Hearing loss is a major public health concern, affecting over 30 million Americans. Few adults who could benefit from hearing aids use them. Hearing aids are now available over-the-counter (OTC) for persons with perceived mild-to-moderate hearing loss. Community pharmacies will sell OTC hearing aids to increase public access to hearing healthcare. The purpose of this study was to describe pharmacist awareness, interest, and readiness to offer OTC hearing aids at community pharmacies. A multiple-item online survey was designed using the Theory of Planned Behavior and responses were collected from licensed pharmacists from July 2021 to December 2021. Descriptive statistics were used to summarize the 97 responses collected. Most respondents were not aware of the upcoming OTC hearing aid availability. Most respondents were somewhat or very interested in increasing their knowledge on OTC hearing aids, selling OTC hearing aids, and assisting patients with OTC hearing aid selection. Most respondents disagreed or strongly disagreed that they had the necessary knowledge to counsel patients on OTC hearing aids. The most reported supporting factor was training and educational resources. OTC hearing aids are a unique public health initiative which will expand patient access to hearing health care to community pharmacies. Hearing loss is a major public health concern. According to data from the National Institutes of Health (NIH), 30 million Americans have hearing loss in both ears, and approximately 28.8 million adults in the United States could benefit from hearing aids . DespiteThe Reauthorization Act of 2017 required the U.S. Food and Drug Administration (FDA) to create and regulate a category of over-the-counter (OTC) hearing aids for adults with perceived mild-to-moderate hearing loss. The FDA issued its final rule establishing OTC hearing aids as an approved product category on 17 August 2022 . The finBecause OTC hearing aids will not require a prescription or a medical evaluation, it is likely that community pharmacists will be called upon to support safe and effective use for patients contemplating the purchase of OTC hearing aids at the community pharmacy . This suThe purpose of this study is to describe pharmacist awareness, interest, and readiness to offer OTC hearing aids at community pharmacies. Understanding pharmacist awareness, interest, and readiness for OTC hearing aids serves as a first step towards maximizing pharmacists’ ability to provide safe and effective supportive care to patients seeking hearing self-care at the community pharmacy. A 28-item online survey was designed to elicit responses regarding pharmacist awareness, interest, and readiness for OTC hearing aids. The survey was administered using Qualtrics  and distributed through social media and an electronic newsletter distributed by a nationwide pharmacy organization representing community pharmacists. Survey questions probed pharmacists’ knowledge and interest in OTC hearing aids. Questions regarding barriers and facilitating factors were included to assess readiness. The Theory of Planned Behavior and the research framework of Dissemination and Implementation Science were used to develop survey questions . DescripInclusionary criteria included U.S. pharmacists over 21 years of age licensed to practice. Participation was anonymous and voluntary. No compensation or incentives were provided to participants. Participants were able to stop taking the survey at any time. Prior to national distribution, the survey was piloted using a convenience sample of practicing pharmacists known to the investigators to gather feedback on survey content and design. The pilot sample was recruited through email, text messaging, and use of instant messaging on social media platforms. The pilot survey included an optional free response prompt at the conclusion of each section to elicit user feedback on survey content and navigation. Responses from the pilot were used to revise the survey structure and content in preparation for survey distribution and data collection.The finalized survey was opened in July 2021 and responses were accepted until December 2021, after which the survey link was closed. The survey was initially distributed through a three-day advertisement in a daily email newsletter published by a national community pharmacy organization, and a second advertisement was distributed prior to the end of the recruitment period. Participants were also recruited through social media platforms, including LinkedIn, Facebook, and Reddit to broadly capture perspectives of practicing pharmacists. The survey was shared on the investigators’ personal pages in addition to interest groups, pages, and forums for pharmacists on the various social media platforms. Pharmacist interest groups based in specific U.S. states were targeted to ensure the study population included participants from the Northeast, Midwest, South, and West regions of the U.S.The survey instrument collected participant age, professional experience, practice setting, and personal use of hearing devices. Additional survey questions were included to assess participant awareness of the legal status and availability of OTC hearing aids, and perceptions of the patient population served by the participant. Interests were probed through items focusing on knowledge, sale of, and resources for OTC hearing aids. To assess readiness, participant perceptions of competence, barriers, and facilitating factors to offering OTC hearing aids in a community pharmacy were also collected. Questions also explored pharmacist and employer preparation to sell OTC hearing aids, current sale of unregulated hearing devices like personal sound amplification products, and access to education and training resources during hours of employment. Lastly, participants were asked to share their concerns and perceived benefits of providing OTC hearing aids in the pharmacy. The full survey instrument is included as The survey received 97 total responses. Due to the dissemination methods, the response rate could not be determined. Eligible respondents held practice sites in 27 states, representing the Northeast, Midwest, South, and West regions of the United States . RespondOf 88 respondents, 57 (64.77%) were not aware of pending OTC hearing aid availability prior to the survey. Most respondents, 48 (54.55%), stated that they were “not at all familiar” with OTC hearing aids prior to the survey. Of 87 respondents, 68.97% reported frequent interaction with persons with hearing loss who use hearing devices, while 50.57% of respondents reported interacting frequently with persons with hearing loss who do not use hearing devices. Additional data about awareness is summarized in Fifty (67.6%) of the respondents who had never personally used a hearing device were not aware that OTC hearing aids will be available in pharmacies prior to taking the survey. Among the respondents who had used a professionally fitted hearing aid, 6 (60%) were not aware. Of the respondents who had used a personal sound amplification product, only 2 (28.6%) were not aware of OTC hearing aids.Of 85 respondents, 94.1% were somewhat or very interested in increasing their knowledge about OTC hearing aids. Preferred education resources for OTC hearing aids from 79 respondents included continuing education (91.1%), followed by webinars (59.5%), and certificates or micro-credentials (41.8%). The majority of 85 respondents were somewhat or very interested in selling OTC hearing aids at their own practice (71.8%) and assisting patients with OTC hearing aid selection (72.9%). Pharmacist interest data is summarized in Pharmacists employed by a mass merchant, independent pharmacy, or a traditional chain were most interested in selling OTC hearing aids at their practice. All 7 (100%) of the mass merchant pharmacists responding to “How interested are you in selling OTC hearing aids in your practice?” indicated that they were somewhat or very interested. Of the 39 independent pharmacists who responded, 34 (87.2%) were interested, and 11 (78.6%) of 14 traditional chain pharmacists were interested. Of the five respondents who stated that they were not interested in increasing their knowledge about OTC hearing aids, all (100%) stated that they were not interested in selling OTC hearing aids at their own practice and not interested in assisting patients with OTC hearing aid selection.n = 71) reported differing levels of interest in selling OTC hearing aids. Out of 23 respondents in rural locations, 82.61% were somewhat or very interested in selling OTC hearing aids, followed by 82.35% of pharmacists in urban settings (n = 17). Of 31 respondents in suburban locations, 77.42% indicated that they were somewhat or very interested in selling OTC hearing aids. Of 17 respondents at urban sites, 58.82% agreed or strongly agreed that patients in their community would purchase OTC hearing aids, followed by 74.19% (n = 23) of 31 respondenents from suburban locations. Of 23 respondents at rural sites, 56.52% (n = 13) agreed and 21.74% (n = 5) strongly agreed that patients would purchase OTC hearing aids.Respondents practicing in rural, suburban, and urban pharmacies (n = 3) or very interested (n = 6) in increasing their knowledge. Of 72 respondents who had never used a hearing device, only 5 (6.94%) remained not interested in increasing their knowledge of OTC hearing aids. Additionally, 6 of 7 (85.7%) of the respondents who had used a PSAP were very interested in selling OTC hearing aids in their practice, compared to 4 of 9 (44.4%) of respondents who used a professionally fitted hearing aid and 16 of 72 (22.2%) of respondents who had never used a hearing device.Of 7 respondents who had personally used a PSAP, 6 (85.7%) were very interested in gaining more knowledge about OTC hearing aids and 1 respondent (14.3%) was somewhat interested. All (100%) of 9 respondents who had used a professionally fitted hearing aid were either somewhat  agreed or strongly agreed that patients in their community would purchase OTC hearing aids at a community pharmacy. However, 57 (67.06%) of respondents disagreed or strongly disagreed that they had the necessary knowledge to counsel patients on OTC hearing aids. Of 82 respondents, 70 (85.37%) considered training and educational resources for pharmacy staff to be a supporting factor for integrating OTC hearing aids into practice, followed by professional connections to hearing healthcare professionals like audiologists 51 (62.2%) and expertise of pharmacy colleagues 49 (59.76%). The most common barriers to selling OTC hearing aids expected were pharmacist time and workflow constraints 76 (92.68%), available training and/or continuing education for pharmacists 54 (65.85%), and level of pharmacist expertise 54 (65.85%). Additional readiness data is summarized in n = 39) were the only category of respondents stating they intended to offer OTC hearing aids once available, 30.8% (n = 12). Additionally, 43.59% of 39 respondents at independent pharmacies stated that their workplace would allow time for education and training about OTC hearing aids during work hours. In contrast, only 1 (7.69%) traditional chain, 2 (2.86%) mass merchant, and 0 (0.00%) of supermarket pharmacists believed that their employer would allow time for education and training during work hours. Employer readiness is summarized in Most respondents employed at traditional chains (76.92%), mass merchants (85.71%), and supermarkets (60.0%) endorsed that the decision to sell OTC hearing aids at their pharmacy was not within their control. The remainder of respondents in these categories stated they were unsure if they would offer OTC hearing aids. Respondents employed at independent pharmacies  approximately two years after the federal reclassification of CBD. The authors reported that more respondents were uncomfortable than comfortable counseling on CBD products, similar to our findings in the context of OTC hearing aids . A seconThis study is limited by the utilization of a convenience sample and by the timing of data collection. Firstly, due to convenience, the respondent sample may not comprehensively represent pharmacist awareness, interest, and readiness for OTC hearing aids despite responses from all four regions of the U.S. and a diverse profile of employers. It is also possible that pharmacists with interest in OTC hearing aids self-selected to provide responses and, as such, are overrepresented in our study. Secondly, in October 2021 the FDA released proposed OTC hearing aid regulations increasing public awareness to OTC hearing aids as a new category of hearing devices. Because regulations were proposed in the middle of our collection period (July 2021–December 2021), pharmacists who responded after may have answered differently than how they would have responded before the regulations were proposed.OTC hearing aids are a unique public health initiative which will expand patient access to hearing health care to community pharmacies. Pharmacist awareness of OTC hearing aids was limited at the time of this study. Pharmacists were interested in learning more about OTC hearing aids and in assisting patients with the selection of these devices. Most pharmacists did not feel prepared to counsel patients on OTC hearing aid use. The development and dissemination of training and educational resources for pharmacists would be beneficial to the success of OTC hearing aids as a public health initiative.


Unilateral hearing loss is characterized by difficulties in speech perception in noise, difficulty in sound localization and increased overall effort to understand speech.Studies performed on the deficits of patients with unilateral hearing loss, reported more difficulties when the sound or speech origin came from the impaired side, presumably due to a reduced exploration of binaural information processingCROS  device fitting is considered an option for patients with this type of loss. A microphone is placed in the impaired ear and sends a signal via wireless technology to a receiver placed in the normal hearing earThe aim of this study is to assess the performance of a patient with the CROS amplification system.T.C.B.M. developed mumps at 5 years of age. Audiological tests indicated profound right-side sensorineural hearing loss and normal hearing on the left.In 2011, T. then was 19 years old, a college student in a speech and hearing therapy program, sought assistance complaining of a difficulty to understand the professor in the classroom, communication difficulties in noisy environments and impaired sound localization. She was referred to CROS SSmart Audéo IX fitting.1.HHIA (“Hearing Handicap Inventory for Adults”) questionnaire before and 3 months after the fitting;2.Sound localization questionnaire;3.Measurements using a probe microphone;4.Evaluation of speech perception in noise.To assess the benefits and satisfaction with the device, the following procedures were performed:The HHIAThe Sound localization questionnaireIn using the probe microphone for the measurements, there should be two reference microphones - paramount to accurately compare the amplification device output when the sound is presented to the better ear versus the impaired ear. The probe microphone is inserted only in the normal hearing ear - the one that has an output from the CROS system.For the HINTThe patient had results consistent with a significant handicap in the HHIA questionnaire (46%); with a greater hearing difficulty in social situations, which is common for such environments to be noisy.After using the ISAD for 3 months for about 10 to 12 hours per day, the HHIA results were considered absent (8%), indicating a benefit of fitting a CROS.Sound localization is affected because individuals with unilateral hearing loss do not have the benefit of interaural time: when a sound comes from one direction, the interaural time difference and phase differences of continuous sounds in both ears allows the individual to determine which direction the sound is coming fromIn the questionnaire, T. showed a value indicating lower degree of difficulty with the use of hearing aids (3.32) vis-à-vis the absence of amplification (1.67). Fitting a CROS should be indicated for patients who are able to control the location and positioning of the head in relation to an undesirable noise, optimizing device useThe probe microphone measurements allowed to objectively check the CROS operating system and the elimination of the head shadow effect.The HINT test results before and after fitting are depicted on The profound unilateral sensorineural hearing loss proved to impair the daily life of the patient, and with the CROS fitting there were improvements related to the handicap, sound localization ability, head shadow effect and in speech discrimination.


The role of genetic exchanges, i.e., homologous recombination (HR) and horizontal gene transfer (HGT), in bacteria cannot be overestimated for it is a pivotal mechanism leading to their evolution and adaptation, thus, tracking the signs of recombination and HGT events is importance both for fundamental and applied science. To date, dozens of bioinformatics tools for revealing recombination signals are available, however, their pros and cons as well as the spectra of solvable tasks have not yet been systematically reviewed. Moreover, there are two major groups of software. One aims to infer evidence of HR, while the other only deals with horizontal gene transfer (HGT). However, despite seemingly different goals, all the methods use similar algorithmic approaches, and the processes are interconnected in terms of genomic evolution influencing each other. In this review, we propose a classification of novel instruments for both HR and HGT detection based on the genomic consequences of recombination. In this context, we summarize available methodologies paying particular attention to the type of traceable events for which a certain program has been designed. The bacterial genome is shaped by homologous recombination (HR) and horizontal or lateral gene transfer (HGT/LGT), with the latter represented by variable molecular mechanisms ,2. RecomApart from practical implications, recombination exerts an effect on phylogenetic studies altering almost all trees’ parameters. Models applied in conventional phylogenetic analysis are based on the assumption that any parts of DNA or amino acid sequences determine the evolutionary history in the same way . NonetheAs stated above, HGT and HR are different, yet genomically connected processes. From a genomic perspective, it is virtually impossible to determine specific mechanisms and causes of a particular transfer and/or exchange event; therefore, researchers use indirect computational methods, namely, comparative genomics and phylogeny reconstruction. Here, we analyze state-of-the-art bioinformatics tools for detecting HGT and HR. We discuss conventional approaches as well as novel tools in the context of their pros and cons. We propose an integrated classification of the algorithms based on the ramifications of genetic exchanges, both HGT and HR. Finally, we examine major trends in modern tools’ designing new software and discuss the perspective of further developments.Bioinformatics approaches for detecting genetic exchanges can be divided into several groups depending on the nature of the tasks set, applied algorithms, and genomic consequences that are analyzed. In the existing literature, researchers have separately discussed how to trace homologous recombination and HGT proposing distinct classifications. It is explainable as these two groups seem to have different goals: the former methods are aimed to calculate HR rates and detect chimeric loci in the closely related genomes ,26, wherConsidering the end goals of the analysis, methods for HR and HGT detection are divided depending on whether they accomplish: (i) revealing the evidence of exchanges/acquisitions, (ii) identifying mosaic sequences, (iii) finding breakpoint sites, or (iv) calculating recombination and HGT rates . The firSimilarity methods are designed to reveal gene conversion by tracking anomalous identity in variable parts of the genome ;Distance methods find local dissimilarities between sequences using a sliding window technique ;Compatibility methods detect phylogenetic incongruence of individual sites from alignments and do not require the phylogeny itself ,40;Substitution distribution approaches group together sequences with similar patterns of integral substitution properties through comparison with the calculated model distribution ;Phylogenetic methods are based on topological differences between phylogenetic trees, and they represent the most frequently used class of methods in the current studies ,43,44.When describing the types of methods for HR analysis according to the statistical basis, it should be noted that they belong to so-called parametric and non-parametric methods. The former methods aims to calculate population parameters from a sample . It implThere are three groups of methods for revealing HGT, with two of them being similar to what is applied in HR detection. . The firAs mentioned above, the interconnection between HGT and HR should not be ignored because simultaneous detection of these events can help to disentangle genome evolution. Moreover, the underlying algorithms in described methods are quite similar, and, furthermore, they actually deal with similar, but not opposite, goals, namely, finding loci subjected to recombination/transfer and calculating the frequency of such events. Different classifications do not contradict each other, thus, allowing us to unify them into a combined classification scheme based on the consequences of both HR and HGT . There aMycobacterium leprae, which displayed that pseudogenized loci were transferred with increased frequency in contrast to functional genes [Looking from the angle of genomic context, it is possible to find HGT signals in a synteny-aware way. Synteny has been defined as the degree of genomic conservation regarding the relative positions between genes . Hence, al genes . Unfortual genes . The priAlthough other synteny-aware utilities do not report HGT events directly, they can indirectly point out candidates to explore. Lots of genomic browsers have been developed to visualize synteny, namely, BAGET for retrieving syntenic information for a certain gene , Synima One approach to finding present recombination events is called phylogenetic networks. In as much as recombination events lead to intermingling between evolutionally distant lineages, a conventional representation of the evolution as a tree does not reflect the actual phylogenesis. Given that phylogenetic networks pose a more suitable visualization for genetic exchange, there are two distinct types of phylogenetic networks, namely explicit and implicit . The advOnce potential signals are found, it becomes possible to identify breakpoints and to find chimeric sequences. The combination of phylogenetic and distance approaches has revealed these regions that possibly transferred during recombination and the disentangling evolutionary relationships between analyzed sequences regarding these genetic exchanges . Dividinw test [At the moment, the most frequently applied novel programs to examine homologous recombination, as well as HGT, are based on phylogenetic methods. Among these, RDP4  represenw test , the fouw test , and adaw test . In RDP5w test . Still, w test , SARS-Cow test , human rw test , and felw test . Howeverw test . Thus, tAnother group of phylogenetic tools can apply the so-called clonal model ,44,64,73Gubbins starts with removing SNPs (single nucleotide polymorphisms) that do not fit the assumption of a constant per-site mutation rate, and then places these inconsistencies among the tree built on the remaining polymorphisms . Among iProchlorococcus lineages [Staphylococcus aureus strains [Salinispora sp. [ClonalFrameML uses a pre-reconstructed starting tree and calculates the probability of engaging in recombination for each site using Bayesian maximum likelihood (ML) calculations . ClonalFlineages , Staphyl strains , and biopora sp. .Streptomyces species [Staphylococcus aureus strains [Xylella fastidiosa isolates [Although BratNextGen and fastGEAR are not truly phylogenetic methods, they still operate with clonal relationships, hence, it is more appropriate to discuss them in the current section. However, they do not analyze single nucleotide polymorphisms (SNPs) directly but compare the distributions of variants within clonal lineages using hidden Markov model (HMM) approaches ,64. Nota species , antibio strains , and difisolates .On the one hand, all the programs described provide a characterization of SNPs, revealing whether they originate from mutation or recombination, which allows calculating the r/m rate (the probability that a given site stems from recombination rather than mutation) as a proportion of recombination-derived variants. Moreover, these algorithms can handle large datasets due to their high computational capacities. On the other hand, all described tools cannot efficiently distinguish recombination from mutations in the presence of disruptive selection; they also lack statistical power when analyzing highly similar sequences . AnotherIn revealing HGT events, explicit phylogenetic methods are presented by straightforward testing of topological similarity , decompoBurkholderia glumae [Aspergillus sp. genomes [HGT-Finder implies a BLAST-based algorithm to provide a set of likely transferred sequences with a transfer index value and significance estimations . The resa glumae  and Aspe genomes .Legionella sp. [Nocardia sp. [Blautia sp. [HGTector is another tool depending on BLAST searches coupled with taxonomic inference. First, it categorizes genomic hits into three groups: self (the closest strains), close (the same genera or close family), and distal  . The disella sp. , Nocardirdia sp. , and Blautia sp. .Rhizobium strains [RecentHGT was developed to reveal HGT events between close species . It perf strains ,97.HGT-Finder and HGTector are more sophisticated taxonomy-wise methods as compared with simple BLAST searches; however, it should be considered that they lack sensitivity as the success of detection depends on taxonomical distance ,93. TheiRhodanobacter denitrificans with high accuracy [Of the most current tools to mention, ShadowCaster represents a hybrid approach incorporating both composition-based support vector machines (SVMs) and implicit phylogenetic methods based on the phylogenetic shadow that is constructed on proteomes of species both closely related and distant to the analyzed ones . ShadowCaccuracy . Neverthaccuracy . As it ww test [Being non-phylogenetic, compatibility methods now seem of great potential due to their ease and computational effectiveness. The basic approach of such evaluations is a so-called ”four-gamete test” . If two w test , both deStaphylococcus aureus [The recently developed ptACR program identifies potential breakpoints with a sliding window followed by a permutational test to calculate the significance of found events . Its arcs aureus  Nonethels aureus , that isXanthomonas oryzae evolution study [Similar to compatibility approaches, substitution distribution methods have regained attention due to their high speed as compared with phylogenetic approaches. HREfinder is a dynamic algorithm that divides the genome into blocks where each polymorphism is estimated to result from mutation, homologous recombination, or sequencing error . The steon study . The senon study . Hence, on study .p) is calculated as eN is the effective population size and r stands for per-site recombination rate for one generation. Similarly, the population mutation rate is determined by the following equation: p/θ ratio is considered to be an average quantitative variable characterizing recombination for a particular population [Parametric methods are mostly aimed at evaluating the overall HR rate based on population genetics principles. . Populatpulation .i + l site for a randomly chosen site i, where l is the distance in nucleotides. The function P(l) is constant in the absence of recombination, whereas the presence of recombination causes a monotonic decrease of the P(l) function [Escherichia coli ST131 populations in the infant gut microbiome [One program implementing these methods is Mcorr . This tofunction . The metfunction  or multicrobiome . The preA distinct method combining phylogenetic incongruence detection, population genetics principles of coalescent theory, and phylogenetic networks is a reconstruction of so-called ancestral recombination graphs (ARGs) . The ARGEscherichia coli serotype O157 representatives [Bacter, a Bayesian algorithm, has been applied to reconstruct ARGs based on the ClonalOrigin model and Markov chain Monte Carlo (MCMC) algorithm that are used jointly to infer genealogical relationships as well as homologous conversion events and the overall conversion rate . This sintatives . Still, ntatives .To handle the inference of ARGs on a large genomic scale, a computationally efficient alternative has been proposed. This approach is called topological data analysis (TDA) in which genomes are treated as points in a high dimensional space with pairwise distances delineated by genetic dissimilarities . Loops iSample-based parametric methods in the context of an HGT analysis have been considered to be less accurate than phylogenetic methods which are dominant in the repertoire of HGT detection programs; however, recently, novel tools with better performance have been devised. They have been applied to obtain the most probable HGT-subjected parts of the genome and the overall transfer frequency. The respective HGT-rate computations rely on the calculation of the HGT-affected genome fraction , the ratStaphylococcus aureus [To reveal HGT-subjected parts, sequence clustering methods seem to be a perspective approach to deal with the constraints of current tools. The Clusterflock algorithm utilizes a model of self-organizing swarm intelligence originally proposed to imitate bird and insect behavior . This mos aureus , still, Enterococcus faecium strain [The genome mosaic structure (gmos) algorithm was developed to overcome difficulties related to computational costs of full genome-comparison alignments . This prm strain . The advm strain .Escherichia coli and Salmonella Typhimurium; nonetheless, it is designed for a specific aim to identify intraspecies events, while its dependence on core SNPs may probably restrict the sensitivity of the analysis [GeneMates is an R package to reveal co-transferred genes in bacterial genomes associated with mobile genetic elements . In the analysis .H. pylori dataset and two real E. coli datasets [The abovementioned tools rely on completed and maximally annotated genomes. In contrast to it, Daisy is a reference-free method that processes short reads to detect HGT boundaries via split-read mapping and coverage information, and it leads to outperforming assembly-based approaches . Its perdatasets . While pMycobacterium tuberculosis genomes revealed that most of the recombination events described in the literature were artifacts [To choose a particular algorithm to detect HR and HGT in biological data, it is useful to understand the expected rate of false-positive calls. Erroneous identification of recombination events may occur when analyzing extremely divergent sequences, given that in the tools applied, statistical power proportionally increases with sequence divergence . Howeverrtifacts . They ocrtifacts . Sample rtifacts ,119. Thertifacts .Given a great variety of cases in which correct detection of HGT and HR is hampered , the limHomologous recombination (HR) and horizontal gene transfer (HGT) in bacteria are fundamental mechanisms of their evolution, and these two processes are inextricably connected on a genomic scale. HR provides allelic diversity and causes genetic gain/loss . It may