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.

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.

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.

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.

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.

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.

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.

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.

Re-Sounding Alarms: Designing Ergonomic Auditory Interfaces by Embracing Musical Insights.

Auditory alarms are an important component of human-computer interfaces, used in mission-critical industries such as aviation, nuclear power plants, and hospital settings. Unfortunately, problems with recognition, detection, and annoyance continue to hamper their effectiveness. Historically, they appear designed more in response to engineering constraints than principles of hearing science. Here we argue that auditory perception in general and music perception in particular hold valuable lessons for alarm designers. We also discuss ongoing research suggesting that the temporal complexity of musical tones offers promising insight into new ways of addressing widely recognized shortcomings of current alarms.

Efficiency of Crude Protein Utilisation in Grazing Dairy Cows: A Case Study Comparing Two Production Systems Differing in Intensification Level in New Zealand.

In this study, we modelled and compared lactation curves of efficiency of crude protein utilisation (ECPU) and the nitrogen (N) excreta partitioning of milking cows of two contrasting spring-calving pasture-based herds to test some aspects of farming intensification practices on cow performance and N partition. In the low-intensity production system (LIPS), 257 cows were milked once-daily and fed diets comprised of pasture with low supplementary feed inclusion during lactation (304 kg pasture silage/cow). In the high-intensity production system (HIPS), 207 cows were milked twice-daily and fed pasture with higher supplementary feed inclusion (429 kg pasture silage and 1695 kg concentrate/cow). The dietary crude protein (CP) utilisation was calculated for each cow at every herd test date as the ECPU as a proportion of protein yield (PY) from the CP intake (CPI) derived from intake assessments based on metabolisable energy requirements, and the CP balance (CPB) calculated as the difference between CPI and PY. Total N excreta partitioned to faeces (FN) and urine (UN) was estimated by back-calculating UN from FN, considering dietary N, and from N retained in body tissues, taking into account live weight change during the lactation. The higher CPI (2.7 vs. 2.5 kg CP/day), along with the reduced milk yield (1100 kg milk/cow less), of the LIPS cows led to a lower ECPU (23% vs. 31%) and to a higher CPB (2.1 vs. 1.8 kg CP/day) when compared to the HIPS cows. Mean N excreta, and particularly UN, was significantly higher in LIPS cows, and this was explained by higher dietary CP and by the reduced PY when compared to the HIPS cows. Reducing the low-CP supplementation in the "de-intensified" herd lessened the ECPU, resulting in higher UN, which is sensitive in terms of body water eutrophication.

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.

Comparison of sonication with chemical biofilm dislodgement methods using chelating and reducing agents: Implications for the microbiological diagnosis of implant associated infection.

The diagnosis of implant-associated infections is hampered due to microbial adherence and biofilm formation on the implant surface. Sonication of explanted devices was shown to improve the microbiological diagnosis by physical removal of biofilms. Recently, chemical agents have been investigated for biofilm dislodgement such as the chelating agent ethylenediaminetetraacetic acid (EDTA) and the reducing agent dithiothreitol (DTT). We compared the activity of chemical methods for biofilm dislodgement to sonication in an established in vitro model of artificial biofilm. Biofilm-producing laboratory strains of Staphylococcus epidermidis (ATCC 35984), S. aureus (ATCC 43300), E. coli (ATCC 25922) and Pseudomonas aeruginosa (ATCC 53278) were used. After 3 days of biofilm formation, porous glass beads were exposed to control (0.9% NaCl), sonication or chemical agents. Quantitative and qualitative biofilm analyses were performed by colony counting, isothermal microcalorimetry and scanning electron microscopy. Recovered colony counts after treatment with EDTA and DTT were similar to those after exposure to 0.9% NaCl for biofilms of S. epidermidis (6.3 and 6.1 vs. 6.0 log10 CFU/mL, S. aureus (6.4 and 6.3 vs. 6.3 log10 CFU/mL), E. coli (5.2 and 5.1 vs. 5.1 log10 CFU/mL and P. aeruginosa (5.1 and 5.2 vs. 5.0 log10 CFU/mL, respectively). In contrast, with sonication higher CFU counts were detected with all tested microorganisms (7.5, 7.3, 6.2 and 6.5 log10 CFU/mL, respectively) (p <0.05). Concordant results were observed with isothermal microcalorimetry and scanning electron microscopy. In conclusion, sonication is superior to both tested chemical methods (EDTA and DTT) for dislodgement of S. epidermidis, S. aureus, E. coli and P. aeruginosa biofilms. Future studies may evaluate potential additive effect of chemical dislodgement to sonication.

Current Status of Musculoskeletal Trauma Care Systems Worldwide.

BACKGROUND AND RATIONALE: Although general trauma care systems and their effects on mortality reduction have been studied, little is known of the current state of musculoskeletal trauma delivery globally, particularly in low-income (LI) and low middle-income (LMI) countries. The goal of this study is to assess and describe the development and availability of musculoskeletal trauma care delivery worldwide. MATERIALS & METHODS: A questionnaire was developed to evaluate different characteristics of general and musculoskeletal trauma care systems, including general aspects of systems, education, access to care and pre- and posthospital care. Surgical leaders involved with musculoskeletal trauma care were contacted to participate in the survey. RESULTS: Of the 170 surveys sent, 95 were returned for use for the study. Nearly 30 percent of surgeons reported a formalized and coordinated trauma system in their countries. Estimates for the number of surgeons providing musculoskeletal trauma per one million inhabitants varied from 2.6 in LI countries to 58.8 in high-income countries. Worldwide, 15% of those caring for musculoskeletal trauma are fellowship trained. The survey results indicate a lack of implemented musculoskeletal trauma care guidelines across countries, with even high-income countries reporting less than 50% availability in most categories. Seventy-nine percent of the populations from LI countries were estimated to have no form of health care insurance. Formalized emergency medical services were reportedly available in only 33% and 50% of LI and LMI countries, respectively. Surgeons from LI and LMI countries responded that improvements in the availability of equipment (100%), number and locations of trauma-designated hospitals (90%), and physician training programs (88%) were necessary in their countries. The survey also revealed a general lack of resources for postoperative and rehabilitation care, irrespective of the country's income level. CONCLUSION: This study addresses the current state of musculoskeletal trauma care delivery worldwide. These results indicate a greater need for trauma system development and support, from prehospital through posthospital care. Optimization of these systems can lead to better outcomes for patients after trauma. This study represents a critical first step toward better understanding the state of musculoskeletal trauma care in countries with different levels of resources, developing strategies to address deficiencies, and forming regional and international collaborations to develop musculoskeletal trauma care guidelines.

Acoustic Constraints and Musical Consequences: Exploring Composers' Use of Cues for Musical Emotion.

Emotional communication in music is based in part on the use of pitch and timing, two cues effective in emotional speech. Corpus analyses of natural speech illustrate that happy utterances tend to be higher and faster than sad. Although manipulations altering melodies show that passages changed to be higher and faster sound happier, corpus analyses of unaltered music paralleling those of natural speech have proven challenging. This partly reflects the importance of modality (i.e., major/minor), a powerful musical cue whose use is decidedly imbalanced in Western music. This imbalance poses challenges for creating musical corpora analogous to existing speech corpora for purposes of analyzing emotion. However, a novel examination of music by Bach and Chopin balanced in modality illustrates that, consistent with predictions from speech, their major key (nominally "happy") pieces are approximately a major second higher and 29% faster than their minor key pieces (Poon and Schutz, 2015). Although this provides useful evidence for parallels in use of emotional cues between these domains, it raises questions about how composers "trade off" cue differentiation in music, suggesting interesting new potential research directions. This Focused Review places those results in a broader context, highlighting their connections with previous work on the natural use of cues for musical emotion. Together, these observational findings based on unaltered music-widely recognized for its artistic significance-complement previous experimental work systematically manipulating specific parameters. In doing so, they also provide a useful musical counterpart to fruitful studies of the acoustic cues for emotion found in natural speech.

[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.

[Radiologic Presentation in Subspine Impingement and Correlation with Intraarticular Impingement in the Hip]. / Konventionell-radiologische Darstellung des subspinalen Impingements und Koinzidenz mit intraartikulärem Impingement am Hüftgelenk.

Background Besides the known intraarticular femoroacetabular impingement (FAI), recently forms of extra-articular impingement of the hip have been increasingly recognized. Recent studies have described an extra-articular impingement between a distal extension of the anterior inferior iliac spine (AIIS) and the femoral neck (AIIS or subspine impingement). Evidently, an association between this subspine impingement and an intraarticular FAI seems to exist. Little is known about the incidence of this impingement type and the value of its radiological diagnostics. The aim of this study was therefore to evaluate the correlation of a subspine impingement with intraarticular femoroacetabular impingement and radiological criteria of subspine impingement. Material and Methods In 2013 arthroscopic correction of intra-articular femoroacetabular impingement was performed in 80 cases. This collective was evaluated for simultaneous intraoperative findings of subspine impingement. In addition, the patients were evaluated for radiological signs of subspine impingement in conventional X-ray. A projection of the AIIS either below the acetabular sourcil or the anterior acetabular rim in an AP pelvis X-ray was considered as a radiological sign of low AIIS formation. These radiological findings were compared with the presence of intraoperative signs for subspine impingement, which are defined as a combination of focal capsule synovitis, labral ecchymosis close to the AIIS and a decreased offset between the acetabular rim and the AIIS. The specificity and sensitivity of the pre-operative radiological signs were calculated. Results A subspine impingement was found in 17 cases (21 %, 3 female, 14 male, mean age 28 years). A projection of the AIIS caudal to the acetabular sourcil in the AP pelvis X-ray was represented in 15 of the 17 cases detected (sensitivity 0.90, specificity 0.88). A projection below the anterior glenoid rim was detectable in 2 cases with symptomatic AIIS impingement (sensitivity 0.12, specificity 1). Conclusion A relevant proportion of patients with intraarticular FAI showed intraoperative signs for an additive extraarticular AIIS impingement. Preoperative pelvic X-rays are helpful with a sensitivity of 90 % in detecting the presence of a distal extension of the AIIS in FAI patients. Evaluation of the preoperative AP pelvis x-ray should include the projection of the AIIS. We recommend evaluation for subspine impingement during routine arthroscopy.

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.