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Time and place are central concepts to the dynamic system and phenomenon of fashion. Yet, perhaps for the first time in history, fashion seems to be out of sync with the values, mindsets and wisdom of this time and this place. Despite fashion’s claim to be situated in the ‘now’ or an idealized future, much of what we think and know about clothing from production, design, aesthetics, use and disposal speaks to, and is from, another time and place ‐ the past ‐ when our relationship with and understanding of our place in nature and the earth was markedly different. Western exceptionalism has led to a superiority of thought and action, as we have deemed ourselves to be above and apart from nature. We behave like the planet’s resources and capacity are infinite and limitless, ours for the taking. An anthropocentric, reductionist, modernist, colonial, capitalist, materialistic growth logic has ruled our thinking, actions and conception of time and place. It is clear that the construction of this ‘place’ or system does not consider planetary boundaries or a multiplicity of voices, particularly Indigenous voices. This exploratory design article was conducted through the lens and methodology of Transition Design, and builds on the work of the Earth Logic Fashion Action Research Plan, to acquire new insights to develop a roadmap for change through recommendations for new models, methods and mindsets. As the models of the past have abruptly stopped or been put on hold by the COVID-19 pandemic, this article seizes this moment and this place to open new entry points for change. It asks us to deeply examine and reimagine the fashion system as part of nature, a ‘whole place’ that honours and is conscious of all worldviews and different modalities of time.

Background: Despite the importance of reducing treatment burden for people with cystic fibrosis (CF), it has not been fully understood as a concept. This study aims to quantify the treatment burden perceived by CF adults and explore the association between different validated treatment burden measures. Methods: This is a cross-sectional observational study of CF adults attending a single large UK adult center. Participants completed an online survey that contained three different treatment burden scales; CF Questionnaire-Revised (CFQ-R) subscale, CF Quality of Life (CFQoL) subscale, and the generic multimorbidity treatment burden questionnaire (MTBQ). Results: Among 101 participants, the median reported treatment burden by the CFQ-R subscale was 55.5 (IQR 33.3 – 66.6), the CFQoL subscale was 66.6 (IQR 46.6 – 86.6), and the MTBQ reversed global score was 84.6 (IQR 73.1 – 92.3). No correlation was found between respondents’ demographic or clinical variables and treatment burden measured via any of the three measures. All treatment burden measures showed correlations against each other. More treatments were associated with high treatment burden as measured by the CFQ-R, CFQoL subscales, and the MTBQ. However, longer treatment time and more complex treatment plans were correlated with high treatment burden as measured by the CFQ-R and CFQoL subscales, but not with the MTBQ. Conclusions: Treatment burden is a substantial issue in CF. Currently, the only available way to evaluate it is with the CF-specific quality of life measure treatment burden subscales (CFQ-R and CFQoL); both indicated that treatment burden increases with more treatments, longer treatment time, and more complex treatments.

IntroductionPatient preferences (PPs) are an important source of evidence in health technology assessment (HTA). However, a methodological framework to achieve their integration in decision-making is lacking. We aim to investigate the potential role of evaluative frameworks to integrate PP evidence into HTA and decision-making.MethodsWe undertook a scoping review to identify potential methodological frameworks to consider PP evidence in HTA and evidence of the acceptability of these frameworks for decision-makers. We searched PubMed, Cochrane, and the grey literature to identify relevant studies, reports, or guidance documents. We restricted our search to the use of PP rather than patient experience data and excluded articles solely relating to deliberative approaches.ResultsFrameworks identified as having the potential to integrate PP evidence included cost-utility analysis, cost-consequence analysis (CCA), the efficiency-frontier approach, and multi-criteria decision analysis. All have been used in various HTA contexts, but not necessarily for inclusion of PP evidence. Distinct benefits and challenges of integrating PP data were identified for each framework. These included the theoretical basis of the frameworks, their ability to consider non-health as well as health outcomes, and their ability to separate outcomes based on PPs from outcomes based on population preferences. There is limited evidence and no consensus on the application of these frameworks to consider PPs in HTA or on their acceptability for decision-makers. However, CCA has the advantage that it is both based on economic decision theory and it leaves patient preferences disaggregated from population preferences in an HTA.ConclusionsThe frameworks identified in this review offer potential approaches to systematically and transparently integrate PPs into HTA and decision-making. Based on the review findings, we propose a research agenda to explore the potential of CCA in particular. We anticipate that our findings will augment the recommendations of the Innovative Medicines Initiative PREFER project, which are expected to report in 2022.

Fashion, like all ecosystems, is complex and dynamic. The fashion system comprises intangible, and tangible aspects, all of which have significant consequences. The linear structure of this system, used throughout the twentieth century—referred to as ‘take, make and waste’—has set artificial boundaries and driven a wedge between players in this system. This has led to the global fashion, and textiles industry being one of the world’s most polluting industries, and overshadows the potential of the fashion system as a powerful vehicle for social and environmental change. Design can be key to reorienting the fashion system and bringing the disparate parts together. Design research, and practice can generate new ways of understanding, being, and doing ‘fashion’ that acknowledges the complexities and the varieties of fashion(s) in an authentic twenty-first-century context. This exploratory design paper incorporates a multidisciplinary mixed methods approach, and a systems lens to the fashion system to examine the boundaries of conventional fashion practice, to encourage more complex interrelationships between, and around garments. The theoretical framework is informed by systems thinking, and a critique of the paradigm of growth, in conjunction with the ‘four orders of design’. It invites us to ask, through design research, what a holistic, flourishing, responsible fashion and textiles system for the twenty-first century might look like, by widening the parameters of the fashion system in order to critically examine the tension between analytical and systematic thinking for fashion. This study acts as a catalyst for a conceptual model showing how the fashion system can reconnect, and fashion design can engage with a higher order of design to encompass sustainable practices.

In 2012 the company New Zealand Post and Kiwibank approached the Massey researchers with the declaration “‘We have a problem. We have a waste stream we would like to take responsibility for.” The company currently source around 9,000- 10,000 garments per year from a corporate uniform manufacturer which once they have reached their end of life; i.e. either worn-out, or obsolete after a redesign or a change in corporate branding; due to security issues, and to protect their corporate image, they are exported to Papua New Guinea to be disposed. This issue prompted Whitty and McQuillan to ask, can they as fashion researchers/designers develop a collaborative solution for step-change through social innovation with a corporate partner by extending their environmental responsibility? Can they adopt and implement new green business thinking (Niinimaki) to address these issues and develop alternative connections between design, manufacturing systems and consumption habits? Their response has been to establish a strategic enterprise/research innovation at the College of Creative Arts in Massey University called ‘Space Between’ (2015) that has led to a new business model for fashion design. It takes the form of design-led activism, exploring the potential of a ‘fashion incubator’ for fashion enterprise and research with an agenda to bring about 'positive change' in industry. It proposes a new social dimension for design practice, social development and for increased societal participation in the design process (co- design/pre-order/feedback fashion/crowd sourced). It will be oriented towards addressing sustainability issues such as resource depletion, consumption and production. The innovation incorporates Alastair FuadLuke’s framework for contextualising design activism (2009). The design actions and outputs will result in: information/communication (online, workshops, garment patterns etc), process (manufacturing/design techniques), action (design and production) and artefacts (garments). It will aim to find a sustainable balance (Niinimaki 2013) between the design, manufacturing and consumption of garments by reducing the speed, volume and impacts of ‘waste-ready’ global consumerism by examining the productservice system to transforming negative consumption and production patterns. It will enable designers (students/graduates/lecturers) to harness the ‘waste’ from industry to work together towards a shared goal. Space Between (2015) has the potential to make a meaningful contribution to the economic and social development of New Zealand and other communities globally because it utilises a ‘solution oriented design’ method of addressing waste stream from industry. It creates employment as a social enterprise in partnership with EarthLink; and provides an opportunity for students to integrate real world experiences into their learning.