Bakgrund: Patienter på en intensivvårdsavdelning är ofta i behov av avancerad medicinsk behandling på grund av sitt livshotande sjukdomstillstånd. Återkommande störningar av sömnen är ett av de vanligaste återkommande klagomålen från patienter vilket bidrar till att perioden upplevs som särskilt svår. Syfte: Att belysa vad vuxna patienter upplever stör sömnen på en intensivvårdsavdelning. Metod: Allmän litteraturstudie där 12 vetenskapliga artiklar ligger till grund för resultatet. Resultat: I analysen av artiklarna framträdde fyra kategorier som alla tillsammans påverkade patientens sömn negativt. Kategorierna var rädsla/oro över att inte bli frisk, smärta från till exempel operationssår, inskränkning av integriteten samt störningar från vårdrelaterade interventioner såsom kontroll av vitalparametrar, munvård och förbandsbyte. Diskussion: Tidigare forskning har påvisat ljus och ljud från apparater som störande för patientens sömn, resultatet från denna studie visar dock att samtal mellan personalen är mer störande. Personalen kan behöva uppmärksamma detta och anpassa samtalsnivån därefter. Genom att informera patienten om vad som händer på intensivvårdsavdelningen kan man öka deras känsla av trygghet. Rutinmässiga vårdrelaterade interventioner skulle kunna samordnas nattetid för att ge patienterna sammanhängande sömn. Slutsats: Personal inom intensivvården skulle behöva uppmärksamma vad patienten upplever stör sömnen under vårdtiden. Ytterligare forskning med kvalitativ ansats behövs där patientens upplevelser sätts i fokus. / Background: Patients in an intensive care unit (ICU) often require sophisticated treatment due to life-threatening conditions, but disturbed sleep has been found to be one of the most reoccurring complaints from patients in intensive care. Purpose: To highlight what adults perceive disturb their sleep in an intensive care unit. Method: General literature review where twelve scientific articles form the basis of the results. Result: When analysed, four categories emerged, which when combined adversely affected patients sleep. The categories were fear/worry about not recovering, pain from e.g. surgical wounds, limitations of integrity caused by being attached to wires and tubes, and disturbance from care related interventions by staff checking vital observations, oral hygiene, wound dressings. Discussion: Previous research has found light and machinery noise disruptive, however, our findings show staff communication levels to be more disturbing. Straff need to be aware of speech noise levels, reminding colleagues when required. Informing patients of ICU activity helps increase patients’ sense of security which when combined with coordinated, care related interventions at night helps with continous periods of sleep. Conclusion: ICU staff need to identify patients concerns regarding perceived sleep disruption. Further research is required where patients perception of sleepdisturbances is in focus.

Cell survival in conditions of severe oxygen deprivation depends on a wide variety of biochemical modifications, which result in a large-scale suppression of metabolism, preventing [ATP] from falling to fatally low levels. We investigated whether AMP-activated protein kinase (AMPK) has a role in the coordination of cellular modification during hypoxia, which leads to a regulated state of metabolic suppression in the goldfish (Carassius auratus). Energy charge, AMPK activity, protein and gene expression, as well as the translational capacity and phosphorylation state of a downstream target were measured in goldfish tissues during exposure to hypoxia (-0.3 mg 02/L) for up to 12 h. AMPK activity in the goldfish liver increased by 4-fold at 0.5 h hypoxia and was temporally associated with a —11-fold increase in calculated AMPfree/ATP. No change was observed in total AMPK protein or relative gene expression of identified AMPK isoforms. Changes in AMPK activity were also associated with a decreased rate of protein synthesis and an increase in the phosphorylated form of eukaryotic elongation factor-2 (eEF2; relative to total eEF2). Increases in AMPK activity were not seen in hypoxic goldfish muscle, brain, heart or gill, nor was a significant alteration in cellular energy charge seen in muscle. Still, the present study is the first to show that AMPK activity increases in liver in response to short-term severe hypoxia exposure in a hypoxia-tolerant fish. The decreased rates of protein synthesis, a well known component of metabolic suppression, combined with increased phosphorylation of eEF2, a downstream target of AMPK, potentially implicate the kinase in the cellular effort to suppress metabolism in hypoxia-tolerant species during oxygen deprivation.

Obesity is becoming a worldwide concern, with more than 300 million individuals who are obese and a further 750 million who are overweight. This increase is important as obesity has been linked to an increased incidence of cardiovascular disease, type two diabetes mellitus, stroke and some cancers. One factor receiving increasing attention to explain variation in obesity prevalence is the role of the built environment. This involves examining how features of the built environment such as green space or food premises vary by neighbourhood area. The presence of such resources within a neighbourhood can influence obesity through encouraging a healthy or unhealthy environment. It is important to understand how neighbourhoods influence obesity. This will allow the creation of effective public policy and urban design initiatives to reduce the obesity prevalence. Little research has examined how the quality of these resources varies between neighbourhoods and their effect on the prevalence of obesity. This thesis addresses this using a systematic site survey tool to investigate how the quality of built environment resources varies by neighbourhood deprivation. It also employs a questionnaire to examine residents’ perception of their neighbourhood as these can influence obesity through the utilisation of healthy resources. Three key findings were identified: there is a significant relationship between deprivation and the number of neighbourhood resources; the quality of these resources increases as deprivation increases; and residents in a high deprivation neighbourhood had a more positive perception of the neighbourhood. As a result, high deprivation neighbourhoods may be less likely to promote obesity as they have higher quality resources and residents have a more positive perception of the environment. These findings suggest that the influence of the built environment is context specific and that it may not be as influential on obesity in Christchurch. It highlights the need to consider both individual and environmental factors in explaining the geographic variation of obesity.

Laboratory and field studies have consistantly shown that sleep loss negatively impacts on neurobehavioural performance and alertness. Moreover, recent research suggests that the detrimental effects of sleep loss are qualitatively and quantitatively similar to the effects of alcohol intoxication. Despite this, sleepiness-related performance impairment has not been subject to the strict levels of regulatory intervention that govern alcohol consumption when driving and/or at work. It has been proposed that this failure to address the occupational, health and safety impact of sleep loss, and the subsequent lack of legislation to manage and control sleepiness in a manner commensurate with the associated statistical risks, may in part, reflect a failure to provide policy makers with a readily understood index of the relative risk associated with sleep loss. Therefore the aim of the studies in this thesis was to assess and quantify the effects of sleep loss on a range of measures, including neurobehavioural performance, sleepiness, and daytime sleep quality and quantity.

Thesis (M.S.)--University of North Carolina at Greensboro, 2007. / Title from PDF t.p. (viewed Feb. 28, 2008). Directed by Kenneth Gruber; submitted to the School of Human Environmental Sciences. Includes bibliographical references (p. 67-70).

Thesis (M.S.)--Auburn University, 2007. / Abstract. Vita. Includes survey instruments. Includes bibliographic references (ℓ. 49-56)

Thesis (D. Psych.)--Victoria University (Melbourne, Vic.), 2007. / Includes bibliographical references.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2010. / Title from first page of PDF file (viewed February 17, 2010). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references (p. 81-86).

Thesis (D.N. Sc.)--Catholic University of America. / Typescript. eContent provider-neutral record in process. Description based on print version record. Bibliography: leaves 106-109.

Thesis (M.S. in Operations Research)--Naval Postgraduate School, Sept. 2004. / Thesis advisor(s): Nita Lewis Miller. Includes bibliographical references (p. 87-90). Also available online.