Creating a therapeutic environment : a non-randomised controlled trial of a quiet time intervention for patients in acute care

Background: Noise is a significant barrier to sleep for acute care hospital patients, and sleep has been shown to be therapeutic for health, healing and recovery. Scheduled quiet time interventions to promote inpatient rest and sleep have been successfully trialled in critical care but not in acute care settings. Objectives: The study aim was to evaluate as cheduled quiet time intervention in an acute care setting. The study measured the effect of a scheduled quiet time on noise levels, inpatients’ rest and sleep behaviour, and wellbeing. The study also examined the impact of the intervention on patients’, visitors’ and health professionals’ satisfaction, and organisational functioning. Design: The study was a multi-centred non-randomised parallel group trial. Settings: The research was conducted in the acute orthopaedic wards of two major urban public hospitals in Brisbane, Australia. Participants: All patientsadmitted to the two wards in the5-month period of the study were invited to participate, withafinalsample of 299 participants recruited. This sample produced an effect size of 0.89 for an increase in the number of patients asleep during the quiet time. Methods: Demographic data were collected to enable comparison between groups. Data for noise level, sleep status, sleepiness and well being were collected using previously validated instruments: a Castle Model 824 digital sound level indicator; a three point sleep status scale; the Epworth Sleepiness Scale; and the SF12 V2 questionnaire. The staff, patient and visitor surveys on the experimental ward were adapted from published instruments. Results: Significant differences were found between the two groups in mean decibel level and numbers of patients awake and asleep. The difference in mean measured noise levels between the two environments corresponded to a ‘perceived’ difference of 2 to 1. There were significant correlations between average decibel level and number of patients awake and asleep in the experimental group, and between average decibel level and number of patients awake in the control group. Overall, patients, visitors and health professionals were satisfied with the quiet time intervention. Conclusions: The findings show that a quiet time intervention on an acute care hospital ward can affect noise level and patient sleep/wake patterns during the intervention period. The overall strongly positive response from surveys suggests that scheduled quiet time would be a positively perceived intervention with therapeutic benefit.

Time use clusters of New Zealand adolescents are associated with weight status, diet and ethnicity

OBJECTIVE: To describe New Zealand adolescent time use clusters and correlate cluster profiles. METHODS: Data were from the cross-sectional 2008/2009 National Survey of Children and Young People's Physical Activity and Dietary Behaviours, which surveyed a random sample of 10-16 year-old New Zealanders (study subset n=679). Time use data were collected using the Multimedia Activity Recall for Children and Adults, and collapsed into 17 age-adjusted variables for sex-specific cluster analysis. Cluster associations with socio-demographic, anthropometric, physical activity and dietary variables were analysed. RESULTS: Three time use clusters were discovered for both boys and girls. For boys, the Techno-active cluster was characterised by high levels of team sports and TV; the Quiet movers cluster by transport (active and passive) and quiet time; and the Social studious cluster by reading, study activities and social interaction. The boys' clusters were associated with ethnicity. The girls'Social sporty cluster was characterised by sports and social interaction; the Screenie tasker cluster by TV, computer, chores and work; and the Super studious cluster by reading, study and school-based activities. The girls' time use cluster membership was associated with weight status and serves of extra foods. CONCLUSIONS: Distinct sex-specific time use clusters and correlate profiles exist among NZ adolescents. IMPLICATIONS: These findings may assist the development of targeted time use interventions to improve adolescent health and well-being.

Magnetospheric access of solar particles and the configuration of the distant geomagnetic field

The access of 1.2-40 MeV protons and 0.4-1.0 MeV electrons from interplanetary space to the polar cap regions has been investigated with an experiment on board a low altitude, polar orbiting satellite (OG0-4).

A total of 333 quiet time observations of the electron polar cap boundary give a mapping of the boundary between open and closed geomagnetic field lines which is an order of magnitude more comprehensive than previously available.

Persistent features (north/south asymmetries) in the polar cap proton flux, which are established as normal during solar proton events, are shown to be associated with different flux levels on open geomagnetic field lines than on closed field lines. The pole in which these persistent features are observed is strongly correlated to the sector structure of the interplanetary magnetic field and uncorrelated to the north/south component of this field. The features were observed in the north (south) pole during a negative (positive) sector 91% of the time, while the solar field had a southward component only 54% of the time. In addition, changes in the north/south component have no observable effect on the persistent features.

Observations of events associated with co-rotating regions of enhanced proton flux in interplanetary space are used to establish the characteristics of the 1.2 - 40 MeV proton access windows: the access window for low polar latitudes is near the earth, that for one high polar latitude region is ~250 R_⊕ behind the earth, while that for the other high polar latitude region is ~1750 R_⊕ behind the earth. All of the access windows are of approximately the same extent (~120 R_⊕). The following phenomena contribute to persistent polar cap features: limited interplanetary regions of enhanced flux propagating past the earth, radial gradients in the interplanetary flux, and anisotropies in the interplanetary flux.

These results are compared to the particle access predictions of the distant geomagnetic tail configurations proposed by Michel and Dessler, Dungey, and Frank. The data are consistent with neither the model of Michel and Dessler nor that of Dungey. The model of Frank can yield a consistent access window configuration provided the following constraints are satisfied: the merging rate for open field lines at one polar neutral point must be ~5 times that at the other polar neutral point, related to the solar magnetic field configuration in a consistent fashion, the migration time for open field lines to move across the polar cap region must be the same in both poles, and the open field line merging rate at one of the polar neutral points must be at least as large as that required for almost all the open field lines to have merged in 0 (one hour). The possibility of satisfying these constraints is investigated in some detail.

The role played by interplanetary anisotropies in the observation of persistent polar cap features is discussed. Special emphasis is given to the problem of non-adiabatic particle entry through regions where the magnetic field is changing direction. The degree to which such particle entry can be assumed to be nearly adiabatic is related to the particle rigidity, the angle through which the field turns, and the rate at which the field changes direction; this relationship is established for the case of polar cap observations.

A quantitative investigation of the solar modulation of cosmic-ray protons and helium nuclei

The differential energy spectra of cosmic-ray protons and He nuclei have been measured at energies up to 315 MeV/nucleon using balloon- and satellite-borne instruments. These spectra are presented for solar quiet times for the years 1966 through 1970. The data analysis is verified by extensive accelerator calibrations of the detector systems and by calculations and measurements of the production of secondary protons in the atmosphere.

The spectra of protons and He nuclei in this energy range are dominated by the solar modulation of the local interstellar spectra. The transport equation governing this process includes as parameters the solar-wind velocity, V, and a diffusion coefficient, K(r,R), which is assumed to be a scalar function of heliocentric radius, r, and magnetic rigidity, R. The interstellar spectra, j_D, enter as boundary conditions on the solutions to the transport equation. Solutions to the transport equation have been calculated for a broad range of assumed values for K(r,R) and j_D and have been compared with the measured spectra.

It is found that the solutions may be characterized in terms of a dimensionless parameter, ψ(r,R) = ^∞∫_r V dr'/(K(r',R). The amount of modulation is roughly proportional to ψ. At high energies or far from the Sun, where the modulation is weak, the solution is determined primarily by the value of ψ (and the interstellar spectrum) and is not sensitive to the radial dependence of the diffusion coefficient. At low energies and for small r, where the effects of adiabatic deceleration are found to be large, the spectra are largely determined by the radial dependence of the diffusion coefficient and are not very sensitive to the magnitude of ψ or to the interstellar spectra. This lack of sensitivity to j_D implies that the shape of the spectra at Earth cannot be used to determine the interstellar intensities at low energies.

Values of ψ determined from electron data were used to calculate the spectra of protons and He nuclei near Earth. Interstellar spectra of the form j_D α (W - 0.25m)^-2.65 for both protons and He nuclei were found to yield the best fits to the measured spectra for these values of ψ, where W is the total energy and m is the rest energy. A simple model for the diffusion coefficient was used in which the radial and rigidity dependence are separable and K is independent of radius inside a modulation region which has a boundary at a distance D. Good agreement was found between the measured and calculated spectra for the years 1965 through 1968, using typical boundary distances of 2.7 and 6.1 A.U. The proton spectra observed in 1969 and 1970 were flatter than in previous years. This flattening could be explained in part by an increase in D, but also seemed to require that a noticeable fraction of the observed protons at energies as high at 50 to 100 MeV be attributed to quiet-time solar emission. The turnup in the spectra at low energies observed in all years was also attributed to solar emission. The diffusion coefficient used to fit the 1965 spectra is in reasonable agreement with that determined from the power spectra of the interplanetary magnetic field (Jokipii and Coleman, 1968). We find a factor of roughly 3 increase in ψ from 1965 to 1970, corresponding to the roughly order of magnitude decrease in the proton intensity at 250 MeV. The change in ψ might be attributed to a decrease in the diffusion coefficient, or, if the diffusion coefficient is essentially unchanged over that period (Mathews et al., 1971), might be attributed to an increase in the boundary distance, D.

New measurements on the absolute cosmic ray ionization from sea level to 1540 kilometers altitude

An air filled ionization chamber has been constructed with a volume of 552 liters and a wall consisting of 12.7 mg/cm² of plastic wrapped over a rigid, lightweight aluminum frame. A calibration in absolute units, independent of previous Caltech ion chamber calibrations, was applied to a sealed Neher electrometer for use in this chamber. The new chamber was flown along with an older, argon filled, balloon type chamber in a C-135 aircraft from 1,000 to 40,000 feet altitude, and other measurements of sea level cosmic ray ionization were made, resulting in the value of 2.60 ± .03 ion pairs/cm³ sec atm) at sea level. The calibrations of the two instruments were found to agree within 1 percent, and the airplane data were consistent with previous balloon measurements in the upper atmosphere. Ionization due to radon gas in the atmosphere was investigated. Absolute ionization data in the lower atmosphere have been compared with results of other observers, and discrepancies have been discussed.

Data from a polar orbiting ion chamber on the OGO-II, IV spacecraft have been analyzed. The problem of radioactivity produced on the spacecraft during passes through high fluxes of trapped protons has been investigated, and some corrections determined. Quiet time ionization averages over the polar regions have been plotted as function of altitude, and an analytical fit is made to the data that gives a value of 10.4 ± 2.3 percent for the fractional part of the ionization at the top of the atmosphere due to splash albedo particles, although this result is shown to depend on an assumed angular distribution for the albedo particles. Comparisons with other albedo measurements are made. The data are shown to be consistent with balloon and interplanetary ionization measurements. The position of the cosmic ray knee is found to exhibit an altitude dependence, a North-South effect, and a small local time variation.

磁层－电离层电流的暴时变化以及主磁场对空间环境的影响

Two problems are studied in this thesis, the relationship of the magneto-spheric - ionospheric current systems during storms, and the effects of the main field to the space environment. The thesis includes three parts. 1. Magnetic disturbances caused by magnetospheric - ionospheric current systems Transient variations of the geomagnetic field at middle-low latitudes are mainly caused by the ionospheric dynamo current (IDC), the symmetric ring current (SRC), the partial ring current-region II field-aligned current-ionospheric current system (PRFI), and the region I field-aligned current-ionospheric current system (FACI). The storm on May 1 ～ 6, 1998 is analyzed. Firstly, the S_q-field caused by IDC current is removed by using the modified Hibberd's method in which the effect of SRC is considered. The neglect of SRC-field can give as much as 40% error in S_q-field evaluation. Secondly, the disturbance fields at the middle and low latitudes are separated according to their origins. As a result, the disturbance caused by FACI-current is an important part of the asymmetrical depression of H-component in middle and low latitudes during storms. The results show that the relative intensity of the Sq-field increases in the main phase of the storm and decreases in the recovery phase. The latitudinal gradient of the Sq-field is positive during the whole storm. The storm of May 1 ～ 6, 1998 contains two events. In the first event on May 2, the SRC-field is similar to Dst index. But in the second event on May 4 ～ 5, the SRC-field delays to Dst index, and the SRC-field depresses while the PRFI- and FACI-fields recovery. 2. Analysis of S_q~p variation in CGM coordinates In order to study the conjugation of geomagnetic variations between northern and southern hemispheres, we use the corrected geomagnetic coordinates (CGM) instead of the geomagnetic coordinates (GM) to analyze the S_q~P equivalent current system. The CGM coordinates are built up by International Geomagnetic Reference Field (IGRF) model. The S_q~p variations and equivalent current systems in the northern and southern polar regions are more symmetrical in CGM coordinates than in GM co-ordinates. This fact implies that the current distributions in polar regions are governed by the configuration of the geomagnetic field lines. As the elaborate structure of S_q~p current system in quiet time is obtained, we summarize the seasonal variation of the electrojet in quiet time. 3. The magnetospheric configuration of non-parallel-dipole model The magnetospheric configurations are calculated for two possible geomag-netic field models during the geomagnetic field reversals. These models are the dipole field with the axis to the sun and the quadrupole field model. We use the finite element method to solve the magnetic equation, and use the surface evolution method to solve the equilibrium equation. The results show that the main field greatly affects the space environment.

Midlatitude daytime D region ionosphere variations measured from radio atmospherics

We measured the midlatitude daytime ionospheric D region electron density profile height variations in July and August 2005 near Duke University by using radio atmospherics (or sferics for short), which are the high-power, broadband very low frequency (VLF) signals launched by lightning discharges. As expected, the measured daytime D region electron density profile heights showed temporal variations quantitatively correlated with solar zenith angle changes. In the midlatitude geographical regions near Duke University, the observed quiet time heights decreased from ∼80 km near sunrise to ∼71 km near noon when the solar zenith angle was minimum. The measured height quantitative dependence on the solar zenith angle was slightly different from the low-latitude measurement given in a previous work. We also observed unexpected spatial variations not linked to the solar zenith angle on some days, with 15% of days exhibiting regional differences larger than 0.5 km. In these 2 months, 14 days had sudden height drops caused by solar flare X-rays, with a minimum height of 63.4 km observed. The induced height change during a solar flare event was approximately proportional to the logarithm of the X-ray flux. In the long waveband (wavelength, 1-8 Å), an increase in flux by a factor of 10 resulted in 6.3 km decrease of the height at the flux peak time, nearly a perfect agreement with the previous measurement. During the rising and decaying phases of the solar flare, the height changes correlated more consistently with the short, rather than the long, wavelength X-ray flux changes. © 2010 by the American Geophysical Union.

Timing and localization of ionospheric signatures associated with substorm expansion phase onset

In this paper, we present case studies of the optical and magnetic signatures of the characteristics of the first minute of substorm expansion phase onset observed in the ionosphere. We find that for two isolated substorms, the onset of magnetic pulsations in the 24–96 s period wavelet band are colocated in time and space with the formation and development of small-scale optical undulations along the most equatorward preexisting auroral arc prior to auroral breakup. These undulations undergo an inverse spatial cascade into vortices prior to the release of the westward traveling surge. We also present a case study of a multiple activation substorm, whereby discrete onsets of ULF wave power above a predetermined quiet time threshold are shown to be associated with specific optical intensifications and brightenings. Moreover, in the multiple activation substorm event, we show that neither the formation of the small-scale undulations nor the formation of similar structures along a north–south aligned arc is sufficient to produce auroral breakup associated with expansion phase onset. It is only ∼10 min after these two disparate activation regions initiate that auroral breakup and the subsequent formation of a westward traveling surge occur. We discuss the implications of these results in terms of the triggering mechanisms likely to be occurring during these specific events.

Atmospheric cosmic rays in the South Atlantic anomaly region

To study the production and propagation of fast secondaries particles in the atmosphere, data collected during eleven quiet-time balloon flights are analysed. Comparisons of these data with those obtained in different geomagnetic rigidity regions permit to estimate the contributions of the proton and electron components in the measured intensities. Derivations of this last component in the «upward» and «downward» moving electrons fluxes indicate that in the anomaly region a fraction of these particles, produced by the primary protons, are leaving the atmosphere and will not return to the Earth. © 1991 Società Italiana di Fisica.

Abnormal evening vertical plasma drift and effects on ESF and EIA over Brazil-South Atlantic sector during the 30 October 2003 superstorm

Equatorial F region vertical plasma drifts, spread F and anomaly responses, in the south American longitude sector during the superstorm of 30 October 2003, are analyzed using data from an array of instruments consisting of Digisondes, a VHF radar, GPS TEC and scintillation receivers in Brazil, and a Digisonde and a magnetometer in Jicamarca, Peru. Prompt penetrating eastward electric field of abnormally large intensity drove the F layer plasma up at a velocity ∼1200 ms -1 during post dusk hours in the eastern sector over Brazil. The equatorial anomaly was intensified and expanded poleward while the development of spread F/plasma bubble irregularities and GPS signal scintillations were weaker than their quiet time intensity. Significantly weaker F region response over Jicamarca presented a striking difference in the intensity of prompt penetration electric field between Peru and eastern longitudes of Brazil. The enhanced post dusk sector vertical drift over Brazil is attributed to electro-dynamics effects arising energetic particle precipitation in the South Atlantic Magnetic Anomaly (SAMA). These extraordinary results and their longitudinal differences are presented and discussed in this paper. Copyright 2008 by the American Geophysical Union.

Predictors of and reasons for pacifier use in first-time mothers : an observational study

Background: The use of pacifiers is commonplace in Australia and has been shown to be negatively associated with breastfeeding duration. In order to influence behaviour related to the use of pacifiers it is important to understand the reasons for their use. The primary aim of this observational study was to investigate who (if anyone) advises first-time mothers to give a pacifier and the reasons for which they first give (or try to give) a pacifier to their infant. Additionally, this study investigated the predictors of pacifier use and the relationship between pacifier use and breastfeeding duration. Methods: In total, 670 Australian first-time mothers recruited as part of the NOURISH trial completed a questionnaire regarding infant feeding and pacifier use. Results: Pacifiers were introduced by 79% of mothers, of whom 28.7% were advised to use a pacifier by their mother/mother-in-law with a further 22.7% being advised by a midwife. The majority of mothers used a pacifier in order to soothe their infant (78.3%), to help put them to sleep (57.4%) and to keep them comforted and quiet (40.4%). Pacifiers given to infants before four weeks (adjHR 3.67; 95%CI 2.14–6.28) and used most days (adjHR 3.28; 95%CI 1.92–5.61) were significantly associated with shorter duration of breastfeeding. Conclusions: This study identifies an opportunity for educating new mothers and their support network, particularly their infant’s grandmothers, with regards to potential risks associated with the early and frequent use of a pacifier, and alternative methods for soothing their infant, in order to reduce the use of pacifiers and their potentially negative effect on breastfeeding duration

Deep searches for decametre-wavelength pulsed emission from radio-quiet gamma-ray pulsars

We report the results of extensive follow-up observations of the gamma-ray pulsar J1732-3131, which has recently been detected at decametre wavelengths, and the results of deep searches for the counterparts of nine other radio-quiet gamma-ray pulsars at 34 MHz, using the Gauribidanur radio telescope. No periodic signal from J1732-3131 could be detected above a detection threshold of 8 sigma, even with an effective integration time of more than 40 h. However, the average profile obtained by combining data from several epochs, at a dispersion measure of 15.44 pc cm(-3), is found to be consistent with that from the earlier detection of this pulsar at a confidence level of 99.2 per cent. We present this consistency between the two profiles as evidence that J1732-3131 is a faint radio pulsar with an average flux density of 200-400 mJy at 34 MHz. Despite the extremely bright sky background at such low frequencies, the detection sensitivity of our deep searches is generally comparable to that of higher frequency searches for these pulsars, when scaled using reasonable assumptions about the underlying pulsar spectrum. We provide details of our deep searches, and put stringent upper limits on the decametre-wavelength flux densities of several radio-quiet gamma-ray pulsars.

Wavelet phase coherence analysis: Application to a quiet-sun magnetic element

A new application of wavelet analysis is presented that utilizes the inherent phase information residing within the complex Morlet transform. The technique is applied to a weak solar magnetic network region, and the temporal variation of phase difference between TRACE 1700 Angstrom and SOHO/SUMER C II 1037 Angstrom intensities is shown. We present, for the first time in an astrophysical setting, the application of wavelet phase coherence, including a comparison between two methods of testing real wavelet phase coherence against that of noise. The example highlights the advantage of wavelet analysis over more classical techniques, such as Fourier analysis, and the effectiveness of the former to identify wave packets of similar frequencies but with differing phase relations is emphasized. Using cotemporal, ground-based Advanced Stokes Polarimeter measurements, changes in the observed phase differences are shown to result from alterations in the magnetic topology.

“A quiet still voice that just touches”: music’s relevance for adults living with life-threatening cancer diagnoses.

Purpose
Music has historically aided health and loss-adaptation, however, cancer patients’ experience of music for self-care is not well understood. This study examines adult cancer patients’ views about music’s role before and after diagnosis.
Methods
Constructivist approach, with grounded theory informed design using convenience, snowball and theoretical sampling. Patients from Australian metropolitan cancer and hospice settings completed demographic questionnaires and participated in semi-structured interviews. Qualitative inter-rater reliability was applied.
Results
Fifty-two patients reported comparable time spent experiencing music pre-post diagnosis. Music may remain incidental; however, many patients adapt music usage to ameliorate cancer’s aversive effects. Patients often draw from their musical lives and explore unfamiliar music to: remain connected with pre-illness identities; strengthen capacity for enduring treatment, ongoing survival (even when knowing “you’re going to die”), or facing death; reframe upended worlds; and live enriched lives. Patients can ascribe human or physical properties to music when describing its transformative effects. Familiar lyrics maybe reinterpreted, and patients’ intensified emotional reactions to music can reflect their threatened mortality. Sometimes music becomes inaccessible, elusive, and/or intensifies distress and is avoided. Families’, friends’ and professionals’ recognition of patients’ altered musical lives and music-based suggestions can extend patients’ use of music for self-care.
Conclusion
Health professionals can support patients by inquiring about their music behaviours and recognising that altered music usage may signify vulnerability. Although commonly recommended, hospital concerts and music broadcasts need sensitive delivery. Patients’ preferred music should be available in diagnostic, treatment and palliative settings because it can promote endurance and life enrichment.

Quiet-Sun Hα Transients and Corresponding Small-scale Transition Region and Coronal Heating

Rapid blue- and redshifted excursions (RBEs and RREs) are likely to be the on-disk counterparts of Type II spicules. Recently, heating signatures from RBEs/RREs have been detected in IRIS slit-jaw images dominated by transition region (TR) lines around network patches. Additionally, signatures of Type II spicules have been observed in Atmospheric Imaging Assembly (AIA) diagnostics. The full-disk, ever-present nature of the AIA diagnostics should provide us with sufficient statistics to directly determine how important RBEs and RREs are to the heating of the TR and corona. We find, with high statistical significance, that at least 11% of the low coronal brightenings detected in a quiet-Sun region in He ii 304 Å can be attributed to either RBEs or RREs as observed in Hα, and a 6% match of Fe IX 171 Å detected events to RBEs or RREs with very similar statistics for both types of Hα features. We took a statistical approach that allows for noisy detections in the coronal channels and provides us with a lower, but statistical significant, bound. Further, we consider matches based on overlapping features in both time and space, and find strong visual indications of further correspondence between coronal events and co-evolving but non-overlapping, RBEs and RREs.