Healing gardens in the Lady Cilento Children’s Hospital: Reflections on benefits, preferences and design from bench diaries

Background Interest in the use of healing gardens in healthcare settings to provide therapeutic benefits is increasing, however insight is needed to determine whether patients, patient families and friends, and staff who spend time in these gardens use these in the manner for which they were designed, and experience the benefits suggested by broader research in this field. Objective(s) Visitors to four of the LCCH gardens have left comments in ‘bench diaries’ (visitors books). Analysis of these comments yields valuable insights into the use of the gardens, enabling reflection on the design intent and outcomes and guidance regarding how the gardens might be better utilised, as well as a basis for further investigation into the use and value of the gardens. Method(s) Comments have been coded and analysed using a thematic analysis approach to identify patterns relating to the reasons for which people appear to come to the healing gardens; benefits they appear to receive from spending time there; and features and aspects of the gardens that they appear to appreciate in particular. Only comments related to the gardens have been used in this analysis, with all comments being deidentified. Outcome/Conclusion Comments left in the Adventure Garden and Secret Garden bench diaries were used for the analysis, as Staff Garden and Babies Garden bench diary comments did not relate to the garden. There were no negative comments relating to the gardens, other than one comment requesting additional benches. The vast majority of comments expressed gratitude for the space. The four most frequently observed themes from the comments left in the Secret Garden Bench Diary indicated that they were seeking ‘time out’ from their experiences of being at the hospital, a desire for a ‘dose of nature’ (greenery, beautiful garden, etc), and fresh air, and that the garden space provided a restorative experience to them in some manner. Comments in the Adventure Garden Bench Diary related predominately to the view. Analysis of the comments emphasises the importance of gardens providing multi-sensory experiences that significantly differentiate the space from the hospital ward and provide visitors with a sense of being away, of peacefulness, and of familiarity with the outside world. Positioning gardens with prospect, and solar aspect, appears important in these regards, as does the presence of visible greenery. Adequate seating in locations that provide pleasing views appears particularly important for staff and adult visitors. Whilst comments in the Bench Diaries did not indicate direct awareness of the stress and anxiety-reducing effects that research elsewhere has found from viewing plants and nature, however these effects may underpin many of these experiences that visitors did share.

Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial

Exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. The objectives of this research were to assess the impact of an exercise intervention in addition to routine evidence-based care on the healing rates, functional ability and health-related quality of life for adults with venous leg ulcers (VLUs). This study included 63 patients with VLUs. Patients were randomised to receive either a 12-week exercise intervention with a telephone coaching component or usual care plus telephone calls at the same timepoints. The primary outcome evaluated the effectiveness of the intervention in relation to wound healing. The secondary outcomes evaluated physical activity, functional ability and health-related quality of life measures between groups at the end of the 12 weeks. A per protocol analysis complemented the effectiveness (intention-to-treat) analysis to highlight the importance of adherence to an exercise intervention. Intention-to-treat analyses for the primary outcome showed 77% of those in the intervention group healed by 12 weeks compared to 53% of those in the usual care group. Although this difference was not statistically significant due to a smaller than expected sample size, a 24% difference in healing rates could be considered clinically significant. The per protocol analysis for wound healing, however, showed that those in the intervention group who adhered to the exercise protocol 75% or more of the time were significantly more likely to heal and showed higher rates for wound healing than the control group (P = 0·01), that is, 95% of those who adhered in the intervention group healed in 12 weeks. The secondary outcomes of physical activity, functional ability and health-related quality of life were not significantly altered by the intervention. Among the secondary outcomes (physical activity, functional ability and health-related quality of life), intention-to-treat analyses did not support the effectiveness of the intervention. However, per protocol analyses revealed encouraging results with those participants who adhered more than 75% of the time (n = 19) showing significantly improved Range of Ankle Motion from the self-management exercise programme (P = 0·045). This study has shown that those participants who adhere to the exercise programme as an adjunctive treatment to standard care are more likely to heal and have better functional outcomes than those who do not adhere to the exercises in conjunction with usual care.

'Hero to healing' drink driving program for Indigenous communities in Far North Queensland

Issue addressed: Alcohol-related road crashes are a leading cause of the injury burden experienced by Indigenous Australians. Existing drink driving programs are primarily designed for the mainstream population. The ‘Hero to Healing’ program was specifically developed with Indigenous communities and is underpinned by the Community Reinforcement Approach (CRA). This paper reports on the formative evaluation of the program from delivery in two Far North Queensland communities. Methods: Focus groups and semistructured interviews were conducted with drink driver participants (n = 17) and other Elders and community members (n = 8) after each program. Qualitative content analysis was used to categorise the transcripts. Results: The CRA appealed to participants because of its flexible nature and encouragement of rearranging lifestyle factors, without specific focus on alcohol use. Participants readily identified with the social and peer-related risk and protective factors discussed. Cofacilitation of the program with Elders was identified as a key aspect of the program. More in-depth discussion about cannabis and driving, anger management skills and relationship issues are recommended. Conclusions: Participants’ recognition of content reinforced earlier project results, particularly the use of kinship pressure to motivate younger family members to drink drive. Study findings suggest that the principles of the CRA are useful; however, some amendments to the CRA components and program content were necessary. So what?: Treating drink driving in regional and remote Indigenous Australian communities as a community and social issue, rather than an individual phenomenon, is likely to lead to a reduction in the number of road-related injuries Indigenous people experience.

Excimer laser refractive surgery : corneal wound healing and clinical results

Although the first procedure in a seeing human eye using excimer laser was reported in 1988 (McDonald et al. 1989, O'Connor et al. 2006) just three studies (Kymionis et al. 2007, O'Connor et al. 2006, Rajan et al. 2004) with a follow-up over ten years had been published when this thesis was started. The present thesis aims to investigate 1) the long-term outcomes of excimer laser refractive surgery performed for myopia and/or astigmatism by photorefractive keratectomy (PRK) and laser-in situ- keratomileusis (LASIK), 2) the possible differences in postoperative outcomes and complications when moderate-to-high astigmatism is treated with PRK or LASIK, 3) the presence of irregular astigmatism that depend exclusively on the corneal epithelium, and 4) the role of corneal nerve recovery in corneal wound healing in PRK enhancement. Our results revealed that in long-term the number of eyes that achieved uncorrected visual acuity (UCVA)≤0.0 and ≤0.5 (logMAR) was higher after PRK than after LASIK. Postoperative stability was slightly better after PRK than after LASIK. In LASIK treated eyes the incidence of myopic regression was more pronounced when the intended correction was over >6.0 D and in patients aged <30 years.Yet the intended corrections in our study were higher for LASIK than for PRK eyes. No differences were found in percentages of eyes with best corrected visual acuity (BCVA) or loss of two or more lines of visual acuity between PRK and LASIK in the long-term. The postoperative long-term outcomes of PRK with two different delivery systems broad beam and scanning laser were compared and revealed no differences. Postoperative outcomes of moderate-to-high astigmatism yielded better results in terms of UCVA and less compromise or loss of two more lines of BCVA after LASIK that after PRK.Similar stability for both procedures was revealed. Vector analysis showed that LASIK outcomes tended to be more accurate than PRK outcomes, yet no statistically differences were found. Irregular astigmatism secondary to recurrent corneal erosion due to map-dot-fingerprint was successfully treated with phototherapeutic keratectomy (PTK). Preoperative videokeratographies (VK) showed irregular astigmatism. However, postoperatively, all eyes showed a regular pattern. No correlation was found between pre- and postoperative VK patterns. Postoperative outcomes of late PRK in eyes originally subjected to LASIK showed that all (7/7) eyes achieved UCVA ≤0.5 at last follow-up (range 3 — 11 months), and no eye lost lines of BCVA. Postoperatively all eyes developed and initial mild haze (0.5 — 1) into the first month. Yet, at last follow-up 5/7 eyes showed a haze of 0.5 and this was no longer evident in 2/7 eyes. Based on these results, we demonstrated that the long-term outcomes after PRK and LASIK were safe and efficient, with similar stability for both procedures. The PRK outcomes were similar when treated by broad-beam or scanning slit laser. LASIK was better than PRK to correct moderate-to-high astigmatism, yet both procedures showed a tendency of undercorrection. Irregular astigmatism was proven to be able to depend exclusively from the corneal epithelium. If this kind of astigmatism is present in the cornea and a customized PRK/LASIK correction is done based on wavefront measurements an irregular astigmatism may be produced rather than treated. Corneal sensory nerve recovery should have an important role in the modulation of the corneal wound healing and post-operative anterior stromal scarring. PRK enhancement may be an option in eyes with previous LASIK after a sufficient time interval that in at least 2 years.

Variational Asymptotic Analysis of a Self-healing SMA Composite

A Shape Memory Alloy (SMA) wire reinforced composite shell structure is analyzed for self-healing characteristic using Variational Asymptotic Method (VAM). SMA behavior is modeled using a onedimensional constitutive model. A pre-notched specimen is loaded longitudinally to simulate crack propagation. The loading process is accompanied by martensitic phase transformation in pre-strained SMA wires, bridging the crack. To heal the composite, uniform heating is required to initiate reverse transformation in the wires and bringing the crack faces back into contact. The pre-strain in the SMA wires used for reinforcement, causes a closure force across the crack during reverse transformation of the wires under heating. The simulation can be useful in design of self-healing composite structures using SMA. Effect of various parameters, like composite and SMA material properties and the geometry of the specimen, on the cracking and self-healing can also be studied.

Gel Sculpture: Moldable, Load-Bearing and Self-Healing Non-Polymeric Supramolecular Gel Derived from a Simple Organic Salt

An easy access to a library of simple organic salts derived from tert-butoxycarbonyl (Boc)-protected L-amino acids and two secondary amines (dicyclohexyl- and dibenzyl amine) are synthesized following a supramolecular synthon rationale to generate a new series of low molecular weight gelators (LMWGs). Out of the 12 salts that we prepared, the nitrobenzene gel of dicyclohexylammonium Boc-glycinate (GLY.1) displayed remarkable load-bearing, moldable and self-healing properties. These remarkable properties displayed by GLY.1 and the inability to display such properties by its dibenzylammonium counterpart (GLY.2) were explained using microscopic and rheological data. Single crystal structures of eight salts displayed the presence of a 1D hydrogen-bonded network (HBN) that is believed to be important in gelation. Powder X-ray diffraction in combination with the single crystal X-ray structure of GLY.1 clearly established the presence of a 1D hydrogen-bonded network in the xerogel of the nitrobenzene gel of GLY.1. The fact that such remarkable properties arising from an easily accessible (salt formation) small molecule are due to supramolecular (non-covalent) interactions is quite intriguing and such easily synthesizable materials may be useful in stress-bearing and other applications.

Healing time for the growth of thin films on patterned substrates

The healing times for the growth of thin films on patterned substrates are studied using simulations of two discrete models of surface growth: the Family model and the Das Sarma-Tamborenea (DT) model. The healing time, defined as the time at which the characteristics of the growing interface are ``healed'' to those obtained in growth on a flat substrate, is determined via the study of the nearest-neighbor height difference correlation function. Two different initial patterns are considered in this work: a relatively smooth tent-shaped triangular substrate and an atomically rough substrate with singlesite pillars or grooves. We find that the healing time of the Family and DT models on aL x L triangular substrate is proportional to L-z, where z is the dynamical exponent of the models. For the Family model, we also analyze theoretically, using a continuum description based on the linear Edwards-Wilkinson equation, the time evolution of the nearest-neighbor height difference correlation function in this system. The correlation functions obtained from continuum theory and simulation are found to be consistent with each other for the relatively smooth triangular substrate. For substrates with periodic and random distributions of pillars or grooves of varying size, the healing time is found to increase linearly with the height (depth) of pillars (grooves). We show explicitly that the simulation data for the Family model grown on a substrate with pillars or grooves do not agree with results of a calculation based on the continuum Edwards-Wilkinson equation. This result implies that a continuum description does not work when the initial pattern is atomically rough. The observed dependence of the healing time on the substrate size and the initial height (depth) of pillars (grooves) can be understood from the details of the diffusion rule of the atomistic model. The healing time of both models for pillars is larger than that for grooves with depth equal to the height of the pillars. The calculated healing time for both Family and DT models is found to depend on how the pillars and grooves are distributed over the substrate. (C) 2014 Elsevier B.V. All rights reserved.

Phthalate mediated hydrogelation of a pyrene based system: a novel scaffold for shape-persistent, self-healing luminescent soft material

Two-component super-hydrogelation triggered by the acid-base interaction of a L-histidine appended pyrenyl derivative (PyHis) and phthalic acid (PA) was reported. The use of isomeric isophthalic or terephthalic acid or other comparable acids in place of PA does not lead to salt formation and therefore hydrogelation is not observed. Excimer formation of the pyrenyl unit has not been detected although the PyHis : PA = 1: 1 system undergoes extensive self-assembly in aqueous solution. The synergistic effect of intermolecular H-bonding forces, pi-pi stacking, electrostatic interactions, etc. is found to be responsible for robust hydrogel formation. Development of chiral supramotecular assemblies has been verified through circular dichroism spectroscopy. Morphological investigations involving the PyHis : PA = 1: 1 system show vesicular nano-structures with a definite bilayer width at relatively low concentrations. The latter fuses to construct coiled-coil left-handed helical fibers upon increase in the concentrations of the gelators. The intertwining of the resultant helical fibers eventually results in hydrogel formation. The probable bilayer packing in the self-assembled structures has been probed using X-ray diffraction (XRD) studies and lanthanide sensitization, which suggests that the polar imidazolium hydrogen phthalate unit of the gelator forms the head group and faces the hydrophilic water environment while the hydrophobic pyrenyl units sit inside the hydrophobic core of the bilayer. The hydrogel exhibits multi-stimuli responsiveness including thixotropic behavior. In addition, shape-persistent as well as rapid self-healing behaviour of the hydrogel was established. Furthermore load-bearing characteristics of the hydrogel have also been demonstrated.

Maze solving automatons for self-healing of open interconnects: Modular add-on for circuit boards

We present the circuit board integration of a self-healing mechanism to repair open faults. The electric field driven mechanism physically restores fractured interconnects in electronic circuits and has the ability to solve mazes. The repair is performed by conductive particles dispersed in an insulating fluid. We demonstrate the integration of the healing module onto printed circuit boards and the ability of maze solving. We model and perform experiments on the influence of the geometry of conductive particles as well as the terminal impedances of the route on the healing efficiency. The typical heal rate is 10 mu m/s with healed route having mean resistance of 8 k Omega across a 200 micron gap and depending on the materials and concentrations used. (C) 2015 AIP Publishing LLC.