Perceived impact of meteorological conditions on the use of public space in winter settlements.

This study aimed to assess the impact of meteorological conditions on the use of public space in Scandinavia and Canada. Between September 21 and December 18, 2017, a cross-sectional online survey 'EAMQ-Climate: space' was distributed via web-based platforms. Survey responses were received from 361 residents (258 people from Scandinavia and 103 from Canada). The relative impact of the meteorological determinants on the use of public space was calculated, and a factor analysis was performed. Disparities between Canada and Scandinavia as well as between the climate zones represented were analysed using ANOVA. Overall results showed that the most significant meteorological enablers for the use of outdoor public spaces in winter were solar gain, snowfall and snow-covered surfaces. The main barriers were slush-covered and icy surfaces, rainfall and darkness. Wind and cold were conditions with less influence. The impact of rain and ice, however, differed between climatic zones. It was also established that, when addressing the meteorological impact on avoiding the use of public spaces in winter, it is vital to discriminate between conditions related to a) the ground surface and b) ambient conditions, as well as the particular significance of c) snow and sun, and d) darkness. For the design of public space in winter cities, we conclude that designers need to focus on a wider range of weather conditions than sun, wind and cold, and include snow, rainfall, slushy and icy ground and poor visibility. The study suggests that winter public space has a higher climatic design requirement to be successful than streets and pathways that are mainly used for soft mobility.

Measuring arterial oxygen saturation from an intraosseous photoplethysmographic signal derived from the sternum.

Photoplethysmography performed on the peripheral extremities or the earlobes cannot always provide sufficiently rapid and accurate calculation of arterial oxygen saturation. The purpose of this study was to evaluate a novel photoplethysmography prototype to be fixed over the sternum. Our hypotheses were that arterial oxygen saturation can be determined from an intraosseous photoplethysmography signal from the sternum and that such monitoring detects hypoxemia faster than pulse oximetry at standard sites. Sixteen healthy male volunteers were subjected to incremental hypoxemia using different gas mixtures with decreasing oxygen content. The sternal probe was calibrated using arterial haemoglobin CO-oximetry (SaO2%). Sternal probe readings (SRHO2%) were then compared to SaO2% at various degrees of hypoxia. The time to detect hypoxemia was compared to measurements from standard finger and ear pulse oximeters. A significant association from individual regression between SRHO2% and SaO2% was found (r2 0.97), Spearman R ranged between 0.71 and 0.92 for the different inhaled gas mixtures. Limits of agreement according to Bland-Altman plots had a increased interval with decreasing arterial oxygen saturation. The sternal probe detected hypoxemia 28.7 s faster than a finger probe (95% CI 20.0-37.4 s, p < 0.001) and 6.6 s faster than an ear probe (95% CI 5.3-8.7 s, p < 0.001). In an experimental setting, arterial oxygen saturation could be determined using the photoplethysmography signal obtained from sternal blood flow after calibration with CO-oximetry. This method detected hypoxemia significantly faster than pulse oximetry performed on the finger or the ear.

Tactical capacity planning in hospital departments.

PURPOSE: The purpose of this paper is to explore tactical planning potential within hospital departments. The study had two objectives: first, to develop a framework for tactical capacity planning in healthcare departments by identifying and structuring essential components for healthcare capacity management; and, second, to identify context-specific requirements and functionality demands on tactical planning processes within healthcare. DESIGN/METHODOLOGY/APPROACH: A framework for tactical capacity planning was developed through a literature review. Additionally, an exploratory multiple-case study was performed, with cases from three Swedish hospital departments, which provide the opportunity to study framework applicability in its natural context. FINDINGS: Findings illustrate how an active tactical planning process can facilitate adjustments to capacity. However, the multiple-case study shows that there are contextual differences between departments, depending on available treatments and resources that affect capacity adjustments, and how the planning process activities should be structured. ORIGINALITY/VALUE: This project develops a framework for a tactical capacity-planning process adapted to healthcare provider contexts. By developing the framework, based on the literature and tactical level planning processes within three Swedish hospital case studies, the authors bridge gaps between theory and application regarding healthcare capacity planning.

Hyperbaric oxygen therapy in spontaneous brain abscess patients: a population-based comparative cohort study.

BACKGROUND: There is a need to improve outcome in patients with brain abscesses and hyperbaric oxygen therapy (HBOT) is a promising treatment modality. The objective of this study was to evaluate HBOT in the treatment of intracranial abscesses. METHOD: This population-based, comparative cohort study included 40 consecutive adult patients with spontaneous brain abscess treated surgically between January 2003 and May 2014 at our institution. Twenty patients received standard therapy with surgery and antibiotics (non-HBOT group), while the remaining 20 patients also received adjuvant HBOT (HBOT group). RESULTS: Resolution of brain abscesses and infection was seen in all patients. Two patients had reoperations after HBOT initiation (10 %), while nine patients (45 %) in the non-HBOT group underwent reoperations (p = 0.03). Of the 26 patients who did not receive HBOT after the first surgery, 15 (58 %) had one or several recurrences that lead to a new treatment: surgery (n = 11), surgery + HBO (n = 5) or just HBO (n = 1). In contrast, recurrences occurred in only 2 of 14 (14 %) who did receive HBOT after the first surgery (p < 0.01). A good outcome (Glasgow Outcome Score [GOS] of 5) was achieved in 16 patients (80 %) in the HBOT cohort versus 9 patients (45 %) in the non-HBOT group (p = 0.04). CONCLUSIONS: HBOT was associated with less treatment failures and need for reoperation and seemingly with improved long-term outcome. Further, HBOT was well tolerated and safe. Prospective studies are warranted to establish the role of HBOT in the treatment of brain abscesses.

Cervical necrotizing fasciitis: descriptive, retrospective analysis of 59 cases treated at a single center.

To provide retrospective, descriptive information on patients with cervical necrotizing fasciitis treated at a single center during the years 1998-2014, and to evaluate the outcome of a newly introduced treatment strategy. Retrospective analysis of clinical data obtained from medical records. Mortality, pre-morbidity, severity of illness, primary site of infection, type of bacteria, time parameters. The observed 3-month mortality was 6/59 (10 %). The most common initial foci of the infection were pharyngeal, dental or hypopharyngeal. The most common pathogen was Streptococcus milleri bacteria within the Streptococcus anginosus group (66 % of the cases). Using a combined treatment with early surgical debridement combined with hyperbaric oxygen treatment, it is possible to reduce the mortality rate among patients suffering from cervical necrotizing fasciitis, compared to the expected mortality rate and to previous historical reports. Data indicated that early onset of hyperbaric oxygen treatment may have a positive impact on survival rate, but no identifiable factor was found to prognosticate outcome.

Effects of hyperbaric oxygen on nitric oxide generation in humans.

BACKGROUND: Hyperbaric oxygen (HBO2) has been suggested to affect nitric oxide (NO) generation in humans. Specific NO synthases (NOSs) use L-arginine and molecular oxygen to produce NO but this signaling radical may also be formed by serial reduction of the inorganic anions nitrate and nitrite. Interestingly, commensal facultative anaerobic bacteria in the oral cavity are necessary for the first step to reduce nitrate to nitrite. The nitrate-nitrite-NO pathway is greatly potentiated by hypoxia and low pH in contrast to classical NOS-dependent NO generation. We investigated the effects of HBO2 on NO generation in healthy subjects including orally and nasally exhaled NO, plasma and salivary nitrate and nitrite as well as plasma cGMP and plasma citrulline/arginine ratio. In addition, we also conducted in-vitro experiments in order to investigate the effects of hyperoxia on nitrate/nitrite metabolism and NO generation by oral bacteria. METHODS: Two separate HBO2 experiments were performed. In a cross-over experiment (EXP1) subjects breathed air at 130 kPa (control) or oxygen at 250 kPa for 100 minutes and parameters were measured before and after exposure. In experiment 2 (EXP 2) measurements were performed also during HBO2 at 250 kPa for 110 minutes. RESULTS: HBO2 acutely reduced orally and nasally exhaled NO by 30% and 16%, respectively. There was a marked decrease in salivary nitrite/nitrate ratio during and after HBO2, indicating a reduced bacterial conversion of nitrate to nitrite and NO. This was supported by in vitro experiments with oral bacteria showing that hyperoxia inhibited bacterial nitrate and nitrite reduction leading to reduced NO generation. Plasma nitrate was unaffected by HBO2 while plasma nitrite was reduced during HBO2 treatment. In contrast, plasma cGMP increased during HBO2 as did citrulline/arginine ratio after treatment and control. CONCLUSION: HBO2-exposure in humans affects NO generation in the airways and systemically differently. These data suggest that the individual NOSs as well as the nitrate-nitrite-NO pathway do not respond in a similar way to HBO2.

Age-inclusive Arctic outdoor spaces: a policy review in four Nordic countries.

In the last decade, policy strategies were adopted in response to population ageing in the Nordic countries. Governmental actions have to be evaluated in terms of their efficacy. The objective of this article is to identify and review the policies related to age-inclusive outdoor spaces in the Arctic regions of Nordic countries. Our analysis focuses on central government white papers that address the older adults in Finland, Norway, Sweden, and Iceland. A review of such policy documents provides insights into the predominant understandings of older adults and healthy ageing. Moreover, such analysis may identify "blind spots" in the national policies, especially regarding the sparsely researched northernmost and rural Arctic territories. Our results demonstrate how the older populations in the Nordic Arctic and their access to outdoor spaces are addressed in the policy documents. We found that with few exceptions, the older people of the rural Arctic is strikingly absent in the Nordic national governmental papers. Moreover, access to outdoor spaces is mentioned in general terms, and specific challenges of the rural Arctic context, such as the harsh climate, long winters and geographical distances are not addressed. The noticed omissions might be the result of "urban-rural", "south-north", "indoor-outdoor", and "generalisation" biases.

Postural control among individuals with and without chronic obstructive pulmonary disease: A cross-sectional study of motor and sensory systems.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is considered a heterogenic syndrome with systemic effects, including muscle dysfunction. There is evidence of postural control impairments among individuals with COPD, partly related to muscle weakness. However, research is scarce regarding the other underlying systems of postural control, such as the visual, somatosensory and vestibular system. The aim was to compare postural control, as well as the motor and sensory systems, between individuals with and without COPD. METHODS: Twenty-two participants with COPD (mean age 74.0 ±6.2 years) and 34 non-obstructive references (mean age 74.9 ±4.9 years) participated in this cross-sectional study. Postural control was assessed with center of pressure trajectory of postural sway in quiet as well as a limits of stability test, calculating mediolateral and anteroposterior amplitudes for each test. Assessment of function in the motor system included maximum hand grip strength, as well as maximum strength in muscles around the hip, knee and ankle joints. Visual acuity, pressure sensibility, proprioception, vestibular screening, and reaction time were also included. Data was compared between groups, and significant differences in postural control were further analyzed with an orthogonal projection of latent structures regression model. RESULTS: There was a significantly increased sway amplitude in the mediolateral direction in quiet stance on soft surface with eyes open (p = 0.014) as well as a smaller anteroposterior amplitude in the limits of stability test (p = 0.019) in the COPD group. Regression models revealed that the mediolateral amplitude was related to visual acuity and the burden of tobacco smoking assessed as pack-years. Further, muscle strength associated with anteroposterior amplitude in limits of stability test in the COPD group, and with age and ankle dorsal flexion strength among the referents. Besides for lower ankle plantar flexion strength in the COPD group, there were however no significant differences in muscle strength. CONCLUSIONS: Individuals with COPD had a decreased postural control and several factors were associated with the impairments. The findings imply that the burden of tobacco smoking and reduced visual acuity relate to increased postural sway in quiet stance, and that muscle weakness is related to decreased limits of stability, among individuals with COPD.

Identifying work ability promoting factors for home care aides and assistant nurses.

BACKGROUND: In workplace health promotion, all potential resources needs to be taken into consideration, not only factors relating to the absence of injury and the physical health of the workers, but also psychological aspects. A dynamic balance between the resources of the individual employees and the demands of work is an important prerequisite. In the home care services, there is a noticeable trend towards increased psychosocial strain on employees at work. There are a high frequency of work-related musculoskeletal disorders and injuries, and a low prevalence of sustainable work ability. The aim of this research was to identify factors promoting work ability and self-efficacy in care aides and assistant nurses within home care services. METHODS: This study is based on cross-sectional data collected in a municipality in northern Sweden. Care aides (n = 58) and assistant nurses (n = 79) replied to a self-administered questionnaire (response rate 46%). Hierarchical multiple regression analyses were performed to assess the influence of several independent variables on self-efficacy (model 1) and work ability (model 2) for care aides and assistant nurses separately. RESULTS: Perceptions of personal safety, self-efficacy and musculoskeletal wellbeing contributed to work ability for assistant nurses (R2adj of 0.36, p < 0.001), while for care aides, the safety climate, seniority and age contributed to work ability (R2adj of 0.29, p = 0.001). Self-efficacy was associated with the safety climate and the physical demands of the job in both professions (R2adj of 0.24, p = 0.003 for care aides), and also by sex and age for the assistant nurses (R2adj of 0.31, p < 0.001). CONCLUSIONS: The intermediate factors contributed differently to work ability in the two professions. Self-efficacy, personal safety and musculoskeletal wellbeing were important for the assistant nurses, while the work ability of the care aides was associated with the safety climate, but also with the non-changeable factors age and seniority. All these factors are important to acknowledge in practice and in further research. Proactive workplace interventions need to focus on potentially modifiable factors such as self-efficacy, safety climate, physical job demands and musculoskeletal wellbeing.

Nitrox permits direct exit for attendants during extended hyperbaric oxygen treatment.

BACKGROUND: Intermittent breathing of oxygen-enriched air, nitrox (1:1 air:oxygen, 60.5% O2), for attendants in multiplace hyperbaric chambers should enable treatment protocols (HOPAN - hyperbaric oxygen protocol attendants' nitrox) of up to 200 minutes at 2.8 atmospheres absolute (ATA), while retaining the option of a direct decompression and exit. METHODS: HOPAN with cycles of 15 minutes of nitrox breathing followed by 10 minutes of chamber air for attendants were occasionally used from 2007-2009. HOPAN vs. LTP (local treatment protocols) were evaluated via an anonymous enquiry among attendants; patients' medical records were followed six months post-HBO2 treatment (HBO2T). RESULTS: 88 HOPANs, with 59 chamber attendants assisting 30 patients, were documented. HOPAN duration ranged from 55-167 minutes (median 140 minutes). 31/59 attendants answered the enquiry. Perceived comfort of each protocol (HOPAN vs. LTP) by attendants was reported as equal. Symptoms, both minor (parestesias) and severe (joint pain), were reported in connection with LTP, while only one occurrence (mild joint pain) was reported in connection with HOPAN. No complications were documented among the attendants or the patients. It is suggested that nitrox breathing for chamber attendants provide flexible HBO2T for patients at 2.8 ATA for up to 200 minutes within no-decompression limits, facilitating future studies of HBO2T dosage.

Investigation of a demand-controlled rebreather in connection with a diving accident.

This paper describes the examination of a Halcyon RB80 semi-closed underwater breathing apparatus used in a diving accident in 2007. The apparatus was supplied with trimix (oxygen, nitrogen and helium) containing 31% oxygen. The duration of the dive was 105 minutes at 28 meters' average depth in fresh water, with a 19-minute oxygen decompression stop at 6 meters. Upon surfacing the diver experienced seizures and signs of severe neurological deficits. The apparatus was tested with regard to the oxygen fraction drop from the supply gas to the breathing loop--i.e., the oxygen fraction inhaled by the diver (FiO2) was investigated. The FiO2 was measured and found to be lower than the value stated on the manufacturer's web page at the time of the accident. This investigation suggests that during the dive, the actual FiO2% was 17.9-25.3%, which is considerably lower than the FiO2% used for decompression calculations (30%). The underestimation of FiO2 resulted in too short and/or too few decompression stops during ascent. The low FiO2 would also put a diver at risk of hypoxia at shallow depths. It is concluded that inadequate information on the performance of the rebreather was a major contributing factor to this accident.

Positive Self-Perceptions of Aging Play a Significant Role in Predicting Physical Performance among Community-Dwelling Older Adults.

Self-perceptions of aging (SPA) is associated with various health-related outcomes, including physical performance. No previous study has investigated the potential predictive influence of SPA on physical performance among Swedish community-dwelling older adults. This was a cross-sectional study using a random sample of 153 Swedish community-dwelling individuals aged 70 and older. Multiple logistic regression analysis was performed, using the subscale "Attitude Towards Own Aging" of the Philadelphia Geriatric Center Morale Scale, as a measure of SPA. The Short Physical Performance Battery (SPPB) was dichotomized and used as the outcome variable. SPA was a significant predictor (OR = 1.546, CI = 1.066-2.243) of physical performance, adjusted for age, cognitive function, and life-space mobility. Further analyses revealed significant sex differences, with SPA not being included in the model for the men whilst it was still a significant predictor (OR = 1.689, CI = 1.031-2.765) of physical performance in the group of women. SPA plays a significant role in predicting physical performance among Swedish community-dwelling older adults. To further clarify this relationship and its consequences, future longitudinal research should focus on the relationship between SPA, physical performance, and fall risk.

Executive Functions of Swedish Counterterror Intervention Unit Applicants and Police Officer Trainees Evaluated With Design Fluency Test.

Executive functions (EF) represent higher order top-down mechanisms regulating information processing. While suboptimal EF have been studied in various patient groups, their impact on successful behavior is still not well described. Previously, it has been suggested that design fluency (DF)-a test including several simultaneous EF components mainly related to fluency, cognitive flexibility, and creativity-predicts successful behavior in a quickly changing environment where fast and dynamic adaptions are required, such as ball sports. We hypothesized that similar behaviors are of importance in the selection process of elite police force applicants. To test this hypothesis, we compared elite police force applicants (n = 45) with a control group of police officer trainees (n = 30). Although both groups were better than the norm, the elite police force applicants had a significantly better performance in DF total correct when adjusting for sex and age [F(1,71) = 18.98, p < 0.001]. To understand how this capacity was altered by stress and tiredness, we re-tested the elite police force applicants several days during an extreme field assessment lasting 10 days. The results suggested that there was a lower than expected improvement in DF total correct and a decline in the DF3-subtest that includes a larger component of cognitive flexibility than the other subtests (DF1 and DF2). Although there was a positive correlation between the baseline session and the re-test in DF3 [r(40) = 0.49, p = 0.001], the applicants having the highest scores in the baseline test also displayed the largest percentage decline in the re-test [r(40) = -0.46, p = 0.003]. In conclusion, our result suggests that higher order EF (HEF) that include cognitive flexibility and creativity are of importance in the application for becoming an elite police officer but relatively compromised in a stressful situation. Moreover, as the decline is different between the individuals, the results suggest that applicants should be tested during baseline conditions and during stressful conditions to describe their cognitive capacity fully.

Hand grip strength is strongly associated with lower limb strength but only weakly with postural control in community-dwelling older adults.

BACKGROUND: Hand grip strength is frequently used as a measurement of muscle strength, especially among older adults. Muscle strength is only one of the many components in postural control and it is currently unclear to what extent hand grip strength is associated with postural control. The aim was to analyze the association between hand grip strength and lower limb muscle strength, and postural control among older adults. METHODS: Forty-five community-dwelling individuals over 70 years of age provided isometric hand grip strength and lower limb strength (including hip extension and abduction, knee flexion and extension, and ankle dorsiflexion and plantarflexion), as well as postural control measurements. In the latter, center of pressure excursions were recorded for quiet stance and limits of stability tests on a force plate. Orthogonal projection of latent structures regression models were used to analyze associations between hand grip strength and lower limb strength as well as postural control, respectively. RESULTS: Lower limb strength explained 74.4% of the variance in hand grip strength. All lower limb muscle groups were significantly associated with hand grip strength. In a corresponding model, postural control measured with center of pressure excursions explained 20.7% of the variance in a statistically significant, albeit weak, model. CONCLUSIONS: These results support that hand grip strength is a valid method to estimate lower limb strength among older adults on a group level. However, strength measurements seem insufficient as a substitute for measuring postural control, and therefore specific balance tests are necessary.

Tissue oxygenation measured with near-infrared spectroscopy during normobaric and hyperbaric oxygen breathing in healthy subjects.

To evaluate the possibility of using near-infrared spectroscopy (NIRS) to measure tissue oxygenation (StO(2)) during hyperbaric oxygen (HBO) therapy. Nine healthy volunteers (1 female) age 25-37 years, breathed air or oxygen. Tissue oxygenation was measured using NIRS on the thumb. Subjects were blinded to breathing gas. A range of partial pressures of oxygen were administered in 10-min intervals: 21, 101, 21 kPa (compression to 280 kPa), 59, 280, 59 (decompression), 21 kPa. Data were averaged over last 5 min at each pressure. When switching from air to normobaric oxygen (NBO 101 kPa) StO(2) increased from 83% (82-85%, median and interquartile range) to 85% (84-87%) (P < 0.01), while when switching from air at pressure (59 kPa O(2)) to HBO (280 kPa), StO(2) increased from 85% (85-86%) to 88% (87-89%) (P < 0.001). There was no difference between baseline StO(2) while air breathing before NBO or after decompression. Values did not reach the maximal value of 100% at any point. The changes in hemoglobin oxygen saturation in tissue registered by the NIRS monitor when switching from air to oxygen followed inspired PO(2) under normobaric and hyperbaric conditions.

Hand grip strength is associated with fatigue among men with COPD: epidemiological data from northern Sweden.

The aim of this study was to investigate if hand grip strength (HGS) is associated with: 1) fatigue, and specifically clinically relevant fatigue (CRF); 2) low physical activity; and 3) fatigue independent of physical activity level, among individuals with and without COPD. Data were collected from the Obstructive Lung Disease in Northern Sweden (OLIN) COPD-study in 2014. HGS was measured with a hand-grip dynamometer, fatigue and physical activity were assessed by questionnaires; FACIT-Fatigue respectively IPAQ. Among individuals with COPD (n = 389), but not without COPD (n = 442), HGS was lower among those with CRF than those without CRF, significantly so among men (p = 0.001) and close to among women (p = 0.051). HGS was not associated with physical activity levels within any of the groups. HGS was associated with fatigue among men, but not women, with COPD independent of physical activity level, age, height, and smoking habits (Beta = 0.190, 95% CI 0.061-0.319, respectively Beta = 0.048, 95% CI-0.056-0.152), while there were no corresponding significant findings among individuals without COPD. In summary, HGS was associated with CRF among individuals with COPD in this population-based study. Among men with COPD, HGS was associated with fatigue independent of physical activity level and common confounders.

Toward an Integrated Model for Soft-Mobility.

A key urban design challenge is to create built environments that encourage outdoor activity all year round. This study explores a new model for soft-mobility that places the interaction between the urban form, the seasonal climate and climate change, and the individual at the center of people's soft-mobility choices, or in more general, their modal choice. The research methods used were comparative studies of documents, surveys, mental mapping, and photo elicitation. These studies were undertaken to research people's outdoor activity in the built environment during the winter season of a cold climate settlement. The results were analyzed against the three-dimensions of the model. In the discussion it is argued that in places with significant climate variation, the interaction between the urban form, the season, and the individual together influence soft-mobility choices. In turn, these interactions influence people's level of outdoor activity and the individual health benefits such activity can afford. In conclusion, it is highlighted that all three dimensions of the model are in a constant state of change and evolution, especially in relation to planning and development processes and climate change.

Gait Speed with Anti-Slip Devices on Icy Pedestrian Crossings Relate to Perceived Fall-Risk and Balance.

It is important to find criteria for preventive measures and appropriate assistive devices to reduce pedestrian injuries and increase walking in winter. Reducing the rate of falls on icy surfaces and improving people's ability to safely cross a street in winter conditions by achieving an adequate walking speed, for example, need to be considered. This study explores pedestrian perceptions of fall risk, balance, and footfall transitions while using different designs for anti-slip devices on ice and snow-covered ice and relates these to measures of gait speed and friction. Trials were performed with nine pedestrians testing 19 anti-slip devices on ice and ice covered with snow. Laboratory tests of the dynamic coefficient of friction (DCOF) on plain ice were also performed. The findings suggest that there was conformity in the participants' perceptions of good balance and low fall risk for one-fifth of the devices (three whole-foot designs and one design with built-in spikes). We also found that gait speed on icy pedestrian crossings is related to perceived fall-risk and balance control, but not to DCOF of the anti-slip devices.

Winter City Urbanism: Enabling All Year Connectivity for Soft Mobility.

This study explores connectivity for soft mobility in the winter season. Working with residents from the sub-arctic city of Luleå, Sweden, the research examines how the interaction between the built environment and winter season affects people's use of the outdoor environment. The research questions for this study are (1) How do residents perceive the effects of winter on an areas spatial structure and pattern of streets and pathways? and (2) What enablers and barriers impact resident soft mobility choices and use of the public realm in winter? Methods used were mental mapping and photo elicitation exercises. These were used to gain a better understanding of people's perception of soft mobility in winter. The results were analysed to identify how soft mobility is influenced by the winter season. The discussion highlights that at the neighbourhood scale, residents perceive that the winter alters an areas spatial structure and pattern of streets and pathways. It was also seen to reduce ease of understanding of the public realm and townscape. In conclusion, it is argued that new and re-tooled town planning strategies, such as extending blue/ green infrastructure planning to include white space could help better enable all year outdoor activity in winter cities.