Cross-sectional Analysis of Sound Levels in the Neonatal Intensive Care Unit (NICU) at Thomas Jefferson University Hospital

Introduction . Infants in the NICU are considered at greater risk of developmental delay. It is now known that excessively loud noise can have a negative impact on parameters such as blood pressure, breathing, heart beat and oxygen saturation. Previous research has concluded that the optimal decibel (dB) level for proper growth of neonate hair cells rests around 45dB. Consequently, the American Academy of Pediatrics recommends that noise levels in the NICU be maintained to a maximum of 45dBA. However, little research has focused on designing new noise-altering products and their impact on neonatal outcomes. Methods. This was a cross sectional study. The NICU at Thomas Jefferson University Hospital was observed for room arrangements and general workflow. Additionally, decibel levels around empty neonatal incubators were measured. A decibel analyzer (REED Instruments SD-4023, Wilmington, NC) was used to record sound levels, both inside and outside of isolettes during various routine activities, including patient rounds, provider-parent conversations and vital monitoring alarms. Results. 30 discrete data points were surveyed, in addition to a 24-hour continuous decibel recording. Across all discrete data points, decibel levels had a mean of 65.6dB (SD ± 10.3). Ambient noise alone in a patient room was measured at 50dB. Noise levels in an open and closed isolette were measured at 58 and 57dB, respectively. Isolette side door opening and closing had a mean of 80.2dB (SD ± 7.60). With medical devices active in the patient room, noise levels had a mean of 62.7dB (SD ± 7.74). Conclusions. All data points were above the recommended safe noise level of 45dB. This data supports our development of a noise reduction product for use within neonatal isolettes. Our design will incorporate sterilizable, sound-absorbent materials and diffusion technologies to decrease ambient noise within neonatal incubators

Social factors in the decision by Swiss farmers to convert to organic farming

The number of organic farms in Switzerland has remained stable since 2009, although several studies have shown that financial arguments should mean that more farms convert to organic production. These results suggest that either farmers do not behave rationally, or there are other reasons that inhibit farmers from conversion. In this study, 39 organic and non-organic Swiss farmers were interviewed with the aim of identifying barriers to conversion and learning how these have been overcome. The results suggest that the structural conditions for conversion are in place but a range of social factors create barriers. These factors include negative attitudes towards organic farming held by family members; problems with mutual acceptance between organic and non-organic farmers; technical reasons such as fear of weed infestation; and a fear of losing independence. Organic farmers however suggested that these barriers are overestimated. Farmers who are considering conversion are reluctant to ask for advice because this is seen as an irreversible step to conversion. This allows the conclusion that informal events and platforms that enable communication between organic and non-organic farmers could inspire farmers to take the first steps.Keywords: conversion, organic farming, barriers, enablers, motivation

Šum u uhu - sadašnje stanje i terapija privikavanjem

Tinnitus is an abnormal noise in the ear. About six percent of the general population suffers from what they consider to be "severe" tinnitus. Tinnitus can come and go, or be continuous. It can sound like a low roar, or a high-pitched ring. Tinnitus may be bilateral or unilateral. The causes of tinnitus are various, e.g., inner ear injury, 8th nerve lesion, injury of the brainstem, and rarely of the brain. There also are many extracranial causes of tinnitus. Upon making the diagnosis of tinnitus, medical therapy may occasionally help lessen the noise even though the cause has not been identified. Current therapy for tinnitus, so-called tinnitus retraining therapy, first includes learning about what does actually cause the tinnitus. This process is called habituation of reaction. Tinnitus then becomes quieter for long period of time and may eventually disappear, or becomes part of the background .sound of silence (habituation of perception). In some cases, changes in the inner ear function may be important in triggering the occurrence of tinnitus (e.g., Meniere\u27s disease or acute acoustic trauma); however, the retraining approach works independently of the triggering factor. Despite the importance of hearing loss, a recent study in tinnitus patients showed that there was no significant difference in hearing between the tinnitus group and control group of healthy subjects.Šum u uhu je pojava nenormalne buke u uhu. Otprilike 6% populacije pati od tzv. jakog šuma u uhu. Šum se može pojaviti i nestati, ali može biti i trajan. Može zvučati poput duboke tutnjave ili zvonjave visokih tonova. Može nastati u oba uha ili samo u jednom. Uzroci šuma mogu biti različiti, npr. oštećenje unutarnjeg uha, ozljeda osmog moždanog živca ili moždanog debla, ili pak rjeđe ozljeda mozga. Ekstrakranijski uzroci šuma također su brojni. Nakon postavljanja dijagnoze osjet buke u uhu može se ublažiti upotrebom lijekova, iako uzrok šuma jo. nije utvrđen. U suvremenom načinu liječenja šuma, tzv. liječenju metodom privikavanja (tinnitus retraining therapy), najprije treba utvrditi što je zapravo prouzročilo nastanak šuma. Taj se proces zove "privikavanje na nastalu situaciju". Šum se tako može ublažiti na dulje vrijeme, a na kraju može i sasvim nestati ili se stopiti sa zvučnom pozadinom (habituacija percepcije). Promjene u unutarnjem uhu u nekim slučajevima mogu potaknuti naglu pojavu šuma u uhu (npr. Meniereova bolest ili akutna akustička trauma), ali valja naglasiti da liječenje metodom privikavanja daje dobre rezultate bez obzira na to što je u osnovi nastanka šuma. Unatoč važnosti gubitka sluha najnovija ispitivanja u bolesnika sa šumom pokazuju da nema značajnih razlika u sluhu između bolesnika sa šumom i skupine zdravih ispitanika

A Web-Based Application to Simulate Manual Bag-Valve-Tube Ventilation

What’s the Problem? The COVID-19 pandemic has threatened ventilator capacity in many locations which has led to alternative solutions to meet surge ventilator capacity including a strategy for deploying large-scale volunteer continuous bag-valve-tube (BVT) ventilation While an online training module may teach the manual ventilation volunteer force requisite knowledge, evidence suggests technology enhanced simulation training in health professions training is associated with improved outcomes for desired knowledge, skills and behavior

Safer Ambu-Bag Manual Ventilation through Addition of a Second High Efficiency Particulate Air (HEPA) Filter

Experts from the Thomas Jefferson University Health Design Lab met with Emergency Medicine and Anesthesia physicians and local engineers A design was envisioned in which 3-D printed connectors could be created to add an additional HEPA Filter as shown in Figure 1 STL Files for the adapters were created based on standard HEPA filter diameters and 3-D printed The second HEPA filter was easily assembled by novice users using the adapters Ventilation adequacy using the double HEPA filter ambu-bag was similar to single HEPA filtered ambu-bag ventilation based on observed inflation of a test lun

Long-Term Functional Outcomes after 10 Years of Bilateral Cochlear Implantat Use

The aims were to determine the benefit of bilateral cochlear implantation in a 20 years old patient implanted in Croatia on hearing and speech development. The male patient, after 10 years of deafness, got cochlear implants Med-EL Combi 40+ on both sides in one-stage surgery. The etiology of his deafness was posttraumatic meningitis. Auditory capacity and speech recognition tests were performed for both ears separately and together. Average hearing level on the right ear with right cochlear implant switched on started at 62 dB 1 month after the cochlear implantation and was on 55 dB after 10 years. Average hearing level on the left ear with left cochlear implant switched on started at 55 dB 1 month after the cochlear implantation and was on 32 dB after 10 years. Average hearing level on the both ears with 2 cochlear implants switched on started at 35 dB 1 month after the cochlear implantation and was on 27 dB after 10 years. Long- -term functional outcomes with bilateral cochlear implantation provides advantages over unilateral implantation including improved hearing level, speech perception in noise and improved sound localization