Perceived acoustic environments, or soundscapes, of intensive care units (ICUs) can be stressful for patients. We developed an approach to enhance ICU soundscapes with soundscape interventions. Compositions of Natural, Human, or Technological sounds were designed to establish three types of sonic ambiances: Comfortable, Pleasurable, or Stimulating. The objective was to investigate the approach's effectiveness in a real-world ICU environment. In a controlled experiment conducted in a single-patient, sound-proofed ICU room, 26 healthy participants were exposed to simulated ICU soundscapes, including patient monitor alarm sounds and mechanical ventilator sounds. Nine soundscape interventions were played via speakers. Perceived pleasantness and eventfulness of resulting soundscapes and experienced pleasure and arousal of listeners were evaluated with questionnaires. Physiological indicators of stress were measured using electrocardiograms (ECGs). Pleasurable and Stimulating interventions significantly increased perceived pleasantness and eventfulness when introduced to the simulated ICU soundscape. Comfortable interventions had no significant effect, suggesting that Pleasurable and Stimulating ambiances better aligned with participants’ needs relative to the simulated soundscape. It emphasized the need to tailor ICU interventions to the preexisting acoustic environment and sound-related needs of listeners, such as comfort, distraction or reassurance. Participants reported positive emotional states while listening to the soundscape interventions, indicative of positive listener experiences. Preliminary insights regarding changes in heartrate variability hinted that soundscape interventions could potentially contribute to reduced stress levels. The effectiveness of interventions depended on their featured sound categories, highlighting the importance of personalization. Overall, our approach was found effective, showing promise for creating listener-centric, restorative soundscapes during ICU stays.

Soundscape is a recent notion, complementary to environmental noise control. It regards the total auditory experience of the acoustic environment based on descriptors ranging from pleasant to annoying, and from eventful to uneventful. This approach is used outdoors, but indoors too, for example in offices and hospitals. In Intensive Care Units (ICUs) many specific dominant sounds are prevalent; not only permanently active medical equipment such as ventilators, dialysis machines, but also alarms, and conversations by staff members. In such cases a special instance of the soundscape tool is required. The current work focuses on the processing and analysis of 24h long acoustic sets of sound data, collected continuously in the Adult ICU at Erasmus Medical Center. In addition to standard noise metrics like equivalent, peak sound levels and statistical indices, this research explores alternative measures such as restorative periods, fast rises, traffic noise index (TNI) and more metrics based on distributional variables. By adapting metrics from the realm of environmental noise to the ICU context, this work aims to provide a more comprehensive characterization of the acoustic environment. These insights will also facilitate relationships with qualitative soundscape descriptors to be collected in later stages of the project.

Intensive care units (ICUs) are the ultimate socio-technological environments known for their loud sound levels. Alarms, noise produced by patient support devices, loud conversations, physical interactions with tools and the environment in general contribute collectively to a sound quality generally perceived as low. This paper reports the results from a study conducted inside the old and new ICUs at Erasmus Medical Center, Rotterdam, the Netherlands. Sound level measurements have been collected continuously for three weeks in several matching rooms inside the old and new ICUs at full operational level at a one-year distance from one another. The results support the idea that changes in architectural layout, procedures, and culture have contributed to a significant decrease of the measured sound levels across all daily shifts, both inside patient rooms and in the nurse stations. We further discuss the results in light of a series of contextual considerations that emerged from interviews with healthcare providers (i.e., nurses and intensivists) who actively worked in both the old and the new ICU.

Intensive Care Unit (ICU) nurses are burdened by excessive number of false and irrelevant alarms generated by patient monitoring systems. Nurses rely on these patient monitoring systems for timely and relevant medical information concerning patients. However, the systems currently in place are not sensitive to the perceptual and cognitive abilities of nurses and thus fail to communicate information efficiently. An efficient communication and an effective collaboration between patient monitoring systems and ICU nurses is only possible by designing systems sensitive to the abilities and preferences of nurses. In order to design these sensitive systems, we need to gain in-depth understanding of the user group through revealing their latent individual characteristics. To this end, we conducted a survey on individual characteristics involving nurses from two IC units. Our results shed light on the personality and other characteristics of ICU nurses. Subsequently, we performed hierarchical cluster analysis to develop data-driven nurse profiles. We suggest design recommendations tailored to four distinct user profiles to address their unique needs. By optimizing the system interactions to match the natural tendencies of nurses, we aspire to alleviate the cognitive burden induced by system use to ensure that healthcare providers receive relevant information, ultimately improving patient safety.

The sound-driven design approach foregrounds the human-centred sonic, experiential and cultural aspects of listening. However, addressing the temporal and context-dependent nature of sound in multi-stakeholder, collaborative design projects is a challenging activity. Ideation methods are used to generate solutions to a design problem. During idea generation, participants use their creative cognition to generate ideas in quantity, quality, variety, and originality. If this collaboration is managed effectively, a group outperforms its members. We present Soundstorm, a collaborative card game to sensitise group-work in sound-driven generative design sessions. A pilot evaluation using a protocol study with 18 participants showed the potential of Soundstorm in facilitating iteration among team members. The study highlights the importance of putting effort and attention into preparing participants for productive generative sessions.

The hospital soundscape is known for high noise levels and a perception of chaos, leading to concerns about its impact on patients, families, professionals, and other hospital staff. This study investigates the relationship between sound, Annoyance, and sleep quality in a multi-patient neurology ward. A mixed-methods approach was employed. Interviews were conducted with medical staff (n = 7) to understand their experiences with sound. Questionnaires and sleep tracking devices (n = 20) assessed patient sleep quality and Annoyance caused by sound events. In addition, listeners (n = 28) annotated 429 nighttime audio recordings to identify sound sources and rate Annoyance level, which we considered the key emotional descriptor for patients. Over 9,200 sound events were analysed. While snoring, a patient-generated sound dominated the nighttime soundscape and was highly rated for Annoyance, and staff-generated sounds such as speech and footsteps were found to contribute more to accumulated Annoyance due to their extended duration. This study suggests that patient sleep quality can be improved by focusing on design interventions that reduce the impact of specific sounds. These might include raising awareness among staff about activities that might produce annoying sounds and implementing strategies to mitigate their disruptive effects.

We explored the underpinnings of providing positive listener experiences for intensive care unit (ICU) patients with compositions of added sounds. Our objective was to derive an approach to such interventions based on soundscape perception and need fulfillment. In one study, we gathered qualitative empirical data about imagined soundscapes where nine fundamental needs were fulfilled. Hierarchical clustering and thematic analysis showed that imagined soundscapes clustered into four types of sonic ambiances, i.e., affective connotations with soundscapes: Comfortable, Pleasurable, Motivating, or Stimulating ambiances. We derived four design parameters to achieve these ambiances with sound compositions: eventfulness, sonic ambiance qualities, narrative structure, and sound distribution. A sound artist was asked to use these parameters to create sound compositions. In a listening experiment, we examined their effects on the perceived pleasantness and eventfulness of soundscapes and on listeners' experienced pleasure and arousal. Soundscapes were perceived as pleasant with varying eventfulness in line with our structured approach. We found a strong correlation between pleasantness and with listener's pleasure and a moderate correlation between eventfulness and with listener's arousal. Finally, we suggested that in future research, three sonic ambiance types should be considered rather than four. Concluding, we showed that our need-driven approach could form a promising way to support ICU patients.

There is an increased awareness of how the quality of the acoustic environment impacts the lives of human beings. Several studies have shown that sound pollution has adverse effects on many populations, from infants to adults, in different environments and workplaces. Hospitals are susceptible environments that require special attention since sound can aggravate patients' health issues and negatively impact the performance of healthcare professionals. This paper focuses on Neonatal Intensive Care Units (NICU) as an especially sensitive case representing a hostile acoustic environment in which healthcare professionals have little awareness of how unwanted sounds impact the perceived quality of the soundscape. We performed a semi-systematic review of scientific literature on sound assessment studies in NICU from 2001. A thematic analysis was performed to identify emerging themes that informed the analysis of 27 technological solutions for the assessment of sound quality in indoor and outdoor environments. Solutions were categorized by functions and evaluation methods and grouped according to the characteristics of the design components, i.e., acquisition, computation, and communication strategies. Results highlight a lack of solutions to assess the qualitative characteristics of indoor environments such as NICU and forecast the footprint that different sound sources have on the indoor soundscape. Such solutions are urgently needed to empower healthcare professionals, and especially nurses, to actively modify and prevent the negative impact of unwanted sounds on NICU and critical care soundscape.

Exterior vehicle sounds have been introduced in electric vehicles and as external human–machine interfaces for automated vehicles. While previous research has studied the effect of exterior vehicle sounds on detectability and acceptance, the present study takes on a different approach by examining the efficacy of such sounds in deterring people from crossing the road. An online study was conducted in which 226 participants were presented with different types of synthetic sounds, including sounds of a combustion engine, pure tones, combined tones, and beeps. Participants were presented with a scenario where a vehicle moved in a straight trajectory at a constant velocity of 30 km/h, without any accompanying visual information. Participants, acting as pedestrians, were asked to hold down a key when they felt safe to cross. After each trial, they assessed whether the vehicle sound was easy to notice, whether it gave enough information to realize that a vehicle was approaching, and whether the sound was annoying. The results showed that sounds of higher modeled perceived loudness, such as continuous tones with high frequency, were the most effective in deterring participants from crossing the road. The tested intermittent beeps resulted in lower crossing deterrence than continuous tones, presumably because no valuable information could be derived during the inter-pulse intervals. Tire noise proved to be effective in deterring participants from crossing while being the least annoying among the sounds tested. These results may prove insightful for the improvement of synthetic exterior vehicle sounds.

Good sleep is conducive to the recovery process of hospital patients - and yet, in many wards, sleep duration and quality can often be suboptimal, in part due to modifiable hospital-related sounds and noises. At the neurological ward of the Reinier de Graaf hospital in Delft, the Netherlands, we developed and evaluated a prototype information exchange system to raise awareness of specific sounds as disturbing patients' sleep. The system both classifies different relevant sound events and tracks sleep quality (using a Fitbit device). This information is then visualized for patients and staff to present the influence of the soundscape on patients' sleep hygiene in a friendly and comprehensive way. We discuss the design process, including a context study and various evaluations of the technology, interface, and created affordances. Our initial findings indicate that visualizing hospital soundscapes may, indeed, support both patients and staff in their efforts towards better sleep hygiene.

Music as a low-cost sleep aid is a promising way to improve the sleep quality of people. However, most available sleep music playlists are limited to generic, soothing songs, which do not take in account personalisation. In collaboration with the Neurology Department of the Reinier de Graaf hospital (Delft, The Netherlands), we explored a profile-based personalisation approach to deliver music that fits with people' sleep and music preferences. Through generative research, we collected people's preference data and proposed four, evocative sleep music profiles: The Explorer, the Diver, the Hunter, and the Observer. The results of the profiling evaluation suggest that the profile experience is credible, intuitive, and easy to use. Four profiles can reflect people's preferences, but may not be stable.

As socio-technological environments shape and direct listener behaviour, an ecologicalaccount is needed that encompasses listening in complexity (i.e., multiple listeners, multiple sounds and their sources, and multiple sound-induced actions that ensure the success of a mission). In this study, we explored sound-induced action under the framework of “acoustic biotopes” (a notion
of ecological acoustics by Smolders, Aertsen, and Johanessma, 1979 and 1982) in a specific socio- technological environment, i.e., the context of an orthopaedic operating room. Our approach is based on literature research into the topics of environmental psychology and auditory perception and
action and in situ observations in healthcare with field recordings, participatory observations, and interviews on the spot. The results suggest a human-centered definition of sound-induced action in acoustic biotopes: Acoustic biotope is an active and shared sound environment with entangled interactions and sound-induced actions taking place in a specific space that has a critical function.
Listening in highly functional environments is an individual experience and is influenced by hearing function, physical position and role in an environment, and the task at hand. There is a range of active and passive sound listeners as a function of their attentive state and listeners as sound sources within the acoustic biotope. There are many different sound sources and sound locals in socio-technological environments and sounds have great potential to serve critical information to operators. Overall, our study provides a holistic, multi-layered and yet a listener-centric view on the organisation of complex spaces and the results can immediately be applicable for rethinking the acoustic environment for ORs for better listening and sound-induced action.

Nurses rely on patient monitoring systems for care delivery in ICUs. Monitoring systems communicate information to nurses and alert them through audiovisual alarms. However, excessive numbers of alarms often interrupt nurses in their tasks, and desensitize them to alarms. The affective consequence of this problem is that nurses are annoyed and feel frustration towards monitoring alarms. This situation leads to stress on nurses and threatens patient safety. Literature on sound annoyance distinguishes between annoyance induced by bottom-up (perceptual) and top-down (cognitive) processing. Extensive research on perceptual annoyance informs us on how to alleviate the problem by better sound design. However, addressing the cognitive aspect requires a broader understanding of annoyance as a construct. To this end, in this paper we distinguish between the annoyance induced by sensory unpleasantness of alarm sounds, and annoyance induced by frequent task interruptions. We present a conceptual framework in which we can interpret nurses’ annoyance by monitoring alarms. We further present descriptive analysis of the occurrence frequency of patient monitoring alarms in a neonatal ICU to illustrate the current state with regards to alarms. We aim to support nurses’ organizational well- being by providing an alternative hypothesis to explaining nurses’ affective states caused by auditory alarms. Future research can benefit from this paper through understanding of the context and familiarizing with the cognitive processes relevant to processing of patient monitoring alarms.

Inside the Neonatal Intensive Care Unit (NICU), exposure to loud sounds such as acoustic medical alarms can have adverse effects on neonates, parents, and medical staff. With the aim of having an accurate overview of which and how often acoustic medical alarms occur, this paper presents a simple signal processing-based approach for detecting and recognizing automatically and permanently patient monitoring alarms inside the NICU. The proposed algorithm leverages from prior knowledge of the spectro-temporal structures of alarms to first detect each single occurrence of an alarm tone, and then group the detected tones into a known alarm pattern. A preliminary evaluation of the algorithm on a small set of 4-channel recordings capturing a simulated NICU soundscape shows that around 99% of the acoustic alarms are correctly recognized, and that around 99% of the recognized alarms are true alarms. The algorithm lends itself to efficient real-time implementation and to generalization to other alarm patterns as defined by the IEC 60601-1-8 standard.

Psychological needs of users as a basis for design are at the core of design practice, yet the importance of fundamental human needs when designing soundscapes has not been studied specifically. This paper investigates the relationship between nine fundamental human needs and the affective qualities and categories of soundscapes. In a free-labeling survey study, we collected descriptions of imagined sound environments for the fulfilment of the needs, as well as ratings of the perceived affective quality of these environments. We found that needs were associated with pleasant soundscapes, while their eventfulness varied. ‘Human’ sounds were a common category for each of the nine needs considered in this study, but systematic variations of the categories were found dependent on the need. Results suggest that designing categorically different soundscapes dependent on the users’ needs will have beneficial effects.

Quantum Mechanics could have fundamental impact on design models and measurement. Quantum mechanics allows us to fill in the blanks of classical models of design, through its ability to explain ambiguous states of design. An ambiguous state is where design exists in between two binary states, as a superposition. Designers are most likely to be unfamiliar with quantum mechanics, as well as the subject of quantum mechanics being complex and sometimes contradictory to human scale mechanics. By discussing the opportunities of quantum mechanics for design, we are proposing a framework to model and measure ambiguous dimensions of design through quantum superpositions. The proposed framework includes the dimensions for the directionality of design (convergence or divergence), the degree of design embodiment (from low to high) and the decision-making of the designer (yes to no). Once the designer attempts the measurement of a superposition, a binary state can be distilled. For the act of designing, filling in the blanks is equal to sculpting away superposed states. In this philosophy, to design is to measure. This early stage research raises areas of opportunities and suggests further research directions for quantum mechanics and design.

The Audible Universe project aims to create dialogue between two scientific domains investigating two distinct research objects: stars and sound. It has been instantiated within a collaborative workshop that began to mutually acculturate the two communities, by sharing and transmitting respective knowledge, skills and practices. One main outcome of this exchange was a global view on the astronomical data sonification paradigm for observing the diversity of tools, uses and users (including visually impaired people), but also the current limitations and potential methods of improvement. From this viewpoint, here we present basic elements gathered and contextualized by sound experts in their respective fields (sound perception/cognition, sound design, psychoacoustics, experimental psychology), to anchor sonification for astronomy in a more well informed, methodological and creative process.

The chairs' editorial for the theme track 'Sound and Design'

This paper presents CareTunes as a concept to explore musical sonification of patient vitals and the role of music in Intensive Care Units (ICU). In this paper, we first describe the design specifications for the sonification of data in a musical fashion. Secondly, we present two applications for CareTunes in prototype stage and user evaluation studies. The first application regards the ICU nurses’ need to monitor patients from a distance (CareTunes as musical updates for nurses) and second application regards families’ need to connect with their loved in the ICU (CareTunes as musical messages for families). We conclude that music has the potential to represent changes in patient vitals for nurses and emotionally regulate families’ anxieties regarding ICU patient’s condition. Music offers a platform for reutilizing patient data for human-centered solutions.

Sound-driven design is an emerging, human-centered design practice informed by technology and listening in the multisensory dimension of interaction. In this paper we present a discourse analysis approach aimed at qualitatively understanding the constituent concepts of such a practice, by means of semi-structured interviews with sound designers, design researchers, engineers and expert users in the context of critical care. Preliminary results show that sound-driven design is inherently embodied, situated, and participatory, that the four categories of interviewees equally contribute to the definition of the design problem, and yet that a clear, shared arena is still missing.