Sensory Overload Research Articles

Insights into the problem of alarm fatigue with physiologic monitor devices: a comprehensive observational study of consecutive intensive care unit patients.

PurposePhysiologic monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue” which creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload. Using a state-of-the-art technology acquisition infrastructure, all monitor data including 7 ECG leads, all pressure, SpO2, and respiration waveforms as well as user settings and alarms were stored on 461 adults treated in intensive care units. Using a well-defined alarm annotation protocol, nurse scientists with 95% inter-rater reliability annotated 12,671 arrhythmia alarms.ResultsA total of 2,558,760 unique alarms occurred in the 31-day study period: arrhythmia, 1,154,201; parameter, 612,927; technical, 791,632. There were 381,560 audible alarms for an audible alarm burden of 187/bed/day. 88.8% of the 12,671 annotated arrhythmia alarms were false positives. Conditions causing excessive alarms included inappropriate alarm settings, persistent atrial fibrillation, and non-actionable events such as PVC's and brief spikes in ST segments. Low amplitude QRS complexes in some, but not all available ECG leads caused undercounting and false arrhythmia alarms. Wide QRS complexes due to bundle branch block or ventricular pacemaker rhythm caused false alarms. 93% of the 168 true ventricular tachycardia alarms were not sustained long enough to warrant treatment.DiscussionThe excessive number of physiologic monitor alarms is a complex interplay of inappropriate user settings, patient conditions, and algorithm deficiencies. Device solutions should focus on use of all available ECG leads to identify non-artifact leads and leads with adequate QRS amplitude. Devices should provide prompts to aide in more appropriate tailoring of alarm settings to individual patients. Atrial fibrillation alarms should be limited to new onset and termination of the arrhythmia and delays for ST-segment and other parameter alarms should be configurable. Because computer devices are more reliable than humans, an opportunity exists to improve physiologic monitoring and reduce alarm fatigue.

Bombay Blues by Tanuja Desai Hidier (review)

Reviewed by: Bombay Blues by Tanuja Desai Hidier Karen Coats Hidier, Tanuja Desai Bombay Blues. Push/Scholastic, 2014 550p ISBN 978-0-545-38478-0 $18.99 Ad Gr. 10 up Two years in book time have passed since American-born South Asian seventeen-year-old Dimple fell heart-over-head in love with Karsh, the suitable boy her parents had pinned their hopes on (in Born Confused, BCCB 2/03). Since then, [End Page 107] she and Karsh have been pursuing her photography and his DJing in the hottest Desi hip-hop clubs in New York and sharing beds in their NYU dorm rooms. Now Dimple’s cousin, Sangita, has invited them to her wedding in Bombay, and both have trepidation about the trip; Dimple is grieving the death of her Dadaji and Karsh the suicide of his father, and they are wondering what India will mean to them without these native anchors. The journey moves them closer to themselves but farther from each other, as Karsh seeks solace through spirituality and Dimple goes fully carnal through multi-page, perspective-shattering sex with a stranger. This is a very different book than its predecessor, with Dimple at a very different stage of life and the language less accessible and more artful. Dimple ultimately comes to terms with being neither fully inside nor fully outside either of her cultural identities, but her stream-of-consciousness scene-kid narration is so hipster and private that only readers plugged into all of her various currents will be able to take that journey with her. Her exploration of the teeming wonders of Bombay and her reflections on desires and behavior are conveyed through a dizzying blend of inventive intercultural hip-hop terminology that is intricately crafted, but it often proves more baffling than engrossing, more art than story. Nonetheless, readers willing to suspend the need to make complete sense of her lush language and submit instead to its mellifluous sounds will share Dimple’s experience of sensory overload and identity fusion and confusion, and that may be enough for those desperate to know what happened to Dimple after Born Confused. Copyright © 2014 The Board of Trustees of the University of Illinois

Community-based resources for concussion management.

Speech-language pathologists can serve an important role as members of interdisciplinary treatment teams in the rehabilitation of concussion-related cognitive-communicative changes in the community setting. This article discusses the continuum of care for individuals who have experienced concussion and the importance of appropriate assessment and functionally based intervention. Factors such as executive function impairments, sensory overload, and cognitive exertion can yield subtle deficits that can impact functional return to work or school. Community resources such as support groups are discussed, as well as the impact of state and federal policies related to concussion on community activities.

My Outsider Art.

My Outsider Art.

Solitary Confinement: Social Death and its Afterlives. By Lisa Guenther. Minneapolis, MN: University of Minnesota Press, 2013. 321 pp. $25.00 paperback, $13.99 Amazon Kindle.

Solitary Confinement: Social Death and its Afterlives. By Lisa Guenther. Minneapolis, MN: University of Minnesota Press, 2013. 321 pp. $25.00 paperback, $13.99 Amazon Kindle.A developing literature in the social sciences has given attention to the rise of super-maximum confinement in contemporary U.S. penal practice, but few scholars have explored with depth its philosophical, experiential, and ethical implications. Lisa Guenther's volume, Solitary Confinement, does this by presenting us with a critical phenomenological account of the history and con- temporary practices of isolation. Much like torture, solitary con- finement works, according to Guenther, through a self-betrayal where the prisoner's capacity for the relational-the ability to feel, perceive and engage with others-is turned against one's self through a gaping absence of other in time and space. Solitary confinement seeks to foreclose the possibility of meaningful existence, distorting the perceptual to the point of anti-relationality and violating authentic forms of solitude and sociality, both of which are constitutive to being. Guenther argues that the destruction of personhood is, consequently, central to the practice of which she defines as a range of practices including solitary confinement, small-group confine- ment, sensory deprivation, and sensory overload: any form of iso- lation that is structured in a way that diminishes or undermines an open-ended relation to the world and other living beings (loc 2752). This expansive use of the term directs our attention to worlds that, in their extreme isolation, exceed what we under- stand as solitary confinement. It also highlights the more mundane environs of mass incarceration where daily life is defined by a perpetual exposure to others-the overcrowded common rooms, dormitory tiers, and holding cells where there is no break from human exposure, a forced relationality of con- stant surveillance and (loc 3137).Guenther lays out her argument in three parts. Part 1 exam- ines the foundational role of solitary confinement in the early U.S. penitentiary system, including the transposition of slavery into an ongoing form of racialized hyperincarceration. Building upon the concept of civil death, she highlights the law's role in structuring and sustaining racialized practices of social death, like solitary confinement, pointing to the loophole in the Thirteenth Amendment that allows for slippage between slavery and carceral practices, and leaves incomplete the work of abolition. Part 2 pro- vides a fascinating, brutal, and often omitted account of the role of Cold War psychological research, funded by the Central Intel- ligence Agency and Department of Defense, in making solitary confinement, with its emphasis on sensory deprivation and stress positions, an accepted form of behavior modification. Here, Guenther describes the violence done to living, relational by mechanist, hard-wired constructions of the self and how such assumptions produced in solitary confinement a technology for the production of mental illness. Part 3 takes on the more familiar story-the contemporary emergence of control prisons-where the immobilization of inmates has become an end in itself (loc 158). While social death is central to her account, the most origi- nal and innovative aspects of her analysis display how civil and social life are produced in the impossible and deathly spaces of intensive confinement. …

Non‐Redundant Social Information Use in Avian Flocks with Multisensory Stimuli

AbstractAnimals generally live in multisensory worlds; however, our understanding of multisensory perception is rather limited, despite its relevance for explaining the mechanisms behind social interactions, such as collective detection while foraging in groups. We tested how multisensory stimuli affected the antipredator behavior of dark‐eyed juncos (Junco hyemalis) using alarm calls as an auditory signal and flushing behavior as a visual cue. We varied the degree of risk within the group by manipulating the number of group mates alarm calling and/or flushing using robotic birds. We assumed that alarm calling and flushing were redundant stimuli and predicted that they could generate one of three types of responses (enhancement, equivalence, or antagonism) depending on the mechanism of multisensory perception. We set up an artificial flock with three robotic juncos surrounding a live junco and controlled for multiple confounding factors (e.g., identity of the focal, body mass, food deprivation time). We found that the degree of alarm of live juncos increased when at least one robot flushed. However, the time it took the live individuals to react to the robots' behavior increased, rather than decreased, with at least one alarm call. This could be the result of an orienting response or sensory overload, as live juncos increased scanning behavior after being exposed solely to alarm calls. Contrary to some theoretical assumptions, alarm calling and flushing behavior elicited independent unimodal responses, suggesting that they are non‐redundant stimuli and that together they could reduce the occurrence of false alarms and facilitate flock cohesion.

Grasshopper Jungle: A History by Andrew Smith (review)

Reviewed by: Grasshopper Jungle: A History by Andrew Smith Karen Coats Smith, Andrew. Grasshopper Jungle: A History. Dutton, 2014. [464p]. ISBN 978-0-525-42603-5 $18.99 Reviewed from galleys R Gr. 9-12. Austin faces two dilemmas: he is in love with both his girlfriend, Shann, and his best friend, Robby, and the world is ending. This last circumstance is the result of a chain of events that he and Robby have unwittingly set in motion, involving the [End Page 336] release of a genetic agent that infects its human victim with a larva that consumes the host and erupts into a six-foot-tall praying mantis bent on only two things: eating and reproducing. The play of themes and metaphors here is as multi-tiered as a wedding cake but with significantly more deadpan irony than icing; mostly the irony centers on Austin’s confusion with regard to his sexuality, which he continually refers to as experimenting, calling that designation for teenage sexual identity into question as well as drawing subtle attention to the unintended consequences of the decades-long experimenting that led to the giant bug mutations. Austin’s narrative voice fizzes with catchphrases that keep the reader on track as he dives into history and backstory. His obsessively repetitive but somehow endearing style calls to mind Vonnegut and Heller, which, given the characters’ ultimate descent into a bunker left over from the early ’70s, is more than thematically appropriate; indeed, the raw postmodern aesthetics of this text accord with its theme of flawed humanity. It would be easy enough to label the novel edgy, but since many of Smith’s previous offerings, such as Stick (BCCB 12/11), The Marbury Lens, and Passenger (BCCB 12/12), have redefined where exactly the edges are, it’s more accurate to say that this one approaches its own edge of sophisticated brutality, sensory and intellectual overload, and sheer weirdness, and then jumps right off. Copyright © 2014 The Board of Trustees of the University of Illinois

Do animal eyespots really mimic eyes?

Abstract The diversity of anti-predator adaptations in the natural world has long been an active area of research in evolutionary and behavioural biology. A common visually-obvious feature found on prey are ‘eyespots’, being approximately circular markings often with concentric rings and conspicuous colours. These are found on a range of animals, especially adult and larval Lepidoptera and fish. One of the most widespread functions of eyespots seems to be to intimidate or startle predators: delaying, preventing or halting an attack. However, while the fact that they can influence predators in this way is uncontroversial, the mechanism(s) behind why they are effective is debated. Traditionally, they have been assumed to work by mimicking the eyes of the predator’s own enemies, and much research in this field is conducted under the implicit or explicit assumption that this theory is correct. However, eyespots might work simply by being highly salient stimuli that promote sensory overload, biases, or neo-phobic reactions in predators. A range of recent studies has aimed to test these alternatives. Here, we critically evaluate this work and what it tells us about the mechanisms underlying eyespot function. We conclude that although eye mimicry is plausible, there remains a lack of evidence to support it and most observations are at least equally consistent with alternative mechanisms. Finally, we also discuss how the debate can be resolved.

Attention, Please!

The rise of the digital information age to the zettabyte-storage and terabit-communication level has made exploring attention scarcity and the relationship between attention and behavior the critical element in designing today's pervasive computing systems. Researchers and practitioners are challenged to build on attention research and the diverse theories and models it has produced to address issues of information and sensory overload. Ultimately, we must create a bridge between the fundamental results from specific attentional processes, created by research work in psychology and neuroscience, and the endeavors to apply these results to HCI in general and pervasive computing in particular. This department is part of a special issue on managing attention.

Alarm Fatigue

Research has demonstrated that 72% to 99% of clinical alarms are false. The high number of false alarms has led to alarm fatigue. Alarm fatigue is sensory overload when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarms and missed alarms. Patient deaths have been attributed to alarm fatigue. Patient safety and regulatory agencies have focused on the issue of alarm fatigue, and it is a 2014 Joint Commission National Patient Safety Goal. Quality improvement projects have demonstrated that strategies such as daily electrocardiogram electrode changes, proper skin preparation, education, and customization of alarm parameters have been able to decrease the number of false alarms. These and other strategies need to be tested in rigorous clinical trials to determine whether they reduce alarm burden without compromising patient safety.

Differential effects of estrogen and testosterone on auditory sensory gating in rats

Estrogen has been shown to have beneficial effects in patients with schizophrenia. However, the mechanisms involved in this protective effect are unclear. Schizophrenia is associated with deficits in sensory gating, a filtering mechanism which normally prevents sensory overload. In rodent models, acute treatment with drugs such as the dopamine D1/D2 receptor agonist, apomorphine; the dopamine releaser, amphetamine; and the glutamate NMDA receptor antagonists, phencyclidine or MK-801, can induce a phenotype similar to that seen in schizophrenia. Given the putative protective action of estrogen in schizophrenia, here we investigated the effect of ovariectomy (OVX) and estrogen replacement in female rats on drug-induced auditory gating deficits. For comparison, we also assessed the effects of castration (CAST) and dihydrotestosterone (DHT) replacement in male rats. Rats were instrumented with cortical surface electrodes. Test sessions comprised of 150 presentations of paired clicks, 500 ms apart (S1 and S2). Administration of all drugs increased the ratio of responses to S2/S1 in sham-operated female and male rats. OVX reduced event-related potential amplitudes but did not alter S2/S1 ratio or drug effects. In OVX rats with 17β-estradiol implants, the effect of apomorphine was abolished, but there was no change in that of amphetamine and phencyclidine. There were no effects of CAST or DHT replacement in male rats. Chronic estrogen replacement in OVX rats protected against sensory gating deficits caused by direct dopamine D1/D2 receptor stimulation. These data could indicate a possible mechanism by which estrogen exerts a protective action in schizophrenia.

Evidence for impaired sound intensity processing during prepulse inhibition of the startle response in a rodent developmental disruption model of schizophrenia

A number of studies have implicated disruptions in prepulse inhibition (PPI) of the startle response in both schizophrenia patients and animal models of this disorder. These disruptions are believed to reflect deficits in sensorimotor gating and are ascribed to aberrant filtering of sensory inputs leading to sensory overload and enhanced “noise” in neural structures. Here we examined auditory evoked potentials in a rodent model of schizophrenia (MAM-GD17) during an auditory PPI paradigm to better understand this phenomenon. MAM rats exhibited reductions in specific components of auditory evoked potentials in the orbitofrontal cortex and an abolition of the graded response to stimuli of differing intensities indicating deficient intensity processing in the orbitofrontal cortex. These data indicate that aberrant sensory information processing, rather than being attributable to enhanced noise in neural structures, may be better attributed to diminished evoked amplitudes resulting in a reduction in the “signal-to-noise” ratio. Therefore, the ability for sensory input to modulate the ongoing background activity may be severely disrupted in schizophrenia yielding an internal state which is insufficiently responsive to external input.

An alternative to language learner dependence on L2 caption‐reading input for comprehension of sitcoms in a multimedia learning environment

AbstractMost second/foreign language (L2) learners have difficulty understanding listening input because of its implicit and ephemeral nature, and they typically have better reading comprehension than listening comprehension skills. This study examines the effects of using an interactive advance‐organizer activity on the DVD video comprehension of L2 learners to provide an alternative to the scenario of L2 learners experiencing sensory overload in a multimedia learning environment that presents pictures, printed words and speech words. A total of 95 intermediate university‐level L2 learners with an average TOEIC (Test of English for International Communication) score of 565 were placed in four conditions for an English‐language DVD viewing task, including an advance‐organizer group, a captions group, a captions plus advance‐organizer group, and a control group. The study concludes that using advance organizers as an instructional strategy facilitated participant listening comprehension and reduced participant dependence on L2 caption‐reading input by 50% for initial comprehension. Participants also held a positive attitude towards an interactive advance‐organizer activity. The details concerning the role of L2 captions in multimedia listening are also discussed. The findings provide insight into teaching listening to L2 learners who learn most of their L2 in a more reading‐dependent classroom setting and typically have enhanced L2 literacy skills.

The Persistence of Realism

The Persistence of Realism Ulka Anjaria (bio) A review of Fredric Jameson, The Antinomies of Realism. New York: Verso, 2013. Against the myriad negative definitions of realism advanced by scholars—realism as not naturalism, romance, modernism—Fredric Jameson suggests a dialectical model in which realism emerges by means of its opposites: at one end, from récit, “the narrative situation itself and the telling of a tale as such” (10) and, at the other, from “the realm of affect,” in which the present overshadows other temporalities “with impulses of scenic elaboration, description and above all affective investment” (11). These antagonistic forces—narrative and affect—are constantly at play in the continuous production of realism, not reconciling in individual texts but appearing as contradictory pressures productive of meaning. This provocative approach proceeds beyond the analysis of individual texts to grasp realism as a whole, a level of theorization often absent from readings specific to one place or historical period. In Part I, Jameson elaborates the nature of these opposing forces in more detail. Récit, he reminds us in Chapter 1, is not only a naïve reliance on a Barthesian preterite, but any acceptance of underlying narrative motivations such as destiny or fate, “the mark of irrevocable time, of the event that has happened once and for all” (21). Yet even when realism appears indebted to this narrative logic, time past begins to shift to time present in the course of its telling. As this shift occurs “from tale to daily life” (27), we see realism distinguish itself from its narrative predecessors; however, the pressure to fall back into the preterite—to make destiny operative in the narrative sense—continues to haunt the mode, and is thus constitutive of realism itself. Chapter 2 initiates a discussion of the other side of realism—its perceived dissolution into modernism, or the “perpetual present,” which Jameson sees more productively for its affective rather than solely temporal dimension. This is affect as opposed to emotion; while the latter can be named, affect “somehow eludes language” (29). The tension between “the system of named emotions” and “the emergence of nameless bodily states” (32) is visible in Balzac and Flaubert; thus Jameson offers a refreshing new perspective on the Lukácsian distinction between realism and naturalism by rewriting it as between an allegorical and an affective impulse. (Although Jameson does not engage extensively with Lukács, the Hungarian philosopher seems to be his primary interlocutor throughout the book.) Jameson’s focus on intensity rather than essence is also useful for thinking about music and the plastic arts. The discussion of affect leads to a compelling rereading of Zola outside the general disdain of his writing in studies of realism following Lukács. When read in light of the antinomies of realism, Zola’s “sensory overload” is not a rejection of realism but a consideration of “the temporality of destiny when it is drawn into the force field of affect and distorted out of recognition by the latter” (46). Zola’s description, unlike Balzac’s, does not stand outside of time but is subject to it, compiling an aesthetic critique of the affective nature of capitalism. This makes him closer to Tolstoy than Lukács is willing to allow—Tolstoy whose “anti-political” novels revolve around a variety of moods, a “ceaseless variability from elation to hostility, from sympathy to generosity and then to suspicion, and finally to disappointment and indifference” (85). For Jameson, these moods are not contingent elements of War and Peace’s narrative but constitute its very realism, particularly as they surface in tension with the novel’s inordinate number of characters who, despite Tolstoy’s realist promise, do not function as a unity but as a heterogeneity, “held together by a body and a name” (89). It is as if Tolstoy found himself constantly distracted, eager to move from one character to another—and this movement ends up forming a new aesthetic that “effaces the very category of protagonicity as such” (90). The depletion of protagonicity becomes central to the realism of Spanish novelist Benito Pérez Galdós, whose protagonists constitute the background of his novels, and “whose foreground is increasingly occupied...

Older people and outdoor environments: Pedestrian anxieties and barriers in the use of familiar and unfamiliar spaces

A limited number of studies look at older people’s use of space outside the ‘home’ environment, particularly unfamiliar, public urban space. Such unfamiliarity can be created through older people travelling as tourists to new areas; as a consequence of urban regeneration; or as a result of cognitive decline, where the familiar becomes unfamiliar. This paper explores the experiences of older people as pedestrians in unfamiliar urban spaces. In looks at two aspects: older people’s spatial anxieties and the barriers (physical, psychological, spatial and social) they perceive and encounter in unfamiliar surroundings. Forty-four participants who took part in a reality cave exercise and a sub group of 10 people who visited an unfamiliar area as pedestrians describe their experience of walking a predetermined route. Given increasing urbanisation and population ageing this is an area of importance to geographers and gerontologists.Our study showed that there are a number of barriers that are a concern for older people in new environments; these include poor signage, confusing spaces, poor paving and ‘sensory overload’ i.e. noise and complexity of the environment. Landmarks and distinctive buildings were more important to participants than signage in navigating unfamiliar areas. Such experiences can contribute to practice implications for planners in designing neighbourhoods to support older people. Small changes such as placing distance on clearly marked signage; giving further information about particular areas beyond the key tourist points and using landmarks as clear navigational aids are important. This paper also adds to the growing literature on geographical gerontology.

Sex-specific brain deficits in auditory processing in an animal model of cocaine-related schizophrenic disorders.

Cocaine is a psychostimulant in the pharmacological class of drugs called Local Anesthetics. Interestingly, cocaine is the only drug in this class that has a chemical formula comprised of a tropane ring and is, moreover, addictive. The correlation between tropane and addiction is well-studied. Another well-studied correlation is that between psychosis induced by cocaine and that psychosis endogenously present in the schizophrenic patient. Indeed, both of these psychoses exhibit much the same behavioral as well as neurochemical properties across species. Therefore, in order to study the link between schizophrenia and cocaine addiction, we used a behavioral paradigm called Acoustic Startle. We used this acoustic startle paradigm in female versus male Sprague-Dawley animals to discriminate possible sex differences in responses to startle. The startle method operates through auditory pathways in brain via a network of sensorimotor gating processes within auditory cortex, cochlear nuclei, inferior and superior colliculi, pontine reticular nuclei, in addition to mesocorticolimbic brain reward and nigrostriatal motor circuitries. This paper is the first to report sex differences to acoustic stimuli in Sprague-Dawley animals (Rattus norvegicus) although such gender responses to acoustic startle have been reported in humans (Swerdlow et al. 1997 [1]). The startle method monitors pre-pulse inhibition (PPI) as a measure of the loss of sensorimotor gating in the brain's neuronal auditory network; auditory deficiencies can lead to sensory overload and subsequently cognitive dysfunction. Cocaine addicts and schizophrenic patients as well as cocaine treated animals are reported to exhibit symptoms of defective PPI (Geyer et al., 2001 [2]). Key findings are: (a) Cocaine significantly reduced PPI in both sexes. (b) Females were significantly more sensitive than males; reduced PPI was greater in females than in males. (c) Physiological saline had no effect on startle in either sex. Thus, the data elucidate gender-specificity to the startle response in animals. Finally, preliminary studies show the effect of cocaine on acoustic startle in tandem with effects on estrous cycle. The data further suggest that hormones may play a role in these sex differences to acoustic startle reported herein.

Signs of sensory overload

Sensory stimulation is vital for healthy development, especially of language, social and motor skills, but with the constant barrage of the modern world, being over-stimulated is a real cause for concern.

Le Naufrage de la Méduse and Operatic Spectacle in 1830s Paris

Abstract Grand opera's love of all-consuming spectacle is evident in its cataclysmic eruptions, explosions, and shipwrecks, its magnificent processions and ceremonies, and its breathtaking reconstructions of sublime landscapes, from Auber's La Muette de Portici (1828), through Halévy's La Juive (1835), to Meyerbeer's Le Prophète (1849), and beyond. An understanding of the Parisian public's visual experiences and expectations outside the opera house can help in theorizing grand opera's distinctive aesthetic. Contemporary spectacles d'optique, including the tableau vivant, panorama, diorama, and nocturnorama, attest to the higher powers of sensory attentiveness demanded of audiences. Some offered a sensory overload that encouraged complete absorption in the spectacle; others encouraged critical reflection as music and image drew attention to themselves through a disjunction of narrative or mood. Auguste Pilati and Friedrich von Flotow's opera Le Naufrage de la Méduse (Théâtre de la Renaissance, 1839) incorporated an ambitious animated representation of Théodore Géricault's celebrated painting on the subject and generated critical discussion about the relationship between sound and vision. Le Naufrage and the spectacles d'optique of the period offer a prism through which to view opera's evolution from a contemplative to a more involving form of drama in the second quarter of the nineteenth century, and to contextualize French grand opera's distinctive fascination with the interplay of music and spectacle, narrative and display, and the engagement of audiences in constructing meanings.

Alarm Fatigue

Research has demonstrated that 72% to 99% of clinical alarms are false. The high number of false alarms has led to alarm fatigue. Alarm fatigue is sensory overload when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarms and missed alarms. Patient deaths have been attributed to alarm fatigue. Patient safety and regulatory agencies have focused on the issue of alarm fatigue, and it is a 2014 Joint Commission National Patient Safety Goal. Quality improvement projects have demonstrated that strategies such as daily electrocardiogram electrode changes, proper skin preparation, education, and customization of alarm parameters have been able to decrease the number of false alarms. These and other strategies need to be tested in rigorous clinical trials to determine whether they reduce alarm burden without compromising patient safety.

A nose for trouble

As clinicians we work in a world of evidence- based care, making diagnoses using history taking and examination skills. In his William Pickles lecture at the 2011 Spring General Meeting, Dr Terry Davies asked whether GPs sometimes put too much emphasis on the ‘straight line science approach in their diagnoses’ when often their initial ‘hunch’ is the correct one. I suggest that experienced clinicians sometimes make their judgements based not only on experience, but using all their senses including olfaction; they literally develop a ‘nose for trouble’. In our everyday life we take our sense of smell for granted. In cities we are overwhelmed by sensory overload as we walk past fast-food outlets, coffee shops, bakeries, through throngs of shoppers smelling of soap, shampoo, aftershave, and perfume, and the ever-present smell of vehicle exhaust. There are many human smells that we simply do not register in our perfumed and deodorised world such as ear wax, sebum, menstrual blood, and even breath, while other smells we note and find offensive, such as stale sweat, flatus, and teenage boys’ feet. However, which mother has not lingered over the head of her new baby, breathing in the very special smell of baby and milk? Sheep and cattle recognise their offspring by scent and I am certain that humans are able …