Impact case study database

By placing both leading and emerging practitioners, curators, and theorists from across art, design and architecture alongside each other, EP [3.1, 3.2.] brought agents within the creative economy into contact for the first time, instigating new creative approaches. The EP series demonstrated a new awareness of the potential of the transdisciplinary and support of practices that did not entirely fit previous understandings of disciplines as singular. Prior to EP, when reading about their subject, creative practitioners read mostly image driven, discipline-specific publications; while academics adhered to text driven journals and books. EP changed this by providing a common ground in publishing for creative practitioners, curators, researchers and the spectrum of practices in between. In so doing, the publication of EP Vol 1 in 2013 [3.1.] facilitated a fertile space for new collaborations and an opportunity to challenge existing limitations that maintained strict disciplinary boundaries. As stakeholders, the Victoria & Albert Museum, the Venice Biennale, Harvard Design Magazine and Sternberg Press were all able to utilise the findings of EP to bring further benefits for their audiences and networks.

Instigating A Positive Shift in the Creative Economy: Curating

The impact of EP was immediately felt following the publication of Vol. 1, as it provided inspiration for the development of a new design exhibition. In 2014, after reading EP Vol. 1 ‘The Italian Avant-Garde: 1968-1976’, the Chief Curator of the Venice Architecture Biennale, invited Coles’ co-editor, Associate Professor in Design History, Kingston University, to curate a portion of the biennale based on the premise of EP Vol. 1 – a transdisciplinary examination of Italian art, design and architecture - that Coles had shaped. This went on to alter Coles’ co-editor’s approach to curation and editorial projects, as she reflects, “Co-editing the Italian Avant-Garde was a valuable experience, that informed my subsequent participation in the 2014 Venice Architecture Biennale, where I curated an installation on Space Electronic. It was the Chief Curator of the Venice Architecture Biennale’s awareness of the EP book - specifically the chapter on Space Electronic - that led to the invitation to propose an installation for the Biennale’ in the first place” [5.1]. The 2014 Biennale included sixty-five participating nations and attracted 228,000 visitors and the Space Electronic section contributed to the way the biennale broadened the discussion of architecture to include previously neglected social spaces within architectural discourse, such as nightclubs. Coles’ co-editor’s chapter in Vol. 1 then became the premise of an entire exhibition she developed with Vitra Design Museum in 2018 devoted to nightclub design, a previously unexplored area in a gallery setting, titled ‘Night Fever: Designing Club Culture – 1960 To Today’.

Director of Programs at the Victoria & Albert Museum, the world’s largest museum of design and the decorative arts, Sophie McKinlay, attests to how “EP as a publication has led by example. V&A Dundee has used this publication in reading groups and to develop a more transdisciplinary programme which broadens the definition of design. Where in the past the V&A isolated design from art and architecture, it now endeavours to link them together, with a view to enhancing their creative possibilities. This represents a major epistemological shift in strategy for us, to a point whereby curatorially we now approach subjects and themes from a transdisciplinary perspective. EP has triggered a shift to a more expansive definition of design and as a result we have programmed exhibitions such as Hello, Robot: Design Between Human and Machine (November 2019-February 2020) which investigated the subject of robotic technology from multiple perspectives employing art, design and architecture.” McKinlay concludes: “This perspective has meant that in 2019 we attracted over 350,000 visitors to the museum as a result of this type of programming, an increase of 20% over projected figures.” [5.2.].

Transforming Approaches in the Commercial Economy for the Better: Editing and Publishing

EP’s distinctive approach led to the in-house editor at Sternberg Press, to subsequently redevelop the independent publication Harvard Design Magazine. When it was relaunched in 2014, the publication was transformed from being a text driven, academic journal exclusively devoted to design, to an award-winning magazine, which balances image and text to address a range of transdisciplinary topics. This approach of balancing image and text, drew in non-academic readers who would not have engaged previously with a text heavy publication. The editor of Harvard Design Magazine refers to how, “We completely reimagined the editorial purview and design direction of the magazine. EP was, and remains, a critical touchstone for how I approached the redesign process and all future issues of the magazine. It [the changes made after reading EP] had a massive effect on readership and reach, which increased from 10,000 copies per issue to 14,000” [5.3.].

Prior to 2016, the Berlin based publisher of EP, Sternberg Press, founded in 1999 by Caroline Schneider, focused exclusively on art theory and practice, but since the success of the first two volumes of EP they have expanded this area of their publishing portfolio. “Prior to working on EP,” comments Schneider, “our catalogue focused on art and its theorization. In 2013, we began incorporating aspects of both design and architecture, and since 2016 have commissioned accumulatively more titles that examine themes and trends common to art, architecture and design. Titles like ‘Design by Accident’ (2019) and ‘Materialisation in Art & Design’ (2019) have brought in the region of 1000 new readers to Sternberg Press per design themed title. With one new design title published every month, this means 12,000 new readers each year” [5.4.]. This illustrates the key role EP has played in leading a new way for knowledge to be gathered in publication format, set to continue with the publication of EP Vol. 3 ‘Post-Craft’, in April 2021.

Impact on Awareness and Understanding

Over 10,000 copies of EP have to date been printed and sold across Europe, the Americas and Asia by Sternberg Press’ distributor MIT Press. It is sold in museums and galleries of international renown including Tate Modern (London), MoMA (New York), Pompidou (Paris), Moderna Museet (Stockholm), LACMA (Los Angeles), the Stedelijk Museum (Amsterdam), and the New National Gallery (Berlin).

This impact on awareness and understanding has been demonstrated in the positive reviews

EP1 received. The world-leading New York Times design critic, Alice Rawsthorn, commented in the 26.05.2013 issue of the newspaper that EP “reminds us of the movement’s prescience in championing design’s social and ecological responsibilities, the importance of collaboration and self-expression, and other burning issues for designers today” [5.5.]. The Times Literary Supplement critic John Foot commented in the 21.06.2013 issue of paper that “The images and the range of work presented [in EP1] are fascinating and stimulating, and provide a strong basis for future editions of this enterprising journal-book series.” [5.6] Further reviews appeared in Icon magazine: “All this, and more, is covered in this quaffable first volume of the new series EP (Extended Play). It’s more an introductory text than deep analysis, but as there is surprisingly little published in English on this period…it hits a sweet spot.” [5.7.] and The Design Journal [5.8].

.

Hair loss/CIA is one of the most traumatic aspects of chemotherapy treatment, negatively impacting a patient’s quality-of-life, psychological well-being, body image and social relationships. The fear of hair loss causes up to 8% of patients to consider declining potentially lifesaving, chemotherapy treatment ( Marks et al. 2019). Overall incidence of CIA is 65% of chemotherapy patients with 65,000 UK patients and 3.12M worldwide affected annually.

This research has had global-reaching impacts, and was integral to International Regulatory Body Approval (2017-2019). The research has benefitted both patients and clinicians globally, significantly enhancing patient wellbeing, and internationally increasing patient and clinical access to effective scalp cooling treatment, since product launch in 2017. Furthermore, increased awareness has resulted, for the general public and clinical/research fields. Commercially, this research has facilitated SME Paxman to become the Global Leader in the scalp cooling field [a].

International regulatory approval: The patented, award-winning cap [b] was designed within the strict international regulatory framework producing a product suitable for a global market and facilitating successful regulatory approval internationally, including FDA (USA, 2017), Shonin (Japan, 2019), TFDA (Taiwan, 2017) and Brazil (Market Registration June 2019). Subsequent expanded regulatory approval (FDA 2018) further increased the number of patients able to benefit from Paxman scalp cooling, to include patients with solid tumours, as well as breast cancer.

Increased clinical/patient access & production: By revolutionising the design and cap manufacturing process, this research increased production rates by 670% and reduced production costs by 39% [a]. This has dramatically improved the company’s capability to reach more clinics and patients globally, increasing the clinical availability and patient access to effective scalp cooling treatment. Designing the cap for a global market has increased the treatment options for patients internationally, even reaching clinics where no form of scalp cooling was previously offered [e,f]. Prof. M. Toi MD, Director of the Breast Cancer Unit, Kyoto University Hospital Japan, stated ‘We started using Paxman Scalp Cooling caps at Kyoto University Hospital in 2016, prior to this we did not offer scalp cooling device treatment. We found that this method could prevent alopecia remarkably’ [e]. The cap is now distributed to 54 countries, treating a minimum of 42,000 patients/year [a]. In the UK, Paxman now works with 98% of NHS and private hospitals [a]. Paxman have installed the highest number of scalp cooling systems/caps in the world with >3,500 systems in total, and >600 installed in the USA since 2017, reaching patients at 300 locations in 40 states [a] including the top five USA cancer centres (Honor Roll 2019-20). Until 2016, only manual caps were available to USA patients, which are not FDA-approved [c], the USA is now Paxman’s largest market, with a growth rate of 700% in the 2-years post FDA approval [a].

The revolutionary manufacturing approach enabled the creation of innovative designs, which were previously impossible to manufacture. Pioneering the use of 3D printed tooling in silicone sheet moulding batch production, paved the way for mass manufacture. This low-cost printed tooling also enabled affordable design adaptations for regulatory approvals, expediting route-to-market, and facilitated adaptations to address racial variations in head sizes/shapes. The Japanese head shape is more brachycephalic (rounded) than that of Caucasians. A Japan-based clinical trial ( The HOPE Study) initially utilised the Caucasian-fit cap for Asian patients but had reduced success rates, due to sub-optimal scalp-contact/fit. The manufacturing ability to rapidly/economically adapt the design to the more-rounded Asian head shape/size, significantly increased cap-fit for Asian patients [e]. These adaptations opened-the-door to the Japanese market, which is now Paxman’s second largest market. This research enabled Paxman to mass-manufacture a range of 6 cap sizes, addressing racial head shape/size variations and meet the needs of the global market [a]. Recently, Dr. S. Ohsumi MD, Chief of breast oncology, Shikoku Cancer Centre, Matsuyama, Japan, published clinical data which ‘found that the efficacy of scalp cooling, with the Paxman Scalp Cooling System, during chemotherapy infusion for hair loss mitigation in Asian women is similar to that in Caucasian women’ ( Ohsumi et al. 2020) [f].

Enhancing patient wellbeing: The superior design of the cooling-cap reduces the incidence and severity of CIA/hair loss by enhancing thermo-conductivity and scalp-contact, ensuring optimal fit and even cooling. Dr J. Nangia MD, Director Breast Cancer Prevention Program, Baylor College of Medicine USA and PI on the SCALP clinical trial, observed ‘This new cap design provides an enhanced fit which increases efficacy and hair retention rate’ [c]. Recent analysis of patient self-reported hair loss indicated a 15%-20% enhancement in treatment efficacy compared to previous Paxman cap versions [d]. Furthermore, conformation to a greater variety of head shapes/sizes increased treatment efficacy by accounting for racial variations in skull morphology (see above). Patient comfort has been enhanced due to the superior design providing a more ergonomic fit, utilising a softer, flexible silicone enhancing patient tolerability [d]. Prof. M. Toi, HOPE Study researcher & Internationally renowned breast cancer clinician, observed ‘Patient comfort is enhanced, less pressure applied on the chin strap, increasing the patient’s tolerability of scalp cooling & desire to continue scalp cooling treatment’ [e].

Highly significant impacts on patient wellbeing have resulted, quantified through an extensive user feedback analysis of >150 patients across 9 countries [d]. A significant impact was found in five key areas of wellbeing. Ninety-nine percent ( **99%**) of patients, who used this scalp cooling cap, reported some impact on their emotional wellbeing, with 93% stating a very significant/ significant impact on emotional wellbeing in addition to social activities (84%), work activities (77%), relationships with family and friends (70%) and physical/sporting activities (60%) [d]. The sub-themes of the personal impact are summarised in Fig. 3 [d]. USA-based patients commented: ‘It made me feel like I had control over something during a time when things felt completely out of control’, ‘I feel like scalp cooling let me keep my identity, rather than just being a cancer patient’ and ‘Scalp cooling was a way I could minimize the impact cancer has on my young children. It would be frightening to them if mom had no hair’ [d]. Providing patients with an empowering choice and ability to retain a sense of control, encourages positive attitudes towards their overall treatment. Patient confidentiality and work-loss: Retaining hair during chemotherapy provides patients with increased confidentiality. Studies have shown that 40% to 85% of all cancer patients have quit working while undergoing treatment ( Giligan et al. 2018). Removing the visual cues caused by CIA, increases patients’ privacy and choice regarding who to inform about their treatment. Patients report feeling able to continue working, reducing the financial burden. A USA-based patient reported 'The ability to keep my treatment private at work was priceless’ [d]. Longer-term patient outcomes: clinical research demonstrates that scalp cooling, using this cap, not only reduces hair loss but significantly improves post-treatment hair-regrowth and patient outcomes [e] ( Bajpai et al. 2019).

Clinicians and clinical approach: From a Health Economics perspective, nursing time investment is reduced compared to manual scalp cooling methods [c,e], where frozen caps have to be repeatedly replaced at regular intervals during a single treatment session.

The cap supports a patient-centric approach and the increasing importance placed on supportive care, aligning with the shift in clinical understanding, that the patient should be at the heart of the care pathway, not only treating the cancer but supporting the patient holistically. The Chairman of the Department of Breast Medical Oncology at The University of Texas MD Anderson Cancer Center said ‘This is another step forward in making cancer therapy more personalized and putting the patients in the driver’s seat as we create more options and pathways for our patients’ [i-3.2].

Along with their presence, Paxman's influence in the US has grown significantly. In a major step towards making scalp cooling more available in the US, through Paxman’s support the National Comprehensive Cancer Network® (NCCN) updated the Clinical Practice Guidelines in oncology for breast (V1.2019) and ovarian cancer (V1.2020) to include scalp cooling as a Category 2A recommendation [g]. Increasing access to effective scalp cooling provides the potential to reduce the 8% patients refusing chemotherapy due to hair loss fears, enhancing survival chances. Increased awareness: Increased cap production and patient/clinical access have been fundamental to an international awareness-building movement. Awareness of increased access to scalp cooling treatment has been raised by news articles spanning five continents regarding this cap and it’s associated clinical trails/FDA/launch, including high circulation outlets such as The New York Times [i-1.1]. High profile personalities, including BBC presenter, the late Rachel Bland, documented her chemotherapy and Paxman scalp cooling cap experience in her blog with 42k twitter followers and BBC podcast ‘YouMeBigC’ [g]. Accompanying Paxman’s growth has been a rebranding and launch of the ‘Changing the Face of Cancer’ [i-2.1] and ‘Clinical Pioneer Programme’ [i-2.2] to internationally increase awareness and tackle cancer stereotypes. Public awareness of scalp cooling has increased from an estimated 9% to 25% [i-2.1]. Clinicians in USA and India have presented/demonstrated the cap in online videos, reaching out to potential patients [i-1.2]. Clinical awareness has also increased with international scalp cooling research dissemination by leading clinicians, including ESMO 2019 (European Society for Medical Oncology: 25k participants), where research utilising the Paxman cap was presented by three separate teams from Italy, Ireland and India [i-3.3]. Dr. Unver’s team and Paxman have presented the cap extensively at conferences/exhibitions including Medtech 2015 & 2016 (>6k attendees) and Arab Health 2019 & 2016 (>100k attendees annually).

Commercial impact: The development of this product, globally recognised as the premier scalp cooling device, has had significant impacts for SME Paxman. The CEO of Paxman stated ‘The collaboration has been highly successful and has been an integral element to our company’s recent growth and success. We now dominate the market with an 80% share. Turnover has increased from £1.7M in 2015 to £9.35M in 2019, with a 47% increase between 2018-2019’ [a,j]. This growth is primarily due to expansion into 54 international markets with 80% of revenues now generated from overseas sales. ‘The US now represents our largest market. Growth rate in US was 700% for 2017-2018, with US turnover increasing from £0.225M (2017) to £1.58M (2018)’, ‘Paxman was listed on Nasdaq First North Growth Market in 2017, share value has increased by 466% (Q2-2017 to Q3-2019)’ [a]. UK-based employee numbers have increased by >300% since 2012 [a] and Paxman continue to grow as they launch into new international markets [j].

Fundamental to this growth has been the ability to mass-manufacture caps and reduced production-costs, which enabled the adoption of a new business model optimised for international markets [a]. The new business model, now implemented in two of the World’s largest healthcare markets, the US and Japan, ‘is based on a single-patient-use cooling cap, which was not achievable prior to this research. Unlike our historical capital equipment sales business model, this pay-per-cap approach provides the company with a reoccurring-revenue-stream and ultimately a sustainable business future’ [a]. A US subsidiary company was established in 2018 to meet the demands of the growing US market. Two joint patents providing IP protection for the cap design and manufacturing method, have been granted in the UK [3.6] and Japan [3.5], and published in USA, Europe and China. The economic impact of the research benefits British Industry, as both service provider and manufacturer.

In 2019, this successful collaboration led to the establishment of the World’s First Scalp Cooling Research Centre [i-3.3]. Based at UoH, it unites a multidisciplinary team from the School of Art, Design and Architecture and the School of Applied Sciences, with a £1M commercial investment.

Benefits to the locally-based cultural organisations, workers and audiences (activities, opportunities)

As part of this live action research project, the Temporary Contemporary initiative strengthened the conditions for cultural production in the town and demonstrated a strategy that increased the vibrancy of the high street, to the benefit of cultural organisations, cultural workers and audiences. The project began in 2018, in Queensgate Market, an important modernist landmark and retail destination in Huddersfield, when around 30-40 of the Market’s approx. 100 stalls were vacant. In 2019, the Piazza shopping centre, an area of high footfall in the town centre, had over 13 empty units. The vacant spaces in the market and the shopping centre were occupied during the research project by arts and cultural organisations including: West Yorkshire Print Workshop, Children’s Art School and Lawrence Batley Theatre at low or no cost (the rents, rates and utilities value of the spaces are around £700pcm) on a rolling, temporary basis that suited their project-based work. Crucially, the temporary nature of the occupation of the units was underpinned by a longer-term membership of the network, with joined up marketing and strategy meetings and a sense of shared identity, the further impacts of which are outlined below.

Prior to Temporary Contemporary, cultural sector workers based in Huddersfield and the surrounding region did not have regular opportunities to convene and plan future partnerships. The importance of Temporary Contemporary in strengthening the conditions for the creative sector is underscored by the Director for Northern Economy and Partnerships, Arts Council England, who writes: “Cultural practitioners that operate in Huddersfield are based over a wide geography – including Leeds, Manchester and Sheffield. It is important to have opportunities like the Temporary Contemporary happenings to meet and network in Huddersfield. It is critically important and shouldn’t be under-estimated” (5.1). This is reiterated by the Curator of Yorkshire Sculpture Park: “[ Temporary Contemporary] has created conditions for supporting arts and culture in Huddersfield, by embedding arts and culture within a wider ecology and cultivating a network of practitioners and organisations. This is a huge benefit to artists and organisations based outside of large cultural centres who may not otherwise have seen themselves as part of a critical mass” (5.2).

Specific cultural sector workers who have benefited from Temporary Contemporary include Victoria McCorkell, an independent arts development professional, who set up the ‘Parlour’ space in Queensgate market to provide artists with professional development training opportunities. McCorkell explains that Parlour has benefitted from sitting within Temporary Contemporary where it provides artist development support: “[being situated in an] open space in the heart of a community with links to Temporary Contemporary and an artistic and creative community led to new networks and relationships being formed in a short space of time [… Temporary Contemporary has] had a direct impact on our success to date” (5.3). Local artisan beverage businesses Magic Rock and Kwas have benefitted from promoting and selling their products at Temporary Contemporary events. Duncan Sime from Kwas confirmed that it had enabled them to reach new audiences and connect to other creatives: “The happenings have given us a platform and connected us with new audiences, it has been a networking opportunity – helping us spread the love!” (5.4).

The second phase of the project in the Piazza involved delivering joint programming and benefitted from the crossing-over of the arts organisations’ different audiences. The Director of WOVEN in Textiles organisation in Kirklees, which temporarily occupied a Piazza shopping centre unit, describes the impact of the programme in creating a community of cultural producers in Huddersfield: “The [second phase of Temporary Contemporary] is offering a unique opportunity to bring [diverse] organisations together as a collective voice. The partners may not naturally have come together, however, within the opportunity afforded to them they see the power in working together” (5.5).

In July 2020, between the April and November Covid-19 lockdowns in the UK, the project partners organised the event Temporary Contemporary: What’s Next? using the Zoom platform, to reflect on the first two years of programming and plan for the future, given what was already known about the likely effects of Covid-19 on Huddersfield. Following the event, around 15 beneficiaries (locally-based cultural organisations, workers and audiences who had participated in Temporary Contemporary) took the opportunity out of around 200 attendees to feed back to the partners about the first two years of programming and the vision for the future of the initiative in the context of Covid-19. Their feedback included that the initiative promoted: “Social collaboration and cohesion” and was “innovative and exciting”. Another said that the values they associated with the initiative were that it: “[filled] a gap in arts and visual culture that takes place outside the traditional arts venue [and had] power to support regeneration and cultural development” (5.6). The event confirmed the impacts of the initiative to date and helped to shape funding proposals for the onward development of the initiative, in the context of Covid-19 cultural recovery.

Changes to culture, society and environment in Huddersfield

During the period 2018-2020, Temporary Contemporary has increased the vibrancy of the market with: over 20 research exhibitions (some of which have toured internationally to China and New Zealand), music and artisan pop ups, exhibitions by emerging and mid-career artists and practitioners, undergraduate and postgraduate research showcases from the School of Art, Design and Architecture, providing opportunities for students to curate in the public realm, and a host of ‘happenings’ to create networking possibilities for cultural producers. These new activities both support the cultural life of the town and offer a solution to the changes happening on the high street. Audiences reported enjoying “the atmosphere, the space, the curation, the market as an example of classic modernist architecture” and remarked that the initiative added “character to what had become a dated market” (5.7).

Kirklees Council comprised the other main stakeholder and beneficiary group. Insights from the Temporary Contemporary programme fed directly into the Huddersfield Blueprint regeneration plan (5.8), as confirmed by the Creative Economy Manager of Kirklees Council and the Chief Executive of Kirklees Council (5.9, 5.10). The Blueprint is a 10-year vision, launched in 2019 to ‘create a thriving, modern town centre.’ The Creative Economy Manager of Kirklees Council writes: “Eighteen months into the [ Temporary Contemporary] programme and we have been extremely pleased with the results. The partnership has created a sustained, flexible, sensitive and cultural offer that supports place-based making. The perception of the indoor market has shifted from being seen as a building in a managed decline to now a building with potential – it has been identified as a site for cultural activity in the future of the town through its new master plan, The Huddersfield Blueprint”. […] Further to this, the insights and reflections of Art, Design and Architecture have provided a greater understanding of how creative spaces can contribute to wider place-based making” (5.9).

The Chief Executive of Kirklees writes, “For Kirklees Council, the most important insight generated through the Temporary Contemporary research initiative is the importance, not just of arts and culture in place-based-making, but in the close co-existence and negotiation of the arts with food, drink, sport, green spaces, retail and people – all of which, we believe, make a town centre thriving and attractive. [… Temporary Contemporary] benefits the community of artists and makers involved in the initiative, as well as the wider community” (5.10).

The Markets Manager corroborated other testimonials: “A huge benefit to the market, arising from the initiative, is that people can get involved and feel greater ownership of the market – a space that belongs to everyone. […] The occupation of the vacant market stalls has increased the vibrancy of the market. […] It has encouraged people to set up small businesses or events here – they can recognise that there is strength and value in setting up something new within an established community of traders and catering outlets. Temporary Contemporary has generated a change in people’s mindset about more established market contexts and what they can offer against a backdrop of changes on the British high street” (5.11).

Temporary Contemporary is now a core feature of Kirklees Council arts and culture planning. For example, it is embedded within a range of consortia, including the High Street Heritage Action Zone, to help strengthen the cultural offer of the high street, WOVEN in Kirklees and is now operating in collaboration with other space providers in Huddersfield to offer vacant/meanwhile spaces for a range of creative and cultural activities. The Temporary Contemporary partnership secured Innovation of the Year in the National Association of British Market Authorities awards in 2018 (5.12).