Development and evaluation of a novel user-operated slider-based audiometry method.

OBJECTIVE: To evaluate a novel user-operated audiometry method allowing users full control in determining their pure-tone hearing thresholds. DESIGN: Comparative study. Participants were recruited from a hearing clinic after undergoing manual audiometry (six frequencies). They then performed test-retests of a new test (slider audiometry, eight frequencies) and completed the System Usability Scale questionnaire. STUDY SAMPLE: 37 adult participants, including 30 hearing-impaired and seven normal-hearing individuals. RESULTS: Mean (SD) threshold differences for octave frequencies between 250 to 2000 Hz between manual and slider audiometry ranged from -7.8 (6.6) to -5.7 (6.5) dB and were significant. For 4000 and 8000 Hz mean differences were -0.3 (8.4) and 0.0 (9.7) dB and insignificant. Standard deviations ranged from 6.5 to 9.7 dB across six tested frequencies. Slider test-retest mean threshold differences ranged from -1.4 (4.7) to 0.3 (6.0) dB across eight tested frequencies, with standard deviations ranging from 4.1 to 8.5 dB. The average usability score for the slider audiometry was 88.3. CONCLUSION: When compared to manual audiometry, the slider audiometry demonstrated validity at 4000 and 8000 Hz but found significantly lower thresholds for octave frequencies between 250 to 2000 Hz. Test-retests of the new method revealed small mean differences and acceptable SDs.

Harbour porpoises respond to recreational boats by speeding up and moving away from the boat path.

Recreational boats are common in many coastal waters, yet their effects on cetaceans and other sensitive marine species remain poorly understood. To address this knowledge gap, we used drone video footage recorded from a recreational boat to quantify how harbour porpoises (Phocoena phocoena) responded to the boat approaching at different speeds (10 or 20 knots). Furthermore, we used a hydrophone to record boat noise levels at full bandwidth (0.1-150 kHz) and at the 1/3 octave 16 kHz frequency band for both experimental speeds. The experiments were carried out in shallow waters near Funen, Denmark (55.51° N, 10.79° E) between July and September 2022. Porpoises were more likely to move further away from the path of the boat when approached at 10 knots, but not when approached at 20 knots. In contrast, they swam faster when approached at 20 knots, but not when approached at 10 knots. The recorded received sound level did not depend on how fast the boat approached, suggesting that differences in porpoise responses were related to the speed of the approaching boat rather than to sound intensity. In addition, porpoises generally reacted within close proximity (<200 m) to the approaching boat and quickly (<50 s) resumed their natural behaviour once the boat had passed, indicating that the direct impact of small vessels on porpoise behaviour was most likely small. Nevertheless, repeated exposure to noise from small vessels may influence porpoises' activity or energy budget, and cause them to relocate from disturbed areas. The approach used in this study increases our understanding of recreational boats' impact on harbour porpoises and can be used to inform efficient mitigation measures to help focus conservation efforts.

Response of Eurasian otters (Lutra lutra) to underwater acoustic harassment device sounds.

Seal scarers (or acoustic harassment devices, AHDs) are designed to deter seals from fishing gear and aquaculture operations, as well as to prevent seals from entering rivers to avoid predation on valuable fish. Our study investigated the potential effects of AHDs on non-target species, specifically the Eurasian otters (Lutra lutra), by testing the reaction of two rehabilitated otters to simulated AHDs sounds at 1 and 14 kHz, with a received sound intensity of 105-145 dB re 1 µPa rms. The 1 kHz sounds were used to investigate alternative frequencies for scaring seals without scaring otters. The otters reacted to both 1 and 14 kHz tonal signals when retrieving fish from a feeding station 0.8 m below the surface. Their diving behaviour and time to extract food progressively increased as sound intensity increased for all tested sound levels. Notably, the sound levels used in our tests were significantly lower (40-80 dB) than the source levels from commercial AHDs. These findings highlight the importance of caution when using AHDs in river and sea habitats inhabited by otters, as AHDs can change their behaviour and potentially result in habitat exclusion.

Ship noise causes tagged harbour porpoises to change direction or dive deeper.

Shipping is the most pervasive source of marine noise pollution globally, yet its impact on sensitive fauna remains unclear. We tracked 10 harbour porpoises for 5-10 days to determine exposure and behavioural reactions to modelled broadband noise (10 Hz-20 kHz, VHF-weighted) from individual ships monitored by AIS. Porpoises spent a third of their time experiencing ship noise above ambient, to which they regularly reacted by moving away during daytime and diving deeper during night. However, even ships >2 km away (noise levels of 93 ± 14 dB re 1 µPa2) caused animals to react 5-9 % of the time (∼18.6 ships/day). Ships can thus influence the behaviour and habitat use of cetaceans over long distances, with worrying implications for fitness in coastal areas where anthropogenic noise from dense ship traffic repeatedly disrupt their natural behaviour.

Monolithic affinity columns in 3D printed microfluidics for chikungunya RNA detection.

Mosquito-borne pathogens plague much of the world, yet rapid and simple diagnosis is not available for many affected patients. Using a custom stereolithography 3D printer, we created microfluidic devices with affinity monoliths that could retain, noncovalently attach a fluorescent tag, and detect oligonucleotide and viral RNA. We optimized the fluorescent binding and sample load times using an oligonucleotide sequence from chikungunya virus (CHIKV). We also tested the specificity of CHIKV capture relative to genetically similar Sindbis virus. Moreover, viral RNA from both viruses was flowed through capture columns to study the efficiency and specificity of the column for viral CHIKV. We detected ~107 loaded viral genome copies, which was similar to levels in clinical samples during acute infection. These results show considerable promise for development of this platform into a rapid mosquito-borne viral pathogen detection system.

Distinguishing SARS-CoV-2 infection and vaccine responses up to 18 months post-infection using nucleocapsid protein and receptor-binding domain antibodies.

The prediction of the durability of immunity against COVID-19 is relevant, and longitudinal studies are essential for unraveling the details regarding protective SARS-CoV-2 antibody responses. It has become challenging to discriminate between COVID-19 vaccine- and infection-induced immune responses since all approved vaccines in Europe and the USA are based on the viral spike (S) protein, which is also the most commonly used antigen in immunoassays measuring immunoglobulins (Igs) against SARS-CoV-2. We have developed a nucleocapsid (N) protein-based sandwich ELISA for detecting pan anti-SARS-CoV-2 Ig with a sensitivity and specificity of 97%. Generalized mixed models were used to determine the degree of long-term humoral immunity against the N protein and the receptor-binding domain (RBD) of the S protein in a cohort of infected individuals to distinguish between COVID-19 vaccine- and infection-induced immunity. N-specific waning could be observed in individuals who did not experience reinfection, while individuals who experienced reinfection had a new significant increase in N-specific Ig levels. In individuals that seroconverted without a reinfection, 70.1% remained anti-N seropositive after 550 days. The anti-RBD Ig dynamics were unaffected by reinfection but exhibited a clear increase in RBD-specific Ig when vaccination was initiated. In conclusion, a clear difference in the dynamics of the antibody response against N protein and RBD was observed over time. Anti-N protein-specific Igs can be detected up to 18 months after SARS-CoV-2 infection allowing long-term discrimination of infectious and vaccine antibody responses.IMPORTANCELongitudinal studies are essential to unravel details regarding the protective antibody responses after COVID-19 infection and vaccination. It has become challenging to distinguish long-term immune responses to SARS-CoV-2 infection and vaccination since most approved vaccines are based on the viral spike (S) protein, which is also mostly used in immunoassays measuring immunoglobulins (Igs) against SARS-CoV-2. We have developed a novel nucleocapsid (N) protein-based sandwich ELISA for detecting pan-anti-SARS-CoV-2 Ig, exhibiting high sensitivity and specificity. Generalized mixed models were used to determine long-term humoral immunity in a cohort of infected individuals from the Faroe Islands, distinguishing between COVID-19 vaccine- and infection-induced immunity. A clear difference in the dynamics of the antibody response against N protein and S protein was observed over time, and the anti-N protein-specific Igs could be detected up to 18 months after SARS-CoV-2 infection. This enables long-term discrimination between natural infection and vaccine-dependent antibody responses.

Validity of the large language model ChatGPT (GPT4) as a patient information source in otolaryngology by a variety of doctors in a tertiary otorhinolaryngology department.

BACKGROUND: A high number of patients seek health information online, and large language models (LLMs) may produce a rising amount of it. AIM: This study evaluates the performance regarding health information provided by ChatGPT, a LLM developed by OpenAI, focusing on its utility as a source for otolaryngology-related patient information. MATERIAL AND METHOD: A variety of doctors from a tertiary otorhinolaryngology department used a Likert scale to assess the chatbot's responses in terms of accuracy, relevance, and depth. The responses were also evaluated by ChatGPT. RESULTS: The composite mean of the three categories was 3.41, with the highest performance noted in the relevance category (mean = 3.71) when evaluated by the respondents. The accuracy and depth categories yielded mean scores of 3.51 and 3.00, respectively. All the categories were rated as 5 when evaluated by ChatGPT. CONCLUSION AND SIGNIFICANCE: Despite its potential in providing relevant and accurate medical information, the chatbot's responses lacked depth and were found to potentially perpetuate biases due to its training on publicly available text. In conclusion, while LLMs show promise in healthcare, further refinement is necessary to enhance response depth and mitigate potential biases.

AMTASTM and user-operated smartphone research application audiometry-An evaluation study.

OBJECTIVE: To evaluate two user-operated audiometry methods, the AMTASTM PC-based audiometry and a low-cost smartphone audiometry research application (R-App). DESIGN: A repeated-measures within-subject study design was used to compare both user-operated methods to traditional manual audiometry and to evaluate test-retest reliability of each method. STUDY SAMPLE: 58 subjects were recruited in the study of which 83 ears had normal hearing thresholds and 33 ears had hearing loss (pure-tone average > 25 dB HL). Average age of participants was 44.8 years, with an age range of 11-85. RESULTS: Standard deviation of absolute differences ranged between 3.9-6.9 dB on AMTASTM and 4.5-6.8 dB on the R-App. The highest variability was found at the 8000 Hz frequency (R-App and AMTASTM test) and 3000 Hz frequency (AMTASTM retest). Evaluation of test-retest reliability of AMTASTM and R-App showed SD of absolute differences ranging between 3.5-5.8 dB and 3.1-5.0 dB, respectively. The mean threshold difference between test and retest was within ±1.5 dB on AMTASTM and ±1 dB on the R-App. CONCLUSION: Accuracy of AMTASTM and the R-App was within acceptable limits for audiometry and comparable to traditional manual audiometry on all tested frequencies (250-8000 Hz). Evaluation of test-retest reliability showed acceptable variation on both AMTASTM and R-App. Both user-operated methods could be reliably performed in a quiet non-soundproofed environment.

Mental Health Recovery in Social Psychiatric Policies: A Reflexive Thematic Analysis.

The realisation of recovery as an overarching goal of mental health care services has proven difficult to achieve in practice. At present, concepts of recovery are contested and unclear, which affects their implementation in psychiatric practices. We examined social psychiatric policies about recovery with the aim to explore their underlying assumptions about recovery. Relevant texts from the policies' knowledge bases were subjected to reflexive thematic analysis. We developed a central theme: "A clinical standardisation of the concept of recovery". The theme involved meaning clusters that encompassed conflicting and commonly shared assumptions about recovery across the text corpus. We discussed the findings from discourse analytical and governmentality perspectives. In conclusion, the policies' aim of providing clarity about recovery was circumvented by the very knowledge bases used to support their endeavours.

Eye-Tracking on Touch Screen - Evaluating User Interaction.

This paper suggests a setup for using remote eye-tracking on a touchscreen tablet to evaluate user interaction for older adults interacting with a user-driven hearing test. By using video recordings to support the eye-tracking data, it was possible to evaluate quantitative usability metrics that could be compared to other research findings. The video recordings revealed useful information to distinguish between reasons for gaps in data and missing data and to inform future similar studies of human-computer interaction on a touch screen. Using only portable equipment allows researchers to move to the location of the user and investigate the user interaction of devices in real-world scenarios.

Healthcare professionals' perception of their working environment and how to handle mental strain.

Healthcare professionals (HCP) are an important resource, but the shortage of staff and an increased volume of patients with comorbidities might put a pressure on them. We speculated if mental strain was a challenge for HCP working in a department of Anaesthesiology. The purpose of the study was to explore HCP's perception of their psychosocial work environment and how they handle the mental strain in a department of Anaesthesiology in a university hospital. In addition, to identify types of strategies to handle the mental strain. This was an exploratory study based on semi-structured, individual interview with anaesthesiologists, nurses and nurse assistants employed in the Department of Anaesthesiology. The interviews were conducted online and were recorded in Teams, transcribed, and analysed using systematic text condensation. A total of 21 interviews were conducted with HCP from the different sections of the department. The interviewees described that they had experienced mental strain at work, with the unforeseen situation as the most challenging. High workflow is mentioned as an important contributing factor to mental strain. Most of the interviewees found that their traumatising experiences were met with support. Overall, everyone had someone to talk to either at work or privately, but they still found it difficult to talk about collegial conflicts or own vulnerabilities. Teamwork is described as strong in some sections. All HCP had experienced mental strain. Differences were found in how they perceived the experience of mental strain, their reactions and needs of support as well as their coping strategies.

Ambient Noise in Candidate Rooms for User-Operated Audiometry.

Hearing loss is a widespread problem while treatment is not always accessible, mainly because of the limited availability of hearing care professionals and clinics. In this work, part of the User-Operated Audiometry project, we investigate the acoustic environment of inexpensive non-sound-treated rooms that could be used for unsupervised audiometric testing. Measurements of 10 min of ambient noise were taken from 20 non-sound-treated rooms in libraries and private and public clinics, nine of which were measured twice. Ambient noise was compared against two traditional audiometric sound-treated rooms and Maximum Permissible Ambient noise levels by ISO 8231-1, while factoring for the attenuation by the DD450 circumaural headphones provided. In most non-sound-treated rooms, MPAs were violated only by transient sounds, while the floor-noise level was below MPAs. Non-sound-treated rooms' ambient noise levels presented with much larger fluctuations compared to sound-treated rooms. Almost all violations occurred at low to mid-low frequencies. Our results suggest that large-scale implementation of user-operated audiometry outside traditional audiometric rooms is possible, at least under some realizable conditions. Circumaural headphones' attenuation is probably a necessary condition for all cases. Depending on the room, an online system making decisions based on ambient noise might also be included in combination with active attenuation.

Comparison of hearing aid fitting effectiveness with audiograms from either user-operated or traditional audiometry in a clinical setting: a study protocol for a blinded non-inferiority randomised controlled trial.

INTRODUCTION: There is a worldwide need to enhance the capacity of audiometry testing. The objective of this study is to compare the User-operated Audiometry (UAud) system with traditional audiometry in a clinical setting, by investigating if hearing aid effectiveness based on UAud is non-inferior to hearing aid effectiveness based on traditional audiometry, and whether thresholds obtained with the user-operated version of the Audible Contrast Threshold (ACT) test correlates to traditional measures of speech intelligibility. METHODS AND ANALYSIS: The design will be a blinded non-inferiority randomised controlled trial. 250 adults referred for hearing aid treatment will be enrolled in the study. Study participants will be tested using both traditional audiometry as well as the UAud system and they will answer the questionnaire Speech, Spatial and Qualities of Hearing Scale (SSQ12) at baseline. Participants will be randomly divided to receive hearing aids fitted based on either UAud or traditional audiometry. Three months after participants have started using their hearing aids, they will undergo a hearing in noise test with hearing aids to measure their speech-in-noise performance and answer the following questionnaires: SSQ12, the Abbreviated Profile of Hearing Aid Benefit and the International Outcome Inventory for Hearing Aids. The primary outcome is a comparison of the change in SSQ12 scores from baseline to follow-up between the two groups. Participants will undergo the user-operated ACT test of spectro-temporal modulation sensitivity as part of the UAud system. The ACT results will be compared with measures of speech intelligibility from the traditional audiometry session and follow-up measurements. ETHICS AND DISSEMINATION: The project was evaluated by the Research Ethics Committee of Southern Denmark and judged not to need approval. The findings will be submitted to an international peer-reviewed journal and presented at national and international conferences. TRIAL REGISTRATION NUMBER: NCT05043207.

Estimating energetic intake for marine mammal bioenergetic models.

Bioenergetics is the study of how animals achieve energetic balance. Energetic balance results from the energetic expenditure of an individual and the energy they extract from their environment. Ingested energy depends on several extrinsic (e.g prey species, nutritional value and composition, prey density and availability) and intrinsic factors (e.g. foraging effort, success at catching prey, digestive processes and associated energy losses, and digestive capacity). While the focus in bioenergetic modelling is often on the energetic costs an animal incurs, the robust estimation of an individual's energy intake is equally critical for producing meaningful predictions. Here, we review the components and processes that affect energy intake from ingested gross energy to biologically useful net energy (NE). The current state of knowledge of each parameter is reviewed, shedding light on research gaps to advance this field. The review highlighted that the foraging behaviour of many marine mammals is relatively well studied via biologging tags, with estimates of success rate typically assumed for most species. However, actual prey capture success rates are often only assumed, although we note studies that provide approaches for its estimation using current techniques. A comprehensive collation of the nutritional content of marine mammal prey species revealed a robust foundation from which prey quality (comprising prey species, size and energy density) can be assessed, though data remain unavailable for many prey species. Empirical information on various energy losses following ingestion of prey was unbalanced among marine mammal species, with considerably more literature available for pinnipeds. An increased understanding and accurate estimate of each of the components that comprise a species NE intake are an integral part of bioenergetics. Such models provide a key tool to investigate the effects of disturbance on marine mammals at an individual and population level and to support effective conservation and management.

Increased Prevalence of Rare Copy Number Variants in Treatment-Resistant Psychosis.

BACKGROUND: It remains unknown why ~30% of patients with psychotic disorders fail to respond to treatment. Previous genomic investigations of treatment-resistant psychosis have been inconclusive, but some evidence suggests a possible link between rare disease-associated copy number variants (CNVs) and worse clinical outcomes in schizophrenia. Here, we identified schizophrenia-associated CNVs in patients with treatment-resistant psychotic symptoms and then compared the prevalence of these CNVs to previously published schizophrenia cases not selected for treatment resistance. METHODS: CNVs were identified using chromosomal microarray (CMA) and whole exome sequencing (WES) in 509 patients with treatment-resistant psychosis (a lack of clinical response to ≥3 adequate antipsychotic medication trials over at least 5 years of psychiatric hospitalization). Prevalence of schizophrenia-associated CNVs in this sample was compared to that in a previously published large schizophrenia cohort study. RESULTS: Integrating CMA and WES data, we identified 47 cases (9.2%) with at least one CNV of known or possible neuropsychiatric risk. 4.7% (n = 24) carried a known neurodevelopmental risk CNV. The prevalence of well-replicated schizophrenia-associated CNVs was 4.1%, with duplications of the 16p11.2 and 15q11.2-q13.1 regions, and deletions of the 22q11.2 chromosomal region as the most frequent CNVs. Pairwise loci-based analysis identified duplications of 15q11.2-q13.1 to be independently associated with treatment resistance. CONCLUSIONS: These findings suggest that CNVs may uniquely impact clinical phenotypes beyond increasing risk for schizophrenia and may potentially serve as biological entry points for studying treatment resistance. Further investigation will be necessary to elucidate the spectrum of phenotypic characteristics observed in adult psychiatric patients with disease-associated CNVs.

User-operated audiometry - an evaluation of expert vs. non-expert headphone placement.

OBJECTIVE: User-operated audiometry faces multiple barriers. One of these is the concern of audiologists that patients (non-experts) placing headphones by themselves results in invalid hearing thresholds due to greater placement variability. DESIGN: Comparative study. Participants took the AMTAS pure-tone air-conduction audiometry under two different conditions, expert and non-expert circumaural headphone placement for five frequencies within the range 250-8000 Hz. Questionnaires were also used to gain insight into the usability of the user-operated audiometry system - as well as the participants' perceived handling of the audiometry headphones. STUDY SAMPLE: Thirty participants (mean age 67.5 years). RESULTS: No statistically significant mean differences in hearing thresholds between the expert and non-expert conditions were found. The mean system usability scale score was 84.5. Handling the headphones was also rated as being easy (30%) or very easy (60%) by most non-experts. CONCLUSION: The conclusion of the study is that non-experts can be trusted to properly equip a pair of circumaural audiometry headphones for the correct conduction of pure-tone audiometry with only a few digital instructions.

Public perception and acceptance of CCUS: preliminary findings of a qualitative case study in Greece.

The development and implementation of carbon capture, utilisation and storage (CCUS) technologies plays an increasingly important part in European Union (EU) countries' decarbonisation policies and strategies. Several studies have shown the important role social acceptance plays in determining the outcomes of CCUS projects and how social acceptance is shaped by the national and local contexts. Yet most studies on CCUS and social acceptance have focused on a few northern European countries despite the increasing numbers of CCUS projects across the European Union. This study seeks to help address this gap by conducting a case study on how local dynamics shaped people's acceptance and awareness of CCUS in two separate Greek communities. Based on semi-structured interviews with community members near a CCUS pilot plant, and a focus group with community members from a potential storage site, this single case study explores the factors and dynamics that shaped the participants' perceptions of CCUS technologies. Our findings indicate that, despite the low level of awareness of CCUS technologies, participants could draw on their situated knowledge to identify potential drawbacks with their application. We identified scepticism regarding the adoption of new technologies and the organisations involved based on past experiences, and a notable lack of provision of technology and location-specific information as well as public engagement by the project consortium. Our recommendations for future projects and community engagement include the early involvement of the public in project development, location-based transparent information, appropriate channels to facilitate knowledge exchange, and educational initiatives to build communities' capability to influence projects.

Cross-scale regulation of seasonal microclimate by vegetation and snow in the Arctic tundra.

Climate warming is inducing widespread vegetation changes in Arctic tundra ecosystems, with the potential to alter carbon and nutrient dynamics between vegetation and soils. Yet, we lack a detailed understanding of how variation in vegetation and topography influences fine-scale temperatures ("microclimate") that mediate these dynamics, and at what resolution vegetation needs to be sampled to capture these effects. We monitored microclimate at 90 plots across a tundra landscape in western Greenland. Our stratified random study design covered gradients of topography and vegetation, while nested plots (0.8-100 m2 ) enabled comparison across different sampling resolutions. We used Bayesian mixed-effect models to quantify the direct influence of plot-level topography, moisture and vegetation on soil, near-surface and canopy-level temperatures (-6, 2, and 15 cm). During the growing season, colder soils were predicted by shrub cover (-0.24°C per 10% increase), bryophyte cover (-0.35°C per 10% increase), and vegetation height (-0.17°C per 1 cm increase). The same three factors also predicted the magnitude of differences between soil and above-ground temperatures, indicating warmer soils at low cover/height, but colder soils under closed/taller canopies. These findings were consistent across plot sizes, suggesting that spatial predictions of microclimate may be possible at the operational scales of satellite products. During winter, snow cover (+0.75°C per 10 snow-covered days) was the key predictor of soil microclimate. Topography and moisture explained little variation in the measured temperatures. Our results not only underline the close connection of vegetation and snow with microclimate in the Arctic tundra but also point to the need for more studies disentangling their complex interplay across tundra environments and seasons. Future shifts in vegetation cover and height will likely mediate the impact of atmospheric warming on the tundra soil environment, with potential implications for below-ground organisms and ecosystem functioning.

SARS-CoV-2 Surface Swabs in Locations With Public Access-Potential for Improved Source Control.

The presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on surfaces at public locations has been minimally described. By swab testing, we investigated the presence of SARS-CoV-2 on surfaces in public locations during the pandemic in February 2022. The viability of SARS-CoV-2 was not tested. Almost 25% of surfaces were positive for SARS-CoV-2; this was most pronounced in supermarkets.

Key questions in marine mammal bioenergetics.

Bioenergetic approaches are increasingly used to understand how marine mammal populations could be affected by a changing and disturbed aquatic environment. There remain considerable gaps in our knowledge of marine mammal bioenergetics, which hinder the application of bioenergetic studies to inform policy decisions. We conducted a priority-setting exercise to identify high-priority unanswered questions in marine mammal bioenergetics, with an emphasis on questions relevant to conservation and management. Electronic communication and a virtual workshop were used to solicit and collate potential research questions from the marine mammal bioenergetic community. From a final list of 39 questions, 11 were identified as 'key' questions because they received votes from at least 50% of survey participants. Key questions included those related to energy intake (prey landscapes, exposure to human activities) and expenditure (field metabolic rate, exposure to human activities, lactation, time-activity budgets), energy allocation priorities, metrics of body condition and relationships with survival and reproductive success and extrapolation of data from one species to another. Existing tools to address key questions include labelled water, animal-borne sensors, mark-resight data from long-term research programs, environmental DNA and unmanned vehicles. Further validation of existing approaches and development of new methodologies are needed to comprehensively address some key questions, particularly for cetaceans. The identification of these key questions can provide a guiding framework to set research priorities, which ultimately may yield more accurate information to inform policies and better conserve marine mammal populations.