Alarm in the ICU ! Envisioning Patient Monitoring and Alarm Management in Future Intensive Care Units

Özcan, E., Birdja, D., Simonse, L., & Struijs, A. (2018). Alarm in the ICU ! Envisioning Patient Monitoring and Alarm Management in Future Intensive Care Units. In Service Design and Service Thinking in Healthcare and Hospital Management (pp. 421–446).

This article is fresh out of the oven!

The ICU’s in hospitals are equipped with advanced technology to increase the survival of the critically ill patients. Nevertheless, this same technology and their alarms has failed to work as a tool by clinicians: “long exposure to medical alarms induces alarm fatigue in clinicians and can cause patient delirium, or post-traumatic stress disorder” (pp. 422).

In this paper, the authors propose a new way to monitor patients and manage alarms inside an ICU. They state that how monitoring technology is used nowadays is not very different from when it emerged, in the 1950s, thus a revisit to patient monitoring is necessary.


The premisse of the paper is that in the future, the hospital will have more critical cases in-house than regular cases. The latter will be monitores from distance. Thus an intelligent and seamless use of data is needed. One of the measures to achieve this is having a Central Alarm System: ” (…) It would be worth considering removing all sound from the medical devices and create a separate product dedicated to producing a specially designed set of sounds based on the data provided from the several monitoring devices in the ICU.” (pp.437).

The authors described their vision of the the future inside the ICU, and the interesting part is that they have showned it to experts in the field for validation.



Twenty things I wish I’d known when I started my PhD

Nature has recently published a cool article. A bit late for me – anyway, I’ve never followed my OWN advices.

1. Maintain a healthy work–life balance by finding a routine that works for you. It’s better to develop a good balance and work steadily throughout your programme than to work intensively and burn out. Looking after yourself is key to success.

2. Discuss expectations with your supervisor. Everyone works differently. Make sure you know your needs and communicate them to your supervisor early on, so you can work productively together.

3. Invest time in literature reviews. These reviews, both before and after data collection, help you to develop your research aims and conclusions.

4. Decide on your goals early. Look at your departmental guidelines and then establish clear PhD aims or questions on the basis of your thesis requirements. Goals can change later, but a clear plan will help you to maintain focus.

5. “I don’t need to write that down, I’ll remember it” is the biggest lie you can tell yourself! Write down everything you do — even if it doesn’t work. This includes meeting notes, method details, code annotations, among other things.

6. Organize your work and workspace. In particular, make sure to use meaningful labels, so you know what and where things are. Organizing early will save you time later on.

7. It’s never too early to start writing your thesis. Write and show your work to your supervisor as you go — even if you don’t end up using your early work, it’s good practice and a way to get ideas organized in your head.

8. Break your thesis down into SMART (specific, measurable, attainable, relevant and timely) goals. You will be more productive if your to-do list reads “draft first paragraph of the results” rather than “write chapter 1”. Many small actions lead to one complete thesis.

9. The best thesis is a finished thesis. No matter how much time you spend perfecting your first draft, your work will come back covered in corrections, and you will go through more drafts before you submit your final version. Send your drafts to your supervisor sooner rather than later.

10. Be honest with your supervisor. Let them know if you don’t understand something, if you’ve messed up an experiment or if they forgot to give you feedback. The more honest you are, the better your relationship will be. Helping your supervisor to help you is key.

11. Back up your work! You can avoid many tears by doing this at least weekly.

12. Socialize with your lab group and other students. It’s a great way to discuss PhD experiences, get advice and help, improve your research and make friends.

13. Attend departmental seminars and lab-group meetings, even (or especially) when the topic is not your area of expertise. What you learn could change the direction of your research and career. Regular attendance will also be noticed.

14. Present your research. This can be at lab-group meetings, conferences and so on. Presenting can be scary, but it gets easier as you practise, and it’s a fantastic way to network and get feedback at the same time.

15. Aim to publish your research. It might not work out, but drafting articles and submitting them to journals is a great way to learn new skills and enhance your CV.

16. Have a life outside work. Although your lab group is like your work family, it’s great for your mental health to be able to escape work. This could be through sport, clubs, hobbies, holidays or spending time with friends.

17. Don’t compare yourself with others. Your PhD is an opportunity to conduct original research that reveals new information. As such, all PhD programmes are different. You just need to do what works for you and your project.

18. The nature of research means that things will not always go according to plan. This does not mean you are a bad student. Keep calm, take a break and then carry on. Experiments that fail can still be written up as part of a successful PhD.

19. Never struggle on your own. Talk to other students and have frank discussions with your supervisor. There’s no shame in asking for help. You are not alone.

20. Enjoy your PhD! It can be tough, and there will be days when you wish you had a ‘normal’ job, but PhDs are full of wonderful experiences and give you the opportunity to work on something that fascinates you. Celebrate your successes and enjoy yourself.


Going to an international conference to present a PhD research

I have just returned from an international conference on digital audio effects. I loved it, what it has done to me, and to my motivation.


I have made the experimental research on something like the Kansei of sounds, or the subjective perception of very basic artificial sounds. I have written the paper and submitted it to this conference because I knew the conference was good, and this year it happened in my country. The paper matched the conference’s specifications (Perception, psychoacoustics and evaluation) and it got accepted. The two reviews were very positive, I have made a few modifications, the proofreading was spotless and then the paper was ready.

The day approached and a week earlier I started making my presentation. I did it, re-did it, practiced it alone for my phone, heard me over and over again. I was more or less ready.


I have arrived and the audience was very, very, gender unbalanced. Slowly I started talking to some people, the environment was really friendly and relaxed. We had some beers, some wine. I mingled, which is something that does not come easy in me.

I understood very little of everything that was being presented: digital audio filters, algebra, physics. The audience made, what seemed to be, really hard questions. I started to panic, very quietly.

The day arrived, I presented in the afternoon. I ate very little. I went to the bathroom three times in an hour. People told me I looked pretty relaxed: I was not. I was very afraid, feeling that I did not discuss this enough, had not enough feedback from my supervisors, why did I think this was a good idea? WAIT WHAT? T.C. is in my pannel? I just see every one of his talks on youtube, read every paper and have been reading his book on the past year. * GLUP*

My turn comes. I do the presentation, it goes according to planned, I even finish one minute before. I got asked maybe six questions, which is really a lot. The questions were curious, questioning the effect of context in the perception of sounds, of using environmental sounds as alarms, questioning my conclusions about the little effect a variable had (are you sure it was little? you should verify, some effects are ignored just because of the p-value). I believe being a little off-topic made the audience more curious.

It ended. I had the impression it was not very good, not that bad either.


People approached me in the following coffee-break. Talking about their experiences in hospitals regarding sound, about colleagues who are developing medical devices. They told me I did well, I looked cool, the topic was interesting as in “I have never thought about it!”. One person told me to keep doing what I was doing, another proposed ways of designing better sounds using real-world recordings.

I got the impression that it was not that bad.

Then I was really happy because I came. I heard new things, I met new people, I discussed my work with others. I work so alone that it felt like a marvelous new world to me.

I hope to get more opportunities like this, and to grab them like I did. The final lesson is to just go, the final balance will always be positive. I feel like working, man!

Update #4

Update: I have presented my first PhD paper in an international conference. I went very well, uff!
  • Have made an oral presentation at an international conference;  HFES Europe Chapter, 14th Oct 2015 + DAFx2018, 5th September 2018
  • Have 2 work-related papers published; (1 and 2/2)
  • Have 1 PhD-related paper submitted; (dafx2018)
  • Have made sound collections in two different environments (1/2);
  • Have concluded the first and second experimental tasks;
  • Be independent in R, LaTeX, sound capture and it’s edition;
  • Have some sort of project/visit abroad  Summer School in Control Room Verification and Validation in Halden, Norway

Sound design and marimbas

Yesterday I saw this 2016 video where two sound designers react and explain some of the world’s most recognizable sounds. Exactly a day before I had shown some of these sounds to some product design students and it is quite amazing how we are all so tuned into these auditory interfaces.

At some point on the vídeo, about the Marimba iPhone ring, they mention some research made in Bell Labs about the best parameters for a ring tone.

Looking for a bit more info, I found this article about this ringtone, and it says:

Scientists at Bell Laboratories, Human Factors Research Lab performed numerous studies on ringers, from buzzers to thumpers. They studied tonal quality and duration along with the decibel levels needed for the brain to recognized the call alert. They even tested the Grandpa to the iPhone “old phone” ringtone. In 1956, 300 research subjects in Crystal Lake, Illinois found the “musical tone ringer” to be “pleasant,” but took most test subjects over a week or so to get accustomed to it. However, when pressed, a majority of test subjects wanted the old bell ringer back. Not much has changed since from the days of the early Human Factors research, the brain still works the same, but the technology obviously allows for more finite control of the sounds a ringtone creates.

Ideally, a ring tone should register very clearly and distinctively in the audio range that is central to human hearing, from about 2 to 4 KHz, with a Dynamic range (quietest to loudest) of about 96 dB. Even though this audio range is quite crowded with a lot of sound, it is also precisely where most spoken languages carry a majority of phoneme distinction, and thus, we have evolved a relatively high level of sound discrimination central to this audio range.

For a ringtone to be decoded ideally by the brain, the timbre of the audio envelope ideally should pulse to a full dynamic range to nearly no sound with-in a 3 – 5 second cycle (Bell Labs Research). The relative amplitudes of the various harmonics primarily determine the timbre of instruments and sounds, though onset transients, formants, noises, and inharmonicities also play a role.

Iannis Xenakis’ notation

I don’t know much about music. Never had serious music formation, I have real trouble understanding some things. This means I never seriously reflected on many things I take for granted, like music notation.

I am reading “How music works” by David Byrne for several months now. It is not super engaging, but I am enjoying it immensly as I am learning a lot about music.

He speaks about the music notation we use in the west and how much room for interpretation does it leave. I knew there were different notations, but I don’t really know what are the pros and cons of each – still don’t.

He spoke about Iannis Xenakis and how he wrote his pieces and I was really impressed. He made all these lines and connections, and how each should behave in relation to another, and took so much space to do so! I am pro conventions, but to see someone doing things unconventionally is so refreshing! I loved this.

1 Coríntios 14


1 Follow after charity, and desire spiritual gifts, but rather that ye may prophesy.

2 For he that speaketh in an unknown tongue speaketh not unto men, but unto God: for no man understandeth him; howbeit in the spirit he speaketh mysteries.

3 But he that prophesieth speaketh unto men to edification, and exhortation, and comfort.

4 He that speaketh in an unknown tongue edifieth himself; but he that prophesieth edifieth the church.

5 I would that ye all spake with tongues, but rather that ye prophesied: for greater is he that prophesieth than he that speaketh with tongues, except he interpret, that the church may receive edifying.

6 Now, brethren, if I come unto you speaking with tongues, what shall I profit you, except I shall speak to you either by revelation, or by knowledge, or by prophesying, or by doctrine?

7 And even things without life giving sound, whether pipe or harp, except they give a distinction in the sounds, how shall it be known what is piped or harped?

8 For if the trumpet give an uncertain sound, who shall prepare himself to the battle?

9 So likewise ye, except ye utter by the tongue words easy to be understood, how shall it be known what is spoken? for ye shall speak into the air.

10 There are, it may be, so many kinds of voices in the world, and none of them is without signification.

11 Therefore if I know not the meaning of the voice, I shall be unto him that speaketh a barbarian, and he that speaketh shall be a barbarian unto me.

12 Even so ye, forasmuch as ye are zealous of spiritual gifts, seek that ye may excel to the edifying of the church.

13 Wherefore let him that speaketh in an unknown tongue pray that he may interpret.

14 For if I pray in an unknown tongue, my spirit prayeth, but my understanding is unfruitful.


1 Segui a caridade, e procurai com zelo os dons espirituais, mas, principalmente, o de profetizar.

2 Porque, o que fala língua estranha não fala aos homens, senão a Deus; porque ninguém o entende, e em espírito fala de mistérios.

3 Mas, o que profetiza fala aos homens para edificação, exortação e consolação.

4 O que fala língua estranha edifica-se a si mesmo; mas o que profetiza edifica a igreja.

5 E eu quero que todos vós faleis línguas estranhas, mas, muito mais, que profetizeis; porque, o que profetiza é maior do que o que fala línguas estranhas, a não ser que também interprete, para que a igreja receba edificação.

6 E agora, irmãos, se eu for ter convosco, falando línguas estranhas, que vos aproveitará, se vos não falar, ou por meio da revelação, ou da ciência, ou da profecia, ou da doutrina?

7 Da mesma sorte, se as coisas inanimadas, que fazem som, seja flauta, seja cítara, não formarem sons distintos, como se conhecerá o que se toca com a flauta ou com a cítara?

8 Porque, se a trombeta der sonido incerto, quem se preparará para a batalha?

9 Assim, também, vós, se com a língua não pronunciardes palavras bem inteligíveis, como se entenderá o que se diz? porque estareis como que falando ao ar.

10 Há, por exemplo, tanta espécie de vozes no mundo, e nenhuma delas é sem significação.

11 Mas se eu ignorar o sentido da voz, serei bárbaro para aquele a quem falo, e o que fala será bárbaro para mim.

12 Assim, também, vós, como desejais dons espirituais, procurai abundar neles, para edificação da igreja.

13 Pelo que, o que fala língua estranha ore, para que a possa interpretar.

14 Porque, se eu orar em língua estranha, o meu espírito ora, mas o meu entendimento fica sem fruto.