Sleep quality and noise: comparisons between hospital and home settings.

BACKGROUND: Children and their parents report poor sleep in hospital and complain about noise. OBJECTIVE: To measure sleep quality and noise levels in hospital and compare these with the home environment. DESIGN: Observational within case-controlled study. SETTING: Paediatric medical wards at Southampton Children's Hospital and bedrooms at home. PARTICIPANTS AND METHODS: Participants were children aged 3-16 years and their co-sleeping parents. Sleep quality was measured using actigraphy for a maximum of 5 nights in each setting. Median sound levels at the bedside were monitored overnight in a subgroup in both settings. MAIN OUTCOME MEASURES: Total sleep time, sleep efficiency, median sound levels overnight. RESULTS: 40 children and 16 mothers completed actigraphy in both settings. Children had on average 62.9 min, and parents 72.8 min, per night less sleep in hospital than at home. Both children and parents had poorer sleep quality in hospital than at home: mean sleep efficiency 77.0% vs 83.2% for children and 77.1% vs 88.9% for parents, respectively. Median sound levels in hospital measured in 8 children averaged 48.6 dBA compared with 34.7 dBA at home and exceeded World Health Organization recommendations of 30 dB. CONCLUSIONS: Children and their mothers have poor quality sleep in paediatric wards. This may affect the child's behaviour, recovery and pain tolerance. Sleep deprivation adds to parental burden and stress. Sound levels are significantly raised in hospital and may contribute to poor sleep. Reduction in the level of noise might lead to an improvement in sleep, affecting the quality of stay of both parent and child.

Prevalence of Francisella noatunensis subsp. orientalis in cultured tilapia on the island of Oahu, Hawaii.

Francisellosis is an emergent disease in cultured and wild aquatic animals. The causative agent, Francisella noatunensis subsp. orientalis (Fno), is a gram-negative bacterium recognized as one of the most virulent pathogens of warmwater fish. The main objective of this project was to investigate the prevalence of Fno in cultured tilapia (specifically, Mozambique Tilapia Oreochromis mossambicus, Koilapia [also known as Wami Tilapia] O. hornorum, Blue Tilapia O. aureus, and Nile Tilapia O. niloticus hybrids) on the island of Oahu, Hawaii, using conventional and real-time PCR assays followed by statistical modeling to compare the different diagnostic methods and identify potential risk factors. During 2010 and 2012, 827 fish were collected from different geographical locations throughout the island of Oahu. Upon collection of fish, the water temperature in the rearing system and the length of individual fish were measured. Extraction of DNA from different tissues collected aseptically during necropsy served as a template for molecular diagnosis. High correlation between both molecular methods was observed. Moreover, the bacterium was isolated from infected tilapia on selective media and confirmed to be Fno utilizing a species-specific Taqman-based real-time PCR assay. Although a direct comparison of the prevalence of Fno between the different geographical areas was not possible, the results indicate a high prevalence of Fno DNA in cultured tilapia throughout the farm sites located on Oahu. Of the different tilapia species and hybrids currently cultured in Hawaii, Mozambique Tilapia were more susceptible to infection than Koilapia. Water temperature in the rearing systems and fish size also had a strong effect on the predicted level of infection, with fish held at lower temperatures and smaller fish being more susceptible to piscine francisellosis.