Common Practice Research Articles

European practices on antithrombotic management during percutaneous mechanical circulatory support in adults: insights from an international survey

Abstract Background Bleeding and thrombotic complications remain a major concern in cardiogenic shock (CS) patients undergoing percutaneous mechanical circulatory support (pMCS) with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and/or microaxial flow pumps like the Impella. Antithrombotic practices strongly determine the coagulopathic risk, but standardized protocols are lacking in this context. Purpose This survey outlines European practices on antithrombotic management in adults on pMCS for CS, making an initial effort to standardize practices, inform future trials, and enhance outcomes. Methods This online cross-sectional survey was distributed through digital newsletters and social media platforms by the Association of Acute Cardiovascular Care (ACVC) of the ESC and the European branch of the Extracorporeal Life Support Organization (EuroELSO). The survey was accessible from April 17th to May 23rd, 2023. The target population were European clinicians involved in care for adults on pMCS. Results We included 105 responses from 26 European countries. In 72.4% of the European respondents’ institutions, a standardized local anticoagulation protocol is present, with unfractionated heparin (UFH) being the predominantly used anticoagulant (Impella: 97.0%; V-A ECMO: 96.1%). Similarly, the purge solution during Impella support is most frequently UFH-based (84.1%). A bicarbonate-based purge solution (BBPS) as standard purge is reported by only 1.6%. UFH titration based on the activated partial thromboplastin time (APTT) alone is the most common practice either for Impella (43.1%) and for V-A ECMO (32.9%). A minority of 16.9% and 13.2% indicate relying on activated clotting time (ACT) for UFH-titration during Impella and V-A ECMO support, respectively. UFH-titration protocols are anti-Xa based for 12.3% (Impella) and 10.5% (V-A ECMO) of the respondents. An UFH anticoagulant protocol based on APTT and anti-Xa in parallel is the preferred option for 10.8% (Impella) and 14.5% (V-A ECMO) of the respondents. Anticoagulant targets for APTT, ACT and anti-Xa varied across institutions. The majority (83.8%) does not alter their anticoagulation management in case of combined Impella plus V-A ECMO-approach (ECMELLA). Typical thresholds for transfusion or administration of blood products without acute bleeding as indication vary substantially and are frequently not predefined. Following acute coronary syndrome without percutaneous coronary intervention (PCI), 54.0% and 42.7% administered dual antiplatelet therapy during Impella and V-A ECMO support, increasing to 93.7% and 84.0% after PCI. Conclusions Our survey validated the considerable variation in antithrombotic management in adults in CS on pMCS across European centres. There is a pressing demand for a standardized approach to antithrombotic management in this context to mitigate the impact of coagulopathic complications and, consequently, enhance outcomes.Figure 1.Figure 2.

Health literacy in pregnant women facing prenatal screening: a short report from “SaperePer” project

Abstract Advancements in health promotion and prenatal medicine have made noninvasive prenatal testing (NIPT) a common practice during pregnancy, but understanding prenatal health information becomes crucial not only for the well-being of the mother but also for that of the unborn child. Analyze health-related information during pregnancy is fundamental, and this work fits perfectly with this topic, reporting preliminary results from the pilot study “SaperePer”. A health-related questionnaire was administered to 358 women in the first trimester of pregnancy, aiming to study different outcomes: 1.level of knowledge of NIPT; 2.number of screening tests undergone; 3.willingness to undergo a diagnostic test with a high outcome risk of screening test; 4.willingness to end the pregnancy following a diagnosis of pathology. The questionnaire was divided into 3 sections: personal characteristics and lifestyle habits, prenatal health behavior scale (PHBS), and knowledge of NIPT. Preliminary results showed that the level of knowledge of NIPT was higher in older, atheist, working, wealthy highly educated, and preliminary informed women, as well as the higher number of screening tests undergone and the propensity to undergo an invasive diagnostic test after a high-risk screening result (KS and MW tests p < 0.05). On the contrary, women with lower education, faithful and, even more, not preliminary and appropriately informed during prenatal counseling showed lower knowledge of NIPT, lower number of tests undergone, and meager chances to undergo an invasive diagnostic test or to end the pregnancy after a positive diagnosis of pathology (KS and MW tests p < 0.05). In conclusion, this study evaluated health-related information during the first but crucial stages of pregnancy, opening a new understanding of how health literacy and correct prenatal counseling could increase awareness and health promotion in pregnant women, particularly in those women with lower cultural tools. Key messages • Health literacy and correct prenatal counseling could increase awareness and health promotion in pregnant women. • Understanding prenatal health information becomes crucial both for maternal and prenatal well-being.

Infant feeding and treatment practices could lead to enhanced transmission of Kaposi’s sarcoma-associated herpesvirus (KSHV) and other orally shed infections via saliva, in rural south-western Uganda

ABSTRACT This qualitative sub-study investigated household practices affecting orally shed infections using Kaposi’s sarcoma-associated herpesvirus (KSHV) as a focus. Participants enrolled from 50 households in rural south-western Uganda were followed monthly up to three times. At enrolment, in-depth interviews were completed, and venous blood collected. KSHV seropositivity was defined as anti-KSHV antibody detection to any of 25 antigens by multiplex bead-based assay. Mouthwash samples from every visit were tested by qPCR and KSHV shedders defined as individuals with KSHV DNA detected. At least one KSHV seropositive person was in 48/49(98%) households. Among those, 79% had 1+ KSHV shedders including 45% with 1+ always shedders and 92% with 1+ intermittent shedders, not mutually exclusively. All respondents reported feeding infants with pre-masticated hard food/fruits and testing food/tea temperature. Temperature was tested by tasting, pouring tea on their hand, or touching the cup to their cheek. Some cooled food/tea using a utensil or blowing over it. Food sharing amongst children and adults and using the same dish was common practice. To treat colic pain, carers/mothers reported chewing herbs and spitting into the child’s mouth. Feeding and treatment practices did not vary by KSHV status. We identified potential KSHV transmission modes in rural Ugandan households.

Trans-10 shifted ruminal biohydrogenation and its implications for ruminant milk and meat fat content and quality

Feeding high-grain diets is a common practice in intensive ruminant production systems to meet animal energy requirements and maximize feed efficiency. One of the consequences of these diets is trans (t)10 shifted ruminal biohydrogenation, which includes increased formation of t10-18:1 and t10,cis (c)12-conjugated linoleic acid (t10,c12-CLA) at the expense of t11-18:1 and c9,t11-CLA. In dairy cows, the t10 shift has been associated with milk fat depression. In beef cattle, the t10 shift has not been associated with negative effects on animal performance or marbling fat deposition, however, it may negatively impact meat fat eating quality by decreasing its cis monounsaturated fatty acid to saturated fatty acid ratio. Finally, the t10 shift increases t10-18:1 accumulation in ruminant-derived foods (dairy, beef and lamb) which at high enough levels may compromise the nutritional quality of these foods. The present review will cover our current understanding of the rumen microbes involved in the t10 shift and its implications for milk fat synthesis and beef fat quality.

What Is Known About Curriculum Modifications? A Scoping Literature Review

Modifying the curriculum is a common practice used to support students with individual education plans (IEPs). All 13 provinces and territories in Canada (and their associated federally run schools) permit the use of curriculum modifications yet, despite their frequent use, the efficacy of this long-standing practice has rarely been studied. This scoping literature review maps what is currently known about curriculum modifications. Findings reveal two significant issues with the terminology used in the existing literature—inconsistent use of terms and conflation of terms. Additionally, the limited research available reports that while some students identified as having intellectual disability may benefit from modified curricula in certain contexts, other groups of students may experience harm. These findings lay a foundation for future research on curriculum modifications, an area that warrants urgent attention from the anti-oppression movement within special education.

A standards-based software tool to support prognostic modelling: application to exemplar heart failure risk scores

Abstract Introduction Heart failure prognosis is an active research area, with the development of several new risk scores each year. While risk score derivation and evaluation have become common practices, these processes currently lack standardisation. Purpose We aimed to: i) develop a standards-based software tool to support prognostic modelling; and ii) apply the tool to derive, evaluate and compare exemplar heart failure risk models to address a hypothetical question of whether using only non-invasive measurements provides similar prognosis value compared to adding invasive measurements. Methods A software tool was developed based on a prognostic modelling workflow defined using the Common Workflow Language and containing 7 steps: univariate Cox proportional hazard (PH) regression, multivariable Cox PH regression with assessment of proportional hazards and linearity with outcome (Schoenfeld and Martingale residuals), derivation of points per risk factor, risk calculation and stratification, discrimination and calibration assessment. Using data from the PEOPLE heart failure cohort [1], two integer-based risk scores were developed to predict 2-year all-cause mortality. The first model utilised 12 variables available at recruitment informed by prior analysis of the PEOPLE cohort to provide a benchmark for comparison, while the second model is based on 9 non-invasive parameters. The analysis was conducted on cases with complete data (n=781), with no internal or external validation. Results By inputting the dataset and indicating the variables of interest for each model, our software tool automatically generated the patient-specific risk scores, risk strata, c-index, and discrimination and calibration plots. A 12-parameter model based on age, sex, ejection fraction, hypertension, diabetes, atrial fibrillation, ischaemic history, NYHA class, heart rate, systolic blood pressure, creatinine and NT-proBNP yielded reasonable discrimination (c-index=0.77). Graphical assessment of risk strata and calibration (Fig. 1.a and c) revealed good performance overall, apart from the highest risk decile where survival was overestimated. The reduced 9-parameter model excluded creatinine, NT-proBNP, and automatically dropped diabetes status for non-linearity. It showed a substantial drop in discrimination (c-index=0.67), confirmed in graphical assessment of risk strata (Fig. 1.b). Calibration was more variable per decile than seen with the 12-parameter model but was more robust to survival overestimation (Fig. 1.d). Conclusion Our software tool ensures the uniformity and comparability of the two risk models derived by a common statistical process. In this example, we showed how the addition of NT-proBNP, creatinine, and diabetes status improves discrimination for predicting heart failure survival. This tool can be leveraged to test new hypotheses in a standardised and reproducible manner to enhance research in heart failure prognosis.

Insulin Stabilization Designs for Enhanced Therapeutic Efficacy and Accessibility.

ConspectusInsulin has remained indispensable in the treatment of diabetes since it was first discovered in 1921. Unlike small molecular drugs, insulin and other protein drugs are prone to degradation when exposed to elevated temperatures, mechanical agitation during transportation, and prolonged storage periods. Therefore, strict cold-chain management is crucial for the insulin supply, requiring significant resources, which can limit the access to insulin, particularly in low-income areas. Moreover, although insulin formulations have advanced tremendously in the last century, insulin treatment still imposes a challenging regimen and provides suboptimal outcomes for the majority of patients. There is an increasing focus on pursuing improved pharmacology, specifically on safer, more user-friendly insulin therapies that minimize the self-management burden. These challenges underscore the need for developing novel insulin formulations with improved stability that are compatible with advanced insulin therapy.Insulin stabilization can be achieved through either chemical modification of insulin or formulation component design. Inspired by insulin-like peptides from invertebrates, we have developed novel stable insulin analogs based on a fundamental understanding of the insulin receptor engagement for insulin bioactivity. We created a novel four-disulfide insulin analog with high aggregation stability and potency by introducing a fourth disulfide bond between a C-terminal extended insulin A-chain and residues near the C-terminus of the B-chain. In an effort to stabilize insulin in its monomeric state to develop ultrafast-acting insulin with rapid absorption upon injection, we have developed a series of structurally miniaturized yet fully active insulin analogs that do not form dimers due to the lack of the canonical B-chain C-terminal octapeptide. Additionally, our study provided strategies for expanding the scope of cucurbit[7]uril (CB[7])-assisted insulin stabilization by engineering safe and biodegradable CB[7]-zwitterionic polypeptide excipients. We also explored insulin N-terminal substitution methods to achieve pH-dependent insulin stabilization without prolonging the duration of action.This Account describes our exploration of engineering stable insulin analogs and formulation design strategies for stabilizing insulin in aqueous solutions. Beyond conventional stabilization strategies for insulin injections, the unmet challenges and recent innovations in insulin stabilization are discussed, addressing the growing demand for alternative, less invasive routes of insulin administration. Additionally, we aim to provide a thorough overview of insulin stabilization from the perspective of commercially available insulin drugs and common pharmaceutical engineering practices in the industry. We also highlight unresolved insulin stabilization challenges and ongoing research strategies. We anticipate that further emphasis on collective efforts of protein engineering, pharmaceutical formulation design, and drug delivery will inform the development of stable and advanced insulin therapy.

Correcting for Replicated Genotypes May Introduce More Problems Than it Solves.

Across the tree of life, many organisms are able to reproduce clonally, via vegetative spread, budding or parthenogenesis. In population genetic analyses of clonally reproducing organisms, it is common practice to retain only a single representative per multilocus genotype. Though this practice of clone correction is widespread, the theoretical justification behind it has been very little studied. Here, I use individual-based simulations to study the effect of clone correction on the estimation of the genetic summary statistics HO, HS, FIS, FST, F''ST and Dest. The simulations follow the standard finite island model, consisting of a set of populations connected by gene flow, but with a variable rate of sexual versus asexual reproduction. The results of the simulations show that by itself, the inclusion of replicated genotypes does not lead to a deviation in the values of the summary statistics, except when the rate of sexual reproduction is less than about one in thousand. However, clone correction can introduce a strong deviation in the values of most of the statistics, when compared to a scenario of full sexual reproduction. For HS and FIS, this deviation can be informative about the process of asexual reproduction, but for FST, F''ST and Dest, clone correction can lead to incorrect conclusions. I therefore argue that clone correction is not strictly necessary, but can in some cases be insightful. However, when clone correction is applied, it is imperative that results for both the corrected and uncorrected data are presented.

Primary care nurses’ readiness to promote digital health technology use among patients

Abstract Background Digital health technologies (DHTs) aim to optimise resource allocation and improve public health outcomes as care supplements. However, many patients do not access them independently. Nurses, as central contacts for primary care patients, can integrate digital health assessments, patient portals, remote monitoring, and teleconsultations into practice. Insight into their readiness to promote patients’ use of DHTs is important for efficient dissemination strategies. We examined nurses’ referral of patients to use DHTs and whether digital dedication (enthusiasm, inspiration, and pride for DHTs) and service guidance skills were associated with referral behaviour. Methods In spring 2023, the national ‘2023 survey on information systems for registered nurses’ gathered data from 549 nurses in Finnish primary care, comprising registered nurses (62%) and public health nurses (38%). The outcome, frequency of nurses’ DHT referrals, was assessed on a scale ranging from never to daily. We used multivariable ordinal logistic regression to examine associations, adjusted for career length, unit, and location. Results Among the nurses, 31% never or seldom referred patients to DHTs, while 19% did so monthly, 32% weekly, and 18% daily. Multivariable model showed that with each one-point increase in digital dedication (scale 1-5), the odds of referring patients to DHTs more frequently increased by 43% (OR = 1.43, 95% CI 1.21-1.70). Nurses who rated their service guidance skills as good (OR = 1.76, 1.01-3.05) or excellent (OR = 2.89, 1.28-6.62) had greater odds of referring patients to DHTs more frequently compared to those with less advanced skills. Conclusions Referring patients to DHTs is not a common practice for primary care nurses and can undermine care equity. Nurses’ motivation and knowledge about DHTs should be fostered, which may enhance patient referrals. Developing guidelines to assess patients’ digital capability and needs for effective service coordination is paramount. Key messages • Digitally committed and service-aware primary care nurses may refer patients to use DHTs more often than their peers, but we could not consider if suitable DHTs were available for patients encountered. • Nurses should be motivated to use digital tools and provided with instructions for proficiently coordinating services in order to address patients’ underutilisation of DHTs and promote equitable care.

Making health information understandable: the COVID-19 patient guideline

Abstract Issue Evidence-based practice guidelines offer a reliable source of information, providing recommendations based on the most recent evidence. However, these guidelines are complex and difficult to understand for laypersons. This creates a knowledge gap, affecting shared-decision making, treatment acceptance, understanding of a disease and recommendations of disease prevention. Description of the problem Patient guidelines (PatG) aim to bridge this knowledge-gap by providing simplified versions of practice guidelines in lay language. This is a common practice internationally. An example is the German evidence-based COVID-19 practice guideline, published in 01/2024. In March, a multidisciplinary team, including a patient representative, created and reviewed a PatG outline, prioritising topics based on patient relevance, and discussed relevant information. The authors translated guideline recommendations into lay language, researched additional information, and created supporting graphics. A methodology chapter explaining both guidelines and a short medical term dictionary were also included. Results In 05/2024, the COVID-19 PatG, around 70 pages long, was finalized including information on treatment, diagnostics, intensive care, and support resources. A feedback round was initiated. Comments will be incorporated for the final version to be published in the national guideline registry by end of 05/2024. Updates of the PatG and practice guidelines will occur frequently. Lessons We faced challenges in simplifying medical concepts and interventions and accurately translating recommendations without losing key information. The length of the PatG may discourage readers. Despite these challenges, we are committed to enhancing accessibility, using simpler language, and adding supporting graphics to improve the PatG in the future. Key messages • Despite some challenges, patient guidelines pose as a reliable form of patient information. • The COVID-19 patient guideline is a reliable and evidence-based source of information.

Effects of Stumping and Meteorological Factors on Sap Flow Characteristics of Haloxylon ammodendron in Ulan Buh Desert, Northwestern China

The shrub/dwarf tree Haloxylon ammodendron is a prevalent woody plant used to combat desertification in the arid and semi-arid regions of northwestern China. Despite its drought resistance, artificial stands of this species experience significant degradation approximately ten years post-afforestation. Stumping, which involves cutting a portion of the above-ground part of shrubs/trees, is a common practice aimed at reducing water consumption and enhancing the growth of these stands. However, the impact of stumping on the sap flow of H. ammodendron remain inadequately understood, posing challenges to the sustainable management of these artificial stands. In this study, we monitored the sap flow of H. ammodendron subjected to various stumping treatments in the Ulan Buh Desert using the PS-TDP8 tree sap flow monitoring system. Concurrently, we measured several meteorological factors with an automatic weather station. We examined the changes in sap flow velocity following stumping and its response to meteorological factors to elucidate water use during growth. Our findings indicate that both the change in sap flow velocity and characteristics were closely associated with the degree of stumping. The initiation time of sap flow for H. ammodendron under different stumping treatments was earlier than that of the control group. The daily mean value and daily accumulation of sap flow followed the order: 50% stumping > control (no stumping) > 75% stumping > 100% stumping. Sap flow velocity and daily sap flow accumulation increased at 50% stumping but decreased at 75% and 100% stumping. Stumping altered the relationships between sap flow velocity and meteorological factors, with the correlation coefficient between these variables decreasing as the degree of stumping increased. The sap flow following stumping was primarily influenced by both the degree of stumping and meteorological factors. These results may contribute to a better understanding of water transport during the growth of H. ammodendron following stumping.

Trends in Prescribing Systemic Antibiotics by Libyan Dentists and Periodontists

Antibiotic prescription is a common practice in everyday dentistry. Although antibiotics play a crucial role in managing periodontal disease, the threat of antibiotic resistance is an issue that requires more exploration. The aim of this study was to describe the patterns of prescribing systemic antibiotics treating periodontal and peri-implant diseases among Libyan dentists and periodontists. An online cross-sectional survey was designed to investigate the patterns and perspectives of antibiotic prescription. Indication parameters and timing of prescription that were analysed included: chronic gingivitis, chronic periodontitis, aggressive periodontitis, acute gingival and periodontal conditions, periodontal surgery, implant placement surgery, peri-implantitis treatment, and antibiotic prophylaxis for infective endocarditis. Out of the 3000 registered Libyan dentists, only 181 participated in the study. Systemic antibiotic prescription patterns varied markedly for different periodontal or peri-implant diseases among respondents. 72.29% of the respondents reported prescribing systemic antibiotics for the treatment of aggressive periodontitis, while 34.93% prescribed them for chronic periodontitis, 10.24% for chronic gingivitis, 71.15% for periodontal surgery, 64.64% for implant placement surgery, and 67.95% for peri-implanttitis treatment. The most commonly prescribed systemic antibiotics were amoxicillin, the combination of amoxicillin with metronidazole, and clavulanate potassium. This study revealed a high prevalence of overuse and misuse of systemic antibiotics in dental practice. Furthermore, it emphasizes the necessity of improving antimicrobial resistance awareness among Libyan dentists and incorporating antimicrobial stewardship.

Perceptions of nursing graduates regarding artificial intelligence interviews: A Q-methodology study

Background & Aim: The integration of Artificial Intelligence (AI) in recruitment processes is increasingly prevalent, particularly within medical institutions. AI interviews are becoming a common practice, and their impact on the perceptions and experiences of candidates is a subject of growing interest. Nursing graduates, who are often at the forefront of medical practice, frequently encounter these AI-driven evaluations during their job searches. This study attempted to examine the perception of AI interviews among nursing graduates who have experienced AI interviews in medical institutions. Methods & Materials: The Q-methodology was applied by selecting 34 Q samples from the 102 concourses extracted through a literature review and in-depth clinical interviews with nursing graduates. The P sample consisted of 35 nursing graduates who had experienced AI interviews. Data were collected using the PQ Method's Q-methodology program, measured on a 9-point scale frame, and Q samples were normally distributed. Results: The study identified four factors of perception: Proactive AI Interview Preparation, Negative Perception of AI Interviews, Positive Perception of AI Interviews, and Critical Acceptance of AI Interviews. Conclusion: In conclusion, perceptions of AI interviews can be categorized into four main types, highlighting both the positive and negative aspects of this technology. The positive aspects include efficiency, fairness, and convenience, while the negative aspects involve concerns about privacy, bias, and the lack of human elements. To design AI interview programs tailored to specific job roles, it is crucial to balance these pros and cons. Additionally, reducing the burden of AI interviews through informative resources and pre-training programs is essential. For successful implementation, ongoing improvements, transparency, and a balanced integration of human judgment are necessary.

Shadowplay: Journeys to Our Abandoned Selves

Role-playing is a common practice within the bounds of kink, fetish, and/or BDSM erotic encounters. The application of Jungian Shadow concept to the erotic or SM role-play practices is explored in this article, which is an update to the author’s 2007 chapter Shadowplay: SM journeys into ourselves. Areas such as past trauma, cultural trauma, issues around gender and power, and therapeutic aspects of engaging in role-play in the context of BDSM encounters are explored.

Successful management of anaphylactic shock prior to elective cesarean delivery: a case report

BackgroundAnaphylactic cardiovascular collapse is complicated by aortocaval compression during pregnancy, exacerbated by neuraxial anesthesia. Despite recommendations to administer perioperative antibiotics before anesthesia, common practice in Japan involves administering them after anesthesia induction. We report a case of possible antibiotics-induced anaphylaxis just before anesthesia for cesarean delivery.Case presentationA 24-year-old woman at 37 weeks of gestation presented for a scheduled repeat cesarean under spinal anesthesia. After starting administration of cefazolin prior to anesthesia, she developed anaphylactic symptoms. Hypotension refractory to adrenaline necessitated conversion to an emergency cesarean section under general anesthesia. A neonate was delivered with favorable Apgar scores. Post-delivery, the mother’s hemodynamics stabilized significantly. Elevated plasma tryptase confirmed anaphylaxis. Both mother and infant were discharged without further complications.ConclusionsThis case emphasizes the importance of administering prophylactic antibiotic before anesthesia in mitigating severity of shock induced by anaphylaxis and the crucial role of prompt emergency cesarean in achieving successful outcomes.

The Study Peculiarities of Market Valuation of Wheeled Vehicles in Operation

The article critically examines the common practice of wheeled vehicles valuation and substantiates complex forensic approaches and methods for determining their market value. Specific aspects of using a comparative approach to the valuation of wheeled vehicles are discussed, and the procedure for the calculation is substantiated.Basic framework of vehicles average price calculation reviewed in the article can be used in the set of forensic vehicle commodity examination methods, which are now under development.

Testing for genetic and viral etiologies in congenital hearing loss based on a survey of cochlear implant centers: proposed HEARRING group consensus and future directions

Background In cases of congenital sensorineural hearing loss, testing for genetic etiologies and congenital cytomegalovirus (cCMV) infection have become common practice. Aims/Objectives The purpose of this study is to determine which specific testing methodologies should be used and when. Material and methods We surveyed 20 practicing otolaryngologists across eighteen institutions in thirteen countries about their approach to cCMV, GJB2, and wider genetic testing. Results We found 90% of respondents employ all three tests, either in routine or special cases. cCMV testing is widely used, with 95% of respondents incorporating it into their clinical practice. GJB2 testing was employed by 90%. In cases with negative GJB2 test results, a majority of respondents proceeded to wider genetic screening. Test reimbursement was also examined for each test. For cCMV testing, 63.1% reported reimbursement, 68.4% reported reimbursement for GJB2 variant testing and 52.6% reported reimbursement for wider genetic screening. Conclusions and significance A common approach is to perform cCMV and GJB2 testing as the first tests, followed by wider genetic testing. This study offers insight into the prevalence, methodologies, and reimbursement status of these testing methodologies across multiple hearing centers and countries. Current consensus and future directions are described based on the current survey.

Seasonal shifts in depth-to-water uptake by young thinned and overstocked lodgepole pine (Pinus contorta) forests under drought conditions in the Okanagan Valley, British Columbia, Canada

Abstract. As drought and prolonged water stress become more prevalent in dry regions under climate change, preserving water resources becomes a focal point for maintaining forest health. Forest regeneration after forest loss or disturbance can lead to overstocked juvenile stands with high water demands and low water-use efficiency. Forest thinning is a common practice with the goal of improving tree health, carbon storage, and water use while decreasing stand demands in arid and semi-arid regions. However, little is known about the impacts of stand density on seasonal variation in depth-to-water uptake or the magnitude of the effect of growing season drought conditions on water availability. Existing reports are highly variable by climatic region, species, and thinning intensity. In this study, stable isotope ratios of deuterium (δ2H) and oxygen (δ18O) in water collected from various soil depths and from branches of lodgepole pine (Pinus contorta) under different degrees of thinning (control: 27 000 stems per hectare; moderately thinned: 4500 stems per hectare; heavily thinned: 1100 stems per hectare) over the growing season were analyzed using the MixSIAR Bayesian mixing model to calculate the relative contributions of different water sources in the Okanagan Valley in the interior of British Columbia, Canada. We found that under drought conditions the lodgepole pine trees shifted their depth-to-water uptake through the growing season (June to October) to rely more heavily on older precipitation events that percolated through the soil profile when shallow soil water became less accessible. Decreased forest density subsequent to forest thinning did not cause a significant difference in the isotopic composition of branch water but did cause changes in the timing and relative proportion of water utilized from different depths. Thinned lodgepole pine stands were able to maintain water uptake from 35 cm below the soil profile, whereas the overstocked stands relied on a larger proportion of deep soil water and groundwater towards the end of the growing season. Our results support other findings by indicating that, although lodgepole pines are drought-tolerant and have dimorphic root systems, they do not shift back from deep water sources to shallow soil water when soil water availability increases following precipitation events at the end of the growing season.

Effect of Different Intensities of Leaf Removal on Tomato Development and Yield

Defoliation (leaf removal or pruning) is a common practice in tomato production that makes crops more manageable, prevents conditions conducive to fungal attack and increases the exposure of the fruit to light, especially in winter conditions. The intensity and frequency of leaf removal on commercial farms often vary according to workforce availability criteria, which makes it difficult to determine their effect on tomato crop yields. It would be reasonable to think that a reduction in leaf area influences radiation interception and, therefore, the production of assimilates and biomass. However, in intensive production systems with a high leaf area index (LAI), leaf pruning can increase radiation interception, either by reducing competition between productive and vegetative organs or by increasing radiation use efficiency. This study was therefore designed to assess the effect of different intensities and frequencies of basal leaf removal on dry matter production and partitioning between the different organs of the plant, and thus on tomato crop productivity. A series of trials were conducted over three consecutive seasons, with a trial conducted per season: (a) Trial 1: leaf removal control—LRC (with leaves removed from the base to two leaves below the truss close to harvest, T0) was compared with LR1 (leaf removal from the base to two leaves below the truss above T0, i.e., T1) and LR2 (two trusses above T0 (T2)); (b) Trial 2: LRC compared with LR2 and LR4 (four trusses above T0 (T4)), carried out at two frequencies; and (c) Trial 3: LRC compared with an intense leaf removal treatment (LRI) whereby between 10 and 12 leaves were left on each stem. LAI saturation values under our conditions were found to be around 2.0. No significant differences in yield were found between the control and treatments LR1, LR2 and LR4, with a reduction in the number of leaves of up to 35% and LAI values during harvest above 2.0. The intense leaf removal treatment (LRI), which reduced the number of leaves by 47% and the LAI value from 2.8 to 1.5 compared to the control, resulted in a 15% reduction in dry biomass and a 17% decrease in fruit yield.

Machine Learning Approach for Rock Mass Classification with Imbalanced Database of TBM Tunnelling in Himalayan Geology

AbstractThe geological condition of the Himalayan region is very complex and challenging. So far, empirical and analytical approaches for rock mass characterization have been a common practice in the Himalayas. Due to the limitations of input parameters and governing equations in design practices, rock mass characterization in tunnel boring machine (TBM) excavated tunnels is crucial. This research introduces robust machine learning (ML) approaches to predict rock mass quality conditions in complex geological environments, leveraging a large database of TBM parameters and rock mass rating (RMR) values. To do so, a total of 6879 stable phase TBM cycle data were collected from 12 km long tunnel in Nepal. The pre-processed parameters were randomly split into a training set (80%) and a testing set (20%). Seven individual classifiers consisting of logistic regression (LR), support vector machine (SVM), decision tree (DT), random forest (RF), k-nearest neighbor (KNN), extreme gradient boosting (XGBoost), and bagging, and stacking ensemble classifier were exploited with optimal hyperparameters. The comprehensive assessment carried out has shown that the ensemble classifier gave highest overall accuracy as compared to other individual classifiers. More importantly, the synthetic minority over-sampling technique (SMOTE) performs better to handle the imbalanced database, while the RF and stacking classifier demonstrated the best prediction performance with accuracy of 92%. Moreover, for the minority rock mass class, the RF shows better performance compared to stacking classifier. The authors emphasize that the effective application of ML-based data-driven approach shows substantial potential for rock mass characterization in TBM tunnelling.