Acoustic differentiation and classification of wild belugas and narwhals using echolocation clicks.

Belugas (Delphinapterus leucas) and narwhals (Monodon monoceros) are highly social Arctic toothed whales with large vocal repertoires and similar acoustic profiles. Passive Acoustic Monitoring (PAM) that uses multiple hydrophones over large spatiotemporal scales has been a primary method to study their populations, particularly in response to rapid climate change and increasing underwater noise. This study marks the first acoustic comparison between wild belugas and narwhals from the same location and reveals that they can be acoustically differentiated and classified solely by echolocation clicks. Acoustic recordings were made in the pack ice of Baffin Bay, West Greenland, during 2013. Multivariate analyses and Random Forests classification models were applied to eighty-one single-species acoustic events comprised of numerous echolocation clicks. Results demonstrate a significant difference between species' acoustic parameters where beluga echolocation was distinguished by higher frequency content, evidenced by higher peak frequencies, center frequencies, and frequency minimums and maximums. Spectral peaks, troughs, and center frequencies for beluga clicks were generally > 60 kHz and narwhal clicks < 60 kHz with overlap between 40-60 kHz. Classification model predictive performance was strong with an overall correct classification rate of 97.5% for the best model. The most important predictors for species assignment were defined by peaks and notches in frequency spectra. Our results provide strong support for the use of echolocation in PAM efforts to differentiate belugas and narwhals acoustically.

Recommended snapshot length for acoustic point-transect surveys of intermittently available Cuvier's beaked whales.

Acoustic point-transect distance-sampling surveys have recently been used to estimate the density of beaked whales. Typically, the fraction of short time "snapshots" with detected beaked whales is used in this calculation. Beaked whale echolocation pulses are only intermittently available, which may affect the best choice of snapshot length. The effect of snapshot length on density estimation for Cuvier's beaked whale (Ziphius cavirostris) is investigated by sub-setting continuous recordings from drifting hydrophones deployed off southern and central California. Snapshot lengths from 20 s to 20 min are superimposed on the time series of detected beaked whale echolocation pulses, and the components of the density estimation equation are estimated for each snapshot length. The fraction of snapshots with detections, the effective area surveyed, and the snapshot detection probability all increase with snapshot length. Due to compensatory changes in these three components, density estimates show very little dependence on snapshot length. Within the range we examined, 1-2 min snapshots are recommended to avoid the potential bias caused by animal movement during the snapshot period and to maximize the sample size for estimating the effective area surveyed.

Detection and classification of narrow-band high frequency echolocation clicks from drifting recorders.

In the California Current off the United States West Coast, there are three offshore cetacean species that produce narrow-band high frequency (NBHF) echolocation pulses: Dall's porpoise (Phocoenoides dalli) and two species of Kogia. NBHF pulses exist in a highly specialized acoustic niche thought to be outside the hearing range of killer whales and other potential mammal-eating odontocetes. Very little is known about the dwarf and pygmy sperm whales (K. sima and K. breviceps), including their NBHF pulse characteristics. This paper presents a multivariate clustering method using data from unmanned drifting acoustic recorders and visually verified porpoise recordings to discriminate between probable porpoise and Kogia clicks. Using density clustering, this study finds three distinct clusters whose geographic distributions are consistent with the known habitat range for Kogia and Dall's porpoise. A Random Forest classification model correctly assigned 97% of the clicks to their cluster. Visually verified Dall's porpoise clicks from towed hydrophones were strongly associated with one of the clusters, while a second cluster tended to be outside the geographic range of Dall's porpoise and unlike the Dall's porpoise cluster. These clicks, presumed to be made by Kogia, exhibited greater spectral variance than previous Kogia echolocation studies. It is possible that the structure of Kogia NBHF pulses may not be as stereotypical as previously described.

Displaying bioacoustic directional information from sonobuoys using "azigrams".

The AN/SSQ-53 Directional Frequency Analysis and Recording (DIFAR) sonobuoy is an expendable device that can derive acoustic particle velocity along two orthogonal horizontal axes, along with acoustic pressure. This information enables computation of azimuths of low-frequency acoustic sources from a single compact sensor. The standard approach for estimating azimuth from these sensors is by conventional beamforming (i.e., adding weighted time series), but the resulting "cardioid" beampattern is imprecise, computationally expensive, and vulnerable to directional noise contamination for weak signals. Demonstrated here is an alternative multiplicative processing scheme that computes the "active intensity" of an acoustic signal to obtain the dominant directionality of a noise field as a function of time and frequency. This information is conveniently displayed as an "azigram," which is analogous to a spectrogram, but uses color to indicate azimuth instead of intensity. Data from several locations demonstrate this approach, which can be computed without demultiplexing the raw signal. Azigrams have been used to help diagnose sonobuoy issues, improve detectability, and estimate bearings of low signal-to-noise ratio signals. Azigrams may also enhance the detection and potential classification of signals embedded in directional noise fields.

The Effect of Pharmacy-Driven Education on the Amount of Appropriately Administered Tetanus Vaccines in the Emergency Department.

Background: Tetanus vaccinations for wound prophylaxis are routinely administered in emergency departments (ED). Current recommendations from the Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP) regarding tetanus administration for wound prophylaxis differentiate between the tetanus and diphtheria (Td) and the tetanus, diphtheria, acellular pertussis (Tdap) formulations and when they should be administered. Lack of knowledge regarding these recommendations, different formulations, and techniques to locate patient immunization history can lend to increased duplicate and inappropriate vaccinations. Objective: The purpose of this prospective, interventional study with a historical control was to evaluate the impact of a pharmacy-driven education series on the proportion of duplicate and inappropriate tetanus vaccinations administered in a level I trauma center ED. Methods: Three months of tetanus vaccinations administered in the ED after this education were analyzed and compared with a historical control. The primary outcome is the percentage of vaccinations considered duplicates (previous vaccination within the past 5 years) when patients' medical record was reviewed for immunization history. Secondary end points include the percentage of vaccinations considered nonadherent (according to current CDC-ACIP guidelines), the total cost of all duplicate vaccinations, and the percentage of vaccination orders that had the wrong formulation administered. Results: The percentage of duplicate vaccinations decreased from 9.9% (25 vaccinations) to 5.5% (14 vaccinations) (P = .067) from the preintervention group to the postintervention group. Nonadherent vaccinations compiled 3.6% versus 2.8% of the vaccinations (P = .611) and incorrect formulations given were 18.2% versus 11.4% (P = .176) in the preintervention and postintervention groups, respectively. Conclusion: The study suggests that multiple formulations of tetanus vaccinations and fragmented documentation of immunizations increase the prevalence of medication errors related to tetanus vaccinations. It also indicates that interventions more enduring than education are required to prevent these errors.

Safety of bolus-dose phenylephrine for hypotensive emergency department patients.

INTRODUCTION: Bolus-dose phenylephrine (BDPE) is routinely used to treat hypotension in the operating room. BDPE's fast onset of action and ability to be administered peripherally have prompted calls for its use in the Emergency Department (ED). There are few published data on the safety of BDPE use in the ED. Primary concerns include BDPE's potential to cause dangerous hypertension or reflex bradycardia. We hypothesize that BDPE is a safe short-term vasopressor choice for hypotensive ED patients. METHODS: We conducted a structured chart review for all patients who received BDPE from preloaded syringes over 42months. We defined an adverse event (AE) as sBP>180, dBP>110, or HR<50 within 30min of receiving BDPE. We defined a serious adverse event (SAE) as an AE with pharmacologic intervention to correct vital sign abnormality. We also compared mean arterial pressure (MAP), sBP, and dBP pre/post BDPE administration to assess effectiveness. We used a two-sample t-test to assess for differences between the mean delta MAP after low versus high-dose BDPE. RESULTS: We identified 181 cases of ED use. 147 cases had complete pre/post vital signs. We identified 5 AEs and no SAEs. Three patients developed sBP>180mmHg. The patients suffered no apparent harm. No patients had dBP>110. Two patients developed bradycardia post-drug. In both cases, MAP improved despite bradycardia. CONCLUSIONS: BDPE does not appear to cause reflex bradycardia or hypertension requiring intervention among hypotensive ED patients. The apparent safety of BDPE should be confirmed in prospective trials.

Estimating drift of directional sonobuoys from acoustic bearings.

A maximum likelihood method is presented for estimating drift direction and speed of a directional sonobuoy given the deployment location and a time series of acoustic bearings to a sound source at known position. The viability of this method is demonstrated by applying it to two real-world scenarios: (1) during a calibration trial where buoys were independently tracked via satellite, and (2) by applying the technique to sonobuoy recordings of a vocalising Antarctic blue whale that was simultaneously tracked by photogrammetric methods. In both test cases, correcting for sonobuoy drift substantially increased the accuracy of acoustic locations.

Geographic variation in Risso's dolphin echolocation click spectra.

Discrimination of bioacoustic signals to the species or population level is critical for using passive acoustic monitoring to study cetacean ecology. Risso's dolphins off southern California have distinctive peaks and notches in their echolocation clicks, but it was unknown whether Risso's dolphins from other geographic areas have similarly distinctive click spectra and whether populations are acoustically distinct. This study investigates using clicks for species and population identification by characterizing the spectral structure of Risso's dolphin echolocation clicks recorded over wide-ranging geographic regions including the U.S. waters of the North Atlantic Ocean, Gulf of Mexico, and North Pacific Ocean; and international waters of the Eastern Tropical Pacific. All recordings with Risso's dolphin clicks exhibited the spectral peak and notch pattern described off southern California, indicating the presence of peak banding patterns is useful for species discrimination. Geographic regions were a significant explanatory factor for variability in the frequencies of click spectral peaks, with relatively higher frequency peaks and notches found off Hawaii compared to California waters and off the southeast U.S. compared to the Gulf of Mexico. In the North Atlantic Ocean, a latitudinal cline in frequencies was evident. Potential causes of acoustic variation within and among acoustic encounters are evaluated.

Shifts in frequency-modulated pulses recorded during an encounter with Blainville's beaked whales (Mesoplodon densirostris).

Echolocation signals produced by beaked whales (family: Ziphiidae) include frequency-modulated (FM) pulses that appear to have species-specific characteristics. To date there has been no established evidence that a single species of beaked whale might produce more than one type of FM pulse. In 2014 a group of Blainville's beaked whales (Mesoplodon densirostris) were sighted off of Southern California; recordings included FM pulses with significant increases in peak frequency, center frequency, and -10 dB bandwidth relative to FM pulses previously attributed to this species. This research suggests there may be greater variation in received beaked whale FM pulses than previously understood.

Impact of an emergency medicine pharmacist on antibiotic dosing adjustment.

OBJECTIVE: Overall medication-related errors in the emergency department (ED) are 13.5 times more likely to occur in the absence of an emergency medicine pharmacist (EMP). Although the effectiveness of pharmacist-driven renal dosing adjustment has been studied in the intensive care unit, data are lacking in the ED setting. The aim of our study was to evaluate the appropriateness of antibiotic dosing when an EMP is physically present in the ED compared to when absent. METHODS: This was a retrospective cohort study of patients treated in a level I trauma center with 75 adult and 12 pediatric beds and an annual census of 90000 patients. The study period was from March 1 to September 30, 2014. An EMP was physically present in the ED from 11:00 to 01:30 and absent from 01:31 to 10:59. Male and female patients 18years and older were considered for inclusion if cefazolin, cefepime, ciprofloxacin, piperacillin-tazobactam, or vancomycin was ordered. The primary outcome was the composite rate of correct antibiotic dose and frequency. Statistics included a multivariable logistic regression using age, sex, presence of EMP, and creatinine clearance as independent predictors of correct antibiotic use. RESULTS: A total 210 cases were randomly chosen for evaluation, half during times when EMPs were present and half when they were absent. There were 130 males (62%) with an overall mean age of 54±18years. Overall, 178 (85%) of 210 of the antibiotic orders were appropriate, with 95% appropriate when an EMP was present compared to 74% when an EMP was absent (odds ratio, 6.9; 95% confidence interval, 2.5-18.8). In a logistic regression model, antibiotic appropriateness was independently associated with the presence of the EMP and creatinine clearance. CONCLUSION: Antibiotics that require renal and/or weight dosing adjustment are 6.5 times more likely to be appropriate in the ED when an EMP is present. Prevalence of antibiotic dosing error is related to both the presence of EMPs and the degree of renal impairment.

Evaluating community pharmacists' HIV testing knowledge: A cross-sectional survey.

OBJECTIVES: To assess community pharmacists' knowledge of human immunodeficiency virus (HIV), antiretroviral therapy, and new in-home oral fluid HIV test. METHODS: A cross-sectional questionnaire administered to pharmacists, student pharmacists, and technicians before an education program at the New Mexico Pharmacists Association 2013 Mid-Winter Meeting in Albuquerque, NM. The main outcome measure was community pharmacists' correct response rate of 75% or more. RESULTS: Overall survey response rate of attendees was 89% (173/194 attendees). Among them 87 participants were community pharmacists; 87% of community pharmacists responded correctly when asked how HIV antiretroviral medications work and 84.3% correctly identified known sources of HIV infection. The 75% predefined adequate knowledge threshold was not met on any HIV screening or in-home HIV test knowledge items. Only 65.1% of community pharmacists correctly identified the minimum number of antiretroviral drugs that should be included in an ideal HIV treatment regimen. The only variable that positively influenced pharmacists' knowledge was age. An inverse relationship between pharmacist age and HIV knowledge was observed among study participants. CONCLUSION: Community pharmacists from urban and rural areas in New Mexico possessed adequate basic HIV knowledge, but did not demonstrate adequate HIV screening or in-home HIV test knowledge. Future educational interventions aimed at improving pharmacist knowledge in this area are warranted.

Disparity in Patients' Self-Reported and Charted Medication Allergy Information.

OBJECTIVES: The objective of this study was to compare current adverse drug/allergy reaction reporting in patient electronic medical records/charts against information gathered during patient interviews in the emergency department. Our hypothesis was that current methods for allergy reporting results in significant discrepancy between what is documented and the actual allergy history upon interviewing the patient. METHODS: The study was conducted between December 2011 and April 2012 in an academic emergency department. This was a convenience sample study comparing a prospective patient interview with previously documented allergy histories. Demographics for sex, age, and race were recorded. Patients to be interviewed were adults with at least one documented allergy in their chart. Descriptive statistics and percentages were used for demographic and prevalence data. Agreement between interviews and charts was assessed for both the reaction type and the reaction descriptor. RESULTS: There were 101 patients interviewed during this 4-month period, and a total of 235 adverse drug reactions were recorded. There were 66 women and 35 men included in this study. The mean age was 51 ± 17 years. The median number of allergy instances for women was 2 (interquartile range 1-3) and for men the median number of allergy instances was 1 (interquartile range 1-2). The percentage of agreements for overall allergies was 85% and 50% for the type of reaction. Total profile agreement occurred in nine patients. CONCLUSIONS: The percentage of agreement between interviews and charting for reaction type was 50%. Even with the use of electronic medical records, better methods are needed to properly record allergies to ensure patient safety and care.

Discrimination of frequency-modulated Baleen whale downsweep calls with overlapping frequencies.

Automatic classification of fin, sei, and blue whale frequency modulated downsweeps has been a challenging task for bioacousticians. These calls overlap in frequency range and have similar time durations. The traditional spectrogram methodology, the Short Time Fourier Transform, tends to be ineffective because of the large temporal ambiguities needed to achieve the necessary frequency resolution to study the fine time-frequency (TF) structures. Spectrograms generated with the Pseudo Wigner-Ville Distribution (PWVD) provide much higher simultaneous TF resolution compared with the traditional method. The PWVD allows bioacousticians to study the fine TF structures of the sound, such as the instantaneous frequency, instantaneous bandwidth, contour slope, etc. These features set the foundation of identifying sounds that are usually considered difficult to discriminate using the traditional method. Wigner-Ville distribution of the baleen whale downsweeps showed distinguishable characteristics; for example, the TF contour of fin and sei whales exhibited concave and convex shapes, which have never been reported in the literature. A Support Vector Machine classifier was trained and tested based on the parameters extracted from the PWVD.

Antimicrobial Stewardship Intervention and Feedback to Infectious Disease Specialists: A Case Study in High-Dose Daptomycin.

Infectious Diseases specialists have used high-dose daptomycin (≥6 mg/kg/day) in select patients with difficult to treat methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) infections to optimize outcomes. Antimicrobial stewardship programs enforce antimicrobial formulary restrictions; however, interventions specifically aimed at Infectious Disease specialists can be particularly challenging. The purpose of this study was to create a high-dose daptomycin algorithm for Infectious Disease specialists that are consistent with best-practices. Daptomycin prescribing habits pre- and post-daptomycin algorithm implementation were evaluated using a quasi-experimental study design. Patients were included if ≥18 years of age and received daptomycin for ≥48 h. Patients were excluded if daptomycin was initiated on an outpatient setting. During the 12-month pre-intervention phase, 112 patients were included, with 73 patients in the 12-month post-intervention phase. A statistically significant decrease in the mean daptomycin dose from 9.01 mg/kg to 7.51 mg/kg (p < 0.005) was observed, resulting in an annual drug cost-savings of over $75,000 without adversely affecting readmission rates due to infection. Creation of a daptomycin algorithm with consideration of pathogen, disease state, and prior treatment, is an effective means of influencing prescribing habits of Infectious Disease specialists.

Species-specific beaked whale echolocation signals.

Beaked whale echolocation signals are mostly frequency-modulated (FM) upsweep pulses and appear to be species specific. Evolutionary processes of niche separation may have driven differentiation of beaked whale signals used for spatial orientation and foraging. FM pulses of eight species of beaked whales were identified, as well as five distinct pulse types of unknown species, but presumed to be from beaked whales. Current evidence suggests these five distinct but unidentified FM pulse types are also species-specific and are each produced by a separate species. There may be a relationship between adult body length and center frequency with smaller whales producing higher frequency signals. This could be due to anatomical and physiological restraints or it could be an evolutionary adaption for detection of smaller prey for smaller whales with higher resolution using higher frequencies. The disadvantage of higher frequencies is a shorter detection range. Whales echolocating with the highest frequencies, or broadband, likely lower source level signals also use a higher repetition rate, which might compensate for the shorter detection range. Habitat modeling with acoustic detections should give further insights into how niches and prey may have shaped species-specific FM pulse types.

On-site pharmacists in the ED improve medical errors.

OBJECTIVE: The objective of the study was to compare errors in the emergency department (ED) with pharmacists present (PPs) for resuscitations and traumas vs with pharmacists absent (PAs). Our hypothesis was that errors would be significantly fewer during PP than PA times. We also hypothesized that times with PP would affect patients greater when disposition was to more critical areas (intensive care unit, or ICUs). METHODS: The study was conducted during a 3-month period in 2009 in a level 1 trauma center with an emergency medicine residency. This was a cross-sectional cohort study comparing a prospective analysis of patients during the time (10 hour/day) with PP and a retrospective review of the time on the same days (14 hours/day) with PA. Demographics of age, race, and sex were recorded. Patient disposition was either ICU, operating room, non-ICU wards, observation unit, or discharge. Main outcome was errors recorded including medications given but not ordered, medication ordered but not given, and time delays for medications. For demographics and prevalence, descriptive statistics and percentages were used. Percent differences and 95% confidence intervals (CIs) and χ2 were derived. Logistic regression used predictor variables of age, race, sex, disposition, and presence or absence of pharmacists. An a priori power analysis was performed. The study was powered at 80% with 186 subjects per group (PP vs PA), to find a difference of 20% between the 2 groups in percent of medical errors. RESULTS: There were 694 patients included in the 3-month period. A total of 242 presented during PP times and 452 during PA times. There were 383 (55%) male, 301 (43%) female, and 10 (2%) unknown sex. Mean age was 45±18 years in PP group and 48±20 years in PA group (P, nonsignificant). There was no difference in ethnicity between groups. There were 6 (3%) patients with errors recorded during PP times and 137 (30%) with errors recorded during PA times (difference, 27%; 95% CI, 23-32). Controlling for age, race, sex, and disposition, medical errors were 13.5 times more likely during PA than during PP times (adjusted odds ratio, 13.5; 95% CI, 5.7-31.9). CONCLUSION: With pharmacists absent, over 13 times more errors are recorded in our ED than with pharmacists present. An on-site pharmacist in the ED may be helpful in reducing medical errors.

Description of sounds recorded from Longman's beaked whale, Indopacetus pacificus.

Sounds from Longman's beaked whale, Indopacetus pacificus, were recorded during shipboard surveys of cetaceans surrounding the Hawaiian Islands archipelago; this represents the first known recording of this species. Sounds included echolocation clicks and burst pulses. Echolocation clicks were grouped into three categories, a 15 kHz click (n = 106), a 25 kHz click (n = 136), and a 25 kHz pulse with a frequency-modulated upsweep (n = 70). The 15 and 25 kHz clicks were relatively short (181 and 144 ms, respectively); the longer 25 kHz upswept pulse was 288 ms. Burst pulses were long (0.5 s) click trains with approximately 240 clicks/s.

Healthcare IT and connecticut's acute-care hospitals. An analysis of trends, barriers, impacts and perspectives.

In recent years there has been much discussion in regards to the uses of information technology in healthcare. This paper presents a snapshot and analysis of the current information technology outlook in Connecticut's acute-care hospitals. Seventy-seven percent of the state's acute-care hospitals participated in the study. The authors found that the hospitals, on average, have implemented IT applications at a much higher rate than the rest of the United States. The authors also found that patient safety is the leading motivation behind IT implementation.

Sounds recorded in the presence of Blainville's beaked whales, Mesoplodon densirostris, near Hawai'i.

During a combined visual and acoustic cetacean survey of the Hawaiian Islands in 2002, four midfrequency sounds were recorded in close proximity to a group of Blainville's beaked whales, Mesoplodon densirostris. These sounds included one frequency-modulated whistle, and three frequency- and amplitude-modulated pulsed sounds, with energy between 6 and 16 kHz. Until recently, little was known of the acoustic behavior of beaked whales, and early descriptions of audible sounds made by beaked whales are incomplete [Caldwell and Caldwell, Cetology 4, 1-5 (1971); Lynn and Reiss, Marine Mammal Sci. 8(3), 229-305 (1992); T. C. Poulter, "Marine mammals," in Animal Communication; Techniques of Study and Results of Research, edited by T. A. Sebeok (Indiana University Press, Bloomington, 1968)]. Recent recordings of high-frequency clicks (>20 kHz, [Johnson et al., Proc. R. Soc. London, Ser. B (Suppl.) 271, 5383-5386 (2004); Zimmer et al., J. Acoust. Soc. Am. 117(6), 3919-3927.]) were above the frequency response of our equipment, and therefore not detected. Sound production within the midfrequency range of sounds described here suggests that the hearing of M. densirostris is sensitive at frequencies used in some types of active sonars.

A tool for real-time acoustic species identification of delphinid whistles.

The ability to identify delphinid vocalizations to species in real-time would be an asset during shipboard surveys. An automated system, Real-time Odontocete Call Classification Algorithm (ROCCA), is being developed to allow real-time acoustic species identification in the field. This Matlab-based tool automatically extracts ten variables (beginning, end, minimum and maximum frequencies, duration, slope of the beginning and end sweep, number of inflection points, number of steps, and presence/absence of harmonics) from whistles selected from a real-time scrolling spectrograph (ISHMAEL). It uses classification and regression tree analysis (CART) and discriminant function analysis (DFA) to identify whistles to species. Schools are classified based on running tallies of individual whistle classifications. Overall, 46% of schools were correctly classified for seven species and one genus (Tursiops truncatus, Stenella attenuata, S. longirostris, S. coeruleoalba, Steno bredanensis, Delphinus species, Pseudorca crassidens, and Globicephala macrorhynchus), with correct classification as high as 80% for some species. If classification success can be increased, this tool will provide a method for identifying schools that are difficult to approach and observe, will allow species distribution data to be collected when visual efforts are compromised, and will reduce the time necessary for post-cruise data analysis.