An acoustical environment survey of student music practice.

Chronic exposure to loud sound leads to noise-induced hearing loss. This is especially common in collegiate-level musicians. Existing methods for estimating exposure typically do not consider genre- or instrument-specific variability in soundscape/spectral characteristics. We measured sound exposure levels (SELs) across instruments, bands, and genres at a university music school. We found (1) considerable variability in SELs across instruments and bands, (2) that Jazz musicians are consistently exposed to the highest sound levels, and (3) that spectral features of music differ between instrument type and genre, and based on room size. These findings highlight the need for tailored guidelines that moderate the implementation of hearing conservation initiatives for collegiate musicians.

Factors Affecting Peripheral Intravenous Catheter Placement During Pediatric Trauma Resuscitation.

INTRODUCTION: Intravenous access is required for resuscitation of injured patients but may be delayed in children because of challenges associated with peripheral intravenous (PIV) catheter placement. Early identification of factors predisposing patients to difficult PIV placement can assist in deciding strategies for timely intravenous access. METHODS: We conducted a retrospective, video-based review of injured children and adolescents treated between April 2018 and May 2019. Patient demographic, physiological, injury, and resuscitation characteristics were obtained from the patient record, including age, race, weight, injury type, Injury Severity Score, initial systolic blood pressure, initial Glasgow Coma Score, intubation status, activation level, and presence of prearrival notification. Video review was used to determine the time to PIV placement, the number of attempts required, the purpose for additional access, and the reason for abandonment of PIV placement. Multivariable regressions were used to determine factors associated with successful placement. RESULTS: During the study period, 154 consented patients underwent attempts at PIV placement in the trauma bay. Placement was successful in 139 (90.3%) patients. Older patients (OR [odds ratio]: 0.9, 95% confidence interval [CI]: 0.9, 0.9) and patients who required the highest level activation response (OR: 0.0, 95% CI: 0.0, 0.3) were less likely to have an attempt at PIV placement abandoned. Children with nonblunt injuries (OR: 11.6, 95% CI: 1.3, 119.2) and pre-existing access (OR: 39.6, 95% CI: 7.0, 350.6) were more likely to have an attempt at PIV placement abandoned. Among patients with successful PIV placement, the time required for establishing PIV access was faster as age increased (-0.5 s, 95% CI: -1.1, -0.0). CONCLUSIONS: Younger age was associated with abandonment of PIV attempts and, when successful, increased time to placement. Strategies to improve successful PIV placement and alternate routes of access should be considered early to prevent treatment delays in younger children.

The influence of phoneme contexts on adaptation in vowel-evoked envelope following responses.

Repeated stimulus presentation leads to neural adaptation and consequent amplitude reduction in vowel-evoked envelope following responses (EFRs)-a response that reflects neural activity phase-locked to envelope periodicity. EFRs are elicited by vowels presented in isolation or in the context of other phonemes such as consonants in syllables. While context phonemes could exert some forward influence on vowel-evoked EFRs, they may reduce the degree of adaptation. Here, we evaluated whether the properties of context phonemes between consecutive vowel stimuli influence adaptation. EFRs were elicited by the low-frequency first formant (resolved harmonics) and middle-to-high-frequency second and higher formants (unresolved harmonics) of a male-spoken /i/ when the presence, number and predictability of context phonemes (/s/, /a/, /∫/ and /u/) between vowel repetitions varied. Monitored over four iterations of /i/, adaptation was evident only for EFRs elicited by the unresolved harmonics. EFRs elicited by the unresolved harmonics decreased in amplitude by ~16-20 nV (10%-17%) after the first presentation of /i/ and remained stable thereafter. EFR adaptation was reduced by the presence of a context phoneme, but the reduction did not change with their number or predictability. The presence of a context phoneme, however, attenuated EFRs by a degree similar to that caused by adaptation (~21-23 nV). Such a trade-off in the short- and long-term influence of context phonemes suggests that the benefit of interleaving EFR-eliciting vowels with other context phonemes depends on whether the use of consonant-vowel syllables is critical to improve the validity of EFR applications.

Designing Interactive Alerts to Improve Recognition of Critical Events in Medical Emergencies.

Vital sign values during medical emergencies can help clinicians recognize and treat patients with life-threatening injuries. Identifying abnormal vital signs, however, is frequently delayed and the values may not be documented at all. In this mixed-methods study, we designed and evaluated a two-phased visual alert approach for a digital checklist in trauma resuscitation that informs users about undocumented vital signs. Using an interrupted time series analysis, we compared documentation in the periods before (two years) and after (four months) the introduction of the alerts. We found that introducing alerts led to an increase in documentation throughout the post-intervention period, with clinicians documenting vital signs earlier. Interviews with users and video review of cases showed that alerts were ineffective when clinicians engaged less with the checklist or set the checklist down to perform another activity. From these findings, we discuss approaches to designing alerts for dynamic team-based settings.