Tone Pulses Research Articles

Effects of Stimulus Type on 16-kHz Detection Thresholds.

Audiometric testing typically does not include frequencies above 8 kHz. However, recent research suggests that extended high-frequency (EHF) sensitivity could affect hearing in natural communication environments. Clinical assessment of hearing often employs pure tones and frequency-modulated (FM) tones interchangeably regardless of frequency. The present study was designed to evaluate how the stimulus chosen to measure EHF thresholds affects estimates of hearing sensitivity. The first experiment used standard audiometric procedures to measure 8- and 16-kHz thresholds for 5- to 28-year olds with normal hearing in the standard audiometric range (250 to 8000 Hz). Stimuli were steady tones, pulsed tones, and FM tones. The second experiment tested 18- to 28-year olds with normal hearing in the standard audiometric range using psychophysical procedures to evaluate how changes in sensitivity as a function of frequency affect detection of stimuli that differ with respect to bandwidth, including bands of noise. Thresholds were measured using steady tones, pulsed tones, FM tones, narrow bands of noise, and one-third-octave bands of noise at a range of center frequencies in one ear. In experiment 1, thresholds improved with increasing age at 8 kHz and worsened with increasing age at 16 kHz. Thresholds for individual participants were relatively similar for steady, pulsed, and FM tones at 8 kHz. At 16 kHz, mean thresholds were approximately 5 dB lower for FM tones than for steady or pulsed tones. This stimulus effect did not differ as a function of age. Experiment 2 replicated this greater stimulus effect at 16 kHz than at 8 kHz and showed that the slope of the audibility curve accounted for these effects. Contrary to prior expectations, there was no evidence that the choice of stimulus type affected school-age children more than adults. For individual participants, audiometric thresholds at 16 kHz were as much as 20 dB lower for FM tones than for steady tones. Threshold differences across stimuli at 16 kHz were predicted by differences in audibility across frequency, which can vary markedly between listeners. These results highlight the importance of considering spectral width of the stimulus used to evaluate EHF thresholds.

Practical Waveform-to-Energy Harvesting Model and Transmit Waveform Optimization for RF Wireless Power Transfer Systems

The received radio-frequency (RF) power in far-field RF wireless power transfer (WPT)—with or without simultaneous information transfer—is minuscule due to large propagation loss in wireless media. In such scenarios, adapting to the receiver characteristics by transmit waveform optimization is essential for maximizing the harvested direct current (dc) and, thus, the end-to-end efficiency of an RF WPT system. The receiver efficiency in RF WPT is governed by the RF-to-dc efficiency of the rectifier as well as the impedance mismatch at the antenna and load. In this article, we study the receiver efficiency for any fixed load and, subsequently, present a novel rectifier model that relates the average harvested dc power to the distribution, that is, the histogram, of the instantaneous power levels of the RF signal’s envelope over time. The proposed waveform-to-energy harvesting (EH) model enables us to anticipate the average harvested dc power for any waveform, including communication signals as well, given the knowledge of the power-level distribution. Consequently, we conduct rigorous waveform optimization to maximize the average harvested dc power and determine the digital baseband signal at the transmitter that does so, namely prove that a pulsed tone at appropriate frequency is optimal for RF WPT. We present a multiband test-bed for determining the receiver efficiency for any digital baseband waveform. The efficacy of the proposed model is corroborated through experiments as well as simulations, which confirm that it is operational as well as accurate in practice and that single-sine pulses yield higher efficiency than basic multisine waveforms, while a pulsed phase shift keying (PSK) is preferable for simultaneous wireless information and power transfer (SWIPT).

Operant conditioning as a tool to assess hearing abilities in sharks.

Sharks (elasmobranchs) are an ancient, diverse group of fishes, representing a basal stage in the evolution of vertebrate hearing. Yet, our understanding of behavioural measures of hearing abilities in sharks is limited. To address this, an operant conditioning paradigm was designed, and scalloped hammerhead Sphyrna lewini and rig (spotted estuary smooth hound) Mustelus lenticulatus were successfully trained to respond to pure-tone acoustic stimuli from an underwater speaker. After 2-3 weeks of training, both species showed distinctive responses to these acoustic stimuli and retained this behaviour when reinforced. S. lewini responded to a 400 Hz pulsed tone with an abrupt increase in tailbeat frequency (97 beats per 30 s vs. 69 beats for a 2 kHz control and 70 beats for no signal) and sustained vigorous swimming (arousal response) for at least 30 s. In response to a 200 Hz pulsed tone, M. lenticulatus visited a target area under the speaker significantly more frequently (13.4 ± 4.3 times per minute vs. 1.4 ± 1.5 times for a 1.2 kHz control and 0.9 ± 0.01 times for no signal) and swam circles under the speaker to search for food. The authors used S. lewini arousal responses to pure-tone stimuli of 40, 80, 200, 400, 600 and 800 Hz to generate a provisional hearing-threshold curve. The results show that S. lewini adapts to low-frequency hearing (greatest sensitivity at 200 Hz, upper limit 800 Hz), which is like other coastal pelagic sharks that have been investigated so far. Despite challenges operant acoustic conditioning studies are a viable method for revealing auditory capabilities of sharks.

Estimating Passenger Queue for Bus Resource Optimization Using LoRaWAN-Enabled Ultrasonic Sensors

Anecdotal evidence has shown that bus stops around our University campus, specifically those serving express buses to city center, can get very crowded during certain times. This not only causes immense frustration to students who experience large variations in wait-time, but also creates challenges for the university and transport authority in knowing when to schedule extra buses. This article outlines our efforts to instrument a main bus stop on our university campus with Internet of Things (IoT) sensors to monitor passengers queue length. Our specific contributions are as follows: 1) We begin by developing a LoRaWAN ultrasonic sensor for detecting people in the queue. The sensor emits an ultrasonic tone pulse every few seconds, and determines whether someone is in front of it based on the reflections received, if any. Ten sensor units are built, tested, and tuned in a lab environment to achieve optimum detection accuracy and data transmission rate; 2) Next, we install these sensors at a 6-m interval along the campus fence bordering the bus-stop. We develop an algorithm to infer the number of passengers in the queue from sensor data and demonstrate that it achieves reasonable accuracy with a mean absolute error of 10.7 people (for a queue size of up to 100 people); and 3) we develop an optimization model to reschedule bus dispatching time, aiming to minimize total wait time of passengers. We show that a reduction of up to 42.93% in passengers’ wait time can be achieved by adopting demand-driven bus scheduling.

Effects of Audio Brain Entrainment on Korean People with Mild Insomnia.

Sleep health has become an important healthy lifestyle. Research has shown that almost one-fifth of the Korean adult population does not have sufficient sleep. The lack of sleep is associated with significant medical, psychological, social, and economic issues. People are not only yearning for sufficient sleep but the quality of sleep as well. Usually, the obvious choice will be the use of pharmaceuticals however, these often have various side effects, and the lasting use of these medications could become a concern. Therefore, new non-drug alternatives are sought after. Audio brain entrainment is a procedure that modules neural activities by synchronizing brainwave frequency with pulse tones. By producing frequency tones for the deep sleep stage, it promotes a good night's sleep. In this paper, we developed a pillow integrated with the audio speakers that produce alpha and theta beats that should help improve sleep. Sleep polysomnography was performed on 10 people to compare the effects of the audio stimulus. Initial results showed a positive effect on sleep onset latency, indicating that sleep induction happened. This noninvasive stimulation technique can be a promising candidate for wearable bioelectronics medicine and further neuroscience research.

Evaluating enhanced pulse oximetry auditory displays for neonatal oxygen targeting: A randomized laboratory trial with clinicians and non-clinicians

Standard pulse oximeter auditory tones do not clearly indicate departures from the target range of oxygen saturation (SpO2) of 90%–95% in preterm neonates. We tested whether acoustically enhanced tones would improve participants' ability to identify SpO2 range. Twenty-one clinicians and 23 non-clinicians used (1) standard pulse oximetry variable-pitch tones plus alarms; (2) beacon-enhanced tones without alarms in which reference tones were inserted before standard pulse tones when SpO2 was outside target range; and (3) tremolo-enhanced tones without alarms in which pulse tones were modified with tremolo when SpO2 was outside target range. For clinicians, range identification accuracies (mean (SD)) in the standard, beacon, and tremolo conditions were 52% (16%), 73% (14%) and 76% (13%) respectively, and for non-clinicians 49% (16%), 76% (13%) and 72% (14%) respectively, with enhanced conditions always significantly more accurate than standard. Acoustic enhancements to pulse oximetry clearly indicate departures from preterm neonates’ target SpO2 range.

Surface Waves Prediction Based on Long-Range Acoustic Backscattering in a Mid-Frequency Range

Underwater acoustic echosounding for surface roughness parameters retrieval is studied in a frequency band that is relatively new for such purposes. During the described 2-weeks sea experiment, 1–3 kHz tonal pulses were emitted from an oceanographic platform, located on the northern Black Sea shelf. Doppler spectra of the resulting reverberation were studied. The frequency band of the acoustic system, selected for this study, is chosen due to the fact that the sound propagation range is large enough for remote sensing in a coastal zone, and the resolution cell size does not limit the research. Backscattering of acoustical signals was received for distances around two nautical miles. However, it turned to be quite difficult to interpret the obtained data since backscattering spectrum shape was influenced by a series of effects, resulting in a complicated link to wind waves and currents’ parameters. Significant wave height and dominant wave frequency were estimated as the result of such signals processed with the use of machine learning tools. A decision-tree-based mathematical regression model was trained to solve the inverse problem. Wind waves prediction is in a good agreement with direct measurements, made on the platform, and machine learning results allow physical interpretation.

Evaluating the Modulation of the Acoustic Startle Reflex in Children and Adolescents via Vertical EOG and EEG: Sex, Age, and Behavioral Effects.

Acoustic startle reflex (ASR) constitutes a reliable, cross-species indicator of sensorimotor and inhibitory mechanisms, showing distinct signature in cognitive aging, sex, and psychopathological characterization. ASR can be modulated by the prepulse inhibition (PPI) paradigm, which comprises the suppression of reactivity to a startling stimulus (pulse) following a weak prepulse (30- to 500-ms time difference), being widely linked to inhibitory capabilities of the sensorimotor system. If the prepulse–pulse tones are more clearly separated (500–2,000 ms), ASR amplitude is enhanced, termed as prepulse facilitation (PPF), reflecting sustained or selective attention. Our study aimed to investigate early-life sensorimotor sex/age differences using Electroencephalographic recordings to measure muscular and neural ASR in a healthy young population. Sixty-three children and adolescents aged 6.2–16.7 years (31 females) took part in the experiment. Neural ASR was assessed by two different analyses, namely, event-related potentials (ERPs) and first-derivative potentials (FDPs). As expected, PPF showed enhanced responses compared with PPI, as indicated by eyeblink, ERP and FDP measures, confirming the gating effect hypothesis. Sex-related differences were reflected in FDPs, with females showing higher ASR than males, suggesting increased levels of poststartle excitability. Intragroup age effects were evaluated via multipredictor regression models, noticing positive correlation between age versus eyeblink and ERP responses. Attention-related ERPs (N100 and P200) showed distinct patterns in PPI versus PPF, potentially indicative for alternative attentional allocation and block-out of sensory overload. Screening measures of participants’ neurodevelopmental (assessed by Wechsler Intelligence Scale for Children) and behavioral (assessed by Child Behavior Checklist) markers were also associated with increased N100/P200 responses, presumably indexing synergy between perceptual consistency, personality profiling, and inhibitory performance. Conclusively, modulation of ASR by PPI and PPF is associated with biological sex and internal/external personality traits in childhood and adolescence, potentially useful to guide symptomatology and prevention of psychopathology.

Signaling Patient Oxygen Desaturation with Enhanced Pulse Oximetry Tones

Manufacturers could improve the pulse tones emitted by pulse oximeters to support more accurate identification of a patient's peripheral oxygen saturation (SpO2) range. In this article, we outline the strengths and limitations of the variable-pitch tone that represents SpO2 of each detected pulse, and we argue that enhancements to the tone to demarcate clinically relevant ranges are feasible and desirable. The variable-pitch tone is an appreciated and trusted feature of the pulse oximeter's user interface. However, studies show that it supports relative judgments of SpO2 trends over time and is less effective at supporting absolute judgments about the SpO2 number or conveying when SpO2 moves into clinically important ranges. We outline recent studies that tested whether acoustic enhancements to the current tone could convey clinically important ranges more directly, without necessarily using auditory alarms. The studies cover the use of enhanced variable-pitch pulse oximeter tones for neonatal and adult use. Compared with current tones, the characteristics of the enhanced tones represent improvements that are both clinically relevant and statistically significant. We outline the benefits of enhanced tones, as well as discuss constraints of which developers of enhanced tones should be aware if enhancements are to be successful.

Signaling Patient Oxygen Desaturation with Enhanced Pulse Oximetry Tones.

Manufacturers could improve the pulse tones emitted by pulse oximeters to support more accurate identification of a patient's peripheral oxygen saturation (SpO2) range. In this article, we outline the strengths and limitations of the variable-pitch tone that represents SpO2 of each detected pulse, and we argue that enhancements to the tone to demarcate clinically relevant ranges are feasible and desirable. The variable-pitch tone is an appreciated and trusted feature of the pulse oximeter's user interface. However, studies show that it supports relative judgments of SpO2 trends over time and is less effective at supporting absolute judgments about the SpO2 number or conveying when SpO2 moves into clinically important ranges. We outline recent studies that tested whether acoustic enhancements to the current tone could convey clinically important ranges more directly, without necessarily using auditory alarms. The studies cover the use of enhanced variable-pitch pulse oximeter tones for neonatal and adult use. Compared with current tones, the characteristics of the enhanced tones represent improvements that are both clinically relevant and statistically significant. We outline the benefits of enhanced tones, as well as discuss constraints of which developers of enhanced tones should be aware if enhancements are to be successful.

On a measurement of noise-induced hearing considering the age of both ears

The noise-induced hearing loss suffered in the multimedia living environment is difficult to detect because there are few symptoms in the early stages. Existing pure tone audiometry detects the response to whether pure tones are well heard for each frequency to 250–8000 Hz sound, which is mainly used in everyday conversation, but it is inaccurate and takes a long time to measure noise-induced hearing loss. Therefore, in this paper, we propose a new measurement method that can easily and quickly self-measure noise-induced hearing loss in both ears through a smartphone APP. In this method, the age-compensated 9 pure tones for each voice subband are alternately heard in both ears at 10 kHz or higher, thereby rapidly determining one's own hearing loss. When 18 tone pulses were heard for 27 s per person, 68 out of 100 subjects in their 20 s were identified as suspected of partial hearing loss, and 27 including them were identified as having severe noise-induced hearing loss. And when the subjects were instructed on how to discriminate the number of hearings for noise-induced hearing loss, the participants themselves immediately determined whether their hearing was impaired. In the end, the noise-induced hearing loss measurement method in both ears, which took more than 10 minutes with the existing manual method, could be easily and accurately measured with our proposed method.

On a high-speed hearing measurement considering the age of both ears

In order to enrich the human senses, care must be taken not to damage your hearing. Hearing damage suffered in a living environment is difficult to find out because there are few initial symptoms. Existing pure tone hearing test detects whether pure tones are heard well for each frequency for 250–8000 Hz sound, which is mainly used in everyday conversation, but it is inaccurate and takes a long time. Therefore, in this paper, we proposed a high-speed measurement method that can easily and quickly self-measure both ears' hearing damage through an APP of a smart-phone. In this method, nine pure tones that are age-compensated for each voice sub-band are alternately heard in both ears, thereby self-identifying their own hearing damage at high speed. When 18 tone pulses were heard for 27 s per person, 1 out of 12 subjects was identified as suspected of partial hearing damage. When the test subjects were informed of the hearing determination method for the number of hearings, the participants themselves immediately determined whether their hearing was damaged. Eventually, both ears' hearing damage was easily and accurately measured by the method proposed, which took more than 10 min with the existing manual method. As a result, it is possible to maintain a healthy life by simply determining whether or not there is a hearing loss.

Acoustically Enriched Environment during the Critical Period of Postnatal Development Positively Modulates Gap Detection and Frequency Discrimination Abilities in Adult Rats

Throughout life, sensory systems adapt to the sensory environment to provide optimal responses to relevant tasks. In the case of a developing system, sensory inputs induce changes that are permanent and detectable up to adulthood. Previously, we have shown that rearing rat pups in a complex acoustic environment (spectrally and temporally modulated sound) from postnatal day 14 (P14) to P28 permanently improves the response characteristics of neurons in the inferior colliculus and auditory cortex, influencing tonotopical arrangement, response thresholds and strength, and frequency selectivity, along with stochasticity and the reproducibility of neuronal spiking patterns. In this study, we used a set of behavioral tests based on a recording of the acoustic startle response (ASR) and its prepulse inhibition (PPI), with the aim to extend the evidence of the persistent beneficial effects of the developmental acoustical enrichment. The enriched animals were generally not more sensitive to startling sounds, and also, their PPI of ASR, induced by noise or pure tone pulses, was comparable to the controls. They did, however, exhibit a more pronounced PPI when the prepulse stimulus was represented either by a change in the frequency of a background tone or by a silent gap in background noise. The differences in the PPI of ASR between the enriched and control animals were significant at lower (55 dB SPL), but not at higher (65-75 dB SPL), intensities of background sound. Thus, rearing pups in the acoustically enriched environment led to an improvement of the frequency resolution and gap detection ability under more difficult testing conditions, i.e., with a worsened stimulus clarity. We confirmed, using behavioral tests, that an acoustically enriched environment during the critical period of development influences the frequency and temporal processing in the auditory system, and these changes persist until adulthood.

Target detection in healthy 4-week old piglets from a passive two-tone auditory oddball paradigm

BackgroundPassive auditory oddball tests are effort independent assessments that evaluate auditory processing and are suitable for paediatric patient groups. Our goal was to develop a two-tone auditory oddball test protocol and use this clinical assessment in an immature large animal model. Event-related potentials captured middle latency P1, N1, and P2 responses in 4-week old (N = 16, female) piglets using a custom piglet 32- electrode array on 3 non-consecutive days. The effect of target tone frequency (250 Hz and 4000 Hz) on middle latency responses were tested in a subset of animals.ResultsResults show that infrequent target tone pulses elicit greater N1 amplitudes than frequent standard tone pulses. There was no effect of day. Electrodes covering the front of the head tend to elicit greater waveform responses. P2 amplitudes increased for higher frequency target tones (4000 Hz) than the regular 1000 Hz target tones (p < 0.05).ConclusionsTwo-tone auditory oddball tests produced consistent responses day-to-day. This clinical assessment was successful in the immature large animal model.

A sciaenid swim bladder with long skinny fingers produces sound with an unusual frequency spectrum

Swim bladders in sciaenid fishes function in hearing in some and sound production in almost all species. Sciaenid swim bladders vary from simple carrot-shaped to two-chambered to possessing various diverticula. Diverticula that terminate close to the ears improve hearing. Other unusual diverticula heading in a caudal direction have not been studied. The fresh-water Asian species Boesemania microlepis has an unusual swim bladder with a slightly restricted anterior region and 6 long-slender caudally-directed diverticula bilaterally. We hypothesized that these diverticula modify sound spectra. Evening advertisement calls consist of a series of multicycle tonal pulses, but the fundamental frequency and first several harmonics are missing or attenuated, and peak frequencies are high, varying between < 1–2 kHz. The fundamental frequency is reflected in the pulse repetition rate and in ripples on the frequency spectrum but not in the number of cycles within a pulse. We suggest that diverticula function as Helmholz absorbers turning the swim bladder into a high-pass filter responsible for the absence of low frequencies typically present in sciaenid calls. Further, we hypothesize that the multicycle pulses are driven by the stretched aponeuroses (flat tendons that connect the sonic muscles to the swim bladder) in this and other sciaenids.

Test-retest reliability of prepulse inhibition paradigm using auditory evoked potentials

Prepulse inhibition (PPI) is a neurological phenomenon in which a weak initial stimulus reduces the level of responses to a subsequent stronger stimulus. Although acoustic startle reflexes are usually used for PPI examinations, recent studies have observed similar phenomena with event-related cortical potentials. In the present study, test-retest reliability of PPI measured using auditory change-related cortical responses was assessed in 35 healthy adults. Four sound stimuli were randomly presented at an even probability; Standard, Test alone, Prepulse alone, and Test + Prepulse. The Standard stimulus was a train of 25-ms tone pulses at 70 dB for 650 ms, while for Test alone and Prepulse alone, the sound pressure was increased to 80 dB at 350 ms and 73 dB at 300 ms, respectively. Measurements were performed twice with at least 7 days separation, and validity was evaluated using intra-class correlation (ICC) for latency, amplitude, and suppression rate of the P50, N100, and P200 components. The results showed high ICC values for the latency and amplitude of nearly all components, except for response to Prepulse alone (0.3–0.6). Furthermore, ICC for suppression rate was greater than 0.5 for the peak-to-peak amplitude. Good reproducibility for N100 and P200 components was obtained with this method. The present results support the PPI paradigm as a reliable tool for clinical measurements of inhibitory functions.

The rhythm of attention: Perceptual modulation via rhythmic entrainment is lowpass and attention mediated.

Modulation patterns are known to carry critical predictive cues to signal detection in complex acoustic environments. The current study investigated the persistence of masker modulation effects on postmodulation detection of probe signals. Hickok, Farahbod, and Saberi (Psychological Science, 26, 1006-1013, 2015) demonstrated that thresholds for a tone pulse in stationary noise follow a predictable periodic pattern when preceded by a 3-Hz amplitude modulated masker. They found entrainment of detection patterns to the modulation envelope lasting for approximately two cycles after termination of modulation. The current study extends these results to a wide range of modulation rates by mapping the temporal modulation transfer function for persistent modulatory effects. We found significant entrainment to modulation rates of 2 and 3 Hz, a weaker effect at 5 Hz, and no entrainment at higher rates (8 to 32 Hz). The effect seems critically dependent on attentional mechanisms, requiring temporal and level uncertainty of the probe signal. Our findings suggest that the persistence of modulatory effects on signal detection is lowpass in nature and attention based.

Neural Representation of Loudness: Cortical Evoked Potentials in an Induced Loudness Reduction Experiment.

Loudness context effects comprise differences in judgments of the loudness of a target stimulus depending on the presence of a preceding inducer tone. Interstimulus intervals (ISIs) between inducer tone and target tone of about 200 ms and above cause an induced loudness reduction (ILR) of the target tone. As the ILR increases, respectively, the perceived loudness of the target stimuli decreases with increasing ISI. This in turn means that identical stimuli in a different context have a differently perceived loudness. A correlation between specific characteristics in the electroencephalography responses and perceived loudness in an ILR experiment would therefore provide a neurophysiological indication of loudness processing beyond a neural representation of stimulus intensity only. To examine if such a correlation exists, we investigated cortical electroencephalography responses in a latency range from 75 to 510 ms during a psychoacoustical ILR experiment with different ISIs. With increasing ISI, the strength of the N1-P2 deflection of the respective electroencephalography response decreases similarly to the loudness perception of the target tone pulse. This indicates a representation based on loudness rather than on intensity at the corresponding processing stage.

The voice from the hereafter: vocalisations in three species of Atelopus from the Venezuelan Andes, likely to be extinct

Atelopus is a species-rich group of Neotropical bufonids. Present knowledge on bioacoustics in this genus is relatively poor, as vocalisations have been described in only about one fifth of the ca. 100 species known. All studied members of the genus produce vocalisations although, with a few exceptions, most species lack a middle ear. Nonetheless, hearing has been demonstrated even in earless Atelopus making bioacoustics in these toads an inspiring research field. So far, three structural call types have been identified in the genus. As sympatry is uncommon in Atelopus, calls of the same type often vary little between species. Based on recordings from the 1980s, we describe vocalisations of three Venezuelan species (A. carbonerensis, A. mucubajiensis, A. tamaense) from the Cordillera de Mérida, commonly known as the Andes of Venezuela and the Tamá Massif, a Venezuelan spur of the Colombian Cordillera Oriental. Vocalisations correspond, in part, to the previously identified call types in Atelopus. Evaluation of the vocalisations of the three species presented in this study leads us to recognise a fourth structural call type for the genus. With this new addition, the Atelopus acoustic repertoire now includes (1) pulsed calls, (2) pure tone calls, (3) pulsed short calls and (4) pure tone short calls. The call descriptions provided here are valuable contributions to the bioacoustics of these Venezuelan Atelopus species, since all of them have experienced dramatic population declines that limit possibilities of further studies.

Avatar-Based Patient Monitoring With Peripheral Vision: A Multicenter Comparative Eye-Tracking Study.

BackgroundContinuous patient monitoring has been described by the World Health Organization as extremely important and is widely used in anesthesia, intensive care medicine, and emergency medicine. However, current state-of-the-art number- and waveform-based monitoring does not ideally support human users in acquiring quick, confident interpretations with low cognitive effort, and there are additional problematic aspects such as alarm fatigue. We developed a visualization technology (Visual Patient), specifically designed to help caregivers gain situation awareness quickly, which presents vital sign information in the form of an animated avatar of the monitored patient. We suspected that because of the way it displays the information as large, colorful, moving graphic objects, caregivers might be able to perform patient monitoring using their peripheral vision, which may facilitate quicker detection of anomalies, independently of acoustic alarms.ObjectiveIn this study, we tested the hypothesis that avatar-based monitoring, when observed with peripheral vision only, increases the number of perceptible changes in patient status as well as caregivers’ perceived diagnostic confidence compared with a high-fidelity simulation of conventional monitoring, when observed with peripheral vision only.MethodsWe conducted a multicenter comparative study with a within-participant design in which anesthesiologists with their peripheral field of vision looked at 2 patient-monitoring scenarios and tried to identify changes in patient status. To ensure the best possible experimental conditions, we used an eye tracker, which recorded the eye movements of the participants and confirmed that they only looked at the monitoring scenarios with their peripheral vision.ResultsOverall, 30 participants evaluated 18 different patient status changes with each technology (avatar and conventional patient monitoring). With conventional patient monitoring, participants could only detect those 3 changes in patient status that are associated with a change in the auditory pulse tone display, that is, tachycardia (faster beeping), bradycardia (slower beeping), and desaturation (lower pitch of beeping). With the avatar, the median number of detected vital sign changes quadrupled from 3 to 12 (P<.001) in scenario 1, and more than doubled from 3 to 8 (P<.001) in scenario 2. Median perceived diagnostic confidence was confident for both scenarios with the avatar and unconfident in scenario 1 (P<.001), and very unconfident in scenario 2 (P=.024) with conventional monitoring.ConclusionsThis study introduces the concept of peripheral vision monitoring. The test performed showed clearly that an avatar-based display is superior to a standard numeric display for peripheral vision. Avatar-based monitoring could potentially make much more of the patient monitoring information available to caregivers for longer time periods per case. Our results indicate that the optimal information transmission would consist of a combination of auditory and avatar-based monitoring.