***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction This study hypothesised that a reduction of sound during the night using earplugs could be beneficial in the prevention of intensive care delirium .  Two research questions were formulated . First , does the use of earplugs during the night reduce the onset of delirium or confusion in the ICU ? Second , does the use of earplugs during the night improve the quality of sleep in the ICU ? Methods A r and omized clinical trial included adult intensive care patients in an intervention group of 69 patients sleeping with earplugs during the night and a control group of 67 patients sleeping without earplugs during the night . The research ers were blinded during data collection . Assignment was performed by an independent nurse research er using a computer program . Eligible patients had an expected length of stay in the ICU of more than 24 hours , were Dutch- or English-speaking and scored a minimum Glasgow Coma Scale of 10 .  Delirium was assessed using the vali date d NEECHAM scale , sleep perception was reported by the patient in response to five questions . Results The use of earplugs during the night lowered the incidence of confusion in the studied intensive care patients . A vast improvement was shown by a Hazard Ratio of 0.47 ( 95 % confidence interval ( CI ) 0.27 to 0.82 ) . Also , patients sleeping with earplugs developed confusion later than the patients sleeping without earplugs . After the first night in the ICU , patients sleeping with earplugs reported a better sleep perception . Conclusions Earplugs may be a useful instrument in the prevention of confusion or delirium . The beneficial effects seem to be strongest within 48 hours after admission . The relation between sleep , sound and delirium , however , needs further research .Trial registration Current Controlled Trials IS RCT To determine whether the Cheers for Ears Program on noise induced hearing loss prevention was effective in improving current knowledge of noise impact of personal listening devices on hearing , and in changing self-reported listening behavior of primary school students aged between 9 years and 13 years . A survey study was implemented at participating primary schools . Schools represented various levels of socio-economic status . Informed consent ( parents and teachers ) and informed assent ( pupils ) were obtained . All pupils participated in two interactive sessions ( the second 6 weeks after first ) and only those who provided assent and consent were surveyed at three points during the study : Prior to the first session ( baseline ) , directly post-session and at 3 months post-session . A total of 318 pupils were surveyed . The median age of the participants was 11 years ( nearly 50 % of the total cohort ) . Significant changes are reported in their knowledge about hearing and in listening behavior of the participants as measured by pre- and post-measurement . The changes in behaviors were stable and sustained at 3 months post-intervention survey point and the success of the program can be attributed to the multimodal interactive nature of the sessions , the spacing of the sessions and the survey points . Wide-ranging support from schools and departments also played a role . The pilot Cheers for Ears Program is effective in increasing knowledge on the harmful effects of noise and therefore , it may prevent future noise-induced hearing loss BACKGROUND Sleep deprivation may contribute to impaired immune function , ventilatory compromise , disrupted thermoregulation , and delirium . Noise levels in intensive care units may be related to disturbed sleep patterns , but noise reduction has not been tested in this setting . OBJECTIVE To measure the effect of a noise reduction intervention on the sleep of healthy subjects exposed to simulated intensive care unit noise . METHODS After digital audiotape recording of noise and development of the noise reduction intervention , 5 nocturnal 8-hour periods of sleep were measured in 6 paid , healthy volunteers at 7-day intervals in a sleep disorders center .  Polysomnographic data were collected by experienced sleep disorders technicians and scored by certified raters . After the first 3 quiet nights , earplugs were r and omly assigned to be worn on the fourth and fifth nights during exposure to the recorded noise . Sound pressure levels were measured during all 5 nights . RESULTS Sleep architecture and sound measurements on quiet nights did not differ significantly . Sound levels were significantly lower on quiet nights than on noise nights . Exposure to the noise increased the number of awakenings , percentage of stage 2 sleep , and rapid eye movement latency and decreased time asleep , sleep maintenance efficiency index , and percentage of rapid eye movement sleep . Earplugs worn during exposure to the noise produced a significant decrease in rapid eye movement latency and an increase in the percentage of rapid eye movement sleep . CONCLUSION The results provide a reasonable basis for testing the effects of earplugs on the sleep of critically ill subjects Before the opening of the new Munich International Airport and the termination of the old airport , children near both sites were recruited into aircraft-noise groups ( aircraft noise at present or pending ) and control groups with no aircraft noise ( closely matched for socioeconomic status ) . A total of 326 children ( mean age = 10.4 years ) took part in three data - collection waves , one before and two after the switch-over of the airports . After the switch , long-term memory and reading were impaired in the noise group at the new airport . and improved in the formerly noise-exposed group at the old airport . Short-term memory also improved in the latter group after the old airport was closed . At the new airport , speech perception was impaired in the newly noise-exposed group . Mediational analyses suggest that poorer reading was not mediated by speech perception , and that impaired recall was in part mediated by reading Background : It has been suggested that noise exposure increases the risk of hypertension . Road traffic is the dominant source of community noise exposure . Objective : To study the association between exposure to residential road traffic noise and hypertension in an urban municipality . Methods : The study population comprised r and omly selected subjects aged 19–80 years . A postal question naire provided information on individual characteristics , including diagnosis of hypertension . The response rate was 77 % , result ing in a study population of 667 subjects . The  outdoor equivalent traffic noise level ( Leq 24 h ) at the residence of each individual was determined using noise-dispersion models and manual noise assessment s. The individual noise exposure was classified in units of 5 dB(A ) , from < 45 dB(A ) to > 65 dB(A ) . Results : The odds ratio ( OR ) for hypertension adjusted for age , smoking , occupational status and house type was 1.38 ( 95 % confidence interval ( CI ) 1.06 to 1.80 ) per 5 dB(A ) increase in noise exposure . The association seemed stronger among women ( OR 1.71 ; 95 % CI 1.17 to 2.50 ) and among those who had lived at the address for > 10 years ( OR 1.93 ; 95 % CI 1.29 to 2.83 ) . Analyses of categorical exposure variables suggested an exposure – response relationship . The strongest association between exposure to traffic noise and hypertension was found among those with the least expected misclassification of true individual exposure , as indicated by not having triple-glazed windows , living in an old house and having the bedroom window facing a street ( OR 2.47 ; 95 % CI 1.38 to 4.43 ) . Conclusion : The results of our study suggest an association between exposure to residential road traffic noise and hypertension BACKGROUND AND PURPOSE There is disagreement in the literature about the importance of  sleep disruption from intensive care unit ( ICU ) environmental noise . Previous reports have assumed that sleep disruption is produced by high-peak noise . This study aim ed to determine whether peak noise or the change in noise level from baseline is more important in inducing sleep disruption . We hypothesized that white noise added to the environment would reduce arousals by reducing the magnitude of changing noise levels . PATIENTS AND METHODS Four subjects underwent polysomnography under three conditions : ( 1 ) baseline , ( 2 ) exposure to recorded ICU noise and ( 3 ) exposure to ICU noise and mixed-frequency white noise , while one additional subject completed the first two conditions .  Baseline and peak noise levels were recorded for each arousal from sleep . RESULTS A total of 1178 arousals  were recorded during these studies . Compared to the baseline night ( 13.3+/-1.8 arousals/h ) the arousal index increased during the noise ( 48.4+/-7.6 ) but not the white noise/ICU noise night ( 15.7+/-4.5 ) ( P<0.004 ) . The change in sound from baseline to peak , rather than the peak sound level , determined whether an arousal occurred and was the same for the ICU noise and white noise/ICU noise condition ( 17.7+/-0.4 versus 17.5+/-0.3 DB , P=0.65 ) . CONCLUSIONS Peak noise was not the main determinant of sleep disruption from ICU noise . Mixed frequency white noise increases arousal thresholds in normal individuals exposed to recorded ICU noise by reducing the difference between background noise and peak noise BACKGROUND Exposure to noise in a critical care unit may trigger a response by the sympathetic nervous system , thereby increasing cardiovascular work in patients recovering from cardiac surgery . OBJECTIVE To investigate the effects of a music intervention given twice on the first postoperative day on noise annoyance , heart rate , and arterial blood pressure in subjects with high ( n = 22 ) and low ( n = 18 ) sensitivity to noise . METHODS A prospect i ve , quasi-experimental , repeated- measures design was used . Based on results of power analysis , the sample size was 40 . Subjects were recruited preoperatively , and their sensitivity to noise was assessed . On the first postoperative day , repeated- measures data were collected on levels of noise annoyance and physiological variables during 15 minutes of baseline and 15 minutes of music intervention on two occasions . Subjects completed a follow-up question naire regarding their perceptions of the noise in the critical care unit and the music intervention . RESULTS Repeated- measures analysis of variance showed that subjects had lower levels of noise annoyance during music intervention than at baseline . Heart rate and systolic blood pressure decreased during the music intervention compared with baseline . Diastolic blood pressure decreased during the music intervention from baseline during time 2 , but not time 1 . Subjects with high baseline scores of noise sensitivity preoperatively had higher baseline levels of noise annoyance in the critical care unit the first postoperative day . Subjects rated the music intervention as highly enjoyable regardless of their baseline noise sensitivity or noise annoyance . CONCLUSION Results of this study support the idea that noise annoyance is a highly individual phenomenon , influenced by a transaction of personal and environmental factors . Use of a music intervention with cardiac surgery patients during the first postoperative day decreased noise annoyance , heart rate , and systolic blood pressure , regardless of the subject 's noise sensitivity The Norwegian facade insulation study includes one pre-intervention and two post-intervention surveys . The facade-insulating measures reduced indoor noise levels by 7 dB on average . Before the intervention , 43 % of the respondents were highly annoyed by noise . Half a year after the intervention , the proportion of respondents who were highly annoyed by road traffic noise had been significantly reduced to 15 % . The second post-intervention study ( 2 yr after the first post-intervention study ) showed that the proportion of highly annoyed respondents had not changed since the first post-intervention study . The reduction in the respondents ' self-reported sleep disturbances ( due to traffic noise ) also remained relatively stable from the first to the second post-intervention study . In the control group , there were no statistically significant differences in annoyance between the pre-intervention and the two post-intervention studies . Previous studies of traffic changes have reported that people " overreact " to noise changes . This study indicated that when considering a receiver measure , such as facade insulation , the effect of reducing indoor noise levels could be predicted from exposure-response curves based on previous studies . Thus no evidence of an " overreaction " was found OBJECTIVE To determine if Critical Care Unit ( CCU ) sound levels suppress rapid eye movement ( REM ) sleep . DESIGN Posttest-only control group experimental design . SETTING Sleep laboratory located in a university neurologic institute . SUBJECTS Seventy paid ( $ 40 ) women who had no hearing or sleep problems . PROCEDURES Subjects were r and omly assigned to a noise or quiet ( control ) group while attempting to sleep overnight in the laboratory . Noise-condition subjects heard an audiotape recording of CCU nighttime sounds . The audiotape recording was withheld from the control group . RESULTS Subjects in the noise condition showed poorer REM sleep on seven of 10 measures . These included REM activity and shorter REM duration s throughout the night and during the first and second halves of the night as well as a longer interval between the first and second REM cycles . The majority of the t test results were significant at the 0.001 level or better . CONCLUSIONS Although generalization of the results to CCU patients is limited ( because of the use of laboratory subjects ) , the results provided convincing support for a causal relationship between CCU sound levels and suppression of REM sleep Abstract Objective : To evaluate the effectiveness of four NIHL prevention interventions at improving knowledge , attitudes , and intended behaviors regarding sound exposure and appropriate use of hearing protective strategies in children . Design : A r and omized trial of the four interventions with a non-intervention comparison group . Question naires were completed prior to , immediately after , and three months after each intervention . Study : Interventions included : ( 1 ) A classroom presentation by older-peer educators , ( 2 ) A classroom presentation by health professionals , ( 3 ) . Exploration of a museum exhibition , and ( 4 ) . Exploration of an internet-based virtual museum . A comparison group received no intervention . Study sample : Fifty-three fourth grade classrooms ( 1120 students ) participated in the study . Results : All interventions produced significant improvements but the number of improvements decreased over time . In terms of effectiveness , the classroom programs were more effective than the internet-based virtual exhibit , which was more effective than the visit to the museum exhibition . Self-reported exposures indicated that as many as 94.5 % of participants were at risk for NIHL . Con 
    Output:
    
Results showed that many of the interventions were associated with changes in health outcomes irrespective of the source type , the outcome or intervention type ( source , path or infrastructure ) .
For road traffic sources and the annoyance outcome , the expected effect-size can be estimated from an appropriate exposure – response function , though the change in annoyance in most studies was larger than could be expected based on noise level change