We studied the effects of ZnO nanoparticles [ZnO NPs, primary particle size 35 ± 10 nm (circular diameter, TEM)], bulk [160 ± 81 nm (circular diameter, TEM)], and Zn ions (from ZnCl(2)) on mortality, growth, and reproductive endpoints in the sediment dwelling marine amphipod Corophium volutator over a complete lifecycle (100 days). ZnO NPs were characterized by size, aggregation, morphology, dissolution, and surface properties. ZnO NPs underwent aggregation and partial dissolution in the seawater exposure medium, resulting in a size distribution that ranged in size from discrete nanoparticles to the largest aggregate of several micrometers. Exposure via water to all forms of zinc in the range of 0.2-1.0 mg L(-1) delayed growth and affected the reproductive outcome of the exposed populations. STEM-EDX analysis was used to characterize insoluble zinc precipitates (sphaerites) of high sulfur content, which accumulated in the hepatopancreas following exposures. The elemental composition of the sphaerites did not differ for ZnO NP, Zn(2+), and bulk ZnO exposed organisms. These results provide an illustration of the comparable toxicity of Zn in bulk, soluble, and nanoscale forms on critical lifecycle parameters in a sediment dwelling organism.

Background/Aims Excessive noise is a considerable problem in intensive care units, interfering with patient rest, recovery times and patient satisfaction. This quality improvement project aimed to implement and evaluate noise-reduction strategies in a coronary intensive care unit in Doha, Qatar. Methods Rapid plan-do-study-act cycles were used to implement several noise reduction strategies, including the introduction of two designated quiet time periods per day (15:00–16:00 and 2:00–4:00), staff education about the impact of noise, environmental adjustments and an audio-visual device to alert staff, patients and visitors of excessive noise levels. A sound metre app was used to measure noise levels for 4 months before the intervention and for nearly 3 years (April 2018–December 2020) after implementation. Surveys were used to collect informal feedback from staff and patients on the ward. Results The average pre-intervention noise level on the unit were 64.6 dB, which was reduced to a consistent average of 24 dB during designated quiet times following the interventions. No adverse effects on communication or medical errors were observed. Patient and staff feedback was positive, with most patients (n=50) and all staff (n=86) being satisifed with the noise levels following the intervention. Conclusions Although the nature of activity in intensive care units makes them noisy environments, it is possible to reduce noise levels by targeting modifiable factors and implementing simple measures, such as dedicated quiet times, staff education and audio-visual noise alerts.

Background: Excessive noise is a significant problem for patients in intensive care units (ICUs) and is associated with significant psychological effects and the potential to affect patient outcomes. The noise level in our coronary care intensive unit of a cardiac hospital was found to be approximately 80 dB, which exceeded the international recommended level of 35 dB. We sought to review the causes of this excess noise and the effects of an implementation of quiet time and a noise-reduction bundle in the ICU.Methods: A quality improvement initiative was undertaken to solve the noise issue. A multi-disciplinary team was formed and a number of changes were tested. We used a model for improvement, and the changes were tested using small Plan-Do-Study-Act cycles. Two blocks of quiet time (3-4 pm and 2-4 am) were designated as quiet times during which the lights were dimmed, noise-reduction strategies in the form of a bundle were implemented, and procedures were minimized. In addition, educational material and information were disseminated to physicians, nurses, physical therapists, and other potential individuals who might be affected by the changes that were implemented. Quantitative baseline data was collected using sound meter readings three times a day. Qualitative feedback was collected through staff and patient surveys.Results: During quiet hours, the noise level averaged 22 dB—a decrease from 85 dB. One-hundred patients were surveyed and asked for their feedback concerning quiet time: approximately 97% of them were satisfied with the results.Conclusions: It is possible to reduce noise levels in ICUs by implementing simple and effective measures. This reduction has a significant effect on patient satisfaction, and, in addition, promotes healing.