Patient Satisfaction With Noise

Practice Problem: Noise on hospital units can interfere with patient rest, timely recovery, and statisfacton with care. Improvements in the reduction of hospital noise levels lead to improved patient satisfaction and improved rest. Patients were surveyed on their satisfaction with noise during the day and at night. PICOT: In Acute Care Patients (P), does the implementation of a noise reduction program (I) compared to no noise reduction program (C), affect patient satisfaction with noise (O) over a six-week period (T)? Evidence: Studies show that many hospitals have noise levels that exceed the World Health Organization’s recommended standards for noise levels. Evidence showed that implementing a noise reduction program that included quiet times and sleep menus produced an increase in patient satisfaction with noise. Intervention: Implementation of a noise reduction program and establishing a two-hour quiet time during the day. The program also established a sleep menu to identify and support patient bedtime rituals. Outcome: The implementation of a noise reduction program showed a statistical decrease in measurable noise levels. The project produced a clinically significant increase in patient satisfaction during the day and a clinically significant improvement in patient satisfaction with sleep quality and quantity. Conclusion: The goal of the noise reduction project was to improve the patients’ overall satisfaction with hospital noise during the day and overnight. This project showed that a noise reduction program could decrease noise levels and improve patient satisfaction with noise

Chemotactic response and adaptation dynamics in Escherichia coli

Adaptation of the chemotaxis sensory pathway of the bacterium Escherichia coli is integral for detecting chemicals over a wide range of background concentrations, ultimately allowing cells to swim towards sources of attractant and away from repellents. Its biochemical mechanism based on methylation and demethylation of chemoreceptors has long been known. Despite the importance of adaptation for cell memory and behavior, the dynamics of adaptation are difficult to reconcile with current models of precise adaptation. Here, we follow time courses of signaling in response to concentration step changes of attractant using in vivo fluorescence resonance energy transfer measurements. Specifically, we use a condensed representation of adaptation time courses for efficient evaluation of different adaptation models. To quantitatively explain the data, we finally develop a dynamic model for signaling and adaptation based on the attractant flow in the experiment, signaling by cooperative receptor complexes, and multiple layers of feedback regulation for adaptation. We experimentally confirm the predicted effects of changing the enzyme-expression level and bypassing the negative feedback for demethylation. Our data analysis suggests significant imprecision in adaptation for large additions. Furthermore, our model predicts highly regulated, ultrafast adaptation in response to removal of attractant, which may be useful for fast reorientation of the cell and noise reduction in adaptation.Comment: accepted for publication in PLoS Computational Biology; manuscript (19 pages, 5 figures) and supplementary information; added additional clarification on alternative adaptation models in supplementary informatio

Alcoholism and somatic comorbidity among homeless people in Mannheim, Germany

AIMS: To assess the prevalence of alcoholism and somatic codisorders of homeless people. DESIGN: Epidemiological cross-sectional field study in a sample of the homeless in the area. SETTING: The study was conducted from 1997 to 1999 in the inner-city area of Mannheim, Germany (approximately 320 000 inhabitants). PARTICIPANTS: One hundred and two single homeless people (15-16% of the estimated total population of single homeless people in the city). MEASUREMENT: Alcoholism, substance abuse and mental disorders were diagnosed with the SCID. Medical examinations were performed by an experienced physician. Blood samples were taken and urine samples collected. Further assessments were conducted for factors potentially correlating with mental or physical state. FINDINGS: Of the study probands, 63.7% presented with the alcohol dependence syndrome or harmful use, 61.7% had current somatic problems or disorders. Probands with alcohol dependence had significantly more frequent somatic disorders in total, more cerebral degeneration, liver disease or alcoholic polyneuropathies. Multiple stepwise regression identified alcoholism, life-satisfaction, duration of homelessness and lacking social support as significant explanatory factors for having a somatic disorder. Alcoholism increased the risk of physical ill-health more than fourfold. CONCLUSION: Alcoholism is a major contributor to the physical ill-health of homeless people. Treatment or rehabilitation of addictive behaviour among the homeless should be of major concern for adequate service planning or provision

Physicians\u27 tacit and stated policies for determining patient benefit and referral to cardiac rehabilitation.

Background/Purpose. The benefits of prescribing cardiac rehabilitation (CR) for patients following heart surgery is well documented; however, physicians continue to underuse CR programs, and disparities in the referral of women are common. Previous research into the causes of these problems has relied on self-report methods, which presume that physicians have insight into their referral behavior and can describe it accurately. In contrast, the research presented here used clinical judgment analysis (CJA) to discover the tacit judgment and referral policies of individual physicians. The specific aims were to determine 1) what these policies were, 2) the degree of self-insight that individual physicians had into their own policies, 3) the amount of agreement among physicians, and 4) the extent to which judgments were related to attitudes toward CR. Methods. Thirty-six Canadian physicians made judgments and decisions regarding 32 hypothetical cardiac patients, each described on 5 characteristics (gender, age, type of cardiovascular procedure, presence/ absence of musculoskeletal pain, and degree of motivation) and then completed the 19 items of the Attitude towards Cardiac Rehabilitation Referral scale. Results. Consistent with previous studies, there was wide variation among physicians in their tacit and stated judgment policies, and self-insight was modest. On the whole, physicians showed evidence of systematic gender bias as they judged women as less likely than men to benefit from CR. Insight data suggest that 1 in 3 physicians were unaware of their own bias. There was greater agreement among physicians in how they described their judgments (stated policies) than in how they actually made them (tacit policies). Correlations between attitude statements and CJA measures were modest. Conclusions. These findings offer some explanation for the slow progress of efforts to improve CR referrals and for gender disparities in referral rates

Prosodic Phrasing and Syllable Prominence in Spoken Prose. A Validated Coding Manual

Current systems for predicting prosodic prominence and boundaries in texts focus on syntax/semantic-based automatic decoding of sentences that need to be annotated syntactically (Atterer & Klein 2002; Windmann et al. 2011). However, to date, there is no phonetically validated replicable system for manually coding prosodic boundaries and syllable prominence in longer sentences or texts. Based on work in the fields of metrical phonology (Liberman & Prince 1977), phrase formation (Hayes 1989) and existing pause coding systems (Gee and Grosjean 1983), we developed a manual for coding prosodic boundaries (with 6 degrees of juncture) and syllable prominence (8 degrees). Three independent annotators applied the coding system to the beginning pages of four German novels and to four short stories (20 058 syllables, Fleiss kappa .82). For the phonetic validation, eight professional speakers read the excerpts of the novels aloud. We annotated the speech signal automatically with MAUS (Schiel 1999). Using PRAAT (Boersma & Weenink 2019), we extracted pitch, duration, and intensity for each syllable, as well as several phonetic parameters for pauses, and compared all measures obtained to the theoretically predicted levels of syllable prominence and prosodic boundary strength. The validation with the speech signal shows that our annotation system reliably predicts syllable prominence and prosodic boundaries. Since our annotation works with plain text, there are many potential applications of the coding system, covering research on prose rhythm, synthetic speech and (psycho)linguistic research on prosody

Invited Review Article: Instrumentation for nuclear magnetic resonance in zero and ultralow magnetic field

We review instrumentation for nuclear magnetic resonance (NMR) in zero and ultra-low magnetic field (ZULF, below 0.1 $\mu$T) where detection is based on a low-cost, non-cryogenic, spin-exchange relaxation free (SERF) $^{87}$Rb atomic magnetometer. The typical sensitivity is 20-30 fT/Hz$^{1/2}$ for signal frequencies below 1 kHz and NMR linewidths range from Hz all the way down to tens of mHz. These features enable precision measurements of chemically informative nuclear spin-spin couplings as well as nuclear spin precession in ultra-low magnetic fields.Comment: 18 pages, 10 figure