Improving detectability of auditory interfaces for medical alarms through temporal variation in amplitude envelope.

BACKGROUND: Auditory interfaces play a vital role in many applications, informing users about both urgent and routine information critical to safety. Unfortunately, problems related to high alarm rates, low reliability, and sound annoyance create barriers to optimising the quality of patient care in perioperative medicine and critical care. Here, we explore how to reduce annoyance and improve detection by manipulating a sound's temporal envelope or the way its energy changes over time. METHODS: In the first experiment, participants were asked to detect a series of percussive and flat tones presented at six signal-to-noise ratios while performing a concurrent speech comprehension task. In the second experiment, different participants were asked to evaluate the relative annoyance of these same sounds. RESULTS: Relative to industry-standard flat tones, percussive tones were significantly less annoying and more detectable. Although more detectable, percussive tones did not impair concurrent speech comprehension. CONCLUSIONS: Temporal variation in amplitude envelope represents a promising path towards improving auditory interfaces for patient monitoring. By using temporally variable sounds, auditory interfaces can be more effective in alerting users. This is important for safety-critical areas, such as medical alarms, where annoyance often limits efficacy. As this manipulation can preserve the pitch and rhythm of tone sequences, it is compatible with users' pre-existing knowledge of current alarms.

Auditory roughness: a delicate balance.

Auditory roughness in medical alarm sounds is an important design attribute, and has been shown to impact user performance and perception. While roughness can assist in decreased signal-to-noise ratios (perceived loudness) and communicate urgency, it might also impact patient recovery. Therefore, considerations of neuroscience correlates, music theory, and patient impact are critical aspects to investigate in order to optimise alarm design.

Emotion and expertise: how listeners with formal music training use cues to perceive emotion.

Although studies of musical emotion often focus on the role of the composer and performer, the communicative process is also influenced by the listener's musical background or experience. Given the equivocal nature of evidence regarding the effects of musical training, the role of listener expertise in conveyed musical emotion remains opaque. Here we examine emotional responses of musically trained listeners across two experiments using (1) eight measure excerpts, (2) musically resolved excerpts and compare them to responses collected from untrained listeners in Battcock and Schutz (2019). In each experiment 30 participants with six or more years of music training rated perceived emotion for 48 excerpts from Bach's Well-Tempered Clavier (WTC) using scales of valence and arousal. Models of listener ratings predict more variance in trained vs. untrained listeners across both experiments. More importantly however, we observe a shift in cue weights related to training. Using commonality analysis and Fischer Z score comparisons as well as margin of error calculations, we show that timing and mode affect untrained listeners equally, whereas mode plays a significantly stronger role than timing for trained listeners. This is not to say the emotional messages are less well recognized by untrained listeners-simply that training appears to shift the relative weight of cues used in making evaluations. These results clarify music training's potential impact on the specific effects of cues in conveying musical emotion.

More detectable, less annoying: Temporal variation in amplitude envelope and spectral content improves auditory interface efficacy.

Auditory interfaces, such as auditory alarms, are useful tools for human computer interaction. Unfortunately, poor detectability and annoyance inhibit the efficacy of many interface sounds. Here, it is shown in two ways how moving beyond the traditional simplistic temporal structures of normative interface sounds can significantly improve auditory interface efficacy. First, participants rated tones with percussive amplitude envelopes as significantly less annoying than tones with flat amplitude envelopes. Crucially, this annoyance reduction did not come with a detection cost as percussive tones were detected more often than flat tones-particularly, at relatively low listening levels. Second, it was found that reductions in the duration of a tone's harmonics significantly lowered its annoyance without a commensurate reduction in detection. Together, these findings help inform our theoretical understanding of detection and annoyance of sound. In addition, they offer promising original design considerations for auditory interfaces.

Temporal prediction abilities are mediated by motor effector and rhythmic expertise.

Motor synchronization is a critical part of musical performance and listening. Recently, motor control research has described how movements that contain more available degrees of freedom are more accurately timed. Previously, we demonstrated that stick tapping improves perception in a timing detection task, where percussionists greatly outperformed non-percussionists only when tapping along. Since most synchronization studies implement finger tapping to examine simple motor synchronization, here we completed a similar task where percussionists and non-percussionists synchronized using finger tapping; movement with fewer degrees of freedom than stick tapping. Percussionists and non-percussionists listened to an isochronous beat sequence and identified the timing of a probe tone. On half of the trials, they tapped along with their index finger, and on the other half of the trials, they listened without moving prior to making timing judgments. We found that both groups benefited from tapping overall. Interestingly, percussionists performed only marginally better than did non-percussionists when finger tapping and no different when listening alone, differing from past studies reporting highly superior timing abilities in percussionists. Additionally, we found that percussionist finger tapping was less variable and less asynchronous than was non-percussionist tapping. Moreover, in both groups finger tapping was more variable and more asynchronous than stick tapping in our previous study. This study demonstrates that the motor effector implemented in tapping studies affects not only synchronization abilities, but also subsequent prediction abilities. We discuss these findings in light of effector-specific training and degrees of freedom in motor timing, both of which impact timing abilities to different extents.

Economic considerations of breeding for polled dairy cows versus dehorning in the United States.

This paper examines the costs and benefits of selecting for polled dairy heifers versus traditional dehorning practices. Stochastic budgets were developed to analyze the expected costs (EC) associated with polled dairy genetics. The economic assessment was expanded beyond on-farm cash costs by incorporating cost and benefit estimates to generate industry-wide discussion, and preliminary economic evaluations, surrounding the public acceptance and attitude toward polled genetics versus dehorning calves. Triangular distributions, commonly used to represent distributions with limited data, were used to represent labor costs for dehorning, the likelihood of treatment of calf, and the cost of veterinary treatment. In total, 10,000 iterations were run using @Risk v 6.0 (Palisade Corp., Newfield, NY). The EC of the 4 traditional dehorning methods evaluated in this study ranged from $6 to $25/head, with a mean EC around $12 to $13/head. The EC of incorporating polled genetics into a breeding program ranged from $0 to $26/head depending on the additional cost, or premium, associated with polled relative to horned genetics. Estimated breakeven premiums associated with polled genetics indicate that, on average, producers could spend up to $5.95/head and $11.90/head more for heterozygous and homozygous polled genetics, respectively, compared with conventional horned genetics (or $2.08 and $4.17/straw of semen at an assumed average conception rate of 35%). Given the parameters outlined, sensitivity to individual farm semen and dehorning costs are likely to swamp these differences. Beyond on-farm costs, industry-wide discussion may be warranted surrounding the public's acceptance and attitude toward polled genetics versus dehorning or disbudding of calves. The value of avoiding dehorning may be larger for the industry, and perhaps some individual farms, than initially suggested if additional value is put on calf comfort and possible worker aversion to dehorning. If public perception of dehorning influences market access, the EC of dehorning may be large but that cost is unknown at present.

[Antibiotic strategies in trauma surgery : Treatment of implant-associated infections]. / Antiinfektiöse Strategien in der Unfallchirurgie : Therapie osteosyntheseassoziierter Infektionen.

Implant-associated infections represent a serious complication following fracture management. Due to biofilm formation, an optimized treatment strategy is required to treat these infections. Interdisciplinary cooperation between trauma surgeon, infectious diseases specialist and microbiologist enables the deployment of a concerted surgical and antibiotic treatment concept, which significantly influences treatment success. Fracture healing and chronic osteomyelitis prevention are the primary treatment goals. In general, the eradication of infection is possible with surgical debridement, change or removal of the implant and adequate antibiotic therapy. In some cases, suppressive therapy until consolidation of fracture and later removal of the implant is an option.

Composing alarms: considering the musical aspects of auditory alarm design.

Short melodies are commonly linked to referents in jingles, ringtones, movie themes, and even auditory displays (i.e., sounds used in human-computer interactions). While melody associations can be quite effective, auditory alarms in medical devices are generally poorly learned and highly confused. Here, we draw on approaches and stimuli from both music cognition (melody recognition) and human factors (alarm design) to analyze the patterns of confusions in a paired-associate alarm-learning task involving both a standardized melodic alarm set (Experiment 1) and a set of novel melodies (Experiment 2). Although contour played a role in confusions (consistent with previous research), we observed several cases where melodies with similar contours were rarely confused - melodies holding musically distinctive features. This exploratory work suggests that salient features formed by an alarm's melodic structure (such as repeated notes, distinct contours, and easily recognizable intervals) can increase the likelihood of correct alarm identification. We conclude that the use of musical principles and features may help future efforts to improve the design of auditory alarms.

Trained to keep a beat: movement-related enhancements to timing perception in percussionists and non-percussionists.

Many studies demonstrate that musicians exhibit superior timing abilities compared to nonmusicians. Here, we investigated how specific musical expertise can mediate the relationship between movement and timing perception. In the present study, a group of highly trained percussionists (n = 33) and a group of non-percussionists (n = 33) were tested on their ability to detect temporal deviations of a tone presented after an isochronous sequence. Participants either tapped along with the sequence using a drumstick (movement condition) or listened without tapping (no-movement condition). Although both groups performed significantly better when moving than when listening alone, percussionists gained a greater benefit from tapping when detecting the smallest probe tone delays compared to non-percussionists. This complements both the musical expertise and timing perception literature by demonstrating that percussionists with high levels of training may further capitalize on the benefits of sensorimotor interactions. Surprisingly, percussionists and non-percussionists performed no differently when listening alone, in contrast to other studies examining the role of training in timing abilities. This raises interesting questions about the degree to which percussionists' known expertise in timing may interact with their use of motion when judging rhythmic precision.

Injectable autologous chondrocyte transplantation for full thickness acetabular cartilage defects: early clinical results.

INTRODUCTION: Acetabular cartilage lesions are frequently seen in young patients with hip pain and have been identified as an important prognostic factor. New therapies have complemented abrasion and microfracture procedures. The aim of the study is to evaluate the early outcome of patients with arthroscopic injectable autologous chondrocyte transplantations (ACT) for full thickness acetabular cartilage defects. METHODS: A two-step procedure ACT was performed in patients with full thickness acetabular cartilage defects measuring ≥2 cm(2). The patients were closely followed with clinical examination, pre- and postoperative scores until the latest available follow-up of 3, 6, 12, and 24 months. RESULTS: 20 consecutive cases (4 female, 16 male, mean age 33 years) were included. No patients were lost at final follow-up. The average defect size was 5.05 (range 2-6) cm(2). The average follow-up was 12.05 (range 6-24) months. Three months postoperatively the preoperative scores improved significantly from a mean mHHS of 63-81 points (p = 0.009), iHOT33 of 44-66 % (p = 0.028) and subjective hip assessment (Subjective Hip Value, SHV) of 60-87 % (p = 0.007). After 12 months the results improved significantly to a mean mHHS of 93 points (p = 0.017), an iHOT33 of 79 % (p = 0.007) and an SHV of 82 % (p = 0.048) compared with the preoperative scores. DISCUSSION: The injectable matrix associated ACT is a reliable procedure, yielding promising early results with a significant increase of all scores evaluated in patients with full thickness acetabular cartilage defects.

Response to ad libitum milk allowance by crossbred dairy and dairy-beef calves in an automated feeding system.

The objective of this study was to compare three-breed rotational crossbred calves sired by Holstein, Jersey, Montbéliarde, Normande, Viking Red, and Limousin bulls with Holstein's calves fed a high milk allowance for growth, milk consumption, health scores, and profitability in an automated group feeding system. Breed groups were Holstein (n = 16), crossbreds of Montbéliarde, Viking Red, and Holstein (n = 24), crossbreds of Jersey, Normande, and Viking Red (n = 6), and Limousin crossbred beef × dairy (n = 45) calves. Calves were randomly assigned within the breed to one of two treatments from September 2019 to June 2020 at the University of Minnesota West Central Research and Outreach Center in Morris, MN. The five breed groups were balanced across the two treatment groups. Treatment groups were fed 8 L/d (8 L) or ad libitum (AL) milk allowance, and calves were introduced to the automated feeder at day 5 and were weaned at 56 d. Milk feeding behaviors (drinking speeds) were collected from the automatic feeding system and analyzed by feeding and breed groups. Body weights were recorded at birth and weekly through weaning. The health scores of calves were recorded twice per week. Variables included in the statistical model for analyses were fixed effects of birthweight, the season of birth, breed group, and treatment group. Calves fed AL had a greater weaning weight (P = 0.001; 106.4 kg vs. 91.4 kg) and greater (P = 0.001) average daily gain (ADG; 1.11 kg/d vs. 0.87 kg/d) than calves fed 8 L, respectively. The calves fed AL (1,064 mL/min) had a slower drinking speed (P = 0.01) than calves fed 8 L (1,467 mL/min). Most breed groups were not different for weaning weight or ADG across the 56 d. Daily milk consumption per calf was lower (P = 0.009) for Limousin crossbred calves compared with Holstein and crossbred dairy calves. As expected, AL calves had higher (P = 0.001) milk cost ($189.52) than the 8 L calves ($140.71). The average cost per kilogram of gain was similar for calves fed 8 L ($2.89/kg) compared to AL ($3.00/kg) calves. Overall, the Limousin crossbred calves had the least milk cost ($152.75) compared with Holstein ($175.67) calves and Montbéliarde, Viking Red, and Holstein crossbred calves ($177.13). The results from this study found that although feeding calves AL resulted in greater milk consumption and higher cost than 8 L calves, there may be an economic advantage with costs per kilogram of gain to feeding calves ad libitum if increased growth rates are realized.

Von Gierke Disease (Glycogen Storage Disease Type I) and Life-Threatening Abdominal Aortic Aneurysm: A Case Report of an Extremely Rare Condition.

Von Gierke disease, also known as glycogen storage disease type I, co-existent with an abdominal aortic aneurysm (AAA), is an extremely rare combination of diseases that requires challenging therapeutic measures. We present, for the first time in literature, the case of a 62-year-old female with von Gierke disease who required open surgical repair of an AAA with challenging neck anatomy outside of instructions for use of endovascular repair. Even though the surgical risks for life-threatening complications, such as pancreatitis, metabolic acidosis, and kidney failure, were high, the 6-month postoperative course was uneventful. Despite the invasiveness of the treatment, surgery to treat the AAA was safe and effective. Further data is needed to draw robust conclusions about the treatment of choice for those patients with diseases in co-existence with AAAs.

Treatment of long bone defects and non-unions: from research to clinical practice.

The treatment of long bone defects and non-unions is still a major clinical and socio-economical problem. In addition to the non-operative therapeutic options, such as the application of various forms of electricity, extracorporeal shock wave therapy and ultrasound therapy, which are still in clinical use, several operative treatment methods are available. No consensus guidelines are available and the treatments of such defects differ greatly. Therefore, clinicians and researchers are presently investigating ways to treat large bone defects based on tissue engineering approaches. Tissue engineering strategies for bone regeneration seem to be a promising option in regenerative medicine. Several in vitro and in vivo studies in small and large animal models have been conducted to establish the efficiency of various tissue engineering approaches. Neverthelsss, the literature still lacks controlled studies that compare the different clinical treatment strategies currently in use. However, based on the results obtained so far in diverse animal studies, bone tissue engineering approaches need further validation in more clinically relevant animal models and in clinical pilot studies for the translation of bone tissue engineering approaches into clinical practice.

Custom-made composite scaffolds for segmental defect repair in long bones.

Current approaches for segmental bone defect reconstruction are restricted to autografts and allografts which possess osteoconductive, osteoinductive and osteogenic properties, but face significant disadvantages. The objective of this study was to compare the regenerative potential of scaffolds with different material composition but similar mechanical properties to autologous bone graft from the iliac crest in an ovine segmental defect model. After 12 weeks, in vivo specimens were analysed by X-ray imaging, torsion testing, micro-computed tomography and histology to assess amount, strength and structure of the newly formed bone. The highest amounts of bone neoformation with highest torsional moment values were observed in the autograft group and the lowest in the medical grade polycaprolactone and tricalcium phosphate composite group. The study results suggest that scaffolds based on aliphatic polyesters and ceramics, which are considered biologically inactive materials, induce only limited new bone formation but could be an equivalent alternative to autologous bone when combined with a biologically active stimulus such as bone morphogenetic proteins.

Decaying amplitude envelopes reduce alarm annoyance: Exploring new approaches to improving auditory interfaces.

Auditory alarms offer great potential for facilitating human-computer interactions in complex, rapidly changing environments. They are particularly useful in medical settings, where in theory they should afford communication in emergency rooms, operating theatres, and hospitals around the world. Unfortunately, the sounds typically used in these devices are problematic, and researchers have documented numerous shortcomings. Their ubiquity means that even incremental improvements can have significant benefits for patient care. However, solutions have proven challenging for multiple reasons-including issues of backward compatibility inherent in changing any standard. Here we present a series of three experiments showing that manipulations to one specific, understudied property can significantly lower alarm annoyance without harming learning or memory-while preserving an alarm's melodic and rhythmic structure. These results suggest promising new directions for improving the hospital's soundscape, where evidence of problems related to sound are increasingly recognized as affecting medical outcomes as well as physician well-being.

Perceptions of Audio-Visual Impact Events in Younger and Older Adults.

Previous studies have examined whether audio-visual integration changes in older age, with some studies reporting age-related differences and others reporting no differences. Most studies have either used very basic and ambiguous stimuli (e.g., flash/beep) or highly contextualized, causally related stimuli (e.g., speech). However, few have used tasks that fall somewhere between the extremes of this continuum, such as those that include contextualized, causally related stimuli that are not speech-based; for example, audio-visual impact events. The present study used a paradigm requiring duration estimates and temporal order judgements (TOJ) of audio-visual impact events. Specifically, the Schutz-Lipscomb illusion, in which the perceived duration of a percussive tone is influenced by the length of the visual striking gesture, was examined in younger and older adults. Twenty-one younger and 21 older adult participants were presented with a visual point-light representation of a percussive impact event (i.e., a marimbist striking their instrument with a long or short gesture) combined with a percussive auditory tone. Participants completed a tone duration judgement task and a TOJ task. Five audio-visual temporal offsets (-400 to +400 ms) and five spatial offsets (from -90 to +90°) were randomly introduced. Results demonstrated that the strength of the illusion did not differ between older and younger adults and was not influenced by spatial or temporal offsets. Older adults showed an 'auditory first bias' when making TOJs. The current findings expand what is known about age-related differences in audio-visual integration by considering them in the context of impact-related events.

Growth modulation of angular deformities with a novel constant force implant concept-preclinical results.

PURPOSE: Varus-valgus deformities in children and adolescents are often corrected by temporary hemi-epiphysiodesis, in which the physis is bridged by an implant to inhibit growth. With standard implant solutions, the acting forces cannot be regulated, rendering the correction difficult to control. Furthermore, the implant load steadily increases with ongoing growth potentially leading to implant-related failures. A novel implant concept was developed applying a controlled constant force to the physis, which carries the potential to avoid these complications. The study aim was to proof the concept in vivo by analyzing the effect of three distinct force levels on the creation of varus deformities. METHODS: The proposed implant is made of a conventional cerclage wire and features a twisted coil that unwinds with growth resulting in an implant-specific constant force level. The proximal medial tibial physes of 18 lambs were treated with the implant and assigned to three groups distinct by the force level of the implant (200 N, 120 N, 60 N). RESULTS: The treatment appeared safe without implant-related failures. Deformity creation was statistically different between the groups and yielded on average 10.6° (200 N), 4.8° (120 N) and 0.4° (60 N) over the treatment period. Modulation rates were 0.51°/mm (200 N), 0.23°/mm (120 N) and 0.05°/mm (60 N) and were constant throughout the treatment. CONCLUSION: By means of the constant force concept, controlled growth modulation appeared feasible in this preclinical experiment. However, clinical trials are necessary to confirm whether the results are translatable to the human pathological situation.

Influence of milk yield, stage of lactation, and body condition on dairy cattle lying behaviour measured using an automated activity monitoring sensor.

Time spent lying by lactating Holstein-Friesian cows of varying body condition scores (BCS) and milk yield was measured using an animal activity monitor. A 3-week average BCS was calculated for each cow; and in total, 84 cows were selected with 28 cows each among three BCS categories (Thin: BCS<2.75; Moderate: 2.75 > or = BCS<3.25; Heavy: BCS> or = 3.25) and two stage of lactation categories (<150 days in milk or >150 days in milk). Cows were kept in two management systems: parlour/freestall (n=60) or automated milking system/freestall (n=24). Behaviour was recorded for 5.3+/-0.1 d for each cow. Production levels were considered using a 28-d rolling average of daily milk production. Cows that exhibited clinical lameness before or during the observation period were excluded from analyses. For cows exhibiting oestrus, the day prior to, day of, and day following breeding were removed. The final analysis included 77 cows (408 d of observation). A mixed model was fitted to describe average daily hours spent lying. Results demonstrated that lying time increased as days in milk (DIM) increased (P=0.05). Variables that were tested but not significant (P>0.05) were BCS category, parity category (1 or 2) and 28-d rolling average daily milk production. Although a numerical trend for increasing hours spent lying with increasing BCS was observed, after accounting for other factors in the mixed model, BCS did not significantly impact lying time. Continued investigation of these management factors that impact lying time and bouts, using new technologies, more cows, and more herds will help dairy owners better manage facilities and cow movements to optimize this essential behaviour.

Comparison of two methods of assessing dairy cow body condition score.

Two body condition scoring systems were compared for assessing body condition of cows at the Scottish Agricultural College's Crichton Royal Farm. The weekly body condition scores (BCS) were collected for a period of 12 weeks (5 September-21 November). Scores were obtained using the primary systems utilized within the UK and USA. The USBCS were obtained by the same evaluator each week, while the UKBCS were obtained by two different evaluators alternating between weeks. Paired scores (n=2088) between the two systems within week were moderately correlated (r=0.75, P<0.0001). Regression equations to convert scores between the two systems were created using the GLM procedure of SAS (SAS Institute Inc., Cary NC, USA). The simple GLM models to convert from UK to US scores and US to UK scores were USBCS=1.182+0.816 * UKBCS (R2=0.56) and UKBCS=0.131+0.681 (R2=0.56), respectively. These equations may be used to interpret scores within the literature obtained using these two BCS systems, although they must be used with caution.

On the generalization of tones: A detailed exploration of non-speech auditory perception stimuli.

The dynamic changes in natural sounds' temporal structures convey important event-relevant information. However, prominent researchers have previously expressed concern that non-speech auditory perception research disproportionately uses simplistic stimuli lacking the temporal variation found in natural sounds. A growing body of work now demonstrates that some conclusions and models derived from experiments using simplistic tones fail to generalize, raising important questions about the types of stimuli used to assess the auditory system. To explore the issue empirically, we conducted a novel, large-scale survey of non-speech auditory perception research from four prominent journals. A detailed analysis of 1017 experiments from 443 articles reveals that 89% of stimuli employ amplitude envelopes lacking the dynamic variations characteristic of non-speech sounds heard outside the laboratory. Given differences in task outcomes and even the underlying perceptual strategies evoked by dynamic vs. invariant amplitude envelopes, this raises important questions of broad relevance to psychologists and neuroscientists alike. This lack of exploration of a property increasingly recognized as playing a crucial role in perception suggests future research using stimuli with time-varying amplitude envelopes holds significant potential for furthering our understanding of the auditory system's basic processing capabilities.