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Abstract Background Lipodystrophy syndromes are a heterogeneous group of rare, life-limiting diseases characterized by a selective loss of adipose tissue and severe metabolic complications. There is a paucity of information describing the experiences and challenges faced by physicians who have seen and treated patients with lipodystrophy. This study aimed to provide a better understanding of the physician’s perspective regarding the patient journey in lipodystrophy, including diagnosis, the burden of disease, and treatment approaches. Methods Thirty-three physicians from six countries who had seen or treated patients with lipodystrophy were interviewed using a semi-structured questionnaire. Interviews were transcribed, anonymized, and analyzed for themes and trends. Four main themes were developed: (1) the diagnostic journey in lipodystrophy including the disease features or ‘triggers’ that result in the onward referral of patients to specialist medical centers with experience in managing lipodystrophy; (2) the impact of lipodystrophy on patient quality of life (QoL); (3) the use of standard therapies and leptin replacement therapy (metreleptin) in lipodystrophy, and (4) barriers to metreleptin use. Results Participants reported that, due to their rarity and phenotypic heterogeneity, lipodystrophy cases are frequently unrecognized, leading to delays in diagnosis and medical intervention. Early consultation with multidisciplinary specialist medical teams was recommended for suspected lipodystrophy cases. The development and progression of metabolic complications were identified as key triggers for the referral of patients to specialist centers for follow-up care. Participants emphasized the impact of lipodystrophy on patient QoL, including effects on mental health and self-image. Although participants routinely used standard medical therapies to treat specific metabolic complications associated with lipodystrophy, it was acknowledged that metreleptin was typically required in patients with congenital generalized lipodystrophy and in some acquired generalized and partial lipodystrophy cases. A lack of experience among some participants and restrictions to access remained as barriers to metreleptin use. Conclusions To our knowledge, this is one of the first studies describing the qualitative experiences of physicians regarding the diagnosis and management of lipodystrophy. Other physician-centered studies may help increase the awareness of lipodystrophy among the wider medical community and support clinical approaches to this rare disease.

Introduction Recurrent patellar dislocation is a debilitating musculoskeletal condition, affecting mainly adolescents and adults under the age of 30. It can persist for many decades, causing pain and cartilage and soft-tissue damage, potentially leading to osteoarthritis. Recurrent patellar dislocation can be managed with physiotherapy or surgery. However, it is not known which treatment is most effective.Methods and analysis Recurrent Patellar Dislocation: Personalised Therapy or Operative Treatment (REPPORT) is a pragmatic, multicentre, two-arm, superiority, randomised controlled trial. It will compare the clinical and cost-effectiveness of an initial management strategy of personalised, phased and progressive rehabilitation, termed personalised knee therapy versus surgery for recurrent patellar dislocation.The trial’s target sample size is 276 participants who will be recruited from approximately 20 sites across the UK. Participants will be randomly allocated to the two treatment groups via a central computer-based minimisation system. Treatment allocation will be in a 1:1 ratio, stratified by age, presence of patella alta and recruitment site.The primary outcome is participant-reported function using the Knee injury and Osteoarthritis Outcome 4-domain score at 18 months post randomisation. Health economic evaluation will be conducted from a healthcare system and personal social services perspective. Secondary outcome data including patellar instability, health utility, work/education status, satisfaction with social roles and treatment, health resource use and adverse events will be collected at 6, 12, 18 and 24 months. Analysis will be on an intention-to-treat basis and reported in-line with the Consolidated Standards of Reporting Trials statement.Ethics and dissemination The trial was approved by the East Midlands—Nottingham 2 Research Ethics Committee on 30 March 2023.Results will be disseminated via peer-reviewed publications, presentations at national and international conferences, in lay summaries, and using the REPPORT website and social media channels.Trial registration number ISRCTN17972668.

Abstract Senegal banned all imports of uncooked poultry meat in 2006 in response to Avian Influenza outbreaks in many exporting countries. This paper investigates the effects of the import ban on domestic chicken meat production and the performance of Senegal's broiler farms. To do so, we employ various comparative analyses at the farm and macro levels. We use the synthetic control method to estimate the effects on total production, which shows that Senegal’s chicken meat production increased more than it would have without the import ban. This may imply, in line with the infant-industry argument, that the ban has had a positive impact on chicken meat production. In addition, we use a farm-level analysis to evaluate the performance of typical Senegalese broiler farms. The comparison with Ghana shows that Senegalese farms are performing better and have lower costs of production. An opening of the markets should only be implemented gradually, by replacing the ban with tariffs because local industries must have the opportunity to adapt to the competition of the international market step by step.

Some international organizations and civil society activists are blaming exporting countries of frozen chicken products for the underdevelopment of the domestic poultry sectors in developing nations. However, concrete evidence that supports or rejects these criticisms is missing. Against this background, this study was conducted to examine the performance of Ghana’s poultry sector by employing quantitative and qualitative methods. Results of our study highlight the poor economic, social, and environmental performance of the Ghanaian poultry sector. Moreover, weak vertical and horizontal coordination among actors in the value chain in addition to low commitment from supporting stakeholders emerge as the root causes of the challenges the sector faces. We propose an integrated set of sustainable solutions to support the development and growth of Ghana’s poultry value chain. Besides, continuous mutual cooperation is required from all actors and stakeholders in the value chain who operate in transparency and trust.

Introduction Patients with episodes of supraventricular tachycardia (SVT), a common heart arrhythmia, are often attended by ambulance services. International guidelines advocate treatment with the Valsalva manoeuvre (VM), but this simple physical treatment has a low success rate, with most patients requiring conveyance to hospital. The Valsalva Assist Device (VAD) is a simple device that might help practitioners and patients perform a more effective VM and reduce the need for patients to be taken to hospital.Methods and analysis This stepped wedge cluster randomised controlled trial, conducted within a UK ambulance service, compares the current standard VM with a VAD-delivered VM in stable adult patients presenting to the ambulance service with SVT. The primary outcome is conveyance to hospital; secondary outcomes measures include cardioversion rates, duration of ambulance care and number of subsequent episodes of SVT requiring ambulance service care. We plan to recruit approximately 800 patients, to have 90% power to detect an absolute reduction in conveyance rate of 10% (from 90% to 80%) between the standard VM (control) and VAD-delivered VM (intervention). Such a reduction in conveyance would benefit patients, the ambulance service and receiving emergency departments. It is estimated potential savings would pay for devices for the entire ambulance trust within 7 months.Ethics and dissemination The study has been approved by the Oxford Research Ethics Committee (reference 22/SC/0032). Dissemination will be through peer-reviewed journal publication, presentation at national and international conferences and by the Arrhythmia Alliance, a patient support charity.Trial registration number ISRCTN16145266.

Abstract Background Long-acting injectable antipsychotics (LAIs) are an essential maintenance treatment option for individuals with schizophrenia or bipolar I disorder (BP-I). This report summarizes a roundtable discussion on the impact of COVID-19 on the mental healthcare landscape and use of LAIs for individuals with schizophrenia or BP-I. Methods Ten experts and stakeholders from diverse fields of healthcare participated in a roundtable discussion on the impact of the COVID-19 pandemic, treatment challenges, and gaps in healthcare for individuals with schizophrenia or BP-I, informed by a literature search. Results Individuals with schizophrenia or BP-I are at increased risk of COVID-19 infection and increased risk of mortality after COVID-19 diagnosis. LAI prescriptions decreased early on in the pandemic, driven by a decrease in face-to-face consultations. Mental healthcare services are adapting with increased use of telehealth and home-based treatment. Clinical workflows to provide consistent, in-person LAI services include screening for COVID-19 exposure and infection, minimizing contact, and ensuring mask-wearing by individuals and staff. The importance of continued in-person visits for LAIs needs to be discussed so that staff can share that information with patients, their caregivers, and families. A fully integrated, collaborative-care model is the most important aspect of care for individuals with schizophrenia or BP-I during and after the COVID-19 pandemic. Conclusions The COVID-19 pandemic has highlighted the importance of a fully integrated collaborative-care model to ensure regular, routine healthcare contact and access to prescribed treatments and services for individuals with schizophrenia and BP-I.

Reducing tillage and supporting continuous living cover (CLC) can improve agroecosystem sustainability under both organic and conventional field crop production. What is less clear, however, is how reducing tillage affects the economic sustainability of organic field crop systems with CLC as compared to conventional field crop systems. To address this knowledge gap, we conducted a comprehensive economic analysis based on field records and crop yields from the long-term Farming Systems Trial (FST) at Rodale Institute in Kutztown, Pennsylvania. The FST (established in 1981) comprises three farming systems (conventional, low-input organic, and manure-based organic) which were split into tilled and reduced-till treatments in 2008. FST field activities, inputs, and crop yields from 2008 to 2020 were used to construct enterprise budgets to assess cumulative labor, costs, returns, and economic risk of six replicated theoretical farms. Reducing tillage on the conventional farms led to lower gross revenues (−10%), but lower annual costs (−5%) helped maintain similar net returns but increased economic risk as compared to tilled conventional farms. Reducing tillage on the low-input organic farms also led to lower gross revenues (−13%) and lower annual costs (−6%), which maintained net returns and increased risk relative to the tilled, low-input organic farms. For the more diverse manure-based organic farms that include periods of mixed perennial cover, reducing tillage had a smaller effect on overall costs (−2%) and no effect on gross revenues, net returns, or economic risk. Overall, reducing tillage did not affect the long-term profitability of any of the three FST farming systems. Regardless of tillage practices or organic price premiums, the manure-based organic system supported higher net returns than the conventional system. This finding suggests that continuous living cover and manure inputs may have a greater influence on system profitability than tillage practices.

Introduction Systems science methodologies have been used in attempts to address the complex and dynamic causes of childhood obesity with varied results. This paper presents a protocol for the Reflexive Evidence and Systems interventions to Prevention Obesity and Non-communicable Disease (RESPOND) trial. RESPOND represents a significant advance on previous approaches by identifying and operationalising a clear systems methodology and building skills and knowledge in the design and implementation of this approach among community stakeholders.Methods and analysis RESPOND is a 4-year cluster-randomised stepped-wedge trial in 10 local government areas in Victoria, Australia. The intervention comprises four stages: catalyse and set up, monitoring, community engagement and implementation. The trial will be evaluated for individuals, community settings and context, cost-effectiveness, and systems and implementation processes. Individual-level data including weight status, diet and activity behaviours will be collected every 2 years from school children in grades 2, 4 and 6 using an opt-out consent process. Community-level data will include knowledge and engagement, collaboration networks, economic costs and shifts in mental models aligned with systems training. Baseline prevalence data were collected between March and June 2019 among >3700 children from 91 primary schools.Ethics and dissemination Ethics approval: Deakin University Human Research Ethics Committee (HREC 2018-381) or Deakin University’s Faculty of Health Ethics Advisory Committee (HEAG-H_2019-1; HEAG-H 37_2019; HEAG-H 173_2018; HEAG-H 12_2019); Victorian Government Department of Education and Training (2019_003943); Catholic Archdiocese of Melbourne (Catholic Education Melbourne, 2019-0872) and Diocese of Sandhurst (24 May 2019). The results of RESPOND, including primary and secondary outcomes, and emerging studies developed throughout the intervention, will be published in the academic literature, presented at national and international conferences, community newsletters, newspapers, infographics and relevant social media.Trial registration number ACTRN12618001986268p.

(1) Background: Exfoliation syndrome (XFS) is a common cause of secondary open angle glaucoma. In 1971, Faulkner et al. estimated the prevalence of XFS among 50 Navajo Nation residents as 38%. Given that XFS can cause irreversible blindness secondary to glaucoma (XFG), this study aims to identify the current prevalence of XFS among Navajo Nation residents within the Four Corners region of the U.S. (2) Methods: A retrospective chart review was conducted from 2016 to 2021 for patients aged 18 and older. All patients with XFS or XFG diagnosed by slit lamp exam were identified through chart review. (3) Results: Of the 1152 patient charts available for review, eight patients (11 eyes) were diagnosed with XFS with three patients (4 eyes) demonstrating concomitant XFG. Within this XFS population, 50% of the patients identified as male, with a mean age of 73 years. The overall prevalence of XFS was 0.7% and the overall prevalence of XFG was found to be 0.26%. The rate of XFG among patients with XFS was 37.5%. (4) Conclusion: Compared to Faulkner’s study of Navajo Nation residents in 1971, our findings show a considerably lower prevalence of XFS at 0.7%. We present the largest study to date of XFS among this population.

Tourette ‘s syndrome (TS) currently has very limited FDA approved treatment options, despite the fact that TS and other pediatric tic disorders are not uncommon and can cause significant emotional and physical distress for patients and their families. For providers who regularly see these conditions in practice this inadequacy is highly frustrating on the treatment side as there are such limited options to offer to these families, and the outcome to hope for is not highly optimistic. The outcome of this case presentation is an example of how health care providers can use clinical knowledge in combination with evidence-based practice to advocate for their patients and find new solutions that could be, and in this case were, life changing. It promotes providers to advocate for their patients and expand their knowledge. The final medication treatment utilized in this case is currently off label, however the method of finding and obtaining the treatment explained in the case additionally reveal to readers how to cautiously but judiciously make off label treatment decisions that can be important to practice and patient outcomes. In the course of this case the off-label medication use decision was backed by scientific literature and ongoing FDA studies as well as consulting with a collaborating psychiatrist. The subject matter and method of reasoning within this case also promote psychiatric providers use of evidence-based practice and implementation of science into active practice.

Abstract Background Generalised anxiety disorder (GAD) is a chronic and debilitating condition characterised by high co-morbidity. Alongside pharmacological treatment, cognitive behavioural therapy (CBT) is an established psychological therapy for GAD. Its effectiveness is limited, however, with only an estimated 50% of clients presenting in the non-clinical range after a course of treatment. Furthermore, not all clients prefer CBT as a psychological therapy. Recently, emotion-focused therapy (EFT) was developed for GAD and was tested in an open trial with promising results. Methods/design The present research project is a feasibility testing randomised controlled trial (RCT) that compares the efficacy of EFT with an established treatment for GAD, CBT. Sixty clients presenting in a primary care psychology/counselling service will be randomly assigned to one of two conditions: EFT or CBT. Outcomes will be assessed using several measures (Generalised Anxiety Disorder-7, Generalised Anxiety Disorder Severity Scale, Patient Health Questionnaire-9, and Clinical Outcome in Routine Evaluation – Outcome Measure). Clients will be assessed prior to and at the end of therapy, as well as at 6-month follow-up. On the basis of findings from the initial open EFT trial with regard to the optimal length of therapy, it is proposed that therapy last between 16 and 20 sessions. Discussion This study aims to test the feasibility of a full comparison RCT. It will test subject recruitment, therapist adherence to manualised treatment, and client retention rates. It will also provide estimates of comparative outcomes that can inform power calculations for a definitive trial. Trial registration ISRCTN Registry, ISRCTN52689081. Registered on 24 October 2017.

Functional methods identify joint centres as the centre of rotation (CoR) of two adjacent movements during an ad-hoc movement. The methods have been used for functionally determining hip joint centre in gait analysis and have revealed advantages compared to predictive regression techniques. However, the current implementation of functional methods hinders its application in clinical use when subjects have difficulties performing multi-plane movements over the required range. In this study, we systematically investigated whether functional methods can be used to localise the CoR during a quasi-planar movement. The effects of the following factors were analysed: the algorithms, the range and speed of the movement, marker cluster location, marker cluster size and distance to the joint centre. A mechanical linkage was used in our study to isolate the factors of interest and give insight to variation in implementation of functional methods. Our results showed the algorithms and cluster locations significantly affected the estimate results. For all algorithms, a significantly positive relationship between CoR errors and the distance of proximal cluster coordinate location to the joint centre along the medial-lateral direction was observed while the distal marker clusters were best located as close as possible to the joint centre. By optimising the analytical and experimental factors, the transformation algorithms achieved a root mean square error (RMSE) of 5.3 mm while the sphere fitting methods yielded the best estimation with an RMSE of 2.6 mm. The transformation algorithms performed better in presence of random noise and simulated soft tissue artefacts.

Global agricultural production is dynamic and complex as various factors impact it. Understanding global agricultural production systems and farmers’ decisions requires an internationally standardized and scientifically sound approach. The agribenchmark Network is a global, non-profit network of producers and agricultural experts which aims to analyze and understand the key drivers of current and future trends and developments in global agriculture. The Network combines its in-depth knowledge of production systems with its expertise in analyzing international commodity markets and value chains to provide scientifically sound advice to policymakers, producers and agribusinesses. This paper details the agribenchmark Standard Operating Procedure (SOP), which is the step-by-step method of establishing typical farm information and quantifying their data. The paper also illustrates how the typical farm approach is applied by the agribenchmark Network to analyze and understand global agriculture, production systems and adaptation strategies. The paper provides examples of how the Network applies the approach in analyzing the status-quo of production systems, benchmarking, practice change analysis and policy analysis. The paper concludes that although the typical farm approach and the institutional settings (agri benchmark) present some limitations, the approach and the Network provide comprehensive, consistent and coherent data on farm economics.

In regions where natural gas is used for both power generation and heating buildings, extreme cold weather events can place the electrical system under enormous stress and challenge the ability to meet residential heating and electric demands. Residential demand response has long been used in the power sector to curtail summer electric load, but these types of programs in general have not seen adoption in the natural gas sector during winter months. Natural gas demand response (NG-DR) has garnered interest given recent extreme cold weather events in the United States; however, the magnitude of savings and potential impacts—to occupants and energy markets—are not well understood. We present a case-study analysis of the technical potential for residential natural gas demand response in the northeast United States that utilizes diverse whole-building energy simulations and high-performance computing. Our results show that NG-DR applied to residential heating systems during extreme cold-weather conditions could reduce natural gas demand by 1–29% based on conservative and aggressive strategies, respectively. This indicates a potential to improve the resilience of gas and electric systems during stressful events, which we examine by estimating the impact on energy costs and electricity generation from natural gas. We also explore relationships between hourly indoor temperatures, demand response, and building envelope efficiency.

Introduction The development of Regional Medical Campuses (RMCs) in Northern America has been a response to the call to increase undergraduate medical student enrollment and meet the societal needs of healthcare access by addressing physician shortages in underserved and in rural areas. We studied the literature on undergraduate RMCs in US and Canada to identify types of studies and leading themes. Methods Literature searches were performed within the following databases: Medline OVIDSP, Evidence-Based Medicine Reviews OVIDSP, CINAHL EBSCO, ERIC EBSCO, PsycInfo EBSCO, and Web of Science ISI. Articles were included in the review if they discussed undergraduate medical education in allopathic schools in Northern America (US and Canada), were written in English and related to regional medical campuses. Each article was reviewed and assessed by two of the authors, and information extracted from the literature was thematically analyzed. Results Fifty (50) articles were selected for inclusion in the final review. All selected articles fit the definition of Regional Medical Campus developed by the Association of American Medical Colleges’ Group on Regional Medical Campuses (GRMC). The GRMC has defined that RMCs could be of four distinct types: basic science campuses, where students study pre-clinical (basic sciences) courses; clinical campuses, where clerkship training is completed; longitudinal model (for example, Longitudinal Integrated Clerkships) and, usually 4-year campuses, where both pre-clinical and clinical curriculum is delivered. Thirty-six (36) of the reviewed articles (72%) specifically stated that the development of RMCs was in response to the physician shortage and limited access to healthcare in rural areas. Twenty-five (25) articles discussed program models that spanned both basic science and clinical curricula. Of the 50 articles that were included in the final review, 15 (30%) utilized descriptive methodology, and 35 (70%) involved quantitative, qualitative or mixed methods research, with some being considered “program evaluations.” Four major themes emerged from the reviewed articles: workforce, social accountability, distributed medical education, and regional versus main campus settings. Conclusion This study is the first comprehensive literature review of publications on Regional Medical Campuses and thus provides a benchmark and direction for future research in the RMCs topic area.

This article explores the relationship between integral education and the emerging terrestrial consciousness—a consciousness of interdependency, sovereignty, and earthly responsibility. It asserts that integral education is well positioned at this time when urgent environmental catastrophes threaten our planet, to help us recover an integral relation with the universe and our planet Earth, and contribute to restoration of a sense of earthly wonder and reverence.

First paragraphs: Local and regional food system professionals are obliged to rely on imperfect, incomplete, and evolving measures to track economic changes in the local food industry. These data are critical for informing decisions on how to invest limited resources to create optimal impacts. U.S. Department of Agriculture (USDA) Census of Agriculture figures indicate that direct food sales in the U.S. appeared to have increased from US$1.2 billion in 2007 to US$1.3 billion in 2012 — but when adjusted for inflation, sales actually remained steady. These figures, however, do not account for local food sales to institutions, restaurants, and retailers. The 2008 Agricultural Resource Management Survey (ARMS) partially addressed this gap by tracking local food sales from farmers to both individuals and "intermediated" markets such as restaurants and grocery stores. But the ARMS data did not include local food sales to institutions such as schools or hospitals, thus leaving another gap in the data. Data derived from various national sources indicate that local food systems may be growing, but the data collection methods are inconsistent and the results piecemeal (Hunt & Matteson, 2012). Moreover, the information is presented at a scale that often is irrelevant to local professionals serving constituents within a specific geographic region. The absence of locally relevant pre-existing data on local foods means that entities like local governments, community foundations, school administrators, and others are creating policies, programs, and investments that affect the local food sector without having basic information about its scope....

BackgroundNational Institute of Mental Health Project Accept (HIV Prevention Trials Network [HPTN] 043) is a large, Phase III, community-randomized, HIV prevention trial conducted in 48 matched communities in Africa and Thailand. The study intervention included enhanced community-based voluntary counseling and testing. The primary endpoint was HIV incidence, assessed in a single, cross-sectional, post-intervention survey of >50,000 participants.MethodsHIV rapid tests were performed in-country. HIV status was confirmed at a central laboratory in the United States. HIV incidence was estimated using a multi-assay algorithm (MAA) that included the BED capture immunoassay, an avidity assay, CD4 cell count, and HIV viral load.ResultsData from Thailand was not used in the endpoint analysis because HIV prevalence was low. Overall, 7,361 HIV infections were identified (4 acute, 3 early, and 7,354 established infections). Samples from established infections were analyzed using the MAA; 467 MAA positive samples were identified; 29 of those samples were excluded because they contained antiretroviral drugs. HIV prevalence was 16.5% (range at study sites: 5.93% to 30.8%). HIV incidence was 1.60% (range at study sites: 0.78% to 3.90%).ConclusionsIn this community-randomized trial, a MAA was used to estimate HIV incidence in a single, cross-sectional post-intervention survey. Results from this analysis were subsequently used to compare HIV incidence in the control and intervention communities.Trial registrationClinicalTrials.gov NCT00203749.

The Florida strawberry industry has continued to grow. There are now approximately 7,000 acres in production, with a crop value approaching $200 million. This growth is being fueled, in part, by new variety releases from the FAES breeding program. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag207

Meeting the educational needs of students currently requires moving towardcollaborative electronic and mobile learning systems that parallel the vision ofWeb 2.0. However, factors such as data freedom, brokerage, interconnectivityand the Internet of Things add to a vision for Web 3.0 that will require con-sideration in the development of future campus-based, distance and vocationalstudy. So, education can, in future, be expected to require deeper technologicalconnections between students and learning environments, based on significantuse of sensors, mobile devices, cloud computing and rich-media visualization.Therefore, we discuss challenges associated with such a futuristic campus con-text, including how learning materials and environments may be enriched byit. As an additional novel element the potential for much of that enrichmentto be realized through development by students, within the curriculum, is alsoconsidered. We will conclude that much of the technology required to embracethe vision of Web 3.0 in education already exists, but that further research inkey areas is required for the concept to achieve its full potential.

The history of the Jewish community in Saint John, New Brunswick has the characteristics of both large and small-town Jewish communities. Saint John paralleled the early Jewish communities of Montreal and Toronto in its formation by English and German communities in the 1850s. Cultural and socioeconomic divisions between the Anglophile old community and the later immigrants from Eastern Europe resulted in a split into two synagogues in 1906, as was also the case in the larger communities. Economic changes resulted in Saint John's decline as a major industrial centre by 1914. This decline, combined with closer cooperation between the two Jewish groups, produced a sense of community leading to the reunification of the synagogue in 1919-20, thus reverting to the profile of the one-synagogue smaller communities.

This consensus document for the performance of cardiovascular computed tomography (CCT) to guide intervention in the right ventricular outflow tract (RVOT) in patients with congenital disease (CHD) was developed collaboratively by pediatric and adult interventionalists, surgeons and cardiac imagers with expertise specific to this patient subset. The document summarizes definitions of RVOT dysfunction as assessed by multi-modality imaging techniques and reviews existing consensus statements and guideline documents pertaining to indications for intervention. In the context of this background information, recommendations for CCT scan acquisition and a standardized approach for reporting prior to surgical or transcatheter pulmonary valve replacement are proposed and presented. It is the first Imaging for Intervention collaboration for CHD patients and encompasses imaging and reporting recommendations prior to both surgical and percutaneous pulmonary valve replacement., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Relationships with industry for authors are outlined in Appendix A and for reviewers are outlined in Appendix B., (© 2023 The Authors.)

Background: Accurate evaluation of the tricuspid regurgitant (TR) spectral Doppler signal is important during transthoracic echocardiographic (TTE) evaluation for pulmonary hypertension (PHT). Contrast enhancement improves Doppler backscatter. However, its incremental benefit with contemporary scanners is less well established. The aim of this study was to assess whether the TR spectral Doppler signal using contemporary scanners was improved using a second generation contrast agent, Definity® (CE), compared to unenhanced TTE (UE)., Methods: Analysis of patients who underwent UE then CE TR interrogation was performed. TR signal was evaluated by an experienced reader and graded 1 (clear-high level of confidence of interpretation and complete spectral Doppler envelope), 2 (suboptimal with medium-low level of confidence of interpretation and incomplete envelope), 3 (poor-absent and no measurable spectral Doppler signal). Maximal TR velocity (TRV) was defined as peak velocity that could be clearly identified. An inexperienced sonographer read 30 randomly selected studies., Results: 176 TTE were performed in 173 patients (mean age 57 ± 14.8 years). Wilcoxon signed rank test demonstrated significant improvement (p < 0.0001) in TR spectral Doppler signal quality with CE TTE. Mean score CE TTE vs. TTE = 2.32 ± 0.85 vs. 2.56 ± 0.75 respectively (p < 0.0001). Mean maximal TRV CE TTE vs. UE TTE = 2.61 ± 0.44 m/s vs. 2.54 ± 0.49 m/s respectively (p < 0.0001). The inexperienced reader had a greater improvement in scoring CE TTE signals vs. UE TTE (p < 0.0001)., Conclusion: In the era of contemporary scanners, CE improved the ability to detect and measure TRV, except in those with clear unenhanced TR spectral Doppler signals or greater than mild tricuspid regurgitation.

This study examined the interaction of acoustic-phonetic information with higher-level linguistic contextual information during the real-time speech perception process in child, young adult, and older adult listeners. Five age groups were studied: (a) young children ranging in age from 5 to 7 years, (b) older children aged 8 to 10 years, (c) young adults aged 18 to 23 years, (d) older adults aged 60 to 69 years, and (e) older adults aged 70 to 83 years. All subjects were presented with time-gated monosyllabic target words presented in sentence contexts containing contrasting levels of word predictability. Findings indicated that target word predictability influenced the timing and nature of the real-time recognition process including the listeners' use of initial word sounds. Predictability-high (PH) words were recognized earlier and with greater confidence than predictability-low (PL) words. PH recognition performance was more influenced by child development and aging than PL recognition performance. Older adult listeners required more PH-gated word stimuli to produce accurate responses than younger adults. Older children showed more effective use of PH contexts than younger children.

This study examined the effects of signal presentation level and word duration on time-gated isolated monosyllabic word-recognition performance. Measures of listener confidence, word identification, isolation point (IP), confidence at IP, and acceptance point were obtained from normal-hearing listeners. Subjects were presented with non-time-gated and time-gated speech stimuli at 40 dB SPL (N = 21). The resulting performance measures were compared with previously reported results obtained using an 80-dB SPL presentation level. The speech stimuli consisted of 60-msec time-gated isolated monosyllabic words developed from a prerecorded 50-item list (Auditec, NU-6). Comparisons were drawn between presentation levels, word durations, and time-gated and non-time-gated presentation conditions. Poorer accuracy and longer isolation points were observed at the lower signal presentation level. The findings further indicated that listener confidence at IP was only indirectly influenced by presentation level. Monosyllabic word duration was a significant factor in on-line recognition performance, regardless of presentation level.

This investigation was designed to study real-time isolated monosyllabic word-recognition performance and the feasibility of applying time-gated NU-6 word-recognition test materials for real-time assessment of older listeners. Methods and materials developed in a previous investigation were used to obtain time-gated performance measures from 37 older listeners (mean age = 69 years). The older listener performance measures were compared with extant data from 20 normally hearing young adult listeners (mean age = 22 years). Specifically, listener confidence and accuracy by gate as well as listener isolation point, confidence at the isolation point, and total acceptance point measures were evaluated. The results show that major events in the real-time understanding process occur at a slower pace among older listeners. The data indicate that the time-gating method has excellent potential for future research among elderly listeners.

This study examined the effects of forward time gating and word length on monosyllabic isolated word-recognition performance. Fifty (60-ms) time-gated words were developed from a pre-recorded version (Auditec of St. Louis) of the Northwestern Auditory Test No. 6 (NU-6) List 1, Form A. A total of 358 time-gated items were presented monaurally at 80 db SPL, and time-gated word identification, isolation point, acceptance point, and listener confidence measures were obtained from 20 normally hearing listeners. A comparison of conventional nontime-gated word-recognition scores obtained using the NU-6 List 4, Form C with the time-gated measures revealed that, even upon word offset, listeners recognized time-gated words less frequently and with less confidence. The time-gated findings also demonstrated that word length, based on word duration from onset to offset, significantly influenced real-time recognition performance.

This study compared the effects of three conditions of word predictability on recognition performance. Word-recognition scores were obtained for 30 normally hearing listeners using three pairs of sentence lists. Each list contained target words preceded by a variety of predictability-high (PH) and predictability-low (PL) phrases and a constant predictability-neutral carrier phrase (CP) in three signal-to-babble ratio (S/B) listening conditions (-5, 0, and +5 dB). Significant differences (p less than .05) were observed between PH, PL, and CP word-recognition scores for specific S/B's and pairs of sentence lists. The results were interpreted in terms of cognitive processing tasks associated with the various semantic and contextual cues provided by each condition of word predictability.

Word discrimination scores were obtained for 30 normally hearing listeners using Auditec and Rintelmann recordings of the NU-6 presented at 60 and 70 dB SPL in quiet and in a background of multitalker noise at signal-to-noise (S/N) ratios of +12, +6, 0, and -6 dB. This was done to obtain normative data and to determine whether these two recordings of the same word lists were equivalent at conversational levels in quiet and in a noisy background. The word discrimination scores for each recording in quiet and at each S/N ratio were not significantly different when presented at 60 and 70 dB SPL. However, the word discrimination scores were significantly poorer as the S/N ratio became more severe, and the scores obtained with the Auditec recording were significantly poorer than those obtained with the Rintelmann recording at each S/N ratio. These differences between word discrimination scores using the Auditec and Rintelmann recordings were primarily attributed to the recorded level of the test word and secondarily attributed to carrier phrase and talker differences.

Monaural and binaural SRT and speech discrimination scores in a sensorineural hearing-imparied sample (N: 194, aged 3--91 yrs, mn=43 yrs) indicated that while a majority of clients have neither a binaural advantage or disadvantage by these tests, an important minority (5% for SRT, 20% for discrimination) have worse binaural than better-ear scores. Binaural as well as monaural tests of SRT and of speech discrimination should be a standard part of a hearing aid evaluation.