Temporary Places > Community Garden > Peaspark

Temporary Places is a community and art project in North Belfast at two interface areas, New Lodge and Skegoneill/ Glandore. This project (Jan 2013-ongoing) is a collaboration between New Lodge Arts
(lead administrative partner), PS2 (project curators) and Skegoneill & Glandore Common Purpose (community organisation). ‘Temporary Places’ was and still is a project about social and urban regeneration, partly through familiar strategies and activities and partly through more unorthodox, direct and creative interventions. It is an art and community project for all residents and the wider community.

There are several components to the project, but the key and ongoing element is to activate the empty spaces at the Skegoniell / Glandore Interface, by making a 'garden space' of creative activity - now known as Peaspark

Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative-evidence synthesis

Background:
Prolonged mechanical ventilation is associated with a longer intensive care unit (ICU) length of stay and higher mortality. Consequently, methods to improve ventilator weaning processes have been sought. Two recent Cochrane systematic reviews in ICU adult and paediatric populations concluded that protocols can be effective in reducing the duration of mechanical ventilation, but there was significant heterogeneity in study findings. Growing awareness of the benefits of understanding the contextual factors impacting on effectiveness has encouraged the integration of qualitative evidence syntheses with effectiveness reviews, which has delivered important insights into the reasons underpinning (differential) effectiveness of healthcare interventions.

Objectives:
1. To locate, appraise and synthesize qualitative evidence concerning the barriers and facilitators of the use of protocols for weaning critically-ill adults and children from mechanical ventilation;

2. To integrate this synthesis with two Cochrane effectiveness reviews of protocolized weaning to help explain observed heterogeneity by identifying contextual factors that impact on the use of protocols for weaning critically-ill adults and children from mechanical ventilation;

3. To use the integrated body of evidence to suggest the circumstances in which weaning protocols are most likely to be used.

Search methods:
We used a range of search terms identified with the help of the SPICE (Setting, Perspective, Intervention, Comparison, Evaluation) mnemonic. Where available, we used appropriate methodological filters for specific databases. We searched the following databases: Ovid MEDLINE, Embase, OVID, PsycINFO, CINAHL Plus, EBSCOHost, Web of Science Core Collection, ASSIA, IBSS, Sociological Abstracts, ProQuest and LILACS on the 26th February 2015. In addition, we searched: the grey literature; the websites of professional associations for relevant publications; and the reference lists of all publications reviewed. We also contacted authors of the trials included in the effectiveness reviews as well as of studies (potentially) included in the qualitative synthesis, conducted citation searches of the publications reporting these studies, and contacted content experts.

We reran the search on 3rd July 2016 and found three studies, which are awaiting classification.

Selection criteria:
We included qualitative studies that described: the circumstances in which protocols are designed, implemented or used, or both, and the views and experiences of healthcare professionals either involved in the design, implementation or use of weaning protocols or involved in the weaning of critically-ill adults and children from mechanical ventilation not using protocols. We included studies that: reflected on any aspect of the use of protocols, explored contextual factors relevant to the development, implementation or use of weaning protocols, and reported contextual phenomena and outcomes identified as relevant to the effectiveness of protocolized weaning from mechanical ventilation.

Data collection and analysis:
At each stage, two review authors undertook designated tasks, with the results shared amongst the wider team for discussion and final development. We independently reviewed all retrieved titles, abstracts and full papers for inclusion, and independently extracted selected data from included studies. We used the findings of the included studies to develop a new set of analytic themes focused on the barriers and facilitators to the use of protocols, and further refined them to produce a set of summary statements. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to arrive at a final assessment of the overall confidence of the evidence used in the synthesis. We included all studies but undertook two sensitivity analyses to determine how the removal of certain bodies of evidence impacted on the content and confidence of the synthesis. We deployed a logic model to integrate the findings of the qualitative evidence synthesis with those of the Cochrane effectiveness reviews.

Main results:
We included 11 studies in our synthesis, involving 267 participants (one study did not report the number of participants). Five more studies are awaiting classification and will be dealt with when we update the review.

The quality of the evidence was mixed; of the 35 summary statements, we assessed 17 as ‘low’, 13 as ‘moderate’ and five as ‘high’ confidence. Our synthesis produced nine analytical themes, which report potential barriers and facilitators to the use of protocols. The themes are: the need for continual staff training and development; clinical experience as this promotes felt and perceived competence and confidence to wean; the vulnerability of weaning to disparate interprofessional working; an understanding of protocols as militating against a necessary proactivity in clinical practice; perceived nursing scope of practice and professional risk; ICU structure and processes of care; the ability of protocols to act as a prompt for shared care and consistency in weaning practice; maximizing the use of protocols through visibility and ease of implementation; and the ability of protocols to act as a framework for communication with parents.

Authors' conclusions:
There is a clear need for weaning protocols to take account of the social and cultural environment in which they are to be implemented. Irrespective of its inherent strengths, a protocol will not be used if it does not accommodate these complexities. In terms of protocol development, comprehensive interprofessional input will help to ensure broad-based understanding and a sense of ‘ownership’. In terms of implementation, all relevant ICU staff will benefit from general weaning as well as protocol-specific training; not only will this help secure a relevant clinical knowledge base and operational understanding, but will also demonstrate to others that this knowledge and understanding is in place. In order to maximize relevance and acceptability, protocols should be designed with the patient profile and requirements of the target ICU in mind. Predictably, an under-resourced ICU will impact adversely on protocol implementation, as staff will prioritize management of acutely deteriorating and critically-ill patients.

Protocolized versus non-protocolized weaning for reducing the duration of invasive mechanical ventilation in newborn infants: review

Background
Mechanical ventilation is a life-saving intervention for critically ill newborn infants with respiratory failure admitted to a neonatal intensive care unit (NICU). Ventilating newborn infants can be challenging due to small tidal volumes, high breathing frequencies, and the use of uncuffed endotracheal tubes. Mechanical ventilation has several short-term, as well as long-term complications. To prevent complications, weaning from the ventilator is started as soon as possible. Weaning aims to support the transfer from full mechanical ventilation support to spontaneous breathing activity.

Objectives
To assess the efficacy of protocolized versus non-protocolized ventilator weaning for newborn infants in reducing the duration of invasive mechanical ventilation, the duration of weaning, and shortening the NICU and hospital length of stay. To determine efficacy in predefined subgroups including: gestational age and birth weight; type of protocol; and type of protocol delivery. To establish whether protocolized weaning is safe and clinically effective in reducing the duration of mechanical ventilation without increasing the risk of adverse events.

Search methods
We searched the Cochrane Central Register of Controlled trials (CENTRAL; the Cochrane Library; 2015, Issue 7); MEDLINE In-Process and other Non-Indexed Citations and OVID MEDLINE (1950 to 31 July 2015); CINAHL (1982 to 31 July 2015); EMBASE (1988 to 31 July 2015); and Web of Science (1990 to 15 July 2015). We did not restrict language of publication. We contacted authors of studies with a subgroup of newborn infants in their study, and experts in the field regarding this subject. In addition, we searched abstracts from conference proceedings, theses, dissertations, and reference lists of all identified studies for further relevant studies.

Selection criteria
Randomized, quasi-randomized or cluster-randomized controlled trials that compared protocolized with non-protocolized ventilator weaning practices in newborn infants with a gestational age of 24 weeks or more, who were enrolled in the study before the postnatal age of 28 completed days after the expected date of birth.

Data collection and analysis
Four authors, in pairs, independently reviewed titles and abstracts identified by electronic searches. We retrieved full-text versions of potentially relevant studies.

Main results
Our search yielded 1752 records. We removed duplicates (1062) and irrelevant studies (843). We did not find any randomized, quasi-randomized or cluster-randomized controlled trials conducted on weaning from mechanical ventilation in newborn infants. Two randomized controlled trials met the inclusion criteria on type of study and type of intervention, but only included a proportion of newborns. The study authors could not provide data needed for subgroup analysis; we excluded both studies.

Authors' conclusions
Based on the results of this review, there is no evidence to support or refute the superiority or inferiority of weaning by protocol over non-protocol weaning on duration of invasive mechanical ventilation in newborn infants.

Theorizing temporary spatial clusters and institutional boundary-work in industrial markets

To better understand the nature of temporary spatial clusters (TSC’s) in industrial marketing settings, this conceptual paper first provides a theoretical synthesis of spatial understanding from the industrial marketing (IM) and economic geography (EG) fields, focusing particularly on Doreen Massey’s work on relational space. This leads to a conceptual schema for organizing the IM literature in terms of spatiality, and which also helps clarify the ontological nature of TSCs. We then move to introduce the notion of institutional boundary-work, drawing on the work of Thomas Gieryn, and Andrea Brighenti’s examination of territorology, to conceptualize the activities of market actors engaged in the ongoing social accomplishment of TSCs. Such activities, we suggest, involve these actors ‘marching’ boundaries to assume network influence and maintain market order in IM settings. In summary, therefore, our paper addresses two fundamental questions: i) How do we conceptualize the form of TSCs in IM settings? And, ii) what function(s) are TSCs performing (and how is this being undertaken) in IM? The paper closes by providing methodological guidance for how a research agenda on TSCs within IM activity might be developed, followed by a summary of the managerial implications that emerge from our theorizations.

Weaning from ventilation

Aims/purpose: Getting off the ventilator is an important patient-centred outcome for patients with acute respiratory failure. It signifies an improvement in patient condition, enables easier communication, reduces fear and anxiety and consequently a reduced requirement for sedatives. Weaning from ventilation therefore is a core ICU nursing task that is addressed in this presentation.
Presentation description: There are different schools of thought on when ventilator weaning begins including: (a) from intubation with titration of support; and (b) only when the patient’s condition improves. There are also different schools of thought on how to wean including gradual reductions in ventilator support to: (a) a low level consistent with extubation; or (b) to a level to attempt a spontaneous breathing trial followed by extubation if successful. Regardless of the approach, what is patient-relevant is the need to determine early when the patient may be ‘ready’ to discontinue ventilation. This time point can be assessed using simple criteria and should involve all ICU staff to the level of their experience. This presentation challenges the notion that only senior nurses or nurses with a ‘weaning course’ should be involved in the weaning process and proposes opportunities for engaging nurses with all levels of experience.
Conclusion: An ICU nursing taskforce that is focused and engaged in determining patient readiness for weaning can make a strong contribution to patient-relevant outcomes.

Protocolised weaning from mechanical ventilation: pairing a qualitative review with an effectiveness review

In our systematic review of protocolised weaning from mechanical ventilation (Blackwood 2014) we found significant heterogeneity that could not be explained by subgroup analysis (type of protocol, ICU). We suspected that factors unreported in the trials relating to context and mechanisms of using the weaning protocols contributed to the heterogeneity. Therefore we set out to conduct a Cochrane qualitative evidence-synthesis of ‘sibling studies’ (qualitative studies undertaken alongside the included trials that may have examined these factors) and ‘stand-alone’ qualitative studies reporting barriers and facilitators to successful implementation of weaning protocols. The qualitative review was novel, there were few templates or guidelines which challenged us to consider how best to synthesise and report this evidence. However, the benefits of conducting this review are that not only do we have a template for future qualitative syntheses for the ACE group, but specifically for trials of weaning protocols, we found context-specific evidence concerning if, how and why specific protocols have been effective in the settings in which they were delivered and received.

Compared with specialist registrars, experienced staff nurses shorten the duration of weaning neonates from mechanical ventilation

OBJECTIVE: To compare the overall performance of specially trained neonatal nurses acting autonomously, unsupervised, and without a protocol with specialist registrars when weaning neonates from mechanical ventilation.

DESIGN: Prospective, randomized, controlled trial.

SETTING: A single neonatal intensive care unit.

PATIENTS: Neonates requiring conventional mechanical ventilation (n = 50).

INTERVENTIONS: Infants on conventional ventilation were randomly assigned to receive either nurse-led (n = 25) or registrar-led (n = 23) weaning. A total of 48 infants completed the study (two infants in the registrar group were excluded when their parents withdrew consent).

MEASUREMENTS AND MAIN RESULTS: The main outcome measure, median weaning time, was 1200 mins (95% confidence interval [CI], 621-1779 mins) in the nurse group and 3015 mins (95% CI, 2650-3380 mins) in the registrar group (p = .0458). The median time from treatment assignment to the first ventilator change was 60 mins (95% CI, 52-68 mins) in the nurse group and 120 mins (95% CI, 103-137 mins) in the registrar group (p = .35). On average, the nurses made ventilator changes every 4.5 hrs (95% CI, 2.9-6 hrs) and the registrars every 7.2 hrs (95% CI, 5.4-9 hrs; p = .003). The median number (range) of backward steps taken per infant was 0 (0-5 steps) in the nurse group and 1 (0-5 steps) in the registrar group (p = .019).

CONCLUSIONS: The findings of this study suggest that additional domains of neonatal critical care could be reviewed for their potential transfer to appropriately prepared nurses.

Gazing at Ground Zero: Tourism, Voyeurism and Spectacle

This essay uses the temporary viewing platform at the site of the former World Trade Center to explore our fascination with violence, conflict and disaster. It illustrates how discourses of voyeurism and authenticity promote a desire for sites of horror, and examines how that desire both disrupts and reinforces our prevailing interpretations of global politics. The viewing platform at Ground Zero was initially constructed to manage the thousands of people who traveled to New York in response to the shocking media images of 11 September. However, their desire to escape mediation and touch "the real" had the opposite effect - it transformed Ground Zero into a tourist attraction. Using Ground Zero as a starting point, this essay theorizes discourses of voyeurism and authenticity through the work of Baudrillard, Debord and Bauman in an effort to position the tourist as a significant political subject.

Creative Activism: a pedagogical and research tool

Environmental activism has a long history in protest, addressing issues of degradation and segregation that threaten existing ecologies, social and built fabrics. Environmental activism is traditionally understood as a reaction, chiefly by groups of people, against a perceived external threat. In the 60’s and 70’s, an activist stance began to emerge in the work of some artists and architects, who used creative methods such as performances, happenings, temporary spatial interventions etc to convey their political/aesthetic messages. Some of this work engaged directly with communities but predominantly it was the production of one individual working ‘outside’ society. However such actions demonstrated not only the power of the visual in conveying a political message but also the potential of conceptual creative approaches to reveal alternative values and hidden potentials. This marked a shift from activism as protestation towards an activism of reconceptualisation. Recently, activist groups have developed a more politically informed process. Whilst their ‘tools’ may resemble work from the 60’s and 70’s , their methodologies are non-traditional, ’rhizomatic’, pedagogical and fluid; working alongside, rather than against, the established power and funding structures. Such creative processes build new, often unexpected, stakeholder networks; offer neutral spaces in which contentious issues can be faced; and create better understanding of values and identities. They can also lead to permanent improvements and development in the physical fabric. This paper will discuss a pedagogical example of activism in architectural education. The event (www.fourdaysontheoutside.com) is in its fifth year of existence and as such has revealed a value and impulse beyond its learning and teaching value. The paper will discuss how the event contributes to the university’s outreach programme and how its structure acts as a seedbed for potential research projects and partnerships. UK Universities talk extensively about applied research but have few actual strategies by which to generate it. Fourdaysontheoutside offers some potential ways forward.

From Rights to Compassion: The D Case and Contemporary Abortion Politics

This chapter is concerned with exploring the dynamics of contemporary debate on women’s reproductive choices and rights in the somewhat transformed social, political and economic context of the Republic of Ireland. News coverage of the events of April and May 2007 provide the focus of attention, as the case of ‘D’, a 17 year old in the temporary care of the state, seeking to terminate her pregnancy after a diagnosis of severe foetal abnormality, became yet again a focus of public debate on abortion access within the state. The analysis explores how the issues this case raised were framed in the public domain, in order to consider the shifting moral grammar shaping the debate. The paper explores the ways in which this case illustrates the ongoing tensions between changing characterisations of Irishness, and the social dynamics of access to reproductive rights, particularly for national minors in the care of the state.

Hiring Incentives and Labour Force Participation in Italy

A long-standing economic tradition maintains that labour supply reacts to market tightness; its sensitivity to job quality has received less attention. If firms hire workers with both temporary and open-ended contracts, does participation increase when more permanent jobs are available? We investigate this relationship within a policy evaluation framework; in particular, we examine how labour supply reacted in Italy to a recent subsidy in favour of open-ended contracts. This subsidy increased labour force participation by 1.4% in 2001 and 2.1% in 2002. This increase was concentrated on males aged 35-54, with a low or at most a secondary schooling level.