Nonlinear dynamic analyses of reinforced concrete (RC) frame buildings require the use of effective stiffness of members to capture the effect of cracked section stiffness. In the design codes and practices, the effective stiffness of RC sections is given as an empirical fraction of the gross stiffness. However, a more precise estimation of the effective stiffness is important as it affects the distribution of forces and various demands and response parameters in nonlinear dynamic analyses. In this study, an evolutionary computation method called gene expression programming (GEP) was used to predict the effective stiffness ratios of RC columns. Constitutive relationships were obtained by correlating the effective stiffness ratio with the four mechanical and geometrical parameters. The model was developed using a database of 226 samples of nonlinear dynamic analysis results collected from another study by the author. Subsequent parametric and sensitivity analyses were performed and the trends of the results were confirmed. The results indicate that the GEP model provides precise estimations of the effective stiffness ratios of the RC frames. The effective stiffness of reinforced concrete (RC) frame members significantly influences the computed nonlinear dynamic response of the structure. Improper estimation of member stiffness leads to an inaccurate evaluation of structural response quantities. Some of the important factors that are affected by member stiffness are the period of the structure, deformation demands, distribution of loads, and yield displacement ,3,4,5,6.Generally, design codes recommend effective stiffness values as a fraction of gross stiffness, based on the axial load ratio. The American Society of Civil Engineers ASCE 41-13)  have rec  have reThe predictive ability of genetic programming and gene expression programming  models has attracted interest from researchers investigating structural engineering problems ,21,22,23It has been observed from the literature that the percentage of reinforcing steel, axial load, and section dimensions are the most influential parameters when evaluating the effective stiffness of columns. Most of the effective stiffness models reported in the literature do not consider all the above mentioned parameters together. In addition, manual computation of the effective stiffness of RC column sections is a very tedious process. To ease the tedious evaluation procedures, soft-computing models, such as GEP, can be used as an alternative to manual computations. GEP models are advantageous over other soft-computing techniques as they provide an explicit mathematical equation for prediction. In , model eThe paper has been further divided into five sections. From the moment–curvature relationship, the flexural stiffness of a reinforced concrete section can be expressed as follows: It has been observed that for a given section, the yield curvature does not depend on variations in the moment capacity, axial load ratio, and reinforcement ratio of RC columns. However, for high material strength  of column sections was prepared from a set of buildings that had been designed via the unified performance-based design (UPBD) method [x- and y-directions. In plan II  using SAP2000 software. The database of 226 samples of effective stiffness ratios (ρt), axial load (P), and depth of the column in both directions  are considered as input parameters to obtain the effective stiffness ratios of columns in both the orthogonal directions  method . RC fram plan II b, the baFerreira  initiallIn contrast, the mathematical expression is translated by the GEP as simple, compact, linear, and relatively small fixed-length strings. In addition, genetic handling is easy via the expression of trees of various shapes and sizes. In the chromosome, GEP genetic operators are used; however, these operators are indirect for the considered solution (ET).Through this recreation technique, accompanied by the chromosome’s structure and its translation procedure in the expressing tree, unrestricted genetic modifications are always possible for creating effective expression trees. The very simplified form of genetic variation is one of the most important strengths of the GEP method because genetic operators act at the chromosome level. Some researchers believe that another merit of the GEP approach is related to its unique and multi-genetic features that lead to the development of more complicated programs consisting of numerous sub-plans. In this regard, the GEP approach with these features outperforms the GEP in terms of convergence speed for benchmark function results and organization issues . The GEPAs shown in GEP plays an important role in linear chromosomes and ETs with a fixed length. The aim of an innovative language—for example, the Karva language for the GEP—is to improve the recitation and expression of any programmed and processed information in the chromosomes. The Karva language is an unequivocal and bilingual illustration system that can be regarded as a tree. In addition, the language involves a worldwide technique for efficiently demonstrating any scientific or common-sense notation that can be provided as a tree. In addition, Ferreira  believesn) using the equation t=h (n−1) +1. For example, a gene consisting of the function series  and the set of terminals  involves n = 2. If it is decided that h = 10, then t = 11; therefore, the gene’s length is 21. Hence, the gene’s code sequence terminates at position 10 whereas the end of the gene is at position 20. In cases where a mutation occurs via alterations to a terminal or function at any location in the coding sequence, various genes are prepared with a static length, probably coding for ETs with various shapes and sizes. For chromosomes with several genes, the considered solution is advanced by attaching the sub-ETs of the equivalent genes with the connecting functions ; therefore, the problem’s mathematical function is stated by the arrangement of sub-ETs. For each problem, the head’s length is selected and the tail length is assessed as a head function and the argument number  in the heads, whereas termini can merely turn into other termini in the tails. Instead, modifications through an inverse operator are limited to the gene heads. The rearrangement is driven on a chromosome section to another position in the chromosome. The transposing operator haphazardly duplicates the chromosome fragments and places them in another location. Recombination is an alteration process on a chromosome pair. Using the GEP’s recombining operator (or crossover), two parent chromosomes are selected and paired randomly to transact some features within them via three diverse operations (one-and two-point recombination and gene recombination). GEP operators are used with a definite likelihood of a chromosome (or operator rate) specified by the user prior to analysis. It is stated that the inversion and mutation rates are usually utilized within a range of 0.01–0.1. Furthermore, the recombination and transposition rates alternate in the range of 0.1–1, although moderate rates (0.1–0.4) have typically been proposed for them ,31. Alte(1)Arbitrarily dividing the dataset into testing and learning subsets;(2)Collecting the general background , rate of fitness function, and genetic operators for modeling the data;(3)Selecting a suitable function set ;(4)Administrating the evolutionary procedure until the achievement of the prediction results;(5)Exhibiting the best-of-run model in ETs and changing the mathematical expression.According to Ferreira , the proAppropriate operator rates and settings typically rely on the number of probable solutions and the difficulty of the problem. These constraints can be based on some formerly proposed values and numerous trials. The improvement of the GEP models is provided in detail in the next section.xr and yr), using a database obtained from [xr, and yr, as expressed in Equation (3):tρ is the percentage of longitudinal reinforcement (%), P is the axial load (×103 kN), and xD and yD are the depth of the column section in each orthogonal direction (m). According to this database, the model was organized using four input variables within the GEP method. Based on these input variables within the GEP approach model, the effective stiffness ratio of the columns in both directions can be predicted. The findings of the model training and testing sets and the experimental results were compared. These results demonstrate that the GEP is a robust method for predicting xr and yr. The learning of functions is performed by the addition of arithmetic functions. The selected functions are given by the following equations:In this work, the use of GEP is represented as a tool for predicting the effective stiffness ratio of columns in both directions  were employed to train the GEP model and the remaining 46 (20%) datasets were used to test the GEP model.R > 0.8, a strong correlation exists between the predicted and measured values. Nevertheless, it should be noted that R2 = 1 is never an indication that the prediction of the dataset is perfect [R2 values. Therefore, the study adopted other proven statistical indices, including mean square error (MSE), mean absolute percentage error (MAPE), and root mean square error (RMSE), given in the form of Equations (6)–(8).ia and ic are the actual and calculated outputs for the i-th output, respectively, and n is the number of samples. The performance statistics of the GEP-based formulations for the entire database are summarized in  perfect . It is oR and low MAE and RMSE values. In x axis shows the real values and the y axis indicates the predicted values by GEP.As both training and testing data are involved in the model selection process (which is not a good practice), it is highly recommended to have three subsets in which the models are trained using training data (~70% of the data) and the model with the best performance on the testing data (~15%) is presented as the optimal model. Finally, this model was externally validated using unseen validation data (~15%). It can be inferred from To verify the GEP-based prediction model in this section, sensitivity and parametric analyses were performed. Using a sensitivity-like analysis affected by importance measures, it can be shown that GEP introduces features into evolved models that have little impact on a given model’s behavior. In addition, parametric analysis was used to study the response of the predicted outputs from the GEP equations to a set of predictor variables. The robustness of a design formulation is specified by evaluating the agreement between the predicted output values and the basic physical behavior of the investigated system .fmax(ix) and fmin(ix) are the maximum and minimum values, respectively, of the predicted output over the i-th input domain in which the other input values are equal to their mean values. The results of the sensitivity analysis for the estimation of the effective stiffness of RC columns are listed in x-direction is xD, followed by yD, P, and tρ. The sensitivity analysis for RC column sections in the y-direction identified yD, P, tρ, and xD as the most influential variables in the prediction of yr.Sensitivity analysis investigates the contribution of input parameters to the output predictions. For the sensitivity analysis, a simple procedure was proposed. The sensitivity percentage of the output to each input parameter can be determined using the following formulas :(9)Ni=fmtρ, P, xD, and yD.For better validation of the GEP-based formulations, a parametric analysis was conducted following the procedure suggested in ,37. In gxr continuously increases with increasing tρ, P, and yD, which agrees with the trend reported by Kuntia and Ghosh [yr increases with increasing tρ, P, and xD. In contrast, xr and yr decrease with increasing xD and yD, respectively. This trend can be validated by the observations of Kumar and Singh [As presented in nd Ghosh  Similarlnd Singh .R) of 0.983 and 0.990 for training and testing purposes, respectively. This establishes the prediction power of the GEPs. The validity of the model was established using sensitivity analysis and parametric analysis. The results of the parametric analysis being verified with that of similar studies reported in the available literature show that the model has captured all the input parameters correctly. It should be mentioned that the suggested model based on GEP in this study is provided in an obvious form and involves an extensive and varied range of input parameters. Hence, the suggested xr and yr can be calculated, allowing the use of the model in real-world situations.An innovative model was established to predict the effective stiffness ratios of RC columns using the GEP method. A combination of genetic operators, including transposition, crossover, and mutation, was used in the study. The results indicate that the GEP model can successfully predict the effective stiffness ratios of the RC columns. GEP-based explicit formulations for predicting effective stiffness ratio were obtained and were compared with the generated database results. Various statistical evaluation criteria were used to evaluate the fitness accuracy of the model and the present equations. It was found that the suggested model displays the least errors  and the highest correlation coefficients (


Few estimates are available of the need for assistive devices (ADs) in African settings. This study aimed to estimate population-level need for glasses and hearing aids in The Gambia based on (1) clinical impairment assessment, and (2) self-reported AD awareness, and explore the relationship between the two methods. The Gambia 2019 National Eye Health Survey is a nationally representative population-based sample of 9188 adults aged 35+ years. Participants underwent standardised clinical vision assessments including the need for glasses (distance and near). Approximately 25% of the sample underwent clinical assessment of hearing and hearing aid need. Data were also collected on self-reported awareness, need and access barriers to vision and hearing ADs. Overall, 5.6% of the study population needed distance glasses (95% CI 5.0–6.3), 45.9% (95% CI 44.2–47.5) needed near glasses and 25.5% (95% CI 22.2–29.2) needed hearing aids. Coverage for each AD was very low (<4%). The agreement between self-report and clinical impairment assessment for AD need was poor. In conclusion, there is high prevalence and very low coverage for distance glasses, near glasses and hearing aids in The Gambia. Self-report measures alone will not provide an accurate estimate of AD need. Globally, the World Health Organization (WHO) estimates there are at least one billion people in need of assistive technology (AT). AT includes both assistive devices (ADs) and the systems and services related to AD delivery ,2. AT usThere has been an increase in global initiatives to scale up AT access over the past ten years, including the WHO Global Cooperation on Assistive Technology (GATE) initiative  and ATScThere are other approaches to measuring AT need which differ in the way impairment, AT and functioning are defined, conceptualised and measured. For example, clinical impairment assessment  uses standardised clinical methods to assess the presence of impairment followed by a clinician’s assessment of AD needs  based on type, cause and severity of the impairment. Clinical assessment provides important information on whether AD or medical treatment is needed, but may be costly to administer, often requires input from clinical staff and may not take into account the participant’s perceptions/environment. Previous analysis of surveys in India and Cameroon suggested substantial discrepancy between self-report and clinical assessment approaches ,7. HowevThe Gambia is a small country in western Africa with a population of 2,335,000 and life expectancy of 62 years in 2018 . Given tEstimate population-level total need, unmet need and coverage for glasses (distance and near glasses) and hearing aids, two of the five ATScale priority ADs.Estimate reported AD awareness, need and access barriers.Explore the relationship between clinical impairment and self-report assessment methods for assessing AD need within population surveys.In this paper, we conduct an analysis of national-level survey data in The Gambia in adults 35 years and above in order to:A National Eye Health survey was conducted in The Gambia in adults 35 years and over from February to July 2019. Hearing assessments were completed in clusters visited by one of the four teams which equated to approximately one-quarter of participants.The methodology of the full survey is published elsewhere . Using tStandard Gambia Bureau of Statistics (GBoS) Census Enumeration Areas (EAs) were used as clusters, and the 360 clusters were randomly selected via PPS. For each cluster, enumerators first undertook a household listing of eligible participants. Using this information, the cluster was then subdivided into segments each including approximately 30 adults aged 35+. One segment was randomly selected, and all adults in the selected segment were invited to a central location the following day for clinical assessments.Data were collected in a central location on mobile tablets using Open Data Kit (ODK). There were four survey teams each comprised of one ophthalmologist, one optometrist or optometry technician, one senior ophthalmic medical assistant (SOMA), one general nurse, one mental health nurse, and two enumerators. In one team, the one practicing audiology nurse in The Gambia was included. Teams underwent ten days of training which included standardised tests of protocol adherence, practice examinations and pilot testing. Questionnaires were pre-tested and revised where necessary following the pilot. A formal interobserver variability test was completed for vision testing only, with kappa agreement of 0.7 and 0.8 for two teams, while one team achieved a fairly low agreement (0.4) requiring further training review before data collection .All participants completed a general demographic and socioeconomic questionnaire which included use of the EquityTool, an objective tool comprised of 12 country-specific assets that was used to generate a wealth index . All stuBefore the clinical assessments, data on self-reported level of difficulty in seeing and hearing were collected on all participants using the relevant questions from a modified version of the Washington Group Short Set questions ,15. ThesDistance and near visual acuity (VA) were measured indoors by the team optometrist or optometry technician as follows:Distance VA: Uncorrected VA and corrected VA  were measured at 3 metres using Peek Acuity, a validated visual acuity test on tablet devices . All parNear vision screening: Presenting near vision  was screened at N8 threshold. A binary outcome of can or cannot identify 4 out of 5 tumbling E optotypes at 40cm was recorded. Participants who were able to see N8 wearing near vision glasses were categorised as “met need”. Participants unable to see N8 were re-tested using an age-appropriate near add correction in trial frame and classified as needing either new near glasses (unmet need) or updated near glasses (undermet need) depending on glasses ownership.All participants were assessed for contrast sensitivity and intraocular pressure, and a dilated clinical eye examination  was undertaken.For people with vision impairment (VI), the main cause of VI was assigned following WHO protocol of “easiest to treat” .In one team, the audiology nurse screened for hearing impairment (HI) using the Rapid Assessment of Hearing Loss (RAHL) methodology . All parIn this paper, “mild/worse VI” will be used to refer to the threshold of VA < 6/12 in the better eye, and “moderate/worse VI” will be used to refer to the threshold of VA < 6/18 in the better eye, based on WHO vision categories. For hearing, based on WHO categories, “mild/worse HI” will be used to threshold of HL > 25 dB in the better ear and “moderate/worse HI” will be used to refer to HL > 40 dB in the better ear.Stata 16.0  was used to analyse the data. The ‘svy’ command was used to derive proportion estimates accounting for cluster sampling. Data from the 2013 population housing census were used to create weights which were then used to adjust the prevalence estimates (of impairment and need/unmet for AD) for age, sex and regional clusters for vision and age and sex only for hearing, to account for differences in the sample and census population.Met need: Needs and observed to be using an appropriate AD/total population examined.Undermet need: Needs and observed to be using an AD which did not correct vision/hearing to required threshold/total population examined.Unmet need: Needs but not observed to be using the AD/total population examined.Total need: (summation of met need + undermet need + unmet need)/total population examined.Coverage: (met need + undermet need)/total need.Effective coverage   and hearing aids were stratified by age, sex, socioeconomic status and urban/rural location with logistic regression used to calculate test for trends. These analyses were also calculated to account for the weighting and clustering. Self-reported functional limitations and unmet/undermet need for glasses and hearing aids were compared to AD unmet/undermet need identified through clinical impairment assessment, making the assumption that clinical assessment provides more reliable data . A total of 2935 people were enumerated in the clusters where hearing assessment was included and 1393 participants underwent hearing assessment (response rate 47.5%). Demographic characteristics of the 2013 census population, vision study sample and hearing study sample are presented in Overall vision and hearing clinical impairment  and self-reported difficulty results are presented in The prevalence of mild/worse HI (>25 dB) was 28.1%  and moderate/worse HI (>40 dB) was 1.6% . Self-reported “some or worse” hearing difficulty was 1.7%  and for “a lot or worse”, it was 0.2% .Overall, based on mild/worse VI, the prevalence of total need for distance glasses  was 5.6%  and unmet need was 5.4% . Only 14 people were observed as having met needs and 3 had an undermet need for glasses. Based on moderate/worse VI, the prevalence of total need for distance glasses was 4.3%  and unmet need was 4.3% (95% CI 3.8–4.9). Only 10 people were observed as having met need and 4 had an undermet need. Coverage was therefore low for both mild/worse VI  and moderate/worse VI  cut-offs, and even lower for effective coverage .The prevalence of total need for near glasses was 45.9% (95% CI 44.2–47.5). The prevalence of unmet near glasses need was 44.9% . Only 8 people were classified as having met need and 63 as having an undermet need. There was, therefore, low coverage of near glasses  and even lower effective coverage .Overall prevalence of total need for hearing aids based on mild/worse HI was 25.5% , while based on moderate/worse HI, it was 1.5% . Only one participant was identified as wearing a hearing aid, but they were referred for further diagnostic audiology and possible hearing aid fitting. Therefore, there was no met need and no effective coverage.p < 0.01) (p < 0.02). In contrast, the need for near glasses was significantly higher among men compared to women (p < 0.001). There were no differences between the socioeconomic categories or urban and rural categories. With adjustment for age and sex, these results were essentially unchanged.The total need for distance glasses (mild/worse VI and moderate/worse VI), near glasses and hearing aids (both mild/worse HI and moderate/worse HI) all increased significantly with age ( < 0.01) . The neeOf those who self-reported “some or worse” difficulty in vision (n = 2530), 72.8% (n = 1816) reported awareness of spectacles and 8.3% (n = 209) reported awareness of white canes, while awareness was low (<4%) for other vision ADs including talking or touching watch, magnifier or telescope, and braille equipment. Overall, 28.0% (n = 709) reported being unaware of any vision AD. In terms of self-reported unmet/undermet need, 66.4% (n = 1681) reported an unmet/undermet need for spectacles, while <1% reported needing each of the other vision ADs. Overall, 17.7% (n = 447) reported not needing any vision AD. Of those who reported unmet/undermet need for spectacles, the most commonly reported access barriers were AD not locally available (44%), transport not available (43%), and cannot afford (35%).Of those who self-reported “some or worse” difficulty in hearing (n = 385), 86.0% (n = 331) were not aware of any hearing AD. Overall, 12.5% (n = 48) reported prior awareness of hearing aids, 2.1% (n = 8) reported awareness of alarm signallers with light/vibration and <1% (n = 2) reported awareness of personal frequency modulation (FM) system. For self-reported unmet/undermet need, 58.0% (n = 223) reported needing hearing aids, 8.8% (n = 34) needing alarm signallers and 2.6% (n = 10) needing personal FM system. Just over a third  reported not needing any hearing AD. Of those who reported unmet/undermet need for hearing aids, most common access barriers were AD not locally available (76%), transport not available (74%), unaware of AD (62%) and no one available to instruct how to use (59%).Of the 4166 people identified as having near and/or distance (mild/worse VI) URE, three-quarters  self-reported they did not need glasses  actually needed near and/or distance glasses (for mild/worse VI) based on clinical impairment assessment. Of the remaining participants, 311 (19%) needed cataract surgery, 75 (4%) had other causes of VI where glasses would not be of benefit, 15 (1%) had an unknown cause and 289 (17%) did not have VI (see Of the 367 people with mild/worse HI (>25 dB) who were clinically assessed to likely need hearing aids, 11 (3%) reported needing one, 354 (97%) reported not knowing what it was and <1% (2 participants) were either observed to be wearing one (n = 1) or reported not needing one (n = 1)  actually needed hearing aids based on clinical assessment and 5 (29%) did not (see This study found evidence of high need and very low coverage of two priority ADs (glasses and hearing aids) among adults aged 35+ years in The Gambia based on clinical impairment assessment. Total need was highest for near glasses (45.9%), followed by hearing aids based on mild/worse HI (25.5%), and distance glasses was lower . The total need for all ADs increased significantly with age. Total need was significantly higher among females compared to males for distance glasses (mild/worse VI and moderate/worse VI) and hearing aids (mild/worse HI), and significantly higher among males compared to females for near glasses.AD coverage was very low with fewer than 4% of people who needed distance glasses, near glasses or hearing aids actually observed wearing them. These findings further indicate that glasses and hearing aid provision services are very limited in The Gambia and need to be scaled up . For exaCompared to other studies of multi-domain clinically assessed AD need, our findings align with a survey in Cameroon showing high need and low coverage for distance glasses and hearing aids . A surveFor vision, it is challenging to compare our glasses (distance and near) unmet need results with the previous 1996 Gambia National Eye Health study, given differing definitions and methods of calculating these estimates . Our finHowever, it is also noted that population-based clinical impairment studies often do not explicitly measure or present specific AD need alongside estimates of impairment type, cause and severity. Therefore, to address the AD data gap, it is recommended that future surveys include these estimates on AD need and coverage for vision and hearing as well as the assessment of additional functional domains and related ADs. Additionally, this paper provides comparison between mild and moderate impairments for distance glasses and hearing aids. Though unmet need for moderate/worse VI/HI is more imperative, our analyses show that a high number of people with mild VI and HI might also benefit functionally from distance glasses and hearing aids. It is recommended that the mild/worse threshold is reported as need for these two ADs at a minimum, which is congruent with recent recommendations  and willOur findings further emphasise that glasses are the most well-known vision AD (72.8%), and that the use of pictorial showcards with item descriptions appears to enhance understanding of the ADs in participants , so this is recommended in future self-reported studies [The agreement between AD unmet/undermet need measured by self-report and by clinical impairment assessment, for glasses (near and distance) and hearing aids, was very poor. Additionally, awareness about ADs was low, even with the addition of AD pictures and item descriptions during the survey. Further, AD unmet/undermet need was consistently either under-reported or over-reported. For example, hearing aids were under-reported by people who were clinically assessed to need them given poor awareness of what they were, and 75% of people who were clinically assessed to need near and/or distance (mild/worse VI) glasses did not perceive any need for glasses. At the same time, AD need was over-reported, given at least 40% of those who self-reported needing glasses (distance and/or near) actually did not need them. Our findings are similar to previous findings from the Cameroon and India AD study, even with additional breakdown by level of severity for distance and hearing aids and two types of glasses (distance and near) . Though Research comparing AD need measurement approaches is limited as population surveys typically use either self-reported AD methodology or clinical impairment assessment methodology. For example, Pryor et al.’s study in two districts in Bangladesh solely used WHO GATE’s rATA  and SINTIt is also important to note that our comparative findings rely on clinical impairment assessments as the “gold standard”, and there are limitations with this approach as well. Most notably, impairment assessment methods typically only focus on the more “medical” component of body structure and function in the international classification of functioning, health and disability (ICF) . In ordeThis study provided population-based estimates for three ADs in The Gambia based upon standardised clinical impairment assessment procedures. It also included self-reported AD measures which enabled comparison of the two measurement approaches, including different severity levels. Further, uncorrected VA was measured in addition to presenting which provided more accurate data for met and undermet need, as well as for coverage and effective coverage than using methods that aligned with the recent vision sector indicator .possible hearing aids fittings, due to difficulties accurately assessing this in the field.However, there were limitations. There were higher than expected incomplete examinations and non-response rates, and an under-sampling of younger men due to the pre-rainy and rainy/farming season skewing the survey sample towards females, which required sampling weights. Logistical challenges, such as finding adequate space for the central location set up in each cluster, often resulted in delays, and human resource constraints did not allow for continuity of examiners during the survey which potentially led to measurement bias. It was also challenging to find quieter areas for conducting the hearing test and the hearing survey response rate was low (47.5%). This may be related to response burden as the hearing assessment was often conducted at the end of all the other survey assessments . It is iIt is noted that AD ‘use’ was reported in three different sections of the survey by different data collector cadres, and our analysis was based on participants being observed wearing the AD at the time of the clinical assessment conducted at a central point. However, this may have led to underestimates of use as participants might have been unaware they should bring their glasses/hearings aids or expected a new pair of glasses or hearing aid following the exam. It is recommended that future surveys provide clear communication indicating if the AD should be worn at the central location and if there will or will not be provision of free ADs following a survey. Further, for the self-report data, participants were only asked about ‘glasses’ overall, not separately for distance and near glasses, which limited our comparisons with the clinically assessed glasses need. Given the large difference in need, it is recommended that future surveys using self-report  should ask about need for distance and near glasses separately.Finally, this study explored need in an adult 35+ population for only 2 of the 50 priority ADs. Future studies are needed to assess access for younger age groups, and data on other ADs are lacking and should be included in future data collection efforts when possible. For example, low vision AD need should also be assessed in VI surveys. Specifically, as part of the broader survey, contrast sensitivity impairment was clinically measured; however, it was not fully assessed with regard to AD need . It is rIn The Gambia, the need for distance glasses, near glasses and hearing aids is high, yet coverage is very low. Our findings generated much-needed data on population-based AD need in this setting. It will be important for national health, local policy and social services planning to address the barriers identified to accessing ADs, whilst supporting the essential development of vision and hearing AD services, including rehabilitation, with the overall aim to improve functioning and quality of life for individuals in The Gambia. Additionally, our methodological comparison highlights limitations when using self-report alone and further emphasises the need for improved population-level survey methods to estimate AD need. Scheduled GBoS surveys are opportunities that can incorporate AT assessment tools to address this data gap in The Gambia.


The Src homology and collagen 4 (SHC4) is an important intracellular adaptor protein that has been shown to play a pro-cancer role in melanoma and glioma. However, the biological function and detailed mechanisms of SHC4 in hepatocellular carcinoma progression are unclear. This study aimed to evaluate the potential prognostic and treatment value of SHC4 in patients with HCC.The expression status of SHC4 in HCC tissues were investigated by immunohistochemistry and western blotting. Clinical significance of SHC4 was evaluated in a large cohort of HCC patients. The effects of SHC4 repression or overexpression on migration, invasion, and tumor growth were detected by colony formation assay, wound healing, transwell assays, and xenograft assay. Cell cycle and EMT-related proteins were detected by western blotting and immunofluorescence. In addition, the molecular regulation between SHC4 and STAT3 signaling in HCC were discovered by western blotting, immunofluorescence and xenograft assay.SHC4 was overexpressed in HCC compared to adjacent normal liver tissues and increased SHC4 expression was associated with high AFP level, incomplete tumor encapsulation, poor tumor differentiation and poor prognosis. SHC4 was shown to enhance cell proliferation, colony formation, cells migration and invasion in vitro, and promotes cell cycle progression and EMT process in HCC cells. Tumor xenograft model assay confirmed the oncogenic role of SHC4 in tumorigenicity in nude mice. Moreover, activation of STAT3 signaling was found in the SHC4 overexpressed HCC cells and HCC tissues. Further intervention of STAT3 confirmed STAT3 as an important signaling pathway for the oncogenic role of SHC4 in HCC.Together, our results reveal that SHC4 activates STAT3 signaling to promote HCC progression, which may provide new clinical ideas for the treatment of HCC.The online version contains supplementary material available at 10.1186/s12935-022-02446-9. Hepatocellular carcinoma (HCC) is one of the most common and highly malignant neoplastic diseases, with a global morbidity ranking sixth among all tumors and a mortality rate ranking third among tumor-related deaths . HCC is The Src homology and collagen (SHC) family is one of the most studied adaptor protein families consisting of four members, SHC1, SHC2, SHC3, and SHC4. SHC1 is the most ubiquitous member of the family but limits to neurogenic areas in mature nervous system . In contMAPK signaling pathways have been shown to play an important role in tumor progression that SHC1 and SHC3 mediated . InvolveThe HCC tumor tissues and adjacent normal tissues of 138 patients were collected from resected specimens at Tongji Hospital of Huazhong University of Science and Technology between 2012 and 2016. Tissue microarray plates containing 105 HCC cases were constructed from paraffin-embedded HCC tissues. The diagnosis was based on the pathological examination. HCC staging was defined according to the criteria of the seventh edition of AJCC (American Joint Committee on Cancer) TNM classification. All patients received a standardized follow-up protocol, and the median follow-up was 25 months (range 0.5–65 months) . WrittenSHC4 cDNA was kindly provided by Han’s Lab and cloned into pLenti-CMV-GFP vector to generate SHC4 expression plasmid which was confirmed by sequencing. The target sequences in the pLKO.1-SHC4 shRNA vector against human SHC4 were 5′-GCCTAGCATTTCTCAGTGTTT-3′, 5′-GAATGGCCCAAGACGTCATAA-3′ and 5′-ATGTTGCCTACGTAGCTAAAG-3′. pLenti-CMV-GFP and PLKO.1 were purchased from Addgene. Smartpool siRNA against human STAT3 was from RiboBio. The STAT3 siRNA target sequence was 5′-UCUACUUGGCUCCCAACUU dTdT-3′. Stattic was from MedChemExpress. Lipofectamine 2000 was from Invitrogen. Dulbecco’s modified Eagle’s medium (DMEM), Opti-MEM reduced serum media and fetal bovine serum (FBS) were from Gibco. Polybrene and puromycin were from Sigma. Primary antibodies used in this study include: SHC4 , GAPDH , c-Myc , Cyclin D1 , p21 , E-cadherin , Occludin , Slug , STAT3  and p-STAT3 .HL7701, HL-7702, HepG2, Huh7, Sk-Hep1, Bel7402, HLE, HLF and Alex cell lines were purchased from China Center for Type Culture Collection . MHCC-97 H and HCC-LM3 cell lines were obtained from Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China. 293T cells were purchased from the American Type Culture Collection. Cells were cultured in DMEM  supplemented with 4.5 g/L glucose and 10% FBS . All cell lines have been tested for their authenticity. Transfection were performed using Lipofectamine 2000  according to the manufacture’s instruction. For lentivirus production, pLKO.1 vector and pLKO.1-shSHC4 or pLenti-CMV-GFP vector and pLenti-CMV-GFP-SHC4 (6 µg), psPAX2 (4.5 µg), pMD2.G (1.5 µg) were purchased from Addgene, Inc.  and were co-transfected into 293T cells. The virus-containing supernatants were collected and filtered 48 h after transfection. Freshly made virus supernatants supplemented with 8 µg/mL polybrene (Sigma-Aldrich) were added to exponentially growing HepG2, Huh7 or HCC-LM3 cells. After 8 h, fresh medium was added. SHC4 stable overexpression or knockdown cells were achieved by 1-week puromycin  selection.Immunohistochemistry (IHC) of clinical tumor samples and tumor xenograft samples was performed using antibodies against SHC4, Ki67 and E-cadherin. Briefly, tissue sections were deparaffinized in xylene, rehydrated with ethanol and subjected to antigen retrieval in boiling citrate buffer for 15 min. After peroxide block, the section was incubated with primary antibody at 4 °C overnight. The section was then treated with secondary antibody  for 1 h at room temperature. The peroxidase reaction was developed with diaminobenzidine . Images were acquired using 3DHIESTECH scan system and software. Cell-based average integrated option density (IOD) for SHC4 expression in each sample was analyzed by Image-Pro Plus 6.0 software . The cutoff for the definition of high expression group or low expression group was the median value. Accordingly, samples were segregated into two groups for further analysis.Cells were grown on coverslips in a 24-well culture plate, fixed with 4% paraformaldehyde for 15 min, permeabilized with 0.1% Triton X-100 for 15 min and blocked with 5% bovine serum albumin for 1 h. Cells were then incubated with primary antibodies overnight, followed by incubation with Alexa Fluor-conjugated secondary antibodies  for 1 h. Finally, coverslips were incubated with DAPI (Sigma) for 5 min and visualized under an inverted fluorescent microscope.Cells or tissues were lysed in RIPA buffer supplemented with 1% protease (Roche) and 1% phosphatase inhibitor cocktail (Sigma). The protein samples were quantified using BCA assay, separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and transferred onto polyvinylidene fluoride (PVDF) membranes (Millipore). After blocked with 5% skim milk, the membranes were probed with the indicated antibodies and then exposed to horseradish peroxidase (HRP)-linked secondary antibodies. The enhanced ECL was used for signal detection and western blot images were collected using Bio-Rad GelDoc system.HCC cells were seeded in 96-well microplate at the density of 1000 cells per well. After culture for 24, 48, 72, 96 and 120 h, the cells were treated with Cell Counting Kit-8  for 2 h at 37 °C. Then the optical density was measured at 450 nm using an enzyme-linked immunosorbent assay plate reader .HCC cells were seeded in 6-well plate at the density of 800 cells per wells. After 14 days, the colonies were fixed in 4% paraformaldehyde and stained with 1% crystal violet. The plates were taken picture and the number of colonies larger than 100 μm in diameter were counted.Cell migration and invasion abilities were determined by Transwell assay as previous described . In brie6 of Huh7 cells stably transfected with vector or SHC4 were subcutaneously inoculated into the flanks of nude mice. The mice were sacrificed by cervical dislocation 3 weeks after injection, and tumors were excised and weighed. Tumor volume was estimated according to the formula: volume = length × width2/2. The excised tumors were either embedded in paraffin for IHC analysis or snap frozen in liquid nitrogen for protein extraction. For the Stattic treatment, Huh7-vec and Huh7-SHC4 (2 × 106/mouse) cells were subcutaneously implanted into the flanks of nude mice. When tumors grew to 3–5 mm in diameter, the mice were peritoneally treated with Stattic . Xenograft tumor samples were then collected for further analysis.BALB/c nude mice  were purchased from HUAFUKANG . 2 × 102 or Fisher’s exact test was used to analyze qualitative variables. Comparisons between Kaplan–Meier curves were performed using the log-rank test. P < 0.05 was considered statistically significant.Statistical analyses were performed using SPSS software  or the GraphPad Prism software . Values were expressed as the mean ± SD from at least three independent experiments. Quantitative variables were compared using Student’s t-test or Mann–Whitney-U test when applicable. Also, the one-way ANOVA followed by a Turkey post hoc test was performed for multigroup comparison. The Pearson’s χP < 0.0001, Additional file To investigate the relevance of SHC4 to HCC, we first examined SHC4 protein expression in a liver tumor tissue microarray containing 105 HCC tissue and adjacent normal liver tissues by IHC staining. We found that SHC4 was significantly overexpressed in HCC compared to adjacent normal liver tissues , AFP level (P  < 0.01), tumor encapsulation (P  = 0.002), and tumor differentiation (P  = 0.023). TNM stage III–IV was more commonly found in patients with high SHC4 expression than those with low SHC4 expression, although significance was not demonstrated (P  = 0.167). Additionally, we found that female patients and patients with high AST and AFP, poor tumor differentiation, advanced TNM stage, incomplete tumor encapsulation appeared to exhibit high SHC4 expression  and high SHC4 group (n = 52). The detailed clinicopathological features is summarized in Table We performed immunofluorescence and immunohistochemistry staining to demonstrate that SHC4 localizes in the cytoplasm  for 48 h prior to cell proliferation and transwell assays. We found that cell growth was significantly suppressed following either siSTAT3 or Stattic treatment in SHC4 overexpressed HepG2 and Huh7 cells Fig. A, B. TraThe oncogenic role of SHC4 was further investigated with an in vivo model. Huh7 stably overexpressing SHC4 or vector control cells were subcutaneously injected into the posterior flanks of nude mice. Tumor sizes and weights were measured 21 days after inoculation. SHC4 overexpressed Huh7 cells developed significantly larger tumors than vector control cells Fig. A, B. To SHC4 was first identified and confirmed in melanoma in 2007. Ernesta Fagiani etc. found that SHC4 expression is essential for the growth of metastatic melanoma in vivo . SubsequThe typical structural domain of the SHC family is (CH2)-PTB-CH1-SH2. Although SHC articulators have a conserved structure and common binding partners, the SHC adaptors and their isoforms can generate distinct downstream signals and make unique physiological contributions . The molSHC4 promotes migration and invasion of melanoma cells through activation of Ras-dependent or Ras-independent pathways , 28. SHCAs is mentioned above, studies on how SHC1 and SHC3 activate downstream molecules are well established. Even though we have proposed a new viewpoint on HCC progression, deeper mechanisms how SHC4 activate STAT3 signaling is yet to be explored. Acting as an adaptor protein, SHC4 itself don’t have the activity of protein kinase. Therefore, it usually interacts with other proteins to regulate signal transduction, so our further study will focus on the molecular mechanisms underlying the SHC4 induced STAT3 signaling activation.In conclusion, overexpression of SHC4 potentiates STAT3 activation and stimulates a repertoire of downstream tumorigenic responses, including proliferation, migration, invasion, and EMT, leading to aggressive clinicopathological characteristics and poor prognosis in HCC patients. These evidences support the feasibility of SHC4 as novel therapeutic target for HCC.Additional file 1: Figure S1. SHC4 is overexpressed in HCC tissues and associated with aggressive clinicopathological characteristics. Figure S2. SHC4 knockdown or overexpression in HCC cell lines. Figure S3. STAT3 inhibition blocks the promotive effect of SHC4 on migration, invasion and EMT in HCC cells.


Undiagnosed hearing deficits hamper a child’s ability to learn. Hearing screening in school aged children helps detect educationally significant hearing loss and prevents negative impacts on academic achievement. The main purpose of this study was to improve early detection and assess the incidence of hearing disorders in first-graders from rural areas and small towns in the Małopolskie Voivodeship of Poland. There were 5029 children aged 6–7 years. Hearing thresholds were measured over the frequency range 0.5–8 kHz. A result was considered positive  if the hearing threshold was worse than 20 dB HL at one or more frequencies. The prevalence of hearing loss was estimated in terms of four-frequency hearing loss, high-frequency hearing loss, and low-frequency hearing loss. Parents filled in a brief audiological questionnaire. The analysis was performed using IBM SPSS Statistics, version 24. Of all the children, 20.5% returned a positive result and were referred for further audiological diagnoses. The estimated prevalence of hearing loss was 11.6%, made up of 6.5% with FFHL, 7.6% with HFHL, and 8.2% with LFHL. This study showed that large numbers of children in the district had hearing problems. Adoption of hearing screening in primary schools is recommended as a routine procedure within preventive pediatric health care. Hearing loss has been classified as one of the most common causes of disorders among conditions arising in chronic disease and trauma. This dysfunction has been ranked higher than many other chronic diseases such as diabetes, dementia, and chronic obstructive pulmonary disease . The abiThe European Consensus on hearing, vision, and speech screenings in preschool and school aged children encouraged the implementation of the preschool hearing screening program ,16. HoweIn 2008, the Institute of Physiology and Pathology of Hearing in collaboration with the Polish Agricultural Social Insurance Fund and the Association of the Deaf and Hearing Impaired ‘Homo-Homini’ performed the first stage of screening examinations for children attending rural schools and small towns (below 5000 inhabitants) in eastern Poland, during which 92,876 pupils were examined . This stThe main goal of the program was to increase early detection and assess the number of hearing disorders in first grade primary school children from rural areas and small towns from the Małopolskie Voivodeship. The second goal was to increase the knowledge in the participants of the program about the potential causes of hearing disorders and the possibilities of prevention, diagnosis, treatment, and rehabilitation when it occurs. Information materials about the program, along with a prevention booklet and consent forms for the examination, were distributed to schools through local government units . The teachers distributed the materials among parents during regular meetings. Cooperation between regional councils and local authorities with the school helped to increase the school attendance in the program.Hearing screening was performed in 630 primary schools located in 19 communities in the Małopolskie Voivodeship. Significant difficulties in program implementation were the high dispersion of schools in the regions covered by the program. The rural regions were predominantly small schools with less than twenty children participating in the program. The initial study sample consisted of 5038 students. Nine children with a prior clinical diagnosis of any hearing impairment were excluded from the analysis. Finally, there were 5029 children, including 2015 children aged 6 years and 3014 children aged 7 years. The study sample consisted of 2281 girls and 2748 boys.® central database, through which it is possible to perform a statistical analysis and transfer collected data to the Institute Physiology and Pathology, where they can be evaluated by a specialist audiologist or ENT. The collected results were marked with a unique identifier, which guarantees full protection of personal data of persons under examination in accordance with applicable law.The examination was performed using the Sensory Organs Examination Platform, which was developed by the Institute of Physiology and Pathology of Hearing and the Institute of Sensory Organs ,22. The Audiometric hearing tests were supplemented by the results of a questionnaire filled in by parents or legal caregivers. The questionnaire included five questions: Do you think your child has any problems with his/her hearing? Does your child complain of tinnitus in their ears/head when in quiet? Does your child often listen to loud music? Has your child been treated for otitis media? Does your child complain about noise at school? The response format was yes or no.A result of the screening was regarded as positive (refer) if a hearing threshold was above 20 dB at one or more frequencies in at least one ear. Hearing loss was defined as a pure-tone average higher than 20 dB in at least one of the following pure-tone averages: four-frequency pure-tone average (FFPTA), high-frequency pure-tone average (HFPTA), and low-frequency pure-tone average (LFPTA). Firstly, speech relevant hearing loss was defined as the four-frequency pure-tone average (FFPTA) at 0.5, 1, 2, and 4 kHz at a value for a threshold of >20 dB ,26. HFPTp-value of <0.05. The analysis was performed using IBM SPSS Statistics, version 24.The prevalence of hearing loss in children was estimated by dividing the number of cases by the total number of individuals. Additionally, 95% confidence intervals (95% CIs) were calculated to indicate uncertainty of estimates. A chi-square test for independence was conducted to assess the relationship between the child’s hearing status and the parental questionnaire. Statistical significance was established as a Positive results of the hearing screening were obtained in 1032 out of 5029 children . This rate was 20.5% . There were 20.6% of the girls  and 20.4% of the boys  with a positive outcome.There were 581 children with hearing loss, i.e., having FFPTA HL, and/or LFPTA HL, and/or HFPTA HL in at least one ear. The estimated prevalence of HL was 11.6% . The prevalence of the three types of hearing loss was estimated in all children, and in girls and boys separately, and is shown in Unilateral hearing loss was found in 388 children, 7.7% , and bilateral hearing loss was found in 193 children, 3.8% .n = 66) in comparison to parents of the children with normal hearing . The relationship was statistically significant, χ2 = 36.74; p < 0.001.The parents’ answers were compared to their children’s hearing status . It was found that parents of children with hearing loss more often suspected problems with hearing in their children  than children with normal hearing , χ2 = 7.59; p = 0.006. We did not find any statistically significant relationship between the children’s hearing status and tinnitus , otitis media , or complaining about school noise . The questionnaire was completed by 4564 parents. Their answers are shown in Our study also showed that, in the parents’ opinion, children with hearing loss more often listened to loud music  had a positive result. All children with a positive result were referred for a further diagnosis to an audiologist or ENT specialist. In comparison, the prevalence of hearing loss children attending rural schools and small towns throughout Poland has been estimated as 16.4% . Data fr childrenLow-frequency hearing losses were identified in 8.2% of the tested children in the Małopolskie Voivodeship. The data reported in another study conducted in Poland indicated the rate of low-frequency HL was estimated to be 6.2% . For comHigh-frequency hearing losses were identified in 7.6% of the tested children in the Małopolskie Voivodeship. Our result is in line with results reported in the study conducted by Johnson et al.  on 2867 Our findings showed that unilateral hearing loss (UHL) was more frequent (7.7%), than bilateral hearing loss (BHL) (3.8%), which is in line with results reported by a previous study in Poland . In the Results of the hearing screening obtained due to audiometric testing were supplemented with information from the questionnaire completed by parents. We found that 6.4% of the parents suspected some problems with their child’s hearing. This figure was not high, and in fact it was lower than the estimated prevalence of hearing loss in the children. Moreover, the parents’ opinions were not accurate. Admittedly, in the group of hearing loss, parents suspected that there was a problem with their child’s hearing (12.5%) significantly more often than in the group with normal hearing (5.6%); however, parental perception was still not appropriate. These results are in line with other researchers’ findings ,44,45 anOur study revealed that 12.2% of the parents indicated that their children have tinnitus. In the recent systematic review undertaken by Rosing et al.  it was sOur screened children were first-graders, and they were 6–7 years old. Even so, 10.4% of their parents reported that the children often listen to loud music. Leisure time noise and loud music are a known risk factor for noise-induced hearing loss ,49,50,51A study conducted by Harmes et al.  reportedThis study has revealed that hearing problems are common among first-grade students at primary schools in rural areas. There are many factors that prevent children from receiving medical care. Such obstacles involve a lack of available transportation to medical centers, the parents’ inability to both take time off from their jobs, and the family’s lack of financial resources. Thus, there is a need to consider whether participation in hearing screening for first-graders should be mandatory, or at least strongly recommended by central or local education authorities. The first step is to appoint a project coordinator at a a local authorites -level. It should be a local person who can collaborate with the community and coordinate information, resources, and program services. For large schools it would also be useful to establish a school coordinator  who is able to get in touch with children and their parents.Inexpensive hearing screening examinations could improve the hearing health of children from rural areas. With appropriate screening equipment and protocols, and in close collaboration with well-trained personnel at the school , it is feasible to conduct hearing screening among school aged children. The proposed protocol and the Sensory Organs Examination Platform used in the current study are cost-effective and safe tools and appear to be a successful method for identifying children with postnatal hearing disorders, allowing the provision of early intervention services in a timely manner.This was a cross-sectional study; therefore, it was not feasible to distinguish between congenital and acquired HL to identify if any of the cases had developed or progressed to HL. A prospective study would be needed to establish this, but such a study would be difficult due to the technical and infrastructure difficulties. This project would require repeated hearing tests for toddlers, and preschool children to identify those children who acquire losses . Moreover, methods used in the program did not differentiate between permanent and periodic hearing disorders. In addition, future research should consider a teacher questionnaire regarding noticing the prevalence of hearing problems among students.Routine hearing screening among school aged children is still not part of public health policy in Poland. Hearing screening is an important element of health education and should be aimed not only at children, but also at parents and teachers. There is still a need to improve early detection of hearing impairment in children starting their school education. It is recommended that conditions for screening school aged children be established in terms of study population, methodology, criteria used to determine which children should be referred, and the staff and equipment needed.


There is substantial evidence that newborn hearing screening (NHS) reduces the negative sequelae of permanent childhood hearing loss (PCHL) if performed in programs that aim to screen all newborns in a region or nation . The World Health Organization (WHO) has called in two resolutions for the implementation of such programs and for the collection of large-scale data. To assess the global status of NHS programs we surveyed individuals potentially involved with newborn and infant hearing screening (NIHS) in 196 countries/territories (in the following text referred to as countries). Replies were returned from 158 countries. The results indicated that 38% of the world’s newborns and infants had no or minimal hearing screening and 33% screened at least 85% of the babies (hereafter referred to as UNHS). Hearing screening programs varied considerably in quality, data acquisition, and accessibility of services for children with PCHL. In this article, we summarize the main results of the survey in the context of several recent WHO publications, particularly the World Report on Hearing, which defined advances in the implementation of NHS programs in the Member States as one of three key indicators of worldwide progress in ear and hearing care (EHC). Unaddressed permanent hearing loss, particularly when it is congenital or acquired early in life, significantly impedes a child’s development ,2. PermaSome potentially negative consequences of NHS programs need to be considered such as parental uncertainty about screening results and further optimal diagnostic and treatment pathways for their baby when very young , but parCost-effectiveness of NHS has been demonstrated ,8,27,28.As far back as 1995, a WHO resolution was adopted that urged member states to prepare national plans for the prevention and control of major causes of avoidable hearing loss and for early detection of hearing loss in babies, toddlers, and children . Yet, inConsistent with this goal and as a basis for further improving the effectiveness of NHS programs, a survey was recently conducted on the global status of program coverage, strategies, and outcomes, as well as the relationship between national economic indicators and key screening metrics of newborn and infant hearing screening (NIHS) . HearingIn response to the 2017 resolution, the WHO released the first World Report on Hearing in March 2021 [This article reviews the global status of newborn and infant hearing screening as assessed by the above-mentioned survey  and the The World Report on Hearing , among oDistribution of questionnaires via e-mail started in 2014; updates were accepted until 2019. The original reference year was 2014, but only older data were available for many NIHS programs, so the survey period for the final data ranged from 2009 to 2019. The survey began by identifying individuals in as many countries as possible who were involved in ear and hearing health and who were able to provide information on the status of NIHS in their country. It took substantial effort to identify such key people, especially in regions where audiology services were scarce. As a result, this process took years for some countries, particularly in Africa, Latin America, and parts of Asia. The identification of key individuals was supported by various organizations related to ear and hearing care such as the International Society of Audiology (ISA), Hearing International, the Coalition for Global Hearing Health (CGHH), the International Association of Logopedics and Phoniatrics (IALP), the International Working Group on Childhood Hearing, the American Academy of Audiology (AAA), but also by non-governmental organizations (NGOs) like Soundseekers and the Christoffel Blindenmission (CBM) and in French-speaking Africa through the network of the Société Oto-rhino-laryngologie (ORL) des pays francophones d’Afrique (SORLAF), either by signing a letter of invitation or by contact referral or by direct data delivery.Many individuals were identified through personal contacts of the authors of this article through conferences, through contacts via the WHO Programme of Prevention of Deafness and Hearing Loss, others through national or state NHS centers, ministries of health, regional WHO offices or through authors of publications with pediatric-audiological topics. Inquiries were made via e-mail, telephone or personal contact by the first author. Various contacts also passed the questionnaires on to other colleagues able to provide information. Whenever possible, the data were checked for plausibility and confirmed by either a second or third independent person or by one of the named institutions.The survey provided information from 158 countries. The results indicated that less than one-third of the world’s newborns and infants were enrolled in universal NIHS programs covering at least 85% of all babies in a region or country, despite evidence of the effectiveness of this strategy for optimal rehabilitation of deaf and hearing-impaired children. In contrast, about 38% of babies are born in countries with no or minimal NIHS of less than 1% coverage . The couAccording to the survey, most NIHS programs use “physiological” (objective) screening methods. These include otoacoustic emissions (OAE) measurements to assess inner ear function, automated auditory brainstem response (AABR) recordings to evaluate auditory pathway function up to the brainstem, and two-stage OAE-AABR procedures, i.e., AABR is recorded only when OAE fails. These methods achieve high validity, in contrast to behavioral or questionnaire-based methods . Of the Infants with a PCHL who underwent hearing screening were diagnosed as hearing impaired at an average age of 4.6 months and received initial treatment at an average age of 6.7 months. This was one of the most encouraging results of our study because it demonstrates that treatment begins at an age that still falls within the sensitive periods of basal maturation of the neural structures of the auditory pathway , which includes a cascading sequence of opening and closing developmental windows shortly after hearing onset, during which the infant brain is still well amenable to treatment ,36. ThisOn average, 4.5% of the babies who underwent NIHS failed the screen. The proportion of infants failing screening was significantly lower in countries with high NIHS coverage of 85% or more and its range was narrower (0.3–11.6), compared to countries with lower screening coverage. It is particularly concerning that 17.2% of children who failed screening were lost-to-follow-up. These rates were 7% lower in countries with high NIHS than in countries with low coverage .The lack of systematic data collection and databases compromises the quality of many screening programs. Survey results showed a lack of tracking programs for babies who did not receive screening and for those who failed screening and would need to be referred to audiological diagnostic and treatment services. Without tracking, the lost-to-follow-up rate is generally high or simply unknown. This can also be seen in the wide range and many apparently unreasonable figures for reported lost-to-follow-up rates, which ranged from 0% to 98.2% of infants who failed screening, depending on the program .It is striking that screening coverage and other measures are closely associated with average living standards, as measured by national average nominal gross domestic product per capita (GDP). Countries with NIHS coverage of 85% or more have median living standards that are 10 times higher than those in countries with screening coverage of less than 10%. However, countries with relatively high coverage have large variance in GDP and include countries with low GDP of <10 . GDP correlates negatively with screening failure rate, prevalence of PCHL, median age at diagnosis, and median age at intervention onset. The dramatically lower standard of living of countries with low screening coverage is more significant given that 80% of people with disabling hearing loss live in low- and middle-income countries , where pHearing screening was performed in birth facilities in 93% of the countries, in other places such as pediatric, hearing care, immunization or well-baby clinics in 51% and in the homes in 14% of the countries (percentages sum to >100% because a single country could have screening done in multiple places). It was carried out by physicians (26% of the countries), audiologists, audiological staff, or technicians , nurses, midwives and nonprofessionals such as community health workers  .As mentioned in the World Report on Hearing, hearing screenings can follow one of two approaches: They may be universal, aiming to cover all infants in a country or region, or they may be targeted to infants at risk for early hearing loss, which has been reported to affect approximately 8% to 10% of all newborns . HoweverA key issue to improve the effectiveness of NIHS programs worldwide and thus its cost-efficiency is the reduction of high lost-to-follow-up rates. In our survey, from the 27 countries that provided trustworthy data nearly half 48%) exceeded 30% of lost-to-follow-up cases and thus failed the minimum of 70% return-for-follow-up suggested by the Joint Committee on Infant Hearing (JCIH) ,44 and o% exceedeThe prevalence numbers of PCHL in our survey ranged from 0.3 to 15 per 1000 newborns with a median of 1.70 . This agGenetic factors account for about 50% of neonatal hearing loss  and syndTo further expand and improve NIHS programs around the world, the following initiatives should be considered following the results of our survey and the WHO recommendations ,33,34,53Governments should take on leadership responsibility with regard to the strategic direction and implementation of measures to address hearing loss in an integrative way in their health systems ,30,32. TGovernments should establish national committees on ear and hearing care, led by their ministries of health and a national ear and hearing care coordinator to develop EHC strategies that include national NHS programs as an important component ,55. CommGovernments should take advantage of assistance offered by WHO in planning and implementation of national EHC strategies and explicitly on the implementation, organization, control, and monitoring of NHS programs. Currently available documents include the World Report on Hearing , an Ear The WHO has identified raising public awareness and reaching policymakers, health professionals and stakeholders as critical to implementing and funding national EHC policies. National committees that centrally coordinate strategic tools and information materials should be represented in initiatives related to technology, training, infrastructure, equipment, finance, and advocacy. Standard operating procedures (SOPs) should unify workflows, criteria, and benchmarks, e.g., the allowable repeats of a failed primary hearing screenings and how, where, and when positively screened babies should be followed up ,55. ReguGovernments should enact legislation to formalize the operation of NIHS programs.Data collection and tracking systems should be established, preferably from the beginning of NIHS program implementation, to track babies who have failed or missed screening and to provide systematic information on the coverage and quality of screening, intervention, and rehabilitation services for individual children and their families, as well as on successes and gaps in these services. These systems should consider the use of telemedicine components and bidirectional data flow between decentralized screening devices and hearing screening centers .NIHS programs should include the opportunity for case discussions in professional excellence circles with boards of experts .Governments should guarantee equal access to pediatric audiology services for all infants with PCHL. This requires pursuing creative and affordable solutions for wider availability of hearing technology including bulk purchases of hearing aids or implants ,30,54.As with other diseases, hearing loss rehabilitation is underrepresented in many countries. Therefore, a new WHO resource currently being developed in collaboration with Cochrane as Package of Rehabilitation Interventions (PRI)—a set of prioritized evidence-based interventions along with resource requirements for their implementation—also focuses on hearing loss rehabilitation . RegardiCountries with high NIHS coverage should ensure equitable access in their population. They should volunteer to be available as a resource to countries with more limited NIHS programs.In addition to NIHS programs, measures to prevent neonatal hearing loss as described in a WHO publication on childhood hearing loss  and in tNIHS followed by early intervention and accompanied by measures preventing childhood hearing loss has been shown to be effective, cost efficient, and an excellent investment of resources. Our survey confirmed for the first time worldwide that newborn hearing screening benefits children in terms of early diagnosis and treatment initiation of PCHL, but that large global disparities remain. As the world moves toward achieving the 2015 Sustainable Development Goals and universal health coverage, it is important that the needs of children with hearing loss are addressed and “no one is left behind”. For them all to achieve their “highest attainable standard of health”, the provision of NIHS as part of national plans for universal health coverage is a matter of equity and equality.


The increase in life expectancy has proliferated the number of elderly and subsequently increased the prevalence of disability among the elderly. This study assesses the prevalence of Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) and analyzes determinants of ADL and IADL among elderly aged 60 and over living in India.The study utilized the Longitudinal Ageing Study in India  data, and information was sought from 31,464 elderly aged 60 years and above. An index of ADL and IADL was created on a scale of three levels, exhibiting no, moderate, or severe levels of ADL/IADL disability. Multinomial logistic regression was used to determine the effect of socio-demographic parameters on ADL and IADL disability among the elderly.Around 3% of the elderly reported severe ADL disability, and 6% elderly reported severe IADL disability. Elderly who were not involved in any physical activity than their counterparts were more likely to report severe ADL  and severe IADL  than no ADL and no IADL, respectively.Amidst the study finding, the study emphasizes the importance of setting-up of geriatric care centers in rural and urban areas. It would be feasible to provide geriatric care under the umbrella of already functioning government health facilities in different parts of the country. Community interventions earmarking the elderly with a focus on physical activity, specifically based in group physical exercise and implemented through existing networks, are rewarding for the elderly. Globally, the life expectancy at birth has increased from 66.5 years in 2000 to 72 years in 2016 . On the back of improvements in the educational system, health facilities, and life expectancy, the percentage of elderly in India had risen from 5.3% in 1971 to 5.7% in 1981 and further from 6% in 1991 to 8% in 2011 . The devOver 1 billion (15%) individuals worldwide have experienced one or more disability conditions. The global trends among the ageing population and the risk of disability lead to a higher disabled population . DisabilIn the twenty-first century, the low and middle-income countries have experienced an upward shift in life expectancy . Thus, iMany studies were conducted for older adults, which measured their functional performance through self-reported ADL andIADL based on their daily activities. Examining functional disability through ADL and IADL provides a better insight as these two indicators cover a range of disabilities. However, unfortunately, the tools do not provide a clear picture of the actual functional capacity of an older person . Thus, iThis study is based on secondary data available in the public domain. Anyone can access the data without any legal or ethical considerations. Therefore, there is no ethical approval required for this study as this study did not involve human or animal participants directly. However, the Indian Council of Medical Research (ICMR) provided the ethical approval for conducting the Longitudinal Ageing Study in India (LASI) survey. Also, informed consent was provided to the participants before undertaking the survey. To maximize the cooperation of the sampled households (HHs) and individuals, participants were provided with information brochures explaining the purpose of the survey, ways of protecting their privacy, and the safety of the health assessments as part of the ethics protocols. As per ethics protocols, consent forms were administered to each HH and age-eligible individual.We used the data from the Longitudinal Ageing Study of India (LASI), Wave-1, a longitudinal survey of the older men and women age 45 years and above in India . The LASActivities of daily living (ADL) and instrumental activities of daily living (IADL) disability were self-reported scores of functional limitations recorded over more than 3 months. These functional problems that occurred in the last less than 3 months were excluded from the study. The ADL scale was considered from five indicators: bathing, dressing, mobility, feeding, and toileting. Further, ADL has been categorized into three categories as “severe ADL disability,” “moderate ADL disability,” and “No ADL disability.” Severe ADL ability is considered as those elderly who were not able to do in any of five activities, moderate ADL disability included those elderly who could not function in less than five activities, and no ADL disability included elderly who were able to perform in all five activities .Further, the IADL scale  covered The covariates included sex ; age (60–69 and 70 years and above); marital status ; living arrangements , place of residence ; wealth index ; covered with health insurance (yes and no); use of tobacco (yes and no); self-rated health (poor and good) and physical activities (yes and no).Data were analyzed using STATA version 16. Descriptive statistics was carried out to estimate the proportion of ADL and IADL by socio-demographic variables among the elderly. Bivariate analysis was adopted to estimate the prevalence of ADL and IADL disability with the level of significance. In addition to that, the chi-square test was used to check the level of significance. Further, multinomial logistic regression was used to determine the effect of socio-demographic parameters on ADL and IADL disability among the elderly. Multinomial logistic regression is used in categorical dependent variable/s found with two or more unordered levels. The outcome of multinomial logistic regression comes in terms of relative risk ratio (RRR), the probability of choosing one outcome category over the baseline category. The equation of multinomial logistic regression is;Where RRR is the relative risk ratio, and P is the probability of occurrence. If the RRR is equal to 1, then the association between the response variable to the exposed group are unlikely to exist, when RRR > 1 then increases the risk of response variable among the exposed group and when RRR < 1 then decreases the risk of response variable among the exposed group. All methods were performed in accordance with the relevant guidelines and regulations.Figure Figure Table p-value. A higher percentage of female elderly had severe ADL disability (3.5% vs 2.8%) and severe IADL disability (7.5% vs. 4.2%) than their male counterparts. Similarly, a higher percentage of elderly aged 70+ had severe ADL disability (5.7& vs 1.4%) and IADL disability (11.1% vs 2.3%) than elderly who were 60–69 years of age. Around 6.5% of the never-married elderly had severe ADL disability. A higher percentage of uneducated elderly had severe ADL disability (2.9% vs 1.9%) and severe IADL disability (4.6% vs 1.6%) than elderly who had higher education. Furthermore, severe ADL and IADL disabilities were more prominent among rural elderly, poorest elderly, those who were not covered by health insurance, who had poor self-rated health and were not involved in any physical activity than their respective counterparts.Table Table Over the last few decades, India has witnessed a remarkable increase in life expectancy and a significant increase in the proportion of older adults . UnfortuFemale elderly were more likely to have the risk of ADL and IADL limitation than male elderly. Previous studies are in line with the finding of this study , 31–34. Age is another strongest predictor of poor ADL and IADL among the elderly. Despite having two categories in age (60–69 years and 70 and above), the importance of increasing age in highlighting the functional disability cannot be ruled out. The study found that the risk of severe ADL and IADL increases with an increase in age of the elderly. Almost all the research in the literature arena concord with this finding , 42–45; The study noticed that the risk of disability was lower among the elderly with higher education than their uneducated counterparts. The Association between functional disability and the education status of the elderly is also well established , 51. Hu In reference to the elderly living alone, elderly living with spouses had a higher risk of severe ADL disability. This finding inculpates that elderly living alone tends to help themselves by carrying out work required for daily living; therefore, these elderly are less likely to report severe ADL disability than those who live with their spouse. Further, those with good self-rated health had a lower risk of reporting severe ADL and IADL related disabilities than those who reported poor self-rated health. Previous studies also highlighted that poor self-rated health affects limitations associated with ADL and IADL among the elderly , 53. In The elderly who were not physically active had a higher risk of severe ADL and IADL disability than physically active ones. Studies have noted that physical activities improve ADL and IADL related disabilities among the elderly , 54. PhyThe study is not free from some potential limitations. The foremost limitation is the self-reporting of data related to ADL and IADL. However, several previous studies measured ADL and IADL through self-reporting data only , 52, 54.Disability is the best quality of life indicator as it captures both diseased and non-diseased persons and hence provides an unambiguous assessment of well-being than traditional morbidity and mortality data . There i


The morphological and molecular available evidence suggests the existence of a single species, Deschampsiacespitosa (L.) P. Beauv., in which individuals belonging to the same morphological gradient have received different names in different taxonomic categories throughout its wide distribution range. An evaluation of the available names indicates that all uses of the epithet “alpina” are illegitimate. A new combination is proposed at the infraspecific level as Deschampsiacespitosasubsp.neoalpina Chiapella, Xue & Greimler.The epithet “ Deschampsiacespitosa (L.) P. Beauv. has a nearly cosmopolitan distribution, being more common in cold temperate regions of the Northern Hemisphere. This extended geographic distribution shows different morphological variants, which have been considered in two alternate ways, either as infraspecific taxa of a widely distributed species  Roem. & Schult., Deschampsiacespitosasubsp.alpina Tzvel. and Deschampsiacespitosavar.alpina Schur.Taxa delimitation and nomenclatural problems are common in Deschampsiacespitosa may vary greatly in short environmental gradients. Plants growing along a 40 m long gradient on tidal soils showed significant differences in plant height and leaf width DeschampsDeschampsia is the development of the sprouting spikelet , a consequence of the pseudovivipary typical in the taxon named “alpina”. These parts elongate beyond the habitual range of D.cespitosa, eventually becoming plantlets. Pseudovivipary is an asexual reproductive strategy commonly found in grasses, in which plantlets develop from spikelets and detach from the parental plant after development  Roem. & Schult.  Tzvel. has been deemed an illegitimate homonym  Hook. in 1870, however in another genus. Furthermore, Article 11.4  Tzvelev would have been used.The combination  homonym  because nclature , states cle 11.4  rules thtwo infraspecific taxa of the same species at different ranks are homonyms if they are not based on the same type”. In 1869, Ducommun published a textbook on the Swiss flora, including three combinations in Deschampsiacespitosa (L.) P. Beauv.: α) D.cespitosa (L.) P. B. var. genuina G.; ß) D.cespitosa (L.) P. B. var. pallida K.; and y) D.cespitosa (L.) P. B. var. alpina G. Explicitly the var. alpina was based on Airaalpina Roth non L., based on another type. Therefore, since both names, the one by Schur and the one by Gaudin are based on different types, they are homonyms.However, Article 53.3  rules spThe debates on delimitation of taxa -at specific or infraspecific level- have been recurrent during the 1990’s . While nDeschampsiacespitosa comprises a set of morphological data for Central Europe  Roem. & Schult. Syst. Veg. 2: 686. 1817.  ≡ Airaalpina Lilj., Utkast Sv. Fl. 49. 1792.  ≡ Airaalpinavar.vivipara Parn., Grasses Brit.: 242 t. 109. 1845.  ≡ Avenaalpina (L.) Trin., Fund. Agrost.: 157. 1820.  ≡ Airacaespitosa subsp. alpina (L.) Hook. f. Student Fl. Brit. Isl. 3: 437. 1870.  ≡ Airamajorsubsp.alpina (L.) Syme ex J.E. Sowerby, Engl. Bot. (ed. 3B) 11: 65. 1877.  ≡ Deschampsiacespitosa (L.) P.Beauv. var. alpina Vasey in Beal, Grasses N. Amer. 2: 368. 1896.  ≡ Deschampsiacespitosasubsp.alpina (L.) Tzvel., in Fed., Fl. Evrop. Chasti SSSR 1: 209. 1974.  ≡ Airaalpina Roth, Tent. Fl. Germ. 2(1): 98. 1789.  = Airalaevigata Sm., Engl. Bot. 30: t. 2102. 1810.  = Deschampsialaevigata (Sm.) Roem. & Schult., Syst. Veg. 2: 687. 1817.  = Deschampsiacespitosavar.alpina Schur, Oesterr. Bot. Z. 9: 326. 1859.  = Deschampsiacespitosavar.alpina Gaudin ex Ducommun, Taschenb. Schweiz. Bot, 861. 1869.  = Deschampsiacespitosa var. alpina (Hoppe) Honda (J. Fac. Sci. Univ. Tokyo (1): 139. 1930.  = Airacaespitosavar.alpina Hoppe, Flora: 166. 1817–1823.  = Deschampsiacespitosavar.alpina (Hoppe) Honda, J. Fac. Sci. Univ. Tokyo, Sect. 3, Bot. a3(1): 139. 1930.  = Airacaespitosavar.alpina Gaudin, Fl. Helv. 1: 323. 1828.  = Deschampsiacespitosavar.alpina Gaudin ex Ducommun, Taschenb. Schweiz. Bot. 861. 1869.  = Airacaespitosavar.alpina Heuff. Verhandlungen der Zoologisch-botanischen Gesellschaft in Wien 8: 228. 1858.  = Airavivipara Steud., Syn. Pl. Glumac. 1: 222. 1854.  = Airaalpinavar.vivipara (Steud.) Lange, Consp. Fl. Groenland. 3: 163. 1880.  = Sweden, Torne Lappmark, Mt. Njuolja, 25.07.1950, leg. N.D.Simpson 50133 (BM), neotype selected by Cope in Cafferty et al., Taxon 49: 293. 2000.


The decreasing coercivity is discussed in the framework of two opposing models: grain refinement on the one hand and dissolution of cementite on the other hand. Auxiliary measurements give a clear indication for the latter model, delivering a sufficient description of the observed evolution of magnetic properties.The paper describes the capability of magnetic softening of a coarse-grained bulk material by a severe deformation technique. Connecting the microstructure with magnetic properties, the coercive field decreases dramatically for grains smaller than the magnetic exchange length. This makes the investigation of soft magnetic properties of severely drawn pearlitic wires very interesting. With the help of the starting two-phase microstructure, it is possible to substantially refine the material, which allows the investigation of magnetic properties for nanocrystalline bulk material. Compared to the coarse-grained initial, pearlitic state, the coercivities of the highly deformed wires decrease while the saturation magnetization values increase—even beyond the value expectable from the individual constituents. The lowest coercivity in the drawn state is found to be 520 A m Accompanying the nanocrystalline microstructure  in a controlled manner, the coercive field strength cH can be modified correspondingly. Herzer showed for very small grains from the so-called random anisotropy regime, where the magnetic exchange length exL covers many grains, that coercivity collapses with D6 for decreasing grain sizes [Not only the mechanical properties but also physical properties are affected by the substantial microstructural refinement. It is well known that the microstructure of a ferromagnetic material has a strong influence on the magnetic properties. Consequently, if one alters the microstructure , thin wires experiencing true drawing strains of 5.42 (finishd = 36 µm) and 6.23 (finishd = 24 µm) were investigated regarding magnetic properties such as coercivity and saturation magnetization.The hypereutectoid pearlitic steel containing 0.98 wt.% C was initially provided in the shape of a wire with a diameter −3 [−4 mm3.A superconducting quantum interference device , a very sensitive magnetometer for detecting tiny changes of magnetic moments in magnetic fields, was used to measure the volume saturation magnetization at very high fields up to 7 T and the variations of coercivity with changing temperature. Checking reproducibility, the saturation magnetization of two wires of 36-µm thickness was determined. SQUID measurements yield the total magnetic moment of the whole sample volume and for an accurate determination of the saturation magnetization, a normalization with respect to the sample volume has to be made. For the determination of the volume of the thickest wire, a conventional laboratory scale  and using the known mass density of pearlite (7845 kg m−3 ) provideThis extremely small sample volume, albeit of ferromagnetic nature, generates a very small SQUID-signal. As the SQUID should detect only the tiny magnetic moment of the wire, it is necessary to compensate any predominant and inhomogeneous background, e.g., of the sample holder on which the sample is mounted. Following the idea of Topolovec et al., long adhesive tapes were used to fix the sample within the SQUID . These tThe room temperature coercivities of the wires were determined using a vibrating sample magnetometer . Due to the soft magnetic nature of the material, these measurements include the correction of the results for the remanence of the pole pieces, using a paramagnetic Pd standard, which was measured under the same conditions.For all magnetic measurements (SQUID and VSM), the wires were brought into the magnetic field with the long axis of the wire, being some millimetres of length, aligned with the magnetic field. Due to the large aspect ratio (specimen length/diameter), even for the thickest wire, the influence of shape anisotropy  can be cScanning electron microscopy d was perCombining the measured volume and the magnetic moment from SQUID measurements, the volume saturation magnetization can be calculated and the results for all investigated wires are presented in 6 A m−1 for two of the thin wires, while it is slightly larger for one of the two 36-µm wires. The difference, however, can be regarded as a minute one since an uncertainty of only ~2% of the wire’s diameter could explain the deviation. In contrast, a much lower value (1.57 ± 0.01) × 106 A m−1 was found for the cementite-containing, non-deformed wire.In 6 A m−1  are involved in Fe emu g−1 ,17 or 0.sJ, which can easiest be achieved with high Fe-contents. When using the bottom-up process, several other—very often non-magnetic—elements have to be used to accomplish the goal of formation of nanocrystalline alloys from e.g., amorphous melt-spun ribbons. Suzuki et al. [Additives, independent of the type of the additive. Here it was demonstrated that pearlitic steel even increases its saturation magnetization upon severe deformation with the very small amount of C (in wt.%) being of no relevance in regard of the above-mentioned decrease of sJ with additive content.An advantage of pearlitic steels is their chemical composition. An important aspect of the formation of soft magnetic materials is maintaining a high saturation magnetization i et al.  found a In short, while the thick, non-deformed wire shows the expected pearlitic behaviour in saturation magnetization, all thin wires show values near or even above pure Fe. The slight surplus in saturation magnetization is possibly due to C in supersaturated solid solution, which is typically present in the severely deformed wires ,7.D > ~100 nm) materials [exL covers many grains, coercivity collapses with D6 [exL, is derived from a competition between magnetic exchange and magneto-crystalline anisotropy energy K1 and it is given by:A being the exchange stiffness constant  and (3) [For an ideal soft magnetic material, the coercivity should tend towards zero, easing the magnetization process and reducing the hysteretic heat losses for certain applications. The coercivity does not necessarily increase with decreasing grain size, as it is the case for “coarse” grained . Contrarily, for the 0.70 wt.% material a peak at low strains  is followed by a drop in coercivity, reaching about 1200 A m−1 at a true strain of ~3.5. The decreasing coercivity is explained by a combination of volume reduction of cementite as well as rotation and fragmentation of cementite lamellae. These arguments are complemented by Ul’yanov et al. who found a low coercivity state (cH ~8000 A m−1) of cementite after strong deformation using ball milling [Focusing on pearlitic steel, References ,27,28,29cH of the thin wires, as determined by VSM, are smaller  than that of the thick wire (540 µm: 1510 A m−1). The coercivity of the pristine state is in agreement with results of both, a cold drawn, 0.8%C steel “music wire” (cH ~1590 A m−1) [cH ~1350 A m−1 [The measured coercivities 0 A m−1)  as well 50 A m−1 .−1 or 12% due to this annealing treatment.In a previous work by our group, a strong, beneficial influence of a low temperature annealing treatment  on the coercivity of severe plastically deformed materials was found . For difmaxσ ~6.2 GPa) to 6.52 (maxσ ~6.8 GPa) [If one strictly connects the grain size with coercivity, the magnetic measurements would indicate that there is hardly any further refinement of grain size when drawing the wire from 36 to 24 µm in diameter, albeit the reduction in diameter constitutes a substantial degree of further deformation. Along with the impart of additional strain, Li et al., observed a further strengthening of the material for increasing the strain from 5.1 (6.8 GPa) . If one 6.8 GPa) . The magDue to the findings of microstructurally refined and magnetically soft materials, Equation (2) is applied to draw the graph in c/a < 1.01) of the bcc crystal present in the severe plastically deformed material [c/a = 1.23) [Regarding the thin wires, there is a small tetragonal distortion  . HoweverK1 taken from literature [D6) on coercivity. However, the trend in measured coercivities perfectly follows the ones in literature. While the magneto-crystalline anisotropy only drops by a bit more than 10% for bcc-Fe [3C would be much larger, about 50% [Another proof for the dissolution of cementite to a large extent in the severely drawn wires is provided by temperature dependent measurements of coercivity. Using the SQUID, the coercivity as a function of temperature was measured for a 36-µm wire, which provides—besides the saturation magnetization—another strong hint for the predominance of the bcc Fe phase, but not of the cementite phase. This measurement involves recoil loops of going to the highest fields, saturating the sample and then accurately measuring the coercivity applying small fields. These loops are repeated in temperature steps of 20 K. No Pd-standard was available at that time for SQUID measurements, thus, the measurements of the coercivity always include a systematic offset due to the residual magnetic fields of the superconducting magnet . To apprterature ,24,25. Ar bcc-Fe ,24,25, tbout 50% . Taking The slightly smaller value of coercivity after the annealing treatment of 150 °C for 30 min is also shown in Another aspect of the discussion of the coercivity of severely deformed wires is the already found trend of decreasing coercivity with increasing applied strain (up to ~3.5) . ThereinWhen comparing the two different approaches for describing the decreasing coercivity with increasing strain, it has to be mentioned that wire drawn materials feature a very pronounced texture. In , the proPearlitic wires—ferritic wires in different wire-drawn states—were subjected to magnetic measurements, focusing on the volume saturation magnetization and coercivity.According to the indirect phase analysis based on the evaluation of saturation magnetization data, the drawn wires with diameters of 24 and 36 µm behave—from a magnetic point of view—like pure Fe with cementite being dissolved. This finding is supported by an independent measurement of the temperature dependent coercivity, also fitting to the behavior of pure Fe.The measured values of volume saturation magnetization of the thin wires, who experienced a drawing strain larger than 5.4, are slightly higher as it can even be expected for pure Fe. This can be attributed to Fe being supersaturated by C, as it enlarges the magnetic moment of Fe-atoms.It was demonstrated that an annealing treatment has a positive effect to magnetically soften the wire. Annealing at 150 °C for 30 min slightly reduces the coercivity, which is most likely due to a reduction of residual stresses being present from the severe deformation process.