Healthcare consumption among subjects with otitis media undergoing middle ear surgery-analysis of cost drivers.

PURPOSE: To map healthcare utilized by subjects with chronic otitis media, with or without cholesteatoma and perform a cost analysis to determine key drivers of healthcare expenditure. METHODS: A registry study of 656 adult subjects with chronic otitis media that underwent a middle ear surgery between 2014 and 2018. Healthcare contacts related to all publicly funded specialist ENT care, audiological care and primary care for a disease of the ear and mastoid process were extracted. The data are extracted from the Swedish National Patient Registry on subjects that reside in western Sweden. RESULTS: Subjects made 13,782 healthcare contacts at a total cost 61.1 million SEK (6.0 million EUR) between 2014 and 2018. The mean cost per subject was 93,075 SEK (9071 EUR) and ranged between 3971 SEK (387 EUR) and 468,711 SEK (45,683 EUR) per individual. In the most expensive quartile of subjects, mean cost was 192,353 SEK (18,747 EUR) over the 5-year period. These subjects made 3227 ENT contacts (roughly four each year) and 60% of total costs were associated with in-patient ENT care. CONCLUSION: Patients with chronic otitis media are associated with high ENT resource utilization that does not diminish after surgical intervention and the disease places a long-term burden on healthcare systems. Significant costs are attributed to revision surgeries, indicating that these patients could be managed more effectively. In many such cases, reoperation cannot be avoided, especially due to recurrence of cholesteatoma. However, in some patients, when the indication for subsequent surgery is only hearing improvement, alternative options, such as hearing aids or implants, should also be considered. This is especially true in difficult cases, where revision ossiculoplasty is likely.

GM2 Gangliosidoses: Clinical Features, Pathophysiological Aspects, and Current Therapies.

GM2 gangliosidoses are a group of pathologies characterized by GM2 ganglioside accumulation into the lysosome due to mutations on the genes encoding for the ß-hexosaminidases subunits or the GM2 activator protein. Three GM2 gangliosidoses have been described: Tay-Sachs disease, Sandhoff disease, and the AB variant. Central nervous system dysfunction is the main characteristic of GM2 gangliosidoses patients that include neurodevelopment alterations, neuroinflammation, and neuronal apoptosis. Currently, there is not approved therapy for GM2 gangliosidoses, but different therapeutic strategies have been studied including hematopoietic stem cell transplantation, enzyme replacement therapy, substrate reduction therapy, pharmacological chaperones, and gene therapy. The blood-brain barrier represents a challenge for the development of therapeutic agents for these disorders. In this sense, alternative routes of administration (e.g., intrathecal or intracerebroventricular) have been evaluated, as well as the design of fusion peptides that allow the protein transport from the brain capillaries to the central nervous system. In this review, we outline the current knowledge about clinical and physiopathological findings of GM2 gangliosidoses, as well as the ongoing proposals to overcome some limitations of the traditional alternatives by using novel strategies such as molecular Trojan horses or advanced tools of genome editing.

Pressure-Controlled Layer-by-Layer to Continuous Oxidation of ZrS2(001) Surface.

Understanding oxidation mechanisms of layered semiconducting transition-metal dichalcogenides (TMDC) is important not only for controlling native oxide formation but also for synthesis of oxide and oxysulfide products. Here, reactive molecular dynamics simulations show that oxygen partial pressure controls not only the ZrS2 oxidation rate but also the oxide morphology and quality. We find a transition from layer-by-layer oxidation to amorphous-oxide-mediated continuous oxidation as the oxidation progresses, where different pressures selectively expose different oxidation stages within a given time window. While the kinetics of the fast continuous oxidation stage is well described by the conventional Deal-Grove model, the layer-by-layer oxidation stage is dictated by reactive bond-switching mechanisms. This work provides atomistic details and a potential foundation for rational pressure-controlled oxidation of TMDC materials.

Impact of climate change on groundwater recharge in shallow young glacial aquifers in northern Poland.

We investigated the influence of climate change in the period 1951-2020 on shallow aquifers in the Brda and Wda outwash plains (Pomeranian Region, Northern Poland). There was a significant temperature rise (0.3 °C/10 years), which accelerated after 1980 (0.66 °C/10 years). Precipitation became increasingly irregular - extremely rainy years occurred right after or before extremely dry years, and intensive rainfall events became more frequent after 2000. The groundwater level decreased over the last 20 years, even though the average annual precipitation was higher than in the previous 50 years. We carried out numerical simulations of water flow in representative soil profiles for the years 1970-2020 using the HYDRUS-1D model, developed and calibrated during our earlier work at an experimental site in the Brda outwash plain (Gumula-Kawecka et al., 2022). We used a relationship between the water head and flux at the bottom of the soil profiles (the third-type boundary condition) to reproduce groundwater table fluctuations caused by recharge variability in time. The calculated daily recharge showed a decreasing linear trend for the last 20 years (0.05-0.06 mm d-1/10 years), and dropping trends in water table level and soil water content in the entire profile of vadose zone. Field tracer experiments were performed to estimate impact of extremely rain events on water flux in vadose zone. The results suggest that tracer travel times are strongly determined by water content in the unsaturated zone which is determined by precipitation amount in span of weeks, rather than extremely high precipitation events.

Recent Advances in 2D Material Theory, Synthesis, Properties, and Applications.

Two-dimensional (2D) material research is rapidly evolving to broaden the spectrum of emergent 2D systems. Here, we review recent advances in the theory, synthesis, characterization, device, and quantum physics of 2D materials and their heterostructures. First, we shed insight into modeling of defects and intercalants, focusing on their formation pathways and strategic functionalities. We also review machine learning for synthesis and sensing applications of 2D materials. In addition, we highlight important development in the synthesis, processing, and characterization of various 2D materials (e.g., MXnenes, magnetic compounds, epitaxial layers, low-symmetry crystals, etc.) and discuss oxidation and strain gradient engineering in 2D materials. Next, we discuss the optical and phonon properties of 2D materials controlled by material inhomogeneity and give examples of multidimensional imaging and biosensing equipped with machine learning analysis based on 2D platforms. We then provide updates on mix-dimensional heterostructures using 2D building blocks for next-generation logic/memory devices and the quantum anomalous Hall devices of high-quality magnetic topological insulators, followed by advances in small twist-angle homojunctions and their exciting quantum transport. Finally, we provide the perspectives and future work on several topics mentioned in this review.

Measuring and Then Eliminating Twin Domains in SnSe Thin Films Using Fast Optical Metrology and Molecular Beam Epitaxy.

van der Waals (vdW) layered chalcogenides have strongly direction-dependent (i.e., anisotropic) properties that make them interesting for photonic and optoelectronic applications. Orthorhombic tin selenide (α-SnSe) is a triaxial vdW material with strong optical anisotropy within layer planes, which has motivated studies of optical phase and domain switching. As with every vdW material, controlling the orientation of crystal domains during growth is key to reliably making wafer-scale, high-quality thin films, free from twin boundaries. Here, we demonstrate a fast optical method to quantify domain orientation in SnSe thin films made by molecular beam epitaxy (MBE). The in-plane optical anisotropy results in white-light being reflected into distinct colors for certain optical polarization angles and the color depends on domain orientation. We use our method to confirm a high density of twin boundaries in SnSe epitaxial films on MgO substrates, with square symmetry that results in degeneracy between SnSe 90° domain orientations. We then demonstrate that growing on a-plane sapphire, with rectangular lattice-matched symmetry that breaks the SnSe domain degeneracy, results in single-crystalline films with one preferred orientation. Our SnSe bottom-up film synthesis by MBE enables future applications of this vdW material that is particularly difficult to process by top-down methods. Our optical metrology is fast and can apply to all triaxial vdW materials.

Hearing Rehabilitation of Patients with Chronic Otitis Media: A Discussion of Current State of Knowledge and Research Priorities.

Although chronic otitis media is a major cause of conductive and mixed hearing loss, auditory rehabilitation is currently not optimal for this patient group. Planning for hearing rehabilitation must accompany strategies for infection control when surgically managing patients with chronic otitis media. Several barriers prevent adequate hearing restoration in such a heterogeneous patient population. A lack of standardized reporting of surgical interventions, hearing, and quality of life outcomes impedes meta-analyses of existing data and the generation of high- quality evidence, including cost-effectiveness data, through prospective studies. This, in turn, prevents the ability of clinicians to stratify patients based on prognostic indicators, which could guide the decision-making pathway. Strategies to improve reporting standards and methods have the potential to classify patients with chronic otitis media preoperatively, which could guide decision-making for hearing restoration with ossicu- loplasty versus prosthetic hearing devices. Appropriately selected clinical guidelines would not only foster directed research but could enhance patient-centered and evidence-based decision-making regarding hearing rehabilitation in the surgical planning process.

Coupling time-lapse ground penetrating radar surveys and infiltration experiments to characterize two types of non-uniform flow.

Understanding linkages between heterogeneous soil structures and non-uniform flow is fundamental for interpreting infiltration processes and improving hydrological simulations. Here, we utilized ground-penetrating radar (GPR) as a non-invasive technique to investigate those linkages and to complement current traditional methods that are labor-intensive, invasive, and non-repeatable. We combined time-lapse GPR surveys with different types of infiltration experiments to create three-dimensional (3D) diagrams of the wetting dynamics. We carried out the GPR surveys and validated them with in situ observations, independent measurements and field excavations at two experimental sites. Those sites were selected to represent different mechanisms that generate non-uniform flow: (1) preferential water infiltration initiated by tree trunk and root systems; and (2) lateral subsurface flow due to soil layering. Results revealed links between different types of soil heterogeneity and non-uniform flow. The first experimental site provided evidence of root-induced preferential flow paths along coarse roots, emphasizing the important role of coarse roots in facilitating preferential water movement through the subsurface. The second experimental site showed that water infiltrated through the restrictive layer mainly following the plant root system. The presented approach offers a non-invasive, repeatable and accurate way to detect non-uniform flow.

Success rates in restoring hearing loss in patients with chronic otitis media: A systematic review.

OBJECTIVE: To assess the effectiveness of tympanoplasty in treating chronic otitis media-related hearing loss, published literature was systematically reviewed to determine the clinical success rate of tympanoplasty at restoring hearing in chronic otitis media patients at a minimum follow-up period of 12-months. DATA SOURCES: PubMed, Embase and the Cochrane Library. METHODS: Two independent reviewers performed literature searches. Publications reporting long-term (≥12-month) hearing outcomes and complications data on adult and pediatric patients with chronic otitis media were included and assessed for risk of bias and strength of evidence. To assess how tympanoplasty influences long-term hearing outcomes, data on pure tone audiometry (air-bone gap) and complications were extracted and synthesized. RESULTS: Thirty-nine studies met the inclusion criteria. Data from 3162 patients indicated that 14.0% of patients encountered postoperative complications. In adult patients, mean weighted air-bone gap data show closure from 26.5 dB hearing level (HL) (preoperatively) to 16.1 dB HL (postoperatively). In studies that presented combined adult and pediatric data, the mean preoperative air-bone gap of 26.7 dB HL was closed to 15.4 dB HL. In 1370 patients with synthesizable data, 70.7% of patients had a postoperative air-bone gap ˂ 20 dB HL at long-term follow-up. Finally, subgroup analysis identified that mean improvement in ABG closure for patients with and without cholesteatoma was 10.0 dB HL and 12.4 dB HL, respectively. CONCLUSION: In patients with chronic otitis media, tympanoplasty successfully closed the air-bone gap to within 20 dB HL in 7/10 cases and had an overall complication rate of 14.0%. LEVEL OF EVIDENCE: 2a.

Reactivity of vadose-zone solids to S-metolachlor and its two main metabolites: case of a glaciofluvial aquifer.

The vulnerability of groundwater to pesticides is governed in part by sorption mechanisms in the vadose zone, commonly studied in soil but less well-known in the geological solids. To alleviate this lack of knowledge, adsorption of the herbicide S-metolachlor (SMOC) and of two of its metabolites-metolachlor ethane sulfonic acid (MESA) and metolachlor oxanilic acid (MOXA)-was studied with batch equilibrium method on seventeen surface soils and three geological solids of the vadose zone overlying a glaciofluvial aquifer. In grainsize terms, the latter three were sand for the first two samples and gravel for the third. Adsorption is ordered as follows: SMOC > > MESA > MOXA, except for one of the geological solids for which MESA adsorption was slightly higher than that of SMOC (Kd = 0.73 vs. 0.44 L kg-1). The low MOXA adsorption could only be quantified for the gravel sample (Kd = 0.74 L kg-1), which was also more reactive than all the other samples to MESA and SMOC (Kd = 2.08 and 28.8 L kg-1, respectively). Statistical multivariate tests related the highest Kd values for SMOC with the soils and geological solids with the highest organic-carbon and clay-fraction contents. The highest Kd values for MESA were found in the samples containing high oxide concentrations. Our results shed a new light on the adsorption of SMOC, MESA and MOXA suggesting that during their transfer to groundwater, pesticides and metabolites can be adsorbed in the vadose zone on both soils and geological solids.

Field measurement of effects of individual and combined application of biochar and polyacrylamide on erosion variables in loess and marl soils.

Controlling soil erosion, especially in its initial stages, is greatly important in natural resources management. Consequently, the present research aimed to control splash and interrill erosion in two soil types (marl at Marzan-Abad and loess at Maraveh-Tapeh sites in northern Iran) using biochar (BC) and polyacrylamide (PAM). We established 0.5 × 0.5-m plots and applied BC (800 g·m-2), PAM (2 g·m-2), and BC + PAM (800 g·m-2 + 2 g·m-2) with control plots and three replications on a slope of ~25%. We used a rainfall simulator to achieve rainfall intensity of 50 mm·h-1 with 30-min duration in the experiments. Analysis of the results obtained from the variables of splash and interrill erosion during the rainfall-runoff process showed that the PAM significantly (p ≤ 0.05) increased all study variables of splash erosion. For interrill erosion, it reduced the variables of soil loss and sediment concentration. However, the difference was not significant (p > 0.05) compared to the control plot and runoff from the two treatment sites increased relative to that from the control plots. The plot treated with BC showed decreased runoff volume, runoff coefficient, and soil loss compared to the control plot at the Marzan-Abad site, but the differences were not statistically significant (p > 0.05). However, the plot in which loess soil was treated with BC at the Maraveh-Tapeh site exhibited considerably (p ≤ 0.05) increased runoff and soil loss compared to the control plot. The entire results verified a wide range for benefit reduction of study treatments from +25.09 to -37.49% for runoff and from +38.59 to -231% for soil loss with more effectiveness for Maraveh-Tapeh Loess soil as well as combined application of BC and PAM. These findings contribute to improved understanding of proper application of soil amendments to control runoff and soil loss in loam and loess soils.

Phosphate-solubilizing Pseudomonas sp., and Serratia sp., co-culture for Allium cepa L. growth promotion.

Different genus of bacteria has been reported with the capacity to solubilize phosphorus from phosphate rock (PR). Pseudomonas sp., (A18) and Serratia sp., (C7) isolated from soils at the "Departamento de Boyacá" Colombia, where Allium cepa is cultivated. Bacteria were cultured in MT11B media and evaluated as a bio-fertilizer for A. cepa germination and growth during two months at greenhouse scale. Pseudomonas sp., and Serratia sp., cultured at 30 °C, 48 h in SMRS1 agar modified with PR, (as an inorganic source of phosphorus), presented a phosphate solubilization index (SI) of 2.1 ± 0.2 and 2.0 ± 0.3 mm, respectively. During interaction assays no inhibition halos were observed, demonstrating there was no antagonism between them. In MT11B media growth curve (12 h) demonstrated that co-culture can grow in the presence of PR and glucose concentrations 7.5-fold, lower than in SMRS1 media and brewer's yeast hydrolysate; producing phosphatase enzymes with a volumetric activity of 1.3 ± 0.03 PU at 6 h of culture and 0.8 ± 0.04 PU at 12 h. Moreover, co-culture released soluble phosphorus at a rate of 58.1 ± 0.28 mg L-1 at 8 h and 88.1 ± 0.32 mg L-1 at 12 h. After five days of evaluation it was observed that germination percentage was greater than 90 % of total evaluated seeds, when placing them in contact with the co-culture in a concentration of 1 × 108 CFU mL-1. Furthermore, it was demonstrated that co-culture application (10 mL per experimental unit to complete 160 mL in two months) at 8.0 Log10 CFU mL-1 twice a week for two months increased A. cepa total dry weight (69 ± 13 mg) compared with total dry weight (38 ± 5.0 mg) obtained with the control with water.

Detecting infiltrated water and preferential flow pathways through time-lapse ground-penetrating radar surveys.

The objective of this paper was to identify the incidence and extent of preferential flow at two experimental areas located in Lyon, France. We used time-lapse ground-penetrating radar (GPR) surveys in conjunction with automatized single-ring infiltration experiments to create three-dimensional (3D) representations of infiltrated water. In total we established three 100 cm × 100 cm GPR grids and used differenced radargrams from pre- and post-infiltration surveys to detect wetting patterns. The analyzed time-lapse GPR surveys revealed the linkage between nonuniform flow and heterogeneous soil structures and plant roots. At the first experimental area, subsurface coarse gravels acted as capillary barriers that concentrated flow into narrow pathways via funneled flow. At the second experimental area, the interpolated 3D patterns closely matched direct observation of dyed patterns, thereby validating the applied protocol. They also highlighted the important role of plant roots in facilitating preferential water movement through the subsurface. The protocol presented in this study represents a valuable tool for improving the hydraulic characterization of highly heterogeneous soils, while also alleviating some of the excessive experimental efforts currently needed to detect preferential flow pathways in the field.

A perspective on research, diagnosis, and management of lysosomal storage disorders in Colombia.

Lysosomal storage diseases (LSDs) are a group of about 50 inborn errors of metabolism characterized by the lysosomal accumulation of partially or non-degraded molecules due to mutations in proteins involved in the degradation of macromolecules, transport, lysosomal biogenesis or modulators of lysosomal environment. Significant advances have been achieved in the diagnosis, management, and treatment of LSDs patients. In terms of approved therapies, these include enzyme replacement therapy (ERT), substrate reduction therapy, hematopoietic stem cell transplantation, and pharmacological chaperone therapy. In this review, we summarize the Colombian experience in LSDs thorough the evidence published. We identified 113 articles published between 1995 and 2019 that included Colombian researchers or physicians, and which were mainly focused in Mucopolysaccharidoses, Pompe disease, Gaucher disease, Fabry disease, and Tay-Sachs and Sandhoff diseases. Most of these articles focused on basic research, clinical cases, and mutation reports. Noteworthy, implementation of the enzyme assay in dried blood samples, led to a 5-fold increase in the identification of LSD patients, suggesting that these disorders still remain undiagnosed in the country. We consider that the information presented in this review will contribute to the knowledge of a broad spectrum of LSDs in Colombia and will also contribute to the development of public policies and the identification of research opportunities.

Glyphosate and AMPA adsorption in soils: laboratory experiments and pedotransfer rules.

Adsorption of the herbicide glyphosate and its main metabolite AMPA (aminomethylphosphonic acid) was investigated on 17 different agricultural soils. Batch equilibration adsorption data are shown by Freundlich adsorption isotherms. Glyphosate adsorption is clearly affected by equilibration concentrations, but the nonlinear AMPA adsorption isotherms indicate saturation of the adsorption sites with increasing equilibrium concentrations. pHCaCl2 (i.e. experimental pH) is the major parameter governing glyphosate and AMPA adsorption in soils. However, considering pHCaCl2 values, available phosphate amount, and amorphous iron and aluminium oxide contents by using a nonlinear multiple regression equation, obtains the most accurate and powerful pedotransfer rule for predicting the adsorption constants for these two molecules. As amorphous iron and aluminium oxide contents in soil are not systematically determined, we also propose a pedotransfer rule with two variables-pHCaCl2 values and available phosphate amount-that remains acceptable for both molecules. Moreover, the use of the commonly measured pHwater or pHKCl values gives less accurate results compared to pHCaCl2 measurements. To our knowledge, this study is the first AMPA adsorption characterization for a significant number of temperate climate soils.