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.

Caveat Anicula! Beware of the Quiet Little Old Ladies : Demographics, Pharmacotherapy, Survival and Readmissions in a 10 Year Cohort of Heart Failure Patients with Preserved Systolic Function

Objective--To determine whether heart failure with preserved systolic function (HFPSF) has different natural history from left ventricular systolic dysfunction (LVSD). Design and setting--A retrospective analysis of 10 years of data (for patients admitted between 1 July 1994 and 30 June 2004, and with a study census date of 30 June 2005) routinely collected as part of clinical practice in a large tertiary referral hospital.Main outcome measures-- Sociodemographic characteristics, diagnostic features, comorbid conditions, pharmacotherapies, readmission rates and survival.Results--Of the 2961 patients admitted with chronic heart failure, 753 had echocardiograms available for this analysis. Of these, 189 (25%) had normal left ventricular size and systolic function. In comparison to patients with LVSD, those with HFPSF were more often female (62.4% v 38.5%; P = 0.001), had less social support, and were more likely to live in nursing homes (17.9% v 7.6%; P < 0.001), and had a greater prevalence of renal impairment (86.7% v 6.2%; P = 0.004), anaemia (34.3% v 6.3%; P = 0.013) and atrial fibrillation (51.3% v 47.1%; P = 0.008), but significantly less ischaemic heart disease (53.4% v 81.2%; P = 0.001). Patients with HFPSF were less likely to be prescribed an angiotensin-converting enzyme inhibitor (61.9% v 72.5%; P = 0.008); carvedilol was used more frequently in LVSD (1.5% v 8.8%; P < 0.001). Readmission rates were higher in the HFPSF group (median, 2 v 1.5 admissions; P = 0.032), particularly for malignancy (4.2% v 1.8%; P < 0.001) and anaemia (3.9% v 2.3%; P < 0.001). Both groups had the same poor survival rate (P = 0.912). Conclusions--Patients with HFPSF were predominantly older women with less social support and higher readmission rates for associated comorbid illnesses. We therefore propose that reduced survival in HFPSF may relate more to comorbid conditions than suboptimal cardiac management.

Professor Emeritus Leo G Carney Optometry's quiet achiever

Perhaps more than any other sub-discipline in optometry and vision science, the academic field of cornea and contact lenses is populated by an assortment of extroverted and flamboyant characters who constantly travel the world, entertaining clinicians with dazzling audiovisual presentations, informing them about the latest advances in the field and generally promoting their own scientific agendas. The antithesis of this is Leo Carney (Figure 1), a highly accomplished researcher, teacher, mentor and administrator, who has quietly and with great dignity carved out an impressive career in academic optometry. Indeed, Leo Carney is optometry's quintessential ‘quiet achiever’

Foot massage versus quiet presence on agitation and mood in people with dementia : a randomised controlled trial

Background There is increasing interest in using complementary and alternative treatments to manage behavioural and psychological symptoms of dementia such as agitation, aggression and depressed mood. Objective To compare the effect of foot massage (intervention) and quiet presence (control) on agitation and mood in people with dementia. Design A randomised controlled trial using a within-subjects, crossover design. Settings Five long-term care facilities in Brisbane, Australia. The primary outcome was the Cohen-Mansfield Agitation Inventory (CMAI) and the secondary outcome was the Observed Emotion Rating Scale (OERS). The screening and data collection research assistants, families, and care staff were blinded to participant allocation. Participants Participants of the study were 55 long-term care residents aged 74–103 years (mean age 86.5), with moderate to severe dementia and a history of agitated behaviour according to the Pittsburgh Agitation Scale. A computer-program randomised participants to 10-min foot massage (intervention) or quiet presence (control), every weekday for 3 weeks. Results A carry-over effect was identified in the data, and so the data was treated as a parallel groups RCT. The mean total CMAI increased in both groups (reflecting an increase in agitation) with this increase greater in the quiet presence group than the foot massage group (p=0.03). There was a trend towards a difference on OERS General Alertness, with a positive change in alertness for participants in the foot massage group (indicating reduced alertness) and a negative change for participants in the quiet presence group (indicating increased alertness) (F(1,51)=3.88, p=0.05, partial ή2=0.07). Conclusions The findings highlight the need for further research on the specific conditions under which massage might promote relaxation and improve mood for people with dementia. The unfamiliar research assistants and variations in usual activity may have contributed to the increase in agitation and this needs further research.

The covenant for quiet enjoyment : a potential nuisance to lessors

Under Australian law, a tenant complaining of nuisance caused by another tenant traditionally had no recourse to the lessor unless the lessor actively participated in the nuisance. A recent Queensland Court of Appeal decision, Aussie Traveller Pty Ltd v Marklea Pty Ltd, has found that a lessor who fails to take steps to control a tenant's nuisance may be liable to other tenants for breach of the covenant of quiet enjoyment. This paper considers the recent decision in light of common law developments in Australia, England and the United States, including the American concept of constructive eviction.

Mired in the shadows: Quiet students in secondary schools

Quiet students are a feature of the organisation of secondary schools. Using qualitative methods and Deleuzean conceptualisations of modern subjectivity, this paper explores the ways that quiet students negotiate the terrain of their school. These negotiations often seem to produce a self that is trapped rather than a subject who seizes opportunities to be inventive, creative and experimental of their self. Understanding the faciality of quiet students provides opportunities to advance debate on how schools could encourage freer selves.

Nature of Quiet Sun Oscillations Using Data from the Hinode, TRACE, and SOHO Spacecraft

We study the nature of quiet-Sun oscillations using multi-wavelength observations from TRACE, Hinode, and SOHO. The aim is to investigate the existence of propagating waves in the solar chromosphere and the transition region by analyzing the statistical distribution of power in different locations, e.g. in bright magnetic (network), bright non-magnetic and dark non-magnetic (inter-network) regions, separately. We use Fourier power and phase-difference techniques combined with a wavelet analysis. Two-dimensional Fourier power maps were constructed in the period bands 2 -aEuro parts per thousand 4 minutes, 4 -aEuro parts per thousand 6 minutes, 6 -aEuro parts per thousand 15 minutes, and beyond 15 minutes. We detect the presence of long-period oscillations with periods between 15 and 30 minutes in bright magnetic regions. These oscillations were detected from the chromosphere to the transition region. The Fourier power maps show that short-period powers are mainly concentrated in dark regions whereas long-period powers are concentrated in bright magnetic regions. This is the first report of long-period waves in quiet-Sun network regions. We suggest that the observed propagating oscillations are due to magnetoacoustic waves, which can be important for the heating of the solar atmosphere.

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.

The dayside high-latitude trough under quiet geomagnetic conditions: Radio tomography and the CTIP model

Pryse, Sian; Dewis, K.L.; Middleton, H.R.; Balthazor, R.L., (2005) 'The dayside high-latitude trough under quiet geomagnetic conditions: Radio tomography and the CTIP model', Annales Geophysicae 23(4) pp.1199-1206 RAE2008

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.

Propagating waves and magnetohydrodynamic mode coupling in the quiet-sun network

High-cadence multiwavelength optical observations were taken with the Dunn Solar Telescope at the National Solar Observatory, Sacramento Peak, accompanied by Advanced Stokes Polarimeter vector magnetograms. A total of 11 network bright points (NBPs) have been studied at different atmospheric heights using images taken in wave bands centered on Mg I b(1) - 0.4 Angstrom, Halpha, and Ca II K-3. Wavelet analysis was used to study wave packets and identify traveling magnetohydrodynamic waves. Wave speeds were estimated through the temporal cross-correlation of signals, in selected frequency bands of wavelet power, in each wavelength. Four mode-coupling cases were identified, one in each of four of the NBPs, and the variation of the associated Fourier power with height was studied. Three of the detected mode-coupling, transverse-mode frequencies were observed in the 1.2-1.6 mHz range (mean NBP apparent flux density magnitudes over 99-111 Mx cm(-2)), with the final case showing 2.0-2.2 mHz (with 142 Mx cm(-2)). Following this, longitudinal-mode frequencies were detected in the range 2.6-3.2 mHz for three of our cases, with 3.9-4.1 mHz for the remaining case. After mode coupling, two cases displayed a decrease in longitudinal-mode Fourier power in the higher chromosphere.

Ultraviolet oscillations in the chromosphere of the quiet Sun

Quiet-Sun oscillations in the four Transition Region and Coronal Explorer (TRACE) ultraviolet passbands centered on 1700, 1600, 1216, and 1550 Angstrom are studied using a wavelet-based technique. Both network and internetwork regions show oscillations with a variety of periods and lifetimes in all passbands. The most frequent network oscillation has a period of 283 s, with a lifetime of 2-3 cycles in all passbands. These oscillations are discussed in terms of upwardly propagating magnetohydrodynamic wave models. The most frequent internetwork oscillation has a period of 252 s, again with a lifetime of 2-3 cycles, in all passbands. The tendency for these oscillations to recur in the same position is discussed in terms of "persistent flashers." The network contains greater oscillatory power than the internetwork at periods longer than 300 s in the low chromosphere. This value is shown to decrease to 250 s in the high chromosphere. The internetwork also displays a larger number of short-lifetime, long-period oscillations than the network, especially in the low chromosphere. Both network and internetwork regions contain a small number of nonrecurring long-lifetime oscillations.