Bridging the Gap between Field Experiments and Machine Learning: The EC H2020 B-GOOD Project as a Case Study towards Automated Predictive Health Monitoring of Honey Bee Colonies.

Honey bee colonies have great societal and economic importance. The main challenge that beekeepers face is keeping bee colonies healthy under ever-changing environmental conditions. In the past two decades, beekeepers that manage colonies of Western honey bees (Apis mellifera) have become increasingly concerned by the presence of parasites and pathogens affecting the bees, the reduction in pollen and nectar availability, and the colonies' exposure to pesticides, among others. Hence, beekeepers need to know the health condition of their colonies and how to keep them alive and thriving, which creates a need for a new holistic data collection method to harmonize the flow of information from various sources that can be linked at the colony level for different health determinants, such as bee colony, environmental, socioeconomic, and genetic statuses. For this purpose, we have developed and implemented the B-GOOD (Giving Beekeeping Guidance by computational-assisted Decision Making) project as a case study to categorize the colony's health condition and find a Health Status Index (HSI). Using a 3-tier setup guided by work plans and standardized protocols, we have collected data from inside the colonies (amount of brood, disease load, honey harvest, etc.) and from their environment (floral resource availability). Most of the project's data was automatically collected by the BEEP Base Sensor System. This continuous stream of data served as the basis to determine and validate an algorithm to calculate the HSI using machine learning. In this article, we share our insights on this holistic methodology and also highlight the importance of using a standardized data language to increase the compatibility between different current and future studies. We argue that the combined management of big data will be an essential building block in the development of targeted guidance for beekeepers and for the future of sustainable beekeeping.

Cytosine-rich mismatched DNA aptamer combined with superparamagnetic photonic crystal sensing material for the specific visual detection of silver ions.

DNA aptamer superparamagnetic photonic crystals (DSPCs), enriched with a highly selective cytosine-rich mismatched single-stranded DNA aptamer (CRDA), were successfully employed in a novel visual detection strategy for the detection of silver ions (Ag+). The technologies of superparamagnetic colloidal nanospheres (SCNs), DNA aptamer, and photonic crystals were combined to fabricate DPSCs. The aptamer was immobilized via electrostatic adsorption with amino groups that were chemically introduced on the surface of the SCNs, forming D-NH-SCNs. The detection is achieved by forming an Ag+ complex (C-Ag+-C) between Ag+ and D-NH-SCN. The DSPCs assembled under a magnetic field by D-NH-SCNs effectively detected Ag+ in the range of 1 µg/L to 5 mg/L, corresponding to the critical concentration range for heavy metals in drinking water. During the detection, the DSPC exhibited a wavelength blueshift from 652.8 nm to 626.4 nm (26.4 nm), as well as changes in reflection intensity. Notably, when detecting Ag+, a change in DSPC color from orange to yellow was observed. In summary, the developed visual detection material facilitates direct Ag + sensing. In the future, different DNA aptamers will be modified further to detect various targets in the fields of medicine, environmental monitoring, and food safety.

How patients with severe mental illness experience care provided by psychiatric mental health nurse practitioners.

BACKGROUND: Previous studies in somatic health care revealed that patients find nurse practitioners reliable, helpful, and empathic and feel empowered, at peace, and in control when cared for by nurse practitioners (NPs). Only one study so far considered what value people with severe mental illness (SMI) attached to treatment by a psychiatric mental health nurse practitioner (PMHNP). PURPOSE: To explore what meaning people with SMI associate with the care provided by a PMHNP. METHODOLOGY: A qualitative study from a phenomenological perspective was conducted, in which 32 people with SMI were interviewed. Data were analyzed using Colaizzi's seven-step method and the metaphor identification procedure (MIP). RESULTS: Eight fundamental themes emerged: (1) impact of the PMHNP on well-being, (2) feeling connected with, and (3) acknowledged by the PMHNP; (4) the PMHNP's care (not) needed; (5) perception of the PMHNP as a person; (6) shared decision-making; (7) PMHNP's expertise; and (8) flexibility of contact with the PMHNP. MIP analysis revealed six metaphors: PMHNP is a travel aid, means trust, is a combat unit, means hope, is an exhaust valve, and a helpdesk/encyclopedia. CONCLUSIONS: The interviewees highly appreciated the treatment and support by the PMHNP for the impact on their well-being. Thanks to the connection with and recognition by the PMHNP, they felt empowered, human, and understood. Challenged by the PMHNP, they focused on possibilities to strengthen self-confidence and self-acceptance. IMPLICATIONS: For further positioning of and education for PMHNPs, it is recommended to consider the meaning people with SMI associate with treatment and support by a PMHNP.

A Fully Integrated Miniaturized Optical Biosensor for Fast and Multiplexing Plasmonic Detection of High- and Low-Molecular-Weight Analytes.

Optical biosensors based on plasmonic sensing schemes combine high sensitivity and selectivity with label-free detection. However, the use of bulky optical components is still hampering the possibility of obtaining miniaturized systems required for analysis in real settings. Here, a fully miniaturized optical biosensor prototype based on plasmonic detection is demonstrated, which enables fast and multiplex sensing of analytes with high- and low molecular weight (80 000 and 582 Da) as quality and safety parameters for milk: a protein (lactoferrin) and an antibiotic (streptomycin). The optical sensor is based on the smart integration of: i) miniaturized organic optoelectronic devices used as light-emitting and light-sensing elements and ii) a functionalized nanostructured plasmonic grating for highly sensitive and specific localized surface plasmon resonance (SPR) detection. The sensor provides quantitative and linear response reaching a limit of detection of 10-4 refractive index units once it is calibrated by standard solutions. Analyte-specific and rapid (15 min long) immunoassay-based detection is demonstrated for both targets. By using a custom algorithm based on principal-component analysis, a linear dose-response curve is constructed which correlates with a limit of detection (LOD) as low as 3.7 µg mL-1 for lactoferrin, thus assessing that the miniaturized optical biosensor is well-aligned with the chosen reference benchtop SPR method.

Choice of treatment evaluated after trial periods with bone conduction devices and contralateral routing of sound systems in patients with single-sided deafness.

Objectives: Patients with single-sided deafness (SSD) may experience difficulties with speech perception in noise, sound localization, have tinnitus and experience a reduced quality of life (QoL). contralateral routing of sound hearing aids (CROS) or bone conduction devices (BCD) may partly improve subjective speech communication and QoL in SSD patients. A trial period with these devices can help in making a well-informed choice of treatment. Our aim was to evaluate factors influencing the choice of treatment made after a BCD and CROS trial period in adult SSD patients. Methods: Patients were randomized in the: "first BCD, then CROS" or "first CROS, then BCD" trial period group. After the BCD on headband and CROS were tested for 6 weeks each, patients choose for BCD, CROS or no treatment. Primary outcome was the distribution of choice of treatment. Secondary outcomes included the association between the choice of treatment and patient characteristics, reasons for treatment acceptance or rejection, device usage during the trial periods, and disease-specific QoL outcomes. Results: Of 91 patients randomized, 84 completed both trial periods and made their choice of treatment: 25 (30%) BCD, 34 (40%) CROS, and 25 (30%) no treatment. No characteristics were found to be related to choice of treatment. Top three reasons for acceptance or rejection were: device (dis)comfort, sound quality and (dis)advantage of subjective hearing. Average daily device use during the trial periods was higher for CROS than for BCD. Choice of treatment was significantly related with both duration of device usage and greater improvement of QoL after the corresponding trial period. Conclusion: The majority of SSD patients preferred BCD or CROS over no treatment. Evaluating device usage, discussing treatment (dis)advantages and disease-specific QoL outcomes after trial periods are to be considered during patient counseling and could facilitate whether to choose one of these treatments. Level of evidence: 1B.

[Deployment of the nurse practitioner and physician assistant in The Netherlands]. / De inzet van de verpleegkundig specialist en physician assistant.

The Physician Assistant and the Nurse Practitioner have been successfully implemented in the Dutch health care system. The professionals provide good quality care, contribute to reducing the workload of physicians, and in most cases are cost-effective. The changing labor market, the increased demand for care and the way health care is organized will further increase demand. Within the labor market, we see several developments affecting the demand for PAs and USs; the need for physicians to have more work-life balance and the shortage of residents not in training ('anioses'). The increased and changing demand for care also requires additional staff, in this case PAs and VSs. In addition, it appears to be quite possible to have care performed by a PA or VS supported by the use of technology and guidelines.

Neonicotinoid Microsphere Immunosensing for Profiling Applications in Honeybees and Bee-Related Matrices.

Neonicotinoids are the most commonly used insecticides due to their effectiveness. However, non-targeted insects, especially bees, are also affected by neonicotinoids. Therefore, neonicotinoid application can contribute to the declining bee populations worldwide. The presented study describes the development of novel competitive, fluorescent microsphere-based suspension immunoassays for neonicotinoid profiling and their application to bees and essential bee-related matrices, using the Multi-Analyte Profiling (xMAP) technology. For the construction of these neonicotinoid microsphere immunoassays (nMIAs), neonicotinoid-ovalbumin conjugates were coupled to unique fluorescent, paramagnetic microspheres, which competed with the free neonicotinoids that were present in test samples for interacting with the corresponding, specific antibodies. In total, five independent nMIA's were developed for the detection of imidacloprid, acetamiprid, clothianidin, thiacloprid, thiamethoxam, dinotefuran, nitenpyram and imidaclothiz with the limits of detection being for 0.01 ng/mL, 0.01 ng/mL, 0.02 ng/mL, 0.02 ng/mL, 0.003 ng/mL, 2.95 ng/mL, 0.09 ng/mL and 0.04 ng/mL, respectively. The developed nMIAs were applied to fortified matrices including surface water, pollen, honey and honeybees. All of the neonicotinoids, except dinotefuran, could be sensitively detected in all of the tested environmental matrices and bees, with there being sensitivities of 1 ng/mL in water and 10 ng/g in solid materials. These nMIAs provide a rapid profiling method for all of the common neonicotinoids, including those that are banned by the European Union for outdoor use. The developed method can contribute to healthy and sustainable beekeeping, globally, via its application in the apiary environment.

Biosensing Chlorpyrifos in Environmental Water Samples by a Newly Developed Carbon Nanoparticle-Based Indirect Lateral Flow Assay.

Pesticides are used in agriculture to prevent pests. Chlorpyrifos (CHLP) is an insecticide with potentially detrimental effects on humans, bees, and the aquatic environment. Its effects have led to a total ban by the European Union (EU), but outside the EU, CHLP is still produced and used. An indirect lateral flow immunoassay (LFIA) for the detection of CHLP was developed and integrated into a cassette to create a lateral flow device (LFD). Species-specific reporter antibodies were coupled to carbon nanoparticles to create a detector conjugate. Water samples were mixed with a specific CHLP monoclonal antibody and detector conjugate and applied to the LFD. Dose-response curves elicited the detection of low concentrations of CHLP (<1 µg/L). This sensitivity was recorded through a rapid handheld digital imaging device but also visually by naked eye. The CHLP LFD was applied to a range of European surface water samples, fortified with CHLP, revealing a sensitivity in these matrices of 2 µg/L, both by digital and visual analysis. To improve the simplicity of the CHLP LFIA, the assay reagents were dried in tubes, enabling to carry out the test by simply adding water samples and inserting the LFIA strips. This CHLP LFIA is thus suited for the on-site screening of surface waters.

Exposure and risk assessment of acetamiprid in honey bee colonies under a real exposure scenario in Eucalyptus sp. landscapes.

Honey bee colonies have shown abnormal mortality rates over the last decades. Colonies are exposed to biotic and abiotic stressors including landscape changes caused by human pressure. Modern agriculture and even forestry, rely on pesticide inputs and these chemicals have been indicated as one of the major causes for colony losses. Neonicotinoids are a common class of pesticides used worldwide that are specific to kill insect pests, with acetamiprid being the only neonicotinoid allowed to be applied outdoors in the EU. To evaluate honeybees' exposure to acetamiprid under field conditions as well as to test the use of in-situ tools to monitor pesticide residues, two honeybee colonies were installed in five Eucalyptus sp. plantations having different area where Epik® (active substance: acetamiprid) was applied as in a common spraying event to control the eucalyptus weevil pest. Flowers, fresh nectar, honey bees and colony products samples were collected and analyzed for the presence of acetamiprid residues. Our main findings were that (1) acetamiprid residues were found in samples collected outside the spraying area, (2) the amount of residues transported into the colonies increased with the size of the sprayed area, (3) according to the calculated Exposure to Toxicity Ratio (ETR) values, spraying up to 22 % of honeybees foraging area does not harm the colonies, (4) colony products can be used as a valid tool to monitor colony accumulation of acetamiprid and (5) the use of Lateral Flow Devices (LFDs) can be a cheap, fast and easy tool to apply in the field, to evaluate the presence of acetamiprid residues in the landscape and colony products.

Development of a Microsphere-Based Immunoassay Authenticating A2 Milk and Species Purity in the Milk Production Chain.

Processed milk and milk products produced from bovine milk, commonly contain ß-casein A1 (ßCA1) and ß-casein A2 (ßCA2). Since the presence of ßCA1 is linked to milk intolerance and digestion problems, A2A2 milk, which only contains ßCA2, is proposed as a healthier alternative. To support this health claim, the purity of A2A2-milk has to be guaranteed. In the presented study, a multiplex immunoassay, able to distinguish between ßCA2 and ßCA1, was developed and real-life applicability was shown on raw milk samples from genotyped A1A1, A1A2 and A2A2 cows. Because of its ability to discriminate between ßCA2 and ßCA1, this newly developed method was able to detect the addition of common bovine A1A2 milk to A2A2 milk, as low as 1%. Besides the detection of A2A2 milk purity, the developed assay can also be implemented as a rapid phenotyping method at dairy farms to replace the more invasive DNA-based screening. Additionally, the developed method was capable of detecting the addition of common bovine milk up to 1% in sheep, goat, buffalo, horse and donkey milk, which conforms to EU recommendations. In conclusion, a newly developed multiplex method capable of reliably detecting the dilution of A2A2 milk of multiple species, with common bovine milk up to 1%, is presented.

Computer-aided profiling of a unique broad-specific antibody and its application to an ultrasensitive fluoroimmunoassay for five N-methyl carbamate pesticides.

Pollution of N-methyl carbamate (NMC) pesticides is threatening the non-target organisms' survival. Thus, broad-specific antibodies and class-selective immunoassays are demanding for multiple NMCs determination. In this study, we employed a molecular docking-based virtual screening strategy to fast profile antibody spectrum, based on a designed chemical pool containing 17 compounds. A monoclonal antibody (mAb)-6G against carbofuran was used as the objective. The recombinant full-length IgG was successfully expressed to validate the antibody sequences for homology modeling. After docking, we manually categorized the antibody-chemical binding strength into three groups. Non-competitive surface plasmon resonance (SPR) demonstrated the mAb-6G affinitive binding toward five NMCs (carbofuran, isoprocarb, propoxur, carbaryl and carbosulfan), which were classified into strong and moderate binding categories. Antibody binding properties were confirmed again by ic-ELISA and lateral flow immunochromatographic strip. Subsequently, an ultrasensitive indirect competitive fluoromicrosphere-based immunoassay (ic-FMIA) was established with the IC50 (half-maximal inhibitory concentration) values of 0.08-3.37 ng/mL. This portable assay presented a 30-230-fold improved sensitivity than traditional ic-ELISA and was applied in European surface water analysis. Overall, our work provides an efficient platform integrating in-silico and experimental methodologies to accelerate the characterization of hapten-specific antibody binding properties and the development of high-sensitive immunoassays for multi-pollutants monitoring.

Short-term outcomes of cochlear implantation for single-sided deafness compared to bone conduction devices and contralateral routing of sound hearing aids-Results of a Randomised controlled trial (CINGLE-trial).

Single-sided deafness (SSD) leads to difficulties with speech perception in noise, sound localisation, and sometimes tinnitus. Current treatments (Contralateral Routing of Sound hearing aids (CROS) and Bone Conduction Devices (BCD)) do not sufficiently overcome these problems. Cochlear implants (CIs) may help. Our aim was to evaluate these treatments in a Randomised Controlled Trial (RCT). Adult SSD patients were randomised using a web-based randomisation tool into one of three groups: CI; trial period of 'first BCD, then CROS'; trial period of 'first CROS, then BCD'. After these trial periods, patients opted for BCD, CROS, or No treatment. The primary outcome was speech perception in noise (directed from the front (S0N0)). Secondary outcomes were speech perception in noise with speech directed to the poor ear and noise to the better ear (SpeNbe) and vice versa (SbeNpe), sound localisation, tinnitus burden, and disease-specific quality of life (QoL). We described results at baseline (unaided situation) and 3 and 6 months after device activation. 120 patients were randomised. Seven patients did not receive the allocated intervention. The number of patients per group after allocation was: CI (n = 28), BCD (n = 25), CROS (n = 34), and No treatment (n = 26). In S0N0, the CI group performed significantly better when compared to baseline, and when compared to the other groups. In SpeNbe, there was an advantage for all treatment groups compared to baseline. However, in SbeNpe, BCD and CROS groups performed worse compared to baseline, whereas the CI group improved. Only in the CI group sound localisation improved and tinnitus burden decreased. In general, all treatment groups improved on disease-specific QoL compared to baseline. This RCT demonstrates that cochlear implantation for SSD leads to improved speech perception in noise, sound localisation, tinnitus burden, and QoL after 3 and 6 months of follow-up. For most outcome measures, CI outperformed BCD and CROS. Trial registration: Netherlands Trial Register (www.trialregister.nl): NTR4580, CINGLE-trial.

Controlled Production of Zearalenone-Glucopyranoside Standards with Cunninghamella Strains Using Sulphate-Depleted Media.

In recent years, conjugated mycotoxins have gained increasing interest in food safety, as their hydrolysis in human and animal intestines leads to an increase in toxicity. For the production of zearalenone (ZEN) glycosides reference standards, we applied Cunninghamellaelegans and Cunninghamella echinulata fungal strains. A sulphate-depleted medium was designed for the preferred production of ZEN glycosides. Both Cunninghamella strains were able to produce zearalenone-14-ß-D-glucopyranoside (Z14G), zearalenone-16-ß-D-glucopyranoside (Z16G) and zearalenone-14-sulphate (Z14S). In a rich medium, Cunninghamellaelegans preferably produced Z14S, while Cunninghamellaechinulata preferably produced Z14G. In the sulphate-depleted medium a dramatic change was observed for Cunninghamellaelegans, showing preferred production of Z14G and Z16G. From 2 mg of ZEN in sulphate-depleted medium, 1.94 mg of Z14G and 0.45 mg of Z16G were produced. Following preparative Liquid Chromatography-Mass Spectrometry (LC-MS) purification, both fractions were submitted to 1H and 13C NMR and High-Resolution Mass Spectrometry (HRMS). These analyses confirmed that the purified fractions were indeed Z14G and Z16G. In conclusion, the presented research shows that a single Cunninghamella strain can be an effective and efficient tool for the controlled biotransformation of ZEN glycosides and other ZEN metabolites. Additionally, the biotransformation method was extended to zearalanone, ß-zearalenol and other mycotoxins.

Impact of nurse practitioner care on patients with chronic conditions.

BACKGROUND: A previous study found that care provided by a nurse practitioner (NP) during oncological or palliative care was highly regarded. These patients, however, were considered a special population due to suffering from life-threatening illnesses. It remains unclear whether the results are transferable to patients with chronic conditions. Patient's perceptions of the quality of NP care have reflected that it equals or exceeds that of physicians, but the root causes of these remarks remain unclear. PURPOSE: To describe the difference in perception of NP care by patients suffering from chronic heart failure (CHF) or inflammatory bowel disease (IBD) in contrast with NP oncological or palliative care. METHODOLOGICAL ORIENTATION: A qualitative study from a phenomenological perspective was conducted. Data were analyzed using Colaizzi's seven-step method and the Metaphor Identification Procedure. SAMPLE: In 2018 and 2019, 16 outpatients receiving CHF or IBD care were interviewed. CONCLUSIONS: Although chronic and life-threatening diseases may differentiate patients' perspectives, it can be generally stated that patients value NPs to be reliable, helpful, and empathic. Patients feel empowered, at peace and in control thanks to integrated care by dedicated experts. IMPLICATIONS FOR PRACTICE: Outpatients highly appreciate the "communicator role" and "skilled companionship" performed by NPs, to fulfill their needs for attention to the "complete picture." Therefore, further consideration of these competencies is recommended.

Nurse practitioners leading the way: An exploratory study on the added value of nurse practitioners in outpatient care in the Netherlands.

BACKGROUND: Many Dutch nurse practitioners (NPs) work together with physicians and specialized nurses (SNs) in outpatient clinics, although the latter have questioned the added value of NPs in the outpatient clinic. Clarification of the distinction between and the added value of both nursing professions in relation to each other could lead to optimal use of the unique competencies of each type of nurse. PURPOSE: To explore NPs' perspectives on their added value in relation to SNs in the outpatient clinic. METHODOLOGICAL ORIENTATION: Data were analyzed by Braun and Clarke's thematic analysis. The CanMEDS competences were used to identify the NPs' comments about their practice. SAMPLE: Twelve semi-structured interviews were conducted with NPs from two hospital settings. CONCLUSIONS: The added value of NPs was most evident in: nursing leadership, integrating care and cure and performing an expert level of nursing expertise, and competencies in science. To optimize their roles, NPs and SNs need to make all team members aware of their unique competences and promote role clarification. IMPLICATIONS FOR PRACTICE: This study provides barriers in barriers that influence optimal positioning of NPs within the interdisciplinary team, stresses the importance of discussion on the optimal skill mix within the interdisciplinary team, and describes the NPs' leadership role because this is the encompassing link between the main competencies of their practice. Addressing and overcoming these findings could improve the NPs' positioning and effective collaboration within (the outpatient clinic's) interprofessional teams.

Nurse practitioners' perceptions of their ability to enact leadership in hospital care.

AIMS AND OBJECTIVE: To gain insight into nurse practitioners' (NP) leadership roles in Dutch hospital care, by exploring the perceptions regarding their current leadership role and the differences with their previous role as a registered specialised nurse. BACKGROUND: To meet today's challenges of the increasing healthcare demands, the employment of NPs is proliferating. NPs have the ideal position to play a pivotal role within healthcare reforms, yet full expansion of their scope of practice and expertise is having limited success. Long-term sustainability of NPs depends on the ability to perform and develop a leading role. DESIGN AND METHODS: This qualitative descriptive study was conducted in fifteen Dutch hospitals. Data were collected from April-July 2018, and purposive sampling was used for eighteen semi-structured interviews. This study is conducted and reported according to the COREQ checklist. RESULTS: Three main themes concerning NPs' current leadership role emerged, and they were all linked to a successful positioning of NPs. All themes seemed to be of influence on NPs' scope of daily practice. Direct patient care was emphasised, and leadership on other levels appeared to be underused. Most NPs desired to reshape their profession. However, unprofitable use of their leadership skills especially on professional and organisational level and lack of supportive factors seemed to hinder them. CONCLUSIONS: An adequate use of leadership is crucial for role development and positioning of NPs. Further development of the NP profession can help to better differentiate between the tasks of registered specialised nurses and NPs. RELEVANCE TO CLINICAL PRACTICE: Leadership in nursing contributes to the improvement of the quality and efficiency of health care. Further positioning of the NP profession depends on a profitable use of leadership competencies. Besides, NPs should collaborate with healthcare organisations, educational institutions and professional associations to value the NP profession in the current healthcare system.

Trial registration, publication rate and characteristics in the research field of otology: A cross-sectional study.

OBJECTIVES: To examine 1) the publication rate of registered otology trials in ClinicalTrials.gov, 2) the public availability of the results, 3) the study characteristics associated with publication, and 4) the time to publication after trial completion. BACKGROUND: Publication bias, the publication or non-publication of research findings, depending on the nature and direction of results, is accountable for wrong treatment decisions. The extent of publication bias in otology trials has not been evaluated. METHODS: All registered otology trials were extracted from ClinicalTrials.gov with completion date up to December 2015. A search strategy was used to identify corresponding publications up to June 2017, providing at least 18 months to publish the results after trial completion. Characteristics were obtained from ClinicalTrials.gov and corresponding publications. Regression models were used to examine study characteristics associated with publication or non-publication. RESULTS: From the 419 trials identified on ClinicalTrials.gov, 225 (53.7%) corresponding publications were found in PubMed. Among these, 109 (48.4%) publications were cited on ClinicalTrials.gov and 124 (55.1%) articles reported the National Clinical Trial registry number. For 36 (8.6%) trials, results were only reported in ClinicalTrials.gov. Trials with a biological intervention were more likely to be published than studies involving drugs (odds ratio (OR) 10.41, 95% confidence interval (CI) 1.26-86.22, P = 0.030). Trials funded by industry were less likely to be published (OR 0.46, CI 0.25-0.84, P = 0.011). The median trial duration was 20 months (interquartile range (IQR) 26 months), and median time from trial completion to publication was 24 months (IQR 22 months). CONCLUSION: In 37.7% of the registered otology trials the results remained unpublished, even several years after trial completion. With little citations on ClinicalTrials.gov and low reporting of the Clinical Trial registry number, the accessibility is limited. Our findings show that there is room for improvement in accuracy of trial registration and publication of results, in order to diminish publication bias in otology studies.

An integrative review of leadership competencies and attributes in advanced nursing practice.

AIM: To establish what leadership competencies are expected of master level-educated nurses like the Advanced Practice Nurses and the Clinical Nurse Leaders as described in the international literature. BACKGROUND: Developments in health care ask for well-trained nurse leaders. Advanced Practice Nurses and Clinical Nurse Leaders are ideally positioned to lead healthcare reform in nursing. Nurses should be adequately equipped for this role based on internationally defined leadership competencies. Therefore, identifying leadership competencies and related attributes internationally is needed. DESIGN: Integrative review. METHODS: Embase, Medline and CINAHL databases were searched (January 2005-December 2018). Also, websites of international professional nursing organizations were searched for frameworks on leadership competencies. Study and framework selection, identification of competencies, quality appraisal of included studies and analysis of data were independently conducted by two researchers. RESULTS: Fifteen studies and seven competency frameworks were included. Synthesis of 150 identified competencies led to a set of 30 core competencies in the clinical, professional, health systems. and health policy leadership domains. Most competencies fitted in one single domain the health policy domain contained the least competencies. CONCLUSIONS: This synthesis of 30 core competencies within four leadership domains can be used for further development of evidence-based curricula on leadership. Next steps include further refining of competencies, addressing gaps, and the linking of knowledge, skills, and attributes. IMPACT: These findings contribute to leadership development for Advanced Practice Nurses and Clinical Nurse Leaders while aiming at improved health service delivery and guiding of health policies and reforms.

Comparison of Place-versus-Pitch Mismatch between a Perimodiolar and Lateral Wall Cochlear Implant Electrode Array in Patients with Single-Sided Deafness and a Cochlear Implant.

BACKGROUND: In electric-acoustic pitch matching experiments in patients with single-sided deafness and a cochlear implant, the observed "mismatch" between perceived pitch and predicted pitch, based on the amended Greenwood frequency map, ranges from -1 to -2 octaves. It is unknown if and how this mismatch differs for perimodiolar versus lateral wall electrode arrays. OBJECTIVES: We aimed to investigate if the type of electrode array design is of influence on the electric-acoustic pitch match. METHOD: Fourteen patients (n = 8 with CI422 + lateral wall electrode array, n = 6 with CI512 + perimodiolar electrode array; Cochlear Ltd.) compared the pitch of acoustic stimuli to the pitch of electric stimuli at two test sessions (average interval 4.3 months). We plotted these "pitch matches" per electrode contact against insertion angle, calculated from high-resolution computed tomography scans. The difference between these pitch matches and two references (the spiral ganglion map and the default frequency allocation by Cochlear Ltd.) was defined as "mismatch." RESULTS: We found average mismatches of -2.2 octaves for the CI422 group and -1.3 octaves for the CI512 group. For any given electrode contact, the mismatch was smaller for the CI512 electrode array than for the CI422 electrode array. For all electrode contacts together, there was a significant difference between the mismatches of the two groups (p < 0.05). Results remained stable over time, with no significant difference between the two test sessions considering all electrode contacts. Neither group showed a significant correlation between the mismatch and phoneme recognition scores. CONCLUSION: The pitch mismatch was smaller for the perimodiolar electrode array than for the lateral wall electrode array.