Mining and analysis of audiology data to find significant factors associated with tinnitus masker

Objectives: The objective of this research is to find the factors associated with tinnitus masker from the literature, and by using the large amount of audiology data available from a large NHS (National Health Services, UK) hearing aid clinic. The factors evaluated were hearing impairment, age, gender, hearing aid type, mould and clinical comments. Design: The research includes literature survey for factors associated with tinnitus masker, and performs the analysis of audiology data using statistical and data mining techniques. Setting: This research uses a large audiology data but it also faced the problem of limited data for tinnitus. Participants: It uses 1,316 records for tinnitus and other diagnoses, and 10,437 records of clinical comments from a hearing aid clinic. Primary and secondary outcome measures: The research is looking for variables associated with tinnitus masker, and in future, these variables can be combined into a single model to develop a decision support system to predict about tinnitus masker for a patient. Results: The results demonstrated that tinnitus maskers are more likely to be fit to individuals with milder forms of hearing loss, and the factors age, gender, type of hearing aid and mould were all found significantly associated with tinnitus masker. In particular, those patients having Age<=55 years were more likely to wear a tinnitus masker, as well as those with milder forms of hearing loss. ITE (in the ear) hearing aids were also found associated with tinnitus masker. A feedback on the results of association of mould with tinnitus masker from a professional audiologist of a large NHS (National Health Services, UK) was also taken to better understand them. The results were obtained with different accuracy for different techniques. For example, the chi-squared test results were obtained with 95% accuracy, for Support and Confidence only those results were retained which had more than 1% Support and 80% Confidence. Conclusions: The variables audiograms, age, gender, hearing aid type and mould were found associated with the choice of tinnitus masker in the literature and by using statistical and data mining techniques. The further work in this research would lead to the development of a decision support system for tinnitus masker with an explanation that how that decision was obtained

Temperature sensitivity of organic matter decomposition of permafrost-region soils during laboratory incubations

Permafrost soils contain more than 1300 Pg of carbon (C), twice the amount of C in the atmosphere. Temperatures in higher latitudes are increasing, inducing permafrost thaw and subsequent microbial decomposition of previously frozen C, which will most likely feed back to climate warming through release of the greenhouse gases CO2 and CH4. Understanding the temperature sensitivity (Q10) and dynamics of soil organic matter (SOM) decomposition under warming is essential to predict the future state of the climate system. Alaskan tundra soils from the discontinuous permafrost zone were exposed to in situ experimental warming for two consecutive winters, increasing soil temperature by 2.3 °C down to 40 cm in the soil profile. Soils obtained at three depths (0-15, 15-25 and 45-55 cm) from the experimental warming site were incubated under aerobic conditions at 15 °C and 25 °C over 365 days in the laboratory. Carbon fluxes were measured periodically and dynamics of SOM decomposition, C pool sizes, and decay rates were estimated. Q10 was estimated using both a short-term temperature manipulation (Q10-ST) performed at 14, 100 and 280 days of incubation and via the equal C method (Q10-EC, ratio of time taken for a soil to respire a given amount of C), calculated continuously. At the same time points, functional diversities of the soil microbial communities were monitored for all incubation samples using a microbial functional gene array, GeoChip 5.0. Each array contains over 80,000 probes targeting microbial functional genes involved in biogeochemical cycling of major nutrients, remediation strategies, pathogenicity and other important environmental functions. Of these, over 20,000 probes target genes involved in the degradation of varying C substrates and can be used to quantify the relative gene abundances and functional gene diversities related to soil organic matter turnover. The slow decomposing C pool (CS), which represented close to 95% of total C in the top 25 cm soils, had a higher Q10 than the fast decomposing C pool (CF) and also dominated the total amount of C released by the end of the incubation. Overall, CS had temperature sensitivities of Q10-ST = 2.55 ± 0.03 and Q10-EC = 2.19 ± 0.13, while the CF had a temperature sensitivity of Q10-EC = 1.16 ± 0.30. In contrast to the 15 °C incubations, the 25 °C microbial communities showed reduced diversities of C-degradation functional genes in the early stage of the incubations. However, as the incubations continued the 25 °C communities more closely paralleled the 15 °C communities with respect to the detection of microbial genes utilized in the degradation of labile to recalcitrant C substrates. Two winter seasons of experimental warming did not affect the dynamics and temperature sensitivity of SOM decomposition or the microbial C-degradation genes during incubation. However, under the projected sustained warming attributable to climate change, we might expect increased contribution of CS to organic matter decomposition. Because of the higher Q10 and the large pool size of CS, increased soil organic matter release under warmer temperatures will contribute towards accelerating climate change

Temperature sensitivity of organic matter decomposition of permafrost-region soils during laboratory incubations

Permafrost soils contain more than 1300 Pg of carbon (C), twice the amount of C in the atmosphere. Temperatures in higher latitudes are increasing, inducing permafrost thaw and subsequent microbial decomposition of previously frozen C, which will most likely feed back to climate warming through release of the greenhouse gases CO2 and CH4. Understanding the temperature sensitivity (Q10) and dynamics of soil organic matter (SOM) decomposition under warming is essential to predict the future state of the climate system. Alaskan tundra soils from the discontinuous permafrost zone were exposed to in situ experimental warming for two consecutive winters, increasing soil temperature by 2.3 °C down to 40 cm in the soil profile. Soils obtained at three depths (0-15, 15-25 and 45-55 cm) from the experimental warming site were incubated under aerobic conditions at 15 °C and 25 °C over 365 days in the laboratory. Carbon fluxes were measured periodically and dynamics of SOM decomposition, C pool sizes, and decay rates were estimated. Q10 was estimated using both a short-term temperature manipulation (Q10-ST) performed at 14, 100 and 280 days of incubation and via the equal C method (Q10-EC, ratio of time taken for a soil to respire a given amount of C), calculated continuously. At the same time points, functional diversities of the soil microbial communities were monitored for all incubation samples using a microbial functional gene array, GeoChip 5.0. Each array contains over 80,000 probes targeting microbial functional genes involved in biogeochemical cycling of major nutrients, remediation strategies, pathogenicity and other important environmental functions. Of these, over 20,000 probes target genes involved in the degradation of varying C substrates and can be used to quantify the relative gene abundances and functional gene diversities related to soil organic matter turnover. The slow decomposing C pool (CS), which represented close to 95% of total C in the top 25 cm soils, had a higher Q10 than the fast decomposing C pool (CF) and also dominated the total amount of C released by the end of the incubation. Overall, CS had temperature sensitivities of Q10-ST = 2.55 ± 0.03 and Q10-EC = 2.19 ± 0.13, while the CF had a temperature sensitivity of Q10-EC = 1.16 ± 0.30. In contrast to the 15 °C incubations, the 25 °C microbial communities showed reduced diversities of C-degradation functional genes in the early stage of the incubations. However, as the incubations continued the 25 °C communities more closely paralleled the 15 °C communities with respect to the detection of microbial genes utilized in the degradation of labile to recalcitrant C substrates. Two winter seasons of experimental warming did not affect the dynamics and temperature sensitivity of SOM decomposition or the microbial C-degradation genes during incubation. However, under the projected sustained warming attributable to climate change, we might expect increased contribution of CS to organic matter decomposition. Because of the higher Q10 and the large pool size of CS, increased soil organic matter release under warmer temperatures will contribute towards accelerating climate change

Just-in-Time Evidence-Based E-mail “Reminders” in Home Health Care: Impact on Nurse Practices

OBJECTIVE: To test the effectiveness of two interventions designed to improve the adoption of evidence-based practices by home health nurses caring for heart failure (HF) patients. DATA SOURCES/STUDY SETTING: Information on nurse practices was abstracted from the clinical records of patients admitted between June 2000 and November 2001 to the care of 354 study nurses at a large, urban, nonprofit home care agency. STUDY DESIGN: The study employed a randomized design with nurses assigned to usual care or one of two intervention groups upon identification of an eligible patient. The basic intervention was a one-time e-mail reminder highlighting six HF-specific clinical recommendations. The augmented intervention consisted of the initial e-mail reminder supplemented by provider prompts, patient education material, and clinical nurse specialist outreach. DATA COLLECTION: At each home health visit provided by a study nurse to an eligible HF patient during the 45-day follow-up period, a structured chart abstraction tool was used to collect information on whether the nurse provided the care practices highlighted in the e-mail reminder. PRINCIPAL FINDINGS: Both the basic and the augmented interventions greatly increased the practice of evidence-based care, according to patient records, in the areas of patient assessment and instructions about HF disease management. While not all results were statistically significant at conventional levels, intervention effects were positive in virtually all cases and effect magnitudes frequently were large. CONCLUSIONS: The results of this randomized trial strongly support the efficacy of just-in-time evidence-based reminders as a means of changing clinical practice among home health nurses who are geographically dispersed and spend much of their time in the field