Standard Target Research Articles

Intravenous fluid therapy: an audit and discussion of improvements required for prescribers and administrators.

Foundation doctors and nurses are the clinicians most closely involved in fluid assessment, intravenous (IV) fluid prescription and administration. However, both groups report challenges regarding IV fluids. At a large NHS trust in England, adherence to the National Institute for Health and Care Excellence (NICE) guideline CG174, regarding IV fluids, was largely unknown. To assess the baseline adherence, within the hospitals, to CG174 and identify areas for improvement. A set of 12 audit standards were developed and used to collect data across 29 clinical areas between September 2022 and May 2023, with 255 patients receiving IV fluids at any time during their inpatient stay included. For two standards target adherence of 95% was achieved, with an adherence less than 50% in most. Areas of particularly poor adherence included assessing and meeting fluid and electrolyte requirements, patient reassessment and developing IV fluid management plans. Trust baseline adherence to NICE CG174 requires improvement, particularly regarding patient assessment and reassessment, and meeting electrolyte requirements.

IMPLEMENTASI KEBIJAKAN STANDAR PELAYANAN MINIMAL (SPM) PADA PELAYANAN KESEHATAN DIABETES MELLITUS (DM) DI PUSKESMAS BIROBULI

. This research aims to describe and explain the implementation of the SPM policy in Diabetes Mellitus (DM) health services at the Birobuli Community Health Center. This research method is a qualitative descriptive research method and data collection techniques are by means of observation, interviews and documentation. This research was conducted at the Birobuli Community Health Center using a purposive selection and selection technique for informants as many as 6 (six) people. This research uses aspects used by Donald Van Meter and Carl Van Horn, namely: 1. Policy Standards and Targets 2. Resources 3. Characteristics of Implementing Organizations 4. Communication between Implementing Organizations 5. Attitudes of Implementers 6. Social, Economic and Environmental Environments Political. Based on the results of research and discussion, standard variables and SPM policy targets for DM sufferers at the Bureaubuli Community Health Center still reached 80.13%, this figure has not yet reached the target set in Minister of Health Regulation No. 4 of 2019 because it is still hampered by the stages of data collection activities and early detection of DM sufferers. . Resource variables that do not fully support the implementation of the Diabetes Mellitus Health SPM at the Bureaubuli Community Health Center are also a factor in achieving the Health SPM target that has not reached 100%, such as human, financial and infrastructure resources that are still insufficient. The variable characteristics of implementing agents are related to the bureaucratic structure, norms and relationship patterns that are formed between policy implementers and have run well and in accordance with SOPs. Communication variables between implementers in implementing SPM policies for diabetes mellitus sufferers do not experience obstacles. The communication variable between implementers at the community health center is carried out directly because they are still in the same work area, while communication with implementers in the community is also carried out well and is supported by the use of online communication. The attitude/tendency variable of policy implementers such as the Health Service and the Bureaubuli Community Health Center gave a good response with the existence of a clear policy governing how to implement Diabetes Mellitus services in accordance with SPM Health standards. Economic, social and political environmental variables still have obstacles regarding all funding for SPM which must be accommodated with SPM. This means that in planning the Palu City regional budget, the SPM must be taken into account first in the budget planning. Apart from that, the economic capacity of the people of Palu City is also a supporting factor in the success of the Diabetes Mellitus Health SPM. Apart from that, political support is still lacking in perceived benefits in supporting DM health services that are in accordance with the SPM. The general conclusion is that the implementation of the Minimum Service Standards (SPM) policy in the Diabetes Mellitus (DM) Health Service at the Birobuli Health Center has not gone well.

A Robustness Study on Early Fire Image Recognitions

With the advancement of society and the rapid urbanization process, there is an escalating need for effective fire detection systems. This study endeavors to bolster the efficacy and dependability of fire detection systems in intricate settings by refining the existing You Only Look Once version 5 (YOLOv5) algorithm and introducing algorithms grounded on fire characteristics. Primarily, the Convolutional Block Attention Module (CBAM) attention mechanism is introduced to steer the model towards substantial features, thereby amplifying detection precision. Subsequently, a multi-scale feature fusion network, employing the Adaptive Spatial Feature Fusion Module (ASFF), is embraced to proficiently amalgamate feature information from various scales, thereby enhancing the model’s comprehension of image content and subsequently fortifying detection resilience. Moreover, refining the loss function and integrating a larger detection head further fortify the model’s capability to discern diminutive targets. Experimental findings illustrate that the refined YOLOv5 algorithm attains accuracy advancements of 8% and 8.2% on standard and small target datasets, respectively. To ascertain the practical viability of the refined YOLOv5 algorithm, this study introduces a temperature-based flame detection algorithm. By amalgamating and deploying both algorithms, the ultimate experimental outcomes reveal that the integrated algorithm not only elevates accuracy but also achieves a frame rate of 57 frames, aligning with the prerequisites for practical deployment.

Optimization of CNC milling parameters using the response surface method for aluminum 6061

The manufacturing sector is constantly seeking ways to optimize the machining process, specifically for 3-axis CNC machines. This study aims to identify the optimal parameter values that result in the lowest roughness and the highest process capability in 3-axis CNC milling. The roughness level (Ra) of the product is primarily influenced by factors such as feed rate, spindle speed, and depth of cut. Additionally, the reliability of the machining process was analyzed to evaluate its ability to consistently achieve low roughness values and to validate the process capability of the VH850L3 series 3-axis CNC milling machine. The suggested approach for this analysis was the RSM central composite design method, which involved conducting experiments under various input conditions. The results indicated that the feed rate had the most significant impact on roughness, followed by the spindle speed, while the depth of cut had no effect. The parameters that resulted in the lowest roughness response were a spindle speed of 2589.76 rpm, a depth of cut of 0.159 mm, and a feed rate of 247.731 mm/min. These parameter values were tested on a 3-axis CNC machine, and the resulting data exhibited variations. Data processing revealed that the machine still performed optimally in the machining process, as indicated by the value of . However, the milling process deviates from the standard target, as the response value shows significant variation with a Cpk value 1.

Performances of Large Language Models in Detecting Psychiatric Diagnoses from Chinese Electronic Medical Records: Comparisons between GPT-3.5, GPT-4, and GPT-4o

Objectives: As a type of artificial intelligence (AI), the large language model (LLM) is designed to understand and generate human-like fluent texts. Typical LLMs, e.g., GPT-3.5, GPT-4, and GPT-4o, interact with users through “prompts” and some internal parameters, like “temperature.” Currently, some AI models have been widely used in the field of psychiatry, but systemic reports examining the capacity and suitability of LLM in detecting psychiatry diagnoses are still lacking. In this study, we intended to explore the performances of different generations of LLMs with different levels of temperature in detecting mental illnesses from electronic medical records (EMRs). Methods: We collected 500 Chinese EMRs from one mental hospital in northern Taiwan, with the “current medical history” section as corpuses. We used the GPT-3.5-turbo-16K, GPT-4, and GPT-4o models provided by Microsoft’s Azure OpenAI service (www.portal.azure.com) to generate AI-based predictions (the probability) for the diagnoses of major depressive disorder (MDD), schizophrenia (SCZ), attention-deficit/hyperactivity disorder (ADHD), and autistic spectrum disorder (ASD). Clinic diagnoses made by qualified psychiatrists were treated as gold standards (target) of receiver operating characteristic curve analysis. Then, their area under the ROC curve (AUCs) were compared using the DeLong test. Results: Among 500 recruited Chinese EMRs in this study, 56.6% were primarily diagnosed with MDD, as well as 22.4% with SCZ, 11.2% with ADHD, and 9.2% with ASD. In general, our LLMs achieved AUCs of 0.84 to 0.98 for detecting four different diagnoses. There were no significant differences between versions, but newer versions (GPT-4o models with AUCs of 0.98–0.97 for SCZ, ADHD, and ASD) performed better than older versions (GPT-3.5 models with AUCs of 0.88–0.96) except for MDD (AUC of 0.95 for GPT-4 and AUC of 0.93 for GPT-4o). Although DeLong tests showed nonsignificant differences between the AUCs of models with different levels of temperature, models with zero temperatures generally represented the best performances in magnitudes. Conclusion: To the best of our knowledge, this study is the first to demonstrate that LLMs performed excellently in distinguishing some mental illnesses. Nevertheless, the diagnostic capabilities of LLMs differed from other diagnoses such as MDD. We hypothesize that this phenomenon may partially result from the complexity of symptomology and/or the content filtering rules of OpenAI. Therefore, more advanced models, e.g., GPT-5, or private training models, e.g., Llamma 3, with the relevance generative answering technique, are expected to answer our questions.

Policy Evaluation Of Minimum Service Standards For Hypertension Health Services At Mabelopura Health Center

Hypertension is a chronic medical condition in which arterial blood pressure increases, causing the heart to work harder. At Puskesmas Mabelopura, hypertension has not yet reached the Minimum Service Standard (MSS) target with an achievement of only 68.61% of the 95% target. This study evaluated the SPM policy on hypertension services at the Mabelopura Health Center using a descriptive qualitative method with informants from Key Informants and Triangulated Informants. The results showed that the implementation of SPM Hypertension only reached 68.61% of the 95% target, indicating that the target has not been achieved. Health services are in accordance with SPM standards but not optimal, due to differences in central target data with Puskesmas data and limited human resources. The low number of community visits for hypertension screening, due to the community's lack of perceived importance of routine control, was also a major factor. This study concluded that to achieve SPM targets, intensive efforts are needed from Puskesmas Mabelopura and the Health Office of Palu City to establish better communication with Pusdasten and increase community awareness of the importance of routine check-ups. Thus, it is expected that Puskesmas Mabelopura can be more effective in achieving SPM targets and improving the quality of life of people with hypertension in the area.

Leukemic Stem Cells and Hematological Malignancies.

The association between leukemic stem cells (LSCs) and leukemia development has been widely established in the context of genetic alterations, epigenetic pathways, and signaling pathway regulation. Hematopoietic stem cells are at the top of the bone marrow hierarchy and can self-renew and progressively generate blood and immune cells. The microenvironment, niche cells, and complex signaling pathways that regulate them acquire genetic mutations and epigenetic alterations due to aging, a chronic inflammatory environment, stress, and cancer, resulting in hematopoietic stem cell dysregulation and the production of abnormal blood and immune cells, leading to hematological malignancies and blood cancer. Cells that acquire these mutations grow at a faster rate than other cells and induce clone expansion. Excessive growth leads to the development of blood cancers. Standard therapy targets blast cells, which proliferate rapidly; however, LSCs that can induce disease recurrence remain after treatment, leading to recurrence and poor prognosis. To overcome these limitations, researchers have focused on the characteristics and signaling systems of LSCs and therapies that target them to block LSCs. This review aims to provide a comprehensive understanding of the types of hematopoietic malignancies, the characteristics of leukemic stem cells that cause them, the mechanisms by which these cells acquire chemotherapy resistance, and the therapies targeting these mechanisms.

Preliminary result of combined treatment with scanning carbon-ion radiotherapy and image-guided brachytherapy for locally advanced cervical adenocarcinoma.

Although there is growing evidence of the efficacy of carbon-ion radiotherapy (CIRT) for locally advanced cervical adenocarcinoma, reports on combined treatment with CIRT and image-guided brachytherapy (IGBT) are scarce. We retrospectively analyzed patients with International Federation of Gynecology and Obstetrics (2008) stage II-IVA locally advanced cervical adenocarcinoma who received combined scanning CIRT (sCIRT) and IGBT between April 2019 and March 2022. sCIRT consisted of whole-pelvic irradiation with 36Gy (relative biological effectiveness [RBE]) in 12 fractions and subsequent local boost irradiation with 19.2Gy (RBE) in 4 fractions. Three sessions of IGBT were administered after completion of sCIRT. Concurrent chemotherapy using weekly cisplatin (40mg/m2/week) was also administered. Efficacy, toxicity and dose-volume parameters were analyzed. Fifteen patients were included in the analysis. The median follow-up period was 25months. The 2-year overall survival, progression-free survival and local control rates were 92.3% (95% confidence interval [CI] = 77.8-100%), 52.5% (95% CI = 26.9-78.1%) and 84.8% (95% CI = 65.2-100%), respectively. Neither severe acute toxicity necessitating treatment cessation nor grade 3 or higher late toxicity were observed. The sigmoid D2cm3 of the patient who developed grade 2 late sigmoid hemorrhage was 65.6Gy, which exceeded the standard deviation and target dose. The combination of sCIRT and IGBT for locally advanced cervical adenocarcinoma showed acceptable efficacy and safety. Further large-scale and long-term studies are warranted to confirm the efficacy and safety of this treatment.

Optimised production of technetium-94m for PET imaging by proton-irradiation of phosphomolybdic acid in cyclotron liquid target

Natural-abundance phosphomolybdic acid (H3(Mo12PO40) ‧12H2O, 0.181–0.552 g Mo/mL) solutions were irradiated with 12.9 MeV protons on a GE PETtrace cyclotron using an adapted standard liquid target. Technetium-94m (94mTc) was produced through the 94Mo(p,n)94mTc nuclear reaction with saturation yields of up to 53 ± 6 MBq/μA. End of bombardment activities of 161 ± 17 MBq and 157 ± 7 MBq were achieved for the 0.552 g Mo/mL solution (10 μA for 30 min) and 0.181 g Mo/mL solution (15 μA for 60 min), respectively. No visible degradation of the niobium target body and foil were seen during the irradiations of up to 15 μA for 60 min. The produced 94mTc was separated from the target phosphomolybdic acid solution with >98% recovery using an aqueous biphasic extraction resin. Compared to previous reported liquid target methods for 94mTc production, the better production yield, in-target solution stability during irradiation and 94mTc separation recovery of phosphomolybdic acid makes it a very promising target material for routine clinical 94mTc production at medical facilities with liquid targets already installed for 18F production.

Comparison of an Affibody-based Molecular Probe and 18F-FDG for Detecting HER2-Positive Breast Cancer at PET/CT.

Background Human epidermal growth factor receptor 2 (HER2) affibody-based tracers could be an alternative to nonspecific radiotracers for noninvasive detection of HER2 expression in breast cancer lesions at PET/CT. Purpose To compare an affibody-based tracer, Al18F-NOTA-HER2-BCH, and fluorine 18 (18F) fluorodeoxyglucose (FDG) for detecting HER2-positive breast cancer lesions on PET/CT images. Materials and Methods In this prospective study conducted from June 2020 to July 2023, participants with HER2-positive breast cancer underwent both Al18F-NOTA-HER2-BCH and 18F-FDG PET/CT. HER2 positivity was confirmed with pathologic assessment (immunohistochemistry test results of 3+, or 2+ followed by fluorescence in situ hybridization, indicated HER2 amplification). Two independent readers visually assessed the uptake of tracers on images. Lesion uptake was quantified using the maximum standardized uptake value (SUVmax) and target to background ratio (TBR) and compared using a general linear mixed model. Results A total of 42 participants (mean age, 56.3 years ± 10.1 [SD]; 41 female) with HER2-positive breast cancer were included; 42 (100%) had tumors that were detected with Al18F-NOTA-HER2-BCH PET/CT and 40 (95.2%) had tumors detected with 18F-FDG PET/CT. Primary tumors in two of 21 participants, lymph node metastases in four of 21 participants, bone metastases in four of 15 participants, and liver metastases in three of nine participants were visualized only with Al18F-NOTA-HER2-BCH. Lung metastasis in one of nine participants was visualized only with 18F-FDG. Al18F-NOTA-HER2-BCH enabled depiction of more suspected HER2-positive primary tumors (26 vs 21) and lymph node (170 vs 130), bone (92 vs 66), and liver (55 vs 27) metastases than 18F-FDG. The SUVmax and TBR values of primary tumors and lymph node, bone, and liver metastases were all higher on Al18F-NOTA-HER2-BCH images than on 18F-FDG images (median SUVmax range, 10.4-13.5 vs 3.4-6.2; P value range, <.001 to .02; median TBR range, 2.7-17.6 vs 1.2-7.8; P value range, <.001 to .001). No evidence of differences in the SUVmax and TBR for chest wall or lung metastases was observed between Al18F-NOTA-HER2-BCH and 18F-FDG (P value range, .06 to .53). Conclusion PET/CT with the affibody-based tracer Al18F-NOTA-HER2-BCH enabled detection of more primary lesions and lymph node, bone, and liver metastases than PET/CT using 18F-FDG. ClinicalTrials.gov Identifier: NCT04547309 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Ulaner in this issue.

Phytotoxicity of glycosylated flavonols extracted from Annona coriacea (Annonaceae) on germination and initial growth of standard target species and an invasive grass

Phytotoxicity of glycosylated flavonols extracted from Annona coriacea (Annonaceae) on germination and initial growth of standard target species and an invasive grass

Novel diamine-scaffold based N-acetylgalactosamine (GalNAc)-siRNA conjugate: synthesis and in vivo activities.

GalNAc-conjugated siRNA has shown remarkable potential in liver-targeted delivery in recent years. In general, tetrahydroxymethylmethane or other branching clusters constitute the basis of GalNAc's structure, which yields trivalent or tetravalent ligands. A novel diamine-scaffold GalNAc conjugate was synthesized and evaluated for its efficiency in siRNA administration. It exhibits comparable siRNA delivery effectiveness to a GalNAc NAG37 phase II clinical drug candidate targeting ANGPTL3. In addition, it exhibits more powerful silencing activity when connected to the 3'-end of the sense strand with an additional PS-linkage instead of a PO linkage between the ligand and the oligomer compared to a GalNAc L96 standard targeting TTR. Taken together, the incorporation of a diamine-scaffold into the GalNAc conjugate structure has potential in the field of gene therapy.

Next step towards point-of-care molecular diagnosis of female genital schistosomiasis (FGS): evaluation of an instrument-free LAMP procedure

Detection of Schistosoma spp. DNA in gynaecological samples by quantitative real-time polymerase chain reaction (qPCR) is considered to be the reference diagnostic test for female genital schistosomiasis (FGS). However, qPCR needs expensive laboratory procedures and highly trained technicians. Loop-mediated amplification (LAMP) is a more field-friendly isothermal procedure for the detection of parasite-specific DNA, but it still requires electrically powered equipment. Here, we validated a Schistosoma haematobium-specific Sh-LAMP procedure and tested a fully instrument-free isothermal amplification using a novel low-cost, and reusable Temperature-cup (T-cup) device. Specific primers were selected based on published assays, targeting the ribosomal intergenic spacer (IGS) region of S. haematobium. Technical validation of the IGS-Sh-LAMP was performed using 20 negative controls, including DNA extracts of soil-transmitted helminths and S. mansoni, and a 10-fold dilution series (100–10−3) of DNA extracted from a single S. haematobium egg (n=4). For clinical validation, the IGS-Sh-LAMP was tested on 125 DNA samples extracted from vaginal swabs of a previous FGS study in Madagascar. Results were compared with the quantification cycle value (Cq) of the standard ITS-2 targeting qPCR. Single S. haematobium egg DNA up to a 10–2 dilution and an ITS-2 Cq &amp;lt;35 tested positive in the IGS-Sh-LAMP. The specificity was found to be excellent (100%). In the clinical samples, IGS-Sh-LAMP showed comparable results with the qPCR, with 35.2% and 33.6% positives, respectively, and a concordance of 79.2% (99/125). Of the 12 false-negatives, 5 corresponded to the 7 qPCR positive samples with very low DNA levels (Cq ≥35). On the other hand, IGS-Sh-LAMP detected 14 additional cases that were not detected by qPCR. The T-cup IGS-Sh-LAMP performance was evaluated in a representative sub-selection (n=10) of IGS-Sh-LAMP positive clinical samples. The T-cup IGS-Sh-LAMP was found to be a very user-friendly method, but in different runs, it missed 1 to 4 of the 10 IGS-Sh-LAMP positive samples, specifically those with a low DNA load. Our results show that the IGS-Sh-LAMP is a suitable alternative to the ITS-2 qPCR for the diagnosis of FGS in gynaecological samples, with high potential for the T-cup as a fully instrument-free isothermal amplification device for point-of-care diagnosis in low-resource settings.

32. Comparative Analysis of Intensive vs Standard Blood Pressure Targets on Mortality and Vascular Events in Hypertensive Patients with a History of Stroke: A Meta-Analysis Study

32. Comparative Analysis of Intensive vs Standard Blood Pressure Targets on Mortality and Vascular Events in Hypertensive Patients with a History of Stroke: A Meta-Analysis Study

Selection of Optimum Ternary Binder Systems that Enhance the Workability and Durability of Concrete used in Marine Railways

In this study, the improvement of the compressive strength and duradbility of concrete used in marine railways by adding binding agents was investigated. The test speciments used in the study comprised developed product A (DP_A), developed product B (DP_B), Ordinary Portland Cement (OPC), admixture A, and admixture B, in the study, the optimum ternary binder systems of the test specimens were identified. An optimum ternary binder system would facilitate the simultaneous enhancement of the durability and workability of concrete used on undersea tunnel linings and bridge structures. The compressive strength of each specimen tested after 16h could easily meet the specified standard target strength (&gt; 3.0_MPa). Moreover, the 7d long term strength of each test specimen exceeded 3.0 MPa. When binders were used, the chloride penetration resistance (DP_A was exceptional)_2.741C (normal) and, 1.490C (low) following-28 and 91days. The surface diffustion coefficient of (DP_B) at 91days 9.12 (× 10-12, m&lt;sup&gt;2&lt;/sup&gt;/sec) was higher than that of OPC 9.55 (× 10-12, m&lt;sup&gt;2&lt;/sup&gt;/sec). However, the surface diffusion coefficient of (DP_A) was 4.15 (× 10-12, m&lt;sup&gt;2&lt;/sup&gt;/sec) which was lower than OPC by approximately 57%, indicating the outstanding durability of DP_A.

A Multi-Stage Approach to Assessing the Echo-Tech Feasibility of a Hybrid SAM-CREST Model for Solar PV Power Plants in Maryland, USA

Maryland is actively working towards doubling its Renewable Portfolio Standard (RPS) target, aiming to increase the share of renewable energy from 25% by 2020 to 50% by 2030. Furthermore, Maryland stands out as a state that strongly supports solar initiatives, offering incentives and specialized programs to assist residents in adopting solar energy solutions. The paper presents a multi-stage approach: Stage 1—Location Selection Process, Stage 2—Technical Feasibility Study, and Stage 3—Economical Feasibility Study. In Stage 1, the study focuses on three potential solar farm locations in Maryland: Westover, Princess Anne, and Eden. Stages 2 and 3 involve a feasibility assessment with detailed technical analysis using the NREL System Advisor Model (SAM) and PVWatts to determine monthly power to the grid and Energy Yield. Subsequently, economic feasibility is assessed using the NREL Clean Renewable Energy Estimation Simulation Tool (CREST), focusing on competitive levelized costs of energy (LCOE), payback time, and cumulative cash flows. Results indicate that all three locations exhibit promising solar irradiance levels, system outputs, and potential energy yields. Due to high solar irradiation, the Westover area has the highest energy yield at 1583.13 kWh/kW, while Princess Anne boasts the highest system output at 333.59 GWh. The economic evaluation suggests that all three locations become profitable within a two-year payback time, with competitive levelized costs of energy (LCOE). Westover emerges as the most cost-effective option at 5.99 cents/kWh, attributed to its higher solar irradiation values and energy yield compared to Princess Anne and Eden. Cumulative cash flows provide insights into long-term profitability, with Princess Anne, MD, having the highest Cumulative Cash Flow over 25 years at $183,383,304. By evaluating technical and economic aspects, this feasibility study offers quantitative insights to guide decision-making for the installation of Solar PV, considering both technological and economic feasibility.

Evaluation of alternate image capturing devices for recording fingermarks at crime scenes

ABSTRACT This project evaluated the fingermark imaging ability of several alternate image capturing devices selected for their potential to assist with the recording of fingermarks in difficult-to-reach locations commonly encountered at crime scenes, e.g. the inside surface of door handles. Four small form-factor non-DSLR camera systems — intraoral camera, borescope, fibre-optic camera and an iPhone — were evaluated under controlled conditions for their ability to image fingermarks with sufficient detail for identification. Evaluation was conducted using black powdered fingermarks and standard photographic test targets. A qualitative visual evaluation approach was also developed to gauge whether image quality was appropriate for fingermark identification. The results obtained indicated that most of the systems were capable of capturing fingermark details suitable for identification in controlled environments; however, the inherent contrast of the fingermark had an impact on the success of various imaging devices. The practicality and capability of alternate camera devices for fingermark recovery in pseudo-operational conditions is part of ongoing research.

Remote or in-clinic? The effect of service delivery mode on hearing aid output: study protocol for a double-blinded, randomised trial in adults with mild to moderate sensorineural hearing loss

BackgroundTeleaudiology can potentially improve access to hearing healthcare services. Remote hearing aid fittings offer a new mode of service delivery that removes barriers of geography and access to an audiologist. Real-ear measurements (REMs) are the gold standard for hearing aid output verification but require in-clinic appointments. This study will investigate whether remote hearing aid fittings can provide clinically equivalent outcomes when compared to current, in-clinic, best practice guidelines.Research designA repeated measure, double-blinded crossover design will be used. Participants will be randomly allocated to one of two groups to determine order of intervention, balanced for degree of hearing loss.Study sampleSixty adults with mild to moderate hearing loss and at least 1 year of experience with hearing aids will be recruited.Data collection and analysisParticipants will complete two hearing aid fitting protocols, one using an in-clinic fitting process and the other using a remote (at-home) fitting process. In-clinic fittings will include REMs with adjustments to standard (NAL-NL2) prescription targets. The two fitting protocols will then be randomly assigned to participants in a crossover design, so participants and researchers will be blinded to the order of the two fitting protocols. Participants will then have a 4-week period with follow-up appointments for participant-directed gain adjustment. For each fitting protocol, participants will complete objective measurements of final hearing aid output with REMs, speech-in-noise testing, subjective measurements of hearing aid performance, and quality of life measurements. They will then begin an identical period of living with, adjusting, and objective assessment with the other fitting protocol. Data will be analysed as repeated measures with statistical control for potential confounding variables.ResultsData will compare the four-frequency average real-ear aided response (4FREAR) for hearing aids programmed in-clinic and hearing aids programmed remotely, after participant-directed gain adjustments. Secondary measures will assess clinically significant differences in estimated speech intelligibility, hearing-related quality of life, hearing aid benefit, sound quality and preference, and speech-in-noise ability.ConclusionsThis study will inform the development of best practice guidelines for remote hearing aid fittings. If no clinically significant differences are found between in-clinic and remote fit hearing aids, it has the potential to expand teleaudiology initiatives.Trial registrationAustralian New Zealand Clinical Trial Registry, ACTRN12623000028606p. Date of registration: 12 January 2023.

Sustainable development and the degree of implementation of European Union environmental directives

EU Member States must implement environmental policy in accordance with the specified rules, including standards supporting the implementation of the adopted EU policies. The standards (target values) for the levels of environmental indicators are included in EU directives. Compliance with EU environmental standards is already bringing many benefits, but there is still much to be done. The aim of our study is to assess the current levels of environmental indicators in EU countries, since prompt achievement of their target values is a prerequisite for sustainable development in this area. A classical correspondence analysis was used to evaluate the degree of differentiation of the levels of indicators in the EU countries based on the data presented in a binary matrix of indicators. As a result, countries have been identified in which indicators monitoring the state of environmental protection have achieved a level in line with the target values indicated in EU directives, and those in which this level has not been achieved. The research procedure used in the article is universal in the sense that it can be used to assess the situation of the objects under study (countries, regions) regardless of the specifics of the phenomenon under study, provided that comparable data are available.

Capability of Activity Planning Based on Organizational Citizenship Behavior to Accelerate Development

The research aims to determine the capability factors of regional development activity planners in Fakfak Regency. The vast area of the district and the many technical problems for regions in Indonesia's frontier, outermost and underdeveloped regions; requires equitable and targeted development planning to accelerate economic development. Combination research with a qualitative-quantitative-qualitative design was carried out during 2023. Data was obtained through closed interviews using a questionnaire tool. The question grid in the questionnaire refers to the standard target answers, so that respondents' answers can be given a weight value. Weighting uses a scale of 1-10. Test the validity of the answers using the cross triangulation technique. The interview data was then analyzed using the SPSS statistical tool. The qualitative analysis description reviews the regression model based on the results of the analysis of the coefficient of determination (R-square). The research results show that the capabilities of development planners including: competence, integrity, innovation, motivation and empathy still need to be improved in order to achieve accelerated development evenly in Fakfak district. Budget planners still need to train themselves to be more focused on achieving the vision, mission and goals of the Fakfak Regency Government by implementing organizational citizenship behavior (OCB)