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This paper presents an experimental study of the effects of individual sound parameters on perceived (psychoacoustic) urgency. Experimental Series 1 showed that fundamental frequency, harmonic series, amplitude envelope shape, and delayed harmonics all have clear and consistent effects on perceived urgency. Experimental Series 2 showed that temporal and melodic parameters such as speed, rhythm, pitch range, and melodic structure also have clear and consistent effects on perceived urgency. The final experiment tested a set of 13 auditory warnings generated by an application of the earlier experimental findings. The urgency rank ordering of this warning set was predicted, and the correlation between the predicted and the obtained order was highly significant. The results of these experiments have a widespread application in the improvement of existing auditory warning systems and the design of new systems, where the psychoacoustic and psychological appropriateness of warnings could be enhanced.

The effects of four parameters (speed, fundamental frequency, repetition units, and inharmonicity) on perceived urgency were scaled using an application of Stevens's power law. From the exponents obtained, equal units of urgency change were calculated for three parameters. The units were combined in a set of stimuli, and the order of urgency was predicted. The obtained and predicted orders of urgency were highly correlated. The results also showed that even when equalized by psychophysical techniques, some parameters contribute more to perceived urgency than do others. This may be attributable to the different types of parameters scaled or the proportion of the usable range of each parameter that represents a unit change in urgency. The implication of the work for the design and improvement of auditory warnings is discussed.

Objective In this work, we systematically evaluated the reserved alarm sounds of the IEC 60601-1-8 international medical alarm standard to determine when and how they can be totally and partially masked. Background IEC 60601-1-8 gives engineers instruction for creating human-perceivable auditory medical alarms. This includes reserved alarm sounds: common types of alarms where each is a tonal melody. Even when this standard is honored, practitioners still fail to hear alarms, causing practitioner nonresponse and, thus, potential patient harm. Simultaneous masking, a condition where one or more alarms is imperceptible in the presence of other concurrently sounding alarms due to limitations of the human sensory system, is partially responsible for this. Methods In this research, we use automated proof techniques to determine if masking can occur in a modeled configuration of medical alarms. This allows us to determine when and how reserved alarm sound can mask other reserved alarms and to explore parameters to address discovered problems. Results We report the minimum number of other alarm sounds it takes to both totally and partially mask each of the high-, medium-, and low-priority alarm sounds from the standard. Conclusions Significant masking problems were found for both the total and partial masking of high-, medium-, and low-priority reserved alarm sounds. Application We show that discovered problems can be mitigated by setting alarm volumes to standard values based on priority level and by randomizing the timing of alarm tones.

The relationship between the semantics of words and the acoustics of the way they are spoken is explored. Actors spoke warning signal words in urgent, nonurgent and monotone style, and participants rated the urgency of the words. Results showed effects for signal word and style of presentation. Acoustic analysis showed that the urgent words were spoken at higher frequency with a broader pitch range and were louder than the nonurgent or monotone words. These acoustic differences were used to synthesize artificial versions of signal words in urgent and nonurgent formats. The urgent words were rated as more urgent than the nonurgent words, a finding attributable to their differing acoustics. Within each speaking style the words were acoustically the same, yet effects for signal word were found, suggesting that semantics is also important in urgency perception. This research has implications for the design and implementation of speech warning systems, particularly those in which urgency mapping is required.

Three studies explored amateur and professional users' compliance with pesticide warning labels. Professionals were classified as people working in a profession in which the use of pesticides is a necessary part of their job. Amateurs used pesticides only in their leisure time. The first study showed that the wording used affected perception of the appropriateness of hazard statements, one of the most effective variations being the use of the personal pronoun (statements beginning "You should..."). The location of warning information was also found to affect actual compliance: Compliance increased when warning information was presented in the directions for use section. A supplemental directive increased compliance only for professional users. In a final study, "best-case" and "worst-case" linguistic variations were combined with best-case and worst-case locations for safety information. Instruction statements using the personal pronoun and presented in the directions for use section resulted in the highest levels of compliance. The differences in compliance between amateur and professional users are interpreted within the framework of Rasmussen's (1986) distinction among skill-, rule-, and knowledgebased behavior. Actual or potential applications of this research include the design of warning labels and safety information.

Objective Address the alarm problem by redesigning, reorganizing, and reprioritizing to better discriminate alarm sounds and displays in a hospital. Background Alarms in hospitals are frequently misunderstood, disregarded, and overridden. Method Discovery-oriented, intervention, and translational studies were conducted. Study objectives and measures varied, but had the shared goals of increasing positive predictive value (PPV) of critical alarms by reducing low-PPV alarms in the background, prioritizing alarms, redesigning alarm sounds to increase information content, and transparently conveying who initiated alarms. An alarm ontology was iteratively generated and refined until consensus was achieved. Results The ontology distinguishes five levels of urgency that incorporate likely PPV, three categories for who initiates the alarm (hospital staff, patient, or machine), whether it is clinical or technical, and clinical functions. Conclusion This unique collaboration allowed us to make progress on the alarm problem by making unintuitive leaps, avoiding common missteps, and refuting conventional healthcare approaches. Application Hospitals can consistently redesign, reorganize, reprioritize, and better discriminate alarms by priority, PPV, and content to reduce nurse response times.

Objective This research investigated whether the psychoacoustics of simultaneous masking, which are integral to a model-checking-based method, previously developed for detecting perceivability problems in alarm configurations, could predict when IEC 60601-1-8-compliant medical alarm sounds are audible. Background The tonal nature of sounds prescribed by IEC 60601-1-8 makes them potentially susceptible to simultaneous masking: where concurrent sounds render one or more inaudible due to human sensory limitations. No work has experimentally assessed whether the psychoacoustics of simultaneous masking accurately predict IEC 60601-1-8 alarm perceivability. Method In two signal detection experiments, 28 nursing students judged whether alarm sounds were present in collections of concurrently sounding standard-compliant tones. The first experiment used alarm sounds with single-frequency (primary harmonic) tones. The second experiment's sounds included the additional, standard-required frequencies (often called subharmonics). T tests compared miss, false alarm, sensitivity, and bias measures between masking and nonmasking conditions and between the two experiments. Results Miss rates were significantly higher and sensitivity was significantly lower for the masking condition than for the nonmasking one. There were no significant differences between the measures of the two experiments. Conclusion These results validate the predictions of the psychoacoustics of simultaneous masking for medical alarms and the masking detection capabilities of our method that relies on them. The results also show that masking of an alarm's primary harmonic is sufficient to make an alarm sound indistinguishable. Application Findings have profound implications for medical alarm design, the international standard, and masking detection methods.

Objective Four sets of eight audible alarms matching the functions specified in IEC 60601-1-8 were designed using known principles from auditory cognition with the intention that they would be more recognizable and localizable than those currently specified in the standard. Background The audible alarms associated with IEC 60601-1-8, a global medical device standard, are known to be difficult to learn and retain, and there have been many calls to update them. There are known principles of design and cognition that might form the basis of more readily recognizable alarms. There is also scope for improvement in the localizability of the existing alarms. Method Four alternative sets of alarms matched to the functions specified in IEC 60601-1-8 were tested for recognizability and localizability and compared with the alarms currently specified in the standard. Results With a single exception, all prototype sets of alarms outperformed the current IEC set on both recognizability and localizability. Within the prototype sets, auditory icons were the most easily recognized, but the other sets, using word rhythms and simple acoustic metaphors, were also more easily recognized than the current alarms. With the exception of one set, all prototype sets were also easier to localize. Conclusion Known auditory cognition and perception principles were successfully applied to an existing audible alarm problem. Application This work constitutes the first (benchmarking) phase of replacing the alarms currently specified in the standard. The design principles used for each set demonstrate the relative ease with which different alarm types can be recognized and localized.