Urban tinkering.

Cities are currently experiencing serious, multifaceted impacts from global environmental change, especially climate change, and the degree to which they will need to cope with and adapt to such challenges will continue to increase. A complex systems approach inspired by evolutionary theory can inform strategies for policies and interventions to deal with growing urban vulnerabilities. Such an approach would guide the design of new (and redesign of existing) urban structures, while promoting innovative integration of grey, green and blue infrastructure in service of environmental and health objectives. Moreover, it would contribute to more flexible, effective policies for urban management and the use of urban space. Four decades ago, in a seminal paper in Science, the French evolutionary biologist and philosopher Francois Jacob noted that evolution differs significantly in its characteristic modes of action from processes that are designed and engineered de novo (Jacob in Science 196(4295):1161-1166, 1977). He labeled the evolutionary process "tinkering", recognizing its foundation in the modification and molding of existing traits and forms, with occasional dramatic shifts in function in the context of changing conditions. This contrasts greatly with conventional engineering and design approaches that apply tailor-made materials and tools to achieve well-defined functions that are specified a priori. We here propose that urban tinkering is the application of evolutionary thinking to urban design, engineering, ecological restoration, management and governance. We define urban tinkering as:A mode of operation, encompassing policy, planning and management processes, that seeks to transform the use of existing and design of new urban systems in ways that diversify their functions, anticipate new uses and enhance adaptability, to better meet the social, economic and ecological needs of cities under conditions of deep uncertainty about the future.This approach has the potential to substantially complement and augment conventional urban development, replacing predictability, linearity and monofunctional design with anticipation of uncertainty and non-linearity and design for multiple, potentially shifting functions. Urban tinkering can function by promoting a diversity of small-scale urban experiments that, in aggregate, lead to large-scale often playful innovative solutions to the problems of sustainable development. Moreover, the tinkering approach is naturally suited to exploring multi-functional uses and approaches (e.g., bricolage) for new and existing urban structures and policies through collaborative engagement and analysis. It is thus well worth exploring as a means of delivering co-benefits for environment and human health and wellbeing. Indeed, urban tinkering has close ties to systems approaches, which often are recognized as critical to sustainable development. We believe this concept can help forge much-closer, much-needed ties among engineers, architects, evolutionary ecologists, health specialists, and numerous other urban stakeholders in developing innovative, widely beneficial solutions for society and contribute to successful implementation of SDG11 and the New Urban Agenda.

Management of procedures and reactions following first aid.

Registered nurses may fear that offering first aid will expose them to legal action and emotional stress. The final article of this series emphasises the importance of accurate record-keeping and provides advice on co-operating with legal procedures, including providing information to other professionals, obtaining consent and reporting a death. Providing emergency first aid can be an emotional experience. This article offers advice on coping after the incident, and reflection as a means of allowing nurses to assess their actions and resolve any issues.

Management of water incidents: drowning and hypothermia.

Dangers exist wherever water is present, and death resulting from submersion in water is likely to occur rapidly. This article discusses the management of drowning and hypothermia. Information on water hazards and preventive measures, the risks associated with rescuing people from water, and the pathophysiology of drowning and hypothermia is provided, enabling practitioners to translate theory into practice. The emphasis of first aid in this setting is on quick, effective action, including alerting the emergency services and maintaining the safety of all potential rescuers.

Management of home emergencies.

This article, the third in a series of eight, discusses the management of some of the accidents and emergencies that commonly occur in the home. It discusses the prevalence of these incidents and the role of the registered nurse in providing assistance. The emphasis is on ensuring the safety of the casualty, as well as nurses and any other rescuers or bystanders. Information is provided to enable the nurse to understand the priorities in managing the first aid situation.

Initial management of patients in an emergency situation.

Success in first aid is based on the ability to make the most of the resources available and on maintaining the casualty in the best possible condition until specialist help arrives. This article, the second in a series of eight, discusses how to assess and stabilise the casualty's condition and how to manage the emergency situation. Using case examples, it provides a methodical approach to risk assessment for casualties, bystanders and rescuers, as well as ascertaining and providing clear and accurate information for the relevant emergency services.

Providing first aid and assisting forensic investigations.

Forensic investigation is mandated not only in cases of criminal injury or death, but also where an unexplained death has occurred. The registered nurse involved in providing first aid in such a situation should remember that, while taking steps to maintain patient confidentiality, he or she has a duty to co-operate with any subsequent investigation. This article describes the basic management of hanging and strangulation, poisoning and sexual assault, and provides advice on record-keeping, preservation of evidence and the need for obtaining professional indemnity and support from professional bodies.