Stroke Inpatient Rehabilitation Environments: Aligning Building Construction and Clinical Practice Guidelines Through Care Process Mapping.

BACKGROUND: Stroke inpatient rehabilitation is a complex process involving stroke survivors, staff, and family utilizing a common space for a shared purpose: to optimize recovery. This complex pathway is rarely fully described. Stroke care is ideally guided by Clinical Practice Guidelines, and the rehabilitation built environment should serve to optimize care delivery, patient and staff experience. We aimed to articulate the inpatient stroke rehabilitation process of care in a series of process maps, and to understand the degree to which current stroke clinical and building construction (ie, design) guidelines align to support inpatient stroke rehabilitation. METHODS: We used the Value-Focused Process Engineering methodology to create maps describing the events and activities that typically occur in the current stroke inpatient rehabilitation service model. These maps were completed through individual and group session consultations with stroke survivors, architects, policy makers, and clinical experts. We then determined which sections of the Australian Stroke Rehabilitation Guidelines and the Australasian Health Facility Design Guidelines could be aligned and applied to the process maps. RESULTS: We present a summary process map for stroke inpatient rehabilitation, alongside detailed process maps for 4 different phases of rehabilitation (admission, a normal weekday, a weekend day, and discharge) using Value-Focused Process Engineering notation. The integration of design and clinical guidelines with care pathway maps revealed where guidelines lack detail to be readily linked to current stroke inpatient care practice, providing an opportunity to design stroke inpatient rehabilitation spaces based on the activities occurring within them. CONCLUSIONS: Our findings highlight gaps where clinical and design experts should work together to use guidelines to their full potential; and to improve the process of planning for future stroke rehabilitation units.

Informing Streetscape Design with Citizen Perceptions of Safety and Place: An Immersive Virtual Environment E-Participation Method.

As our cities grow, it is important to develop policies and streetscape designs that provide pedestrians with safe comfortable walking conditions and acknowledge the challenges involved in making urban places feel liveable and safe while understanding the critical role of streets around busy destinations. To understand these challenges at a nuanced, human level, new methods of citizen engagement are needed. This paper outlines the development and application of a new citizen perception collection method, using immersive virtual environments (IVE), coupled with an interactive emoji affective activation-pleasure grid and digital slider elements, embedded within an online e-participation survey to quantify, and rank the impact of individual (single-variable) urban design elements and safe system treatments on pedestrians' perceptions of safety and place. The results demonstrate the effectiveness of this method for providing detailed, interrogable, scalable citizen perception data of a variety of urban street design elements and safe system treatments, which allows a statistical analysis of responses and prioritization of the most effective pedestrian-oriented interventions for maintaining or enhancing street vibrancy and liveability. Our IVE e-participation approach is an important contribution to forming a better understanding of streetscapes and provides a valuable method for urban designers and transport planners to prioritise different streetscape place and safety approaches.

Perceived Safety Influencing Active Travel to School-A Built Environment Perspective.

Despite the many research studies on active school travel (AST), the number of children walking/cycling to school is decreasing as there is a lack of implementable research evidence. This review through database searches from 2000 to 2020 aims to identify research gaps and explore new perspectives. The articles are selected and screened methodically for systematic presentation of the review. An existing active school travel framework is used to structure and discuss this review paper on mediating factors influencing children's active travel to school, that is the perceived traffic safety, neighborhood safety, and distance to school. Perception of traffic safety could be ameliorated through lateral separation from the traffic, and this could be a new area of research. The neighborhood safety perception may require more research to validate the previous findings. Schools should be located within high-density residential development so that many children can walk to school.

Effects of the Visual Character of Transitional Spaces on Human Stress Recovery in a Virtual Reality Environment.

As people's levels of stress increase with the complexity of contemporary urban life, the stress healing agenda in built environments has become more critical than ever. Previous research has demonstrated that linear and nonlinear shapes in the environment have an impact on human stress recovery. However, to date, most studies have focused on indoor and outdoor spaces, while research on transitional spaces is still limited. Transitional spaces connect the interior with the exterior and are ubiquitous in the city, such as plazas, open cafes, and urban corridors. We hypothesize that curved and linear environments affect human stress recovery differently in transitional spaces. To test this hypothesis, virtual reality (VR) technology and experiments were conducted with 40 participants. At the end of the Trier Social Stress Test (TSST), participants were randomly assigned to four VR environments to test which environment is more effective in stress recovery for humans. Participants' physiological data, including heart rate and blood pressure, were measured by bio-monitoring sensors. The psychological data were tested by the State-Trait Anxiety Inventory (STAI). In general, the resulting data indicate that the curved environment is more effective than the linear environment for the recovery of human stress in transitional spaces.

Study on Spatial Distribution Equilibrium of Elderly Care Facilities in Downtown Shanghai.

With the growing challenge of aging populations around the world, the study of the care services for older adults is an essential initiative to accommodate the particular needs of the disadvantaged communities and promote social equity. Based on open-source data and the geographic information system (GIS), this paper quantifies and visualizes the imbalance in the spatial distribution of elderly care facilities in 14,578 neighborhoods in downtown (seven districts) Shanghai, China. Eight types of elderly care facilities were obtained from Shanghai elderly care service platform, divided into two categories according to their service scale. With the introduction of the improved Gaussian 2-step floating catchment area method, the accessibility of two category facilities was calculated. Through the global autocorrelation analysis, it is found that the accessibility of elderly care facilities has the characteristics of spatial agglomeration. Local autocorrelation analysis indicates the cold and hot spots in the accessibility agglomeration state of the two types of facilities, by which we summarized the characteristics of their spatial heterogeneity. It is found that for Category-I, there is a large range of hot spots in Huangpu District. For Category-II, the hot-spot and cold-spot areas show staggered distribution, and the two categories of hot spot distribution show a negative correlation. We conclude that the two categories are not evenly distributed in the urban area, which will lead to the low efficiency of resource allocation of elderly care facilities and have a negative impact on social fairness. This research offers a systematic method to study urban access to care services for older adults as well as a new perspective on improving social fairness.

Green Infrastructure and Urban-Renewal Simulation for Street Tree Design Decision-Making: Moderating Demands of Stormwater Management, Sunlight and Visual Aesthetics.

The design of green infrastructure in urban renewal sites is complex, requiring engagement with existing communities and future sustainable development goals, consideration of existing and future urban forms, changing climatic conditions, and the sites often being in low-lying and flood-prone areas. Traditional street tree decision-making approaches are inadequate for addressing the scale, environmental complexity, and mutability of decisions involved in urban renewal projects-new tree selection approaches that consider complex competing criteria for tree selections addressing stormwater management systems, visual assessment and solar amenity are needed. This paper describes a new method of multi-criteria street design decision modelling that combines outputs from hydrology modelling, digital procedural tree modelling and urban form analysis, with animation and gaming technologies. We evaluate our approach through application to the design of a large-scale, urban renewal project underway in Melbourne, Australia. The results of the study demonstrate the functionality of our model, which allowed the simultaneous output of streetscape visualisation, with tree selection responding to integrated stormwater management infrastructure and flooding, along with the likely overshadowing conditions of urban renewal built-form. Our multi-criteria approach makes a significant contribution to the tools available to urban designers, planners and landscape architects in their pursuit of smarter streetscape design decisions that respond to complex spatial, cultural and climatic urban challenges.

Do Safe Bike Lanes Really Slow Down Cars? A Simulation-Based Approach to Investigate the Effect of Retrofitting Safe Cycling Lanes on Vehicular Traffic.

Cycling is a sustainable transportation mode that provides many health, economic and environmental benefits to society. Cities with high rates of cycling are better placed to address modern challenges of densification, carbon-neutral and connected 20-min neighbourhood goals. Despite the known benefits of cycling, participation rates in Australian cities are critically low and declining. Frequently, this low participation rate is attributed to the dangers of Australian cycle infrastructure that often necessitates the mixing of cyclists with car traffic. In addition, residents of car-dependent Australian suburbs can be resistant to the installation of cycle infrastructure where threats to traffic flow, or decreased on-street parking availability are perceived and the prohibitive cost of reconfiguration of other infrastructure maintained by the local councils to retrofit safe bike paths. This study investigates the effects on traffic behaviour of retrofitting safe, separate cycling lanes into existing residential streets in a Melbourne suburb suitable for accessing the primary neighbourhood destinations. We utilise only the widths available on the existing roadway of these streets, with minimal incursion on other facilities, such as the vehicle network and parking. Using only the existing roadway reflects the common need for municipal asset managers to minimise disruption and costs associated with street redesign. Using a traffic simulation approach, we modelled travel demand that suits suburban trips to services and shops, and we selectively applied separate cycling lanes to suitable residential streets and varied the effect of lowering speed limits. Simulations show that the selective inclusion of safe cycling lanes in some streets leads to a mere 7% increase in the average car travel times in the worst case, while requiring cyclists to increase their travel distance only marginally to avoid streets without dedicated cycling lanes. These results demonstrate that reasonable compromises are possible to make suburbs safer for cyclists and bring them closer to the 20-min neighbourhood goal. There is significant potential to enhance the result by including more street types and alternative designs. The results can inform councils in their cycle path infrastructure decisions and disprove assumptions about the influence of cyclists on car infrastructure.

Why hospital design matters: A narrative review of built environments research relevant to stroke care.

Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. How building design can best support healthcare services, staff, and patients is important to consider. In this narrative review, we outline why the healthcare environment matters and describe areas of research focus and current built environment evidence that supports healthcare in general and stroke care in particular. Ward configuration, corridor design, and staff station placements can all impact care provision, staff and patient behavior. Contrary to many new ward design approaches, single-bed rooms are neither uniformly favored, nor strongly evidence-based, for people with stroke. Green spaces are important both for staff (helping to reduce stress and errors), patients and relatives, although access to, and awareness of, these and other communal spaces is often poor. Built environment research specific to stroke is limited but increasing, and we highlight emerging collaborative multistakeholder partnerships (Living Labs) contributing to this evidence base. We believe that involving engaged and informed clinicians in design and research will help shape better hospitals of the future.

Built environments for inpatient stroke rehabilitation services and care: a systematic literature review.

OBJECTIVES: To identify, appraise and synthesise existing design evidence for inpatient stroke rehabilitation facilities; to identify impacts of these built environments on the outcomes and experiences of people recovering from stroke, their family/caregivers and staff. DESIGN: A convergent segregated review design was used to conduct a systematic review. DATA SOURCES: Ovid MEDLINE, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched for articles published between January 2000 and November 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Qualitative, quantitative and mixed-methods studies investigating the impact of the built environment of inpatient rehabilitation facilities on stroke survivors, their family/caregivers and/or staff. DATA EXTRACTION AND SYNTHESIS: Two authors separately completed the title, abstract, full-text screening, data extraction and quality assessment. Extracted data were categorised according to the aspect of the built environment explored and the outcomes reported. These categories were used to structure a narrative synthesis of the results from all included studies. RESULTS: Twenty-four articles were included, most qualitative and exploratory. Half of the included articles investigated a particular aspect of the built environment, including environmental enrichment and communal areas (n=8), bedroom design (n=3) and therapy spaces (n=1), while the other half considered the environment in general. Findings related to one or more of the following outcome categories: (1) clinical outcomes, (2) patient activity, (3) patient well-being, (4) patient and/or staff safety and (5) clinical practice. Heterogeneous designs and variables of interest meant results could not be compared, but some repeated findings suggest that attractive and accessible communal areas are important for patient activity and well-being. CONCLUSIONS: Stroke rehabilitation is a unique healthcare context where patient activity, practice and motivation are paramount. We found many evidence gaps that with more targeted research could better inform the design of rehabilitation spaces to optimise care. PROSPERO REGISTRATION NUMBER: CRD42020158006.

Using simple agent-based modeling to inform and enhance neighborhood walkability.

BACKGROUND: Pedestrian-friendly neighborhoods with proximal destinations and services encourage walking and decrease car dependence, thereby contributing to more active and healthier communities. Proximity to key destinations and services is an important aspect of the urban design decision making process, particularly in areas adopting a transit-oriented development (TOD) approach to urban planning, whereby densification occurs within walking distance of transit nodes. Modeling destination access within neighborhoods has been limited to circular catchment buffers or more sophisticated network-buffers generated using geoprocessing routines within geographical information systems (GIS). Both circular and network-buffer catchment methods are problematic. Circular catchment models do not account for street networks, thus do not allow exploratory 'what-if' scenario modeling; and network-buffering functionality typically exists within proprietary GIS software, which can be costly and requires a high level of expertise to operate. METHODS: This study sought to overcome these limitations by developing an open-source simple agent-based walkable catchment tool that can be used by researchers, urban designers, planners, and policy makers to test scenarios for improving neighborhood walkable catchments. A simplified version of an agent-based model was ported to a vector-based open source GIS web tool using data derived from the Australian Urban Research Infrastructure Network (AURIN). The tool was developed and tested with end-user stakeholder working group input. RESULTS: The resulting model has proven to be effective and flexible, allowing stakeholders to assess and optimize the walkability of neighborhood catchments around actual or potential nodes of interest (e.g., schools, public transport stops). Users can derive a range of metrics to compare different scenarios modeled. These include: catchment area versus circular buffer ratios; mean number of streets crossed; and modeling of different walking speeds and wait time at intersections. CONCLUSIONS: The tool has the capacity to influence planning and public health advocacy and practice, and by using open-access source software, it is available for use locally and internationally. There is also scope to extend this version of the tool from a simple to a complex model, which includes agents (i.e., simulated pedestrians) 'learning' and incorporating other environmental attributes that enhance walkability (e.g., residential density, mixed land use, traffic volume).