingly smaller allotments.3 The open semi-public spaces they have created became the focus of my Dunbar study
'Planetary health' leadership at a time of a triple planetary crisis and breached planetary boundaries
No full textHealth professionals (HPs) have been called on to be resource stewards and sustainable healthcare champions2 or climate leaders.3 Many have also lobbied governments to address air pollution.4 In early 2020, as countries were closing borders due to COVID-19, Judy McKimm and I published an article calling for eco-ethical leaders in health professions education (HPE) to tackle our ‘wicked’ planetary issues and to prepare the next generation of ethical, just and ecologically conscious HPs.5 The ‘eco’ reflected the need to protect (and restore) the world’s ecosystems while the ‘ethical’ related to the unequal impact of rising greenhouse gas emissions, pollution and ecosystem damage (hence biodiversity loss) on those least responsible (ie, communities in low-middle income countries; other living ‘beings’). Yassaie and Garman’s BMJ Leader call for ‘planetary health’ leadership articles is also a call to action: “As the science progresses, pressure is increasing on health leaders to incorporate a planetary health lens into their decision-making” (p. 1).6 Their editorial ended with a poignant rhetorical question at a time of ’a triple planetary crisis’ (changing climate, biodiversity loss, pollution)7 and six of nine planetary boundaries breached:8 “After all, if we are not leading for planetary health, what on Earth are we leading for?
Engaging anaesthesia professionals as co‑faculty in stroke thrombectomy simulation training: associations with clinical care and patient outcomes
No full textBackground:Simulation-based training for endovascular thrombectomy (EVT) may improve care for patients with acute ischaemic stroke. This study investigated whether engaging anaesthesia professionals as co-faculty in an established in situ simulation programme influenced EVT care and patient outcomes.Methods:This single centre pre-post interventional study (2017-2023) evaluated the impact of revising an EVT simulation training programme by engaging anaesthesia professionals in its design, delivery, and debriefing. Outcomes were measured by changes in: (1) anaesthetic management (relative and absolute time systolic blood pressure was outside protocol thresholds, hypoxic time, and protocol adherence), (2) workflow process (time metrics, successful revascularisation rates, and intraprocedural complications), and (3) patient outcomes (intracerebral haemorrhage, National Institute of Health Stroke Scale scores and modified Rankin Scale scores).Results:A total of 275 stroke patients were treated with EVT during the study period (189 pre- and 86 postintervention). Anaesthetic management improved significantly in the postintervention group, with a decrease in the proportion of time that systolic blood pressure remained outside thresholds (37.0% to 27.7%, p = 0.02), increased compliance with recommended anaesthetics (27.5% to 100.0%, p < 0.001), and a reduction in hypoxia (5 to 0 min, p < 0.001). Time from suite arrival to groin puncture increased from 15 to 20 min in the postintervention group (p = 0.003). No significant differences were observed between the groups in the remaining workflow time metrics, reperfusion rates, or procedural complications. The proportion of patients with an excellent outcome (modified Rankin Scale 0–1) improved significantly from 23.4% to 42.6% in the postintervention group (p = 0.01).Conclusions:The engagement of anaesthesia professionals in the EVT simulation training faculty was associated with improved EVT anaesthesia care and improved patient outcomes. The multidisciplinary nature of the EVT team should be reflected in faculty composition for EVT simulation training
Quadriceps, hamstring and patella tendon autografts for primary anterior cruciate ligament reconstruction demonstrate similar clinical outcomes, including graft failure, joint laxity and complications: A systematic review with meta-analysis of randomised controlled trials
Get PDFPurpose:Graft failure following anterior cruciate ligament reconstruction (ACLR) remains a significant challenge, driving discussion for optimal graft choice. Traditionally, hamstring tendon (HT) and bone-patella tendon-bone (BPTB) autografts have been favoured for ACLR. Recently, quadriceps tendon (QT) usage has increased. This systematic review with meta-analysis aims to investigate the available evidence for QT compared to HT and BPTB autografts in terms of graft failure, clinical outcomes, functional outcomes and patient-reported outcome measures (PROMs).Methods:Five databases (PubMed, Cochrane, Embase, SPORTDiscus and CINAHL) were searched to identify randomised controlled trials comparing QT versus HT or BPTB autografts. Outcomes included graft failure, donor site morbidity, complications, reoperations, clinical measures, functional outcomes, and PROMs. Risk of bias was assessed using the Cochrane risk-of-bias tool (RoB2). Meta-analysis using a random effects model was conducted to determine the pooled risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs), and certainty of evidence was evaluated via the GRADE approach.Results:Twelve RCTs consisting of 636 patients were included. Meta-analysis revealed no differences in graft failure rates (RR = 1.00; 95% CI = 0.97–1.04; p = 0.83; I2 = 0%; high certainty). QT autografts demonstrated lower donor site morbidity when compared to HT and BPTB autografts (RR = 1.45; 95% CI = 1.24–1.70; p < 0.001; I2 = 0%; high certainty). No differences were observed in joint laxity or PROM scores at 12 and 24 months, except for Knee injury and Osteoarthritis Outcome Score favouring HT and BPTB at 12 months (RR = 2.49; 95% CI = −4.69 to −0.28; p = 0.03; I2 = 0%; very low certainty).Conclusion:QT autografts have similar outcomes for graft failure, laxity and PROMs compared to HT and BPTB; however, QT autografts may have lower donor site morbidity. While each graft type is associated with specific complications and post-operative strength deficits, all three remain viable options for ACLR.Level of Evidence:Level I, systematic review of Level I randomised controlled studies
Co-design of a multifaceted intervention to improve quality handover of medicine information at discharge from hospital
Get PDFBackground:Timely and accurate discharge medicine information is essential for primary care clinicians, including general practitioners and community pharmacists, to provide safe and effective post-discharge care. Inadequate handover of discharge medicines poses risks of medication-related harm, compromising patient safety and leads to hospital readmissions. This study aimed to develop a multifaceted intervention targeting older patients (>65 years) to enhance medicine handover at hospital discharge.Methods:Following an initial consensus-building workshop, a structured five-step co-design process was implemented. Step 1 involved workshops and interviews with hospital clinicians, hospital leadership, primary care providers, and consumers experienced in discharge medicine handover. Stakeholder input in Step 2 refined intervention components and developed training materials. Step 3 obtained endorsement from health service decision makers and governance approvals. Step 4 included pharmacist upskilling, end-user testing, and feedback collection. Step 5 finalised intervention components and constructed a Logic Model.Results:Seventy-eight stakeholders participated in workshops and interviews from August to November 2023. Four key medicine handover objectives for older patients emerged, which were operationalised into intervention recommendations over a five-month period (December 2023-April 2024). Component 1 empowered patients to query clinicians about their medications via a dedicated website with a question builder and evidence-based resources. Component 2 involved training doctors to document reasons for medicine changes in patient records. Component 3 implemented patient risk stratification to guide tailored strategies for communication to primary care clinicians. Component 4 focused on discharge reconciliation planning by unit pharmacists in collaboration with physicians. End-user testing yielded positive feedback.Conclusions:A co-designed multifaceted intervention was developed to enhance medicine handover during hospital discharge. The intervention will undergo feasibility testing to assess its impact on reducing medication-related harm and hospital readmissions
Payment and Pleasure: Monetary and Social Ties in Shared Consumption Experiences
Get PDFDespite rising living costs, consumers are increasingly investing in shared consumption experiences in the pursuit of happiness. However, in financially constrained contexts, payment distribution—that is, how the cost of an experience is covered among consumers—has become a more salient and psychologically meaningful component of the experience. This paper investigates how the payment distribution shapes anticipated happiness in shared consumption between two consumers. Across three experimental studies (total N = 2640), we find that consumers anticipate greater happiness from an experience when paying the full amount (vs. 50:50) when the experience is shared with a strong (vs. weak) social tie. This effect is explained by the expectation of reciprocity, which becomes more salient in interactions with weak ties, and in turn reduces anticipated happiness (Studies 2 and 3). These findings reveal that who pays has important affective consequences when consuming experiences together with a strong social tie, offering new insight into the intersection of financial decision-making, social ties, and consumer wellbeing
Are surfers and scuba divers an overlooked at-risk group for age-related macular degeneration?
Get PDFEvery day, across the world’s coastlines, millions of individuals enter the ocean in pursuit of recreation, connection, and challenge. From surfers waiting in stillness for the next wave to divers submerged just beneath the glittering surface, these individuals are uniquely positioned at the intersection of two environmental factors, sunlight and seawater, that may, in combination and over time, adversely affect ocular health
Why Middle Power Coalition Strategies Fail Against Great Powers
No full textThis article critically examines the limitations of middle power coalition strategies in countering great power influence, particularly in the context of U.S. economic nationalism and China’s strategic assertiveness. Drawing on historical and contemporary examples—including the Cairns Group, MIKTA, and the proposed JACK coalition (Japan, Australia, Canada, South Korea)—the authors argue that structural asymmetries, economic dependencies, and strategic defection undermine the viability of sustained middle power cooperation. The failure of coordinated responses to U.S. tariff threats illustrates the prisoner’s dilemma dynamics that incentivize individual accommodation over collective resistance. The article contends that middle powers must abandon idealistic coalition-building in favor of pragmatic, issue-specific cooperation and deeper integration within existing alliance structures. By aligning with hegemonic frameworks while negotiating implementation details, middle powers can preserve strategic relevance without directly challenging dominant powers. This approach offers a more realistic pathway for maintaining liberal international order and managing great power competition
Correction to: The relationships between Dark Tetrad traits and adolescent cyberbullying and cybertrolling with online time and life satisfaction as moderators (Discover Psychology, (2025), 5, 1, (29), 10.1007/s44202-025-00351-6)
No full textFollowing the publication of the original article, the authors reported some typos that need to be corrected. In Table 3, the column header reads "SEt" should have read: "SE". Moreover, under Table 2, the correlation between cyberbullying and psychopathy was presented as 0. 52***.*. An extra punctuation and asterisk afterwards should be removed. It should read: 0.52***. The original article [1] has been corrected.</p
Shared decision making teaching frameworks: Oxford Textbook of Shared Decision Making in Healthcare
No full textThis chapter explores the importance of shared decision making teaching and presents an overview of four frameworks that can be used as part of teaching it: the three-talk model, Stiggelbout’s four steps, the SHARE approach, and the five questions approach. The chapter also articulates why patient perspectives should be incorporated into shared decision making teaching and provides some suggestions for how this can be done. It concludes by highlighting some of the challenges and opportunities for future research in the area of shared decision making teaching