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Background: Suction drains are commonly placed after rhytidectomy to avoid seroma formation that may result from dead spaces between skin layers. Fibrin sealants promote tissue adherence by crosslinking with extracellular matrix proteins, which may reduce the dead space under skin flaps. Objectives: The authors evaluate the safety and efficacy of the fibrin sealant (FS) VH S/D 4 s-apr (Artiss; Baxter Healthcare Corp, Deerfield, Illinois), added to standard-of-care (SoC) treatment, in improving flap adherence and reducing dead space in patients undergoing rhytidectomy. Methods: Patients with planned facial rhytidectomy were enrolled in this phase 3, prospective, controlled, randomized, patient-blinded, multicenter trial. They received SoC treatment on 1 side of the face and adjunctive FS VH S/D 4 s-apr on the other. Results: Seventy-five patients completed the trial. The mean (SD) drainage volume was 7.7 (7.4) mL from the sides treated with sealant and 20.0 (11.3) mL from the SoC-only sides ( P < .0001). Rates of hematoma and seroma were similar for the 2 treatments, as were changes in postoperative skin sensitivity. Adverse events generally were mild; 2 serious adverse events were reported (wound abscess, dehydration). Conclusions: Adjunct use of FS VH S/D 4 s-apr in rhytidectomy was proven safe in this study. It significantly reduced drainage volumes without increasing the incidence of hematoma or seroma, which suggests that it eliminates dead space through improved flap adherence. Level of Evidence: 2 ![Graphic][1] [1]: /embed/inline-graphic-1.gif

Background: Suction drains are commonly placed after rhytidectomy surgery to avoid seroma formation that may result from dead spaces between skin layers. Fibrin sealants promote tissue adherence by cross-linking with extracellular matrix proteins, which may reduce the dead space under skin flaps. Objectives: The authors evaluate the safety and preliminary efficacy of the fibrin sealant (FS) VH S/D 4 s-apr (ARTISS; Baxter Healthcare Corp, Deerfield, Illinois), added to standard-of-care (SoC) treatment, on tissue plane adherence and local hemostasis in rhytidectomy patients. Methods: In this phase 2, prospective, controlled, randomized, evaluator- and patient-blinded, multicenter study, 45 patients (of 56 possible enrollees) received SoC treatment on 1 side of the face and adjunctive FS VH S/D 4 s-apr treatment on the other side. Outcomes measures included visual assessments of ecchymosis (by blinded reviewers), grading of ecchymosis and edema, drainage volumes, occurrence of hematoma/seroma, safety evaluations, and patient-reported assessments of pain, numbness, and treatment preferences postoperatively. Results: Mean patient age was 55.1 years. Rates and grades of ecchymosis and edema were similar for the 2 treatments. The mean (SD) drainage volume 24 hours after surgery was 11.5 (13.7) mL from the FS VH S/D 4 s-apr–treated sides of the face and 26.8 (24.0) mL from the SoC-only sides ( P < .0001). Patient assessments of pain, numbness, and preference favored treatment with FS VH S/D 4 s-apr. Adverse events were mild to moderate in severity. Conclusions: Adjuvant use of FS VH S/D 4 s-apr appears to be safe and results in lower drainage volumes than SoC treatment alone. Level of Evidence: 2 ![Graphic][1] [1]: /embed/inline-graphic-1.gif

Noise from aircraft ground operations often reaches residences in the vicinity of airports via grazing incidence paths that attenuate high-frequency noise more than air-to-ground propagation paths, thus increasing the relative low-frequency content of such noise with respect to overflight noise. Outdoor A-weighted noise measurements may not appropriately reflect low-frequency noise levels that can induce potentially annoying secondary emissions inside residences near runways. Contours of low-frequency noise levels were estimated in a residential area adjacent to a busy runway from multi-site measurements of composite maximum spectra of runway sideline noise in the one-third octave bands between 25 and 80 Hz, inclusive. Neighborhood residents were interviewed to determine the prevalence of annoyance attributable to runway sideline noise at frequencies below 100 Hz, and of its audible manifestations inside homes. Survey respondents highly annoyed by rattle and vibration were concentrated in areas with low-frequency sound levels due to aircraft operations in excess of 75 to 80 dB.

Dosage‐response functions that relate the time‐weighted daily average sound power of outdoor noise to the prevalence of a consequential degree of noise‐induced annoyance in communities are often viewed as providing a basis for land use compatibility policy recommendations. Although such functions advance understanding of the rate of growth of annoyance with sound level and of related matters, they do not in themselves dictate any particular policy recommendations. It is therefore useful to consider how the growth of noise‐induced annoyance is itself related to other nonacoustic measures of community response to noise exposure, such as the rate of growth of neighborhood noisiness judgments with sound level. A probabilistic model of community response to noise exposure developed by Green and Fidell (1991) is shown to provide a good account of a set of neighborhood noisiness judgments. The model is used to relate the growth functions for judgments of neighborhood noisiness and the prevalence of annoyance to one another.

Behaviorally confirmed awakenings were recorded during nighttime hours for periods of approximately one month in 45 homes of 82 test participants. Measurements of awakening and of both indoor and outdoor noise exposure were made for a total of 632 subject nights near a military airfield, 783 subject nights near a civil airport, and 472 subject nights in neighborhoods with community noise exposure of nonaircraft origin. Sound exposure levels of individual noise intrusions were much more closely associated with awakenings than long‐term noise exposure levels. The slope of the relationship between awakening and sound exposure level was rather shallow, however. Although the present findings do not resemble those of laboratory studies of noise‐induced sleep interference, they are in good agreement with the results of other field studies.

A social survey was undertaken to compare the prevalence of noise‐induced annoyance in two residential populations with similar aircraft noise exposure in the vicinity of Hartsfield International Airport (ATL) in Atlanta, Georgia. One population was composed of residents of homes that had been treated to increase their acoustic transmission loss. The other population was composed of residents of homes that had not been so treated. No clear benefit of home noise insulation was observed in terms of lowered prevalence of annoyance to aircraft noise exposure.

A near-replication of a study of the annoyance of rattle and vibration attributable to aircraft noise [Fidell et al., J. Acoust. Soc. Am. 106, 1408–1415 (1999)] was conducted in the vicinity of Minneapolis-St. Paul International Airport (MSP). The findings of the current study were similar to those reported earlier with respect to the types of objects cited as sources of rattle in homes, frequencies of notice of rattle, and the prevalence of annoyance due to aircraft noise-induced rattle. A reliably lower prevalence rate of annoyance (but not of complaints) with rattle and vibration was noted among respondents living in homes that had been treated to achieve a 5-dB improvement in A-weighted noise reduction than among respondents living in untreated homes. This difference is not due to any substantive increase in low-frequency noise reduction of acoustically treated homes, but may be associated with installation of nonrattling windows. Common interpretations of the prevalence of a consequential degree of annoyance attributable to low-frequency aircraft noise may be developed from the combined results of the present and prior studies.

Twenty-nine people judged the relative annoyance of five variable level signals and 29 impulsive and non-impulsive fixed-level signals in an adaptive paired comparison study. Signals were presented for judgment as heard indoors in a facility capable of accurately reproducing the very low-frequency content of sonic booms. When the annoyance of sonic booms unaccompanied by rattle was compared with that of sounds containing more higher-frequency energy (an aircraft flyover and an octave band of noise centered at 1 kHz), the relative rate of growth of annoyance, as expressed in C-weighted SEL units, was nearly 2:1. In other words, to maintain subjective equality of annoyance, each increase in level of sonic booms had to be matched by nearly twice the increase in level of an aircraft flyover or an octave band of noise centered at 1 kHz. Relative rates of growth of annoyance of sonic booms accompanied by rattle and of non-impulsive sounds, including both low- (63-Hz octave band of noise) and high-frequency energy (1-kHz octave band of noise and an aircraft flyover), were closer to 1:1. Relative rates of growth of annoyance for sonic booms unaccompanied by rattle and low-frequency sounds (63 Hz) were also about 1:1. These differences in relative rates of growth of annoyance of impulsive and non-impulsive sounds are as plausibly attributed to their relative low-frequency content as to impulsiveness per se. It may therefore be more useful for some purposes to express the annoyance of impulsive signals and other environmental noises containing substantial low-frequency energy in terms of effective (duration-corrected) loudness level rather than commonplace ASEL or CSEL.

Community response to a step change in aircraft noise exposure associated with the opening of a new runway at Vancouver International Airport was documented in two rounds of telephone interviews. One round of interviews was conducted 15 months prior to the start of operations on the new runway, while a second round of interviews was undertaken 21 months after the start of operations. The proportion of respondents who described themselves as “very” or “extremely” annoyed by aircraft noise in a residential area with increased aircraft noise exposure after the runway opening was markedly greater than that predictable from well-known dosage–response relationships. Analysis suggests that a good part of the “excess” annoyance is attributable to the net influence of nonacoustic factors.

A field study of habituation to aircraft noise-induced sleep disturbance was conducted near DeKalb-Peachtree Airport (PDK), a large general aviation airport north of Atlanta, Georgia. Increased aircraft operations were expected in nighttime hours due to the Olympic Games in Atlanta in July/August 1996. Indoor and outdoor measurements of aircraft and other nighttime noises were made in 12 homes in a community north of PDK for a period of approximately 6 weeks, beginning 2-1/2 weeks prior to the Olympics and ending one week after their conclusion. Sleep disturbance information suitable for analysis was measured during 686 subject-nights by self-report, behaviorally-confirmed awakening (button pushes upon awakening) and sleep motility (via a wrist-worn recording accelerometer). No major differences were noted in sleep disturbance during or after the Olympics. Inclusion of data from all time periods with results of prior studies did not affect a prior dosage-response relationship between awakening and sound exposure level. A subsequent study involving an additional 117 subject-nights was undertaken to compare the sensitivity and interpretability of sleep motility measurements made in analysis epochs ranging from 2 to 30 seconds in duration. The pattern of findings of the methodological study revealed little benefit of analyzing motility measurements in short duration epochs.

On‐site and telephone opinion surveys were conducted to assess outdoor recreationists’ annoyance with aircraft overflights of wilderness areas. Although current technology for measuring noise exposure does not yet permit accurate and cost‐effective estimates of dosage‐response relationships in outdoor recreational settings, it was nonetheless possible to construct a rough relationship between estimated aircraft noise exposure and annoyance from the data of the on‐site study. In the second survey, telephone interviews were administered to another sample of outdoor recreationists within 2 weeks of their return from visits to 12 wilderness areas. The prevalence of aircraft noise‐induced annoyance (in any degree) among respondents in all wilderness areas ranged from 5% to 32%. The prevalence of a consequential degree of aircraft noise‐induced annoyance among respondents was less than 5% in all wilderness areas combined. Noise‐induced annoyance proved to be a more direct measure of the effects of aircraft overflights on recreationists than more global measures such as visit satisfaction or intent to revisit.

Concerns about the appropriateness of representing low‐frequency aircraft ground and near‐ground noise in A‐weighted units, and about the adequacy of standard interpretive criteria for assessing community response to low‐frequency noises, are becoming more common at large civil airports. Residents of a neighborhood adjacent to a busy runway were interviewed to determine the annoyance of runway sideline noise at frequencies below 100 Hz, and of its audible manifestations inside homes. Extensive measurements were made to estimate low‐frequency noise contours in the interviewing area, and street addresses of respondents were geo‐coded to permit assignment of low‐frequency noise levels to each household. Residents who were highly annoyed by low‐frequency sideline noise were concentrated in areas with maximum sound levels summed in one‐third octave bands between 25 and 80 Hz (inclusive) that were in excess of 75–80 dB. These levels are consistent with Hubbard’s (1980) estimates of low‐frequency airborne sound levels capable of inducing secondary emissions in light architectural elements of residences.

Two groups of 30 audiometrically screened test participants judged the relative annoyance of two comparison (variable level) signals and 30–34 standard (fixed level) signals in an adaptive paired comparison psychoacoustic study. The signal ensemble included primarily stage II and stage III aircraft overflights, as well as synthesized aircraft noise signatures. Test signals were presented for judgment as heard indoors (test 1) and outdoors (test 2), in the presence of continuous background noise, under free‐field listening conditions in an anechoic chamber. For both tests, analyses of the performance of 30 noise metrics as predictors of these annoyance judgments confirmed that the more complex metrics were generally more accurate and precise predictors than the simpler methods. EPNL was slightly less accurate and precise as a predictor of the annoyance judgments than a duration‐adjusted variant of Zwicker’s loudness level. [Research was supported by NASA, Langley Research Center, Hampton, Virginia.]

An empirical, market‐based method was developed to assess whether military aircraft noise exposure has affected residential property values in the vicinity of Langley Air Force Base over the last two decades. Multiple regression models that accounted for the bulk of the variance in property sale prices were developed and validated for independent samples drawn from areas of Hampton, VA exposed to levels of military aircraft noise lower than DNL=60 dB. The predictive performance of these models was indistinguishable in areas of Hampton exposed to military aircraft noise in excess of DNL=65 dB. Maps constructed by geo‐coding property sale locations permitted spatial comparisons of property values with aircraft noise exposure contours. These maps confirmed the independence of the spatial distributions of property values and aircraft noise contours in the vicinity of Langley Air Force Base.

Various ‘‘corrections’’ have been suggested to measures of high‐energy impulsive sounds to account for their seemingly anomalous annoyance, some on the basis of the findings of studies that may not have accurately reproduced the low‐frequency content of high‐energy impulses. The present study measured rates of growth of annoyance of impulsive and nonimpulsive sounds by adaptive paired comparisons of the annoyance of five variable level signals and 29 impulsive and nonimpulsive fixed level signals. All test sounds were presented for judgment in a specially designed low‐frequency test facility. When the annoyance of an aircraft flyover was compared to that of a low‐frequency band of noise and of sonic booms accompanied by rattle, the relative rates of growth of annoyance were not much different from 1:1. When the annoyance of sonic booms that were not accompanied by rattle was compared with that of sounds containing more higher‐frequency energy (an aircraft flyover and an octave band of noise centered at 1 ...

Since useful field studies of the annoyance of high energy impulsive sounds are costly and difficult to conduct, comparatively little is known empirically about community response to high energy impulsive noise exposure. Several attempts have therefore been made to generalize the results of controlled exposure studies of the relative annoyance of impulsive and nonimpulsive noises to community‐level analyses. Although such studies have yielded a range of level‐dependent growth functions for the annoyance of impulsive sounds, it is commonly observed that the annoyance of impulsive sounds increases more rapidly with level than that of nonimpulsive signals. The findings of a recent set of paired comparison judgments, in which the very low‐frequency content of sonic booms was accurately reproduced, suggest that the steep slope of human hearing sensitivity at low frequencies may provide a good account for the common observation, at least for the case of sonic booms. If this is so, then ad hoc ‘‘adjustments’’ to the annoyance of impulsive sounds based on rise time, crest factor, and similar waveform characteristics may be superfluous. [Study supported by U.S. Air Force Air Combat Command.]

A methodological study was undertaken to investigate the sensitivity of sleep motility to noise‐induced disturbances. Indoor noise exposure and sleep motility of 22 test subjects were measured for 109 subject nights under a range of conditions of noise exposure and familiarity of sleeping quarters. Recording accelerometers stored the number of times that vertical motion of the wrist‐worn devices exceeded 0.0002 g at frequencies below about 3 Hz during a 2‐s interval. Noise monitors continuously recorded 2‐s time histories of indoor noise levels throughout each night of data collection. Additional sequences of varying epoch durations were constructed analytically from the 2‐s intervals of noise levels and sleep motility data. Analyses of accelerometric recordings in 2‐, 4‐, 6‐, 8‐, 10‐, 20‐, and 30‐s epochs included an examination of the relationship between synchronous indoor noise level and motility, description of motility observations on a nightly basis, characterization of general serial dependence in...

As quieter aircraft have begun to replace some of the noiser ones in the civil air transport fleet, aircraft noise exposure levels in certain airport neighborhoods have declined to some degree. Federal agencies with interests in aviation noise have not yet offered policy guidance for gauging the smallest decrease in aircraft noise that may be considered meaningful under these circumstances in airport neighborhoods. An empirical study of this issue was thus underken in residential areas near a large airport at which noise exposure levels had declined by several decibels over the last few years. Very few neighborhood residents either noticed a decrease in aircraft noise in the recent past or decribed themselves as less annoyed by aircraft noise than in prior years.

More than 1800 subject‐nights of observations have been completed in a large‐scale, in‐home study of awakenings associated with nighttime aircraft noise exposure in the vicinity of an Air Force base, a major civil airport, and several sites in urban neighborhoods with negligible nighttime aircraft noise exposure. A statistically reliable relationship was found between behaviorally confirmed awakenings and indoor sound exposure of individual noise events. This relationship is similar to one reported in another recent large‐scale field study, and also with a relationship summarizing the findings of several earlier field studies of noise‐induced sleep disturbance. The findings do not, however, agree well with those typically found in laboratory studies of sleep disturbance, nor with an interim dosage‐response relationship adopted by the Federal Interagency Committee on Noise. [Research sponsored by U.S. Air Force Armstrong Laboratory, Wright‐Patterson Air Force Base, OH.]

Sounds created by the interaction of wind and foliage (as well as sounds of running water and animal populations) are the principal sources of the ambient noise environments in many uninhabited areas. Since these indigenous sources create much of the masking energy in outdoor recreational settings, which limits the audibility of noise intrusions, characterizing their influence is an important step in predicting and managing natural quiet. Cross‐correlational analyses of time series of wind speed and A‐weighted sound‐pressure observations in a wilderness environment indicate that over half of the variance in ambient sound levels can be predicted from knowledge of wind speed. [Research sponsored under National Park Service Contract CX‐2000‐9‐0026.]

Conventional social survey and noise measurement techniques are not well suited to characterization of exposure and collection of prompt reactions to aircraft overflights in outdoor recreational settings. For example, place‐oriented measurements cannot be assumed to represent personal exposure as in residential settings, and exit and mailback surveys introduce inevitable delays in responding. A miniaturized, computer‐based instrumentation system for simultaneous real‐time monitoring of noise exposure and recording of responses may provide a cost‐effective alternative to traditional methods of assessing aircraft noise impacts in parks and wildernesses.

Outdoor recordings made in low ambient noise conditions are susceptible to wind noise artifacts associated with turbulence around microphones. Even the use of large windscreens may not always eliminate such artifacts. For certain purposes, such as characterizing nonindigenous noise intrusions in outdoor recreational settings, additional measures are necessary. Signal‐processing algorithms for rejecting wind noise artifacts, based on setting simultaneous thresholds for average derivatives in several frequency regions, can be effective in obtaining unbiased estimates of ambient levels.

Although much less is known about ambient noise distributions in park and wilderness areas than in populated areas, ambient noise levels of natural origin are often believed to be uniformly low in absolute level and spatially homogeneous. Initial field measurements made for purposes related to Public Law 100‐91 reveal considerable spatial and temporal heterogeneity of ambient noise environments of natural origin. Means and variances of one‐third octave band measurements of acoustic energy of natural ambient levels made at a number of remote sites are compared with one another and with urban spectral distributions.

The audibility of man‐made noise intrusions in park and wilderness environments is determined not only by masking of natural origin, but also by the self‐noise of outdoor recreationists. The relative influences of self‐noise and ambient noise on the audibility of aircraft noise, a matter of central concern for aircraft overflight management for purposes of Public Law 100‐91, thus vary with the activity and location of outdoor recreationists. Comparisons of spectral distributions of acoustic energy from fixed and at‐ear microphone locations document large differences between estimates of masking based on place‐oriented rather than visitor‐oriented acoustic measurements in outdoor recreational settings.