Therapeutic Garden Design in Hospice Settings: A Case Study Employing the Lake Superior Hospice Garden in Marquette, MI

Gardens have been used as places for meditation, relaxation, and restoration through the ages. From the earliest times, gardens were used as sanctuaries and restorative places, providing psychological, spiritual, emotional, and physical health care delivery in Western, Eastern, and Asian societies. In the late twentieth century Roger Ulrich’s (1984) scientific investigations showed the tie between nature’s positive effects on human health and the ability of patients to recover from surgery faster. This and other scientific research gave rise to the creation of therapeutic gardens in healthcare facilities. Today, therapeutic gardens are designed to meet medical goals through activities known to improve human health—e.g., walking, socializing, massage therapy, etc. The intent is to support the patient’s recovery in the medical environment, and to provide positive measurable results (Gerlach-Spriggs & Healy 2009). Conventional wisdom suggests that the most effective therapeutic gardens tend to be designed for a specific patient group, and those surrounding the patient—i.e., medical staff, family members, and care givers. Specific activities can be designed into a therapeutic garden that match the standards of care and therapeutic outcomes defined for a patient group. These may include: walking (physical therapy), planting (horticulture therapy), smelling (aroma therapy), viewing flowers and plants (chromotherapy, cognitive therapy), and all other therapeutic treatments aided by nature. Since a therapeutic garden often targets the deficits of specific patient groups, they oftentimes are not designed alike nor do they follow the same guidelines. This project identifies tests the idea that therapeutic gardens should be designed for the primary patient population and/or the secondary support personnel that care for a patient; it uses a hospice garden to test whether this notion of unique design is appropriate within the broader specialty area of therapeutic garden design. This professional paper is an exploratory study that examines the distinct benefits that a garden provides under hospice conditions. Unlike more traditional therapeutic gardens, the primary user group—i.e., the patient—quickly fades from the program elements, leaving three distinct secondary populations to being served—medical staff, family members, and care givers. Understanding the desired outcomes for these three populations helped the author broaden her knowledge and appreciation of the relationship between, and among, health care delivery, therapeutic garden goals/objectives, and standard treatment protocols. It is for this reason that this study attempted to define when standard therapeutic garden design protocols and goals are appropriate, and when the designer must go to a broader set of goals and objectives that address the health and wellbeing of a secondary “patient” group—i.e., those medical staff, family, and care giver who have been left behind. This paper is organized into four parts—a literature review, methodology section, data findings, and a conclusions chapter. The literature review section presents a general history of garden use in the treatment of patients and contemporary thoughts on gardens in health care delivery. It also discusses current needs for therapeutic gardens in hospice care, since hospice is the final stage in palliative care delivery. The methodology chapter begins with a typical request for a design project with solution, involving the Lake Superior Hospice Association and their property in Marquette, MI. At that time, a preliminary set of plans were completed, using the typical questions a designer would address with a client. Among the questions to be addressed were what are the specific characteristic of this hospice; what do we know about its users and their needs in terms of garden program? To broaden out an understanding of hospice environments, this preliminary set of plans were set aside to pursue a second and third phase of inquiry involving this evaluation of four other hospice facilities and their users in order to develop baseline data on the similarities and differences in hospices. It allowed the author to define a broader base of personal, professional and/or therapeutic benefits a hospice garden might provide to its users; it also identified other needs that hospices might have that were different from the Lake Superior case study. The chapter on data findings summarizes the investigation into hospice similarities and differences and is applied to the Lake Superior Hospice (LSH)Association) in Marquette, MI in a final set of plans which can be found in the conclusions chapter. The paper essentially involved studying the pre-construction condition of a site with a narrow perspective on hospice garden design, which was then followed by a broader investigation of hospice facilities operating elsewhere, and using that data to suggest possible improvements (i.e., a metaphoric post-construction evaluation) in the original design that serves the LSHA more appropriately. This project will contribute to the advancement of landscape architecture as it continues its transition to an evidence-based profession. Findings from the case study and baseline data comparison was used to create a conceptual framework for decisions affecting garden design that serves patients, patient advocates, and hospice staff, who deal with end-of-life circumstances. The appropriateness of certain design elements under different hospice conditions—structurally, environmentally, managerially, and demographically – must be taken into account. This will provide better design outcomes that can be used to compare and analyze the decisions affecting therapeutic gardens in a hospice healthcare system

Networks of Opportunity: A Citywide Vision for Pedestrian and Bicycle Pathways in Chicopee, Massachusetts

The goal of the Master of Regional Planning Studio is to develop a student’s techniques for collecting, analyzing, and synthesizing spatial and non-spatial data and then presenting that collective data in a manner (i.e., report, video, presentation, and charettes) that is understandable to academics, professionals, and the public. Planning Studio allows students to integrate knowledge from coursework and research, and apply such knowledge to resolving representative planning problems. At UMASS Amherst, these problems are found in neighborhood, rural, urban, and/or regional settings. In the fall of 2016, the City of Chicopee gave the Regional Planning Studio four directives that aim to increase local and regional connections for the City’s pedestrians and bicyclists. The directives are as follows: A delineation of sectors, or cohesive spatial sub-units, that will divide the City and serve as the backbone of a vision for pedestrian and bicycle networks. The definition of key destinations within each of these sectors, which will serve as nodes to connect the districts. The creation of proposed paths, which will function as connections between destination points. Public engagement centered on soliciting input from community members and stakeholder groups impacted by safe walking and bicycling routes to school. These directives stem from the Chicopee Planning Department’s observation that the City’s data pedestrian access illustrate highly inconsistent and incomplete sidewalk network. These conditions have resulted in pedestrian access challenges to major local destinations including schools, recreational facilities, commercial areas, services, and surrounding communities. Networks of Opportunity: A Citywide Vision for Pedestrian and Bicycle Pathways in Chicopee, Massachusetts aims to improve pedestrian and bicyclist safety by suggesting paths that transverse the city, infrastructure improvements to make key roads safer for all users, and highlight local recreational and cultural opportunities for community residents

Search for gravitational-lensing signatures in the full third observing run of the LIGO-Virgo network

Gravitational lensing by massive objects along the line of sight to the source causes distortions of gravitational wave-signals; such distortions may reveal information about fundamental physics, cosmology and astrophysics. In this work, we have extended the search for lensing signatures to all binary black hole events from the third observing run of the LIGO--Virgo network. We search for repeated signals from strong lensing by 1) performing targeted searches for subthreshold signals, 2) calculating the degree of overlap amongst the intrinsic parameters and sky location of pairs of signals, 3) comparing the similarities of the spectrograms amongst pairs of signals, and 4) performing dual-signal Bayesian analysis that takes into account selection effects and astrophysical knowledge. We also search for distortions to the gravitational waveform caused by 1) frequency-independent phase shifts in strongly lensed images, and 2) frequency-dependent modulation of the amplitude and phase due to point masses. None of these searches yields significant evidence for lensing. Finally, we use the non-detection of gravitational-wave lensing to constrain the lensing rate based on the latest merger-rate estimates and the fraction of dark matter composed of compact objects

Search for eccentric black hole coalescences during the third observing run of LIGO and Virgo

Despite the growing number of confident binary black hole coalescences observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that were already identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total mass M>70 M⊙) binaries covering eccentricities up to 0.3 at 15 Hz orbital frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place an upper limit for the merger rate density of high-mass binaries with eccentricities 0<e≤0.3 at 0.33 Gpc−3 yr−1 at 90\% confidence level

Ultralight vector dark matter search using data from the KAGRA O3GK run

Among the various candidates for dark matter (DM), ultralight vector DM can be probed by laser interferometric gravitational wave detectors through the measurement of oscillating length changes in the arm cavities. In this context, KAGRA has a unique feature due to differing compositions of its mirrors, enhancing the signal of vector DM in the length change in the auxiliary channels. Here we present the result of a search for U(1)B−L gauge boson DM using the KAGRA data from auxiliary length channels during the first joint observation run together with GEO600. By applying our search pipeline, which takes into account the stochastic nature of ultralight DM, upper bounds on the coupling strength between the U(1)B−L gauge boson and ordinary matter are obtained for a range of DM masses. While our constraints are less stringent than those derived from previous experiments, this study demonstrates the applicability of our method to the lower-mass vector DM search, which is made difficult in this measurement by the short observation time compared to the auto-correlation time scale of DM

Eficiencia de mercado en la bolsa chilena

Tesis (Ingeniero en Administración de Empresas)"El mercado de capitales es un conjunto de mercados formales e informales formado por instituciones e instrumentos de financiación e inversión. En estos mercados existe transferencia de recursos desde aquellos agentes económicos que tienen superávit de recursos financieros hacia aquellos que necesitan cubrir déficit de recursos financieros . Por esta razón el mercado de capitales es esencial para asignar eficientemente los recursos de ahorro hacia los distintos proyectos de inversión que crean empleo y riqueza para los chilenos. En los últimos años, el mercado de capitales chileno ha experimentado un fuerte crecimiento gracias a un conjunto de políticas económicas que se han implementado, constituyendo una defensa contra las turbulencias financieras sufridas recientemente en los mercados internacionales. La hipótesis de los mercados eficientes tiene importantes implicaciones para la teoría financiera, tanto en el contexto de los mercados financieros y las decisiones de los inversores individuales, como en el ámbito de la dirección financiera de la empresa. Si los mercados son eficientes, los precios reflejan toda la información disponible sobre el valor intrínseco de cada título, protegiendo al inversor de los posibles efectos perjudiciales que se podrían dar por falta de conocimiento o experiencia sobre el funcionamiento del mercado. Es así como un mercado eficiente es un mercado equitativo en el que todos los inversores, especializados o no, tienen el mismo grado de información y, por tanto, tienen las mismas posibilidades de ganar o perder. La predicción en el cambio de precios siempre ha sido un tema de gran importancia en el estudio de las finanzas, esto se refleja en la hipótesis de la caminata aleatoria, el cual indica que el movimiento de precios de los activos financieros es imprevisible o recorre un camino aleatorio, es decir, no hay ninguna tendencia perceptible en el movimiento de los activos. Si esta tendencia existiera, los inversores podrían utilizarla para poder obtener beneficios extraordinarios. Esto nos llevaría a la problemática de la eficiencia de mercado, la cual indica que este tipo de mercado es clave para la determinación del precio real de los activos, así las empresas y los inversionistas deberán esperar recibir solo un precio justo por los activos financieros que se ponen en venta en el mercado. El mejor indicador de un mercado de capitales es su grado de liquidez, un mayor grado de liquidez se traduce en primer lugar en una reducción del riesgo de no poder liquidar la inversión. Así también, una mayor liquidez genera una externalidad positiva puesto que genera una mayor confianza en el mercado como indicador del verdadero valor de las empresas y una menor probabilidad de enfrentar abusos y manipulaciones de precios. La mayor liquidez y la confianza en el mercado se retroalimentan mutuamente en un círculo virtuoso. Lo anterior nos lleva a preguntar ¿Existe eficiencia de mercado en la Bolsa Chilena? El presente Seminario de Título pretende estudiar y analizar esta interrogante, para ello se investigaran las Normas, Organismos y Marco Regulatorio del Mercado de Capitales chileno. Además, en este mismo sentido nos enfocaremos en la Bolsa de Comercio de Santiago de Chile, por que es ella la que concentra históricamente la organización del Mercado de Valores en Chile. En segundo punto, analizaremos el complemento de lo descrito anteriormente a través de una de las maneras en que se manifiesta la eficiencia de mercado a través del Test de los Signos, Test de Hurst, Test Durbin Watson y el Test Kolmogorov-Smimov. Todo esto nos dará una aproximación para saber si existe eficiencia de mercado en la Bolsa de Comercio de Santiago

El rol de la familia en la educacion del nino (a)

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Longitudinal assessment of bacterial vaginosis prior to and during incident pregnancy: an observational study in Kenyan adolescent girls and young women

Objective To determine bacterial vaginosis (BV) status at multiple time points among adolescent girls and young women (AGYW) and assess the impact of pregnancy on their BV status.Design Longitudinal cohort study.Setting Thika, Kenya.Participants AGYW aged 16–20 years enrolled prior to first sex or reporting only a single lifetime partner.Main outcome measures The primary outcome was relative risk (RR) of BV during pregnancy compared with before pregnancy by analysing longitudinal trends in BV over time. BV risk was estimated using Poisson regression models.Results A total of 121 AGYW became pregnant in the parent cohort and had BV results before, during or after pregnancy. Point prevalence of BV was 11.0% at visits >12 months pre-pregnancy, 13.0% at 3–12 months pre-pregnancy, 22.1% at <3 months pre-pregnancy and 13.4% during pregnancy. Compared with visits during pregnancy, RR of BV was 1.65 (95% CI: 1.00 to 2.71; p=0.05) at visits <3 months pre-pregnancy, 0.97 (95% CI: 0.62 to 1.52; p=0.90) at visits 3–12 months pre-pregnancy and 0.82 (95% CI: 0.44 to 1.53; p=0.53) at visits 12 months pre-pregnancy. An adjusted analysis including age, income, residence, date of first sex, recent sexual activity and positive sexually transmitted infection test resulted in small changes in risk estimates, with adjusted RR of BV of 1.66 (95% CI: 1.04 to 2.67; p=0.04) at visits <3 months pre-pregnancy compared with visits during pregnancy.Conclusions BV risk during pregnancy was lower than during the immediate pre-pregnancy period. Hormonal changes in pregnancy may reduce BV

Risk of COVID-19 after natural infection or vaccinationResearch in context

Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health